HomeMy WebLinkAboutAPPLICATION - 17-00133 - 476 Maple Dr - Furnace ChangeoutpTxaUq
dot 2� CITY OF
REXBURG
Amerints filmiiy rommunfg•
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North list East
Rexburg, Idaho 83440
For Office Use
PermitNot nb :` 11 001.�� PermitType:'ONew O'Remodel OAddition'.i]DasementFinish
Fees Paid: , Yes ❑ No
1, Proper Owner
Narne: 919
Address: City: State: Zip Code:
Phone &Type: — O Office O Mobile Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are youa homeowner doing work on your own home? E3 yes (Skip to #3 and complete the Homeowner's Exemption page)
m No:1 am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property
NOTE: Any mntrac[nrs/sub-contrectos hrvolved willneed to submit theirovns signed applications.
2. Mecl u l I,o)lcr
Name:
Address:
Phone &Type:
Contact/Rep. Name:
Mechanical,Contractor Authorized
>, . Wil. - ► a a = -
t A
3. Project De,s,cription , /
Address:
24`-7 4p /"rig "a LLLh -OR- Lot #:_Block it: _Subdivision:
Check one: I,%§ingle-family Residence O Multi -family Residence O Commercial
Check one: O New yXtruction"' O Re�md o�el O Addition OBasepntF]nish /
Description of wort[:
Calculated Fee [See Below): $
New Commercial Work: Contracted amount: $ ..
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001-$100,000 =((total Lost of system -10,000) x .Ol) + $260
O Over $100,001= ((total cost of system -100,000) x .005) + $1,160
New Single -Family Residential Work: Sq. Ft.
O Up to 1,500 Sq. Ft. _ $130 O 1,501.2,500 Sq. Ft. _ $195 O 2,501-3,500 Sq. Ft. _ $260 O 3,501-4,500 Sq. Ft. = $325
O Over 4,500 Sq. Ft. _ $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $
New Mulii-Fauliiy Residential, O Ddplex = $260 O Three or more Units= $((130 x # of buildings)+(65 x # of units))$-_
New work on any other residence and Detached Shops: _ (65 + (10 x # of HVAC fixtures))
MisceUaileous: ❑Gas Pressure = $65 ❑Furnace orA/C = $65 O Water Heater = $65 O Requested Inspection = $65
O Gas Line = $65 O Fireplace/Solid Fuel Burning Unit= $65 O Technical Service= $65/hour
O Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHO RIZATIDN: Under penalty of perjury, I hereby certify that I have read this application and state tbaethe information herein
is correct and t swear that any Inform auon which may hereafter be given by me in hearings be rare the Planning and zoning commission or the aty council for the City of Rexburg
shall be truthful and correct 1 agree to comply with all city regulations and State laws relating to the sub)ect matter of this application and hereby aver t need representatives of the
City to enter upon the aboveanentianed property for inspections purposes. NOTE: The buiid)ag official may revoke a permit on approval issuedunder the provisions of the 2012
International Code in msesofanyfatsesmtement or mlerepresentationoffactin the application or an the plans on which the permit or aroval was based. Permit void if not
pp
stanedwitldn 100 days. Pe orkstcps for 1 D days. (�
Applicant's Name [print
h Signature: ate: 7
inspections must he called in before SAM on the day the Inspection is requested Inspectionn regtstcalled inclan -(200) after 8 AM 3 72ilt be scheduled for the nextgevixd Match,
business day.
Inspection Hotline -(2D8)372.2344 www.rexburg.org
l,'d b69OZ4980Z nV6w1eaHeu!dIV d£OZOL1.OZJON