HomeMy WebLinkAboutAPPLICATION - 17-00116 - 616 W 7800 S - County Furnace & FireplaceC iTY OP
REXBURG
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Ameriaa3 romay Gatmansly
Building Safety Department
City of Rexburg
Submit By Email 35 North tat East
Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
For office (Ise
Permit Number; P-00110 PermltTypet 0 New 0 Remodel 0 Addition 0 Basement Finish
Fees Paid: 0 Yes, 0 No
1. Proper Owner
Name: gyialiom =1rrpne
Address: (DIC JAJt "'IWQ S. City: IeAb4 State; =0. Zip Code: &3440
Phone &Type, ___0 Office O Mobile Email;
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Arg you a homeowner doing work on your own home? O Yes (Skip to 03 and complete the Homeowner's Exemption page)
No: I am a contractor working for the homeowner O No: This property is a Multi -faintly Residence or Commercial Property.
NO Cli: Any contracturi'l ubcoinnctors Involved will need to submit ti¢ir own slyned appllcatlons,
2. Mechanical Cc tract` - 1Y1 = 151 • ate;.ejp;c6
Name: eQt�rLl 1 jP Registration #: �1�1 Exp.:
Address: 0K�.L96S, ,• City:3.dnho ftillc State;_7.0_Zip Code:
Phone & Type; Q�� _❑ Uffce �vobile Email:
@(aPhone:�t-
0W6all:Contact/Rep, NameCe
Mechanical Contractor Authorized Signature: l.enaj( 00f}kez" Date;
3. Project Description
Address: OR- Lot #:_ Block #;,,Subdivision;
Check one: O Single-family Residence O Multi -family Residence O Commerclal
Check one: 0 New Construction* O Remodel r1 dditlon 0 Basement Finish
Descri tlun of work: rJl Cc,rC
New Commercial world Contracted amou 1t: $ Calculated Fee (See Below): $
Q Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001•$100,000 = ((total cost of system -10,000) x r01) + $260
O Over $100,001 = ((total cost of system -100,000) x.005) + $1,160
New Single-Famlly Resicicntial Work: Sq. Ft.
❑ Up to 1,500 Sq, Ft. = $].30 ❑ 1,50]: 2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 O 3,501.4,500 Sq. Fc = $325
O Over 4,500 Sq. Ft. = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereD $
New Multi-Famfly Residential: Q Duplex = $260 ❑ Three or more units= $((130 x # of but ldings)+(6S x #'of units))$„
New work oil any of er residence an Uetac a Shops: _ + (10 x # of HVXC fixtures))
Miscellaneous; ❑ Gas Pressure = $65 Furnace or A/C = 65 ❑ Water Heater= $65 0 Requested Inspection = $65
O Gas Line = $65 Elf fireplace/Solid Fuel Burning Unit= $65 O Technical Service= $65/hour
Q Plan Check -1.0% of Contracted Amount
APPLICANT'S SIGNATURR, CORTIPICATION AND AUTIlOR12ATIONt Under penalty of perlury.I hereby carery that I have road this application and stili that the Infunnaudn heroln
Is correct alld I swear that any Infotmaden which may herealler he III van by me In hearlaip before the Plaanllgand Zaning Cemmisslen or in. City CmwdI for the Clty of Rexburg
slbll be eruthlW and cprrccr- I agree m e.aaply wall nil CIryregulu ions and Statelava relatlng m tM: subs wt mBttcrof this. pplle2l on and florally authunsed repmcngllvus or the
City to enter upon the abom•mentioned property foo' Inspecuom porpoees. NOV; The bulldingafticlal may revoke a permltoa approval Issued under the provisions of rhe 2012
International Code In lases ofahyfalse ammmcntor niisreprt5efltation of fact In Out application or on tl which toe permitvrapprovol was based. Pcrmltvnldiruut
started within 180 days. Permit void If
work stops for IDU days.
Applicants Name (print): \ b.1 to L(+ b fi� Signature: Date:, 1ln - 0
t
Inspections must be called In before RAM on the day the liapoction b requested. Inspccnen requests collgd In aa<r 0 AM will be echndidad far Ibe next liwilu 6s day.
lnapa0enuat8no...(208)272.23a www.rexbuhioN Permit Tcchniclan-(208)372.2341 Revised March, 2016
T/T'd 220£6S£:Ol :WOa2 OS:6T LT02-91-NUW