HomeMy WebLinkAboutAPPLICATION - 17-00070 - 52 E Main - Game Pulse - Soda DrainsCITY OF
REXBURG
America' Family Cormnunily
Submit By Email
i f J IT,
City of Rexburg
35 North 1St Bast
Rexburg, Idaho 83440
Fc r Office Use
PE rmit Number: Permit Type: 0 New 0 Remodel 0 Addition 0 Basement Finish
F es Paid: 0 Yes ONO
1. Property Ow er a %�
N me: ( p h 40
Address: City: State:. tJJ Zip Code:
P1 one & Type:2b&_31 (—MaO Office Mobile Email:
Ux der Idaho Building Code, a homeowner is allowed to do work on their own home.
At e you a homeowner doing work on your own home? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
0 No: I am a contractor working for the homeowneNo: This property is a Multi -family Residence or Commercial Property.
N : Any contractors/subcontractors involved will need to submit their own signed applications.
2. Plum ' C ntract 7
Name: 11 9 r Registration #: 0I / Exp.: j
Address: 7() City: State: Zip Code: M10
P one & Type: Office 0 Mobile E ail: e f ( C • cbm
Cc ntact/Rep. Name: Phone: �,5q-22y7 EmaiI: JIM'
Pl mbin Contractor Authorized Signature Date: LI/L7
3. Project Description Water Meter Quantily Water Meter Size:
Address- -OR- Lot #: _ Block #: _ Subdivision-
Check
ubdivision:C eck one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
C eck one: 0 New Construction* 0 Remodel 0 Addition 0 Basement Finish
D scription of work:
N w Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ q"7® (1
Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
0 Over $100,001 = ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft.
• Up to 1,500 Sq. Ft. _ $130 01,501-2,500 Sq. Ft = $195 0 2,501-3,500 Sq. Ft = $260 0 3,501-4,500 Sq. Ft = $325
0 Over 4,500 Sq. Ft. _ $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: 0 Duplex= $260 []Three or more units= $((130 x# of buildings)+(65 x # of units))$____
0 Gray Water Systems= $130 0 Lawn Sprinklers/Backflow device= $65 0 Multipurpose Fire Sprinkler & Domestic Water
S pply System = $65 or $4 per sprinkler head (whichever is greater)
New work on any other residence and Detached Shops: = 65 for sewer and water stub connections ❑
Miscellaneous: 0 Sewer Line = $65 0 Water Line = $65 0 Sewer and Water Line = $65 ®Requested inspection = $65
0 Sewer Turnaround (septic to City) = $65 0 Hydronic Heating= $65 + ($10 x # of manifolds/zones)
0 Technical Service= $65/hour 0 Plan Check =10% of Contracted Amount
GNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
I and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
on the above-mentioned property for inspections purposes. NOTE: The building official y revoke a permit o roval issued under the provisions of the 2012
)de in cases ofany false statement or misrepresentation offact In the application or o a lansonwhichth a torapprovalwasbased. Permitvoidifnot
80 days. Permitvoid if o ikstos for 180 s.
Name (print): Fereq Signature: Date:' 7
ections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
ine - (208) 372.2344 www.rexburg.org Permit Technician- (208) 372.2341 Revised March, 2016