HomeMy WebLinkAboutAPPLICATION - 16-00766 - 2468 N 2000 W - Furnace ChangeoutAlpine Heating Air
CITY OF
REXBL RG Submit By Email
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BUILDING APPLICATION
`. Mechanical
2085520594 p.1
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
_For Office Use...
Permtt h'ulilb Permit Type ❑ New ❑ Remodel in Addition ❑Basement Fm3sh
Fees PaidYes 13 -No..
1, Proper Owner
Name:
Address:aWg Al U) city: State: �� Zip Code: ��Yy
Phone &Typ DHH3i�-A—,,�'TS7❑Dffice)lMabile Email: �
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
o: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NO L: Any cmttractom/sub-contraaom involved will need to submit thefruwn signed applications,
2. Mechanical Contractor
Name: Alpine Heating& Air Conditioning Registration#: HVAC -C-3258 Exp.:
Address: 170 N. Eastern Ave City: Idaho Falls State: ID Zip Code: 83402
Phone & Type: 2oe-523-5542 El Office ❑ Mobile Email: jim@alptneheatingair.com
Contact/Rep. Name: Paula Anderson Phone: 208-523(-5542 Email: paula@alpineheatingair,mm
Mechanical Contractor Authorized.Sign ature:''5E� F7iLJ1 t Date: 1�
3. Project Des ripYian
Address:��4t? /U `�Onf� -IN OR- Lot 4i:�Block #:_Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑New Construction' ,Remodel 3C1Addition ❑ Basement Finish f
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Description of work: D
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to 510,000 = (total cost of system x.02) + $60 ❑ $10,D014100,000 = ((total cost of system -10,000) x.01) + $260
❑ 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 ❑ 1,501-2,500 Sq. Ft = $19S ❑ 2,501-3,500 Sq. Ft. = $260 ❑ 3,501-4,50D Sq. Ft = $325
❑ Over 4,500 Sq. Ft = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential: ❑ Duplexz: $260 ❑ 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)) $
Miscellanenas: ❑ Gas Pressure= $65 ❑ Furnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection= $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIPICATION AND AUTHDRIZATfON: Underpenaltyef perjury,, I hereby certify that I have read this application and state thatthe information herein
is correct and[ swearthat any information which may hereafter be given by me in hearings before the Plenning and Zoning Commission orthe city Council for the CftyofRexburg
shall be truthful and correct I agree to comply with all City regulations and State laws relating to thesubject matterufthls application and hereby authorized representatives a fthe
City to enter upon the above-mendaned property for inspections purposes. NOTC: The bufldingofDcial may revoke a permit on approval Issued under the provisions of the 2012
International Code incases of any false statement a r misrepresenmtian of fact in the application or on the plans on whichthe permit or approval was based: Permit void if not
starMd within 18D days. Permttvoid i fwork stops for 180 days.
`t) f
uwl �1t� < 5ignature: Hca 5 •-` (l�Q lillct - Date:
Applicant's Name [print): t
Inspections must be called in before SAM on the day the inspection is requested. inspection requests called in after SAM will be scheduled for the nextbusin es, day.
Inspection Hotline -(203)372.2344 www.rexburg.org Permit Technician -(208)392.2341 Revised March, 2016
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