HomeMy WebLinkAboutAPPLICATION - 16-00760 - 4232 W 1000 N - MechanicalC.1 TY ti p Building Safety Department
RMUR'x City of Rexburg
°G 35 North 1St East
.,, uirntrim3FamilyGmmunily Rexburg, Idaho 83440
BUILDING APPLICATION
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For Off ceUse „ ..
AermitNumber W;60760 a Permit Type.:'ijNew f7 _Remodel DAdditian.OBasemeht:FihiSti'
Fees Paid:Ye
: O s 1No -
1 Property Owner
Name.(, X i
Address: 44 7- ttic City: a bl� _State: _Zip Code:
Phone &Type:Z08-Za0.3C0 ❑OfficelWobile 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)
19:1,11o: I am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
NOTC: Any contractors/subcontractors involvedwill need to submittheirown signedapp6caUons.
2. Electrical Con acor
Name: C:Ci. 21/JC', Re is ation #: Exp.:
Address: City: Stae: Zip Code:
Phone&Type: - '7 7 2 -WfficepMobile Email, C, ntemu ifzi+c ,t( NA)e I corVI
Contact/Rep..Name: "A. Phone: 51Z.-7777Email:_65(Z
Electrical GontractorAnehoriidd Signatiiret Date:
3.Projectq_esLcr�7 n y,
Addresg: �t{{ SS woe) i� -OR- Lot #: _ Block #: _ Subdivision:
Check one:-plingle-family Residence ❑ Multi -family Residence []Commercial
Check one: New Cons uctione 13 Remodel ❑ Addition ❑ Basement Finish
Descri tion of work: - -%
! [lew Commercial Work "Contracted-amoun[: $ ..> i. Calculated Fee(See .Below)o-$
Tpto$1'0;000 -:(total costofsystem'x.02) + $60 0 $10 001=$100,000=(ttotal cost ofsystem-10;000) x.01) + $260 ..
O Over $1110 001- ((tonal cost ofsystem -100;000),x.005),+,$1,160
New Single -Family Residential Work: Sq. Ft
,11Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325
❑ Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $
'New Multi: -Family
Resiel.'ential O Duplex = $26'0:, ❑fihree-or more units $((130 ic# of buildings)+(65 x # of units))$_'
New work on any other residence and Detached Shops: _ (65 + (10 x # of branch circuits))
Miscellaneous. SInaILWorks ("work costingless thann$200'with no -change ni service connecti"ons)=$10[needs no inspection:
O•Central-Heanng/Cooling Systems'='$65 17 Spas, HotTubs and Swimming Pool's_ $65'� LRegnestedllspection = $,fi5` .
❑ Pumps -Water, Irrigation Sewage "(per motor) b $65 up to 25HP O $95 267200HP (7'$13.0 over 200HP
O IrrigationeMachine = $65 for'center pivot+ $SO pertowerof drive motor $ ❑ TechmcalServiee = $65/hour
IOTempor4ryAntusement=$65+$10perrida;concession;..orgenerator$ OPlan:Check-10%of Contracted Amouni
47I.Terntiorery tonstruetionServices..ONLY=$65. 20.Oain .orless.Onel.,4tion forless than l. year.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaltyofpedury, Iherebycertify that l have read this application andstate that the information herein
Is cartectand I swearthatanyinformation which mayhereakerbe given byme in hearings before the Planningand ZuningCommimlon orthe CltyCoundl forthe CltyofRexburg
shall be truthfuland correct I agree to complywith all City regulationsand State laws relating to the subjectmatterofthiv application and hereby authorized representatives ofthe
City to enter upon the above•mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012
International Code in cases ofanyfalse statementor misrepresentation offactin the application o onthel Ion whit of permit rappmval was based. PermltvoidifnoC
staRedwlthin180days. Permit fdtfworksta far 180 days. 11
Applicants Name (print): CtT 'i G QSII Signature: Date:Jj (Ly l iv
Inspections most be ailed In before 8 AM on the day the Inspection is requested. inspection requests called in after 8AM will be scheduled for the next bmi nus,d�(ay.
Inspection Hodlne-(208)372.2344 www.rexburgotg Permit Technician -(208)372.2341 Revised March, 2016