HomeMy WebLinkAboutAPPLICATION - 16-00705 - 1154 Stocks Ave - Ele OnlyCITY OF
11,M V RG Submit By Email
CW
Ameriads Family Community
BUILDING APPLICATION
Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Ito- CI® 705 Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner
Name: act
- L
N (�
Address:—115U City: E&A/at State: Zip Code:
Phone &Type:02-d42-1717 ❑Office Omobile 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)
?No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
OTE: Any contractors/sub-mntractors involved will need to submit their own signed applications,
2. Electrical Contracto // _
Name: 6-L a -r" S rLP r -Mt C Registrj� tion #: Exp.:
Address: l r G/esce�d! D!Z City: Oar State:Zip 3
Code: <C�C�
Phone & Typ -7(2.4 ❑ Office OUobile Email: _ 4.
Contact/Rep. Name: L Phone 4 - Email: R les. ,VA �t�t4 n� -/ru
Electrical Contractor Authorized Signature; Date: ' e 1e
3. Project Description
Address: _ OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((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. = $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 Residential: ❑ Duplex= $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 branch circuits))
Miscellaneous: FSmall Works (work costing less than $200 with no change in service connections) =$1 0(needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 ,((Requested Inspection= $65
❑ Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 200HP
❑ Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor $ [:]Technical Service= $65/hour
❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun
0Ternporary Construction Services ONLY= $65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pewltyofperjury, l hereby certify that i have read this application and state thatthe information herein
I. correct and 1 swear that any information which may hereafter be given bymein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct I agree to complywith all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
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 ofany false statement or misrepresentation offset in the application oron el lansm ,yiic(the permit or approval was based. Pennitvoidifnot
stamedwithin180 days. Permitvoidil`Zor tops for 180 days.
Applicant's Name (print): 4 & LJ�IdS Signature: IL Date: oct 2e /�,
Inspections mustbe called in before 8 AM on the day the inspection is requested. Inspection requests called in atterB AM will be scheduled forthe nextbusiness day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016