HomeMy WebLinkAboutAPPLICATION - 16-00690 - 601 Casper - Gas Pressure�s.Dtnnxe gD
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CITY OF Building Safety Department
REXI3URGCity of Rexburg
Submit By Email 35 North tat East
nmer7mi:(NntnyGbmmanlry Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
For Office Use
Pejrnfdoumber; '00 ._ PermitTypel ❑NeW ❑.Remodel MAddition 11 Basement Finish
... ..
Fees Paid: ❑Yes ❑ No > ..
1. Property Owner
Name:—( IMWI I E lJIS �3,1
Address: _IDB 1 G4C_tA- City:-_ State: _ Zip Code:
Phone & Type: [3 Office ❑ Mobile Email: 0-
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)
IM No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Anycontrocmrs/subconnacrors involved will need to submit their own signed applIcations.
2. Mechanical Contractor , I
Name:. ��pnQA,7 Registration #: Imo. ,— 6523G Exp.: 't l 4 1 i q
Address' t-F'"Lid �54 City:J.clra_ Ind ��I l State: M4_ZipCode: 33C109 _
Phone & Type: 522-337 Office ❑ Mobile Email:
Contact/Rep. Name: _ Phone: ( Email:
Mechanical Contractor Authorized Signature:. C*o 7dLf')GLC 46i Date;
i
3. ProjectDesc
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 Commereia7Work:.Contracted amount:! Calculated Fee -(See :Below): $
❑ Up to -$10,000 (total costof system x.02) + $60 17:$10,001-$100,000 = ((total costof system -1o;000) x-.01) + $260
13Over-$100,001 =-[(total costof 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. FL = $195 ❑ 2,501-3,500 Sq. FL = $260 ❑ 3,501-4,500 Sq. Ft. = $325
❑ Over 4,500 Sq. Pt = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential' 13 Duplex =.$260 ❑ Three or more units= $((130: z.# of buildings)+(65 x# of units))$_
New work on any other residence and Detached hops: _ (65 + (10 x # of HVAC fixtures) I
Miscellaneous. Gas Pressure = $65 Furnace or A/C =.$65 0 Water Heater=.:$65O RequestedIhspection = $65-
❑ Gas Line =.$65 ❑Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
El Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Underpenalty ofperluty, l herebycertify that I have reacitlris applirationand scale thatthe information herein
Is correct and I swearthatanyinfotmadonwhich may hereafter begiven byme in hearings before the Planning and Zoning Commission or the city council for the City of Rexburg
shallbe tmthful and correct. 1 agree to complywith all city regulations and State laws relatingto the sub)ectmatterofthis application and herebyauthoriaed representatives ofthe
City to enterupan the above-mentioned property forinspections purposes. NOTE: The building official mayrevoke a permftnn approval issued under the provisions ofthe 2012
International Cade in rases ofanyfalsesratement ormisrepresentatlon offset In the application oron the plans on which the permitorapproval was based. Permitvoldifnot
started within 180 days. Permlteoid Hworksnops for 180 days.
Applicant's Name (print):
Signature:
InspecUonsmustbe called in Warne AM on the day the inspection is requested.lnspectian requests called in after 8AM WE be scheduled far thenextbushose day,
Inspection Hotline -(208)372.2344 www.rexburg.org PennitTechnlchm-(208)372,2341 Revised March,2016