HomeMy WebLinkAboutAPPLICATION - 16-00687 - 345 Bare St - Water LineCITY OF
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BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North Is' East
Rexburg, Idaho 83440
For Office Use
Permit Number: [&g Ore Permit Type:. ❑ New []Remodel ❑ Addition []Basement Finish
FeesPaid:❑Yes ❑ No
1 'PropSa Owner
Name: *44L aIncl llheftSCt .`enInc ins
Address: S4'S P�one S,E. City: .I?PXf 04 State: Zbo Zip Code: Z,a;c-1416
Phone &Type:(S-i)❑OfficeoMobile Email: S(2eieC61Z3G(o Caot•C6�
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? Ones (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.
NOTE: Any contractors/sub-contractors involved will need to submit the! rown signed applications,
2. Plumbing Contractor
Name: Registration #: Exp.:
Address: City: - State: Zip Code:
Phone & Type: —[]Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
Plumbing Contractor Authorized Si nature Date:
3. Project Description Water Meter Quantity: Water Meter Size: �n
Address: 3NS Rn K -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): $
13Up 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= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply 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: ❑ Sewer Line = $65 ater Line = $65 ❑ Sewer and Water Line= $65 ❑Requested inspection =$65
❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x # of manifolds/zones)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, Ihereby certifythat l have read this application and state that the information herein
is correct and I 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
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 of the 2012
International Code in cases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit orappreval was based. Permitvoidifnot
started within 180 days. Permit void ifwUrk stops for 180 days. ,---- V_
Applicant's Name (print): 1 121=(.1 'J enk� nQ Signature:/ Date: 1� _ (o " ((,,
Inspections most he called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled forth next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016