HomeMy WebLinkAboutAPPLICATION - 16-00571 - Madison Park Apartments - Water LineCITY OF
REXB V G Submit By Email
Aurcdw's Family Community
Building Safety Department
City of Rexburg
BUILDING APPLICATION
Plumbing AUG 2 2 ih
35 North 1st East
echo 83440
For Office Use _ - ,
Permit Number: iir"°�7� Permit Type:: ❑New ❑:Remodel -❑Addition DBasementFinish
Fees Paid: ❑ Yes []No
1. Proper Owner
Name: ,!I'dAC k *&m77vtOyq-t<
Address: G/f/ _,s4725 -Gy City: 60_^, f e State:`—Zl_� Zip Code:
Phone & Type: ❑ Office ❑ Mobile 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 43 and complete the Homeowner's Exemption page)
❑ No: I am a contractor working for the homeowner1y/��,t,�o: This property is a Multi -family Residence o ommercial Proper
NOTE: Any contractors/sub-contractors involved will need to submit theirokvn�signed applications.
2. Plumbing ContrraLc-to�r
Name:`-l'-e-Y�til��C-,) �XC',q-J ar'Ttnilr— RegPistration#: Exp.:
Address:City: CCI 3yt State: 7�_ Zip Code:
Phone&Type:��ld�—�S/—Sl%'S2--- ❑Office`"obile Email'if�.ncl�m
Contact/Rep. Name: one: Email:
Plumbing Contractor Authorized Signature: Date:
3. Project Description Water Meter Quantity: Water Meter Size:
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 ❑ $10,001-$100,000 = ((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: O 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 isgreater)
New work on any other residence and Detached Shops: = $65 for sewer and water stub connections ❑
Miscellaneous: ❑Sewer Line = $65 ❑ Water 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, I hereby certify that 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. I 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 revok a permit on approvalissusd under the provisions ofthe 2012
International Code in cases of any false statement or misrepresentation effect in the application or on the plan which the permit or approval was based. Permitvoidifnot
started within 180 days. Permitvoid ifw��r `stops for 160 days c
Applicant's Name (print): /C /ten ��iiLC�� Signature: � , ate:
Inspections must be called in before 8 AM on the day the Inspection is requested. Inspection requests called matter 8 AM will be scheduled forthe next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016