HomeMy WebLinkAboutAPPLICATION MECHANICAL - 16-00526 - 525 South Center - BYUI Kimball Mech modC I TY OF
RE uBlJRG Submit By Email
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Amerid Family Communhy
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number, Permit Type- .❑ New,.,E] Remodel ❑ Addition ,❑ Basemen't Finisb
Fees Paid: ❑ Yes [,]No
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1. Property Owner
Name: BYU-Idaho
Address: Kimball Building
-City: State: 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 #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 their own signed applications.
2. Mechanical Contractor
Name: Lewis Corporation Registration #: HVC-C-4440 Exp.: 5-31-19
Address: 15136 W Hunziker Rd .Pocatello
Phone & T e: 208.238.1202
City
State: Idaho Zip Code: 63202
YP El Office E3Mobile Email: kenyan@lcorp.com
Contact/Rep. Name; Kenyan Lewis P one: 2 20z Email: Kenyan Lewis
Mechanical Contractor Authorized Signature: Date: 7-21-19
3. Project Description
Address: BYU-I Kimball Building -OR- Lot #: _ Block #: _ Subdivision
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* EIRemodel ❑ Addition ❑ Basement Finish
Description of Work: Modifications to the HVAC Fan&Chillers
New Commercial Work: Contracted amount: $ 201610.00 Calculated Fee (See Below): $1666.05
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
El Over $100,001= ((total cost ofsystem -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 HVAC fixtures)) $
Miscellaneous: ❑ Gas Pressure= $65 ❑ Furnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection = $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that he 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 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 theproviShmsofthe 2012
International Code in rases ofany fake statement or misrepresentation of fact in the application or on the plans on which the permit orappmval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Kenyan Lewis
SignC.:
Date: 7-21-16
Inspections must be called in before 8 ANI on the day the inspection is request'on requests called after HAM will be scheduled for the next business day.
Inspection Hotline-(ZOB)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March,2016