HomeMy WebLinkAboutAPPLICATION - 16-00522 - 11 W 7th S - Playing field water meterBen Munns
Project Manager
Building Safety Department 2680 W 5200 S City of Rexburg Rexburg,ID 83440 lsubmltByEmanl 35North1"East INCORPORATED
General Contractordlbeckbenm@gmail.com
Cell: 208-313-3949 Rexburg, Idaho 83440
Office: 208-656-9344 .-------------------
Fax: 208-656-9345 1
HLD1NG APPLICATION J Plumbing
For Office Use ..
Permit Number: Permit Type: D New D Remodel D Addition D Basement Finish
Fees Paid: DYes DNo
. .·
1.Prop� Owner
Name: _}1,!.-�1> City: R ..... � Address: State: :CD Zip Code: 8,J<-1 '{1)
Phone & Type: D Office D 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? OYes (Skip to #3 and complete the Homeowner's Exemption page)
D No: I am a contractor working for the homeowner D No: This property is a Multi-family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed appli cations.
2.Plumbing Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone & Type:D Office D Mobile Email:
Contact/Rep. Name:Phone: Email:
Plumbing Contractor Authorized Signature:! Date:
3.Project Description Water Meter Quantity:I Water Meter Size: ::}N
Address: -OR-Lot#: Block#: Subdivision: Check one: D Single-family Residence D Multi-family Residence .li(Commercial Check one: D New Construction* DRemodel D Addition D Basement Finish
Description of work:
New Commercial Work: Contracted amount:$ Calculated Fee (See Below):$
D Up to $10,000 = [total cost of system x .02) + $60 D $10,001-$100,000 = [[total cost of system -10,000) x .01) + $260
D Over$100,001 = ((total cost of system -100,000) x .005) + $1,160
New Single-Family Residential Work: Sq. Ft.
D Up to 1,500 Sq. Ft= $130 D 1,501-2,500 Sq. Ft.= $195 D 2,501-3,500 Sq. Ft.= $260 D 3,501-4,500 Sq. Ft= $325
D Over 4,500 Sq. Ft. -$325+(65 x # ofadditional 1,000 Sq. Ft (or portion thereof))$
New Multi-Family Residential: D Duplex= $260 D Three or more units= $((130 x # ofbuildings)+(65 x # of units))$_
D Gray Water Systems = $130 D Lawn Sprinklers/Backflow device = $65 D 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 D
Miscellaneous: D Sewer Line -$65 �ater Line = $65 D Sewer and Water Line = $65 DRequested inspection= $65
D Sewer Turnaround (septic to city) = $65 D Hydronic Heating= $65 + ($10 x # of manifolds/zones)
D Technical Service= $65/hour D Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the infonnation herein
is correct and I swear that any Information which may hereafte r be given by me in 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 Jaws re lating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-me ntioned 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 fals e statement or misrepresentation of fact in the application or on the plans on ich the permit or approval was based. Permit void if not
started within 180 days. Permit void i�k stops ro:,.xso days.
Applicant's Name [print):<1MM Signature: 1MIIIJ Date: 7-Jf-/6
Inspections mw;t be �lied In beforn BAM on the day the Inspection Is rnquested. lns�l� �e:Ue� ��ed lnaOe, Bi l��!�e �=!ne� �"1 Inspection Hotline -(208) 372.2344 www.rexburg.org PennitTechnidan -(208) 372.2341 Revised March, 2016