HomeMy WebLinkAboutAPPLICATION - 16-00512 - 261 Ricks Ave - Water LineCITY OF
RMLTRG
_ America's Family fammaniry_.
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owneera ��
Name: �1 9 � are 3r ,�/ �y
Address: 2 (�( /-C-r k Ake- City: c It State: ¢� Zip Code:
Phone & Type: 3 96 -42VO 13 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)
Rgo: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/subcontractors Involved will need to submit their own signed applications.
2. Plumbing Coi4ractor
f` G
Name: rr l� Regi n #: Exp.: `
Address: �3 .f/- Sr �*�^City: State: '�' Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: 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 Constructi * 11 Remodel ❑ dditi p ❑ Basement Finish
Descriptionofwork: t rr n
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up 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 unitsa: $((130 x# of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 []Multipurpose Fire Sprinkler & Domestic Water
Supply System= $65 or $4 per sprinkler head whichever isreater)
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 ifD t IcD
$65
❑ Sewer Turnaround (septic to city):a $65 ❑ Hydronic Heating:a $65 + ($10 x # of manifolds/zones)
❑ Technical Service = $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpsoury, l hereby certify than have read this application and state that[ a informationh!m
is correct and l swear that any Information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Cannot for the it Rexb rg
shallbetruthfulandcorrect. I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby�r se t l�( rg
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued un onslonsofthe2012
International Code in cases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoldifnot
started within 180 days. Permit void Ifwoplotops fqF 180 .
Applicant's Name (print): G( I-r.� Signature: Date: 7 4
Inspections most be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the nett business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016