HomeMy WebLinkAboutAPPLICATION - 16-00476 - 525 N 5th W - Water Reclamation Facility - PlumbingCITY OF
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BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use 1
Permit Number. %U'o0'tl� Permit Type: ,l4New ❑Remodel ❑Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner n
Name: Of- 6E- tln
Address: 5Z 5i w City: Rere„ Q6) State: T-0 Zip Code: 6_7yY 0
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: 1 am a contractor working for the homeowner o: 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. Plumbi Contractor p
Name: O�`�A/N I't�0 1� HI c(1�A.tc/iL gistration #: 1` 1_4— L' I%r'?0Exp.: �z
Address: e;74, W 4"7-G) S City: r 8V9_1 State: TO Zip Code: %YWYO
Phone &Type: 35 0 --y31-0 ®"Office ❑ Mobile Email: 114-1",4 AP 01WiIA 0I9, CT—, a oM
Contact/Rep. Name:-J•+�tt.� 0-tu Pho e: 710"00}Email: .ws}ir��dJlhulPt DIkt�T•G°
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PlumbingContractor Authorized Signature: Lk'lub Date: 7� /
3. Project Description Water Meter Quanti Water Meter Size:
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Cory$tr�ction* ❑ Remodel ❑ A dition ❑ Basement Finish
Descriptionofwork: KZ1c Q 1✓ "2 'r rwJ rA
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 Units= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 O Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head whichever is reater
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 me in 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. NO TE: Thebuilding offlcia rf5y)evokeapermit on approval Issued under the provisions of the 2012
InternationalCodeincases ofany fakestatement ormisrepresentation of factintheappllcatlonor the nso vlf cTiln efrun orappmvalwas based. Permit void lfnot
startedwithin 180 days. Permit void if�work ^stops for 180 days.
Applicant's Name (print): lVgiS'/'J I-�/`�— Signature. Date:
Inspections must be called In before 8 AM on the daythe inspection is requeste nspectum requests called matters AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016