HomeMy WebLinkAboutAPPLICATION - 16-00434 - 371 S 3rd E - MechanicalAlpine Heating Air
Ce ppxPtl4q
F r� CITY OF
0
REXBURG
aw
Amental nnnify Community
2085520594 p.1
Building Safety Department
City of Rexburg
Submit By Email 35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
For Office Use
Permit Number: Ib -00434 Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No ,
1. Property Owner
Name! A.Ve ZIZi1W e�
Address: 7l .2- 3 _ City: =K 61 ' Q Sate: Zip Code:, K Sin
Phone&Type:�75J-'%473 ❑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)
MO: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE:Any contranu rsjsuh-mntracturs Involved will need to submit the:rown signed applications.
2. Mechanical Contractor (Q
Name: Alpine Heating& Air Conditioning Registration #: HVAC -C-32513 Exp.:
Address: 170N. Eastern Ave City: Idaho Falls State: to Zip Code: 83402
Phone &Type: 208.523.5542 l7 Office ❑ Mobile Email: 1im@alpineheatingair.com
Contact/Rep. Name: Paula Anderson Phone: 2081 Email: paula@alpineheatingairxom
Mechanical Contractor Authorized Signature: Date:
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ZrSingle-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Cons uc(jon* ❑ R mo el ❑ Addition ❑ Basement Finish
Description of work AI
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to 510,000 = (total cost of systemx.02) + $60 ❑ $10,001-$100,000 = ((total costof system -10,000) x.01) + $260
❑ Over $100,001= ((total cast of system -100,000) x.005) + $1,160
New Single-FalnilyResiden Hal Work: Sq. Ft
❑ Up to 1,500 Sq. Ft = $13D ❑ 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 tt of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Fancily Residential: ❑ Duplex= $260 ❑ Three or more Units= $((13D x # of buildings)+(65 x # of units))$_.
New work oil any other residence and Detached Shops: _ (65 + (10 x # of HVAC fixtures))
Miscellaneous: ❑ Gas Pressure= $65 urnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection = $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Servicec: $65/hour
❑ Plan Check= 10% of Contracted Amount
APPLICANTs51CNA7URE,CERTIPICATIONANDAUTHORIZATION: Under panaltyofpedury, I hereby certify that l have read this application and state that the information herein
Is correct and 1 swear that any information which may hereafter be given by me In heari ngs before rhe Planning and Zoning Commission or the City Council for the Cityof Rexbcrg
shall be truthful and correct 1 agree to comply with all Clry regulations and State laws relatingto the subject matterof this application and hereby aathedxad representatives of the
City to enterupon the above-mentioned propertyfo rinspecdons purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
InternadanaiCode Incases of any fake statement or misrepresentation offact inthe application or on the plans on which the permit or approval was based. Permit void tfrot
started within 180 days. Permit voted ifworksto ps for 180 days. �
Applicanes Name (print): t �Q Ef�5191� Signature: 1 Qct. n 1 Date: —�o
Inspections must be called In before SAM on the day the inspection Is requested. Inspection requests called In after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 ivodv.rexburg.mg Permit Techrician-(208)372.2341 Revised March, 2016