HomeMy WebLinkAboutAPPLICATION - 16-00388 - 29 E Poleline Rd - MechanicalAlpine Heating Air
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CITY OF
REXBURG
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2085520594 p.1
Building Safety Department
City of Rexburg
Submit By Email
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
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Fol' Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: []Yes ❑ No
].. Proper caner
Name: Z t oK.�L ttJ11� )
Address e � G �[ � duets to �4 eX. City: _w' .tLl�t-t�t t State: �—� Zip Code:
Phone&Type::%O9—/.i.9-1❑Off! cekMobile Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your awn home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
o: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any mntracmrs/sulscontra eomnnolved wit. need In submit taeirown signed applications.
2. Mechanical Contractor
Name: Alpine Hratfng& Air Conditioning Registration #: HVAC -C-3258 Exp.:
Address: 170 N. Eastern Ave City: Idaho Falls State: 11) Zip Code: 83402
Phone &Type: 208-523.5542 D Office ❑ Mobile Email: Ilm@alpineheatingair.com
Contact/Rep. Name: Paula Anderson —Phone: 208mS223.5�^542�� Q� Email: paula@alpineheatingaiocom
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Mechanical Contractor Authorized Signature: Date: 17
3. ProjectDescription
Address: A9 �a Kcl. -OR- Lot #:_ Block #:_Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Rmodel ❑ Addition ❑ Basement Finish
Description of work:
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: ❑ Duplexe: $260 ❑ Three or more unitsc: $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: = $(65 + (lox # 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 ❑TechnicalService =$65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the information herein
Is arrmt and I swea rthat any Infomtation which may hereafter be given by we In bearings before the Planning and Zoning Commission or the City Council forthe Cityof Rexburg
shall be truthful and correct. I agree to comply with all City regulations and Srate laws relating to the subject matter of this application and herebyauthodaed representatives of the
City to enterupon the abovementioned property for inspections purposes. NOTE: The building official may revoke a permit on approval Issued under the previsions of the 2012
International Code In rases of any fake statement or an tvrepreseniation of fact In the application or on the plans on which the permit or approval was based. Permit void If nat
started within 180 days. Permit void l (work stops for 180 days.
Applicants Name (printl� �CSZi��$ignature; y o x `X Rte. �k�'t+�Ll til -yam Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called In after D AM will he scheduled for the next business day.
Inspection Hotline -(208)372.2344 wwwrexburg.org Permitrechdclon-(208)373.2341 Revised March, ZD16