HomeMy WebLinkAboutAPPLICATION - 16-00341 - 305 S 3rd E - Water LineCITY OF
RMURG
C%
Anuo*6 Fnmify Community
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.Prope ty0w�ygr
Name: �Av reS( l
Address: 365- S. ,4 Es, City: r x State: ZA Zip Code: g3 Yyn
Phone&Type: 7o6 ❑ Office GLMobile 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)
AND: 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 awn signed applications.
2. Plumbing Contractor
Name: Dn.q-s Kga,,r T7. c Registration #: Exp.:
Address: 3`1/ , lj"A-LAfh City: State:-�r_ A Zip Code: a,?YVn
Phone&Type: oS! 4 �4 ❑OfficepMobile Email:
Contact/Rep. Name: _10t2VI 6 /'V14,,, �, s Phone: ?f/ -L'76 1 Email:
.Plumbing Contractor Authorized Signature: Dater
3. Project Description ater Mwr Quantity: Water Meter Size:
Address: 30F x / -OR- Lot #: _ Block #: _ Subdivision:
Check one: pVingle-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New ConsVuction* ❑ Re oriel ❑ Addi 'on ❑ Basement Finish
Description of work: Wes e✓
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.
ID 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 ❑ 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
11 Sewer Turnaround (septic to city) = $65
El Heating = $65 + ($10 x # of manifolds/zones)
❑ Technical Service= $65/hour 13 Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 mein 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 of this application and hereby authorized represenmtives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012
International Code in cases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit orapproval was based. Permitvoldlfnot
started within 180 days. Permit void if work stops for 180 days. /)
Applicant's Name (print):
Inspections most be called in before B AM on the day the inspection Is requested. Inspection requests called in after B 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