HomeMy WebLinkAboutAPPLICATION PLUMBING - 13-00382 - 240 S 3rd E - Bathroom Remodel°pppxnugp
CITY OF
REXBURG
Amorkai Family Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
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Permit Number: Permit e: ❑New
Typ Remodel ❑Addition 13 Basement Finish
Fees Paid: J6Yes ❑ No
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone &Type: ❑ Office El 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: I am a contractor working for the homeowner O No: 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. Plumbing Contractor
Name: i�sr l.�ac�Wn.-�-L` Registration#: PM -e-- /2S'3-4 Exp.: %Z�J'
Address:_ Ve) Sex IIN City:�rw CA✓ State: =m Zip Code: f; 4)qC
Phone & Type: _20 9 - 5" R 00ffice 181 Mobile Email: tdrol o I L g�,� t s e w
Contact/Rep. Name: S.,_.,., Phone: S� Email: - -
Plumbing Contractor Authorized Si afore: L Date: e /6
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot #: —Block #: _ Subdivision:
Check one: 13 Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* Cl Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
Cl 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 ❑ 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. inspection= $65
❑ Sewer Turnaround (septic tocity) = $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: Underpenalty ofperiury, l hereby certify that I have read this application and state that the information herein
is correct and i 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 ofthis application and hereby authorized representatives of the
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 rases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit voidif not
started within 180 days. Permitvoid ifwork stops for 180 days.
Applicant's Name (print): Signature: Date
Inspections must 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 next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016