HomeMy WebLinkAboutAPPLICATION - 16-00547 - 436 Maple Dr - PlumbingCITY OF
RMV RG Submlt By Emall
ter
America's Family Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: PermitType: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
FeesPaid: ❑Yes❑No
1. Propertyl)wner _
Name:�1tVarr a I wy\
Address: L41G MsOlp (O,r City:ts,-u4, State: Ib Zip Code: 'SCSI. -11-16
Phone & Type: V ❑ Office ❑ Mobile Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
yyyAyyre-you a homeowner doing work on your own home? [3 Yes (Skip to #3 and complete the Homeowner's Exemption page)
IVo: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTA: Any contmcters/sub-contractors involved will need to submit their own signed applications,
2. Plumbin Cn act9y
Name: n�ly� Registration (k: (5)-rl J,ZJ Exp.:
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Address: 1(',�a F l�wa, 5�Y City: I,Wok, t N1lC State: j; Zi Co e: ` L161
Phone&Type: )ice ❑Office-�tobile Email:. .(.�Qi w'•.v(b' G .�.C-MI
Contact/Rep. Name: one: Email: T
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Plumb in Contractor Authorized Si natured _ Date:
3. Project Description Water Meter Quantity: Water Meter Size:
Address: OR- Lot #: Block #: Subdivision:
Check one: ,]Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Constructi n* ARemodel ❑� tAddition ❑Basemen Finish
Descriptionofwork: 61=` tisowrr � lam," t�JtJ is.�s"'k;
New Commercial Work: Contracted amount: $ S OOp 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 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head (whichever is greater)
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 penaltyofperjury, l hereby certifythat 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 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 ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revokeapermito pproval issued under the provisions ofthe 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on thhichthe ern', o Ipt ,Iwasbased. Permitvoidifnot
started within 180 days. Permit void if w aksop4 for18 `a
Applicant's Name (print): Z�f 6fatL,-VAU Signature: — Date:
Inspections mustbe called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the nextbusiness day.
Inspection Hotline -(208)372.2344 wwmrexburg.org Permit Technician -(208)372.2341 Revised March, 2016