HomeMy WebLinkAboutAPPLICATION - 16-00503 - 6579 S 2000 W - County Mechanical only07/18/2016 16:08 FAX
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Q CITY OF Building :safety Department
REXBURG City of Rexburg
_. n ...._..._..._. 35 North ist East
.meatal:family Comumit, Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
Permit Number. Permit Type: 0 New ❑ Remodel 0 Addition 0 Basement Finish
Fees Paid: 13 Yes 0 No
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Name: To dd t'TnIlleAG �
Address: �/ �— 000 City L State: �!f 7 r/e
Zip Code: � :
Phone&Type: 97-/9O3r ❑Officel9'ftobile 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 Homeowners Exemption page)
12(No; I ala a contractor working for the homeowner 0 No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/subcontractors involved will nrrd to submit [heir own.ngned applications.
Name:_ T eL 0f Re istr ti n#: Exp.:,
Address: City: te: Zip (lode:
Phone &'type: DD Office ❑Mobile Email: 0 Cohn
Contact/Rep. Name:e-f b%Uish Phone:
-JIS-g/4iF Emaib
Mechanical Contractor Authorized Signature, -,-Date:
Address; 5 S a00p -OR- Lot #:__ Block III: —Subdivision:
Check one: Single-family Residence O Multi -family Residence ❑ Commercial
Check one; ❑ New Construction' 0 Remodel M4ddition ❑ Basement Finish
Description of work:
Contracted amount: $ Calculated Tree (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,0014100,000 = ((total cost of system -141,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
Sq. Ft
V1Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 0 3,501-4,500 Sq. Ft = $325
❑ Over 4,500 Sq. Ft = $325+[65 x # of additional 1,000 Sq. FL for portion thereof)) $
❑ Duplex = $260 ❑ Three or more units = $((130 x# of buildings)+(66 x # of units))$
6 « 10 x # of HVAC xtures
Gas PressureIn $65 PFurnace or A/C to $65 ❑ Water Heater = $65 0 Requested Inspection = $65
O Gas Line a: $65 121 Fireplace/Solid Fuel Burning Unit= $65 0 Technical Service = $6S/hour
❑ Plan Check=101% of Contracted Amount
APPLICANTB SIGNATURE, CRRTIPICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have road this application and State that the information herein
Is mrrect and( awearthat any infoemotion which mayhereaRer be given by me In hearings before the planning and Zoning Commission Ordte city Council fortbe Ckyof Rexburg
.,hall be truthful and eermM 1 agree to comply with all City ro0ubmnns andStatu Iowa relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mendoned property for inspcCdom purposes. NOTE: The bufldlog ofdelal mayrevoke a permit on approval Issued underthe previsions Ofthe 2012
Internatlnnal Code In mNeN nfnnylatecebtemont ormi:repregeonstion of Not In the application or he plans on which the permit of approval was based. Permitvoidifaot
startedwlthln leo days, Pcrmit sold lfwarkstops for leo oys.
Applicant's Name (print): (ALL—Signature: % ~ Date:
Inspections mum be called in before BAN onthe day the lospemion le requested. Inspection requests Called in after 0 AMwlll be schodultxl for the next business day.
Impaction llotllne - (ZOO) 372.23" www.rexilat org Permit Technician -(200)373.2341 Revised March, 2016