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HomeMy WebLinkAboutAPPLICATION PLUMBING - 16-00454 - Madison Park Apartments ClubhouseC I T Y O F REXBURG �Imerica' Family Communily Submit Sy Email BUILDING APPLICATION Plumbing Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Permit Type: ❑ New C Remodel ❑ Addition ❑ Basement Finish Fees Paid: C{ Yes ❑ No 1. Property Owner Name: frrl Address: I I lj;City:?8X'X State: Zip Code: 3y Phone &Type: �3 Hifi - 6 .;�, 7 2 _ �Of6ce ❑Mobile Email: Under Idaho Building Code, a homeowner is allowed to do u w6rk on their own home. Are yoa homeowner doing work on your own home? t ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page) ❑ No: i am a contractor working for the homeowner )KNo: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors involved will need to submit their o-o(signed applications. 2. Plumbing Contractor 1 t 1 0 Name: F) a 1 U A --%—Ji i 1nj)!9S* Registration #: e l Exp.: Address: I'?,D / City: _ ]`Desj State: ZZ -n— Zip Code: Phone & Type: w_Rti�- In 5a 1 L XOffice ❑ Mobile Email: ,a Contact/Rep. Name:Phone Email: PlumbingContractor Authorized Si ature. Date: 3. Project Description Water Meter Quantity: Water Meter Size: Address: -OR- Lot #:' Block #- _ Subdivision: Check one: ❑ Single-family Residence ❑ Multi -family Residence X'Commercial Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish Description of work: New Commercial Work: Contracted a punt: $ Calculated Fee (See Below): $, Z ❑ Up to $10,000 = (total cost of system x.02) + $60 0$10,001-$100,000 = ((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 =_U25+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $ New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # ofbuildings)+(65 x # of units))$_ ❑ 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 cospe.,ptions ❑ Miscellaneous: O Sewer Line = $65 ❑ Water Line = $65 Xsewer and Water Line =06S ❑Requested inspection = $65 ❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x # of mani o s/zones) ❑ Technical Service= $65/hour ❑ PIan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION ANQAUTHORIZATION: Underpenaltyofperju is correct and 1 swear that any information which may hereafter be given by me in hearings of shall be truthful and correct 1 agree to comply with all City regulations and State laws rela g City to enter upon the above-mentioned property for inspections purposes. NOTE: The buil 'n International Code in .rases of any false statement or misrepresentation of fact in the applicati started within 180 days. Permit void ifwark stops for 180 days. Applicant's Name (print): tJ!V4 Wh 4P,4tt-f�P_Signature: hereby certify that 1 have read this application and state that the information herein o e the Planning and Zoning Commission or the City Council forthe City of Rexburg to he subject matter oftbis applic on and hereby authorized representatives of the 'o cial may revoke a pe tan a vol issued under the provisions of the 2012 or theplansonwhi h�ej= or approval was based. Permitvoid,ifnot Date: f _o Insp orlc mwst be ca0ed in N-13before 8 AIN on the day the inspection is requested. Inspe © in after 8 AM will be scheduled for the next business day. Inspection }Eotlin – [208} 372.2344 wwov.rexburg.org Permit technician (208) 372.2341 Revised March, 2016