HomeMy WebLinkAboutAPPLICATION MECHANICAL - 16-00413 - 501 Rolling Hills - AdditionCITY OF
l EXB V G Submit By Emall
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A,nerwa5 Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: (G -"o H 13 Permit Type: []New ❑ Remodel ❑ Addition ❑ 1asement Finish
Fees Paid: ❑ Yes []No
1. Proper wner "�-,
Name: A6,0— w of i
Address: 5V/ /fid/!i /S I%r- _City: 6k State:�ZipCode: ��yiy�
Phone &Type: 22,M390-?9?J c ❑ Office pMobile Email: ,r7finiio (P-6"au , coo
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)
P)No: 1 am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sulfcontmctors involved will need to submit their own signed applications.
2. Mechan/ica,.l, Contractor
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Name: /�V-D Re istration #:_ 7 Exp.:Address: SUdUwt 1A,71f r City, 6%A= State: O Zip Code: r
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Phone & Type: '20t — 3 iD -- 78 7D' _ ❑ Office q Mobile Email: Z&2 ccuef G nR� ` . Go n 2
Contact/Rep. Name: Phone: __Zdd8"'BW- Email: uo uny
Mechanical Contractor Authorized Signature: _ �Q� ar--� Date:4/ 1
3. Project Description
Address: ,fl)/ Rd //tom //i`1/r ✓J/ -OR- Lot #: _ Block #: _ Subdivision:
Check one: ($"Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: /❑_New Construction* f�IRemodel 14Addition ❑ Basement Finish
Description of work: L "k -
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
❑ 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= $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: _ (65 + (10 x # of HVAC fixtures))
Miscellaneous: ❑ Gas Pressure= $65 urnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection= $65
PtGas Line = $65 Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hemloycertify that l have read this application and state thatthe information herein
is correct and I swear that any information which may hereafter he given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correm I agree to comply with all City regulations and State laws relating to the subject matter of this application and herebyauthmixed 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 of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application oron the plans on which the permit or approval was based. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days. p -
Applicant's Name (print): ��ic-✓r� /"V.— V.— Signature: Date:
Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016