HomeMy WebLinkAboutAPPLICATION MECHANICAL - 16-00306 - 593 S Hidden Valley Rd - SFRpP.%RUp
A4op �,C CITY OF
REXBURG
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Arnericn's Wmify Co nnumity
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg,ldaho 83440
BUILDING APPLICATION
Mec�ianical
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For Office Use
Permit Number: /%—eYa_ Permit Type: KNew ❑Remodel ❑Addition ❑ Basement Finish
Fees Paid: D Yes ❑ No
1. Property Owner
Name:
Address: � _--___— _ City: State: Zip Code:
Phone & Type: _ ❑ Office ❑ 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-cantractms involved will need to submit their own signed applications.
2. Mechanical Contractor dffok4a P10 W1,1;-
Name: _ �istration#AKJ ,G'Z I/`� Exp.:_
Address: _ �,_� City:.1-e-lG.hrs .E�. State: _Q— Zip Code: _
Phone &Type: // 7i - C _ ❑ Office ❑ Mobile Email:
Contact/Rep. Name:I}/}I/,�P-7))hone: 1A..7 X41 Email: %✓I yam 1A � 'Q
Mechanical Contractor Authorized SignaturetA Date:
3. Project Description UU ��
Address: -OR- Lot #: -_ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Coni nercial 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. PAID
❑ Up to 1,500 Sq. Ft. = $130 ❑ 1,501-2,500 Sq. Ft. = $19S 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)) $ 1111 2 12016
New Multi -Family Residential: O 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 ❑ Furnace or A/C = $65 ❑ Water Heater= $65 %0R1quj54tea Inspection= $65
❑ Gas 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 ofpedury, I hereby certify that 1 have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter he given by me in hearings before the Planning and Zoning Commission or the Oty Council for the City of Rexburg
shall he truthful and correct. I 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 Farallon approval Issued under the provisions of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permitvoid Ifworkstops for 180 days.
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Applicant's Name (print): _u)"e yY' L N Signature: Date:
Inspections must he called in before BAM on the day the inspeai is requested. Inspection requests called in after BAM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March,2016
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