HomeMy WebLinkAboutAPPLICATION PLUMBING 2 - 16-00221 - 1121 S 5th W - SFRe�"°xn°8q CITY OF Building Safety Department
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City of Rexburg
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rm, 35 North 1st East
Ameriw' Family communis' Rexburg, Idaho 83440
BUILDING APPLICATION
Plumbing
For Office Use
Permit Number: Permit Type: ❑ New p Remodel' ❑ Addition ❑ Basement Finish
Fees Paid:' ❑ Yes ❑ NO
1. Property Owner
Name: Erikson
Address: 11215 5th W City: Rexburg State: ID Zip Code: 83440
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)
0 No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Plumbing Contractor
Name: Chad Ban construction Registration M RCE41524 Exp,: 01.24.17
Address: 445 W Haven Loop City; Rexburg State: ID Zip Code: 83440
Phone &Type: 208-390.7060 ❑ Office 21 Mobile Email: customhackhoe@msn.com
Contact/Rep. Name: Chad Ball Phone: 26039D7060 Email: custombackhoe@numcom
Plumbing Contractor Authorized Si gnaturec Chad Ban Dam: 9-16.16
3. Project Description Water Meter Quantity: Water Meter Size:
Address: 1121 s stn w, Rexburg, ID 83440 -OR- Lot #: _ Block #: _ Subdivision:
Check one: O Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: G3New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work: New sewer linefnstai
>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
O 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 # ofadditional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65"x # of units))$_
17 Gray Water Systems= $130 13 Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System= $65 oc $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)
0 Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Underpenahy ofperjuty, I hereby certifythatl have readtbis applicati"nand state that the informationherein
Is mrrectand I swearthmanyinformationwhich may heraa herbegivenbyme in hearings befrrethe Planning and ZordngCommission ortheotyCouncil forthe Cityof Rexburg
shallbe truthfuland correm lagree to complywitha8 Cityregulations and State laws relatingto the subjectmatterof this application andhereby authorized representatives ofthe
Cityto eraerupon the abom&rnention sd propertyfarinspections purposes. NOTE: The building official mayrevokea permiton approval issued underthe provisions oftbe 2012
International Code Incases ofany fake statement ormisrepresemation offacalaths, application or on the plans on whichthe permitorappmval was based. Permit midifnot
starred within 180 days. Permitvaid Ifworkstops for 180 days.
Applicants Name (print): Chad Ball Signature: Chad Ball Dam: 9-16-16
Inspections musthe abed inbefore 8 AM onthe day the inspection is requested. Inspection requests called inafter8 AM will bescheduled forthe nextbusiness day.
Inspection Hotline -(208)372.2344 www.rexburgorg Permit Technician -(208)372.2341 Revised March, 2016