HomeMy WebLinkAboutAPPLICATION ELECTRICAL 2 - 16-00683-684 - Sugar Mill ApartmentsCITY O F
REXBURG
America's Family Community
Building Safety Department
Submit By ECity of Rexburg
mail
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: Permit Type: l6 New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Ow ler
Name: Zip Code: �7
Address: City: �eiY'G,.r State: �'_ p11
_
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 ❑ 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. Electric l Co tractor
Name: Re istration #: Exp.:
Address: - city: State: - Zip Codet�
Phone &Type:❑ Office ❑ Mobile Email: reg,--L� IJGC is-��1�
Contact/Rep. Name: Phone: Email:
Electrical Contractor Authorized Signature: — — Date:
3. Project Disc} j t!i
Address: V Lt/ - �r ^^!! -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence - 214ulti-family Residence ❑ Commercial
Check one: CiNew Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
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 branch circuits)) $
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections)=$ 10 (needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 []Requested Inspection = $65
❑ Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 200HP
❑ Irrigation Machine = $65 for center pivot+ $10 per tower of drive motor $ []Technical Service = $65/hour
❑ Temporary Amusement = $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun
14Temporary Construction Services ONLY = $65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council forthe City of Rexburg
shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter of this 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 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 or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void ifpqk s for 180 days.
Applicant's Name (print): VO, ignature: /_9T,,, J Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016
an