HomeMy WebLinkAboutAPPLICATION - 17-00420 - 851 Heritage Rd - New SFR MechanicalP�ati4
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BUILDING PERMIT FORM 11
updated 212017
Building Safety Department
City of Rexburg
35 North 111 East
"111" 0.3 Amaim sFamiyCommunity Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
For Office Use
Permit Dumber: ❑ Mechanical Fee Paid
1. Property Owner
Name: X9.414 -T-7 PPf=-T1' 5
Address: 15 5J iIE�-r+X4-66 V- T> City: F e-i--� (_�IState- T� Zip Code: 03 S' o
Phone: Z 0! i Zc71 - 2.1 t3!5 Email: 'r P4 e -1-r- -- .5
Under Idaho Building Code, a homeowner is allowed to do work on their awn home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to section 3 of this application and complete the Homeowner's Exemption page as well)
)( No, i am working with the homeowner
2. Mechanical Contractor
Business:-3-0Ile? SatJ 40_ A-r� - 6 State License JL. -C-- r3 Z-7 Exp.:
Address: to qb Gi C ci e_ City: U, ri�i State: ;t�b Zip Code: 14 y o
Phone: -,7 V 3 90 - c]S"2s Email: _ olip7GL),.
Contact/Rep. Name:}no 11 ^-' .air hn 5u^�a Phone: ' he., rn�) wtis+J-'cci
Mechanical Contractor Authorized Signature: Hate:, '7. 7-1 ` /`7
A copy ofyour state registration/license is required to be on file. Ifthis is e first time you have done work in the City of Rexburg please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 051 µe1-1_r"(7e- P P -OR- Lot #: _ Block #: — Subdivision:
Description of work: 0 JAC. I ^j v-�o.,e_
❑ SFR Construction: Y-02 sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq, ft = $230 + $65 for each odditfonal 1,000 sq. ft or
portion thereof.
o Up to I,500 sq. f t. = $130. Up to 2,500 sq. ft = $195. Up to 3, 500 sq. ft. = $260. Up to 4,500 sq. ft- = $325, etc. (i.e. a
home with 3,675 sq, ft. will be charged $325)
❑ Number of Fireplaces: !
• Note that fireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating: —
• Note that hydronk heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
montfolds/zones)
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that the information
herein is correct and I swear that any information which may hereafter be ,given by me in hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthful and correct. I agree to comply withal] 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 Lssued 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 if work stops for 180 days.
Applicant's Name {print]: &T)"— Z24$150-1 Signatur Date: 7
Inspections must be called In before 8 AM on the day the inspection is requested. Inspection requests ca d in after 8 AM will be scheduled for the next business day.
Inspection Hotline- (248) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341