HomeMy WebLinkAboutAPPLICATION - 16-00519 - 727 N 2nd E - Great Scott's Water LineO�pP %aUgC
CITY OF
n
REXBURG
tti America's Famriy Community
Submit By Email
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: ❑New []Remodel ❑Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner .L S" -0T' .-,fs.
Name: feat]— J � .'I
Address: N ;I � City: Q}(j U State: `�' Zip Code:
Phone&Type: O'Office❑Mobile Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Wou a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
: 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. Plumbi ntr for
Name: S 5)CCc(VGthld5 L LG isq ation #: Exp.:
Address: 0 f �.City: 5 . State. Zip Cod
Phone & Type: u�, _ /b E/ office ❑ Mobile E il:
Contact/Rep. Name: ( Phone: 3� 4__ 719 Email f� 5b�-f
----Ib
PlumbingSi Contractor Authorized nature? Date:
3. Project Description W ter Meter Quantity: Water Meter Size: 02 rr
Address: a- f✓ -OR- Lot #: _Block #: _Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence $<ommercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
16p 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= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $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)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Under penalty ofperjury,Ihereby 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shallbetruthful and correct. I agree to comply withal] City regulations and state laws relating to thesu' t rofthis application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: Thebuilding offici mayre apermiton apr 'sued under the provisions ofthe 2012
International Code in rases ofany false statement or misrepresentation offset in the application oro the plans w cht mitorapprova as based. Pennitvoidifnot
started within 180 days. Permit void ifw 99tops��orq s
Applicant's Name (print): Pb d CC II Signature:
Inspections most be called in before a 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