HomeMy WebLinkAboutAPPLICATION - 17-00428 - 265 Polo Dr - A/C AdditionJul 26 17 11:02a
Alpine Heating Air
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REXBURG
,4nerMri Ftmily Cornmuniry
BUILDING APPLICATION
. Mechanical
2085520594 p.2
Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
For Office 'Use.
Permit Number: Permit Type:! ❑ New O Remodel, ❑ Additiont 0 BaserlientFinish
Fees P' idi O Yes `❑ No .
1. Pro e�r��J,�y0wner d ,
Namep/CtnlLA.
Address: 11 LIQ 5 City: State: l Zip Code: 8 Y S C J
Phone&Type:e2Lq3` SSSO ❑ OfficeMobile 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 ereteaemrs/sub-contmcmrs involved will needtn submit their own s.gned applltations,
2. Meeh�asl7n'cratl Contract( 1A '
Name: 7 44Ai-y /T Re istr tion
Address: � City:2 .0 State: MD 2 p Code: ��„LD �
Phone&Type: 52-3-SSSLZ I)(r0ffice❑Mobile Email:
Contact/Rep. Name: �Phon/e�: �j Email:
Mechanical ContractorAuthoriiedSignature: ` a.� JC9�— (J[1_%�n`--- Date:
3. Project Descriptiov-,
Address: A (Q S' ��j0 �alC OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence 0 Multi -family Residence ❑ Commercial
Check one: ❑NewC nstruction* 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 ❑ $10,001-$1D0,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single-Famlly 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 # cf 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 oil any other residence an De ched Shops: _ (65 + (10 x # of EVAC fixtures))
Miscellaneous: ❑ Gas Pressure = $65 Furnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection= $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit = $65 ❑ 1'echnical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I herehycertify that) have read this application and state that he information herein
Is correct and I swear thatany Infocleatlon which may hereaRerbe given by me In hearings before the Planningand 20111119 Commission orthe City Council for the City of Rexburg
shall be truthful and onnem I agree to comply with all City regulations and State laws relati ng to the subject matter of this application and hereby authorized representatives of the.
City to enter upon the above-mentioned property for Inspections purposes. NOPE; The building official may revoke a permiton approval issued under the pravlsiom of the 2012
Interrational Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit orapproval was based. Permitvoid Ifnot
started within 190 days.
Applicants Name
inspections must be called in before 8 A?t on the day the h,spedion Is requested. Inspection requests called in aficr 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 wwwrexburgorg . Perm it Technician -f20B)372.2341 Revised March, 2016