HomeMy WebLinkAboutAPPLICATION - 17-00429 - 449 Rolling Hills Dr - A/C ChangeJul 26 17 11:02a Alpine Heating Air
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CITY OF
REXBURG
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BUILDING APPLICATION
Mechanical
2085520594 p.1
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Fdr Office Use
TeImitNumber: Permit Type: El New ;D Remodel 0 -Addition 0BasementFinish
Fees Paid: Oyes D No-':
1. F'1•op Owner
Name: Q
Address: City: -�jZ� State: l Zip Code:
Phone at Type: ' 00 0 Office 4 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? 0 Yes (Skip to #3 and Complete the Homeowner's Exemption page)
NNo:1 am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
E: Any cosstracto;s/sots-cuntractontuvolvedwlll need In submittheh own signed spplicat3nrs.
2. Mccha]]lical f,ontr-acItIor r
Name:;Li �fV'.aa...�.tQr �! eg1 Ur tion #: Vl_. ' -Zits Exp.:
Address: ?9 ! r -L City:- State: .Z Zip Code: D�-
Phone 8c Type: Z'— 5rl z- Office O Mobile Email:
Contact/Rep. Name: Phone: Email.
Mechanical Contractor Authorized Signature: CID�o Ak --� Date:
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: O Single-family Residence O Multi -family Residence 0 Commercial
Check one: 0New Cns uction* ❑Remodel ❑Addition 0BasementFinish
Description of work:
New Commercial Work: ontracted amount: $ 4 . Calculated Fee (See Below): $
O Up to $10,000 = (total cost of system x.02) + $60 D $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
O 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 O 1,501-2,500 Sq. Ft = $195 D 2,501.3,500 Sq. Ft. = $260 D 3,501-4,500 Sq. Ft = $325
0 Over 4,500 Sq. Ft.= $325+(65 x # ofadditional 1.000 Sq. Ft. (or portion thereof]) $
New Multi
-Family Residential: D Duplex = $260 O Three or more units= $((130 x # of buildings)+(65 )z # of units))$_
New work on any other rest ence and Detached Shops: _ (65 + (10 It # of HVAC fixtures)) $
Miscellaneous: O Gas Pressure= $65 urnace or A/C = $65 0 Water Heater= $65 0 Requested Inspection= $65
O Gas Line = $65 O Fireplace/Solid Fuel Burning Unit= $65 0 Technical Service= $65/hour
D Plan Cl =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I he reby certify that I have read this appllatio n and state that the Information herei n
Is correct and I swearthatany infonnade n which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council forthe Cltyof Rexburg
shall be truthhsl and correct I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions of the 2012
Internationa: Code in cases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit voldif not
started within 180 days. Permit void If we rk stopsfor180 days. p j l� �t
Applicant's Name (print).• 1� �X( �$DhSignatua JCR.- / re: lckl)ate:
Inspections must be called in before SAM on the daythe Inspection Is requested. Ins pectiun requests called in after 8 AM will be scheduled for the next business day.
inspection Hotline -(208)372.2344 mvvv.rexburg.urg Permit TechWeian-(208)372.2341 Revised Nlarch,2016