HomeMy WebLinkAboutAPPLICATION - 17-00436 - 750 S 2nd E - Rexburg Temple - Generator Building CircuitsCITY OF
R,Y BUILDING PERMIT FORM 420
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America's Family Cormnonity
BUILDING APPLICATION
Miscellaneous Electrical Work
Building Safety Department
City of Rexburg
35 North 1s1 East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Electrical Fees Paid
1. Prope Owner
Name: ,d�cbU,'Templv
Address: City: State: Zip Code:
Phone: 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 section 4 of this application and complete the Homeowner's Exemption page as well)
❑ No, 1 am working with the homeowner
7. Electrical Contractor
Under Idaho Building Code, a1 registered contractor must do the work for a Commercial Building.
Business: FJV FJp GIee,+r e, State License#: 017go�/ Exp.: / 1
1-7
Address: 1s3-Q.S-),A � O S City: Qe7(bvTState: 7�D Zip Code: tESZ__
Phone: '20—Email: e,I4t toga alee+rte_ 4C
Contact/Rep. Name: grid Phone: Email;
Electrical Contractor Authorized Signature: Date:?/ .
A copy ofyour state registration/license is required be on %Ile. l his is the firs ime you have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit' Technician by calling (288) 372-2341.
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
What type of pProperty: ❑ Residential'commercial
Cost of job: $ 'i -S /�
Description of work: 1
4.Fees: Check all that apply:
❑ Central Heating/Cooling Systems = $65 ❑ Pumps - Water, Irrigation, Sewage (per motor)
❑ Temporary Electrical Services ONLY = $65 (200 amp o $65 - up to 25HP
or less. One location, for less than 1 year.) o $95 - 26- 200HP
0 New Circuits = $(65 + ($10 It # of branch circuits)) o $130 - ovel- 200HP
$ 75. 61 ❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Miscellaneous/Requested Inspection = $6S ❑ Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per Inspection fees can be bundled upon request. Re -inspect fees will be
tower or drive motor = $ enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATI ON: Under penalty ofperjury, l hereby certify that l have read this application and state mat the Information herein
is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commissl on or the City Council for the City of Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 per mit 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 veld if not
started within 180 days. Permit void ifwork stops for 180 days. 1
Applicant's Name (print): h0 Signature: Date: Z&
Inspections must be called in before 8 AM on the day the inspection is requested. Inspe Ion requests Calle in.fts,BAM4ill be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexbui g.org Permit Technician - (208) 372.2341