HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00413 - 636 Centennial Loop - SFRPage 3 0
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1E"MG BUILDING PERMIT FORM 120 City of Rexburg
35 North 111 East
Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Electrical
For Office Use
Permit Number: ❑ Electrical Fee Paid
1. Property Ownet'
Name: SDH Construction
Address: 1825 Midway Ave _ — City: Ammon _ State: �D —Zip Code: _83406
Phone: 20-aggAg6. _ Email: _bertha@copperereekhomesidaho.com
UnderIdaho Building Code, a homeowneris allowed to do work on their own home
Are you a homeowner doing work on your own home?
❑ Yes (Skip to 43 and complete the Homeowner's Exemption)
)Q No, I am working with the homeowner
2. Electhcal Contractor
Business: Gri ly Electric State License #: , RCE -9536 _ Exp,; 01/17118
Address: 142 N. 4400 East City: Rigby _ State: i --Zip Code: _83442
Phone: _2D8-520-= _ Email: _0r�lvelectr;r Q71ive-corn
Contact/Rep. Name: Quinton Bair —Phone: 208-520-5225 Email: grizzlyelectric@live.00m
Electrical Contractor Authorized Signature: _ Date:
A copy of your state registration/license is required to be on file. if this is the first timeyou have done work in the City of Rexburg, please provide
a photo cop), ofyour license, lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3, Project Description
Address: 636 Centennial Loop, Rexburg Idaho -OR- Lot #: Block #: _ Subdivision:
Description of work, New Construction ^� _
CkNe+v SFR COWSILI'uctiun: 3060 _sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq. ft = $130 + $65 for each additional 1,000 sq. ft. or
portion thereof.
o Up to 1,500 sq, ft. = 5130. Up to 2,500 sq, ft = $195. Up to 3,500 sq. ft =$260. Up to 4,500sq, ft = $325, etc. (i.e. a
home with 3,675sq. ft. will be charged $325)
❑ Spas/Pouts/Gerteratot�: ❑ Yes C* No
• Note that spas/pools/generators are not included in square footage costs and will be charged $65 per inspection.
APPLICANT`S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pena ty of perjury. I hereby certify that I have read thlsapplicatlon and state that the lnformationhereln
Is correct and I swear that any information which may hereafter be given by me In hearhigs before the Planning and Zoning Commissbn or the City Council for the City of Rexburg
shall be truthful and correct I agree to comply %ith all City regulations and State laws relating to the subject matter of this appllcation and hereby authorized representatives of the
Citytoenter upon the above-nientloned property for inspections purposes, NOTE: The building officialmayrevoke apernaitonapprovalIssued undertheprovisions ofthe2012
International Code incases of any false statementor misrepresentation of fact In the applicationor on the plans on which the permit or approval was based Permit void If not
started within 180dws, Permltvold Ifworkstops for 180days-
4
Applicant's Name (print); _ _ Signature: Date:
07/20/17
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