HomeMy WebLinkAboutAPPLICATION MECHANICAL - 17-00413 - 636 Centennial Loop - SFRC I TY O F
1�_EXBT TR BUILDING PERMIT FORM 110
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Building Safety Department
City of Rexburg
35 North 1`t East
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Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
For Office Use
PermitNumber: ❑ Mechanical Fee Paid
1. Property Ota'nei
Name: cnu;�
Address: 1825 Midway _ City: Ammon -- State: I_Zip Code: _83 .6
Phone: 208-346-M6 Email:_ bertha_Ca)wooerereekhomesidaho.00m
Underldaho Building Code, a homeowneris allowed to do workon theirown home
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
CkNo, I am working with the homeowner
2. Nlechanical Contractor
Business: amendable Heating & Air Conditioning_ State License #:�' i ` ` Exp.:
Address: 3851 E 22 N f City: Rigby State: JQ__ Zip Code: $3442
Phone: 208-821-7520 _ Email:_ depndab1ehvac06( rahoo.00m
Contact/Rep. Name: Dennis Hayden —Phone: 20-821-752Q__ Email: D2pendablehvac06(a hoo.com
Mechanical 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 copy ofyour license, Ifyou are unsure ifyour license is on file please check with the Permit Technician by calling (208) 372.2341.
3. Project Description
Address:636 Centennial -OR- Lot #: Block #: Subdivision:
Description of work: _New Construction
gSFRConstruction: _. 3060 sq. ft
• Foes for new construction are charged by square footage: Up to 1500 sq. ft. = $130 + $65 for each additional 1,000 sq. ft or
portion thereof.
a Up to 1,500 sq. ft. =$130. Up to 2,500 sq. ft =$195. Up to 3,500 sq. ft =$260. Up to 4,500 sq. ft = $325, etc (he. a
home with 3,675 sq. ft will be charged $325)
❑ NUIllber of Fireplaces: 0 _
• Note thatfireplaces are not included in square footage costs and will be charged $65 per inspection
❑ Ilydr•onic lleating: No
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information
herein is correct and I gear that any information which may hereafter be Riven by mein hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthful 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 purpose& NOTE: The building official may revoke apermit onapproval 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 void if not started within 180 days. Permitvoldffwnrkstopsfor180days.
Applicant's Name (print): J6AJ� `Signature- / Date: O
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