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HomeMy WebLinkAboutAPPLICATION & RECEIPT - 17-00483 - 263 Harvard Ave - RemodelCITY OF REXBURG fbr AmerltaY Family Community BUILDING PERMIT FORM 111 ",JAW1012016 BUILDING APPLICATION Remodel SFR Mechanical Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Mechanical Fee Paid 1. Property Owner Name: �/_ Q11V mcV �/ Address: r �: !�/ State: ' Zip Code: % e�l Phone: - Email: ZD(o yS� 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) U-N—o �Iam working with the homeowner 2. Mechanical Contractorff / / D 2 %59 Ex Business: C' birl State is see#: p.: Address: City: :� �Jd State: Zip Code Phone: o,- Email: I e �A aap a.' . coy1� Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: Date:_ A copy ofyour state registration/license is r Ire to be on file. If this is the first time you have done work in the City of Rexburg, plea a provide a photo copy ofyour license. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Des cri n�� Address: Description of work: �.q S �� 1-" ❑ Remodel Cost: $ • Fees for remodels are charge by cost.- 0 ost:o First $10,000 = 2% + $60. From $10,000 to $100,000 = 196 + $260. Above $100,000 =.59b +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 195 of the remaining $5,000 = $260 + $50 = $310 total fee APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein is correct and I swear that any information which may hereafter be given 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 purposes. NOTE: The building official may revoke a permit on approval issued underthe 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. Permit void if work stops for 180 days. Applicant's Name (print): e/ r Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -(208) 372.2341 CITY OF REXBURG n., America's Family Communally BUILDING PERMIT FORM 131 uod.red 10/2016 BUILDING APPLICATION Remodel SFR Plumbing Building Safety Department City of Rexburg 35 North 15L East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Plumbing Fee Paid 1. Property Pwper Name V ✓ �y L/ Address: City:&A111a,Stater Zip Code: d 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 #3 and complete the Homeowner's Exemption) KHfo, I am working with the homeowner 2. Plumbing Con act �p q Business: t h GG -L_ S e u se #: U� / D E. 00 Address: City: 6%/f/ , State: ZipCocje: Phone: Email: Contact/Rep. Name: l Phone: Email: Plumbing Contractor Authorized Signature• Date: - A copy ofyour state registration/license is required to be on file. If this is the first timey-ad have done work in the City ofRexbur , ease provide a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Des cri io Address: Description of work: D O qS ❑ Remodel Cost: $ • Fees for remodels are charge by cost: - o First$10,000 = 2% + $60. From $10,000 to$100,000=196+$260. Above $100,000=.595+$1,160. i.e. Work costing $15,000 will be charged $60 for the first $10,000 and 1 % of the remaining $5,000 = $60 + $50 = $110 total fgg APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that he information herein is correct and I swear that any information which may hereafter be given 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 purposes. NOTE: The building official may revoke a permit 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. Permitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: #Py Inspections must be called in before 8 AM on the day the Inspection Is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline- (208) 372.2344 www.rexburg.oig Permit Technician - (208) 372.2341 00I rr or REXB IIt - aavna,7 h,n+ih•Conroivrrn XBP Confirmation Number: 32952108 City of Rexburg 35 N 1 at East I PO Box 280 Rexburg, ID 83440 208-359.3020 ub@rexburg.org Transaction detail for payment to City of Rexburg. Date: 0810912017.4:32:02 Ph Transaction Number: 72212763PT Visa — XXXX-XXXX-XXXX-0297 Status: Successful Account # Item 'Quantity Item Amount Mechanical Permit 1 $65.00 Plumbing Permit 1 - $72.00 Notes: WAYNE HENRY TOTAL: $137.00 Billing Information - Transaction taken by: amandaw STEVE ORR .83440