HomeMy WebLinkAboutAPPLICATION - 17-00490 - 261 E Main St - A/C ReplacementC I TY OF
REXBURG
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BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Proper Ownyc�
Name: e. fid jfj eAox.
Address: _2bl a mril City: State: _LU Zip Code:
Phone & Type:RZ��i- J%5 ❑ Office ❑ 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? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/subcontractors involved will need to submit their awn signed applications.
2. Mechaical Contr ctor
Name: Re istratio a #: r Exp.: I
Address: City: State: Ip Code:
Phone &Type: 3U�i'7N� Qy Office ❑ Mobil mail: I I .030
Contact/Rep. Name: <�ar) Phone: 6?(',R'•7y L2YLIEmail' Ip %
Mechanical Contractor Authorized Signature: XA" YA Iki Date:
3. Project D cription
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ingle-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New onstruction* ,Remodel ❑ Addition ❑ Basement Finish
Description of work: KI/Wo axrr�
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
❑ Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. FL = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. FL = $325
❑ Over 4,500 Sq. Ft. = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: _ (65 + (10 x # of HVAC fixtures)) $
Miscellaneous: ❑ Gas Pressure= $65 Furnace or A/C = $65 ❑ Water Heater= $65 ❑ Requested Inspection= $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, Ihereby certify that l have read this application and state that the information herein
is correct and 1 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 in 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 ofany false statement or misrepresentation of fact in the application or on the plans on which the peOnit or approval was based. Permit void if not
started within 180 days. Permit void ifworkstops for 180 days. t e `
Applicants Name (print): ZNW $ n��,� Signature: t7.M Date: ?-Jkrob
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.org Permit Technician - (208) 372.2341 Revised March, 2016