HomeMy WebLinkAboutAPPLICATION - 17-00491 - 271 W 1st N - Furnace & A/C ReplaceCITY OF
REX ,URG
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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. Property Ow erg
:
Name:PA I l
I)2n 2/'C
Address: 11 �1h7 City: State: VZip Code:
Phone & Type: 715- MY Ill 17 OOfficeAMobile 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)
Io: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
E: Any contractors/sub-contractors involved will need on submit their own signed applications.
2. Mech nical Contractor�s�/�
Name: Registration #: TiU��' l T AYM(n Exp.:
Address: City: Stater Zip Code:
Phone & Type: J Office ❑ Mobile Il: I
Contact/Rep. Name: 'ice Phone:( )A-745-7q5
\Email: G I 7
Mechanical Contractor Authorized Signature: �%1 l t1 l W Date: S h5h L
3. Project Description
Address: ' 0 I w I s`� A) OR- Lot #: _ Block #: _ Subdivision:
Check one: PSingle-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* )dRemodel ❑ Addition ❑ Basement Finish
Description of work:l
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. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $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
APPLICANTS 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 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 Cityof Rexburg
shall be truthful and corre= I agree to comply with all City regulations and state laws relating to the subject matter of this application and hereby authorized represenmdves 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 an which the permit or approval was based. Permit void if not
started within 180 days. Permit void iff�wo��rk stops for 180 days.
Applicant's Name (print): <�f 7.Y�\ w n= Ili Signature:Date: L / %
Inspections must be called in before SAM 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