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Home My WebLink AboutAPPLICATION - 17-00502 - 1085 Greenside Loop - Water & Sewer & Concrete0 CITY OF OQ µEXBUgC Building Safety Department � ra REXBURG BUILDING PERMIT FORM 102 City of Rexburg C urawa2f2ott 35 North 1St East Amerimd Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Single Family Residence Remodel For Office Use tj R a Permit Number: Zoning: Zoning: Application Fee Paid:lfi $108- 1. Property Owner Name: 6X -Mm Address: 1085 PRee.vSrAd Loop City:/%oxbcAra State: Zip Code: _99 5650 Phone: 390-q-1?8- Email:. Jot Anhfkds4.ni.f.[°oin 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? MYes (Skip to section 4 of this application and complete the Homeowner's Exemption page as well) ❑ No, I am working with the homeowner 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: 3. General Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: A copy ofyourstate registration/license is required to be on file. If this is the first time you 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. 4. Project Description Address: 1085 aggeo-a'24 Xo)e Project Description: --- • - • Estimated Total Cost: $ • Check All Included in Scope of Work: ❑ Mechanical Work Cost: $ ❑ Electrical Work Cost: $ ❑ Plumbing Work Cost: Note: Any contractors involved will need to fill out their respective application. • Fireplace(s) Being Installed? ❑ Yes ❑ No Building Permit fees for remodels are charged based on cost The application fee applies toward the fee total. For details on how fees are calculated, contact the Building Department There will also be a plan review fee totaling 10% ofthe building permitfee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, Ihereby cerd"at l have read this application and state thatthe information herein is correct and I swear that any information which may hereafter be given by me In hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and coned. 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. Permit void Hart started within 180 days. Permitvuid If work stops for 180 days. Applicant's Name (print): QV 91 249Mdtfo.✓ 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 be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 VV µtxana CITY O F Building Safety Department oe ca � a — Ow City rt Rexburg BUILDING PERMIT FORM F4-3-011 ups.maz/zot> 430 35 North 15t East Americas Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Miscellaneous Plumbing Work For Office Use Permit Number: (� oaytl JQPlumbing Fees Paid 1. Property Owner Name: ,Qoua= Rjt 9 rlbdi S SP f� /� Address: IOY5 OgeeAl4r�,0 Z-ooP City: Ree hyyA State: ci.F• Zip Code: 3V,9�O Phone: CPO I?— -A90—ci'/92- Email: n nfids (A qMA;/ ram 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? M Yes (Skip to section 4 of this application and complete the Homeowners Exemption page as well) ❑ No, I am working with the homeowner 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing Contractor Authorized Signature: Date: - A copy ofyour state registration/license is required to be on file. If this is the first time you 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: -OR- Lot #: _ Block #: _ Subdivision: What type of Property: ❑ Residential ❑ Commercial Cost of job: $ Description of work: 4. Fees: Check all that apply: L' Gas Line = $65 7- Hydronic Heating = $65 + ($10 x # of * Water Heater = $65 manifolds/zones) = $ ® Sewer Line = $65 ❑ Miscellaneous/Requested inspection = $65 ® Water Line = $65 ❑ Sewer Turnaround (septic to city) = $65 71 Lawn Sprinklers/Backflow device = $65 Inspection fees can be bundled upon request. Re -inspect fees will be ❑ Gray Water Systems =$130 enforced if inspection requests exceedfee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperlury,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 me in 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): Q&V Q ^t9A,9 9SOW Signature: Date: inspections must be called in before 8 AM an 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 - (288) 372.2341 69