HomeMy WebLinkAboutAPPLICATION - 17-00509 - 8995 S 400 W - Ductless Mini Split4ug 18 17 10:33a Alpine Heating Air
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BUILDING APPLICATION
Mechanical
2085520594 p.1
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}} Owner
Name: r°hra t -/-�
Address- Q - S City: State: -I - —Zip Code:
Phone &Type:00❑O(CtcebTMobile 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)
hl No: I ama contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any conlrnemrs/sub-eon's tors Involved will need to submit their own signed applications.
21 Mocha ice (:ontractor —p \
Name: ��t�LVk.n �94tJr Registration #f7 V " Exp.:
Address ��
City: State: ��_ Zip Code: � B�
Phone & Type:9151- .SS'- Office ❑ Moh a Email:
Contact/Rep. Name: o.4D_, l —Phone: S2,',-5-59tL Email:
MechanicalContractor Authorized Signature5_:� � �D.CJV�— Date:Aw
3. Project D .scription
Address: 999 g 4460.0 OR- Lot #: _ Black #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ NO Construction" ❑ Remodel ❑ 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 ❑ $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
❑ Diver $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 O 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 orA/C = $65 ❑ Water Heater= $65 ❑ Requested inspection= $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit = $65 ❑ Technical Service = S65/hour
0 Plan Check =10% of Contracted Amount
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underponalty ofperlury, I hereby cent ly that I have read this application and state that the information herein
is correct and I swear that any Information which may hereafter he given by me In hearings before the Planning and Zoning Commission or the City Council for the Cl tyef Rexburg
shall he truthful and correM 1 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 provisinns of the 2012
International Code in cases clans' ralso statement or misrepresentation offset In the application or on the plans on which the permit or approvalwas based. Petmitwidifnot
started within IOD days. Permit void fwork staps far 180 days.
ApplicanCs Name Signature: � a ._- Q•_ �tLati a m nater
Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day.
Inspcctionllatl1oc-(208)372.2344 vr.vwrexbutg.org Permit Technician -(200)372.2341 Revised March, 2016