HomeMy WebLinkAboutAPPLICATION - 17-00515 - 145 Madison Ave - Furnace & A/C InstalC I TY OF
REXBURG
C14
America4 Family Community
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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. PropeOwner
Name:
Address: 1t City: L State:,M Zip Code-- yU2u
Phone & Type: ❑ OfficeC?Qlobile Email: l
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)
No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
Any cmntracmrs/suammractors involved will need m submit their own signed applications.
2. Mechanical Contractor
Name: Registration #: Exp.:
Address: JJQ bQX Jy4q.City: State: Zip Code:
Phone &Type: tQffice ❑Mobile �jy l3�3
Contact/Rep. Name: wv Phone: �/)-1
,� �-9qS,,/-,qOi mail:
Mechanical Contractor Authorized Signature: ami A /) 1J I LI U.)—Date: W)1-7
3. Project Des rip ' n
Address:_Subdivision:
Check one: Ingle -family Residence ❑ Multi -family Residence ❑Commercial
Check one: New Construction* ❑Remodel Addition ❑Basement Finish
Descri tion of work: 7
New Commercial Work: Contra d 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 + (10x # 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, l 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 cornea Iagree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe
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 fake 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 ifwoorrk�stops for 1880 days.
Applicants Name (print): Signature: Date:L�IdqI n
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