HomeMy WebLinkAboutAPPLICATION - 17-00611 - 464 Yale Ave - Fireplace and Gas lineCITY OF
REXBURG
America's Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1S1 East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: New Remodel Addition Basement Finish
Fees Paid: Yes No
Name:' AWN H 011 U P'k
Address: H (p Y IY UL W V C City: ILQ,k 6U aI State: 0 Zip Code: 0 31iqo
Phone & Type: -101 - y I I I 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)
No: I am a contractor working for the homeowner No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Mechanical Contractor y� C
Name: �U`jP (000J2 — UJ5UI)k rIVUJ f` rNC- Registration #: II VC -JL- s Exp.:
Address: Z7()0 ili , 'AJQQf?FI�Urf City: tf)rlNO raw> State: Zl') Zip Code: K'NO
Phone&Type: (ZGE)i23-4`( Y Office Mobile Email: WHO ��F,15(lilP.tliUUliNc (G�✓i
Contact/Rep. Name: Lj0f2GlI1\i Phone: Email:
Mechanical Contractor Authorized Signature: — . Date: 101S
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: Single-family Residence Multi -family Residence Commercial
Check one: New Construction* Remodel Addition Basement Finish
Description of work: til o
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-Familv 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)) $
li l: Fu;::i1y 1Zesidentiai: Duplex = $260 Three or more units = $((130 x # of buildings)+(65 x # of units))$_
other residence and Decached Shops: = $ 65 + 10 x # of HVAC fixtures $
Miscellaneous: Gas Pressure = $65 Furnace or A/C =$65 Water Heater = $65 Requested Inspection = $65
Gas Line = $6 Irep�uL
oiFuel Burning Unit $$65 Technical Service = $65/hour
Plan Check =10% of Contrac
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the 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 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 revolve 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 if not
started within 180 days. Permit void if work stops for 180 days.
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