HomeMy WebLinkAboutAPPLICATION - 17-00617 - 1257 Morningside Dr - MechanicalCITY OF
REX 7LTRG
CUA
Americas Family Community
Building Safety Department
City of Rexburg
Submit By Email 3S North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
For Office Use
Permit Number: Permit Type: ❑ New ,IKRemodel []Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Cw.ner /7
Name: S /�ll"td i J_eog ipp�//
Address: J2 S /�ld✓ni1yJI /)� City: /�PkFxC State: 'Z/% Zip Code: If 3YY0
Phone &Type: ❑ 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)
�fNo: 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. Mechani 1 Contract/Name: ] / -_Z11
Registr ti �{VL'-60—(4�1S Exp.:_
Address: 0 Z ZZI ww4i rt— City: Nal7ar2l/ State:.7t&
D Zip Code: f 0-5--
Phone&Type:C2DSF%5Xr5=-S-`&8 1 is ffice❑Mobile Email: JW" ;*f (�/+`gdtthcuGifactebo/�d�/
Contact/Rep. Name: _ /L-e,*'ry Phone: Email:
Mechanical Contractor Authorized Signaturo��6 Date: 0 S�
3. Project Descr�iptiu
Address: /Z)7i
/7df^,�GJi k -OR- Lot #: _ Block #: _ Subdivision:
Check one: Dingle -family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* Re2odel ❑ Addition ❑ Basement Finish
Description of work:. �.4c �f ?0 /}G fi ✓ r /✓t!�
M'
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 #rFurnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection= $65
YfGas 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 ofperjury, I hereby certify that l have read this application and state that the information herein
is correct and 1 swear that any information which mayhereafter he given byme in hearings before the Planning and Zoning Commission or the City Council forthe 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 mayrevoke a permit on approval issued under the provisions of the 2012
international Code in cases of any false statement or misrepresentaEon off act in the application or on the plans on which the permit or approval was based Permitvoidifnot
started within 180 days. Permitvoid if/tw�orkstops for 180 days.
Applicant's Name (print): 15'ty-elk Signature: _ Date:
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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