HomeMy WebLinkAboutAPPLICATION - 17-00621 - 235 S 4th W - Meter PanelsC-BuildingSafetDepartment
T.TY O F `'y h
o City of Rexburg
PXMURG 35 North 15t East
N,
'Arncric6 Famih, Community
^�Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
O Yes ❑ No =`
Name: / t
Address: <3� S• �`/ i'� 2 City: X of State: Zip Code:
Phone & Type: x051.1080- q71 9�_ ❑ Office 0,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 theirown signed applications.
2. Electrical Contractor --�-
Name:_ Pi rtj- e&,A Registration #: 0 Exp.:
Address: M10 0 /44//1 j00VK City: �_ kQ f Q C[s State: .-�;�_N Zip Code: 539 0
Phone & Type: JD 3--6 -e , — 7 7 7 7 13 Office ❑ Mobile Email:
Contact/Rep..Name: 6A - I 'D `f- Phon
Electrical CoritractorAuthoKJL d Signator Dater _01 b
3. Project D,a PT, r� , t
Address: �� a -OR- Lot #: _Block #: _Subdivision:
Check one: 19Single-familyResidence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* []Remodel ❑ Addition ❑ Basement Finish
Description of work: maer ,kIAlt l7 PaA4�5
New Commercial Work Contracted amount: $ Calculated Fee($e60,
elo$
❑ Upto $10,000 (total cost of system x 02) + $60 ❑ $10,001 $100;000 ,((total cost of system 10;000) x 011 + $260
Over $10!),.001= ((total cost ofsystem-100,000)x .005);+ $1,16o
- ._ _.
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 Muiti Family Residential ❑Duplex $260 O Three' or more units;= $[(130 x # of buildings)+(65;k # of units))$
New work on any other residence and Detached Shops: = $(65 + (10 x # of branch circuits)) $ f, �5,yo
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty of perjury, l hereby certify that 1 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 forthe Cityof 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 offact in the application or on the plans on which the permit or approval was based. Permit void ifnot
started within 180 days. Permit void ifworkstops for 180 days.
Applicant's Name (print): Signature: Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8AM will be scheduled for the next business day.
Inspection Hotline — (208) 372.2344 www.rexburg.org Permit Technician — (208) 372.2341 Revised March, 2016