HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 17-00399 - 398 Pioneer Rd - Rocky Ridge Apartments Bldg 14 - 4 PlexCITY OF
REXBURG
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BUILDING APPLICATION
Fire Sprinkler
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: (4-663g9 Permitapproved: ❑Yes ❑No
Fees Paid: kYes ❑ No
1. Applicant
Business Name: Phoenix Fire Protection
Office Address: 4130 Airport Rd. City: Nampa State: ID Zip Code: 83687
Office Phone: 208.468-9115 Contact Person: Teri Cruickshank Cell Phone:
Contractors Authorized Signature: Trent Bice Date: 10.0317
License/Registration# FPSC-108 Expiration: 12/2017
2. Location of Work to be Done
Street Address: 275 Pioneer Rd City; Rexburg State; ID Zip Code: 83440
Business Name: Rocky Ridge Apt Bldg#14
Contact/Rep. Name: Teri Cruickshank Phone: 208-468-9115 ❑Office ❑Cell Phone
Email: teri@phoenixfp.com
Dates for work to be done: From to
3. New Construction Contracted Amount: $ 144,398.00 Calculated Fee (See Below): $ 1382.00
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
4. Miscellaneous
[Z]New Construction = $1 per sprinkler head ($2,000 max) # of heads:
[]Existing Inspection Base = $65
17 Plan Review =10% of Contracted Amount
❑Re -Inspection = $65
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, t hereby certify that l have read this application and state that the information herein
correct and 1 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
betruthfulandcorrect. I agree to complywith all City regulation and State laws relatingw the subject matter ofthis application and herebyauthorized representatives ofthe City
to enter upon the above-mentioned property for inspections purposes. NOTE: The buildingoffidal may revoke a permiton approval issued underthe provision ofthe 2012
International Code in cases ofany fake statement or misrepresentation of fact in the application or on the plans on which the Permit orappmval was based Permitvoidifnot
started within 180 days. Permit void ifworkstops for 180 days.
Teri _
Applicant's Name (print): Teri Cruickshank Signature: Cruickshank Date: 10.03.17
Inspections mustbe abed in before 8 AM on the day the inspection is requested inspection requests mlled inafter8 AM will be scheduled for the nextbusinsss day.
Inspection Hodine - (208) 372.2344 www.rexburg.org PermitTechnician-(208)3722341 Revised March, 2016