HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 17-00400 - 398 Pioneer Rd - Rocky Ridge Apartments Bldg 15 - 4 PlexCITY o F Building Safety Department
REKBURG Submit ey Email City of Rexburg
Oft, 35 North 1n East
America's Family Community Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number: 1-4-601+&D Permit approved: ❑ Yes ❑ No
Fees Paid: lK Yes []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:
Contractor's Authorized Signature: Trent Bice Date; 10.03.17
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#15
Contact/Rep. Name: Teri Cruickshank Phone: 206-468-9115 f+l 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 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
El Over $100,001= ((total cost of system -100,000) x.005) + $1,160
4. Miscellaneous
I] New Construction = $1 per sprinkler head ($2,000 max) # of heads:
[]Existing Inspection Base = $65
El Plan Review =10% of Contracted Amount
❑ Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury, I hereby certUI that l have read this application and slue that the information herein
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
betmthfulandcorrect. (agree to comply with an City regulations and State [am relating[o the Subject maner of this application and hembyauthorived representatives of the City
to enter upon the above-mentioned property for inspections purposes. NOTE: The buiidingofficial may revoke a permiton approval issued under the provisions of the 2012
International Code in cases ofany false statement or misrepresentadon offact in the application oron the plans on which the permit orapproval was based. Permit void ifnot
started within 180 days. Permit void ifworkstops for 180 days.
Teri
Applicant's Name (print): Teri Cruickshank Signature: Cruickshank ,;m-;S-�, Date: 10.03.17
Inspections must be called in before 8 AM on the day the inspection is requested. inspection requests called in after8 AM wi0 be scheduled for the next business day.
Inspection Hoth. - (208) 372.2344 www.rexburg.org PermitTechnician-
(208) 372.2341 Revised March, 2016