HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 17-00401 - 398 Pioneer Rd - Rocky Ridge Apartments Bldg 16 - 4 PlexCITY OF
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Amerima Family Community
BUILDING APPLICATION
Fire Sprinkler
Building Safety Department
City of Rexburg
35 North 1n East
Rexburg, Idaho 83440
For Office Use
Permit Number: 11 - 0014 A 1 Permit approved: ❑ Yes ❑ No
Fees Paid: ❑ 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 #16
Contact/Rep. Name: Teri Cruickshank Phone: 208-468-9115 ❑Office ❑Cell Phone
Email: Leri@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 El$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
❑+ New Construction = $1 per sprinkler head ($2,000 max) # of heads:
❑Existing Inspection Base = $65
0 Plan Review =10% of Contracted Amount
❑Re -Inspection = $65
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury, l hereby certify that l have read this application and state 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
be truthful and correct I agree to complywith all City regulations and State laws relatingto the subject matter ofthis application and herebyauthorisd representatives ofthe 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 ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitmidifnot
started within 180 days. Permit void ifworksmps for 180 days.
Applicants Name (print): Teri Cruickshank
Teri
Signature: Cruickshankv „!M.^tr:_ Date: 10.03.17
Inspections must be called in before 8 AM on the day the inspection is requested. inspection requests called inafter 8 AM will be scheduled for the nextbusines day.
Inspection Hotline -(208)372.2344 www.rexburg.otg Permit Technician -(208)372.2341 Revised March, 2016