HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 17-00402 - 398 Pioneer Rd - Rocky Ridge Apartments Bldg 17 - 4 PlexCITY OF Building Safety Department
REXBUZG Submit By Email City of Rexburg
Ow 35 North 1n East
Amenort Family community Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number: i1-(S6LhM2 Permit approved: ❑Yes 0 N
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#17
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
O Over $100,001 ((total cost of system -100,000) x.005) + $1,160
4. Miscellaneous
❑p New Construction = $1 per sprinkler head ($2,000 max) # of heads:
❑Existing Inspection Base = $65
❑ Plan Review = 10% of Contracted Amount
El Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaltyofperjury,I herebycertify 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall
be truthful and correct 1 agree to comply with all City regulations and State laws mladng to the subject matter ofthis application and herebyauthorired representatives ofthe City
to enter upon the above-mentioned propertyforirnpecdons purposes. NOTE: The buildingofficial may revoke a pemuiton approval issued under the provisions of the 2012
International Code in cases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void ifnot
starred within 180 days. Permit void ifwork amps for 180 days.
Teri _
Applicant's Name (print): Teri Cruickshank Signature; Cruickshank —Date: Date; 10.03.17
Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called inaRer8 AM will be scheduled for the nextbushos day.
Inspection Hottine-(208)372.2344 www.rexburgorg Permit Technician -(208)372.2341 Revised March, 2016