HomeMy WebLinkAboutAPPLICATION - 17-00717 - 4198 W Hwy 33 - Fireplace ChangeoutNov 171707:57a Alpine Healing Air 2085520594 p.2
CITY Or
REXBURG
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Anterlai6 Fdmlly community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use '
Permit Number: PermitTypei ❑ New ❑ Remodel- Addit on ❑ Basement Finish.
Fees.Paid ''0 Yes ❑ No : -
;
1. Property Owner, atm
Name:
Address hits*'�_3 City:t State: Zip Code:
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Phone &Type: A_VS 2�7�t7 Office ❑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)
XNo: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any mntracmis/subcontractors iwolved will need to submit theirmim signe d applications.
2. Meeh ni .al Contractor r p�
Name: �n}-�+-Q 'µ-pu r. r. ; " Registration 114(ykd_'.32S Exp.:
Address __City:Tia l it a aA State: 1`5_ Zip Code: '9*-3c/QI
Phone &Type:ZL`i3 ❑Office❑Mobile Email:
Contact/Rep. Name: —Phone: f). Email:
Mechanical Contractor Authorized Signature: �'� L'� Q �' Date:
3. Project Mn
Address: `� -OR- Lot #: _ Block;4: _ Subdivision:
Check one: XSingle-family lit' idS ence ❑ Multi -family Residence O Commercial
Check one: E) New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work: E2A e, 4 dY 7
New Commercial Work: Contract amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $101001-5100,000 = ((total costof system -10,000) x.01) + 5260
❑ Over $100,001 = ((total cost of system • 100,000) x .005) + $1,160
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 therecif) $
New Multi-Foinily Residential: ❑ Dtiplex = $260 ❑ Three or more units= $((130 x# of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: _ (65 + (10 x # of HVAC fixtures))
Miscellaneous: ❑ Gas Pressure= $65 ❑ Furnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection = $65
❑ Gas Line = $65 Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10%of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION:-Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
Is correct and [..ear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council forthe City of 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 enterupon the above-mentioned property for inspections purposes. NOTE: The building afficial may revoke a permlton approval Issued under the provisions of the 2012
International Code in uses ofany false statementor misrepresentatio n offact in the application or on the plans on which the Permit or approval was based. Permavoidlf not
started within 180 days. Permit void ifwodr stops for v18�0 days. -...._
Applicant'sName (print):� u�f4 41�E2�U"lSignature: � _xoz�� PL Date:
Inspections must be called In before SAM on the day the Inspection Is requested. lnspecdan requests called in after 8 AM will be scheduled for the next business day,
17711AA wnvv.rexbure.ora 'Penmit'rechnicbm-(200)372.2341 Revised March,2016