HomeMy WebLinkAboutAPPLICATION - 17-00773 - 506 Angela Dr - Changing ServiceCITY OF
REXBURG
011,
Amairni Famrfy Community
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BUILDING APPLICATION
Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Qwner
Name: VittIS50, AYi*—y' ���, ��''�
Address: �ne-(fa -Y
Qle RACity: V State:1�ZipCode:�M40
Phone & Type: -T ❑ 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 P, and complete the Homeowner's Exemption page)
o: I am a contractor working for the homeowner C3 No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contnemrs/sub-contractors ioru lea d v::ll uocd to suhmlt their own signed apphcnrnnu
2. Electrir�I ongaFtor F
Name: (a 4=11W L
Ab lecAy lG e i tration#: Exp.:
Address: 1131 x V state: 11 Zip Code:
Phone & Type: ❑ Office ❑ Mobile Em
Contact/Rep. Name: LP�� AW OX S Phone: 208 LO 6 mail: G GD
Electrical Contractor Authorized Signature: Date:—LS
3. Project Descripqq'on
Address: C)010 -ft q to OR- Lot #: _ Block #: —Subdivision:
Check one:Single-family Residence ❑ Multi -family Residence []Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description ofwork
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ 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. FL = $19S ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325
❑ Over 4,500 Sq. FL = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$
New work on any other residence anti Detached Shops: _ (65 + (10 x # of branch circuits))
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections) =$10(needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps -Water, Irrigation, Sewage (per motor) _ ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 200HP
❑ Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor $ ❑ Technical Service= $65/hour
❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun
Temporary Construction Services ONLY= 65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certlly that l have read this application and state that the information herein
Is turrect and I swear that any infommtlon which may hereafterbe given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall he truthful and coma. 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 enter upon the above-mendoned property for Inspections purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions of the 2012
International Code In rases 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 If not
started within 180 days. Permit void If7�work stops tar 180 days. V,
Applicant's Name (print): f�1MbcIA4 y-VAL65 Signature: Y1m 'i— Date: tJ 1
Inspections most be called In before RAM an the day the inspection is requested. Inspection requests called In after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexhurg.org Permit Technician -(2081372.2341 - Revised March, 2016