HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00583 - 235 S 4th W - Duplex Conversion"�pY.7NU�.•'G C I T Y o r: Building Safety Department
n7-� City of Rexburg
' l�.T. �m V l\G Submit By Email 35 North 1St East
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Rexburg, Idaho 83440
BUILDING APPLICATION
Plumbing
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Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1, Pl,lpr`i''" iib"1 ,:1'
Name: ��
ss:
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AddreCity: ��XK�I Q State: If) Code:
Phone & Type: ❑ OfficeGrMobile 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 #:' and complete the Homeowner's Exemption page)
)dNo: 1 am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE. Any contractor,/suF} ontractors irivoIv, d will nerd to suhill it their nwn signed appli(ations.
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Name: fGi Registration #: Exp.:71-3/1-2010
Address: City: i State: Zip Code;
Phone & 26 9
3 51Z �f�Office Mobile Email:
Contact/Rep. Name: jitt6nie Pctrw one: Email:
PlurnbinR Contractor Authorized Signature: Date: Z ) 1
Water Meter Quantity:Water Meter Size:
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
�:l;utllterc!A "01nck. 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
V:a�ti n ;i� lankly !;� ;i�i�rrrtlai \tirr,;-k: 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 thereof)) $
V, ,, Mtill i -f, a mik, ?;� lder,t;Li 1. ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # ofunits)]$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head (whichever is greater)
N, -�V 'u,"olli C)l; .iiltl ; nth -i i ,sits ,�e anti Ut�t.,-herd Shops = $65 for sewer and water stub connections
N1,l�,cr.:91_ullotir,_ 00 Sewer Line = $65 ❑ Water Line = $65 ❑ Sewer and Water Line = $65 wequestedinspe ion=,$65
❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x # of manifolds/zones)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount S
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, t hereby certify that 1 have read this application Ind state that the information herein
is correct and 1 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 comply with all City regulations and State laws relating to the subject m r f this application a( a by authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official m eva a permiton appy a1' ued under the provisions of the 2012
International Code in cases of any false statement or misrepre: ntation of fact in the application or on plan • n which the per o proval was based. Permits ' ' not
started within 180 days. Permit void if"t 0 d s
Applicant's Name (print): Signature Date: L 7
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Inspections must be called in before 8 AM on the day the inspection is requestedAlispection requests called iKafter 8 AM *9rbe scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016
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