HomeMy WebLinkAboutAPPLICATION - 17-00785 - 4471 N 5000 W - Gas Insert ChangeDec 20 17 08:24a
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Alpine Heating Air
CI Tl' OF
+XBURG Submit By Email
Cut,
Annabel Pomilr Cumuusnfty
BUILDING APPLICATION
Mechanical
2085520594
p.1
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For Office Use
Permit Number: . Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid; ❑ Yes ❑ No
1. Proper wrier
Name: eti`�
Address:_ _S City: State: Z�_Zip Code: !Z
Phone & Type _:(Q% ❑ 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 43 and complete the Homeowner's Exemption page)
�No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NIyrc: Any contmclmx/sub.mntracmn involved will cued to sulnsit the IT awn signed apptcations.
2. Mechanical Conhactnr
Name: alpine hean�n &Air Conditioning _ Registration #: HVAC -3258 Exp.:
Address: 170 N. Eastern Ave. _ _ City: Idaho Falls State: I0 Zip Code: 83502
Phone & Type: 208-523-5542 O Office ❑ Mobile Email:
Contact/Rep. Name:— Phone: 208-523-5542 Email:_
Mechanical Contractor Authorized Signature: _ Date:_
3. Project Do cri rtion- /
Address: t500 .� _ -OR- Lot #: — Block #:—Subdivision:—
Check
—Subdivision:_Check one: ❑Single-family Residence ❑Multi -family Residence ❑Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition [3 grit Finish
Description ofwork: _—
New Coolnlercinl Work: Contracted amount: $_ _ Calculated Fee (See Below): $
❑ Up to $10,000 = (total costof system x .021 + $60 ❑ $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.00S) + $1,160
Now 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 # ofadditional 1,000 Sq. Ft. (or portion thereof)) $ _
New Multi -Family Residential: Cl Duplex= $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 EJ Technical Service = $65/hour
❑ Plan Check =10% ofContracted Amount
APPLICANT'S SIGSATURE, CEIUIFICATION AND AUTI IORILWICIM Under penalty ofperjury. I hereby certify that I have read this application and state that the Information herein
Is correct and 1 sv,ear that any information which may hereafter be given by me In hearings before the Planning and Zoning Commission orthe CityCuundl for the City of Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relatingtu the subject matter ofthis application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for Inspections, purposes. NOTE: The building official may revoke a permiton approval issued under the provisions of the 2012
Intentional Code In cases of any false statementor misrepresentation offset In the application or on the plans on %vidcli the permit or approval was hazed. Permit Vold 1not
started within 180 days. Permit
—void
Kww�ork steps for 180 days.
Applicant's Name (print): 61 � I'30t. Signature �a ��ate: f %td %
Inspections must be called in before RAM on the day the inspection is requested. Inspection requests called In after RAM will be scheduled for the next business day.
Inspection8otline-(209)372.2384 uavwxexhurg.ore PormkTeehnicom-(209)372.2361 Revised Marh,2016