HomeMy WebLinkAboutAPPLICATION 2 - 16-00525 - 1440 Barney Dairy Rd - County MechanicalCITY OF
REXBURG
Americai Famity Community
BUILDING PERMIT FORM 11
Land 2/2017 01
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North lxt East
Rexburg, Idaho 83440
For Office Use
Permit Number: Ro –a52 G ❑ Mechanical Fee Paid
1. Property Owner
Name: Ktv l fn
Address: /L/yO 1(a.4qll4 ✓may} —City: ze&;4 State: Zip Code:
Phone: 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 section 3 of this application and complete the Homeowner's Exemption page as well)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Business:13t_� dl xi1g ! J4 �c r--r,g State License #: 14L ie --12.? / Exp.: />5*7
Address: Wg2 ,5 City: State: 24l Zip Code:
Phone: Email: 13L.tc1t 1 Sn ®irrG/= A67gn
Contact/Rep. Name: Phone: Tail:
Mechanical Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license, Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: ! 41'/0 OR- Lot #: _ Block #:._ Subdivision:
Description of work: fn -r i – –/W g S L t n'e lr
❑ SFR Construction: sq. ft.
• Fees far new construction are charged by square footage: Up to 1,500 sq, ft. = $130 +$65 for each additional 1,000 sq. ft. or
portion thereof.
0 Up to 1,500 sq. ft. = $130. Up to 2,500 sq. f t. = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq. ft = $325, etc. (i.e. a
home with 3,675 sq. ft. will be charged $325)
❑ Number of Fireplaces:
• Nate that fireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, t hereby certify that l have read this application and state that the information
herein is correct and I 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. 1 agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized
representatives ofthe City to enter upon the above-mentioned property for inspections purposes. NOTE: The buildingofficial ke a permit on approval issued under the
provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application oro ep son which the permit or approval was
based. Permit void if not started within SRO days. Permit void if work stops for 180 days.
Applicant's Name (print): Signature: Date: