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Home My WebLink AboutAPPLICATIONS & RECEIPT - 17-00789 - The Grind Coffee House - Ele Servicen CITY OF REXBURG cY Americus Pnmiiy Con om i BUILDING PERMIT FORM 4 2 "dated 10/2016 Building Safety Department City of Rexburg 35 North 1st East I no, Rexburg, Idaho 83440 BUILDING APPLICATION Miscellaneous Electrical Work For Office Use Permit Number: 11-007T9 PrElectrical Fees P 1. Property Ownpr (1�� Name: - is Cu+a 1htiv Lt{p,J -�-� Address: a & City: t Y 1�� S�ta��te�:,yll_v Zip Code: 0 Phone: 1$'��DIO IICh W-) Email: aVfmr`&1,4--,tArueld U• &m. Under Idaho Building Code, a homeowner is allowed to do work on theihoMn home. ✓% Are you a homeowner doing work on your own home? ❑ Yes (Skip to #4 and complete the Homeowner's Exemption) ❑ No, I am working with the homeowner 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work far a Commercial Building. Business: tf MlIdAin EkMC, tate License #: Exp.: Address: 0 N City: Y State: Zip Code: Phone: , I� • 3111,11SkQ Email C 6 4 OW .!lbm Contact/Rep. Name: Scot 149sm Phone: VMO Email: IYI I Electrical Contractor Authorized Signature: Date: 42-1-1 A copy ofyour state registration/license is required to be on file. Ifis i le first tirneyou have done work in the Cily of Rexburg, please provide a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description p)D,�n Address: UaR IMDI ID�� 'M — -. -OR Lot #: _ Block #: _ Subdivision: What type f Property: ❑ Residential ❑ Commercial MAUI (P '1'►2XV011it Cost of job: $ 5r00b ' 1000 Description of work: mDleillp 5 *ilk ElzetVkdl= 411 F -Il i'R eAt 1S Adw 4. Fees: Check all that apply: ❑ Central Heating/Cooling Systems = $65 ❑ Pumps - Water, Irrigation, Sewage (per motor) ❑ Temporary Electrical Services ONLY = $65 (200 amp o $65 - up to 25HP or less. One location, for less than 1 year.) o $95 - 26- 200HP 14 New Circuits = $(65 + ($10 x # of branch circuits)) o $130 - over 2o0HP $ ❑ Spas, Hot Tubs, and Swimming Pools = $65 Cl Miscellaneous/Requested Inspection = $65 ❑ Temporary Amusement = $65 + $10 per ride, ❑ Generators = $65 concession, or generator $ ❑ Irrigation Machine = $65 for center pivot + $10 per Inspection fees can be bundled upon request. Re -inspect fees will be tower or drive motor = $ enforced If inspection requests exceed fee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the Information herein Is correct and 1 swear that any Information which may hereafter he 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 matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes, NOTE: The building official may revoke 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 or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days, Applicant's Name (print): Signature:Date: 11.30' I� VV Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after a AM will be scheduled for the next business day. Inspection Hotline - (208) 372,2344 www.rexhurg.org Permit Technician - (208) 372.2341 0 A;ax pp.%e UqV'' 7� Tit; I TY OF Building Safety Department REXBLTRG BUILDING PERMIT FORM 430 City of Rexburg cw Updaue 10/2016 35 North 1st East Americas Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Miscellaneous Plumbing Work For Office Use Permit Number: 1 - �g�i ❑ Plumbing Fees Paid Proper 0 I er _ �W Cir Q N I, Name: K CC T 39 Address: r- ritQ "Pity: 1' State: Tn Zip Code: � Phone: 61.6- nalp Email: am Under Idaho Building Code, a homeowner is allowed to do work on their own ome. Are you a homeowner doing work on your own home? ❑ Yes (Skip to #4 and complete the Homeowner's Exemption) ❑ No, l am working with the homeowner 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work fora Commercial Building. Business: rte. �K PIUI]lbtl j4�— State License #:6j�3v Exp.: Address: iab4S NMrthJUfn V City: TQIW4 State:P�ZipCo/de Phone: s Email: 'th KCEM11rS HMbiA9(�/tGi/�7..lOry1 Contact/Rep. Nam Mi� ne: mail: Plumbing Contractor Authorized Signature: Date: .ar- A copy ofyour state registration/license is required to be on file. f this is he first time you have do a work in the City of Rexburg, please provide a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project WCription -1 'J y� Address: 12K1Y Q 'WT �I� &yt 0R- Lot #: _ Block #: _ Subdivision: What type of Property: ❑ Residential ❑ Commercial YVl Ibllz'�1�t1 �R Cost of job: $ , Description of work: l71 T 1 r n ltit b Q 4. Fees: Check all that apply: ❑ Gas Line = $6S ❑ Hydronic Heating = $65 + ($10 x It of F Water Heater = $6S manifolds/zones) = $ ❑ Sewer Line = $65 IM Miscellaneous/Requested inspection = $65 ❑ Water Line = $65 ❑ Sewer Turnaround (septic to city) = $65 ❑ Lawn Sprinklers/Backflow device = $65 Inspection fees can be bundled upon request Re -inspect fees will be j9( Gray Water Systems = $130 enforced if inspection requests exceedfee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. Iagree 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-mentioned property for Inspections purposes. NOTE: The building official may revoke 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 or on the plans on which the permit or approval was based. Permit void Hoot started within 180 days. Permit void if work stops for 180 days. //�� -�((((� � Applicant's Name (print): Signature: L� O-& [�_ Date: Inspections must be called in before 8 AM on 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.rexburg.org Permit Technician - (208) 372.2341 12/20/2017 06M RFXtiUI2G ti .a..� F...aY c.....wy XBP Confirmation Number: 37992217 Xpress Bill Pay - Payment Processing City of Rexburg 35 N 1st East I PO Box 280 Rexburg, ID 83440 208-359.3020 ub@rexburg.org 0 Transaction detail for payment to City of Rexburg. Date: 12/20/2017 -3:26:49 PM Transaction Number: 78034313PT Visa — XXXX-XXXX-XXXX-9567 Status: Successful Account# Item Electrical Permit Notes: The Grind - 404 N 2nd E Billing Information Jen Kennedy Jen Kennedy , 83440 jkennedy@ruddco.com Quantity Item Amount 1 $65.00 TOTAL: $65.00 Transaction taken by: porter https://secure.xpressbillpay.com/common/payment_process.php 1/1