HomeMy WebLinkAboutAPPLICATION - 17-00791 - 4469 N 2000 W - Furnace Replace- (^uYnact rcPlafR�t
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REXBURG
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Americas PRtufy COMMUnny
BUILDING PERMIT FORM 110
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BUILDING APPLICATION
New SFR Mechanical
I
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For Office UsekMechanical Fyal
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Permit Number: 17-16"l"l
1. Proper owner
Name: ()6v\ Narr `s YLlb
Address: Htd3I N 2000 W City: �(tXbur� State: �'� Zip Code: FU
Phone: (1-8) 35t0 - QIOIo Email: 41 I ck,'o&r 101 InA l yd Cr. Co Iry'\
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?
XYes (Skip to #3 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Business:
Address:
Phone: _
Contact/Rep. Name:
_ State License #:
City:
Email:
Phone:
Exp.:
State: Zip Code:
Email:
Mechanical Contractor Authorized Signature: Date:
-
A copy ofyour state registration/license is required to be on file. If this is the first time you 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 ,0
Address:00DW /cLki7Ni9 -OR- Lot #:_ Block #:_Subdivision:
Description of work: WeA nttu -Co.r 53 to tw5eJ 71# m
❑ SFR Construction: 117 8 sq. ft.
Fees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. f t or
portion thereof.
o Upto1,S00sq.ft=$130.Upto2,500sq.Jt=.$19SUpto3,500sq.jt=$260. Up to4,500sg.1t=.$325, etc. (fe.a
home with 3,675sq. ft will be charged $325)
❑ Number of Fireplaces:
. Note thatffreplaces arenot included in squarefootage costs and will be charged$65per inspection.
❑ Hydronic Heating:
Note that hydronlc besting is not included in square footage costs and will be charged and additional $65+ ($10 x # of
manifolds/zones)
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofinniury, I hereby certify that l have read this application and state that the information
herein is corzea and 1 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 I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized
representativesofthe LTty[o official may revoke a permit on approvalissuedunder the
enter upon the above-mentioned property for inspections purposes. NOTE: The building o
provisions of the 2012 International Cade 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): ()Ort Hart i 5 Signature: Date: 12- -.2�
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after H AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341