HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00026 - 430 S 3rd W - Exhaust Fansnaso=pp<oCITY OF Building Safety Department
° REXBURG
BUILDING PERMITFORM4,20 City of Rexburg
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Am.Nmt randy cpmmamy 35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
1. Prope Owner
Name: 'IP nt$'T IP 1�e i1AYC2II
Address: � p� ��� �
Phone: - _ 0 City:�Y�y� State: )D Code: (l LL
Email, l —
Underldaho Building Cod4 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 4 of this application and complete the Homeowner's Exemption page as well)
GA..I am
2. Electrical Contractor
Underldaho Building C1ode a registered contractor must do the work for a CommeMa/BuildiFig.
Address:
Phone:
Contact/Rep, Name:
Electrical Contractor.Authorlaed signamre: r�
A copy ofyoursam, registration/license is required to be on file. lfthis is Mefirst unceyou hove done work in the city ofRex
a photo copy ofyourlicense. ffyou are unsure ifyourlicmee is on file, please check 6urg, pleose Protwith the Permi[Technician q' ca!!fltq (208) 3721341.
3. Proiect Des
"`"""'I -'p'" r'- hill -OR- Lot#:_Black#:-_Suhdivision:
What type of Property: 12 Residential I�Commercial
Costofjoh: $�V,O .
Description of work:PYi'AjA� ,f -fiPIM
4. Fees: Check all that apply:
❑ Central Heating/Cooling Systems=$65
❑ Temporary Electrical Services ONLY= $65(200 amp
or less. One location, for less than 1 year.)
❑ New Circuits = $(65 + ($10 x # of branch circuits))
❑ Miscellaneous/Requested Inspection = $65
❑ Generators = $65
❑ Irrigation Machine =$65 for center pivot +$30 per
tower or drive motor = $
❑ Pumps - Water, Irrigation, Sewage (per motor)
o $65-upto25HP
o $9S-26-200HP
o $130-over200HP
❑ Spas, Hot Tubs, and Swimming Pools =$65
❑ Temporary Amusement =$65+$10 per ride,
concession, or generator $_
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Applicant's Name (print): Signature:
Date: �' I 't'6
lmonnevsmust be2,23 In bHoree AM °n Me tlay Na inspxtien is requesmdlnspectlen requeaa relied inaner8AM will beacheduled for thenextbusMevs tlay.
Inspectlonaodabseca dilb. a2344
w.vw.rexburgusg PelmitTednioan-(208)302.2341