HomeMy WebLinkAboutAPPLICATION - 18-00032 - 117 Madison Ave - Electrical Only�.pe�`°•�, CITY OF Building Safety Department
i�allBURG City of Rexburg
+ cr Submit ey Email 35 North 1St East
Atnmkai Faintly Commnniry
Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: Permit Type: ❑ New X Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property. caner
Name: \ O\1 u
Address:— a d i n n Av [_ City: State: �_ Zip Code: 9344O
Phone&Type:Lr6 g ❑ Office KMobile Email: i
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 #3 and complete the Homeowner's Exemption page)
9 No:1 am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any cmuractors/sub-contractors Involved will tend m submit their own signed applications.
2. Electrical Contractor
Name: rL Registration#: l;\-G-�.-(ll4 Exp.:
Address: U-61 Cxe-wenn- Ull City: 2Ckb�n State:_�b Zip Code:
Phone&Type: s1 ❑ Office ®,Mobile Email:
Contact/Rep. Name: Le&v� E WArdS Phone: SO. -MC Email: Sa Me
Electrical Contractor Authorized Signature: Date:
3. ProjectDescrippp'�n
Address: 117 MQdVSonVe -OR- Lot #: _ Block #: _Subdivision:
Check one: IkSingle-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New onstruction* %Remodel ❑ Addition ❑ Basement Finish
Description of work: e C e
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
❑ Up to 1,500 Sq. FL = $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 # of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: El Duplex= $260 0 Three or more units= $((130 x # of buildings)+(65 x # of units))$
New wor on any other residence and Detached Shops: _ (65 + (10 x # of branch circuits)) $
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps- Water, Irrigation, Sewage (per motor) _ ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 2OOHP
❑ Irrigation Machine= $65 for center pivot + $10 per tower of drive motor $ []Technical Service = $65/hour
❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun
E]Temi)orary Construction Services ONLY= 65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Under penalty of perjury, I 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. I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized representatives of the
City to enter upon the ahow-mentioned property for inspections purposes. NOTE: The building official may revolve 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 bated. Permit void if not
started within 180 days. Permit void ifworkstops for 180 days.
Applicant'sName (print):,VirAloer\u Signature:-V1V&1k" 6Yr�S Date: 1 l
Inspections most be called In before 8 AM on the day the Inspection is requested. Inspection requests called In after SAM will be scheduled for the next business day.
Inspection Hotlire-(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016