HomeMy WebLinkAboutAPPLICATION - 17-00643 - 3076 W 1000 N - SFR Mechanical Only{.1 .... °*06 clrx of - Building Safety Department
a` to 1T]G BUILDING PERMIT FORM 110 City of Rexburg
V 1�
"'°'�°�°°" 35 North In East
Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
For Office e ��3
Permit Numm ber: ❑Mechanical Fee Paid
1. Property caner
Name: �k P,U.tr'
Address: 1>0_7(G w IUt7C9n City: F-ExQwa4 State: Zip Code: Y40
Phone: -2-4D el - 3%0 � CO to NO 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)
,N$o, l am working with the homeowner
2. Mechanical Contractor
Business: )AQDFadFoLrlKQda",#FA-7ra4 ItFCC2ntr,n State License#: 013-STz- Exp.:
Address: 3`13% e 2HopJ City: 12_tC State: 'I D Zip Code: 53 3 t/Y2.
Phone:OB' Email: O%F ICf @ r -Dst` n+ arr. cw-,
Contact/Rep. Name:N`(da c`W GM L1E Pho e: :-oQ-zNg >-zaf Email: y}r."eJ 2./-caci PHW ro.+�
Mechanical Contractor Authorized Signature: I Date: /-)-3 )1-7
A copy ofyour state registradan/license is required to befile. chi ( ou ave done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on(le, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 30110 a I000,-1 -OR- Lot#: Block#: Subdivision:
Description ofwork: NC W hihaC , (,0S LI—S �,_P Fg(R . Ia37� 6—(2ooK0 /F
SFR Construction: 'LI O9 sq. it
• Feesfor new construction are charged by squarefootage: Up to 1,500 sq.ft.=$130+$65for each additional 1,000 sq.fG or
portion thereof.
o Upto1,500sq.ft=$130. Upto2,500sq.ft=$195. Upto3,500sq.)t=$260. Upm4,500sq.ft.=$325,etc.(i.e.a
home with 3,675 sq. ft will be charged $325)
Number of Fireplaces:
• Now thatfireplaces are not included in squarefootage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in squarefootage casts and will be charged and additional $65 + ($10 x At of
manifolds/zones)
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpmany, l hereby certify not I have read this application and state that the innrmatlon
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 betruthPol and correm 1 agree to comply with all City regulations and State laws relating to the subje¢matter oftMs application and hereby authorized
representatives ofthe City to enter upon Ne above-mentioned property far irepeaiona imposes. NOTE: The building.ficial may revoke. permit on approval issued under the
pro's of the 2012 lnteroational Carle in es of any false statement or misrepresentation of fact in the application or on the plans on which the permit .Approval was
based.Permit void if not started within 100 days. Permit void Swath stops for 100 days. /
Applicant's Name (print): A doo ,' goYt'r Signature: Date: 2O 1-3 I )
mapectlans must be called in before SAM on the day the inspection is impulsed. Inspoemon requests called in after 8 AM will be scheduled for the more buslness day.
Inspection Hotline- (208) 372.2344 wwwosolmrg.mg Permit Technician- (208) 372.2341