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HomeMy WebLinkAboutAPPLICATION 2 - 18-00468 - 50 Mill Race Rd - Attached DeckC I TY OF 1�G BUILDING PERMITdFORM 10/2016 22� America's Family Community BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: Address: 367) h , _Sc jj-L City: r I State: Zip Code: ? Ua Phone:205-3'5-4y-Doq;5- Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Akkl ;Fkdr, X Qrfd IML .Sey State License #:5LE 6 30DQ15- Exp.: 1 Address: 3U) _F47'ny1 City: / State: �_ Zip Code:153 d Phone: - —ti Email: r l c' Contact/Rep. Name: Phone:' Email: m Electrical Contractor Authorized Signature: Date: - A copy of your state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide a photo copy afyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Descriptio QQ Address: rec .h e i, A0.ar' Y..►S-G'o7 Description of work: mAd 11CLIJim J T r ❑ Project Cost: $ ZZ 700,06 • Fees for commercial projects are charged by cost. o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1 % + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10% of the above fee. 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 I swear that any information which may hereafter be 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): / /1/Lf hb�r�[ a Signature: Date: l .� 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 C IT Y OF REXBURG 0& America's Family Community BUILDING PERMIT FORM 210 Updated 10/2016 BUILDING APPLICATION Commercial Mechanical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ 1. PropertyRwner Name: Uf C tcl le V � 1)Ia mr. 33�heun�� Address: iam 1J, � � �.t �. City: x L State: Zip Code: �k 3 *Yl) Phone:jlO,:,_®Q�% ��near�z Crr/��Q7/(,- Email: 2. Mechanical Contractor Under Idaho Building Code, q registered contractor must do the work for a Commercial Building. Business: k)AACP rkdrlYCuld 9U1k-5LruJec State License#: ©��; s�'Sl Exp.: Address: _,3ba) T fc t-, City: _:Mka K lk State: 7W . Zip Code: yY Y6 e, Phone: & S-- 7l Email: c' Contact/Rep. Name: Phone: 'W -7/k- Email: knU,eler e& r1 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, p ease provide a photo copy ofyour license. lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description� S UAddrM ess: _ (LIP t' t� , 33" (0/ 2 Description of work: 21 1 aLe �'d wA,y44/ e_.& iril t) VC.14 MQ 4 Ti vht-v ❑ Project Cost: $ 12,760,00 • Fees for commercial projects are charged by cost: o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 = .5Vo +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 140 of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10916 of the above fee. 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 I swear that any information which may hereafter be 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): tl i K [_ A -a-0 Signature: 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