HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00635 - 40 Valley View Dr - New SFRREX V 11 BUILDING PERMIT FORM
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BUILDING APPLICATION
Miscellaneous Electrical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Permit Number: ❑ Electrical Fees Paid
Name: A,
Address: City: 'ek State: � � Zip Code: 530W
Phone: I- y _ 6 �% -- �� Email: �i--T5C, A 0 --of; �i f
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 of this application and complete the Homeowner's Exemption page as well)
o, l am working with the homeowner
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: Gr c[ � %• State License #: Exp.: z�X?
Address: _7jV-( ZdCa City: pc! r!+V State Zip Code:
Phone: 00S 310 4_30 - Email:
Contact/Rep. Name: rAo.'ttiois-1 t_ni-f\Sft1e2 Phone: Email: rf
Electrical Contractor Authorized Signature: Date:
cohv of vaur state regrstrutran/license is required to on file. If thh; . e Jirct time tans have done tvor•k fit the City of Rexbar;q, please provide
a photo copy nf:vnur license. lj-vou are unsure if iso license is on file, pleuse check tvith the Permit Technician liv, callinq (20RI.372-2341.
Address: Z/0 Val V�-eiv----ori -OR- Lot #: _ Block #: _ Subdivision:—
What type of Prope esidential ❑ Commercial
Cost i job:
Description of work: i
Check all that apply:
❑ Central Heating/Cooling Systems = $65 ❑ Pumps - Water, Irrigation, Sewage (per motor)
❑ Temporary Electrical Services ONLY = $65 (200 amp o $65 - up to 25HP
or less. One location, for less than 1 year.) o $95 - 26- 200HP
❑ New Circuits = $(65 + ($10 x # of branch circuits)) o $130 - over 200HP
$ ❑ Spas, Hot Tubs, and Swimming Pools = $6S
❑ Miscellaneous/Requested inspection = $65 ❑ Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per
Inspection fees can be bundled upon request. Re -inspect fees will be
tower or drive muton = $ enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNXI`ORE, CERTIF1CA1 [ON AND AUTHORIZKHON Under penalty of perjury, I hereby certtly 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. 1 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 2U I2
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 ,tops for 180 days. Q�
Applicant's Name (print): l �` Signore: Date:
Inspections most he called in before 8 AM oil the day the inspection is requested. Ins n requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(2013).472.2344 www.rex org Permit Technician -(208)372.2341