HomeMy WebLinkAboutAPPLICATION - 17-00580 - 555 Mikan Dr - Eden - Garage 2 - SW�e �t. xnt•Rc
F Building Safety Department
y" REXBURG BUILDING PERMIT FORM 420 City of Rexburg
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A35 North 1St East
mericas Family C:mnnetutitr
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
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Permit Number:
❑ Electrical Fees Paid
1. Propel tt' Ownel,
Name: e�e.h ApRy-fW.eA,*S t f
Address:_L-E&�i#21 city: State: Zip Code: g3 qqO
Phone: 20$ SZ Z L 1(, Email: el�0 t t,1, r- A09,
Under Idaho. Building Cade, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to arCtion -1 of this application and complete the Homeowner's Exemption page as well)
no,1 am working with the homeowner
2. FICCEI- d(t tutlraclot
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License #: d�� Exp.:
Address, 9 �/ Z06 City: P05S State—,Z74� Zip Code: X I/
Phone; %–'G `ra — 17 Emai :.
Contact/Rep. Name:�tWs�t c. Phone: Email:��fS
Electrical Contractor Authorized Signature: Date: r'`G'!�"%
A colav of your state registration/license is required to nil file. tf this t e first tune you have done work in the Citr oDaLebul;g, pease provide
a photo copy afyour license. lj'vou are linsure if yo 11MISC is Qn file, please check ttitlt the Permit rechniciau b_v calling (208) 372-2341.
3. Projet:t-
Address: 5 5'5- I•tJ nrr r (C 4,K p2 _OR_ Lot #: ____ Block #: — Subdivision:
What type of Property: D Residential D Commercial
Cost of job: $
Description of work; _!6S t!� S� 2•
-1. Fet-, 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 - aver 200HP
$ 0 Spas, Hot Tubs, and Swimming Pools = $65
❑ Miscellaneous/Requested Inspection = $65 D Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per
Lower or drive motor = $ Inspection fees can be bundled upon request Re-inspectfees will be
enforced if hispectioii requests exceed fee totals.
APPLICANT'S SIGNA'i'URE, CERTIFICATION AND AUTll0R1ZA•n0N: 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 7oning Commission or Ute City Council for the City of Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State lolls relating to the subject matter of this application and hereby authorized representatives of the
city to enter upon the above-mmntioned property for inspections purposes. NOTE: The building official may rcvoke a permit mt approval issued under the provisions of the 2012
International Code in cues of any false statement or misrepresentation of fact in the application 4""
rl a rntit or approval was based. Permit void if not
started within 1130 days. Permit void if ta- rI stops for s.
Applicant's Name (print): V Signature: Date: /2 i 3 _
Inspections most he called in before R AN i on the day the inspection is requested. inspecafter H ivili be scheduled for the neat business day.
Inspection Hotline- (209) 372.2344 www.rexhurg.org
Permit Technic ion - (2t1R) 372.2:347