HomeMy WebLinkAboutAPPLICATION - 17-00579- 555 Mikan Dr - Eden - Garage 2 - SW0 \ N C'krU
11
" F Building Safety Department
REX.BURG
BUILDING PERMIT FORM 4,20 City of Rexburg
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-- :rr.:,r<,zarrr 35 North 1st East
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Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
Permit Number;
❑ Electrical Fees Paid
Name: EAS a.r �+c-e t„ LL G
Address:�S9 Sr l��Ar„�Ja,>J¢yN •(eTpl City;1_ State:
Phone:-Z0,3-So�p %34�f
` Zip Code:
_ 21((. 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 of of this application and complete the Homeowner's Exemption page as well)
8LNO, l am working with the homeowner
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: < ✓Lir Gi ti 'State License it: 0996D— 1Ex ,am. -e 2� /9
Address: q�/3 deb %�j p'
Phone: 0-C-4; - 3 Ir r_> >- e1,�----3 City j�Sy State:.Z.IL� Zip Code: 3 Y
Email:
Contact/Rep. Name: �v.tw e� ,A Phone:
Email: r mkt_r, )11"x. G
Electrical Contractor Authorized Signature: -
Date:
A calm of hour• state rcc�istr'atiort/license is required to crlt jTte. 7j'this . t e� rcpt tirTle a•r�,r hater:<donc� tt•urk in ft7e� C'itt� o% RexGtrr;q, please pr'rwit�le,
r (nc�>to co/it, o1your license. lJ Pou arc unser e ffyo license is on /ilc Please check tt Ith the Permit 7"cchrtr`cirm irr callir(cl (20 ) 3?2-2.341.
;. t'r t,jt,, r 1)t•�cr!)t;un
Address: E5G W WM I V -c,..,; Dy- �OR-
What type of Property: ❑ Residential ❑ Commercial
Cost of job: $
Description of work:
- Check all that apply:
❑ Central Heating/Cooling Systems = $65
❑ Temporary Electrical Services ONLY = $65 (200 amp
or less. One location, for less than 1 year.)
❑ New Circuits = $(65 + ($10 x # of branch circuits))
❑ Miscellaneous/Requested Inspection = $65
❑ Generators = $65
❑ Irrigation Machine = $65 for center pivot + $10 per
Lower or drive rnotor = $
Lot #: — Block #: _ Subdivision:
❑ Pumps - Water, Irrigation, Sewage (per motor)
o S65 - up to 25HP
o $95 - 26- 20011P
o $130 - over 200HP
❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Temporary Amusement = $65 + $10 per ride,
concession, or generator $
lnspectiori fees can be bundled upon request. Re-inspectfees trill be
enforced if inspection requests exceed fee totals.
APPLICAN'i"S SIGN,Vl'UKE. CERTIFICATION AND At!';'I]ORIZA'I'ION: Under penalty of periury. l hereby certify that t have read ihiv application and state that the information herein
is correct anti I swear that any information which may hereafter he giveat by me in hearings before the Planning asd Zoning Commission or the City Council For the City of Rexburg
shall be [rutlila I and correct. 1 agree to comply with all City regulations ant] State law , relating to the subject matter of this application and hereby authorized representatives a! Lite
City to enter upon the above-mentioned property for inspections purposes. NOTT-v The building official may revok
Ie a permit on app; oval issued under Che provisions of the 2012
nlernatiotta; Code nt cases of any false statentcnt or tttisr'cprescntcttioo of fact iu the application or oft the plans on tr is nit Of approval was based. Permit void if not
started within 180 days. Permit void if wi)rk stops ft) -180 days. t
Applicant's Name (print): !/ Signature: Date:
Inspections tnust he called in before 8 AM on the day the inspection is requested. inspection roque. s called in atter Y 9i trill he sh
cedu]ed far the next husincss day.
Inspection Hotline - J208)372,2344 www.rexhurg.org
Permit Technician - (208) :372.2:341