HomeMy WebLinkAboutAPPLICATION - 18-00727 - 2791 W 2600 S - MechanicalCITY OF
,1 EXBURC7016
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Amerimi Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: Pew ❑ Remodel []Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Prop Own
Name: \ArJ2
Address:> aIn S City: 2Y State: Zip Cod E9\ l
Phone & Type: — ❑ Office C4&bile 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 #3 and complete the Homeowner's Exemption page)
52(Po: l am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contmemrs/sulrmntmttors involved will need to submit their own signed applications.
2. Mecnical Contractor
Name: �C C�fl Registration #: - G - Exp.:
Address: City: XY-q State: ip Cade. L
Phone &Type: Office❑Mobile Email: Y YYIS e.(�(AA1nNQV\GC S,
Contact/Rep. Name: ne:3 1 \ Email:
Mechanical Contractor Authorized Signature:
3. Project Description
Address: P_:�cII U &OU S• -OR- Lot #:_ Block III: _Subdivision:
Check one: Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: 1KNew Construction*_ ❑Remodel ❑ Addition ❑ Basement Finish
L 1
Description of work: R 6tez <s s « r r cssurc Gsl
New Commercial Wolk: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work:J aC, Sq. Ft
Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. FL = $325
❑ Over 4,500 Sq. Ft = $325+(65 x # ofadditional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: = $(65 + (10 x # of HVAC fixtures)) $
Miscellaneous: ❑ Gas Pressure = $65 ❑ Furnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection = $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service = $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and sate that the information herein
is correct and l swear that any information which may hereafter be given by me In hearings before the Moral and Zoning Commission or the City Council for the CityofRexburg
shall be truthful and correct I agree to comply with all City regulations and State laws relating to the suhl tteroft/htpermitorapprovalwasbased.
ation and hereby authorized representatives of the
City to enter upon the above-mentlonedproperty for inspections purposes. NOTE: The building o(flclal a vokea ppproval issued under the provisions ofthe 2012
International Cade in cases of any false statement or misrepresentation of fart In the appllmtionoro a ons an wlsicPermit void ifnot
startedwithin 180 days. Permit void ifwork stops for leo days.
No
Applicant's Name (print):��CL �2f�lj Signatq Date:40
Inspections mug be called in before 8 AM on the day the inspection is requested, InsKcdon requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016