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HomeMy WebLinkAboutAPPLICATION - 19-00025 - 66 W 1st N - DuplexaF RaxeoA�. C IT Y OF T� r. y BUILDING PERMIT FORM 3 21 l� Updated 10/2016 America's Family Community BUILDING APPLICATION Remodel Electrical Building Safety Department City of Rexburg 3S North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Electrical Fee Paid 1. Property Owner Name: I-IAN�L_eK LssINo Address: G (o W es r 1 S I No . City: k' �LXS O RG State: IL Zip Code: Phone: 0 1 8S lz� 3 1 on 7 Email: C+4 A N 1 LQA (Q cel', 2. Electrical Contractor Business:'Tkl ��. State License #: Exp..- Address: xp.:Address: City: State: Zip Code: "�Q Phone: 2b ��lc� ���©• Email: Contact/Rep. Name:%4��, P one:-�"� ��a Email: Electrical Contractor Authorized Signature: Date: V3-1� A copy of your state registration/license is required to be on Ve. If thise he first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Remodel Cost: �� sq. ft. • Fees for remodels are charge 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 1 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): 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 C I TY OF REXBURG -- OW - America's Family Community BUILDING PERMIT FORM 311 Updated 10/2016 BUILDING APPLICATION Remodel Mechanical Building Safety Department City of Rexburg 35 North 1St East RexburL-, Idaho 83440 For Office Use Permit Number: ❑ Mechanical Fee Paid %. Property Owner Name: C N 8 N b Le R LQ S S 1 N Address: Co W@ S j j S I n/ O R r H City: 2 Q_ X G U State: Zip Code: Phone: 01 SR 415����jT Email: C. 1-1 nl d l- e k IQ C P 1 T 8 U (_ k. C o /v% —z 2. Mechanical Contractor �}-�fC� "C— Business: 6 State License #: I!q 110 Exp.: Address: ty: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: 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, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Remodel Cost: i)42C_'0sq, ft. • Fees for remodels are charge 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 ee • 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): -wt 'bh/`� 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 �� RkxnoRr C I TY OF XBURG 04 America's Fancily Community BUILDING PERMIT FORM 3 31 Updated 10/2016 BUILDING APPLICATION Remodel Plumbing Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Plumbing Fee Paid I . Property Owner Name: C H (AN1 L(z L -e SS/nlq Address: Co (p W C ST i S`i- N O City: /� -,o X � U R State: Zip Code: Phone: Email: CI A IV -I L C P I -FR U Ck > d M on�tlrac or ` Business: `'� tu,�6 State License #: I �j��J�) Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing 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, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Remodel Cust: ��^� +�(sq. ft. • Fees for remodels are charge 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 ee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 1 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):y\ Signature: i 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 o� RsxnuR� C I TY OF Building Safety Department Y� 7 REXB �tG BUILDING PERMITdFODRM 301 City of Rexburg "® 35 North 1St East America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION MFR Remodel For Office Use Permit Number: Application Fee: ❑ $100 1. Property Owner Name: ( Fj—��L_�R LeSSI Address: C,,(. W g. S; 1 S i /V ON City: R e k g U r? r State: Zip Code: Phone: 80 ( RR R -31 Email: C I A Aj b L2 IZ C P% P R UCk . OM 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: I General Contractor Under Id o Building Code, a registered contractor must do the work for a Commercial Building, Name: CA / R2 Istra tion #: f- -1')-5 Exp.: Address: City: Phone: 2� State: Zi Code: oj � - �iL-1 ! S'l � p Email: �"mct r7i-t� �. i --% Contact/Rep. Name: -e ,r+ VYl ✓�-'1� Phone:db8 -� �c� - Email: �z , C- 14 411 e ,y411e General Contractor Authorized Signature: X11 N, Date: I-7 l9 A copy ofyourstate registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description Address: Description of Work: Project Description: • Total cost of project - materials and labor: $ • Check all that apply: ❑ Mechanical: Cost $ ❑ Electrical: Cost $ ❑ Plumbing: Cost $ ❑ Fire Alarm: Cost $ —El Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. Building Permit fees for MFR remodels are charged by cost. The application fee applies towards the total fee. For details on how fees are calculated please check with the building department. There will also be a plan review fee totaling 10% of the permit fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 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): 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 - (2081 372.2341