HomeMy WebLinkAboutAPPLICATION - 19-00030 - 830 S 5th W - Water HeateroY gcxaupc
' CITY OF Building Safety Department
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REXBJ MG BUILDING PERMIT FORM 42 City of Rexburg
eyr Updated 2/2017 35 North 1St
America's Family Community East
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
For Office Use
Permit Number:
❑ Electrical Fees Paid
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone:
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 section 4 of this application and complete the Homeowner's Exemption page as well)
L"No, I am working with the homeowner
2. Electrical Contractor
Under Idaho tBuilding Code, a registered contractor must do the work for a Commercial Building, J
Business: State License #: C X8573
Address: Sri// �J � Exp.:
L �IL.C,6 00 ld>l City Stat�e:J�-�Zip Code: ���/y�_Phone: 4/-QZ Emai : _ J/�/
Contact/Rep. Name: hone: Email:
Electrical Contractor Authorized Signature:
Date:
A copy of your state registration/license is required 2be on file. if thi e first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ify ur license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: '{ �/G�� -OR- Lot #: — Block #: _ Subdivision:
What type of Property: ❑ Residential [!'Commercial
Cost of job: $ IJV
Description of work: /l%/ /
4. Fees: 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 = $65
Miscellaneous/Requested Inspection = $65 ❑ Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per
tower or drive motor = $ Inspection fees can be bundled upon request. Re -inspect fees will be
enforced if inspection requests exceed fee totals.
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): j� Signature:
Date: � y
Inspections must be called in before 8 AM on the day the inspection is requested. InspecZon 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