HomeMy WebLinkAboutAPPLICATION - 19-00060 - 645 S 5500 W - Gas stove and water heaterSTATE OF IDAHO DIVISION OF BUILDING SAFETY 1090 East Watertovver Street, Suite 150
Meridian, Idaho 83642
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Phone: 1-800-955-3044
Fax 1-877-810-2840
dhs_idaho.gov
APPLICATION FOR HOMEOWNER PERMIT
DBS use only
P#
Date:
Please fill out this application completely and submit with payment. If you have questions or need assistance completing the application, please call the
Division of Building Safety. Please note: permit fees are non-refundable and non -transferable.
HOMEOWNER NAME: Martin W. Rich
MAILING ADDRESS: 1531 Jensen St.
CITY: Pocatello STATE: ID ZIP: 83201
PHONE: 480-231-2633 FAX:
EMAIL ADDRESS (REQUIRED):_ richmart@isu.edu
SELECT THE METHOD YOU WISH TO RECEIVE YOUR PERMIT:
Q('D WEMAIL ❑ MAIL ❑ FAX
DESCRIPTION OF WORK: Install qas line shop heater C4_ ,< Lf'4A) Sle,r w
JOB SITE ADDRESS: 645 S. 5500 W.
CITY: Rexburg ZIP. 83440 COUNTY: Madison
DIRECTIONS TO JOB SITE: west of Rexburcl on hwy 33 to 5500 W south —1/2 mile to propertv on west side
of road, chain across double qreen gates on south end of property has no lock• shop with pump house
(If known) LOT: BLOCK: SUBDIVISION:P(�'to�-r
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AN ADDITIONAL $65 FEE MAY BE ASSESSED if the location is not clearly given either by directions or an attached map
THIS PERMIT APPLI ATION I NOT AN INSPECTION REQ ST Please call 1-800-839-9239 or go to dbs.idaho.gov to
schedule your inspection.
We Accept: cash, check, money order, Visa, MasterCard, American
Express and Discover. Make checks payable to the Division of Building GRAND TOTAL FEES PAID*
Safety or DBS
*Please use the worksheet on page 2 to determine the total fees and enter the amount to be paid here.
PUBLIC R e) pS MOT/ — Business information such as your company address and phone number is regarded as public information
according to the Idaho Public Records Act. Your business address and phone number maybe provided to a third party upon written request.
DATE: 2-5-19
SIGNATURE: % PRINTED NAME: Martin W. Rich
Page 1 Revised 03/17/2017
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STATE OF IDAHO DIVISION OF BUILDING SAFETY 1090 East Watertower Street, Suite 150
• S Meridian, Idaho 83642
n00 955-3044
Fax 1-877-810-2840
HOMEOWNER HVAC PERMIT WORKSHEET (FEE SCHEDULE)
This worksheet must accompany the Homeowner application. Use this worksheet to calculate the fees and transfer the grand total to the application.
RESIDENTIAL Total $
• New: Single Family Dwelling, including all buildings with HVAC being constructed on each property.
* Based on living space (see definition below)
XUp to 1,500 sq. ft. $130
❑ 1,501 to 2,500 ft. `:
sq. $195 Total Square Footage
❑ 2,501 to 3,500 sq. ft. $260 (All Fireplace/Gas line installations not to exceed 3,500 sq. ft. = $260.00)
$
❑ 3,501 to 4,500 sq. ft. $325
❑ Over 4,500 sq. ft. $325 plus $65 for each additional 1,000 sq. ft. or portion thereof
$325 + ( $65 x # of additional 1.000 so. ft or portion thereof )
• Manual S, J, & D Review - $25 (Required when installing the primary heating and/or cooling source)
Living Space — space within a dwelling unit utilized for sleeping, eating, cooking, bathing, washing and sanitation purposes.
An unfinished basement is considered part of the living space.
• New: Multi -Family Dwelling
❑ Duplex: $260
$
Existing Residence Detached Shop:
$65 dollars plus $10 per piece of additional HVAC equipment (furnace, boilers, wood stoves, factory -built
fireplace, gas lines, heaters,
pool mini -split system, hydronic system, etc.) and / or exhaust ducts (range hoods,
dryer, exhaust fans, etc.). Fee shall not exceed 'New Residential' square footage fee.
$
Total Pieces of Equipment
*One piece of equipment or exhaust duct is included in the $65.00 fee
Requested Inspection: $65
$
GRAND TOTAL: $
Please transfer this fee to your application
Page 2
Revised: 11/26/2018