HomeMy WebLinkAboutAPPLICATION MECHANICAL/PLUMBING - 19-00117 -270 W Main St - Basement FinishRemodelFor Office Use
Permit Number:
CITY OF
REXBURG
America's Family community
1. Property Owner
Name:
Address:
Phone:
BUILDING PERMIT FORM 111
Updated 3/2018
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Remodel SFR Mechanical i P�J
❑ Mechanical Fee Paid
City: State: Zip Code:
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)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Business: �L��u Pl 4>.r1P71 is C State License #:
Address: City:
Phone:
Email:
State:
Exp.:
- Zip Code:
Contact/Rep. Name: Phone/ Email:
Mechanical Contractor Authorized Signature: Date:
-
A copy ofyourstate registration/license is required to be on fie. If this is the first timeyou 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: $ _
• Fees for remodels are charge by cost:
Cost of project:
Calculation for inspection fee:
If project cost is between $0 to $10,000 then:
(Cost of project * 29,66) + $60
If project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) * 190 + $260
If project cost is greater than $100,001 then:
((Cost of project - $100,000) * �6 %) + $1160
❑ Number of Fireplaces:
• Note thatfireplaces are not included in square footage costs and will be charged $65 per inspection as shown below.
o ❑ Built-in $130 ❑ Free-standing $65
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 ZoningC mmission 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 s application and hereby authorized
representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The buildin officia,Vmay 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 applica n or o 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