HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 19-00140 - 693 S 2275 W - New SFRF� 4p¢Xn URCITY OF Building Safety Department
BIMG itGJ r, y BUILDING PERMIT FORM 12 O City of Rexburg
UpJauJ 10(2016 35 North 1St East
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America's FandlyCommunity Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Electrical
For Office Use
Permit Number; ❑ Electrical Fee 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 #3 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
Z. Electrical Contractor
Business: eb,z —State License #: 0�$�'�A Exp.:
Address: x City: P_ I 111- 1, c State: Tf _ Zip Code:
Phone: — — Email:
Contact/Rep. Name: AM—AWift Phone: Email:
Electrical ContractorAuthorized Signature: Date:
A copy ofyour state registration/license is require be on le. Iflis fiis the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyolt are unsure i otir license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Description ofwork:
❑ New SFR Construction: sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq. fl: =$130 + $65 for each additional 1,000 sq, fl. or
portion thereof.
o Up to 1,500 sq. ft. =$130. Up to 2,500 sq. ft. = $195, Up to 3,500 sq. Jt. = $260. Up to 4,500 sq. ft. = $325, etc. (i.e. a
home with 3,675 sq. ft. will be charged $325)
❑ Spas/fools/Generators; ❑ Yes ❑ No
• Note that spas/pool s/generato(s are not included in square footage costs and will be charged $65 per Inspection.
APPLICANT's SIGNATURE,, CERTIFICATION AND AUTHORIZATION: Under penally 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 Zo lug Conunission or the City Council for the Cityof llexburg
shall be truthful and correct. I agree to comply with all (:try regulations and State laws relating to the subject mailer of this application and hereby authorized representatives of the
City to enter (]poll the above-mentioned In for Inspections purposes. NOTE: The building official may revoke a pet ndtoil approval issued under the provisions of the 2012
International Code In cases orally false statement or misrepresentation of fact In the application or on the plans on which the permit or approval was based. Perndl void If not
started within 100 [lays. Permit void if work stops for 180 days.
Applicant's Name (print):
Signature:
Date:
Inspections must be called in before 8 AM on the clay 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