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HomeMy WebLinkAboutAPPLICATION MECHANICAL - 19-00140 - 693 S 2275 W - New SFR�io�arxeuao,°.. CITY OF REXBURG America's Family Community BUILDING PERMIT FORM 110 Updated 10/2016 BUILDING APPLICATION New SFR Mechanical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Mechanical 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 2. Mechanical Contractor I 'W, _ _ Business: b State License #: ©/ 7- � Z Exp.: Address: c City: State: -W*Pl Zip Code: � 3,1yZ Phone: `b � Em il: 0 w nc� G r Contact/Rep. Name: �h/� I Phone: S -1Email: Mechanical Contractor Authorized Signature: Date: 71-11—/ A copy of your state registration/license is required to be on file. If this Is thifirst time you have done work in the CityofRexburg, please provide a photo copy ofyour license. Ifyou are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: -OR- Lot #: _ Block #: _ Subdivision: Description of work: ❑ SFR Construction: sq. ft. • Fees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. ft. or portion thereof. o Up to 1,500 sq. ft. = $130. Up to 2,500 sq. ft = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq.ft. = $32S, etc. (i.e. a home with 3,675 sq. ft. will be charged $325) ❑ Number of Fireplaces: • Note that fireplaces are not included in square footage costs and will be charged $65 per inspection, ❑ Hydronic Heating: • Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of manifolds/zones) 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. 1 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