HomeMy WebLinkAboutAPPLCATION FIRE SPRINKLER 2 - 17-00238-45,17-00355-361 - 295 Ella Ln - Kenneth Square - MFRoFPExa°"e o CITY o F Building Safety Department
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BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number: /1-O 239 ^
Permit approved: ❑ Yes ❑ No
Fees Paid: VYes []No
1. Applicant
Business Name: Phoenix Fire Protection
Office AddreSS: 4130 Airport Rd. City: Nampa
State: ID Zip Code: 83687
Office Phone: 208-468-9115 Contact Person: Teri Cruickshank
Cell Phone: —
Contractor's Authorized Signature: Trent Bice
Date: 08.28.17
License/Registration # FPSC-108 Expiration: 12/2017
2. Location of Work to be Done
Street Address: 814 W Yellowstone Hwy City: Rexburg
State: to Zip Code: 83440
Business Name: Kenneth Square Apt
Contact/Rep. Name: Teri Cruickshank Phone: 208-468-9115
❑+ Office ❑ Cell Phone
Email' teri@phoenixfp.com
Dates for work to be done: From to
3. New Construction Contracted Amount: $ 8,494.00 Calculated
Fee (See Below): $ 230.00
[] Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001-$100,000 = ((total
cost of system -10,000) x .01) + $260
❑ Over $100,001 = ((total cost of system -100,000) x.005) + $1,160
4. Miscellaneous
[Z]New Construction = $1 per sprinkler head ($2,000 max) # of heads: 23
❑ Existing Inspection Base = $65
I7 Plan Review= 10% of Contracted Amount
❑Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that the information herein
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. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authoriwd 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):. >7 vnel .-, higna
Date:z
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 husiness day.
Inspection Hotline -(208)372.2344 www.rexburgurg Permit Technician -(208)372.2341 Revised March, 2016