HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 66 W 1st N - DuplexC I T s' n F Building Safety Department
REXBURG BUILDING PERMIT FORM 42 City of Rexburg
-. 0W...__.__..__. Updated 1U/2016 35 North 1St East
America's Family Conununity
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
For Office Use
Permit Number: I 0C 0 d 'S ❑ Electrical Fees Paid
1,01: ity
Name- ,/
Address:4 City: �- State:. _ Zip Code: Q O 3 qe 6
Phone:RD%,
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 J74 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: Lely 1 m Qh E( 1�� State License #: C ► �3? Ex
Address: qq oS �f ui Ci p.. _' JD
City: _State: �_ Zip Code -."16 3 q-�
Phone: ZBR - 3 s & - 3 7 70 Email:
Contact/Rep. Name: P ne: Email:
Electrical Contractor Authorized Signatur Date: �Vl, A copy ofyour state registration/license is r ulred tobe on file. If is the first timeyou have done work in the City of Rexbu gplee
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Pennit Technician by calling (208) 372-2341.
:. P1....xi(�Ct Description
Address: %� LtJ f/� -OR- Lot #: —Block #:—Subdivision:
What type of Property: CW�esidential ❑ Commercial
Cost of job: $� v
Description of work:,
4, Fe. cs: Check all that apply:
❑ Central Heating/Cooling Systems = $65 ❑ Pumps - Water, Irrigation, Sewage (per motor)
❑ Temporary Electrical Services ONLY = $65 (200 amp o $65 - up to 25HP
or less. One location, for less than 1 year.) o $95 - 26- 200HP
❑ New Circuits = $(65 + ($10 x # of branch circuits)) o $130 - over 200HP
$ ❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Miscellaneous/Requested Inspection = $65 ❑ Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per
tower io drive motor = $ Inspection fees can be bundled upon request Re-inspectfees will be
enforced if inspection requests exceed fee totals.
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 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 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- hich 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): 6rDNr� �l$/Lth cry Sig 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.mg
Permit Technician - (208) 372.2341