HomeMy WebLinkAboutAPPLICATION - 19-00246 - 476 Maple Dr - ElectricalOF gEXB(,$C
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REXBURG BUILDING PERMIT FORM 4,2 O City of Rexburg
041Updated'° Zo» 35 North 1St East
America's Family Community
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
For Office Use
Permit Number:
❑ Electrical Fees Paid
1. Proper Owner
Name: 1, f:�r: �t a kr c�
Address: `i'? 0 lbw i
�' D r City: —
Phone: State: _ T- 2 Zip Code: c{ 1
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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 #4 and complete the Homeowner's Exemption)
jE] No, I am working with the homeowner
Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
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Business: 'Z- r r '; L i C
Address
Phone:
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Contact/Rep. Name:
State License #: E Ii -C - a(-CiA ( Ex
City: (� � p.:
�`� State: � Zip Code:
Email: __i:a 0,P,er-'ic �� g
Phone:2 23ftl> -t 7J ( Email: 5 --c >
Electrical Contractor Authorized Signature: _ q
A copy ofyour state registration/license is required to be on file. if this is thefirst _rst time you have done work in the City of Rexburg, please pros
a photo copy ofyour license. !f you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
What type of Property: d%Residential ❑ Commercial
Cost of job: AID I"�
Description of work: c n,.,,
4. Fees: Check all that apply:
❑ Central Heating/Cooling Systems = $65
❑ Temporary Electrical Services ONLY = $65 (200 amp
or less. One location, for less than 1 year.)
❑ New Circuits = $(65 + ($10 x # of branch circuits))
❑ Miscellaneous/Requested Inspection = $65
❑ Generators = $65
❑ Irrigation Machine = $65 for center pivot + $10 per
tower or drive motor = $
❑ Pumps - Water, Irrigation, Sewage (per motor)
o $65 - up to 25HP
o $95 - 26- 200HP
o $130 - over 200HP
❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Temporary Amusement = $65 + $10 per ride,
concession, or generator $
Inspection fees can be bundled upon request. Re-inspectfees will be
enforced ifinspection 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 he,
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 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): ��^"c1 �-- 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