HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 19-00152 - 118 N 1st E - Electrical ServiceOF 1tEXBU,gG
v� r� CITY OF Building Safety Department
» REXB ^ BUILDING PERMIT FORM 121 City of Rexburg
Updated 10,2016
'•<„ America's FamilyCommunily
35 North 15Y East
Rexburg, Idaho 83440
BUILDING APPLICATION
Remodel SFR Electrical
For Office Use
Permit Number: ob 1 a ❑ Electrical Fee Paid
1. Propert Owner
Name: U U
Address: 1 j /�1�� Peril -f f r S f City: State:1 93
f
Phone: 64'Z— % S = ff �',r Zip Code: _ yya _
Email:e/ , �O , eAey1
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)
0 No, I am working with the homeowner
2. Electrical Contractor
Business: W�?/ F ZC, State License #: b1S"y
Address: /691 G✓ --s, Exp.:
/i�Qir'�1vi �'!� City: d✓) State: /
Phone: — OS'- 41 Zip Code: to
Email: Q &��Jyi/.J
Contact/Rep. Name: Phone: mai1: a Z aYL�jY"'��,�•a/G Ga
Electrical Contractor Authorized Signature: Date::
A copy ofyour state registration/license is require on file. If this is the first tlmeyou have ne work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address:1/jE /V 1�-- /i
Description of work: 5�VlL& Lal
❑ Remodel Cost: $
uuu---, P-1 , eviewJee is required which Is 10% of the calculated inspection fee I
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 1 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 mein 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): a(�o 0/f/ ' Signature: Date:�— /? S
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
Cost of project:
Calculation for inspection fee:
If project cost is between $0 to T10,000 then:
(Cost of project* 2%) + $60
If project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) * 1%) + $260
If project cost is greater than $100,001 then:
((Cost of project - $100,000) * Y2%) + $1160
uuu---, P-1 , eviewJee is required which Is 10% of the calculated inspection fee I
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 1 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 mein 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): a(�o 0/f/ ' Signature: Date:�— /? S
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