HomeMy WebLinkAboutAPPLICATION - 19-00296 - 831 W 3000 N - County Mechanical SFRo44CX8URG
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CITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM 110
Updated 3/2019
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
SFR MECHANICAL BUILDING APPLICATION
New Construction ❑ Addition ❑ Basement Finish ❑ Accessory Structure > 200 sq. ft.
For Office Use
Permit Number: —G-6 ZQ
1. Property Owner
Name:
Address: 1j 3/ 40' City:
Phone:
❑ Mechanical Fee Paid
State: /�� Zip Code:
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
Business: State License #: QiS �Exp.:
Address: a ra''r Z 4/ City: 7r j6 State:F6"' Zip Code: 0 3 51,1V"
Phone: O�� �'� —ll y� Email: L*�l��G /�' gt 6
Contact/Rep. Name: �df Phone 0/ -ll Cly Email:
Mechanical Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required to be on file. If th" rst timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is onfile, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: �/ *' -OR- Lot #: _ Block #: _ Subdivision:
Description of work: i-c-ee _
Z SFR Construction: 45_"o sq. ft.
Fees for additions are charged by square footage: Up to 1,500 sq. ft. =$130 + $65 far each additional 1,000 sq. ft. or portion
thereof.
Square Footage
Total Cost
0 to 1,500 sq. ft.
$130
1,500 to 2,500 sq. ft.
$195
2,500 to 3,500 sq. ft.
$260
3,500 to 4500 sq. ft.
$32S
Add $65 per additional thousand sq. ft.
Pf Number of Fireplaces:
• Note that fireplaces are not included in square footage costs and will be charged $65 per inspection as shown below.
o ❑ Built-in $130 ❑ Free-standing $65
❑ 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 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. y
Applicant's Name (print): �Zeye f Signature: : Date: i(d -l/
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