HomeMy WebLinkAboutAPPLICATION MECHANICAL - 19-00238 - 159 E Main St - Madison County Courthouse���Rf�BVRr
c I r v 0 r Building Safety Department
V. REXBURG BUILDING PERMIT FORM 210 City of Rexburg
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t,»erica4Fn»rtl•Con 35 North Is' East
Rexburg, Idaho 83440
COMMERCIAL MECHANICAL BUILDING APPLICATION
❑ New Construction ❑ Addition N) Remodel ❑ Tenantlmprovement ❑ Accessory Structure>200sq.ft
For Office Use
Permit Number: - 0b a JF5
Mechanical Fees Paid ❑
1. Property Owner
Name: Madison County
Address: City: State: Zip Code:
Phone: Email:
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Business: Lewis Corporation State License #; HVC-C-4440Exp.: 5-31-22
Address:_. 151 36 W Hllnziker Road City: Pocatello State: Idaho Zip Code: 83202
Phone: X08.238 120_ Email: heidi(Qlcom.com
Contact/Rep. Name: Heid► Pope Phone: 208.238.1202 Email: heida-1corg.com
Mechanical Centmctor Authorized Signature; Date: 7-19-19
A copy afynfu state. registration/license is required to he on file if this is the first time you have clone work in the City ofRexbui-fd, please provide
a photo copy of your license.
,�/// jyou ,are unsure ifyour license is on file, please check with the Perinit Technician by calling (208) 372-2341.
3. Project i)escription "15-Tyt. C o u r F�GI rTIcSR
Address: 134 East Main Street, Rexburg, Idaho 83440
Description of work: HVAC Upgra es
❑ Project Cost: $ 188,512.00
tin uaaiaonai pian review fee is required which is 10% of the calculated inspection fee
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I herebycertify that f have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter be given by me in hearings before the Planningand 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 statmuent or misrepresentation of fact in the application or un the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print): Kenyan Lewis- -- 7-19-19
Signatur . '`'� Date:
Inspections must be called in before 8 AM on the day the inspection is requeste . nspection requests called in after RAM will be scheduled for the next business day.
Inspection Hotline -(208) 372.2344 www.rexburg.org
Permit Technician - (2011) 372.2341
Cost of project: Calculation for inspection fee:
$0 to $10,000 then: (Cost of project' 2%) + $60
$10,000 to $100,000 then: ((Cost of project- $10,000) *1%) + $260
Greater than $100,000 then: ((Cost of project $100,000) * lfz%) +$1160
tin uaaiaonai pian review fee is required which is 10% of the calculated inspection fee
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I herebycertify that f have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter be given by me in hearings before the Planningand 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 statmuent or misrepresentation of fact in the application or un the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print): Kenyan Lewis- -- 7-19-19
Signatur . '`'� Date:
Inspections must be called in before 8 AM on the day the inspection is requeste . nspection requests called in after RAM will be scheduled for the next business day.
Inspection Hotline -(208) 372.2344 www.rexburg.org
Permit Technician - (2011) 372.2341