HomeMy WebLinkAboutAPPLICATION - 19-00453 - 1165 Barney Dairy Rd - County Mech.pdfo� ,oXB UR31 N 1st EC
">> ° Rexburg Building Department Rexburg, Idaho 83440
NT Ph: (208)372-2160
SNeo e
Mechanical Permit Application rexburg.org
Please fill out this application completely and submit with payment. If you have questions or need assistance completing the application, please call the
Rexburg Building Department. Please note: permit fees are non-refundable and non -transferable.
1. Property Owner
Name:AC6e{ kcW1,K04
Address: ?-z, ( City:
Phone:
2. Mechanical Contractor
ZeXi'JUic, State: Zip Code: (5141418
Email:
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: _A'' State License #: - Exp.: 4
Address: 7 �G !� ��� {r a Eft^ City: r(5d _ , State: Zip Code:
Phone: --,-o 9 — 711- Email:
Contact/Rep. Name: fZJ 7J 7/Phone: ,�-� Email:
Mechanical Contractor Authorized SignatCedto
Date:A46,15
A copy ofyour state registration/license is reqon file. Ift isis efirst ti uhave done work in the City of Rexburg, ease provide
a photo copy ofyour license. Ifyou are unsure ense is on file, please check with the Permit Technician by calling (208) 372-2160.
DESCRIPTION OF WORK: ///'r /z
JOB SITE ADDRESS: & ^tet
CITY: ZIP:COUNTY:
DIRECTIONS TO JOB SITE:
AN ADDITIONAL $65 FEE MAY BE ASSESSED if a re -inspection on the project is required.
THIS PERMIT APPLICATION IS NOT AN INSPECTION REQUEST: To schedule inspections please call (208) 372-2344
It is the responsibility of the permit holder to arrange access to the premises with the property owner in order for the city
to complete the inspection.
We Accept: cash, check, money order, Visa and MasterCard. GRAND TOTAL FEES PAID*
Make checks payable to the City of Rexburg
*Please use the worksheet on page 2 to determine the total fees and enter the amount to be paid here.
PUBLIC RECORDS NOTICE — Business information such as your company address and phone number is regarded as public information
according to the Idaho Public Records Act. Your business address and phone number may be provided to a third party upon written request.
DATE
SIGNAT
PRINTED NAME:
Page 1
Revised 7/08/2019
U�04 AeXBU,pC
Rexburg Building Department 31 N 1st E
N� Rexburg, Idaho 83440
Ph: (208)372-2160
rexburg.org
MECHANICAL PERMIT WORKSHEET (FEE SCHEDULE)
This worksheet must accompany the Contractor Application. Use this worksheet to calculate the fees and transfer the grand total to the application.
RESIDENTIAL Total $
• New: Single Family Dwelling, including all buildings with HVAC being constructed on each property.
Calculation for inspection fee:
* Based on living space (see definition below)
(Cost of project* 2%) + $60
❑ Up to 1,500 sq. ft. $130
((Cost of project - $10,000) * 1 %) + $260
❑ 1,501 to 2,500 sq. ft. $195 Total Square Footage
((Cost of project - $100,000) * Y2%) + $1160
❑ 2,501 to 3,500 sq. ft. $260
,501 to 4,500 sq. ft. $325
❑ Over 4,500 sq. ft. $325 plus $65 for each additional 1,000 sq. ft. or portion thereof
$325 + ( $65 x # of additional 1,000 sq. ft. or portion thereof )
Living Space — space within a dwelling unit utilized for sleeping, eating, cooking, bathing, washing and
sanitation purposes. An unfinished basement is considered part of the living space.
• New: Multi -Family Dwelling
❑ Duplex: $260
❑ Three or more multi -family units: $130 per building plus $65 per unit
$
( $130 x # of buildings) + ( $65 x # of units )
Existing Residence Detached Shop:
$65 dollars plus $10 per piece of additional HVAC equipment (furnace, boilers, wood stoves, factory -built
fireplace, gas lines, pool heaters, mini -split system, hydronic system, etc.) and / or exhaust ducts (range
$.3Z110
hoods, dryer, exhaust fans, etc.). Fee shall not exceed `New' square footage fee.
Total Pieces of Equipment
*One piece of equipment or exhaust duct is included in the $65.00 fee
Requested Inspection : $65
$
Plan Check : $65 per hour
$
COMMERCIAL /INDUSTRIAL
• The fees listed under this inspection type shall apply to any and all HVAC installations not specifically
mentioned elsewhere on this form. This shall include all labor, materials, equipment, overhead and profit, as
well as all labor, materials, and equipment supplied by others. The project value cannot be reduced by labor,
material or equipment that is donated or supplied by others. At the time of "Final" inspection, the scope of
work, valuation, and permit fees will be verified.
Total cost of HVAC system (Cost of project): $
Cost of project:
Calculation for inspection fee:
If project cost is between $0 to $10,000 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
An additional plan review fee is required which is 10% of the calculated inspection fee.
GRAND TOTAL: $ '12 0C_U
Please record this fee on the application
Page 2 Revised: 7/08/2019