HomeMy WebLinkAboutAPPLICATION - 19-00456 - 6267 W 3000 N - Mechanical31N1stE
Rexburg Building Department Rexburg, Idaho 83440
Ph: (208)372-2160
Mechanical Permit Application rexburg.org
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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: _ c1 L - )�'L(31.cM
Address: _OOP' '7 CJWt) Y'I r - City:
Phone: &Nk - J-0 I - ci 4 SZn
2. Mechanical Contractor
g'1&t i' State: Jar) Zip Code: -3`I410
Email:
Under Idaho Building Code, a registered contractor must do the work far- a Commercial Building.
Business: E'_, Lt2 •fir C, State License #: itk -G- III/& Exp.: 2L- &&Z 1
Address: q O W, --City: - tib _ State: Zip Cade: '? Ws
Phone: a it - ] Email: Jg!a ., , 5�km Y sCA122, g e.t
Contact/Rep. Name:
Mechanical Contractdja' Owmilg e:
A cony? ofyour state registration/license is required to be on file. If this is the firs time you 1
o photo copyofyour license. Ifyou are unsure ifyour license is on file, please check 1„ with tile
Date:
se work in the City of tlesybur,, please provide
Technician b;, calling (20) 372-2160,
DESCRIPTION OF WORK: Ackt-4ii&,I 66P,✓d -t)ud �u6li'wf Sri �_._u`��f�Ctrsyar evh&tta{ `A,,,
JOB SITE ADDRESS: UU(.0? 10 _.Q&5n Y"1 ,
CITY: , cl_ ZIP: ,.3Vt/O COUNTY: 1'YIaeliSt
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 responsibiliky 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 PEES 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: F/ -5/ 1 f
SIGNATURE: PRINTED NAME:
Page 1 Revised 7/0812019
Rexburg Building Department 31 Iv 1st 1=
Rexburg, Idaho 83440
Ph: (208)372-2160
rexbur .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 fol- inspection fee:
* Bused on living space (see definition below)
(Cost of project *2916) + $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
$
❑ 2,501 to 3,500 sq. ft. $260
Q 3,501 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 sg. ft. or portion thereof )
Living Space — space within a dwelling unit utilized for sleeping, eating, cooking, bathing, washing and
sanitation purposes. An unfinished baserr:ent is considered part sof the living space.
i
• 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,ZE)
xisting Residence {detached Shop:
$65 dollars plus $10 per piece of additionalWAC equipment (furnace, boilers, wood stoves, factory -built
fireplace, gas lines, ,pool heaters, mini -split system, hydronic system, etc.) and 1 or exhaust ducts (range
oU
$
hoods, dryer, exhaust fails, etc.). Fee shall not exceed `thew' square footage fee.
Total Pieces of Equipment
"Cine piece of equipment or exhaust duct is included in the $65.00 fee
Requested inspection : $65
$
Pian 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 (Cosi of project): $
Cost of project:
Calculation fol- inspection fee:
If project cost is between $0 to $10,000 then:
(Cost of project *2916) + $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) * k 96) + $1160
An additional plan review fee is required which is 10% qf'the calculated inspection fee.
GRAND T TAE,S`-'
Please record this pee on the application
Page 2 Revised: 7/08/2019