HomeMy WebLinkAboutPA SUMMARY - 20-00020 - 393 E 2nd N - Rexburg Medical Center - HVAC`F trx o upr
G I 1 1 O F Building Safety Department
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11G1� IMGBUILDING PERMIT FORM 210 City of Rexburg
City . _____- opaa:.a,ia,znt�
.lmrrirn's Hadily t',u,r,rttrrtih� 35 North 11t East
Rexburg, Idaho 83440
COMMERCIAL MECHANICAL BUILDING APPLICATION
❑ New Construction ❑ Addition Xl Remodel
For Office (lse
Permit Number:
I. Itror)erly Qw'nel,
Name: Rexburg Medical Center
Address:393 East znd Norft--
Phone: _ 90A 1RAi 5401 City:
Met'hanlral Cuntreiuto
C) Tenant improvement ❑ Accessory Structure > 200 sq. ft
Mechanical Fees Paid ❑
Rexburg state: IdahoZi83440
p Code:
Email:
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: _ Lewis Corporation HVC-C-4440 5-31-22
State License #:
Address:er Exp.:
Phone: 208 238 1902 oad City: Pocatello State: Idaho Zip Code: 83202
Contact/Rep. Name: Hejdj Pope Email: heidiCa7lcnrn Com
—_— Phone: 208.238. 1201- Email: _ corn
Mechanical ContractorAuthorized Signature:
0 lupi of yaur stats r icer rntir Oicense is required to be on file. if this is the first time yolt have done work in the City of Date: 1)le )3-20vide
...hnto copy ojyo1'r license. 7/21(11' are ur)sure ifyuttr license is oil flit', please check with tire Permit Technician by calling (2013) 372.2341.
3. Project Description Rexburg Medical Center Basement
Address: 393 East 2nd North, Rexburg, Idaho 83440
Description of work: HVAC Upgra es
❑ Project G»t $ 26,449.00
Cost of project: Calculation for inspection fee:
.$0 to $10,000 then: (cost of project * 2%) + $60
$1 Q000 to $100, 000 then: ((Cost of prroject - $10,000) *1%) + $260
Cr•etlter than $100,000 then: ((Cost of project - $100,000) *'/z%) + $1160
An additional plan review fee is required which is 10% of the calculated inspection fee 4
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that
is ccr ect and I swear that any information which may hereafter be given by me in lien nngs before the Planning and Zoning C I Zs application
ssion or
the City Council for the City of Rexburg
the information hereto
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 tite p revisions 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 riot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Kenyan Lewis
Signature- Date: 1-13-20
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Inspections must be called in before 8 AM an the day the inspec
Inspection Hotline - (208) tion rs retluest . nspection requests called in after SAM will be scheduled for the next business day.
372.2344
www.rexhurg.org Permit Technician — (208) 372.2341