HomeMy WebLinkAboutMECHANICAL APPLICATION - 20-00286 - 3196 W 6200 S - New SFR MechanicalOF t6.X n URC
C I TY OF Building Safety Department
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RExBuRGCity of Rexburg
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35 North 1St East
America's Family Community
Rexburg, Idaho 83440
For Office Use
Permit Number:
Fees Paid: ❑ Yes ❑ No
BUILDING APPLICATION
Mechanical
Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
I. Property Owner
Name:
AddreSS-. � 1c 1t�ia S City: _I 3� J`C, __ State
Phone & Type: _ ❑ Office ❑ Mobile 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 page)
No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
_Z-0 Zip Code: �34YO
2. Mechanical Contractor
Name: 2(0- ti le %{ 6,4 S,� _ , _
�/'c p'fu�✓ Ci R gtration #: �1� ----Exp.:
Address: /y
city: ---� _State: �D Zip Code: Yg"-'
Phone &Type: �Zt3Is 3i3 7l�[GU _ ❑ Office aMobile Email: CC,��,� _-
Contact/Rep. Name: � C-Ef-4rp .S --Phone: ZC -3i3 7k i D Email:
Mechanical Contractor Authorized Signature:
3. Project Description
Address:31% c �n Z „ r-9 -OR- Lot #: _ Block #: __ Subdivision:
Check one: Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: XNew Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount
❑ Up to $10,000 = (total cost of system x.02) + $60
Date: S Z5<=LcJf e
Calculated Fee (See Below): $
13 $10,001-$100,000 $10,001-$100,000 = ((total cost of system -10,000) x .01) + $260
r-1 r) $100,001 = ((total cost of system -100,000) x .005) + $1,160
New Single -Family Residential Work: — Sq. Ft.
)KUp to 1,500 Sq. Ft. _ $130 ❑ 1,501-2,500 Sq. Ft, = $195 ❑ 2,501-3,500 Sq. Ft. = $260 ❑ 3,501-4,500 Sq. Ft. = $325
❑ Over 4,500 Sq. Ft. _ $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $---
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$__
New work on any other residence and Detached Shops: = $(65 + (10 x # of HVAC fixtures))
Miscellaneous: ❑ Gas Pressure = $65 ❑ Furnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection = $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit = $65 ❑ Technical Service = $65/hour
❑ Plan Check =10% of Contracted Amount
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 1 swear that any information which may hereafter be given by mein hearings before the Planning and Zoning commission or the City Council for the Cityof Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter of this applicatio and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revpermit on a roval 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 plan's ofi which the p mit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name � y
Pp (print): t-�f�t`1�i5 --Signature: �G� �i�'� ,
Date: _ "�'Z��
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requ sts 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 Revised March, 2016