HomeMy WebLinkAboutAPPLICATIONS - 07-00487 - 245 W 3rd N - ShedBuilding Safety Department
City of Rexburg
19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
OWNER'S NAME _ !c
PROPERTY ADDRESS Z N S CJ. 3 �- Permit#
SUBDIVISION
PHASE
BLOCK
CITY OF
REXBURG
tti
Amerieai Family Community
Regzuredffl ELECTRICAL Electrical Contractor's Name "'F7 l� Business Name /�J ��IA� I'V`et%6x%—
Address tg&5 WMtrt.. iAhy LAzt-i DiL City t'C_ex� State Zip L44r)
Cell Phone (2A)*4WS- 610t Business Phone ( )
Fax ( ) Email Dl let`S&SELF-CMtc- two 6D 94sN . CcxLt
Electrical Estimate (cost of wiring & labor) $ %'o'er (COMMERCIAL/MULTI-FAMILY ONLY)
TYPES OFINSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same time)
Number of meters being installed
Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and/or Cooling (when not RabcKT
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and no additional wiring) V L5Modular, Manufactured or Mobile Home
Other Installations: Wiring not specifically covered by any ) 0 2007Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage) y O F EXB U R G
Requested Inspections (of existing wiring)
Temporary Amusement/Industry
*In ;maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
Signature of Licened Contractor
24423
License number
to-7-a
Date
The
tehedak it the .came at
the State
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Please complete the entire Application!
NAME
PROPERTY ADDRESS
SUBDIVISION
Requiredffl
Mechanical Contractor's Name
Cell Phone ( )
Fax ( )
MECHANICAL
AlodLw—
Phone ( )
Permit#
Name
Mechanical Estimate $ (Commetcial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in of future outlets
Inlet Pressure (Meter Supply) PSI
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The
License number
seheduk is the same as
The State
Date
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SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
EXEMPTIONS FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please send a copy of your state registration or
fill out this form showing your exemption and send it with your license renewal or your next permit application.
(This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions please
see the State's website at www.ibol.idaho.gov/cont.htm)
❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractors/Journeyman,
12 Engineers/Surveyors,
19 Public Works Contractors (exempt from fee only registration required),
26 Plurnbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or
50 Installation of heating, ventilation and air conditioning systems
❑ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable
activity with no wages or salary
❑ Employee of a US Government agency (State, City, County, or other municipality)
❑ Public Utility doing construction, maintenance, or development to its own business
❑ Involved with gas, oil or mineral operations
❑ Supplier doing no installation or fabricating
❑ Contracting a project or projects with a total cost less than $2000
❑ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
❑ Any type of water district operations
❑ Work in rural districts for fire prevention purposes
❑ Owner who performs work on own property or contracts with a registered contractor to do work as long as
the property is not for resale within 12 months
❑ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that
property
❑ Real estate licensee/property manager acting within Idaho Code
❑ Engaging in the logging industry
❑ Renter working on the property where they live with the property owners approval
❑ Construction of a building used for industrial chemical processing per Idaho Code
❑ Construction of a modular building (defined by Idaho Code) to be moved out of state
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature
Print Name
Date