HomeMy WebLinkAbout1401 Rollingwood Ln - Applications/Electrical - 11/09/2012Cit% of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
�t Coltins Fort Collins, CO 80524
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Phone 99770�-34116-2740 Fax
224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) IN Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �) I r)�1-1 q Date
For ofce use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1401 Rollingwood Lane Fort Collins, CO 80525
$660.00
Property Owner Name Address
City/State Zip
Phone
Steve Batson 1401 Rollingwood Lane
Fort Collins/ CO 80525
Applicant Name Address
City/State Zip
Phone
Douglas A. Coger 2050 Marconi Drive, Suite 200 Alpharetta / GA 30005
770-772-3400
Contractor Address
City/State Zip
Phone
Lin R. Rogers Electrical Contractors 2050 Marconi Drive, Suite 200 Alpharetta / GA 30005
770-772-3400
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number Isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) IN Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Install a GE WallStation EVSE Charging Unit using an existing 2P 40AMP circuit breaker - EVSE to be insta
in the garage. Plug in application using NEMA 6-50 receptacle.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician ME-6911 Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: C�*IlGS (04e,1L- Signature `"'• Date u1401Z