HomeMy WebLinkAbout901 E Lake St - Applications/Air Conditioner - 12/29/2011CityOf Planning, Development &Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO80524
Phone 970-416-27402740 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). 'K Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Cl 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 applic ble information on the application. Incomplete applications will not be accepted.
Application # // -� Date Aop_'�G%/
For offlce use only
Job Site Address (required) Value of Construction (tabor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/S to Zip
Phone
Contractor Lic #
Address
Ci /State Zip
Phone
P ms 0 - GZ
c�,
2-24
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here *Report
Sales tax number Is requkedbyall conbad=
Are you paying with your trust account?
❑ Yes KNo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
C] Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar gChurch ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes b(Ao Afyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prW to 1975, you wig need an asbestos assessment to submIt with this application.
Description of work
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Collins license,#
Electrician O&J&F1 fWc.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. �jt�' �Ii.11 R Signature ` �u� Date i 2 - l�t� l
City of Community Development & Neighborhood Services
Fort COL�m Fort ConCollege o5241e
970.416.2740
Over the counter permit info sheet for. -
New and rev/acement hvac roof-tov equipment
The following information must be Included on commercial/multi-family projects to approve
the permit.
1. The hvac equipment is:
X Replacement of existing equipment.
❑ New/additional roof -top equipment.
2. For Replacement -equipment:
Equipment is the same weight or lighter and similar or smaller size/footprint.
❑ Equipment is heavier and will provide engineered documentation showing roof can
support new equipment or modifications that must be done to support such
equipment.
Replacement equipment is in the same location and not taller than previous.
❑ Replacement equipment Is in new location and/or taller.
3. For New equipment:
❑ See attached engineered documentation showing roof can support new equipment
or modifications that must be done to support such equipment.
4. Is outside air (ventilation) being provided for building occupants through this hvac system
(see 2009 IMC chap 4). How will equipment be set to meet this requirement? If not how
is ventilation provided? UNi cS VAPjJ g Z,625 GR E Cr-
Applicant signature and date
(Form updated 9-22-2010)