HomeMy WebLinkAbout4812 Mcmurry Ave - Applications/Mechanical - 11/29/2011Fort Collins
OVER-THE-COUNTER PERMITS ONLY
Planning, Development & Transportation
281 N. College Ave' P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ 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 #�Date
o�
Fo ce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
P one
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Applicant Namep,£d„.t D4 1�,GGr� Address,
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone.
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequiredbyall 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) ❑ Garage
If commercial, is it: ❑ Bank ❑ Barr ❑ Church. ❑ Hotel/Motel ❑ Medical office SPOffice,. ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes - O� No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? % f 8,9
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work 11vsi-r1v1_ �.o U�r� s 3 0oN
*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 CAWOyW_ 1AI 2�1�1Alumber AnLo- Mechanical Roofer
l
Other
1 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:`J r %n t. �rir)r � Signatu /��/ Date //I-. 9l / i
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of
Fort Collins
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Over the counter permi in o s ee for;
New and replacement hvac roof -top equipment
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524
970.416.2740
The following information must be included on commercial/multi-family projects to approve
the permit.
1. The hvac equipment is:
❑ Replacement of existing equipment.
,kNew/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? NJ QS kVAAP'SkA r1n�4nk v�VS,%"t A 0-,nA S.
Applicant signature and date
(Form updated 9-22-2010)