HomeMy WebLinkAbout505 S Shields St - Applications/Mechanical - 05/11/2012Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 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). lia Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
C9 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 # In Date 5 111IIz
For o1r1ce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
5zS S, Sr1eN'Ic,S S\vee4 $ 1z�qui
Property Owner Name Address
City/State Zip
Phone
-vv)e- Soulhtiand Corp �.0.(iox 'li(
1\0S kX -1S2Z I-0111
99b-i4g3- q
Applicant Name Cle0.nSWeep IIC Address
City/State Zip
Phone
-Ad�iUY�CeL� Com�o2� P.
3`lq$ Yee �0�33
?,70 339310$
Contractor Lic # Address
City/State Zip
Phone
RME' 1A-1-Iq�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Mere ❑ Report
Sales lax number is required by alloon&actors
Are you paying with your trust account? ❑ Yes J11 4o
- \ 2,50
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 ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Metail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need 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
s. ,
-4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Crty of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
5—)1—f2
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: �(�'�J
Print Name: N I-t lc,-, �uS 4 Signature \\ `mac Date 5 11 IZ
SOS 6%St"
Community Development & Neighborhood Services
Cit;raf
} 281 North College Avenue
Foerr` Collins Fort Collins, CO 80524
970.416.2740
Over the counter permit info sheet for. -
New and replacement hvac roof -top equioment
The following information must be included on commercial/multi-family projects to approve
the permit.
1. The hvac equipment is:
�< 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? /4, o! r o X - 2 3 0 <- -F'" C9 p
Applicant signature and date
(Form updated 9-22-2010)