HomeMy WebLinkAbout301 E Prospect Rd - Applications/Electrical - 08/12/2014City f' Planning, Development & Transportation
Y O281 N. College Ave P.O. Box 580
�,.F rrt Collins 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). ❑ 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 # 11!40(n02(n Date August 12, 2014
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
301 E Prospect Road
$6,300.00
Property Owner Name Address
City/State Zip
Phone
ANDREWS NELSON FAMILY TRUST C/O,MARK W AND VIRGINIA N ANDREWS 520 A AVE CORONADO, CA 92118
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Glanz Electrical Contracting, Inc. 1713 Lincoln
Ave. Al Fort Collins, CO 80524
970-482-5218
Contractor City of Ft. Collins Sales Tax # 21494
Are you paying taxes here or by report?
❑ Here M Report
Sales tax number is required byall conbactors.
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 ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, 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 Install the following:150 amp meter/main panel on detached garage, 150 amp main
panel on house, grounding, re feed 120 volt circuits in garage and house from new breaker panels,
4-wire circuit and receptacle for range and drver, 20 amp circuit and receptacle for washer.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license #
Electrician 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: Thomas I Glanz Signature
Date