Loading...
HomeMy WebLinkAbout620 Powderhorn Dr - Permits/Gas - Log, Line, Pipe - 12/07/2020of �.,F`o�trYt Collins Site Address: 620 POWDERHORN DR Job Valuation: $3,766.00 Category: Residential Owner: STOLL DOUGLAS D/RACHEL 1 620 POWDERHORN DR FORT COLLINS, CO 80526-2607 Community Development & Neighborhood Services 281 N. College Ave Fort Collins, CO 80522 970.221.676o 970.224.6134 -fax Building Permit #: B2013296 Issued Full: 12/07/2020 Permit Type: Residential Gas Log Phone: 970-222-2804 Zoning: Front setback: Rear setback: Right setback: Left setback: Minor Amend #: Plat File #: ZBA Case #: Zoning district: RL - LOW DENSITY RESIDENTIAL DISTRICT Legal: Subdivision/PUD: Code: Res sq ft: Com sq ft: # of stories: Occ Group: Fire Sprklr: Stock plan #: Filing #: Lot #: Block #: Ind sq ft: _ Const Type: _ Stock plan options: Contractor: License #: Phone: Subcontractor(s) Phone Work Description: install gas fireplace with 40' of gas line. Homeowner affidavit on file. Basement sq ft: Supervisor cert#: License Number IISCHEDULE INSPECTIONS: ** via Text Message: 888406-6394 ** By Phone: 970-221-6769 II ** Online Portal: fcgov.com/CitizenAccess ** Online Portal via Mobile Device: fcgov.com/CitizenAccess/mobile IlPossible Inspections Required: 406 204 II TOTAL FEES PAID AS OF 12/07120: $112.56 Payment method: Credit Card 1965 Fee Detail Displayed on Next Page As a condition for the issuance of a permit, I hereby declare that I am the owner or owners agent, authorized to perform the proposed work on the property described herein. I agree to comply with all the requirements contained herein, and City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the event that issuance was based on incorrect information. This permit shall become null and void if the work authorized by such permit is not commenced, suspended, abandoned or not inspected within 180 days from the date of such permit. Carbon Monoxide Alarm required within 15 feet of each bedroom entrance. Signature: Print Name: Date: Form Revised Oct 2010 City of .City Collins Site Address: 620 POWDERHORN DR Job Valuation: $3,766.00 Category: Residential Transactions Method Check Number Date Paid Credit Card CK#1965 12/07/2020 Receipt issued: 12/07/2020 Total Paid to Date: Fee Description Account Code City Sales/Use Tax 251.122030 County Sales/Use Tax 100.217030 Permit Flat Fee w/o Subs $25 1000.422010 TOTAL FEES: Amount Paid $112.56 $112.56 Community Development & Neighborhood Services 281 N. College Ave Fort Collins, CO 80522 970.221.676o 970.224.6134 -fax Comments Building Permit #: B2013296 Issued Full: 12/07/2020 Permit Type: Residential Gas Log Fee Amount Amount Paid $72.50 $72.50 $15.06 $15.06 $25.00 $25.00 $112.56 $112.56 Date Paid Amount Due 12/07/2020 $0.00 12/07/2020 $0.00 12/07/2020 $0.00 TOTAL BALANCE DUE AS OF 12107/2020: $0.00 0.00 Fee Amounts are valid for date of this document only. Fees subject to change without notice. Form Revised Oct 2010 Building Permit Over the Counter Application 2. 1. Job site address: 620 Powderhorn Dr.,FortColllns, CO80526 2. Property owner name: Douglas Stoll 3. Property owner address: StreetAddress::620 Powderhorn Drive City:: Fort Collins State:: CO Zip::80526 4. Property owner phone number: 9702222804 5. Project type: Residential 6. What type of residential? Single Family Detached 7. Value of work (Labor and Materiials)($): 3766.00 8. Type of permit: Gas/Wood Burning Appliances Please note: each individual lot requires a separate application and permit. Please note: each individual appliance requires a separate application and permit. 9. Scope of work: Gas Fireplace 10. Length of extensions of gas line (il necessary): 40' 11. Contractor name: Self 12. Contractor address: 620 Powderhorn Drive 13. Contractor phone number: 970-222-2804 14. Contractor email: dougdstoll@gmail.com 15. License number: Homeowner 16. Certificate number: Homeowner 3. Review >7 20.1 hereby acknowledge that 1 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. Signature of: Douglas D. Stoll Date Signed: 12/03/2020 21. Please Include an email address to receive a confirmation and a copy of your answers. dougdstoll@gmall.com 4. Thank You! Thank you for submitting your application for processing. To submit another over the counter application, click here. City Of Building Services Co llins PO Box 580 ppp���{ �` Co lins 281 N College Ave Fort Collins, CO 80524 970-416-2740 phone 970-224-6134fax HOMEOWNER AFFIDAVIT I , 1 J©L) otL ID. 5-L1 as owner of record of the property located at: Poc ✓y7 ��� �✓ _ —,Fort Collins, Colorado, hereby declare and attest to the following: (please check only the one that applies): OPTION 1: CONSTRUCTION OF NEW HOME ❑ I am acting on my behalf for the purpose of obtaining a building permit and personally constructing my home. The home to be constructed is on the above property and will be my primary residence. I have not personally constructed any other new homes in the Fort Collins city limits within the past 24-month period. I am acting on my behalf for the purpose of obtaining a building permit and personally constructing an alteration or addition to my house, acting as my own general contractor. The house to be altered is on the above property and is my personal rn imaWesidence. OPTION 3: PERMITED WORK ON ATTACHED SINGLE FAMILY DWELLING UNIT. ❑ I am acting on my behalf for the purpose of obtaining a building permit and personally constructing a non- structural alteration to my attached single family dwelling unit. The house to be altered is my personal rp Immy-residence. I am aware that I cannot do any structural, electrical, plumbing or mechanical work and must hire contractors/subcontractors who are currently licensed and insured with the City of ForlCollins. I am personally performing all of the work or hiring City of Fort Collins licensed trades people, or will be continuously supervising unpaid volunteers (see Option 3 for attached dwellings), The work is directly related to the construction of the above referenced home. I understand that any person(s) or agent(s) contracted to perform structural wood -framing, plumbing, HVAC, electrical or roofing work, MUST BE licensed contractors in accordance with the regulation of the City of Fort Collins. I understand that failure to comply with any of the above conditions may result in revocation of any permits associated with the above Permit Application number, forfeiture of any fees that have been collected, a Stop Work Order and potentially a court summons. Sign in the Bence of aryPubli, Owner The foregoing Affidavit was acknowledged before me on this 7iln- day of Zo9b (month,year)by JDMAQIai 5�dl Witness my hand and official seal My commission expires: &ZL—D otary P is CORINA HARTZOG Notary Public State of Colorado Notary ID # 20174008848 My Commission Expires 02-27.2021 Revised 1011912020