HomeMy WebLinkAbout1015 S Shields St - Applications/Mechanical - 07/07/2016Planning, Development & Transportation
CetY$of 281 N. College Ave P.O. Box 580
&t 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
molition (interior non-structural) ❑Electrical Alteration (not service change) u vas Lighter u vas 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.
r� I
Application # !h U A
For office use only
Date T11d,
Job Site Address (required)
Value of Construction (labor, materials, profit)
. SHIFL83 ME
/0 000.
Property Owner Name Address
City/State Zip
Phone
M
L Ns $D 5 Z I
- 39/- y�osi
Applicant Name Address
City/State Zip
Phone
CUSTOM HEATING INC 395 DELOZIER DR #120 FORT COLLINS, CO 80524
282-7220
Contractor Address
City/State Zip
Phone
SAME AS APPLICANT
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑
Yes "0-
31254
Is this a residential or commercial project? ❑ Residential [9"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 detail
❑ Restaurant ❑ Other (explain &AS SJA'rr o V _
Is this building 50 years of age or more? ❑ Yes 4YNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 Plumber.
Mechanical H-1004 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: MICHAEL WETZBARGER ✓44i� 1N'e &r eY Date
Print Name: ignature g
Community Development & Neighborhood Services
t�O«�nS 281 North College Avenue '
F _Ofry M Fort Collins, CO 80524
970.416.2740
Over the counter permit. info sheet for. -
New and replacement hvac roof -top equipment, furnaces, and water
heaters
The following information must be included to approve the permit. Check all that apply.-
1. Roof -top equipment and furnaces:
Replacement of existing equipment.
❑ New/additional roof -top 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.
❑ For New equipment. See attached engineered documentation showing roof can
support new equipment or modifications that must be done to support such
equipment.
❑ Ground or floor mounted.
2. Hot Water Heater:
❑. Replacement
❑ New
❑ Same size or smaller than previous.
❑ Larger than previous water heater.
❑ If for a restaurant I have approval from Larimer County Health Dept for minimum
water heater capacity.
3. All equipment/appliances must be installed in compliance with 2009 IMC, IFGC, IPC, and
2011 NEC.
Applicant._s' nature. _an--
._. ate_.....- - - -
(Form updated 1-18-2013)