HomeMy WebLinkAbout3563 Sunflower Way - Applications/Solar - 09/17/2018Planning, Development and Transportation
City Of Building Services Department
281 N. College Ave P.O. Box 580
F 01rr•} l Collins IS Fort Collins, CO 80524
/ Phone 970-416-2740 Fax 224-6134
SOLAR PERMIT APPLICATION FORM
This application is to be used to apply for the following permits only (check the appropriate box):
❑ Photovoltaic Solar (PV)
❑ Thermal Solar (Hot Water System)
Complete all applicable information on the application. Incomplete applications will not be accepted.
%Application # & V Date 09/17/2018
For Acevse only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3563 Sunflower Way
$20,550
Property Owner Name
Address
City/State Zip
Phone
Jennifer Bergdolt
3563 Sunflower Way Fort Collins CO 80521
(970) 222-6899
Applicant Name
Address
City/State Zip
Phone
Davis Clayton
6707 Winchester
Circle Fort Collins CO 80301
(919) 306-7955
Solar Contractor License #/Co.
Name Address
City/State Zip
Phone
Lic: S-2592 Namaste Solar
6707b
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
IR Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ® No
48551
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? 1A 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 SO years of age or more? ❑ Yes ® No Ifyes, you may need to contact Historic Preservation
Description of work*
Installation of 6.65 kW solar PV system grid tied and flush mounted to roof of residential home. 19 Panels. No Battery
*Please note in description if; roof flush mounted, roof mounted & elevated, ground array, kw amount, how many solar panels.
Subcontractors: List the company name or City of Ft Collins license # (PV MUST fist City Registered Electrician — Thermal MUST
list City Registered Plumber)
Electrician Plumber Roofer (For solar PV shingles)
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: �� i S Q��0
Print Name: (�f Signature Date