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Home My WebLink About4700 Lady Moon Dr - Applications/Tenant Finish - 12/18/2018City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES F`rt Collins 281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.com/building BUILDING PERMIT APPLICATION 1 FOR OFFICE USE APPLICATION NUMBER: 1� � �� APPLICATION DATE -.:a `� s Job Site Address 4700 Lady Moon Drive, Fort Collins CO 80528 Unit# PROPERTY OWNER INFO: (All owner information is required — NOT optional) Last Name BANNER HEALTH SYTEMS Street Address 1441 N. 12th Street City Phoenix State AZ Zip 85006 Phone # 970-631-6075 Email brad.mccaslin@bannerhealth.com Name of Business (COMMERCIAL USE ONLY) Banner Health Fort Collins Medical Center CONTRACTOR INFO: Company Name AP Mountain States DBA Adolfson and Peterson Construction License Holder Name KENT WEIGHT LIC # B-157 CERT # LEGAL INFO: Subdivision/PUD Filing # Lot # Block # Lot Sq Ft _ CONSTRUCTON INFO: Total Building Sq Ft (NOT Including basement) Total Garage Sq. Ft. Residential Sq Ft Commercial Sq F Pf Stories Bldg Ht # of Dwelling Units 1st Floor Sq Ft 2nd Floor Sq Ft qtdflF�oor Sq Ft Unfinished Basement Sq Ft Finished Basement Sq Ft # of Bedrooms 6 Rooms # of Full Baths %Baths Y2 Baths # Fireplaces ENERGY INFORMATION: (CHECK ONE) ComCheck 91 UA (ResCheck) ❑ SPA (Simulated Performance Alternative) Air Conditioning? YES ❑ NO ❑ City of Fort Collins Approved Stock Plan # SPO ❑ Prescriptive❑ List Option #s 6 Baths ERI(Energy Rating Index) ❑ UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal Yes ❑ No ❑ Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp ❑ Other ❑ ZONING INFO: (COMMERCIAL USE ONLY) Proposed Use: (i.e. medical, office, bank, retail, etc.) Medical For Commercial remodels and tenant finishes, please answer the following auestions: Is the remodel/tenant finishes for an existing or new tenant? (Please check one) Existing Tenant® New Tenant❑ If for a new tenant, is this the first tenant to occupy this space? Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space? Are there any exterior building changes (including mechanical) associated with the work? Yes ❑ No 191 If yes, please describe: J Description of Work: JOBSITE SUPERVISOR CONTACT INFO: Name Jayson Mallsanl- Superintendent Phone 720-656-7854 SUBCONTRACTOR INFO: Electrical _ unknown yet Mechanical unknown yet Plumbing unknown yet Framing Holsinger Drywall Roofing Fireplace Solar Other ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a remodel permit, shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (ACM's). ❑ I do not know if an asbestos inspection has been conducted on this property. lZ An asbestos inspection has been conducted on this property on or about (enter date) 12/2016 ❑ An asbestos inspection has not been conducted on this property. Applicant: 1 hereby acknowledge that 1 have read this application and state that the above information is correct and agree to comply with all requirements contained herein and City of Fort Collins ordinances and state laws regulating building construction. Applicant Signature i?fa,,p,`�✓.� Type or Print Name Jayson Malisani Phone # 720-656-7854 Email imalisani@a-p.com THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE Planning, Development & Transportation Services FCoty o f Community Development & Neighborhood NorthCollege Avenue �t Collins 80524 ` �� (�` 011 970.416.2740Building Permit Submittal Checklist: ComFercia R�r>IioJd/T�e na0nt Finish Incomplete or deferred submittals will not be accepted --Required NA=NotApp'licable NIS=Notirlscope A Fully Stamped Set is required for any of the following (4) conditions: No 1. Scope of work greater than 5,000 square feet No 2. First Tenant to occupy a space No 3. Change of Occupancy (see additional handout) No 4. New 3 phase service or service change greater than 225 amps -Only for Electrical Scope. Existing and Proposed Scaled Drawings Floor Plans with room labels and areas Accessibility details as required Interior Elevations including restrooms Structural Drawings (stamped by a State of Colorado licensed Structural Engineer or qualified Architect) Exterior Elevations (see Zoning requirements) Wall types, sections and details. Mechanical Drawings X Drawings to show supply, Return, Exhaust, Hoods, and other special equipment. Electrical Drawing X Outlets, lighting plan, panel, one -line, equipment. Plumbing Drawings X Waste and Vent Isometric, Supply, Equipment. ComCheck or Lighting Wattage Worksheet X Required for Lighting alterations more than 50%. �•• • • requireL (may .. Larimer County Health Department 1525 Blue Spruce / (970)-498-6785 X https://www.larimer.org/health Required for food or drink service, preparation, or processing; daycares; schools; and healthcare. Energy Assessment: 970-221-6818 assessments@fcgov.com NR (n' Free assessment by Fort Collins Utilities. Required for alterations of $50,000 +, or has not had an assessment within the past 3 years. Poudre Fire Authority: 102 Remington / (970)-416-2891 https://www. poudre-fire.org/online-services ✓ A separate submittal is required through the Poudre Fire Authority website for most tenant finish projects. Fire suppression system modification will also require a separate additional submittal. Zoning: 281 N College / (970) 416-2745 zoning@fcgov.com Change of Use or Exterior modifications (i.e.: facade, parking, landscaping, or other changes visible to the public), may require a minor amendment. Are you building in a Floodplain? https://www.fcgov.com/uti I ities/what-we- do/sto rmwater/flood i n g/fl ood pla i n-maps-documents Historic Preservation Review www.fcgov.com/h istoricpreservation Alterations to, or Demolitions of buildings more than 50 years old will be reviewed for Historic Eligibility Applicant Name: Jayson Malisani- Adolfson and Peterson Job Site Address: 4700 Lady Moon Drive Fort Collins CO 80528 Construction Phone: 720-656-7854 Email (Required): jmalisani@a-p.com