HomeMy WebLinkAbout227 Jefferson St - Applications/Mechanical - 12/11/2019City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 # IS1 q ( 6 qq (o Date 12/10/19
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
227 Jefferson St. 6702.51
Property Owner Name Address City/State Zip Phone
Doug Holt 2945 Julliard St. Boulder, CO 80305 3146810629
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Drive #4 Fort Collins,CO 80524 9704844552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Drive #4 Fort Collins,CO 80524 9704844552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here iz Report
Sales tax number is required by all contractors Are you paying with your trust account? ® Yes ❑ No
31906
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 ♦a 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?
Description of work Replace Single head Mini Split (outdoor unit is on the roof)
*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 H1309 Roofer Other Boomer Cranes
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: Amanda Elder Signature Amanda Elder Date 12/10/19
Revision date 2162017
Fort Collins
Community Development &
Neighborhood Services
281 N College Ave. P.O. Box 580
Fort Collins, CO 80524
Phone: 970,416.2740 Fax:970.224.6134
www,fcgov com
Over the counter permit information 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
uipment.
!!! placement 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.s han previous.
❑ Large an previous water heater.
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 2012 IMC, IFGC, IPC,
and 2014 NEC.
Applicant signature and date110M 6 � q I (..a -q L(�2
Permit number