HomeMy WebLinkAbout1101 Lory St - Applications/Solar - 12/08/2016Fort Collins
Planning, Development and Transportation
Building Services Department
281 N. College Ave P.O. Box 580 U
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 # b I(PO 1eetlPl Date
For ogre use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1101 Lory St., Ft. Collins, CO 80521
$10,080.00
Property Owner Name Address
City/State Zip
Phone
Jim Matlock 1101 Lory St.
Ft. Collins, CO 80521
(970) 231-0909
Applicant Name Address
City/State Zip
Phone
EcoMark Construction 4665 Paris St. Ste C-300, Denver, CO 80239
(303) 667-2538
Solar Contractor License #/Co. Name Address
City/State Zip
Phone
S3606/EcoMark Construction 4665 Paris St.
Ste C-300, Denver, CO 80239
(303) 667-2538
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contactors
Are you paying with your trust account?
❑ Yes ,kNo
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? O Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ,Eningle 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 50 years of age or more? ❑ Yes ,>LNo If yes, you may need to contactHistonc Preservation
Description of work*
5.04 kWDC solar PV system. Rooftop, flush mounted. Utilitjnterconnected, 18 solar PV modules.
*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 # (PlIMUST list City Registered Electrician - Thermal MUST
list City Registered Plumber)
Electrician M E-1480 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:
Print Name: Jason R. Wheeler Signature Date