HomeMy WebLinkAbout2121 Brookwood Dr - Applications/Solar - 11/16/2016Planning, Development and Transportation
City Of Building Services Department
rr++} • r1 281 N. College Ave P.O. Box 580
of l Collins t5 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
For office use only
Date IIh4 (� Z0(4
Job Site Address (required) Value of Construction (labor, materials, profit)
2121 Brookwood Dr., Ft. Collins CO 80525 $15,680.00
Property Owner Name Address City/State Zip
Phone
Lindsay Connors 2121 Brookwood Dr. Ft. Collins CO 80525
970 372-8403
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? Z9iere ❑ Report
sales tax number is required by all contactors. Are you paying with your trust account?
❑ Yes ❑ No
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? ❑ Yes
Is this a residential or commercial project? ,11 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 50 years of age or more? ❑ Yes rd'No If yes, you may need to contact Historic Preservation
❑ No
Description of work*
7.84 kWDC solar PV system. Rooftop- flush mounted. Utility interconnected. 28 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 # (PV MUST list City Registered Electrician — Thermal MUST
list City Registered Plumber)
Electrician ME-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 Signatur Date 1 I