HomeMy WebLinkAbout2601 Midpoint Dr - Applications/Mechanical - 01/17/2017City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580 V
Fort Collins, CO 80524
/V'��_ J►��,` Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY '��g`7D
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 # (-,b two 04 Date I - 1 /.
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
B'FFere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes tYNo
Is this a residential or commercial project? ❑ Residential O'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 ❑ No If yes, you may need to contact Historic Pieseruation
If this is for a demolition permit, what year was the building constructed?
Description of work /,: /« 11, i e c le er/«c A-t~ 4.� J-
*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 #
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Electrician Plumber Mechanical_ A Roofer Other
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: Signature
/ ��` "'�`��� Signature
Date / %
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City Of I community Development &
Y Neighborhood Services
F6rt CQ`lins For 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 Commercial 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 heating/cooling/ventilation equipment:
T"'Replacement of existing equipment.
❑ New/additional roof -top equipment.
e' 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
equipment.
❑ Replacement equipment is in the same location and not taller than previous.
G3"IReplacement equipment is in new location an or taller.
❑ For New equipment. See attached engineered clocu entation 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 smaller than previous.
❑ Larger than previous water heater.
❑ If 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.
Appli signature and date
Permit number
(Form updated 01.08.2014)