HomeMy WebLinkAbout1017 W Magnolia St - Applications/Solar - 01/11/2017Planning, Development and Transportation
City Of Building Services Department
281 N. College Ave P.O. Box 580
!6r } l Collins 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 boz):
❑X Photovoltaic Solar (PV)
❑ Thermal Solar (Hot Water System)
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # B 17 0 014 2 Date
For office use only
ENTERED JAN 1 12017
Job Site Address (required)
Value of Construction (labor, materials, profit)
1017 W Magnolia St , Fort Collins
CO 80521 6364.8
Property Owner Name
Address City/State Zip Phone
Greg Obermann
Same as above (970) 405-3745
Applicant Name
Address City/State Zip Phone
Solar City
470 E 76th Ave #3A Denver, CO 80229 253-720-4461
Solar Contractor License #/Co. Name
Address City/State Zip Phone
Solar City
470 E 76th Ave #3A Denver, CO 80229 253-720-4461
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? QX Here ❑ Report
Sales tax number is required by all contactors.
Are you paying with your trust account? ❑ Yes ❑X No
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? E Yes O No
Is this a residential or commercial project? ❑X Residential ❑ Commercial
If residential, is it: OSingle 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 Preservation
Description of work*
Install a 4.68 kW roof -mounted grid -tied solar PV system
*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 C—Ity Registered Plumber)
Electrician Solar City 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: Digitally signed by Jerertn Burks
Jeremy Burks Jeremy BUrkSDate:i017.01.0a,327:36 1/4/2017
Print Name: Signature -)Too Date