HomeMy WebLinkAbout4380 Ziegler Rd - Applications/Tenant Finish - 03/15/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F,`rt Collins
281 N. College Ave. •Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: BMMI3 APPLICATION DATE: b fd
Job Site Address 4380 Ziegler Rd Ft Collins CO 80525 _bitdq 4:k Unit#
PROPERTY OWNER INFO: (All owner information is required — NOTopt zonal)
Last Name Broadcom —AvaBo Tech Wireless Manufacturing LLC First Name Middle
Street Address 1320 Ridder Park Drive City San Jose State CA Zip 95131_
Phone # Email MattS@sunconstruction.com Name of
Business (COMMERCIAL USE ONLY) Avago Technologies Wireless (USA) Manufacturing, LLC, a Delaware Limited Liability Company
CONTRACTOR INFO: Company Name SUN Construction & Facilities Services
License Holder Name Scott Solem LIC # C1-84
CERT # LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. 0
Residential Sq Ft Commercial Sq Ft 10,045 # of Stories Bldg Ht
# of Dwelling Units_ 1st Floor Sq Ft_2nd Floor Sq Ft 3rd Floor Sq Ft
Unfinished Basement Sq Ft_ Finished BasementSq Ft
—# of Bedrooms # of Full Baths
Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECKONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ Prescriptive El ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric X Electric Temp. Pedestal Yes ❑ No X
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.) office
For Commercial remodels and tenant finishes, please answer the followingauestions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
Existing Tenant New Tenant❑
If for a new tenant, is this the first tenant to occupy this space?
Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space?
Are there any exterior building changes (including mechanical) associated with the work? Yes ❑ No X
Description of Work:
Am
JOBSITE SUPERVISOR CONTACT INFO: Name 2lG �� Phone
SUBCONTRACTOR INFO: Electrical _ 'rt' Mechanical —T-bi,11%
Plumbing I,1- Framing Roofing
Fireplace 7 Solar Other
ASBESTOS STATEMENT DISCLOSURE: in accordance with the State of Colorado Senate Bill13-152, property owners, applying for a
remodel permit shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (ACM's).
❑ I do not know if an asbestos inspection has been conducted on this property.
X An asbestos inspection has been conducted on this property on or about (enterdate)
❑ An asbestos inspection has not been conducted on this property.
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to
comply with all requirements contained herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant zN
Type or Print Name�� V�J
Phone# Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
OQ; c0 Submit (onn to:
w "= Dept.
for
Coloratlo DDept. BUILDING OWNER'S Penn"Co
• '� %: of Public Health
and Environment
ASBESTOS ABATEMENT PROJECT MANAGER APCD-SS-61
l* *� 430D Cherry Creek Drive South
* WAIVER APPLICATION De CO 60246.1530
Phone: 303-692-3100
�876, Fax: 303-782-0278
Building Owner Broadcom - Avago Technologies Wireless Manufacturing, LLC
Street 1320 Ridder Park Drive
City San Jose State CA Zip Code 95131
Phone Number 610 739-4718
Building Name Industrial Building
Street 4380 Ziegler Road, Building 1
City Fort Collins State Colorado Zip Code 80525
Abatement Contractor Risk Removal, LLC GAC# 10406
Proiect Manager Waiver
Colorado Regulation No. 8, Part B, requires that project managers be used to monitor asbestos abatement projects in which
the amount of friable asbestos containing material exceeds 1000 linear feet or 3000 square feet. This requirement may be
waived if the contractor performing the abatement has a history of compliance with Regulation No. 8, or if the building owner
can demonstrate that this requirement is overly burdensome or not feasible by providing a written explanation below.
Check which condition applies:
FThe abatement contractor has informed me that they have fewer than two compliance determinations with a finding
of guilty in the preceding two years.
For the above project, the project manager requirement is overly burdensome or not feasible. I request a waiver
from the project manager requirement for the following reason(s). Please attach additional pages If necessary.
I understand that use of a Project Manager is an effective means of ensuring the project is properly conducted in compliance
with applicable regulations.
I, the undersigned, hereby certify that the aforementioned statements requesting the waiver are true to the best of my
knowledge and request that the requirement for a project manager be waived for the duration of this asbestos abatement
project.
Sf;2„e=N Nyman r-j
Building Owner or Legal Agent (print name) Signature
S� . MA4t.JAC5 4aF \n/
Title
The foregoing instrument was acknowledged before me this (month/day/year)
Witness my hand and
My commission expires (month/day/year)
KATHLEEN M. MANKE I
Notary Public
State of Colorado
Notary ID # 1987412554A
My Commission Expires 03-03-2022
)h. /"1
Notary Public (sign)
Rev. 3103, CaUserslsn8895971Box Sync%DocumentslProjects120181Fort Collins Cafe and Mlnl MarketlDesfgnlPermiAl-0996 Broadcom Flooring Abatement Project Manager Waiver.doc