HomeMy WebLinkAbout623 S Grant Ave - Permits/Plumbing - 06/03/2020Owner: SHIELDS RAFFAELE WILLIAM
623 S GRANT AVE
FORT COLLINS, CO 80521-3618 Phone: 970-231-7665
Zoning: Front setback: Rear setback: Right setback: Left setback:
Minor Amend #: Plat File #: ZBA Case #:
Zoning district: NCM - NEIGHBORHOOD CONSERVATION - MEDIUM DENSITY DISTRICT
Legal: Subdivision/PUD: Filing #: Lot #: Block #:
Code: Res sq ft: Com sq ft: Ind sq ft: Basement sq ft:
# of stories: Occ Group: Const Type:
Fire Sprklr: Stock plan #: Stock plan options:
Contractor: RDB PLUMBING, LLC
408 N. Loomis Ave.
FORT COLLINS, CO 80521
License #: MP-976
Phone: 970-308-1470
Supervisor cert #:
Subcontractor(s) Phone License Number
Plumbing: RDB PLUMBING, LLC 970-308-1470 MP-976
Work Description: Gas line, stubbed line through exterior wall at front of house to add a has meter to separately meter the
APPROVED DUPLEX.
SCHEDULE INSPECTIONS: ** via Text Message: 888-406-6394 ** By Phone: 970-221-6769
** Online Portal: fcgov.com/CitizenAccess ** Online Portal via Mobile Device: fcgov.com/CitizenAccess/mobile
Possible Inspections Required: 200 204 102 301 302 300
TOTAL FEES PAID AS OF 06/03/20: $30.81 Payment method: Credit Card 9541
** Fee Detail Displayed on Next Page
As a condition for the issuance of a permit, I hereby declare that I am the owner or owner's agent, authorized to perform the proposed workonthepropertydescribedherein.
I agree to comply with all the requirements contained herein, and City ordinances, and State laws associated with suchwork. I understand that such permit may be
revoked in the event that issuance was basedonincorrectinformation. This permit shall become null and void if the work authorized by suchpermitisnotcommenced,
suspended, abandoned or not inspected within 180 days fromthedateofsuchpermit.
Carbon Monoxide Alarm required within 15 feet of each bedroom entrance.
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 - fax
Building Permit #: B2005709
Issued Full: 06/03/2020
Permit Type: Residential Plumbing
Site Address: 623 S GRANT AVE
Job Valuation: $250.00 Category: Residential
Signature: Print Name: Date:
Form Revised Oct 2010
Transactions
Method Check Number Date Paid Amount Paid Comments
Credit Card CK # 9541 06/03/2020 $30.81
Receipt issued: 06/03/2020 Total Paid to Date: $30.81
Fee Description Account Code Fee Amount Amount Paid Date Paid Amount Due
Building Permit Fee Without
Subs
1000.422010 $25.00 $25.00 06/03/2020 $0.00
City Sales/Use Tax 251.122030 $4.81 $4.81 06/03/2020 $0.00
County Sales/Use Tax 100.217030 $1.00 $1.00 06/03/2020 $0.00
TOTAL FEES: $30.81 $30.81 $0.00
TOTAL BALANCE DUE AS OF 06/03/2020: $0.00
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 - fax
Building Permit #: B2005709
Issued Full: 06/03/2020
Permit Type: Residential Plumbing
Site Address: 623 S GRANT AVE
Job Valuation: $250.00 Category: Residential
Fee Amounts are valid for date of this document only. Fees subject to change without notice.
Form Revised Oct 2010
Application # _____________________________
Date Received ___________________________
PLUMBING PERMIT APPLICATION
ALL information is REQUIRED. Incomplete applications will not be accepted.
Job Site Address
Address ________________________________________________________________ City/State/Zip _________________________
Property Owner Information
Name ______________________________________________________ Phone Number _____________________________________
Address ________________________________________________________________ City/State/Zip _________________________
RESIDENTIAL Single Family Detached Townhome (attached) Duplex Apartment/Condo Garage/Other
COMMERCIAL Bank Bar Church Hotel/Motel 0HGLFDO2I¿FH 2I¿FH Retail Restaurant
Value of Work
Labor and Materials $ ________________________________
Scope of Work
Sewer line replacement / new Feet to be replaced / installed _____________________
Water line replacement / new Feet to be replaced / installed _____________________
Gas line replacement / new Feet to be replaced / installed _____________________
Other plumbing work _____________ ________________________________
Additional Information
(if applicable)
Plumbing Contractor or Excavation Company
Name ________________________________________________________________________________________________________
Address ________________________________________________________________ City/State/Zip _________________________
Phone Number ____________________________________ Email ______________________________________________________
License Number ___________________________________
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.
Print Name Signature Date
Community Development and Neighborhood Services
281 N College
Fort Collins, CO 80524
buildingservices@fcgov.com
970-416-2740
623 S. Grant Ave. Fort Collins/ CO/ 80521
Raffaele Shields 970.231.7665
623 S. Grant Ave. Fort Collins/ CO/ 80521
X
250.00
X
Gas line was existing in home when purchased. Stubbed line through exterior wall at front of
house to add a gas meter to separately meter the duplex. Line is on test for inspection.
RDB Plumbing; licensed plumber Matt Briscoe
< 6 LF through exterior wall
408 N Loomis
MP-976
Fort Collins/ CO/ 80521
970.308.1470
Ralph Shields Ralph Shields 06/03/2020
Digitally signed by Ralph Shields
DN: C=US, E=rshields@bellisimoinc.com,
CN=Ralph Shields
Date: 2020.06.03 14:15:24-06'00'