HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 5/8/2014Planning, Development & Transportation
City
}Of 281 N. College Ave P.O. Box 580
F6r` CollinsIFort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY.
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 Awater 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 # 1151 i022(P �7 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, pro it) li 5cv'
l 2-ltiS
Q�dS
Ceq76) 54,D7 -
Property Owner Name Address
City/State
Zip
Phone
Applicant Name Address
City/State
Zip
Phone
Contractor Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ 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 0 Medical office ❑, Off)ce ❑Retail
17 Restaurant ❑ Other (explain Pti ZF �--
Is this building So years of age or more? ❑ Yes 0-No If es, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
6
*If laws{ sprinkler/backfiow
W
list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Co of Ft Collins license #
Electrician Plumber ^ Mechanical 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:�i/i y6 �Pti Signature `% F. Date
FA
010
Community Development & Neighborhood Services
CILY01 I 281 North College Avenue
�
F6rl CoWnS Fort Collins, CO 80524
f 970.416.2740" Li�v?ZW�
Over the counter permit info sheet for. -
New and Mplacement h vac roof-W equipment, furnaces, and water
heaters
The following information must be included to approve the permit. Check all that apply. t
1. Roof -top equipment and furnaces:
❑ Replacement of existing equipment.
❑ New/additional roof -top equipment.
o 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.
a Replacement equipment is in the same location and not taller than previous.
o Replacement equipment is in new location and/or taller.
❑ For New equipment. See attached engineered documentation. showing roof can
support new equipment or modifications that must be done to support such
`equipment:
❑ Ground or floor mounted.
2. Hot Water Heater:
�6 Replacement
❑ New,
9- 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 2009 IMC, IFGC, IPC, and
2011 NEC.
f
Applicant signature and date
(Form updated 1-18-2013)