HomeMy WebLinkAbout621 ROOK ST - APPLICATIONS - 12/30/2011COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER kI 1 . 'LA —I APPLICATION DATE le%b kk
Job Site Address 6,-V eooe 571-e-e,70"' Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name �/'�rt /��e GLG' First Name Middle
Street Address 2�38 �a,t° City tZ7 L//j�o11/if State—,/,—ZipAhfo:;?z 4
CONTRACTOR INFO: Company Name Arl or- y1Cj/ Contractor Phone # 79roz�
Lic Holder Name r� wS57 / �!/{�I r�%/f City of Fort Collins License # L.2 647 Supervisor Certt # 4 �, —e,2
Mailing Address y�����-T/ic/C�D/' City �1iW1141_ State �O Zip 176 oZy
LEGAL INFO: ��
Subdivision/PUD eDL✓ni V/?4,vl Filing #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) IV !; l
Residential Sq Ft S�.Z Comm9 Sq Ft_
Is' Floor Sq Ft 2nd Floor Sq Ft
0
Lot #A�S__ Block # Lot Sq Ft ;23177
yo
Total Garage Sq Ft
# of Stories_ Bldg Height # Dwelling Units l
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft /ar.Z-
Finished Bsmt Sq Ft O # of Bedrooms Y # of Full Baths t{ '/< Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes tIT�o Energy info: ( Circle appropriate choice) 1. ComCheck ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
Water Tap Size Zl— Sewer Tap Size / Metered: Yes or No Temp. Pedest Yes r No
Type of Heat: j�Gas ❑ Electric Electric Main Breaker Size (Residential only) 1§50 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ d U-279
Description of Work: /Ulmer/
if
Contact Name & Phone # of JOBSITE SUPERVISOR: Cyr
Subcontractor Info: /]
Electrical `"4ow"X Mechanical 44" /'%%� Plumbing
Framer q Roofing % O-4u Concrete Uti 11/IGI10C Fireplace
Solar
Other
Other
Other
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 r fnances and state laws regulating building construction.
Applicant Signature /'�i P /! Print Name t�(// `CC, Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
B1111Ae9172013
r F01't CO«1115 Planning, Development 8 Transportation Services
Community Development & Neighborhood Services
20I2 FORT COLLINS RESIDENTIAL ENERGY CODE COMPLIANCE FORM
FORM I - NON -ELECTRIC HEAT (If using e%c heat form 3 must be used), use this
form for single family houses, dup/ex, townhouses, or multi -family up to 3
stories.
Permit Number:
Address:
DIRECTIONS: Place a check next to Prescriptive, UA, or SPA indicating the path chosen. Next, circle the
method within that path you intend to follow. If choosing prescriptive or UA, the applicant must also
choose between Air sealing or Blower Door Test.
BUILDING ENVELOPE
Wood frame wall insul r-value
Metal frame wall insul r-value
Crawl space wall
Roof insulation in attic
Roof rafter insulation
Walls below grade
Wood floor over un-cond
Slab on grade floor, unheat
Windows
for house, 2009 IRC, section N110
INSULATION R-VALUE
R-20 or 13+5ci
R-13+9ci or R-19+8
R=13 or R-10ci
R-38
R-30 .
5 R-13 / R=10ci
R-30
R-10, 24" DEEP
U-.35
(B)TOTAL UA ALTERNATIVE (ResCheck), 2000 IRC, SECTION N1102.1.3
Submit a passing UA calculation (i.e. ResCheck) using .2009 IRC/IECC. The rating must be submitted at time of
application and must include address of residence; name of, individual completing the rating form; name &
version of software tool i.e. ResCheck). Air Sealing Checklist or Blower Door Test is re '
Circle one for either method above: Air Seaiing(visuai inspection) Blower Door Test
(C)SIMULATED PERFORMANCE ALTERNATIVE, 2009 IECC, SECTION 405
An energy rating system must be utilized using approved computer software tool such as the new modified Fort
Collins version of RemRate. A preliminary rating passing the 2009 IECC must be submitted at time of application.
Rating must include Address, Name of individual completing the rating,& Name & version of software tool. Final
rating requires a blower door t%t. Final passing rating must be submitted for certificate of occupancy.
climate zone 5.
SIGN:
DATE:
/
CONTRACTOR: <1 /�� (��
PHONE: ellgno