HomeMy WebLinkAbout913 CHEYENNE DR - APPLICATIONS - 7/8/2015Jul 08 15 03:21 p Hahn plumbing
970-493-5325 p.1
City of
Fort CoWns
Planningr Development & Transportation
281 N. College Ave P.O. Box 580
Fort 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). 0 Air Conditioning
O Demolition (interior non-structural) El Electrical Alteration (not service change) ❑ Gas Ughter Cl Gas Log
CI Heating Unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line . ❑ Photo -voltaic
❑ Ventilation�OWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manutacturer)l
Complete all applicable information on the application. Incomplete applications will not be accepted.
9150 57, 1- - W +i V ii
Application Z ( - ini tj N Z Date d
Sor o>"fice use only
Job Site: Address (required)
1
Value of Construction (labor, materials, profit)
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Property O er NamA
Address
City/State Zip
Phone '
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins S
Tax # fYt P— I S
Are you paying taxes here or by report? ❑ Here
I'Report
Sa/as tax numberIsrequi ed byron&actas
Are you paying with your trust account? )(Yes
❑ No
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?s this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: 17 Single Family Detached Q Condo/townhome (single family attached) - - I3 Duplex
❑ Multifamily (apartment) L7 Garage
If commercial, is it: n Bank ❑ Bar 0 Church ❑ Hotel/Matel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to cont3ctH8to cFreservafion
If this is for a demolition permit, what year was the building constructed?
If prior is 1975, you will nezd an asbestos assessment to submit with this application.
of work
*If lawn spr[nkierlbackftow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or Gly of 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 Nam Q V'hj`Q Signature S2 falJ, / , Date 7 �4 IS-
Jul 08 15 03:21 p Hahn plumbing 970-493-5325 p.3
FortnCollins
Community Development & Neighborhood -Services
281 North College Avenue
Fort Colons, Co 60524
970.416.2740
over the counter ver nit info sheet for;
New and replacement hvac roof-tov eauiyment, furnace& and water
heaters
The following information must be included to approve the permit. Check all that apply.
1. Roof -top equipment and furnaces:
❑ replacement of existing equipment.
❑ Newladditional roof -top equipment.
❑ 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.
❑ Replacement equipment is in the same location and not taller than previous.
❑ 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:
Replacement
❑ New
Same size or smaller than previous.
i
❑ 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, IEGC, IPC, and
2011 NEC.
Applicant sig ature and d
(Form updated 1-18-2013)