HomeMy WebLinkAbout4700 LADY MOON DR - APPLICATIONS - 1/24/2020City of
Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
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%PPLICATION NUMBER: fJ R 00-0 —iAPPLICATION DATE: I .Ly
Job Site Address 4700 Lady Moon Drive Unit#
PROPERTY OWNER INFO: (All owner information is,required — NOT optional)
Last Name Health First Name Banner Middle
Street Address 1801 16th Street City Greeley State CO Zip 80631
Phone # 970-810-2011 Email Randy.Sullivan@BannerHealth.com
Name of Business (COMMERCIAL USE ONLY) Banner Forth Collins Medical Center
CONTRACTOR INFO: Company Name Sailer Construction
License Holder Name John Sailer LIC # B-434 CERT # 949-BZ-3
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) 1,739 Total Garage Sq. Ft.
Residential Sq Ft Commercial Sq Ft 1,739 # of Stories I Bldg Ht 1 P-9" # of Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Unfinished Basement Sq Ft
Finished Basement Sq Ft # of Bedrooms # of Full Baths
3/ Baths Y2 Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ® UA (ResCheck) ❑ SPA (Simulated Performance ❑ Prescriptive[] ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES 29 NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal Yes ❑ No ❑
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.) Medical - Ambulatory Care Facility
For Commercial remodels and tenant finishes. please answer the following auestions:
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 ❑
If yes, please describe:
Value of Construction (materials and labor): $ 369,248.00 ,
Description of Work: Constructing a short-term addition to an existing hospital. The addition is a vestibule,
clean storage and pump room which connects a prefabricated modular catherization lab building to the hospital.
The plan is for the lab to remain three to eight years while a permanent lab is designed and constructed.
Previously permitted (#B 1805719), being resubmitted with some minor changes to building and location.
JOBSITE SUPERVISOR CONTACT INFO: Name John Sailer Phone
970-412-9605
SUBCONTRACTOR INFO: Electrical Fiske Electric Mechanical Innovative Design
Plumbing Innovative Design Framing Baldrey & Sons, Inc. Roofing Douglass Colony
Fireplace
Solar
Other
ASBESTOS STATEMENT DISCLOSURE: in accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a
remodel permit shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (RCM's).
❑ I do not know if an asbestos inspection has been conducted on this property.
® An asbestos inspection has been conducted on this property on or about (enter date) 1/16/2015
❑ 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 Signature Terrell Hastings mType or Print Name Terrell Hastings
Phone # 307-632-3144 ext. 122 Email terrell@tobin-assoc.com
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE