HomeMy WebLinkAbout1412 SIOUX BLVD - PERMITS - 1/8/2021Owner:OSBORN BRUCE TAD/JANELL LEE
1412 SIOUX BLVD
FORT COLLINS,CO 80526-2593 Phone:970-420-2619
Zoning:Front setback:Rear setback:Right setback:Left setback:
Minor Amend #:Plat File #:ZBA Case #:
Zoning district:RL -LOW DENSITY RESIDENTIAL 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:SANDBOX SOLAR,LLC
430 N.College Ave.,Ste.435
FORT COLLINS,CO 80524
License #:ME-1713
Phone:970-673-7733
Supervisor cert #:
Subcontractor(s)Phone License Number
Electrical:SANDBOX SOLAR,LLC 970-673-7733 ME-1713
Work Description:Panel change out for solar permit,no service upgrade.
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:201 206 301 103 302 300
TOTAL FEES PAID AS OF 01/06/21:$111.50 Payment method:Trust Account
**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 work on the property described herein.
I agree to comply with all the requirements contained herein,and City ordinances,and State laws associated with such work.I understand that such permit may be
revoked in the event that issuance was based on incorrect information.This permit shall become null and void if the work authorized by such permit is not commenced,
suspended,abandoned or not inspected within 180 days from the date of such permit.
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 #:B2100101
Issued Full:01/06/2021
Permit Type:Residential Electrical
Site Address:1412 SIOUX BLVD
Job Valuation:$2,000.00 Category:Residential
Signature:Print Name:Date:
Form Revised Oct 2010
Transactions
Method Check Number Date Paid Amount Paid Comments
Trust Account 01/06/2021 $111.50
Receipt issued:01/06/2021 Total Paid to Date:$111.50
Fee Description Account Code Fee Amount Amount Paid Date Paid Amount Due
City Sales/Use Tax 251.122030 $38.50 $38.50 01/06/2021 $0.00
County Sales/Use Tax 100.217030 $8.00 $8.00 01/06/2021 $0.00
Permit Flat Fee -$65 1000.422010 $65.00 $65.00 01/06/2021 $0.00
TOTAL FEES:$111.50 $111.50 $0.00
TOTAL BALANCE DUE AS OF 01/06/2021:$0.00
Community Development &Neighborhood Services
281 N.College Ave Fort Collins,CO 80522
970.221.6760 970.224.6134 -fax
Building Permit #:B2100101
Issued Full:01/06/2021
Permit Type:Residential Electrical
Site Address:1412 SIOUX BLVD
Job Valuation:$2,000.00 Category:Residential
Fee Amounts are valid for date of this document only.Fees subject to change without notice.
Form Revised Oct 2010
Community Development and Neighborhood Services
281 N College
Fort Collins, CO 80524
970-416-2740
buildingservices@fcgov.com
ELECTRICAL 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 Medical Office Office Retail Restaurant
Value of Work
Labor and Materials $ ________________________________
Scope of Work
Panel change out Meter change out Upgrade existing wiring
Panel Upgrade (May require additional review time. A commercial panel upgrade of 225A or 3 phase requires a 1 line diagram.)
Other electrical alterations _________________________________________________________________________________
Service Upgrade Yes No
Existing Amps _________________________________
New Amps ____________________________________
Additional Information
(if applicable)
Electrical Contractor Information
Name ________________________________________________________________________________________________________
Address ________________________________________________________________ City/State/Zip _________________________
Phone Number ____________________________________ Email ______________________________________________________
License Number ME- _______________________________
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
Application # _____________________________
Date Received ___________________________
800
Sandbox Solar
430 N College Ave # 435 Fort Collins, CO 80524
(970) 279-1035 engineering@sandboxsolar.com
1713
Dylan Gibson
2000
1412 Sioux Blvd Fort Collins 80526
Tad Osborn 970-420-2619
1412 Sioux Fort Collins, CO 80526
1/6/2021
To accompany PV permit for same address
B2100101
1/6/2021