HomeMy WebLinkAbout6420 FOSSIL CREST DR - PERMITS - 5/19/2021City of
k!:tColli~
Site Address : 6420 FOSSIL CREST DR
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 -fax
Building Permit#: B210525 7
Issued Full : 07/07/2021
Permit Type: Residential Mino r Alterati on
Job Valuation: $1,200.00 Category: Residential Remodel
Owner: NOLL KENT I
6420 FOSSIL CREST DR
FORT COLLINS, CO 80525-40 10 Phone : 970-222-0443
Zoning : Front setback Rear setback: Right setback ____ _ Left setback:
Minor Amend#: ______ P lat File#: ZBA Case# -----Zoning district: UE -URBAN ESTATE DISTR ICT
Legal: Subdivision/PUD ________________ Filing#: Lot#: B lock #:
Code: Res sq ft 0 ----# of stories :
Fire Sprklr:
Contractor :
Subcontractor(s)
Com sq ft:
0cc Group:
Stock plan# ----
Ind sq ft
Const Type:
--------
Basement sq ft _______ _
---------------------Stock plan options
License#: Supervisor cert#:
Phone :
Phon e License Number
Work Description: After the fact irstall ation of 30 ft of gas line for new water heater and flue . Con ve rted electric wate r heater to gas
water heater. Homeowner affidavit on file.
SCHEDULE INSPECTIONS: ** via Text Message: 888-406-6394 ** By Phone: 970-221-6769
** Online Portal: fcgov.com/CitizenAccess ** Online Portal via Mobi le Device : fcgov.com/CitizenAccess /mobile
Possible Inspections Required : 102 205 200 202 204 303 302 203 301 201 300 207
TOTAL FEES PAID AS OF 07/07/21: $59.74 Payment method: Check 5854
** Fee Detail Displayed on Next Page
As a condition for the issuance of a permit, I 1ereby declare that I am the owner or own ers 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 perm it shall become null and vo id 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 with in 15 feet of each bedroom entrance.
Signa ture: Print Name: Date: -------------------------------------
Form Revised Oct 201 a
City of
k tCollir!:
Site Address: 6420 FOSSIL CREST DR
Community Development & Neighborhood Services
281 N . College Ave Fort Collins, CO 80522
970.221.6760 970.22 4.6134 -fax
Building Permit#: B2105257
Issued Full: 07/07/2021
Permit Type: Residential Minor Alteration
Job Valuation: $1,200.00 Category: Residential Remodel
T'"ansactions
Me thod
Check
Check Number
CK# 5854
Date Paid
07/07/2021
Amount Paid
$59.74
Comments
Receipt issued: 07/07/2021 Total Paid to Date: $59.74
Fee Description Account Code
Building Permit Fee w/S u bs 1000.422010
TOTAL FEES:
Fee Amount Amount Paid
$59.74 $59.74
$59.74 $59.74
Date Paid
07/07/2021
TOT AL BALANCE DUE AS OF 07/07/2021:
Amount Due
$0.00
$0.00
Fee Amounts are valid for date of this document only. Fees subject to change without notice.
Form Revised Oct 2010
Commun ity Development and Neighbo rhood Services
281 N College buildingservices@fcgov.com
Fort Co lli ns, CO 80524 970-416-2740 Date Received
ALL information is REQUIRED. Incomplete applications will not be ac ce pte d.
Job Site Address
Address 6L/2o Foss; IL C/U:S T Di(' City/State /Zip f",c_ LC>· 8 052>
Property Owner Information
Name /(E A,1 I All> LL Phone Number --'-°'--~-~-·--'--· :2_2---"2CC...--O_l.(__,4 ___ '"3 __ _
Address SAME.. City/State/Zip----------
0 Other Gf,5 LI#£ 4-FL (If!:_ 7.
Contractor Information
Name--------------------------------------------
Company _________________________ _
License Holder ______________ _ License Number _______________ _
Electrical Contractor Information (only required for new installs)
Name--------------------------------------------
Com pany License Numbe r ME-___________ _
Rooftop O Yes O No Note For new rooftop equipment or replacements that are heavier than original, engineered documentation
ne eds to be provided to show roof can support equipment.
Equipment is same weight or lighter
Equipment is in same location
Location
OYes
OYes
QNo
QNo
Equipment is same footprint or smaller O Yes
Equipment is same height or smaller O Yes
QNo
QNo
If for a water heater or boiler in any food or beverage serving facil ity/Day Care/Institution occupancies , I have approval from the
Larimer County Health Department fo r minimum water heater capacity. 0 Yes O No
Tenant Name ________________________ _
I hereby acknowledge th at I have read this application and state t hat the above information is comp lete and correct I agree to co mply
with all requiremen ts contained he re in and city ordi nances an d state laws reg ulating bui lding cons tru ction . I know that a permit is not
valid until it has bee n paid and issued.
/<f!i'AJT /vtf'LL
Signature ~ UZ4/ 7w 7-2 /
Print Name Date
City of
ktColli~
Building Services
PO Box 580
281 N College Ave
Fort Collins, CO 80524
970-41 6-2740 phone 970-224-6134 fax
HOMEOWNER AFFIDAVIT
I/we, ~f:NT iJOLl, , as owner(s) of record of the property located
PR -, Fort Collins , Colorado, hereby declare and attest At: c LJ20 rtJ~s,1. <::.R€sr
to the following: (please check only the one that applies):
OPTION 1:
OPTION 2:
OPTION 3 :
□ I am/ we are acting on my/ our behalf for the purpose of obtaining a building permit and
personally constructing my/our home. The home to be constructed is on the above property and
will be my/our primary residence. I/we have not personally constructed any other new homes
in the Fort Collins city limits within the past 24-month period.
~ am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing an alteration or addition to my/our house, acting as our own general
contractor. The house to be altered is on the above property and is my/our personal primary
residence.
□ I am/we are acting on my/our behalf for the purpose of obtaining a building permit and
personally constructing a non-structural alteration to my/our attached single family dwelling
unit. The house to be altered is my/our personal primary residence . I am aware that I/we
cannot do any structural , electrical , plumbing or mechanical work and must hire
contractors/subcontractors who are currently licensed and insured with the City of Fort Collins.
I am/we are personally performing all of the work or hiring City of Fort Collins licensed trades people, or will be
continuously supervising unpaid volunteers (see Option 3 for attached dwellings). The work is directly related
to the construction of the above referenced home, which is described more fully on Permit Application #
_________ (obtained from the Building Services office).
I/we understand that any person(s) or agent(s) contracted to perform structural wood-framing, plumbing ,
HVAC, electrical or roofing work, MUST BE licensed contractors in accordance with the regulation of the City
of Fort Collins.
I/we understand that failure to comply with any of the above conditions may result in revocation of any permits
associated with the above Permit Application number, forfeiture of any fees that have been collected, a Stop
Work Order and potentially a court summons. s~nm~epVJM'
Co-owner Owner 7{V°'
"-: foregoing Affidavit was acknowledged before me on this -~-------
..J, )\\[ d(Jl\ (month, year) by ---+-,._,,,,,..._.J...1--..--t-Nf'....,_-t--:=-1H+~++--
Witness my hand and official seal
My commission expires:
,\~~~~~~~ l RACHEL BESEL
Notary Public
Sta:e of Colorado
Notary i D # 20174000633
My Commission_f.xpi res 03 -03-2025
R evised 6/10/2014