HomeMy WebLinkAbout3112 WORTHINGTON AVE - PERMITS - 6/8/2021City of
~~tColli~
Site Address: 3112 WORTHINGTON AVE
Job Va luatio n : $1 ,800.00 Cate g o ry : Residential
Owner: LAVOIE ANNA/CHRISTIAN
3112 WORTHINGTON AVE
FORT COLLINS, CO 80526-2735
Zoning: Front setback: Rear setback:
Minor Amend#: ______ Plat File#:
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 -fax
B ui ldi ng Pe rm it #: 82104378
Is s ued Full: 06 /08/202 1
P e rmit Type : Res idential Elect rical
Phone: 978-594-3454
R ight setback: ____ _ Left setb ack
ZBA Case#:
Zoning district RL -LOW DENSITY RES IDENTIAL DISTRICT
Legal : S ubd ivision/PUD: ________________ Fil ing # Lot#: Block# --------
Cod e: Res sq ft: ____ Com sq ft:
# o f stories: ____ 0cc Group:
Fire Sprkl r ____ Stock plan #: ___ _
Contracto r: KINNETIC ELECTRIC LLC
1208 W Myrtle St
FORT COLLINS , CO 80521
Subcont ractor(s)
Electrical: KINNETIC ELECTRIC LLC
Work Description: Panel change out, NO service upgrade.
Ind sq f t: ______ Basement sq ft: _______ _
Cons t Ty p e ____________________ _
Stock p lan options: _________________ _
License#: ME-1274 Su pe rvisor ce rt #:
Phone: 9 70-690-7022
Phone
970-690-7022
Li c ense N umber
ME-12 74
SCHEDULE INSPECTIONS: ** via Text Message: 888-406-6394 "" By Phone: 970-221-6769
** Online Portal: fcgov.com/CitizenAccess ** Online Portal via Mobile Device: fcaov.com/CitizenAccess/mobile
Possib le Inspections Requ i red: 20 1 206 301 103 302 300
TOTAL FE ES PAID A S O F 06/08/21: $106.85
** Fee Detail Displayed on Next Page
P aym e nt meth od: Cre dit Ca rd 6112
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 wi th all the requirements contained herein, and City ordinances, and State laws associated with such work . I understand that such perm it may be
revo ked in the event that issuance was based on incorrect information. Th is permit shall become null and vo id if the work authorized by such permit is not com menced,
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 .
Signa ture: Print Name : Date : -------------------------------------
Form Revised Oct 2010
City of
k tColli~
Site Address: 3112 WORTHINGTON AVE
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224.6134 -fax
Building Permit#: 82104378
Issued Full: 06/08/2021
Permit Type: Residential Electrical
Job Va l uation: $1,800.00 Category: Residential
Transaction s
Method
Credit Card
Check Number
CK#6112
Date Paid
06/08/2021
Receipt issued: 06/08/2021 Total Paid to Date:
Fee Description
C ity Sales/Use Tax
County Sales/Use Ta x
Permit Flat Fee -$65
Account Code
251.122030
100.217030
1000422010
TOTAL FEES:
Amount Paid Comments
$106.85
$106.85
Fee Amount
$34.65
$7.20
$65.00
$106.85
Amount Paid
$34.65
$7 .20
$65.00
$106.85
Date Paid
06/08/2021
06/08/2021
06/08/2021
TOTAL BALANCE DUE AS OF 06/08/2021:
Amount Due
$0.00
$0.00
$0.00
$0.00
Fee Amounts are valid for date of this document only. Fees subject to change without notice.
Form Revised Oct 2010
City of
~ort Collins
' ~'
Community Development and Neighborhood Services
281 N College 970-416-2740
Fort Collins, CO 80524 bui!dingservices@fcgov.com
ELECTRICAL PERMIT APPLICATION
Application# B Z I f-cl 13 76
Date Received ~ < ~ • 1 (
ALL information is REQUIRED. Incomplete applications will not be accepted.
Job Site Address
Address 2 I l 7 City/State/Zip ~ Ce> (.;1..._ IA) \
Property Owner Information
Name A,r-J;vA l-AVO \:{ Phone Number °{7 8 ~ sq '-I -3 t cs-y
Address "3 { I L ~It-\-(tJ b1'1'0N ~ City/State/Zip fo«.--T u U /.A[\
Single Family Detached Q Townhome (attached) Q Duplex Q Apartment/Condo Q Garage/Other
0 Bank Q Bar Q Church Q Hotel/Motel Q Medical Office Q Office QRetail ______________ ............................ .
Value of Work
Labor and Materials $ __ \~8""---"0"-""b""'----------
of Work
0 Meter change out 0 Upgrade existing wiring
0 Panel Upgrade (May require additional review time. A commercial panel upgrade of 225A or 3 phase requires a 1 line diagram.)
0 Other electrical alterations ---------------------------------
Service Upgrade O Yes i No
Existing Amps ____________ _
New Amps ______________ _
Additional Information
(if applicable)
Electrical Contractor Information
Name ¥= \ 1'.1 t--1TIJ C. te-~~ \C-
Address \21.) B W fV\ '1 f?ty~ g\
Phone Number 17 () -t) 11 ,... '5 l S-Q Email
License Number ME-_\~2.-:~1~~~---------
City/State/Zip ~ CJ1 'l,,L ! 10 S
'X)A tv \ ~L.-@ ~ \,-J~\1C...~t.Ae~\ C Goe-IV"\
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.
DA.rv1..V..---\~·t:P-.
Print Name / f,/&/2-1 Date
. .... ~ . . . . ..