HomeMy WebLinkAbout2638 ROCK CREEK DR - PERMITS - 9/28/2021City of
k tColli~
Site Address: 2638 ROCK CREEK DR
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221 .6760 970.224 .6 134 -fax
Building Permit#:
Issued Full:
B2107802
09/28/2021
Permit Type: Residential Water Heater
Job Valuation: $725.00 Category: Residential
Owner: CASTIGLIONI RONALD C
2638 ROCK CREEK DR
FORT COLLINS, CO 80528-3121
Zoning: Front Setback:
Minor Amend #:
Phone: 970-988-5190
Rear Setback: ___ Right Setback:
Plat Fi le#: ___ ZBA Case#:
Zoning District: LMN -LOW DENSITY MIXED-USE NEIGHBORHOOD DISTRICT
Left Setback:
Legal: Subdivision/PUD: Filing#: __ _ Lot #: _14__ Block#: _2 __ _
Code: Res sq ft:
# of Stories:
Fi re Sprklr:
Contractor:
Subcontractor( s):
-----
Com sq ft:
0cc Group:
-----Stock plan#:
Ind sq ft: Basement sq ft:
Const Type: ----------------------
-----Stock plan options:
License#: ___ _ Supervisor Cert#: ____ _
Phone:
License Number:
Work Description: After the fact permit for a 40 gallon 40,000 BTU water heater replacement. Homeowner affidavit on fi le.
SCHEDULE INSPECTIONS: **vi a Text Message : 888-406-6394
Online Portal : f cg ov .c om l Citi zenAccess
**B y Phone: 970-221 -6769
Possible Inspections Required: 300 301 302
TOTAL FEES PAID AS OF 9/28/2021: 65.00
***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.
Signature: Print Name: Date: -------------------------------Form Revised July 2021
City of
,ktColli~
Site Address: 2638 ROCK CREEK DR
Job Valuation: $725.00 Category: Residential --------
Transactions:
Community Development & Neighborhood Services
281 N. College Ave Fort Collins, CO 80522
970.221.6760 970.224 .6134 -fax
Building Permit#:
Issued Full:
82107802
09/28/2021
Permit Type: Residential Water Heater
Method Ref Number
Credit Card 3828
Date Paid
09/28/2021
Amount Paid Comments
$65.00
Total Paid to Date: ...... $6=-5,__.0=0.__ __ _
Description
Permit Flat Fee -$65
TOTAL FEES:
Fee Amount
$65.00
$65.00
Amount Paid
$65.00
$65.00
Date Paid
09/28/2021
Amount Due
$0.00
$0.00
TOTAL BALANCE DUE AS OF 9/28/2021 : $0.00 =======
Fee amounts are valid for date of this document only. Fees subject to change without notice.
Form Revised July 2021
City of ~
Community Development and Neighborhood Services
281 N College buildingservices@fcgov.com
Fort Collins, CO 80524 970-416-2740
WATER HEATER & HVAC PERMIT
APPLICATION
Application# __________ _
Date Received
ALL information is REQUIRED. Incomplete applications will not be accepted.
Job Site Address
Address ::l.."'3 8 'Kc2c.kCre.J,(, O'l'"\.._11._('.: ____ _
~os--z.e
City/State/Zip F+C c-\ \ 11\ S, . ( e:>
I
Property~ner Inflation _ ~ _ \ ,. ,
Name 1::v,\ ~ C Cc'.!-<;;· I~\ 01"\ 1
Address 26 .3 !s" RockC-rc:,..,k_ Q-c\v-e
Scope of Work
0 Air Conditioner
0 Furnace
OMinisplit
OBoiler
0 Water Heater
Oother
Contractor Information
Company
License Holder ______________ _
Electrical Contractor Information (only required for new installs)
PhoneNumber Cf."1() -P\e;-&--s\qD
City/State/Zip fj--c;,\\,O\) ( ,;,'f<>f""2rf
J
License Number _______________ _
Name-------------------------------------------
Company License Number ME-___________ _
Rooftop O Yes O No Note For new rooftop equipment or replacements that are heavier than original, engineered documenta~on
needs to be provided to show roof can support equipment.
Equipment is same weight or lighter
Equlpment is in same location
Loca1!on
OYes
OYes
ONo
ONo
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 facility/Day Care/Institution occupancies, I have approval from the
Larimer County Health Department for minimum water heater capacity. 0 Yes O No
Tenant Name ________________________ _
City of
~Colli!!_S
Building Services
PO Box 580
281 N Co llege Ave
Fort Collins, CO 80524
970-416-2740 phone 970-224-6134 fax
HOMEOWNER AFFIDAVIT
I ' )Z,," '"J ,A C C Q.l ·:Hs \~(I ✓\ J ' as owner of record of the property localed at:
Z b 3 ~ \Zuo le V cc k \) r r, ✓-(_ , Fort Collins, Colorado, hereby declare and attest to
the following: (please check only the one that applies):
OPTION 1: CONSTRUCTION OF NEW HOME
□ I am acting on my behalf for the purpose of obtaining a building permit and personally
constructing my home. The home to be constructed is on the above property and will be my
primary residence. I have not personally constructed any other new homes in the Fort Collins
city limits within the past 24-month period.
OPTION 2: PERMITTED WORK ON DETACHED SINGLE FAMILY HOME
ir' I am acting on my behalf for the purpose of obtaining a building permit and personally
constructing an alteration or addition to my house, acting as my own general contractor. The
house to be altered is on the above property and is my personal primary residence .
OPTION 3: PERMITED WORK ON ATTACHED SINGLE FAMILY DWELLING UNIT.
□ I am acting on my behalf for the purpose of obtaining a building permit and personally constructing a non-
structural alteration to my attached single family dwelling unit. The house to be altered is my personal
prjmary residence. I am aware that I 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 personally performing all of the work or hiring City of Fort Collins licensed trades people, or will be conti nuously
supervising unpaid volunteers (see Option 3 for attached dwellings). The work is directly related to the construction of the
above referenced home.
I 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 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 co llected, a Stop Work Order and
potentially a court summons.
2. t:gf.!1 day of
( month, year) by__..,(2-E.c);.c.k:l4>1"""-\.4,/J_b'------'c~~~6"Ft'Hi 'i,.,.,_._.; I~, ffof-"V'\--'+-i ----·
~ .. ~ Witness my hand and official seal
My commission expires: __ _
COR I NA HARTZOG
N otary Pub li c
Sta te of Colo rad o
No t ary I D# 20174008848
My Commissi on Expires 02-27-2026
Revised 10/19/2020