HomeMy WebLinkAboutPERMIT 1450 Big Thompson Ave Add Toilet & Wash Basin 2011-03-15Re+red Dui
•
Received By
Department of Building 8af try 170 MacGregor Avenue P.O. Bost 1200 Estes Park, CO 80517 Application Expire,;
General Information and Inspection Line (970) 577-3731 w FAX (970) Safi-0249 ■ www.mtesnet.com
NOTE: Use this Form for Longterm Residences 30 days or more.
,;,.. Permit Ex
Job Address:
Lot: Block:
Owner Name:
Address: f
sik
Long -Term Residential Application / Building Permit
■at'� " ' Condo: 0 No Ll Yes; Lot Size:
af/ac
Subdivision: .
Parcel 0:3P i^,�..
hone: 059.21Y.,""2,3
St>Eet (City) (stela) � ' � l
(tip Code)
Contractor: °, ,�.L- /0.1 Town License 0: C20e Phone: 2 "2:7 +CO" ,..
Address:ram -�
Town of Estes Park Permit Norther
The Fo k,, : A to New Work Only — Complete all that a; 0 New Building 0 Alteration
Butldme Usels); 0 Owner / Reaideace 0 Rental —30 days or more 0 Accessory Dwelling
Bxi. . 8' use: •+ Proposed use: AtleZorrientm..; # of New D
1EstesPark 5 w �e: � # of New Kitchens:
Cl Upper Thompson Sanitation 0 Private
k "' LI tq': ra o "des'— State and Town Licenses —RequiresApplicantRegto first as to -the Health t.
Fixtures: Add ElR ....w Replace�� }" � lFo tegrrf.
❑ 0 Demolish Water Service: Existing 0 New - # of Meters:
uric Involved: 0 No ,Yes — State & Town LicenseImpaction. . Meter Size: inchesRequired. State PenNtwrd Required.
Service; w r O New: 0 Overhead ❑ U 1 , , • Meter Size:
# of
• T- Meter: 0 No D Yes
Total Valuadons (Labor & Materials)
I certify this appiicadan is true and correct and agree to perform the work described e000nding to pia ect submitted,
local ordinances, state and federal taws as well as building codes. Ice property P permission
i n to p ly or t approved, and comply with
UNDERSTAND THAT I AM " r�"g �' that I have the ro rt owner's authority and petmiasion to apply for this permit. Additionally, I
RESPONSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW, PERMITS, INSPECTIONS AND OTHER
ASSOCIATED WITH THIS APPLICATION.
Job Description
Occupant Load(s):
Variances:
Setbacks
toning
landing Official
0 Owner 0 Owner's Agent
Floor Load(s):
Hazards Census #
Wildfire Flood
ouo
ervecI3thuidIngdeptlForms1ApplicationstRdIdlueLong-term Residaatial Building Permit1Lona-term Residential Hiifld nu va.,, , .�. .
0 Tenant
Date, fi Print r
*** Office Use Only''**
Public Works
Class(es): Water
Roof Load:
Light & Power
Planning
Fire Departnseut
Building
Plan Review
County Tax
Certificate of Occupancy
Total
Application .information
E
RE
(New •mmerclaVR: idential Constru ''on, or CommerciaVResidential Remodels)
OWNER NAME:
CONTRACTOR NAME:
PHYSICAL ADDRESS (Lot, Address)
MAILING ADDRESS:
FIXTURE TYPE
Bathtub & Shower Combo
Bathtub only
Shower only
Drink i�x .; (cooler)
prInking fountain (public),.F*
Kitchen sink
Lavatory
Laundry trays
Service sink
Urinal, pedestal flush valve
Urinal, wall or stall
Trough (2' unit)
Water closet,M lush valve
'.,.aaa_„„„„k t1+
Water closet tan
Dishwasher
Washing machine
Hose bile
r:
DEMO " EXISTING
.11
ROUGH -IN NEW TOTAL # X FIXTURE VALUE
t@Ipf,,muto ri 49,p I,iueg;te.C1w4pfRai7y
x 8=
x 4=
x 4=
x 1 =
x 2= 2
x 3=
x 2=
x 3=
c1
awl 4,c-04
x 3=
x 35 =
x 12 =
x 2=
x 5 =
1 x 33 = C CQedr' DJE5
L
x 4=
x 6 =
x 6=
Ix3=
x =
nretAfictuSIIIY nv'�V nw dt,nm�t ����� M Y@'!+��V�' a" ry v^tY."1,
DO NOT WRITE BELOW THIS UNE: FOR OFFICE USE ONLY
Total number of fixture units:
Comments:
X $ 61 C per unit =
WATER DEPARTMENT, TOWN OF ESTES PARK
$ 't 75-rna
Total amount due
11Se ve:a
Wiwi= Ponnsillnure Unit Value Sheet-