HomeMy WebLinkAboutPERMIT 509 Birch Ave Miscellaneous 2010-11-01Office
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Received Date Oii.Town of Estes Park Permit Number M-0 (l ‘-to
Received By ‘fr Application for Miscellaneous Permit Application Expires t/-‘3 U
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 tc.’IL
General Information &Inspection Line (970)577-3731 *FAX (970)586-0249 *wsvw.estesnet.com Permit Expires ‘1’2 -
Job Address:‘c (U 1 “
OwnerName:LOrSj C1-,144AJ Phone:j
Address:1I1(iEj (\khy)c/ot €P Cc ccs?’
(Street)(City)(Statel Zip Code)
1’‘‘-‘i
Contractor/Applicant:i’1t’V”A (.Town License #:
_______Phone:______________
Address:
(Street)(City)(Slate)(Zip Code)
Long-term Residential (30 days)D Short-term Residential (<30 days)D Commercial
E4eplace Furnace D Gas Line (ft.)
D Replace Boiler D Replace WindowslplaceHotWaterHeaterElInstallAirConditioning
‘Minor Plumbing El Temporary Structure Use________________
El Minor Remodel Time Period
___________________________
El Fireplace Insert —circle one:Gas,Wood,Pellet;El Other
Description of Work:,OUts ,i&L—OwSi 4”’1 -‘-L --L’\&&ctQ ie—1
Valuation (Total Cost of Material &Labor):$
I certify this application is true and correct and agree to perfomi the work described according to plans/specifications submitted,reviewed and approved,and comply with
local ordinances,state and federal laws as well as btulding codes.I certify that I have the property owner’s authority and permission to apply for this permit.Additionally,I
UNDERSTAND THAT!AM RESPONSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW,PERMITS,INSPECTIONS AND OTHER
FEES ASSOCIATED VITH THIS APPLICATION.Note:The work authorized by this permit requires the building be provided with smoke alarms complying
with municipa codes.•
Signatur £Datc/1/!Print Name
***Office Use Only ***
Inspection Checklist:
El Address Posted El Equipment Access El T &P 0 Smoke Detectors
El Contractors Licensed El Equipment Listed El Gas Pipe El Rough Inspection
El Permit Packet Available El Equipment Clearances El Vent El Final Jnspection
El Safe Access El Pan and Drain El Combustion Air
Comments:
Coá%iqcL s.’ii1+4gici i2,tI (GM s Permit Fee:
Census #Construction Tpe:Occupancy:q3c1 County Tax:
Building Of1lial Date
(4/,—
Total:
i -
**SMOKE ALARMS ARE REQUIRED**
Servera\comm dev\Building\Fornts Applications ()ver Ihe Counter Page I of I Revised 7/142006 -CB
Received Date I I I Permit Number /4 0 (2J1 —
Received By cI%(4-
TOWN OF ESTES PARK
Department of Building Safety
OWNER’S ACKNOWLEDGEMENT FORM
If a commercial or residential project includes demolition or renovation work,the property
owner(s)must contact the Colorado Department of Public Health and Environment to obtain
either a State Demolition Penjiit or a State Asbestos Abatement NotificationlPerrnit.
The Colorado Dept.of Public Health and Environment
4300 Cherry Creek Drive South
Denver,CO 80246-1530
Phone:303-692-3100
Fax:303-782-0278
e-mail:www.cdphe.state.co.us
This form must also be completed and signed by the owner prior to issuance of a Town of Estes
Park Building Permit.
I (D.’j VUilq4?,‘tJ (owner)agree to contact the Colorado Department
of Public Health and Environment to determine the state requirements for any work on my
property located at (address):(
EsTE L oi2 -__
I understand that I am accepting full legal responsibility for all Colorado State requirements and
liabilityassociated with the project.
K )/1 /
S gnature of Owner Date
(c ç L g o -s
Address Telephone
PL Cc’
City State
(970)577-3735 +P.O.Box 1200 +170 MacGregror Avenue +Estes Park,CO 80517
Zip
‘Scrvera\cornin_des’BuildingFomm’Various Forms’()wner Acknowledgement Form (demo and asbestos).doe Revised 9/I 9’08-kB