HomeMy WebLinkAboutPERMIT 540 Birch Ave Demo Water Damage 2011-02-23Received Date ôi i.ô i.-)Town of Estes Park c,rc.Permit Number D
Received By Demo Application /Permit Application Expires
_______
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 C)
General Information &Inspection Line (970)577-3731 *FAX (970)586-0249 *www.estesnet.com Permit Expires jr3I 1,,,
Job Address:3 /‘‘-c1 A -s L ,e o f”7 Parcel #:j•
Owner Name:/)C’Ir 7)//I ,Phone:
Address:q7 2a
(Street)(City)(State)
(Zip Code)
Contractor:Town License #:
Phone:
Address:
(Street)(City)(State)
(Zip Code)
,Long-term Residential (30 days)U Short-term Residential (<30 days)U Commercial
Note:A Demo Permit does not authorize any work in or on public right-of-ways,wetlands,floodplains,or other
properties -separate additional permits are required.
Note:Separate permits required for each address,each lot,or each owner.
Description of Work
Valuation (Total Cost of Material &Labor):$/
Inspection Checklist /Signoffs
U Sanitation District -abandon /vacate sewer
U Health Department -abandon /vacate septic
U Water Department —abandon I vacate water
U Light &Power —abandon /vacate electric
U Xcel —abandon /vacate gas
U Building Department -Final Inspection
U State Demolition Permit/Owner’s Acknowledgement Form
I certify this application is true and correct and agree to perform the work described according to plans/specifications submitted,reviewed and approved,and comply
with local ordinances,state and federal laws as well as building codes.I certify that I have the property owner’s authority and permission to apply for this permit.
Additionally,I UNDERSTAND THAT I AM RESPONSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW,PERMITS,INSPECTIONS
AND OTHER FEES ASSOCIATED WITH THIS APPLICATION.
U Contract Owner U Owner’s Agent U Tenant
Date nt Name //
***Office Use Only ***
Staff Comments:.Application Information
Fee
Permit Fee:I
BUildjt4”4’
Date
$50/building I
Total:DOO
ISSUE OF THIS PERMIT DOES NOT AUTHORIZE ANY NEW CONSTRUCTION
—1.
Received Date iji t.Z)Permit Number V QO(I —Ii
Received By
______________
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 Permit or a State Asbestos Abatement Notification/Permit.
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 ;-L /)//yL\(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):Aye.i k
(970)577-3735 D P.O.Box 1200 170 MacGregror Avenue Estes Park,CO 80517
I understand that I am accepting full legal responsibility for all Colorado State requirements and
liability associated with the project.
2/i
(sign’áture ofQe,1 Date /
97-P6 2 -
Address
/S /2
City State
Telephone
Zip
C:\Documents and Settings\FIP Adrnrnistrator\Local Settings\Temporary Internet Files\Content.1E5\ZNNMKXKL\Owner Acknowledgement Form (demo and