We've detected that Javascript is not enabled. It is required for an optimal survey taking experience. Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

1. Job site address: *This question is required.(including direction and suffix)

2. Property owner name: *This question is required.

3. Property owner address: *This question is required.

Street Address:

City:

State:

Zip:

4. Property owner phone number: *This question is required.

5. Project type: *This question is required.

Residential

Commercial

6. What type of residential? *This question is required.

Single Family Detached

Townhome (attached)

Duplex

Apartment/Condo

Garage

Other:Please enter an 'other' value for this selection.

6. What type of commercial? *This question is required.

Bank

Bar

Church

Hotel/Motel

Medical Office

Office

Retail

Restaurant

Other:Please enter an 'other' value for this selection.

6. Value of work (Labor and Materials)($): *This question is required.

7. Type of permit: *This question is required.

Electrical

Gas/Wood Burning Appliances

Lawn Sprinkler

Plumbing

Water Heater and HVAC

Roofing

8. Scope of work: *This question is required.

Panel change out

Meter change out

Upgrade existing wiring

Panel upgrade (May require additional review time. A commercial panel upgrade of 225A or 3 phase requires a 1 line diagram).

Other electrical alterations:Please enter an 'other' value for this selection.

8. Service upgrade: *This question is required.

Yes

No

8. Existing amps: *This question is required.

8. New amps: *This question is required.

8. Contractor name: *This question is required.

8. Contractor address: *This question is required.

8. Contractor phone number: *This question is required.

8. Contractor email: *This question is required.This question requires a valid email address.

8. License number ME- *This question is required.

8. Additional information if applicable:

8. Scope of work: *This question is required.

Wood/Pellet stove (required to be EPA approved)

Gas Fireplace

Fire Pit

8. Model name: *This question is required.

8. Manufacturer name: *This question is required.

8. Length of extensions of gas line (if necessary):

8. Please list plumber fireplace contractor if not completing:

8. Contractor name: *This question is required.

8. Contractor address: *This question is required.

8. Contractor phone number: *This question is required.

8. Contractor email: *This question is required.This question requires a valid email address.

8. License number: *This question is required.

8. Certificate number: *This question is required.

8. Subcontractor license (if applicable):

8. Subcontractor name (if applicable):

8. Additional information if applicable:

8. Landscape company name:

8. Landscape company address:

8. Landscape company phone number:

8. Landscape company email: This question requires a valid email address.

8. Master plumber company name: *This question is required.

8. Master plumber company address: *This question is required.

8. Master plumber company phone number: *This question is required.

8. Master plumber company email: *This question is required.This question requires a valid email address.

8. License number MP- *This question is required.

8. Additional information if applicable:

8. Scope of work: *This question is required.

Sewer Line Replacement

Water Line Replacement

Gas Line Replacement

Other Plumbing Work

8. Number of feet to be replaced: *This question is required.

8. Describe other plumbing work: *This question is required.

8. Master plumber or excavation company name: *This question is required.

8. Master plumber or excavation company address: *This question is required.

8. Master plumber or excavation company phone number: *This question is required.

8. Master plumber or excavation company email: *This question is required.This question requires a valid email address.

8. License number: *This question is required.

8. Additional information if applicable:

8. Unit type: *This question is required.

Air Conditioner

Furnace

Minisplit

Boiler

Water Heater

Other:Please enter an 'other' value for this selection.

8. Please choose one of the following: *This question is required.

The water heater is a replacement.

The water heater is new.

8. Please choose one of the following: *This question is required.

The water heater is the same size or smaller than the previous.

The water heater is larger than the previous.

8. Is the water heater for a restaurant? *This question is required.

Yes

No

Please acknowledge:*This question is required.

I have approval from the Larimer County Health Department for minimum water capacity.

I do not have approval.

8. Will the equipment be placed on the rooftop? *This question is required.

Yes

No

8. Please choose on the following: *This question is required.

This equipment is a replacement of existing equipment.

The equipment is a new/additional equipment and we will provide engineering documentation showing roof can support new equipment or modifications that must be done to support such equipment.

8. Please choose one of the following: *This question is required.

The equipment is the same weight.

The equipment is lighter, and similar or smaller size/footprint or Equipment is heavier and we will provide engineered documentation to buildingservices@fcgov.com showing roof can support new equipment or modifications that must be done to support such equipment.

8. Please choose one of the following: *This question is required.

The replacement equipment is in the same location and not taller than the previous.

The replacement equipment is in a new location and/or taller.

8. Please choose one of the following: *This question is required.

The equipment is on the ground.

The equipment is floor mounted.

8. Is this new install or a replacement install?

New

Replacement

8. Please provide the the ME number:

8. Contractor company name: *This question is required.

8. Contractor company address: *This question is required.

8. Contractor company phone number: *This question is required.

8. Contractor company email: *This question is required.This question requires a valid email address.

8. License number: *This question is required.

8. Additional information if applicable:

8. Manufacturer of materials: *This question is required.

8. Number of squares: *This question is required.

8. Number of stories: *This question is required.

8. Is it a flat roof (less than 2:12 pitch)? *This question is required.

Yes

No

8. Are you tearing off existing roofing materials to the decking? *This question is required.

Yes

No

8. How many layers are there? *This question is required.

8. What kind of material are they? *This question is required.

8. Is there existing insulation? *This question is required.

Yes

No

8. Will any insulation be removed/replaced? *This question is required.

Yes

No

8. Check one: *This question is required.

Roof Repair 49% of roof area max. Class 4 shingle is not required.

Roof Repair 50% or more of roof area. Class 4 shingle is required.

8. Contractor company name: *This question is required.

8. Contractor company address: *This question is required.

8. Contractor phone number: *This question is required.

8. Contractor company email: *This question is required.This question requires a valid email address.

8. License number: *This question is required.

8. Certificate number: *This question is required.

8. Work performed by: *This question is required.

License/Certificate Holder

Payroll Employees

Exempt Roofer (1099)

8. Exempt roofer name: *This question is required.

8. Exempt Roofer License EX_____: *This question is required.