new business ceclst 9 - northglenn packet... · 2018-07-13 · cit of northglenn new business...

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City of Northglenn Economic Development Division | 303-450-8743 | www.northglenn.org/biz NEW BUSINESS CHECKLIST ü Questions? Contact Economic Development Manager Debbie Tuttle at 303-450-8743 or [email protected]; or Economic Development Specialist Jill Mendoza at 303-450-8938 or [email protected]. DISCOVER Northglenn Thank you for bringing your business to Northglenn. Going over this list will help streamline the new business approval process and make sure you have all the correct documentation for a successful opening. You may not need approvals and permits from all the listed departments and agencies. If you have any questions, please use the related contact information or contact the city for guidance. 1. Economic Development Division o All businesses should contact the Economic Development Division before opening or relocating in Northglenn. We will help you connect with the right departments, answer your questions and provide a wide range of information on assistance, programs, real estate, resources, demographics and more. Other helpful links: Contact: Debbie Tuttle at [email protected] or 303.450.8743 2. Building Division o Building Permits – SAFEbuilt handles all building division services for the city and has a satellite office in City Hall. Prior to making any modifications to the existing location – whether interior or exterior – you must get approval from the Building Division. To obtain building permits call SAFEbuilt at 303.450.8745. o Certificate of Occupancy - Upon final inspection, a Certificate of Occupancy (CO) will be issued prior to opening the business. To obtain a CO call SAFEbuilt at 303.450.8745. o Safety Inspection, Existing Commercial Space – When a change in use to an existing space occurs, a building permit is required. For a safety inspection call SAFEbuilt at 303.450.8745. Contact: Main Line: 303.450.8745 or [email protected] | Inspection Line: 303.450.8748 Dan Wester, building official, at [email protected] or 303.450.8814 More information: www.northglenn.org/building Business Assistance & Incentives: www. northglenn.org/incentives Resources: www.northglenn.org/edgroups Business Directory: www.shopnorthglenn.org Demographics: www.northglenn.org/demographics Commercial Real Estate: www.northglenn.org/ commercialrates Urban Renewal Areas: www.northglenn.org/nura

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Page 1: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Economic Development Division | 303-450-8743 | www.northglenn.org/biz

NEW BUSINESS CHECKLIST ü

Questions? Contact Economic Development Manager Debbie Tuttle at 303-450-8743 or [email protected]; or Economic Development Specialist Jill Mendoza at 303-450-8938 or [email protected].

DISCOVERNorthglenn

Thank you for bringing your business to Northglenn. Going over this list will help streamline the new business approval process and make sure you have all the correct documentation for a successful opening.

You may not need approvals and permits from all the listed departments and agencies. If you have any questions, please use the related contact information or contact the city for guidance.

1. Economic Development Division

o All businesses should contact the Economic Development Division before opening or relocating inNorthglenn. We will help you connect with the right departments, answer your questions and provide a widerange of information on assistance, programs, real estate, resources, demographics and more.

Other helpful links:

Contact: Debbie Tuttle at [email protected] or 303.450.8743

2. Building Division

o Building Permits – SAFEbuilt handles all building division services for the city and has a satellite office in CityHall. Prior to making any modifications to the existing location – whether interior or exterior – you must getapproval from the Building Division. To obtain building permits call SAFEbuilt at 303.450.8745.

o Certificate of Occupancy - Upon final inspection, a Certificate of Occupancy (CO) will be issued prior toopening the business. To obtain a CO call SAFEbuilt at 303.450.8745.

o Safety Inspection, Existing Commercial Space – When a change in use to an existing space occurs, abuilding permit is required. For a safety inspection call SAFEbuilt at 303.450.8745.

Contact:

• Main Line: 303.450.8745 or [email protected] | Inspection Line: 303.450.8748

• Dan Wester, building official, at [email protected] or 303.450.8814

More information: www.northglenn.org/building

• Business Assistance & Incentives: www.northglenn.org/incentives

• Resources: www.northglenn.org/edgroups

• Business Directory: www.shopnorthglenn.org

• Demographics: www.northglenn.org/demographics

• Commercial Real Estate: www.northglenn.org/commercialrates

• Urban Renewal Areas: www.northglenn.org/nura

Page 2: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Economic Development | 11701 Community Center Drive | 303.450.8743 | www.northglenn.org/biz 2

City of Northglenn New Business Checklist

3. Fire Department - North Metro Fire Rescue District

o Fire Department Approval – Before a storefront business opens, the North Metro Fire Rescue District (NMFRD) must inspect the building to make sure your space meets International Fire Code. They also conduct inspections during the construction, remodeling and operational stages of all commercial buildings. Requests for all inspections and acceptance testing of fire protection systems must be made and confirmed with the NMFRD Fire Prevention Division at least two business days in advance. Also, a safety inspection is required if the desired space has been vacant for more than six months.

Contact: www.northmetrofire.org or 720.887.8217 | More info: www.northmetrofire.org/permitsinspections.html

4. Planning and Development Department

o Zoning & Land Use Approvals – The Planning Division provides planning and zoning approval recommendations based on the zoning ordinances of the city. Before selection of a commercial location for your business, contact the Planning and Development division to ensure that your business is eligible to open in the desired location. In some cases, the Development Review Committee or Planning Commission may need to give approval.

More information: www.northglenn.org/planning | Contact: [email protected] or 303.450.8739

o Signage Approvals –The Planning and Development Division is the primary contact for permanent and temporary signage needs. A sign permit is required on all signage requests.

More information: www.northglenn.org/signcode | Contact: [email protected] or 303.450.8739

5. Sales and Use Tax Division

o Sales Tax Rules –To learn more about the business tax rates in Northglenn, and the sales and use tax requirements and forms for your business visit www.northglenn.org/taxes.

Contact: [email protected] or 303.450.8729

Page 3: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Economic Development | 11701 Community Center Drive | 303.450.8743 | www.northglenn.org/biz 3

City of Northglenn New Business Checklist

6. Business Licensing Division

o Business License - All businesses must have a business license, including storefront, service, nonprofit, home-based and companies simply engaged in business in Northglenn. Applying for a business license early is important, as the licensing process may take up to 20 days. A business license can be obtained at www.northglenn.org/bizlicense. The application can be mailed or delivered to the City of Northglenn, 11701 Community Center Drive, Northglenn, CO 80233-8061.

Please submit the following documents along with your Business License Application:

• $15 processing fee by check or credit card

• Legible copies of valid driver’s licenses for all owner(s), partners, etc. of the business

• Copy of your State of Colorado sales tax license, if applicable

• Any additional forms identified in the Business License Application

• If you are a home-based business, you must complete a Home Occupation Agreement, located at www.northglenn.org/bizlicense.

Contact: [email protected] or 303.450.8729 | More information: www.northglenn.org/taxes

7. Public Works Division

o Industrial Pretreatment Questionnaire – Under EPA requirements, all new businesses (both home-based and storefront) must complete the questionnaire. Depending on your business, further requirements may be necessary to comply with the city’s Municipal Code.

Contact: [email protected] or 303.450.4026 | More information: www.northglenn.org/pretreatment

o Right-of-Way (ROW) Permits – If you are doing work on a city easement or city property, please contact the city to see if a ROW permit is needed.

Contact: Terrie Pineda at [email protected] or 303.450.8984 | More info: www.northglenn.org/row

o Utility Connection – Is your building not connected to the water or sewer system? The city charges residential and non-residential customers to connect to the municipal system based on a formula described in Section 16-10-3(e) and Section 16-14-5 of the Municipal Code at www.northglenn.org/municode/ch16/content_16-14.html.

Contact: Terrie Pineda at [email protected] or 303.450.8984 | More info: www.northglenn.org/utilities

o Business Trash Removal – Businesses must contract out for trash removal with an independent provider. The city only picks up trash from residences. Please check with your property owner or management team or with a commercial trash removal provider to determine your options.

Page 4: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Economic Development | 11701 Community Center Drive | 303.450.8743 | www.northglenn.org/biz 4

City of Northglenn New Business Checklist

8. State of Colorado

o State of Colorado Sales Tax License – If your business sells goods, food or merchandise you will need a sales tax license, you must attach a copy of it to your Northglenn Business License Application. Apply for a state sales tax license in person or by mail with the Colorado Department of Revenue, 1375 Sherman St., Denver, CO, 80261.

Contact: Colorado Department of Revenue, 303.238.7378

More information: www.colorado.gov/apps/jboss/cbe/start-business.xhtml

o Enterprise Zone State Income Tax Credits – The majority of businesses are located in the State of Colorado’s enterprise zone. In order to be eligible for various state income tax credits, it is very IMPORTANT to pre-certify in ADVANCE of making any equipment investments, hiring employees and other potential credits at www.advancecolorado.com/funding-incentives/incentives/enterprise-zone-tax-credits/apply-enterprise-zone-tax-credits.

More information: www.northglenn.org/incentives (bottom of page)

o Hazardous Material Removal – If your business is moving into part or all of an existing structure, you may have hazardous materials present, such as asbestos or lead-based paint. Removal of this material must be done in accordance with federal and state law. Permits for the removal of hazardous material can be acquired at the Colorado Department of Public Health and Environment. City building permits cannot be issued for impacted buildings until proof of cleanup has been received from the state.

Contact: [email protected] or 303.692.3100 | More information: www.cdphe.state.co.us/ap/asbestos/

o Health Department License – Tri-County Health Department (TCHD) is the government agency that oversees Colorado’s retail food establishment rules and regulations in Northglenn. If you are selling or serving food to the public, a license from TCHD is required.

Some exceptions include:

• Coffee

• Bottled or canned beverages

• Pre-packaged non-potentially hazardous foods such as chips and candy

• Non-potentially hazardous pastries and bagels that have been prepared in a approved facility.

TCHD also oversees daycare and body art establishments, among others. Contact TCHD to see if your business needs to meet any of their requirements.

Contact: 303.452.9547 | More information: www.tchd.org

City of Northglenn New Business Checklist

Page 5: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Economic Development | 11701 Community Center Drive | 303.450.8743 | www.northglenn.org/biz 5

City of Northglenn New Business Checklist

9. Special Northglenn Permits

Type You Need This If Online Contacto Amusement You have coin operated

amusement devices such as arcade games, pool tables, crane games, etc.

www.northglenn.org/ amusement

City Clerk’s OfficeLisa Andrews, landrews@ northglenn.org or 303.450.8755

o Guard Dog You have a guard dog at your place of business.

www.northglenn.org/guarddog

City Clerk’s Office(see above)

o Door to Door Sales You sell items door to door. www.northglenn.org/peddler

City Clerk’s Office(see above)

o Parks Permit You sell items in a Northglenn park or open space area.

www.northglenn.org/parksboard

Parks and Rec DepartmentBelia Straushein, [email protected]

10. Special Northglenn Licenses

Contact Lisa Andrews in the City Clerk Office at 303.450.8755 or [email protected] for information on any of these licenses. * – License required by City and State

Type You Need This If Onlineo Liquor License* You sell or distribute any alcoholic beverages. www.northglenn.org/liquorlicense and

www.colorado.gov/pacific/enforcement/liquor

o Marijuana License*

You operate a medical or retail marijuana business.

www.northglenn.org/mbl and www.colorado.gov/pacific/enforcement/ application-and-licensing-marijuana-enforcement

o Massage Service License

You provide massage services solely by State of Colorado Certified Massage Therapists. Proof of certification is needed.

www.northglenn.org/massage and www.colorado.gov/pacific/dora/Massage_Therapy

o Massage Parlor License

You provide massage services with one or more persons who are not certified with the state as a massage therapist.

www.northglenn.org/massage

o Non-Alcoholic Dance Club License

On a regular basis, you provide live or re-corded music and a dance floor, but do not serve alcohol.

www.northglenn.org/danceclub

o Pawn Broker License

You operate a pawn shop, offering secured loans with items of personal property used as collateral.

www.northglenn.org/pawnbroker

o Admissions Tax License

You charge admission to your establishment for an event or performance.

www.northglenn.org/admission

o Sexually- Oriented Business License

You operate a sexually-oriented business. See Section 11-54-1 of the city’s Municipal Code for a complete definition.

www.northglenn.org/adultbusiness

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ZONING PERMIT Application Guide

OVERVIEW Zoning Permits are intended to be used to facilitate the opening of businesses in the City by verifying whether or not a use is permitted within a building or tenant lease space in accordance with the city’s Zoning Ordinance (Chapter 11 of the Municipal Code). A Zoning Permit is required for all businesses in Northglenn and will be distributed to all businesses applying for a business license and must be completed and returned to the Planning and Development Department. Zoning Permits require review and approval by Planning staff prior to any business being opened. This approval will provide confirmation that the use being proposed is compatible with the zoning of the property. Please note that the approval off a Zoning Permit does not constitute approval from Building, Fire Department or other agency codes or requirements. However, Planning staff will provide you with comments from other city-wide departments that might be applicable to the opening of your business in Northglenn. As a result, you may be required to coordinate with other departments to address any specific requirements they may have. In some cases a pre-application meeting may be recommended.

SUBMITTAL REQUIREMENTS A Zoning Permit shall be submitted directly to the Planning and Development Department. You may submit application in person to the permit counter or vial email at [email protected]. The following application package must be submitted to the Planning and Development Department to commence review:

Completed Application (see attached).

Completed Questionnaire (see attached) that describes the proposed business. Completed Industrial Pretreatment Questionnaire required for all new businesses.

PROCESS

Prior to opening of your business, you will need to submit to the Planning and Development Department a fully completed Application and Questionnaire for a Zoning Permit. A Zoning Permit is required with any new business, change in business name, ownership, or location. A Zoning Permit can be applied for concurrently with a business license or any building permits that may be required prior to opening of your business. DISCLAIMER – The issuance of a business license does not confirm that the use of the property is permitted in accordance with the underlying zoning for the property.

Zoning Permits are reviewed administratively by Planning staff. Planning staff will also forward the permit for review by various city departments, including but not limited to the following: Public Work (including engineering and utilities), Building, Economic Development, and Finance, if necessary.

If the use being proposed is consistent with the underlying zoning of the property, the Zoning Permit will be issued by the City. If any conditions are associated with the approval, they will be noted on the permit.

North Metro Fire Rescue conducts separate review of permits for compliance with the fire code. Separate approval may be required from NMFRD. You may contact NMFRD at 720-887-8217.

CODE REQUIREMENTS

Chapter 11 of the Municipal Code is the city’s Zoning Ordinance. The city’s various zone districts allow for different land uses. If you would like to know the zoning of your property, you can use the QuickZone link on the city’s website (http://biz.northglenn.org/quickzone) or contact the Planning and Development Department directly at 303-450-8739 or via email at [email protected]. You can obtain a list of allowed uses for the various zone districts by accessing the Zoning Ordinance through the City of Northglenn Municipal Code: www.northglenn.org/municode.

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ZONING PERMIT Application

PROJECT INFORMATION Site Address:

Business Name: New Building Existing Building

PROPERTY OWNER(S) INFORMATION Name:

Company (if applicable):

Address:

City: State: Zip:

Phone: Email:

TENANT INFORMATION (If other than owner) Name:

Company (if applicable):

Address:

City: State: Zip:

Phone: Email:

OWNER(S) & AGENT CERTIFICATION I hereby depose and state under the penalties of perjury that all statements, proposals and/or plans submitted with/or contained in this application are true and correct and the application is complete to the best of my knowledge and belief. Agent’s Signature: Date: Owner(s)’ Signature(s): Date: STAFF USE ONLY:

Zoning: Nonconformities: Yes No

Describe any NCs:

Approved Denied

By: Date:

Comments:

Date Application Received:

Page 8: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

ZONING PERMIT Questionnaire

BUSINESS NAME:

BUSINESS ADDRESS:

1. What is the proposed use of the building/tenant space?

2. What was the previous use of the building/tenant space?

3. What is the square footage of the building/lease area?

4. Is your business currently operating in Northglenn at a different address? Yes No

If yes, address:

5. Retail Restaurant Office Manufacturing/Distribution Service Other:

6. Provide a detailed description of operation/s to be performed within the building:

7. Is there food preparation involved: Yes No

8. Number of employees:

9. Describe any specific EQUIPMENT and MATERIALS that may be used to conduct your business:

Any outdoor storage of materials: Yes No If yes, describe:

10. Are there any CHEMICALS that will be stored on site:

INSIDE:

OUTSIDE:

11. Will there be any alterations to the interior or exterior of the building or tenant space: Yes No

Will a new or replacement plumbing fixtures be installed? Yes No

If yes to either of the two questions above, provide a description of the work proposed:

Page 9: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

City of Northglenn Phone: 303-450-8729Sales Tax Division Fax: 303-450-870811701 Community Center Drive Email: [email protected], CO 80233-1001 Website: www.northglenn.org/taxes

BUSINESS LICENSE APPLICATION

Pursuant to City Code Section 5-3-8(a)(b) It shall be unlawful for any person to engage in the business of selling at retail, as the same is defined in this Code,

tangible personal property and services subject to the tax imposed by this Code, without first having obtained a license therefore, as provided by Section 5-3-19.

Every person, retailer or lessor, who comes within the definition of "engaged in business in the City," as defined, shall obtain a Sales and Use Tax License in

order to do business in the City of Northglenn. Merely obtaining a business license does not excuse, nor supersede any other permits and/or

approvals necessary to actively engage in business within the City. It is the responsibility of each business to acquire all of the appropriate permits,

licenses, and/or approvals as listed in the ‘New Business Checklist’ prior to conducting business within the City.

APPLICATION FOR ONE OF THE FOLLOWING:

Business License - $15 Fee (Service or Sales) OR

Home Occupation Business License - $15 Fee(Enclose Home Occupation Agreement)

OR Exempt Institute License – No Fee

(Enclose a copy of the IRS 501(c)(3)Letter of Exemption)

1. Filing Frequency: If Sales Tax Collected is: $100/quarter or less – ANNUALLY

$100/month or less – QUARTERLY

$100/month or more – MONTHLY

Filing frequency subject to City approval. Annual filing status is typically granted to service businesses,wholesalers, & non-profit 501(c)(3) organizations

2. Indicate Type of Organization:

INDIVIDUAL ASSOCIATION LIMITED LIABILTY COMPANY GOVERNMENT

PARTNERSHIP ESTATE/TRUST CORPORATION LP, LLP, LLLP

NON-PROFIT (501(c)(3) non-profits must enclose copy of IRSexemption letter)

3. Full legal name of Business or Corporation:

4. Trade Name (Doing Business As):

5. State of Colorado Sales Tax License #: (Enclose a copy of the license)

6. Physical Business Location (Street & Unit #):

City State Zip Code Square Feet

Landlord (if business located in Northglenn) Phone

7. Mailing Address (if different from location address):

City State Zip Code

Continued on next page

(Office Use Only)

License Number: 99- __ __ __ __ __ __

Business Type: ______ Geo Code/Org: ______

Lot: ______ Cust: ______ NURA: __ Yes __ No

Check this box if company creates its owntax returns and does not need the City ofNorthglenn to supply them. (Enclose acopy of created tax return for Cityapproval)

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8. Business Location Phone: Fax:

9. Business Website Address:

10. Nature of Business/Type of Sales:

11. North American Industry Classification System (NAICS) Code (if known):

12. Days and Hours of Business Operation: # of Employees:

13. Date business activity began or will begin in Northglenn: ____________________________________

14. Did You Purchase an Existing Business?: Yes No If Yes, Date of Purchase

Name of Prior Owner and Business Name

15. List any other current or past businesses (within the past 5 years) owned in Northglenn:

1. 2.

16. *List all principal owners, partners, and or corporate officers (attach an additional sheet if necessary):

1. Name Home Address

Title Home Phone Cell Phone

Date of Birth Email Address

Valid Identification Number _______________________________ Valid Identification Type__________________

2. Name Home Address

Title Home Phone Cell Phone

Date of Birth Email Address

Valid Identification Number __________________________________ Valid Identification Type_______________

* Valid proof of identification includes a State Driver’s License, State Identification Card, U.S. Passport, Resident Alien Card,

and/or Military Identification card. Enclose a legible copy of valid identification.

17. Colorado Registered Agent (if Corporation or LLC):

Address ____ ___

Phone Fax Email

18. Contact for Business Records/Accountant: Phone

Address Email

19. Emergency Contact Name: Phone

“I declare under penalty of perjury, that this application has been examined by me and the statements made herein are made in good faithpursuant to the City of Northglenn tax laws and regulations, and to the best of my knowledge and belief, are true, correct, and complete. Ialso understand that additional permits and/or approvals (as described in the ‘New Business Checklist’) will be necessary prior to conductingany business within the City of Northglenn.”

Signature of Owner/Officer Date

Printed Name Title _____________________________________

Incomplete applications will not be processed. Applications will not be processed until$15.00 license fee is received. Please allow 20 days for processing.

Items noted with an asterisk (*) are kept strictly confidential.

kryan
Cross-Out
Page 11: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

For questions regarding this questionnaire, please contact the Industrial Pretreatment Division at 303-450-4026.

Based upon your business or wastewater discharge classification, an additional survey may be required.

Changes to state regulations require the City of Northglenn to conduct onsite survey inspections of all non-

single family home water service connections to determine if there are any uncontrolled cross-connections.

The City must also ensure that approved backflow prevention methods or assemblies are installed at service

connections. Prior to conducting the State-Mandated Onsite Survey Inspections, the City has opted to have

customers complete the following questionnaire.

If you do not participate in completing the questionnaire, or if the results of the questionnaire are inconclusive

to determine whether any uncontrolled cross-connections exist at your facility, it is anticipated that the City of

Northglenn will conduct an onsite survey inspection at your facility based on state regulations.

Please return the completed questionnaire by _________________, 2017. Questionnaires may be

submitted via mail, email, or fax.

Business Name: _______________________________________________________________________

Type of Business: ______________________________________________________________________

Business Address: _____________________________________________________________________

City of Northglenn Water Account Number: __________________________________________________

Contact Name: __________________________________ Title: _________________________________

Phone: ________________________________________ Email: ________________________________

Mailing Address (if different that business address): ___________________________________________

City: ________________________ Zip: _______________________ Phone: ____________________

Industrial Pretreatment Division

Cross-Connection Control Questionnaire Submit this completed and signed questionnaire via mail, email, or fax to:

City of Northglenn

Backflow Prevention Program

2350 W. 112th Ave.

Northglenn, CO 80234

Email: [email protected]

Phone: 303-450-4026

Fax: 303-450-4020

I. Overview

II. Property Information

Page 12: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

Page 2 of 3 Industrial Waste Questionnaire

CCCQ Revised 2/2017

Assembly #1:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #2:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #3:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Yes No Unsure

1 Is there a fire sprinkler system in place?

2 Is there a lawn irrigation system on the property?

3 Is the irrigation system on a dedicated water line?

4 Does the irrigation system use chemicals or fertilizers

5 Is there a large, commerical bioler at the facility?

6 Is there a cooling tower?

7 Does the facility have medical or dental equipment?

8 Does the facility have laboratory or photo equipment?

9 Does the facility have a carbonated beverage machine?

Are there backflow prevention assemblies installed at the facility?

If so, please complete the informaton in the next section

10

III. Plumbing Cross-Connection Type

IV. Backflow Assembly Information

Page 13: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

Page 3 of 3 Industrial Waste Questionnaire

CCCQ Revised 2/2017

Assembly #4:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #5:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

I certify under penalty of law that I have personally examined and am familiar with the information submitted in

this document and attachments. Based upon my inquiry of those individuals immediately responsible for

obtaining this information reported herein, I believe that the submitted information is true, accurate, and

complete. I am aware that there are significant penalties for submitting false information.

Name: ____________________________________ Title: _____________________________

(Please Print)

Signature: _________________________________ Date: _____________________________

V. Certificate of Information

Page 14: NEW BUSINESS CECLST 9 - Northglenn Packet... · 2018-07-13 · Cit of Northglenn New Business Checklist 6. Business Licensing Division o Business License - All businesses must have

For questions regarding this questionnaire, please contact the Industrial Pretreatment Division at 303-450-4026.

Based upon your business or wastewater discharge classification, an additional survey may be required.

Changes to state regulations require the City of Northglenn to conduct onsite survey inspections of all non-

single family home water service connections to determine if there are any uncontrolled cross-connections.

The City must also ensure that approved backflow prevention methods or assemblies are installed at service

connections. Prior to conducting the State-Mandated Onsite Survey Inspections, the City has opted to have

customers complete the following questionnaire.

If you do not participate in completing the questionnaire, or if the results of the questionnaire are inconclusive

to determine whether any uncontrolled cross-connections exist at your facility, it is anticipated that the City of

Northglenn will conduct an onsite survey inspection at your facility based on state regulations.

Please return the completed questionnaire by _________________, 2017. Questionnaires may be

submitted via mail, email, or fax.

Business Name: _______________________________________________________________________

Type of Business: ______________________________________________________________________

Business Address: _____________________________________________________________________

City of Northglenn Water Account Number: __________________________________________________

Contact Name: __________________________________ Title: _________________________________

Phone: ________________________________________ Email: ________________________________

Mailing Address (if different that business address): ___________________________________________

City: ________________________ Zip: _______________________ Phone: ____________________

Industrial Pretreatment Division

Cross-Connection Control Questionnaire Submit this completed and signed questionnaire via mail, email, or fax to:

City of Northglenn

Backflow Prevention Program

2350 W. 112th Ave.

Northglenn, CO 80234

Email: [email protected]

Phone: 303-450-4026

Fax: 303-450-4020

I. Overview

II. Property Information

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Page 2 of 3 Industrial Waste Questionnaire

CCCQ Revised 2/2017

Assembly #1:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #2:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #3:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Yes No Unsure

1 Is there a fire sprinkler system in place?

2 Is there a lawn irrigation system on the property?

3 Is the irrigation system on a dedicated water line?

4 Does the irrigation system use chemicals or fertilizers

5 Is there a large, commerical bioler at the facility?

6 Is there a cooling tower?

7 Does the facility have medical or dental equipment?

8 Does the facility have laboratory or photo equipment?

9 Does the facility have a carbonated beverage machine?

Are there backflow prevention assemblies installed at the facility?

If so, please complete the informaton in the next section

10

III. Plumbing Cross-Connection Type

IV. Backflow Assembly Information

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Page 3 of 3 Industrial Waste Questionnaire

CCCQ Revised 2/2017

Assembly #4:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

Assembly #5:

Manufacturer: ________________________________________________________________________

Model: _____________________________________ Size (in inches): _______________________

Type (RPZ, DC, PVB, SVB): ____________________ Serial Number: ________________________

Location of Assembly: (mechanical room, boiler room, outside, etc.) _______________________________________

Last Date Assembly Tested: ____________________ Testing Company: _____________________

I certify under penalty of law that I have personally examined and am familiar with the information submitted in

this document and attachments. Based upon my inquiry of those individuals immediately responsible for

obtaining this information reported herein, I believe that the submitted information is true, accurate, and

complete. I am aware that there are significant penalties for submitting false information.

Name: ____________________________________ Title: _____________________________

(Please Print)

Signature: _________________________________ Date: _____________________________

V. Certificate of Information

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SIGN APPLICATION GUIDE The City of Northglenn Sign Code (Chapter 21 of the Municipal Code, www.northglenn.org/municode) promotes economic vitality for business, other non-residential uses and multi-family development in the community through consistent but flexible guidelines. This sign application guide is intended for the following uses: multi-family residential, business retail or service, office, institutional and industrial. This guide contains information intended to help customers understand Northglenn’s sign code and when a sign permit is required. The attached application form must be completed and submitted to the Building Division of the city’s Planning & Development Department. Prior to approval of a sign permit, the Planning Division staff will review the site plan and elevation plans of the proposed signage for compliance with the regulations in the city’s sign code review. Additionally the Building Division staff will review the signage for compliance with all applicable building code requirements, including but not limited to structural and electrical review. There are two types of signs allowed in the city: permanent and temporary. Permanent signs are any sign with a structure that is permanently placed or affixed to a building or in the ground. Temporary sign are used only for regulated periods of time and are not permanently mounted. How to Apply for a Permit: The attached application must be completed to acquire a sign permit. The following information must be included as part of the application:

1. Names and addresses of the applicant and owners of the sign. 2. The address where any signs are to be erected. 3. Type of sign (e.g. wall sign, monument sign, temporary sign, etc). 4. Cost of the sign. 5. An illustration of the sign, showing all dimensions. 6. For detached signs, provide a site plan showing the sign location, other significant structures

onsite, property lines, sidewalks and bike paths, along with the distance from the curb. 7. For wall signs, show a drawing or photo of completed building façade, sign size and

dimensions of building facade. The drawing will need to include the dimensions of the tenant/building store front, including length and height to the top of the wall (including any parapet wall).

8. Applicant and tenant/owner signature on the application indication that the sign(s) comply with all the requirements of the Sign Code.

When is a Sign Permit Required? The majority of non-residential signs require a sign permit whether it is permanent or temporary. The following information outlines when a permit from the city is required and the performance standards that need to be met prior to the city approving the permit.

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2

PERMANENT SIGNAGE

For Multi-Family Signage see Section 21-1-5(a.1.B) of the city’s Municipal Code (www.northglenn.org/municode)

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3

TEMPORARY SIGNAGE

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SIGN PERMIT APPLICATION Planning and Development Department

SIGNAGE INFORMATION

ADDRESS OF PROPOSED SIGNAGE:

BUSINESS/TENNANT NAME:

TYPE OF SIGN PROPOSED: Wall Sign Detached (Freestanding) Sign Joint Identification Sign Other:

SIGN VALUATION: TYPE OF WORK: New Alteration Relocation EXISTING ELECTRICAL: Yes No

SIGN FEATURES: Direct Illumination Indirect Illumination Internal Illumination Electronic Message Sign (LED or Digital)

FOR WALL SIGNS: # of signs Length: Height: Area:

Area of Wall Façade: Length of tenant space Height (to top of parapet) Area

FOR DETACHED SIGNS: # of signs Length: Height: Area:

Height of Structure: Distance from Curb: (sign cannot encroach into ROW)

FOR TEMPORARY SIGNS: Type: Regular Limited Duration Date to be Erected: Date Removed:

Wall Signs: # of signs Length: Height: Area:

Detached Signs: # of signs Length: Height: Area: Dist. from Street:

Features: Wind Activated Pennants (Number , Area ) Portable Balloons (Number , Area )

PROPERTY OWNER(S)/TENANT INFORMATION

Name:

Company (if applicable):

Address:

City: State: Zip:

Phone: Email:

AUTHORIZED AGENT

Name:

Company (if applicable):

Address:

City: State: Zip:

Phone: Email:

ELECTRICAL CONTRACTOR (IF ANY ELECTRICAL WORK IS PROPOSED)

Name:

Company (if applicable):

Address:

City: State: Zip:

Phone: Email:

DATE RECEIVED:

PERMIT NUMBER:

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SIGN PERMIT APPLICATION Planning and Development Department

OWNER(S) & AGENT CERTIFICATION

I hereby depose and state under the penalties of perjury that all information submitted with/or contained in this application are true and correct and the application is complete to the best of my knowledge and belief. Agent’s Signature: Date: Owner/Tenant Signature: Date: STAFF USE ONLY: