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Home My WebLink AboutB13-0114 Use Tax Refund Requesti TOWNOFVi� Application for Refund of Use Tax Paid Please refer to instruction on the back of this form. Taxpayer Name: American Mechanical Services of Denver LLC Project Address: 181 West Meadow Drive Mailing Address: 6810 S Tucson Way, Centennial, CO 80112 Phone or e-mail: 303 - 806 -7300 Building Permit Number: 813 -0114 Date of Payment: 05/13/2013 Total Amount Paid: use Tax $1,503.50 Total Refund Requested: $1,503.50 Reason for Request (please mark the appropriate line): Construction materials costs were less than 50% of the project valuation shown on the building permit. An audit of the project cost is required before the town can provide any refund for this reason. Audit costs are borne by the taxpayer. Documentation showing the total cost of the project, copies of paid invoices for materials, and bills of lading showing delivery to the project site should accompany this request. If a determination cannot be made based upon the information provided, additional information and /or audit procedures may be required. The taxpayer will be notified if audit costs are expected to exceed $500. XExemption under section 2 -8 -5 of the Vail Town Code (see www vailgov com) Deed restricted employee housing with a price appreciation cap 4r Tax paid in error or by mistake " D, " Provide details on reverse side or on a separate sheet of paper. Attach all supporting documentation. I declare under penalty of perjury that this request, including all attachments, is true and correct to the best of my knowledge. If I have requested a refund because my materials cost less than 50% of the project valuation, I acknowledge the Town of Vail may charge to $50�* audit costs without additional notification. N/A 'S .---&, o � 3 -ZJo6' P7; z, Numder V.P. /G.M. vale P_ t or4ms6),}M5ef u64,c+��- E -mail address Date 75 South Frontage Road — Vail, Colorado 81657 — (970) 479 -2100 —FAX (970) 479 -2157 1� TOWN OF V Details and supporting information: Vail Valley Medical Center and /or Vail Clinic Inc. is an Exempt Organization INSTRUCTIONS 1.) Attach a copy of the building permit or permit receipt showing the original amount of use tax paid. 2.) If you are claiming a refund because: a. actual cost of materials used for a project is less than 50% of the valuation shown on your building permit — submit this form for review along with the appropriate documentation. b. you are exempt from the use tax - Identify which of the exemptions cited in section 2 -8 -5 of the Vail Town Code (available at www.vail-gov.com) applies to you and attach documentation to support your claim. Submit this form within 60 days after issuance of the building permit. c. you paid tax on materials used to construct deed restricted employee housing units which have a price appreciation cap — submit a certified copy of the recorded deed restriction conforming to Title 12 of the Vail Town Code within 60 days of issuance of the last certificate of occupancy. J you paid the construction use tax in error or by mistake — provide an explanation as to why the tax paid is erroneous and any calculations used to determine the amount of the error. Submit this application within three years after the date the materials are used. 3.) Sign the affidavit on the front of this form. 4.) Keep a copy for your records. 5.) Submit original form to the Finance Director, Town of Vail, 75 South Frontage Road, Vail, Colorado 81657 by mail or hand delivery to the front desk of the municipal building. For Town of Vail Use Only Amount of Refund: /`� , Date: 9.1 L Approved by: Account Code: 75 South Frontage Road —Vail, Colorado 81657 —(970) 479 -2100 —FAX (970) 479 -2157 NO , THIS PERMIT ull ST BE POST9 -Q,4 SI JDB$1 ArA T11V10 MWOFV Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657 p. 970.479.2139, f. 970.479.2452, inpsections 970.478.2149 COMBINATION BLDO PERMIT Permit # 01340t14, r Projec# # PF�J13 0�129.� dobAddress: 1-81-w-MEADOW DR VAIL Applied ..: 04/113/201 "3 x Locators VVj1iIC 2ND FLOOR BOILER ROOM BETWEEN C -SEC Issued.. 05/1612013 Pa " rcel No..... 210107101013 OWNER VAIL.CLINIC INC 04/18/2013 APPLICANT ;,-AMERICAN "MECHANICAL SERVICES 04 /18/2013 Phone: 303 -806 -7300 CAL SERVICES 04/18/2013 Phone: 303 -806 -7300 CO 86112 License: 'C600003468 Occupancy: Type Construction: 'S AND DOLER AND =ED REPIPE V CONTROL Valuation: $85,175.00 M*ttNNM1�Ni,NN+ ANN} fftNNlwNHe1M1H1rfARNN1rHf4 }i-RtHH4AiN'IN�f,N FEE SUMMARY Building Permit > $895.75 Bldg Plan Check $582.24 Use Tax Fee " Electrical Permit > $115.00 Elec Plan Check �m > $7A.75 Restuatant Plan Review — -> Mechanical Permit —> $1,680.00 Mach Plan Chock > $420.00 Additional Fees—,> ,$0.00 Plumbing Permtt > Plumbing $0.00 Pimb Plan Check > $000 Recreation Fee —> $D'00 Investigation —> $OOQ WII Coal' > S10.t)0 TOTAL PERMIT FEES > $3,803:25 I agree to comply with the information and plot plan, to comply with all Town ardinances and state laws andto build thlS structure according to�the town's zoning and subdivisioncodes,,design review approved, International Buildingand `Residential'Code "s'arid other ordinances of the Town applicable thereto. REQUESTS FQR INSPECTION SHALL BE MADE TWENTY -FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149 OR AT OUR OFFICE FROM 8:00 AM - 4:00 PM. combination permit 012811 ************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** TOWN OF VAIL, COLORADOCopy Reprinted on 09 -25 -2013 at 14:47:51 09/25/2013 Statement ************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Statement Number: 8130000608 Amount: $3,308.50 05/16/201303:26 PM Payment Method: Check Init: CG Notation: ck 930773575 american mechanical ----------------------------------------------------------------------------- services Permit No: B13 -0114 Type: COMBINATION BLDG PERMIT Parcel No: 2101 - 071 - 0101 -3 Site Address: 181 W MEADOW DR VAIL Location: VVMC 2ND FLOOR BOILER ROOM BETWEEN C -SEC Total Fees: $3,803.25 This Payment: $3,308.50 Total ALL Pmts: $3,803.25 Balance: $0.00 ************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ACCOUNT ITEM LIST: Account Code -------------- Description Current Pmts - - - EP 00100003111100 - -- ------------------------ - - - - -- ------ - - - - -- ELECTRICAL PERMIT FEES 115.00 MP 00100003111100 MECHA CAL PERMIT FEES 1,680.00 WC 00100003112800 WILL CALL INSPECTION FEE 10.00 r r C) M r m C 0 p N Z C v (D C > O a ,oil C C m m Z N N F N Cl) Ln �p n U cn .0 o m 0 m O O m Cl) L M L Y N Y N U E U E Gr�Re: N CD N7 O O �c c jm d CL >. , m m F- a a a M N F- o M Cl) le N N N ICAO O IiC I i w D v O Ta 0 F- v v Z M LO M r' O Y v M M N Ln Z :: M rn Cl) rn N m 0 O co ED r C E m y d m m co ov co N C O O O O F— F— (O H O O Il O Z O O CL d o 0 d sM— M r r C) M r m C 0 p N Z C v (D C > O a ,oil C C m m Z N N F N Cl) Ln �p n U cn .0 o m 0 m O O m Cl) L M L Y N Y N U E U E Gr�Re: N CD N7 O O �c c jm d CL >. , m m F- a a a M N F- o M Cl) le N N N ICAO O IiC I i w D v O Ta 0 F- Fee Items- B13 -0114 14:48 09/25/2013 Item # Descri tion Fee Amount Pmt Amount Balance Account code 10 BUILDING PERMIT FEES $0.00 $0.00 $0.00 BP 00100003111100 20 PLUMBING PERMIT FEES $0.00 $0.00 $0.00 PP 00100003111100 30 MECHANICAL PERMIT FEES $1,680.00 $1,680.00 $0.00 MP 00100003111100 40 ELECTRICAL PERMIT FEES $115.00 $115.00 $0.00 EP 00100003111100 47 1 ELEC PLAN REVIEW $74.75 $74.75 $0.00 PF 00100003112300 80 PLAN CHECK FEES $420.00 $420.00 $0.00 PF 00100003112300 140 RECREATION FEES $0.00 $0.00 $0.00 RF 11100003112700 150 WILL CALL INSPECTION FEE $10.00 $10.00 $0.00 WC 00100003112800 160 RESTAURANT PLAN $0.00 $0.00 $0.00 FS 00100003112400 1210 INVESTIGATION FEE BLDG $0.00 $0.00 $0.00 PN 00100003153000 Total Rows: 11 Page 1 Pew N: 11313-0114 Status: JISSUED Date . 104/18/M3 0 L 11 - -- Address: 1181 W MEADOW DR VAIL OWNER: IVAIL CLINIC INC h V, Mis t Fee S�aarary Calculated Fees: $5,281.24 Addtior►al Fees: ($1,477.§R etais Total Fees: ('- -- . $3 �3 52 etarTs Payments: [ $3,803.25 I Details Balance:I so.uo Include deferred payments in Fee Deus: r Include Taut transactions in Payment Details: r Pay Specific - Suppress zero balance items r Pay Full Balance Assess Additional Fee Partial Payment Ra4sbWe Oveewnert Pay 2Oedn Yoid Paymo"s it s Trust Account Transact S f1wirt Receipt Pay Deferred Fria Grid omit.* r A DR 0160107192! COLORADO DEPARTMENT OF REVENUE 1375 $HOMAN DENVER CERTIf ICATE OF EXEMPTION FOR SALES AND USE TAX ONLY pQNVER CO CD !0461 THIS LICENSE IS NOT TRANSFERABLE USE ACCOUNT NUMBER for all references LIABILITY INFORMATION ISSUE DATE 98 -01218 -0000 44 060 8611 N 080179 APR 14 1997 181 W MEADOW DR VAIL CO !{ ��I�t�tittlltt, 1, itlrttltl�{ tllttt�ltl�tt�ltit�ltt�tll�littl VAIL, CLINIC, INC VAIL VALLEY MEDICAL CENTER 181 W MEADOW DR VAIL CO 81657 -5058 A I DETACH HERE A yVie'n Exocuilve Olnc 06partrrmtt of Rgvenuw 13