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Home My WebLink About4280 Harlan Streeti CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: &/ C `i - P , ,n a Job Address: L) ?'a O Iq " r- Ja n S Permit Number: '2 0 I-7 0 go -3 q V%j ❑ No one available for inspection: Time y QPM Re -Inspection required: Yes Q When corrections have been made, call for re -inspection at 303-234-5933 Date: 7 J 9 / 8 inspector: DO NOT REMOVE THIS NOTICE L/ i CITY OF WHEAT RIDGE Building Inspection Division. (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: '-1 C 9 - ``f'n c-, Job Address: 41-PS o Permit Number: -9 0 1-7 0 S O 2 L-1 q:_inoL1 Par•4,a) ons, R 0 0-p� 0 %r . P) f' a r•e 5 c v of o r -e R 0114 ❑ No one available for inspection: Time 8 = S1 &PM Re -Inspection required: es No When corrections have been made, call for re -inspection at 303-234-5933 Date: -S- &S1 / S Inspector: —Tb DO NOT REMOVE THIS NOTICE V2 -Z i CITY OF WHEAT RIDGE Building -inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 306 -46 Uo� Job Address: u2 i)O Hol' i'1) EJ, Permit Number: 2Dl ;5p00,zq ❑ No one available for inspection: Time 1 o � M Re -Inspection required: Yes Po When corrections /have been made, call for re -inspection at 303-234-5933 Date: bw, q '/ Inspector: l p►,C t DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE 13�ilding Insdectit)6 Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: Permit Number: M[ Ci - 3 V /P - 0) '.d Lia So Par lay, 'D 0 1 -7 0 'F o -D L) �o,,-p s� IVo / GZ ei IS el 0(1- Irls,bec 1C7i1 fV0 or �� ,�� e oL cap O�- V P r) < o -E' , y V n c� ❑ No one available for inspection: Time @Qpm Re -Inspection required: Ye No When corrections have been made, call for re -inspection at 303-234-5933 Date:-'-/1ao / S Inspector: _T15 DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201708024 PERMIT NO: 201708024 ISSUED: 10/05/2017 JOB ADDRESS: 4280 Harlan ST EXPIRES: 10/05/2018 JOB DESCRIPTION: Residential Re -roof to install GAF asphalt shingles - 20 sq Pitch = 5/12 *** CONTACTS *** OWNER (303)423-9277 DRAPEAU ROLAND M SUB (303)295-2220 Tomas Wofram 110052 Core Contractors, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 12,138.00 FEES Total Valuation 0.00 Use Tax 254.90 Permit Fee 251.85 ** TOTAL ** 506.75 *** COMMENTS *** *** CONDITIONS *** Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required for both the midroof and final inspections. The 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec. R806. The installation of ridge venting requires the installation or existence of soffit venting. For calculation purposes, one hat or turtle vent equal to one-half of one square foot of opening. Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, the 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. � ' , City of Wheat Ridge Residential Roofing PERMIT - 201708024 1 PERMIT NO: 201708024 ISSUED: 10/05/2017 JOB ADDRESS: 4280 Harlan ST EXPIRES: 10/05/2018 JOB DESCRIPTION: Residential Re -roof to install GAF asphalt shingles - 20 sq Pitch = 5/12 I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications2 app ioa le building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attest th I m e ally authorized to include all entities named within this document as parties to the work to be performed an�that ih1 0Wk r rmed is losed in this document at d/or� its' accPmpanying approved plans and specifications. Signature NER o CONTRACTOR (Circle one) Date I . This permi was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to t e compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180.days made be granted at the discretion of the Chief Budding Official and may be subject to a fee equal to one-half of the original permit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or gr%L� shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable code orrebn o his risdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett 'z 0 170? O From: no-reply@ci.wheatridge.co.us Sent: Monday, October 2, 2017 4:07 PM c To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application r� Follow Up Flag: Follow up FlagStatus: Completed Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes (- ��' �� U� 17 residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address 4280 Harlan St Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) Roland Drapeau 303-423-9277 Property Owner Email pisterzi@netzero.com Address Do you have a signed Yes contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Drapeau Contract.pdf Contract CONTRACTOR INFORMATION Contractor Business Core Contractors Name Contractor's License 110052 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-295-2220 Number (enter WITH dashes, eg 303-123-4567) Contractor Address 4049 Saint Paul St, Denver, CO 80216 (Primary address of your business) Contractor Email Address docs@coredoes.com Retype Contractor Email docs@coredoes.com Address DESCRIPTION OF WORK TOTAL SQUARES of 20 the entire scope of work: Project Value (contract '� 12138 value or cost of ALL materials and labor) Are you re -decking the No roof? Is the permit for a flat Pitched roof (2:12 pitch or greater) roof, pitched roof, or 78 both? (check all that apply) What is the specific pitch of the PITCHED roof? How many squares are part of the PITCHED roof? Describe the roofing materials for the PITCHED roof: Type of material for the PITCHED roof: Provide any additional detail here on the description of work. (Is this for a house or garage? Etc) 5/12 20 GAF Timberline Armor Shield II Asphalt Re -roof SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this Yes application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work Yes may not begin on this property until a permit has been issued and posted on the property. I certify that I have been Yes authorized by the legal owner of the property to 79 submit this application and to perform the work described above. I attest that everything Yes stated in this application is true and correct and that falsifying information in this application is an act of fraud and may be punishable by fine, imprisonment, or both. Name of Applicant Brady Burkholder Email not displaying correctly? View it in your browser. 80 • CONTRACTORS ROOFING SYSTEMS Property Owner Roland Drapeau Property Address 4280 Harlan St Wheat Ridge, CO 80033 Agreement "Doing it right matters" Effective Date 08/10/2017 4501 Logan St, Denver, CO 80216 303.997.1559 City/State Zip Wheat Ridge 80033 Primary Phone number Secondary Phone Number 3034239277 3039052802 Email Address pisterzi@netzero.com Terms: By signing this agreement, the property owner authorizes CORE Contractors, Inc. ("CORE") to perform the work and supply the materials as agreed upon by the property owner's insurance carrier. The homeowner agrees to use CORE exclusively, and authorizes CORE to obtain labor and materials in accordance with the scope agreed to by the insurance company and the specifications set out in this agreement to accomplish the replacement or repairs. The initial proposed scope of services is attached to this agreement. This agreement does not obligate the homeowner or CORE in any way, unless the damage is approved by homeowner's insurance carrier. Roofing Scope: The roofing system replacement includes all shingles, Additional Roofing Scope Notes underlayment, valley linings, and miscellaneous flashing, IR dying on the main home. All gutters and partial per local applicable municipal code. This also includes full downspouts to be replaced. Mod bit roofing clean-up of the property and a 5 year Roof Workmanship system on backyard shed. Warranty (on full roof replacement only). A one year workmanship warranty is included on all non -roof work performed by CORE. Due to the nature of repairs related to insurance claims, this contract includes an estimated repair price of the roof system. S 12138 Because the final scope has not been agreed upon with the insurer, this repair price may change. The amount of this contract is for 100% of the replacement cost approved by the insurance company for the work to be completed by CORE. Reaching agreement on the full scope of repairs involves considerable time on CORE's part and we will not proceed with that phase unless you agree to allow us to do the work once the scope is agreed upon. By signing this contract, you authorize CORE to reach an agreement on the scope of repairs on your behalf. CORE agrees to bid the work using the primary insurance industry pricing database (Xactimate) based on the scope of work agreed upon with your insurer. You, the homeowner, recognize CORE Contractors, Inc. as a general contractor and as such shall be entitled to overhead and profit, at customary insurance industry rates (20% on Xactimate line items). Any substantial additions or deductions to the scope of work will be handled on the Customer Verification Form. The property owner, you, must agree that, once a scope of work and project cost is agreed between CORE and the insurance carrier, they are responsible to pay ONLY the . w'ERFJ aY "", CafiV85 www.aocanvas.com� r, tz_ deductible amount per their replacement cost insurance policy. Any further changes, in addition to the insurance work, must be requested in writing, by the property owner. If, you, the property owner, plan to use the proceeds of a property and casualty insurance policy issued pursuant to Part 1 of Article 4 of Title 10, C.R.S. to pay for roofing work, pursuant to Section 6-22-105, C.R.S., THE ROOFING CONTRACTOR CANNOT PAY, WAIVE, REBATE, OR PROMISE TO PAY, WAIVE, OR REBATE ALL OR PART OF ANY INSURANCE DEDUCTIBLE APPLICABLE TO THE INSURANCE CLAIM FOR PAYMENT FOR ROOFING WORK ON THE COVERED RESIDENTIAL PROPERTY. PAYMENTS ARE TO BE MADE: HALF (OR FIRST INSURANCE CHECK RECEIVED — ACV CHECK) UPON DELIVERY OF ROOFING MATERIALS, AND FINAL BALANCE UPON COMPLETION OF WORK. THE WORK IS TO BE COMPLETED WITHIN APPROXIMATELY 90 DAYS OF EXECUTED CUSTOMER VERIFICATION FORM. CORE SHALL HOLD IN TRUST ANY PAYMENT FROM THE PROPERTY OWNER UNTIL THE ROOFING CONTRACTOR HAS DELIVERED ROOFING MATERIALS AT THE RESIDENTIAL PROPERTY SITE OR HAS PERFORMED A MAJORITY OF THE ROOFING WORK ON THE RESIDENTIAL PROPERTY. All estimates or contract amounts include a 3.5% discount for cash or check transactions. Property Owner's Initials Right to Cancel You, the homeowner, have the right to rescind this agreement and obtain a full refund of any deposit within 72 hours after entering the agreement. If you plan to use the proceeds of a property and casualty insurance policy to pay for the roofing work, you may rescind this contract within 72 hours after you receive written notice from the insurer that your claim has been denied in whole or in part. Property Owner Roland Drapeau Property Owner Signature Date 08/10/2017 Insurance Company State Farm d RE�wC-=CclI1V3S www.aocanvas.com CORE Contractors, Inc. ("CORE") is authorized to provide you with this NOTICE. You are therefore notified that: (a) ANY PERSON OR COMPANY SUPPLYING LABOR OR MATERIALS FOR THIS IMPROVEMENT TO YOUR PROPERTY MAY FILE A LIEN AGAINST YOUR PROPERTY IF THAT PERSON OR COMPANY IS NOT PAID FOR THE CONTRIBUTIONS. 1. All contracts are subject to approval of our credit department and office without exception. The person executing this contract must obtain the approval from the officer of the CORE Contractors, Inc. for this contract to be effective under any conditions. 2. SHOULD DEFAULT BE MADE IN PAYMENT OF THIS CONTRACT CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE HALF (1 %2) PERCENT PER MONTH (18% ANNUM) WITH A MINIMUM CHARGE OF $20.00 PER MONTH, AND IF PLACED IN THE HAND OF A COLLECTION AGENCY, ALL COLLECTION, LEGAL, AND FILING FEES SHALL BE PAID BY CUSTOMER ACCEPTING SAID CONTRACT. 3. CORE Contractors, Inc. shall have no responsibility for damages from rain, fire, tornado, windstorm, or other perils, as is normally contemplated to be covered by home owners risk insurance or business risk insurance, or unless a specified written agreement is made therefore prior to commencement of the work. 4. Should legal action be necessary, because of any act that might arise during the course of this agreement, CORE shall be entitled to all costs incurred in connection with such action, including a reasonable attorney's fee. 5. The parties hereto agree that all actions or proceedings arising in connection with this agreement shall be tried and litigated exclusively in the State and Federal courts located in the County of Denver, State of Colorado. 6. Replacement of deteriorated items (such as decking, fascia boards, roof jacks, ventilators, flashing, or other materials) not covered by insurance, discovered during construction and required by governing code or necessary for product warranties are NOT INCLUDED and will be charged as an extra on a time and materials basis unless STATED IN THIS CONTRACT. 7. CORE Contractors, Inc. shall not be liable for failure of performance due to labor controversies, strikes, fires, weather, inability to obtain materials from usual sources, or any other circumstances beyond the control of CORE Contractors, Ins. whether of a similar or dissimilar nature. 8. Subsequent to property owner's insurance carrier approval, if this agreement is terminated by the owner, the owner shall be financially responsible for all work performed based on the following milestones (percentages are additive). a. Consulting Phase: Preparation of CORE Xactimate scope of work and adjuster appointment — 3% of total bid. b. Substantial agreement or scope confirmation with insurer — 5% of total bid. c. Ordering and scheduling of work — 2% of total bid. d. Repair Phase: Any line item of physical work that has been started shall be completed by CORE; if the owner terminates this agreement while physical work is ongoing, they shall be responsible for all costs related to that line item, plus general contractor overhead and profit. 9. In addition, the owner shall be responsible for all other reasonable fees and expenses incurred prior to termination of the agreement, including permit fees, deposits paid by CORE to suppliers and subcontractors, subcontractor fees and expenses, etc. to the extent they are not already included in the line items for work that has been completed. All fees and expenses incurred prior to termination of this agreement shall be paid POWERED BY canvas www. ocanvas.com �'- 'I O�)�C�� .i, i) ,k °,6 ti_:; by the owner within 30 days of invoice date. 10. If material has to be reordered or restocked because of a cancellation by the customer; customer will have to pay the restocking fee assessed to CORE by the supplier. 11. If any provision of this contract should be held to be invalid or unenforceable, the availability and enforce -ability of the remaining provisions of this contract shall not be affected thereby. 12. ANY REPRESENTATIONS, STATEMENTS, OR OTHER COMMUNICATIONS, NOT WRITTEN ON THIS CONTRACT ARE AGREED TO BE IMMATERIAL, are not relied on by either party, and do not survive the execution of this contract. 13. The maximum liability for CORE Contractors, Inc. shall be the original cost of labor and materials for the repair, which the customer agrees shall be the liquidated sum, under any event of default of CORE Contractors, Inc. herein. 14. During the duration of the work, the customer's HOMEOWNER'S INSURANCE will be responsible for any interior damage as long as CORE Contractors, Inc. has taken appropriate action to protect the roof and siding during the repair of the roof. 15. CORE Contractors, Inc. is not responsible for existing construction problems of customer's home. If pointed out and notified to CORE, we will try to assist you in correcting the existing construction problems on a time and material basis. 16. THIS CONTRACT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE CONTRACT BY THE PARTIES. POWERED BY C. canvas www.gocanvas.com "'i cic:€7�i2 >�=l(7fk-1 St)> g.>€i4 S 1 OMCE USE ONLY ' ►: Si A � .0 �a #'. Building Permit Application �` �. +� �; a. °:� .�'.�t �.x t 1 g* g • °� xi ^}:�. ° f�>: :,� ` 7 d.p'.„� e i 'E :gip': ;� ,� 4 • ae y.. .� #= . • X1 `e Y!f a qtr a +w` a " I W.R, City Lb M W.R. City Uce rtes # MR, City Ucense Obw City L stt tl b: OMer t at Uoe nsed Sub: pity Lime # CRY U06ne 0 Complete A information on BOTH sides of this form CITY OF WHEAT RIDGE Building Inspection Division (303) 234 -5933 Inspection line (303) 235 -2855 Office ' (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type, Job Address i ,29e> Ix-,v 7 Permit Number lla6F/ nr• 'THIS NOTICE " 1 City of Wheat Ridge 1� Homeowner Plumbing PERMIT - 110691 PERMIT NO: 110691 ISSUED: 06/16/2011 JOB ADDRESS: 4280 HARLAN ST EXPIRES: 06/15/2012 DESCRIPTION: 39 if of sewerline repair * ** CONTACTS * ** owner 303/423 -9277 Roland Drapeau ** PARCEL INFO ** ZONE CODE:. UA USE: UA SUBDIVISION: UA BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 1,500.00 FEES Permit Fee 60.50 Total Valuation .00� Use Tax 27.00 4 e ** TOTAL ** 87.50 Conditions: I, the property owner, by my signature, attest that I currently reside at the project property, intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, except electrical, without the assistance of hired or professional workers. Consultation and courtesy inspections will only be performed with the homeowner of record. Subject to field inspections. I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in this doc gent and/ it/sr''{�' /{Pc��mpagny�ing� �approved plans and specifications. //_� 1 / //. af`L /LG.:4LC� '11 ( ` /U/ — // Signature of O RI or CONTRAITOR (Circle one) Date 1. This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one- half of the original permit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and procedures for approval of any new permit. Re- issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building. and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field i sp t'on. Signatur o 'ef Building Offical Date INSP TION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. d n a d City of Wheat�� COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 29" Ave., Wheat Ridge, CO 80033 Office: 303 -235 -2855 * Fax: 303- 237 -8929 Inspection Line: 303 - 234 -5933 Date: Plan # Permit # Ut Build Permit Application Property Owner (plea print): �® / c/46LLt+tq /`� Pllonw Mailing Address: (if different than property address) Address: City, State, Zip: Corit_racto_r: 14,* /n e D Gl) /I,) Contractors City License #: Phone: Sb7iContractq"TS Electrical: Plumbing: Mechanical: City License # City License # City License # Descrlptton 'of work; p 1 to d s� `f' f t �� I (f �l Contract Value: Review Fee (due at time of submittal): Squares BTU's Gallons Amps Sq Ft. $ OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. CIRCLE ONE y (OWNER) (C TRACTOR) or REP / RESENTA 7VE aof (OR'NER) (CONTRACTOR) PRINT NAME: „ B �� ✓" ` a SIGNATURE: ' \ DATE: �f ,., e�, ., �.✓w.v. r v,,.., ✓ r � ..,,w.,i�o, ,, � yam, .. �u, ,, �a � ✓srre... r ...e<..,,, ,.� ?„<.,.,_ „.�; � y ✓ cunitiy � if ✓ '. ✓ ,� h �� r :;. o- y, ,+f' �l � ✓: ✓ F r y < � e%” � �a ✓ Z ✓�; ✓ w .� i YRBVIBWer � > ✓r 'f ✓ ,� ✓ t .� " n 9 •� i �; � ✓' .:Fx1 S"%� ,��Y/r✓�� -1 J J r7. r r r r 5 � U ,+ r ✓ µ l �� ✓✓ >� {T r J,r ✓ /'r �'+� i ✓�✓ n �,.�i'r r✓, c i r tit ✓ BUILDING bEPARTMEN7 C01'vIMEN7S'� � " z n rte✓ rv✓: r � � / ��. �`"., �� ✓ ✓� � rs 2""' �r �',� Rev ewer ✓ F. 7 ✓ G y � '-� .,.»✓ f ° ✓ ✓ /' �^✓ ✓ / y . ✓✓ �h ✓ ✓5 � r h..J� S,x�h - � a ✓ ✓ fi � Pik ✓ ✓ r � S 1 ✓ ✓ � � k ✓ � ✓„✓ h � fi✓ 1 m r ✓ ,r, ,,. <✓ s li ii z) ^ F'{ >Y yf'c- �F , "" " � � t v ✓n : �' i s i` M � c ✓a r� � ✓5 �-t" � , �*i�. - tea. ;� v c� �; . �� . � * ,,.� ` ✓ lil ) ✓� 1 4 ^ � F es✓ ✓✓ � s ✓ ✓✓? ✓ s , '' a is s si r i ✓ �1 J ✓ t"`.,.' ✓,u"✓'i v "�1 sS bpi POBLIC WORKS C�MENTS r✓ t�. � , ti a ✓ ✓r✓ . � ,.�,? �' ; i `' ✓m � �?n.QC�PANCY z. � �'. � Re`wewer` < u S ��,!•^, �� 1 ✓ � /l � ✓ r,✓ a G .� r,y- ✓ �. ✓.�- s ✓ ✓ T °" T r ✓/ �' ,� ,..Gi � ✓< �,� i • 1..�^b• t' ✓ ✓ S ✓^f Y „� 3 G R r „FIRE DEPAY2TMENT b�approvgd WI oor�,mgnfs„'p�isaRprove� , O,nA Bldg Valuation $