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Home My WebLink About6235 W. 45th Avenue-2 G INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Occui)ancv/TvDe Inspections will not be performed unless this card is posted on the project site. **Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day.** Inspector Must Sign ALL Spaces pertinent to this project Foundation Inspections Date Inspector Comments Initials Pier Concrete Encased Ground (CEG) Foundation / P.E. Letter uo rvor your t_oncrPTP wrinr 1 n An muni ( it 1 ho Ahnvn Incnnr•tinne Underground/Slab Inspections Date Inspector Comments Initials Electrical Comments Sewer Service Plumbing Do njoi Lover unnerarouna or KP-Inw/In-Slah Wnrk Prinr Tn Annrnual rlf Thn Ahnun Iner�nn+i.,.,e Rough Inspections Date Inspector Initials Comments Wall Sheathing Mid -Roof %OG Lath / Wall Tie Rough Electric Rough Plumbing/Gas Line Rough Mechanical Rough Framing Rough Grading Insulation Drywall Screw / Nail Final Inspections Date Inspector Initials Comments Landscaping & Parking / Planning Dept. Inspections from these entities should be requested one week in advance. For landscaping and parking inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection / Fire Protection Dist. Final Electrical Final Plumbing Final Mechanical Roof i J V Final Window/Doors m Final Building NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. ror iow voitage permits - riease De sure tnat rougn inspections are compieted trom the Tire Uistnct and electrical low voltage by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather City of Wheat Ridge � Residential Roof=ing PERMIT - 201704462 PERMIT NO: 201704462 ISSUED: 07/20/2017 JOB ADDRESS: 6235 W 45th AVE EXPIRES: 07/20/2018 JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles with 20 sq. (16 sq. pitched, 4 sq. flat) *** CONTACTS *** OWNER (720)298-0147 CORTES CRYSTAL SUB (303)981-1265 Jon Lowrie 100243 Monarch Construction & Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,100.00 FEES Total Valuation 0.00+ Use Tax 149.10 Permit Fee 172.60 * * TOTAL * * 321.704 *** COMMENTS *** *** CONDITIONS *** 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) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. 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. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. PERMIT NO: JOB ADDRESS: JOB DESCRIPTION; City of Wheat Ridge Residential Roofing PERMIT - 201704462 201704462 6235 W 45th AVE Residential Re -roof to install Owens 20 sq. (16 sq. pitched, 4 sq. flat) ISSUED: 07/20/2017 EXPIRES: 07/20/2018 Corning Duration asphalt shingles with 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 ermrt. I further attest that I am legally authorized to include alI entities named within this document as partes to the work to be performed and that all work to be perp ed is dis in this document and/or its' accompanying approved plans and specifications. 0,/ Signature of OWNER or CONTRAC (Circle one) Date 1. This permit was issued based on the information provided in the permit application and accompanying Flans 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 originalpermit 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 granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any applicable code or any §din ce or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Dare REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. :aeew.cxnArtDx.zurrarau Top 1% of roofing contractors }t 491(Rw4tuU. t7 tltl3Rtl PHe%8�{S0.iJQtl41x6S PA%:rAO.t)b rs.aR91 kT441l: Mtl'?iAxL#ICYt(d4Atan.S;U�i - � I B88 '. iT xy A tYMRY.M(INAGf1rYQtlfi%f C.nM { X Install Decking (7116" OSB),?-_ sheets of 088 are included, each additional sheet will be $65 per sheet X install New Underiayment —151b. _301b. X Synth. Customer Name Crystal Cortes Jobb X Valley(s) will be closed with ice & water shield G Valleys) will be open ,X Ridge (s) to be color -coordinated with shingle Address 6235 w 45th ave Wheat Ridge co 80033 Phone 720298p147 Ah. Phone X Replace vents as needed Email Cortes6235&gmail X Re -flash chimney(s) and all wall abutment as needed Insurance Company American Modern clarmit 341727!n 4 X Install ice & Water shield per code, as well as all vents and skylights Ins.Policy# 0047664237 Monarch Construction & Roofing, LLC will be referred to in this contract as Monarch. The scope of work and materials identified below are the scope of work recommended by Monarch Construction & Roofing; Monarch is not obligated to perform any part of the scope of work that is not approved by the insurance company unless you authorize the work and agree to pay for this additional work. 16,102.76 American Modern The approximate cost of the services based on damages known at the time this contract is ente d is *_ _- determined by - insurance. Monarch will perform the scope of work approved by the insurance company. Monarch will supplement for items priced low, not included or items needed to pass city/county codes, which may increase initial dollar amount that insurance is paying out. Supplemental claims billed by Monarch that are approved by the insurance company for additional work or increases in costs become a part of this contract. The final scope and price agreed on between the insurance company and Monarch shall become the final contract price for the insurance approved scope. Customer will be responsible to pay for any upgrades; deductible, non-recoverable deprecation or additional work authorized by the customer that the insurance company determines is not covered within the scope of coverage provided by your insurance policy. Approximate Rates of Service: 4 to 5 Weeks __ these dates of service are subject to change due to unusual delays in transportation of materials, payment delays, insurance approval, ordinary weather delays, or by any other causes beyond rzasonable control of Monarch. Monarch will provide communication to customer to show tentative dates. Notice: If the property owner plans to use proceeds of a property and casualty insurance policy issued pursuant to part 1 of article 4:19, C.R.S., to pay for the roofing work, pursuant to section 6-22.105, the roofing contractor cannot pay, waive, rebate, of promise to pay, waive, or rebate all or past of any insurance deductible applicable to the insurance claim for payment on the covered residential property. I(we) hereby authorize & instruct the insurance company & lien holders to include the name of Monarch Construction & Roofing LLC as co -payee on any subsequent loss draft or checks after today s date as indicated above. I (we) authorize any legal representative and/or agent of Monarch Construction to obtain information necessary to complete any funding process relative to the claim number referenced above. I (we) further authorize Monarch to pick up in person any loss drafts or checks on my/our behalf and behalf of Monarch. Deposit Amount: $ 8051.38 Date: 6/7/2017 8:00:00 PM Rep, Initials Monarch Construction &Roofing LLC shall hold intrust any payment from the property owner Until Monarch Censtrucbon & Roofing LLC has delivered roofing materials at tho residenLai property site or has performed a majority of the roofing work on the property. I (we) agree, by signing below, to all the contract conditions, both front and back of this agreement. Date ofAcceptance: 6/7/2017 8;00:00 PM CustomerSignature(s): Customer S�natf.r ;Q' Monarch Represent-atve:Zach Griffin C., 51hinoilil Marrujactwer: Jo mqtrh TOW Tomatch CollifTo match Int X Tear off all existing layers (!_layers) r) Tear off one layer of wood shake shingles X Install Decking (7116" OSB),?-_ sheets of 088 are included, each additional sheet will be $65 per sheet X install New Underiayment —151b. _301b. X Synth. (` X Install Pre -Painted metals to code Brown Charcoal Tan Gray XWhite OtherWhRe __ Int__-_ X Valley(s) will be closed with ice & water shield G Valleys) will be open ,X Ridge (s) to be color -coordinated with shingle Ridge(s) to be High -Profile and color -coordinated with shingle X Install new pipe jacks X Replace vents as needed X Re -flash chimney(s) and all wall abutment as needed _ Install Ridge Vent _LF X Install ice & Water shield per code, as well as all vents and skylights X_ Install 4-6 nails per shingle as required by city/county codes. Satellite/ Dish Alignment (each customer will need to contact the provider to ro-align dish after roof installation) Int. X Final Inspections will be completed as city/counties allows. I have read the bask of contract # 23 Int._A� X_ 5 -year workmanship warranty on roofing_, all other constructiun trades will receive a 1 yr. workmanship warranty Extended Warranty Per Sq. $ _ _ Circle: Owens Conning Platinum GAF Other; _X_ Monarch Construction & Roofing will provide general liability Msurance coverag€+ of $2,00,000 general aggregate X Perform magnetic sweep of driveway and yard for remo 4 of ar, ;lis X Remove all trash and debris from work listed 51n While Gutters?l9.09 _L F Size 5 -inch or 6 -inch Color, - lnt - -._r Replace Gutter Screens Type; 0-r --- Insurance funds include Mortgage Company nes Nc_ (if yes please! ompieie the third party authorization form) lnt,t-_-_ Special Instructionsj-•F.uJOtua 4't3 Fitt c8,,+rl-kkttr4� rstuit .a#St alar-- , __-.n_,. _—�_.—r. 16,102.76 American Modern The approximate cost of the services based on damages known at the time this contract is ente d is *_ _- determined by - insurance. Monarch will perform the scope of work approved by the insurance company. Monarch will supplement for items priced low, not included or items needed to pass city/county codes, which may increase initial dollar amount that insurance is paying out. Supplemental claims billed by Monarch that are approved by the insurance company for additional work or increases in costs become a part of this contract. The final scope and price agreed on between the insurance company and Monarch shall become the final contract price for the insurance approved scope. Customer will be responsible to pay for any upgrades; deductible, non-recoverable deprecation or additional work authorized by the customer that the insurance company determines is not covered within the scope of coverage provided by your insurance policy. Approximate Rates of Service: 4 to 5 Weeks __ these dates of service are subject to change due to unusual delays in transportation of materials, payment delays, insurance approval, ordinary weather delays, or by any other causes beyond rzasonable control of Monarch. Monarch will provide communication to customer to show tentative dates. Notice: If the property owner plans to use proceeds of a property and casualty insurance policy issued pursuant to part 1 of article 4:19, C.R.S., to pay for the roofing work, pursuant to section 6-22.105, the roofing contractor cannot pay, waive, rebate, of promise to pay, waive, or rebate all or past of any insurance deductible applicable to the insurance claim for payment on the covered residential property. I(we) hereby authorize & instruct the insurance company & lien holders to include the name of Monarch Construction & Roofing LLC as co -payee on any subsequent loss draft or checks after today s date as indicated above. I (we) authorize any legal representative and/or agent of Monarch Construction to obtain information necessary to complete any funding process relative to the claim number referenced above. I (we) further authorize Monarch to pick up in person any loss drafts or checks on my/our behalf and behalf of Monarch. Deposit Amount: $ 8051.38 Date: 6/7/2017 8:00:00 PM Rep, Initials Monarch Construction &Roofing LLC shall hold intrust any payment from the property owner Until Monarch Censtrucbon & Roofing LLC has delivered roofing materials at tho residenLai property site or has performed a majority of the roofing work on the property. I (we) agree, by signing below, to all the contract conditions, both front and back of this agreement. Date ofAcceptance: 6/7/2017 8;00:00 PM CustomerSignature(s): Customer S�natf.r ;Q' Monarch Represent-atve:Zach Griffin Dan Schultz zPo(7(_)446�� From: no-reply@ci.wheatridge.co.us Sent: Wednesday, July 12, 2017 10:20 PM To: Permits CommDev Subject: Online Form Submittal: Residential Roofing Permit Application G Categories: Danny 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 residential roof? How many dwelling units Single Family Home 6 are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 6235 w 45th ave crystal cortes 7202980147 Field not completed. 3a1.7o Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. CONTRACTOR INFORMATION Contractor Name monarch construction Contractor's License 100243 Number (for the City of Wheat Ridge) Contractor Phone 3039811265 Number Contractor Email Address blowrie@monarchroofs.com Retype Contractor Email blowrie@monarchroofs.com Address DESCRIPTION OF WORK Are you re -decking the No roof? Description of Roofing o/c duration Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 16 material selected above? Does any portion of the ✓ property include a flat y6�5 p Y roof? If yes, how many squares 4 on the flat roof? TOTAL SQUARES of all 20 roofing material for this project Provide additional detail house and garage and shed here on the description of z work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 7100 value or cost of ALL materials and labor) 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 submit this application and to perform the work described above. Name of Applicant brie lowrie Email not displaying correctly? View it in your browser. 3 i CITY OF WHEAT RIDGE - Building Inspection Division r (303) 234-5933 Inspection line (3n3) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: p Y Job Address: G 2. ►r5//ST T Permit Number: 01"2 O L/ c/,/v ? ❑ No one available for inspection: Time/ i Re -Inspection required: Yes When corrections have been made, call for re-inspec` n at Date:` �`� % Inspector: �� vlf AM/PM d 1 i 44. CITY 0F,WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: zo Job Address: Permit Number: 7 C/-,�, Q /-/L,/ ❑ No one available for inspection: Time G > 1 AM/PM Re -Inspection required: Yes? No When corrections have been made, call for re -inspection t 303-234-5933 Date: `/1" / Inspector: /L�/, Ptessecom all blahliahted a b oth of this form. ln nplete application may not be p Property Address. - Prca r (p lease print): Phone: Property Ow Emall M ailing dress: (if different than pr operty address) Address: Q , State, l hitectlEnaineer Arch teeV E Pho Contractor jAal:�dp ) Contra License Phone: � gtontractor E -mail Address: Sub Contra tors: Electrical: Plumbing: Mechanical: W.R. City License # W,R. City L icense # W.R. City License Other City Licensed Sub. Other City Licensed Sub. City License # City License Complete all information € n BOTH sides of this farm w• Sq. Ft. F Btu's Gallons Amps Squares Other . R Building & Ins 7600 W. 2e Ave., Wheat Ridge, ► err Office; =• Building Inspection Une: 303-234-5933 Permit Application . ♦ • .. s ' ! I I I I ♦ rta: :ra Addy City, State, zip, a r Date: plan P)Orm INSPE _._:JN RECORD Occunancv 'V INSPECTION LINE (303) 234 -5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. r Ik ?. U�i� �i _� 1 7- / S /P lnn,� na — e -- — VIA f 1 J >l. d IV A " INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS J OB FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: Footings /Caissons Stemwall / (EEG) Concrete Encased Ground Reinforcing or Monolithic Weatherproof / French Drain Sewer Service Lines Water Service Lines POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS Parking & Landscaping SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. "'NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. Plumbing (Underground) Heating (Underground) DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGHS Sheathing Lath /Wall tie Mid -Roof Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical Framing ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Insulation Drywall Screw FINALS 1 Electrical Plumbing Mechanical Roof Building Final Fire Department R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS Parking & Landscaping SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. "'NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER j. �, V 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 45� Z3S Permit Number ❑ No one available for inspection� AM /PM Re- Inspection required: Yes/ N City of Wheat Ridge Residential Electric PERMIT - 110294 PERMIT NO: 110294 ISSUED: 03/23/2011 JOB ADDRESS: 6235 W 45TH AVE EXPIRES: 03/22/2012 DESCRIPTION: 100 amp service change * ** CONTACTS * ** owner 303/881 -5896 Jim Jercinovich sub 720/470 -7218 Christopher Hannon 11 -0070 Great American Electric LLC ** PARCEL INFO ** ZONE CODE: UA USE: UA SUBDIVISION: 0801 BLOCK /LOT$: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 1,250.00 FEES Permit Fee 53.70 Total Valuation .00 Use Tax 22.50 C�rJ�CFf��r'j ** TOTAL ** 76.20 Conditions: Must comply w/ 2006 IRC & 2005 NEC. Subject to field inspection. 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 document an1or itsL y ccompanying approved plans and specifications. a Sigllata� - 0?!F/ or CONTRACTOR (Circle one) bate / 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 inspec ion. signature f Building Offical Date INSPE IO REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUE TS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. i lyo 1 - heatIjidge Date: COMMUNITY DEVELOPMENT Plan # Building & Inspection Services Division 7500 W. 29" Ave., Wheat Ridge, CO 80033 Permit# t'U)N Office: 303 -235 -2855 * Fax: 303 - 237 -8929 Inspection Line: 303- 234 -5933 Building Permit Application Pao ertyAdd%sss & G✓, 4'S -4 AVE- Property Owner (please print): Ttt 1 w G / -hf Phone: 30 Mailing Address: (if different than property address) Address: City, State, Zip: Coii(rac* �c� �ubGIG�N �L T7t /C Contractors City License #: Phone: 770 x/70 - 7ZI VV �ub'�ontra� #c�T"s�` Electrical: Plumbing: Mechanical: City License # City License # City License # 15esarlptlo5i f �nrork "t? SE1cvl c C- 6 �''V , Contract Values $ Ii 19100 Review Fee (due at time of submittal): Squares BTU's Gallons Amps _ !yO Sri 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 die 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 (OWNER) (CONTRAt C (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) PRINT NAME: /STSYFiIst / - 4, VW ®A/ SIGNATURE: � _: - ----- "t1AT FIRE DEPARTMENT ❑�appJov'£tl 3S /pommets''L]d�Sa APO r�V)ew ce�Slii d Bldg Valuation $