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Home My WebLink About5210 W. 28th AvenueFrom: no-reolvCalci.wheatridae.co.us To: CommDev Permits Subject: Online Form Submittal: PERMIT APPLICATION Sewer or Water Line Repair Date: Friday, May 27, 2022 10:53:09 AM CAUTION:This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Report any suspicious activities to the IT Division. PERMIT APPLICATION Sewer or Water Line Repair This application is exclusively for SEWER OR WATER LINE REPAIR -IN YARD Your Permit will be emailed to the email address provided below once it is processed. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN WORK UNTIL PERMIT HAS BEEN ISSUED. Right of Way permits must be applied for with the Public Works Department. Is this application for Yes sewer line or water line repair - in yard only? PROPERTY INFORMATION Is this Residential or Residential Commercial? Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123- 4567) Property Owner Email Address Attach City of Wheat Ridge Electronic Payment Form - "DO NOT ATTACH A PICTURE OF A CREDIT CARD" 5210 W 28TH AVE BILLY 303-415-9201 Field not completed. WHEAT RIDGE CREDIT AUTH O.odf CONTRACTOR INFORMATION Contractor Business TRENCH RIGHT Name Contractor's License 130022 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-287-9009 Number (enter WITH dashes, eg 303-123- 4567) Contractor Email OFFICE@TRENCHRIGHT.COM Address Retype Contractor OFFICE@TRENCHRIGHT.COM Email Address 01:K163CiIi1 ffl0N]&TO(6]S:/ Is this a sewer line or Sewer Line water line repair? Length of repair 10' Location of repair FRONT YARD (backyard, frontyard, etc) Provide additional INSTALL CLEANOUTS details including installation of clean - outs. Project Value (contract 7000 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 work Yes may not begin on this property until a permit has been issued and posted on the property. I certify that I have Yes been authorized by the legal owner of the property to 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. Person Applying for JASON LAMB Pe rm it Email not displaying correctly? View it in your browser. NEAel!T: JOB CODE:- INSP � -� INSPECTION RECORD �I Inspection online f P Cancellations must be submitted via Ithe online form before 8 a m. the' dapection _ y of the Inspections will not be performed unless this card is posted on the project s tetion Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the he following business Foundation Inspections Date Inspector 102 Caissons / Piers Initials Comments 103 Footing / P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector 201 Electrical / Cable/ Conduit Initials Comments 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 206 Water Underground Do Not Cover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector 301 Rough Framing Initials Comments 302 Wall Sheathing 303 Roof Sheathing'_ 304 Sheer Inspection 305 Insulation t f 306 Mid -Roof f 307 Metal / Lath / Stucco 308 Rough Electrical Residential 309 Rough Electrical Commercial 310 Electrical Meter Residential 311 Electrical Meter Commercial 312 Temp. Const. Meter 313 Rough Plumbing Residential 314 Rough Plumbing Commercial 315 Shower Pan SEE OVER FOR ADDITIONAL INSPECTIONS igh Inspection (continued) Rough Mechanical Residential Rough Mechanical Commercial 3 Boiler I Furnace a Hot water tank 0 Drywall screw and Nail 1 Moisture board I shower walls .2 Rough Grading !3 Miscellaneous anal Inspections 02 Gas Meter Release 03 Final Electrical Residential 04 Final Electrical Commercial 05 Final Mechanical Residential 106 Final Mechanical Commercial t07 Final Plumbing Residential 408 Final Plumbing Commercial 409 Final Roof 410 Final Window/Door 411 Landscape/Park/Planning 412 Row/Drainage/Public Works 413 Flood plain inspection 414 Fire Insp. I Fire Protection 415 Public Works Final 416 Storm Water Mgmt. 417 Zoning Final Inspection Al R Ruilding Final Inspection Date Date Inspector Initials Inspector Initials comments comments Inspections from these entities shall be requested one week in advance. For landscaping and parking inspections please call 303-235-2846 inspections please call For ROW and drainage 303-235-2861 For fire inspections please the Fire Protection District for your project, approved by Planning, Public Works, Fire and Building Note: All items must be complet y is issued. Approval of the Final Building Inspection does not before a Certificate of Occupancy constitute authorization of occupancy. completed b the Fire District and For Low Voltage permits please be piv sion.t rough inspections are comp Y Electrical low voltage by the Building 521u�2 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: H �, co�_ Job Address: 2-(C) Permit Number: 1210 (7 0�� - MEM ❑ No one available for inspection: Time IPM Re -Inspection required: Yes When corrections have been made, call f re -inspection at 303-234-5933 Date: � hrI Inspector: 4)c- UtIt., DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201707872 PERMIT NO: 201707872 ISSUED: 09/29/2017 JOB ADDRESS: 5210 W 28th AVE_, EXPIRES: 09/29/2018 JOB DESCRIPTION: **REVI ION; Add decking to existing permit*** Residential Re -roof to instal7CS aspTi2C'"s`Iiirig es - 18 sq Pitch = 5/12 *** CONTACTS *** OWNER (303)237-1120 CRIBARI GEORGE S SUB (303)804-0303 Tom Brown 070055 Northwest Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,849.00 FEES Total Valuation 0.00 Use Tax 227.83 Permit Fee 220.15 ** TOTAL ** 447.98 *** 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. kLL City of Wheat Ridge Residential Roofing PERMIT - 201707872 PERMIT NO: 201707872 ISSUED: 09/29/2017 JOB ADDRESS: 5210 W 28th AVE EXPIRES: 09/29/2018 JOB DESCRIPTION: **REVISION; Add decking to existing permit*** Residential Re -roof to install OC asphalt shingles - 18 sq Pitch = 5/12 I, by rn 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 thispermit 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 andd�at (work to be performed is disclosed in this document and/or its' acco panying approved plans and specifications. A Signature of OWNER or CONTRACTOR (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 androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Off�ial and is not guaranteed. A 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 re uired 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 inspection. Signature of Chief Bung ltio al� � Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheat l dge COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: perm its(a)ci.wheatridge.co.us FOR OFFICE USE ONLY Date: Add to Permit # --7 Building Permit Revision/Amendment Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: D �> Property Owner (please print): b'6 o 2C>E Phone: 303 2,3 ,7 //ZO Property Owner Email: ti 0 N� r Mailing Address: (if different than property address) Address City, State, Zip: � vel2�- /y ('RFs , aF( 4 Contact Person: �� J /��1 V 612 t o Phone: 3 U3 —t " 7 (4' Contractor: /Vd 2 %lf wC'S % leec le", I.) Contractors City License #: Zig L��7 Phone: -7 0-3 ?61Y O.�O-3 Contractor E-mail Address: 1�0 ti 0,/(>(��jNGc-��'%— DF�,�6. Corte Please Note: Additional valuation must include all general and subcontracted work to be performed related to the revisions and/or amendments declared in the description of work and which were not included in the original permit valuation. If revisions or amendments increase the original valuation, additional fees will be due at the time of approval. Depending on the scope of work, additional plan review fees may be due upon approval ($60.00 an hour — 2 hour minimum). Description of revised/amended work: 1 Sq. Ft./LF Amps Btu's Squares Gallons Other Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above) $ 2g610oG 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 on this application. CIRCLE ONE: (OWNER) �-(CON7RACTQr (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) PRINT NAME: G r� L/ r�li "C�� Q SIGNATURE: /✓ DATE: /4;/ 7 DEPARTMENT USE ONLY ZONING COMMMENTS: Reviewer: OCCUPANCY CLASSIFICATION: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: �, •• ••- �" -"-"" Reviewer: ' ..... ter. PROOF OF SUBMISSION FORMS Fire Department ❑ Received ❑ Not Required Water District ❑ Received ❑ Not Required Sanitation District ❑ Received 0 Not Required Building Division Valuation: $ A , City of Wheat Ridge Residential Roofing PERMIT - 201707872 PERMIT NO: 201707872 ISSUED: 09/29/2017 JOB ADDRESS: 5210 W 28th AVE EXPIRES: 09/29/2018 JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 18 sq Pitch = 5/12 *** CONTACTS *** OWNER (303)237-1120 CRIBARI GEORGE S SUB (303)804-0303 Tom Brown 070055 Northwest Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,049.00 FEES Total Valuation 0.00 Use Tax 169.03 Permit Fee 188.45 ** TOTAL ** 357.48 *** 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 - 201707872 PERMIT NO: 201707872 ISSUED: 09/29/2017 JOB ADDRESS: 5210 W 28th AVE EXPIRES: 09/29/2018 JOB DESCRIPTION: Residential Re—roof to install OC asphalt shingles — 18 sq Pitch = 5/12 I, by my signature, do hereby attest that the cr be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applica e i a codes, policies and procedures, and that I am the legal owner or have been authorized by the legal ow of the pro and a 1z o obtain thispermit and perform the work described and approved in conjunction with this , . er atte am 1 a ed to include all entities named within this document as parties to the work to be per e n that a r o be ger isclosed in this document and/or its' accompanying approved plans and specifications. igna re for C RACTOR (Circle one) Date T s permit w issued ba d 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, po icies 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 maybe subject to a fee equal to one-half of the originalpermitfee. 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 an manner shall be performed that shall results in a changeof 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 inspection. SignatureO �SINESS Date REQUESTS MUST BE MADE BY 11:59PM DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett 0 i 7 0 7 e 7 Z From: no-reply@ci.wheatridge.co.us Sent: Wednesday, September 27, 2017 1:24 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application 5— Follow Up Flag: Follow up Flag Status: Completed c�. 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 �. (- n�r V i 7 residential roof? L, Cy,CA 0/ 11 /'7 How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) 5210 W 28TH AVE GEOGE CRIBARI 303-237-1120 89 Property Owner Email Address Do you have a signed contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Contract Ihammons@northwest-roofing.com Yes 170475 Contract.pdf CONTRACTOR INFORMATION Contractor Business Name Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone Number (enter WITH dashes, eg 303-123-4567) Contractor Address (Primary address of your business) Northwest Roofing 070055 3038040303 2425 S Colorado Blvd #280 Contractor Email Address Ihammons@northwest-roofing.com Retype Contractor Email Ihammons@northwest-roofing.com Address DESCRIPTION OF WORK TOTAL SQUARES of 18 the entire scope of work: r Project Value (contract 8049.00 value or cost of ALL materials and labor) Are you re -decking the roof? Is the permit for a flat roof, pitched roof, or No / Pitched roof (2:12 pitch or greater) 90 both? (check all that apply) What is the specific pitch 5/12 of the PITCHED roof? How many squares are 18 part of the PITCHED roof? Describe the roofing OC DURATION materials for the PITCHED roof: Type of material for the Asphalt PITCHED roof: Provide any additional HOUSE detail here on the description of work. (Is this for a house or garage? Etc) 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 91 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 LEILA HAMMONS Email not displaying correctly? View it in your browser. 92 REcaa NIZED AS A North West Rg ootin Since 1963 2425 S. Colorado Boulevard, Suite 280 1 Denver, CO 80222 ( (303) 804-0303 1 Fax (888) 846-5545 3630 Sinton Road, Suite 100 1 Colorado Springs, CO 80907 1 (719) 632-6185 1 fax (888) 846-5545 ACCREDITED BUSINESS Proposal ubmitte to z 2 �t c�3 J North West Roofing Estimator 12f� ► i��Ztr Date Street _Z 1 D rii V t . City, State, Zip . r�� %) 7 Job Location/C mmum y S LOQ > L Ne` - Phone 3L� I .� 7 Insurance Company A Policy # 6 t o o i SR,,,K Email _ Adjuster i b A )0 CA2 l,f =� Claim # j &k9Z V ,-�s6C� Q JI Scope of Work and Materials to be Provided: The scope of work and mat ' 1 ntified below will be completed by North Wesst� Roofing. �• Tear Off Layers ❑ Install Decking (7/16 in. OSB)ECK DECKI - L Install 90 Ib or Ice & Water Shield in Valleys � &(L GU (%( [Install 2 x4 in. Metal Drip Edge Color (,t1 t- (Tf Initials Install new Felt jl y 1.4 Recover Roof with ��h+S �(� N s �V l (y✓i T (�t Pr -i I -T" Wt 30 Year Manufacturer's Warranty El Shingle Manufacturer(/ tolorUPT-TC Initials Closed Valleys - With Ice and Water Shield Underlayment ❑ Open Valley - With Painted Metal t� Ridges to be color coordinated shingles Replace - Rubber Pipe lacks Z _ / Paint Roof Stacks To Match Shingle Color ALL 71 Replace -Low Profile Vents Z- — V Turbine Vents North West Roofing 3 Year Labor Warranty Metal Step Flashing A, Step Flashing Chimney North West Roofing will Provide General Liability Insurance of at least $1,000,000.00 ,,EJ Clean Up and Haul Off all Trash ElProtect and Clean Up Landscaping Q Clean around bushes and shrubs Clean Out Gutters Roll yard with magnetic roller Permit Furnished by North West Roofing I agree, by signing below, to all the contract conditions, both front & back of this agreement. Representative Signature PUEBLO (719) 633-7773 IffBy signing this agreement the homeowner authorizes North West Roofing to represent the homeowner's best interest in pursuit of roof replacement or repair due to storm damage. This contract does not obligate the homeowner or North West Roofing until the claim is approved by the insurance Company and accepted by North West Roofing. Upon Approval of the claim, North West Roofing will complete specific work at the price agreeable to the Insurance company and to North West Roofing. There is no additional cost to the homeowner except for their deductible. The agreed upon price will become the final contract price and North West Roofing will receive all insurance proceeds and supplements for the work completed by North West Roofing. , Initials The Approximate Costs of the Services $- 7 Shall Be The Agreed Upon Cost Between North West Roofing and �ry Your Insurance Carrier. Their RCV Cost Plus Supplements. �! NOTICE If the Property Owner Plans to use The Proceeds Of a Property and Causality Insurance Policy, Part 1 of Article 4 of Title 10, C.R.S., In accordance to Title 10 C.R.S., section 6-22-105, the roofing contractor cannot pay waive rebate, promise to pay or waive rebate or any part of insurance deductible applicable to the insurance claim for payment for the work on the covered property Wr Deposit Amount $ LIMOO Date:/tom` li41- UG t ` North West Roofing shall hold in trust any payment from the property owner until materials are delivered or have performed a majority of the roofing work on the property. *May not include any additional taxes, base service fees and or supplements that pertain to the claim. NO CASH ACCEPTED U Approximate Dates of Service: DAYS AFTER AGREEMENT 0 Theset. YZc h' (L/ (/� t 1 J dates of service ares b) c t -o hange�eto unusual delays in transportation of materials, ordinary weather delays, or by any other causes beyond the reasonable control of Contractor. ❑ SPECIAL INSTRUCTIONS _ (800) 333-1704 DENVER (303) 804-0303 I fax (888) 846-5545 li ? Date of Acceptance FORT COLLINS (970){484-9430 1-1C:) H i CITY OF _WH EAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE ❑ No one available for inspectio TmeTAM/PM Re -Inspection required: Yes No When corrections have been made, or re-inspZ�203-m -5933 1 0-- (- /;- Date:Z Inspector: DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE /j Ao/ Inspection Type: _�✓ r Job Address: 14 V,< Permit Number: 2� �`7 C7 �'`� `% Z_ M ❑ No one av ilable for inspection: Time) ' -' AM/PM tYe,-,,,) Re-Inspec on required: No When corrections have been made, call for re-inspec t 303-234-5933 Date./ () -5 5 r Inspector: 4' City of Wheat Ridge ]�� Residential Roofing PERMIT - 111325 PERMIT NO: 111325 ISSUED: 10/28/2011 JOB ADDRESS: 5210 W 28TH AVE EXPIRES: 10/27/2012 DESCRIPTION: Remove and replace 14 sqs of asphalt shingles * ** CONTACTS * ** GC 303/459 -7889 Quality Construction 11 -0245 Quality Construction Owner 303/237 -1120 George Cribari ** PARCEL INFO ** ZONE CODE: UA .USE: UA SUBDIVISION: 0528 BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 6,951.34 FEES Permit Fee 156.75 k Total Valuation .00 Use Tax 125.12o(p�✓ ** TOTAL ** 281.87 Conditions: 6 nails per shingle is required. Ice dam membrane is required from eave edge to 2' inside exterior walls. Board sheathing with any gap greater than 1/2" requires panel sheathing overlay on entire roof. Sheathing inspection is required prior to covering. Contractor shall provide ladder for inspections. Scheduled inspections that cannot be performed due to inclement weather must be cancelled prior to 8:30 a.m. on the day of inspection or a re- inspection fee will be assessed. 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 and /ors' accompanyi .approved plans and specifications. Signature of /AWNER or CONTfACTOR (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 inspection. w Signature of Chief Date INSPECTION RE LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.. Y City of Wheat' idge 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 Property Owner (plez Mailing Address: (If different than property address) Address: City, State, Zip: Contractor: Contractors City License #: Phone: Electrical: City License # Plumbing: City License # Descrlptlon `ofwork , Squares i 4 BTU's Gallons Ft. Date: Plan # Permit # ///3Z_!�— -45 L? - z Mechanical: City License # Contrac Value- Review Fee (due at time of submittal) 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. CIRCLEONE. (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) J . PRINT NAME � 'n SIGNATU � = °� �_ _ \ DATE: Bldg Valuation: Building Permit Application