HomeMy WebLinkAbout3655 Benton StreetPERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Homeowner Electrical PERMIT - 202100389
202100389
3655 Benton St
Electrical upgrade 200 AMPS
ISSUED: 02/26/2021
EXPIRES: 02/26/2022
*** CONTACTS ***
OWNER (720)404-8048 FORSTER ELIZABETH M
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 21250.00
FEES
Total Valuation 0.00
Use Tax 47.25
Permit Fee 93.35
** TOTAL ** 140.60
*** COMMENTS ***
*** CONDITIONS ***
Must comply w/ 2018 IRC & 2020 NEC . Subject to field inspection.
A printed copy of the permit and city stamped on-site plans must be available on-site for
the first inspection.
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, without the assistance of hired or
professional workers. If professionals are hired, those contractors are licensed with the
City of Wheat Ridge and are listed on the permit.
NOTE: Consultations and inspections will only be performed with the homeowner of record
present.
1* � 4 41'
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Homeowner Electrical PERMIT - 202100389
202100389
3655 Benton St
Electrical upgrade 200 AMPS
ISSUED: 02/26/2021
EXPIRES: 02/26/2022
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 permrt. I further attest that I am leg ally 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/or its' accompanying approved plans and specifications.
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 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 requ�ired
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, anviolation of any provision of any
pplicab e code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
02/26/2021
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
From: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Electrical Service Change/Upgrade/Electrical Work Permit Application
Date: Friday, February 26, 20212:02:43 PM
Electrical Service Change/Upgrade/Electrical Work Permit
Application
This application is exclusively for RESIDENTIAL ELECTRICAL SERVICE
CHANGE OR UPGRADE (200 amps or less).
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
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.
Is this application for Yes
electrical service
change or upgrade -
200 amps or less?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 3655 Benton St
Property Owner Name Laura D Goldhamer
Property Owner Phone 860-538-8369
Number (enter WITH
dashes, eg 303-123-
4567)
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business Laura D Goldhamer
Name
Contractor's License
000
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
860-538-8369
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Igoldhamer@gmail.com
Address
Retype Contractor
Igoldhamer@gmail.com
Email Address
DESCRIPTION OF WORK
Is this an electrical
Upgrade, Change
service upgrade or
change?
Number of Amps
200
Location of work
house
(garage, house, etc)
Provide additional
n/a
details, if needed.
Project Value (contract
$2,250
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 Laura D Goldhamer
Permit
Email not displaying correctly? View it in your browser.
PERMIT: . .
ADDRESS:
INSPECTION RECORD
JOB CODE:
Inspection online form: http://www.ci.wheatridge.co.us/inspection
Cancellations must be submitted via the online form before 8 a.m. the day of the inspection
Inspections will not be performed unless this card is posted on the project site
Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business
Foundation Inspections
Date
Inspector
Initials
Comments
102 Caissons / Piers
103 Footing / P.E. Letter
104 Foundation Setback Cert.
2�
k
105 Stem Walls
106 Foundation wall Insulation
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground / Slab Inspections
Date
Inspector
Initials
Comments
201 Electrical / Cable/ Conduit
202 Sewer Underground Int.
203 Sewer Underground Ext.
2�
k
204 Plumbing Underground Int.
205 Plumbing Underground Ext.
206 Water Underground
Do Not Lover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections
Rough Inspection
Date
Inspector
Initials
Comments
301 Rough Framing
302 Wall Sheathing
303 Roof Sheathing
2�
k
304 Sheer Inspection
305 Insulation
306 Mid -Roof
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
I t
"
314 Rough Plumbing Commercial
315 Shower Pan
Roug.i Inspection (continued)
Date
Inspector
Initials
Comments
316 Rough Mechanical Residential
317 Rough Mechanical Commercial
318 Boiler / Furnace
319 Hot water tank
320 Drywall screw and Nail
321 Moisture board / shower walls
322 Rough Grading
323 Miscellaneous
t 3
2I
Final Inspections
Date
Inspector
CommentsInitials
402 Gas Meter Release
403 Final Electrical Residential
404 Final Electrical Commercial
405 Final Mechanical Residential
406 Final Mechanical Commercial
407 Final Plumbing Residential
408 Final Plumbing Commercial
409 Final Roof
t 3
2I
410 Final Window/Door
411 Landscape/Park/Planning
Inspections from these entities shall be requested
one week in advance.
For landscaping and parking inspections please
call 303-235-2846
For ROW and drainage inspections please call
303-235-2861
For fire inspections please contact the Fire
Protection District for your project.
412 Row/Drainage/Public Works
413 Flood plain Inspection
414 Fire Insp. / Fire Protection
415 Public Works Final
416 Storm Water Mgmt.
417 Zoning Final Inspection
418 Building Final Inspection
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.
For Low Voltage permits please be sure that rough inspections are completed by the Fire District and
Electrical low voltage by the Building Division.
\ n�
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECT,I.—ONNNNOTI E
Inspection Type:
o oh
Job Address: �� ' (� fi
Permit Number: 0 "C)
❑ No one available for inspection: Time z)`" e, AM/PM
Re -Inspection required: Yes ;No
When corrections have been made, call for re -inspection at 303-234-5933
Date: ,� �f Inspector: �� C
DO NOT REMOVE THIS NOTICE
CITY OF WHEAT RIDGE °#
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICEr
Inspection Type:
Job Address:
Permit Number: o
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made, call for -re -inspection at 303 -234 -
Date: Inspector:
DO NOT REMOVE THIS NOTICE
f City of Wheat Ridge
Residential Roofing PERMIT - 201708176
PERMIT NO: 201708176 ISSUED: 10/10/2017
JOB ADDRESS: 3655 Benton ST EXPIRES: 10/10/2018
JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 22 sq Pitch = 6/12
(3rd party inspector required)
*** CONTACTS ***
OWNER (720)404-8048 FORSTER ELIZABETH M
SUB (720)697-6131 Andrew Chambers 130049 Vivax Pro 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: 10,738.00
FEES
Total Valuation 0.00
Use Tax 225.50
Permit Fee 220.15
** TOTAL ** 445.65
*** 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.
City of Wheat Ridge
Residential Roofing PERMIT - 201708176
PERMIT NO: 201708176 ISSUED: 10/10/2017
JOB ADDRESS: 3655 Benton ST EXPIRES: 10/10/2018
JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 22 sq Pitch = 6/12
(3rd party inspector required)
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable buildin codes, and all appli ble municipal codes, policies and procedures, and that I am the legal owner or have been authorized
a' the legal owne of the property and m authorized to obtain this permit and perform the work described and approved in conjunction with
this permit. I urt er attest that I a le' ally authorized to include all entities named within this document as parties to the work to be
performed t t X11 work to bees` rmed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signatu e of /OWMR-/O ' C CTOR (Circle one) Date / / I /
I, Thi pe it "s issued base on he information provided in the permit application and accompanying plans and specifications and is
sub ct the compliance w' h se documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This. ermit shall expire 365 a 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 maybe 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, 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 Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dane Lovett
From:
no-reply@ci.wheatridge.co.us
Sent:
Monday, October 9, 2017 11:00 AM
To:
CommDev Permits
Subject:
Online Form Submittal: Residential Roofing Permit Application
Follow Up Flag:
Follow up
Flag Status:
Completed
C
i�
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
are on the property?
PROPERTY INFORMATION
!)1_..
Property Address 3655 Benton St
Property Owner Name Liz Foster
Property Owner Phone 720-404-8048
Number (enter WITH
dashes, eg 303-123-4567)
21
Property Owner Email
Address
Do you have a signed
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Field not completed.
Yes
Attach Copy of Executed Forster roof bid-signed.pdf
Contract
CONTRACTOR INFORMATION
Contractor Business Vivax Pros
Name
Contractor's License 130049
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 303-330-8482
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Address 1050 Yuma St
(Primary address of your
business)
Contractor Email Address coleman@vivaxpros.com
Retype Contractor Email coleman@vivaxpros.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of 22
the entire scope of work:
Project Value (contract
value or cost of ALL
materials and labor)
Are you re -decking the
roof?
Is the permit for a flat
roof, pitched roof, or
10738
ZIP@
Pitched roof (2:12 pitch or greater)
22
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
oof
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)
6:12
IXI
OC/Duration/Onyx Black
Asphalt
Complete tear off and reroof
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
23
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 Coleman Harris
Email not displaying correctly? View it in your browser.
24
1050'Yuma St Family-owned & locally
Denver CO 80204 operated in the
Fax (303) 997-5467 -" VIVAX PDenver Metro area
www.vivaxros.com
p Protecting, Beautifying,
,.-
info@vivaxpros.com I !' ` Office: (720) 331-9735 and Powering Homes.
Vivax Pros will complete work above. Estimate $ Vis' nt is likely to change after insurance adjustment and
negotiations on the scope of work. Homeowner is not required to pay this amoun oe
i
A. Contingency Agreement: By authorizing this Agreement, the Property Owner allows Vivax Pros to represent the Property Owner's
best interest for a project replacement or repair at a price agreeable to the insurance company and Vivax. When an agreeable price
is determined between Vivax Pros and the Homeowners Insurance Company; it shall become the final contract price, including
overhead and profit; with no additional out of pocket cost to the Property Owner except the deductible. Upon the scope of work
being approved by the insurance company, the Property Owner and Vivax Pros shall enter a building contract for the work
described above.
Property Owner / Homeowner Vivax Pros Date
Customer agrees to allow Vivax Pros perform the work as specified on the Insurance Loss Sheer and/or this contract.
B. Contract Amount
Initial Insurance { RCV) $ Customer Upgrades $
Final Insurance ( RCV) $ (Out of Pocket)
Permit Fee $ Total Amount $
Approximate Start Date / /
Homeowner has the right to rescind conctract for full refund of deposit before date of material delivery.
Homeowner to provide Vivax Pros with final supplemented Insurance loss sheet.
All deposit funds will be held in trust and used only for above homeowner's job.
I hereby outhrize Vivax Pros to complete work as specified above.
Sign:8 Date: 10/09/17 Vivax: Date:
**Full Payment Required at completion of each Trade
Payment to be made as follows: Customer may pay Vivax as funds are received from their insurance company
Deposit $ Check#___ Date
Due upon signing this contract or receipt of first check from customers' insurance company. Minimum of 3545.
ACV Payment S Check# Date
Due upon signing this contract or due upon delivery of materials is equal to the full balance ofthe ACVamount issued by insurance including supplements.
Additional Payment $ _._ Check# Date
Additional Payment $ Check# Date
DAVE Torch
Awards
LOGAN-ro. forEthies
ROOF ESTIMATE 1 AGREEMENT Date of Estimate 05—// 7 /Z-7
Name i,:I- Fi2r3fr
Email
Street Address: 3q,Sy
City
Zip Code t%2 r "L Phone 71.00• fte , 1<10 49 Alt Phone
Estimator Name: JL.A AokPhone
aQ 3 . S` -V- / J!Jf Lead Source
Lead Source
HOA (Homeowner Responsible)
Vivax Pros is covered by
7,000,000 in General Liability Insurance and Worker's Compensation
Existing Roof Condition:
Roof Surface: sn hs I f
Roof Size: Roof Height: Ridge LF:
Roof Slope: V % i L
Number of Layers: 1 Currently Leaking:
New Roofing System Options:
Brand: Vw(4f Cv-ru j X
Type: X Color: Ltt LI� blaCk X
Manufacturer's Warranty: L� r F ;.a
Vivax Warranty: .x,� c�•a ik-.,� ur
Flashi : Color:_
Underlayment: �tthetic
rave Drip Edge 2X4 2 C nter
[. hChimney its _S ❑ Type 15 LB (fie 30 LB
E9,9-ake Edge Style D: Step
[-ripe Jacks_. galley Style: I&W Shield:
Installation Process
a ley_ ❑ Eave
glnn^stall 6 nails per shinglenspect
all roof Deckinqhtf can out gutter
magnet to capture nails in yard & driveway ispose of all tear -off debrist
VBuilding Code Upgrades
❑ Other
Additional Work:
utters
❑ 5iding/Trim
❑ Stain Deck/Fence
❑ Windows/Doors/Screens
❑ Paint
_ Shed Included: ❑ Yes ❑ No
Vivax Pros will complete work above. Estimate $ Vis' nt is likely to change after insurance adjustment and
negotiations on the scope of work. Homeowner is not required to pay this amoun oe
i
A. Contingency Agreement: By authorizing this Agreement, the Property Owner allows Vivax Pros to represent the Property Owner's
best interest for a project replacement or repair at a price agreeable to the insurance company and Vivax. When an agreeable price
is determined between Vivax Pros and the Homeowners Insurance Company; it shall become the final contract price, including
overhead and profit; with no additional out of pocket cost to the Property Owner except the deductible. Upon the scope of work
being approved by the insurance company, the Property Owner and Vivax Pros shall enter a building contract for the work
described above.
Property Owner / Homeowner Vivax Pros Date
Customer agrees to allow Vivax Pros perform the work as specified on the Insurance Loss Sheer and/or this contract.
B. Contract Amount
Initial Insurance { RCV) $ Customer Upgrades $
Final Insurance ( RCV) $ (Out of Pocket)
Permit Fee $ Total Amount $
Approximate Start Date / /
Homeowner has the right to rescind conctract for full refund of deposit before date of material delivery.
Homeowner to provide Vivax Pros with final supplemented Insurance loss sheet.
All deposit funds will be held in trust and used only for above homeowner's job.
I hereby outhrize Vivax Pros to complete work as specified above.
Sign:8 Date: 10/09/17 Vivax: Date:
**Full Payment Required at completion of each Trade
Payment to be made as follows: Customer may pay Vivax as funds are received from their insurance company
Deposit $ Check#___ Date
Due upon signing this contract or receipt of first check from customers' insurance company. Minimum of 3545.
ACV Payment S Check# Date
Due upon signing this contract or due upon delivery of materials is equal to the full balance ofthe ACVamount issued by insurance including supplements.
Additional Payment $ _._ Check# Date
Additional Payment $ Check# Date
F
a
i CITY OF WHEAT RIDGE
- Building Inspection Division ?�
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICEr`
Inspection Type:
Job Address:
Permit Number: '/�D / �&
U No one available for inspection: Time %'/ I,` AM/PM-
Re -Inspection required: Yes
When corrections have been made, call for re-fts ection at 303-234-5933
17
j
Date: ��� � � Inspector)- z
i
DO NOT REMOVE THIS NOTICE
4
CITY OF WAT RIDGE
1 10-054 M cdbb
Colon 1 as
RECEIPT
K0:00009292
Amw
WSP Install 75,0 btu Y
72.E
201381199
Pervit Fee
48.0
Use Tax?
62.E
RECEIVED PAYMENT
9164
72.0
Auth '2
6158
TOTAL
72.0
•
Pj��� (please print):
Phone: 3 '
Address:
City, State, Zip.
Contractors City License #: 4 Phone: 3 33 - 6
Sub Contractors:
Electrical: Plumbing: Mechanical:
City License # City License # C> 7?_ 0 9 City License #