HomeMy WebLinkAbout3775 Kipling Street
.,_~.."k?","".J"....."."JI!i~,~l"'~~I%"""""''l'" r',.."".,,!,'''"''''"~!"'''P'l''''''''\;~''~''''''''''''''' ",'"'~.N":' """".~,,,,,,,,.,~,,,,,?,,,,,,,,,,,",.,,,..,~.i..""l,,",,,.i",,, ""~,,.l~
DEPA.RTME"T OF PLA....I..G AND DEVELOPMENT Building Permit Number: 4698
;"..x:,. BUILDING INSPECTION DIVISION - 235.2855
CITY OF WHEAT RIDGE Date: 3/6/97
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Property OWner:
Property Address: 3775 KIPLING ST
Contractor License No,: 18738
Company: A Adkisson Electric, Inc.
Phone:
Phone: 2309550
OWNERlCONTFlACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I h....by c:ertify ~ ~ _ael< cli8tancas pIOIlOS8d by "'Is perm. BIlPlicatIon ara accurate,
and do not vlcilale~cable ordl!W1~, ruleS or ragulallons of the city of Wheat Ridge or
.. CClVllnants,~...".ms or IUtrlclkms of record; that an measurementa shown, and allagatlons
'!:~~!:~~g7
,
Description : ELECt~ICAL FOR BUS SHELTER
Conslfuction Value :.
Permit Fee :
Plan Review Fee :
Use Tax :
Total:
$325.00
$45.00
$0.00
$3.90
$48.90
BUILDING DEPARTMENT USE ONLY
SIC: Sq. Ft :
Approval:
Occupancy :
Walls:
Roof:
Stories:
Residential Units :
Electrical License No :
Company:
Plumbing License No :
Company:
Mechanical License No :
Company:
Expiration Date :
Approval:
.
Expiration Date:
Approval:
.
Expiration Date:
Approval:
.
(1) ~ pennIt..... _In 1lClCllnla""" _the pnlVislons Hlforth In yopur application ond Is _to the laws 01 the _ 01 CoIolado Ind to the ZonIng
RogUIotionI ond Bulldino Colle a _ RIdpe, CoIoIado or any _ __ ordIn8l1C18 a the CIty.
(2) llliI pom1I1lho11 elqlire. (A) the -" I_ad Is not commoriood withln obdy (eO) daysrrom Iaouo dale or (8) the building _II ouspended or
abandoned lor. pei1oda'l20 dayO.
(3) If\llll pormI1e>qlirM. I nowporml1m8Y be lll:qtJnd lor 1l8e of _the omounl nonnoHy Illllulnld. provided no ~ h8v8 _ or will be mode in the
orIgIn8I pI8rlS Ii\d ~ ond any ouaponolor1 or lbandonment hel not _ ono (1) year, If ~ore mode or If __ or _odol,nlllrt
......,. ana (1) _, IuA -$hili be j>aId lor I ___
l4l No -" of any _nor _ bedono th8l will cI10ngelhe natural tIow of _ ClUlIno I drainage probIom,
5)~. .ohoII noCIlylh. SUIIdIng I__-Icur (24) hou..1n _noolor Iff fnspodiol1s ond lhall.-.o _ opprovaI on inopec:IIon cord before
__OUlli:osolvo=' of the Job,
(8) 'Ibe iIsU8riCo oil _ or . . -' of drowIngo ond ~ ohall not be construod to be. pennff lor, nor on Ip/>IOVII 01, any _ 01 the pIOViIionI
of ~_ nonoo,low,rulsorNlllUlotlon,
Building InspeCtor
IS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR
CALL: 234-6933 24 HOURS PRIOR TO INSPECTION
DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number:
BUILDING INSPECTION DIVISION - 235-2855 -)
CITY OF WHEAT RIDGE Date: -:5/ S- 9/
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Property Owner: OJ.. i-fJooR PIZD-rYDTT:::D1J.s
Property Address: 37"7 S I,,-r: P /':[:10 ~
Contractor License No, : I~I So S'
Company: A, A\) I<-r',,SO,J f LL(-t(l:r.C1..l10(',
Phone:
Phone: d 30-95\"V
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
Construction Value :J:j 3 d S '00
Permit Fee:
Plan Review Fee:
Use Tax:
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 aU conditions printed on this
application, and that I assume full responsibilit for compliance with the Wheat Ridge Building
Code (U.B.C.) and all other applicable idge ordinances, for work under this permit.
(OWNER)(CONTRACTOR) SIGNE DATE3-S -'17
Description: (jU S
~L'L
Total:
BUILDING DEPARTMENT USE ONLY
SIC:
Sq. Ft:
?i5hl~~mlJ1-'I1Js.;J
Approval:
Zoning:
Jily!It!!.~l)l1J\!1.mt!'JI
Approval:
pal1J/laW~~mm'-ll.~
Approval:
Occupancy: Walls:
Roof:
Stories:
Residential Units:
Electrical License No :
Company:
Plumbing License No :
Company:
Mechanical License No :
Company:
Expiration Date:
Approval:
III
. .. . ; i . ~ .
::0' ._
Expiration Date:
Approval:
. lCL~ql!!~.c;1
(I)
(2)
(3)
This permit was issued in accordance with the provisions set forth in yopur application and is subject to the laws of the State of Colorado and to the Zoning
Regulatio,:,s and Buil~in9. Code of Wheat Rid'iile, C;olorado or any other. al?pliC?ble ordinances of. the City. , , ..
This permit shall expire If (A) the work authonzed IS not commenced within SIxty (60) days from Issue date or (B) the bUIlding authonzed IS suspended or
abandoned for a period of 120 day's.
If this permit expires, a new permit may be acquired for a fee of ona-half the amount normally required, provided no changes have been or will be made in the
original plans and specifications and any suspension or abandonment has not exceeded one (1) year, If changes are made or if suspension or abandonment
exceeds one (1) year, full fees shall be paid for a new permit.
No work of any manner shall be done that will change the natural flow of water causing a drainage problem,
Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive written approval on inspection card before
proceediing with successive phases of thel'ob,
The issuance of a permit or the approval 0 drawings and specifications shall not be construed to be a permit for, nor an approval of. any violation of the provisions
of the building codes or any other ordinance, law, rule or regulation,
(4)
(5)
(6)
Chief Building Inspector For Mayor
THIS PERMIT VALID ONLY WHEN SIGNED BYTHE CHIEF BUILDING INSPECTOR AND MAYOR
CALL: 234-5933 24 HOURS PRIOR TO INSPECTION
."""""''''''''''''''"W,,,,,,,,,,,,,,,,,~,,,",,,.",,,,",,,,, "',,,,,,,,,, c,' '..""",,1,"1' "'''' "1'"""~,~""~,Jh","",,,,,C',,,,,,,,",,,,,,,l~,lf'!!,, ",l".~""J~"'''I"!,,II,1;.J ,~",,,,,,,,,,~'m,,,,1I!ilU)"~~JI!
I;l;I;PARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number: 4617
. BUILDING INSPECTION DIVISION - 235.2855
/ CITY OF WHEAT RIDGE Date: 2/19/97
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Property OWner:
Property Address: 3775 KIPLING ST
Contractor License No,: 19316
Company: Outdoor Promotions, LLC.
Phone:
Phone : 2251550
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that tha setback distances proposed by this permK application are accurate,
and do not violate appncable ordinances, rules or regulations of lite 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 condKions printed on this
application, and that I assume full re 0 laiblllty for compllanca with tha Wheat Ridge Building
Code (U.B,C.) and an other appllca Wh t Ridge ord,nan under thIS permK,
(OWNER)(CONTRACTOR) SIGNED ATE;2 -19-9 7
Total:
$4,300.00
$100.50
$0.00
$51.60
$152.10
Construction Value :
Permit Fee :
Plan Review Fee :
Use Tax :
Description :
BUS SHELTER
- \C\ -YI
5~q
BUILDING DEPARTMENT USE ONLY
SIC: Sq. Ft. :
Approval:
Occupancy:
Walls:
Roof:
Stories:
Residential Units :
Electrical License No :
Company:
Plumbing License No :
Company:
Mechanical Licenso No :
Company:
Expiration Date :
Approval:
.
Expiration Date:
Approval :
.
Expiration Date:
Approval:
.
(1) This permit was issued In accordance with the provisions set forth In yopur application ancl is subject to the laws of the State of Colorado and to the Zoning
ROguIoIlono ond Buildlno Code ofWheot R_, Colorado or Iny other IPpllc8blo ordinances oItho City,
(2) Thil ponnI1 oh8Il expire R fA) tho -" outhorfzod il not commoilcod within obdy (GO) days fn:>m iosue dole or (B) tho building luIhorizod il suspendod or
abandOnec:l.forapertod~of120 s. '
(3) If this petTI'Mt expires, a new . may be acquired for a fee of one-half the amount normally required, provided no changes have been or wlR be made In the
originSl plans aM ns and any suspension or abandonment has not exceeded one (1) year. If changes are mide or If suspension or abandonment
oxcoods one (1) Ydf. fuIll8e8 1h811 be paid lor I now pennlt,
(45l No worK of any manner shall be done that will change the natural flow of water causing a drainage problem.
( Contractor shaH notify the BuDding Inspectortwenty-four (24) hours in advance for all Inspections and shall receive written approval on Inspection card before
orocoodllng , s_ phollS 01 tho job,
(6) !he Issua a permit or the approval of drawings and specifications shall not be construed to be a permit for. nor an approval of, any violation of the provisions
of the or any other ordinance, law, rule or regulation.
C 'f i1ding Inspector
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR
CALL: 234-5933 24 HOURS PRIOR TO INSPECTION
DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number:
BUILDING INSPECTION DIVISION - 235-2855
CITY OF WHEAT RIDGE Date:
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
/"
Property OWner:
PropertyAddress: 377 <;" Kt)>J,'v-.7 Sf,
Contractor License No.: I ~ 3 1 b
Company: 6,,-,fv'~T;'- fr....-T-,'-.s
Phone:
Phone: <17t:'-;;l;1.S'-/ SS-o
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify lItat lite setback distances proposed by this permn application Ire accurate,
Ind do not violate Ipplicable ordinlnce., rule. or ragulations of lite City of Wheat Ridge Of
covenants, easements or restrictions of record; that all measurements shown, and allegations
made Ire accurate; lItat I have read and a9.'" to abide ~ III conditions printed on this
Ipplication, and thlt I I.sume full responsibility for comphance with lite Whelt Ridge Building
Code (U,B.C.) Ind all other applicab eat Flidge ord,nlnce. for wall< under this permit
(OWNER)(CONTRACTOR) SIGNED
. OATE/f-ttJ-1 ,
Description: B~.$ S ivz.-Iw "1:. ",s-/...I/4.-I-1 """'-
Construction Value: '( -3 0'tJ
Permit Fee: / (J-eJ.S7J
Plan Review Fee :
Use Tax: ,)/ Ld
Total:
BUILDING DEPARTMENT USE ONLY
z.o!.l!!liRComl!1!!nts~ '2' II. '\;-
Appro~al: -?r>- <?~"-' ~ l-x.- L (9 ~
Zomng:C-1 ;t<- - -
BplRll~!k.C~tnmJl'!!.~ ':J,(j AMJ. I<g~,
Approval:
~(jIjIRa~omm!l.D~
Approval:
Occupancy: Walls: Roof: Stories:
SIC: Sq. Ft :
'2-10 I ~~ 'b
Residential Units :
Electrical License No :
Company:
Plumbing License No :
Company:
Expiration Date:
Approval :
E ~.!lSll:<eq!1f!t'.g ~
Expiration Date :
Approval:
II
J: - '~l(" '_'
.i: r. "WJIJ!! : .
Mechanical License No :
Company:
Expiration Date:
Approval:
.
(') llliI pemlit woo _In occordanc:e _ the provIalons let fonh In yopur Ipplk:otIon IIld II sUb;oct 10 the laws ri/ the SlII8 a ~ IIld 10 the Zoning
Regulo_ ond Buildlno CadI of Whoa' !lidIlI. ~Ofony___ri/the City,
(2) This pennit shd expire iI' (A) U1ewotk authorized is not ~._....ad within Iixty (80) ct.yI from iIIue dMe or (8) the building aIthoriztId ill'flll IIded or
"_ for I poriod ri/120 days,
(3) If Ihi. pennil oxp;res, I _ pennil may be acqulled for I foe of _ the amount normally 1llllUIrod, ...- no __ _ _ Of wII be __ in the
original plans and specifications and any auspension or abandonment hu not exceeded one (1) year. If changeI.... made Of if suspension 01 att.!'Cfol.m.ent
exceeds one (l) year, fuQ fees IhaII be Plki tor. new permit.
(4) No work of any tnlnner shall be done that will change the natural now of water Clusing . problem.
(5) Conlrador shall nolify the Building Ins_lWenty.tout (24) houtIln _ for.. ' 1Ild.....-... '
-- - pho of the lob
(6) The ~nc. of. permit or the ~ of drMings and apecitic:ations Ihd noc be
orthe Idlng W""'Inonce.I8w,ruIoOflegul8lion'
on...-. _beIonI
, a the plOOiIions
C e Building Inspector For Mayor
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR A
CALL; 234-5933 24 HOURS PRIOR TO INSPECTION
.DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number:
BUILDING INSPECTION DIVISION. 235-2855
CITY OF WHEAT RIDGE Date:
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Property Owner:
Property Address: 377 $" K.{> J''V-..J; Sf. Phone:
Contractor License No.; I "1 3 I b
Company: 6u..{j"..,,,.. fr....-+:-..s Phone:'17&>-;:2;2.s"-ISs-O
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
Construction Value: '13 ~
Pennit Fee :
Plan Review Fee :
Use Tax:
I hereby certify lItat lite setback distances proposed by this permK application Ira Iccurate,
and do not violate applicable ordinlnces, rules or regulations of the CiIy of Wheat Ridge or
covenants, easements or restrictions of record; that all measurements shown, and allegltio"s
mlde are accurate; that I have read and "9- to Ibide by III condKions printed on litis
application, and thltl assume full responslbilily for comploance with the Whelt Ridge Building
Coda (U,B.C,) and III other IPPllcab~eat Ridge Ordlnl~rk under this permK.
(OWNER)(CONTRACTOR) SIGNED~ /1'-.... -;7 ./ ~' OATE/I,.,,,-1 i
-
Description: B~.s S JvzJI-v- 'X.nS-l..}lo..-I-l ~
BUILDING DEPARTMENT USE ONLY
Total:
Ziitf!!\lJlCl)m~
Approval :
Zoning:
BptRljr.rl&-c;91!'1I:!le!1~
Approval:
~(jI)IIf;l~!)mm!ID~';!
Approval :
Occupancy: Walls:
SIC: Sq. Ft. :
Roof:
Stories:
Residential Units :
Plumbing License No :
Company:
Mechanical License No :
Company:
Electrical License No :
Company:
Expiration Date :
Approval:
E
~ .1.i.U:l!.ij~, ,_
Expiration Date :
Approval:
II
.1i.!l;lil.;t;.U: ~l(U- '_
Expiration Date:
Approval:
.
.'. ..wJl.<~\!lJGoI -
(1) ThI1 _ WII _ In -..co with the proo;llons Nt ""'" In yoput IppIJcolkln end Is sUbioct to tho laws a tho Stole or CcIoIodo end to tho ZonIng
Rogulo_ end Bwlding Cede 01_, Ridae, CcIoIodo or any _ _ __ alho CIty,
(2) Thil _ sh8IIexpiro W (A) tho-" "_eel Is not c:cmmoncod _ obdy (00) dayo from..... _ or (B) tho bulIdlng _Is __ or
lbandonod for I period or 120 dayo,
(3) If this pennit expires, . new pemut may be ac:qulfWd for. fee 01 one-haIf the amount nonnaIIy 1'tlqUiNd, ptOVidecI no c:hangn: haw been or wiI be made in the
original plans and apecificltionl and any suspenlion or abandonment has not excMded one (1) year. It changeI....m..a 01' it suspension at aNndonment
excHds one (1) year, full fee. wi be paid for. new permit.
(') No -" of any manner..... be done th8t will d18ngo the natural _ 01 wotor ClusinSl" droInogo prol>lem,
(5) Conlradct oIoaIJ nolify tho Building I~ twenty.four (2') hours in advance for 11",,- ond shalIlOC8iYe _1pIlIllVIl on '"- c:onI before
(6) ~=~n::. w: ;I;:~~ ~::r~ng, and specifications IhaII not be construed 10 be . permit for. nor an approwI d. any viotation fA the provisions
of the building codes or any other ordinance. law. ruM or regulation.
Chief Building Inspector For Mayor
THIS PERMIT VALID ONLY WHEN SIGNED BV THE CHIEF BUILDING INSPECTOR AND MA VOR
CALL: 234-5933 24 HOURS PRIOR TO INSPECTION
. , :Box 270807
Ans, CO 80527
(970) 225-1550
QUT>>OOR ~
p,ROMOT/ONS llC
MultJ.MedIa t.\:ldoetIng _1_
. Don Goette
Vice President of Operations
Cellular #: (970) 566-1589
Bus Shelter Worksheet
City: State: Sight Location: s w Shelter #:
w~K~ c- e... j(. lp I,,",:? ,. 3g'f1.-
Landmarks: c.~
,:::'" '''"' fly r h r } /'-1
'c()her~~.~"\;t,t~!I~~~J Phone #: M#:
Name:
"
Contracted Date: Date Complet~d: Cost
'. " ,',', , ," Phone #: M#:
EI e<:~.,C::oo~rn~'t~~;
". .-. " -: '-,. \. - -:.::' :,-:' :,"'~<':~;::~/;~',!A\~%~.~~,s~,:~~.:\~~:.%{~P(
Name: Locate Conf #:
Contracted Date: Date Completed: Elee. Insp. I Insp Date:
"
Oth' I'\.l,..'fii''i!i,;p;:~, Land Owner:
' '" '. .' ~"" n"C),.,."""""
~ '- ,:." -~, ,::,::.;:,\:,,!:,:(-!.::::::~:~:\~~:~~:ih~;;A*~~k:;(~~f?!~~~~tt;~
Land Owner Signature: .
(I Hove Been Notified: x )
Special Requests I Additional Information:
1<0 I I , Pro
W ('V\ Fe-
SightJM":,;",~\%@,,,g jJ
,'" 0,."....'"
'. ,',',.....;.';;';,;n(y~!:;\~;~J1'1tW!..
l'
- ~ g+'k
I 5/0 3 a-t+- ,
?-~b ~C
_0 ""ef ("k
, . f"
fle~ {.o pc ....r 5 '"
-:5.- ..
ik ..-A J:... 30 I I___y
5 ~
BUS SHELTER LOCATION
Posting Certification
.~ /'.-i.L /?I / I L? -.J. ,
I, J...,)CJv"- ~-'Jc U",,-"I ,- _o.r / /,,,,....-0,, er--..r
(name)
residing at J 8'3 C; ~s!r M-r7 i~...J tt 11~'+ I{ f#-+4> 11,\.s" c.. Pas <5
(applicant's address) .
as the applicant for a bus shelter with advertising, hereby certify that I have posted the Notice
of Public Hearing at
3 7 7 S . K t'=l'h. Sf- ·
IT ':7 _
.
(location of shelter)
on the I It day of :]I...... e. ,199.6, and do hereby certify that
said sign has been posted and remained in place for twenty five (25) days prior to issuance of
a permit for construction of a bus shelter with advertising.
~ /7L-".~_~
Applicant Signature '---I:;_.~ ".....~
NOTE:
This form must be submitted to the Planning and Development Department together with a '
8uilding Permit application fonn and supporting documents, for each proposed bus shelter
location
STAFF FINDINGS:
There were no registered complaints, regarding the above bus shelter location, during the
twenty.five (25) days for which the site was posted.
Staff Signature
.'/
Whit. _icanl
LORADO DEPARTMENT OF TRANSPORTATION c.....,. [Mtric:tfi..
UT(LITY PERMIT Pink MUlt. F~
~.;rD~: ~~:
, ERMITTEE DEPARTlolENT UjEi O,,"V
;ame Outdoor Promotions LLC Dat.issued 02 06 97
Don Goette Pennit # ':1/-UbU
,ddress 1839 E. Harmony Rd. S,H.# JOil A. M,P, b.4JU L
Um.t 4 District 06 b.'l'lU L
Fort Collins, CO 80525 Section 08
elephone (9 7 0 ) 225-1550 Patrol U:,
\lQTlCE TO PERMITTEE: You must notify owners or operators of underground utility facilities at leas! t'MJ (2) business days prior to making or beginning excavations in the vidnlry 01
:uch facilities, as required under Section 9-1.5-103, Colorado Revised $tatutes. CAll UTILITY NOTIF"ICATlON CENTER OF COLORADO fUNCC). 1.80()"922-1987, OR 534-6700 IN
'..1ETRQ DENVER. FOR MARKING OF MEMBER UTILITIES. CONTACT NON.MEMBER UTILITIES DIRECTLY
:Tlvrrv DESCRIPTION: (furnished by Permittee)
::>URPOSE ~ Installation 0 AdjustmenVRelocation 0 Removal 0 Maintenance 01 {txistinil facility
" 'a1 te) 5,uO root
;=ACILlTY (Type, size, class of transmltta,rlt. deSign pressur, or potent! . e .
concrete pad, and bus shelter
NATURE OF INSTALLATION Ii} Longitudinal (Parallel) 0 Transverse (Crossing)
.:J Buried" ~ AeriaVGround.moun1ed 0 Attach to Hwy, Str, ~"r
.OCAll0N Statl Hwy, No, 391 County Je erson
\lilepoint(s) or intersecting feature(S)t>W corner, K~pl ~ng &
wide sidewalk,
C'~rr wneac
I own
JtJt:n venue
KJ.dge
,OOITlONAL REMARKS
<For underground k>cation information, contact:
Ut~l~ty Not~!~Cat:~on cent:er or coloLddo
~u~;~-ouO-922-1Sa1
Telephone
., PLANS,; Attach plans ,or work sketch ,-EXHIBITA-) showing location, ctfaracter. dimensions. and details of the work'to 'be done. 4 'setS 'minimuni
required. Compliance with the plans or sketch, as approved by the Department, shall be a condition of this permit
'ECIAL PROVISIONS (completed by the Department) The Spacial Provisions are terms and conditions of this perm".
\ny work shall only be in accordance with the approved plans. Standard Provisions, and Special Provisions as set forth in this permit.
me COOT inspector is Erni e
Nork to be completed on or before:
Nork time reStrictions:
)esignated Minimum cover is .
)avement cuts permitted onty as follows:
Romero
0(, / o.!, 191
Telephone
303-757-9892
. Designated minimum overhead clearance is
,eplace pavement to the following specifications:
~equjred location aids (buried facilities)'
lTHER:
SEE ,ATTACHED SHEET(S) NUMBERED 2 THRU 3 FOR TERMS AND CONDITIONS
ermittee is prohibited from commencing any work within highway ROW prior to issuance 01 a tully endorsed and validated permit.
ermit, plan eXhibit, insurance eertificate(sr, and traffic control plan". must be available on site dUring work. {.See Std, Provisions}
'our request to use andfor occupy Slate highway system right ot way as described above is granted. subject to ttle terms and conditions 01 this permit, indUding the Standard and
,pecial ProviSIons, as Sho'Nf1 on the FRONT and BACK hereol. IT IS UNDERSTOOD ltlalthe Permittee will acx:ompllsh the worl( at no expense 10 the Department and will own and
laJntain tt'le fadHUes permittea.
)ermlne. hereby assumes: releases and agrees to Indemnify, defend, plotecl and save the Slate 01 Colorado harmless from and against any loss of and/or damage 10 the property
r the Slate at COlorado. [turd parties or the Perm.ttee's fadlitles. and all less andfor damage on account of Injury to or death 01 any persons whomsoever. arising at any time, caused
'lor growing out of the OCClJt)81ion of Colorado Slate Highway rights of way by Permlnee'S facilities or any part thereof, InCluding but not limited 10 Installation, adjUstment. relocation,
'aintenanceor operation, or removal of eXiSting ladlities. unless such loss and/or damage arises trom the sole negligence or wilful oonduct ol.the Stale of Colorado or Its employees
, agents.
ajlure by the Perminee 10 comply with any 01 the induded terms or conditions may subject this permit to suspension or cancellation, at the discretion 01 the Departmentaf
'ansportation.
-liS PERMIT IS NOT VALID UNTIL FULLY ENDORSED BY ALL PARTIES, WITH DATE OF ISSUE AFFIXED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPARTMENT.
FULLY EXECUTED COPY OF THIS PERMIT MUST BE ON FILE AT THE TRANSPORTATION DISTRICT OFFICE.
, accepting this permll the undersigned, representing the Permittee. verities that he or she has !ne authority to sign lor and bind the Perminee, and that he or she has read,
lderstarlds and accepts alt the Included conditions.
asted
Date
Date
:2 -(0- 0
o
Title
COLORADO DEPARTMENT OF TRANSPORTATION
Chief Engineer
f2.t -vi,' o---.f"
.~
Date of issue
COO Form '333 4/92