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HomeMy WebLinkAbout3705 Jay StreetP� Building Permit Application (Complete jU highlighted areas) ���er (please prin Phone: -3- Address: City, State, Zip: I Review Fee (due at time of submittal): 111 i I 1 15 l�'i i I rules or regulations of the City of Wheat Ridge or covenants, easements or restricti of record * ; that all meas��cments shown an 1 'Vt;6W.k'q 0-0 ZONING COMMENTS: Zoning: Reviewer: i-111140,11HO M PUBLIC WORKS COMMENTS: OCCUPANCY:- Reviewer FIRE DEPARTMENT:. 13 approved w/ comments 0 disapproved 0 no review required Bldg Valuation: M Plan View ' , 1 s� N, k z Owner/Contractor is responsible for locating property lines and constructing improvements according to the approved plan andrequired development standards, "l "lac City is not responsible for inaccurate information srilrraaitt:cal within the plan sit and any c nstructi ?ta cr °cars resulting from inaccurate information, t+ ! 1 WIT ro .r� TYP. Both Su pports §n� oil I Client: City of Wheat Ridge 5�.,. R evisions: j , l 1 ! D 3705 Jay St. Safety Requireme II II Scale: Clie Wheat idge, CO OqThis design is the exclusive property of Gordon Sign and cannot be reproduced either in whole or in part without their consent. Sheet 8 of 16 Gordon Sign will endeavor to closely match colors, including PMS colors where specified. We cannot guarantee exact matches due to varying compatibility of surface materials and paints used Alr .11/12/2002 10: 34 FAX 9708423048 ASH & WHITE ~01 Pc Baz 35 Bruoh, CO 80723 !I7lIIII42-3046 FAX:. 9701842-3048 Ash & White Construction Co. Fax ~OOJ~--1 ~~ 'nllft: 5elh Noble, PrcjeCl Manager P..- b Date: 1l/r2lo"Z- Fa... ~n~ z..3~ - ~ PIlonr. ~03-;e.3 s- ~~ 3 ...~ I"S-lrft...s fb. I~ 0 {L.. {J. CCl o u.._ 16. For RlIVi_ 0 PIetISe Co_t 0 Please RepI}r Cl ........1I8cJde ./ ,/ . C6AL~LLtm leAk- J-- 0 rc:....J .'ot,s. ~ /Ju.,.>e..-J. / /5~6 \~ \ \ \ \ \, / ,/// 'rf~~ / / ~QV' ~. ~../ . ./ \ V' ',,--, 11/12/2002 10:34 FAX 9708423048 ASH & WHITE ~,~ ".' . , ~ ~ Ash & White Construction Co. P.o. I!lDx 35 Brush, CO 80723 (970) 842-3046 FAX; (970) 842-3048 November 12, 2002 Darin Morgan City ofWbeat Ridge 7500 West 29'" Wheat Ridge, CO 80033 RE: Approval ofll'..ndiclJll Ramp Dear, Darin Upon C('111IIV'lICing the contract work for the " Davis Property S-Aae NeigbborlJood Park" Ash and White Construction Company was ask to add a p...m,..ap Ramp from the park to, the Christopher House Nursing Home. Please find attaebed, for yom approval, sketches sbowiDgjust bow the ramp will be buih. I already have Joyce Manwariai's appro'Vlll to 'complete the ",Milinual work on the park property. Please also let me krow what I need to do as mr as getting a permit to complete this work. Joyce Manwaring has informed me that there would not be a permit file. Please notify me as !lOon as possible to let me know if this ramp is approved SO that I can I . schedule the work. If you have any questions you may contact me at 970-842-3046 ext 106. . Seth Noble, Proje&:t Mmager !gJ02 I I I I ... ... , ... N , N o o N ... o Co> .. ..., ~ '" .... o '" .. N Co> o .. '" ;.. '" = ll" ~ - ;j IBi o Co> I. Fo-r tlc-..l..-.e..;l ~ dMtlJI Clt~~ ,Of r~~r~ f.A.;(.~ (s4-l) 2. ""~tGcA lJ III 'e.. p..r ~ I ftlSlu.-dLJ?- k-c... c... '} cJ=' () Ltu....(.. L~. 3. It \l Lc,,~..vclA... ~ III In.. 3 eX) " p~ r:>J"' ~ ~.IZ/'; 4. rt.,'!, l:of1'~ t- c.:~ ~pp~l! ~. rt.Lo~ as ~ froj-eJ St...H k C~l,"lr:.fJt.e.r ~~. c... ~ (.pi^. t ro.J.a.r "Sl-.... ~\ ~ As 4.. -.J w L.A-c..- c.. "-4 ~ r ...d, ~ (0 "f?-' gu.~J'".,....k 11"0'0\. ~ \--~,A-i'Aj.- u-.......r ~...u l_,~ ~ 1~t.1 p.r 'j- <;;fa. I 3" J, .;- t..;-P 6~ t..-L"'} r - IH ~l ~~k~. { (: """ I I ,e.'''''''' ; -- - .. "-u . - --- . .. c.~c.v\r"""i!t'll..\e t ... lie"". !~,}c. r """ (lk-~.f _ _ p:rlL ~..rf'"",,") ... ... 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';J rUin; wlIlh <8.11.ndoMI pl~l)fm Figure 17 Examples of Edge Protection and Handrail Extensions w DEPARTMENT OF PLANNING AND DEVELOPMENT BUILDING INSPECTION LINE - 303-234-5933 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 - (303-235-2855) Building Permit Number: 14777 Date: 11/12/02 Property Owner: CITY OF WHEAT RIDGE Property Address: 3705 JAY ST Contractor License No. : 18437 Company: SELECT ELECTRIC, INC, OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Phone: 431-2728 Phone: 431-2728 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 responsibilit for campUa e with the Wheat Ridge Building Code (U.B.C.) and all other applicable Wh i e ordin cas for work unDdAeTrElh/7J1;; I ~ ,_ (OWNER)(CONTRACTOR) SIGNED /. a ~ Use: Construction Value: Permit Fee: $12,000,00 Total: $0.00 $0.00 $0.00 Plan Review Fee: Use Tax: Description: NEW 5 ACRE NEIGHBORHOOD PARK, INSTALLING PARKING LOTS POLE LIGHTS, SMALL PANEL BUILDING DEPARTMENT USE ONLY --- Approval: TRC Zoning: R.1C SIC: Sq, Ft.: OK ~ Approval: OM OK. LIGHT POLE HEIGHT NOT TO EXCEED 18'-0" FROM FINISH GRADE. 11/12/02 Approval: Occupancy: Walls: Roof: Stories: Residential Units: Electrical License No : 18437 Company :SELECT ELECTRIC, INC, Expiration Date: 2/28/03 Approval: OKlKS Plumbing License No : Company: Mechanical License No : Company: Expiration Date: Approval: Expiration Date: Approval: (1) (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 Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of the City. This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (B) the building authorized is suspended or abandoned for a period of 120 days. If this penni! expires, a new permit may be acquired for a fee of one-half the amount nonnally 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 procee" with successive phases of the job. e' a ~~ or the approval of drawings and specifications shall not be construed to be a permit for, nor an approval of, any violation of the pro ;0: 07 T~Olh.' o,d;o.oc., I.w, cui. DC '.9ulal;00, Chief Building spector (4) (5) (6) "'-~' ~Hr4r0 '- , ~ - 0 U ~ COL ORP-QG J)EPARTM:ENT OF PLANNING AND DEVELOPM:ENT BUILDING INSPECTION LINE - 303-234-5933 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 - (303-235-2855) APPLICATION ~;.~ ~~~~ . c .) ":7 -:t- JA-tf C:j, L-er ~/O.5Jtc') ~t.9;{e:!3o~-I-~j-i1~~ I -? ( . ~'Ethr- ~ tI-~ Phone:~ ~ - ?i'-77 -S 7<./7 Building Permit Number: Date: ^\~. ~'0 Property Owner: Property Address: Contractor License No,: Company: OWNERJCONTRACTOR SIGNATURE OF UNDERSTAND:rnG AND AGREEMENT I hereby certify that the setback distances proposed by this permtt application are' accurate, and do not vi.olate appUcable 'Ordinances, rules 'Or regulations afthe City 'Of Wheat Ridge or covenants, easements 'Or restrictions of record; that all measurements sho'Wn, and allegations made are accurate; that I have read and _agree to abtde by all conditions printed on this appticatton and that I assume full responsibility - for compliance with the 'Wheat Ridge Building Code CU.B.C) and aU ather applicable Wheat lUdge Ordinances, for work under this permi~ . ~ (Om.'ER)(CONTRACTOR), SIGNED ~~a.u.. , ~IE h~./, ~ Construction Value: Permit Fee: Plan Review Fee: Use Tax: Total: Nr+- 0'2- Description:;J~ 5~~~~ p.~/L~~"tA~'tt.cA ;Jk f.i,tU, &n.a-d. r'<:,--<,.~. ' BUILDING DEPARTMENT USE ONLY SIC: Sq,Ft. : ZONING COM~eNTS:~, .i.............,.."H..l. ' , "\t'.t-''''''' ........ 'Zoning: 1"'-\ . ~~. BUILOING COMMENTS: Of- - fole ht.1hf Approval: . <hr,I';i-'-. r~ PUBLIC WORKS COMMEN1'S: Approval: jK}f II) ey;c.dd 1&'..0'1 ~rn 1/ (t i-feJl.-- ~ .-- . r rwv 0 7 ....,') I.\JU,. . 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: (I) (2) (3) T!lls permit was lssued in accordance 'Wi,th the provisions set forth in your applicatfon me!. is suojcct to the laws afthe State of Color..do and to the Zowg Regulations and Building Codes ofW1:J.eat Ridge, Colorado or my other appUcable ordi.na.nc~ of the Ci.ty this permit shall expia if (A) the wack authonz:ed lS not cOJ:U.:!J.cnced within sixty (60) da)'s from issue date or (9) the build..iLg authorized is suspec..ded or abandoned for a period of 120 days. If this permit expires, a new permit may be acquired for a fee of o!le-haJfthe unOllllt e.ormally required, provided e.o changes have beec. or will be made in the crigiualplans and specificatioc.s and any s\l.Spec.sioIl.or aba.ndoo.m.ee.:b.a.s !lot exceededot\e (1) year. If ch<l.llges haye beee. or iisuspensioc.or abandonment exceeds one (1) year, full fees mall be paid for a l'I.eW permit. No work of my r:'..arl.Iler s.h.all be done that ;vi,U change the :latural flow of water ca.using a drainage; problem.. Contractor sb.allnotify the Building J:nsPector t\l{e.!lty-four (H) hours in adyance for ill inspections a.n.d sb.a..U recelve v,.-ritter.. approval on mspeclion card before proceeding witb. successive pb.a.se.s of the job. . The isstl1nce of a permit or the approval of draW1..i1gs ud specifications ma.llllot he con..str\led to be a permit for, nor an approYll of, my viobtion of be p of the building codes or any other ordinance., law, rule or regula.tion.. (') (5) (6) rng I I t I I I I I I I 1 I I I I I I I I : y I I I I I I I I I I I J_ _ NORTH ELECTRICAL LEGEND NOT ALL SYMBOLS SHOWN ON PLANS " - 1T2 GI I I I I :- - - - - -1 - - - - - - -,.........':.....::.....'~.."'.-:.....;. - - - - - - - - ..'" .... ~.~ .:.. ". . ~ .. .:; I I I I I I I I I I I I I I I -xi;- ---- - ----- X I I : X I I I X I I : X I I I I x I t=-i= - r~-x~ - -- - o I I : o I I I I I I I o I I __--1--------- -[2]---------- e LUMINAIRE SC.HEDULE KEY DESCRIPTION FINISfI I MOUNTING DIMENSIONS MANUF ACTlTRER CATALOG NO. VOL TS WATTS LAMPS 70W HPS PEDESTRIAN POLE LAMP, ARCHITECTURAL AREA SL VGPT5-70HPS120-LXN-PR4- (1) A TYPE V DIST, CLEAR ACRYLIC LENS DARK BORNZE 12' POLE 16-1/2" DIAM LIGHTING 4RI2-125-DBZ 120 94 LU701DlMED W /PHOTOCELL OSRAM 175W l\ffiT AL HALIDE PARKING LOT ~ 21.75" Lx CM-PM5..M175..II1-1,IT -DBZ (1) B TYPE III TErv1PERED GLASS LENS W / DARK BRONZE 16ft W X SPAULDING 120 210 MS175/C/HOR PHOTOCELL lOUR 18-SQS-411-SGL- DBZ OSRAM 70W :METAL HALIDE SHELTER 9" W x (1) C LIGHT CLEAR PRISMATIC DARK BRONZE SURFACE 9" L x KENALL H99D-C-DB-70M-1-120-9500 120 94 MP70/C/U/i'v1ED REFRACTOR TAMPERPROOF 7-112" D OSRAM -- - -6"W- - ---S0~ - - - --:t\SPHALTPATCH- - ENDNEWCURS;ALK _ ATNEW//RB=\ _ _ II I XCEL ENERGY I I VJ ,., I:..KvA I I ~ f;~/24~ IFI4 I I\':\?>:':\:-l.~'~' I ~ 'Me- - - - - - - - - - - - - :O1=l~ - - - - - - - - - - - - - VFfE:= - - - L - - - - - -':~~V4.>;~};~:!; - - - - - - - - ~ - - - - - - - - - - -1- - - - - - - - - - - - - - - - - - - 'J- . . ,,' . . . .,. . / / / / .. /,/ \ I - - - - - -0- - -6 w- - - - - - - - - - LL - -JAY-~~ - 5TRE -/~ - -6"W- _/~ - ~ -- -=-t5 _ _ _ _ _ _ _ _\_ _ _ _ _~;kf't= if3CFf?t1f/-o-F, tuNWAT1=fftG1=ff3)-2"GAS- L---=--=-e=-=-= I I // // 45 R.O.W. // //-- T J ---------- - ~ --- --- I I I --- ..------- - /"'r- T E o ~ e A S . P H A L T 1/2, A N r:- p 1/4, 5 n 1/4, SEe 25 U T H (\/ n 5 U R ? B 0 I n ~ W LINE NE NW 1 /2, W G H L R r:- r VI ~ ') 51 h ? o N o T o /\/ HI NOTEo: o 15 ~ Dimen&iOn &hall bs ba&sa Orl ealculatlOrl& ('or &011 conc::UtlOrl& and wind loading ('or 1c2>0 "V mph with 110 mph guat6. o Contractor &ha II coordinate &ervice <<Itrllnce connecttOrl with Xcel energ~ repre&emative. Provide &tub-up with 3~ feet of' &ervice <<Itrance conductor coiled at bs&e or pole.. 60 30 SCALE: 1 "==30' Contractor &hall provide and tn&tall TorI<. Model ~103 ttme clock. in lockable NEMA .3~ enclosure. Connect ltehttns circuIts. for parle. o~eratlona I hour&. Unc:::lergroUl'ld branch circuit& &hall be '1~ With '12 grounc:::l cOrlductor& in 3/4IlPVC. PrOVide panel and di6connect in NEMA ~ enclo6urse With padlOCk provision6. PrOVIde and tn&taill Torte. Modsl 21tZ>1 photoelectriC contrOl ror &t1elter fIxture t~pe "CU. o <3> ~ ~ SITE fIN8I8> -DH- OVERHEAD SECONDARY POWER LINE - P - OVERHEAD PRIMARY POWER LINE - T - OVERHEAD TELEPHONE LINE ---up --- UNDERGROUND PRIMARY PDWER - -- UG - - - UNDERGROUND SECONDARY POWER --- T --- UNDERGRDUND TELEPHDNE lu ~ fi: a ~ . PDWER POLE e-<b 1 PHASE UTILITY TRANsr BANK T 3 PHASE UTILITY TRANsr BANK e-c SITE LTG POLE WI 1 fIXTURE 0+0 SITE LTG POLE VI 2 fIXTURES oio SITE LTG POLE VI 3 fIXTURES + SITE LTG POLE VI 4 fIXTURES W PAD MDUNTED TRANrSrDRMER IIIiii DISTRIBUTION PANEL ~ METER rzr fUSED DISCONNECT SWITCH 7 \ \ 1 ( f -t 0> FI><TU~ TYPE A POLE MOUNTING DETAIL - NO 5CALE ,e o PANEL: llAll RATING: 100Amp 120/240 V. lPh. 3W: G BUS(Y] I HAINS: 100A MLO MOUNTING: NEMA 3R Isc = 10.000 Amp 12 C1<TS MAXIMUM DEMAND CAPACITY: GOlL PANEL FEEDER: REFER TO 1-LINE DIAGRAM LOAD DESCRIPTION CB No Ph No CB DESCRIPTION LOAD 492 LIGHTING 20 1 A 2 20 SPARE 282 lIGHTInG 20 3 B 4 15 IRRIGATION 360 SPACE 5 A 6 SPACE SPACE 7 B 8 SPACE SPACE 9 A- 10 SPACE SPACE 11 B 12 SPACE PANEL SUMMARY CONNECTED NEe DEMAND LTG 0,000 Kw x 1.25 :: 0,000 1<va HID 0.774 Kv1/ . 9pf x 1.25 = 1.018 Kva RECEPT~ 0.000 Kwlst 1 OKv+. 5rem 0.000 1<va LG MTR 0.000 Kv1/ .8 5pf x 1.25= 0.000 Kva MTR 0.000 1<w /.85pf :: 0.000 I<va HEAT 0.000 Kw x 1.00 :: 0.000/ Kva KITCH 0.000 Kw x 1.00 :: 0.000 Kva MISC 0.360 Kv1 x 1.00 = 0.360 Kva SPARE 0 000 Kw x 1.00 = 0.000 Kva -----------........ ------------ TOTAL 1.134 Kw 1.378 .Kva 4.7 Amp 5.7 Amp PH A: 0.492 l{T,y BALANCE A:B 4.1 77% PH B: 0.642 I<v1 BALANCE B:A 5.4 130% GARAGE o kd FI><TU~ TYPE 6 POLE MOUNTING DETAIL - NO 5CALE 12<Z>/240V lP~, 3W e~ORT CIRCUIT CURRENT LEee T~AN 1<Z>,000A Ae PER T A6LE vi I IN FeCO 6LUE 600K .3~AI2P 30A W~M F~R F ANEL A o WF Rf GlND ROD FEEDER eC~EDULE (.3-.~T~WN CU)llIpvC -6 6ARE CU ~ND G (3--eT~UJN CU,I--10 GlND)3/4"EMT ONE=..L (NE-D (AG~AM rpSA ..., power ~&tem& Ana l!:Jete, '"c 5120 e<p 11th Ave" Denver, COloradO 8022(1) ~3c2).3) 3~9-281& ..J. NOIUUS Dl.1I11I~ Planning Landscape Architecture 710 West Colfax Denver, Colorado 80204 Fax: 303 8921186 Phone: 303 8921166 ~ 0::: ~ a a a J::: 0::: a co J::: (!) --- ~ I I I ..g '-L.J~ 0:::-2 08 ~a:) ,~ ~i LJ:~ Owner: City of Wheat RidgE PGrks Ie RecI Departrr ~005 Kipling street Wheat Ridge. CO 80C Phone: 303.231.13C Fax: 303.231.1350 Issue Date Revision Date cas % Fe~IT 6/13/02 1122/(/)2 Sheet Title EI ectricQI .Plon Sheet Number E-1 WHEAT RIDGE FIRE DISTRICT "Dedicated To Serve Through Excellence" P. O. Box 507 . 3880 Uphom 51. . Wheot Ridge, CO 80034 . 303-424-7323 . Fox 303-940-0350 May 1,2002 To: Joyce Manwaring Director of Parks and Recreation City of Wheat Ridge Wheat Ridge, Co, 80033 .-:-: j, 21D~ J' Subject: Fire Department review of proposed Five Acre Neighborhood Park located at approximately 3S Ave & Jay Street Dear Joyce, After a review of your proposed park located at approximately 35 Ave, & Jay Street, the fire department has determined that there are no fire requirements that need to be met at this time. It apprears that there is adequate access to the park in the event of an emergency response by our agency, Thank you for the opportunity to review the proposed plans, Ifthere are any questions or concerns regarding this issue, I can be contacted at 303-403-5902, or Pager number 303-687- 7336, Thank you for your help and consideration regarding this matter. j::ll~ Dave Roberts FM., WRF,P,D, Cc: Darrin Morgan, CBO, City of Wheat Ridge REPORTING AGENCY: Business Name. UNDERGROUND TANK REMOVAL CR No.: Business Address; .s 3 Permit Holder: Business Telephone: Size of Tanks: Product Stored: Serial Numbers: Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 88PD-'3 - I~ Y'Y' -r...c.c.., III &~O ~(,J> /I~.:.&I III oA)- 10 Stote ogency hos been notified lb Dote notlflod: /2. -:;, rt - 'i'1 1 c Approved plans from State Oil and Gos ore ottached Oate: I Z- -'I q 13l (3) Inspector's Initials COMMENTS: Yes No ?"'-=- kH~~/~-.I Inspector's Initials 28 All electrical lines and connections have been disconnected. Inspector's Signature: Agency: Doto: Time: NOTE: No work shalt be undertaken by contractor until thls step has been completed. ~~~ 30 Received opproved pions from State Oil & Gos 3b Approved plans ore ottsched 3c Product has been drained from pipes Into tank 3d Piping has been capped or removed 3e Residues ond liquids have been romoved fro[ll tank 3f How was rinsato dlsposod 01'1 ..c;-{-..:u ]l,~....~ 3g Evocuote to the top on the tank 3h Fill pipe, gouge pipe, vopor recovory touch connection, pumps ond other tank fixtures have been removed, 31 Vent line Is stili connected. 4a Solid corban dioxide used to vont vapors 4b Other vapor removal system used (describe) 4c Venting 01 tonk II propor 4d Tank LEL reading Is 20 percent or lower 4e All holes plugged with a minimum of 0 1/2' hole 41 Vont line hos been dllconnected 4g Evacuate area around tank and remove tank 4h Tonk hos been labelod after removal 41 Tonk will. bo tronsported to dlsposol site on the ssme day tt was taken out of ground. Tank Is property securod on truck with vent hole on top 4) 50 . Is soli contomlnatlon prelent after twk romov,l? n If yos, describe: L{ ~~"'~~ 5b If yes, notify Stote Health Deportment: Person Notlfled: 5c If yes, notify Stote 011 & Gos: Porson Notified, 5d Name and address of tank ,:. Co- 5e Were pictures taken? If so, whot agency took pictures? Were $Amples token ot site? If so, what agency took samplos? 5g Wore spilt samples offored? If so, person accepting samples: 5h Dote/1lmo semples relinquished COMMENTS: }.{ we. Inspector'. Inltltals COMMENTS: rn !:!2 ~=>Le,fIu- V-- -;:/ = -L fJ/A -;:r' -YL ./ -- ---AI/IL ia-.... ~ d,ISUJ"~ ~ bvDv-~Q r'f{7''''1- T"r~ 'CJf~'^ +"'f';j:>t.:>....IC. \A,~l L-e,,- ~ COMMENTS: - {/ \ \...&\ -b.\.. e \~lAlV ~ , ~ c.,~ -T 'i' "'^:; ~\-e. {~>~I Inspector'. Inltltets COMMENTS: i:n !:i2 Dale: Dote: k)~r~ IHII.J.lrl',.,~...r I..d.FPb 51 FI~~~~J~~ES: Flr~~rict Approving SIgnature Other Aoencles PresentJReDresentatlve 1. ~r: - 77 ~ ~,( U/7Li:J.n....J / 2. 3, ,J-'i-<'D Dote 4, 5. 6, Pink copy of this lonn given to: '-B. "'",, > I L .~.....,.J'$CI~~e.~ . :i7 '. . (printname). /J_ J T L':' L.. ____ (Slgnoture 01 Above P....on) Dato lonn given: ~-~ -eo T1me lann given: WhIt, copy - Enforcement Agency Yellow Copy . Approprllrte F1r.:OIstrlct ?",,'T ""w::r -It W~~""'''''IooJ<.-$ r.......+ t.J<-<<,'\-ffi ':b IN \..0,., (d. ST$El- \ I t9 0 Ll-....~+; lie.. , ~~u<1L.. c.., , f -cCJ Data e IZ~3s-?M Pint!. Copy . OWner/Permlt Hotder " PROJECf: _0 A V,' S JOB NO, '1(,,997-363 , rerracon US- I / DA-ViS c.l,AU'?n'~<!..s Page J Date I A -), 9 -q 9 Comp, By tf., Xi"lJl/,.flv CHECKED BY: of I NOTE -..' ....'~U i:- 3 ~~. fl~ Wlieat'R~ge Fire Pro1llc~oIi Disirici Plans Review " '" : Bate: ''l-d~''~~'~~M' R 'l.,,, .;--'..-- .,...,c. ',. eviews ,..y",8VIU .' ooefts'~.L' . .. Uniform Fire Code CenificatiOn #53275 ... . Colorado State Fire Suppression System .' .Cj . , . !n~pgclor Certification #B2-173 :. " ',:". .. .. '. -.," ~llmm~I\tI:Q@IL-~~': .;;,~ti - ..., ~,., ':':'-:--'-'::~r :..:..- -=-. '----.--;-~ - (j'tt:~~7'-h> siJ.',;f:;, ,t, i . ' "-.;",::'J' ;~<J.<.-lPlZy"'b .. :1'1"'/ k' 4""""""~ ,... .. .: _, +~t{,:,~...n' '~-"--,. r 1Z~,~. .. .~ ...., ,,' ",+. ,;'".m _l.: __"" __ ' ____; ~- __ ,.., """ __" -i_- ___ __!-~,:~----:,,-~ 1.';.Kh,~,,"...t }";,,..,,:! I},../'f-,......f-.co,..,~'l A; +hL .h,__K,.i/ Jo.."l..-9.. b~l':;~~:';., tho<< l=.r~+:t...<>J..(.;", rif"s SD" \-1. ..f .j-k~ e;.ft~ ';',).y ""AI.a ~H\~~~-A . . iOc-fJ~' rw-l- . (.),4ir.;J (3<>:1) Lj:J. Lf -"'}-)..II j' _;mi, 1 ..... !"-----;---.. 1--- i. - _,__.__...._______/10 __.____ r:. 'G- o flyA.IA..>t I .'~OB .c . ..... ~',.,J.lll' .......;:;.:..--.-----/4" ..../111(6 ,.....- '..-- 1:>.. "'@c:i3" '..\...l~i,. . "'~. '!~. .... . ... . I n ~.~ J,.... X :l .. -- --.:1 e _M_'__ _"-;. r .. >...-~ :- -'{;' <> . -':-'~ !'. ---.., ~ -. --- - '~'i' ~ _e)< -; '" ,) '1 '(OrJc.(c.t... fc.<"L I /' t:ul..F <D"U"'~c.. f<4l' .c. j-------- . T'-' tV "u,~. ! .--- -/ (3v1)<-I;n-3JOO ." c.rr"-'or1, . .' . ,. /0"'). 5"'. W....sf.L:.7o Fro",",,? Po.!, NodI" , ... .. S"if... 'i' ,.,... .. .,..... ,.or"'" I!-l c.. ., &007:1 .~-_..._---,-,-Wl\~r-- ", " :J ,-0 __ - ,J - ! - :, , ~;I.~'~I'== , i UST . t~---~.' orm 112-5.93 .' ,_..--,.~._.,. '- - - '.'''0' - , . 05-' . -. .~ DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number: BUILDING INSPECTION LINE - 303-234-5933 CITY OF WHEAT RIDGE Date: 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 - (303-235-2855) 9959 12/29/99 Property Owner: Property Address: 3705 JAY ST Contractor License No, : 20548 Company: Scott Contracting, Inc, OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Phone: 424-7211 Phone: 279-0900 Construction Value: 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 a~ree to abide by all conditions printed on this application, and that I assume full responsibility for compliance with the Wheat Ridge Building Code (U.B.C.) and all other applicable Wheat Ridge ordinances, for work under this permit. (OWNER)(CONTRACTOR) SIGNED Total: DATE Use: Description: Excavation to remove 8,000 gallon underground fuel storage tank $4,000.00 $97.25 $0,00 $60.00 $157.25 III U_ - Approval: Zoning: SIC: BUILDING DEPARTMENT USE ONLY Sq, Ft: --- Approval: ~.- 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: 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 Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of the City. This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (8) the building authorized is suspended or abandoned for a period of 120 days. If this permit expires, a new permit may be acquired for a fee of one-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 the job. The issuance of 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 building codes or any other ordinance, law, rule or regulation. Chief Bu't?n~n- (1) (2) (3) (4) (5) (6) DEPARTMENT OF PLANNING AND DEVELOPMENT BUILDING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 Building Permit Number: Date: /2.. - 2.. 'J - 9'7 APPL\C"TID N Property Owner: Property Address: Contractor License No. : OAI/;S D..'/-uf'('s<<'!> 11-0:;- :JAy Sfol~,,-f- :< DI~ 7'/3 Phone (;05 )7'-2,-/- f;:( 1/ Company: ~ rr6<- (,v,J 5<.<>f(- c:.o,~tlf'<' ~;"11 T",<.. Phone (]v:?) :t ?-9 -6900 OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value y:. 4, iY'<) Permit 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 all conditions printed on this application, and that I assume full responsibility for compliance with the Wheat Ridge Building Code (U.B.C.) and all other applicable Wheat Ridge ordinances, for work under this permit. (OWNER)(CONTRACTORlSIGNED4'::.. T~ DATE /2-2'1-99 Total: Use: Description: I. ?tIh OVC: goOD 6rA/I?!-u Ur'~7';Oo,),"i. Skvl'}-=- l"A-v,z ) BUILDING DEPARTMENT USE ONLY SIC: Sq, Ft: ~qg~mmeJ)JS~ Approval: Zoning: :.,~~ Approval: .~lJg~Q.~~!~~~~ Approval: Occupancy: Walls: Roof: Stories : Residential Units: Electrical License No : Company: Plumbing License No : Company: Mechanicai License No : Company: Expiration Date: Approval: Expiration Date : Approval: Expiration Date: Approval: (1) (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 Regulations and Building Code of Wheat Ridge, Colorado or any other applicable 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 authorized is suspended or abandoned for a period of 120 days. If this permit expires, a new permit may be acquired for a fee of one-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 now 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 proceed,ing with successive phases of the job. , , . The issuance of a permit or the approval of drawings and specifi,cations 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 12/28/99 09:29 '5'303 620 4303 OIL INSP SECTION ~002 BILL OWENS Governor DEPARTMENT OF LABOR AND EMPLOYMENT Oil Inspection Section Tower 3, Suite 610 1515 Arapahoe Street Denver CO 80202-2117 (303) 620-4300; Fax (303) 620-4303 VICKIE L, ARMSTRONG Executive Director RICHARD D. PIPER State Inspector of Oils December 28,1999 Terracon Attn, Brian Kindsvatter 10625 W. 1-70 Frontage Rd. North, Ste. 3 Wheat Ridge, CO 80033 RE: Waiver of 10 day notification to the Oil Inspection Section Dear Mr. Kindsvatter: The Oil Inspection Section received a fax from you dated December 27, 1999, regarding tank removal for the site located at 3705 Jay St, Wheat Ridge, CO. Your request for expedited removal of one tank(s), at the above stated location has been approved on December 28, 1999. Your ACK letter and Storage Tank Update Form are also enclosed. If you should have any further questions or concerns please feel free to call me at (303) 620-4310. Sincerely, d~~ Oil Inspector II enclosures ejf/WS 12/28/99 09:30 ~303 620 4303 OIL INSP SECTION IiiJ 003 BIll OWENS Governor COLORADO DEPAR.TMENT OF LABOR AND EMPLOYMENT Oil Inspection Section Tower 3, Suite 610 1515 Arapahoe Street Denver, CO 80202..2117 (303) 620-4300; Fax (303) 620-4303 VICKIE L. ARMSTRONG ExecutiveOirector JEFFREY M. WELLS DeputyE;xecutlveDlmctor RICHARO O. PIPER State Inspector of Oils ACK# J.22 - 00 TERRACON BRIAN KINDSVATTER 10625 W 1-70 FRONTAGE RD N STE 3 WHEAT RIDGE CO 80033- Dear Sir or Madam: Your notice of Intent to close or remove 1 undergroundlaboveground storage tanks at: SITE NAME: DAVIS ENTERPRISES SITE ADDRESS: 3705 JAY Sf SITE CITY: WHEAT RIDGE has been received by the State Oii Inspection Section, FACILITY ID # 14743 OWNER ID #: lllQ1Z '..J No. of tanks, size, or contents of tanks not inciuded D Actual location oftanks not clearly stated D No record has been found for this facility. We have assigned this site the above Facility ID #, If there are any other underground storage tanks at this site, you MUST register them on the enclosed form, D No mention of a "site assessment" was made. (You must assess the tank site for possible contamination at the tIme ofclosure)...see "Note" below and appropriate attachments. ~ You must also notifY the Fire department having jurisdiction over the fadlity, and make sure that no building perrml is required by zoning commIssion. D No problems with the notice. ~ Please contact the Oil Inspector who services your area 48 hours before the tank is scheduled to be dosed/removed. Oil Inspector for your area and his phone number is: RALPH ACIERNO (303) 686-1068 Erica Ferauson 12/28/99 NOTE: A site assessment Is required in accordance with Colorado State Regulations upon closure of the tank(s). The Oil Inspection requires site assessment and closure Information be documented an one of the new standardized formats. If contaminated soils, ground water, or free product as a liquid or vapor is discovered during site assessment, or by any other manner, owners and operators must begin correctIve action. All closure reports must be kept on site for a period of three years or transferred to the Oil Inspection Section/Remediation office. The remediation/technical assistance telephone number Is (303) 620-4029, 12128/99 09:30 'a303 620 4303 OIL INSP SECTION I4i 004 BILL OWENS Governor COLORADO DEPARTMENT OF LABOR. AND EMPLOYMENT 011 Inspection Section Tower 3, Suite 610 1515 Arapahoe Street Denver, CO 80202-2117 (303) 620-4300; Fax (303) 620-4303 VICKIE L. ARMSTRONG Executive Director JEFFREY M. WELLS Deputy Executive Director RICHAR.D O. PIPER State Inspector of Oils , STORAGE TANK UPDATE FORM DEAR OWNER I OPERATOR: Please complete and retum this form after you have removed/closed your tanks and completed your site assessment. If you have outstanding fees due, please submit payment when you return this form. A registration fee of $35.00 per tank per year is required for all regulated storage tanks. Fees are due for the year In whIch the tank(s) are being closed in the ground or removed. FACILITY ID # 11lli OWNER 10 # 1aQ1Z ACK# ~-oo FACILITY NAME AND ADDRESS: DAVIS ENTERPRISES 3705 JAY Sf WHEAT RIDGE TANKS: SIZE OF TANKS: Date of removal{ closure: If filled in place, what inert material was used: Was a site assessment performed? YES_ NO_ Date: ** Was contamination found? YES_ NO_ If so what tanks? Signature and Address: THANK YOUI ** If YES, you must report It within 24 hours to the Technical Assistance line in our office: (303) 620-4029 Return of this tank update form will assure that these tanks are closed in our database and you will not be billed for them in the future. PROJECT: OAlI,'I, , lerracon u ~ r / OA-1/;S ~,I\AU'1'r":'~s Page J Date I A -), '7 -q 9 Comp, By 8. x;,..lJlI,4fk CHECKED BY: of J JOB NO. 1.1(/197-363 NoT~ '. , 1 I 1 i I I.DO"'I"'~ ...Lt }.,.........9.~f.+...+-,.......f-C~~l( A I +~, +.....K;~llo..~k.9. btf';',~."'" fh.~ l= I r$ t, +...<>J..,.;., f i fG 5 S" u \-1., of fk" "'.->t/~",....y ~AI.itJ, ..,;+l. i'-' A. OVJ~<A' !k~t (J"..n) (3"':1) 4)."1 -7-:),11 : ' i . ! j -,... ,-.-- -Tj 'f- 3~t!. (l~ , , , - - j "1' ,', - I " -- j - - , - ,I, , · 'Wh!aiRidge Fire prot~ctibn District Pffi~SReView ' , ___,_1_______ ___ ___ ---'- ---~ ----- ---------T-~:~~~;r~~!id'\;iR~b~t~--- - ,,- - ------ ~hiform Fire Cod Certijjcation # 3215! L ~OIOrado StatUi e! Supprfssibli S slem ' - , i , ',. ! '- 1\ ,Inspector eer ifiClllll1fl#9lJlj ----,---- - i -] ------.-- ------ ~j - '-lOg 5 '1<11 Z-:-t>> .s~... ~ c;>( , ~ I :j'f'~ v-\- ' . ~ ~wJf;~ Pv ',l(t.- - ! - . I ,-. -. .' - - , tj'" , " , j ! , '! ' -----'-.-:...-+--1;-.:..,----- -=------,-~---~,-~.--.---'------+ '-~--..-'O;;.~'---71- '/ffIM'f,c~"- _...!.. , " , " , ' ~, ' ,- I' 3' - - '!i" ., , , j' - I, ,'-, - \i~ - ,i - - , ' - - ~ !, ,'! -,' , , l' U\ ,- - .... x ! __ - j , !' , " ,,-I 0, "1 i,', 't " " 0 -, - -! 0 ( ,. i'.! L~! - 't ~ ---'---.~-------L,.-----r--- ---------:-----~-~j_-!..~---_+-----.- : ___:'1' L ~~ ' . . . > . HyJ.'A..,t + I ! I f ~ ! ca ' · (\ - )< -. " -- ----: co",c.re.tc. f........ I /' 1:ul..f .:.>..",..I-~ f....<. .. N .~. ..-,.-/....----- ... --(; -;jj.:;}13--13'oo-T-------"'lf ?-;;~~i:-'--' . : <.rrtJ.(.",J. . f . . , . - , /0(;,'),5" WG.sf 1--70 Fr.>,Jf...../{J. Ndrl-h. ! U' sr ! . , 1.." I ," I ii' . l- ~(, i T C. ~' , ' , " _ __ i,' _ 1 j i I wh~f ,({'f'.:., c..OEpoCJJ'3 . .1' '1 ~-I::' Form 112-5.93 ~~,:t~1'-~;'t:, ;g~f~J#~:.~f?;~!:~"Wift~)?1:~~<~~f~~~,~~r:;.:{~:~~~:~f~tP"~f~;{~~~~'.~~~.;s~':~~-;; .,....;...-....,- '0;,1 _v-'i.}_!:.,:-}!:4f*f-;'_,~:'f.1:;:"~.,:#r~ _::.~:~i~~~~~~'_t?>.. DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number: 8270 BUILDING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE Date: 12/10/98 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 Property Owner: Property Address: 3705 JAY ST Contractor License No. : 20199 Company: Frontier Environmental Services Phone: 303-489-7740 Phone: 303-234-9350 OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value: Permit Fee: Plan Review Fee: Use Tax: (OWNER)(CONTRACTOR) SIGNED DATE Total: $1,200,00 $41 .25 $0,00 $18,00 $59.25 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 the Wheat Ridge Building Code (V. B.C.) and all other applicable Wheat Ridge ordinances, for work under this permit. Use: Description: Remove 500 gallon fuel oil underground storage tank BUILDING DEPARTMENT USE ONLY -- Approval: Zoning: SIC: Sq, Ft: ~ Approval: ~ 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) 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 Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of the City. (2) This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (8) the building authorized is suspended or abandoned for a period of 120 days. (3) If this permit expires, a new permIt may be acquired for a fee of one-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. (4) No work of any manner shall be done that will change the natural flow of water causing a drainage problem. (5) 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 the job. (6) The issuance of 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 ofthj~j1;deS or~ance. law, rule or :e:;t7ft ~hief BUildin~pector ( THIS PERMIT V AUD 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 :/7 ///j,'V 7500 WEST 29TH AVENUE '-(tVit' II WHEAT RIDGE, CO 80215 Property Owner: Property Address: Contractor License No. : Company: /2tVIS U~t1FNS -l./<='~ L+ 3Je'5- :ft) )1- c:;201 '1'0 ,?Jn1lfo- fi:.lJ'~~ Sz"-'/0 Phone :(jo:)) 'I'5f-l1<fo OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Phone QP.J ) ;J..JY-P.5V Construction Value: I AO't;J I hereby certify that the setback distances proposed by this pennit 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 bide by all conditions . ted on this application. and that I assume full r nSIQ,i1ity for ompha . . h t at Ridge Building Code (U,B,C.) and all other appli Ie Wheat Rid ordln , fonder this penni!. DATE 17./11://7':1 'f Use: Description: ~~ \5<:/'-;,;;- ~ J u,.Ar 54r fa .L BUILDING DEPARTMENT USE ONLY Permit Fee: Use Tax: Total: $0.00 ~~1I\itfm9ml@Jre;] Approval : Zoning: emRlI.!!m.QQl1mt.elL~ Approval : ~~9tR~_Q!Um1!fltQ Approval : Occupancy: Walls: SIC: Sq. Fl: 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: (4) (5) This permit was Issued In accordance with the provisions set forth In yopur application and Is subject to the laws of the Slate of Colorado and to the Zoning Regulations and Buildi~ Code of'th11eat Rldpe, Colorado or any other applicable Otdinances of the City. This permit shall expire If (A) the wort authOCtZed Is not commenced within sixty (60) days from issue dale or (B) the building authoriZed Is suspended or abandoned for a period of 120 dar.s. . 'f this pennit expires. a new permit may be acquired for a fee of one-half \he 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 pakl ror a new pennil No war\( of any manner shall be done that will change the natural flow of waler c:ausi~ a drainage problem. Contrador shalt notify the Building Inspector twenty.four (24) hours in advance for alllnspeclions and shall recetve wrinen approval on Inspection card before' proceediing with successive Dhases of the lob. The issuance of a permit or the approval of drawings and specifications shall not be construed to be a permit for, J'lO( an approval of. any violation of the pcovIslons of the building codes or any other Ofdinance. law. nde or regulation. . (1) (2) (3) -, -(6) Chief Building Inspector For Mayor THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR CALL: 234-5933 24 HOURS PRIOR TO INSPECTION REPORTING AGENCY: Permn Number: Business Name: UNDERGROUND TANK REMOVAL CR No.: Business Address: Date: t$ .,--~s:-;" a........+..T-303-'I.t."-7LI/ Business Telephone: Permit Holder: Size of Tanks; 18 State agency has been notified 1 b Dote nolified: I '2. -7 ,o;S 1 c Approved plans from State 011 and Gas are '!l~ched Inspector's Initials COMMENTS: Yes No ~ --=- /- Product Stored: Serial Numbers: Step 1 Step 2 28 All electrical lines and connections have been disconnected. Inspector's Signature: Agency: Date: Tlme: NOTE: No work shall be undertaken by contr8ctor until this step hlls been completed. Inspector's Inltlals Yes No COMMENTS: }oJ'"", e-I~ J......es , ",,,s.....-.'V; Step 3 Inspector's Inltltals COMMENTS: Yes No ?I.."'h''''..j...j -I t""1i...,e~ T LAf~ 30 Received approved plans from State Oil & Gas ....- 3b Approved. plans are attached 0/" - 3c Product has been drained from pipes Into tank .... 3d Piping has been capped or removed .....- 3. Residues and liquids have been removed from tank ~ 3f How was rinsate disposed of? 3g Evacuate to the top on the tank . ! .-L,_ 3h Fill pipe.;ga:uge pipe', vapor recovery-touch connection, ..;.' pumps and other tank fIXtures have been rem?ved. ~- 31 Yent line is still connected. -L_ Step 4 Inspector's -lnltl4ls COMMENTS; Yes !i2 , 40 Solid carbon dioxide used to vent vapors --oL_ ~'-"":zr ~"1~r; 4b 9ther vapqr . removal syste,n U5,ed (describe).'~ .~~ 4c Venting of tank Is proper -L_ 4d Tank LEL reading Is 20 percent or lower -L,_ 4. All hotes plugged with 8 minimum of a 1/2- hole -- 4f Vent line has been disconnected 4g Evacuate area around tank and remove tank 7'- 4h Tank has been labeled after removal ~- -- 41 Tank will be transported to disposal site on the same day it was taken out of ground. ~ 4j Tank is properly secured on truck with vent hole on top Step 5 Inspector's InlttlaJs COMMENTS: Ye. No 5a Is soil contamination present after tank removal? -- If yes, describe: LL.k.16.t., "" 1J 5b If yes, notify Stote Health Deportment: Person Notified: Dote: 5c If yes, notify Stote 011 & Gas: Person Notified: ~te' 5d Name and address of tank estlnation: ~l<.o,J-t U(" ,,/. -,::...(!.., . ..... 2- 5. Were pictures taken? , -~ If so, what agency took pictures? l1t.,.vv.", Gtto:JL.I. 5f Were samples taken at site? M.w.-;"" ';flUl~' 0/"_ If so, what agency took samples? 5g Were split samples offered? .....- -- If so, person accepting samples: 5h Oatemme samples relinquished Step 6 FIN~~~O~RES: Fire District Approving Signoture Other A encies Presen e. resentative 1, 2, 3, jZ-t i-''tB Date Z-II-f8 Dole 4. Step 7 I , , Pink D of this fonn given 10: .--- ~ ~"J:IIJ,,~ , t nome) Date fonn given: I 2 _!/~~P (Signoture of Above Penson) Time fonn given: /3 ~ ~t> ISPQ-13 White Cop>, . Enforcement Agency Yellow Copy - Appropriate Are' DIstrict PInk Copy - O>NnerlPermlt Hokter