HomeMy WebLinkAbout4271 Hoyt CourtFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Furnace/Boiler Replacement Permit Application
Date: Thursday, November 4, 20214:10:58 PM
Furnace/Boiler Replacement Permit Application
This application is exclusively for RESIDENTIAL REPLACEMENT FURNACE or
BOILER - LIKE FOR LIKE ONLY.
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 a Yes
replacement residential
furnace or boiler like for
like?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4271 Hoyt Court Wheat Ridge, CO 80033
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"
Terry Martinez
303-467-0279
permits@fixmyhome.com
CONTRACTOR INFORMATION
Contractor Business fix it 24/7
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 chad caruso
Permit
Email not displaying correctly? View it in your browser.
Name
Contractor's License 180142
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
303-659-3400
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
permits@fixmyhome.com
Address
Retype Contractor
permits@fixmyhome.com
Email Address
DESCRIPTION OF WORK
What type of unit is
Furnace
being installed?
Number of BTUs
70
What is the efficiency
80
(%) of the unit?
Is the unit GAS or
gas
ELECTRIC?
Where is the furnace or
basement
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract
6750.00
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
v ` INSPECTIIOlk ( RECORD
fINSPECTION REQUEST LINE: (303) 234-5933
°°°agar �'T, e
Inspections will not be performed unless this card is posted on the project site.
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date Inspector Comments
Initials
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections
Date Inspector Comments
Initials
Electrical
Comments
Sewer Service
Plumbing
,
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Ins ections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
,
Mid -Roof
y
n
Floodplain Inspection (if applicable)
Lath / Wall Tie
Fire Inspection / Fire Protection Dist.
Rough Electric
Final Electrical
Rough Plumbing/Gas Line
Final Plumbing
Rough Mechanical
Final Mechanical
Rough Framing
Roof
_
Rough Grading
Final Window/Doors
Insulation
Final Building
Drywall Screw/ Nail
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.
Final Inspections
Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof
_
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
*For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage
by the Building Division.
**For Inspection Time Window — Please email insptirnerequest@Ci.Wheatridge.Co.US by 8:00 A.M. the morning of the
inspection with the property address in the subject line of the email. Time window is based on the inspector's route.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
,, ry City of Wheat Ridge
Residential Roofing PERMIT - 201701743
PERMIT NO: 201701743 ISSUED: 06/08/2017
JOB ADDRESS: 4271 Hoyt CT EXPIRES: 06/08/2018
JOB DESCRIPTION: Permit for residential reroof: remove existing materials, install OC
Duration 17 squares, house 5/12 pitch
*** CONTACTS ***
OWNER (303)467-0279 MARTINEZ ROBERT L
SUB (303)663-5615 Joel/Channa Speckman 080141 All In One Contractors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,369.00
FEES
Total Valuation 0.00
Use Tax 91.75
Permit Fee 125.05
** TOTAL ** 216.80
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) requires an approved inspection
prior to installation of ANY roof coverings and is require on the entire roof when spaced
or board sheathing with ANY gap exceeding iN2-inch exists. Asphalt shingles are required to
be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is
required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave
and secured in place is required to be provided for all roof inspections. Roof ventilation
is required to comply with applicable codes and/or manufacturera€ms 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's 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.
i CITY OF WHEAT RIDGE
f —- Building Inspection Division
` (303) 234-5933 Inspection line
�(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Insnection Tvne: ��
❑ No one available for inspection ime AM/PM
Re -Inspection required: YesNo
When corrections have been made, call for re -inspection at 303-234-5933
Zg_1 f
Date: Inspector: .j
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
Inspection Type:
Job Address: OY+
Permit Number: O) %O
❑ No one available for inspection:
Re -Inspection required: Yes 6o
When corrections have been made, call for re -inspection at 03-234-5 33
Date ! I I Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 201701743
PERMIT NO: 201701743 ISSUED: 06/08/2017
JOB ADDRESS: 4271 Hoyt CT EXPIRES: 06/08/2018
JOB DESCRIPTION: Permit for residential reroof: remove existing materials, install OC
Duration 17 squares, house 5/12 pitch
*** CONTACTS ***
OWNER (303)467-0279 MARTINEZ ROBERT L
SUB (303)663-5615 Joel/Channa Speckman 080141 All In One Contractors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,369.00
FEES
Total Valuation 0.00
Use Tax 91.75
Permit Fee 125.05
** TOTAL ** 216.80
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) requires an approved inspection
prior to installation of ANY roof coverings and is require on the entire roof when spaced
or board sheathing with ANY gap exceeding Al/z-inch exists. Asphalt shingles are required to
be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is
required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave
and secured in place is required to be provided for all roof inspections. Roof ventilation
is required to comply with applicable codes and/or manufacturera€ms 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's 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 - 201701743
PERMIT NO: 201701743 ISSUED: 06/08/2017
JOB ADDRESS: 4271 Hoyt CT EXPIRES: 06/08/2018
JOB DESCRIPTION: Permit for residential reroof: remove existing materials, install OC
Duration 17 squares, house 5/12 pitch
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applica le 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
thisermit. Iftirthe at I am le ally authorized to include all entities named within this document as parties to the work to be
performed a`� attif�a Itwork cried isclosed in this document and/or its' acco panyin approved plans and specifications.
Signature oWGNER �CQITRACTOR (Circle one) Date
I . This permit w ss ased 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 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 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 an manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5, The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date V
REQUESTS MUST BE MADE BY 11:59PH ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Inspection time requests will be accepted by email only. Please email requests to insptimerequestgci.wheatridge.co.us
between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line.
JO Ci
Antoinette Kulick
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, June 7, 2017 3:32 PM
To: Permits CommDev
Subject: Online Form Submittal: Residential Roofing Permit Application
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. 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. Permits are currently being
processed within 24-48 hours, subject to change based on volume.
For all other requests:
Homeowners wishing to obtain a roofing permit must apply for the permit in person
at City Hall. Existing permits that require amendments (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.
PROPERTY INFORMATION
Property Address 4271 Hoyt Ct.
Property Owner Name Robert Martinez
Property Owner Phone (303) 467-0279
Number
Property Owner Email j44c50@aol.com
Address
Do you have a signed Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
CONTRACTOR INFORMATION
Contractor Name All In One Contractors
Contractor's License
Number (for the City of
Wheat Ridge)
Contractor Phone
Number
080141
(303) 663-5615
Contractor Email Address j44c5o@aol.com
(permit pick-up
instructions will be sent
to this email)
DESCRIPTION OF WORK
Is this application for a Yes
new permit for a
residential roof?
Are you re -decking the No
roof?
Description of Roofing OC Duration
Material
How many squares of 17
material?
Provide additional detail House 5/12
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract 3,4pe�
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full Yes
responsibility for
compliance with
applicable City of Wheat
Ridge codes and
ordinances for work
under any permit
issued based on this
application.
I understand that this Yes
application is NOT a
2
a- -I x 0 _
Lf -5ke,- 1
permit. I understand I will
be contacted by the City
to pay for and pick up the
permit for this property.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have been Yes
authorized by the legal
owner of the property to
submit this application
and to perform the work
described above.
Name of Applicant Joel Speckman
Email not displaying correctly? View it in your browser.
INSPECTION RECORD OGCUDaNGVI7yDe
INSPECTION LINE: (303) 234 -5933
Inspections will not be made unless this card is posted on the building site
Call by 3:00 PM to receive inspection the following business
�,J INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB
FOUNDATION INSPECTIONS
DATE INSPECTOR
INITIALS
COMMENTS: -
Footings /Caissons
Stemwall / (CEG) Concrete
Encased Ground
Reinforcing or Monolithic
Weatherproof / French Drain
Sewer Service Lines
-
Water Service Lines
- POURNO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
Heating (Underground)
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGHS
Sheathing
-
Lath / Wall tie
Mid -Roof
o -6 -
Electrical Service
Rough Electric
Rough Plumbing
Gas Piping
Mechanical
Insulation
- Drywall Screw
FINALS
p
Electrical
Plumbing
Mechanical
Permit Fee . __ 144.70 ... .
ER.O.W
Use Tax 80.84
_.
Final PAYMENT RECEIVED.. AMOUNT...
partment - VS 0244 225 S4
Auth Code
& Drainage �C /� INSPECTIONS FOR - fi42023 & Landscaping SHOULD BE CALLt
"NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND Z(
CERTIFICATE OF OCCUPANCY 1S ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONST/TUTEAUTHORI7AnoN
OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY.
PROTECT THIS CARD FROM THE WEATHER
♦ 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: FlNR l_ /Z90 F
Job Address: A271 I-io,), Cl"
Permit Number: Q 9715'6
/Q o~szrr~
❑ No one available for inspection: Time AM/PM
Re-Inspection required: Yes No
When corrections have been made, call for re-inspection at 303-234-5933
Date: /0 _;~i Inspector: R U
DO NOT REMOVE THIS NOTICE
♦ i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 235-2857 Fax
INSPECTION NOTICE
❑ No one available for inspection: Time AM/PM
Re-Inspection required: Yes No
"When corrections have been made, call for re-inspection at 303-234-5933
Date: /6- 61-0q Inspector:
DO NOT REMOVE THIS NOTICE
Inspection Type: 1,121,9 fiao 1~s,h~t7ia~✓
Job Address: 11271 l1ay; C'z
Permit Number: 0J2g56
City of Wheat Ridge
r4000r Faxed Roof Permit PERMIT - 092956
PERMIT NO: 092956 ISSUED: 10/02/2009
JOB ADDRESS: 4271 'HOYT CT 'EXPIRES: 03/31/2010
DESCRIPTION:` Reroof;22 sqs
CONTACTS
' owner 303/467-0279 Robert Martinez
sub 303/332-6224 Chuck Gardner 02-1423 GARDNER CONTRACTING, LLC
**PARCEL INFO
ZONE CODE: UA - USE: UA
✓ SUBDIVISION:` 0258 BLOCK/LOT#: 0/
FEE SUMMARY ESTIMATED PROJECT. VALUATION: 4,491.00
FEES
Permit Fee 144.70
Total Valuation ;00.- `T
Use. Tax ;.80.84
TOTAL `225.54
Conditions:
Both 'front and back of permit need to be posted on job site. If one or the other:.
is not present, INSPECTION WILL NOT. BE PERFORMED.
6 nail installation & mid roof inspection required: Board sheathing spaced more
thana 1/2 of an inch apart requires plywood overlay on entire roof. Ice and
water shield required from eave edge to 2' inside exterior walls.
Subject to field inspection.
h
I hereby certify that the setback distances proposed by this p y permit applicationare accurate, and do not violate applicable
ordinances, rules or regulations of the City of Wheat. Ridge or covenants, easements or lrestrictions` 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`(I.B.C) and all other...
applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field inspection.
c
y Signature of contractor/owner -date
>a
1. This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the
State of Colorado and to the Zoning Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable
'c
ordinances of the city._
2. This permit shall expire 180 days from the issue date Requests for an extension must be received prior to expiration
date. An extension may be granted at the discretion of the Building Official.
3. If this permit expires, a new permit may be acquired for a fee of one-half the amount normally required, provided no
5S 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 have been or if suspension or abandonment' exceeds one (1) year, full fees shall
2.e
N be paid for anew permit:
ds; 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 she Building Inspector twenty-four (24) hours in advance for all inspections and shall receive
.y; written approval on inspection card before proceeding 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 a royal ':o ny violation of the
pp provisions of the building codes or any other ordinance, law,.. rule or regulation.
cz. A11' n J is subject to field inspections.
r,
Signat of hief Building Official :date
is INSPECTION REQUEST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855
F REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
INSPECTION RECORD Occupancy/Type
'INSPECTION LINE: (303) 234-5933
Inspections will not be made unless this card is posted on the building site
Call by 3:00 PM to receive inspection the following business day.
INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB
FOUNDATION INSPECTIONS
DATE
INSPECTOR
INITIALS
COMMENTS:
Footings/Caissons
Stemwall / (CEG) Concrete
Encased Ground
Reinforcing or Monolithic
'
Weatherproof / French Drain
Sewer Service Lines
Water Service Lines
YOUR NO CONCRETE UNTIL ABOVE HAS BEEN JIGNED
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
Heating (Underground)
DO N
OT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGHS
Sheathing
Lath / Wall tie
Mid-Roof
Electrical Service
Rough Electric
Rough Plumbing
Gas Piping
"
Rough Mechanical
ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PR
Insulation
Drywall Screw
CITY OF WHEAT RIDGE
10/02/09 3:32 PH edba
FINALS
-
Charles Gardner
-
Electrical
Plumbing
RECEIPT NO.CDA802723
AMOUNT
DPSP Reroof 22 sqs _
225.54
Mechanical
092956
it F
- -
P
44
70
Roof
erm
ee
Use Tax
1
.
80.84
Building Final
PAYMENT RECEIVED
AMOUNT
Fire Department
VS 0244
225.54
-Auth Code:
R.O.W & Drainage
INSPECTIONS FOR
612023
Parking & Landscaping
SHOULD BE CALLE
_
TOTAL
225.54
""NOTE: ALL ITEMS MUST
BE CO
MPLETED AN
D APPROVED BY P
LANNING AND Z(,
"
CERTIFICATE OF OCCUPANCY IS
ISSUED. FIN
AL INSPECTION B
Y THE BUILDING DIVISION DOES NOT CONSTITUTEAUTH
ORIZATION
OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
PROTECT THIS CARD FROM THE WEATHER
OCT-02-2009 09:03 PM
Sep 01 09 03:57p Gardner
8666241369
p.1
P. 02
City of Data;
iWheatUZd e
COMMUNCTY Dt~VEC.OC'ME[JT Petrnlt tl: ~
Office: 303-235-2855 " Fax: 303-237-8929
Inspection Line: 303-234-5933
Facsimile Building Permit Application
Property Owner (please print): 206 EST /'7/~/( J~ / 1f/CZ Phone: J d / ` - ~7
Maliing Address' (if different than property address)
Address; 5A"~
g4lo'botor:
Contractor License M
3-33a-OVAA
Use of s ace descrf lion): R 6 - Ro6 F 4
Dstruetlon value: IQ, 42 Plan Review (due at time ofsubmitial)z S
Sq. FULPt added: --ir _ Squares ~T BTU's Gallons Amps
[RMI WNEIRMONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT here cadlfy Ihat the setback diatenoae proposed by thla pernR application ere arsurete, and do not vi0lato sppllcabk Vlnancea,
les or repulallnne of Iha City of Wheat Rld®e or oovenenta, eaaameMa or reetnctlana of record; that It meRauremenls shown, and
egations made are aceurete; that Lhave read and agree to abide by all condltbne pdnled on thla application and them 1 assume full
e o t lbNlty Por wmpllanee whh the Wheat RkYge Dulidlnp Cade (La,C) and all other applicable Wheat Ridge Ordinances, for work
er (his perm4LCE ONETRAT NAME: _'Sr°" lYG'!~ 810NATURE~ Date:
Bldg Valuation:
Credit Card Payment: Use credit card listed on file. Date:
Print name: Signature:
J
- HAZARD - -~ 7Ct?-14
CONDITION TO BE CORRECTED AS SHOWN BELOW CREATES AN IMMEDIATE HAZAR. S EQUIP~ IE ~ BACK IN
SERVICE UNTIL REPAIRS AND A THOROUGH INSPECTION HAVE BEEN MADE BY A QUAURED CONTRACTOR. CONTACT YOUR LOCAL
BUILDING DEPARTMENT FOR CODE AND PERMIT REQUIREMENTS PRIOR TO PERFORMING REPAIR WORK.
NAME AND TYPE OF APPLIANCE