HomeMy WebLinkAbout3725 Marshall StreetCity of Wheat Ridge
#r.
Residential Roofing PERMIT - 201708959
PERMIT NO: 201708959 ISSUED: 11/09/2017
JOB ADDRESS: 3725 Marshall ST EXPIRES: 11/09/2018
JOB DESCRIPTION: Permit for reroof: INstall 17 squares 5/12 pitch GAF Armorshield II
laminate shingle House and shed.
*** CONTACTS ***
OWNER (720)891-7861 PRINGLE JESSICA M
SUB (303)895-7968 Lousberg Roofing 120073 Lousberg Roofing and Exteriors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,100.00
FEES
Total Valuation 0.00
Use Tax 107.10
Permit Fee 140.90
** TOTAL ** 248.00
*** 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.
8806. 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.
PERMIT N0:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Residential Roofing PERMIT - 201708959
201708959 ISSUED: 11/09/2017
3725 Marshall ST EXPIRES: 11/09/2018
Permit for reroof: INstall 17 squares 5/12 pitch GAF Armorshield II
laminate shingle House and shed.
I, by my signature, do Mereby attest that the work to be performed shall comply with all accompanyingg approved plans and specifications,
applicable building des, and all applicable municipal codes, policies and procedures, and that I , t7�e legal owner or have been authorized
by the e wn f the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
thise it. er est that I am le ally authorized to include all entities named within this document as parties to the work to be
perat al work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signatur of ER or CONTRACTOR (Circle one) Date
1, This nit 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, po Flans
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 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 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 Inspectiow 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 cooany 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.
PREFERRED Al"U"BERG
CONTRACTOR LQ b
ROOFING & EXTERIORS
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3705 W� 73" Avonue. W"tnllrs;ter, CO 80030 PhOft' '303,895-7M Fax: 9 "ol-5311
«rrsA0,
Antoinette Kulick
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, November 8, 2017 3:20 PM
To: CommDev Permits
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 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
Property Address 3725 Marshall Street
Property Owner Name Jessica Pringle
Property Owner Phone 303-726-8864
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email Field not completed. /
Address
1
13
Do you have a signed
Yes
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed
Pringle contract.pdf
Contract
CONTRACTOR INFORMATION
Contractor Business
Lousberg Roofing & Exteriors
Name
Contractor's License
120073
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone
720-724-3213
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Address
3705 W. 73rd Ave
(Primary address of your
business)
Contractor Email Address
jose@lousbergcontracting.com
Retype Contractor Email
jose@lousbergcontracting.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of
17 squares total main house and shed
the entire scope of work:
Project Value (contract
5100
value or cost of ALL
materials and labor)
Are you re -decking the
No
roof?
Is the permit for a flat
Pitched roof (2:12 pitch or greater)
roof, pitched roof, or
both? (check all that
apply)
14
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 of material for the
PITCHED roof:
Provide any additional
detail here on the
description of work. (Is
this for a house or
garage? Etc)
5/12
17
GAF Armorshield II laminate shingle
Asphalt
For main house and shed
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full
responsibility for
compliance with
applicable City of Wheat
Ridge codes and
ordinances for work
under any permit
issued based on this
application.
I understand that this
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
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have been
authorized by the legal
owner of the property to
submit this application
Yes
Yes
Yes
Yes
15
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 Jose Silva
Email not displaying correctly? View it in your browser.
16
Inspection onh ,
Cancellations must be submitter.
Inspections will not be performed ume,
Request an inspection before MIDNIGHT (11:59 PM) to 1-6
PERMIT:
ADDRESS:
Foundation Inspections
Date Inspector
102 Caissons / Piers Initials Comments
103 Footing / P.E. Letter
104 Foundation Setback Cert.
105 Stem Walls
106 Foundation wall Insulation
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground / Slab Inspections
Date Inspector
201 Electrical //Cable/ Conduit Initials Comments !y
202 Sewer Underground Int.
203 Sewer Underground Ext.
204 Plumbing Underground Int.
205 Plumbing Underground Ext.
206 Water Underground
Do Not Cover Underground or Below / In -Slab Work Prior To A
Rough Inspection
pproval Of The Above Inspections -
Date Inspector
301 Rough Framing Initials Comments
302 Wall Sheathing
303 Roof Sheathing
304 Sheer Inspection
305 Insulation
306 Mid -Roof _
307 Metal / Lath /Stucco
308 Rough Electrical Residential
�'-3-09 Rough Electrical Commercial
10 Electrical Meter Residential
311 Electrical Meter Commercial
1312 Temp. Const. Meter
313 Rough Plumbing Residential
314 Rough Plumbing Commercial
315 Shower Pan
SEE OVER FOR ADDITIONAL INSPECTIONS
I �a1 ADDRESS:
OB CODE: _
=RMIT:
Inspector Comments
uDate
ugh Inspection (continued) Initials
i Rough Mechanical Residential
7 Rough Mechanical Commercial
8 Boiler I Furnace
9 Hot water tank
,0 Drywall screw and Nail
?1 Moisture board I shower walls
?2 Rough Grading
23 Miscellaneous
'inal Inspections
102 Gas Meter Release
t03 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
410 Final Window/Door
411 Landscape/Park/Planning'
412 Row/Drainage/Public Works"
413 Flood plain Inspection"
414 Fire Insp. I Fire Protection"""
415 Public Works Final'
416 Storm Water Mgmt."
417 Zoning Final Inspection'
UA; Finallnspection
Date
/17—
Inspector
Initials
Comments
Inspections from these entities shall be requested
one week in advance. lease
*For landscaping and parking inspections p
call 303-235-2846 lease call
"For ROW and drainage inspections p
303-235-2861
'For fire inspections please contact the Fire
Protection District for your project.
418 Buil ing
must be completed and approved by Planning, Public Works, Fire and Building
Note: All items is issued. Approval of the Final Building Inspection does not
before a Certificate of Occupancy
constitute authorization of occupancy. leted b the Fire District and
For Low Voltage permits please be sure that rough inspections are comp Y
Electrical low voltage by the Building Division.
CITY OF WHEAT RIDGE
g Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: 7
Job Address:
Permit Number:C7/9D 5
❑ No one available for inspection: Time IV[/PM
Re -Inspection required: Yes
When con' ions have been made, call for re -inspection 303-234-593
f3
r
Date: , 1 I eE or� r �, . ►
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: Q
Job Address:
Permit Number: 12 06 2
❑ No one available for inspection: Time I ' , (_ ,AM/PM
Re -Inspection required: Yes No
When correcti ns have been made, call for rhe-iinnjspection at 303-234-5933
Date: Inspector: %" � /
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
#r.
Residential Roofing PERMIT - 201708959
PERMIT NO: 201708959 ISSUED: 11/09/2017
JOB ADDRESS: 3725 Marshall ST EXPIRES: 11/09/2018
JOB DESCRIPTION: Permit for reroof: INstall 17 squares 5/12 pitch GAF Armorshield II
laminate shingle House and shed.
*** CONTACTS ***
OWNER (720)891-7861 PRINGLE JESSICA M
SUB (303)895-7968 Lousberg Roofing 120073 Lousberg Roofing and Exteriors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,100.00
FEES
Total Valuation 0.00
Use Tax 107.10
Permit Fee 140.90
** TOTAL ** 248.00
*** 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.
8806. 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.
PERMIT N0:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Residential Roofing PERMIT - 201708959
201708959 ISSUED: 11/09/2017
3725 Marshall ST EXPIRES: 11/09/2018
Permit for reroof: INstall 17 squares 5/12 pitch GAF Armorshield II
laminate shingle House and shed.
I, by my signature, do Mereby attest that the work to be performed shall comply with all accompanyingg approved plans and specifications,
applicable building des, and all applicable municipal codes, policies and procedures, and that I , t7�e legal owner or have been authorized
by the e wn f the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
thise it. er est that I am le ally authorized to include all entities named within this document as parties to the work to be
perat al work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signatur of ER or CONTRACTOR (Circle one) Date
1, This nit 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, po Flans
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 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 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 Inspectiow 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 cooany 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.
PREFERRED Al"U"BERG
CONTRACTOR LQ b
ROOFING & EXTERIORS
. ...... ...
NvMkWCZ coup",.
. . ..... . ..
*w" OF To *gpqoAmoAilsmc -mwvlF4 AW
7 K;r i A, Ax .0m > s V 9'' Tr A, ft $ w VA %, C V crWAAl M L i 401 1 S * v i D ", t wm* n s Y Ll,"jSW W,i 4, V^A w 6 A, f X ' C Rl CM-- L# 4 L -- a$ t" t 3 A 0 0 ot " D 14 f i S 4 ' J 6ti
LouWAO fvoorwj 4t E 06*0ft 4 W)l t)K KAI V I0 4*wOtW AN f ; Ael OF THE WOPE Of yf":'W-
*A. a u toot,
top t
-- -- - -- - ----- L4 . .. . .....
wof
LV
-,Z"- a %09f. ROOF oumal PANT wotom" oympt VM"
ALAWAACO,_
COMP 9W5 ON ALL CROX
KAW-
AL tAft VAT% **"TK 40
1FOR W A ' -
'STS dr '-HOU
40met,4,4, llwe *ONTRACT
'i
wc xz YE Wlcoiko*uAX A,E --ff;t ACII J
wswLe #ON 4" 0A ADUCTOLF Ake MPLACEJAEW Cos., ;A,
.<:.T_; TtAr.pffIrr. mm3, IN mli. .s 'Ofty, op"CIV 0.5 pop. 14C
cvu - 41��. UAY *
vio� m EKNO
A jXAt+%ko PM U"Vs�* o pm-mvw- " W,4" PWL)PfA-o AMRAWA C""j. Y400N n-?�aa �E,-E&vo *r -r
'Tgr I A � IME a,* i It 4Vll(-,W�aATlllVll)r RE
ta RL,$POWWX TZ}Afft QR4UR DFOX.
VAO#*MY QWA""" 0"CAKI EXIOW)PS Q4) C#'AN A r- - pFF'-A*oF AW
tX+o!9rWV*4 ?%''N1 s A77" -vTr4uf4 TIIE C,-WMAC'
LtWftf#6 ROOP"Id AND FkMMJM4 PMLL"4 0 IN IRUST 4Ky 7'Avovl7r pp" r+,,f. p.� VW Y,—T.R UNI�- De MUVERID 144 Roofmc KATMALS ro
fA WCq
IR r Ykf., ''LW 4FKKOLk CCWT141A Qf fC*rPA0T* "TWATO W YT,% 4V
.if
4077Ce. Ynwe YKv*owwk 4f , Amv WV;l l&WED To PAQT I ON AP'ICLL A )f 14f ' M F,
WAWE '0R-4CAWJFT0PAY "A 'ART
4FO"N I W 4*opr*; r,
VfVCPC6& AW (A-00 M44 AV; r -k WA'C`t)ay ARE 'ERE*4 '"C"o
T'r'
rvC:AV I C* k0k N31"k"C'c c; -"c Or "Awi. A lVC.N. -911, CAMEV, V IWWQ W, 109
AQM- 81 IKWW�,�i N Irf-- QIAL? BOTH rROMT & BACK ArAZEEMENT
........... . .....
cvVANct AFP9r2t.MA" SXAA'Wk�
J�A Tr CW At -,
3705 W� 73" Avonue. W"tnllrs;ter, CO 80030 PhOft' '303,895-7M Fax: 9 "ol-5311
«rrsA0,
Antoinette Kulick
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, November 8, 2017 3:20 PM
To: CommDev Permits
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 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
Property Address 3725 Marshall Street
Property Owner Name Jessica Pringle
Property Owner Phone 303-726-8864
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email Field not completed. /
Address
1
13
Do you have a signed
Yes
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed
Pringle contract.pdf
Contract
CONTRACTOR INFORMATION
Contractor Business
Lousberg Roofing & Exteriors
Name
Contractor's License
120073
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone
720-724-3213
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Address
3705 W. 73rd Ave
(Primary address of your
business)
Contractor Email Address
jose@lousbergcontracting.com
Retype Contractor Email
jose@lousbergcontracting.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of
17 squares total main house and shed
the entire scope of work:
Project Value (contract
5100
value or cost of ALL
materials and labor)
Are you re -decking the
No
roof?
Is the permit for a flat
Pitched roof (2:12 pitch or greater)
roof, pitched roof, or
both? (check all that
apply)
14
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 of material for the
PITCHED roof:
Provide any additional
detail here on the
description of work. (Is
this for a house or
garage? Etc)
5/12
17
GAF Armorshield II laminate shingle
Asphalt
For main house and shed
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full
responsibility for
compliance with
applicable City of Wheat
Ridge codes and
ordinances for work
under any permit
issued based on this
application.
I understand that this
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
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have been
authorized by the legal
owner of the property to
submit this application
Yes
Yes
Yes
Yes
15
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 Jose Silva
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16
City of Date: C� CS
W h6
" Ldge
LJNII'Y DEVELOPMEN"T Plate rte
Building & Inspection Services Division 2-
7500 W. 29'h Ave., Wheat Ridge, CO 80033 Plan Review Fee:
Office: 303-235-2855 * Fax: 303-237-8929
inspection Line: 303-234-5933
Building Permit Application
Please complete all highlighted areas on both sides of this form. incomplete applications may not be processed.
'7
Property Address:
Property Owner t0lease pfinP. A oz "e, I Phone- 7,4 0,
Property Owner Email: 1q/
I
C
Arqb1j9990QiML ----- ----- 4 1 1 14
Architect/Engineer E-mail: Phone:
Contractor:
Contractors City License Phone: 4IL-7-
M
Complete all'information on BOTH sides of this form
813 V L L 9 L Lo deS
, ELECTRICAL SERVIC...
STRUCTURE[3 NEW COMMERCIAL STRUCTURE
NEW RESIDENTIAL COMMERCIAL ROOFING
COMMERCIAL ADDITION 0 RESIDENTIAL ROOFING
RESDENTIAL ADDITION WINDOWa
CEMENT
COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
gyp. STRUCTURE.w' shed, deck,
MECHANICAL SYSTEWAPPLIANCE REPAIR or REPLACEMENT
ELECTRICAL
M p+ A REPAIR
M • X3N, REPLACEMENT
OTHER
+ (Describe)
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(For ALL projects, please provide a jeft:11_1e"d description of work to be performed, including current use of areas,
proposed uses,square footageI existing(condftion and proposed new condition, appliance size and efficiency" type and
amount of materials to be used, etc.)
Amps Squar", Other
«re t as ♦ • t• t:
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with applicable
or have been i by the legal owner Of the Property to perform the described work and am also atitho ' vii by t e legal owner of any
4altity included ork this appiwatiou it) list that 4:11cay Oil this application,
CIRCLE ONE(OWNER)(:(C NT R") or (AUTMO ZED C' RNTATIV) of fOWN R) (CONTRACTOR)
NAM': ta*1 testi--1 /L SIGNATURE: '� � DA cERM !� /
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NEW COMMERCIAL STRUCTURE ELECTRICA SERVICE UPGRADE
NEW RESIDENTIAL STRUCTURE COMMERCIAL
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11/03/2014 11:26 FAX 713 521 2888 ACC LAINED ROOFING SVCES
FOR OMCE U.';E ONLY
Pbn Roview F**�
Building Permit Application
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