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Home My WebLink About3905 Moore StreetRr,4 0 ( (-, N aWaF K"' INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Occupanr" 113V YW Inspections will not be performed unless this card is posted on the project site. **Request an inspection before 11:59 p.m. (midnight) 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 Underaround or Below/In-Slab Work Prior To Approval Of The Above Inspections Rough Inspections Date Inspector Initials Comments Wall Sheathing Mid -Roof Lath / Wall Tie Rough Electric Rough Plumbing/Gas Line Rough Mechanical Rough Framing Rough Grading Insulation Drywall Screw / Nail 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 t Final B .,ilding NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Ocrupancy 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 Uistrict and electrical low voltage by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather A 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: POF Job Address: 2jg (.)4--, M wl) _E S -r Permit Number: 9-0 i 04n,'D � 6 ❑ No one available for inspection Ti e UU AM/�M Re -Inspection required: Yes /No When corrections have been made, call for re hspection t 03-23 -5 33 Date: 13 Inspector: /,1 DO NOT REMOVE THIS NOTICE f i CITY OF WHEAT RIDGE _1�9�Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Al`s L�) Job Address: 3 l 5 /// 61cl?! S ___ Permit Number: / `% (5 'ICAC ❑ No one available for inspection: Time( )R`/ AM/PM Re -Inspection required: Yes When corrections have been made, call for re-inspf ction at 303-234-5933 ' Date: �_... Inspector:—(,,- DO NOT REMOVE THIS NOTICE A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office o (303) 237-8929 Fax Inspection Type: Job Address: Permit Number: INSPECTION NOTICE ::Z� ❑ No one available for inspection: Time AM/PM Re -Inspection required: Yesdr' No When corrections have been made, call for re -inspection at 303-234-5933 �.. Date:' DO NOT REMOVE THIS NOTICE PERMIT NO: JOB ADDRESS: JOB DESCRIPTION: City of wheat Ridge Residential Roofing PERMIT - 201704016 201704016 ISSUED: 07/14/2017 3905 Moore ST EXPIRES: 07/14/2018 Residential Re -roof to install GAF Timberline HD asphalt shingles with 24 sq. *** CONTACTS *** OWNER (608)792-4559 ZINIEL EMILY SUB (303)346-6010 Roy Thomas 090287 Mountain States Home Improve *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,000.00 FEES Total Valuation 0.00 Use Tax 168.00 Permit Fee 172.60 ** TOTAL ** 340.60 *** 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 one half 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 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. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. City of Wheat Ridge ..� Residential Roofing PERMIT - 201704016 PERMIT NO: 201704016 ISSUED: 07/14/2017 JOB ADDRESS: 3905 Moore ST EXPIRES: 07/14/2018 JOB DESCRIPTION: Residential Re—roof to install GAF Timberline HD asphalt shingles with 24 sq. I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property. and am authorized to obtain this permit and perform the work described and approved in conjunction with rt. I further attes th am this_permlegally authorized to include all entities named within this document as parties to the work to be performed and that a wo o be performed is disclosed in this document and/or its' accompanying approved plans and specifications. 1'"? -(F- -?00 Signature of WNER or CONTRACTOR (Circle one) Date 1. This pe it was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Officcial and is not guaranteed. 4. No work of any manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applS;; ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett �1"-) 0� From: no-reply@ci.wheatridge.co.us Sent: Wednesday, July 5, 2017 11:52 AM To: Permits CommDev Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Danny 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 Property Owner Name Property Owner Phone Number Property Owner Email Address 3905 Moore St Emily Ziniel 6087924559 Field not completed. 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 Contractor's License Number (for the City of Wheat Ridge) Contractor Phone Number Mountain States Home Improvement 090287 3033466010 Contractor Email Address andrew@mountainstatesroofinginc.com Retype Contractor Email andrew@mountainstatesroofinginc.com Address DESCRIPTION OF WORK Are you re -decking the No roof? Description of Roofing GAF Timberline HD Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 24 material selected above? Does any portion of the No property include a flat roof? If yes, how many squares Field not completed. on the flat roof? TOTAL SQUARES of all 24 roofing material for this proj ect Provide additional detail Reroof home, 6/12 pitch, t/o 1 layer to deck here on the description of z work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 8000 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 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 Andrew Thomas Email not displaying correctly? View it in your browser. 3 7/5/2017 IMG 6571.JPG RGkia.� l 9^o-373-5838 Mum-Irm W HSIGNED)IfFr0WWOW12 AitttfOMISIPIG 7D AA`r, WANE, OR REBA'tEfitLOFFxrY AND C4sU+' Ll INSURER FORA+I POLICY. ;nv M«„ race,ttaud (GRS 1B:i3.114.a'").-tater:. that paying, waiving oi' rebating a Pmpstty Sieg-Requipra the following Information to appear on all contracts All tnFi for' ct$9@ to bulklings is exciud-^d 45 dsy'a.,= comp;eflon date and the ovine is notified that any damage to contents will bethe responsibility of th_: otmerand his its el ca cottiq sy All diaa"sj to #hs huifdrs°-? which' occUned white roofing we,;. in Fragres will be covered by the contractor_ tt witaih SCtBa P +cfng, tnc rnqusas ro down, paymM rnvti 3r rt one :r g(ven, Mountain States lac. Shy t22!� f�ytc si any Payne t tecetved fromyou untiTMouMain States Roairq! tnL ba dalide ad reot4V ro,etia's at ni site or 1 's pericrmed i rna(onty of the �t -.your property - .o. Slams Roofing, inn~, carries wnrAar's rraMUSTMOun, ., IMCC a, and «ctrmeruiW ,,eneral P7bf y tidily InturY v (�tsttrarir of frtattrrr- t df3fifl} T a. lrtRurii TCe cam s tytiesanG tinea i+sof Covaraga and our insurance corlfecd lnformaUan�f , . .1I'l tCmer r ed herel rf8i'::ice-ait5u'dtr?..fe5fd6rEd.i.SrJ-'rtoftf,.l<-tnrtr�ct. !no oblafn I -full r�tt.,}o of any d pa> g you P h k sYflfun 72 hou 5 if Brent ;n the contract. If u i tb� o 1, j4and casual Y mai rQ"Cd vat��n it nour�.tittb, you r -c lva 1'1rtt4n nat(ce from the p , your eiaim er hipttrrtaf') StbtW-Rgrjiigg lae:ts enutfed to retain ney-epts ordaposd tocompensate tarn footing work wcpns slabs wAhstanifasd'sr oflr� trade try PIaeN s > Mauniafn Sirkas Reefing. lnc cannel waive _ o r _ waive of t?aY. eapp-=hle,0.#* tnsdnn cs ci, rn for payment forrpayng wasrR n your prope�#y' Mountein'618tes Raofimg tnc wilC " in.any work tun right kjt'te.� a�ioil is?nod(s} kiarc ltptn� Afl wodt+ata bk,ronl ,etea fna vtadkmnnfllse manner-ccnrding to stain -rd practices- All interior damdg<ta buildings incurred O days is 'MiiaF d that try rir sag to wnwrtts will be the r,,sp omih 'ty of tt:j owner and'ineu insurance company All damage to the g W'C'w2i=d'1oy fie ear ttaafox rXfiBgo-mantr are cnnt],rcga t non 8164 acclgents. or delays beyond our control, t Tyner fire. 7edfHpg'wlli'ua done i;Laad an rfat+}:slgi+ed Out ltmlted is at+alfttbirtjjr of tlJelssrlals and crews. and weather cbndifigns. Til.. ifome�i :. W'auteail.apcouota:-30'-Jays past'dtre. Inadditfan, cgztz ;Anti:d. ret. onahie at ern' sfeeslor collections may be ahaMed on any account upon; completion 3r In the arhatint of 11Y peiaerAvI the contract pine unless it is due to rWm being denied. by. mall,. f7o& je ,A ' 'old sett tc.,,,a pisysicataddressstatsd rt ih5 contract: -or_ - `.tetirrsw. . https://maiI.google.com/mail/u/O/#inbox/15cfabfO2l7e4614?projector=l 1/1 .. Lh ,� NOTE- Rop4wament al dctenorared docking and facial boaid% nntassotNmw/tA:#alrdmmit; contracteranot hWudadandwAl "Wd rslm on a -lima and matarfais" abash% /{� lx+Ch�h%l�l�ItQdipI7r fJl.. >�ow nils d i�i•� , AUJ%u'`4 r +zm Maw r A. r�.n T 0 Ale y,.., it jCa Lli f 3 _�„f Y :_rte �n, 'T• � ,/ ( ,lam' / �.� J V�+ .� � (tCi .�Y � ured r ni-tr 1tIEF(ME L/ YES s 13 36 y U - YES prsdud.r Yes Mum-Irm W HSIGNED)IfFr0WWOW12 AitttfOMISIPIG 7D AA`r, WANE, OR REBA'tEfitLOFFxrY AND C4sU+' Ll INSURER FORA+I POLICY. ;nv M«„ race,ttaud (GRS 1B:i3.114.a'").-tater:. that paying, waiving oi' rebating a Pmpstty Sieg-Requipra the following Information to appear on all contracts All tnFi for' ct$9@ to bulklings is exciud-^d 45 dsy'a.,= comp;eflon date and the ovine is notified that any damage to contents will bethe responsibility of th_: otmerand his its el ca cottiq sy All diaa"sj to #hs huifdrs°-? which' occUned white roofing we,;. in Fragres will be covered by the contractor_ tt witaih SCtBa P +cfng, tnc rnqusas ro down, paymM rnvti 3r rt one :r g(ven, Mountain States lac. Shy t22!� f�ytc si any Payne t tecetved fromyou untiTMouMain States Roairq! tnL ba dalide ad reot4V ro,etia's at ni site or 1 's pericrmed i rna(onty of the �t -.your property - .o. Slams Roofing, inn~, carries wnrAar's rraMUSTMOun, ., IMCC a, and «ctrmeruiW ,,eneral P7bf y tidily InturY v (�tsttrarir of frtattrrr- t df3fifl} T a. lrtRurii TCe cam s tytiesanG tinea i+sof Covaraga and our insurance corlfecd lnformaUan�f , . .1I'l tCmer r ed herel rf8i'::ice-ait5u'dtr?..fe5fd6rEd.i.SrJ-'rtoftf,.l<-tnrtr�ct. !no oblafn I -full r�tt.,}o of any d pa> g you P h k sYflfun 72 hou 5 if Brent ;n the contract. If u i tb� o 1, j4and casual Y mai rQ"Cd vat��n it nour�.tittb, you r -c lva 1'1rtt4n nat(ce from the p , your eiaim er hipttrrtaf') StbtW-Rgrjiigg lae:ts enutfed to retain ney-epts ordaposd tocompensate tarn footing work wcpns slabs wAhstanifasd'sr oflr� trade try PIaeN s > Mauniafn Sirkas Reefing. lnc cannel waive _ o r _ waive of t?aY. eapp-=hle,0.#* tnsdnn cs ci, rn for payment forrpayng wasrR n your prope�#y' Mountein'618tes Raofimg tnc wilC " in.any work tun right kjt'te.� a�ioil is?nod(s} kiarc ltptn� Afl wodt+ata bk,ronl ,etea fna vtadkmnnfllse manner-ccnrding to stain -rd practices- All interior damdg<ta buildings incurred O days is 'MiiaF d that try rir sag to wnwrtts will be the r,,sp omih 'ty of tt:j owner and'ineu insurance company All damage to the g W'C'w2i=d'1oy fie ear ttaafox rXfiBgo-mantr are cnnt],rcga t non 8164 acclgents. or delays beyond our control, t Tyner fire. 7edfHpg'wlli'ua done i;Laad an rfat+}:slgi+ed Out ltmlted is at+alfttbirtjjr of tlJelssrlals and crews. and weather cbndifigns. Til.. ifome�i :. W'auteail.apcouota:-30'-Jays past'dtre. Inadditfan, cgztz ;Anti:d. ret. onahie at ern' sfeeslor collections may be ahaMed on any account upon; completion 3r In the arhatint of 11Y peiaerAvI the contract pine unless it is due to rWm being denied. by. mall,. f7o& je ,A ' 'old sett tc.,,,a pisysicataddressstatsd rt ih5 contract: -or_ - `.tetirrsw. . https://maiI.google.com/mail/u/O/#inbox/15cfabfO2l7e4614?projector=l 1/1 7/5/2017 IMG 6570.JPG pr Claim No. r. Ridge: —'Starter. _�. BILL 12-M SIGNED INTO LAW -6/06/12 NG, OR PROMISING TO PRY,. WAIVE, OR REBATE ALL OF PART OF ANY INSURANCE DEDUCTIBLE R'S PROPERTY ANIS CASUALLY INSURER FOR PAYMENT FOR ROOFING WORK ON THE ISURANCE POLICY I (CRS 18.15.179:5) states that paying, Waiving or rebating a property owner's insurance e following information to appear on all contracts - - and the owner is noted that any damage to .contents will be the responsibility iich occurred while roofing was in progress will be covered by the contractor. given, Mountain States Roofing, Inc. shall hold in trust any payment received from you until Mountain ted a majority of the roofing work on your property. ,d commercial general liability (bodily injury and property damage insurance). A certificate of 'erage and our Insurance contact fnforrz ahQrS can be provided to Customer and is incorporated herein by osit within 72 hours after entering the contract. if you plan to use the proceeds of a property and casualty thin 72 hours after you receive written notice from the property and the casualty insurer that your claim !s entitled to retain payments or deposits to compensate Mountain States Roofing, Inc. for roofing work industry practices. Mountain States Roofing, Inc. cannot pay, waive, rebate, or promise to pay, waive or n for payment for roofing work on your property. Mountain States Roofing, Inc. will not begin any work re expired: tvorkmanlIke, manner according to standard practices. All interior damage to buildings incurred 90 days itents will be the responsibility of the owner and their insurance company. All damage to the building greerrients are contingent upon strives accidents, or delays beyond our control. Owner is to carry fire, 1e signed bit limited to availability of materials and crews, and weather conditions. The home owner due. In addition, costs and reasehabl'e attorney's fees for collections may be charged on any account ellatlon feein the artiourtt of 10 ercernt of the contract price unless it is due to claim being denied. ling, !m by rie elec -nf¢ Transrn ss'ion i inited States Mall, postage :prepaid, sent to .the physical address stated in the contract; +ot offecti a upon delivery i V;i https://mai1.google.com/mail/u/0/#inbox/I5cfabfO2l 7e4614?projector=l 1 /1 IIan, I l,,( n ACORff CERTIFICATE OF LIABILITY IMUIRANCE DATE(MM/DD/YYYY) ll%� 7/3/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Judy Graham LAKESIDE INSURANCE CENTER, LLC PHONE(303)421-8590 FAX AIC No:(303)531-5433 7728 Vance Drive E-MAIL ADDRESS: certs@lakeside- insurance. com, INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ 5,000 ARVADA CO 80003 INSURERA:PeleuS Insurance Co. 34118 INSURED INSURERB:Travelers Casualty Insurance 19046 Kudu Roofing, LLC INSURERC:FirSt Mercury Insurance Company 2709 W Belleview Avenue INSURERD:Pinnacol Assurance Company 41190 Suite B INSURER E: Littleton CO 80123 INSURER F: I.IJ V!•KOl�P1 I.FK I IF 1!'D � F NIIM QGO•1 /— 1 M A 1 h9 vQ n C�a�fiaT �G�/Il�lI1�1 X11 I��e��e�_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF MM/DD1YYYY) POLICY EXP I (MMIDDNYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GLOO1872500 7/1/2017 7/1/2018 ,000,000 EACH OCCURRENCE $ 1,000,000' DAMA E O R TE 50,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 0 JET - LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Additional Insd Completed $ B AUTOMOBILE X X LABILITY ANY AUTO ALL AUTOS OWNED SCHEDAUTOSULED HIRED AUTOS j( NON -OWNED AUTOS RAfiJ030847 7/1/2017 7/1/2018 Ea aBBINEDISINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Medical payments $ 5,000 C X UMBRELLA LIABX EXCESS LAB OCCUR CLAIMS -MADE CAEX000007369801 i 7/1/2017 7/1/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X I RETENTION 0 $ D WORKERS AND EMPLO ERS' L ABII ITY Y / NN ANY PROPRIETOR/PARTNER/EXECUYI T . OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) ti yes, describe under DESCRIPTION OF OPERATIONS below N / A 9094954 'i 7/1/2017 � 7/1/2018 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) 1.A171..CLLA 1IUM (303)237-8929 City of Wheat Ridge Building & Inspection Service Division 7500 W. 29th Ave. Wheat Ridge, CO 80033 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael McCarron/JUDY -may �� z (9 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1NS025 /gnrdm � E $ 0 c f 3 3 CL o \ z § ° � � o=� %�� . E) 3 -Z \3 ? >0 §2 0 fo ? %3 So / k C; _ a 2 Q C ■ : \§ / 0 \D 7 ] . _ . ■ \} (0 (� CL c . 0 n � \ / §D « p\ a z 0 % \# Cr § n ■ ± / / / § Z E c \ . j [ §CD 0 < CP , ƒ§ \ } } FOR OFFICE USE ONLY City of gate: CCS iMUNrr' EvEtoi'hAENT plarilpermit # Buitctfrtg & Inspection ,Services Division 7509 W, 2e Ave., Wheat Midge, CO 80033 Plan Review Office: 303.235-2855 * Fax: 303-237-8929 Inspection Line; 303-234-5933 Email. permitspci.wheatridge.co.us Building er it Application please complete all highlighted areas on both sides of this,form. incomplete applications tr not be processed, Property Address. Property Owner {`please erinL) X�Phone: Property leer Email: Mailing Address: if different than property address) Address: City, Mete, i Arch tectlE in r malls Phone: Contractor: L, L Contractors City License k4 Contra forE-mail Address: L - i ' Qlrk V-) d)f � Sub Contractors: Electrical:luibin Mechanical: WR City License # W.F . City License # W.R. City license # Other City Licensed Sub; {ether City Licensed Sub: City License # City License # Complete all information on BOTH sides of this form COMMERCIAL *-RESIDENTIAL ► rt ti al cifwork: (Check all that apply) NEW COMMERCIAL STRUCTURE ELECTRICAL SERVICE UPGRADE NEW RESIDENTIAL STRUCTURE COMMERCIAL ROOFING COMMERCIAL ADDITION RESIDENTIAL ROOFING RESDENTIAL ADDITION WINDOW REPLACEMENT COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT rLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ELECTRICAL SYSTEM/APPLIANCE REPAIR, or REPLACEMENT icauc car maiertais to ram usec, e.j 0-4/ m, Hk, r Sq, FULl= Btu's Gallons Amps Squares Other GSW City of Oma Mile, f`k CO • R Ofte: 30$235-2M * Far. 303-2374929 Ir"Oebon Lk*. 303434-M Ry: t.. # h t a f M Building Permit Application Iit=-Yr #:..i:: + i f # ♦ ♦:.. ♦ I W IF t: E-mail: phone, f • ': f � •� : i .call � # :. WIN Sub M EkK «.bftMlkei. W.R. City #.# W.R. City L WL CAy p M. Y Complete all Information on BOTH sides of this form COMMERCIALNEW -SERVICE UPGRADE 3 NEW. OMME_ ROOFING • • s STRUCTURE re •WINDOW REPLACEMENT RESIDENTIAL ROOFINGSTRUCTURE n REPAIR or fitfiLACtMENT REPAIR or REPLACMENT It ELECTRICAL SYSTEMIAPPLLANCE REPAIR or REPLACEMENT is e►IER r R #w - h## a # ss o ty of, h6 - C W COMMUNrry DEVELOPMENT Property Address* Propetty Owner Einall. Address: goohkWE.ma I Add M-Mall City License # I i I I 1111 11, lill�� Plumbing: -I- A, kxx% "It, it' Ilk -A;0 %A.7X�o %�.Al 10 A4 I Do ft. al �qll(� PISNP&MIt QMM�� Complete all information on BOTH sides of this form NEW COMMERCIAL STRUCTURE ELECTRICAL SEROVICE UPGRADE NEW RESIDENTIAL STRUCTURE 5COMMERCIAL ROFING COMMERCIAL ADDITION RESIDENTIAL ROOFING RESDENTIAL ADDITION B WINDOW REPLACEMENT COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ELECTRICAL SYSTEMIAPPLIANCE REPAIR or REPLACEMENT OTHER (Describe) reACCA--o- fy,\ vv:yj Y" A 3 c (r SqFtA.F Stu's Galtons s"— OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT 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, casements 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 applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the le, al owner of the property to perform the described work- and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I. the applicant :fear this building permit application, warrant the truthfulness of the infortnation provided on the application. ,'gr AUTHORIZED REPRESENIAT) of IVE(OWNER) (CONTRACTOR) CONTRACTOR)' ( CIRCLE ONE: (OWNER) <(6' ftMgk.&Nhn (fimt and hwt name): DATE: FOR OFFICE USE ONLY „ � 1 City o tat: tf �_ "jg Building & Inspection Services Division 7500 W. 2e Ave., Wheat Fridge, CO 80033 Marr Review Fee: Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email:emits ci wheatrid e.co.0 BuildingPermit Application Please complete sr1 highlighted areas on both sues of this form. IntompleteaWleations may not be pro sect. Property Address.- � . _ �,. 7- PropertyOwner jplaa ,pfint): .y . - Phone: Property Owner Email.- ding Address: (if different than property address) Address: City, state, i Archite Engin r E-mail*- Phare. Contractor: �4 e Contractors City License M. � � _ � Phone.. Contractor E,.mall Address. 1594 Stub Contractors: Electrical; plumbing ie W.R. City License ## W.R. City License ## W.R. City License # Other City LicensedSub- tither City Licensed Sub; City License # City License Complete plete ail information on BOTH sides of this form to � i 1 111 r r- Y Y Y •711 1 s 7► }, r� 1►.. 111 ;� 77r p1 t i1 • i 77Y • Y • � M s Y k y�, w 1 Sq. FULL F Stu's .� Gallons Amps Squares Other A I CITY OF WHEAT RIDGE , Building Inspection Division / (303) 234 -5933 Inspection line (303) 235 -2855 Office - (303) 235 -2857 Fax INSPECTION NOTICE Inspection Type: /, kj- e Job Address /Permit Number: - ❑ No one available for inspection: Time A } Re- Inspection required: 'Yes When corrections have been made, call for r - inspection at 303 - 234 -5933 g i Date: -d }'f Inspector: p DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 2345933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: Nom& Te v� Job Address: 39oS %anr� Permit Number: 1N PG ✓n LAG/ Ida //Y 1_Yf1isA i bb/L79vew i , No one available for inspection: Time Re- Inspection required: Yes No When corrections have been made, calf for re inspection at 303 - 2345933 Date: 12 -ice Inspector: ,PI 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: rR V (V, iZp0(- Job Address: 205 00ORF _ Permit Number: Gu}IGl52 /✓fS~Ad~.~i7 deG?r ~(2d~ fl ~o JC~~Pl~ G.~~ T/~ .S'/UO U7 - i No one available for inspection: Time L/O AM/F Re-Inspection required: Yes, No When corrections have been made, call for re-inspection at 303-234-5933 Date: :1- o9 Inspector:( DO NOT REMOVE THIS NOTICE veu aVa FJ! a>e> ~a3 "8, ny wau1/002 . ti. - :•i~.. ;.ter': ?s:~NLS' 'Gill - •:'+sssgxu;,: ~:.n9 ,03'x, - 09 ~ B CITY OF WHEAT RIDGE 03/11/10 7:53 AM edbb Andrea N. Reitzel RECEIPT NO:CDB004104 AMOUNT DPSP Reroof 13.62 sqs 90.5; 091952 Extend Expired Permi 30,55 PAYMENT RECEIVED AMOUNT VS 1602 9@.55 Auth Code: 005246 TOTAL 30.55 13 f'V./.!-mow ir' ~ya`R•".. w`d'.: P Law ~o k )T . S 9 /rte 1 40 EIT1 OF UNEA1"RIDGE Y rc o ~r.~C~ 0 3 X3309 lay wee ` YB/10 1 kBPMed6a Irxx;N Rar.tzel fik:`ia'ai~03786 .Ar00hIT U'`Resaaf 13.b2 sqs 6l.BB 091S5$ XHT: RECEIVED AMOUNT REQU~kA MUST BE Cqty9Y0 M GCItNJHdteFOR INSPECTION THE FOLLOWING BUSINESS DAY. ~.r Faxed Roof Permit PERMIT - 091952 PERMIT NO: 091952 ISSUED:- 09./03/2009 - JOB ADDRESS: 3905 MOORE ST ;EXPIRES: 03/02/2010 DESCRIPTION:. Reroof 13.62 sqs CONTACTS owner 720/297-6419 Angel Foster sub 303/733-7663 John E. Hopper 09-0140 ist'Choice Roofing" **:PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION:- 0207: BLOCK/LOT#: 0./ FEE SUMMARY ESTIMATED PROJECT: VALUATION: 6,032.52 FEES Permit Fee 181.10 Total Valuation .00 e~ t Use Tax 108.59 d kte 4 TOTAL 289.69 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 than a 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield required from'eave edge to 2' insideexterior walls.` Subject to field inspection.. 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 (I.B.C) and all other: a9~Pi~lirrcable Wheat i,dnge Ordinances, for work under this permit. Plans subject to field inspection. ' ( x) ~ { -iklll signature of contractor/owner date 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 '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 maybe granted at the discretion of the Building: Official. 3. If this permit. expires, a new permit may beacquired 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 have been 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 adrainage problem. S. Contractor shall notify the Building inspector twenty-four (24) hours in advance for all inspections and shall receive 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 approval of, any violation of the provisions of the building codes or any other ordinance, law,. rule or regulation. All plan review 's 3. ect to field inspections. Signature of C 'e ilding Official 'date 61 INSPECTIO REQUEST LINE: (303)234-5933 BUILDING. OFFICE.: (303)235-2855 REQUESTS MUST BE MADE BY': 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. i Call by 3 00-PM to receive inspection the following business day. x INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB , FOUNDATION INSPECTIONS DATE . INSPECTOR (NITIALS COMMENTS otings/Caissons wall / (CEG) Concrete t ern F - E n cased G round - - Reinforcing or Monolithic Weatherproof/ French Drain Sewer Service Lines Water Service Lines POUR NO CONCRETE UNTIL ASOVE.HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) ' -"DO NOT POUR FLOOR UNTIL ABOVE 'HAS BEENSIGNED ROUGHS Sheathing Lath /Wall fie Mid-Roof Electrical Service k Rough Electric z. Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TO BE;SIGNED PRIOR TOP(OCEEDING Framing Insulation Drywall'Screw Y; - FINALS ' Electrical Plumbing Mechanical' CITY OF WHEAT RIDGE 09/03/69 7.39 AM edba Root Andrea N Reitzel Building Final , _ = R RECEIPT NO.CDA602284 Fi D t t AMOUNT R re epar me LR5P Re-roof I3.62 eq> 289.69 ' _ ROW & Dralrag7NSPEe' ~d 091952 Permit Fee 181 16 F Parking & Landscaping;' ~SHOUL vALi Use Tax - . 108.59 ' NOTE: FILL ITEMS MUST`,BE 65,, LETED AND APPROVED 8YPt:ANNlN6 A PAYMENT RECEIVED AMOUNT 'C<E'RTlFICATE OF QC6UPANCX%i-ISSfIED, FINAL INSPECTION BY;THE U// $_D/N6 V5 1602 289.69 R P'ERM' lS,S4 Auth Code. ' - OF A CERTIFICATE OF OCCUPANGI'~NO , 011965 OC,tyUPANCY NOT'PERMITTED UNTIL CERTIFICA TOTAL 289.69 PROTECT THI.s CARD FROM THE r City of Date: G'~/4 ~ba JAI, le & t WE lthtt+UmTYDegLOPMENT Permit#:ogjq~-~ W. 9 Ave., Wheat Ridge, O 8 33 Office: :303-235-2855 Fax: 303-237-8929 Inspection Line: 303-234-5933 Facsimile Building Permit Application Property Owner (please print)_~y~~e~,®QJr-I,~l~-~ Mailing Address: (indifferent than p Address party address) : City, State, Zip: Contractor License Phone_ Use of s ace descri tion): oae"S &V cl~k ogw~'e ~U fan Review (due at time of submirtag: $ . Ft./L-Ft _added: STU's Gallons Amps OWNERtcoNTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT rules 1 or hereby regu egultarybthaons. that of the the setback distances pproposad by this permit aPPlI ation are Accurate, and do not violate applicable ordinances, City of Wheat.Rldge or covenants, easements or restrictions of record; that all measurements shown,.and allegations made are accurate: that L have read and roe to abide by all conditions printed an this application and that I assume full responrthis fSjh5 q permfor i rmlt plans compliance with the Wheat Ridge Building Code (I,B.C) and all other applicable Wheat Ridge Ordihanoe i, for work' unde subject fo•frera Inspection. CIRLCE ONE: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIVE of (OWNER) (CONTRATOI~ PRINT NAME: SIGNATURE: Date Bldg Valuation: $ Credit Card Payment: lJ e.1Fredlt card fisted on file. Print name. IN/( Signatures' h~OF WHEqrq~o COMMUNITY DEVELOPMENT DEPT. a m Inspection Services Division (303) 235-2855 ~otoRpo° Correction Notice Job Address: d5- m 00 Y'-Q- .~v ncTt- d. Y. U \ c., +J U Y' ~ When corrections have been made, call for re-inspection at 303-234-5933. A ~ DO NOT REMOVE THIS NOTICE L~, t'rA 4JC COMMUNITY DEVELOPMENT DEPT. In~Nection Services Division (303) 235-2855 e otoCorrection Notice Job Address: ~1 c. - i ~ r YY^, t~ i yN F" When corrections have been made, call for re-inspection at 303-234-5933. r' ~ N\ ~ A t l ~ DO NOT REMOVE THIS NOTICE ~ ) ~ ; • ~ i'AMKUW Elrte CilasF•Seal ~ cOaeeEacwl-rRODucrs REsoMULLPacoucrs cEM9+rsac0Atrr•:vHOOUCT5 vute+wRWfMwt~c's ~ woaro raOoorrs RESt11811'PIAL PBODOCTS ELITE GLASS-SEALJ Stylish, long-lasting 3-tab fiberglass shingles Our highest-quality 3-tab shingles will9ive you years of maintenance-free protection with style. Featuring durable fiberglass construction, these popular shingles provide economical, reliable roofing protection as well as fire and wind resistance. Their traditionai selfsealing square-tab design also creates a smooth, crisp appearance thafs attractive on any roof. . Made with TAMKO's own fiberglass mat, our shingles are the highest- quality fiberglass 3-tab shingles available. . Elite Glass-Seal is backed by a 25-year limited product warranty • Variety of colors to complement any combination of building materials: wood, stone, brick or stucco. • Certification: Undervoriters Laboratories: Wind Resistant, Class A Fire Resistant; ASTM Spec: D3462, D3018 Type I, D3161 Type I, E108 Class A; Fed. Spec: Exceeds SS-S-001534 Class A, Type 1, ICC-ES Legacy Report ER-5375 Additional Joplin Certification: ASTM D3161 Type I modified to 110 mph Produced at: Joplin, Missouri - Phillipsburg, Kansas Coloes Prodticed ira Jop9in, P01issouri: Antique Slate Empire Green Blend Grey Blend Oxford Grey Pastel Brown Pastel Green Pastel Red Rustic Black Rustic Cedar Rustic Hickory Rustic Slate Tile Red Blend Tweed Blend Weathered Wood White View Colors (2 MEG) GoVors Peociuceat irl F'hiflipsbuPg, Kansas: Antique Slate Empire Green Blend Grey Blend Pastel Green Pastel Red Rustic Black Rustic Brown Rustic Cedar Tile Red Blend Tweed Blend Sand Pebble Weathered Wood White http://www.tamko.coxn/residentiaUshingles/3/eli-g-seal.htm 10/20/2004 COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Number : 17887 BUILDING INSPECTION LINE -(303-234-5933) Date : 10/14/2004 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80033 - (303-235-2855) Property Owner: DON & MARNIE ROLLINS Property Address : 3905 MOORE ST Phone : 274-5688 Contractor License No. : 18538 Company : Blue Lake Const. Phone : 422-2625 OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Valuation : $3,200.00 1 hereby certify that the setback distances proposed by this permit application are accurate, and Permit Fee : $126.50 do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or 0 00 covenants, easements or restrictions of record; that all measurements shown, and allegations Plan Review Fee : . $ made are accurate; that I have read and agree to abide by all conditions printed on this Use Tax : $38.40 applicalion, and that I assume full responsibility for compliance with the W heat Ridge Buildinq Code (U.B.C.) and all other applicable W heal Ridge ordinances, for work under this permit. Total: $164.90 (OWNER)(CONTRACTOR)SIGNED - DATE/O-~LN-Dy Use: CC-~ "I`~{ Z~~ ~ Description : 20 SQ. 3-TAB. 9 SQ. ODIFIED BIT (TORCH-ON). TEA R OFF TO DECKING NEW 28# FIBERGLASS BASE FOR TORCH-ON & NEW 30# TO ROOF (3-TAB) NEW 2}A,QRIP EDGE. Z:7t~v BUILDING DEPARTMENT USE ONLY ~ di-a-7 Zoning CommBRt$:i SIC : Sq. Ft. : Approval : Documents from the manufactvYer' .rhall be Zoning : onsite for final roof insPection which specify Bu41~Cng ~qtiirri~en~s:; roofirrg materials have been insta~le BC e 110 MPH three-secn►ut wind 8w' (90 Approval : mpHwind load-UBC)• Public Works Comments:` Approval : Occupancy : Walls : Roof : Stories : Residential Units : Electrical License No : Plumbing License No : Mechanical License No : Company: Company: Company: Expiration Date : Expiration Date : Expiration Date : Approval : Approval : Approval : (1) This permit was issued in acwrdance with the provisions set foAh in yopur application and is subject to the laws of the Slale of Colorado and ta the Zoning Regulafions and Building Cotle of Wheat Ridge, Colorado or any other applicable ordinances of the City. (2) This permit shall eapire if (A) the work authorized is not commence0 within sizty (60) dayslrom issue date or (B) 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 specifcations and any suspension or abandonment has not exceeded one (1) year. If changes are made or if suspension or abandonment exceeds one (1) year, fu0 fees shall be paid for a new pertnit. (4) No work of any manner shall be done that will change the naNral Flow of water causing a dreinage problam. (5) Contractor shall notify the Building Inspeclor N+enty-four (24) hours in advance for all inspections and shall receive written approval on inspection card Oefore proceediing with successive phases o( the job. (s) The issuance o( mit or the apprevalof drawings and specifcations shall not be construed to be a permit for, nor an approval of, any violation of the pmvision Idin e7es or any other oMinance, law, rule or regulation. _ Chief Building Inspector Please sign Terms and Conditions on reverse side of page. W~Eq COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Number: oF 'q BUILDING INSPECTION LINE • 303-234-5933 Date: = g CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80033 - (303-235-2855) ~°`°R"°~ APPLICATION Property Owner: >nN t YHhs2i~i 5 2oc<.ou-, 2-7 1 -y(o $S PropertyAddress: 3~(O`~j ~7~•~= S%- Phone:30'+-49~W- Contractor License No.: ! f3 3J3 Company: &60Si`_ Phone:,?,o3-y22--26'L$ OWNER/CONTRACTOR SIGNANRE OF UNDERSTAND7NG AND AGREEMENT I hereby certify ihat the setback distances DroPosed by ihis pertnit aDG~icalion are accurate, and do not violate applicable ordinances, rules or regulatlons oi the Ciry ot Wheat Ridge or covenants, eauments or restrictions of record; ihat all measurements shown, and allegations made are accurate; that I have read and agree to abide by all conditions pnnted on Nis apPlicaUon and that I assume full responsibility for compliance wiM Me Wheat Ridge Builtling Code (U.B.C) anC all other applicable Wheat Ridge Ortlinances, for work under fhis permit. (OWNERNCONTRAGTOR) Value:$ ~752c~)-O' Permit Fee:S Plan Review Fee:$ Use Tax~$ Total:$ Description: 0 5~ 3 -'i A6 q sq M oD I F i E-21) 9 . 7- (n'/krt b~') TEA-R.- o F~ ro D c-c.rli,vc' /I/Gw 2 gIriar.LfiY (v tA55 .KiFs.~ t n~t : a/loif m✓ af-- N67u 3~190 7'0 Sq.Ft.added Expiration Date: Expiration Date: Expiration Date: Approval: Approval: Approval: (1) This permil was issued in acmrdance with the provisions set toAh in your applicalion and is subject to the laws of the State of Cobrado arW W the Zoning RepulaGOns and Buildinp Cotles of W heat Ridge. Colorado or any other applicabie ordinances of the Ciry. (2) This permit shall expire if (A) the work aufhorizetl is not commencetl within sixty (60) days 6om issue date w(B) the building auNorized is suspended or abandoned fa a period of 120 daya. (3) IF Mis pertnd expires, a new pertnil may be acQuired fw a tee of one-halt the amount normally reQuired, provided no changes have been or will be maAe in the original plans and spetlfications anA any suspension or abandonment has not exceeded one (1) ypar. If changes have been or if Suspension or abandonment exceetls one (1) year, tull fee5 5ha11 be paid for a new permiL (4) No work ot any manner shall De Cone Ihat will change the naWral flow ot water causing a drainage problem. (5) Contrador shall notify the Buildinp Inspedw twrenty-tour (24) hours in advance for all inspections and shall receive written approval on inspaction qrd betore proceedinp witli suxessive phases of the job. (6) The issuance of a pertnit w the approval of 02wirqs and spedfiptions shalt not be consWed to be a permii for, nor an approval of, any vialation ol the provisions oi the building codes a any other ordinance, Iaw, rule w regulation. Chief Building Official Electrical License No: Plumbing License No: Mechanical License No: Company: Company: Company: