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HomeMy WebLinkAbout3485 Miller Street20/703 z 6I 3Tb�VW11(rsfi INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Occupancy/Type P�� 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 Initials Comments Pier Concrete Encased Ground (CEG) Mid -Roof Q t7 Foundation/ P.E. Letter Floodplain Inspection (if applicable) Lath / Wall Tie Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground/Slab Inspections Date Inspector Comments Initials Electrical Sewer Service Plumbing Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections Rough Inspections Date Inspector Initials Comments Wall Sheathing 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. Mid -Roof Q t7 pl 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 Alk riSSQCcr U r,/l y,c, Final Mechanical 0 PA9 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. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather Property Address Permit Number Permit Issued Date The City of Wheat Ridge Third Party Form 3 y 2Q l70 _ -715 1 zo f 1 Owner Information Property Owner Information Property Owner Address `3 Lf 2s: M l LLr&-e S'F_ Inspector Information Inspection Company Construction Support Services, inc Inspector Name Richard Boon Inspector Contact info. 303-221-1559 Inspector Statement and Acknowledgement I hearby acknowledge the roof I am inspecting is 6/12 or over all roofs that are under 6/12 must be inspected by the City of Wheat Ridge Buiding Dept. * I hearby acknowledge the roofing system for the referenced building has been insl and found to be in compliance with the minimum requirements of the 2012 IRC and IBC as well as all City of Wheat Roo Policies and Procedure and Manufacturer's recommendations and specif on . Inspector: Richard A. P. Date: F' 1'_/ )- Property Owner Statement of Acknowledgement *1 hearby acknowledge that I am the owner of the building referenced above and I g my consent for the listed third -party inspection company to perform my roof inspecti in lieu of the City of Wheat Ridge Building Division inspection. Propery Owner/ Agent: Date: This original document as well as the roofing check list, must be submitted to the CI Building Offical within seven days of the final inspection. Drop off in person Permit counter 2nd floor 7500 W. 29th Ave Wheat Ridge CO 80033 Drafted Date: 7/26/17 Submit via Email Kcook(cD,ci.wheatridge.co.us Please add note to reverse side The City of Wheat Ridge Inspection Check List notes Mid -Roof Property Address 3 Permit Number Permit Issued Date Roof Inspection Pass FAIL Date of Inspection: 8-2-17 Structural roof components x Verify that no more than 2 layers of shingles exist x Flashing for roof and walls If new sheathing is installed verify that it is listed in the permit description (Valuation must be adjusted) Verify sheathing nail pattern ( See policy & Proceedures) x Crickets and saddles where needed x Verify B vent must have boot same gauge as pipe x Verify vent caps x Verify no flashings are damaged or rusted x Step flashing shall be min. of 8x8 piece per shingle Verify scuppers allow for proper drainage x Ice and water shield 2' in heated wall spaces x Underlayments must follow 2012 IRC / 2012 IBC x Verify roof slope for proper drainage x Dripedge shall have min of 2" overlap x Dripedge should extend down min 2" past roof deck x Dripedge shall be mechanicaly fastened 12" OC 90 LB roll roofing shall not be applied to roof slopes less than 2:12 slope: Exception, detached garages, patios, carports, open on three sides with min. slope of 1:12 Modified Bitumen, EPDM, TPO min slope 1/4:12 slope Above roof insulation R-25 NOTES Company Construction Support Se Inspector signature: 1 The City of Wheat Ridge Inspection Check List notes Final Roof Property Address ems 5� Permit Number Permit Issue Date Roof Inspection Pass Fail N( Structural roof components Y Verify that no more than 2 layers of shingles exist Flashing for roof and walls If new sheathing is installed verify that it is listed in the permit description (Valuation must be adjusted) Verify sheahing nail pattern ( See policy & Proceedures) Crickets and saddles where needed Verify B vent must have boot same gauge as pipe Verify vent caps Verify no flashings are damaged or rusted Step flashing shall be min. of 4x4 piece per shingle Verify scuppers allow for proper drainage �o Ice and water shield 2' in heated wall spaces Underlayments must follow 2012 IRC / 2012 IBC Verify roof slope for proper drainage Dripedge shall have min of 2" overlap Dripedge should extend down min 2" past roof deck Dripedge shall be mechanicaly fastened 12" OC 90 LB roll roofing shall not be applied to roof slopes less than 2:12 slope: Exception, detached garages, patios, carports, open on three sides with min. slope of 1:12 Modified Bitumen, EPDM, TPO min slope 1/4:12 slope Above roof insulation R-25 Below roof residential R-38 Below roof commercial R-32 Notes Ir 0 Company Name: 6 9 e Inspector signature: Date of Inspection: / 1 ems; i CITY OF WHEAT RIDGE :�9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office - (303) 237-8929 Fax ZU INSPECTION NOTICE i- 1 D 1 f Inspection Type: U Job Address: Permit Number: lU o A -N -5 w z a ► Da 62 v .1) P p ) P k-� L M d ,� u K IU ,4 l ❑ No one available for inspection: Time ° �Apm Re -Inspection required Yes No < - f, C When corrections have been made, call for re -inspection at 303-234-5933 Dater- &,� ( / �) Inspecto q4� �, DO NOT REMOVE THIS NOTICE V City of Wheat Ridge Residential Roofing PERMIT - 201703261 PERMIT NO: 201703261 ISSUED: 07/05/2017 JOB ADDRESS: 3485 Miller ST EXPIRES: 07/05/2018 JOB DESCRIPTION: Residential Re -roof to install Lifetime CertainTeed Northgate Max Def Weathered Wood asphalt shingles - 34 sq. *** CONTACTS *** OWNER (303)233-1848 CASSA KAREN SUB (303)663-5615 Joel/Channa Speckman 080141 All In One Contractors *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 15,045.85 FEES Total Valuation 0.00 ' Use Tax 315.96 Permit Fee 299.40 ** TOTAL ** 615.36 *** 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. a ` City of Wheat Ridge Residential Roofing PERMIT - 201703261 PERMIT NO: 201703261 ISSUED: 07/05/2017 JOB ADDRESS: 3485 Miller ST EXPIRES: 07/05/2018 JOB DESCRIPTION: Residential Re—roof to install Lifetime CertainTeed Northgate Max Def Weathered Wood asphalt shingles — 34 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 this�permit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be performe hat all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER orCONTRA2rmation (Circle one) Date I. This permit was issued bas provided in thepermit 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 maybe subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, anew permit maybe required to be obtained. Issuance of anew 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 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 applicableany ordinan_ cep reg alio 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. Inspection time requests will be accepted by email only. Please email requests to insptimerequestgei.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. Kimberly Cook 7&703Z From: no-reply@ci.wheatridge.co.us Sent: Thursday, June 22, 2017 10:39 AM 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 5 business days, 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. 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 3485 Miller Street Wheat Ridge, CO 80033 Property Owner Name Karen Cassa Property Owner Phone 3032331848 Number Property Owner Email cassa36@comcast.net 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. i nI [41 a I� I I t IIY*C ►7 7 �iI_ epk Contractor Name All In One Contractor's License 080141 Number (for the City of Wheat Ridge) Contractor Phone 8175659922 Number Contractor Email Address verticalorders@gmail.com Retype Contractor Email Address DESCRIPTION OF WORK Are you re -decking the roof? Description of Roofing Material Select Type of Material If "Other" is selected above, describe here: How many squares of the material selected above? Does any portion of the property include a flat roof? verticalorders@gmail.com No Lifetime Certainteed Northgate Max Def Weathered Wood Asphalt Field not completed. 34 No If yes, how many squares Field not completed. on the flat roof? TOTAL SQUARES of all 34 roofing material for this project z i CITY OF WHEAT RIDGE Vr _1�9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: !?n F - Job Address: 3 Y,,�s M iL(�Uf T Permit Number: -Zc:>l-)c) -3Z61 A PP ,zv ED y party - N/o S-7wu c 7 cw '7 U slOC-r S CeV' c S` , IA -C . ❑ No one available for inspection: Time W /PM Re -Inspection required: Yes No When correctionshavebeen made, call for re -inspection at 303-234-593 Date: I ��f -) Inspector:le" DO NOT REMOVE THIS NOTICE Provide additional detail here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract value or cost of ALL materials and labor) House, 4/12 Pitch 5045.8 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 Karen Cassa Email not displaying correctly? View it in your browser. 3 BBB Ratina: A+ Customer Name: Jobsite Address: City, State, Zip George and Karen Cassa 3485 Miller St. Wheat ridge, Co, 80033 Email: Cell Phone: Additional Phone: Cassa36@comcast.net 303.885.0827 Insurance Company: Claim # Agent Name: State Farm 0615676h7 Is this a rental property? If so, address of owner How did you hear about us? Project Manager Referral Brandon Rolan ONE STORY ACCESS ® Yes [3 No PITCH 5/12 TEAR OFF and haul away 1 layers of existing shingles. ® DECKING — Remove and replace decking, as needed, for $50 per sheet extra. ❑ RE -DECK - Remove and replace all decking UNDERLAYMENT - We will install Synthetic underlayment SHINGLES — Certainteed Northgate (Brand & Style) F]INSTALL (yr) 3-TabMaxdef alheRed'00360Cl P1 INSTALL LT (yr) Dimensional (color) Ja RIDGE - M3 -Tab Ridge 0 Matching Hip & Ridge ❑ High Profile Ridge ADDITIONAL ITEMS Detached Garage ❑ Shed [] Patio Covering ❑ Other Install squares of ALUM SEAMLESS GUTTER - See Gutter Diagram & Notes n ANY CURRENT LEAKS? © Yes ®No If so please explain below ANY INTERIOR DAMAGE?[:] Yes ®No If so please explain below (Please provide photos of leaks & Interior damage) ANY AREAS EXCLUDED FROM WARRANTY? ®Yes ®No 0 FLASHING - We will replace flashing as needed. Please describe: 0 VALLEYS & PENETRATIONS — Install ice & water shield. ' •ST - CONSTRITCTION ✓0 PIPES - Install &paint 2 1 112 2 2^ 1 3" _4" lead stacks Clean roof, gutters, and lobsite Q 25 Point Inspection METAL EDGEKeep oro Replace all Gray (color). QCollect Payment Q Haul off excess material Q■ Sweep site with magnet VENTILATION Install 1 Cardinal Solar Power Vents 20 Watt Black IISSUANCE OF _wind turbines 8 low profiles _ power vents _ LF Ridgevent W2 Year Workmanship0 Other WORK ROOFING: Remove and replace entire roof. Northgate IR Remove and replace gutters, linen M UPGRADES: Northgate IR upgrade UPGRADE AMT: 1,400.00 P1 WILL DO JOB FOR INSURANCE PROCEEDS OR r7 CASH CONTRACT AMOUNT $ Original RCV Amount $ 18,184.42 : 'This may not be final contract price and does not include upgrades or any supplements paid by insurance company. ✓ Does the first insurance check need to be signed by the mortgage company? nYES ®NO ® Already Signed ✓ Homeowner has read and understands the 'What to Expect' insert and all pages and terms of this contract? ®YES ® NO Material Placement: Right side Special Instructions: Company's Surety and Liability Insurer Information Insurer: Gemini Insurance Company Address: 7233 East Butherus Drive City, State, Zip Code: Scottsdale, AZ 85260-240 Phone Number: (480) 951-0905 ACCEPTANCE OF TERMS H�WeAC�(ttomer's signature below signifies acceptance of all teLJ" k 6M17 6M17 Customer Signature Date Project Manager Signature Date Page 1 CUSTOMER NAME: George and Karen Cassa GUTTER D IAG RA M Rear JV Left 26 JOB ADDRESS 3485 Miller St. Right L,ono ext¢ns on on front of house needed Front GUTTERS vi 5" 6" DOWNSPOUTS ❑2X3 03X4 COLOR Linen INSURANCE PAID FOR: ®FULL REPLACEMENT PARTIAL REPLACEMENT GUARDS Yes[] Nop GUTTERS & DOWNSPOUTS (TOTAL LF INS. PAID) 196.42 GUTTERS & DOWNSPOUTS (ACTUAL LF - FULL HOUSE) GUTTER LF TO BE SUPPLEMENTED -196.4'2 TOTAL # OF DOWNSPOUTS 1STORY 2STORY INSURANCE PAID PARTIAL, BUT OWNER WANTS FULL & AGREES TO PAY DIFFERENCE IF INSURANCE WILL NOT ❑Yes RN, NOTES: Customer Initials Page 2 All in One noted the following items that were not included in your insurer's repair estimate. 1ff-PAYMENT is due upon roof completion. Amount of 1st PAYMENT $147310.15 $ 3,882.89 "Out of Pocket Expense" included in 1st PAYMENT FINAL PAYMENT is due upon receipt from insurance or 30 days after job completion, whichever is sooner. Amount of FINAL PAYMENT— $ 3,545.21 —1 understand all applicable supplements and/or general contractor overhead & profit paid by insurance company will be owed in addition to this amount. Additional payments sent by insurance for depreciation/supplements will also be due upon receipt. RIGHT OF CANCELLATION PURSUANT TO FEDERAL REGULATION AND COL. REV. STAT. § 5-3-403: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. RIGHT OF CANCELLATION PURSUANT TO COL. REV. ST. § 6-22-104: YOU, THE BUYER, MAY CANCEL THIS AGREEMENT AT ANY TIME WITHIN 72 HOURS AFTER YOU HAVE BEEN NOTIFIED THAT YOUR INSURER HAS DENIED YOUR CLAIM TO PAY FOR THE GOODS AND SERVICES TO BE PROVIDED UNDER THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Company shall hold in trust any payment from Customer until Company has delivered the materials to your property or has performed a majority of the work on the property. By signing this Agreement you agree that you have also been provided notice of this right to cancel orally in addition to the writing contained herein. ACCEPTANCE OF TERMS Customer's signature below signifies acceptance of all terms anAgreement. _ alin"� ` 6/7/17 d dition et fo in is _ 617/17 Customer Signature Date Project Mana er Signature F Date Page 3 DETAILBALANCE 1. IST INSURANCE CHECK (ACV Less Deductible) 10,427.26 2. INITIAL RECOVERABLE DEPRECIATION 4,262.16 3. NON-RECOVERABLE DEPRECIATION – NOT COMPLETING WORK NOT COMPLETING 4. NON-RECOVERABLE DEPRECIATION –ARE COMPLETING INSURANCE SECTION DESCRIPTION OF WORK NOT COMPLETING ITEM #'s NOT ACV NOT DEP NOT Front Elevation Paint garage, clean and paint siding 13-15 220.21 0.00 Right Elevation Paint and clean fascia 17-18 5948 0 00 Rear Elevation Clean and paint siding, stain wood fence/gate 20-22 Contract start date: 6/7/17 'Estimated Job Completion Date' shall be on or before 180 days after the 'Contract Start Date' 1 ) Line 7 t 1 Line 8 1ff-PAYMENT is due upon roof completion. Amount of 1st PAYMENT $147310.15 $ 3,882.89 "Out of Pocket Expense" included in 1st PAYMENT FINAL PAYMENT is due upon receipt from insurance or 30 days after job completion, whichever is sooner. Amount of FINAL PAYMENT— $ 3,545.21 —1 understand all applicable supplements and/or general contractor overhead & profit paid by insurance company will be owed in addition to this amount. Additional payments sent by insurance for depreciation/supplements will also be due upon receipt. RIGHT OF CANCELLATION PURSUANT TO FEDERAL REGULATION AND COL. REV. STAT. § 5-3-403: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. RIGHT OF CANCELLATION PURSUANT TO COL. REV. ST. § 6-22-104: YOU, THE BUYER, MAY CANCEL THIS AGREEMENT AT ANY TIME WITHIN 72 HOURS AFTER YOU HAVE BEEN NOTIFIED THAT YOUR INSURER HAS DENIED YOUR CLAIM TO PAY FOR THE GOODS AND SERVICES TO BE PROVIDED UNDER THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Company shall hold in trust any payment from Customer until Company has delivered the materials to your property or has performed a majority of the work on the property. By signing this Agreement you agree that you have also been provided notice of this right to cancel orally in addition to the writing contained herein. ACCEPTANCE OF TERMS Customer's signature below signifies acceptance of all terms anAgreement. _ alin"� ` 6/7/17 d dition et fo in is _ 617/17 Customer Signature Date Project Mana er Signature F Date Page 3 DETAILBALANCE 1. IST INSURANCE CHECK (ACV Less Deductible) 10,427.26 2. INITIAL RECOVERABLE DEPRECIATION 4,262.16 3. NON-RECOVERABLE DEPRECIATION – NOT COMPLETING 4. NON-RECOVERABLE DEPRECIATION –ARE COMPLETING 5. PROPERTY OWNER DEDUCTIBLE 3,495.00 6. UPGRADES / ADDITIONAL WORK 1,400.00 7. WORK NOT COMPLETING (ACV Value) ( ) 8. WORK NOT COMPLETING (Depreciation) ( ) 9. TOTAL OWED TO ALL IN ONE... $ 17,855.36 1ff-PAYMENT is due upon roof completion. Amount of 1st PAYMENT $147310.15 $ 3,882.89 "Out of Pocket Expense" included in 1st PAYMENT FINAL PAYMENT is due upon receipt from insurance or 30 days after job completion, whichever is sooner. Amount of FINAL PAYMENT— $ 3,545.21 —1 understand all applicable supplements and/or general contractor overhead & profit paid by insurance company will be owed in addition to this amount. Additional payments sent by insurance for depreciation/supplements will also be due upon receipt. RIGHT OF CANCELLATION PURSUANT TO FEDERAL REGULATION AND COL. REV. STAT. § 5-3-403: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. RIGHT OF CANCELLATION PURSUANT TO COL. REV. ST. § 6-22-104: YOU, THE BUYER, MAY CANCEL THIS AGREEMENT AT ANY TIME WITHIN 72 HOURS AFTER YOU HAVE BEEN NOTIFIED THAT YOUR INSURER HAS DENIED YOUR CLAIM TO PAY FOR THE GOODS AND SERVICES TO BE PROVIDED UNDER THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Company shall hold in trust any payment from Customer until Company has delivered the materials to your property or has performed a majority of the work on the property. By signing this Agreement you agree that you have also been provided notice of this right to cancel orally in addition to the writing contained herein. ACCEPTANCE OF TERMS Customer's signature below signifies acceptance of all terms anAgreement. _ alin"� ` 6/7/17 d dition et fo in is _ 617/17 Customer Signature Date Project Mana er Signature F Date Page 3 ADDITIONAL TERMS AND CONDITIONS This agreement, including the additional terms and conditions on the reverse side and any agreement executed in writing pursuant thereto (this "Agreement"), is entered into between Storm Operations of America LLC ("Company"), and the property owner(s) or property owner's representative(s) set forth on the opposite side of this Agreement ("Customer'), for the purpose of replacing or repairing Customer's property that was damaged. 1. Approval / General Contractor. Customer hereby certifies that Customer is the owner of the property described herein and authorizes Company to obtain labor and materials to accomplish the replacement or repair in accordance with the Agreement. This Agreement is subject to the credit and pricing approval of Company. Customer acknowledges that Company is a general contractor and as such will be entitled to 10% overhead and 10% profit, as allowed by Customer's insurance company and state standards. 2. Agreed Price. The full amount of all monies as specified by the agreed upon price ("Agreed Price') does not include any extras such as carpentry repairs or other repairs not specified in this Agreement that may be necessary to complete the repair or replacement process as required by local building codes or to cosmetically satisfy Customer. 3. Materials. All materials provided by Company will be standard stock materials, unless otherwise specified, and will match existing materials within reasonable tolerance as to color, texture, design, etc. Notwithstanding the foregoing, other products and materials may be substituted for equivalent products due to availability. Customer understands that there is a 2 -day minimum charge for all drying, water extraction and dehumidification equipment provided by Company. All excess materials remain the property of Company. 4. Access to Property. The prices and terms of Company's estimate and this Agreement are based upon completion of the work during normal working hours, and Customer agrees to provide Company access to Customer's property as required for completion of the work. Customer will be responsible if any interruption of Company's work results from Customer's failure to provide reasonable access or due to the acts or negligence of others not under Company's direction Company shall not be responsible for damages arising from delay due to inclement weather, strikes, fires, accidents, delays in shipments or delivery of materials, or any causes beyond Company's reasonable control. Customer agrees that Customer's telephone, electricity and water will be made available to Company's personnel during the course of the work. Customer will also furnish at its expense, single phase, 220 -volt, 50 -amp electrical service. Company shall not be responsible for protection of Customer's property, except to provide that protection which is specifically called for under the specifications provided by this Agreement. Customer also agrees to remove, store and/or protect personal property during Company's work. Customer will manage and be responsible for protection of vehicles and property exposed to damage by Company's work 5. Job Completion / Past Due Amounts. Job completion shall be the date on which Company's work is substantially finished (as distinguished from the date of Customer's acceptance thereof) or the date of Company's last item of work at the property, whichever is earlier. Customer's failure to make prompt payment shall entitle Company, on forty-eight hours (48) hours' written notice, to stop work The Agreed Price shall be increased by Company's reasonable costs to stop the project and/or resume work In the event Customer chooses not to pay for a part of the work, an individual line item, or a trade, Customer releases Company of its obligations for the performance of that component with regard to the integrity of the building system as a whole. Customer agrees to pay a service charge of 8% per annum or the maximum amount allowed by law, whichever is less, on all balances 30 days or more past due. Customer also agrees to pay for all collection costs, including employee time and expense and all attorneys' fees and costs Company incurs in either collection of and/or protection of its interests in Customer's past due account or performance of this Agreement. 6. Insurance/ Mortgage CompM Customer hereby authorizes its insurance and/or mortgage company listed on the front of this Agreement to pay Company directly for all work and materials provided by Company to accomplish Customer's replacement or repair. Customer further directs its insurer and/or mortgagee to include Company as a payee on all checks or drafts now or hereafter payable for such loss. Company reserves the right to supplement Customer's insurance and/or mortgage company price for increases in the scope of work and/or documented price increases. Customer agrees to allow these supplements to be paid directly to Company. Company makes no representations or warranties regarding Customer's insurance coverage or if Customer's insurer will pay for all or any of the work to be performed by Company under this Agreement. Customer agrees to pay Company in full for all work performed by Company under this Agreement, regardless of Customer's insurance coverage. Customer also agrees to pay Company directly for all amounts, despite depreciation or deductibles, and to also pay for additional work not covered by Customer's insurer and that said amounts must be paid beforejob completion. In the event Customer breaches this Agreement, Customer agrees to pay Company: a) in full, on a time and materials basis, for all work and materials provided by Company as of the date of such breach; and b) a consulting fee equal to 20% of the total cost of work and materials provided by Company as of the date of such breach, which fee represents the industry standard for reasonable profit and overhead and is not a penalty. Company and its authorized representatives are NOT acting as public adjusters. 7. Limited Warranty. A written limited warranty may be offered on workmanship and materials provided pursuant to this Agreement on the terms and conditions reflected in any written limited warranty materials provided at the time of sale. If Company is not paid in full in accordance with this Agreement, all such warranties are null and void. 8. Hazardous Materials / Mold. Nothing contained in this Agreement shall be construed to require Company to determine the presence or absence of any hazardous materials or asbestos -containing materials affecting the property or to require Company to remove or protect such materials. In the event that Company learns of the presence of such materials on Customer's property, Company reserves the right to immediately stop work and negotiate a change order for such additional work as may be required. In addition, this Agreement does not include, unless expressly specified, any mold abatement, removal or cleaning. If mold is found existing on the Customer's property, any cost to abate, remove or clean shall be paid by Customer as an additional cost Any warranty provided herein excludes the cost to abate, remove or clean any mold on Customer's property. 9. Liability. Company is not responsible for damage or loss caused in whole or in part by: the acts or omissions of other parties, trades or contractors; lightning, gale force winds (+50 m.p.h.), hailstorms, ice damage, ice damns (caused by thawing and freezing of ice, water or snow) hurricanes, tornados, floods, earthquakes or other unusual phenomena of the elements; structural settlement; failure, movement, cracking or excess deflection of the roof deck; defects or failure of materials used as a roof substrate over which Company's roofing material is applied; faulty condition of parapet walls, copings, chimneys, skylights, vents, supports or other parts of the building; vapor condensation beneath the roof; penetrations for pitch boxes; erosion, cracking and porosity of mortar and brick; dry rot; stoppage of roof drains and gutters; penetration of the roof from beneath by rising fasteners of any type; inadequate drainage, slope or other conditions beyond the control of Company which cause ponding or standing water, termites or other insects; rodents or other animals; fire; or harmful chemicals, oils, acids and the like that come into contact with Customer's roof and cause a leak or otherwise damage Customer's roof. If Customer's roof fails to maintain a watertight condition because of damage by reason of any of the foregoing, any applicable written limited warranty shall immediately become null and void for the balance of its term. Company accepts no liability to indemnify or hold Customer harmless for claims or damages to persons or property, except to the extent that such damage occurs during performance of Company's work and are the direct result of Company's error or omission. Notwithstanding the foregoing, Company shall not be responsible for damages to any area of the property upon which Company's work has not been completed nor is Company responsible for slight scratching or denting of gutters, oil droplets in driveways, hairline fractures in concrete, damage to flowers or landscaping, or minor broken branches on trees, plants or shrubbery. In no event shall Company be responsible for any type of damage resulting from vibrations, including, but not limited to, interior drywall damage, nail pops or disconnection of chimneys, flues, air ducts, ventilation shafts, exhaust vents, furnace vents or sewer vents. Company is not responsible for damaged electrical, cable, A/C, or plumbing lines installed within 6 inches of the roofline. Customer understands and agrees that Company shall have no responsibility for damages of any kind to persons or property occurring after job completion. 10. Hold Harmless. Customer agrees to hold Company harmless in connection with the work described herein and that Customer's maximum recourse shall be, and Company's maximum liability under this Agreement shall be limited to, the amount Company billed to Customer. Customer understands and acknowledges that Company does not warrant or guarantee previous workmanship or pre-existing materials, nor any materials or labor not originally provided by Company. Company shall not be responsible for latent defects in materials and accessories supplied. Company shall not be responsible for rework required as a result of the acts or errors of others. it. PRE -LIEN NOTICE: COMPANY HEREBY PROVIDES NOTIFICATION THAT ANY PERSON OR COMPANY SUPPLYING LABOR OR MATERIAL FOR THIS IMPROVEMENT TO YOUR PROPERTY MAY FILE A LIEN AGAINST YOUR PROPERTY IF THAT PERSON OR COMPANY IS NOT PAID FOR THE CONTRIBUTIONS. Upon default in payment, alien will be placed on the property and charges will be added from the date of substantial completion at the maximum rate allowed by law. 12. Insurance Deductible. If Customer plans to use the proceeds of an insurance policy to pay for any of the work under this Agreement, Company shall not pay, waive, rebate or promise to pay, waive or rebate all or part of any insurance deductible applicable to the insurance claim for payment for the work under this Agreement 13. Miscellaneous. This Agreement constitutes the entire agreement and understanding of Company and Customer relating to all of the subject matter hereof, and supersedes all prior agreements, arrangements and understandings, written or oral between the parties concerning such subject matter. ANY REPRESENTATION, STATEMENTS, OR OTHER COMMUNICATIONS NOT WRITTEN IN THIS AGREEMENT, OR MADE IN WRITING PURSUANT THERETO, ARE AGREED TO BE INVALID AND NOT RELIED ON BY EITHER PARTY AND DO NOT SURVIVE THE EXECUTION OF THIS AGREEMENT. This Agreement is subject to the laws of the state in which it has been signed and executed. Customer shall not assign this Agreement without the prior written consent of the Company. Other than as permitted herein or as permitted by applicable law, this Agreement cannot be canceled or amended without written mutual agreement of both parties. Company and Customer intend and agree that if a court of competent jurisdiction determines that the scope of any provision of this Agreement is too broad to be enforced as written, the court should reform such provision(s) to such narrower scope as it determines to be enforceable. Company and Customer further agree that if any provision of this Agreement is determined to be unenforceable for any reason, and such provision cannot be reformed by the court as anticipated above, such provision shall be deemed separate and severable and the unenforceability of any such provision shall not invalidate or render unenforceable any of the remaining provisions hereof. THE TERMS IN THIS AGREEMENT ARE SPECIFICALLY AGREED TO AND INCORPORATED HEREIN. Toll Free: 888.794.5226 1 Fax: 888.255.6732 1 www.stormoperations.com CLAIM #: 0615676h7 INSURANCE CO: State Farm INSURED: George and Karen Cassa ADDRESS: 3485 Miller St. cn/STATE/zip: Wheat ridge, Co, 80033 INSURANCE WAIVER AUTHORIZATION AND WAIVER OF CONFIDENTIALITY If insurance is involved in the funding of this Contract in any amount the Customer authorizes and expressly agrees to direct State Farm Insurance Company in writing to pay Storm Operations of America LLC solely and directly for any Services Storm Operations of America LLC furnishes to the Project under this Contract that are covered and funded by Customer's Insurance Company, including any and all supplements and/or supplemental Services additionally covered and funded by Customer's Insurance Company. Therefore, Customer hereby appoints Storm Operations of America LLC as attorney-in-fact, authorizing Storm Operations of America LLC to communicate directly with Customer's Insurance Company to discuss Storm Operations of America LLC's scope of work/ costs for the Services, including, any and all estimates and/or supplements to Storm Operations of America LLC's scope of work/costs for the Services before, during, or after the Project. Customer further appoints Storm Operations of America LLC as attorney-in-fact, authorizing Storm Operations of America LLC to endorse Customer's name on and deposit any and all checks or drafts issued by its Insurance Company to Customer, whether solely or jointly as payment for Storm Operations of America LLC's Services. ACCEPTANCE OF TERMS Customer's signature below signifies acceptance of all terms and conditions set forth in this Agreement SW 6 Cam►, . 6/7/17 Customer Signature Date Page 9 ATTENTION NO VERBAL AGREEMENTS All work we are completing must be 1N WRITING on the contract. CHANGE ORDERS Any changes in scope after a contract is signed must be filled out on a change order. SUPPLEMENTS Sometimes we bill the insurance company for additional money called a supplement. This money will be due to us in addition to the regular contract amount. READ OUR TERMS In circumstances that are beyond our control and not the result of negligence, we wil not be held responsible. Drywall nail pops from vibrations and damage to utility lines placed too close to the roof deck are just a few of these types of examples. 6M17 Customer Signature Date Page 10 4 la sni7 7 Project Manager Signature Date Date: 6/7/17 Attn: Claims Department RE: Selection of Contractor Insured: George and Karen Cassa Claim Number: 0615676h7 Address: 3485 Miller St. Wheat ridge, Co, 80033 To whom it may concern: This letter is to inform you I selected Storm Operations of America LLC as my general contractor of choice to complete repairs to my residence. I have selected Storm Operations of America LLC because they provide an additional layer of supervision over the work instead of relying on the word of a roofing company. In addition, they have agreed to coordinate the work between the various trades to minimize my inconvenience throughout the restoration process. By using a general contractor I am able to avoid wasted time and effort, on my part, in getting prices from several different specialty contractors; and then getting contractors to show up when they are scheduled to bid or do the work. Working with them also saves me the worry of having different specialty contractors taking my deposits without doing the work (a real concern for me), also in determining what to do if I cannot find someone to do the work items for the offered settlement prices. Storm Operations has agreed to bid the work using their subcontractors, including 20% for overhead & profit since they are a General Contractor. Sincerely, S 0, aD E 0 a� a 0 CD 0 0 75 Y Q L 0 78 J 0 N N t L 0 N m _V A� W ,V Y^/ Li r 0 -- CL a 0 a a N T Y U 0 w C 0 ■_ L u r f L 0 4w co " E E o E � � a owe 'E 'b 9E0 r� o2a £=w s� � n E v « o soL Ea 3 o n AeE 3 �3- E t ^ E a -moo o o j 0, ,x oz W � W�SQ F o 0 ¢ o z i 0 o eta„ zo�t; oo=g EtJ a� d o w ooi 0 W r 11 d L E c C E E O A 3 0 o o s> E 3'3 cb E E Q E 9 c o - o m > <E 0— m`oi _qe9 in i cQ e m rg bE a TE .g v E oN _ E m = c t 70 o b e ^ E0. e o E E v E . . . . . . . . . . . . . . . . 3 a -moo o o j 0, ,x oz W � W�SQ F o 0 ¢ o z i 0 o eta„ zo�t; oo=g EtJ a� d o w ooi 0 W r 11 d NOTICE OF CANCELLATION 6/7/17 You may CANCEL this transaction, without any Penalty or Obligation, within THREE BUSINESS DAYS from the above date. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instrument executed by you will be returned within 10 BUSINESS DAYS following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any property delivered to you under this contract or sale, or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the property at the seller's expense and risk. If you do make the property available to the seller and the seller does not pick up such property within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the property without further obligation. If you fail to make the property available to the seller, or if you agree to return the property to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this Cancellation Notice or any other written notice, or send a telegram, to Storm Operations of America LLC at 9830 W. 59`h Place Arvada, CO 80004 NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE ABOVE DATE. I HEREBY CANCEL THIS TRANSACTION. 6/7/17 BUYER'S SIGNATURE DATE George and Karen Cassa BUYER'S PRINTED NAME NOTICE OF CANCELLATION 6/7/17 You may CANCEL this transaction, without any Penalty or Obligation, within THREE BUSINESS DAYS from the above date. If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instrument executed by you will be returned within 10 BUSINESS DAYS following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any property delivered to you under this contract or sale, or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the property at the seller's expense and risk. If you do make the property available to the seller and the seller does not pick up such property within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the property without further obligation. If you fail to make the property available to the seller, or if you agree to return the property to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this Cancellation Notice or any other written notice, or send a telegram, to Storm Operations of America LLC at 9830 W. 59th Place Arvada, CO 80004 NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE ABOVE DATE. I HEREBY CANCEL THIS TRANSACTION. 6/7/17 BUYER'S SIGNATURE DATE George and Karen Cassa BUYER'S PRINTED NAME NOTICE OF CANCELLATION If you are notified by your insurer that all or any part of the claim or Agreement is not a covered loss under the insurance policy, you may cancel the Agreement by mailing, emailing or delivering a signed and dated copy of this cancellation notice or any other written notice to Storm Operations of America LLC at 9830 W. 59'h Place Arvada, CO 80004 any time within 72 hours after you have received such notice from your insurer. Even if you timely deliver this Notice of Cancellation, the contractor may still retain all payments or deposits made by you to compensate contractor for roofing work actually performed in a workmanlike manner consistent with standard roofing industry practices, to an extent necessary to compensate the contractor for the actual work performed. If you cancel, any payments made by you under the Agreement, other than those excepted in the prior sentence, will be returned to you within 10 days following receipt by the contractor of your cancellation notice. I HEREBY CANCEL THIS TRANSACTION. 6/7/17 Date Insured's Signature George and Karen Cassa Insured's Printed Name NOTICE OF CANCELLATION If you are notified by your insurer that all or any part of the claim or Agreement is not a covered loss under the insurance policy, you may cancel the Agreement by mailing, emailing or delivering a signed and dated copy of this cancellation notice or any other written notice to Storm Operations of America LLC at 9830 W. 59`" Place Arvada, CO 80004 any time within 72 hours after you have received such notice from your insurer. Even if you timely deliver this Notice of Cancellation, the contractor may still retain all payments or deposits made by you to compensate contractor for roofing work actually performed in a workmanlike manner consistent with standard roofing industry practices, to an extent necessary to compensate the contractor for the actual work performed. If you cancel, any payments made by you under the Agreement, other than those excepted in the prior sentence, will be returned to you within 10 days following receipt by the contractor of your cancellation notice. I HEREBY CANCEL THIS TRANSACTION. 6/7/17 Date Insured's Signature George and Karen Cassa Insured's Printed Name 06-1 567-6117 cIASSA, GEORGE State Farm State Farm P.O. Box 100169 Atlanta, GA 30348-6169 Fax: 1-844-236-3646 statefarrn fi reclaims (&statefurni.com Structural Damage Claim Policy When you have a covered structural damage claim to your real property, you should know: • We want you to receive quality repair work to resume the damages to your property, • We will provide you with a detailed estimate of the scope of the damage and costs of repairs. Should the contractor you select have questions concerning our esumate, they should contact your claim representative directly. • Depending upon the complexity of your repair, our estimate may or may not include an allowance for general contractor's overhead and profit. If you have questions regarding general contractor's overhead and profit and whether general contractor services are appropriate for your loss, please contact your claim representative before proceeding with repairs. • There may be building codes, ordinances, laws, or regulations that affect the repairs of your property. These items may or may not be covered by your policy. Please contact your claim representative if you have any questions regarding coverage which may be available under your policy. • If you select a contractor whose estimate is the same as or lower than our estimate, based on the same scope of damages, we will pay based upon their estimate. If your contractor's estimate is higher than ours, you should contact your claim representative prior to beginning repairs. • State Farm® cannot authorize any contractor to proceed with work on your property. Repairs should proceed only with your authorization. • State Fann does not guarantee the quality of the workmanship of any contractor or guarantee that the work will be accomplished within any specific time frame. • It is understood that the contractor is hired by you, our insured, and that they work for you - not State Farm. If you have any questions or need additional information regarding your claim, please contact your claim representative immediately. ate: 5/26/2017 9:19 AM 132214.1 06-18-2009 : State,Fartr- Building Estimate Summary Guide This summary guide is based on a sample estimate and is provided for reference only. Please refer to the estimate for specifics of your claim. State Farm Insurance Insured Smith, Joe 8 Jane I>roperty. 1 Main Street Policy Number Anywhere, IL 00000-0004 Type of Loss. Other Deductible: $1,000 00 Estimate: 00-0000-040 Claim number- 00-0000-000 Policy Number 00-00-0000-0 Price List: ILBL8F_MAR 13 Restoration/Service/ Remodel F = Factored In, D = Do Not Apply Summary for Dwelling Lire Item Total1[] Material Sales Tax 10.000% x 1,520.00 Subtotal General Contractor Overhead @ 10.0% x 6,105.10 General Contractor Profit @ 10.0% x 6,105.10 Replacement Cost Value (Induding General Contractor Overhead and Profit 03 Less Depreciation (Including Taxes) Less General Contractor Overhead $ Profit on Recoverable 8 Non - recoverable Depreciation Less Deductible LJ Net Actual Cash Value Payment Maximum Additional Amounts Available If Incurred: Total Line Item Depreciation (Including Taxes),, 832.50 Lose Non - recoverable Depreciation (including Taxes) a7 Subtotal Genual Contractor O&P on Depreciation 166.50 Less General Contractor 08P on Non - recoverable Depreciation Subtotal Total Maximum Additional Amounts Available If Incurred Tota; Amount of Claim If Incurred Claim Representative 312.50 5,953.10 6,105.10 610.51 7,326.12 (832.50) (166.50) ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND LIMITS OF YOUR POLICY, 06-1567-6117 1. Line Item Total - Total value of all line items in the estimate plus possible adjustments for labor minimums. Labor Minimum is to cover a certain minimum number of hours for drive -lime, set up time and applicable administrative costs and repairs 2. General Contractor's Overhead and Profit - General contractor's charge for coordinating your repairs. 3. Replacement Cost Value (RCV) - Estimated cost to repair or replace damaged property. 4. Depreciation - The decrease in the value of property over a period of time due to wear, tear, cond+Gon, and obsolescence A portion or all of this amount may be eligible for replacement cost benefits S. Deductible - The insurer will pay for losses, up to the policy limits, in excess of your applicable deductible. 6. Net Actual Cash Value Payment (ACV) - The repair or replacement cost of the damaged part of the property less depreciation and deductible. 7. Non Recoverable Depreciation - Depreciation applied to items that are not eligible for replacement cost benefits. 8. Total Maximum Additional Amount if Incurred - Total amount of recoverable depredation after actual repair or replacement of the property. 9. Total Amount of Claim if Incurred - Total amount of the claim, including net actual cash value payment and total maximum additional amount available if incurred. 9gUifif 1)"281 t}t- Dau: 5/MO17 9:19 AM �' ,GEORGE Insured: Property: Home: Type of Loss: Deductible: Date of Loss: State Farm 06-1567-6H7 CASSA, GEORGE Estimate: 06-1567-6147 3485 Miller St Claim Number: 0615676147 Wheat Ridge, CO 80033-5656 Policy Number: 06-52-4860-6 303-233-1848 Price List CODE -28 MAY17 Hail Restoration/Scrvice/Remodel $3,495.00 5/8/2017 Summary for Coverage A - Dwelling - 35 Windstorm and Hail Line Item Total Material Sales Tax Replacement Cost Value Less Depreciation (Including Taxes) Less Deductible Net Actual Cash Value Payment Maximum Additional Amounts Available If Incurred: Total Line item Depreciation (Including Taxes) 4.262.16 Replacement Cost Benefits Total Maximum Additional Amount Available If Incurred Total Amount of Claim If Incurred 4,262.16 Best, Mike 866-787-8676 x 1515 ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND LIlMTS OF YOUR POLICY., it: 5nWO17 9:19 AM 17,721.52 462.90 18,184.42 (4,262.16) (3,495.00) S10,427.26 4,262.16 $14,689.42 pa= Name- Address: City: State/Zip: Insured: Date of Loss Explanation of Building Replacement Cost Benefits Homeowner Policy Coverage A - Dwelling - 35 Windstorm and Hail CASSA, GEORGE 3485 Miller St Wheat Ridge CO, 80033-5656 CASSA, GEORGE 5/8/2017 Claim Number: 0615676H7 Cause of Loss: HAIL Your insurance policy provides replacement cost coverage for some or all of the loss or damage to your dwelling or structures. Replacement cost coverage pays the actual and necessary cost of repair or replacement, without a deduction for depreciation, subject to your policy's limit of liability. To receive replacement cost benefits you must: 1. Complete the actual repair or replacement of the damaged part of the property within two years of the date of loss; and 2. Notify us within 30 days after the work has been completed. 3. Confirm completion of repair or replacement, by submitting invoices, receipts or other documentation to your agent or claim office. Until these requirements have been satisfied, our payment(s) to you will be for the actual cash value of the damaged part of the property, which may include a deduction for depreciation. Without waiving the above requirements, we will consider paying replacement cost benefits prior to actual repair or replacement if we determine repair or replacement costs will be incurred because repairs are substantially under way or you present a signed contract acceptable to us. The estimate to repair or replace your damaged property is $18,184.42 . The enclosed claim payment to you of $10,427.26 is for the actual cash value of the damaged property at the time of loss, less any deductible that may apply. We determined the actual cash value by deducting depreciation from the estimated repair or replacement cost. Our estimate details the depreciation applied to your loss. Based on our estimate, the additional amount available to you for replacement cost benefits (recoverable depreciation) is $ 4,262.16 . If you cannot have the repairs completed for the repair/replacement cost estimated, please contact your claim representative prior to beginning repairs. All policy provisions apply to your claim. It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the department of regulatory agencies. ate: 5/26/2017 9:19 AM I-Ct}0116615 11/3/2015 Page. /A,ORGE Roof t State Farm Source - Eagle View Source - Eagle View 3,375.76 Surface Area 310.83 Total Perimeter Length QUANTITY UNIT PRICE TAX 1. Remove Tear off, haul and dispose of comp. shingles - High pro. 33.76 SQ 52.92 0.00 2. Laminated - comp. shingle rfg. - w/ felt 26.67'% r 37.33 SQ 228.48 314.05 3. R&R Exhaust cap - through roof - 6" to 8° 22.86°% 1.00 EA 81.57 2.48 4. R&R Furnace vent - rain cap only, 6" 32.00% 1.00 EA 41.29 1.68 5. Detach & Reset Evaporative cooler - 5200 cfm (114.14) 1.00 EA 550.30 0.00 6. R&R Flue cap 2.00 EA 121.85 13.12 7. R&R Chimney flashing - large (32" x 60") 1.00 EA 443.39 6.63 8. Ice & water shield 973.74 SF 1.65 31.16 9. R&R Drip edge 310.83 LF 2.26 15.91 10. R&R Flashing -pipe jack 5.00 EA . 40.15 2.92 1 I . R&R Roof vent - turtle type - Metal 8.00 EA 57.85 9.22 Totals: Roof Area Totals: Source - Eagle View Date: 5/26/2017 9:19 AM 06-1567-6H7 33.76 Ntunber of Squares 110.64 Total Ridge Length RCV AGE/LIFE DEPREC. ACV CONDITION DEP % 1,786.58 1,786.58 8,843.21 8/30 yrs 26.67'% Avg. 84.05 8/35 yrs 22.86°% Avg. 42.97 8/25 yrs 32.00% Avg. 550.30 256.82 8/18 yrs Avg. 450.02 1,786.58 1,637.83 8/30 yrs 26.67'% Avg. 718.38 8/35 yrs 22.86°% Avg. 203.67 8/35 yrs 32.00% Avg. 472.02 8/35 yrs (114.14) Avg. 397.17 15,045.85 3,260.72 11,785.13 Page: 5 u 1,786.58 (2,358.19) 6,485.02 26.67'% (19.22) 64.83 22.86°% (13.76) 29.21 32.00% (107.89) 550.30 (114.14) 142.68 44,44% 3,260.72 11,785.13 Page: 5 u 450.02 (436.76) 1,201.07 26.67% (164.20) 554.18 22.86% (46.56) 157.11 22.86% (107.89) 364.13 22.86% 3,260.72 11,785.13 Page: 5 u ' State Farm A. GEORGE 06.1567.6H7 557.96 1 xtenor Wall .Area 3,375.76 Surface Area 33.76 Number of Squares 621,66 Total Perimeter Length 110.64 Total Ridge Length Total: Source -Eagle View 397.17 IS,045.BS 3,260.72 11,785.13 Fran Elevation 0.00 SF Walls 0.00 SF Floor 0.00 SF Umg Wall QUANTITY UNIT PRICE 12. R&R Gutter / downspout - aluminum - up to 5" 36.17 LF 5.79 Includes one down spout 13. Paint double garage door opening & trim - 1 coat 1.00 EA 68.99 14. Seal & paint wood siding 69.00 SF 1.05 15. Clean siding -wood 200.00 SF 0.38 Includes garage door and trim Totals: Front Elevation F 0.00 SF Ceiling 0.00 SF Walls & Ceiling 0.00 SF Stam Wall 0.00 LF Floor Pentneter Right Elevation 0.00 LF Cu1. Perimeter TAX RCV AGE/LIFE DEPREC. ACV 0.00 SF Floor CONDITION DEP % 0.00 L.F Floor Perimeter 0.00 SF Long Wall 0.00 LF Ceil. Perimeter 6.02 215.44 8/25 yrs (68.95) 146.49 ACV Avg. 32.00% CONDITION DEP % 0.57 69.56 69.56 2.04 74.49 5.80 207.47 74.49 0.16 76.16 76.16 8.79 435.65 68,95 366.70 Right Elevation 0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls & Ceiling 0.00 SF Floor 0.00 SF Short Wall 0.00 L.F Floor Perimeter 0.00 SF Long Wall 0.00 LF Ceil. Perimeter QUANTITY UNIT PRICE TAX RCV AGE/LIFE DEPREC. ACV CONDITION DEP % 16. R&R Gutter / downspout - aluminum - up to 5" 34.83 LF 5.79 5.80 207.47 8/25 yrs (66.39) 141.08 Avg. 32.00% Includes one down spout 17. Prime & paint exterior fascia - wood, 4% 6 wide 30.00 LF 1.28 0.38 38.78 38.78 18. Clean fascia 30.00 LF 0.69 0.00 20.70 20.70 Totals: Right Elevation Date: 5/26/2017 9:19 AM 6.18 266.95 66.39 200.56 Page: 6 Left ©evation 0.00 SF Walls 0.00 SF Floor 0.00 SF Long Wall QUANTITY UNIT PRICE 0.00 SF Ceiling 0.00 SF Wails A Ceding 0.00 SF Short Wall 0.00 LF Floor Perimeter 0.00 LF Cell, Perimeter TAX RCV AGEAME DEPREC. CONDITION DEP % ACV 23. R&R Gutter / downspout - aluminum - up to 5" 47.17 LF 5.79 7.85 280.96 280.% Totals: Lett Elevation Debris Removal 0.00 SF Walls 0.00 SF Floor 0.00 SF Long Wall QUANTITY UNIT PRICE 7.85 280.% 0.00 SF Ceiling 0.00 SF Short Wall 9.00 280.% 0.00 SF Walls & Ceiling 0.00 LF Floor Perimeter 0.00 LF Ceil. Perimeter TAX RCV AGEILIFE DEPREC. ACV CONDITION DEP % Date: 5/26/2017 9:19 AM Page: 7 ram 0 00 SF Wane ON VC411101 0 W SF wa* A C4ih% 0 OD SF Now 000 0 9It1r1 wa 0 SID I.F Flow FWaskm ov SF IA" wan 0 00 LF Cot, Poswo a► QUANTi?Y Uri!" KI TAX lm"V ACV co 19, It&it Qutm / duwnwm - alumtw4ni - tq 0 76 25 l,P 5,79 1 48ia V23 >1s (14+911) 316.94 Avg. 32W% u►tlude� ! drawn � 20 Clean wd+ng wax! Six 0.38 0.22 193 10 105.10276,00 N)tCb and gsblo 21, Seal & paint woad m4ing 276 W SP 1.168,17 !'i.i1? V 1 S yrs (1 561T)Z) 139 ixi Avg, 553.33% Parch and SW34t 22. Suun -wood tencetW 1.680.00 SP 0.61 21.30 1.046.30 ' VIS yrs (55903) 4118.27 Avg. 53.33% Totals: Rear Rkvatlon 4291 1a1SA6 866.10 1,pJ6 Left ©evation 0.00 SF Walls 0.00 SF Floor 0.00 SF Long Wall QUANTITY UNIT PRICE 0.00 SF Ceiling 0.00 SF Wails A Ceding 0.00 SF Short Wall 0.00 LF Floor Perimeter 0.00 LF Cell, Perimeter TAX RCV AGEAME DEPREC. CONDITION DEP % ACV 23. R&R Gutter / downspout - aluminum - up to 5" 47.17 LF 5.79 7.85 280.96 280.% Totals: Lett Elevation Debris Removal 0.00 SF Walls 0.00 SF Floor 0.00 SF Long Wall QUANTITY UNIT PRICE 7.85 280.% 0.00 SF Ceiling 0.00 SF Short Wall 9.00 280.% 0.00 SF Walls & Ceiling 0.00 LF Floor Perimeter 0.00 LF Ceil. Perimeter TAX RCV AGEILIFE DEPREC. ACV CONDITION DEP % Date: 5/26/2017 9:19 AM Page: 7 State Farm A. G13OR©P 06.1567-6H7 CONTMF.D . Debris Removal QUANTITY UMT PRICE TAX RCV AGF/LIFE DEPREC. ACV CONDITION DEP % 24. Haul debris - per pickup truck load - including dump fees 1.00 EA 131.74 0.00 131 74 131.74 Totals: Debris Removal 0.00 131.74 0.00 131.74 Area Totals: Source - Eagle View 557.96 Exterior Wall Area 3,375.76 Surface Area 33.76 Number of Squares 621.66 Total Perimeter Length t 10.64 Total Ridge l ength Total: Source - Eagle View 462.90 18,076.61 4,262.16 13,814.45 Labor Minimums Applied QUANTITY UNIT PRICE TAX RCV AGFJLIFE DEPREC. ACV CONDITION DEP % 25. Fireplace repair labor minimum 1.00 EA 107.81 0.00 107.81 107.81 Totals: Labor Minimums Applied 0.00 107.81 0.00 107.81 Line Item Totals: 06-1567-6H7 462.90 18,184.42 4,262.16 13,922.26 Grand Total Areas: 557.96 Exterior Wall Area 3,375.76 Surface Area 110.64 Total Ridge Length 33.76 Number of Squares 621.66 Total Perimeter Length 5/26/2017 9:19 AM Page. 8 GEORGE State Farm Recap of Taxes, Overhead and Profit 06.1567-6H7 GC Overhead (0%) GC Profit (0%) Material Sales Tax Manuf. Home Tax Storage Rental Tax Local Food Tax (896) (896) (89fe) (S,Ll6) Line items 0.00 0.00 462.90 0.00 0.00 0.00 TOW 0.00 0.00 462.90 0.00 0.00 am Die: NM017 9:19 AM PW r Date: T 2� U s I r ❑ No one available for inspection:, T' e AM /PM Re- Inspection required: Yes o When corrections have been mad , for - inspection at 303 -234 -5933 p Date: d Insector: �G t ♦ A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234 -5933 Inspection line 0 10 303) 235 -2855 Office • (303) 237 -8929 Fax. INSPECTION NOTICE 104 Inspection Type: aot z 1>l,�� Job Address Permit Number: ,fedf� t/f.�J�r�a21�iF✓ �- ��'u�L � zc,�L- �f'?�-c.v s I r ❑ No one available for inspection:, T' e AM /PM Re- Inspection required: Yes o When corrections have been mad , for - inspection at 303 -234 -5933 p Date: d Insector: �G cv. s ADSC: AN INTERNATIONAL ASSOCIATION , +- OFFOUNOATIONURILLINGCONTRACTORS °r °un.h 5135 Ward Road • Wheat Ridge, Colorado 80033 • Office (303) 423 -6834 / Fax (303) 423 -0603 July 16, 2010 Bob and Karen Cassa 3485 Miller St. Wheat Ridge, CO 80033 Dear Bob and Karen: Ref: 52159 This letter is written to detail our recent steel helical piering installation at your residence. We installed nine HPC -15X piers to support the south crawl space wing. The piers were installed according to the manufacturer's recommendations by certified installers to a depth of 24' with 5,000 ft-lbs. of torque. Please refer to the attached installation record and field sketch for additional details. Underpinning brackets were installed on top of the piers to transfer the loads from the foundation into the helical piers. This underpinning system is rated to an ultimate capacity of 50 kips per pier. The following warranty applies to that area of the foundation underpinned during this operation. The work performed under this agreement is guaranteed for a period of five years against all defects in material and workmanship. If any significant vertical movement of the new steel piers occurs for a period of five years, other than movement caused by earthquake, severe wind, flood, extreme change in the water table, other Acts of God, or any similar man-made condition, D +B Drilling,hro.(D+B) will, at no cost, or expense to you, correct any defect in workmanship or material that may have occurred in order to stabilize such area. THE FOREGOING IS OUR SOLE WARRANTY. ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING WARRANTY OR MERCHANTABILITY AND WARRANTY OF FITNESS FOR PURPOSE ARE EXCLUDED. Your exclusive remedy shall be for Correction of any defect in workmanship and materials, as set forth above. In no event shall you be entitled to consequential damages regardless of whether the claim is based on warranty, contract, tort or otherwise. In no event shall any recovery ever exceed the contract amount. Thank you for contracting with D +B Engineering Contractors. "'A7 2 O y � D m 5 m z o o o z z m m A A 0 z O ' O Z 0 n y rT y Z n o�-OO m W y y T Dym o o� 0 c am? > y n a yZO W, 4 U M 2 m wAmo N M EM 5n3Z o ' o m yX r y A D_ y A V v N T (O W V Ol (r A W N A w 0 k N 41 m 0 X N N m 0 k N (n W 0 X N V m 0 X N V ao 0 X N V m 0 X N J a o X N J m a X N V m W 0 T mA mx r�Om XN X Z m r A C) u Z 4 � y m z r O 2Nz G) " N N N N N N N N N N r Z V G " O A Y o A . A A A A A y y A D x r N N N N 4f N VI 41 N y �1 O a o o ° o ° o a o a o o a o y C ti m y y 0 o a o a o 0 o a m 3 m z y A m 3 D A x N 2 O y � D m 5 m z o o o z z m m A A 0 z O ' O Z 0 n y rT y Z n o�-OO m W y y T Dym o o� 0 c am? > y n a yZO W, 4 U M 2 m wAmo N M EM 5n3Z o ' o m yX r y A D_ y A V v N 9 of " "r R City of Wheat Ridge Building Division 7500 W. 29 Ave., Wheat Ridge, CO 80033 Office: 303 - 235 -2855 * Fax: 303- 235 -2857 =`. o Inspection Line: 303 - 234 -5933 O CORP� Building Permit Application Date: 7T-7 It Plan* Permit #: Property Owner (please print): B��c lhgEn/ c ffSSq- Phone: Mailing Address: (if different than property address) Address: State, Electrical City License* Plumbing City License* Mechanical City License #: Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of s ace (description): Construction Value: ' C�G/O 1 "',` (as calculated per the Buildinluatfon U�od2 O. ✓ !1.✓O �Q�GtZQ/a�G T.f« L°,4/fti/L SDivc�' 6./j�q <!3/�✓ls' S ?c� f{c�LI�L�Di Plan Review (due at time of submittal): $ d "�•. Sq.. Ft. /L.Ft added:: / Squares BTU's Gallons Amps OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT 1 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 applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field ins coon. C/RLCE ONE:: (OWNER) (CONTRACTOR or PERSONAL RE ES ATIVE_(0� °' PRINT NAME: s %G� 6 G�iQ i /L SIGNATUR__-!/ Date: 7- 7 -10 ZONING COMMENTS: Zoning: Reviewer: DEPARTMENT USE ONLY PUBLIC WORKS COMMENTS: Reviewer. ✓rdG'..27� BUILDING DEPARTMEMTS:/ Y" ST.9-'TirvPa F- 8v/AI:9•IrL. E- OCCUPANCY: Reviewer �/ra s>vS�AE'e'T"ic�.cd FIRE DEPARTM ❑ approved w/ comments [3 disapproved El no required Bldg Valuation: $ Contractor License M Phone: Electrical City License* Plumbing City License* Mechanical City License #: Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of s ace (description): Construction Value: ' C�G/O 1 "',` (as calculated per the Buildinluatfon U�od2 O. ✓ !1.✓O �Q�GtZQ/a�G T.f« L°,4/fti/L SDivc�' 6./j�q <!3/�✓ls' S ?c� f{c�LI�L�Di Plan Review (due at time of submittal): $ d "�•. Sq.. Ft. /L.Ft added:: / Squares BTU's Gallons Amps OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT 1 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 applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field ins coon. C/RLCE ONE:: (OWNER) (CONTRACTOR or PERSONAL RE ES ATIVE_(0� °' PRINT NAME: s %G� 6 G�iQ i /L SIGNATUR__-!/ Date: 7- 7 -10 ZONING COMMENTS: Zoning: Reviewer: DEPARTMENT USE ONLY PUBLIC WORKS COMMENTS: Reviewer. ✓rdG'..27� BUILDING DEPARTMEMTS:/ Y" ST.9-'TirvPa F- 8v/AI:9•IrL. E- OCCUPANCY: Reviewer �/ra s>vS�AE'e'T"ic�.cd FIRE DEPARTM ❑ approved w/ comments [3 disapproved El no required Bldg Valuation: $ (�i�55 ✓�QEi ft�ia/° DRILLING IIN:c S JOB HEET NO _ OF ffE N N ,,E-E R I N G CALCULATED BV O N A R S CHECKED BY V DATE 1,�� f � f�`3�� � �srg'�rvaF�?',✓ 5135 Ward Road Wheat Ridge, Colo "redo 80033 Office (303) 423.8 ( FaY ,(903) 423 - 9155 Pt.ei 5A 3t i x or, �xxn 'r w ti Y ) t \y Ilk �' A, �' o °° ° a'y � 0 P p..� •. O so r a; :�� *w z .y �,, _ `p 4 it iG '�Sfi £.�ti y � } S it✓ 3 A t 2"� �. p hi y'��LGdk4YY1S - HPC -15X' 0 z U w K a a a ° w 0 w ti i 3 a 0 COUPLING COUPLING 1.5" HELI -PILE CONVENTIONAL HELICAL PILE CATALOG NUMBERS BEGINNING WITH HPCL -15X AND`HPCE -15X (EXTRA HIGH STRENGTH SHAFT STEEL, Fy =90 KSI) 1 3" 3" LEAD SECTION SINGLE OR MULTIPLE HELIX NO SCALE 3 , SHAFT HELIX EXTENSION NO SCALE 3', 5', OR 7' — SHAF PLAIN EXTENSION NO SCALE z 1. THIS DRAWING COVER 1.5" HELI -PILE ® SOLID ROUND CORNER SQUARE SHAFT HELICAL (CATALOG NUMBERS BEGINNING WITH HPCL -15X 6 HPCE -15X) z 2. SOLID ROUND CORNER SQUARE SHAFT MATERIAL IS PER ASTM A29 OR AISI 1530, Fy =90. w 3. ALL HELIX MATERIAL IS 0.5" THICK AND IS PER ASTM A656 Gr 80 TYPE 7 (Fy =80 KSI). 0 4. CONNECTION BOLTS ARE 0.75" DIAMETER ASTM A449, 3" LONG, THREADS OUTSIDE THE a 5. ALL WELDS MINIMUM 0.25" FILLET WITH ER70S ELECTRODE. w 3 6. ALL STEEL IS GALVANIZED PER ASTM 8633 -85 FE/7N 5, TYPE III 7. ULTIMATE AXIAL MECHANICAL CAPACITY IS 70,000 LBS. 8. ULTIMATE SHAFT TORQUE CAPACITY IS 7,000 FT -LBS. 9. ULTIMATE HELIX MECHANICAL CAPACITY: 6 "-12" DIAMETER =70,000 LBS, 14" DIAMETER =56,000 LBS H`t *��`C O SPECIFICATION 1.5 CONVENTIONAL SHEET EXTRA HIGH STRENGTH IMR, Inc. - DENVER HELICAL PILES 5135 Ward Road, Wheat Ridge, Colorado, USA HPC- 15X.DWG SHEET 1 OF 1 u 3031123 -0591 Fax: 303 -423 -9155 DRAWN BY: ENGINEER: DATE: I REVISION: www.helipile.DOm CSM JSP. 05/19109 1 3, 5, OR 7 40NGy z G W U O W 0 O 2 F Q F D 6 a 0 7 8 UP -150 UNDERPINNING 11 1 U —2 2— U 3 3 4 4 1 -- 5 5 -- 7 - --------- 6. THREAD ROD: 14' WILLIAMS GR 75, 18" LONG - . /L�.Ai 6tv 4Pr✓ F J 7. NUT: 1 - 2 1 " o 8. r_J L -1 9. PIPE SLEEVE: CARBON MECHANICAL TUBING: 62 Yl w 2.75" OD, 2.125" ID, 0.313" WALL TH., 6" LONG I I I 1 I I 1 9 I 1 I I I I I I I FRONT ELEVATION i NO SCALE 0 w 1. STRUCTURAL ANGLE: 8" X 8 "X i ", 12" LONG 0 2. CONCRETE EXPANSION BOLT: ? X 5-}" REDHEAD OR EQ z 3. NUT ON EXPANSION BOLT ET 7 I 8 I 1 I I I I 9 �I I I I 1 I I 4 5 T lo / SIDE ELEVATION NO SCALE z 4. WASHER ON EXPANSION BOLT ° 5. SLOTTED HOLE: 3" X s" z a 10. GUSSET PLATE: 3"X 3"X i 11. CONCRETE FOOTING OR GRADE BEAM 3 a NOTE: ALL ANGLE STEEL, PLATE STEEL, & STRUCTURAL TUBING IS A36. "? ALL PIPE IS 35 KSI MIN YIELD. x ULTIMATE CAPACITY 200,000 LBS HELH ILE IMR, Inc. - DENVER 5135 Ward Road, Wheat Ridge, Colorado, 80033 USA 303 - 423-0591 Fax: 303-423 -9155 www.helipile.00m SPECIFICATION SHEET "BY: RSV ENGNEER: JSP U.S. PATENT NO. 5,800,094 UP -150 UNDERPINNING BRACKET 150.DWG SHEET 1 OF 1 05/19/09 REVISION: 1 0 t= 6. THREAD ROD: 14' WILLIAMS GR 75, 18" LONG - . /L�.Ai 6tv 4Pr✓ 7. NUT: 1 - 2 1 " o 8. STRUCTURAL TUBE: W X 4" X t. 11.5" LONG 07kej- 9. PIPE SLEEVE: CARBON MECHANICAL TUBING: 62 Yl w 2.75" OD, 2.125" ID, 0.313" WALL TH., 6" LONG a 10. GUSSET PLATE: 3"X 3"X i 11. CONCRETE FOOTING OR GRADE BEAM 3 a NOTE: ALL ANGLE STEEL, PLATE STEEL, & STRUCTURAL TUBING IS A36. "? ALL PIPE IS 35 KSI MIN YIELD. x ULTIMATE CAPACITY 200,000 LBS HELH ILE IMR, Inc. - DENVER 5135 Ward Road, Wheat Ridge, Colorado, 80033 USA 303 - 423-0591 Fax: 303-423 -9155 www.helipile.00m SPECIFICATION SHEET "BY: RSV ENGNEER: JSP U.S. PATENT NO. 5,800,094 UP -150 UNDERPINNING BRACKET 150.DWG SHEET 1 OF 1 05/19/09 REVISION: 1 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. Electrical err 7 2 1 �o- INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS - ' DATE INSPECTOR INITIALS COMMENTS: Footings /Caissons Roof Stemwall / (CEG) Concrete Encased Ground Building Final Reinforcing or Monolithic Fire Department Weatherproof/ French Drain R.O.W & Drainage Sewer Service Lines Parking & Landscaping Water Service Lines POUR NO 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 -,Z, j- Pf' Ili L'EP vo T /(.nPF Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing Insulation Drywall Screw FINALS Electrical Plumbing Mechanical Roof Building Final Fire Department R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Parking & Landscaping "NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, . BUILDING AND PUBLIC WORKS. BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION . DOES NOT CONSTITUTEAUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ♦ i CITY OF WHEAT RIDGE Bung Inspection Division r4000 (303) 234-5933 inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Poo F Job Address: 3'VeE Permit Number: ❑ No one available for inspecti . Time A M!5 Re-Inspection required: Yes t No When corrections have been made, call for re-Inspection at 303-2345933 Date: 21 to - ( Inspector: ~i . I , UE 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 T Inspection Type: xfd,soer Job Address: ` qg/ 1 `11`1~fl ~m Permit Number: ✓00 v? gQ ❑ No one available for inspection: Time .2:j AM MM Re-Inspection required: Yes When corrections have been made, ca0 fo re-Inspe tion at 2.3 -23 -5933 Date: _A1_21_/_01? Inspector: ~2 r i" d~C JS DO NOT REMOVE THIS NOTICE 3 1 41 CITY OF WHEAT RIDGE ~ i Building inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office - (303) 235-2857 Fax i INSPECTION NOTICE Inspection Type: jt 'cr), 11,h 1F / Job Address/Permit Number: ?L ff,'l~F;i c/ >`f}ORr,%13 44;J-+,iviv /0k 1 i i ❑ No one available for inspection: Time / r~r3 AM Re Inspection required: Yes ,t`lo / i When corrections have been made, call for re-inspection at 303-234-5933 t r /'I'~ t✓ ,V / Date: Inspector: lh kf,' DO NOT REMOVE THIS NOTICE k. 1 y City of Wheat Ridge Residential Roofing PERMIT - 092289 PERMIT NO: 092289" `ISSUED: 09/11/2009 r, JOB ADDRESS: 3485 MILLER ST'. EXPIRES: 03/10/2010 DESCRIPTION: T/O ; Install 30.67 sgs,of GAF :Elk timberline prestique. CONTACTS, «e- owner 303/233 -1848 Bob/Karen Cassa 3 gc 303/425 7531 John Borfitz 01 9983 J &'K Roofing Inc **:PARCEL INFO y; ZONE CODE: UA.USE: UA SUBDIVISION:. 0646.BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: '.'9,453.00'. FEES Permit Fee 235.70 ' Total Valuation , 00 ; g Use Tax 170.15 :t* TOTAL 405.85 r; • 'Conditions: 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 ,,V. water from'eave edge to 2' inside exterior walls. I' Subject to field inspection:` Sry 0 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 z application and that I assume full responsibility for compliance with the wheat Ridge Building Code ..(I.B.C) and all other r' applicable Whea dge Ordinances, for work under this permit. Plans" subject to field inspection. x ' Bignatur «of contra or/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 ei State of Colorado and to the Zoning Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable 1,. 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. A 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 r." 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 afnew permit. 4. No work of any manner shall be done, that will. change thee. natural flow of water causing a drainage. problem. ' S Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive approval on inspection card before proceeding with successive phases of the job.` s., written " 6. The:. issuance of a e or the approval of drawings and. specifications shall'. not be construed to be a permit for, nor di an approval olation of the provisions of the building codes or any other ordinance, law, rule or regulation. All -plan rev object to field inspections. "Signature of ief:BUildmg Official : date -,INSPECTION REQUEST LINE: (30.3)234-5933 BUILDING OFFICE: (303)235-2855 ,REQUESTS MUST, BE MADE BY 3PMANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. oFw"~>R City of Wheat Ridge Building Division ~Om 7500 W. 29th Ave., Wheat Ridge, CO 80033 otO Office: 303-235-2855 * Fax: 303-235-2857 a Inspection Line: 303-234-5933 OGORP~ Building Permit Application Date: Plan pormit Property Owner (please print): r r t R~~ (2,(,' Phone: Z~ 3 `v Mailing Address: (if different than property address) Address City State Zip: Contractor License # Phone: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Approval: Approval: Use of space (description): th-gA:- o-f O-tL (rne-)~ Sq. Ft.IL.Ft added: Squares? BTU's Ga Exp. Date: Approval: Construction Value: S gh<5~, (as calculated perthe Building Valuation Data sheet) Plan Review (due at time of submittal): $ Ions Amps OWNERICONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are rules or regulations of the City of Wheat Ridge or covenants, easements or restrlc allegations made are accurate; that I have read and agree to abide by all condltior responsibility for compliance Wth the Wheat Ridge Building Code (I.B.C) and. all o under this permit. Plans subject to field inspect!0-M-.. CIRLCE ONE:: PRINT NAME: or PERSONAL TOR) Date: and do not violate applicable ordinances, ecord; that all measurement$~shown, and on this application and thatlassume full !cable Wheat Ridge Ordinances, for work M ' .f. . i. CITY OF WHEAT RIDGE Building Inspection Division I ~ (303) 234-59331nspection line i (303) 235-2855 Ollice '(303) 235-2857 Fax INSPECTION NOTICE Inspection Type: /ZveY' Job Address/Permit Number: 3V85 .rrid~,~Z sT• e5maG81 1 1.,fFAZ _2~~( srAP~i ca,a rf a.. Yr . s, CNs L~/,44~/ iviff.(f ~d~'Y i~attYS" 1'fr~f- .f/• laRLf ~ ❑ No one available for inspection: Time ;7, 7 f AM/PM I Re-Inspection required: C251-11 No I ~When corrections have been made, call for re-inspection at 303-234-5933 Date: Inspector:,z,F> DO NOT REMOVE THIS NOTICE , A~ ~ GTY OF WHEAT RIDGE Building Inspection Division ~ (303) 234-59331nspeciion line (303) 235-2855 Office ' (303) 235-2857 Fax I INSPECTION NOTICE ~ Inspection Type: minA?~r I ~ Job Address/Permit Number: 3'/S5^f111F2 s'` o9?X-f'4 .723 «7J'/~~F~ i ~ i ~ i ! i ❑ No one available for inspection: Time AM/PM ; ; Re-Inspection required: ej~js> No ~ ~ When corrections have been made, call for re-inspection a[ 303-234-5933 i ~ Date: 55 :/;110/w Inspector. - DO NOT REMOVE TH/S NOTICE I ' DEPARTMENT OF PLANNING AND DEVELOPMENT - BUILOING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE 7500 WEST 29TH AVEI3UE WHEAT RIDGE, CO 80215 Property Owner C/~S/7 3 yg '-s' S / Property Address Contractor License No. Company i~"Yv L Building Permit Number : Date : J'- OC/ Phone : 1 ~ j - f ~ y0 /X:~G- Phone: ~~/•~Ui,'~ OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value I hereby certify that the setback distanws proposed by this permit application are acwrate, P2fRllt FBE antl do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or wvenants, easements or restrictions of recorU: that all measurements shown, antl allegations made are accurate; that I have read and agree to abide by aU conditions pnnfed on this Use Tax application, and that 1 assume full responsibility for compliance with e Wheat Ridge Building Code (U.B.C.) and all other applicablat 'ge ordi , s work under tnis permrt. Total (OWNER)(CONTRACTOR) SIGNE ~ n---~ 'T F!) - Description ~ BUILDING DEPARTMENT USE ONLY Approvai: Zoning : ~l[eiihe~~ents'~ Approval: CptitlE"w0i'kjgMhl6nts:! Approval : ~ f ra Occupancy : Walis Roof : Stories : Residentiai Units : Electricai License No : Plumbing License No : Mechanical License No : Company : Company . Company : Expiration Date : Expiration Date : Exoiration Date : Approval: Approval: Approval: J(1) This permR was issueE in acmrtlance with the provisians set torth in yopur applitation and is subject to the laws of the State af Colo2tlo anA to the Zoning Regulations antl Builtling Cotle M Wheat Pitlge, Calorado or any oUer appBCable ordinances ot the Ciry. (2) This permil shall expire it (A) the wodc authonzetl is not wmmencetl within sixty (60) Eays from issue tlate or (B) the building authonzetl is suspentled or abanAOned for a periotl of 120 days. (3) If this pemnl axpires, e new pammt may De acquvetl tor a fee of one-balt the artwunt normalry repuire4 Dmvitl80 no change5 have been or will be matle in the original plans anA specificatwns and any suspension or abantlonment has not ezceetletl one (1) year. If chan9es are made or if suspension or abandonment exceetls one (1) year, full lees shall be paid for a new permit. (4) No work of any manner shall oe tlone that wtll change tlle natural flow ot water causing a tlrainage problem. (5) Contractor shall notiry the Building Inspeclor Rvenry-four (24) hours in advance for all inspecUOns and shall receive wntlen approval on inspection wrtl before proceediing with successive phase5 of the lob. (6) The issuance ol a pecmit or the approval M drawings antl speciLwtions shall nol be wnsVUetl to be a pertnR for, nor an approval of, any violatlon of the provisions of the building cotles or any oNer ortlinance, law, rule or regula6on. Chief Building Inspector For Mayor THIS PERMIT VALID ONLY WHEN SIGNED BY 7HE CHIEF BUILDING INSPECTOR AND MAYOR CALL: 234-5933 24 HOURS PRIOR TO INSPECTION ; " ; City of Wheat Ridge Residential Roofing PERMIT - 080682 1/9r PERMIT N0: 080682 ISSUED: 06/19/2006 JOB ADIJRESS: 3485 MILLER ST EXPIRES: 12/16/2008 DESCRIPTION: T/0 31 sq shake put on 30 yr dimensional CONTACTS owner 303/233-1848 Karen Casa gc 303/548-5000 Gary Mitchell 02-1001 Roof Corp. PARC:EL INFO ZONE CODE: UA USE: UA SUBDIV]:SION: 0646 BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,750.00 FEES M Permit Fee 162.90 ~.~t~r1 Total Valuation .00 ~ Use TzLx 103.50 T01'AL 266.40 Conditi.ons: 6 nail installation & mid-roof inspection required. Board sheeting spaced more then a 1/4 of an inch apart requires plywood overlay on entire roof I hereby cer[ify that the setback dis!:ances proposed by this permit applica[icn are accurate, and do not violate applicable ordinances, rules or regulations of tl:e City of wheat Rid9e or covenants, easemen[s or restrictions of record; that all measurements shown, and allegatione msde are accurate; that i have read and agree [o abide by all conditions printed on Chis applicatlon and that I assume fu11 respensibility for compliancp with the Wheat Aidge Building Code (I B.C) and all other applicab.e Wheat Ridge Ordinances, fox work undex this permit. Plans subject to field inspection. Signature of contractor/ownen date 1. This permit was issued in accordance with the provisionc set forth in your application and is subject [o the laws of the State of Coiorado and to the Zoniny Regulations and Building Codes of wheat Ridge, Colorado or any other applicable ordinances of the City. This permit ehall expire 180 days =roin the issue date Requests for an extension must be received prior to expiration date. M extension may be granted at the discretion of the Huilding Official 3. Sf th:ie permit espires, a new permit may be acquixed for a fee of one-half the amount normally required, provided no changes have been or will be made i.n the original plans and specifications and any suspension or abandonment has not excee(ied one (1) year. If changes have been or if suspension or abandonmen[ exceeds one il) year, full fees shall be pa:id for a new permit 4. No wmrk of any mannex eha11 be 3one that will chanqe the natural flow of water causinq a drainage problem. 5. Contractor shall notify the Buildir:g mspector twenty -foux (24) hours in advance for all inspections and shall receive written approval on inapection r_ar<1 before proceeding with successive phases of the job. 6 The i:;suance of a permit or the ap}:roval of drawings and specificaCions sha11 not be consCrued to be a pezmit for, nor an approval of, any violation oE the provisions of the building codes or any oCher ordinance, law, rule or regulation. All plan review is subject to fielif inspections Signature of Chief Huilding Official date INSPECY'ION RHQVEST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 REQUES'I'S MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheat Ridge / Residential Roofing PERMIT - 080682 PERMIT NO: 080682 ISSUED: 06/19/2008 JOB ADDRESS: 3845 MILLER ST EXPIRES: 12/16/2008 :DESCRIPTION: T/O 31 sq shake put on 30 yr dimensional CONTACTS owner 303/233-1848 Karen Casa gc 303/548-5000 Gary Mitchell 02-1001 Roof Corp. PARC:EL INFO ZONE CO:DE: UA USE: UA $UBDIVISION: 0209 BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,750.00 FEES Permit Fee 162.90 E~J92be-1Total valuation . oo , Use Ta:!c 103.50 TOTAL 266.40 Conditions: b nail :installation & mid-roof inspection required. Board sheeting spaced more then a:L/4 of an inch apart requires plywood overlay on entire roof I hereby certify [hat the setback dist,iccs prcposed by this permit application are accurate, and do uct violate appliceble oxdinances, rules or regulations of th._ City of Wheat Ridge or covenants, eesements ox res[rictions of record; that all measuremente shown, and allegarions macte are accurate; that I have read and agree to abide by all conditions printed on this aPPlication and that I assume full responsibili[y for compliance wi[h the Wheet Ridge euilding CoQe ?z.B.C1 aad all other applicab lWheat Aid9e Ordi nc , for woxk undex this perniit. Plans subject to field inspection. '.SignaCUre of ntractox/owner da[e 1 This permit was issued in accord3na• with the provisions set forth in your applicacien and is sub7ecL [o the laws of the S[ate of Colorado and to the 'loning ftegulations and euilding Codes of Wheat Ridge, Cnlorado cr any ather applicable ordinancea of the City 2. This permiC shall expire 180 days from the issue date Requests for an extension must be received pxiox to expiration date. An extension may be granted ..t the discxetien of the Building Official 3. If [hic permit expires, a new permic may be acquired for a fee of one-half the amount normally required, prwided no change:; have been or will be made in Che original plans and specifications ard any suspension or abandorimen[ has no[ exceeded one (1) year. Sf chang=_s ]mve been or if suspension or abandonment exceeds one ilyear, full fees shal: be paid £or a new permit. 4. No worlc of any manner shall be done that will change the natural flow of water causing a drainage problem. S Contrar.tor shall notify the Buildiny Inspector [wenty-four i24) hours in advance fux a11 inspections and sha11 receive written approval on inspecCion card before proceediny wiCh successive phases of the jeb. $ The is:;uance of a permit or the approval oE drawings and specificatiovs shall not be cons[rued to be a pexmit for, nor an approval of, any violationof provisions oE [he building codes or any other ordinance, law, rule or regulation Al1 plan review is sub7epy rp E' d inspections 8ignature of Chief Buildin//Off~ial date INSPHCTYON REQUEST'LINE: (303)234-5933 BUILDING OFFICE: (303)235 2855 REQUEST:i MUST BE MF1DE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. oF'""~Tq, City of Wheat Ridge Building Division Date: ~ ~ m 7500 W. 29th Ave., Wheat Ridge, CO 80033 - Office: 303-235-2855 * Fax: 303-235-2857 Plan ~~~oRAO~ ~ Inspection Line: 303-234-5933 Permit Building Permit Application Property Address: M- 11,P-0 Property Owner (please print): 4:~c ~ • ` Phon~L-~-~" Mailing Address: (if different than property address) Address: City, State, Zip: Contractor. Contractor License Sub Contractors: Electrical City License Company: Exp. Date: Approval: Use ot space (description): Descri tion of work: o Q~~ Phone: Plumbing City License Mechanical City License # Company Company: Exp. Date: Exp. Date: Approval: Approval: Construction Value: E1"L.J U (as calculated per the Buildinq Valuation Data sheet) 30 Sq. Ft./L.Ft added: Squares 3 ( BTU's Plan Review (due at time olsubmittal): b Gallons Amps OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certiry that the setback distances proposed by this permit application are accurate, and tlo not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of rewrd; lhat 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, kr work under this permit. Plans subject to f' CIRLCE ONE:: (/OWNE (CO/NTRACTO~RSONAL REPRES TATIVE of ( N )(CONTRATOR) PRINT NAME. ISI~+~N fl rff~ GI SIGNATURE. ~ ~ Date: J ZONING COMMENTS. Zoning: Reviewec PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY BUILDING DEPARTMENT COMMENTS. Reviewer: OCCUPANCYFIRE DEPARTMENT:: ❑ apPfOVed w/ Comments ❑ diSappfOVOd ❑ no feview required I Bldg Valuation: $ -DEPARTMENT OF PLANNING AND DEVELOPMENT BUILDING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 Property Owner : Praperty Address : 3485 MIILER ST Contractor License No. : 17152 Company : Precise Plumbing Building Permit Number Date 6373 12/12/97 Phone : 233-1848 Phone : 534 0881 OWNER/CONTRACTOR SIGNATURE OF UNDERS7ANDING AND AGREEMENT Construction Value : $430.00 I henaby certify that the setback distances proposed by this permit application are accurate, P@fmlt F@2 : $22.00 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 Plan Review Fee : $0.00 made are accurate; that I have read and ayree to abide by all conditions printed on this application, and that I assume full responsibility for compliance with the Wheat Ridge Building US@ TaX : $0.00 Code. (U.B.C.) and all other applicable Wheat Ridge ordinances, for work under this permil. (OWIVER)(CONTRACTOR) SIGNED DATE TOf81 : $22.00 Description : REPLACE WATER HEATER BUILDING DEPARTMENT USE ONLY 99MONNEW SIC : Sq. Ft. : Approval: Zoning : 110INNYINIMMI TAX # 80-02148 Approval: Approval: Occupancy : Walls : Roof : Stories : Residential Units : Elec:trical License No : Company: Plumbing License No : Company : Mechanical License No : Company: Expiration Date : Expiration Date : Expiration Date : Approval: Approval: Approval: ~ mo r,. W-4 a_ 3pfig~a im ~f~RM.. (1) This permit was issued in accorciance with the provisions set forth in yopur application and is sub7'ect to the laws of the State ot Colorado and to the Zoning Regulations antl Builtling Cotle oF Wheat Ridge, Colorado or any other appliwble ordinances of ihe Ciry. (2) This permit shall expire if (A) the work authorized is not commenced within sizry (80) days trom issue date or (B) the builtling authorizetl is suspentletl or abantloned for a period of 120 days. (3) If this permit ezpires, a new permit may be acquiretl for a fee of one-half the amount normally required, provitled no changes have been or will be made in the original plans antl specifcations and any suspension or abandonment has not exceeded one (1) year. If changes are made or if suspension or abandonment exceed5 one (1) yeaf, full fee5 5ha11 6e paitl for a new permit. (4) No work oF any manner shall be done Ihat will change the natural Flow of water causing a drainage problem. (5) Coniractor shall notiry the Building Inspector hventy-tour (24) hours in advance for all inspections and shall receive written approval on inspection card before proceediing with successive phases of the job. (e) The issuance of a permit or the approval of tlrewings antl 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, rula or regulation. Chief Building Inspe~ THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR CALL: 234-5933 24 HOURS PRIOR TO INSPECTION I ~Ucuvdlluy . vvans . Roof : Stories : Residential Units : Electrical License No : Plumbing License No : Mechanical License No : ComFiany: Company: Company: Expirition Date : Expiration Date : Expiration Date : Approval: Approval: Approval : -3 : PJVrs:R6bu1red::7. I -Ff,hs Re'quired." ~ -4 TME111111Muir3tlica (t) This permrt was iswca n amoroance wrm me proiryens set krtn m yoour ao0unaon ana is suoiact ro me ywa ol tne State d Cobnoo arq te the Zatinp RepWauons ana Builemq Coae of VMeat RWga. Co;waao a airy oNW ac0liv01e oroinancas of the Ciry. (2) This permrc snau eamrc n(n) me wonc aummzee is roz commenaee wmun uxty (60) aays hom fuus dau a(e) the Cuibi`p auuwnzea n swparwW a aWnOOnea for a pemC ot 120 aays. (3) it wa permrt exouea. a new oermn may oe acywrse ror afae d on"arc the amount nomuuy requuW, provqw no cn"ss naw eesn a wiu ps mms n tne urgwl Wans anG a. anC arry suspsnsqn pr a0anaonmpnt nas nOi one (1) Yeu. II UyllpO/ aro mYas a II luipantqn pspaIppry11eK lxMOE3 Ol1! I/ ) Y!!f. MI kH flMll DG Oiq /0f a n!w 0lRM. (4) NO WOIk Of 2ny R12npll iflsll D! COne tlyf wlll tYfinq! VI! NNOI IIOW Of wi1H GUAnq i 0liillige pfppllT. (5) Conuaaor snai noury tne BwiCmg inspepy nvenry-iour (ZS) rwm m savance ror an inapscoons and shali racene woteen ipDrovilil on mspacoon nro pslpe proceeCUng wim successrve onases of tne po. (6) TTe nsuante Of a permtt or Ine aPOrovai ol Otawmq= an0 SDeaM1nGOns snall not De Cpnstrultl lo Dp i pemu( fpf. ny ln aOProvaI Of. iny ndiU0f10! V1e prpwlpns M the ounamg coees or any omer omimnee, uw. ro.e or reguuuon. • DEPARTMENT 01: PLANNING AND DEVELOPMENT , BUILDING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE ~ 7500 WEST 28TH AVENUE WHEAT RIDGE, CO 80215 Property Owner : I( C x-s's • Properry Address : 3 y Contractor License No. : / 7/ Company: /oPPG%St I-V !;^q .Z" C-- .m ~ 04VNEWCONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I Meraby xrtAy that Me setbadc tlistances proposed Dy this permrt appueation are accurata. antl tlo not violate appUCabb oromances. rubs or regunuons of Ne City of Nrtiaa[ Ridge or covenants. easemems or resmaions ot recoro: Nat au measurortartts shown, ano allaqatwns rmatle are accunce: that 1 have ieatl anC agree w abde by all conORmns pnntstl on Nis appfKatlon. anc mat 1 auumelutl rcsaonsbtlilv for -,.-nee wrth the when Ridge Builtlinp CaOa (U.B.C.) ana a0 oMer appunbls Wheat Rieya ordmaness/. fo'rw/ork uMSr Mis psmmt (OWNER)(CONTRACTOR) SIGNED/O~a-, . iC.e.r L6/ pq~ . v ~ - Phone : i -j s~ Phone : s"-'y-O Conswc6on Value : y3, - - Pertnit Fee : A y UseTax:,~~~s Total : 2 A ^ Descnption: /'t~o/ce /'f<,71',y ece'- /`7 5"ooc4/0.n BUILDINCa DEPARTMENT USE ONLY Z,.01ah""W"'M91 Approval : Zoning : Approval.: ~ PI16 _ ' Approval : Occupancy : Walls : Roof : Stories : Residential Units : Electncal License No : Plumbing License No : Mechanical License No : Company: Company: Company: ExpireHon Date : Expiration Date : Expiradon Date : Approval : Approval : Approval : ~ rPl~ris'Ri~olulred~ ~ ~ PIlihs Rdouirod'.'" ~ulmzia (t) This pemirc was usuw n acmraance wm me . set krm n yopur appunoon ana u welM m me inw W tns Stata d Coloram ano to pr Zmog Requlauons ano BwlOirg Coaa of NTeat Ritlqe. Coanao w anry mnar aopuraels oroinanps of Ina Cily. R) Th is parmn snLl upxs d tAl Ma waK autnonzap q not eommsnnp vnwn wny (60) AaYS hom issus Cate q(B) tha CuiWUq auUqnzeC q si.., or aWnOOnea for a oanoa o! 130 CaYS. (a) n tnn pam+rc axaros. a naw pamirt may w aoquaw ror a f" M onNUM ms amouni nemuxy roqurcw. pevqw nc yunpss nws psen or wix pe mey n me orgml pana ana u aM a11y . . a aGinOOnmMt Ms nOt ex4"aW One (1) yeu. If axC000t Ont 11) Yw. hJll MN fMN DO oW fOf a new 0lrtM. ~ ~ro rt1~0~ Of d WtpOllfqfl M ~WMO~RMM (4) NO WOIK Of 2Iry RIaIIIIlf fllall 0! COM tllit Nnq Wllq! N! MNlil ibW Of WYW 4ULnq 7 Clfq49! qOdlT. (5) Convaaor snan noury me emwirg maoeaor nvemy-iour (14) noura m aavance ror an mspecuons ana msq rxqve wntten aODtovai on mfpsmon eara Oalan ora'eeonn9 witn succeune onasea ol tne pb. (8) Tne asuance of a permrc or me aoDrovai of anwmqs ana soeafiouons snan not De wnstruetl w ee a pertml for. nor an o07,wa10l. arry ndaoon o11M prpmqns of ine ounamg eooes or arry otner ommarux, uw. nae a requnuon. Chief Building Inspector For Mayor Building Permit Number : Date : THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDINCa INSPECTOR AND MAYOR CALL: 234-5933 24 HOURS PRIOR TO INSPECTION