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HomeMy WebLinkAbout4520 Holland Streeti CITY -OF WHEAT RfDGE Building Inspection'Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: �� ��� ' �� Job Address: Permit Number: ❑ No one available for inspection: ime �� T Re -Inspection required: Yes o When corrections have been made, call for re -inspection at 303-234-5933 Date: Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Miscella PERMIT - 201709295 PERMIT NO: 201709295 ISSUED: 11/28/2017 JOB ADDRESS: 4520 Holland St EXPIRES: 04/12/2019 JOB DESCRIPTION: SWO Permit to install drywall @ kitchen area, aprox 8 sheets, mud and texture *** CONTACTS *** OWNER (303)358-2832 SERVIS RONALD W SUCCESSOR PERS SUB (720)668-3603 Thomas Roca 150236 Tri -States General Contractors *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 300.00 FEES Total Valuation 0.00 Use Tax 6.30 Permit Fee 26.50 Investigative Fees 26.50 ** TOTAL ** 59.30 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. 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_�ppermit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be pertormed and th work to be performed is disclosed in this document nd/or ts' accompanying approved plans and specifications. Signature of OWNER o ONTRA OR (Circle one) ate 1. This permit was issue cased on the inf6rmation provided in thepermit application and accompanying plans and specifications and is subject to the compliance with tlrose�ocuments, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Budding Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5, The permit holder shall notify the Building and 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 applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. :SFT la A V City Of r W heat Idge COMMUNITY DEVELOPMENT City of Wheat Ridge Municipal Building 7500 W. 29" Ave. Wheat Ridge, CO 80033-8001 P: 303.235.2855 F: 303.237.8929 Permit Extension Request Form Permits 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 may be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the original permit fee. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. Please complete this form in its entirety and submit to the Building Division at permits ,ci.wheatrid e� or fax to 303-237-8929. 6—c--,mF" ( & Party requesting permit extension: Permit = u Property Address: Phone # � y' _-5 Email Address: Reason for extension request: Number of days requested: Printed Name: -� �wo kI Signature: For office use only This request has been: CyApprov LI Denied Approved by: www.ci.wheatridge.co.us Date: Date: * //z? Extended until: vhai )q City of Wheat Ridge E -Res. Window Replacement PERMIT - 201900303 PERMIT NO: 201900303 ISSUED: 02/21/2019 JOB ADDRESS: 4520 Holland St EXPIRES: 02/21/2020 JOB DESCRIPTION: Replacement of 10 windows throughout whole house, U -factor of .27, like for like with no structural changes. *** CONTACTS *** OWNER (303)358-2832 SERVIS RONALD W SUCCESSOR PERS SUB (888)736-6335 Adam Kaliner 160260 Power Home Remodeling Group *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 16,081.61 FEES Window Replacement 50.00 Total Valuation 0.00 Use Tax 337.71 ** TOTAL ** 387.71 *** COMMENTS *** *** CONDITIONS *** Both the front and back of this permit are required to be posted on the job site at all times. If the complete permit is not present, inspections WILL NOT be performed. Work shall comply with 2012 IRC & 2017 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. 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. 1 further attest that I am legally authorized to include all entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER or CONTRACTOR (Circle one) Date I . This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This pen -nit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made -be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the original permit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and procedures for approval of any new pen -nit. Re -issuance or extension of expired pen -nits 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 grantmg of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any apphc b code or any Idinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Lagenia Reimer From: no-reply@ci.wheatridge.co.us Sent: Thursday, February 21, 2019 6:32 AM To: CommDev Permits Subject: Online Form Submittal: Residential Window/Door Replacement Permit Application Residential Window/Door Replacement Permit Application This application is exclusively for RESIDENTIAL REPLACEMENT WINDOWS and DOORS - LIKE FOR LIKE ONLY. YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM AND WINDOW/DOOR CUTSHEET (SPEC SHEET) IN ORDER FOR THE PERMIT TO BE PROCESSED. Your Permit will be emailed to the email address provided below once it is processed. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN WORK UNTIL PERMIT HAS BEEN ISSUED. Is this application for Yes replacement window(s) and/or door(s) like for like? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) Property Owner Email Address Attach Credit Card Authorization Form - **DO NOT ATTACH RANDOM DOCUMENTS** 4520 South Holland Street Josh Valentine 720-231-6492 oodyek@gmail.com Valentine - CC auth.pdf CONTRACTOR INFORMATION Contractor Business Power Home Remodeling Name 1 337�� Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone Number (enter WITH dashes, eg 303-123-4567) Contractor Email Address Retype Contractor Email Address DESCRIPTION OF WORK Number of window and/or doors being replaced Location of window(s)/door(s) being replaced (for example, master bedroom, kitchen, bathroom, etc): What is the a -value of the window(s)/door(s)? City of Wheat Ridge requires the u -value to be .32 or better on windows.. Attach copy of window/door cut sheets showing sizes and u -value Project Value (contract value or cost of ALL materials and labor) 160260 888-736-6335 shane.laird@powerhrg.com shane.laird@powerhrg.com (1�o indows throughout whole house 27 i Valentine - app.pdf 16081.61 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 2 issued based on this application. I understand that work Yes may not begin on this property until a. permit has been issued and posted on the property. I certify that I have been Yes authorized by the legal owner of the property to submit this application and to perform the work described above. I attest that everything Yes stated in this application is true and correct and that falsifying information in this application is an act of fraud and may be punishable by fine, imprisonment, or both. Person Applying for Shane Laird, PowerHRG Permit Email not displaying correctly? View it in your browser. National Headquarters 2501 Seaport Drive, Chester, PA 19013 888-736-6335 WWW.POWERHRG.COM PROJECT AMENDMENT Josh Valentine 33-68410 Buyer(s)' Information and Description of the Property: Project Number: 33-68410 February 08, 2019 Josh ValentineDate (720) 231-6492 (Josh's Cell) ol'Agreement February 20, 2019 4520 South Holland Street Date orAmendmenr Wheat Ridge, CO, 80123 oodyek@gmail.com County: Jefferson E -Mail Address 1 Township: Wheat Ridge This Amendment ("Amendment") is to the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT ("Agreement") by and between Power Home Remodeling Group, LLC ("Contractor"), and "Buyer(s)" listed above. Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and conditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions, alterations, or deletions to the products and services Buyer(s) ordered are being made: Previous Project Price: Previous Down Payments Required: Previous Down Payments Collected: New Project Price: Additional Down Payment Required: Additional Down Payment Collected: Additional Down Payment Still Due: It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowledges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date written below. I have read and received each page of this 4 page amendment. Pop r Home Remodeling Group / v /02/20/19 Signature of PHRG Representative Joshua Chiero February 20, 2019 16:29 09- ilyW9 /02/20/19 Signature Josh Valentine National Headquarters 2501 Seaport Drive, Chester, PA 19013 888-736-6335 WWW.POWERHRG.COM Amended Project Specifications Windows: Master bath 1 30.0"x45.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details Special Options (ie. Full Screen, Obscure Glass, etc) Full Screen No I Obscure Glass Double Hung : Both Sashes I Specialty Color No I Different Color Capping No I Trim Options No I Frame Options No I Remove and Reinstall No Windows: Master 1 30.0"x45.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White: Grid Pattern : None I Removal Aluminum / Vinyl Additional Details None Windows: Master 1 30.0"x45.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl Additional Details None Windows: Spare 1 58.0"x34.0" WINDOWS: Models SL 2700 Styles Slider Types 2 -Lite Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: Office 1 58.0"x34.0" WINDOWS: Models SL 2700 Styles Slider Types 2 -Lite Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: Fam room 1 67.0"x56.75" WINDOWS: Models SL 2700 Styles Bow Types 4 -Lite Configs End Casements OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Head, Seat and Jambs Birch I Additional Details None February 20, 2019 16:29 Josh Valentine 33-68410 National Headquarters Josh Valentine 2501 Seaport Drive, Chester, PA 19013 33-68410 888-736-6335 WWW.POWERHRG.COM Amended Project Specifications Windows: Kitchen 1 21.5'x34.5" WINDOWS: Models SL 2700 Styles Casement Types Single Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: Living 1 70.0"x34.0" WINDOWS: Models SL 2700 Styles Slider Types 2 -Lite Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl Additional Details None Windows: Living 1 70.0"x34.0" WINDOWS: Models SL 2700 Styles Slider Types 2 -Lite Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl Additional Details None Windows: Bath 1 20.5'x30.25' WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White: Grid Pattern : None I Removal Aluminum / Vinyl Additional Details Special Options (ie. Full Screen, Obscure Glass, etc) Full Screen No I Obscure Glass Double Hung : Both Sashes I Specialty Color No I Different Color Capping No I Trim Options No I Frame Options No I Remove and Reinstall No February 20, 2019 16:29 National Headquarters Josh Valentine 2501 Seaport Drive, Chester, PA 19013 33-68410 888-736-6335 WWW.POWERHRG.COM Amended Project Specifications Doors. Grand enrty 1 36 0"x80.0" DOORS: Models Dynasty Series Styles Entry Door Types Composite Configs Smooth Steel Options Innocent Peek : Majestic (Black) Color 2 -Color : Options Exterior Color Wineberry I Interior Color White Hardware Hancock Knob Handleset : Smart Code Dead bolt: Contemporary: Satin Nickel J Additional Details None February 20, 2019 16:29 City of Wheat Ridge Residential Miscella PERMIT - 201709295 PERMIT NO: 201709295 ISSUED: 11/28/2017 JOB ADDRESS: 4520 Holland ST EXPIRES: 11/28/2018 JOB DESCRIPTION: Permit to install drywall @ kitchen area, aprox 8 sheets, mud and texture *** CONTACTS *** OWNER (303)358-2832 SERVIS RONALD W SUCCESSOR PERS SUB (720)668-3603 Thomas Roca 150236 Tri -States General Contractors *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 300.00 FEES Total Valuation 0.00 Use Tax 6.30 Permit Fee 26.50 Investigative Fees 26.50 ** TOTAL ** 59.30 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. 1, 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. 1 further att- s that I am legally authorized to include all entities nfimed within this document as parties to the work to be performed and that all Erk to be performed is disclosed in this docum an or its' accompanying approved plans and specifications. ,.L` :' L' / ✓ . /i re . _>/­? Signature of OWNER or -'CONTRACTOR (Circle one) Date I . This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the originalpermit fee. 3_ If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and 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 W14 not be cons"to be aper it for, or an approval of, an violation of any provision of any applicable code or any ordinance or�r ,his jury ti A " roval 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. City of W heat COMMUNITY DEVELOPME![�ZjAe T Building & Inspection Services Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits oki.wheatridge.co.us FOR OFFICE USE ONLY Date: I i PlaMPermit # .13 1 109 Plan Review Fee: Building Permit Application in *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: ���o TI'V1114AJ Property Owner (please print): CS7,4TC— D F 1n tdr,.,d Phone: ,,3D3-356-Zr Property Owner Email:_ R2Roct m 9 MA; / - C o fin Mailing Address: (if different than property address) Address: 8710 1Kc'5-tilk 13f'h AVe_ City, State, Zip: "KCw0crf ('() Spzls 0 Architect/Engineer E-mail: Contractor: Phone: 241// Contractors City License #: ! Z..3 }0 Phone: 7v�Q "� 3 ° 3 Contractor E-mail Address: Sub Contractors: N � Electrical: pIJ Plumbing: � p a Mechanical: � W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: JV 0 ' Other City Licensed Sub: 1'O City License # City License # /V Complete all information on BOTH sides of this form ❑ COMMERCIAL RESIDENTIAL Description of work: (Check all that apply) ❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE ❑ NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING ❑ COMMERCIAL ADDITION ❑ RESIDENTIAL ROOFING ❑ RESDENTIAL ADDITION ❑ WINDOW REPLACEMENT ❑ COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) ❑ RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) ❑ MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT ❑ PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ❑ ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT OTHER (Describe) (For ALL projects, please provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc.) / S fN IL 0R�WA c;2�tC r �c �-el�_ rte- . Sq. Ft./LF Amps Btu's Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, 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 applicable City of Wheat Ridge codes and ordinances for wor under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perfo the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this applicat n. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONTRkV7VRrTED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY DATE: ! %� OCCUPANCY CLASSIFICATION: Building Division Valuation: $ PROKOP Environmental, LLC October 12, 2017 Colorado Disaster Restoration 12081 W. Alameda Parkway #423 Lakewood, CO 80228 Re: Prokop Environmental, LLC Project Number: 10-17.2353 Subject Property Owner and Address: Rick Rodriguez 4530 Holland Street Wheat Ridge, Colorado 80033 1'o Whom It May Concern: Prokop Environmental, LLC was pleased to be contacted and authorized by the above referenced parties to perform a limited asbestos survey at the subject property. This limited asbestos survey was conducted for the purpose of identifying the presence of asbestos containing materials (ACM) in the areas of the building that was part of the scope of work communicated to Prokop Environmental, LLC as required by state and/or federal regulatory agencies. The survey was performed by a Colorado Department of Public Health and Environment (CDPH&E) certified asbestos inspector and in compliance with applicable federal, state, and local regulatory rules. Please see the attached copy of the limited asbestos survey report for detailed information on the survey performed. If you have any question regarding this report or need additional assistance please f--' free to contact Prokop Environmental at anytime. Sincerely, Doug Prokop Prokop Environmental, LLC 720-232-7152 Ste'` Enclosed: Limited Asbestos Survey Report Prokop Environmental, LLC 9457 S. University Blvd., Suite 612 Highlands Ranch, CO 80126 720-232-7152 10-17.2353 Rick Rodriguez 4530 Holland Street Wheat Ridge, Colorado 80033 LIMITED ASBESTOS SURVEY REPORT PROJECT BACKGROUND INFORMATION Firm Performing Survey: Survey Site Name and Property Type: Survey Site Address: Survey Performed For: Prokop Project Number: Date of Survey: Prokop Environmental, LLC 9457 S. University Blvd., Suite 612 Highlands Ranch, CO 80126 Phone: 720-232-7152 Rick Rodriguez Single Family Residential 4530 Holland Street Wheat Ridge, Colorado 80033 Colorado Disaster Restoration 12081 W. Alameda Parkway #423 Lakewood, CO 80228 10-17.2353 October 11, 2017 Licensed Inspector: Ron Davis CDPH&E Asbestos Building Inspector: 22466 AHERA Certification Number: I15342 Inspector Signature: Date of Report: October 12, 2017 # of Samples Collected: 9 (Nine) # ofMaterial(s) Containing>1% Asbestos: 3(Three) Report Attachments: List of Homogeneous Areas Identified & Sampled Summary Chart of Sample Collected for Analysis Photographs of the Property and Homogeneous Materials Chain of Custody and Laboratory Report Inspector, Consulting Firm and Laboratory Certifications Prokop Environmental, LLC 9457 S. University Blvd, Suite 612 Highlands Ranch, CO 80126 720-232-7152 10-17.2353 Rick Rodriguez 4530 Holland Street Wheat Ridge, Colorado 80033 PROJECT SUMMARY INFORMATION Sample Collection Protocol: As part of this limited asbestos survey a CDPH&E certified asbestos building inspector performed an onsite inspection of the property to visually and physically identify suspect ACM and it's condition within the area of the building that was damaged and part of the scope of work that was communicated to Prokop Environmental, LLC. The identified suspect ACMs were each assigned a homogenous area (HA) number and randomly sampled in accordance with regulatory guidelines. Homogenous areas are defined as an area of material that is uniform in color and texture. The HA list for this project including the description, location, categorization, and condition of each material on the HA list is attached to this report. Also attached is a digital photo of each HA. Materials that were not observable, accessible, or not part of the scope of work communicated to Prokop Environmental, LLC are not included in this limited survey. If additional materials that are not included in this survey are found, samples of these materials should be tested for asbestos content. Methods: The samples collected were delivered under chain of custody to Reservoirs a National Voluntary Laboratory Accreditation Program (NVLAP) and CDPH&E certified laboratory. Laboratory accreditations and certifications are attached to this report. Laboratory analytical method used: EPA Method 600/M4-82-020; 600/R-93/11. Limitations: This limited asbestos survey was conducted following federal and CDPH&E protocols for identifying ACM. Areas of suspect ACM may be present in areas not visible or accessible during this limited asbestos survey. Prior repairs or remodeling of the subject property and materials may have altered building materials so that suspect ACM could not be identified during this inspection. If any additional suspect ACM is discovered these materials should be properly sampled and tested for asbestos content. Reasonable attempts have been made to ensure that this report is complete and accurate with respect to Prokop Environmental, LLC's authorized scope of investigation. Our site visit was of a limited nature with emphasis on bulk asbestos testing based on the scope of work communicated to Prokop Environmental, LLC at the subject property identified herein. Test results represent the samples collected and the conditions present at the time of the inspection and are limited to the scope described herein. This report shall not be reproduced except in full and only with the written approval of Prokop Environmental or the client. Our services consist of professional opinions, conclusions and recommendations that are made in accordance with generally accepted consulting standards, principles and practices. Prokop Environmental assumes no liability for any loss, injury, claim, or damages arising directly or indirectly from any use or reliance on this report or the opinions expressed herein. Prokop Environmental makes no risk assessment, warranty, guarantee or insurance policies of any kind, express or implied. Prokop Environmental, LLC 9457 S. University Blvd., Suite 612 Highlands Ranch, CO 80126 720-232-7152 10-17.2353 Rick Rodriguez 4530 Holland Street Wheat Ridge, Colorado 80033 Limitations - Continued: This report was prepared pursuant to the contract, either written or verbal, Prokop Environmental has with the client. That contractual relationship included an exchange of information about the subject property that was unique and between Prokop Environmental and its client and serves as the basis upon which this report was prepared. Because of the importance of the communication between Prokop Environmental and its client, reliance or any use of this report by anyone other than the client, for whom it was prepared, is prohibited and therefore not foreseeable to Prokop Environmental. Findings: The following material(s) were found to contain greater than I% asbestos: • The Texture on the Basement Family Room, Family Room Closet, and Utility Closet Ceilings. This material is categorized as Surfacing, Friable, and in Damaged Condition. Prokop Environmental, LLC 9457 S. University Blvd., Suite 612 Highlands ranch, CO 80126 720-232-7152 10-17.2353 Rick Rodriguez 4530 Holland Street Wheat Ridge, Colorado 80033 HOMOGENEOUS AREA LIST 01 Texture, Tape, Joint Compound, Drywall Basement - Family Room And Closet - Ceilings Surfacing - Friable - Damaged 350 Sq. Ft. 02 Texture, Tape, Joint Compound, Drywall Utility Closet - Ceiling I Surfacing - Friable - Good 50 Sq. Ft. 03 Texture, Tape, Joint Compound, Drywall Bas —�ent - Family Room - Ceiling Patch Area Surfacing - Friable - Damaged <32 So. Ft. SAMPLE SUMMARY CHART Sample 10-17.2353 -0t I C r 1 11 O1 Niaterial Description Texture Sample Location Basement - Family Room - Ceiling Asbestos 4% Chrysotile 10-17.2353 -01 2 01 Paint Basement- Family Room - Ceiling None Detected 10-17.2353 -01 3 01 Drywall Basement -Family Room -Ceiling None Detected 10-17.2353 -02 1 01 Texture Basement - Family Room - Ceiling Positive Stop 10-17.2353 -03 1 01 Texture Basement - Family Room Closet - Ceiling Positive Stop 10-17.2353 -04 1 02 Texture Utility Closet - Ceiling 2% Chrysotile 10-17.2353 -04 2 02 Drywall Utility Closet - Ceiling None Detected 10-17.2353 -05 1 02 Texture Utility Closet - Ceiling Positive Stop 10-17.2353 -06 1 02 Texture Utility Closet - Ceiling Positive Stop 10-17.2353 -07 1 03 Texture Basement - Family Room - Ceiling Patch Area 3% Chrysotile 10-17.2353 -07 2 03 Joint Compound Basement - Family Room - Ceiling Patch Area None Detected 10-17.2353 -07 3 03 Paint Basement - Family Room - ceiling Patch Area None Detected 10-17.2353 -07 4 03 Drywall Basement - Family Room - Ceiling Patch Area None Detected 10-17.2353 -08 1 03 Texture Basement - Family Room - Ceiling Patch Area Positive Stop 10-17.2353 -09 1 03 Texture Basement - Family Room - Ceiling Patch Area Positive Stop Prokop Environmental, LLC 9457 South University Blvd., Suite 612 Highlands Ranch, CO 80126 720-232-7152 Reservoirs Environmental, Inc. Effective January 1, 2015 Reservoirs Environmental QA Manual T:IQAQCILab\Reservoirs Environmental QA Manual.doc REI LABReservoirs Environmental, Inc. November 27, 2017 Prokop Environmenta# 9457 S. University Blvd. #612 Highlands Ranch CO 80126 Dear Customer, Subcontract Numuer: Laboratory Report: Project # / P.O. # Project Description: tv RES 391883-1R 10-17-2353 Rick rodriquez 4530 Holland St Wheatridge CO 80033 Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0 for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American Industrial Hygiene Association (AIHA), Lab ID 101533 - Accreditation Certificate #480 for Phase Contrast Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs respectively. Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The analysis has been completed in general accordance with the appropriate methodology as stated in the attached analysis table. The results have been submitted to your office. RES 391883-1 R is the job number assigned to this study. This report is considered highly confidential and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those of the client. The results described in this report only apply to the samples analyzed. This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full, without written approval from Reservoirs Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any questions about this report, please feel free to call 303-964-1986. Sincerely, LL _) C- � L L CA --i.' 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E £ `> 0 U t-00 Colorado Department of Public Health and Environment ASBESTOS CERTIFICATION* This certifies that Ronald L Davis Certification No.: 22466 has met the requirements of 25-7-507, C.R.S. and Air Quality Control Commission Regulation No. S, Part B, and is hereby certified by the state of Colorado in the following discipline: Building Inspector* Issued: September 29, 2017 Expires: October 07, 2018 * This certificate is valid only with lite possession of a current Division -approved training course certification in the discipline specified above. rized APCD tese tive Rep SEAL Lo co 4—OLOO �aNCN ocL7CQ3LU 4 N coc .0 co 0 T' aa� V C CL U ( C: 4a Co �co � co � a L _ 0 �.,.,� O Co N __ _ Z- 0 Poo � � �� OCi i••► o c rti^a � -�y � t°i NULL t Q L .� Q. �°'n w fi O co �, s Q Q �_� Q C/i O m ivy UNt�' '1 ca co i L a U U rcts —Q D a�i cc E O Ei m m - 2 +s a � c�V m a � � o .°' $ I -t) «, o (17 i U c% -7t: 0 L � � �00 OF CO3_ National Voluntary Ot U\j� Q Laboratory Accreditation Program a4risOt SCOPE OF ACCREDITATION TO ISOJEC 17025:2005 Reservoirs Environmental, Inc. 5801 Logan Street, Suite 100 Denver, CO 80216 Ms. Jeanne Spencer Phone: 303-964-1986 Fax: 303-477-4275 Email: jeanne@reilab.com http://www.reilab.com ASBESTOS FIBER ANALYSIS NVLAP LAB CODE 101896-0 Bulk Asbestos Analysis Code Description 18/A01 EPA 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R-93/116: Method for the Determination of Asbestos in Bulk Building Materials Airborne Asbestos Analysis Code Description 18/A02 U.S. EPA's "Interim Transmission Electron Microscopy Analytical Methods -Mandatory and Nonmandatory -and Mandatory Section to Determine Completion of Response Actions" as found in 40 CFR, Part 763, Subpart E, Appendix A. For the National Volunta rat Accreditation Program Effective 2016-07-01 through 2017-06-30 Page I of i INSPECTION RECORD OCOIIDaDCV/Td .pF- Inspections will not be made unless this card is posted on the building site Call by 3•M PM fn rPrPivA incnarfinn fhA fnllnwinn hllcinnwc dav_ 1 i P(HIR Nil Cnmr.RFTF I INTII ARIIVF HGS RFFN CI(:NFO CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground). Heating (Underground) n(1 N(1T PllI1R FI 11l1R IIUTII ARl1 \/F Hn< RCCN CII�IJCII ROUGHS Sheathing Lath / Wall tie Mid -Roof INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS J OB FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: Footings /Caissons Rough Electric j Stemwall / (CEG) Concrete Encased Ground Rough Plumbing - - —J Reinforcing. or Monolithic Gas Piping - Weatherproof / French Drain Rough Mechanical Sewer Service Lines ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Water Service Lines ..� P(HIR Nil Cnmr.RFTF I INTII ARIIVF HGS RFFN CI(:NFO CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground). Heating (Underground) n(1 N(1T PllI1R FI 11l1R IIUTII ARl1 \/F Hn< RCCN CII�IJCII ROUGHS Sheathing Lath / Wall tie Mid -Roof 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 f F iloing,Final Ire Department -� ).W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND'PUBLICE WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. �'l.ng & Landscaping '.' 1 ,4 om: ALL ITEMS MUST BE COM.PLL TED "ND APPROVED BY PL ANNIN AND :ZONING, BUILDING ANU PUBLIC WORKS, BEFORF. A : °ERTIFICATE OF OCCUPANCY IS ISSUa D. r' VAL 1 ;S(EC710t\ .31< THI fi' ! L DING D V/$ /Old OC ?ES'NOT CONSTITUTE AU HOh'�' ^, R: V ICCUPANCY NOT PE.RVIIT '7C+ UNPI COI r:1 I fit? GF "- UPANICY I`> r1" r" PROTE" I THIS °APD THE r:ATHER i CITY OF WHEAT RIDGE Bung Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: R0.0 (IJob Address: t'; U- t40LLA- Ai t.h 5T Permit Number: 0%-c ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes e No When corrections have been made, call f r~-inspeot/on at 303-234-5933 Dater t? inspector' t 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 Inspection Type: R r�s/ Job Address: V5.° o ® BP5_3c> Permit Number: e9 1 _ `.3.3 t f ,'�- .�r�1?,4 ✓�ia/C �fi'xclr,�c`f7 �✓ ��6'��s� .�r�7'c. 2r ��) �� �oDw` ��s�'.�'� ✓�f ems. � lm�,��.�,��= a,C� t"� el£ �.5 s � �cva�rrr /.7 ,�?1 ir� S.C'�'� T J BZ��✓adG ❑ No one available for inspection: Time AM /PM Re- Inspection required: No * When corrections have been made, call for re- inspection at 303-234-5933 Date: /, 9 Inspecto DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Bung Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: 40 Job Address: Permit Number:.` ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No When corrections have been made, call for re-inspection at 303-234-5933 Date: Inspector: 4446 DO NOT REMOVE THIS NOTICE ...:jute ♦ ♦ CITY OF WHEAT RIDGE Building Inspection Division r (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: 04.C4,F Job Address: yS;2~ - a~~~,tT Permit Number: gM533 1-48U0 4P ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No *When corrections have been made, call for re-inspection at 303-234-5933 Date:/20 fury Inspector: DO NOT REMOVE THIS NOTICE " City of Wheat Ridge Residential Roofing PERMIT - 091533 PERMIT -NO: 091533 '.ISSUED.: .08/21/2009 JOB ADDRESS: 4520-30 Holland St. ...EXPIRES: 02/17/2010 DESCRIPTION: T/o: 'Install 28 sgs..:3 tab Tamko shingles. CONTACTS owner 720/447-2808 JT gC 303/669-9344 Silvestre Cuellar 06-0076 C-S 'Roofing **PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION:. 0243. BLOCK/LOT#: ,0/ FEE SUMMARY ESTIMATED. PROJECT VALUATION: 4,956.00 FEES Permit Fee 144.70 Total Valuation .00 Use Tax 89.21 * .'TOTAL .233.91 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 water shield required from eave edge to 2' inside exterior walls. Subject to field inspection. i hereby certify. that the setback distances proposed by this permit application are accurate, and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown, and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that i assume full responsibility for compliance with the Wheat Ridge. Building Code (I.B.C). and all other applicable Whe Ridge 0 'FInances, for work under this permit. Plans subject to field inspection. Signature of contractor/owner °date 1. This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the state of Colorado and to the Zoning Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable ordinances of the City..: 2.• This permit -shall expire 180 days. from the issue date 'Requests for an extension must be received prior to. expiration date. An extension maybe granted. at the discretion of. the Building Official. 3. If this permit expires, a new permit may be `acquired fora fee of one-half the amount normally required, provided no `changes have been or will be.made ".in the original plans and :specifications and any suspension or.-abandonment.. has not exceeded one (1) year. If changes have been or if suspension or abandonment exceeds one (1) year,... full fees. shall be paid for a new permit. 4. No :work of any manner shall be done that will change the natural flow of water causing a drainage problem. 5. Contractor shall notify the Building Inspector twenty-four (24) hours in advance for.. all. inspections and. shall receive - written approval on inspection card before :proceeding with successive phases of the job. 6. The issuance of a permit or the approval of. drawings and specifications 'shall not be construed to be a permit for, nor an.. approval of, any violation of the provisions of the building codes or any other ordinance, law,. rule or. regulation. All plan revie is ject to field inspections. Signature of i ilding Official date INSPECTI~ REQUEST LINE: (303)234-5933 'BUILDING OFFICE: (303)235-2855 2EEQUESTSG.MUST BE MADE BY 3PM ANY. BUSINESS :DAY FOR INSPECTION THE FOLLOWING. BUSINESS DAY.. oFW"E?rq City of Wheat Ridge Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 oo<olenoo Inspection Line: 303-234-5933 Date: Plan Permit Building Permit Application Property Address; u ~ visa°l ll~~~P S Property Owner (please print): t f Phone:71- 0- Mailing Address: (if different than property address) y7-~ ~ Address: City, State, Zip: Contractor: (f -S Contractor License Phone: 7 J I Sub Contractors, Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Dater Exp. Date: Approval: Approval:: Approval: Use of space (description): L ' G 4C--) F Construction Value: $ Description of Work. (as calculated per the Building Valuation Data sheet) Plan Review (due at time of submittal); $ Sq. Ft./L.Ft added: Squares 2 BTU's Gallons Amps OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate, and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, 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 fief d_Inapgption. - CIRLCE ONE:: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIVE of (OWNER) CONTRATOR) PRINT NAME: S' i de U C.I/SIGNATURE: Date: c2 / G DEPARTMENT USE ONLY ZONING COMMENTS. Zoning: ' Reviewer.: . : r.i PUBCICY}~ORKS COMM'M,EN Ni RQwewer:. - BUILDINGDEPARTMEN7 COMMENJ?$ M " - . OCCUPANCY I E DEPA , TMENT Elapproved AV/ comme(lts O disapproved q ulrCd': ❑ no re Bldg Valuation: $ n: v" "",_,<c~___.,~"""" "'~_"""""'~_,.._..~..."",,,"_..., APT. NO ACTION TAKEN NO S . OFF lANCE OFF BOTH APPl. & METER OFF D METER SHUT OFF - HAZARD - ;; rr1 0 z:: CQllpmON''I'lllE CORRECTED AS SHOWN BELOW CREATES AN IMMEDIATE HAZAR, S e;;;;;PMENT 'sf NOT BfPuy sEtMC~ REP S AND A THOROUGH INSPECTION HAVE BEEN MADE BY A QUALIFIED CONTRACTOR. CONTACT R LOCAL FOR CODE AND PERMIT REQUIREMENTS PRIDR TO PERFORMING REPAIR WORK, --....-J<................_-'-'-".~_.'-'-'-'"__._.,-'-'.__._~.""-'-..:......~-----"__~:_.__;.:..~__."".___.:._.__"~'''''''';'''~----'--.' .,l..__~'--"_'_...c.'-_..c._:,~---,",~__~.......~..