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HomeMy WebLinkAbout9725 W. 38th Avenue7 0706Z%� q725L,(3cbtA #,e, INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Occupancy/Type 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 Sewer Service i Mid -Roof Lath / Wall Tie Rough Electric Concrete Encased Ground (CEG) Plumbing I Foundation / P.E. Letter Do Not Pour Concrete Prior To ADnroval Of The Ahevp IncnE►r_tinne Underground/Slab Inspections Date Inspector Comments Initials Electrical Sewer Service i Mid -Roof Lath / Wall Tie Rough Electric Plumbing Rough Plumbing/Gas Line Do rvox Cover Underground or Below/in-5iab Work Prior To Approval Of The Above Insp actions Rough Inspections Date Inspector Comments Initials Wali Sheathing i Mid -Roof Lath / Wall Tie Rough Electric -i-- Rough Plumbing/Gas Line i+ Rough Mechanical Rough Framing Rough Grading Insulation Drywall Screw/ Nail Final Inspections Date Inspector Initials Comments Landscaping & Parking / Planning Dept. Inspections from these entities should be requested one week in advance. For landscaping and parking inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection / Fire Protection Dist. Final Electrical Final Plumbing Final Mechanical Roof 0 , 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 dues not constitute authorization of occupancy. 1 VI IW- ,,W COU0 PE riIlLS — riease ue sine uiat rougn inspections are compietea Trom the Fire uistrict and electrical low voltage by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather City of Wheat Ridge Residential Roofing PERMIT - 201706273 PERMIT NO: 201706273 ISSUED: 08/17/2017 JOB ADDRESS: 9725 W 38th AVE EXPIRES:• 08/17/2018 JOB DESCRIPTION: Residential Re -roof to install CertainTeed Landmark asphalt shingles - 42 sq *** CONTACTS *** OWNER NEUMAN ERIC SUB (303)425-7531 John Borfitz 019983 J & K Roofing Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 17,817.00 FEES Total Valuation 0.00 Use Tax 374.16 Permit Fee 331.10 ** TOTAL ** 705.26 *** 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) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, orae hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be providers for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: t-- 10 4�,L r-,cxj ' Job Address: `'j 125 !29�)74 %.VE-- Permit Number: ❑ No one available for inspection: Time C1 M/ M Re -Inspection required: Yes No When corrections have been made, call fo -inspection at 303-234-5933 Date: Ili `5 i I I Inspector: 4n C_ ykj,� DO NOT REMOVE THIS NOTICE A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: -5,0 " ( D Job Address: Permit Number: -701-70-62,22) 14 19 Va*__ C,76w L erFL ,I,No one available for inspection: Time IT. . 1U AIV Re -Inspection required: Yes No When corrections {have been made, call for :T:tion at 303- 34-5933 Date: l rr / Inspector: t DO NOT REMOVE THIS NOTICE A City of Wheat Ridge Residential Roofing PERMIT - 201706273 PERMIT NO: 201706273 ISSUED: 08/17/2017 JOB ADDRESS: 9725 W 38th AVE EXPIRES: 08/17/2018 JOB DESCRIPTION: Residential Re -roof to install CertainTeed Landmark asphalt shingles - 42 sq *** CONTACTS *** OWNER NEUMAN ERIC SUB (303)425-7531 John Borfitz 019983 J & K Roofing Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 17,817.00 FEES r y Total Valuation 0.00 t, Use Tax 374.16 Permit Fee 331.10 ** TOTAL ** 705.26 *** 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) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. , A City of Wheat Ridge Residential Roofing PERMIT - 201706273 PERMIT NO: 201706273 ISSUED: 08/17/2017 JOB ADDRESS: 9725 W 38th AVE EXPIRES: 08/17/2018 JOB DESCRIPTION: Residential Re—roof to install CertainTeed Landmark asphalt shingles — 42 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 I l 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 ermit I further attest that I am le horized to include all entities named within this document as parties to the work to be performed and that all work to be is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER or CONTRACTOR JCircle one) Date 1. This permit was issued based on the infonnation 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 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 issua or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any applica a co or any ordin or r ala on of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett �,01 7062 79 From: no-reply@ci.wheatridge.co.us Sent: Tuesday, August 15, 2017 4:30 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Follow Up Flag: Follow up Flag Status: Completed Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Duplex are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) 9725 & 9735 W. 38th Ave Eric Neuman 303-489-8538 �z6 Property Owner Email Field not completed. Address Do you have a signed Yes contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed neuman contract.pdf Contract CONTRACTOR INFORMATION Contractor Business J & K Roofing Name Contractor's License 019983 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-425-7531 Number (enter WITH dashes, eg 303-123-4567) Contractor Address 13000 W. 43rd Dr., Golden Co 80403 (Primary address of your business) Contractor Email Address kathyv@jkroofing.com Retype Contractor Email kathyv@jkroofing.com Address DESCRIPTION OF WORK TOTAL SQUARES of 42 the entire scope of work: Project Value (contract17817 value or cost of ALL materials and labor) Are you re -decking the No roof? 2 Does the scope of the project include a flat roof (less than 2:12 pitch)? Does the scope of the project include a pitched roof (2:12 or greater pitch)? How many squares are part of the pitched roof? Describe the roofing materials for the pitched roof: Type of material for the pitched roof: Provide any additional detail here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) No / Yes 42 CertainTeed Landmark Asphalt House - Pitch 4/12 & 6/12 SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work may not begin on this property until a permit has been issued and posted on the property. Yes Yes Yes 3 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. Name of Applicant Kathy Vendegna Email not displaying correctly? View it in your browser. Aug 11 17 05:11p Henson Properties, Inc. tjUji /UU-ftUbC N. 1 IL IMP_tifdn 1. X f1�C�r"FSGr� �'�o CONTRACTjf rd j�® A. J&K Roofing 13000 W. 43rd Drive • Golden, CO 80403 Phone: 303-425-7531 Fax: 303-425-1562 www.ikrooling.com C1 t ' 3v 3 - z% 72 - Q Date— 20� i_l t Contact - �� — Phone _�'3- `7�`!- FS7 3email •.ri5Cd1 _ — Name T— 9'L_V� S 7}q- 9737 " a ��Z. CityWa Wl,� pis zlp Address - ---- Pinnace) Assurance Cincinnati Specialty Underwriters 303-653-0023 303-361-4000 General Liability Insurance Workers Compensation Insurance Policy #CS00061742 Policy 1+4079290 LA80R AND MA ERIAL SPE IFICATI NS TERMS, Extra work AND CONDITIONS-PL,�ASE READ CAREFULLY: P.Lf k�•�/ Ji C�:3a2:a?L y s � Recove rOOt with,e5 Color of shingles ___s�'4•!'lY"i %S Manufacturer's Warranty 1- � 4 -JAN it!_ ------- V'Tear off `_j 1G (d! J.,w.kaSf✓• Install Underlayment .v-ck,, Double all Eaves �!« _. Re -Flash Chimney and/or Skylights - 4 New Valleys •�_ w':a. �' � z j� 4Replace Ridge - — ZfVentilation re VAA Ca ._ .Z{ Galvanized Fastoners_}rtGL Plumbing Jacks •V Paint roof stacks to match' ]i ` yvuJ .nn irVp }� �s cc, C:.f.%v�. The property owner is is not— using proceeds from property and casualty insurance policy. Deductible if applicable $� c 0 d State Law CRS§6-22-105 which states• 100% Metal Edging U✓� �Lj! _14 �[ Install___ ►' g g Per Colora o the responsibility of the homeowner to pay this amount J & K Patio or Flat roof_N� �'- - Roofing will not reimburse or promise to reimburse in whole or in part any amount of the deductible. Year Warranty on labor ^-� chi J & K Roofing to furnish all material and tab�--�- - Estimated Start Date Permit: ,t }j�CL1 Included _ NOT Included i ✓1 `, r� �C TOTAL ESTIMATE $ ©� • `��� — Mclean -up debris and haul off all trash from roof- ALL PROPOSALS ARRJECT TO MANAGEMENT _SWAPPROVAL Roll yard with magnetic roster Xr Gutters cleaned of rooting debris ,7j Decking Repairs S r peT i ti _ J&K Representativ - Hidden Layers (tear oft) $ t __— per layer _ _Date__ ! Homeowr r - - �- /p ,cmX-i – { •� �j,�/ 1Pol:cy Numlx:rl p Homeo - tea — -- 4Adjuaior Cta,m �__ _---- Date------+` --'- ticatyage Cc,} lmongage Lwn MIMI"") Expiration .1�__- You have the right to recind this contract and obtain a full refund of any deposit within 72 hours after entering the contract. If you plan to use the insurance to pay for the roofing work, you may rescind this contract within 72 hours after receiving Proceeds from a property and casualty policy written notice from your insurance carrier that your claim has been denied In whole or in part. However, J&K Roofing is entitled to retain payments or with standard roofing practices. deposits to compensate for roofing work actually performed In a workmanlike manner consistent PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION ♦ i CITY OF WHEAT RIDGE Building Inspection Division 4 00 0 (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE � Inspection Type: `� '^ Job Address: l2, -3P Lam), ?P Permit Number: 01-7cb 7 7Q El No one available for inspection: Time / A iPM `. Re- Inspection required: Yes o r When corrections have been made, li for re-Inspection a 303 - 234-5933 k. FN Date: Inspector: DO NOT REMOVE THIS NOTICE SEP -15 -2010 14:55 From: 6115 Ben Ploce, Suite A Boulder, CO 80301 303 -449 -5176 303 -449 -8473 Fax TO: ' n1tLL r I WJ.-4 — L ) ,.,&f FROM: PHONE: RE: CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Cornrnents: 'DDB, TAMT oq 1LOIF - PKIMT pF, mT use - 1 DATE: m CITY Of WHEAT RIDGE 09/15/10 2:45 PM cdha Daniel J. Zahtila RECEIPT HO:CDA005031 AMOUNT BPSP Rereof 54 sqs 117.85 091698 Extend Expired Perri 117.85 BPSP Reroof 37,5 sqs with 145.15 094379 Extend Expired Perri 145.15 BPSP Reroof 43 sqs 245.25 094577 Extend Expired Perwi 245.25 , PAYMENT RECEIVED AMOUNT MC 0482 508.25 Auth Code: 096413 TOTAL ---------------------------------------- 508.251 i " ' City of Wheat Ridge .� Faxed Roof Permit PERMIT - 094379 PERMIT NO: 094379 ISSUED: 12/10/2009 JOB ADDRESS: 9725 -35 W. 38th Ave EXPIRES: 12/31/2010 DESCRIPTION: Reroof 37.5 sqs with 30 yr Tamko shingles H &G * ** CONTACTS * ** owner 303/730 -1251 Benson Properties sub 303/449 -5176 Tim Black 01 -9440 Black Roofing, Inc. ** PARCEL INFO ** ZONE CODE: UA USE: UA SUBDIVISION: UA BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 12,665.00 FEES Extend Expired Permi 145.15 Permit Fee 290.30 Total Valuation .00 Use Tax 227.97 ** TOTAL ** 663.42 Conditions: Both front and back of permit need to be posted on job site. If one or the other is not present, INSPECTION WILL NOT BE PERFORMED. 6 nail installation & mid -roof inspection required. Board sheathing spaced more than a 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield required from eave edge to 2' inside exterior walls. ** *Contractor /Property owner shall provide ladder(s) secured in place for inpsections. 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 Wheat Ridge Ordinances, 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 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 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. S. Contractor shall notify the Building Inspector twenty -four (24) hours in advance for all inspections and shall receive written approval on inspection card before proceeding with successive phases of the job. 6. The issuance of a permit or the approval of drawings and specifications shall not be construed to be a permit for, nor an approval of, a violation of the provisions of the building codes or any other ordinance, law, rule or regulation. All plan v' subject to field inspections. Signature o Chi Building Official date INSPECTION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. i CITY OF WHEAT RIDGE Building Inspection Division r (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE' Inspection Type: .P/_ Job Address: 7 ? - ,3a Aag Permit Number: f 9'y'✓ 7 7 F ❑ No one available for inspection: Time GU �ykpM i Re- Inspection required: Yes No When corrections have been made, call for re- inspection at 303 - 234 -5933 i Date: Inspector n, DO NOT REMOVE THIS NOTICE ♦ I4' CITY OF WHEAT RIDGE ~-j Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office. • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: - . Job Address: 9J~ 0).. Permit Number: - L ❑ No one available for inspection: Time G AM/P Re-Inspection required: Yes IfVo *When corrections have been made, call for re-inspection at 303-234-5933 i Date: Inspector: ;L V DO NOT REMOVE THIS NOTICE INSPECTION RECORD Occupancy/TVp INSPECTION LINE: (303) 234-5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS I DATE I INSPECTOR I COMMENTS: INITIALS Footings/Caissons Stemwall / (CEG) Concrete Encased Ground Reinforcing or Monolithic Weatherproof / French Drain Sewer Service Lines Water Service Lines CONCRETE SLAB FLOOR Plumbing (Undergroun, Heating (Underground) ROUGHS Lath / Wall tie Mid-Roof Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical HAS UNTIL ABOVE INSPECTIONS TO BE SIGNED PRIOR T Framing CITY OF WHEAT RIDGE Insulation 12/10/099 9:48 All edba Drywall Screw Daniel 7. Zahtila I_ FINALS RECEIPT NO:CDA063422 AMOUNT PPSP Reroof 37.5 sqs with 518.27 Electrical _ 094379 Permit Fee 290.30 Plumbing ";Use Tax 227.97 Mechanical -PAYMENT RECEIVED AMOUNT Roof MC 0482 518.27 Auth Code: Building Final 046087 - TOTAL 518.27 Fire Department R.O:W & Drainage - - INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS Parking & Landscaping SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. `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 CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED ♦~~41 /{City of -(2 hea-t-~ge Date: COMMUNITY DEVELOPMENT Permit#: ~~~OF Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 " Fax: 303-237-8929 Inspection Line: 303-234-5933 Facsimile Building Permit Application Property Address.:; Property Owner (please Mailing Address: (if different than property address) Address: '56}( & 14 _ city, state zip: Lf Tfil t ~i~ l n6166 Contractor: Contractor License n t ~~-(5 Phone: l '44q- ,517G, Sub Contractors: Company Name: License Expiration Date: Trade/Profession: Approval: Use of Space (description): Description of work: OWNERICONTRACTOR 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 subj o ie ction. CIRLCE ONE:: (OWNER (CONTRACTOR or PERSONAL REPRESENTATIVE of rN,ER) (CONTRATOR) PRINT NAME: I e- SIGNATURE: t- VIYG Date: i~ avoy Sq. Ft./L.Ft added: Squares37Z BTU's Gallons Amps Credit Card Payment: Use credit card listed on file am : 4 111 Jam ° C:SF> I Print name: f-I6,KI l~i 6110A~ Signature: rl/LYG 'zA