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Home My WebLink About11003-11105 W. 41st Avenuei CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: r Ik� 16, L QD D Job Address: ! � U® 2-:;- YA 41 �;,T j.V f�, Permit Number: k`j ()d;;j4(D2, ❑ No one available for inspection: TimeV Z2AM PM Re -Inspection required: Yes 6Nob When corrections have been made, call f r -inspection at 303-234-5933 Date: 1-1 Inspector: C DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Min V,2Dr- Job Address: 5 W -4 L�SY Permit Number: ��_01-70n4be2, ❑ No one available for inspection: Time U_ V AM/ M Re -Inspection required: Yes No When corrections have been made, call fo re -inspection at 303-234-5933 i )c � Date: Inspector: Vwv.A, DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201709462 PERMIT NO: 201709462 ISSUED: 12/06/2017 JOB ADDRESS: 11003 W 41st AVE EXPIRES: 12/06/2018 JOB DESCRIPTION: Residential re -roof on duplex with Certainteed Northgate IR shingles on main house. Pitch: 4/12 and squares:32. *** CONTACTS *** OWNER (303)726-7771 HILDENBRAND CHRISTOPHER L SUB (303)798-0111 Larry Johnson 150247 Superoofs *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 12,087.00 FEES Total Valuation 0.00 Use Tax 253.83 Permit Fee 251.85 ** TOTAL ** 505.68 *** COMMENTS *** *** CONDITIONS *** Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required for both the midroof and final inspections. The 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec. R806. The installation of ridge venting requires the installation or existence of soffit venting. For calculation purposes, one hat or turtle vent equal to one-half of one square foot of opening. Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. IV, �.®41 PERMIT NO: JOB ADDRESS: JOB DESCRIPTION City of Wheat Ridge Residential Roofing PERMIT - 201709462 201709462 110Q3 W 41st Residential main house. AVE ISSUED: EXPIRES: re -roof on duplex with Certainteed Pitch: 4/12 and squares:32. 12/06/2017 12/06/2018 Northgate IR shingles on 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 theproperty 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 performed an that all hwork to b performe disclosed in this document and/or its' accompanying approved plans and specifications. LAI _-! �� Z t 1 I Zc'`- �'� Signature of OWNER or` "e RACTO � (Circle one) Date I. This permit was issued based on the information 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 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 iss granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicab a or any or or re ulat' n 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. Dina Kemp / From: no-reply@ci.wheatridge.co.us Sent: Tuesday, December 5, 2017 11:44 AM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Dina 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 11003 - 11005 W 41st Avenue Christopher Hildenbrand Property Owner Phone 303-726-7771 Number (enter WITH dashes, eg 303-123-4567) 0S I Property Owner Email Address Do you have a signed contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Contract clhildenbrand@comcast.net Yes Hildenbrand 11003 Roof Contract.pdf CONTRACTOR INFORMATION Contractor Business Name 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 Address (Primary address of your business) My Home Solution Colorado, LLC d/b/a Superoofs 150247 303-947-1608 191 University Blvd., #317, Denver CO 80206 Contractor Email Address Larry@superoofs.com Retype Contractor Email Larry@superoofs.com Address DESCRIPTION OF WORK TOTAL SQUARES of % 32 the entire scope of work: Project Value (contract 12087 value or cost of ALL materials and labor) Are you re -decking the Nod roof? Is the permit for a flat Pitched roof (2:12 pitch or greater) roof, pitched roof, or z 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 Larry Johnson Email not displaying correctly? View it in your browser. both? (check all that apply) What is the specific pitch of the PITCHED roof? How many squares are part of the PITCHED roof? Describe the roofing materials for the PITCHED roof: Type of material for the PITCHED roof: Provide any additional detail here on the description of work. (Is this for a house or garage? Etc) 4:12 32 Certainteed Northgate IR Shingles Asphalt Main House 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 3 RESIDENTIAL ROOFING CONTRACT NO. MHC 17.113 191 University Blvd., #317 Denver, Colorado 80206 www.SUPEROOFS.com 6oiv, " S011T f ON CO. LLL OFFICE: 303.798.0111 FAX: 303.798.5211 SA owner's Name: Owner's Address: Christopher Hildenbrand 9001 W. 38th Ave. Cell � rs -!R Owner's City, State, Zip: Owner's Phone: Owner's Alt. Phone: Wheat Ridge, CO. 80033 303-907-4746 Project Name & Address: Email: 11003 & 11005 W. 41St. Ave. Wheat Ridge, CO. 80033 clhiIden brand @comcast, net I/WE, the Owner(s) of the premises described above authorize My Home Solution Colorado, LLC dba Superoofs, hereinafter referred to as "Contractor", to furnish all materials and labor necessary to roof and/or improve these premises according to the following terms, specifications and provisions: PROPERTY OWNER IS INTENDING TO MAKE PAYMENT FROM THE PROCEEDS OF A PROPERTY AND CASUALTY INSURANCE POLICY. INITIALS a. Scope of Roofing services and Materials to be Provided: Remove 32.00 squares of existing roofing material to clean deck on main dwell- ing; Replace with Certainteed Winterguard Ice & Water Shield on all eaves, valleys & penetrations; Certainteed Diamond Deck syn- thetic underlayment; 2" x4" drip edge on all eaves and rakes; CT Landmark shingles in( ); Shadow Ridge cap; Replace all storm caps and collars, pipejacks and chimney flashings. $12,087.78 _ Owner may upgrade to Landmark lRClass-4 shingles for$704.00 APPROVED DECLINE Al. R&R—Prime&Paint 210 LF Gutter/Downspout-aluminum-up to 5" $1,519.47 A2 Certainteed-4-Star-extended Material warranty and 3-yearWorkmanship Warranty. _-No Charge. SEE CONTINUATION PAGE * ACV & Deductible Due upon -completion ofroof. Depreciation Due_When.receivedfrom Insurer. b. Description of any areas that will NOT be worked on: None This list of specifications may be continued on subsequent pages (see page number below). c. Approximate Costs of the Services for Damage Known at This Time: Contractor will perform the above, (subject to any additions and/or deductions pursuant to authorized change orders), for the Approximate Sum of $116,844.96+Permit Down Payment (if any) $ 12,235.89 * INSURANCE: THIS AGREEMENT IS NULL AND VOID AND DOES NOT OBLIGATE ANY PARTY TO IT SHOULD THE INSURANCE COMPANY REFUSE COVERAGE UNDER THIS CLAIM OR SHOULD THE COVERAGE OFFERED BE INSUFFICIENT FOR CONTRACTOR TO PROPERLY DO THE WORK. THE ONLY COST TO THE PROPERTY OWNER IS THEIR DEDUCTIBLE, PLUS ANY UPGRADES CHOSEN OR ANY NON COVERED ITEMS THAT MUST BE REPLACED TO COMPLETE THE REPAIRS. THE CONTRACT BALANCE (ACTUAL CASH VALUE OF THE WORK) IS PAID BY YOUR INSURANCE COMPANY PER FINAL LOSS INVOICE. ALL PROCEEDS FROM THE INSURANCE COMPANY INCLUDING, BUT NOT LIMITED TO, PROCEEDS FOR SUPPLEMENTAL CLAIMS MADE BY CONTRACTOR ON BEHALF OF OWNER, PROCEEDS FOR PROFIT & OVERHEAD, AND PROCEEDS FOR RECOVERABLE DEPRECIATION, ARE GIVEN IN PAYMENT FOR THE WORK OF CONTRACTOR AND OWNER AGREES TO TIMELY, (WITHIN 24 HOURS OF RECEIPT BY OWNER), REMIT ALL SUCH PROCEEDS TO CONTRACTOR. PER COLORADO SB38, CONTRACTOR SHALL HOLD IN TRUST ANY PAYMENT FROM THE PROPERTY OWNER UNTIL CONTRACTOR HAS DELIVERED ROOFING MATERIALS AT THE RESIDENTIAL PROPERTY SITE OR HAS PERFORMED A MAJORITY OF THE ROOFING WORK ON THE RESIDENTIAL PROPERTY. d. Approximate Dates of Service: Substantial commencement of work shall mean either the physical delivery of materials onto the premises or the performance of any labor and shall be subject to any permissible delays as per provision (S) on the reverse side. Approximate Start Date: Oct 09, 2017 Approximate Completion Date: Oct 13. 2017 e. Acceptance: This contract is approved and accepted. I (we) understand there are no oral agreements or understandings between the parties of this agreement. The written terms, provisions, plans (if any) and specifications in this contract is the entire agreement between the parties. Changes in this agreement shall be done by written change order only and with the express approval of both parties. Changes may incur additional charges. Additional Provisions Of This Contract Are On The Reverse Side And May Be Continued On Subsequent Pages (see page number below). appr ved and ac ped (owner) dat approved and accepted (owner) ap roved (contractor) date CANCELLATION POLICY: Your right to cancel this contract is limited to the following: 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 the attached Notice of Cancellation form for an explanation of this right. Per Colorado SB38, you may also cancel this contract within 72 hours after being notified by your insurer that any part of or all of your claim is denied. See the notice on the reverse side for an explanation of this right. NOTE: This contract may be withdrawn or renegotiated after N/A days from N/A if not approved and signed by BOTH parties. Form RC31-C Copyright @ 1996-2016 ACT Contractors Forms (800) 820-5656 www.calform.com Nage uNt ori_ iotai rages 191 University Blvd., #317 Denver, Colorado 80206 OFFICE: 303.798.0111 FAX: 303.798.5211 Project Owner's Name: Brief Description of Project: Christopher Hildenbrand Storm Restoration Project Address: Project City, State, Zip: 11003 & 11005 W. 41ST. Ave. Wheat Ridge, CO. 80033 CONTINUATION SHEET NO. MHC 17.113 www.SUPEROOFS.com SA f 6bt � iy Cell so -_'7 qLiq — This is a continuation of that certain Contract MHC 17.113 briefly described above between My Home Solution Colorado, LLC dba Superoofs, and the project owner named above which is dated A3. Front Elevation- R&R window screens 1- 9 sf. (4), R&R exterior door - metal -insulated - flush or panel style (2)., Prime & Paint door slab only - exterior (per side)., Detach & reset door lockset (2), R&R Overhead door &hardware - 8'x7' (2), Paint overhead - 2 coats (per side). $2,850.16 A4. Rear Elevation- R&R window screens 1- 9 sf. (3). $129.21 A5. Left Elevation- Scrape the surface area & prepare for paint 72.00 sf., Prime & paint exterior fascia - wood - 4" - 6" wide 72 If., $126.26 A6. Haul debris $132.08 Owner may upgrade to Cr 5 -Star 25/50 Year Warranty for $295.00 APPROVED DECLINE Contractor Liability and Workman's Comp Insurance through Alliance Insurance Agency (720-836-3411 ext 211) * Any Upgrades are Due upon completion with Supplements & Permit due when received by Insuror. Contracto`ror Contractor's Agent sign here Owner sign here rOi m l.D1W1-t. I-Opyngnt W 17yD-LUlb At -I Lonlraciors Corms 16uu) 622} >bbb WWW.caltorm.com Page ONE of Total Pages ♦ 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: feel Aa9 Job Address: Permit Number: dVyl9 d' ❑ No one available for inspection: Time : 30 AM' Re- Inspection required: Yes When corrections have been made, call for re- inspection at 303 -234 -5933 Date: 4? /f JO' ? Inspector• THIS NOTICE INSPECTION RECORD occUDanwlTVne 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. d Q�J �I, \/Q L c r i INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB <FOUNDATION INSPECTIONS DATE INSPECTOR - INITIALS COMMENTS: Footings /Caissons - '..Electrical Service ..`Rough Electric Stemwall /.: (CEG) Concrete Encased Ground '.Gas Piping 'Reinforcing or Monolithic 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 CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. Weatherproof/ French Drain PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED Sewer Service Lines Water Service Lines CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) - DO NOT POUR FLOOR UNTIL AROVF HAS RFFN SIGNFn ..`ROUGHS •:Sheathing 'Lath / Wall tie Mid Roof '..Electrical Service ..`Rough Electric Rough Plumbing '.Gas Piping .Rough Mechanical INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS :SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Avuvi, INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing 'Insulation Drywall Screw ir.. f. lw, IF' ?51 `FINALS :Electrical .Plumbing Mechanical '. R /}? 0 �' 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 CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER III{ ♦ 1 I i CITY OF WHEAT RIDGE Bung Inspection Division r (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 111)6; of Job Address: 1160,3-0s- III-" Fde Permit Number: pe)4111,V 14;VllOUPa' I r ❑ 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: / 2 -t - o q Inspector: _iV DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line p sr (303) 235-2855 Office • (303) 237-8929 Fax I '4 INSPECTION NOTICE Inspection Type: //"//n ./~006 Job Address: //0,'? -US GrlSfll0C Permit Number: Cy4_11alq A No one available for inspection: Time I,S AM/ Re-Inspection required: `es No When corrections have been made, cafi for re-inspection at 303-234-5933 Date: inspector: 'y DO NOT REMOVE THIS NOTICE .sA~voy2g City of Wheat Ridge roooor Residential Roofing PERMIT - 094194 PERMIT NO: 094194 ' ISSUED:i 11/20/2009 JOB ADDRESS:' 11003-05 W. 41st Ave EXPIRES:: 05/19/2010 DESCRIPTION:! Reroof-34 sqs ***.CONTACTS owner 303/726-7771 Colonade Real Estate sub 303/422-2725 Gary Theriaque 02-1170 Bear Brothers Roofing PARCEL 'INFO ZONE CODE: 8/2/0 USE: UA SUBDIVISION: 0190. BLOCK/LOT#: 0/. FEE SUMMARY ESTIMATED PROJECT VALUATION: 11,105.00f FEES Permit Fee ' 272.10 Total Valuation 00 Use Tax 199.89 = s TOTAL 471.99 Conditions: 6 nail installation & mid-roof inspection required.' Board sheathing spaced more thana 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 provideladder(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; thatI 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. X/Cu ci ~~~f -su- 2-V v q Signatur of contractor/ovine date 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. 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'. If this permit expires, a new permit may be acquired fora fee of one-half the amount nokmallv'reouired. Drovided no ew"ejT, City of Wheat Ridge Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 " Fax: 303-235-2857 oQ AOO Inspection Line: 303-234-5933 Building Permit Application Piro pertMi'tress, O 1 Obi - I 1005 w. LII'll` Avf., Property Owner (please print): Mailing Address: (if different than property address) Date: Plan i Permit k Phone:.)O.---~ " Address: iK) '3~// wQ City, State, Zip: ~7~? a t C~GQ L Contrlc': ~jfo-I~hklS ~ODCi n0. Contractor License 0a 11-10 Phone: 3Q3-yea-a-Ja5 $ izl* tactors Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ l I, W 5 040 nptl#t1`0 A1tOTIE' (as calculatedpertheBuildingValuationDatasheet) 11 Tear Orr ' Z11'n rodr- I O3 o -I 1 Plan Review (due at time of submittal): $ 3yo G4F 3oyts Ste, k G rrE Sq. Ft./L.Ft added: - Squares BTU's Gallons Amps 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 subject to field inspection. CIRLCE ONE:: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIVE , TATIVE of (O (CONTRA TOR) PRINT NAME: C40- A 9,U -c SIGNATURE: = U '17