HomeMy WebLinkAbout4440-4442 Upham StreetrZ0t7 of
�� V a; + INSPECTION RECORD
PECTION
ONLINE FORM: http://www.ci.wheatridge.co.us/inspection
Cancellations must be submitted
INSPECTION
a the onlin eEo�rm before UEST L8 a m. th03) 234-5933
e day of the inspection
tOccupancy/T
_ypee
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
Pier
Initials Comments
Concrete Encased Ground (CEG)
Foundation/ P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date Inspector
Electrical Initials Comments
Sewer Service
Plumbing
Do Not Cover Under round or Below/In-Slab Work Prior To Approval Of The Above Ins
Rough Inspections Date Inspector
Wall Sheathing ---
Initials Comments
Mid -Roof
Lath / Wall Tie
Rough Electric'
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw / Nail
Final Inspections Date Inspector
Initials
Landscaping &Parking /Planning Dept.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof
Final Window/Doors
Final Building
Comments
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.
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Bui/ding before a Certificate
Of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
*For low voltage permits —Please be sure that rough inspections are completed from the Fire District and electrical low voltage
by the Building Division.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
ons
City of Wheat Ridge
Residential Roofing PERMIT - 201706541
ERMIT N0:
201706541 ISSUED: 08/24/2017
EXPIRES: 08/24/2018
OB ADDRESS: 4440 Upham ST
OB DESCRIPTION: Residential Re -roof to install asphalt shingles - 45 sq
** CONTACTS ***
)WNER (303)424-7378 JAMES STEVE 020371 Jenesis Roofing, LLC
;UB (303)789-1505 Jennifer Petersen
** PARCEL INFO *** USE: UA / Unassigned
SONE CODE: UA / Unassigned
/
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0
** ESTIMATED PROJECT VALUATION: 16,617.00
*** FEE SUMMARY FEES
Total Valuation 0.00
348.96
Use Tax 315.25
Permit Fee 664.21
** TOTAL **
*** COMMENTS ***
*** CONDITIONS***
Effective December 1, 2014, asphalt shingle installations require an approvedriorr
oof
to final
inspection, conducted when 25-75 percent of the roof covering is installed, p
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,
lon ocsimilar
whichever is more stringent. In order to pass a final insoval f romthemanufacturertechnical
type roof coverings, a letter of inspeec
ction and app
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.
f ins ections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd
Roo p
party inspection report will be collected at final roof inspection performed by City o
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: (409- �7, ,, a )
Job Address: f-1 I-1 o USS A ^ m S4
Permit Number: 'D 0 1-7 p &5"-q I
0
❑ No one available for inspection: Time 1-1) r PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303 -234 -
Date: If 110 l Inspector: - r—b
DO NOT REMOVE THIS NOTICE
M
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: (-1 0 9 - r--.
Job Address: L% L-/ 0 D ,A -7-
Permit Number: 'a o f "7 v (. 5 --Lf I
r001 I 11/ 04-
a
V e sc-) f. V .
❑ No one available for inspection: Time `l = aS QPM
Re -Inspection required: (Yje No
When corrections have been made, call for re -inspection at 303-234-5933
Date: ) a )/72 Inspector: -T/b
DO NOT REMOVE THIS NOTICE
71M Mriv_
N 0
_R INC.
1125 S. tipan Street Denver, CO 80223
PROPOSAL/CONTRACT
Phone 303-789-1505 Fax 303-789-0830
THIS AGREEMENT AND CONTRACT BETWEEN JENESIS ROOFING INC
DATE: 08/11/17
NAME: Steve James
ADDRESS: 4442 Upham St.
CITY, STATE Wheat Ridge, Co. 80033
HOME PHONE: 303-424-7378
WORK PHONE:
EMAIL ADDRESS: sajames@msn.com
JOB LOCATION: Same
HEREINAFTER CALLED CONTRACTOR AND:
t.
r
THE ABOVE, HEREINAFTER CALLED PURCHASER, PROVIDES FOR PERFORMANCE BY, CONTRACTOR OF THE WORK STIPULATED BELOW BY THE TERMS AND CONDITIONS SET
FORTH BELOW. CONTRACTOR AGREES TO PERFORM THE WORK DESCRIBED BELOW FOR THE CONSIDERATION INDICATED BELOW. PURCHASER AGREES TO ASSIGN AND BY
SIGNATURE BELOW DOES HEREBY ASSIGN TO CONTRACTOR ALL RIGHTS PURCHASER HAS IN ANY INSURANCE SHOULD SOME BE AVAILABLE TOWARD THE PAYMENT OF WORK
PERFORMED BY CONTRACTOR NOT TO EXCEED THE AMOUNT OF THIS CONTRACT PRICE. SAID ASSIGNMENT SHALL NOT RELIEVE PURCHASER OF HIS OBLIGATION TO PAY IN
FULL PER THE TERMS AND CONDITIONS OF THE CONTRACT.
RE -ROOFING ESTIMATE
• Remove one layer of existing of exiting roofing materials to wood decking on house and 2 sheds.
• Remove and replace decking on ridge.
• Remove all existing gutters and downspouts,
• Install 2x2 pre painted metal drip edge per the city of Wheat Ridge codes.
• Install ice and water shield per the city of Wheat Ridge codes.
• Install 30 pound underlayment.
• Install Owens Corning Storm shingles with #4 impact rating.
• Color of new shingles: TBD
• High wind nail shingles.
• Install new pipe flashing around all plumbing pipes.
• Install new attic vents like existing
• Install new pre painted step flashing. Install all new gutters and downspouts like existing.
• Color of new gutters and downspout:
• Magnetic sweep of yard and complete clean-up of trash and debris after job completion.
• Dump fees and permit are included.
• All materials, taxes, insurance, permits and labor are included.
• Five year full workmanship guarantee.
• ADDITIONAL WORK: Full payment is due on completion.
THIS QUOTE IS GOOD FOR 30 DAYS: AND IS SUBJECT TO MANAGEMENT APPROVAL.
Upon completion of work by contractor purchaser agrees to pay the sum of $16.617.00
Put chasets property y contractor, nis ager DAMAGE: Should purchaser become aware of damage to
or employees ounng a course roofing wore set ortabove. said damage s a i be broug to ne a ention of the Contractor in writing prior 10 the time of payment for
the roof in question. N Purchaser fails to notify Contractor in writing of said damage, within 5 working days of occurrence then Purchaser shall waive ail rights against Contractor, his agents, or employees concerning
said damage. Not responsible for concrete damage.
DELAYS: Purchaser hereby acknowledges that Contractor may be subject to delays occasioned by acts of God including but not limited to inclement weather, labor disputes. and material supply shortages which are
beyond the control of the Contractor and Purchaser hereby accepts any delays occasioned by one or all of these circumstances in the instaliation of his roof. Purchaserfurther agrees to pay to Contractor an amount
equal to 10% of the total contract price as liquidated damages should Purchaser cancel his contract for any reason prior to Contractors initiation of work on Purchasers roof.
THIRD PARTIES: It is agreed that Contractor shall not be responsible, nor shall any warranty extend to, any damages to the property subject of this agreement caused by third parties. INTEREST: Purchaser expressly
agrees that Contractor shali be entitled to interest at the rate of ten (10°!,) percent per annum on any past due amounts owed by Purchaser to Contractor under terms of this contract.
ATIORNEY FEES: In the event it becomes necessary for Contractor to hire an attorney to collect any amounts due under this agreement. Purchaser agrees to pay Contractor reasonable attorney fees
ENTIRE AGREEMENT: This Agreement contains the entire agreement between the parties hereto with respect to the matters to which it pertains, and may be ammended only by written agreement signed by
Purchaser and Contractor and by reference made as part hereof.
I HAVE READ THIS AGREEMENT. UNDERSTAND ITS TERMS. AND ACC ITS RIGHTS AND OBLIGATIONS.
PURCHASERS SIGNATURE 9
DATE
AUTHORIZED SIGNATURE _Ray DeLarber.
DATE 08/11/17
1125 S. Lipan Street
Denver, Co 80223
Phone 303-986-5080
Fax 303-986-6119
r City of Wheat Ridge
Residential Roofing PERMIT - 201706541
PERMIT NO: 201706541 ISSUED: 08/24/2017
JOB ADDRESS: 4440 Upham ST EXPIRES: 08/24/2018
JOB DESCRIPTION: Residential Re -roof to install asphalt shingles - 45 sq
*** CONTACTS ***
OWNER (303)424-7378 JAMES STEVE
SUB (303)789-1505 Jennifer Petersen 020371 Jenesis Roofing, LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 16,617.00
FEES
Total Valuation 0.00
Use Tax 348.96
Permit Fee 315.25
** TOTAL ** 664.21
*** 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.
City of Wheat Ridge
. st
Residential Roofing PERMIT - 201706541
PERMIT NO: 201706541 ISSUED: 08/24/2017
JOB ADDRESS: 4440 Upham ST EXPIRES: 08/24/2018
JOB DESCRIPTION: Residential Re—roof to install asphalt shingles — 45 sq
I, byy ;si
ggnaturedohereby attest that the work to be performed shall comply with all accompanying approved plansandspecifications,
appiuilding esand all appicablemunicipalcodes,poiciesand procedures, and thatamthe galowner orhavebeen authorized
bythal wn o the pertyand am authorzed toobtain this permitand performthe work described and approved in conjunction with
this pe a atIamlegallyauthorizedtoinclude all entities named within this documentaspartestothework to be
perfo ork to be performed is disclosed in this document and/or its'�ccompanying approved plans and specifications.
Sign re `of OWNER or CONTRACTOR (Circle one) Ddte ✓
1, This permit was issued based on the information provided in the permit application and accomanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. Thispermit 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 originalhermit 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 !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 Chi �icial ° — 0 Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dane Lovett ( 0 l 7 D 6�� l
From: no-reply@ci.wheatridge.co.us
Sent: Tuesday, August 22, 2017 11:35 AM
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)
4440-4442 Upham St
Steve James
303-424-7378
133
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
NA
Yes
4440-4442 Upham St.pdf
CONTRACTOR INFORMATION
Contractor Business
Jenesis Roofing
Name
D
Contractor's License
020371
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)
303-789-1505
1125 S Lipan St
Contractor Email Address rosalie@jenesisroofing.com
Retype Contractor Email rosalie@jenesisroofing.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of 45 /
the entire scope of work:
Project Value (contract16617.00
value or cost of ALL
materials and labor) -
Are you re -decking the No
roof?
134
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
45
OC TD Storm
Asphalt
Includes 2 sheds.
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
135
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 Rosalie Garcia
Email not displaying correctly? View it in your browser.
136
CITY OF WHEAT RIDGE
_��9�Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
Inspection Type:
INSPECTION NOTICE
Job Address: 11`"✓e l� i / z I " S,
Permit Number: .e-1
-wj
Ll No one available for inspection: Time AM/P`
Re -Inspection required: Yes ( o
When corrections have been made, call for re -inspection at 303-234-5933
Date: 11.1 Inspector: �
DO NOT REMOVE THIS NOTICE
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CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: s:w.`l Q4g>~-
Job Address: yyYo - (12 Lj PW,4,w ST
Permit Number: /dv W2
~Pa'Ra~rf r~
,
❑ No one available for inspection: Time /,0 PM
Re-inspection required: Yes No
When corrections have been made, calf for re-inspection at 303-234-5933
Date: Inspector:
DO NOT REMOVE THIS NOTICE
INSPECTION RECORD OccupanDV/Tvpe
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.
K tit
I NSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS J OB
FOUNDATION INSPECTIONS DATE INSPECTOR COMMENTS:
'INITIALS
Footings /Caissons !
Stemwall./ (CEG) Concrete
Encased Ground
Reinforcing or Monolithic
Weatherproof / French Drain
Sewer Service Lines
Water Service Lines
`POUR No CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- 'CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
Heating (Underground)
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGHS
Sheathing
`.
Lath /Wall tie
Mid -Roof ' ; �s �r lam
Electrical Service
Rough Electric
Rough Plumbing
:. Gas Piping.: ..
Rough Mechanical
ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING -
t ming ulation wall Screw
I-.INALS
Electrical
Plumbing
Mechanical '>
Roof
Building Final
Fire Department
R.O.W &Drainage INSPECTIONS FOR PLANNING S ZONING, FIRE AND PUBLICE WORK
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 1S. ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION.
OF.A:CERTIFICATEOF OCCUPANCY NOR PERMISSION FOR OCCUPANCY.
vl.l.Ul:"ANL;Y. IYL) PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
PROTECT THIS CARD FROM THE WEATHER
a
A s CITY OF WHEAT RIDGE
° Building Inspection Division
f~ (303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: &iZ i=
Job Address: Mo oP1-X&,o4 s7-
Permit Number: /OO VV2
'Poe
f'.4i1C?,SJ`,~1}' rZrr*.1'~ isv f✓1//~c~l./i~ K~L9 /S ~iN/~
.al~s6~rJJFl7
❑ No one available for inspection: Time , 3ra A
j Re-Inspection required: Yes /No
"When corrections have been made, calf for re-inspection at 303-234-5933
Date: ,~llr Inspectors
DO NOT REMOVE THIS NOTICE
a `e CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234~5933 Inspection line
(303) 235-2855 office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: set€f1,✓c~'
Job Address: IIYYr? 4,V&,4-nom, :7-
Permit Number: i~ra (f5 ,2
~+f
i
f
c
❑ No one available for inspection: Time fF' c7 AM)PM
Re-Inspection required: Yes No
When corrections have been made, call for re-inspection at 303-234-5933
Date: ~hU1ia Inspector:T ~
DO NOT REMOVE THIS NOTICE
x
City of Wheat Ridge
Homeowner Roof PERMIT -
100452
PERMIT NO:
100452 ISSUED:
02/17/2010
JOB ADDRESS:
. 4440 UPHAM ST EXPIRES:
08/16/2010
'
DESCRIPTION:
Remove and replace 38.sgs. pf`asphalt shingles
and redeck
FEE SUMMARY ESTIMATED PROJECT
FEES
=it Fee X181.10
=it fee 'additiona 157.51
>tal valuation .00
;e Tax 121.07
TOTAL X459.68
r
{oF wRrR, City of Wheat Ridge Building Division
o;„a. m 7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-235-2857
Inspection Line: 303-234-5933
OLORA~
Property Owner (plei
Mailing Address: (if different than property address)
Address:
Date:1.7 to
Plan
Permit 14052,
City, State, Zip:
IWN2cv
Contractor License Phone:
1=6;-C hkcd`dka
Electrical City License
Company:
Exp. Date:
Plumbing City License
Company
Exp. Date:
Mechanical City License
Company:
Exp. Date:
Use of s ace (descri tion): 1 Construction Value: $
p r'
INA J') ~y~ as calculated per the Building Valuation Data sheet)
NiC p l 0
14, c~ ('py~Qtii J/ L Plan Review (due at time of submittal): $
Sq. FL/L.Ft added: Square BTU's Gallons Amps
OWNEWCONTRACTOR 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 1 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 REPRE UNTATIIVV/EE of WNER) (CONTRATOR)
PRINTNAME: SIGNATURE: of
Dal
Building Permit Application