HomeMy WebLinkAbout4120 Jay Streeti CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
t/63 F1.0-tt Elec.
Inspection Type: 310 E MR
Job Address: YQ0 5
Permit Number: DO)o ) 3cq
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes
When corrections have been made, schedule for re -inspection online at:
http //www.ci.wheatridge.co.uslinspection
Date: (G'3�"� `� Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address:
Permit Number: 1 '
❑ No one available for inspection: Tim6--'t' ,-t'_AM/PM
Re -Inspection required&s/ No
When corrections have been made, schedule for re -inspection online at:
http✓/www.ci.wheatridge.co.us4nspcti
Date - Inspecto
City of Wheat Ridge
E -Res. Electrical Service PERMIT - 201902138
PERMIT NO:
201902138
ISSUED:
10/08/2019
JOB ADDRESS:
4120 Jay St
EXPIRES:
10/07/2020
JOB DESCRIPTION:
Electrical upgrade,
200 AMPS in
house and a 50 AMP
sub -panel.
*** CONTACTS ***
OWNER (303)458-5582
MARNIN JAMES ALLEN
SUB (720)381-1767
LOUIS STEPHENS
140291 ABSOLUTE
ELECTRICAL SERVICES
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE:
UA / Unassigned
SUBDIVISION CODE:
2405 / BARTHS, COULEHAN GRANGE,
WHEAT BLOCK/LOT#:
0 /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION:
4,956.00
FEES
Total Valuation
0.00
Use Tax
104.08
Permit Fee
125.05
** TOTAL **
229.13
*** 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 m 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 an authorized to obtain this permit and perform the work described and approved in conjunction with
this pennit. I 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. 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 originalermit 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 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 gra ting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
apble code or 41 ordinance or regulation of this jurisdiction. Approval of work is subject to f any
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 Whoot Ridge
1O/O8/2O19 15f11 CyGA
Electrical upgrad--�j
CDA021739 AMOUNT
8PSP 4120 Jay St 229.13
APPL/P[RMIT NO; 281902138
PAYMENT RECEIVED AMOUNT
PP / 088 229,13
WH CODE: 65175407
T0TAL 229.13
-----------------------
Dina Kem
From: no-reply@ci.wheatridge.co. us
Sent: Tuesday, October 8, 2019 1:53 PM
To: CommDev Permits
Subject: Online Form Submittal: Residential Electrical Service Change/Upgrade Permit
Application
Categories: Dina
Residential Electrical Service Change/Upgrade Permit Application
This application is exclusively for RESIDENTIAL ELECTRICAL SERVICE CHANGE
OR UPGRADE (200 amps or less).
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM 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
electrical service change
or upgrade - 200 amps or
less?
PROPERTY INFORMATION
Property Address 4120 Jay Street
Property Owner Name Jim Marnin
Property Owner Phone 303-803-4526
Number (enter WITH
dashes, eg 303-123-4567)
Attach Credit Card autho form.pdf
Authorization Form -
**DO NOT ATTACH
RANDOM
DOCUMENTS**
CONTRACTOR INFORMATION
Contractor Business Absolute Electrical Services
Name
Contractor's License 140291
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 720-381-1767
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Email Address michelle@absolutefix.com
Retype Contractor Email
Address
DESCRIPTION OF WORK
Is this an electrical
service upgrade or
change?
Number of Amps
Location of
upgrade/change (garage,
house, etc)
michelle@absolutefix.com
Upgrade
200
house
Provide additional details, also adding a 50 amp subpanel
if needed.
Project Value (contract 4956.00
value or cost of ALL
materials and labor)
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 work
may not begin on this
property until a permit
has been issued and
posted on the property.
Yes
Yes
z
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 Michelle Holm
Permit
Email not displaying correctly? View it in your browser.
INSPECTION RECORD
INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/forms.aspx?fid=79
JINSPECT REQUEST LINE: (303) 2%A I34-5933 " 4 4^". 1 4*01 0%, 7C_
Inspections will not be performe les th rd is posted on e project site.
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date
Inspector
Initials
Comments
Pier
Plumbing
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Lath / Wall Tie
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections
Date Inspector Comments
Initials
Electrical
Comments
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
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
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 Piumbing
Final Mechanical
Roof
%
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
"For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage
by the Building Division.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is I*QuPd
'�)r-fect This Card From 7, ll,^P tea- '��
City of Wheat Ridge
Residential Roofing PERMIT - 201702415
PERMIT NO: 201702415 ISSUED: 06/22/2017
JOB ADDRESS: 4120 Jay ST EXPIRES: 06/22/2018
JOB DESCRIPTION: Residential reroof: Remove and replace roofing on house 4/12 pitch, house
patio 1/12 pitch, house -carport 1/12 pitch, dog house 4/12 pitch. 17.33
squares Tamko Heritage 30 year laminateed composition SA Modified bitumen
low slope application 4.58 squares flat
*** CONTACTS ***
OWNER (303)458-5582 MARNIN JAMES ALLEN
SUB (303)340-8979 John Coplan 170282 C Property Restoration
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,924.28
FEES
Total Valuation 0.00
Use Tax 208.41
Permit Fee 204.30
** TOTAL ** 412.71
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) requires an approved inspection
prior to installation of ANY roof coverings and is require on the entire roof when spaced
or board sheathing with ANY gap exceeding k/2 -inch exists. Asphalt shingles are required to
be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is
required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave
and secured in place is required to be provided for all roof inspections. Roof ventilation
is required to comply with applicable codes and/or manufacturera€ms 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's 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.
City of Wheat Ridge
Residential Roofing PERMIT - 201702415
PERMIT NO: 201702415 ISSUED: 06/22/2017
JOB ADDRESS: 4120 Jay ST EXPIRES: 06/22/2018
JOB DESCRIPTION: Residential reroof: Remove and replace roofing on house 4/12 pitch, house
patio 1/12 pitch, house -carport 1/12 pitch, dog house 4/12 pitch. 17.33
squares Tamko Heritage 30 year laminateed composition SA Modified bitumen
low slope application 4.58 squares flat
11 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 1 am the legal owner or have been authorized
by the legal owner of the property and am authorized to btain this permit and perform the work described and approved in conjunction with
this permrss. I further attest that I am leggallxauth ize include all entities named within this document as parties to the work to be
performed and t w rk to be perfo e r is e n this documepf' d/or its' ccompanying approv ns and specifications.
-.-. .,/
- :�� -
Signature of O ER or CONTRA O (Circle one) Date
1. This permit was issued based on the' it5 ormation 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 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 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 shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subj&Ctq field inspection.
Te
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ci.wheatridge.co.us
between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line.
Antoinette Kulick
—)r,4"1 b2- q 15
'gli
From: no-reply@ci.wheatridge.co.us
Sent: Tuesday, June 13, 2017 12:53 PM
To: Permits CommDev
Subject: Online Form Submittal: Residential Roofing Permit Application
Residential Roofing Permit Application
This application is exclusively for new permits for residential roofs and for licensed
contractors only. This type of permit is ONLY being processed online --do not come
to City Hall to submit an application in person. Permits are processed and issued in
the order they are received. YOU WILL BE CONTACTED WHEN YOUR PERMIT
IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME
WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your
contractor's license or insurance has expired, and you may update those
documents at the time you are issued your permit. Permits are currently being
processed within 3-5 business days, subject to change based on volume.
For all other requests:
Homeowners wishing to obtain a roofing permit must apply for the permit in person
at City Hall. Revisions to existing permits (for example, to add redecking) must be
completed in person at City Hall. All other non -roofing permits must be completed in
person at City Hall. The Building Division will be open from 7:30-10:30 a.m.,
Monday through Friday to process these types of requests.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
Property Owner Email
Address
4120 Jay St, Wheat Ridge, CO 80030
Jim Marnin
303-458-5582
jmar254@aol.com
Do you have a signed Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
CONTRACTOR INFORMATION
Contractor Name
Contractor's License
Number (for the City of
Wheat Ridge)
Contractor Phone
Number
C Property Restoration
170282
303-340-8979
Contractor Email Address getmecpr@gmail.com
(permit pick-up
instructions will be sent
to this email)
Retype Contractor Email getmecpr@gmail.com
Address
DESCRIPTION OF WORK
Are you re -decking the No
roof?
Description of Roofing Tamko - Heritage 30 Year Laminated Composition
Material
Select Type of Material: Asphalt, Other (specify below)
If "Other" is selected SA Modified Bitumen Low slope application
above, describe here:
How many squares of the 17.33
material selected above?
Does any portion of the Yes
property include a flat
roof?
If yes, how many squares 4.58
on the flat roof?
z
TOTAL SQUARES of all
roofing material for this
proj ect
Provide additional detail
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract
value or cost of ALL
materials and labor)
21.91
Remove and Replace Roofing on House 4/12 pitch, House
Patio 1/12 pitch, House -Carport 1/12 pitch, Dog House 4/12
9924.28
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full Yes
responsibility for
compliance with
applicable City of Wheat
Ridge codes and
ordinances for work
under any permit
issued based on this
application.
I understand that this Yes
application is NOT a
permit. I understand I will
be contacted by the City
to pay for and pick up the
permit for this property.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have been Yes
authorized by the legal
owner of the property to
submit this application
and to perform the work
described above.
Name of Applicant Scott Crosby
Email not displaying correctly? View it in your browser.
3
Job Address: 4120 Jay St, Wheat Midge, CO 80030
Contact: Jim Marnin Phone: 303458-5582
- .LL_ RCCF11Vb
Prop. No,: 4006 Sheet No.: 17-11631 Date: 6/13/2017
We hereby Propose to Furnish all the materials and Perform all the labor necessary for the completion of>>
1. Remove Ridge Cap: Yes
2. Tear -Off: One Layer(s), Clean -Up and Haul Away.
3. Re -Roof. 30 Year *Lifetime Laminate Color Of Choice TAMKO - Heritage, Painted Desert
4. Other: WE HEREBY PROPOSE TO FURNISH ALL LABOR AND MATERIAL NECESSARY TO REROOF THE ABOVE PROPERTY,
ROOFING SHALL BE PROPERLY INSTALLED IN ACCORDANCE WITH MANUFACTURES RECOMMENDATIONS. ROOFING
INCLUDES ALL NEW GALVANIZED METAL, ALL STEP AND STEP WALL FLASHING REPLACED, ALL NEW ROOF VENTS,
PIPE JACKS, ROOFING UNDERLAYMENT, ICE & WATER SHIELD, DRIP EDGE, ALL FASTNERS NEC. SA MODIFIED AT LOW
SLOPE AREAS.
All work will be performed in a timely, professional manner, meeting all Colorado and City Codes. Material is guaranteed to be as
specified. All work to be completed in a substantial workmanlike manner. For The Sum Of: $9,926.60
With Payments to Be Made As>> For Material: INCLUDED
Completion of Tear -Off: INCLUDED
Completion of Roof: $9,926.60
Completion of #4: INCLUDED
Completion of Gutters: Norte
C Property Restoration hereby referred to as C P R
Any alteration Or Deviation From The Above Specifications Involving Extra Costs Will Become An Extra Charge Over And
Above The Estimate. To Include Any Hidden Layers Needing To Be Removed, To Stay In Compliance With Colorado & City
Codes. ALL Agreements- Contingent, Upon Strikes, Structural Or Accidents Beyond Our Control. Owner To Carry Fire, Tornado
and Other Necessary Insurance. Owner is responsible for the realignment of any satellite dishes once work commences. C P R will R & R (Dishes)
Labor Warranty Does Not Cover Damage To Roofs Due To Settlement, Distortion, Failure Or Cracking Of The Roof Deck, Walls,
Or Foundation. C P R is not responsible for any interior damage or mold below the roof due to leaks by excessive rain, wind, ice dams, hail or preexisting
construction defect during the period of the warranty.
C P R, will not be responsible for damage or mold below the roof due to workmanship leaks if not notified in writing within 24 hours of the first occurence.
1. All Surplus job materials belong to C P R.
2. Purchacer will supply all electricity for work.
1 All monies are due to C P R at the completion of work according to terms and conditions of this agreement.
4. ROTTEN OR DETERIORATED WOOD; We will install approved exterior -grade sheathing (decking) where needed.
no charge or estimate has been made for replacing such rotten wood. If such conditions are founil duping installation, an
additional charge will be made in writing under a separate form. CUSTOMER INITIAL N1 . .
5. CAUTION; New Shingles Will Conform To Any Unevenness of existing deck and or shingles.
6. IF MORE lavers are found; During The installation that are determined by City or County Codes to be removed
an additional charge per layer per (I00sq. ft.) will be over and above the original contract.
CUSTOMER INITIAL
Charge of Permits = Cost. Amount Only Equal To Receipt From City Or County. CUSTOMER INITIA
ABOVE PROPOSAL PRICE GOOD FOR 30 DOS. /All Payments made with credit card will be ged a 3.75% processing fee.
Respectfully Submitted, �fl
>>ACCEPTED> >>DATE rc
15461. Batavia Dr. Ste B, Aurora, CO 80011
303-340-8979 • Fax: 303-340-2079 e getmecpr@gmail.com
i CITY OF WHEAT RIDGE
_:�9rBuilding Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: ! Y► )
Job Address: ) Z_0 _�A\q ST
Permit Number: zl�D 1 "7 OZ q ( S_
❑ No one available for inspection: Time i'ggO ANEf5O
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date: to�ZC�l�� Inspector: 6
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
�(303)
(303) 234-5933 Inspection line 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type:
Job Address:
Permit Number: e
f
❑ No one available for inspection: Time/PM
Re -inspection required: Yes QNo
When corrections have been made, call for re -inspection at 303-234-5933
Date: C / C inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGEpA,1
Building Inspection Division
(303) 234-5933 Inspection line Pi to
(303) 235-2855 Office • (303) 237-8929 Fax Q d 0
INSPECTION NOTICE
Inspection Type: je D
Job Address: y/ 'D -D
Permit Number: :;L b s 7 b "A V/ L
ll; _
❑ 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:
DO NOT REMOVE THIS NOTICE
i
♦ 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: _ /%�er¢L , Pegno1 -
Job Address: Vl.2r 44 te ST
Permit Number: /e"a7oG
r,4,
� � ? /�ZJPX J T / � / j F <�G �e / ' ✓ / .!^ // lYf't�/ //
f � TiT AbF. / f7f/v Cl 3S w 7 \ ✓ � / f 7leL/ �K-f F' ^ ���
h ?,rsv, .5� ifii,E° ✓LS � /SFi�vvf�L� )
❑ No one available for inspection: Time _/ 3S AM/�J/�}
i Re- Inspection required: �s No
"When corrections have been made, calf ff or rr/ re- fnspection at 303:234 -5933
Date: ` io 10 Inspector: `� r
DO NOT REMOVE THIS NOTICE
♦ A i CITY OF WHEAT RIDGE
Building Inspection Division
— rd (303) 234 -5933 Ins P ectiomline
(303) 235 -2855 Office • (303) 237 -8929 Fax
IN NOTICE
Inspection Type: k
Job Address: g1PFD Kati, f
Permit Number: !r 17U
tn)kPin ✓, ko C��l7
No one available for inspection: Time i AM M
Re- inspection required: I Yes No
'When corrections have been made, call for re -ins actin at 303 -234 -5933
Date: Inspector:
DO NOT REMOVE THIS NOTICE
4 4 , City of Wheat Ridge
f Res. Miscellaneous PERMIT - 101706
M PERMIT NO: 101706: ISSUED: 07/07/2010
'JOB ADDRESS: 4120 JAY ST EXPIRES: 01/03/2011
r"DESCRIPTION:. R &R 17 sqs siding; T /o. roofing - install 13 sqs. 30 yr Tamko Di
** CONTACTS * **
Nowner 303/803-4526 Jim '.Marnin..
go 303/340 -8979 02-0420 A Professional Service Co
t ** PARCEL INFO **
ZONE CODE: UA USE: UA
t:it of
Y
heat I Date:
C.OMMUNny Dr.VELOPMEN ii✓ T
Plan #
Building & Inspection Services Division Permit #
7500 W. 29 Ave., Wheat Ridge, CO 80033
Office: 303 - 235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303 - 234 -5933
Building Permit Application
Property AtJdress;, / 7i9
Property Owner (please print): `//����/ Phone36C?�3
Mailing Address: (if different than property address)
Address:
City, State, Zip;
Contractors City License #: Phone: 3 3 �/o
% Contractors:
Electrical: Plumbing: Mechanical:
City License # City License # City License #
5
Descripttoii•otwerka "7 L
Z,,, To '
Contract Value:
// �� "' // 1p�.Y,• �- Review Fee (due at time of submittal):
Squares I BTU's Gallons Amps Sq Ft.
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 work 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 perform the described work
and am also authorized by the legal owner y entity included on this application to list that entity on this application.
CIRCLE ONE (OWNER) (C NTRACTOR or (AUTHORIZED REPRESENTAT /VE) f (CONTRACTOR)
PRINT NAME; �j SIGNATURE: DATE: �I Z °moo
r
,. y ✓": FDE��AR7M�NT�USE OfdLYs s sr ✓ � >n a �
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