HomeMy WebLinkAbout3975 Miller CourtCity of Wheat Ridge
Residential Roofing PERMIT - 201703457
PERMIT NO: / 201703457 ISSUED: 07/07/2017
JOB ADDRFSS: 3975 Miller CT EXPIRES: 07/07/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration Brownwood 30 year
asphalt shingles with 33 sq.
*** CONTACTS ***
OWNER (303)420-3821 HUITT J GALEN / HUITT HELEN AN
SUB (303)660-5133 Chris Horning&Christopher Teem 140211 Priority Restoration Inc.
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE. UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT*: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,000.00
FEES
Total Valaation 0.00
Use Tax 189.00
Permit Fee 188.45
** TOTAL ** 377.45
*** 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 one half 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 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 Lhe
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.
`1,g AJ 1,?K INSPECTION RECORD
1�
INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection
INSPECTION REQUEST LINE: (303) 234-5933
Occu nnc /T e
lliq C , _—]
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 Comments
Initials
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date Inspector
Initials
Comments
Electrical
Comments
Sewer Service
f 7
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections
Date
Inspector
Initials
Comments
I Sheathing 0 t
f 7
J �-
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 Plumbing
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 Issued
Protect This Card From The Weather
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 o
Job Address: 3 9'75 7 lu
Permit Number: 7 t z i b-� y S-2
� � t r- til F4 it MC
< Tn, .r .0 - ( h .— „ / - 4
❑ No one available for inspection: Time 2 /")AM/PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date: V 7 Inspector: -
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: J"
Job Address': 7 9 7 M; I if
Permit Number: p l'7 3 VS, 7
AI-) A('I-DfvUY_n
❑ No one available for inspection: Time �� AM/PM
Re -Inspection required: Yes No
When corrections have been mace call_,#or re p�ction at 303-234-5933
Date: Inspebor : Y
DO NOT REMOVE THIS NOTICE
CITY OF WHEAT RIDGE ;
Building Inspection Division:.,
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: M lk 1D h t
Job Address: 2 2 `7
Permit Number: i
't
1
❑ No one available for inspection: Time 1 I AM/PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
j
Date: `" l' Inspector:
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: 1`n
Job Address: R '7S" r�h i 1 IVB,
Permit Number: -a, o f -) p --S w S -7
Nd� �lpxa��n.
1�
❑ N6,,one available for inspection: Time% y AM/PM
Re -Inspection regairEd: Yes No
When corrections have been made, Cain re -inspection at 303-234-5933
Date: Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 201703457
PERMIT NO: 201703457 ISSUED: 07/07/2017
JOB ADDRESS: 3975 Miller CT EXPIRES: 07/07/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration Brownwood 3(; •yea:
asphalt shingles with 33 sq.
**REVISION***ADD REDECKING ***$1500
*** CONTACTS ***
OWNER (303)420-3821 HUITT J GALEN / HUITT HELEN AN
SUB (303)660-5133 Chris Horning&Christopher Teem 140211 Priority Restoration Inc.
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,500.00
FEES
Total Valuation 0.00
Use Tax 220.50
Permit Fee 220.15 L __
** TOTAL ** 440.65
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved r:_: F
inspection, conducted when 25-75 percent of the roof covering is installed, pr----,
approval. Installation of roof sheathing (new or overlay) requires an approved
prior to installation of ANY roof coverings and is require on the entire roof when _; a :i
or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are
required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice arc;
water shield is required. Eave and rake metal is required. A ladder extending 3 Feet
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 inspec�iL,n
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
Residential Roofing PERMIT - 201703457
PERMIT NO: 201703457 ISSUED: 07/07/2017
JOB ADDRESS: 3975 Miller CT EXPIRES: 07/07/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration Brownwood 30 year
asphalt shingles with 33 sq.
**REVISION***ADD REDECKING ***$1500
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the roperty and am authorized to obtain this permit and perform the work described and approved in conjunction with
this permit. I furthe s hat I am legally authorized to include all entities named within this document as parties to the work to be
performed an all wk to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
,S' ure o OWNER or CONTRACTOR (Circle one) Date
1. 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 maybe subject to a fee equal to one-half of the original ermit 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 gr f a rin s c nstrued to be a permit for, or an approval of, any violation of any provision of any
applicable code y r r jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS NUST BE NADE BY 11:59PH ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of
- Wheat"
ge
COMMUNiTy DEVELOPMENT
FOR OFFICE USE ONLY
Date:
Add to Permit #
Building & Inspection Services Division
7500 W. 29"' Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 *Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: permits(c�ci.wheatridge.co.us
Building Permit Revision/Amendment Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address:
Owner
Property Owner Email:
Mailing Address: (if different than property address)
Address:
City, State, Zip: I-,
Submitting Company:
Contact Person:
Contractor: C! ��Y� Dj Poi � L1
,G'f - -�> Phone: L[ZZ- ru42 S'_
Phone:
Contractors City License #: Do 3 Lf Lf Phone:
Contractor E-mail Address:
Please Note: Additional valuation must include all general and subcontracted work to be performed
related to the revisions and/or amendments declared in the description of work and which were not
included in the original permit valuation.
If revisions or amendments increase the original valuation, additional fees will be due at the time of
approval. Depending on the scope of work, additional plan review fees may be due upon approval
($60.00 an hour — 2 hour minimum).
Description of revised/amended work:
Sq. Ft./LF
Amps
Btu's
Squares
Gallons
Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
$ �
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 1 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 of any
entity included on this application to list that entity on this application.
CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
PRINT NAME: . )A,,
44 SIGNATURE S DATE: 7 -19,13 -
DEPARTMENT
113
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received ❑ Not Required
Water District ❑ Received ❑ Not Required
Sanitation District ❑ Received ❑ Not Required
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
City of Wheat Ridge
" Residential Roofing PERMIT - 201703457
PERMIT NO: 201703457 ISSUED: 07/07/2017
JOB ADDRESS: 3975 Miller CT EXPIRES: 07/07/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration Brownwood 30 year
asphalt shingles with 33 sq.
*** CONTACTS ***
OWNER (303)420-3821 HUITT J GALEN / HUITT HELEN AN
SUB (303)660-5133 Chris Horning&Christopher Teem 140211 Priority Restoration Inc.
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 /
*** MI. ("
FEE SUMMARY *** ESTIMATED PROJECT VALUATION: � ,
FEES
Total Valuation 0.00 ---
Use Tax 189.00
Permit Fee 188.45
** TOTAL ** 377.45
*** 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 one half 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 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
Residential Roofing PERMIT - 201703457
PERMIT NO: 201703457 ISSUED: 07/07/2017
JOB ADDRESS: 3975 Miller CT EXPIRES: 07/07/2018
JOB DESCRIPTION: Residential Re—roof to install Owens Corning Duration Brownwood 30 year
asphalt shingles with 33 sq.
I, by my signature, do hereby attest that the work to be perfonned shall comply with all accompanying approved plans and specifications,
applicable building codes, aid all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this permit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be
perfonned and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
r,.
ZSignatw6 of `OWNER or CONTRACTOR (Circle one) Date
1. 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 writingand
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.
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 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 subject to field inspection.
awl
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.
Dan Schultz
PO R 0 _;5 4 c��7
From:
no-reply@ci.wheatridge.co.us
Sent:
Monday, June 26, 2017 2:50 PM
To:
Permits CommDev
Subject:
Online Form Submittal: Residential Roofing Permit Application
Categories: Danny
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 Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
3975 Miller Court
Helen Huitt
303-420-3821
Property Owner Email
chrishorning@priority-restoration.com
Address
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
Priority Restoration Inc.
Contractor's License
140211
Number (for the City of
Wheat Ridge)
Contractor Phone
3033499792
Number
Contractor Email Address
chrishorning@priority-restoration.com
Retype Contractor Email
chrishorning@priority-restoration.com
Address
DESCRIPTION OF WORK
Are you re -decking the
No
roof?
Description of Roofing
Owens Corning Duration Brownwood 30 year shingles
Material
Select Type of Material:
Asphalt
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
30
material selected above?
Does any portion of the
/
No t/
property include a flat
roof?
If yes, how many squares
Field not completed.
on the flat roof?
0)
TOTAL SQUARES of all 33 V
roofing material for this
proj ect
Provide additional detail House roof, 4/12 pitch
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract 9000.
value or cost of ALL
materials and labor)
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 Christopher Horning
Email not displaying correctly? View it in your browser.
3
CUSTOMER AGREEMENT
Email
7340 South Alton Way 11-J, Centennial, CO 80112
Phone: 303-650-5133 1 Fax. 303-660-5148
Email: lnfo@Priarity-Restoration.com
rsNWIT%
BBR'Web.
www.Pdorily-Restoratjon.(;om105W
IORITYE.�
Priority Estimator
Restoration
I ir1pnqPH P. lnct irpri - i orallv Owned & Operated
insurance Co p�any
6 1-- A A
roperty Owner
Email
Date
I'? , / —4
treet Address
Priority Estimator
.
-6ity, State, Zip
insurance Co p�any
6 1-- A A
Tome Phone IJ
31S4
Work Phone
Claim#
C) G I or
0 No Deposit Req fired* R1 20 Year Roof Labor Warranty 0 Gen. Liability/Workers'ComP. 0 OSHA Certified
Estimated Estimated UWL"t. B Full partial Repair
�ap'6��e 6 1 WW
Start Date Completion Date kUg
Start
Ful Partial Repair Damage: Yes 8:
) PATIO (%��(SHED2 '
HOUSE G STUCCO YL WO OTHER:
Shingle/ color Style: jai Repair
Drip Edge Color: 16W Full Parr
inspect Decking 21 Inspect Flashings 6" - Comm. Alum. Steel
Clean Up & Remove Trash 0 �--It 141�1 11� color: Permit 1--�
M
Work to be completed according to the above specifications in the amount of:
not to include insurance supplements. rrriit costs or any unforeseen construdlon costs $ to
[ Balance due upon completion [I CASH SALE I
pursuit
AGREEMENT The homeowner authorizes Priority Restoration, Inc. to represent their best interest in
it of full replacement costs for damages believed to be covered under homeowner's insurance and allows Priority
Restoration, Inc. to deal directly with the insurance company regarding this claim. This contract does not obligate the
homeowner or Priority Restoration, Inc. until the claim is approved by the insurance company, and accepted by Priority
Restoration, Inc. Upon approval of claim, Priority Restoration, Inc. will complete all specified work at a price agreeable to
the insurance company (RCV only) and Priority Restoration, Inc, with no additional cost to the homeowner except for the
deductible. Final agreed upon price will become the fir, at contract price, regardless of estimated contract price above, and
we request that all payments also be made payable to Priotity Restoration, Inc * "Priority Restoration, Inc. will hold in
trust any payment from property owner until we have delivered roofing materials to the jobsite or until a majority
of the roofing work has been performed."
I (Wel c19ree, by signhV bel6w, to all the contract condifim oon both front and back, of this, agreement.
— j
Homeowner's Sig
njture: Representative signature:
A
N
♦ i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5,933 Inspection line
(303) 235 -2855 Office • (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type: o ��
Job Address: 7Sr'
Permit Number: In r 197
e No one available for inspection: Time !,' A !PM
` Re- Inspection required: Yes " No
When corrections have been made, call for re -Insp ction at 303 -234 -5933
Date: Inspector:
DO NOT REMOVE THIS NOTICE
s
City of Wheat Ridge
PERMIT NO: 101
5` JOB ADDRESS:'. 397
DESCRIPTION: Rer
* ** CONTACTS
LVN UZU7 a`.BLO
JMMARY ** :'ESTIMATED >PROJE
FEES
lee 272.10
iluation .00
214.74
4Ar RA
IS:
05/12/2010
11/08/2010
)76 Mills Roofing Co. /Decker Lane
�.� �••��•+ .•.... +. ..+++ ... -u.!y ui ,�rv.cuvi ovo lav riuu !utfi Cv1C 11VJ Y8U11VN 1R8 C VLLVW11V lz YSUJ INSJS LHY.'
d e d City of
.� W heat �idge Date:
COMMUNITY DEVELOPMENT
Plan #
Building & Inspection Services Division permit # ( f
7500 W. 29 Ave., Wheat Ridge, CO 80033 1
Office: 303 - 235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303 - 234 -5933
Building Permit Application
Property Atictress 3 n 7 � � /yi /�-4.� iZ, c /^
Property Owner (please print)`. Phone: a
Mailing Address: (if different than property address)
Address:
City, State, Zip:
- GJ /f,Lr97Z(7G C �
Contractors City License M Phone: 30 2 3 2 .0 —7 y
Sub Qontractors
Electrical: Plumbing: Mechanical:
City License # City License# City License #
�esirtptlo�is`i'F work°
?Lr2o c' o rC A � ,<k, ltlr /7C4 icy v
ontra
C 21:
3 � Review Fee (due at time of submittal):
Squares 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 of any entity included on this application to list that entity on this �application.
CIRCLEONE: (OWNER) (CONTRACTOR)or (AUTHORIZEDREPRESENTATIVE OWNER) ( rVTRACTOR)
PRINTNAME: SIGNATURE: DATE : 411X /
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