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Home My WebLink About4600 Garland Streeti CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: L10 L r— Job Address: q C-00 < l017 S � Permit Number: "2017 0 Fy l oo a L)No one available for inspection: Time PM Re -Inspection required: Yes 0 When c(io7;7 ave been made, call for re -inspection at 303-234-5933 Date:1orre Inspector: NO 7--b DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Mechanic PERMIT - 201708562 PERMIT NO: 201708562 ISSUED: 10/24/2017 JOB ADDRESS: 4600 Garland ST EXPIRES: 10/24/2018 JOB DESCRIPTION: Permit to remove and replace 3 ton A/C unit like for like, 13 seer. *** CONTACTS *** OWNER (303)467-0163 SISSON KATHLEEN A SUB (303)487-5157 Shannon Monahan 160018 Service Experts *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,575.00 FEES A/C Replacement 60.00 Total Valuation 0.00 Use Tax 75.08 ** TOTAL ** 135.08 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R314, smoke detectors are iequirFd to be installed in every sleeping room, in hallways outside of sleeping rooms, and ori ✓ery level of the structure. 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 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 alp entities named within this document as parties to the work to be perfrmed and that all work to be pe formed is disclosed in this docume and/or its' accompanying approved plans and specifications. _.0,00 -- / Signatur of OWNER or CONTRACTOR (C11' 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 Bui Iding 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 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 pmmit 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 f regulation of this jurisdiction. Approval of work is subject to ield inspection. 4 , q Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. I FOR OFFICE USE ONLY City of Date: WheatR dge COMMUNI f Y L)LVL:LOPMLN r Plan/Permit# Building & Inspection Services Division e) 0 1,7 7500 W. 291h Ave., Wheat Ridge, CO 80033 Plan Review Fee: Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: Property Owner (please print): k, �j��-�1 Q,Q S + S�p t1 Phone:5 - j2j Property Owner Email: Mailing Address: (if different than property address) Address: 1L_)C0Y _L City, State, Zip: Architect/Engineer: Architect/Engineer E-mail: Phone: Contractor: V Contractors City License #:J Phone: "rJ71—� 3fl� Contractor E-mail Address:"'q1 Sub Contractors: Electrical: ft) �_ Ejtl'+ jC W.R. City License # Other City Licensed Sub: City License # Plumbing: W.R. City License # Vi Other City Licensed Sub: City License # Mechanical: W.R. City License # Complete all information on BOTH sides of this form Description of work: (Check all that apply) ❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE ❑ NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING ❑ COMMERCIAL ADDITION ❑ RESIDENTIAL ROOFING ❑ RESDENTIAL ADDITION ❑ WINDOW REPLACEMENT ❑ COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) ❑ RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) MECHANICAL SYSTEM/APPLIANCE REPAIR o ACEVID1Tj PLUMBING SYSTEM/APPLIANCE REPAIR or R MEN I ❑ ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT ❑ OTHER (Describe) (For ALL projects, please provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc.) a4 ,l � -}b tori 4/C or' J_/ Sq. Ft./LF Amps Btu's Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) JJ 1 �" 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. CIRCLE ONE:(OWNER)R C ,A^CTO) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)9 V41OLo PRINT NAME: �.(' SIGNATURE: ( DATE: l !�'1177 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 DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION Rnilrlit+n r\i�iicinn \/al�.a{: n..• Q s City of Wheat Ridge Residential Roofing PERMIT - 201705547 PERMIT NO: 201705547 ISSUED: 08/07/2017 JOB ADDRESS: 4600 Garland ST EXPIRES: 08/07/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline Laminate asphalt shingles with 22sq ( 20sq pitched & 2 flat) Remove existing roof down to deck, replace with laminate shingles, ice and water shield and all applicable flashings. *** CONTACTS *** OWNER (303)467-0163 SISSON KATHLEEN A SUB (303)888-4884 Rupert Lona 150282 Little Wing Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,500.00 FEES Total Valuation .00 P 1"' Use Tax 1366.50 Permit Fee 156.75 ** TOTAL ** 293.25 *** COMMENTS *** *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. A City of Wheat Ridge Residential Roofing PERMIT - 201705547 PERMIT NO: 201705547 ISSUED: 08/07/2017 JOB ADDRESS: 4600 Garland ST EXPIRES: 08/07/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline Laminate asphalt shingles with 22sq ( 20sq pitched & 2 flat) Remove existing roof down to deck, replace with laminate shingles, ice and water shield and all applicable flashings. I, by my signature, hereWe ttest h th work to, be performed shall comply with all accompanying approved plans and specifications, applicable building odes,all a p cab municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner f the prty am thorized to obtain this permit and perform the work described and approved in conjunction with this permit. I furth attestI a 1 ally authorized to include all entities named within this document as parties to the work to be performed and tha all worbe a orm d is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OJNE�Y oY CONTRACTOR (Circle one) Date 1. This permit w sued based on the information provided in thepermit application and accompanying Flans 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 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 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 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 f any inspection. Signature of Chief Building Official V Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY, Dan Schultz From: no-reply@ci.wheatridge.co.us Sent: Monday, July 31, 2017 9:16 AM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Gina ^' 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 v 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? 1 I )w� /� / J "% PROPERTY INFORMATION `, -/J M Property Address 4600 Garland t Property Owner Name Kathy Sisson Property Owner Phone 303-467-0163 Number Property Owner Email kathyasisson@gmail.com Address On �. ;s Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. Attach Copy of Contact Sisson, Kathleen Contract.pdf CONTRACTOR INFORMATION Contractor Business Name Contractor's License Number (for the City of Wheat Ridge) Contractor Phone Number Little Wing Roofing 150282 303-888-4884 Contractor Email Address support@littlewinggc.com Retype Contractor Email support@littlewinggc.com Address DESCRIPTION OF WORK Are you re -decking the No roof? / Description of Roofing GAF Timberline Laminate shingle Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: / How many squares of the 20 Squares material selected above? Does any portion of the Yes property include a flat roof? If yes, how many squares 2 on the flat roof? TOTAL SQUARES F2) (pitched + flat) of all 2 roofing material for this project 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) Remove existing roof down of deck, replace with laminate shingles, ice and water shield and all applicable flashings. 6500.00 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 Damon Lona Email not displaying correctly? View it in your browser. 3 LITTLE WING GENERAL CONTRACTORS 10343 Federal Blvd #1447 Little Wing Westminster, CO 80260 General Contractors Phone: 303-888-4884 • Fax: 303-200-8856 E -Mail: support@littlewinggc.com www.littlewinggc.com �.: .� A � ulaamc� ti Ma:, 1, c o . 14l5oa. e Mom o erHome Ph. Cell Ph. f3p-144,- 1to3 3a3z5-aj-�a8 Oa t '�Y?%:� Zo Addres City State a Ii Code ko6-3 Insurance Co /y% Damage Storm Date `\Y Insurance Ph. Clam t5 / 2—+ J �f/ ADJUSTER APUIfv�NT`DE&TIME •(may j PLEASE CALL/� IMMEDIATELY! ✓� ^��/ PHONE: 2b ;(!CJt( 2- 2 -0—x 14 elf -3H � SPECIFICATIONS Roof 6/0)`0, 30 bw� T4 Install felt underlayment �+ Replace vents gear workmanship warranty] Replace valleys 19 Tear -off existing shingles and/or fiatA001 Replace drip edge ' l Approximate date of service: �� tpproximate cost of services: l U)0 Labor furnished by Little Wing General Co tractors 0 Permit furnished by Little Wing General Contractors Materials furnished by Little Wing General Contractors VClean-up and haul -off of roofing trash All work to be completed per insurance estimate k6 This Agreement is void if not approved by the insurance company N5womeowner authorizes L GC to receive a copy of the insurance estimate �J Homeowner authorizes LWGC to represent them during the adjustment for this claim. HO initials �5 process. HO initials I.-s— INSURANCE ALLOWANCE AGREEMENT I/We, the Homeowner(s), agree to retain Little Wing General Contractors (LWGC) to act as our restoration contractor to complete the full insurance scope of repairs on the property aforementioned, contingent upon LWGC obtaining the insurance company's approval and payment to have said work done. We give LWGC the right to speak with our lawyer, public adjuster, or third party estimator regarding our claim. It is understood and agreed that LWGC is to contact my insurance carrier and meet with their representative in order to discuss the repair or replacement work to be done to the property. Upon the insurance carrier's and LWGC's agreement to the extent of the damages and cost of fixing them, LWGC may begin work on said property. The Homeowner's out-of-pocket expense will not exceed the deductible amount, unless upgrades - including code -required upgrades that are not covered by insurance - are added. The Homeowner also agrees to provide all necessary documentation for the claim (also providing all pertinent documentation to facilitate payment from the insurance carrier and/or mortgage company). LWGC reserves the right to file for supplemental claims due to material and/or labor increases due to a storm environment and/or if insurance measurements are proven to be incorrect. Roofing contractors are prohibited by law from paying, waiving, rebating, or promising to pay, waive, or rebate all or part of any insurance deductible applicable to an insurance claim made to the property owner's property and casualty insurer for payment for roofing work on the residential property covered by a property and casualty insurance policy, per C.R.S.6-22-101(c). RIGHT TO CANCEL: if this Agreement is signed at a residence, and the Homeowner does not want materials and/or services, the Homeowner may cancel the contract and obtain a full refund of any deposit within 72 hours after entering the contract. The Homeowner may also cancel the contract within 72 hours after receiving written notice from the Insurance Company that the claim for roofing work on the property is denied in whole or in part. All payments for this agreement will be made out to Little Wing General Contractors. LWGC shall hold in trust any payment from the Homeowner until LWGC has delivered roofing materials at the residential property site or has performed a majority of the roofing work on the residential property. By signing this Agreement, it is understood and agreed that LWGC and/or LWGC's insurer will be held harmless for alleged or actual damages/claims as a result of mold, algae or fungus. It is understood that LWGC and its insurers will exclude all coverage, including defense, damages related to bodily injury, property damage and clean-up caused directly or indirectly or in whole or in part for any action brought by mold, including fungus and mildew, regardless of cost, event, material, product or workmanship that may have contributed or in any sequence to the injury or damage that occurs. In witness where of Buyer(s) acknowledge(s) receipt of a completed copy of this Agreement on the day and year written below. 1/WE have read, understood, and accept the terms included on the front and back this Agreement. s /0 CUSTOMER SIGNATU !*.. ........... ..._t DATE:,....Z., LWGC REP'S SIGNATURE ....... .................................. DATE: S.....�............... A 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: �1 Job Address: gboo 6f Permit Number: 20 ) i 0 5-15-5/2 ❑ No one available for inspection: Time 15111 AM/PM Re -Inspection required: Yes N When corrections have been made, ca for re -inspection at 303-234-5933 Date: -?)/)5 I Inspector: DO NOT REMOVE THIS NOTICE INSPECTION RECORD' O��unanovRvpe 'INSPECTION LINE (303) 234 -5933 FINALS 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. Plumbing Mechanical INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS J OB FOUNDATION INSPECTIONS DATE INSPECTOR ...COMMENTS:. INITIALS Footings /Caissons Fire Department Stemwall / (CEG) Concrete Encased Ground R.O.W &Drainage Reinforcing or Monolithic INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICS WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Parking & Landscaping -... '. 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 Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing Insulation Drywall Screw FINALS Electrical Plumbing Mechanical Roof Building Final Fire Department R.O.W &Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICS 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 'RLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING: n' =6UTHORIZATION OFA CERTIFICATEOF OCC UPANCY I- �- - CUPANCY NOR PER OCCUPANCY NOT PERMITTED UNTIL CFr Pmn Twi(z r ♦ 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: Job Address: yl >() Permit Number: f ❑ No one available for inspection: Time AM /PM Re- Inspection required: Yes No I When corrections have been made, call for re- inspection at 303 - 234-5933 Date: 11 116 Inspector: DO NOT REMOVE THIS NOTICE ♦ 7 CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION N TICE Inspection Type: Job Address: 6-c?Ooe~lrwc.C-i Permit Number: 1 Co(}3S~ ❑ No one available for inspection: Time E '0-7 _ M/ M Re-Inspection required: Yes *When corrections have been made, call f"-1 nspection at 303-234-5933 Date: _ l U Inspector: DO NOT REMOVE THIS NOj ICE of ""E?Tq City of Wheat Ridge Building Division Date: 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Plan A oo<oRPO° Inspection Line: 303-234-5933 /ClC' Permit ) Building Permit Application PropertyArJdress: 1-46600 Y- Property Owner (please print): is Sn hl Phone: 3C '7 Mailing Address: (if different than property address) Address: State, Contractor: OV R2icn,~ Poye Contractor License c> q h Phone: 303 3i(- i 3 Sub Contractors: Electrical City License Company: Plumbing City License Company Mechanical City License Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): 1->eas L2z o~ [!Construction Value: $ `i 700 of work: s tabulated per the Building Valuation Data sheet) 011.eQ. j k r e. r-V N e.,;, M 8i i L k.DC- t Plan Review (due at time of submittal): $ 3Cya- iFlmtie 3 w mom, Sq. Ft./L.Ft added: Squares BTU's Gallons Amps 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 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 of (OWNER) (CONTRATOR) PRINT NAME: rrTr=0 'r'7,s T o n.,\ yAj-1,i k. SIGNATURE: %v. 24, in 1.+~r Date: -i 0 d Bldg Valuation: $