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HomeMy WebLinkAbout4695-4697 Hoyt StreetINSPECTION RECORD Inspection online form: http://www.ci.wheatridge.co.us/inspection Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Inspections will not be performed unless this card is posted on the project site Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business day PERMIT: A,/ -tb= ADDRESS: JOB CODE: Foundation Inspections Date Inspector Initials Comments 102 Caissons / Piers 103 Footing/ P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation �. Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector Initials Comments 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. �. 206 Water Underground / ) Do Not Cover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector Initials Comments 301 Rough Framing 302 Wall Sheathing 303 Roof Sheathing 304 Sheer Inspection 305 Insulation 306 Mid -Roof / ) 307 Metal / Lath / Stucco 308 Rough Electrical Residential 309 Rough Electrical Commercial 310 Electrical Meter Residential 311 Electrical Meter Commercial 312 Temp. Const. Meter 313 Rough Plumbing Residential 314 Rough Plumbing Commercial 315 Shower Pan SEE OVER FOR ADDITIONAL INSPECTIONS ADDRESS: JOB CODE: �Ir Rough Inspection (continued) Date Inspector Initials Comments 316 Rough Mechanical Residential 317 Rough Mechanical Commercial 318 Boiler / Furnace 319 Hot water tank 320 Drywall screw and Nail 321 Moisture board / shower walls 322 Rough Grading 323 Miscellaneous [ L Final Inspections Date Inspector Initials Comments 402 Gas Meter Release 403 Final Electrical Residential 404 Final Electrical Commercial 405 Final Mechanical Residential 406 Final Mechanical Commercial 407 Final Plumbing Residential 408 Final Plumbing Cornnnercial 409 Final Roof [ L 410 Final Window/Door 411 Landscape/Park/Planning* Inspections from these entities shall be requested one week in advance. *For landscaping and parking inspections please call 303-235-2846 **For ROW and drainage inspections please call 303-235-2861 ***For fire inspections please contact the Fire Protection District for your project. 412 Row/Drainage/Public Works' 413 Flood plain Inspection' 414 Fire Insp. / Fire Protection*** 415 Public Works Final** 416 Storm Water Mgmt.** 417 Zoning Final Inspection* 418 Building Final Inspection 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 by the Fire District and Electrical low voltage by the Building Division. I A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax tI/NSPECTION NOTICE Inspection Type: laq- -na I Roof Job Address: 9 6 R 7 1 S Permit Number: 2 of )0 ❑ No one available for inspection: Time q1 3J AM%PM Re -Inspection required: Yes (No When corrections have been made, call for re -inspection at 303-234-5933 Date: 3/1 gljj Inspector: lan'p— L'Oyf�i 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: M - Job Address: y (© �i'7 fl . + Permit Number: aC>1 0 D U Z �2 ❑ No one available for inspection: Time cV �J MC�M Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: j i j l� Inspectors f DO NOT REMOVE THIS NOTICE A City of Wheat Ridge Residential Roofing PERMIT - 201800559 PERMIT NO: 201800559 ISSUED: 02/28/2018 JOB ADDRESS: 4697 Hoyt ST EXPIRES: 02/28/2019 JOB DESCRIPTION: Residential re -roof on both sides of duplex main roof with Tamko Heritage 30 asphalt shingles. Squares:34; Pitch: 4/12 *** CONTACTS *** OWNER 303-425-5049 CASEY PENA SUB (720)314-2846 Roger Peterson 020791 PHI Homes Inc. *** 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: 14,088.63 FEES Total Valuation 0.00 Use Tax 295.86 Permit Fee 283.55 ** TOTAL ** 579.41 *** COMMENTS *** *** CONDITIONS *** Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required for both the midroof and final inspections. The 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec. R806. The installation of ridge venting requires the installation or existence of soffit venting. For calculation purposes, one hat or turtle vent equal to one-half of one square foot of opening. Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. �4 PERMIT NO: JOB ADDRESS: JOB DESCRIPTION City of Wheat Ridge Residential Roofing PERMIT - 201800559 201800559 4697 Hoyt ST Residential re -roof on both sides 30 asphalt shingles. Squares:34; ISSUED: 02/28/2018 EXPIRES: 02/28/2019 of duplex main roof with Tamko Heritage Pitch: 4/12 I, by my signature;.do hereby attest at thework.to.be performed shall comply with all accompanying approved plans and specifications, applicable buil�tingtcodes, and'all a Jieable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner'of the propertacid am authorized to obtain this permit and perform the work described and approved in conjunction with thispennit. fuser attest tiTat l`ai legally authorized to include all entities named within this document as parties to the work to be performed ndIhat all work t .b6 performed is disclosed in this document a7272-VI r 'ccompanying approved plans and specifications. Signature of a R or • NTRACTOR (Circle one) D to I, This permit as issued based on the information provided in the permit application and accompanying dans and specifications and is subject to compliance with those documents, and all applicable statutes, ordinances, regulations, po plans 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 pe it shall not be construed to be a permit for or an approval of, any violation of any provision of any applicable code or any ordma or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Officihl Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Al �Ot)5S7 Dina Kemp From: no-reply@ci.wheatridge.co.us Sent: Wednesday, February 28, 2018 2:23 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Dina Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Duplex are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) 4697 Hoyt Street Kazimierz Pena 303-425-5049 Property Owner Email fhotv6@gmail.com Address Do you have a signed Yes contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Pena Re-Roof.pdf Contract CONTRACTOR INFORMATION Contractor Business Name Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone Number (enter WITH dashes, eg 303-123-4567) Contractor Address (Primary address of your business) Contractor Email Address Retype Contractor Email Address DESCRIPTION OF WORK PHI Homes Inc 020791 720-314-2846 11953 W 56th Circle roger. phi. homes@gmail.com roger. phi.homes@gmail.com TOTAL SQUARES of 34 the entire scope of work: Project Value (contract 14,088.63 value or cost of ALL materials and labor) Are you re -decking the No roof? Is the permit for a flat Pitched roof (2:12 pitch or greater) roof, pitched roof, or 2 both? (check all that apply) What is the specific pitch of the PITCHED roof? How many squares are part of the PITCHED roof? Describe the roofing materials for the PITCHED roof: Type of material for the PITCHED roof: 4:12 34 Tamko Heritage 30 Antique Brown Asphalt Provide any additional both sides of duplex main roof detail here on the description of work. (Is this for a house or garage? Etc) SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this Yes application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work Yes may not begin on this property until a permit has been issued and posted on the property. I certify that I have been Yes authorized by the legal 3 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 Roger Peterson Email not displaying correctly? View it in your browser. 2/27/2018 PHI Homes, Inc Roger Peterson 11953 W 56th Cir 720-314-2846 Arvada, CO 80002 roger.phi.homes@gmail.com Contract Agreement Owner/Agent Kazimierz Pena Phone 303-425-5049 Property Location 4697 Hoyt Street Wheat Ridge, CO 80033 PHI Homes will re -roof property based on American Family Insurance claim number 00225198683 with added changes for missing items and code compliance as described in summary below: Roofing line items total on claim detail 11,607.56 Supplements on Roofing 1. Add for Ice and Water shield (2 Ft Overhang and wall width requires 1.5 rows on conditioned eaves to meet code) 151 Ft total. Note: Garage Roof not conditioned and is not required to have Ice and Water Shield. 679.5 sq ft Price 1.65 ITax 20.71 1 1,141.88 2. Add step Flashin 56 ft I Price 8.79 ITax 5.60 1 497.84 3. Add for Increasing Roof Ventillation, See Tables on Page 2 11 EA Soffit Tprice 36.50 includes cut in labor ITax 7.61 409.11 8 EA Turtle jPrice 52.83 with Cut in ITax 9.60 432.24 Total Supplement on Roofing 2.481.07 Category Totals 14,088.63 Roofing Permit Fee before Use Tax 283.55 Contract Total 1 14,372.18 Warranty The roof shall have a five (5) year fully transferable workmanship warranty The roof material shall have a limited lifetime warranty as described by Manufacturer Terms and Acceptance of Agreement Terms PHI Homes will provide material and labor to complete the Restoration for the sum of Fourteen Thousand -Three Hundred -Seventy -Two and 18/100 Dollars ($14,372.18) to be paid as follows: On Compi ion orwt tomer satisfaction. PHI s Inc Owner/Agent < - wig Z12-8118 Signe ate Signed date Claim# 00225198683 Page 1 of 2 FOR OFFICE USE ONLY City of Date: *qgl Commti t i it Lt i t EN plan1pormit Building & Inspection Services Division Z- 7500 W. 29' Ave., Wheat Ridge, CO 80033 Plan Review 303-235-2555 " : 303-237-8929 Inspection Line: 303-234-5933 Building it Application . m (if dfferent than property address) Address: 2!! Y, Mate; z'r :960 3 rctt rr r art:phoh : t Electrical: Plumbing: Mechanical: WA. City License # W.R. City License # W.R. City License Cather City Licensed Sub: Other City Licensed Sub: City License # City License t 1m 1111Ir r i is T-141,111MI _ W + u._ ♦ d A MMM 1 M 1 1 'M � M.. M 1 ni oT matenais to oe Asea, etc.)5,Cw - i,i, p .sc._� J 39' 41 rt 54 r Sq. FULF Btu's Gallons Amps Squares Other INSPECTION RECORD Occupancy/Type 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. INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS .LOB FOUNDATION INSPECTIONS DATE INSPECTOR ..:INITIALS CommENis: Footings /Caissons I: 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 Electrical Service -- Rough Electric Rough Plumbing 1Gas Piping•: 'Rough Mechanical 'ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing Insulation 4NCY. I CUPANCY IS ISSUED E: DO NOT REMOVE THIS NOTICE a CITY OF WHEAT RIDGE r I Inspection Division (303) 234 -5933 Inspection line ( (303) 235 -2855 Office - (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type d d A - gv P Z��24M Job Address V V& 77 zy���` Permit Number s s X3 DO NOT REMOVE THIS NOTICE a INSPECTION RECORD Occupancy /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. "INSPE TOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: - Footings /Caissons In sulation - - Stemwall / (CEG) Concrete Encased Ground Drywall Screw Reinforcing or Monolithic - Weatherproof / French Drain Sewer Se rvice Lines. Water Serv ice Lines ABOVE HAS BEEN SIGNED ';<.. CONCRETE SLAB FLOOR Electrical (U nderground) Plumbing (Underground) Heating (Underground) ROUGHS Sheathing Lath / Wall tie - Mid -Roof ` Electrical Service Rough Electric Rough Plum F as PipEin g ough c h anical DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ABOVE INS Framing PECTIONS TO BE SIGNED PRIOR TO PROCEEDING In sulation Drywall Screw - R:O.W &Drainage _ INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS Parking $ Landscaping I 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.IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ♦ 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: fGQS - g7 f eoy7` 5' Permit Number: / ,9/G_3® f ❑ No one available for inspection: Time s' .5. 'M M Re- Inspection required: Yes When corrections have been made, call for re- Inspection at 303-234-5,933 Date: `c A /0 Inspector DO NOT REMOVE THIS NOTICE City of Wheat Ridge r 0000r Residential Roofing PERMIT - 101630 PERMIT NO: '101630 ISSUED: 06/28/2010 JOB ADDRESS: 4695-97 Hoyt St ::EXPIRES: 12/25/2010 DESCRIPTION: Reroof '14 sqs with aphault .'shingles ** *CONTACTS * ** .owner 303 -/425 5049 Kazima.erz Pena n ,,. - - - +' ** PARCEL INFO +'- ZONE CODE: UA SUBDIVISION: 0250' ** FEE SUMMARY ** ESTIM k Permit Fee I0 Total Valuation Use :Tax ! 4 * *rTOTAL ** _15 Conditions: 6 nails per shingle is required. Ice dam mem 2' inside exterior walls. Board sheathing wi requires panel sheathing overlay on entirelr required prior to covering. Midroof inspecta purchased after 4/18/10. Contractor shall pr Scheduled inspections that cannot be perform cancelled prior to 8:30 a.m. on the day of'.i will be assessed. USE: UA ' BLOCK /LOT #: 0/ D "PROJECT :VALUATION: 12,478.00 l 30; :0 30 ine`is required from eave edge to any gap greater than 1/2 ..Sheathing inspection is is not required on permits Lde ladder for inspections; due to inclement weather must be )ect:ion or a re-inspection fee mit application are accurate, and do not violate applicable covenants, easements or restrictions ' of record; that all ive read and agree to abide by all conditions :printed on this with the Wheat Ridge Building Code;(I.B.C) and all other City of _ �, - Date: CO MMUNITY DEVELOPMENT - 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 q q - Building Permit Application PY -0j erty Address:: 7 (o � l `7 /f O Z I s� Property Owner (please print): kA Z e KiE2 Z y {= a/A Phone: Mailing Address: (if different than property address) Address: City, State, Zip: t_3 4lt°L�- i p. a c 3 3 9001400: (,-- .4 21 ru 'n PF t/yti License Ph one: AUn, Vg1`D CLOi53 Electrical: Plumbing: Mechanical: City License # City License # City License # T)escrl»taon of W�Drk' 4 /A-(`% 7 7 1 (4-Lf Contract Value: $ 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. CIRCLE ONE: ('WN ) (CONTRACTOR). or (AUTHORIZED REPRESENTATIVE) of (OWNER). (CONTRACTOR) PRINT NAME: IZA Zt %"l r (,=1 i t SIGNATURE: DATE: Bldg Valuation: 1111111-111-7-7 7 P PERMIT NO: .` 10163 JOB ADDRESS: 4G97 DESCRIPTION: Insta 3' Hoyt St 11 new swamp cooler owner----- 303/,425=504-9 Kazimierz Pena ZONE :d CODE: UA I- USE: UA SUBDIVISION:.'. 0250 ':BLOCK /LOT #: 0./ * *.FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 1,600.00 FEES Permit Fee 60.00 Total Valuation .00 MM Use Tax :28.80 * *;- .TOTAL *. *. .,.' 88.80 Conditions:': Subject to field inspections. I hereby certify that the setback distances proposed by this permit application are accurate, and do not violate applicable This permit was issued in accordance with the provi State of Colorado and to the Zoning Regulations anc ordinances of the City..' This permit lshall expire 180 days ;from the issue do date. An extension may granted at the discretic If this permit expires, 7,a new permit may be Sacquirc changes have been or will be made in the original I exceeded one ':(1) year. :.If changes have been or if be paid for a new permit. No work of any manner shall be done that will chani Contractor shall notify::: the Building Inspector twee written approval on inspection card before proceedi The issuance of a permit or the approval of drawinc an]appr yval any violation of the provisions of Al is subject to field inspections. re 9 Chief Building; Official PECTION REQUEST LINE: (303)234 -5933 UESTS 'MUST BE :MADE BY 3PM ANY'BUSINEt Pu aanus suo]ecc to rieia inspection. e to et forth in your application and is subject to the ng Codes of Wheat Ridge, Colorado or any other app] ration< Cit of Y �?�,'� j, Date: ✓"' MUNtlY DEVELOPMENT Plan # Building & Inspection Services Division 7500 W. 29 Ave., Wheat Ridge, CO 80033 Permit# Office: 303 - 235 -2855 * Fax: 303 - 237 -8929 Inspection Line: 303 - 234 -5933 Building Permit Application Pxoper + 40* s _ 402 go ; 5y Property Owner (please print) V-A2- ( t j r—aL pc-- Phone: 3 Mailing Address: (if different than property address) Address: City, State, Zip: L,)C•{ -L/� -� �-t �D Sri:. C� • � � 3 � C- onfractor: Contractors City License #: Phone: 4* 944#4** rs: Electrical: Plumbing: Mechanical: City License # City License # City License # iDe�iofu+ibrk �t Q ST A ht f� ,r4 n P �c t t Contr2ct Value: 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. CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) p PRINT NAME: \e A 2-t ?'I r-- 4-T KK SIGNATURE: �.. DATE: W � `, '� ✓�'� `� "DEf�1R7JVl�1�i`fUlS�E�t1(✓ �� �; � <,F y, ZONING CO MENTS� -� ` e p ✓✓ �'✓. �e �'�" '✓.>, "tr '%r"i U` =.''i r' t � IOnll]J 2 ✓ r �= ✓c ref' r- ✓ .r ) ✓ " s ✓ ✓ ✓ r . -`' ✓� ,� � r .✓ r��� � ✓ v RevleWeY ✓ r f ✓ 1 :S u � �. '� r `` ✓ � �� ✓ ...c ) � Yr � ✓ ✓_$ r ✓ f f✓ 9„f ✓ r r ✓ 1,. � �f_ ✓ ✓ ✓ ✓ ✓,,? /J ✓ s. ( F^ �BJ3ILDING DEPARTMENT COM1dIE1�7S G, t i� n i , ✓ � ✓� � � ✓'fir J� F�T�"`✓�„�� �' ✓l t ,� ' �"r"f� f r ' R @Vte�{Ve'k' ✓'� �, ✓✓ � r r ^ '' / s a j -, o `�' ,: r f a / � � r� Ya b � .r /fsdf �rr ✓ tr C�� �� s �: ✓✓ ✓ ° ✓ ! % ✓ m� ✓ /> /r ;✓ r3 FX ✓ `r✓i� ?✓ �✓ s . ✓✓f< S � fx„ ✓>tx 4 r C '? rh rz ,z r r✓n .. ✓ f. 3 , `� :% r ✓ cr ✓.�s: ri�',.F`✓✓"�'- "✓rf`s✓'3 1 `� r✓✓ G r Bldg Valuation: