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Home My WebLink About3990 Ammons StreetPERMIT0/705/6)` ADDRESS: 3?9/lYVlr1%0Y9S;JOB CODE: INSPECTION 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 Foundation Inspections Date Inspector CommentsInitials 102 Caissons / Piers 103 Footing / P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation 41 Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground /Slab Inspections Date Inspector CommentsInitials 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 41 r206�WateUnderground lUr 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 41 306 Mid -Roof lUr 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 Rough Inspection continued g p 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 V-71 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 Commercial 409 Final Roof V-71 410 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. City of Wheat Ridge Residential Roofing PERMIT - 201705131 PERMIT NO: 201705131 ISSUED: 07/31/2017 JOB ADDRESS: 3990 Ammons ST EXPIRES: 07/31/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 35 sq *** CONTACTS *** OWNER (303)888-7274 JAMES D THOMAS PENSION & PROFI SUB (303)296-8551 Production 019898 AVI, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** Total Valuation Use Tax Permit Fee Misc. Fee ** TOTAL ** *** COMMENTS *** ESTIMATED PROJECT VALUATION: FEES 0.00 188.90 188.45 25.00 402.35 8, 995.00 *** 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. i . City of Wheat Ridge Residential Roofing PERMIT - 201705131 PERMIT NO: 201705131 ISSUED: 07/31/2017 JOB ADDRESS: 3990 Ammons ST EXPIRES: 07/31/2018 JOB DESCRIPTION: Residential Re—roof to install GAF Timberline asphalt shingles — 35 sq 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 erm�t. I further attest that I am legally authorized to include all entities named within this document as parties to the work �to be performed al d +�La!-raLb� nrk to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Sigrfgu-re o OWNER o 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 original permit fee. 3. Ifthis permit expires, anew permit maybe required to be obtained. Issuance of anew permit shall be subject to the standard requirements, fees and rocedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Offcial 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 issuan granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicabl .co e rpatny.grdi�a cen �y reg l:ti of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. 301ION S/HI 3AOW3hf ION 00 Jo}aadsul £E6 -b£Z-E E uojjoads.`aj joj peo `apew uaaq aney suoi;aaaaoo uayM, oN spA :paainbaa uoiloodsul-aa avail milaadsui aol ajgaj!LAU auo ON n :aagwnN Iiuuad :ssaippd qor :adA.L uoiloadsul 331ION N01133dSNl XeJ 6E68 -210E (000) . a0!-40 598E -90E (000) auij uoi;oadsu/ £E65-ti£9 (EOE) uoisinia uoipedsul 6uippe 3Jala lV3HM =10 A113- i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INS ECTIIOO—N NOTICE Inspection Type: 0 /- - Job Address: 1«( ONS ST Per',TtN um cLs ❑ No one available for inspection: Time/AM/PM Re -Inspection required Yes No ,r *When corrections have been made, call for re-inspectiop, at -3 3-234-5 33 Date: �` Inspector: f f rF r 4i 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 i D Job Address: !f90 Ah,,MMM5 Permit Number: SO 11 to Jam) 5 j ❑ No one available for inspection: Time '� 1 AM/UM Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: 14 O Inspector: C - DO NOT REMOVE THIS NOTICE i City of Wheat Ridge Residential Roofing PERMIT - 201705131 PERMIT NO: 201705131 ISSUED: 07/31/2017 JOB ADDRESS: 3990 Ammons ST EXPIRES: 07/31/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 35 sq *** CONTACTS *** OWNER (303)888-7274 JAMES D THOMAS PENSION & PROFI SUB (303)296-8551 Production 019898 AVI, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UP. / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,995.00 FEES Total Valuation 0.00 Use Tax 188.90 Permit Fee 188.45 ** TOTAL ** 377.35 *** 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 elastcmeric 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. 1* ` 41 City of Wheat Ridge Residential Roofing PERMIT - 201705131 PERMIT NO: 201705131 ISSUED: 07/31/2017 JOB ADDRESS: 3990 Ammons ST EXPIRES: 07/31/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 35 sq 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 an 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. rr, — K t ,I -, n/I_ _P/_ /, Signature of OWNER or COJtTRACTOR (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, po ides 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 originalermrt 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 apple de or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dan Schultz lel 70 S 111 From: no-reply@ci.wheatridge.co.us Sent: Friday, July 21, 2017 9:50 AM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Danny 1 � j 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 3990 Ammons St L Property Owner Name Jim Thomas f� Property Owner Phone 3038887274 Number Property Owner Email jimthomas@remax.net Address 1 y -?7, �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. CONTRACTOR INFORMATION Contractor Business Name Contractor's License 019898 Number (for the City of Wheat Ridge) Contractor Phone 303296851 Number Contractor Email Address production@aviroofing.com Retype Contractor Email production@aviroofing.com Address DESCRIPTION OF WORK Are you re -decking the No roof? Description of Roofing Tear off 1 of 1 layers and install 35 sq of Gaf Timberline. Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 35 material selected above? Does any portion of the No property include a flat roof? If yes, how many squares on the flat roof? TOTAL SQUARES (pitched + flat) of all roofing material for this project Field not completed. 35 Sq� z Provide additional detail 4/12- House here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract--7655.- value or cost of ALL materials and labor `1 "� 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 Cara Meyer Email not displaying correctly? View it in your browser. 3 1290 E. S8th Avenue Denver, CO 80216 �� PHONE: 303-296-8551 E-mail: office@aviroofing.com www.aviroofing.com FAX: 303-Z9b-8557 Name: JIM THOMAS Billing Address: 11734 APPLEWOOD KNOLLS DR Job Address: 3990 AMMONS ST AVI Roofing, Inc. ('Contractor'I agrees, subject to the Additional Terms and specified below located at the address stated above: CELL # 0 Home Phone: 303-888-7274 Email: jimthomas@femax.net LAKEWO(CO 80215 , WHEAT R CO 80033 Conditions on the reverse side of this Proposal & Agreement, to furnish all materials, labor and equipment necessary for the work 1 The Home Owner has a 3 day right of recision to cancel this contract within 72 hours of the date signed on this contract. DESCRIPTION OF WORK TO BE PERFORMED AND MATERIALS TO BE SUPPLIED: Shingle Manufacturer and Field Squares 35.00 sqs GAF TIMBERLINE HD COLOR 0.00 Ridge Type 5 bundles SEAL A RIDGE H&R 12" X 25' Manufacturers Warranty 5YSTEN15 PLUS 50 YEAR NON -PRORATED AGAINST MANUFACTURE DEFERS AVI Workmanship Warranty 5 years Tear off existing roof layers and haul away 1 layers Install base felt S rolls TIGER PAW Remove and replace plumbing flashings 5 each Install all new roof vents 6 each DURAFLO WP 50 Install valley material 5 rolls 90LB Install 2 X 2 rake flashing 120 feet WHITE Install 2 X 4 eave flashing 190 feet WHITE Install step flashing 1 bundles 8X8 GAL SKYLIGHTS 2 each KIT Color CHIMNEYS 1 each KIT Color REDECKING HOUSE 117 sheets MODIFIED LOW SLOPE 3 sqs Permit furnished by AVI ROOFING SPECIAL INSTRUCTIONS: 1 The Home Owner has a 3 day right of recision to cancel this contract within 72 hours of the date signed on this contract. 2 The approximate work start date is . The job should take at total of days. 3 The price on this contract does not include Lead Mitigation. 4 Decking will be inspected after the roof is torn off and if material Is deterioated AVI will remove and replace it with your approval at an cost of $65.00 per sheet to remove and replace a 48 sheet. $3S.00 per sheet to layover existing decking. CONTRACT PRICING: RE -ROOF PRICE: $ 11,128 5" GUTTERS: $ 1,557 TOTAL CONTRACT PRICE: $ 12,685 PERMIT COST TO BE BILLED TO THE INSURANCE AS AN EXTRA. Payments to be made as follows: 50X is due upon delivery of materials. The balance is due upon completion of work. All money collected prior to the job starting will be held in a separate account until the job is at least SO/.complete. If payment Is made by oedlt card o 5% service charge will apply. Repiacement of deteriorated decking, fascia boards, roof lacks, ventilators, flashing or other materials, unkss otherwise stated in this Proposal & Agreement are not included and will be charged / or metal. The as an extra on a time and material contractor shall not be fequaed to basis. Owner 1"s respons tete for removal of all outdoor furniture, awnings, or other outdoor fixtures prior to the start of the work. Owner to prime and paint any replaced wood and cost to render harmless this material in the event that such material is discovered, This Proposal & perform work relating to asbestos or pohychbrinated biphenyl (PCB). Owner will be responsible for the additional cost of removal or dare is m writing by the contranor and this Proposal & Agreement is thereafter accepted by Agreement will expire in ten (101 days from date unless accepted in writing within that time by Owner, or unless the expiration extended in with costs in effect at that time. All proposals are subject to approval of Contractor's Owner before the extended expiation date Also, after 10 days from the date below, Contractor reserves the right to revise its price accordance Management. r The above prices, specifications and conditions are satisfactory and are hereby accepted. AVI Roofing, Inc. is authorized to do the work as specified. ACCEPTANCE OF PROPOSAL: This agreement made this day of 20 Date salesmen Signature By signing this agreement i have read and understand the Additional Terms and Conditions are part of this Proposal & Agreement. MIKE DANCAUSE 06/02/17 Date C 3 Q V Pill, N INSPECTION RECORD OGGUpancyRype INSPECTION LINE: (303) 234 -5933 y: �y a. v 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. , c1 b .1 b 1 -. r L_ INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: Footings /Caissons Roofar Stemwall / (CEG)Concrete Encased Ground Building Final Reinforcing or Monolithic Fire Department Weatherproof / French Drain R.O.W & Drainage Sewer Service Lines INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Parking & Landscaping Water Service Lines POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) "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. Plumbing (Underground) Heating (Underground) FINALS Electrical Plumbing Mechanical Roofar Building Final Fire Department R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE 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, 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. vccUNANGY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PDnTCI'T TLJIC I- ADrI CDnl%A TLJC 1AICATLJCD ! d ✓ CITY OF WHEAT RIDGE ' Building Inspection Division (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTIO NOTICE Inspection Type: NPIN Job Address: Permit Number: /U7))94 c ❑ No one available for inspection: Time a] AM. Re- Inspection required: Yes N * When corrections have been made, calf for - inspection at 303 -234 -5933 J Date: �� Inspector: DO NOT REMOVE THIS N ICE ti s CITY OF WHEAT RIDGE • Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: {I/i r c ~~ri Job Address: f r~c~ rr S Permit Number: Li45 1 f 8 ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No - When corrections have been made, call for re-inspection at 3o3-234-5933 Date: ea Inspector: _ ~%7,L_Z. O NOT REMOVE THIS NOTICE t CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: ; i A7 yam" Job Address: 3 1 2 0 ~1 T e~ r o n S S 7` Permit Number: #ov j'? ❑ 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: ~ : 2 9 Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Building Division Date: '3 m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Plan inspection Line: 303-234-5933 Permit#: Building Permit Application Property Address 3q9 i y~ rvyBVy~ ~~3 Property Owner (please print): fir,\4 ~c Z Phone: 42A ~S9S Mailing Address: (if different than property address) Address: S o~r+1P City, State, Zip: Contractor: Qjr a ICe~. ~fts~ruc3io~ Contractor License fj Phone (L) 4 c,( 0:1 - Sub' Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ \h. SaD. 51 D~E7SCCi (pltlon of 1NUrk: (as calculated per the Building a/uafion Data sheet)I \ op "I` -RGN D V c~ b t r J win (pbS A i Plan Review (due at time of submittati: $ Sq. Ft./L.Ft added: Squares n!~- BTU's Gallons Amps OWNER/CONTR %CTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT 1 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:: -(tO^WNER) (CONTRACTOR) or PERSONAL REPRES - IVE of to ER) (CONTRATOR) PRINT NAME: J ~ 4 e~ cn SIGNATURE: e% Date:. I z0 1 C~ DEgARTMI=NT OSE bNtY Bldg Valuation: $