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HomeMy WebLinkAbout4090 Field DrivePERMiT: rr�- ADDRESS: J�, ZiU JOB CODE: INSPECTION RECORD PAS 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 Initials Comments 102 Caissons / Piers 302 Wall Sheathing 103 Footing / P.E. Letter 303 Roof Sheathing 104 Foundation Setback Cert, 305 Insulation 105 Stem Walls 306 Mid -Roof i 106 Foundation wall Insulation 307 Metal / Lath / Stucco Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector Initials Comments 201 Electrical / Cable/ Conduit 302 Wall Sheathing 202 Sewer Underground Int. 303 Roof Sheathing 203 Sewer Underground Ext. 305 Insulation 204 Plumbing Underground Int. 306 Mid -Roof r7 205 Plumbing Underground Ext, 307 Metal / Lath / Stucco 206 Water Underground 309 Rough Electrical Commercial 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 r7 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) 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 Zr-t L Final Inspections Date Inspector CommentsInitials 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 Zr-t L 410 Final Wirdow/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 Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: ��6�l3 777 - Permit -Permit Number: �>c �>/ � r ❑ No one available for inspection: Time -` AM/PM- Re-Inspection required: Yes �___,) When corrects ns have been made, call for re -inspection at 303-234-5933 Date: /r>' J / Inspector:" r' DO NOT REMOVE THIS NOTICE ► ' , City of Wheat Ridge Residential Roofing PERMIT - 201707871 PERMIT NO: 201707871 ISSUED: 09/29/2017 JOB ADDRESS: 4090 Field DR EXPIRES: 09/29/2018 JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 40 sq Pitch = 4/12 *** CONTACTS *** OWNER (303)807-1829 RICKMAN WILLIAM L SUB (303)466-0161 Bernie Reitz 019543 Reitz Roofing, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 15,772.00 FEES Total Valuation 0.00 Use Tax 331.21 Permit Fee 299.40 ** TOTAL ** 630.61 *** 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. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, 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. City of Wheat Ridge ♦ y Residential Roofing PERMIT - 201707871 PERMIT NO: 201707871 ISSUED: 09/29/2017 JOB ADDRESS: 4090 Field DR EXPIRES: 09/29/2018 JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 40 sq Pitch = 4/12 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 erim . I further attest that I am legally authorized to include all entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in this document and/or its" accompanying approved plans and specifications. Signature of OWNER or CONTRACTOR (Circle one) Date 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 ISO 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 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 an 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, any violation of any provision of any applicable code or any ce or regulation of this uris fiction. 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. Dane Lovett J l v � From: no-reply@ci.wheatridge.co.us Sent: Wednesday, September 27, 2017 12:58 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Follow Up Flag: Follow up Flag Status: Completed 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 4090 Field Dr. Property Owner Name Bill Rickman Property Owner Phone 303-807-1829 Number (enter WITH dashes, eg 303-123-4567) 85 Property Owner Email Field not completed. 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 Signed proposal for 4090 Field Dr..pdf Contract CONTRACTOR INFORMATION Contractor Business Reitz Roofing, Inc. Name Contractor's License 019543 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-466-0161 Number (enter WITH dashes, eg 303-123-4567) Contractor Address 11925 Quay St., Broomfield, CO 80020 (Primary address of your business) Contractor Email Address Reitzroofinginc@gmail.com Retype Contractor Email Reitzroofinginc@gmail.com Address DESCRIPTION OF WORK TOTAL SQUARES of 40 the entire scope of work: Project Value (contract 15772.00 � value or cost of ALL �. � materials and labor) Are you re -decking the No %I roof? Is the permit for a flat Pitched roof (2:12 pitch or greater) roof, pitched roof, or 86 both? (check all that apply) What is the specific pitch 4/12 of the PITCHED roof? How many squares are 40 part of the PITCHED roof? Describe the roofing Owens Corning Duration 30 Year Dimensional Shingles materials for the PITCHED roof: Type of material for the Asphalt PITCHED roof: Provide any additional Tearing off (1) layer and reroofing house 1 story 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 owner of the property to 87 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 Bernard J Reitz Email not displaying correctly? View it in your browser. 88 Reitz Roofing, Inc. 11925 Quay St. Broomfield, CO 80020 (303) 466-0161 Fax: (303) 466-0811 Email: Reitzroofinginc@gmail.com }��,r�. reiizroofin U. corn NAME PHONE DATE ADDRESS JOB LOCATION CITY, STATE & ZIP CITY, STATE & ZIP 1 - �l Reroof the entire house/building with I-, 4r Reroof the entire house/building with Underlay valleys with roll roofing or galvanized valley tin. k-r'r, [� Seal or counter flash all walls, flues and vents. Replace 1 1/2" ! 2" 07 3" 4" Pipe Jack Flashings. Clean up and haul off any debris. Furnish Permit: Install roof to meet all City and IBC Building Codes. Warranty roof for. (5) years on all workmanship. Supply customer with lien waiver, proof of insurance and manufacturer's warranty. Tear off_ layer(s) of roofing on the entire roof. Install 2x2 Drip Edge Install Base Felt -Tmy-c-417YYI We propose hereby to furnish material and labor - complete in accordance with above specifications for the sum of: � _/ tr 41oa �n l f2cneaa"-5-ete-i L- 4nAt,2, �n_yY.vry --Tib J 7%-2 TERMS AND CONDITIONS Payment to be made as follows:Q Paid in lull upon completion ofjobQ % down Reitz Roofing is not liable or responsible for any hidden and/or unforeseen circ m- balance upon completion_ Reitz Roofing guarantees that all materials will be as specified stances that can not be predetermined in advance. Reitz Roofing will be bound above. Reitz Roofing will perform its part of the contract in a manner consistent with industry by such change in the specifications only if it is in writing. The property owner is standards. Performance by Reitz Roofing is subject to strikes, accidents and delays beyond to carry Fre. Tornado and other appropriate casualty insurances. the control of Reitz Roofing_ Reitz Roofing is not responsible for any damage to the property before the roof is applied. Reitz Roofing carries Disability and Public Liability Insurance. Default of payment. The undersigned agrees to pay interest in the amount of one Three days after acceptance, if cancelled, the customer must pay for any'restocldng charges, and one-half percent (1-1/2%) per month from the date due on any unpaid portion permit fees or any other costs that Reitz Roofing Inc. has incurred from the acceptance of this - of the contract price. The undersigned also agrees to pay all costs of collection proposal. The undersigned agrees that he/she 'It be liable for the reasonable additional including the costs of perfecting a mechanics liens, court costs and all reasonable costs necessitated by his/her request for a Charg the above specifications, and that Reitz attorney's fees and interest in the amount of one and one half percent (1 -1/2°A ) Roofing will be bound by such above specifications per month an all collection costs from the date incurred. Both parties have read and un st this contract and agree to the terms and conditions here-in. Signature: X Authorized Signature: , . lfi �, For: Berniekl I Rei Roofing, Inc. Date of acceptance: % K- ) 7 Note: This proposal may be withdrawn by us if not accepted within 30 days. a i CITY OF WHEAT RIDGE tV Building Inspection Division } (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: `\� Job Address:lf?C } - cl�� r Permit Number: :2 oI-�e' ❑ 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 - Date: " / 1%� Inspector:f :c��� j DO NOT REMOVE THIS NOTICE City of Escrow/Letter of Credit Wh6afl�j�i!d jge �C DEVELOPMENT Transmittal Sheet 1 Drive. The escrow is in the amount of One hundred dollars and no ggjjj� R V Landscaping under Planninp- & Devel2pment: Installation of ground 0 Street Improvements under Public Works: installation of curb, gutter and The escrow shall be held by the City as reimbursement to offset cost to City for installation of outstanding landscaping improvements. REM Name MR e This agreement made this 25Lh day of Jantian, 2013, by and between the City of Wh Ridge and Bill Rickman jgrogeM ow ger) for escrow in the amount of one hundred dollars ,JJIOO.00) being held by the City of Wheat Ridge until all outstanding landscap unprovements are competed at: � IIDIIII EMUEMM�# . y � Signature Print Name Business Address / Phone Date Title By: Title: Date:— 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 ) Permit Number ��/ 1 - ?Q A I -, / ) ) !P �— AL nl a.r — T No one available for inspection: Time ( AM /PM Re- Inspection required:rYes No * When corrections have been made, call for re- inspection at 303 - 234 -5933 Date: 11 11 � 1 � Inspector: ° _o DO NOT REMOVE THIS NOTICE 701 Park St., Unit E Castle Rs 80109 Landmark Garages 8526 E. 163 Avenue Brighton, CO 80602 I III! � yqiii 10111 Foundation Wall Reinforcing: The steel reinforcing for the foundation walls was installed in general conformance with the projects plans. All foundation forms were free of debris and in generally good condition. Concrete Encased Electrode: The concrete encased electrode was found to be properly installed. A 10' long vertical piece of #4 rebar was tied to the horizontal wall steel with standard wire ties, including, one bar at the bottom of the wall. The bottom rebar is also tied to the vertical breakouts. It was veed that the bottom o be encased by a minimum of 2" of concrete. Darin Dent P.E. Managing Pinner 4 1 CITY • WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235 2855 Office - (303) 237 8929 Inspection T ,,, --- , 4 - Job Address -------- --- -- Permit Number City of ., «r. Plan # Building Permit Application (Com plete glt highlighted gear) Property Address: Property Ow ner lease rent R �4 / � /� v►i r City o , ]�� Wh6at B C'(O DEVELOPMENT � Do t e : �w� w Plan Building &Inspe Services Div ision )11 7500 W. 29 h Ave., Wheat Ridge, CO 80033 Permit Office: 303 - 235 -2855 * Fax: 303.237 -8929 Inspection Request Line: 303-234-5933 r r "a «• • � ` «.o M • i�" alt" Add res s: City, State, Zip. • « (AUTHORIZEDRE of ( (CONTPACTOR) A. m I • V AIZI ll e-? -, y o f'- 4let a OL4 alu-A Lm-k) cAe p I Avt v - m MM ff'Minimum Ix IZ- ridve board Provide roof fie downs 6 roof structure shown, @ comers and each 25' of wall. M RU , M 1101 • m m 0 m / ���_� ^���� � °° � ^�� I m I v� City of «° COM . . MUNR$ 2?:«o*kE*T — « «2 «f ±+ £ a d 11,11,11,1 t2 © l l q lm � 1111111111�111111111 111 p « Address: City, State, 3¢ ------------ »ma« I 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 bus9ness day. INSPECTOR MUSTSIGN ALL SPACES PERTAINING To THIS JOB FOUNDATION INSPECTIONS T DATE INSPECTOR E NTS: INITIALS COMME '. Footings /C aissons Stemw / (CEG) Concrete Encased Ground' - Reinforcing or Monolithic d Weatherproof / French Drain Sewer Service Lines Water Service Lines I I I ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) nn NnT Pn. 10 r---- I...... RL)UUHb Sheathing ` Lath /Wall tie e :Mid Roof Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical AROVF 6 (. Framing Insulation Drywall screw INSPECTIONS TO BE SIGNED. PRIOR TO PROCEEDING r INAL0 Electrical Plumbing Mechanical `.. Roof Building Final.- —1 Fire. Department - I R.O.W &Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS Parking & LandScaping SHOULD.BECALLED 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 OFA 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: t_. r S Job Address: Yo 1,1-) f> P /rte ;7 Permit Number: t~) ~7 S ( C 77 ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No When corrections have been made, call for re-inspection at 303-2345933 Dater I Inspector: DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection I line f (303) 235-2855 Office • (303).237-8929 Fax INSPECTIONNOTICE' Inspection Type: Job Address: Permit Number: '/Sf ry ❑ 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 1 Date: i' I " Zr% Inspector , : , 60 NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 094565 PERMIT NO: `f 094565 ISSUED: 12/28/2009 JOB ADDRESS: 4090 FIELD DR EXPIRES.: 06/26/2010 DESCRIPTION: Remove and replace 28 'sqs. of asphalt shingles ***'CONTACTS gc 303/431-8665 01-8796 Ziska Construction,: Inc. **PARCEL INFO ZONE :CODE: UA USE: UA SUBDIVISION: 0284 .'BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,000.00 FEES Permit Fee 144.70 Total Valuation .00 Use :Tax :90.00-fJ~JD~j~SG+ d $ TOTAL 234.70 ..M '.W. - Comments: Conditions: 6 nail installation mid-roof inspection required. Board sheathing spaced more than 'a 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield` required from eave edge to 2' inside exterior walls. ***Contractor/Property owner shall provide=.ladder(s) secured in place for'. inpsections.It is the responsibility of the person/firm requesting the speczion.,co insure roofs are clear ror:inspection. acneauiec.inspections tnat nnot be performed due to inclement weather must be cancelled prior to 8630 n. on the day of inspection or a re inspection fee of $61.00 will be assessed.) oject to field inspection. hereby certify'. that the setback distances proposed by this permit application'. are accurate, and do not violate applicable dmances, rules or regulations of the City of [cheat Ridge or covenants, easements or restrictions of record; that all asurements shown, and allegations made are accurate; that I have read and agree to abide. by all conditions printed on this olication and that I assume full responsibility for compliance with the Wheat Ridge Building Code (I.B C):andall other olicable Wheat Ridge Ordinances, for work under this permit. Planssubject to.. `field inspection. gnatu contractor/owner -date ;s permit was issued in accordance with the provisions set forth in your application and is subject to the. laws of the State of Colorado and to the Zoning Regulations and Building Codes'. of wheat Ridge, Colorado or any other applicable ordinances of the City. This permit shall expire 180 days from the issue date. Requests for an extension must be received.' prior to expiration date. An extension maybe granted at the discretion of the Buildinq official. ue. YCiu for-a. uew-.peinu c, 4. No `work of any manner shall be done that will change the natural flow of water causing a drainage problem. 5. Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive written approval on inspection card before proceeding with successive phases of the job. 6. The'. issuance of a permit o the approval of drawings and specifications shall. not be construed to be a permit for, nor' an approval of, a v' Is n of the provisions of the :building codes or any other ordinance, law;, rule or regulation.. Allplan review i to field inspections. Signature of Chief ildmg..Official `:date W HEgT City of Wheat Ridge Building Division m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 °Ototxao° Inspection Line: 303-234-5933 Building Permit Application Date: Plan Permit#: MI-5-6,5- Property Address; Property Owner (please print): Mailing Address: (if different than property address) Address: Phone:/ State, Zip: Contractor:f~ Contractor License D Phone: A101 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): Construction Value: $c~~ Description of work- (as calculated per the Building Valuation Data sheet) a aelc- Q1~ lv e- Plan Review (due at time of submittal): $ Sq. Ft./L.Ftadded: Squares r!~ BTU's Gallons Amps OWNERICONTRACTOR 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 ail conditions printed on this application and that 1 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: SIGNATURE: Date: