HomeMy WebLinkAbout7085 W. 32nd Place43-7 5 -
INSPECTION RECORD
INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection
INSPECTION REQUEST LINE: (303) 234-5933
0cw.DancY/TvDe
Inspections will not be performed unless this card is posted on the project site.
**Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date
Inspector Comments
Initials
Pier
Sewer Service
Concrete Encased Ground (CEG)
Plumbing
Foundation-T.E. Letter
Mid -Roof �,���
Do Not Pour Concrete Prior To Approval Of The Above Insnections
Underground/Slab Inspections Date
Inspector Comments
Initials
Electrical
Comments
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Insnectinns
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
Mid -Roof �,���
<✓
Lath / Wall Ti
Rough Electric
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw / Nail
Final Inspections Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof l
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage
by the Building Division.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
I* � 4 a City of Wheat Ridge
Residential Roofing PERMIT - 201704375
PERMIT NO: 201704375 ISSUED: 07/19/2017
JOB ADDRESS: 7085 W 32nd PL EXPIRES: 07/19/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles with
28 sq.
*****REVISION ADD REDECKING (HOUSE ONLY 17 SQ)***********$2200.00******
*** CONTACTS ***
OWNER (303)618-3404 VASSOS LARRY L
SUB (303)289-7220 David Bybee 170363 Classic Roofing & Gutters, Inc
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 16,124.26
FEES
Total Valuation 0.00
Use Tax 338.61
Permit Fee 315.25 -- —
** TOTAL ** 653.86
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) requires an approved inspection
prior to installation of ANY roof coverings and is require on the entire roof when spaced
or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are
required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and
water shield is required. Eave and rake metal is required. A ladder extending 3 feet above
the roof eave and secured in place is required to be provided for all roof inspections.
Roof ventilation is required to comply with applicable codes and/or manufacturer
installation instructions, whichever is more stringent. In order to pass a final inspection
of elastomeric or similar type roof coverings, a letter of inspection and approval from the
manufacturer technical representative stating that "the application of the roof at (project
address) has been applied in accordance with the installation instruction for (roof
material brand name) roof covering" is required to be on site at the time of final
inspection.
Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd
party inspection report will be collected at final roof inspection performed by City of
Wheat Ridge. If report is not available the final inspection will not be completed.
City of Wheat Ridge
Residential Roofing PERMIT - 201704375
PERMIT NO: 201704375 ISSUED: 07/19/2017
JOB ADDRESS: 7085 W 32nd PL EXPIRES: 07/19/2018
JOB DESCRIPTION: Residential Re—roof to install Owens Corning Duration asphalt shingles wizh
28 sq.
*****REVISION ADD REDECKING (HOUSE ONLY 17 SQ)***********$2200.00***x**
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanyingg approved plans and specifications;
applicable building codes, and all applicable municipa es, policies and procedures, and that 1 am t1�e legal owner or have been authorized
by the legal owner of the property and am authurl o obtain this permit and perform the work described and approved in conjunction with
this ermit. I further attest that I ale horized to include al[ entities named withirLthis d�cum nt as�arties to �hework to be
performed and that all���� `fR d is disclosed�ihidocument andlor its' accompanying aproved plans and speci�ication� s
rb Signaturor CONTRACTOR (Circle one) Date1. This based on the information provided in the permit application and accompanying pians and specifications and is
subjence with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. Th e 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
ceiate of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
sal and may be subject to a fee equal to one-half of the original permit fee.
3, f this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. To 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, h c�pe,rmit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspeiahons and shall hot 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 co any ordinance or regulation of this jurisdiction. Approval of work is subject to Field inspection.
E&A AA
/ J
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of
,9rW heat Midge
COMMUNITY DEVELOPMENT
I FOR OFFICE USE ONLY
Date: �c H
I I
Add to Permit #
Building P & Inspection Services Division
7500 W. 291h Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: eermitsaci.wheatridge.co.us
ID
Building Permit Revision/Amendment Application--------,
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address:
Owner
Property Owner Email:
Mailing Address: (if different than property address)
Address
City, State, Zip:
Submitting Company:
2 4)�_D 11__:� (
Contact Person: Phone:
I
Contractor:
Contractors City License #:
Contractor E-mail Address: C
W
Phone: _? -
9
-/'- 3 V-1
Phone: -3- 2 M — -"?Z ? C'
P cl� A /06
Please Note: Additional valuation must include all general and subcontracted work to be performed
related to the revisions and/or amendments declared in the description of work and which were not
included in the original permit valuation.
If revisions or amendments increase the original valuation, additional fees will be due at the time of
approval. Depending on the scope of work, additional plan review fees may be due upon approval
($60.00 an hour - 2 hour minimum).
Description of revised/amended work:
Sq. Ft./LF
Amps
Btu's
Squares
Gallons
Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
$Z0ck:>
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or
regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are
accurate; that 1 have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance
with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that 1 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)RA� CTOr(AUTHORIZED REP�T111 E) of (OWNER) (CONTRACTOR)
PRINT NAME:
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received
Water District ❑ Received
Sanitation District ❑ Received
DEPARTMENT USE ONLY
DATE:
OCCUPANCY CLASSIFICATION.
❑ Not Required
❑ Not Required
❑ Not Required Building Division Valuation: $
City of Wheat Ridge
Residential Roofing PERMIT - 201704375
PERMIT NO: 201704375 ISSUED: 07/19/2017
JOB ADDRESS: 7085 W 32nd PL EXPIRES: 07/19/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles with
28 sq.
*** CONTACTS ***
OWNER (303)618-3404 VASSOS LARRY L
SUB (303)289-7220 David Bybee 170363 Classic Roofing & Gutters, Inc
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 13,924.26
FEES
Total Valuation 0.00
Use Tax 292.41 P A I D`
Permit Fee 267.70
** TOTAL ** 560.11- --- —�
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) requires an approved inspection
prior to installation of ANY roof coverings and is require on the entire roof when spaced
or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are
required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and
water shield is required. Eave and rake metal is required. A ladder extending 3 feet above
the roof eave and secured in place is required to be provided for all roof inspections.
Roof ventilation is required to comply with applicable codes and/or manufacturer
installation instructions, whichever is more stringent. In order to pass a final inspection
of elastomeric or similar type roof coverings, a letter of inspection and approval from the
manufacturer technical representative stating that "the application of the roof at (project
address) has been applied in accordance with the installation instruction for (roof
material brand name) roof covering" is required to be on site at the time of final
inspection.
Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd
party inspection report will be collected at final roof inspection performed by City of
Wheat Ridge. If report is not available the final inspection will not be completed.
r City of Wheat Ridge
Residential Roofing PERMIT - 201704375
PERMIT NO: 201704375 ISSUED: 07/19/2017
JOB ADDRESS: 7085 W 32nd PL EXPIRES: 07/19/2018
JOB DESCRIPTION: Residential Re—roof to install Owens Corning Duration asphalt shingles with
28 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 author' ed to obtain this permit and perform the work described and approved in conjunction with
this permit. I further attest that I am le all brized to include all entities named within this document as parties to the work to be
performed and that all wo pe ed is disclosed in this do companying ap roved Tans and specifications.
�?
Signature of OWNE CONTRACTOR (Circle one) Date
I . This permit w sued based on the information provided in the permit application and accompanying plans and specifications and is
subject t compliance with those documents, and all applicable statutes, ordinances, regulations, po Flans
and procedures.
2. This pe rt 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 originalpermit fee.
3. If this permit expires, anew 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
Divisio
6. The issuan( r ntfn o it 11 t be construed to be a permit for, or an approval of, an violation of any provision of any
applicabl a 'na n 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
201�'764'S7�-
From:
no-reply@ci.wheat ridge.co.us
Sent:
Tuesday, July 11, 2017 8:56 PM
To:
Permits CommDev
Subject:
Online Form Submittal: Residential Roofing Permit Application
Categories: Danny
Residential Roofing Permit Application
This application is exclusively for new permits for residential roofs and for licensed
contractors only. This type of permit is ONLY being processed online --do not come
to City Hall to submit an application in person. Permits are processed and issued in
the order they are received and due to the volume of requests, time to process
varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR
PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE
AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if
your contractor's license or insurance has expired, and you may update those
documents at the time you are issued your permit.
For all other requests:
Homeowners wishing to obtain a roofing permit must apply for the permit in person
at City Hall. Revisions to existing permits (for example, to add redecking) must be
completed in person at City Hall. All other non -roofing permits must be completed in
person at City Hall. The Building Division will be open from 7:30-10:30 a.m.,
Monday through Friday to process these types of requests.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
Property Owner Email
Address
7085 W 32nd Place
Larry Vassos
303-618-3404
Field not completed.
Do you have a signed
Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
CONTRACTOR INFORMATION
Contractor Name
Classic Roofing & Gutters, Inc.
Contractor's License
170363
Number (for the City of
Wheat Ridge)
Contractor Phone
303-289-7220 303-704-0502
Number
Contractor Email Address
crgil989@yahoo.com
Retype Contractor Email
crgil989@yahoo.com
Address
DESCRIPTION OF WORK
Are you re -decking the
No
roof?
Description of Roofing
Tear off to deck Install Owens Corning Duration
Material
Select Type of Material:
Asphalt
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
28
material selected above?
Does any portion of the
/
No
property include a flat
roof?
If yes, how many squares
Field not completed.
on the flat roof?
l /
TOTAL SQUARES of all
28
roofing material for this
project
Provide additional detail
House 17sq 4/12 Garage 9sq 4/12
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)
13924.26
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 David Bybee
Email not displaying correctly? View it in your browser.
3
6793 West 98th Circle
Westminster, CO 80021
CLASS! C 303-289-7220
www.classicroofingandgutters.com
ROOFING ESTIMAI E AND/OR CONTRACT
Nl a.rmle
Addrf
City:
State:
Zip C
f, } C JZI( f 7;?t�a�i,. .
Daytime Phone:
Evening Phone: :3— Q,
Fax:
E-mail:
I/We the OWNER agree to pay upon completion the sum of $ Z L' (p
CI.,ASSIC ROOFING & GUTTERS, INC. to $
furnish all material & labor. $
�A:Tearoff - Number of Layers: �.
Type of Roofing Shingles- ����/� / �� ❑ Flat roof applications:
Manufacturer: C7 S C. c7 Type of Material:
Shingle Color: Material Color:
Material Warranty: Underlayments:
Tearoff - Number of Layers:
R' New Decking as needed: $ _AL571r sheet
New flashings as needed
ew felt underlayinent
New
Q Extras:
�^ All taxes and permits included
years guarantee on labor
'leanup & haul off all roofing debris
'f!kail,jsweep with magnetic roller
q Gutters cleaned
MNew Roof -Jack Flashings
Neve 490 tb�closed cut valleys \{ �❑ New Stacks: use
Yom- j&�ew Vents: El re -use
New edge metal as needed: Z X 2
Co .ments: L ` e.J�Z k I�a�/� i'j CLASSIC ROOFING & GUTTERS, INC.
G
1�111� '�i 10011111 AFI
S.
t- Date:
(See- ver %e for terms and conditions)
2
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: D�-
Permit Number:
0 a
❑ No one available for inspection:,Time c ..5--AM/PM
Re -Inspection required: YesNo
t'
When corrections have been made, call for re-insppctioi at 303-234-5933
Date: "Aq j Inspector:
DO NOT REMOVETHIS NOTICE
-r i CITY OF WHEAT RIDGE
_( -
�� Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
"fl�o � /j
Inspection Type:
7 &
Job Address: _?(j 1°�' .3
Permit Number: i -r
❑ No one available for inspection: Time ? AM/tI
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date: 9! y Inspector: +/ y
DO NOT REMOVE THIS NOTICE
♦ 6 A i CITY OF WHEAT RIDGE'
�I Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office • (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type:
Job Address: 755 w 3� r fib,
Permit Number: 16kfp47 0
❑ No one available for inspection: Time I %;ate �pM
Re- Inspection required: Yes
"When corrections have been made, call for re- inspection at 303- 234 -5933
Date: Y 7 1�v Inspecto
e
DO NOT REMOVE THIS NOTICE
c F"' '.y, R. K vTy . e�"f�+'a'•�`YY '`t'IXbnry
4
g
4 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: 7685 ev .g
Permit Number: !w C170
❑ 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: e r Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
_r-
Residential Roofing PERMIT - 100978
PERMIT NO: 100978 ISSUED: 04/19/2010
JOB 'ADDRESS.: 7085 W-32ND PL- ?EXPIRES: 10/16/2010
DESCRIPTION:. Reroof 24 sgswith 30.: yr 'shingles
***CONTACTS
owner 303/237-4547 Larry Vassos
sub 303/500-3101 Giovonny Varts 10-0056 Cornerstone Roofing & Restorat
**'PARCEL ;INFO
ZONE CODE: UA c USE: `UA
SUBDIVISION:: 0554 BLOCK/LOT#: 0/
**FEE SUMMARY ESTIMATED PROJECT VALUATION: 7,800.00
FEES
Permit Fee 199.30
Total Valuation .00 ~j)P)W J(r~
Use Tax 140.40 gy
TOTAL '.339.70
Conditions:'
6 nails per `shingle is required. Ice dam membrane is required from eave'edge to.:
2' inside exterior walls. Board sheathing with any gap -greater than 1/2"
requires panel sheathing overlay on entire roof. Sheathing inspection is
required prior to covering.,.Midroof inspection is not required on permits
purchased after 4/.18/10. Contractor shall.. provide ladder for inspections.
Scheduled inspections that cannot be performed due to inclement weather must be
cancelled prior to -8:30 a.m.. on the day of inspection ora re inspectionfee
will be assessed.
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 orcovenants, .easements or restrictions of record; that all...
measurements shown, and allegations made are accurate; that Ihave read and agree to abide by all conditions printed on ..this
application and that Iassume full responsibility for compliance . with the Wheat.. Ridge Building Code (I.B.C) and all other
applicable Wheat/AAedge Ordinances, for work under this permit. Plans subject to field inspection.
Signature 'of/ ntiactor/owner da e
1. This 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 may be granted`. at the discretion of the Building Official.
L If this permit expires, `.a new. permit may be acquired for a fee of one-half the amount normally required, provided no
changes have.. been or will be made in the original plans and specifications and any suspension or abandonment' has not
exceeded one -(1) year. If changes have been or if suspension or abandonment exceeds one (1) year, full fees: shall
be paid for anew permit.
k. No work of any manner shall be done that will change the natural flow of water causing a drainage problem.
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.
The issuance : of a permit or the approval of drawings and specifications shall not be construed to be a permit for, nor'
an approval of, any violation of : the provisions of the :building codes or any.: other ordinance, law; rule or regulation.
All plan revie is subject to field inspections.
signature f Building. Official date
CNSPEC ON REQUEST :LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855
.
2EQUES S MUST BE MADE BY 3PM ANY BUSINESS `DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
APR-19-10 MON 10:55 AM NMBAA
FAX NO. 5745832997 P. 02
City of
e f ,r Date:
o` CQMMUNITY DEVELOPMENT Permit
pBuilding Division
7500 W. 29th Ave„ Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection ,Line: 303-234-5933
Facsimile Building Permit Application
Property Address: Z 1"". •7z t~:_/ PL,
Property Owner (please print): L.-Or rv t'/ lej S So 5 Phone: 363 23 7-
M ailing Address: (if different than property dress)
Address:
Sub Contractors:
CompanyName• LicenseM Expiration Date: Trade/Profession: Approval:
r
Use of space (description): _
Description of work: G . 00
~~/rr.6}ZL., 61G( 5fllnyllS •TB 7J~~j ~ plan Review (due at time cfsubmiltal):$__`___
fet¢s cfi/ / /"O 31yr flV/44ry1f ~e. <
Sq. Ft./L.Ft added: Squares BTU's Gallons Amps
OWNERICONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby oedify 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 Wheal Ridge Ordinances, for work
under this permit. Plans subject to field inspection.
E (CONTRA70R)
C(RLCL=ONF.:: (OWNER) ONTRACTOR) or PERSONAL REPRESENTATIVE of(OWN
)?RINT NAME: _,,,_J - - SIGNATURE: ~ - .u Oate: 9-/0
ZONING COMMENTS:
Zoning!
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewff:r.
DEPARTMENT USE ONLY
BUILDING DEPARTMENT COMMENTS: OCCUPANCY: .
Revlewec
FIRE DEPARTMENT:: CI approved w/ comments C:I disapproved ❑ no review required Bldg Valuation:
Credit Card Payment: Use credif card listed on file. Date:
Print name: _ Signature:
Contractor License M /OpC7 SYv Phone; ',50 3- 5 oc -_5 I u 1