HomeMy WebLinkAbout3420 Harlan 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 businells day
PERMIT: ADDRESS:,3yk0AI-10 n `^�- JOB CODE: 1
T
Foundation Inspections
Date
Inspector
Initials
Comments
102 Caissons / Piers
103 Footing / P.E. Letter
104 Foundation Setback Cert.
30- 1g
—7-b
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.
30- 1g
—7-b
204 Plumbing Underground Int.
;205 Pluonbirg Underground Ext.
206 Water Underground
_7
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
30- 1g
—7-b
304 Sheer Inspection
305 Insulation
306 Mid -Roof
_7
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
PERMIT:l�ADDRESS: 'lF.� f� ��✓1.�11'� 4� JOB CODES `y
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
Final Inspections
Date
Inspector
Initials
Comments
401 Gasline
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
j
{�
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.
S_
I* � 4 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: 3y20 St.
Permit Number: '2010005 %
'Ad N oo f�-
❑ No one available for inspection: Time '�� ",� �4M1iPM
Re -Inspection required: Yes (N�*When corrections have been made, call for re -inspection at 303-234-5933
Date: q /5% 1 Inspector:AQnv to✓Ptt
DO NOT REMOVE THIS NOTICE
I�
i CITY OF WHEAT RIDGE
Building Inspection, Division
1� (303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
1SPECTION N - - -
Inspection Type: 3 G 3 L-210 1,
Job Address: -3 If -0 (7 n r- %x n S4
Permit Number: 'a o 19 G G 5--7 L
M d - �oor,c/e d
C�Ew, 77vund 4 4-r- c -,.,i, 4L
❑ No one available for inspection: Time ('d - 9 9 AMAM
Re -Inspection required: Yes 9
When corrections have been made, call for re -inspection at 303-234-
Date:--s
03-234-Date:-s 30 /IF Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
` Residential Roofing PERMIT - 201800576
PERMIT NO: 201800576 ISSUED: 03/02/2018
JOB ADDRESS: 3420 Harlan ST EXPIRES: 03/02/2019
JOB DESCRIPTION: Redeck (house only) and reroof with GAF Timberline HD asphalt shingles;
2/12, 4/12, 5/12; 33 squares
*** CONTACTS ***
OWNER (602)790-9302 WILLIAMS JOHN BRITTAN
SUB (303)658-0390 Troy Buskirk 110235 Red Diamond Roofing
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,275.00
FEES
Total Valuation 0.00
Use Tax 194.78
Permit Fee 204.30
** TOTAL ** 399.08
*** 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.
City of Wheat Ridge
_''� Residential Roofing PERMIT - 201800576
PERMIT NO: 201800576 ISSUED: 03/02/2018
JOB ADDRESS: 3420 Harlan ST EXPIRES: 03/02/2019
JOB DESCRIPTION: Redeck (house only) and reroof with GAF Timberline HD asphalt shingles;
2/12, 4/12, 5/12; 33 squares
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 an 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
thispermit. 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 wolc to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) DatJ
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, po icies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
Official and maybe subject to a fee equal to one-half of the originalpermit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees 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. 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 ofa it shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordina 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.
From: no-reply@ci.wheatridge.co.us
Sent: Monday, February 26, 2018 10:59 AM
To: CommDev Permits
Subject:
Categories:
Online Form Submittal: Residential Roofing Permit Application
Invalid Contract, Kim
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 `lam
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
residential roof? `�qq,
How many dwelling units Single Family Home f
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
3420 Harlan St., Wheat Ridge, CO 80033
John Williams
602-790-9302
Property Owner Email
Address
Do you have a signed
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed
Contract
tara@reddiamondroofing.com
Yes
Williams Contract.pdf
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)
Red Diamond Roofing
110235
303-658-0390
Contractor Address 7000 N. Broadway Suite 101, Denver, CO 80221
(Primary address of your
business)
Contractor Email Address tara@reddiamondroofing.com
Retype Contractor Email
Address
DESCRIPTION OF WORK
TOTAL SQUARES of
the entire scope of work:
Project Value (contract
value or cost of ALL
materials and labor)
Are you re -decking the
roof?
Is the permit for a flat
roof, pitched roof, or
tara@reddiamondroofing.com
33
9,275.00
Yes
Pitched roof (2:12 pitch or greater)
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:
Provide any additional
detail here on the
description of work. (Is
this for a house or
garage? Etc)
5:12, 4:12, 2:12
33
GAF Timberline HD
Asphalt
Complete re -roof. Re -decking the house only. Re -shingling the
house and attached shed and detached garage.
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 Tara Olson
Email not displaying correctly? View it in your browser.
6) 4 .
$T .�®r,
D F /.N J�?edD�amond
R Q G Job Number:
Client Name: —_...%% - r�
Project -Manager:
MACLk LAxZ
-
Address:
Project Manager Phone:
a6•
!TL0-Z7'�"Z
MWCity,
State: Zip:
insurance Provider:
106p aj I
Pr
a
Municipality:
Policy Number:
Phone 1:
•z...-- 7 p • 3oZ
Claim Number:
Phone 2:
Insurance Deductible:
Email: M`5 ; r
Insurance Coverage: M
RCV 0 ACV E6
Code Upgrade
Date: -� � � '"� _
%S
Mortgage Company:
Scope of Roof Work to be Completed by Red Diamond Roofing
Obtain Permits and Coordinate Inspections as Necessary to Ensure Code Compliance
Tear Off �_ Layer(s) of Composite Shingles Layer(s) of Wood Shake Shingles Layer(s) Other
El Replace/ Install Decking (1/2" OSB typically) Describe Location: peg x,('P�_
tJ install Ice & Water Barrier: []Eaves Valleys Intrusions 44-
Install Perimeter Flashing (Drip Edge): Eaves Rakes [1�Color:
Install Underlayment: []15# Felt 030# Felt Synthetic )
L�dt � Manufacturer:____ � A
Install New Roofing: 030YR 040YR 050YR Lifetime 01R
s Series: ) ML,114-A
4-A
Closed Valley with ApproveYinsfall
derlayment []Open Valley with Valley Metal N
Color: w Initial:
7stat( Standard Ridge High Profile Ridge Install Ridge Vent
R,eplace Pipe Jacks (if) [ Replace Bath Vents Replace Heater Caps And Base � �R�
❑ Replace Attic Vents Turtle Type Vent(s) J ne Vent(s) Other. _ +l 1/�/
eplace Damaged Flashing as Required by Local Code or as Prescribed by Insurance Company's Adjuster Report
Paint Pipe Jacks and Vent Stacks to Match Shingles
Existing Low Slope Roofing Type: Replace With:
Clean Up All Construction Debris and Haul Away % T6� � �j�s
l• � Tota! Roof Price
Roof Upgrades (applies only jf Customer Decides to Upgrade their Current Roof Sy)m):
I Upgrade Item I Quantity I Unit Price I Upgrade Cost
Special Instructions: I Total Upgrade Cost to Customers
By signing this agreement the Property Owner authorizes Red Diamond Roofing Inc to represent the Property
/1,••r+n vow {�..e»♦ .»i»....wi .» »........:a ..� ......1 .....�1....»..��»a �.. ........... J... a. �a_...V J��__._
Building r it Application
Complete all information on BOTH side of this form
S
L�� \........ .... .
.- .. .. i .
SPACES INSPECTOR MUST SIGN ALL - ,-
I
r
».i
s -.
City of Wheat Ridge
S/4'5 2014 07:31 CDBA
Install 40 gallcm ho
6SP 3420 Haplap ST 56«20
APPUPERMIT HIN 201400576
PAYMENT RECEIVED AMOUNT
kis / 9 56.20
TH CODE: 86501
TOTAL 56.
OCCUPANCY OF OCCUPANCY IS ISSUED
PROTECT THIS CARD FROM THE WEATHER
05/05/2014 07:55 3035341481
From:
I R,
UNARWA
PAGE 01
0611112012 07,06 #231 N002/002
ME=
91
sub loot to flold Iftspectron,
,IRLCE otvf ( OWNr-R) (CONTRACTOR) or PERSONAL REPM
EMT NAM9, $14NATUM!
0 1
Credit Card Payment: Use credit card listed 6h Ale. D te:
Print name*
INSPECTION RECORD OBCDDaDCY/TVDe
INSPECTION LINE (303) 234 -5933
Inspections will not be made unless this card is posted on the building site
Cal by 3:00 PM to receive inspection the following business day.
0 , y�
INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB.
FOUNDATION INSPECTIONS
DATE
INSPECTOR
INITIALS
:COMMENTS: '.
Footings /Caissons
Lath / Wall tie
Stemwall /.(CEG) Concrete
Encased Ground
V
Electrical Service
Reinforcing or Monolithic
N'
Rough Electric
Weatherproof / French Drain
Rough Plumbing
Sewer Service Lines
Water Service Lines
%r
Rough Mechanical
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS
SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS.
< POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED' -
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
Heating (Underground)
cDn NOTPn11RFInnRIINTII ARnVFFIGA
FINALS
ROUGHS
Sheathing ,
'
Lath / Wall tie
Mid- Roof'
V
Electrical Service
Roof
N'
Rough Electric
°
Rough Plumbing
Gas Piping
R.O.W & Drainage
%r
Rough Mechanical
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS
SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS.
x
Framing
Insulation
Drywall Screw
FINALS
Electrical
Plumbing
Mechanical
Roof
_
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
OCCUPANCY NOT PI
WITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
P ROTECT 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: K' u-,)r
Job Address: --}(g-a _P1kv_iCk
Permit Number: I~
No one available for inspection: Time - AM%IVI~
Re-Inspection required: Yes l
When corrections have been made, call for re-inspection at 303-234-5933
~s
Date: Inspector: {.1{U+
t
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:
/)"I
Job Address: )L1~1 ST
Permit Number: SCI c3 ~(~4
❑ No one available for inspection: Time AM/PM
Re-Inspection required: Yes No
' When corrections have been made, call for rfnspVfon at 303-234-5933
Date: Inspector:Ox
Y,\,
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
►J Residential Roofing PERMIT - 092869
PERMIT NO: 092869 iISSUED:' 09/30/2009
JOB ADDRESS': 3420 'HARLAN ST EXPIRES: 03/29/2010
DESCRIPTION:. T/o: Install 20 sqs of 30 yr shingles (house/garage)
CONTACTS
owner 303/237-3266 Steven & Ellen Stenberger:
**'.PARCEL. INFO
ZONE:. CODE: UA USE: UA
SUBDIVISION:' 0465 BLOCK/LOT#: 0./
**FEE SUMMARY ESTIMATED PROJECT VALUATION: 3,540.00
FEES
Permit Fee 126.50
Total Valuation .00'~-° ` a;..
Use Tax 63 72 1 2
**.TOTAL .190.22
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 21 inside exterior walls.
Subject to field inspection.
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 Iassume 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.
&Q ~ 'e p~ r-'&~ -0
Signature of contractor owner date
1. This permit was issued in accordance with ther 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.
2 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 Building Official'.
3. 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 a. new permit.
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 S
written approval on inspection card before proceeding with successive phases of the job..'
6. 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, y ation of the provisions of the building codes or any other ordinance, law; rule or regulation.
All plan revue Sect to field inspections.
Signature of ef. B ildmg:. Official ;date
INSPECTION REQUEST LINE: (303)234-5933 BUILDING OFFICE:: (303)235-2855 REQUESTS MUST BE MADE BY 3PMANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. '
~oF "'"E?T~,, City of Wheat Ridge Building Division Date:
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929 Plan
o Inspection Line: 303-234-5933
°~oRpO Permit
Building Permit Application
PropertyAddressi ;j `~elG j~r~tt , s).y e! l~~t~ t ¢ C'U ~v03j
Property Owner (please print):: &6,20A- € File" 9,d n b er4 uv Phone 3 . -Q Z 7 32 C
Mailing Address: (if different than property address)
Address:
City, State,
Contractor:
Contractor License
Phone:
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: $
Description of work, (as calculated per the Building Valuation Data sheet)
~~AC Plan Review (due at time of submittal): $
Qk ~y
Sq. Ft./L.Ftadded: Squares,I BTU's Gallons Amps
OWNER/ceCONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
reby rtify th
1heat 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.
C/RLCE ONE:: (OWNER (CONTRACTOR) or PERSONAL REPRESENTATIVE of (OWNER) (CONTRATOR)
PRINT NAME: e'llom l S-j-erna.trlPe l- SIGNATURE: Zg&s dif AJ?,c t Date: 30 82
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BUILDING DEPARTMENTCOMMENT.S
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fIFtE OPARTMENT D approvedI eommente d d)~Sappeoved kl rto Tevrea requreed„, Bldg Valuation: $