HomeMy WebLinkAbout4036 Newland Streetq(A lllzvla) s-�
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INSPECTION
RECORD
1 SPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection
INSPECTION REQUEST LINE: (303) 234-5933
Cancellations must be submitted via the online form before 8 a.m. the day of the inspection
Occupancy/Type
&,F
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
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date
Inspector
Initials
Comments
Electrical
Wall Sheathing
2
Sewer Service
Mid -Roof
Plumbing
'in
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
2
Mid -Roof
'in
Lath / Wall Tie
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
q
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
�' ' 4 City of Wheat Ridge
Residential Roofing PERMIT - 201705919
'ERMIT NO: 201705919 ISSUED: 08/11/2017
FOB ADDRESS: 4036 Newland ST EXPIRES: 08/11/2018
FOB DESCRIPTION: Residential Re -roof to install Owens Corning TruDef Duration Storm
Laminated Lifetime asphalt shingles with 18 sq.
** CONTACTS ***
>WNER (303)875-0679 SCHILLER MARCIA
UB (303)960-2783 Josh Lucero 110099 Expert Exteriors
** PARCEL INFO ***
ONE CODE: UA / Unassigned USE: UA / Unassigned
UBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,626.00
FEES
otal Valuation 0.00
se Tax 97.15
ermit Fee 125.05
* TOTAL ** 222.20
** 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 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.
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Residential Roofing PERMIT - 201705919
201705919 ISSUED:
4036 Newland ST EXPIRES:
Residential Re -roof to install Owens Corning TruDef
Laminated Lifetime asphalt shingles with 18 sq.
***********revision add redeckingl8 sq**************
08/11/2017
08/11/2018
Duration Storm
*** CONTACTS ***
OWNER (303)875-0679 SCHILLER MARCIA
SUB (303)960-2783 Josh Lucero 110099 Expert Exteriors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,032.25
FEES
Total Valuation 0.00
Use Tax 126.68
Permit Fee 156.75
** TOTAL ** 283.43
*** 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 elastomeric or similar
type roof coverings, a letter of inspection and approval from the manufacturer Lechnica-
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 - 201705919
PERMIT NO: 201705919 ISSUED: 08/11/2017
JOB ADDRESS: 4036 Newland ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning TruDef Duration Storm
Laminated Lifetime asphalt shingles with 18 sq.
***********revision add redeckingl8 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
bythe 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 am legally authorized to include all entities named within this document as parties to the work to be
perforir�ed and that all vyork to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CON kACTOR (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 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 re uired
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
applicable r any ordinance or regulation of this jurisdiction. Approval of work is subject to f�eld inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of
Wheat dge
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: perm its(cD-ci.wheatridge.co.us
FOR OFF CE USE ONLY
Date:
Add to Permit #
2 0 17 6 /
Building Permit Revision/Amendment Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address: y d 3(.c sk-
Property Owner (please print): IMC'Lrr-;C' IIS Phone: 3•g-7$- 0(0-7�L
Property Owner Email:
Mailing Address: (if different than property address)
Address
City, State, Zip:
Submitting Company: Gw:t }- 6x�1'irl✓c
Contact Person: Phone: y - 5"2G
Contractor: E.4cat.-4—
Contractors City License #: NJwoy� Phone: 3`1roo Z7&-),
Contractor E-mail Address:
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
/1, oza 5 Q 5
Btu's
Squares
Gallons
Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
$ hyo I qn%. Z5
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 I am the legal owner
or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any
entity included on this application to list that entity on this application.
CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHO ZED REP SENTATIVE) of (OWNER) (C5` k yTOR)
PRINT NAME: � Lra6 L wL& k.- SIGNATURE:
ZONING COMMMENTS-
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received ❑ Not Required
Water District ❑ Received ❑ Not Required
Sanitation District ❑ Received ❑ Not Required
DEPARTMENT USE ONLY
DATE:
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
A 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: ` f�� ( f' �� 5+
Permit Number:C��h
❑ No one available for inspection: Time `! rAMIPM
Re -Inspection required: Yes
When corrections have been made, call` for re -inspection at 303-234-5933
Date: C-) I I Inspector.// ,
DO NOT REMOVE THIS NOTICE
r
City of Wheat Ridge
Residential Roofing PERMIT - 201705919
PERMIT NO: 201705919 ISSUED: 08/11/2017
JOB ADDRESS: 4036 Newland ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning TruDef Duration Storm
Laminated Lifetime asphalt shingles with 18 sq.
*** CONTACTS ***
OWNER (303)875-0679 SCHILLER MARCIA
SUB (303)960-2783 Josh Lucero 110099 Expert Exteriors
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,626.00
FEES
Total Valuation 0.00
Use Tax 97.15 - - -
Permit Fee 125.05
** TOTAL ** 222.20
*** 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 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
v-
`` Residential Roofing PERMIT - 201705919
PERMIT NO: 201705919 ISSUED: 08/11/2017
JOB ADDRESS: 4036 Newland ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning TruDef Duration Storm
Laminated Lifetime asphalt shingles with 18 sq.
I, b 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 er rther attest that I am le ally authorized to include alI entities named within this document as parties to the work to be
per
ed that alrk to performed is disclosed in this document and/oy its' accompanying approved plans and specifications.
Syf'gn�,afure of O R or CONTRACTOR (Circle one) Date'
�✓ This/perm*as issued based on the information provided in the permit application and accompanying plans and specifications and is
subjcompliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. Thisall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
receto 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, 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, any violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
e
Signature of C ie Building Officia Date
REQUESTS MUST BE MADE BY 11:59PM ANY BIPINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dan Schultz
From: no-reply@ci.wheatridge.co.us
Sent: Monday, August 7, 2017 5:02 PM
To: CommDev Permits
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
DC
4036 Newland St.
Marcia Schiller
(303) 875-0679
Field not completed.
.r
Ili ��• J
Do you have a signed
Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
Attached Copy of
Schiller Build Contract .pdf
Contract
CONTRACTOR INFORMATION
Contractor Business
Expert Exteriors
Name
L -
DL -
Contractor's License
Contractor's
110099
Number (for the City of
Wheat Ridge)
Contractor Phone
(720) 329-6028
Number
Contractor Email Address
tcoberly@expexts.com
Retype Contractor Email
tcoberly@expexts.com
Address
DESCRIPTION OF WORK
Are you re -decking the
No
roof?
Description of Roofing
Owens Corning, TruDefinition Duration Storm, Laminated -
Material
Lifetime- comp. shingle rfg.
Select Type of Material: Asphalt
If "Other" is selected Field not completed
above, describe here:
How many squares of the 18
material selected above? /
Does any portion of the No c/
property include a flat
roof?
If yes, how many squares Field not completed.
on the flat roof?
TOTAL SQUARES 18 V
(pitched + flat) of all
2
roofing material for this
project
Provide additional detail
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)
House, 4/12 pitch, 1 layer, 1 story, 18sq
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 Tom Coberly
Email not displaying correctly? View it in your browser.
3
Agreement
Expert Exteriors, LLC
6245 Clermont St. Commerce City, CO 80022
Office: 303.960.2783—Fax: 720.242.7480—expertexteriors@gmail.com
FXPEiO EXTERIORS SERVING COLORADO
CUSTOMER INFORMATION
First: _ 1�.C�C'.\ Last:
Property (Worksite Addr: WaVA 4
Mailing (if different) Addr:
Phone 1: (�)- H _w_
Email 1:��P�� M (, 1, �ay^
First: Last:
City: % State: o Zip
City: State: Zip:
Phone 2: �)
Email 2:
H_C_W_
INSURANCE INFORMATION ff
g ?(P7 - ZC)5/
Company:AA-0 f l tyyyPi�}j Claim#:
DOL: /
Deductible Amount: $ 1001 or % Code Coverag . es No RCV Coverage es`- No
Main Phone: Ext:Fax: O
-
E-mail:
Adj's Name, First:AAJ& U1 Q Last:
Cell:
"PRICE AGREEABLE" AGREEABLE" PAYMENT SCHEDULE
ACV CHECK DUE UPON MATERIAL DELIVERY
SPECIFICATIONS
ALL OTHER AMOUNTS DUE ON COMPLETION OF WORK
❑
RFG GRADE & STYLE: l Vl
THE AMOUNTS BELOW ARE ESTIMATES. FINAL PRICE YOU OWE 1S DEFINED BY THE REPLACEMENT COST VALUE
(RCV CALCULATED BY EXPERT EXTERIORS OR YOUR INSURANCE, WHICHEVER IS GREATER, PLUS ANY AMOUNTS
❑
El
COLOR OF SHINGLE: T•
"
GUTTER: "a
SPECIFIED IN THIS CONTRACT.)
UNDER COLORADO LAW, EXPERT EXTERIORS CANNOT WAIVE YOUR INSURANCE DEDUCTIBLE.
THE DATE OF INSPECTION, FINAL INSPECTION, CERTIFICATION OR OTHER ACTIVITIES BY ANY CITY, COUNTY OR
❑
LF COLOR: INT•
DRIP EDGE': LF COLOR: 14-- INT;
CODE ENFORCEMENT AGENCIES ARE COMPLETELY IRRELEVANT TO THE DETERMINATION OF THE COMPLETION
DATE. THE COMPANY WARRANTS THAT ITS WORK WILL PASS INSPECTION. ISSUANCE OF WARRANTY• CERTIFI-
CATE & LIEN WAIVER WILL FOLLOW AFTE FINAL PA
❑
('�/✓� •
VENTS: Color: INT
RCV AMOUNT: $ h ITC7 5's,
❑
RIDGE VENT ($7.29/FT): YES_ NO / LF
❑
TEAR OFF: LAYER: A— SQS: LAYER SQS:_
DEPRECIATION: (-) $( 9Q . ) Due upon Completion
❑
_:
BOOT JACKS: QTY: Dz SIZE:_in QTY:_SIZE:_in
DEDUCTIBLE: (-) $( 1 C)OO G 1 Due upon Completion
❑
FELT: 15# SQS 30#
ACV AMOUNT:= $ Due upon Material Del.
❑
\SQS
ICE & WATER SHIELD: VALLEYS EAVES
SUPPLEMENTS*: + $ Due upon Completion.
❑
PERMIT REQUIRED: YES% NO
CUST UP -GRADES: + $ T9� f D Due upon Completion.
❑
CLEAN ROOFING DEBRIS
TOTAL: _ $ (� (� . S� +SUPPLEMEN S
❑
❑
PROTECT LANDSCAPING WHERE NECESSARY
ROLL YARD WITH MAGNETIC ROLLER
MONEY DOWN:(-) $( o(09 -k (a DATE:
❑
DECKING: I SQ FREE CODE REQ, FULL _YES )<NO
` tt)
CUST REF FEES:(-) $( l�i[� gi I 11 t1� pit
❑
LEAKS PRIOR TO STORM: YES_ NO_>C
BALANCE OWED•= $ 3L401- H � +SUPPLEMENTS
'
❑ Dates of service:
This date is an estimate and may change based on the actions of
Special Instructions:
This is a contract between Expert Exteriors, LLC ("Expert" or "Contractor") and the customer identified above and signing below ("you" or
"Customer"). Customer wishes to engage Expert to perform work on Customer's property as Expert recommends, which may include repair
and construction work. Customer will pay Expert for this work as calculated under the terms of this Agreement.
Expert agrees to communicate with Customer's insurance company ("insurer") to determine the scope and price and to perform labor and
furnish materials in accordance with the scope of the work approved by the insurance company with NO ADDITIONAL COST TO THE
HOMEOWNER EXCEPT FOR THE DEDUCTIBLE. Customer authorizes Expert to communicate with the insurer and irrevocably
instructs the insurance company to cooperate fully with Expert on this claim. Customer understands that Expert's obligation to perform labor
and furnish materials may be contingent upon the insurer approving the recommended services or materials and authorizing sufficient funds
to complete the project.
Per Senate Bill 12-038 deposits paid to Expert will be held it in trust until materials are delivered to the work site or a majority of the
scope of roofing work s een done on the property.
Respectfully Submitted By: ion I !� '0nz ..c7S L�Approved:
ert eri LLC Sales Rep (signature) Expert Exteriors LLC Sales Rep (print) Sales Rep Cell # Expert Exteriors, LLC
By signing below, I o edge and agree to be bound by all terms and conditions on the reverse side. I understand that this is a contract,
not an estimate or 1)posa . I acknowledge that Expert Exteriors is being hired as a General Contractor.
t.Y�vr. /�
n11
Customer Signature Date Customer Signature Date
Proudly Insured by: Western Pacific Insurance, 10397 West Centennial Road, Suite
127
TERMS AND CONDITIONS
1. PAYMENT. You are personally obligated to pay the final price for all work and materials provided by Expert.
The final price will be determined by calculating the Replacement Cost Value (RCV) of the work performed. You
will pay the RCV amount calculated by Expert or your insurance company, whichever is greater. In addition, you
also agree to pay the amount of any insurance supplements and any costs, including profit and overhead,
related to necessary work not included in the insurance company estimate but undertaken by Expert at its sole
discretion, including but not limited to destructive testing, repair and replacement of damaged property, improve-
ments to the property, supplements requested by you or recommended by Expert, or upgrades required by
code, permit, or other law. You represent to Expert that the price will be paid by your insurance company,
except for your deductible, but you agree that you will be personally liable for all amounts due to Expert under
the terms of this Agreement. This total may not be known with certainty until the project is completed, and so
Expert will inform you of its best estimate of the final cost for purposes of computing amounts due. UNDER
COLORADO LAW, EXPERT CANNOT PAY, WAIVE, REBATE, OR PROMISE TO PAY, WAIVE, OR REBATE,
YOUR INSURANCE DEDUCTIBLE.
2. DUE DATE. Payment equal to the Actual Cost Value (ACV) of your insurance claim is due upon delivery of
materials. If you do not receive a check for your ACV, then payment equal to the cost of Expert's materials is
due at that time. Upon completion of work, defined as the date when the work is substantially complete, Expert
shall provide a final invoice. Work may be complete even if warranty, minor, or trivial work remains to be done.
This invoice is due upon receipt. Payments with restrictive endorsements or conditions are prohibited and will
not be accepted. If any dispute arises related to this Agreement or the work, you must send all payments,
including those offered as settlement or payoff, to Expert's attorneys and not to Expert directly.
3. LATE PAYMENT. Payments not received by Expert within 5 calendar days of the due date are in default. In
that event, you will pay a one-time 10% late fee and the total amount owing shall bear interest from the date due
at the lesser of 18% per annum compounded annually or the maximum rate permitted by law. You are solely
responsible to pay for all of Expert's costs, damages, and attorney fees for any dispute related to this Agree-
ment. Expert has a security interest in the property at which the work is performed for any amount due under
the terms of this Agreement. This interest may be enforced by filing a mechanic's lien. You agree to waive your
homestead exemption with respect to any lien, foreclosure, collection, or judgment. The security interest and
lien arises under C.R.S. 38-41-212 and your homestead exemption is not applicable. Nothing in this section
limits Expert's lien rights under Colorado law. All of Expert's rights are all cumulative.
4. INSURANCE.
4(a). Communication. You authorize Expert to contact and negotiate with your insurance company to file a claim
on your behalf and determine the scope of work, Replacement Cost Value, Supplements, and all other issues
related to the work. You instruct your insurer to cooperate with Expert, and agree that you and your insurer shall
cooperate fully and in good faith with Expert.
4(b). Scope of Work. Because the services rendered by Expert may be intended to address an emergency
situation at your property, it may not be possible to determine the final scope of work and price until after Expert
has begun or completed work. Expert will undertake reasonable efforts to agree on a scope of work and price
with your insurance carrier, but cannot guarantee your insurance company will agree to the scope and price or
approve the work. In the event that Expert and your insurance company agree on a scope of work, you agree
that Expert will perform all work in that scope for the prices identified in that scope unless you and Expert agree,
in writing, specifically which items on the scope of work will not be undertaken.
4(c). Adequacy. Expert's obligation to perform the scope of work under this Agreement is contingent upon your
insurer authorizing sufficient funds to complete the project. If, in its sole discretion, Expert determines that your
insurer cannot be made to pay funds commercially reasonable and sufficient to complete the project, Expert
may cancel this Agreement without penalty to Expert.
4(d). Assignment. You today assign to Expert the right to collect funds that may be owing to you or paid by your
insurer to you related to Expert's scope of work. Expert will receive all funds paid by your insurance company,
unless you and Expert reach a specific written agreement, signed by both parties, specifying which portions of
the insurance scope of work will not be performed and the total amount of related insurance funds that will be
released back to your ownership.
4(e). Funds Held in Trust. If you receive any money from an insurance company, to the extent you owe or will
owe funds to Expert, that money is owned by Expert and you shall hold them in trust for Expert. The funds will
not be subject to any claim or lien by any other person, and you indemnify Expert against any damages or costs
related to the same. You agree that you will be subject to liability, including liability under C.R.S. §§ 18-4-401, et
seq., for breach of this paragraph. Expert is not your agent or fiduciary, and you shall indemnify and hold Expert
harmless from all costs or damages related to its negotiations With your insurance company.
5. INJURIES. You agree not to enter or permit others to enter the work area while work is ongoing or to ap-
proach Expert's equipment or materials. EXPERT IS NOT RESPONSIBLE FOR INJURIES TO THOSE WHO
ENTER THE WORK AREA. YOU SHALL INDEMNIFY, DEFEND, AND HOLD HARMLESS EXPERT FROM
ALL DAMAGES TO ANY PERSON NOT AN AGENT OF EXPERT INJURED AT THE PREMISES.
6. HAZARD TESTING. By signing this Agreement, you are representing to Expert that, to the best of your
knowledge, understanding, and belief, your home does not contain asbestos or any other hazardous material.
Nevertheless, if Expert determines that a test for asbestos or other environmental hazard is necessary, you
agree to pay the costs for such a test and approve delay related to such testing.
7. INCIDENTAL AND CONSEQUENTIAL DAMAGES. You agree that Expert is not liable for damages
of any kind, whether direct, consequential, incidental, or otherwise, resulting from the actions of Expert or
its subcontractors. You agree to indemnify and hold harmless Expert and any of its employees, agents, or
subcontractors from any claim. Expert's liability is limited to its warranty.
8. PRE-EXISTING OR HIDDEN DEFICIENCIES. Expert is not responsible for inspecting the property for
structural deficiencies or other pre-existing hazards, or those occurring as an inevitable consequence of
proper work, including but not limited to deflections, protrusions, damage to stucco or siding, problems
with decking, fascia boards, buffets, jacks, ventilators, gutters, or flashing. You acknowledge that discov-
ery of such deficiencies or hazards may alter the scope of work, cause damage, increase the Price, or
cause delay or additional testing, at Expert's sole option.
9. HANGING ITEMS AND ATTACHMENTS. Roofing work creates vibrations that may damage hanging
items, so you agree to remove items hanging from inside and outside walls, soffits, and ceilings. If it is
necessary or prudent to remove roof -mounted equipment to perform work, you will remove and reinstall
the same at your cost. Expert may remove the equipment if you have not done so in order to complete
work and, If it does, it has no obligation to reinstall or align that equipment.
10. WARRANTY AND LIMITATIONS. Expert warrants that its work will be performed in a good and work-
manlike manner and that your roof will pass any inspection required by law. You agree to notify Expert
within 72 hours of discovering any problem with its work and to immediately take reasonable action to
prevent any further damage and allow Expert to inspect and cure any alleged defects. If you fail to do so,
Expert shall have no liability for related damage and its warranty shall be void. Upon appropriate notice,
Expert will send a representative to investigate any problem. Multiple investigations may be necessary. If
Expert determines that further work is required, it will cooperate with you in ensuring that work is complet-
ed. You agree to cooperate with such inspections or additional work by providing to Expert access to the
interior and exterior of your property at reasonable times. Expert provides a lifetime non -prorated warranty
against defects in its work on your roof repairs. Some of the material used on your project may be covered
by manufacturer's warranties, and if so, Expert will transfer the warranties to you upon payment in full.
Expert is not responsible for work done by others. If you have an other contractor finish or redo Expert's
work without its written approval, including work on or removal of solar panels, such work will void Expert's
warranty. EXCEPT AS SPECIFICALLY WRITTEN HERE, EXPERT MAKES NO WARRANTIES, EX-
PRESS OR IMPLIED, INCLUDING WARRANTIES OF FITNESS OR MERCHANTABILITY. ALL WAR-
RANTIES ARE VOID IF YOU BREACH THIS AGREEMENT OR IF YOU FAIL TO MAKE FULL PAYMENT
AS REQUIRED BY THE DEADLINES SET FORTH IN THIS AGREEMENT.
11. ACCIDENTS OR ACTS OF GOD. Expert is not responsible for damage from fire, rain, windstorm, hail,
tornadoes, terrorist attack, hurricanes, or other hazards to work in progress, completed work, or the
property or your personal property. You agree to maintain in force a policy of homeowner's insurance
covering casualty to your property from such conditions.
12. CANCELLATION I RESCISSION. You may cancel and rescind this Agreement and receive a refund of
any deposit paid, by delivering written notice to Expert at 8120 Sheridan Blvd, #C-315, Westminster, CO
80003, received on or before 72 hours after you sign this Agreement. You may give notice by personal
delivery, email, or mail. You may also cancel or rescind this Agreement under C.R.S. § 6-22-104. If you
cancel before Expert begins work on the property, you agree to pay to Expert the sum of $500.00 as
compensation for its time preparing to begin work and as liquidated damages, and not a penalty. If you
cancel after work has begun, you will still pay to Expert the price for any work completed before the
cancellation or such as is necessary after cancellation to prevent damage or loss to any property after-
wards.
13. AUTHORITY. Expert is not obligated under this Agreement until it is signed by an officer of the compa-
ny, an authorized agent, or work has commenced.
14. ASSIGNMENT This Agreement is non-transferrable, and you may not assign or delegate any of your
rights or obligations. There are no third -party beneficiaries.
15. GOVERNING LAW. This Agreement shall be governed by the laws of Colorado. All lawsuits or other
disputes related to or arising under this Agreement shall be brought only in Arapahoe County, Colorado, or
in the County in which the property is situated. At Expert's sole election, all such disputes shall be re-
solved by binding arbitration under the rules of the American Arbitration Association, with you and Expert
each paying ane -half of the costs of any arbitration. Expert may recover its costs to conduct arbitration
from you in addition to any other amounts if it prevails.
16. MODIFICATION. This Agreement may only be modified in writing, signed by you and by Expert. The
headers in this Agreement are for organizational purposes only and are not themselves terms of the
Agreement. No failure by Expert to enforce any provision of this Agreement will be construed as a waiver.
17. INCORPORATION. This Agreement constitutes the full and complete agreement between us. You
agree that you will not rely upon and have not received any representations by Expert or its agents except
those in this Agreement, and that no additional promises or representations have been offered as an
inducement to sign.
18. INVALIDITY. If any provision of this Agreement is invalid under applicable law, it is to that extent
deemed omitted. The remainder of this Agreement shall be valid and enforceable to the maximum extent
possible.
19. COUNTERPARTS. This Agreement may be executed in more than one copy and by different parties
on separate copies; all such copies together constitute the same agreement.
fL,
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: -/034 N e w S 4
Permit Number: 01-7n x - g I
'
i1 !/!f C oe%
❑ No one available for inspection: Time
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date:- Q1 y /I--;, Inspector: `_F ff,
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Mechanic PERMIT - 201601638
PERMIT NO: 201601638 ISSUED: 10/19/2016
JOB ADDRESS: 4036 Newland ST EXPIRES: 10/19/2017
JOB DESCRIPTION: Install 78,000 btu furnace (replacement).
*** CONTACTS ***
OWNER (303)875-0679 SCHILLER MARCIA
SUB (720)363-7600 Fred Pedroza 150089 Tradewinds Heating and Cooling
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: /
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,000.00
FEES PAID
Total Valuation 0.00
Use Tax 90.00 _
Permit Fee 40.00
** TOTAL ** 130.00 �L1�
*** COMMENTS ***
*** CONDITIONS ***
work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R313, smoke detectors are required
to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every
level of the structure.
I, by my �Id
naturedoereby attestthat theworktobe performed shallcomplywith all accompanyiapproved plansand specifications,
applicableing codesand all applable municipalcodespolicies and procedures, and that Iame legal ownerorhave been authorized
byhe legownerofthe property and am authorizedtoobtainthispermitand performthe work described andapproved in conjunction with
thispermiI further attest that I am le ally 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 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}dans 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 errmt 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 anmanner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit ho der 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
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to fYeId inspection.
Signature of Chief 95iTding O'fPfci'al ---U
Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
* a-0 j00 n Occuvancv/Tvae
�iO,'O vw�knl - INSPECT RECORD
P_0 INSPECTION REQUEST LINE: (303) 2345933
Inspections will not be performed unless this card is posted on the project site.
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date Inspector Comments
Initials
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter ,
Do Not Pour Concrete Prior To Approval Of The Above Ins ections
Underground/Slab Inspections Date Inspector Initials comments
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To A rovai Of The Above Ins
Rough Inspections Date Inspector Comments
Initials
Wall Sheathing
Mid -Roof
Lath / Wall Tie
Rough Electric
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Insulation
Drywall Screw / Nail
Final Inspections
Final Electrical
Final Plumbing
Final Mechanical
Roof
Final Window / Doors
Final Building
Landscaping & Parking / Planning Dept.
City of Wheat Ridge
10/19/2016 11:11 CDBB
Inspector Install 78,000 btu f
Date Initials CDB013834
BPSP 4036 Newland ST
APPL/PERMIT NO: 201601638
ROW & Drainage / Public Works Dept. I I I
Fire Inspection / Fire Protection Dist.
PAYMENT RECEIVED
VS / 7941
AUTH CODE: 021108
TOTAL
Inspections from uivaG
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.
ns
AMOUNT
130.00
AMOUNT
130.00
130.00
MOTE: 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.
"For Inspection Time Window Requests — Please email insptimerequest(cDci.wheatridcae.co.us by 8:00 A.M. the day of the
inspection with the property address in the subject line of the email.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
„ .
City Of
_�qrWheat ,Oge
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 29"' Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 " Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: perm itsna.ci.wheatridge.co.us
FOR OFFICE USE ONLY
Date:
(n/ /
Plan/Perrnit # 2VO ( W
Plan Review Fee:
Building Permit Application
' Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. I
Property Address:
40')(0 C -e-e ' ,\ o-V,A S�
Property Owner (please print): 0, c��`� e Phone:
Property Owner Email i�� � cC � c cx c- CK A,, c o c O m.
Mailing Address: (lf different than property address)
Address: c c� F
City, State, Zip:
Arch itecVEng 6 neer:
Arch itecVEng i neer E-mail:
Phone:
Contractor. r�� w t c� S
N e cr`� ��
C� C� C�� ��
�} `ZZN C
Contractors City License #: S O O
CZ `A
Phone: a� -
- (0 O
Contractor E-mail Address: ��� - C�� �,.� ��C�S �ecL� �:�c� c�.�t'� C 0 O� �'V\
CaM
Sub Contractors:
Electrical:
W.R. City License #
Other City Licensed Sub:
City License #
Plumbing:
W.R. City License #
Other City Licensed Sub:
City License #
Mechanical:
W.R. City License #
Complete all information on BOTH sides of this form
❑ COMMERCIAL RESIDENTIAL
Description of work: (Check all that apply)
❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE
NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING
COMMERCIAL ADDITION ❑ RESIDENTIAL ROOFING
❑ RESDENTIAL ADDITION ❑ WINDOW REPLACEMENT
❑ COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
❑ RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT
ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
❑ OTHER (Describe)
(For ALL projects, please provide a detailed description of work to be performed, including current use of areas,
proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and
amount of materials to be used, etc.)
Sq. FtJLF
Amps
�,A (\
Btu's
Squares
I
Gallons
Other
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or
regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are
accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance
with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner
or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any
entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the
truthfulness of the information provided on the application.
CIRCLE ONE: (OWNER) CONTRACTO � Q (AUTHOR17-ED RErt1401C0T'4==N'
ENTATIVE) of (OWNER) (CONTRACTOR)
Electronic Signature (first and last name): K 1 �/�/t DATE• `0 i9 ( ,
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: b
♦ i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office • (303) 235 -2857 Fax
IN PECTION NOTICE
Inspection Type: � F f j f V A
Job Address: e (� f �)
Permit Number: 09 1 a 'I)
❑ No one available for inspection: Time AM /PM
Re- Inspection required: Yes o
"When corrections have been made, cal for -i s Octipn at 303 - 234-5933
Date: (5`' Inspector:
DO NOT REMOVE THIS NOTICE
J
PERMIT NO: 091591 "ISSUED: 08/24/2009
JOB ADDRESS:' 4036 NEWLAND ST :EXPIRES.: 02/20/2010
DESCRIPTION:.. T/o: Install 24 sqs of+LimitedLife asphalt.
***CONTACTS
owner Schuller
gc 303/462-374S MARY PHILLIPS 08-0034 O'CONNOR ROOFING
PARCEL INFO
ZONE CODE: UA USE: UA
SUBDIVISION:'. 0403.-BLOCK/LOT#: 0/;
FEE SUMMARY ESTIMATED PROJECT VALUATION.: }7,910.00`.
FEES r°"' t
` Permit Fee 199.30
Total Valuation
Use Tax 142.38
TOTAL 341.68
t,
11 Conditions:
6 nail installation& mid roof inspection required. Board sheathing spaced more
a 1/2 of ;
Dject to field inspection.
contractor/owner
plywood overlay on entire roof. Ice and
to 2' inside exterior walls.
ad by this permit application are accurate, and do not violate applicable
eat Ridge or covenants, easements or restrictions of record; that all
ate; that I have read and agree to abide by all conditions printed on this
for compliance with the Wheat Ridge Building Code (I.B.C) and, all other
this permit. Plans subject to field inspection.
date
revisions. set forth in your application and is subject to the `laws of the
and Building Codes of Wheat Ridge, Colorado or any other applicable
e date. Requests for an extension must be received prior to expiration
etion of the Building Official.
uired fora fee of one-half the amount normally required, provided no
al plans and specifications and any suspension or abandonment: has not
if suspension or abandonment exceeds one (1) year,. full fees shall
hangs the natural flow of water causing a drainage problem.
twenty-four (24) hours in advance for all inspections and shall receive
eeding with successive phases of the job::
wings and specifications shall not be construed to be a permit for, nor
of the building codes or any other ordinance, law, rule or regulation.
F W"E^r~o City of Wheat Ridge Building Division Date:
m 7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929 Plan
C o Inspection Line: 303-234-5933 Permit
OGORPO
O
Building Permit Application
Pro pert y'Addressi yp 3
Property Owner (please print): SILILL. Phone:
Mailing Address: (if different than property address)
Address: '-to j (o
City, State, Zip: (y 0 0 7 3,
Contractor: C C-t~
Contractor License Phone: 3 O 3 - '/(o Z- 3 c/5
Sub Contractors:
Electrical City License
Company:
Plumbing City License
Company
Mechanical City License
Company:
Exp. Date:
Approval:
Use of space (description):
Description of work:
r a to >
Sq. Ft./L.Ft added: Squares _
Exp. Date: Exp. Date:
Approval: Approval:
Construction Value: $ 7WeD
(as calculated per the Building Valuation Data sheet)
Plan Review (due at time of submittal): $
-
UI+~ arz a--,Gallons t 2
BTU's Gallons Amps
OWNER/CONTRACTOR 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:: (OWNER) (CONTRACTOR) or PERSONAL, REPRESENTATIVE of (OWNER) (CONTRATOR)
PRINT NAME: SIGNATURE: Date:
{;,1 Bldg Valuation: $ 1