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Home My WebLink About4550 Balsam StreetPERMIT: 777 77( ADDRESS: '�fr�- >> JOB CODE: INSPECTION RECORD Inspection online form: http://www.ci.wheatridge.co.us/inspection Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Inspections will not be performed unless this card is posted on the project site Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business Foundation Inspections Date Inspector Comments Initials .----� 102 Caissons / Piers 201 Electrical / Cable/ Conduit 103 Footing / P.E. Letter 202 Sewer Underground Int. 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation 204 Plumbing Underground Int. Do Not Pour Concrete Prior To Approval Of The Above Inspections `,�' Underground / Slab Inspections Date Inspector Initials Comment 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 206 Water Underground - Do Not Cover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector Initials Comments 301 Rough Framing 302 Wall Sheathing 303 Roof Sheathing 304 Sheer Inspection 305 Insulation 306 Mid -Roof - 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 201:7-0 7-71(v 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 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 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. ► ' r City of Wheat Ridge Residential Roofing PERMIT - 201707776 PERMIT NO: 201707776 ISSUED: 09/28/2017 JOB ADDRESS: 4550 Balsam ST EXPIRES: 09/28/2018 JOB DESCRIPTION: Residential Re -roof to install asphalt shingles - 22 sq Pitch = 5/12 *** CONTACTS *** OWNER (720)878-7421 KIRKLAND RAYMOND E SUB (720)399-0355 William Hutchison 130071 Independence Roofing & Ext. In *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,654.00 FEES Total Valuation 0.00 Use Tax 118.73 Permit Fee 140.90 ** TOTAL ** 259.63 *** COMMENTS *** *** CONDITIONS *** Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required for both the midroof and final inspections. The 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec. R806. The installation of ridge venting requires the installation or existence of soffit venting. For calculation purposes, one hat or turtle vent equal to one-half of one square foot of opening. Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, the 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. 0 City of Wheat Ridge Residential Roofing PERMIT - 201707776 PERMIT NO: 201707776 ISSUED: 09/28/2017 JOB ADDRESS: 4550 Balsam ST EXPIRES: 09/28/2018 JOB DESCRIPTION: Residential Re -roof to install asphalt shingles - 22 sq Pitch = 5/12 I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I fort es that Lam legally authorized to include all entities named within this document as parties to the work to be per arfhat all w o be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature qff O'WV ER or CONTRACTOR (Circle one) Date I. This p'eft t 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 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 androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4, No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or -granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any applicable c de o ny ordmanQa q regul i®n f this jurisdiction. Approval of work is subject to f any inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett cr From: no-reply@ci.wh eatridge.co.us Sent: Monday, September 25, 2017 8:37 AM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application -' Follow Up Flag: Follow up Flag Status: Completed Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed , contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those C 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 r. .�L Property Address 4550 Balsam St Property Owner Name Ray Kirkland Property Owner Phone 720-878-7421 Number (enter WITH dashes, eg 303-123-4567) Property Owner Email Field not completed. Address Do you have a signed Yes contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed IMG 2219.JPG Contract 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) Independence Roofing & Exteriors 1925E 1� 720-399-0355 Contractor Address 510 Compton St unit 101 (Primary address of your business) Contractor Email Address hutcherson98@gmail.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 hutcherson98@gmail.com 22 4200---- No 200 - No Pitched roof (2:12 pitch or greater) 10 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 22 Asphalt Dementional Asphalt Ranch style house. 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 11 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 Jake R Hutchison Email not displaying correctly? View it in your browser. 12 F t 0 tl a al n J( INDEPENDENCE ROOFING & EXTERIORS 510 Compton Street - Suite 101 Date 7/16/2017 Broomfield, CO 80020 proposal # 2701 720-399-0355 / Fax 303-736-2282 IRE insured by Preferred Contractors Insurance Company, RRG 720-984-2471 IRE ("Contractor") agrees subject to the Additional Terms And Conditions page in agreement to furnish all materials, labor and equipment necessary for the.work specified below located at: Billing Name / Address: Ray Kirkland 4550 Balsam St Wheat Ridge, CO Job Name / Address: 4550 Balsam St Wheat Ridge, CO 720-878-7421 THE HOMEOWNER HAS A 3 DAY RIGHT OF RECISSION TO CANCEL THIS CONTRACT IN WRITING WTPHIN 72 HOURS OF THE DATE SIGNED BY THE CUSTOMER ON THIS CONTRACT AND HAVE 100% OF ANY DEPOSIT REFUNDED. Homeowner retains the right to cancel thic contract at anytime before materials are delivered or work has begun and obtain a full refund of any deposit Replacement of deteriorated decking,fascia boards, roof jacks, ventilators, flashing or other material unless otherwise stated in this proposal and agreemerr are not included and will be charged as an extra on a time and material basis. The Owner is responsible for removal of all outdoor furniture, awnings or other outdoor fixtures prior to the start of the work. The Owner is to prime and paint any replaced wood or metal. The Contractor shall not be required to perform work related to asbestos or Polychlorinated Biphenyl (PCB), the Owner will be responsible for the additional cost of removal or cost to render harmless material in the event that such material is discovered. The Proposal and agreement will expire thirty (30) days from the date of the contract unless accepted in writing within that time by the Owner or unless the expiration date is extended in writing by the Contractor and this propos and agreement is thereafter accepted by the Owner before the extended expiration date. Also, after (30) days from the date signed, the Contractor reserrve the right to revise its price in accordance with the cost in effect at the time. All proposals are subject for approval of the contractor's management. Per Colorado Senate Bill 12-038; If payment will be through an insurance claim, the property owner may rescind this contract within 72 hours after receiving notice from their insurer that the claim has been denied in whole or part The Contractor (IRE) will not pay, waive or rebate the Homeowner's Insurance Deductible in part or in whole Independence Roofing & Exteriors shall hold in trust any payment from the property owner until the contractor (IRI: has delivered roofing materials to the jobsite or has performed a majority of the roofing work on the property. } IRE Authorized Representative � _Customer or ! tS f Down Payment: Due Upon Delivery: $6,412..0 Options: Total Contract Amount: $12 Date of Acceptance A I' $cooe Of Work Re -Roof Installation Of New Roofing Material As Described Below. Approximate dates of service -TBD SUPPLY & INSTALL Owens Corning Duration RIDGE TYPE Matching hip and ridge SHINGLE COLOR TBD Tear -Off All layers on house BASE FELT PAPER 30# Synthetic felt paper ICE & WATER SHIELD 2 Rows at all eaves an valleys PLUMBING JACKS Replace all with (3) plumbing (t) electrical total (4) VALLEY TYPE Closed Liner VENT TYPE Replace all with new (3) turtle (2) turbine total (5) EAVE EDGE METAL 2"X4" 120 degree (White) drip edge GABLE EDGE METAL New metal on rear patio gables CHIMNEY FLASH NA Skylight Remove solar tube skylight and install new ( similar size) SWAM" COOLER NA GUTTERS Replace all gutters and downspouts (White 5") IRE LABOR WARRANTY 10 Year MATERIAL WARRANTY Limited Lifetime PERMIT FURNISHED IN Wheat Ridge NOTE: Price includes house roof; all gutters and downspouts. New solar tube skylight. New furnace flashing, cap an( collar. THE HOMEOWNER HAS A 3 DAY RIGHT OF RECISSION TO CANCEL THIS CONTRACT IN WRITING WTPHIN 72 HOURS OF THE DATE SIGNED BY THE CUSTOMER ON THIS CONTRACT AND HAVE 100% OF ANY DEPOSIT REFUNDED. Homeowner retains the right to cancel thic contract at anytime before materials are delivered or work has begun and obtain a full refund of any deposit Replacement of deteriorated decking,fascia boards, roof jacks, ventilators, flashing or other material unless otherwise stated in this proposal and agreemerr are not included and will be charged as an extra on a time and material basis. The Owner is responsible for removal of all outdoor furniture, awnings or other outdoor fixtures prior to the start of the work. The Owner is to prime and paint any replaced wood or metal. The Contractor shall not be required to perform work related to asbestos or Polychlorinated Biphenyl (PCB), the Owner will be responsible for the additional cost of removal or cost to render harmless material in the event that such material is discovered. The Proposal and agreement will expire thirty (30) days from the date of the contract unless accepted in writing within that time by the Owner or unless the expiration date is extended in writing by the Contractor and this propos and agreement is thereafter accepted by the Owner before the extended expiration date. Also, after (30) days from the date signed, the Contractor reserrve the right to revise its price in accordance with the cost in effect at the time. All proposals are subject for approval of the contractor's management. Per Colorado Senate Bill 12-038; If payment will be through an insurance claim, the property owner may rescind this contract within 72 hours after receiving notice from their insurer that the claim has been denied in whole or part The Contractor (IRE) will not pay, waive or rebate the Homeowner's Insurance Deductible in part or in whole Independence Roofing & Exteriors shall hold in trust any payment from the property owner until the contractor (IRI: has delivered roofing materials to the jobsite or has performed a majority of the roofing work on the property. } IRE Authorized Representative � _Customer or ! tS f Down Payment: Due Upon Delivery: $6,412..0 Options: Total Contract Amount: $12 Date of Acceptance A I' INDEPENDENCE ROOFING & EXTERIORS September 29, 2017 City of Wheatridge To whom it may concern: Independence Roofing & Exteriors authorizes new employee Jorge Cruz to pick up and pay for permits. Please call with any questions or concerns. Since ly �,� &k�— William Hutchison President 1070 W. 124th Ave. Suite 200 Westminster, CO 80234 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: � ° & - /) I , C1 Job Address: G/ 5-5—o `F3 eL 16.n n, S4 - Permit 4 - Permit Number: w, c- P o o -t'- //—I f 0 M t, -e (-) ❑ No one available for inspection: Time /'& = 3 S` AMG Re -Inspection required: Yes 6 When corrections have been made, call for re -inspection at 303-234-5933 Date: / e 1_i f'? Inspector: 771�) DO NOT REMOVE THIS NOTICE «° CITY OF WHEAT RI G? . fU"o'9 » , #? ? 4» 1 84-5 : « pectic ° :» » » 03 2 37-8929 Fa a . N»: 4M11P < 2 11 OFFICE O Property Owner Email: Mailing Add ress: (if different than property address) Address. Complete all information an BOTH sides of this for INSPECTION RECORD OcDUpancy/TVpe 'O LINE: (303) 234 -5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. INSPECTOR sMUST SIGN ALL SPACES' PERTAINING TO THIS JOB ION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: aissons 'Mechanical rete / (CEG)Conc round * ce - :Building.Final g or Monolith ic Fire Department oof /French Drain INSPECTIONS FOR PLANNING & ZONING FIRE AND PUBLICE WORKS - BNOULD RE CALLED ATLEAST ONE WEEK PRIOR =TO FINALAN5PECTIONS- Pd1 h1171� & Ed15d3l.a J�IITI� "_ ' - - ice Lines - Water Service Lines POUR NO.CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) Do NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGHS Sheathing lath /Wall tie Mid Roof lb - Electrical Service Rough Electric z . Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING - Framing Insulation' <: Drywall Screw FINALS t Electrical Plumbing 'Mechanical Roof a - :Building.Final Fire Department R.O W & Drainage INSPECTIONS FOR PLANNING & ZONING FIRE AND PUBLICE WORKS - BNOULD RE CALLED ATLEAST ONE WEEK PRIOR =TO FINALAN5PECTIONS- Pd1 h1171� & Ed15d3l.a J�IITI� "_ ' - - I .""NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY /S ISSUED. FINAL INSPECTION. BY THE BUILDING. DIVISION DOES NOT CONSTITUTEAUTHORIZATION OF A CERTIFICATE OF OCCUPANCY. NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER CITY OF WHEAT RIDGE ~n Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax IN - PECTION NOTICE Inspection Type: Job Address: a, Permit Number: a r r No one available for inspection: Time l El 'A MiPM l 4 Re-Inspection required: Yes ll1o} When corrections have been made, call for re-inspection at 303-234-5933 r Date: Inspector: t DO NOT REMOVE THIS NOTICE ♦ 41 CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 0 } Job Address: ' q5o > L` 1t2 5-T Permit Number: ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No When corrections have been made, call for re-??.spec "on at 303-2345933 Date: i9_.~)-O --CJ inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 093459 PERMIT NO: 093459' ISSUED:: 10/19/2009 JOB ADDRESS: 4550 BALSAM ST. EXPIRES..: 04/17/2010 DESCRIPTION: Reroof `28 sqs CONTACTS owner 970/590-1771 Raymond Kirkland sub 303/684-9195 DAVID ROWDEN 07-0207 ALL 'CITY ROOFING, INC. **PARCEL INFO ZONE 'CODE: UA-USE: UA SUBDIVISION:'. 0311 BLOCK/LOT#: 0/: FEE SUMMARY ESTIMATED PROJECT VALUATION: 7,804.00 FEES Permit Fee : 199.30 Total Valuation ,00 Use :Tax 140.47 t',~~~13~I1 r w * * TOTAL * * 339.77 Conditions; 5 nail installation mid roof inspection required. Board sheathing spaced more Ghana 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield required from save edge to 21 inside exterior-.walls.' "**Contractor/Property owner shall provide :ladder(s) secured in place for inpsections. 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 r ulations of the City of Wheat Ridge. or covenants, easements or restrictions of record; that all measurements shown, a~ 1legations made are accurate; that I have read and agree to abide by all conditions. printed on this application nd:t t ssume full responsibility for compliance with the Wheat :Ridge Building Code (I.B.C) and all other applicable ea i Ord' noes, for work under this permit. Plans subject to.. field inspection. -p~ Signature of contractor/owner :date 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 expire180 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. If this permit expires, 'a new permit may be acquired fora 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. 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 ~oF ""EtTq City of Wheat Ridge Building Division Date: 7500 W. 291h Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Plan oo~oRPOO Inspection Line: 303-234-5933 Permit ~ Building Permit Application Property-Addre'ss ~F"j ~ ~ y} ~ S p~ ~ ~YL~LI~ i nC~' ~c7~ Property Owner (please pringjto t, l~r.1,D i,e k ),aoz Phone: 5)l 5J D % 7 71 Mailing Address: (if different than property address) Address: 4 ft. _ Zip: Contractor: i 1' C Contractor License Phone: Sub.Contractorss Electrical City License Company: Plumbing City License Company Mechanical City License Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ 7 Sj o Description of works gL 0 (as calculated per the Building Ua/uaffon Data sheet) 40 44(~~(e" 7n i i}11'~,' a cl r~ .JT Plan Review (due at time of submittal): S J~(S~~SiO ri/l. Sq. Ft./L.Ft added: Squares 8 BTU's Gallons Amps OWNEWCONTRACTOR 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 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:: (ccOWNER)/ ONTRACTO or PERSONAL REPRE7,- ATI WNER) (CONTRATOR) PRINT NAME: ✓-tu~fC 6WW ti., Date: SIGNATURE: Bldg Valuation: