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HomeMy WebLinkAbout3300 Moore Streeti CITY OF WHEAT RIDGE Tq Buildrfig Inspection DiAsion (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: �k)M_1Z fL i h 6 -e- Job Job Address: `'CSO IM UO" ST,,' Permit Number: `�� 1 C�( <?-34- IJ ?34- ❑ No one available for inspection: Time AM/PMS Re -Inspection required: Yes,__ When corrections have been made, -call for re -inspection at 303-234-5933 Date: (0-2b' I D Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Sewer Repair PERMIT - 201801834 PERMIT NO: 201801834 ISSUED: 06/25/2018 JOB ADDRESS: 3300 Moore ST EXPIRES: 06/25/2019 JOB DESCRIPTION: Replace leaking water service line from meter pit to house. 40 ft of 1 inch type K copper. *** CONTACTS *** OWNER (720)394-8200 CRITCHFIELD FAMILY TRUST SUB (603)391-1204 Brian McAndrew 170089 Excavators, LLC *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 2,000.00 FEES Total Valuation 0.00 Use Tax 42.00 Permit Fee 77.50 ** TOTAL ** 119.50 *** COMMENTS *** *** CONDITIONS *** ALL sewer repair/replacements for which a permit is issued MUST be inspected by and receive written approval from the City of Wheat Ridge BUILDING DIVISION, regardless of inspection by any Sanitation District representative. Inspection and approval of work by any Sanitation District representative DOES NOT grant authority to cover work without the approval of the Building Division. **For trenchless sewer replacements - The contractor will verify proper slope of new sewer piping in conformance with the IRC and IPC of 1/4 inch per foot unless otherwise allowed specifically by the applicable code. The plumbing contractor will provide verification of proper slope and drainage in writing as a condition of approval of the permitted work.** City of Wheat Ridge Residential Sewer Repair PERMIT - 201801834 PERMIT NO: 201801834 ISSUED: 06/25/2018 JOB ADDRESS: 3300 Moore ST EXPIRES: 06/25/2019 JOB DESCRIPTION: Replace leaking water service line from meter pit to house. 40 ft of 1 inch type K copper. 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 inconjunction with this_�ppermit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be pe/rtimmed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. It ��" r % � G%�.�—� " /` f •. z� %tel sl � �� Siinature of OWNER or CONTRACTOR (Circle one) Dater 1. This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 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 permit 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 Offcial and is not guaranteed. 4. No work of any manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall n t roceed or conceal work without written approval of such work from the Building and Inspection Services Divi 6. The s nce r grant of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any ap or 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. City Of W heat ��dge COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 2911 Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits(o-ki.wheatridge.co.us I FOR OFFICE USE ONLY Date: &/XJ/9 Plan/Permit # Plan eview Fee: Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: Property Owner (please print): �'-' �� ���-(� 4 i -c Cc Phone: Property Owner Email: Tenant (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Enaineer: Architect/Engineer E-mail: Phone: Contractor: City of Wheat Ridge License #: T` v Phone: �U� �j�(� �? �"i � Contractor E-mail Address:_ For Plan Review Questions & Comments (please print): CONTACT NAME (please print): Phone: CONTACT EMAIL(p/ease print): Sub Contractors (Must provide Wheat Ridge License No.): Electrical: Plumbing: Mechanical: W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: Other City Licensed Sub: City License # J� ! 700City License # ❑COMMERCIAL ESIDENT IAL Description of work: For ALL projects, 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. /'def -e- F -- q0 ' C -s Sq. FULF Amps BTUs Squares Commercial Projects Only: Occupancy Type: CCPD- -e' -- Gallons Construction Type: 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. 1, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLEONE. (OWNER) (CONTRACTO or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: Printed Name:: r I/:/1 M !).1 J. DEPARTMENT USE ONLY ZONING COMMMENTS: OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: Building Division Valuation: PERMIT: ADDRESS:�I�� JOB CODE: INSPECTION RECORD !�/12 Inspection online form: http://www.cl.wheatridge.co.us/inspection Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Inspections will not be performed unless this card is posted on the project site Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business Foundation Inspections Date Inspector Initials Comments 102 Caissons / Piers 103 Footing / P.E. Letter 104 Foundation Setback Cert. 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. 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 INSf ECTIONS -.a ftY Rough Inspection (continued) Date . T _ InspectsCominents Initials 316 Rough Mechanical Residential Comments 402 Gas Meter Release 317 Rough Mechanical Commercial 403 Final Electrical Residential 318 Boiler / Furnace 404 Final Electrical Commercial 319 Hot water tank 405 Final Mechanical Residential 320 Drywall screw and Nail 406 Final Mechanical Commercial 321 Moisture board / shower walls 407 Final Plumbing Residential 322 Rough Grading 408 Final Plumbing Commercial 323 Miscellaneous 409 Final Roof 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. 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: 4 tZod�- Job Address: 00 M Dot— Permit Number: '2,000-113-7 ❑ No one available for inspection: Time AM�PM Re -Inspection required: Yes to) When corrections have been made, call forme -inspection at 303-234-5933 Date: �, J'l 1 17 Inspector: 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: �' T _. Job Address: S �C�O Permit Number: ❑ No one available for inspection: Time /PC_ Re -Inspection required: Yes When corrections have have been made, cafffor re -inspection at 303-234-5933 Date: :'! Inspector: ! _ c �' DO NOT REMOVE THIS NOTICE ► ' , City of Wheat Ridge Residential Roofing PERMIT - 201707737 PERMIT NO: 201707737 ISSUED: 09/27/2017 JOB ADDRESS: 3300 Moore ST EXPIRES: 09/27/2018 JOB DESCRIPTION: Residential Re -roof to install Malarkey asphalt shingles - 33 sq Pitch = 5/12 *** CONTACTS *** OWNER (720)394-8200 CRITCHFIELD FAMILY TRUST SUB (720)921-6717 Kurt Ulrich 170107 The Colorado Roofing Company *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 14,000.00 FEES Total Valuation 0.00 Use Tax 294.00 Permit Fee 267.70 ** TOTAL ** 561.70 *** COMMENTS *** *** CONDITIONS *** Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required for both the midroof and final inspections. The 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec. R806. The installation of ridge venting requires the installation or existence of soffit venting. For calculation purposes, one hat or turtle vent equal to one-half of one square foot of opening. Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) is required on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and mid -roofs may be called in at the same time, one hundred percent of the sheathing must be complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, the 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. City of Wheat Ridge Residential Roofing PERMIT - 201707737 PERMIT NO: 201707737 ISSUED: 09/27/2017 JOB ADDRESS: 3300 Moore ST EXPIRES: 09/27/2018 JOB DESCRIPTION: Residential Re -roof to install Malarkey asphalt shingles - 33 sq 5/12 Pitch = 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 thispermrt. I further attest that I am lly authorized to include all entities named within this document as parties to the work to be Vol, and at4 work t er ormed is disclosed in this document and/. r its' accompanying approved plans and specifications. �, 0 Signature of OWNER or CONTRACTOR (Circle one) Date ` 1. This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 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 originalermit 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 Off-cial and is not guaranteed. 4. No work of any manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable code or any ordinance 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. Dane Lovett 2 0/7077,_,_'7 From: no-reply@ci.wheatridge.co.us _ Sent: Friday, September 22, 2017 12:11 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application C G Follow Up Flag: Follow up c Flag Status: Completed Residential Roofing Permit Application 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 (enter WITH dashes, eg 303-123-4567) �1). 3300 Moore St Wheat Ridge 80033 Katie Critchfield 720-394-8200 53 This application is exclusively for new permits for residential roofs and for licensed �c 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 c ' 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 (enter WITH dashes, eg 303-123-4567) �1). 3300 Moore St Wheat Ridge 80033 Katie Critchfield 720-394-8200 53 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 gregcritchy@gmail.com Yes signed 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) Contractor Address (Primary address of your business) The Colorado Roofing Company, Ilc. 170107 720-921-6717 9 Blue Sage Littleton CO 80127 Contractor Email Address info@coroofingco.com Retype Contractor Email info@coroofingco.com Address DESCRIPTION OF WORK TOTAL SQUARES of 33 the entire scope of work: Project Value (contract 14000,,E value or cost of ALL materials and labor) Are you re -decking the No roof? Is the permit for a flat Pitched roof (2:12 pitch or greater) roof, pitched roof, or 54 both? (check all that apply) What is the specific pitch 5:12 of the PITCHED roof? How many squares are �. all 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) malarkey legacy Asphalt house and attached 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 owner of the property to 55 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 Kurt Ulrich Email not displaying correctly? View it in your browser. 56 9 Blue Sage Littleton Co 80127 720-921-6717 Client Name:3 Address: P 5� BBB, City: ``+- ` State: C2 Zip Code: OO THE COLORADO ROOFING COMPANY The CRC Rep: Cell Phone: 7 2 o Date: 2 0 Z Gutter Replacement: Yes No Gutter Color: _-7-60 Downspout Color: Phone.• Email: .' rq, Paint: Yes No Color: l t 5 c� n ��r� � Trim: -Yes No Color* Manufacturer: Siding: -Yes No Make &Size: Shingle Color. N A � D4.14-/ Perimeter Drip Edge - Color: Step Flashing - Color: Touch -Up Point - Color: Current Roof Ventilation: �L Recommended Ventilation Pull all necessary permits / Complete Inspections install per local building codes & manufacturers spec's y6 nails per every shingle flew step flashing where appropriate (sidewalls, skylight) rNew pipe jacks TlClean roof and gutters of debris ^+Magnet sweep for nails after every day Perform visual inspection for nails and debris every day ,(Clean neighbor's property of our debris (w/permission) k(5 -year warranty on labor Clean all sky lights ce & Water shield at eaves, valley's and around skylights Additional Services: 40 IV V lit - OL L I ! Project Total: gc�/ o f" ` "14- 4 SSbc1 t � � / 5 cenx a t - ow i.GPALtr Estimated Date of Work: Or-V16Zou *The CRC cannot be held liable for delays due to material shortage, weather, labor or other circumstances beyond our control. The Colorado Roofing Company, tic. (rhe CRC) shall hold in trust any payment received from you, the client, until The CRC has delivered roofing materials at the site or has performed a majority of roofing work on your premise. Insurance Related Information Insurance Company: Policy Number: r Claim Number: Adjuster: Claim Date: Deductible: Payment Terms: 30% of the roof portion of the insurance claim upon delivery of materials. Upon completion of work The CRC will invoice both you, the client, and the insurance company verifying the deductible has been paid and the work complete. When final payment from your insurance company is received, the final payment to The CRC is due. 9 The Colorado Roofing Company, Ilc. DATE I, the property owner of the above listed address, retain The Colorado Roofing Company, Ilc. to repair/replace the root/property associated with the insurance claim per the approval and payment of the insurance company. I allow The CRC to negotiate with the insurance company on my behalf to ensure that all damage is properly compensated for and that I am represented fairly. In the event the insurance company fails to properly reimburse for damages, The CRC may not be held liable and this contract may be void. "The clients out of pocket expenses will not exceed the deductible amount on the policy affiliated with the property address listed above unless specifically noted. Owner/Owner's DATE You, the client, have the right to rescind this contract within 72 hours of signing, as does The CRC. If you plan to use the proceeds of a property and casualty insurance policy to pay for the work, you may rescind this contract depos t for2workhours performed inreceiving written a workmannotice like manner consim has istent with theen deniede The CRC is entitled To retain payment or standard roofing practice. Integrity, Quality and Customer Satisfaction to the roofing industry. ACORL3� CERTIFICATE OF LIABILITY INSURANCE DATE(MMl06130'20172017 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ADD Risk Services Central, Inc. Southfield MI Office CONTACT NAME: PHONE (A/c. No. Ext): (166) 283-7122 FAX No �. (800) 363-0105 3000 Town Center Suite 3000 E-MAIL ADDRESS: Southfield MI 48075 USA Ons EACH OCCURRENCE $2,000,000 INSURER(S) AFFORDING COVERAGE NAIC # INSURED r V INSURER A: Lloyd's syndicate No. 3624 AA1120098 Belfor USA Group, Inc. dba508 BelforKalam Property Restoration 5085 Kalama02 Street INSURER B: AIG Specialty Insurance Company 26883 INSURER C: National union Fire Ins Co of Pittsburgh 19445 9 Denver Co 80221 USA INSURER D: The Insurance Co of the State of PA 19429 INSURER E: American Home Assurance Co. 19380 V INSURER F: GUVEKAGES CERTIFICATE NUMBER: 5/0067390799 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested R LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYV POLICY EXP FOLICV EXP LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR GL7468694 SIR applies per policy terns _6.1 & Condi.! Ons EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $2,000+000 PREMISES Ea occunence MED EXP (Any one person) $10,000 X SIR of $500.000 PERSONAL& ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X PRO X LOC �JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER. C AUTOMOBILE LIABILITY CA 3194557 AOS 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT Ea accident) $3,000,000 BODILY INJURY (Per person) C X ANY AUTO CA 3194558 07/01/2017 07/01/2018 C X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED AUTOS NON -OWNED ONLY AUTOS ONLY MA CA 3194559 VA 07/01/2017 07/01/2018 BODILY INJURY (Per accident) PROPERTY DAMAGE Peraccident C X UMBRELLA LIAB I X I OCCUR 28189212 07/01/2017 07/01/2018 EACH OCCURRENCE $5,000,000 EXCESS UAB CLAIMS -MADE AGGREGATE $5,000,000 DED RETENTION D D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR I PARTNER / EXECUTIVE OFFICER)MEMBEREXCLUDED' N/A WC014629466 AOS wc014629467 07/01/2017 07/01/2017 07/01/2018 07/01/2018 X PER oTH- STATUTE ER E.L. EACH H ACCIDENT $1+000+000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under FL E . DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) i Re: Building Inspections Division. i I i I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of wheatridge AUTHORIZED REPRESENTATIVE 7500 W. 29th Ave. wheat Ridge Co 80033 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD L d AGENCY CUSTOMER ID: 570000005415 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk Services Central, Inc. NAMED INSURED Belfor USA Group, Inc. POLICY NUMBER See Certificate Number: 570067390799 CARRIER See certificate Number: 570067390799 NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i ;x: ri a AW J 1 .- ...... -_. --- ..__......... . 3 �0 Vt Si S LWLV YtVW INSPECTION RECORD INSPECTION REQUEST LINE: (303) 234 -5933 Inspections will not be performed unless this card is posted on the project site. F Call the inspection request line before 3:00 p.m. to receive an inspection the following business day. Inspector Must Sign ALL Spaces pertinent to this project Foundation Inspections Date Inspector I Comments Initials Monolithic Slab Reinforcement Caissons Concrete Encased Ground (CEG) Footing /Stemwall P.E. Letter Do Not Pour Concrete Prior To Approval of Thp Ahnuo lncnar inns Underground /Slab Inspections Date Inspector Comments omments Electrical (Underground) Sewer Service (Underground) /( Water Service (Underground) Plumbing (Below / In -slab) Heating (Below / In -slab) VV 1VVL l UVtl1 urluergruunu or oeiownn -ataD vvorK vrlor 10 Approval Ut The Above Inspections Rough Inspections Date Inspector Comments Initials Wall Sheathing Roof Sheathing Lath / Wall Tie Rough Electric Rough Mechanical Gas Piping Do Not Proceed Without Approval Of Above Rough Inspections Rough Framing Insulation Drywall Screw / Nail Final Inspections Date Inspector Comments omments Final Electrical Final Plumbing Final Mechanical Roof Final Building / Frame Landscaping & Parking / Planning Dept. Inspections from these entities should be requested one week in advance. For landscaping and parking ROW & Drainage / Public Works Dept. inspections call 303- 235 -2846. For ROW and drainage inspections call 303 - 235 -2861. For fire inspections Fire Inspection / Fire Protection Dist. contact the Fire Protection District for your project. * *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 author of occu pancy. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather r i CITY OF WHEAT RIDGE f Building Inspection Division r (303) 234 -5933 Inspection line ( 303) 235-2855 Office •,.(303) 237 -8929 Fax INSPECTION NOTICE Inspection Type Job Address Permit Number ❑ No one available for inspection: Time AM /PM Re- Inspection required: Yes 411 "When corrections have been made, call for re- inspection at 303 - 234 -5933 '• Date: r / Inspector: DO NOT REMOVE THIS NOTICE I U City of Wheat Ridge 1� Residential Plumbing PERMIT - .111364 PERMIT NO: 111364 ISSUED: 11/07/2011 JOB ADDRESS: 3300 MOORE ST EXPIRES: 11/06/2012 DESCRIPTION: Repair 10 if of sewer line in yard only * ** CONTACTS * ** owner 303/462 -1950 Vicki Seal sub 303/696 -9599 Steve Wakeham 01 -9921 Pipeline Industries, Inc. ** PARCEL INFO ** ZONE CODE: UA SUBDIVISION: 0647 USE: UA BLOCK /LOT #: 0/ ** FEE SUMMARY ** Permit Fee Total Valuation Use Tax ** TOTAL ** Conditions: Subject to field inspections. ESTIMATED PROJECT VALUATION: 2,275.00 FEES 93J5 40.95 134.30 U 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 further attest that I am legally authorized to include all entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in this document and or its' accompanying approved plans and specifications. Signatu O ER or CONTRACTOR (Circle one) Date 1. This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 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 permit 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 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 'ne ion. Signet ief Building Offical Date INSP CTION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of C.E)14A4U.`J[71' +CV[tQC'NSFiNT 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 Building Permit Application Date: Plan # Permit# l 3� Property Address:' Property Owner (plea Mailing Address: (if different than property address) Address: 33dC MW(P 5 City, State, Zip:, � I I n . Contractor: Contractors License #: ) 6 -qsq Electrical: Plumbing: Mechanical: City License # City License # City License # ®escription ofwork- m p (CfQ o f y sea3c Tepl � contr c v me IV\ �Uct� detn oo�S $ Review Fee (due at time of submittaq: Squares BTU's Gallons Amps Sq Ft. $ O WNER/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. CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) /.. PRINT NAME: FAQ, j SIGNATURE: DATE: 0 Bldg Valuation: r M t1 L.,JNE JOB DATE 11116. ill iND R INC. DATE P.O. Box 370 ® Watkins, CO 80137 11 1 ® E$rIMA`OR gg TT ]] �� , 1 Fax(303)671-6871 SERVICEMAN INVOICE# JOB # CALL ORIGIN bo Po # JOB INFORMATION' ; ' BILLING INFORMATION .. NAME V; k; Seu NAME ADDRESS ADDRESS CITY TE ZIP CITY STATE ZIP / �� PHONE� � 7 ( HONE DESCRIPTION OF SERVICES ESTIMATE -: +e an8 pee%Icm a s r nyl $227 I on jAnee noy4 S%& I nabil &MI d eoA . - 4s " A r \r 10' to 8' d m +.ViL a 6ca'l nfi 3 2 -5 ct �t -Y ter- Er_ 1 ARRANTY Terms of Warranty. APPROVA i CX_ SIGNATURE COMMENTS: YOU ® SUBTOTAL C' av 51 % S& e 'F PLEASE PAY THIS A� ®ANT e� ITEMS NOT INCLUDED. Landscape, grass, sod, trees, bushes, flowers, plants, fence repair, decorative rock, utility conflicts, private utilities, sprinklers, waterlines, electrical, gas, I etc. Not responsible for damage caused by unstable soil, cave -ins or any other complications. TERMS: Job cancellation fees will apply. Invoices are payable -1/2 down and balance upon completion of work performed. Any invoice not paid when due, shall incur interest at the rate of 111% per annum. In the event that it becomes necessary to collect any unpaid balance owed, Pipeline Industries, Inc. shall be entitled to receive all costs of collection, including reasonable attorney fees. Pipeline Industries, Inc. shall be entitled to assert a mechanic's lien for all unpaid materials and labor supplied to buildin rojects pu sua I o Color law. .� t � SIGNATURE AC TANC ji" ..INVOIL ( SIGs t E ❑ VISA El M/C El AMEX CARD # EXP APPROVAL # ❑ CASH ❑ CHECK# CHARGE A/R ACCOUNT # INSPECTION RECORD Occupancvrrype INSPECTION LINE: (303) 234 -5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE INSPECTOR - INITIALS COMMENTS: Footings /Caissons Stemwall / (CEG)'Concrete Encased Ground Reinforcing or Monolithic Weatherproof / French Dram Sewer Service Lines Water Service Lines INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. 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 Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing Insulation Drywall Screw I FINALS F, 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 PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ♦ � CITY OF WHEAT RIDGE Building Inspection Division (303) 234 -5933 Inspection line (303) 235 -2855 Office ` (303) 235 -2857 Fax INSPECTION NOTICE Inspection Type: lm; d (r" Job Address /Permit Number: 3309 `� 1r0',?L P 4 , j t 1 t o � 6 ❑ No one available for inspection: Time f fi AM - M� Re- Inspection required: Yes When corrections have been made, call for re- inspection at 303-2 34 - 5933 , '- r,� Date: ��`��`l�vt Inspector. DO NOT REMOVE THIS NOTICE I;. ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: Pcol` FirvAZ Job Address: 3300 r P4?9e: 57- Permit Number: c~~1 S2 ❑ No one available for inspection: Time d AM/PM Re-Inspection required: Yes "When corrections have been made, call for re-inspect(on at 303-2345933 Date: T ZS-/v5' Inspectors [~~cL~L(t ` DO NOT REMOVE THIS NOTICE CITY OF WHEAT RIDGE / Building Inspection Division (303) 234-5933 Inspection line ~JJ (303) 235-2855 Office " (303) 235-2857 Fax INSPECTION NOTICE Inspection Type:; Job Address/Permit Number: a506 /Y)608 S7- A 4' City of Wheat Ridge Residential Roofing PERMIT - 091268 v'PERMIT NO: 091268 'ISSUED: 08/12/2009 JOB. ADDRESS: 3300 MOORE ST. EXPIRES: 02./08/2010 DESCRIPTION:' Reroof 33 sgs'with asphault shingles ***CONTACTS*** owner 260/484-7704 Kevin Pziombre sub 303/422-2725 Gary Theriaque 02-1170 Bear Brothers Roofing **:PARCEL INFO ZONE CODE: UA USE: UA r SUBDIVISION: 0647 BLOCK/LOT#: 0/ L' FEE SUMMARY ESTIMATED PROJECT VALUATION: 12,300.00 FEES Permit Fee 290.30 Total Valuation .00 Use Tax 221.40 TOTAL 511.70 C./bKa>~OR& ,p k n. Conditions: G 6 nail installation & mid roof inspection required. Board sheathing spaced more I, than a 1/2 of an inch apart requires plywood overlay on entire roof. Ice. and water shield. required from'eave edge to 2';inside exterior walls. - . Subject to field inspections. 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 arty of Wheat Ridge or covenants, easements or restrictions. of record; that all. u' measurements shown, and allegations made are accurate;. that I have read and agree to abide by all.: conditions :printed on. this v application and. that I assume full responsibility for compliance with the wheat RidgeBuilding Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field inspection. F~ F, Signature of contractor/o(ner 'date r 1. ..This permit was issued in accordance with the provisions set forth in your application and is subject to thee: laws of the Y. a^ '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 may be 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 : 'M w; be paid for a new permit. F~ 4. No work of any manner shall be done that will change the natural flow of water causing -a drainage problem. S. Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive ` written approval on inspection card before proceeding with successive phases of the lob. 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, an viol atron of e the provisions of the building codes or any other ordinance, Iaw, .'rule or. regulation. P All plan revi i ject to field inspections. P; F o r Signature of is uildrng 'Official date 11INSPECT N REQUEST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 R&' REQUESTS MUST BE MADE BY 3PM ANY BUSINESS 'DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.'. I, r S of W"EqT~ City of Wheat Ridge Building Division m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 Inspection Line: 303-234-5933 CO<ORP~O Date: OS ia169. Plan Permit#: Oq~ Building Permit Application Property Address: 3-300 Property Owner (please print): KC U;1J ~b 7 t p}aS ~KC Phone: Zlsd- 4cd~ - Z7ny Mailing Address: (if different than property address) Address: City, State, Zip: Contractor: i AZ 194AS Contractor License Phone: ?7 fF ZI Sub Contractors: Electrical City License Company: Plumbing City License Company Mechanical City License Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Description of work: -C cf+Q- 6 ~ 9 To 3o y -EALn Sq. Ft./L.Ft added: _ Squares h ~ BTU's Construction Value: $ 'ZZi 2~ o (as calculated per the Building Va uation Data sheet) Plan Review (due at time of submittal): $ Gallons Amps OWNERICONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate, and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown, and allegations made are accurate; that I have read and agree to abide by 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 PRINT NAME: O aAA ate.- SIGNATU (CONTRATOR) Date: 2-01 Reviewer DEc-~/- 4, PL K A CPW5' 51 tN31-e O.C Bldg Valuation: $