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HomeMy WebLinkAbout3643 Taft CourtINSPECTION RECORD INSPECTION 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 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 Plumbing nr% Nnt Pniir Cnne rate Prinr Tin Annrnval UT 1 ne At]Ave inspections Underground/Slab Inspections Date Inspector Comments Initials Electrical Wall Sheathing Sewer Service Mid -Roof Plumbing 111111111 a17.4 1 rT. /7T.Tm1:T. WaTA :i] rsVnl ri?Ki F1 MT0 •lTii 7'lJTiTA Kill M I iI�7G\ *I•171a 1 it -1 �I�tl �i•]l�� Rough Inspections Date Inspector Initials Comments Wall Sheathing Mid -Roof 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 60 01 Final Window/Doors Final Building NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate sof Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. 'For low voltage permits -- Please oe sure tnat rouqn inspections are compiewu ir+)m int rile LIISUIGL drill t;ICGL1 It'dI low vuII_,A c by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather i CITY OF WHEAT RIDGE _:�9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: I-) e 9 - t- .'„ G I Job Address: -S G Li 3 Tr; 4 C ) Permit Number: a v ► 7 0 .S_ ' `I ❑ No one available for inspection: Time Re -Inspection required: Yes When corrections have been made, call for re -inspection at 303-234- Date:- //'-7 Inspector: `r"'_� 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- I n a I Job Address: '3 & N3 t Permit Number: 'a o 1-7 0 S 9,9 17 �nAj uas r` o n Q e c"c 4- No r Cc 47v r n cmcrV L Cort- ❑ No one available for inspection: Time = 0 tiAl�ll/PM Re -Inspection required: es No When corrections have been made, call for re -inspection at 303-234-5933 Date: r `I Inspector: T 6 DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201705889 PERMIT NO: 201705889 ISSUED: 08/10/2017 JOB ADDRESS: 3643 Taft CT EXPIRES: 08/10/2018 JOB DESCRIPTION: Residential Re -roof to install IKO Cambridge asphalt shingles with 33 sq. *** CONTACTS *** OWNER (303)949-4601 ROBERTS NICHOLAS SUB (303)942-1539 Phil Theriault 130200 Top That Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,481.00 FEES Total Valuation 0.00 Use Tax 178.10. Permit Fee 188.45 ` ** TOTAL ** 366.55 *** 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. le City of Wheat Ridge V Residential Roofing PERMIT - 201705889 PERMIT NO 201705889 ISSUED: 08/10/2017 JOB ADDRESS: 3643 Taft CT EXPIRES: 08/10/2018 JOB DESCRIPTION: Residential Re -roof to install IKO Cambridge asphalt shingles with 33 sq. I, byy m siggnature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applic wilding codes, and 11 applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by th le I owner of the p op and am authorized to obtain this permit and perform the work described and approved in conjunction with this e . I further attest a I am legally authorized to include all entities named within this document as parties to the work to be pe ` e and that all wor t be performed is disclosed in this document and�or is' accompanying approved plans and specifications. Sii1nat of OWNER Or 'CONTRACTOR (Circle one) Date ' l 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 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 i e 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 . apple abl de onany erdiWtice oryregylation 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 From: no-reply@ci.wheatridge.co.us Sent: Thursday, August 3, 2017 1:06 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Follow Up Flag: Follow up Flag Status: Flagged 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 3643 Taft C CT Nicolas Roberts 303-949-4601 no) 1� Property Owner Email nicroberts82@gmail.com Address 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 Nicolas Roberts 3643 Taft Ct.pdf Contract CONTRACTOR INFORMATION Contractor Business Top That Roofing Name Contractor's License 130200 Number (for the City of Wheat Ridge) Contractor Phone 303-942-1539 Number Contractor Email Address lorena@topthatroofing.com Retype Contractor Email lorena@topthatroofing.com Address DESCRIPTION OF WORK Are you re-decking the No roof? Description of Roofing IKO Cambridge Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 33 material selected above? Does any portion of the / No v property include a flat roof? If yes, how many squares Field not completed. on the flat roof? z TOTAL SQUARES (pitched + flat) of all 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) 33 Complete re -roof with lifetime shingles 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 Phil Theriault Email not displaying correctly? View it in your browser. 3 TOP THAT ROOFING 9940 E COM ILLA AVE, SUITE N CENTENNIAL, CO 80112 PERMISSION TO COMMUNICATE I/We have. authorized Top That Roofing to make repairs to our pro e damaged by hail and/or wind on or about 5 ~ it - p m' at the address below, 20 [/We authorize communicate directly with Top That Roofing regarding the scour company, to ope'of wok to be per -forme all necessary con�rponents to complete work meeting code requirements and in a d and .understanding of the project, manner, as they are experts and have a full workmanlike 1/We authorize mOrt directly to our contractor, Top That Roofing regarding the insuranceour related repair, to speak performing or have completed and to release any checks for these repairs. pairs they are ly to order:of Top That Roofing and to mail any -and all related payments -d rectly t t hem. the Loss Address: 3 (o Li 3 Mortgage/Loan# Best Phone: Email. Signed this day of 20 Print Name {Owner):®�, n r,.r� Signature: Print NameO ( caner}: Signature: MWon ACCREQI7EQ AffIR"MMMNALr•F e • E ER • + I . f '�L¢EEtpg�� C'iACO ��f;S [E[t�\ ELIABpE Qualified Applicator �9gPR0`1¢�-: 9940 East Costilla Avenue, Suite N, Centennial, CO 80112 Office Phone: 3033-942-1539 Fax: 303-997-2109 AGREEMENT This agreement dated —4 - a - i -I- , is between Top That Roofing and M i C OLA 5 Q O'GeltT S (hereinafter referred to as "insured") for claim #_ y5 9! "t y s S under policy # 0 3 t i�lyg i e1 D properly scoped. In consideration of Top That Roofing's services Insured hereby The Insured is desires to have Top That Roofing aid in the process of the Insured's Claim being agrees Top That Roofing as the contractor for any and all of the work associated with this claito utilize otherwise agreed in writing the Insured will have no additionam. Unless l cost associated with the work associated with this claim other than the Insurance Proceeds Insured's deductible. resulting from this claim and the Top That Roofing will utilize its expertise to aid the Insured with the proper scoping of the claim. In particular, Top That Roofing may, in Its sole discretion, engage Engineers, Attorneys, Public Adjusters, Building Department Services, Appraisers and other professionals during the claim scoping process. Unless otherwise agreed in writing the Insured shall not be responsible for the payment of any professionals. Within 30 days of the signing of this agreement, insured agrees to execute whatever documents that are necessary to authorize and direct the Insurance Company for this claim to include Top That Roofing as a payee on all Insurance proceeds that are dispersed. General payment terms include 50 of payment for services being due upon delivery of materials to the job and the balance being paid upon completion of work. Ired: N c o; -A 1��; R,- Date: and Authority: 'heriault: Date: 'ent tiemb7e and Sealing Rooting Products Ahorizeu ---- SAIN CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: m~rb Job Address: Permit Number:. ;'a 76 5 ❑ No one available for inspection: Time, r� 5�AM/,.PM Re -Inspection required: Yes ,f No__,f d iia.....<:.....:_. When corrections have been made, call for re -inspection at 303-234-5933 Date: /Z, Z 7 Inspector: ,J r,i 16N— 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: R P.E Job Address: -3 t L/ 2 % Permit Number: C�' C / -7 0 G / 6 A P r K(�vf ❑ No one available for inspection: Time -Z .'3 4) AM/PM Re -Inspection required: Yes No *When corrections have been made, call for re -inspection at 303-234-5933 $i Date: Inspector: DO NOT REMOVE THIS NOTICE .1 ► I - _ /-, n r-,1 -1 nn 11 „'.I 1 0` 4-_ l I 0 �i V t INS CTION RECORD INSPECTION REQUEST LINE: (303) 234-5933 Occupancy/Type 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 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. Concrete Encased Ground (CEG) Foundation / P.E. Letter Fire Inspection / Fire Protection Dist. Do Not Pour Concrete Prior To Annroval Of The Above In-nnectionn Underground/Slab Inspections Date Inspector Comments Initials Electrical Sewer Service Plumbing Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections Rough Inspections Date Inspector Initials Comments Wall Sheathing 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. Mid -Roof Fire Inspection / Fire Protection Dist. Lath / Wall Tie Final Electrical Rough Electric " Final Plumbing Rough Plumbing/Gas Line Final Mechanical Rough Mechanical Roof Rough Framing Final Window/Doors Insulation Final Building a t y n Drywall Screw/ Nail 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. 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. Fire Inspection / Fire Protection Dist. Final Electrical Final Plumbing Final Mechanical Roof Final Window/Doors Final Building a t y n 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. "*For Inspection Time Window Requests — Please email insptimereguest(&ci.wheatridae.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 l / CITY OF WHEAT RIDGE. Building Inspection Division i (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: € Job Address: 3 C Li Permit Number: e) r o o / ); Ij 1 ❑ No one available for inspection: Time 'V6 AM/PM Re -Inspection required: Yes No When corrections have been made, calf for re-inspe tion at 303-234-5933 Date: Inspector: DO NOT REM0VE'TH1S NOTICE 3 City of Wheat Ridge HO Interior Remodel PERMIT - 201700163 PERMIT NO: 201700163 JOB ADDRESS: 3643 Taft CT JOB DESCRIPTION: Replace shower pan *** CONTACTS *** OWNER (303)949-4601 CASSIE ROBERTS - AVERSANO ISSUED: 02/06/2017 EXPIRES: 02/06/2018 *** 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 t11 ` Plan Review Fee 50.38`` Use Tax Permit Fee 36.00 77.50 ** TOTAL ** 163.88 *** COMMENTS *** *** CONDITIONS *** MM: Approved with red line notes on plans. Must comply with 2012 IRC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. I, the property owner, by my signature, attest that I currently reside at the project property, intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers. Consultations and inspections will only be performed with the homeowner of record present.Approved per plans and red -line notes on plans. City of Wheat Ridge w� "LLQ HO Interior Remodel PERMIT - 201700163 PERMIT NO: 201700163 JOB ADDRESS: 3643 Taft CT JOB DESCRIPTION: Replace shower pan ISSUED: 02/06/2017 EXPIRES: 02/06/2018 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 partes to the work to be performed and that all ti'ork to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signaturi,-_of OWNII: R" or CONTRACTOR (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 original permit fee. 1 If this permit expires, a new permit may be required to I 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, an violation of any provision of any aRpli abI code or any ord na e or r ulation of this jurisdiction. Approy I of work is subject to field inspection. d� /01 i Signature of Chief Building Official U Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequestgei.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. City of Wheat,ddge 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: permits(D_ci.wheatridge.co.us FOR OFFICE USE ONLY Date: 0 9.( 0� � (-+ Plan/Permit # WIQ (� 3 Plan Review Fee: t I I I I 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): Phone: Property Owner Email: C.C-A � _�� �c� —I c V-e�1 Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Engineer: Arch itect/E ng 1 neer E-mail: I Contractor: Contractors City License #: b Phone: Phone: Contractor E-mail Address: 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 RIOTHER (Describe) - r. 5�'� u =a (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. Ft./LF Amps Btu's Squares 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.(:(OW:�NER:))(CONTRACTOR) or UTHORI D EPRESENTATIVE) of (OWNER) (CONTRACTOR) 0 Electronic Signature (first and last name): DATE-' DEPARTMENT USE ONLY Vo ZONING COMMMENTS: OCCUPANCY CLASSIFICATION: R'.._ ID Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: vty 1(0 Building Division Valuation: City of Wh6atp..,,dge COMMUNITY DEVELOPMENT Official Certification of Property Owner Permit THIS IS TO CERTIFY that I, the property owner, by my signature, attest that I currently reside at the project property, or intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers, or, if hiring sub -contractors, list them on the permit. Consultations and inspections will only be performed with the homeowner of record present at the project property. Property Owner(s): Project Property: Notarizkd slRhature State of Colorado County of Jnli�aSSa� ca nt } ss The foregoing instrument was acknowledged by me this _ r day of e arm , 20 17 by C G.g Aoer5,yn TAMARA D ODEAN NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20164015481 MY COMMISSION EXPIRES APRIL 22, 2020 _ OQ� — My Commission Expires qJ -4?2j20a?d Notary Public z ...0 O i� �o ol H q a 10 A O U m O 43 43va 44 41 O Hrd m I0 N9 m H E 44 m U O 4j 2C 43 .cl ,F3 q U m od m •R U 44 rq 43 .c! q m H 0.0 0, 1l 14 R� U z° � m m m O N m a N m u b d N � m N m m N A O Q A m b R o N � o a t1 � io N z ei a A .0 O o m o (.,) a a �Lll`•1 • O O a a m u H M W `/ z w 00 xm E1 a m o w v � 5 �0 u u o v z 14 H F O WcEnm m v V a U U m 0 o v �y� u a s x - v ame M A w V u ma+ a a A O 3 A m C 0 00 ° � y� M x u b a y F ..i 4 Nm A O V c O N Go vi �7�ii o �Agm�p 43 u Q�pS�s -ri a N u q o q g 4 E W u° a °a O i� �o ol H q a 10 A O U m O 43 43va 44 41 O Hrd m I0 N9 m H E 44 m U O 4j 2C 43 .cl ,F3 q U m od m •R U 44 rq 43 .c! q m H 0.0 0, 1l 14 R� U z° A �t tib f ldf C� ffit T Re5la KeTAOLL I Wi 16 A R E C 0 R D INSPECTION REQUEST LINE: (303) 234-5933 Occupancy/Tvpe 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 Initials Comments Monolithic Slab Reinforcement 'Comments Caissons Concrete Encased Ground (CEG) Footing/Stemwall P.E. Letter Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground/Slab Inspections Date Inspector Comments Initials Electrical (Underground) Sewer Service (Underground) Date Water Service (Underground) 'Comments Plumbing (Below/ In -slab) Heating (Below / In -slab) Do Not Cover Underground or Below/in-Slab Work Prior To Approval Of The Above Ins Inspector Rough Inspections Date .:Comments Initials Wall Sheathing Roof Sheathing Lath / Wall Tie Rough Electric . ,. Rough Plumbing: Rough Mechanical Gas Piping Do Not Proceed Without Approval Of Above Rough Inspections Rough Framing Insulation Drywall Screw/ Nail Final Inspections Date Inspector Initials 'Comments Final Electrical 8 Lf Final Plumbing- Final Mechanical Roof Final Building / Frame E Landscaping & Parking / Planning Dept. Inspections from these entities should be requeste 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. Fire Inspection / Fire Protection Dist. **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. Occupancy Is Not Permitted until A Certificate of Occupancy Protect This Card From The Weather 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 / / P f / l:� F Job Address: 36 `r3 Tri "' G Permit Number: 2-0 / 6 00 -7,6 L ❑ No one available for inspection: Time A pM. Re -Inspection required: Ye No When corrections have been made`, call for re -inspection at 303-234-5933 Date: f Z` Inspector: DO NOT REMOVE THIS NOTICE A i CITY OF WHEAT RIDGE Building Inspection Division 1� (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: t- r (f IAF f r Job Address: Aq3 Tfi -'T c Permit Number: 261,6 ®d 791i r; le"*-'- : rtid es / e r6\fe,-fn p\ ;r94 _fir r f r cc U 3 -tic( <lC(1Ci �i"'1k . 6t 5'( CLL e k I:+cker, o ;'N S1 -ems I -OU--, 41La✓. ! CI Z 1 �4Y" G! e C FSS Amc( r9-,4 V a 4- 4--,,1 6 M a c (_s 'Id :n I- ;11A tvJ J�Ct I I h qlc( f �'r e l� loctc 44- e (ec / e rArkr,e OJC- 3 Pe -0,/: G (� O! fPSS cn L" 4 I 1Q fry. s o .4 C %NeP t'Iti��: x.45. A►r`ee-.►ars. El No one available for inspection: Time Re -Inspection required,(Yes No *When corrections have bads, call for re -inspection %at�303-234-5933 Date: Inspector: DO NOT REMOVE THIS NOTICE FOR OFFICE USE ONLY lb d �r Date: "� 6 Citi Buildings & Inspection Services Division 7500 W, 29th Ave., Wheat Ridge, CO 30033 Plan review Fee: Office: 303235-2855 * Fax: 303-237-5929 Inspection Lire: 303-234-5933 Email: permits@ci.wheatridge.co.us Wilding Permit Applicaition Please complete all highlighted are"' batty shies of this form. Incomplete plete appll ti o*t to processed. Prop+ Addre s : Property Owner (please print : Property Owner Ismail.; Mailing Address: ('if different than property address) Address: City, State, i Archie tlEnl ne r E-mail: Phone: Contractor: Contractci i1cense#*._1A0t69 -P hone. Cont ctor'f,ma l Addl assn Sura Contractors: ue Electrical. Plumbing: Mechanical: W.R. City License ## WR City License ## WR City License ## Other City Licensed Sub: dither City Licensed Sub: City License ## City License Complete all information on IE3C3TH sides of this form •(Check all that apply) NEW COMMERCIAL tli M C F YIPMF ELECTRICAL A Jk ROOFING UPGRADE NEW Y : A Mt F COMMERCIAL COMMERCIAL ADDITION RESIDENTIAL ROOFING RESDENTIAL ADDITION . WINDOW REPLACEMENT COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) RESIDENTIAL wA ACCESSORY sr (Garage, shed, deck, MECHANICAL A A YFP1Y REPAIR Y • AMr or REPLACEMENT • A PLUMBING s k 1111 A!A: REPAIR P ♦ IR o REPLACMENT g ELECTRICAL A A. !1F1A REPAIR R iF AiY or REPLACEMENT F • A Sq. FULF Stu's Gallon Amps Squarea 01ther APPROVED S,ubject to Field Inspections wheat Ridge wilding Dept, D...naaP,r�o,. -Plan Ctiecker Jheat Rid BUILDING of perrrait: The Mum and COMPUMlons taaii not any Of the provisions o Permks pmurningto give fsilrt"srtq COOS or 00 Btiilding Department FFA SAL DATE of a Pamitor approval of PINS, specific Ferrol for, or an WOW oto anyV*13001146 e branding code or of any City orrsc anrit to violate or cancel the provisiont0f �rdins rceq of the City shall not be Well. JON 3643 Taft Court Wheat Ridge, Co 80033 [a Bearing (B) # Vanity (C - ----------- ------------- Bath Tub Toilet Close in pocket door - (A) Remove non -load-bearing wall (B) Move vanity plumbing (C) Add shower plombinj�(( A I I AAAIP� F West t 5/31/2016 3643 Taft Court Wheat Ridge, Co 003 Ia»¥+«>«< *+t ++t2<I< v»*� ■? $±+d«+ � y� $� f^ G8 !O ©Double \ Vanity§ Shower G8 | | #0. � C) | | () ?#2¥f»\«I Bah Tub } \*§f< 3643 ,r Wheat Ridge, 8W33 s <--Exterior Bearing Wall--> lift 110 110 Cabinet DW Sink Cabin Cabinet n , inFCabinet 110 Cook op CA 22€1 Cabinet 20 liven rCabinet 110 110 110 110 3643 1 Court Wheat Ridge, Co 80033 Om Bearing i lift r, 'tlr t' �SinkCabine I ti +4 24 r. 330" opening 30" opening Cabinet Cabinet et 1t 110 f Range Cabinet 220 3011 110 fbinet 30" opening 30" opening be Cabinet Cabinet Cabinet 2" Microwave " ypt 11 2424 110 110 110 110 Im proport�ddress.3643 Taft Ct., Wheat Ridge, CO 80033 Rropr lease print): David Aniezes • 949-400-2785 Address: Atchltecttll5641neert-mall. Phone: Contractor: Techmasters Electrical LILC I,-,--, ------- I - -- --- ------- Contractor6CIty�Ucenrw#: 140268 phone. 303-332-6438 Contractotl4nall-Address: techmasterselectrical@yahoo.com Plumbing: W -Z Ciby Unit Mechanical: — --- — ------ Complete all information on BOTH sides of this form 0 NEW COMMERCIAL STRUCTURE ELECTRICAL SERVICE UPGRADE NEW RESIDENTIAL STRUCTURE COMMERCIAL ROOFING COMMERCIAL ADDITION RESIDENTIAL ROOFING RESDENTIAL ADDITION WINDOW REPLACEMENT COMMERCIAL ACCESSORY STRUCTURE (Garage, Shed, dock, RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ELECTRICAL SYSTEWAPPLIANCE REPAIR or REPLACEMENT mo*V outlat acwr*V to mw couMw, ad&V 6 oan 09ft kitchen and 6 in iving room, . ... .... ........ . .. amount Of m4*ais to This is a kitchen remodel where we are moving the kitchen outlet according to the new kitchen Itaddirto C94 fia4lts i1a t Sq. FtJLF Btu's Gallons Amps Square's Other Project Vatue- (Contract value or the cost of #Lmaterials and labor included In the 1_nfire project) $1, 0.0 OWNERICONTRACTOR SIGNATURE OF UNDERSTANDLNG AND AGREEMENT I hereby certify that tire setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application, 1, the applicant for this building penn, it application, warrant the truthfulness of the information provided on the application. CIRCLEONE. (OWNER) (CONTRACTOR) gr (AUTHOALZEDREPRESENTATIVE) of (OWNER) (CONTRACTOR) . Michael J Geia '. rthat checking this box, that I acknowledge that this constitutes a legal signature. CCUPANCY CLASSIFICATION: Building Division Valuation:$-, ♦► I t r CITY OF WHEAT RIDGE Building Inspection Division (303) "234 -5933 Inspection line (303) 235 -2855 Office * (303) 237 -8929 Fax INSPECTION NOTICE 9't Inspection Type U M Jf flq- n err d ,rr4' Job Address Permit Number (IfAR f/aEt f [5�`E�IfQ ✓fi`i N.a�1� a ?3 * r _ , hln nnn n..niln Mln,'fnr - r;-- AKA/hOK16 DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Plumbing PERMIT - 110238 PERMIT NO: 110238 ISSUED: 03/10/2011 JOB ADDRESS: 3643 TAFT CT EXPIRES: 03/09/2012 DESCRIPTION: Replace 10 if of sewer line inyard only * ** CONTACTS * ** owner 303/423 -9939 Florinda LaRocco sub 303/696 -9599 Steve Wakeham 01 -9921 Pipeline Industries, Inc. ** PARCEL INFO ** ZONE CODE: UA SUBDIVISION: 0813 USE: UA BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 4,500.00 FEES Permit Fee 125.05 Total Valuation .00 Use Tax 81.00 ** TOTAL ** 206.05 Conditions. Subject tpield inspections. I, by my i nature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifi on s, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal o er or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform the wo described and approved in conjunction with this permit. I further attest that I am legally authorized to include all entit' named within this document as parties to the work to be performe and that all work to be performed is disclosed in this /or its' accompanying approved plans and specifications. Sig atuzc 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 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 <W any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to fie p on. Signatur of of Building Offical Date INSPE TION 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 Wheat �idge COMMUNITY DEVELOPMENT Building & Inspection Services Division Permit # 7500 W. 29 Ave., Wheat Ridge, CO 80033 Office: 303 - 235 -2855 * Fax: 303 - 237 -8929 Inspection Line: 303 - 234 -5933 Building Permit Application Property Addr,`;ess - 7 - Cl 6-�- / f Property Owner (please print): `n( � ,� , 2 9Q11( Gt D Phone: � q —� I Mailing Address: (if different than property address) Address: City, State, Zip: Co nactoP: < T� AC/ S t Contractors City License #: n —Qq ZI Phone: q 6 — G' S -[ G( �ub;�ContractoYss Electrical: Plumbing: Mechanical: City License # City License# City License # D:e iptiminiof�xork. { �, Contract Value: cr1 Review Fee (due at time of submittal): Squares BTU's Gallons Amps Sq Ft. $ 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 or ' ces for work under any permit issued based on this application; that I am the legal owner or have been authorized by the lega er of the property to perform the described work and am also authorized by the legal owner of any entity included on this app ca on to list that entity on this application. CIRCLE ONE.' OWNER) ( 1 ONTRACTOR) or (AUTHORIZED REPRES ATIVE) of (OWNER) (CONTRACTOR) PRINTNAME: Q-� �) UC 'J12 . SIGNATUR DATE: u. N �'1tVtENTS a � r'i c1^ >�iP,,> ra,.y. � � � "''l ,9 � > t �� � »r/,�"M.✓"%�r;� ">f�/� >^'F.r� g,c^` ,r 20NI 6C0 c 'd 8 r n ¢, t .- Z: tie ✓ . .,�� Y � .�.. 4a✓ . �OntIIY,J �/ ` ✓ <"Pr�� Y l � v ls�>rW�fl x� ' r>"r Y�� / „mv° > � > ' �,� y � � �' �1� � ° ,fir >j >.i /7L c ✓ S '"� tr6 - y .'d`.Y,r� w. >�`�. � 5 S „';^ .� r„rr "i r� ; ,J/ rr -.� � / � / �ReWeWer Sy "`r, r' �` r`.�a F „r x � a 'c x � l.�•. '>' a ir- -..✓;: /e )yv4 f,,�•'r✓ r� /r�� ar r�:Fe '" <✓ is ' s����o��.;vs ,�`5���,''.�c Y. sf / .:�r'�(r�� , � �� } '��EK, s ',�' c . _' ' 2' .. r'",,.? r /„y'r� iY . r�i .+ra �' /'rly.,..✓` w,., �bs n"s* �T�Y7'>"� k;✓c..^ ti.,'! %.. J'6UIfD1NG `�'_.,.._.•,,.ReGleiNe!' " ' 3� �r��' °.� •,.: ":`��' i`Yr�'- ,,.,;";,. " fir ' r sue, ?��,:�� a,v��„ ?,f'ra, -i".r "�,'2„_; `'.`..r Date: Plan # �Fl)tE DEPARTMFN7" ❑ approved'w/ commepts YJ`disapproved,rto rev e require , Bldg Valuation $ tA=— E JOB DATE 03/1o/11 INDUSTRIES INC. DATE P.O. Box 370 • Watkins, CO 80137 03/10/11 ESTIMATOR (3 Chandler Fax(303)671-6871 SERVICEMAN INV ®ICE# 0 1— 41362 JOB # CALL ORIGIN Co. Sew./Wes PO # JO$'I,P1FOr11V1;A'FI®N' , BILCIN�'INFUIiMAT10N;1 '` NAME Florinda LaRocca NAME ADDRESS 3643 Taft C it. ADDRESS CITY WheatRid a STATE CO ZIP 80033 CITY STATE ZIP PHONE 303- 423 -9939 PHONE i.1ESCRIPTIO.FYiOF, ,SERVICES �ESTIIMATE Excavate /Replace 10' of 4" main drain in the front yard. s 4,500.00 Approximately 10' long and up to 8' deep. *Includes: Excavation, Plumbers, Laborers, Pipe & Fittings, C /O's, Bedding, Backfill, Compaction, Clean -up, Haul Away, Permit and Inspection. * All Items included if needed. X WARRANTY Terms of Warranty: 3 Year- Parts & Labor APPROVAL '� < / SIUNAIU Kt Excludes: Roots & Ground Movement (Acts of Nature) COMMENTS: YOU o f 1 SUBTOTAL Excludes private utility repair, sprinkler and landscape repair. TAX PLEASE PAY THIS AMOUNT i s ITEMS NOT INCLUDED. Landscape, grass; sod, trees, bushes, flowers, plants, fence repair, decorative rock, utility conflicts, private utilities, sprinklers, waterlines, electrical, gas, etc. Not responsible for damage caused by unstable soil, cave -ins orany other complications. TERMScJob 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 18% 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 building projects pursuant to Colorado law. s i _ :_ �5l 1 SI NATURE f ACCEPTANCE OF INVOICE 'SIGNATUR ❑ VISA ❑ M/C ❑ AMEX CARD # EXP APPROVAL # .__ ❑ CASH CHECK# Aq /_® CHARGE A/R ACCOUNT If A 4' City of Wheat Ridge Residential Roofing PERMIT - 091754 PERMIT NO: - 091754 ISSUED: 08/28/2009 JOB ADDRESS: 3643 TAFT CT EXPIRES: 02/24/2010 < DESCRIPTION: Reroof 30.58 sqs ***.CONTACTS owner 303/423-9939 Dolly Larocco sub .303/412-1550 Todd Coombs `02-0995 TLC Roofing **-PARCEL INFO ZONE. CODE: UA .'USE: UA SUBDIVISION:. 0690: BLOCK/LOT#: 0/. FEE SUMMARY ESTIMATED PROJECT VALUATION: 9,500.00 FEES Permit Fee < 235.70 _ Total Valuation .00 Use Tax 171.00 TOTAL . - t1. -ar c 406.70. Conditions: 6nail installation& mid-roof. inspection required. Board sheathing spaced more... than a 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield required from eave edge to 21 inside exterior walls.?. Subject to field 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 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 eat Ridge dinances for work under this permit. Plane abject to field inspection. rz 7 gnature of contractor/owner dat 1. This permit was issued in accordance with the provisions set forth in. your application and issubject to the laws of the 3 State of Colorado and to the zoning Regulations and Building Codes of Wheat Ridge, Colorado or. any l. other applicable w 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. Anextension maybe granted at the discretion of the Building Official. 3. If this permit expires,, a new permit may be acquired for a fee of one-half the amount normally required, provided no changes have been or will be made in the original plans and specifications. and any suspension or abandonment. has not exceeded one '.(i) year. If changes have been or if suspension or. abandonment' exceeds one (1) year, full fees. shall be paid for a new permit. 4. No work of any manner shall be done. that will change the natural flow of water causing a drainage problem. 5. Contractor shall notify the. Building Inspector twenty-four ..(24): hours in advance for all inspections and shall receive written. approval on inspection card before. proceeding with successive phases of the job.. 6. The issua e permit tor the approval of drawings and specifications shall not be construed to be a permit for, nor an a o , any violation of the provisions of the building codes or any other ordinance, law,. rule or regulation. All rew i l is subject to field inspections. ..`S ignat 7eof Chief Building Official -:date INSPECTION REQUEST LINE: (303)234-5933 :BUILDING OFFICE: (303)235-2855 ry REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. ~oF""~'T~,o City of Wheat Ridge Building Division m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 °o~oRAOO O Inspection Line: 303-234-5933 Building Permit Application Property~Address! 3~ / 3 ~g~f (O(L Property Owner (please print): Mailing Address: (if different than property address) Date: Plan Permit Phone: -D/y~S Address: 3 (per State, Contractor: Contractor License Phone: Sub Contractors: Electrical City License Plumbing City License Company: Company 0 Mechanical City License Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ -,Sw ® Description of wOrk: (as calculated per the Building Valuation Data sheet) Pol-04 Plan Review (due at time of submittal): $ Sq. Ft./L. Ft added: Squares L !BTU's Gallons Amps 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 1 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 fi ection. CIRLCE ONE:: (OOWNE (CONTRACTOR) r PERSONAL REPRESENTAT E of (OWNER) (CONTRATOR) PRINT NAME: 4 SIGNATURE: /gam G/ Date: a;~ Bldg Valuation: $