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12082 W. 36th Place
property until a permit has been issued and posted on the property. I certify that I have Yes been authorized by the legal owner of the property to submit this application and to perform the work described above. I attest that everything Yes stated in this application is true and correct and that falsifying information in this application is an act of fraud and may be punishable by fine, imprisonment, or both. Person Applying for Tracey L Johnson Permit Email not displaying correctly? View it in your browser. From: no-reolv(alci.wheatridae.m. us To: CommDev Farm is Subject: Online Form Submittal: Water Heater Replacement permit Application Date: Friday, November 19, 20219:16:27 AM Water Heater Replacement Permit Application This application is exclusively for RESIDENTIAL REPLACEMENT WATER HEATERS - LIKE FOR LIKE ONLY. YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN ORDER FOR THE PERMIT TO BE PROCESSED. Your Permit will be emailed to the email address provided below once it is processed. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN WORK UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes replacement water heater like for like? PROPERTY INFORMATION Property Address 12082 W. 36th Place, Wheat Ridge, CO 80033 Property Owner Name Derek Linares Property Owner Phone 917-930-9986 Number (enter WITH dashes, eg 303-123- 4567) Property Owner Email permits@applewoodfixit.com Address (Leave blank if not known) Attach City of Wheat Ridge Electronic Form (2021).Ddf Payment Form - "DO NOT ATTACH A PICTURE OF A CREDIT CARD" CONTRACTOR INFORMATION Contractor Business Applewood Plumbing, Heating & Electric Name Contractor's License 18236 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 Email Address Retype Contractor Email Address DESCRIPTION OF WORK Number of gallons KI8B1E,W- IS61-I: permits@applewoodfixit.com permits@applewoodfixit.com IN Is the water heater Gas GAS or ELECTRIC? If GAS, enter # of 40 BTUs. If electric, enter n/a Where is the water Basement heater located (for example, basement, crawlspace, etc)? Project Value (contract 2889.00 value or cost of ALL materials and labor) 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 work Yes may not begin on this 1* ► � i City of Wheat Ridge '/� Resid. Windows/Doors PERMIT - 202101082 PERMIT NO: 202101082 ISSUED: 05/21/2021 JOB ADDRESS: 12082 W 36th Pl EXPIRES: 05/21/2022 JOB DESCRIPTION: New door in downstairs living room to be installed with a dog door aspect. ***ALL STICKERS TO REMAIN ON GLASS FOR INSPECTION*** *** CONTACTS *** OWNER (303) 980-4949 LINARES DEREK GC (303)237-1687 JOHN MCDADE 021066 CONSERVATION CONSTRUCTION *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 11899.00 FEES Window Replacement 50.00 Total Valuation 0.00 Use Tax 39.88 ** TOTAL ** 89.88 *** COMMENTS *** *** CONDITIONS *** Windows shall comply with all applicable codes, have a .30 or better U -factor and shall be safety glazing if within a tub enclosure, less than 18 inches above the floor or within 24 inches of a vertical edge of a door. I, by my signature, do hereby attest that the work to, be performed shall comply with all accompanying approved plans and specifications, applicae building codes, and all applicable municpal 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�permrt. I further attest that I am leg ally authorized to include alI 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. 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 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 requ�ired 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, anviolation of any provision of any �pplicabje code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. 05/21/2021 Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheatludge COMMUNITY DEVELOPMENT Building & Inspection Services 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax 303-237-8929 Inspection Line: 303-2345933 Email: permits(3ci.wheatridge.co.us FOR OFFICE USE ONLY Date: PlaniPermit # Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: 12082 W 36th PI. Wheat Ridge, CO 80033 Property Owner (please print): Derek Linares Phone: 917-930-9986 Property Owner Email: conservationco@gwestoffce.net Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) City, State, Zip: Architect/Engineer E-mail: Contractor Name: Conservation Construction City of Wheat Ridge License #: 021066 Contractor E-mail Address: kcochranecc@gmah com Phone: 303237.1687 {main office) For Plan Review Questions & Comments (please print): CONTACT NAME (please print): Krista J. Cochrane Phone: 720.726.5472 klesk/direct) CONTACT EMAIL(please print): kcochranecc@gmahcom Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): 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 # City License # Complete all highlighted fields. ❑COMMERCIAL ❑x RESIDENTIAL Provide 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. Replacing 1 door with no change to the structure. Sq. Ft./LF BTUs Gallons Amps ____ Squares ____ For Solar: ___ KW _____# of Panels _Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ 1,899 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. X CIRCLE ONE: (OWNER) (CO CTOR) or (AU IORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature pirst and last name): 5/19/2021 Printed Name: Krista J. Cochrane ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: �; na►�es �5o7a-( Colorado Window Contract onservation onstruction canservaGoncoQgwestalNea,nq w•1!M.�>IKVKiO>tgnlh'MCNPn.Cgln Name: r Address LI NARES050721 Prim D E N 9101 W. Coltax A,ye. Lakewood, CO M14 Phone: y*Z?4687 Fax: 303-237.1$lo Y. Emma.: W414 zip: 4ae-v— �AwIterlalte: Are eou8j 6 pay wiudm aired taefpg? 1 An grids being changed i removed? CHANGED LI.gMOVL D Grids to Match Existing? 1( H Window Brand; amj"O+t�WA4i* J Windowcolor C-4--' *— _ Qyanthy � Glass Grid sh Location Model Type Glass {Moils Type Nett Hoe. Hight 22 q J 4 5 6 7 9 10 13 14 _ IL�.JI n ��— • 15 16 v 18 n u n is Clean up all job Mooed debris. Nd painting.:taining. or disconnectiotJrecopn[xti installation and a 1 * 4i. wwra ly fium themaaufachm. Conservet all meeting rails. Glass to be double pane, double su=gih, gas filled 'ilea) steel oma lack and BcmVue screen (unless otherwise specified). Inside removab seneni repair - see warranty for exclusions. Price includes all tax, pennies, rnateru Floor in Width Height House? zv If 7 fLl-'t a mc`le 5 VOCY-11 rmft Pmt doac S1zg, Door �p hovo foe ki in Ron and four notlre r bQetvtMfmlUu PmrkrraddadmoorpporamWmeeWrb4aeu4CapnnpaaCaapmctioo(qp eklpbn ralael:yt Job A*b4iunllotsnrmvav4iawdawwith eulptsrai�ioga9r1walsmd 3' rarmarrria aareiamerironrd fodR nim Slpwddkpl-aerobe Lilco (arrgy.noSOM o s°'R'� �-had riioa.:sn'bm m C�ttmliwcaumraion Cels. m.epfiepe Lary ton�Osa «m o<airri aniar �9.�11 nd �te"6lrfarddgd pYse9 6p tnika, wutlar4oatitiow. Qdpr wabmging mrgrirb, aAst ram—«r.remns. + mlasrtWtNraee:YtradC+ntrntlogCoo+hilelNrflry re.apomak4r MAft 41m.11wdfll arrftbh this wtxdI"kO1.4 dthtk adt9q!pUgVgph araarbb+ku4l�pyftaar Koreralrt{rAh�lda(kfeedgtbeir*.Yoy bLbQrCr,mrreaaed0iratattetanatuMllimetrirrtlnudldlYloftkr]Idbuwes+ey,Ratindtltarfldrpft ,mma MAdmd-kgottaoedWafuan(mrrM*Amf aofftr*t ke t►arrmdsed"to debtlad 1h Qt Una rfthbspwrre If xeatd. rdipjp,{ QM will rarfiM in plus uffio odglnal doeymeM ! Purchaser I Homeowner pate Purchaser l Homeowner _Date -- OO 81kn MM) Amerimax WINDOWS & ODORS M50 WHEDFORD DR PIRI 800 827 4369 L0W�9,C0M53N F. 800 601 3227 Imm"Ya. RAW mN,tmt 1I PII -- Walla „R Daram 1—! 6 all—! Imm"Ya. RAW mN,tmt A i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: Job Address:^%• �,:%��' �r'�. Permit Number: ❑ No one available for inspection: Time Re -Inspection required: YesNo When corrections have been made, schedule for re -inspection online at: http.lAvww.ci.wheatridge.co.uslinspection Date:—/,..,? • -;Z ! . I j Inspector: �-- DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: Job Address:% Permit Number: ❑ No one available for inspp tion: Time/c, " �� AM/P F Re -Inspection require]: Yes No *When corrections have been made, schedule for re -inspection online at: http ✓/www. ci. wheatridge. co. uslinspection Date: o' i,F-- I 1-1—inspector: �z-- 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: 1 Job Address: Permit Number: vZ_ ❑ No one available for inspection: Tim ,r Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: /D (?L1 q Inspector:----- -- DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE _1�9�Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type::) L -TZ- - lyWc CA -4 - Job Address: ;L'Z > - U) 23 Permit Number: ❑ No one available for inspection: Tiimer5l"f l`-- Re -Inspection required: Yes N- o l When corrections have been made; a71 for re -inspection at 303-234-5933 Date: I (f> i 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:.a `f�L� Job Address: V;;Z-,D 1 . R �' h Permit Number: � / 9 C) z ❑ No one available for inspection: Time i `= Re -Inspection required: Ye �.No When corrections have been made, all for re -inspection at 303-234-5933 Date:_? `? - f • ( `f-' Inspector:-,,�-- -. DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSSP TION N-OTI Inspection Type: �---- Job Address: Permit Number: ❑ No one available for inspection: Ti�AM/PM �- Re -Inspection required: Yes wo When corrections have been made, schedule for re -inspection online at: http✓/www.ci.wheatridge.co.ushnspedTl'on,, s .___. \ Date: Z In 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: l c Job Address: �a PermitNumber: ❑ No one available for inspection: Tiz!�e� ;0M Re -Inspection require� � No d *When corrections have been made, aaTh or re -inspection at 303-234-5933 Date: ' T Inspecto - — -' a DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Remodel PERMIT - 201901483 PERMIT NO: 201901483 ISSUED: 09/10/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 09/09/2020 JOB DESCRIPTION: SWO Remodel master bath, main bath, kitchen and basement; 2,000 sq ft total REVISION: Upgrade breaker box to 200 amps, install outlets in kitchen island, install recessed cans in kitchens and living room, hard wire smoke detectors; Added valuation: $4,800.00 *** CONTACTS *** OWNER (303)423-5054 PAULMANN ELISABETH GC (720)422-3167 RICHARD COLLINS 100264 UNITED PLUMBING SERVICES CO. SUB (303)340-0077 Chris Houchin 130060 The Weather Changers SUB (720)422-3167 RICHARD COLLINS 100264 UNITED PLUMBING SERVICES CO. SUB (720)732-2178 JOSE LARA SOTO 090307 NEW AGE ELECTRIC, INC. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 34,800.00 FEES Total Valuation 0.00 Plan Review Fee 362.08 Use Tax 730.80 Permit Fee 557.05 Investigative Fees 499.55 ** TOTAL ** 2,149.48 *** COMMENTS *** *** CONDITIONS *** All roughs to be done at Framing Inspection. Approved per plans and red -line notes on plans. Must comply with 2012 IRC, 2017 NEC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. I 11 City of Wheat Ridge Residential Remodel PERMIT - 201901483 PERMIT NO: 201901483 ISSUED: 09/10/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 09/09/2020 JOB DESCRIPTION: SWO Remodel master bath, main bath, kitchen and basement; 2,000 sq ft total REVISION: Upgrade breaker box to 200 amps, install outlets in kitchen island, install recessed cans in kitchens and living room, hard wire smoke detectors; Added valuation: $4,800.00 I, by my signature, do ereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building c d s, and all applicable municipal codes, poles and procedures, and that I am the legal owner or have been authorized by the legal owner o h property and am authorized to obtain this permit and perform the work described and approved in conjunction with this ermIt. I further t t that I am le ally authorized to include all entities named within this document as partes to the work to be performed and that a rk to be erormeisdisclosein this document and/or its' accompanying approved plans and specifications. .-a 0-- 1 Signature of O or CONTRACTOR (Circle one) Date I. This permit was i ued based on the information provided in the permit application and accompanying plans and specifications and is subject to the co fiance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall xpire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and maybe subject to a fee equal to one-half of the originalpermitfee. 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 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. City of I Wheat Pj.,dgie COMMUNITY DEVELOPMENT Building & Inspection Services 7500 W. 291' Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: perm its(a)ci.wheatridge.co.us FOR OFFICE USE ONLY Date: Plan/Permit# a 111 Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** tS�� Property Address: _ ! �©34 Property Owner (please print): M L'4 C,3 Phone: - Z.w -3.3 Property Owner Email: Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Engineer E-mail: Phone: Contractor Name: �L') n Cw� City of Wheat Ridge License #: 66i 03C Phone: —4 -Zj;:::)- DTZ -- Contractor E-mail Address: (1.2 ()J CACI---7 e U2_'� r e 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 & Signed Subcontractor Authorization form): 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 # City License # Complete all highlighted fields, if applicable. ❑COMMERCIAL ❑4ESIDENTIAL Provide 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. 4 P-,5 ► ►rt.S"-�a11 oU4le4S_ t✓is�c,I� iZe�PSScinj iV-, kl)(L'ev--' r"11 f IV),1I -0DY>- wlc"-> S �� 3.4e,�c-�-ts Sq. FULF BTUs Gallons Amps Squares For Solar: KIN # of Panels Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: _ Occupancy Load: Square Footage: 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 �at entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided A application. CIRCLE ONE: (OWNER) (CONT or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: a 0 + 9 Printed Name: ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type:-�A Job Address: / S'�Z &fo :5 �_ . Permit Number: ❑ No one available for inspection: Re -Inspection required: Yes No When corrections have been made, schedule for re -inspection online at: http://www.ci. wheatridge.co. uslinspection Date: ° 1 Inspector: 3'1 DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Remodel PERMIT - 201901483 PERMIT NO: 201901483 ISSUED: 09/10/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 09/09/2020 JOB DESCRIPTION: SWO Remodel master bath, main bath, kitchen and basement; 2,000 sq ft total *** CONTACTS *** OWNER (303)423-5054 PAULMANN ELISABETH GC (720)422-3167 RICHARD COLLINS 100264 UNITED PLUMBING SERVICES CO. SUB (303)340-0077 Chris Houchin 130060 The Weather Changers SUB (720)422-3167 RICHARD COLLINS 100264 UNITED PLUMBING SERVICES CO. SUB (720)732-2178 JOSE LARA SOTO 090307 NEW AGE ELECTRIC, INC. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 30,000.00 FEES Total Valuation 0.00 Plan Review Fee 324.71 Use Tax 630.00 Permit Fee 499.55 Investigative Fees 499.55 ** TOTAL ** 1,953.81 *** COMMENTS *** *** CONDITIONS *** All roughs to be done at Framing Inspection. Approved per plans and red -line notes on plans. Must comply with 2012 IRC, 2017 NEC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. 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 rope rty and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attes that I am legally authorized to include al( entitle named within this document as parties to the work to be perforipend that all work to be performed is disclosed in this docurlgend/or its' accompanying approved plans and specifications. Si na e o OWNE or CONTRACTOR (Circle one) Date 1. T is pe it was iss ed based on the information provided in the permit application and accompanying Flans and specifications and is su ect the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This rmit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and maybe subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a 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 gran ing of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any app ble code ora ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of C ief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheat Ridge Residential Remodel PERMIT - 201901483 PERMIT NO: 201901483 ISSUED: 09/10/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 09/09/2020 JOB DESCRIPTION: SWO Remodel master bath, main bath, kitchen and basement; 2,000 sq ft total 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 rope rty and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attes that I am legally authorized to include al( entitle named within this document as parties to the work to be perforipend that all work to be performed is disclosed in this docurlgend/or its' accompanying approved plans and specifications. Si na e o OWNE or CONTRACTOR (Circle one) Date 1. T is pe it was iss ed based on the information provided in the permit application and accompanying Flans and specifications and is su ect the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This rmit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and maybe subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a 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 gran ing of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any app ble code ora ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of C ief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheat dge COMMUNITY DEVELOPMENT Building & inspection Services 7500 W. 291h Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 " Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits(fti.wheatridge.co.us FOR OFFICE USE ON i -Y Date: Pian/Permlt�'� ^ � U i 1�3 Plan Review Fee: { Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: Owner Property Owner Email: Cv Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (rf different than property address) Architect/Engineer E-mail: Contractor_ Name City of Wheat Ridge License #: Contractor E-mail Address: For Plan Review Questions & Comments (pleaeWprint): Phone: CONTACT NAME (please print): `� = v i 4-12�7 Cck Phone: -(a, " L - CONTACT EMAIL(p/ease print): `'� CEJ✓+�tYU[%oD►'� (ac�vvlcn+ . CyVY1 Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authoriza 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 # City License # q� form): Complete all highlighted fields. []COMMERCIAL [✓r RESIDENTIAL Provide description of work: For ALL projects, provide a detailed description of wor performed, including current use of areas, proposed oses,�qquare footage, existing conditio proposed new condition, appliance size and efficienicyj .�pe'and amount of materials to be i ZQ - 4 1n SC . 4-ovdv-,5 ✓-ellctLe.-�, t e�- �-- �a;-,� �eiY,vi-ti 4- `. �✓t�u-�Ji 1 P�C�-E'r�ri �'' i.cx'�111`� -C2tt�1n.�G Z Sq. FULF r 2, 6&Q BTUs '`'— Gallons Amps '—_ Squares For Solar: icw �- # of Panels `—Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ V,0.000 G¢� - 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, i regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegation accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for coin with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant t! truthfulness of the information provided on thea lication. CIRCLE ONE: (OWNER) ( I T or T D RE��� ENTATIVE) of (OWNER) (CONTRACTOR) i ature (first and last name): r DATE: ' Printed Name: ZONING COMMMENTS: Reviewer. BUILDING D ENMENT Reviewer 3 111. PUBLIC WORKS COMMENTS: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION g-orm a6%C1Uf L 1.7i, 12>1000 VIMMW ISI 410 r SE/+ti&rr Z az Reviewer. Building Division Valuation: be etc. or 1IS are at owner any -.T City of � 4 W h6, atI�idge COMMUNITY DEVELOPMENT SUB -CONTRACTOR AUTHORIZATION FORM This form must be signed by each sub -contractor. This form will not be accepted with missing information. Subcontractor's City of Wheat Ridge License number must be provided in the applicable space. Subcontractor's insurance and license must be up to date prior to permit issuance. Project Address: (20Q)2. W - t; ' JP(. Permit #: General Contractor: Electrical Sub -Contractor Company Name: State License #: Phone #: Master #: Wheat Ridge License #: (required field) Signature of Authorized Agent Date Plumbing Sub -Contractor Company Name: Phone #: State License #: t�) Zp Master #: Wheat Ridge License #: !0021 trequired field) Sig atur f Authorized Agent Date Mechanical Contractor Company Name: Phone: Wheat Ridge License #: (required field) Signature of Authorized Agent Date City of Wh6atl�idge COMMUNITY DEVELOPMENT SUB -CONTRACTOR AUTHORIZATION FORM This form must be signed by each sub -contractor. This form will not be accepted with missing information. Subcontractor's City of Wheat Ridge License number must be provided in the applicable space. Subcontractor's insuranand license must be up to date prior to permit issuance. 11 Project Address: l dG� (J1 , 3VKA/ Permit #: General Contractor: I Electrical Sub -Contractor Company Name: Phone #: State License #: Master #: Wheat Ridge License#: (requircA field) Signature of Authorized Agent Date Company Name: Phone #: State License #: Master #: Wheat Ridge License #: (required field) Signature of Authorized Agent Date Mechanical Contractor Company Name: �v Phone: DJO-7) Wheat Ridge License #: Jl�(. i1. _(required field) SignaQKe of uth r ed Agent Date h6City 8f WatR4d COMMUNITY DEVELOPMENTft,..,g SUS -CONTRACTOR AUTHORIZATION FORM This form must be signed by each sub -contractor. This form will not be accepted with missing information. Subcontractor's City of Wheat Ridge License number must be provided in the applicable space. Subcontractor's insurance and license must be up to date prior to permit issuance. At. a! Project Address: j �O $- 36 t Permit #: General Contractor: Electrical Sub -Contractor Company Name: f3e_0 AX 2 r: C Phone #: State License #: q%4 2 3 Master #::)AGO S - Wheat k4e License #: O q 0 3 Q -? (required field) of Authorized Agent Plumbing Sub -Contractor Company Name: State License #: Wheat Ridge License #:. Signature of Authorized Agent Mechanical Contractor Company Name: !I_S P9 Date Phone #• Master #: _(required field) Date Phone: Wheat Midge License #: trequired field) Signature of Authorh ed Agent Date Randy Slusser To: 4gsconstruction@gmail.com Subject: Plan review for 12082 W 36th Place Good morning Greg, During the review process of this project, it has been determined that an asbestos test is required for the materials being removed for this project. If more than 32 sf of drywall or other materials are being demolished, this triggers an asbestos test per CDPHE. (See attached sheets for additional information). You may email the report to expedite approval. Sincerely, Randy Slusser, CBO Chief Building Official Building Division 7500 W. 29th Avenue Wheat Ridge, Colorado 80033 Office Phone: 303-235-2803 www.ci.wheatrid eg co.us r W}xat11,kI ' CONFIDENTIALITY NOTICE: This e-mail contains business -confidential information. It is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are notified that any disclosure, copying, distribution, electronic storage or use of this communication is prohibited. If you received this communication in error, please notify us immediately by e-mail, attaching the original message, and delete the original message from your computer, and any network to which your computer is connected. Thank you. CLOSEOUT REPORTS REFERENCE SHEET Generally, 2 Copies of Closeout to be made: One for the client with original waste manifests, and one copy for the Intertech Environmental. Inc. file. Sometimes 3 Copies (2 for the Client, One for file) V, TAB l — Permits/Notifications: A.C. (General Abatement Certificate) Asbestos Permits 1 will gmq;l A -he -1 wi�h d-hc t4iakew' mwr� ❑ Demo Permits (If Applicable) 011- when & cj rri VcS . ❑ If no asbestos permit, include only GAC TAB 2 — Disposal Documentation: V"Original Waste Manifests (with stamps) ❑ Make 2 color copies of Original, original to client closeout, one copy to Intertech closeout, one copy for file. TAB 3 —A' Monitoring: 6 All Air monitoring reports (Usuall)r- Reservoirs) in order by date. ❑ If not air monitoring, exclude this tab. TAB 4—Inurance: Certificate of Insurance ❑ If none, exclude this tab TAB 5 — Activity Logs: J All daily reports, organized by date, to include Daily sign -in, activity log, safety meeting, inspection forms. ❑ Containment logs and manometer strip tape go behind daily paperwork, in order by date as well. ❑ Manometer strip tape is usually taped to back of containment sign -in and extra sheets when necessary and needs to be copied separately front and back. TAB 6 — Licenses/Certifications: A t! " � ❑ Certifications of all workers listed on the daily reports. Usually Certification are already in the job file directly from job book, but verification is needed to ensure all certs are included. ❑ Clean Copy of Certifications should go to client, and original job site certs can go in Intertech closeout files. (only 1 copy of certs will need to be made in this case) If no copies of certs are in the file, 2 will need to be made. 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F �+cF$a U5o r`�-: jz a) i 6 ti O LD C a rc vrr to O O f04 v� d c_ E- m j +VY0Cm 0 rw�>�c_� m i R 721a m N hr U a C O y;J7 I 1 Z 0, 1 2— D -, s Y- % G u' dd I s- y )' -c_ V: u 7 m v .G E v. j 7 i u F ! V~ W r i r c E io rn z cn mCL p]nut>ccCoE�� pO c a o �o m— Emv��rc z'QY S;* 9W a.+so..., 60 8000" (7Z0)Z51J76f4o., ASBESTOS REMOVAL, RENOVATION, AND DEMOLITION INSPECTION FORM JOB #: 0o23 DATE: bS 110 1l �ei� �lirlcSY, JOB NAME: I aZ©$2 W • 36}� ?t • L��S 1 a' nee LOCATION: 3(vVii- L I t 1• T l Con t C, V•n m -e-A SUPERVISOR:. '�OL,r�s V,'G n 1 WORK SITE BARRIER YES NO Area ventilation off ✓ All edges scaled All Penetrations sealed — *� Entry curtains —*o",_ H. NEGATIVE AIR PRE SURE HEPA vacuum ✓ Ventilation system Constant operation Negative pressure achieved - .02 Smoke test airflow Filters changed Ill. SIGNS 'Work area entrances Bags labeled IV. WORK PRACTICES Removed material, promptly bagged, and scaled !Material worked wet HEPA vacuum used No smoking, eating, or drinking Air monitors in place and functioning Work area cleaned after daily activities Personnel decontaminated each department Procedures in accordance with specifications V. PROTECTIVE EQUIPMENT Disposable clothing used ane time Proper NIOSH -approved respirators used and functioning Vl. DECONTAMINATION UNIT AND SHOWER On Site Functioning property Soap and towels l"sed by all personnel YES NO YES NO YES NO YES NO YES NO e�— VII. POST ASSESSMENT YES NO Air samples collected and identified ✓ Removed material properly bagged, sealed and labeled —0 — Critical barriers and pot) checked and intact —&111— N'orked area cleaned Decontamination unit maintained and secured %Iorked area secured �— %•+ . .cJi..�C .dtr.•.:�iao.» ZVf S i�5p g:' at~, 60 80013 && (720)?3/,i76f qji.- (303)755-0 16 PROJECT PUNCH LIST I he follo%%ing Punch List %%ill he used throughout all Intertech I.m ironmental projects lasting one «eek or longer, Lach item %sill he checked ofl when done. and turned in %%ith project ending papensork. Project Name: 12 d$ V 2_ W. 3W" P1. � Ren '.-A e� Project Number: E tq --02.3 Super-,isor: 5 e bc-5 C I ct r\ (41 Mobilizing ✓ Stage all materials and equipment in an orderh fashion ✓ Locate I-Aw cr & nater . ✓ All equipment is plugged into ground fault circuit mterruptn. ✓ Post all permits. notices. OSI IA signs. etc J Prep ✓ Set up negaln c air machines and %ent oulsidc ✓ Pre- clean and install critical barriers I/y ✓ Set up de -con & load out __ ✓ Install manometer ✓ Finish building containment ( floor. %%all, f xir. %%all ceding %%nh 24" merlap) ✓ I urn on paper to manometer Removal & Final cleaning V All emplocoes are using proper PPI ✓ %k ci method, are being used during rcmo%al ✓ Suflicicnt ,lir pressure has been achie%ed and maintained ✓ Proper air monitoring conducted & Results Ix%st ✓ ✓ OK I's arc being used to protect against shock ✓ All A ante is being properly bagged and disposed of ✓ All Employee certification on site & current. ✓ ✓ Safety meetings held daily ✓ I int aid kit inspected daily lou adequacy ✓ 1k orkers showering out of containment. ✓ Ilot & cold %%ater functioned properi\ 17 ✓ I ire extinguishers checked daily 61, ✓ 11 as containment smoke tested on a daily basis ✓ %fork area cleaned at lunch & end of shift daih ✓ Super%icor %isualh inspected arca %%ith a flashlight beliue calling lin final %isual and air clearances Tear Do%%n & De-Nloh ✓ l aretully Renun e poh & properly hag, %%aste ✓ Caretulh renio%c duct tape and tape residue /T ✓ t oad I gwpment and Waste roto Van I railer in an orderly fashion ✓ ✓ Make Sure all power & %Nater are turned oft (/ ✓ !%lake sure shoucts, & mater heaters are drained ✓ ✓ Make sure %%atcr filtration unit filters are changed Make sure all %acuuni hags arc' changed / lel ✓ Return Maierials and equipment to %%arehouse ✓w ✓ Dispose of Haste in proper duntpsters behind %%arehousc r%, 7ZO ZR.376f �', k4 . f 66* T.us►r�it �:,z y.N," q Anww&4ol k 9 y . 2vtq (,sou rdav) 1 to L DAILY ACTIVITY LOG Job# t q -02-C Date Job Name I'�d2 ice SFr' Work Area _ 12 $ Z VJ - 3 Q+ ? L Supervisor li% C. -r-, Q) ke-A[G Dail\ Activity Checklist: Worker Protection (Hard Hat, Boots, Salet\ vest. Glasses. etc) Cre % sign in sheet complete Pre -task planning / Safety meeting Decontamination unit functioning OSHA monitoring Housekeeping (storage, cords, hoses, trash, etc) Inventory of storage and clean room Site safety inspection (tools, ladders, fire extinguishers, etc) Inspection of critical barriers / Containment End of shift - water off End of shift - site secure CSa ivr a � i i1 rYtc+R� --- N/A Yes No M Explain "No" answers above t\� __ _ _ ( inusual conditions or problems - — )one- Actions taken to correct problems N Air monitoring firm onsite Visitors onsite —TO a d A Inspections made (pre -abatement. post-abatement)Cry+f � bc�Y f�"�e� i tr Com__ V U l I ests performed (bulk samples. clearance air monitoring) LYV"k 0 l ecA ne nm*ay"5 Description of work on back to be completed Bail\ Supervisor signature Q� Description of work (( )% 10 \ I RI)f 1-11M ( )I P %1'I R - -- AU �iys 3, - o2"ol Cl CFf I JCV) IoM I € I I - 027 Job Name 1120a Work Area ) Supervisor _ DailN Activity Checklist: DAILY ACTIVITY LOG Date © S Worker Protection (Bard Hat, Boots, Safety vest, Glasses, etc) Crew sign in sheet complete Pre -task planning / Safety meeting Decontamination unit functioning OSHA monitoring Housekeeping (storage, cords, hoses. trash. etc) Inventory of storage and clean room Site safety inspection (tools, ladders, fire extinguishers, etc) Inspection of critical barriers / Containment End of shift - water off End of shift - site secure (I: r%CIC4 Y ) N/A Yes No Explain "No" answer; above T - Unusual conditions or problems (U O`R� Actions taken to correct problems Air monitoring nrm onsite IVOXXC. Visitors onsite ' j C)Y-1 _ Inspections made (pre -abatement, post -abatement) �� � rxrY-k-y- -I _ Pests performed (bulk samples. clearance air monitoring) OS H It Description ofwork on back to be completed daily Supervisor signature . __ .0151- W_ Description of �Nork i( )\ RI L I ktil 511 tI ( )1 P %P1 tt w A_)QU5� _02,2 Rol 1 ThUrsGf� r 'n o Job# I E 19 - Q 23 Job Name 1;L 0$ ; Work Area I �R.0 xs Supervisor Daily Activity Checklist: DAILY ACTIVITY LOG Worker Protection (Hard Hat. Boots, Safet\ vest, Glasses, etc) Crew sign in sheet complete Pre -task planning / Safety meeting Decontamination unit functioning OSHA monitoring Housekeeping (storage, cords, hoses, trash, etc) Inventory of storage and clean room Site safety inspection (tools, ladders, fire extinguishers, etc) Inspection of critical barriers / Containment End of shift - water off End of shift - site secure N/A Yes Fxplain "No" answers above f _ Unusual conditions or problems 1&)C)n P_ No Actions taken to correct problems Air monitoring tine onsite 61\.e - V isitors onsite 00,(l -e Inspections made (pre -abatement, post -abatement) �r'i et -5 }_ -tests performed (bulk samples, clearance air monitoring) Description of work on back to be completed daily Supervisor signature ___ A:?__ _ --- Description of work i ( )N KI \ I KtiI IsID1 ( it 1-04 K osk p CI if -_- -- r r _ -� -1 00 A •-� i h c�_O_r e-uj cwr CtJGr rs . en Vi 1e. �J �Gc en wr OreSSuxe Ccs ren aC �� c0d mgi'n ------ I �OMA -E _qnd' I bcl (�-_We- f-�ol� c/he / ;R "oy P.M and erne a ! :00 P A4�e1%�h ------ I �OMA -E DAILY ACTIVITY LOG .lob# IM9_" 023 Date Job Name 1 2 (�' $: 3r -+ti �1• � «ie nem ) Work Area 2 3 } 1• 7 fl - Supervisor C., n uo CL Oed n esdc•y I n m ICn Daily Activity Checklist: N/A Yes Worker Protection (Hard Hat. Boots. Safety vest, Glasses, etc) Crew sign in sheet complete _ Pre -task planning / Safety meeting Decontamination unit functioning OSHA monitoring Housekeeping (storage, cords. hoses. trash. etc) � Inventory of storage and clean room Site safety inspection (tools. ladders, fire extinguishers, etc) Inspection of critical barriers / Containment End of shift - water off End of shift - site secure Fxplain "No" answers above ___ _—Wa IJnusual conditions or problems n -e- No Actions taken to correct problems Air monitoring firm onsite Ott e Visitors onsite i)plfl-G Inspections made (pre -abatement, post -abatement) Tests performed (bulk samples, clearance air monitoring) i 05+4 q (Iftl Description of work on back to be completed dail} Supervisor signature — Description of work i ( )N KI % I RSI tiIl )1 (it P M11 K) (Acm,.d 4W 5 j�� 5?r a.4., M 8000 " (700)051,3rW755_15.�;16 DAILY SAFETY INSPECTION CHECKLIST JOB NAME: JOB NUMBER: 1 C t9 - C);Z3 DATE: SUPERVISOR: MUST BE COMPLETED ONCE DURING EACH SHIFT 9,w. 7ZO Ul.!r 74, V +" a. T. t7 r. �4. q <,. . &4. 1 YES NO ARE ALL REQUIRED PERSONNEL RECORDS CURRENT& ON SITE? ........................... WAS AN EMPLOYEE SAFETY ME.FTING CON DUCIT [)TODAY" ........ ......... I ......... 1. . ARE ALL REQUIRED POSTER & NO1 WE POSTED ON SITE? ..................................... HAS FIRST All) KIT BEEN INSPECTED AND ADEQUATE? .................................... I IAS BARRIER TAPE BEEN FRECTIA)TO DENOTE WORK ARES? .................................. ARE SUFFICIENI N-1 MBERSOFOSHA WARNING SIGNS POSTED? .......................... ARF ADEQUATE PROCEDUR[-',S IN USE 10 CONTROL ENTRY & EXIV ........................ ARE SUFFICIENT FIRE ESHNGUISIIF.R LOCA IED IN WORK AREA'? .. ............ I ............... HAS EACI I FIRE EX"I INGUISHER BEEN INSPFCT TODAY? ................ .......... HAS RI-QUIRED DIFFFRE'NTIAI. PRESURE BEEN ACIlIFVE.D? ................................ WAS LACI I ( ON I AINMEN I SMOKE I FS I ED A I BEGINNING OF SHIFT .............. ENTER MANOMETE'R'S CURREN READING +;_...................................... <-' 0 - 2 - ARE WORKLRS IN CONTAINMI N I PRO I FICA ED A6AINS'I LIVE VOI, I AGE? .............. ARE GI -Cl BREAKERS BEING I S.1,I) \\D I U S 11-11) DAILY" ........ I I .............. I .... V-1, HAVE: A 1, 1. Et.ECTRIC' CI IORDS 131.1 \ I N'SPECI LD TODAY? ...................................... IS REMOVED REGULATEDWASTE BEING Wk EVI ED. I.ABFI.I.D AND BA66131)7 ........... IS WORK ARF.A BEING CLEANED A*1'1.1:('Nl I & END Of: SIIII7T? .............. ARI-;SHOWERSFINUI IONIN6 PROPI-,'RLYW I I IJ HOT& COLD ",AI I I,, ............. IS I I1LRI-. AND ADLQUA"I E WATER I'll. I'RA_I ION SYSI EM BEING I IS AIR MONITORING BEING ONDUC ILD AND RESt ILTS POS -1 LD? ...... IS EACH JOB BIEN(; ANALYZED TODIAERMINE. PROPER Pill,") CORRECTIVE ACTIONS TAKEN: 9,w. 7ZO Ul.!r 74, V +" a. T. t7 r. �4. q <,. . &4. 1 'tf DAILY SAFETY INSPECTION CHECKLIST .IOB\AMl.: JOB MAMI R: DA 11: Dsl a3 apl-q St ITRVISOR: 3, 6cs � Li YX die MUST BE COMPLETED ONCE DURING EACH SUHFIF 74.r.. 7L0.25/,J76! +--v 0- 7-51 e- Y-- 0/ }'IS No ARI At I RI.QI ARLD PI-RSo\i'\I.l RI.('ORDS C( T RREN I & ON til I I.-) ..... .. I.— ......... WAS AN S \1 I IYMI 1: 1 IN(i CONDI!(' 11:1) 1 ODA}":' ................................ ARF A11 RI,Qt 1IRED 110S I ER & \0 I ICFPOS 11.1) ON Sl I F".1...................... I IAS I I IF. FIRST All) KI I BITNINSPLUt 1.1) AND ADIM 'A I I,'? ........................... ..... .. ✓ I IAS BARRIER FAI'L 131A.\ LRI.Cl 1.1) 10 DI :No I I WORK ARI -.S'? . . ..... ........ ............... . ARE S1 111 WI LN I NI NIIWRS OF OSHA WARNING SIGNS POS I LIP .......................... ARL ADI 01 A 1-1 PROCIAWRI 1, 1N I SI; 10 (-ON I ROI. I :N I RY & FX I I '! .... . .......... ARI Sl 1- 1:1( 11 NI I IRI I SI I NG1 ISIII I R LOCA I ID I N WORK K AR I A? IIAS IA('II I IRI: I I I\GI ISMER IIFTN INSPIt'I IODAN"? ...... . . ..... ..................... HAS RLQUIRID D11 I I RI N I IAI PRI St R1 III I N \('IIlIA LIP ........................................ "AS LAt 11 t ON I AINMLNI SMOKE I LSI IDA I III 0I\\I\G Ol Still'[ . ....... LN I LR NIANOMIA ER'S Ct IRRFN RLADIM". I . I — ........... ... I ............................ Q L4 ARI \% ORKI.RS IN ('ON I AINMENI PRO I I,('I IA) AGAINS I LIVI. Vol, I AGI'! ............... ARI (it ( I IIRI:AKI:RS BLIN(i I ISFI) •\\D I I S I 1 1) DAI I N"? .............................................. I IAVI AI I - IA EC' I IRI(' CHORDS BEL\ INSPI ( I1 1) 1 ODAN"? .......... .... ...... ..................... IS RLMOVID RIAJI 1 A I 1J)"AS I I BLING W I I I 1 1). LABLIJl) AND BAG(iLlY! ........... IS \%ORK ARI A 131 IN;(i ( I I \NI DA I 1 11 \11 & IND 01 Sl IIF I'! ................. ...... ARF SIIO\k I RS FINCI 1ONl\(r PROPI RI Y\k I I I I 110 1 & COLD \N A I I.R'-' IS 1111 RI \\DADI-QI A I I kNA I 1,R 1 11 1 R \ I ]()\SYs I IA1 BLING ( SI.IY., IS AIR MONI IORIN(i BFINO ONIA (11 1) \\D RI `1 11 1 S IIOS I LIT? ............... IS I.A('Il JOB lilt MI \NAI Y/I 1) 10 DI I I R\11\1 PROPER PIT? ....... CORRETTIVE ACTIONS TAKEN: 74.r.. 7L0.25/,J76! +--v 0- 7-51 e- Y-- 0/ -'460--d ve– Z5Z# $ ;�� 5k 4.1~, 60 80013 e,&. (700)25t-3769 (303) 755-5.'116 DAILY SAFETY INSPECTION CHECKLIST JQ OBNAME: M�lz e naw-) JOB NUMBER: DATE: 08 SUPERVISOR: MUST BE COMPLETED ONCE DURING EACH SHIFT 724.43/.3769 +--% 0— 1?— q YES NO ART-,' ALL REQUIRED PERSONNEL. RECORDS CURRENT& ON SITE? ........................... WAS AN EMIII,OYI-"E SAFEI Y MEE HNG CONDI Vil"D TODAY? ........................... ARE At.[. REQUIRED POSTFIR &, NOTICE POSTED ON SI I ..................................... HAS "TILE FIRST AID KIT BEEN INSPECTED AND ADEQUATE? .................................... HAS BARRIER TAPE; BEEN I -REV -111) 10 DENOTE WORK ARES? — ............................... ARE SUFFICIENT NUMBERS 01: OSHA WARNING SIGNS POSTED? .......................... ARE ADEQUATE PROCEDURE'S IN I jSI-.'I 0 CONTROI, I -IN I-RY & EX I I'? ........................ ART: St TF1C'1F.NT IIR1 I Sl IN(it JISI JER LOCATED IN WORK AREA? .............................. I1.1S I MAI IARE I ;X I I MIT i ISHER l3EI�N INSI'l .('I*'I'ODAY? ............ I IAS REQUIRED DIFFERENTIAL PRESURF BI-[:\," ACHIEVED? ............................... WAS [:A('IICON IAINMFNI SMOKE TES TED AI'BE(jiNNIN(iOI- SHIFT .................. ENTER MANOMF I VR*S Cl IRRLN READING: t .. ............ ... 1. � ............ ............. I I .... I .... <, —0. 050 7 ARE WORKERS IN CONTAINMENT U'Rol I('ITI)AGAINS'l L,IVI-'V(.)I,I-A(;I:'! ............... ARE GI CI BR[iAKERS BITING USED AM) l l?S IIiD DAILY'? ................ .............................. IIAVI-'Al.LELECTRIC' C'IIOR[)SBEEN INSPI-',('IEI)TODAY?... ............... ........................ IS REMOVED REX.ATAH-DWASIL BEING Wl:l ITT). LABELED AND BA(iGED? ........... IS WORK AREA BEING Cl.l-.ANI-.1) A IL[ WNI I& I ND OF still: I? .................................... ART-. SHOWERS FINCHONING PROPFRI,N'WlI'H IIOF& COLD WA'11--,R'? ...................... IS HIERF, AND Al)l-'.Q( A Il t\ Al FR FIL URA I 1()\�YSTLM BEING USED? ..................... vz' IS AIR MON I 10 R I N G BEING ON Dt I CTE 1) AND RI '-t I I TS POSTED? ........................ IS I:A('Il JOB BIENG ANAI.Y/I-'D TO DIAT-IRMINE PROPER I'll"') . .................................... CORRECTIVE ACTIONS TAKEN: 724.43/.3769 +--% 0— 1?— q 2%ZY 5 JQ� 5k A.rw+... G'O 800/3" (720)25/.,37670,x: (30s)75--,-53/6 DAILY SAFETY INSPECTION CHECKLIST .1()Ik \ \\n.: 12th$ 2 W- _361h P1 4tnecl RM\1 1BER: 1 C-19—C�2(3 St i'LRVISO)R: .._ �G S �14 Yd v t ey MUST BE COMPLETED ONCE DURING EACH SHIFT rX..twcr.i. A. 710.25/,376,r fi r. 7.-.t7 t7 -?. ?feo.w 6q �.,orvlesf8ol YI s NO \Rf AT I RI-Ol IRLD PIRSO\NI I RL('ORDS ('I RRFN 1 & ON Sill-"? ........................... "A'-) \\ I MI'I OYII SAI I- FY MI -1- - I ING CONDI ( If 1) I ODAY?................................ ARI :\I I RI Ot IRI:D POS1 FR & \MWI: POSIED ON til I f-:'.' ..................................... I AS 1111 I IRS I All) KIT RI_[ \ INSPLC ILD ANI) ADI.Q1 All.'? ........ I ...... I ....... I............ 11;\S IIARRI[ R I AI'L- BI•I.N I:RLC' I [:D [O 1)1-.N(11 t. N'ORK ARES? ............................. - :\RI. SI'I IICII NI NI MBERS OF OSIIA XVAR\INO SIGNS POS I I:D? .......................... ARI ;\DI (11' \ I I PROl'I I RI S I\ I S1. 10 ('ON I ROL I N 110 & LXI I'! ........ _ ARI St FFIC'll \ I I IRI I S11\(i1 ISl11.R LOCA I ID IN WORK ARIA,! ..... ........... I IAS LACI l FIRI: LX I IN61. ISIII.R 141,1 \ INSPI ( I I QDAY? ......1 ... .. ............ . HAS RI OI IRI 1) DIFITRINI IAI PRI St Rl, 111.I.N ACT III:VLD'...................... N AS I.AC I I ('ON I AINIM LN I SMOKE I IS I I D A I BLGINNING Of SI III I ............. I.NI l'R ►v1AM)MI. I LIL"S t't'RRI:N RLADIN(;: .......... . .............................. C b • 0 ? ART \\ ORKI RS IN C'ON I AI\MLN I I'Rt) I I.C' I LD A(i:\I\S I 1 1\'I Vol 1:1(iI:? .............. \RI (if ( i IIRLAKI-.RS BLIN(i l'SI:D AND I LS l LD DAILY? ...................................... IAV1 Al 11.1.1:('1"RI(' (IIORI)S BEI \ I\SI'I ( I FD I ODAY7......................................... IS RI \IU\ I I) RI -6111 A I FDWAS I I BLIND \\ I.1 l I.D. I.ABLLI.D A\I) BAGGI D.' / IS N"ORK ARI •\ III 1N(i ( 1.I:ANI.) Al I 1 ( til I & 1 \D OF SIIII I :' . ........I ...................... ARI Sl IO 'I RS I INC11ON1\G I'ROPi.RI Y WI I I 11101 & COLD \\A I LR? ..... . ...... � IS I IIF.RI AND AT)[ QI1 A11, \\AIFR FIT.IRAI ION SYSII•.M 1111\6 IISLD" .... ...... IS AIR MONI I ORINO BLIND ONDt1(' I LD AND RI.SUL I S POSIT D'.) _ _..... _ _ ✓ IS I -AC II JOB BIL\(i .\NAI Wl 1) IO DI 11 RMINI PRO1'I It CORRECTIVE ACTIONS TAKL\: _ -- I \ o t� rX..twcr.i. A. 710.25/,376,r fi r. 7.-.t7 t7 -?. ?feo.w 6q �.,orvlesf8ol 5�p 9C Q«w, 60 8000 es& (Zo)etZ76' f <303) 75�53�6 �� ��t►�ILrI R ur eA _ _ c►Iec� SI°bG�c�tc�n ,.� 'R()IF< 1 1->,NiH._ 20 8' W. 36l r'HA51ct 3 NT NINMI V Vrrx l vrsvi DS/a4l12p « 7=1 nul Ct c�rcnecs 4-,, .u) ON N I R kt I OR Intertcch I T nnn nuental SI pf RVIM W - W[_ 11t ,I C a Int 07:4y:12 -0.020" WC 08-24-19 TIME HI "WC 00:00 -0.038 00:15 -0.040 00:30 -0.039 00:45 -0.039 01:00 -0.040 01:15 -0.040 01:30 -0.040 01:45 -0.039 02:00 -0.039 02:15 -0.039 02:30 -0.039 02:45 -0.039 03:00 -0.039 03:15 -0.039 03:30 -0.039 03:45 -0.019 04:00 -0.039 04:15 -0.037 04:30 -0.038 04:45 -0.038 05:00 -0.039 05:15 -0.040 05:30 -0.040 05:45 -0.040 06:00 -0.040 06:15 -0.040 06:30 -0.039 06:45 -0.040 07:00 -0.040 07:15 -0.040 07:30 -0.040 07:45 -0.029 LO "WC -0.043 -0.041 -0.043 -0.042 -0.042 -0.041 -0.041 -0.041 -0.042 -0.041 -0.041 -0.041 -0.041 -0.042 -0.044 -0.043 -0.046 -0.045 -0.044 -0.043 -0.042 -0.042 -0.042 -0.041 -0.041 -0.041 -0.041 -0.041 -0.041 -0.041 -0.041 -0.041 ALARM i W -0.020" WC 07:46:57 -0.019" WC 07:47:12 -0.018" WC 07:47:27 -0.019" WC 07:47:42 -0.019" WC 07:47:57 -x3.020" WC 07:48:12 -0.020" WC 07:48:27 -0.020" WC 07:48:42 -0.020" WC 07:48:57-0.0?t+" ' ?"of;r" Pi -.40.4a,, %. . 7zo 25/ NORMAL OP 07:49:18 ALARM 1 W -0.020" WC 07:50:45 -0.018" WC NORMAL OP 07:50:55 TIME HI "WC LO "WC 08:05 -0.020 -0.055 08:20 -0.020 -0.040 08:35 -0.035 -0.042 08:50 -0.040 -0.042 09:05 -0.041 -0.042 09:20 -0.041 -0.043 09:35 -0.041 -0.044 09:50 -0.034 -0.060 ALARM 1 d -0.020" WC 10:02:38 -0.019" WC 10:02:53 -0.019" WC 10:03:08 -0.020" WC NORMAL OP 10:03:09 ALARM 1 @ -0.020" WC 10:17:41 -0.019" WC 10:17:56 -0.020" WC NORMAL OP 10:18:07 TIME HI "WC LO "WC 10:33 -0.021 -0.025 ALARM 1 a -0.020" WC 10:41:26 -0.019" WC NORMAL OP 10:41:32 ALARM 1 @ -0.020" WC 10:41:40 -0.019" WC NORMAL OP 10:41:51 ALARM 1 1 -0.020" WC 10:44:34 -0.019" WC 10:44:49 -0.002" WC END JOB �' JC.�owboel�ml 12082 W 36th P1 Z52# S 5': a..1o,.., 60 800/3 ".. (720)251.3769 (303)7. 16 X11A11 11 I! Id iii FKl�.lt( I N1 11111-K / r-/ et - o 23 i i.J 11 \10 0 iil `Knit.( 1 N %N11 I'; -t) S 7 W- 3'C.+h Ill. � Qe5 rice,) t E\ I K V HIR 08-23-19 TIME HI "WC LO "WC 00:00 -0.061 -0.062 00:15 -0.061 -0.062 00:30 -0.061 -0.062 00:45 -0.061 -0.062 01:90 -0.061 -0.1062 01:15 -0.061 -0.063 01:30 -0.060 -0.062 01:45 -0.060 -0.064 02:00 -0.059 -0.063 02:15 -0.061 -0.065 02:30 -0.0E.l -0.063 02:45 -0.060 -0.065 03'00 -0.061 -0.064 03:15 -0.060 -0.064 03.70-0.V16N -0.063 03:45 -0.061 -0.062 04:00 -0.161 -0.063 04:15 -0.061 -0.063 04:30 -0.061 -0.064 04.45 -0.664 -0.6;5 05:00 -0.060 -0.063 05:15 -0.060 -0.063 05:30 -0.060 -0.063 05:45 -0.059 -0.063 06:00 -0.060 -0.063 06:15 -0.060 -0.061 06:30 -0.060 -0r.062 06:45 -0.05': -0.062 07:00 -0.060 -0.061 07:15 -0.059 -0.061 07:30 -0.034 -0.062 ALARM 1 d -0.020" WC 07.7,7.5? -0.019" WC NORMAL OF 07:34:08 ALARM 1 m -0.020" Wi- 07:48:25 -0.019" WC 07:48:40 -0.0'20" WC NnRMH OP Gi7:48:53 TIME Hi "WC LCI "WC: 08:03 -0.021 -0.037 '1iAs1 .C"N'f�1! 1n111� S�icx�l O,,eck It Seba.san DJ�ceti 08:15 -0.034 -0.036 08:33 -0.034-0.037 19:45 ALARM 1 i -0.020" WC 08:44:46 -0.019" WC 08:45:01 -0.015" WC 08:45:16 -0.016" WC 17:45 18:00 18:15 18:30 18:45 19:00 19:15 -0.031 -0.037 -0.036 -0.039 -0.039 -0.039 -0.040 0 NORMAL OF 08:45:19 19.30 -0.84 TIME HI "WC LO "WC 19:45 -0.039 09:00 -0.021 -0.049 20:00 -0.038 09:15 -0.024 -0.050 20:15 -0.039 09:30 -0.027 -0.047 20:30 -0.040 09:45 -0.043 -0.047 20:45 -0.040 10:00 -0.045 -0.052 21:00 -0.040 10:15 -0.047 -0.051 21:15 -0.039 10:30 -0.047 -0.050 21:30 -0.039 10:45 -0.846 -8.051 21'45 -0.039 11:00 -0.046 -0.052 2:00 -0.039 11:15 -0.048 -0.050 22:15 -0.039 11:30 -0.028 -8.055 22': 7, 0 -0.040-0.0 11:45 -0.028 -0.061 :45 245 2`2: 40 12:00 -0.028 -0.048 00 -0.040 12:15 -0.045 -0.047 23:15 -0.039 12:30 -0.046 -0.049 23:30 -0.040 12:45 -0.047 -0.051 23:45 -0.039 13:00 -0.047 -0.050 13:15 -0.047 -0.051 13:30 -0.045 -0.050 13:45 -0.045 -0.049 14:00 -0.045 -0.049 14:15 -0.046 -0.050 14:30 -0.046 -0.050 14:45 -0.046 -0.048 15:00 -0.046 -0.048 15:15 -0.046 -0.050 15:30 -8.045 -0.048 15:45 -0.045 -0.846 16:00 -0.045 -0.046 16:15 -0.040 -0.054 16:30 -0.040 -0.059 16:45 -0.029 -0.051 17:00 -0.041 -0.045 17:15 -0.041 -0.045 17:30 -0.070 -0.050 ..�. %..o. Ito.Z5/376! +.f 0. Tsv..,t71F. V..r... q 1... &y.l -10.'94( -0.046 -0.047 -0.047 -0.044 -0.043 -0.043 -0.042 -0.042 -0.044 -0.042 -0.041 -0.041 -0.041 -0.041 -0.042 -0.042 -0.040 -0.041 -0.041 -0.041 -0.041 -0.041 -0.041 -0.042 S ;Q� 9r moo+,.. 60 800/3 e.& (VO)Z51-376f T:u: (303) 755,53/6 PRO.111A I'NI }IM R )EM -0.23 Opt 11 110 D F! SC s�iun �JP�� 'Rcurc I �,NNII 12662 W. 3�#h. p .__ ._ PHASIF&NJTAINMENI C) 1eG(n I•a � pg�22�2or9 C �'cs idcnc�) C7hursa/4c*i' ON I R 1( I OR Inicrtcch I m iroumcmal 'it P[ R% ICOR �^ bas k� A h � I�CIS ' ,; POWER FAIL V 08-21-I9 21:21:26 _ v.aJ� -0.056 12:18 -0.040 it: rt3:9c M1.013 WC CURRENT JOB -0.846 12:33 -0.043 14:58:57-0.016- WC 12 -0'016-0.015m 1' 0U2 G! 36th P1 12:48 -0.043 -0.049 13:03 14:59:27 WC -0.035 -0.067 14:59:42 -0.015" WC OMNIGUARD 4 ALARM 1 -0.016" WC 01-01-13 12:01:34 -0.020" WC 13:11:29 -0.018" 15:00:12 WC ALARM 1 @ -0.020" WC WC 13:11:44 -0.020" 15:00:27 -0,019" WC ALARM 2 @ -0.100" WC WC NORMAL OP 12:01:40 NORMAL OP 13:11:45 NORMAL OP 15:00:28 TIME HI "WC "WC NEW DATE ALARM 1 -0.020" WC LO 15:15 -0,021 -0.060 15:30 -0.034 p 08-22-19 13:15:33 2 -0.019° WC -0,059 15:45 -0.037 -0,044 NEW TIME NORMAL OP 13:15:33 16.00 -0'028 -0.058 16:15 -0.040 06:47 TIME HI "WC LO "WC 13:30 -0.021 -0.062 16:30 -0.057 -0.069 ALARM 1 ai -0.020" WC -0.039 13:45 -0.026 -0, 043 16:45 -0.060 -0.068 17:00 -0.059 00:57:39 -0.019" WC 14:00 -0.030 14:15 -0.045 -0.036 -0.064 17:15 -0.061 -0.065 06:57:54 -0.019" WC -0.046 14:30 -0.039 17:3,0 -0.063 -0.066 -0.048 17:45 -0.064 -0.069 NORMAL OP 06:58:03 18:00 -0.063 -0.065 ALARM 1 d -0.020" WC POWER FAIL 18:15 -0.057 -0.069 18:30 -0.060 07:03:30 -0.019" WC 0$-22-19 14 '31:53 -0.067 18:45 -0.056 -0.068 CURRENT JOB 19:00 -0.061 -0.065 NORMAL OP 07:03:41 "WC 12082 W 36th P1 19:15 -0.661 -0.065 TIME HI LO "WC 19:30 -0.06 -0.064 07:18 -0.021 -0.050 OMNIGUARD 4 19:45 -0.061 -0.063 07:33 -0.046 -0.047 07:48 -0.046 -0.048 01-01-13 12:01:32 20:00 -0.061 -6.062 20:15 08:03 -0.047 -0.048 ALARM 1 a -0.020" WC ALARM -0.661 -0.063 10:'0 -0.061 -0.064 08:13 -0.047 -0.043 2 @ -0.100° WC 20:45 -0.060 -0.063 08:33 -0.047 -0.083 -0.056 -0.086 NORMAL OP 12:01.35 21:00 -0.060 -0.063 08:48 21:1` 09:03 -0.048 -0.081 NEW DATE -0.057 -0.063 21:30 -0.056 -0.069 09:18 -0.059 -0.069 08-22-19 21:45 -0.060 -0.063 09:33 -0.066 -0.073 22:00 -0.060 -0.064 09:48 -0.046 -0.073 NEW TIME 22:15 -0.061 -0.063 10:03 -0.039 -0.076 14:34 22:30 -0.060 -0.063 _. 10:18 -0.074 -0.078 TIMEHI "WC "WC 22:45 -0.060 -0.062 10:33 -0.030 -0.083 L O 14:48 -0.031 23:00 -0.061 -0.062 10:48 -0.046 -0.096 -0.049 23:15 -0.061 -y,0E2 11:03 -0.039 -0.087 ALARM 1 @ 23:30 -0.060 -0.06 2 11:18 -0.044 -0.088 -0.020" WC 14:52:27 23:45 -0.061 -0.063 11:33 -0.024 -0.069 ww -0.019" WC . 7 ��,,6 (fs..s, ,,p 14:52:42 11:48 -0.025 -0.046 -0.015" WC 12:A? _" n'" 14:52:57 -0.013" WC 14:53:12 WC 14:57' %.< i A.., Z%?y S ,K; & g' au4o"o, GO $000 GaIG (720)x543769 fyiew (303)7;�M X1181,%11 I IN IU i'I{o ff i 1 Al \IUI P Plil 1' 00 It Hl 023 h (ied,, ki►iat i ea��i % 2fi$2 ?6 fh rI. PCP i ClIecini CWet.��1c f5 cj ''� og/21/�olq j e v1C e 11,It - - : 4 till fla h-" START JOB 12082 W 36th P1 f 11:25:31 -0.103" WC 11:25:46 -0.102" WC 11:26:01 -0.103" WC NORMAL OP ALARM 1 @ -0.020" WC 13:15:06 -0.019" WC NORMAL OP 13:15:15 TIME HI "WC LO "WC 13:30 -0.021 -0.055 13:45 -0.052 -0.056 14:00 -0.030 -0.057 14:15 -0,029 -0,055 14:30 -0.032 -0.044 14:45 -0.032 -0.039 15:00 -0.029 -0.035 15:15 -0.030 -0.039 ALARM 1 @ -0.020" WC 15:15:51 -0.019" WC NORMAL OP 15:15:53 TIME HI "WC LO "WC 15:30 -0.021 -0.092 15:45 -0.022 -0.058 16:00 -0.033 -0.052 16:15 -0.044 -0.046 16:30 -0.644 -0.047 16:45 -0.045 -0.046 17:00 -0.045 -0.046 17:15 -0.033 -6.645 17:30 -0.026 -0.100 17:45 -6.031 -0.039 18:00 -0.035 -0.037 18:15 -0.031 -0.043 18:30 -0.028 -0.046 18:45 -0.034 -0.040 19:00 -0.035 -0.038 19:15 -0.035 -0.038 19:30 -0.027 -0.646 19:45 -0.034 -0.042 20:00 -0.035 -0.041 20:1` -0.635 -0.037 20:30 -6.07r y_� 26:45 -0,034 -0.037 21:00 -0.072 -0.038 21:15 -F . NORMAL OP 11:26:14 OMNIGUARG 4 08-21-19 08:41:43 ALARM 1 @ -0.020" WC ALARM 1 a -0.020" WC 11:39:43 -0.018" WC ALARM 2 d -0.100" WC 11:39:58 -0.013" WC NORMAL OP 09:52:08 NORMAL OP 11:40:05 ALARM 1 al _0.820" WC TIME HI "WC LO 'WC 11:55 -0,021 -0.058 09:54:01 -0.019" WC 12:10 -0.042 -0.050 09:54:16 -0.015" WC 12:25 -0.044 -0,048 09:54:31 -0,011" WC 12:40 -0.022 -0.048 09:54:46 -0.011" WC 12:55 -0.024 -0.028 09:55:01 -0,013" WC 09755:16 -0.013" WC ALARM 1 -0.020" WC 09:55:31 -0.013" WC 12:58:39 -0.019" WC 09:55:46 -0.017" WC 12:58:54 -0.018" WC 09:5b:01 -0.013" WC 12:59:09 -0,018" WC NORMAL OP 09:56:09 12:59:24 -0.017" WC TIME HI "WC LO "WC 12:59:39 12:59:54 -0.017" WC -0.018" WC 10:11 -0.021 -0.054 13:00:09 -0,020" WC ALARM i d -0,020" WC 13:00:24 13:00:39 -0.020" WC -0.020" WC 10:14:15 -0.018" WC 10:14:30 -0.010" WC NORMAL OP 13:00:46 10:14:45 -0.009" WC 10:15:00 -0.009" WC ALARM 1 a -0.020" WC 10:15:15 -0.008" WC 13:00:54 -0.019" WC 10:15:30 -0.008" WC 13:01:09 -0.017" WC NORMAL OP 10:15:35 13:01:24 -0.018" WC 13:01:39 -0,017" WC ALARM 1 @ -0,020" WC NORMAL OP 13:01:51 10:18:20 -0.018" WC NORMAL OP 10:18:22 ALARM I d -0.020" WC 13:06:12 -0.019" WC ALARM 2 W -0.100" Wr: 13:06:27 13:06:42 -0.010 WC -0.010 WC 10:32:59 -0.101" WC 10:33:14 -0.103" WC NORMAL OP 13:06:52 ALARM '120" WC 9" WC NORMAL OP ALARM 1 @ -0.020" WC 13:15:06 -0.019" WC NORMAL OP 13:15:15 TIME HI "WC LO "WC 13:30 -0.021 -0.055 13:45 -0.052 -0.056 14:00 -0.030 -0.057 14:15 -0,029 -0,055 14:30 -0.032 -0.044 14:45 -0.032 -0.039 15:00 -0.029 -0.035 15:15 -0.030 -0.039 ALARM 1 @ -0.020" WC 15:15:51 -0.019" WC NORMAL OP 15:15:53 TIME HI "WC LO "WC 15:30 -0.021 -0.092 15:45 -0.022 -0.058 16:00 -0.033 -0.052 16:15 -0.044 -0.046 16:30 -0.644 -0.047 16:45 -0.045 -0.046 17:00 -0.045 -0.046 17:15 -0.033 -6.645 17:30 -0.026 -0.100 17:45 -6.031 -0.039 18:00 -0.035 -0.037 18:15 -0.031 -0.043 18:30 -0.028 -0.046 18:45 -0.034 -0.040 19:00 -0.035 -0.038 19:15 -0.035 -0.038 19:30 -0.027 -0.646 19:45 -0.034 -0.042 20:00 -0.035 -0.041 20:1` -0.635 -0.037 20:30 -6.07r y_� 26:45 -0,034 -0.037 21:00 -0.072 -0.038 21:15 -F . O O n n a, ..3 7z 7z 0o m ORT. J tA I I A C't7 1 I = �s C«C<C«C< rcll C N n � X o -c y o in C � I I � r N `I X z ' � m i z O O n n a, ..3 7z 7z 0o m ORT. J tA L 7 I o� Ioo C I i T CA CA V) C/% Cf C4 C4 C4 '' CJ: CA 7� � rn z I z 7hvrs� s rn I rn ICC�C«<C«<CC IJ z i �N X II OC, -� o I o I z rn � j I X � � � z El m (ved17 V —41 d �I o m ' z , 1 �o C4 cn cn C4 Cn cn cn Cn :n Cn i� T < i m z o o' rm rri I � z V —41 JOB q JOB NAME: CONDUCTED BY: TRAINING SUBJECT: L2# 5�* -9?1.* 4."~. W 8000" (7Z0)Z51-m69 4.00, (303)75,xMM SAFETY MEETING SIGN -OFF DATE: cscJvw&d . 12 - -.1 A PRINTED NAME Lwmlt OiCIA 2. 3. 4. 5. 6. 7. 8. 9. 10. If. 12. 13. 14. COMMENTS: kOone, HANDOUTS AND TRAINING AIDS USED: SIGNATURE NJ pus 2. 3. 000, 4. 5. 6. 7. 8. 9. W 12. 13. 14 'X.t&cr"4 'Aw. 7ZO 4V3Wf qjo" 0.-t, Two., 7r. A",. t7 K.,0.64./ 6 252'f s sr. a.,., 60 $000 " (W )Z51U769 755,5:16 SAFETY MEETING SIGN -OFF JOB:;: — j�jq - O oZ3 DATE: Oa ( I �9 C Friday� JOB NAME: lad�� W 3(0�' Ql hesiknc-e I ---- T CONDUCTED BY: 5t�gyan 7�tlw TRAINING SUBJECT: GJanr nil `iDPF pit- all �jmnr. [ase D(- OcTC4 Q(eLn PRINTED NAME 3. ptd oi ejq 4.� 5. 6. 7. 8. 9. 10. Ii. 12. 14. COMMENTS: IV �ri SIGNATURE ,. --- 3. 4. -000,--- 5. 6. 7. 8. 9. HANDOUTS AND TRAINING AIDS USED: %t.-r.A eir,x..to.a wa..-W,, %... -20251,576" *.,, a... T. ,r7 ?. �aweee 0j K_w..I Zfz# 5�� 5?r 60 80013 &a (7.e0)Z51_.V6f 1303)ML-OM SAFETY MEETING SIGN -OFF JOB iE Iq - 0013 DATE: 0% lap,/ Uhuftd-y� JOB NAME: Pvwclence) CONDUCTED BY: TRAINING SUBJECT: all qpgw�onatc Fee Qk 7// PRINTED NAME 2. 3. 4. 5. 6. 7. 8. 9. 10. I]. 12. 13. 14. COMMFNTS: Q oqe- HANDOUTS AND TRAINING AIDS USED: SIGNATURE Ut, .414 2. 3. 4, 7"t.0" %. 720.44576- +" 0. �6. q F S i�.� 5?' a.... GO 8000 &a MO),M-376' +.. (303) 755,5-V6 SAFETY MEETING SIGN -OFF JOB 4: �E.lq.-—Gafl.. _ DATE: 05/ o%( /�Ll1c8rieStay JOB NAME: ISLOO - 1!J CONDUCTED BY: TRAINING SUBJECT: Lk�ur all Qpe-Yoo pprl u 6 pPC R t Q11 6=fs, n. PRINTED NAME I . licA O �edq 2. LW"'A 01. a., 3. /,,-. 14 wzz_, z 4. s. 6. 7. 8. 9. 10. H. 12. 13. 14. COMMENTS: HANDOUTS AND TRAINING AIDS USED: SIGNATURE 8. 9. IU. l 1. 12, 13. 14, Oone X l .. W. L5/. 3761� �' "8 0-- -7— �''— q 4W S 1* 5r A.~. M MOM &a (720)251_3769' 1. 03)755.5316 DAILY SIGN -IN SHEET JOB# 115 I Cl - 0.23 DATE: 08 / € #j Q019 CSU turd C1 y } JOB NAME: X20 8 W • 3(�+� jam' I • l_ Rest`�_tn9=�' LOCATION: o 2 w- 36v. r TI ! . -T- 1 0-cw -"10 Ince SUPERVISOR: 8,e_6as+ � ari r - Worker Name (PRINT .... First and Last Worker Signature Morning Time In Time Out Afternoon Time In Time Out Total Hours cx�x p; : o o 0-0 I,.01 "00 i' f �.,; ©0 ov .� 6 4%e# 5 KV& �r a.~. ew soom " (720)e4376f q. (303) 7575-016 DAILY SIGN -IN SHEET JOBB JOB NAME: 1.()('A,riON: St 11FRVISOR: 16101 - Ows - __ _DATE:_QlSj9C5h1 C�t6 all, Worker Name (PRINT.... First and Last) Worker Signature Mornine Time In TOut Afternoon To "a, Lime Time In Out Hours 7 12 % 00 (41 -0 -1:50 Q v DAILY SIGN -IN SHEET JOB# 161g - 0a's DATL: o -g /9-9-1 19 C-awnsc y � JOB NAME: JaZagj W ?Ltft ;>I LOCATION: ta08a. W 3(.+h P SUPERVISOR: zgbasklm acjA ov Worker Name (PRINT.... First and Last) Worker Signature Morning Time In Time Out Afternoon Time In Time Out Total Hours -7-00 14,60 12 30 q. oo 1 :00 1,2, 60 *3 Q Ll 0.0 Q_�e&_fi TOO la:00 30 OD C. j z5zf S Y� 5?r a.awo.... 60 80013 (�lG (7z0)z5l�7690 (303)75 5�/6 DAILY SIGN -IN SHEET .10134 16 11 - 0,*3 DA I L: 0"610q1/19 C �neSda� SOB NAME: 1'a0$a w Mo" Ol C Resid,►ncei _ _ I OCATION: (20g 9. St IPI-:RVISOR: V4 orker Name (PRINT.... First and last) Mornine Worker Signature Time In Time Out Afternoon Time In Time Out Total Hours Qb iian -7.,00 1&-.00 m: 30 '.30 -1.00 1a:60 I2. 1 o S' 3c) ra — .0U a-00 12310 V 1a=00 30 _ - i /Z0.ZV 3761 64, rw mZ7 Aw, yr~ 0/ 1G,o«,lsclgel IT r Awwno-, A9 8000 " (7zo)4fl-?,r76f WEEKLY PROJECT TIME SHEET PROJECT NUMBER: - QI 7 WEEK ENDING: asi.201cl C5Unc4V) I PROJECT NAME: )X082. W- 3C." Fl. (Re-sk'4cyla.,r-� NAME MON li St OT' TUE M14D]II SY 6T WED --FT—H( FRI 09121114 08 c3 SY 110f ST' '0T- ST T SAT 0112WIf sf 'oi- SUN QW2SI/4 st 10T TOTAL ST OT col - 3 tee 4 12 �2 cl 7 9 12 13 14 15 16 TOTAL, comments: uoyl-e— Report by 5ebast ;art Qlectq— Signature: ?~,. ZeOZft,376'f +" a— �,— �— q �•. tet, . P. V# S i�� Ar 0.,.e.., CO 800/3 Gall (720)25/_3769 �`°" (303}755_53/6 SUPERVISOR CHECK LIST MUST BE COMPLETED WEEKLY AND TURNED IN WITH YOUR PAPERWORK! Week Ending. © gam 5f aom ( sc)ncC..4) -- Job #: ) E 19 - o a3 Project Name: lao�'z 1 1 6+� •P��_ke5i-8cnee) Supervisor Name: ��bc�,s,' b A5 +� 1) PROJECT WEEKLY TIME SHEET 2) DAILY SIGN IN 3) SAFETY MEETING SIGN OFF 4) CONTAINMENT LOG S) MANOMETER READINGS/TAPE 6) DAILY SAFETY INSPECTION CHECKLIST 7) DAILY ACTIVITY LOG 8) PROJECT PUNCHLIST 9) EMPLO YEE TI ME SHE F. T 10) AIR SAMPLES (� 11) MANIFEST kL-,0K d fie( ►-��e LY 12) ASBESTOS REMOI AI. INSPECTION FORMS 7to.t3/.376f 6 fi r, Twu.ZV, A.,, *ww, q r"1 INTEENV-01 ASC ORO CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDlYYVY) 812712019 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 CONTACT Beckie Larke NAME Six & Geving Insurance, Inc. PHONE FAX 3630 Sinton Road #200 (ANC. No. Ext). (719) 867-4118 IAIC. No) (719) 590-9992 'Colorado Springs, CO 80907 -MOMSS: blarke@six-geving.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A Arch Specialty Ins Co 21199 INSURED INSURER a Arch Insurance Company 11150 Intertech Environmental, Inc. INSURER C: Raquel Arredondo de Ojeda 2524 S. Rifle St. INSURER D: Aurora, CO 80013 INSURER E: _ INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 INSR TYPE OF INSURANCE SR ADDL SUBR POLICY EFF POLICY EXP L.� _ — INWVD _ POLICY NUMBER JMMfDDtYYVYI IMM/DDM'YYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000' CLAIMSMADEX OCCUR 12EMP0524405 2121/2019 2/21/2020 DAMAGE TO RENTED PREMISE. cEa occurrence; 5 100,000 MED EXP (Any one person) _ 5 5,000!' PERSONA:. B ADV INJURY S 1,000,000; GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE , $ 2,000,000I POLICY X PELT LOC PRODUCTS COMP/OP AGG S 2'000'000 _ OTHER B AUTOMOBILEUABIUTY ---_----� -_ COMBINED SINGLE LIMIT e 1 iEa aGS+dSnJ . $ i ANY AUTO 11CA692425 OS 212112019 2/21/2020 BODILY INJJR. (Per persona $ OWNED SCHEDULED X , AUTOS ONLY AUTOS BODILY BODILY INJURv IPeraccident), 5 X AUTOS X AUOTOS acEc,R�T rnDAMAGE ONLY ONLY (PeOr 5 UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION$ $ AND EMPLOYERS' LIABILITY YIN .. ' STATUTE EP pANY PROPREIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT $ (MFaodE ry le "BEXCLUDED'EXCLUDED'/ N I A (M HH EL DISEASE - EA EMPLOYEE. S Ityes descriDe uncer _ DESCRIPTION OF OPERATIONS oelow E L DISEASE - POLICY LIMIT S _ A CPL Pollution Liab 12EMP05244 05 2/21/2619 2121/2020 Per Occur DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE_ HOLDER Metro Solutions LLC 12082 W. 36th Place Wheat Ridge, CO 80033 ACORD 25 (2016103► _— CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD c0�0 1876 Colorado Department of Public Health and Environment ASBESTOS ` CERTIFICATION* This certifies that f, Joseph Todd Anderson Certification No.: 2157 has met the requirements of 25-7-507, C.R.S. and Air Quality Control Commission Regulation No. 8, Part B, and is hereby certified by the state of Colorado in the following discipline: Air Monitoring Specialist's Issued: December 19, 2018 Expires: December 19, 2019 This certificate is valid only nvith the possession of a current Division -approved training course cerdficador G in the discipline specified above. A ionized APCt] epres ntaf ie SEAL Rocky Mountain Center for Occupational and Environmental Health Department of Family and Preventative. Medicine University of Utah certifies that has completed a Continuing Education Post Graduate course entitled ..Its �• .�� �+ r- a I \-UUIK LAICUL11 A NIOSH Sponsored Educational Resource Center PCM REPORT Inc' 8985 L. Nichols :A%enue. Suite 350 Centennial. Colorado 80112 (303) 799-6100 Client: Intertech Environmental Inc. Project ID: 12082 %%.30"' Place Project Location: 12082 W. 361" Place. Wheatridge. CO Identification: Asbestos. Air Filter Analysis 1 e t Method: Phase Contrast Microscopy (PUM) NIOSH Method 7400 Sample Sample I Sample Description Location Fiber Concentration \umber Date (f cc) 8-24-01 8-24-2019 Field Blank NA 8-24-02 8-24-2019 i Field Blank NA 8-24-03 8-24-2019 Clearance. Basement 0.004 8-24-04 8-24-2019 Clearance. Oarden le\el -0.004 8-24-05 8-24-2019 Clearance. Main le%el. kitchen living room 0.004 8-24-06 8-24-2019 Clearance, Second floor north bedroom ,0.004 8-24-07 8-24-2019 Clearance. Second floor master bedroom 0.004 i i i t.,ults mdreate the concentration of all fiber, I he N %I methicl cannot po.:u%ek idenut+ a,besw, tiller, orbs ma, not he reproduced e\cept in full I"hu report relate, onh w the ,ample, tested kATC August 25. 2019 Ms. Raquel Ojeda Intertech Environmental_ Inc. _i-"4 South Rifle Street Aurora. CO 80013 RE: Clearance Air Monitoring 12082 W. 36" Place Wheatridge, Colorado 80033 Ms. Ojeda: 8985 E. Nichols Avenue. Suite 350 Centennial, Colorado 80112 Telephone 303-799-6100 Fax 303 799.3441 Mr. Todd Anderson provided Clearance Air Monitoring services for Intertech Environmental. Inc. at the residential asbestos abatement project. The visual inspection and clearance air monitoring was completed inside the house located at 12082 W. 36'x' Place in Wheatridge. Colorado. The visual inspection and clearance air monitoring was conducted in accordance w ith Colorado Regulation Number 8: Section III.P. Mr. Anderson conducted a visual inspection and collected five (5) clearance air samples inside the containment on August 24. 2019. The air monitoring results indicated that concentrations of airborne fibers were less than the concentration recommended by the Environmental Protection Agency (EPA) and Colorado Regulation Number 8 air monitoring guidelines of 0.01 fibers per cubic centimeter (f/cc) for Phase Contrast Microscopy (PCM) for re -occupancy of a space following an abatement project. Furthermore. Mr. Anderson did not observe am_ visible dust or debris remaining in the containment during the visual inspection event. Air sample results are summarized in the enclosed Air Monitoring Report. The work area that was tested has passed the required clearance criteria. If you have any questions please call me at 303-799-6100. Sincerely. 1 odd Anderson Air Monitoring Specialist Certification No.: 2157 Enclosure: PCM Report and Certifications 4RW REPUBLIC JOA SERVICES NON -HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST If waste is asbestos waste, complete Sections I, 11, III and IV If waste is NOT asbestos waste. complete Sections 1, II and III GENERATOR (Generator completes la -r) a. Generator's US EPA ID Number b. Manifest Document Number C. Page 1 of d. Generator's Name and Location: I. Phone: e. Generator's Mailing Address: g. Phone: If owner of the generating facility differs from the generator, provide. h. Owner's Name: _ ~ i. Owner's Phone No.: J. Waste Profile # k. Exp. Date I. Waste Shipping Name and Description m. Containers n. Total Quantity o. Unit Wt/Vol No. Type renovation operation or both GENERATOR'S CERTIFICATION. I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to applicable regulations: AND, if this waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions. I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR 268 and is no longer a hazardous waste as defined by 40 CFR 261. p. Generator Authorized Agent Name (Print) q. Signature r Dale 11910 a Transporter's Name and Address b. Phone. III. DESTINATION (Generator complete Illa-c and Destination Site completes Illd-a) a Disposal Facility and Site Address b. c US EPA Number d. Discrepancy Indication Space. I hereby certi that the above named material has been accepted and to the best of my knowledge the foreaoinq is true and accurate. e. Special Handling Instructions and Additional Information I. Friable ❑ Non -Friable ❑ Both % Friable 90 Non -Friable OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name e. Name of Authorized Agent Pnnt f. Signature I a. Date IV. ASBESTOS (Generator completes IVa -f and Operator complete IVg-i) a Operator's Name and Address- c. Responsible Agency Name and Address: I b Phone: d. Phone: e. Special Handling Instructions and Additional Information I. Friable ❑ Non -Friable ❑ Both % Friable 90 Non -Friable OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classified, packaged, marked and labeled/placarded and are in all respects in proper condition for transport according to applicable international and national govemmental re ulations. g. Operator's Name and Title (Print) I h. Signature i Date 'Operator refers to the company which owns, leases, operates, controls, or supervises the facility being demolished or renovated, or the demolition or renovation operation or both REV 01114 RS•F11A n z Main FI'oor Note: +tett be replacing toilet and vanity in Powder Bath er All new and existing smoke alarms shall be interconnected so the actuation of one alarm will activate all of the alarms per 2012 IRC R314.5. ' ► City of '� W heat IRiS e COMMUNITY DEVELOPMENT APPROVED Reviewed for Code Compliance " A� `) 13, 1 tg Plan Examiner Date VaNdltr of oemN: 7be issuance of o p~ or appromt of plant sw1kat om and omMutatrons shall not be o pnmit for, or an oAmord of, arty mlonan M any cf the prowslom of the bu Wing code or of aW CNy ar&*xxn PWmlb premmV to gW ourho►fty to wolair a SW"1 Mr pnwafont offt MilltD cntha a ~ orakronon of the sity shad not be W0" AU- wow 7-0 C�m�c y w r -y 0017— 12C • Cb1 0241?o j>Lumg106- ® Z----, n N G:C OooC- 51 -revel Note: N111 be replacing cabinets and counter tops. Nil install new sink and appliances. New woad flooring and the on splash. Pt&> V10IC-, Lj,-776e 0 F7AM I IjvSpEc�<%'j FO New NfA#*e City of Wheat Ridge Upper Floor Existing Bedroom cv 1 0,-2'h a\ECr:_ HEED Address: 12062 N 36th Pi. Meat Ridge, CO. 80035 Cn;; jI,ryj�r. ._ jam' 1 Ve 101,51h Master bath are eAsting. s, 5' 1 oftExistingMain Bath - Mill install new tile, new variW and new toilet. L:::: Existing shower pan will rernair existing in master bath. t f - kNill install new tile, new vanities, Alland new toilet in Main bath. C Existing tub will remain existing Master Master Sats-, in, Main Bat 511 c/L PW Lo��ry 7'b C01PIAI —61-11 '1180 G� set , install new dense shield W BTW All smoke deter -tors will be installed accordingly through out house ire both master and main bath shower surrounds. v Existing Bedroom 13'-b 1/2" Ear Existing Master Bedrooml�L 1 b'-8" City of �"eat Ridge �( Pct c s -r ooh 4, Note: 1. Basement will not be finished . Combustion air uuill be puff in the machanical morn C►) E�ES5 wwow fz-F—a�• 1N 6i) R or -fl c- l,V"� t L. AO�Q, CAI 01 Oleat Fudge City of Wheat Ridge Residential Asbestos Abatement PERMIT - 201901841 PERMIT NO: 201901841 ISSUED: 08/29/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 08/28/2020 11OB DESCRIPTION: Asbestos Abatement - 2,798 sq ft total *** CONTACTS *** OWNER (303)980-4949 METRO SOLUTIONS SUB (720)251-3769 RAQUEL ARRENONDO DE OJEDA 190242 INTERTECH ENVIRONMENTAL *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,300.00 FEES Asbestos Abatement 50.00 Total Valuation 0.00 ** TOTAL ** 50.00 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2017 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. I, by my 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 ermI . I further attest that I am legally authorized to include all entities named within this document as partes to the work to be perform and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. ❑I Signature of `OWNER or CONTRACTOR (Circle one) Date r I, This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subaect 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 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. City of W heat I�jdge COMMUNITY DUVELOPMENT Building & Inspection Services 7500 W. 29t' Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits@ci.wheatridge.co.us I FOR OFFICE USE ONLY I Date: Plan/Permit # Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: I ZM 2 W. 36th ?I. Property Owner (please print): I el rb 5n to t' on s LLC Phone: 6303) q� qq q Property Owner Email: Ka4111 aft neIrnSo(A'Ons—l1C • CU,M Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address: 'x.2 9. S S • Dt° f rG m -e k City, State, Zip: Ldke Wood P'[) �3 0228 Architect/Engineer E-mail: Phone: Contractor Name: To t e_r r_ a h L n Ll ron rn {n to I In C City of Wheat Ridge License #: 19 ().a- L< 2 Phone: '7!2c7 mss) - 3 -76> Contractor E-mail Address: I h �e r 1 .e o-11 en G)Kc> � Moti ( • I? om For Plan Review Questions & Comments (please print): CONTACT NAME (please print):KQQ(),0A k • O j eA� Phone: -79061 _1J CONTACT EMAIL(p/ease print): 1 A �er- �e Ct �%en tY c'. Co rV1 Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): 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 # City License # Complete all highlighted fields, if applicable. [—]COMMERCIAL ❑ RESIDENTIAL Provide 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. M.aLor Sp,ll response- aet►on Pel III.T.t to c.nFu�q am deoonl-Qm(nca+e fnlennar of ?q� -,Fhome- Trt he owner did fhe derrnoltlion ,' Phe hovse-, he reinoved c-ftwo,,cfmcrfcly7DSF; ai Irlor h-1, debris 0,ps4Afrs bGf hrooms.T'here is no demo rnafierikl on s,t� of DuJa -f hc- only thinbc f h4� We need i -o ptok Up is the aper and ?IAstca covers From Ae('lw> - (��'Ar-h Cinct W,nC&Wr. dvsi- Ct Vt _-he e?j l prnerl c-(ntl so rrle ✓ dLo rtie er(W �ha J Aty l [ 4h e. remodel,- of +h -c h"–' use on r-re,,rY►oc�-e la [-ton . �"k�y plrnasl- Ta ,;�ed c.,y hoose. 7hcy cFaPred L,),00 the C��y s'toppcd yAe-m From 46t'a`q c+/ly�h+'nJc elle. We - 1,() o n'4- re more n Y ctr.o5F Perr%ov�.1. -the o(rp� o4 hooa h e-epl fv be o l eu neo( d nder t l l -T• 1 A e �t �(- door, Seaor►�l floor, sec{vrul Floor anal fxtsenten I, 7hts r'�el�des dcciorlkamtet"kt,ov\ o f C -a% �{ec) 06tcc-1 be rc,'erc wli h -02 ne C$1-J'Je PJrSLr,e/ Sq. Ft./LF 9.1101 ? S.F. BTUs Gallons Amps Squares For Solar: KW # of Panels Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: Proj t Value: (Contract value or the cost of all materials and labor included in the entire project) s'02> 06 %ice ONN'NER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONT' OR) or (AUTHORIZED REPRESENTATIVE) of ('OWNER) (CONTRACTOR) / Signature (first and last name): � Cid V,,d4 DATE:0 /1,2019 1 Printed Name: Ql A r r1—ndAde ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: fl (D ;?w 7 p 2, LU N CD 0 p 2a s a c N- CD c� n�g fi .m`��m jCtJ CD, ::I, (0 N N ED CD O a O. 3@ O a= F .�c03= a.n =m n r��oa ro C ra O = CD Orr a O- m W N N N Cw mom3nm3mCD �N0-32 a o—x v s 3,p ao O A 3 �. y -3O CL a7 c �F CL —y v [n < y n 0 N NT. O O Dun > > 2 O 'co c Ca tD 7 O L) O -0 3 0 SSU 6 n N �0 ..m Co t3ta c w' jc D N y coso m a -i _ice 7 X 0 =o m 3 °t'-cga C o m D y y A a'� M w=ac Wr m 0 y�==Q? 0 m 0 c _ e 3 n O c) N 0 ry CD � �v� M3 a O w a �-. CT ma5 Lx CD = n aas 0 O N y m <n 3 sro `L = s� =30 �cc Oa m w'ML� a=i im j o x N F rn 0 CD a a N ��a�MNoa� `.N O c m N R' n2�a,allo�o. La ''tea `.v 2ro =� ,Ty 7 a 7 '3 i 5 a ;— �a_ MNa N an a x co »�p3=D3cF M Q L to 0 3 iL r Q N .�. C, � � .3 J 0 13 ` t° m F a x D a p 15 x @ m .pas O p'� s 3', m C -) n' ., Chi Ni p40 mss" v R f9 �m 4ti i CL 2 N x cr p N` O _ N .0 (D CD (� N tj rn O � n n 0� C) D ci n O I p O O Q M t �y t N Cn IJ N CD a nI' Om O k O n j vi a7t I0.;� 3! N Ni o SOD p'co a co 0 . Q Q m n� Ent s� ca 0ff` c Cwt ,tet W co 3 a' t iSf C. a N s fi CD ;Np' - a vt3t7' o -. 1v W 3• { j � 33- Z Cl) C�„ �l N D 2 a '00Da i o N a CT Er cD O 63 A: >inCL � Qc !� co IFZ om CD y' �� i N W CR U' a n ca o CL E CD - 3 r O CD 0 La �< � N r O 4 %r ? ; Z 4. CO = Q as CJm N ! CS yi tp y i N y. N 6 rpR ' < m O 0 '� 0 *� D _ w 1 in jU)CL m o �. C7 ...�cn N -i T I La O a O i O 4? CL � co CD N ari rw CD ,,,, it a Oo (9 CA < � � A O p'� O', mss" v R f9 m m t!] 0 D n C7 nM Z < m 00 .{ o z n o-4 V r m mip D 16 l J > q 0-4 cn r r m X C m0 +Ic Colorado Department of Public Health and Environment Air Pollution Control Division — Indoor Environment Program — Asbestos/IAQ Unit 4300 Cherry Creek Drive South, APCD-IE-B1 Denver, Colorado 80246-1530 Phone: 303-692-3100—Fax: 303-782-0278 E-mail: asbestos@state.co.us ASBESTOS ABATEMENT PERMIT "Il- is permit is granted subject to Colorado Air Quality Control Commission Regulation No. 8, Part 13, adopted December 21, 2007, :rid effective January 30, 2008, the Colorado Air Pollution Prevention and Control Act (25-7-101 or 25-7-501 et seq., C.R.S.) and th;V following provisions. It is only for the purpose of allowing asbestos abatement. A )DITIONAL PERMIT PROVISIONS: By performing work under this permit the abatement contractor agrees that the Division may revoke or suspend this permit should the Division find that the contractor: • has violated or has aided and abetted in the violation of 25-7-101 or 25-7-501 et seq., C.R.S. or Regulation No. 8, Part 13, or an order of the Division or Commission, • has failed to meet any permit and notification requirement or failed to correct any violations cited by the Division during any inspection within a reasonable period of time, as may be determined by the Division, . has used misrepresentation or fraud in obtaining this permit, or, s has committed any act or omission which does not meet generally accepted standards of the practice of asbestos abatement. A a contractor, you may be subject to other licenses and permits, depending on the requirements of the county and municipality which the work is being performed. The Colorado Department of Public Health and Environment, Air Pollution Control i)ivision strongly suggests that you check with county and municipal authorities in order to determine any other local building/permitting requirements that must be met. THE ORIGINAL PERMIT MUST BE POSTED ON SITE AT ALL TIMES. Immediately notify the Asbestos/IAQ Unit of project modifications by fax (number above) or e-mail (address above) and in,, appropriate county health department by fax. Project modifications include changes in the scope of work or the scheduled work dates, etc. This asbestos abatement permit is valid beginning 8/21/2019 through 11:59 PM on 9/19/2019. The actual scheduled work dates are from 8/21/2019 through 8/24/2019. Approval issued on: 8/22/2019 Fee paid: $400.00 Record number: 151807 Notice Number: 19JE5461A Variance: None Comments: Major Spill Clean up or the location specified below: 12082 W. 36th Pl. (Residence) 1st, 2nd floor, basement 12082 W. 36th Pl. W heatridge .Jefferson County I 'iis permit has been issued to: Intertech Environmental, Inc. 2524 South Rifle St Aurora, CO 80013 Check number: CC 1020 Project Supervisor: Sebastian Ojeda Cerification No.: 22881 Project AMS: Joseph Todd Anderson Cerification No.: 2157 Project Manager: Issued by: SM ;STC August 25, 2019 Ms. Raquel Ojeda Intertech Environmental, Inc. 2524 South Rifle Street Aurora, CO 80013 RE: Clearance Air Monitoring 12082 W. 36' Place Wheatridge, Colorado 80033 Ms. Ojeda: 8985 E. Nichols Avenue, Suite 350 Centennial, Colorado 80112 Telephone 303-799-6100 Fax 303.799.3441 Mr. Todd Anderson provided Clearance Air Monitoring services for Intertech Environmental, Inc. at the residential asbestos abatement project. The visual inspection and clearance air monitoring was completed inside the house located at 12082 W. 36`x' Place in Wheatridge, Colorado. The visual inspection and clearance air monitoring was conducted in accordance with Colorado Regulation Number 8; Section III.P. Mr. Anderson conducted a visual inspection and collected five (5) clearance air samples inside the containment on August 24, 2019. The air monitoring results indicated that concentrations of airborne fibers were less than the concentration recommended by the Environmental Protection Agency (EPA) and Colorado Regulation Number 8 air monitoring guidelines of 0.01 fibers per cubic centimeter (f/cc) for Phase Contrast Microscopy (PCM) for re -occupancy of a space following an abatement project. Furthermore, Mr. Anderson did not observe any visible dust or debris remaining in the containment during the visual inspection event. Air sample results are summarized in the enclosed Air Monitoring Report. The work area that was tested has passed the required clearance criteria. If you have any questions please call me at 303-799-6100. Sincerely, —A, Zy1%a�ll4i.�l Todd Anderson Air Monitoring Specialist Certification No.: 2157 Enclosure: PCM Report and Certifications PCM REPORT ATC 8985 E. Nichols Avenue, Suite 350 Centennial, Colorado 80112 (303) 799-6100 Client: Intertech Environmental Inc. Project ID: 12082 W. 36" Place Project Location: 12082 W. 36`h Place, Wheatridge, CO Identification: Asbestos, Air Filter Analysis Test Method: Phase Contrast Microscopy (PCM) NIOSH Method 7400 Sample Sample Sample Description / Location Fiber Concentration Number Date (f/cc) 8-24-01 8-24-2019 Field Blank NA 8-24-02 8-24-2019 Field Blank NA 8-24-03 8-24-2019 Clearance, Basement <0.004 8-24-04 8-24-2019 Clearance, Garden level <0.004 8-24-05 8-24-2019 Clearance, Main level, kitchen/living room <0.004 8-24-06 8-24-2019 Clearance, Second floor north bedroom <0.004 8-24-07 8-24-2019 Clearance, Second floor master bedroom <0.004 Results indicate the concentration of all fibers. The PCM method cannot positively identify asbestos fibers. Results may not be reproduced except in full. This report relates only to the samples tested. Rocky Mountain Center for Occupational and Environmental Health Department of Family and Preventative Medicine University of Utah certifies that has completed a Continuing Education Post Graduate course entitled A NIOSH Sponsored Educational Resource Center Colorado Department of Public Health and Environment ASBESTOS CERTIFICATION* This certifies that Joseph Todd Anderson Certification No.: 2157 has met the requirements of 25-7-507, C.R.S. and Air Quality Control Commission Regulation No. 8, Part B, and is hereby certified by the state of Colorado in the following discipline: Air Monitoring Specialist* Issued: December 19, 2018 Expires: December 19, 2019 x This certificate is valid only with the possession of a current Division -approved training course certification in the discipline specifier! above. A horized APCD epres ntative SEAL C4 (Dw rN > 'o E ` < C) < :F U — Ln 0 U)7 6 lu Q) > > — 0 z ca. LO < C: 0 0 L) I MR I z 0 U -TZ = r - 'E rz C - cc 7' Ln .0 LiJ b.0 0 kn 0 (1) LONO Ora m OR �5 C`4 Wy FD < z U u 0 CL CIO �5 z 0 CL CIO x 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: 45M) Job Address: 1 __;5c -- Permit Number: ►�' t= ❑ No one available for inspection: Time A�M Re -Inspection required'YesNo When corrections have been made, call for re -inspection at 303 -234 - Date: 03 -234 -Date: -' 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:�'- Job Address: Permit Number: ❑ No one available for inspection:._Time jQ( _ AM/PM Re -Inspection required: YesNo When corrections have been made, call for re -inspection at 303 -234 - Date: ' =` Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Sewer Repair PERMIT - 201901340 PERMIT NO: 201901340 ISSUED: 06/27/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 06/26/2020 JOB DESCRIPTION: Sewer Repair - 10 ft; install dual sweep cleanouts *** CONTACTS *** OWNER (303)423-5054 PAULMANN ELISABETH SUB (303)519-0240 R. ANDREW RUSSELL 120161 THE ELITE PIPE MD *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 2,800.00 FEES Total Valuation 0.00 Use Tax 58.80 Permit Fee 93.35 ** TOTAL ** 152.15 *** 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 - 201901340 PERMIT NO: 201901340 ISSUED: 06/27/2019 JOB ADDRESS: 12082 W 36th P1 EXPIRES: 06/26/2020 JOB DESCRIPTION: Sewer Repair - 10 ft; install dual sweep cleanouts I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized bythe legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with this ermit. I further attest that I am le ally authorized to include all entities named within this document as parties to the work to be per rmed and tha ork to be-Dg&rmed is disclosed in this document and/or it'ccompanying approved plans and specifications. ---� �7.77 nature of OWNER " or CONTRACTO ircle one) Date This permit was issued base 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. 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. 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 Offiial and is not guaranteed. 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. 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. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any applicable code orr apy ordinance gri-egulation 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 Wheat -Midge 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(cDci.wheatridge.co.us I FOR OFFICE USE ONLY Date: �P I Plan/Permit # OT M13 ( `�' Plan Review Fee: Building Permit Application Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** I Z o ?"L Property Address: W. -'-m I,- ()/,(. W ktac'i (Z " d Property Owner (please print): MP o 5o t o�S �- G Phone: 3 / C1 50 - G1 cl'�1'1 Property Owner Email: Mailing Address: (if different than property address) Address City, State, Zip: Arch itect/Enaineer: Architect/Engineer E-mail: Phone: Contractor: ke, Contractors City License #: Z0 6 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' & 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.) O❑ ECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT LUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ❑ ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT ❑ OTHER (Describe) (For ALL projects, please provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc.) I D' Lowy S�we� �e��; ��N �S 0 v� s �n 5kc.tt vc. i Sw� Sq. Ft./LF Amps Btu's Squares 7-' 25� 06a -r Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ Z wo °� OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) CONTRACTOR) r (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: Z 7 / ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $ City of Wheat Ridge Residential Roofing PERMIT - 201704183 .i, PERMIT NO: 2017041.83 ISSUED: 07/17/2017 JOB ADDRESS: 12082 W 36th PL EXPIRES: 07/17/2018 JOB DESCRIPTION: Residential Re -roof to install Dimensional 30 year asphalt shingles with 28.7 sq. (25 sq. pitched, 3.7 sq. flat) *** CONTACTS '*** OWNER (303)423-5054 PAULMANN ELISABETH SUB (303)548-4667 Douglas R. McFarland 170366 Castlecove Construction 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: 14,524.00 FEES Total Valuation 0.00 Use Tax 305.00 Permit Fee 283.55 ** TOTAL ** 588.55 *** 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) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. 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. cPDt76 �11d`3 INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 �Occupaixy/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 ■T71M. Nor. fir.T.T=2 rM U7r.TMA• 'liTTilTf51E61MITTc7!\aTelv1:1I@J.M*I:Iy4[all F� Underground/Slab Inspections Date Inspector Comments Initials Electrical Comments Sewer Service Plumbing n., Kl^f I Inrinrnrni inr1 nr Ralnwlln.Slah Wnrk Nrinr I n Annroval UT I ne ADove InSDecuonS 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 Final Window/Doors Final Building NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. *For low voltage permits —Please De sure inat rougn inspections are cornpreieu rrUnr urc rr[C urauwi a 1U VIUU UCII by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather City of Wheat Ridge Residential Roofing PERMIT - 201704183 PERMIT NO: 201704183 ISSUED: 07/17/2017 JOB ADDRESS: 12082 W 36th PL EXPIRES: 07/17/2018 JOB DESCRIPTION: Residential Re -roof to install Dimensional 30 year asphalt shingles with 28.7 sq. (25 sq. pitched, 3.7 sq. flat) *** CONTACTS *** OWNER (303)423-5054 PAULMANN ELISABETH SUB (303)548-4667 Douglas R. McFarland 170366 Castlecove Construction 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 FEES Total Valuation 0.00 Use Tax 305.00 ----- - Permit Fee 283.55 ** TOTAL ** 588.55 *** 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) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. 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. 1* � A �, City of Wheat Ridge Residential Roofing PERMIT - 201704183 PERMIT NO: 201704183 ISSUED: 07/17/2017 JOB ADDRESS: 12082 W 36th PL EXPIRES: 07/17/2018 JOB DESCRIPTION: Residential Re—roof to install Dimensional 30 year asphalt shingles with 28.7 sq. (25 sq. pitched, 3.7 sq. flat) I, by my signature, do heattest 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 eft. I further attest that am le al authorized to include all entities named within this document as parties to the work to be perform' ed nd that all work be g�rf�d is disclosed in this document and/or its' accompanying approved plans and specifications. Signathre of DOWNER '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, po Flans and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and_procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4, No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuanaoranti;gofa permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable nyauGzi regulation of this jurisdiction. Approval of work is subject to field inspection. f 770 Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dane Lovett X170 oQ3 From: no-reply@ci.wheatridge.co.us Sent: Saturday, July 8, 2017 10:33 AM To: Permits CommDev Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Danny Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof.? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 12082 West 36th Place Paulmann, Elisabeth 3034235054 Field not completed. .(011:; ��- ST— Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. CONTRACTOR INFORMATION Contractor Name Castlecove Construction Contractor's License 170366 Number (for the City of Wheat Ridge) Contractor Phone 303-548-4667 Number Contractor Email Address castlecoveconstruction@gmail.com Retype Contractor Email castlecoveconstruction@gmail.com Address DESCRIPTION OF WORK / Are you re -decking the No ✓ roof? Description of Roofing 30 year dimensional shingles Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 25 material selected above? Does any portion of the Yes property include a flat roof? If yes, how many squares 3.7 on the flat roof? / TOTAL SQUARES of all 28.7 V/ roofing material for this project Provide additional detail 4-12 pitch house with rear porch here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract14524.00 value or cost of ALL materials and labor) 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 Doug McFarland Email not displaying correctly? View it in your browser. 3 CASTLECOVE CONSTRUCTION, LLC ®) P.O. Box 158 Kiowa, CO 80117 �� f Office: 303-621-9090 0� r �/ lf Contract Property Owner l ,L A F P*U-Mao_Phone#?-Y,933z5-e/-CelI'Y j� Q) 4 f dC �-� State Zip Code D Address�0� / / City Job Address City State Zip Code Insurance Information — Company "A _Policy # Phone Agentr"�%� S Claim #r�® �D� Adjuster Mortgage Co. Loan # JOB SPECIFICATIONS LABOR MATERIALS AGREEMENT AND CONDITIONS Castlecove Construction will furnish all labor and material. The applicable permits will be obtained by Castlecove Construction if required. All jobs are professionally supervised and inspected by ICC approved personnel. Workmanship warranty is 1 year. 50% of job cost due at material order Cash Job Cost: $ I/We have read, understand, and accepted the terms and condition above and on the reverse side. ` oint owne date Property owner r; Date'' /��% CCC Representative Dat ,, �''` Signature Management Approval Denial ©2009 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:c� Job Address: Permit Number: c 12 i . ❑ No one available for inspection: Time A /PM Re -Inspection required: Yes11 o', , When corrections have een made, call for re -inspection at 303-234-5933 ADate: L Inspector:' DO NOT REMOVE THIS NOTICE .6 r1 INSPECTION NOTICE Inspection Type:c� Job Address: Permit Number: c 12 i . ❑ No one available for inspection: Time A /PM Re -Inspection required: Yes11 o', , When corrections have een made, call for re -inspection at 303-234-5933 ADate: L Inspector:' DO NOT REMOVE THIS NOTICE A CITY OF WHEAT RIDGE - Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: ice% 7� Job Address: ' 2G L2 CJ 3� f L Permit Number: ❑ No one available for inspection: Time / 1 Z2 AM/I�q Re -Inspection required: Yes N-6 When *When corrections have been made, call for re -inspection at 303-234-5933 _` j_ ' Date: � 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,wZ koor Job Address: J„�o �T,7 uw, 34 Permit Number: t37951S Ae/Rell4 Agevc GILT AQeW } ❑ No one available for inspection: Time ; � PM Re- Inspection required Yes o When corrections have been made, call for re- inspection at 303 - 234 -5933 Date: /.P r' /cr Inspecto DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Building Inspection Division �r (303) 234 -5933 Inspection line r (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: Job Address: 12©,g2 des° . ?6 Permit Number: No one available for inspection: Time .'3r AM PN( Re- Inspection required: Yes When corrections have been made, call for re- Inspection at 303-234-5933 Date: : -12 r10 Inspector: AV DO NOT REMOVE THIS NOTICE i INSPECTION RECORD Occupancy/Type 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 / (EEG) Concrete Encased Ground Reinforcing or Monolithic Weatherproof/ French Drain 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) HAS BEEN ROUGHS Sheathing Lath / Wall t Mid -Roof Electrical Service Rough Electric Rough Plumbi Gas Piping Rough Mechanical INSPECTIONS Insulation Drywall Screw FINALS Electrical Plumbing Mechanical Roof Building Final Fire Department R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Parking & Landscaping * * /VOTE. ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY ISISSUED. 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 ♦ A i CITY OF WHEAT RIDGE ~"00000 Building Inspection Division r (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: pcr Job Address: lad fit)C~`(/, Permit Number: /f ll S/ ❑ No one available for inspection: Time /f :o ~ A Re-Inspection required: ,Yes No "When corrections have been made, calf for re-inspection at 303-234-5933 Date: t'Jq Inspector: 4L -PFP;_, ^ DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE r Bung Inspection Division 1 (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax. INSPECTION NOTICE r A Inspection Type: )n Job Address: Permit Number: / 5(-ftl Or 1"n [f J 6, I El No one available for inspection: Time AM IS 1 Re-Inspection required: K'es No *When corrections have been made, call for r~-i ns action at 303-2 4-5933 Date: 1-0*r• Inspector: f r~~ PCB DO NOT REMOVE THIS NOTICE ♦ ♦ CITY OF WHEAT RIDGE Building Inspection Division ,a (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: f5` rr Job Address: / Permit Number:( E ❑ No one available for inspection: Time ) AM/ M Re-Inspection required: Yes "When corrections have been made, call for re-inspection !/j(~ at 303-234-5933 Date: ICJ l' 9 Inspector: NI11ri~~„r j~i „-tr 5hg DO NOT REMOVE THIS NOTICE City of Wheat Ridge . Residential Roofing PERMIT - 092515 r0000or PERMIT NO:. 092515 `ISSUED: 09/17/2009 JOB ADDRESS:. 12082 W 36TH PL EXPIRES: .03/16/2010 DESCRIPTION:.T/o: Install 30 sqs O.C. Duration 50 yr premium.!. CONTACTS.*** owner 303/423-5054 'Elizabeth Paulman gC 303/825-5273 08-0138 Colorado Roofing Exteriors PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION:. 0689 BLOCK/LOT#: 0/ **FEE 'SUMMARY ESTIMATED. PROJECT VALUATION: 6,.667.0.0 FEES Hermit Fee 181.10 Total Valuation .00 Use Tax X120.01 PP "±L'? ~''s **-TOTAL 301.11 1 ':.Conditions: ;6 nail installation mid-roof inspection. required. Board sheathing spaced more than a 1/2 of an inch apart requires plywood overlay on entire roof. Ice and water shield required from eave edge to 2' inside exterior walls. Subject to field inspection. I hereby certify that the setback distances proposed by this permit application. are accurate, and do not violate applicable ordinances, rules or regulations of, the City of. Wheat Ridge or covenants, easements or restrictions of :record; that all measurements shown, and allegations made are accurate; that I.have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with the. Wheat Ridge Building Code (I.B.C)and-all other applic Wheat Ridge Ordinances, for work under this permit. Plana. subject to field inspection. Signature o contractor/owner as e 1. This permit was issued in accordance with the provisions set forth in your application and is aubj ect to the of the r" 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 r be paid for a new permit. 4. No work of any manner shall be done that will.. change thenatural -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 job.: J. 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, any violation. of the provisions of the building codes or any other ordinance, law,. rule or regulation. All plan review i Jett to is d inspections. " Signature of ilding Official date U INSPBCTI REQUEST LINE: (3.03)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUST BE MADE BY. 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Y: y ti ~oF W"E'?R City of Wheat Ridge Building Division Date: -f11? ° 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 Plan ooLORPOO Inspection Line: 303-234-5933 Permit Building Permit Application Property Address: 1~0 Z 0 36.~ r t Property Owner (please print): G/l;Zai2oi'L" YAU~fA(StrIN Phone: 3 412,3 Soft Mailing Address: (if different than property address) Address: i>rQ-2 , 7 4h9- City, State, Zip: M33 Contractor: Contractor License a ;61--W Phone: 3M 13M-60'3 Sub Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Description of work: ~C t Ab w/11' Sq. Ft./L.Ft added Construction Value: $ 7 04 (as calculated per the Building Valuation Data sheet) tY3t oGaK PKNrR(Nt Plan Review (due at time of submittal): $ Squares 0 BTU's 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 REPRESENTATIVE of(OWNER) NTRA OR PRINT NAME: p4ya XV SIGNATURE: Date: ~ ~7 lo7 ZONING~COMMENTS: Zoning: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY: FIRE DEPARTMENT:: ❑ approved w/ comments ❑ disapproved ❑ no review required DEPARTMENT OF COMMUNITY DEVELAPMENT 7500 WEST 29tn AVENUE BUILDING INSPECTION DIVISION PERMIT N0. M91#17275 237-6944 EXT. 255 P.O. BOX 638 CiTY OP wHEAT RIDGE, CoLO. . THIS PERMIT VALID ONLY WHEN SIGNEO BY THE CHIEF BUILDING INSPECTOR AND RECEIPTED BELOW. PP ICATION FOR MISCELLANEOUS P~ERMIT JOB ADDRESS /Q0c2. W• 3lo~ 1-IoY~~F 1mQl~t'1 CONTRACTOR ADDRESS I~C7~n~ Lt~• 1~~ • ADDRESS PHONE 5C~'rJ~ ZIP CODE ~ CITY , IP CODE [OWNER ONTRACT PRICE $ S-0 PHONE 1. TYPE LICENSE N0. 1 2. MATERIAL Total Squara Feef SIGNS 3. ILLUMINATION Yea❑ No❑ Type Eleet Permif No. 4. SET BACK FROM PROPERTY LINE 1. TYPE FENCES 12. MATERIAL More Than BO% ODOn[] ProieefinOU OMer SorOFOCs Zone_ ADDroved,2oneinspsctor Leee Thon 80% Opan 3. SET BACK FROM PROPERTY LINE WhICh 18 OTHER I2 3. Height N_ S_ E_ W Zons_ Apprwad,Zons Inepectw ❑ ❑ ❑ ❑ Disa00roved . DRAW SKETCH Oft SHOW BELOW, THE FENCE,SIGN,OR OTHER STRUCTURE,GIVifVG DISTANCES FROM PROPERTY LINES. (SETBACKS OR PROJECTIONS INCLUDEO) . ~ SPECIFY NORTH STREET NAME SHOW DISTANCES FROM THE MAIN BUILDING TOIADJOINING NOUSES, STREETS, AND PROPERTV lINES; ON IRREGULAR LATS, SHOW LEAST DISTANCE TO PROPERTY LINES, NOT MAXIMUM OR AVERA6E DISTANCE. - APPLICATION FOR PLUMBING; ELECTRICAL; MECHANICAL PERMIT THIS APPLICATION WILL BECOME A PERR9IT TO PERFORM THE INDICATED WORH IXVLY UPON VALIDATION BY THE BUILDING INSPECTION DIVISION. PERMIT WILL EXPIRE 60 DAYS FROM DATE OF ISSUANCE !F WORK IS NOT STARTED WITHlN THAT TIFIE. ELECTRICAL PERMIT STATE LICENSE NO. PLUMBING PERMIT STATE IICENSE N0. MECHANICAL PERMIT ALUM INUM WIRE UNDER SIZE 8 ILLEGAL FLOOR BSM i ST 2ND 3RD 4TH N0. FtffL•Cirele0ns Ga ql Propane Cool Elx Solor N0. WATER CIASET FORCED AIR 8TU TEMPORARY METER WASH BOWL HOT WATER - BTU NEW SERVICE AMPS BATH TUB STEAM - BTU CHANGE SERVICE-AMPS SHOWER AIR CONDITIONING-BTU LIGHTING SINK OTHER HEATING GARBAGE DISP. REFRIGERATION SYSTEM POWER SUB-CIFCUITS WATER HEATER qetri erant Group UTILITY(RANGE,OISPOSER,E7C) AU70.WASHER Poundf CAor e FI%TURES DISH WASHER AUTOMATIC SPRINKLER SYSTEM WIRING MOTORS Q CONTROLS FLOOR DRAIN EIEVATOR SIGNS URINAI TRANSFORMERS 9 RECTFIERS SEWERS ADDITION TO OLD WORK OTHER MOTORS OVER I HP TOTAL FIXTURES I hereby ucknowledqe ihot this applica- tion is Corract and understand ihaf I cannot start this project unfil this appli- cation ie opproved. I sholl comply with ihe lows of the State of Colorado and to the Zoning Regulafions ond Building Code of the City of Wheat Ridpe. Any violotion oi the above ferms will cause immediate r0vocotion of this permit. PERMIT PEE USE TAX TOTAL FEE ~ $ 1 c4a, S~ CHIEF BUILDKO IIVSPECTOR,City of Wheat Ridge IssuPd sr' 9 / CALL 237-8944 EXT. 255 24 HOURS IN ADVANCE FORINSPECTIONS