HomeMy WebLinkAbout3195 Wadsworth BoulevardT
DEPARTMENT OF GOMMUNITY DEVELOPMENT ~
7500 WEST 29th AVENUE BUILDING INSPECTION DIVISION PERMIT N0. 137 O
234-5933 P.O. BOX838 CITY OF WHEAT RIDGE, COLO.
THtS PERMIT VALID ONLY WMEN SIGNED BY THE CHIEF BUILDING INSPECTOR ANC RELEIPTEDBEIOW.
APPLICATION FOR MISCELLANEOUS PERMIT
JOB ADDRESS OWNER
.
CONTRACTOR ADDRESS
r~-~ r//1 A/'o C-f 4--'11 71 ~ _ PHONE ~ ZIPCODE
ADDRESS ~
CITY ~
PHONE ~
SIGNS
pitAW SNETCH OR SHOW BELOW, THE FENCE,SIGN,OR OTHER STRULTURE, GIViK3 DISTANCES FROM PROPERTV LINES.
(SETBACKS OR PROJECTqNS INCLUDED)
I. TYPE Solidr-1 Mon TAOn 80% ODenO Lose Thon 80% Open
MATERIAL . HeiQM
FENCES 3. SET BACK FROM PROPERTY LINE N_ S__ E_ M' Zon~_ ADCrwW,Zoro In~pacta
~ ~ 0 DiaaDOrovad
(Soecifv which ie iront) _ ❑ _ „ .
OTHER 12
3.
~
SPEqFY NOiiTN
ELECTRICAL PERMIT
STATE LICENSE NO.
STREET NAME
$HOW DISTANCES FROM THE MCIN BUILDING TPADJOINING 1WUSE5, STREETS,AND PROPERTY lINES; ON IRREGULAR LATS, SHOW LEAST
DISTANCE TO PROPERTY lINE5,N0T MA%IMUM OR AVERAGE DISTANCE.
APPLICATION FOR PLUMBING; ELECTRICAL; MECHANICAL PERMIT
THIS APPLICATION WILL BECOME A PERMIT TO PERFORM THE INDICATED WORK ONLY UPON VALIDATION BY THE BUILDING INSPECTION DIVISION.
PERN(IT WILL EXPIRE 180 OAYS FROM THE DATE OF ISSUANCE IF WORK IS NOT STARTED WITHIN THAT TIME.
IMINUM WIRE UNDER 512E 8 ILLEGA
TEMPORARY METER
NEW SERVICE - AMPS
CHANGE SERVICE -AMPS
I.IGHTING
HEATING
POWER SUB-CIFCUITS
UTILITY ( RANGE, DISPOSE R, ET
FIXTURES
WIRING MOTORS 9 GONTROLS
ZIP CODE Q_
LICENSE NO.
CONTRACT PRICE $
DATE
1. TVPE Ground❑ Woll❑ Proiectiep❑ 01hsr SorDFate
2. MA?ERIAL Total Spuon Faet
3 ILLUMINATION Yas❑ No❑ TYDS ElW. Permit No.
Zons._ ADD~~~d~Za^~Insp~etor
4. SET BACK FROM PROPERTY LINE N_ 5- E- W
fSeeeitv whith ia front) _ ❑ ❑ ❑ pisopDrwad
SIGNS
TRANSFOfiMERS 9 RECTFIERS
ADDITION TO OLD WORK
unrnas OVER I HP
I hsreby acknowledpe tnot tnis avDIICO-
tion u correct and understond ihat I
tonnof Start this proltltt unfil ihis oppG-
ootion if opproveC. I shall comply wiih
fM lows oi the State of Colorodo and 10
the ZOninp Requlations ond BuildinQ
Code of 1he Gty of Wl+eai_Ridqe.'Aa✓I
.,(1
PLUMBING PERMIT MECHANICAL PERMIT
STCTE LICENSE N0.
WATER CLDSET FORCED AIR -
WASH BOWL FqT WATER -
BATH TUB STEAM -
----T- I I I I I I AIR CONDITIONIlk
DISP
AUTO.WASHE
DISH WASHER
FLOOR DRAIN
URINAL
NOT VALID UNLE55 REGEIP
PERMIT FEE V
USE TAX ~
TOTAL FEE APPR OVED DISAPPROVED
CHIEF BUILDIN ;1$
R,Cityof Wheat Ridqe
CALL 234-5933
24 HOURS IN ADVANCE
L'^ 3 FOR INSPECTIONS
Date Issued
Permtt Number:
REPORTING
AGENCY:
UNDERGROUND TANK REMOVAL
CR No.:
Business Neme:
C
Oete:
y-23-93
Busine55 AtlOre55:
/A S
Business Telephone
:
.
1
Permit Holtler.
Per6on CoMecleO:
Size of Tenks:
(1)
(2)
(3)
(4)
SL
ProCUCt Stored:
`I
G
o 14 G
&c
s
Serial Numbers:
(7)
o I6
(2)
A)D T&-
(3)
LLL Itt
I
(4)
AIo' lt
(b)
(6)
SteP 1
InsOectar's Inltkls
COMMENTS:
Ves No
1a
State agency has been notified
-
1b
Date notified: U-+-l-g3
tc
Approved plans irom State Oil and Gas are atteched
S•tBP •l
InsOeclor's Inttlals
COMMENTS: r
ves No
£~u~'✓~s'o'~ d'O}L°'.»"a'fc.f!
2a
All electrical lines and conneclions have been disconnecled.
cr {a rcvwua~ by PS`°"
Inspector's Signafure: Agency:
Date
: Time:
NOiE: No work sAell Oe undertaken by wnVector uMll this step hes been com0leteG.
Step 3
Inspector's Inttttels
COMMENTS:
Ves No
3a
Received approved plans hom State Oil & Gas
✓
3b
Approved plena ere ettached
3c
Product has been dreined irom pipes Into tank
_
3d
Piping has been cepped or removed
✓ ~
3e
Residues end Iiquids heve been removed hom tenk
_
3i
How was dnsate disposed ott tfi"..Q wj j aukS.
3g
Evacuate to the top on the tenk
~L -
3h
Fill pipe, gauge pipe, vapor recovery touch connection,
pumps and othx tank fixlures have been removed.
~
,
n
k
31
Vent line is still connected.
?
"SuX ~
v4+4Q~.es
StBp 4
Inspector's Inttlels
COMMENTS:
Yes No
4a
Solid carbon dioxide used to vent vapors
4b
Other vepor removal syatem used (describe)
Sl/LF
4c
4d
Venting of lank Is proper
Tank LEL reading Is 20 percent or lower
~
4e
All holes plugged with e minimum of a 1/2" hole
4f
Vent line has been disconnected
_
4g
Evecuate aree around tank and remove tenk
✓
4h
Tenk has been labeled aRer removel
41
Tenk wili be transported to disposel site on the same day
~
it was taken out of ground.
t hole on to
e
t
k
ith
l
d
4]
p
n
ruc
w
v
y secure
on
Tank is proper
Step 5
Inspeclor's InlUtels
COMMENTS:
/
"
5 ,~,~„~tos
5a
Is soil contemination resent ailer tank r~mova17
i(~f11lNf d od02
1
_
- • SI~4
T
vsri+~7
Il
If yes, describe:
aw.ws
~
c
yI
ti~
~
j
~
ya,~„,Q~✓~~4~- Poss ~
S.
5b
Ii yes, noti(y State Heaflh Department
~
Person Notified: Date:
.
5c
If yes, notify State Oil 8 Ges: u/ Q
Person Notified: Date:
5d
Name and eddress of ta k destlnation:
NCti.~
5e
Were pictures taken4
rao1
t
R
p t
L
v.
f3_
,
If so, what agency took pictures7 W
Sf
Were samples teken at srie7
✓~j'L
If so, what egency look samples?
Sg
Were splft samples oHered?
If so, person eccepting semples:
5h
Date/Tlme samplas relinquished
Step 6
L INSP~ TION G TU ES:
Z3-
- w~
t
.
u,
strict Approvfng Signeture Dete
6eraq~Approving Signeture te
Other encies Presen Sesenta(ive
, her A endes Presen e resentativ
1.
d '
4.
2.
5.
3
6
Step 7
%nk c of thia 1o gN to
-a
i
r-
~ /1AL7 afL_ . i
~
ti
n
am
,
(Signature of Above Person)
~&4
! v
Dete form given: Zo~el ~
S
- ~
Time 1am given: ~JO
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