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HomeMy WebLinkAbout4485 Teller StreetCity of `7`Iheat pdg� COMMUNITY DEVELOPMENT City of Wheat Ridge Municipal Building 7500 W. 29th Ave. Wheat Ridge, CO 80033-8001 P: 303.235.2855 F: 303.237.8929 Permit Extension Request Form Permits 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 may 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. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. Please complete this form in its entirety and submit to the Building Division at permits(a-),ci.wheatridge.co.us or fax to 303-2,.7-$929. Party requesting permit extension, Permit # O/ 7JO,�?,�9 Property Address: 41V4019- %�.-- r �//� r sII' �� . ��,�!.1 moi. moi. Reason for extension request: RIJ Number of days requested: Printed Name 0 Signature f Date; �s For office use only This request has been: Appr ved E Denied Extended until: Approved by: Date: NVWW.ci.-'N heal ridgV.mus .� i CITY OF WHEAT RIDGE _1�9rBuilding Inspection, Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 3 O 4 - f'1 1. j Job Address: —1, Iler- S4' Permit Number: 0 1? 0 9 3 0 0 -P N rr i 0/14 M r- -t n i ❑ No one available for inspection: Time)?: y I A49 Re -Inspection required: is No When corrections have been made, call for re -inspection at 303-234-5933 Date: / 19 Inspector: 1 DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201702293 PERMIT NO: 201702293 ISSUED: 06/21/2017 JOB ADDRESS: 4485 Teller ST EXPIRES: 06/21/2018 JOB DESCRIPTION: Residential reroof: Owens Corning Woodmcr/timber asphalt, 22 squares house 6/12 *** CONTACTS *** OWNER (303)456-6195 CULLEY ALAN E SUB (303)744-9000 Rick Langley 150079 Western Maintenance & Construc *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,654.00 FEES Total Valuation 0.00 Use Tax 118.73 Permit Fee 140.90 ** TOTAL ** 259.63 *** COMMENTS *** *** CONDITIONS *** 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 A2 -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 manufacturera€ms 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&#39;s 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. City of Wheat Ridge Residential Roofing PERMIT - 201702293 PERMIT NO: 201702293 ISSUED: 06/21/2017 JOB ADDRESS: 4485 Teller ST EXPIRES: 06/21/2018 JOB DESCRIPTION: Residential reroof: Owens Corning Woodmor/timber asphalt, 22 squares house 6/12 I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with thisermit. I further attest that 1 am legally authorized to include all entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. 11 I (01` \-1 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 maybe subject to a fee equal to one-half of the originalpermit fee. 3. if this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, 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 %A REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ci.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. Antoinette Kulick From: no-reply@ci.wheatridge.co.us Sent: Monday, June 12, 2017 11:39 AM To: Permits CommDev Subject: L) Online Form Submittal: Residential Roofing Permit Application 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. 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. Permits are currently being processed within 3-5 business days, subject to change based on volume. 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. J PROPERTY INFORMATION Property Address 4485 Teller Street Property Owner Name Allen Culley Property Owner Phone 303-210-8935 Number Property Owner Email Field not completed. Address Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. 1 CONTRACTOR INFORMATION Contractor Name Western Maintenance & Construction Contractor's License Number (for the City of Wheat Ridge) Contractor Phone Number 150079 303-744-9000 Contractor Email Address gkelley@westernmc.com (permit pick-up instructions will be sent to this email) Retype Contractor Email gkelley@westernmc.com Address DESCRIPTION OF WORK Is this application for a new permit for a residential roof? Are you re -decking the roof? Description of Roofing Material Select Type of Material If "Other" is selected above, describe here: Yes No Owens Corning Woodmor/timber Asphalt Field not completed. How many squares of the 22 material selected above? Does any portion of the property include a flat roof? If yes, how many squares on the flat roof? Yes 0 we are not doing that portion TOTAL SQUARES of all 22 roofing material for this proj ect 2 Provide additional detail re roof for house 6/12 here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 5500 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 Gena Kelley Email not displaying correctly? View it in your browser. 3 Vol City of Wh6atRidge COMMUNITY DEVELOPMENT 7500 W. 2911 Avenue * Wheat Ridge, CO 80033 * O: (303)235-2855 * F: (303)235-2857 Contractor Waiver for Workers' Compensation Insurance I, (print your name), ��_ VA L/ 7�" J�� verify that I am the sole owner or partner of (company name): A I / which has no employees Ad is not required by the State of Colorado to carry workers' compensation insurance. I further state that if I hire subcontractors, they are in compliance with the State of Colorado Workers' Compensation insurance requirements and have obtained the required contractor's business license from the City of Wheat Ridge. Sign Date: L10'2 2 , 1 -7 CERTIFICATE OF LIABILITY INSURANCE DATE 4/21 /2017 PRODUCER Affordable Insurance Group, Inc. 378 Cherokee Roseburg, OR 97471 541 647-1155 INSURED -- --- - _--- - - ---- — Western Maintenance and Construction, Inc. 1795 W. Yale Ave. Englewood, CO 80110 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I NAIC # INSURERA: United Specialty Insurance Company INSURERB: Golden Insurance Company INSURER C: NorGuard INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T POLICY NUMBER POLICY D I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 �( COMMERCIAL GENERAL LIABILITY S 110604E28640 7/25/2016 7/25/2017 FIRE DAMAGE( Anyone fire) $ 1000,000.00 CLAIMS MADE 7 OCCUR MED EXP( Any one person ) $ 5,000,00 A PERSONAL && ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP / OP AGG $ 2,000,000.00 X POLICY JE � - LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS ( Per person ) $ HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS ( Per accident ) PROPERTY DAMAGE $ ( Per accident ) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 2 000 000.00 XI OCCUR CLAIMS MADE GIC 1301394 12/21/2016 12/21/2017 AGGREGATE $ 2,000,000.00 B $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU - DTH - TORY LIMITS ER EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? If yes, describe under E. L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER $ C P915EU7761 11/10/2016 11/10/2017 Pollution Limits $ 1,000,000.00 $ _ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS �,r-rNilrll,FliL:nvLUF-rA I X ADDITIONAL INSURED; INSURER LETTER:A IIMIYI,CI-uYIIVIN Certificate Holder: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Wheat Ridge NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 7500 W .29th Avenue Wheat Ridge, CO 80033 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fax: 303-235-2857 0 0 r I: BBB ROOFING 8�b�Z, 1300 CONSTRUCTION BBB Agreement Name: Date: O Address: r City/State: Zip: 7_063, ? E -Mail: Phone:_?—"� I h – tF'93:�'"" Work: Cell: Sales Rep-7,1/-4...� Phone:(ra-�) 4 7 9- r 9/()Storm Date: n </ �-�/ i'-7 ROOFING ASSESSM NT GUTTER ASSESSMENT v Grade of Shingle: Style: Size: LF: Color: Pitch:_12 2 -Story: Tear off: Ridge Cap: SIDING ASSESSMENT Felt: Valley. Grade of Siding: Style: Color: Vents: 750's Turbines: Fascia: Color: Pipe Jacks: Skylights: Ice/Water: Drip Edger Contract Total: $ `,�c� =:^/i ah 1411 < e Remove debris from roof, gutters, and yard 1st payment $ Protect landscaping and gutters Final Payment due at completion $ Furnish Permit as required by City/County DAMAGE ASSESSMENT NOTES l l _.S C P n 1A 4441r -l' A,_(A/ toll o-bn-L L64-�- 1 s a. e d r ACE Roofing & Construction Limited Warranty Right To Cancel: You, the consumer, may cancel this transaction at any time prior to midnight of the third business day after date of this transaction. General Contractor: Homeowner acknowledges ACE ROOFING & CONSTRUCTION as a general contractor and as such shall be entitled to over head and profit, as allowed by insurance industry standards. This only applies if the insurance company allows for overhead and profit Terms: This agreement does not obligate the homeowner or ACE ROOFING & CONSTRUCTION in any way unless the damage is approved by your insurance company and accepted by ACE ROOFING & CONSTRUCTION. By signing this agreement the homeowner authorizes ACE ROOFING & CONSTRUCTION to pursue homeowner's best interests for a Roof and/or Gutter replacement or repair at a "price agreeable "to the insurance company and ACE ROOFING & CONSTRUCTION with no additional cost to the homeowner except for the insurance deductible. When "price agreeable "is determined it shall become the final contract price of the INSURANCE PROCEEDS+INSURANCE DEDUCTIBLE AND HOMEOWNER AUTHORIZES ACE Roofing & Construction to obtain labor and material in accordance with the "price agreement" and the specifications set out therein and on the reverse sjqe thereof Iq accomplish the replacement or repair. or Agent Signature Date ACE Representative Insurance Co. ! Claim# 0 D 11, S__ % 0 O =CQrdr"ied PREFERRED ME1* CONTRACTOR T*s deeu.d,.Besr 1795 W. Yale Ave. Englewood CO. 80110 Office (303)223-6623 www.aceroofco.com i ♦ i CITY OF WHEAT RIDGE r Building Inspection Division 1 (303) 234-5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: Job Address: '1` /;Y - _5' Permit Number: f 2 ❑ No one available for inspection: Time AM /PM € Re- Inspection required: Yes No *When corrections have been made, call for re- inspection at 303- 234 -5933 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) 235-2857 Fax INSPECTION NOTICE Re-16 spebtion required: Ye a When corrections have been ma IxfBr re-inspection at 303-234-5933 Dal: Inspector: DO NOT REMOVE THI NOTICE ❑ No one available for inspection: Time~M/pM Inspection Type: Job Address: 1 Permit Number: /If,, z; b U ♦ i CITY OF WHEAT RIDGE ~~-j- Building Inspection Division / (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: I Job Address: q- Rrj Permit Number: M 19 SC) k t 4. s< ❑ No one available for inspection: Time AM/PM k Re-Inspection required: 6e_D16 *When corrections have been made, caii fooq inspection at 303-234-5933 Date: '3- -0 C) Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge r4000or Faxed Roof Permit PERMIT. - 091950 PERMIT NO: 091950 ISSUED: - 09/03/2009 JOB ADDRESS: 4485 TELLER ST EXPIRES:. 03/02/2010 DESCRIPTION: Reroof 20.68. sqs CONTACTS owner 303/456-6195 DwanCulley - sub 303/394-2802 Tim O'Connell 01-7590 C:J Roofing Co. PARCEL INFO ZONE CODE:. UA. USE: UA -SUBDIVISION: `0009 ..BLOCK/LOT#: -0/. FEE SUMMARY ESTIMATED PROJECT VALUATION: 8,276.02 FEES Permit Fee 217.50 Total Valuation LW~ Use Tax 148.97 ~[n TOTAL 366.47 Conditions: Both front and back of permit need to be posted on jobsite. ..Ifone or the other. is.. not present, INSPECTION WILL NOT BE PERFORMED. ,~..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 save 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 F; 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 R' g Ordinances, for work under this permit. Plans subject to field inspection. v~ Signature of contr for/owner date 1. This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the State of Colorado and to the.. Zoning Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable _ -ordinances of the City.. - ;b 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 r, changes have been. or will be made in the original plans and specifications and any suspension or abandonment has not. exceeded one (1) year- If changes have been or if suspension or abandonment exceeds one (1).. year, full. fees shall be paid for a new permit. f„ 4. No. work of any manner shall be done that will change the natural flow of water causing a drainage problem. S. Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive e written approval on inspection. card before proceeding with successive phases of the job. 16, 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.. v; All plan review Y s ject to field inspections. amp Signature XIREQUEST uilding Official "date w'INSPECTLINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 . r:'REQUEST STBE MADE BY3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING 'BUSINESS DAY. l w~rw~■ o.~~www®a. uaH Dy s:uu , ,Iw to receive Inspecnon,tne touowing Duslness "y. INSPECTOR MUST SIGN ALL'SPACES PERTAINING TO THOS JDs FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: - r. Footings/Caissons Stemwall / (CEG) Concrete Encased Ground Reinforcing or Monolithic Weatherproof/French Drain Sewer Service Lines Water Service Lines POUR NOCONCRETE-UNTIL ABOVE.HAS BEEN SIGNED ' CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) 'DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGHS Sheathing Lath / Wall tie Mid-Root Electrical Service rc Rough Electric Rough Flu Plumb g Gas Piona %LS Timothy J 7 Cormetl P cal ECEIPT NG.CDA602281 BP'P Re-r f 36 AMOUNT ing oo ,94 sas 691949 476.95 nical" permit Fee IISe Tax 272.16 ?NS AS BI SF Re'Lf 20,68 sqs 366 47 091156 , g Final Permit Fee 217.50 apartment - Use fax 148.97 & Drainage' ,`YNSpEC P PAYMENT RECEIVED US @353 AMOUNT j& Landscapi ng; SHOUL _-.,ca Auth cod'. 843.42 E: ALL, irEMs 911&7B8 COAOLETED AND APPROV€D IB.Y LANNING fiND 0562251 TOTAL l F r r _ a * r c nC77crirmenllw r c ~eciii I F 001 /nrcacnrindi o~ iruc W I W I Sfr. - - 843.42 From:CJ Roofing 3033942808 08/29/2009 MOH M 13. PAX 303 237 8929 303 Best way ilia s ON 09/02/2009 17:20 #459 P.0021003 X001/001 :a Ii~t Date. MMUNITYI~EVELOPMENT' Pevmit#:~I (~GI"~' Bu//d/ng D/rr/s/on 7500 W. 290i Ave:, Wheat Ridge, CO 80033 Office: 303-235-2855.x Fax: 303-237-8.929 Inspection Line: 303-234-5933 Facsimile Building Permit Application rJ TI? l fir 4~seP~ ~M~ I ~ (~0 8c~33 Property Owner (please print): Q U ~~e Phone 3a3 4S Mailing Address: (f different than property address) Address: Cyr ~2 City, State, zip: • ~ ~ ' ~l I~IY i Y1Ct Contractor License Phone° ~ ~ 3q 41 - 2-60L PERMIT.NO: .070639 ISSUED: 06/26/2007 JOB ADDRESS: 4485 TELLER ST EXPIRES: 12/23/2007 DESCRIPPION:.T/O 5 LAYERS, REPLACE WITH GAFMODIFIED 6 SQUARES FLAT ROOF CONTACT5 x**GC 303/394-2802 Tim O'COnnell . 01-7590 C J Roofing Co. OWNER 303/456-6195 ALAN CUI,LEY . PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION: 0009 BIACK/LOT#: 0/ **FEE SUP4MARY** . ESTIMATED PROJECT VALUATION: 2,793.00 FEES Permit Fee . 108.30 - Total Valuation .00 Use Ta x 50.27 3im *w TOTAL 158.57 Comments:MUST MEET-106MPH 3 SECOND WIND GUSTS . MID-ROOF INSPECTION REQUIRED IF ANY DECKING IS REPLACED OR INSULATION IS INSTALLED SUBJ&CT TOFIELD INSPBCTIONS I hereby certlfy that the eetback flietanceeproposed by thie pezmit application are accurate, and do not violate applicable ordinanSee,.rvlee or.regulatiosis oE the C1ty of Wheat Ridge or covenante, eaeemente or reetrictione of record; tha[ all meaeurementeshown, and allegations made are accurate; tha[ I have read and a9ree to abide by all conditione printed on this appllcation and that I aeeume full reeponeibility for compliance with the Wheat Ridge Building Code .(I.B.G and all other appllcable.Wheat RidgeOzdinancee, for work under this pezmit. Plane eubject to field inapection. ✓ . I n of contractor/owner aace 1. Thia pezmitwae iamued ia accordance.with the provieione eet forth in }rour application and ie subjectto the laws of the State of Colorado and to the Zoning Re9ulatione and Building Codee of Wheat Ridge, Colorado or any other applicable ordinancen of theCity. 2. Thfe permltehdll exglre 186 daye from the lseue date. Requeete for an exteneion muet bereceivad pritlr to expiration date. An.extmeionmay be granked at [he discretion of the Building Official. . 3. If.thia pemit explree, a new pemit may be acquired for a fee of one-half the amount normally zequired, provifled no changeahave beenoY will be made in the orlginal plane and epecificatione and any euepenaion or abaidonvk.nt Ma noC exceeded one (1) year. If.ekangee have been or if euepeneion or abandonment exceede one (1) year, full feee ahall be paid for a new pexmit. a. No work of any manner ehall be done that will change the natural flow of water caueing a drainage problem. 5. Contractor ehall notify theHUilding Inepector twenty-four (24) houra in advance for all inepeceione and ehall zeceive written:approval m inepecelon.card before proceeding.with eucceeeive ptiaees of the job. 6. The iesuanceof a pemit or the approval of drawinge and epecificatione ehall not be conetrued to be a pemit for, nor an appzovaY of, any v ion of ehe roviaione of the building codee or any othez ordinance, law, rnle or regulation. All plan revlew ieto fi~eRectione. o£ Chlef BUildinq (SPf1<1S'I"_'^-` date INSP$CTION R8QV83T LINB:(303)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUSTBE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.tlaet uroofln9' ~meterials habeen nataNed to ►rteet 100 mph three-second ►Mnd Oust, shall be onsite for flnYl mof inap00110n, -18C COMMUNfTY DEVELOPMENT DEPARTMENT Building Permit Number: o' W"E"T,~ BUILDING INSPECTION LINE - 303•234-5933 Date: ~ g CITY OF WHEAT RIDGE " ^ 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80033 - (303-235-2855) °°~°R^°° APPLICATION Property Owner: l 10_ 6~6 Property Address: zt &5 -TU(F Phone: 6 1q , Contractor License No.: ~ "ISQ0 / {~`Y :!1 Company: ~?C'( ~1 ,[xn~ / tpn - Phone l! c~ OWNER/CONTRACTOR SIGNATURE OF UNOERSTANDING AND AGREEMENT I hereby certi(y that the selback distances proposed by this pertnit application are acwrate, and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenanLS, easements or restriclions of record; that all measurements shown, and allegatlons matle are accurate; that I have read and agree to abitle by all condilions printed on Nis applicatlon and Nat I assume full responsibiliry for compliance wilh the Wheat Ridge Building Code (U.B.C) and all other applicable Wheat Ridge Ortlinances, for work under thi5 permit. (OW NERpCONiAACTOR): SIGNFD OATE Description: T, u i Sq.Ft.added Construction Value:$ Permit Fee:$ Plan Review Fee:$ I leP Tax Total:$ 1~ o cQ~-~ ~ ~ l ~t Expiration Date: Expiration Dale: Expiration Date: Approval: ApProval: ApProval: (7) Ttiis permil was issued in accordance with the provisions set forth in your application and is subjecl to the laws oi the SUIe of Colo2do and to the Zoning Regulalions and Building Codes of W heat Ridge, Colo2do or any other applicable ordinances o1 the Ciry. (2) This pertnit shall expire if (A) the work authorized'rs not commenced within sixty (60) days kom issue dale or (B) the building authorized is suspended or abandoned for a period of 120 tlays. (3) if Nis pertnit expires, a new pertnit may be acquired for a fee ot one-halt the amouni nortnally required, provideC no changes have been w will be made in the origiml plans and spacificaUons and any suspension w abandonment has not exceeded orre (1) year. If changes have been or if susDension or abandonmenl exceetls one (1) year, tull (ees shall be paid for a new permil. (4) No work of any manner shall be done Mat will change the natu2l flow o( waler causing a Crainage problem. (5) ConVaclor shall noGfy Ne Building Inspector twenty-lour (24) hours in advance tor all inspections antl shall receive writlen approval on inspection qrd beFOre proceeding with successlve phases of the job. (6) The issuance o( a permil or the approval o( tl2wings and speclficatlons shall not be consVUed to be a permit tor, nor an approval ot, any violaGOn of the pmvisions ol the builtlfng codes or any olher ordinance, law, rule or regulalion. Chief Building Official Elecfical License No: Plumbing License No: Mechanical License No: Company: Company: Company: Thle Gontrecl, inCluAinq l'll0 Pmvklon'c on ka bndc eNe, antl any su0.waquem egreement marle pur,uanl hnrcm tx4ween C.J. Roonng compflny (Iho'CcmpAny) arq ine cuslomBf(s) (VI9 'Cusrnfmf) wlll he aLMect lo EJI appropAaAe lawa, regulelMne md nrNneMas, aM lo tha IWlowlnp apedel tamre antl cordlNOr15. 1, Thle prapoeel le eubjact t0 flpplOVUI Of au Crcdli DnpxHment 2. Payment sMN ba made upon the fdlawing imms. Net Cnen aua upan compl6tlon of wark Aaynble At 4020 BAghtan 61vtl., D6mvr, CO If work le af euCh nature iflaf II WIII o%C0~'lJ ona ~@ridrr monlh, pB~1ifl1 pflymont shiill Oe rrede an M6 1eM11(1o) of oadl Cfllondar momh, 6xeed on the wMk CamplMed and mererlel an tN6 job of lasl day of t11o plCCOding m9nthn evltlenced 6y aurSt6lmmant. Paymem le dua upon recW ol inroice, flntl 10 not conttnpr,nt upan cHy huikling InspCCtloM, releeee of Inwrnnce monlae, or any HtltlNianal Wol'k [a h4 pP~rned, suCh as: guttor IfflfaF ladon, Mndowe, elding, ealAl insi011ation, ef iny oMer wnrk nof ineMtlol'1Bd hCfpln. 3. Sholiltl IhA cusamer defeNt vn this conffud hy lallura ta meka peyment In dro ' manner SpeclAed aU9va, Imereet charges shall b9 added fran due dete at 6 fAt] ol tliree p6feenl (3 k) p01 mn111h, (36% PER ANNl1M). WflN d InlnMnum cherge ol $2.00 per moMh, antl If pk1cM In ihe MrMe al en etlomey for CotlnG11an aII etlomay (e69, legel casts antl filing laas Shflll M'. psltl 6y Cuelomel 9CCBptlflg RaId mnvecl. a. 7he Gahp9ny Shall naw. no raaponnl611iry Ior aemegas Irom flro, vAndemrm or 01her hazertle, wi1ic11 Af9 noMMilly GrorltarnPleted ro ba CoVBreU 6y Bulldem Flek 3 IfISUf9nc0. unheea 3p9CIfIC VRIIIM 89f99ment hae h69fi fi1El1A 111CfAO1 prbr 10 IP eommoncemam W uw work. compnny L; nm recpomdme mr ine re,alipmnent 01 ~ aolflf p61101G, 38IMIUC tllshaa, or elmllar BqWpmont, :.flld I9 nat reapon5ibla IOf WAter t tlghtneas arountl " MUs Met penetreta roelMg Suflac'+, 5. iha caMfflf.1 prloo on dw fsce harem doas not InclWe expenees or cnargas for »ddklorel hontl ar InaUranW pl'eMpms or weia beyond noRnel6ontl and IneurBMO coveiage, entl eny SUCn atlaPlexwl expanaea,pramiums or cosb nhell be edtlatl lo ihq nmaunf af Me canWet. 8. RaplecemeM oi tlMOYataletl dncMng, teclu 66flMS, foDl JACIu,, ventlleWfe, Ilashing, 9f mher meteriele. unlECS oitwfwlse sreied in ihie contract, arr nm IridudaN antl wlll be Cherged ea en exirt on a IImO flnQ mterlel 6mie. 7. 7yig proWsl wlll evpire 30 days from 09 Aate Pre[ eppenring Oasida Nie custamoYS Ik1me unle9a eccapted By thB cu3romcr or eHtended in wrltMg by ft Company. AIWr 30 we reeerva Iha rigM W ~igC o4f piica In acmM6nee wllh coetv in aHOCI at tnat dmn. e. T11B Gbmpnny 311a11 nGt ba Ilehle M any tlelny a od1Cf f51W~e af perfo~menea ol thia contr6M tl4o Vo labar Candrdverelae, flree. w9Etl1Dr, IneUlllb tD obleln mete1i615 iram ueuN sourCmc. OY ally Othm clrcume[encea 6eyond \he control oi the rnmpnny whelhar ot n similnr ot Qlsshnl4sr nnture. FuRhamtaro, lnlS caMrvct?hru Lx uoltl9blE hy the wmpany in Iha ovont M'. b?comew commerclaliy imp1ac11cal [o pf:rfortn the coMrect tlua tb ;uMinnll.il 121cor er mmerlel caet Incraem, bulldlrp cade modlloaNaie ar alher cilCUmslnnms hoyontl t1W, comral of tha callpaRy M A Slmllnr ar tliselmllar nBWre, ol thls Contrac6 9. uroofingerWOreneatmatat worMishvolvea,kLVUnnmtoodenaaprnedrodwi our etflndeN raof guafFUlt6a, .b^ pfWklBd on ihe back elde of tlti9 COntRICI, shall be nccepreble end ihet ellierrn5 antl proVl5lon Ulereln nhnll pravell, unla93 ofhclwis9 spnrlilcaly egreed In wrlting prior lo Ilm eommenc.omenl al the woAc. 10. II msleAnl hes m he reordered or restoCketl tWCausU o19 charqe arder by Ne Cugmmey Mera wlll ha a reeWCldrg le0 equal io flllaon pa1CFYlt (16%) of thv cronirect vriw:. 17, Thlv corrtren erM wertenry le not aeelgntWlB antl Is nonVAnsfCfable, No wnrkmapehlp guarerdee provided 6y C.J. Rooling Canpany SFlall C%CnM 6 yeefe. Mnnufeclurer'e xarreMlea on mOteHg15 tl191 BI'0 pufCh050tl afC p[+f Ihelf'pearifics- tlonn lor new mal Inamlietlorre only end Bre consklefOC ilMOpCMcnl W The O.J. Raoling Compnny end C.J. Raoling wlll Be Nsltl hARniBSS Mf fRlliua due m me@rlel tlefects or pmduct vAntl pertortti9nCB fallul9a. No repallYrofW manship quammee9 Fhnll excBed 1 year. ' 12. If 1f11S fA0V5Cl IB f9pUUIBlCd U}' Qlf CYSIOmer leter Ihen 9 tleye fram crocutlan oy the cusrortror arM prbr to canmenr,emeM af wark aj ma Campeny. tl1Cf1 lNO CuStOMCf Shflll pay IO lM COmpany (151A) oi Ihe conirnn pdce ee Ilqultl2te,4 damapes, afM not ss a pennlty, 7M Campany agreea to eceept auch unount as rea:.anable arA Ilipt componsatbn for IN damepea reaumng trom customer's deiautt on the contract. Thls contrna c2nnot 4a rnpuantetl arce woric nas wmmaneotl, 11 If any prowsion M this agroemant shoultl t» noir to be ImaIM or une+r'crcaaNn, the veldiry ena enrortaeniiiiy or tne remeininq provisions or utis agroomarn sho.ii not he eflected Mereby. 74. Theee tarme entl condillans ehell he conaltlBred O part of Sny ngreemanl eMered InW or euHwrized lo pracaetl, bohveen NB Comp6ny EVId tl19 cutnomer, tlln vnmo es tl lhay xr.re IncNded thareln. 15. ThlsagaFmk.ntconstllut5,efin,entlreagmmmenrhytweantlwpattlee.nmeyl» enmgmo ony by wrlnan mlCUmont,kanotl by both parcirs. 16, Any f0pr650nWt1o115 or Staamant nb m wAiing are apra«d +o bP kmme+mni, eiW noi MT1etl on by aimer pafty, erid ao nec surviva iha auueculbn N lhls Coniraa. In Ileu oi oflplnal sl(pnetuia M conbeCl M fltltlen9um, laXatl Slpnmul'c wWWBros d1a lerme end WndlNme W ih9 CoMr6d 6nfLOf 6dtlBlttlll111. V. ThkcomreUaha114edeemetlmatleuntlerendqovem89Dy91alaWMt119SU11o ot Cobrado In all respecls InrAtMlnp matters W Irrtarpretetion, veliairy, conslnutlan, padormenca enevor eMOroamani. Cusromar ccaseMS m me Y+dsdknan nnd venue ot any eaull (s1aM Of f6donl InWlM(ng Collnty CouM1) ol Ao"al jurLVtllctlan In iha Gy antl Caunry of DonveR Colorodo, for puryoao M eny ac1lon or proeeading brought to aecure peymBnt at 1he auma tlutl untler IhiB CWitf6C! 01 W.'wI11G 0r CIAQfCP Ille pedormanc9 d ony Ianra, covenems nnM contlitions of IhN comrdCl, Custamer lurthet SAree.a W bring arry legel praceedlrg erfeing out oF tlhia coAV9tt enIy in Ih0 GOURR IOflPdIOnad ebpve. . . . .,,,ig,_C,apNrenor'hes not 6ean noNFletl of anyexp09etl NM 5hOo.IRing Iherelore the owner eccepfe reopon9ibllily br nclil• pon VaWq any sCG faa~ ahe9Ming 7/ Gwnd~ ittltNlt"~•.!`~a4+~ ~^~alFaTan inl bsta 1s, Oudr~p thc rcmoval mM Ins+allaGon W tho m~+li s~am Ihere mey be areaa wnars axpw.,ad caiungs er:lst which may allow dum ar dehd4• ro nNer mto ttw attic epace. Owrrer underetands antl ngreos b pf6pGra+ Icw Clh by coWiring I~ema under xxpoeea cel~~nge. owner aleo recognizea Viet dabr~c whlch may ~ntar Inro tl~e ePoc co or ihrough rool plankinp IMo garege inledore is unavoweble and wlll not hold me cantrncror reaponalble 1or thle p-rtlculw dn"n+P. 20. Cuelaner egrBec to folBflGt and IndamnRy Compn7t irom nny moltl ar relntod ~Inmepe entl liability eB nwfe apBClflcaly provl~ictl he reverea elde Of ihi3 COMIAC4 Whita - oXica; Cnnary • Cwtomnr; Plnk , Snkr.: C.J. ROOFINCa CO. % T . f~ 4020 Brighton Blvd. penvar, CO 80216 E5tap/l~is~hed`1978 303-394-2802 Fax 303-384-2608 C 1,~~.. DATE - &-~2-40-7j CUSTOMER Address City ~ i d; , State-ev zip: 9,003 Phone H:j . ~b 5 W/C:) Job Address (if differo~t) _ r- L's~. WITH:_WIOOI F- f~(`,PlLOR: ~T OfF: (Cust, init)~~'"' ~j o YEARS MANUFACTURER'S LIMITED WARRANTY ❑ DOUBL 1IE5: GI RIDGE ❑ V LLEY Y4WE: PI JACKS: ~ NT ROOF STACKS: " TAL EDGING: MATERIALS 91 GRAOE: ~ -~eri-y} 611-5 Ga'FE UNDERLAYMENT:I - a-dL N UP AND HAUL OFF RP4FING TRASH: MAGNETIC NAIL ROLA.ER THROUGH YARD: ~kEAN GUTfERS OF ROOF DEBRIS: ~ SPECIAL INSTRUCTIONS: ' .~I~ P 1- WO Cc.CrSV~ / JU" W E HEF1ESY PFiOPOSE to lumkh 1at19r and matorlals In accordarwe wtth tha above apecificaliona, tor tna aum M~ f 7q 3' BO- 5tart dam deposlt: eALANCE OUE: pAYMENTS TO BE MADE AS FOLLOWS: nLL PAYMENTS FOfl COMPLETEP WORK aRE DUE PER S OF CONTRACT SEE ITEM #2. rROOFING TO FURNISH WORKERS COMPENSA710N ANO GENERAL LIABILITY INSURANCE, m ~ YEARS WORKMANSHIP GUARANTEE. aYSECURE CITY BUII,DING PERMIT, FEE INCLUDED IN SUM FDTAL OF CONTRACT. - ' 'WHEN ACCEP7Eb 7HIS PROPOSAI. BECOMES A CONTRACT SUBJECT TO THF A90VE SPEGFICATIONS, AILTHE 7ERMS AND GONDITION5 CONTAWED ON THiS FFGE, ni+C Ti lE PROVISIONS ON THE BACK. Accepted hy ALL CONuTRACTS OVER $500.00 SUBJECT TO CREDIT CHECK f $."S# -1.1C413111 pte20 __a-~ EsflmatodSupervisar a~'-' : 303 6 67-52IVD r+ear • u~ ~/om City of Wheat Ridge cO[ORPO~ Residential Electric PERMIT -061231 PERMIT NO: 061231 ISSIIED: 12/27/2006 JOB ADDRESS: 4485 TELLER ST EXPIRES: DESCRIPTION: Service change & install new circuits in garage CONTACTS owner 303/210-8935 Alan Culley gc 303/665-6188 02-0892 Barnes Electrical Contracting PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION: UA - BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 3,800.00 FEES Permit Fee 126.50 Total Valuation .00 im Use Tax 68.40 TOTAL 194.90 Comments I hezeby certify that the setback dietancee proposed by thie permit applica[ion are accurate; and do not violate applicable ordinancee, rulee or regulations of the City of Wheat Ridge or covenants, eaeemente or reetrictione of record; that all measurements ahown, and allegationa made are accurate; that I have read and agree to abide by all conditiona printed on this application and that I aseume full responeibility for compliance with the wheat Ridge Huildin9 Code (I.H.C) and all other applic/a/¢ wheat/ dge Ordi ances, for work under thie petmit. Plana subject to field inapection. ~~Y^ 1~ ignature of contractor/owner date 1. Thie pezmit was isaued in accordance with the provisione set forth in your application anii ie aubject to the laws of the State of Colorado and to the Zoning Regulations and euilding Codes of wheat Aidge, Colorado or any other applicable ordinancea of the City. 2. This permit ehall expire if (A) the work auGhorized ie not commenced within aixty (60) daye from ieeue date or (B) the building authorized is suapended oz abandoned for a period of 180 daye. 3. If this permit expires, a new permit may be acquired for a fee of one-half the amount nozmally required, provided no changee have been or will be made in the ori9inal plane and specificatione and any auepenaion or abandonmen[ hae not exceeded one (1) year. If changee have been or if suapenelon or abandonment exceede one (1) year, full fees ahall be paid for a new permit. 4. No work of any manner shall be done that will change the natural flow of water causing a drainage problem. 5. Contractor shall notify the Huilding Inepectoz twenty-four (29) houre in advance for all inepectiona and ehall receive written approval on inapection card before proceeding with eucceseive phaees of the job. 6. The isauance of a permi[ or the approval of drawings and specifications ehall not be consGrued to be a pezmi[ for, nor an approva E, any ' ' n of the provieione of the building codee or any other ordinance, law, rule or regulation. All viey{.. sub7ect t~f'eld inspectione. Cnief date INSP&CTION RHQVBST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUST BE D711DE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. DEC-26-2006 09:12 AM BARNESELECTRICALCONTR H~ COMMUNITY DEVELUPMENT DEPARTMENT i F~-. q ~ p 9llILDINO INSPECTION LINE - 909-234-5893 CITY OF WHEAT RID(3E 7600 WEBT 29TH AVENIIE \ WHEAT RIDGE, CO e0093.(309-23bZB'30) App,GICA Property Owner: p I.R~ t&i-LZ • Prnperty Addresa: 'Villi$5 TEI'LE1" 5 7 Contractor Licensc No.: compaoy: 8AwNCS ELEG TKI eaC C,WT 0IxNERICON7RnC70R SIGNATURE OF I1NDER6TANDING ANO A6REEMlNT 303 665 2401 P,02 Bullding ParmR Number: pate: f;V -4d3• p.~.~'• aex7 Phone:3AT- I 0 - B'"YJ S Phone: "+J0.,7•4(r~-G/5'd' Bulldlnn Dewt. Valuatlan Flgure: I herepy certlfy that the setbadc dletenee9 propoead 6y thla permlt appllcatlon ere eCCwale, en0 tla not vldeta appllcable ardlnancea, rulea or reg41a4ana of tha Clty of W hoat Rldga or oovenanta, eaeemanta or reatriclione of record; tl+at all mweuroments ahown, and alixpatlone mPdn nm ar.nunlA;lhau he~ read and earoe lo ablde by all condltlana pdnted an thle eppllcaUOn aad ihel i abeume NII rosponsl6111ty for compllaoca with tha W haet Rldga Bullding Cod9 (1,B.C) dnd all ofhereppllnable W hewl Rldga Ordineaces,lor woAc under thle permd. PI9na OupJecl lo Ileld Inspectlan. (oWNLPNCOfJrMCTOp): slcNeo un I o_...f_ (OWNFA)(COMRACTOR)IPRIPlrED ..'t,ppTr Use of Space (description): Descriptlonofwark: 54.^J( Cf C~4NT[ 4 'YNf7A6[ N[w.! CtNC4.I TS !^'~'j4/'-ftC Sq. Ft. adMd (1) Thia ry+rmil wwn inxu0[i ln BCmMB11Ce WIUI UI! PfaV1810f18 BBt fOfth 1f1 yiluf 6PPIICdH011 BflQ IB Bl1EJeCt t0 Ule 18W8 Of Ih0 Stale bF rolornAo anQ tn Ihn Znninp Rngiaxtinnn ena Buildinp Cedes ol Wheat Rldpe, Coloredo arany olher eppllceEla ordlnanrea of me ciry. (9) Thin pnrmlf nhnll evpire If (A) Ihe woHt authoAZad la nol commancetl wtlhln eixty (80) daye ffom iaeue date or (B) tha bulidlnp aulhodzed le euepended or a6andonad for a panod o1.18U d8ys. (3) If mle permlt explrea, a new parmlt may be acquiretl 1or a fee otone-half the amount normally requlrad, provided no chanpas have hwwn or will b• msde In 1he orlpinml plrni and apaclllcatlons end eny auspvnolon Or A6endeement hnc nM evcsoclwd nnn (1)yxar. uchanpeanaveueenorllauapenalonorabandonmentexceedaorre(7)yeaGtull(eeaehellbepaldforanewpertnlt. (4) No vrork ot any menner ahell be dona that wlll changa the naWral flow of water ceuaing e arainage problem. (5) Ccntrecbr ahall nolity the 8uilding Inepaclcv Iwenly-h+ur (24) hourn In advnnnn fir nll inepecliona and ahall receive wrlnen qppmval nn InxpnM.lnn rard hefnre pmceetlinp wllh eutceeelVe phaBBe of thefob. (e) The iaauance al a parmlt or 1ha approval af drawlnps and epaefieatione ehall not de eenatrued m 6e a permit for, nar an appmval of. any vlalagon of d1e qrOVlelOne OI NB bulldlnC Cade9 Of any Other ofdlnance, law, rule or repuletlon. All plan 1eNSw Is auhhMlo fNld Inspectlans. Chief Bullding OfFlcial V31UC: $ Perrnif Fee:$ Plan Rcvicw Fcc:$ Use Tax:$ TOtOl:$ Electrical Licanse No: ;000J,0-- Plumbing License No: Mechanical License No; Company:,,Jp*A/EC: ww.:,ri,srs_ Company: Company: 00Ji"rn#. . Expiratlon Date: owiwoy Expiration Date: Expiration Date: APProvaP ApPravaP APProval: _ ~