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BUSINESS LICENSE INSPECTION
PERMIT NO. 201900675
BUSINESS NAME:
i
INSPECTION DAY/TIME Fri. June 14 p@ 10 am
INSPECTION DAY/TIME
INSPECTION DAY/TIME
Hemp Hearts of Wheat Ridge
ADDRESS: 6814 W 38th Avenue
CONTACT NAME: Amir
850 SQ FT
a (-
OCCUPANCY TYPE
OCCUPANCYLOAD
� � V—,
CONSTRUCTION TYPE
�❑,/S�PRINKLERED
M NON-SPRINKI FRFs
, 0? a -3 -
Date
1 ,:7) cr-?
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:,�,`y;' �' -d ✓ `�-
Permit Number:
❑ No one available for inspection: Time /t%
Re -Inspection required: Yes, No
When corrections have been made, cal ror re -inspection at 303-234-5933
Date " • 12� - ) 51 Inspector: ~--"
DO NOT REMOVE THIS NOTICE
CITY OF WHEAT RIDGE
-.A Building Inspection Division
(303) 234-5933 Inspection line
'(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
2;
Inspection Type:
Job Address:
Permit Number: 7'/�7
?
❑ 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
CITY OF:WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type:
JobAddress: �f�I '� ,r -I ✓�
Permit Number: ;;•0 1'7,c_ � (,)
NJ
❑ No one available for inspection: Time
Re -Inspection required: Yes'(No:)
When corrections have been made, ca or re -inspection at 303-234-5933
Dater �'� 1 Inspector: 7 --
DO NOT REMOVE THIS NOTICE
i<. CITY OF WHEAT RIDGE
Building'Inspeion Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
4.Inspection Type: rg 4�_-/,J.
Job Address:
Permit Number:
❑ No one available for inspecti
Re -Inspection required:
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) 237-8929 Fax
INSPECTION NOTICE
r�--- ) _
Inspection Type: t'"
Job Address:
Permit Number:
r
❑ No one available for inspection: Ti.PM
Re -Inspection required: Yes
When corrections have been ma ,;or re -inspection at 303 -234 -Date: 5 �Ins
DO NOT REMOVE THIS NOTICE
i CITY`OF WHEAT RIDGE
_:�9�Building Inspection Division
(303) 234-5933 Inspection line
1(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: W 25
Job Address: ('4 -S 1 ;'i
Permit Number: ,7 /1 D
❑ No one available for inspection: Time
Re -Inspection required:,, Ye
s No
9,r
When corrections have been -made, call for re -inspection at 303-234-5933
Date: '�;� ,, r - R�
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: 1
Job Address: (_.qQ
Permit Number:
❑ No one available for inspection: Time -` AM/PM
Re -Inspection required: YescN
When corrections have been made, for re -inspection at 303-234-5933
Date:" Inspec
DO NOT REA OVE THIS NOTICE
A i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
-:; ' d � -( z . �� 4 G,
Inspection Type:
Job Address:
Permit Number:
No one available for inspection: T'& _ AM/PM
Re -Inspection required: Y�de,11`fo
' o
*When corrections have beer► re -inspection at 303-234-5933
Date._ Inspe r:
DO NOT REM E 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:. Wq � \
Job Address: L' a �{ w �'�c 1 �, C•�
Permit Number: c• b i , (; �,
❑ No one available for inspection: Time - '., AM/PM
Re -Inspection required: Yes ANO
"When corrections have been made, call for re -inspection at 303-234-5933
Date: '� `Z Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT`AIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: '` l
Job Address:
Permit Number:��r�,�
❑ No one available for inspection; Time�"T�-;�" ` AWPM
Re -Inspection required: Yes/N
When corrections have been mad�.cail for re -inspection at 303-234-
Date:- 5, 1 , %'? Inspector: ;__L ----
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT`AIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: '` l
Job Address:
Permit Number:��r�,�
❑ No one available for inspection; Time�"T�-;�" ` AWPM
Re -Inspection required: Yes/N
When corrections have been mad�.cail for re -inspection at 303-234-
Date:- 5, 1 , %'? Inspector: ;__L ----
DO NOT REMOVE THIS NOTICE
i_ ... CITY O WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
Inspection Type: (--�
Job Address:
Permit Number:
'�.-,��J��+
_i�■rrr
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Ye NQ,,-'`
When corrections have been made, mor re -inspection at 303-234-5933
Date:
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION
City of Wheat Ridge
Comm. Tenant Finish PERMIT - 201900552
201900552
6814 W 38th Ave
SWO Add one wall
- 240 sq ft total
ISSUED: 04/16/2019
EXPIRES: 04/15/2020
**REVISION: add outlets, switches and lighting; removed half wall; Added
valuation: $2,000.00
Tenant: Hemp Hearts of Wheat Ridge
*** CONTACTS ***
OWNER (303)432-3789 SAMUELS DAVID
GC (720)642-7310 PAUL MALONE
SUB (720)483-7514 CRAIG SANCHEZ
150114 DIRC HOMES LLC
190078 SKYLINE ELECTRIC LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: UA / Unassigned BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,245.92
FEES
Total Valuation 0.00
Plan Review Fee 112.19
Use Tax 152.16
Permit Fee 172.60
Investigative Fees 140.90
** TOTAL ** 577.85
*** COMMENTS ***
*** CONDITIONS ***
All roughs to be done at Framing Inspection.
Approved per plans and red -line notes on plans. Must comply with 2012 IBC, 2017 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
**Prior to final inspection approval - As-builts are required before approval of the
Building Final Inspection and Certificate of Occupancy can be issued.
City of Wheat Ridge
.'` Comm. Tenant Finish PERMIT - 201900552
PERMIT NO: 201900552 ISSUED: 04/16/2019
JOB ADDRESS: 6814 W 38th Ave EXPIRES: 04/15/2020
JOB DESCRIPTION: SWO Add one wall - 240 sq ft total
**REVISION: add outlets, switches and lighting; removed half wall; Added
valuation: $2,000.00
Tenant: Hemp Hearts of Wheat Ridge
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this permit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be
performed and -that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) Date
1. This permit was issued based on the information provided in the permit application and accompanying pFlans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building 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, an violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to f any
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
C.OMMUNITy DEVELOPMENT
Building & Inspection Services Division
7500 W. 2911 Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: Perm its(a)6wheatridge.co.us
FOR OFFICE USE ONLY
Date:
/-// f�
Add to Permit #
� a19 Do SS'z
Building Permit Revision/Amendment Application
I Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address: � 0 �V �-� U ��
Property Owner (please print): ��V0 0 Phone.`- / S7q '9� /
Property Owner Email: �K—L) L=7—
Mailing
Mailing Address: (if different tthnann property address)
Address: 7`7 � �=�J �_
City, State, Zip: �� ; � k- 0 � `� o 7s� ZG2
Contact Person:_�j l
y Phone: ':� a 7_5
Contractor. -- ► tom- .
Contractors City License #:
lD
l 1 �{ Phone:
-720
Contractor E-mail Address:
Please Note: Additional valuation must include all general and subcontracted work to be performed
related to the revisions and/or amendments declared in the description of work and which were not
included in the original permit valuation.
If revisions or amendments increase the original valuation, additional fees will be due at the time of
approval. Depending on the scope of work, additional plan review fees may be due upon approval
($60.00 an hour — 2 hour minimum).
Description of revised/amended work:
C �: i< C-- () 6- - . t,- (- ( P' � 0 q- i,-
bUTCc�v�t
i S -Ptt L
�' C) l ; c -C� e-�
I
:dtl ,2, J )S l av
00
e v t c r i
Sq. FULF Btu's 4S� ®� Gallons
Amps
Squares Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
U
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.
CIRCLEONE: OWNE (CONTRACTOR) or (AUTHORF,D `� IVE) o (OWN R) (CONTRACTO )
PRINT NAM—E SIGNATURE:t 41/
DATE:3
ZONING COMMMENTS:
Reviewer.
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received
❑ Not Required
Water District ❑ Received
❑ Not Required
Sanitation District ❑ Received
❑ Not Required
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
zc)lqoosTz
LIMITED ASBESTOS INSPECTION REPORT
6814 W. 38th Ave
Wheat Ridge, CO
3/21/2019
Prepared for:
David Samuels
West 38th Ave. Complex, LLC
6814 W. 38th Ave
Wheat Ridge, CO
(303)514-1831
davidsamuels@comcast.net
Prepared by:
Alta Environmental LLC
CDPHE Registration No.: ACF - 24509
3924 S. Wadsworth Blvd. #208
Lakewood, CO 80235
Contact@AltaEnv.CO
(303) 669-7007
`9v IRO,VAw
Table of Contents
Section 1 Inspection Project Summary
1.1 Homogenous Areas in Work Scope - Table
1.2 Summary of Asbestos Samples
1.3 Sample Locations (optional)
Section 2 Results and Recommendations
2.1 Post -Renovation Asbestos Containing Materials Notice (if identified)
2.2 Photo Log of Asbestos Containing Materials (if identified)
Section 3 Project Overview
Section 4 Asbestos Inspection Procedure
4.1 Suspect Asbestos Containing Building Materials
4.2 Sampling and Laboratory Analysis
Section 5 Conclusion
5.1 Limitations
Appendix A - Laboratory Report and Chain of Custody Form
Homogenous Material
Types - Reference List
Surfacing Material
List of Acronyms
TS
Textured Surfacing
ACM
Asbestos Containing Materials
PL
Plaster
ACBM
Asbestos Containing Building
CMS
CMU Sealant
Material
SOF
Spray -on Fire Proofing
Thermal System Insulation
G
Good
DT
Duct Tape/Wrap
D
Damaged
PI
Pipe Insulation
SD
Significantly Damaged
Miscellaneous
BBA
Baseboard Adhesive
F
Friable
CA
Carpet Adhesive
NFI
Non -Friable Category I
CDW
Composite Drywall
NFII
Non -Friable Category II
CT
Ceiling Tile
DW
Drywall
NA
Not Analyzed
FTM
Floor Tile Mastic
ND
None Detected
MA
Miscellaneous Adhesive
MS
Miscellaneous Sealant
EA
Each
OT
Other Material
LF
Linear Feet
RSG
Roof Shingle
SF
Square Feet
RSH
Roof Sheeting
RSL
Roofing Sealant
Trace
:51% by (Point Count/Composite)
SVF
Sheet Vinyl Floorin 41,
h@at
ACM
ACM (>1% asbestos)
WG
Window Glazing
R%a
Section 1 Inspection Project Summary
Job ID: 20190321-1 Inspector: Joshua Masek
Date: 03/21/19 State Cert #: 22489
Client: West 38th Ave. Complex, LLC
Customer: West 38th Ave. Complex, LLC
Prouerty Details:
Site Address: 6814 W. 38th Ave
Wheat Ridge, CO
Property Type: Commercial
Age of Construction: Renovation:
Inspection Details:
Type of Inspection: Limited/ Renovation ACM AHERA/Reg 8
Reason of Inspection: Remodel
Affected Area(s): Throughout unit
Scope of Inspection: Partial Renovation
Potential Spill Identification?: Yes (See Section 2 Results and Recommendations)
Work Scope Notes: Retro -active demo inspection
Sample Notes:
Laboratory: Reservoirs
NVLAP #: 101-896-0
Results Time: Rush
# of Samples 13
1.1 Homogenous Areas in Work Scope - Table
ID*
Material
Type**
# of
Samples
Material Description
Functional Space
Quantity
in Scope
1
TS
3
drywall w covering
walls throughout
800 SF
2
CDW
2
drywall j.c.
drywall joints
800 LF
3
SVF
2
brown faux -wood sheet vinyl
floors throughout
450 SF
4
CA
2
multi -color carpet w mastic
floors throughout
460 SF
5
CT
2
gray 2'x4' ceiling tile
suspended ceiling
900 SF
6
BBA
2
brown 4" baseboard w mastic
walls throughout
300 LF
7
8
9
10
-1D - Homogenous Materials 1D in Homogenous Areas Table & Bulk Samples Table
**See table of contents Reference List for how to classify homogenous materials type cnyar
Wheat Ridge
1.2 Summary of Asbestos Samples
Sample
ID
Homog.
Mat'l ID
Sulk Sample & Locations Table
Sample Location ID*
Material
Condition
Friability
Category
Analytical
Results
TS 1-1
1
w wall, 9'4" N, 36" up
SD
F
ND
TS 1-2
1
debris pile
SD
F
ND
TS 1-3
1
debris pile
SD
F
ND
CDW 1-1
2
half -wall SW corner, S wall, 84" up
SD
F
ND
CDW 1-2
2
E wall, NE corner, 72" up
SD
NFII
ND
SVF 1-1
3
entryway fl, 45" S, 64" W
SD
NFII
ND
SVF 1-2
3
debris pile
SD
F
ND
CA 1-1
4
18'8" S, 46" W
SD
F
ND
CA 1-2
4
debris pile
SD
F
ND
CT 1-1
5
debris pile
SD
F
ND
CT 1-2
5
debris pile
SD
F
ND
BBA 1-1
6
hall, W wall, 14'6" N
SD
F
ND
BBA 1-2
6
debris pile
SD
F
ND
1.3 Sample Locations
Chy of
Wheat Ridge
1.3 Sample Locations Map (Continued)
Section 2 Results and Recommendations
No asbestos -containing building materials have been identified within the affected area(s) of the Site
Address (see Section I of this report for limited scope of inspection and affected areas). Please work safely
and if any additional materials are discovered that are not listed in the "Homogenous Areas in Work Scope"
table, please contact Alta prior to disturbing these materials.
According to federal and state regulation, any materials that have not been sampled by a State-certifed
Asbestos Building Inspector and analyzed by an AIHA-accredited laboratory must be assumed asbestos
containing, regardless of the year of construction/renovation.
Any work performed on asbestos -containing building materials and/or trace asbestos -containing building
materials is subject to OSHA regulations, including but not limited to: hazard communication, asbestos
construction industry, general construction industry, and respiratory protection standards. Worker exposure
assessments are part of the asbestos construction industry standard and include excursion limits and 8 -hour
time -weighted permissible exposure limits which, if exceeded, may require additional engineering or
administrative controls to properly protect workers engaged in activities that may damage or disturb
materials which contain asbestos.
C7Y Of
W�'eat Rage
Section 3
Project Overview
Alta Environmental LLC (Alta) was contracted by the client to perform a limited
repair/renovation specific asbestos inspection (inspection) at the above referenced "Site
Address". The inspection was conducted by an Environmental Protection Agency (EPA)
accredited and Colorado Department of Public Health and Environment (CDPHE) certified
Asbestos Building Inspector. The inspection was performed at the direction of the client
and only includes those materials, locations, and quantities specified in the "Homogenous
Areas in Work Scope Table".
The client is planning repair/renovation activities that will disturb suspect Asbestos
Containing Building Materials (ACBM) within the repair/renovation affected areas at the
Site Address. CDPHE Air Quality Control Commission Regulation No. 8, Part B — Asbestos
(Reg 8) requires that all suspect ACBMs be properly inspected and sampled by certified
personnel prior to conducting any repair/renovation activities that will disturb the suspect
ACBMs. All samples were analyzed by a laboratory accredited under the National
Voluntary Laboratory Accreditation Program (NVLAP). The CDHPE has established the
following trigger levels for different types of properties, which specify how suspect and
confirmed ACBMs are inspected and subsequently abated:
• With regard to single-family residential dwellings (SFRD), the trigger levels are
50 LF on pipes, 32 SF on other surfaces, or the volume equivalent of a 55 -gallon
drum
• With regard to all areas other than SFRDs, the trigger levels are 260 LF on pipes,
160 SF on other surfaces, or the volume equivalent of a 55 -gallon drum
The purpose of the inspection was to identify, visually inspect, and sample all suspect
ACBMs, at the direction of the client, which may be disturbed during the course oJJJ;&
repair/renovation work. city of
Wheat Ridge
Section 4
Asbestos Inspection Procedure
The inspection procedure was conducted in accordance with EPA Asbestos Hazard and
Emergency Response Act (AHERA), the EPA Pink Book, CDPHE Reg 8, and applicable
Occupational Safety and Health Administration (OSHA) guidelines and regulations. These
regulations specify requirements and protocols for conducting asbestos inspections,
sample analysis, and asbestos abatement.
4.1 Suspect Asbestos Containing Building Materials
Homogenous Material Types
The inspection involved identification and sampling of suspect ACBMs in the areas
established by the client that would be part of the scope of work. Suspect ACBMs were
grouped into homogenous materials based on color, texture, and date of application.
Homogenous materials were given distinct codes (CDW01, F rCO2, TS05, etc.) based on
the type sequence of the homogenous material. Details about the size, color, condition,
friability, quantity, location within each functional space and other important details for
each homogenous material were reported as part of the inspection. Homogenous
materials are grouped into one of three categories based on intended use:
1. Surfacing Material — material that is sprayed on, troweled on, or otherwise
applied to surfaces, such as acoustical plaster on ceilings and fireproofing materials
on structural members, or other materials on surfaces for acoustical, fireproofing,
or other purposes.
2. Thermal System Insulation — material applied to pipes, fittings, boilers,
breeching, tanks, ducts, or other interior structural components to prevent heat
loss or gain, or water condensation, or for other purposes.
3. Miscellaneous Materials — interior building material on structural components,
structural members or fixtures, such as floor and ceiling tiles, and does not include
surfacing material or thermal system insulation.
City of
Wheat Ridge
Homogenous Material Friability
Each homogenous material was given one of the three following friability categories
defined by the EPA and CDPHE:
1. Friable Material — materials that can be crumbled or reduced to powder by hand
pressure.
2. Category I Non -friable Material — materials that cannot be crumbled or
reduced to powder by hand pressure including resilient floor coverings, gaskets,
packing materials and asphalt impregnated roofing materials.
3. Category II Non -friable Materials — all other materials that cannot be
crumbled or reduced to powder by hand pressure that do not include category I
non -friable materials.
Homogenous Material Condition
Each homogenous material was given one of three condition categories based on visual
observation defined by the EPA and CDPHE:
1. Good Condition — No visible signs of damage were observed during the
inspection.
2. Damaged Condition — Visible signs of damage less than ten percent spread over
the entire material or twenty five percent localized.
3. Significantly Damaged Condition — Severe damage greater than ten percent
spread over the entire material or twenty five percent localized.
4.2 Sampling and Laboratory Analysis
Sample Collection
Bulk samples of each suspect homogenous material were collected randomly throughout
the homogenous material area within the scope of work. Bulk samples were sampled all
of the way through the material so that all associated layers within each homogenous
material are represented. Bulk samples were placed in closeable sample bags and then
labeled with a permanent marker with distinct sample identifiers (e.g., CDW1-1, FTC7�
MISC2-3, etc.) for transport to the laboratory. Sample locations and photographs of tf��or
Wheat Ridge
homogenous materials were also collected at this time during the inspection. Sample
quantities of each homogenous material were collected based on material type and
quantity detailed in the following table as required by regulation:
Homogenous Material
Minimum Number of
Quantity
Type
Samples
0 to <1,000 SF
3
Surfacing material
1,000 to 5,000 SF
5
>5,000 SF
7
Each Material
3
Thermal System Insulation
Patch < 6 LF, SF
1
Miscellaneous Material
Each Material
2
Laboratory Sample Analysis
Bulk samples were submitted to the laboratory along with a completed chain of custody
form to the above listed NVLAP accredited laboratory for analysis by polarized light
microscopy (PLM) techniques per EPA methodology (EPA -600/M4-82-020, Dec. 1982).
Microscopic visual estimation was used in obtaining the percentage of asbestos within
each layer of the bulk samples.
Asbestos Containing Building Materials
EPA and CDPHE both define an asbestos containing building material (ACBM) as a
material which has an asbestos content of greater than one percent. In the event that a
friable material is estimated to contain "trace" or between zero -to -one percent, that
material must undergo a point -count analysis by the laboratory to confirm that the
material is trace asbestos -containing. Further, if a point count analysis is performed on a
bulk sample, the point count result takes precedence over the visual estimation result.
See appendix A for laboratory report and chain of custody documents.
City of
Wheat Ridge
Section 5
Conclusion
Alta has performed a limited repair/renovation specific asbestos inspection of the
home/facility located at the Site Address. Through visual inspection and laboratory
analysis of bulk samples collected at the Site Address, Alta recommends hiring a certified
general asbestos abatement contractor to remove any ACBMs that may have been
identified within the scope of work. All inspection activities were conducted at the
direction of the client and only include those materials, quantities and locations detailed
in sections 1 and 2 of this report. See sections 1 and 2 of this report for information
regarding inspection scope of work, suspect ACBMs, confirmed ACBMs, sample
information and laboratory analysis results.
5.1 Limitations
General Comments and Limitations
Reasonable effort was made by Alta to locate and sample accessible suspect ACBMs
within the scope of work. However, for any structure, the existence of unique or
concealed suspect ACBMs is a strong possibility. Alta only inspected and collected suspect
ACBM bulk samples in the repair/renovation areas at the direction of the client. This
limited repair/renovation asbestos inspection report is not considered a comprehensive
asbestos inspection report and is only valid for the materials and locations detailed in
sections 1 and 2 of this report.
Should further repair/renovation work expand outside of materials and locations listed in
sections 1 and 2 of this report, those locations must be properly inspected and sampled
by qualified personnel prior to disturbance of suspect ACBMs. Any subsequent abatement
of ACBMs must be performed in accordance with all federal, state and local regulations
pertaining to abatement, transport, and disposal of ACBMs.
City of
Wheat Ridge
Diviso
The asbestos inspection was conducted in a manner consistent with the level of care and
skill exercised by professionals of the asbestos inspection profession. The results,
findings, conclusions and recommendations expressed in this report are based on
conditions observed during our limited inspection of the repair/renovation areas. The
information contained in this report is relevant to the date on which this survey was
performed, and should not be relied upon to represent conditions at a later date. This
report has been prepared on behalf of and exclusively for use by the client for specific
application to the project as discussed. Contractors or consultants reviewing this report
must draw their own conclusions regarding further investigation or remediation deemed
necessary. Alta does not warrant the work of regulatory agencies, laboratories or other
third -parties supplying information which may have been used in the preparation of this
report. No warranty, express or implied is made.
Sincerely,
r
Joshua Masek
Alta Environmental LLC
3924 S. Wadsworth Blvd #208
Lakewood, CO 80235
303.669.7007
contact@AltaEnv.CO
city of
Wheat Ridge
Appendix A
Laboratory Report and Chain Of Custody Form
City of
Wheat Ridge
Reservoirs Environmental, Inc. Effective April 2, 2018
Reservoirs Environmental QA Manual Q:\QAQC\Lab\Reservoirs Environmental QA Manual.doc
RE� - -
T
Reservoirs En vironmen tal, Inc.
March 21, 2019
Josh Masek
Alta Environmental Colorado
7045 W. 37th Ave
Wheat Ridge CO 80033
Dear Customer,
Subcontract Number:
Laboratory Report:
Project # / P.O. #
Project Description:
NA
RES 430889-1
20190321-1
6814 W. 37th Ave., Wheat Ridge,
CO
Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and
Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0
for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American
Industrial Hygiene Association (AIHA), Lab ID 101533 - Accreditation Certificate #480 for Phase Contrast
Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs
respectively.
Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The
analysis has been completed in general accordance with the appropriate methodology as stated in the attached
analysis table. The results have been submitted to your office.
RES 430889-1 is the job number assigned to this study. This report is considered highly confidential
and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with
personnel other than those of the client. The results described in this report only apply to the samples analyzed.
This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the
U.S. Government. This report shall not be reproduced except in full, without written approval from Reservoirs
Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any
questions about this report, please feel free to call 303-964-1986.
Sincerely,
Jeanne Spencer
President
P:303-964-1986
F: 303-477-4275
5801 Logan Street, Suite 100 Denver, CO 80216
Page 1 of 1
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41 CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
'(303) 235-2855 Office # (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: -,(- U �,- � r -
Job Address: (j
Permit Number: 0 C)
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L) No one available Tor inspection: Time AM/PM
Re -inspection required: Yes i No
When corrections have been made, call for re -inspection at 303-234-5933
Date: � f. ( -7 1 C (—Inspector:
DO NOT REMOVE THIS NOTICE
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION
City of Wheat Ridge
Commercial Remodel PERMIT - 201900552
201900552
6814 W 38th Ave
SWO Add one wall
- 240 sq ft total
ISSUED: 04/16/2019
EXPIRES: 04/15/2020
*** CONTACTS ***
OWNER (303)432-3789 SAMUELS DAVID
GC (720)642-7310 PAUL MALONE 150114 DIRC HOMES LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: UA / Unassigned BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,245.92
FEES
Total Valuation 0.00
Plan Review Fee 91.59
Use Tax 110.16
Permit Fee 140.90
Investigative Fees 140.90
** TOTAL ** 483.55
*** COMMENTS ***
*** CONDITIONS ***
All roughs to be done at Framing Inspection.
Approved per plans and red -line notes on plans. Must comply with 2012 IBC, 2017 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
**Prior to final inspection approval - As-builts are required before approval of the
Building Final Inspection and Certificate of Occupancy can be issued.
City of Wheat Ridge
Commercial Remodel PERMIT - 201900552
PERMIT NO: 201900552 ISSUED:
JOB ADDRESS: 6814 W 38th Ave EXPIRES:
JOB DESCRIPTION: SWO Add one wall - 240 sq ft total
04/16/2019
04/15/2020
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications2
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 ermIt. I fu rthe�att�rstrthatLally authorized to include all entities named within this document as parties to the work to be
performed and that 11 o to rmed 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.
Thispermit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Offcial and is not guaranteed.
4. No work of any manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordinance or r elation of this jurisdiction. Approval of work is subject to field inspection.
1�K
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Lily of
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COMMUNITY DEVELOPMENT
Building & Inspection Services
7500 W. 29"' Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: perm its(aki.wheatridge.co.us
4I1
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FOR OFFICE USE ONLY
Date: �/ ✓� � / / l�
Plan/Permit #
Plan Review Fee:
U076
Building Permit Application
*** Complete all applicable highlighted areas on both sides of this form.
Incomplete applications may not be processed. ***
Property Address:
Owner (please print): J ow 1
Property Owner Email:
Tenant Name (Commercial Projects Only)
Property Owner Mailing Address: (if different than property address)
Address:
State, Zi
Architect/Engineer E-mail:
Contractor Nan
Phone::/
G(,i 4L--rv-- .
City of Wheat Ridge License M. ISO I ' / Phone: 77o-1 q2 -731(1 -
Contractor
2'73/GContractor E-mail Address:_ (I MT -o (') Da( Hogq� _ /O,A
For Plan Review Questions & Comments (please print):
CONTACT NAME (please print): TAt iF � Phone: 7Z6�7
N� -,7z OG
CONTACT EMAIL(p/ease print): r IIATr �rlvd Ar(0. CUM
k3_3
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.
P�/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.
s- rg-e--z" 4-M
Sq. FULF BTUs AW -Gallons
Amps Squares For Solar: KIN # of Panels Requires Structural
For Commercial Projects Only: Occupancy Type: Construction Type: �19
Jtj�n, ��L� Occupancy Load: Square Footage: —=6a, tc�—'
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or
regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are
accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance
with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner
or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any
entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the
truthfulness of the information provided on the application.
CIRCLE ONE:
Signature (first
Printed Name:
DEPARTMENT USE ONLY
ZONING COMMMENTS:
Reviewer:
(OWNER)) (CONTRACTOR)
t,TE / 24"V %
OCCUPANCY CLASSIFICATION:
CONSTRUCTION TYPE: � 5
BUILDING DEPARTMENT COMMENTS: 3 [� +� X �l) ri _ t.] x C/17
Reviewer: ► Ll
PUBLIC WORKS COMMENTS:
Reviewer:
Building Division Valuation: Z. a yS 9'--�
Jill Samuels 303-912-0606
From: NoReply@mobile-eyes.com
Sent: Wednesday, March 27, 2019 3:21 PM
To: Jill Samuels 303-912-0606
Subject: Permit application accepted - West Metro Fire Protection District
Your permit request for Vacant at 6814 West 38th Avenue Wheat Ridge, CO 80033 has been accepted.
The Job Number is: 190327006
Description: placing new walls and flooring
Thank you for submitting to West Metro Fire. Our typical review turnaround is approximately 4-5 weeks.
If additional information is required, you'll receive a notice from the reviewer assigned, or a no -reply notice from
Mobile Eyes. Please be sure to check your junk folder if you feel you are not receiving the Mobile Eyes notices and
select "Not Junk".
NOTE: Re -submissions shall only include the pages that are affected and additional pages
that may be required for the needed corrections. Re -submission of full sets, unless
specifically requested, shall result in the rejection of plans.
A e_ CITY OF WHEAT RIDGE
_:�9�Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office ® (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: \J
7 I
Job Address:';''
Permit Number:
e ` '11 tn
k
r. .
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yds No
When corrections have been made, call for re -inspection at 303-234-5933
Date: f` f. y, ' d Inspector:
DO NOT REMOVE THIS NOTICE
DEPARTMENT OF PLANNING AND DEVELOPMENT
BUILDING INSPECTION DIVISION - 235-2855
CITY OF WHEAT RIDGE
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Building Permit Number: 4552
Date : 2/6/97
Property Owner :
Property Address : 6814 38TH AV Phone : 432-3789
Contractor License No.: 19362
Company : Action Signs Phone : 431 1182
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
Construction Value :
$800.00
1 hereby certify that the setback distances proposed by this permit application are accurate,
Permit Fee :
$15.00
and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or
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made are accurate; that I have read and agree to abide by all conditio printed on this
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application, and that I assume full res onsibility for comp a ce with the heat Ridge Building
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.
Code (U.B.C.) and all other applicabl
heat ge ordin ces, for wor under this p rmit.
Total :
$24.60
(OWNER)(CONTRACTOR) SIGNED
DATff
Description : REPAINT D REFACE 4'X 8'POLE SIGN
BUILDING DEPARTMENT USE ONLY
SIC: Sq. Ft.
Approval : SM 2/6197 6' OVERALL HT. (ATLEAST 5' SETBACK FROM FRONT PROPERTY
Zoning : C-1 LINE TO LEADING EDGE OF SIGN) PROPOSED SIGN WILL SET
BACK 16'1/2"
Approval :
NNENEEMNIM
Approval :
Occupancy : Walls : Roof : Stories : Residential Units
Electrical License No : Plumbing License No : Mechanical License No:
Company : Company : Company :
Expiration Date : Expiration Date : Expiration Date
Approval: Approval: Approval:
I m IN 01 i1110119IN10100
(1) This permit was issued in accordance with the provisions set forth in yopur application and is subject to the laws of the State of Colorado and to the Zoning
Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of the City.
(2) This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (B) the building authorized is suspended or
abandoned for a period of 120 days.
(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 are made or if suspension or abandonment
exceeds one (1) year, full fees shall be paid for a new permit.
(4) No work of any manner shall be done that will change the natural flow of water causing a drainage problem.
(5) Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive written approval on inspection card before
proceediing with successive phases of the job. -
(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 Abe building codes or any other ordinance, law, rule or regulation.
Lief Building Inspector
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR
CALL: 234-5933 24 HOURS PRIOR TO INSPECTION
DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number:
BUILDING INSPECTION DIVISION - 235-2855
CITY OF WHEAT RIDGE Date
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215 -
Property Owner: Cell7-e-IL
Property Address : g~~ W w~~r Phone : 3 2 3 7 ~g
Contractor License No.
Company : 5I g kx-r $kv_ Phone :
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value : 8 o a y
1 hereby certify that the setback distances proposed by this permit application are accurate, Permit Fee
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 Plan Review Fee
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 wit the Wheat Ridge Building Use Tax
Code (U.B.C.) and all, other applicable heat Ridge ordin nces, fo work under this permit.
mit~t.. C/~-/7
(OWNER)(CONTRACTOR) SIGNED - DAT C," Total :
Description: re4ace ( Yepa" { Cv~ erS ~C-t p e)e
ti'&' qx
Approval : Lj-r
Zoning : C -
Bulydtnno'" Fniiients
Approval:
Approval
Occupancy : Walls
BUILDING DEPARTMENT USE ONLY
(R' Bsler,u.Q~ I-k~~-~'- ~Z~e6tSfi 5'
Roof : Stories
SIC: Sq.Ft.: 32
.r
I(v) r/v
Residential Units :
Electrical License No
Company :
Plumbing License No:
Company :
Mechanical License No:
Company :
Expiration Date : Expiration Date : Expiration Date
Approval : Approval : Approval
8pla`ns~kR®~t7t~ed_. 81'IaRlied ~ula~s3RcdQidga..,,..
(1) This permit was issued in accordance with the provisions set forth in yopur application and is subject to the laws of the State of Colorado and to the Zoning
Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of the City.
(2) This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (B) the building authorized is suspended or
abandoned for a period of 120 days.
(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 are made or if suspension or abandonment
exceeds one (1) year, full fees shall be paid for a new permit.
4) No work of any manner shall be done that will change the natural flow of water causing a drainage problem.
5) Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive written approval on inspection card before
proceediing with successive phases of the'ob.
(6) The issuance of a permit or the approval o~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.
Chief Building Inspector
For Mayor
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR
CALL: 234-5933 24 HOURS PRIOR TO INSPECTION
DEPARTMENT OF COMMUNITY DEVELOPMENT
7500 WEST 29th AVENUE BUILDING INSPECTION DIVISION PERMIT NO. M92#17924
237-6944 EXT. 255 P.O. BOX 638 CITY OF WHEAT RIDGE, COLO.
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND RECEIPTED BELOW.
JOB ADDRESS v el f 7 w' _J6 - e1~ I OWNER
CONTRACTOR '-'G~✓-tJ ADDRESS S R I y Z° 3 8
ADDRESS/ NJ7e-r~~'LJ•y~ PHONE 'YE'_J0'-9 -ZIP CODE V022
CITY ~`~-E-~r--d-a•T~ ZIP CODE f0/-2 2- G. CONTRACT PRICE $
PHONE LICENSE 1, DATE tea 26 /9 9 z-
1. TYPE Groundo WGII❑ Proieeting❑ Other Sor D Face
SIGNS
2. MATERIAL Total Square Feet
3. ILLUMINATION Yes® No El Type Elect. Per vi
4. SET BACK FROM PROPERTY LINE N~ S_ E_ W e Zo A zone Ins ctor
(Specify which is front) ❑ ❑ ❑ Disapprove 'Zo'
1. TYPE Solid[:] More Than 80%a Open❑ Less Than 80% Open
FENCES
MATERIAL Height
3. SET BACK FROM PROPERTY LINE N_ S_ E_ W Zone- Apprwed,Zorn Inspector
(Specify which is front) ❑ ❑ ❑ ❑ Disapproved
I
.
2
OTHER
.
3.
DRAW SKETCH OR SHOW BELOW, THE FENCE, SIGN, OR OTHER STRUCTURE, GIVING DISTANCES FROM PROPERTY LINES.
(SETBACKS OR PROJECTIONS INCLUDED)
STREET NAME -3 o _ 6 &J
Y
z
x
N
SPECIFY NORTH
SHOW DISTANCES FROM THE MAIN BUILDING TO ADJOINING HOUSES, STREETS, AND PROPERTY LINES; ON IRREGULAR LOTS, SHOW LEAST
DISTANCE TO PROPERTY LINES, NOT MAXIMUM 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,
PERMIT WILL EXPIRE 180 DAYS FROM THE DATE OF ISSUANCE IF WORK IS NOT STARTED WITHIN THAT TIME.
ELECTRICAL PERMIT
STATE LICENSE NO.
PLUMBING PERMIT
STATE LICENSE NO.
MECHANICAL PERMIT
ALUMINUM WIRE UNDER SIZE 8 ILLEGAL
FLOOR
BSM
IST
2ND
3RD
4TH
NO.
FLEL:CWGOrw Gas011Pmmne Cool Elec Solar
NO.
WATER CLOSET
FORCED AIR - BTU
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-CIRCUITS
WATER HEATER
Refrigerant Group
UTILITY (RANGE, DISPOSER, ETC.)
AUTO. WASHER
Pounds Charge
FIXTURES
DISH WASHER
AUTOMATIC SPRINKLER SYSTEM
WIRING MOTORS a CONTROLS
FLOOR DRAIN
ELEVATOR
SIGNS
URINAL
TRANSFORMERS B RECTFIERS
SEWERS
ADDITION TO OLD WORK
OTHER
MOTORS OVER I HP
TOTAL FIXTURES
PERMIT FEE
I hereby acknowledge that this applica-
tion is correct and understand that I
USE TAX
li-
ct until this a
t
t this
oj
t
pp
ar
pr
s
e
canno
cation is approved. I shall comply with
TOTAL FEE
r
do and to
St
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f C
l
f th
a
o
a
e
e o
o
the laws o
the Zoning Regulations and Building
APPR
Code of the City of Wheat Ridge. Any
1
violation of the above terms will cause
CHIEF BUILDING
immediate revocation of this permit
&zg >r I Date
Appk,iinfe Signalure
NOT VALID.UNLES
"e~ l6R7
$a.3° lp o
City of Wheat Ridge
a x;7la-J3'
q &l4,E
CALL 237-6944 EXT. 255
24 HOURS IN ADVANCE
FOR INSPECTIONS