HomeMy WebLinkAbout5965-5975 W 30th Avenuei CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:�
Job Address: 2 tom( I)
Permit Number: -
❑ No one available for inspection: Tire
Re -Inspection required: Yes
When corrections have been made,
h ttp://www. ci. wheatridge.co. uslinspi
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CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: Z5 /17/
Job Address: 7S vv -70
Permit Number: ;7,,, 0 ?_,
-
Ll No one available for inspection: Time -,"AM/-PM
Re-Inspection required: Yes No
When corrections are complete, schedule re -inspection online.
Date: Inspector
DO NOT REMOVE THIS NOTICE
41 CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: 9
Job Address: �.S_ 14/
Permit Number: Z-0 40 0 4- 0 7 Z
,4 1 'Op'-Ot/0
J No one available for inspection: Time
Re -Inspection required: Yes No
When corrections are complete, schedule re -inspection online.
Date: Inspector:
DO NOT REMOVE THIS NOTICE
i
i CITY OF WHEAT RIDGE
�V, Building Inspection Division
(/ (303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: _ z
Job Address: 23LAZ
-% ?.-
Permit Number: 7 67 2e e?2 Z�-
f
❑ No one available for inspection: Time .'�` `45MRIPM
Re -Inspection required: Y( No
When corrections have been made, schedule for re -inspection online at:
http://www. ci. wheatridge. co. usfinspection
Datel 2- A-4 2C'Inspector: --5
DO NOT REMOVE THIS NOTICE
41 CITY OF WHEAT RIDGE
V, Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: � F /
Job Address: :�� .7f L -e-,
Permit Number: .29 -7 Z
�7
IV, __ f .- 1/
J No one available for inspection: Time AMOPM
Re -Inspection required: Yes, No
When corrections have been made, schedule for re -inspection online at:
http://Www. cL wheatridge. co. uslinspection
Date: i ?`- !6't�71nspector:
DO NOT REMOVE THIS NOTICE
1* ► � i City of Wheat Ridge
'/� Residential Roofing PERMIT - 202002093
PERMIT NO: 202002093 ISSUED: 10/15/2020
JOB ADDRESS: 5975 W 30th Ave EXPIRES: 10/15/2021
JOB DESCRIPTION: Residential re -roof with GAF asphalt shingles on house and attached garage.
Squares: 33; Pitch: 4/12
*** CONTACTS ***
OWNER (303)257-9808 BAKER W I L L I AM & BARBARA
SUB (720)280-3900 GREG MAKOWS KI 140212 RECOVERY ROOFING LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 15,000.00
FEES
Total Valuation 0.00
Use Tax 315.00
Permit Fee 283.55
** TOTAL ** 598.55
*** COMMENTS ***
*** CONDITIONS ***
ALL PITCHED ROOFS REQUIRE A MIDROOF INSPECTION REGARDLESS OF PITCH.
FOR ROOF PITCH 6/12 AND OVER: Midroof & Final Roof inspections for ROOFS with 6/12 PITCH &
OVER REQUIRE A 3RD PARTY INSPECTION. The 3rd party inspection report must be dropped off to
the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner.
REGARDING ROOF VENTILATION: Roof ventilation shall comply with Building Division Policy
BD -18-001 for Balanced Ventilation Systems, or manufacturer installation instructions,
whichever is more stringent.
MIDROOF & SHEATHING: Effective December 1, 2014, asphalt shingle installations require an
approved mid -roof inspection, conducted when 25-750 of the roof covering is installed,
prior to final approval. Installation of roof sheathing (new or overlay) is required on the
entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists.
Sheathing and mid -roofs may be called in at the same time, one hundred percent of the
sheathing must be complete and 25-750 of the mid -roof may be complete. Asphalt shingles are
required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and
water shield is required. Eave and rake metal is required.
LADDER MUST BE SET FOR ALL ROOF INSPECTIONS: A ladder extending 3 feet above the roof eave
and secured in place is required to be provided for all roof inspections.
COMMERCIAL ROOFS: In order to pass a final inspection of elastomeric or similar type roof
coverings, a letter of inspection and approval from the manufacturer technical
representative stating that "the application of the roof at (project address) has been
applied in accordance with the installation instruction for (roof material brand name) roof
covering" is required to be on site at the time of final inspection.
1* � � i City of Wheat Ridge
�� Residential Roofing PERMIT - 202002093
PERMIT NO: 202002093 ISSUED: 10/15/2020
JOB ADDRESS: 5975 W 30th Ave EXPIRES: 10/15/2021
JOB DESCRIPTION: Residential re -roof with GAF asphalt shingles on house and attached garage.
Squares: 33; Pitch: 4/12
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
thispermrt. I further attest that I am leg ally authorized to include alI entities named within this document as parties to the work to be
performed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) Date
1, This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This.permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180, days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and��procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all requ�ired
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, anviolation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
From: CommDev Permits
TO: Dina Kemp
Subject: Fw: Online Forth Submittal: Roofing Permit Application
Date: Sunday, December 13, 2020 4:00:52 PM
From: no-reply@ci.wheatridge.co.us <no -reply@ ci.wheatridge.co.us>
Sent: Thursday, October 15, 2020 10:14 AM
To: CommDev Permits
Subject: Online Form Submittal: Roofing Permit Application
Roofing Permit Application
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this property Residential
Commercial or
Residential?
How many dwelling Duplex
units are on the
property?
PROPERTY INFORMATION
Property Address 5975 W 30th Ave
Property Owner Name I AM Enterprises
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
Address
3032579808
greg@recovery-roofing.com
Do you have a signed Yes
contract to reroof this
property?
CONTRACTOR INFORMATION
Contractor Business Recovery Roofing
Name
Contractor's License 140212
Number
Contractor Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Address
7202803900
greg@recovery-roofing.com
Retype Contractor greg@recovery-roofing.com
Email Address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
DESCRIPTION OF WORK
TOTAL SQUARES of
the entire scope of
work:
Project Value (contract
value or cost of ALL
materials and labor)
WheatRidae Pay form.odf
33
15, 000.00
Are you re -decking the No
roof?
Is the permit for a flat
roof, pitched roof, or
both? (check all that
apply)
What is the specific
pitch of the PITCHED
roof?
How many squares are
part of the PITCHED
roof?
Pitched roof (2:12 pitch or greater)
er`Va
33
Describe the roofing
materials for the
PITCHED roof:
Type of material for the
PITCHED roof:
Provide any additional
detail here on the
description of work. (Is
this for a house or
garage? Etc)
GAF Armor Shield II
Asphalt
House and attached garage
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 Yes
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
I attest that everything Yes
stated in this
application is true and
correct and that
falsifying information in
this application is an
act of fraud and may
be punishable by fine,
imprisonment, or both.
Person Applying for Greg Makowski
Permit
Email not displaying correctly? View it in your browser.
.CITY OF WHEAT RIDgg , ,
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address: `
r
Permit Number:
❑ No one available for inspection: Tim#7f'_ �%AM/PM
Re -Inspection required: Ye,�C__I jo)
When corrections have been made, scheI le for re -inspection online at.
http✓/www.ci. wheatridge.co. uslinspectior ,
spec r:,
i CITY OF WHEAT RIDGE
�/- Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: a�---'
Job Address:
C:�C
Permit Number:
IJ No one available for inspection: Time/(��a DA/PM
Re -Inspection required`^
When corrections have been made, edul for re -inspection online at:
http //www.ci.wheatridge.co.u�nsp ction._
Dat: sect
x
CITY OF WHEAT RIDGE
<:1 - Building Inspection Division°
(303) 235-2855 Office :+ ;
INSPECTION NOTICE
Inspection Type: W.>
Job Address: � � .. _ 3e-,) -/ ;Z
;_; -
Permit Number:'
❑ No one available for inspection: Time / s AIV14cy
Re -Inspection required: Yes d
When corrections have been made, schedule for re -inspection online at:
httpYAvww.ci.wheatridge.co.us inspection
Date: /l `/ Inspector: -!
DO NOT REMOVE THIS NOTICE
Y 1,
y CITY OF WHEAT RIDGE
_t Building Inspection Division.-'
(303) 235-2855 Office'
INSPECTION NOTICE
Inspection Type: D L4/—S
Job Address: 4L�"_ !'—
Permit Number: _ 2 ;r d57 Z 17
❑ No one available for inspection:_ Time. 13�o A
Re -Inspection required: Yes 10
When corrections have been made, schedule for re -inspection online at:
http Owww.ci.wheatridge.co.us<nspection
Date: //- Y-202'( 2 Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address:
Permit Number:
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made, schedule for re -inspection online at:
http.lAvww.ci.wheatridge.co.uslinspection
Date:Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: fz x / f Al �� f
Job Address: ir_
Permit Number: c""C C 0 - C
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made, schedule for re -inspection online at:
http://www. ci. wheatridge. co. uslinspection
Date: / � ��''� � Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: _ 4Z ,0
Job Address:
Permit Number:
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made,-siedule for re -inspection online at:
http✓/www.ci.wheatridge.co.uslinspectioiy
i CITY OF WHEAT RIDGE
Building Inspection Division .
(303) 235-2855 Office
INSPECTION NOTIC
Inspection Type: t
Job Address:
Permit Number: r
❑ No one available for inspection: Time AMM
Re -Inspection required: Yes
When corrections have been made,s�h�e 1 re-�ns onlua�t:
httpJ/www.ci.wheatridge.co.us�nsp ction
Date 1,24wln'spector
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
❑ No one available for inspection: Time M/PM
Re -Inspection required: Yes No
When corrections have been made, schedule for re -inspection online at:
http✓/www. ci. wheatridge. co. us/inspection
Date:`'T✓ Inspector:',
DO NOT REMOVE THIS NOTICE
i CITY 00 WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: cc,/ rC 2 E-5
Job Address: _ 5 ��� t V a � ¢', A
Permit Number: ZQ2 ® OZ— fit j 7
r.
f r"" t`r v� s ��f s y r t r—
❑ No one available for inspection: Time AM/11
Re -Inspection required: Yes X'10.__'
When corrections have been made, schedule for re -inspection online at:
http✓/www. ci. wheatridge. co. usrnspection
Date: /0 z el_o?a inspector: ,,
DO NOT REMOVETHIS NOTICE
� A i = CITY OF WHEAT RIDGE
Y Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address: -7
Permit Number: 7_0 z 0 e
ts� f � _ ate.`. �'+%� �✓�ae� �;�- ��` �.ry g.'��''�+"_ i
❑ No one available for inspection: Time/'c' / AM64
Re -inspection required: Yes Ko
When corrections have been made, schedule for re -inspection online at:
http://www.ci.wheatridge.co.us inspection
Date:_ / -1- _020 Inspector:
DO NOT REMOVE THIS NOTICE
� ► � i City of Wheat Ridge
Residential Remodel PERMIT - 202002078
PERMIT NO: 202002078 ISSUED: 10/27/2020
JOB ADDRESS: 5975 W 30th Ave EXPIRES: 10/27/2021
JOB DESCRIPTION: SWO Interior remodel to include kitchen - new layout and appliances,
bathroom, all new electrical, new roof, new paint, flooring, furnace and
vents, evap cooler, new plumbing, relocate laundry room and gas stove in
kitchen - 768 sq ft total
*** CONTACTS ***
OWNER (303)257-9808
BAKER W I L L I AM &
BARBARA
GC (303)257-9808
BARBARA BAKER
100097 I AM ENTERPRISES,
INC.
SUB (303)289-2070
LLOYD LADD MATTHEW ROBLEDO
090062 ULTIMATE HEATING &
COOLING LLC
SUB (720)296-5786
ROSENDO RODRIGUEZ/JOSEPH MOLIM
130053 TED'S PLMB., HEAT
& SEWER
SUB (303)475-3660
DUSTIN GREEN
202249 GREEN ELECTRIC
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE: UA
/ Unassigned
SUBDIVISION CODE:
2412 / LAKESIDE,
STEWART GARDENS,
OLI BLOCK/LOT#: /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION: 44,000.00
FEES
Total Valuation
0.00
Plan Review Fee
429.36
Use Tax
924.00
Permit Fee
660.55
Investigative Fees
660.55
** TOTAL **
21674.46
*** COMMENTS ***
*** CONDITIONS ***
All roughs to be done at Framing Inspection.
A printed copy of the permit and city stamped on-site plans must be available on-site for
the first inspection.
Approved per plans and red -line notes on plans. Must comply with 2018 IRC, 2020 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
1* ► � i City of Wheat Ridge
'/� Residential Remodel PERMIT - 202002078
PERMIT NO: 202002078 ISSUED: 10/27/2020
JOB ADDRESS: 5975 W 30th Ave EXPIRES: 10/27/2021
JOB DESCRIPTION: SWO Interior remodel to include kitchen - new layout and appliances,
bathroom, all new electrical, new roof, new paint, flooring, furnace and
vents, evap cooler, new plumbing, relocate laundry room and gas stove in
kitchen - 768 sq ft total
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this�permrt. I further attest that I am leg ally authorized to include al entities entities named within this document as parties to the work to be
performed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) Date
1, This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180, days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and��procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all requ�ired
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, anviolation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
From: no-reolv(alci.wheatridae.co. us
To: CommDev Perm is
Subject: Online Form Submittal: Residential Interior Remodel
Date: Wednesday, October 14, 2020 7:11:48 AM
Residential Interior Remodel
This application is exclusively for Residential Interior Remodels and other scopes
of work which do not have a specific form already available.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
Your Permit will be emailed to the email address provided below once it is
processed.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
PROPERTY INFORMATION
Property Address
5975 W 30th Ave
Property Owner Name
William H & Barbara J Baker
Property Owner Phone
303-257-9808
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
thanksb@comcast.net
Address
Attach City of Wheat
Electronic -Payment -Form - sianed.odf
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
APPLICANT INFORMATION
Applicant Name
I AM Enterprises, Inc
What is your role in the
General contractor
project?
Wheat Ridge 100097
Contractor's License
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contact Phone Number 720-323-3336
(enter WITH dashes,
eg 303-123-4567)
Contact Email Address Jonathan@i-am-enterprises.com
for Plan Review
Comments
Retype Contractor Jonathan@i-am-enterprises.com
Email Address
0]:R16]CII91M0N]MYLO]M:/
Detailed Scope of
Full replacement of roofing. New entry doors, garage overhead
Work - In the space
door and all new interior doors. Replacing all windows. New
below (not as an
flooring in kitchen and bath. Updating bath to include new tile tub
attachment), Provide a
surround, new tub, toilet, vanity and plumbing fixtures. New
detailed description of
kitchen cabinets and countertop. All new kitchen appliances to
work including
include refrigerator, dishwasher, garbage disposal, gas range
mechanical, electrical,
and microwave range hood. Installing stackable washer and
plumbing work
dryer. All new paint for interior, exterior soffits and trim. Electrical
system will be updated to NEC 2020 with new service, sub panel
occurring,
and branch circuits for kitchen and bath remodels. All light
adding/removing walls,
fixtures, switches and receptacles to be replaced. HVAC work to
etc
include combustible air for furnace and vents for appliances and
bathroom. Evaporative cooler. Plumbing to include new
tub/shower valves, shut offs at all fixture locations, water heater,
new laundry location and adjustment to gas line for gas range.
Building 4'x8'x8' storage shed in back yard.
I, the applicant,
I have entered a detailed scope of work.
understand my
application will be
rejected if I do not
include a Detailed
Scope of Work.
Location of Work
Kitchen, living room, bedrooms, bath room, garage, backyard
and roof.
Square Footage Area
768 sf
of Work Being
Performed
Asbestos Report
Field not completed.
Upload letter size
Field not completed.
documents here
Construction Plans
scanned on 11'x17" or
larger
Project Value (contract $44,00(
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTAND
I assume full Yes
responsibility for
compliance with
applicable City of
Wheat Ridge codes
and ordinances for
work under any permit
issued based on this
application.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have Yes
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
Remodel: 768sf x $49 = $37,632
Windows: 8 x $300 = $2,400
Evap: $1,400
Elec Service: $1,750
Total: $43,232
Person Applying for Jonathan Austin
Permit
I attest that everything Yes
stated in this
application is true and
correct and that
falsifying information in
this application is an
act of fraud and may
be punishable by fine,
imprisonment, or both.
Email not displaying correctly? View it in your browser.
City of
91C(0Mk4MUNiTY Wheat idge
DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Electrical Subcontractor
This form must be completed & signed by the ELECTRICAL SUBCONTRACTOR
performing electrical work on site.
Subcontractor's insurance and license must be up to date prior to permit issuance.
Project Address: 5965 & 5975 W 30th Ave
General Contractor: I AM Enterprises, Inc.
FORM WILL NOT BE ACCEPTED WITH MISSING INFORMATION
Company Name: Uy Lo e rl &let k— C Contact Phone #: 303-'/ 75-'3�66?
Wheat Ridge Contractor License #: 20220 9 (required field)
State License #: 6 7 70
Master License #: 2 / b 7(
/7
I l(,s �01I U reel
Printed nted Name of Authorized Agent
Signature of Authorized Agent Date
1*�AI
IV
]AVV Wheat I i.dgie
COMMUNITY DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Mechanical Subcontractor
This form must be completed & signed by the MECHANICAL SUBCONTRACTOR
performing mechanical work on site.
Subcontractor's insurance and license must be up to date prior to permit issuance.
Project Address: 5965 & 5975 W 30th Ave
General Contractor:
I AM Enterprises, Inc.
FORM WILL NOT BE ACCEPTED WITH MISSING INFORMATION
Company Name: u 1+vv�o�k h4i�S d Colo 6 Contact Phone #:
Wheat Ridge Contractor License #: UR (required field)
Printed Nam4 of Authorized Agent
%Z61 TbL
Signature 6f Au hoorrizzed Agent
Io4ao
Date
te
9/City of
COMMUNITY Wheatl�idge
CDEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Plumbing Subcontractor
This form most be completed At signed by the PLUMBING SUBCONTRACTOR
performing plumbing work on site.
Submnttacmrs insurance and license must be up to dale prior to permit issuance.
Project Address: 52%5 W ioJss ii
GeneralCmntractur, x ¢m En1CI�t^IPCS
FORM WILL NOT BE ACCEPTED WITH MISSING INFORMATION
CompvoyNami'FIa..,A.y{//rza,.3 tLWIlContael Phori—l2_02Y6 5�si�
Wheat Ridge Contractor License p: 13]OS3(requlred Reld)
State License N. 00001G3
Mester License g: Yi 0
!o Mall✓,
Printed Name afAuthorized A
In/Iq/7 oan
Slgoatt Authorized Agent Date i
Scanned with CernScanner
City of
.kf.
COMC W heat �idge
MUNITY DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Plumbing Subcontractor
This toms must be completed & signed by the PLUMBING SUBCONTRACTOR
performing plumbing work on site -
Subcontractor's insmmucc and license must be up to dole prior to permit issuance.
Project Addren: .14b5
W
-JO Li.
General Contractor. L
Om
LnACrlrlg_.
c
Company Name -re A-SAumb IWr ,If l5eU Can �d Phone g: 1Z02Yb $�8�
Wheat Ridge Comanager Litton d: Ii00$3 fregvired Beldl
State Licmtse lf: fennn:4 6? I
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Asbestos Containing Materials Report
S
Best
Environmental
Services
Testing
Prepared for:
Barbara Baker
I -AM- Enterprises
Sampling Location:
5975 W. 30th Avenue
Wheat Ridge, CO 80214
No ACM Found - RS
10/16/20
October 15th, 2020
Project# OCT1520EO-02
2705 S. Kendall Way
Denver, CO 80227
303-549-7118
susanannon@comcast.net
S
Best
Environmental
Services
Testing
2705 S. Kendall Way
Denver, CO 80227
Asbestos Containing Materials Report
(Limited Asbestos Building Inspection)
I rill :1441•] aK•7 01111 =I 0111 M
SECTION
I. Introduction pg. 3
II. Visual Inspection pg. 3
III. Testing Conducted pg. 3
IV. Results pg. 4
V. Recommendation pg. 6
VI. Limitations pg. 4-6
VII. Attachments pg. 6-12
Page 2 of 12 5 BEST LLC
S
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October 16th. 2020
I. Introduction
2705 S. Kendall Way
Denver, CO 80227
This inspection report and subsequent attachment(s) serve to document the limited asbestos
sampling for the property located at 5975 W. 30th Ave. Wheat Ridge, CO 80214 on October
15th, 2020. Erin Orthun, a Colorado Licensed Asbestos Building Inspector (CDPHE# 21523)
with S BEST LLC, conducted sampling for suspect asbestos containing building material
(ACBM) in the wall materials in the kitchen and bathroom. No other materials outside this scope
were sampled at this time.
II. Visual Inspection
An investigation of the areas where potential asbestos containing materials were suspected was
conducted. Construction materials were visually examined, and suspect materials were sampled
and hand delivered to the laboratory for PLM analysis. Every reasonable effort was made to
identify suspect materials in all areas to be affected by upcoming renovations; however, it is still
possible that suspect materials may be discovered in hidden spaces such as behind walls and
ceilings or under flooring, which would require further testing.
III. Testing Conducted
The inspection was completed in accordance with the standards and practices of the state and
federal regulations in effect at this time of the report, including but not limited to the Colorado
Department of Public Health and Environment (CDPHE) Air Quality Control Commission
Regulation No. 8 Part B Asbestos (5 CCR 1001-10, Part B), and the U.S. Environmental
Protection Agency (EPA) Asbestos Hazard Emergency Response Act (AHERA) (40 CFR 763
Subpart E).
The number of samples taken for each homogeneous area corresponds to the specific quantity
of material to be disturbed (quantities listed in the table below). Sampling locations were
selected randomly to represent the entire sampling area. Any further renovation activities that
may disturb suspect materials other than those identified for this survey, including larger areas
of materials already sampled for this survey, may require further testing and should be
completed only after additional sampling of such materials has been conducted.
Three (3) samples were collected in sealed sampling bags. Samples were hand delivered to the
lab for asbestos analysis.
Page 3 of 12 5 BEST LLC
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IV. Results
2705 S. Kendall Way
Denver, CO 80227
Samples were analyzed by PLM analysis at Aerobiology Laboratory Associates Inc, a NIST
accredited laboratory (NVLAP#200860). The analysis has been completed in accordance with
the appropriate methodology as stated in the laboratory report (see attached).
The results from the submitted samples are listed in the table below. All layers of the materials
were tested. Any materials or locations not listed below are excluded from this inspection and
must be presumed to be ACBM until sampled and reported otherwise.
Map
Sample
Area
Fria
Description
Sampling location
Asbestos Results
Cond.
Qty.
ID
number
represented
ble
5975
1
Kitchen S. Wall
All Layers ND
PL1-1
Texture over
Walls in
Plaster with
Kitchen and
250
2
5975-
Drywall
(Multiple Layers)
Bathroom
Kitchen W. Wall
All Layers ND
Yes
Damaged
sq. ft.
PL1-2
(HA1)
Surfacing
5975-
3
PL1-3
Bathroom W. Wall
All Layers ND
I\\I�H\\C7�Ta�Z�in'3i�'ifI�TF.R�i7L3i�1C�
Friable asbestos, when dry, can be crumbled, pulverized, or reduced to powder by hand pressure, and
includes previously non friable material such as floor mastic after such previously non friable material
becomes damaged.
V. Recommendation
All samples are none detected for asbestos.
Please note that the scope of this inspection only included testing for asbestos materials, and no
other hazards such as lead based paint, radon, mold, or otherwise were included unless
reported separately. This report is prepared solely for your use, and reliance on it by any other
parties is not authorized and all liability for unauthorized use is disclaimed.
VI. Limitations
Services were performed with the level of skill and care that conforms to standard industry
practice. The objective of this project was to identify the presence of asbestos for the awareness
and safety of the workers. This report is not intended to be used for billing, budgeting or bidding
Page 4 of 12 5 BEST LLC
S
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Services
Testing
2705 S. Kendall Way
Denver, CO 80227
and is only for use at the location sampled. S BEST LLC is not responsible for any hazards or
risks other than those included in this report. This report is only for use at the location sampled.
If you have any questions, or need further assistance, please contact S BEST.
Prepared by:
J
Susan Bailey
Owner/Senior Consultant
Industrial Hygienist
AMS/BI (13996)
RA (13355)
HAZWOPER
15r� �i /I ui+
Erin Orthun
Industrial Hygienist
BI (21523)
Meth. Consultant (ML -1356)
HAZWOPER
Mold Professional
Asbestos Consulting Firm (ACF -25582)
Asbestos Laboratory (AL -21765)
Meth. Consulting Firm (ML -F133)
Disclaimer:
No evaluations beyond those described in the report have been made. As with any conclusions made based on
visual observations and/or random and limited sampling, there is an inherent possibility that undetected conditions
exist, and S BEST LLC does not accept liability for any such conditions. Sampling can be inherently intrusive and S
BEST, LLC does not accept liability for any damage to the property reasonably incurred during the scope of work
performed as outlined in this report. The only warranty expressed or implied is that the services were performed
with the level of skill and care that conforms to standard industry practice. Any reports issued are for the sole use of
the client and reliance on it by others is at their sole risk.
VII. Attachments
a. map pg. 6
b. lab results pg. 7-8
c. bulk inspection forms pg. 9
d. pictures pg. 10
e. firm certification pg. 11
f. inspector certification pg. 12
Page 5 of 12 5 BEST LLC
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Denver, CO 80227
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2705 S. Kendall Way
Denver, CO 80227
5975 W. 30th Avenue
Exterior
Bathroom
Kitchen
Kitchen
Page 10 of 12 S BEST LLC
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5975 W. 30th Avenue
Exterior
Bathroom
Kitchen
Kitchen
Page 10 of 12 S BEST LLC
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Colorado Department
of public Health
and Environment
ASBESTOS
CERTIFICATION''`
This certifies that
Erin Ortllun
Certi£catioa No.: 21523
has met the requirements of 25-7-507, C.R.S. and Air Quality Control
Commission Regulation No. 8, Part B, and is hereby certified by the
state of Colorado in the following discipline:
Building Inspector-*
Issu¢d: Juu¢ 01, 2020
Expires: April 30, 2021
7'/,/s .-sN[1[eu[� tr vn[)d only w[e[, [ha Poasrssion to
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Page 12 of 12 S BEST LLC
AEROb olociy LAbORATORy
ASSOCIATES, INCORPORATED
Expertise Since 1997
Client Name
Street Address
City, State ZIP
Attn:
Client Project Name:
Test Requested:
Method:
S. BEST, LLC
2705 S. Kendall Way
Denver, CO 80227
Erin Orthun
OCT1520EO-02 / 5975 W. 30th Ave.
3002, Asbestos in Bulk Samples
Certificate of Analysis
TESTING
NVLAP Lab Code 200860-0
780 Simms Street
Suite 104
Golden, CO, 80401
303.232.3746
www.aerobiology.net
Date Collected:
10/15/2020
Date Received:
10/15/2020
Date Analyzed:
10/15/2020
Date Reported:
10/15/2020
Project ID:
20044175
EPA 600/R-93/116: Method for Asbestos in Bulk Building Materials, EPA -- 40 CFR Appendix E to Subpart E of Part 763, Interim Method for Asbestos in Bulk Insulation Samples
Sample Identification
Physical Description of Sample/Layer
Homo-
geneous
(YN)
Layer
percentage
Asbestos Detected
Asbestos Percentage
Non -Asbestos
Fiber
Percentage
Non -Fibrous
Material
Percentage
Matrix
Material
Composition
Client
Lab Sample Number
5975-PL1-1
20044175-1A
Light Gray/Multicolored Paint
N
10
ND
100
20044175-1B
White Perlitic Plaster
N
20
ND
100
P
20044175-1C
Gray Granular Perlitic Plaster
N
5
ND
100
P,Q
20044175-1D
Gray/Brown Drywall
N
65
ND
45 CELL
55
G
5975-PL1-2
20044175-2A
Green Paint
N
1
ND
100
20044175-2B
White Perlitic Plaster
N
84
ND
100
P
20044175-2C
Gray Granular Perlitic Plaster
N
15
ND
100
P,Q
5975-PL1-3
20044175-3A
Yellow Resinous Material
N
2
ND
100
20044175-3B
Green Paint
N
1
ND
100
20044175-3C
White Perlitic Plaster
57
ND
100
P
20044175-31)
Gray Granular Perlitic Plaster
N
40
ND
100
P,Q
/ j
a� y
Anita Grigg
Laboratofy Analyst
Page 1 of 2
} Z
Shannon lNehittnora_
Aaba_sto3 Lab Sup_2r _iL or
AC = Actinolite
AM = moi0 to
AX = A nthophVlUte
AH = Animal Half
CELL = Celh:lose
FG = Fibrow Glass
B = Bines
C=cadte
D = Diatoms
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AERObIOlOGy LAbORATORy 780 Sinus Street
ASSOCIATES INCORPORATED Suite 804104
� Golden, CO. 804401
Expertisence Si1997 3bolog.3746
Certificate of Analysis www aerobiology net
Client Name S. BEST, LLC^nom n���® Date Collected: 10/15/2020
Street Address 2705 S. Kendall Way w v Date Received: 10/15/2020
City, State ZIP Denver, CO 80227 TESTING Date Analyzed: 10/15/2020
Attn: Erin Orthun NVLAP Lab Code 200860-0 Date Reported: 10/15/2020
Client Project Name: OCT1520EO-02 / 5975 W. 30th Ave. Project ID: 20044175
Test Requested: 3002, Asbestos in Bulk Samples
Method: EPA 600/R-93/116: Method for Asbestos in Bulk Building Materials, EPA -- 40 CFR Appendix E to Subpart E of Part 763, Interim Method for Asbestos in Bulk Insulation Samples
General Notes
• ND indicates no asbestos was detected; the method detection limit is 1 %.
• Trace or "< 1" indicates asbestos was identified in the sample, but the concentration is less than 1% and cannot be quantified without point counting.
• Samples identified as inhomogeneous (more than one layer) are separated into individual layers, and each layer is analyzed and reported separately.
11
All regulated asbestos minerals (i.e. chrysotile, amosite, crocidolite, anthophyllite, tremolite, and actinolite) were sought in every layer of each sample, but only those asbestos minerals detected are
listed. Amosite is the common name for the asbestiform variety of the mineral grunerite. Crocidolite is the common name used for the asbestiform variety of the mineral riebeckite.
• Tile, vinyl, foam, plastic, and fine powder samples may contain asbestos fibers of such small diameter (< 0.25 microns in diameter) that these fibers cannot be detected by PLM. For such samples,
more sensitive analytical methods (e.g. TEM, SEM, and XRD) are recommended if greater certainty about asbestos content is required. Semi -quantitative bulk TEM floor tile analysis is accepted
under NESHAP regulations.
• These results are submitted pursuant to Aerobiology Laboratory Associates, Inc.'s current terms and conditions of sale, including the company's standard warranty and limitation of liability
provisions. No responsibility or liability is assumed for the manner in which the results are used or interpreted.
• Unless notified in writing to return the samples covered by this report, Aerobiology Laboratory Associates, Inc. will store the samples for a minimum period of thirty (30) days before discarding. A
shipping and handling charge will be assessed for the return of any samples.
• Aerobiology does not guarantee the results of tape lifts, microvacs, wipe, and/or debris samples. Accurate analysis cannot be performed due to particle size, media used, and/or amount of material
given. Analysis of these materials should be preformed by a TEM. A result of ND does not indicate that the sample area does not contain ashestos. It means the analyst could not identify
ashestos in the specific sample for the reasons listed above.
Notes Required by NVLAP
• This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government.
• This test report relates only to the items tested or calibrated.
• This report is not valid unless it bears the name of a NVLAP-approved signatory.
• Any reproduction of this document must include the entire document in order for the report to be valid.
Page 2 of 2
ON SITE PLANS
MUST BE ON SITE FOR INSPECTION
ALL Projects are
Subject to Field Inspections
All work shall comply with:
• 2018 International Residential Code
• 2020 National Electrical Code
• State of Colorado Plumbing Code
#5965
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4'-11"- 13'-5 1/2" 10'-3 1/2"
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DRAWN BY: JEA
FILE:
596575 W 30th Permit Set
REVISION DATE:
10/8/2020
PROJECT TYPE
1 of 1
A- 1
� ► � i City of Wheat Ridge
Residential Remodel PERMIT - 202002077
PERMIT NO: 202002077 ISSUED: 10/27/2020
JOB ADDRESS: 5965 W 30th Ave EXPIRES: 10/27/2021
JOB DESCRIPTION: SWO Interior remodel to include kitchen, bathroom, all new electrical, new
roof, new paint, flooring, furnace and vents, evap cooler, new plumbing,
relocate laundry room and gas stove in kitchen - 768 sq ft total
*** CONTACTS ***
OWNER (303)257-9808
BAKER W I L L I AM &
BARBARA
GC (303)257-9808
BARBARA BAKER
100097 I AM ENTERPRISES, INC.
SUB (303)289-2070
LLOYD LADD MATTHEW ROBLEDO
090062 ULTIMATE HEATING & COOLING LLC
SUB (720)296-5786
ROSENDO RODRIGUEZ/JOSEPH MOLIM
130053 TED'S PLMB., HEAT & SEWER
SUB (303)475-3660
DUSTIN GREEN
202249 GREEN ELECTRIC
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE: UA / Unassigned
SUBDIVISION CODE:
2412 / LAKESIDE,
STEWART GARDENS,
OLI BLOCK/LOT#: 0 /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION: 44,682.00
FEES
Total Valuation
0.00
Plan Review Fee
436.83
Use Tax
938.32
Permit Fee
672.05
Investigative Fees
672.05
** TOTAL **
21719.25
*** COMMENTS ***
*** CONDITIONS ***
All roughs to be done at Framing Inspection.
A printed copy of the permit and city stamped on-site plans must be available on-site for
the first inspection.
Approved per plans and red -line notes on plans. Must comply with 2018 IRC, 2020 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
1* ► � i City of Wheat Ridge
'/� Residential Remodel PERMIT - 202002077
PERMIT NO: 202002077 ISSUED: 10/27/2020
JOB ADDRESS: 5965 W 30th Ave EXPIRES: 10/27/2021
JOB DESCRIPTION: SWO Interior remodel to include kitchen, bathroom, all new electrical, new
roof, new paint, flooring, furnace and vents, evap cooler, new plumbing,
relocate laundry room and gas stove in kitchen - 768 sq ft total
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this�permrt. I further attest that I am leg ally authorized to include 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 plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180, days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and��procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all requ�ired
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, anviolation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
From: no-reolv(alci.wheatridae.co. us
To: CommDev Perm is
Subject: Online Form Submittal: Residential Interior Remodel
Date: Wednesday, October 14, 2020 7:07:44 AM
Residential Interior Remodel
This application is exclusively for Residential Interior Remodels and other scopes
of work which do not have a specific form already available.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
Your Permit will be emailed to the email address provided below once it is
processed.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
PROPERTY INFORMATION
Property Address
5965 W 30th Ave
Property Owner Name
William H & Barbara J Baker
Property Owner Phone
303-257-9808
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
thanksb@comcast.net
Address
Attach City of Wheat
Electronic -Payment -Form - sianed.odf
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
APPLICANT INFORMATION
Applicant Name
I AM Enterprises, Inc
What is your role in the
General contractor
project?
Wheat Ridge 100097
Contractor's License
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contact Phone Number 720-323-3336
(enter WITH dashes,
eg 303-123-4567)
Contact Email Address Jonathan@i-am-enterprises.com
for Plan Review
Comments
Retype Contractor Jonathan@i-am-enterprises.com
Email Address
0]:R16]CII91M0N]MYLO]M:/
Detailed Scope of
Full replacement of roofing. New entry doors, garage overhead
Work - In the space
door and all new interior doors. Replacing all windows. New
below (not as an
flooring in kitchen and bath. Updating bath to include new tile tub
attachment), Provide a
surround, new tub, toilet, vanity and plumbing fixtures. New
detailed description of
kitchen cabinets and countertop. All new kitchen appliances to
work including
include refrigerator, dishwasher, garbage disposal, gas range
mechanical, electrical,
and microwave range hood. Installing stackable washer and
plumbing work
dryer. All new paint for interior, exterior soffits and trim. Electrical
system will be updated to NEC 2020 with new service, sub panel
occurring,
and branch circuits for kitchen and bath remodels. All light
adding/removing walls,
fixtures, switches and receptacles to be replaced. HVAC work to
etc
include new 80% furnace and flue, combustible air for furnace
and vents for appliances and bathroom. Evaporative cooler.
Plumbing to include new tub/shower valves, shut offs at all fixture
locations, water heater, new laundry location and adjustment to
gas line for gas range. Building 4'x8'x8' storage shed in back
yard.
I, the applicant,
I have entered a detailed scope of work.
understand my
application will be
rejected if I do not
include a Detailed
Scope of Work.
Location of Work
Kitchen, living room, bedrooms, bath room, garage, backyard
and roof.
Square Footage Area
768 sf
of Work Being
Performed
Asbestos Report
Field not completed.
Upload letter size
Field not completed.
documents here
Construction Plans
scanned on 11'x17" or
larger
5965 75 W 30th Permit Set.ndf
Project Value (contract $41,000
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTAND
I assume full Yes
responsibility for
compliance with
applicable City of
Wheat Ridge codes
and ordinances for
work under any permit
issued based on this
application.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have Yes
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
Kemoael: 766SI x �)4V = �0/,6J6
Windows: 8 x $300 = $2,400
Evap: $1,400
Furnace: $1,500
Elec Service: $1,750
Total: $44,682
Person Applying for Jonathan Austin
Permit
I attest that everything Yes
stated in this
application is true and
correct and that
falsifying information in
this application is an
act of fraud and may
be punishable by fine,
imprisonment, or both.
Email not displaying correctly? View it in your browser.
1*�AI
IV
]AVV Wheat I i.dgie
COMMUNITY DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Mechanical Subcontractor
This form must be completed & signed by the MECHANICAL SUBCONTRACTOR
performing mechanical work on site.
Subcontractor's insurance and license must be up to date prior to permit issuance.
Project Address: 5965 & 5975 W 30th Ave
General Contractor:
I AM Enterprises, Inc.
FORM WILL NOT BE ACCEPTED WITH MISSING INFORMATION
Company Name: u 1+vv�o�k h4i�S d Colo 6 Contact Phone #:
Wheat Ridge Contractor License #: UR (required field)
Printed Nam4 of Authorized Agent
%Z61 TbL
Signature 6f Au hoorrizzed Agent
Io4ao
Date
City of
.kf.
COMC W heat �idge
MUNITY DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Plumbing Subcontractor
This toms must be completed & signed by the PLUMBING SUBCONTRACTOR
performing plumbing work on site -
Subcontractor's insmmucc and license must be up to dole prior to permit issuance.
Project Addren: .14b5
W
-JO Li.
General Contractor. L
Om
LnACrlrlg_.
c
Company Name -re A-SAumb IWr ,If l5eU Can �d Phone g: 1Z02Yb $�8�
Wheat Ridge Comanager Litton d: Ii00$3 fregvired Beldl
State Licmtse lf: fennn:4 6? I
Mager License p: 00 18 024 E 0
ymq M01 Vl°s
Printed Name fAuthorlud Agent
to/13/LoZr)
SI ur fAmihoriutl Agent Oah
Scanned with CamScanner
City of
.kf.
COMC W heat �idge
MUNITY DEVELOPMENT
SUBCONTRACTOR AUTHORIZATION FORM
Plumbing Subcontractor
This toms must be completed & signed by the PLUMBING SUBCONTRACTOR
performing plumbing work on site -
Subcontractor's insmmucc and license must be up to dole prior to permit issuance.
Project Addren: .14b5
W
-JO Li.
General Contractor. L
Om
LnACrlrlg_.
c
Company Name -re A-SAumb IWr ,If l5eU Can �d Phone g: 1Z02Yb $�8�
Wheat Ridge Comanager Litton d: Ii00$3 fregvired Beldl
State Licmtse lf: fennn:4 6? I
Mager License p: 00 18 024 E 0
ymq M01 Vl°s
Printed Name fAuthorlud Agent
to/13/LoZr)
SI ur fAmihoriutl Agent Oah
Scanned with CamScanner
Asbestos Containing Materials Report
S
Best
Environmental
Services
Testing
Prepared for:
Barbara Baker
I -AM- Enterprises
Sampling Location:
5965 W. 30th Avenue
Wheat Ridge, CO 80214
No ACM Found - RS
10/16/20
October 15th, 2020
Project# OCT1520EO-03
2705 S. Kendall Way
Denver, CO 80227
303-549-7118
susanannon@comcast.net
S
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Environmental
Services
Testing
2705 S. Kendall Way
Denver, CO 80227
Asbestos Containing Materials Report
(Limited Asbestos Building Inspection)
I rill :1441•] aK•7 01111 =I 0111 M
SECTION
I. Introduction pg. 3
II. Visual Inspection pg. 3
III. Testing Conducted pg. 3
IV. Results pg. 4
V. Recommendation pg. 6
VI. Limitations pg. 4-6
VII. Attachments pg. 6-12
Page 2 of 13 5 BEST LLC
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October 16th. 2020
I. Introduction
2705 S. Kendall Way
Denver, CO 80227
This inspection report and subsequent attachment(s) serve to document the limited asbestos
sampling for the property located at 5965 W. 30th Ave. Wheat Ridge, CO 80214 on October
15th, 2020. Erin Orthun, a Colorado Licensed Asbestos Building Inspector (CDPHE# 21523)
with S BEST LLC, conducted sampling for suspect asbestos containing building material
(ACBM) in the wall materials in the kitchen and bathroom. No other materials outside this scope
were sampled at this time.
II. Visual Inspection
An investigation of the areas where potential asbestos containing materials were suspected was
conducted. Construction materials were visually examined, and suspect materials were sampled
and hand delivered to the laboratory for PLM analysis. Every reasonable effort was made to
identify suspect materials in all areas to be affected by upcoming renovations; however, it is still
possible that suspect materials may be discovered in hidden spaces such as behind walls and
ceilings or under flooring, which would require further testing.
III. Testing Conducted
The inspection was completed in accordance with the standards and practices of the state and
federal regulations in effect at this time of the report, including but not limited to the Colorado
Department of Public Health and Environment (CDPHE) Air Quality Control Commission
Regulation No. 8 Part B Asbestos (5 CCR 1001-10, Part B), and the U.S. Environmental
Protection Agency (EPA) Asbestos Hazard Emergency Response Act (AHERA) (40 CFR 763
Subpart E).
The number of samples taken for each homogeneous area corresponds to the specific quantity
of material to be disturbed (quantities listed in the table below). Sampling locations were
selected randomly to represent the entire sampling area. Any further renovation activities that
may disturb suspect materials other than those identified for this survey, including larger areas
of materials already sampled for this survey, may require further testing and should be
completed only after additional sampling of such materials has been conducted.
Three (3) samples were collected in sealed sampling bags. Samples were hand delivered to the
lab for asbestos analysis.
Page 3 of 13 5 BEST LLC
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IV. Results
2705 S. Kendall Way
Denver, CO 80227
Samples were analyzed by PLM analysis at Aerobiology Laboratory Associates Inc, a NIST
accredited laboratory (NVLAP#200860). The analysis has been completed in accordance with
the appropriate methodology as stated in the laboratory report (see attached).
The results from the submitted samples are listed in the table below. All layers of the materials
were tested. Any materials or locations not listed below are excluded from this inspection and
must be presumed to be ACBM until sampled and reported otherwise.
Map
Sample
Area
Fria
Description
Sampling location
Asbestos Results
Cond.
Qty.
ID
number
represented
ble
5965-
1
Kitchen W. Wall
All Layers ND
PL1-1
Texture over
Walls in
Plaster with
Kitchen and
250
2
5965-
Drywall
(Multiple Layers)
Bathroom
Kitchen S. Wall
All Layers ND
Yes
Damaged
sq. ft.
PL1-2
(HA1)
Surfacing
5965-
3
PL1-3
Bathroom E. Wall
All Layers ND
I\\I�H\\C7�Ta�Z�in'3i�'ifI�TF.R�i7L3i�1C3
Friable asbestos, when dry, can be crumbled, pulverized, or reduced to powder by hand pressure, and
includes previously non friable material such as floor mastic after such previously non friable material
becomes damaged.
V. Recommendation
All samples are none detected for asbestos.
Please note that the scope of this inspection only included testing for asbestos materials, and no
other hazards such as lead based paint, radon, mold, or otherwise were included unless
reported separately. This report is prepared solely for your use, and reliance on it by any other
parties is not authorized and all liability for unauthorized use is disclaimed.
VI. Limitations
Services were performed with the level of skill and care that conforms to standard industry
practice. The objective of this project was to identify the presence of asbestos for the awareness
and safety of the workers. This report is not intended to be used for billing, budgeting or bidding
Page 4 of 13 5 BEST LLC
S
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Environmental
Services
Testing
2705 S. Kendall Way
Denver, CO 80227
and is only for use at the location sampled. S BEST LLC is not responsible for any hazards or
risks other than those included in this report. This report is only for use at the location sampled.
If you have any questions, or need further assistance, please contact S BEST.
Prepared by:
Susan Bailey
Owner/Senior Consultant
Industrial Hygienist
AMS/BI (13996)
RA (13355)
HAZWOPER
Erin Orthun
Industrial Hygienist
BI (21523)
Meth. Consultant (ML -1356)
HAZWOPER
Mold Professional
Asbestos Consulting Firm (ACF -25582)
Asbestos Laboratory (AL -21765)
Meth. Consulting Firm (ML -F133)
Disclaimer:
No evaluations beyond those described in the report have been made. As with any conclusions made based on
visual observations and/or random and limited sampling, there is an inherent possibility that undetected conditions
exist, and S BEST LLC does not accept liability for any such conditions. Sampling can be inherently intrusive and S
BEST, LLC does not accept liability for any damage to the property reasonably incurred during the scope of work
performed as outlined in this report. The only warranty expressed or implied is that the services were performed
with the level of skill and care that conforms to standard industry practice. Any reports issued are for the sole use of
the client and reliance on it by others is at their sole risk.
VII. Attachments
a. map pg. 6
b. lab results pg. 7-9
c. bulk inspection forms pg. 10
d. pictures pg. 11
e. firm certification pg. 12
f. inspector certification pg. 13
Page 5 of 13 5 BEST LLC
S
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Environmental 2705 S. Kendall Way
Services Denver, CO 00227
Testing
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Page 6 of 13 S BEST LLC
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S BEST LLC
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Denver, CO 80227
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Page 12 of 13 S BEST LLC
S
Best
Environmental
Services
Testing
f.
2705 S. Kendall Way
Denver. CO 80227
op'c
t
x 't
[ [H7
Colorado Department
of public Health
and Environment
ASBESTOS
CERTIFICATION''`
This certifies that
Erin Ortllun
Certi£catioa No.: 21523
has met the requirements of 25-7-507, C.R.S. and Air Quality Control
Commission Regulation No. 8, Part B, and is hereby certified by the
state of Colorado in the following discipline:
Building Inspector-*
Issu¢d: Juu¢ 01, 2020
Expires: April 30, 2021
7'/,/s .-sN[1[eu[� tr vn[)d only w[e[, [ha Poasrssion to
o[rrmt 0(vf/lon-apPruvsd tralNr,g cour�� c�rljJlcuryon _ _ _ _ _
to lFr dlydp([ir apcc[Ji� abou� .eN Q
Page 13 of 13 S BEST LLC
AERObioloci LAboRATORy
ASSOCIATES, INCORPORATED
Client Name
Street Address
City, State ZIP
Attn:
Client Project Name:
Expertise Since 1997
S. BEST, LLC
2705 S. Kendall Way
Denver, CO 80227
Erin Orthun
OCT1520EO-03 / 5965 W. 30th Ave.
Test Requested: 3002, Asbestos in Bulk Samples
Certificate of Analysis
Hly
TESTING
NVLAP Lab Code 200860-0
780 Simms Street
Suite 104
Golden, CO, 80401
303.232.3746
www.aerobiology.net
Date Collected:
10/15/2020
Date Received:
10/15/2020
Date Analyzed:
10/15/2020
Date Reported:
10/15/2020
Project ID:
20044173
Method: EPA 600/R-93/116: Method for Asbestos in Bulk Building Materials, EPA -- 40 CFR Appendix E to Subpart E of Part 763, Interim Method for Asbestos in Bulk Insulation Samples
Sample Identification
Physical Description of Sample/Layer
Homo-
geneous
(Y�
Layer
Percentage
Asbestos Detected
Asbestos Percentage
Non -Asbestos
Fiber
Percentage
Non -Fibrous
Material
Percentage
Matrix
Material
Composition
Client
Lab Sample Number
5965-PL1-1
20044173-1A
Yellow Resinous Material
N
2
ND
100
20044173-1B
Light Green Paint
N
1
ND
100
20044173-1C
White Plaster
N
5
ND
100
G
20044173-1D
Gray Granular Perlitic Plaster
N
7
ND
100
P,Q
20044173-1E
Gray/Brown Drywall
N
85
ND
25 CELL
75
G
5965-PL1-2
20044173-2A
Gray Paint with White Texture
N
5
ND
100
G
20044173-2B
Light Gray/Multicolored Paint with Off-
White Texture
N
5
ND
100
C
20044173-2C
Off-White/Green Paint
N
1
ND
100
20044173-2D
White Perlitic Plater
N
15
ND
100
C,P
20044173-2E
Gray Granular Perlitic Plaster
N
54
ND
100
P,Q
All a."ZLire
�
Anita GGriER
Laboratory irialy }t
Page 1 of 3
1 !�
ShanfloII '%T�Iitmof2
Asbstas Lab Supe -.visor
AC = Actinalite
m Anthophyllit,e
rRaViNIM013TITli
l;;I •3i *r*rMTC3 'i'!'q
G = Ca:citf
CHRY a Chrysotile LW w h ineril Wool G ('rri'p&um
Cly 0 Cr*6&4>1it* OT m Oth*r tri Rik[3
T NI aTnm*Eit* n -N ■ S5nthat1c OX a Crwi'c
Tr m Trac# TL f Talc OP in O��
N -D = ?coni Ditwt*4 W = WgLutonik# P = F11rliti
Q = Q�Lrtz
T = Tar
V = Tef icalitf
AERObioloci LAboRATORy
ASSOCIATES, INCORPORATED
Client Name
Street Address
City, State ZIP
Attn:
Client Project Name:
Expertise Since 1997
S. BEST, LLC
2705 S. Kendall Way
Denver, CO 80227
Erin Orthun
OCT1520EO-03 / 5965 W. 30th Ave.
Test Requested: 3002, Asbestos in Bulk Samples
Certificate of Analysis
Hly
TESTING
NVLAP Lab Code 200860-0
780 Simms Street
Suite 104
Golden, CO, 80401
303.232.3746
www.aerobiology.net
Date Collected:
10/15/2020
Date Received:
10/15/2020
Date Analyzed:
10/15/2020
Date Reported:
10/15/2020
Project ID:
20044173
Method: EPA 600/R-93/116: Method for Asbestos in Bulk Building Materials, EPA -- 40 CFR Appendix E to Subpart E of Part 763, Interim Method for Asbestos in Bulk Insulation Samples
Sample Identification
Physical Description of Sample/Layer
Homo-
geneous
(y�
Layer
Percentage
Asbestos Detected
Asbestos Percentage
Non -Asbestos
Fiber
Percentage
Non -Fibrous
Material
Percentage
Matrix
Material
Composition
Client
Lab Sample Number
5965-PL1-2
20044173-2F
Gray/Brown Drywall
N
20
ND
50 CELL
50
G
5965-PL1-3
20044173-3A
Gray/White Paint
N
1
ND
100
20044173-3B
White Plaster
N
40
ND
100
G
20044173-3C
Gray Granular Perlitic Plaster
N
52
ND
100
P,Q
20044173-3D
Gray Granular Material
N
5
ND
100
Q
20044173-3E
Green Paint with White Plaster
N
2
ND
100
G
All a."ZLire
�
Anita GriQQ
Laborat inaly }t
Page 2 of 3
1 !�
shanfloII '%Vhitmof2
Asbstas Lab Supe -.visor
AC = Actinalite
m .nthophyllit,e
rRaViNIM013TITliM
l;;I •3i *r*rMTC3 'i'!'q
G = Ca:citf
F m 2 3 FeV,-,,41
CHRY a Chrysotile LW w hfineril Wool G ('rri'p&um
Cly 0 Cr*6&4>1it* OT m Oth*r tri hrWA
T NI aTnm*Eit* SYN ■ S5nthat1c OR a Crwi'c
Tr m Trac# TL f Talc OF in O��
N -D = ?coni Ditwt*4 W = WgLutonik# ? = pqffliti
Q = Quartz
T = Tar
V = Ten icalitf
AERObIOlOGy LAbORATORy 780 Sinus Street
ASSOCIATES INCORPORATED Suite 804104
� Golden, CO. 804401
303.232.3746
Expertisence Si1997
Certificate of Analysis www aerobiology net
Client Name S. BEST, LLC^nom n���® Date Collected: 10/15/2020
Street Address 2705 S. Kendall Way w v Date Received: 10/15/2020
City, State ZIP Denver, CO 80227 TESTING Date Analyzed: 10/15/2020
Attn: Erin Orthun NVLAP Lab Code 200860-0 Date Reported: 10/15/2020
Client Project Name: OCT1520EO-03 / 5965 W. 30th Ave. Project ID: 20044173
Test Requested: 3002, Asbestos in Bulk Samples
Method: EPA 600/R-93/116: Method for Asbestos in Bulk Building Materials, EPA -- 40 CFR Appendix E to Subpart E of Part 763, Interim Method for Asbestos in Bulk Insulation Samples
General Notes
• ND indicates no asbestos was detected; the method detection limit is 1 %.
• Trace or "< 1" indicates asbestos was identified in the sample, but the concentration is less than 1% and cannot be quantified without point counting.
• Samples identified as inhomogeneous (more than one layer) are separated into individual layers, and each layer is analyzed and reported separately.
11
All regulated asbestos minerals (i.e. chrysotile, amosite, crocidolite, anthophyllite, tremolite, and actinolite) were sought in every layer of each sample, but only those asbestos minerals detected are
listed. Amosite is the common name for the asbestiform variety of the mineral grunerite. Crocidolite is the common name used for the asbestiform variety of the mineral riebeckite.
• Tile, vinyl, foam, plastic, and fine powder samples may contain asbestos fibers of such small diameter (< 0.25 microns in diameter) that these fibers cannot be detected by PLM. For such samples,
more sensitive analytical methods (e.g. TEM, SEM, and XRD) are recommended if greater certainty about asbestos content is required. Semi -quantitative bulk TEM floor tile analysis is accepted
under NESHAP regulations.
• These results are submitted pursuant to Aerobiology Laboratory Associates, Inc.'s current terms and conditions of sale, including the company's standard warranty and limitation of liability
provisions. No responsibility or liability is assumed for the manner in which the results are used or interpreted.
• Unless notified in writing to return the samples covered by this report, Aerobiology Laboratory Associates, Inc. will store the samples for a minimum period of thirty (30) days before discarding. A
shipping and handling charge will be assessed for the return of any samples.
• Aerobiology does not guarantee the results of tape lifts, microvacs, wipe, and/or debris samples. Accurate analysis cannot be performed due to particle size, media used, and/or amount of material
given. Analysis of these materials should be preformed by a TEM. A result of ND does not indicate that the sample area does not contain ashestos. It means the analyst could not identify
ashestos in the specific sample for the reasons listed above.
Notes Required by NVLAP
• This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government.
• This test report relates only to the items tested or calibrated.
• This report is not valid unless it bears the name of a NVLAP-approved signatory.
• Any reproduction of this document must include the entire document in order for the report to be valid.
Page 3 of 3
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i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address:
Permit Number:
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made, schedule for re -inspection online at:
http://www. ci. wheatridge. co. uslinspection
Date: Inspector: .
DO NOT REMOVE THIS NOTICE
3D -4-k f 4L�-o- 2 c-,� 1,5 0 1 �-J L�,-)OAA-er 1--kk4-ee- Llo
INSPECTION REQUEST 0 234-5933
Inspections will not posted
Call the inspection
request w
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---------------
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one week In advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections # For -- t
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DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number : 11803
BUILDING INSPECTION LINE - 303-234-5933 Date : 2/22/2001
CITY OF WHEAT RIDGE
' 7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215 - (303-235-2855)
Property Owner :
Property Address : 5975 W. 30TH AVE Phone : 3032381629
Contractor l.icense No. : 17013
Company : MAJOR HEATING & AIR COND. Phone : 424-1622
OWNER/CONTR,4CTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposed by this permR application are accurate,
and do not violate applicable ordinances, rules or regulahons of the City of Wheat Ridge or
covenants, easements or restrictions of record; that all measurements shown, and allegations
made are accurete; that I have read and agree to abide by all conditions printed on this
application, and that I assume full responsibil for compliance ith the Wheat Ridge Building
Code (U.B.C.) and all other applicable Wt~eaidge ord'nsnc5, for work under this permit.
r
(OWNER)(CONTRACTOR)SIGNE, ~ ~Z"~
Description : INSTALL NEW FURNACE MODEL 58 PAV070
Construction Value :
$3,90050
Permit Fee :
$97.25
Plan Review Fee :
$0.00
Use Tax :
Total:
$97.25
Use:
BUILDING DEPARTMENT USE ONLY
SIC : Sq. Ft. :
Occupancy : Walis
TAX 00442
Roof : Stories
Residential Units :
Electrical License No :
Company :
Expiration Date :
Approval :
Plumbing License No :
Company:
Expiration Date :
Approval:
Mechanical License No : 17013
Company : MAJOR HEATING &
AIR COND.
Expiration Date : 2/22/2002
Approval:
(t) This pertnil was issuetl in accordance with the provisions set forth in yopur apDlication antl is subjed to the laws of the State oI Coloretlo and to the Zoning
Regula4ons and Building Code of Wheat Ridge, Coloredo or any other applicable ordinances of the Ciry.
(2) This permtt shall expire if (A) the work authorized is not commenced wiMin sizty (80) days from issue date or (B) the buildin8 euthorized is suspended or
ahantloned for a period of 120 days.
(3) If this pertnit expires, a new permit may be acquired for a fee of one-half the amount normally required, provided na chenges have been or will be matle in the
original plans ana specifications and any suspension or abandonment has not ezceeded one (t) year. If chan9es are made or if suspension or abandonment
pacceetls one (t) year, full tees shall be paid for a new pertnit.
(4) No work ot any manner shall Ge tlone that will change the natural flow of water causing a drainage problem.
(5) Contractor shall notlry the Builtling Inspeclor hventy-four (24) hours in atlvance for all inspections and shall receive written approval on inspectlon car0 before
proceediing with successive phases of the ob.
(e) The issuance of a perm' e approval tlrawings and specifications shall not be construed to be a pertnit for, nor an aDProval of, any violation of the provisions
of Me bulltling co n othe ce, law, rule or regulaNan.
Building Inspector
DEPARTMENT OF PLANNING AND DEVELOPMENT Buiiding Permit Number :
BUILDING INSPECTION DIVISION - 235-2855
CITY OF WHEAT RIDGE Date :
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215 APPLICATIo N
Property Owner : ~~G/rf/ ~CIGU~nr'
Property Address :S-975- u) lG
Contractor License No. : l'7c / 3
Phone : 303'-;~3 8 - /~z y
Company : 7P/~30 Phone : 3o3-el,2
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value
I hereby certiy that the setbaek distances praposed by this pertnit application aro aceurate, permit Fee :
and do not violate applicable ordinances, rules or regulaGons af the Cily of Wheat Ritlge or
covenants, easements or restrictions of rewrd; that all measurements shown, and aikgations
made are acwrate; that I have read and agree to abida by all condkions printed on this Use Tax : evD 41-~l~--
appliwtion, and that 1 assume full responsibilky r compliance +th the Wheat Ridge Building
Code (U.B.C.) and all other applicable Wt~Eat idge ord~nce~forr/ork under this pertnd. TOtal :
(OWNER)(CONTRACTOR) SIGNF~~~ USe
Description c-'
~
GL'✓LG~G~~~v ~i~"~' ✓j~~i~'~f~C4"1 C'I" -4z~~~~
BUILDING DEPARTMENT USE ONLY
SIC : Sq. Ft. :
Approval :
Zoning :
Approval :
Approval :
Occupancy : Walls : Roof
Electrical License No : Plumbing License No :
Company : Company :
Stories : Residential Units :
Mechanical License No : 1'7013
Company : z>7~9 .ra,^ if
Expiration Date : Expiration Date : Expiration Date :
Approvai : Approval : Approval :
(1) This permit was issued in aaaEance wifh the proviaions set forth in yopur applicaUOn end is subjeU to the laws of the State of CdoraCO anE to tthe.'nninp
Regulations and Builtling CoEe of VMeat Ritlge, ColoraCO w any other aDPIip01e wtlinantes of the Cily.
(2) This permft shall ezpire ff(A) the work authonzed is not commenceE wiNin aiMy (80) tlays from iaaue Cate or (B) the Duiltling authonzetl is suspenEetl or
abantlonetl for a periotl ot 120 Oays.
(3) If Mis pertnit expircs, e rrew pertnit may be acquiretl lor a fee of one-haM the amouM nortnalty requireQ provideE no changes have been or vnll Ee matle in the
oriqinal plans antl specificatians antl any auapenaion a abanOOnment haa rwt mcceetled wre (1) year. If changes are maEe or if auspansion w abanEOnmeM
exceetls one (1) year, NII fees shali be paid for a nev/ permiL
(a) No woiic of any manner shall be tlone Mat vnll change the notumi flwa o/ we[er wusing a tlrainage proDlem.
(5) Contraclor shall notiry the Builtlirp Ina twmry•tour (24) I+oun in advance lor all inspecuons ana ahall receive written approval on inapectlon cartl batorc
proceetliing with su rve phases Me pb.
(e) The issuance of a or I W tlrowinpa aM specifin5ons shell nM be mns4uetl W be a pertnil far, rwr an appioval ol, a'ry violatlan o1 the pmviaiona
o( the bulltlin s a inana, law, rule or regula6on.
Building Inspector
7500 WEST29th AVENUE
234-5933 P.O. BOX 638
ruie ocaw7 vG1 ID ONLY WHEN SIGNED
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING INSPECTION DIVISION
CITY OF WHEAT RIDGE, COLO.
TFiE CHIEF BUILDING INSPECTOR AND RECEIPTED BELOW.
JOB ADDRESS
CONTRACTOR
ADDRESS _
CITY
PHONE ~
SIGNS
FENCES
FOTHER
0
✓CG/7 ZIP CODE
- 14AG ~ LICENSE NO. 1
OWNER ~L~-/'L~-~!
ADDRESS s<i
PHONE • -~0
CONTRACT PRICE $ .
DATE
~ 9~-l
=-f---
I. TY7E Ground❑ Woll❑ Praieclinp❑ 01Mr SaDFOCe
2. MATERIAL Toral Squan Faat
3. ILWMINATION ria❑ No❑ TYCe Elect. Pamit No.
4 SET BACK FROM PROPERTY IINE N_ 5_ E_ W Zons_ ApMrn'b, Zo^e InSpOofa
' (Spxity which ia fronf ) ❑ ❑ ❑ ❑ Disopproved
i L TYPE Solid~ Mon Thon 80% Op&nO Lon Thon 80% OWn
MATERIAL
3. SET BACK FROM PROPERTY LINE
(SPecify which is }ront)
2.
i3.
HeipM
N, S_ g- W 2me_ ApDrwW,Zone ImDeeta
❑ ❑ ❑ ❑ DiscCMOVed
, n n
INSPECTION TICKET
b
DRAW SKETCH OR SHOW BELOW,TNE FENCE, SIGN, OR OTHER STRUCTURE,GNINo D joB i
(SETBACKS OR PROJECTIONS INCLUDED) ADDRESS c~ ~
I~~9u
DATE: BLDG. PE~iMITN rj ~G r3
PERMITB
BLDG. CONTR.
SUBCONTRACTOR
DATE INSP. REQ. G' v
STREET NP.ME
TYPE OF INSP. ~
SHOW DISTANCES FROM THE MAIN BUILDING TQADJOINING HOUSES, STREETS, AND PF u y~~
. ~
DISTANCE TO PROPERTY LINES, NOT MAXIMUM OR AVERAGE DISTANCE. INSPECTION MADE
APPUCATION FOR PLUMBING; ELECTRICAL; D
THIS APPLICATION WILL BECOME A PERMIT TO PERFORNi THE INDICATED WORK ONLV REMARKS
PERMIT WILL EXPIRE 180 DAYS FROM THE DATE OF ISSUANCE IF WO
ELECTRICAL PERMIT PLUMBING PERMIT
STATE LICENSE N0. STATE LICENSENO. G`"r
BSM I5T 2ND :
UMINUM WRE UNDER $IZE 8 IILEGAL FLOOR W.R. FORM 6-19
yyATER CIASET
TEMPORARY METER WASH BOWL /
rcw ecavicF - GMPS BATH TUB
HEATING
FI%TURES
R
WIRING MOTORS 9 CONTROLS
R DRAIN
-
SIGNS
AL
TRANSFORMERS d RECTFIERS
ERS
t
ADDITION TO OLD WORK
ER
OOT,
MOTORS OVER I HP
L FIXTURES
REMARKS
~
N IPTI
I hsrebY acknowledQe that this oDDllca-
I
PERMIT FEE _
tion u tonett and undentond that
USE TAX
connot ttort tnie project until this opvti'
cation is aDOroved. I snoll comply witn
TOTAL FEE
the lows of the Sto1e o1 Colorado and 10
tM Zoninp Repulations and Bwldinq
APPROVED_ ry,l
l (p
.
Code of the City of Wheaf Ridpe. AnY
e
n
DI
CHIEF BUILDI INSPECTOR,City of
Whiat Ridye
caus
violotion ot the above terme wi
n of tnis permit
CALL 234-5933
immediote revocouo
24 HOURS IN ADVANCE
/T-
Date Issued
FOR INSPECTIONS
PERMIT N0. M941i19613
' .~L "d f ~
~ ZIP CODE
7CC, e, C: