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Home My WebLink About10770 W. 46th Avenue1* � � i City of Wheat Ridge �� E -Res. Sewer/Waterline Repair PERMIT - 202100318 PERMIT NO: 202100318 ISSUED: 02/18/2021 JOB ADDRESS: 10770 W 46th Ave EXPIRES: 02/18/2022 JOB DESCRIPTION: Sewer repair, 10 feet in front yard installing clean outs. *** CONTACTS *** OWNER (720) 630-9181 MANES GLENN D SUB (303)287-9009 BRAD WAKEHAM 130022 TRENCH RIGHT LLC *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2408 / FRUITDALE, LEES, STONERIDGE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 51000.00 FEES Total Valuation 0.00 Use Tax 105.00 Permit Fee 125.05 ** TOTAL ** 230.05 *** COMMENTS *** *** CONDITIONS *** ALL sewer repair/replacements for which a permit is issued MUST be inspected by and receive written approval from the City of Wheat Ridge BUILDING DIVISION, regardless of inspection by any Sanitation District representative. Inspection and approval of work by any Sanitation District representative DOES NOT grant authority to cover work without the approval of the Building Division. **For trenchless sewer replacements - The contractor will verify proper slope of new sewer piping in conformance with the IRC and IPC of 1/4 inch per foot unless otherwise allowed specifically by the applicable code. The plumbing contractor will provide verification of proper slope and drainage in writing as a condition of approval of the permitted work.** Both the front and back of this permit are required to be posted on the job site at all times. If the complete permit is not present, inspections WILL NOT be performed. 1* � � i City of Wheat Ridge �� E -Res. Sewer/Waterline Repair PERMIT - 202100318 PERMIT NO: 202100318 ISSUED: 02/18/2021 JOB ADDRESS: 10770 W 46th Ave EXPIRES: 02/18/2022 JOB DESCRIPTION: Sewer repair, 10 feet in front yard installing clean outs. 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 �pplicabje code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. 02/18/2021 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.m. us To: CommDev Pets Subject: Online Form Submittal: Sewer or Water Line Repair Permit Application Date: Thursday, February 18, 20212:36:55 PM Sewer or Water Line Repair Permit Application This application is exclusively for SEWER OR WATER LINE REPAIR - IN YARD 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. Right of Way permits must be applied for with the Public Works Department. Is this application for Yes sewer line or water line repair - in yard only? PROPERTY INFORMATION Is this Residential or Residential Commercial? Property Address 10770 W 46TH AVE Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123- 4567) Property Owner Email Address Attach City of Wheat Ridge Electronic Payment Form - "DO NOT ATTACH A PICTURE OF A CREDIT CARD" GLENN MANES Field not completed. CONTRACTOR INFORMATION Contractor Business TRENCH RIGHT Name Contractor's License 130022 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-287-9009 Number (enter WITH dashes, eg 303-123- 4567) Contractor Email OFFICE@TRENCHRIGHT.COM Address Retype Contractor OFFICE@TRENCHRIGHT.COM Email Address DESCRIPTION OF WORK Is this a sewer line or Sewer Line water line repair? Length of repair 10, Location of repair FRONT YARD (backyard, frontyard, etc) Provide additional INSTALL CLEANOUTS details including installation of clean- o uts. Project Value (contract 5000 value or cost of ALL materials and labor) SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that work Yes may not begin on this 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 JASON LAMB Permit Email not displaying correctly? View it in your browser. City of Wheat Ridge Residential Roofing PERMIT - 201706242 PERMIT NO: 201706242 JOB ADDRESS: 10770 W 46th AVE ISSUED: 08/17/2017 JOB DESCRIPTION: Residential Re -roof to install Atlas Pinnacle asphalt08/h7/2018 s angles - 40 sq *** CONTACTS *** OWNER (303)425-5357 MANES GLENN D SUB (303)660-5133 Chris Horning&Christopher Teem 140211 Priority Restoration Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned SUBDIVISION CODE: 2408 / FRUITDALE, LEES, STONERIDGE BLOCK/LOT#: UA / Unassigned 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 11,000.00 Total Valuation FEES Use Tax 0.00 Permit Fee 231.00 ** TOTAL ** 220.15 451.15 *** COMMENTS *** *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) 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 25-75 percent 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. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastomeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. s i „q0/706,< � 4,— Occupancy/Type 720 cAJ, �t6 66 INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Cancellations must be submitted via the online form before 8 a.m_ the day of the inspection Inspections will not be performed unless this card is posted on the project site. **Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day.** Inspector Must Sign ALL Spaces pertinent to this project Date Inspector Comments Foundation Inspections Initials Pier Concrete Encased Ground (CEG) Foundation I P.E. Letter Do Not Pour Concrete Prior To Approval Of The Above Inspections Inspector Comments Underground/Slab Inspections Date Initials Electrical Sewer Service Plumbing Do Not Cover Underground or Below/In-Slab Work Prior To Date Inspectr Rough Inspections7 Initials; Wall Sheathing Mid -Roof Lath / Wall Tie Rough Electric ” Rough Plumbing/Gas Line Rough Mechanical Rough Framing Rough Grading Insulation Drywall Screw / Nail Date Inspector Final Inspections Initials Landscaping & Parking I Planning Dept. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection / Fire Protection Dist. Final Electrical Final Plumbing r Final Mechanical Roof Final Window/Doors I Of The Above I Comments Comments ons Inspections from these entities should be requested one week in advance. For landscaping and parking inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. Final Building NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. *For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage by the Building Division. Occupancy Is Not PermittThis Cardntil A 'ficate of From The Weather occupancy Is Issued Protect d City of Wheat Ridge Residential Mechanic PERMIT - 201703433 PERMIT NO: 201703433 ISSUED: JOB ADDRESS: 10770 W 46th AVE EXPIRES: JOB DESCRIPTION: Replacing existing furnace and adding A/C *** CONTACTS *** OWNER (303)425-5357 SUB (720)800-6655 SUB (303)421-2161 MANES GLENN D Douglas L Warman Stephen Lanyon 07/07/2017 07/07/2018 170049 Storm Electrical Services Inc. 017835 Blue Sky Plumbing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2408 / FRUITDALE, LEES, STONERIDGE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,900.00 FEES A/C Replacement 60.00 Furnace Replacement 40.00 Total Valuation 0.00 Use Tax 165.90 ** TOTAL ** 265.90 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicabble building codes, and all applicable municipal codes, policies and procedures, and that I an 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 permtt. I further attest that I am le 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 ai the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, 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 Bu ng Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequestgei.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. & INSPECTION RECORD Occupanc /Type INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/forms.aspx?fid=79� INSPECTION REQUEST LINE: (303) 234-5933 C; Inspections will not be performed unless this card is posted on the project site. Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.** Inspector Must Sign ALL Spaces pertinent to this project Foundation Inspections Date Inspector Comments Initials Pier Concrete Encased Ground (CEG) Foundation / P.E. Letter UO Not Four C:Oncrete Prior 10 Approval UT I ne Above Inspections Underground/Slab Inspections Date Inspector Comments _ Initials ir cal Sewer Service Plumbing Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections Rough Inspections Date Inspector Initials Comments Wall Sheathing Inspections from these entities should be requested one week in advance. For landscaping and parking inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. ROW & Drainage / Public Works Dept. Mid -Roof Fire Inspection / Fire Protection Dist. Lath / Wall Tie to Final Plumbing Rough Electric Final Mechanical 711 `%// Rough Plumbing/Gas Line Roof Rough Mechanical Final Building Rough Framing NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. Rough Grading Insulation Drywall Screw / Nail Final Inspections Date Inspector Initials Comments Landscaping & Parking / Planning Dept. Inspections from these entities should be requested one week in advance. For landscaping and parking inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection / Fire Protection Dist. Final Electrical to Final Plumbing Final Mechanical 711 `%// Roof Final Window/Doors Final Building NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. *For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather 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: En 1 "1 F l Job Address: 10-77 W H 6 AV6 Permit Number: 7-0)'70 3Y fr /'hF/ rev Veep. ❑ No one available for inspection: Time 10_5Q I/PM Re -Inspection required: Yes I When corrections have been made, call for re -inspection at 303-234-5933 Date: M6/%17 Inspector: 619P DO NOT REMOVE THIS NOTICE ► ' City of Wheat Ridge Residential Mechanic PERMIT - 201703433 PERMIT NO: 201703433 ISSUED: 07/07/2017 JOB ADDRESS: 10770 W 46th AVE EXPIRES: 07/07/2018 JOB DESCRIPTION: Replacing existing furnace and adding A/C *** CONTACTS *** OWNER (303)425-5357 SUB (720)800-6655 SUB (303)421-2161 MANES GLENN D Douglas L Warman Stephen Lanyon 170049 Storm Electrical Services Inc. 017835 Blue Sky Plumbing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2408 / FRUITDALE, LEES, STONERIDGE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,900.00 FEES A/C Replacement 60.00 Furnace Replacement 40.00 Total Valuation 0.00 Use Tax 165.90 ** TOTAL ** 265.90 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2014 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. I, by msignature, do hereby attest that the work to be performed shall comply with all accompanyingapproved plans and specifications, applicay le building codes, and all applicable municipal codes, policies and procedures, and that I am t e legal owner or have been authorized by the legal own of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with thisermit. I rt r attest that I am legally authorized to include all entities named within this document as parties to the work to be performed d t 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 V I. This permit was issued based on the information provided in thepermit 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 originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable code or any ordinance or r n of this jurisdiction. Approval of work is subject to field inspection. n t'. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ci.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. City of W heat�idg� COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 29" Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: Perm its(@.ci.wheatridge.co.us I FOR OFFICE USE ONLY I Date: Plan/Permit Plan Review Fee: Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: ) O3 q lfD W , 44 (.o+h Property Owner (please print): Phone: Property Owner Email: Mailing Address: (if different than property address) Address: City, State, Zi Architect/Engineer: Architect/Engineer E-mail: Contractor: I Phone: Contractors City License #: lea &-6s V Phone: 3 p-3 l 442-1 - zi co I Contractor E-mail Address: 12►�bl,u2sk.ul� �/N�� 1 X01 iL o Sub Contractors: y Electrical: 5NO( 1 Plumbing: Mechanical: W.R. City License # 1' 0041 61 W.R. City License # W.R. City License # Other City Licensed Sub: Other City Licensed Sub: City License # City License # Complete all information on BOTH sides of this form ❑ COMMERCIAL ESIDENT IAL Description of work: (Check all that apply) ❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE ❑ NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING ❑ COMMERCIAL ADDITION ❑ RESIDENTIAL ROOFING ❑ RESDENTIAL ADDITION ❑ WINDOW REPLACEMENT ❑ COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) 'O❑ IDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) IESCHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT ❑ PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT ❑ ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT ❑ OTHER (Describe) (For ALL projects, please provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc.) Sq. FULF Amps C i ex'6bn R) fY &UQ - Btu's I 10 U.— Squares Gallons Other / 1 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 prov the application. CIRCLE ONE: (OWNER) CONTRA OR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Electronic SiSnature (first and last name): .�.� �/ Q / DATE: / ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $ CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax,' INSPECTION NOTICE j Inspection Type: �/ \ 0 r Job Address: `7 20 w Permit Number: 7-0/706'Z,,-1'2 ❑ No one available for inspection: Time(-,// AM/PM Re -Inspection required: Yes` When corrections have been made, call for re-ins"ctidn at 303-234- Inspec 5933 Date: '�- / J tor: . City of Wheat Ridge Residential Roofing PERMIT - 201706242 PERMIT NO: 201706242 ISSUED: 08/17/2017 JOB ADDRESS: 10770 W 46th AVE EXPIRES: 08/17/2018 JOB DESCRIPTION: Residential Re -roof to install Atlas Pinnacle asphalt shingles - 40 sq *** CONTACTS *** OWNER (303)425-5357 MANES GLENN D SUB (303)660-5133 Chris Horning&Christopher Teem 140211 Priority Restoration Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2408 / FRUITDALE, LEES, STONERIDGE BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 11,000.00 FEES Total Valuation 0.00 Use Tax 231.00 Permit Fee 220.15 ** TOTAL ** 451.15 *** COMMENTS *** *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) 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 25-75 percent 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. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturer installation instructions, whichever is more stringent. In order to pass a final inspection of elastcmeric or similar type roof coverings, a letter of inspection and approval from the manufacturer technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. r City of Wheat Ridge Residential Roofing PERMIT - 201706242 PERMIT NO: 201706242 ISSUED: 08/17/2017 JOB ADDRESS: 10770 W 46th AVE EXPIRES: 08/17/2018 JOB DESCRIPTION: Residential Re -roof to install Atlas Pinnacle asphalt shingles - 40 sq 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 le ally authorized to include all entities named within this document as parties to the work to be perform and that all work to be orme is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER or CONTRAVOR (Circle one) Date 1. This permit was issued based on the formation 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 ermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dan Schultz q 0170 ,� Z THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 10770 W. 46th Ave Glenn Manes 303-425-5357 -Tns cOre4 e/�/!7 chrishorning@priority-restoration.com a O B This application is exclusively for new permits for residential roofs and for licensed c>_ aZ From: no-reply@ci.wheatridge.co.us to City Hall to submit an application in person. Permits are processed and issued ins Sent: Saturday, August 5, 2017 10:48 PM varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR To: CommDev Permits 1 ti Subject: Online Form Submittal: Residential Roofing Permit Application d p x -a documents at the time you are issued your permit. R Categories: Dane 1 For all other requests: S Homeowners wishing to obtain a roofing permit must apply for the permit in person 8 A, - Residential Roofing Permit Application A p_ i_ THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 10770 W. 46th Ave Glenn Manes 303-425-5357 -Tns cOre4 e/�/!7 chrishorning@priority-restoration.com a O B This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come 3 to City Hall to submit an application in person. Permits are processed and issued ins the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR �- PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE 1 ti AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those x -a documents at the time you are issued your permit. R o- 1 For all other requests: S Homeowners wishing to obtain a roofing permit must apply for the permit in person 8 at City Hall. Revisions to existing permits (for example, to add redecking) must be - completed in person at City Hall. All other non -roofing permits must be completed in- . person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 10770 W. 46th Ave Glenn Manes 303-425-5357 -Tns cOre4 e/�/!7 chrishorning@priority-restoration.com a O B Do you have a signed contract to reroof this property? It will need to be provided at the time of permit pick-up. Attached Copy of Contract Yes Manes Contract.pdf CONTRACTOR INFORMATION Contractor Business Name Contractor's License Number (for the City of Wheat Ridge) Contractor Phone Number Priority Restoration Inc. 140211 303-660-5133 Contractor Email Address chrishorning@priority-restoration.com Retype Contractor Email chrishorning@priority-restoration.com Address DESCRIPTION OF WORK Are you re -decking the No/ roof? Description of Roofing Atlas Pinnacle Weathered Shadow Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: / How many squares of the r material selected above? O ` Does any portion of the No / property include a flat roof? If yes, how many squares Field not completed. on the flat roof? TOTAL SQUARES 40 / (pitched + flat) of all i roofing material for this proj ect Provide additional detail here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract value or cost of ALL materials and labor) HOUSE AND GARAGE, 5/12 SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this Yes application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work Yes may not begin on this property until a permit has been issued and posted on the property. I certify that I have been Yes authorized by the legal owner of the property to submit this application and to perform the work described above. Name of Applicant Chris Horning Email not displaying correctly? View it in your browser. 3 CUSTOMER AGREEMENT j� 7340 South Alton Way 11-J, Centennial, CO 80112 Phone: 303-660-5133 1 Fax: 303-660-5148 Email: Info@Priority-Restoration.com LJ ®N Web: www.Priority-Restoration.com ff-RIIORIT Licensed & Insured • Locally Owned & Operated Property Owner �/� Email Los ��0451 . SVG% Date Date Street Address Priority Estimator City, State, Zip Insurance Company v-,-J� e� X33 PA C— Home Phone Work Phone Claim# 03- - z(2 ��% (,;)S - - 3 IJ No Deposit Required* LJ 20 Year Roof Labor Warranty IJ Gen. Liability/Workers' Comp. Z OSHA Certified Estimated I Estimated Full Partial Repair Start Date 1 l'1 Completion Date • • Full Partial Repair OUSE ARA PATIO SHED SHED2 Shingle / Color: Ak4, Q ;�-, rz-o` L,) . "SU J Drip Edge Color: ok,.:, ye -0 Inspect Decking Lr I Inspect Flashings Lr I Clean Up & Remove Trash L I Permit Damage: Yes No Type: STUCCO VINYL WOOD OTHER: Style: GUTTERS:(!♦ L.f.: _ W Color: Partial Repair Alum.C::je�:) Color: � ,. 6k Work to be completed according to the above specifications in the amount of: (not to include insurance supplements. permit costs or any unforeseen construction costs) pN� ® Balance due upon completion ❑ CASH SALE P9 INSURANCE AGREEMENT. The homeowner authorizes Priority Restoration, Inc. to represent their best interest in pursuit of full replacement costs for damages believed to be covered under homeowner's insurance and allows Priority Restoration, Inc. to deal directly with the insurance company regarding this claim. This contract does not obligate the homeowner or Priority Restoration, Inc. until the claim is approved by the insurance company, and accepted by Priority Restoration, Inc. Upon approval of claim, Priority Restoration, Inc. will complete all specified work at a price agreeable to the insurance company (RCV only) and Priority Restoration, Inc. with no additional cost to the homeowner except for the deductible. Final agreed upon price will become the final contract price, regardless of estimated contract price above, and we request that all payments also be made payable to Priority Restoration, Inc. * "Priority Restoration, Inc. will hold in trust any payment from property owner until we have delivered roofing materials to the jobsite or until a majority of the roofing work has been performed." I (We) agree, by signing below, to all the contract conditions on both front and back, of this agreement. Homeowner's Signaturg�� / r '� . Date of Acceptance: Homeowner's Signatu G Signature: i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: 0 ` s �� eller Permit Number: ❑ No one available for inspection: Time ' CM/PM Re -Inspection required: Yes When corrections haavver been made, call for re -inspection at 303 -234 - Date: Inspector)<_A_ DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE _��9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-855 Office • (303) 237-8929 Fax .INSPECTION NOTICE Inspection Type: Job Address: 107`70 (A) . t 4k Ave Permit Number: -2617062A2 ❑ No one available for inspection: Time V AM_ /, M Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 I � i Date: rI2 1 (i Inspector: DO NOT REMOVE THIS NICE i CITY OF WHEAT RIDGE _��9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-855 Office • (303) 237-8929 Fax .INSPECTION NOTICE Inspection Type: Job Address: 107`70 (A) . t 4k Ave Permit Number: -2617062A2 ❑ No one available for inspection: Time V AM_ /, M Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 I � i Date: rI2 1 (i Inspector: DO NOT REMOVE THIS NICE INSPECTION RECORD �ccuna `Z INSPECTION LINE: (303) 234 -5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. Water Service Lines POUR NO CONCRETE UNTIL ABOVE HAS BI CONCRETE SLAB FLOOR Electrical (Underground) .Plumbing (Underground) < _ Heating (Underground) Eu� INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE / 'INSPECTOR .INITIALS COMMENTS Footings /Caissons Insulation Mechanical Stemwall / (CEG) Concrete Encased Ground fj Drywall Screw Reinforcing or Monolithic Fire Department Weatherproofs /French Drain R.O.W &'Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED. AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Sewer Service Lines 'NOTE: ALL ITEMS. MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY.IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. ROUGHS Sheathing Lath / Wall tie .'Mid Roof Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical' Framing Is<'.Z c ' 3 Ja✓ Plumbing Insulation Mechanical fj Drywall Screw Building Final Gy° Fire Department .FINALS — Electrical Plumbing Mechanical Roof Building Final Gy° Fire Department R.O.W &'Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS SHOULD BE CALLED. AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. ParlCing &.�andScaping 'NOTE: ALL ITEMS. MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY.IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL' CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER I INSPECTION RECORD 1 Occupancv/TVpe �'INSPE&TION LINE: (303) 234 -5933 Inspections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. „j QI r i 1/� , _ V_ _ INSPECTOR MUST SIGN ALL SPACES. PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE INSPECTOR INITIALS COMMENTS: ' Footings /Caissons - Stemwall / (CEG) Concrete Encased Ground - Reinforcing or Monolithic Weatherproof /French Drain Sewer Service Lines Water Service Lines - POUR No CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB. FLOOR Electrical (Underground) Plumbing (Underground) - Heating (Underground) DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .;r ROUGHS.. - Sheathing C Lath / Wall tie 3 Mid Roof Electrical Service i .Rough Electric •r Rough Plumbing Gas Piping , Rough Mechanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING G Framing ' 'Insulation Drywall Screw FINALS gy m, Electrical Plumbing Mechanical Roof Building Final Fire Department R.O W & Drainage r, INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS { Parking & Landscaping SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. ".NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION DOES NOT CONSTITUTE AUTHORIZATION OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED ,UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ♦ 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: 61- Job Address: /0 7 70 4( ile- Permit Number: 09,9- ?�a 1 \\ 1 No one available for inspection: Time /� �� AMYPM Re- Inspection required: Yes No "When corrections have been made, call for re- inspection at 303- 234 -5933 t Date: Inspector: / DO NOT REMOVE THIS NOTICE trr Y Y v. r r ='T ti't ♦ 4' CITY OF WHEAT RIDGE Bung Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: G~ - Job Address: 10990 L~ r~ G Permit Number: i 2 t i ❑ No one available for inspection: Time AM/PM p Re-Inspection required: Yes No ' When corrections have been made, call for re-inspection at 303-234-5933 t r s Date: I Inspector: , ' f DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Bung Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office. • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Ih>= Job Address: f%77~ 4~ ref .419 permit Number: c2~717 Y2 /'j d~ I3~t f~ /A/ Qr2 ~d✓Sa~F~7rr>>✓ yut~ft~ Z"v t ❑ No one available for inspection: Time /.2,'W AM' s Re-Inspection required: No When corrections have been made, call for re-inspection at 303-234-5933 Date: /440 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 u INSPECTION NOTICE Inspection Type: /,//o ~F Job Address: /0%70 /Jzsi ` I~tJL Permit Number: 11927°2 i~6;tirw~r.~ P<Q - &17P.i 0V^fi7/O~ G~an~ OBI /.yf2SY' c i ,L ,'4„ ~,C/ 9V ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes *When corrections have been made, call for re-inspection at 303-234-5933 Date: Inspector: 12'V' DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division r' (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 6ZA11, Job Address /0`770 Ak5? i f,/hoe Permit Number: x92 79U G. If %G`/L/(7/L fC~E~ (vn/. G1 eS7 -5'/05; off' t: 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 f' ♦ i CITY OF WHEAT RIDGE fj Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: M lj d~F~ 3 Job Address: ,Jt7 ~>6 !,1 y ~t l U Permit Number: t)5 ❑ 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: i Inspector: tom, o 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: (-In 1.5 5 G tj Job Address: )0-7 r?0 l Jns i fViz; Permit Number: c~)9 7 -7cii 2R 11 r 4 ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes (JIN 'When corrections have been made, call for re-inspection at 303-234-5933 Date: 16 - 22 - o 9 Inspector: DO NOT REMOVE THIS NOTICE J " 1 City of Wheat Ridge 1 r40000r, Res. Add Structure PERMIT - 092792 PERMIT NO: 092792' ?ISSUED:'. 09/28/2009 JOB ADDRESS: 10770 W 46TH AVE EXPIRES: 03/27/2010 DESCRIPTION:.. Extend front porch down side of house. CONTACTS owner 303/425-5357 Glenn Manes` PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION:'. 0141 BLOCK/LOT#: 0/:. FEE SUMMARY ESTIMATED `PROJECT VALUATION: 2,200.00. FEES Permit Fee 108.30 Plan Review Fee 70.40'` Total Valuation 0 Use Tax -39.60 * * TOTAL * * 218,30 Conditions: 4T: `Permit approved KC: Approved per plans and notes on:plans. .:Subject :to field inspections. 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 measureme shown, and allegations made are accurate; that I have read and agree to abide by all conditions printed on this applies on and that I assume full responsibility for compliance with the Wheat :Ridge Building Code (I.B.C) and all other appli ble Wh e Ordina es, for work under this permit. Plans subject to field inspection. 'Signature of:. contractor/owner date This permit was issued in accordance with the _provisions set forth in your application and is subject to the laws of the State of Colorado and,to the Zoning Regulations and. Building Codes of Wheat Ridge, Colorado or any other applicable ordinances of the city. This permit shall expire 180 days from the issue date. Requests for an extension must be received prior to expiration date. An extension may be granted at the discretion of the Building Official. If this permit expires, a new permit may be acquired for a fee ofone-half the amount normally required, provided no changes have been or will be made: in the original plans and specifications and any suspension or. abandonment has not exceeded one (1) year. If changes have been or if suspension or abandonment exceeds one (1) year, full fees shall be paid for a new permit. No .`work of any manner shall be done that will change the natural flow of water causing a drainage problem. Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive written approval on inspection card before proceeding with successive phases of the job. The issuance of a permit or the approval of drawings and, specifications shall not be construed to be a permit. for, nor an approval of, any violation of the provisions of the building codes or any :other ordinance, Iaw,rule or regulation. All :plan ev is subject to field inspections. ignatur /ief"Buildina Official ~~ro City of Wheat Ridge Building Division m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 o Inspection Line: 303-234-5933 OCORAO Building Permit Application r-" Prope y Address: ",770 f",770 LA) q&7T4- AVC Property Owner (please print): Mailing Address: (if different than property address) Address: Phone: `f `G'1 City, State, Zip: Contractor: #ta1,11e 0to ti-ey- Contractor License Sub Contractors; Electrical City License Company: Exp. Date: Use of space (description): Description of,work EYT~n1D r-&iuT of t~avse. Phone: Plumbing City License Company Exp. Date: oRZif dowvt 5,OC- Mechanical City License Company: Exp. Date: Construction Value: $ 0(--( 6) U ° (as calculated per the Building Valuation Data sheet) I Plan Review (due at time ofsubmittaq: $ W oTu `il ~z r7 PIR Sq. Ft./L.Ft added: (e Squares BTU's Gallons Amps 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 the Wheat Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Plan bject to field inspection. CIRLCE ONE:: OWNN (CONTRACTOR) or PERSONAL REPR TIVEoftO NER) (CONTRATOR) PRINTNAME: (~r&/yA( y4A,05 SIGNATURE: Date: Date: Plan Bldg Valuation: r T3 F~ fs- Y • ~ pp r~ bbl n; L[W F„ e A O d z i, i ,i i City of Wheat Ridge r4000"F, Residential Roofing PERMIT - 091742 PERMIT NO: 091742. ISSUED: 08./27/2009 JOB ADDRESS: 10770 W. 46TH AVE EXPIRES: +02/23./2010 DESCRIPTION: Reroof: 28 sgs:.house and garage CONTACTS owner 303/425-5357 Glenn Manes PARCEL INFO ZONE CODE: UA USE: UA SUBDIVISION:. 0141 ..BLOCK/LOT#: 0/ *.FEE SUMMARY ESTIMATED PROJECT VALUATION: 6,726.00 FEES. Permit Fee 181.10 Total Valuation .00 Use. Tax 121.07 d-a **.TOTAL 302.17. Conditions: 6nail `installation & mid-roof inspection required. Board sheathing spaced more than a..1/2of an inch apart requires plywood overlay on entire roof. ice and water shield required from eave edge to 2' inside exterior walls. P Subject to field inspections. T 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 applicat on and that I assume full responsibility for compliance with the Wheat Ridge Building Code (I.B.C) and all other appl' able Wheat Ridge ordinances, for work under this permit. Plans subject to field inspection. - Signature of contractor/owner ..date y 1. This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the State of. Colorado and to. the Zoning Regulations and Building Codes of Wheat Ridge,. Colorado or any other applicable r' ordinances. of the City: 2. This permit shall expire. 180. days from the. issue date. Requests for an extension must be received. prior to expiration ' date. An extension may be granted at the discretion of the Building Official. ? 3. If this permit expires, a new permit may be acquired for a fee of :one-half the amount. normally required, provided no changes have been or will be made in the original plans and specifications and any suspension or abandonment has not p, exceeded one (1) year. If changes have been or if suspension or abandonment exceeds one.(1).year, full fees shall is 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 proceeding with successive phases of the. job. ` r 6 The. issuance. of a permit or the approval of drawings. and. specifications shall. not be construed to be a permit for, nor an approval of, any violation of the provisions. of the building codes or any other ordinances, law, rule or. regulation. All plan revie i ject to field inspections. 2 Signature of ie wilding Official -.date - 'INSPECT N REQUEST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUST BE MADE BY 3PM: ANY BUSINESS DAY FOR INSPECTION THE `FOLLOWING BUSINESS DAY.. J OF WHEgT v Pim OO~ORPOO City of Wheat Ridge Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Property Address: Property Owner (please print): Mailing Address: (if different than property address) 4-t Address: 56;,~o V4 AV& City, State, zip: W "T t 6 (20 , Contractor: "ower dow 0OContractor License Phone: Sub Contractors: Electrical City License Company: Plumbing City License Mechanical City License Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): fJ~?Iv°~Ca f~ Construction Value: $ Description of~Work: ,I~ (as calculated per the Building Valuation Data sheet) I -C-1,-6 42'. Plan Review (due at time of submittal): $ Sq. Ft./L.Ft added: Squares 30 BTU's Gallons Amps 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 the Wheat Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Pla 'ect to field inspection. C/RLCE ONE E (CONT ACTOR) or PERSONAL REPRES . TATIVE oR) (CONTRATOR) PRINT NAME: rV SIGNATURE: ' r 4- Date: Date: Plan Permit #:~ql Bldg Valuation: $ ( 4 Building Permit Application t'EIZMITTRACKING FORM ADDRESS ICJ ~7Q LQ~ . y(,l..iL DATE SUBMITTED/0-/-U PERMIT NUMBER7aSR9S IYPE OF PERMIT P 5Z_A.('R4/PaPlSYI CON7RACTOR PHONE OWNER ~:jLl!l7n ~~){~I1`lU L_QS PHONE 'S,'3-:97 NPE OF REQUEST (.L~'~.C?ILtLail ar -4Y6-14/ (p U ~ DATE PERtv11T APPROVED S0 ADS-9S DATE AND REASON FOR PERMIT DENIAL REQUIRED CONDITIONS MET PRIOR TO PERMIT APPLICATION 7 YES NO N/A CONDITIONS OF APPROVAL DATE IN DATE OUt ~ BUILDING DEPAPTMENT D" I- C d ~ a ❑ ENGINEERING DEPARTMENT fG PLANNING DEPAPTMENT ❑ FIRE DEPARTMENT ❑ CIN ARBORIST ❑ POLICE DEPARTMENT ❑ SEWER DISTRIGT O WATER DISTRICT O OTHER CERTIFICATE OFOCCUPANCY / GERTIFICATE OF COMPLETION DATE IN DATE OUT ❑ BUILDING DEPAPTMENT ❑ ENGINEERING DEPAPTMENT ❑ PLANNING DEPAPTMENT ❑ FIRE DEPARTMENT D$T«614ERTIFICATEAF.OCCUPANGY/GERTIFICATEOFCOMPLETION 155UED 16-9&-C FB TEMPORARY CERTIFICATE OF OCGUPANCY DATEIN DATE OUT ❑ BUILDING DEPAPTMENT ❑ EN6INEERING DEPAPTMENT O PLANNIN6 DEPARTMENT 0 FIRE DEPAPTMENT PLANNIN6 ESGROW CONDITIONS ENGINEERING ESCROW DATE TEMPORARY CERTIFICATE OF OCCUPANGI' 155UED DATE EXPIRED BUILDING DEPARTMENT (303) 235-2855 CITY OF WHEAT RIDGE Job Located at /a 770 L. Ae~ I have this day inspected this structure and these premises and have found the following violations of City and/or State taws gov- erning same: X n 1 ~ ~a~ - ct~c Z~ 01J'~ef" CC.]~' O//u7/~er- SlGi:r' RrG~t /'7Q.C c~s J~O 6F C_L Correction Notice You are hereby notified to correct the foregoing violations. When corrections have been made, call for inspection. Date r- Inspector for Building Dept. DO NOT REMOVE THIS TAG FORM WR6-22 PERMRNUMBER F 0 m 0 0 0 ~ T 3 ~ ~ m m y c Q n a I' m a p m C! m o 3 ~ N ~ m m ~ w O m n = o Q c m a w 3 ~ m ~ ~ a 0 3 3 ~ ~ m ~ C 00 ~ o O ~ - m m c y a a ~ mm m F 0 c O 0 ~ w n m m F O 9 2 m O ~ ~ z ~ C 9 O N m n D n 0 ~ 7 1 ~ ~ r v D ~ r m O ~ m n D 9 O ~ a O y Z (p O V V 0 f ? a) C+ s a < (D ~ ~ m E S (D v ~ ;10 C') O OD O 0 W W O O 2 ~ D 0 i O T O ~ w N Z m m n S ~ ~ m c a m 9 m ~ m ~ y aa- s ~m R' n• ~CDmm tl M ~ 3a»m LJ B m 5 M Q ~mdm !•r J m°o~ c°~mID y ~ N m ~ ' m~3m 3 P) 0 (D w m° 3~ c^~ m r p y ~ 9g 0 ~ 7 M .omn m ~ lJ c m nW= m m m a n a o s m 0 ~ ya ~ m <-1 m a~ 0 o C ~ O ~ m m O c y a m m J tn m a a ~--7 < Q p Fn~ m O O a ~ ~ 3~a ~ ~o~ o z ~ m °jO1~ v m /1 tl f o m .A rn y 0 ? o 3 S. Q n ~ c+ ~'-a a r+ rr~ 5 O mFm cr < 0=m Z N ~ ~c n 0~p N C m " Ol N ~ t-~ to 3 t0 N W Q~ rF ~O d ~ (D C") O r i Date:_ l0 A Certificate of Occupancy or Completion has been requested for: ADDRESS: (-o. Purpose of Structure: F P 4~~{ ~t 176,,) Building Department Approval: Remazks: ~ u Zoning Approval: Remazks: Public Works Remazks: Fire Mazshall Approvz (If Applicabie) Remazks: W H ~ W N C) Z Z = 0 W J I G ~ ; a m ~ ~ W fl W 2 O 1 Z j W r I ~ ~ o i (j) a ~ I ~ Z O ~ G ~ N Z ~ - ~ T U) O V LLJ N Z 0 ~ Q cc V ~ Z ~i M M m LO ~ No O ~ aM ~ ~ O M er o 0 (a) J W 0 cr V M% Q z W ~ O ~ o= ~W F- Q LL.I "I W~~ ~ ~ N (j) P t4 U) Z W d% 5 Lt') F f*- U Z a • U 0 w a ~ 0 / 0 Z H ~ w 2 Z ~ w 0 3 ci G ¢ 0 ~ 2 8 ~ ~ ~ w ~ ~ 0 ~ 0 Z ~ W z J a 2 O LL Y ¢ ~ ~ ~ O U w m 0 ~ z ~ ~ = F - 0 0 Z Z ~ ~ w a w LLI a ) a a ~ ~ a Z 0 Fn U) LE 0 W a U) Q U ? F- LU o ~ Z C - Q O' p . ~ o y ~ a ~ C C C N O :C tq C (6 LL ti U m 0 w z 0 fn z u, W m a w > m Q F z ~ FW- w cc U Z O O z cc ~ a° a • + 0 w z 0 (1) z W W m a _ w O m Q H Z D x 0 0 LL ¢ ~ O a 0 z 0 0 U U N W . c 0 ~ a c J ~ 0 0 a o ~ N OC y m j a d ~ ~ m • CS N ~ N s a Q ~ ~ I ~ I U ~ r ~ ~ u U o 3 0 m U 0) ~ 1 O ~ ~ ❑ ~ (U J C C ltl o _ o 06 N q'S c ~ = 3 ` O N C N :o E c ~ d N O p N i IL v i ~ Z O cc N OC [L lL . W d 2 ii CC li d . - ' - e . • - • • LL 0 F° ~ LL LU cr. W J W Cl) UJ , Z Cl) H , ~ ~ ~ Cl) N o LLI ~ ' ~ z ir . ~ 40 LLI D ~ a L) 0 0 . Z w 0 Z a ~ 0 / DEPARTMENT OF PLANNING AND DEVELOPMENT BUILDING INSPECTION DIVISION - 235-2855 CITY OF WHEAT RIDGE 7500 WEST 29TH AVENUE WHEAT RIDGE, CO 80215 Property Owner : BUILDING DEPARTMENT USE ONLY Use 7268 6/12/98 Property Address : 10770 W. 46th Avenue Contractor License No. : Company: Phone : 425-5357 Phone OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certiry that the setback distances proposed by this permit application are accurate, and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown, and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application, and that I assume full responsibility for compliance with the Wheat Ridge Building Code (U.B.C.) and all other applicable Wheat Ridge ordinances, for work under this permit. (OWNER)(CONTR4CTOR) SIGNED DATE Desceiption : Single family home addition approximately 360 square feet Approval : MLC Zoning : R-2 Approval: BG Approval: Occupancy : Walls OK Building Permit Number Construction Value Permit Fee Plan Review Fee Use Tax Total Date $6,500.00 $125.00 $0.00 $162.50 $287.50 SIC : Sq. Ft. : ->M_ , OK , Roof : Stories : Residential Units : Electrical License No : Company : Plumbing License No : Company : Mechanical License No : Company : Expiration Date : Expiration Date : Expiration Date : Approval : Approval : Approval : (i) This permit was issuetl in accordance with the provisions set forth in yopur application and is subject to the laws of the State of Coloredo and to the Zonin9 Regulations and Building Code of Wneat Ridge, Colorado or any other applicable ordinances of the City. (2) This permit shall expire if (A) the work authorized is not commencetl within sixry (60) days from issue date or (B) ihe building authorized is suspendetl or abandoned for a period of 120 days. (3) If this permit expires, a new permi[ may be acquired for a fee of one-half the amount normally required, provided no chanqes have been or will be made in 1he original plans and specifications and any suspension or abandonment has not exceeded one (7) year. If changes are matle or if suspension or abantlonmen[ exceeds one (7) year, full fees shall be paid for a new permit. (4) No work of any manner shall be tlone tha[ will change the natural flow of water causing a draina9e problem. (5) Contrector shall no[iry the Building Inspeclor hventy-four (24) houre in advance for all inspections antl shall receive written approval on inspection card before proceetliingwithsuccessive phasesofihejob. (6) The issuance of a pertnit orthe approval of tlrawings and specifications shall not be construed to be a permit for, noran approval of, any violation of fhe provisions of the i in9 co~~nordinance, law, rule or regulation. x . yW[ 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 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:CS/~N~✓ f~ ~ ~!'rrJ~C~'~~ r1~✓U~S Property Address : 10770 4" 116 ~v~ WbpR7R'~~ 00"~3phone -2 Contractor License No.: 1-1-111r ~/"c e03 Company : Phone : OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT Construction Value : zg/. S dC) ca~m I hereby certify that the setback distanees proposed by this permR application are accurate, Pgfrtlit F6e : ~ZJ~. Sd and do not violate appiieable ordinances, rules or regulalions of the City of VJheat Ridge or wvenants, easements or restridions of recorcl; that all measurements shown, and allegations made are accurate; that I have read and agree to abide by all eonditions printed on this Use Tax : application, and that I assume full responsibility-for compliance w8h the Wheat Ridge Building Code (U.B.CJ and all other applicable Wh at~Ridge ordinances, for. Zork under this pertnit TOtHI : $0.00 . SIGNE DATE S~"% TOR If~ ) (OWNER)(CONTRAC US2 : I Description : 5~ ~..Zmn~ 4~'~. m[il?] Approval: Zoning : R-z Approval: Approvai: Occupancy : Wails : Electrical License No : Company : Expiration Date : Approval: BUILDING USE ONLY RECEIVED JUN o Plumbing License Na : Company : Expiration Date : Approval: (.Q ~.JIL4-I.U-V SIC : Sq. Ft Residential Units : Mechanical License No : Company: Expiration Date : Approval: (1) This pertnit was luued in acmrdance with the provisions sM forlh in yopur applica6on an0 is suhject to the laws of the State ol CobraEO anE lo the Zoning RegulaUOns aM Building Code of Wheat RiEye, Colorado a any oNer applicaEle adinances ol the Ciry. (2) This pertnd shall expire d(A) the work auUwnzed is not wmmenced wiUMin sary (60) days hom issue tlate or (8) the buiitli`p authorizetl is suspended u abandoneC for a peAOtl of 720 days. (3) It Ihis pemN expires. a new pemul may be acquired lor a fee o1 one-hall Ne amount normaly require4 pioNded no chan9es have been w win be maEe in the onginal plan5 anC speafipGons anC any suspension w a6antlonment has not exceeEeG one (1) year. II Uhanges are made a N suspension a a0andonment erzceeds a~e (t) year, full fees shall be paid for a new pertnit (4) No vrork ol any manner shall ba date ihat will change the naWral flow of waler causing a dainage problem. (5) Contradw shail rwtiry the BuiiEing InspeUOr twenrydour (24) hours in advance for all inspeUions anC shall receive written approral on Inspedion cartl Defore proceediirg wiN successive phasea of the lob. (6) The issuanCe ol a pemul M ihe approval o(tlrawtngs antl spedfiraGanS shall 7be cons be a peimit tof, YaJ~~ 10(. arry WWa6on ol the provisions - . 01 the buildinq codes or any other ordinance, Ww, fule a reguWGOn. Mayor ~ Chief Buiiding Inspector For~ ~S. d Gl r4-1 O Yl THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND MAYOR CALL: 234-5933 24 HOURS PRIOR TO INSPECTION SINGLE FAMILY HOUSE ADDITION All of the following must be provided with your completed permit application. TWO SETS OF PLANS DRAWN TO SCALE These plans must be complete showing all proposed foundation, franung, plumbing, heating aud electrical work. ✓ The house addition location must be shown on the plot plan or the improvement location certificate and must be to scale. N The foundation must be designed by a licenced engineer unless the new foundation is the same style as the existing foundation. ~ The framing plan must show the dimensions of all the framing members. LA The plumbing plan must show the location of all fixtures and the size of all waste, vent / and supply piping. i~ The heating plan must show the location of all heat supply registers ,location and size of supply piping , location and size of furnace or boiler, location and size of flue stack and the location and size of the gas pipe. ~ The electrical plan must show the location of all outlets , light fixtures , and other electrical appliances. The plan must also show all modifications to the electrical panel. ir If the wark involves the building of additional sleeping space or the valuation of the work exceeds one thousand dollars ($1000.00) smoke detectors must be installed through out the house. 1,v ;741;( A COPY OF THE DEED OF TRUST A copy of the deed of trust should be in the closing documents of your house if it has been lost a duplicate copy may be obtained through the mortgage company or the county tax assessors office. A PLOT PLAN OR AN IMPROVEMENT LOCATION CERTIFICATE This document is normally included with the banks closing papers, if however this document is not auailable , the services of a surveyor will be needed to create this document. GRADING PLAN The grading plan must show that Yristorical water flows are not modified by the construction. If the construction does modify lustorical water flows the plan must show how this change will effect sunounding properties , and that it will have no adverse effect on those properties. The review time for this type of pernut is normally five to ten working days from time of submittal. c~ c t ~ (V F- r m ~ N r7 ~ r cn < e ? E ~ :~C v ?p ~ = t_~• u.~ ~ ~TIe:O , E-0 93 w= o omor W D • 0 ~ -i m r mz N M O W H X E i o m ~ cl~ un Ul rri Ul -i , - F ln F U7 n ~ a ~ • C m G p H o z a c~ GJ ~ ~ H z n D) a ~ n c-) r - :3 m o- n j 0- - m r-~ m n 0 J h(G 07 -I H p y (TI r u . :7 H C TI N a7 [p (9 F-j H a N 0 ` o c~ ❑ ~ m C~--- a,< a n . rs, , r• • -i ~ [7 E3 n rTt Ul ~D m m r 7 1-1 [9 O ~ -t -O [7] ct 7 TI O f➢ -1 W F'• N 17 N H ❑ ~l H. 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ID o ~ ~ y K ~ N 2 = ~ w ~ ~ b J 0 0 tv d ~ ~ H a a n n 0 o , 0 n x ~ ~ 0 n No. w m " DEED OF TRUST ~ m FROM TO THE PUBLIC TRUSTEE FOR THE USE OF STATE OF COLORADO County of lss. ) ° 1 hereby certify that this instrument was filed for record in my office at o'clock M., , 19 , and is duly recortled in book page Film No. Reception No, Clerk and Recorder, Depury Fees, S ~u~ W~?RL CREDlT CO. UNiON a.a-aox ss» ENGLEVI►OOD. CO 80155-6611 ~F O g ? ~ s G ~ . a m y ~ m ~ O Z o zW d y 2 0 6] ~ N y ~ O £ w° 6 ~ ~ ~ ~ xy H 3 C X1 K d q -°n ~ ~ Z J Q Q 3-D ~ c a ' Fr o ~ N w Z C7 0 4 0 ° m 41 o P7 po N K b ~ J x H K1 Cs] ~ K ~ ~ N ~ Cz~] d ~ ~ 66 d g`°' °mB C S~ 0 ~ E c~S ~5 IIJ ~ „e v °e n w 000 m G C. - d'nq ~x~ o0 NO.y 3,y.~+ a~~:: rn~3 S~Wm wa a~~ Qryy ~°nd 6Wd ~°o~ `~cr =Lri7 goSd .2., " 2 S.y a2~ y a oc oa.m ~2~ myw ,.o„m mco ^d n y c ° ~ y c.w ~ c 5' ~y n 9 y ow~ rn,c.. m F ~ c,-n ~ o - !~f N. N. 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' 5 ~ a . ~ d 'G~rcf~crJ grj ~ W 3''__s <--2--►I. . ` ° . Tyr,vrn;~. ` 0 1360 Roun.~ 4 - E _ ~ ~ _[L~.~° r- ,-•r- _ _ _ ~sr~i~ _.e q A ~ /5i FIDPAL BUILDING DEPARTMENT (303) 235-2855 CITY OF WHEAT RIDGE Notice Job Located at , 770 1,d, A)2. You are hereby notified to correct the foregoing violations. When corrections have been made, call for inspection. Date 7 L5 ~ Buiiding Dept. DO NOT REMOVE THIS TAG FOHM WR6-22 I have this day inspected this structure and these premises and have found the following violations of City and/or State laws gov- erning same: BUILDING DEPARTMENT (303) 235-2855 CITY OF WHEAT RIDGE * * ~ CQrrectidn Notice ~ Job Located at 10770 w 1( I haye this day inspected this structure and these premises and have tound the following violations of City and/or State laws gov- erning same: You are hereby notified to correct the foregoing violations. I V ~ When corrections have been made, call for inspection. k ' Date _S ~ FORM WRB-22 Inspector DO NOT REMOVE THIS TAG Dept. BUILDING DEPARTMENT (303) 235-2855 CITY OF WHEAT RIDGE Correction Notice Job Located at I~ 77~ Y`ro c4 1 have this day inspected this structure and these premises and have found the following violations of City and/or State laws gov- erning same: 1ioslOCa,k /hivS 4 S-o G~5 qo% b')i~doN~s'a2mz{ .~h~ C<'v5si-~~3 rh o r e 7~n L/ ~ U" c) F / You are hereby notified to correct the foregoing violations. When corrections have been made, cali for inspection. Date for Building Dept. DO NOT REMOVE THIS TAG FOHM WR6-22 FL no Z 2~ PA /0770 W "lCvTµ IIVG - 1yLI: rloo2 /4 DD) rronl i f(fl'o"-- _-t I ~ - I i ~ ~ !N'ot' ' ~ Nc W Cov~Rea_ - o 14~XlG~YY" ConCR6fE pAD - R P ~P O, t' E ~b)ect to F-'seld tr~sFec'ci 5G I Wheat Ri e Building :},°.p't. Q?.1.~'-• W/~~~ !an CheckeP , H,o xy,0° ~ I ~ _ L(/ IN OO W ~ ~ , . 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Ftij_m 13lNCz _4 ~et}T_LNa- .4 p p R 0 V sublect to Field Ins~~~ D ~s n/heat Ridge guilding LEpt, ; SiU'ned..._ Date..-G,h/9G~ Checker FI DUI?~C.Lk.IL' &L~~_~N CA 7 ND _ =~-:a