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HomeMy WebLinkAbout7960 W. 39th Avenue70 i ,q,� INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Occupancy/Type 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 Foundation Inspections Date Inspector Comments Initials Pier Concrete Encased Ground (CEG) Foundation / P.E. Letter Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground/Slab Inspections Date Inspector Comments Initials Electrical Sewer Service Plumbing Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections Rough Inspections Date Inspector tials Comments Sheathing Mid -Roof A {' ��`s / r✓ 6 Lath /Wall Tie V Rough Electric Rough Plumbing/Gas Line Rough Mechanical Rough Framing 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 Final Plumbing Final Mechanical 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 O A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTIC Inspection Type: A41 n If Job Address: CwU /C Permit Number: 7,-176 ❑ No one available for inspection: Timey /IPM -Inspection required: e No *When corrections have been mad , for-re�inspecttio_n/at 3f0_3--234-5933 Date: 7le- Inspector: /Z DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201703597 PERMIT NO: 201703597 ISSUED: 07/10/2017 JOB ADDRESS: 7960 W 39th AVE EXPIRES: 07/10/2018 JOB DESCRIPTION: Residential Re -Roof to install Asphalt shingles with 27 SQ. **REVISION**Adding redecking; Added valuation: $3500.00 *** CONTACTS *** OWNER (723)422-6225 FLUHRER ELWINA SUB (303)942-1386 Michael J. McCarthy 130014 Golden Spike Roofing, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 15,700.00 FEES Total Valuation 0.00 Use Tax 329.70 PAID Permit Fee 299.40_ ** TOTAL ** 629.10 *** COMMENTS *** *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or 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. City of Wheat Ridge Residential Roofing PERMIT - 201703597 PERMIT NO: 201703597 ISSUED: 07/10/2017 JOB ADDRESS: 7960 W 39th AVE EXPIRES: 07/10/2018 JOB DESCRIPTION: Residential Re -Roof to install Asphalt shingles with 27 SQ. **REVISION**Adding redecking; Added valuation: $3500.00 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 ermit and perform the work described and approved in conjunction with this ermit. I further attest that I n legally authorize o in lu ntities named within this docurnent as parties to the work to be performed and that all work t e erfo is disc d ' is d ment and/or its' accompan i gproved plans and specifications. Signature of OWNER `of - NTRACTOR (C' e one) Date I . This permit was issued based on the informa provided in the permit application and accompanying plans and specifications and is subject to the compliance with those docume is' and all applicable statutes, ordinances, regulations, policies and procedures. 2. This. permit shall expire 365 days after the to 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 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 applical�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. City of �WheatR MUNiT-y DEVELOPMENT Building & Inspection Services Division 7500 W. 291h Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits .ci.wheatridge.co.us I FOR OFFICE USE ONLY I Date: Add to Permit # b1l'o 55 Building Permit Revision/Amendment Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: 60 cu Property Owner (please print): E6 lei yxly- Q �e�� Phone: Property Owner Email: Mailing Address: (if different than property address) Address City, State, Zip: Submittin Company:� C9� Contact Person:� ��— Phone: %, �O 7 Contractor: Contractors City License #: © Phone: ZW'76.3 Contractor E-mail Address: / K2dY�-- Please Note: Additional valuation must include all general and subcontracted work to be performed related to the revisions and/or amendments declared in the description of work and which were not included in the original permit valuation. If revisions or amendments increase the original valuation, additional fees will be due at the time of approval. Depending on the scope of work, additional plan review fees may be due upon approval ($60.00 an hour - 2 hour minimum). Description of revised/amended work: / if 60e ek� Sq. Ft./LF Btu's Amps Squares Gallons Other Additional Project Value: (MusJ„ir�lude all general and subcontracted work to be performed related to revisions/amendments described above) $ OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this pennit 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 perforin 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. CIRCLE ONE: (/OfW�NER) . CO T CTOR) or (AUTHORIZED REP SEN PRINT NAME: ''�" t / SIGNATURE: / DEPARTMENT USE ONL ZONING COMMMENTS! Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: PROOF OF SUBMISSION FORMS Fire Department ❑ Received ❑ Not Required Water District ❑ Received ❑ Not Required Sanitation District ❑ Received ❑ Not Required Of ( ER) (CONTRACTOR) DATE: / `� / 7 OCCUPANCY CLASSIFICATION: Building Division Valuation: $ O A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTIC Inspection Type: A41 n If Job Address: CwU /C Permit Number: 7,-176 ❑ No one available for inspection: Timey /IPM -Inspection required: e No *When corrections have been mad , for-re�inspecttio_n/at 3f0_3--234-5933 Date: 7le- Inspector: /Z 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 INSP,ECTION NOTICE �f Inspection Type: � ` () Job Address: —7 1l L �✓ 3 Permit Number: L 14 7; r- y ❑ No one available for inspection: Time r i 6MIPM Re -Inspection required: Yes to When corrections have been made, call for re -inspection at 303 -234 - Date:— 03-234-Date:rInspector: DO NOT REMOVE THIS NOTICE *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or 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. City of Wheat Ridge r` Residential Roofing PERMIT - 201703597 PERMIT NO: 201703597 ISSUED: 07/10/2017 JOB ADDRESS: 7960 W 39th AVE EXPIRES: 07/10/2018 JOB DESCRIPTION: Residential Re -Roof to install Asphalt shingles with 27 SQ. *** CONTACTS *** OWNER (723)422-6225 FLUHRER ELWINA SUB (303)942-1386 Michael J. McCarthy 130014 Golden Spike Roofing, Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 12,200.00 FEES Total Valuation 0.00 Use Tax 256.20 Permit Fee 251.85 ** TOTAL ** 508.05 *** COMMENTS *** *** CONDITIONS *** Effective December 1, 2014, asphalt shingle installations require an approved midroof inspection, conducted when 25-75 percent of the roof covering is installed, prior to final approval. Installation of roof sheathing (new or overlay) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding one half inch exists. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or 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. City of Wheat Ridge Residential Roofing PERMIT - 201703597 PERMIT NO: 201703597 ISSUED: 07/10/2017 JOB ADDRESS: 7960 W 39th AVE EXPIRES: 07/10/2018 JOB DESCRIPTION: Residential Re -Roof to install Asphalt shingles with 27 SQ. 1, by m�si' nature do hereby attest that the worktobeperformed shall comply with all accompanying approvedplans and specifications,applicauiing codesand all applicablemunicipal codes, policies and procedurs,and that I am the legl ownerorhave been authorized by thelal ownerofthropertyand am authorzed to obtain this permit and perform the work described and approved in conjunction with thisperit. 1 further attest that I am leggally authorized to include all entities named within this document as partes to the work to be performed and that all work to be pertonmed 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 infornafon 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, po icies 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 an manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance or granting of a permit shall not be construed to be a permit for or an approval of, any violation of any provision of any applicalde or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. O 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. Dane Lovett �y a, q I , : C__) " I q From: no-reply@ci.wheatridge.co.us Sent: Tuesday, June 27, 2017 11:28 AM To: Permits CommDev Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Gina Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received 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 AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. 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 7960 W. 39th Ave r Elwina Fluhrer 7234226225 n, Property Owner Email Field not completed. Address Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. CONTRACTOR INFORMATION Contractor Name Golden Spike Roofing Contractor's License 130014 Number (for the City of Wheat Ridge) Contractor Phone 3039421386 Number Contractor Email Address spike@goldenspikeroofing.com Retype Contractor Email spike@goldenspikeroofing.com Address DESCRIPTION OF WORK Are you re-decking the No roof? Description of Roofing Asphalt shingles Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 7.,- 27.,- material selected above? material Does any portion of the No property include a flat roof? If yes, how many squares Field not completed. on the flat roof? z TOTAL SQUARES of all 27 < roofing material for this proj ect Provide additional detail House roof here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 12200 value or cost of ALL materials and labor) SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this Yes application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work Yes may not begin on this property until a permit has been issued and posted on the property. I certify that I have been Yes authorized by the legal owner of the property to submit this application and to perform the work described above. Name of Applicant michael mccarthy Email not displaying correctly? View it in your browser. 3 Customer: .�i`'i 7200 E. Hampden Ave. #202 Denver, CO 80224 Fax 303-942-1854 Proposal • Contract .� l Date: Billing/Job address: ! �(G (,�,/ 7�� Phone: \ c% GOLDEN SPIKE ROOFING, Inc. hereby proposes to furnish the materials and perform the labor shown or described below for the completion of the following: Scope of Work Tear Off layers of roofing on Install New CGC( - i�'" �'j�� bf�� shingles with felt paper. Install 2x2 and/ Idr 2x4 Cft edge metal in` with ice and water shield Replace flashing at C P CL Replace plumbing vent jacks. Install vents._ Valley flashing shall be �&e Low slope roof areas will be If new 7/16ths OSB decking is needed it shall be $, Additional items included in contract C� �-/?ee-- additional to contract.' Clean site and haul debris Approximate start date -' / n -1 GOLDEN SPIKE ROOFING, Inc. proposes the above specifications for the sum of: $ �� , with payment made to said contractor upon completion, subject to adjustments pursuant to insurance supplements attho�rizre2d Cha�ng7/yaq GENERAL PROVISIONS i GOLDEN SPIKE ROOFING, Inc. warrants all work for a period of�years following completion. If insurance proceeds are used to pay for services` rendered contractor may not waive or rebate the deductible, in part or in whole. All work shall be performed in a workmanship like manner and in compliance with all city building codes and other applicable laws. Contractor may, at its discretion, engage subcontractors to perform work hereunder, provided individuals are duly licensed to perform said work, and Contractor shall remain responsible for proper completion of this contract. Contractor is adequately insured for injury to its employees as a result of acts of employees/subcontractors, and Owner agrees to carry homeowner's and other necessary insurance. Contractor carries commercial liability insurance through the John Brown agency, Farmers Insurance, they can be contacted at 773-770-2100. Homeowner has a three day right to rescind the contract with no penalties. No down payment is required. Contractor shall not be liable for any delay due to circumstances beyond its control including weather, disaster, strikes, casualty, or general unavailability of materials. Contractor shall obtain all permits necessary for said work to be performed. GOLDEN SPIKE ROOFING, Inc. may withdraw the proposal, if not accepted wAVin �i I days 5apce charges may be appited16 invoices past 30 days due. Respectfully submitted by:� Phone # /"7 z;�'7 Accepted by: d. , �: Ciy1fL �41-liy72, Lu-); LL E-1 L;,h Date: 9 ♦ v CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: fi,41.a-2 5ekv Job Address: 79,Ce u.,. 3yzw ~svf Permit Number: 6917V 9.S? gp e't0 ❑ No one available for inspection: Time ~lP3 AM/PM Re-Inspection required: Yes *When corrections have been made, calf for re-inspection at 303-234-5933 Date: o Inspector: DO NOT REMOVE THIS NOTICE INSPECTION RECORD OccDDancvlTvDe '91NSPECTION 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. _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 N OT POUR FLOOR UNTIL ABOVE. HAS BEEN SIGNED: ROUGHS Sheathing Lath / Wall tie Mid-Roof Electrical Service Rough Electric Rough Plumbing Gas Piping Rough Mechanical ABOVE INSPECTIONS TOBESIGNED PRIOR TO PROCEEDING r Framing Insulation Drywall Screw FINALS Electrical Plumbing Mechanical Roof Building Final Fire Department '.R.O.W & Drainage 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 sza rt INSPECTION NOTICE Inspection Type: Job Address/Permit Number: 61/ 1 t 9 i` w ) ❑ No one available for inspecti ime IW6 AMfPM~ E Re-Inspection required: Yes No When corrections have been made, call or re-inspection at 303-2345933 Date: 71,1110 Inspector: DO NOT REMOVE THIS NOTICE a City of Wheat Ridge Building Division 7500 W. 29th Ave.; Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 Inspection Line: 303-234-5933 Date: tco/ Plan Permit#: e Building Permit App '-ati An Property Address: b 1 lJ . J- Property Owner (p/ease print): Phoney 3 ~[~-G "C~Z ~ Mailing Address: (if different than property address) Address: Sub' Contractors: Electrical City License Company: Plumbing City License Company Mechanical City License Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ Description of'work: (as calculated per the Building Valuation Data sheet) Plan Review (du at tim fs~kmitt $ Sq. Ft./L.Ftadded: Square 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. Plans subject to field inspection. _ /fin CIRLCEONE:: (OWNER) (CONTRACTOR) or PERSONAL PRINT NAME: SIGNATURE: Date? ,iI Bldg Valuation: $'-r, I Contractor License Phone: Z 6 " Z (J ~ Z a-:5 / j Fonm (K) <iaozaizt f' pUBLICSERVIC, iOF COLORA 4 5 ' AOOflE55 ~ ~ ~ , HGT. NO. t . INSTOMEP l~ry1 1PPIINT1" : 1 + ~ . ' I . ~ OWNER TENANY~ • : SPEbFV . - ` AGENT E] OTHER 0 CONDITION 70 BE COHfiECTEO AS SHOWN BELOW CHEATES AN IMMEDIATE HAZARD.. THIS EpUIPMENT MI15T NOT.BE PUT BACK IN SEPVICE IINACNEPAI9S,,ANO ATHOHOUGN INSPECTION HAVEBEEN MAQE:6Y f+ QUALIFIEOCONTRpCTOR. CONTACT YOUfl LOCAL BIIILDING UEPARTMENT FOfl COOE ANO PEflMIT fiEQUIREMENTS PAIOF TO PEFFORMING AEPAIR WOBK.