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Home My WebLink About4700 Upham StreetCity of Wheat Ridge Residential Roofing PERMIT - 201702423 PERMIT NO: 201702423 JOB ADDRESS: 4700 Upham ST ISSUED: 06/23/2017 JOB DESCRIPTION: Residential Re -roof to install Owens CorningSDuration6asphalt 8shingles with modified bitumen on flat portion 23.18 sq. flat) (21.17 sq, pitched and 2.04 sq. *** CONTACTS *** OWNER (303)257-7346 WORKMAN MARK S SUB (303)694-4363 Glen & Sandra Thiessen 140071 Thiessen Const. & Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: UA / Unassigned 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,245.63 Total Valuation FEES Use Tax 0.00 Permit Fee 215.16 ** TOTAL ** 220.15 435.31 *** COMMENTS *** *k* CONDITIONS *** Lffcti;;. December. i, 2014, q asphalt shin l.e installations require an approved inspection, conducted when 25-75 percent of the roof covering is instacarnidroof approval. Installation of roof sheathing (new or overlay)ur ur tc final prior to installation of ANY roof coverings and is requireonthe roof when spaced or board sheathingwith ANY a an Pproved inspecL-ion gap exceeding A34_ inch exists. Asphalt shingles are required to be fastened to the roof deck with aminimum 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 ventilacio;7 is required to comply with applicable codes and/or manufacturera€l's 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 a manufacturer&439;s technical representative stating that "the a approval from the (project address) has been applied in accordance with the he application of the roof ofoat (roof material brand name) roof covering" inspection. is required to be on site at the time of final ae� e 2 23 Occupancy/Type INSPECTION RECORD SPECTION ONLINE FORM: http://www.ci,,tithp,=-it,-'dge.co.us/forms.as 3?fid=79 INSPECTION REQUEST LINE: (303) 234-59 Inspections will not be performed unless this card is posted on the project site. Y ** Call the inspection request line before 11:59 p.m. to receive an inspection the following business da Inspector Must Sign ALL Spaces pertinent to this project Date Inspector Comments 'oundation Inspections Initials 'ier ;oncrete Encased Ground (CEG) oundation I P.E. Letter royal Of The Above Inspections Do Not Pour Concrete Prior To App Inspector Comments Underground/Slab Inspections Date Initials Electrical Sewer Service Plumbing royal Of The Above Inspections Do Not Cover Under round or Below/in- pea bWork Prior To App Comments Rough Inspections Date Initials Wall Sheathing Mid -Roof Lath /Wall Tie Rough Electric Rough riumbing/Gas Line Rough Mechanical Rough Framing Rough Grading Insulation Drywall Screw I Nail Final Inspections Landscaping & Parking / Planning Dept. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection I Fire Protection Dist. Final Electrical Final Plumbing Final Mechanical Roof Final Window/Doors Date Inspector Comments Initials 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 PlanninPu61ic Works, Fire and Building before a Certificate NOTE: All items must be completed and approved by g, 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 UnhiS C rd Certificate From The Weather occupancy Is issued Protect T City of Wheat Ridge Residential Roofing PERMIT - 201702423 PERMIT NO: 201702423 ISSUED: 06/23/2017 JOB ADDRESS: 4700 Upham ST EXPIRES: 06/23/2018 JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles with modified bitumen on flat portion 23.18 sq. (21.17 sq. pitched and 2.04 sq. flat) *** CONTACTS *** OWNER (303)257-7346 WORKMAN MARK S SUB (303)694-4363 Glen & Sandra Thiessen 140071 Thiessen Const. & Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,245.63 FEES Total Valuation 0.00 Use Tax 215.16 Permit Fee 220.15 Y, 1 ** TOTAL ** 435.31 *** 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 A% -inch exists. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave and secured in place is required to be provided for all roof inspections. Roof ventilation is required to comply with applicable codes and/or manufacturera€'"s 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's technical representative stating that "the application of the roof at (project address) has been applied in accordance with the installation instruction for (roof material brand name) roof covering" is required to be on site at the time of final inspection. City of Wheat Ridge Residential Roofing PERMIT - 201702423 f' PERMIT NO: 201702423 ISSUED: 06/23/2017 JOB ADDRESS: 4700 Upham ST EXPIRES: 06/23/2018 JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt modified bitumen on flat portion 23.18 sq. (21.17 sq. pitched flat) shingles with and 2.04 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 ap�,i cable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the legal owner of the property anam authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attest that I atrl allyauthorized toncludeall entities named within this document as partes to the work10 be performed and that allwork tobe permed is disclosed in this document and/or its' accompanying approved plans and specifications. �. .:t — Signature of OWNER or CONTRACTOR (Circle one) Date 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 andprocedures. 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 Budding Official and may be subject to a fee equal to one-half of the original permit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4, No work of any manner shall be performed that shall results in a 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 oranyordinance or regulation of this jurisdiction. 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. Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ei.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. Antoinette Kulick From: no-reply@ci.wheatridge.co.us Sent: Tuesday, June 13, 2017 7:58 AM /I To: Permits CommDev , _ Subject: Online Form Submittal: Residential Roofing Permit Application P V Residential Roofing Permit Application (17 This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your .� contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. Permits are currently being processed within 3-5 business days, subject to change based on volume. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address Do you have a signed contract to reroof this property? It will need to be provided at the time of permit pick-up. 4700 Upham Street Karen and Mark Workman 303-257-7346 Field not completed. Yes � x-35. 3l CONTRACTOR INFORMATION Contractor Name Thiessen Construction and Roofing Contractor's License 140071 Number (for the City of Wheat Ridge) Contractor Phone 303-694-4363 Number Contractor Email Address Office.thiessenroofing@gmail.com (permit pick-up instructions will be sent to this email) Retype Contractor Email Off ice.thiessenroofing@gmail.com Address DESCRIPTION OF WORK Is this application for a Yes new permit for a residential roof? Are you re -decking the No roof? Description of Roofing Owens Corning Duration Shingles Material Select Type of Material: Asphalt, Other (specify below) If "Other" is selected Modified bitumen on flat portion above, describe here: How many squares of the 21.17 material selected above? Does any portion of the Yes property include a flat roof? If yes, how many squares 2.04 on the flat roof? TOTAL SQUARES of all 23.18 roofing material for this project z 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) Reroof House 4/12 pitch and Flat area with 2/12 pitch 10,245.63 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 Sandra Thiessen Email not displaying correctly? View it in your browser. 3 Date / Customer Address %� �1! rl C 0 o City State zip Ph ne E ail n 63SSS Yr -/S-D Insurance Com any Claim # H IESSE N C O N S T RUCTION & ROOF ING 8200 S. Quebec St. #A3-502 Office: 303-694-4363 Centennial, CO 80112 Fax: 303-779-1377 A Colorado Licensed Specialty Contractor 0rInsured by: lecure American Insurance - 970-222-7202 Thiessen Construction and Roofing (TCR) shall hold in trust any payment received until the materials have been delivered to the property above or the majority of the work has been completed. Colorado Law grants the homeowner a three (3) day Right of Rescission (See back for more information). By Colorado Law; TCR cannot pay, waive, rebate or promise to pay, waive or rebate all or part of any deductible applicable to the claim for roofing work on the covered residential property. Permit Furnished: -------------- Grade/MFG of Shingle: _-------__ Shingle Color &Qty: -___---_---- RidgeMaterial &Qty: ----___---- Valleys/Qty: ------------------- Tear Off Qty & Number of Layers: __- Pitch: Stories: 151b Felt: 301b Felt: Plumbing Boot Jacks: ---____----_ Vent Caps & Collars: ____---_--_-- Ice/WaterShield &Qty: ---------- Drip Edge/Flashings:--_--___-_-_ Gutters & Downspouts Qty: - ------ Skylights: _-___Skylights: ---------------------- Attic Vents: _------------------_ Special Decking Requirements: Windows & Screens: .--___-_-_--_ Siding &Trim: __________________ Painting&Misc.:-_______________ r 2 3 vL Pew ink Remove Demolished Debris from Roof, Yard and Gutters Protect Landscaping (Where Necessary) Contract Amount: _------------ $ 31, , 3 3 Date to Begin ------------------ sJ bt.�".o ';l3r Payment: 1/2 no later than delivery of materials and balance upon receipt of funds from the insurance company This agreement is for the full scope of the insurance proceeds and is subject to the insurance company approval. By signing this agreement the customer is authorizing Thiessen Construction and Roofing (TCR) to pursue the customer's best interest in all repairs at a price agreeable to the insurance company and TCR. The only cost to the customer is the deductible and any agreeable upgrades. The final cost agreed upon by the insurance company and TCR shall be the final contract cost. All work is guaranteed to be free of defect from installation and workmanship for a period of five (5) years. n CustomerSignature Date Au orizedAgentSign �ure Date A 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: R O Job Address: 11700 ,�— Permit Number: ❑ No one available for inspection: Time AM/PM Re -Inspection required: Yes No Whencorrecti ns have been made, call for re -inspection at 303-234-5933 Date: Inspector: I®l 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:-Z�-� Job Address: Permit Number: Z c,)/o Z I -/Z ❑ No one available for inspection: Time/ AM/PM Re -Inspection required: Yes N When corrections have been made, call for re-insp tioli at 303-234-5933 Date: Inspector: U DO NOT REMOVE�a=11S NOTICE 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. rzl V 1cn S _ aq C 1. INSPECTOR MUST SIGN ALL SPACES PERTAINING To THIS JOB FOUNDATION INSPECTIONS _ DATE INSPECTOR NITIALS I COMMENTS: Footings /Caissons re Stemwall / (CEG) Concrete .Encased Ground ice - Reinforcing or Monolithic. g c. Weatherproof / French Drain Rough Plumbing - - Sewer Service Lines - Gas Piping Water Service Lines Rough Mechanical POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) I ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING g:` Framing §, Drywall Screw FINALS - Electrical -- -- Plumbing — "" Mechanical - »„ Roof ? Building Final Fi re Department R O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLIC WORKS SHOULD Parkin I & Landscaping " P BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. ** No TE. \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 AUTHORIZA i OF A CERTIFICATE OF OCCUPANCY NOR PERMISSI FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ' R re ice g c. Rough Plumbing _ Gas Piping Rough Mechanical 301ION SI1413n0W3M 10N 00 n , u t :aoloedsul }�_ �aC :Oleo 8885 6EZ E08 ]v uopge Lqi io/ ❑vo 'epem ueeq envy suoµoeijoo ueyM / ON ) sek :paAmbaa uoiloadsul -aa W owLL .uoiloodsui aoi opepene auo ON ❑ hi - 7! ld?C� :aagwnN }lwaad :ssaippd qop Grg :adA.L uoiloodsul 30110N N01103dSNI xez 6068 LEO (EOE) egl.40 9980 -S£Z (£0£) au/i uogoedsul 8865-tiEZ (Co uoisiniU uol}oodsul 6ulplin8 3000 ltl3HM =10 A110 I 1 s: l _ _. ♦ 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: h4a Job Address: 970D u,AU sT Permit Number: 0741FFA ❑ No one available for inspection: Time AL' tS AM PM Re- Inspection required: (e) No When corrections have been made, call for re- inspection at 303- 234 -5933 Date: yl3ala Inspecto DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 235 -2857 Fax INSPECTION NOTICE Inspection Type: riJrt?dM1�r Job Address: y`7 r r.rf ?' a 57 Permit Number: g�,'9'03''r 2 C j' r ❑ No one available for inspection: Time >l f AM /PM Re- Inspection required: Yes _ No When corrections have been made, call for re- Inspection at 303 - 234 -5933 Date: W Inspector DO NOT REMOVE THIS NOTICE i6 ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303).235-2855 Office (303) 237-8929 Fax 11 1 INSPECTION NOT CE Inspection Type: ~ YV~4 Job Address: ~U U Permit Number: 0qo < r I e r, ❑ No one available for inspection: Time 10.1w CAQVPM Re-Inspection require , Yes No When corrections have been made, call for re-inspection at 303-234-5933 Date: 4 ~ Cites Inspector: DO NOT REMOVE THIS NOTICE y e a o CITY OF WHEAT RIDGE ' Building Inspection Division (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: i Job Address: Permit Number: J'� ?� ❑ No one available for inspection: Time ` 5 A PM Re- Inspection required: Yes No When corrections have been made, calf for re- inspection at 303-234 -5933 Date: Inspector r DO NOT REMOVE THIS NOTICE City of Wheat Ridge -rr Residential Mechanic PERMIT - 092652 PERMIT NO: 092652! sISSUED: 09/22/2009 JOB ADDRESS: 4700 UPHAM ST-. '.EXPIRES: 03/21/2010 DESCRIPTION.: Replace water heater.( 40 gallon, 38 BTU's CONTACTS owner 303/237-5099 Mark/Karen Workman gc 866/898-0008 Mariana Kitchukova 08-0021 Colorado Delta Mechanical Inc. **'PARCEL :INFO ZONE CODE: UA USE: UA SUBDIVISION: 0009 BLOCK/LOT#: 0/ **'FEE -SUMMARY ESTIMATED PROJECT VALUATION: 975.00 FEES Permit Fee 50.40 Total Valuation .00 Use Tax 17.55 **TOTAL 67.95 I hereby certify that the wetback 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(I.B.C). and all other.. applicable Wheat Ridge Ordinances, for work under this permit. Planssubject to field inspection. 7n` Signature of contractor/owner ' date 1. This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the -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 exceeded one (1) year. If changes have been'. or if suspension or abandonment exceeds one (1) year, full fees shall be paid fora 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 t written approval on inspection card before proceeding with successive phases. of the job. 6. :The issuance of a permit or the approval of ldrawings and specifications shall not be construed to be a permit for, nor an approval of, any violation of the provisions of the building codes or any. other ordinance, law, rule or. regulation..'. All plan review iub t to field inspections. O Signature of. Chie Bui ng<Official date INSPECTION QUEST LINE: (3.03)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUST BE MADE BY '3PM ANY .`BUSINESS : DAY FOR INSPECTION THE'.: FOLLOWING BUSINESS DAY.' 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: Plan Permit Property Address; Property Owner (please Mailing Address: (if different than property address) Address: ISUI I - Contractor: Contractor License Cb k Phone: I Sub Contractors, Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ < DO ❑eSCrlptlOn pf WOrk,` ~l/~/~ I/ (as calculated per the Building Valuation Data sheet) I n{/l/wI r Plan Review (due at time of submittal): $ Sq. Ft./L.Ftadded, Squares BTU's M GallonsL-10 Amps OFW H~Tgi > OCORA00 OWNERICONTRACTOR SIGNATURE OF L I hereby certify that the setback distances pr rules or regulations of the City of Wheat Rid allegations made are accurate; that I have re responsibility for compliance with the Wheat under this permit. Plans subject to field insF CIRLCE ONE: OWNER) CONTRACTOI PRINT NAME: Y K ,ERSTANDING AND AGREEMENT used by this permit application are accurate, and do not violate applicable ordinances, or covenants, easements or restrictions of record; that all measurements shown, and and agree to abide by all conditions printed on this application and that I assume full ige Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work SIGNATURE: I Bidg Valuation: $ I a Building Permit Application ♦ A ♦ CITY OF WHEAT RIDGE Building Inspection Division i,00000 (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: _aFcor' Job Address: Y~~c> c p Pl?l Y.~? s 7 Permit Number: F~9O15°1 j, E.; ❑ No one available for inspection: Time ll;,0,S AM/PM Re-Inspection required: Yes No When corrections have been made, call for re-inspection at 303-234-5933 C Date: o Inspector: DO NOT REMOVE THIS NOTICE k, 4700 UPHAM ST EXPIRES': 01/12/2010 T/O reroof sas.'. with 10'. yr OC litions: ail installation & mid roof inspection required.. Board sheeting spaced more FW"QTR City of Wheat Ridge Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 \ ~oLORPOO Inspection Line: 303-234-5933 - Building Permit Application Property Address: O M V Property Owner (please print) V0''))'' ~ h4,q/J Mailing Address: (if different than property address) Address: sy~ Date: Plan Permit -7-T-dgI City, State, Zip: al(g,Z ~t7 Contractor: rnfeiS ~~7~ fgooV-~;.-ra Contractor License Ol9q~ g Phone: ,3/ 760? - 3 7 0 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: $ b 0 Description of work: (as calculated per the Building Valuation Data sheet) Ir.~r Plan Review (due at time of submittal):$ leomf L.,/o c 30vrn l Sq. Ft./L.Ft added: Squares Of_ - 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. CIRLCE ONE:: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIVE of (OWNER) (CONTRATOR) PRINT NAME: 14*n Soir SIGNATURE: Dater / DEPARTMENT USE ONLY ZONING-COMMENTS: Zoning Reviewer PUBLIC WORKS COMMENTS: Reviewer BUILDING DEPARTMENT COMMENTS: OCCUPANCY: Reviewer FIRE DEPARTMENT:: ❑ approved w/ comments ❑ disapproved ❑ no review required Bldg Valuation: $ ✓ Y