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Home My WebLink About3076 Eaton StreetPERMIT: 611 0-5-"i l % ADDRESS: `26, -Q -,I" . JOB CODE: Rough Inspection (continued) Date Inspector Initials Comments 316 Rough Mechanical Residential 317 Rough Mechanical Commercial 318 Boiler / Furnace 319 Hot water tank 320 Drywall screw and Nail 321 Moisture board / shower walls 322 Rough Grading 323 Miscellaneous - J - 1 $ -Tb Final Inspections Date Inspector Initials Comments 402 Gas Meter Release 403 Final Electrical Residential 404 Final Electrical Commercial 405 Final Mechanical Residential 406 Final Mechanical Commercial 407 Final Plumbing Residential 408 Final Plumbing Commercial 409 Final Roof - J - 1 $ -Tb 410 Final Window/Door 411 Land scape/Park/Planning* Inspections from these entities shall be requested one week in advance. *For landscaping and parking inspections please call 303-235-2846 **For ROW and drainage inspections please call 303-235-2861 ***For fire inspections please contact the Fire Protection District for your project. 412 Row/Drainage/Public Works** 413 Flood plain Inspection** 414 Fire Insp. / Fire Protection*** 415 Public Works Final** 416 Storm Water Mgmt.** 417 Zoning Final Inspection* 418 Building Final Inspection 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 by the Fire District and Electrical low voltage by the Building Division. INSPECTION RECORD Inspection online form: http://www.cl.wheatridge.co.us/inspection 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 MIDNIGHT (11:59 PM) to receive an inspection the following business day PERMIT: % v51 ADDRESS:JOB CODE: Foundation Inspections Date Inspector Initials Comments 102 Caissons / Piers 103 Footing / P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector Initials Comments 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 206 Water Underground q-.)/- l 7 �I^D Do Not Cover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector Initials Comments 301 Rough Framing 302 Wall Sheathing 303 Roof Sheathing 304 Sheer Inspection 305 Insulation 306 Mid -Roof q-.)/- l 7 �I^D 307 Metal / Lath / Stucco 308 Rough Electrical Residential 309 Rough Electrical Commercial 310 Electrical Meter Residential 311 Electrical Meter Commercial 312 Temp. Const. Meter 313 Rough Plumbing Residential 314 Rough Plumbing Commercial 315 Shower Pan SEE OVER FOR ApnITIONAL INSPECTIONS WA i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 1-10 9- F-, rl I ( Job Address: 30-71_ Jon S� Permit Number: 'a 0 1-7 o s 9 9 1 ❑ No one available for inspection: Time . 2D.� S_t� AM/la) Re -Inspection required: Yes Flo When corrections have been made, call for re -inspection at 303 -234 - Date:— i Inspector: Tb DO NOT REMOVE THIS NOTICE �.i CIT; OF W14 `A 'RIDGE _:�9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 3 0 & - li') . j Job Address: 3 0 -7 (v �' -L n S �- Permit Number: a c 1-7 o s Cl q I ❑ No one available for inspection: Time = a ?AM/& Re -Inspection required: Yes oNo When corrections have been made, call for re -inspection at 303 -234 - Date: 9 a'I 17 Inspector: 'T-6 DO NOT REMOVE THIS NOTICE A o City of Wheat Ridge Residential Roofing PERMIT - 201705991 PERMIT NO: 201705991 ISSUED: 08/12/2017 JOB ADDRESS: 3076 Eaton ST EXPIRES: 08/12/2018 JOB DESCRIPTION: Residential Re -roof to install GAF asphalt shingles - 22 sq (18 sq pitched / 4 sq flat) *** CONTACTS *** OWNER (303)233-3976 JAMES CLIFFORD HUGGINS & MARY SUB (303)600-8696 Lawrence Kerr 110274 Formula Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATIO . 111000.00 FEES "As I Co 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 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 - 201705991 PERMIT NO: 201705991 ISSUED: 08/12/2017 JOB ADDRESS: 3076 Eaton ST EXPIRES: 08/12/2018 JOB DESCRIPTION: Residential Re—roof to install GAF asphalt shingles — 22 sq (18 sq pitched / 4 sq flat) 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 roperty and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attesfthat I am legally authorized to include all entities named within this document as parties to the work to be performed tat all work to be wed 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 Flaps 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 maybe 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.igLe 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. AGREEMENT 4560 Columbine 5t. Denver, ED 80216 FORMULA 303.600.8696 ROOFING a REMODELING FAX 303.600.8654 Building Solu?ons for Colorado Customer Name: Jim Huggins Address: 3076 Eaton Street Customer Phone 303 -946 -4622 -Scotts Ph#2 Adjuster Name: Adjuster Phone:_ Customer In s 71 Shingle Manufacturer: GAF V Style of Shingles: Timberline HD Color of Shingles: %7 - Number of Squares: 17-89+4-72 Tear off # of layers: 1 Layer Install Felt: Replace Plumbing Jack: Replace Roof Vents: Ice and Water ShieldEaveS & Valleys Of Nailing Pattern: 6 nails per Shingle— Of Drip Edge: Appropriate County/City Code Requirements Clean-up and haul off all trash from roof Roll yard and driveway with magnetic roller Clean gutters of roofing debris Fonnula R & R will furnish all material &labor Permit pulled by Formula R & R All new roofs guaranteed for 5 years All repairs guaranteed for 90 days. Additional Warranty: System Plus Y Homeowner Upgrades: Total Cost: $ 11,600.04+Supplements Excluding permit and code requirements Customer 51Initials Customer Initials 51 M'M raster Elite WEATHER STOPPERROOFING CONTRACTOR Rep: Mark Dulon Phone: 720-432-2539 Email: dulonm(a amail.com Pitch: 7/12 Stories: 1 Adjuster Email: Trailer Access: No Formula Roofing & Remodeling will perform all repairs as outlined and approved by the Homeowner's insurance company, including supplements. Gutters227 Gutters & Downs outs -Match current color Windows 2 windows to be realazed Screens/Glazing Bead 2 screens Paint Fence/Deck NA Siding 2 spts of Shutters, 3 metal awnings Additional Comments: By signing this contract 1, the property owner, agree to the above listed work being completed as outlined. Insurance Claim: By signing this contract I do hereby give Limited Power of Attorney to Fonnula Roofing & Remodeling, authorizing my insurance company to speak with my contractor Formula Roofing & Remodeling on my behalf with anyand all dealings regardingthe current claim listed in this contract. Limited Power of Attorney is to be withdrawn when Forniula Roofing & Remodeling is paid in full. Formula Roofing & Remodeling will bill my insurance company for all work, including code required work necessary, which, in most cases, is payable by my insurance company. 1, the insured, will not be responsible for any monies not paid by the insurance company except for the deductible and optional upgrades listed on contract: unless notification is made prior to work being completed, or in cases of"No Code Coverage" or "Non -Recoverable Depreciation" on my insurance policy. Code items are required to comply with city/county code and are not optional. Formula Roofing & Remodeling will request the final inspection with the appropriate City/County Authority. Formula Roofing & Remodeling will perform any and all supplemental work approved by the property owner's insurance company. Any additional funds allocated for additional work as part of this claim will be payable to Fonnula Roofing & Remodeling once the work has been completed and funds have been released. THE "TERMS AND CONDITIONS OF THE AGREEMENT" PRINTED ON THE BACK OF THIS PAGE ARE INCORPORATED INTO, AND FORM A PART OF, THIS AGREEMENT. Contractor shall hold in trust any payment received from Owner until Contractor has delivered roofing materials to the site or has performed a majority of the roofing work on the property, whichever occurs first. Deposit Received: $ ACV Due on Approximate date of Se Ice commencement: asap Insurance claims proceeds: Owner to remit ACV insurance payment no later than date of service commencement. Final payment due upon completion of scope of work as agreed upon, receipt of insurance proceeds (if applicable) and/or approval of building department final inspection. Upon signing of the contract the owner reserves the right to a three day rescission period. If the contract is canceled after that th(�^[7� ee day period, customer will pay 25% of contract price. Customer Signature: ® Date: 07/19/2017 Customer Signature: Date: Formula Representative: P'" QK6.1 Date: 06/29/2017 Doc ID: 42da3b9b6bbbfld163efc37decOaf355f56682c5 Dane Lovett 2olTDSV� From: no-reply@ci.wheatridge.co.us Sent: Tuesday, August 8, 2017 3:28 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Dane 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 3076 Eaton St Property Owner Name Jim Huggins Property Owner Phone (303) 233-3976 Number (enter WITH dashes, eg 303-123-4567) Property Owner Email Address Do you have a signed contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Contract formularoofing1 @gmail.com Yes Jim Huggins Agreement 5-8-17.pdf CONTRACTOR INFORMATION Contractor Business Formula Roofing Name l) L Contractor's License 110274 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone Number (enter WITH dashes, eg 303-123-4567) Contractor Address (Primary address of your business) 303-600-8696 4560 columbine st Contractor Email Address form ularoofing1@gmail.com Retype Contractor Email formularoofing1 @gmail.com Address DESCRIPTION OF WORK TOTAL SQUARES of 22 the entire scope of work: Project Value (contract 11000 value or cost of ALL materials and labor) Are you re -decking the No/ roof? z Does the scope of the project include a flat roof (less than 2:12 pitch)? How many squares are part of the flat roof? Describe the roofing material for the flat roof: Type of material for the flat roof: Does the scope of the project include a pitched roof (2:12 or greater pitch)? How many squares are part of the pitched roof? Describe the roofing materials for the pitched roof: Type of material for the pitched roof: Provide any additional detail here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Yes ! 4 Mulehide Mod Bit Rolled Yes 18 GAF Shingles Asphalt Install shingles and Ice & Water with new drip edge pitch is 6/12 to 9/12 SIGNATURE OF UNDERSTANDING AND AGREEMENT 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. I understand that this application is NOT a permit. I understand I will be contacted by the City Yes Yes 3 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. 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. Name of Applicant Dominick Orrino Email not displaying correctly? View it in your browser. I -J 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: ED -' Job Address: 0.7 to tj C) r✓ (7-r Permit Number: p -7 6 0 3 s 9 A ('Ju co I A%U_5 M0 Y c� ❑ No one available for inspection: Time r` r �--AM/PM Re -Inspection required: Yes No * When corrections have been made, can for r -inspection at 303-234-5933 Date: Inspector: i 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: Job Address: Z 0 -/ o ' C -r- Permit Number: 16 l'7 6 0 -1 S I' 0/7 Ij ❑ No one available for inspection: Time 10 AM/PM Re -Inspection required: Yes No *When corrections have been made, call for re -inspection at 303-234-5933 Date: / -7 Inspector: s DO NOT REMOVE THIS NOTICE } CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office - (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: M ti Q / SA c Job Address: Z o':7 L cr s o -57 7' Permit Number: ;�C i 7 6 2 o k--, -t- (_ N I I t, t- LNIIt, chf /u m1iD/KaF 1i (! epic k rr) ? o 1c, -t �in4' ❑ No one available for inspection: Time I L 6 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 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: tN'1 i i� / � A N Job Address:. "k 6 -7 1- 4 Permit Number: ") U / '7 ' ' 4AAt�2� ❑ No one available for inspection: Time } F `� AM/PM Re -Inspection required: Yes No *When corrections have been made, call for pection at 303-234-5933 Date: `'� /'7 Inspector: r DO NOT REMOVE THIS NOTICE a City of Wheat Ridge Residential Roofing PERMIT - 201700359 PERMIT NO: 201700359 ISSUED: 03/13/2017 JOB ADDRESS: 3076 Eaton ST EXPIRES: 03/13/2018 JOB DESCRIPTION: Tear off and install ice & water shield, new underlayment; GAF shingles; re -deck included; 22 squares *** CONTACTS *** OWNER JAMES CLIFFORD HUGGINS & MARY SUB (303)600-8696 Lawrence Kerr 110274 Formula Roofing *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,000.00 FEES Total Valuation 0.00 Use Tax 162.00 Y3 1 It 'IF Permit Fee 188.45 � ** TOTAL ** 350.45 l✓1L *** 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€ms 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. 6 4 a( City of Wheat Ridge N ,AIF Residential Roofing PERMIT - 201700359 PERMIT NO: 201700359 ISSUED: 03/13/2017 JOB ADDRESS: 3076 Eaton ST EXPIRES: 03/13/2018 JOB DESCRIPTION: Tear off and install ice & water shield, new underlayment; GAF shingles; re -deck included; 22 squares I, by m si >nature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable wilding 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 an authorized to obtain this permit and perform the work described and approved in conjunction with this permit. 1 further attest that I am legally authorized to include all entities named within this document as parties to the work to be permed and that all wto be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER or TRACTOR (C CONircle one) Date I . This permit was issued based on thein onna ion 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 an 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 de 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. 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 ?'Whea-W,0 ge L,OM.�v um'ry DEVELOPMEN i 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 FOR OFFICE USE ONLY Date: 3113 > Plarwermit # i o f mo3scj- 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: Property Owner (please print): Q � Phone: '-Y) Mf� Property Owner Email: _5_!fo f c'N��nlC� CC' S t, �� co "6 wN Mailing Address: (if different than property address) Aririracc- City, State Zip: Arch itect/Enaineer: - Architect/Engineer E-mail: Contractors City License #: Contractor E-mail Address: --A Sub Contractors: Electrical: W.R. City License # Other City Licensed Sub'. City License # Plumbing: W.R. City License # Phone: Phone: 363 _(Q V6 Other City Licensed Sub: City License # Mechanical: W.R. City License # Complete all information on BOTH sides of this form ❑ COMMERCIAL X1 RESIDENTIAL 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.) RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.) MECHANICAL 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. FtAF Btu's Gallons Amps Squares _ Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONTRACTO or UTHORIZED REPRESENTATIVE) of (OWNER) CONTRACTOR) ,i Electronic Signature (first and last name), zr�-� �� DATE: —7 �r ZONING COMMMENTS: Reviewer BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $