HomeMy WebLinkAbout4060 Otis Street1* � � i City of Wheat Ridge
E -Res. Boiler Replacement PERMIT - 202001862
PERMIT NO: 202001862 ISSUED: 09/17/2020
JOB ADDRESS: 4060 Otis St EXPIRES: 09/17/2021
JOB DESCRIPTION: Installing 135k BTU, 80% efficiency gas boiler in basement.
*** CONTACTS ***
OWNER (303)420-4726 FOX HELEN R
SUB (303)798-8783 ERIC BEARDEMPHL/DARRIN ERDAHL 018464 COFFMAN & CO HEATING AND A/C
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 81740.00
FEES
Boiler Replacement 40.00
Total Valuation 0.00
** TOTAL ** 40.00
*** COMMENTS ***
*** CONDITIONS ***
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.
Work shall comply with 2018 IRC & 2020 NEC. Smoke alarms shall comply with 2018 IRC Section
134. Interior alterations, repairs, fuel -fired appliance replacements, or additions, any of
which require a building permit, occurs or where one or more rooms lawfully used for
sleeping purposes shall have an operational carbon monoxide alarm installed within fifteen
feet of the entrance to each room lawfully used for sleeping purposes.
I by m si nature do hereby attest that the work to be performed shall comply with all accompanyin approved plans and specifications
applica le uilding codes, and all applicable municipal codes, policies and procedures, and that I am t e legal owner or have been authorized
by the legal owner of theproperty and am authorize to obtain this ermit 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
per ormed and that all work to be per ormed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) Date
1, This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180, days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and��procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all requ�ired
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, anviolation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
From: CommDev Permits
TO: Dina Kemp
Subject: Fw: Online Forth Submittal: Furnace/Boiler Replacement Permit Application
Date: Sunday, December 13, 2020 4:28:20 PM
Furnace/Boiler Replacement Permit Application
This application is exclusively for RESIDENTIAL REPLACEMENT FURNACE or
BOILER - LIKE FOR LIKE ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
Your Permit will be emailed to the email address provided below once it is
processed.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
replacement residential
furnace or boiler like for
like?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4060 Otis St
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Helen Fox
t<i8icMMIX1 `z-3
Property Owner Email Field not completed.
Address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business Coffman & Company Heating and AC LLC
Name
Contractor's License
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 Email pschmidt@coffmanco.com
Address
Retype Contractor
Email Address
DESCRIPTION OF WORK
pschmidt@coffmanco.com
What type of unit is
Boiler
being installed?
Number of BTUs
135000
What is the efficiency
80%
(°%) of the unit?
Is the unit GAS or
Cas
ELECTRIC?
Where is the furnace or
basement
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract
8740
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 Patricia J Schmidt
Permit
Email not displaying correctly? View it in your browser.
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type:
Job Address:` =ro
Permit Number: 7�?Z'0,) /
t
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
When corrections have been made, schedule for re -inspection online at:
http✓/www. ci. wheatridge.co. ushnspection
Date: ; zr� ,.,/ ,�' /,' /?�__51Inspector:
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: ,A-1 J`
Job Address: 41i!�7 w""_0 ' S. l
Permit Number: ee�,-7 f' �� Z-
❑ No one available for inspection: Time. A/ M
Re -Inspection required: J'�eNo
When corrections have been made, schedule for re -inspection online at:
http✓/www.ci. wheatridge.co. ussfinspection
Date: IZS Z>67e,�Mnspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
w E -Res. Boiler Replacement PERMIT - 202001862
PERMIT NO: 202001862 ISSUED: 09/17/2020
JOB ADDRESS: 4060 Otis St EXPIRES: 09/17/2021
JOB DESCRIPTION: Installing 135k BTU, 80% efficiency gas boiler in basement.
*** CONTACTS ***
OWNER (303)420-4726 FOX HELEN R
SUB (303)798-8783 ERIC BEARDEMPHL/DARRIN ERDAHL 018464 COFFMAN & CO HEATING AND A/C
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,740.00
FEES
Boiler Replacement 40.00
Total Valuation 0.00
** TOTAL ** 40.00
*** COMMENTS ***
*** CONDITIONS ***
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.
Work shall comply with 2018 IRC & 2020 NEC. Smoke alarms shall comply with 2018 IRC Section
134. Interior alterations, repairs, fuel -fired appliance replacements, or additions, any of
which require a building permit, occurs or where one or more rooms lawfully used for
sleeping purposes shall have an operational carbon monoxide alarm installed within fifteen
feet of the entrance to each room lawfully used for sleeping purposes.
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 legally 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 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 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 gra ting 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 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.
Dina Kemp
From: no-reply@ci.wheatridge.co.us
Sent: Thursday, September 17, 2020 9:S6 AM
To: CommDev Permits
Subject: Online Form Submittal: Furnace/Boiler Replacement Permit Application
Categories: Dina
Furnace/Boiler Replacement Permit Application
This application is exclusively for RESIDENTIAL REPLACEMENT FURNACE or
BOILER - LIKE FOR LIKE ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
Your Permit will be emailed to the email address provided below once it is
processed.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
replacement residential
furnace or boiler like for
like?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4060 Otis St
Property Owner Name Helen Fox
Property Owner Phone 303-420-4726
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email Field not completed.
Address
Attach City of Wheat 4060 Otis St - Credit Card Authorization Form.pdf
Ridge Electronic Payment
Form - **DO NOT
ATTACH A PICTURE
OF A CREDIT CARD**
1
CONTRACTOR INFORMATION
Contractor Business
Name
Contractor's License
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)
Coffman & Company Heating and AC LLC
18464
303-366-1112
Contractor Email Address pschmidt@coffmanco.com
Retype Contractor Email pschmidt@coffmanco.com
Address
DESCRIPTION OF WORK
What type of unit is being Boiler
installed?
Number of BTUs 135000
What is the efficiency 80%
(%) of the unit?
Is the unit GAS or Gas
ELECTRIC?
Where is the furnace or basement
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract 8740
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
z
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 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.
Person Applying for Patricia J Schmidt
Permit
Email not displaying correctly? View it in your browser.
City of Wheat Ridge
Residential Roofing PERMIT - 201705212
PERMIT NO:
201705212
ISSUED:
08/02/2017
JOB ADDRESS:
4060 Otis ST
EXPIRES:
08/02/2018
JOB DESCRIPTION:
Residential Re -roof to install
Owens Corning Duration asphalt shingles with
ROOF DECKING - 28 sq. (20 sq. on the house, 8 sq. on
the garage)
*** CONTACTS ***
OWNER (303)420-4726
FOX HELEN R
SUB (303)763-9114
Scott Riopelle
019938 Interstate
Roofing Incorporate
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE:
UA / Unassigned
SUBDIVISION CODE:
2405 / BARTHS, COULEHAN GRANGE,
WHEAT BLOCK/LOT*:
0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,383.50
FEES PAID
Total Valuation 0.00
Use Tax 197.05
Permit Fee 204.30
** TOTAL ** 401.35--
*** 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
Residential Roofing PERMIT - 201705212
PERMIT NO: 201705212 ISSUED: 08/02/2017
JOB ADDRESS: 4060 Otis ST EXPIRES: 08/02/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles with
ROOF DECKING - 28 sq. (20 sq. on the house, 8 sq. on the garage)
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 thispermit and perform the work described and approved in conjunction with
thispermit. 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.
M
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 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 anmanner 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
applic e� 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 C�w76SS l C�1_
From: no-reply@ci.wheatridge.co.us
Sent: Tuesday, July 25, 2017 12:38 PM
To: CommDev Permits
Subject: Online Form Submittal: Residential Roofing Permit Application
Categories: Danny rr
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 Q
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 Z
AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if n
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
Property Owner Email
Address
4060 Otis St bL
Helen Fox
3034204726
jwiles@interstateroof.com
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 Business Interstate Roofing
Name
Contractor's License 019938
Number (for the City of
Wheat Ridge)
Contractor Phone 3037639114
Number
Contractor Email Address jwiles@interstateroof.com
Retype Contractor Email jwiles@interstateroof.com
Address
DESCRIPTION OF WORK
Are you re -decking the (::Yes
roof?
Description of Roofing O/C Duration
Material
Select Type of Material: Asphalt
If "Other" is selected Field not completed.
above, describe here:
How many squares of the 20 C3Y1
material selected above?
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 20
(pitched + flat) of all
roofing material for this
project
z
Provide additional detail house, 5:12 pitch
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract --gt;`6 �i �jC . S�
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 John Quante
Email not displaying correctly? View it in your browser.
3
hi J f /9y�I -J47,1
FNts�CrTreHtOgY_ �\
referraoistcam INTERSTATEACCREDITED
�_�-- - c -- ROOFING 1-18-871
Submitted To i e.I e %i Date
Email °'U r` 1 Phone "`� +✓ ' R24 Alt. Phone
r A
Street 1- j o 6r b l f -S - City State U Zip
insurance Company E f rd (� Ciaim# Policy#
Scope of Work and Materials to be Provided. The scope of work and materials identified below are the scope of work recommended by interstate
Roofing Inc.; however, Interstate Roofing is not obligated to perform any part of the scope of work that is not appy ved by the insurance company
unless you authorize the work nd agree topay for this additional work. 01����,r
Shingle Manufacturer dYt T e 1. Color
[�1' Tear off layers of composition shinglest ❑ Tear off one layer of wood shingles - s�
(M" -Install Decking (7116" OSB) -fpr C a l dip f �-y j5 -A-
Install new felt ( f f -
(� Install pre -painted eave metal to codde,- Color Brown Charcoal Tan Gray White int. -`* 1
([ Valley(s) will be closed Z x> eS ❑ Valleys will be open
Ridges) to be color -coordinated ` ( t❑ - v`+d iarK N Q { trTt,a� a m
Ridge(s) will be "High Profile Ridge" color -coordinated shingles � f(j ote, VJ
Install new pipejacks r
Replace Vents as needed t n ft - - "' '` Sof t f G� � ✓ `
l Re -flash chimneys and all wall abutment as needed and if possible (stucco or siding may be a deterrent
❑ Install In, ft. of series ridge vent j
{ Install in. ft. of ice &water shield tom ( G'LtiC
Install nails per shingle
EJ Clean out gutters
5-1 5 year workmanship warranty P �rli j Rz s S
(� 014-
Interstate Roofing, Inc. will provide general liability insurance coverage of $2,000,000, general aggtlegate d- ILO� V l
Cff Make a magnetic sweep of driveway and yard for removal of any nails
W Remove all debris resulting from above work ���
99 Special Instructions
•-r �� �c �.rLuq u-a�- •„= v ..., r ,U -r c--bJ ! � VfJ t..s � �� � t�('6�.F
The a,�proximate cgstJaf the services based on damages known at the time this contract is entered i$s
Interstate Roofing, Inc., however. will perform the scope of work approved by the insurance company for the amount of the insurance approved
t proceeds, with no additional costs to you except for your deductible. The final sco�ann�rice agreed on between the insurance company and
Interstate RoRf , Inc. shall become the final contract price for the insurance approved scope. You will be responsible to pay for any upgrades or
-- -
additions! Werk authorized by you that the insurance company determines is not covered within the scope of coverage provided by your insurance
policy. Supplemental claims billed by Interstate Roofing, Inc. that are approved by the insurance company for additional work or increases in costs
become a part of this contract.
! �s
iA troximate Dates of Service: Zk t �1 T These dates of service are subject to change due to unusual delays in
transportation of materials, ordinary weather lays, or by any other causes beyond the reasonable control of Contractor
Notice:
Iff the property owner plans to use the proceeds of a property and causuaity insurance policy issued pursuant to part 1 of article 4 of tire 10, C.R.S., to
pay for the rooting work, pursuant to section 6-22-105, the roofing contractor cannot pay, waive, rebate, or promise to pay, waive, or rebate all or part
of any insurance deductible applicable to the insurance claim for payment for work on the covered residential property.
Terms:
I (We) hereby authorize d instruct the insurance company & all lien holders to include the name of interstate Roofing, Inc, as co -payee on any
subsequent loss drafts or checks after today's date as indicated above.
I (We) also authorize any legal representative and/or agent of Interstate Roofing, Inc. to obtain information necessary to complete any funding
process relative to the claim number referenced above.
I (we) further authorize interstate Roofing, Inc. to pick up in person any loss drafts or checks on my/our behalf and behalf of Interstate Roofing.
Deposit Amount:
Interstate Roofing shall hold In trust any phyment from the property owner until Int
materials at the residential property site or has preformed a majority of the roofing
on the property.
I (We) agree, by signing below, to all the contract conditions, both front & back of this agreement
roofing
Date of Acceptance
t � 7
Client Signature(s)
Representative:
r
Corporate Headquarters
Colorado Springs Office
Fort Collins Office
Cheyenne Office
Black Ins, Agency
1000 W. 47th Ave.
2161 N. Academy Blvd.
P. 970.482.7722 F. 970.682.1016
1010 5 Greeley Highway
9600 E Arapahoe Rd #205
Deaver. CO 80211
Colorado Springs, CO 80909
Toll Free 877.698.8144
Cheyenne. WY 80211
Englewood, Co 80112-3726
P. 303.763.9114 F. 303.789.3790 P.
719.471.9752 F. 719.597.4444
www_ interstateroof.com
P. 307.634.2553
(303) 397-7820
www.interstateroof.com
info@interstateroof.com
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:
Permit Number: 2�'/'y�?
Is
❑ No one available for inspection: Time < --0 AM/PM
Re -Inspection required: YesA
When corrections have been made, call for re -inspection at 303-234-5933
Date:Inspector:
DO NOT REMOVE THIS NOTICE
R Pp
1V i CIjY OF WHEAT RIDGE `
- Building Inspection Division
r (303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: ZIA _�
Job Address: L/n ! Q r)+., 5 `)'V
Permit Number: Cj /-)o / 2
❑ No one available for inspection: Time ' = r - , AM/,PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date: `� nspector:`
DO NOT REMOVE THIS NOTICE