HomeMy WebLinkAbout4523 Holland StreetCity of Wheat Ridge
Residential Plumbing PERMIT - 201800278
PERMIT NO: 201800278 ISSUED: 01/26/2018
JOB ADDRESS: 4523 Holland ST EXPIRES: 01/26/2019
JOB DESCRIPTION: Residential water heater replacement 36,000 BTU's, 40 gallons.
*** CONTACTS ***
OWNER (303)420-2769 HINELINE DIANNE M
SUB (303)280-5765 Larry Benavidez
100318 Colorado Heating & Cooling
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,451.00
FEES
Total Valuation 0.00
Use Tax 30.47
Permit Fee 60.50
** TOTAL ** 90.97
*** COMMENTS ***
*** CONDITIONS ***
All work shall comply 2012 International Codes, 2014 NEC (if applicable), and ordinances
adopted by the City of Wheat Ridge. Work is subject to field inspections.
I, by m 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
thispermt. I further attest that I am legally authorized to include al�entities named within this document as parties to the work to be
performed and that all work to be per me is
disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACTOR (Circle one) Date
I. 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 tee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new pennit 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 proceedor conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting �f a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable cdde o" a dinane I er_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.
,mag
City of
_�69'"'W heat Midge
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 291h Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Ins ection Line: 303-234-5933
FOR OFFICE USE ONLY
Date: L
Plan/Permit #
D0i8a� 5./
P
Email:ep rmits ci.wheatrid e.co.us
Lj,o
9 Application
Permit A lication
*** Please complete all highlighted area both sides of this form. Incomplete applications may not be processed. "**
Property Address:
Property Owner
Property Owner Email:
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Architect/Egineer
Architect/Engineer E-mail:
Contractors City License #:
Contractor E-mail
For Plan Review Questions & Comments (please print);
i
CONTACT NAME (please print): �� 1 V 11
CONTACT EMAIL(please
Sub Contractors:
Electrical:
W.R. City License #
Other City Licensed Sub:
City License #
City License #
Plumbing:
W.R. City License #
Phone:
Phone:
Phone:CI�j��,�
Other City Licensed Sub:
12 -29
Mechanical:
W.R. City License #
Complete all information on BOTH sides of this form
'76 c
❑ COMMERCIAL YRESIDENTIAL
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. Ft./LF
Amps
Btu's Gallons
Squares
Other
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
$ G'�
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 1 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) (CON CTOR) �ror (AUTHORIZED REPRESENTATIVE); of (OWNER) (CONTRACTOR)
Sienature (first and last name): DATE: v r f
DEPARTMENT USE ONLY
ZONING COMMMENTS: OCCUPANCY CLASSIFICATION:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
Building Division Valuation: $
0
L c Ou S,
INSPECTION RECO
=tO/---�7 gINSPECTION ONLINE FOR ww.ci.wao.us/inspection
INSPECTION
Occupancy/Type
Inspections will not be performed unless this card is posted on the project site.
**Requ i;t acs 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 Initials Initials _
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
UO Not Four concrete Prior I o A proval Ut I he Above imnijectior s
Underground/Slab Inspections Date Inspector Commends
Initials
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Ines=sections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
o
j
j
Floodplain Inspection (if applicable)
ie
Fire Inspection / Fire Protection Dist.
Rough Electric
Final Electrical
Rough Plumbing/Gas Line
Final Plumbing
Rough Mechanical
Final Mechanical
Rough Framing
Roof
Rough Grading
Final Window/Doors
Insulation
Final Building
Drywall Screw/ Nail
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.
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
i A City of Wheat Ridge
.r r
"'f Residential Roofing PERMIT - 201704326
PERMIT NO: 201704326 ISSUED: 07/18/2017
JOB ADDRESS: 4523 Holland ST EXPIRES: 07/18/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles -
33.92 sq
*** CONTACTS ***
OWNER (303)420-2769 HINELINE DIANNE M
SUB (970)207-0000 James Simpson 130058 Affordable Roofing Inc.
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,717.44
FEES
Total Valuation 0.00
Use Tax 183.07
Permit Fee 188.45
** TOTAL ** 371.52
*** 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.
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION
City of Wheat Ridge
Residential Plumbing PERMIT - 201709727
201709727
4523 Holland ST
Residential Plumbing
ISSUED: 12/29/2017
EXPIRES: 12/29/2018
*** CONTACTS ***
OWNER (303)420-2769 HINELINE DIANNE M
SUB (303)280-5765 Larry Benavidez 100318 Colorado Heating & Cooling
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,451.00
FEES
Total Valuation 0.00
Use Tax 30.47
Permit Fee 60.50
** TOTAL ** 90.97
*** COMMENTS ***
*** CONDITIONS ***
All work shall comply 2012 International Codes, 2014 NEC (if applicable), and ordinances
adopted by the City of Wheat Ridge. Work is subject to field inspections.
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 erm t. 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' y ccompanying approved plans and specifications.
/
Signature of OA NER- or C_O R rcle one) Date
I. This permit was issued base in ormation provided in the permit application and accompanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
2. This. permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the original ermit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4, No work of any manner shall be performed that shall results in a 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. TheJssu ce 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 r any ordinanpe or re ulat'on 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
w heat ljgie
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 2911 Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: permits(a)-ci.wheatridge.co.us
FOR OFFICE USE ONLY
Date:
Plan/Permit #
Plan Review Fee:
Building Permit Application
Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *"
Property Address:
Property Owner Email:
Mailing Address: (if different than property address)
Address:
, State, Zi
ArchitectlEngineer:
Architect/Engineer E-mail:
Contractor:
Phone:
Contractors City License #: / 003 / �r Phone: 13q z1810 ,r_) %65
Contractor E-mail Address:
For Plan Review Questions & Comments (please print):
f
CONTACT NAME (please print) (fl6' `t +� Phone: �O�_2ffO-�
CONTACT EMAIL(please print):
Sub Contractors:
Electrical:
W.R. City License #
Other City Licensed Sub:
City License #
City License #
Plumbing:
W.R. City License #
Other City Licensed Sub:
Mechanical:
W.R. City License #
Complete all information on BOTH sides of this form
7 b9
❑ COMMERCIAL 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
amoury of materials to be used, etc.)
�a
�
�� �, 606 6�U
J
Sq. Ft./LF
Amps
Btu's & f Ca) Gallons
Squares
Other
q6, 0
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
$ N5� - 00 1
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 j the lip�thisng permit application, warrant the
truthfulness of the information provided on the applicatio
CIRCLE ONE: (OWNER) (CONT CTOR). AUTHORIZED REPRESENTATIVE) (OWNER) (CONT CTOR)
Signature (first and last name): DATE: J2, 1Z / 7
DEPARTMENT USE ONLY
ZONING COMMMENTS: OCCUPANCY CLASSIFICATION:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
Building Division Valuation: $
City of Wheat Ridge
4 ly
Residential Roofing PERMIT - 201704326
PERMIT NO: 201704326 ISSUED: 07/18/2017
JOB ADDRESS: 4523 Holland ST EXPIRES: 07/18/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles -
33.92 sq
*** CONTACTS ***
OWNER (303)420-2769
HINELINE DIANNE
M
SUB (970)207-0000
James Simpson
130058 Affordable Roofing Inc.
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE: UA / Unassigned
SUBDIVISION CODE:
2002 / KIPLING,
I-70 & CLEARCREEK
ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION: 8,717.44
FEES
Total Valuation
0.00
Use Tax
183.07
Permit Fee
188.45
** TOTAL **
371.52
*** 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.
, ► A 4 City of Wheat Ridge
Residential Roofing PERMIT - 201704326
PERMIT NO: 201704326 ISSUED: 07/18/2017
JOB ADDRESS: 4523 Holland ST EXPIRES: 07/18/2018
JOB DESCRIPTION: Residential Re -roof to install Owens Corning Duration asphalt shingles
33.92 sq
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this'?ermit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be
perrm d; that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Y- -��-- 7
Anature of OWNER r CONTRACTOR (Circle one) Date
1. This permit was issued based on the information provided in the permit application and accompanying Flans 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 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 construe a permit for, or an approva of, any violation of any provision of any
applicable code or any ordinance or regulation of this jurisdi n. Approvrk is ubj t 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.
Dane Lovett
From:
Sent:
To:
Subject:
Categories:
2o/70p3Z6
no-reply@ci.wheatridge.co.us
Monday, July 10, 2017 10:24 AM
Permits CommDev
Online Form Submittal: Residential Roofing Permit Application
Danny
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 le�J
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address 4523 Holland Street, Wheat Ridge, CO 80033
Property Owner Name Dianne Hineline
Property Owner Phone 303-420-2769
Number
Property Owner Email Field not completed.
Address
�371;Sz
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
Contractor's License
Number (for the City of
Wheat Ridge)
Contractor Phone
Number
Affordable Roofing
130058
970-207-0000
Contractor Email Address cynthia@affordableroofinginc.com
Retype Contractor Email cynthia@affordableroofinginc.com
Address
DESCRIPTION OF WORK
Are you re -decking the
roof?
Description of Roofing
Material
No /
OC Duration Storm Driftwood
Select Type of Material: Asphalt
If "Other" is selected Field not completed.
above, describe here:
How many squares of the 33.92
material selected above?
Does any portion of the
property include a flat
roof?
If yes, how many squares
on the flat roof?
No �/
Field not completed.
TOTAL SQUARES of all 33.92
roofing material for this
project
Provide additional detail 4/12
here on the description of
z
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)
4�71J,V4
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 Cynthia Hoover
Email not displaying correctly? View it in your browser.
3
AFFORDABLE
Roofiarg & Restoration
Property Owner Name:
Property Address:
Billing Address, if different:
Email Address:
JORIZATION T
Dianne Hineline
4523 Holland St.
4523 Holland St.
diannehineline@gmail.com
Affordable Roofing & Restoration is hereby engaged to obtain and install the roofing m
contained herein.
SCOPE OF SERVICES TO BE PROVIDED: (list below)
Roof replacement, gutter replacement and exterior work
on the sides and back of the house per insurance
paperwork.
APPROXIMATE DATES OF SERVICE:
;cribecl below, for the contract price
Shingle Type:
oc duration storm
Gutter Color
to match existing
elow, on the terms and condition!
Shingle Color:
driftwood
Drip Color
tan
25 -Jul
APPROXIMATE COST OF SERVICE: Based on damages known as of date of this contract. Affordable Roofing services described herein does not include issues not
$ - (per Affordable Roofing estimate)
$ 17,555.99 Per insurance estimate plus insurance approved supplements, if any, (e.g.. Permit).
$ 7,000.00 Amount to be collected at job start
SIDING. Affordable Roofing has identified siding damage on my home. I understand and have been advised this to be a pre-existing condition that will exist at
the conclusion of my project.
FASCIA. Affordable Roofing has identified fascia damage on my home. I understand and have been advised this to be a pre-existing condition that will exist at
the conclusion of my project.
FFORDABLE SHALL HOLD IN TRUST ANY PAMENT FROM PROPERTY OWNER UNTIL THE ROOFING CONTRACTOR HAS DELIVERED ROOFING MATERIALS AT THE RESIDENTIAL PROPERTY SITE OR
AS PERFORMED A MAJORITY OF THE ROOFING WORK ON THE RESIDENTIAL PROPERTY.
DEDUCTIBLE. If Property Owner plans to use insurance proceeds to pay for the roofing work, Affordable Roofing 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 the roofing work on the covered property. It is not legal for us to cover your deductible.
AFFORDABLE SHALL HOLD INTRUST ANY PAMENT FROM PROPERTY OWNER UNTIL THE ROOFING CONTRACTOR HAS DELIVERED ROOFING MATERIALS AT THE RESIDENTIAL PROPERTY
SITE OR HAS PERFORMED A MAJORITY OF THE ROOFING WORK ON THE RESIDENTIAL PROPERTY.
RESCIND/CANCELLATION. Property owner may rescind the contract within 72 hours after the property owner receives written notice from the property and casualty insurer that the claim
for payment for roofing work on the residential property is denied in whole or in part. The property owner's right of rescission does not apply when the insurer denies, in whole or in part, a
claim related to a request for supplemental roofing services if the damage requiring the supplemental roofing services could not have been reasonably foreseen as necessary and related
roofing service at the time of the initial roofing inspection or the execution of the initial roofing contract. Property owner must give notice of rescission of the contract to Affordable Roofing
by email, by US Mail or by personal delivery.
Cancellation must be in writing at least two days from the scheduled date of install or material delivery. Affordable Roofing may retain all or a portion of any payments or deposits made by
a property owner to compensate the roofing contractor for roofing work actually performed. Affordable Roofing may also pursue common law remedies for the reasonable value of
roofing materials ordered and actually installed on the residential property before property owner rescinded the contract. If property owner elects to rescind any of this contract under the
paragraph above, the entire contract may be rescinded by Affordable Roofing.
UNFORSEEN ITEMS will be discussed and billed accordingly. If plywood is needed per building code, replacement cost will be $1.85/SF. Affordable Roofing will notify homeowner
immediately if there are additional layers of roofing or unforeseen damages that need to be addressed. If any code item is needed that is not covered by my insurance company, I agree to
pay for the item out of pocket. (Not all code items are covered by insurance.)
COLLECTION. Any unpaid balance will be due upon completion. I acknowledge that any unpaid charges outstanding for a period of thirty (30) days from the final billing date, may be subject
to a Mechanic's Lien. If other collection efforts are made by Affordable Roofing, I agree that Affordable Roofing shall be entitled to recover all costs of collections, including reasonable
attorney fees even if suit is not commenced. All past due balances will be subject to a finance charge of 24% per annum. Delays in inspection by the required permitting jurisdiction shall
not delay payment.
Agreed & Authorized by: Date: 7/6/2017
Zompany Representative: dIi01�'—
insurance Company: Farmers Claim #: 3008706065-1-1
4dditional Notes:
165 S Madison Ave Loveland, CO 80537 • 970.207.0000 phone • 970.207.0289 fax 0
affordable@affordableroofinginc.com BBB
How to Prepare for a Re -roofing Project
1. Remove all fragile items, including light fixtures, mirrors, pictures, figurines, etc. from the walls, ceiling and shelves. These
items can fall if not firmly attached.. We suggest that you check to make sure they are scored. If in doubt, take them down. small
cracks or crow's feet wall sometimes appear in older plaster and sometimes small particles of the acoustical will fall. We cannot
assume the responsibility of these items as a result of re -roofing.
2. Please remove all items from around the perimeter of the house that could be hit by falling roofing material, such as cars, boats,
furniture, barbecues, plants, etc. Please use extreme caution around your home after material has been loaded on the roof and be
advised that roofing materials could fall at any time! Affordable Roofing will not be held liable for any damaged items.
3. Be Prepared for noise! there will be constant hammering for two or more days, depending on the sixe of your roof. you may
want to plan on some tome away from the house while the job is in progress.
4. Your contract will be estimated on allowing access to the driveways for our trucks and access to electricity. If exterior plugs
are not available, please fun an extension cord through a window or door. during the time of your project, we ask that no vehicles
be placed in the driveway area near our trucks due to the debris during construction. We will not be held responsible for damage
to a vehicle during this time.
5.If you have low hanging branches over your roof, some trimming may be necessary. Our men will only cut those limbs which
limit our ability to do an efficient job. in some cases, you may prefer to have the tree or trees trimmed by professionals before we
begin our job. We will notify you if this is a concern.
6. PLEASE KEEP CHILDREN AND/OR PETS OUT OF WORK AREA AS INJURY OR DEATH COULD OCCUR
7. THERE WILL BE DEBRIS! Please be aware that small parts of shingles and some dirt will fall into the attic and garage
wherever there is any space or joint in the plywood or plank decking. There is no way to prevent this. Please remove cars from
garage and cover anything that you want protected from falling debris. Affordable Roofing is not responsible for any damage or
clean -up.
8. After the roofing job is complete, the roofers will sweep around the house and driveway with a magnetic nail roller. We will
make every effort to pick up all nails. Please be advised that some nails hidden in the grass or shrubbery may remain.
9. Affordable Roofing must detach your satellite dish and/or antenna to replace your shingles. The dish/antenna is installed
exactly where it was removed, but there are instances where re -aligning is necessary. Affordable Roofing cannot be held
responsible for those costs incurred.
10. In Colorado, all concrete driveways will crack. The trucks used in the roofing process are large and heavy and can cause a
weak driveway to prematurely crack. If your driveway was constructed according to industry standards ---correct backfill and
tamping, 4" thickness, and steel mesh reinforcement--- it is highly unlikely that these trucks will crack the driveway. Because it is
impossible to determine if the driveway was properly installed, Affordable Roofing will not be responsible for driveway damage.
*******Access issues may incur additional costs.
Customer Name: Date:
Dow -w 3--
Signature Certificate
E]�) Document Reference: FVHKJKJIV5FY3U4A7CCW6R
Dianne Hineline
Party ID: 22FSNUJLF15N2LWT6UL3VJ
IP Address: 75.166.231.128
1—viR1FIEo EMAIL: , diannehineline@gmail.com
L,, I ------
Easy Online Document Signing
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ir 9 97c546613fe3417465bd2fe90715967ca51944a3 'III t1[ a {�tWtU1.0M, an1I !II
Digital Fin er rint Checksum �'fif7,( Qr (*f�" 1
Timestamp Audit
2017-07-07 08:09:29 -0700 All parties have signed document. Signed copies sent to: Dianne Hineline and
Affordable Roofing.
2017-07-07 08:09:29 -0700 Document signed by Dianne Hineline (diannehineline@gmail.com) with drawn
signature. - 75.166.231.128
2017-07-07 07:41:20 -0700 Document viewed by Dianne Hineline (diannehineline@gmail.com). -
75.166.231.128
2017-07-06 18:07:37 -0700 Document created via the RightSignature API by Affordable Roofing
(rig htsignature@affordableroofinginc.com). - 52.200.135.132
91 E
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Page 1 of 1
i
A i CITY dF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
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Re -Inspection required: Yes (5:)
When corrections have been made, call for re -inspection at 303 -234 -
Date: io / Inspector: _T -t>
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: -31011- )) t , d
Job Address: `-15 1. 1--), P ,, d S+
Permit Number: 17 C k -r 3 "
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❑ No one available for inspection: Time i 0 , '9 a LAM,/0M
Re -Inspection required: <9 No
When corrections have been made, call for re -inspection at 303-234-5933
Date: 9 / 7 C Inspector: T6
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: M,
Job Address: q -5— ;;o 3 i4c 1/o, n J 9'
Permit Number: a01 a o L/3 a (2
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❑ No one available for inspection: Time ./D= oa M PM
Re -Inspection required: Ye No
When corrections have been made, call for re -inspection at 303 -234 -
Date:— q/t/ Inspector:
DO NOT REMOVE THIS NOTICE
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A i CITY OF WHEAI!RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION/ NOTICE
Inspection Type: M , d
Job Address: Ll S 3 14.11S�-
Permit Number: o
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❑ No one available for inspection: Time ?a - 0 1 A PM
Re -Inspection required: & No
When corrections have been made, call for re -inspection at 303-234-
Date:- q /14 8 Inspector: T
DO NOT REMOVE THIS NOTICE