HomeMy WebLinkAbout8735 W. 32nd AvenueCity of Wheat Ridge
Residential Plumbing PERMIT - 202000493
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PERMIT NO: 202000493 ISSUED: 03/04/2020
JOB ADDRESS. 8735 W 32nd Ave EXPIRES: 03/04/2021
JOB DESCRIPTION: Install tankless boiler combi 95% AFUE, 199K BTUs in basement
*** CONTACTS ***
OWNER (720)560-8128 BALDWIN TERRY G & SHARON
SUB (720)799-8012 PHILLIP EASTWOOD 160081 TIPPING HAT PLMBG, HTG & ELEC
*** .PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 12,000.00
FEES
Total Valuation 0.00
Use Tax 252.00
Permit Fee 236.00
** TOTAL ** 488.00
*** COMMENTS ***
*** CONDITIONS ***
All work shall comply 2012 International Codes, 2017 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 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 original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chie ut mg is �, "
ficta Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
�����tRids?
03/04/2020 13�18 C0B8
Iostall tonkless boi
CDB022656 AMOUNT
?.PSP 8735 W 32nd Ave 488,00
APPL/PERMIT NO! 202000493
PAYMENT AMOUNT
py / 6197
4GG.00
AUTH CODE: 72223822
TOTAL
488.00
Kimberly Cook
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, March 4, 2020 10:59 AM
To: CommDev Permits
Subject: Online Form Submittal: Residential Furnace/Boiler Replacement Permit Application
Categories: Kim
Residential 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
Property Address
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email
Address
Attach Credit Card
Authorization Form -
**DO NOT ATTACHED
RANDOM FORMS**
8735 W 32nd Ave Wheat Ridge, Co 80033
Sharon Baldwin
720-560-8128
sbaldwins@comcast.net
credit card authorization 1.pdf
CONTRACTOR INFORMATION
Contractor Business Tipping Hat Plumbing, Heating and Electric
Name
1
Contractor's License 160087
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 720-799-8010
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Email Address erin@tippinghat.com
Retype Contractor Email erin@tippinghat.com
Address
DESCRIPTION OF WORK
What type of unit is being Boiler
installed?
Number of BTUs 199000
What is the efficiency 95
(%) 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 12000
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
N
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 Erin Eastwood
Permit
Email not displaying correctly? View it in your browser.
-�2,0(-7050"L
INSPECTION ONLINE FORM: nttp://\fvvvvv.ci.dvnea[ridge.(;o ;Js/inspectijrl
INSPECTION REQUEST LINE: t3U3) 234-5933
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 11:59 p.m. (midnight) to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date Inspector Comments
Initials
Pier—___—
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
aT7dr-.%i-m-r2ffZT-MJii Fol" r•7.116181(•I'll -1RU1=■11:4ff.111•1•l•/74E11 KIvl=iw7R1.1It-
Underground/Slab Inspections
_ Date Inspector Comments
Initials _
Electrical
—
Sewer Service
Plumbing
—
t•.A lrT'1�T_l7fT!5=T--►-17-r717T:T.1rT2M=T-1r 1T.gAr.74ZIF_1.1U•r•l ra• J r Wr[l11_l 1919Grr1l=]W.! LOA'& til F7 f1=117►�� n>_
Rough Inspections
Date
Inspector
CommentsInitials
Wall Sheathing
Mid -Roof
7 V �� ✓�
Lath / Wall Tie
Rough Electric'
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw / Nail
Final Inspections
Date
Inspector
Initials
Comments
_
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof
F
I®
S 7 ` N
Final Window/Doors
d
Final Building
> f�. All items must De compterea ana aliluluvau uy rlannnly, r U V VFW. -a, . — -- --I-,- - —- -�
r. •oancy is issued. Approval of the Final Building inspection does not constitute authorization of nc -. upan,
voltage permits — Please be sure that rough inspections are completer frc -- " ,..? ;1,l v
:ding Division.
Occupancy Is Not Po—,"' a' `
A
R A I City of Meat Ridg,,
Residential Roofing P 201705651
PERMIT NO: 2017056
JOB ADDRESS: 8735 �,' r.
JOB DESCRIPTION: Residenti::.- L c f tr _ ,q
pitched / 4 sq flat)
*** CONTACTS ***
OWNER (303)233-4909 BALDWIN TERRY G
SUB (303)729-3683 William Marvin 170219 Western -lg
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,800.00
FEES
Total Valuation 0.00
Use Tax 226.80
Permit Fee 220.15
** TOTAL ** 446.95
*** 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.
r
i CITY OF WHEAT RIDGE
_1�9rBuilding Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: HIS1 4wL, 12 -(DC F
Job Address: 51.35 I4 75SI%40
Permit Number: '2b 1-10 .5 (y 5 1
`r U
❑ No one available for inspection: Time OM/M
Re -Inspection required: Yes No
When corrections have been made, can fo. e-inspe�ctiionnaat 303-234-5933
Date: « i Inspector: `�1� i'
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: k�y__
Job Address: W, 321yD l -
Permit Number: 01 ZQO 6 %
c-umUS 6PnwG770Y1
F'F i T S I -I c.t. INSi PrU
,A FIK Q i T &rS AAE
//YJ�%, e–/7GY7
❑ No one available for inspection: Time /I'vy AM M
Re -Inspection requiredYes No
When corrections have been made, call for re -in ection at 303-234-5933
Date: / k_/ 12_� Inspector: Jkoq
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: _��? ( ',�)2 t-�D AVC
Permit Number: %j -7/)C -241z
❑ No one available for inspection: Time 1,G AMJ4M
Re -Inspection required: Yes No
When corrections have been made, call for re-i/l pection 3-234-5933
Date: �� I'�' Inspector: {
DO NOT REMOVE THIS NOTICE
A i City of Wheat Ridge
® Residential Roofing PERMIT - 201705651
PERMIT NO: 201705651 ISSUED: 08/08/2017
JOB ADDRESS: 8735 W 32nd AVE EXPIRES: 08/08/2018
JOB DESCRIPTION: Residential Re -roof to install CertainTeed asphalt shingles - 36 sq (32 sq
pitched / 4 sq flat)
*** CONTACTS ***
OWNER (303)233-4909 BALDWIN TERRY G
SUB (303)729-3683 William Marvin 170219 Western Summit Roofing
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,800.00
FEES
Total Valuation 0.00
Use Tax 226.80
Permit Fee 220.15
** TOTAL ** 446.95
*** 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.
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�errnrt. I further attest t I am 1 ally authoriz include alI entities named within this document as parties to the work to be
per Ormed that al r i�sc ose m t is iiocument d/or its' accompanying approved plans and specifications.
Signature OT 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, po Flans
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 androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
�t
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of Wheat Ridge
Residential Roofing PERMIT -
201705651
PERMIT N0:
201705651
ISSUED:
08/08/2017
JOB ADDRESS:
8735 W 32nd AVE
EXPIRES:
08/08/2018
JOB DESCRIPTION:
Residential Re -roof to install CertainTeed asphalt
shingles - 36 sq (32 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 property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this�errnrt. I further attest t I am 1 ally authoriz include alI entities named within this document as parties to the work to be
per Ormed that al r i�sc ose m t is iiocument d/or its' accompanying approved plans and specifications.
Signature OT 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, po Flans
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 androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
�t
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dan Schultz -700-54)"
From: no-reply@ci.wheat ridge.co.us
Sent: Tuesday, August 1, 2017 1:55 PM
To: CommDev Permits)
Subject: Online Form Submittal: Residential Roofing Permit Application
Categories: Dane
=!
For all other requests: 1
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 fora Yes
14r�
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address 8735 w 32nd Ave Wheat Ridge, CO 80033
Property Owner Name Terry Baldwin
Property Owner Phone 3032334909
Number
Property Owner Email Field not completed.
Address
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
C•
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
�-J7
AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if
9
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: 1
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 fora Yes
14r�
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address 8735 w 32nd Ave Wheat Ridge, CO 80033
Property Owner Name Terry Baldwin
Property Owner Phone 3032334909
Number
Property Owner Email Field not completed.
Address
Do you have a signed Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
Attached Copy of Field not completed
Contract
CONTRACTOR INFORMATION
Contractor Business Western Summit Roofing Contractors
Name
Contractor's License 170219
Number (for the City of
Wheat Ridge) J
Contractor Phone 720-454-8778
Number
Contractor Email Address will@westernsummmitroofing.com
Retype Contractor Email will@westernsummitroofing.com
Address
DESCRIPTION OF WORK
;
Are you re -decking the
No
roof?
Description of Roofing
Certainteed
Material
Select Type of Material:
Asphalt
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
32
material selected above?
Does any portion of the
No
property include a flat
roof?
If yes, how many squares
4
on the flat roof?
TOTAL SQUARES
36
(pitched + flat) of all
z
roofing material for this
proj ect
Provide additional detail
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract
value or cost of ALL
materials and labor)
Replacing hail damaged roofing on house, 5:12 pitch
10800
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 Colin Krautkremer
Email not displaying correctly? View it in your browser.
9
AO. -IN[ ROOFING CONTRACTORS LLC.
AGREEMENT
SUBJECT TO INSURANCE COMPANY APPROVAL
820 Newton St.
Denver, CO 80204
Phone: 720-454-8778
Fax: 303-223-9269
westernsummitroofing@gmail.com
Property Owner Name: / f Jr t / 4.�
Address. _ l� ���i }
City, State & Zip:_/.P J
Phone: _30S y
f,. r�
Email: �� SCJ Gc l GLi ! S <GF!/ l �uY) i ��sLiI�1✓ „ �� v �f
Western Summit Roofing will furnish all labor and materials to construct and complete the following general services:
21"TTear off L layers of existing roof covering. Material Color _
2�11nstall new underlayment �v`� anufacturer! model stall pre -painted rake metal o]or ,KV lleys will be closed ; open
�I i t stall new flaJhings as need d ,place gutters and downspouts as required
7asteners : YJ 11 ( [Mean out gutters
7 place vents as needed ake a magnetic sweep for removal of nails
Re -flash chimneys, wall abutments and penetrations 5 year workmanship warranty
❑ Install new deckin
(S�precial Instructions / Product upgrades:
C- c5� '� o -�Yl �G
ks e_ It 4- t
All construction will be completed in compliance with prevailing building codes of the governing municipality
Contract Price: $ " t V5 .00 (Property Owner agrees to pay Western Summit Roofing total
contract amount.)
Initial Payment. $ $1$O . 00 Construction Completion Payment: $_ 3S05.00
Approximate Start Date: < �' 1-'r1� tIZS y
PP Approximate Completion Date:
Terms;
Western Summit Roofing will advocate the Property Owner's best interest in restoration of property damage and complete all
work in accordance to insurance company agreed scope of loss. This agreement does NOT obligate the property owner or
Western Summit Roofing in any way unless the insurance claim is approved by the insurance company and accepted by Western
Summit Roofing. The "total contract amount" shall be equal to the Insurance Proceeds and Deductible, and property owner
authorizes Western Summit Roofing to provide labor and material in accordance with this agreement and the specifications set
out herein and on the reverse side hereof to accomplish the roof replacement.
Property Owner Signature: X_\1 v�I�� Date: � Vv) �)
Insurance Co.:rt�n S Claim #: `� Vb � � '-t 6 2
Mortgage Co.: Deductibl Amo nt:$
Field Representative: r—i two,$ Phone#:u`