HomeMy WebLinkAbout2705 Lamar Street2765 INSPECTION RECORD
INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection
INSPECTION REQUEST LINE: (303) 234-5933
Cancellations must be submitted via the online form before 8 a.m. the day of the inspection
Occupancy/1 ��
k r
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
Lath /Wall Tie
Do Not Pour
Concrete Prior To Annroval of Tho Ahnva Inenar-finne
Underground/Slab Inspections Date Inspector Comments
Initials
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Annroval Of Thp Ahnvp Inanar_finne
Rough Inspections
Date Inspector
Initials
Comments
Sheathing
Mid -Roof
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
7v�
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 iow voltage permits — Hease 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
City of Wheat Ridge
Residential Roofing PERMIT - 201705918
PERMIT NO: 201705918 ISSUED: 08/11/2017
JOB ADDRESS: 2705 Lamar ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 40 sq
***revision add sheathing 38sq*****
*** CONTACTS ***
OWNER (303)472-0617 RUDY RICHARD L
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: 12,734.75
FEES
Total Valuation 0.00
Use Tax 267.43
Permit Fee 251.85
** TOTAL ** 519.28
*** 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 - 201705918
PERMIT NO: 201705918
JOB ADDRESS: 2705 Lamar ST ISSUED: 08/11/2017
EXIES:JOB DESCRIPTION: Residential Re -roof to install GAP Timberline asphalt08shingie1/20is
***revision add sheathing 38sq***** glen - sq
I, by my signature, do hereby attest that the work to be performed shall comply with all accom an ink�*
applicable building codes, and all applicable municipal codes, policies and procedures, and thapl am thepegal ownerlbio and specifications e been autl ns,
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved a conjunction with
this permit. I further attest that I am legally autho ized to include all entities named within this document as parties to the work to be ioi ized
perforrr�ed and that all work to b rforrr d 's 'se osed 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 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 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, 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 C7;'lefBuilding Official Date
11:59PM A
REQUESTS MUST BE MADE BY ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of
Wheat l, jAc
COMMUNITY DEVELOPMENT
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(a)-ci.wheatridge.co.us
FOR OFFICE USE ONLY
Date: q h f (
Add to Permit # A170TW9
Building Permit Revision/Amendment Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address: 'o70 5 1-1 rn G I'/ -
Owner
Property Owner Email:
K`
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Submitting Company:
Contact Person:
Contractor: T Yl Tt r 5 /'°1 � P
V A.
Phone•
Contractors City License #: 6 1 1� 3 X Phone:
Contractor E-mail Address:
Phone:
Please Note: Additional valuation must include all general and subcontracted work to be performed
related to the revisions and/or amendments declared in the description of work and which were not
included in the original permit valuation.
If revisions or amendments increase the original valuation, additional fees will be due at the time of
approval. Depending on the scope of work, additional plan review fees may be due upon approval
($60.00 an hour - 2 hour minimum).
Description of revised/amended work:
Sq. Ft./LF
Amps
3 � �J v0�fe-
Btu's
Gallons
Squares 3 /) Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
$ ! 9Uo_UU
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.
CIRCLE ONE: (OWNER) (CONTRACTOR) I r (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
PRINT NAME: t Vq h U Q` ite SIGNATURE: 41�&DATE: "// —
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received ❑ Not Required
Water District ❑ Received ❑ Not Required
Sanitation District ❑ Received ❑ Not Required
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
City of Wheat Ridge
Residential Roofing PERMIT - 201705918
PERMIT NO: 201705918 ISSUED: 08/11/2017
JOB ADDRESS: 2705 Lamar ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 40 sq
*** CONTACTS ***
OWNER (303)472-0617 RUDY RICHARD L
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: 10,280.00
FEES
Total Valuation 0.00
Use Tax 215.88
Permit Fee 220.15
** TOTAL ** 436.03
*** COMMENTS *** v 7�IN C-7
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.
7—v
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle instal _130
inspection, conducted when 25-75 percent of the ro
( r
0 � �ljQ � J
al
approval. installation of roof sheathing (new or o
when spaced or board sheathing with ANY gap exceed
-roofs be in —
�Y(I tm -I r lb/0=
d
mid may called at the same time, one h
e
complete and 25-75 percent of the mid -roof may be
d
to be fastened to the roof deck with a minimum of
eld
is required. Eave and rake metal is required. A la
ave
and secured in place is required to be provided fo
on
is required to comply with applicable codes and/or
s,
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 CITY OF WHEAT RIDGE
l Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: 07_
Job Address: 7 70 ) C
Permit Number: 7 V %v j a'
{
❑ No one available for inspection: Time �I/pm
Re -Inspection required: Yes �0
When corrections have been made, call for re -inspection at 303-234-
Date:- (� r G Inspector:
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 NOTIC
Inspection Type:
�_r I
"Llf 2�
Job Address: 7u ``+✓�-` -
Permit Number:
10
l :?O J U C, " y (a, tl /, --c, f?"f�
❑ No one available for inspection: Time ' U AM/
Re -Inspection required: Yes
When corrections have been made, call for re -inspection at 303-234-5933
rl
Date: VW31 , Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 201705918
PERMIT NO: 201705918 ISSUED: 08/11/2017
JOB ADDRESS: 2705 Lamar ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re—roof to install GAF Timberline asphalt shingles — 40 sq
I, by my signature, do hereby attest
applicable building codes, and all al
by the legal owner of the roperty a
this permit. I further attesFthat I am
performed and that all work to be pi
work tobe performed shall comply with all accompanying approved plans and specifications,
municipal codes, policies and procedures, and that I am the legal owner or have been authorized
uthorized to obtain thispermit and perform the work described and approved in conjunction with
authorized to include all entities named within this document as parties to the work to be
I 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 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 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 grant' of a permit shall of be construed to be a permit for, or an approval of, an violation of any provision of any
applicable code or c r reg ion thi 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.
41 City of Wheat Ridge
Residential Roofing PERMIT - 201705918
_1�9r
PERMIT NO: 201705918 ISSUED: 08/11/2017
JOB ADDRESS: 2705 Lamar ST EXPIRES: 08/11/2018
JOB DESCRIPTION: Residential Re -roof to install GAF Timberline asphalt shingles - 40 sq
*** CONTACTS ***
OWNER (303)472-0617
RUDY RICHARD L
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: 10,280.00
FEES
Total Valuation
0.00
.:
�� •y � e
,
Use Tax
215.88
_.
Permit Fee
220.15
** TOTAL **
436.03
*** 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.
Dan Schultz
From: no-reply@ci.wheatridge.co.us
Sent: Monday, August 7, 2017 11:08 AM
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
Property Owner Name
Property Owner Phone
Number
Property Owner Email
Address
2705 Lamar St
Richard Rudy
3034720617
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.
Attached Copy of
contract.pdf
Contract
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
No
roof?
Description of Roofing
GAF Timberline
Material
Select Type of Material:
Asphalt
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
40
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
40
(pitched + flat) of all
2
roofing material for this
project
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 e2otp
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
re�errelistcom TN7TERSTATE t�� IM
-- ----- -- aorl ] V G
Submitted To Kc, i�V cly ahidi /-i''= OoDate -ZJ Jqc 17
a�'
Ktc < c.irl -,03 47Z- o017
Email r C:s�f net Phone ji_s( 454rb•7367 Alt. Phon�
Street -f- 5 Li hinjav City'' e v4lel State CO Zip BOZ19
t
insurance Company hyrneyY Claims-3oOS5881Policy;r
Scope of Work and Materials to be provided. The scope of work and materials identified Mow are the scope of work recommended by Interstate
Roofing Inc., however, Interstate Rooting is not obligated to perform any part of the scope of work that is not approved by the Insurance company
unless you authorize the work and agree to pay for this additional work.
ShindeManufaMurar 1 7Ak Twin
t+
\E—) Tear off fiIIF .IJ layers of composition shingles [I Tear off one layer of wood shingles
Ile Instal! Decking (7116" OSB) JO
�] Install new fell �P2t 4tA
Install pre -painted
�eave metal to code - Color Brown Charcoal Tan Gray White i+ rat._______.
Valley(s) will be closed ❑ Valleys will be ope
Ridgets)to be oolor-coordinated Z
❑ Ridge(s) will be 'High Profile Ridge' color -coordinated shingles '
�] Install new pipejacks
\1 Replace Vents as needed
Re -flash chimneys and all wall abutment as needed and if possible (stucco or siding may be a deterrent)
�^�°^...®ft et ones--------Wdge.vEnt �,rptp�
Instal3 In. ft. of ice &water shield tv code v�
f
t] Install �' nails per shingle
Lj Clean out gutters
t7 5 year workmanship warranty
❑ Interstate Roofing, Inc will provide general liability insurance coverage of S2,00Q000. general aggregate
LI Make a magnetic sweep of driveway and yard for removal of any nails
b Remove all debris resulting from above work
U -
CC, r"' e(, 31
. d
I Oil L 114.
The approximate costs of the services based on damages known at the time this contract :s entered Is $ �U
interstate Roofing, Inc., however, will perform the scope of work approved by the insurance company for the amount of the insurance approved
proceeds, with noadditionalcists to You except for your deductible. The final scope and price agreed on between the Insurance company and
Interstate Rooting, Inc. shall= this final contract price for the insurance approved scope. You will be responsible to pay for any upgrades or
additional work 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. +
Approximate Dates of Service: �r L`� These dates of service are subject to change due to unusual delays,n
transportation of materials, ordinary weather delays, or by any other causes beyond the reasonable control of Contractor
Notice:
It the property owner plans to use the proceeds of a property and causuatty insurance policy Issued pursuant to part 1 of article 4 of title 10. C.R.S.. to
pay for the roofing 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 & instruct the insurance company & all hen 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.
t (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 Rooting, Inc. to pick up In person any loss drafts or checks on my/our behalf and behalf of Interstate Roofing.
Deposit Amount: $ !1 V,J V � io,!' y/
Date:
Rep. Initials;
Interstate Roofing shall hold in trust any payment from the ptoperty owner until interstate Roofing has di
materials at the residential property site or has preformed a majority of the roofing work on the property.
I (We) agree, by signing below, to all the contract conditions, both front & back of this agreement
Date of Acceptance Z �( (7 Client Signature(s)
r r
Representative
Corp. Headquartwo Colorado Sprfngs Office Fort Collins Office Cheysrrne office Stack Ina Agency
I OM W 47th Ave 2161 N Academy Blvd. P, 970.482.7 722 F- 970.682.10,a I01O S G111ay Highway 4600E Arapahoe Rd OM
Denver, CO 90211 colorado Springs. CO 60909 Too Free 87' 098 8144 Cheyenne, Wy 80211 c,
P 303.7834114 F 303 789 3790 P 719471.9752 F. 719.547444 4www. intarstateroof.eom P. 307.&34.2553 � C-0 80112-37226
(303) 397.7820
www.interstateroof.com info@interstateroof.com