Loading...
HomeMy WebLinkAbout3910 Harlan StreetFrom: no-reolv(alci.wheatridae.m. us To: CommDev Pets Subject: Online Form Submittal: PERMIT APPLICATION Furnace/Boiler Replacement Date: Wednesday, January 12, 2022 11:44:15 AM PERMIT APPLICATION Furnace/Boiler Replacement 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 3910 North Harlan Street Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123- 4567) Property Owner Email Address Attach City of Wheat Ridge Electronic Payment Form - "DO NOT ATTACH A PICTURE OF A CREDIT CARD" Eden Armendariz 3032323494 EArmendariz@brothersredevelopment.org CONTRACTOR INFORMATION Contractor Business Sensible Energy Name Contractor's License 202242 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 720-876-7166 Number (enter WITH dashes, eg 303-123- 4567) Contractor Email jo@sensibleheat.net Address Retype Contractor jo@sensibleheat.net Email Address DESCRIPTION OF WORK What type of unit is Furnace being installed? Number of BTUs 60,000 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 5748.00 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 JoEllen Jensen Permit Email not displaying correctly? View it in your browser. City of Wheat Ridge s Residential Roofing PERMIT - 201707588 PERMIT NO: 201707588 ISSUED: 09/22/2017 JOB ADDRESS: 3910 Harlan ST EXPIRES: 09/22/2018 JOB DESCRIPTION: Residential Re -roof to install Modified Bitumen with ROOF DECKING - 4 sq (flat only) Pitch = 0/12 *** CONTACTS *** OWNER (303)232-3494 ARMENDARIZ EDEN R SUB (303)763-9114 Scott Riopelle 019938 Interstate Roofing Incorporate *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT*: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,340.50 FEES Total Valuation 0.00 Use Tax 28.15 Permit Fee 57.10 ** TOTAL ** 85.25 *** 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. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, the 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. City of Wheat Ridge Residential Roofing PERMIT - 201707588 PERMIT NO: 201707588 ISSUED: 09/22/2017 JOB ADDRESS: 3910 Harlan ST EXPIRES: 09/22/2018 JOB DESCRIPTION: Residential Re -roof to install Modified Bitumen with ROOF DECKING - 4 sq (flat only) Pitch = 0/12 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 perfc ed and that all Iwoo/rj%�_ to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. V w `-X� 1 Signature of OWNER or CONTRACTOR (Circle one) Date I. This permit was issued based on the information provided in thepermit 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 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 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 appirc epc�o�de or any 'ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. ftAXuL 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: no-reply@ci.wheatridge.co.us Sent: Tuesday, September 19, 2017 1:44 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Follow Up Flag: Follow up Flag Status: Completed 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 Hail. 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 3910 Harlan St Property Owner Name Eden Armendariz Property Owner Phone 303-232-3494 Number (enter WITH dashes, eg 303-123-4567) 73 Property Owner Email Field not completed. Address Do you have a signed Yes contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed contract.pdf Contract CONTRACTOR INFORMATION Contractor Business Interstate Roofing Name Contractor's License 019938 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-763-9114 Number (enter WITH dashes, eg 303-123-4567) Contractor Address 1000 W 47TH AVE (Primary address of your business) Contractor Email Address jwiles@interstateroof.com Retype Contractor Email jwiles@interstateroof.com Address DESCRIPTION OF WORK TOTAL SQUARES of 4 the entire scope of work: Project Value (contract •-400 value or cost of ALL '. materials and labor) Are you re -decking the Yes roof? Is the permit for a flat Flat roof (less than 2:12 pitch) roof, pitched roof, or 74 both? (check all that apply) What is the pitch of the FLAT roof? How many squares are part of the FLAT roof? Describe the roofing material for the FLAT roof: Type of material for the FLAT roof: If "Other" is selected above, describe here: Provide any additional detail here on the description of work. (Is this for a house or garage? Etc) 0:12 4 mod bit Other (specify below) REDECK permit only, 4 squares FLAT roof only SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application. I understand that this application is NOT a permit. I understand I will be contacted by the City to pay for and pick up the permit for this property. I understand that work may not begin on this property until a permit has been issued and posted on the property. Yes Yes Yes 75 I certify that I have been Yes authorized by the legal owner of the property to submit this application and to perform the work described above. I attest that everything Yes stated in this application is true and correct and that falsifying information in this application is an act of fraud and may be punishable by fine, imprisonment, or both. Name of Applicant John Quante Email not displaying correctly? View it in your browser. 76 — referralisto com M40i -as Me W NTERSTATE ROOFING gss Date 0 Email e.fS m�R - Phorfe f 315 1g7Y Alt. Phone y � Street JJ /1) 4 t +/� .� I ` ,rt City State Zip Insurance Company(". Claim# C �J 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 approved by the insurance company unless you authorize the and agree to pay for this additional work.} � �� Shingle Manufacturer J/1 �n�% L/_1tYpe V �) �f� l QA% Color J>y►t Int J Tear off layers of composition shingles ! (� ❑ Tear off one layof wood shingles 47 Install Decking (7/16" OSB) R:./ 1 P&irkNi'z f —A Install new felt Install pre -painted eave metal to code - Color Brown Charcoal Gray White int. .B Valley(s) will be closed ❑ valleys will be open f J J (i Jnl,� pal m, XRidge(s)10 be color -coordinated 8 Ridges) will be "High Profile Ridge" color -coordinated shingles V Install new pipejacks 0 Replace vents as needed ;2 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 n Install In. ft. of ice & water shield to code A A N) e Q��e� � h r Instal nail, �j-er s Ingle / J o L w . Z Clean out gutters A�(m /NUS C � j, ! s 'ir 5 year workmanship warranty +t [(�� J• Interstate Roofing, Inc. will provide general liability insurance coverage of $2,000,000, general aggregate Make a magnetic sweep of driveway and yard for removal of nyplails Qw a Remove all debris resulting from above work ,) GAJ t :A( ,( ❑ Special Instructions tt ©b O The approximate costs of the services based on damages known at the time this contract is entered is 41 ( ir"+ I , Interstate Roofing, Inc., however, will perform the scope of work approved by the insurance company for the amount of the insurance appricived proceeds, with no additional costs to you except for your deductible. The final scope and price agreed on between the insurance company and Interstateoo Ing, nc. s a ecomee r 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 proved by the insurance company for additional work or increases in costs become a part of this contract. Ato6-f Approximate Dates of Service: � 1 N ��Ue `' �J f�Lc ' ese dates of service are subject to change due to unusual delays in transportation of materials, ordinary weather delays, or by any other causes beyond the reasonable control of Contractor Notice: If the property owner plans to use the proceeds of a property and causuaity 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- I Terms; •;%._� I (We) hereby authorize & instruct the insurance company & all lien holders to include the name of ng, c. 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 LF 1 Lperson any loss drafts or checks on my/our behalf and behalf of Interstate Roofing. floP'L Up, Gf�l/Ld� Deposit Amount: $ nates.ao., In;ft ale Interstate Roofing shall hold in trust any payment from the property owner until Interstate Roofing has delivered roofing materials at the residential property site or has preformed a majority of the roofing work on the property. 1(We) agree, by signing below, to all the contract conditions, both front & ck of is agr t 1 [late of Acceptance tient Signature{ Representative n, Corporate HesdquartColorado Springs office Fort Collins Office Cheyenne Office Black ins. Agency 1000 W. 47th Ave. 2161 N. Academy Blvd. P. 970.482.7722 F. 970.682.1018 1010 S Greeley Highway 9600 E Arapahoe Rd #205 Denver, CO 80211 Colorado Springs, CO 80909 Tall Free 877.898.8144 Cheyenne, WY 80211 Englewood, Co 80112.3726 P. 303.763.9114 F. 303.789.3790 P. 719.471.9752 F. 719.597.4444 www.interstateroot.com P. 307.634.2553 (303) 397-7820 www.interstateroot.com info@interstateroof.com I& i CITY16F W EAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: -/ w? - f= I Job Address: 5 q 1© {-i < < 14n „ 4 - Permit Number: -r o r 70 -7 S-1:9 0 � 1 , ' Nr- 7 1 1L G� Dor7' bC _ ❑ No one available for inspection: Time 0 : "D- &M Re -Inspection required: Yes When corrections have been made, call for re -inspection at 303-234-5933 Date: /,ol'<s ZI -? Inspector: DO NOT REMOVE THIS NOTICE M 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: 4-10 A - i`= , `,, a ) Job Address: __S9 in a V- )e� 11 S �- Permit Number: -a o l `7 0 .5--& 3 and r-ecal!. ❑ No one available for inspection: Time 10 = 2) (0PM Re -Inspection required: es No When corrections have been made, call for re -inspection at 303-234-5933 Date: /o -7 Inspector: %-iJ DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE _:�9rBuilding Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE 3e7� Inspection Type: i Job Address: 9 i c r4a Permit Number: a G 1-7 o s- 3 3 ePVt'r"e S045:414 vend-•�,ti 4 re C d S , -,L t, ., e-1 4 : M (—, D r Cc r- ep CA. -7 ❑ No one available for inspection: Time J o = H o MwM Re -Inspection required: Yes OD When corrections have been made, call for re -inspection at 303-234-5933 Date: (' Inspector: -I- DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Roofing PERMIT - 201705633 PERMIT NO: 201705633 ISSUED: 08/07/2017 JOB ADDRESS: 3910 Harlan ST EXPIRES: 08/07/2018 JOB DESCRIPTION: Residential Re -roof to install OC Duration asphalt shingles - 14 sq *** CONTACTS *** OWNER (303)232-3494 ARMENDARIZ EDEN R SUB (303)763-9114 Scott Riopelle 019938 Interstate Roofing Incorporate *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,680.00 FEES Total Valuation 0.00 Use Tax 77.28 ?" Permit Fee 109.20 ** TOTAL ** 186.48 *** 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 - 201705633 PERMIT NO: 201705633 ISSUED: 08/07/2017 JOB ADDRESS: 3910 Harlan ST EXPIRES: 08/07/2018 JOB DESCRIPTION: Residential Re—roof to install OC Duration asphalt shingles — 14 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 ermrt. I further attes{ 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 perfo ed .s disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNER or CONTRACTOR (Circle one) Nate 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 and procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Budding 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 applicab or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Att'M_ I ; Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dan Schultz zc-17c7 633 From: no-reply@ci.wheatridge.co.us Sent: Tuesday, August 1, 2017 3:14 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Dane Residential Roofing Permit Application This application is exclusively for new permits for residential roofs and for licensed contractors only. This type of permit is ONLY being processed online --do not come to City Hall to submit an application in person. Permits are processed and issued in the order they are received and due to the volume of requests, time to process varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Revisions to existing permits (for example, to add redecking) must be completed in person at City Hall. All other non -roofing permits must be completed in person at City Hall. The Building Division will be open from 7:30-10:30 a.m., Monday through Friday to process these types of requests. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN REROOFING UNTIL PERMIT HAS BEEN ISSUED. Is this application for a Yes residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address 3910 Harlan St Eden Armendariz 3032323494 jwiles@interstateroof.com =1 Q1 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 O/C Duration Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 14 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 14 (pitched + flat) of all z roofing material for this project 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) house, 5:12 pitch 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 ROW IlsmMcnneati4Rc.'s __ ___ referralist0 com NTE R STATE ROOFING see Submitted To t N ! 1 rrrc� ,y (� �L�'% ? Date a� Email �" � � ® ��z r�{ �� ��(� (t.xNlP"_4L ho�r% ^ 1*31. " 7Y Alt. Phone Street ��� rids cvCity & State Zip"r� o -�� Insurance Companyf Claim# L /� l,) r� T golic # y 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 approved by the insurance company unless you authorize the work and agree to pay for this additional work. ` Shingle Manufacturer / [ ��^)� 01%A%YpeON _ Color fL Int -4 - Y Tear off _ 1 layers of composition shingles ❑ Tear off one lay of wood shingles t v Install Decking (7/16" OSB)ii� R„( j,Nk-rill Install new new fellt iiL r 7j Install pre -painted eave metal to code - Color Brown Charcoal CD Gray White int.A� �( Valley(s) will be dosed ❑ Valleys will be open ` l ,tiV m+ Ridge(s) to be color -coordinated jd Ridge(s) will be 'High Profile Ridge" color -coordinated shingles [ instali new pipejacks pf Replace Vents as needed 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 XInstail In. ft. of ice & water shield to code A, ANA, p wed Install nail per s ngle j J o r CJr1-N1—it/JJM.�6JJn`', !try�x iSrl Clean cut gutters 5 year workmanship warranty Interstate Roofing, Inc. will provide general liability insurance coverage of $2,000.000, general aggregate Make a magnetic sweep of driveway and yard for removal of any pails % yr2' Remove all debris resulting from above worknK1 � fi;L 6N. % ❑ Special Instructions i 0 14 k - V / `1JJ * a iY t!i r' r} j - A ! The approximate costs of the services based on damages known at the time this contract is entered is D vc rfli" 1 interstate Roofing, Inc., however, will perform the scope of work approved by the insurance company for the amount of the insurance app ved proceeds, with no additional costs to you except for your deductible. The final scope and price agreed on between the insurance company and Interstate oo.ing, nc. s a ecome e I r 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. tc�� /QIJ� Z Approximate Dates of Service: p1l�� N + �� U� `� �(e esa dates of service are subject to change due to unusual delays in transportation of materials, ordinary weather delays. or by any other causes beyond the reasonable control of Contractor Notice: If the property owner plans to use the proceeds of a property and causualty insurance policy issued pursuant to part 1 of article 4 of title 10. C.R.S., tc 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: 1 (We) hereby authorize & instruct the insurance company & all lien holders to include the name of mg, c. as co -payee on any subsequent loss drafts or checks after today's date as indicated above. 1 (We) also authorize any legal representative and/or agent of interstate Roofing, Inc. io obtain information necessary to complete any funding process relative to the claim number referenced above. I (we) further authorize Interstate Roofing, Inc. to pick1'�person any loss drafts or checks on my/our behalf and behalf of interstate Roofing. Deposit Amount: $ S F S v t,., "fe /veet nates Interstate Roofing shall hold in trust any payment from the property owner until Interstate Roofing has delivered roofing materials at the residential property site or has preformed a majority of the roofing work on the property. 1 (We) agree, by signing below, to all the contract conditions, both front &k�of s agraiiii t rl Date of Acceptance , '' ^ li > k� � ter:# Signature( Representative+ t 1 r, �, Corporate Headquart Colorado Springs Office Fort Collins Office Cheyenne Office Black Ins, Agency 000 W- 471h Ave 2161 N. Academy Blvd. P 970 482 7722 F 970.682.1018 1010 S Greeley Highway 9600 E Arapahoe Rd #205 Denver. CO 80211 Colorado Springs, Co 80909 Toil Free 677.898.8144 Cheyenne, WY 80211 Englewood Co 80112-3726 P 303 763.9114 F 303 ?89.3:790 P 719.471 9752 F. 719.597.4444 whw interstaterocl P. 307.634.2553 (303) 397-7820 www.interstateroof.com info@ interstateroof.com i CITY OF WHEAT RIDGE _:�9�Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: , Job Address: '3Cf1 o w,, r - fah s4 - Permit Number: % 1 7tJ sL-z, 3 -A 5r>.rr1,11_n 7,P , eC Lcl LI r-Fy rr� 4- roams 1MIJUM R . ❑ No one available for inspection: Time 4; a SS OPM Re -Inspection required: es No When corrections have been made, call for re -inspection at 303-234-5933 q � Date: /'? Inspector: .7- 6 DO NOT REMOVE THIS NOTICE