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3455 Lutheran Parkway (2018)
tESTING ADJUSTING SYSTEM BALANCING rABB CERTIFIED ?ROJECT LOCATION kRCHITECT MECHANICAL ENGINEER COMPLETE MECHANICAL BALANCING, INC. 3HEETMETAL CONTRACTOR 3ALANCING CREW ?LOW HOOD kNEMOMETER Y_ _ SPEED INDICATOR '1MMETER / VOLTMETER NCLINED DRAFT GAGE VIAGNEHELIC GAGE ?RESSURE GAGE GENERAL INFORMATION LMC X-RAY 1 CR TO DR CONVERSION PAGE 13540 P.O. BOX 27706 DENVER, CO. 80227 FAX 303-761-1317 PHONE 303-948-5429 �?01g003']0 3455 N. LUTHERAN PARKWAY, WHEAT RIDGE, CO 80033 CATOR, RUMA & ASSOCIATES APOLLO MECHANICAL A.STRUBLE DATE FEBRUARY 219 INSTRUMENTS USED ALNOR / SHORTRIDGE DAVIS TYPE LCA 6000 BIDDLE TYPE 9915 _ AMPROBE TYPE DIGITAL DWYER 0-0.25" 0-0.50" 400" 0-0.50" 0-1.0" 0-2.0" 0-4.0" 0-8.0" -30--+30 PSI 0-60 PSI 0-100 PSI ?RESSURE GAGE DIFFERENTIAL BARCO 0-50" 0-100" 300" 500" 0-100' PYROMETER ALNOR CHERMOMETERS FLUKE TYPE 52 AICROMANOMETER ALNOR TYPE 530 ?ROJECT ALTITUDE 5200' LOW HOOD CORRECT 1.10 APPLIED TO; AREA (K FACTOR) STATIC PRESSURE CORRECTION 1.21 2ECORDED PRESSURE READINGS ARE MEASURED X KI CORRECTED Anthony Strubte TA88 Stews — 88868351S December 31, 2920 VELOCITY LMC X-RAY 1CR TO DR CONVERSION 3455 N. LUTHERAN PARKWAY WHEAT RIDGE, CO 80033 FEBRUARY 2019 TESTINGComplete ADJUSTING Mechanical TABB CERTIFIED SYSTEM BALANCING Balancing, Inc. PO BOX 27706 DENVER, CO. 80227 FAX 303-972-7453 PHONE 303-948-5429 COMPLETE MECHANICAL BALANCING PROJECT LOCATION FAN SYSTEM CONTRACTOR LMC X-RAY I CR TO DR CONVERSION I ST FLOOR VAV APOLLO MECHANICAL PAGE NO 13540-2 DATE 02-06-19 BALANCER A.S. � 0 ) q o .-,? --; qo OPENING B0-173-1 2 TOTAL RETURN TOTAL PLAN 24/24 24/24 24/24 SIZE kCT'IAREA - - --------- - - 1.101 1.101 1.10 REQUIRED VEL 273 273 - 545 _TL CFM 300 300 6001 600 ------- 600--- — -- -- TEST VEL 110 100 620 -- ----- ----- 1 % 40 37 114 TEST 2, % I TEST VEL 3 % VEL 270 280 FINAL CPM 297 308 0% 99 103 REMARKS MIN 120 100% OPEN KF 1168 550 605 605j 101 - - ------- - - . ... ........ .. ---------- ------ - - ---------------- REMARKS FTT MIMI COMPLETE MECHANICAL BALANCING, INC. AIR SYSTEM RECAP SHEET _ . __. PAGE 13540-1 JOB: LMC XRAY 1CR TO DR CONVERSION ZONE OR REQ'D ACT'L % OF FUNCTION UNIT NO. MAIN CFM CFM REQ'D HEAT REMARKS PAGE SUPPLY BO -173 1-2 600 605 101 2 TOTAL 600 605 101 RETURN RETURN 600 605 101 2 TOTAL 600 605 101 BELLMAN ENGINEERING, INC. MECHANICAL CONSULTING ENGINEERING January 25, 2019 Al Green A Squared Mechanical Firestone, CO RE: ADCS 3455 W. Lutheran Parkway Suite 110 Wheat Ridge, CO Mr. Green, This letter is to clarify the code requirements for the thermostat that controls the transfer fan, TF -1 in the ADCS space at the Lutheran medical office building. This fan is intended to provide additional cooling to the IT room whenever it is needed (usually during nights or weekends when the base building system is not providing cooling). Per the 2012 IECC section C403.2.4.3 exception 1, thermostats that are to provide continuous control are not required to have automatic setback capabilities. Also, per IECC C403.2.4.3 exception 2, systems with a full load of less than 6,800 Btu/hr are not required to have automatic setback capabilities. The transfer fan, TF -1, meets both of these exceptions, since it is intended to provide 24/7 cooling, and since the heat removal capacity of the system is approximately 3,900 Btu/hr. Therefore, it is not required to be a programmable thermostat with automatic setback capabilities. Regards, Jeff Bellman, P.E. BELLIVIAN ENGINEERING, INC. 1120 SECREST STREET GOLDEN, CO 80401 (720) 334-1033 PHONE i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: 3`1 < ✓ r �' -1 Permit Number: v 1 9 (,i'�`� rUv(cr ❑ No one available for inspection: Time , 2'2 PM Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234- Date:- Inspector: ) DO NOT REMOVE THIS NOTICE ELITE BALANCING N'E[�e 21 N. 1 st Ave, Suite GL10 • Brighton, CO 80601 • Phone: (720) 523-0209 • Fax: (720) 523-0225 • http://www.elitebalancing.com Certified Test, Adjust, and Balance Report Address: Date: Job Number: Mechanical Engineer: Mechanical Contractor Submitted & Certified By: Elite Balancing LLC Certification Number: 3502 ADCS 3455 West Lutheran Parkway Suite 110 Wheatridge, CO 01/22/2019 2019-1129 Bellman Engineering, Inc. A2 Certification Exp Date: March 31, 2020 NEBB Qualified Certified Professional: Kevin Shaw KEVIN L. SHAW CERTIFICATION 3502 Exp. 3131120 The data presented in this report is a record of system measurements and final adjustments that have been obtained in accordance with the current edition of the NEBB PROCEDURAL STANDARDS FOR TESTING, ADJUSTING, AND BALANCING OF ENVIRONMEMTAL SYSTEMS. Any variances from design quantities, which exceed NEBB tolerances, are noted in the Test -Adjust -Balance Report Project Summary. Revision Number Date Description 1 01/22/19 Final Report Issued Elite Balancing, LLC 1/12 ELITE iz'a BALANCING 'ELB 21 N. 1 st Ave, Suite GL10 • Brighton, CO 80601 • Phone: (720) 523-0209 • Fax: (720) 523-0225 • http://www.elitebalancing.com Table of Contents Instrument Calibration Report ............... 3 Abbreviations Page ....................... 3 Report Summary / Remarks ................ 4 Air Handling Reports ...................... 5 Fan Reports ............................. 10 Prints .................................. 11 Elite Balancing, LLC 2/12 21 N. 1st Ave, Suite GL10 • Brighton, CO 80601 • Phone: (720) 523-0209 • Fax: (720) 523-0225 • http://www.elitebalancing.com Instrumentation Rotation Measurement Extech 461995 Temperature Measurement Extech HD500 Electrical Measurement Fluke 335 Air Pressure Measurement Alnor EBT731 Air Velocity Measurement Alnor EBT731 Air Volume Measurement Alnor EBT731 Humidity Measurement Extech HD500 Hydronic Pressure Measurement Alnor HM670 Abbreviations A Amperage FBO Furnished By Others NIG Not In Contract A/C Air Conditioning FCU Fan Coil Unit NO Normally Open AHU Air Handling Unit FG Floor Grille OBD Opposed Blade Damper B Boiler FILT Filter OSA Outside Air BD Backdraft Damper FLA Full Load Amps PH Phase BP Boiler Pump / Booster Pump FPM Feet per Minute PSI Pounds per Square Inch BTUH British Thermal Unit FPVAV Fan Powered Variable Air Volume RA Return Air CAV Constant Air Volume FSD Fire Smoke Damper RF Return Fan CD Ceiling Diffuser ftH2O Feet of Water Column RG Return Grille CFM Cubic Feet per Minute FURN Furnace RH Relative Humidity CH Chiller GC General Contractor RPM Revolutions per Minute CP Condenser Pump GPM Gallons per Minute RTU Roof Top Unit CRAC Computer Room Air Conditioner HP Heat Pump SA Supply Air CT Cooling Tower HP Horsepower SF Supply Fan CUH Cabinet Unit Heater HVAC Heating, Ventilating & Air Conditioning SF Service Factor CW Chilled Water HW Heating Water SP Set Point CWP Chilled Water Pump HWP Heating Water Pump SP Static Pressure CWR Chilled Water Return HWR Heating Water Return SP Suction Pressure CWS Chilled Water Supply HWS Heating Water Supply SW Side Wall DB Dry Bulb inH2O Inches of Water Column TA Transfer Air DDC Direct Digital Control LAT Leaving Air Temperature TDH Total Dynamic Head DIFF Differential LWT Leaving Water Temperature TEMP Temperature DP Differential Pressure MAU Make - Up Air Unit TF Transfer Fan DP Discharge Pressure MBH 1000 BTU Per Hour THO Thermal Overload DWDI Double Width, Double Inlet MC Mechinacal Contractor TSP Total Static Pressure EAT Entering Air Temperature MD Moterized Damper UH Unit Heater EC Electrical Contractor MOSA Minimum Outside Air UV Unit Ventilator EF Exhaust Fan MVD Manual Volume Damper V Voltage EG Exhaust Grille N/A Not Applicable VAV Variable Air Volume ESP External Static Pressure NAC No Access VEL Velocity EWT Entering Water Temperature NC Normally Closed WB Wet Bulb Elite Balancing, LLC 3/12 ,BALANCINGN E to 13 21 N. 1st Ave, Suite GL10 • Brighton, CO 80601 • Phone: (720) 523-0209 • Fax: (720) 523-0225 • http://www.elitebalancing.com Report Summary / Remarks 1. See notes throughout report. Elite Balancing, LLC 4/12 ELITE IBALANCING Air Handling Unit PROJECT: ADCS LOCATION: 'Co PROJECT #: 2019-1129 SYSTEM/UNIT: (E)AHU-01 NORTHIVAV-1-53 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 27.81 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTH/VAV-1-53 Supply Outlet Summary DATE: 1/22/2019 CONTACT: Kevin Shaw Tested By: Jarrod Smith Date: 1/18/2019 Term Box Test Data Design Max Airflow 150 CFM Total Connected 150 CFM Actual Max Airflow 150 CFM System/Unit Outlet Size AK Factor Design Final Design Prelim Final % Final Velocity Velocity Airflow Airflow Airflow Diff. —Type Outlet -01 SD -1 8 150 160 150 100 Totals: - - - - 160 160 160 100 SYSTEM/UNIT: (E)AHU-01 NORTH/VAV-1-54 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 72.06 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTH/VAV-1-54 Supply Outlet Summary Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 400 CFM Total Connected 400 CFM Actual Max Airflow 405 CFM System/Unit Outlet Type Size AK Factor Design I Final Velocity Velocity Design Airflow Prelim Airflow Final Airflow % Final Diff, Outlet -01 SD -1 6 100 30 95 95 Outlet -02 SD -1 6 100 70 100 100 Outlet -03 SD -1 8 100 150 105 105 Outlet -04 SD -1 8 100 150 105 105 Totals: - - - - - 400 400 40b 101 Elite Balancing, LLC 5/12 ELITE IBALANCING Air Handling Unit PROJECT: ADCS DATE: 1/22/2019 LOCATION: 'Co CONTACT: Kevin Shaw PROJECT #: 2019-1129 SYSTEM/UNIT: (E)AHU-01 NORTHIVAV-1-55 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 58.33 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTH/VAV-1-55 Supply Outlet Summary Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 350 CFM Total Connected 350 CFM Actual Max Airflow 340 CFM System/Unit Outlet Type Size AK Factor Design Final Design VelocVeioci Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 R 8 175 210 175 100 Outlet -02 R 8 175 200 165 94 Totals: - - - - - 360 410 340 97 SYSTEM/UNIT: (E)AHU-01 NORTH/VAV-1-56 Unit Data VAV Address N/A Box Inlet Size 8 K Factor 36.93 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTH/VAV-1-56 Supply Outlet Summary Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 400 CFM Total Connected 400 CFM Actual Max Airflow 415 CFM System/Unit Outlet Type Size AK Factor Design Final Veloci VelocitV Design Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 SD -1 8 100 130 105 105 Outlet -02 SD -1 8 100 165 110 110 Outlet -03 SD -1 6 100 95 95 95 Outlet -04 SD -1 6 50 85 55 110 Outlet -05 E 6 50 0 50 100 Totals: - - - - - 400 476 416 104 Elite Balancing; LLC 6/12 ELITE IBALAN Air Handling Unit PROJECT: ADCS DATE: 1/22/2019 LOCATION: 'co CONTACT: Kevin Shaw PROJECT M 2019-1129 SYSTEM/UNIT: (E)AHU-01 NORTHIVAV-1-57 Unit Data VAV Address N/A Box Inlet Size 8 K Factor 35.61 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTH/VAV-1-57 Supply Outlet Summary Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 650 CFM Total Connected 650 CFM Actual Max Airflow 635 CFM System/Unit Outlet Type Size AK Factor Design Final Velocity Velocity Design Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 SD -1 8 100 190 95 95 Outlet -02 SD -1 8 180 145 175 97 Outlet -03 SD -1 8 180 110 180 100 Outlet -04 SD -1 6 25 90 25 100 Outlet -05 R 8 165 120 160 97 Totals: - - I - I - r --1 660 666 636 98 SYSTEM/UNIT: (E)AHU-01 NORTHIVAV-1-68 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 29.38 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTHIVAV-1-58 Supply Outlet Summary Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 200 CFM Total Connected 200 CFM Actual Max Airflow 205 CFM System/Unit Outlet Type Size AK Factor Design Final Design Veloci Velocity Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 R 8 100 110 100 100 Outlet -02 R 8 100 115 105 105 Totals: - - - - 200 226 206 103 Elite Balancing; LLC 7/12 C ELITE IBALANCING -�- Air Handling Unit PROJECT: ADCS LOCATION: 'Co PROJECT #: 2019-1129 SYSTEM/UNIT: (E)AHU-01 NORTHIVAV-1-69 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 50.03 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 NORTHIVAV-1-69 Supply Outlet Summary DATE: 1/22/2019 CONTACT: Kevin Shaw Tested By: Josh Drake Date: 1/18/2019 Term Box Test Data Design Max Airflow 315 CFM Total Connected 315 CFM Actual Max Airflow 325 CFM System/Unit Outlet Type Size AK Factor Design Final Design Velocity Velocity Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 SD -1 8 110 130 105 95 Outlet -02 R 10 205 270 220 107 Totals: - - - - - 316 400 326 103 SYSTEM/UNIT: (E)AHU-01 SOUTH/VAV-1-68 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 68.28 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 SOUTH/VAV-1-68 Supply Outlet Summary Tested By: Jarrod Smith Date: 1/18/2019 Term Box Test Data Design Max Airflow 450 CFM Total Connected 450 CFM Actual Max Airflow 450 CFM System/Unit Outlet Type Size AK Factor Design Final Velocity Velocity Design Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 R 6 75 80 75 100 Outlet -02 R 8 125 135 130 104 Outlet -03 R 8 125 140 130 104 Outlet -04 R 8 125 120 115 92 Totals: - - I - 1 - I - 1 460 1 476 460 100 Elite Balancing, LLC 8/12 a� $j ELITE BALANCING -C Air Handling Unit PROJECT: ADCS DATE: 1/22/2019 LOCATION: 'Co CONTACT: Kevin Shaw PROJECT #: 2019-1129 SYSTEM/UNIT: (E)AHU-01 SOUTHIVAV-1-69 (E)AHU-01 SOUTHIVAV-1-69 Supply Outlet Summary Tested By: Jarrod Smith Date: 1/18/2019 Term Box Test Data Design Max Airflow 800 CFM Total Connected 800 CFM Actual Max Airflow 805 CFM System/Unit Unit Data VAV Address N/A Box Inlet Size 12 K Factor 26.64 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 SOUTHIVAV-1-69 Supply Outlet Summary Tested By: Jarrod Smith Date: 1/18/2019 Term Box Test Data Design Max Airflow 800 CFM Total Connected 800 CFM Actual Max Airflow 805 CFM System/Unit Outlet Size AK Factor Design Final Velocity Design Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 —TypeVelocity R 8 175 200 185 106 Outlet -02 R 8 175 200 170 97 Outlet -03 SD -1 6 95 130 100 105 Outlet -04 SD -1 8 115 205 115 100 Outlet -05 SD -1 8 125 240 115 92 Outlet -06 R 8 115 170 120 104 Totals: - - - - - 800 1146 806 101 SYSTEM/UNIT: (E)AHU-01 SOUTHIVAV-1-60 Unit Data VAV Address N/A Box Inlet Size 6 K Factor 27.50 Terminal Type SHUT OFF W/ HEAT (E)AHU-01 SOUTHIVAV-1-60 Supply Outlet Summary Tested By: Jarrod Smith Date: 1/18/2019 Term Box Test Data Design Max Airflow 155 CFM Total Connected 155 CFM Actual Max Airflow 155 CFM System/Unit Outlet Type Size AK Factor Design Final Design Veloci Veloci Airflow Prelim Airflow Final Airflow % Final Diff. Outlet -01 R 8 125 100 125 100 Outlet -02 SD -1 6 30 75 30 100 Totals: - - - - - 166 176 166 100 Elite Balancing, LLC 9/12 ELITE IBALANCING -� Fan Unit PROJECT: ADCS DATE: 1/22/2019 LOCATION: 'Co CONTACT: Kevin Shaw PROJECT #: 2019-1129 SYSTEM/UNIT: (E)EF-01 Tested By: Jarrod Smith Date: 1/18/2019 Test Data Actual Airflow 75 CFM Log: (E)EF-01 1/18/2019 Josh Drake Existing fan not in contract (E)EF-01 Exhaust Inlet Summary System/Unit Inlet Type Size AK Factor Design Final Velocity Velocity Design Airflow Prelim Airflow Final Airflow % Final Diff. Inlet -01 75 75 75 100 Inlet -02" 75 50 50 67 Totals: - - - - - 160 126 126 83 Log: (E)EF-01/Inlet-02 1/18/2019 Josh Drake Existing damper on existing system is 100% open. SYSTEMIUNIT: TF -01 Tested By: Josh Drake Date: 1/18/2019 Unit Data Fan Manufacturer Twin City Fan Model Number T500 Fan Serial Number 81A31H Design Airflow 422 CFM Design ESP 0.25 in. we Fan SP In Atmosphere in. we Fan SP Out Starter Data Starter Manufacturer None Tested By: Josh Drake Date: 1/18/2019 Test Data Actual Airflow 440 CFM Actual RPM Direct Drive RPM Volts 121 Volts Amps 0.5 Amps Speed N/A Fan SP In Atmosphere in. we Fan SP Out Atmosphere in. we Tested By: Josh Drake Date: 1/18/2019 Sheave Data Motor Sheave Model Direct Drive Elite Balancing, LLC 10/12 Motor Data Motor Manufacturer Broan-Nuton Motor HP 32 W Motor RPM 815 RPM Motor Rated Volts 120 Volts Motor Phase 1 Motor FL Amps 1.7 Amps Motor Service Factor 1.0 Sheave Data Motor Sheave Model Direct Drive Elite Balancing, LLC 10/12 It giz 11 111 P1 I III 1 101 111 9119 €v a ARA a $€ § s� z g z$ �� A� 9°$ �1�$ Ages¢ 3'z _ $ mill I°$w $$aw $ A as A $�!i a R � ' '� a yaw lip All Al$l $ F N " � W �i . � � 1 z pn $ I a z x $ dA S $ �� d` $ °�.� 1 110 4�� lq_g Ogg$ ill m 11 1 1 IN M011 11 ��� lip Ill 11 �i P 3910 gill % �$9 I �� if $ mal 4 �1 11 5 o PH I 11 '1 1 itP4 I; "E 0 �A 1 �g$� $ 4 b � A 5 �t ADCS BELLMANEKG NMRING. W. �}gip O e 3455 WEST LUTHERAN PARKWAY c $ � m ��-v O SUITE 110 WHEAT RIDGE, COLORADO x Z a ga D 0 P m € G) m z 0 b � A 5 �t ADCS BELLMANEKG NMRING. W. �}gip O e 3455 WEST LUTHERAN PARKWAY c $ � m ��-v O SUITE 110 WHEAT RIDGE, COLORADO N ADGS BELLMAN tg a i ENGINEERING. INC. [ g r Nv O " -=F,o MxleNm'CawWWp E�^•.M1'B � C i 3455 WEST LUTHERAN PARKWA*r V SUITE 110 WHEAT RIDGE, COLORADO Q i : 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: 41()3 EF Job Address: L&t-Q Permit Number: 19 ❑ No one available for inspection: Time, AM/PM Re -Inspection required: Yes When corrections have been made, call for-mseecbon M303= Date''"q ( Inspector: DO NOT REMOVE THIS NOTICE I* � 4 i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspedtion line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: Permit Number: .2G 17 U Z'Z C)`' nC s ,J J \0C -I c CC Y -L , 1 AS bL ❑ No one available for inspection: Time AM/PM Re -Inspection required: FN o When corrections have been made, call for re -inspection at 303-234-5933 Date: 112-i �� Inspector: 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 PE,CTJ�QN NOTICE Inspection Type: _ K ACI Job Address: 5 1%U Permit Number: () Ro Zq.Oy J ❑ No one available for inspection: Tim /PM Re -Inspection required: Yes No When corrections have been ma , eal( for re -ins ection 303-234-5933 Dater DO NOT RE VE 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 tj Inspection Type: LO\ -2 �, ` Job Address: 7."j Permit Number: U Qom, V i ( (-) s (.". ❑ No one available for inspection: Time" AM/PM Re -Inspection required: ,Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date:T� 1 r"I Inspector: DO NOT REMOVE THIS NOTICE e I' CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: 3y Permit Number: �)�� ( C> • o '( ❑ No one available for inspection: Time AM/PM Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: I Inspector: DO NOT REMOVE THIS NOTICE A 4' CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office * (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: Permit Number: /j LAd- Lc) �2 C V., c r LJ No one available for inspection: Time I - AM/PM Re -inspection required: /,Yes' No When corrections have been made, call for re -inspection at 303-234-593 Date: 4 I-,,\ Inspector: ®O 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: t h 1, `-,n i ! �c ✓c�i Job Address: Permit Number: 2 G 2-3 u -f ❑ No one available for inspection: Time AM/PM Re -Inspection required:`` Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: I � Inspector: ®O 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:'" > �,� C v" c 1 t(t Job Address: c r y-r���..,� t Permit Number:y� �j" - u-( A1C_ o r. r-, ( �V < , , ) r'-) C t1-- f r-_ f - U,t 1 t ❑ No one available for inspection: Time AM/PM Re -Inspection required: Yes When correctith e been made, call for re-inssect"ion at 303-234-5933 Date: I'- ; k Inspector: DO NOT REMOVE THIS NOTICE N* i CITY OF WHEAT RIDGE _1�9�Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE- Inspection Type: \-; r, c c �-.. Job Address:r,� Permit Number: ❑ No one available for inspection: Time -bL'Ad�7pM Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: 4-� ; ' i 3 Inspector: t DO NOT REMOVE THIS NOTICE 6-10 i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address: e Permit Number: �ojgo, 90q' )sj ❑ No one available for inspection: TimeAM/PM Re -Inspection required: Yes ;No- _ When corrections have been made, call for re -inspection at 303-234-5933 Date: )l / Inspector: T I DO NOT REMOVE THIS NOTICE i i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-594q. Inspection line (303) 235-2855 Office , ,(303) 237-8929 Fax INSPECTION NOTICE Inspection Type: rl1 Job Address: -Y--1 V" C. cll � Permit Number: ❑ No one available for inspection: Time wt AM/ 'F 0 Re -Inspection required: Yes When corrections have been made, call for re -inspection at 303-234-5933 Date: Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Commercial Roofing PERMIT - 201803139 PERMIT NO: 201803139 ISSUED: 12/04/2018 JOB ADDRESS: 3455 Lutheran Pkwy EXPIRES: 12/04/2019 JOB DESCRIPTION: Commercial re -roof with 1/2 cover board and 60 mil TPO, 44,500 square feet. *** CONTACTS *** OWNER (720)304-8940 EXEMPLA LUTHERAN SUB (303)288-2635 Robert Bechtholdt 021419 Douglass Colony Group *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 1 / Commr Vacant BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 394,000.00 FEES Total Valuation 0.00 Use Tax 8,274.00 Permit Fee 3,028.35 ** TOTAL ** 11,302.35 *** COMMENTS *** *** CONDITIONS *** In order to pass a final inspection on commercial elastomeric or similar type roofing, 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. 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 -roof inspections may be called in at the same time, 100 percent of the sheathing must be complete and 25-75 percent of the midroof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. 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. City of Wheat Ridge E Commercial Roofing PERMIT - 201803139 PERMIT NO: 201803139 ISSUED: 12/04/2018 JOB ADDRESS: 3455 Lutheran Pkwy EXPIRES: 12/04/2019 JOB DESCRIPTION: Commercial re -roof with 1/2 cover board and 60 mil TPO, 44,500 square feet. I, byy m signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applic building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by t le al owner of the property and am authorized to obtain thispermit and perform the work described and approved in conjunction with this e it. I further attest that I am le ally authorized to include all entities named within this document as parties to the work to be pe orm nd thatall work to e perfo ed is disclosed in this document and/or its' ac ompanying approved plans and specifications. (71 Signature of OWNEWor CONTRACTOR (Circle one) Date 1. This permit was issued based on the information provided in thepennit 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 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 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 amanner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit ho lnyder 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 ` ance orIr it shall not be construed to be a permit for, or an approval of, an violation of any provision of any ap i le der 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. City of dgeJ��Wh6atl MUNiTy DEVELOPMENT Building 8 Inspection Services Division 7500 W. 29" 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 I FOR OFFICE USE ONLY I Date: /W Y/100 Plan/Pennit # 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: Sg55 ge L Property Owner (please print): L N R 7- oha�P4C LLQPhone:..303 -0915,9&l Property Owner Email: RDDis�R• 5�9NDdVRLi'� �rl,�l8R1DG�,GDYYI Mailing Address: (if different than property address) Address: 35515 Lu 4 4zon P ku)y Su i 4,-- 1 � D ,W h ea4 R Architect/Ennineer: Architect/Engineer E-mail: Contractor: D 0h 03 Contractors City License Contractor E-mail Address: 0 5'i b 5. ib d 0 u� IQ55 ( Sub Contractors: Electrical: W.R. City License. # Other City Licensed Sub: City License # NONE" Plumbing: W.R. City License # Phone: Phone: 303` � F$-9435 (Qnv. Co Other City Licensed Sub: City License # Mechanical: W.R. City License # Complete all information on BOTH sides of this form 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 amount of materials to be used, etc.) f e-dical ®-r'ice /3ui (drpa Re, Cts vvz q45 !% R04, jrcmo eXI54-1nCJ � mem brave- 4 Bova 6oagd . Px-P 14�-c j r w e4l da may -d lw<w l n,� DA as l� eed °Ld . Aec,' "ic�.11 y Lei, kch Art, w 1i4" CO U eR bnct�d, �t,lly aJk re New 40ml- l TPD, Remove exi6�m5 /Yie / e p1l 4 oi57W/ IV,e w d4ff4- Pr -e � htshY,d C pt rt ) 5(,upptp-e,, Co lledo,e Ae4d5 � d6Wn,5P0043 Sq. FtJLF 7TH Soo 54 Btu's Amps Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ �qq 0b0. co 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: �I (OWNER) (CONTRACTOR or (AUTHORIZED PRESENTATIVE) of (OWNER) (CONTRACTOR) PRINT NAME: 17'1 614 s j N S SIGNATURE: r DATE: ) lg,? g 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 OCC UPANCY CLASSIFICATION TYPE OF CONSTRUCTION SPRINKLERED OCCUPANT LOAD Building Division Valuation: $ 10/8/2018 Go gie Maps 3455 N Lutheran Pkwy 3455 N Lutheran Pkwy - Google Maps Imagery 02018 Google, Map data 02018 Google 100 ft https:/MNww.google.com/maps/place/3455+N+Lutheran+pkwy,+Wheat+Ridge +CO+80033/@39.7656076,-105.090687,413m/data=!3m111e3!4m5!3m4!1SOx876b8657e9f096d3:Ox3cbb7da25141b2alem... 1/1 DOUGLASS COLONY GROUP ROOFING FIELD WORK TICKET Project: Ventas MOB 3 Job Number: 50-010-2912 Warranty: 10 year Firestone Address: 3455 North Lutheran Parkway. Wheat Ridge, CO 80033 Roof System: Re -Cover w/ 60 mil TPO Fully Adhered Job Size: 44,446 SF Deck Type: Metal Deck Insulation Type Application Fastener/ Adhesive Layout Base Layer Existing 5" Remains 211 Layer V Layer Cover -board '/2" HD IsoGard Mechanically Attached 12 Field, 18 Perimeter, 32 Corners Taper/Crickets Membrane Mil Thickness Size Application TPO 60 mil 1 0x1 00 Fully Adhered Side Lap Width Detail Application Per Firestone Details End Lap Width Detail Application Per Firestone Details Sheet Metal Sub: DCG Contact: Bryan Bangs 970.396.3011 Client Contact: Lillibridge Healthcare Roger Sandoval 303.653.3006 Job Specific Installation Instructions: Re-cover with new cover board and TPO membrane. Demo and dispose existing membrane and cover board. Leave existing 5" insulation in place. Keep wood nailers and any metal flashing cleats intact as much as possible. Mechanically attached new Y2" HD IsoGard cover board at rate of 12 fasteners in Field, 18 fasteners at Perimeter & 32 fasteners at Corner. Use 8' as perimeter and corner guide. Follow Firestone fastener pattern provided in job book. Fully adhere 60 mil TPO at rate of 60 SF per gallon bonding adhesive. All TPO flashing details per Firestone 10 year warranty requirements. Coordinate metal install for new metal coping cap, counterflashing, drip edge, fascia, unit slip flashing, scuppers, gutters, collector heads and downspouts. 8/27/2018 Print - PhotoMaps by nearmap Date: Wed, 27 Jun 2018 Notes: http://maps. us. nearmap.com/print?north=39.76641886392552&east=-105.08843661544182&south=39.76546119625848&west=-105.090784889434368zoom=20&date=20180627 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: ��� ?f�G Job Address: 5Y '�,5 L i,fhe;-o/ 7 Permit Number: (90/902- 12`1 ❑ No one available for inspection Time .12 AM/PM Re -Inspection required: YesNo When corrections h ve been made, c for re-inspecton at 303-234-5933 J Date: / �� /G Inspector:!! T# DO NOT REMOVE THIS NOTICE, City of Wheat Ridge Comm. Tenant Finish PERMIT - 201802804 PERMIT NO: 201802804 ISSUED: 11/05/2018 JOB ADDRESS: 3455 Lutheran Pkwy Suite 110 EXPIRES: 11/05/2019 JOB DESCRIPTION: Interior renovation including electrical, hvac and plumbing - 4,344 sq ft total *** CONTACTS *** OWNER (720)304-8940 EXEMPLA LUTHERAN GC (303)757-3033 Mark Stratton/Jennifer Byrden 150163 Coda Construction Group LLC SUB (720)325-3731 Scott Smith 150159 Copper Smith Electric SUB (303)237-8575 Tim O'Connor 000193 O'CONNOR PLUMBING LLC SUB (303)459-7785 Allen Green 170499 A Squared Mechanical Solutions *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 1 / Commr Vacant BLOCK/LOT#: / *** FEE SUMMARY *** Total Valuation Plan Review Fee Use Tax Permit Fee ** TOTAL ** "** COMMENTS *** ESTIMATED PROJECT VALUATION: FEES 0.00 1,683.34 6,844.36 2,589.75 11,117.45 325,922.00 *** CONDITIONS *** All roughs to be done at Framing Inspection. Approved per plans and red -line notes on plans. Must comply with 2012 IBC, 2017 NEC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. **Prior to final inspection approval - As-builts are required before approval of the Building Final Inspection and Certificate of Occupancy can be issued. City of Wheat Ridge Comm. Tenant Finish PERMIT - 201802804 PERMIT NO: 201802804 ISSUED: 11/05/2018 JOB ADDRESS: 3455 Lutheran Pkwy Suite 110 EXPIRES: 11/05/2019 JOB DESCRIPTION: Interior renovation including electrical, hvac and plumbing - 4,344 sq ft total I, by my signature, do hereby attest that the work to be per 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 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. nature of OWNER or CONTRACTOR (Circle one) Date 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. 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. 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. No work of an manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 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. The Jssuapekor granting permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any applicab e any or ance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of W heat fidJ�c COMINUNIIY DIV[IOI'MrN-r Building & Inspection Services 7500 W. 291h Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits CcDci.wheatridge.co.us FOR OFFICE USE ONLY Date: Plan/Permit # Plan Review Fee: J ll <' 2 Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: .- It %a. Property Owner (please print): oA Phone: "t 2 -- Property Owner Email: % %-A-- Tenant Name (Commercial Projects Only) ^K>c- s Property Owner Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Engineer: w. _. .._► a Po��.+.�� Architect/Engineer E-mail: GaeP.hone: 303 . -"N -t . -is -z.$- •Z.... Contractor Name: City of Wheat Ridge License #: x S o v3 Phone: �2-� z-�� • ��� o Contractor E-mail Address:-��s.-@ For Plan Review Questions & Comments (please print): CONTACT NAME (please print): Phone: ��•-o • 'z -Y 8�� o CONTACT EMAIL(please print): ag cc-'- . cam Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): Electrical: Plumbing: Mechanical: W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: Other City Licensed Sub: City License # City License # Complete all highlighted fields, if applicable. COMMERCIAL ❑ RESIDENTIAL Z'�� l S,-�- � coq Provide description of work: For ALL projects, 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. —T -vi S i S of 4i 3L+Lt $"Ir ill--wio✓ ►rtV10va.H©V1 Jo,. a d2vMe'ADI GN,,A co�,m tA--1�u ►•c� �� �) v -o v ► d(�,. A0 vv�.eA ; c'..Q Sq. Ft./LF moo MS Lo I ` rt Q•Io Ma� Q�-'P a L l Pel C ,-u 4 BTUs U Y-v's ('V6VkA-�oI lrA v .� cA oci'ra,1k- 4o �Cku,AX '- __\<� C 0 WI& <:�r; Jr, --o Gallons Amps Squares For Solar: Kw # of Panels Requires Structural For Commercial Projects Only: Occupancy Type: 1'-> Construction Type: 'd Occupancy Load: %: ►oc Square Footage: 3,-►-r-� Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ �—L11� 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. 1, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER (CONTRACT4 or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: X Printed Name: % : �y ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMM TS: Reviewer: / - /a/3i PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: 6 5.7, 58 —�Z SL- , I (It? .� Building Division Valuation: SUB -CONTRACTOR AUTHORIZATION FORM This form must be signed by each sub -contractor. This form will not be accepted with missing information. Subcontractor's City of Wheat Ridge License number must be provided in the applicable space. Subcontractor's insurance and license must be up to date prio 1 to permit issuance. Project Address: 3455 Lutheran Pkwy. , #110 Permit #: General Contractor: Coda Construction Electrical Sub -Contractor Company Name: Coppersmith Phone #:720-325-3731 State License #: EC.0100350 Master #: ME.0600185 Wheat Ridge License #: 150159 (required field) W4/' 1 10/10/18 Si ture of Authorized Ag Date Company Name: O'Connor Plumbing Phone #: State License #: Master #: Wheat Ridge License #: 000193 (required field) — 10/9/18 Signature of Authorized Agent Date Company Name: A squared Mechanical Phone: 720.862.9552 Wheat Ridge License #: 170499 (required field) 10.9.18 Signature of Authorized Agent Date Kelsy Welsh �!5" �Vi � 070 6f From: Jennifer Byrden Sent: Monday, October 15, 2018 2:55 PM To: Kelsy Welsh; Kimberly Astler Subject: FW: Permit application accepted - West Metro Fire Protection District Jennifer Byrden Coda Construction Group, LLC 444 Lipan St Denver, CO 80204 www.codacg.com 0:303.757.3233 C: 720.250.8272 F: 303.757.3083 From: NoReply@mobile-eyes.com [mailto:NoReply(abmobile-eyes.com] Sent: Monday, October 15, 2018 2:49 PM To: Jennifer Byrden Subject: Permit application accepted - West Metro Fire Protection District Your permit request for ADCS at STE 110, 3455 Lutheran Parkway Wheat Ridge, CO 80033 has been accepted. The Job Number is: 181015005 Description: Tenant Finish Demo and Remodel Thank you for submitting to West Metro Fire. Our typical review turnaround is approximately 2 weeks. If additional information is required, you'll receive a notice from the reviewer assigned, or a no -reply notice from Mobile Eyes. Please be sure to check your junk folder if you feel you are not receiving the Mobile Eyes notices and select "Not Junk". NOTE: Re -submissions shall only include the pages that are affected and additional pages that may be required for the needed corrections. Re -submission of full sets, unless specifically requested, shall result in the rejection of plans. S&RJ.M� 3:,,� s'f�t`11111t'„iillt i,tfJlif��F,k 5801 Logan St. Suite 200 Denver, CO 80216 (303) 297-1645 Phone (303) 297-1646 Fax www. srenvironmentalconsulting.com October 19, 2018 Kimberly Astler CODA Construction 444 Lipan Street Denver 80204 fi L=4'etzg Me 5 fUrm mgmai RE: Limited Bulk Sampling for Asbestos 3455 West Lutheran Parkway, Suite 110 Wheat Ridge, CO 80033 S & R Project Number: 018437 Dear Ms. Astler, 2-OlKot�B0 If S&R Environmental Consulting, Inc. (S&R) is pleased to provide the results of the bulk samples collected from suspect asbestos -containing materials (ACM) identified at 3455 West Lutheran Parkway, Suite #110 in Wheat Ridge, Colorado. The collection of representative bulk samples and delivery of the samples to an independent analytical laboratory were conducted on October 17, 2018. The work was performed by S&R Asbestos Building Inspector, Les J. Puvathingal, who is certified by the Environmental Protection Agency (EPA) and the Colorado Department of Public Health and Environment (CDPHE). INTRODUCTION S&R understands that Coda Construction was seeking a professional environmental consulting company to collect representative bulk samples of the suspect asbestos -containing materials that may be impacted during an upcoming renovation project in the building space. Samples were submitted to an independent analytical laboratory for asbestos content analysis. S&R understands that a report of findings would be prepared based on the results of the analysis. SCOPE OF WORK Twenty-nine (29) representative bulk samples were collected from suspect asbestos -containing materials identified throughout the office suite. Samples were submitted for asbestos content analysis. No samples were collected from the exterior or any other areas of the building. The following is a list of suspect building materials identified in the office space that were tested: city of whoa" Rage • Multi -Color Smooth Texture Drywall Materials • 4" Cream Color Cove Base & Associated Mastic Materials • 4" Tan Lined Cove Base & Associated Mastic Materials • 4" Grey Cove Base & Associated Mastic Materials • 2'x2' White Medium Fissure Ceiling Tile Materials • 2'x4' White Deep Fissure Ceiling Tile Materials • 2'x4' White Medium Fissure Ceiling Tile Materials • Tan Flower Pattern Wall Paper & Associated Mastic Materials • Green Flower Pattern Wall Paper & Associated Mastic Materials • 12"x12" Tan Streaked Vinyl Composite Tile & Associated Mastic Materials • 12"x12" White Streaked Vinyl Composite Tile & Associated Mastic Materials • Multi -Color Carpet Square & Associated Mastic Materials • Grey Ceramic Tile Mortar ANALYTICAL PROCEDURES The bulk samples collected from suspect asbestos -containing materials were delivered to DCM Sciences Inc., a National Voluntary Laboratory Accreditation Program (NVLAP) asbestos laboratory located in Wheat Ridge, Colorado for a twenty-four hour turnaround time. All bulk samples are archived for six months unless otherwise stipulated by the client. According to the analytical laboratory, the bulk samples were analyzed in accordance with EPA Method 600/R-93/116. Small portions of the sample were placed in Series: E High Dispersion Refractive Index Liquid on a microscope slide. The prepared samples were observed at 100X (power) under polarized light using a McCrone Dispersion Staining Objective. The characteristics of the fibers were compared to the known properties of asbestos fibers for dispersion, color, polarity, distinction and general morphology. Sample content (given by percentage) was made by visual estimates by comparison of asbestos fibers to total materials. RESULTS The US Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), and the State of Colorado Air Quality Control Commission consider a material as asbestos containing if the reported amount of asbestos is greater than one percent (1%). Based on the analytical report, all of the samples were reported as none detected (ND) for the presence of asbestos. A list of all tested materials, locations and results follows. Suite 110 Sample Number Material Location Result Tape Condition/HA fntity Multi Colored Smooth Suite 110 Reception Area Texture Drywall South Wall ND 4,000 A N/A/1 437 -DW -02 Multi Colored Smooth Suite l 10 Bathroom ND Texture Drywall HallwayEast Wall 4,000 A N/A 1 437 -03 Multi Colored Smooth Suite l 10 Room 120 North -DW Texture Drywall Wall ND 4,000 A N/A/1 437 -DW Multi Colored Smooth Suite 110 Reception Area -04 Texture D Drywall West Partition Wall7aity ND 4000 , 1 of 437 -DW -05 Multi Colored Smooth Suite 110 Sub Wait Area ND Texture Drywall Room 120-114 East Wall 4,000 N/A/ 1�`h6 t Rid. uiiding Divispry e h';dse ui/ain y 9 ail �. 3 t 4" Cream Color Cove 437 -CB -06 Base & Associated Suite 110 Reception Area ND 45 C N/A/2 Mastic South Wall 4" Cream Color Cove 437 -CB -07 Base & Associated Suite 110 Reception Area ND 45 C N/A/2 Mastic North Wall 4" Tan Lined Cove 437 -CB -08 Base & Associated Suite 110 Reception Area ND 25 C N/A/3 Mastic South Wall 4" Tan Lined Cove 437 -CB -09 Base & Associated Suite 110 Reception Area ND 25 C N/A/3 Mastic North Wall 437 -CB-] 0 4" Grey Cove Base & Suite 110 North Hallway Associated Mastic East Wall ND 30 C N/A/4 437 -CB -11 4" Grey Cove Base & Suite 110 North Hallway Associated Mastic West Wall ND 30 C N/A/4 437 -CT -12 2'x2' White Rough Suite l 10 Reception Area Texture CeilingTile Ceiling ND 1,300 C N/A/5 437 -CT -13 2'x2' White Rough Suite 110 Reception Area Texture Ceilin Tile Ceiling ND 1,300 C N/A/5 437 -CT -14 2'x4' White Deep Suite 110 Suite 122 ND Fissure Ceiling Tile Hallway 400 C N/A/6 437 -CT -15 2'x4' White Deep Suite 110 Suite 122 ND 400 C N/A/6 Fissure Ceiling Tile Hallway 437 -CT 2'x4' White Medium Suite 110 North Hallway -16 Fissure Ceiling Tile Ceiling ND 1,150 C N/A/7 437 -CT 2'x4' White Medium Suite 110 Sub Wait (Room -17 Fissure Ceiling Tile 120-114) Ceiling ND 1,150 C N/A/7 Tan Flower Pattern 437-WPG-18 Wall Paper & Suite l 10 Sub Wait Room ND 250 C N/A/8 Associated Mastic Doctor Office East Wall Tan Flower Pattern 437-WPG-19 Wall Paper & Suite 110 Sub Wait Room ND 250 C N/A/8 Associated Mastic Doctor Office West Wall Green Flower Pattern 437-WPG-20 Wall Paper & Suite 110 West Bathroom ND 450 C N/A/9 Associated Mastic Hallway East Wall Green Flower Pattern 437-WPG-21 Wall Paper & Suite 110 West Bathroom ND 450 C N/A/9 Associated Mastic Hallway West Wall 12"x12" Tan Streaked 437 -VCT -22 Vinyl Composite Tile Suite 1 l0 Sub Wait (Room ND 700 C N/A/10 & Associated Mastic 120-114) North Hallway 12"x12" Tan Streaked 437 -VCT -23 Vinyl Composite Tile Suite 110 Sub Wait (Room ND 700 C N/A/10 & Associated Mastic 120-114) North Hallway 12"x12" White 437 -VCT -24 Streaked Vinyl Composite Tile & Suite 110 Staff Lounge ND 750 C N/A/11 Associated Mastic 12"x12" White 437 -VCT -25 Streaked Vinyl Suite 110 Staff Lounge ND 750 C N/A/I1 Composite Tile & Hallway Associated Mastic Multi -Color Carpet 437 -CS -26 Square & Associated Suite 110 Reception Area ND 3,700 12 Mastic CityoN h';dse ui/ain y 9 ail �. 3 t ND= None Detected HA=Homogeneous Area Type A=Surfacin B=Thermal System Insulation TSI C=Miscellaneous Material Multi -Color Carpet 1. Damaged or significantly damaged TSI ACBM 2. Damaged friable surfacing ACBM 3. 437 -CS -27 Square & Associated Suite 110 Reception Area ND 3,700 C N/A/12 7. Mastic 437 -CTM -28 Grey Ceramic Tile Suite 110 Reception Area ND 300 C N/A/13 Grout HallwayEast Bathroom Grey Ceramic Tile Suite 110 Reception Area 437 -CTM -29 Grout Open Space West ND 300 C N/A/13 Bathroom ND= None Detected HA=Homogeneous Area Type A=Surfacin B=Thermal System Insulation TSI C=Miscellaneous Material RECOMMENDATIONS AND SUMMARY None of the tested materials in Suite 110 contain any amounts of asbestos. The materials may be demolished or impacted using conventional methods. Suspect materials are sometimes located behind walls and above ceilings, and were considered inaccessible during the survey. Therefore, all materials that contain asbestos may not have been observed or sampled. If additional suspect asbestos -containing materials are identified during restoration, all activities should stop until these materials are sampled. Work should not resume until the results are reported and removal completed, if required. LIABILITY LIMITATION S&R reserves the right to amend or alter this protocol as conditions change and materials not initially visible are revealed. All quantities are onsite estimates and reflect the amounts observed at the time of sampling. Actual material quantities should be field verified when developing a scope of work. S&R assumes no liability greater than the sum of the invoice for its services. CLOSING COMMENTS S&R appreciates the opportunity to assist with your asbestos sampling needs. If you have any questions regarding this report, please do not hesitate to call us at (303) 297-1645. CONFIDENTIALITY This communication including all contents and attachments are confidential and may be subject to privilege. City of , Wheat Ridge e Condition 1. Damaged or significantly damaged TSI ACBM 2. Damaged friable surfacing ACBM 3. Significantly damaged friable surfacing ACBM 4. Damaged or significantly damaged friable misc. ACBM 5. ACBM with potential for damage 6. ACBM with potential for significant damage 7. Any remaining friable ACBM or friable suspected ACBM RECOMMENDATIONS AND SUMMARY None of the tested materials in Suite 110 contain any amounts of asbestos. The materials may be demolished or impacted using conventional methods. Suspect materials are sometimes located behind walls and above ceilings, and were considered inaccessible during the survey. Therefore, all materials that contain asbestos may not have been observed or sampled. If additional suspect asbestos -containing materials are identified during restoration, all activities should stop until these materials are sampled. Work should not resume until the results are reported and removal completed, if required. LIABILITY LIMITATION S&R reserves the right to amend or alter this protocol as conditions change and materials not initially visible are revealed. All quantities are onsite estimates and reflect the amounts observed at the time of sampling. Actual material quantities should be field verified when developing a scope of work. S&R assumes no liability greater than the sum of the invoice for its services. CLOSING COMMENTS S&R appreciates the opportunity to assist with your asbestos sampling needs. If you have any questions regarding this report, please do not hesitate to call us at (303) 297-1645. CONFIDENTIALITY This communication including all contents and attachments are confidential and may be subject to privilege. City of , Wheat Ridge e Sincerely, S&R ENVIRONMENTAL CONSULTING, INC. Les J. Puvathingal Project Manager CDPHE Building Inspector #15037 Attachments: • Site Photos • Laboratory Results & Chain of Custody Digitally signed by Les Puvathingal DN: cn=Les Puvathingal, o=S&R Environmental Consulting, —S&R, em11=1es@smnvimnmentalconsuking.com, =t1S Date: 2018.10.19 090607 -06'00' S�Pa�e Multi -Color Smooth Texture Drywall 4" Tan Lined Cove Base & Associated Mastic 2'x2' White Rough Texture Ceiling Tile 4" Cream Color Cove Base & Associated Mastic 4" Grey Cove Base & Associated Mastic 61Pagc t 2'x4' White Medium Fissure Ceiling Tile Green Flower Pattern Wall Paper & Associated Mastic 1 9 ALL',., Tan Flower Pattern Wall Paper & Associated Mastic 12"x 12" Tan Streaked Vinyl Composite Tile & Associated Mastic city of heat Ridge 71Pat,e 12"x 12" White Streaked Vinyl Composite Tile & Associated Mastic Grey Ceramic Tile Grout Multi -Color Carpet Square & Associated Mastic city of Wheat Ridge 8111age 0 0 0 0 0 0 W W J J J 00 nCda W J A W J o O A O O N � p 0 0 0 0 0 0 00 00 a C7nW a 00 C7n07a 00 nCda 0 C7nb7a mC7ntca ISMO x xxo� ::�w�o7 xo�� �M� xox ��IX0 xxo� ��b7C) G xxoXrm- m mra�ro r�n�mro r�n�r�iy mr�n�,�� r'nm�,'v, p ro dC7„ao„aa �Xiz z d �o ����Pd oo�,a C7r a� rZ� �0 >o� ��C, O rr`� rcr r�� rrrl o m cr,�r � m z O W In O N W O O N VJi In O W kA tlj N � O O W -- O O O O O O O C O O O O O O C O O O O O O o e o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 z z z z z z z z z z z z z z z z z z z z z d O0ac C70007 coo 0000 C7C70 C70 o -o00 Oo.-O - o 0 0--00 00000 0 o n 0 0 n O 0 o 0 o n 'v, o 0 0 E iA O o 0 O �O 'O O �o 10 O 10 10 10 10 O 10 10 O 0 0 000 00 o }o0 0 0 oo 10�o00 O o n o o o o c o o n n o o 0 n n o 0 0 O O O o o 0 0 0 O 0 0 O 0 0 0 O O O CO C 0 0 0 0 0 0 0 0 09 0 0 0 0 0 0 0 0 0 0 0 O O C o 0 0 0 0 00 C 0 0 0 00 O 0 0 0 C z 0 � � r a mo cn z L) m 0 City of Wheat Ridge 3Ulldinn N; lj ,,,, 0 0 0 0 0 0 0 00 �za 00 00 00 00 a 00 wa A A A A A zx xzx xzx w w J J w J w J w J w J w J w J xz from z rzm �m 71 71 mem r"3n m m �a ra ra a�� a�z a� a> a O Ln 000 JO 0 0 0 0 0 0 0 00 �za 00 00 00 00 a 00 wa 0o tsra x > z� zx zx xzx xzx x xz from z rzm �m mem mem r"3n m m �a ra ra a�� a�z a� a> a Ln M o r r r o x o x o r [= r m m m m C C) d d ,Oro r r r r C C O O 1 Cl Cl C, C> o D o 0 O o o O O O O O o o O o o O o O O 00 00 o0 coo cod o0 00 0 of a vl �� of o� d� o 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 o v, v, o in in o in 0 in o w O N O N O O o O O 'o o O c O cO 0 00 0 0 0 0 o 0 0 o o c 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 l 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 z Ln O zn C r z ro m OItm �n m M c a � r [ mrA C O z M m 0 a to m O m ° C) it O n O O x � m z o L6rA Zo 3Co CALn am�.� z z Dy > C7 m n r m z d�gn z m <'rm O C a ozo m z U r C n O o L' O ia" z C) City of Wheat Ri.g. 0 J 0 J 0 J 0 J 0 J 0 J 0 J 0 J 00 �a 70 boa W a a 00 d��oa 00 a�a 00 a�a 00 �a zz x z xoxx W W W W w m� J J J J J W J W J W J mm �m mm mm m� m m x 71 n n n n Dr r >� p, N C �C 00 r < r m 0 J 0 J 0 J 0 J 0 J 0 J 0 J 0 J 00 �a 70 boa W a a 00 d��oa 00 a�a 00 a�a 00 �a zz x z xoxx zx zx zx m� m mm �m mm mm m� m m x -< ri Dr r >� r r r r < r m m m n d m m O m trn C) L) L) �- �� 0 0 0 0 0 o c o 0 0 o c c o 0 o a o 0 0 0 0 0 0 0 0 0 0 z z z z z z z z z z z z z z z z d d O O 0 t7 0 C7 C7 u C7 = G O = 0 OIcI UI CI OI 0 d 0 0 0 Ni o 0 0 0 0 0 o c o CD n n o o c o o v in o 0 0 0 U J 1010 N O N C W O O O �o �c O O O C O O O to in O O O O C �n cn O O C O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 z r z 0 b m n m z a n m 0 Inb O =� C O C = r - Ln z Ym Enr zm0E- tn.�)po 14 0 En Ln��OdzC7 O wine n� mz > mrzmr a -3� �tn0 -3 A O a v�wo A -- O O O to 00 00 J oo �C00 0o x m b x m C) m O rBuildinq J .. ._ � 00 00 00 � C x m b x M d O m p City of Wheat Ridge oXV) d N N yy 10 00m N N N N N ril A A A A A A A z C/o n rn J J J J J J J C r =� < < < z LO) to r J \O W A w a o °e < m d o r a LID m m a 00 00 Go 0. 00 oc a� on °7a a ara y a to> a 0 V) d O rriz z r- r. z zn z -mG {0 O L)m mp C)� Z a7 0 z o �F z (F� za xxxa z e m d y d ny MK ° m a y ° rz •v m ro m o rrn a a X v am o � ro o � m �., �n �., � CSA r o0 oc 0 0 o0 0 0 � - � - o •v z ny a o0 oe o0 0o 00 c o 0o c ,.� � m 00 00 0 m co Ln co Ln mC4 G7 Ln -� m m Ln 0 O x U M z O z m � o z z z z z z z z z z z zz z o a < m a o a�° m r m O n O z m 4j m k rz mn o 0 0 0 0 0 0 0 0 0 0 0 0 � 0 0 0 0 0 0 0 0 v o n in 0 Ln W n C r r z o z 0 0 0 0 0 0 0 0 n o LnC/) C7 m m a 0 > 0 c c 0 Cl o 0 0 p 0 0 0 c o J .. ._ � 00 00 00 � C x m b x M d O m p City of Wheat Ridge aDCM I (ABORA'PORY, INC. 12421 W. 49th Avenue, Unit #6 Wheat Ridge, CO 80033 DCM Project No.: SREC 896 Client Job No.: 018437 Bulk Sample Analysis Page Is of BULK SAMPLE ANALYSIS PROCEDURES: DCM Science Laboratory, Inc. analyzes bulk asbestos samples following procedures developed by the McCrone Research Institute and in compliance with guidelines established by the Environmental Protection Agency (EPA -600/M4-82-020,1982 and EPA -600/R-93/116, July, 1993). Bulk samples are prepared for analysis using a 10X -80X stereo microscope in a hepa filter hood which provides a contamination -free environment. The sample is then analyzed by polarized light microscopy (PLM) at 100X. When the sample consists of more than one layer, each layer is prepared and analyzed separately. Fiber and matrix materials are identified by the characterization of optical properties including color and pleochroism, form, cleavage, relief, birefringence, extinction, orientation, twinning, interference figure and other distinguishing features. Dispersion staining is also used to further aid in mineral identification. All percentages of asbestos, other fibers and non-fibrous constituents are calculated from the values obtained from analyses using the stereo and PLM microscopes. In-house and NIST standards as well as a chart prepared by R.D. Terry and G.V. Chilinger for "The Journal of Sedimentary Petrology", (Volume 24, pp. 229-234, 1955) provide a guide for estimating percentages. All samples are archived for six months unless other arrangements are made by the client. ACCREDITATION: DCMSL is accredited by NVLAP (since April 1, 1989). Our NVLAP Lab Code is 101258-0. DCMSL complies with NVLAP requirements unless otherwise noted. ENDORSEMENT: The results of this analysis must not be used by the client to claim endorsement by NVLAP or any agency of the U.S. Government. The analysis was performed by: John Silverman, Analyst Zn Barnes, Analyst [tel%Z.N. TE9TIN6 NVLAP Lab Code 101258-0 Ron Schott, Analyst Date Ron Schott Laboratory Director City of Wheat Ridge DCM tAwRATOAY,1Nc. 12421 W. 49" Avenue, Unit #6 Wheat Ridge, CO 80033 (303) 463-8270/(800) 852-7340 (303) 463-8267 — fax Date/Time Received P-1 JLQ 16 DCMSL Group No. 1 ���7 DCMSL Log No. -S �_� L �n Field Data Sheet/Chain of Custody Samples Submitted By - Company: Company: S �+yJ� P'0 n(ruj4k Address: Contact: Phone: Cell:X01 - Email: te, eP_ zeovi"nit\P_*t,I_rAmu ,"nt .Cc, Job/P.O. # O f R 7 3':; - Project Title''l �). t4e(ur►. U),e a* R; d C e Archive: Asbestos samples are archived for 6 months unless other arrangements are made. All other samples are archived for 3 months. Turnaround Time Requested: [ ] Standard (3 to 5 Business Days) [ ) 2 Hour Rush (Asbestos Only) 24 Hour Rush [ ] Other Procedure Requested: ASBESTOS DUST & SILICA OTHER SERVICES Bulk Standard EPA [ ) Silica - Air NIOSH 7500 [ ] Optical Microscopy [ ) Progressive [ ] Silica - Bulk [ ) X-ray Diffraction - Scan/Search [ ) Point Count [ ) Silica - Bulk Respirable [ ] X-ray Diffraction - Clay/Bulk [ ] Other [ ] Dust - NIOSH 0500/0600 [ ] SEM Air [ ) NIOSH 7400 Other Analysis: [ ] OSHA ID -160 [ ] Other Client Sample No.: Sample Date Air Volume Other Information 1 y 3-4- o w o f I b-)7- 76 116 2-6� 3 03. 4 `- 01 5 —0.5, 8 3 -4- CP> 6 9 10 Relinquished Date/Time _l t) -P- !b 1110 R ceiv�d By: col i ko"', Date/Time inirrl[Fs WV City of Wheat Ridge Commercial Demolition PERMIT - 201802806 PERMIT NO: 201802806 ISSUED: 10/22/2018 JOB ADDRESS: 3455 Lutheran Pkwy Suite 110 EXPIRES: 10/22/2019 JOB DESCRIPTION: Demolition of 4344 square feet for a tenant finish (permit#201802804 ADCS). Demo of all finishes, ceiling and lights. Asbestos report on file. Report number 018437. No asbestos found. *** CONTACTS *** OWNER EXEMPLA LUTHERAN TEN (303)422-9500 Rodger Sandoval ARCS GC (303)757-3033 Mark Stratton/Jennifer Byrden 150163 Coda Construction Group LLC *** PARCEL INFO *** ZONE CODE: UA / Unassigned SUBDIVISION CODE: 1 / Commr Vacant USE: UA / Unassigned BLOCK/LOT#: / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 10,000.00 FEES Total Valuation 0.00 Demolition Fee 50.00 ** TOTAL ** 50.00 *** 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 bye legal owner of the property and am authorizes to obtain this permit and perform the work described and approved in conjunction with thJ§r attestthat Iam legallyauthorized toinclude alpermed and that all work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. � V -k - i c> - 'Z --L iii Signature of OWNER or CONTRACTO ircle one) Date 1. This permit was issued based on the informs ion provi ed 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 andspecific 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 t7 ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Sig4aiure`oTCyiief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of W heat 1,idge COMMUNITY DEVELOPMENT Building & Inspection Services 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: Plan/Permit # Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: Property Owner (please print): Phone Property Owner Email: --_4r:_ :7-----���-./p-`-�_ �.� _,� �Vtx-z_\ Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address:�-- City, State, Zip: Architect/Engineer: . \_ ���V-2)/-- roe -k ,r --S Architect/Engineer E-mail: `- Phone: Contractor Name: 0 �, cz�,v-. City of Wheat Ridge License #: �� _c��� Phone: Contractor E-mail Address: 66—Z) 1Q_ - For Plan Review Questions & Comments (please print): CONTACT NAME (please print): Phone: \-x_� '2-'&'11'\ - CONTACT EMAIL(p/ease print): i -N..-- G y ' C , cry. c:-- C, . Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): Electrical: Plumbing: Mechanical: W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: City License # Other City Licensed Sub: City License # Complete all highlighted fields, if applicable. COMMERCIAL ❑ RESIDENTIAL Provide description of work: For ALL projects, 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 - BTUs Amps Squares For Solar: Gallons KW # of Panels Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: _ Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ -Vic:.:, acv 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. 1, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name) ,�r�G %` � �w'�T — DATE: %,c=, Printed Name: ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: i n5�n„itrr�c�nla� � xwt.nitany, 5801 Logan St. Suite 200 Denver, CO 80216 (303) 297-1645 Phone (303) 297-1646 Fax www.srenvironmentalconsulting.com October 19, 2018 Kimberly Astler CODA Construction 444 Lipan Street Denver 80204 RE: Limited Bulk Sampling for Asbestos 3455 West Lutheran Parkway, Suite I10 Wheat Ridge, CO 80033 S & R Project Number: 018437 Dear Ms. Astler, S&R Environmental Consulting, Inc. (S&R) is pleased to provide the results of the bulk samples collected from suspect asbestos -containing materials (ACM) identified at 3455 West Lutheran Parkway, Suite #110 in Wheat Ridge, Colorado. The collection of representative bulk samples and delivery of the samples to an independent analytical laboratory were conducted on October 17, 2018. The work was performed by S&R Asbestos Building Inspector, Les J. Puvathingal, who is certified by the Environmental Protection Agency (EPA) and the Colorado Department of Public Health and Environment (CDPHE). INTRODUCTION S&R understands that Coda Construction was seeking a professional environmental consulting company to collect representative bulk samples of the suspect asbestos -containing materials that may be impacted during an upcoming renovation project in the building space. Samples were submitted to an independent analytical laboratory for asbestos content analysis. S&R understands that a report of findings would be prepared based on the results of the analysis. SCOPE OF WORK Twenty-nine (29) representative bulk samples were collected from suspect asbestos -containing materials identified throughout the office suite. Samples were submitted for asbestos content analysis. No samples were collected from the exterior or any other areas of the building. The following is a list of suspect building materials identified in the office space that were tested: • Multi -Color Smooth Texture Drywall Materials • 4" Cream Color Cove Base & Associated Mastic Materials • 4" Tan Lined Cove Base & Associated Mastic Materials • 4" Grey Cove Base & Associated Mastic Materials • 2'x2' White Medium Fissure Ceiling Tile Materials • 2'x4' White Deep Fissure Ceiling Tile Materials • 2'x4' White Medium Fissure Ceiling Tile Materials • Tan Flower Pattern Wall Paper & Associated Mastic Materials • Green Flower Pattern Wall Paper & Associated Mastic Materials • 12"x 12" Tan Streaked Vinyl Composite Tile & Associated Mastic Materials • 12"x12" White Streaked Vinyl Composite Tile & Associated Mastic Materials • Multi -Color Carpet Square & Associated Mastic Materials • Grey Ceramic Tile Mortar ANALYTICAL PROCEDURES The bulk samples collected from suspect asbestos -containing materials were delivered to DCM Sciences Inc., a National Voluntary Laboratory Accreditation Program (NVLAP) asbestos laboratory located in Wheat Ridge, Colorado for a twenty-four hour turnaround time. All bulk samples are archived for six months unless otherwise stipulated by the client. According to the analytical laboratory, the bulk samples were analyzed in accordance with EPA Method 600/R-93/116. Small portions of the sample were placed in Series: E High Dispersion Refractive Index Liquid on a microscope slide. The prepared samples were observed at 100X (power) under polarized light using a McCrone Dispersion Staining Objective. The characteristics of the fibers were compared to the known properties of asbestos fibers for dispersion, color, polarity, distinction and general morphology. Sample content (given by percentage) was made by visual estimates by comparison of asbestos fibers to total materials. RESULTS The US Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), and the State of Colorado Air Quality Control Commission consider a material as asbestos containing if the reported amount of asbestos is greater than one percent (I%). Based on the analytical report, all of the samples were reported as none detected (ND) for the presence of asbestos. A list of all tested materials, locations and results follows. Suite 110 Sample Number Material -Location Result Qua Type Condition/HA 2) Multi Colored Smooth Suite 110 Reception Area 437 -DW -01 Texture Drywall South Wall ND 4,000 A N/A/1 Multi Colored Smooth Suite 110 Bathroom 437 -DW -02 Texture Drywall HallwayEast Wall ND 4,000 A N/A/1 Multi Colored Smooth Suite l 10 Room 120 North 437 -DW -03 Texture Drywall Wall ND 4,000 A N/A/1 Multi Colored Smooth Suite 110 Reception Area 437 -DW -04 Texture Drywall West Partition Wall ND 4,000 A N/A/1 Multi Colored Smooth Suite 110 Sub Wait Area 437 -DW -05 Texture Drywall Room 120-114 East Wall ND 4,000 A N/A/1 21l' L 311'ag,ti 4" Cream Color Cove 437 -CB -06 Base & Associated Suite 110 Reception Area ND 45 C N/A/2 South Wall Mastic 4" Cream Color Cove Suite 110 Reception Area 437 -CB -07 Base & Associated North Wall ND 45 C N/A/2 Mastic 4" Tan Lined Cove Suite 110 Reception Area 437 -CB -08 Base & Associated South Wall ND 25 C N/A/3 Mastic 4" Tan Lined Cove 437 -CB -09 Base & Associated Suite 110 Reception Area ND 25 C N/A/3 Mastic North Wall 437 -CB -10 4" Grey Cove Base & Suite 110 North Hallway ND 30 C N,, A, Associated Mastic East Wall 437 -CB -1 l 4" Grey Cove Base & Suite 1 10 North Hallway ND 30 C N;AA Associated Mastic West Wall 437 -CT -12 2'x2' White Rough Suite l 10 Reception Area 1,300 C N/A/5 Texture CeilingTile CeilingND 437 -CT -13 2'x2' White Rough Suite 110 Reception Area 1,300 C N/A/5 Texture CeilingTile CeilingND 437 -CT -14 2'x4' White Deep Suite l 10 Suite 122 400 C N/A/6 Fissure CeilingTile HallwayND 437 -CT -15 2'x4' White Deep Suite 110 Suite 122 ND 400 C N/A/6 Fissure Ceiling Tile Hallway 437 -CT -16 2'x4' White Medium Suite 110 North Hallway 1,150 C N/A/7 Fissure CeilingTile CeilingND 437 -CT -17 2'x4' White Medium Suite 110 Sub Wait (Room ND 1,150 C N/A/7 Fissure Ceiling Tile 120-114) Ceiling Tan Flower Pattern 437-WPG-18 Wall Paper & Suite 110 Sub Wait Room ND 250 C N/A/8 Associated Mastic Doctor Office East Wall Tan Flower Pattern 437-WPG-19 Wall Paper & Suite 110 Sub Wait Room ND 250 C N/A/8 Associated Mastic Doctor Office West Wall Green Flower Pattern Suite 110 West Bathroom 437-WPG-20 Wall Paper & Hallway East Wall ND 450 C N/A/9 Associated Mastic Green Flower Pattern Suite 110 West Bathroom 437-WPG-21 Wall Paper & Hallway West Wall ND 450 C N/A/9 Associated Mastic 12"x12" Tan Streaked 437 -VCT -22 Vinyl Composite Tile Suite 110 Sub Wait (Room ND 700 C N/A/10 & Associated Mastic 120-114) North Hallway 12"x12" Tan Streaked 437 -VCT -23 Vinyl Composite Tile Suite 110 Sub Wait (Room ND 700 C N/A/10 & Associated Mastic 120-114) North Hallway 12"x12" White 437 -VCT -24 Streaked Vinyl Suite 110 Staff Lounge ND 750 C N/A/11 Composite Tile & Associated Mastic 12"x12" White 437 -VCT -25 Streaked Vinyl Suite l 10 Staff Lounge ND 750 C N/A/11 Composite Tile & Hallway Associated Mastic Multi -Color Carpet 437 -CS -26 Square & Associated Suite l 10 Reception Area ND 3,700 C N/A/12 Mastic 311'ag,ti ND= None Detected HA = Homogeneous Area Type A=Surfacin B=Thermal System Insulation TSI C=Miscellaneous Material Multi -Color Carpet 1. Damaged or significantly damaged TSI ACBM 2. Damaged friable surfacing ACBM 3. 437 -CS -27 Square & Associated Suite 110 Reception Area ND 3,700 C N/A/12 7. Mastic 437 -CTM -28 Grey Ceramic Tile Suite 110 Reception Area ND 300 C N/A/ 13 Grout HallwayEast Bathroom Grey Ceramic TileSuite 110 Reception Area 437 -CTM -29 Grout Open Space West ND 300 C N/A/l3 Bathroom ND= None Detected HA = Homogeneous Area Type A=Surfacin B=Thermal System Insulation TSI C=Miscellaneous Material RECOMMENDATIONS AND SUMMARY None of the tested materials in Suite 110 contain any amounts of asbestos. The materials may be demolished or impacted using conventional methods. Suspect materials are sometimes located behind walls and above ceilings, and were considered inaccessible during the survey. Therefore, all materials that contain asbestos may not have been observed or sampled. If additional suspect asbestos -containing materials are identified during restoration, all activities should stop until these materials are sampled. Work should not resume until the results are reported and removal completed, if required. LIABILITY LIMITATION S&R reserves the right to amend or alter this protocol as conditions change and materials not initially visible are revealed. All quantities are onsite estimates and reflect the amounts observed at the time of sampling. Actual material quantities should be field verified when developing a scope of work. S&R assumes no liability greater than the sum of the invoice for its services. CLOSING COMMENTS S&R appreciates the opportunity to assist with your asbestos sampling needs. If you have any questions regarding this report, please do not hesitate to call us at (303) 297-1645. CONFIDENTIALITY This communication including all contents and attachments are confidential and may be subject to privilege. 4111a.�e Condition 1. Damaged or significantly damaged TSI ACBM 2. Damaged friable surfacing ACBM 3. Significantly damaged friable surfacing ACBM 4. Damaged or significantly damaged friable misc. ACBM 5. ACBM with potential for damage 6. ACBM with potential for significant damage 7. Any remaining friable ACBM or friable suspected ACBM RECOMMENDATIONS AND SUMMARY None of the tested materials in Suite 110 contain any amounts of asbestos. The materials may be demolished or impacted using conventional methods. Suspect materials are sometimes located behind walls and above ceilings, and were considered inaccessible during the survey. Therefore, all materials that contain asbestos may not have been observed or sampled. If additional suspect asbestos -containing materials are identified during restoration, all activities should stop until these materials are sampled. Work should not resume until the results are reported and removal completed, if required. LIABILITY LIMITATION S&R reserves the right to amend or alter this protocol as conditions change and materials not initially visible are revealed. All quantities are onsite estimates and reflect the amounts observed at the time of sampling. Actual material quantities should be field verified when developing a scope of work. S&R assumes no liability greater than the sum of the invoice for its services. CLOSING COMMENTS S&R appreciates the opportunity to assist with your asbestos sampling needs. If you have any questions regarding this report, please do not hesitate to call us at (303) 297-1645. CONFIDENTIALITY This communication including all contents and attachments are confidential and may be subject to privilege. 4111a.�e Sincerely, S&R ENVIRONMENTAL CONSULTING, INC. Les J. Puvathingal Project Manager CDPHE Building Inspector #15037 Attachments: a Site Photos • Laboratory Results & Chain of Custody Digitally signed by Les Puvathingal DN: cn=Les Puvathingal, o=s&R Environmental Consulting, —S&R, ema il—les@srenvironmenta Iconsulting.com, -us Date: 2018.10.19 09:06:07 -06'00' 51Pa L Multi -Color Smooth Texture Drywall 4" Tan Lined Cove Base & Associated Mastic 2'x2' White Rough Texture Ceiling Tile 4" Cream Color Cove Base & Associated Mastic 4" Grey Cove Base & Associated Mastic 2'x4' White Deep Fissure Ceiling Tile 6 1 P a g : 2'x4' White Medium Fissure Ceiling Tile ir 0 Green Flower Pattern Wall Paper & Associated Mastic Tan Flower Pattern Wall Paper & Associated Mastic 12"x 12" Tan Streaked Vinyl Composite Tile & Associated Mastic 7 1 P a re 12"x 12" White Streaked Vinyl Composite Tile & Associated Mastic t Grey Ceramic Tile Grout Multi -Color Carpet Square & Associated Mastic 81'ap 0 0 0 0 0 0 J 71 J J J J 00 00 a dntoa onma ntza onma mdntoa ��xn s x x o x s o x :�W:� x o x ggaln s s o m tzn-< s s o m r m mmz-u mzmb mzm mmz� mmz c A A A A A A W W J J W J W J W J W J Drr� >C: C) O ° rata raca-� tara� O Cl 0 0 0 0 0 0 J 71 J J J J 00 00 a dntoa onma ntza onma mdntoa ��xn s x x o x s o x :�W:� x o x ggaln s s o m tzn-< s s o m r m mmz-u mzmb mzm mmz� mmz c do a r7 va_ o d dd a oo a� Drr� >C: C) O ° rata raca-� tara� o d o o 0 d < m z O � WO, N J-- A W N AW N O w cn O N oo O O N cn In O W to C N Q. 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O A o N NN o J N N N N c J o� D w a D a s ro a W W W W W W W J J J J J J J Z z � z n n n N N Jri w p pp a A 0 J o J c J o J 0 J o J c J o� D w a D a s ro a ro a x D C) n n Po a v a z a D c z Z z � z z z m C) m n zo a m;c m ;o a n nrrlz C� A 0 0 1O 10 -- 1O 10 -- O o r O O O O m cn m cn O O O O 0 0 0 0 no >o 0 0 0 0 o C4 m 7� m m a a a a Ln z z z z z z z z z z z z z z O p u u C7 C7 0 r7 C7 r7 C7 ° ° p z m p m m m d d o 0 0 0 o ° 0 o O O o p p p 0 0 0 0 0 0 0 0 0 0 0 0 0 o o 0 0 0 0 0 0 0 o s o in in o 0 0 0 0 0 0 0 0 0 0 0 0 0 pp 0 o pp P0 0 0 0 0 p Cl 0 0 0 0 Cl Cl 0 0 0 0 0 Cl 0LID 0 -D z z o pr" m �, a r m a r CA ° m m z 0„ z � � < r m ?L)< a ozo 0 z m z � a � r C o N C4 O C CD z C r Y _ y A a � - p D b v o CA S m ;t 3 O p z n m w \ L O Cr Al �� T z n m O m y 'a-1 o Z m c O z -- -- m v a a C� A 0 0 1O 10 -- 1O 10 -- O o r O O O O O O 0 0 O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 o m 7� z z z z z z z z z z z z z z O p u u C7 C7 0 r7 C7 r7 C7 ° ° p z m p m m m d d o 0 0 0 o ° 0 o O O o p p p 0 0 0 0 0 0 0 0 0 0 0 0 0 o o 0 0 0 0 0 0 0 o s o in in o 0 0 0 0 0 0 0 0 0 0 0 0 0 pp 0 o pp P0 0 0 0 0 p Cl 0 0 0 0 Cl Cl 0 0 0 0 0 Cl 0LID 0 -D z z o pr" m �, a r m a r CA ° m m z 0„ z � � < r m ?L)< a ozo 0 z m z � a � r C o N C4 O C CD z C r Y _ y A a � - p D b v o CA S m ;t 3 O p z n m w \ L O Cr Al �� T z n m O m y 'a-1 o Z m c O c-m I LABORATORY, INC. 12421 W. 49th Avenue, Unit #6 Wheat Ridge, CO 80033 DCM Project No.: SREC 896 Client Job No.: 018437 Bulk Sample Analysis Page 1r) of G BULK SAMPLE ANALYSIS PROCEDURES: DCM Science Laboratory, Inc. analyzes bulk asbestos samples following procedures developed by the McCrone Research Institute and in compliance with guidelines established by the Environmental Protection Agency (EPA -600/M4-82-020, 1982 and EPA -600/R-93/116, July, 1993). Bulk samples are prepared for analysis using a 1 OX -80X stereo microscope in a hepa filter hood which provides a contamination -free environment. The sample is then analyzed by polarized light microscopy (PLM) at 100X. When the sample consists of more than one layer, each layer is prepared and analyzed separately. Fiber and matrix materials are identified by the characterization of optical properties including color and pleochroism, form, cleavage, relief, birefringence, extinction, orientation, twinning, interference figure and other distinguishing features. Dispersion staining is also used to further aid in mineral identification. All percentages of asbestos, other fibers and non-fibrous constituents are calculated from the values obtained from analyses using the stereo and PLM microscopes. In-house and NIST standards as well as a chart prepared by R.D. Terry and G.V. Chilinger for "The Journal of Sedimentary Petrology", (Volume 24, pp. 229-234, 1955) provide a guide for estimating percentages. All samples are archived for six months unless other arrangements are made by the client. ACCREDITATION: DCMSL is accredited by NVLAP (since April 1, 1989). Our NVLAP Lab Code is 101258-0. DCMSL complies with NVLAP requirements unless otherwise noted. ENDORSEMENT: The results of this analysis must not be used by the client to claim endorsement by NVLAP or any agency of the U.S. Government. The analysis was performed by: John Silverman, Analyst n Barnes, Analyst aTESTINGnN NVLAP Lab Code 101258-0 Ron Schott, Analyst ja - (& - /$' Date Ron Schott Laboratory Director 4DCM I I.ABOM' OA ' INc. 12421 W. 49`x' Avenue, Unit #6 Wheat Ridge, CO 80033 (303) 463-8270/(800) 852-7340 (303) 463-8267 — fax Date/Time Received l (}- 016 DCMSL Group No. �i DCMSL Log No. Field Data Sheet/Chain of Custody Samples Submitted By: Company:�t\yi RA INmuirl Job/P.O. # (� g - Address: �} Project Title25V1 S� �, Ly`I hP(G rt V, w� Co Contact: Phone: _ Archive: Asbestos samples are archived for 6 months Cell: unless other arrangements are made. All other samples Turnaround Time Requested: [ ] Standard (3 to 5 Business Days) [ ) 2 Hour Rush (Asbestos Only) 24 Hour Rush [ ] Other rocedure Requested: ASBESTOS DUST & SILICA OTHER SERVICES Bulk Standard EPA [ ] Silica - Air NIOSH 7500 [ ] Optical Microscopy [ ] Progressive [ ] Silica - Bulk [ ] X-ray Diffraction - Scan/Search [ ] Point Count [ ] Silica - Bulk Respirable [ ] X-ray Diffraction - Clay./Bulk [ ] Other [ ] Dust - NIOSH 0500/0600 [ ] SEM Air [ ] NIOSH 7400 Other Analysis: ( ] OSHA ID -160 [ ] Other Client Sample No.: Sample Date Air Volume Other Information I Ll 3-4- D W- 01 I P-)7- 7618 Relinquished $ Date/Time 1 R ceiv d By: Date/Time 1 t + !7 Client Sample No.: 1 q3q-C6-11 12 13 14 C --T- 15 1 ) 5- 16 �?j7� (fT- j b 17 1 - l� 18 19� rf� 20 21 22 j - Vc— - E2 23 - 23 24 25 26 27 aC 28 -/3 C 1 Jai- a 29 fQ� 30 31 32 33 34 DCMSL Field Data Sheet/Chain of Custody — page 2 Sample Date Air Volume Other Information 35 Relinqui )y: Date/Time ceived By: Dater'Time -Y