HomeMy WebLinkAbout4084.5 Wadsworth BoulevardFrom: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Electrical Service Change/Upgrade/Electrical Work
Date: Friday, January 28, 2022 9:40:44 AM
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PERMIT APPLICATION Electrical Service
Change/Upgrade/Electrical Work
This application is exclusively for RESIDENTIAL ELECTRICAL SERVICE
CHANGE OR UPGRADE (200 amps or less).
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 Yes
electrical service
change or upgrade -
200 amps or less?
PROPERTY INFORMATION
Is this Residential or Commercial
Commercial?
Property Address 4084.5 Wadsworth Blvd.
Property Owner Name Scott Kallase/ Concrete Works of Colorado Inc.
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
303-419-5428
CONTRACTOR INFORMATION
Contractor Business Sturgeon Electric
Name
Contractor's License 018567
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone 303-591-5317
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email JApplegate@myrgroup.com
Address
Retype Contractor JApplegate@myrgroup.com
Email Address
Is this an electrical
Change
service upgrade or
change?
Number of Amps
100
Location of work
S.E corner of Wadsworth Blvd. and 41St. Ave.
(garage, house, etc)
Provide additional
120/240V 100A Metered Service for CDOT Traffic Signal.
details, If needed.
Metered service is number 5 of 5 on City of Wheat Ridge
Wadsworth Widening Project
Project Value (contract
3000.00
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 Rick Aspden
Pe rm it
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City of
��Wh6atp'Nide
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City of Wheat Ridge Municipal Building 7500 W. 29th Ave. Wheat Ridge, CO 80033-8001 P:303.235.2846 F:303.235.2857
January 4, 2022
OFFICIAL ADDRESS NOTIFICATION
NOTIFICATION is hereby given that the following address has been assigned to the property/properties as
indicated below:
NEW ADDRESS: 4084.5 Wadsworth Boulevard
AUTHORIZED BY:
DISTRIBUTION:
1. Property Owner
2. Applicant
3. Xcel Energy, gary.d.motsiner ,xcelenergy.com
4. Wheat Ridge Building Division
5. Log File
NOTE: Please notify all other parties concerned.
ADDRESS MAP UPDATED BY:
www.ci.wheatridge.co.us
DATE: , 13 /202Z
DATE:
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