HomeMy WebLinkAboutB12-0152 . �
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11-14-2012 Inspection Request Re orting Page 8
4 28�m VaiL,S�Q—�itv
Requested Site Addr�ess: 1422 MOyRAINE DR VAIL 2012
AIPID Information
Activity: 612-0152 Type: COMBO Sub TUse: RS3 R Insp Area: ISSUED
Const Type: Occupancy:
Owner: GRIER, JOHN
Contractor: KNEPPER CONSTRUCTION Phone: 303-840-9118
Description: remodel 7 bathrooms and hot tub and sitting deck at rear of property.
Requested Inspection(s)
Item: 9 DG-Final Requested Time: 01:00 PM
Requestor: EPPER CONSTRUCTIO Phone: 303-840-9118
Commen . 720-635-7298 Entered By: JMONDRAGON K
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Assigne o: Time Ex
tion: p�
It m: 534 PLAN -FINAL C/O Requested Time: 08:00 AM
Requ tor: KNEPPER CONSTRUCTIO Phone: 303-840-9118
Com nts: 720-635-7298 Entered By: JMONDRAGON K
Assign To: BGIBSON Time Ex
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Inspection Historv
Item: 10 BLDG-FOOTING "`Approved '�
09/20/12 Inspector: mdenney Action: AP APPROVED
Comment: for spa.
Item: 20 BLDG-Foundation/Steel �� roved�'
Item: 120 ELEC-Rough App
06/05/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 200 MECH-Rough '"Approved"
06/06/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 220 PLMB-Rough/D.W.V. "�Approved""
05/29/1Z Inspector: sgremmer Action: PI PARTIAL INSPECTION
Comment: upper bathrooms
06/04/12 Inspector: sgremmer Action: AP APPROVED
Comment: ** roved�"
Item: 230 PLMB-Rough/Water App
06/04/1Z Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 30 BLDG-Framing �"Approved""
06/06/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 60 BLDG-Sheetrock Nail '�Approved**
06/11/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 190 ELEC-Final '"Approved"*
11/02/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 390 MECH-Final
Item: 290 PLMB-Final **Approved"`
11/01/12 Inspector: jrm Action: AP APPROVED
Comment:
REPT131 Run Id: 14621
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10-30-2012 Inspection Request Reporting Page 16
4 25�m VailYCO Citv Of
Requested Inspect Date: Wednesday October 31, 2012
Site Address: 1422 MORAINE DR VAIL
A/P/D Information
Activity: 612-0152 Type: COMBO Sub TUse: R 3FR Insp Area: ISSUED
Const Type: Occupancy:
Owner: GRIER,JOHN
Contractor: KNEPPER CONSTRUCTION Phone: 303-840-9118
Description: remodel 7 bathro and hot t and sitting deck at rear of property.
Re uested Ins ec ' n s �
It : 29 PLMB-Final Requested Time: 08:00 AM
Requ tor: EPPER CONSTRUCT N Phone: 303-840-9118
Com ents: 03-912-4866 Entered B JMONDRAGON K
Assig d To: JMONDRAGON Y�
Action: Ti,�e��
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Inspection History
Item: 10 BLDG-FOOTING "Approved"`
09/20/12 Inspector: mdenney Action: AP APPROVED
Comment: for spa.
Item: 20 BLDG-Foundation/Steel
Item: 120 ELEC-Rough ""Approved"'
06/05/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 200 MECH-Rough *"Approved*"
06/06/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 220 PLMB-Rough/D.W.V. **Approved "
05/29/1Z Inspector: sgremmer Action: PI PARTIAL INSPECTION
Comment: upper bathrooms
06/04/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 230 PLMB-Rough/Water "''Approved""
06/04/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 30 BLDG-Framing `'`Approved""
06/06/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 60 BLDG-Sheetrock Nail `*Approved**
06/11/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 190 ELEC-Final
Item: 390 MECH-Final
Item: 290 PLMB-Final
Item: 21 PLAN-ILC Foundation Plan
Item: 534 PLAN-FINAL C/O
Item: 90 BLDG-Final
REPT131 Run Id: 14616
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NOTE: TH/S PERM/T MUST BE POSTED ON JOBSITE AT ALL TIMES
,.
TOWN OF YA1I, '
Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657
p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149
COMBINATION BLDG PERMIT Permit #: B12-0152
Project #: PRJ12-0209
Job Address: 1422 MORAINE DR VAIL Applied.....: 05/04/2012
Location......: Issued. . . : 05/22/2012
Parcel No....: 210312209011 �
OWNER GRIER, JOHN 05/04/2012
300 HIGH STREET
DENVER
CO 80218
APPLICANT KNEPPER CONSTRUCTION 05/04/2012 Phone: 303-840-9118
7210 E. HOMESTEAD RD
PARKER
CO 80138
License: C000003497
CONTRACTOR KNEPPER CONSTRUCTION 05/04/2012 Phone: 303-840-9118
7210 E. HOMESTEAD RD
PARKER
CO 80138
License: C000003497
Description:
remodel 7 bathrooms
Occupancy: R-3 Type Construction: VB Valuation: $46,000.00
,....,...,>...........................,...,.,,,..,,.............,........,..,...,. FEE SUMMARY ,,...,...................,,,.,,..,,,,...,...,,.....>,..,,_.,.,.,...............,
Building Permit-----------> $603.35 Bldg Plan Check----------> $392.18 Use Tax Fee-----------------------> $720.00
Electrical Permit---------> $0.00 Elec Plan Check-----------> $0.00 Restuarant Plan Review--------> $0.00
Mechanical Permit------> $60.00 Mech Plan Check---------> $15.00 Additional Fees--------------------> $0.00
Plumbing Permit--------> $120.00 Plmb Plan Check---------> $30.00 Recreation Fee--------------------> $0.00
Investigation-----------------------> $0.00
Will Call------------------------------> $15.00
TOTAL PERMIT FEES--------------> $1,955.53
Payments-------------------------------> $1,955.53
BALANCE DUE------------------------> $0.00
.....................................................,,.......�.........,....,.,,..,...,..,.,,...............,,...,,,.,.,...�,.,,..,�..x.,.,,,......»......,...,..,....,.,,................
IDECLARATIONS
I agree to comply with the information and plot plan, to comply with all Town ordinances and state laws, and to build this structure
according to the town's zoning and subdivision codes, design review approved, International Building and Residential Codes and
other ordinances of the Town applicable thereto.
REQUESTS FOR INSPECTION SHALL BE MADE TWENTY-FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149
OR AT OUR OFFICE FROM 8:00 AM -4:00 PM.
combination permit_012811
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.....+...+...�......................+.............:......:........:....�.......:::.............:.......�....+++..:................�.................:.............,............+..... I
CONDITIONS OF APPROVAL TO BE MET PRIOR TO FINAL SIGN OFF I
Permit#: 612-0152 Address: 1422 MORAINE DR VAIL
Owner: GRIER, JOHN Location:
.....................................................................................................................................................................................
Cond: 42
(BLDG 2009) CARBON MONOXIDE DETECTORS REQUIRED TO BE
INSTALLED PER 2009 IRC R315
Cond: CON0012589
Framing inspection to include finals for permits 611-0486
and M95-0051
combination permit_012811
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TOwN OF VAI� `
�********.*...*..,.*.���.******.*****************.**************.*************..****..�*�***�*.****„***********.,**�*,�.�*******.****„*.*.***,.**,.�.��
REQUIRED INSPECTIONS AND STATUSES
Permit#: B12-0152 Address: 1422 MORAINE DR VAIL
Owner: GRIER, JOHN Location:
*********.*,.�****...**********.***.,*�„**«**„*,.*.«*.,****„*««««****«*.,,,,,*.,,,.,.*..*«***.********,,,.*****.,**«****„««..,***..*,....**�..*.#*.**.,�*,.«*«**««*,.*«*.,
Item: 00120 ELEC-Rough
Item: 00200 MECH-Rough
Item: 00220 PLMB-Rough/D.W.V.
Item: 00230 PLMB-Rough/Water
Item: 00030 BLDG-Framing
Item: 00060 BLDG-Sheetrock Nail
Item: 00190 ELEC-Final
Item: 00390 MECH-Final
Item: 00290 PLMB-Final
Item: 00090 BLDG-Final
combination permit_012811
*****�**�****�***�****�************�******����**********�*****�*s*****�************s*+*****�
TOWN OF VAIL, COLORADO Statement
*��******��************s************�**����***********��******�******�**********�****�**r**�
Statement Number: R120000415 Amount: $359.35 05/04/201201:59 PM
Payment Method:Credit Crd Init: LC
Notation: CREDIT CARD
FROM ROBERT KNEPPER
-----------------------------------------------------------------------------
Permit No: B12-0152 Type: COMBINATION BLDG PERMIT
Parcel No: 2103-122-0901-1
Site Address: 1422 MORAINE DR VAIL
Location:
Total Fees: $1, 772.20
This Payment: $359.35 Total ALL Pmts: $359.35
Balance: $1, 412.85
**�***�******************************�*********�*******��******�***�***�*******************s
ACCOUNT ITEM LIST:
Account Code Description Current Pmts
I -------------------- ------------------------------ ------------
PF 00100003112300 PLAN CHECK FEES 359.35
-----------------------------------------------------------------------------
.
Department of Community Development
' 75 South Frontage Road
�OWN OF l/AIL�� vai�, co s�ss�
Tel: 970-479-2128
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm &sprinkler)
- ----._ _..__.___ ----- --__..__ ------ _.___... _______. -- n
�Project Street Address: Project#: 1`�`2 'V (XJ
�¢�� tMo�ine Dr��re
Number DRB#:
( ) (Street) (Suite#)
Building Permit#: h(��� ��Z
Building/Complex Name:
�Contractor Information 'Lot#: Block# Subdivision:
1 Business Name:�jA,epn�r Cer►.S'T�uc.}�oh l,p� - --
I Business Address: Z2�� �. *ro�'►lt�eacF Ipl� • Work Classl New( ) Addition( ) Alteration(�() �
i
i .�.�
;City �a�k�r State: � • Zip: $O l'J9 Type of Building:
Single-Family(�) Duplex( ) Multi-Family( ) ,
Contact Name: �ob ��e nn e v� Commercial( ) Other( )
Contact Phone: 383- 90 8 ��4 2q-- -- _..._...-_------ -.-
----------------------------------_------I
1 �
� � �q��� . �� WorkType: Interior(x) Exterior( ) Both( )
�Contact E-Mail:���„ty.s�S.�,�f�eh
� �—
� -----._.._..---_--- --- -------
� I hereby acknowledge that I have read this application,filled out Valuation of
in full the information required,completed an accurate plot plan, Work Included Plans Included Work
and state that all the information as required is correct. I agree to Electrical ( )Yes ( )No ( )Yes ( )No
� comply with the information and plot plan,to comply with all Town
� ordinances and state laws, and to build this structure according to Mechanical (x)Yes ONo OYes ONo 30��
! the town's zoning and subdivision codes, design review ap- `
proved,Intemational Building and Residential Codes and other Plumbing (�()Yes ( )No ( )Yes ( )No 8,da°��0
ordinances of the Town applicable thereto. �o o��
Building (�Yes ( )No ( )Yes ( )No ,
X � 1K�T�UJ. CLu � Value of all work being performed: $ �/}oOO,eU
�Owner/Owner's Represe tive Signature(Required) (value based on IBC Section 109.3 8 IRC Section 108.3�
Electrical Square Footage
Applicant Information
Detailed Scope and Location of Work:
ApplicantName: herHadrl 7 �af( /�6.y� S
Applicant Phone:
Applicant E-Mail:
I
�Project Information �bf n �r i e r
Owner Name: �� �''
Parcel#: a l 0 3 - !2,2 - a 9 v 1 -' � j
(For Parcel#,contact Eagle County Assessors Office at(970-328-8640 or visit �'.
www.eaglecounty.us/patie) �
�
---------------- �--- -- --� (use additional sheet if necessary)
_ _ _ _. _ _ _ _ _ _ _ _
For Office Use Only: � (� � � �/ �
Fee Paid: �359.�5 Date Received: D v
Received From: MpY o 3 �012
Cash Check#
CC: isa MC Last 4 CC# 5'�D'1 exp date: � 2;ISQrr� �
a�m #3°oo3S� i�oa�T w, Ka e�E� TOWN OF VAIL
M x i mu,m
15-I�ar-2012
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Date: 05-14-12 Asbestos Sampling Report Page: 1/ 1
To: Bob Knepper Regarding: 1422 Moraine Rd. Vail, Colorado
Mr. Knepper,
Per your request, on 5-09-12, ECOS Environmental & Disaster Restoration Inc. conducted a
limited asbestos inspection of VISIBLE suspect asbestos containing materials which may be
impacted during the proposed remodel of the residence we inspected. If other suspect
materials become visible/apparent during demolition or construction activities, work in that
area should be halted and more sampling/testing must take place, per Colorado regulations.
A limited bulk sampling of suspect ACM from drywall on the ceiling and walls was conducted in
accordance with Colorado State Requirements. Said requirements state: For each homogenous
area of less than 1000 SF, a minimum of three samples must be collected randomly. For each
homogenous area of 1000-5000 SF, a minimum of five samples must be collected. For areas
larger than 5001 SF a minimum of seven samples must be collected, respectively. A
homogeneous area is defined as one which shares suspect material, texture, color, location,
and/or apparent time of construction.
Josh Johnson, a Colorado Department of Public Health & Environment certified building
inspector, certification number: 18401, performed the inspection. Samples taken were sent to
the lab Reservoirs Environmental, in Denver, for PLM (Polarized Light Microscopy) analysis.
Attached are the lab's documents with analyses and findings.
DESCRIPTION OF SAMPLING AREA
Downstairs Master Bathroom and 5 Upstairs Master Bathrooms.
SUSPECT MATERIALS SAMPLED
Drywall,Joint Compound,Tile Adhesive
CONCLUSIONS
No asbestos was detected.
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_-_---, �
'r �-��e= Inspection Request Reporting Page 8
= �� �^? Vail, CO - Citv Of
Requested Inspect Date: Thursday, November 15, 2012
Site Address: 1422 MORAINE DR VAIL
,=tP;`� fr�i��rra�on
_ . :' ^'�_ �ce: C�P�tSJ Sub Ty pe: ASFR Status: ISSUED
.. � —.r�. �`�..c a^cy: Use: R-3 InspArea:
„,•r�.,�. ,:%� R :�.�,�P�
" �,:-a_��: �C`'_='==� �C�h��;;�:iC�iC� Phone: 303-840-9118
�esc�iptic.^.: �ema�el�bathroams and hot#ub and sitting deck at rear of property.
Requested ins�ection(s)
item: 9d BLDG-Final Requested Time: 01:00 PM
Requestar: KNEPPER CONSTRUCTION Phone: 303-840-9118
C o m m e nts: 720-635-7298
Assigned To: **'*�"*"*"""` Entered By: JMONDRAGON K
Action: Time Exp:
Item: 534 PLAN -FINAL C/O Requested Time: 08:00 AM
Requestor: KNEPPER CONSTRUCTION Phone: 303-840-9118
C o m m e n ts: 720-635-7298
Assigned To: BGIBSON Entered By: JMONDRAGON K
Action: Time Exp:
��� /�G r�/�s��.-
;�
Insqection Historv
�� Item: 10 BLDG-FOOTING "`Approved"`'
09/20/12 Inspector: mdenney Action: AP APPROVED
' Comment: for sp a.
`° Item: 20 BLDG-Foundation/Steel
� Item: 120 ELEC-Rough �*Approved*"
06/05/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 200 MECH-Roug h **Approved""
06/06/12- Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 220 PLMB-Rough/D.W.V. *"Approved`*
05/29/1Z Inspector: sgremmer Action: PI PARTIAL INSPECTION
Comment: upper bathrooms
06/04/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 230 PLMB-Rough/Water ''*Approved`''
06/04/1Z Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 30 BLDG-Framing '"Approved"`
06/06/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 60 BLDG-Sheetrock Nail "*Approved""
06/11/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 190 ELEC-Final *"Approved"`
11/02/12 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 390 MECH-Final
`' Item: 290 PLMB-Final ""Approved*'`
11/01/12 Inspector: jrm Action: AP APPROVED
Comment:
REPT131 Run Id: 14621
NOTE: TH/S PERM/T MUST BE POSTED ON JOBSITE AT ALL TIMES
,.
ro�r���r�, .
Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657
p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149
COMBINATION BLDG PERMIT Permit #: B12-0152
Project #: PRJ12-0209
Job Address: 1422 MORAINE DR VAIL Applied.....: 05/04/2012
Location......: Issued. . . : 09/17/2012
Parcel No....: 210312209011
OWNER GRIER, JOHN 05/04/2012
300 HIGH STREET
DENVER
CO 80218
APPLICANT KNEPPER CONSTRUCTION 05/04/2012 Phone: 303-840-9118
7210 E. HOMESTEAD RD
PARKER
CO 80138
License: C000003497
CONTRACTOR KNEPPER CONSTRUCTION 05/04/2012 Phone: 303-840-9118
7210 E. HOMESTEAD RD
PARKER
CO 80138
License: C000003497
Description:
remodel 7 bathrooms and hot tub and sitting deck at rear of
property.
Occupancy: R-3 Type Construction: VB Valuation: $55,900.00
....,,...»«««.................................�,....,,.,.........«..,..,..,,..... FEE SUMMARY ......,.,.................,.........,.,.,....,,..,,.......,....................,,.,,
Building Permit-----------> $748.75 Bldg Plan Check----------> $486.69 Use Tax Fee----------------------> $918.00
Electrical Permit---------> $0.00 Elec Plan Check-----------> $0.00 Restuarant Plan Review-------> $0.00
Mechanical Permit------> $60.00 Mech Plan Check---------> $15.00 Additional Fees--------------------> $0.00
Plumbing Permit--------> $135.00 Plmb Plan Check---------> $33.75 Recreation Fee--------------------> $0.00
Investigation-----------------------> $0.00
Will Call------------------------------> $15.00
TOTAL PERMIT FEES--------------> $2,632.19
Payments------------------------------> $2,632.19
BALANCE DUE------------------------> $0.00
.......................................>.......,,,,..,.......,,,,,...........,.».....,,......................,.,,....«..........,,.,..........................,............,...,,.........,,....�
DECLARATIONS
I agree to comply with the information and plot pian, to comply with all Town ordinances and state laws, and to build this structure
according to the town's zoning and subdivision codes, design review approved, International Building and Residential Codes and
other ordinances of the Town applicable thereto.
REQUESTS FOR INSPECTION SHALL BE MADE TWENTY-FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149
OR AT OUR OFFICE FROM 8:00 AM -4:00 PM.
combination permit_012811
r
t
1 V��V���i t
*�f�f#/I�I�*444**#trf V f'RiRf1rR#V rtY'fiRf"Frttrt�RY`4'k+t#*'k*1`/#f*4R*t`4�f'f`frRfrR�R}rf'ffr**fiititfA'tkYrfrfYr4*fA'�FV VY4fiYrfr'kYtty'YtYrk�'Y�M4*#fR1rlRfdRRiht}f'ffrfR4f'fffrRfrf'11'f'f'f�illrYrRV�RfrARA'1rfi*YrffAA'frYfrRRRlrrtPrffffRfrf'il4rRRlRfR�R1r4
CONDITIONS OF APPROVAL TO BE MET PRIOR TO FINAL SIGN OFF
Permit#: B12-0152 Address: 1422 MORAINE DR VAIL
Owner: GRIER, JOHN Location:
.��..............................................................................<,.,....,.........,.........,......................,.......».....,.,,................................
Cond: 42
(BLDG 2009) CARBON MONOXIDE DETECTORS REQUIRED TO BE
INSTALLED PER 2009 IRC R315
Cond: CON0012589
Framing inspection to include finals for permits B11-0486
and M95-0051
combination permit_012811
�
�
�O�WNOF YAIL '
,*..***„****.,*,,..*,*.,.******************....*,.,....,....*.**.*.**..*...****.**********�.,*.*********.****************.,.*****************.,,,..****
REQUIRED INSPECTIONS AND STATUSES
Permit#: B12-0152 Address: 1422 MORAINE DR VAIL
Owner: GRIER, JOHN Location:
,*****..,,,,,,.,*«.,*.,,,.******«««**„«««,,,,*,****«„******«*««*****,.*********..*******«******.********«..*******.***.***.*.***..******.,,,****«.,,,*********.******
Item: 00010 BLDG-FOOTING
Item: 00020 BLDG-Foundation/Steel
Item: 00120 ELEC-Rough
06/05/2012 By: sgremmer Action: AP
Item: 00200 MECH-Rough
06/06/2012 By: sgremmer Action: AP
Item: 00220 PLMB-Rough/D.W.V.
05/29/2012 By: sgremmer Action: PI Comments:
upper bathrooms
06/04/2012 By: sgremmer Action: AP
Item: 00230 PLMB-Rough/Water
06/04/2012 By: sgremmer Action: AP
Item: 00030 BLDG-Framing
06/06/2012 By: sgremmer Action: AP
Item: 00060 BLDG-Sheetrock Nail �
06/11/2012 By: sgremmer Action: AP
Item: 00190 ELEC-Final
Item: 00390 MECH-Final
Item: 00290 PLMB-Final
Item: 00021 PLAN-ILC Foundation Plan
Item: 00534 PLAN - FINAL C/O
Item: 00090 BLDG-Final
combination permit_012811
******+*****************+***+**+**+***
****************************+******+**
+***************
TOWN OF VAIL, COLORADO
Statement
********+*****************************
+******�**********�*******************
********�*******
Statement Number:R120001363
Amount: $676. 6609/17/201203:56
PM
Payment Method:
Credit CrdInit: LC
Notation: credit card
from Mark T Knepper, MTK
Construction
------------------------------
------------------------------
-----------------
Permit No:B12-0152
Type:
COMBINATION BLDG PERMIT
Parcel No:2103-122-0901-1
Site Address:
1422 MORAINE DR VAIL
Location:
Total Fees:
$2, 632. 19
This Payment: $676. 66Total
ALL Pmts: $2, 632. 19
Balance:
$0.00
+************************+*+**********
*******+**+**********************+****
****************
ACCOUNT ITEM LIST:
Account Code
Description
Current Pmts
-------------------- ----
--------------------------
BP 00100003111100
BUILDING PERMIT FEES
145.40
PF 00100003112300 PLAN
CHECK FEES
318.26
PP 00100003111100
PLUMBING PERMIT FEES
15.00
UT 11000003106000 USE
TAX 4%
198.00
------------------------------
------------------------------
-----------------
����� Department af Commu�ity Develapment
�
. � j� � � � � 75 Sau�h �rantage Road
���'�' �� ���� � D V Vait, CO 8-1657
'Tet: 970-479-2128
�U� l 3 2012 www.vaifgov.com ,
,
Development Re�riew Coordinator
ORM �
Revision Submittals: �'
1. "Fieid SeY'of approved plans MUST accompany revisions. •
2. No fu�ther inspections will be performed untii the revisions are approved&the permit is re-issued.
3. Fees for reviewing revisions are$55.00 per hour(2 hour minimum), and are due upon issuaR ce.
Permit#(s)information applies to: Attention: ( )Revisions
� � '1 ` ��� �� ( )Response to Correction Letter
��� attached copy of correction letter
( )Deferred Submittal
. ( )Other
Project Street Address: �
1�2 Z. Y71o1x,v�m�.. �'n.w<.*
(iVumber) (Street} • {Suite#)
Building/Complex Name: Description/List of Changes:
I Contracfar lnformation
Ia!t�.�' �,� ��. ��.�,� d�..l�, r�.�' ' �A�
IBusiness Name: �,,c�i13<.+, f{+�:���E.�.��r: �• � '�'"`�`�
�Business Address: 7Z(� �. r���y�;,�U���f'•�;;,�• �
City ��,.�a State:�_Zip: �J`F�` �
Contact Name: ,� �s.:�, � � �
k (
Contact Phone: �'��'#�� "�,y��-� (use additionai sheet if necessary)
Contact E-Mail: � ,�,.��,�t (� c,n,Q;� �,�.
� Revised ADDiTiONAL Valuations(Labor�Materials)
(DO NOT include originai valuation)
I hereby acknowledge that I have read this application,fifled out
in full the information required,completed an accurate plot plan, Buiiding: $ !,.�����,
and stafe that all the information as required is correct. I agree to
comply with the infoRnation and plot plan,to comply with all Town Plumbing: $ So 0
ordinances and state laws, and to build this structure according
to the town's zoning and subdivision codes, design review ap- Electrical: $ �p p
proved,fntemationa!Building and Residential Codes and other
ordinances of the Town appiicable thereto. Mechanical: $
� ,,�.,%�-(�1 • �, �=
Owner/ wner's Repre entative Signature(Required) Total: $ -�y R DO•
Applicant Information _
Applicant Name: I Date Received:
Appiicant Phone:
IApplicant E-Mail:
For Office Use Only:
Fee Paid: "
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp,date:
Auth#