HomeMy WebLinkAbout2150 Bock St - Special Inspections/Field Verification - 10/09/2018Planning, Development & Transportation Services
City, of Community Development & Neighborhood Services
// F6�``''ii ■ 281 Nortcoch College Avenue
n ® � P.OFort Collins,580
r Fort ollns, CO 80522.4580
970.4161740
970.224.6134- fox
fcgov rom
City of Fort Collins
Roofing/Re-Roofing Field Verification Form
(Above Two -Stories)
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Job Site Address Permit Number
A building permit (re -roofing) was obtained for the above address. This building exceeds the City's
ability to access the roof for inspection with a standard two-story ladder.
You are the listed Fort Collins licensed roofing contractor of record for this project. As such, you are
authorized to complete this Roofing/Re-Roofing Field Verification Form in lieu of arranging for the City
inspection. Please return the completed form to Building Services in order for the project to be approved
and the permit closed.
1 hereby certify that the roofing installed at the above listed address complies with the applicable City of
Fort Collins Residential or Commercial building codes as amended and adopted. I further certify that the
roofing materials used on this project were installed per the manufacturer's instructions in high -wind
areas."
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Roofing Company Name Certi cate Holder Name (Print) License 4
1o.g. I 1
Date ertificate Holder Name (Sign)
If the work was performed on the aforementioned permit using a City of Fort Collins Registered Exempt
Worker crew, please acknowledge below:
Exempt Company Name
Date
Registered Exempt Worker (Print) Registration #