HomeMy WebLinkAbout306 E Magnolia St - Special Inspections/Field Verification - 11/04/2019Fort Collins
Planning, Development & Transportation Services
Community Development & Neighborhood Servkcs
281 North College Avenue
P.O. Box 580
Fort Collins, CO 80522.0590
970.4161740
97a224.6134- fax
fegoveom
City of Fort Collins
�toofrng/Re-Roofing Field Verification Form
/ (Above Two -Stories) pan A��
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 RoofnnglRe-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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RooflnjCompakiye Certificate Holder Name (Print) License #
Date Certificate 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:
N1o114�� J r. } J J ffl a(1-Vs E�2c �,,
Exempt Company Narhe Registered Exempt Worker (Print) ReWstration #
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