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Home My WebLink About1352 Leahy Dr - Correspondence/Plans Approval - 04/15/2019Cornmunily 281 N. College Development /1.vc. roil Collins, & co No.80522; ighhorlluocl Voice: FAX: 970-970-Set 221-22'1-vices 61:6760 Yl Note: City slafl CONS'l'HUC'flON is able lo assisl if you hc:WASTli 1vP. questions IVI/\N/uboul \ ,. ;:imple111e11ti119 Ml:N'I' PL/\a N com,n11cl lruclion DOCUMJ:site recydin�J N'l'/\.l'ION prog1c�n1. plcc1sc c,111 Jo11alho11 Nagel al (970) 416-2701 Pl �OJf�C'i' INFORM1\'1'ION Atldress(Pon nit �f.(es) s) __5_See ee a.a11Qck\:thc lid eJ :\ hfJt k'St _______________ __ ____ _ General Contractor & Contact Info: _j re,/ (�....L..\< ....... < ...�-. --!::f l() , :/7 9 · 7�"--'-�=�--- __ _ lrn,subrniltc:trnctlons: 11, do 1101 Submit include lho tho conslruclion total volume/waste weights, management hnuler signatures plan at the or documentation. be�Jinning and end /\t project of each completion project. /\I resubmit first this plan, during with tho /\p1ojoct, LL fields i11dicato completed, as such. alonu wilh tho required documentation. If one or more materials wore 1101 generated you 1Jocurne11tc1tlo11: lrnulecl the materials Provide yourself, documentalion attach tickets from from the hauling all facililies company recycling listing the the materials. project address and services provided. If Material Concrete/(Required) Masonry Wood/(1-<<�quired) Lumber Vendor 111aterlal haulit1fJ tho Indicate if self-hauled Metal!:l -------+--...::.:..�-=--..=.::::-'-- C, 11 ((I Ill c.�nciu11ed) llJorn qu1r,d ,d) r f I 1 1(( , ,' 1 "l i'c\111 1 £1(11 Facility n i;recycll11g =1forlal the } ,,rl fo//1, C,, 1.H }, r r \ ( \\l I I !r' //n•,�r,1 111 ' MI /,£ - �(!,/e. __ (' ,,J rJ ,I , nr r,'n i,1 I I , " I 111/(iJI : �,., 1 ,·� Total volume of material or weight Jl!:!clicate unil$) Nl=---=B =l \ 10 cuD\1C yds. Traslt 11--j-, I a, , ",1 er-r1.. -=-),71-, --1 1//o,,>, ./311//d, I\J//\ con1rn1 ,-inatecl --lo:- :id8 -..::..-!cm-=--,..S-cc-""'""V�'°t-..a;4..,5e___ I ---=--=----- (Intended recyclables, sent N//\ I to lo11drill. Indicate material) I clav 1111clo1cta11d of the violation that my a11d failuro up to to clx follow montln.: l11is in plan jail. 01 I certify 1esuhr11it that this the above plan could 111atoiials Include front penaltlos my construction of over site $2,wero 500 1>cr recycled in the volumo / w ifJht ,1,9scrihed and '.'.'"re taken to the facilities described. Print } \ Name l I ( & � (Signature ) ( ) - @; Contractor )J 1 or � i Owner {i!_ _ -• Lj Dae l f;). l \9 (If rint mullipfe, Name indicate & Signature vendor - and Haul i 1clude s) si�111ature from each) �9 1-f l>/1 l{C\' 6-1-2017 T. \' tri Fc)rt c:ollins Cornrnunlty D<�velopment & Neighborhood Services 281 N. College Ave. Fort Collins, CO 80522; Voice: FAX: 970·224-970·221·6760 6134 Noto: Cily stµff CONS'fRUCTION is ahlu lo usslsl if you haw:i WASTE questions MANAGEMENT <)boul implcmenlin�J PLAN a crnrnlruction and DOCUMEN'fATION silr. ,eq,din�J pro�11c-nn. plcm;o call Jonnlhon Nnuel al (\r/0) ,11r;.2701 PROJECT INFORMATION /\cl<lross(os) __ (��I,(_: /}/ /1Jcl1(A _J, ,':,_·/j _____ .. _______________________ Ponnlt 1/(s) ----·---·------II ·-·---·------- _________________ ---------------------· General Contraclor & Contnct Info: J:.u! d_ {}.cx1 Ke�_ <fJj) · ,]L2. · 7k5'C:, -------·--- submillal, lnstructlonB: do !]QSubmll \ Include tho 1110 co11structio11 Iola! volunrn/waste wolnhts, managonrnnl hauler signatures plan nt tho or clocumenlatlon. lrnginnlng and encl /It project of om:h completion projccl. /11 resubmit firs! this plan, durino with tho /\projocl, LL fields lndicale completed, as such. along with lhe required documentation. If one or moro materials woro not nonoraled you Documentation: hauled tho maloilals l'rovlclo yourself, clocumontalion attach tickets from from Iha hauling all facllltios company recycling llsilng tho tho nmlorials project . aclclross ancl servicc,s provided. If .---------�------ ---·- ·--- " ------- --="===,·=====-= Matorlal Vontlor hauling tho r !Ill II ti Totnl voh1mo or woluhl material ·ac Y rocyc nu 10 of material jlndicalo _If self-lmulecl) - _____nrntorlal _ �- ..... >---=�Ji!!<Rcnt��l!!�� Concroto/Maso111 y I,,' I f" 11 i' ,., ', · (Hequi<ed) /,\) f I.', 1·tr NO I (�( t\' /,t ,, . I o,,(' cwliu, ·� 1----�-------1----tlCilli./_dL1:,L\--- -- . --f=·=--..,,.,===·-=== w��:.':1�,��;);n' -·--- __ l/.)::r,,.�;.�,::�1'' � �1::�·��·;: 11_ !, i' / /. - ... 150 y f} (l (} 5' Metals (ltc-.·qt111(;1i) c;mdl>(f �c'!_!omd lfiF'd) :(·11:-,1'.<\,1/(1 !,'i)fflt ,. (1,r1/.,1u�lo J.,01, : ; f}(' /,, / /1.:r1,;_1r:1 '·r:)_1/- l,,,.,1/111 ·V 1{,· u11·k. ---.. ·�- ----·" ·--·-- I ·--- --- "-"'"'"'-· Trm;h //11011 .(�uflrk r, -Contmninnlod (�-lntonclccl �-rncycioblos, loads --- --sent -·-··· __ ,,,�,t;JCJ�t, ·'=·=--=· ·-+··--.. --............ Ni/\ NII\ ,.--,---·-·-·I--b = .. :·=5 -b ···--fo/V·=·--.. "=S -"" I �to!.!'!�"!m:;�li!!l;lil� .••. � ln�d}.:cia�t�o�;:. .. �'.:!!:�"\.J.-... -........ ,-........... - 1. .._ ................. ....................... . - ·---·· ···--· �--" ��---�--.. , "- lliJ.YI untlorstand _CJf the violation that my a111l lalluro up lo to six follow montlrn lhls h• Jlli!!L!all, or I rnsuhmlt cmtify Ilia! thls lhu __ abovo nlan could rnalorials lncludo from po11aitios my conshudion of ovnr�iOOJ!!.lsilo wero r r� ct olc, _ l In th _: vo _ lu - mo _ _ , WK�J5t�'-i amlwer _ · _ Crn 11111u11ily 1.fil N. C:ollt:IJevdnpme1 !Jl! /IV<!. 1"01i Collins, it l� CO Nd�Jl1lmrl1nrn BO�iV; Voice: 970-I S0.2?.1 l·G?vic:c)GO !; F/\X: 970·7.2'1·61:M c.Nole: 111 Jonnt11011 City st?.ff Naw·I GONS'ITHJ 1s ahlc ;:l lo (9/m;0) �i:C"11 ;t IG t"ii IUN rou ?70 lmvo I WMrl°I: qucst1om, l 1ROJl�G·1· IVI/\N/\almul (:il�Ml�N-INHH�M/\i111plt111c11li111i r Pl "flON /\,N 1 cn11!illlrl ;liur.I lUC..tion :silo UIVll:ir.q,N·rn·noN dillH pron1c:rn. plcns!' /\dtfrcss(cs) __ ------------------- -- - -- Pc11nilil(s)_ __ ____ _ _ ____ �------- Gcnornl Contractor & Contucl Info: _h_e ,) ( 1 ( X> \:' e _ < l 1/ IL] L!i · Z?_5'%, l11strnctlo11!'sulm1illul, do 110 .: Sul>i11cluclo mit the the conslruclion total volume/waste weights, nrn11ageme11t hauler signatures pl<111 <11 lho or documentation. 1>cni11ni11!) and end /\I projocl of each co111plction project. /\I rcsubmi\ firsl this ch11ing pion, wilh the /\project, LL Holds i11dicc1le co111pleted, as such. alon!J with the wquircd documcn talio11. If one or 1110,c malcriuls wore 110111c11eralccl you I Juc11111011tullu11: hauled tho malerinls Provide yourself, documentalio11 allach licl(from ols from the hauling c1II f;:u:ilities company rccycli110 lislinu the tho materials. projecl nddrcss nml service:; provided. If Mntcrlul Vendor l1i111llnn tho (Indicate nrntorlal if selr-1,aulud Fac:lllly 11 111torlal rocyi;ll11u the Total volume of 111aterlul or woi(Jht Concrcte/Mnso111 y (lndicale units (H!!quirP.d) Wood/(l{eql•rrr:L111nbe1 d) Metal:; C ;,11 II <dlwwd m?llli•.<i) I I I I,\' II' i ! 11 r1aslt I, 1)11/1 1/ II • -1 , , - . {' ,-, , , , (Cuntrn lntondecl 11i11atecl recyclables, lo..idi; sc11t I Sf....)'�11·1. ks, lo irn1dlill. indicnlc malarial) )vrl t',1//1.. t' 1..A �' � 11/ I 1" \I..t)-, \,'!·: I .1, - 1·. I I ln-1 r,1<111 ,, .ll' I c , f. ' / /. I 'I I ,, ( ,.,l,. , I -- --1--= I I • lt,I (.J ntf/I I(/ /It' J/ I I (I) � / I/ I-JI/\ NII\ day i 1111dorctm1cJ of tho vlolntion that my m1<fnll1110 l 11p to to :;folluw ix mo11tl1:lhb ; 111 pla11 jail. u1 I certify rcsuhmit lhat this tho <11lm1 1bovc r:01ili.LJ111alcliab ncluclo lro111 penalllos my co11sl1 of udio11 over site S?.,were 1100 par recycled in tho volume/ \'l�g�loscribecl and '.'i"ro lnkcn to the focililiAs drn;crihccl. l ·d ( � Jr/) .\ oul)( �� ( !r) - --- l'ri11t Name & Signature - Contractor or Owner � � Print Name & Signature �/JJ - I lauler(�L s cf)� Onie (If mullipfe, indicale vendor and include signature from each) ---.=---_,. l(ev 6· 1 ·2017 Enclave at Registry Ridge Lot House ti Street Permit Date Permit ti 2016 6.5 6744 Snowdon Dr 02/12/16 81508979 5.6 6727 Snowdon Dr 08/25/16 81502559 7.6 6739 Snowdon Dr 11/02/16 81604397 4.5 1309 Leahy Dr 12/16/16 81606204 9.6 1334 Leahy Dr 12/16/16 81606209 2017 2.5 1321 Leahy Dr 02/27/17 81607709 11.6 1346 Leahy Dr 04/07/17 81606501 12.6 1352 Leahy Dr 04/07/17 81606500 15.6 6702 Ranger Dr 05/08/17 81702502 3.5 1315 Leahy Dr 08/01/17 81703763 3.6 6715 Snowdon Dr 09/11/17 B1703743 2018 13.5 6702 Snowdon Dr 01/30/18 81706106 8.5 6732 Snowdon Dr 05/03/18 81800536 12.5 6708 Snowdon Dr 05/17/18 B1800537 4.6 6721 Snowdon Dr 07/10/18 B1802957 11.5 6714 Snowdon Dr 07/11/18 81802956 2.6 6709 Snowdon Dr 10/15/18 81807452 INSIGNIA HOMES§ April 12, 2019 Community Development & Neighborhood Services c/o Jonathan Nagel 222 LaPorte Street Fort Collins, CO 80522 IN RE: Construction Waste Management Plan and Documentation Dear Jonathan, 310 East 5th Street Loveland, CO 80537 970-6G7-1292 Eix 970-667-1302 Per our discussion Insignia Homes, Ltd., the builder of the referenced address and permits on the attached Project Information Form, disposed of the cardboard waste from the homes we built by delivery to the Larimer County Recycling Facility. Each time a home was completed we filled a trash trailer with approximately 10 cubic yards of cardboard primarily from the light fixtures, appliances and hardwood floor boxes, and some miscellaneous deliveries for each of the 17 homes that were constructed by Insignia. All other contractors (i.e. framers, roofers, plumbers, HVAC contractors) contracts were "turn-key", so they were responsible for removal from the jobsite all of their related waste and debris. Except, the homes that Insignia initially were built a wood specific sealed dumpster was provided from Home Builder Services. A letter verifying the wood waste removal is being provided by HBS directly. I hope I have properly responded and if any additional information is needed please do not hesitate to give me a call at (970) 379-7696. April 12, 2019 Community Development & Neighborhood Services 222 LaPorte, Street Fort Collins, CO 80527. To Whom It May Concern, Please let this letter serve as verification that Home Ouilder Services, Inc. collected approximatc,ly five 30 yard "wood only'' dumpsters for Insignia I lomes, lld. at the Enclave at Hegistiy Ridge project. Some of the receipts are attached to this letter. Since rely, Home Ouilclers Services, Inc. 1065 Poplar Street Johnstown. CO 80534 970-669-9912. FAX 970-669-9926 FOR: Insignia Homes 6715 Snowdon Drive Fort Collins, CO INVOICE 32417 I 03/29/18 I SITE 15189 01/31/17 15189 01/31/17 15189 01/31/17 15189 01/31/17 15526 02/17/17 15526 102111111 I 15867 I 02128/17 I 17139 I 03131111 I 18360 l 04/30/17 I 19337 I 05/31/17 20255 06/14/17 20255 I 06/14/17 I 20852 I 06t30111 I ot I I I I I I I I I I I I I I OFFSET Subtotal: January Rental: 12 yd Concrete November Rental: 12 yd Concrete October Rental: 12 yd Concrete September Rental: 12 yd Concrete Subtotal: Concrete Haul Fee - Roll-off Concrete Subtotal: Rental: Concrete Roll-off Subtotal: Rental: Concrete Roll-off Subtotal: Rental: Concrete Roll-off Subtotal: Rental: Concrete Roll-off Subtotal: Concrete Haul Fee - Roll-off Concrete Subtotal: Rental: Concrete Roll-off Subtotal: SHIPPING STATEMENT 01/01/2017 To 03/31/2019 75.00 75.00 -50/EA -50.00 -50/EA -50.00 r;J..) �v asme t ya divison �?a��t��prises, Inc. 1065 Poplar Street Johnstown, CO 80534 970-669-9912. FAX 970-669-9926 SHIPPING STATEMENT 01/01/2017 To 03/31/2019 Page 2 �RAO°e-No. -· '"sHIPOATE . r1c'ker NO�'-·- REF NO.� ,, "'"'eaulPMEl'IT ;;' ,., ,--........ : .,., -r "'oeSCRIPT i°oN ·--·. • . , • . -·-,�· �U N.I TS___ .-weiGH T(,L BSJ ..... PRIC E-·"!, .. ,.AM OUITT ' .�...._,.,:.._ ... .;J..,A,.. _ _..._.a.._.:...,.!.. :.lJ,.l .... .f..-....J ... �-· l�, .h..4 • .&..,-••�J-.. _ ..... _..---�-.��-....i,___.,i,_�J) ..... .,.,:....J.. - .....i;...:.:,.,l.-� .. � .. -�� ..... _ ..... .-1.._ .. _, .;;� -�.._v. ... �· . ..,,.,.J. .. ..;.,:.._ =-�-�....l,.IIOL� .......... ..l.--.r�� SITE 21861 I 07/30/17 I I I I Rental: Concrete Roll-off -50/EA -50.00 Subtotal: -50.00 22871 I 08122111 I I I I Concrete 17,860 0/LBS 0.00 22871 I 08/22117 I I I I Haul Fee - Roll-off Concrete -225.00 Subtotal: 17,860 -225.00 22318 108/31/17 I I I I Rental: Concrete Roll-off -50/EA -50.00 Subtotal: -50.00 24052 I 09/30/17 I I I I Rental: Concrete Roll-off -50/EA -50.00 Subtotal: -50.00 25232 110101111 I I I I Rental: Concrete Roll-off -SO/EA -50.00 Subtotal: -50.00 25605 111/01/17 I I I I Rental: Concrete Roll-off -50/EA -50.00 Subtotal: -50.00 26607 112/01/17 I I I I Rental: Concrete Roll-off -75/EA -75.00 Subtotal: -75.00 28990 I 01/01/18 I I I I Rental: Concrete Roll-off -75/EA -75.00 Subtotal: -75.00 28080 I 01/12/18 I I I I Concrete 16.360 0/LBS 0.00 28080 I 01112118 I I I I Haul Fee - Roll-off Concrete -225.00 Subtotal: 16,360 -225.00 29671 102/01/18 I I I I Rental: Concrete Roll-off -75/EA -75.00 Subtotal: -75.00 30766 103/01/18 I I I I Rental: Concrete Roll-off -75/EA -75.00 Subtotal: I -75.00 30791 104/01/18 I I I I Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 32113 I 05/01/18 I I I I Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 33256 I 06/01/18 I I I I Rental: Concrete Roll-off 1 -75/EA -75.00 Pl� vv asite ot [ 1 Ja Recycling / a divison of Earth Enterprises, Inc. 1065 Poplar Street Johnstown. CO 80534 970-669-9912, FAX 970-669-9926 SHIPPING STATEMENT 01/01/2017 To 03/31/2019 Page3 ·-�-..... ,. � '•" .... ' ' .. · r· "tn-•-, · ····•·· • •• .,. .• , ... --1" .,,_ "' -.. ..... 11--�-,r-- ..... ,. .... :: . .,,.;.1,.,,-,..-... """' • � -..-...,-,w:, ., .. ,, ... -.... .,..� , T.��-E-�?� .•. ..c.�H� DATE . .T!J�ET_�o� ......... R�!: N�., _ ...... �9��§I�.L .. ,. "" ........ _, £.�2�� _. .. ____ ..__,_...:,.. ��T,.�.--� ... ...:...:w..!''�1:.!:�-s�..._-..,.�-�-��..;jll SITE Subtotal: -75.00 33724 I 06/13/18 I I 1 l Concrete 15.260 0/LBS 0.00 33724 I 06/13/18 I I I l Haul Fee -Roll-off Concrete -225.00- Subtotal: 15,260 -225.00 33939 I 06/20/18 I I I l Concrete 16,980 0/LBS 0.00 33939 I 06/20/18 I I I l Haul Fee -Roll-off Concrete -225.00 34298 I 07/01/18 I I I Subtotal: I Rental: Concrete Roll-off 1 16,980 -225.00 -75/EA -75.00 Subtotal: -75.00 34554 I 07/11/18 I l I l Concrete 15,260 0/LBS 0.00 34554 I 07/11/18 ·,-----, I ·1 Haul Fee -Roll-off Concrete -225.00 Subtotal: 15,260 -225.00 35334 l 08/01/18 I l I T Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 35725 I 08/07/18 I T I T Concrete 12.040 0/LBS 0.00 35725 I 08/07/18 I T I l Haul Fee -Roll-off Concrete -225.00 Subtotal: 12,040 -225.00 36589 I 09/01/18 I T I l Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 37635 I 10/01/18 I l I l Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 38126 I 10/04/18 I I I I Concrete 16.680 0/LBS 0.00 38126 110/04/18 I I I IHaulFee-Roll-offConcrete -225.00 Subtotal: 16,680 -225.00 38962 111/01/18 I I I I Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: I -75.00 40019 112/01/18 I T I 1 Rental: Concrete Roll-off 1 -75/EA -75.00 Subtotal: -75.00 41284 I 01/01/19 I l I 1 Rental: Concrete Roll-off 1 -75/EA -75.00 ste-Not g .I a divison of Earth Enterprises, Inc. 1065 Poplar Street Johnstown. CO 80534 970-669-9912, FAX 970-669-9926 SITE 42652 02/01/19 43672 03/01/19 Subtotal: Rental: Concrete Roll-off Subtotal: Rental: Concrete Roll-off Subtotal: Location Subtotal: SHIPPING STATEMENT 01/01/2017 To 03/31/2019 Page4 -75.00 1 -75/EA -75.00 -75.00 1 -75/EA -75.00 -75.00 145!720 -3925.00 Total: 145,720 LBS $ -3,850.00 •1/1�'1201/J 11 �i4 AM t:it<.tt1 I HAGEMAN EARTH CYCLE '.150 I F <H.I Pro!>pect Bond roil Cull111S, co 805/f) 9/0nl-7173 BHI To: ww�, HBS. 118S. hnycrnttncurlhcp:Inc Inc lo 1:0111 l 3031 ()O(JIIIDUI Hwy 1 CO HJ UO!iO<l Dc-�,:111,11011 I C<-'11<,!r11d1on t..lalt:11< counly Sn!es rm Oly A,;,:<xmt �225 RECEIPT 00 TOTAL: s111,I iah11u <1U1t•1•lop,,y�8 . -1/ nt acc01,ltn!Jloe.i1d If h'iucr crcd1! ogreemen! voocher) (me1chan ·agree,u..-.nt ff� 11trt,/Jt.1Jtt",t,,lt, 4�.F COMPAfllONSWITII tlAl UHE It It I': " � I $ t � I I I11 I ,;, 111 s I I- I Sales Receip t #6i1707 6t1.Gf2017 1 :: OS PM S,.OfE: 1 .,, - � HAGEMAN EA Rirl c�cLE 3:iOi E.a-:;t Pro $lle.:t Ro"-d ro,1 Collrns. CO 8052:i S70-W·7173 NN'J. h<1ge1 m,ne.-.1thcyd t:.con'1 Bil\ "fo: r1es. inc H8S inc ?,03' \-IW'i 119 Longrno1'it co eoso-. C;:i:.lw:1 �,,; r:a D�<;.c11�1t10n 1 cc.n::Muct:o n Mot�n Cl:t\' pr,r,::. r;:,.t P:"1 oi· C.::iunty Sales To, RECEl?i TOTAL: accoun\ :;;:::2:· Signswrn • 00 7', .. --M-- -- - _ __. \ agre<:: tc· p.;.'/ .;\bO'"O: atn.J nt ac HAGEMAN EARTH CY 3501CLE• E ast Pr.ispect Fon Road Collins. CO 80525 970-221.77 W'Nw 73 h<1gi:1nane1111hcyc/e.co Biu T m o: Has. In c HBS. Inc 3031 Hw,; 11£, tongmoo r Co 80 C 50.: �1:ter M.)f;,Jo Dt::scriptr.::,o 1 Cons.1ruc1 1on Mare n., Coumy Sal es Ta> Ory 30 Pnce Ext Pnc� RECEIPT T R9;;,;;777 fi/OTAL: 4e_ s;gnaru ,- _ 1 agr(:e to Pay __ <1.J:2 Do,/[J!- c::. t{_!} "'c_c6rding __fo __Cdfd ____ issuer og reemen/ !merchan t .;l'Qreern i:,")t ;1,,ea,r vc..,coe ,1 Th&nk YOU Pj'-c;./ hd.J' for your bu smess, cor,j1ng tv (;i',.[•:1 is•::M.::r agr.:: e-f;',t:nt irn"e:r chant agrt:�n-1ent 1t creo1t ·.·ouc\1 d) Ri:91S'll'{ R1,19 e \t\ai'IK 'Jou fOf 'JOLlfbUSlfloc:: SSl 0)\\/IPANION S W1 H NA TURE. -50/EA -50.00 -50/EA -50.00 -200.00 17,060 0/ST 0.00 -225.00 17,060 -225.00 -50/EA -50.00 -50.00 -50/EA -50.00 -50.00 -50/EA -50.00 -50.00 -50/EA -50.00 -50.00 18,220 0/LBS 0.00 -225.00 18,220 -225.00 -50/EA I -50.00 I -50.00 laknn to tho facilities described, rrint l , <:Name :d Co:& Signature. ,iV:e 1 Conlraclor . . 1�>.....or Owner -� � _11 / 1:1µ')_ �Aanc��Po C-�Vkrl/ � ;;;::;;__-· - Yf-�,h-9�--�-��J rlnt Name & Signature • Haule� Oat r mulliple, indicate vendor and include sig11aturo from oach) ��==UY- - =".-.:==�=====-'� -- -� -•-==-��--=-==""'"�""'""__,._"'= I(('\' 6-1·1017