HomeMy WebLinkAbout1212 W Mountain Ave - Special Inspections/Field Verification - 05/06/2019Planning, Development & Transportation Services
City/ Of Conuauuity Aevelopraeal & Nelgiborhood ServicesvvrF&t Collins 281 North College Avenue
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FOA Collbrk% CO 90522.0590
970.4162740
970.224.6134-far
jcgoroom
City of Fort Collins
Roofiog/Re-Roofing Field Verification Form
(Above Two Stories)
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Job Site Address FC 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 Roofrng/Re Roof1ng Field Verification Fornt 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
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Roofing Company 14MR,
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Date
Certificate Holder Name (Print) License #
C rcate older 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 Registered Exempt Worker (Print) Registration #
Date