HomeMy WebLinkAbout508 W OAK ST - SPECIAL INSPECTIONS - 9/5/2019Planning, Development & Transportation Services
City,of
I Community Development & Neighhorhood Servkes
281 • Or�.IoWns P.O. Bo h College Avenue
F.O. Box 580
Fort Collins, CO 80522.0580
970.4162740
970.224.6134• fax
fcgoeeom
City of Fort Collins
Roo5nglRe-Roofing Field Verification Form
(Above Two -Stories)
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 Yerrficalion 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.
"I 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. 1 further certify that the
roofing materials used on this project were installed per the manufacturer's instructions in high -wind
areas,"
Roofing Company Mame Certificate Holder Name (Printl License 4
s�
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:
I
aad'f ) Ins 9a (LO
empt Company ame Registered Exempt Worker (Print) Registration #
Date