HomeMy WebLinkAbout6126 POLARIS DR - SPECIAL INSPECTIONS - 10/11/2019Planning, Development & Transportation Services
City, of Community Development & Neighborhood Services
—d I ■Collins281 North College Avenue
t CO«5 P.O. Cox580
Fort Collins,s
CO 80522A580
970.416.2740
970.224.6134- fax
Jcgor.com
City of Fort Collins
Roofing/Re-Roofing Field Verification Form
(Above Two -Stories)
CD 12& Rolarl S Qr 81 CT 17-055
Job Site Address 1'or� �011 n5, � Permit Number
8C5-Ze-/
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.
"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. I further certify that the
roofing materials used on this project were installed per the manufacturer's instructions in high -wind
areas."
5evere- WenlW-+ Wa' s�s1w■i;,,� L1L
Roofing Company Name
oa. - I112019
Date
If the work was performed on the
Worker crew, please acknowledge
op 3 & 4crn S2rV,t_-_s
Exempt Company Name
10'1l' 19
Dates
�o vtv\
Apra �-Z152
(Print) License #
permit using a City of Fort Collins Registered Exempt
�Y n�twr+n�•� ��tflvl't�.ie � �X — ZS�1Z�
Registered Exempt Worker (Print) Registration #