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Depattment of Local Affairs
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Buitding Department Representitive Printed
Buitding Department Representitive Si
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Not Required
Accept Defer lnspection
lf appticabte:
Fire Safety Official. Printed Name
Fire safety officiat sign
Contact emait:_
ls a fire protection system required? (check one) Required
lf required, the inspection is to be performed by (check one):
Fire Department: (
OR
Colorado Division of Fire Prevention & Controt
Manufacturer's Authorized Quatity Assurance Representative
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Manufacturer's Authorized Quatity Assurance Representative
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Contact .,nu11. kbrower@commodorehomes.com
lf the inspection has been deferred and the manufacturer etects to utitize an Approved Third Party
Agency to inspect the "OC" items on behatf of DOH, ptease sign and date betow.
Approved rhird Party Agent Printea Nuru T*ining Con*'ltit ibbets)
Approved Third Party Agent Signatu s?/I'
2423.08.16
Contact smr11. stibbits@radcoinc.com
Governor Jared 5. Potis I Rick M. Garcia, Executive Director I Atison George, Division Directo( .,
1313 Sherman St., Room 320, Denver, C0 80203 P 303.864.7810 F 3A3.864.7557 TDD/Try 38.864.7755 www.dota.colorado.gov 'f'
Strengtheni ng Colorado Communiti es
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EOIJAT ITOUSING
OFPORTUNI'Y
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IULY 2023
The following is based on information provided to the Division of Housing (DoH) and may be modifiedbased on the actual findings of the field inspection:
DATE: 07t30t2024
MANUFACTURER: Commodore Homes, LLC.lD NO.: 170
CONTACT: Brent DeLaruelte pHONE 119.. 574-533-7100 Ext. 105
MODEL NO.: 21M1012_V9 DOH P/A NO.
INSPECTION REQUTREMENTS: Check on site:
"oc'on ltems
Governor Jared 5, Potis I Rick M, Garcia, Executive Director I Alison 6eorge, Division Director
1313 Sherman 5t., Room 320, Denver, C0 80?.03 P 303.864.7810 F 303.864.7857 TDD/TW 303.864.775s www.dota.colorado,gov ,.i::J
Strengthening Colorado Cornmunities ; I 't:
Supporl posts
peak closure components
Gable end wall installation
kit installation
and connectors fbr HVAC systems
floor plumbing installation
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EOUAI. HOUIING
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