HomeMy WebLinkAboutApplicationC
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Garfield Cottrtt),,
108 8th Street, Suite 401, Glenwood Springs, CO 81601
Ph:970-945-82 1 2 Fx:970-384-3440 Inspection Line:888-868-5306
www.Barfi c ld-county. com
BUILDING PERMIT APPLICATION
STAFF USE ONLY
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South Rockies Unit
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I Parcel No: (this information is available at the assessors ofrtce 970-915-9l3l)
1917-274-00-012
Block No: Subd./ Exemption:Lot No
nla
2 has not been assigned, pleose provide CR, HW or Street Name & City) or aad legal description
N22 496 Man Camp
Job Address: (if an address
Sec 22, T4S, R96W
3 Ov,tner : Qt ro pe rt y ow ne r)
Encana Oil & Gas (USA) lnc
Mailins
2717 CH.
Address:
2'15 Parachute, CO 81635
Ph:
970-285-2656
AIt Ph:
4 Contractor:
Mtn West Oilfield Services
Mailing Address: 864- 20 Rd
Fruita, CO 81521
Ph:
970-858-8859
AIt Ph:
5 Manufactured home installer:Mailing Address:Ph:Lic#:
6 Architect:Mailing Address Alt Ph
7 Engineer:
MPA Consulting Engineers
Mailing Address: 715 Grand Avenue
Glenwood Springs, CO 81601
Ph: 970-928-8536 Alt Ph:
8 Sq. Ft. ofBuildh*, ,rUO Sq. Ft. or Acres of Lot: ,.U acre well pad Height:No. of Floon: 2
9 Use of Building:
EResidential ECommercial Eother ENew EAlteration EAddition flRepair EDemo EMove
Class of Work:
l0 Describe Work: lnstallation of manufactured buildings for a Man Camp on drilling location
ll Garage:
EAttached EDetached EISDS Ecommuniw
Septic:
ENat. Cas ElPropane EElecric Eother
Type of Heat:
12 Driveway Permit: NUA Owners valuation of Work:
NOTICE
letter of authority, signed by the Omer, must be provided with this Application.
LesalAccess. ABuildingPemitcmnotbeissuedwithoutproofoflegalmdadequateaccesstothepropertyforpurposesofinspectionsbytheBuildingDepilhnent.
County Highway/ Road Acc€ss or a State Wastewater Dischage pemit.
days after commencement.
and specifications and other data submitted by me or on my behalf(submittals), based upon my certification as to accuracy.
the submittals reviewed by the Building Department.
construction or use ofthe shucture(s) md facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
of Couty Regulation(s) or my other applicable law.
limitation my architect design€r, engineer md./ or builder.
I HEREBY ACKNOWLEDCE THAT I HAVE READ AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE:
SIGNATURE Coordinator DATE
Special Conditions:
q t
Adjusted Valuation
74,?52, oo
PIan Chtck Fee:fiz.n Permit Fee:8t8.79 Manu home Fee:
6oo. @ Misc Fees:
Total Fees:
tq 50.q1
Fees Paid:
100
Balance Due:
l g 50.91/
BP No & Issue Date:
BL9 -a)34
ISDS No & Issued Date:
rrs cr t E'zq'rt
Ftoo' pt@: St<to
Setbacks:OCC Group:
R"z
Const Type:Y9 Zoning:
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APPROVAI,DATE DATE
Building Plan Review
Deecription of YVork MF man camp
Bin #:
Location Address: Nee 4!X
PARACHUTE,CO
Care Managcr: David Bartholomen,
Plnn Case Number: Bl,DG'llll-70lz
Parcel: 1917274W012
Application Dstc: 09/30/20 1 I
Owncr: EnCana Oil and Gas
Applican* EnCanaOil and Gas
Appllcant Phone: 7 2087 *3513 Email: bob.weaver@encana
General Irrforrnatron (i ontacts
Buildins
Foundation
Driveway Pennit
Surveyed Site Plan
Permit and Setbacks
Minimum Application Questionnare
Su bdivieion Plat Notes
Fire Department Review
Conditions
Snowload Letter - Manu. Homes
Report
PlanninqZonins
/
GradelTopography 30%
-41-^*ch
Residential Plan Review List
/ Property Line Setbacks
,/ ,Oft stream setbacks
/ Ftood Ptain
/ ,uirding height
// Toning Signoff
ad lmpact Fees
fu/4 ,aoArDRc Approva!
/t
J-tanning tssueo
Grade/Topography 40%
General Comments:
,/aluation Determination/Fees '/ *ubdivision Ptat
./
' Red Line Plans/Stamps/Sticker
Application Signed
lan Reviewer To Sign Application
arcel/Schedule No.
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Thureday, October 27, 2011
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NOTE: lf any required information is missing, delays in issuing the perm it are to be expected. lf
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application m ay be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The building department willcollect a Plan Review fee at time of application submittal. The Permit Fee,
as well as any Septic or Road lmpact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by a person having written authority from the
owner to act as their rep resentative.
I hereby acknowledge ! have read, understand, and will abide with the requirements of this
checklist.
I
re of Owner Date
Garfield County Building & Planning
108 8th Street, Suite 401
Glenwood Springs, CO 81601
Phone: 97 0-945-8212 F ax: 97 0-384-347 0
www. oa rfi e ld -cou nty. co m