HomeMy WebLinkAboutApplicationRECEI
slip IQ15
mmunity Development Department
GPBF�ELD CO t4ft 108 8th Street, Suite 401
VANITY DEVE! Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-countv.com
Garfield County
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
Manufactured Home (SF or Duplex)
0 Residential (SF, Duplex, or Townhome)
BUILDING PERMIT
APPLICATION
0 Demolition
0 Reroof
INVOLVED PARTIES
Property Owner:to ,. cwi Phone: 4j- ) 230-0391,,
Mailing Address: _ � tz Ca 3 ' ' L (J3 I+ L4 F7
Contractor: t ' .'o Q,S Phone: ( (1 70 } 214
Mailing Address:���` r--
.
Architect: Phone: (
Mailing Address:
Engineer: (.1.E-1/\%.+ C Cv. ct r Phone: (L 3 6-) 7 Ss cj - 6-14-4?
�7
Mailing Address: PG 6ex L�5�' v vL4_` k: T '4 '7
-�icnc 37 j
Manufactured Home Installer:Pci-A 1 c 1
_" Phone:( } ZSO -23e,
Mailing Address: 0 7' LI
PROJECT NAME AND LOCATION 11 n
Describe Work: _ Its '07\ . D C1� T� `2 [L 2 T o.0
,
Job Address: 2.1-1. 2 'l `. 5 1
r
Assessor's Parcel Number: 2-0-5-3‘q -02-c I Sub. t 14 ti c.. c .`y Lot 2 3 Block 5
Owner's Valuation of Work: $ ; DZs wjC-f-ifeiProperty Size (Sq.Ft or Acres): (.3 3 b
Sq.Ft of Building: tc3b T) Height: t # of Floor
Class of Work: "New 0 Alteration 0 Addition 0 Repair 0 Move/Relocation
Garage: 0 Attached !' Detached aZI
Septic: 0 OWTS 0 Community
Type of Heat: m Natural Gas 0 Propane 0 Electric ❑ Other
Driveway Permit: 0 Exempt 0 Permit #:
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Legal Access, A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility{ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
I hereby acknowledge that I have
have provided he required info
r
ation
and understand the Notice and Certification above as well as
which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign
7-zz-(6-
Date
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
i bi206 r
Plan Check Fee:
181. 51
Permit7Fee: y .Jc
2 / /. f+
Manu home Fee:
4]D.oV
Misc Fees:
Total Fees:
860.76
Fees Paid:
L{ Do .00
Balance Due:
1.60- 76
BP No:
OWTS No:
&INF- 3gb{-
Setbacks:
rz5, iQ' j so
OCC Group: _
_Loc..
Const Type: n�
T'F-'�--
Zoning:
NIT
BUILDING / PLANNING
DIVISION : .0-0f't-.-4---
6(��
Signed Approval Date
.itoc.00) J# `f6fivia) fi13 is
NOTE: If any required information is missing, delays in issuing the permit are to be expected. If
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Septic or Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
hereby acknowledge I have read, understand, and will abide by the requirements of this
checkti
LA _a_.
17 22 -/.-
Property Owner Print and Sign Date
July 22, 2015
Garfield County Planning Department
08 8`h Street, #401
Glenwood Springs, CO 81601
Dear Sir or Madam:
I hearby give permission Richard Ruse of Clayton Homes to be an authorized signer in obtaining building
permits from Garfield County. If you have any questions, t can be reached at 970-230-0396.
nk you,
Tere d on
Garfield County
Building/ Zoning Plan Review Checklist
Permit Number: 6.L A4 F-7-/5-30494
Building
Engineered Foundation
074._ Driveway Permit
Surveyed Site Plan
Septic Permit and Setbacks
Grade/ Topography 30%
Attach Residential Plan Review List
Subdivision Plat Notes
PA Fire Department Review
Valuation Determination/ Fees
Red Line Plans/ Stamps/ Sticker
Attach Conditions
Application Signed
Plan Reviewer to Sign Application
Parcel/ Schedule No.
40# Snowload Letter— Manu. Homes
N/
Soils Report
jPlanning/ Zoning
�` Property Line Setbacks 1- /C iat7d.
30 ft. Stream Setbacks
/ Flood Plain
% Building Height
Zoning Sign -Off
Road Impact Fees
Grade/ Topography 40%
Planning Issues
Subdivision Plat
General Comments:
ih 474
/800 X900 = e/4 Zan