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GARAELD COUNTY BUILDING PERMIT APPLICATION
108 glh Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 /Fax: 970-384-3470 I Inspection Linc: 888 ·868-5306
www .garfield-county .com
Parcel No: (this infonnalion is available al the assessors offic:c 970·945·9134} ~ \':\-1--~~-(\0-4 '9q
Job Address: (if 1111 address has not b=n assigned, please provide Cr, Hwy or Street Name & City) or and legnl description
'32Sl \I <l~~ss t'\ESI\ \ol.O I ~\("le , (.Q. '2.\~50
3 Lot No: 35 Block No: l~~u~~m"e~ RoncH
4 Owner: (property o"'ncr) Mailing Address: ~1.fL~.eo Ph: Alt Ph ;
KOl3E.ITT ~ ~AA\l"('~ 1\-\f\\('tt:i\.t \>.o. B'Di'-\\S\ b\C:.So C\1o A"\8 ·SSS!>
5 Contractor: Mailing Address: Ph: Ah Ph:
ll\11tJER
6 Architect I Engineer: Mailing Address: Ph : Ah Ph:
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7 Sq. Ft. ofBuilding: 'S?>l'.t Sq. Ft. or Acres of Lot: 40 f\C. Height: No. ofFloors:
' 8 Use ofBuilding:
9 Describe Work: \>(\\\<I t>EC\< bert!CV.~
10 Clnss of Work:
~New a Alteration o Addition
11 Garage: Septic :
o Attached 0 Detached oJSDS o Communitv
12 Driveway Pennit:
6:x1.srtN{;
Owners valuation of Work: s
NOTICE
Authority. This epplicarioo for a Buildins Pcnnit must be signed by lhc Owner of the pnipcny, dcsrnl>cd above, or an authorized agmL If the signaiwe below is not tho! of the Owner, a separ.>te
lcuu of authority, sisncd by the Owner, must be provided with this Application.
I .g:1I A«OM. A Building Permit c:annot be issued without proof oflcgal and adequate a<:ccss to the pmpctty for purpose• of inspections by the Building Department.
Other Permits. Multiple separate pc:nnits may be requital: (I) State Elcdrical Pcnnit, (2) County ISDS Pmnit. (3) anothi::r permit rcquin:d far use DD the property idcntilkd above, e .g. State or
County Highway/ Road Acccu or a Stale Wastewater DiscbatS" Permit
Void Permit. A Building Permit becomes null and void if the woi\i: authorized is not commenced within 180 dlys oflbc date of issuance and if work is suspended or abandoned for a period of 180
d.ys alter commcnccmmL
CERTIFICATION
I hcn:hy ccrlify that I have read this Application and that the Wonnation contained above is tnlC and =t. I understand that the Building Oc:panmcnt accepts the Appli cation, along with the plans
nnd specifications 8lld otbc:r data submitted by me or on my behalf (submittals), based upon my ccni6cation as to amncy
Asswnins completeness oflhc submiuals and approval ofthis Application, a Building Pc:nnit will be issued gnmting permission to me, as Owner, to construet the stn1etuR(s) and facilities detailed on
the submittals reviewed by the Buildins OcputmmL
In considcnition of the issuance oftbc Bw1ding Pcnnit. I agree that I and my agents will comply with provisions oflllly fcdcnil, stale or lacal law regulating the work and the Garfield County Building
Code, ISDS resuJations and applicable land we rqiulations (County Rcgulation(s)). I acknowledge that the Building Permit may be suspended or rcvolc cd, upon notice lium the County, ifthc location,
consuuction or use of the structuR(s) and liicility(ics). dcscnbcd above, arc not in compliance with County Regulation(•) or any other applicable law.
I hereby grant permission 10 the Building Ocpanment to enter the propcny, described above, 10 inspect lhc woi\i:. I further adcnowlcdg1: that the inuance of the Building Pmnit docs not prevent the
Building Official from: (I) requiring the co=ction of mt1rs in the wbminals, if any, discovered after issuance; or (2) stopping construction or use of the stnu:tllll:(s) or txility(ics) ifsuch is in violation
ofCoWJty Regubtion(s) or any other applicable law
' Review ofthis Application, including sublllinals, and inspections of the worl: by the Buildins Di:p~nt do not constitute 1111 acc eptance ofrcspomibility or liability by the County of errors. omiuinns
or dis=Jlancic•. ~ the Owner, I acknowledge that responsibility for compli11Dce with federal. •tole and local laws and County RcsuJntions rest with me and my authorized agents, including without
limitation my architect designer, engineer 1111d/ or builder.
I HEREBY ACKNOWLEDGE TitA T I HA VE READ ANO UNO ERST AND rnE NOTICE & CERTIFlCATION ABOVE.
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OWNERS SIGNATURE 7-f(/.//L l.:L.Jr DATE 10-?d -2n10
>\QV)f l0-4'Ct-l0
STAFF USE ONLY
Special Conditions:
Adjusted Valuation: Plan Check Fee: Permit Fee: ' Manu home Fee: Misc Fees:
5;:i 32.00 81 .l/ I 12:5, ZS'
JSDS Fee: Total Fees: Fees Paid: Balance Due: .l!.!.'.N2 & Issue Date: JSDS No & Issued Date:
'2.06 . '76 '~·B l t3l{. 35 -\&I l -
Setbacks: OCC Group: Const Type: . 'Zoning:
25" t5' /b I .:CJZC .I~C ~
BLD~DEPT: PLNGDEPT~
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APPROVAL DA TE 7
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AiPROV AL DA TE 7
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The following items are required by Garfield County for a final Inspection:
l) A final Electrical Inspection from the Colorado State Electrical Inspector.
2) Permanent address assigned by Garfield County Building Department and posted at the
structure and where readily visible from access road.
3) A finished roof; a lockable building; completed exterior siding; exterior doors and windows
installed; a complete kitchen with cabinets, sink with hot & cold running water, non-absorbent
kitchen floor covering, counter tops and finished walls, ready for stove and refrigerator; all
necessary plumbing.
4) All bathrooms must be complete, with washbowl, tub or shower, toilet, hot and cold running
water, non-absorbent floors, walls finished, and privacy door.
5) Steps over three (3) risers, outside or inside must be must have handrails. Balconies and decks
over 30" high must be constructed to all IBC and IRC requirements including guardrails.
6) Outside grading completed so that water slopes away from the building;
7) Exceptions to the outside steps, decks, grading may be made upon the demonstration of
extenuating circumstances., i.e. weather. Under such circumstances A Certificate of
Occupancy may be issued conditionally.
8) A final inspection sign off by the Garfield County Road & Bridge Department for driveway
installation, where applicable; as well as any final sign off by the Fire District, and/or State
Agencies where applicable.
A CERTIFICATE OF OCCUPANCY (C.O.) WILL NOT BE ISSUED UNTIL ALL THE
ABOVE ITEMS HA VE BEEN COMPLETED.
A C.O. MAY TAKE UP TO 5 BUSINESS DAYS TO BE PROCESSED AND ISSUED.
OWNER CANNOT OCCUPY OR USE DWELLING UNTIL A C.O. IS ISSUED.
OCCUPANCY OR USE OF DWELLING WITHOUT A C.O. WILL BE CONSIDERED AN
ILLEGAL OCCUPANCY AND MAY BE GROUNDS FOR VACATING PREMJSES
UNTIL ABOVE CONDITIONS ARE MET.
I understand and agree to abide by the above conditions for occupancy, use and the issuance of a
C.O. for the building identified in the Building Permit.
ID· 24 -lo tO
OWNERS SIGNATURE DATE
Bapplicationdcccmbcr2007
35. Do you understand that you will be required to hire a State of Colorado Licensed Electrician and
Plumber to perform installations and hookups, unless you as the homeowner are performing the
work? The license number of the person performing the work will be required at time of
applicable inspection.
Yes N(&
36. Are you aware, that on the front of the Building Permit Application you will need to fill in the
Parcel/Schedule Number for the lot you are applying for this permit on prior to submittal of a
building permit application? Your attention in this is appreciated.
Yes X
37. Do you know that the local fire district may require you to submit plans for their review of fire safety
issues?
Yes X (please check with the building department about this requirement)
38. Do you understand that if you are planning on doing any excavating or grading to the property prior
to issuance of a building permit that you will be required to obtain a grading permit?
Yes ')(
39. Are you aware that if you will be connecting to a public water and/or sewer system, that the tap fees
have to be paid and the connections inspected by the service provider prior to the issuance of a
Certificate of Occupancy?
Yes N / l'\
40. If you anticipate obtaining a water tap from the City of Rifle, please provide a letter indicating that
the City will provide water service. No building permit application will be acce pted without such
a letter.
Yes kl (A
I hereby acknowledge that I have read, understand and answered these questions to the best of
my ability.
-f? 1-HJ \ft.. f-I 0 -?. ~ -2 0 I 0
Signature of Owner Date
Phone: ~(0 ~9AH -5553 (days); __ 2 ..... 4_._/_7 ____ (evenings)
Project Name: ____________________________ _
Project Address : 3 2 S l G R~Ss IY\E"S t\ Rof\D, R l.fu: , C:>
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