HomeMy WebLinkAboutApplication�R{
Garfield County
0 1% Community Development Department
ma108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
BUILDING PERMIT
APPLICATION
0 Demolition
❑ Manufactured Home (Single or Multi -Level)
ti Residential (SF, Duplex orTownhome) , ❑ Reroof
INVOLVED PARTIES
Property Owner: 0, r, rar .. rt r f`) P1--v-r1 r-,
Phone: (
Mailing Address:
Contractor: �nI-�l„ ,Mr,,, .�J� �`i,„,r Phone: ('7b )<Ir I --15t�cS
Mailing Address: ? O S':Sf, (I C; � C�t.c'•C
cC
Architect: \/ft -
Phone: (fir )
Mailing Address:
Engineer: (-) 11(7 Ct rfr t ►. �=� rr. ,.� . Phone: (r' ()) lO0C-,
•
Mailing Address: _ '? r�')�,a r 1� 4 r `��;v ; 4r' n r\
Manufactured Home Installer: P' -J' Phone: (
Mailing Address:
PROJECT NAME AND LOCATION
Describe Work: , f I
la vV
Job Address:. ? r`
I , C. 1t L i c. c.r./ o fl t,s r L (16C ,
C
Assessor's Parcel Number: `.' c c: -C-. G 1-r1.Sub. J Lot Block
Owner's Valuation of Work: $ f' C , C,(_. 0 • GO Property Size (5q. Ft. or Acres): /"+ , rip r-
Sq. Ft. of Building: Height: # of Floors:
Class of Work:
O New
0 Alteration
0 Addition
O Repair
Garage:
0 Attached
O Detached
Septic:
OWTS
❑ Move/Relocation
O Community
Type of Heat:
O Natural Gas
Propane
Driveway Permit:
0 Exempt
0 Electric
O Permit #:
0 Other
1f
[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
1 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 1 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 read and understand the Notice and Certification above, as well as,
have provided the required information wh, h is correct and accurate to the best of my knowledge.
F rt,i ci/ , We 6T -
Property Owner Print and Sign
5io/r�
Date {{
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
3o 85(p
Plan Check Fee:
ic.io
Permit Fee:
4'51.s
Manu home Fee:
Misc Fees:
Total Fees:Fees
16.56.
Paid:
SS ' 14
Balance Due:
I O. (e i
BP No:
131AzE-- b
OWTS No:
tpising # gds'
Setbacks:
OCC gC-
ff�1``77��
Const
�} �. RCR
Zoning:
BUILDING / PLANNING
. L
1 '
DIVISION : �'' 3-n--
1p
Signed Approval Date
. {.41 WA/ 3 to Ito
Gntfield County 1
�l=a��flaaa 1
Permit Number:
/-(1-4•Building
Engineered Foundation
:� - Driveway Permit
/4' 4- - Surveyed Site Plan
PNS7z Septic Permit and Setbacks ljA UTFO
63,8.4'.
N fit- Grade/ Topography 30%
Attach Residential Plan Review List
Subdivision Plat Notes
1u e Fire Department Review
Valuation Determination/ Fees
Red Line Plans/ Stamps/ Sticker
A ch Conditions
pplication Signed
Pia, • eviewer to Sign Application
/4#.
J� Parcel/ Schedule No.
� 4 . 40#Snowtoad Letter— Manu. Homes
'JrHSoils Report
Planning/ Zoning
roperty Line Setbacks — 5/ 7
)0/1--% 30 ft. Stream Setbacks
yl - A. Flood Plain
/It wilding Height
Zoning Sign -Off
A / � Road impact Fees
n` rA Grade/ Topography 40%
Kirit Planning Issues
' 1- Subdivision Plat
cS�L
General Comments:
Ni c -1t.Poi
Arim Taraperi
3 21) s. v► 7 41-'- 2t/9P
Old -414.44L )3/9Frie
447-6
2223.E
X30 04611.= 30, �
s �� .
•
This does not constitute
a building or use permit.
GAR FIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945.7255
INDIVIDUAL SEWAGE DISPOSAL PERMIT N? 845
Owner
Edward E. Pearson
System Location
County Road 126 -- 4 )y-)
Licensed Contractor
' Conditional Construction approval is hereby granted for a /00e) gallon
�,. Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Parc rate of one inch in minutes requires a minimum of
i1-1
sq ft of absorption area per bedroom.
Therefore the no. of bedrooms x /1/ sq. ft. minimum requirement = a total of 123 sq. ft. of absorption area.
May we suggest /2x 3(.0`x 5 `C7 G -,PD O f" / X. 2 /it f F>p r
Inspector �. ��� !�/��tu •-✓[,
Date
FINAL APPROVAL OF SYSTEM:
r
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system Is approved prior to covert-
Eng
over=Eng any part.
dv
vK
d k
eke
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials an assembly.
.e Inav w !
Trade n me f sept c tank or aerated treatmentunit.
Adequate absorption (or dispersal) area. / 8 'K 24' . - .6-,//e 1 el ,
li " Adequate compliance with permit requirements.
r 1
Adequate compliance with County and State regulations/requirements.
---
Other
Date /9/'/''o Inspector 44/t 174* -1-'1
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
`CONDITION
1. All insta latlon must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuantto au-
thority granted in 66.44-4, CRS 1963, amended 66.3.14, CRS 1963.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements.
Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a viola-
tion of a requirement of the permit and cause for both legal action and revocation of the permit,
3. Section 1I1. 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which in-
volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class
Petty Offense (5500.00 fine — 6 months in jail or both).
Building Official — Permit White Copy Applicant — Green Copy
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Dept. — Pink Copy
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Owner:
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Page Two Fees Paid $ dD
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date 57-3C) -
4-2,1v Hrd P feso A
Mail Address: /)0- Bs /o 57 City: q/,rlwaJ $ ,sZi p: r/60
INFORMATION REGARDING PROJECTSUBMITTEDFOR REVIEW ('6.
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable buildings, location of potable water wells, soil percola-
tion test holes, soil profiles in test holes (see Page 3). /1
Location of Facility: County GARFIELD City or Town e.vivoud� S7r ,J¢S
Legal Descriptionbi. it Sc 9 717 S P o r111ot Size ' /2, e "Icre 5
Phone :79.57 5-Z 78
.
2. No. of Bedrooms 3
Septic Tank Capacity /o0064c..
3. Source of Domestic Water: Public (name):
4r Pr.•i.
Private: Well Depth e'c shea'Other
Aeration Unit Capacity
Rs
Depth to 1st ground water table
4. Is facility within boundaries of a city/town or sanitation district? ,llo .
5. Distance to nearest sewer system: ,s /.(,.e s
Have you attempted to arrange a connection with the
If rejected, what was the reason?
6. If R.P.F. tested, state rate of absorption in test holes shown on the location map,
minutes per inch of drop in water level after holes have been soaked for 24 hours:
system?
in
7. Name, address, and telephone of R.P.E. who made sail absorption tests:
8. Name, address, and telephone of R.P.E. responsible for design of the system:
9. Express permission is hereby granted for the inspection of the above property by any
member of the Garfield County Building & Sanitation Department and/or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Building & Sanitation Department.
10. I have been given an opportunity to read the Individual Sewage Disposal Systems Regula-
tions of Garfield County and I hereby agree to comply with all terms, conditions and
requirements included therein.
2/(e0
Dat Signature o app icant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)