HomeMy WebLinkAboutApplicationGarfield County
Community Development Dj p,,!l rtment
108 glh Street, Suite~< 6 Glenwood Springs, CO 81601 lD/;
(970) 945-8212
www.garfield-county.com
[ TYPE OF CONSTRUCTION
[ D Commercial/Multi·F ~mily
D Manufactured Home (SF or Duplex)
t [!] Residential (SF, Duplex, or Townhome)
1 INVOLVED PARTIES
D Demolition ______ ]
[!] Reroof
Property Owner: _o_o_n_T_h_o_m_a_s ____________ Phone: ( 307 )_3_8_9-_5_09_7 ___ __,
Mailing Address: 340 Ponderosa Circle Battlement Mesa Co
Contractor: _c_M_G _________________ Phone: ( 970 )_6_25_4_05_0 ____
1
Mailing Address: PO Box 152 Rifle Co 81650
Architect:-------------------Phone:( ___ -------
Mailing Address:-----------------------------
Engineer: ___________________ Phone:( __ -------
Mailing Address : ____________________________ _
Manufactured Home Installer:------------Phone :( _________ l
Mailing Address :-----------------------------
[ PROJECT NAME ~f!D LOCATION
Describe Work: Remove existing roof, install new dry in and new 30 year laminate shi ngles
Job Address: 340 Ponderosa Circle
j Assessor's Parcel Number:
Owner's Valuation of Work: $_1_17_7_0_.o_o ______ Property Size (Sq.Ft or Acres): -----.,
Sq.Ft of Building:--------Height: #of Floors: ==---J
Class of Work: I Cl New ~ D Alteration D Addition [!] Repair D Move/Relocation -~
Garage: ~ D A~ache ~ -----D o;tached I
Septic: I D 1505 l!J Community 1
I [!]Natural Gas ~F ropane ~ D Electric !D Other
_______ Sub. _________ lot ___ Block
Type of Heat:
Driveway Permit: ' D Exempt D 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 pro~ided 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 ISDS 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 constr uct the struct ur e(s) and facilities detailed on the submittals reviewed by the
Building Divisi on . In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
w ith provisions of any federal, state or local law regulating the work and the Garfield County Building Code, ISDS
regulati ons 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, a re 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 Divis i on 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 _J
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required inf ect and accurate to the best of my knowledge .
4/20/2016
Pro perty Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Manu home Fee:
A
Adjusted Valuation: Plan Check Fee: Permit Fee:
il>(C(J , <O
Misc Fees :
Balance °OS BP No: ISDS No:
Setbacks: DCC Group: Const Type: Zoning :
BUILDING/ PLANNING DIVISION: fb~IJ. W~
Signed Approval Date