HomeMy WebLinkAboutApplicationßArßkw tI
Community Development Department
tOA gth Street, Suite 401
Glenwood Sprlngs, CO 81601
(e701 94s-8212
www.ga rfield-countv.com
Garfield County
GRADING PERM¡T
APPLICATION
TYPE OF GRADING
EI MAJOR tr MINOR
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INVOTVED PARTIES
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Phone:( q'?n I Z8S - s¿{32-
Email Address:
Mailing
LProperty Owner:
Address: /{{¡t, ?** ¡A4¡qr
Phone: I IContractor:
Mailing Address:
Email Address:
Architech Phone: ( I
Mailing Address:
EmailAddress:
Phone: (%? t76Z- SoZBEngineer:
Mailing Address:
Email Address:
PROJECT NAME AND TOCATION
Job Address:
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Assesso/sParcelNumber: L
Earthwork (Cubic Yards|:Earthwork (square feetf :
Sub.
Describe Work:
Project
Lot __Block
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Community Development Department
t08 8s Street, Suite 401
Glenwood Springs, CO 81601
(e?ol 94s-8212
www.sarf¡eld-cou ntv.com
Garfield County
GRADING PERMIT
APPLICATION
WPE OF GRADINGl[ ueron tr MINOR
INVOTVED PARTIES
Property Owner:
Mailing Address:
Email Address:
Phone:1176 ftL\'zls{
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Contractor: Phone:{)
MailinsAddress:
Email Address:
Architect:Phone: ( ì
Mailing Address:
Email Address:
Ensineer:Phone: ( I
Mailing Address:
Email Address:
PROJECT NAME AND LOCATION
Proiect
Describe Work:
Job Address:
Assessol's Parcel Number:
Sub. Lot Block
Earthwork (square feet):
-
Earthwork (Cubic Yards|:
AtL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. lf 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 Perm¡t 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 âbove, 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 afiler commencement.
CERTIF¡CATION
certify that I have read this Application and that the information contained above is true and correct. I
nd that the Building Division accepts the Applicat¡on, along with the plans and specifications and other
data subm¡tted 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. ln 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, ifthe location, construction or use ofthe structure{s)
and facility(ies), described above, are not in compliance w¡th County Regulation(s) or any other applícable 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 w¡th 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.
that I have read and understand the Notice and Cert¡f¡cation above as well as
and accurate to the best of my knowledge.
tl,tlr+
Date
USE ONIY
Print
/Special Conditions:
Misc Fees:Total Fees:
4oo rp
Feespaid:
4æ. WPermit Fee:
4ÖD DD
'Nnnltzlssue Date:Zoning': gl udue: ¡
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Balance Gradlng Permit:
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BUITDING / PTANNING DIVISION :8"\t, )þi2
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project name/operator: fu"qf* / Tf+rA
Project general location: ,V. 4^r^"F+,+1A-
Project acrease: 2 57 ¡,1">zt-7 fuyç*ç G¿,pw+l
Pipeline Grading Permit Checklist
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Project length and pipe size: ("tl t 7æo'Ê-
Bond Amount (must equal acreage x Szsoo): Ó'/( .
Weed management plan approved by Veg. Managem ent, fu)
Property owners including federal lands with easements: fuç^*
Engineered sealed plans:lp,
Plan set to county engineer consultant for review:ul,t
State storm water permit: O., (
Any county road cut permits needeO' ¡Vo
Any land use permits needed based on size or flood plain: Þø¿
Any Corp of Eng. wetland issues: U*
Original Bond and map to Treasurer's office: Ù, lL
Copy of bond in file: ì5, L
Map to GIS:N
Other:
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Pending items/date: úU¿ Þ+ô
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