HomeMy WebLinkAboutApplication- PermitJob Address
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No. 5734
GARIIELD COUNTY
BUILDING, SANITATION and PLANNING DEPARTMENT
109 Sill Slrcol Suite 303
Glenwood Springs, Colorado 81601
(303) 945-8212
31947 Highway 6 & 24, Silt
!Velum of Work Building Permit
Use ofl3ndding_ Single Family Dwelling w/Double Garage
Owner Ron & Jean Smith
Coal rector
Crystal Valley Homes, Inc.
Arnouul of Permit $ 2,094.17 Date November 21, 1995
Permit: 1269.00
Plan . 825.17
Paid $825.17 8/11/95
S. Archuleta
Clerk
BUILDING PERMIT APPLICATION
GARFIELD COUNTY, COLORADO I
Applicant to complete numbered spaces only. PERMIT NO. S73 PARCEUSCHED NQ�f l��'t
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3
CONTRACTOR C �� //,c
ADDRESS ]os 6/ f01 zowQrkr
PH.�//03;:i ')
LICENSE NO.
4
ARCHITECT OR DESIGNER 116-Bonvcp
ADDRESSIY laa'l OhE+4G/90,i)
PH.7 J T:/r
LICENSE NO.
5
ENGINEER .2_4;4.z .21 t YL9i0 nf
ADDRESS
PH.
PH.
LICENSE NO.
6
S.F OF BUILDING ,R 3 /
S.F OF LOT a® .J-
HEIGHT/C:/
NO. OF FLOORS
7
USE OF BUILDING c/ but, LL l'A-An e t _J G?.5:S[ !)u/ -IQ
8
CLASS OF WORK: SEW in ADDITION o ALTERATION o REPAIR MOVE etREMOVE
9
DESCRIBE WORK:
10
CARPORT SINGLE DOUBLE
AGE SINGLEBL
DRIVEWAY PERMIT ON SITE SEWAGE DISPOSAL PERMIT SITE PLAN
11
b1/1 ()CJU' ADJUSTED VAL.$
VALUATION OF WORE: $meq
PLAN CHECK FEE V �5, / 7
PERMIT -4E ✓�2 4 9 t
0 0
SPECIAL CONDITIONS: Ee j 4A- l4porim- +lA/T upon/
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6i4GC,ESCO • OWE'Gi1A4, 7041,N PItd✓41LBAlcf
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SCHOO,PP CT FEE
p a. O O
NO. OF BUILDINGS ON
PARCEL
USE OF BUILDINGS NOW ON
PARCEL
JJ X4N.i1
40 -its ",O
OCC. GR
y�
CONST. TYPEAten i
OP c/oN/krOTICE Meard4P ^
PERMITS ARE REQUIRED FOR ELECTRICAL PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TH
S PERMIT BECOMES NULL
VOID IF WORK OR CONSTRUCTION
NOIr COMMENCED WITHIN 1 0 DADYS, ORF CONSTRUCTION OR WORK A8 SUSPENDED
OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND
THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES
GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT.- THE GRANTING OF A PERMIT DOES NOT PRESUME
AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE
LOCAL LAW REGULATING ON TRUCTION DR THE PERFORMANCE
CONST• CTI
7-.� �- (Date)
f
RIZED G,RECEIVED
WORK IS
KNOW
DATE PERMIT ISSUED N-171/-9,5"SEPARATE
WATER SUP ljy4j%J
'l�
SPECLAL APPROVALS
REQUIRED
NOT REWIRED
ZONING
{�
iTv,/4` //�
/aw ��
HEALTH DEPT.
FIRE DEPT.
TO GIVE
OR
OF
SOIL REPORT
SETBACKS
-
FLOOD HAZARD
//'/�l
S'; ature of Owner tractor or authorized age Niiita�d nd rs1E ood notice
ri y
?rim, L, Wit h
above.
MANUF. HOME
Thing Department Approve/dale Planning •' p. ment Approval/dale
OTHER
AGREEMENT
PERMISSION IS HEREBY GRANTED TO THE APPLICANT AS OWNER, CONTRACTOR AND/OR THE AGENT OF THE CONTRACTOR OR OWNER TO
CONSTRUCT THE STRUCTURE AS DETAILED ON PLANS AND SPECIFICATIONS SUBMITTED TO AND REVIEWED BY THE BUILDING DEPARTMENT
IN CONSIDERATION OF THE ISSUANCE OF THIS PERMIT THE SIGNER HEREBY AGREES TO COMPLY WITH ALL BUILDING CODES AND LAND USE
REGULATIONS ADOPTED BY GARFIELD COUNTY PURSUANT TO AUTHORITY GIVEN IN 30.28.201 CRS AS AMENDED. THE SIGNER FURTHER
AGREES THAT IF THE ABOVE SAID ORDINANCES ARE NOT FULLY COMPLIED WITH IN THE LOCATION, ERECTION, CONSTRUCTION AND USE OF
THE ABOVE DESCRIBED STRUCTURE. THE PERMIT MAY THEN BE REVOKED BY NOTICE FROM THE COUNTY AND THAT THEN AND THERE IT
SHALL BECOME NULL AND VOID.
THE ISSUANCE OF A PERMIT BASED UPON PLANS, SPECIFICATIONS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM
THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS, SPECIFICATIONS AND OTHER DATA OR FROM PREVENTING BUILDING
OPERATION BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF THIS CODE OR ANY OTHER ORDINANCE OR REGULATION OF THIS
JURISDICTION.
THE REVIEW OF THE SUBMITTED PLANS AND SPECIFICATIONS AND INSPECTIONS CONDUCTED THEREAFTER DOES NOT CONSTITUTE AN
ACCEPTANCE OF ANY RESPONSIBILITIES OR LIABILITIES BY GARFIELD COUNTY FOR ERRORS, OMISSIONS OR DISCREPANCIES. THE
RESPONSIBILITY FOR THESE ITEMS AND IMPLEMENTATION DURING CONSTRUCTION RESTS SPECIFICALLY WITH THE ARCHITECT, DESIGNER,
BUILDER AND OWNER. COMMENTS ARE INTENDED TO BE CONSERVATIVE AND IN SUPPORT OF THE OWNERS INTEREST.
Garform.003 I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE AGREEMENT ABOVE IINITIA
Ea-Cfrl2 Sl r�-55
inn 8706 733
EXHIBIT N'AN
tONNBNIP ¢ SOUTH war 92 WEST or TEE 6TH P.N.
SECTION It, BW1/18W1/4 four TEAT PART LYING NORTH 07 TEE
CENTERLINE OP THE LONER CACTUS VALLEY DITCH AB DESCRIBED
IN DEED RECORDED NOVEMBER 24, 1980 IN DOGS 560 AT PAGE
704.
RECTION St TEAT PART 07 LOT 2 IN TRE NN1/INWI/4 LYING NORTH 07 THE
RIGHT OP NAY OP TEE DENVER AND RIO GRANDE RAILROAD
COMPANY EXCEPT TEAT PART LYING WITHIN HIGHWAY 6 AND 21
AR DESCRIBED IN DEED RECORDED NAY 7, 1972 IN BOOR 159 AT
PAGE 246.
GARFIELD COUNTY BUILDING AND PLANNING
MINIMUM APPLICATION REQUIREMENTS
for
SINGLE FAMILY DWELLING CONSTRUCTION
including
NEW CONSTRUCTION
MANUFACTURED HOMES
ADDITIONS
ALTERATIONS
and
MOVED BUILDINGS
In order to understand the scope of the work intended under a permit
application and expedite the issuance of a permit it is important that
complete information be provided. Adequate and complete information will
prevent delays in the plan review process. Reviewing a plan and the
discovery that required information has not been provided by the applicant
may result in the delay of the permit issuance and in proceeding with
building construction. The owner or contractor may be required to provide
this information before the plan review may proceed. This causes delays
because other plans that are in line for review may be given attention before
the new information may be reviewed after it has been provided to the
Building Department.
Please review this document to determine if you have enough
information to design your project and provide adequate information to
facilitate a plan review. If you do not, it may be helpful to obtain a book
titled "Dwelling construction under the Uniform Building Code. This
book is available to you through this department at our cost. Also,
please consider using a design professional for assistance in your
design and a construction professional for construction of your project.
To provide for a more understandable plan in order to determine
compliance with the building, plumbing and mechanical codes, applicants
are requested to review the following check list prior to and during design.
Applicants are required to indicate appropriately and to submit
completed check list at time of application for a permit:
I
Is a site plan included that indicates the distance of the proposed
building or addition to property lines, other buildings, set back
easemynts and utility easements?
Yes XI No Not necessary for this project (2)
Does the site plan include the location of the I.S.D.S. (Individual
Sewage Disposal System) and the distances to property lines, wells (on
subject property and adjacent properties) , streams or water courses?
Yes No ,,, Not necessary for this project ,2,
Does the site plan indicate the location and direction of the County or
private road accessing the property?
Yes No (I) Not necessary for this project (2)
4. Do the plans include a foundation plan indicating the size, location
and spacing of all reinforcing steel in accordance with the uniform
building code or per stamped engineered design?
Yes v' No
t---- (i) Not necessary for this project ,2,
5. Do the plans indicate the location and size of ventilation openings for
under floor crawl spaces and the clearances required between wood
and earth?
Yes No (1) Not necessary for this project Y___(2)
6. Do the plans indicate the size an Location of ventilation openings for
' <'6 rthe attic, roof joist spaces and soffits?
Yes/__ No (,) Not necessary for this project (2)
7. Do the plans include design loads as required under the Uniform
Building code for roof snow loads, (a minimum of 40 pounds per
square foot in Garfield County) floor loads and wind loads?
}
Yes __ No (1) Not necessary for this project >,
8. Does the plan include a building section drawing indicating
found9xiion, wall, floor and roof construction?
Yes 7_�__ No (I) Not necessary for this project 12)
9. Does the building section drawing include size and spacing of floor
joists, call studs, ceiling joists, roof rafters or joists or trusses?
Yes No („ Not necessary for this project (2)
2
10. Does the building section drawing or other detail include the method
of posite connection of all columns and beams?
Yes Ft_ O
No , Not necessary for this project (2)
11. Does the plan indicate the height of the building or proposed addition
from the highest point of the building or addition measured at mid
span between the ridge and the eave down to existing grad�e� �contours?
Yes No fl) Not necessary for this project )S J__(2)
i
12. Does the plan include any stove or zero clearance fireplace planned
for installation including make and model and Colorado Phase II
certifications or phase II EPA certification?
Yes No (1) Not necessary for this project (2)
13. Does the plan include a masonry fireplace including a fireplace
section indicating design to comply with the Uniform Building Code
Chapter 37?
Yes _____ No (i) Not necessary for this project (2)
14. Does the plan include a window schedule or other verification that
egress/rescue windows fromsleeping rooms and/or basements
comply, with the requirements of the Uniform Building Code?
Yes . No (n Not necessary for this project (2)
15. Does the plan include a window schedule or other verification that
windows provide natural light and ventilation for all habitable rooms?
Yes No ,i, Not necessary for this project (2)
16. Do the plans indicate the location of glazing subject to human impact
such as glass doors, glazing immediately adjacent to such doors;
glazing adjacent to any surface normally used as a walking surface;
sliding glass doors; fixed glass panels; shower doors and tub
enclosures and specify safety glazing for these areas?
Yes _>::__ No (1) Not necessary for this project (2)
17. Is the location of all natural and liquid petroleum gas furnaces, boilers
and water heaters indicated on the plan?
Yes No O, Not necessary for this project (2)
18 Do you understand that if you belong to a homeowners association, it
is your responsibility to obtain written permission from that
association, if required by that association, prior to submitting an
application for a building permit?
Yes No O) Not necessary for this project;(- _(.,)
3
19. Have two (2) complete sets of constructions drawings been submitted
with the application?
Yes ___ No o, Not necessary for this project (2,
20. Is this an application for the placement of a manufactured home?
Yes
No�_--
If yes, have you pecified the size of the unit; live roof load;
foundation design; method of anchoring?
Yes No ' ,,, Not necessary for this project
(21
21. Have you designed or had this plan designed while considering
building and other construction code requirements?
Yes
-- No ())
22. Does We plan accurately indicate what you intend to construct and
what will receive a final inspection by the Garfield Building
Department?
Yes 741- _ No
c3,
23. Do you understand that approval for design and/or construction
chanes are required prior to the application of these changes?
Yes _X__ No
24. Do you understand that the Building Department will collect a "Plan
Review" fee from you at the time of application and that you will be
required to pay the "Permit Fee" as well as any "School impact" or
"Septic systern " fees required, at the time you pick up your building
perm t?
Yes No
25. Are you aware that you are required to call for all inspections required
under the Uniform Building Code including approval on a final
inspection prior to receiving a Certificate of Occupancy and
occupancy of the building?
Yes __ No
26. Are you aware that the person signing the Permit Application whether
the "Owner", "Agent of the Owner", "General Contractor" "Contractor"
or otherwise, signing the application is the party responsible for the
project"complying with the Uniform Codes".
Yes ��__ No („
(CONTINUED ON NEXT PAGE)
4
I hereby acknowledge that I have read, understand and answered these
questions accurately to the hest of my ability.
Phone:
3 a. 7_(days):
Project Name:
Project Address:
Notes:
(1) If you have answered "No" on any of these questions you may he required to provide this information at
the request of the Building Official prior to beginning the plan review process. Delays in issuing the
permit are to he expected. Work may not proceed without the issuance of the permit.
nit _ /-77-# . tic £
(evenings)',
St 7'71 dw/ cCir 1'0ee'e4DO
(2) If you have answered "Not necessary for this project" on any of the questions and if is determined by the
Building Official that the information is necessary to review the application and plaits to determine
minimum compliance with the adopted codes, please expect the following:
A. The application may be placed behind more recent applications for building permits in the review
process and not reviewed until required information has been provided and the application
rotates again to first position for review.
B. Delay in issuance of the permit.
C. Delay in proceeding with construction.
(3) If you answered "No" to this question the circumstances described in the question could result in a'Stop
Work Order" being issued or a "Certificate of Occupancy" not being Issued.
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05/01/96 14:15 FAX 9709454877 R&S DRYWALL
R.S. DRYWALL SUPPLY,INC.
0161 MARAND AVE.
P.O.BOX 97
GLENWOOD SPRINGS, CO. 81602
FA X COVER SHEET
DATE: `�1 V �Q.� `/ 1791
f6 FAX NUMBER: -9(1/-5 77J5 -
TO:
COMPANY.
FROM: (inn TNT/ 1/k)
NUMBER OF PAGES: c -1 -
RE:
COMMENTS:
0161 MARAND AVE.
P. O BOX 97
GLENWOOD SPRINGS, CO 81602
TEL
FAX:303-945-4877
f�o01
05/01/96 14:15 FAX 9709454877 R&S DRYWALL
Form No. OFFICE OF THE STATE ENGINEER
GWS -25 COLORADO DIVISION OF WATER RESOURC 4 ! ,1 f7 !::„ - a
.i
APPLICANT
818 Centennial Bldg., 1313 Sherman St, Denver, Colorado 60203 + ti
(303) 866-3581
RONALD W & JEAN M SMITH
31947 HWY 6 & 24
SILT CO 81652-
(970)876-2070
X002
EXST
WELL PERMIT NUMBER 046427
r__
DIV. 5 CNTY. 23 WD 39 DES, BASIN MD
Lot: Block: Filing: Subdiv:
EXPANSION OF USE OF EXISTING WELL
APPROVED WELL LOCATION
GARFIELD COUNTY
SW 114 SW 1/4 Section 4
Twp 6 S RANGE 92 W 6th P.M.
DISTANCES FROM SECTION L1NES
165 Ft. from South Section Line
5032 Ft. from East Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDmONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the
permit does not assure the applicant that no injury will occur to another vested water right or preclude another
owner of a vested water right from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless
approval of a vorianoo has boon srantod by tho Stato S ' rcl of �vnmir uarq of Water Wall Cnnstruction and Puma
Ir istalIatiun Contractors in accordance with Rulo 18.
3) Approved pursuant to CRS 37-90-137(2) for the expansion of use of an existing well, permit no. 10593 (canceled),
appropriating ground water tributary to the Colorado River, as an alternate point of diversion to the Avalanche
Canal and Siphon, on the condition that the well shall be operated only when the West Divide Water Conservancy
District's substitute water supply plan, approved by the State Engineer, is in effect and when a water allotment
contract between the well owner and the West Divide Water Conservancy District for the release of replacement
water from Ruedi Reservoir is in effect, or under an approved plan for augmentation. WDWCD contract
#950815JS(a).
4) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family
dwellings, the irrigation of not more than 24,000 square feet of home gardens and lawns, and the watering of
domestic animals, all on this 28.51 acre parcel being described on the attached exhibit 'A'. All use of this well will
be curtailed unless the water allotment contract or a plan for augmentation is in effect.
5) The maximum pumping rate shall not exceed 15 GPM,
6) The average annual of amount of ground water to be appropriated shall not exceed two (2) acre-feet (651,700
gallons).
7) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records
of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division
Engineer upon request.
8) The well shall be located not more than 200 feet from the location specified on this permit.
9) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court
case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these
markings. cp r.e. ,)-96
APPROVED
J02
74eld
state Engineer
Receipt No. 0397778
DATE ISSUED APR 1 8 1996
EXPIRATION DATE APR 18 1997
05/01/96 14:15 FAX 9709454877 R&S DRYWALL
Form No, OFFICE OF THE STATE ENGINEER :Ir- i.
GWS -25 COLORADO DIVISION OF WATER RESOURC
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 86G-3581
APPLICANT
RONALD W & JEAN M SMITH
31947 HWY 6 & 24
SILT CO 81652-
(970)876-2070
,F t
rIL
7 r
LQj 003
16,0
EXST
WELL PERMIT NUMBER 046427
r__
DIV. 5 CNTY. 23 WD 39 DES. BASIN MD
Lot: Block: Filing: Subdiv:
EXPANSION OF USE OF EXISTING WELL,
APPROVED WELL LOCATION
GARFIELD COUNTY
SW 1/4 SW 1/4 Section 4
Twp 6 S RANGE 92 W 6th P.M.
DISTANCES FROM SECTION LINES
165 Ft. from South Section Line
5032 Ft, from East Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the
permit does not assure the applicant that no injury will occur to another vested water right or preclude another
owner of a vested water right from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless
approva[ of a variance has been granted by the State Board of Examiners of Water Weil Construction and Pump
Installation Contractors in accordance with Rule 1B.
3) Approved pursuant to CRS 37-90-137(2) for the expansion of use of an existing well, permit no. 10593 (canceled),
appropriating ground water tributary to the Colorado River, as an alternate point of diversion to the Avalanche
Canal and Siphon, on the condition that the well shall be operated on when the West Divide Water Conservancy
District's substitute water supply plan, approved by the State Engineer, is in effect and when a water allotment
contract between the well owner and the West Divide Water Conservancy District for the release of replacement
water from Ruedi Reservoir is in effect, or under an approved plan for augmentation. WDWCD contract
#950815JS(a).
4) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family
dwellings, the irrigation of not more than 24,000 square feet of home gardens and lawns, and the watering of
domestic animals, all on this 28.51 acre parcel being described on the attached exhibit 'AI. All use of this well will
be curtailed unless the water allotment contract or a plan for augmentation is in effect,
5) The maximum pumping rate shall not exceed 15 GPM.
6) The average annual of amount of ground water to be appropriated shall not exceed two (2) acre-feet (651,700
gallons).
7) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records
of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division
Engineer upon request.
8) The well shall be located not more than 200 feet from the location specified on this permit.
9) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court
case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these
markings. 9 /f. -i ,) -q6,
APPROVED
JD2
7ilte
State Engineer
Receipt No, 0397778
DATE ISSUED APR 1 8 1996
By
EJXPIRATION DATE APR 1 8 1997
05/01/96 14:15 FAX 9709454877 R&S DRYWALL
FORM NO.
GWS -10
03/92
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
818 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203
(303) 8663581
FOR INSTRUCTIONS, SEE REVERSE SIDE
STATEMENT OF BENEFICIAL USE
WELL PERMff NUMBER
1.
2.
WELL OWNER
NAME(S)
Mailing Address
City, St. Zip
Phone ( )
For Office Use only
Z 0 0 4
WELL LOCATION: COUNTY OWNER'S WELL DESIGNATION
(Address) (City) (State) Lip)
1/4 of the 1/4. Sec. Twp. 0 N. or 0 S., Range ❑ E. or D W. P.M.
Distances from Section Lines Ft. from 0 N. or 0 S. Line, Ft. from 0 E. or 0 W. Line.
3.
4.
5.
6.
The well is being used for the following purpose(s):
Water from the well was first used beneficially
under this permit number, for the above described purposes on
(Do not report a date which is before the issued date of this permit)
The pumping rate claimed is gallons per minute.
The average annual amount of water diverted is acre feet.
7. The land area irrigated (watered) by water from this well is:
8.
described as:
or as
(Number)
19
0 Acres or 0 Square feet,
(Legal Description)
Subdivision Lot(s) Block Filing/Unit
Well drilled by: Llc. No:
Lic. No!
Pump installed by:
9.
10.
Meter Mfg. by Serial No.: Date installed:
I (we) have read the statements made herein, know the contents thereof, and state that they are true to my (our)
knowledge. [Pursuant to Section 24-4-104 (13)(a) G.R.S., the making of false statements herein constitutes perjury
in the second degree and is punishable as a Class 1 misdemeanor.]
Signature
Name/Title (Please type or print)
State Engineer
Court Case No.
FOR OFFICE USE ONLY
Date
BY Date
Div. Co. WD Basin MD Use
05/01/96 14:15 FAX 9709454877
FOR
NO.
GWS -2
09/93
R&5 DRYWALL
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203
(303) 866-3581
WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-137(2)
(IRRIGATION, COMMERCIAL, INDUSTRIAL, MUNICIPAL AND OTHERS)
PLEASE NOTE CAREFULLY THE CONDITIONS OF APPROVAL ON THE ATTACHED COPY OF YOUR PERMIT.
THE CONDITIONS MUST BE COMPUED WITH IN ORDER FOR THE PERMIT TO BE VALID.
THE ISSUANCE OF THIS PERMIT DOES NOT CONFER A DECREED WATER RIGHT.
A STATEMENT OF BENEFICIAL USE MUST BE SUBMITTED PRIOR TO THE EXPIRATION DATE OF THE PERMIT.
THE PERMIT EXPIRATION DATE IS ONE YEAR FROM THE DATE ISSUED. The well must be constructed, the
pump installed and the well must be used for the approved purposes prior to the expiration date of the permit.
Evidence of the use must be received in the form of a Statement of Beneficial Use (Form No. GWS -10) PRIOR TO
THE EXPIRATION DATE OF THE.PERMIT. Beneficial use is generally defined as the use of that amount of water
that is reasonable and appropriate under reasonably efficient practices to accomplish, without waste. the purpose
for which the appropriation is lawfully made. Evidence of well construction and pump installation must be
submitted to this office in the form of a well construction report and the pump installation report from the -respective
contractors showing that construction and pump installation was completed prior to the expiration date of the well
permit. The well permit number is located in the upper right hand corner of the permit, and the expiration date is
located in the lower right hand corner. The expiration date of the permit may be extended for a maximum time of
one year at the discretion of the State Engineer for good cause shown. If an extension of time is necessary to put
the well to use, you must file a written request with this office along with a $60.00 filing fee prior to the expiration
date. The request must state why the well has not been completed, must include an estimate of time required to
complete the well, and must specify the length. 01 extension you desire, not to exceed one (1) year.
ADDITIONAL INFORMATION REGARDING WELCPONSMICT)014.:ANE9N.I.ELLONMEMI REGULATIONS
ARE FOUND ON THE REVERSE SIDE OF THIS SHEET_
THE WELL MUST BE CONSTRUCTED AND THE PUMP INSTALLED BY CONTRACTORS WITH CURRENT
LICENSES) ISSUED BY THE STATE OF COLORADO unless exempted as described on the reverse side. The well
construction and pump installation reports must be submitted to the office of the State Engineer within sixty (60)
days of completion of the work or within seven days after expiration of the permit, whichever is earlier_ Your
contractor must provide you with a copy of the work report(s) he has filed with the State Engineer. The Well
Construction and Test Report, Form Number GWS -31 and the Pump Installation and Test Report, Form Number
GWS -32 are available from the Division of Water Resources offices.
You u have been provided with at least two copies of the well permit. The owner's copy is for your records. The second copy
is for the pump installation contractor. You may make additional copies for the well.construction contractor_if you select one
different from the one indicated in your application. if you did not indicate a proposed well construction contractor on the
application, four copies of the permit are enclosed. DO NOT GIVE YOUR 'OWNER'S COPY' TO THE CONTRACTOR .
The original permit is on file in the Denver Office Records Section. Additional copies may be obtained for a fee of 50 cents
per page. Any change of mailing address or ownership should be reported to the State Engineer by the new owner on a
'Change in Ownership/Address°, form number GWS -11.
If you have questions, contact the Denver Office, or the Division Office where your well is located.
IA 005
NON-EXEMPT
DMSION 1
800 8th Ave Rm 321
Greeley CO 80631
(303) 352-8712
DIVISION 5 Box 396
56633 US Hwy 6 & 24
Glnwd Spgs CO 81601
(303) 945-5665
DMSION 2 Box 5728
219W5th Rm223
Pueblo CO 81003
(719) 542-3368
DMSION 6 Box 773450
625 So. Lincoln Ave.
Stmbt Spgs CO 80477
(303) 679-0272
DIVISION 3 Box 269
422 4th St
Alamosa CO 81101
(719) 589-6683
DIVISION 7 Box 1880
1474 Main St
Durango CO 81302
(303) 247-1845
DIVISION 4 Box 456
1540 E Niagara
Montrose CO 81402
(303) 249-6622
DENVER OFFICE
Rm 821
1313 Sherman St
Denver CO 80203
(303) 866-3581
_:o: _i 4arua dui
THIS ems a PUI CED i f E JOB
24 HOURS NOTICE REQUIRED FOR INSPECTIONS
BUILDING P R 1
GARFIELD COUNTY, COLORADO
Date Isst ed Zoned Area Permit No....;.)..../ _ ; 4/-
AGREEMENT
fAGREEMENT
In consiueration of the issuance of this permit, the applicant hereby agrees to comply with
all laws and regulations related to the zoning, location; construction and erection of the
proposed structure for which this permit is granted, and further agrees that if the above
said regulations are not fully complied with in the zoning, location, erection and
construction of the above described structure, the permit may then be revoked by notice
from (}►� jCounty uildin pectoraria a IMM D ATEgLY BECOME NULL AND VOID,
Use �` r"��''ji'' ..�'' 7 d w
Address or or Legal , es ription i "L I" lJ� " �i1, tail r
11 I \ •
Owner�r� ��� Contractor .c 1 v\ G ,
Setbacks
Front
Side
Side
Rear
This Card Must Be Posted So It Is Plainly Visible From the Street Until Final Inspection.
INSPECTION RECORD
Zoning
Roof Covering
Footing /._.:y S , 2-,v._
Electric -Final (by STATE inspector) `f-l`i-r-
Pe2 M 1s-crq`
Foundationta_'-Vas-1413,7,n
Plumbing -Underground /-. j - %< jcf(
Gas Piping %? -jJe
Heating Ventilation
Frame ? 72 -9E Tale
Insulation .A -r 7 -yG Gu-,._
Plumbing -Rough 2..-z7-9,1 a:j
Drywall ?_ ;;_6z,, .,
Electric -Rough ,,'/2//f( //,'
(by STATE inspector)
Final rim? 9._94 4t
ALL LISTED ITEMS MUST BE INSPECTED AND APPROVED BEFORE COVERING —
WHETHER INTERIOR OR EXTERIOR, UNDERGROUND OR ABOVE GROUND.
THIS PERMIT IS NOT TRANSFERABLE
Phone 945-8212 10 9 8th Street, County Courthouse, Glenwood Springs, Colo.
APPROVED ��' DO NOT DESTROY THIS CARD
Date ( I % `"_t gv `) '_
Cm-