HomeMy WebLinkAboutApplicationGarfield County j
Community Development Department
108 8th Street, Suite 401
RECEIVED Glenwood Springs, CO 81601
JAN 2 2017 (970) 945-8212
www.garfield-county.com
GARFIELD COUNTY
COMMUNITY
BUILDING PERMIT
APPLICATION
Ctifft@iftiKSTRUCTION
❑ Commerclal/MuItI-Family
❑ Manufactured Home (Single or Multi -Level)
Residential (SF, Duplex or Townhome)
P Demolition
Reroof
INVOLVED PARTIES
Property Owner:7-Phone: 70 ) 3[)-
2( )
Mailing Address: C Je r C C) .C.'/ 6S2
Email Address:
Contractor: r)l t:) r C Phone: (
Mailing Address:
Email Address:
Architect: Phone: (
Mailing Address:
Email Address:
Engineer: I3o / I K i/ K Phone: (
Mailing Address:
Email Address:
Manufactured Home Installer: Phone: (
Mailing Address:
Email Address:
PROJECT DETAILS
Describe Work:
Z>vs i 4Z Lc]O /72 C9U// 1L -7C
Job Address:
(ow S -
Assessor's Parcel Number: Qt[Si I
Sub. Lot Block
Owner's Valuation of Work: $ n. 00 Property Size (Sq. Ft. or Acres): . q
Sq. Ft. of Building: �CJG S1 Height: 1 U # of Floors: 1
Class of Work: New Alteration
Garage: Attached
El Addition 0 Repair 0 Move/Relocation
D Detached
PROJECT DETAILS CONTINUED
Septic:
OWTS
Type of Heat:
Driveway Permit:
Natural Gas
flPropane
Exempt
Community
Q Electric ❑ Other
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 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
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 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 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, 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,
provided the reyt#Ired informatiorytryhich is correct and accurate to the best of my knowledge.
01'004- 4,04"
Prope Owner Print nd Si
//- 22 - />
Date
have
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
3�G27o, 06
Pan Check Fee:
`� Fr4 I I
Permit Fee:
�
Manu home Fee:
i YA
Misc Fees:
e.
Total Fees:
$ 13-7.6,
Fees Paid:`)
1011.
Balance Due:
X3.-2
BP No:
OWTS No:
`C 2F 1
N A-
S tbacks:
(= R. ,25 C3.
J =10
OC G�
J
Const T L
L.
Zon ng:
BUILDING / PLANNING DIVISION : I�
1 /2`4 18
Signed Approval Date
Garfr�Id Cattnl}• ,
Buildiniul Zoning Plan Review Checklist
Permit Number:
Building
noe
j(414.14- p ►hof
Engineered Foundation
_4_ Driveway Permit
Surveyed Site Plan
Septic Permit and Setbacks
Grade/ Topography 30%
V Attach Residential Plan Review List
NSA Subdivision Plat Notes
N A Fire Department Review
Valuation Determination/ Fees
Red Line Plans/ Stamps/ Sticker
Attach Conditions
Application Signed
Plan Reviewer to Sign Application
Parcel/ Schedule No.
40#Snowload Letter — Manu. Homes
N/A Soils Report
Planning/ Zoning
Property Line Setbacks
N/A 30 ft. Stream Setbacks
Flood Plain
Building Height
Zoning Sign -Off
Road Impact Fees
Grade/ Topography 40%
Planning Issues
Subdivision Plat
General Comments:
15000 . 6ts 9 '44
AB. Garf ald Cau ri 7
Building/ Zoning Plan Review Checklist
Permit Number:
Building Planning/ Zoning
Engineered Foundation Property Line Setbacks
_N/K Driveway Permit WA 30 ft. Stream Setbacks
Surveyed Site Plan Flood Plain
Septic Permit and Setbacks Building Height
Grade/ Topography 30% Zoning Sign -Off
Attach Residential Plan Review List Road Impact Fees
WA Subdivision Plat Notes Grade/ Topography 40%
VA Fire Department Review Planning Issues
Valuation Determination/ Fees Subdivision Plat
Red Line Plans/ Stamps/ Sticker
Attach Conditions
Application Signed
• Plan Reviewer to Sign Application
Parcel/ Schedule No.
_VA_ 40# Snowload Letter— Manu. Homes
IWA Soils Report
General Comments:
s�, ano . 9; if-