HomeMy WebLinkAboutApplicationDocuSign Envelope ID: 92AC90AA-80A3-4008-9566-D398D1 F2FC84
Garfield County
Community Development Department
RECENE0 108 8th Street, Suite 401
5 _� � ,�.�1 Glenwood Springs, CO 81601
(970) 945-8212
LD CpUNDY GARFIHi
www. arfield-countv.com
co111MM110y5Y 0E11ELQPiVIE
TYPE OF GRADING
0 MAJOR
INVOLVED PARTIES
Property owner: Clough Sheep Company
0 MINOR
Mailing Address: P 0 BOX 686 RIFLE, CO 81650
Email Address: d_snyder@live.com
Phone: (970 ) 618-7749
Contractor: Crossfire Phone: (435 781-6353
Mailing Address: 1360 US -40, Vernal, UT 84078
Email Address:
Architect: N/A
Phone: (
)
Mailing Address:.
Email Address:
Engineer: Greg Wall Phone: (870 ) 285-5455
Mailing Address: 4980 State Hwy 374 Green River, WY 82939
Email Address: greg.wall@williams.com
PROJECT NAME AND LOCATION
Project Name:24 inch gathering line replace
Describe Work: We will be replacing 200 feet of 24 inch pipe. Because the
pipe is 9 feet deep and within a corridor, the safest way to do this was
determined to be capping and abandoning the 200 feet, and adding the new
line on the outside of the corridor.
Job Address: 39.517192°, -107.887624°
Assessor's Parcel Number: 21 7521 1 00022
Sub. No Tots or Subdivisions listed on county site
Earthwork (square feet): 88543
Lot
Block
Earthwork (Cubic Yards): 1500
DuuuSiyri Envelupe ID, 92AC90AA-80A3-4008-9588=D308D1F2FC84
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
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
have provided the required information which is correct and accurate to the best of my knowledge.
-- Doc uSlgf d by:
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8/6/2020
Date
OFFICIAL USE ONLY
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