HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
BUILDING PERMIT
APPLICATION
TYPE CSF CONSTRUCTION
❑ Commercial/Multi-Family
❑ Demolition
gManufactured Home (Single or Multi -Level)
Residential (SF, Duplex or Townhome) ❑ Reroof
INVOLVED PARTIES
Property Owner:
Mailing Address:
Email Address:
Contractor:
o a.C> V K\ I t n NkaPhone: (0flDc
11 1 Aum 1-)3 %- �� CCLdloc ct.cLL ,
L rtuv.v'mtla I cmc 1 . c x -y1
Mailing Address:
Email Address:
Phone:
Architect:
Mailing Address:
Email Address:
Phone:
Engineer: 1-1Yl ?_ VC.�Y a Phone: (72.6,
Mailing Address: 'a302. elrClr1d_301C*iC CCo SJ
Email Address: Fera • tC`(\A" • -201 4*C1:1 • COM
Manufactured Home Installer: ...(4)00:11 ELY 1KrY�A c Phone: [ leo ) 4"4 "S"--1 10
Mailing Address: {`) Z -}��\Jla a 51702! SO Ettro ci 30-1C Uv-, (-O .
Email Address: • A • Q.C. o L. C� r� l S k__ •
PROJECT DETAILS
V()
Describe Work: We_ ijO!')Ultti l L 4_.(2 7 C q-) cm 0fo rl c wed Vior_
CYl k\& L pic43eA
* •
Job Address: TS'M 1* 1� i 1 �a C 1)9i 1.7 I4 sr last Lit -\-o`jksL
2k'-1 <1 - - 00011.
Assessor's Parcel Number:
Sub. Lot Block
Owner's Valuation of Work: $ Property Size (Sq. Ft. or Acres): 2.. i -cAre,
Sq. Ft. of Building: Height:. # of Floors:
Class of Work:
Garage:
4 New
Alteration
Addition
Attached
DRepair
.Detached
Li Move/Relocation
PROJECT DETAILS CONTINUED
Septic: 1
OWTS
L Community , AtA_i-E-in_(' Oo
Type of Heat:
Natural Gas
J Exempt
fl Propane
U Electric
U Permit #: C"+
Other
— Oil—
Driveway Permit:
.�r';/�
NOTICE
Authority. This application
for a Building Permit must be signed by the Owner of the property, described above,
If the signature below is not that of the Owner, a separate letter of authority, signed by
provided with this Application.
Permit cannot be issued without proof of legal and adequate access to the property for
by the Building Division.
separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
for use on the property identified above, e.g. State or County Highway/ Road Access
Discharge Permit.
Permit becomes null and void if the work authorized is not commenced within 180 days
and if work is suspended or abandoned for a period of 180 days after commencement.
or an authorized agent.
the Owner, must be
Legal Access. A Building
purposes of inspections
Other Permits. Multiple
(3) another permit required
or a State Wastewater
Void Permit. A Building
of the date of issuance
CERTIFICATION ,: 1.,,,•. • {; zt i,
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.
Pro wner Print and Sign
Date
OFFICIAL. USE ONLY
Special Conditions:
4/.L DtftGI 4149
Sf of Cafldl
PFee: an Check F
4313.10
f i o In S.
P rmit Fee:
1, 2. IS
Manu home Fee:
440o. 00
*G( SWI cf- F -
(Notetti hi Stvi c
Misc Fees:
4 I) n. oo
Adjusted Valuation:
4 3,..4(0.00
T tal Fees:
9I,
Fees Paid:
4Oo. oo
alance Due:
*715
.�r';/�
BP No:
OWTS No:
join -6 31
Type:
R6
al of Cat
Zoning:
kuPC1,
14020
(q5.
S tbacks:
R.= ael Sato
OCC Group:Const
016.
BUILDING / PLANNING
DIVISION :
Signed Approval Date
Garfield County J
BUILDING DEPARTMENT
108 Eighth Street, Suite 401, Glenwood Springs, CO 81601
Tel: (970) 945-8212
PLAN REVIEW CHECKLIST
Building Issues
Permit No: $3I4 12-70- 41
Planning/Zoning Issues
Engineered Foundation
Driveway Permit
X
Surveyed Site Plan
�a 7bwh OF
Septic Permit and Setbacks4
Grade/ Topography 30%
Attach Residential Plan Review List
Subdivision Plat Notes
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
/ ! Soils Report
% Property Line Setbacks
ti/A 30 ft. Stream Setbacks
Flood Plain
Building Height
Zoning Sign -Off
Road Impact Fees
Grade/ Topography 40%
Planning Issues
1
N/A Subdivision Plat
General Comments:
COW] 9 %
?�1 x(04=
J6 trove
141,5 x $I41.00= 4.-110•
leoe�d 4fpo- F.Gt, 41,332.019
( '+In °' Siri +)