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Home My WebLink AboutApplication - PermitProject Address Garfield County Building & Planning Department 108 8th Sheet Suite 401 Glenwood Springs, CO 81601- Phone: (970)945-8212 Fax: (970)384-3470 Parcel No.Subdivision Section Township Range 0-1 Expires: 02101120'11lssue Date: 815l2O1O 02I98 ELK RIDGE DR SILT, GO 192312100120 Owner fnformation Address Phone Cell 571-268-42Ê0James Suehring co Contractor(s)Phone Primary Contractor Froposed Construction / Details detached garage addition. FEES DUE FEES PAID Required Inspections: For lnspect¡ons ""rr ' I (888)868-5306 lnspection IVR Valuation: Total Sq Feet: $ 56,520.00 2916 Building Department Gopy See Permit Record Fee Amount Plan Check Fee Residential Building Fee Total: $450.29 $692.75 $1,143.04 lnv Total Paytype Amt Paid Amt Due lnv # BLRE-7-10-204'12 $ 1,143.04 Check# 1525 Check# 1523 $710.95 $432.09 $ o.oo 2Thursday, August 5, 2010 GARFIELD COUNTY BUILDING PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phonø. 97 0 -9 45 -8212 / F ax'. 97 O -38 4-3 47 0 I Inspection Line: 970-3 84-5003 wW!--BtrfiCld:Sa!-$L Parcel No: (this information is available at the assessors ofñce 970-945-9134) tqz3-t¿- oo- lzÔ1 2 Job Address: (if an address has not been assigned, please provide cr, Hwy or Street Name & City) or and legal descriPtion z3rrg 3 I Block No:Lot No .ZEoo eJftMailing Address L 4 Owner: (property owner) Alt Ph:PhMailing Address:5 AIt PhPhMailing Address:Architect / Engineer:6 No. of FloorsHeight Z1t-o,'Lot:So. Ft. or Acres of' 3l,l ¿r7Sq. Ft. of z t 8 W/,n+v S¡JOr¡tloq gUse of Building: 3 9 CO¡Snan¿rn--¡ gç dG'v¡ Describe Work:6¿rrrÞ¡o(l 10 Class of Work:n Additionn Alteration Sentic: t' NIA n ISDS un Attached Garage: Detached 11 Owners valuation of Work: $7o aoo.ooDriveway Permit: N /l2 þtter ;i âuthority, signed by the Owner, must be provided with this Application Leeat Access. A Buitding fåimii cannót be issued without proof of legal and adequate access to the,ProPerty for purposes of inspections by the Building Depanment' Courity Highway/ Road Access or a State Wastewater Dischæge Pemit' days aftercommencement- .ERTIFI.ATI'N md specificatiïns and other data submitt"d by -" ot on my behalf (submittals), based upon my certification as to accuracy. the submittals reviewed by the Building DePârtment. construction oiuse ofthe struãiure(s) and faciliry(ies), described above, are not in compliance with County Regulation(s) or any other applicable law' NATURE NOTICE ì-O - ZÒto the of omsslonsenors,by Countyliability withoutauthorizedincludingagents.my DATE STAFF USE ONLY Special Conditions Manu home Fee:Misc FeesPermit Fee: 6?3.7,f Plan Check Fee: /5o. Z? Adjusted Valuation: 5¿íza æ- ISDS No & lssued Date:Balance Due: 7 /C. ?r Date:BP NoFees Paid: t/(3.0 Total FeesISDS Fee: Const Type: -øúE'9 OCC Group:Setbacks: Fzl k'Zre 9to PLNG APPROVAL Zorung The items are required by GarfTeld Countv for a final Insnection: 1) A final Electrical Inspection from the Colorado State Electrical Inspector 2) Permanent address assigned by Garfield County Building Department and posted at the structure and where readily visible from access road. 3) A finished roof; a lockable building; completed exterior siding; exterior doors and windows installed; a complete kitchen with cabinets, sink with hot & cold running water, non-absorbent kitchen floor covering, counter tops and finished walls, ready for stove and refrigerator; all necessary plumbing. 4) All bathrooms must be complete, with washbowl, tub or shower, toilet, hot and cold running water, non-absorbent floors, walls finished, and privacy door. 5) Steps over three (3) risers, outside or inside must be must have handrails. Balconies and decks over 30" high must be constructed to all IBC and IRC requirements including guardrails. 6) Outside grading completed so that water slopes away from the building; 7) Exceptions to the outside steps, decks, grading may be made upon the demonstration of extenuating circumstances., i.e. weather. Under such circumstances A Certificate of Occupancy may be issued conditionally. 8) A fînal inspection sign off by the Garfield County Road & Bridge Department for driveway installation, where applicable; as well as any final sign off by the Fire District, and/or State Agencies where applicable. A CERTIFICATE OF OCCUPANCY (C.O.) WILL NOT BE ISSUED UNTIL ALL THE ABOVE ITEMS HAVE BEEN COMPLETED. A C.O. MAY TAKE UP TO 5 BUSINESS DAYS TO BE PROCESSED AND ISSUED. OWNER CANNOT OCCUPY OR USE D\ryELLING UNTIL A C.O. N ISSUED. OCCUPANCY OR USE OF DWELLING WITHOUT A C.O. WILL BE CONSIDERED AN ILLEGAL OCCUPANCY AND MAY BE GROUNDS FOR VACATING PREMISES UNTIL ABOVE CONDITIONS ARE MET. I understand and agree to abide by the above conditions for occupancy, use and the issuance of a C.O. for the building identified in the Building Permit' 1-3O -?-oto o t Bappli SIGNATURE DATE VAI,UATION F.EE DETERTIIINATION Applicant Address Datc Crawl Space Total James Suehring Subdivlsion Lot/Block Contrector Ou'ner West Elk Creek Sub Exemption 2l9SElkRidceRd Silt I"ot I 8l4l20to Finished (Livable Area): Main Upper Lower Other Total SquareFeet Valuafion Basement: Unfinished Conversion of Unfinished to Finished Tot¡l Valuation Garage/Storage (wood framed) Carport: Total Valuation sq.ft sq,ft sq.ft sq.ftX $74.68 0 ¡q.ft sq.frX $al.oo sq.frx $33.68 286E sq.ftX $18.00 sçftX $12.00 sq.frX $9.00 64 sq.ftX $24.00 280 sq.frX $12.00 Valuation Commercial 0.00 0.00 51,624.00 0.00 4,896.00 0.00 DeckV PatiosÆorches Cove'red Open Total Valuation Type of Construction: Occupancy:sfX sfX sfX sfX sfX sfX Valuafion Total Valu¿tion 56,520.00 Description of Work detached garage addition. Bin #: Locst¡on Address: 02198 ELK RIDGE DR SILT, CO Building PIan Review Cese Managcr: David Bartholomew Pl¡n Case Number¡ BLDG-7 -1M533 P¡rcel: 1923121ffi120 Application Datez 07 I 30l20l 0 Ownen James Sueûring Applicanû James Suehring þpficant Phone: 57 1'268*4,26A EmaiÈ ContactsGeneral Inforllatron '1rt Driveway permit / Parcellschedule No. lf "ubdivision Ptat Notes P/n rÀlÍaalr Minimum Application Questionnare Fire Department Review Line Plans/stamps/sticker Conditions Signed Reviewer To Sign Application Zoning Sign-off lu/'! . *o.d tmpact Fees //t,.. *oA/DRcApprovar "/Grade/Topognphy 4Ùolo / / u^luation Determination/Fees / *"o Surveyed $ite Plan Permit and Sethacks /30o/o t/Residentlal Plan Review List Buildinq Foundation Snowload Letter- llllanr¡. Homes PlanninslZonino / Property Line Setbacks Stream Setbacks Plain height ning lssues --------------.gu bd ivis ion plat General Wh#¡* 56,12Ò. od þ//o< ê/2'7f þ¿r¿¿¿.ur4e ?íO ,z 7/// // / 3,0/ ,//q 3z.orJþ Report -^ot¿e 7/O. ?s GARFIELD COI-TNTY BI]ILDING A\ID PLANNING 970-94s-8212 MINIMUM APPLICATION REQUIREMENTS For SINGLE FAMILY DWELLING CONSTRUCTION Including NEW CONSTRUCTION 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 imporønt that complete information be provided. When reviewing a plan and it's discovereã that required information has not been provided by the applicant, this will result in the delay of the permit issuance and in proceeding with building construction. The owner or contractor shall be råquired fo provide this information before the plan review can proceed. 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. T\ilO (2) SETS OF CONSTRUCTTON DRAWINGS & TWO (2) SITE PLANS MUST BE SUBMITTEDFOR ALL APPLICATIONS. please review this document to determine if you have enough information to design your project and provide adequate information to facilitate a plan review. Also, please consider using a design profôssional for assistance in your design and a construction professional for construction ofyour project. Any project with more than ten (10) occupants requires the plans to be sealed by a Colorado Registered Design Professional. 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 checklist prior to and during design. Appticants are required to indicate appropriately and to submit the completed checklist at time of application for a Permit. plans to be included for a Building Permit, must be on drafting paper at least 18"x24" and drawn to scale. I plans must include a floor plan, a concrete footing and foundation plan, elevations all sides with decks, balcony, steps, hand rails and guard rails, windows and doors, including the finish grade line and original gruå". A section showillg in detail, from the bottom of the footing to the top of the roof, injuainf ,e-bar, anchor bolts, pressure treated plates, floor joists, wall studs and spacing, insulation, sheeting, house-rap, (which is required), siding or any approved building material. Engineered foundations maY be required. A window schedule. A door schedule. A floor framing plan, a roof framing plan, roof must be designed to withstan d a 40 pound per square foot up to 7,000 feet in elevation, a 90 M.P.H. wind speed, winã exposure B or C, and a 36 inch frost depth' All sheets to be identified by number and indexed. All of the above requirements must be met or your plans will be returned- All plans submitted must be in compliance with the 2003 IRC, and 2006 IECC. i. Is a site plan included that identifìes the location of the proposed structure or addition and distances to the property lines from each comer of the proposed structure(s) prepared by a licensed surveyor and has the surveyors signature and professional stamp on the drawing? Properties with slopes of 30%o or greater must be iho*n on the site plan. (NOTE Section: 106.2) Any site plan for the placemeit of any portion of a structure within 50 ft. of a property line and not within a previously ,,rrv"y"d building envelope on a subdivision hnal plat shall be prepared by a licensed surveyor and have the surieyor's signature and professional stamp on the drawing. Any structure to be built within a building "n*lop" of a lot shown on a recorded subdivision plat shall include a copy of the building "nv"top" as it is shown on the final plat with the proposed structure located within the enveloPe. Yes K 2. Does the site plan also include any other buildings on the property, setback easements and utility easements? please refer to Section 5.05.03 in the Garfield County Zon\ng Resolution if the property you are applying for a building permit on is located on a comer lot. Special setbacks do apply Yes 3. Does the site plan include when applicable the location of the I.S.D.S. (Individual Sewage Disposal System) ãnd the distances to the property lines, wells (on subject property and adjacent properties), streams or water courses? Yes 4. Does the site plan indicate the location and direction of the County or private road accessing the 2 propertY? Yes K 5. Have you provided any RESOLUTIONS and/ or LAND USE PERMIT(S) associated with thrs 6. Are you aware that prior to submittal of a building permit application you are required to show proof ãf a legal and ádequate access to the site? This may include (but is not limited to) proof of your right to use a privaie easemenlright of way; A County Road and Bridge permit; a Colorado Dept. oigigh*uy Permit, including a Notice to Proceed; a permit from the fe{9ral government or any combination. you can contact the Road & Bridge Department at 625-8601. See phone book for other agencies Yes X, 7. Do the plans include a foundation plan indicating the size, location and spacing of all reinforcing steel in accordance with the IRC or per stamped engineered design? Yes * property? Yes 8. Do the plans indicate the clearances required if Yes please provide a COPY. No )l location and size of ventilation openings for under floor crawl spaces and the between wood and earth? NoYes úl 9. Do the plans indicate the size and location of ventilation openings for the attic, roof joist spaces and soffits? Yes ( 10. Do the plans include design loads as required by Garfield Counfy for roof snow loads, (a minimum of 4b pounds per rq,rui" foot up to & including 7,000 feet above sea level), floor loads and wind loads? Yes X 1i Does the plan include a building section drawing indicating foundation, wall, floor, and roof construction? Yes )( 12. Does the building section drawing include size and spacing of floor joists, wall studs, ceiling joists, roofrafters orjoists or trusses? Yes X 13. Does the building section drawing or other detail include the method of positive connection of all columns and beams? Yes X No 14. Does the elevation plan indicate the height of the building or proposed addition from the undisturbed gradã to the midpoint between the ridge and eave of a gable or shed roof or the top of a flat roof? (Building height measurement usually not to exceed 25 feet) 3 Yes X 15. 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? NoYes 16. Does the plan include a masonry fireplace including a fireplace section indicating design to comply \Ã/ith the IRC? Yes 17. Does the plan include a window schedule or other verification that egress/rescue windows from sleeping rooms and/or basements comply with the requirements of the IRC? Yes Y l g. Does the plan include a window schedule or other verification that windows provide natural light and ventilation for all habitable rooms? Yes K No ú 19. Do the plans indicate the location of glazing subj-ect to human impact such as glass doors' glazing immediately aá;acent to such doori $az1,ng adjacent to any surface normally used as a walking surface; ,fi¿ing'Àlu* doors; fixed glaJs punJt; ,ho*". doors and tub enclosures and specify safety glazing Yes 20. Is the location of all natural and liquid petroleum gas fumaces, boilers and water heaters indicated on the plan? Yes for these areas? {No Yes x Yes /v be the onlY residenti al structure on the Parcel? No if no-Explain 24.Havetwo (2) complete sets of construction drawings been submitted with the application? 2I.Doyou understand that if you are building on a parcel of land created by the exemption process or the subdivision process, are building plans in compliance with all plat notes and/or covenants? 22.Doyou understand that if you belong to a Homeowners Associatíon (HoA), it is your responsibility to obtain written permirrío" from tñe association, if required by that association, prior to submitting an application for a building permit? The building permit application will be accepted without it, but you run the risk of the HO,A, bringing action to enforce the covenants, which can result in revocation "f p"Ài, issued. Additionãlly, yor. Plan Review fee is not refundable if the plans have been r.uii*"¿ by the Building Department prior to any action by the HoA that requires either revocation or substantial modifrcation of the plans' 23. Will this Yes 4 Yes ,v 25.Do you understand that the minimum dimension a home can be on a lot is 2Oft.wide and 20ft. long? Yes ,( 26. Have you designed or had this plan designed while considering building and other construction code requirements? Yes X 27.Do your plans comply with all zoning rules and regulations in the County related to your properties zone district? Yes K 2g. Does the plan accurately indicate what you intend to construct and what will receive a final inspection by the Garfield County Building Department? Yes 29. Do you understand that approval for design and/or construction changes are required prior to the application of these changes? Yes tI 30. Do you understand that the Building Department will collect a "Plan Review" fee from you at the úme of application submittal and that you will be required to pay the "Permit Fee" as well as any "Road Impact" or "Septic System" fees required, at the time you pick up your building permit? Yes * 31. Are you aware that you must call in for an inspection by 3:30 the business day before the requested inspection in order to receive it the following business day? Inspections will be made from 7:30 a.m. to 3:30 p.m. Monday through Friday. Inspections are to be called in to 384-5003. Yes No 32. Are you aware that requesting inspections on work that is not ready or not accessible will result in a $50.00 re-insPection fee? Yes 33. Are you aware that you are required to call for all inspections required under the IRC including uiprovul on a final inspection prior to receiving a Certificate of Occupancy and occupancy of the building? Yes X 5 35. Do you understand that you wilt be required to hire a State of Colorado Licensed Electrician and ÉtumUer to perform installations and hookups, unless you as the homeowner are performing the work? The license number of the person performing the work will be required at time of applicable insPection. 34. Areyou aware that the pennit Application must be signed by the Owner or a written authority being given for an Agent and that thå party responsible for the project must comply with the IRC? Yes V Yes 36. Are you aware, that on the front of the Building Permit Application you will need to fill in the parceVschedule Number for the lot you are applying for this permit on prior to submittal of a building permit application? Your attention in this is appreciated. Yes )ú 37.Do you know that the local issues? Yes { fire district may require you to submit plans for their review of fire safety (please check with the building department about this requirement) -l--)o Date 3g. Do you understand that if you are planning on doing any excavating or grading to the property prior to issuance of a building permit that you will be required to obtain a grading permit? Yes 39 Are you aware that if you will be coffiecting to a public water and/or se1¡/er system, that the tap f"es huv" to be paid and the connections inspected by the service provider prior to the issuance of a Certificate of OccuPancY? Yes l/ I hereby acknowledge that I have read, understand and answered these questions to the best of my ability.\ S of wner 41o.8)6, LEoO 6 4 0 If you anticipate o btaining a water tap from the C Ity of Rifl please provide a letter indic ating that ication v/r ll be accepted thout suchtheCityw1IIprovidewaterservlceNobuildlngpermitappwl ïL',** ü I [+ Phone:qrr S (days);glt -"t"ç-4L( Project Name S,aþTt *ro g B,¿ t,lòr ñ (r Project Address ZtlQ(øo i;"^opfeaì rì^p0 lltån. êov+\ ouTNotes: If any required information is missing delays in issuing the permit are to be expected. Work may not pro"eed without the issuance of a permit. If it is determined by the Building Official that additional information is necessary to review the application and plans to determine minimum compliance with the adopted codes, the application may be piaced behind more recent applications for building permits in the ,"ui"* process un¿ trôt reviewed until required information has been provided and the application rotates again io first position for review, delay in issuance of the permit or delay in proceeding with construction. bpminreqsfMar2009 7 GARFIELD COT]I\TY BT]ILD II\ G RE QT]IRE MEI\T S Codes: 2003 IRC, IBC, IFGC, IMC, IPC, 2006 IECC' setbacks: check subdivisions and zone district for setback requirements. Snowload (measured at the roofl Not ground): 40PSF up to 7000ft' elevation' 50PSF 700lftto 8000ft. 75PSF 800lftto 9000ft. 100PSF 900i to 10000ft. Seismic design category: B Weathering probability for concrete: Severe' Termite infestation probability: None to slight' Wind speed: 90mPh' Decay probabilitY: None lVind Exposure: B or C (see section R301'2'1'4) Frost Depth: 36in. to 8000ft. elevation. 42in. 8001 and above. winter Design Temperature: Minus 2to 7000ft.; minus l6over 7000ft. elevation' Air Freezing Index: 2500deg F-days to 7000ft.; over 7000ft. to be determined by Building ofhcial Ice shield under-layment required. Mean Annual temP: Variable Insulation: windows/doors u:.3 5, Skylights IJ=,6, TBL 402. 1. l, 2006 IECC. Minimum R-Values: . Ceilings/roofs R values are R-38 stick built structures. R38 log construction and steel rafter construction' . Walls R values are R-19 wood frame; R-l9 cavity R-3 sheathing or R-10 sheathing for steel studs' . Floors R-values are R-30 or enough to fill cavity. . Basement wall R-values are R-10 below grade, R-19 above grade. . Slab perimeter R-values and depth is R-10/24in . Crawl space wall R-value are R-10 below grade and R-19 above grade' if floors over crawl space are not insulated, the crawl space walls must be insulated. Basement wall must be insulated to frost depth. Common walls garage to house must have R-19 insulation. Common ceiling/floor garageto house must have R-19. Take precautions to protect plumbing in these areas. 8 bpminreqsfMar2009 GAr{FIELÐ CÛUNTY DRIVEIVAY PERMIT RÐQ{IIREMENTS Inforrnatio¡ reqttirecl lry Garfieltl County Roatl & Britlge for tlrivovay pcrmifs or exemption letters: Þ State your request (drivwày peunits vs' exemption)' be easilY readable). Þ Subcon(ractor lifappticabie) rvith coritact peibon' address' phorre' fax & cel[' Quick refererrce guidcline for ¡terv or cltatrge of use dt'ivervays: Þ l)rivsivay nmoff ¡rlüqt rtot teqch Counþr road! Contact: Road&BricfgeMainOffice:0298CR3334,(Hutrter'MesaRd),Rifle,Co 81650-Ph625-8601' Office hoursãre 7:00anr to 4:00prti Morrday tlrtough lrriclay' The Road & Bridge olfice tvill issr¡e the i)eÍInit. It can be picked up at llte above addressi or faxed tlpon teceipt of ¡laynrenl. Payrnent ca' be i¡rade rvit¡ a c¡eck or credit cai'cl- 1. Permit Owner : 2, Mailing Acicltess: 3. Ciry: Carbondale 81623 Neq¡ Castle 81647 Parachute 8i635 Garfîekl CounfY Road & Briclge 0298 CR 333NlPtBox426 Rif1e, CÛ 81650 PH: 97A-62s-86Û1 FÄX: 97A-62s-8627 roaclaridliridee(A,ea rfielcl-equrty. coltl Ðrivervay Per¡nif Check Off Forrn Gienwood Springs 8160i 4. PironeNo: 5. County Rd. No: 6, Nearest Intersectíon or aclch'ess: 7. Distance from Int' or address: 8. Direotion fi'om Int. or addressl N g. Side ofro¿d¡ N 10. S/ìclth of driVervay: 3O-foot Other': I i. Culvert requiled: Yes 72, Size of ctúr'ert reqr'rirecl: 12-ineh Other: i3. Length of culvert reclrrirecl: 3O-foot 14, Asphalt or conctete pad requited: silr 81652 Rifle 81650 Other FaxNo: E S 'v/ E S w 40-foot 100-foot No 15-inch 18-inch 40-fooi NoYes 15. Sjze of padr 30,foot wide x i0-foo! long x 4 inches thj.ck: Yes 4O-foot wicle X t0-foot long X 4-inches thick: Yes 10O-foot u'ide X 2O-foot long X 4-inches thick: Yes Oiher: 16. Gravel portion required: 17. Length of gravel portion: 40-foot ,Yes 5O-foot No 1 00-foot No No No 18. Ti'ees ol brush romoved for visibilityl Yes No 19, Distance and clirectiou froin driveway to be rernoved: 20, Driveway must be 11o molo than 3 % slope arvay from Couuty road. 21. Dr.ive rnust be coustructed so rro clraínagg accesses Coully road fiom dr'iriewai. 22. Certifiecl traffic çontrol requirecl: Yes 23. Work zone signage only lequiled: Yes 24. Stop sign required at entt'airce to County Rd. Yes 25. ¡ispection of clrír¡elvay tvi11 r'ec¡rired upon conpletion ancl inust be ai:proved by person issui¡g per¡rit oT I'epfese¡ltative of person iss¡ing permit. 26, Persott Reqr"iesting Periuit: 27, Pelson issuing Permit: 28. District perurit issued in: 29 . D ate checklist comPleted : 1 J2 BO,ARD CIF COUNTY COMT'ÍTSSÍO}{ERS OF GARE'IEID COIINTY CERTIFTCATIÖN AND ¡IE'FIDAVÍT REGARDING ILLEGAÍ, ÃITENS, The Contracto::, uhöse name end signatìlre appears belot", certifies and agreès as l.)I10Þ¡s : i. The Contractor shall conply.I.rith the proVisions of C-R.S. B-1?-5-101 et seq. The Contractor shall not kngr.ríngly empJ-oy or contraqt r'¡ith an illegal al-iên to'perform ç¡ork for the Board of County Commissíciners of Gar.f ield County, Colårado (*BOcc.) or enter into a cont::act r.¡ith a subcontrastor that knor'ringly employs or contracts t¡ith an illegal- a1icn, 2. The Cqntractor repreèentS, r.rarrants, and agrees thàt it has verified that it does not employ any ill"gal a.líens; that it has participatêd or attenpted to partícipate in tfre easic Pilot Employmenl Verifícâtion Pr'ograrn adminisLe::qd by tn. Sccial Security Administration arid Department of Homeland Security; and otherr+i-se shall comp)-y ',¡ith the requj-remerits of c.R.s. 8-17.5-LQ2(2) (b) . 3. The Contractor sha1l comply r¿íth al-l r:easonab-le r9questq made in the course of an Ínvestigation urider C.R..S. B-l-7.5-102 by the Coiorädo Department of Labor and Emplo¡r¡nenl. If the Contractor faíIs tq cor-nply with ¿ny requi-remçnE of this provísion-òr C.n.S, B-1?.5-l0l- et seg.¡ thé BOGG inay tèrmínate r'iork for Ì:rèach ànd the Contrac¡or shall be liable for actual and co¡rsequential- damages to the State. 4, ff the Contracto¡ rs a sole proprietor, thd undersigned hereby sl{ears or ¿ffi rms uryd.er penalty of perjur/ unde.f the laws of the State of Colorado thát (check one) i f am a Uníted States cj-tizen, or f am a Pêrmanént Resident Of the United Stabes, or I arn lar.¡ful1y present in the United States pursuant to Federal lar¿ I understanci that this slporn statement is required by larr because. I am à 6o1e proprietor entefing íntci a contract to perfoim l.¡o.rk for the Bocc. I underst.and i,ha{: state larv requires me to pro.ride proof that, f am lar,riully prdsent i¡r the United StaLes príor ta startíng' r¡ork for the Bocc. I fiuther ãcknor.'ledge Lhat I. r+i]l comply wíth Lhe requireÍ¡rents of, c"R. s. 24*'7 6.5-L01 eË seg. and y¡il-l produce the requirèd form of identificatíon prior to starting t¡ork' I acknor,¡ledge that making a false, ficLitious, or fraudulent statement or iepresentation in thi s sr.rorn aíf idavit ì-s puníshable unde¡ the, crimlnal lar'¡s of Co-lorado as perjury in the second degree under C'R'S' 18-8-503' CERTTFIBD arìd AGREED to this - day of 200 CONTR.ACTOR (Contractor FulI LeÇaI Naräe FETN or Social Securíty Nurnbe¡ By Signature of Àuthorize d Rep f nrnigration Àf f ida\.it (08/061 Ftnal EXHIBIT Title Account Account: R042296 Location Parcel Num be r 1923 -l2l -00 -120 Situs Address 002198 ELK RIDGE DR C¡ty Silt ZipCode81652 Tax Area 015 - 2H-SF - 015 Legal Summary Section: 12 Township: 4 Range: 92 A TR IN PCL 3 OF THE WESTELK CREEK RANCHES AKA LOT I WEST ELK CREEK SUB-DIV EXEMPTION CONT 3I.72I AC, Tr4nsfers Sale Priee $283.500 Tax Historv Tax Year Taxes Owner Informatign Owner Name SUEHRING, JAMES Owner Address 2198 ELK RIDGE RD NEìV CASTLE,CO 81647 Sale Date 05t28t2010 tUlT/2009 10109/2009 09t30/2049 Images Phats Sketch GIS Page I ofl Assessment History Actual (2010) $381,930 Primary Taxable $30,540 Tax Area: 015 Mill Levy: 44.6490 Type Actual Assessed Acres Units Improvement $381,270 $30,350 1.000 Land $660 Sl90 31.721 Book PageTypeDoc 389 PTD A$N 315 *2010 2009 $1,363.60 $r,363.60 * Estimated https:llact.garfield-county.com/assessor/taxweb/accountjsp?accountNtrn:R042296 7/3012010