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Community Development Department
L08 8th Street, Suite 401
Glenwood $prings, CO 81601
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îYPE OF CONSTRUCT¡ON
Com ulti-Fami
Manufactured Home (Single or Multi-Level)
Residential F,lex or Town Reroof
IIUVOTVED PARTIES
Property Owner CHRISTIAN CHURCH CAMP ASSOCIATION Phone:972 841-5093
Maillng Address:2915 County Road 241
Email Addresr. bojacq6@msn.com
contractor: Foundation Repair of Western Colorado phone;970 628-3738
Mailing Address: 2575 Highway 6 & 50, Ste A
Email Adclress: 'ictkc . o a-Kã1 @ rc-g<.ir¿¡^.þg. <D.a4
Architect:Phone: (_)
Mailing Address:
Ëmail Address:
Englneer:DL Engineering lnc Phone:720 444-9450
Mailing Address:
Email Address:
9100 W Jewell Ave, Lakewood CO 80232
Manufactured llome lnstaller:Phone: {_)
Mailing Address:
Email Address:
¡Demol¡t¡on
PROJEgT
Þescribe*¡or¡. lnstall 6 push piers and steel tubing u4
JobAddress;2915 County Road 241 - N¿w ","Sþl¿ 81t41
212307300039Assessor's Parcel Number:
Sub.
Owner's Valuation of Wo¡k: $17,890
Sq. Ft. of Building:
Class of Workl
tot 3 atock
Property Size {Sq. Ft. or Acres}:
f of Floorsr_Height
Addition
i
Garage:ched
Remodel/Alteration
Detached
(
(
:
I
PROJECT DETAITS CONTINUED
Septic:Community
Type of Heat:Natural Aas Ot¡Propane El ectric Other
Driveway
Permit:
NOTICE
Author¡tv. This application for a Buildíng Permit must be signed by the Owner of the property, described above,
or an authorized agent. lf 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 Perm¡ts. Multiple separate permits may be required: (J.) State Electrical Permit, (2) County OWTS Permit,
(3) another permit reguired for use on the property identified above, e.g. State or County Highway/ Roacl Access
or a State Wastewater Discharge Permit.
Void Permit. A Buildirrg Permit becomes null and void if the work authorized is not commenced withirr 1-80 days
of the date of issuance and if work is suspended or abandoned for a period of L80 days after conrmencement.
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 ôccepts the Application, along wíth the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
conrpleteness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to n1e, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by
the Buildirrg Division. ln consideratiorr of the issuance of the Building Permil, I agree that I and my agents will
comply with provisiorrs of any.federal, state or local law regulating the work and the Garfield County Buildirrg
Code, OWTS regulatiorrs and applicable land use regulations (County Regulatíon(s)). I ackrrowledge that the
Building Pernrit 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 ¡n compliance with County Regr,rlation(s) or any
other applicable law.
: I herebv grant permission to the Building Divisiorr to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not preverìt the BLrilding Official from: (1)
requiring the correction of errors in the sub¡¡ittals, 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 subrnittals, and inspections of the work by the Building
Division do not constitute an acceptance of responsibility or liability by the County of errors, or¡issions or
discrepancies. As the Owner, I acknowledge that responsibif ity for compliance with federal, state and local laws
and County Regulations rest with me and nry ar-rthorized agents, including without limitation my architect
desigrrer, engineer and/ or builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided rhe and accurate to the best of my knowledge.
[owrs lt
Exempt /v*Permit #
9/a,l /Bos I
Property Owner Date
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Soecial Conditions:'"'älä,i.+;r*! {-ru nÅû-irr' ffi, r?- pa.ir a n( bl
{rqw,'l;r"'#zïä:zE Mlånu. Home Feel' N/a
Adiusted Valuation¡
tÍ1"8ßÛ,æ '
fWfsc. Fees:
TotafFees: ^ )
#t+ø3,8b
Fees Paid
þ l1o,ç,1
Balance Du
#2q3 "'zÉ BP No:
Btß¡€- 7 o11
OWTS No:--lïo
Setbacks:âsn?OCC Grouo:'fia c*l$dtqe¿const' ïYTþc,Zoning:ÊvÈAl-
ele.d/*æ-BUtLOTNG / pLANNTNG DtvtstON
Signed Approval
?-to-zl
Date
NOTE: tf any required information is missing, delays in issuing the permit are to be expected. lf
determined by the Building Officialthat additional information is necessary to review the application
and/or plans ior compliance, the application may be placed on hold untilthe required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The Permit Fee, âs
well as any Road lmpact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by a person having written authority from the
owner to act as the¡r representative.
I hereby acknowledge I have read, understand, and will abide with the requirements of this
checklist.
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Property Owner Print and S
(rt I
Date
Gurfteld County
BUILDING DEPARTMENT
L08 E¡ghth Street, Sulte 407, Glenwood Spr¡ngs' CO 87607
Tel: (97O) 945-8272
PLAN RE VIE CHEC KLIST
Permit No:BtRe-ffi-zl -'7C 7î
Building lssues Pl a n n ing I Zoning lssues
Engineered Foundation
Driveway Permit
Surveyed Site Plan
Septic Permit and Setbacks
Grade/ TopograPhY 30%
nttach Residential Plan Review List
Subdivision Plat Notes
Fire DePartment Review
Valuatíon Determination/ Fees
Red Line Plans/ StamPs/ Sticker
Attach Conditions
Application Signed
Plan Reviewer to Sign APPlication
Parcel/ Schedule No.
Property Line Setbacks
30 ft. Stream Setbacks
Flood Plain
Building Height
Zoning Sign-Off
Road lmpact Fees
Gradel Topography 40%
Planning lssues
Subdivision Plat
40# Snowload Letter - Manu' Homes
b.,tl'td':n
Soils RePort
Desc ion & Summa
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