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HomeMy WebLinkAboutApplicationGarfield County GRADING PERMIT APPLICATIONCommunity Development Department 108 8rh Street, Suite 401 Glenwood Springs, CO 81601 l970l94s-82t2 www.garfi eld-countv.com TYPE OF GRADING tr MAJOR tr MINOR INVOTVED PARTIES Property Owner: Mailing Address: xTo P 143 Diamond Ave. Parachute, CO 81635 re79-l 285-2611Phone: EmailAddress:Ed Seymour <eseymour@caerusoilandgas.com> Contractor:Qualcorr p¡on". ¡303 )587-4501 Mailing Address:Castle Rock Colorado, 80109 Emait Addrer* Cjenn ings@qualcorr.com Architect:Phone:(I Mailing Address: EmailAddress: Engineer:David Bull Phone'1713 1517-0301 Mailing Address:13781 Pacific Circle, Mead, CO 80504 EmailAddress:david. bull@williams.com PROJECT NAME AND LOCATION Project Name Allen Point CP Site Describe Work:lnstall Cathodic Protection Site Job Address: 39.53047777, -108.04660833 Assesso/s Parcel Number: Sub. 217112300003 S 18 65 95W Lot Block Earthwork (square feet):2700 Earthwork (Cubic Yards). 100 ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING NOTICE Authoritv. This application for a Building 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 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. VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof 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. ln consideration of the ìssuance 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(ìes), 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 construct¡on 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 requ¡red information which is correct and accurate to the best of my knowledge. 1012512021 Property Owner Print and Sign Date OFF.C'AL USE ONLy p4\. fl ro€. óct ú tolzrl¿a¿t ¿þ,þ_t Special Conditions: Â/a /<naatn teeaa/;?rþ{ e xøtn7 artlt*t-ra b,+r //, ny .sþ u c>Çre s re /a'b 4 >b r%, s,€ ¿ap taFeesIPaid: 100,CrÈt Perm¡ti o Fee: ,0 Misc Fees:t"s'i"ó'ô . o'o Grading Permit: 0RAD-7}l{ lssue Dâte:ßþzlat Ê.L Zoning:due:røBalance /0-2t-Ø2BUITDING / PLANNING DIVISION Signed Approval T Date DocuSign Envelope lD: 35902 167-096C-4E64-BFE2-8675868664C9 Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,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. Lesal 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. VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement. 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. ln 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, construct¡on 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. ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING NOTICE CERTIFICATION 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. DocuS¡gned by:10t2512021 Print and Sign Date OFFICIAL USE ONtY Special Conditions Permit Fee Misc Fees:Total Fees:Fees Paid: Balance due Grading Perm¡t:lssue Date:Zoning BUILDING / PLANNING DIVISION : Signed Approval Date