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Comrnunlty Dcwlopmcnt Dcprrtment
108 8ü Str€et, Sr¡hs ¡101
Glenwood SFultU¡, OO 81601
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TYPEOTGRADING
E MAJOR El n¡r¡¡oR
GRADING PERMIT
APPLICATION
IilVOLI'EDPARNE
Propertyû¡mer:
Mallln¡Address:
Allison & David Fataiczak Phonc:P02 tilsæß
PO Box 7968, Aspðn CO 81612
ãmallÂddrcss:allisonrataicaak@gmall.com
Contr.ctor:Keelty Construction Phon*:p7o | 429-8139
MalthUAddress:204 ParkAve, Suite 1K, Basalt, CO 81621
Em¡ll Address:scot@ keeltyconsür¡clion.com
Ard*tect:Eerkes Architects, Les Eerkes Phonc:po6 tffig'Tng
MalllrryAddrass:120 Madrone Lane Norft, Suile ä1 Bainbddge lsland, WA 98110
Em¡llAddress:los @ esrkesarch itects.com
Ene!¡reen Boundarles Unllmited lnc., Deric Water ptnon ,PTo t 61&70ß5
MallhuAddress:923 CooperAve., StE.201 Glenwood Springs, CO 81601
EmallAddres:deric@bu-lnc.æm
PROJECT IUAME AND IOCAT¡OT{
Frdect Ratajczak residence
Descrlbt Work:gradlng permit for properly aæs. The welldrilling rþ and geotechnicalteam
need access to lhe vacant paræ!.
Job Addrcss:0052 Stover Valley Road, prov,lded by Garfield County ComDev
Assessot's Parcel l{umber:218736200008
Sub.Hornestead Estates þr I
-Block-
Eanhworl lsquare feetl:19,500 Earthwor* lCublc Yardsl :4,500
Authorlw. This application for a Building Perm¡t must be signed by the Owner of the property, described abæe, or
an authorlzed agent. lf the signature bclow is not that of the Owner, ã separate letter of authority, signed by the
Owner, must be provided with this Applicatíon,
lesal Acæs¡. A Euilding Permit cãnnot be issued without proof of legal and adequate access to the property for
purposes of inspeclions by the Building Division.
Other Pêrmlts. Multiple seperðte perm¡ts may be required: {1) State Elestr¡cal Permit, (2} County OWTS Permit,
(3) another permit required for use on the property ldentified above, e.g. State or County Highway/ Road Access or
a Ståte Wâstewater Discharge Permit.
Void Permlt A Build¡ng 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 commencemenL
CERNFICANON
I hereby ccrtifo that I have read this Applicetion and that the information contained above is true and correct- I
understand that the Bullding Division âccepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf {subminals}, based upon rny cert¡ficat¡on as to accuracy. Assuming
comp¡eteness of the submittals and approval of thls Application, a Building Permit will be lssued Srant¡ng
permission to me, es Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. ln consideration of the issuance of the Bu¡lding Permit, I agree that I and my agen6 will comply
with provislons of any federal, state or local law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulatlon(sll. I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, con-lruction or use of the structure(s)
and facility{ies}, described âbove, 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, d¡scribed above, to ¡ßpect the worþ I
further acknowledge thãt the issuance of the Euilding Permit does not prevent the Bu¡ld¡ng Offìcial from: (11
requiring the correction of errors in the submittalt if any, discovered after lssuance; 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 Buildlng Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepanc¡es, As the
Owner, I acknowledge that respons¡bility for compliance with federal, state and local laws and County ßegulatlons
rest w¡th me and my euthor¡¿ed agents, including without limitation my architect designer, engineer and/ or
builder.
ATt UTITITIES MUST BE LOCATED PRIOR TO ANV GRADING
that I have read and understand the Notice andt hereby
have
Property Owner Print and $ign
required information which is correct and accurate to
Certlficatlon above ås well as
the best of my knowledge,
S L2_
Date
. oFFrcrAr usE oNtY P t Þ ttOO.qo <.c. o€/ot/zee;
"-¿al¿uþîG r/èk-.
Çvo buíl,ry ætie/af*btâ af ret'n
Special Conditìons:êra/t
lot¡l Fecc:* t00. ao
Fccs P¿ld:4 tocl C¡
FC€:Permitt 100.ôc
Mlsc Fces:
5-6-2/tz-
l¡ruc Dãtel tonlng:
Rur¿¡ t-t VBalanca Grading Permit:
çRAÞ - 7î0t
€-6-2û/lrr%sutrÐrNG/ PT.ANNING DrVrSrON :
Signed Approv¡l Oatc