HomeMy WebLinkAboutApplicationGa7.-field G'ount
108 8h Street, Suite 401, Glenwood Springs, CO 81601
Ph: 970-945-8211 Fx:970-384.3440 Inspection Line:888-868-5306
www.garfield-county.com
BUILDING PERMIT APPLICATION
Parcel or (dos r nrnmli�+r i. uvuilahrc• of fhL. urt4s.vart ricin 9 J1 9a5 -9t31)
L
Lot No: Block No: Subd./ Exemption:
Job Address: (ifun uddress has nal hemp assigned, ii'uce provided 'rt HWVY or 'freer Name & c nv) or and legal description
(o/Z coun�Y �i5 . /173
5
Owner (propersvowner)
6to1.4r- cm/AD S
Mailing Address:
Ph:
Alt Ph:
Contractor:
XJ D fIao. me,477
Manufactured Itome installeiaC
NA t --TT
Mui d,dgee0 5370 - 5.V,
Mailing Address:
Ph:
(0" F-- 33
Ph:
Alt Ph:
Lis #:
6
Archjl& Mo ail✓
7
Engineer.
1;`/1g pddreSsAe/NQ s7. ext
Mailing Address:
Ph:
Ph:
Alt Ph:
Alt Ph:
8
Sq. /Z Buil r !O�
x
Sq. Ft, ori/A. of Lot:
Heigh
No. of Floors:
9
10
11
Use of Building:
Class of Work:
Residential ❑Commercial ❑Other ❑New ❑Alteration ❑Addition DRepair Memo ❑Move
Describe Wo.S7 rk•
LOG 7ew, 70
f1AC,.r ":45cc itc/ U iT s 4Atitre & M
Garage: Type of Heat:
❑Attached ~Detached
Septic:
DISDS ❑Community
❑Nat. Gas ❑Propane [Electric ❑Other
12
Driveway Permit:
,‹-r
Owners valuattonf Work: Q
D0.0p
NOTICE
Authotj . This application for a Building Permit must be signed by the Owner of the property. described above, or an authorized agent. 1 f the signature below is not that of the Owner. o scparaie
letter of authority. signed by the Owners must be provided with this Application.
Legal Access A Building Permit cannot be lamed without proof of legal and adequate access 10 the propcny for purposes of inspections by the Budding Department
Other Permits, Multiple separate permits moy be required: (1) State Electrical Permit, (2) County ISDS Permit, (3) another permit required for use an the property identified above, e.g State or
County Highway/ Road Access ar a State Wastewater Discharge Permit.
Void Permit, A Building Permit becomes null and void if the work authorized is not commenced within I 80 days of the date of issuance and if work is suspended or abandoned for a period of 180
days after commencement
CERTIFICATION
1 hereby certify that I have read this Application and that the information contained above is true and correct. 1 understand that the Building Department accepts the Application, along with the plans
and specifications and other data submitted by mc 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 submmals reviewed by the Building Department.
In consideration of the issuance of the Building Permit, 1 agree that I and my agents will comply with provisions of any federal, state or local law regulating the work and the Garfield County Budding
Code, ISDS regulations and applicable land use regulations (County Regulation(s)). 1 acknowledge that the Building Permit may be suspended or revoked, upon notice from the County. if the location,
construction or use of the structures) and facihty(ies:, described above, ore not in compliance with County Regulation(s) or any other applicable law
1 hereby gram permission to the Building Dclsanmcnt to enter the property, described above, to inspect the work 1 further acknowledge that the issuance of the Building Permit does not prevent the
Building Official from: (I ) 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 to violation
of County Regulation(s) or any other applicable law.
Review of this Application. including submittals. and inspections of the work by the Building l3epamment do not constitute an acceptance of responsibility ar liability by the County of errorsomissions
or discrepancies As the Owner. 1 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 ACI:NOWLEDGE THA f 1 HAVE. READ AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE.
OWNERS SIGNATURE
Dopr
17
a i 1a2/rf
DATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
°175D. 610
Plan Check Fee:
1/7 g i
Permit Fee:
1, 1.26 --
Manu home Fee:
Misc Fees:
Total Fees:
Z ci-Q(to
Fees Paid:
•a9 .v(L.
Balance Due:
BP No & Issue Date:
ISDS No & Issued Date:
SRL aa90
Setbacks:
OCC Group:}
rtKC .
Const Type: Zoning:
Poi
BLDG DEPT
J - 2 2— /l
PLNG DEPT
' �T� 22-1
APPROVAL DATE
APPROVAL DATE
NOTE: If any required information is missing, delays in issuing the permit are to be expected. If
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The building department will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Septic or Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge 1 have read, understand, and will abide by the requirements of this
checklist.
1),0,01 1401 1- 2 - /
Signature of Owner Date
Garfield County Building & Planning
108 8th Street, Suite 401
Glenwood Springs, CO 81601
Phone: 970-945-8212 Fax: 970-384-3470
www.garfield-countv.com
Total Due: $0.00 I
Receipt
Garfield County
108 8th Street Suite 401
Glenwood Springs, CO 81601 -
Phone: (970)945-8212 Fax: (970)384-3470
Pieturn to:
Garfield County
108 8th Street Suite 401
Glenwood Springs, CO 81601 -
Owner's Information
George Conrades
,co
Invoice Number: BLRE-11-11-21542
Invoice Date: November 23, 2011
Permit Number: BLRE-11-11-2290
Bond Number:
Comments:
George Conrades-Preserve @Prehm Ranch
L Permit Type: Residential Building / Work Classification: Addition I
Date
11/23/2011
11/23/2011
Fee Name
Residential Building Fee
Plan Check Fee
Fee Type
Adjustable
Percentage
Fee Amount
$18125
$117.81
Total Fees Due:
$299.06
Payments
Date Pay Type
Check Number Amount Paid
11/23/2011 Check
4457 $299.06
Change
$0.00
Total Paid: $299.06
Wednesday, November 23, 2011
