HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
www °gariic1d-Ctrunt'S," cora
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Parcel No: (this information is available at the assessors office 970-945-9134)f r7 [ 114-
1 -. OO _ i f 4.
2
Job Address: (if an address haj not been assigned, please provide Cr, Hwy or Street Naame& City) or and legal description)
PC`d p ii it'Vcro S"rccS 1, M;ncofg, Es-1-&-fcs L wtttl.ew P Arte
3
Lot No: Block No: Subd./ Exemptio :
Mi 'Its tt. ffilatcS
4
Owner: (property awn( a
Di' oet l+1lHtcr totah.d6fiah
Mailing Address.
0b0 M.Cc4.a.i
►rwi ,DOI051L
"
r<-
Ph:
i 214521.$70(}
Ph:Alt
410. 42:3.. 9 S 2 ..
Alt Ph;
603-b[
Ph: ' •] B410
q i ..,
5
Contractor: A r
'o PS604-Ces
MailingAddress:
lei,-ticie.kDr� Dri
6
Architect / Engineer:
Mailing Address:
Ph:
Alt Ph:
7
Sq. Ft. of Buildi Q
Sq. Ft. o�rr Acres of Lot:
Height:: t 6tt
' No. ofYloors:
8
Use of Building: f' rr cap. n'
ll r �i O([SC M%�tr C C1%er. �t�+,ti rp S LGr. G �E a/ `
9
Describe Work:
LILStc. b( Ntv k; of IP IMt.s+rr,..l 6IA ISZb
10
Class of Work:
taw o Alteration o Addition
11
Garage:
o Attached o Detached
Septic:
o ISDS o Community
12
Drivew Permit_ D
Lt �cgiiin a.CLCSS road -fpr rwaj
Owners valuation of Work: $
2501000
ptit itA,l� _
,6uthartty. This application for o iuilding Permit must be signed by
letter of authority, signed by thc Owner, must be provided
Legal Access, A Building Permit cannot be issued without proof of
NOTICE
the Owner of thc property, described
with this Application.
legal and adequate access to the
Electrical Permit, (2) County
Discharge Permit.
authorized is not commenced within
CERTIFICATION
contained above is true and
based upon my certification
a Building Permit will be
and my agents will comply with
Regulation(s)) 1 acknowledge
arc not in compliance with
described above, to inspect
if any, discovered after
work by the Building Department
compliance with federal, state
THE NOTICE & CERTIFICATION
above, or an authorized agent. If the signature below is not that of the Owner, a separate
propeny for purposes of inspections by the Building Department..
ISDS Pcrmit, (3) another permit required for use on the property identified above c.g, State or
180 days oldie date of issuance and if work is suspended or abandoned for a period of 180
correct. 1 understand that the Building Department accepts thc Application, along with the plans
as to accuracy.
issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on
provisions of any federal, state or local law regulating thc work and thc Garfield County Building
that the Building Permit may bc suspended or revoked, upon notice from the County, if thc location,
County Regulation(s) or any other applicable law.
the work. 1 funhcr acknowledge that the issuance of the Building Permit does not prevent the
issuance; or (2) stopping construction or use of the structure(s) or facility(ics) if such is in violation
do not constitute an acceptance of responsibility or liability by the County of errors, omissions
and local laws and County Regulations rest with me and my authorized agents, including without
ABOVE:
Other Permits, Multiple separate permits may bc required: (1) State
County Highway/ Road Access or a Stare Wastewater
Vold Permit, A Building Permit becomes null and void if thc work
I hereby certify
and specifications
Assuming
the submittals
In consideration
Code, ISDS
construction
I hereby grant
Building
of County
Review of
or discrepancies,
limitation
1 HEREBY
days after commencement.
that 1 have read this Application and that the information
and other data submitted by me or on my behalf (submittals),
completeness of the submittals and approval of this Application.
reviewed by the Building Department.
of the issuance oldie Building Permit, I agree that I
regulations and applicable land use regulations (County
or use of the structure(s) and facility(res), described above,
permission to thc Building Department to enter the property,
Official from: (I) requiring thc correction of errors in the submittals,
Rcgulatian(s) or any other applicable law
this Application, including submittals, and inspections of the
As the Owner, I acknowledge that responsibility for
my architect designer, cnginccr and/ or builder
ACKNOWLEDGE TH T1 HAVE READ AND UNDERSTAND
OWN
NATUR DATE
Bis
STAFF USE ONLY
Special Conditions:
/dzre Itc)_639 —9S
Adjusted Valuation:
2
Plan Check
SieckFee:
/7
Permit Fee:
Manu home Fee:
Mise Fees:
ISDS Fee:
Total Fees:
Fees Paid:
Balance Due: HP No & issue Date:
ISDS No & issued Date:
6‘SO•e
Pr --.31
.7 ' —12+7
Setbacks:
OCC Group:�
(.y
Const Type:
v- 0
Zonin .•
Y
BLD ' EPT:
P: G DEPT:
APPROVAL D7TE
APP OVA DATE.
45. If you anticipate obtaining a water tap from the City of Rifle, please provide a letter indicating that
the City will provide water service. No building permit application will be accepted without such
a letter.
Yes
Olt
I hereby acknowledge that I have read, understand, and answered these questions to the best of my
ability.
• ceicia, 9(6 -
Li 5/10
Date
Phone:lW.2 5� 7 (days); 1213-235 -2-175 (evenings)
Project Name: VAUc) ra.r''t, ["`tc4f0, �kG1: iarl
Project Address: Pad t t Ir4 ' Kesources Nt;kyrot"k. £*4-4 DrbiC
Note:
On any of these questions you may be required to provide this information. If required information is not
supplied, delays in issuing the permit are to be expected. Work may not proceed without the issuance of the
permit.
*If you have answered "Not necessary for this project" on any of the questions and it is determined by the
Building Official that the information is necessary to review the application and plans to determine minimum
compliance with the adopted codes, please expect the following:
A. The application may be placed behind more recent applications for building permits in the review process
and not reviewed until required information has been provided and the application rotates again to first position
for review.
B. Delay in issuance of the permit.
C. Delay in proceeding with construction.
bpminrepcommMar2009
7
STATEMENT OF AUTHORITY
Pursuant to C.R.S. §38-30-172, the undersigned executes
this Statement of Authority on behalf of
a (corporation, limited liability
company, general partnershi
p, registered limited liability
partnership, registered limited liability limited partnership,
limited partnership association, government agency, trust or
other), an entity other than an individual, capable of holding
title to real property (the "Entity"), and states as follows:
The name of the Entity is
and is formed under the laws of
p j+�TimmAqi&r11
The mailing address for the Entity is ---62u
The name and/or position of the person aLthorized to
execute instruments conveying, encumbering, or otherwise
affecting title to real property_ on beha_f of the Entity is
The limitations upon the authority of the person named
above or holding the position described above to bind the Entity
are as follows: No -me
(it: no limitations, insert "None")
Other matters concerning the manner in which the Entity
deals with any interest in real property are:
(if nu other matter, leave this section blank)
EXECUTED this .11-3t- :ay of
STATE OF 7 x4 -s
COUNTY OF
A/OvAhe
Signature:
taame(typed nr printed: tsC \Oct , -
T]• a (_: an/): ! I -'e t��
, 20
utits
)SS.
)
foregoing instrument was ac ie��J.ed ed et ce me this JVd day of
200 by Por:•� ra�..-tf—
'MAW-
on behalf of
' a AtQ� so,ePa e4-7/oAl.
05/09
Witness my hand and •:,ffi,:i i
fly commission expires:
[SEAL;
ISABELLE A MORO
M•...
-6- 1,1 !VOTARY PUBLIC
�`L r; : State of Texas
Comm. Exp. 02-26-2011
a. >keg—
Notary Public)
STATEMENT OF AUTHORITY
Pursuant to C.R.S. 538-3C-172, the undersigned executes
this Statement of Authority on behalf of ` tu_ nye?, a.44r
a Tex as Pt i i�1 (corporation, limited liability
company, genera partners ip, registered limited liability
partnership, registered limited liability limited partnership,
limited partnership association, government agency, trust or
other), an entity other than an individual, capable of holding
title to real property (the "Entity"), and states as follows:
The name of the Entity is
and is formed under the laws of
OW t :X0'Y1 Y14,044, 0,1
The mailing address for the Entity is 6460 N. 4.1,A,CALedme
The name and/or position of rhe person authorized to
execute instruments conveying, encumbering, or otherwise
affecting title to real property on behalf of t.e Ent'ty is
� 1e44,ek
r
The limitations upon she a..:thority of the person named
above or holding th_e,position described above to bind the Entity
are as follows: NON,
(if no 1 irnitati:•ns, insert "None")
Other matters concerning the manner in which the Entity
deals with any interest in real property are:
(if no other matter, leave this section blank)
EXECUTED this QAb day of A/OV2:7446"— y4, 2009
Signature:
Name Itypel or printed: CLIA A of . (,
AA i4Ii
_ aa ��
` A1
"i.Ie (ti .any):
STATE OF MOS
Il��� AS ISS.
COUNTY OF U/�F+•t�7� }
The foregoing instrument was a:icnow1edoed before me alis � ND day o_
NopVE tg2 Ino? y C�l.�l17 J�1_ 4gYiTie,, on behalf of
7- Ixom &4 'bra/Lao-Pam , a IMKAS NOW MAW" CokA5 44770x/ .
WiLnemy hand and official seal.
My commission expires:
7,5/09 ':? �L;• ISABELLE A MORO
i+fi, 'E NOTARY PUBLIC
State of Texas
%.".10f:`' Comm. Exp. 02-26-20t1
(Ncr.ary Public)
STATEMENT OF AUTHORITY
this Statement of A,.-h•oti-
yjPursuant to CJ,
. . - �b-3t;-;-2, the undersigned executes
c,n behalf -
_ l j1——f (c rp .ran ton, imi
tecliability
COAUary, genal parrrr=nip, `egistered 1_m;ted liabrartnerMhip, registered _ir;_ed:aniiity limitedpartnrship,-=rire: partnership as= tar'.=n,
government agency, trust or
other), an entity othe: -ii..-:t an s:,d i v, c ual, capable of holding
title to real properly i;••."rn:ity"1, and states as follows:
The name o rca 113t -:; [ Aft
and is rormt.ti under !Ale =w: f
The mailing address for :he Entity is
The name and/or ors) -tor: of the person authorized to
execute ir,struments cc veyirg, encumbering, or otherwise
afffr-ctn title to rear property ,-:n behalf of the ;entity is
The limitations upon the aut.hcrity of the person teamed
above or holding the r :s_:i )n described above to bend the E:,tity
are as follows: /y4- AL. -yy
..�� - .. <..,.s Zr
f rir ) in; !' a, ions e" �. ,r,_
::tsar: "None"}
Other matters corwe:-r:ir.g :he manner in which! the Entity
t.
deals with any interesis real property are: fV47c
t -f no t>th ma, t leave this sect, 3n blank)
fl ,
r+�
R�
FXErlr1'EG this 2.3 2= ti, -
Nemo ypE.r' S: ere i:t&etl:
STATE OP 6-04.442-42)_ I . l f 7y �ssAyrCOLNTY OF
9
Tho- w'?�]7:.: tilt _ ri i N�i :�. kii.
��11QQ1 /��// leage�d%before me this �3 gay ui
r..vl!�_ on mohair of
w: thes _ my clan~ .•u.QQ ,- , ;,,,�.
:11 i_UT. U $1:'A�t exp ir.cs:l'-Z3-01
JANET SAMFORD
NOTARY PUBLIC
State of Taxes
Comm. Exp. 09-23-2009
{Notary :ubi:cl
ANTERO
hint' tl 100+1
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1: ht.11 Volk1't. 11 I
Building Plan Review
Description of Work: House water injection pumps and ancillary equipment. Install module
Bin #: D-6
Location Address:
SILT, CO
General Information
rCase Manager. Ken Smith
Plan Case Number. BLDG -1-10-6271
Parcel: 217911400114
Application Date: 11/25/2010
MEM
Owner. Dixon Water Foundation
Applicant Dixon Water Foundation
Applicant Phone: 214-521.8200 Email:
Building
Planning,Zoning
Engineered Foundation Property Line Setbacks
Driveway Permit 30ft Stream Setbacks
Surveyed Site Pian Flood Plain
Septic Permit and Setbacks_Building height
Grade/Topography 30% 7oning Sign -off
Attach Residential Plan Review List Road Impact Fees
Minimum Application Questionnare HOA/DRC Approval
Subdivision Plat Notes Grade/Topography 40%
Fire Department Review Planning Issues
Valuation Determination/Fees Subdivision Plat
Red Line Plans/Stamps/Sticker General Comments:
Attach Conditions
application Signed
plan Reviewer To Sign Application
parceUSchedule No.
40# Snowload Letter - Manu. Homes
Soils Report
Tuesday, January 26, 2010