HomeMy WebLinkAboutApplicationGrrt:) 24472 tom,
108 8't' Street, Suite 401, Glenwood Springs, CO 81601
Ph:970-945-8212 Fx:970-384-3440 Inspection Line:888-868-530
www.garfield-caunty.com
BUILDING PERMIT APPLICATION
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Parcel No: (this information is available at the assessors office 970-945-9134)
3'f - 33t 7001
Lot No: Block No: Subd./ Exem,}'tion: cf p 4
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Job Address: (if an address has not been assigned, please provide CR, HWY or Street & City) or and legal description
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Owner: ronnertyowner)Mailin
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Address:
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Ph:
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Alt Ph:
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Contra�ctc :Mailing
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Address: Le;
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Pb:
614/67-64-i7
Alt Ph:
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' Manufactured home installer:
Mailing Address:
Ph:
Lic #:
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Architect:
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Mailing Address:
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Ph:
Alt Ph:
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Engineer:/ ttr (��I
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Mailing Address: / d.utS•
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Ph:
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Alt Ph:
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Sq. Ft. of Building: ,
Sq. Ft. or Acres of Lot:
Height:
No. of Floors:
9
Use of Building:Class
1 esidential ❑Commercial ❑OtherTew
of Work:
DAlteration DAddition ❑Repair ❑Demo DMove
10
Describe Work: 1�Iter (J g / {'
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Garage:
DAttached etached
Septic:
,ISDS ❑Community
Type of Heat:
[Nat. Gas ❑Propane Electric DOther
12
Driveway Permit:
Owners valuatio of Work:
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. If the signature below is not that of the Owner, a separate
letter of authority, signed by the Owner, must be provided with this Application.
,I-eaaI Access, A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Department.
Other Permits. Multiple separate permits may be required: (I) State Electrical Permit, (2) County ISDS 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.
Vold Permit, A Building 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 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 Department 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 Department.
In 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, 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 structu re(s) and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to die Building Department 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 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 Department do not constitute an acceptance of responsibility or liability by the County of errors, omissions
or discrepancies. As the Owner, 1 acknowledge that responsibility for compliance with federal, state and local laws and Comity Regulations rest with me and my authorized agents, including without
limitation my architect designer, engineer and/ or builder.
I HEREBY ACKNOWLEDQ THAT I HAVE READ AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE:
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OWNERSaSI ATURE DATE
PIOnY I1-7.1
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STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
/9y, ood '
Plan Check Fee:
BDt .t/lJ
Permit Fee:
,,/, y6). /5-
Manu home Fee:
-
Mise fees:
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Total Fees:
2 ° (i 6. Z5-
Fees Paid: �}
,o'11 .LT 5
Balance Due:
BP No& Issue Dale:
ISDS No & issued Date:
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Setbacks:" / /
/= z3, 1225, 510
OCC Group:
rgC,
Const Type:
:roc_
Zoning:
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APPRAL DATE
V
APPROVAL DATE:
1
Building Plan Review
Description of Work: Bam
Bin #:
Location Address: 4264 CR 117
GLENWOOD SPRINGS, CO
•
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General Information
Case Manager: David Bartholomew
Plan Case Number: BLDG -11-12-7432
Parcel: 239503307001
Application Date: 11/07/2012
Contacts
Owner: John Groth
Applicant: John Groth
Applicant Phone: (970)945-6427 Email:
Building
Engineered Foundation
Driveway Permit
Surveyed Site Plan
/ Septic Permit and Setbacks
Grade/Topography 30%
Attach Residential Plan Review List
Minimum Application Questionnare
t.i/ A Subdivision Plat Notes
/ /fFire Department Review
Valuation Determination/Fees
Red Line Plans/Stamps/Sticker
Attach Conditions
Application Signed
f Plan Reviewer To Sign Application
Parcel/Schedule No.
I 40# Snowload Letter - Manu. Homes
Nr Soils Report
Planning/Zoning
Property Line Setbacks
30ft Stream Setbacks
Flood Plain
Building height
Zoning Sign -off
/1/0 Road Impact Fees
/4-1/4 HOAIDRC Approval
Grade/Topography 40%
Planning Issues
Subdivision Plat
General Comments:
Thursday, November 8, 2012