HomeMy WebLinkAboutApplication- PermitGarfield County
Building & Sanitation Department
108 8th Street, Suite #201 Glenwood Springs, Co. 81601
Office- 945-8212 Inspection Line- 384-5003
NO. Cf -3s
Job Address O4 02 1 I R �� h
Nature of Work
Use of Buil
Owner
Contractor
Buildine Permit 3T,q j -3- and - (Thc) -
Amount of Permit $ 1. 1 17
GARFIELD COUNTY BUILDING PERMIT APPLICATION 4313 -ail - °°-
11175-
p
Permit No: s JC3 > Parcel/Schedule No: +'n ' �T L;I ` k31- 3"
108 8'° Street, Suite 201, Glenwood Springs, CO 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
AGREEMENT
PERMISSION 1S HEREBY GRANTED TO THE APPLICANT AS OWNER, CONTRACTOR AND/OR THE AGENT OF THE CONTRACTOR OR OWNER TO CONSTRUCT
THE STRUCTURE AS DETAILED ON PLANS AND SPECIFICATIONS SUBMITTED TO AND REVIEWED BY THE BUILDING DEPARTMENT.
IN CONSIDERATION OF THE ISSSUANCE OF THIS PERMIT, THE SIGNER. HEREBY AGREES TO COMPLY WITH ALL BUILDING CODES AND LAND USE
REGULATIONS ADOPTED BY GARFIELD COUNTY PURSUANT TO AUTHORITY GIVEN IN 30.28501 CRS AS AMENDED. THE SIGNER FURTHER AGREES THAT
EF THE ABOVE SAUJ ORDINANCES ARE NOT FULLY COMPILED WITH IN THE LCOATION, ERECTION, CONSTRUCTION, AND USE OF THE ABOVE DESCRIBED
S'TRUCTURE,THE PERMIT MAY BE REVOKED BY NOTICE FROM THE COUNTY AND THAT THEN AND THERE IT SHALL BECOME NULL AND VOID.
THE ISSUANCE OF A PERMT BASED UPON PLANS, SPECIFICATIONS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER
REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS, SPECIFICATIONS AND OTHER DATA OR FROM PREVENTING BUILDING OPERATION BEING
CARRIED ON THEREUNDER WHEN 134 VIOLATION OF THS CODE OR ANY OTHER ORDINANCE OR REGULATION OF THIS JURISDICTION.
THE REVIEW OF SUBMITTED PLANS AND SPECIFICATIONS AND INSPECTIONS CONDUCTED THEREAFTER DOES NOT CONSTITUTE AN ACCEPTANCE OF
ANY RESPONSIBILITIES OR LIABLITIES BY CARFIEID COUNTY FOR ERRORS, OMISSIONS OR DISCREPENCIES. THE RESPONSIBILITY FOR THESE ITEMS
AND IMPLEMENTATION DURING CONSTRUCTION RESTS SPECIFICIALLY WITH THE ARTICTECT, DESIGNER, BUILDER,,Ix.ND OER. COMMENTS ARE
INTENDED TO BE CONSERVATIVE AND IN SUPPORT OF THE OWNERS INTEREST.
Garfem.003 �
MKS( ACKNOWLEDGE THAT I HAVE READ APth°f Ai4D EIS AGREEMENT ACME tlNn'fAL):
R.,s,1 14, 3, 31 CieFt 24 02_
Job Addreso“Ec
6 ct _ itc. Q4Q 1W2. �
..*._
sJXJ2
1 Lot No: Block No: Subd. / Exemption:
2
Owner:lmorris
As
Ph:61g,-"SZ10
s .
3
Contract�/l
Address:
Ph:
Lic. No. .
4
Architect ' eer••
Address:
Ph:
Lic. No.
5
Sq. Ft. of Building:
Sq. Ft. of Lot: j f
Height:
No. of Floors:
6
Use ofBulldiny•
g'
- 7C.JL/�
7
Describe W� .: / I. . •.hei•
8
Class of Work: o N o Alteration ❑ Remove
Addition ❑ Move
9
Garage: a Single
❑ Double
Carport: ❑ Single
o Double
10
o Driveway Permit ❑ On -Site Sewage Disposal o Site Plan
(Septic)
11
Valuation of Work: S,2c er°-
f
AdJv444A. ons: $
2 ,�
12
Special Conditions: a d
'f�Juua/y S, r. -12F.44,4 7- '714.1 t -c RTK'itlf
NOTICE
A SEPARATE ELECTRICAL PERMIT IS REQUIRED AND MUST BE
ISSUED BY THE STATE OF COLORADO.
Plan Check Fee:
The p/
Permit Fee:
421,5c
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORILS NOT COMMNCED WITHIN CONSTRUCTIONZED OR WORK IS SUSPENDED OR 180 BABANDO ED FOR A
PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
'Total Fee: /y / // Dated Permit Issued:
6-1 S• Ma � j aI• SS
///1 / /
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS GOVERNING THIS TYPE OF WORK WILL BE
OCC Group: Const. Type:
�^
COMPLETED WITHIN WHETHER SPECIFIED HEREIN OR NOT. THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY
TO VIOLATE OR CANCEL T. yyy88• °VISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING RUCTION OR THE PERFORMANCE
OF Co ilj 100 i
Zoning:
Setbacks:
•,
1� In 1
'
bs
Manu. Home: ISDS No. & Fee:
S
u t qyt' ER L
t 14 0 1- 25-0S iia.
ATE
/ 7�5-�
B
P C. DEPT.
1ATE APPROVAL/DATE
`�?) .
�t'"5S
AGREEMENT
PERMISSION 1S HEREBY GRANTED TO THE APPLICANT AS OWNER, CONTRACTOR AND/OR THE AGENT OF THE CONTRACTOR OR OWNER TO CONSTRUCT
THE STRUCTURE AS DETAILED ON PLANS AND SPECIFICATIONS SUBMITTED TO AND REVIEWED BY THE BUILDING DEPARTMENT.
IN CONSIDERATION OF THE ISSSUANCE OF THIS PERMIT, THE SIGNER. HEREBY AGREES TO COMPLY WITH ALL BUILDING CODES AND LAND USE
REGULATIONS ADOPTED BY GARFIELD COUNTY PURSUANT TO AUTHORITY GIVEN IN 30.28501 CRS AS AMENDED. THE SIGNER FURTHER AGREES THAT
EF THE ABOVE SAUJ ORDINANCES ARE NOT FULLY COMPILED WITH IN THE LCOATION, ERECTION, CONSTRUCTION, AND USE OF THE ABOVE DESCRIBED
S'TRUCTURE,THE PERMIT MAY BE REVOKED BY NOTICE FROM THE COUNTY AND THAT THEN AND THERE IT SHALL BECOME NULL AND VOID.
THE ISSUANCE OF A PERMT BASED UPON PLANS, SPECIFICATIONS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER
REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS, SPECIFICATIONS AND OTHER DATA OR FROM PREVENTING BUILDING OPERATION BEING
CARRIED ON THEREUNDER WHEN 134 VIOLATION OF THS CODE OR ANY OTHER ORDINANCE OR REGULATION OF THIS JURISDICTION.
THE REVIEW OF SUBMITTED PLANS AND SPECIFICATIONS AND INSPECTIONS CONDUCTED THEREAFTER DOES NOT CONSTITUTE AN ACCEPTANCE OF
ANY RESPONSIBILITIES OR LIABLITIES BY CARFIEID COUNTY FOR ERRORS, OMISSIONS OR DISCREPENCIES. THE RESPONSIBILITY FOR THESE ITEMS
AND IMPLEMENTATION DURING CONSTRUCTION RESTS SPECIFICIALLY WITH THE ARTICTECT, DESIGNER, BUILDER,,Ix.ND OER. COMMENTS ARE
INTENDED TO BE CONSERVATIVE AND IN SUPPORT OF THE OWNERS INTEREST.
Garfem.003 �
MKS( ACKNOWLEDGE THAT I HAVE READ APth°f Ai4D EIS AGREEMENT ACME tlNn'fAL):
R.,s,1 14, 3, 31 CieFt 24 02_
Applican
PLAN REVIEW CHECKLIST
Building
Engineered Foundation S' i c#
�l?Q Driveway Permit' y,j 0.7mWnt
/Sarw.y..d Site Plan 'go f
Q.Septic Permit and Setbacks
‘6{ 30%
L/A��ttach Residential Plan Review List
L'Minimum Application Questionnaire
(/ Subdivision Plat Notes
Ail. Fire Department Review
Valuation Determination/FeeC ,
.../Red Line Plans/Stamps/Sticker
,_ -Attach Conditions tf (�.yi ri,
(Application Signed
tAlan Reviewer To Sign Application
(�arcel/Schedule No. klia-4bj
40# Snowload Letter- Manf. Hms.
GENERAL NOTES:
Date /2 C �Q.3
Planning/Zoning
YProperty Line Setbacks
//1 /4. 30ft Stream Setbacks
Flood Plain
D,4'. Building Height
Zoning Sign -off
//A Road Impact Fees
HOA/DRC Approval
(/(Wade/Topography 40%
4/4 Planning Issues
4/4 Subdivision Plat Notes
z4o ig = 4.320
3ko x=J3-c7- 2344,
4/
/co& 15
GARFIELD COUNTY BUILDING AND PLANNING
970-945-8212
MINIMUM APPLICATION REQUIREMENTS
For
SINGLE FAMILY DWELLING CONSTRUCTION
Including
NEW CONSTRUCTION
ADDITIONS
ALTERATIONS
And
MOVED BUILDINGS
In order to understand the scope of the work intended under a permit application and expedite the
issuance of a permit it is important that complete information be provided. When reviewing a plan
and it's discovered that required information has not been provided by the applicant, this will result
in the delay of the permit issuance and in proceeding with building construction. The owner or
contractor shall be required to provide this information before the plan review can proceed. Other
plans that are in line for review may be given attention before the new information may be reviewed
after it has been provided to the Building Department.
Please review this document to determine if you have enough information to design your
project and provide adequate information to facilitate a plan review. Also, please consider
using a design professional for assistance in your design and a construction professional for
construction of your project. Any project with more than ten (10) occupants requires the plans
to be sealed by a Colorado Registered Design Professional.
To provide for a more understandable plan in order to determine compliance with the building,
plumbing and mechanical codes, applicants are requested to review the following checklist prior to
and during design. Applicants are required to indicate appropriately and to submit the
completed checklist at time of application for a permit.
Plans to be included for a Building Permit, must be on drafting paper at least 18"x24" and
drawn to scale.
1
Plans must include a floor plan, a concrete footing and foundation plan, elevations all sides with
decks, balcony, steps, hand rails and guard rails, windows and doors, including the finish grade line
and original grade. A section showing in detail, from the bottom of the footing to the top of the roof,
including re -bar, anchor bolts, pressure treated plates, floor joists, wall studs and spacing, insulation,
sheeting, house -rap, (which is required), siding or any approved building material. Engineered
foundations may be required.
A window schedule. A door schedule. A floor framing plan, a roof framing plan, roof must be
designed to withstand a 40 pound per square foot up to 7,000 feet in elevation, a 90 M.P.H. wind
speed, wind exposure B or C, and a 36 inch frost depth.
All sheets to be identified by number and indexed. All of the above requirements must be met or
your plans will be retumed.
All plans submitted must be incompliance with the 2003 IRC.
1. Is a site plan included that identifies the location of the proposed structure or addition and
distances to the property lines from each comer of the proposed structure(s) prepared by a
licensed surveyor and has the surveyors signature and professional stamp on the drawing?
Properties with slopes of 30% or greater must be shown on the site plan. (NOTE
Section: 106.2) Any site plan for the placement of any portion of a structure within 50 ft
of a property line and not within a previously surveyed building envelope on a
subdivision final plat shall be prepared by a licensed surveyor and have the surveyor's
signature and professional stamp on the drawing. Any structure to be built within a
building envelope of a lot shown on a recorded subdivision plat shall include a copy
the building envelope as it is shown on the final plat with the proposed structure located
within the envelope.
Yes ✓
2. Does the site plan also include any other buildings on the property, setback easements and
utility easements? Please refer to Section 5.05.03 in the Garfield County Zoning Resolution
if the property you are applying for a building permit on is located on a corner lot. Special
setbacks c).9. -apply.
Yes
3. Does the site plan include when applicable the location of the I.S.D.S. (Individual Sewage
Disposal System) and the distances to the property lines, wells (on subject property and
adjacent properties), streams or water courses?
Yes i.ld
2
4. Does the site plan indicate the location and direction of the County or private road accessing
the property?
Yes ✓
5. Do the plans include a foundation plan indicating the size, location and spacing of all
reinforcing steel in accordance with the IRC or per stamped engineered design?
Yes
6. Do the plans indicate the location and size of ventilation openings for under floor crawl
spaces and the clearances required between wood and earth?
Yes O m
7. Do the plans indicate the size and location of ventilation openings for the attic, roof joist
spaces and soffits?
Yes 140
8. Do the plans include design loads as required by Garfield County for roof snow loads, (a
minimum of 40 pounds per square foot up to & including 7,000 feet above sea level), floor
loads and wRad
Yes ��*n ,
9. Does the plan include a building section drawing indicating foundation, wall, floor, and roof
construction?
Yes
10. Does the building section drawing include size and spacing of floor joists, wall studs, ceiling
joists, roof rafters or joists or trusses?
Yes1EF.-44/44l-PED11;00t dyer
11. Does the building section drawing or other detail include the method of positive connection
of all cglumns and beams?
Yes t1O
12. Does the plan indicate the height of the building or proposed addition from the highest point
of the building or addition measured at mid span between the ridge and the eave down to
existing (undisturbed) grade contours?
Yes ✓
13. Does the plan include any stove or zero clearance fireplace planned for installation including
make and model and Colorado Phase II certifications or phase II EPA certification?
Yes No '
14. Does the plan include a masonry fireplace including a fireplace section indicating design to
comply with the IRC?
Yes No
15. Does the plan include a window schedule or other verification that egress/rescue windows
from sleeping rooms and/or basements comply with the requirements of the IRC?
Yes No V
16. Does the plan include a window schedule or other verification that windows provide natural
light and ventilation for all habitable rooms?
Yes No t'
17. Do the plans indicate the location of glazing subject to human impact such as glass doors,
glazing immediately adjacent to such doors; glazing adjacent to any surface normally used as
a walking surface; sliding glass doors; fixed glass panels; shower doors and tub enclosures
and specify safety glazing for these areas?
Yes No
18. Is the location of all natural and liquid petroleum gas furnaces, boilers and water heaters
indicated on the plan?
Yes No
19. Do you understand that if you are building on a parcel of land created by the exemption
process or the subdivision process, are building plans in compliance with all plat notes and/or
covenants?
Yes ✓ No
20. Do you understand that if you belong to a homeowners association, it is your responsibility
to obtain written permission from the association, if required by that association, prior to
submitting an application for a building permit? The building permit application will not
be accepted without it.
Yes ✓ No
21. Will this be the only residential structure on the parcel?
Yes No If no -Explain:
22. Have>o o (2) complete sets of construction drawings been submitted with the application?
Yes
23. Do you understand that the minimum dimension a home can be on a lot is 20ft.wide and 20ft.
long?
"eYes No
4
24. Have you designed or had this plan designed while considering building and other
construction code requirements?
Yes No IJP
25. Do your plans comply with all zoning rules and regulations in the County related to your
properties zoite district?
Yes No
26. Does the plan accurately indicate what you intend to construct and what will receive a final
inspection by the Garfield County Building Department?
Yes No
27. Do you understand that approval for design and/or construction changes are required prior to
the application of these changes?
Yes No A'
28. Do you understand that the Building Department will collect a "Plan Review" fee from you
at the time of application submittal and that you will be required to pay the "Permit Fee" as
well as any "Road Impact" or "Septic System" fees required, at the time you pick up your
building permit?
Yes No
29. Are you aware that you must call in for an inspection by 3:30 the business day before
the requested inspection in order to receive it the following business day? Inspections
will be made from 7:30 a.m. to 3:30 p.m. Monday through Friday. Inspections are to be
called in to 384-5003.
Yes No a►
30. Are you aware that requesting inspections on work that is not ready or not accessible will
result in a $47.00 re -inspection fee?
Yes No
31. Are you aware that you are required to call for all inspections required under the IRC
including approval on a final inspection prior to receiving a Certificate of Occupancy and
occupancy of the building?
Yes No 1A`
32. Are you aware that the Permit Application must be signed by the Owner or a written
authority being given for an Agent and that the party responsible for the project must comply
with the IRC?
Yes No
5
33. Are you aware that prior to submittal of a building permit application you are required to
show proof of a driveway access permit or obtain a statement from the Garfield County Road
& Bridge Department stating one is not necessary? You can contact the Road & Bridge
Department at 625-8601.
Yes No
34. Do you understand that you will be required to hire a State of Colorado Licensed Electrician
and Plumber to perform installations and hookups, unless you as the homeowner are
performing the work? The license number of the person performing the work will be
required at time of applicable inspection.
Yes '� No
35. Are you aware, that on the front of the Building Permit Application you will need to fill in
the Parcel/Schedule Number for the lot you are applying for this permit on prior to submittal
of a building permit application? Your attention in this is appreciated.
Yes No
36. Do you know that the local fire district may require you to submit plans for their review of
fire safety issues? Yes No (please check with the
building department about this requirement) aa
I hereby acknowledge that I have read, understand and answered these questions to the
best of my a ty.
41- al b t&j
Signature o'f Owner
Phone: cO - tl� (days);
Project Name: `1' Tl GT` �%�,�,(� /,'per -, `
Project Address: COO an- �C2!SO (f2- £M 4N 4'}
Date
(evenings)
Notes: If you have answered "No" on any of the questions, you may be required to provide this
information at the request of the Building Official prior to beginning the plan review process.
Delays in issuing the permit are to be expected. Work may not proceed without the issuance of a
permit. If it is determined by the Building Official that additional information is necessary to review
the application and plans to determine minimum compliance with the adopted codes, 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, delay in issuance of the permit or delay in proceeding with construction.
Bpminreg0ct2004
6
RF c
BUILD,N- ; L:
22 December 2004
Steve Hackett, Building Inspector
Garfield County Building & Planning
109 8's Street
Glenwood Springs, CO 81601
970-945-8212
RE: Pitts Residence
485 CR 112
Dear Steve,
ordan Architecture Inc.
After discussing the issues at hand in regards to the aforementioned residence, I have come up with the
following existing conditions to accommodate the Uniform Building Cade/Intemational Building Code to
satisfy Garfield County.
Existing Conditions:
1. Shop Addition (approx. 10' x 24') with shed roof extension from existing garage. 2 x 12 rafters @
24" O.C. Roof spans of 10' from bearing to bearing, is in excess of minimum requirements.
2. Exercise Room Addition (approx. 24' x 24') with gable roof. 2 x 12 ratters @ 24" O.C. 5 1/8" x
21" Glue I amid Ridge Beam. Roof spans of 12' from bearing to bearing, is in excess of
minimum requirements.
3. Exterior wall coition is 2 x 6 @ 16" O.C. with R-19 batt insulation.
4. Roof insulation is R-30 batt insulation between roof rafters.
5. The roof has been ventilated at the ridge with a continuous vent
Conclusions:
1. The Shop and Exercise Room Additions have been constructed to meet the current Building
Codes.
2. Roof ventilation should be continuous from the eave to the ridge. Therefore, cave vents should be
installed to accommodate this requirement. The two options would be to have a continuous eave
vent or 1-3" diameter vent in each rafter space at the underside of the eave.
Therefore, 11 is my opinion that the existing structure and addition meet or exceed the requirements of
Garfield County with the noted exception above.
If I can be of any further assistance in this matter, please feel free to contact me.
410 20th Street, Suite 204 • P. O. Box 1031 • Glenwood Springs, Colorado 81602 • Phone: 970-947-1837 • Fax: 970-947-0425
COUNTY OF GARFIELD - BUILDING DEPARTMENT
CORRECTION NOTICE
108 8th St., Suite 201 Glenwood Springs, Colorado
Phone (970) 945-8212
Job located at QL/SC Ole ) 1 2._
PermitNo. q 3 80
1 have this day inspected this structure and these
premises and found the following corrections needed:
Q SJe-60 reekn nic k acid &J £4 D , \-Aaivedi
lam/ kit 00.3 k 11444- S prm - Let)kiin.>
p le t÷se 5 10 € n -k e a.. eo_Q) i t -14,e
G1y5-SLIZ- LXT. tlsln
You are hereby notified that the above correction must be inspected
before covering.
When correction(s) have been made, call for inspection at 970-384-5003.
Date .2 -15 'OS—
Building
oSBuilding Inspector's
Phone (970) 945-8212
ng xnspezt ors—To: 314-4ru PAGE. 00. OF OU1
COLORADO STATE ELECTRICAL BOARD
1580 Logan Street, Suite 550
Denver, CO 80203-1941
Inspection Report
Date Inspected: 02/01/2005
PERMIT #: 544535
Permit JIM PITTS
Holder: 485 COUNTY ROAD 112 CARBONDALE 81623
Phone: 963-0950 Fax: Email: jimigIandscapeworkshopinc.com
Site 485 County Road 112 Carbondale, Garfield County , 81623
Owner: JIM PITTS Phone:
Status Accepted
Inspection type: Final Partial Inspection:N
ADDITION RESIDENTIAL Trim Permit:N
Inspector: Greg Winders 970-625-4561
Corrections:
230.2E --Permanently identify combinations of services, feeders, or circuits supplying a building
Comments:
Installer on site making corrections
Card signed for C.O.
I checked some make up at switches receptacles and luminaires and the panel. This wiring is
professionally and soundly done.
2/2/2005 Page 1
Na
93sr
Job Address 17` �S
Owner % lL
Assessor's Parcel N
BUILDING PERMIT C RD
(-,-/l a ca
) Address
Contracto ) j VTh P
Setbacks: f Front
oc9 3 S.3/ -to -d%G
Date V/9705
Phone #91 a&3
Address Phone #9C- sG
RH LH Zoning
INSPECTIONS
Sols Test
Footing
Foundation
Grout
Underground Plumbing
Rough Plumbing
Framing
Insulation
Roofing
Drywall
Gas Piping
NOTES
Weatherproofing
Mechanical
Electrical Rough (State)
Electri al Final (S te)
Final 2CO. ecklist Completed'
Certificate Occupancy #
Date
Septic System #
Date
Final
Other
(continue on back)
BUILDING PERMIT
GARFIELD COUNTY, COLORADO
Date Issued.//4s7 /Zoned Area Permit No �-"[.;;.Z
AGREEMENT
In consideration of the issuance of this permit, the applicant hereby agrees to comply with all
laws and regulations related to the zoning, location; construction and erection of the proposed
structure for which this permit is granted, and further agrees that if the above said regulations
are not fully complied with in the zoning, location, erection and construction of the above
described structure, the permit may then be revoked by notice from the County Building
Inspector and IMMEDIATELY BECOME NULL AND VOID. <
Use �ti J 1��IFv�—. /, s • s s
rpsd�Lc&fl Description 3
Own
Add
Contractor Cacta-n-itste
Setbacks Front Side Side Rear
This Card Must Be Posted So It is Plainly Visible From The Street Until Final Inspection.
INSPECTION RECORD
Footing
Foundation
Underground Plumbing
Insulation
Rough Plumbing
Drywall • •
Chimney & Vent
Electric Final (by State Inspector),, ( �tki.1
Gas Piping
Final <
<
3 _ z=03 71
Electric Rough (By State Inspector)
Septic Final
Framing
(To include Roof in place and Windows
and Doors installed).
Notes:
ALL LISTED ITEMS MUST BE INSPECTED AND APPROVED BEFORE COVERING -
WHETHER INTERIOR OR EXTERIOR, UNDERGROUND OR ABOVE GROUND.
THIS PERMIT IS NOT TRANSFERABLE
Phone 384-5003 109 8th Street County Courthouse Glenwood Springs, Colorado.
APPROVEDDO NOT DESTROY THIS CARD
Date I 2`]I/1By
alat
IF PLACED OUTSIDE = COVER WITH CLEAR PLASTIC