HomeMy WebLinkAboutApplication - Permit2
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GARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8111 Street, Suite 401 , Glenwood Springs, Co 81601
Phone: 970-945-8212/ Fax: 970-384-3470 /Inspection Line: 970-384-5003
Use of Bu ilding: SJ
I
9 Describe Work : ~~-+~~~~~~~LP~~~~b~Pc~o~u-~~-~~rl __ 7C~o ~=-~--~--------------------------------~~~-K~M-~~~~~~~
10 Class or Work :
oNew
II Garage :
1J Attached
12 Driveway Pennit:
o Altemtion
o Detached
Addition
Septic:
oiSDS
, Owners voluation or Work:
!
s
NOTICE
oCommuni
~. This application for a Building Permit must be signed by the Owner of the propcny , dcsaibcd above, or an authorited agall lfthe signature below is llOithll of the Owner, a separate
leiter of aulhorily, signed by the Owner. musl be provided with this Appliwion .
l.epl Amss, A Building Permit c:annot be issued without proof oflcgal and adcquale access to the property for purposes of inspcclions by the Building Department
Other Pmni!J. Multiple scparate permits may be required: (I) Stale Elecuical Penn it. (2) Counly ISDS Permit, (3) another permit required for use on the ]II'O]ICI1Y idcnlilied above, e.g. Stale or
Counly Highway/ Road Access or a Stale Wastewater Disdtarcc Pmnil
Void PermiL A Building Permit becomes null and void if the woO: authorized is not mmmcnccd within ]80 days of the date ofissuanQ: IUid if work is suspended or abandoned for a period ofl80
days after commenc::cmcnL
CERTIFICATION
I hen:by ccrtil)l thai I have n:ad this Applicalion and thai the inform.~lion contained above is ll'IIC and correct. I understand thai the Building Ocputment '"CJIIs the Applicalion, along with the plans
and spc:cilicalions and other data submitted by me or on my bdlalf(submittals), based upon my catilicalion as toaCCUJllcy ,
Assuming completeness of the submittals and approval of this Appl ication, a Building Pamit will be issued granting permission 10 me, as Owncr,lo consuuc:t the strudurc(s) and fac:ilitics dc:lailed on
lhc submittals reviewed by the Building llepattmcnt
In consideration of the issuana: of the Building Permit, I agree that land my agents will ClOIIIply with proYISions llf uy fcdcral. state or local law rq;ulalins the woO: and the Glflield County Building
Code, ISDS rcsuJalions and applicable laad usc rq;ulalions (Cilunly Rq;ulalion(s)). I admowledgc thai the Building Pcrnut may be suspended or rnokcd. upon notice from the County. if the localion.
consuuction or usc of the structurc(s) aad facil ily(ics). dcsaibc:d above, arc nol in compli~ with Counly Rcgulation(s) or uy other applicable law .
I hen:by grant permission to the Building Department to enter the prqxo1y, dc:saibcd ebovc, to inspect the woO:. I further admowledgc thalthe iSSU~J~CCofthe Build ing Pamil docs not prcvCSIIthe
Building OIT'ICial fiom: (I) requiring the corrcttion of errors m the submnllls, if any. discovered after issuance; or (21 Slopping consuuc:tJon or usc of the struCIW'I:(s) or facilily(ics) if such is in violation
of County Rc:gulalion(s) or any other applicable law .
Review of this Appl ication. including submittals, IUid inspcaions of the wort by the Bui lding Depuuncnl do not constitute aniiCI:CJllliiiCc of n::sponsibilily or liabilily by the Counly of emn, omissions
• or disaq>ancics. As the Owner, I admowlcdgc thai n:sponsibilily folo Clllllpliaw;c with federal , statc aad local laws and Counly Rc:gubtions rest with me and my authorited agents. including without
limitation my an:hilect designer, engineer and/ or bu1ldcr ...L.
I HEREBY ACKNOWLEDGE TIIA T IIIAVE ~D AND ~DERST AND f ilE :OTICE &. CERTIFICATION ABOVE: ~~~ v._ L)t,.__) I
0
-() f ~~RS SIGNATUR't DATE
STAFF USE ONLY
i Special Conditions:
Adjusted Valuation: Plan Check Fee: Permit Fee: "l.S' Manu home Fee: Mise Fees:
:L (..,\ \ '\l.., ~ (,.. :)..S'"\) \ ~'\\ cp t;Y
ISDS Fee:
Total Fb~ ( Sy ,~·-1 \ Balance Due: ~ ~:~~t3rSf~·~~-~ ISDS No & Issued Date: ({ 5~b ~(tPr
Setbacks: OCCGroup: ConstType: . Zoning:
~(U.,
BLDG DEPT: PLNG DEPT:
~\..1--. ~ L\ ... \~ ,Of) U_\ \ll '-\ -\\. ~eN
APpno:.tl DATE I APPiti)\\\}.. DATE
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. __ ~~~-----------
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 v:=:::
36 . Do you know that the local fire district may require you to submit plans for their review of fire safety
issues?
Yes r:::=: (please check with the building department about this requirement)
37. Do you understand that if you are planning on doing any excavating or grading to the property prior
to issuance of a building permit that you will be required to obtain a grad ing permit?
Yes v--
38. Are you aware that if you will be connecting to a public water and/or sewer system, that the tap fees
have to be paid and the connections inspected by the service provider prior to the issuance of a
Certificate of Occupancy?
Yes V:: ~/It
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I hereby acknowledge that I have read, understand and answered these questions to the best of
my ability.
~ .. ~,.. I.;-~_, .11 ,.<~.,: o'~ » ;;> Signature of Owner Date
-4 -1 -o8'
Phone: ,-,o -R7 fw. -5 73 L (days); j 7b -i' 7 L -":)7 3 f (evenings)
Pr~ectName:. ____ ~P~~~v~r~=~~~cl~~/~~b~t~~~~~~~o~J~J~-------------------------
Project Address: 0 Lf ' 1 ~r--o E6 I A AI £ .C , l... T ~ o L c . gn.::,-:2. J
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Garfield County
Building & Planning Department
108 8th Strut, Suite #401 Glenwood Springs, Co. 81601
Offlr:e:970.945-8212 Fax: 970-384-3470
Inspection Line: 970.384-5003
Building Permit No. /0Cf33
Parcel No: 2127-364-00-046
Locality:
Job Address:--------·-041 r~!261, ~It
Use of Building: Enclosed porch for sunroom --------------------
Owner: ____ D_a_rd.ynski, La ny. ______________ _
Contractor: ___________ B_o_b_L_,ay.__man/ Wood Peeker Work ~hop Inc _
Fees: Plan Check: $ 254.31 Septic:
Bldg Permit: $ 391.25 Other Fees:
Total Fees: $ 645.56
Clerk: (!.~ Date: 11t =a-llf I J 61) J> I
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