HomeMy WebLinkAboutApplicationc:E Garfield County
Community Development Department
108 au. Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
D Commercial/Multi-Family I D Demolition
D Manufactured Home (SF or Duplex)
_g Res i dential (SF, Duplex, orTownhome) I D Re r oof
INVOLVED PARTIES
Property owner: Curfjs k a1Afm~n. Phone: ( )
Mailing Address: '7'70 5 c hoon e ~ Letne C Cir btn ofa I~
Contractor: fl i 0.X R oonn1 Phone: ( 011 {) ) q g 7. 3 q ? 2
0 -
Malling Address: L/ o l Pt4rt fhrv (ArJlf-.D Msa tr f o t L(ti)_ l
Architect: Phone: ( )
Malling Address:
Engineer: Phone: ( )
Mailing Address:
Manufactured Home Installer: Phone: ( )
Mailing Address:
PROJECT NAME AND LOCATION
Describe Work: ~en10\"e \eat~ ccof (Cor --fc11 s t~(\d/fl,·l Sean,,). /fJ Sftrl J
1 /~" Den)dafl 1 ~O Yhi I TVO' Ro6f (Clari A-lrssen /hltj·
Job Address: 7 lo 5L-f'J Od n~IG {;rive rt11btnd uu t cJ g/0 23
Assessor's Parcel Number: 2 3 '1 I 2 '' ?o ~DJ -f Sub. St 1tl I~ f<.t\f\ Ch lotke1ock __
Owner's Valuation of Work: $ 14 I ~f70 Property Size (Sq .Ft or Acres):
Sq.Ft of Building: Height: ~o· #of Floors: ~
Class of Work: D New j D Alter ation I D Addition f !Fair I D Move/Relocation
Garage: D Attached D Detached
Septic: 015D5 D Community
Type of Heat: D Natural Gas I D Propane I D Electric 1 Cl Other
Driveway Permit: D Exempt D Permit#:
t hereby cettlfy tNt thaw! r.ad thh Applk'ation and Nt the inh>nnltJon conta~ above ls true and correct I
u"detuand thn the 8ulid1ng OMsion accepts the Appial1on, .;on, with the pl i m .ind ~~flutt-~; and athar
.Uta wbmltud bv me or on my behaff fsubmitulsL hued upan my artatitabOtl ;as to accuracy Assuming
comJ*tmeu of the svbmlttab artd ipprcml of this ~tfon , 1 Buildlna PMT'it will be iuued y.anttna
pemtulott to me, n Owrurr, to consiruct tht! srructurl!'(t) and fKWties det.ailed on th~ subnrin~fs rtMt'Wed by the
Buddi"I OMslon. In cansidetation of the issu.anu of tM SuUc:Una Pftmit. 1 ~ff th.it I and mv acents llltiII comptv
with provil'°1\S of ~Y feder.1 1. stale ot local taw rqutalins IM work .-nd th~ GMfleld Cou nty Buildinl Codf. tSOi
! r~t!oe and~~ l~d UH rect-tfatiom {Cou nty R--cutatlon(s}! I Mk~~ that I~ BuMd ~& Permtt
may a.~ or rcrwooked , upon notice from the County. U w location, construction or U$e of the structur et s )
j and fldUty(iaL dncrtbed lbcwe, 1ru'Ot in ccmpltance with COunty Regul1tlonbl or 1nyother applicable law.
I h~eby lflnt pennlsstop ID the Bulldlna DMslon to ent~ the ptoPerty. described above. to Inspect th~ work I
further acknowlcdp that the iu&aance of the 81.rikfina Permit doa not prevent the BuikHn1 Official from . ( 1)
NH;Wrfnl th• corrft'dan of erron"' me submittal$. ~I •nv~ ~ 1ft~ ~e. or (2} it~ construcrlon
or use of~ 1truaurt(sl or tadlltv(les) tf such ts In vkntJon of County ~gvlatfon(1 J or anv ot~ ippitc:..~ ~ 1
Rcrwiew at this Applbtlon. Anc:kldin1 ~ mes JnsoectJons of the WOtt bV the ButJdina OMiion do not
toMUtutt! •n UUpUnu of r~ 01 Uablllty by ihe County of rnOB. omissions or dlsuepandes.. As the ll
Ovtner, I 1ellnoWdp that ~bHftv far can'll)M&nce with fedem. 5tallt 1nd foal law1 and County Jte&i,tlatloni
1 mt wtth me ind my 1uthorUed »tents. lndudlnl \ltlthout Umitltlon my ~rthite<t desienet, engtneer and/ or
bu~
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T Gta:I fe!K~ fftshld: ...... Dur. W!li ISDSftll
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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.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of Inspections by the Building Division .
Qther Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISOS 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 Division 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 submlttals and approval of this Application, a Building Permit will be Issued granting
I permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. 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, ISOS
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility(les}, described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or factlity(ies) if such rs in violation of County Regulation(s) or any other applicable law.
Review of this Application, including submlttals, and inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I 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 desfgner, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information which Is correct and accurate to the best of my knowledge.
Property Owner Prin'f'and Sign
v'S/(<)
Date
OFFICIAL USE ONL V
Spedal Conditions:
Adjusted Valuation: Plan Check Fee: Manu home Fee: Misc Fees:
Total Fees: Fees Paid: a:> Balance Due: !f.!!2:
4/(J{J. 60 ~/ti ~ co 1(ro ·F-L/2' ..
Setbacks: OCCGroup: Const Type: Zoning:
(-1 J-R \ G p
BUILDING/ PLANNING DIVISION : ~JA!a.k.~f (o,/(o I {fl.
Signed Approval Oate