HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.ga rfiel d -c a unty.com
7 ....., ,
BUILDING PERMIT 1
APPLICATION
I lir&
TYPE OF CONSTRUCTION
Commercial/Multi-Family
Demolition
Manufactured Home (Single or Multi -Level)
Residential (SF, Duplex or Townhome) U Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
INVOLVED PARTIES
1
PropertyOwner: Jason Dru Clark Phony (970 ) 379-0303
Mailing Address 460 County Road 259 - Rifle, CO 81650
Email Address lasonc@oksatealumni.org
Contractor: O1- , ,.1L,,,.v—S eAc, Phone: ( fid) 9�Ilk- 7o 2- Lf
Mailing Address:, 2- 3 t:' .cpYrrr_r (123c, -r l 1coo
441
Email Address: C.) ravwir, ® yd. at) I C F14
I Architect: i l i&1. o1klsrrv- Phone•( )
Mailing Address.
Email Address:
Engineer: _ \,\cr L&.\ A cL r . 0.4-N\ Phone• (
Mailing Address.
Email Address •
Manufactured Home Installer: Phone: (
Mailing Address
Email Address:._
PROJECT DETAILS
Describe Work*
Job Address. 60
Assessor's Parcel Number
)
Sub. Lot Block
co
Owner's Valuation ofWork:6)rr1r6 Property Size (Sq.Ft. orAcres):_t: _dG?
Sq.Ft.ofBuilding: ,2 WO Height: , j" #of Floors: ol-
Class of Work:
Garage:
New
Remodel/Alteration
Addition
Attached
Detached
PROJECT DETAILS CONTINUED
Septic: f nOWT'S n Community
Type of Heat: nNatural Gas 71 Propane n Electric I❑ Other
Driveway Exempt Permit#
Permit:
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above,
oran authorized agent. If the signatu re below is notthatofthe 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.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, c.g. State or County Highway/ Road Access
ora State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days
ofthe dateofissuanceand ifwork is suspended orabandoned fora period of 180daysaftercommencement.
CERTIFICATION
I hereby certify that I have read thisApplication and that the information contained above istrue and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me oron my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of thisApplication, a Building Permit will be issued granting
permission to me, as Owner, to constructthestructure(s) and facilitiesdetailed on the submittals reviewed by
the Building Division. In consideration ofthe issuance ofthe Building Permit, I agreethat I and my agents will
comply with provisionsofany federal, stateorlocal law regulating the work and the Garfield County Building
Code, OWTS 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
ofthe structure(s) and facility(ies), described above, are noti n compliancewith County Regulation(s)orany
other applicable law.
I herebygrantpermission totheBuilding Division toenterthe property, described above, to inspect the work. 1
furtheracknowledgethattheissuance ofthe Building Permit does not preventthe Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping
construction oruseofthestructure(s) orfacility(ies) ifsuch is in violation ofCounty Regulation(s)oranyother
applicable law. ReviewofthisApplication, including submittals, and inspectionsofthe work bythe 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 restwith me and my authorized agents, including without limitation my architect
designer, engineer and/ or builder.
hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required in
L
Jason D. Clark _
Property Owner Print and
nd accurate to the best of my knowledge.
7-3 -�
Date
OFFICIAL USE ONLY
Special Conditions:
L.1 m f - NJGIl f
epiIi 76 2WRiligitIV,11
6fipmsted Valuation:
.7c1/ DE0
Plan Check Fee:
414
PermitFee:
N1. 7Jr
Mint'. Home Fee:
.
Misc. Fees:
Total Fees:ees
7� $ , 81
Paid:
$3c0. 203
BalanceBP
Due: 72 , oG
No:
-Vi If
OWTS No:EyISflN&
a3°I ON
Setbacks:
OCC Gr up: Const
T pe:
Zoning: ppp
BUILDING/PLANNING
VA.
DIVISION: 1`T
Si. =dA ; •royal Date
P1) 3'* •06'3, CGS } lip
NOTE: If any required information is missing, delays in issuing the permit are to be expected. If
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge I have read, understand and will abide by the requirements of this
checklist.
Jason D. Clark
Property Owner Print
y_3 -rte
July 29, 2020
Date