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Home My WebLink AboutApplicationDocuSign Envelope lD: 49990034-EAAB-47D2-BABF-249O37 5Ð3278 Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 1e70l94S-82t2 www.ga rfield-cou ntv.com TYPE OF GRADING tr MAJOR tr MINOR Gørfield County INVOTVED PARTIES property owner: XTo Energy lnc phone: P32 ) 625-7966 Mailing Address 22777 Springwoods Village Pkwy, Spring, TX 77389 EmailAddress:ma rk.f.warren@exxon mobil. com Contractor:Bid not awarded - Dale Day, Williams CM phone, (509 )710-8935 Mailing Address 13781 Pacific Circle, Mead, CO 80504 EmailAddress:dale.day@will iams.com Rrch¡tect: N/A Phone:() Mailing Address: EmailAddress: DR Griffin . p07 362-5028 Engineer:Phone ) Mailing Address 1414 Elk Street, Suite 202, Rock Springs, WY 82901 EmailAddress:tmorrey@drg-\trY PROJECT NAME AND TOCATION Project N 30" Drip Removal Describe Work:At the Haybarn and Substation locations we are performing work to remove low point liquids collection piping as it is deemed a risk of corrosion concerns without adequate means of measurement. We are pro-actively removing these, they have been in service for only a few years and we do not have concerns of corrosion/leaking having taken place to date Job Address:39.466190', -108.038917" , l-70 Frontage Road, .88 miles north of beginning of the road, Assesso¡/s Parcel Number:2407061001 39 Sub. Lot Block Earthwork (square feet) :40554 Earthwork (Cubic Yards).1502 DocuSign Envelope lD: 49990034-EAAB-47D2-BABF-249037 5D3278 ALL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING NOTICE Author¡tv. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. lf the signature below ís 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. 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, e.g. State or County Highway/ Road Access or a State Wastewater Discharge Permit. Void 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 contai ned ab ove 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 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 Division. ln consideration of the issuance of the Building Permit, lagreethat land myagentswill comply with provisions of any federal, state or local 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 of the structure(s) and facility(ies), 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 construct¡on 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 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 wíth me and my authorized agents, including without limitation my architect designer, engineer and/ or builder I hereby acknowledge that I have read and understand the Notice and Certification above as well as have provided the requ¡red information which is correct and accurate to the best of my knowledge. Docusigned by: l\^j,yL F ll¿wnu luly 7, 202L Print and Sign Date oFFrcrALUsEoNtY ?à # t{ôo.:g ec ø1/otltoztéÞ 4rt t)frrr¡Sfi'r^;;''ô-,r'f; V,,¿t ¿J,u< ryi,þT /0n !trt¿ PtLl ST W)trar;r.s QtN'<.t<9. Permit Fee:ho I Mísc Fees:ñ/n Total Fees:-f4oo.É Fees Paid:* too.9 Balancgdue: r'tN äËÅii'bÊqo lssue Date: otT* /tou Zoning: Rt- 7-7BUILDING / PLANNING DIVISION : Date