HomeMy WebLinkAboutApplicationGørfield County
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6sCommunity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
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www.garf ield-countv.com
BUILDING PERMIT
APPLICATION
l--l Commercial/Multi-Family E Demolition
E Manufactured Home (Sinele or Multi-Level)
fl ReroofE Residential (SF, Duplex orTownhome)
Phone:
Email
MailingAddress:
Property
Phone:
ð"Mailing Address:
Email Address:
Phone:êbt só6 -ôsff
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Arch¡tect:
Mailing Address:
Email Address:
/¡)ørr-Ê-s el -fu^Phone:
Mailing Address:
Engineer:
"/ðrczEmail Address:¿r¿,eful4,ÉÊst a
ç3OrOfø' - Propertys¡ze(sq.Ft.orAcres): /,á ¿¿ 5
Describe Work:
Phone:
/
Height:
Block
Owne/s Valuation of Work:
Sq. Ft. of Building:
Manufactured Home lnstaller:
Assessol's Parcel Number:
Job Address:
Sub. lot
* ol Floorsz ,/
Mailing Address
Email Address:
l_lAlteration ll Rddition ll Repair | | Move/RelocationClass of Work:ffi ruew
!Rttacrreo ,[SfoetachedGarage:
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PROJECT DETAITS CONTINUED
Septic:OWTS
Type of H
Driveway Perm¡t:Exempt
eat Propane
Community
Electric
Permit #:
Other
NOTICE
Authoriw. ThisapplicationforaBuildingPermitmustbesignedbytheOwnerof theproperty,describedabove,
or an authorized agent. lf 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.
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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80days
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 submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to constructthe structure(s) and facilities detailed on the submittals reviewed by
the Building Division. ln 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, 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
construction 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 with me and my authorized agents, including without limitation my architect
r,e and/ or builder
I hereby acknowledge that I have read and understand the Not¡ce and Certification above, as well as, have
provided the required information which is co rrect nd accurate to the best of my knowledge.
Property Owner Print and Sign Date
h4
Natural Gas
OFFICIAT USE ONtY
Special Condit¡ons:
Misc Fees:Plan Check Fee:Permit Fee:Manu home Fee:Adjusted Valuation:
BP No:
ß-ute-UID4L-5
OWTS No:
3o¿l
Total Fees:Fees Paid:91Lçz Balance Due:
Const Type zonine:
¿¡Setbacks OCC Groupf
BUILDING / PLANNING DIVISION :
Signed Approval Date
BuítdÍ ns"l T,omims PIan Review Checklist
Perrnit Number: øVKe- 2b-lø' b2þ4
V nlolaT Þ.cfarotwf ew/rj"(
Buildins
Engineered Foundation
Driveway Perm Çþry-,,"ø*,a9
Site P
NÁ Septic Permit and Setbacks
A al PIan Review List
Plannine/ Z-oning
--:- Property Line Setbacks
NA 3o ft. srream setbacks
N/e Ftood plain
' Building Height
ZoningSign-Off
Subdivisíon PIat
Coøu^^,à^L
-2 tl
N/A
-
Valua natíon/ Fees N/A
Subdívisíon Plat Notes
re Department
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l.tr o t A*l trwr i rw{'|aø''
Red Líne Plansl StampslSticker
Attach Conditions
N 40# Snowload Letter - Manu. Homes
Soils
Plan Revíewer to Sign Applícatíon
'/ Parcel/Schedule No.
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General Comments:
A/r/4¿ Att*,
26Ø x D?= I/19
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tß15x ø32fr = t47po0.0o
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Grade/ Topography
d lmpact Fees
Grade/ Topography 40%
cation
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