HomeMy WebLinkAboutApplicationGarfuld County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l e45-82t2
www.garfield countvco.gov
BUILDING PERMIT
APPLICATION
WPE OF CONSTRUCTION
Commercial/Multi-Fam I Demolition
Manufactured Home or Tiny Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)Reroof
Dwelling Unit (ADU - MAXIMUM SIZE OF FEET
INVOTVED PARTIES
Property Owner:
Mailing Address:
o /,Phone:30 -s?31
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EmailAddresrr <)-z-lt€l"
Phone: flTOlSlq^8/O4Contractor:
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Mailing Address:
Email Addressr o ,t
Architect:Phone:
Mailing Address:
Email Address:
Engineer:Phone: ( )
Mailing Address
Email Address:
Manufactured Home lnstaller:Phone:
Mailing Address
Email Address:
PROJECT DETAILS
Describe Work:o 4
Job Address
Assessor's Parcel Number
Sub.s q" alock f
Owner's Valuation of Work:(Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building:6 Height:l3f6"#of
I l"ooo
Class of Work:New Remodel/Alteration Addition
Garage:Attached Detached
Y]WTSSeptic:
Type of Heat:E[ut"alca'Propane
Driveway
Permit:
Fxempt Permit #:
Electric
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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.
NOTICE
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is tru.e 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 ccrtification o5 to accuracy. Assuming complctcncss
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, 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)). All County development requiring a permit, except for
residential uses are subject to Article 7 of the Land Use and Development Code. 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.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. 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
sl.r ucLure(s) or faciliLy(ies) if sucli is irr violaLiorr oI Counl.y Regulation(s) or any otlrer applicable law. Revicw of this
Applicatron, rncludrng submrttals, and rnspectrons of the work by the Burldrng lJrvrsron 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 designer, engineer and/ or builder.
PROJECT DETAITS CONTINUED
Communlty
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the req uired information which is correct and to the best of my knowledge.
ro Y-O 2oz{
Property Owner Print and Sign Date
OFFICIAT USE I
Special Conditions:
Adjusted Valuation Plan Check Fee:'"'$fi'@ Manu. Home Fee:Misc. Fees:
Total Fees:5o 90 oo*)
Fees Paid Balance Due:&BP No:OWTS No:
Const. Type:'iijf $?Setbacks OCC Group:
7 -3o-25BUILDING / PLANNING DIVISION :
Signed Approval Date
Colorado Department
of PublicHealth
andEnvironment
DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUST ACCOMPANY THIS FORM
INCOMPLETE APPLICATIONS W|LL BE RETURNED
(Notice will be mailed to the demolition contractor unless specified otherwise)
Fee: $50 + $5 per 1000 ft2 of area to be demolished =
(See instruction #1 on reverse side)
means (a)(b)
Cafegory I nonfriable ACM that will be or has been subjected to sanding'grinding, cutting,
to powder by the
or abrading or (d) Cateoory ll nonfriable ACM that has a high
probability of becoming or has become
demolition or renovation operations reg
abated/removed prior to demolition.
crumbled, pulverized, or reduced forces expected to act on the material in the course of
Asbestos-containing sheet vinyl and linoleum must be properly
* Regu
Submit form to:
Permit Coordinator
Colorado Dept. of Public
Health and Environment
APCD.IE-81
4300 Cherry Creek Drive
South
Denver, CO 80246-1530
Phone: 303-692-3100
Fax: 303-782-0278
Asbestos@state.co.us
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Name:
of facility or portion of to demolished
cit': g| ll State: -@,ZioI
Fax #
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Counfu:'6or.EeJd Zip Code:#t*+7
Cell Phone #()Proposed Start Date Proposed Completion Date
t certirylnat tne dertified Asbestos Building lnspector has informed me
about lny remaining asbestos-containing materials in the facility to be
demolished.
Method/Means of Demolition:
[J wrecking E Burningt f1 lmplosion fl Moving El other, speciry:
tBurning requires additional authorization - Please call (303) 692-3100 and ask
to soeak to the Ooen Burninq Permit Coordinator
Signature:Print Name:
Landfi ll Receiving Building Debris:
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General Abatement Contractor (GAC)
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CDPHE Asbestos Permit #Total Ouantity ofAsbestos Removed Street: - .A3, I {2 f.lrt c/ e l? r"
Date Removal Completed Telephone #()"lf/u "r' (- "'l/e
State:
(CI 'hW'rr
Type(s) of Asbestos-Containing Material Removed:Contacfs Name:Teleohone #'iq6- soq^sv3L
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With my signature beloq I certify that I possess current AHERA accreditation and state of Colorado certification as
an Asbestos Building lnspector. I also certify that I have thoroughly inspected the facility to be demolished, as listed
in the Demolition Site block above, sampled allsuspect materials, had all samples analyzed for the presence of
asbestos by a NVIAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the
facility.* I also certify that I have informed the owner/operator of the facility or the demolition contractor that any
asbestos-containing material allowed to stay in the facility
of ACM remaining, below: (check appropriate box(es)):
must remain non-friable during demolition. Specify type(s)
n Vinyl asbestos floor tile (V4l)
n Sprav-applied tar coafings E
n Vnf mastic fl Tar/asphalt impregnated roofing fl Asphaltic pipe coatings
Caulkino l-l Glazino n otner . soecifu:
Signature: (ln Printed Name:
'{a6nx' {^vf ar
Date of Firfal lnspection I co c({.-t.v-?eL{ I2*tft
Expiration Date Telephone #
&Vw \ qL&{*Lgsd &'}
Cell Phone #
r 4rntryv'& -q6t.t
at from air recovered in accordance No.
1 5 (for information on cFc requirements call further verifo th at all been
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disposed of in accordance with 6 CCR 1
CHECK THE APPROPRIATE BOX:
007 -1 s ubpart (for inform ation
n Buitding owner Contractor Other Date:
Signature:Print Name:
Postmark or Hand Delivery Date:Approved By:Code: n initial-31o n transfer-380
Form of Payment & #:Permit #:Record #Date lssued:
Fom: DNA08
ulated by this regulation. Note:
Rev. 0lB0/08