COLUMBINE LAKE COUNTRY CLUB, INC

Columbine Lake Country Club, Inc.

P. O. Box 714

Grand Lake, CO 80447

Telephone: 970/627-8120 Fax: 970/627-3313

Building Request, Checklist and Permit

Exhibit A

(House)

THIS FORM MUST BE COMPLETED, SIGNED BY LOT OWNER, AND APPROVED BY COLUMBINE LAKE COUNTRY CLUB, INC., BEFORE ANY EXCAVATION, CONSTRUCTION OR INSTALLATION WORK HAS BEEN COMMENCED. BEFORE PROCEEDING, IT IS EXTREMELY IMPORTANT TO REVIEW AND UNDERSTAND THE "DECLARATION OF PROTECTIVE COVENANTS, RESTRICTIONS, EASEMENTS, AND RESERVATIONS, COLUMBINE LAKE SUBDIVISION", THE "COLUMBINE LAKE COUNTRY CLUB, INC. BUILDING CRITERIA AND INFORMATION", AND THE INFORMATION CONTAINED IN THIS APPLICATION. GENERAL INFORMATION AND IMPORTANT NOTES ARE WITHIN THIS FORM.

1. Owner__________________________________________________________________________

2. Mailing Address__________________________________________________________________

3. Phone Numbers: (Home)_________________________(Work)____________________________

4. Columbine Lake Property: Block No. ____ Lot No. _________ Email: _____________________

5. Builder or Contractor (Name)_________________________(Company)______________________

Mailing Address__________________________________________________________________

Phone: ___________________________________ Fax: __________________________________

6. Construction Start Date (Proposed): __________________________________________________

__________________________________________________________________________________

FOR OFFICE USE ONLY

Date received from Owner: ___________________________________________________________

Date Approved: _________________________Date Permit Issued: ___________________________

Check Info: Amount_______________ Number_______________Date of Deposit_______________

Date of Disapproval: _________________________________________________________________

Date of Mailing Notice of Disapproval: _______________________________________________

BUILDING SPECIFICATIONS

IMPORTANT: ALL MEASUREMENTS MUST AGREE WITH DRAWINGS, PLANS, ETC.

1. Setbacks:

Front _________ (Minimum of 30 ft. from any structure, overhang, deck, step, etc. to front lot line.)

Rear __________ (Minimum of 25 ft. from any structure, over-hang, deck, step, etc. to rear lot line, unless property abuts a body of water, in which case a minimum of 30 ft. from any stream or lake is required.)

Side___________ (Minimum of 10 ft. from any structure, overhang, deck, step, etc. to side lot line.)

2. Square Footage: Each Floor ___________________________________________________________

Total in House ________________________________________________________

3. Height of Building, measured from highest original grade next to foundation (SEE NOTE 3).

Height ____________________________________________________________ (maximum 26 feet)

4. Exterior (Attach color samples for each)

A. Siding: Type ____________________________ Color ______________________________

B. Trim Color, including window trim & doors: _______________________________________

C. Window and Door color: (White is Not Allowed)

D. Exterior lighting (motion sensor required for ingress/egress):

Type ___________________________ Wattage ___________________ (Cannot exceed 75W)

5. Roof

Material _____________________________ Color ________________________ (Attach color sample)

6. Foundation (SEE NOTES 1, 2, & 3)

Material __________________________________________________________________________

Finish Material _______________________ Color _______________________ (Attach color sample)

Basement? Yes_______________________________ No____________________________

Exposed Foundation Height, from original grade (SEE NOTE 3):

Front ___________________________________ Back ____________________________________

7. Items 7a through 7e MUST be submitted with this properly signed form:

a. GRADE MODIFICATION PLAN - showing height of any fill, &/or depth of any excavation, including the footing and foundation holes, with scale measurements.

b. FINAL LANDSCAPING PLAN - plan must include off-street parking for at least 3 automobiles &/or trucks with a minimum size requirement of 10' x 20' for each parking space; culverts will be make of corrugated steel and be no less than 12" in diameter (if need is determined by the ARC); any other drainage needed; a grading and re-vegetation plan. Plan is to be submitted as a sketch, using a written description for clarification.

c. DEPOSITS & FEES (SEE NOTES 8a, 8b, 8c & 8d)

d. COMPLETE SET OF BUILDING PLANS (blueprints):

- Show all elevations and grade lines.

- Indicate actual original grade line in red on front, rear, and side elevations.

e. PLOT PLAN:

- Show building orientation on the lot, with distances from ALL property lines to the closest edge of any portion of the structure, including eaves, decks, steps, drip-lines, etc.

- Show eave projection, using dotted line.

- Show location of ALL utility lines: Gas, electric, water, sewer, any other. Utilities for new construction must be installed underground.

- The location of all exterior lighting must be indicated in red on all elevation diagrams. No more than 2 light bulbs per fixture, no more than 6 light bulbs per building, and no more than 3 light bulbs per facing will be allowed for exterior lighting

- Show location of required off-street parking (space for at least 3 cars &/or trucks with 10' x 20' for each space).

- Show area on lot to which snow will be pushed from the driveway/parking area (cannot be pushed from your property into the road).

- Landscaping &/or re-vegetation plan may be shown on plot plan.

8. General Information

a. You will be notified within thirty (30) days after receipt of this information if your plans have been approved or disapproved. If your plans are disapproved, the entire form with attachments will be returned, with the items causing disapproval marked and noted.

b. Both a Grand County Building Permit and a Columbine Lake Building Permit must be posted on the site, prior to any excavation or construction. The permits must be posted at all times so that they are accessible for check-offs and are visible from the road.

c. It shall be the sole responsibility of the owner(s) and builder(s) to monitor and comply with all the building criteria. Any change or deviation from the approved plans, as submitted to the Architectural Review Committee and the Columbine Lake Country Club, Inc. Board of Directors could result in the revocation of the building permit issued by Columbine Lake Country Club, Inc. If the Columbine Lake Building Permit is revoked, this information will be forwarded to the Grand County Building Department, and all construction activity will be terminated. Construction activity cannot resume until after compliance with the originally approved plans, or until changes have been approved.

d. As per requirements of the Grand County Building Department, Columbine Lake Country Club Inc. will require that a regulation portable toilet facility will be available at the site of new construction until such time as an approved permanent toilet facility is available in the structure.

e. The sale of your property will transfer to the new owner the obligations of the building covenants and restrictions and, therefore, should be considered as conditions to the right to build/sell/purchase at Columbine Lake Subdivision.

CERTIFICATION

I HEREBY CERTIFY THAT I HAVE EXAMINED AND COMPLETED THIS APPLICATION, AND KNOW

THE INFORMATION I HAVE GIVEN TO BE TRUE AND CORRECT. I FURTHER CERTIFY THAT I HAVE READ AND UNDERSTOOD THE COLUMBINE LAKE COUNTRY CLUB, INC. BUILDING CRITERIA AND INFORMATION AND THE DECLARATION OF PROTECTIVE COVENANTS, RESTRICTIONS, EASEMENTS, AND RESERVATIONS OF COLUMBINE LAKE SUBDIVISION, AND I WILL COMPLY WITH ALL SPECIFICATIONS. I WILL POST THE GRAND COUNTY BUILDING PERMIT AND THE COLUMBINE LAKE BUILDING PERMIT WHERE THEY ARE ACCESSIBLE FOR CHECK-OFFS AND ARE VISIBLE FROM THE ROAD. I ALSO UNDERSTAND I WILL NOT BE PAID ANY INTEREST ON DEPOSITS MADE TO CLCC.

__________________________________________________________________________________________

Signature of Lot Owner(s) Date

DISCLAIMER

NOTHING CONTAINED IN THE BUILDING APPLICATION FORM, PROCESS, PLANS, OR APPROVALS SHOULD BE CONSTRUED TO REPRESENT ANY ASSURANCE WHATEVER THAT THE BUILDING, AS CONSTRUCTED, NECESSARILY COMPLIES WITH ANY ZONING, BUILDING CODE, DESIGN REVIEW, OR OTHER GOVERNMENTAL ORDINANCE, RESOLUTION, REGULATION, STATURE, OR REQUIREMENT. NO OWNER MAYRELY UPON ANY APPROVAL BY THE ARCHITECTURAL REVIEW COMMITTEE AS AN ASSURANCE OF COMPLIANCE WITH THE FOREGOING. FURTHER, THE OWNER IS ADVISED THAT ANY REVIEW BY THE ARCHITECTURAL REVIEW COMMITTEE IS FOR ARCHITECTURAL CONTROL PURPOSES, ONLY. NOTHING IN SAID REVIEW PROCESS OR APPROVAL SHOULD BE CONSTRUED BY THE OWNER OR BY ANYONE ACTING BY OR THROUGH THE OWNER TO CONSTITUTE A SUBSTITUTION FOR OR A REPLACEMENT OF ANY SURVEY, LOCATION CERTIFICATE, INSPECTION, OR OTHER PROFESSIONAL REVIEW OF THE CONSTRUCTION.

__________________________________________________________________________________________

Signature of Lot Owner(s) Date

APPLICATION CANNOT BE PROCESSED UNLESS THE ABOVE CERTIFICATION

& DISCLAIMER HAVE BEEN PROPERLY SIGNED, AND THE DEPOSIT CHECK RECEIVED.

REFERENCE NOTES

NOTE 1: A REFERENCE ELEVATION MARKER MUST BE ESTABLISHED, VERIFIED BY THE COLUMBINE LAKE COUNTRY CLUB MANAGER, AND MAINTAINED DURING EXCAVATION AND FOUNDATION CONSTRUCTION. FOOTING ELEVATION MUST BY VERIFIED BY COLUMBINE LAKE COUNTRY CLUB MANAGER, BEFORE POURING CONCRETE. BEFORE A FOOTING INSPECTION IS REQUESTED, STRING LINES MUST BE IN PLACE ALONG ALL LOT LINES FROM PIN TO PIN, AND MARKING THE PERIMETER OF THE STRUCTURE AT THE DRIP-LINE ON ALL SIDES (INCLUDING EAVES, DECKS, STEPS, AND ANY OTHER OVER-HANGS).

NOTE 2: ANY FOUNDATION WALL OR CONCRETE FOOTER THAT HAS ONE (1) FOOT OR MORE OF EXPOSED SURFACE MUST BE FINISHED WITH SIDING, PAINT, OR NATURAL ROCK, TO BLEND WITH THE BUILDING COLORS.

NOTE 3: ORIGINAL GRADE IS THE LEVEL OF THE GROUND BEFORE ANY DIRT HAS BEEN MOVED OR FILL HAS BEEN ADDED.

NOTE 4: THE OWNER OR CONTRACTOR IS RESPONSIBLE FOR NOTIFYING COLUMBINE LAKE COUNTRY CLUB, INC. FOR INSPECTION REQUESTS. AT LEAST ONE WORKING DAY ADVANCE NOTICE MAY BE REQUIRED PRIOR TO PERFORMING INSPECTION.

NOTE 5: COMMUNITY TRASH COMPACTOR IS FOR HOUSEHOLD TRASH ONLY, NOT FOR CONSTRUCTION TRASH. NO BURNING OF CONSTRUCTION TRASH IS PERMITTED. DEPOSIT TO BE FORFEITED IF REGULATIONS ARE VIOLATED.

NOTE 6: THE LIABILITY OF THE PROPERTY OWNER OR CONTRACTOR SHALL NOT BE LIMITED BY PREPAID DEPOSIT, IF ACTUAL ROAD REPAIRS EXCEED THE DEPOSIT AMOUNT.

NOTE 7: ONLY WATER, SEWER, TELEPHONE, GAS AND ELECTRIC UTILITY COMPANIES HAVE EASEMENTS IN COLUMBINE LAKE ROADS AND RIGHTS-OF-WAY, FOR THEIR UTILITY LINES. NO PRIVATELY OWNED LINE SHALL BE INSTALLED IN, UNDER, OR OVER-HEAD ABOVE ANY COLUMBINE LAKE ROAD OR RIGHT-OF-WAY.

NOTE 8: BUILDING DEPOSITS AND FEES (8a, 8b, 8c, & 8d)

a. NON-REFUNDABLE BUILDING PERMIT FEES:

- NEW HOUSE, $7000.00

b. $1500 LANDSCAPING, GRADING, TRASH REMOVAL DEPOSIT:

FINAL APPROVAL FROM THE ARCHITECTURAL REVIEW COMMITTEE AND A CERTIFICATE OF OCCUPANCY FROM GRAND COUNTY ARE REQUIRED FOR REFUND OF THIS DEPOSIT. FINAL INSPECTIONS WILL NOT BE MADE WHILE SNOW IS ON THE GROUND. IN ADDITION TO ANY OTHER REMEDY AVAILABLE TO COLUMBINE LAKE COUNTRY CLUB, INC., A $400 PER MONTH PENALTY WILL BE CHARGED AGAINST THIS DEPOSIT FOR EACH MONTH WORK REMAINS INCOMPLETE AS FOLLOWS: WITHIN 6 MONTHS OF THE ISSUANCE OF THE COLUMBINE LAKE BUILDING PERMIT, THE STRUCTURE'S EXTERIOR INCLUDING FOUNDATION, WALLS, SIDING, ROOF, ROOFING MATERIAL (SHINGLES, METAL, ETC.), DECKS, ALL EXTERIOR DOORS AND WINDOWS INCLUDING GARAGE DOORS, BACKFILLING, INITIAL GRADING, AND TRASH CLEANUP AS NECESSARY MUST HAVE BEEN COMPLETED. THE ENTIRE PROJECT MUST BE COMPLETE WITHIN 18 MONTHS OF THE CLCC BUILDING PERMIT'S ISSUANCE.

c. $850.00 ROAD REPAIR DEPOSIT:

$150.00 OF ROAD REPAIR DEPOSIT IS NON-REFUNDABLE.

$250.00 OF ROAD REPAIR DEPOSIT WILL BE REFUNDED 60 DAYS AFTER THE TAP DATE FOR WATER/SEWER (DATE PROVIDED BY THE THREE LAKES WATER & SANITATION DISTRICT), IF DITCHES HAVE BEEN COMPACTED PER THE COLUMBINE LAKE COUNTRY CLUB, INC. CRITERIA, AND ROADS HAVE BEEN RETURNED TO ACCEPTABLE CONDITION.

$250.00 OF ROAD REPAIR DEPOSIT WILL BE REFUNDED WHEN THE TRASH/LANDSCAPING DEPOSIT IS RETURNED, IF DITCHES HAVE BEEN COMPACTED PER THE COLUMBINE LAKE COUNTRY CLUB, INC. CRITERIA, AND ROADS HAVE BEEN RETURNED TO ACCEPTABLE CONDITION.

$200.00 OF ROAD REPAIR DEPOSIT WILL BE RETAINED FOR 2 YEARS AFTER THE WATER/SEWER TAP DATE, TO PAY FOR REPAIRING ANY ROAD SINKAGE THAT MAY OCCUR DUE TO YOUR UTILITY LINE INSTALLATION(S). ANY UNEXPENDED BALANCE OF THIS AMOUNT IS REFUNDABLE 2 YEARS AFTER THE TAP DATE. (THE $850.00 ROAD REPAIR DEPOSIT IS NOT REQUIRED IF UTILITY HOOKUP IS DONE IN COUNTY ROAD 49, WITH NO EXCAVATION IN A PRIVATE ROAD. HOWEVER, GRAND COUNTY MAY REQUIRE THE POSTING OF A BOND.)

d. ALL DEPOSITS WILL BE REFUNDED TO WHOMEVER IS THE CURRENT PROPERTY

OWNER OF RECORD AT THE TIME THE REFUND IS DUE.

9. REGARDING SEWER CONNECTIONS AND SERVICE, CONTACT:

Three Lakes Water & Sanitation District

1111 County Road 48 (Golf Course Road)

P. O. Box 899

Grand Lake CO 80447

Phone 970/627-3544

10. REGARDING WATER CONNECTIONS AND SERVICE, CONTACT:

Columbine Lake Water District

1111 County Road 48 (Golf Course Road)

P. O. Box 555

Grand Lake CO 80447

Phone 970/627-3683

11. REGARDING ELECTRIC CONNECTIONS AND SERVICE, CONTACT:

Mountain Parks Electric, Inc.

321 West Agate Avenue

P. O. Box 170

Granby CO 80446

Phone 970/887-3378

12. REGARDING NATURAL GAS CONNECTIONS AND SERVICE, CONTACT:

Xcel Energy

Phone 1-800-895-4999

13. REGARDING TELEPHONE CONNECTIONS AND SERVICE, CONTACT:

QWEST

Phone 1-800-244-1111