CDOT Form 1433 "Cevms Conversion Permit Application" - Colorado

What Is CDOT Form 1433?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 1433 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 1433 "Cevms Conversion Permit Application" - Colorado

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Colorado Department of Transportation
Reset Form
CEVMS CONVERSION PERMIT APPLICATION
Print Form
Outdoor Advertising Program • 4201 East Arkansas Avenue, 4th Floor • Denver, CO 80222 • (303) 512-4496
The Rules Governing Outdoor Advertising in Colorado can be found at:
https://www.codot.gov/library/manuals/outdoor-advertising-manual
Rule 12.00 addresses off-premise CEVMS advertising devices.
Leave no space blank. Mark "n/a" if not applicable. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
Part 1: Applicant information, sign specification
SIGN OWNER NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE
E-MAIL
SIGN OPERATOR NAME AND PHONE
EMERGENCY CONTACT NAME AND PHONE
PROPERTY OWNER NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE
E-MAIL
PURPOSE OF APPLICATION
CONVERSION DATE
Attached Exhibit A, Colorado Secretary of State certificate of corporate good standing, if applicable.
Conversion of permit No.: _________________
Attached Exhibit B, Copy of original permit application.
Attached Exhibit C, Current property owner's lease agreement or notarized letter of consent, if applicable.
How many sign faces will be converted to CEVMS? _____________
Attached Exhibit D, Sign location (metes & bounds, survey) with latitude and longitude coordinates.
Attached Exhibit E, Copy of local jurisdiction's relevant rules regarding CEVMS, if any.
Sign(s) is(are) facing: North South East West
Attached Exhibit F, Architectural or engineered drawings of the sign structure with operation specifications.
SIGN DIMENSIONS
SIGN LOCATION
GPS DATUM
SURVEYOR
DISTANCE TO NEAREST CEVMS (FT)
SIGN FACE HEIGHT (FT)
SIGN FACE LENGTH (FT)
LONGITUDE
LATITUDE
AREA (SQ FT)
HEIGHT ABOVE GROUND (FT)
Spacing Along Highway (Ahead)
Spacing Along Highway (Behind)
 Kerr Area Exception
 Cotton Area Exception
Does the proposed/existing sign reside within an unincorporated area? Yes No
Is the proposed/existing sign adjacent to or within the limits of an auxiliary lane? Yes No
NAME OF HIGHWAY
HIGHWAY ROUTE NUMBER
SIDE OF HIGHWAY
ESTIMATED MILE POINT
STREET ADDRESS OF SIGN SITE
SUBDIVISION
PARCEL NUMBER
LOT
BLOCK
CITY
Zip
STATE
DISTANCE FROM ROW (ft)
Part 2: Certification of applicant
The applicant or authorized representative of the applicant certifies by signing below that the information contained in this application is accurate and complete,
that information was accurate and complete when the local jurisdiction signed its certification, and that no changes were made since, or will be made after, the
local jurisdiction certification. The applicant further certifies by signing that the land described in this application is not encumbered by any prohibition on this
type of sign, and that highway right of way will not be crossed to access the sign or site for construction or maintenance. The applicant agrees to erect and
maintain the advertising device in a safe, sound, and good condition. By signing this application, the applicant certifies that the sign will comply
with the Rules Governing Outdoor Advertising in Colorado, 2 CCR 601-3, including section 12.00, Off-Premise CEVMS Advertising Devices. Failure to
comply with the Colorado Outdoor Advertising Act, C.R.S. § 43-1-401, et seq., and the Highway Beautification Act, 23 U.S.C. 131, et seq., its
regulations codified at 23 CFR 750, et seq., shall result in revocation of the permit and removal of the sign.
PRINT NAME AND TITLE OF ORGANIZATION (IF SIGNING AS DULY AUTHORIZED OFFICER OR AGENT FOR SIGN OWNER)
PRINT SIGN OWNER NAME
SIGNATURE
DATE
X
PRINT PROPERTY OWNER NAME
PRINT NAME AND TITLE OF ORGANIZATION (IF SIGNING AS DULY AUTHORIZED OFFICER OR AGENT FOR SIGN OWNER)
SIGNATURE
DATE
X
CDOT #1433 04/17
Colorado Department of Transportation
Reset Form
CEVMS CONVERSION PERMIT APPLICATION
Print Form
Outdoor Advertising Program • 4201 East Arkansas Avenue, 4th Floor • Denver, CO 80222 • (303) 512-4496
The Rules Governing Outdoor Advertising in Colorado can be found at:
https://www.codot.gov/library/manuals/outdoor-advertising-manual
Rule 12.00 addresses off-premise CEVMS advertising devices.
Leave no space blank. Mark "n/a" if not applicable. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
Part 1: Applicant information, sign specification
SIGN OWNER NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE
E-MAIL
SIGN OPERATOR NAME AND PHONE
EMERGENCY CONTACT NAME AND PHONE
PROPERTY OWNER NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE
E-MAIL
PURPOSE OF APPLICATION
CONVERSION DATE
Attached Exhibit A, Colorado Secretary of State certificate of corporate good standing, if applicable.
Conversion of permit No.: _________________
Attached Exhibit B, Copy of original permit application.
Attached Exhibit C, Current property owner's lease agreement or notarized letter of consent, if applicable.
How many sign faces will be converted to CEVMS? _____________
Attached Exhibit D, Sign location (metes & bounds, survey) with latitude and longitude coordinates.
Attached Exhibit E, Copy of local jurisdiction's relevant rules regarding CEVMS, if any.
Sign(s) is(are) facing: North South East West
Attached Exhibit F, Architectural or engineered drawings of the sign structure with operation specifications.
SIGN DIMENSIONS
SIGN LOCATION
GPS DATUM
SURVEYOR
DISTANCE TO NEAREST CEVMS (FT)
SIGN FACE HEIGHT (FT)
SIGN FACE LENGTH (FT)
LONGITUDE
LATITUDE
AREA (SQ FT)
HEIGHT ABOVE GROUND (FT)
Spacing Along Highway (Ahead)
Spacing Along Highway (Behind)
 Kerr Area Exception
 Cotton Area Exception
Does the proposed/existing sign reside within an unincorporated area? Yes No
Is the proposed/existing sign adjacent to or within the limits of an auxiliary lane? Yes No
NAME OF HIGHWAY
HIGHWAY ROUTE NUMBER
SIDE OF HIGHWAY
ESTIMATED MILE POINT
STREET ADDRESS OF SIGN SITE
SUBDIVISION
PARCEL NUMBER
LOT
BLOCK
CITY
Zip
STATE
DISTANCE FROM ROW (ft)
Part 2: Certification of applicant
The applicant or authorized representative of the applicant certifies by signing below that the information contained in this application is accurate and complete,
that information was accurate and complete when the local jurisdiction signed its certification, and that no changes were made since, or will be made after, the
local jurisdiction certification. The applicant further certifies by signing that the land described in this application is not encumbered by any prohibition on this
type of sign, and that highway right of way will not be crossed to access the sign or site for construction or maintenance. The applicant agrees to erect and
maintain the advertising device in a safe, sound, and good condition. By signing this application, the applicant certifies that the sign will comply
with the Rules Governing Outdoor Advertising in Colorado, 2 CCR 601-3, including section 12.00, Off-Premise CEVMS Advertising Devices. Failure to
comply with the Colorado Outdoor Advertising Act, C.R.S. § 43-1-401, et seq., and the Highway Beautification Act, 23 U.S.C. 131, et seq., its
regulations codified at 23 CFR 750, et seq., shall result in revocation of the permit and removal of the sign.
PRINT NAME AND TITLE OF ORGANIZATION (IF SIGNING AS DULY AUTHORIZED OFFICER OR AGENT FOR SIGN OWNER)
PRINT SIGN OWNER NAME
SIGNATURE
DATE
X
PRINT PROPERTY OWNER NAME
PRINT NAME AND TITLE OF ORGANIZATION (IF SIGNING AS DULY AUTHORIZED OFFICER OR AGENT FOR SIGN OWNER)
SIGNATURE
DATE
X
CDOT #1433 04/17
Part 3: Certification and Approval of local jurisdiction – zoning and compliance with local regulations.
This section is to be
completed by the representative of the local jurisdiction. Applications without local jurisdiction approval will not be processed.
Please contact the CDOT Outdoor Advertising Region Inspector with questions (see attached region map and contact information).
ZONING OF THE SIGN SITE (MAP AND LOT INFORMATION IN THE SIGN LOCATION INFORMATION ON PAGE 1)
A. Current zoning of the sign site described on this application:
_____________________________________________________________________________________________________
B. This is a (check one):
 Commercial classification
 Industrial classification
 Other (describe):
_______________________________________________________________________________________________________________________________________________
If Other, does this zoning classification encompass commercial or industrial type of land use? If YES, please attach a copy of the zoning
code classifications and approved uses.
YES
NO
NOTE: CDOT RESERVES THE RIGHT TO CHALLENGE THE LOCAL JURISDICTION'S "COMMERCIAL CLASSIFICATION" OR
"INDUSTRIAL CLASSIFICATION" DETERMINATION.
C . Location was first zoned a commercial or industrial classification:
 On or before January 1, 1970
 After January 1, 1970
D. Check if the following statement is accurate:
 Current zoning was established as part of a comprehensive plan for the development of the overall area and not as spot or strip zoning devised primarily
for the purpose of allowing outdoor advertising signs.
Does the local jurisdiction have a prohibition on CEVMS signs? If YES, please attach a copy of the code/ordinance.
YES
NO
COMPLIANCE WITH LOCAL REGULATIONS AND ORDINANCES
Check only one:
 The proposed sign location and structure comply with all applicable ordinances, plans, rules, and other requirements of this jurisdiction.
 The proposed sign location and structure do not comply with all applicable ordinances, plans, rules, and other requirements of this jurisdiction.
Certification of local jurisdiction
All of Part 3, including any required attachment, is accurate based on the written information provided on this application by the applicant.
(Erroneous information or improper zoning can result in permit cancellation.)
PRINT NAME OF CITY/COUNTY REPRESENTATIVE
CITY OR COUNTY WITH JURISDICTION
TITLE OF CITY/COUNTY REPRESENTATIVE
PHONE
E-MAIL
SIGNATURE OF CITY/COUNTY REPRESENTATIVE
DATE
X
Approval of local jurisdiction
Check only one:
 Applicant has received written approval from this jurisdiction for sign conversion from static to CEVMS.
 Applicant has not received written approval from this jurisdiction for sign conversion from static to CEVMS.
PRINT NAME OF CITY/COUNTY REPRESENTATIVE
CITY OR COUNTY WITH JURISDICTION
TITLE OF CITY/COUNTY REPRESENTATIVE
PHONE
E-MAIL
SIGNATURE OF CITY/COUNTY REPRESENTATIVE
DATE
X
CDOT #1433 04/17
Leave no space blank. Mark "n/a" if not applicable. Please Note: INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
CDOT USE ONLY
IS THE STATIC SIGN CONFORMING? YES NO
APPLICATION RECEIVED
PERMIT INFORMATION
PERMIT NO.
DATE
TIME
RECEIVED BY
OWNER NUMBER
CONVERSION DATE* (if applicable)
PERMIT FEES PAID?
 YES
 NO
SIGNATURE OF LOCAL JURISDICTION REP VERIFIED?
 YES
 NO
EXISTING ZONING VERIFIED?
 YES
 NO
APPROVAL DECISION
 Approved
 Denied
DECISION MADE BY
DECISION DATE
REASON(S) FOR DENIAL, IF APPLICABLE:
* Failure to convert within 365 days results in cancellation of permit.
PERMIT FEE
CHECK NUMBER
DATE PAID
$
CDOT #1433 04/17
Do not write below this line –
CDOT USE ONLY
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