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Home My WebLink AboutBLDG PERMIT #17-0449 (Shower Pans)7 OFFICEFOpy3Date: ,; l / CITY OF CAPE CANAVERA.Tracking # R CEWED BUILDING PERMIT APPLICATION Permit # 1 JAN 24 20, I (321)868-1222 City of Cape Canaveral Building Department - P.O Box 326 - 110 Polk Avenue - Cape Canaveral, FL 32920 You may download this application: www.cityofcaecanaveral.org. You may fax to: (321)868-1247. All applications must include the backside of this form and 2 sets of supporting documents. Important: Please complete the checklist on the back of this form and provide other documentation as indicated on the checklist. A copy of contract may be required. Application packages will not be accepted unless complete. APPLICANT WILL BE CALLED WHEN PERMIT 1S READY (Contractor/Owner-Builder is required to -ion for the building permit, unless indicated otherwise by affidavit. I.D. may be required) Address of Job Site:,/�� _ Zoning classification: Flood Zone: Legal description of prope : TWN: -RNG: SEC: SUBD: BLK: LOT: PB: PG: Property Owner Name: Phone: Address: Fee Simple Titleholder's Name (if odw than Owner): Address: Bonding Company: Address: Mortgage Lender: Address: --� Type of Permit Brief description of work: ,�� 5 Building Occu- Electrical City Sewer Plumbin i f1 c. -G, MNS G S Mechanical Feet BuildingFee' Other panty Architect/Engineer Name: Address: Type of Square Const. Occu- FPL lines City Sewer # of # of # of # of # of Primary Contractor Name: Address: Feet BuildingFee' Type panty currently available Concrete/ stories dwel- bed- water Valuation of work Electrical Contractor Name: Address: _ (lA, Classifice available to to serve Asphalt ling rooms closets (Copy or Contract Required) Plumbing Contractor Name: Address: D (please roof VB, -tion serve this this Parking units Fax: 9 -/ l Mechanical Contractor Name: Address: indicate as etc) (13,R1,113 property? property? Spaces Fax: Specialty/Other Contractor Name: Address: applicable) Name of Company: etc.) Yes/No yesNo Phone (cell/pager.): Fax: Commercial $ SFR $ /OOp• O �j Townhouse $ Apartment $ ondominiu $ Cher I $ Architect/Engineer Name: Address: Name of Company: State License No.: Phone (office): 'Phone (cell/pager.): Fax: Primary Contractor Name: Address: Name of Company: State License No.: Phone ('office): _ Phone (cell/pager.): Fax: Electrical Contractor Name: Address: _ ^ Name of Company: State License No.: Phone (office): Phone (cell/pager.): Fax: Plumbing Contractor Name: Address: D .^ DcoA Name of Company: IP, o :S e cf/ `L �oZ fir- State License No.: —G hone (office): -S Phone (cell/pager.): Si Fax: 9 -/ l Mechanical Contractor Name: Address: Name of Company: State License No.: Phone (office): Phone (cell/pager.): Fax: Specialty/Other Contractor Name: Address: Name of Company: State License No.: Phone (office): Phone (cell/pager.): Fax: Building Permit Application Checklist Notes Completed Permit Application Current code edition: FL Bldg. Code Fifth Edition (2014) Current survey showing all proposed construction and landscaping Check with Bldg. Dept. for setbacks Notarized si ature — Owner/Builder Affidavit If owner is acting as contractor Sewer Impact Fee receipt May be deferred until C.O. Unless job is remodeling County Impact Fee receipt May be deferred until C.O. Capital Expansion Impact Fee receipt Maybe deferred until C.O. Sidewalk Im act Fee receipt If sidewalk exists on lot Recorded Warranty Deed / Proof of Ownership Copy of Recorded Notice of Commencement over $2,500) Over $7,500 for Mechanical change out Current Cert. Of Liability Ins./Worker's Comp. Policy / Exemption Record will be kept on file after initial submittal CommunityAppearance Board Approval For all work visible from Public Right -Of -Way Planning and Zoning Board Site Plan Approval For all new construction of four units or more Concurrency Forms For all new construction not part of approved site plan Primary Contractor's State License Record will be kept on file after initial submittal Subcontractor's Authorizations: State License Record will be kept on file after initial submittal Notify Building Department of contractor changes Plumbing Contractor Plumbing Contractor Electrical Contractor Electrical Contractor Mechanical Contractor Mechanical Contractor Roofing Contractor Roofing Contractor Swimming Pool Contractor Swimming Pool Contractor Gas Contractor Gas Contractor Specialty/Other Contractor Specialty/Other Contractor Construction Drawings: Per F.B.C. 104 Three sets of scaled construction drawings Per F.B.C. 104 Truss layout and reaction summary Cut sheets and shop drawings will be needed at time of inspection Electrical Load Calculations Plans must indicate person responsible for calculations Electrical Riser All new service must be located underground Plumbing Riser Plans must indicate person responsible for design A/C layout Plans must indicate person responsible for design Two sets of Energy Calculations Plans must indicate person responsible for calculations Lot Drainage Survey Four sets of Fire Su ression/S rinkler,!Alarm specifications Requires Fire Dept. approval prior to issuance of permit Pool Barrier Requirement Form (signed) Pool permits will not be issued without barrier Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. The Building Code in effect at the time of this application is the Florida Building Code 5th Edition. I understand that all permits require inspections as indicated and that it is the responsibility of the permit holder to notify the building department when ready for inspection(s). This permit application is valid for 180 days from date of submission. By signing, applicant affirms that all above is true and correct and that he/she is an authorized agent of the Contractor/Owner and has the authority to apply for this permit. *ALL OTHER APPLICABLE STATE OR FEDERAL PERMITS MUST BE OBTAINED PRIOR TO COMMENCEMENT* Applicant's Name: r/r� ,2 ,�� Applicant's Signature: Date: �� Site Address: For Notary use only: State of Florida, County of Brevard Sworn and subscribed before me this-� ay of 20_, by A 61 Printed name of Applicant who produced identification: or s personally known to me. 1 ;. KAREN HUTCHINSON Seal: MY COMMISSION t FF 951009 EXPIRES: January 18, 2020 �-' Signature - otary Public At Large 3onded Thru Notary Public Underwriters may be duplicated. 05/05/2016 04:46 3217991714 fro in; ;,ape �anavr.reI mon, Vey 321 868 ?.41/05.20 Y ,r 14:38 a/I{, 05 PAGE 01 021 N.001/001 Froa::xpt Conaysrl::04 OIv 3�1 8i,8 tai' o6rtt'�D'S t0:l8 li3Ur P.oOu gOt City of Cape Conavorat A NUAI AU1'Y2M T/DAI [ORM Clt�vf GP► Cm=vent WiidM� iko&nM*nt 1110 Pwk Ave Cop* G►+werd." Fl 320.111 U C"(0112t1865-12U11tax f321IW4241 t7AT[:40 (VoufistMoweloa/ to* •utifwMartiw form, tltiC relrisrcana BLrohs & JI Q.-djuClatz Mu NAlvr.YbuE6109 Morm'.& tompirlyNawit: 'CLA' ;.704,;K`F �, herby s,�lhu�ee the orrsertl!{ bNowta obu�r, ! Pv m t on unoar n►y lots :ktoatts! t!! ial�ld by the /pattnlent of �ueinnt Iud prore�+ a ttftu"on, Constructlpn rOCII'.«rnm?) Thn AuthofiteWlt vwl be Good for ons CslenOsr vest And h will bs me tots rotporuibihty of the t:crwcto► to Inform tttib City of Caa Cj ntvxrt: t0dirK Dsparbnent of oay Chsrdet, !t w,N be the foie moponsibintV 40 Ow Q)nttamor to rtnlwthis four IW!u1Nv. N Crty of Cape CtnlmnlKQM be held fespand4it. br 4soy OefA b )taws 1N! twin by tray 41116 eM perfo^! 111ted Wow wtida LhiA d,Tcum ant is III tdfrect. TIV 9ty of (Ata Ctnwsnt *&-gm bs %too rerpensib'E for rtenewel Of1ha 40wmnt. 46 �' �rlt�lCSQ.6ElEptt,ui t , ....../.r M_.. N..M./.f....rl-..MM.MW.�.�.I�MO.wMrW�.Yr.yY.. N.r•rw_.- rY .. r r.�.Mr�.M..r.wrr.�..�.....wr Swotn aid iJ0lt/ibld t+otora trsa thls�,SC ``d&V otM . R. 20.4—,0, 6y.4 Rte, nAft. who producedidentiMeatbn: � —at l Peen'Wiir kfwWn to mt Scat: Sitn4tUra • Notaty dubl:c A! L1r�f; r,-„,,�, 40ti1Rim LW&f IN AM MOWN”, KATE of PLalllgt', C0odrPlft9Mef1! 1611*0 !!i4ml CO '20VO. ItoL//C. 6C�it5fiL :.'; ce:U 3 •.�;�!f'1l£a