HomeMy WebLinkAboutBLDG Permit #17-0196 (Replace fence) Date: I CIY OF CAPE CANAVERAL Tracking# d
BUILDING PERMIT APPLICATION Permit# - C) I y
(321)868-1222
City of Cape Canaveral Building Department-P.O.Box 326— 110 Polk Ave.-Cape Canaveral,FL 32920
You may download this application: www.cityofcapecanaveral.org. You may fax to: (321)868-1247. All applications must include the
backside of this form & 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 the contract may be required.Application packages will not be accepted unless
complete.
APPLICANT WILL BE CALLED WHEN PERMIT IS READY
(Contractor/Owner-Builder is required to sign for the building permit,unless indicated otherwise by affidavit. I.D.may be required)
Address of Job Site: .2 0/ 77�rro /1/( Zoning classification: Flood Zone:
Legal description of property:TWN: RNG: SEC: SUBD: BLK: LOT: PB: PG:
Property Owner Name: 17;1,4v id L7. .AD/440 s /Aired/4p - P vlfr✓ —,)a (z.3 Phone: 99'71 6/9, 26/k
Address: ,P,44 TT/A. ive / C,fie <'d£4 a£-PV /
Fee Simple Titleholder'f Name(if other than owner): Address:
Bonding Company: Address:
Mortgage Lender: Address:
Type of Permit Brief description of work:
Building
Electrical n/) 6
Plum int
i' l
e hhanical ,n
Other )4,PtP l �A ,1 ( Q C i ' t l
Type of Square Const. Occu- FPL lines City Sewer #of #of #of #of #of
4 Building Feet Type pancy currently available Concrete/ stories duel- bed- ,rater Valuation of work
under (IA, Classifca available to to serve Asphalt hug rooms doses (espy sr Cornett Required)
(please
roof VB, -tion serve this this Parking units
indicate asle) etc) (B,RI,R3 Property? prop'- spaces
etc.) Yes No YesNo
yC ercial s
FR Sn
Townhouse
Apartment S
Condominium $
Other S
Architect/Engineer Name: Name of Company:
Address: _
State License No.: Phone(office): Phone(cellppager.): Fax:
Primary Contractor Name: Name of Company: yt n(— )J3 f ?
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
Electrical Contractor Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
Plumbing Contractor Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cellipager.): Fax:
Mechanical Contractor Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
Specialty/Other Contractor Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cellipager.): 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 signature–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 Impact 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
Community Appearance 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: Record will be kept on file after initial submittal
State License 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 sealed 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 Suppression/Sprinkler/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. I 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:jou/Ad Zt peo S Applicant's Signature:
Date: 9/ /UO l/ a WO Site Address: ,,, (e/ / /Pk-
iefe
For Notary use only: State of Florida,County of Brevard
Sworn and subscribed before me this 7 t day of Oy o"zt^ x— ,20 l kQ ,by D
Printed name of Applicant
who produced identification:PC— De-we-4- C-5,CA or
gisjaer old %pozn to ine. _
;90‘.1
'��"�"��'' BRYAN BELOFF
Seal:0 Notary Public-State of Florida Commission N FF 986309 Signature-No ary Public At rge
-• .r—My Comm.Expires May 7-2020
This form may be duplicated.
4
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e
CityCapeof Canaveral
Date:
RE: HURRICANE MATTHEW STORM DAMAGED PROPERTY—Property damaged as a
result of Hurricane Matthew is eligible for free permitting by the City of Cape Canaveral
I hereby certify I am the owner/owners agent of property located at 7/Pv A/e
and the work associated with Building Permit# ) (p is related to damage caused
by Hurricane Matthew.
I understand that by so attesting,there will be no permit fees.
• • 1 • :ent Signature
Roddi.Carlyd
,.s°° Pia;••, BRYAN BELOFF ( d(1 ►Au. T
3 a* .' Notary Public-State of Florida ILL -
*, Commission*FF 988309 4 �"
�•',� "�. ° My Comm Expires May 7,2020 -- - m: dmf .—_
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f11/111PaiMi*Ilam
Mailing Address:P.O. Box 326 Physical Address: 110 Polk Avenue
Cape Canaveral,FL 32920-0326
Telephone(321)868-1222—Fax(321)868-1247
www.cityofcapecanaveral.org e-mail: info@cityofcapecanaveral.org
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DAVID
ID DWA YNE JONES AND HEATHER PARKER-JONES,
SUNT RUST MORTGAGE INC, LANDAM£RICA-CULFATLANTIC TITLE,
LA:/YLRS 1I TLE INSURANCE CORP.
DESCRIPTION AS FOLLOWS; •
THE WEST 36 FEET OF t OT 1, BLOCK 42, A VON-B Y-TILE SEA, AS RECORDED IN PLAT BOOK 3
PAGE 7, PUBLIC RECORDS OF BR£VARD COUNTY, FLORIDA.
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Karen Hutchinson
From: David D.Jones, MD <david.djones69@gmail.com>
Sent: Friday, December 02, 2016 9:05 AM
To: Karen Hutchinson
Subject: allowance.
Follow Up Flag: Follow up
Flag Status: Flagged
Karen Hutchinson, good morning (from David D. Jones, MD). Please allow Darrell McClane to pick up permit
for tree removal and fence placement due to hurricane damage in my place. Thank you. I can be reached by
information below if needed. Have a nice day!
David D. Jones, MD, MBA, FAAFP
Family Physician, Board Certified
7228 Winding Lake Circle
Oviedo, FL 32765
Home: 407.359.2572
Cell: 407.399.8779
email: david.d.jones69@gmail.com
Florida has a very broad public records law. As a result, any written communication created or received by the
City of Cape Canaveral officials and employees will be made available to the public and/or media upon request,
unless otherwise exempt. Under Florida Law, email addresses are public records. If you do not want your email
address released in response to a public-records request, do not send electronic email to this entity. Instead,
contact our office by phone or in writing