HomeMy WebLinkAboutBLDG PERMIT #0337 (SWITCH IN KITCHEN)Date: CITY OF CAPE CANAVERAL
RECEIVED BUILDING PERMIT APPLICATION
JAN 0 3 1017 (321)868-1222
Tracking # 'a5'
Permit # r't
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 sign for the building permit, unless indicated otherwise by affidavit. I.D. may be required)
Address of Job Site: eQQ, _Tw lljt AV-( , Zoning classification: Flood Zone:
Legal description of property: TWN: NG: SEC: SUBD: BLK: LOT: PB: PG:
Property Owner Name: J>A tD j� - -S p r_ s Phone: 4;'o7 - 399 -T 7.7 1
Address: -,-- I T 14 ye-C-4Pe QGAc* Vesal
Fee Simple Titleholder's Name tfotherthanowner): Address:
Bonding Company: Address:
Mortgage Lender: Address:
Type of Permit Brief description of work:
Building
Electrical c s..t a .v u Nttn �rclttnJ % . �o C K tet�1 fiu '
Plumbing
Mechanical
Other
Type of
Square
Const.
Occu-
FPI, lines
City Sewer
# of
# of # of
# of
# of
Building
Feet
Type
panty
currently
available
Concrete/
stories dwel-
bed-
Valuation of work
water
(please
under
(IA,
ClassiLca
available to
to serve
Asphalt
ling
rooms
closets (Copy orContnct Required)
indicate as
roof
VB,
-tion
serve this
this
Parking
units
Phone (cell/pager.);
Fax:
Specialty/Other Contractor Name:
Address:
etc)
(B,RI,R3
property''
property?
Spaces
Fax:
applicable)
etc.)
YesNo
Commercial
$
SFR
$
Townhouse
$
Apartment
$
k-eNdominiu'm
$1700, •o
ther
I$
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: a7;&Z
Address: IS8 T+rc" S_T.
FVctrte
77-4.8.
Name of Company: IEMXt1k Ei.0 fdAC
/Air-.
State License No.: f-t13n1417 0
Phone (office):
on (ce1V er.): jX-591-2b73
Fax:
Plumbing Contractor Name:
Address:
Name of Company:
State License No.:
Phone (office):
Phone (cell/pager.):
Fax:
Mechanical Contractor Name:
Address:
Name of Company:
State License No.:
Phone (office):
Phone (cell/pager.);
Fax:
Specialty/Other Contractor Name:
Address:
Natne of Company:
State License No.:
Phone (office):
Phone (cell/pager.):
Fax:
41 Buildin Permit Application Checklist
Notes
Completed Permit Application
Com
Current code edition: FL Bldg. Code Fifth Edition (2014)
Current surve 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.D.
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:
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 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
j 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 rinkier.!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 Sth 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
*ALL OTHER APPLIMBLE STATE OR FEDERAL PERMITS MUST BE TAINED 411 TO COMMENCEMENT*
T F
Applicant's Name: lid('o Applicant's Signature:
Date: ' 3 ' , Site Address:
For Notary use only: State of Florida, C unty of Brevard
Sworn and subscribed before me this day of'Ja //I , 20k, by
Printed name of Applicant
CEwho produced identification: or
.is personally known to me'. 1.
' i KAREN IIWCHINSON
MY COMMISSION / FF 951009
g EXPIRES: January 18, 2020 �
Seal: �,. Bonded Thru Notary pudic Undenrdtera `tel
signature - Notary Public At Large
This form may be duplicated.
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