HomeMy WebLinkAboutBLDG PERMIT #10689 (Water Heater) #206 03,/14/2014 00:45 3217991714 PAGE 01
Date:
, CITY OF GAPE CANAVERAL T� knG� ^e- " . = #
BUILDING PERMIT APPLICATION
Permit b 1 0 6 8 �
(321)86$-1222
City ofCape Canaveral building Depatrimm -7510 N.Atlantic Ave.-Cape Canaveral,FL 32920
You may download this application: Www.cjtvofca vmLank. You may fax to: (3214%4247. All applications must include the
backside of this form. important; Please complete the checklist on the back of this form and provide other docramentactinn.as,infacatrAnn.
the checklist A copy of contract may be required. Application packages will not be
APPLICANT WILL RE CALLED WHEN PERMIT Iaccepted
READYY complete.
(Contractor/Avner-Builder is required to sign for the buildigit,unless indictecl otherwise by afSdavit I.D.may be required)
Address of Job Site: 236 / �, A �Q Zoning classification: Flood Zone:
Legal description of property:TWN: RNG: SEC: SUED: � -Property Owner Name: ± -- —�ei.K: LOT: Pg;--�—PG.
��'`''�P��!
Address: �. E+ `ea Phone:
� 4 '' -711,
Fee Simple Titleholder's Name pPoNrorManawaer>: Address:_
Bonding Company: Address:
Mortgage Lender: Address:
NlType of Permit Briefdeseription of work:
iBwMn
C�trircl
Plumbin �% r h
Mechanical
(lthsx
TyN Of Square Const. Own- FTI. Ck&way p of #of N of q of Out
F*0 Type polity eurrsndy ova�bk `r �Plredli��aS�sMc
Building ar.tlableto to Caatretd .les el- bed Now
-
under (IA, 111514 ea Asphalt ling rooms e�
(Owe
roof vs. .cion Alis tt� rMfung soft
00 MXIjt3 PMPW- 11118W1117
Yes/Alo YesrAto
Fit S
oa�Ocrse S
S
er $
Adftm
Stale Lictarsc No.: . Ph=(office): Phone(c:elv'paw-.. Fax: —
Primary Cow actor Nam Niam of Compay:
Address:_
She l.kvm No-, Phone(ofTice): Phoae(ctfl/paW*_
FAecu ical Contractor Nmc Now ofCoft .'
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
Plitmung Contrac:tur -- ;70 b vex of t;omparty: �N ro•, S e 6u
Addres. .ftp' A-AJ+��'S 53�: �q ,� 72S 20
Slate l;uaensc No. (fr2A1&V P4ia*rce(o4fice):7y -$'fr5► Pltidtre celUpagca:y:_7Y9- 1 r Fax: S�
MecbanIc al ConmictorNarne: Name of'Company:
Address;
State License No.: Phone(of3lce): Phone(rill/pager.): _Fax: _
Spec(aity1 tAer Contractor Nm nes: Name ofCompany: r
Address:
State License No.: Phone(office), Phone(cell/pager): _.Fax:
03•/14/2014 00:45 3217991714 PAGE 02
Buiklln Permit Application C1Wk1ht Notes
Com leted Permit A lication Carter:erode
Current surve show all New2da constructlon and land sca ' Check with Bldg Det.for setbacks
Notarizcxt si ft—Owner/8tti[der Aftidavlt frowner is seting as earmaator
Bower Ica Fee receipt May be 400 n xl utmi GA,Uniess lob is remodeling
COUIKY lm et Fee recei ba cued scall c.o.
tel$ l Yve>eo Maybe detbrreat until CO..
Sidewtlllt IcaPM Fa receint ►Esiaewal on let
Recgrded W-W—M peed/Proof of OwnersN
Co of Recorded Notice of Commencement over$2,500 $'l,soo for Mcchanieal c se out
Ctumnt Ccat.Of Liability1MJWorker's Comp.Policy/Exem tion Record will be kept on le atter Initial subnnivaf
Communi ce Board Approval Forall work visible&am Public Way
Plarmin and Zoain Board Site Plan roval For an new wnatty wo of tour units or mare
ConcurrencyForms For all raw ca muction,at part of 8pprav�s ss'AOT a
primary Conft*toes$tate License Record wit-be kept on file dW initial submival
Subcontractor's Authorizatitms: Record will kept on file ager initW:utmtitml
State LicWWJ Notify Bull(%Oaparwwt of conumor changes
Plumbing Contdactor Plumbing Contractor
E rectricati Contractor Electrical Contractor
Mecbanieal Contractor Mechanira)Contractor
Agoting Contractor Roofing Conhador
swimming pool Contractor swimmingPoo!Contractor
Gas Contractor Gas Contractor
Speclalty/Outer Contractor Specialty/Other Gaut cow
Construction Drawings: Per F.R.C,104
Three no of sated eonsftction drawings Per F.B.C.M
Truss layout and roaction summary Cut sh m Wd shop dawinp vAKne L-afte V,am&.
Electrical Load Calculations Plans must imiirate pmn responsible for calcutations
Electrical Riser All new service must be located u»dnmuW
Plvbim Riser Plans must indicate person responsibie for dwiga
A/C layout Plans must indicate pasan responsible for design
Two sell of Energ Calculations Plans must roil-eat person msponsible for calculations
Lot Drainage Survey
Four sets of lire Su ression/S nkler/Alam specifications 7 eW1 a -Rm Dcpt.approval prior to issuance or permit
Pool Barrier Requirement I:orm(signed) Pool pamiB win not W issued without barrier
Application is hereby fade to obtain a permit to do the work and installations as indicated. 1 ceMfy 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 W effect at the time of this application is the Flori
Building Code 2010 fAi ion. l 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 six
months 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*
Contzactoes Name: 6a rrr;V `T Aonftdoes Signature:
Date: .-► �'� / Site Address: �Jd Com+ A-M IL"o JG
For Notary use only: State of Florida, of Brevard
Sworn and subscribed before me this Zday of Z&ee 20/4V,by ex/'/'i'-4P .
Panted tame of Applicant
Rwho pTedmced ideAt milon- Orf
is personally known to me.
tp/
seat: SHM t.YNhl BrXVM
NOTARY PUBW Signature- POW At l arge
STATE OF FI.ONDA
. CalrwrdR FFOM302 This aorta my be dapfieated.
?!1412018