HomeMy WebLinkAboutBLDG PERMIT #11477 (Plumbing) #307 ' 11/02/2014. 22:10 3217991714 PAGE 02
Date:!t�- CITY OF CAPE CANAVERAL 00
BUILDING PERMIT APPLICATION Peretlt#
City Of CW Canaveral Building {32168-1222
You may download this Departrumt -75 10 N.Atlantic Ave.-traps Canaveral,FL 32920
backside of this form. I application: �esvw.c)n+,o p avt3r8l_Q*o. You may Fax to: (321)868-1247. All applications must include the
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 unle w complete.
APPLICANT WILL BE CALLED WHEN PERMIT IS READY
(Contractor/Owner-Buildsr is mgniretl to sign for the building permit,unless indieded Otherwise by afHdavk. J.D.may be required)
Address of Job Site: 230, C:p�r., sem, �9
Legal desixi tion of �=....—��B classification:,�Flood Zone:
p prop".m. RM. SEC,• SIM_—.�.—.�.13LK:_LOT• P)3; po:
Property Owner Name: Phone:
Address: Q.• Ti�rt.. ►
ffilgAtStlPL I
Fee Simple Titleholder's Name(fa wtheeawaer): Address: .
Bonding Company: Address:
Mortgage Leader Address:
TY
of Pern* Brief description of work:
tulduag
E,lectlical
Plumbinghi�.d dy •��
Mechanical
Lj Other
Type&V sgoare Const Octal- FPL hese City Sewer a of d of tt of iF of d Ot
1� ElWIding Fat Type panty a—enely available Concretd starla dwel- bed- water ti'alft*n orwork
(Plisse under (MA ctwoQea avdlabte to to serve Ago" frog rumps etesefa (C*W•TC=ft*Rcvd al
indicate as roof VB, -don serve this ibis Pari ft nnift
etc) (BAl,R3 P"P"? prop"r
'br e) ere. YM No Yew* tea'
om nercial --
FR �
ownhouse $
t $
ondonaini S
er $
Architect/Engineet Nam: Name of Company:
Address:
State License No.: Phone(office): Phone(ce11/pagor): _ Fax:
Primary Contractor Name: New of Company.._
Address:
State License No.: Phone(office): Pbwo(coll/pager): Fax:
Electrical Contractor Nance Nam of spiny:
Address:
State License No.: Phone(office): Pbone(cell/pager): Flus:
Plumbing Contract acne: 4G- :.,144 Name of
Address: .
State License Na.:CIa'/ �G.,G.� Phone(office): 715•m'{/ one(cell/pager.):Zyq,NS'is" Fax:
Mechanical Coatt utor Name: Name of Company:
Address:
State License No.: phone(office): Phone(cell/pager.): Fax:
Specialty/Other Contractor Nance: �.-- Name of Company:
Addt•ess:
--
State License No. Phone office). Ph
• _ _ ( ons(cell/pager): tax-
11/02/2014 22:10 3217991714 PAGE 03
Boal ' PC ea In Checklist
Com feted Ponmit lication
stave 5howin atl Cuarut Cade edit M FL 81dg.Code 2010(as revised)
roustructbon and lands G7tadc with Bldg nest.Ear se6mft
Notanizcd si tM–Ovvaer/Builder Affidavit If owner is eating as eontrac
Sewer I t Pao receipt May 1c dererrad�Mul c o,Unress loci�rwr oder tW
C I Fce rtxe May be d erred raft!C.O.
Ca 'ter!E ion l ct Fee recei t Maybe d--WA omit C,0.
Sldewallc I Fee rccei t
Recardea wamm Deed/pmf of
IPaidxwalk extras on lot
Co of Recorded Notice of Commencement over S2 500 er$7,500 for eohmrfeai change our
Current Cort Of Liab IAsJw*-eex Co .F'o' /Ext= on Rawev l win be apt on filo abet tp W submittal
cottnatt�aui sarance Board A vel Por sol work visible Publto Right-M-Way
PI and Zonin Board SitePlan A rove! For etl new�onspucdoa of four units or more
Concrri rencW-- For all aea muniaim mot
Primary Contractor's State License t= of approved sit,plea
Will be kept CRI file altar imitlal,tabmittel
Subcoulmotorrs AuthOt izatiomS; Redd w�pe kept W Rte aft III sobptipal
State License Notify Bttildiog n eparttpem of ewepactor cbaogca
Plumbitrg ContracWrPlumnbhis Contractor
lrlecb ical Contractor Electrical Contractor
Mechanical Contractor !Mechanical Contractor
-A00ft Contractor -900111 19
Swimtnin Pool C.ontractm S Pool Contractor
Gas Contractor Gas Contractor
S ecialty/t?ther Contractor I spedi /Other Co tox
Cousbution Drawings: per F.B.C.too
111ri sets of Waled co»struction drawings Pet P.B.C.104
TTU5$ Wat and t' etibu Cut abasia and atop W9—n-uI W a eeded at time of msp.
ElectucalLoadCalculations 1PlaasontsciodicatePam raponaibte5orealeq tions
Electrical Riser I AR new smiee mut be rotated cutcdet�toupd
Plumbing Riser Pta"must iragate PMOD rrsportslble for 2;i—V
A/C layout Ptaas fAUA indite pmm ruble for design
Two scu ofEEM Calculations Plans must indiew person ceepopat'bla for ealeaiadow
CD survey
Four sets of Fire S ionlS tinider/Alarm w=ifications Reguia:a Pias Dept app*Q prior to ig896lrtee of path
Pool Barrier Requifeinft Form si Pool penPR will pot.be iSMW WKiWW battle
Application is hereby made to obtain a permit to do the work and nostallataions as indicated, I certify that no work or
installs iioti has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all
laws regulating constrmedon in this jurisdiction. The Building Code in effect at the time of this application is the ftd4
$uildine.Code 2010 , it'on. I understand that all permits require inspections as indicated and that it is the responsibility of
the pexmit holder to notify the building departrnent when ready for inspection(s). This permit application is valid for six
months from date of submission, By signing, applicant affirm that all above is true and correct and that he/she is an
authorized agent of the Contractor/Owner and has the authority to apply for this permit.
*ALL OTHER APPLICABLE STATE OR FEDERAL PERMITS MUST BE OBTAINED PRIOR TO CO CEMENT*
Contractor's Name: �CI-1.1 y Contractor's Signa*'� ?
Date: t l • 3 1L4- Site Address: 'OZZ-I Cb.),tx% :co
For Notary use only: State of Florida,t�,ty of$rev rd
Sworn and subscribed before me this_I—day of_ evem&eC,20)q ,by f,6+ t-1
Primed fipple of Applicant
w110 Qraduced ldentiScatit�lo,;
or
is personally known to me.
S"ERRI LYNN BURL
Seal: NOTARY Pat,BM
STAT@ OF FLUNDA Signatwa.Nalky Public At Urge /1-3—/Y
t;otttrati tcFp
Etlpl►Bs 2/14/ 075 This form may be dupliaucd.
' 1'1/02/2014 22:10 3217991714 PAGE 01
r C17Y OF CAFE CANAVERAL
AUTHORIZATION FORM
City ofC"Canvetal building Dcpartment 7510 N.Atlantic Ave. Cape Canaveral,FL 32920
(321)US-1222
(You may download this autborization:1�,Iv �cityille�l You tnay ft to:(321)868-1247.
Date: l • 14r Permit#•
CONTRACTORS AND SUBCONTRACTORS-PLEASE HAVE YOUR SIGNATURE
NOTARN ED AND SUBMIT TINS FORM WITH THE PERMIT APPLICATION.
Company Name: i�"
,hereby authorize /C �-
(State License Holder's Meme—PLEASE PR DM (Autlmrizcd Person—PLEASE PWT)
to obtain a permit on my behalf under my state licenses)as issued by the Department of
Business and Professional Regulation,Constructions Industry Licensing Board
{state Luse Number(s))
for the job site described below.
An authorization will be required for each permit
of Permit befJma S D»M rr— - _
Building Name of Property Owner
Plumbing J, Wm4A, bg
W0�- ...
Electrical Address of Job Site
Mechanical '
Roofing
Swimming Pool
Specialty Structure Signature of License Holder
Other—Specify-
For Notary use only: State of lurid �ulfty of Brevard tel, 7 .
Sworn and subscribed before me this day of t t+>�e r,20144,by 40�' ' Q o'n
Name or Applicant
who produced ideretiFcation: or
is personally known to me.
LVW e1JRNFE
Seal: NOTARY PllblJty
muft 11>E fATL OF RAT44 Signature-Note lie At uwse3a X. cool FROM
AM B.0"3li40"'B
o:xo1d&Xiw..anns\Aethotimti*"Form This f�rm my be duplicated.