HomeMy WebLinkAboutBldg Permit #16-0723- 230 Columbia Dr - 8/22/1608/21/2016 21:28 3217991714
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Date: g- 2 r CITY OF CAPE CANAVERAL Tracking #!
RECEIVED BUILDING PERMIT APPLICATION Permit # -' 03- 01 3
AUG 22 2016. (321)868-1222
City of Cape Canaveral Building Department - P.Q. Box 326 - 110 Polk Ave. - Cape Cana%eral, FL 32920
You may download this application: tvi,vw•Amfopectulaverolat 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 packak;rs will not be accepted unless
complete.
APPLICANT W1Ll. R MrF
(Contmeter'Owner-Builder is required to sign for the build; tg permit. notes indicated od rwise bysfratavit, 1.D mety be rcqurntn
Address of Job Site: ri 30 £ /U_ /t'1 f'S'A4 3 /y. zoning classification: Flood Zone:
Legal description of pro TWN: RN SEC: SUED•—__ ... lytx ....... LW :
. 1.)70,
Property Owner Name: 0„1- �/in/ U/L Ph �°
Address:
-e/Lx/ ' Z sc. �_�- 3. y s
Fee Simple Titleholder'sName Welbernunownctr _. , Address:
Bonding Company: Address:
Mortgage Lender: Address'
Brief d`nption of work:
Mechanical
Other
741- Type of gaare
Building wader
1 (pe roof
indicate NS
applicable)
'ornmercial
)R
ownhousc
Torment
'ordonnini
ther
Coast.
Type
IIA.
V8,
etc)
ate.
Cios lea
•tion
(B,R1.R3
etc.)
FPL
currently
available to
,erne this
property?
Yes'No
Nor
wirer
dosrie
Valuation •of *ark
ttep??rem:Mad aequ'r ")
of Company
ArchitectiEngineerNalme
Address: !'hone (cclt•pagcr) _Fax
State License leo.: _� �...-
Phone (office)
---..
Woe afr Consille -�•
Qom) � ...��
• +c+ls Cm�taa/um Celmexer
aged) ^� Fax _—....^....,--
- - ... _---_ - Picone (office) - _-Phone (cellp .,
Primary Commetor Nagle
fix:•
Start License
14 Address
Name of Company: Kg1�8t[ti`'"1uR14Ws i • ..,
!'lambing Contractor Name: _„ •, .s G.a - e _ • 6d8,_ 2 31 �l —�.. _ _. �� f"32 -1-Z994744._
Address: License
o.; -GF =~ Pbot1e (Q '), 32�t?hone ( pa8 -- --- -
Stete License 1Vo.: „�E;a.q,��4•- Ntame of Cotttpany: _ ... _. .•...... .....' -_ J"� .....-._
State License No:
Meclmorieel Contractee NeB�. ��,.._..— .----� -�-- -.•• — Fax
-----�•_.-"�'�-piepne (ctlVpageir.): --� Address:- ._-- Pkuiae (office): _
State License 1tio.:..._. _.��- Name of Company: .... -, .... ..�'- - . ••••••w
Specialty/Other ContractorName:�� .. -.�^
Phone (cellrpager,): Fax
__.- .-• .�
AddreB
s' „•
State license NPhone (office): , , - .. • • . -NO.: ...� .�
08/21/2016 21:28 3217991714
Badding Permit Ap lication Checklist Notes
Completed Permj.111.1Alication Cin t%code edition: FL Bldg, Code 20/0 ss:ear
all ro seri construction and laudscap Cask with Bldg, tle7i, for setbanka ,
Current sutvey showisrg —"—" _
e •- Owner. Builder Affidavit tf owner a eating r3 wntracto
Notarized Ammo �
Sewer 1 •.: Fee_ recexps. __. - :Nae to ed u"^ b� 4•fr. Unit= job is remodeling _
pct Fee e�ac¢�tt i �O
Maybe defemd until C.O. .....—
If sidewalk exists on lot S., ..........1 ..,.•
PAGE 02
Capital Expansion Impact Fee recti • I
Sidewalk lttd ct Fee receipt
!eeorded Warranty Dee& Proof ofOanership
L" of Recoi dad Notice of Cmumencemeatover S2, OU)
Current Cert. Of Liability Ins.IW rker's Com . Polly Exam ion
Community Appearance Board Approval
Fla • . and Zolsin_ Board Site Plan A. .royal
Concurrency Forms
Primary Contractor's State License
Subcontractor's Authorizations:
State license
Plumbing Contractor
Plumbing Contractor $
Electrical Contractor Electrical Contractor
M chanicai Contractor Mechanical Contractor
Rodin : Contractor Roofin: Contractor
Svdmmin_ Pool Contractor 111111 Swimntingjool Contractor
w Gay Contractor Gas Contractor
Specialty'Other Contractor y _SP alty/Other Contractor n I
Construction Drawings: ...
Three sets of sealed construction drawings
Truss layout and reactitm summary
Electrical Load Calculate 'ns — �...M,—
Electrical Riser -- —
Ower 57300 for Mechanical chorea tete
Record *ill be kept on file after miti t submittal _y
.
For all work visible from Public Rilbt.0 =We .
For all new construction of four units or more
For all new construction not pail of approved site plan
Reco►d will bc kept on file after initial submittal
Record will be kept on file after initial submittal
Notify Building Department of sordsactswcharges
Per F.B,C. 104
Per FIX. 104 - —
Riser .
......— .
A.'C layout. ,
Two sets of Etter C;alcutateons _
Lot Drains a Sun'e ��— S µ�yuire5 Fire Urlrt. g1>tm►'+al i nrcd xss� c� eta °i ^~
Four sets of Fire S , y, sssirnNSprinIclerdAlarm frcations t ---_--- t ---:At
Pool Barrier ltrirerrtent Form (signed)
Pool permit ---s will nue be rr6ual a 1 thant bUtlycr -
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 c ettify.• that no Fork or
installation has commenced prior to the issuance of a permit and that all work will bc performed to meet the standards of all
laws .regulating construction in this jurisdiction, The Building Code in effect at the time of th,ts application is the
l afloEof
da
1,3uildirre Code 5th Edition. 1 understand that all permits require inspections as indicated and that it is the responsibility
the permit holder to notify the building department when ready for inspeGtion(s). This permit application is valid for l 80
days from date of submission. By signing, applicant affirms that ail above is true and correct and that heisbe is an
authorized agent of the Contractor/Owner and has the authority to apply for this permit.
*ALL (YTRER APPLICABLE STATE OR FEDERAL PERMITS MUST BE OBTAINED PRIOR TO COMMENCEMENT*Signature: '
Contractors Si M
Contractor's Name: Carrie S. POiftelC gn __
Site Address:
eelr 4 Cm-rk/ .41-1/4.-",-,1- C., ��.
Cut slices and Shap dmwiriss will be needed at ultra of in p. � 4
Plans crust eitheate person scspo nyblc for catcsiiissions
MI neww a rvicr must be loaded uirtvg.i �rn
Plans must iridium maim rtis'Ontiltie for dmlgn
Plans t�stta indicateperSOn ibleib''de-•,ign
Plans meta indicate puv rn oesprinublc flu caletal
Date: 22- /
Por Notary use only: State of Florida, County of Brevard AP ��,v 74�-/<
Sworn and ribed before me this, "daY of L. sr ' �4-- by -
printed Mitof Applicant
ced identification: ____ _ — or
Seal:
SHERRI LYNN IMKE
NOTARY PUBUC
STATE OF FLORIDA
Cotrvn FF009352
Expires 2/14/2018
F>.02, —.i/ Thit 1'turt era) be I3 a rd,