HomeMy WebLinkAboutBldg Permit #17-1215- 230 Columbia Dr #101- 7/21/17//7 CITY
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Off' CAPE CANAVERAL Tracking Aric;<31
RECEIVE D BUILDING PERMIT APPLICATION Permit #
J U L 21 2 (321)868-1222
City of Cape Canaveral Building Department - P.O Box 326 • ! 10 Polk Avenue - Cape Canaveral, FI, 32920
You may download this application: wwr.citynfpgpecanayerat.urg. 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 IS READY
(Contractor/Owner-Builder is required to sign fur the building permit, unless indicated otherwise by affidavit. 1.D. may be required)
Address of Job Site: (2 Jo e Oi ',1 'rA Q%*6 /OJ Zoning classification: Flood Zone;
Legal description of property: TWN: 2 MG: - SEC:SURD: _ MAC: LOT: PB: PG
Property Owner Name: 1,444 CJ' Phone: 6 -P ---a2/2=7_
,a 1/� -
Address: '; ' 70 . G
Fee Simple Titleholder's Name tir°therei n owner):
Bonding Company:
Mortgage Lender:
• I<
Type of Permit
Building
Electrical
Plumbing
Brief description of work:
Address:
Address:
Address:
Mechanical
Other
Type of
.4 Building
(please
indicate as
applicable)
Square Coast, Om- FP1. lines City Newer q of
Feet Type pancy eurrentlY available Concrete/
under (IA, C:lassifica available to to serve Asphalt
roof Vat .tion serve this this Parking
etc) (B,RI,R3 property? property? Spaces
etc.1 Yes/No ¥es/No
Commercial
SFR
Townhouse
Apartment
Condominium
Other
Architect/Engineer Name:
Address:
State License No.:
Nof
stories
N or
dwel-
ling
units
ti of
bed-
rooms
N of
water
closets
Valuation orwork
(Copy or Contract aputred)
S
s
S
Name of Company:
Phone (office):Phone (cell/pager.):
Primary Contractor Name:
Address:
State License No.:
Name of Company:
Phone (ofce): Thane (cell/pager.): _ Fax:
Name of Company:
Electrical Contractor Name:
Address:•
State License No.: Phone (office): Phone (celI/pager.):
Plumbing Contractor Name: Name of Company:
Address:
State License No.:
Mechanical Co actor Name:.,. 11
Address: r r d Q YY
State Livens No.:. [ 0 Ylsi_
Fax;
Phone (office): Phone (cell/pager.):
Specialty/Other Contractor Name:
Address:
State License No.:
TOO I i
Nance of' Company:
Fax:
Phone (office): WA- ,Phone (cell/pager.):
Name of Company;
Fax:
Phone (office): Phone (cel /pager.):
Fax: ,.
%Vd 5C:0T LTOZ/TZ/L0
07/21/2017 10:36 FAX
•
Building Permit Application Checklist
Completed Permit Application _
110 01
Notes
Current code edition: FL Bldg, Code Fifth F.dition (2014)
Check with Bldg. Dept, for setbacks
Current survey showing all proposed construction and landscaping
Notarized signature — Owner/Builder Affidavit
Sewer impact Fee recei•t
County Impact Fee receipt
Capital Expansion impact Fee recent
Sidewalk Impact Fee receipt _..-
Recorded Warranty Deed / Proof of Ownership
if owner is acting as contractor
May be deferred until CO. Unless Job is remodeling
May be deferred until C.O.
Maybe dalbrred until C.U.
lfsidewalk exists on lot
Over $7,500 for Mechanical change out
Copy of Recorded Notice of Commencement over S2 500 F
Current Cert. Of Liability Ins./Worker's Com . Polic / Exem tion
Community Appearance Board Approval
Record will be kept on file after initial submittal
F'Or all work
visible from'Public Right -Of -Way
For all new construction of four untie or more
Planning and Zoning Board Site Plan Approval
Concurrency Forms
Primary Contractor's State License
Subcontractor's
State license
For all now construction not part of approved site plan
Authorizations:
Record will ire kept on file after initial submittal
Record will be kept on file after initial submittal
Notify Building Department of contractor changes
Plumbing Contractor
Electrical Contractor
Mechanical Contractor
Plumbing Contractor
Electrical Contractor
Mechanical Contractor
Roofing Contractor
Swimmin Pool Contractor
Gas Contractor
Specialty/Other Contractor
Construction Drawings:
Roofing Contractor . .
Swimming Pool Contractor
Gas Contractor
Specialty/Other Contractor
Three sets dusted construction drawings
Truss layout and reaction summary
Electrical Load Calculations
Per F.B.C. 104
Electrical Riser
Per F.B.C. 104
Cut sheets end shop drawings will be needed at time ut'inspection
Plumbing Riser
A/C layout
Two sets of Energ Calculations
Plans must indicate person responsible for calculations
All new service must be located underground
Plans must indicate person responsible for design
Plans must indicate person responsible for design
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 Formisigned) 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. 1 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 1S0
days from date of submission. By signing, applicant affirms that all above is true and correct and that be/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*
t
Applicant's N e: /1011 fes'' AWL. Applicant's Signature:.
Date: "901 Site Address: OC 70 Co cC A Lag_
For Notary use only: State of Florid Co my of re d
Sworn and subscribed before me thi day of U
2 who produced identification:
is personally known to me.
Seal:
KAREN HUTCHINSON
MY COMMISSION # FF 951009
.ftt t EXPIRES: January 18, 2020
i�
e'�' BondedThruNotaN Public Underwriters
ti••
or
duplicated.
,20 1T,by
hOYVkad
Printed name of Applicant
Signature. Notary Public Al Large