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Home My WebLink AboutBLDG PERMIT # !7-0772 (A/C) #4 04/17/2017 15:13 FAX 'E. l ' CD 1 001 t► G•— Date: I%77 CITE' OF CAPE CANAVERAL Tracking • _ BUILDING PERMIT APPLICATION Permit a (321)868-1222 City of Cape Canaveral Building Department - P.O Box 326- 110 Polk Avenue•Cape Canaveral,FL 32920 You may download this application: By w.cityapecatjdygrahortt. You may fax to: (321)866-1247. 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 fo the building permit.unless indicated otherwise by affidavit. I.D.may be required) Address of Job Site:_WS( CJrc el Y T Zoning classification: Flood Zone; Legal description of property: TWN: RNO: SEC: SURD: BLK: LOT: _PB: pa: C Property Owner Name: /1.1<j -Cie4' _Phone: — f�t 1 t 0-, _ Address: '5( ç f («drY Fee Simple Titleholder's Name(irotlbrmon owner):_ Address: - Bonding Company:_ Address: - Mortgage Lender: Address: - .- 7-Type of Permit Brief description of work: an.a .. • L! / A Building Electrical - 5 � -- Plumbing (>7/5 ' / / Mechanical _ Other .,. FPI,lines Cita Sewer n or #of #of #of #of Type of Square Const Occu- Feet Type panty currently available Concrete/ stories dwcl- bed- water Valuation of work •\/ Building under (IA, Classifies available to to serve Asphalt ling rooms closets (Copy of Cenlnei Required) (please serve this this Parkin units roof VB, -lion F indicate as etc) MAI,R3 property? property? Spaces ! (...vG-- applicable) etc.) Yes/No Yes/No Commercial J $ SFR $ _ s 'Townhouse ~Apartment _ y — _ S Condominium - Other S - --- — Architect/Engineer Name: _ Name of Company: Address: State License No.: Phone(office): Phone(cell/pager.): Fax: Primary Contractor Name: __ Name of Company: Address: State License No.: Phone(office): ! Phone(cell/pager.):_ Fax: Electrical Contractor Name: Name of Company: Address: State License No.: ._ Phone(office): Phone(cel/pager.): Fax: Plumbing Contractor Name: Name of Company: Address: '-"'— State License No.: Phone(office): Phone(cell/pager.):_ Fax: Mechanical tractor Name: i . Name of Company: r�. + . Address: 2urb ,?.?v yy7 _ Cc State License No.: Gera/i? Phone(office): 4 /Q.7, Phone(cell/pager.): Fax: —_ Specialty/Other Contractor Name: Name of Company: Address: State License No.: Phone(office):_ Phone(cell/pager.):_••_ Fax: 7 Building Permit Application Checklist Notes �., Completed Permit Application Current code edition:FL Bldg.Code Fifth Edition(2014) Current survey showing all proposed construction and landscaping Check with Bldg.Dept.for setbacks Notarized signature—Owner/Builder Affidavit lfowner 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.O. 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 Cart.Of Liability ins./Workor'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 i 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 atter initial submittal Subcontractor's Authorizations: Record will be kept on file after initial submittal State License 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 Swimmineool 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 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 hire Suppression/Sprinkler/Alarm specifications Requires Fire Dept.approval prior to issuance of permit Pool Barrier Requirement Form(signed) Pool permits will not be issued without harrier 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 perfonned 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 5ih 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 permit. *ALL OTHER APPLICABL STATE OR FEDERAL PERMITS MUST BE OBTAINED PRiOR TO COMMENCEMENT* Applicant's Name: A tOP114/ --- Applicant's Signature: :` Date: 9//(1 ,7 Site Address: ( C/1-16- d! P For Notary use only: State of Florid County of Br and - _ " ,,,, cc Sworn and subscribed before me this .' ..) .'day of -Y-) �_ ,20/ -q,by'hCY v -� 13 K 11A- Printed nerve of Applicant who produced identification: or ' is personally known to me. Seal: KAREN HUTCHINSON r A--e ` ÷()�"' 1c. r� '+9*r8'c;''=- MY COMMISSION 4 FF 951009 Signatu -Notary Public At Large :e: au •,*. �`: EXPIRES:January 18,2020 -• 'a,4q?+ Bonded ThruNotary Public Tlidirietatrn be duplicated. T 0 0 21 Xv3 CT:2T LTOZ/LT/170