HomeMy WebLinkAboutBldg Permit #11426- 8699 Astronaut Blvd- 10/21/14Date: I 0 Z,l—.t L( CITY OF CAPE CANAVERAL Tracking # /005Z-
BUILDING
b®5zBUILDING PERMIT APPLICATION Permit# i 1 �2 (p
(321)868-1222
City of Cape Canaveral Building Department - 7510 N. Atlantic Ave. - Cape Canaveral, FL 32920
You may download this application: www.cityofcapecanaveral.org. You may fax to: (321)868-1247. All applications must include the
backside of this form. 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 for the building permit, unless indicated otherwise by affidavit. I.D. may be required)
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Address of Job Site: tg , [ .4-&-z Tip 1\i -g, - ?L'i. Zoning classificati .n�, Flood Zone:
Legal description of property: TWN: �C C� RNG:1 SEC: 1,3 SUBD: 06 BLK $ 17L OT C O • Cr PG:
Property Owner Name: 16,% �8 f S L, A ,1i:S Phone:
Address: t, rb-1 k A v+0 A o -J �t 0� Coe,. A C L
Fee Simple Titleholder's Name (ifotherthan owner): Address:
Bonding Company:
Mortgage Lender:
Address:
Address:
'1
Type of Permit
Brief description of work:
Const.
Type
(IA,
VB,
etc)
Building
FPL lines
currently
available to
serve this
property?
Yes/No
City Sewer
available
to serve
this
property?
Yes/No
Electrical
# of
stories
# of
dwel-
ling
Plumbing
# of
water
closets
NC
Mechanical
P Com. A / C_
Other
'1
Type of
Building
(please
indicate as
le
applicable)
Square
Feet
under
roof
Const.
Type
(IA,
VB,
etc)
Occu-
pancy
Classifica
-tion
(B,R1,R3 ,
etc.)
FPL lines
currently
available to
serve this
property?
Yes/No
City Sewer
available
to serve
this
property?
Yes/No
# of
Concrete/
Asphalt
Parkingpsunits
Spaces
# of
stories
# of
dwel-
ling
# of
bed-
rooms
# of
water
closets
Valuation of work
(Copy of Contract Required)
Phone (cell/pager.):
Commercial
Primary Contractor Name: 4111,t ` , ,L „ d„N
Name of Compan : ), j k. ur SeN-.
$
SD, a'
1
SFR
Address: 1-402-_ d.. eaGt✓1c S3-- �' 1 6
State License No.: (' tftiC0 51 (L,-LPhone (office):
_SZIj
6,4 Phone (cell/pager.):
Fax:
,?7
Townhouse$
Electrical Contractor Name:
Name of Company:
Address:
State License No.: Phone (office):
Apartment
Fax:
Plumbing Contractor Name:
Name of Company:
.
$
Condominium
State License No.: Phone (office):
Phone (cell/pager.):
Fax:
$
Mechanical Contractor Name:
Other
Address: -
State License No.: -Phone (off ce):Phone
$
Fax:
Architect/Engineer Name:
Name of Company:
Address:
State License No.: Phone (office):
Phone (cell/pager.):
Fax:
Primary Contractor Name: 4111,t ` , ,L „ d„N
Name of Compan : ), j k. ur SeN-.
* d, C
[r
1
'
Address: 1-402-_ d.. eaGt✓1c S3-- �' 1 6
State License No.: (' tftiC0 51 (L,-LPhone (office):
_SZIj
6,4 Phone (cell/pager.):
Fax:
,?7
Electrical Contractor Name:
Name of Company:
Address:
State License No.: Phone (office):
Phone (cell/pager.):
Fax:
Plumbing Contractor Name:
Name of Company:
.
Address:
State License No.: Phone (office):
Phone (cell/pager.):
Fax:
Mechanical Contractor Name:
Name of Company:
Address: -
State License No.: -Phone (off ce):Phone
(cell/pager.):
Fax:
Specialty/Other Contractor Name:
Name of Company:
Address:
State License No.: Phone (office):
Phone (cell/pager):
Fax:
(i:li1(1g.1)ept.l'onns Building Permit Application Rev. \lad 16, 2012
4
Building•Permit Application ChecklistNotes
Completed Permit Application
Current code edition: FL Bldg. Code 2010 (as revised)
Current survey showing all proposed construction and landscaping
Check with Bldg. Dept. for setbacks
Notarized signature — Owner/Builder Affidavit
If owner 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 Cert. Of Liability Ins./Worker'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
Planning and Zoning Board Site Plan ApprovalFor
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 after initial submittal
Subcontractor's
State License
Authorizations:
Record will be kept on file after initial submittal
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
Swimming Pool 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 insp.
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 Fire Suppression/Sprinkler/Alarm specifications
Requires Fire Dept. approval prior to issuance ofpennit
Pool Barrier Requirement Form (signed)
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 2010 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 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 > ' OR OMMENCEMENT*
Contractor's Name: I,\SAS iS (LS
Contractor's Signa
Date: 1,O--2,.% — / (( Site Address:
For Notary use only: State of Florida, County of Brevard
Sworn and subscribed before me this Z< day of , 20, (y, by
t0 who produced identification: - t v C.or
is personally known to me.
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44,y.et;�c SUSANJUUMIO
_.. �� '•_- MY COMMISSION # FF 114297
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:"'tt:` Banded ThPIRES:ru NotaAprilry Public 7Underwriters
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Printed name of Applicant
Signature - No Public At Large
This fonn may be duplicated.