HomeMy WebLinkAboutBldg Permit #12729- 8699 Astronaut Blvd- 11/24/15Date: 112' t- /3
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CITY OF CAPE CANAVERAL Tracking #t C---
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BUILDING PERMIT APPLICATION Permit # 1 X3(,^1 Qct
(321)868-1222 l`_
City of Cape Canaveral Building Department - P.O. Box 326 - 110 Polk Ave. - Cape Canaveral, FL 32920
You may download this application: www.citvofcapecanaveral.org. 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 packages will not be accepted unless
complete.
APPLICANT WILL BE CALLED WREN PERMIT IS READY
(Contractor/Owner-Builder is required to sign for the building permit, unless indicated otherwise by affidavit. I.D. may be required)
Address of Job Site: g(0 9 `i AS+roe A v+ 1 I v c4' Zoning classification: Flood Zone:
Legal description of property: TWN: RNG: SEC: SUBD: BLK: LOT: PB: PG:
Property Owner Name: Kk, r .`,A cos L,4}yfe_s " CI, A,. I,•c Phone: 3Zi 3 2- 2-V---
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Address: r 33 /fit-- /v ' (4 vc i r( oc.u� 13, -"c -t-, FL 3 Z 3/ - j 01
Fee Simple Titleholder's Name (if other than owner):
Bonding Company:
Mortgage Lender:
Address:
Address:
Address:
iJBuilding
Type of Permit
Brief description of work:
Const.
Type
(IA,
VB,
etc)
Occu-
pancy
Classifiica
-tion
(B,RI,R3
etc.)
FPL lines
currently
available to
serve this
property?
YesiNo
City Sewer
available
to serve
this
propert)?
Yes.No
# of
Concrete/
Asphalt
Parking
Spaces
Building
# of
dssel-
ling
units
# of
bed-
rooms
# of
water
closets
Valuation of work
(Copy ofContrael Required)
State License No.: Phone (office): Phone (ce1L'pager.): Fax:
Commercial
Mechanical Contractor Name: Name of Company:
Electrical
Q --:c
/ooit 1-e
S.,,.'4 -c.,.,
,tet-+,,( 0,-,.k- 1-e f
State License No.: Phone (office): Phone (cell pager.): Fax:
Plumbing
SFR
Mechanical
s
Other
>
12 -se .n owe:
t7; l w/i- 11
, Devil PfI-4-L11
An,,l
i")14-,' et t -
iJBuilding
Type of
(please
indicate as
applicable)
Square
Feet
under
roof
Const.
Type
(IA,
VB,
etc)
Occu-
pancy
Classifiica
-tion
(B,RI,R3
etc.)
FPL lines
currently
available to
serve this
property?
YesiNo
City Sewer
available
to serve
this
propert)?
Yes.No
# of
Concrete/
Asphalt
Parking
Spaces
# of
stories
# of
dssel-
ling
units
# of
bed-
rooms
# of
water
closets
Valuation of work
(Copy ofContrael Required)
State License No.: Phone (office): Phone (ce1L'pager.): Fax:
Commercial
Mechanical Contractor Name: Name of Company:
Address:
State License No.: Phone (office): Phone (cell/pager.): Fax:
Specialty/Other Contractor Name: Name of Company:
Address:
State License No.: Phone (office): Phone (cell pager.): Fax:
SFR
s
Townhouse
$
Apartment
$
Condominium
$
Other
5
Architect/Engineer Name: '-/ L...4 --se (;o A s„ 1 E.Q., i Name of Company:
Address: / lc 3 3 2 />,o,+t, �.o- l� Sit ,../c. (>2,
State License No.: Phone (office): Phone (cell/pager.): eri-'-{Gi- 2'1 7 Fax:
Primary Contractor Name: ,q ii.., .1. -]oc.; t, e, 4(} 2) Name of Company: (3x'7.1✓ /'►1 v n le i3j, (/-a r; 14
l
Address: 2- Cat.). pA-14..1 IA leo 012 i tli 7-..,,,-i-4 as (.a, J' Fi 32_ 7c Z
State License No.:Ca&12...6,05-, Phone (office): Phone (cell/pager.):32-1 - 2-% A- - y/12 Fax:
Electrical Contractor Name: A .-•, -e-S 8 e LIC er Name of Company: U'ils(i, ,'t- l; tee I.. i.=)/ .Su I.1 -h ',..•,, r
i4
Address: Ill 5 /J/. dog. }-r-+.a PILw , 5,,, Fc /%j r�t-ri-, f.i- rt- 3 Ly. -j'
State License No.: ER L 3 0 / 5'o3 y hone (oflice):37,• '`+'`L -0,c7 a Phone (cell/pager.): Fax:
Plumbing Contractor Name: Name of Company:
Address:
State License No.: Phone (office): Phone (ce1L'pager.): Fax:
Mechanical Contractor Name: Name of Company:
Address:
State License No.: Phone (office): Phone (cell/pager.): Fax:
Specialty/Other Contractor Name: Name of Company:
Address:
State License No.: Phone (office): Phone (cell pager.): Fax:
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. 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 APPLICABLE STATE OR FEDERAL PERMITS MUST BE OBTAINED PRIOR TO COMMENCEMENT*
Contractor's Name: A 1 /4.0 Contractor's Signature:
Date:
/f- Ly- rs�
Site Address:
if & ren 4 fi ;3 t,C4 (4,0<
2 -
For
For Notary use only: State of Florida, County of Brevard _
Sworn and subscribed before me this 4L-E�► day of j am , 20 /5 , by fi-I,funA J • Waovep-
who produced identification: Lai vele L -I eems� or
R----
is personally known to me.
Seal:
r�sTi
°i�'; DUREE B. ALEXANDER
..__ 1 MY COMMISSION # FF 922877
a`•. - EXPIRES: Sep ember 30,
~ ife t1t , Bonded Thru Notary 2019
Public Underwriters
Printed name of Applicant
Signatur - Notary Public At Large
This form may be duplicated.
v Building Permit Application Checklist
Notes
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
Ifsidewalk 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 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 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
A1C 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 of permit
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 5th 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 APPLICABLE STATE OR FEDERAL PERMITS MUST BE OBTAINED PRIOR TO COMMENCEMENT*
Contractor's Name: A 1 /4.0 Contractor's Signature:
Date:
/f- Ly- rs�
Site Address:
if & ren 4 fi ;3 t,C4 (4,0<
2 -
For
For Notary use only: State of Florida, County of Brevard _
Sworn and subscribed before me this 4L-E�► day of j am , 20 /5 , by fi-I,funA J • Waovep-
who produced identification: Lai vele L -I eems� or
R----
is personally known to me.
Seal:
r�sTi
°i�'; DUREE B. ALEXANDER
..__ 1 MY COMMISSION # FF 922877
a`•. - EXPIRES: Sep ember 30,
~ ife t1t , Bonded Thru Notary 2019
Public Underwriters
Printed name of Applicant
Signatur - Notary Public At Large
This form may be duplicated.