HomeMy WebLinkAboutBLDG PERMIT #17-0632 (Driveway/Drainage) r .
:" 4) 1000
Date: /rye CITY OF CAPE CANAVERAL Tracking# l 14;9.-5
SITE PLAN PERMIT APPLICATION Permit# 1 4 - oir.3
RECEIVED
FEB 14 201? (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: www.cityofcapecanaveral.org. 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 for the building permit,unless indicated otherwise by affidavit. 1.D.may be required)
Address of Job Site: Bb S R Ariro/7 .-/ 8/vJ Zoning classification: Flood Zone:
Legal description of property: TwN: aY-s RNG:37 E SEC: /5 SUBD: • BLK: LOT: PB: PG:
Property Owner Name: LafL , ,(--,7„--, <,u s ,,- ,v7c.;-, , -7,--,,,,, /e.,-, Phone: J<;d/- aS I -7 F3
Address: /3..3 ,-,,---/„ Avc C, ' a.„,4 , ,z .7,)-sI/
Fee Simple Titleholder's Name(if other than owner): Address:
Bonding Company: �f Address:
Mortgage Lender: Address: Y
Type of Permit Brief description of work:
Building
Electrical
Plumbing
Mechanical
f/ Other Of-iv-c-- •.-c> #- Ora,,-,c f e
Type of Square Const. Occu- FPL lines City Sewer #of #of #of #of #of
q Building Valuation of work
Feet Type parley currently available Concrete/ stories dwel- bed- water
under (IA, Classifica available to to serve Asphalt ling rooms closets (Copy o(coeind R,qw,J)
(please serve this this
roof VB, -tion Parking units
indicate as etc) (B,RI,R3 property? property? Spaces
applicable) etc.) Yes/No Yes/No /K,w
./Commercial as 5,/d ci 0"`'"
SFR S
Townhouse S
Apartment S
Condominium S
Other S
Architect/Engineer Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
Primary Contractor Name: >Y,cA HA4- Name of Company: f,,NAL /Je ve/cra/-7-7r'„ / /,
Address:1.2 Cf' f/,-/: fie,/ / £'C/(Le_r�e FL 7af...571-
S tate
fState License No.:C[?c cYV 6 S/ Phone(office): G 33-e%/U Phone(cell/pager.): ,,?SP-7 F7 0 Fax: 6.3/-OG/1
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(office): Phone(cell/pager.): Fax:
Specialty/Other Contractor Name: Name of Company:
Address:
State License No.: Phone(office): Phone(cell/pager.): Fax:
1
r .
r - .
ill 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
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 57,500 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 subnunal
Subcontractor's Authorizations: Record will be kept on file after initial submittal
Notify Building Department of contractor changes
State License
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 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 Fire Suppression/Sprinider/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 P TO CO M CEME
Applicant's Name: /"2c-ie. /2474'AL Applicant's Signature:
4
Date: x4,1/27- Site Address: ff 4, r,,,c_/ /.----
For
'For Notary use only: State of Florida,County of Brevard ✓ �,
Sworn and subscribed before me this /L/�� day of F,. br rr.-1 ,20 1'2,by N\\ i c o l c s /V - i?0,17
Printed name of Applicant
who produced identification:R.
or
is personally known to me.
Seal: e"' DOROTHY M.HODGE
f MY COMMISSION#FF986877 Sign re-Notary ubli t Large
0,nd+ EXPIRES:June 05,2020 this form may be duplicated