PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
Application number ..... : 01 00001624
Application status, date : FINALED
Property .......... : 2004 S FEDERAL HWY 108
PCN ............. : 08-43-45-33-22-004-1080
Lot Number ......... :
ii/i3/02
12/12/02
11:15:08
Zoning ........... : R3 MULTI FAMILY (10.80}
Application type ...... : EWHC WATER HEATER REMOVE & REPLACE
Application date ...... : 4/18/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 8528
REPLACE 30 GALLON TANK
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Owner's NaT'ne"- _~,-//
Owner's AcJ~ess ~.~,-'~c./.-~'.
City ~ ~~' ~/~'
Fee Simple T~e HOlder's Name ,
Fee Simple Title Holder's Address
Contractor's Company ~/~ .~~
DEPARTMENT OF DEVELOPMENT 0 , BUILDING,DIVISION
BUILDING PERMIT APPLICATION Rec. #
~~ Permit~ ~[-- /~OR
PE~ITS
ONL~
(Palm Beach County Prope~ Control
Owner's Phone ~ .~~~
State ~, Zip
(If other than owner's)
.. (If other~n owner's)
Company Phone ~
Contact person and emergen~phone ~ ~
Compa~Addre~ ~~¢ ~ ~/~-~ ~ ' ,_ Pager/Fax~ ,
City ~/~/// /~~, ~ Start /~ Zip . ~ ~.
Job Name ~ / ~.'~ , ~ ,, / ~~./
Job Address ~5/ ~../~/~ ~~_/~~~
Legal Description ~~/~. ~
~~ ~ ' Zoned
Bonding Company ~
Bonding Co. Address
Architect/Engineer's Name
City State
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Add~§s
SINGLE FAMILY -'/' DUPLEX
MULTI-FAMILY HOTEL RETAIL OFFICE
INDUSTRIAL
(check one)
ESTIMATED VALUE OF CONSTRUCTION..~$
DETAILED DESCRIPTION OF WORK:
Application is hereby required to obtain a permit to do 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 codes, laws, rules and
regulations governing construcUon in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING,
SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONING WORK, ETC.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all ~vork will be done in compliance with all applicable
codes, laws, rules and regulations governing construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
!': ~,YING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
~TH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
,~erty Owner's or Agent's Signature
Date
.. E OF FLORIDA, COUNTY OF PALM BEACH
:going instrument was acknowledged before me this
ersonally known to me or who has produced
~ath.
(date) by
as identification and who did (did not)
cnature of person taking acknowledgement Name of
nted or stamped Title or rank
)n tractor's Signature ,~~.
~'ATE OF FLORIDA, COUNTY OF PALM BEACH
~e foregoing instrument was acknowledged before me this
,~ is persona!Iv known_to me or who ~&aamduced
': an oath ¢74q"',, I~llloe~~'ttt~'
~re of pers~%~~ We/J/~[8 ~ Name
t or stamped ~ ~ ~' ' Tit~ra~
(C~ificate of Competency Hold,r)
~or's Stat~ C~ification of R~istration No.
nsurance Expiration Dat~
Componsation Expiration
~ Approwd By ~ ~ P~rmit O~c~r
40
alia
(date) by
officer taking acknowledgement - typed,
Serial Number, if any
Date
as identification and who did (did not)
of officer taking acknowledgement - typed,
Serial Number, if any
in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit prior
n consideration of granting this permit, the owner and builder agree to erect this structure in full compliance with the Building
;odes of the City of Boynton Beach.
permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have
~rtification or County Competency plus County and City Occupational Licenses prior to obtaining permit.
!SSUANCE OF THIS PERMIT DOF_~ N~-,-r'~AUTHORIZE VIOLATION OF DEED RE_~i,TRIC'rJO~S
FEES ARE NOT REFUNDABLE - '":/';:/ ~ ~ z. uui
A\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/2~/2000
APPLICATION #
APPLICATION DATE:
SETBACKS:
ZONE:
LEFT
(THIS SIDE FOR OFFICE USE ONLY)
RIGHT
MASTER PERMIT #
APPLICATION ACCEPTED BY:
FRONT REAR
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
FENCE TYPE
ROOF TYPE
FLOOD ZONE
BASE FLOOD ELEVATION
FINISH FLOOR ELEV. (PROPOSED)
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
AREA SQUARE FEET (GROSS)
AREA SQUARE FEET (NC)
# OF STORIES
# OF BEDROOMS
REMARKS:
Recpt#
ADDITIONAL FEE
BCAIF
PARKS FEE
PENALTY FEE
PUBLIC BLDG. FEE
RADON FEE
ROAD IMPACT FEE
SCHOOL FEE
SEWER FEE
WATER FEE
FIRE DEPT. FEE
OVERTIME FEE
SUB-TOTAL
VALUATION
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
CK #
Cash Rec'd from:
.FEE
Accepted by: (Initials)
IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date
Recpt #
BALANCE DUE
CK#
Cash Rec'd from:
Accepted by: (Initials)
\\CH~MAIN\SHRDATA~DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION A, DOC- Revised 6/1~8/97, 1114/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
DEVELOPMENT DEPARTMENT
BUILDING DIVISION
WATER HEATER CHANGE-OUT
applicant is required to complete this form in order to receive a turn-arOund permit for an bxact Water
t tealer Change-Out, By accurately completing this form the applicant is attesting to the fact that by
irmlallin9 the new unit there will not be an increase in element wattage or wire size.
By signature below I verify that either I or a representative of my company have inspected tile existing
(:orMilkms and lhere is no upgrade of the electrical system or service wiring changes required for the new
~mit(.~) being installed,
Print legible or type. All areas listed below shall be completed.
Qualifier or
Authorized ager~~~_A fl License No._
Signature: .~~~:~_,~3.~,~ Phone ( ) -
....... r ~ ~ v ~,t ~.~r-~¢~--,,~.----~ ·
New unit will be installed in what type of facility (circle type of facility or fill in
OTHER):
Residential: Single-family, detached
Multi-family, apartment
Commercial Industrial
Other:
Single-family, attached
Multi-family, condo
Public facility
Job address:
(Including unit number) .. z:~:~'~Y-~'
/
/,; .'
Existing unit information:
Make of unit:
1 ) Total watts of each element:':'""" -
2) Size (Gallons): ,'~(::~ ....
3) Energy Rating: .............
,1) Breaker Size: ................
5) Heat Recovery Unit: Yes: ............................... No: .....................
Location of Water Heater:
Disconnect:_
Proposed new unit information:
1 ) Total watts of each element: ........
2) Size (Gallons): .............................. ~ ..........................................
3) Energy Rating: ......................................................................
4) Breaker Size: .........
5) Heat Recovery Unit: Yes: N°i~'-'-'~- ..... ~.~._~i__.i. '
(Note an electric permit complying with code is required for the installation of a new disconnect)
Location of Water Heater:
Office use only
Roviewer's signalure
Dale
t \,';I IR ')ATA\DeveI¢ pmenl\FORMS doc\Water Heater Change-out.doc - TL/arw - 11/16/2000