PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
12/12/02
11:00:38
Application number ..... : 02 00001618
Application status, date : FINALED
Property .......... : 40 SOUTHPORT LN A
PCN ............. : 08-43-46-06-06-000-0401
Lot Number ......... :
5/09/02
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : E ELECTRIC PERMIT
Application date ...... : 5/01/02
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 2428
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DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
02-1618
PeN# Og/"~._3 </..~/~Z~/~ ~,/0<:~ (Palm Beach County Property Control#)
uity ~N rqO~ ~Oh / Slate ~ _ Zip
Fee Simple Ti{le Holder's Name ~m (If other than owne?)
Fee Simple Title Holder~Address /~, ' ' qf nther th~-
~on~ra~torsComp~ny ~q0~(~(~5~ ~~ ~,~, Comp~n~hono~ ~(0~~
uontactperson anag~erg~y p~n~ ~1 II ~~aYfx% D6q-~l . ~
Com~ny Address ~)(~ ~.~, ~ ~'~ ' ~' Page~ax~'~
City ~0~~ '~h ~ State ~ zip
Job Nam~ ' '
Job Address
Legal Description
City State
Rec.#
Permit #
(FOR SUB PERMITS ONLY)
HOTEl~__ OFFICE INDUSTRIAL
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's A~ess'
SINGLE FAMILY ~DUPLEX MULTI-FAMILY
(check one)
ESTIMATED VALUE OF CONSTRUCTION $
DETAILED DESCRIPTION OF WORK: ~'~=~.e¢:
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 construction 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 work 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
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATFORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Property Owner's or Agent's Signature
Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
Thc foregoing instrument was acknowledged before me this
who is personally known to me or who has produced
take an oath.
(date) by
as identification and who did (did not)
(SEAL)
Signature of person taking acknowledgement ~, Name of officer taking acknowledgement - typed,
printed or stamped .... ;~ / Tit~e or rmtk Serial Number, if any
Contractor's Signature {y~~ '-----~---Dat. /"~' '
Signature of person taking acknowledgemeq~~° ~'~mR a~mowledgement - treed,
printed or stamped (,,/ J/ ' ' T~fl- ~-~~~umber, ir any
(Certificate of Competency Holder)
Contractor's State Certification of Registration No.
Liability Insurance Expiration Date ~.---~.
Workers' Compensation Expiratio~Q Date" /__
Application Approved By -.--~---~.~//C~'~/
/
Any change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit pdor
to starting. In consideration of granting this permit, the owner and builder agree to erect this structure in full compliance with the Building
and Zoning Codes of the City of Boynton Beach.
NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have
valid Slate Certificalion or County Competency plus County and City Occupational Licenses prior to obtaining permit.
ISSUANCE OF THIS PERMIT DOES NOT AUTHORITE VIOLATION OF DEED RESTRICTIONR
FEES ARE NOT REFUNDABLE
,~'\DFVELOPMENT~FORMS.DOC\PERMIT APPI IEATION D~3C I'~ovi,~ml RIIR/q7 11/4/97 l?lqR R/c)o R/hq ~/~n R/on
APPLICATION #
APPLICATION DATE:
SETBACKS: LEFT
ZONE:
MASTER PLAN #
RECEIVED BY:
RIGHT 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 (NET)
# OF STORIES
# OF BEDROOMS
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
REMARKS:
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUATION FEE
SUB-TOTAL
REQUIREMENTS ~r
CERTIFICATE OF OCCUPANCY
CER~FICATE OF COMPLETION
FINALS:
SITE SIGN
__ FIRE ~ FENCE/BUFFER WALL
DRAINAGE
PAVING OTHER '
SITE LIGHTING OTHER
AUTHORIZATION for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZATION for CERTIFICATE OF COMPLETION:
Date
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
DATE ISSUED
INTERIM SERVICES FEE CALCULATIONS:
Residential:
=
Applicable Interim
Monthly Fee Services Fee
S:\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION.DOC- Revised 6/18/97, 1114/97, 12/98, 6/99, 8/99, 5/00, 8/00
Base Sq. Ft Applicable Interim
Monthly Fee Services Fee
# of Sq. Ft
# of Units
Commercial:
Divided by 1,000 =
(rounded to Base Sq. Ft
Nearest tenth) Rate
PREPARED 5/01/02, 8:38:34 PAYMENTS DUE RECEIPT
CITY OF BOYNTON BEACH PROGRAM BP820L
APPLICATION NUMBER: 02-00001618 40 SOUTHPORT LN A
FEE DESCRIPTION AMOUNT DUE 0 2 - 1 6 1 8
PLAN CHECK FEE
35.00
TOTAL DUE 35.00
Please present this receipt to the cashier with full payment.
Oper: HONC~YDD
Date: 51~11e2
Total tendered
Total payment
Receipt .o: 238778
$78.88
$7~.~