PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
1/o6/o3
11:52:15
Application number ..... : 01 00000708
Application status, date : FINALED
Property .......... : 45 MAYFAIR LN
PCN ............. : 08-43-45-08-03-016-0080
Lot Number ......... :
i2/ii/02
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : RR RE-ROOF
Application date ...... : 2/20/01
Tenant nbr, name ...... : SHINGLES
Master plan nbr, revwd by : 01-318 RA
Estimated valuation .... : 2100
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 2337
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DEPARTMENT OF DEVELOPMENT= 0
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print) Permit# .~-~/..-'-~ .'~/
PCN~ ~ g ~ ~
Owner's Name ~~
Owner'[Address ~
City ~~ ~o
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address ~~ ~ (If other than owner's)
(If other than owner's)
Contractor's Company ~~~
Contact person and emergency phone
/
Company Address ~ ~ ~ ~~ ~ ~ ~ ~ - Pager/Fax~
City ~~ ~~t~
Job Name
Job Address
Legal Description .-' , .
' Zoned
Bonding Company
Bonding Co. Address " ~ State
ArchitecFEngineer's Name
ArchitecFEngineer's Address
Mo~gage Lender's Name
Mo~gage Lender's Address
S~GL~ FAMILY _ D~LE~ ~L~-F~[LY __ ~TA~ OFF[CE ~US~L
(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 pdor 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 1'O 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
The 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
printed or stamped
Contractor's Signature ~~~
Name of
officer taking acknowledgement- typed,
Serial Number, if any ~
Date ~ '-~0 ' <:~ (
The foregoing ins munent was acknowledged before me this r-~ '~' O/ (date)by ~~~J '/'~~
who is personally known to me or who has produced as i-d~tifica'tioh arid who did (did not)
t~ke an oath. //~'~ J/ I~
(SEAL) -- t ~_~ltl~ ~YCO~ISSION ~CC980079 ( '
Signature of person taking acknowledgeme _~l~,~e~;2~'~' a~mowledgement - typed,
· 3.NOTARy FL .,,~ ~,,~, & ~=, umber If an
printed or stamped (//-- · ~~~~'~_t~[~qu ,' y
(G~, ~;[k.~.~ u; ,Gu,,,~;.~,,~:V ;';u;d~, )
Contractor's State Certification of Registration No.
Liability Insurance Expiration D~e
Workers' Compensation Ex, la)r.~_q.n Dat~ /
Application Approved By/~/! ~ Permit Officer Date: /
Any change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit prior
to starting. In consideration of granting this permit, the owner and builder agree to erect this structu~re in full compliance with the Building
a nd Zoning CodeSn~[ E~of the Gib/. obE~ynk~a,~. ~ ~.~hr S ET
NOTE Th,s"er
: ' ~, ESS the work which it covers has comm~
valid State Certificati plus County and City Occupational Lice~
[~. All Contrac~or~
pri~ o~t~n~j)ern
DEl iD RESTRICTIONS
e
ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF
FEES ARE NOT REFUNDABLE j
~.~TMENT
J:\SHRDATA\DEVELOPMEN~FORMS.DOC\PERMIT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
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
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
SUBTOTAL
REMARKS:
IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date
VALUATION
SINGLE FEE
Building
Cleadng & 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
Cash Rec'd frc, rn:
Accepted by: (Initials)
BALANCE DUE
Recl3t # CK #
Cash Rec'd from:
J:\SHRDATA\DEVELOPMENT~FORMSDOC\PERMIT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000