PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
1/06/03
11:39:44
Application number ..... : 01 00000841
Application status, date : FINALED
Property .......... : 28 HASTINGS LN
PCN ............. : 08-43-45-08-06-010-0190
Lot Number ......... :
12/13/02
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : AC AIR CONDITIONING
Application date ...... : 3/01/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 5747
C/O A/C SYSTEM
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DEPARTMENT OF DEVELOPMEI T '0 1 -. 0 8 4 1 -
BUILDING DIVISION
BUILDING PERMIT APPLICATIOn]
(Please Print) Permit #
(FOR SUB PERMITS ONLY)
(Palm Beach County Properly Control
Owner's Name ~W ~.~ Owner's Phone ~
Owner'~ddre~ ~¢ ~~
City ...... ~ ~
Fee Sim~ Title Holder's ~ State ~ Zip
Fee Simple Title Holder's Address (If other than owner's)
onlraclor's Name ~[~~ ~ ContraO~¢- ~---- ~ ~- ~ .... (If other than owner's)
rojectManagerandemergencvD~one~ ~/~.z~ /.f. _
, -- . ~
C~ntractor s Address ~~
zip
Job Address
kegal Description
Bonding Company
Bonding Co. Address City
ArchitecFEngineer's Name
Architect/engineer's Address
Modgage Lender's Name
Modgage Lender's Address
SINGLE FAMILY ~ DUPLEX MULTI-FAMILY HOTEL RETAIL
(check one) - ~ - OFFICE I~UST~
ESTIMATED VALUE OF CONSTRUCTION $ ~7~ ~ ~ ~
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 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
SI'ATE OF FLO~DA, COUNTY OF P~M BEACH ~ g~ver'~ ~ ~ ~ I~* ~2 ~-$g--I)~
x.. ~= - i~nQficafion ~d who ~d ~d not
~kc an oath. ,-'K~ ~r~ ~a~ B. In~vi~lio ( )
· ~ '~ '~ ~V COMMI~ION ~ CC634~B7
Signature of pcrsOll Ii~ing ackllowlcdgenlcllt z~ · ~ .0r¢~ T~ racy FAIN IN~UP3NOE
' - -. Seri~ Number, iffy
' P~ BgA~{ '
U TY O~
l'?e {orcgoing inslnm,ent was acknowledged before me Ihis ~ ' ~ 8' O I ,~-: .... ~'&
· no ~s pe~sonall known to me or who has ro , ,.~,~ "% . ~.
_, . Y_~ p duced ~ . . .
eke an oath. - ~,, as Identification. ~d wi ~d
(~d not)
~*~' ~ %~ MY COMMISSION g 8C634187 ~PtRES
,e. o. o,~l~u Title ~ rank ·
-~, ,a,m ~ Serial Nmnber, iffy
(Ceaifieato of Competency Holder)
2ontractor's State Ceaification of Registration No. ~ ~O. ~
.lability Insurance Expirat~n Date -
Norkers' Compensation Expiration Date
~pplicalion Approved By '~ ¢~ Permit Officer Date: .. ~ ~
~ny change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit pdor
o staHing. In consideration of granting this permit, the owner and builder agree to erect this structure in full compliance with the Building
md Zoning Codes of the City of Boynton Beach.
qOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contra~ors must have
/alid State Cedification or County Competency plus County and City Occupational Licenses prior to oblaining pe~it.
ISSUANCE OF THIS PERMII DOES NOI AUIHOREE VIOLAIION OF DEED RESTRICTION~
EEES ARE NOT REFUNDABLF -
WHXMAINkSIII[I)ATAxDF. Vi.'.i. ~ ' : ,'. ' q ' I'I.ICATION DOC
el Nil NlM ()RMS I)O[~1'1 RMII AP
(THIS SIDE FL~i.( OFFI;.,~.. LJSE ONLY)
Application #
Master Plan #
APPLICATION DATE:
RECEIVED BY:
SETBACKS: LEFT
RIGHT FRONT REAR
ZONE:
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
ROOF TYPE
FENCE TYPE
AREA SQUARE FEET
FLOOD ZONE
BASE FLOOD ELEVATION
FINISH FLOOR ELEVATION
NUMBER OF STORIES
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
# OF BEDROOMS
# OF BATHROOMS
ROAD IMPACT FEE
SEWER FEE
WATER FEE
PARKS FEE
SCHOOL FEE
PUBLIC BLDG. FEE
LAW ENFORCEMENT FEE
RADON FEE
BCAIF
ADDITIONAL FEE
PENALTY FEE
SUB-TOTAL
REMARKS:
SINGLE FEE
Site Improve.
Building
Electrical
Mechanical
Plumbing
Roofing
Drainage
Excavation
Landscaping
Paving
Sign
Sewer
SUB-TOTAL
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE 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
RECEIPT NUMBER
DATE ISSUED
VALUATION
INTERIM SERVICES FEE CALCULATIONS:
Residential:
X =
# of Units Applicable
Monthly Fee
Divided by 1,000
(rounded to
Nearest tenth)
Applicable
Monthly Fee
Commercial:
# of Sq. Ft
Base Sq. Ft
FEE
Interim
Services Fee
Base Sq. Ft~
Rate
Interim
Services Fee
Revised 6118197, 1114197
DEVELOPMENT DEPARTMENT
BUILDING DIVISION
EXACTA/C CHANGE-OUT = 0
The applicant is required to complete this form in order to receive a turn-around permit for an Exact A/C
Change-Out. By accurately completing this form the applicant is attesting to the fact that by installing the
new unit there will not be an increase in total K.W. for either the compressor or heat strip(s).
By signature below I vedfy that either I or a representative of my company have inspected the existing
conditions and there is no upgrade of the electrical system or service wiring changes required for the new
unit(s) being installed. The condenser/compressor unit. air handler/heat strips, and KVV size will not
increase.
Print legible or type. All areas listed below shall be completed. ~.- / ¢ ~ /_.o ~'~ x ~"'~-
Qualifier or
agent~ ~/"~/~)/Z~.-- ~/'~'¢f License No. ~
Authorized
Signature: . .'~.-~~_~~ Phone (5-.~f) ....r'-/7- /goo
New unit will be installed in what type of facility (circle type of facility or fill in
OTHER): ~ ..
Residential:(~ingle-famil¥, detache~ Single-family, attached
Multi-family, apartment Multi-family, condo
Commercial Industrial Public facility
Other:
Job address:
(Including unit number) ,.,'~
Existing unit information:
Make of unit: ~'~,~. f"/) ~
Condenser MOdel No.:
Cooling Coil Model No.:
Type
of Heat: ~-¢~¢ ~/,-l fc
Make of Air Handler: ~'-I/2-S
ARI Std. Cap. BTU/H:.
ARI Total Watts:
Amperage of existing disconnect:
Location of:
Condenser
Air Handler
Disconnect
Total K.W.: ~
EER or SEER ~..,Y'-
Proposed new unitj~f, et'mation:
Make of unit:
Condenser Model No.: _. ~/~'~o ?o ,~--/~;--z.
Cooling Coil Model No.: ~'¢A~.~4, z~/
Type of Heat: ~__,,/"~,__,'-/,,t,i
Make of Air Handler:
ARI Std. Cap. BTU/H:
FILE COPy
ARI Total Watts: EER or SEER /'A, ~7~
Amperage of new disconnect and identify wire size:
(Note an electric permit complying with code is required for the installation of a new disconnect)
Location of:
Condenser '~'~",-~
Air Handler
Discor
Office use
MEH - 04/13/98
\\CH\MAIN\SHRDATAkDevolopment\Building.6870\Documonts\FORMS\Exact AC Change-oul.doc