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PERMIT APPLICATIONBP200101 CITY OF BOYNTON BEACH Application Inquiry 11/27/01 13: 52: 22 Application number ..... : 00 00001248 Application status, date : CERTIFICATE ISSUED Property .......... : 541 SE 18TH AVE PCN ............. : 08-43-45-33-00-000-1490 Lot Number ......... : 149 ii/ig/oi Zoning ........... : C3 COMMUNITY COMMERCIAL Application type ...... : CH CHURCH Application date ...... : 3/22/00 Tenant nbr, name ...... : Master plan nbr, revwd by : Estimated valuation .... : Total square footage .... : Public building ...... : NO Work description, qty . . . : Pin number ......... : 2788 NEW CHURCH BUILDING JP 400000 0 Press Enter to continue. F3=Exit FS=Land inq Fi0=Fees Fll=Receipts FT=Appl names F12=Cancel FS=Tracking inq F13=Val calcs Fg=Bond inquiry F24=More keys ~ DEPARTMENTOFDEVELOPMENT BUILDING DIVISION , '~ BUILDING PERMIT REVISION APPLICATION~~~ PLEASE PRINT ORIGINAL PERMIT # 00 ~' b~ MASTER PLAN # PROJECT NAME: ~ O6w¢~-c.D-.x¢~' ADDRESS: Contractor's Name Yq A0...V-.- ,,./ 6..~,,&~'~x,.,~..~to,,2 Contractor's Phone TOTAL ESTIMATED VALUE OF THIS REVISION: $ c~' O(J57 ~ DESCRIPTION OF WORK (Please specify in detail what is being revised from original permit): ]~UILDING:-'['o,q-~,~6~ '~ c : ~. ~ , .~ t.~ '( o '" - t'~ o .~ , ~ (h ~t,..~ff Value of Work: $ CLEAPANG & GRU~D4G: Value of Work: $ Value of Work: ELECTRICAL: Value of Work: $ EXCAVATION: Value of Work: FILL: Value of Work: $ FIRE SPRINKLER: Value of Work: $ tt/A l RRIGATION: ~/~. Value of Work: LANDSCAPING: Value of Work: $ MECHANICAL: Value of Work: ~pAVING: Value of Work: $ __ ~,l/p, PAVING/DRAINA(? i. ~/t* ffalue of Work: PLUMBING: Value of Work: $ Value of Work: $ ~ L , SITE LIGHT'G: ~ Value of Work: $ ~ '~ ~'~ F' ~'' I wish to revise the above referenced permit to perfo~ the work described herein. I ce~ify that all work will be cons~cte~ confomance with all laws, codes, regulations, mieN, etc. governing Boston Beach, and I eeni~ that ~e above infomtion is t Cott~actor's Signam~ ~ ~. Date: Value of Work: $ SIGN: STATE OF FLORIDA, COUNTY OF PALM BEACH . .,-'.. ~ '!'he foregoing instrument wa~s i\~tk[- ~ (date) by' ;tagX,~.% >~X,[~t~.~\~, e~ , who is ~¢,sonally known to m~ or whc produced ,~ ....... ~'~k OoRANT [} (type ot ,denUtlcauon) as Ment,l~caoon and who d~d (dM not) take an oath. S,gnalure of~'~son ,aki,,g acknowledgemcnl 0,'3~ Na= of o~cer taking ac~owledge=m-ty~d printed or _ ... 'ntlep~~ ~ / Serial numar, italy APPLICATION APPROVED ~ff~~~~4~_l'ermitOfficer Date: FEES FOR REVISIONS ARE NOT R~FIINDARI.E ~i JiJ~ ~Ji.;l~ i'(3i( (31'l'jt.t~ t3~l~ C;L%[,~ Application # Master Plan # PCN # APPLICATION DATE: (Palm Beach County Property Control #) RECEIVED BY: ZONE: 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) NUMBER 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: ~ Building. ' ' . Clearing & Grubbing ~"/i''~ ~-"~'~'~~~ ~Drainage t i [7:t ~_~~,~,,~ ~"' ~ ~Elec~ical //~~~~~~~/~ Excavation ~ ... ' ~ ~' ~ ~Fire Sprinkler ~1/.. ~ ~ '~~ ~ ~ ~/ ?~ hanical tJ Roofing . Si~ . Site Lighting SUB -TOTAL REVISION # ~'~ Permit # ffgO,/'~_ c ~ Review ~'~ TOTAL Date stamp ~(arking On the plans~ Date turneff over to ~ Review / ~ompleted By .(~ 1, 't Date ///Oq/~ i LESS PLAN' FIL~ FEE uate Sta/fNotifie~ Il [~q/~O I~it~als .~ D~te applicant called ~yg~ fl~2 ~g. J°gick'~ c°~ent~~ ~ ~"~' Initials Date'~ta~-~arking off the plans --~ ~' Date mined over to Pla~~~ ee~i~ Completed By , Date Date StaffNotified b, - '-----~...,--Initial-- .. ,.:.. Utilities I Police P.w. IParks IF6r&ter'l Date applicant called to pick-up comments Initials !!., :,. .... .. ..~ S: \Developm. ent\FORMS doc\REVISION APPLICATION. doc e,,c> / z. Date stamp marking on the plans VALUE FEE /','7 ov Review " Date turned over t~Al~ Review Completed By _//-./, Date Staff Notified_._. Elec. I Mech. ~ Utilities I Police Date applicant caller to pick-up comments I. , ,t P.W. Parks } Forester Dev.' Dept Initials DEPARTMENT OF DEVELOPMENT BUILDING PERMIT APPLICATION Rec. # _ (Please Print) Permit # (FOR SUB PERMITS ONLY) PaN# -~-z.~ CO O(~ ~/~ O (Palm Beach County Property Control #) Owner's Phone # Owner's Name Owner's Add C~ty Fee Simple Title Holder's Name Fee Simple Title Holder's Contractor's Company Contact person and Company Address city Job Name Job Address Legal Description Bonding Company State ~r~--'/.. Zip (If other than owner's) (If other than owner's) r~ Company Phone # ~["9.-:~c'~-- CT Pager/Fax~ State ~' Zip Zoned Bonding Co. Address Architect/Engineer's Name Architect/Engineer's Address Mortgage Lender's Name Mortgage Lender's Address · A II/I !vn ~VI~ City State SINGLE FAMILY DUPLEX MULTI-FAMILY __ HOTEL RETAIL OFFICE __ INDUSTRIAL (check one) C5 ~ ~-'/~ & ~ ESTIMATED VALUE OF CONSTRUCTION $ DETAILED DESCRIPTION OF W.ORK: 'Tt~cr- 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 goveming 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 ATrORNEY 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 Name of officer printed or stamped ~. ./ Contractor's Signature ~_,~_ sTaTE OF COUgar OF.AL A __ The foregoing ~~ was .c~owledged ~fo. me who is pe~o~l~o~ t0-~ or who has produced take ~ oam. ~.,:[~.. ;, Sis~e ofpemon ~S ac~owledsement ~- p~ted or s~d Tide or ~n~a~ofs S~te Ce~t~n of R~is~afion ~. , ~ ~ ~ ~ ~'~~ Liabili~ Insumn~ Expiration Date [~/) ~ / ~/ Wo~em' ~m~n~fion Expiration Date ~ ' (~i'x I ~ / · · - ; ' Pe~K' ~cer Date: Apphcaflon Appmv~ By Any change in building plans or specifications must be r~ord~ wi~ this office. Any ~ not ~ver~ a~ve must have a valid pe~it pdor to s~ding. In ~nsideration of gran~ng this pe~it, ~e owner and builder agr~ to erect this structure in full ~mpliance with the Building and Zoning Codes of the Ci~ of ~ynton Beach. NOTE: Yhis permit VOIO after 180 OAYS UNLESS the work which it covers has commenced. All Contractors must have valid State Ce~ification or Coun~ Competency plus Coun~ and Ci~ Occupational Licenses prior to obtaining permit. talcing acknowledgement - typed, Serial Number, if any ~ as idenfffication and who did (did not) of officer taking acknowledgement - typed, Serial ~Number, if any I$~I,IANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS FEES ARE NOT REFUNDABLE J:\SHRDATA~DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8100, 9/25/2000 APPLICATION # APPLICATION DATE: SETBACKS: ZONE: LEFT (THIS SIDE FOR OFFICE USE ONLY) MASTER PERMIT # APPLICATION ACCEPTED 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 (A/C) # 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 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 Rec~t # SINGLE FEE Building Clearing & Grubbing Drainage Electrical Excavalk>n Fill Fire Alarm Fire Sprinkler Irrigalion landscaping Mechanical Paving Paving/Drainage Plumbing Roofing Sign S~te Ugllflng SUB TOTAL TOTAL LESS PLAN FILING FEE CK # Cash Rec'd fTOm: Accepted by: (Initlall) BALANCE DUE RecDt # CK # Rec'd fTom: Accepted by: (Initials) J \SHRDATA\DEVELOPMEN'~,FORMS.DOC\PERMiT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98.6/99, 8/99, 5/00, 8/00.9/2512000 DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Rec. # (Please Print) COMPLETE EACH BOXED ENTRY Permit # PCN# ~ /~ ~,,~ Owner's Name~ k.~/+ ~P~ ~ Owner's Address~ ~"Tq~- ~'~ City~ ~ ~ ~ Fee Simple Title Holder's Name Fee Simple,Title Holder's Ad.ss Contractor s Compan~ ~ ~ ~~ Contact person and emergehcy phone State (FOR SUB PERMITS ONLY) (Palm Beach County Property Control #) IOwner's Phone ~ P [ Zip ICompany Phone (If other than owner's) (If other than owner's) Company Addre_ss City ~...-~ ~','- ob Name~ ob Addres~ egal Description Bonding Company State ~c~;ager/Fax# Zip Zoned Bonding Co. Address City State Architect/Engineer's Name Architect/Engineer's Address Mortgage Lender's Name Mortgage Lender's Address SINGLE FAMILY DUPLEX MULTI-FAMILY HOTEL RETAIL OFFICE INDUSTRIAL (check one) -- ESTIMATED VALUE OF CONSTRUCTIONI DETAILED DESCRIPTION CHECK R~,V,~"~[ REQUIRED: ~ f ~ FC~ ISTRUml {' Irl_~l~ ~OTHER~ Applicat~"~s'lTereby required to obtain a permit'1'o"d~ 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, 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 (SEAL) Signature of person taking acknowledgement printed or stamped STATE OF FLORIDA, COUNTY OF PALM BEACH as identification and Name of officer taking acknowl Title or rank Serial Numb, Date vho did (did not) 5gement - typed, r, ifany __ Twhh~ f. oregoing!,ns,t,rument.wasackno,wle, dged before me. j~his, C:~/'~I . (41ate~,l:)7 ~-~[~(~'~~..L,)~ no ,s personauy mown to me or WhO nas produced /,.~-~-/u,O ~L~ ~. ~r2, ~-q~ - ~O_-Q-(_J~O ~F.) as identification and-who did (dht-noO-- take ~a~_.cl~line Co~lin ~ ~ / w (SEA'S4'?,,/Expims September 10, 2001 [ t ,--, ) ~-~-~')c--'-~' Signature or person taking acknowledgeme~._t ~~~ r officer printed or stamped Title or rank (Certificate of Competency Holder) V~I x, 'la~rmit Officer Date: Contractor's State Certification of Registration No. Liability Insurance Expiration Date Workers' Compensation Expiration Date Application Approved By taking acknowledgement - typed, Serial Number, if any 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 stading~ tn consideration of-grantingihis perrrfit, the~wnerandbzJ~Tder~§tb-e~ er~~-s~re ~n~h~l 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 State Certification or County Competency plus County and City Occupational Licenses prior to obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS FEES ARE NOT REFUNDABLE J:\SHRDATA\DEVELOPMENT~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 SUB-TOTAL REMARKS: Recpt # VALUATION SINGLE FEE Building Clearing & Grubbing Drainage Electdcal 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 # FEE Cash Rec'd from: Accepted by: (Initials) IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT TO A FINAL INSPECTION ONLY. AUTHORIZED for CERTIFICATE OF OCCUPANCY: Date AU-I-~oRizE~-~;;-CE'RT'i~i~-ATE-0F c0Mp-~TION:- Date BALANCE DUE Recpt # CK # Cash Rec'd from: Accepted by: (Initials) J:\SHRDATA\DEVELOPMENT\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 DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Rec. # (Please Print) Permit ~ ~ /.Z (FOR SUB PERMITS ONLY) PCN# (Palm Beach County Property Control #) Owner's Name ~ _,~_~ Owner's Phone # Owner's Address ~f'7 q'¢¢ f__-~ T/'t-'T-t ,¢ ~4r City l/~ ~.J~, ' ~'"' ' State ,~-=L Zip Fee Si~n-pt~ Title Holder's Name (If other than owner's) Fee Simple Title Holder's .Address _ (If.ot_he.[r_th. an owner's) Contractor's Company .,'afl/*,~.~"~ .,~..~/~_., . Company Phone # Contact person and emergenCy phone # - ~.J '~ ¢,',/ /,. -y~ (_., Ir~/fl3/~4~' ?y..q ri C27F2 - - ' Company,4,d,~ress'"~'/ '4 ~'X'/"P~r-/..,,¢/~.,¢;' ....... '._' Page~/Fa~# - City )U.?(~_A~'i'~.c~t--7 ~'i.~ .... State .-~, Zip Job Name - ["~ -..Pc. ~J i J~'~, -i .-C:.4,~ ~ [-¢~ Job Address -~'7/ %"~¢'~] /<~' .'~.t,~ ~* Legal Description '~r' /{ t r_/ ,¢ />/-.~ /~/4'~H'P /"/~" ._~,¢~.. ';~ ;~ ~"/,,~ . _/o~ /'.,4 [.,~'. _,~ [ .4~--,/ ./.4:/~(~ - u ......... Zoned Bonding Company Bonding Co. Address Architect/Engineer's Name City State Architect/Engineer's Address Mortgage Lender's Name Mortgage Lender's Address SINGLE FAMILY DUPLEX MULTI-FAMILY HOTEL (check one) ESTIMATED VALUE OF CONSTRUCTION $ ~"~:::, ~'-~) DETAII..~D D. ESCRIPTION ~F WORK: i lA,,, RETAIL OFFICE ~ INDUSTRIAL 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. 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 ~ -" Title or rank I0-- )--cO Thc foregoing instrument was acknowledged before mc this (date) by ~.lm.i~t~-son~y known to me or who has produced take an oath. , Christine Or.alto ~ (SEAL) ,~ w .... ~ecen. bet 0S 2003 · ' eSU ' Signature of~a~'nV-(fi~g acknowledgement printed or stamped Contractor's State Certification of Registration No. Liability Insurance Expiration Date Workers' Compensation Expiration Date Application Approved By Name of officer taking acknowledgement - typed, Serial Number, if any __ .,0 / ._ as identification and who did (did not) (Certificate of Competency Holder) of officer taking acknowledgement - typed, Serial Number, if any 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 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 State Certification or County Competency plus County and City Occupational Licenses prior to obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS FEES ARE NOT REFUNDABLE \\CH\MAIN\SHRDATA\DEVELOPMEN%FORMS.DOC\PERMIT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98, 6~99, 8/99, 5/00, 8~00 APPLICATION # APPLICATION DATE: SETBACKS: LEFT ZONE: (THIS SIDE FOR OFFICE USE ONLY) MASTER PLAN # RECEIVED BY: RIGHT FRONT 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 WAT~ ~, FEE FIRE ~PT. FEE OVE? ;MEFEE SUB-TOTAL REMARKS: SINGLE FEE Building Cleadng & Grubbing Drainage Electdcal Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Paving/Drainage Plumbing Roofing Sign Site Lighting SUBTOTAL VALUATION RE,~R FEE REQUIREMENTS for CERTIFICATE OF OCCUPANCY CERTIFICATE OF COMPLETION FINALS: SITE SIGN FIRE FENCE/BUFFER WALL DRAINAGE PAVING OTHER SITE LIGHTING OTHER TOTAL LESS PLAN FILING FEE TOTAL AMOUNT DUE RECEIPT NUMBER DATE ISSUED INTERIM SERVICES FEE CALCULATIONS: Residential: X = # of Units Applicable Monthly Fee AUTHORIZATION for CERTIFICATE OF OCCUPANCY: Date AUTHORIZATION for CERTIFICATE OF COMPLETION: Commercial: # of Sq. Ft Divided by 1,000 (rounded to Nearest tenth) Interim Services Fee Base Sq. Ft Rate Date Base Sq. Ft Applicable Interim Monthly Fee Services Fee \\CH\MAIN\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION.DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 6/99, 5/00, 8/00 DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT APPLICATION Rec. # (Please Print) Permit # o c~/~/-/,~' PCN# Owner's Name ~4-? ~' Owner's Address ,g/7 '~ 5' City '~'~' ~' ' . -~'~ Tq' Fee Simpl~[~ ~°l~r's Name Fee Simple Title Holder's Address Contractor's Company ~[~N Contact person and emergency phone Company ~ddress Z ~ 2 ~ / Job Name /~ ~ ~ ~/~ ~ Job Address ~/ ~ /~ Legal Description ~ ~ - q¢ - / (FOR SUB PERMITS ONLY) (Palm Beach County Property Control #) Owner's Phone # State /:'Z ,"7- Zip (If other than owner's) (If other than owner's) /./77-2~7/~ Company Phone # ~'1: / - Zoned PageflFax# State ~/-- Zip Bonding Company Bonding Co. Address Architect/Engineer's Name City State Architect/Engineer's Address Mortgage Lender's Name Mortgage Lender's Address 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 goveming 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. Property Owner's or Agent's Signature Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before mc 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 j Title or rank STATE OF FLORIDA, CQUNTY OF PALM BEACH The foregoing insmunent was acknowledged before me this w_ho is personally known to me, or who has produced take an oath. I OFFICIAL NOTARY SEAL ~'T.w'''t~n~ il NOTARY PUBU¢ STA'I~E QF~& Jb,,~/~ //~SANDRA M RIPPEL c'xl ~ ' ,,/. ame printed or sta~g~ coI~u~n~o~, ~xP. ^rn~. m:~n I Title'm: rank ((.;emncate Contractor's State Certmcabon of Registration No. Liability Insurance Expiration Date q- / - / Workers' Compensation Expiration Date ..~-._.3 ~ { Name of officer (date) by taking acknowledgement - typed, Serial Number, if any __ Date 7'~Z~-O~ as identification and who did (did._i.i.i.i.i.i.i.i~ of officer taking acknowledgement - typed, Serial Number, if any 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 structure in full compliance with the Building and Zoning Codes of the City of Boynton Beach. I',IOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have valid State Certification or County Competency plus County and City Occupational Licenses prior to obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS ..... FEES ARE NOT REFUNDABLE \\CH\MAIN\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION.DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00 APPLICATION # APPLICATION DATE: SETBACKS: LEFT ZONE: (THIS SIDE FOR OFFICE USE ONLY) MASTER PLAN # RECEIVED BY: RIGHT FRONT TYPE OF CONSTRUCTION OCCUPANCY TYPE FENCE TYPE ROOF TYPE FLOOD ZONE BASE FLOOD ELEVATION FINISH FLOOR ELEV. (PROPOSED) NUMB--'R OF UNITS PARKING SPACES REQUIRED PARKING SPACES PROVIDED AREA SQUARE FEET (GR.OSS) 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 Cleadng & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Paving/Drainage Plumbing Roofing Sign Site Lighting SUB-TOTAL VALUATION REAR FEE 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: TOTAL LESS PLAN FILING FEE TOTAL AMOUNT DUE RECEIPT NUMBER DATE ISSUED # of Units Commercial: INTERIM SERVICES FEE CALCULATIONS: Residential: X = APPlicable Interim Monthly Fee Services Fee Divided by 1,000 = # of Sq. Ft (rounded to Base Sq. Ft Nearest tenth) Rate Date Base Sq. Ft Applicable Interim Monthly Fee Services Fee \\CH\MAIN\SHRDATA\DEVELOPMEN~FORMS.DOC\PERMIT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00 /5ARTM ENTBo,Lo,no PERM,TOF DEVELO'PM g'NT . BUILDING DIVISION, (Please Print) Permit (FOR SUB IqCRMri's ONLY) PCN~ '~-- q~-~ ~ ~-- ~ ~ ~ -- / qqO (Palm Beach County Property Control Owner's Phone ~ ~1 Owner's Name ~~ ~C~~~~, Owner's Address __~~_ CItaTIOn' bE. - ...... State_~& Zip City ~ ~ ~C~ ~~ , Fee Simple Tille Holder s Name A /~~ (If other than owner's) Fee Simpl~ Title Holder's Address _ / V f.~ ~._ 'Compan~Phone, ~S~' ~4~'1" olher~t~than owner's) Contractor s Company ~ ~'~ '~~~_ ~ ~7~ P- ~' ~U ~I-~ Contact person and emergency ~hone g ~t~ ~ Company Address _2~0 ~' ~. /0 ~_~., ~PagerlFaxg~~ City ~~q~qtO ~ State -~. ~ Zip ( Job Address . Legal Description ~_ / ] ~ ~-- Bonding Co. Address-- ~:~ /~ 'y ~~ /~.Mte_ ArchitecUEngineers Name p~ ~_ Archilec~Engineer's Address X~ ~o ~~ Mortgage Lenders Name - ~ / /~ ~;'/:~, , Mortgage Lender's Address / ~ ,/J~ _ ~ "- ~ ~'../ SING[.B FAMii. Y DUPI.EX ~U~.I'I-F~.Y I10~ RF~IL OFF~E __ INDUSTRIAL ESTIMATED VALUE OF CONSTRUCTION $ ~O, ~ / .... ~ DETAILED DESCRIPTION OF WORK: ~t% ~~C~ ~~ 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 Ihe issuance of a permit and that all work will be performed to meet the standards of all codes, laws, rules and regulalions 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 I'oregoing information is accurate and that all work will be done iii 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 TOffOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT BEFORE RE.G.(;~DIN~ YOUR N OF COMMENCEMENT.. . WITH YOUR LENDER OR AN ATTORNEY IOTICE Pr°port' Owner's °r Agent's $'onature· -- STATE OF FIAJRII)A, COUNTY OF PALM BEACII (SEAL) Signature of person taking acknowledge~ent ~ _~_ ~,,,~?~('~, ~'n~ ~f~;~er ta~ng acknowledgement - typed printed or stamped STATE OF FLORII)A, COU~T¢ OF PALM BEACII } e o who has roduc [ ) as identihcatlon aad d~d IlOlJ lake all Oalll. ~ ~ ~ -.x ~- . - , primed or slamped --" - v ~-~v, ~:i'ille or ra 'k Serial Nmnhc,', il'any (Cerlilicale of Competency Hokler) Contractor's State Ceflificalion ~gis~tion 8o. Workers' Compen salio~t~// Al, plication Approve,., ~~~~ ...... Permit O,,icer Date: ~(__ ~_.~ _~__ Any change in I)uildin~~ons ~.~t ~o rot;or(J{,d with ibis office. Any work not covered above must have a valid I)onnlt prior Io starting, in conside~ ~r~ng this p~rmit the owner anti builder agree to erect Ihis structure in full compliance wilb the Building and Zoning Codes of the City el Boynton Beach. NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have valid State Certification or County Competency plus County and City Occupalional Licenses prior Io obtaining permit. ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS F E _E_S__,~. _ R_ .E_ _N 0 T R_E FU N_Dg_B_L_E JPLICA1 ION # ~PLICATION DA-'r--E'- .......L~-~ -~' SETBACKS: LEFT RIGHT ZONE: MAGILH PLAN ti _RECEIVED 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 (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 SUB-TOTAL REMARKS: c;,,,'} SINGLE FEE Building Clearing & Grubbing Drainage ~--.~- _ ~lectrical Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Paving/Drainage Plumbing Roofing Sign Site Lighting VALUATION F.EE. SUB-TOTAL REQUIREMENTS for CERTIFICATE OF OCCUPANCY CERTIFICATE OF COMPLETION FINALS: SITE FIRE DRAINAGE PAVING SITE LIGHTING SIGN FENCE/BUFFER WALL OTrtER OTHER AUTHC~,RIT,,~TION for CERTIFICATE OF O(~CUP~,NCY: AUTItORIZATION Ior CER'rlFICATE OF COMPLETION: Date TOTAL LESS PLAN FILING FEE TOTAL AMOUNT DUE RECEIPT NUMBER ~ DATE ISSUED # of Units Commercial: INTERIM SERVICES FEE CALCULATIONS: Residential: X = Applicable Monthly Fee Divided by 1,000 (rounded to Nearest tenth) # of Sq. Ft X Base Sq, FI Applicable Monthly Fee :\s~. iI{I)ATA\DEVELOI MENT\FORMS.DOC\PERM,T APPLICATI(.)N.r)OC - Revised 6/18197, 1114197, 12198, 6~99, 8199 -i~niedm Services Fee Base Sq. FI Rale Interim Services Fee LEGEND: GREE. SCREEN E.TER NPUT I I j RED SCREEN--"DO NOT ENTER ANY DATA'' ~YELLOW SCREEN REFERENCE DATA ONLY I 03/23/2000 ADDRESS: ESTIMATED FEES APPLICATION DATE ~EFFECTiVE DATE 01/01/2000 ~ERMIT NUMBER- 00-1248 I I , "COMMERCIAL FEE CALCULATION" Setbacks: I WORK SHEET FOR PERMIT Left: 4J~0 TYPE OF PERMIT B ' Right: SPACE NUMBER OVERTIME Front: 50= FEESI I i $370.00 Rear: I 196 OTHER I I $43.11 Type Of Const: IV Bcaif ' i . USE I !CHURCH Public Bldg. i I ~ $283.49 i i ' i $43.11 Road Impact Occ. OTHER Radon Fee I Exist. Bldg. N Road Impact : $8,183.57 Occupancy ASSEMBLY Sewer Fee CHURCH ' $1,394.40 Tenant Separation 1HR F re Insp. Fee ! ~ $452.17 Ceiling Type rid ' I I I $o.oo N , Sprinklered , . ' i i $0.00 Roof Type: I TiLE 14.5 Water Fee CHURCH I i $6,279.81 :inish Floor Elev: , i I $0.00 , ' : $0.00 Parking provided: I 50 SQ.FT. RATE [ Parking req'd:I 50 $57.20 i , i $0.00 Gross Area S.F.: ' 8622 $445,931.20 SINGLE SUB TOTAL VALUATION i $17,049.66 Fir. level this space: 7796i 0! FEE ' I FEE Second Level space ~ 0~ Misc.structures 826 11,812 Site $0.00 $0.00 TOTAL CONST.COST $457,743 Bldg. $457,743.00 I $7,323.89 Pub.bldg.check y Elec. $0.00 $0.00 Number of Stories: ! Ii Mech $0.00 $0.00 Application cost Est i $400.00 PImbg. ~ I $0.00 $0.00 Plan Filing Fee ' $2,197.171 i I Fee Collected $6,400.00 Roof i $0.001 ! $0.00 i Drngd i $0.00 I $0.00 Elevator ~ $0.00 ~ . Additional fees 0 I Excav. $0.00 $0.00 Sewer Calc's Sub-GPD 0! I Lands ' $0.00 I $0.00 Water Calc's Sub-GPD 0 ] Paving $0.00/ ! $0.00 Number of Seats/Station 300 Sign , $0.00i $0.00 Number of Empiyees 0 Sewer $0.00! ~ $0.00 I I Number of Beds 0 i SUB TOTAL Fire Insp. Sq. Ft. Fee . 7796 I ! 'Sq.Ft. Calculation 0i i [ - i ' $7,323.89 Sbcci fees , $457,743.00'ri iTOTAL FEE I $24,373.55 CREDITS , $0.00 School/Parks Dist. i NORTH [ LESS Road area i NORTH $0.00 I LESS . PFFIii $6,400.00 Water Credits N ! I $17,973.55 Sewer Credits I N $0.001 TOTAL AMT DUE i Road Credits IN $0'00/ Parks Credit i IN $0.00/ Public Bldg.Credit N $0.00, , School Credit N : $0.00I Seating-Sq. Ft. Fee ~ $452.17I Standpipe-Sprkl N $0.001 ! FirePumps !IN $0.00! i Fire Det. i , N I $0.00i Fire Supp. I I~ I $0.00 i I I Haz. Mat. ; , I $0.00 DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT REVISION APPLICATION PLEASE PRINT ORIGINAL PERMIT MASTER PLAN # PROJECT NAME: ADDRESS: 5'~qt Contractor's Name /IA/~}~ ~ 6"~o~4, Contractor's Phone · oz u SZIM Zm OF TH S VISXO : $ aESCmPT~ON OF WO~ (Please specify,in detail what is~ei~ revi~ed from original pe~it): Value of Work: $ CLEARING & GRUBBING: Value of Work: $ DRAINAGE: Value of Work: $ ELECTRICAL: Value of Work: $ EXCAVATION: Value of Work: $ FILL: Value of Work: $ FIRE SPRINKLER: Value of Work: $ '. IRRIGATION: Value of Work: $ LANDSCAPING: Value of Work: $ MECHANICAL: Value of Work: $ PAVIN~G: Value of Work: $ PAVING/DRAINAGE:/ Value of Work: $, PLUMBING: Value of Work: $ ROOFING: Value of Work: $ SIGN: Value ofWork: $ SITE LIGHTING: Value ofWork: $ I wish to revise the above referenced permit to perform the work described herein. I certify that all work will be constructed in conformance with all laws, codes, regulations, rules, etc. governing Boynton Beach, and I certify that the above information is true and correct. Contractor's Signature ~ Date: STATE OF FLORIDA, COUNTY OF PALM BEACH e" The foregoing instrument ~v_a_s _ac?n~ o_wje_d_ge_d_b_e f~or_e_rnf this_ .... (date) by....h~q~x.._ {__ .~¢~1,'/~', wh; is personally known to me or who has produced ii .~:8/~,. ~it~i~.i Cji'7 !~_ (type of identification) as identification and who did (did not) take~ ~*r'{~_.?.,~ MY COMMISSION#C 978869 S~gnature of person taMn~a~owledge ent · I/],.C4~/ ~ 3/ ~ Name of officer tak]n . - - rfg~m - --~ v ~ ' g acknowledgement-typed printed or stamped t~pl~/p~,.At,~'~l ~"~Lt,~O~l-'J Title or rank ~ON~{~' Serial number, if any ' LICATION APPROVED BY ~ ~ Permit Officer Date: ISSUANCE OF THIS REVISED PERMIT DOES NOT AUTHORIZE VIOLATION OF CITY CODES OR DEED RESTRICTIONS FEES FOR REVISIONS ARE NOT REFUNDABLE (Tills SIDE FOR Application # PCN # (Palm Beach County Property Control #) ZONE: OFFICE USE ONLY) Master Plan # APPLICATION DA'FE: RECEIVED BY: 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 SQUAKE FEET (GROSS) AREA SQUARE FEET (NET) NUMBER OF STORIES # OF BEDROOMS ADDITIONAL FEE BCA1F 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: REVISION #_ q Permit# {~)0 Date accepted submittal Elec. Mech. ~~ [~~! [ F~re Completed by P&Z ~ ~[~ Utilities ERC Police I~. Parks Forester Completed by _. Date to Records i. o Date called for co~ents Initials,,, Permit # Review F H Date accepted submittal Elec. Mech. Completed by Plumbing t Structural Fire Date to P&Z/Records P&Z Police Eng. Utilities P.W. Parks Completed by, Date entered into Permit Log Date called for comments ERC Forester Date to Records Initials Initials Building. Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler ~Irrigation Landscaping Mechanical Paving jPaving/Drainage Plumbing Roofing Sign ~Site Lighting SUB-TOTAL TOTAL .. LESS PLAN FILING F .VALUE FE__ E ,40 ,od) TOTAL AMOUNTDUE RECEIPT NUMBER DATE PERMIT ISSUED Permit # __ Review F II Date accepted submittal Elec. Mech. Plumbing Structural Fire Completed by_ Date to P&Z Records P & Z Eng. Utilities ERC Police P.W. Parks Forester Completed by Date to Records Date entered into Permit Log hfitials Date called for comments Initials, \Development\FORMS.doc\REViSiON APPLICATION2.doc 12/98,Rev.6/99,8/25/2000 new label attached to application. DEPARTMENT OF DEVELOPMENT BUILDING DIVISION BUILDING PERMIT REVISION APPLICATION PLEASE PRINT ORIGINAL PERMIT # PROJECT NAME: Contractor's Name TOTAL ESTIMATED VALUE OF THIS REVISION: $ u ESCRIPTION QF WORK (Please specify in. detail w~at is being.revised from original permit): ILDING: ~9oot Value of Work: $ CLEAR~G & GRUBB~G: MASTER PLAN # ADDRESS: Contractor's Phone Value of Work: $ DRAINAGE: lalue of Work: $ , Value of Work: $ EXCAVATION: Value of Work: $ FILL: Value of Work: $ FIRE SPRINKLER: Value of Work: $ IRRIGATION: Value of Work: $ LANDSCAPING: BUILDING DEPARTMENT Value of Work: $ MECHANICAL: Value of Work: $ PAVING: Value of Work: $ PAVING/DRAINAGE: Value of Work: $ PLUMBING: Value ofWork: $ ROOFING: Value ofWork: $ SIGN: Value of Work: $ SITE LIGHTING: Value ofWork: $ I wish to revise the above referenced permit to perform the work described herein. I certify that all work will be constructed in zonformance with all la~,s, codes, regulations, rules, etc. governing Boynton Beach, and I certify that the above information is true ~nd correct. '~~ ,..ontractor s Slgnature~~~ Date:__ CTATE OF FLORIDA, COUNTY OF PALM BEACH ~'/~-0/ siJid~d~~n' ' ' ' I'he foregoing instrument was acknowledged be/bre me this (date)by l,~n~a~54o~i~.~!dqot,~ta~:nally known to me or who has a ..... (' ) ,roduced .(type of identification) t ,k;~'~M¥ commission ~C8§1~/' ;ignature of person taking acka, owledgement !~.~' ..~ J.~7/~ ) Name of officer tak nowledgement-typed, printed or stamped ~~____ Title or,~k - [-/ ' - Serial number, if any s~PPLICATION APPROVED BY -~ ssu^ c OF mlS REVISED PERMIT DOES NOT ^U OmZE WOLATION OF CITY CODES E¢/ ES Cr ONS FEES FOR REVISIONS ARE NOT REFUNDABLE (Tills SIDE FOR Application # PCN # (Palm Beach County Property Control #) ZONE: 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) NUMBER OF STORIES # OF BEDROOMS OFFICE USE ONLY) Master Plan # APPLICATION DATE: RECEIVED BY: 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: REVISION Date accepted submittal Mech. Completed by P&Z E4. Police P.W. Completed b~ ~ate to P&~ ?~/ecf~$/ I Utilities Parks ERC Forester Date to Records Date entered into Permit Log 05 )JI~, J(~l Initials ..~. Date called for comments Initials Permit # Date accepted submittal Eiec. [ Mech. Completed by Review F H Plumbing I Structural Date to P&Z/Records Fire P&Z Police Eng. P.W. Utilities Parks ERC Forester Completed by,, Date to Records Date entered into Permit Log Initials Date called for comments Initials Building. Clearing & Grubbing Drainage Electrical Excavation Fill Fire Sprinkler Irrigation Landscaping Mechanical Paving Paving/Drainage Plumbing Roofing Sign ~Site Lighting SUB-TOTAL TOTAL LESS PLAN FILING FEE yALUE FEE TOTAL AMOUNT DUE RECEIPT NUMBER DATE PERMIT ISSUED Permit# ~ Review F II Date accepted submittal Elec. Mech. Plumbing Structural Fire Completed by Date to P&Z Records P & Z Eng. Utilities ERC Police P.W. Parks Forester Completed by Date to Records Date entered into Permit Log Initials Date called for comments Initials ~SHRDATA\Development\FORMS.doc\REViSiON APPLICATION2.doc 12~98,Rev.6~99,8~25~2000 new label attached to application. 0~/07/~994 0~:54 P~GE 82. ME?R0~OLIT4N 0&CI[ COUNTY ~.~ETRO-D,~OE g. RODUCT CONTROL N_C)T .~.ACCEPTA~CK Johnz Manville P,O. 110~ SlOg r)t.,n~ ct, CO 80!17 Your appl,eMio~ t'o~ Product Apprn~a.~ of: tAX ~33S~ Johnl ~la,,~'ille ~lodified Bilumc, Ruofinf System over Steel Deck u,~der Chopt~-r 8 of the .M)ami-Dade County C~c govemm8 the dsc of Al~em~e M~rer:3~ a,)d Cofl~lruct~on, and complete y descreb~g i~ :he plans, spcc~cofions and calcul~hon~ 3~ submin~t by Fic~o~ Mutual Rescdrch Corporalion. Warflo~k He~e)'~ and Undc~rflc~ l,aboratories, h~c, been rccomme,de~ fbr acceptance by thc guildin~ Code Compliancr Office tu be used {n Coum~. Flor;da under ~hc spec,~ ccnd,:ioqs se~ fo~h ~ page~ 2.20 a~ the ~andard ¢ondit~o,~ on This approval $h3|! flol be va:,d after the expiration dat.~ Slated bclo~ The Iquildmg CoJ~: Com~l,.,~cc Ot~ce rese~¢~ I~e r~ht to Secure i~ls prOd,Ct Or ma{crta~ at 3ny {im~ f~om a job~i:e ~r :n~u(oct,r~r's Buildm~ Code COmpliance Off, ce may rev~kc, mod~. 0r suspend [l~c ~se of suc% prOduc~ or imme~iale:y The Building C~e Compl,ance Office re~cs thc r~gh~ :o revoke th,s 3ppro,ul dctermincd b) [Itc ~uildmg Co~e Comphance Office Iha( this pr~uc~ cr malarial fa*Is to ] he ex~nfe or ~uch Ig~:ing wdl be incurred by Ihe manufaclurer. ACCE~TA~'CE NO: ~a-O~O8.Ol Revisc~:9%0S09.02 E~PIRE~. 08/27/~ Raul Rodriguez ~.[S~OV[IISi[[~7.5[[ AUDITJONAL PACES FOR 5J'EC~iC AN ~.~N~.~L ¢ONpITIO~S ~ILDi~C ~OD[ CO~IMi~[[ Thi~ applicatio, for Product Approval ha~ been rcv,cwcd by zl~e .%.l,aan~._~¢e Cour. ty B~lng Code- Compliance Office and approved by t~e Building Code Commmee ~cd~ D~cc ~t~, ~lor~a Clmrlc's O,m~er P ~ O~rcctor Build,ng Code Compliance ~cpt RPI'R~%'ED:~ g~2T~ M,am*-Dadc Count~ I FILE COPY BL~,!.DING DIVISION MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING PRODUCT CONTROL NOTICE OF ACCEPTANCE Monier Lifetile LLC 135 NW 20 St. Boca Raton FL 33431 Your application for Product Approval of: BUILDING CODE COMPLIANCE OFFICE METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET. SUITE 1603 MIAMI, FLORIDA 33130-1563 t305) 375-2901 FAX (305) 375-2908 CONTRACTOR LICENSING SECTION f305) 375-2527 FAX (305) 375-255:g CONTRACTOR ENFORCEMENT SECTION (305) 375-2966 FAX (305) 375-2908 PRODUCT CONTROL DIVISION (305) 375-2902 FAX ~305) 372-6339 The expense of such testing will be incurred by the manufacturer. Acceptance No.:99-1012.04 (Revises No.: 9%1124.18) Expires: 12/16/2002 Monier Spanish "S" High Profile. under Chapter 8 of the Code of Miami-Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami-Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at anytime from ajobsite or manufacturer's plant for quality control testing. if this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Building Code. Chief Product Control Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by' the BCCO and approved by' the Building Code and Product Review Committee to be used in Dade County., Florida under the conditions set forth above. Approved: 12/30/1999 I of 7 Inter'net mail address: postmaster~buildingcodeonline.com k,'Francisco I. Quintana, R.A. Director Miami-Dade County' Building Code Compliance O( FEB-22-2000 TUE 02:bb PM 'IRRGO S~GURI'I'Y W~D FRX NU, JUbbU~tqq! r. UI ~RODUCT CONTROL NOTICE OF ACCEPTANCE Sec~urity Windows & Doors 5100 NW 72 Ave. Miami FL 33166 MI AMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING BUILDING CODE CCHI~I-IANC£ OFFICE ME"TRO-DADE YLAGLER BUILDING t40 WF_.ST FLAGLEK STREET. SUITI~ MIAMI. FLORIDA ]~130-156~ CONTRACTOR LgC~NSIN~ (~5) 37J-2~2~ FAX (~o$) CONT~ACTOg ENfOrCEMEnT O05) ~7~-2~ PAX (30J) ~-2~8 raOoUCT CONTROL DIVISION Your application for Product Approval of: Oos~ ~s.,_9o: ~^x O0~ ~-6~9 Series 2]00 Aluminum Fixed H/indow under Chapter 8 of thc Code of Miami-Dado CouaW governing thc use of Altcma~c Matc6al$ and Types of Construction, and completely dCScfibcd herein, has Ix'ca recommended for acceptance by the Miami-Dado County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval ~hall not be valid afxer Ihe expiration date stated below. BCCO reserves thc right to secure this p~oduct or maxe~iaJ at anytime from ajobsi(e or manuf, acturcr's plant for quality contxol testing. If this product or matcrial fails to Ix:dorm in the approved manner, BCCO may revoke, modify, o~ suspend thc usc of such product or ma~crial immcdla~¢ly- BCCO reserves thc righ~ Io revoke this approval, if it is determined BCCO that this product o~ matc6al fails to mcc! the requirements of thc South Florida Building Code. The expens~ of such testing will bc incurred by the manufacturer. Acceptance No.:99-0330.03 Ex p i res: ?4/25/2002 Chief Product Conlro[ Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCY REVIEW COMMrI'I'EE This application for Product Approval has been reviewed by thc BCCO and approved by thc Building Code ~nd Product Review Committee to be used in Dadc County, Florida under the conditions set forth above. ~t~u intana, K.A. Director I of 3 Miami-Dado County Building Code Compliance Office Approved: 06/2411999 Interact uaesil address: postma.~tvr~bu~lding¢oaeonliee'c°m  HoK, cpeKe:'btt p:/'/~ FILE COPY BUlL. DING DIVISION__ FEB-22-2000 TUE 03:01 PM TRAOO SECURITY W&D FAX NO, 305592744? P, 13 MIAMI-DAnE COUNTY. FLORIDA METRO-DAD£ FLAGLER BUtLDIIqG RUILDING CODE COblI'LIANC£ OSTICE, PRODUCT CONTROL NOTICE OF ACCEPTANCE Security Windows & Doors $I00 NW 72 Ave. Miami FL 33166 Your application for Product Approval of: METRO-DAnE FLAGLER BUILDING tn0 WF_ST FLAGLER STI~F...I-.'T. SUITE t603 MIAMI. FLORIDA 3]130-i~6~ 005) ]75-2901 FAX (]0~;) 375-2908 CONTRACTOR LICENSING SECTION (305) 37~.2.~27 FAX 005) 37~-2558 CONTRACTOR £NFORCE~.tKNT SECTION (305) 3?5-2%6 FAX {305} 325.2908 fRODUCT CONTROL DIVISION {3OS) 3?5-2902 FAX (305) 372-6339 Series Doral $ Ou~swing Aluminum Patio Door under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Ts'pcs of Construction, and completely described in the plans, specifications and calculations as submitted by: Applicant, along with Drawing No. W98-71, Sheet~ I thru 4 of 4. (ThL~ NOd renews NOA Ne. 94-111ZO1.) has be~n recommended for acceptance by the Building Code Compliance office to be used in Dade County, Florida under the specific conditions set forth on pages 2 ct. seq. and the Standard Conditions on page 3. This approval shall not be valid after the cxpiration da(c stated betoxv. The Office of Code Compliance reserves the righ! to secure this product or material at anlaimc from a jobs(re or manufacturer's plant for ~qality control to-sting. If this prodoct or material fails to perform in thc approved manner, the Code .):nplianc¢ Office may revoke, modify, or suspend the use of such product or material immediately. The applicant shall re-evaluate this product or material should any ammendments to the Sou~h Florida Building Code bc enacted affecting this product or material. The Building Code Compliance Office reserves the the right to revoke this approval, if it is dctem~ined by thc Building Code Compliance Office that this product or material fails to meet the requirements of the South Florida Building Code. The expense of Accepianee No.:98-0928.03 Expires:09/14101 Product Control Supervisor THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE COMMITI'EE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in Dado County, Florida under the conditions set forth above. ..... A~ [ g ~ Building Code Compli~ce Dept. Approved: 10~9/98 Metropolitan Dade County ln~cr~t/t~agi~ nddresq: po~tn~n~,t~r~bu,ldmgcodt~nhnc-com ii Orr~¢paRc: h t ~ p:/t w v, v,.b u i~dIL"n , Broward County Product Approval Submittal Form Exterior Door SubmittaIDate: For Bldg. Dept Use Only Control/Permit#: 1.0 Detailed Product Description 4.0 Specific Installation Requirements JlA Manufacturer: O~eral Products Co., lac a) Model Name: Bendu~ark & L~gmd 4. I Type of Opmings: Masonry, Wood Framed, Other b) Model Number: Outswing Jambs e) Unit Size: tW to 8'4 x g'0 a) Fasteners (Type & Size): ~ installation inaructions on reverse side d) Panels (Number & Size): Max 4 up to 36" x 93" e) Rated Uniform Air Pressure Capacity(Based on Test Data) b) Fastener Spacing: wee installation instzuctions on reverse side ii) Negative (ps0: see limitations ii) Positive (psf): see limitations e) Minimum Fastener Embedmmt: if anchor extends through mb-buck us~ f) Impact Resistibility X Yes (opaque panels)' tapcon type with minimum 1- I/4" imbedmmt hao masom~/ g) Me~a Means of Escape X Yes d} Maximum Shim Spacing: Sill 2.0 Material C'haracteristirs a) Fasteners (Type & Size): see installation in.motions on reverse side 2.1 Door (Type & Thickness): steel - 1-3/4" a) Jamb (Type & Thicknesn~ wood 4-1/2" x 1-1/4" b) Fastener Spacing: see inslallation ins~'uctions on reverse side b) Sill (Type & Thickness): Aluminum mia 4" x I/T' 2.2 Glazing ¢) Minimum Fastener Embedment: minimum !-1/4" imbedmmt into masom'y a) Glazing Material: tempered insulated mia 1/2" d) Maximum Shim Spacing: 3/8" b) Glazing Method: Bendunark Integral surround 2.3 Hardware Head a) Description & Location of locking device: 33-1/2" & 46" up a) Fastmers (Type & Size): see installation instructions on rever~ side Kwikset Titan Series passage & deadboR 2.4 Weepholes: none b) Fastener Spacing: see installation instructions on reverse side 2.5 Type of Weatherstripping: magnetic & or compression 2.6 Additional Reinforcement: Aluminum astrafial c) Minimum Fastener Embedment: if anchor extends through sub-buck use 2.7 Location & Type of Required Field Applied Sealants: __ tapcun type with minimum 1-1/4" imbedment into masonry Latex caulk as needed to fill ioints on wood iambs d) Maximum Shim Spacing: 3/8" 3.0 Limitations: Design Pressures 4.2 Buck Opaque single with sidelites +60.0 psf -60.0 psf a) Type/Material: Wood Opaque double with sidelites +55.0 psf -55.0 psf b) Size: 2 by as needed for width of iamb Opaque single +70.0 psf -70.0 psf ¢) Configuration: behind ve~ical iambs ~hat contact masom-¥ partition Opaque double +55.0 psf -55.0 psf d) Structural: _ Yes X_. No Glazed single or double w or w/o sidelites +47.5psf -50.4psf 4.30ptionalGraphiclllustratiun: X Yes No (S~e reverse side this page) 5.0 Mandatory Te~ts Test Description Test Location Test Date Test Report # Certi~ing Engineer &Liemse No. ASTM E-330-g4 Uniform Static American Test Labs April 29, 1996 0429.04-96 William Mdmer P.E. Air Pressure Fort Lauderdale, FI. 0429.03-96 No. 7496 AA~LA 1302.5 Forced Entry American Test Labs April 29, 1996 0429.04-96 William Mdmer P.E. Fort Lauderdale, FI. 0429.03-96 No. 7496 If eomparative analysis was used please indicate _ Yes X__ No 6.0 Supplemental Tests (optional tests) Test Description Test Location Test Date Test Report # Certi~ing Engineer &License No. SFBC 2315.2 Large Missile American Test Labs April 29, 1996 0429.04-96 William Mdmer P.E. Fort Lauderdale, FI. 0429.03-96 No. 7496 SFBC 23 ! 5.3 Small Missile N/A N/A N/A N/A ASTM E331-86 Water Penetration N/A N/A N/A N/A ASTM E283-84 Air lafilitration American Test Labs April 29, 1996 0429.04-96 William Mdmer P.E. Fort Lauderdale, FI. 0429.03-96 No. 7496 7.0 G~neral Notes 7. I Teal reports are not required to be submiaed. 7.2 Application for building permit shall include (2) originals of this report, signed and sealed by a Professional Engineer, reviewed and approved by the desigl~ professional of record. 7.3 Lalx,-Is and identification shall be in accordance with the requirements of Section 350g. 7.4 All other provisions of the South Florida Building Code, Broward Edition, shall apply. 7.5 TesLn are required if l.l.fis checked 8.0 Certification 9.0 Aclmo~ledg~ ~tefit~by Design Professional of R~ord g.i To the best of my knowledge and abilRy the above e~erior door \~ conforms to the requirements of the South Florida Building Code, Broward County Edition. _. State of k"lla'fda, Professional Engineer or Registered Architect State of Florida. Professional En,:~.eer No. ,0116 _ ~.e.,~Y~._. _~,~ ' Job/Site Lodation I~-.!' ~ll: Berber, Pat From: Sent: To: Cc: Subject: Johnson, Don Friday, August 10, 2001 8:06 AM Bud Gall; Glen Steg; Joseph Patrick; Marshall Souther; Mike Ricard; Sam Dillingham Large, Tim; Berger, Pat FW: BAPS Temple GENTLEMEN, PLEASE SEE THAT THIS OCCURS PRIOR TO APPROVING A FULL FINAL. THANK YOU. DON ..... Original Message ..... From: Rumpf, Michael Sent: Thursday, August 09, 2001 6:03 PM To.' Johnson, Don Cc: Harper, Andrea Subject: BAPS Temple Regarding the additional ventilation equipment placed on the existing roof, which were not clearly indicated on the permit or site plan drawings, please be informed of my opinion that the subject pipes/equipment do not have to be screened, due to the type of location of the equipment; however, the equipment must be painted to blend in with the building. As discussed, the hot water flue should be painted to match the roof tiles, and the other mechanical ventilation systems should be painted to match the facade. Mike Rumpf