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
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FT=Appl names
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FS=Tracking inq
F13=Val calcs
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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