PERMIT APPLICATIONBP200IO1
CITY OF BOYNTON BEACH
Application Inquiry
i2/i3/0i
07:41:03
Application number ..... : 01 00001582
Application status, date : CERTIFICATE ISSUED
Property .......... : 128 SAUSALITO DR
PCN ............. : 08-42-45-13-16-000-1280
Lot Number ......... : 128
9/28/0i
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : SF SINGLE FAMILY-BLANKET
Application date ...... : 4/16/01
Tenant nbr, name ...... : MODEL C/ PRIOR #98-1204
Master plan nbr, revwd by : 95-3788 TKL
Estimated valuation .... : 29000
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 6118
Press Enter to continue.
F3=Exit FS=Land inq
F10=Fees F11=Receipts
F7=Appl names
F12=Cancel
FS=Tracking inq
F13=Val calcs
F9=Bond inquiry
F24=More keys
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
PCN#
tOwner'sNam~ Home D;,narn~.S .q~lvoradn T,_P
wner's AddressI 4R1 0 N. ~(3mm~r~a ] Blvd.
ity~ Tamarac
Rec. #
Permit #
Fee Simple Title Holder's Name Same
Fee Simple Title Holder's Address Same
IContractor's Compan~ Waterproofinq Systems
Contact person and emergency phone~ Bernie Pena
SC
State FL
ICompany Phone
786-388-0888
Zip 3331 9
(If other than owner's)
(If other than owner's)
786-388-0990
Company Address 8356 S. W. 8th' Street
City Miami State FL
obNam~ Sausalito Place
obAddres~ 128 Sausalito Drive
egal DescriptionJ
Pager/Fax# 786-388-0990
Zip 331 44
Bonding Company N/A
Zoned
Bonding Co. Address N/A
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
City State
Miklos & Associates
2263 N.W.Boca Raton Blvd., Boca Raton
Mortgage Lender's Address
SINGLE FAMILY
DUPLEX XX MULTI-FAMILY ItOTEL RETAIL OFFICE
INDUSTRIAL
check one) --
ESTIMATED VALUE OF CONSTRUCTIONJ $ ¢~k.~~-
DETAILED DESCRIPTION OF WORK:I Tn=6= 1 1 =~- ~ ~n nF P'i nn~r ("~mc, n~- ~i 1 ~_ w~th one screw
CHECK REVIEWER REQUIRED: .....................
~ ~ ~ [STRUCT] ~" [FIREI [.OTHER]
Application is hereby required to obtain a permit to do work and installations as indicated. I cedify 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 cedify Ihat 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
STATE OF FLORIDA, COUNTY OF PALM BEACII
Date
The foregoing instrument was acknowledged before me this (date) by
who is personally known to me or who has produced
take an oath, as identification and who did (did not)
(SEAL) ~ ~
Signature ofpersontaking~achmwledgen~nt ~ k X X N~,e of officer
printed or stamped Xxx ~ / ~ ~ TitleXr~nk ) taking achiowledgement- t~ed,
..... Serial Number, iffy ~
Contractor's Signature %% ~~~ ~_ ,~% Date ~/ ~/5 ~
STATE OF FLO~DA, CO~TY ~ALM ~ ~ ~ ~ ~ ~ ~ C / [
BEACH
The foregoing instrument ,vas acknowledged be fore me this ~} ~'~ (date) by ~[~~-e~
who is personally known to me or who has produced as identification and who did (did not)
t~e an oath.
(SEAL) c~~
S,~natpre' or person [~:~,?cknowleqg, e .
printed or stamped z? ~,,'%,'~ ~ - ~unc~c / itle or ra~ ~ame of officer taking ac~owledgement - t~ed,
"-~:" : ..... .%3,:cq, ~ cc8429;5 ~:<? ~; ~ Serial Number, if any
Contractor's State Cedification of Registrati0~ NC:" ' -~ ~~,%%~'
Liability Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By Permit O~cer 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 starling. In consideration of granting this permit, lhe 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 Centractors 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 RESTRICTIONg
FEES ARE NOT REFUNDABLF
S:\DEVELOPMENT\FORMS.DOC\PERMIT APPLICATION MOD.A.DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/9% 5/00, 8/00, 9/25/2000
1.~ _1. v It..L:) _L
BUILDING PERMIT APPLICATION
{Please Print[
Permit #
(FOR SUB PERMITS ONLY)
pcu {
(Palm,BeachJCounty Property Con~rol #}
Owner S Name .... ~ ---r-- - ftc~ ~r
Owner's Addr~ I
State ~
res Sk~Ple-Tktlehola~f~s Name.
{Ii Other than owner)
owner's Phone
Fee Simple Titleholder's Address ·
~[~{~ Othe~ than owner's)
Contractor's Name ~Jo~r)~
Stat~ ~
' Job Name
Job Addr~
Legal beedr~p6£o
Company
City. ' state
Bonding Co. Address__
Architect/Engineer's Name
Architect/Engineer's Address
Hot:gage Lender's Name
Hot:gage Lender's Address
SINGLE FAMILY:~/__ DUPLEX~ MULTI-FF~4ILY~ HOTEL:
{check one)
ESTIMATED VALUE OF ~ONSTRUCTION: ,$ i,....~00- (-~
DESCRIPTION OF WORK. %~,,J4,%l~ Gl(.
RETAIL: OFFICE: INDUSTRIAL: .
~i[~h~[6. la h6~Ay ma~e 60 obta/h a perm/~ to do th& Work and tna~bliak/ons as indicated.
certify that no work or installation has commenced prior to the issuance of a permit and that
ail work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,
PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and R[R CONDITIONERS, ETC.
oWIIER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating constr~ction and zoning.
HARIIING TO OWNER: YOUR FRILDRE TO RECORD A NOTICE OF COMMENCEMENT 14~%Y RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO ]fOUR PROPERTY. IF YOU INTEND TO OBT;%IN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY' 'BEFOI%lg R~CORDXNO YOUR NOTICE OF COMMeNCEMeNT.
Property Owner's or .Agent's Signature Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
Tile foregoing instrument was acknowledged before me tills {date) by
, who is personally known to me or who has produced ·
{type of identification) as identification and whb~did ddi.d no~l[LOtake a~
Signature of perso, taking acknowledgement~~
{tame of officer taking acknowl~dg~m~~3, p~tn(dd Or ~amped__ '' ' "~''
Ti:Is or rank //~ ~al number, if any __
STATE OF FLORIDA, COUNTY OF P~LH BEACH
Th~ for~gotn9 tn~trum~nt wa~ acknowledged before m~ this ~/¢-¢/ {dat~} by
~iu[~t{ T' ~'~n~ , who is.iersonally_knowp to me.or who has produced
~h. {type of identification) as identification and who did {did not) take an
( SEAL )
Signature of person taking acknowledgement
[tame of officer ~aking acknowledgement--typed, priuted o~ ~tamped
Title or rank Serial number, if any
{Certificate of Competency Holder)
Contractor's State Certification or Registration No. ~_~CO(3i~
CoNtractor's certifica~e of Competency No.
LIABILITY INSURANCE EXPIRATION DATE: ~ ~.-/-0~ .
WORKERS' COMPENSATION EXPIRATION DATE: ' - ~ /-./--ok
APPLICATION APPROVED BY Permit Offic'~ Date:
DO'rE: This permit VOID after 180 DAYS UNLESS the work which it covers has been commenced.
Contractors must have va]id State Certification or County Competency plus County and City
Occupational Licenses prior to obtaining permit.
ISSUANCE OF TIllS PERMIT DOES NOT__~g~IOORIZE VIOLATION OF DEED RESTRICTIONS
THIS PERMIT OR PLANS FILING FEE 1S NOT REFUNDABLE
A~y change in building plan~ or ..pecification.q musk be recorded with thi.~ of{ich, a,,y work
covered above must have a valid permit prior to gtarti~g. In considers:lo, a[ the granting of
this permit, the owner and builder agree to erect t:hLs structure in full compliance with the
Building and Zoning Codes of the City of Boynton Beach.
App! ]cat ion #
Master Plan # --
APPLICATION DATE:
RECEIVED BY:
SETBACKS:~ LEFT
ZONEr
RIGHT
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
ROOF TYPE
FENCE TYPE
AREA SQUARE FEET
FLOOD ZONE
BASE FLOOD ELEVATION
FINISH FLOOR ELEVATION
NUMBER OF STORIES
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
~ OF BEDROOMS
# OF BATHROOMS
FRONT REAR
ROAD IMPACT FEE
SEWER FEE
WATER FEE
PARKS FEE
SCHOOL FEE
PUBLIC BLDG. FEE
LAW ENFORCEMENT FEE
RADON FEE
BCAIF
ADDITIONAL FEE
PENALTY FEE
SUB-TOTAL
VALUATION
.F. EE
IEMARKS:
SINGLE FEE
~Slte Impr.
~Building
Electrical
Mechanical
~Plumbing
Roofing
~Drainage
Excavation
~Landscaping
~Paving
~Sign
Sewer
SUB-TOTAL
TOTAL
LESS PLAN FILING FEE
E_QUIREMENTS FOR CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
SITE FINAL
__~F I RE FINAL
SIGN FINAL
OTHER
OTHER
~DRAINAGE FINAL
~FENCE/BUFFER WALL FINAL
SITE LIGHTING FINAL
!.O. OR C.C. AUTHORIZATION
tgnature
Date
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATE PERMIT ISSUED
INTERIM SERVICES FEE CALCULATIONS
Residential: X
# of units applicable
monthly fee
Interll,
Services Fee
Commercial:
divided by 1,000 =
# of sq.ft. (rounded to
nearest tenth)
base ~q.
ft. rate
X
base sq.ft, ap~l-~ie
rate monthly fee
Interlm
Services
Fee
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
PCN#
wn~ Home Dynamics Silverado L.P.
wner'sAddr~Ssl 4810-N. W. Commercial Blvd.
ity I Tamarac
Fee Simple Title Holder's Name Same
Fee Simple Title Holder's Address Same
Contractor's Company] Bomac Electric
Contact person and emergency phone ~ Gary
McDaniel
State
(Palm Beach County Property Control #)
IOwner's Phone ~
FL
Icompany Phone
7698'0054
Zip3331 9
(If other than owner's)
(If other than owner's)
792-7294
Company Address 3532 S_ W. 12th Placxe
City Ft.. T.anderdale
IobNameJ Sausalito Place
obAddres~ 128 Sausalito Drive
ILegal Descriptionl
Pager/Fax#
State ~'L Zip 33312
Zoned
Bonding Company N/A
Bonding Co. Address N/A
Architect/Engineer's Name IVlik]os
Architect/Engineer's Address ? 26 q f~ _
Mortgage Lender's Name
City State
& Associates
w_ Roca Raton Blvd.~ Suite 112, Boca Raton, F1
Mortgage Lender's Address
SINGLE FAMILY DUPLEX xx MULTI-FAMILY __
(check one) --
ESTIMATED VALUE OF CONSTRUCTIONI $ /./-/"04¢) '"'-
DETAILED DESCRIPTION OF WORK:] El-~trical
HOTEL RETAIL OFFICE INDUSTRIAL
CHECK RE,V, IEWER REQUIRED:
~ ~ ~ ~ ISTRUC'I1 IFIRI~ ~OTHER~
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 Name
printed or stamped . ,~ ... Title 05 rank
STATE OF FLORIDA, CO~TY OF PALM BEACH
The foregoing ins~ment was ac~owledged before me this ~ [ ~ ]OX (date) by
who is personally ~ow~Jo ~ or who. has nroduced
. ~ ~ rm~J~a~l~ ~ ~
ta~e an oath. {~, ~ C~m~,~ CC~g~ ~()
Signature of person taking ac~owledgement~v ~ Name of officer
printed or stamped Title or ra~
of officer taking acknowledgement - typed,
Serial Number, if any
Date
as identification and who did (did not)
taking acknowledgement - typed,
Serial Number, if any
(CeG~fLc~ate of ¢o.maet0nj;:y H0.Jder)
Contractor's State Certification of Registration/kiD. --. ~.-[~ d~'al~(Jr 't~'d~"~ /", ~G'.~' ,~/~-I / ~'~7'~_./,
Liability Insurance Expiration Date ! ! -'
Workers' Compensation Expiration Date
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.
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 MOD.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)
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
REMARKS:
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
Recpt #
Cash
VALUATION
FEE.
SUBTOTAL
TOTAL
LESS PLAN FILING FEE
CK#
Rec'dEom:
Accepted by: (Initials)
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, pt #
BALANCE DUE
CK #
Cash
Rec'd from:
Accepted by: (Initials)
J:\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMiT APPLICATION MOD.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
(Please Print)
COMPLETE EACH BOXED ENTRY
PCN#
wner's Name{ ~¢~"r~
wner's Addres~ ~ {~.
ity] ~~ ~
Fee Simple Title Holder's Name
Fee Simple ~itle Holder's A~dress ~.~
~Contractor s Compan~ ~x%
~ontact person and emergency phone
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
(Palm Beach County Property Control #)
~_\~c~.. ]Owner's Phone~ r~)-~_. C:~clq~
State ~ Zip "~'~'~ ~Cl .
(If other than owner's)
~lf other than owner's)
JCompany Phone ~ c~cl-
Company Address ..~'~1 Qb-~ [.~"~' .,<'~'.
City '~'~Q,.Y'~'"'~ ~ _ State
~ob Addres~ / ~ ~~ ~~ _
ILegal DescriptionI L~ ~ ~- ~ ~ ~%~~ ~
FL
Bonding Company
Bonding Co. Address
ArchitectJEngineer's Name
ArchitectJEngineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
Zoned
City State
SINGLE FAMILY ~ DUPLEX ~ MULTI-FAMILY __ HOTEL~ RETAIL OFFICE 'INDUSTRIAL
check one) ~"
ESTIMATED VALUE OF CONSTRUCTIONL $
DETAILED DESCRIPTION OF WORK:] ~}\t~.~-~'k3,c'c,/ - ~o,,"~ P-._c~Ch~'-~-t~c'¥t~A, '
CHECK REVIEWER REQUIRED:
~ ~ ~PLMG~ t./' [STRUC'I1 IFIR~ ~OTHERI
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, ruffs 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 Name
printed or stamped ~ (~ _.,,~,~) Title or rank
Contractor's Signature AL~~B
STATE OF FLORIDA, COUNTY OF P ACH - -
The foregoing instrument was acknowledged before 1~~
who is personally known to me or who has produced ~_(.~*_~_?~)'~.) ~n~'~'~;~i~',~i
take an oath. ' I¥'C~Y. /.-'lq-o. CC691841
~ ~ ~o,,reersona,y Known I 1
(SEAL)
Signature of person taking acknowledgement Name
printed or stamped Title or rank
of officer
taking acknowledgement - typed,
Serial Number, if any ~
Date '~ - .3.~, 0 1
by
as idcntific~on and who did (did not)
of officer taking acknowledgement- typed,
Serial Number, if any,
(Certificate_ of Competency Holder)
Contractor's State Certification of Registration No.
Liability Insurance Expiration Date Co -
o!
Workers' Compensation Expiration Date '~- 1
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.
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 MOD.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:
(THIS SIDE FOR OFFICE USE ONLY)
LEFT
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 #
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
CK#
Cash Rec'd from:
VALUATION
FEE
Accepted by: (Initials)
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
BALANCE DUE
Recpt # CK #
Cash Rec'd from:
Accepted by: (Initials)
I:\SHRDATA\DEVELOPMENT'~FORMS.DOC\PERMiT APPLICATION MOD.A.DOC - Revised 6118/97, 11/4/97. 12/98, 8/99, 8/99. 5/00, 8/00, 9/25/2000
DEPARTMENT OF DEVELOPMENT ---
BUILDING DIVIS qN o.,
BUILDING PERMIT APPLICATION Rec. #
(Please Print) '- ~ -~ ~ ~--'
COMPLETE EACH BOXED ENTRY Permit #
(FOR SUB PERMITS ONLY)
PCN# 08-42-45-1 3-1 6-000-128
Owner's Name{Home Dynamics Silvera~o, b.P.
Owner's Address~ 481 0 W. Commercial B±v~.
CityI Tamarac
State
Fee Simple Title Holder's Name Same as above
Fee Simple Title Holder's Address Same as above
Contractor's Compan~ Home Dynamics Construction Co m
:~. [p..a y Phone
Contact person and emergency phone~Mike Hanley 954-bZu-~ov~
(Palm Beach County Property ContrQl~l
IOwner's Phone ~ 954-484-4800
FL Zip 333i 9
(If other than owner's)
954- 4~/- .$ ..S _s~°the~r"th-'~ owner's)
Company Address 5411 NW 93rd Terrace
City .q-nri sP. State ~'~'
~JobName{ Sausaljto Place .. -..-_ 7-
~lob Addres~ /~-~ Sausalito Drive ,~* ....~
~Legal Oescripti0n~
Pager/Fax#'. 954-747-3321
Zip 33361
Bonding Company N / A
Bonding Co. Address N/A
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
J~["(' -- ,, Zoned
-'
Miklos & ASSOC.
2263 NW Boca Raton BI~Q .... 5~te ,,z, Boca Kat~n
Mortgage Lender's Address
SINGLE FAMILY
DUPLEX x MULTI-FAMILY
HOTEL RETAIL OFFICE
INDUSTRIAL
check one) ~ -- L_ d.,_ i --
ESTIMATED VALUE OF CONSTRUCTIONL $ c~_ (./
DETAILED DESCRIPTION OFWORK:J -oaeJ-'-C
CHECK REVIEWER REQUIRED: ·
~ ~ ~ JSTRUC31 ~'"'"IFIREJ ~OTHER~ NA Mas~er Pla~
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 BE.~'I~i~IING~YOUR NOTICE OF COMMENCEMENT.
Property Owner's or Agent's Signature .d~~~/,~,~~~,--'' Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowl~me th.i, q/[ ~' 10' (d~)~l/O/~t)lJ ~'?¢.~(' ~L. ~Y.~/'C,j
.w,ho is per~~a~ pLod_u_ce.d-") ~.{L~z~,-/tO . I '7 ~- ~"~- ,~'~c/_ ~) k_.Na' k.. as identification and who did (did not)(J-
trace an oaIh. ~x~v ~t,~ .......... ~ ) ~
;'gnat~rl"~l~~~r~m~&ntl L/"~ Name of officer taking acknowledgement - typed,
printed o~-'-: -- .... ~.-'-~.? ,~ . ~'itle or rank Serial Number, if any
ContractorsS,gnature ~~~, ~/"~~ Date q.-.~'/
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this
who is Rersonally known to me or who has produced
take an oath ~,,,,,. ~-~ rran~J Valentin
· #]~r,~ My Commission CC935799 ~ ~
Sign'at-are of person laking acknowledgemen~ ~ ~
printed or stamped Frances J Valent~_n Title or rank
(date) by
Name of
Carlos Lopez
as identification and who did (did not)
officer taking acknowledgement - typed,
Serial Number, if any
(Certificate of Competer~f)~older)
Contractor's State Certification of Registr~ior~l~o_. 01 CGC 036008j/
Liability Insurance Expiration Date - -
Workers' Compensation E 'xmralieerB-~ 1,,0-2~.,,01 ., J/-/r / /
Application Approved ~ J,,"', ~ [/ ~. ,~i Permit Officer Date:
' ' ]~C,-"' -/ '' '/ /
Any change in building plans or .~pectcations must be rec~ed with thisJ~-ice. Any work not covered above must have a valid permit prior
to starting. In consideration of graYrb'ng this permit, the owrT~r 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
J:\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION MOD.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)
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
REMARKS:
IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date ~ .
AUTHORIZED'fi'or CERTIFICATE OF COMPLETION:
Date
,/SINGLE FEE
~/Building
Clearing & Grubbing
Drainage
----~" Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
-~' Mechanical
Paving
__/Paving/Drainage
v///Plumbing
· ,¢/ Roofing Sign
Site Lighting
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
Recpt ? L #
Cash Rec'd from:
VALUATION
FEtE
Accepted by: (Initials)
BALANCE DUE
Recpt Ct CK Ct
Cash Rec'd from:
Accepted by: (Initials)
J:\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMiT APPLICATION MOD.A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
MIAMI'OAOE
MIAMI-DADI:'- COUNTY. FLORIDA
METRO-DADE FLAGLER BUILDING
PRODUCT CONTROL NOTICE OF ACCEPTANCE
Ocean Shutters IYl.anufitcturing, Inc.
4900-B N.E. llth Avenue
Fort Lauderdalc,FL 33334
Your application !'or Notice or'Acceptance (NOA) or':
BUILDING CODE COMPLIANCE OFFICE
*II:71'RO-DADE FI,AGt. I'~R llUII.I)ING
140 WI-~SI' FLAGLER STI(EET. SUII'E 16~13
MIAMI. FLORIDA 33130-1563
(305) 375-2901 FAX (305) 375-2008
CONTI~AC'rOR LICENSING SECTION
(305) 375-2527 FAX (305) 375-25511
CON'rRAC'rOR ENFORCEMENT I}iVISION
(305) 375-2966 FAX {305) 375-290:1
I'ROI}t:c?r CONTIt, Ot. I)lVISl(}N
13051 375-2q02 FAX (305! 372-633q
20 Ga. Galvanized Steel Storm Panels.
trader Chapter 8 or'the Code of Miami-Dade County governing thc use o1' Alternate Materkds and 'Fypcs o1'
Construction, and completely described herein, has been recommended t'or acccptuncc by the Miami-Dado
Count)' Building Code Compliance Office (BCCO) trader the conditions specified herein.
The expense or'such testing will be incurred by the manufacturer.
ACCEPTANCE NO.: 00-0726.06 EXPIRES: 08/22/2003
This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure this
product or material at an)' time from a jobsite or manut'acturer's plant for quality control testing. It' this
product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspertd the
use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is
determined by BCCO that this product or material tails to meet the requirements of the South Florida
Building Code.
Raul Rodriguez
Chicl' Product Control Division
THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL
CONDITIONS
BUILDING CODE & PRODUCT REVIEW COMMITTEE
-Fl'tis application tbr Product Approval has been reviewed by the BCCO and approved by the Building
Code and F'roduct Review Committee to be used in Miami-Dade County. Florida t, nder the conditions set
forth above.
SHEET OF PERMIT SET
DO NOT RE v1OVE
AP.P-ROVED: 09/28/20t~},_ ·
[A~L WORK INVOL~D ON THIS PERMIT SHAL~CONFORM/
IWITH ~ O~ OF 8OYNTON B~CH BUI~I~ C~[S.J
\\s04S0001\pc20OO\~templates\nodce acceptance cover page.dot
Internet mldl nddrcss: ims.tmas~er~lmildingcodeonline-c~,::: .-Homelmgc: ls;,~'//~w....
Francisco J. Qt, intana, R.A.
Director
gl iami-Dade County
Building Code Compliance O1'1~c¢
APR '16 2001
FiLE COPe
BUILDING .O{V.[~[ON
,TrOiitiingcuucu,,,, ..........