PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
2/08/02
13:33:11
Application number ..... : 01 00002649
Application status, date : FINALED
Property .......... : 142 W TARA LAKES DR
PCN ............. : 08-43-45-30-20-000-1420
Lot Number ......... :
7/27/01
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : SE SCREEN ENCLOSURE
Application date ...... : 6/26/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 3729
10 X 26 ALUM ROOF/SCREEN
BD
2500
0
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D PARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
COMPLETE EACH BOXED ENTRY Permit # /'~ I- Z-(oq
PCN# ~ ¢¢~ f-/,,,~' ~ ~
Owner's NameI ~ ~,~ ~e S
Owner's Address ~.~ ~ ~ ~ ~s ~ ~
~City J~ ~~~ ~
Fee Si~ple~itle Holder's Name
Fee Simple Title Holder's Address
Contractor's Compan~ ~)d~u~~A ~v, ~C-
Contact person and emeroency phone ~
Coml3a~v Address
,city'
~Job NameI ~J '--!
}Job Address~ i u~
ILegal DescriptionI
(FOR SUB PERMITS ONLY)
(Palm Beach County Property Control #)
JOwner's Phone ~
State
State
ICompany Phone
Zip %J ,~ ~ ~ ~
(If other than owner's)
(If other than owner's)
Pager~'~_ '"7..~' -,~ ~, (/c/
F-L_ Zip '~ ..~ q ~ ¢:
Zoned
Bonding Company i~, :i
'~':, City State
Bonding Co. Address ~,:.,.-: ';
Architect/Engineer's Name .: '" ti Ik! ? ~ ~.~0i ~ '
Architect/Engineer's Address i'~ ~' ""~" - ~ ,
Mortgage Lender's Name ~
Mortgage Lender's Address ~ ~' --.~ ~?',~'~.,"L-~',. ~
SINGLE FAMILY ~ DUPLEX. ~): .~bFAM~ ..... HOTEL~ ~TAIL ~ OFFICE INDUSTmAL
(check one)
ESTIMATED VALUE OF CONSTRUCTIONJ $~. ~
IDETAILED DESCRIPTION OFWORK' ~ --~ ~ ~ / ~ ~ .~ ~ ~ L
App icadon is hereby required to obta n a permit to do work and installations as indicated. I cedi~ that no work or installation has
commenced prior to the issuance of a permit and that all work will be pedormed 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 ceHi~ 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 RECORD~G YO~ NOTICE OF COMMENCEMENT.
'~'~ ~~. Date
Propedy Owner's or Agent's Signature
STATE O~ FLO~DA, CO~T~ OF PAL~ ~ACH ~ ' ~
g g nowteagedoemre methis & ~' -- (date) by ~ ~~ ~OO
wh° is pers°nallx kn°wn t° me °r whoh~r~ed ~ ~P ~~~ ~~ as ide~ation and who dl
take an oath. A~1~O~ JOANN T. BO~DELON i I 'd (did not)
~ ~ ~ CO~SSIO~ * CC 707a54
(SEAL) $~ ~ ~PI~ES FEB 28, 2~2 -
~na~reor~t~~. W~(~ '/, ~~Name of omcer taking ac~owledgement- t~ed,
printed or stamped ~ ~ / J ~ Title or ra~ ~ Serial Number, if any
C ontractor'sSignature Z~~~ Date
STAT~ O~ ~LO~DA, CO~T~ OF PALM BEACH
The foregoing instrument was ao~owledgcd before me this ,/~ (date) by ~,~¢~~
who is personally hmwn to me or ~vho has produced ' · - ' '. - - .
ta~ an oath. as tdenbficanon and who dM (did not)
Signature of person taking ac~owledgement Nam t - t~ed,
printed or stamped
(Cedificato of Competency Holder)
Contractor's Stato Ce~ification of ~oCstration ~o.
Uabifity Insuranco [xpiration
Workors' Compensation [xpir~tio~ato
Application Approved By ~ ~y~ Permit Officer Date: 7/ >/~/
Any change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid pe~it prior
to starling. 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 REFUNDABL F
S:~DEVELOPMEN~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 (A/C)
# OF STORIES
# OF BEDROOMS
REMARKS:
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
VALUATION
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
Recpt # ,,~ ?~('/b CK#
Cash Rec'd from:
Accepted by: (Initials)
FEE
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)
S:\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