PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
2/11/02
14:02:26
Application number ..... : 01 00002724
Application status, date : CERTIFICATE ISSUED
Property .......... : 1847 MAGLIANO DR
PCN ............. : 08-43-45-18-21-003-0030
Lot Number ......... : 3
11/09/01
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : SF SINGLE FAMILY-BLANKET
Application date ...... : 7/02/01
Tenant nbr, name ...... : MODEL 1805-B/RIGHT
Master plan nbr, revwd by : 00-4703 BD
Estimated valuation .... : 86678
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 8539
Press Enter to continue.
F3=Exit FS=Land inq
F10=Fees Fll=Receipts
FT=Appl names
F12=Cancel
FS=Tracking inq
F13=Val calcs
Fg=Bond inquiry
F24=More keys
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
(Please Print) Permit # (~/- ~;~'7r~
(FOR SUB PERMITS ONLY)
(Palm Beach County.Property Control #)
' .Owner's Phone # (,;..~'C,..~'~.~ ,~/~
State ~ I Zip ~ ::?~(~ 1
(If other than owner's)
,- (If other than owner's)
Company Phone # (.,?:J5:~'-~.~',9~._0-/~--z:.~-
PCN#
Owner's Name ('~(*~F)
Owner s Address ~? ~'
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address.
Contractor's Company_
Project Manager and emergency phone
Company Address ~h~
City ~
Job Name
Job Address
Legal Description
State_
PagedFax~
Bonding Company
Bonding Co, Address
City State
Amhitecl/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's .Ad, dress
SINGLE FAMILY ~' DUPLEX
(check one)
ESTIMATED VALUE OF CONSTRUCT. ION $
DESCRIPTION OF WORK: ~
MULTI-FAMILY ~ HOTEL~ 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 pdor 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 (date) by
take an oath. as identification ,and who did (did not)
(SEAL)
Signature of person taking acknowledgement Name of officer
printed or stamped
.--'--~ _--, Title or rank
Contractor's Signature ,,.z ~/'~ Date
STATE OF FLORIDA, COUNTY 0]~ PALM BEACH""
The foregoing ~stmmcnt was acknowledgcd before me tlfis (date) by ~.b-~'q hj~O~rr&~
who is personally known to me or who has produced
take an oath. as identification ~md who did (did not)
(SEAL) ~
Signature of person taking acknowlcdgcmcn
printed or stamped ...... er
Tire or rank
(Certificate of Competency Holder)
taking acknowledgement - typed,
Serial Number, if any
taking acknowledgemenl -typcd,
Serial Nt,mber, if any
Contractor's State Certification of Registration No.
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 Ihe work which it covers has commenced. All Contractors must have
valid Slate Certification or County C~)mpelency plus County and City Occupational Licenses prior to obtaining permit.
J.SSUANCE OF THIS PERMIT DOES 'NOT AUTHORIZE VIOLATION-OF DEED RESTRICTION,,;
.FEES ARE NOT REFUNDAB[F
J:\SHRDATA\DEVELOPMENT~FORMSDOC\PERMIT APPLICATION.DOC - Revised 6/18/97, 1 I/4/97, 12/98
APPLICATION #
APPLICATION DATE:
SETBACKS: LEFT
RIGHT
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)
# OF STORIES
# OF BEDROOMS
MASTER PLAN #
RECEIVED BY:
FRONT
REAR
ADDITIONALFEE
BCAIF
PARKS FEE
PENALTY FEE
PUBLIC BLDG. FEE
RADON FEE
ROADIMPACTFEE
SCHOOL FEE
SEWER FEE
WATER FEE
SUB-TOTAL
REMARKS:
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUAflON
FE__[
SUB-TOTAL
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
FINALS:
~SITE SIGN
~ FIRE ~ FENC~DUFF£R WALL ,,
DRAINAGE
PAVING OTHER
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATE ISSUED
__ SITE LIGHTING OTHER
AUTHORIZATION for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZATION for CERTIFICATE OF COMPLETION:
Date
INTERIM SERVICES FEE CALCULATIONS:
Residential:
=
# of Units Applicable
Commercial:
# of Sq. Ft
Monthly Fee
Divided by 1,000
(rounded to
Nearest tenth)
X
Base Sq. Ft Applicable
Monthly Fee
J:\SHRDATA\DEVELOPMENT\FORMS.DOC\PERMiT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98
Interim
Services Fee
Base Sq, Ft
Rate
Interim
Services Fee
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION..
(Please Print)
Permit # ~)//-" ~ -~ ~..
(FOR SUB PERMITS ONLY)
PCN# ' (Palm Beach County Pr_.operty Control #) .
ow.e?. m
Owner s Addr~, ~ ~ ~ . ' t~te ~/ ' Zip ..... ~
City . ~ t ~ ] =- " -- , (If other than owner
Fe~ Simple Title ~:11~:;;: ~:ss (~ other than own~r's)~
Fee Simpl~ Title ' '~ Corn an Phone ~ ~~ ~ ~
Cordractors Company ~/~[) ~J~~ P Y ~ '
Project Manager and ememencypl'Lone # ~
C°mpan?jQAddress ~{~)~'J"' "/'~ State
City ' ' '
JobN~'m~ - ' . . .~ . _
Job A~_~gSS...-- _. ,'-, ~ ' '
Legal Descripti~'~ , ' _ _ .
PagedFax# ,,
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
INDU~-iRIAL
(check one)
ESTIMATED VALUE OF CONSTRUCTION $
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 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 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.
,~roperty Owner's or Agent's Signature
STATE OF FLORIDA, COUNTY OF PALM BEACH
The !bregoing i~tstrument was acknowledged before mc this
who ts personally'known to me or who has produced
lake a~ oath. ' f
Date
(date) by
as identification and who did (did not)
(SEAL).
Signature of person taking acknowledgement
printed or stamped
Contractor's Signature .~ _ z~ ~
STATE OF FLORIDA, COUNTY OF PALM BEACH
The fore§Ding instrument was acl~owledged before me this
w~rsonally known to me or who has produced
ti~ke an oath. .
Title or rank
Name of officer
"-'/-~--(-~/ ' (date) by
taking acknowledgement - typed,
Serial Number, if any .~
Date -'7--'~--~l~'-~ (
as identification and who did (did not)
(SEAL) -"~ £ ~ "~ /~
Signature of person takin, acknowledgement ~'~'~~'~. ~-~N~ of off~cer taking acknowledgement - typed,
printed or stamped ~ t"3 Ct_-.[" .-~ '-~(30,._~/' { Title or rank ! -~ ~ .... 6m~t ~ I
Contractor's S~te Ce~ifi~tion of Eegistration No. I~ ~ 5 c~l~ I
Liabili~ Insuran~ Expiration Date ~ ~0~ ~0 Aue. 5,2003 ]
Workem' Compensation Expiration Date
Application Approved By Permit Officer Date:
Any change in building plans or specifications must be recorded with this o~ce. Any ~ not covered above must have a valid permit prior
to sta~ing, Ip consideration of granting this permit, the owner and builder agree to erect this structure in full ~mpllance with lhe Building
and Zoning Codes of the Ci~ of Boynton Beach.
NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have
valid Stale certification or County Competency plus County and City Occupational Licenses prior to obtaining permit.
ISSUANCE OF THIS PERMIT DOES NOT AUTHOEIZE VIO~TION OF DEED EESTRICTIO~S
FEES ARE NOT REFUNDABLE
j:~%HRDATA~DEvEi.~P~EN~FORMSDOC~PER~IT APPLICATION.DOC - P~vi~ed 6118197, 11/4/g7, 1~98, 6~9
APPLICATION #
APPLICATION DATE:
SETBACKS: LEFT
ZONE:
('['his SIDE FOR OF, ::
RIGHT
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
REMARKS:
USE ONL'¥)
MASTER PLAN #
RECEIVED BY:
FRONT
ADDITIONALFEE
BCAIF
PARKS FEE
PENALTY FEE
PLJBLIC BLDG. FEE
RADON FEE
ROAD IMPACT FEE
SCHOOL FEE
SEWER FEE
WATER FEE
FIRE DEPT. FEE
SUB-TOTAL
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUATION
SUB-TOTAL
REAR
FEE
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
FINALS:
SITE SIGN
FIRE FENCE/BUFFER WALL
DRAINAGE
PAVING OTHER
SITE LIGHTING.__ OTHER
ALITHORIZATION for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZATION for CERTIFICATE OF COMPLETION:
Date
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATEISSUED
# of Units
Commercial:
INTERIM SERVICES FEE CALCULATIONS:
Residential:
X =
Applicable
Monthly Fee
# of Sq. Ft
Divided by 1,000
(rounded to
Nearest tenth)
Base Sq. Ft
X
Applicable
Monthly Fee
Interim
Services Fee
Base Sq. Ft
Rate
Interim
Services Fee
ID E t:'~P. TM E NT OF DEVELOPMENT
~BrJI LID ~~ iD I ViE S ~ glUT,..
Any work nob
covered above mus~ have a valid pea'mit p~'£o~' ~o uuar~inql, In conuLde'~'a[Zon o~ ~he granting o~
~hLo permit, ~he owl~e~, a[~
Building and Zoning Coda.
NOTE: This perm[~ VOID a~eu 100 DRYS U~LE$~ ~ne work which i[ cover~ ham been commenced,
¢ontracto~ mua~ have valid $~a~e Cor~kfica%kon o~ County Competency plus County and City.
Occupat'£onaL bic.mnsee p~Lor to ob~ain£n9 permit,
ISSUANCE OF, THIS...~EB~.Z.T DOES NOT AUTI~R~7,$ v,IO~TION oM DEmD..i~$ST%I¢TZONS
THIS PERH~T OR Pr,,AN~_~'_L%.[,~ EE~ ~$' NOT REPUHDABLE
contractor', stat. Certification or Ragl,%ra~lon ~1o. RB0030623~/
Contractor", C.r~i,ica,,. o~ co~pe~.ncy~.,T~.:~9273" ,, .
~:ABILIT¥ ~NSURANCE ~XPIP~NTION DATEI
WORKERS' COMPENSATION ~XP~RATXON DATE:~s~"/~'.,~" , . .
APPLICATION APPROVED BY
PON ~
(Palm- Beach Coun%~ P~'ope~'6y .c. oH~roI'-~')' -
Owner', Nasa'Con:inert':aZ aDs'es ,. Owner's Phone ~(3'05) 512-4954
Fee Simple T~l'el~old~rfa Addre~
con~rac~or,,,. ,Name M &~'L .RQu~zng .: . . 'o) ,..
c~ntraa~o'r,s Phone ~ (56,1) 736-~211
Cl%y~. Bovnto~ Beach Pnx: (56l) 736-1977
Job Name.- ......... Zip 3342~..
City .'
aondin~ to,Address C~7 ....
Mortgage Lender'~ Name
Ho~gage' Lamnder'. Add~ - -
.SINGLE F~ILY~ DUPLEX,__ MU~TI-RAMIL~~,pBL~_ RETAIL: OFFICE: INDUSTRIAL~
{check oriel - - _
App' ' ca,.on ~ mre y ma ~ "o
~ify that no work o~ lns~.Zla~ion hog commenced pv~c~' to the iamuance o~ a permit and that
all work will be parrot'mad ~o meet ~l~e s~andarda o~ all lawm regulating conmtruction in thi.
Jurisdiction. [ underm~and that a meparato permit mu~t bu secured fo~ ELECTriCAL WORK~
PLUHB2NO, SIGNS, WE~L~. POOLS, FUEHACES, DOIDE~S, HCATER~, TANKS, and'AIR CONDITIONERS, ETC.
OWNER'~ AFFIDAVIT: I ca['~l~y ~ha~ ~lZ tl~e ~oregoing.~n~o~matl~n i~'accura~e and that all. work
WA~INO TO O~DRI YOUR FAILURZ TO K~CORD R NOTICZ O,V CO~ENCEMENT ~y RESET IN YOUR PAYING
~IO~ FOR ;IMPI~OVEMER"~S TO YOgi( PKOPEF(TY, IF YOU Ih'TEND TO OBTAIN PII.~,ICINO, COHSI~ W~U~H'
LENDER OR ~ A~O~EY B~O~ R~CO~NO YOUR N02'IC= OF COi~NCEHZ~, '
P~operty'Owne~'~ or A~e~t's $igna~u~m Date
STA,TE OF FLORIDA, COUHTY 0D PALM BEACH ~ "
The ,foregoing lnstrumen~ was acknowledged before me thio . (data) by
,' who is pereonaZ[y known to me on wh6 has pr66uoed
o~h, " (type Of' identification} a~ ident.Lf'lcatkon and who" did (did not) taka
( SEAL ) , /~
Title or rank Florida Notary L~/_~l numbe~', l~ ~ny
4. ~v~o.. ~M. Da~t fry, pa ~o~ ~dor~L-~ication) us iclenti~icution and who ~id (did nou') take an
~P~ OF COHSTRUCTION
:CUPA'NTy TYPE
:NCE TYPE
LEA SQUAK~'FE~T
,ODD
~$E PLO0'D ELBVATION
~MB~R OF UNITS
~RKING SPACES REQU.IR~D
,RKING SPACES PROVIDED
OF BEDROOMS
OF BATHROOHS
RECEIVED BY
FRONT REAR
RORD IHPACT F~E
WATER
PARKS FEE
PUBLIC BLDG,
LAW ENFORCEMENT F~
RADO~ PU~
DCAZP
ADDITIONAL
P~NALT¥
~UB-TOTAL
'MA~KSr'
7-
~ FOR C~RTiFICATS OF OCCUPANCy
C~RTIFICATD 07 COMPLETION
__SITZ FINAL ~IGN ~INAL
.... FIR~ FINAL
· . _OTHZR
~PAVING FINAL _OTHER
~DRAINAG~ F~NAL
__Site Impr '"' ' '"
__Su~lding --
~Plumbing - ' -
__Roofing
. Excavation -
- ' Landscaping '
Pav£n~
_ _Sl~n
..... Sewer
SUB-TOTAL
TOTAL
TOTAL AMOUNT DUE
R~CEIPT NUMBER
DATD PI R14IT ISSUED
X
# Of uni=s - .appllcab~-- ~'~=srim
monthly fee SerVices Fee
divided Dy 1,000 =
~r-~--sq, f'~- [rounded ~O base
neare~ ten~h) ft. rau~
raue mon'~hl~, fee "Services.
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
~Ownerls N-arr~e (~','~ ~~[l
uwner s Address ~Ot~ C~'Od~
City._~;~, ~&~:5
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Company ~C[~q0
Contact person and emergency p~e
Company~ddr~ss ~ ~O ~u~,~
City ~_~F ~C[i,'~ ~.~oh
Job Name ~ o~ic,.~
Job Address '~/~ ~'~ ~t~.~
Legal Description L c ~ ~/~
Bonding Company
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
(Palm Beach County Property Control #)
Owner's Phone # ~.,~O_C-) -- ,/--) i 2_- ~. ~,.~?
'~1 v,)..5~_,
State FIo~-;c~ Zip
(If other than owner's)
(If other than owner's)
Company Phone ¢ 'Iq ~ ;3f ~,~
Zoned
Bonding Co. Address
City State
Architect/Engineer's Name
ArchitectJEngineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY '~__ DUPLEX __ MULTI-FAMILY
(check one)
ESTIMATED VALUE OF CONSTRUCTION
DETAILED DESCRIPTION OF WORK:
HOTEL ~ 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, roles 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 BEACH
The foregoing instrument was acknowledged before me this
who is personally known to me or who has produced
take an oath.
Date
(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 ~~~
STATE OF FLORIDA, COUNTY ( PALM BEACH
of officer
taking acknowledgement - typed,
Serial Number, if any ~
Date ¢7'-Z7-2_0C4/'
The foregoing instrument was acknowledged before me this
who is personally know.ri to me or who has produced ,A/'/~ ~as identi~- ..........
.... ..:~,'~'d.':,, *.~d~.~. ~.-. , .cauon an~ WhO ma (did not)
take an oam. ,,'~,'~t'~.~:',
tit' ~ '~;,~ MY COMMISSION # CC1~$245 EXPIRES
(SEAL1
~,gnature otperson tag.t~g aqknowledge~ent//c-~.L.-.~:-',~.'~'~.-4/t'~/.Namc of officer taking acknowledgement
printed or stamped ~/.~q.C~, y ~L t"~ -~ C Cf-? / ~/Fitle or ~ff"nk /~/9 '/'o f ~-/ Serial Number, if any - typed,
(Certificate of Competency Holder)
Contractor's State Certification of Re0istration No.
Liability Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By Permit Officer Date:
Any chan0e in buildin§ Dlans or specifications must be recorded with this office. Any work not covered above must have a valid permit prior
to startin§. In consideration of granting this permit, the owner and builder agree to erect this structure in full compliance with the Buildin§
and Zonin§ 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 6118/97, 11/4/97, 12198, 6/99, 8/99, 5100, 8/00, 9125/2000
(THIS SIDE FOR OFFICE USE ONLY)
APPLICATION #
APPLICATION DATE:
SETBACKS:
ZONE:
LEFT
RIGHT
MASTER PERMIT #
APPLI(~ATION 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
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 for CERTIFICATE OF COMPLETION:
Date
R'ecpt #
Cash
SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electdcal
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
SUBTOTAL
TOTAL
VALUATION
FEE
LESS PLAN FILING FEE
CK #
Rec'd from:
Accepted by: (Initials)
Recpt #
BALANCE DUE
CK#
Cash
Rec'd from:
Accepted by: (Initials)
v~ r- ,. ., ', ~, ,, ^tN~,o, ,~r~A",' "r~l::'drl C;,PMF_N''r "),RMS DOC',Pr"F'MtT APPLICATION A.D£ ;d 6/18/97. 1 I/4/97. 12/9,q. 6/qq.
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print) Permit # ~)/-
(FOR SUB PERMITS.ONLY)
PCN# Ot~ ~C/'~ I~ Z{ 003 t~30 (Palm BeachCountyPropertyControl#)
Owner'.sAddress BOO (~OLIP..~M01~._% ~-->~.. -d=lDI "
City ~, I~l !%4 ko..,l~ ~ State FL Zip
Fee Simple Title Holder's Name (If other than owner's)
Fee'Simpl.,e Title Holder's A.,tddress , ..- (If other th, an owner's)
Contractor s Company (~t~t~r~VL~'~.,~ ~_P-;~_ .~Comp.any Phone # *,.~-~ ID ~ cf:5'clc X IO.~
Contact person and emergency phone # ~t L ~,~c'l,,r3CA ~*--' - "Tq ;L--'/OO I '
Company Address ::::~c~.: - ' Pager/Fax# -
Legal Description .. %/ ,-
Zoned
Bonding Company
Bonding Co. Address 'City
i '~ ~ 'ii'ii
Architect/Engineer's N~me
Architect/Engineer's Address
Mortgage Lender's Name 1 ~ .............. : ........
[ , -, ' '""W:-:~ R" ' "~
Mortgage Lender's Ad~ress ~ L!h. ~.'~'*,'-:: ................. _~___.,
SINGLE FAMILY ~¥~ DUPLEX .......... ~-ULTI-F~M'~i~ HOTEL__
(check one)
FSTIMATED VALUE OF CONSTRUCTION $ ~? ~:~ ~' '
O~rAI[.ED DESCRIPTION OF WORK:
State
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 pdor 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 ATrORNEY
Property Owner's or Agent's Signature
STATE OF FLORIDA, COUNTY' OF PALM BEACH
who ~-~rsona_.lly known to me.~r who hu produced
take an oath.
(SEAL) t~~/[~, ~C~_.4L~ ~__
Signature of person talcing acknowledgemen
printed or stamped .~~~ Title or rank
Contractor's Signature . -
STATE OF FLORIDA, COUNTY OF PALM BEACH
The£ore~zoinr~sm,mentwasacknowled,edbe£oremethis
who i~_na_l!y kaLwn to m~or who has produced
take an oath.
(SEAL)
Signature ofperson taking acknowledgemen
printed or stamped
Contractor's State Certification of Registration No.
Liability Insurance Expiration Date
Workers' Compensation Expir. i.i.~ti(~f~Date
Application Approved By
NOTICE OF COMMENCEMENT.
~ /¢ Date
~ identification ~d who di~
N~/officer ~a~wledgc
'(date) by
~nt - typed,
~1 wh~) did d~~
as identification .
Name of officer taking acknowledgement - typed,
Title or rank _Seria _l.~[umber.~i~,~s~_-
I ~~-~----~/-- ....
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 THI~ PERMIT DOES NOT AUTHORIZE VIQI.flTION OF DEED RESTRICTIONS
FEES ARE NOT REFUNDABLE
J:\SHRDATA~DEVELOPMENTWORMS.DOOPERMIT APPLICATION A.DOC - Revised 6/18/97, 1114197, 12198, 6/99, 8/99. 5100, 8100, 912512000
~U~PUCATION #
~,PPUCATION DATE:
SETBACKS:
· ZONE:
LEFT
(THIS SIDE FOR OFFICE USE ONLY) ' '
RIGHT
MASTER PERMIT #
APPLICATION ACCEPTED BY:
FRONT REAR
TYPE pF.C0NSTRUCTIO.'
OCCUPANCY TYPE
FENCE, TYPE ·
ROOF TYPE
FLOOD Z~3NE
BASE FLOOD ELEVATION
FINISH FLOOR ELEV. (PROPOSED)
NUMBER OF UI~ITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
AREA SQUARE FEET (GROSS)
AREA SQUARE FEET (A/C)
# OF S~'ORIES':
~ .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:
, I~ ', ~:.'.:' :', -' ,~,.' ' ..-':~.,~ ...:;: )
,~ ,.., .:.' ,, .. :-,,..,:~l.' .... :.:: ~ :.'..;
IF THIS BOX'IS'NOT'COMPI'ETED;'THI$ PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date
SINGLE FEE
Building
Clearing & Grubbing
Drainage
Elect~cal
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUATION
SUB TOTAL
TOTAL
LESS PLAN FILING FEE ( ~.,~, ~O
Recp~ # ~ ~..,4'~, CK #
Cash Rec'd ftc-m:
Accepted by: (Initlale)
Recpt #
Cash
BALANCE DUE
Accepted by: (IniUals)
PROJECT NAME: A
Contractor s Name Q~_ _t~.'--~P .~t2 ~
TOTAL ESTIMATED VALUE OF THIS REVISION: $
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT REVISION APPLICATION
PLEASE PRINT
MASTER PLAN
ADDRESS: ~k~t-'/
Contractors Phone ~~~¥~-qq S-
DESCRIPTION O~F~W~ pRK (Please specify in detail what is being revised from original permit):
BUILDING:
Value of Work: *
CLEARING & GRUBBING:
LoT
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: $
PAVING:
Value of Work: $
PAVING/DRAINAGE:
Value of Work: $
PLUMBING:
Value ofWork: $
ROOFING:
Value of Work: $
gIGN.:
Value of Work: $
CITE LIGHTING:
v'alue ofWork: $
wish to revise the above referenced permit to perform the work described herein. I certify that all work will be constructed in
:onformance with all laws, codes, regulations, rules, etc. governing Boynton Beach, and I certify that the above information is true
rna correct. Q /9 0 '~ [
"ontractor'sSignature .g-~.-'4 I~--'''' Date: 7. a!01
he foregoing instrument was acknowledged belbre me this "7 [ (date , who is personally known to mc or whO has
reduced (type of identification) as identification and who did (did not) take an oath.
~gnature of person taking acka~owled ement ~
· g ,,. ~JC{)~)~. ~nn~Nl PEDRETTIt, lame o~0ffiCer taking acknowledge~nt-t~ed, printed ~ stumped
,PPLICATION ~PROVE~~~~ ~~~O&er Date;
SSUANCE OF ~IS ~~~T DO~S ~~~~~~v%l~l'y CODES O~ DEED RES~ICI'iONS
voR sIoss aRE sox
(Tills SIi)E FOR
Application #
PCN #
(Palm Beach County Property Control #)
ZONE:
OFFICE USE ONLY)
Master Plan #
APPLICATION DATE:
KECEIVED 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 SQUARE FEET (GROSS)
AREA SQUARE FEET (NET)
NUMBER OF STORIES
# OF BEDROOMS
REMARKS:
REVISION #.. /
if
Permit # ;~ /- ~-'~-.: O~ ? Review( F )tl
Date accepted submittal /-',~ ~-
Elec. [ Mech. Plumbing~[~~S Fire
-- :
Completed by//i~_~//9:¥'' Date to P&Z-/Rfd6-rd[~ '" ?'-c?/~),
P & Z Eng.
Police P.W.
Completed by /}wre/re.-
Utilities
Parks
ERC
Forester
Date to Records
Date entered into Permit Log \- ['J,~-~)~. Initials
Date called for comments Initials
Permit #
Date accepted submittal
Review F H
Elec.
Mech.
Plumbing [ Structural } Fire
Completed by
Date to P&Z/Records
P&Z
Police
Eng.
P.W.
Utilities
Parks
ERC
Forester
Date entered into Permit Log
Date called for comments
Date to Records
Initials
Initials
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
cUilding.
learing & Grubbing
~.Drainage
Electrical
Excavation
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
~.Sign
Site Lighting
VALUE
FEE
SUB-TOTAL
TOTAL
LESS PLAN FILING 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
\\CH\MAIN\SHRDATA\Development\FORMS.doc\REViSiON
APPLICATION2.doc 12/g8,Rev.6/99,8/25/2000 new label attached
to application.
STANDARD RESIDENTIAL WORKSHEET
APPL. DATE 07/02/2001 PBC FEE,~ EFFECTIVE DATE 1/1/00
PERMIT NUMBER- 01-2724 TYPE OF PERMIT B MASTE 00-4703
Setbacks:
Left: 13.43,
Right: O COST: FEES:
Front: 20.1
Rear: 38.43
Type Of Const: VI Bcaif $13.34
Occupancy Type: R Parks Fee $472.93
Base Flood Elev. Pub. Bldg Fee $134.92
Prop. Fin. Floor Elev: 14,7 SQ. FT.COST Radon Fee $13.34
Parking provided: ;3 $51.45 Road Impact Descrp. "D" $3,055.20~
Parking req'd: ;3 School Fee $1,214.10
Gross Area S.F.: 2667 Y_ALUE,_ES~ Sewer Fee-#Bed Rm. 4 $332.00
Air cond. Area:@100' 2218 114,116 Water Fee $1,866.00
Garage S.Ft:@50% 402 10,343 Overtime-Add'l fees $0.00
Porch-entry:@25% 47 604 SUB-TOTAL $7,101.83
Number of Bed room,, 4 $125,063
Number of Units: I SINGLE FEE VALUATION FEE
Number of Stories: 2 Clrg.& grub(cg) $0.00 $0.00
UNIT SQ. FT L/A 2,Z~ ~/Bldg (B) $125,063 $2,001.01
,,' Elec. (E) $0.00 $0.00
Application cost Est $86.678.00 c/~,lech (ME) $0.00 $0.00
Plan Filing Fee $600.30 ~mbg. (PL) $0.00 $0.00
Fee Collected $1,387.00 Ir, r,~g. (IR) $0.00 $0.00
Elevator $0.00 ~Roof (R) $0.00 $0.00
Additional fees 0 Drngd (D) $0.00 $0.00
Penalty fees 0 Excav. (EX) $0.00 $0.00
Flood Zone: B Lands (L) $0.00 $0.00
Sbcci fees $125,063 Paving (P) $0.00 $0.00
School/Parks Dist. Sign (S) $0.00 $0.00
Road area Site Ltg. (SL) $0.00 $0.00
Bcaif N $0.00 Fill (F) $0.00 $0.00
Radon N $0.00 Fire Sprlr.(FS) $0.00 $0.00
Building Permit N $0.00 Fire Alarm (FA) $0.00 $0.00
Water Credits N $0.00
Sewer Credits N $0.00 SUB-TOTAL $2,001.01
Road Credits N $0.00 TOTAL FEE $9,102.84
Parks Credit N $0.00 LESS CREDITS $0.00
Public Bldg.Credit N $0.00 LESS PFF $1,387.00
School Credit N $0.00 ~
NOTE:IF BOX BELOW NOT COMPLETED-FINAL INSP.REQ'£ TOTAL AMT DUE
AUTHORIZATION FOR CERTIFICATE OF OCCUPANCY
COMMENTS:
DATE
AUTHORIZATION FOR CERTIFICATE OF COMPLETION
DATE
APPLICATION APPROVED BY:
PERMIT OFFICER