PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
2/11/02
13:45:46
Application number ..... : 01 00002729
Application status, date : CERTIFICATE ISSUED
Property .......... : 1849 MAGLIANO DR
PCN ............. : 08-43-45-18-21-003-0020
Lot Number ......... : 2
ii/19/O1
Zoning ........... : PUD PLANNED ZONED DISTRICT
Application type ...... : SF SINGLE FAMILY-BLANKET
Application date ...... : 7/02/01
Tenant nbr, name . ..... : 1803 C/LEFT
Master plan nbr, revwd by : 00-4885 BD
Estimated valuation .... : 80000
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 3539
Press Enter to continue.
F3=Exit F5=Land inq
F10=Fees Fll=Receipts
F7=Appl names
F12=Cancel
FS=Tracking inq
F13=Val calcs
Fg=Bond inquiry
F24=More keys
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
PCN#
_wner s Name
Owner's Address - ~¢T)'h'
City ~ i-~~
eec ~imple Title Holder s Name
Fee Simple Title Holder's Address,
Contractor's Company_
Project Manager and emergency phone
Company Adcl, ress
City /'~/'~_ I ~'.~
Job Name
Job Address
Legal Description
Bonding Company
BUILDING PERMIT APPLICATION
(Please Print) Permit #
(FOR. SUB PERMITS ONLY)
(Palm Beach County.,Prope(ty Control #) Owner's Phone # {~S) ~]
(If other than owner's)
.r , (If other than owner's~
Company Phone ~ (~~,~.~-t ~- / '
Bonding Co, Address
State.
Pager/Fax#
I Zip _'"~ ~::~C'~.'~ Ct?.
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 CONSTRUCTgDN $.
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 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 IMPROVEMENT8 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 oalh.
as identification ,and who did (did not)
(SEAL)
Signature of person taking acknowledgement
Name of officer
printed or stamped ,,- ~---"~"-"~'_,--~ ... _Tide or rank. _
The foregoing instrumcnt was acknowledgcd before me this .-I-01 (~,,e) by
who is personally known to me or who has produced ~'~'- - ', ................ - .
take an oath. =i ,-';';':,';',~' ....... :----~--~ ~ as ~denhficat~on ired who d~d (did nol)
(SEAL) ~ ~~: EXPIRES: June 23, 2002
Thru Notary Public Underwfilers_ ti
Signature of person taking acknowlcdgemen ~~--'-~ r; ..... 6~lffficcr taking acknowledgement - typed,
printed or stamped Title or rank Serial Number, if any
(Certificate of.Competency Holder)
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 the work which it covers has commenced. All Contractors must have
valid State Certification or County C6mpetency plus County and City Occupational Licenses prior to obtaining permit.
iSSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION.OF DEED RESTRICTION,-;
?.EES ARE NOT REFUNDABLF
taking acknowledgement - typed,
Serial Number, if any ..
J:\SHRDATA\DEVELOPMENT\FORMS'DOC\PERMIT APPLICATION,DOC - Revised 6/18/97, 11/4/97, 12198
APPLICATION #
APPLICATION DATE:
SETBACKS: LEFT
ZONE:
RIGHT
MASTER PLAN #
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
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
VALUAI'ION
SUB-TOTAL
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
FINALS:
SITE SIGN
FIRE ~ FENCE/DUFr'.'-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:
X =
# 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\FORMSDOC\PERMiT APPLICATION.DOC - Revised 6/18/97, 11/4/97. 12/98
Interim
Services Fee
Base Sq. Ft
Rate
Inlerim
Services Fee
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION.
(Please Print)
Permit # ~/--
(FOR SUB PERMITS ONLY)
PCN#
Owner's Name ("~:~3/3--J-- i (~-'~)-~LF3,- I
Owner's Addres.~ ;~;~'/')~ ~'~<:::3
C'~ty ... ~ ~ ~1' L~
Fep Simple 'Title Holder's Name
Fee Simple Title Holder's
Cor0ractor's Company Addr~/~ r~
Project Manager and emergency phone ~
Comimny Address, [~ ~-~ ~
City _. ~ ~ ~ ~; ~ ~ State
Job Name D' ~~
Job Address / ~' ~~ [~~ "~ '
Legal Description ~ --~
(Palm Beach County Pro_perry_Control #)
' Owner's Phone # ,~O~_'_~-~*/'*,--'-'-} _,z./~'q
Company Phone #
Pager/Fax#
Zip ,._-'~L~d'3//.~
(If other than owner's)
(If othe. r than owner'_s).
Zip c'~.'~C~},~ _
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
City
State
Architect/Engineer'S Address
MOrtgage Lender's Name
Mortgage LendePs Address
SINGLE FAMILY DUPLEX
MULTI-FAMILY HOTEL ~ RETAIL OFFICE__
INDUSTRIAL
(check one)
ESTIMATED VALUE OF CONSTRUCTION
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, roles 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 tbregoing irts?umcnt was acknowledged bcforc mc this
who ts personally known to mc or who has produced
take at, oath.
(date) by
as identification and who did (did not)
(SEAL).
Signature of person taking acknowledgement
printed or stamped //~o.~c...~Title °r rank
Contractor's Signature .,_ _ --.
STATE OF FLORIDA, COUNTY OF PALM BEACH
l'hc foregoing instrument was acknowledged before mc this '7"-'o3,~:)--~__) / ' (date) by
who is personally known to me or who has produced
ta'k~e, an oath. : ~
~gE~\)m) re o f person ta.k~ng acknowle .~mc~ ~._ .,~~nk-~e of
printedorstampcd V-~(f[ I J ~ t~ , ~--D G(-~ I I 'liueorra
(Cedi~cate~f Competency Hplder)
Contractor's State Certification of Registration No.
Name of officer
taking acknowledgement - typed,
Serial Nnmber, if any
as identification and who did (did not)
officer taking acknowledgement - typed,
~o~,' ~ -~6 vmus aSOW~LL I
~ ~ ~ c~ ~ I
'~,_- ~ ~ aY ~ ~mES I
~g FL~ AUG~ 5,20~
Liability Insurance E~xpiration 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. Ip 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:V,~HRDATA\DEvELOpMENT~FORMS.DOC\PERMIT APPLICATION.DOC - ~'~,,,l~ed 6118/97, 11/4197, 12/98, 6199
APPLICATION #
APPLICATION DATE:
SETBACKS: LEFT
ZONE:
(TIl1,'5 SIDE FOR OF,- ~
RIGHT
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
FENCE TYPE
ROOF TYPE
FLOQD 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 ONLY)
MASTER PLAN #
RECEIVED BY:
FRONT
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,
SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUATION
SUB-TOTAL
REAR
FEE
REQUIREMENTSfor
CERTIFICATE OF OCCUPANCY
CERTIFICATEOF 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:
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
# 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
~v:Lpzwo P~RH%T
PON
Owner,. Name,CoDtine~tai homes ,
~ee Simple Ti'~leholda~ts Add~'e~
Con~r~c:or,..a .~ame .' M & L Ro, ofing c~n:ra::o'r's Pnoae ~ (56,1). 736-721q
City , B6vnton Beach . PaN: .(561 ) 736-.1977
Architect/Enginee:,s Name ..... ' State
ArchLbec~/Enginee:, s Addr~'e e "
certify ~ha~ no work or ins~,LlatLon has commenced prior %o ~he i~J~&ncl o~ & ~J~l~ and
all work will be performmd ~o meet ~lle s~andards of all laws regulating construction in this
~LUNSING, ~ION$, WELLS, POOLS, ~URNACZ$, 0OID~B~, HEATERS, TANKS, and'RIB CONDITION~R~, ETC,
OWNER'~ AFFIDAVIT: Z ce~'~lfy ~hat al~ ~l%m foregoing.kafo~ma~kon i~'accura~e and ¢hat all work
WA~INO TO O~ERI YOUR FAILURE TO RECORD A NOTICE OF CO~ENCEM~NT ~y' RESET IN YOUR PAYING
~ZCE FOR IMPi~OVEMEh'T$ TO YOU~( PKOPET(TY. IF YOU ,th'TEND TO O'~TAIH rZ~.f~'tCZNO, CONS~ W,::'Hr '~.~U~
LENDER OR ~ A~O~EY BEFO~ RECO~NO YOUM NOTICE OF COI~ENCZME~.
Property-Owner,~ or A~e~'s $igna%u=m
STA,TE OF FLORIDA, COUNTY OF PALM BEAC~ ' Oa~e ,
,' who is pe~onaily know~ ~o me o~ Qho has pr66ueed
(SEA~) , '
Signature of pe~oon ~aking, acknowLa~g~3en3 · .'.' ' '. ' . '
Name of officer :taking acknowle~ge~--~y~ad, p~il%~ad or s:a'~{ped ' ' ',l -
Title or rank Florida Not.ar~/.//~arial numbe:', if' any ........
M'~"~';FL'd~j~ ..... '~, ~ , who is ~'mona~y known ~o m~ o~ who~ham .pr~duce~ I '
~_~'~_ __~o~.~:~y~. ~.~y~la o~' LdenCL~LcatLon) aa ~da~tL~LcatLon and who did (did no~') t~ke an
Con:rac¢or'e S~a:e Cer:ificauion or Regis:re%ion No, RBO03062 / ,:
, Contractor". Cer~LfLca,m of 'Competen¢y ~.~-1 9273'
WORKERS' COMPENSATION ~XP~TION OATS: '
APP~Z.CATION APPROVED BY --- ' ' Permf~"bf~-icer Pa~e~ , -
Any changm i~ building piallo si' sp~cifkcaulo~%~ mu~u be k'~COrdGd WLtI% ~hLs O~fiC~, Any work
this permit, the ow%et and builder' ngL'ee us m~'ucu I:hLm ~%ruc%ur~ in ~uLL compliance w'/~h the
Building and Zoning Codes of '~h~ C.i~y of'Doyn~ol%
NOTEt This petal: VOID af:er 100 DRYS UNLESS ul~e work which it covers has be~n co~enced, All
Con~rac%ora mue: have valid SLa%e ~ar~kfica%Lon o~' County Competency plu~ County and
Occ.upationa~ Lie.ShOeS prior to ob%aining permit.
.!~SUANCE OF, T~II, S, ,P~R~IT~DO~8 NOT 5UTHOJ~?,E V,~OL~',~ON 0F D~$D,R~STRIOT~ONa
;NEt
RECEIVED
RIGHT
}OF TYPE
~NCE TYPE
~EA SQUARE FEET --
,OOO ZON'E
~$Z'FLOOD ELEVATION" --..
:NISH FLOOR ELEVATION'"
IHBER OF STORIES
tMBER OF UN~TS
~RKING SPACES REQUJREO
~RKING SPACES PROVIDED
OF BEDROOMS .
OF BATHROoMs
REAR
ROAD IMPACT FEE
SCtIOOL ~EE
LAW ENfORCEmENT FEE
DCAIF
ADOITIONAL
PENALTY FEE.'
SUB-TOTAL
~ FOR CERTIFICATE OF OCCUPANCy
C~RT~FIEATE OM COMPLETION
__SITE FINAL '~IGN FINAL
· . -,FIRE FINAL ..........
.... PAVIN~ FINAL _
_ SITE LIGHTING FINAL
i
SINGLE FEE ' .... ....
Site Impr ..... .. . ~,
__~uiid~ng ,,,. ..... .~ ,,
~ect~£cal.,,,,~--,.,,.,:...,.i,~.,.,,~.i..; -..., _
_--~"-'~echanic~ - -..
~Plumbing ' ' , -'~ -
.Roofing ....
Excava~£on..
-'' .-Pav£n~ .....
._ _Sign
Sew~
SUB,TOTAL
TOTAL
TOTAL A~OUNT. DUE,
RECEIPT..NUMB~B
DATE PER~IT ISSUED
IN 'ER I : S~RV CE~ ~EE CALC LA-''O-'~ ' '
X
mon~hZ¥ ~ee ser~lce~ ~ee'
Commercial:
divided by 1,000 =
~r-'~-~q,f.~- (rounded ~o " base sq~-~
ra~e mon'~hl~,,fee ..... Sergicee
Fee
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
,,BUILDING PERMIT APPLICATION Rec. #
(Please Print) Permit #
PCN# 4 5q5
Owner's N~rr~e (L£'¢'~
Owner's Address ~OC~}
...... p ~o~r. . .'3_~
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Company
Contact person and emergency p~d~e
Company ~ddress ~5
City ~P ~iDq
Job Name
dob &ddress
Legal Descriptio~ . ~ c
Bonding Company
(FOR SUB PEI~MITS ONLY)
(Palm Beach County Property Control Owner's Phone ~
State ~loCi~ Zip
(If other than owner's)
(If other than owner's)
Company Phone ~ 'Iq ~ ':3t ~,~
Pager~
State F/,~F, ~>¢4 Zip _-~ ;~ q ( /
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 CONSTRUCTION $ .~//~.
DETAILED DESCRIPTION OF WORK: L
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
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
(date) by
as identification and who did (did not)
(SEAL)
Signature of person taking acknowledgement
printed or stamped Title or rank
STATE OF FLORIDA, COUNTY OF PALM BEACH
Name of officer
taking acknowledgement- typed,
Serial Number, if any ~
Date ~"--~7- ~__~ /
The foregoing instmment was acknowledged before me this 7--Z7 ~.20(D/ (date, by ~.~
who is personally known to me or who has produced /t/j/9 'as identificatiox~ and who did (did not)
take an oath. ~.; I~di,/ahRerry ·
--"ii ~ '~ MY COMMISSION # CC843245 EXPIRES
t e,'-^.t ~7~1;..~-~ August 15, 2005 .....,
:~l.gnaturc o£person ta]~g aC, knowledgeg~ent ~,,~~,-~f~..,~_~,,..~ N. ame of officer taking acknowledgement
pnnted or stamped D. Cf~ 6t ~ ' C' / !
/V' ¥ ' ~"C F'- ~ Titl%~z/~ra'nk A,! O ¢¢:' F c/ Serial Number, ir'any - typed,
(Certificate of Competency Holder)
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 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'iRFORMS.DOC\PERMiT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
(THIS SIDE FOR OFFICE USE ONLY)
APPLICATION #
APPLICATION DATE:
SETBACKS:
ZONE:
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
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)
BALANCE DUE
Recpt # CK it
Cash Rec'd from:
Accepted by: (Initials)
~\¢':~4\MA~NI\~MI:;'nATA\I'3F'JFI (~PMFh?'"':OF~MS r3C'~',P/RMIT APPLI(" '"'!ON A.DO('t, - Revis¢,d 6f18/97, ~ w4/97. 12fnr* 6/9(3, 8/c)9.5/00, fi/On
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print) Permit #
(F(JR S~ PE~TS.ONL~
PCN~, O~Y~ V~/~/O~3 ~~ (Palm Beach Coun~ Prope~ Control
Owner s Name ~b q~l ~E~ ~q ~ Owner's Phone
Owner'.sAddress ~00 ~d~d~ ~ . ~tgl "
Ci~ ~ ~ ~ L~ ~ State ~L Zip
Fee Simple Title Holder's Name (If other than owner's)
Fee'Simpl~ Title Holder's ~dress , (If ot~r t~an owner's)
Contractor s Company ~~~ ~M.~ .Company Phone ~
Contact person and emergency phone $ ~t ~ ~cA ~ -- ~q ~-~ I
Company Address ~~ - ' PageflFax~. -
City ~~ State '~ Zip
Job
Ngme
Job Address
Legal Description
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's A(t~ress
SINGLE FAMILY 'v~ DUPLEX
MULTI-FAMILY
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 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 ATTORNEY ~NOTICE OF COMMENCEMENT~.~
Property Owner's or Agent'e Signature , Date ~9 ~"~O /
STATE OF FLOR[DA, COUNTY' OF PALM BEACH
The for~goimz instalment w%acknowledged before mc this
who ~y known to me~r who has produced
take an oath.
Signature of person taking acknowledgement
printed or stamped -t~ e"-~ . Title or rank
Contractor'e Signature ,
STATE OF FLORIDA, COUNTY OF PALM BEACH
who i~.l~P_nally lolo__wn to m~r who has produced
take an oath.
Signature ofpersontakingacknowledgeme Name of officer taking acknowledgement - typed,
printed or stamped ,Title or rank. _:~eriaLNumber._if, all.V~__
Contractor's Stat, Certification of Registration No. ~ I[// t ~;~co0'2,s'~4 ~
Liability Insurance Expiration Date ...... .. ~ ~e.-~m~s.. ~mf~,,, ~
Workers' Compensation Expir~tion.,~te ti \ Il t / lj".~."" .... _ .... ~,~a~co [
App,c tion Approved By LJl=e' t o c 'r
· ,.,, - -7-/! ///]/
Any change in building plans or specifications must be recorded with this office. Any work not covered above mu~t,hadda'Vaqrd 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.
as identification ~i wh~) did.
I$~UANC[~ OF THI,,~ PERMIT DOES NOT AUTHORIZE VIOI,~TIQN QF DEED RESTRICTION~
FEES ARE NOT REFUNDABLE
J:\SHRDATA\DEVELOPMENT~FORMS.DOC'tPERMIT APPLICATION A.DOC - Revised 6/18/97, 1114197, 12/98, 6/99, 8/99. 5/00, 8/00, 9/25/2000
a, PPUCATION #
M~PUCATION DATE:
SETBACKS:
· ZONE:
LEFT
(THIS SIDE FOR OFFICE USE ONLY) * '
RIGHT
MASTER PERMIT #
APPLICATION ACCEPTED BY:
FRONT REAR
TYpE pF.C0NSTRUCTION*
OCCUPANCY TYPE
FENCETYPE ·
ROOF TYPE
FLOOD Z~NE
BASE FLOOD ELEVATION
FINISH FLOOR ELEV. (,PROPOSe:
NUMBER OF U~ITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
AREA SQUARE FEET (GROSS)
AREA SQUARE FEET (NC)
# OF si'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
SUBTOTAL
'):~,: ,,.:=. ,., .....,:.., ..::..'.~:.'.~, '*'~:~'.... !'
, .'..', .... :.{l'l?'l "..J.: "'. :4.
IF THIS BOX'IS'NOT'COMPL:ETED;~THIS PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
A ~Uy~-'~R IZ~ID fOr CERTIFICATE OF OCCUPANCY:,/,,~/..
~V./~ ~ Date / ~/~ ./~ /
·
I /
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date
SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Ughting
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
Ro(=~ # 2. ~ 35'7 CK #
Cash Rec'd frcm:
Accepted by: (Initlale)
Rec~t N
Cash
BALANCE DUE
Accepted by: (Initials) ~ ~
Q BUILDING DIVISION
STANDARD RESIDENTIAL WORKSHEET
APPL. DATE 07/02/2001 EFFECTIVE DATE 1/1/00
PERMIT NUMBER- 01-2729 TYPE OF PERMIT B MASTER~ 00-4885
Setbacks:
Left:
Right: Q COST: FEES:
Front: 20.1
Rear: 31.77
Type Of Const: VI Bcaif $10.51
Occupancy Type: R Parks Fee 0 $406.84
Base Flood Elev. Pub. BIdg Fee $116.07
Prop. Fin. Floor Elev: 14.3 Radon Fee $10.51
Parking provided: 3 Road Impact Descrp. "D" 0 $3,055.20
Parking req'd: 3 School Fee 0 $900.60
Gross Area S.F.: 2102 ~ Sewer Fee4CBed Rm. 3 $298.80
Air cond. Area:@100' 1668 79,797 Water Fee $1,679.40
Garage S.Ft:@50% 413 9,879 Overtime-Add'l fees $0.00
Porch-entry:@25% 21 251 SUB-TOTAL $6,477.93
Number of Bed room,' 3 $89,927.00
Number of Units: I SINGLE FEE VALUATION FEE
Number of Stories: i Clrg.& grub(cg) $0.00 $0.00
UNIT SQ.FT L/A 1.668 Bldg (B) $89,927.00 $1,438.83
Elec. (E) $0.00 $0.00
Application cost Est $80.000.00 Mech (ME) $0.00 $0.00
Plan Filing Fee $431.65 Plmbg. (PL) $0.00 $0.00
Fee Collected $1,280.00 Irrig. (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 $89,927.00 Paving (P) $0.00 $0.00
School/Parks Dist. Sign (S) $0.00 $0.00
Road area Site Ltg. (SL) $0.00 $0.00
Fill (F) $0.00 $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 $1,438.83
Road Credits N $0.00 TOTAL FEE $7,916.76
Parks Credit N $0.00 LESS CREDITS $0.00
Public Bldg.Credit N $0.00 LESS PFF $1,280.00
School Credit N $0.00
~IOTE:IF BOX BELOW NOT COMPLETED-FINAL INSP.REQ'D TOTAL AMT DUE
AUTHORIZATION FOR CERTIFICATE OF OCCUPANCY
COMMENTS:
DATE
AUTHORIZATION FOR CERTIFICATE OF COMPLETION
DATE
APPLICATION APPROVED BY:
PERMIT OFFICER