PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
Application number ..... : 01 00002816
Application status, date : FINALED
Property .......... : 453 SW 3RD AVE
PCN ............. : 08-43-45-28-28-000-0120
Lot Number ......... :
Zoning ........... : R2 DUPLEX (9.68)
Application type ...... : F FENCE
Application date ...... : 7/10/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 0449
6 FT WOOD 2 GATES
RA
1500
0
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DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print) '-- ~
COMPLETE EACH BOXED ENTRY Permit # () [- ~- O~ I ~:~
(FoR SUB PERmTS ONLV
PCN# ,O~/¢'~ ~"~' ~-~
IOwner s Addr~ ' ~ ~
Fee S~mpl~ Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Compan~ ~~ ~.
Contact person and emergency phone
State
(Palm Be,a. ch County Property Control #)
IOwner s Phone ~'-'~'/-
Zip ,
(If other than owner's)
(If other than owner's)
ICompany Phone ~
Company Address Pager/Fax#
City State Zip
IobName~ '7~J~/"~
ob Addres~ ~ ~ ~~Y~ ~-'~'~-~'~ ~' '
.'~ ~ ......... .... Zoned
Bonding Co. Address ~ /~ / ~,,~'~! ~Cit~', '. ' r State
Architec~Engineer,s Name
Architec~Engine~r s Address
Mortgage Lenders Name ~ ~ I ~ ~] ~ ;- ~','.LT'~?:~ :,J'5~' '
Modgage Lender's Ad. ss
S~GLE FAMILY ~ DUPLEX -- MULTI-FAMILY HOTEL ~TAIL OFFICE ~ ~US~L
check one)
STIMATED VALUE OF CONSTRUCTION $
· , '
~ ~ ~ ~TRUC~ IFIREI pTHE~ I / .... / '~' '
Application is hereby required to obtain 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 cedi~ that all the foregoing information is accurate and that all wor~ 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
STATE OF FLO~DA. CO~TY OF PALM BEACH /
The foregoing ins~ment was acknowledged before me this _ ~/~' (date) by
who is pers~~_~m~4 ~ff~ 3 - {~ [ ~ ~- ~ ~ as identification dnd who did (did not)
take an oat~..~ RI~Y ARMOLD ~ --~ '
(SEAL) %~ ;¢ EXV~ ~:~
Signamre~~i~.~ ~ ]~~ Name of o~cer tak~g ac~owledgement - ~ed.
printed or ~ ................. ~ ' Title or ra~ Serial Number. if ~y
Contractor'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
Name of officer taking acknowledgement - typed,
Title or rank Serial Number, if any
(Certificate of Competency Holder)
Contractor's State Certification of Registration No.
Liability Insurance Expiratiop~,e
Workers Compensation E)(j;~i~n_ Da~;~ /
Application Approved By/C/ ,~ 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 permit prior
to stating. 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\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
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
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:
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)
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
JUN-29-8 1
16:82 FROM:COMCAST ADVERTISING ID:561 686 2288
To:
Address:
PAGE 1/2
DEPARTMENT OF D ]' " -
EV.ELOPMEN~I
BUILDiNG DI~$ION
.EASEMENT CONSENT FOf&M JULY 199~
Gentlemen:
I mt the r¢cerd ti'dehoide~ o£property located at ~
to apply fbca pe~ ~om :he C~j of~ton Be~i: to cons~cr or ~s~l a
in the __ ('~ ~/ easement on my prope~y, legally desc~bed:~
'Lot '~/~ B~.oek SubdNi~ion
or Metes & Bo~ds
Please complete ~ of' .k..is form indicating your approval or disapproval ofthls work·
I tmd,rstaad fhat you """ '
· ;'m not be re~pons/ble for repairs to, or replacement oL2',any portion of the above
i~to'¢e,me.n.t. ~d th~t any .removal or replacement of this i.mprovement necessary fbr our use or a re:ere"aced
ea~em~n, wtll be pertonnea at my expense or my su~9.~ssOt~ in inter~. '~ Y cces~ to this
/4:~,,4/e. ..:~ /- 7.57- ~f
Owner's Sigmature & Date
(over)
ALI.. WORK INVOLVED ON THIS PERMIT SHALL CONFORM
om=
JUN-29-01 18:02 FROM:COHCAST ADVERTISING ID:5~l
ACK~.NO WL EDG.~iE~£:
W '%1o not ag,'ee) to the proposed ]mj~roveme~t umior the ~ireum~t~nces descril~d on the rcvms¢ side.
c'£e~$eme~t J:olcl<r
please Call For Utili~ ~r~ ~ ~ ~ ~
1~0I No~hpo~t
STATE OF FLORIDA
COUNTY OF PALM BEACH
The £oregoi~xg instrument. ',va:~ ackn. ow]ed$cd before
by
-ne tMs __ clay of
who is personaiiy ]cno~<t ~.o me or wtxo ha,~ produced
SEAL
aa identification and who (did) (did not) take an oath
19
Type o£LD
(Signa~t-e of person mkj;~ aekuowledgemer, 0
~4ame of officer:;taking acknowled~..nent
t~ed, printed or ~tamped)
(Title or rard¢)
(Sedal Number, if ~ny)
P ~ D~I$_~PB H~G~ ~ 7426357
NO. 045 P001
To:
Address:
EA5 EM ENT CON~ E NT
,JULY 1995
Geutlemen:
I am the record titleholder of property located at '9~'~-~ ,-%"
to apply for a perrnj~ from the City of Boy'neon Be'ach to ~nst~uc'i or install
ir] the ("~' ff~ easement oi1 lily property, legally describe~ asr ' ' -
'Lot ~/~ Block ~~ Subdivision
or Metes & Bo~ds ~ ' .....
Please complete the
. I propose
of this form iudicating your approval or disapproval of this work,
I understand that you ;viii not be responsible for repairs to, or replacement of,', any potion of'the ~ove referenced
improvement and that any removal or replacement of this improvement ne~ssary for your use or access to this
easement will "' ~ .....
be perfo~ed at my expense or my suq~ss~s m Inte~.
Owner's Signature & Date
(over)
B-3b
06×Z8×~001 88:16 P S DAVIS_WPB ENGR m 7426~57 N0.845
ACI~OWL~DG~IENT:
JUN
r tl~e ' ~ ' ~~,:o~ ~he rekerse side.
We (agrce) (doj3ot agree) to the propo,,
Title: ~/f-2d .~.~..~-~/1~-..~ '
/ -'-2
STATE OF FLO~DA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me t~s __ day of
by _, who is personally known to me or who has produced
as identitication and who (did) (did not') take an oath.
Type of ID
SEAL
(Signature of person taking acknowledgement)
(Name of officer taking acknowledgment
typed, printed or:stamped)
(Title or rank)
(Serial Number, ffany) --
DEPARTMENT OF DEVELOPMENT
BUILDING DMsION
EA$EMENT CONSJgNT FOR~!
JULY I995 '.
Na~eofensement holder ' -/ ~
Gert tlemen:
I am the record tRleholder~ 'p~pe.y located at _ ~-~ ~'~~ ~
to apply for a pe~ ~m th Ciw of Boston Beach to ¢~a:t~ct 0~ ~tall ~_ ~~ -
~ eas~ent on my pro~y, legacy described:
Please ¢ompl~t~ the t,varse ide of ~is fo~ indicating your approval or di~approwI of t~s work.
I ~derstand that you will ne b~ ~aponaibt= for repairs to, or rapid,merit o~ ~y
improvement and that any re noval or replacement of this imp~ment n~s~ for
easement will b~ p~rfot~d a my ~p~nse or mr $uc~ss~ in int~ .....
propose
06/27/2001 15:28 5617422016 FP&L
P~E
~-me of c~err~nt holder
Address:
~o apply ~r a p~ ~om the Ci~'
in the
or ~$~ ~ Bo~
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
EASEMENT CON!t~ENT FORM JULY 1995
. I propose
Pl¢~c ¢omplem the reverse side oft. his form indicating you~ approval or dLiapprovai of this work.
I undet~taad that you will rtot be responsible for rep~im to, or r~l~ement o~ ~y po~ion of the above r~er~
improveme~t ~ taat ~y removal or r~lao~ment of this improv~t ne~ for yo~ use or access
~t ~ll bc p~ ~ my ~ense or my su~ss~ i~ int~
~ Own:~ Si~ & D~te ~ - f /
(over) "
B-3b
': tJ 2001
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
REMOVAL AGREEMENT
DATE: PERMIT NO:
(print)
"Owner(s)") are desirous of construction or installing a
in aportion ofthe ro ert
description of this p p y being as follows:
Lot / ~ Block
Subdivision
or Metes & Bounds
(hereinafter referred to as
A"e, vd
easement on my property, the legal
WHEREAS, the Owner(s) do covenant that they are the fee simple owner(s) of the
property; and
WHEREAS, the above is to be erected for the use and enjoyment or proper functioning
of the property and special aesthetics;
NOW, THEREFORE, in the consideration of the City of Boynton Beach ("City") not
immediately enforcing its rights or the rights of any others, now existing or which may in the
future exist, against the Owner(s) or the property, the Owner(s) hereby a~ee with the City to
remove, at no expense to the City, the Easement holders, or the beneficiaries of the easement, the
above described improvement from the property, within (30) days of written notice addressed to
ADDRESS:them °r their success°rs in interest' at: c~///~._,. ~2~,~.-~
notifying them that said irhprovement is inconsistent with the use of the Easement. It is a~eed
by the Owner(s) that the improvement shall be as depicted on Exhibit "A" and filed with the City
of Bo ynton Beach Building Department, and that no other construction slX'a4)
Easement. It is ageed by the parties, hereto, that this Declaration will b
of the Owner(s) in the Official Records of Palm Beach County, Florida and that this 3ecl~ion
shall be a covenant running with the land and be binding upon the heirs, personal representatives,
grantees, assigns and successors in interest of the Owner(s).
Owner(s) shall immediately remove the improvement permitted herein in the event that
the City or Owner(s), or both, are challenged with respect to the City's authority to attthorize the
placement of said improvement in the Easement or a claim of damages is made as a result of the
placement of said improvement in the Easement. In the event that the City and/or Owner(s) are
challenged with respect to the placement of said improvement in the Easement, or a claim for
damages is made as a result of the placement of said improvement in the Easement, Owner(s)
shall indemnify, defend, and save the City harmless against and from said challenge.
Upon the vacation, abandonment or discontinuance of thJ Easement, this Declaration
shall immediately and automatically terminate and be of no further force and effect.
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGED on this day of
,20
WITNESS:
(Owner's Signature)
(Owner's Signature)
STATE OF FLORIDA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this
day of 20 , by
(Name of Person Acknoxvledging)
who is personally kno~vn to me or ~vho has produced
(Type of ID)
as identification and ~vho did/did not take an oath.
SEAL
(Signature of person taking
acknowledgement)
(Name of Officer taking
ackno~vledgement typed, printed or
stamped)
(Title or rank)
(Serial number, if any)
\\CHXMAFN\SHRDATA\Development\FORMS.docX, Removal A=m'ecment--Easement Consent Form.doc - I0/2000
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
EASEMENT CONSENT FORM
JULY 1995
To:
Address:
Name of fiasement l~lder
Gentlemen:
I am the record titleholder'ofproperty located at .~..J'~.~ .~--~/~~
to apply for a permit from the City of Boynton Beach to construct or install a ..~rqxS~j
in the (q/" ~7 easement on my property, legally described as{ - ' -
· Lot "--~/~2.a Block ,~"~
or Metes & Bounds
· I propose
Subdivision
Please complete the reverse side of this form indicating your approval or disapproval of this work.
I understand that you ',viii not be responsible for repairs to, or replacement of, any portion of the above referenced
improvement and that any removal or replacement of this improvement necessary for your use or access to 'this
easement will be performed at my expen..se or my suc.~ss .~ in intel~.~ __
'' __Ownerfs Signature & Date ~'/ /' /
Owner's Signature & Date
(over)
B-3b
ACKNOWLEDGMENT:
We (agree) (do not a~ee) to the proposed improvement under the circumstances described on the reverse side.
By: /~>~/~__~t.~.~
STATE OF FLORIDA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this I 0 day of !oL4h !sO,~r
by I~d]CtF~ LGlt{) - , who is personally knoTw~ io me or v~ ~Joduced
as identification and who (did) (did not) take an oath.
SEAL
Type of ID
My Commission CC915256
F-..R~res ~ 02, 2004
(Sig-"f~r~ ~f person taking acknowledgement)
(Name of officer taking acknowledgment
typed, printed or stamped)
(Title or rank)
(Serial Number, if any)
J:\SHRDATA\Development\POLICY MANUAL.wp\POLICYMH\SPECCON\EASECON.WPD - AN:nth 9/15/94,WVH:mh Rev 2/6/95,
3/23/95, 5/10/95, 6/26/95, 7/17/95, 1/9/96, 2/5/96,*3/99, 8/00
PAGE 02
N~me of casement
Title: FLORIDA PLIBLI
Date:
ACKNOWLEDGMEWr:
We (agree) (do. not__~.g_ree) tel thc proposed improvement under thc circum.~t~nces described on die reverse side.
o.
WEST PAL~ BEACh, FL 33401-339~ ~ ;
DAVID E. PELLI~
DIVi~'N ENGll
STATE OF FLOR.IDA
COUNTY OF PALM BEA'
- UTILITI_ti:S_COHp_4Ny ...
:0
lEER
;H
:acknowledged before me this __
dsy of_=:
1-800.43:1.4'/'/e
., 19
The foregoing inst~men~ wa
by
as idcmitication and who (did
(Signature o£person taking ac
(did not) take a~ oath.
SEAL
.... who is personally known to me or who l~s produced.
Type
mowledgement)
('Name of oftker:itakin~i;mowleclgment
typed, printed or:'.stamped)
(Serial Numbor, i~r ~ny)
I__
1~48 HOURS BEFORE YOU DIG
I ?~11~ ~, CALL SUNSHINE
' 1-80 0-432-4770
"~ i~8 TH~ LAW IN FLO~,4
200!
06/27/2001 15:28 5617422016 FP&L
ACKNOWLEDGMENT:
We (ogree) (do not agree) to thc proposed improvement under ~h¢ cireumst&nces described on the ~eve~e siCe.
STATE OF FLORIDA
COUNTY OF PALM BEACH
The fotegoinggg/st~ment was acknowledged before me tb.b day of_ i /~ .... 19~
by_
(Signature efpersoh taing acknowledge'"'~ ~t)