PERMIT APPLICATIONBP200101 CITY OF BOYNTON BEACH 5/13/02
Application Inquiry 13:52:45
Application number ..... : 01 00004643
Application status, date : FINALED 4/25/02
Property .......... : 932 SW 34TH AVE
PCN ............. : 08-43-46-05-06-000-0270
Lot Number ......... :
Zoning ........... : R1AAB SINGLE FAMILY (4.84)
Application type ...... : GP GAS PIPING
Application date ...... : 11/28/01
Tenant nbr, name ...... : PROPANE INTERIOR LINES
Master plan nbr, revwd by : WE
Estimated valuation .... : 1150
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number .......... : 7721
Press Enter to continue.
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F10=Fees Fll=Receipts F12=Cancel F13=Val calcs F24=More keys
DEPARTMENT OF DEVELOPMENT 0
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
COMPLETE EACH BOXED ENTRY Permit ~
(FOR SL~ PE~TS ONL
PCNff , 0 ~ '~ ~ ~ ~ 0 ~ ~ O O O ~ O' (Palm Beach County ~rope~y Control
Owner s Nam~ ~~ ~~ [Owner's Phone
Owner'sAddres~ ~ ~,~ ~ ~ c ~V~
ICityl ~gVA/T~ , ~C.h State Fi~I zip
Fee Simple ~itl'e 'Holder s Name (If other tha~ ~wner's)
Fee Simple Title Holder's Address (If other than owner's)
ContractorsCompan~ ~ ~V~T~ ~
&~. ~C, ICompany Phone' ' ~ ~
Contact person and emergency phone ~ ~ ~~
Company Adqress 0~ . E ~ , Pag~Fax~
City
~[~. State FI~, Zip 33
ob Nam~
ob Addres~ ~ ~ AAff ~4 ~ ~5Og~, ,
Zoned
Bonding Company
Bonding Co. Address ~ ,: State
ArchitecFEngineer's Name
ArchitecFEngineer'SMo~gage Lender's NameAddress LL ' , 8 .
Mo~gage Lender's A~dress ~LTI-FAMILY ~_ F(';'
S~GLEFAMILY ~' D~LEX~ ~gL2'~':~'~]~-T~'ILI OFFICE ~US~L
(check one) g .....
ESTiMaTED V~LU~ OF CO~STRUCTIONI $ //~, ~
DETAILED DESCRIPTION OF WORK: ~O~cP~)u ~ ~ ~ C- ~. ~ 3
CHECK REVIEWER REqUIReD:
Application is hereby required to obtain a permit to do wo~ and installations as indicated. I ceai~ that no wo~ or installation has
commenced pdor to the issuance of a pe~it and that all wo~ will ~ perched to meet ~e s~ndards of all codes, laws, roles and
regulations governing ~nstruction in this jurisdiction. I unders~nd that a separate pe~it must be secured for ELECTRICAL, PLUMBING,
SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONING WORK, ETC.
OWNER'S AFFIDAVIT: I ceAi~ that all the forgoing information is accurate and that all wo~ will be done in ~mpliance wi~ all applicable
codes, laws, roles and r~ulations governing construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING ~ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN A~ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Prope~y Owner's or Agent's Signature Date
STAT5 OF FLO~DA, CO~Y OF PALM BEACH
~e foregoing ins~ment w~ ac~owl~g~ before me this (date) by
who is personally ~o~ to me or who h~ produc~ ~ identification ~d who did (did not)
take an oa~.
(SEAL)
Signamre ofperson~ingac~owlcdgement N~e of o~cer m~g ac~owledgement- ~ed,
printed or stamped Title or r~ Serial N~b~, iffy
Contractor's Sionatur '.~~ ~
~e foregoing ins~ment was ac~owledged before me ~is ~ (date) by
who is personally ~own to me or who has produced ~~ - -0~ ~0 as identification anU who did (did not)
take a~ ~-~
} ~v~o~ RICKY ~MOLD ~
Signa~r~on t~~geme~t Name of officer ~g ac~owledgement- ~ed,
nri~.'~ ~a~ FL ~ ~ & ~, I~. ( lc or ra~ Serial N~ber, if any
(Ce; 2ficate of Competenoy Hold,r)
Gontractor's State Gea]fi~tion of R~istraOon No.
Liabili~ Insurance Expiration Date /~/~/~]
Workers' Compensation Expiration D~te
Application Approved By ~/ ~ Permit Officer Date: /
/ - /
Any change in building plans or specifications must be recorded with this office. Any wo~ not covered above must have a valid permit pdor
to s~Aing. In ~nsideration of granting this permit, the owner and builder agree to erect this structure in full ~mpliance with the 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 State CeAification 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
S:kDEVELOPMEN~FORMS.DOCkPERMIT APPLICATION MODA.DOC - Revised 6/18/97, 11/4/97, 1~98, 6/99, 8/99, 5/00, ~00, 9/25/2000
(THIS SIDE FOR OFFICE USE ONLY)
APPLICATION # MASTER PERMIT #
APPLICATION DATE: APPLICATION ACCEPTED BY:
LEFT RIGHT FRONT REAR
SETBACKS:
ZONE:
TYPE OF CONSTRUCTION ADDITIONAL FEE
OCCUPANCY TYPE BCAIF
FENCE TYPE PARKS FEE
ROOF TYPE PENALTY FEE
FLOOD ZONE PUBLIC BLDG. FEE
BASE FLOOD ELEVATION RADON FEE
FINISH FLOOR ELEV. (PROPOSED) ROAD IMPACT FEE
NUMBER OF UNITS SCHOOL FEE
PARKING SPACES REQUIRED SEWER FEE
PARKING SPACES PROVIDED WATER FEE
AREA SQUARE FEET (GROSS) FIRE DEPT. FEE
AREA SQUARE FEET (A/C) OVERTIME FEE
# OF STORIES
# OF BEDROOMS SUB-TOTAL
VALUATION FEE
REMARKS: SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electrical
Excavation
Fire Alarm
Fire Spdnkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Roofing
Sign
Site Lighting
SUB TOTAL
TOTAL
Recpt # CK #
Cash Rec'd from:
Accepted by: (Initials)
BALANCE DUE
....... .,. :$ NO i COMPLETED, ",'HIS F~ERivliT i~ '
SUBJECT TO A FINAL INSPECTION ONLY.
Cash Rec'd from:
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Accepted by: (Initials)
Date
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date
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
DEPARTMENT OF DEVELOPMENT 0 1 4
BUILDING DIVISION
BUILDING PERMIT APPLlCATION
Please Print
Date:
Original Permit # ~/~)~)o 4) (/4, ~$ Master Permit #
Project Name: /'~//_/4 ,~ ~' ~/~'~>~ ~! ~'~
Project Address: ~:5 ?_. $.CO. ,~'/zF~v'~' City/State/Zip:
Contractor's Name: ~.~ ~'~5~-b,~,,l '/~(.~ ~)J~'. Contractor's Phone#
Total Estimated Value of this Revision $ q
Description of Work: (Please specify in detail what is being revised from original permit.)
Building: Value of Work:
Electrical: Value of Work: $
Fire Sprinkler: Value of Work: $
Irrigation: Value of Work: $
Mechanical: Value of Work: $
Plumbing: .~/v_~-/--',<)~.~._ ~x ~/~,4: ~o ~,~yc"'/,- Value ofWork: $ r-/~
Roofing: Value of Work: $
, Sign: Value of Work: $
Site Lighting: Value of Work: $
Clearing & Grubbing: Value of Work: $
Paving/Drainage: Value of Work: $
Fill/Excavation: Value of Work: $
Landscaping: Value of Work: $
I wish to revise the above referenced permit to perform the work described herein. I certi~ that all work will be constructed in conformance with all
laws, codes, regulations, rules, etc. _q.gverning Boynton Beach,,~;;ld I certify that the above information is true and correct.
Contractor's Signature['~,~~ ~_~'~,,~~ Date: ~---.-/2~/O~-
The foregoing instrument was ....
acknowledged before me this ~ ~ ~ ~, ~ 0 ~ d v
....... ( ate)b.
Who is persor'~.~'2'~- ~'-~'-~ "-'-- ............ / .
has produ ced ~1 ~{'./~,% THOMAS J. GORMAN I~ ~.- / ~-- ,~-*-,,/...(' c: ~,s.~ntification and who did (d~not)
take an oath. II&..e'~'~. ~¥COMMISS~ON#DD0~994 II .,~
II~....-,~..~ EXPIRES: November 15, 2005 Il ./ / f! /
(SEAL) ./
Signature o~'per~u, t~ng ac,~now,eugemen! .~..~.~'..~~
~arne ol officer takin§ acknowleO~ement typed, printed or stained~ '~-~'~.,~'
Application approved byPete Date ~..
ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS
FEES ARE NOT REFUNDABLE
S:\I)EVELOPMENF~FORMS&TEMPI.,,\TES\BI ILDING PI~RMIT APPI.ICATION REVISION-IgI-Rev. 12198, 6~99, gtO0, 10/01, I 1/01
(For Office Use On/v) I
Original Permit # Master Permit #
PCN (Palm Beach County Property Control #)
Application Accepted By:
Type of Construction ADDITIONAL FEE(S)
Occupancy Type BCAIF
Fence Type Parks Fee
Roof Type Penalty Fee
Flood Zone Public Building Fee
Base Flood Elevation Radon Fee
Finish Floor Elev. (Proposed) Road Impact Fee
Number of Units School Fee
Parking Spaces Required Sewer Fee
Parking Spaces Provided Water Fee
Area Square Feet (Gross) Fire Department Fee
Area Square Feet (Net) Overtime Fee
Number of Stories
Number of Bedrooms Sub-Total
Remarks: SINGLE FEE VALUE FEE
Building
Clearing & Grubbing
Drainage
Electrical
, Excavation
Permit# (~l-- [ Review H Fire Sprinkler
s ubmittal Acceptance..Dat~ O~- p~'o --(~ Irrigation
Landscaping
Elec bl~ch Struct _
Completed by Date to P&Z records Roofing
Sign
Utilities I Police P.w. Parks Forester Dev Dept Site Lighting
Sub-Total
Completed by Date records Less Plan Filing Fee
Date entered into Permit LEg Initials TOTAL AMOUNT DUE
Date called for comments Initials Receipt Number
Permit # Review F H Date Permit Issued
Submittal Acceptance Date
Elec Mech Plumb Struct P&Z I Eng I Fire
Permit # Review F H
Completed by Date to P&Z records
_ Submittal Acceptance Date
Completed by . Date to P&Z records
Completed by Date records
Utilities Police I P' W. I Parks Forester Dev. Dept
Date
entered
into
Permit
Log
Initials
Date called for comments Initials
Completed by Date records
Date entered into Permit Log Initials
Date called for comments Initials
S:\DEVELOPMENT~FORMS&TEMPLATES~BUILD1NG PERMIT APPLICATION REVISION-IgI-Rev. 12/98, 6/99, 8/00, 10/01, 11/01