PERMIT DOCUMENTS
CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT I BUILDING DIVISION
100 East Boynton Beach Boulevard. Boynton Beach, FL 33435. (561)742-6350. Fax (561)742-6357
PERMIT APPLICATION FORM
Application Date
Cell Phone
Fax No,
D Check if Owner/Builder (Attach O/B Prerequisite Form)
Contractor Licen~e No. --.l..L1'X 'I \0 ~
compan~\a{CQ.s+' ~ \hU~1 [.
AddreSS~S\rJ LfV1$\ SL .
City OdV ( e., State P 0 zip3~
Phone ~~1 )~ 1 d ' Ilbfeaxft5-j )58/- \31f1
Email
Architect / Engineer's Name
Address of Improvement
S Address., " '
CitylfjJj ~ @ ~ @" ~~ State Zip
Phon~ ('r:J~~ ~ ~ '"',mJiJ
E 'I' glYJu\YJ
mal
s::J
Fee Simple Title Holder (if other than owner)
Address
Mortgage Lender
Address
City
Bonding Company
Address
State
Zip
.S
ew D Addition
,)( Structural D Electrical
Current Use or Occupancy
D Repair
D Plumbing D Mechanical
D Temporary D Other
D Roof D Fire D Gas
D Other
D No
15 this a Change in the Use or Occupancy? 0 Yes
'.,,"-,"""'.:'-'-'-':'--'-'-':':';"':':.';'-':':'::.:.::.,-.-:....-.:......-..:.:-.-:-:..-:-,-:-.-:-....:-..:-,.:-...-:-:-:-.-:-:.:-:.....:.:.-............,..'.""
........ . . "'.,' ..,' "..' .," .. . ..........-...................--..--.--------
, UCTUREINFORMATIO
Type of Construction D I-A
Total Sq. Ft. tZZS-
D I-B D II-A D II-B
Building Height 6 - 30 '
D III-A D III-B
No. of Units
DIV
D V-A D V-B
Stories
Is the building served with an automatic fire sprinkler system?
DYes
D No
Job / Construction Value $ 51 35""
.
Applicant may be asked to provide copy of a signed contract to determine job value.
($46.00 Minimum)
S:IDevelopmentIBUlLDINGIForms- T emplates-signslPermit Application.doc
Revised 10/23/07.7/1/08.2/2/09
Page 1
PPLlCA TlON CERTIFICA TIONANllACKNQ\lVL.EDG
Application is hereby made to obtain a permit to do work and installation as indicated, Applicant certifies 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 laws regulating
construction in this jurisdiction, A City Building Permit does not assure compliance with Homeowners Association's rules,
regulation and/or deed restrictions. Applicant is advised to obtain approval from the Homeowners Association before
improving any property. Applicant further acknowledges the following:
. This permit becomes null and void if work or construction authorized is not commenced within 6 months or if
construction or work is suspended or abandoned for a period of 6 months at any time after work is
commenced. Permit will be considered suspended or abandoned if it does not pass an inspection within 180
days.
. Failure to comply with all applicable construction regulations may result in the withholding of future permits.
. Submission of any false information or misrepresentation is a violation of law and shall result in revocation of
your permit. ,
. NOTICE: In addition to the requirements' of this permit, there may be additional restrictions applicable to
this property that may be found in the public records of this county, and there may be additional permits
required from other governmental. entities such as water management districts, state agencies, or federal
agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. ~ IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
.,It ...., '",' " .,'-.'
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR
NOTICE OF COMMENCEMENT.
:. ...
OWNER'S AFFIDA VIT: I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating
construction or the erformance of construction.
~
Date
COUNTY or, q 11M BEACH
S- I() ,
STATE OF FLORIDA, COUNTY OF PALM BEACH,
The following instrument was acknowledged before me
this t "I, day of ~'1' ,20 lZ>.
by L.Wq MQIC( K (Print Owner Name),
who is personally known to me or who has produced
-pc." Dr;J Ul Ltc... (Typ~ (litNJ) a.& }p,entification
,\ I"
Er '
c:..~ ", .pO',
, ,
.. ~ ..':'" ,\9-201;.t. ~-:.
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: ... i> THROUGH (/11 < =
V :~::lE FLORIDAVICd e ::
... '. NA"'-SER "! lI:' ::
q; ~ 'b'-C"
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, ~ ........ 0....
""l.I13l.IC 5T"'''''' ........
'i . \'
it"IIII\\\\
i.eDp,,}do
Print Name of Notary
Seal
S:\Development\BU1LD1NG\Forms-T emplates-Signs\Permit Application,doc
RACTOR
D , COUNTY (j)F P.;.LM BEACH
S"IZCIIO'
~
Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The following instrument was acknowledged before me
this 2-0 day of Me.. 'f ' 20 t d ,
by ,M rC~Qe"L CC()~
(Print Owner Name),
who is personall
or who has produced
(TypeoflD) as identification
III
Revised 10/23/07,7/1/08,2/2/09
Page 2
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'UBCONT~CT()R,INFORMAT
Qualifier I Agent
Signature
Contractor License No.
Company
Address
City
Phone (
Email
State_ Zip
Qualifier I Agent
Signature
Contractor License No.
Company
Address
City
Phone (
Email
State_ Zip
Qualifier I Agent
Signature
Contractor License No.
Company
Address
City
Phone (
Email
Qualifier I Agent
Signature
Contractor License No.
Company
Address
State_ Zip
City
Phone (
Email
State_ Zip
Qualifier I Agent
Signature
Contractor License No.
Company
Address
City
Phone (
Email
State_ Zip
Qualifier I Agent
Signature
Contractor License No.
Company
Address
City
Phone (
Email
State_ Zip
Owner Builder Disclosure Statement (489.103 FS.)
To Qualifv for the ownerlbuilder exemption in Florida Statute 489.103 (7) (b). an owner must personallv appear and
sil!:n the buildinl!: permit application. State law requires construction to be done by licensed contractors, You have applied for
a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own
contractor with certain restrictions even though you do not have a license, You must provide direct, onsite supervision of the
construction yourself, You may build or improve a one-family or two-family residence or a farm outbuilding, You may also
build or improve a commercial building, provided your costs do not exceed $75,000, The building or residence must be for
your own use or occupancy. It may not be built or substantially improved for sale or lease, If you sell or lease a building you
have built or substantially improved yourself within I year after the construction is complete, the law will presume that you
built or substantially improved it for sale or lease, which is a violation of this exemption, You may not hire an unlicensed
person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that
people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not
delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done,
Any person working on your building who is not licensed must work under your direct supervision and must be employed by
you, which means that you must deduct F.I,C.A. and withholding tax and provide worker's compensation for that employee, all
as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
regulations.
S:IDevelopment\BUILDINGIForms- T emplates-SignslPermit Application.doc
Revised 10/23/07, 7/1/08, 2/2/09
Page 3
Approved by: - ~#~_.
~er
F D H
D
Application accepted by:
Additional Fees(s):
BCAIF
Fire Dept Review
Fire Assessment
Overtime
Parks
Penalty (Bldg. or Fire)
Public Art
Public Building
Radon Trust
Road Impact
School
Sewer
Water
P & Z Review
Sub-Total (I)
Remarks:
IF THIS BOX IS ~OT COMPLETED,
THIS PERMIT IS SUBJECT TO A
FINAL INSPECTION ONLY
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date:
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date:
S:\Development\BUILDING\Forms- T emplates-Signs\Pe~it Application,doc
- ~- --:];.0 -dO /0
Date
Application #
Single Fee:
_ Building
Clearing & Grubbing
Drainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Plumbing
Roofing
Sign
Site Lighting
Sub-Total (2)
Sub-Total (1)
TOTAL
Value
Fee
Less Plan Filing Fee
Receipt #
BALANCE DUE
Receipt #
Revised 10/23/07.7/1/08,2/2109
Page 4
"WARNING TO OWNER: YOUR FAILURE TO
RECORD A NOTICE OF COMMENCEMENT MAY CITY OF BOYNTON BEACH
RESULT IN YOUR PAYING TWICE FOR BUILDING DIVISION
IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
B P 4 0 0 L 3 . 0 Date Applied: 5 / 2 0 11 0
NOTICi::ii
II\IADDtrI()N'T()tHEREQUIREnIIl:,.J'I'$QFTHtsPERtJlrr;....HI:R~MAyI3I;ADDI'I'I()NAL
RE~...RIC1"IQNSAF'~Li~AIa'-l;iTPltlIS>F'ROPl:t(T'X"IliA...MAYIaI;~()IJNPINTHl;l?lJElI.J(f
RECORDSQFIHI$C()U~TYANP,.HI;Rl;fy'I?<Y$I;ADDITIQNAIlF'eRIVIITSRI;Clt.JIRE[)FRQM>
~6~~~I~~'h'kR~~~l.tCA~€~1!fE\~H9~?<~lI\I?<!~g~NA~E;fy'lE;~T[)I~'11~19I~k$...~lPp
Permit Type:
Prepared By:
CLINEK
Date Issued:
5/20110
PIN 1551076
HURRICANE PROTECTION
INSPECTIONS ARE REQUIRED: SEE BACK OF PERMIT CARD FOR REQUIRED INSPECTION.
569429
Permit No:
1000001497
City Range Twnshp, Section Sub Division Block Lot Plat/Book/Page
08 43 45 17, 12 007 0090
Property Address Zoning Reviewed By
3174 N GREENLEAF CIR LAM
Subdivision Name Legal Address
QUANTUM PARK TOWNHOMES LT 9
Owner's Name/AddressfTelephone Contractor's Name/Address/LicensefTelephone
MALA FA LI N DA J & RICHARD A GOLD COAST HURRICANE
3174 N GREENLEAF CIR 5900 SW 44TH ST
BOYNTON BEACH FL 33426-8664 FORT LAUDERDALE FL 33314
561 329-1030 954 472.7766
BOYNTON BEACH U-18762 3635000
Additional Description General/Architect/Engineer
8 ACCORDIAN SHUTTERS
Construction BFE FFE FLZ
Occupancy Sq.Ft. Valuation Improvements
3.135 SHUTTERS
Schedule of Fees
* THIS PERMIT FEE IS NOT REFUNDABLE *
OTHER FEES:
'w~
AUTHORIZED SIGNATURE ~~~
NOTICE: CALL 742-6355 FOR INSPECTIONS 24 HOURS IN A[Y~NCE-(BEFORE-5;OO-P~M~)
THIS PERMIT SHALL BECOME NULL AND VOID UNLESS THE WORK AUTHORIZED 15 COMMENCED WITHIN ONE HUNDRED AND EIGHTY (180) DAYS AFTER ISSUANCE
OR IF THE WORK AUTHORIZED HAS NOT RECEIVED AN APPROVED INSPECTION FOR A PERIOD OF ONE HUNDRED AND EIGHTY (180) DAYS.
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 the granting
of 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, Florida. This permit fee is not
refundable.
05/15/2010
07:59
9545871319
GOLDCOAST
PAGE
01/02
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Gold Coast Burricane Shutters. ~nC.
.
. . ,.
NOTICE OF ACCEPTANCE:
EVIDENCESUBNUTTED
A. DRAWINGS:
1. Drawing No. 08-GCH-00Il, titled ('Accordion Shutter with Alum. or
Polycarbonate B1Cldes H, sheets 1 through 8 of 8, prepared by Engineering
Express. dated September 25, 2008, signed-and sealed by Frank 1. Bennardo,
P.E., on September 25,2008,
B. TESTS
1. See Association's generic approval under 08-0599.
C. CALCULATIONS .
1, See Associatipn 's generic approval under 08.{jjrl)f),
D. QUALITY ASSURANCE
1, By Miami-Dade County Building Code Compliance Office.
E. MATERIAL CERTIFICATIONS
1, See Association's generic approval under 08-0599.
F.
STATEMENTS
1. Release letter issued by Impact Technology Association, Inc.. dated September 23.
2008, certifying this product to meet the criteria of product tested and approved.
and allowing Gold Coast Hurricane Shutters, Inc.. to use the test results approved
under Miami-Dade County Approval No. 08-0599, signed by Tanya Tarantino.
2. Acknowledgment letter by Gold Coast Hurricane Shutters, Inc., dated September
23, 2008, signed by Mr. Michael Cooper.
3. Letter by Engineering Express. dated September 25, 2008, certifying that the
drawing (No, 08-GCH-OOII) prepared for Gold Coast Hurricane Shutters, Inc.,
signed and sealed by Mr. Frank L. Bennardo, P.E., is engineering wise identical
to Impact TechnologyAssociation, Inc., generic drawing (No, 08-IV-0001).
; .
. .
$
I/.~m;:.~s.
Product Control Examiner
NOA No. 08-1001.21
Expiration Date: 12/04/2013
Approval Date: 12/04/2008
E-l
. .
ACCORDION SHUTTER
WITH ALUMINUM ORPQLYCARBONATE BU\DES
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T-HANOU: LOCK ASSEMBLY WITH
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ANCHOR NOTES:
1. ANOiORS SHAll. BE INSTAUED IN ACCORDANCE WITH
MANUfACtuRERS' RECOMHS'tDAUONS.
:t . TAPCONS"MAY 5e CARSON ~EL OR STAINLESS STEEl
ANO 5t1AU. BE- MANUFACTURED BY IT.W.
3. ENSURE MINIMUM 2.5" eDGE DISTANCE FOR AU.
ANCHORS TO CONCRETE &.10 tfOl..LdW BLOC<.
4. WHERE ANCHORS FASTEN TO NJ.AAOW fACE OF STUD
FRAMINC;, "ANCHOR'SHALL BE LOcATED IN CENl'ER. OF NOMINAL
2x {MIN} WopO STUD.(I.a. 3{4- E1G!! OtsrANCE 15 ACCEPTABLE
FOR. ANCHORS TO WOOD FRAMING}.
.!i. WOOD HOST STRUCTUFlE SHALL Be "SOltrHERN PINE"
G-a.55 OR GREATER. DENSIJY.
~ ~M_EMeED~ SHALL BE AS NOlB) IN ANa-IOR
soreoULE. MlHIMUM-~BEDMENT AND EDGE DJ'STANCE
EXClUDES'STUCCO, FOAM, BRIQ{, AND OTH9:WA1.LFINISHES.
7.' PRODUCTS
ElClSTXNG CONDmONS HAY VARY. -1'lfLD'VEJUfYTHAT
~eR5 ARE INTO 'ADEQUATE WOOD FRAMlNG MEMBERS,
NO't'INTO PLYWOOD. .
9. WOQO BUCKS (BY OTHERS) SHALL BE ,AropiORED
PROPERLY.TO 'fRANSFBl LOADS TO THE exrsrtNG STRUCTURE.
10. MACHINe SCREWS SHAU..HAVE MINIMUM OF 1{2"
ENGAGEMENT OP THREADS IN BASE ANOIOR. AND MAY HAVE
etrHER to. PAN HEAD, TR.USS HEAD, OR WAFER HeAD
("SIDEWALl( SOLT') U.N.Q.
11. 12'ZaI'?Jl DesIGNATeS ANotOR. CONomONS WHtOi ME
NOT ACCEPrABt.E FOR. use.
13. * DESIGNATES ANCHORS WHICH ARE REMOVABLE.
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