PERMIT DOCUMENTS UNIVERSAL COUNTY-WIDE/MUNICIPAL FOR OFFICE USE ONLY
BUILDING PERMIT APPLICATION FORM FBC Version: Permit Type:
July 2013 Edition Accepted By: Application Date:
Approved for use throughout Palm Beach County and Municipalities Application N:
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KIND of PERMIT(CHECK ONE): PROPERTY OWNER:
❑ PRIMARY PERMIT TENANT: II., rt,p
VSUB-PERMIT-If Fee&value of a Sub-Permit are ADDRESS: V Qfy UNIT•
covered under a Primary Permit,complete boxes 1 3 4,5.6 &
8 only to apply.If not covered under a Primary Permit, CITY: Oct
�U STATE: ZIP:
complete the entire application to apply. PHONE: A,-. 3 u 2974 FAX:
EMAIL: elm kE ers .
1 ' NNta lir r
TRADE(CHECK ONE): � PROJECT NAME: s°fja/Th f c//7 Wan/.
❑ STRUCTURAL o ROOFING ra4LECTRICAL PCN: /
o MECHANICAL 0 PLUMBING ❑ FIRE ❑GAS
o OTHER: LEGAL DESCRIPTION:
PRIMARY PERMIT U: /f a,3F‘,.? ADDRESS:/050 _ a ,S Gig
CITY: k i/ ' AT ea L
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FURTHER WORK DESCRIPTION: Cr WorkDIWorki
i
Type of Work: o New e'<ddition o Alteration o Repair o Demo o Temporary o Other
VALUE: 2, goo-' PERMIT FEE: NET S.F(for SFD's):
(SEE FEE SCHEDULE) (AS APPLIES) (AS APPLIES)
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0/ OWNER BUILDER PER FL.ST.489(AS NAMED ABOVE,FOR CONTACT INFORMATION SEE BOX 2)
/CONTRACTOR(CERT.HOLDER): Atl1GHAG1- D. (2Qa\eaMal/ License#: -/- oty'Q9~f
DBA(COMPANY NAME):r(nflGffT' Eta , Contact Persony9Zlstt 4.4R/G7V4y✓
ADDRESS: .26/o 'o/e5 Ok. Jto13r Pb STE: CITY: Yl//°I3 STATE: /— ZIP:
PHONE: ,570i--6.99-3.5 DO FAX EMAIL:mcar optani .- A cc ,,a,.o Cart
Application is hereby made to obtain a permit to do the work and installations as indicated. I certif�r 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. I understand that a separate permit must be secured for ELECTRICAL
WORK, PLUMBING,SIGNS,WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,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 laws regulating construction and zoning.
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(Signature of Owner or Agent)(Including contractor) (Signature of Owner or Agent)(including contractor)
Print Name: Print Name: /Ilicnsait 2— b Ole/6649n/
NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/ NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/
BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA BUILDERS REGARDLESS OF VALUE STATE�
STATE OF FLORIDA
,
COUNTY OF COUNTY OF &kVr. c2t- —
in 59
Sworn to(or affirmed)and subscribed before me this Sworn to(or affirn7ed)and subscribed before me this 1 ,_
day of 20 .by day of aQi 4{L'.• 0 CA-- 20 I
� IH ,by I � _
q
ll1 I " eins\o "Z
fName of person making statement) ('ame• person ' ? m1
a
(Signature of Notary Public-State of Florida) V ' wi
(Print,Type,or Stamp Commissioned Name of Notary Public) (Signatur of Notary Public-State of Florida)
(Print,Type,or Stamp Co missioned Name of Notary Public)
Personally Known_OR Produced Identification /rA `�_ A
PersonallyKnown ti/ OR Produced Identification • -'- •
Type of Identification Produced ' 1
Type of Identification Produced "Car
Page 1 of 2
Air Flow Specialists,. Inc.
5400 S..University Drive,Suite 206B,Davie,FL.33328
Phone(954)727-9507 Fax(954)727-9509
DATE: October 31,2014
To: The City of Boynton Beach
Development Department
Building Division
100 E. Boynton Beach Boulevard
Boynton Beach, Florida 33425
Mechanical Inspector
RE: PremitNo. 14-00003862
Hood(Mechanical)
1050 Gateway Blvd. 103
Olen Property.Corp.
Please accept this certification that the 2"bathroom roof vent has been relocated to
beyond the l0'-0"radius of the Make-up Air inlet for the referenced Hood System,
and that the method of relocation of the vent is an acceptable construction standard.
Thank you for your consideration,
/ /,_ _'parr.
arry Al'eters, P.E.
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,S�oNA`let'�
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Air Flow Specialists,, Inc.
5400 S.University Drive,Suite 206B,Davie,FL.33328
l Phone(954)727-9507 Fax(954)727-9509
DATE:November 3,2014
To: The City of Boynton Beach
Development-Department
Building Division
100 E.Boynton Beach Boulevard
Boynton Beach, Florida 33425.
Mechanical Inspector:
RE: Premit No. 14-00003862
Hood(Mechanical)
1050 Gateway Blvd. 103
Olen Property.Corp.
Please accept this certification that,the bathroom exhaust fan vent has been relocated to
beyond the 10'-0"radius of the Make-up Air inlet for the referenced Hood System,
and that the method of relocation of the.vent.is an acceptable construction standard.
Please see the attached sketch.
Thank you for your consideration,
letFT Larry4/ 'eters,P.E. N *
- ATE OF ;4/Z":
3 % / /4F.?4l.
1111
•
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lAir Flow Specialists, Inc.
5400 S.University Drive,Suite 2068,Davie,FL.33328
' .Phone(954)727-9507 Fax(954)727-9509
DATE: November 3,2014
To: The City of Boynton Beach
Development Department
Building Division
100 E.Boynton Beach Boulevard
Boynton:Beach,Florida 33425 •
Mechanical Inspector:
RE: PremitJL4_000038623
Hood(Mechanical).
1050 Gateway,Blvd..103
Olen Property Corp.
Sketch for the relocation.of a bathroom exhaust fan vent for the referenced project.
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Air Flow Specialists, Inc.
5400 S.University Drive,Suite 206B,Davie,FL.33328
Phone(954)727-9507 Fax(954)727-9509
DATE: October 31,2014
To: The City of Boynton Beach
Development Department
Building Division
100 E. Boynton Beach Boulevard
Boynton Beach,Florida 33425
Mechanical Inspector:.
RE: Premit No. 14-00003862
Hood(Mechanical)
1050 Gateway Blvd. 103
Olen Property Corp.
Sketch for the relocation of a 2"bathroom roof vent for the referenced project.
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2"Pre VENT
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