PERMIT DOCUMENTS OA cp
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/} ITY OF BOYNTON BEACH
o��� DEVELOPMENTIDEPARTMENT I BUILDING DIVISION
,_ v 100 East Boynton Beach Boulevard•Boynton Beach,FL 33425•(561)742-6350•Fax 742-6357
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APPLICATION FOR
TEMPORARY/PI ARTIAL CERTIFICATE OF OCCUPANCY
Fee: $450.00
Permit# •
Tenant I 1 — `a�S
Job Address , 1k • . (� o Unit ‘
Contractor of Record ! •Itilaei.,„, C Phone 9sc-_s _co0
Qualifier/Authorized Agent C\(.‘ n S2. i
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We, the undersigned, are requesting a Temporary/Partial Certificate of Occupancy (hereinafter, "the
TCO") for the building, or portion of the building, identified by the job address stated above in relation
to work done under the permit number(hereinafter, "the permit") stated above.
We understand and agree to comply with the following stipulations:
1. The TCO is valid for thirty (30) days and expires at 1.1:59pm on the thirtieth (30th) day from the
date of issuance.
2. All means of egress shall be kept clear and accessible while the building is being occupied. All
life safety systems shall be maintained and operable at all times. All equipment and facilities
shall be maintained in such manner that there is no'hazard to life or property. The TCO may be
revoked by the Building Official at any time should the space become unsafe or if any code
violation(s) affecting the proper occupancy of the area is evident.
3. The undersigned hold harmless from any liability the City of Boynton Beach in the event of any
accident or damage to life or property.
4. Issuance of the TCO does not constitute in itself permission to operate a business.
5. The TCO is issued for the work completed under the permit. If the permit is allowed to expire,
the TCO will automatically be revoked, and the space must be vacated immediately.
6. Expiration or revocation of the TCO may result in the issuance of a Notice of Violation and/or
disconnection of utility services.
The building official may require a cash surety for unfinished work or revision of plans until a
permanent Certificate of;Occupancy is issued. Sdeh-eaehrsaretratratli'seiRpial-to one-hundred-
arid-ten-percent-(t10%) of theestImated-value-of-the-remaining-work---including-lobar-and-
rnateria he-desigmprofessianel—with-$2;000-as-a-minimdm. The design
professional shall submit a signed and sealed document attesting to the ametmt--required-to
i cover-4he-cash-surety.-If work has not been completed and all finals for the permit requested
within,ninety (90) days of issuance of the TCO, the City of Boynton Beach retains the right to
143eti d to dry-dee the�shrtbe•reematrti�avock.
8. It is the responsibility ofjthe contractor and property owner to monitor the progress of the work
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L- covered under the permit until a permanent Certificate of Occupancy is issued.
i (Continued on other side) Page 1 of 2
Contractor
(Signature)
STATE OF FLORIDA if I
COUNTY OF PALM BEACH
, '• jI II . . , .
.•
• The foregoing instrument was acknowledged before me this day of ' (month), (year),
PI/
(name of signer).
Notary's signature
.... i (SEAL)
Notary's name, printed,typed or sta Eyed .
'Personally known l OR producced identification
•1Type of identification'produced ' " •
i I
I
Tenant L : : EE ,
! = (Signature)
STATE OF FLORIDA
COUNTY OF PALM BEACH
r.•1 a• . : 0,, : .y .r _i, 1 'i, ` ' month (year),
The foregoing instrument was acknowledged before me this day of. (month),
b Ei'. t /'• (name'ofsloner). ,
Y
Notary'saignature k u (SEAL) . .1
Notary's name printed typed or stamped 1 ,,
, personally known , + OR produced Identification
Type of identification produced - " •
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al
•
— - J". FOR OFFICE USE ONLY •J ,
i • 1. ' ' Date of Approval-_ -Approved by �
SPP
Page 2 of 2
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1
1
Reinaldo A. Gomez, R.A.
Architect
Ar#0013736
December 12,2017
Reference: Permit Number 17-2005
488 N. Federal Hwy
Assured Contracting Services
TCO Application
Please note as a registered architect in the state of Florida, I certify that the following
outstanding items shall be satisfied accordingly as stated below:
1. Fire Alarm systems-Application has been submitted within 30 days.
2. Temporary requirements per Fire Marshall shall be to install to 10 year battery
operated smoke detectors located within each unit.
Please feel free to contact me in regards to the project.
emails: rei@reigomez.com
Thank you
'S OF F....
.c .•�y.�co A �O
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1373E
12.12.17 TQC
FRED ARS
Reinaldo A. Gomez, R.A.
14884 SW 24th Street Miami, Florida 33185
Phone:786-261-955 I E-mail:rg4email@bellsouth.net