UNIFORM PERMIT APPLICATION FOR OFFICE USE ONLY Building · PDF fileUniform Permit Application...

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Transcript of UNIFORM PERMIT APPLICATION FOR OFFICE USE ONLY Building · PDF fileUniform Permit Application...

  • D.E.R.D #: ___________________ Permit Type: ________________________________ Permit No: _________________________________

    Uniform Permit Application Building Department Page 1 of 2 02/01/2014

    FOR OFFICE USE ONLY

    UNIFORM PERMIT APPLICATION Building Department

    401 NW 70 Terrace Plantation, FL 33317

    Ph: 954-797-2714 Fax: 954-797-2273

    Contractor Registration Fax: 954-797-2270

    Inspection Line: 954-587-4456 ext. 5000

    Online Services: www.velocityhall.com

    FOR OFFICE USE ONLY

    Kind of Permit (Check one): Master Permit Sub Permit Master Permit# ________________________

    Trade (Check one): Structural Electrical Mechanical Plumbing Engineering Other: _______________________

    Permit Holder: Contractor Owner Builder (per FL Statutes 489) see box above for contact information.

    Company Name: _______________________________________________ Qualifiers Name: ______________________________

    Mailing Address: ____________________________________________________________

    City: ___________________________________ State: _______ Zip: ______________

    Phone: ( ______ ) ______ - ___________ Fax: ( ______ ) ______ - ___________ Email: _________________________________

    Property Owner: ____________________________________________________________

    Mailing Address (if different from job address): _________________________________________________________

    City: ___________________________________ State: _______ Zip: ______________

    Phone: ( ______ ) ______ - ___________ Fax: ( ______ ) ______ - ___________ Email: _________________________________

    Project Information

    Job Address: _______________________________________________________ Folio #: _______________________________

    Legal Description: ___________________________________________________________________________________________

    Residential Non-Residential || Interior Exterior || Square Ft: _________ Lineal Ft: __________

    Type of Work: New Addition Alteration/Completion Demo Repair Roofing Other: _________________________

    Type of Construction: _____________ Occupancy Group: ____________ Occupant Load: ____________

    Tenant: _______________________________________________ FBC/NEC Edition: _________________________________

    Description/Scope of Work: ____________________________________________________________________________________

    __________________________________________________________________________________________________________

    Total Contract Cost: $_______________________

    Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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. OWNERS 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.

    ____________________________________________________________ Signature of Owner or Authorized Representative (Circle One)

    ____________________________________________________________ Owner or Auth. Representatives Name & Title, if not Owner (Please Print)

    _____________________________________________________________ Signature and Stamp of Notary Public, State of Florida

    Sworn to (or affirmed) and subscribed before me this _________ day of

    _______________________________________________, 20______, by

    _____________________________________________________, who is

    personally known to me or has produced _______________________

    as identification. Did Take an Oath Did Not Take an Oath

    ______________________________________________________________ Signature of Contractor Qualifier or Agent (Circle One)

    ______________________________________________________________ Qualifier or Agents Name (Please Print)

    State Registration #: _____________________________________________

    State Cert./Cert. of Competency #: __________________________________

    ______________________________________________________________ Signature and Stamp of Notary Public, State of Florida

    Sworn to (or affirmed) and subscribed before me this _________ day of

    _______________________________________________, 20______, by

    _____________________________________________________, who is

    personally known to me or has produced _______________________

    as identification. Did Take an Oath Did Not Take an Oath

    http://www.velocityhall.com/

  • Permit Fee: $ ___________________________ Permit No: __________________________________

    Uniform Permit Application Building Department Page 2 of 2 02/01/2014

    Architect/Engineers Name: ____________________________________________________________________________________

    Architect/Engineers Address: __________________________________________________________________________________

    Bonding Company: __________________________________________________________________________________________

    Bonding Company Address: ___________________________________________________________________________________

    Fee Simple Titleholders Name (If other than owner): ________________________________________________________________

    Fee Simple Titleholders Address (If other than owner): ______________________________________________________________

    Mortgage Lenders Name: _____________________________________________________________________________________

    Mortgage Lenders Address: ___________________________________________________________________________________

    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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.

    IMPORTANT: Give notice for Inspections as per Florida Building Code 110.4 and 110.5; All approved plans, permit card and specifications MUST be on the job when an inspection is made; and Permit shall expire as per Florida Building Code 105.11.2.1 if construction is not begun or suspended. 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. All city streets, sidewalks and curb damaged due to the construction shall be repaired to the satisfaction of the Public Works Department prior to issuing the Certificate of Occupancy. City properties on which earth spills or other debris falls shall be cleaned immediately. The owner of the building and the undersigned agree to conform to all applicable laws of this jurisdiction.

    FOR OFFICE USE ONLY BELOW THIS SECTION

    DEPARTMENT APPROVED BY DATE DEPARTMENT APPROVED BY DATE

    ZONING FIRE

    STRUCTURAL LANDSCAPE

    ELECTRICAL ENGINEERING

    MECHANICAL UTILITIES

    PLUMBING

    Application Approval: ________________________________________________ Date: _____________________

    * This Permit does not become valid until signed by the Building Official or an Authorized Representative.

    Reset Form: Print: Sub Permit Master Permit: Other: KindofPermit: Trade: Company Name: Mailing Address: PermitHolderCity: PermitHolderState: PermitHolderZip: PermitHolderPhone: PermitHolderPhone1: PermitHolderPhone2: PermitHolderFax: PermitHolderFax1: PermitHolderFax2: PermitHolderEmail: PermitHolder: Qualifier's Name: Property Owner: Owner Mailing Address: Owner City: OwnerState: OwnerZip: OwnerPhone: OwnerPhone1: OwnerPhone2: OwnerFax: OwnerFax1: OwnerFax2: OwnerEmail: Job Address: Folio: Legal Description: Square Ft: Lineal Ft: Total Contract Cost: TypeofWork: Int_Ext: Res_Non-Res: DescriptionScope of Work: DescriptionScope of Work cont'd: Owner or Auth Representatives Name Title if not Owner Please Print: Qualifier or Agents Name Please Print: State Registration: State CertCert of Competency: Type of Construction: Occupancy Group: Occupancy Load: Type of Work: FBCNEC Edition: Tenant: ArchitectEngineers Name: ArchitectEngineers Address: Bonding Company: Bonding Company Address: Fee Simple Titleholders Name If other than owner: Fee Simple Titleholders Address If other than owner: Mortgage Lenders Name: Mortgage Lenders Address: