Building Permit Application
Building Permit Application DMS Permit No.:
For projects permitted by the Department of Management Services
Department of Management Services
Division of Real Estate Development and Management
Bureau of Building Construction
4050 Esplanade Way, Suite 335
Tallahassee, Florida 32399-0950 Date:
*All construction shall comply with the latest edition of the Florida Building Code.
Project Name: ________________________________________________
Project Address: ______________________________________________
DMS Project Number:
Agency Name & Address:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Telephone: ______________ E-Mail Address: _______________________
Contractor Business Name & Address:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Telephone: ______________ E-Mail Address: _______________________
License Holder Name: __________________________________________
State License #: _________________ Expiration Date: ___________
Architect/Engineer Name and Address:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Telephone: ______________ E-Mail Address: _______________________
License Holder Name: __________________________________________
State License #: _________________ Expiration Date: ___________
Description of Work:
Type of Construction:
Occupancy Classification:
Construction Classification:
Height:
Number of stories:
Sprinklered: Y / N
Site Work: Y / N
State of Florida Energy Calculations: Y / N
Valuation of Work: $
Permit Fee: To be determined upon receipt of Building Official’s fee proposal.
Instructions
In order to obtain a DMS Building Permit please email and submit the documents listed below to:
Mr. Otto J Letzelter, PE, SI, BCA, LEED AP
Contract Building Code Administrator BU1294
OLetzelter@
Calvin, Giordano & Associates, Inc.
1800 Eller Drive, Suite 600
Fort Lauderdale, Fl 33316
Direct: 954.266.6497
Cell: 954-650-3371
Fax: 954.921.8807
_____ (2) Sets of plans signed /sealed
_____ (2) Sets of specifications signed /sealed
_____ DMS Permit Application
_____ Copy of Contractor/Subcontractor License
_____ Copy of State Fire Marshal approval letter
_____ Executed Contractor Disclosure Statement (see below)
We also ask that you please copy the DMS Project Manager with the documents referenced above.
CONTRACTOR DISCLOSURE STATEMENT
Application is hereby made to obtain a permit to do work and installations as indicated. State law requires construction to be done by licensed contractors and subcontractors. Exemptions to that law may apply. 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 all SIGNS, WELLS, POOLS, and TANKS.
NOTE: A notarized letter of authorization must be submitted if anyone other than license holder is to pick up permit.
Contractor is responsible to maintain on site a list containing all project subcontractors License Information and a copy of each subcontractor’s current workers compensation policy.
Agencies enforcing building codes are required when issuing building permits, to provide a declaration stating that additional permits may be required from other governmental entities, such as Water Management Districts, State Agencies, and Federal Agencies, as required by State and Federal law.
It is the owner/operator’s responsibility to comply with asbestos removal in accordance with NESHAPS regulations and Florida Statute 469.003
Supply a copy of the following items with application:
• Submittal of Certificate of Workers’ Compensation coverage is required under Chapter 440 of the Florida Statutes.
• Submit a copy of the State Contractors License listed on the application.
Contractors Signature:
STATE OF FLORIDA
COUNTY OF ____________________
Sworn to (or affirmed) and subscribed before me this ____ day of _____, ___
(Signature of Notary Public)
Personally Known _____ OR Produced Identification _____
Type of Identification Produced ______________________
................
................
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