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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