Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
FLOOD INFORMATION
SUMMARY
PROJECT INFORMATION::
(PROJECT NUMBER)
OWNER'S NAME: PROPERTY ADDRESS:
ADDITION; REMODELING
DATE STRUCTURE BUILT:
CONTRACTOR'S NAME:
APPLICANT'S SIGNATURE: DATE:
PROCESSING INFORMATION
FLOOD ZONE: REQUIRED ELEVATION:
; ;
MAP:
VALUE OF EXISTING STRUCTURE: (CHECK ONE)
COPY OF CERTIFIED APPRAISAL
VERIFIED ASSESSMENT (BY:
)
COST OF CONSTRUCTION: (CHECK ONE)
FROM ATTACHED COPY OF CONTRACT/COST BREAKDOWN
FROM ICC VALUATION TABLE
$
COST OF WORK DONE WITHIN ONE YEAR:
$
TOTAL COST
TO RECEIVE AN EXEMPTION FROM NFIP RULES, THE COST OF THE PROJECT MUST BE LESS THAN, THE ALLOWED PERCENTAGE OF
EXISTING STRUCTURE.
FLOOD ZONE COMPLIANCE (CHECK ONE)
COMPLIANCE REQUIRED; COST EXCEEDS ALLOWED PERCENTAGE OF VALUE
COMPLIANCE REQUIRED; STRUCTURE BUILT AFTER ORDINANCE (06/18/80)
COMPLIANCE NOT REQUIRED; COST IS LESS THAN THE ALLOWED PERCENTAGE
COMPLIANCE NOT REQUIRED;
(SPECIFY)
FLOOD SUMMARY APPROVED BY: DATE:
APPRAISAL COUNTY ASSESSMENT
$ $
$
$
Last Revised: 8-07-17
*Appraisal must be attached if checking this box. *County Assessment must be attached if checking this box.
**Appraisal must be dated within the last twelve (12) months.
Print Form
Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
Reconstruction/Improvement
Contractor Attestation
Parcel ID#:
Name of Contractor:
Address of Contractor:
Phone Number:
Contractor's License No.:
Property Address:
I hereby attest to the fact that I personally inspected the above-mentioned property and produced the attached itemized list of
repairs, reconstructed an/or remodeling list, which are hereby submitted for a Substantial Damage/Improvement Review.
These damages/improvements are all of the damages/improvements sustained by this structure, and that all additions,
improvements, or repairs proposed on this subject building are included in this estimate.
I also understand that I am subject to enforcement action if inspection of the property reveals that I have made repairs or
improvements not included on the attached list repairs to my home, or that I have included non-conforming or illegal structures/
additions to the existing structure, without having presented plans for such additions.
(See attached itemized list)
Total Labor & Materials:
Overhead & Profit:
Total Cost:
Contractor's Signature:
Last Revised: 8-07-17
5% Contingency:
Print Name of Contractor:
Date:
Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
Reconstruction/ Improvement
Owner Attestation
Parcel ID #
Name of Contractor:
Contractor's License #:
Owner's Name:
Owner's Address:
Owner's Phone #:
I hereby attest to the fact that the repairs/construction and/or remodeling list submitted by my contractor for the
Substantial Damage/Improvement Review are all of the damages/improvements sustained by this structure that
will be done to the existing building; and that all additions, improvements or repairs on the subject building are
included in the construction estimate. No other contractor has made any repairs or reconstruction or additions or
remodeling not included in the attached list.
Total Cost
I also understand that I am subject to enforcement action if inspection of the property reveals that I have made
repairs or improvements not included on the attached list of repairs to my home, or that I have included
non-conforming or illegal structures/additions to the existing structure without having presented plans for such
additions.
Owner's Signature:
Last Revised: 8-07-17
Print Name of Owner:
Date:
Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone: (813) 274-3100
Substantial Improvement
Cost Breakdown
www.tampagov.net/permits
Fax: (813) 259-1712
General Information
Zip Code:Project Address:
Folio #: Permit or Tracking Number:
Items
Description of Work
Quantity
Labor (L)
Materials Cost (M)
Demolition
Includes all associated costs for demolition including rental
equipment.
Does not include debris removal.
Slab on Grade
Includes monolithic footing and required reinforcing steel.
If stem wall construction, only include slab.
Slab area sq ft.
Foundation and
Concrete
Reinforcing Steel
Includes poured in place footings and stem walls to finished floor
elevation.
Length of foundation linear ft.
Masonry Wall
Includes all masonry materials including cement, fill cell and
tie-beam steel, lintels and sills.
Total area of all masonry walls
sq ft.
Lumber/Framing
Includes all conventional rough framing lumber including
conventional roof and floor framing.
Pre-Engineered
Roof Trusses
Total number of trusses
Pre-Engineered
Floor Trusses
Total number of trusses
Wall Sheathing
Includes all exterior wall sheathing and fasteners.
Total area of wall sheathing
sq ft.
Roof Sheathing
Includes all roof sheathing and fasteners.
Total area of roof sheathing
sq ft.
Floor Sheathing
Includes all interior floor sheathing and fasteners.
Total area of floor sheathing
sq ft.
Finish Carpentry
Includes all interior trim materials for doors, windows, openings.
Includes wood and non-wood products.
Structural Steel Includes all structural steel excluding concrete reinforcing steel.
L $
M $
L $
M $
L $
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M $
Items
Description of Work
Quantity
Labor (L)
Materials Cost (M)
Stucco
Includes all exterior plaster including stucco or cementitious
finishes.
Total area to receive stucco sq ft.
Exterior Wall
Siding
Includes all exterior siding, fasteners, vapor barriers and flashings.
Soffit
Includes all exterior soffit and fasteners.
Total linear feet of soffit
sq ft.
Elevator
Roof Covering Total number of roof squares:
Addition Only
Entire Building
Tile
Shingle
Metal
Built-up
Total area of wall siding sq ft.
Fascia
Includes all exterior fascia and fasteners.
Total linear feet of fascia
sq ft.
* Cabinets
Includes all new/replaced or re-laminated millwork and counter
tops.
*Provide separate sheet showing millwork breakdown.
*Built-in
Appliances
Includes new: dishwasher, trash compactor, water heater, range,
oven and other built-in appliances.
*Provide separate sheet showing millwork breakdown.
Includes all required materials and equipment for a complete
installation.
Gas
Includes all new or replaced gas piping, regulators and final
connections.
Plumbing
Includes all new or replaced waste, vent and water piping and all
new fixtures.
Electrical
Includes all new or replaced services, panelboards, circuits, smoke
detectors, receptacles, disconnects, switches, ceiling fans, security
systems and fixtures.
HVAC
Includes all new or replaced equipment, duct work, exhaust fans,
thermostats and drains.
Doors
Exterior Entry
Includes all new or replaced entry doors less finished carpentry
trim.
Number of new exterior doors
L $
M $
L $
M $
L $
M $
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M $
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M $
Items
Description of Work
Quantity
Labor (L)
Materials Cost (M)
Interior Doors
Includes all new or replaced interior side swing doors less finished
carpentry trim.
Number of new interior doors
Garage Door
Includes all new or replaced garage doors including automatic
openers.
Sliding Glass
Includes all new or replaced sliding glass doors less finished
carpentry trim.
Number of new sliding glass doors
Number of new garage doors
Fascia
Includes all exterior fascia and fasteners.
Total linear feet of fascia
sq ft.
New Windows
Windows
Includes all new windows less finished carpentry trim.
Number of new windows
Replacement
Windows
Includes all replacement windows less finished carpentry trim.
Number of replacement windows
Skylights
Includes all new or replacement skylights less finished carpentry
trim.
Number of new or replacement skylights
Insulation
Includes all roof, wall, floor insulation.
Total area roof insulation sq ft.
Total area wall insulation sq ft.
Total area floor insulation sq ft.
Gypsum Wall
Board
Includes all new or replaced gypsum wall board and finishes
required for paint.
Total area of new or replaced gypsum board sq ft.
Fireplace
Includes any new or replaced wood burning, gas or electric
fireplace.
Interior Painting
Includes all interior painting, staining or varnishing of interior
walls, ceilings, floors and trim.
Total area of interior paint sq ft.
Exterior Painting
Includes all painting or liquid applied exterior waterproofing.
Total area of exterior paint sq ft.
L $
M $
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L $
M $
Items
Description of Work
Quantity
Labor (L)
Materials Cost (M)
Interior Paneling Includes all new or replaced paneling.
Total area of interior paneling
Wall Paper
Includes all new or replaced wall paper.
Ceramic Tile
Includes all new or replaced floor, wall or ceiling tile.
Total area floor tile
Total area of wall paper
Carpet
Floor Covering
Includes all new or replaced carpet.
Total area of carpet
Wood Flooring
Includes all new or replaced wood flooring.
Total area of wood flooring
Other floor
covering such as
vinyl or
linoleum
Includes all new or replaced.
sq ft.
sq ft.
sq ft.
Total area wall tile
sq ft.
Total area ceiling tile
sq ft.
sq ft.
sq ft.
Total area of other flooring sq ft.
L $
M $
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M $
Miscellaneous Construction Materials Not Otherwise Classified
sq ft.
sq ft.
sq ft.
L $
M $
L $
M $
L $
M $
sq ft.
L $
M $
Instructions: Use this section to input any construction materials not otherwise listed in the categories
above. When applicable, please enter square footage of construction involving these materials.
Description
Material
Overhead amount:
Profit amount:
Overhead + Profit Total:
Contingency - Per contract or contingency of approximately
5% to allow for change orders and/or unforeseen field conditions:
Total value of all improvements (labor, materials, overhead, profit, and contingency:
Signature of Contractor
Date
Contractor’s State License #
Materials Cost (M) + Labor (L) Total:
% Overhead
% Profit
Cost Breakdown Calculations
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$
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Print Name of Contractor
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