Fillable Form 13: Community Development Department (Charlotte County BCC)

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Form 13: Community Development Department (Charlotte County BCC)

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BROWSE CHARLOTTE COUNTY BCC (FL) FORMS

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Community Development Department
Zoning Division
18400 Murdock Circle | Port Charlotte FL 33948-1094
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
12/2017 jg
Name:
RangeLot Block Section Subdivision
Address of work to be done:
Description of Work:
Corner Lot Inside Lot
Map PageFlood Zone
City:
St :
Owner Information
Phone No.:
Fax No.:
Form 13
Township
Zoning Class
Residential Seawall/Riprap Quick Permit
Address:
Tax I. D.
Manmade Canal
Name of Body of water:
New Repair
LF Seawall
Material:
Concrete
Riprap
Access to Job:
Water Road
Concrete Ramp
Other
Zip:
Contractor Information
Name:
Address:
City:
St:
Zip:
Phone: Fax No.:
The undersigned applicant for this building permit does hereby certify that he/she has or will, prior to the performance of any work in connection with
the authorization granted under this permit, comply with the provisions of the Florida Workman's Compensation Act of Employer's Liability Insurance
and Social Security Act, the Florida Child Labor Laws, and other safety and labor laws of the state. Violation will invoke severe penalties. All work,
materials, equipment, and design shall meet the minimum standards of the Florida Building Code.
I certify that I have read the foregoing and the information I established on this affidavit is true to the best of my knowledge:
Signature of Contractor or Owner-Builder:
Date:
Contractor License #: Construction Cost (including labor) $
Include the following required documents:
1. Engineered design specifications for concrete seawalls; all concrete to be a minimum 5,000 p.s.i. for salt or brackish waters; Riprap
seawalls shall follow Charlotte County Code (attached) (one copy).
2. D.E.P./U.S. Army Corps of Engineers or other required permits if to be built over State or Federal jurisdictional waters (one copy).
3. Copy of property survey showing all maintenance, utility, and right of way easements OR an Affidavit for Applicant Accessory
Structures (one copy)
4. Site plan showing footprint of proposed scope of work, equipment location, setbacks (two copies).
5. Owner/Builder Affidavit (if applicable) (one copy)
6. Subcontractor Worksheet (one copy).
7. Notice of Commencement (if project is $2,500 or more)(one copy) must be submitted prior to scheduling first inspection.
8. Application form (two copies).
NOTE: All subcontractors must have a Charlotte County Certificate of Competency. Permit is void if construction is not started within 180 days or
does not receive an approved inspection within 180 days from the date of issue. An approved inspection will extend this permit for an
additional 180 days.
WARNING TO OWNER: Your failure to record a Notice of Commencement may result in your paying twice for improvements to your property
.
Email:
Community Development Department
Zoning Division
18400 Murdock Circle | Port Charlotte FL 33948-1094
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
12/2017 jg
OWNERS/AGENT SIGNATURE
State of Florida, County of
Signature of Notary
Notaries Printed Name
Commission Number
The foregoing instrument was acknowledged before me this
day of 20 by
who is personally known to me or who
has produced as identification and
who did/did not take an oath.
CONTRACTORS SIGNATURE
Signature of Notary
Notaries Printed Name
Commission Number
The foregoing instrument was acknowledged before me this
day of 20 by
who is personally known to me or who
has produced as identification and
who did/did not take an oath.
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 issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in
this jurisdiction.
The undersigned applicant for this permit does hereby certify that he/she has or will prior to the performance of any work in connection
with the authorization granted under this permit comply with the provisions of the Florida Worker's Compensation Act of Employers
Liability Insurance, the Social Security Act, the Florida Child Labor Laws and all other applicable safety and labor laws of the state.
Violation will invoke severe penelties.
Owners Affidavit: I hereby 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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE: In addition to the requirement 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, or federal agencies.
Name of Fee Simple Titleholder (if not owner)
Street City State Zip Phone No
Bonding Company Name
Application for Construction Permit
Street
State
Zip
Architect/Engineer Name
Mortgage Lender
Street
State Zip
Street State Zip
State of Florida, County of
Community Development Department
Zoning Division
18400 Murdock Circle | Port Charlotte FL 33948-1094
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
12/2017 jg
Riprap Seawall Design
Add new Section 1814.5 -
“Riprap seawalls will be required to be permitted and must meet the following minimum requirements.
a) Riprap density to meet D.O.T. specifications and a minimum size 60% of 8” or larger diameter.
b) Slope not to exceed 2:1.
c) Filter X or equivalent sall be laid on the slope prior to riprap placement. The top end of filter material
shall be dug into ground a minimum of 8” or poured into concrete. The bottom end of filter material is
to be wrapped around the bottom layer of riprap and held in place by the second layer.
d) The bottom layer of riprap shall be burried a minimum of one foot into the ground.
e) The mean high water line shall be at least one foot above the bottom riprap layer."
Community Development Department
Zoning Division
18400 Murdock Circle | Port Charlotte FL 33948-1094
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
12/2017 jg
Affidavit of Application for Accessory Structures
To be used only if a copy of the property survey is not available
Applicants Name:
Note: all site plans, drawings or sketches must be drawn to scale and shall include all buildings, easements and setbacks
Real Estate Services may be contacted at 941-764-5589 for Information regarding easements.
I, the undersigned applicant, being first duly sworn, depose and say that I am the owner, attorney, attorney-in-fact, agent,
contractor, lessee or representative of the owners of the majority of the property described and which is the subject matter
of the proposed application; that all answers to the questions in this application, and all site plans, sketches, data and other
supplementary matters attached to and made part of the application are honest and true to the best of my knowledge and
belief.
Any costs, expenses, liens, lawsuits and liabilities that arise form the issuance of this permit regarding building location is
the sole responsibility of the contractor and property owner. It is also understood that the County does not verify the
final location of structures or their setbacks and that all structures must be located in compliance with required
setback regulations.
State of:
County of:
The forgoing instrument was acknowledged before me this _________day, of _________________________
_________________________ by_______________________________________________
(Month)
(Year)
who is personally know to me or has produced______________________________________________________
as identification and who did / did not take an oath.
______________________________________________ ___________________________________________
Printed Name of Notary
Signature of Applicant (or Contractor)
______________________________________________ ___________________________________________
Signature of Notary
Contractor License Number
______________________________________________ ____________________________________________
Commission Number
Phone: Area Code & Number
Zoning Form
(Return completed form to Zoning Office)
Established: November, 2010
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Form 13: Community Development Department (Charlotte County BCC)

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Completed 21 January 2021

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