Fillable Form 20: Community Development Department (Charlotte County BCC)

Fill Online, Printable, Fillable, Blank Form 20: Community Development Department (Charlotte County BCC) Form

Use Fill to complete blank online CHARLOTTE COUNTY BCC (FL) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 20: Community Development Department (Charlotte County BCC)

On average this form takes 58 minutes to complete

The Form 20: Community Development Department (Charlotte County BCC) form is 22 pages long and contains:

  • 0 signatures
  • 16 check-boxes
  • 223 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Charlotte County BCC

BROWSE CHARLOTTE COUNTY BCC (FL) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Mobile Home & Recreational Vehicle Permit Application Information
(Revised 07/2015)
Please submit the following for tie-down permits:
1. Survey, signed and sealed by a Florida registered Land Surveyor (note: not required in
Mobile Home Parks).
2. Site drainage plan indicating the existing and proposed grade elevations at the
corners of the structure and along the property lines. Indicate that the drainage will
flow to an approved drainage facility and away from the structure.
3. Homes set in Flood Zones will require Engineered Foundations. An Elevation
Certificate and an As-Built Survey indicating the finished grades will also be required
prior to final inspections.
4. Provide a floor plan of the Mobile Home or R. V. unit.
5. Submit a copy of state registration or title for a used mobile home.
6. Provide a copy of the Manufacturer's Setup Manual.
7. Provide proof of the Mobile Home or R.V. being designed for Zone III Wind Loads.
8. Submit any additional information necessary to show compliance with Florida
Administrative Rule 15-C or other applicable Codes.
9. Provide information that water and sewer are available from the park or are existing,
or provide an approved septic permit.
Print Form
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
STABILIZER PLATE
180 sq. in. Hot Dip Galvanized (2 ounces per sq.
ft.)
Manufacturer:
_____________
Model:
___________________
STEEL STRAP FRAME TIE
With approved pivoting clamp and
radius clip
Type 1, Finish "B" , Grade "1", 109,000 min.
Yeild strength; .035 min. Thickness, hot
dipped galvanized coating: 60 ounces per sq. ft.,
1 ¼ width, ASTM Spec D3953-91
Manufacturer:
_____________
Model:
___________________
LONGITUDINAL ANCHORS With
approved bolt type clamp and radius
clip and stabilizer plate
Shall be installed at the end of each I-beam at
both ends of all units, minimum of 8
anchors for a single wide unit.
Manufacturer:
_____________
Model:
___________________
CONCRETE SLAB ANCHORS
Tensioning devices for use in concrete slab
shall be tested and approved. Instructions from
manufacturer must be included with
permit application.
Manufacturer:
_____________
Model:
___________________
Foundation bearing capacity based on pocket penetrometer test at six locations, certification attachment required.
Load bearing capacity 16" x 16" 18 ½" x 18 ½ " 20" x 20" 26" x 26"
1000 psf _____
3' spacing 4' spacing 5' spacing 8' spacing
1500 psf _____
4' 6" spacing 6' spacing 7' spacing 8' spacing
2000 psf _____ 6' spacing
8' spacing 8' spacing 8' spacing
Reviewer:
Date:
Permit #:
Address:
Approved: Disapproved:
Contractor:
License:
WIND ZONE III ONLY
YEAR BUILT & MANUFACTURE MODEL OR ITEM
WIDTH X LENGTH
R. V. PARK MODEL
Check Correct Value
GROUND ANCHOR TYPE I
Manufacturers set-up spec. Must
be submitted to use 48" anchors
or unit built prior to July 13, 1994,
max. spacing 5'4"
Soil class 4(a) loose to medium dense sands
Torque value between 276-350
Manufacturer:
Model:
GROUND ANCHOR TYPE II
60 " anchors must be used when
manufacturer set-up specs are not
available and unit was built after
July 13, 1994, max. spacing 5'4"
Soil class 4(a) loose to medium dense sands
Torque value between 175-275
Manufacturer:
Model:
STABILIZER PLATE
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Florida Identification # _____________________________________________________to me.
_______________________________________
Date: ___/___/___
Permit #: ______________________
Address: ___________________________________________
License #: _____________________
Contractor: _________________________________________
Torque Tests
This will certify the completion of two (2) Soil Probe Tests on the above described site:
TEST LOCATION
TEST VALUE
A
FRONT OF HOME
B
REAR OF HOME
POCKET PENETRO METER TEST
NO.1 NO.2 NO.3
NO.4 NO.5 NO.6
NO.7 NO.8 NO.9
Signature of Tester: _____________________________
Date: ___/___/___
Notary:
STATE OF FLORIDA
COUNTY OF CHARLOTTE
The foregoing instrument was acknowledged before me this _____
day of _____________20__,
By ______________________________________
.
who is personally known to me or presented
SEAL
Signature of Notary
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Additional unit width may require additional information
NAME: ________________________________________________________________________________
LOCATION: ____________________________________________________________________________
UNIT SIZE: ____________________________________________________________________________
FOUNDATION PAD SIZE & SPACING: ______________________________________________________
TORQUE TEST: _____ YES _____ NO
POCKET PENETROMETER TEST _____ YES _____NO
ANCHOR TYPE II 60" @ 5'4" SPACING IF MANUFACTURERS SPECIFICATION ARE NOT SUBMITTED
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
SITE PREPARATION
Site Graded and Fill Dirt compacted to 90%
- or -
Page:
Drain Tile and sump pump to be installed
- or -
Describe any other site prep method to be used
Page:
Page:
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Range
Unit #
Tax Folio # Lot Block
Section
Subdivision
This building will be used as
Description of work to be done
Model Home
Corner Lot
Inside Lot
Waterfront
Map Page
Flood Zone
City
State
Owner Information
Phone No.
Fax No.
Email
Contractor Information
Name
Construction Cost (excluding lot but including labor)
Township
Wind Zone Exposure
Zoning Class
Contractors State Certification or Registration No.
Contractors Certificate of
Competancy Number
Waterfront
Application for Construction Permit
Job Site Details
Name
City
State
Phone
Email
Fax No
Address:
Number Name
Type:(St., Dr., Pkwy., Blvd., etc.)
Address
Type:(St., Dr., Pkwy., Blvd., etc.)
Name
Number
Address
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Architect/Engineer Name
OWNERS/AGENT SIGNATURE
CONTRACTOR'S SIGNATURE
Signature of Notary
Notary's Printed Name
Commission Number or stamp
The foregoing instrument was acknowledged before me this
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 penalties.
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
(cont.)
Application for Construction Permit
Street
State
Zip
Mortgage Lender
Street
State
Zip
Street
State
Zip
State of Florida, County of
20
by
day of
Signature of Notary
Notary's Printed Name
Commission Number or stamp
The foregoing instrument was acknowledged before me this
who is personally known to me or who
has produced
as identification and
who did/did not take an oath.
State of Florida, County of
20
by
day of
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Application for Construction Permit
Additional Information
(To be filled out with New Construction or Additions)
Enclosed Living Area:
Other Area:
Height:
Number of Stories:
Total Rooms:
MATERIALS:
Roof:
Built-up:
Slope:
Tile:
# of Plumbing Fixtures
A/C (Tons):
ZONING:
SETBACKS:
Front:
Rear:
Left:
Right:
LOT:
Width:
Depth:
Bedrooms:
Bathrooms:
Walls (Exterior:)
Walls (Interior):
Heat (kw):
Commercial A/C Contract Cost:
AMPS:
New Service:
Commercial Roofing Contract Cost:
Septic No.:
Sewer Company:
Owner Name:
Address:
Number & Street Name
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
AFFIDAVIT
Form 5 (b)
FIRE HYDRANTS
day of
Signature of Owner/Agent/Contractor
Sworn to (or affirmed) and subscribed before me this 20 by
Type of Identification
Notary Name (Printed)
Commission NumberNotary Signature
Personally Known
OR Produced Identification
Printed Name of Owner/Agent/ Contractor
Owner's Name
Subdivision
Street Name
Unit #
Tax Folio # Lot Block
Street Number
Street Type
I, the undersigned, being the legal owner of the above described property, investigated and determined the
following:-
1. Public Water service -
is available is NOT available
2. A fire hydrant -
is within the prescribed distance
is NOT within the prescribed distance
Hydrant distances are as follows:-
1) Mobile Homes, Single Family, Duplexes and Triplexes - Maximum 500' from building
2) Commercial, Apartments and other high value - Maximum 300' from building
3) Heavy Industrial and Manufacturing - Maximum 300' from building
If public water is available and a fire hydrant is not within the prescribed distance as stated above, please contact
the appropriate utility for a fire hydrant.
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Parcel ID #
10/16/2015 jg
SEWER DISPOSAL / WATER AFFIDAVIT
Signature of Owner/Agent/Contractor
Printed Name of Owner/Agent/ Contractor
701.2 Sewer required. Every building in which plumbing fixtures are installed and all premises having drainage piping shall be connected to a public
sewer, where available, or an approved private sewage disposal system in accordance with the International Private Sewage Disposal Code.
Person making affidavit:
SEWAGE DISPOSAL - Please select one of the following:
Owner Name:
Number & Street Name City Zip Code
Lot
Block
Subdivision
Contractor Name
Phone #
Fax #
License #
Owner(s)
Owner(s) Agent
Owner(s) Contractor
Public Sewer Available: I, the undersigned, have verified and confirmed that the address listed above does have Public Sewer
available. If the utility company is other than Charlotte County Utilities, please provide proof of availability in the form of a
letter from the utility company on their letterhead. The permit WILL NOT be issued without proof of availability.
Onsite Sewage Disposal System: I, the undersigned, have verified and confirmed that the address listed above will have an
approved Onsite Sewage Disposal System.
Name of Utility Company:
Charlotte Co. Health Dept. Permit Number:
Signature of Notary
as identification and who did/did not take an oath.
Printed Name of Notary
Commission Number
The foregoing instrument was acknowledged before me this
day of
20
who is personally known to me or who has produced
Seal
State of Florida, County of
by
Unit #:Building #:
Address:
WATER AVAILABILITY - Please select one of the following:
Name of Utility Company
Well Water
Public Water Available - I, the undersigned, have verified and confirmed that the address listed above does have Public Water
available. If the utility company is other than Charlotte County Utilities, please provide proof of availability in the form of a
letter from the utility company on their letterhead. The permit WILL NOT be issued without proof of availability.
NOTE: When a low pressure sewer (LPS) system provides service to multiple dwelling units, the electrical service must be on a
separate, dedicated electrical meter under the property owner's FPL account. I acknowledge that I have read and understand all
Charlotte County Utilities' Standard Specifications and Drawing Details related to LPS installation (CCU 941.764.4300, Ext. 3).
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
AFFIDAVIT
STATEMENT THAT THE BUILDING SITE CONTAINS NO COUNTY OR PUBLIC UTILITY STRUCTURES
day of
Signature of Owner/Agent/Contractor
Sworn to (or affirmed) and subscribed before me this 20 by
Type of Identification
Notary Name (Printed)
Commission NumberNotary Signature
Personally Known
OR Produced Identification
Printed Name of Owner/Agent/ Contractor
Name of person making statement
Owner(s) Owner(s) Agent Owner(s) Contractor
I, the undersigned, hereby certify that I have inspected , or caused to be inspected by a qualified person or firm, the
property proposed as the building site for which I am applying for a building permit. I have determined that the
proposed site does not contain any County or Public Utility structures above, on or under the proposed building
site, whether within or without any easements, except as noted below.
I understand that should any County or Public utility structure not disclosed above be discovered on the proposed
building site, the County will not be responsible for any expenses related to moving, abandoning or taking any
other action related to any such structure, or the proposed building or structure, on the building site.
Subdivision
Street Name
Unit #
Tax Folio #
Lot Block
Street Number
Street Type
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
A recorded Notice of Commencement is required in the Permitting Office prior to the first inspection.
04/14/2016 jg
Subcontractor Worksheet
This form is to be submitted at the time of Permit Application and must be completed with all information.
Changes in subcontractors are allowed by submitting a Change in Subcontractor form.
Permit Number
Contractor Name
Contractor's Certification or Registration No.
Contractor Signature
Unit #:
Building #:
Address:
Trade
Subcontractor Company Name
Subcontractor
Telephone No.
Subcontractor
License No.
A/C and Heating
Electric
Plumbing
Roofing
Date
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Select from the following:
Tree Preservation
Tree Removal Authorization
Memorandum of Exemption of Fees
No Tree Affidavit
1
I certify that _____ (number) of trees on the above-described property are to be preserved/protected according to the methods set forth in Charlotte
County Buffers, Landscaping, and Tree Requirements, Section 3-9-100. (Provide one (1) site plan.)
CHARLOTTE COUNTY TREE PERMIT APPLICATION
Job Address: _________________________________________________________________________________ Parcel ID _________________________________
Lot Number: _______ Property Type: Residential ____ Commercial ____ Check all that apply: Individual Trees ____ Lot Clearing ____
Contractor or Owner/Builder: ___________________________________________________________ Contractor License #: _____________________________
Mailing Address: _________________________________________Phone: ______________________Email:______________________________________________
1. Tree Preservation:
Will any trees be preserved on site? Yes_____ No _____
2. Tree Removal Authorization:
Will any trees be removed from the site? Yes_____ No _____
I request that _____ (number) trees on the above-described property and indicated on the attached site plan be removed utilizing the Tree Removal
Authorization as provided in Charlotte County Buffers, Landscaping, and Tree Requirements, Section 3-9-100. (Provide one (1) site plan) Indicate reason
for removal:
___________________________________________________________________________________________________________________________
---------------------------------------------------- ---------- AND / OR --------------------------------------------------------------------
3. Memorandum of Exemption of Fees:
I certify that _____ (number) trees on the above-described property are exempt from Tree Removal Authorization and removal fees as provided by the
tree protection requirements of Charlotte County Buffers, Landscaping, and Tree Requirements, Section 3-9-100. (Provide one (1) site plan) Indicate
reason for removal:
___________________________________________________________________________________________________________________________
------------------------------------------------------------------ OR ------------------------------------------------------------------------
4. No Tree Affidavit:
There are NO TREES currently located on site. (Use affidavit below)
________________________________________________________ ________________________________________________________
Signature of Applicant Printed Name of Applicant
State of Florida, County of ________________________________
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.
___________________________________________ __________________________________________ ______________________
Signature of Notary Notary’s Printed Name Commission Number
I agree to assume full responsibility for the removal of said trees(s) and for compliance with all applicable County and State regulations
regarding the proper disposal of brush and yard trimmings. Further, I will replace trees as required by the Charlotte County Code.
Environmental Inspection*: $ 55.00
*Please note site review is cursory, additional wildlife or environmental reviews may be required by
state and federal agencies if protected species are found on site.
*Required for all lot clearing applications
For properties in which the total area to be cleared exceeds 1 acres, the submittal of a current
protected species assessment and FLUCCS map will be required.
Residential Tree**: $ 70.00
Commercial Tree**: $ 80.00
**Plus total # of caliper inches removed __________ x $1.00 (total from page 2): $____________
Total Fee: $____________
Applicant’s Signature: _____________________________________________________ Date: ___________________________
Authorized County Official: _________________________________________________ Date: ___________________________
An approved barricade inspection must be obtained in order to receive credit for tree preservation.
To request a barricade inspection, call (941) 743-1204 or (941) 743-1205.
A final inspection may be conducted by staff to ensure compliance with all of the applicable permit conditions
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
Community Development Department
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201| Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
"To exceed expectations in the delivery of public services"
For Office Use Only
Permit Number
Application Date
20
CSR Initials:
EXAMPLE SITE PLAN
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 20: Community Development Department (Charlotte County BCC)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document