Fillable Form BCAD 100 - REV 080116: BUILDING PERMIT (Broward College)

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Form BCAD 100 - REV 080116: BUILDING PERMIT (Broward College)

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  • 18 check-boxes
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Building Code Administration
Form BCAD 100 - REV 080116
1335 Shotgun Road Sunrise, Florida 33326 • (954) 635-2130 • Fax: (954) 206-7227 • CA9224
Page 1 of 2
BUILDING PERMIT APPLICATION
Separate permit applications for each sub-consultant must be submitted for each discipline: Mechanical,
Electrical, Plumbing, Roofing, F/A, F/S, Site Work, etc. Contact our office for information.
FOR OFFICE USE ONLY
INSTRUCTIONS: Application must be typed or printed in ink. Submit
original application signed and notarized. Attach (2) two sets of hardcopy
plans, specs, product approvals, calcs and asbestos abatement report
(REQUIRED). For further assistance call (954) 635-2130.
Permit No.
File No.
PERMIT TYPE (check one): BUILDING MECHANICAL ELECTRICAL PLUMBING
1. BC Proj. Mgr:
Mobile:
Email:
2. BC Project No.:
Mobile:
Email:
3. Campus: North Central South DTC Cypress Coral Springs Miramar
Other:
4. Building No. / Location:
5. Proposed Work: New Addition Alter Maint. Demolition Other
Scope of Work:
6. Est. Cost $ Est. Duration Days Est. Sq Ft.
7. Contracting Firm:
Address:
Qualifier Name:
License No.: Phone:
8. Architect / Engineer:
Address:
Qualifier Name:
License No.: Phone:
9. Present Occupancy
10. Proposed Occupancy
BUILDING PERMIT APPLICATION
041717
Form BCAD 100 - REV 030218
REV 010419
6950 Cypress Rd. Suite 106, Plantation, FL 33317
954.766.2717
Fort Lauderdale Office · 1800 Eller Drive · Suite 600 · Fort Lauderdale, FL 33316 | O:954.766.2717 |·CA514
1335 Shotgun Road Sunrise, Florida 33326 • (954) 635-2130 • Fax: (954) 206-7227 • CA9224
Page 2 of 2
This 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 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 ELECTRICAL WORK,
PLUMBING, SIGNS, WELLS, POOLS, ROOFS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, etc…
OWNER/CONTRACTOR AFFIDAVIT: I 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.
“NOTICE: In addition to the requirements 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 agencies or federal agencies.”
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
11. Owner (or Project Manager):
Print Name of Owner (or PM)
Date:
________________________________
Owner or Program Manager Signature
STATE of FLORIDA, COUNTY of
Sworn to and subscribed before me this day of
, 20 , by .
_________________________________
Notary Signature
(SEAL)
Personally known OR produced identification
Type of identification produced
Contractor Qualifier:
Print Name of Contractor
Date:
________________________________
Contractor (Qualifier) Signature
STATE of FLORIDA, COUNTY of
Sworn to and subscribed before me this day of
, 20 , by .
_________________________________
Notary Signature
(SEAL)
Personally known OR produced identification
Type of identification produced
Building Code Administration Use Only
BCAD Approval Signatures:
Recommended for Approval: __________________________Date: _______________
Application Approved by: _____________________________Date: _______________
6950 Cypress Rd. Suite 106, Plantation, FL 33317
Fort Lauderdale Office · 1800 Eller Drive · Suite 600 · Fort Lauderdale, FL 33316 | O:954.766.2717 |·CA514
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Form BCAD 100 - REV 080116: BUILDING PERMIT (Broward College)

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Completed 18 August 2020

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