HomeMy WebLinkAbout91-1605
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
PermitN~
1605 fJ
Date t~' - ~ '1- '11
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Property Owners Name:
Job Address:, ? R- cf. 'I V
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Legal Description:
Sub.Div.
Lot
Blk.
Zoning CI: J - ,;)... b- Q I ~ 0/ S- 0 - (.,) 0 00 U
Description of Work~o -~} .A'!-;t:(..("o~ - ;;r:}~ A. ,,(J
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Energy Code Readout:
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Complete Plans, Specifications and Fee Must Accompany Application
Fee:3..s-, c.iU
SIGNATU#/ L' 4(..2l.jl
COMPANY
ADDRESS
TELEPHONE #
Estimated Cost: ---:J'/:; o---z:y, 07::>
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All work shal! be performed in accordance
with the above and all City Codes
and Ordinances.
OCCUPATIONAL LICENSE #3/S~.....1 C~-
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Ftr.
Pre SLB
Lintel
FRM.
Insul.CL
WL
~NG
-----
E~CAL
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ME~AL
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SLB
Tub Set
Water
Sewer
Final
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons. a charge of .1_.. [!II 1.10)
dollars shall be made for each _./"r a.. Je. (/-s-: tJl))
(a) Wrong Address
(b) Condemned work resulting from faulty construction
(c) Repairs or corrections not made when inspection called for
(d) Work not ready for inspection when called.
The payment of reinspection fees shall be made before any further permits will be issued to the person owning same.
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ZEPHYRHiU';~u)r.!DA -~4248
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PROPOSAL SUBMITTED TO
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DATE
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CITY, STATE AND ZIP CODE
JOB LOCATION
ARCH ITECT
DATE OF PLANS
We hereby submit specificatIOns and estimates for:
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lltIl' JrUpUfil' hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
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Payment to be made as follows:
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Authorized ,/?;r;l'>: , ("? ~ !: r,> C)' . Ji
Signatury~ \ ,/..,..: :~ ,/,. ---!I
Note: This proposal may be
withdrawn by us if not accepted within _ days. j
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All material is guaranteed to be as specified. All work to be completed In a workmanlike
manner according to standard practices. Any alteration or devidtion from above specifica.
i tions in".to[ving extra costs will be executed only Llpon \~ritten orders, and will become an
] extra charge over and above the e5timate. All agreements contingent upon strikes, accidents
ilor delays b2yond our control. Owner to carry fire, tornildo and other neCeS5d:ry insurance.
lOur workers are fully covered by Workmen's Compensation Insurance.
) Acttplantt af Jrapallul- Th' ,hO"' p"e"" 'p,dl,,,'''"'
II and conditions are satisfactory and are hereby accepted. You are authorized
l'O do th, ."k " 'p,dH"'. P"m,"' .", he m,de "O""'",d. abo~f'
Date of Acceptance:
Signature
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Signature
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APPLICATION FOR PERMIT
. CITY OFZEPHYRHILLS
" /'. BUILDING DEPARIMENT
APPLIGANT$ a~/4L
ADDRESS 3~cgyO ~/7Y
JOB LOCATION 315~'/O /jp/JY Ytv
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PHONE 71,~l - 1'1 6' ~
"
OWNER
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION
PARCEL I.D.~~ a2-'~"':lI- cJ/~O- OtJOOl) OJ:lO
WORK PROPOSED:____New Construction ____Addition ____Alteration ~~epair
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____Install
_Sign/Temp.
PROPOSED USE: ~Single Family
____Sign
_~love
_Demolish
_M/F
_~~ of Units
_____HI II
____Commercial
_Indust.
_Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOFl'IS. ,~*
**COPY OF CONTRACT REQUIRED.
PERMITS REQUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
_MECHANICAL
$
Valuation of Mechanical Installation
____PLlJMB I N"G
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
____Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Regis tra tinn!1 3/ S-'
*******************************
ELECTRTCTAN
Company
State Cert. or Regist. #
City License Registration 0
******************************************
Si!!nature
Company
State Cert. or Regist. #
City License Registration #
******************************************
PLUMBER
Signature
Company
State Cert. or Regist. 0
.City License Registration ~~
****************************************~*
MECHANICAL
Signature
OTHER
Company
State Cert. or Regist. #
City License Registration #
Signature
APPLICATION APPROVED BY
~~~*******************~*****~~*~*~~~~A~~~~
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PEFl'lIT OFFICER.
CONDIT.IONS OF PERMIT AFFIDAVIT
A.'. NOT I CE OF DEED RESTR I CT IONS:. .
The undersigned understands that this perlit lay be subject to "deed restrictions' ~hich ~ay be m~re restrictive than City
regulations. The undersigned assumes responsibili~Y.for, compliance with any applicable deed restrictions.
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B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may b& required to be licensed in accordance with
stitt and local regulations. If the contractor is not licensed as required by la~1 beoth the ollner and contractc.r n.y be
cited for a lisdemeanor violation under state law. . If the ~wner ~r intended contract~r are uncertain as to what licensing
requirelents lay apply for the intended work, theY are advised to contact the City of Zephyrhills 8uilding Departeent, (813)
788-6611.
Furtheraore, if the owner has hired a cDntractor or contractors, he is advised to have the c~ntractor(s) sign portions of the
"Contractor Sections" of this application for which they will be responsible. If y~U~ as the owner sign as the contractor,
y~u are indicating that you, rather than the contractor, are responsible for the wory.. If the contractor wishes y~u to sign
as contract~r that aay be an indication that he is not properly licensed and is not entitled to permitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D.
CONSTRUCTION LIEN LAW
(CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - Ho~eowner's Protection
Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is s~meone other than the
"owner", I certify that I have obtained a copy of ' the above described docuffient and promise in good faith to deliver it to the
'owner" prior to COlmencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all Mork Hill be done in co~pliance with all
applicable laws regulating construction, zoning, and land development.
Application is hereby lade to obtain a perait to do work and installation as indicated. I certify that no work or
installati~n has c~&~enced prior to issuance of a permit and that all wory. Hill be performed to roeet standards ~f all laws
regulating construction, City codes, zoning regulations, and land development regulati~ns in the jurisdiction. 1 also
certify that I understand that the regulations of other governmental agencies ~ay apply t~ the intended Hort, and that it is
ay responsibility to identify what actions llllust take to be in compliance. Such agEncies include but ~le liot li,lited to:
I Departlent of Environ~ental ReQulation - Cypress Bayheads, Hetland Areas and Envir~nmentally Sensitive L~ndsJ
Hater/Wastewater Treatment
I Southwest Florida Hater ManaQelent District - Hells, Cypress Bayheads, Wetland Areas, Altering Hatercourses
I Ar~y CorDS of EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health L Rehabilitative Services. Environmental Health Unit - W~lls, Waste"ater Treat~En:. Septic Tanks
I US Environoental Protection AQency - Asbestos abatement
I also certify that, if filll1aterial is to be used in Flc.od Zone "A" or "A,etc.', it is understc,eod t1.,t a drainage plan
addressing a 'colpensating volu~e" will be submitted which is prepared by a professional engineer regist~ied in the State of
Florida pric1r to perlli t issuance.
A per~it issued shall be construed to be a license to proceed with the "ory. and not as authority to violate, cancel alter, ~r
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official fro~ thereafter
requiring a correction ~f errors in plans, construction, or violations of any code. Every permit iSSlled shall bec~ae invalid
unless the work authorized by such permit is cOlll~enced within six months of issuance, or if Hork authorIzed by the perait is
suspended Dr aband~ned for a period of six lonths after the time the HOry. is commenced. One 90 day e:te~5joll of tiae, lIay be
allowed for the per~it with fee charge of $15.00. The extension shall be requested in Hilting to the Building Official. An
approved inspectie,n r"ust be lcoggedduring each six 1II0nth period, Dr the pr~ject l'Ii II be ce'nsidt?Ted tlbaiide,ned.
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 YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
:~G:A::R~E~;4;~~_ ~~:TI:~G:~TU~_~~__~ ()
~ER 0 A ENT'~ ~- . . CONTRACTOR ~
DATE_____~~-~1':_Qf---------------------- DATE____O~~j{~52~--------------------
NOTARY AS TO /._ . Il .. r tJ.. _. J.:--.J J
OWNER OR AGENT~_~_~~-----
Notary Public. State of Florida
MY COMMISSION EXPIRES_~~~~A~!~19n
Bonded Thru Troy Foin -Insurancelnc:.
NOTARY AS TO Ie- - I'l \ r 11 . (~J
CONTRACTOR_~_-hL_~----
Notary Public. State of Floridcr
MY COMMISSION EXPI~~~~~~~~~r,1993
landed Thru Troy fain -Inwran..lne.