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Home My WebLink About91-1612 ---- STATE OF FLORIDA City of ZephyrhiIIs PASCO COUNTY BUILDING DEPARTMENT 1-813-788-6611 Permit N~ 161211 Date 1(;' -,-2;; -9/ Type of Permit ~rc;N~) ,,- E~ PL~ M~CAL Property Owners Name: Job Address: --':;-3 d-. (, ~~~J~ AO~ ~~ Le~ -P- Legal Description: Sub.Div. Lot Blk. Zoning CI: .~) .J Dese ri plion of Work;or.d2 .A ""} , Energy Code Readout: Estimated Cost: '- j U7;J. cr7) <t 2--Dr q. f O~p Complete Plans, Specifications and Fee Must Accompany Application \. Fee: 0 - o-zJ SIG NA TUR~ ~_~~-)l;;)/2'~~'-l ~ COMPANY ADDRESS TELEPHONE # All work shal! be performed in accordance with the above and all City Codes and Ordinances. \ OCCUPATIONAL LICENSE # tf:~ ~~~~ Ftr. Pre SLB Lintel FRM. Insul.CL WL --- ~AL --------- Tp.Serv. Rough In Meter Can Const. Pole Pool Pre-Meter Final ~NICAL ~. Breakers Ducts Insl. Compressor Final Driveway Relnspect/ons: When extra inspection trips are necessary due to anyone of the following reasons. a charge of~ ['14106) dollars shall be made for each tcip./'rd.-de. (1-6-: t7?J) (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. APPLI'CATION 'FOR PERMIT CITY OFZEPHYRHILLS BUILDING DEPARTMENT APPLICANT f-- /~~ V~~,2,.~ ADDRESS (..r/ 33;2~. P ~~ . ..v-- v PHONE OWNER ~~~ J 0 D LO CA TI 0 N .4.--4<'/l--rL52.._ LOT SIZE x AREA SQ. FT. LEGAL DESCRIPTION: LOT(S) PARCEL 1. D. f~ BLOCK ,.--. SUBDIVISION WORK PROPOSED:____New Construction____Addition ____Alteration v- __Repair ____Install _Sign/Temp. _Sign __~love _Demolish PROPOSED USE: ____Single Family ____M/F ____# of Units _____H / II _Commercial ~Indust. ____Swim. Pool Other _Restaurant & Health Department Approval Height BUILDING SIZE: ~-x.- Square Fee t, RESIDENTIAL: CmfrlERCIAL : ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.** ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORl-IS. ** **COPY OF CONTRACT REQUIRED. pERMITS REQUESTED ~BUILDING $ ~o- tV. c~. Valuation of Total Construction _ELECTRICAL AMP Service Florida Power Corp. _H.R.E.C. ____MECHANICAL $ ~ .-:-N~\:latiQ!~:_5~~e clla n i c a 1 /(~ ;>" GAS ~. E?~ RO~ Installation _PLUMBIN"G SPECIALTY TYPE OF CONSTRUCTION: ____Block ____Frame _Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** CONTRACTOR SECTION Company State Cert. or Regist. 0 City License Rcg'istratinn t~ ****************************************** BUILDER Signature ELECTRICTAN Company State Cert. or Regist. n City License Registration U ****************************************** Sipnature Company State Cert. or.Regist. !~ City License Registration 0 ****************************************** PLUMBER Signature Company State Cert. or Regist. 0 ,City License Registration 0 ****************************************** MECHANICAT" Signature Company State Cert. or Regist. 0 City License Registration 0 OTHER Signature APPLICATION APPROVED nY:~;::~'*~::;:;:'~'*":'*'********* PO~IIT OFFICOR. ""ii-., CONDITIONS. OF PERMIT AFFIDAVIT A.': NOT T CE OF DEED RESTR I CT IONS ;', ... Tht undtrsigned undtrstinds that this plrlit lay bl subJlct to "deed restrlcti~ns" which ~ay ba sore rts,rictlve than City regulations. lht undD~slgned essuleS responsibili'~.fo~ co.pliance with any applicable deed restrictions. .:" I.:" ," I ~.' . .. . ~ B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES ;.....,.... If the owner has hired a contractor or contractors to undertake wor~, they lay be required t~ be licensed in accordance with statt and local rtgulations. If the contractor is not licensed as required by law, both the OHner and contractor ~ay bt cited for a aisdeaeanor violation under state laK.', If the ~wner ~r intended c~ntract~r are uncertain as to what licensing requireaents aay apply fe.r the intended Hork, theY are advised to cc,ntact the City elf Zephyrhills Building Departeent, (8131 788-(,(,1 \."" Furtherlore, if the owner has hired a contractor 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 w~rt. If the contract~r wishes y~u to sign a5 c~ntract~r that Day be an indication that he is not pr~perly licensed and is not entitled to per&itting 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 certi'fy that I, the applicant, have been provided Kith a copy of "Flc.rida's C[.nstruction Lien Law - He,aeowner's Preltection Guide" prepared by the Florida Departlent of Agriculture and Consumer Affairs. If the applicant is SO!EOne other than the .owner", I certify that I have obtained a copy of.the above described document and pro.15e in good faith to deliver it to the "owner' prior to cOi~encement. E. CONTRACTOR'S/OWNER'S AFFIDAVIT 1 certify that all the information in this application is accurate and that all Mort Mill be done in co~pliance with all applicable laws regulating c~nstructi~n, zoning, and land development. Application is hereby fiade to obtain a ~er.it lo'do work and installation as indicated. I certify that n~ work or installati~n has c~&!enced priDr to issuance of a perlit and that all w~rt will bn performed to ~ect standards ~f all laws regulating Cttnstrudie,n, City ct.des, 20ning re'gulati~ns, and land devele,prnent. regulatie,ns in the jurisdictie.n. I also certify that 1 understand that the regulations of other g~vernmental agencies ~dY apply to the intended work, and that it is /lY resp~nsibility to identify lIhat actions 1 must'tate to be in c('l1lpliance. Such agencies include bllt ~l e IiCII I i'li ted trJ: I Departlent of Envir~noental ReQulation - Cypress Bayheads, Hetland nreas and Environmentally Sensiliv~ L~nds, Water/Wastellater Treatment I Southwest Florida Ilater ManaQe~ent District - Hells, Cypress Bayheads, Hetland Areas, Altering Haterc~urses I Army Coros ~f Enoineers - Seawalls, DrJcks, Navigable Waterways I Departaent of Health L Rehabilitative Services. Environ~ental Health Unit - W~lls, Wastewater Treat~~n~. Septic Tanks I US Environaental Pr~tection Aoency - Asbestos abatement. 1 also certify that, if fill material is to be used in Flc,~d ZClnl! "A" or "A,etc.", it is underste,[.d t,,~t a drainage plan addressing a 'colpensating volule" will be subJitted which is prepared by a professional engineer reqisl~ied in Ihe State of Florida prior to permit iS5u,ance. A perlit issued shall be construed to be a license to proceed with the work and not as authority to yiol~te, cancel alter, or set aside any provisi~ns Df the technical codes, nor shall issuance of a permit prevent the Building Official fro~ Ihereafter requiring a correction of errors in plans, construction, or violati~ns ~f any code. Every per~it issued ~ha)1 bec~.e invalid unless the work authori2ed by such permit is cO/l~enced within six /I~nths of issuance, Dr if UDlk authorIzed by the perait is suspended or abandoned for a pl!riod of six lonths after the till! the Mort is c~~menced. One 90 day e:te~5iDII Df til!?, Day be allowed for the per~it with fee charge of $15.00. The extension shall be requested in writIng to the Building Official. An approved inspedirln l!Iust be IClgged 'during each six IIDnth period, Clr the pre,jed \.,ill be ((.nsidered ~b,;Hd[.rl;;d. 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 DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". 51 GNATURE~:_:~--_&~~---- OWNER OR AGENT n DATE_________~~-~~ri~!!------------- 11 ~e~~~yO~SA~~NT_~~~~-~~------- MY COMMISSION EX ~~*~T~~--------------- ~;/ ;.:.. >. c g~Tf i'c. ~:/1\';0:i ~ .::; OJ LHIJ <J SIGNATURE~~--~~-~~-- CONTRACTOR DATE_____~~~~~-~y(-LY~~------------- 1/ ~~~~~~c~~n~~__'1l;"Q"-~cf~-f------ , MY COMmSSIOI'l EXP1RES__________________ l'.::~\~i~ ;:. r.: ''! l'~ ~':y ~.'::\ ~r ;",!,-:, :~ i <J. - 1:"l;_\ ,;'+ .",;;'" iJ:;" ~