HomeMy WebLinkAbout91-1621
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
Permit X~
1621 L::
Type of Permit
B~ ~ECT'RICV
Date~7- 3 - 7'/
~..
MEC~
prOperlyOwners~ame c/d~ (~~ xJ~J~J
Job Address: --S ~ 0 b .. J 7~J
SUbDi~~ Lot,~; _Lj
ZoningCI: L/ -~d-./ /d-/ -:!j ~ ":!;Z
Description of VVork ~, :rJ ,:) . r~-:' +- ~ . .. 4.~
Legal Description:
Energy Code Readout:
l+ 1-J'~ I&.:~
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost:
AI I'A-
/
Fee:
"-
SIGNA TURE
COMPANY
ADDRESS
TELEPHONE #
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances.
OCCUPATIONAL LICENSE # /.:-5>'-7 ;;gJ~ ~
t:f:[ ~/
ELECTRICAL'
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
MEC~AL
......
stm.o 11\1 ~
~S=r
PLU
SLB
Tub Set
VVater
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul.CL
VVL
Breakers
Ducts Insl.
Compressor
Final
Driveway
Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of teu f$'I.QO)
dollars shall be made for each ~.T r--a-. d. e... (/ s: tl?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.
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APPLICATION FOR PERMIT
CITY OFZEPHYilllILLS
BUILDING DEPARTMENT
APPLICANT
AllL
~e
ADDRESS
PHONE
OWNER Bl~~Y'Z:: '
JOB LOCATION 0 . {(BiJp
UvY\.L+" .E
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
PARCEL I.D,{~~ IJ~
BLOCK/ell
SUBDIVISION
WORK PROPOSED:____New
I t!'--J S - V
1.0
Construction~Addition
/ /~ r9- G -- c9-/
~Alteration ____Repair
____Install
____Sign/Temp.
_Sign
__~love
____Demolish
PROPOSED USE: ____Single Family
_M/P
--,--f~ of Uni ts
.____~l/ H
____Commercial
~Indust,
____Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square feet,
Height
RESIDENTIAL:
COmlERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOR~IS. ,~*
**COPY OF CONTRACT REQUIRED,
PRRMITS RROURSTED
____BUILDING
$
Valuation of Total Construction
____ELECTRICAL
AMP Service
Florida Power Corp.
_H.R.E.G.
____MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBIN'G
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
_F'ram~ ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT,
******************************************
Signature
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration i~
******************************************
BUILDER
Company
State Cert. or Regist. 0
Cit;.y License Registration il ~
************************************
Signature
Company
State Cert. or.Regist. #
City License Registration 0
******************************************
PLUMBER
SignatuFe
Company
State Cert. or Regist. 0
City License Registration 0
******************************************
~IECHANICAL
OTHER
Signature
Company
State Cert. or Regist. 0
City License Registration a
**********************************~*******
PERl-lIT OFFICER.
APPLICATION ,APPROVED BY
,'f
~
, . .. :,,:, ,
."'"
..
CONDIT,IONS OF PERMIT AFFIDAVIT
A". NOT r Ce: OF De:e:D Re:STR I CT IONS ;', , . '
The underslgnad underslinds that this plrllt lay bl sub3ect to 'deed re5trlctl~ns' which ~ay b~ a~r~ res'rlctlve than City
regulations. The unde~slgned assules re,pons1blll', for cOlpliance with any applicabl~ deed restrictions.
.:. I :'~"',',. .. .,', ,
B. UNLIGENSED CONTRACTORS AND CONTRACTOR RESPONSJ:BILITIES
..'",:"
If the owner has hired a contractor or contractors to ~ndDr~ake wor~, they ~ay b& r~qu\red to be licensed In accordance with
state and local regulations, If tht contractor 11 not Ilc:i!f\1C!d as rt.quircd by law, both tbe ~\fner :arld'co,ntracteor nay be
cited for iI Ilsdueanor violation under state lall,-, If the Clllner 'or intended cContrad(.r arc uncert~ln asto what licensing
requlreaents aay apply f(or the intended work, theY are advis:?dto cClntact the City clf Zeph~th'ill!i.\~uildlng Departeent, (813)
7813-6611. ' . ',',
Furtheraore, 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 ~wner sign i1S the contractor,
you are indicating that you, rather than the contractor, are responsible for the wor~. If the contractor wishes you to sign
as contractor that aay be an indication that he is not properly licensed and Is not entitled to per&ittlng privileges in the
City of Zephyrhllls.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D.
CONSTRUCTION LIEN LAW
(CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I cedify that I, the applicant, have been providedwlth a copy of 'Flc,rida's CClnstruclion Lien Lali - HC.Deoliner's Prc,teclion
Guide' prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is so~e(.ne other than the
'owner', I certify that I have obtained a copy of ' the above described document and promi~e in good faith to deliver it to lhe
'owner' prior to cOi~encement,
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work Hill be done in co~pliance with all
applicable laws regulating construction, zoning, and land develop~ent.
Application is hereby .ade to obtain a ~er.it to"do Mork and installation as indicated. I (ertify that no work or
Installation has cO&lenced prior to issuanct of a perlit and that all work Hill b~ perfor~ed to ~eet standards of all laws
regulating n.nstruc:tic,n, CHy c(,des, zoning nigulations, and land develclpl!lent, requlatic.ns in the jurisdic:ticon. I also
certify that 1 understand that the regulations of other governmental agencies ~ay aoplv to the intended liorK, and that it is
fJY responsibility to identify what actions 1 aust'take to be in n.mpliance. Such aqencies include bllt ~1 e 1i(lt li,lited to:
I Departsent of Envir'onl!ental ReQulation - Cypress Bayheads, Hetland Areas and Envirclnmentally Sensitive L~ilds,
Water/Wastewater Treatment
I Southwest Florida Hater ManaQeftent District - Wells, Cypress Dayheads, Hetlano nreas, hltering HatercOUfses
I Army CorDS of Enoineers - Sealialls, Docks, Navigable HaterNays
I Departaent of Health L Rehabilitative Services. Environmental Health Unit - W~lls: Wa!i.teHater Treat~en~. Septic Tanks
I US Environ~ental Protection AQenc~ - Asbestos abatement
1 also certify that, if fill lIatr:rial is to'be used in Fl(ood ZClne "A" or 'A,etc,', it is understc'(ld t,,~t a drainage plan
addressing a 'colpensating volule" will be subtitted which is prepared by a profcS!i.iDnal engineer registered in the State of
Florida prior to permit is!i.~anc~.
A per~it issued shall be construed to be a license to proceed with the work and not as authority to yiol~te, cancel alter, Dr
set aside any provisicofls of the technical codes, nor shall issuance ()f a "pl~rmi t prevent the Bui Iding Official fre." thereafter
requiring a correction (,f erTe,rs in plans, cconsnucticln, or violati~ns clf any. qo!l~~ Every per"ilit issued ohall bec'oae invalid
unless Ute lioTk authorized by such permit is cDIUlenced within six months of issua'Dce, ,.r it' ,iOlk authMj,ed bi the perlit is
suspended or abandconed f(.r a perlcld c.f six tonths after the tillle the;llotk is {:Mlmcl1ced.pr;e 9(;.da)' l'~lt,;o;i'<11 c.r tiae, aay be
allowed for the per~it liith fee charge of $15,00, The extension shall b~ requested in ~iitinq 16 the Building Official. An
approved Inspecticln I'mst be lc,ggedduring each six Mnth period, (If the protect Hill be [(.nsider"d dbaildc.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 LE DER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENC NT. J UNDER $21500 IN VALUS
DO NOT NEED TO RECORD AND POST A "NOTIC 0 CEMENT".
SIGNATURE_11J~_-- (J -~- -~ --
OWNER OR AG~~----- CONTRA
DATE_____SZ:-~-=_1-1----------------------
DATE 2-"">- q I
------- --~----------------------
NOTARY AS TO . It, /J. '
OWNER OR AGENT_~_~k~~~
Notwy PuIIIf. Stott .. flarklll
MY COMMISSION EXPIRES__~~~!~~~J!g~-~JId
........ TllfV Tf01 FolIl......_ ....
~~~~~~C~~~~~_;b::~~L~~-
MY COMI'1I 55 ION EXP I RMyE~(__=~!.G!'_~!f!rjlIL-
amm Expires Oct. 9. 19"
"114'; "'"' Tf01 fain. In......_lnc,
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