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Home My WebLink About91-1856 STATE OF FLORIDA City of Zephyrhills Type of Permit c2-eJ. tri) B~_~' PASCO COUNTY BUILDING DEPARTMENT 1-813-788-6611 do ' crV P~ ~A~~ Permit :N'~ 1856/1 Date / IJ - /6- - ? / Property Owners Name: ~A ~ ~!,L/L..2 Job Address: If!-~ 'If) ~ ,,~~ 5l ~. Legal Description: Sub.Div. 0 Olb 0 Zoning CI: / '! - ,2(? ~ l'l-I Description of Work 7/..;;.LAY Ale Lot 6/J:,o Blk. 0 E> C9 6' C~ Energy Code Readout: f-yJ.t II~U-tl} / dJ- Complete Plans, Specifications and Fee Must Accompany Application Estimated Cost: ~ b 7 0 - crD Fee. c<;-Oti: " ) ~ ~ SIGNATUR t;j~ c_ 8J2&C?'{Af--1....... All work shal! be performed in accordance with the above and all City Codes and Ordinances. COMPANY ADDRESS TELEPHONE # , OCCUPATIONAL LICENSE #1f.Y-b BUlL ~ Tp.Serv. Rough In Meter Can Const. Pole Pool Pre-Meter Final Ftr. Pre SLB Lintel FRM. Insul.CL WL Breakers Ducts Insl. Compressor Final Tub Set Water Sewer Final Driveway Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten (SIO.oo) dollars shall be made for each trip. (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. APPLICATION FOR PERI-lIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT APPLICANT 4 c ~ If e ff--I i -fl, r ~ ho{~ ~tv G . " ADDRESS Q)"l W. /lr1Plh1ortt').( a It'd. )f}~ei-l9l"j 1J}"OfpHONE (:fYJ) ~f>? 2. z.:J? OWNER Do;-o +A J} S (0 (17 dh-J JOB LOCATION '/(, $10 tfl-for c.e.. Sf 1. epiYki'rfLr 3JfY(OT SIZE_X AREA SQ. FT. 015....0 BLOCK~aQO<::) SUBDIVISION 0 j.Jo () LEGAL DESCRIPTION: LOT(S) PARCEL 1. D. ~~ WORK PROPOSED:____New Construction _Addition _Alteration _Repair _Install ____Sign/Temp. _Sign _Hove _Demolish PROPOSED USE: ---,-Single Family _M/F -~~ of Units .._M/H _Commercial _Indust. _Swim. , Pool Other IV.... J-..."- 1-./ _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 FORNS.** **COPY OF CONTRACT REQUIRED. PERMTTS REOUESTEll _BUILDING V ELECTRICAL V MECHANICAL $ Valuation of Total Construction AMP Service Florida power Corp. _W.R.E.C. $ / '7 rs.o 0 Valuation of Mechanical Installation _PLUMBING GAS ROOFING SPECIALTY -~ ~ . TYPE OF CONSTRUCTION: ____Block _Frame _Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** Signature ~ONTRACTOR SECTION Company State Cert. or Regist. ~ City License Registration ff /U2' 7!?}1i::;;":::::::';:'~';;~';:~:':':;~". _ p" c . State Cert. or Regi~t. i~ 1-:-500000(,/ City License Registration ifr (J/IItj <;'1 7 ****************************************** nllTLDER f,T.F.CTRTCTAN ~ Signature Signature Company State Cert. or Regist. 6 City License Registration ff ****************************************** (". Ii C- - J') 7.rF ~ PLUMBER Signature Comp:my lie e 17 e~h( ~R I~ ,+--r~;" ~~ State Cert. or Regist! ~fr C fJ.c. () iA/X(}j City License Registration 1.~ .. .............................*'.. Company State Cert. or Regist. ff City License Registration ff f/f'C, J ? 7J-~- C-y '3 llECIlANTC(: Signatur ~vU2/ Q'J'HER APPLICATION APPROVED BY ~************1:************************* , "-d ~"A~-W-- , PERMIT OFFICER. . CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS . The,undersigned understands that this per.it .ay be subject to "deed restricti~ns" which may be ~ore restr,ictive than City regulations. The undersigned assut'S responsibility~for cOlpliance with any applicable deed restrictions. 8. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a c~ntractor or contractors to undertake work, they lay be required to be licensed in accordance with state and local regulations, If the contractor il not licensed as required by law, both the owner and contractor May be cited for a sisde.eanor violation under state law. If the owner or intended contract~r are uncertain as to what licensing requirelents lay apply for the intended work, they are advised to contact the City of 2ephyrhills Building Depart_ent, (813) 788-6611. 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 "ill be responsible. If you, as the ~wner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that lay be an indication that he is not properly licensed" and is not entitled to per&itting privileges in the City of 2ephyrhills, 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 Departlent of Agriculture and Consumer Affairs. If the applicant is SOleone other than the 'owner', I certify that I have obtained I copy of the above described document and promise in good faith to deliver it to the 'owner' prior to cOIMencement, E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning, and land development. Application is hereby lade to obtain a perlit to do work and install~tion as indicated. I certify that no work or installation has cOllenced prior to issuance of a perlit and that all work "ill be performed to leet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental agencies ~ay apply'to the intended work, and that it is IY responsibility to identify what actions I lust take to be in compliance. Such agencies include but ~l e not limited to: '" . Depart.e~t of Envir~nlental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment . Southwest Florida Water ManaQelllent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses . ArlY Corps ~f EnQineers - Seawalls, Docks, Navigable Waterways . Departlent uf Health ~ Rehabilitative Services. Environmental Health Unit - Wells, Wastewater Treat~en~. Septic Tanks . US Environaental Protection AQency - Asbestos abatement I alsu certify that, if fill laterial is to be used in FlC.od 20ne "A" or "A,etc.', it is understoc,d th3t a drainage plan addressing a 'colpensating vulute" will be sublitted which is prepared by a professi~nal engineer reqist~ied in the State of Florida prior to perlit issuance. A pertit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, ur set aside any provisions of the technical cudes, nor shall issuance of a permit prevent the Building Official frOM thereafter requiring a correctiun of errors in plans; construction, or violations uf any code. Every permit issued :haII becole invalid unless the Mork authorized by such permit is coalllenced within six months of issuance, Dr if H~I'k authol Ized by the per_it is suspended or abandoned for a period of six lonths after the tiJe the wDrk is commenced. One 90 day e:tensiDII of tile, lay be allowed for the permit with fee charge of $15.00, The extension shall be requested in writing to the Building Official. An approved inspection lust be logged during each six month period, ur the project will be considered aballdoned. 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". CONTRA DATE__~-f:.~_!fr.Lfy. ~ /J NOTARY AS ,. ~' CONTRACTOR . _~- (~~~~-~~~ " Nota Public, Stott of Florida MY COMMISSION EXPIRE"~~~~~!~P~~_~~::3,1994 Bonded Thru Troy kJin" Insuranc\) me. ~ ~1' .1 . / .' . SIGNATURE_ __~__ _.' L_______ OWNER 0 AGENT DATE____~f:-j~LL-_j-'-/-_i-f2.!---.------- NOTARY AS TO-=1 i . (/~' /; OWNER OR AGENTZe-U~_~-' LLf&!::!:.~_"":..~L- Motary Pu lic, State of Florida MY COMMISSION EXPIRES~~~Wtij~JJ~~4 Bonded Thru Troy Fain. Insurance Inc. SIGNATUR APPLICATION FOR PER1'lIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT APPLICANT !Ie 4. f1 e +f-flf..e j-ftf(c/r- Y;tJC I ADDRESS q 2-3 U/. i111.L m or-r'n-L (J I rei. j nil.. e t.nAJ OWNER Dol"o f-~ 115/0 r It drd JOB LOCATION 'I" va )..&/01- c..(. [( J }yO! PHONE( 3'1 J/)' <0 P? - }... 2. ] Y '. LEGAL DESCRIPTION: LOT(S) PARCEL 1. D. ~~ lif - ~ 10- 'L ( Z-p~q^lt~ -':JJSY( LOT SIZE_X , CJ /5'0 AREA SQ. FT. BLOCK 00000 SUBDIVISION 0 J 6 0 WORK PROPOSED:____New Construction _Addition _Alteration ____Repair _Install _Sign/Temp. _Sign _Hove _Demolish PROPOSED USE: ____Single Family _M/F _~~ of Units ,._M/H _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 FORMS.** **COPY OF CONTRACT REQUIRED, FF.RM1TS REOUESTED _BUILDING ~ELECTRICAL $ g75.oa Valuation of Total Construction / )<5 AMP Service Florida power Corp. ~ 51)':0" _W.R.E.C. _MECHANICAL $ Valuation of Mechanical Installation _PLUMBING GAS ROOFING SPECIALTY TYPE OF CONSTRUCTION: _Block _Frame _Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** ~ONTRACTOR SECTION Company State Cert. or Regist. n City License Registration # ****************************************** lW1LDER Signature ::::::::::~.. _ K~ Company IJ c..e 17 Q ~ r~91l ,. If trot' .J: /~ G State Cert. or Reg1st. ~I [; s C) 000 0 ~ ( . . Ci ty License RegiS t ra t ion " y,/ 7 . ****************************************** Signature Company State Cert. or Regist. # City License Registration # ****************************************** PLUMBER Signature _ Company ~- ~~ State Cert. or Regist. ~F I h V/lJI City License Registration iF *** ***************'fd'******~'*****~ **1, Company State Cert. or Regist. # City License Registration # MF.\.HANTC~ Signatur /~~ DTHER ****************************************** PERMIT OFFICER. APPLICATION APPROVED BY CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTION~ The,undersigned understands that this perlit lay be subject to "deed restricti~ns' which may be lore restr.ictive than City regulations, The undersigned assu.es responsibility;for co.pliance Nith any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they .ay be required to be licensed in accordance Nith state and local regulations, If the contractor is not licensed as required by law, both the owner and contractor lay be cited for a .isde.eanor violation under state laN, If the ~Nner ~r intended contract~r are uncertain as to what licensing require.ents lay apply f~r the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, (813) 788-6611. Further.ore, 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 Nill be responsible. If y~u, as the ~wner sign as the c~ntractor, you are indicating that you, rather than the contractor, are resp~nsible for the w~rk. If the c~ntract~r Nishes y~u to sign as contractor that lay be an indicati~n that he is not properly licensed-and is not entitled to perlitting 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 C~nstructi~n Lien Law - Ho.eoNner's Protection Guide' prepared by the Florida Departlent of Agriculture and Consu.er Affairs. If the applicant is sOlec.ne other than the "owner", 1 certify that I have obtained a. c6py of the above described doculent and promise in good faith to deliver it to the "owner' prior to cO.lencelent. E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning, and land developDent. ' Application is hereby lade to obtain a pertit to do work and install~tion as indicated. I certify that no work or installation has COI.enced prior to issuance of a perlit and that all work will be performed to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental agencies ~ay apply' to the intended work, and that it is IY responsibility t{. identify what actions I must take to be in compliance. Such agencies include bllt ~l e m.l lillited lo: . ~.."'" I Department of Environmental ReQulation - Cypress Bayheads, Wetland Areas and Envirunmentally Sensitive L~nds, Water/Wastewater Treatment * Southwest Florida Water ManaQement District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses * Arty Corps ~f EnQineers - Seawalls, Docks, Navigable Waterways * Departlent of Health ~ Rehabilitative Services, Environmental Health Unit - Wells, Waslellater Trcat~en~, Septic Tanks I US Environaental Protection AQency - Asbestos abatement I also certify that, if fill laterial is to be used in FIt.od ZClne "A" or 'A,etc.', it is underst{.c.d that a drainage plan addressing a 'colpensating volule" will be sub.itted which is prepared by a professional engineer reqist~ied in lhe State of Florida prior to permit issuance, A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official frol thereafter requiring a correction of errors in plans; construction, or violations of any' code. Every permit issued :hall becole invalid unless the work authorized by such permit is CO.Denced within six months of issuance, ~r if work authol lzed by the perlit is suspended or abandoned for a period of six lonths after the tiae the work is cDmmenced. One 90 day e:tE~sioll of tile, lay be alloNed for the permit with fee charge of $15.00, The extension shall be requested in writing to the Building Official. An approved inspecti{.n JlIust be logged during each six lonth period, or the prc,jecl llill be cc.nsidered ilb.\ld{,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 DO NOT NEED I~ RECORD AND POST A "NOTICE OF CDMMENCEMENT"% ~ SIGNATURE__~~~-- SIGNATURE~__~~~ OWNER OR AGENT CONTRACTOR DATE__{Qdd~-Lt:/_L:l.2L____------ DATE_lPd~0-Ljr-.L2.YL_-____-- ~~~~:V o~S A~~N~U<-y_~~_d4f~ . ~~~~:~c~~_~'~c'_-d~~G Mota;:;~~te of Florida" r tfotary Public. Statt of Florida MY COMMi SSION EXP IRES_1Iy.!Jm:lmiui211~'p!!~j!P.!._,~!..!~4 MY COMMI SSION EXPIRES '" (~an-EllF!i~J8. 1994 Bonded Thru Troy Foin - Insurance Inc. IolI'ldfid Thru Troy f-.uir. . InsuranC5 Inc.