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Home My WebLink About91-1913 STATE OF FLORIDA City of Zephyrhills PASCO COUNTY BUILDING DEPARTMENT 1-813-788-6611 Permit X~ 1913 f1 Date /J - , .- 9 / Type of Permit -8UILnING - I:.LECTRICJ~L ~ GCHA~ Property Owners Name:]? ~ AT Job Address: ~ 1r 0 d- ~ _.-/~ ~ J... UL Legal Description: Sub.Div. Zoning CI: / / - ;).. b .-..,;L J .- 0 0 0 () Description of Work'-- ~.:; -f ~r"..,j h ~ Lot Blk. oo~ov- 0000 ~~d~~~ ~~ /.J- /S-- 9e:L ~ Energy Code Readout: Complete Plans, Specifications and Fee Must Accompany Application Estimated Cost: ~ All work shaH be performed in ac~r nce with the above and all City Codes and Ordinances, OCCUPATIONAL LICENSE #S31 PL SLB Tub Set Water Sewer Final Ftr. Pre SLB lintel FRM. Insul.CL WL Driveway Fee: :2 0 ," criJ SIGNATURE / ~ COM PAN? ADDRESS TELEPHONE # ~~ Tp.Serv. Rough In Meter Can Const. Pole Pool Pre-Meter Final Breakers Ducts Insl. Compressor Final Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten ($10.00) 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 PERl-lIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT ,{ - t:i ~ APPLICANT ,." 4./> , OWNE?---. I #__P-<:7 . ~~ JOB LOCATION 3xOZZ j/~L .;~. PHONE s-~ /" ~5S/0 ~ LOT SIZE_____~ AREA SQ. FT. LEGAL DESCRIPTION: LOT(S) PARCEL 1. D .IF (1VUu- DO;)' Do -DDDD BLOCK SUBDIVISION I L{ -ab -~I /Ins tall WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ____Sign/Temp. ____Sign ____Nove ____Demolish PROPOSED USE: ____Single Family ____M/F ____i~ of lIni ts _____rl / H ____Commercial ____Indust. ____Swim. Pool Other ____Restaurant & Health Department Approval BUILDING SIZE: ?/-l0 X~, Square Fee t , Height RESIDENTIAL: COMMERCIAL : ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FOR.l-J.S. ** ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORNS. ,~:* **COPY OF CONTRACT REQUIRED. PERMITS REOUESTED ____BUILDING $ Valuation of Total Construction ____ELECTRICAL ~CHANICAL AMP Service Florida Power Corp. _____h' .R. E. C. $ Valuation of Mechanical Installation _PLUMBING GAS R'V-'PTT\T(' \,VVJI. ..I...L.1....... SPECIALTY TYPE OF CONSTRUCTION: ____Block _Frame ____Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** CONTRACTOR SECTION} ~~ - ~ Company . ~lifLA4f. ~ ~ State Cert. or Reg's t .' iF tZ' ~ --:> City License Registration 4~ ****************************************** BUILDER Signature Si!:!nature Company State Cert. or Regist. 0 City License Registration 0 ********************************~********* El.ECTRTCTAN Company State Cert. or Regist. # City License Registration 9 ****************************************** PLlIMBFR Signature MECHANICAl. Company _J/...I'/~;~ 4/ 4:~ A &. S ta to Cert. or R "is t, i! --'22' . -n',-M /-r ;> Signature/ / y~~;;::************~:;~*:~~:~~~,.,~~~~~;~:~;~~:~'~ S- 3/ Company State Cert. or Regist. 0 City License Registration, OTHER Signature APPLICATION APPROVED BY *~~.,~~****~******~****~~*~~*~~~~~~~~~~~~b~ 71;~~ -~~;'.~~' ... ,.",.. PERmT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed restrictions' which may be mDre restrictive than City regulations. The undersigned assules responsibility for co~pliance with any applicable deed restrictiDns. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the Ollner and contractor ~ay be cited for a ~isdeleanor violation under state law. If the owner or intended cDntractor are uncertain as to what licensino requirements may apply for the intended work, they are advised to contact the City of Zephyrhills Building Department, (8131 7BB-bbll. Furthermore, if the ollner has hired a contractor or contractors, he is advised to have the contractortsl sign pe,rtions of the 'Contractor Sections' of this application for which they will be responsible. If you, as the owner 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 te' 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 - Homeowner's Protection Guide' prepared by the Florida Departlent of Agriculture and Consumer Affairs. If the applicant is so~eone e,ther thon the 'owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the 'ollner' prior to cOimencement. E. CONTRACTOR'SIOWNER'S AFFIDAVIT I certify that all the infor~ation in this application is accurate and that all wor~ will be done in cOipliance with all applicable laws regulating construction, zoning, and land developlent. Application is hereby made to obtain a per.it to do work and installatioD as indicated. ] certify that no work or installation has comreenced prior to issuance of a per.it 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 may apply to the intended work, and that it is flY responsibility to identify what actions I must take to be in c[llT'pliance. Such agencies include bll! ~I e ;,[,l li'lited tel: I Department of Environmental Reoulation - Cypress iayheads, WeLiand Areas and En~ir0nlentalli Sensi tjj~ ldnds, Water/Wastellater Treatment I Southwest Florida Water ManaQe!ent District - Wells, Cypress Bayheads, Wetland Areas, Aitering WatercDurses I Army Corps of EnQineers - Seawalls, Ducks, Navigable Waterways I Departient of Health L Rehabilitative Services. Environmental Health Unit - Wells, Wastewater Treat~en~. Septic Tan~s I US Environeental Protection AQency - Asbestos abatement I also certify that, if fill Jl:aterial is to be used in F!c1cld ZClne "A" or "I\,etc.", it is undl'rs,te,od lio,,( ~ d'ainage plan addressing a 'colpensating volu~e' will be submitted which is prepared by a professional engineEr reglste;ud in the State of Florida prior to permit issuance. A per~it issurd shall be construed to be a license to proceed with the work and not as authority to ,ioj~te, cancel alter, or set aside any provisions of the technical ((Ides, nor shall issuance elf a pl!rmit prevent the Building tJff;ci~1 fl('1Ii thefeaftel requiring a correction of ernrs in plans, ((Instruction, [lr vicolatie,ns of any codc,. Every peri!lit iSSIIl!d "hall beC(dlie in'lalid unless the wClrk authclri2ed by such permit is cC'llilllenced within six illonths elf issuance, or if \'I[,ry. aut!,!.. j,eC h)' the per~it is suspended or abandoned for a period of six lonths after the time the ~ork is commenced. One 90 day f=te~5ID" of ti&e, may be allowed for the per0it with fee charge of $15.00. The extension shall be requested in writing to thE Building Official. An approved inspection roust be logged during each six month period, or the project will be considered dbdl,doned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERfY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN A1TORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED _ _______)D__; 7!_?_P_:_S_T__,_, _____ CE OF COMMENCEMENT". SIGNATURE OWNER ~~~ SIGN~T~~_________ DATE______~~~_~~_~~_____________________ DATE__~~:~~~~~________________ ~~~~:YO~SA~~N~_~----- NOTARY AS TO /' } :-J-' I J J' ..;, CONTRACTOR_____~-~-- MY COMMISSION EXPIRES______________________ C Nota'! Public, Stat. 0' Fforief<t"'l My Comrmssicl'l E:z;;J;l'!; fJ,;'J. :n, ~1J9'" Bonded Toru TrOt' r\Ji;1 . :'...,ct:r\~;:.~~-~~,~::, .- MY COMMISSION EXPIRES NOTARY PUBLIC, 51' A TE- of' F'COlffn.!\. - - -- MY COMMISSION EXI');n'S: N"v. 19, :\~H. BONDED THRU NOTARY Pl.LaUC UNUEHWrllfERS. ~ \}. ~ ~ 4- ~ ~ ~ uJ ~ ( l~ s: ~ ~if' .:s ~ J 1'~~:'!.~:;m;;i::;:~~'Xlr~jf~~:;:~::::;::~:; Iii !, :j Hi; " 1:1 ;1 '\'" 1:11i'''' \ ,1.,1 ~ \.IW;, \-\ ~:l Ill'!] '1!1Ii jl;j'I\fI'l till -:" Ih,,, ",': 'i"i't,;iHIEif',;:ii';:, ~ IA ~~ I ~ j'i ',I Ii li!_n :; i'i'r"!ltw>; :: ii! iii " ": 'II :; 11'1 ii' :1 'Iii Ii! ", 'I "j d Ii ili II III Iii II iillll A t ~ ~,.., '''''":(1' " Y' ,(.:..., 1..1...1 "5'''' .1...... 11, I.... { ....., "::';'i ....", IJ...! Lt.! u::: !""'1 LL. -t.... .' t..... I.....! r:c '...."J i;"] J:'.1 (J] l.l" i ~':"'! .., l::1 ::":"::. I::.:....! !! L..l >1 iJ.! r:, ;:..:; ;)1'1 w'!' II, '.....i 'j'" .!.... 0::: 1 C....) i).! i iI" UJ Ll..l cq ~:f,.? ::,:!~ 1::::1 '(::1 ::;1:: ~E I.,.., 1"1'" 1:1:::1 C'~I :L :..;... I",) II.. (::i (j] Lt.l ::,1;; rT'J 1"',1 ,.,... (':i F:~ ul ;;' U.f ~,:..I ~8~ CONSTRUCTION INDUSTRY NOTICE OF ELECTION TO BE EXEMPT FROM THE PROVISIONS OF THE F~ORIDA WORKERS' COMPENSATION LAW MAIL TO: Department of Labor & Employment Security Bureau of W.e. Compliance 2728 Centerview Drive, 100 Forrest Bldg. Tallahassee, Florida 32399-0661 STATE USE ONLY POSTMARK DATE I~ PLEASE TYPE OR PRINT: This noticc shall be in effect tllr Iwo (2) years from the dkctive date of] - ;Jf)-q ( unli-;-r... ;26-'1~, or until revoked, whichever comes firsl. RE: ~.~~/2n1t V (~tng Address) J!AO.- LL-7' .,et. --J.jS:~- ~~~~839a 'ity) (State) (Zip) (Federal Ll1lployer Identification Numhen Nature of Business or Trade: ;C.?E: P9L.JIP~I'A/'T .f)~A.L~-X (D/B/A [I' Applieahk) /Z hW,1l:.F/l/CI!. ~D_ (Stn.'L't~ddn:ss. if dilkn.'lltl As of 12:01 a.m. 30 days following the date of the mailing of this form, you are hereby notified that the following Sole Proprietor, Partner or Corporate Ofllcer of the above named business does elect to be exempt from the provisions of the Florida Workers' Compensation Law. I understand that by this action I am not entitled to benetits under chapter 440, Florida Statutes, By filing this form I have not exceeded the exemption limit of three Partners or three Corporate Officers. I fUlther celtity that any employees of the business named above are covered by workers' compensation insurance, The following are the certified or registered licenses held by me pursuant to chapter 489 Florida Statutes (If none, so state): (I) Type: esr 07 Numbef'07t)9S"JDOOJ~;> (2) Type: 11'/ Number:O.l."''''9i.ot')l''lJ~1D INSURANCE CARRIER INFORMATION (If Applicable): A construction industry employer with one (I) or more employees must maintain Workers' Compensation coverage, Failure to comply will result in a lIve-hundred dollar ($500) fine and a one-hundred dollar ($100) fine for each day of noncompliance (see section 440.43, FS,), Name of Carrier Carrier Address Policy Number _EI'FEC]'IVE DATE Insurance Agent (Agency) Agency Address Signature ./ ~~ . Su,i,,' S,,,,,i.y Numb" OS""'-'I~-08:Y? Type/~ame Jfi'y~' gxow.!</'. --~-- Position: Proprietor ~/Partner _lor/Office; CTitk'i .(}:II.1./Ja'Ji'--- IMPORTANT: Individual exemption filing fe€, pursuant to Section 440.05, F.S" is seven dollars and fifty cents ($7.50) and is payable only by money order or cashier's check" to W,(:',:Admi!listrative Truet Fund. Failure 10 enclose fee will result in return of request and delay of certification, SWORN T~AN~ S~BSCRIBED BEFORE ME THIS AT A~() L( eet;:;, , FLORIDA.. '" _ ? t,u~/RY ..F'U~~~;r. ~ "jlr~ ~ r .. / };\. C:';"~lr,',,,,~ ,;~.(O.or ..U~;O~ "'~:'l' -. ,,:...' ", e',..,.. rL[.. " lr"5 U'.J.\ 'cu ',' 1,'.1 . ~-, 'rl"'.Il1 . . ::>'7, "'" ',L.C,;,.-,. 1.1.:5_ ;'I.;f~ DAY OF -{ -( ./ .,'-' / (" I', / ju (/~ / r ..._ '''- ~'-. r ~ _/:/. ._~. 1.., .' Notary Public. State of Florida My Commission Ex.pires: LES FORM BCM-204 (517191) . ST ATE OF FLORIDA OFFICE OF TREASURER DEPARTMENT OF INSURANCE TALLAHASSEE, FLORIDA FIRE EQUIPMENT Oe_LER LICENSE FM030Q2 HIS CE~TIFIES THAT: SECURITY FIRE EaUIPMENT CO 12 LA~RF:NCF. ROAD DADE CITY. FL 33525 AS COMPLIED WITH SECTION 633.061. FLORIDA STATUTFS. AND HAS QUALIFIED FOR THE YPE AND CLASS SHOWN HFREON: o SERVICE. FF:PAIR. INSTALL OR INSPFCT ALL TYPES OF PRE-ENGINEERED FIRE XTINGUISH ING SYSTE<'1S. Jo-~ 01 91 07 04 2:.'\ ~~?c ;: ,~:?,~,~.~o?o71-" 9~: '?o~'~ 00 2 12'5.00 ~~IIE GllTE TY.Pf:" r..1 AS~; r::OIiNTV CQtJEAt'l'L TREASURER 1 2 3 1 9 1 INSURANCE COMMISSIONER . _ EXPJAATlilli..., I:'DI: Mlll:::IC;,~I.HU