HomeMy WebLinkAbout92-2077
BUILDING PERMIT
Permit
207'1i5
1-:1 Y-9:2w
CITY OF ZEPHYRHILLS
(813) 788-6611
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Date
c9 EL~ PL~
Pcop,rty Own'" ~ ^-~ ~ L ,'Q:" dA -
Job Address: ~~
Parcell.D, #
Zoning: Energy Code:
Description of wo-;;;- .i( ~ ~.A.
M~L
Sewer Conn
Water Conn:
Water Meter:
T,I,F.'s:
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee ~ <-; trD
SignatUre ?1-(~~ c-cJ .': .2(}~~~
Company
Address
Telephone#
Valuation or
Contract Price
/;--0-0.
-'
cr-o
City License Registration # iQ. ~y
State Certified License#
m~-J ~ )J~A~4
~UILDING~ -==::>
Ftr. Tp. Servo
Pre SLB Rough In
Lintel Meter Can
EL~AL
------
.~
~
M~NICAL
-------
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Const. Pole
Pool
Pre-Meter
Final
FRM.
Insul. CL
WL
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a, Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT ~ +- ~ u
ADDRESS ~ / V0 C~
2lfmE
JOB LOCATION f;'lJ.mG (f)oh S ,Cd <2
~ k<-~,
C7
PHONE
/:Yf~-$(~R
OWNER
LOT SIZE
x
AREA SQ.FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I. D. #
WORK PROPOSED:_New Construction ----Addition ----Alteration _Repair _Install
_Sign/Temp.
_Sign
_Move
_Demolish
PROPOSED USE: _Single Family
~/F
_~~ of Uni ts
__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.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
_MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
BUILDER
~w~
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
******************************************
(;2< ~ Cf
Signature
SilIDature
Company
State Cert. or Regist. #
City License Registration #
******************************************
ELECTRICIAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
PLUMBER
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
MECHANICAL
Signature
Company
State Cert. or Regist. #
City License Registration #
OTHER
Signature
":* *** * ** * * *****~/**** * ***:-* ** * * * * * ** * * * * *
APPLICATION AP".R;:D B~_'?;!~1- .'><J....L~'r
. f!i..".' . ~>\:
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PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this per.it '.ay be subject to "deed restrictions" which .ay be .ore restrictive than City
regulations. The undersigned assu.es responsibility for co.pliance with 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 with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor .ay be
cited for a .isde.eanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
require.ents .ay apply for 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 contractor!s) sign portions 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 .ay be an indication that he is not properly 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 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 Depart.ent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
"owner", I certify that I have obtained a copy of the above described docu.ent and pro.ise in good faith to deliver it to the
"owner" prior to co..ence.ent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infor.ation in this application is accurate and that all work will be done in co.pliance with all
applicable laws regulating construction, zoning, and land develop.ent.
Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no work or
installation has co..enced prior to issuance of a per.it and that all work will be perfor.ed to .eet standards of all laws
regulating construction, City codes, zoning regulations, and land develop.ent regulations in the jurisdiction. I also
certify that I understand that the regulations of other govern.ental agencies .ay apply to the intended work, and that it is
'Y responsibility to identify what actions I .ust take to be in co.pliance. Such agencies include but are not li.ited to:
I Depart.ent of Environ.ental ReQulation - Cypress Bayheads, Metland Areas and Environ.entally Sensitive Lands,
Water/Wastewater Treat.ent
t Southwest Florida Water "anaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I Ar.y Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Depart.ent of Health l Rehabilitative Services. Environ.ental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
I US Environ.ental Protection AQency - Asbestos abate.ent
I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "co.pensating volu.e" will be sub.itted which is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance.
A per.it 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 per.it prevent the Building Offici.l fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every per.it issued shall beco.e invalid
unless the work authorized by such per.it is co..enced within six .onths of issuance, or if work authorized by the per.it is
suspended or abandoned for a period of six .onths after the ti.e the work is co..enced. One 90 day extension of ti.e, .ay 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 inspection .ust be logged during each six .onth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COKKENCE"ENT KAY RESULT IN YOUR PAYING TWICE FOR IHPROVEKENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUlT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COKKENCEKENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COKHENCEHENT".
SIGNATURE: OWNER OR AGENT
~ .e_ ~~___g___fJ~gfl~~-_-----
~~~~ONTRACTOR
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(Signature)
~~~~~YO~FF~~~~~~~~_________________________
The foregoing instrument was acknowledged
before me this __~~~~~~-, 19~~__ by
_~lf~~~~_~~!~~~~!________________
who is personally known to me or who has
produced _______~_______________________
as identification and who did/did not
~ta~ -:~~:~G.?~-~---------------
(S"gnature)
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(Name Typed, Printed or Stamped)
NOTARY PUBLI C
JAMES A. STONe
Nor., P\Jblic. State of FIortfa
My comm. expires May 16, 1995
CC110274- ,
STATE OF FLORIDA
COUNTY OF ____~~~~_______________________
The foregoing instrument was acknowledged
before me th i s S1..I1..~_ii!..LJ.._, 19 _'t.J:_ by
----------------------------------------
who is personally known to me Dr who has
produced _______________________________
as identification and who did/did not
take an oath.
-----------------------------------------
-----------------------------------------
(Name Typed, Printed or Stamped)
NOTARY PUBLI C