HomeMy WebLinkAbout92-2091
BUILDING PERMIT
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CITY OF ZEPHYRHILLS
813) 788-6611
Permit
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209W
Date I -:.,~ 0 - 9 ~.......
Sewer Conn
Water Meter:
T,I.F.'s:
Zoning:
FINAL 'L-Z - 2-
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
C.O.
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Permit Fee
Signature~'\ln,-'" (S:L
Company
Address
Telephone# 'l~ ~- tl/~ /9
Inspector
Valuation or ,..,. 6. - . P<J
Contract Price i Q-o
City License Registration # ,~ 2..
State Certified License#
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Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Brea
Ducts Insl.
Compressor
Final
F .
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
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.
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APPLICATION FOR PE~lIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
ADDRESS
PHONE
OWNER
JOB LOCATION S ,Rv 'l.. -43o(
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D. 4F
WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair
~stal1
_Sign/Temp.
_Sign
_Move
____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.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
-(' MECHANICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
.Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
******************************************
BUILDER
Signature
SiQnature
Company
State Cert. or Regist. #
City License Registration #
******************************************
ELECTRICIAN
Company
State Cert. or Regist. #
City License Regisiration #
******************************************
PLUMBER
Signature
MECHANICAL
Signaturer}<~ A.
. Company N~ \2- S', )\<~:) ~T
\:) __~ State Cert. or Regist. 4F
\j<~~..,) City License Registration #
******************************************
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Company
State Cert. or Regist. #
City License Registration #
OTHER
Signature
****************************************~*
, ,
APPLICATIq~ A~PROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlitlay be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay 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 lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furtherlore, 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 lay be an indication 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 Construction Lien LaN - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all Nork will be done in co.pliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby tade to obtain a pertit to do work and installation as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended Nork, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not Iilited to:
f Departlent of EnvironlentaI ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Departlent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environtental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit 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 perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pertit issued shall becole invalid
unless the work authorized by such perlit is cOllented within six lonths of issuance, Dr if work authorized by the perlit is
suspended or abandoned for a period of six tonths after the tile the work is cOllenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing tD the Building Official. An
approved inspection lust be logged during each six tonth period, or the projert will be ronsidered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COM"ENCEMENT "AY 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
CO""ENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
Ih1Wo/1-(J~ Q~~. Q~
SIGNATURE: CONTRACTOR
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SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA ~ (\ h
COUNTY OF f\5\..L1
The foregoing instrument
befc.re me this \ '- 30
was ~knOWledged
, 19 ~y
f(\f\V\ ~
who is personally known to me or who has
produced .,J) ~lU:::>. ~()WL.S~GG
as identiflcation and who did/did not
t~~:;~ /)O)an~
(Signatu~e).\ '\ _ 0'\1"\ \.
\-.D l'-'Nf\ 'J. _P\ ~~b\~'-J~
(Name Typed, Prjnted or Gt6~ped)
NOT R PUBLI -~-
\)R~ \ ~~
1).
STATE OF FLORIDA () ~C' (\ ("\
COUNTY OF r " lV '-V
The foregoing instrument
befc.re me this \ - '30
\o'Jas a~no\o'Jledged
, 19~y
lJ)
Pe-tLb
me or who has
A,
.::s. fi~{)\Z;R-~-
NotarY PublIc, StIle of FlorIda
My Commission ExpIr8I Slpllmber VJ, 1993
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