HomeMy WebLinkAbout92-2101
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788.6611
Permit
:Nt! 2101;8
~ -s -/;~
Date
C::~ EL~ ~
::::::,~':~d~;~ ~~~,. 0
Parcell.D. # ,? -.;Lb - ,;2/ - 13 -- 0
M~L
Sewer Conn
Water Conn:
Water Meter:
T.I.I=.'s:
Zoning: Energy COd:!)
Description of Work /S---X /---5,- fJ-e:...~
Radon Gas:
NO OCCUPANCY BEFORE C,O,
FINAL .
1....
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O,
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee~~
Signature_ ~ /11.
Compa~
Address
Telephone#
~
Valuation or
Contract Price .~ ~ -UZ;;. 0-0
City License Registration #
State Certified License#
0)/1 /Yl....P ../'\...-
CBU'LD~
Ftr.
Pre SLB
Lintel
FRM,
Insul. CL
WL
~AL
----
'PWMBING
--------
M~ICAL
~
Breakers
Ducts Insl.
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Compressor
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.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
t:d tf:A .
A J'- rB. a::
OWNER ~,..A J/J ~A.A. R--<4
JOB LOCA~ 3'7?' (J S- ~~) ~
APPLICANT
PHONE 7 %~ -- 79/:1
ADDRESS
LOT SIZE~X /~ AREA SQ.FT,
LEGAL DESCRIPTION: LOT(S) BLOCK
PARCEL I.D.# .5 - ~ 6 - eJ-/ - /:5 - 0
SUBDIVISION
WORK PROPOSED:____New Construction ~Addition ____Alteration ____Repair ____Install
____Sign/Temp,
PROPOSED USE: ~Single Family
____Sign
_Move
_Demolish
_M/F
____~~ of Uni ts
__M/H
_Commercial
_Indust.
_Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE: /-r X IS- , L9~
Square Feet.4~ ~ ~
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
i//BUILDING
$
$
0'h.h
Valuation of Total Construction
____ELECTRICAL
AMP Se:rvice
Florida Power Corp.
_\-l.R.E.C.
____MECHANICAL
$
Valuation of Mechanical Installation
____PLlJMBING
GAS
/Block
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION:
_Frame _Steel
J<..~ Other
I
FINISHED FLOOR ELEVATIONS:.3 FT.
******************************************
.d _ J j,., _ /l . CONTRACTOR SECTION
BUILD~ ~ ~ Company
I /; d. State Cert. or Regist. iF
Signature ... ~ /1J ~.J City License Registration #
~ ******************************************
ELECTRTCTAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
Company
State Cert. or Regist. iF
City License Registration #
******************************************
PLUMBER
Signature
MECHANICAL
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
OTHER
Company
State Cert. or Regist. #
City License Registration #
Signature
APPLICATION APPROVED BY
~;:::~.~~~***********.*.*
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit .ay 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 laM, 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, (8131
788-6611,
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor(sl 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 FEE2.
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 - 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 promise 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 work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a perlit 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 govern.ental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
f Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and EnvironaentaIly Sensitive Lands,
Water/Wastewater Treat.ent
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health L Rehabilitative Services, Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flo~d 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 frot thereafter
requiring a correction of errors in plans, construction, or violations of any code, Every perlit issued shall beco.e invalid
unless the work authorized by such perlit is cOllenced within six lonths of issuance, or if work authorized by the per.it is
suspended or abandoned for a period of six lonths after the tile the work is cOllenced, One 90 day extension of tile, lay be
allowed for the perlit with fee charge of tI5.00. The extension shall be requested in writing to the Building Official, An
approved inspection lust be logged during each six lonth period, or the project will be considered abandoned,
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
COMMENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT",
L~.~ fit &/5 /J_A
~URE: 0 ER OR AGENT
SIGNATURE: CONTRACTOR
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befc.}-e me this
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befc.re me this
Iflas acknc,wledged
, 19_ by
who is personally known to me or who has
produced
as identification and who did/did not
take y oath "
~ hi ~,;?--4
~nature)
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
. ,
CITY OF ZEPHYRHILLS BUILDING DEPARTl\'IENT
OWNER / LyL h'~lt.i! .
JOB LOCA~ 3'7 yo s- 1'Jr<..~d 0 D r~ \'V e.
, .
LEGAL DESCRIPTION/SUB DIV.
BLK,
LOT
Show all existing and proposed structures giving dimensions & setbacks.
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