HomeMy WebLinkAbout92-2115
BUILDING PERMIT
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C~UILDINGJ
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N~
2115~
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c: ,~LECTRICA0 P~--'"
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Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning: 4nergy Code: Radon Gas: ," ;;>
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FINAL
NO OCCUPANCY BEFORE C,O,
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
Company
Address
Telephone#
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Valuation or
Contract Price
City License Registration # /"
State Certified License~
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Breakers
Ducts Insl.
Compressor
Final
BUILDING
ELECTRICAL
PLUMmNG
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Ftr.
Pre SLB
Lintel
FRM. J/... ~../f'Z- &' U-
Insul. CL
WL
Tp. Servo
Rough In ///lj~9~~
Meter Can
Const, Pole
Pool
Pre-Meter
Final
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,
OWNER
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CITY OF ZEPHYRHILLS BUILDING DEPARTl\':EN'l'
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JOB LOCATION ~...; /~ / ~-':
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EGAL DESCRIPTION SUB DIV. '-'~I, /
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Show all existing and proposed structures giving dimensions & setbacks.
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT ~~cJ~
ADDRESS 3 ?cJL .>
6L7o,AJ //
J'i9/7 e
H
yr
uJf! rr~C:IZ
#v ~ 2-,-9;~
tt/.4 &:-~ c- ~
PHONE
7 tf.l'<. ((.' // V
OWNER
JOB LOCATION
LOT SIZE~X/~>ARE.A SQ,FT,
BLOCK c; SUBDIVISION y AJ/ ~.L-/~o6S
LEGAL DESCRIPTION: LOT(S) .:2 8-- 2-1
PARCEL I.D,4~ /2 - U - '2-/ - C.b ~0 - oC'~&(, - 2-J"ZI
WORK PROPOSED:____New Construction. ----Addition ~lteration
R e. M.. ve I"" f S'CJl.ePN S
____Sign/Temp. . -L-Si,gn ~
I~ $714&L IAI/ Wllv~ w ~ - lV
PROPOSED USE: ~Single Family ____M/F ____# of Units
____Repair ____Install
____Move ____Demolish
.~/H
____COlilmerc ial
____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
...::::LBUILDING
$
Valuation of Total Construction
____ELECTRICAL
AMP Service
Florida Power Corp.
_W,R,E,C.
____MECHANICAL
$
Valuation of Mechanical Installa.tion
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block ~Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
/
BUILDER
() /)J IU -( IL.
CONTRACTOR ~CTION
Company
State Cert, or Regist.jf/
city License Registra):1on #
****************)~******************~~****
/ /
/' /
/ Company /
/ State Cert. ~Regist. #
.' City Licens~ Registration 4~
*******~*****************t4**************
/
/
/
Compa9&
Stat;..l Cert, or Regist. 4~
~ CU'y License Registration 4;
..-* * * * * ** ** *********,*'* *** ** * ** ** * * * * * * * * * * * *
Signature
ELECTRICIAN
Sismature
/
PLUMBER
/
/~
Signature
Company
State C~rt. or Regist. 4;
City License Regis~tation 4;
*********************************~~~******
/
MECHANICAL
Signature
Signature
OTHER
4~
APPLICATION APPROVED 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 RESPONSIBILITIE~
If the owner hi' hired a contractor Dr contractors to undertake work, 'ohey lay be required to be licensed in accordant. 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
I ,
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDASTA~TES, AS AMENDED)
I certify that I, the applicant, have been providld with a copy ~f "Flori~a's Construction lien law - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the appli~ant is soaeone other than the
"owner", I certify that I have obtained a copy of the above described docuaent and prolise in good faith to deliver it to the
"owner" prior to cOlaenceaent.
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 coapliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby aade to obtain a perait to do work and installation as indicated, I certify that no work or
installation has cOlaenced prior to issuance of a perait and that all work will be perforaed to aeet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governaental agencies aay apply to the intended work, and that it is
ay responsibility to identify what actions I aust take to be in coapliance. Such agencies include but are not liaited to:
f Departaent of Environaental ReQulation - Cypres5 Bayheads, Wetland Areas and Environaentally Sensitive lands,
Water/Wastewater Treataent
f Southwest Florida Water "anaQeaent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f Aray Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Departaent of Health 1 Rehabilitative Services, Environaental Health Unit - Wells, Wastewater Treataent, Septic Tanks
I US Environaental Protection AQency - Asbestos abateaent
I also certify that, if fill aaterial is to be used in Flood Zone "A" or "A,etc.., it is understood that a drainage plan
addressing a "coapensating volule" will be subaitted which is prepared by a professional engineer registered in the State of
Florida prior to perait 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 Offici~l frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such perait is cOllenced within six lonths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of six aonths after the tile the work is cOllenced. One 90 day extension of tiae, lay 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 aust be logged during each six aonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT "AY RESULT IN YOUR PAYING TWICE FOR IHPROYE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER DR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COftKENCE"ENT, JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF CO""ENCE"ENT".
--Si6~R-A~~----------------
~~~~yO~FF~~~S;_~_______________________
The foregoing instrument was acknowledged
before me this F~J2__~__, 19~~ by
___'11.~~~~illQ..~n~(-__----._-----
who is personally knlMn to m~ or who has
produced _.:f~~i~d..a.-'"D:\..~~~-~J:::.\.S--~~&
as identification and who ~did not
tak n ~at . ~
(Si~~Urr -Jj \
_______lI_~U._ . .L_Gr:LJn.n.CU.L--------
(Name Typed, Printed or Stamped)1
NOTARY PUBLI C
,;.~ il., :JI~l,:. s,H~U I: ((1RIDA.
l\1 { ,-u,,,,,,,S~IO::::J i::xi"'mES; MAR: 3, 1994.
S(')ND~~ THRU NOTARY PUBL.tc UNOe:RWRITER~
-----------------------------------------------------------
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF ______________________________________
The foregc.ing instrument was acknowledged
before me this ___________, 19_____ by
".-----.-'. ,'- -...------------..------------
who is persc.na 11 y known to me or whc. has
produced _______________________________
as identification and who did/did not
take an oath.
-----------------------------------------
(Signature)
----------------------------------------
(Name Typed, Printed or Stamped)
NOTARY PUBLI C