HomeMy WebLinkAbout92-2129
BUILDING PERMIT
Permit
212a;5
Date r;2-lf' 72_
.".--
CITY OF ZEPHYRHILLS
(813) 788-6611
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P<operty owne'~ ~ ~ -a
Job Address: ..~ / t !' ~- .. '/ C ~h-.), -# I
Parcell.D. # J
MECHAl\llr ^ b.
"Sewer Conn
Water Conn:
Water Meter:
T,I.F.'5:
Zoning:
Description of Work
NO OCCUPANCY BEFORE C,O,
Complete Plans, Specifications and Fee Must Accompany Application. C,Q.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Pe,m;t Fee ?Ii ~ .- .
Signature /J etA (lit r 16ilNt
Company
Address
Telephone#
Valuation or -2- ~ - IfJ.<e.J
Contract Price ~ 7/;)'-
City License Registration # ..--/
State Certified License# ~
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BUILDING
ELE~---'
~
Tp. Servo
Rough In
Meter Can
Const, Pole
Pool
Pre-Meter
Final
PLUMB!N8- .
-------
MECH~-" "
--
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
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,
CITY OF ZEPHYRHILLS BUILDING DEPARThffiNT
OWNER /J,q1?1i! Y 8 "Rr.:z::-s'
JOB LOCATION 6 A / h W~j.)r:
LEGAL DESCRIPTION/SUB DIV.
i(DA1:J SL€rfJr IIcJLLow R4"eJ.( H /
BLK. LOT 1../ j-
Show all existing and proposed structures giving dimensions & setbacks.
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To .:C JL/ S '"fA I.. L R .:2 3 X 7
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NO TE EXAMPLES 1 &. 2)
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'R.' J "R'z. ~ J? 3
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:Zoning
Note ~
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APPLICATION FOR PE~IIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT B u r<r ;J:S ) H ~ J? R r
ADDRESS b bib W.J::R.f:: Ro 1+'))
OWNER ,) LEEPY /-/dLlow '?;::rRk I
.
JOB LOCATION '- ()'( d /..f S-
PHONE 78-2... - /3 R ~
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
_M/F
_# of Units
__M/H
_Commercial
_Indust.
_Swim, Pool
Other
_Restaurant & Health Department Approval
BlJILDING 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
V BUILDING
$ 37S-:oo
Valuation of Total Construction
_ELECTRICAL
_M~'CHANICAL
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, #
Signature City License Registration if
******************************************
ELECTRICIAN Company
State Cert. or Regist. if
SiRnature City License Registration #
******************************************
PLUMBER Company
State Cert. or Regist, if
Signature City License Registration ;~
******************************************
MECHANICAL Company
State Cert. or Regist, #
Signature City License Registration iF
******************************************
OTHER Company
State Cert. or Regist. #
Signature City '~,nse Registration 1F
APPLICATION APPROVED BY 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 lay be lore restrictive than City
regulations. The undersigned assu.es 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 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 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 contractorls) 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 leet 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:
f Depart.ent of Environ.ental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treat.ent
f Southwest Florida Water "anaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f Ar.y Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Depart.ent of Health L Rehabilitative Services. Environ.ental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
f 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 Official fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pertit issued shall beco.e invalid
unless the work authorized by such per.it is cot.enced within six .onths of issuance, or if work authorized by the perlit is
suspended Dr abandoned for a period of six .onths after the ti.e the work is co.tenced. One 90 day extension of tile, 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 lust be logged during each six .onth period, Dr 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
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
/tJp~ /fY aS~
SIGNATURe': OWNER OR ~ENT SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF PI1S~ D
The foregoing instrument
before me this f€~. I~
was acknowledged
, 19J..2. by
STATE OF FLORIDA
COUNTY OF
. The foregoing instrument
befol-e me this
was acknowledged
19_ by
HtMJ2V iA.J I t51.LR.11 S
who is personally known to me or who has
produced IJ Y 1>( B /)./,,'/5 sJ3lfi 7857'1'3 II U ~
as id.ntificatiD~.d who did/did not
~~~~(. ~
(Si.g,Qature) ~
.J..) tJ 1M /Y}. LJ/t,u 11::..'->
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
NOTARY PUBLIC, STATE OF FLORIDA
My commission expires Oct. 24, 1992.
Bonded thru Patterson. Becht Agency
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