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BUILDING PERMIT
Permit N~ 2247 il1..1
,
Date s- g()- 7~
CITY OF ZEPHYRHILLS
"q, (813) 788-6611
f) ~ $~ ~
~ ~ ~ ~HANIC~
p,o~rtyOwne, ~ ~
~:~,:~d~~S;' /iq%;,- - t- . - - ~: ~ n_ - ~0090
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description 0
FINAL
C.O.
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.
DATE
Inspector Q &
City License Registration # /1 C; /lIe!-
State Certified License# {! /J en i'p~'1 /
Y~~~~-f~ A/J1t'~~~
~UI - _ ~LEC:rRlc..... _~/(P PL~ -,MECHAN~~-- _'/'1
P 'F ~.~
ermlt ee
s;gna,",.~ . , n .~v6
Company
Address
Valuation or i .!1J f...P tJD
Contract Price ~ J 7 I -
Telephone#
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Serv.
Rough In
Meter Can
Driveway
Const. Pole
Pool
Pre-Meter
Final
~~~.t R.m. '5.. 31 ,elL (5~
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.
-~-------------.,,-.--.._----,---~-_.'_""----_'--
.' f:'
'1
~
PHONE:
r~"e' r/?1te riVt S~
'7 ?22h 7;# J TAM PA-L1TH IA DATE
~ L ~ RIVERVIEW
7 eft? C,7S-...L. (813) 874-3822
Zc (813) 689-5594
Eq
CUSTOMER ~,.J
~ -2..C"92--
ADDRESS
Responsibilities
,Serial
Condo Unit/Heat Pum
Coil/Air Handler/Furnace
Thermostat
Strip
SEER
COP
:~
PERMITS
Equipment Foundation Slab or Blocks
Electrical ~ ',(/&,
Carpentry
Insulation - Floor/Attic/R-13/R-19/R-22
Miscellaneous
5'
(ceiling)
openings and registers as follows:
Metal
(floor)
Fiberglass
~
Duct System will consist of
Duct - Material
C.R.
FLA,
DEN
M.BR.
M.BATH
B.RM.
B.RM.
Size
L.R.
i
2'1 <(
Amount
WARRANTY:
-4 parts & labor
S
NET CASH PRICE
~
year on compressor
(part only)
CARPENTRY
INSULATE A~ ~/7.;:!'.
ELECTRIC t:;-61> ~J ~
TOTAL l..1f (f 7
MISC.
Workmanship:
Work to be performed in a workmanlike manner and will comply with existing codes and regulations,
Warranty:
Seller extends to purchaser the same warranty to the equipment as the manufacturer grants in Certificate qf Warranty, In addition, the seller warrants the Installation
with respect to its responsibilities against defective workmanship and material for a period of one year frol)1 date of completion of installation, Service does not
include the replacement of fuses and/or filters, OPTIONS: I ~ q7/ ~
The average temperature in the conditioned space wiil be: flY dr.'> ""J5:ECO REBATE t..4--
SUMMER. outside temp, 950 . inside temp. 780 l'J..oI"
WINTER. outside temp, 300 - inside temp, 750 7 NET COST
These are the standard temperatures set by the (A,R.I.) American Refrigeration Instit te,
Any material, equipment, or labor in addition to that required in this proposal will be paid for bY Purchaser a ra at AMC Air Systems' normal rates, This proposal
will become a contract between Purchaser and Seller if accepted by Purchaser and thereafter approved and accepted in writing by AMC Air Systems' duly authorized
representative,
For which I ~ to pay A~lr Systems $
$ ~~ upon installation,
The title of said property shall remain In the said AMC Air Systems or Its successors until the amount ot' purchase money shall have been paid, and in case of
my failure to make any payment when due, then the whole unpaid balance shall become due and payable at'once, and the said AMC Air Systems shall have the
right to take possession of said property at once without any legal process, and all payments shail be applied as rent for said property or for depreciation In value,
I further agree that any addiitonal purchases made by me from the above seller, during the time this contract is in effect or prior to the time it is paid in full, are
made on the same conditions and shall become a part of this agreement and should it become necessary to enforce this agreement by legal process, I agree to
~~:~;53:;::" ,Uom~' foe
;!k(Jj'~'7-7~
DAV
~
TITLE
L.
~ ~ -c::<S- -7;;L
DATE
~,
APP;.ICATION FOR PERNIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
#ekA.! /(;/2 ()r/(JC
/d. ~
3t? .;2;')'7 7 - ~ )
2ep4 V,P 1;$ PHONE
f/ /
7J"-?,7J',6
ADDRESS
OWNER
JOB LOCATION
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I. D. iF '.
.
r 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
BUJLDlNG SIZE:
x
._Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORI1S. ;",',
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COpy OF CONTRACT REQUIRED.
PERMITS REDUESTED
_BUILDING
()LELECTRICAL
~. 'r/>
...V:::'HEt:HANI CAL
$
Valuatio::, of Total Construction
~oc AMP Service
__Florida Power Corp.
_\\.R.E.C,
$
.~/~17/7 !!-
~Z1-L- ._Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFTNG
SPECIALTY
TYPE OF CONSTRUCTION: ~Block
_Frame ___Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
900 fJ ~'IL-ff
********************.*'~k******************
CONTRACTJR SECTION
Campa- :-/
State Cert. or Regist. #
CiLY ~icense Registration #
**********************:k******************
BUILDER
Signature
::::::::~ ~ comp""y ?U~hI f /:;~ci,r. ( S(~. .Tn" I
. a ~~ ~~~~e~~~~~~e o~e:~:~~~~i~~n iF ~/ t, dkJ
**********************~*******************
Compar<1
State Cert. or Regist. #
City License Registration ~
*******************~**********************
PLlJMBFR
Signature
MECHANTCA~
Signatur~ ~
Company AJt1rL .4/2 ~~J.?t.-"
Ll- .. State Celt ot'Regist. j,: (Jl'/eo~z~9/
~~ . City ~ic~nse Registration ~
J.. .I.. ~.. .I.. _1..' ....~.'.' J~ '...L .'...L J...L.1.. ......J.. oJ.. J...1..
..** A * ********..*.,.**".,,,*.."'........................
Company
StatF Cert. or Regist. #
City .icense Registration #
OTHER
Signature
*********************~.********************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subje(t t~ "deed restrictions" which lay be lore restri(tive than CitJ
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restri(tions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ONner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance .ith
state and local regulations. If the contractor is not licensed as required by law, both the owner and contra(tor lay be
cited for a lisdeleanor violation under state IaN. 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 Department, (813!
788-6611.
Furtherlore, if the ONner has hired a contractor or contractors, he is advised to have the contractor!s! sign portions (if the
"Contractor Sections" of this application for which they will be responsible. If you, as the ONner sign as the contracto(,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to 51gO
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 FEE~
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided Nith a copy of "Florida's Construction lien Law - HOleowner's ProtectIon
Guide" prepared by the Florida Departlen;; <if Ayri,i..iilture alii] r:i;:I!:iiii~i Affairs. If th~ applicant is sOl1leone othH than tl:2
"owner", I certify that I have obtained a copy of the above described doculent and promise in good faith to deliver it t" the
"owner" prior to cOllencelent.
oj.
,l
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 co.pliance with all
a~plicable laws regulating construction, zoning, and land developlent.
i
Application is hereby lade to obtain a per.it to do work and installation as indicated. I certify that no work or
installation has cOI.enced prior to issuance of a per.it and that all work will be perforled to leet standards of all la~s
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 co.pliance. Such agencies include but are not lilited tD:
f Depart.ent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environ.entally Sensitive Lands,
Water/WasteNater Treatlent
f Southwest Florida Water KanaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f De artlent of Health & Rehabilitative Services Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f Environ.ental Protection AQency - Asbestos abate.ent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,ete.., it is understood that a drainage pla;i
addressing a "compensating volule" will be sllb.ittp.d which is nre~ared by a professional engineer registered in the State Df
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 altef, or
set aside any provisions of the technical codes, nor shall issuance of a per.it prevent the Building Official froD thereafter
requiring a correction of errors in plans, constru(tion, or violations of any code.. Every perlit issued shall beeole invalid
unless the work authorized by such perlit is cOI.enced within six Bonths of issuance, or if work authorized by the per~lt is
suspended or abandoned for a period of six lonths after the tile the Nork is cO&ienced. One 90 day extension of ti~e, ~aj be
allowed for the perlit 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 lonth period, or the project will be considered abandoned.
WARNING TO OIlNER: YOUR FAILURE TO RECORD A NOTICE OF COKKENCEKENT KAY RESULT IN YOUR PAYING TI/ICE FOR IMPROVEMENTS TO 'r(lUR
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 COMMENCEMENT".
SIGNATURE: OIlNER OR AGENT
SIGNATURE: CONTRACTOR
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befol-e me th i s
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befcq-e me th i s
vJas acknc1\.Jledged
19_ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
!Name Typed, Printed Dr Stamped}
NOTARY PUBLIC
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC