HomeMy WebLinkAbout92-2268
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~ CITY OF ZEPHYRHILLS
(813) 788-6611
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BUILDING PERMIT
Permit
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Date
Water Meter:
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Sewer Conn
Property Owner:
Job Address:
Parcell.D. # C?
Zoning: C- <:J.. Energy Code:. ' CJ ~ Radon Gas: P:J
Description of Work / 0 (;, 9' --.S --US n / ~ .J?! /LA.r:l( l:CA < /.. $1 tL.
Water Conn:
NO OCCUPANCY BEFORE C.O.
FINAL
Z-
DATE
Complete Plans, Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances.
ol/6tTC 7~o'-g/87
Inspector
City License Registration # S Y' ;t
State Certified License# C r;. L /) (J 0 / b-5'-
Pe'mlt Fee 1#t~
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Valuation or
Contract Price
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REINSPECTION FE~S: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.001 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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FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 500-A-91 SECTION 5 · BUILDING DESIGN BY COMPONENT PERFORMANCE APPROACH
Non.Resldentlal Buildings ADMINISTERED BY THE DEPARTMENT OF COMMUNITY AFFAIRS
Residential Buildings over 3 stories
Wal-Mart
ALL CLIMATE ZONES
ZONE: 4
BUILDING CLASSIFICATION S :
BUILDING PERMIT NO.: c2
PERMITTING OFFICE:
JURISDICTION NO.:
'-/ /)
BUILDING INFORMATION
WALLS ROOF/CEILING FLOORS DOORS GLASS
TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA
Concrete (CBS) .09 23736 ender attic 07 7F.QlJ.? Slab-<ln-grade INA Wood Single, wall .1 1<;L..
Wood frame Single Assembly Aaised Wood Metal .~ L'J~ Double. wall
Metal frame Other: l)Q ?OlJ.?f:.. Aaised concrete Insulated Single. root
Insulation A-value Insulation A-value Insulation A-value Other . I 224- Double. root
SYSTEMS INFORMATION
AIR CONDITIONER HEATING SYSTEM HOT WATER
TYPE EFFICIENCY TONS TYPE EFFICIENCY BTU/H TYPE
Unitary & Heat Pump Central & Heat Pum~\ Electric
<65,000 BtuJh 9 . 4 SEER -L < 65,ODO Btu/h _HSPF - Aesistance B
~65.000 Btuth ~EER _IPl V ..l.2..O...- ;:: 65,000 Btu/h _COP - Dedicated Heal Pump
Water cooled _COP - Gas
Water Cooled EER IPlV 0
- - - Evaporatively cooled _COP Natural
Evaporahvely Cooled - EER - E!ectnc resistance ----L- COP 1 , 4 J.4.0.04 LPG 0
PTAC - EER - Gas 10il (cirCle one) Oil 0
Chillers COP IPlV < 225,000/300,000 Btu/h _ AFUE - HAU 0
- - - > 225.000/300.000 Btu 1 h Et
Other: Other:
LIGHTING Lighting Budget (from Table 5-13): 'T "\0
Total lighting Wattage 146,052 Total Conditioned Floor Area 97368 - Watts 1 sq, It: 1.50
PRESCRIPTIVE MEASURES (Must be met or exceeded by all buildings.)
COMPONENTS SECTION REQUIREMENTS CHECK
Windows 502.4 Maximum at ,37 cfm per linear foot of operable sash crack, X
Doors 502.4 Maximum of 1,25 cfm per square foot of door area. X
Joints/Cracks 502.4 To be caulked. gasketed. weatherstripped or otherwise sealed, X
Reheat 503.3 Supply air restricted to set cold/hot deck temperature to meet load of worst case zone, Resistance reheat prohibited, NA
Ventilation 503.4 Supplied with readily accessible switch for shut-off and/or volume reduction when ventilation is not required, X
HV AC Efficiency 503.4 Minimum efficiencies-Heating: Tables 5-4, 5-5 & 5-6, Cooling: Tables 5-7A. 5-7B, 5-8 & 5-9. X
Transport Energy 503,5 Minimum of 8,0, X
Balancing 503,6 Provide means for balancing HV AC air system & water distribution system, X
HV AC Controls 503,7 Separate readily accessible manual or automatic thermostat for each svstem, X
HV AC Ducts 503,8 Air ducts. fittings. mechanical equipment and plenum chambers shall be mechanically attached. sealed.
503,9 insulated and installed in accordance with the criteria of sections 503.8. 503,9 and 503. I 0,
503,10 X
Piping Insulation 503.11 In accordance with Table 5.10, X
Water Heaters 504.2 Automatic electric storage water heaters ~1 20 gallons and gas & oil-fired storage water heaters
~ 75.000 Btu/h shall meet performance minimums in Table 5-1 1. Larger sized water heaters shall
meet minimums in Table I I-I of Standard RS-9 alter 1/1/92. X
Swimming Pools 504,2 Spas & heated pools must have covers, Non-commercial pools must have pump timer,
& Spas Gas spa & pool heaters must have minimum thermal efficiency of 78%. NA
Hot Water Pipe 504.4 Piping heat loss is limited to 17,5 Btu/h linear foot at pipe for recirculating systems (see Table 5-12).
Insulation X
Water Fixtures 504.5 Water flow restricted to maximum of 3 gpm at 80 psig; toilets maximum 3,5 gallon flush,
Public lavatory fixture maximum flow of ,5 gpm or ,5 gallon if has self-closing valve, X
lighting 505.1 Lighting power budgets are listed in Table 5-13, Minimum Ballast Efficacy Factors are listed in Table 5-14. v
U wall Allowable TI. 'iH U wall Actual 1 1 Q It complying under the provisions of 5.502.1. enter the comoined Uo values for the entire envelope
ug rootl ceiling Allowable U. U ug rootl ceiling Act~ IT. () J in this section,
Uo floor Allowable U . ,j:J- Uo floor Actual A Uo envelope Allowable O. 156 Uo envelope Actual O.OR
OTTV wall Allowable 5U.7 ~ .-s--- OTTV wall Actual o.
OTTV roof 1 ceiling Allowable OTTV roof I ceiling Actual '1.?fi
~
Compliance with Section 5 was :jelTlonstratoo by ;>, Prescriptive Measures methodology:
O 508,0 (a) Detached commerd<il b!Jildings D 508.0 (b) Skyboxes or sports stadium buildings
less than 100 uare teet. that are used only seasonally,
oy the ca:culauon are in compliance
PREPARED BY:
I hereby certify that
OWNER/AGENT:
DATE:
Revi_ of plans and soecdicabons covered by this calculatlon Indicates compliance With the
Flonda Energy Colle. eetore construction is completed, this building W be inspected for
compliance in accordance With 'on 553, . F.S, -
BUilDING OFFICIAL:
DATE:
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WALL R-VALUES
BUILDING COMPONENT DESCRIPTION WALL WALL WALL WALL WALL
TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5
Exterior air film .25
Stucco
Block 12"Concrete 2.48
Stud
Firring strip
Insulation wfvermicula::e 7. 16
Wall board
Solid
Other
Other
Other
Interior air film .68
R iOTAL 10.57
U = 11R .09
AREA 23736
Weight (Iblsq, ft.) .40
. IF FRAME: Size _ x _ Inches Q,C, _
;
,
!
ROOF/CEILING RNALUES
BUILDING COMPONENT DESCRIPTION ROOF ROOF ROOF ROOF ROOF
TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5
Room air film .25 .25
\Va!! board 5/8"Gvo.Bd 2.60
Tr\;ss
Insulation 9.09 9.09
Other l.ouu. L . .33 .33
un roof1n~
Other Air space .92 .92
Other
Other
Outside air film 1.0
R TOTAL 14. 19 10.59
U = 11R .07 .09
AREA (sq, ft.) 76942 20426
U -;- Te .033 .045
IF FRAME: Size _ x _ Inches Q,C, _
B S W
1400 SOUTH BOSTON, SUITE 300
TULSA, OKLAHOMA 74119-3600
TELEPHONE 918-582-8771
FAX 918-587-3594
April 13, 1992
City of Zephyrhills Building Dept.
Mr. Roy Burnside
5335 Eighth Street
Zephyrhills FL 33540
(813)788-6611
Dear Mr. Burnside:
This letter is to inform you that LAT Construction, Inc. (New Port Richey, Florida)
has been selected by Wal-Mart as the general contractor for this project.
Thank you.
Rob Coday
C: File
ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills, Florida 33540
38410 6th Avenue
(813) 782-8184
FINAL BUILDING INSPECTION
Fire Chief
William T. Fenton
Assistant Chief
Robert Hartwig
DATE: 9/lS/92
OCCUPANCY: WALMART
ADDRESS: 7425 GALL
BUSINESS PHONE: 7!3;! -19S-7
OWNE~ GA~i '))E(l_Oc.~
This buildin~ has l>l:'en inspected by the Zephyrhills
Fire Department under the codes and regulations of the
NFPA ~inimum Standards and other local fire safety codes.
X APPROVED
NOT APPROVED
CO~f~fENTS~;' .J,"BY~~D,FQlt'C.Oo
~IRE EXTINGUISHERS MUST BE MOUNTED IN GARDEN SHOP AND
~bY
. ~t
to~rv
I~ WAREHOUSE B~
2. FIRE ALARM ZONE MAP MUST BE REDONE TO SHOW LOCATION NUMBER FOR EACH
SID AND EACH PULL BOX. ELIMINATE ZO~E # FOR RTU
All OTHFR ITEMS FROM 9/1/92 INSPECTION HAVE BEEN CORRECTED
INSPEcrO~L~
DATE91l57q;:> TIME:1130hr~
SIGNE~~ '
TITLE:
06/17/86 ills
ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills, Florida 33540
38410 6th Avenue
(813) 782-8184
Co~~<>
FINAL BUILDING INSPECTION
P~E \ ~ ~
Fire Chief
ViIliam T. Fenton
Assistant Chief
Robert Hartwig
OCCUPANCY: J..uA-LYV\~+
ADDRESS: 14;Z S- GALL ~{)1>
DATE: 8-lt ~97-
BUSINESS PHONE:
OWNER/MANAGER:
This huilding has heen inspected by the Zephyrhills
Fire Department under the codes and regulations of the
NFPA Minimum Standards and other local fire safety codes.
/ APPROVED r~Cf2.AiLj W / ~t:>td\ ..lojU S
NOT APPROVED
CO~t~tENTS: -,He'S .:::c....S?E'dce.N l,V~c; (b1V~~c...\~1::. l r..) t9(l..bf2 f- ~ ~ s-r
ALL lvl-.sfl-tVAL ~N~(\.JS o-t: ~ Bu...~(.'~, ~f'r-p[~4-u:>A.) of
Tt-l~~ lC\.ls~dU1^-.J tP\.LL ~ +l!!9-IL oe.~'-'i>a.,,-c.~f ~ ~E-
I
fS...t ( (.1::> \. ~ s se:\- ~ ~~ Ol-~ s-bc.\[~ ~ ~a..~, """--+lcs ~~p€d-t.evN
Do~S (\.9~ ~E-~SE- -\.J~ ~<-L~~~~ {;JL C..O. AN~l:LR-
..c;c...Co~ u-p d:A.c;~~olV lPl~ &. U~~,;ij) pfw.'L -k op~"'''-5'
\" r f r. _'" _ r ___(' k.r-~ --6 pA-<Q:~--r;Lc:;.CJlA.j) ~tf..e..E,
"tt:> ~ \J t~~CI^ cs. c.. ",-"b '--t> - ~ \') ~::> ~ 0 ./4 ~
INSPECTOR: (;-4r~ 4--~
DATE: €; --(7 -'1 iL- TIME: ...ttslcL t:i T
/ S-OO.-l-o
SIGNED:
TITLE:
06/17/86 als
. '., ...",#i'J:".~'
~""""."~.'.
/-
ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills Florida 34248
700 6th A venue
(813) 782-8184
pA'jE 2- ~ .3-
Assistant Chief
Robert Hartwig
OCCUPANCY: tu~L~A-e-+
ADDRESS: ?4~ S- GALL el.v.1>
DATE:
8-/7-'12-
Fire Chief
William T, Fenton
BUSINESS PHONE:
OWNER/MANAGER:
THIS INSPECTION REPORT SPECIFIES CODE VIOLATION(S) WHICH IF NOT CORRECTED
COULD CAUSE A FIRE, CONTRIBUTE TO THE SPREAD OF FIRE, OR PREVENT SAFE
EGRESS DURIi\G A FIRE. YOUR IMMEDIATE ATIENTION TO THE CORRECTION OF
THESE VIOLATIONS SHALL BE REQUIRED, AS FAILURE TO DO SO IS A VIOLATION OF
THE CITY OF ZEPHYRHILLS FIRE PREVENTION CODE.
:J:'AJ ~~~ ~e - CD'Du.d- ~ ~ ~ ; s.J.JA~,",-, ~ -+- ~~..t.(.~--t/
-ro A~- pj!\IU,<:_L~ O~ - TYlc..t~ & L-h~ ~ EmS <>js-kP\-.. (~
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I ~ f
~EU~AL IVE-IlE M.c."i>C;c.~ 11^-~ CLPllC ~~~ ----rE-~~ E~;+ ~7f\.JS-'
-r7IelS$: ~~~.2> -&J ~ ~Y:Lc..p--r- -C/L hh'1>l:lL @ ~I ~~ -
SEc.)~dZ._a..C l.U~ 1\''''- SS (~ ~..tb ~::AcL ~~ ~ & ~b ff> (${i;:
T~SE- ~J..MI~b ~L~ a.~ A~,lvM~~ --f.#.lL PA~_l -(we) tv'€A..E.
Mc.SC;~ <5:> {[JjJ - AS- t?F 3S- fJ./C-/l.E t:/A/ S;-/-.E C{~ Ce.d.-!:: t<.~ D....R.~"l
~p~CJV ,- to ~G/LE- Bfa (6'~(.c &:. {A./ A~ ?\-CC c.JA~lf~ As-AP
~<;p~';V~L.c.L S:-'( ~ - 3 :r:A..$p.E-c-.l~/ls IZ<cQ CQ.~.s- 'n\~,:-(f s
~l~~- ALL C:Si~'^'"-S ~.Lk~ A~ 4J''-cAJ~ DA~,
I
1J~t'E--~,/~ <>p2.,,^-,~LE.L 2PA-L /J / ~ ~
. INSPECTOR: ~
mAf'S. ;/-E45 'L.-IHuttYV-<<cy
DATE: 63 --f 7 -Y Z- TIME:
m....... C,I ~e ~-G,.cA--f.-~":s> ~ ----u sk., ..
A~fL .4<:>peek.r'l_C, ~$(f<f($ SIGNED:
1"\ ~):::.. f< ( s.;:...e 5> Sft'IV 1"5 4-,1..ot>, TITL E:
06/17/86 als
"'.--'"
ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills Florida 34248
700 6th A venue
(813) 782-8184
~
3~3
Fire Chief
William T, Fenton
OCCUPANCY:
tu~~AJL-\
7 4- ~c:) 0A-c.(
DATE: ~ - /7 ~ 9 z.....
Assistant Chief
Robert Hartwig
ADDRESS:
BUSINESS PHONE:
OWNER/MANAGER:
THIS INSPECTION REPORT SPECIFIES CODE VIOLATION(S) WHICH IF NOT CORRECTED
COULD CAUSE A FIRE, CONTRIBUTE TO THE SPREAD OF FIRE, OR PREVENT SAFE
EGRESS DURING A FIRE, YOUR IMMEDIATE ATTENTION TO THE CORRECfION OF
THESE VIOLATIONS SHALL BE REQUIRED, AS FAILURE TO DO SO IS A VIOLATION OF
THE CITY OF ZEPHYRHILLS FIRE PREVENTION CODE. @
(!j) ALL Pu.l.L &"'ES tVE4Tesk.-b A~ kl,-up.~~~ FMp' (j S'~p(i
R~ Sp(L<=-~ W<.~ G'-F QMLfd(.~ G) hLL .p.-L{ llolbS ttV
~ @r
(2 - ~~ - ~ftE ~5 Ct.~ pc-pI:.. ltkS r AC. P - ~lL
~('V~~u~,^-> ~ ~1~---- ~ ~~. ALAILvv-- ~nA.S ~L
(!?~~ - p~~ It:'"VES~ fV'.-otv::-l,cc<'~J ~CL'^i ~rf.E 1>>+1'*
~.o.C.ClG-~. --n-\-E- 'b ES l ~ tV '" ^'~ ...c.-~--l.c'^-" as: ~ ~ r..e L
N.-~- <;i <;~~..--...... fv'E.-~-"~<; 4.0 f5r...- "'bl.C;C~~S~~ (u ~l.L
WJM- ~~ @ hflE Dd4:Q1l5 l.P~ /tA."/-/~~,@Kk~ s-k~P€-
f!v..,~ ~~^:) It- ~<!.l ~ ~~ 1~c~ lO~Jl..t'Z<-~ d_ 'D.,La.~~":;:::spJ..
@ Po ~E L/;...J> 6.j#r ~ c-=c(c-~ {:'IL ')...L-+- ~ kOlC( BE-
')tSC .....ss€h w;>.{.d ~a::
INSPECTOR, #4~
DATE: B-1? ~C( L- TIME:
SIGNED:
TITLE:
06/17/86 als
C:ONTF<ACTOI::: "*:
NAt1E: WAL.MART
ADDR: GALL BLVD.
C/:;::T: Z/HILLS
C E N T R ALP E R M I T TIN G DATE: 09/15/92
PASCO COUNTY, FLORIDA PAGE: 1 OF 1
I :::;:::;UE OFF I CE : D
RECEIPT NUMBR: 00150187
OFFICE: DADE CITY
FOR: SOLID WASTE FEE
C:HECI< "* 20752
?~CCNT
114
TOTAL AMOUNT:
COMPNY ACCOUNT CENTER
8450 - 363000 - 2
5181.49
AMOUNT
51:::::1.4'::'
DESCRIPTION/PERMT DATA DRICR
****** 60
RECEIVED BY .L~':::L.ad.Dfl-'- ______
PASCO COUNTY, FLORIDA
Name/Owner l/J lJ?d
County Parcel # ,-?y -~.. .2/ - do-ao ~ ~LJ30 0- 00 Y D
Location 7~:1---s ->it1/! I1?J
Classification/Type of Use ~.A.L'~ 0
Pennit # oZ:.L fc y ;J
Date 9-/ t/-P~
lRANSPORTATION IMPACT FEE CALCULATION
Rate $
Sq. Ft./ Unit
Zone #
-
Impact Fee Amount $
The above impact fee has been establis ursuant to the Pasco County Tran . on Impact Ordinance as adopted by the Board of
County Commissioners. Thi unt is payable PRIOR to the issuance of a Certificate of 0cC y or authority to utilize the permitted
structure.
RESOURCE RECOVERY ASSESSMENT
RESIDENTIAL
# Units
NONRESIDENTIAL
Gross Sq. Ft (GSF) / 0_,;- ~ / ..5-
Rate / ERU = 50.00 x 0.96* / Year
or$0.1315/Day
ERU Assign #
Assessment =
(# Units) x ($0.1315)
x (# Days)
~
Assessment =
!QSEl x (ERU) x (0.1315) x (# Days)
100
TOTAL FEE $
5\ )<149
J
TOTAL FEE $
-
'7
*Discounted for Prepayment
The above assessment has been established pursuant to the Pasco County Ordinance No. 89-07 and Resolution No. 89-197, as commended.
TIlE ASSESSMENT WILL BE CALCULATED AT TIlE TIME OF ISSUANCE OF THE CERTIFICATE OF OCCUPANCY.
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this fonn, placing the building permit
owner on notice of this assessment and the conditions of payment for same.
XP~1fH &!J7
-----------------------------------------------------------------------------------------------------------------------------...----------------------------------
9-
/:;-
Date
9d.
"
OFFICE USE ONLY
lRANSPORTATION REC. #
RESOURCE RECOVERY REC. # /6 n J 217
DATE
DATE
BY
BY
White
Applicant
Canary
Trans / Finance
Canary
RR / Finance
Pink
Office
Green
Bldg / Insp
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
LAT Construction, Inc.
ADDRESS
P.O. Box 1027, Port Richey, FL 34673
PHONE (813) 847-1964
7271 6
OWNER Wal-Mart stores, Inc., 701 S. Walton Blvd., Bentonville, Arkansas
SWC Rt. 301 & Pretty Pond Road
JOB LOCATION Zephyrhills, FL 33540
LEGAL DESCRIPTION: LOT(S)
BLOCK
LOT SIZE X AREA SQ.FT. 17.149 AC
SUBDIVISION S34/T25S/R21E
PARCEL I.D.IF
WORK PROPOSED:~New Construction ____Addition ____Alteration ____Repair ____Install
____Sign/Temp.
____Sign
_Move
____Demolish
PROPOSED USE: ____Single Family
_M/F
____# of Uni ts .
__M/H
~Commercial
_Indust.
____Swim. Pool
Other
_Restaurant & Health Department Approval
.
BUILDING SIZE:
X
106,950
Square Feet,
241
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
2-BUILDING
$
Valuation of Total Construction
2-ELECTRICAL
1600
AMP Service
X Florida Power Corp.
_W.R.E.C.
I
2-MECHANICAL
$ 51,800.00
Valuation of Mechanical Installation
2-PLUMBING
GAS
x
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: -1L-Block _Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: 139 FT.
******************************************
CONTRACTOR SECTION
Company LAT Construction, Inc.
State Cert. or Regist. IF CG C000105
City License Registration IF 342
.**********************************
Signature
ELECTRICIAN Rick Daniels Company AM. Electrical Contractors, Inc.
State Cert. or Regis t. # EC 0000514
Signature City License Registration ~F 137
******************************************
PLUMBER Dewayne Lawhon Company Lawhon Plurnbill9
State Cert. or Regist. # r.F' r.O?1 Cj1 q
Signature City License Registration 4F
f *********************~********************
'f'T.~ ~~...AUA.tJtr ~~~~~
llE~HICAZJ Tern ~tz Company ....."l~. .1.""8j~", t:...) ,
i '" Ste.tt:' Cert. or Regist. If CA C051517 -
Signature' e f~ \ City License Registration ~F /:J?J ~/c!..-
******************************************
Signature
Company
State Cert. or Regist. IF
City License Registration #
OTHER
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perait 'aay be subject to "deed restrictions" which aay be lore restrictive than City
regulations. The undersigned assules responsibility for coapliance with any applicable deed restrictions,
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they aay 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 aisdeaeanor 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 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 - HOleowner's Protection
Guide" prepared by the Florida Departaent 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 protise 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 governlental 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, Metland Areas and Environlentally Sensitive Lands,
Mater/Mastewater Treatlent
t Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Metland Areas, Altering Matercourses
f ArlY Corps of Enqineers - Seawalls, Docks, Navigable Waterways
t Departlent of Health & 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 Flood Zone "A" or "A,etc.', it i's understood that a drainage plan
addressing a "cotpensating 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, Dr
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 perlit issued shall becole invalid
unless the work authorized 'by such perlit is co.tenced within six lonths of issuance, Dr if work authorized by the perlit is
suspended or abandoned for a period of six .onths after the tile the work is cOI.enced. 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 to the Building Official. An
approved inspection lust be logged during each six lonth period, or the project will be considered abandoned.
MARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT "AY RESULT IN YOUR PAYING TWICE FOR IKPROVE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER DR AN ATTORNEY. BEFORE RECORDING YOUR NOTICE OF
C..KEMC....T. JOBS U'DER '2,500 I' VAlUE DO 'OT NEED TO RECOBO AMO POST ~CO""CE"ENT"
SIGNATURE: OWNER DR AGENT SIGNATU E: CONTRACTOR
was acknowledged
, 19_ by
STATE OF FLoR~A
COUNTY OF ~~
. The foregoing instrument was acknowledged
before me this ~ J4 19~ by
J.. Q/V''''-i C\ . '-i ....k~
who is ~ersona 11 y ,known to me 001" ~"''If:. h~
prEteh~e:l!d
a!! iEhmtifiEC\lil.'" and who fMo9Idid not
~e an oath. .
4-1~~_.~J M~a~~
(Signature)
-:::!) oQ.\::x.r-...\.-., fl). -z..: l1'\Me t-n"\..n .., I c...,,('tli'Il~~ i 01'"'> ~ A. ~ S (p t\; , '0 2
(Name Typed, Printed Dr Stamped) .
NOTARY PUBLI C
STATE OF FLORIDA
COUNTY OF
Th~,foregoing ins~rument
before me this
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signatul-e)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
Notary Public, State of Florida
My Commission Expires M::y 28, 1992
Bonded Thru Troy Fain. Imurance Inc.
. L\ J 1\~4G~U"D-~e'"';'-I~SM;;~I~~LVD
V\,. ~ Cs(l(l '\w"S\~.t
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14,338.-00
.lb7.S0
(15'hl~z5
, q <60 ,e'.'
~ o~~. t.s
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\\1~~1.25'
3,2'6/1 25'
, $ LfD. DO
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Not INCL.uDF:.U..
WI L.L Be._.. Bt7~1i- t:~__
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fito" _. G:vu/~~t'-.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
( J dz 7fi;)
---,
ADDRESS
PHONE
OWNER
JOB LOCATION
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.1F
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
'A;
}"
_Restaurant & Health Department Approval
BUJLDING SIZE:
x_.
Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FOR~S.~*
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COpy OF CONTRACT REQUIRED.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_h'.R.E.C.
:,'fo
_MECHANICAL
$
Valuation of Mechanical Installation
_PLVMBING
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
:::::~<5~"~'~ Company
State Cert. or Regis t. l~
. .~ City License Registration ;F
******************************************
f\f\
PLUMBER ~ tz Company
State Cert. or Regist. #
Signature .f',( City License Registration 'F
**********************~*******************
/LfL(
Company
State "ert. o:c Regist.. IF
City L:.cense Registration ,~
******************************************
MECHANICAL
Signature
Signature
Company
State Cert. or Regist. #
City License Registration #
OTHER
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to 'deed restrictions" which lay be lore restrictive than Citv
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 may be required to be licensed in accordance .lth
- 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 Department, (813)
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 contractu"
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to 51g0
as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of 2ephyrhills.
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 - HOleowner's Protect1on
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is 50leone other than the
"owner", I certify that I have obtained a copy of the above described docu.ent and promise in good faith to deliver it t" the
"owner" prior to cOI.encelent.
'I,
,I
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.
I
Application is hereby tade to obtain a pertit to do work and installation as indicated. I certify that no work or
installation has cOltenced prior to issuance of a perlit and that all work will be perfor_ed to teet 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 cOlpliance. Such aqeneies include but are not limited !c,:
I Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treat_ent
I Southwest Florida Water HanaQetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I De art_ent of Health & Rehabilitative Services Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
I Environ.ental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood 20ne "A" or "A,ete.", 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 per_it issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alte" or
set aside any provisions of the technical codes, nor shall issuance of a verlit prevent the Building Official frol thereafter
requirinq a correction of errors in plans, construction, Dr violations of any code.. Every perlit issued shall beeole i0ialid
unless the work authorized by such perlit is cOI.eneed within six lonths of issuance, or if work authorized by the perm1t is
suspended or abandoned for a period of six lonths after the tile the work is co.tenced. One 90 day extension of tile, ~ay be
allowed for the perlit with fee charge of SI5.00. 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
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befol-e me this
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
\.'Jas ackno\.'JledgE'd
19 bv
-'
--
who is personally known t~ me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(SignatLll-e)
(Signature)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC