HomeMy WebLinkAbout92-2283
BUILDING PERMIT
Permit
22838
5'-cJo-?01..
CITY OF ZEPHYRHILLS
(813) 788-6611
N<!
Date
C;':"~ '"EbEQRICAL PL~ ~AL Sewe' Cone
_ __________ Water Conn:
Pwperty own.".~ 1\ Wat~: Mete"
Job Address: to _ _ llcA c T.I.F, s.
Parcell.D. # bL/ -.J..6 - .3 0/30 D - 00 DOD ... 0 0 t!J oS, ()
Zoning: Energy Code: ~adon G~
Description of Work C~A"'~" .A;/~ . - /.' ' ~~
-4..1-.A 17~.A/7 .../) -4'~
-~~r
NO OCCUPANCY BEFORE C,O,
FINAL
'Z-
DATE
Complete Plans, Specifications and Fee Must Accompany Application, C,Q,
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
City License Registration #
State Certified license#
LJL(
Permit Fee f~: t7V ~
Signature J U .~. {iJ/;(
Company
Address
Telephone#
Valuation or
Contract Price ~ bU7::>, o-t)
PLU
Tp, Serv,
Rough In
Meter Can
Const, Pole
Pool
Pre-Meter
tI-2i.ql- f3,u, Final
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,
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT -:7.fI1I tfJ/l5/JN~1 (l bm~ I/\IC-
ADDRESS //'191' c~b~ <..f: g;u:ok:ct II&' r/
II/!:TJII t.L e _
PHONE 9ot/~ 75?9-0d70
BLOCK
LOT SIZE~xIOD/ AREA SQ,FT,
SUBDIVISION 2L:fJ?1-I.e.--f?JJx;6"
PARCEL I. D , # ~I ' ~ - 03 ~ 0/300 . OOLKJ(") - oooo~.V
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
.
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,
~DING
PERMITS REOUESTED
$
~ooo. 00
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp,
_W,R,E.C.
i
_MECHANICAL
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
(JOAl&z.id-r&" Other
TYPE OF CONSTRUCTION: _Block
_Frame ____Steel
FINISHED FLOOR ELEVATIONS: FT,
******************************************
BUILDER
Signature ~~~ ~
CONTRACTOR SECTION
Company Ie
State Cert, or Regist. #
City License Registration
******************************************
Signature
Company
State Cert, or Regist. #
City License Registration #
******************************************
ELECTRICIAN
Company
State Cert, or Regist. #
City License Registration #
*********************F********************
PLUMBER
Signature
f,
Company ,..__ ._,
State Cert. or Regist, #
City License Registration #
******************************************
MECHANICAL
Signature
Company
State Cert, or Regist. #
City License Registration #
OTHER
Signature
APPLICATION APPROVED BY
~********~*************************
a.M .tU ~ r/ AI"r-,...., T
PERMIT OFFICER,
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this penH.ay be subject to "deed restrictions" which .ay be .ore restrictive than City'
regulations, The undersigned assu.es responsibility for co.pliance 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 law, both the owner and contractor .ay be
cited for a lisdeleanor violation under state law. If the owner Dr intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of 2ephyrhills Building Depart.ent, 1813)
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 lay be an indication that he is not properly licensed and is not entitled to pertitting 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 - Ho.eowner'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 docu.ent and pro.ise in good faith to deliver it to the
"owner" prior to co.aencelent.
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 develop.ent.
Application is hereby lade to obtain a perlit to do work and installation as indicated, I certify that no work Dr
installation has coaaenced prior to issuance of a perlit and that all work will be perforled to .eet 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 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 li.ited to:
f Departlent of Environaental ReQulation - Cypress Bayheads, Wetland Areas and Environ.entally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water "anaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f Ar.v Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Depart.ent of Health & Rehabilitative Services. Environ.ental Health Unit - Wells, Wastewater Treattent, Septic Tanks
f US Environtental Protection AQencv - Asbestos abatetent
I also certify that, if fill laterial is to be used in Flood Zone "A" Dr "A,etc,", it is 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 pertit issuance.
A pertit issued shall be construed to be a license to proceed with the wor~ 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 fro. thereafter
requiring a correction of errors in plans, construction, Dr violations of any code, Every per.it issued shall beeo.e invalid
unless the work authorized by such pertit is cO.leneed within six tonths of issuance, or if worK authorized by the perlit is
suspended ~r abandoned for a period of six tonths after the tite the worK is co..eneed, One 90 day extension of tile, lay be
allowed for the pertit with fee charge of SI5.00. The extension shall be requested in writing to the Building Official, An
approved inspection tust be logged during each six tonth period, Dr the project Nill be considered abandoned,
WARNING TO OWNER: YOUR ~AILURE TO RECORD A NOTICE OF COKKENCEKENT "AY RESULT IN YOUR PAYING TWICE FOR I"PROVEKENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COK"ENCE"ENT, JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMKENCEKENT",
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA
COUNTY OF
The~foregoing instrument
before me this 4- I!;?
was acknowledged
, 19.2.2.. by
STATE OF FLo~ ~
COUNTY OF 'J!jVYl flfl7 0
, The forege1ing instrument
befct\-e me th i s J..j'II/)
"las acknowledged
, 19~ by
tf J..J..,6tI-
or Stamped)
G~ Be&'AH
who is per onally known to me or who has
pl-oduced
as identification and who did/did not
take an oath. f\ " d//~/t
)J,/JA'.P./ ,=,,/.e:i:.l31'L
(Signatur~ L' .~
-:12111/1//;: @. IfZlL
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
who is personally known to me or who has
produced
as identificatain and who di~/did not
take an oath. . C?~fi~ IL-
l 0A1P./ ~J!i!L~
(Signature)~
~//1N(f
(Name Typed, Printed
NOTARY PUBLIC
ST Ar~DARD FORM OF AGREEMENT
BETWEEN CONTRACTOR AND OWNER
THIS ACREEMENTm.de th. &F7:4F/V7Y ~.~
Nineteen Hundred anti N//V/.:I/{ - Tv...:;o by and between r e.
hereinafter called tho Contractor, and l-le71-1LL1e~ OR...L;;r/YJJ().~/oj
Owner, Witnesseth, that tho Contractor and the Owner for the conslderatiolU named agree lU follows:
III the year
hereinafter called the
ARTICLE 1, SCOPE OF THE WORK
and perform all of the worle s(wn on the Drawings a~described in the Specifications
entitled ~ t2 710 S.Ln.e5 OA/c..
prepared by ~, .' acting as and In these
Contract Documents entitled the Architec, and shall do everylhlng required by this agreement. the general conditions of the Contract, the
Specifications and the Drawings,
ARTICLE 2, TIME OF COMPLETION ")
The worle to be performed under this Contract shall be comme-ncen M S[:()1l ClS {-(>C'I'Y\'I+ j <,
substantially completed W 1m / N (2) N e-- L2:E-5- k
'-eQte\,)ec\
.nd shall be
ARTICLE 3, THE CONTRACf SUM
The Owner shall Jl" the Contractor for the performance of the Contract, subject to additions and dcductioI:s provided therein, in current
funds as follows(-H 4t1m,60 ) -~ 7J>Ou.$Li!Y~ _ .
- (StOle heft' the lump lurn &mount, unit pr.cc.. or I-oth, as d"lred)
Authorized Change Orders will be submitted by the Contractor for all work not speciBcally includ(~d in tlis Contract.
ARTICLE 4. PROGRESS PAYMENTS
(Ins<!rt he", any provulon made for the runount retalued after the work reaches a ('<'rtain .tage of comp'.:>on.)
. ARTICLE 5, ACCEPTANCE AND FINAL PAn{~'lT
Final payment shall be due ---r}+r-: day, rIif, substantial completion of the worle provided the won: be then fully completed
and the Contract fully performed,
.-
ARTICLE 6, THE CONTRACf DOCUMENTS
The General Conditions of the Contract, the Specl1ications and the Drawings together with tJlis Agreement, fonn the Contract, and they
ILre ns fully a part of the Contract as I hercto attachcd or herein repealed,' The fo(]owing is an itemization of oUlCr essential pertinent
Information:
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