HomeMy WebLinkAbout92-2422
BUILDING PERMIT
Permit
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CITY OF ZEPHYRHILLS
(813) 788-6611
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Date
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Zoning:
Description of Work
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
City License Registration #
Certified License#
/If 7nJ_4~
Inspector
:~;~~::,:etJil~i~
Company
Address
Telephone#
Valuation or ~....; _ ~ ~
Contract Price 0< J /6. (J
ELE AL
Ftr. lo-l'1-q;). 81LL
Pre SLB fD~ ,f)-q~ BILL
Lintel
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
b-Pl-<1:J flU
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
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.
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMEFT
APPLICANT /1V-}/ (fJ ;q9~N'?ll C9YJI!AlT,,/ I\.r /'
ADDRESS 1/'191 6'E))I7Je 6f ~iJk(j Ilk; FI ~3'~(/PHONE 9.ot/~ ?99~,-~~)O
OWNER f! / R-n nil / K<;
JOB LOCATION &'0,-% 7?))')9~ l.lJf-}j LOT SIZE~X/M / AREA SQ. FT.
I
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION )?~Jly;? -;r/~Ar
PARCEL I. D. # 3-.;24> -;;lJ - 0/36 ~ ()/)/X)o - () '-/70
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_I
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
vBUILDING
$~, 3l1(J.oO
Valuation of Total Construction
____ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
,
_MECHANICAL
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block ____Frame ____Steel
,Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
Signature
d~ ~ob
CONTRACTOR SECTION
Company
State Cert. or Regi t. #
City License Registration
******************************************
BUILDER
ELECTRICTAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
PLUMBER
Company
State Cert, or Regist. #
City License Registration #
*********************~********************
Signature
f,
~o ~:f~""
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sliiu~e~fI! - t)~::> "',
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Company
State Cert. or Regist. #
City License Registration #
**********************k*******************
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Company
State Cert. or Regist. #
City License Registration #
'~~Z:"~'"
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 .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 Dr contractors to undertake work, they .ay be required to be licensed in accordance with
state and local regulations. If thl contractor is not licensed as required by law, both th~ owner aid 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 lay 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 contractoT(s) sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the owner sign ~ 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 p!rlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS ~MENDED)
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 Consuler Affairs. If the applicant is so.eone other than the
'owner', I certify that 1 have obtained a copy of the above described docu.ent and pro.ise in good faith to deliver it to the
'oNner' prior to cO.lence.ent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
1 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 per.it to do work and installation as indicated. I certify that no work or
installation has cO'lenced 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 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
,y responsibility to identify what actions 1 .ust take to be in co.pliance. Such agencies include but are not li.ited to:
f Depart.ent of Environlental ReQulation - Cypress Bayheads, "etland Areas and Environlentally Sensitive Lands,
"ater/Wastewater Treat.ent
f Southwest Florida Water "anaQelent District - "ells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Depart.ent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
f US Environ.ental Protection AQency - Asbestos abatelent
1 also certify that, if fill .aterial is to be used in Flood lone "A" or "A,etc.', it is understood that a drainage plan
addressing a 'colpensating 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 perlit prevent the Building Official frol 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 COI.enced within six lonths of issuance, Dr if work authorized by the per.it is
suspended or abandoned for a period of six .onths after the ti.e the work is cOI.enced. One 90 day extension of ti.e, .ay 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 .ust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COK"ENCEKENT "AV 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
CO"KENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECOR~ AND POST A .NOTICE OF COMMENCEMENT'.
t1J);%J ~a~ j
SIGNATURE: OIlNER 0 AGENT
~ v:1oflj~
SIGNATURE: NTRACTOR
STATE OF FLORIDA
COUNTY OF P 11.5(7 0
Th~,foregoing instrument was acknowledged
before me this .. rVvE Jt, 19~ by
-
STATE OF FLORIDA
COUNTY OF !-I eEl?.AI AN /)/)
. The foregcoing instrument
before me this /~
~Jas aC~Wledged
, 19 by
6
Ih-A JJ '1/I.-/;:.J .
who is pers nally known to me or who has
produced R... -:DR/lias /-/('EJ.}3C':
as identification and who did/did not
take an oath. ~ ,A~
(Signature)1-<-AT1-I~ '3 B~o\J
who is pe
produced
as identificat'on
take an oath. I
(Name Typed, Printed Dr Stamped)
NOT ARY PUBL I C NotafY PubUc, State ':'t large, Florida
My commission ExpIres Apnl2. 1995
nHS AGREEMENT made thcFi ~~NT)/
Nineteen Hundred ann Hi AI Y 0
hereinafter called the Contractor, a~d AI A'^f fY7,'/ e5
Owner, Witnesseth, that the Contractor Blld the Owner for
STANDARD FORM OF AGREEMEN'T
BETWEEN CONTRACTOR AND OWNER
by aM between ~;~~ef~
I., the year
the conslderatJons named agree 8J follows:
hereinafter called the
ARTICLE 1. SCOPE OF THE WORK
ARTICLE 2. TIME OF COMPLETION ) I
The work to be performed under this Contract shall be cornmcncecl ffi '5Ct)!1 0.<; (-e(TY\'I+~ \-ec:'le'(,t'C\
substantially completed W rrn IN ONe- ~r k
And shall be
ARTICLE 3. THE CONTRACf SUM
The Owner shall J?,l. the Contr~ for the perfonnance of the Contract, subject to additio~~nd...Jbdyctio~s providcd therein, in current
funds as follows~.Q,~, t?2Co 7H'OL.(<;;q.N~ 71I,ep,cHILN^J'?Y!l /?OD
. ,- (State here the lump rom amount, unit price.. or l'oth. as d."lred) .
Authorized Change Orders will be submitted by the Contractor for all work nol specwcally included in this Contract.
:\RTICLE ". PROGRESS PAYMENTS
(I""'rt here any provision made (or the anlOUD! retained after the work reaches a certain .tage o{ comp>e:ion.)
ARTICLE 5. ACCEPTANCE AND FINAL PAnfENT
Final payment shall be due f7+r=: day, ~ substantial completion of the work provided the V..'Orl.: be then fully completed
and the Contract fully performed.
"
ARTICLE 6. THE CONTRACf DOCUMENTS
The General Conditions of the Contracjjt the Specl1lcations nnd the Drawings, together with this Agreement, form the Contract, and they
~re as f,!lIy a part of the Contract as hercto attached or herein repeated. The following is an itcmizatio.. of other cssential pertinent
mformation:
Otbn 14t.J
~ P'klf' 1Il!;lt-S Ltetn/""
nMINo~t/:r!M'-.?d;;t b:Z=:;
. Notary Public, Stale At Large, Aorida.
My Commission Expires April 2, 1995
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