HomeMy WebLinkAbout92-2513
BUILDING PERMIT
Permit
251311.
7 - .;J..3- 7.1
CITY OF ZEPHYRHILLS
(813) 788-6611
N<!
Date
c9-~, tJlJ
~ ~TRICA0> PLU~_.
Property Owner: ~~ -4~
Job Address: <-? P- 3-5 ~ - /IJ /Z ~ -
,;2..5:
Sewer Conn
Water Conn:
Water Meter:
T,I.1':s:
Parcell.D, #
Zoning:
Description of Work
Energy COde; LA ,r,. Radon Gas:
~/c e'~'rr- ~
FINAL ;2-;Ly-y-?
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee ~-; t:JO /
S;gnatu,. ~ -t<--J. Z-z--
Company --=-- (
Address
Telephone#
Valuation or
Contract Price ~ ~ ,6 (). trb
City License Registration # 7 /
State Certified License#
\~~9~
Tp. SeN. SLB
Rough In Tub Set
Meter Can Water
Const. Pole Sewer
Pool Final
Pre-Meter
Final
(Jl~
Breakers
Ducts Insl.
Compressor
Final
~G
~G
--..........
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 ($15.001 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.
APPLICATION FOR PER~IT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER
~/V S 7' ~. C2'~ IrrA~
7 7 .+,~ /--;j. ~ A/~_
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X>;v C...,. U "-' I /1 9/
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APPLICANT
ADDRESS
PHONE
JOB LOCATION
'? G ?s'~..z
,)()~
It? "t- ffJ e..
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D. ~F
WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ____Ins tall
____Sign/Temp. _____Sign _Move _Demolish
PROPOSED USE: _Single Family _M/F _# of Units ._H/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 FOR~S.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOR~S.**
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_\-l.R.E.C.
_MECHANICAL
$
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. #
City License Registration #
******************************************
BUILDER
Signature
CompanY h'R. -:d- (? /rt >' 5
State ~ert. or Regist: #
City License Registration #
************************************
-----
b~cTL :e-
/ <'~'7
Company
State Cert. or Regist. #
City License Registration #
******************************************
PLUMBER
Signature
OTHER
.,J;,. Company r'" u: C,,~ Ir<~~ ~..~ ~.
State Gel' . or gist. #
r City License Registration 'F 7 I
******************************************
Signature
Company
State Cert. or Regist. #
City License Registration #
Signature
APPLICATION APPROVED BY
~******~***************************
dAu"(] p /) ""')~ r
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 aay be .ore restrictive than City
regulations. The undersigned assuaes 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 .ay 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 .isde.eanor violation under state IaN. If the ONner Dr intended contractor are uncertain as to Khat licensing
require.ents lay apply for the intended work, they are advised to contact the City of 2ephyrhills Building Depart.ent, (BI3)
788-6611.
Further.ore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) 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 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 Protection
Guide" prepared by the Florida Depart.ent of Agriculture and Consu.er 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 prolise in good faith to deliver it to the
"owner" prior to cOI'encelent.
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 cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no work Dr
installation has cOI.enced prior to issuance of a perlit and that all work will be perfor.ed to .eet 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 .ay apply to the intended work, and that it is
.y responsibility to identify what actions I .ust take to be in cOlpliance. Such agencies include but are not li.ited to:
f Departlent of Environ.ental ReQulation - Cypress Bayheads, Wetland Areas and Environ.entally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
t Departlent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
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 "colpensating 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, 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 per.it issued shall becole invalid
unless the work authorized by such perlit is cOllenced within six lonths of issuance, or if work authorized by the pertit is
suspended or abandoned for a period of six lonths after the tile the work is coslenced. 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 .ust be logged during each six lonth period, or the project will be considered abandoned.
WARNINS TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAY INS TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER OR AN ATTORNEY BEFORE RECoRDINS YOUR NOTICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER DR AGENT
SIGNATURE: CONTRACTOR
was acknowledged
, 19____ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
was acknowledged
~ 19_____ by
who is personally known to me Dr 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.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
,'"
,-
, < ~.
Kinsey Central
Heat & Air-Conditioning
7722 fort King Highw~V. P.O. Box 2209
Zephyrhills, Rorida 33539-2209
(813) 782-2300
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DATE PROMISED
APARTMENT
MAXE
NATURE OF r-'\.
SERVICE ~
REQUEST
fj-ESTIMATE
I 0 CASH
o CHARGE
QUAN, PART NO,
DESCRIPTION
PRICE
AMOUNT
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7~~/1 DATE COMPlmO I CASH g~ :~~ETI0N -+ TOTAL / 't3b~~
TECHNICIAN
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