HomeMy WebLinkAbout92-2516
BUILDING PERMIT
Permit
251~,
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7-~? -92
---
CITY OF ZEPHYRHILLS
(813) 788-6611
N~
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~
Date
Property Owner:
~-' ~' Sewer Conn
fl Water Conn:
Q ~ _ ~~~ . W':': Mot"
__ _ _7~_~t ~, T,j,F, s.
//(- ~&.- .:2/- nD 00 - tJO~DO- 000<::)
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Job Address:
Parcell.D. #
Zoning:
Description of Work
Energy Code:
/D 1,;< .L/D (
Radon Gas:
a ()
r
NO OCCUPANCY BEFORE C.O.
FINAl~'"
Complete Plans, Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Valuation or AL ik.>
Contract Price ~.I f? r ' ~
City License Registration # 71
State Certified License#
V~ ~:fi~~ atJ~~
BUILDING ELE~'
-
~~
Address
Telephone#
PLU~.
-
MECHAl\lI( ^.L
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
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.
APPLICATION FOR PERl'lIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
I'J
APPLICANT ~U-N ~.~
~\SL~\ ~'~
"bl'\~9..~ C-~b\L~
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ADDRESS
~~
PHONE( ~ ~- -r~ <::) <8
OWNER
JOB LOCATION
LOT SIZE~~ AREA SQ. FT.
---
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION l;:) \~<~(lh m t\.'?
PARCEL I. D .IF
/ Jf - .:2.h - ;? /- {) 0 0 () - C /J ;;< 0 0 - (} () (J i)
WORK PROPOSED:~New Construction ____Addition ____Alteration ____Repair ____Install
____Sign/Temp.
____Sign
_Move
____Demolish
PROPOSED USE: ____Single Family
____M/F
____4F of Units
,____M / H
____Commercial
____Indust.
____Swim. Pool
Other
> ____Restaurant & Health Departme~~pproval
BUJLDING SIZE: In x~, 4-Cu 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. ~d.
**COpy OF CONTRACT REQUIRED.
PERMITS REOUESTED
____BUILDING
$
Valuation of Total Construction
____ELECTRICAL
,~
____MEt:HANICAL
AMP Service
Florida Power Corp.
_\oj.R.E.C.
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block ____Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
Signature
CONTRACTOR SECTION
Company ~'^~ S\ ~ (J~
State Cert. or Regist. #
City License Registration # "
******************************************
ElECTRICIAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
PLUMBER
Company
State Cert. or Regist. #
City License Registration 1
**********************~*******************
Signature
Company
State Cert. or Regist. #
City License 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 Clt,
regulations. The undersigned assules responsibility for cOlpliance with any applicablp deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPlJNSIBILITIES
If the owner has hired a contractor or contractors to undertake worK, they may-be required ~icensed in accordance Hlth
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lav bE
cited for a lisdeleanor violation under state IaN. If the owner or intended contractor are uncertain as to what lic~nsinQ
requirelents tay apply for the intended worK, they are advised to contact the City of Zephyrhills Building Department, (8131
788-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions Df 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 lephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEE2,
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
6uide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than t~e
"owner., I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it t" the
.owner. prior to cOllencelent.
'I
(
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infortation in this application is accurate and that all Nork will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
$
Application is hereby .ade to obtain a pertit 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 .eet standards of all lans
regulating construction, City codes, zoning regulations, and land developtent regulations in the jurisdiction. I also
certify that I understand that the regulation~ of other govern.ental agencies lay apply to the intended work, and that It is
IY 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 Environlentally Sensitive Lands,
W~ter/Wastewater Treat.ent
. Southwest Florida Water KanaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f Arty Corps of EnQineers - Seawalls, Docks, )!avigable Waterways
f De artlent of Health & Rehabilitative Services Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f Environlental Protection AQency - Asbestos abate.ent
I 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 .co.pensating volute. will be sub.itted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A permit 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 fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code, Every pertit issued shall becole invalid
unless the work authorized by such pertit is cotlenced within six lonths of issuance, or if work authorized by the permIt is
suspended or abandoned for a period of six tonths after the tile the work is cOI.eoced. One 90 day extension of tiie, ~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 lust be logged during each six tonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COKKENCEKENT KAY RESULT IN YOUR PAYING THICE FOR IMPROVEMENTS TO 'tOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCIN6, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
~03;~THEEnTD'~
- -- - -- - "' I\6EHT - -',. ACT: -
STATE OF FLORIDA
COUNTY OF
The foregoing ins~ument was acknowledged
before me this Z; :,,23 ,19~ by
f
STATE OF FLORIDA
COUNTY OF
The foregc. i ng ins ;Zlment
befcl}-e me th i s '1 ~~
vla.S acknc1vJledgE'd
, 19~ by
who is personally known to me or who has
produced
as identificati g and who did/did not
take an o~t,~ e
(Signatuce) NotaryPu licPascoCo.Fl
M r "r' I
. \" .' "'.;,;"l~- "-:1'1'f(S l~a~ p. 1995
(Name Typed, Printed or S~ampe
NOTARY PUBLIC
who is personally known to me or who has
produced
as identificati~~
take an oath K (,
(Signature) Publ~ Pasco Co. FL
Notn'Y de ) \99S
(Name TYPM;,CdIMI~Em1~~Jed)
NOTARY PUBLIC
Ct did/did mot
~~ lIE }' .i.;~
(R1!..S 11)1:::'1 l' Ud, ',,; L J:,~. _ .'
,\..ReEL I. D .
SEt:
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'ROrEHTY t-tEASUHLJ-JENT
:lJHHENT OWNEHS _'_____k?~~-~C~~_____J:\() ~J f>
\lldrnwlngs ahall be dra\i11 to Lieale for H11 parCl~L; ur: ~0L:j
f 1 \' ,.
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SHOW ALL EXISTING AND PHO [,USE]) ST;\lJCTURES C; lV ~lL; DLilL, '; t ',',L
M'Y BODIES OF WATER AND J\OAIJ\-iAYS (lNCUJDItiC ti,~L:S:: IcL:J/',Cl,,"
THE SIZE, YEAR, A.t-.{IJ N/-.;-!E OF t'\'JIHU:; SUCH :\S 12' ;; (. . .';,',
All "EASEMENTS", "RIGHT-OF-\(iAY" and "JUIZlSDICTIUtil\!. l. :::'::<'; " "
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SUN
STATE .6LUMINUM,
37528 Hwy, 54 West
ZEPHyr;Hi~.LS, FLORiD''- 335Lfl
(813) 788.7308
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JOB NAME
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CITY, STATE AND ZIP CODE
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ARCHITECT
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JOB LOCATION
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JOB PHONE
DATE OF PLANS
We hereby submit specifications and estimates for:
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1ItlIr 'rnpnnr hereby to furnish material and labor - complete in accordance
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Payment to be made as follows:
with above specifications, for the sum of:
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All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica-
tions involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate, All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
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Authorized _ _....' ~- ~'~~~~:'2=:~;~Z;~---'<~-'---'-
Signature, _ ..'
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Note: This proposal may be
withdrawn by us if not accepted within
Date of Acceptance:
Signature
days,
, ~. .-..c,.;"
AtttptaUtt nf 'rnpnl1al- The above prices, SP~c'~icati-ons
and conditions are satisfactory and are hereby accepted, You are authorized
to do the work as specified, Payment will be made as outlined above,
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Signature I
I-'RODUCT 118-3 ~s}elnc, Groton, Mass 01471 To Order PHONETOLl FREE 1+800.225.6380