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Home My WebLink About92-2527 BUILDING PERMIT CITY OF ZEPHYRHILLS (813) 788-6611 Permilt N~ 2527? ! Date 7-- J-7- r :J.- ~ EL~ ~V ::::::,~:~e'7J{1?J~ /dW ' Parcell.D. # ..3s- -~S-~I -< ~ - ~ ME~, Sewer Conn Water Conn: Water Meter: T,I.F.'s: Zoning: E~ode: Description of Work .y.!'" ~ Radon Gas: .~ /> ~ ~~I> V\}~ Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. FINAL C.O. DATE NO OCCUPANCY BEFORE C.O. DATE Inspector Permit Fee Jl..6 -: iTV s;gnat"'~ t. ~A...' Compan _ Address Telephone# Valuation or Contract Price ~. a?Jf). o-D " City License Registration # 6 / y-- State Certified License# ~~~ UH~JC-(j ELE~AL ~MBIN~ ME~ICAL ~ ~ SLB Breakers Tub Set Ducts Insl. WaNr Compreswr Sewer Final Final ~nING -- Tp, Serv, Rough In Meter Can Ftr. Pre SLB Lintel FRM. Insul. CL WL Canst. Pole Pool Pre-Meter 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, I'S ,_~ ' APPLICATION TO CONSTRUCT, REPAIR, MODIFY OR ABANDON WELL j',,", '~'~ ; r ", ;, ~ SOUTHWEST FLORIDA .,' / WATER MANAGEMENT DISTRICT ,\"",,-,' 2379 Broad St., Brooksville, Florida 34609-6899, (904) 796-7211 I. Permit No, 'd Fi(/0l; /j/ ./ r) '1 (! . '-- WUP Application No, 17 -524 Well / ?fl,O() Owner Number Stipulations Required 1. .:. . - . . -l.-.~~ !/k 7~-~~:? Telephone Number 2. L) rtl n1 }:f i<T ..., ,/7- S- Well Location: Address, Road Name or Nurrt6er cpaL L Glvri . r'-((//ff l'i '/))~/ 3. L08,.Js* e.,- L....JP II O,..-II,'V1 q Drilling Contractor' .....) 7. zil- ?z- Date 210 '3 License No, Address OT'5 fJlI,o.-, {)~,.o &~Jrh: 1J 5. City I r State I rl. 3 5 _5"'-1 () Zip Code l,tcoso 4. Number of Wells:-1- . Check the Use of the Well: _ Domestic v1rrigation _ Public Water Supply _ Heat Pump! AC Supply _ Recovery _ Class V, Heat Pump! AC Return _ Livestock _ Industrial _ Class I Injection Well _ Test (WUP) _ Monitor (Type) _ Other 5, Application for: 6. Casing _ or Liner _ (Check One) v--- New Construction _ Black Steel - PVC _ Repair/Modify vGalvanized Other (Specify) _ Abandonment 7. Method of Construction: _ Rotary t/""Cable Tool _ Combination _ Auger 8, P8S0('") County Subdivision Name Lot Block 1/ ~L- Diameter Seal Material (Specify) Other 9, Quarter Quarter Section Unit ~ (Indicate Well in Chart) 10.section~ Township ;2.5'"" Range 2./ "I "I Dra~ map of well location and indicate well site with an ,"X", Identify known roads and landmarks; provide distances between well and landmarks. North 11, On 6-inch wells & larger: Latitude Longitude , t,\,. E License No, .... 13,/5 this well or any other well or water withdrawal on the owner's contig a Water Use Permit (WUP) or WUP application? Yes _ NU- If yes, provide WUP No. the owner of the property. that the informa on well location is accurate, and that I 8m aware of my nder Chapter 3 Florida Statutes, to maintain or properly abandon this well; or, I certify that I am the agent for the ed s ae te, d that I have informed the owner of his responsibilities as stated above. .. South ~ """ .wiJ Owner Number: \ Fee Received $: ,. , ,_,.,--...... _ Date: Check No,: Title: .~ THIS PERMIT NOTVALlD UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OF SWFWMD(R), IT SHALL BE AVAILABLE AT THE WELL SITE ~, DURING ALL DRILLING OPERATIONS, SF 30613) REV 4/90 L u,_ _,_,",..,._______ _,. "". DRILLING CONTRACTOR COpy - 1 .- --=:'~,- ~:p..;. ..--- ..--""'.--.'-.- ~-~.:.-,- APPl.I'::ATIOII FOR PElWtTT CITY OF ZEPIIYRHD..LS BUII.DllIG DEPAR'IT/L:!Yf OWNER'S MAIfE~ltA-tJx/ /JJ4t:.-e~1 PIlOn /.g~-S-6.-? '3 OWNER'S ADDRESS ~ Cf /2 f, 14 ( 5(:TbP1/ 14 l/ E Ze 'pIIYIf/.fr (15 . .JOB ADDJlI!SS 7'1;).5 CIjL L ~I nQ ~)I1{ k,11s (J'[ LEGAL DESCRIPTION: I.OT(S) BI..OCK SUBDIVISIOlNl PARCEL I. D . :f 35 -d5- ~J ~'d. WORK PROPOSED:~lIev Construction _Addition _Alteration _Repair _Install S' - 19J1 _Move _Deaolish PROPOSED USE: Single Faaily __KIF _, of Units _K/H _Stria. Pool '=r,n4tcd (Of) Ltlilbt:h:J" _~rcial _InduIst. _Rest:aurant &- Hea1t:h ~t Approval BUILDIIfG SIZE: x Square Feet. Height _ RESIDEIfTIAL: COHKERCIAL : ATTACH (2) PLOI' l'UUIIS &- (2) SEIS OF BUILDING PLAJlS &- (1) SET ENERGY FORKS. ** ATTACH (3) SEJ'S OF BUII.DDIG PLAIIS &: (1) SEI' mmRGY FORKS.** **COPT OF OOllilTRACT RIlQUDnlD. PERl!lITS REQUESTED _BUILDIIfG $ Valuation of Total Construction _ELECTRICAL AftP Service Florida Power Corp. W.R.E.C. _ttEGIIAIUCAL s Valuation of Mechanical. Installation _PLUKBIlfG GAS ROOFlliG SPECIALTY :t:'\"n 1~-+ \..U~ L' 'l() ~ Ot:her TYPE OF COIfSTRUCTION: _Block _}ira.e _Steel FIlfISHED FLOOR ELEVATIOBS: FT. IS PRO.JECT DI FLOOD ZONE AREA? YES NO ****************************************** (X)II"I'RACI'OR SECTION CO!tPAft St:ate Cert. or Regist.., I City License Registration , ****************************************** BmTJ)ER Signature Simtature CO!tPARY St:are Cert. or RegisL, f City Li~ense Registration I ****************************************** ELECTRICIAN Signat:nre CO!tPMY St:ate Cert. or Regist. :/IF Cit::7 "::-':'~"!'i!5e R~e~.st:'!:"..n-m ! **********t\-***....******.,'~*********':.*******... -I: PI.1.ltlBER aJ!IPAlfi St:at.f: CerL or Regist. I City .,icense Registration I *********************'l1'.k, ';.".,,,.************** CDWAnIOC/s('kt:i ~1(1 &t/!t/7C"j ~-ff- St:ate CerL or Regist. f tJ.3 /7'f~--ttl'~<--- City License Registration I, - ~ I f"" ****....,..,,:A-.,...;I:......*****-:t:....*':'** ...***************** MECHANICAL Signature OTHER Signaturer~t: APPLICATION APPROVED BY PERKIT OFFICER. COND I T IONS or: PERM I T AFF I DPl') I T A. NOTICE OF DEED RESTRICTIO~S The undersigned understands that this perlit .ay be subiec~ to "d~ed restrictions" which may be lore restrictive than City regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS ANr C8NTRACTOR RESPONSIBILITIES If the owner has hired a contract"f!lrCo!,ltraciors to c1ertakp- work, thl!Y lay be required to be licensed in accordance with state and local regulations. If the contractor isnDtlicense~ as required by law, both the owner and contractor lay be cited for a lisdeleanor violation under state IaN. If the owner or ~ntended contractor are uncertain as to what licensing requirelents eay apply for the intended worl:, they are advised to Cl\!':"~ct the City [If Zep,hyrhills Building Deparhent, (813) 788-6611. Furtherlore, if the owner has hired a contrartor or contractors; he is advised to have the contractor(s) sign portions of the 'Contractor Sections" of this application for ~hich they will hp responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are r~5ponsible 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 ZephyrhilIs. C. TRANSPORTATION IMPACT FEES AND UTI~iTY CONNECTION FEES. D. CONSTRUCTION LIEN LAW (C~l~PI~R ~~3, ~LORIDA 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 Departlent of Agriculture and Ccnsuler Affairs. If the applicant is sOleone other than the "owner", I certify that I have obtriined a copy of the above described doculent and promise in good faith to deliver it to the "owner" prior to COltenCelent. 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 co.pliance with all applicable laws regulating construction, zoning, and land developlent. Application is hereby lade to obtain a perlit tu do work and installation as indicated. I certify that no work or installation has cOllenced prior to issuance of a perlit anu 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 - Cypr~ss Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatlent f Southwest Florida Water "anaQelent District - Wellsj Cypress Bayheads, Wetland Areas, Altering Watercourses f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways f Departlent of Health ~ Rehabilitative Services. Environtental 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 is understood that a drainage plan addressing a "colpensating volume' will be 5uhl!tted which is Jrepared by a professional engineer registered in the State of Florida prior to perlit issuance. A permit issued shall be construed to be ~ license to proceed ~ith the work and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor shall issuance of a pertit prevent the Building Official fro. thereafter requiring a correction of errors in plansrconstruction, or vi~lations of any code, Every perlit issued shall becole invalid unless the work authorized by such perlit is commenced within six .onths of is~uance, or if work authorized by the permit is suspinded Dr abandoned for a period of six lonths after the tile the work is [omienced. One 90 day extension of ti.e, 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 month period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT MAY RESULT IN YOUR PAYING TWICE FOR IHPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO"HENCEHENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT.. STATE OF FLORID~ COUNTY OF ~ (~ The foregoing instrument was acknowledged before me thiS~... ~ ,Ai, 19~ by 1'\\ ~ P' ~ ~ ..,- who is personally known to me or who has prc1duced ~ \J~s. I lC'6\'l ~F as identification and who did/did not tak~ an oath. .~, CJ eA OCL_~ ~ -ll A..~ (Signature) ~ ~~ (\'\ '- lS~''.:1 ~~O()3147 (Name Typed, Printed or Stamped) ---- NOTARY PUBL I C t,lfJi~S:'r rr.:!UC STATE ,OF :LCRI~^ .", ;','n"'~"l(':': [i'P. t.t5,,/ 21,1994 !"; '..'J' ..'11 ".. ~"., ..,., NS UND i:::,FiJ,;D Tdilll GtCc.ll:;... L.. , . ~<i~ SIGNA URE: CONTRACTOR fL~L~L3~~-J+~s.-c';3--d ~-U STATE OF FLORIDA () COUNTY OF +J:' 'S. Co The foregoing )nstrument was acknowledged befclre me thi~ ~.;,).I , i9~ by ~\~ep~ E. LDe\'ScA:tt-:<<- who is personally known to me or who has produced D~..\. vf.S"fL ') J.-\(" f?J'1 ~ ~ as identification'and who did/did not t a:):' e an CI a t h . 12... "'"'il-:- -C_O..l 00-_ ~ ,~ J I, LV (Signature) ~ X, . I C~~ rv\.. ~~",n-'-f ~ (Ccf)):I-1'-+ 7 (Name Typed~ Printed 01 Stamped) NOTARY PUBLIC Nor.~RY PUBLIC S MY,,~Ci;';:'lISS!ON E;~Tf OF FlORIDA BO',UED THRU Ct"'t"n: M,W 21,1994 , ,,,,"..,L INS. UNO.