HomeMy WebLinkAbout92-2605
BUILDING PERMIT
Permit
260sA
'j
?"-r9.6 -7:J...
CITY OF ZEPHYRHILLS
(813) 788-6611
N~
Date
. EL~ P~
P,"perty Own., J::..!~~-
Job Address::1 7 ~ -
~HANICA~ewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcel 1.0. #
Zonin~: . _ --p ... Energy c,tPe' . J.I ~~n Gas:
Description of Wor~ c ~ _~tri.~
FINAL-t
'2-
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
t;;l3
Permit Fee
Signature
Company
Address
Telephone#
Valuation or
Contract Price
c3, / ..5-7. CTb
"
City License Registration #
State Certified License#
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
~~;!:
c-MECHAry
Breakers
Ducts Insl.
Compressor
Final
BU~
~AL
~erv. ~
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
P't:'bI!v1 BIN G
~
SLB
Tub Set
Water
Sewer
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 PERKIT
CIY'.l OF ZEPIIYlllXII.I..S
BtJrUDlliG DEPAR'DIIlXT
OWNER · S
MAKE ~jZ'fZ-~N\ ~~
vJ~f
PRONE .
.?~1:~
OWNER' S ADDRESS
JOB ADDRESS 31 8l ?
I ? ,t1 G. 1'. W.
LEGAL DESCRIPTION: I.OI'(S)
BLOCK
SUBDIVISION
PARCEL I. D.I
WRJ{ PROPOSED:_5ew Construction .--.J\ddi.tioo. 1A1teration. _Repair _Install
_Sign
_I!tove
_ne.o1ish
PROPOSED USE:
Single Faai1y
-LK/F
_Indust.
_, of Units
_S~. P001, ~ GLf-
_"/H
_~rcia1
Ot:her
_Restaurant &: Hea1t:h Depart:.ent Approva1
BUILDUiG SIZE:
x
Square Feet,
Height
RESIDENTIAL :
cottKERCIAL :
A'l'TACII (2) PLOI' PI..MlS &: (2) SEI'S OF BUllDIMG PLUlS .&: (1) SEI' EllERGY FORMS. **
ATTACH (3) SETS OF BUII.DDIIG PLUlS &: (1) SEI' ENERGY FORMS. **
**COPt' OF CONTRACT REQunmD.
PERl!lITS REQUESTED
_BUILDING
$
Va1uatioo. of Tot:a1 Construction
_ELECTRICAL
-X....KECllAllICAL
.AKP Service
F10rida Power Corp.
W.R.E.C.
$ 31\'157.00
Va1uation of lIIechanica1 Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION!: _B1ock. _Fraae _Stee1
Ot:.her
FIlfiSHED FLOOR ELEVATI05S:
Fr.
IS PRO.JECT IN FLOOD ZONE AREA?
YES NO
********~*********************************
CON'I'RACIOR SECITON
COI!IPMUY
State Cert. or Regist. I
City License Registration I
******************************************
BUILDER
Signature
SiPTlature
COI!IPARY
State Cert. or Regist. I
_ City License Registration 1
******t*t*****......******************t***t**'*
ELECTRICIAN
Signature
COI!IPMiY
State Cert. or Regist. t
City License Registration 1
**********t*****......*************ttt**t**t**
PI.OttBER
Signature
KECllAllICAL
COI!IPANY ?faMN--\ ~\ft.'7 ~1~\l.L.G~~ J INC..
State Cert. or Regist. 1 oo't-'\~BooO\"16
City License Registration 1 ('.?1/ ~
**************......************************** ..-
COI!IPAlWY
State Cert. or Regist. I
City License Registration ,
********t*************************t**t****
.
0'I'1IF.R
Signature
APPLICATION APPROVED BY
}fd.4<.f'~ >B~h-.'-
PERKIT OFFICER.
CON lITIGNS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTF: !_CT r..Q,\JS
The undersigned understands that thi5 per iit .r3V be SUjlj~ct tv "deed restrictiDns. which .ay be lore restrictive than City
regulations. The undersigned assules re~ :onsibil~ty for cOlpli~nce with any applicabl~ deed restrictions.
B. UNLICENSED CONTRACTOI~ AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or n.ltractors to undertah Ilorkl they laY be required to be licensed in accordance with
state and local regulatiflns. If the,.centfactor is not licensed as required by lall, both the owner and contractor laY be
cited for a lisdeleanor \iolation under state law. If the o~nel or intended contractor are uncertain as to "hat licensing
requirelents lay apply fer the intended lurk, they are advised to contact the City of 2ephyrhills Building Deparhent, 18131
788-6611.
Furtherlore, if the ollner has hired a contractor or cOhtractors, he is advised to have the contractorlsl sign portions of the
.Contractor Sections" of this application for IIhich they lIill be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the 1I0rk. If the contractor wishes you to sign
as contractor that .ay be an indication t,;at he is not properly licensed and is not entitled to perlitting privileges in-the
City of Zephyrhills.
C. TRANSPORTATION IMPACr FEES AND UTILITY CONNECTION FEE~
D. CONSTRUCTION LIEN LAY (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have beE:; provided lIith a copy of .Florida's Construction Lien Lall - HOleOllner's Protection
Guide" prepared by the Florida Departaen! of Agriculture and Consuler Affairs. If the applicant is so.eone other than the
"ollner" , I certify that I have obtained a copy of the above described docu.ent and promise in good faith to deliver it to the
"owner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work lIill be done in cOlpliance lIith all
applicable laws regulating construction, zoning, and land developlent. '
Application is hereby aade to obtain a perait to do work and installation 'as indicated. I certify that no 1I0rk or
installation has cOllenced prior to issuance of a perait and that all lIork lIill be perforled to leet standards of all laws
regulating construction, City codes, zoni~g 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
IY responsibility to identify what actiors I lust take to be in cOlpliance. Such agencies include but are not lilited to:
I Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Tre~t.ent
I Southwest Florida Water HanaQelent District - Wells, Cypress Bayheads, Wetland Areasl Altering Watercourses
I ArlY Corps of EnQineers - Seawallsl DorksI Navigable Waterllays
f Departaent of Health ~ Rehabilitative ~ervices, Environaental Health Unit - Wells, Wastewater Treatlent, Septic TanKS
I US Environaental Protection AQency - A~bestos 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 Ie sub.itted IIhich 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 violatel 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 plan~! construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such pertit is cOllenced within six Bonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of SiX ionths after the tile the 1I0rk is com.enced. 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 durinl each six lonth periodl or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAilURE TO RECOR,) A NOTICE OF COHHENCEHENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANi'ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMHENCEHENT. JOBS UNDER $2,500 IN YALU, DO NOT NEED TO RECORD AND POST A"N C OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA . .
COUNTY OF ~~...~.. U:tllr-'}yw?')rll'Jln -
The for~ ackn~wledged
before me this .~! 19~ by
JJ~ .
~ '-01.LcJ . -D fI ~ ~ .'-fl\ I Q 0 on)
who is personall~known to me or who has
pl-oduced I. u .
as identification and who 9id/did not
take an oath.' Ii L--fVl .Il
. '-tY\.ll'W.u ~ ~!MOLJc)
_(Slgnature) tflIChtL.K. 0'\1'-1 'off
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
N~~~ . Publ~. State df Fldrid~
omm. EJlp Feb' 4, 19"5
8..mdea thru PICHARD," "
. ns. Agency
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
was acknowledged
1') by
who is pel-sc,nall y known te, ml! Cl}- who has
produced
as identification and whc. did/did (mt
take an oath.
(Signature)
(Name Typed! Pr i nted Dr Starr'i ied)
NOTARY PUBLIC