HomeMy WebLinkAbout92-2637
BUILDING PERMIT
Permit
2637 ~i
9- / /-91.
,/
50
C~
CITY OF ZEPHYRHILLS
(813) 788-6611
N~
Date
Property Owner:
Job Address:
Parcell.D. #
EL~L PL~' M~
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Sewer Conn
Water Conn:
Water Meter: '
T.I.I=.'s:
Zoning:
Description of Work
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL -L"'D -I 2.- q L
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
Inspector
Valuation or Ji. '-=J
Contract Price ", ~ I 'I7.s- ~ ~
C;ty Licen.e Reg;.".';on # -~~~. .
State Certified Licens ~
Pe,m;' Fee~' ~
S;gn.'u,e -- -. ~
Company
Address
Telephone#
---
ELEC
PL
ME
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
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 ($15.00) shall be made for each trip for each trade:
a, Wrong Address
b. Condemned work resulting from faulty construction.
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
PROPOSAL
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pfriH~;;:i\,lll~ER SUNCO"\Il:"')
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Sheet No.
Proposal Submitted To:
Work To Be Performed At:
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City
State
Phone
Street
City
Date of Plans
Architect
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State
We hereby propose to furnish the materials and perform the labor necessary for the completion of
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All material '3 guar'flnteed to be as specified, and the above work
speclflcatlDiI' submitted for' above work and completed Iii a
with payments tD be made as follows:
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to be performed in accordClnce with the draWing" and
substantial wor'kmanlikp, rnanner for the sum of
Dollars ($ u) t./ ') . - c C)
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A';~' Hlterat,lon (Jr dt~\,:ltjon frurp above speclficatlOi!S :rl'y'olvlnq extr~j
',~ost::;" WII: De ''1~ec,:.Ji'.t~C' only upon V\:ritten orders, 3nd will beC('i11P :::3n
m:tra char'ge OV8i d dbove the estimate. All agreements
upon ~:;ti'l~es. "cCi~_;CILS or delery's beyond our ccntr:.l. Ol/vner
fl!'P" tornado and .JU-;er necessary InsurancE' upon n~cve work '})r,('k
r:-:er:'s Cor'Olppnsat or' PI,II--ll1C Liahility instJrano: on "' uovr:' we' \0( t:u ~,~!
L'ker out
Re~:;pectfljl!y subrrntt80
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f\Jote, fhis [J1'oposai may he WI'>I1,],,,,.,vn by
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within -) "J days
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ACCEPT AI'JCE OF PROPOSAL
Fie abevp ;.li'!ce:,. specifications and conditions ar'e satisfactory and are hereby accepted. )'{)U are authorved to do the work as specified.
Payment will be made as outlined above. / r1
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Signature (7 V7.'V~1'" ...~-, L
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Date
Signature
TOPS~FORM 3850
TRIPLlCA TE
LITHO IN U.S.4,>
...
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
01!J-aY1(l,VP L ,51 ~5{~'
",'7 D L/- 7 f1h. St, '2f/:n'/1"11 "tU)
-~o/he O-",{ abo(V
j(ime- to a0ou-e I1ACU-eJ!;'
I-i-
PHONE
ADDRESS
"
OWNER
JOB LOCATION
LOT SIZE
x
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION
PARCEL I.D.~~ J/~02u - a/-()1)(O - ~o1c1) - LT7) II)
WORK PROPOSED:____New Construction _Addition _Alteration LRepair ____Ins tall
_Sign/Temp. _Sign _Move ~Demolish
PROPOSED USE: ____Single Family ~/F _~~ of Uni ts ,._M/H
_Commercial _Indust. _Swim., Pool Other
_Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) S~T ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**,
**COPY OF CONTRACT REQUIRED.
pERMITS REOUESTED
_BUILDING
$
Valuation of Total' :Construction
_ELECTRICAL
AMP Service
Flo~ida Power Corp.
'__W.R.E.C.
GAS
Valuation of Mechanical Installation
. / 11 &l/15. ({)
v' ROOFING SPECIAl,TY
_MECHANICAL
$
_PLUMBING
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
:! ~I '
******************************************
Signature
CONTRACTOR SECTION
Company
State Cert.or Regist. II
City Licen~e Registration ff
******************************************
JHJ1LDER
SiQ:nature
Company
State Cert. or Regist. ff
City License Registration.ff
******************************************
f,LF.CTRTCTAN
Signature
Company
State Cert. or Regist. II
City License Registration ff
******************************************
PLUMBER
Signature
Company
State Cert. or Regist. ff
City Licepse Ref?istration II
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'. . . __. _ ,f.. S>f.J::UtYL
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Company ~ tD
State Cert. or Regist. 0
City License Registration
MECHANICAL
Signature
OTHER
******************************************
PERMIT OFFICER.
'-'-APPt~mOVED BY
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CONDITIONSi OF,PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Th',und.rsignld undlrltands that this plrlit lay bl subJlct to 'deed rlstrictions' which may be sore restr,ictive than City
regulations. The undersigned assules relp~nsibilit~for"colpliance with any applicable deed restrictions.
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E . UNL I CENSED CONTRACTORS AND ... CONTRACTOR RESPONS I B I LIT I ES
If the owner has hired a contractor 'or contractors to undertake work, 'they lay be required to be licensed in accordance with
stat. and local regulations. If the contractor is not llcenled al required by law, both the owner and contractor lay be
cited for a lisdueanor violation under state hll.! If the owner or Intended contractor are uncertain as to what licensing
requirelents lay apply for the intended 1I0rk, they. are advised to contact the City of Zephyrhills Building Departlent, (8131
788-6611. ' ..
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractorlsl sign portions of the
'Contractor Sections' of thii 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 say be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
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'sConst~uction Lien LaM - HOleoMner's Protection
Guide' prepared by the Florida Dep~rtlent of Agriculture and Consuler Affairs. If the applicant is so.eone other than the
'owner', I certify that I have obtained a,copy of the above described docullent and pf['~lise in good faith to deliver it to the
'owner' prior to cOlllencellent.
~1'~ .~~. ;.11.'
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 coapliance with all
applicable laMS regulating construction, zoning, and land developaent.
Application is hereby lade to obtain a penit to'do Mork and inshll~tion as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be performed to leet standards of all laMS
regulating construction, City codes,. zoning reg~lati&ns, and land development 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 actions I lust take to be in cOlllpliance. Such agencies include b1l1 ~le Bol Iilited to:
.'"
I also certify that, if fill laterial is to be used in Flood Zone "A' or 'A,etc.', it is underste,e,d lh3t a drainage plan
addressing a 'colpensating volule' will be sublitted which is prepared by a professional engineer regist~icd in the State of
Florida prior to per.it issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority lo viol~te, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a p~rmit pr~vent the Building Official frOM thereafter
requiring a correction of errors in plans; construction, Dr violations of any cod~. Every permit issued shall becole invalid
unless the work authorized by such perlit is cOlmenced within six months of issuance, or if work authoflzed by the per.it is
suspended or abandoned for a period Dr six lonths after the tiJe the wDrk is commenced. One 90 day e~l~nsioll of tile, lay be
allowed for the permit with fee charge of $15.00. The extension shall be requested in Hriting to the Building Official. An
aflproved i nspec l i c,n IlIUS t be logged dur i ng each si x lonth peri od, or the pre. jt:>d Hi 11 be ce.ns i dered ilb,i1ldc.ned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WttH YOUR LENDER OR AN ATTORNEY
6EFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
5IGNATU~1.--J:5?==-
CONTRACTOR l-..!.tJ.!::--------
DATE______~~lq~--------------------
NOTARY AS TO _,I ' A..~ ,~. /)')
CONTRACToR__'~jilIJ.:..<=:::-0J.l1[1J..9lJlu----
..
MY COMMISSION EXPIRES --~~
-1Itiif8 of FIortda
.., Comm. Exp. AlIa. 18. 1995
ICe 137140
SIGNATURE
(J.,,', _
- :...-
OfNfR OR AGENT
DATE_________qj[fji.?::::------~-~----------
NOTARY AS TO ~"
OWNER OR AGENT_~
/1("\. KAR INNEGAN
MY COMMISSION EXPIRES ~~ ~~~et~~