HomeMy WebLinkAbout92-2707
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N~
27079 .
Date I tJ -/7'- 7J-
Property Owner:
Job Address:
Parcell.D. #
Zon;ng, .,j[. Ene'g. Code' :1;:,. ~ R.Z" &;
Dose,;.';on of Wo''s ~~""~ r' (8; ~ -<' - V1... - =sf.
ELECTRICAL
MECHANICAL
Sewer Conn
BUILDING
Water Conn:
Water Meter:
T_I.F.'s:
d7 h.H~
.
/~? 7?t/.:S
NO OCCUPANCY BEFORE C.O.
FINAL
1).-C; 2-
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Pe'm;, F~d?1<? - ~
Sig n atu re !41IJ.. 07J>--..-
Company
Address
Telephone#
Valuation or
Contract Price
14
City License Registration # / :L..5>-
State Certified License#
~d~/~~~Lt<::5
PlU~8ING . _ M ~L
SLB Breakers
Tub Set Ducts Insl.
Water Compressor
Sewer Final
Final
~II'IG
ELE~CAL
-----
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
I}tL otf-dk::> ~t/tZ.-,4Li:>
W~
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/1 00 Dollars ($ 1 5.00) 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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OWNER'S
APPLICATION FOR PERKIT
CITY OF ZEPIIYRIIILLS
BDllJllliG DEPAR11IEJlJT
RAIlE q l \\. f c: >; "-- <;. ..( If) cJ I ~
PHONlE
OWNER'S ADDRESS
~[) (
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BI..OCK
SUBDIVISIOIi
PARCEL I. D.'
WORK PROPOSED:_liev Const::ruct::ion _Addit::ion _Alt::erat::ion _Repair _Inst::all
_Sign
_Hove
_Deao1ish
PROPOSED USE:
Sing1e Faai1y
_H/F
_, of Unit::s
_M/B
_c:c:-ercia1
_Indust::.
_Swill. Poo1
Ot:her
_Rest:aurant:: &: Hea1t:h ))eparbIent:: Approva1
BUILDING SIZE:
x
Square Feet::.
Height
RESIDENTIAL :
COHHERCIAL :
ATTACH (2) PLOT PLANS &: (2) SEIS OF BUILDHlIG PLUS &: (1) SEI' ENERGY FORMS. U
ATTACH (3) SETS OF B1ITIJ)lllG PLANS &: (1) SEI' ElffiRGY FORMS. **
**COPI' OF C01'fl"RACT ~mRED.
PElmITS REQUESTED
_BUILDING
$
Va1uat::ion of Tot:a1 Const::ruction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_KECllANICAL
$
Va1uation of Hechanica1 Installation
_PLUHBIHG
GAS
ROOFTIiG
SPECIALTI'
TYPE OF CONSTRUCTION: _B1ock
_Fr:me _St::ee1
Other
FINISHED FLOOR ELEVATIOlWS:
FI' .
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
OOMI'RACI'OR SECTION
BUILDER
COMPMilY
St:ate Cert. or Regist. I
City License Registration t
******************************************
Signat::ure
ELECTRICIAN
COMPANY
Sl:ate Cert. or Regist. ,
City License Regist::rat::ion I
o~" ..................~:..(r~:7i::~ Pk6;~
\U 17 /l Sl:at::e Cert::. or Regist. ,
tv (O;irr--- City License Registration I /? 5
******************************************
Sifmat::ure
PUJlKBER
Signature
MECHANICAL
COMPANY
Sl:at::e Cert::. or Regist::. ,
City License Registrat::ion I
******************************************
Signature
OTHER
S ignat:ure
COMPANY
Stat::e Cert::. or Regist. ,
City License Registration ,
******************************************
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFcIDAVIT
A. NOTICE OF DEED REST~~~TIONS
The undersigned understands that this perlit lay be subject to "deed restrictiDns' which lay be lore restrictive than City
regulations. The undersigned assules responsibility for compliance with ilny appiicable deed restrictions.
B. UNL I CENSED CONTRACTC~R~.....ll~Q CONTRACTQI'< F~sm::Cn"I5.I I~Lh) T l~$.
If the owner has hired a contractor or contractors to undertake work, they ~ay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, bo~h the owner and contractor lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, (813)
788-6611.
Further_ore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
'Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTIO~ FEE$.
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided Nith a copy of "Florida's Construction Lien Law - HOleoNner's Protection
Guide" prepared by the Florida Department of Agriculture and Consuler Affairs. if the applicant is someone other than the
"owner", I certify that I have obtained a copy of the above described document and promise in good faith t~ deliver it to the
'owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be done in compliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a per_it to do work and installation as indicated. I certify that no work or
installati~n has COllenced prior to issuance of a perlit and that all work will be perf~rled to ~eet standards of all laws
regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to the intended work, and that it is
IY responsibility to identify what actions I must take to be in cOlpliance. Such agencies include but are not limited to:
I Department of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treatment
I Southwest Florida Water ManaQelent District - Wells, Cypress Barheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Department of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
I US Environmental Pr~tection AQency - Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone 'A" or 'A,etc.', it is understood that a drainage plan
addressing a 'compensating volume' will be submitted which is prepared by a professi~nal 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 permit prevent the Building Official frol 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 permit is commenced within six months 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 comaenced.One 90 day extension of time, lay be
allowed for the per.it with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection must be logged during each six month period, or the project will be considered aband~ned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHMENCEMENT MAY RESULT IN YOUR PAYING THICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COM"ENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A 'NOTICE OF COMMENCEHENP.
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
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 or who has
produced
as identification and who did/did not
take an oath.
who is per5onall~ known to me Dr who has
produced
as identification and who did/did not
take an oath.
(SignatLn-e)
(Signature)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC