HomeMy WebLinkAbout92-2717
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N?
2717/3
Date / t '- ,::);;). -7;)""
c~o E~ ~'''G ~"CAL S,w",Conn
rcu'~ "<~M~ w,w Conn
Pmp'rty own"';]lP~ - ~~, If fl.!>, Jv~,,: Mot",
Job Address: 6. 6> "'-- T_IF. s.
Parcell.D. # c2 - ;;l.(; -~/- tJ eJ/O - 0-.5/00 - 0 0/0
Zoning: Energy Code:
Description of W~ :/(C7 o-v-e A---
Radon Gas:
FINAL /0- ~ 3 - 9
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Permit Fee
Signature
Company
Address
Telephone#
~/?~~
Valuation or
Contract Price 10?l7:J. ~
City License Registration # 77
State Certified License#
~/~j O~~~
( BUILDIV
Ftr.
Pre SLB
Lintel
E~CAL
---
P~
ME~L
---.
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
FRM.
Insul. CL
WL
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 PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
'~fAF/~
~ 70
y u fh9-S
(
S"(~~/'\./
,
fhw tel kHONE
ADDRESS
OWNER
G. (:, I~ OLl) IJ/~ /<./)
LOT SIZE~X 0<:) AREA SQ. FT.
JOB LOCATION
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.:"
a~
c;2-C-J
~/
,
tfDl ()
6 S-/ {)()
(flJ/{J
WORK PROPOSED:_New Constru,ction _Addition _Alteration _Repair _Install
-ro ;vS77H:-i. /'f) )(~2. ~ F ollU .
_Sign/Temp. _Sign _Move _Demolish
PROPOSED USE: _Single Family
_M/F
_IF of Units
._M/H
_Commercial
_Indust.
_Swim. Pool
Other
}
_Restaurant & Health Department Approval
BUJLDlNG SIZE:
x_,
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. H
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
\~
_MEf:HANICAL
AMP Service
Florida Power Corp.
_h'.R.E.C.
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
BUILDER
CONTRACTOR SECTION c->
. Company 0 ()J../.5~
~ ~. State Cert. or Regist. it
c-o',- . t'.A .2-'... Ci ty License Regis tra tion lfr
******************************************
#C.- () It' I ~ tI /7
77
,
Signature
ELECTRICIAN
Company
State Cert. or Regist. #
City LIcense Registration #
******************************************
Si!?"nature
PLUMBER
Signature
Company
State Cert. or Regist. #
City License Registration 4
**********************t-*******************
MECHANICAl
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
OTHER
Signature
Company
State Cert. or Regist. #
City License Registratinn lfr
***********~******************************
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this peraitaay be subject to 'deed restricti~ns' which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RES~ONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance Nlth
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
cited for a aisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireaents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, (813)
7BB-bb 11.
Furtherlore, 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 contractD;',
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 CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I cerjify 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 Consuler Affairs. If the applicant is sOleone other than the
'owner', I certify that I have obtained a copy of the above described docusent and promise in good faith to deliver it te, the
"owner" prior to cOIsencelent.
~,
I
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 cOlpliance with all
a~plicable laws regulating construction, zoning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all lans
regulating construction, City codes, zoning regulations, and land develop.ent 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 .ust take to be in co.pliance. Such agencies include but are not lilited to:
I Depart.ent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treat.ent
I Southwest Florida Water HanaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I De artlent of Health L Rehabilitative Services Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks
I Environ.ental Protection AQency - Asbestos abate.ent
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 volu.e" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A per.it 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 ~er.it 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 per.it is cOllenced within six .onths of issuance, or if work authorized by the permIt is
suspended or abandoned for a period of six .onths after the tile the work is cOlienced. One 90 day extension of tile, ~3Y 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 lust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCEHENT HAY RESULT IN YOUR PAYING TWICE FOR IHPROVEHENTS TO ',DUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COHHENCEHENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
.....-:c-
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA
COUNTY OF
The foregoing instru ent
before me this
p
f f.I5( 0
STATE OF FLORIDA
COUNTY OF
The foregoing instru ent
befctl-e me th is
who is~
produced
as identif.icatiol~,
take an 0 b ,;....-- /
l .. _. e;.
(SignatLll-e) Notary Public Pasco Co. fL
'E . ~lt~res M~ 11 \(}9S
(Name Ty~~ ~~b Ir Stamped)
NOT ARY PUBLI C
who has
nc,t
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\o'lho is.pel~ai 1 y knol'1n to me Dr who haco
pl-oduced
as identificati9-l"l and who did/did not
take an oatJ~.K ~.
(Signatu-,-e) Pbl'P oCoFL
Notary u lC asc .
<Name Typed M1'€OI\"081tX~~Ji1~\3. 1995
NOTARY PUBLIC
AReEL I.D.
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'roposul
Page No,
of
Pages
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.~~~~
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SU""! STl\TE AlUM~NUM, I~~~~,
37528 Hwy. 54 West
ZEPrlYP~-l~t_L3, FL-<)RIO/\ 3JS~ 1
(813) 788.7308
PROPOSAL SUBMITTED TO
- . -\1:::~;-I--<:;;;' i'---..
STREET
"-A <;-"\"
CITY, STATE AND ZIP CODE
-- \ \ "
-L-- ...)" \ \. \-..l>..
ARCHITECT
\~j
L\ ~wS
PHONE
<"~\I
\ ---...
\,0
JOB NAME
:5L..k,.>C~ q --/
o u u..._...)" ,
"'",
,
~'~sq
DA TE OF PLANS
JOB LOCATION
JOB PHONE
We hereby submit specifications and estimates for:
\ .-:~ -S--,-\:.:..~
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Dr Jrupusr hereby to furnish material and labor _ complete In
....'f.
accordance with
C2,ic--,
~
above specifications, for the sum of:
~---
.......~?
dollars ($ J 0'"'--D --iJ-- )_
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.
... ":>.~~~~. :--_,-::~.:-.:_~--r'
. ..~ -" .~.. ....-
~ -- ----
-- -.. .. . _~_ .--,;;;;.-7" _.. ~~
,,,. .---~,I-_.- '_' .~__ ......--_.._.~~.
L ....:..--..----
Note: This proposal may be
withdrawn by us if not accepted within
days,
Authorized
Signature
(
Atttptautt af Jrapasal- The above prices, specifications
and conditions are satisfactory and are hereby accepted_ You are authorized
to do the work as specified, Payment will be made as outlined above,
Signature i-
-~. /
/~~ ~d-7
... c7
Date of Acceptance:
~
Signature
PRODUCT 118-3 ~~elnc., Groton, Mass. 01471. To Order PHONE TOll FREE 1 +8(}o.225.6380