HomeMy WebLinkAbout92-2836
BUILDING PERMIT
Permit
2836~Pl
I
Date )2--J--9~
CITY OF ZEPHYRHILLS
(813) 788-6611
N?
Property Owner:
Job Address:
Parcell.D. #
ELECTRICAL ~M81~ MECHANICAL
t; t/-~~f?~~ p.
Sewer Conn
Water Conn:
BUILDING
Water Meter:
T.I.F.'s:
Zoning: Energy Code:
De,e';"';o" of wo"'~
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
City License Registration #
State Certified License#
e-tJ 6
--
Permit Fee
Signatu~
,,-:-
Company
Address
Telephone#
Valuation or
Contract Price
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
1~',#so6
PLUM I
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
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.
APPLICATION FOR PEmlIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
~.~
ADDRESS .~~ \0 Pc.?~\ocJc.. L-~,~
OWNER c;.l-\- a
~ u ~ LA. \c:. \' \. 'w--" \ "'C IA. 't"l cn..J.
2. ~t..h\ \~ lZ'L\A.. .~ ~ ':)'" ( PHONE 1 <N-q ~ 3 b
JOB LOCATION 6"1 ~b \4UVl.11 \\,\\,,\011\\ \.~Y' "'2.'M \\\s
.
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION S\ \ veVL rJ"'\<; 5
PARCEL 1. D. ~F
WORK PROPOSED:____New Construction _Addition ____Alteration _Repair ____Ins tall
_Sign/Temp. _Sign _!'love ____Demolish
PROPOSED USE: ____Single Family ~/F ____iF of Units ' _____1'1/ 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) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORHS,H
**COPY OF CONTRACT REQUIRED.
EF.RMTTS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida power Corp.
_W.R.E.C.
____MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
_Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
Signature
CONTRACTOR 0ECTTON
Company
State Cert. or Regist. #
City License Registration a
******************************************
J3UILDER
Signature
Company
State Cert. or Regist. 0
City License Registration a
******************************************
ELECTRTCTAN
Si!lnature
Company ~LJ~ '\ic..; \. v-V \. ~ ~\ \ OV\l
State Cert. or Regist. # v
City License Registration IF ~\"JO
******************************************
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
t1ECHANICA1.
Signature
Company
State Cert. or Regist. #
City License Registration #
OTHER
******************************************
PERtIIT OFFICER.
APPLICATION APPROVED BY
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The.undersigned understands that this per.it .ay be subject to "deed restricti~ns" which may be ~ore restr.ictive than City
regulations. The undersigned assules responsibility~for co.pliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR R~SPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they .ay be required to be licensed in acco'rdance with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
cited for a .isde.eanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply felr the intended work, they are advised to 'celntact the City of Zephyrhil,ls Building Depart.ent, (8131
789-6611.
Further.ore, if the owner has hired a contractor or contractors, he is advised to have the c~ntract~r(sl sign portions of the
'Contractor Sections' of this application for which they will be responsible. If y~u, as the ~wner sign as the c~ntractor,
you are indicating that you, rather than the contractor, are responsible for the w~rk. 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 permitting 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's Constructi~n Lien Law - H~leowner's Protection
Guide" prepared by the Fl~rida Depart.ent of Agriculture and Consumer Affairs. If the applicant i~ s~le{.ne other than the
"owner", I certify that I have obtained a copy of the above described de,cullient and pre,mise in good faith to deliver it to the
"owner" prior to cOlllencellent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be d~ne in coapliance with all
applicable laws regulating c~nstructi~n, z~ning, and land development.
Application is hereby lade to obtain a per.it to do work and installction as indicated. I certify that no work or
installation has c~llenced prior to issuance of a per.it and that all work will be perf~r~ed to meet standards of all laws
regulating constructi~n, City codes, 20ning regulations, and land development regulati~ns in the jurisdicti~n. 1 also
certify that I understand that the regulations of other governmental agencies ~ay apply to the intended ~ork, and ~hat it is
my responsibility to identify ~hat actions I lust take to be in colllplianc:e. Suc:h agencies include bill ~l e m,t lillited to:
.'"
I also certify that, if fill laterial is to be used in Flood Zetne "A" or "A,elc.', it is understc.c<d tJ.~t a drainage plan
addressing a 'co.pensating volullle" will be sublitted which is prepared by a professional engineer regist2ied in the State of
Florida prior to perlit issuanc:e.
A perllit issued shall be construed to be a license to proceed with the work and n~t as authority t~ yiol~te, c:ancel alter, or
set aside any pr~visions of the technical codes, nor shall issuance of a permit prevent the Building Official fr~1Il thereafter
requiring a c~rrection of errors in plans; construction, or violations of any code. Every per~it issll~d ihall bec~.e invalid
unless the work authorized by such permit is comlenced within six months ~f issuance, or if w~l.k authol lled by the per.it is
suspended Dr abandoned f~r a period of six .onths after the tiJe the work is commenced. One 90 day c:lensioll of tile, lay be
all~Hed for the permit with fee charge of $15.QO. The extension shall be requested in writing to the Building Official. An
approved insp.'ectie,n J!lust be le,gged during eac:h six lIonth period, e,r the pr~jed \ii\J be cc,nsidered db.;llde,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 WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UND $2 IN VALUE
DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCE
SIGNATURE__~E~------------
SIGNATURE
DA TE _____~.cl=b=.9.~----------------.-------
DATE
NOTARY AS TO ~ ~ .~.
OWNER OR AGENI~~-----~-~-
MY COMMISSION EXPIRES______________________
NOTARY AS TO
CONTRACTOR___~~-~----
..
MY COMMISSION EXPIRES__________________
Notary 'ublle, Btata of f10rlda
J,,'.:Ei BLACKWELL
M~ Comm. Exp. 9-18.96
Comm. No. CC 228545
',6,'
Notar~ Public, Stole of Florida
J",."n BLACKWELL
M~ Comm, Exp. 9.18.96
Comm. j~o. CC 228545