HomeMy WebLinkAbout93-3038
BUILDING PERMIT
Permit
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Zoning: Energy Code: _, Radon Gas: ~ I ~ t"
Description of Work /~ I >( -:l~ C\.. 4-A~;_ ~~
CITY OF ZEPHYRHILLS
(813) 788-6611
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$0'
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N~
Date
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Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
FINAL
C.O.
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Valuation or
Contract Price
f3:. 'l)i)
6.000'-
,
City License Registration # ~
State Certified License# ~
Telephone#
@Mr/JN
BUILDING
(Q~;~;? a 7J?~: @/>~~ ~a/lv
ELECTRICAL# PLUMBING
Ftr. E-JI 95 ~M1L
Pre SLi):J J" L..lLt
Lintel
FRM. ~-~-~~
InSUI.~~ !:j~~ ~.
Tp. Serv.
Rough In q-l "ir~~
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB 3-2.-q3 t:./J
M Tub Set 4-alo ~q3 Bot..-
~-27yL73 ,tg
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
~ 4~-q3~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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APPLICATION FOR PElUtIT
GI'IY OF ZEPBYImII.LS
B1lJII.DIRG DEPARnIEm"
0l.,"NER · S BAKE
BA-J2.bAM 'S I ~ ~bb
J4J4 I hTn '7>1- 2..tr.ph'1"J.,; lls
PHONE t"J <it )- - /05> ()
'$ 3~4b
OWNER'S ADDRESS
t]A.
.JOB ADDRESS t;;~z-
LEGAL DESCRIPTION: LOT(S) ;)~... /;.. ~ \
BIDCK 41
SUBDIVISIOII
PARCEL L D. t
WORK PROPOSED:_lNIew Construction ~Addition _LAlteration _Repair _Install
_Sign
_Move
_Deaolish
PROPOSED USE:
~ Single Faaily
,
___"IF
_, of Units
---"IH
_~rcia1
_Indust.
_Swi:a. Pool
Other
_Restaurant &: Hea11:h ~t Approval
j I
BUILDDiG SIZE: 12. X 15" .
300
Square Feet.
<;II
Height
RESIDENTIAL :
COItKKRCIAL :
ATI'ACH (2) PI.OT PJ:..AIIS &: (2) SEI'S OF BUILlHBG PI..UlS &: (1) SET ENERGY FORMS.**
ATI'ACH (3) SEI'S OF BUllDIRG PLUlS &: (1) SET ENERGY FORKS. **
**COPl' OF CORl'RAcr ~tl!IRIlD.
--LBUILDING
1ELECTRICAL
ttt<O
$ {, (:;00 Valuation of Total Construction
_I,;}, ~ AKP Service \/'" Florida Power COrp.
PERKT'T'S REOUESTED
W.R.E.C.
~CAL
I" PLUKBING
$
lIaluat:io.Jr. of Kechanica1 Installation
GAS
_____.dOOFHiG
SPECIALTY
TYPE OF CONSTRUCTIOlNl: _Block ~,Fraae _Steel
..
Other
YES
~
NO
FlliISBED FLOOR ELF.VArrO~5:
~,.
"".j .d",jll;~T 1Il'II }t'LOOD ZONE AREA?
***********.******************************
OOW'.tRACI'Oi?, SECTION
COItPiiW.t
St:ate Cert. or Regist. #
City l~icense Registration I
************;0". .......****"'~ ..*******************
ELECTRItIAN
SiPn#llture ~j'~L::>
,
PLUKBER. cL' .... IDIPARY C./(((/-5 j2AIt~ {;JJfmb,)J6
. ~ 0 i2 If State C'.ert. or Regist. , t-or::Y II
Signature '.r61 .ZJ / ~~ City License Registration # S 7 .
*********************;::*-******************
CO!W;~Y
e ' State Cert. or Regist. i- C'I( .w 7 s ~ S
# '71f~- City License Registration ,
******._**************...******************
MECHARICAL
Signature~~ :::
I ..
1DIPM'I~~m '~
Stat:e Cert. or Regist. - ~ :..~
i'f"~'" - CHy License BegisttaU";; :., ~
** *********.::.. <r*"*****i':.a-*******************
O'T'IIRR
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Stc:;~,- Gert. or Regis!.. I
_ ,;H:.:;r License Registration I
*********"'****,,,,'-'c.. ...**--*....********************
Signat:w:'e
APPLICAi'ION APPROVED BY
PERKIT OIlY!:GER.
~
~
CONDIT~ONS OF PERMIT AFFIDAVIT
A. NOT I CE OF DEED RESTR I CT :;J':,N<?,
The undersigned understands that this per.it .~~( ie subject t~ "deed restrictions' which .ay be .ore.restrictive than City
regulations. The undersigned assu.es responsibil"ty for cotpliance with any applicable deed restrictions.
B. ul-iLIC:::~~:::: ~1.:'~!~E.:~I"":..QB5-~ NG __~ON.TRACTOR RESPONSIBILITIES
If the owner has hired a contractor Dr centf<""ors tOI.ndertalCe won, th:~y ~al' be rf!~ui;'2~ to be 1icens~d in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor .ay be
cited for a .isde.eanor viol~ti~n under state ~a~. If the owner ~r intended contractor are uncertain as to what licensing
requirelents .ay apply for the intended work, they are advised to c~ntact the City of Zephyrhills Building Depart.ent; (8131
788-6611.
Further.ore, if the owner has hired a contractor or cDnt~actors, he is ad~ised to have the contractor(sl sign portions of the
"Contractor Sections' of thl~ ~p'~lication for "h~ch they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the c~ntrartor, are responsible for the work. If the contractor wishes you to sign
as contractor that .ay b~ an indication that he 15 1I0t properly licensed and is not entitled to per.itting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D, CONSTRUC'11UN LIE~~ ;....c.~_; U':::-Y':!='TER '7t3~ FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of 'Florida's Construction Lien Law - Ho.eowner's Protect~uif
Guide" prepared by the Florida Depart.ent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
'owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner' prior to CO.lencelent.
E. CONTRACTOR'S/OWNER'S AFFIDaYlI
I certify that all the infor.ation in this application is accurate and that all work will be done in cotpliance with all
applicable laws regulating construction, zonillg, and land develop.ent.
Application is hereby .ade to obtain a pertit to ~o work and installation as indicated. I certify that no work or
installation has co..enced prior to issuance Jf a pertit and that all work will be perforted to leet standards of all laws
regulating construction, City codes; zonin~ reqv.l~~iolis, and land developtent regulations in the jurisdiction. I also
, certify that I understand that the regulatiJns ;i ~ther governlental agencies tay apply to the intended work, and that it is
3j r~r~~n5ih!!;t~ tn irlpotify what actions I .ust take to be in co.pliance. Such agencies include but are not lilited to:
f Depart.ent of Environtental ReQulation - Cipres5 Bayheads, Wetland Areas and Environ.enialiy Sensitive LdilOS,
Water/Wast2water Ir~at.ent
f Southwest Florida Water "anaQetent District - Wells, Cypre~: Bayheads, Wetland Areas, Altering Watercourses
f Arty Corps of EnQineers - Seawalls, Docks, Navigable WaterwdYs O'
f Departlent of Health ~ Rehabilitative Services, Environlental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
f US Environ.ental Pr~~tc~ion AQenrt - Asbestos abatelent
I also certify that, if fill taterial is to be u~ed i" Flood Z~~~ 'A" Dr "A,etc.', it is understood that a drainage plan
addressing a 'colpensating voluae" ~ill be subtitted which is prepared by a professional ergineer registered in the State of
Florida prior to per.it issuance. ·
A per'lt IssueB snaii h~ Lan~tru~d to ~~ ] !~r~~c- tn ;~,[~~j with the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall is!iualice Ilf a pertit prevent tile iluildi,Hj GffiLio:l ~rc'~ ~hereaft!'r
requiring a correction of errors in plans, construction, Dr yiolations of any code. Every per.it issued shall becole invalid
unless the work authorized by such per.it is cOUIP-nced within six .onths of issuance, Dr if work authorized by the pertit is
suspended Dr abandoned for a period of six .onths after the ~i.e th~ work is co..enced. One 90 day extension of tite, lay be
allowed for the pertit wit.h fee r.harge of ~15.C~, T~~ exten~;on shall be requested in writing to the Building Official. An
approved inspection lust be logq~d during each six .onth reriod, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CilKKENCEKENT KAY RESULT IN YOUR PAYING TWICE FOR IKPROVEKENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COK"ENCEKENT. JOBS UNDER $2,500 IN VALUE DO NUl NEED TO RECORD AND POST A "NOTICE OF CO""ENCE"ENT'.
~_......,-
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SIGNATURE: CONTRACTOR
-
SIGNATURE: OWNER OR AGENT
was acknowl~:~?~
19 _ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me thi",
STATE OF~FLORIDA
COUNTY OF
The foregoing instrument
befc.re me this
was acknowledged
, 19_ by
-- ------...,.--
who is persDnally known to me o~ who has
produced
as identification and whc, did/d~. '-;0':
take an oath.
who is personally known to me Dr who has
produced
2S identification and who did/did not
take ail oath.
,::iiy:,aturei
(Signatul-e)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(~~me Typed, Printed Dr Stamped)
NOTARY PUBLIC
.
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BUILOINGDEPT. APPROVE~~
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