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BUILDING PERMIT
Property Owner:
Job Address:
Parcell.D. #
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CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N~
_ 3084,8
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Date
~~sewerconn
Water Conn:
Water Meter:
T,I,F.'s:
Zoning:
FINAL S--Ilf, 'S
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
Pe,mit Fee~' ~
Signature J,- _ z.. -
Company
City License Registration # IliJ Address
State Certified License# r: G-c!() Aj-qf~~ Telephone#
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C~- BUIL~ ~'G~~~~-~'~4 :1-9 PLW~-
Valuation or ~ __, ~)
Contract PriciP <~I ti ()[)
MEC,!;!AAA€-AL
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Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
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.
SEMINOLE FORM 596
PROPOSAL
Page No.
of
I
I
Pages
PROPOSAL SUBMITTED TO:
PHONE:
I
I DATE: '3/1//9'.7
NAME:
LJ,.v,-#,q
I<v-I'r:,.
JOB NAME:
e .-ko~_L
C",[G
J>Lw~
_I STATE:r(
STREET:
CITY:
STATE:
We hereby submit specifications and estimates for:
f),JI'eP-< 8-, tJ)"7
S <~c 07/, ."h)..f~ ON
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,/ We hereby pro:;zto furnish labor and materials - complete in ac~ance with the above specifications, for the sum of:
;!1 If'! L OJ( lL I If.;{ T ~c. U~,I __dollars (S :3 J"l? -e..&/ ) with payment to be made as follows:
/ .
/l ,-C /VJ~ ,4...1
All material is guaranteed to be as specified. All work to be completed in a work manlike manner according to standard practices. Any alteration or deviation
from above specifications involving extra costs, will be executed only upon written orders, and will become an exlra charge over and above the estimate, All
.J' {).
agreements contingent upon strikes, accidents or delays beyond our control. This proposal subiect to acceptance within
thereafter at the option of the undersigned,
days and is void
Authorized Signature
~~~
-
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are hereby accepted, You are authorized to do the work as specified, Payment will be made
as outlined above.
Date
S""~h P~/
Sign re
ACCEPTED:
Scope of work to be done at
59~~ Gull Blvd., By Gordon
Ten Brink. Lie. CGC 043422
Ph. 782- 9138
1) Remove old cabinets
2) Separate existing room with firewall
3) Install new front entrance door and windows
4) Build new handicap entrance ramp
5) Install two new interior class "C" doors
6) Paint new wall
7) Install new exit lighting and signs inside
8) Install new meter if possible for half of building
9) Install smoke detectors where needed cL~~h
Gordon Ten Brink
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APPLICATIOllil FOR PERHIT
CI'IY OF ZEP.IlYRIIILLS
BUILDIlliIG DEPAR1'HElliIT
OWNER'S NAKE
t./kcfJ'f- Re~ /
,jJ 9/ V C c< /{~ /(1 I~ l-i!
\17.50 Cu~( s{~c/
PHONE
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: WI'(S)
J () Z /(
BLOCK SUBDIVISIO~
PARCEL I. D . # // .J e"
..?-/ 0'0/0
002 DO
rJc) / 0
l."ORK PROPOSED :_!!iI'ev Construction -.-J\ddition -.LAlteration _Repair _Ins tall
_Sign
_Hove
_Deaolish
PROPOSED USE:
Single Faaily
_KIF
_' of Units
_H/H
~COBIIercial
_Indust.
_Swi.. Pool
Other
_Restaurant & Health Departaent Approval
BUILDING SIZE: .) J X t ,,) J
Square Feet.
Height
RESIDENTIAL:
COHHERCIAL :
ATTACH (2) PLOI' PI..tUlS & (2) SEI'S. ,'oF ~WLDING PI..i\NS & (1) SET ENERGY FORHS. **
ATTACH (3) SETS OF BUILDDlG PI..tUlS & (1) SET ENERGY FORKS.'u
~~COPY OF CONTRACT REQ[MIRED.
_BUILDING
$ -J,DU
ceO
PEKKITS REOUF_<;TED
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power COrp.
W.R.E.C.
_MECHANICAL
$
Valuation of Hechanica~ Installation
_PLllHBING
GAS
ROOFIJNG
SPECL"'-LTY
TYPE OF CONSTRUCTION!: _Block
_Fr~ _Steel
Other
FINISHED FLOOR EI.EVATImIlS:
FT.
IS PROJECT IN FLOOD ZO~E ARE..~?
//
~
'YES NO
~~~~~~~**~***********~~***~****~~*~**~***~
RUILDY.R
COllilTRACl"OR SECTION
CUlfPMIi 1 (; 0 tLP 0,... ,;e "-f
J j '''7 ~ State Cert:. or Regist. 4#
~ ~ City License Registration
***~**************************************
-<<IV" ,/
c (; C f9 </3 V 2-]..
!It I/O
Signature
RT.ECTRICIAN
COHPANY
State Cert. or Regist. #
City License Registration f
******************************************
5i
'7
PLUKBER CO!fPANY
State Cert. or Regist. #
Signature City License Registration f
************************************~*****
PfECR;\NTCAL CO'IfPANY
State Cert. or Regist:. :f
Signature City License Registration I
**********************~*~*****~******~**~*
OTHER COHPARY
State Cert. or Regist. 4#
Signature City License Registration M
**********~*******************************
APPLICATION APPRO\I'ED BY PER..~T OFFICER.
CONDITIONS OF P~RMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this per.it 'aay be subject to 'deed restrictions. which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contracto~, or contractors to undertake work, they may be required to be licensed in accordance with
state and local regulations. If the'cbnfractor isnot','l icensed as required by law, both 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 2ephyrhills Building Departlent, (8131
788-6611.
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 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 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 Construction Lien Law - HOleoMner'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 document and promise in good fait-h-to deliver it tel the
'owner. prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infor.ation in this application is accurate and that all work will be done in cOlpliance with ,~ll
applicable laws regulating construction, zoning, and land developlent.
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' laws
regulating construction, City codes, zoning reculations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulation2 of other governlental agencies may apply to the intended wor~, and that it is
IY responsibility to identify what actions I lust take to be ih cOlpliance. Such agencies include but are not lilited to:
f Depart.ent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water ManaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of Enqineers - Seawalls, Docks, Navigable Waterways '
f Departlent of Health ~ Rehabilitative Services, Environ.ental Health Unit - Wells, Wastewater Treattent, Septic Tanks
f US Environ.ental Protection Aqency - Asbestos ab~telent
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 volule' will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A periit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical c~des, nor shall issuance of a perlit prevent the Building Official frot thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every periit issued shall beeole invalid
unless the work authorized by such perlit is cOI.ented within six .onths of issuance, or if wor~ authorized by the perlit is
suspended or abandoned for a period of six lonths after the tiee the "or~ is comaenced. One 90 day extension of tile, tay be
allowed f~r the perlit 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 periodror the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT HAY 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 UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A .NOTICE OF COMMENCEMENT..
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
was acknowledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befol-e me th i s
STATE OF ~LORIDA
COUNTY OF
The foregoing instrument
before me this
-
was acknowledged
19_ by
who is personally known to me or who has
pl-oduced
as identification and who did/did not
take an oath.
who is personally ~(nown to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC