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Home My WebLink About93-3286 BUILDING PERMIT _ 328611 Date t-I.~ 73 ~ ELE~ PLUM~ ~ewe,conn ~ /l/J /I Wa'e, Conn Pmp,"yOwn", "..:t~~ (~^-"J(_ Wate, Met", Job Address: -i><?-'3 ~ _ T I.F.'s: CITY OF ZEPHYRHILLS (813) 788-6611 Permit NC! Parcell.D. # Zoning: :1 - Energy C10de: .. Z02=- Description of Work '......7~,,~ ~~/~t?..-d J ~ 7- ~-- FINAL ,f-- / b -'X...5 NO OCCUPANCY BEFORE C.O. DATE Complete Plans, Specifications and Fee Must Accompany Application. C.O. All work shall be performed in accordance with City Codes and Ordinances. DATE Inspector Pe,m;t Fee ~ t!Ti) Signatu~ t::#'~~ Compa ~~ Address Telephone# Valuation or Contract Price I d.. 07J . o-v ./ City License Registration # '- <.-::3 J State Certified License# B~ ---- E~AL ~ ~ING .......... Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter Final Ftr. Pre SLB Lintel FRM. Insul. CL WL 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. APPLICAnmW FOR PERKIT CITY OF ZEPIIYRIIlLLS BUII.DIliG DEPARIKI!'Rr .... OWNER · S liAKE 712- ~;-~7~ , OWRER' S JOB ADDRF-SS ' h LEGAL DESCRIPl'ION: IDI(S) BI.OCK SUBDIVISIOli PARCEL LD.' WORK PROPOSED:_1Iew Construction _AddiLion _Alteration _Repair ~nstall _Sign _Kove _DeIIolish PROPOSED USE: Single Faaily _"IF _' of Unit:s _K/H ~~rcial _Indust. _Swill. Pool Oilier _Restaurant &: Healili Depar~t Approval BUILDING SIZE: x Square Feet. Height RESlDEHTIAL: cottttERCIAL : A'ITACII (2) PI.OI' PLMS &: (2) SEIS OF BUlI..DING PIAliS &: (1) SET ENERGY FORMS. ** A1TACB (3) SEI'S OF BUIIDING PLMS &: (1) SET EHRGY FORtIS.** **COPT OF CON'J'RACf RE.QlJJIRED. PERKIlS REOUESTED _BUILDIHG $ Valuation of Total Construction _ELEC'l'RICAL ~CIIAIIlCAL MIP Service Florida Power Corp. W.R.E.C. $ /,;7(11') ,cf?) Valuation of Kechanical Installation _PLUMBIHG GAS ROOFING TYPE OF CONSTRUCTION: Plock _FraIIe _Steel SPECIALTY Oilier FIIISHED FLOOR ELEVATIONS: FT. IS PROJEct III FLOOD ZONE AREA? YES NO ****************************************** Signature COIII'RACIOR SECl'ION O>>IPAIIY ~ t<,,~,-2' j..:,~ ~ State Cert. or & gist:. I. . . 7 Cit:y License Registrat:ion f ****************************************** BUILDER SiPnature COIIPARY State Cert. or Regist:. I City License Regist:rat:ion t ****************************************** ELEC'l'RICIAN COIIPMW State Cert:. or Regist:. I Cit:y License Registrat:ion , ****************************************** PI.lIIBER Signature IlEaIAIIICAL ampAft 4ftUA;!i. ~d~~ d, ~ Suo. Cert. or Be -'st. # > _ _ _ _] Signature ;c::: #pA/VL/ City License Registration t c~".:? I ? ****************************************** . omF..R COIIPMY State Cert. or Regist:. f Signature City License Registration . ****************************************** APPLICATION APPROVED BY PERKIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this perlit lay 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 ONner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by laN, both the owner and contractor lay be cited for a lisdeleanor violation under state IaN. If the ONner or intended contractor are uncertain as to what licensing require.ents .ay apply for the intended Nort, they are advised to contact the City of Zephyrhills Building Depart.ent, (813) 788-6611. Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor Is} 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 .ay 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 LaN - HOleowner's Protection Guide" prepared by the Florida Depart.ent 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 docu.ent and prolise in good faith to deliver it to the .owner. prior to co..ence.ent. 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 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 installation has cOllenced prior to issuance of a perlit and that all work will be perfor.ed to .eet standards of all laws regulating construction, City codes, zoning regulations, and land develop.ent regulations in the jurisdiction. I also certify that 1 understand that the regulations of other governlental agencies lay apply to the intended wort, and that it is .y responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to: I Depart.ent of Environ.ental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands, Water/Wastewater Treatlent I Southwest Florida Water "anaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways t Depart.ent of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks I US Environaental Protection AQency - Asbestos abatelent 1 also certify that, if fill .aterial 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 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 per.it prevent the Building Official frol thereafter requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid unless the work authorized by such perlit is cOllenced within six lonths of issuance, Dr if work authorized by the perlit is suspended or abandoned for a period of six lonths after the tile the work is cOI.enced. One 90 day extension of tile, lay be allowed for 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 period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COK"ENCEKENT KAY RESULT IN YOUR PAYING TWICE FOR IKPROVE"ENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COKKENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A .NOTICE OF COK"ENCEKENT". i //i:;/~ ~? ~~/C~ SIGNATURE: OWNER OR AGENT /1?~fJ0 /' SIGNA E: CONTRACTOR V STATE OF FlORID~ I J - 1\ COUNTY OF f'J-Ilh.J~ ~-I~ The foregoing instrument was acknowledged before me this~a~ .2(b , 19~ by .:5"f~ III Ap AI T Or!/) Q1 who is personally known to me or who has produced as identification and who did/did nQt take ~a~"}t~. V ...... / . . ~~_e.b.. ~ ~-I<lt> (Signa~-e) ., f(~ ~~ {IlL L. yI.vi^j~ (Name Typed, Printed or Stampe ) NOT ARY PUBL I C Notary Public, Stat. of Florida My Conunisslon Expires Oct. 8, 199~ lencIecI TIvv Troy Foin . In...,on.. In. STATE OF FLORIDA, ./'",1. j ./ COUNTY OF ~A-/~~ The foregoing t~strument was acl~lowledged befc.re me th i s 7 J1.!lt J ..2. t, ,19 ~ by - 7 01 ./ J. C. iJA.()t<JN who is personally known to me or who has produced as identification and who did/did not take an at. (Name Typed, Printed or Stamped) NOTARY PUBLIC Notary Public, Stat. of Florida My Commission Expires Oct. 8, 1993 lolIdeclllw Tf'- fain. IrwIran.. Ine. May 115. 1883 First Baptist Church - 38300 5th. Ave. - Zephyrhills Note: All ChEmical Discharge- piping is sche-duleo 40 galvanized steeL Supply distribution Grease se~JI Not.: Oet~tlon and gas val..... cabl. piping is 112- EMT conduit. 1" SALV. HOOD )'0. F...Li.1cr ....-..... I EXIT I (- IS" 30" Security Fire Equipment-la330 Lawrence Rd. -- Dade City 904-567 -7340. System Type: Kidde HDA 60 DC Dry Chemical (used) Hood: 10' Stalnl.ss Sta.1 with lreas. filters, exhausted throulh roof. (l!!xIR1nl hood). " A ,e ;c, b P'-f' '2 r.}~ f el(,. C ~ P --/ ( / c-f;:,q~ l1:!:de tA-" _ '13 5--Z t, :C=N SI0-LU=~-P ?8" t'Z- N, r. If. A. /71" q t '-lPeU-<-t~: f' ~~ -- :2;> ;-. 5 J ~ STATE OF FLORIDA OFFICE OF TREASURER DEPARTMENT OF INSURANCE TALLAHASSEE, FLORIDA FIRE EQUIPT~ENT DEALER LICENSE FM02772 THIS CERTIFIES THAT: SECURITY FIRE EaUIPMENT COMPANY 12 LAWRENCE ROAD DADE CITY.FL 33525 aUALIFIER: 8ROWN,JAY HAS COMPLIED WITH SECTION 633.061. FLORIDA STATUTES. AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON: TO SERVICE, RECHARGE, REPAIR, INSTALL OR INSPECT ALL TYPES OF FIRE EXTINGUISHERS INCLUDING RECHARGING CARBON DIOXIDE UNITS, AND CONDUCTING HYDROSTATIC TESTS ON ALL WATER, WATER CHEMICAL AND DRY CHEMICAL TYPES OF EXTINGUISHERS ONLY. J....~ APPLICATION TAXES & FEES COMPANY CODE TREASURER 12 31 93 INSURANCE COMMISSIONER EXP6~~~ION FIRE MARSHAL 11 28 93 07 02 28 ISSUE DATE TYPE CLASS COUNTY 024696000186 LICENSE OR PERMIT NUMBER 0766880004 100.00 STATE OF FLORIDA OFFICE OF TREASURER DEPARTMENT OF INSURANCE TALLAHASSEE, FLORIDA FIRE EQUIPTMENT DEALER LICENSE FM02771 THIS CERTIFIES THAT: SECURITY FIRE EQU1PMENT CO 12 LAWRENCE ROAD DADE CITY, FL 33525 aUALI~IER: BROWN,JAY HAS COMPLIED WITH SECTION 633.061, FLORIDA STATUTES, AND HAS aUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON: TD SERVICE. REPAIR, INSTALL OR INSPECT ALL TYPES OF PRE-ENGINEERED FIRE EXTINGUISHING SYSTEMS. TAXES & FEES 4_~"- TREASURER 12 31 93 INSURANCE COMMISSIONER EXP6~~~JON FIRE MARSHAL 01 93 07 04 28 ISSUE DATE TYPE CLASS COUNTY 070951000187 LICENSE OR PERMIT NUMBER 2091650002 lZ5.~0 APPLICATION COMPANY CODE I ...- .... - CONSTRUCTION INDUSTRY NOTICE OF ELECTION TO BE EXEMPT FROM THE PROVISIONS OF THE FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE t.;~, ' , -- -E STATE USE ONLY MAIL TO: Department of Labor & Employment Secutity" ,~.-;':''''':'.i D TO Bureau ofW.C. Compliance C.' 2728 Centerview Drive, 100 Forrest Bldg. 0 . Tallahassee, Florida 32399-0661 J'... -.-------..-- POSTMARK DATE /~ PLEASE TYPE OR PRINT: This notice shall be in effect for two (2) years from the effective date of 1 ~ ,;u)~ ( unti0- ;26-'15. or until revoked, whichever comes first. RE:~~c:.V~~~"" C:.puJP~~..y r- (Lo;gal Business Na e of ~ole PropriNorship, Plirtnership, or Corporation) iP~.&~ /2~1t 0/ (Mailing Address) l?~.- ~ ity) (State) Nature of Business or Trade: ~~ ~. (D/B/A If Applicable) /2 ~1AJ.lZ.~/l/c.6. ~D_ (Street'Address, if different) ?.$S-~S- -(Zip) ~,- Z s-<J 83Cj\ C (Federal Employer Identification Number) ..c9llJPA?~A/T /)~.ALk-.R -- As of 12:01 a.m. 30 days following the date of the mailing of this form, you are hereby notified that the following Sole Proprietor, Partner or Corporate Officer of the above named business does elect to be exempt from the provisions of the Florida Workers' Compensation Law. I understand that by this action I am not entitled to benefits under chapter 440, Florida Statutes. By filing this form I have not exceeded the exemption limit of three Partners or three Corporate Officers. I further certify that any employees of the business named above are covered by workers' compensation insurance. The following are the certified or registered licenses held by me pursuant to chapter 489 Florida Statutes (If none, so state): (1) Type: e:tr Cl7 Number'07t)~-IOOO 187 (2) Type: ()? Number:OZ."I&.q"Ot"')l'\J5l~ INSURANCE CARRIER INFORMATION (If Applicable): A construction industry employer with one (1) or more employees must maintain Workers' Compensation coverage. Failure to comply will result in a five-hundred dollar ($500) fine and a one-hundred dollar ($100) fine for each day of noncompliance (see section 440.43, ES.). Name of Carrier Carrier Address Policy Number Insurance Agent (Agency) Agency Address EFFECTIVE DATE Signature ./ ~~ Social Security Number O~&'-~7'-CJgy9' Type/~ame '_~/ ~. gKOIL/...v' Position: Proprietor -~:::::::'tPartner _/or/Offic!":r I Ti1lp.) 0:* J..4tRJi'_ IMPORTANT: Individual exemption filing fe~, pursuant to Section 440.05, ES., is seven dollars and fifty cents ($7.50) and is payable only by money order or cashier's check. to W.C. -Administrative Tru"t Fund. Failure to enclose fee will result in return of request and delay of certification. SWOR~ T~~AN2 8~BSCRIBED BEFORE ME THIS AT JJ.l.tLti:.( e:7- ' FLORIDA .~_ . . /, f,"}','RYll'-'-. / ~a' 'i:~~'~j[X:~~~;~~'rc: .O~ n.m}OA "'~:."'- ..... 4 -. , ....".. r1:.!I. 11 7""5 l.1V..l.eD ,hl\'j ,"-':ro At I' "::>::7 :t_.~_,..._. f.;s.. liNe.. I' #. '1'- /' DAY OF j-a--?o..A- / , 1/. ~ .., j' ~ /~. '/ / d~>!"L.~~.~ /~k~'-t::/(_I- ,. Notary Pldrffc. State of Honda My Conimission Expires: It.( {j / LES FORM BCM-204 (5/7/91)