HomeMy WebLinkAbout93-3551
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit N ~
3551/1
BUILDING
~CHAN~ Sewer Conn
Water Conn:
Pmperty Owne" f;i~ Wate, Mete"
Job Address: ..s- ~~ ' ~ T.I.F.'s:
Parcell.D. # 1/ -;).0 -ILf ~ /7..;J.-D - d-/~ :J.;)-.;).3.....~V ~ 7
.;.2 b ~ o-z>
~TR~
..J 3 f) , tfTtJ
Date
/tJ -- 7- 9'3
PLUMBING
Zoning: ~ergy Code: Radon Gas
Oe,e,;ption of wo;; K~-</r/f'~; J ~-- ~~k
NO OCCUPANCY BEFORE C,Q.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
Inspector
Permit ~ A ~ "/,7 Lfl A
Signa~--a- __ ~ --
Company
Address
Telephone#
Valuation or
Contract Price
"/t!, ,576 f tit;
/
City License Registration # 6'7 r -+ 3'1 h
State Certified License#
BUILDING
~%~~
PLUMBING
Driveway
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
L~\-\- 6~G..t
ID"22-C[:1;? a
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
V{lF-f5 vvlCL ~S l'
I
16~2L'1'3- tfO
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.
APPLICAnOli fUR PERllI.T
CIlY OF zm.uIKHIl.Lc;
BUII.DllIG DEPAKIIIIlXl'
(
_'s_G~L;liI .K C~f -
OVlIER'S ADDRlrSS / u, rJ I /U 7 T/1 :5-:7r zE r
JOB ADDRlrSS / .t7 0 7 a -4 I r R /v oJ
.
LEGAL DFSCRIPl'IOIIIl: wr(S).I~I.;:o.:2 /.BI.OCX SOBDIVISIOlI
.
)> It E)f Jt.) ~' )C
,
PARCEL LD.'
IiORK PRO~ED:_lIIev Construction _Addition ~ration _Repair _Inst:all
S'
- 19I1
_lIove
_De.olish
PROPOSED USE: Single F,.uy
_II/F
_' of Unit:s _II/H
,....
_S~. Pool @~~ _ Ot:her
.-::7 ~
_ec-ercia1
_Indust.
R_t:aurant & Hea1t:h Depart:aent Approval
BUlLDIIIG SIZE:
x
~e Feet.
Height
RESIDENTIAL:
COHItERCIAL :
A'lTACH (2) PLOI' PIAIIS & (2) SEIS OF BUILDDIG PIAllJS & (1) SKI' ElIERGY FORKS. **
ATtACH (3) SEIS OF BUllDDIG PIAllJS & (1) SKI' EIIERGY FORIIS.*'"
......oopy OF OORDAct :RIIQUI..RIlD.
~ING
~Cl'RICAL
$
PJr.IUf1'1S RmOESTED
J/6? Oe>- ~ (;) ~
.rr-' . Valuation of Tot:a1 Const:ruction
AItP Service
Florida PoiiIer Corp.
W.R.E.C.
----1IECllANICAL
$
_PLuttBING
GAS
Valuation of ltecbanica1. Inst:a11ation
ROOFING ~ClALTY
-~ _Steel J~ 4?k Ot:her
IS PROJEct III FLOOD ZONE AREA?
TYPE OF ooNSTRUCl'IOIl: ---Block
FInSBED FLOOR ELEVAUOIIS: FI' .
YES NO
..............................................................................................................................
aJlIII'IHACIOR SECI'IOJl
RmTDER.. ~ lDIPMY
~ ~ A Sl:ate Cert. or Regist. .
Sigoa~~ tf<.- ~ . City License Regisl:nltion .
..............................................................................................................................
c7cr~d9t,
~ ~ lDIPAIIY //(1(&- CtECr,(JL
St:ate Cert. or Regist. .
S' e ~. .. ~ City License Registration' t9'"3
............................................................................................................................
PLUIIBER.
aJIIPAliY
State Cert:. or Regist. .
City License Regist:ration f
..............................................................................................................................
Signature
IlEalAllICAL
aJIIPAIIY
Sl:ate Cert. or Regist. .
City License Regisl:nltion .
..............................................................................................................................
Signature
0T1IJl.R aBPAIIY
State Cert. or Regist. .
Signature City License Regist:ration .
..............................................................................................................................
APPLICAnOR - BY '-# dA1A' -;r ~ /wA..'l- PIlIlIIIT QFPICIlIl.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlitlay 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 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 law, both the owner and contractor lay be
cited for a lisdeleanor violation under state IaN. If the owner Dr intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departtent, 1813}
788-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor 15) 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 - 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 doculent and prolise in good faith to deliver it to the
'owner' prior to cOllencelent.
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 perlit to do work and installation as indicated. I certify that no work Dr
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 regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
I Departlent of Environaental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatlent
I Southwest Florida Nater "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Departlent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
I US Environaental Protection Aqency - Asbestos abatelent
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 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 perlit 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 cOltenced within six lonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six lonths after the tile the work is cOllenced. 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 Co"~NCE"ENT KAY RESULT IN YOUR PAYING TWICE FOR I"PROVE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUlT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
CO"KENCE"ENT. JOBS UNDER $2,500 IN VAlUE DO NOT NEED TO RECORD AND POST · TICE OF COftKENCEftENT'.
r:?~JJYdL. ~
SIGNATURE: OWNER OR AGENT NATURE: CONTRACTOR
STATE OF FLoRID~
COUNTY OF .=ld.u.-tJ<2.J
The foregoing instrument was acknowledged
before me this ,.:;r~ ~)J419.ll... by
Ca,Vf'"oJ/ fl. Ii ndeys
who is personally ~mown to me ~v l/hl! ktlt!;
WOri'll""'itd
a_s~ntJ ril::~tJl)':.l:~and who did/did not
take an ~ j' L7 ~J)r
(Signat~~ r~ t<-. '--'r
------.
(Name Typed, Printed or Stamped)
NOTARY PUBLIC SHIRLEY R. CROFT
NOTARY PUBLIC, STATE OF FLORIDA
. . c. I-n oq 1994
My CommiSSion LXp,res ." ."',
. . n No AAiL::n3
Comm:ss1o . .
STATE OF FloRID:t:>. I
COUNTY OF u U a,
The foregoing instrument(was acknowledged
befc,re me th i s .;)~ ..5rJ.pb t"hv, 19.fi- by .
& (Vt1 / I {Jnd~
who is personally known to me or who has
produced
as identification and who did/did not
take an o~ f. fir-
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
~~~jr\LC:'( R. CRO"FT
liOT.'.RY i"Uc!!iC, Sii\iE Or FLORIDA
r~'J'/ C;-'mrni~;;'t.:; [:CjiC~~ J;!l~. ::], 1 st):.l
Commi:'siGrt jio. AAj'3221~
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LEGAL DESCRIPTION:
------
That part of Lots 19, 20, 21, 22, 23 and 24,
Block 9, lying West of U. S. High way 301; and that part of lots
13, 14 and 15, Block 2, lying West of U. S. Highway 301; City of
Zephyrhills, as per plat of the TOWN OF ZEPHYRHllLS recorded in
Plat Book 1, page 54, Public Records of Pasco County, Florida.
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THE CIRCLE K CORPORATION
HISCELLANtouS BID AnD. WORK CONTRACT
f ,;
.Wr.
CIRCl..tt< CORPORAT::tON INC.
1601 N. 7'l'H STREET
PHOmtrx, AZ 85606
STORE It 0180 .
AODRmSS.1507 Gall Blvd
J.ePhY;bills .Ft
CONTRACT OATE.~'19193
~:
Genthmen,
F.r, and in ~ondd'rot1On 01. r.rt~ ~.U'and. t~~.. hUIll!.r.d andpiQUX:J Lx
anUoc. · <.~, ~9~. ~ ) . the "eontr...t Sum" to b. Paid by Cir.l. K
Cor;poration, Ina., h,grein~ft~r Cla~led "Owner", and 'rr.eftdw~lLInc.
n.r.lnnl..or ..ll.d "Contr..tor", 0 peroon, fi... or ~orpor.t!.n dUly 11~.';;;~
l';l.1 .'1 COI1trl.i\Ct(Jr: jn eho State of rloriSia _h~reby agree to do and pe.t:'form
tho fOllo"illg d..~ri~d ".rk 1n a~.ord",,~. with and subj.ot c. the term. and
conditlonR print~d and/or written below Oh the att~ched sheet h~reof,
1 )
DESCRIPTION OF WORK (herQafter the "Work")
,...._-----_--;.. ,... "-.~...,....,......'........,.
80S!:: tl'l"li<5i.EO"-
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DRAWINGS AND/OR SP~CIFICATION51
~
A. Owner Shbl1 IIlJ~.ply tht fOllowing met.erial and equipmont.
...........--- ~-..._--s.-pi.- ID . AC G ~ .. ATTACHED
.-.........-.----.~.-....___r.L~. R.Q ~ 1<A J.1
- -.-.------...
-..---.,
Fl. Hanner Md T1me of Doing Work.
Cantractoriaqrees to CdmmenCQ the Work'within 30 days
aft~r aeoeptanee of this bid by Owner, and complete the same in good
.1I1d \"orJoonanlike manner, satbfaetory and ac:eeptable to 0\..l1'l4U' I wi thin
- ;Z~_day(a) thereaft.r (tho ., Contract 'rime ") COntractor .eh.U b~
rUl'OI'\8ibltl to Owner for faithful cemplttion of the WO:-K Covered
hereby in a good and workm.n11ke manner in accordance With all
appli~abl. r~deral, St$te and Looal law, ~d r~gulation..
C. Coner$otor warrants to th~ Owner that all materials and equ1pmont
ineorporated in the Work will b~ of good quality, free from taults and
d~lects,
o. , Contractor:shall pay all 2a10s, consumer us~ and otharsim11ar taXes
and shall 88C\lr~ and pay for all lieensea' and 1nsp.Ctions . neceeIJ.U'..,
for th~ prope~;'8~.out10h and completion of th. Work.
t. Contractor:shall,at all times,keep ~he premises tree tram accumulation
of wa$t~ or rubbish eaueed by his oPtrat!ons. ~.r'
F. Tr) the' tulleat ~xttnt permitted by law, Contt6.otor .hall indemnity end' .
hold harmh.u Own#!r and tho Ownerl1 agents and ernployaottJ from '.
and against 011 c1oim., .w.og.. 1..... ..,d o.pons..., 10,.. ,o,.k P."or..d b, '.. I '
co,t,.ooto,. Ji J"'.... .
G. cr:>nt.t'ar.:eoJ: is .?\w~\re ot all codes and ordianeea 'of l1overnin;<
autnorlt1e$ and has incorporat~d costs of complianees therewith into
the contrnat num.
H.
Contr~ctor $hall complete the Work free and clear of mechanics liens
and. "/hen requeateQ I deliver to the Owner I l1en waiver:s and
Q~t1af.Qtery proof th4t all oue_tanding billa 1neurred tpr material
turnishfJd or ":viets ~edOrmtd have b..n ~a1d, and" hQlcl Owner
harmle., a9ftinBt all claims, 11~n. anddama~e. in conn.eticn
tho:ewith ~d 6ga1not ell oon'.quent =o.~,. txpan.. and damaqla.
ContJ:"ltct shall bt qOvemed by law of the place where the project
h located.
t.
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f)(19,! -~$~I.:?, T?: fJI ~1c)93>i ~1'-!1F.Hl ..', .\
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Hl~CELLANEOVS WORKCONTnACT
PAGE 'I'WO-01S0
3} ~ontractor shall furnish Owner with proof of in~uranca to prot~ct
Owne r from claims und~r work$r' s compensation aottJ &."ld othe r
~~mpl(lye() b~naHt'. <leU, e1aims for daml!\gas b~ca1l8" of bodily. 1njury
lllduding d~ath I and trQRI ehd,lIl~ fUl' /Ja.rnollgon, QthQrthM to the
work its~lf, to p~op.rty which may arise out ot or result from the
Contr;tlotl)L"a o(Jenttlons under thi1scontract, whet.hltrauch opu'atiofilJ
b~ by COlIl,ractor or by any Dubcontractor or any OM dlnwt,ly ()t'
llid1.~'t1r..:tly employed by any ot them. This inourance. shall 1:lt IoIritten
f.or not leoG than any limits o! l1ability 88speoitied by Owner or
t'flgu:L r:ed I,V l~w I wh1chIJver ia the grEtl'ltar., Cllrtificat41J of lI\1ch
1MI.lUnClt shaH be filed wi t.h th6 Owner ~rior to the oomm.no~ment ot
t.he WOl;k.
4)
contrnctor haevi$ited site and i. aware
sl.ll.fac~ cond1 tions e:lCistiog at:. th(t time of
o~sur!ace and sub -
submitting this bid.
5} Owru,~, wi thoutinvaUcl.tlnc; this =on':.tact, mav oz;der OhM.... in the
Work consisting of additiQn" deletions or moditi~ations, the
COl'\1:.rac't Sum ~nd the Contract. Tillie bein~ ~djuBtecl accora1n~ly, All
ut,lch eh&n~u in the Work shall be in writing .1~n.d by OwnU'
(a It Cha(lge Order I. ).
,
6) The Contra~t Sum and the Cont:aQt ~1m. may ~. changed only by ~
ChmrvJe ord.r,
Extcut~(1 th~
(Ht9n~d)__ . _
( Tit 1 e ) ___. !"R,g!..B~~T ~
Addrasl'J .____....T.I~!~P.l1g,!:.~9~~..R..ill.Q___,. T
5024 ROSS~~E,STREET. JACKSONVILLE, FLORIOA }2254
Pllon._...Jj.Q.m~qgo...!L..--. -. . #.
cxnCW~POAA~1? ..
~i~sl ~--Ij _ :-. 19 , - -
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6)
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If a Contractor defaults, persist;.ently fdb or negleots to cllrry
~ut th~ Work in accordance with the tetms of this Contract, or faila
1:(J p~rform any ptovidon of the Cont.2:i.ot, the .Owner, a!t'.er seven
clay~ written notice to Contraotor and without prejud1ceto any
anv ot:..h~r t.'emedy it m~y have ,may make good /Sucn defidhneio~ and rn~y
deduct the CQ~1;. t;.h.reof frl)1I\ th4 payn\ent. then, or thereatt.er, due
Contractor 0:, at it. option, m.y ttrmin.te the Conttact,a.j -.I~
JiilQdjlf'i'i'-~A- ...p '-DI _hA .._~ ".11 ll11J __"'~_'_1~ - _ '~ fL -...... "'~
jW......... 'llT"J"ll:jJiU ... "1~ m'..k.I...-.... t..fIr..~.- .. 'I ~L. - ~~l1\ft-,..
~c1 may finish the Work, by whatever m.tho~1t may deem. expedient.
If. th& unpaid balanoe of the Contract Sum exc.ed. the expense of
fini$hing.the WorK, sueh excess shall be paid to Contractor) but if
a~oh expense ~xc~ed8 unpaid balanoe Oontractor .hall pay the
d.1ff.l:'eno~ to Ownu', . .
In the :evel);y' ot bringing any&otion' by either. party hereto 4S
.?gail'at the/other, by re~son of breaoh ot any a9reem4nt Qont61Md in
~h1n eontraQt, th& p$rty in whcs& f&Vor t1nal judg.mant .hall b~
ant-.e l:'~d Shall b~ ent.i t1ed to have and recovar from the othe l: party
"(~"HI()f\('lbl6 attomcy' B feerJ to be fJ.x~d by tho ~ourt tog~lthGr with
t',he cOI.u:;ta co.u,
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AL TERN" lP,g: (lNCLUDF.. FRmGHT, TAX., OVElUJEAD, PROFIT)
I. Fumi5h and inst.oll 24" fibera1ass ri4cr. lid tu\d manhole for
!$ep$\fate Stase n connection,
2. Fumi~h and instaU Zit vQnt line piping and fittin~.
~._:i'L:--,_._~._.._-'
ContmctQfS Signature, .
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ITEM
RC/nl,)v,,; em! replacc i:lphalt and/or <lQncrctc Qver
proposed lineal and at. diapc~ors 3$ nMded.
Oxc3vateand remo,ve exiatins linMand dispo&o o( properly,
Excnvato N'tl.\ over tMka to n.movo lubmcraibl~, iNean rnnn.
wp.y~,Rnd in9taUncwI\uhmmibte.".~
Fumil$h and install riscrs on b\uks (one for fill, (me for Stage 1)
r-umi:sh and iNtal1 flapper valves.
Furnish and install spill buckets on fill ond Stnge J,
Infsl.gll CNI buckets if po$siblt, .$ 10 9.~, ~ ()
Furnish and in$tall manways at submersible pumP$. $ I ~ 2.2. t> (ill
Furnish and install flex COMectors at dispeMets and submersible, $ q f' 0/. 9 C
Ble~t.ricalfo(~ and di:speJ~ts, $ 3,SS t:'" ~ 0
pipinS lttld fittings.
Furnish and iMtaU 2~ with 3. seeondary <xmtainmcnt product
piping and fittins:(i;nolud~ all pea rock).
Furnish nnd inst41l.311 StGsen pipinS4nd fittings.
Fun..jsh and buUU Bravo boxe:s.
Sct..purge. cllliht'~. and start up new dj,~~rs,
Iro..:stall n~w WMulc in :store.
Ptrf'orm Stego n nitrosen blockage test. Per[um) p'ClS~\Jre
de<:"y t<!:\t if l)(')~ible. '
Fill out undttgrounc.l tsnk ~uipmcnt form and provide 3 sealed
· A~.C.lli1tltdrQWinSS Qf!ocMion's tAnks and piping, lnCllldt'.
c!cviltiollll of pipe, " $ 4- So. d ()
Triband canopy. Fumi:sh \U\U iMtall CM(')PY le/l~e:J. $ I L/ 2J...:.9._ca..
Uutall intercom, Painting. S , S ~. /'0 0
Install <:irclo K t'umished hO$<!s,noult" bre;!bw~y~.gwh'cllil. $ __..3S D. &I 0
Pull Permits with Circle K fuminhed drnwjng.'1. F~es reimbllr~ablu
whh (It cv:st plUlJ 100.4. $
ADOITIONAL ITEMS
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TIfF. CmCLE K CORPORA nON
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<X)NTRACTOR: ,_I.f::5.;o;;itz['7~;,:rCM'-"""---:-
LOCATION: IJ0180. 1S07 Gall Blvd.. Zcphyrhills. FL .
JOB DESCRIPTION: Repi~ with (txistins tNlk" install MPOs
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!r..s~ll ~ddition1tl electrical conduit (2 3/4")
^dditional white puinl on triband.
Fumjsh end install 30. ("'Nl manholes.
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$ 3S~35,oo
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CIRCU; K FURNISHED EQUIPHEN'r
I..CCATIOH #01S~, Zephyrh111sj F1.
1} 2 Gilbar;co, HPOe
2) ., Gilba~<;:o Tl000 console
3) 1 3H 1nteicom
1) 3 - 1 1/2 hpsubmers1blepumps
S) 1 - J pak ileak d.tector
6),Hosea, no~zles, aw1v.ls, breakaway.
LOCATION #0217, Hishland City, FL
1) 2 Gilbarc~ HPOa
2) 1 Giloarco Tl000 con~ole
3} 1 3H inter,cQm
4) J .. 1.1/2 hp 6uPlnersiblo pumps
5) 1 ~ 3 pak ileak detector
6) Hoses, noi~le8, swivels, break8ways
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LOCATION #2814, Crystal River, TL
1) 5 rebuilt Gilbareohi9hlin~8/console
2) 1 3M 1nt4trda1ft
3) ~ 400W super metal hali~. f1xtw:.. and 14 I.r~a light. poles
4) Hoses, no~zles, swivels, bre~ways
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