HomeMy WebLinkAbout93-3668
BUILDING PERMIT
Permit N C?
CITY OF ZEPHYRHILLS
(813) 788-6611
_ 3668,6
1!-~'I-93
/""
~1J'
c8
Date
Property Owner:
Job Address:
Parcell.D. #
E~/ PlU~
Ji~4~~#Z .
MEC~sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
::~~fw~~"iJ~;2~4t~~:::1I~~~7ZA~
FINAL /2- - '-3
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
Valuation or ~ . -
Contract Price .1lJiJO
Permit Fee
C;ty Ucense Reg_;....t;on · ?;~~'1J:~
State Certified Llcense# E 0
..
MEOOJJIe::Al
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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.
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APi'I.j:C~:rIOR FOR PERHIT
CITY OF ZEP.HYRHII.I.s
BUII.DDiG DKPAR1:HElilT
OWNER'S ADDRESS
~} c~,A"-\~O V'..J
Sf, 3d-
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l? C\h~
mONE
Q-d CJ
~-7C\ -L{OCLS
OWNER'S NAKE
G ~,\
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JOB ADDRESS
G- c\. \ \ ~ \ '0 c\ "?- e ry'A '( <' ~ ~ ~ ts-
~_SU8DIVISIOR
\-:- l ..
LEGAL DESCRIPTION: WI'(S)
PARCEL LD.'
WRK PROPOSED: /lNIev Construction
,I.ign
--.JU)dition _Alteration
...!.-.-Repair
_Install
___Move
_Deao1ish
PROPOSED USE:
S:ing1e Faaily "< ----1t/F
__, of Units
_K/B
_<=<-ercia1
_Indust.
_Swi..-. Poo1
Other
--.Jlest:aurant & Hea11:h Deparblent Approva1
I l
BUILDING SIZE: c:, 6 X <;? 0 ,
']' I r II
~e Feet, r:;t-L{ I ( 'I { j 0
Height
. RESIDENTIAL:
COttIIERCIAL :
A'lTACII (2) PLOT PI..AIIS & (2) SEI'S OF BUILDING 1'.LANS & (1) SET ENERGY FORMS...
A1TAaI (3) SEI'S OF BUIIDIRG PI.MS :&.(1) SET ENERGY FORKS. u,
""roPY OF roNTRACT RIlQUIRED. .'
I.'
PERI!IITS REQUESTED
---..BUILDING
$
J () 0 6 -
Va1uation of Tota1 Const.~tion
I
F.T.P.CTRIGAL
AIfp Service
F10rida Power Corp.
W.R.E.C.
---.JIECIIAHIGAL
$
Va1uation of Hechanica1 Installation
----..PLUKBING
GAS
ROOFIlIiCr
SPECIALTY
,TYPE OF roNSTRUGTIOllil: _B1oc1t ~ _Stee1
Other
FTIfISBED FLOOR ELEVAnORS:
FI' .
IS PROJECT IN FLOOD ZON~ AREA?
..........................................
, YES NO
COlD'RACIOR SELTIOIN
BUILDER W'lfPm i A- h ..Q '" I C 0\ '"\ S. ~ ~ '""'- C c
St:ate Cerl:. or Regist. I C '5 0 00 0 '7 ~
Signature City L.i-::ense Registration' ,{; l.5 S'reC:::I'f liy
..~................*...................
ELECTRICIAN W'lfPAlIiY
State Gert. or Registol ,
SiRDature City ~icense Registration .
..........................................
PLUttBER W'lfPARY
State Gerl:. or Regisl:. I
Signature Cit.-y License Registration i
..........................................
KECIIAIlICAL W'lfPMiY
State Gerl:. or Regisl:. I
Signature City License Registration I
..........................................
onIER W'lfP/WY
StatE cert. or Regist. I
Signature City Lic~llSe Registration .
....................*.~.......*...........
APPLICATION APPROVED BY PERHIT OFFICER.
~IZ
I . - / -' I "If -'
,,JcB.-/J.; 1~ ct - ,I 9lf.
r5 D~f)O,
~ .
~GNDllIONS.OF PERMIl AFFIDAVIT
o. . !"1)I.!.r;:=:..J~W T2Cs.l) RESTRICTIONS .
The undersigned understands that this perlit 'lay be subject to "deed restrictions' whith lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance Nith any applitable deed restrictions. '
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ONner has hired a contractor or contractors to underta~e Mork, they lay be required to be licensed in accordance with
state and local regulations. If...the'contractor i~~!lo.\ licensed as required by laM, both the owner and contractor lay be
cited for a lisde.eanor violation under statel:w. If the ONner or intended contractor are uncertain as to what licensing
require.ents lay apply for the intended Mork, they are advised to contact the City of lephyrhills Building nepartlent, lB13)
788-6611.
Furtherlore, if the o"ner has hired a contndor 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 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 cprtifythat If the applicant: have beer Dr""~1ad with a rDfI~ of "Florida's Construction lien Law - HOleowner's Protection
Guide" prepared by the Florida Departlent-of Agriculture and Co,lsuler Affairs. If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy Df the above described dotulent 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 "ill be done in co.pliante with all
applicable laws regulating construction, zoning, and land developlent.
'~ Application is hereby lade to obtain a perlit to do Nork and installation as indicated.' I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all "ork Nill be perforled to leet standards of all laws
regulating construction, City codes, zoning regulations, and l~n~ developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governfental agencies aay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in ccapliance. Such agencies include but are not lilited to:
f Departlent of Environ.ental ReQulation'- Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
, Water/llastewater Treatlent
I Southwest Florida Water nanaQelent District - kells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
t Departlent of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill .aterial is to be used in Flood Zone 'A' or "A,etc.', it is understood that a drainage plan
addressinQ a "colpensatinq volule" Mill be sublitted Nhich i~ 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 Mork 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 cOI.enced within six Donths of issuance, or if Mork authorized by the perlit is
suspended or abandoned for a period of six lonths after the tile the work is cO.lenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of tI5.00. The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged during each six to nth period, or the project "ill be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT KAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT IIITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECOnD AND POST A "NOTICE O~ COMMENCEMENT'.
SIGMATURE. OIlMEN DR ASENT SIS'A1I1RE. ~ ry/
'.
was acknowJedged
, 19 _ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befclre me th i s
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
~':as .?c1:nD~'11edged
, 19_ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known.to me or who has
produced
as identification and who did/did not
take an [lath.
(Signature)
. (SignatLn-e)
(Name Typed,~Pr~nted or Stamped)
NOTARY PUBLIC I
(Name Typed, Printed or Stamped)
NOTARY PUBLIC