HomeMy WebLinkAbout93-3746
BUILDING PERM.IT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit N '?
_ 3746t3
Date /~, bl9-9:3
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a'D~
BUILDING
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Property Owner:
Job Address:
Parcell.D, #
,
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ELECTRICAL P~ M~CAL
~$~~-C;;;#a~,
Zoning:
Description of Work
R~as:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O,
02/21/94
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances,
DATE
9t<
Permit Fee
Signature
Company
Address \
Telephone# ~~(~ -ZB7.-7(J(:/f
W. A. BU.RGESS
Valuation or ~! ~ O~
Contract Price 5'00'
G
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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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PASCO COUNTY 8UILDING PE~MIT APPUCATlON
r SHADED AREAS FOR OFFICE USE ONLY
CENTRAL PERMITTING OFFICES:
. Dade City: (904) 521-4206
410 E. Meridan Ave" Rm 234, Dade City
. New Port Richey: (813) 847-8126 -------=:=:-
7432 Little Road, New Port Richey t~12' 929-f2S6
. Land O'Lakes: (813) 929-6085 -0
l\ \ \ \ .. Land O'Lakes Blvd, (US 41), Land O'Lakes
THIS APPLICATION MUST BE TYPED OR PRINTED IN INK
AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS
------------------------------------------
8 . OWNER'S NAME: tA)A(lt1~~O)A) i oS
~ JOB LOCATION: gq ~ S 'If ,Atllr
a: PARCEL 101: S T R SUB BLK
~ OWNER'S PRESENT ADDRESS: ~9 S'~:r 971>1
~
o
LOT
A~~
, FEE SIMPLE TITLEHOLDER'S NAME (It other than owner):
address (It applicable):
----------~-IT------~---------------------
. DESCRIPTION OF WORK: crl...SJ IC~o O~ "5 r, lr AI~ fiA4
LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF:
# BEDROOMS , SA THROOMS: _0_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER:
CITY
STATE
ZIP
:lC:
g
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CD
~ . IF MOBILE HOME OR RV: MAKE
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In
W
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. MECHANICAL CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE L1C , (it applicable):
o NEW OALTERATION VALUATION: $
YEAR
SIZE
. WORK CODE: _ PLANS ON FILE? 0 NO 0 YES
MODEL NAME:
VALUATION: $ Q1SDO. D'U
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -:=::';:
. BONDING COMPANY:
:lC: ADDRESS: CITY STATE ZIP
0
9 . ARCHITECT/ENGINEER:
CD CITY STATE ZIP
a: ADDRESS:
w
i= , MORTGAGE LENDER:
0
ADDRESS: CITY STATE ZIP
, CONTRACTOR:
SIGNATURE:
PHONE' (
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AMPS:
PHONE # (
CITY STATE
PASCO CO COMPUTER ION:
(Required)
ZIP
, PLUMBING CONTRACTOR:
SIGNATURE:
ADDRESS: CITY
STATE L1C # (it applicable):
# FIXTURES: - SEPTIC PER ,:
PHONE # (
STATE ZIP
PASCO CO COMPUTER ION:
SEWER: WATER:
WELL:
JOBS UNDER $2.500 IN VALUE DO NOT NEED TO
RECORD AND POST A "NOTICE OF COMMENCEMENT"
(permit form 10/91)
EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMIITING STAFF
PC93043032
. " ". NOTiCE....
BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND
SIGN THE REVERSE SIDE OF THIS APPLICATION
CONDITIONS OF PERMIT AFFIDAVIT.
A. NOTIC~ OF DFED RESTRICTIONS
The under&ignect understand that IhIs permit may be aubjec:t 10 "deed restrictions" which may be more restrictive than County regulations. The
undersigned assumes r86ponslblUty for compliance with any applicable deed restrictions,
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors 10 undertake work, !hey may be required 10 be licensed In accordance with slate and local regula-
tionS. lithe conb'actor Is notlic:ensed as required by law, both the owner and contractor may be c118d for a misdemeanor vlolallon under state law, If
the owner or intanded conb'actor are uncertain as 10 whatlloenslng requirements may apply for the Intended work, they 81e advised 10 contact the
Pasco County Building Dlvlslon. LIoenslng Section at (813) 847-8009.
Furthermore, If the owner hashifed a contractor or contractors, he Is advised 10 have the contractor(s)' sign portions of the "Contractor Block" oflhls
application for which they will be responsible. II you, as the owner sign as the contractor, you arelrfdic?ating that you, rather than the contractor, are
responsible for the work. If the contractor wishes you 10 sign as contractor, that may be an Indication that he Is not. properly licensed and Is notendlled
10 permitting privileges In Pasco County,
C, TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVFRV FEES
1he undersigned understand that Transportation Impact Fees and Resource Recovery Fees may apply 10 the construction of new buildings, change of
use In existing buildings, or expansion of existing buildings, as specified In Pasco County Ordinance numbers 89-07 and GO-o4, as amended. The
undersigned also understand \hat such fees as may be due will be identified .at!he time of permitting., Ills further understooc:f that Transportation Impact
Fees and Resource Recovery Fees m:lSt be paid priOr 10 recelvlOQ a "certifICate of occupancy' or final power release. If the project does not Involve a
certificate of occupancy or final power release, the fees must be paid prior 10 permit Issuance,
FUl1hermore,lf Pasco County Water/Sewer Impact fees are due, they must be pald prior 10 permit Issuance, In accordance with appllcable Pasco
County Ordinances.
D. CONSTRUCTION LIEN LAW (Chapter 713, Florida StabJtes, as amended)
If valuation of work is $2500.00 or more, I certify that I, the applicant, have been provided with a copy of "Florida Construction Lien Law - Homeowner's
Protection Guide" prepared by the Aorida Department of AgriculbJr8 and Consumer Affairs, If the applicant is someone other than the "owner," I certify that I
have obtained a copy of the above desaibed document and promise in good faith 10 deliwr it to the "owner" prior 10 commencement.
E, CONTRACTOR'SIOWNER'S AFFADAVIT
I certify that all the Information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construc-
tion, zoning, and land development.
Application is hereby made 10 obtaln a permit 10 do work and Installation as indical8d. I certify that no work or InslaUation has commended prior to
issuance of a permit anc:Ithat aU work will be performed 10 meet standards of all laws regulating cxmstnJction, County codes, zoning regulations, and
land development regulations In the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply 10 the
intended work, and that It Is my responsibility 10 identify what actions I must take 10 be In compliance. Such agenc:les Include but are not Umlted 10:
o Daoartment of Environmental Raaulalion - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, WaterlWastewater Treatment
o Southwest Florida Water Manaoement District - Wells, Cypress Bayheads, Weiland Areas, Altering Watercourses
o Armv Coms of EQClinaars - Seawalls, Docks, Navigable Waterways
o Deoartmant ot Health & Rehabilitative Services E;nvironmantal Health Unit - Wells, Wastewater Treatment, Septic Tanks
o US Environmental ProtectiOrl Aoencv - Asbestos abatement
I understand that the following restrietions'apply to the use of fill:
o Use of fill is not allowed in Flood Zone "V" unless expressly pennitted,
o If fill material is 10 be used in Flood Zone "A", it is underslOod that a drainage plan addressing a "compensating volume" will be submitted at time of
permitting which is prepared by a professional engineer licensed by the Slate of Florida,
o If fill material is 10 be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used onfy
to fill the area within the stem wall.
o If fill material is 10 be used in alW. area I certify that use of such fill will not adversely affect adjacent properties, If use of fill is found 10 adwrsely affect
adjacent properties, the owner may be cited for violating the conditions of the building pennit issued under the attachecl pennit application,
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the pennitting conditions set forth in this affidavit prior 10 commencing
construction.
I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not
specifically included in the application.
A permit issued shall be construed 10 be a license 10 proceed with the work and not as authority 10 violate, cancel, alter, or set aside any provision of
the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors In plans, construction, or
violations of any code, Every permit issued shall become invalid unless the work authorized by such permit Is commenced within six months of permit
issuance, or if work authorized by the permit Is suspended or abandoned for a period of six months after the time the work Is commencecl, One or
more extensions of time, for periods not 10 exceed 90 days each, may be allowed for the permit 1he extension shall be requesl8d in writing 10 the
Building Official, An approved inspection must be logged during each six-month period, or the project will be considered abandoned,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PRO~ERTY.IFYOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORD,ING YOUR NOTICE OF COMMENCEMENT.
SIGNATURE
SIGNATURE
OWNER OR AGENT
CONTRACTOR
DATE
DATE
NOTARY AS TO
OWNER OR AGENT
NOTARY AS TO
CONTRACTOR
MY COMMISSION
EXPIRES
MY COMMISSION
EXPIRES
SITE PLAN
(RESIDENTIAL USE ONLY)
PARCEL J.D.
SEe
TWl'
RNG
~-
SUBU
BLOCK
LOT
PROPEHTY MEASUREMENT
~f)(loO
CUHRENT OWNEHS
W AI2{(E)IJ OIEAJP;..s
DATE ~
All drawings shall be drawn to scale for all parcels or lots five acres or less.
I" = 10' ~
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SHOW ALL EXISTING AND PROPOSED STRUCTURES GIVING DIH..ENSIONS AND SETBACKS. ALSO, INDICATE
M'Y BODIES OF WATER AND ROADWAYS (INCLUDING NAMES) ADJACENT TO THE PHOPEHTY. INDICATE
THE SIZE, YEAR, ~~D Nf~E OF MOBILE; SUCH AS 12' x 60', 1981. FLEETwOOD.
All "EASEMENTS", "RIGHT-OF-WAY" and "JURISDICTIONAL LINES" must be shown on all site plans,
DO NOT ENCROACH INTO ANY EASEMENT WITH A STRUCTURE
HOUSE CONSTRUCTION
"ALl: ,', eo'
PROPOSED ADDITION
l'AlC: .-. .0'
MOBILE HOME SETUP
't"~I: ,-. 10'
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ROAD NAME
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ROAD NAME
ROAD NAME
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Z8phyrhlUs, FL 35M4I
Proposal/Contract
. Screen Rooms. Glass Rooms. Vinyl Windows. Awnings
. Carports . Window Screen. Security Screen Doors . Pool Enclosures
(813) 888-7068
5015-C W. Waters Ave. Tampa, Florida 33614
STREET
JOB NAME
PHONE
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JOB LOCATION
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JOB PHONE
SELECTIONS:
Roof I ':))(.. I ~ Ivory
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATE FOR:
So_ Wall.
16" K.P.
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SPECIAL INSTRUCTIONS
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All material i~ guaranteed to be os ~pecified. All work to be completed in 0 workmanlike monner according Authorized
to s'andard prac'ices. Any alteration or deviation from above soecificotions involving extra cas's will be Signature
executed only upon written orders.. and will become on extra chorge over and above the estimate. All
agreements contingent upon strikes, accidents or delay~ beyond our controL Owner to corry hre, tornado
and other neces.sory Insurance. Our workers ore fully covered by Workmen's Compensation Insurance
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tJJ~' '-J':lil.^~ Q'?~/? # eX $&{) _0'0
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NOTE: This proposal may be v -. 'L -
withdrawn by us if not accepled within
days,
'cceplance of Proposal- The above prices, specifications and conditions
Ire satisfactory and are hereby accepted, You are authorized to do the
vork as specified, Payment will be made as outlined above.
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late of Acceptance:
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