HomeMy WebLinkAbout94-3962
BUILDING PERMIT
Permit N 4?
CITY OF ZEPHYRHILLS
(813) 788-6611
_3962,,8
1/- /{.3 - 7i
Date
Property Owner:
Job Address:
Parcel 1.0. #
E~- P~'
~~3 ~~~Qg'-
M~. Sewer Conn
~~~
Water Conn:
Water Meter:
T.I.F.'s:
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Valuation or 4.. ~ f1"-- I
Contract Price . ) /) :;
oc)
-
Permit Fee
Inspector L{)
.- 00
.'?~.
City License Registration #
State Certified License#
'77
Signature
Company
Address
Telephone# ~
7((e:j
7?Oq'
~MA1J~
c::-~~~~
a~/A1J4c ~
ELEC~.-
PLU~'-
-
M.ECH'A'l"J I C A L
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
Breakers
Ducts Insl.
Compressor
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 ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PERMIT
CITY OF ZEPHYRBILLS
BUILDING DEPARTMENT
OWNER'S NAME
.b ~TT,/ tL 2JllrJ! j) ;?&:$:.
I
5 c; () 3 Ic.(t<- gr-
PHONE
?S~
<
O(J '7 g
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL loD.'
WORK PROPOSED: New Construction _Addition Alteration _Repair /Install
-
_Sign Move Demolish
PROPOSED USE: Single Family _M/F - # of Units _M/H
Commercial Indust. Swim. Pool Other
- ----
_Restaurant & Health Department Approval
BUILDING SIZE: /0 X~, ?a,c/!-o 5/~ Square Feet,
l
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. **
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. **
**COPY OF CONTRACT REQUIRED.
PERMITS REQUESTED
BUILDING
$
'//\ q'.r ~
[~ V~ Valuation of Total Construction
ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: Block Frame Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
CONTRACTOR SECTION
> COMPANY .s (; ^I s T~-r~...
~~ ~ ~) , State Cert. or Regist. #
~~l ~~ City License Registration #
****************************************
If ~1tI if t'J1j rJ ;f
7'7
f
Signature
ELECTRICIAN COMPANY
State Cert. or Regist. #
Signature City License Registration #
******************************************
PLUMBER COMPANY
State Cert. or Regist. #
Signature City License Registration #
******************************************
MECHANICAL COMPANY
State Cert. or Regist. #
Signature City License Registration #
******************************************
OTHER COMPANY
State Cert. or Regist. ,
Signature City License Registration #
************************************~*****
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned understands that this penit lay be subject to 'deed restrictions' wbieb lilY be lOre restrictive.. than City
regulations. 'lbe undersigned assUleS responsibility for CCIIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OIfIIer bas bired a contractor or contractors to undertake IOrk, 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 OlDer and contractor lilY be
cited for a lisd8leanor violation under state law. If the OlDer or intended contractor are uncertain as to wbat licensing
requir8leDts lilY apply for the intended IIOrk, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
788-6611.
FurtheIlOre, if the OlDer bas bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
'Contractor Sections' of this application for wbich they will be responsible. If you, as the OIfIIer sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the IIOrk. If the contractor wisbes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to penitting privileges in the
City of Zepbyrbills.
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 - HoIeoImer's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is 8OI8ODe other than the
'OIfIIerl, I certify that I have obtained a copy of the above described dOCUleDt and pro.ise in good faith to deliver it to the
"OlDer' prior to coaencuent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIliltion in this application is accurate and that all IOrk will be done in cOlpliance with all
applicable lad regulating construction, loning, and land develOpleDt.
Application is hereby lade to obtain a penit to do IIOrk and installation as indicated. I certify that no IOIk or
installation bas CDleDced prior to issuance of a perlit and that all work will be perfoIled to _t standards of all 1_
regulating construction, City codes, loning regulations, and land developll!llt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveruental agencies lilY apply to the intended IOrl, and that it is
If responsibility to identify what actions I lUst take to be in COIPliance. Sueb agencies include but are not liaited to:
t DepartJent of EnvirODleDtal Regulation - Cypress Baybeads, Wetland Areas and InviroDleDtally Sensitive Lands,
Water /Wast8later lreatJent
t Southwest Flolida Water Hana!leleDt District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t AIIJ Corps of Engineers - Seawalls, Docks, lavigable Waterways
t DepartJent of Health i Rehabilitative Services, BnvirODl8Dtal Health Unit - Wells, Wast8later treatJent, Septic lants
t US InvirODleDtal Protection Agency - Asbestos abat8leDt
I also certify that, if filllilterial is to be used in Flood Zone 'A' or "A,etc. I, it is understood that a drainage plan
addressing a '~ating volue' Ifill be sulllitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued sball 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 sbal} i88uance of a peIlit prevent the Building Official fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery perlit issued shall bec:o.e in,alid
unless the work authorized by such penit is COIIeDced within sillDDths of issuance, or if IIOrk autboriled by the penit is
suspended or abandoned for a period of sillODths after the tile the work is co.enced. One 90 day 81tension of tile, lilY be
allowed for the peIlit with fee cbarge of $15.00. !be 81tension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sillODth period, or the project will be considered abandoned.
WARlIIfG to (MER: YOUR FAILURI 10 RECORD A 10000ICE OF COIMDCIIIIH lilY RESUL! II YOUR PAYIIG nICE FOR IHPROVIIID!S to YOUR
PROPmY. IF YOU IJI'lIID to OB!AIIf FlIlAlCIIG, COIISUL! IfI!H YOUR LllfDIR OR AI AftORIIY BEFORE RICORDIIG YOUR DICE OF
COMMIICDIIIf'r. JOBS UID~D.II'5GO II IlL, ~, IlIIlllID IIID l'OSll "101I1:1 OF ClImCIIIIII~~
- ~ ~
SIGIA!UIII: MER otl SI .
SIA!I OF FLORIDA 04-'5
COURY OF r't CO
The foregoing i~~ent was acknowledged
before me this I ..3 , 19 i.!I- by
,
StAlE OF FLORIDA 19
COURY OF r '15 et)
The foregoing in~ent was aCknowledged
before lie this 13, 19~ by
who is personally known to me or who has
produced
as identifica
take an a
who is personally known to me or who has
produced
as identificatio
take an oat .
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC .
Notary Public Pasco Co. FL
My Commission Expires May \3. 1995
(Signature)
(Name Typed, Printed or St~ed)
NOTARY PUBLIC Notaty Pubhc Pasc~ Co. FL
My CommissionEitpi~s M~y 13. 1995
"II c..
J-'L AN
I
PERMIT II
(RESIDENTIAL USE ONLY )
LEGA( DESCRIPTION:
SECTION TOWNSHIP
SUBDIVISION OR OTHER LOCATION DESCRIPTION:
o
RANGE
.~. 526~
/4/(..
,
ST~
.
REAR (
FT. )
.
.
,0
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l-
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FRONT ( FT. ) wM . Jt\:
Show all ~xisting and proposed structures giving dimensions and setbacks. Also. indicate .\.;
any a~jacent bodies of water and roadways ddjacent to the property. Indicate size of ~
mobile homes such as: 12' x 60'.24' x 36'. i
I
I
EXAMPLES
HOllSE CONSTRIJCTT ON
PROPOSFn AnnTTTON
Ml1n TI r IInur rrTIlf'l
.
~g~!-
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SUN STATE ALUMINUM, INC.
37528 Hwy. 54 West /)I'l ?--
ZEPHYRHILLS, fL 33541 j.)U""".
(813) 788.7308
CUSTOMER'S ORDER NO
NAME
PHONE
? ?~o~er~
'D /rl/f V f.Q( Ir
I ~/j" S~
ADDRESS
-09 o~
SOLD BY
CASH
QTY. DeSCRIPTION
/5Jz Ii" P
/ ~ K I?-
II/Y / U-' r- Tdll 'M
4~" Dootl 1-/ /J-r
(./..a 'P 7,,$
I tv' ( ,J DOW ;; 'IT
tIJ/~'
..-~_.-
'/:)JJ. J- .{.fp ,~v- ~
t p~ ~I- III s-";;L.-.
Interest of lW16 per month after 30 days. In
the event. it becomes necessary to place this
account with an attorney or agency for
collection, .. . I/We agree to pay all costs of
collection. including reasonable attorney fees.
RECEIVED BY
DATE
'lAIR ~Ym_.
rJV"" 7i
CoA~.sr (A y.. I..., 'so\'.
MDSE. RErD. PAID OUT
PRice AMOUNT
I
I
/0'(.>' ~
I
I
I
I
/Olco
.~ 0 I co .
I
109-P:O
I
'1- 6-S; 10
1/5'DI./O
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I
I
I
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TAX I
TOTAL
PRODUCT 610
All aims and returned goods
MUST be accompanied by this bill.
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