HomeMy WebLinkAbout94-4006
BUILDING PERMIT
Permit N.~
CiTY OF ZEPHYRHILLS
(813) 788.6611
4006 J3
'1"d-9-7~
Date
~
Pcope"y Owne" 1 t
Job Address: J iJ
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
*1
Water Conn:
tl,~
Water M~ter:
T.LF,'s:
Parcell.D. #
Zoning: ~:lY Code:
Description of Work ~
Radon Gas:
Cfi
Id- }7/
FINAL
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordart:'e with City Codes and Ordinances.
DATE
Inspector
City License Registration #
State Certified License#
'/'1
Permit Fee ~C7 - ~I
Signature 4It. ' y'./ t1M-~
Company
Address
Telephone#
Valuation or
Contract Price
!?tJ-o,o-v
~-+)/ lltd.4<'l<~
BUILDIN;
ELECTRICAL
PLUMBING
MECHANICAL
Ftr. -e'\ ~Jd Q f\ (\
Pre SLa.J~
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Ins!.
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.
APPLICATlOR FOR PERllIT
CITY OF ZEPIIYKIIILLS
BUILDIBG DEPARnIERT
OWNER'S lWtE Wll'\4-er3 f\\ U. p.
mORE
OWRER'S ADDRESS
JOB ADDRESS 3 'ED 4~ \ dd \"e- 'A l) e....
LEGAL DESCRIPl'IOR: LOT(S)
BWCK
SUBDIVISIOR
PARCEL LD.'
WORK PROPOSED:_Rev Construction _Addi t. ion _Alt.erat.ion _Repair _Install
_Sign _Hove _DeJIOlish
PROPOSED USE: Single Fallily --1f/F _, of Unit.s _HIH
_ec:-ercial _Indust. . _Swia. Pool Other
_Restaurant &: Health Depart.llent Approval
BUILDIBG SIZE:
x
~e Feet.,
Height.
RESIDERTIAL:
cotIHER.CIAL :
An'ACB (2) PLOT PLUS &: (2) SETS OF BUlLDIBG PLARS &: (1) SEl' ERERGY FORMS.
An'ACB (3) SETS OF BUILDDiG PLANS &: (1) SEl' ERERGY FOBIIS.
PROPERTY SURVEY RIlQUIBED FOR ALL IiIJ.V mRSmUC'fIOR.
PERKITS REOUESTED
~DILDIRG
$
7DD .0"0
Valuat.ion of Total Construction
_ELEC11UCAL
AIIP Service
Florida Power Corp.
W.R.E.C.
_HECllARICAL
$
Valuation of Hechanical Installation
_PLmtBIRG GAS ROOFlRG
SPECIALTY
TYPE OF mRSTRUCl'IOR: _Block _Fralle _St.eel
Other
FIRISHED FLOOR ELEVATIORS:
FT.
IS PRO.JECI' IB FLOOD ZORE AREA?
YES RO
..........................................
BUILDER
CONTRAGroR SECJ'IOR
COlfPAliY 7]+;1 rrJ/i5z)NI?f.~n7('On+ .lA/C!-,
/J~A'> :,/? ,'-.A,? /.'" _ Stat.e Cert.. or Regist. ,
J!i~ ~k... = Cit.y License Registrat.ion' l/ 'I
..........................................
Signat.ure
F.I.F.C11UCIAII
cotIPARY
Stat.e Cert. or Regist. ,
Cit.y License Regist.rat.ion ,
..........................................
Silnl~t.ure
PLUHBER
cotIPANY
S tat.e Cert.. or Regis t. I
Cit.y License Regist.rat.ion ,
..........................................
Signat.ure
HECllARICAL
cotIPAliY
Stat.e Cert. or Regist. ,
Cit.y License Registration ,
..........................................
Signat.ure
OTRF.R .
cotIPAliY
Stat.e Cert.. or Regist.. ,
Cit.y License Regist.rat.ion ,
..........................................
Signature
APPLlCATIOR APPROVED BY
PERtlIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersignecJ understands that this perait lilY be subject to "deed restrictions" wbich lily be lOre restrictive than City
regulations. !be undersigned as8UJe8 responsibility for cc.pliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas birecJ a contractor or contractors to undertake work, they tay be requirecJ 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 lilY be
cited for a lisdl!lleaJlOr violation under state law. If the owner or intendecJ contractor are uncertain as to _bat licensing
requirl!lel1ts lilY apply for the intendecJ work, they are advisecJ to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtheIlOre, if the owner bas birecJ a contractor or contractors, be is advisecJ to bave the contractor(s) sign portions of the
UContractor Sections" of this application for wbich they will be responsible. If JOU, as the owner sign as the contractor,
you are indicating that JOU, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
as contractor that lilY be an indication that be is not properly licensed and is not entitled to perJitting 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, bave been providecJ with a copy of "Florida's Construction Lien Law - BoIeoImer's Protection
Guide" preparecJ by the Florida Departlent of Agriculture and ConsllleI Affairs. If the applicant is SOEODa other than the
"ownerU, I certify that I bave obtained a copy of the above described dOCUleDt and pIOlise in good faith to deliver it to the
.owner" prior to co.eDCeJeIlt.
E. CONTRACTOR'S/OWER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in COIpliance with all
applicable laws regulating construction, IOning, and land developent.
Application is hereby Jade to obtain a peIlit to do work and installation as indicated. I certify that no work or
installation bas ~ced prior to issuance of a perait and that all work will be perfoIll!d to leet standards of all laws
regulating construction, City codes, zoning regulations, and land develO(llll!Jlt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveI1llleDtal agencies lilY apply to the intended wort, and that it is
If responsibility to identify wbat actions I lUSt take to be in COIpliance. Such agencies include but are not lilitecJ to:
t Departlent of EnvirOl1ll!lltal Regulation - Cypress Baybeads, Wetland Areas and BnvirollleDtally Sensitive Lands,
Water /Wastewater 'freatlent
t Southwest Florida Water ManageleDt District - Wells, Cypress Baybeac1s, Wetland Areas, Altering Watercourses
t ArIy Corps of Engineers - Seawalls, Docks, lavigable Watenays
t DepartJent of Health i Rehabilitative Services, BnvirODJental Health Unit - Wells, Wastewater !reatlent, Septic !ants
t US BnviIOJllelltal Protection Agency - Asbestos abateleDt
I also certify that, if fill tateria! is to be used in Flood ZOne "A" or "A,etc. ", it is understood that a drainage plan
addressing a "COIpeD8ating Vo1U1e" will be sublittecJ wbich is prepared by a professional engineer registered in the State of
Florida prior to peIlit issuance.
A penlit 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 sball issuance of a perait prevent the Building Official fl'Ol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perJit issued shall becCIIe invalid
unless the work authorized by such peIlit is COIIeDced within slllOlltbs of issuance, or if work autboriJed by the peIlit is
suspended or abandoned for a period of sil IOIltbs after the tile the work is CDEDced. One 90 day l!Itension of tile, lilY be
allowed for the perait with fee charge of $15.00. !be l!Itension sball be requested in writing to the Building Official. An
approved inspection lUSt be loggecJ during each Sil IODth period, or the project will be considered abandoned.
WARNING TO OOBR: YOUR FAILURI TO RECORD A IOfICE OF C(IIMBJCIIlm MAY RESULT IN YOUR PAYING 'NICE POR IMPROVEIIDI'S TO YOUR
PROPERtY. IF YOU IIUND TO 0Bt'1I1f FIIfAICIIfG, COIfSUL! WI'IH YOUR LDDIR OR AI AnoRm BlPOD RICORDIlfG YOUR DICE OF
momJlCBMBNt'. JOBS OlDER '2,500 II VALUE DO IOf lIDO 'fO RECORD AID POST A "JlarICE OF C<JIIIDCBIIBJIl'".
SIGIIl!URl: CONt'JlAC'fOR
SIGIA!URI: (MIBR OR AGIJf!
S'fATE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19,__ by
STAR OF FLORIDA
COUNt'Y OF
The foregoing instrument was acknowledged
before me this , 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 oath.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
STANDARD FORM OF . AGREEMENT
BETWEEN CONTRACTOR AND OWNER
.
mIS AGREEMENT made the~ 14l<."+~ - e'-5" *' ~ ~~
Nineteen Hundred an~ N, ^' TI?'J "" FOlic- by and between....-. (' e,
hereinafter called the Contractor, an~ LLJ \ Y\. +--e r'c; m 1+ P
Owner, Witnesseth, that the Contractor and the Owner for the considerations named agree as follows:
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ARTICLE 1. SCOPE OF THE WORK
The Contractor shall furnish all of the
entitled
prepared by + 0
Contract Documents entitled the
Specifications and the Drawings.
f" the year
hereinafter called the
the work shown on the Drawings and described in the Specifications
o
~ J N:' . . acting as and in these
and shall do everything required by this agreement, the general conditions of the Contract, the
ARTICLE 2. TIME OF COMPLETION 1
~ 9lI'J' I ,.yo ~p.::>'17;r i~ /p~e'U#1)
The work to be performed under this Contract shall be commence~ n.:J L ,~~ ~__ - ~- -- -
substantially completed tu/77l/N ONG" ~.K
ARTICLE S. THE CONTRACf SUM
The Owner shall p
funds as follows:
And shall be
bject to additions and deductions provided therein, in current
Authorized Change Orders will be submitted by the Contractor for all work nol specifically included in this Contract.
ARTICLE 4. PROGRESS PAYMENTS
(Insert here any provision made for the amount retained after the work reaches a certain stage of completion.)
ARTICLE 5. ACCEPTANCE AND FINAL PAYMENT
Final payment shall be due 7Jl1:F da~ ~ substantial completion of the work provided the work be then fully completed
and the Contract fully performed.
ARTICLE 6. THE CONTRACf DOCUMENTS
The General Conditions of the Contrac~, the Specifications and the Drawings, together with this Agreement, form the Contract, and they
are as ~lly a part of the Contract as if hereto attached or herein repeated. The following is an itemization of other essential pertinent
information:
SEMINOLE FORM .115
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fnbrlc~tlon, ~nd creccIon of ^lumlnu~ Structures Only.
P.1cfo Sl.1tJ'~: Hlnln:u::J Olly.l~" (ooter \1/20 5 rebl1t".
Effective llovcl1ber 15, 11)90 concrete 81:.111 be 1n:ltallcd as rCCjulrc:d
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