HomeMy WebLinkAbout94-4025
BUILDING PERMIT
Permit N~
CiTY OF ZEPHYRHILLS
(813) 788-6611
_40254
5"//-fr
,-
3D
~ EL~ PL~ M~;w:,cooo
. ~ . ;:)"cooo
Pmp'''Y own"q Rl'~- ~~- ~ ': Met"
Job Address. TI.F, s,
Parcell.D. #
Date
Radon Gas:
Zoning:
Description of Work
NO OCCUPANCY BEFORE C.O.
FINAl~~2b
DA E
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordar~e with City Codes and Ordinances.
DATE
Valuation or
Contract Price
f ~ A-52-.Q.Y
, c::I ~
'"
Permit Fee
Signature
Company
Address
Telephone# ......---
~J-tf's~c)
PLUM
MECHA
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp, Serv,
Rough In
Meter Can
Const. 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,
APPLICATION FOR PERNIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT y~ .:s~ r
::::55 ~.~~~ \ t: ~~~~;~ 7
"I (\ v _ t
JOB LOCATION '3 (f\ta 5 , \\{)('''t.-h ~.
PHONE ~-::! D
jJU)vr-e- ftlG- / M'''-R~r!er
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
0'2 - 2&- Z-/
BLOCK
SUBDIVISION
PARCEL I.D.#
O{)8D~ 00/00"- OIz.O
WORK PROPOSED:____New Construction _Addition ____Alteration _Repair _Install
_Sign/Temp. _Sign _Move _Demolish
PROPOSED USE: _Single Family _M/F ____IF of Units _____M / H
_Commercial _Indust. _Swim. Pool Other
,
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FO~~S.*e:
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
____ELECTRICAL
..'
_MECHANICAL
AMP Service
Florida Power Corp.
_H.R.E,C.
$
Valuation of Mechanical Installation
____PLUMBING
GAS
~ ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block
_Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
******************************************
BUILDER
Signature
ELECTRTCTAN
Company
S ta te . C~rt ',' 0,1' Regis t. ;~
City License Registration #
***********************~******************
Signature
Company
State Cert. or Regist. ~
City License Registration #
**********************ft*******************
PLUMBER
Signature
OT~f~ ~o~ l~
Signature
Company \.,
State Cert. or Regist. #
City License Registration 1
*****************************************~ .
Company ----po...J. ~<:.h~ KQ~~ .~
State Cert. or Regist. ;; Itbw 7
City License Registration if $::-l./.;1.
MECHANICAL
Signature
******************************************
APPLICATION APPROVED BY
PERt-lIT OFFICER.
\
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to "deed restrictions" which aay be lore restrictive than City
regulations, The undersigned assules responsibility for cOlpliance Nith any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ONner has hired a contractor or contractors to undertake Nork, they lay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by laN, both the ONner and contractor lay be
cited for a lisdeleano! violation under state IaN. If the ONner 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 Departlent, IB131
788-6611. '
Furtherlore, if the ONner has hired a contractor or contractors, he is advised to have the contractorlsl sign portions of the
"Contractor Sections" of this application for Nhich they Nill be responsible. If you, as the oNner, sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the Nork. If the contractor Nishes 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 FEE2,
D. CONSTRUCTION LIEN LAW. (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided Nith a copy of "Florida's Construction Lien LaN - HOleoNner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
"oNner" , I certify that I have obtained a copy of the above described doculent and promise in good faith to deliver it to the
"oNner" prior to cOllencelent.
J
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
a~plicable laNs regulating construction, zoning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and installation as indicated, I certify that no Nork or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all la~s
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 Nork, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not liaited tc,:
f Departtent of Environlental Requlation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treat.ent
f Southwest Florida Water Kanaqelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of Enqineers - Seawalls, Docks, Navigable Waterways
f D art.ent of Health ~ Rehabilitative Services Environ.ental Health Unit - Wells, Wastewater Treataent, Septic Tanks
f Environlental Protection Aqency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" Dr "A,etc,., it is understood that a drainage plan
addressing a "colpensating volute" will be sublitted Nhich is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance. .
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alifi, or
set aside any provisions of the technical codes, nor shall issuance of a ~erlit prevent the Building Official frol theredfter
requiring a correction of errors in plans, construction, or violations of any code., Every perlit issued shall becote i0~alid
unless the work authorized by such perlit is cOltenced Nithin six lonths of issuance, or if work authorized by the permit is
suspended or abandoned for a period of six lonths after the tile the work is cOI.enced. One 90 day extension of ti~e, ~3t be
alloNed 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 Nill be considered abandoned.
WARNING TO OIlNER: YOUR FAILURE TO RECORD A NOTICE OF COKKENCEKENT I'IAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO;C'UR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COKKENCEKENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A .NOTICE OF COMMEN KENT..
SIGNATURE I OIlNER OR AGENT
/.A!.ncre.-- m ~/q1L
STATE OF FLORIDA~ 0
COUNTY OF ~ <=-
The foregoing inSj'ument was ~~, ,wledged
befclj-e me this 5"; If ,19 by
J nA~J.-; I.'^-, I .11, tJJ/kJ
j-..Q70f'-L" I , W ,-
who is per nally known to me or ho has
produced i:>L : fJ: WSI (p -533' d7-~ClD
as identification and who d' /did not
take, an 0 th
STATE OF FLORIDA --p A-::J .
COUNTY OF r. () _
, The forego i ng i ns tn~ent vJas ac knovJl edged
befol-e me this ~. / ( , 19~ by
r
Clj- Stamped)
who is Dr who has
pl-oduce
as identi~~ion and who didldid not
takeanc~rn '~
(SignatLrre) ~-- (j
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
(Name Typed, Printed
NOTARY PUB~ll..
~~
JUDITH l, SCHAPER
Notary Public, State of Florida
My Comm. Exp, June 6. 1907
No, CC 292357
I ~.,.f"0.""." SUSAN M. AlMV
;' .' 'Z:,;;~ 61 N:tery Public, State of FIorfdo
. '"',, t..'f Comm, Exp. Mat. 25. 1998
l_~'!"~ ' N.. 359632
F-A~,JL_
S. C H If::; F- .=.'::; R
............,,_.......... ..._,_ __.'........... ..... ...."",. ........ .._....._...._...............__.......w....... . .__ ....,.~_...........'.... ,_h ....._.... ...~ ._........ ....,.... -- ........-.-.....-.,,-.- ....---..-.. -," ....~- .--..-.-. ......... .............. ,- -. ..._'..-.- ..---..... -.. ...-.--- .
~~__....__.........~_..._.__....___M...~.._.__..W_____H_._.__.__h._.______.___..___.___~._..__...__..~.....~___-------.;...-..~
\ i'
C9-
COI"-iSTRUCT I ION
RESIDENTIAL & COMMERCIAL
Fee,:; l~. tel"'e,j
F\>29 l.::; t e t-ea
BU11dlng Contr~ctor
RGotlng Contractor
11250 South Highway 9~,Dade CIty,
Phone # (904)567-8580
Bonded and Insured
:25 yfl- 7)ltU~t'H~
rxltff/3 30 ~.
/\ JI
RB 003252~
j;:C 0056 7 6~.
Flot~ida
33525
ii
Ii
"
"
:1
if
(i
"
ii
II
'I
II
"