HomeMy WebLinkAbout94-4121
. BUILDING PERMIT
Permit N.C!
CiTY OF ZEPHYRHILLS
(813) 788-6611
_ 4121t
6-;2.3-71
Date
~ILDI~
Pmperty Owne" jJ. ~
Job Address: (:; f~~--
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
. fJ;! tbe-
Water Mejer:
T.I.F.'s:
Parcell.D. #
Zoning: Q Energy~
Description of Work ~ ~ _ . _
Radon Gas:
~1vU c:4-~-;ZC~ c.6~
NO OCCUPANCY BEFORE C.O.
/'
.5
1/9
3 ./l?
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C,Q,
All work shall be performed in accordarr:-e with City Codes and Ordinances.
DATE
Inspector
City License Registration #
State Certified License#
;2l/?
:~;~~~~:e P - ~f:t;Ir
,
Company
Address
Telephone#
Valuation or
Contract Price
d.-3 crv . o-.:J
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Serv.
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final
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.
&.11:,,,,,,,, I" I I UN
"
Lots & and 7 in Block 169 of
Northwest 1/4 of the Southeast 1/4
South, Range 21 East, according
recorded in-Plat Book 1, Page 55, 0'
County, Florida.
TOWN OF ZEPHVRHILLS, in the
0' Section 11, TOWh&hip 26
to the map or plat thereof
the Public Records of Pasco
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F 1 F TH
AVENUE
(EASTBOUND)
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APPLICAnOll fUR. PERKlT
CITY OF ZIlHIIKBIU,S
BUII.DIJIC DEPAImIEIrr
OWNER' S RAIlE
:-<AlK't K~Jl'l
3lD l./ 1.3
(, r~' , .. ~ ).
l-l:, )~ t:-
.fIIOIIE
? B 3-/ S-7S
If 3351 .
OWNER · S ADDRESS
JOB ADDRESS
--;) '8 .-<.-
c- J t ;'\ ~,;) C
CHEeR- wool::> ).../1.(" Z~Pf{Y~/I/c.c5
5''''''t-ht 2Ff'HYR.\i I U.J~
o f; 7 ~SOBDIVlSIOR(1,\ Df ~3~'t\1f?:-HIUS
LEGAl. DESCR.I.PI'IOR: I.OI'(S)
PARCEL LB.'
WORK PROPOSIlD:__ev Coos~rUc~ion ----JWdition ~A1tera~ion _Repair _Install
_Si8n
_lIove
_ne.oIish
PROPOSm USE:
Single F..tly
_"'F
_' of Units
_"/8
_~rcia1
_Indust. _Swill. Pool
Other
Restaurant 5- Bea1th Deparblen~ App.r:o\raJ.
BUILDIIIG SIZE:
x
~e Fee~.
Beieht
RE5IDElITIAL: ATTAaI (2) P1OI' PLAIIS 5- (2) SEIS OF BUlLDIIIG PLAIIS 5- (I) SKI' ElIERGY FORtIS...
aNlERCIAL : . ATTAQI (3) SETS OF BUIl..DIIIG PUlIS 5- (I) SKI' btlUlGr .I'1))B;...
..00Pl' OF aJII'DAcr RIIQUJ.JUID.
PllJlJlTlS RIlDIIR.C:J'EI)
_BUlLDUfG
$. '.::> ,. {1 ()
~.j( -(),
Va1ua~ion of TotaJ. Cons~ruction
-ELECIlUCAL
----.JIECIIANICAL
AIIP Service
FIorida Power Corp.
W.R.E.C.
$.
Valuation of lleduanica1 Installation
-PWHBIIIG GAS ROOFIIIG
SPECIALTY
TYPE OF OOIlST.RIJCTIO": ---.JIloclt ----Y'~ _Steel
Other
FlIl1SHED FLOOR ELEVAnOllS:
Fr.
15 lWIJEcr D FLOOD 7.OlIIl: AREA!
..........................................
YES NO
BUlIJ)P.R
c....
S. ,I
I.gDature !
WDRACIDR SECrIOl
r
mtPAlIY CIlRmll}.J, S/~ 1 iE~\i\ ?
Sta~e Cer~. or Regiat.' 0.~G, (1 0 t.f ;Y3SL/-
City License Regfsttation , ,;;<Lj <;
................................
RT.F..CI'.RT~
OOIIP.AH
State Cer~. or Regist. ,
City License Registration ,
..........................................
SilmJllture
PlDlRRR
-
WflPMY
Sta~ Cer~. br Regist. ,
City Li~ Registration ,
..........................................
Sigoa~ure
~CA.L
Signature
mtPMY
Sta~e Cert. or Regis~. ,
City License Registra~ion ,
..........................................
0I1IIIR
Signature
mtPAlIY
Sta~e Cer~. or Regia~. ,
City License Registration .
..........................................
M'PLlCAnOll APPRovIrD BY
'11,u,-"'Q ,'4f:!/'~
PERflIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Th@ undersigned understands that this p@r.it .ay b@ subj@ct to 'd@@d r@strictions- Mhich .ay b@ .or@ r@strictiv@ than City
r@gulations. Th@ undersigned assu.@s responsibility for co.plianc@ Mith any applicabl@ deed r@strictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OMn@r has hired a contractor or contractors to undertake Mork, they .ay b@ required to b@ lic@ns@d in accordanc@ with
state and local regulations. If the contractor is not licens@d as required by laM, both the owner and contractor .ay b@
cited for a .isd@.@anor violation under state laM. If the OMn@r or intended contractor are unc@rtain as to Ihat lic@nsing
r@quir@.@nts .ay apply for the intended Mork, they are advis@d to contact the City of 2@phyrhills Building D@part.@nt, 18J31
788-6611 .
Furth@r.or@, if the OMn@r has hired a contractor or contractors, h@ is advised to have the contractorlll sign portions of the
"Contractor S@ctions- of this application for Mhich they Mill b@ responsible. If you, as the OMner sign as the contractor,
you are indicating that you, rather than the contractor, are r@sponsibl@ for the Mork. If the contractor Mish@s you to sign
as contractor that .ay b@ an indication that h@ is not prop@rly lic@ns@d and is not entitled to p@r.itting privileges in the
City of 2ephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LA~ (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I c@rtify that I, the applicant, have been provided Mith a copy of "Florida's Construction Lien Law - "o.@owner's Prot@ction
Guide- prepared by the Florida Depart.ent of Agricultur@ and Consu.@r Affairs. If the applicant is so.@one other than the
"oMn@r", I c@rtify that I have obtained a copy of the above d@scrib@d docu.@nt and pro.is@ in good faith to deliver it to the
-oMn@r" prior to co..@nc@.@nt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I c@rtify that all the infor.ation in this application is accurat@ and that all IDrk "ill b@ done in co.plianc@ .ith all
applicabl@ la.s regulating construction, zoning, and land d@v@lop.@nt.
Application is hereby .ad@ to obtain a p@r.it to do work and Installation as indicat@d. 1 c@rtify that no Mork or
installation hal cO'l@nc@d prior to issuanc@ of a p@r.it and that all Mork will be p@rfor.ed to leet standards of all laM5
regulating con5truction, City cod@s, zoning regulations, and land d@v@lop.@nt regulations in the jurisdiction. 1 al50
c@rtify that I understand that the regulations of other govern.ental ag@nci@s .ay apply to the intended work, and that it is
.y r@5ponsibility to identify what actions I .ust take to be In cotplianc@. Such ag@nci@5 include but are not li.ited to:
I Depart.@nt of Environ.@ntal R@Qulation - Cypress Bayh@ads, M@tland Ar@as and Environ.@ntally Sensitive lands,
Nat@r/Mastewat@r Trfat,@nt
I Southwest Florida Nater "anaQ@.ent District - NeIls, Cypress Bayheads, Metland Areas, Altering NatercDurs@5
4 Ar.y CorDS If Enain@@rs - SeaMalls, Docks, Navigable Naterways
I D@part.ent of Health l Rehabilitative Services, Enviro",ental H@alth Unit - W@lls, Wastewater Tr@at.ent, S@ptic Tanks
I US Envirln.ental Protectill Aaency - Asbestos abatelfnt
I al50 certify that, if fill .aterial is to be used in Flood Zone "A" or "A,@tc.", it is understood that a drainage plan
addressing a -co.pensating 'Dlu.e- will be sub.itted which is prepared by a professional engineer registered in the State of
Florida prior to p@r.it issuanc@.
A p@r.it issued shall b@ construed to be a licens@ to proceed with the lork and not as authority to violate, cancel alter, or
s@t aside any provisions of the t@chnical cod@s, nor shall issuanc@ of a p@r.it prevent the Building Official frol thereafter
requiring a correttiDn of errors in plans, construction, or violations of any cod@. Every per.it issued shall becole invalid
unless the work authorized by such per.it is co..enced within six lonths of issuance, or if work authorized by the p@r.it is
5usp@nd@d or abandoned for a period of six IOnths after the ti.e the Mork is to..enced. One 90 day extension of ti.e, .ay b@
allow@d for the per.it lith f@@ charg@ of 115.00. Th@ extension shall b@ requested in Mriting to the Building Offitial. An
approved inspection lust be logg@d during each six .onth periDd, or the projett Mill be consid@r@d abandoned.
HARMING TO OUNERI YOUR FAILURE TD RECORD A NOTICE OF c~MCEftEMT KAY RESULT 1M YOUR PAYING TUICE FOR I"PROVE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TD OBTAIN FINANCING, CONSUlT HITH YOUR LENDER DR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COftItEMCE~NT. JOBS UNDER 12,500 IN VAlUE DO NOT NEED TO RECORD AND POST A "NOTICE OF CotItlENCE~NT-.
SI6NATURE: CONTRACTOR
SlAT\' OF flORIDA ~ ~~ - --
COUNTY OF /. /1L:&A
The foregt,ing instrument was acknowledged
b~fore me this, 19_____ by
SIGNATURE: OWNER OR AGENT
SIRIE OF FlllRI.A~ ~ ~,~.
COUNTY OF. -
The foregoing instr ent 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)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLI C