HomeMy WebLinkAbout94-4172
BUIL~t~9HY~L~RM!! m 4172~
(813) 788-6611 Date /'-d.-/-j"!
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ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
~~
Property Owner:
Job Add,.... ~/!' ::: ,. /<~9 J)./I.
Parcell.D. #
Water Conn:
Water Meter:
T.I.F.'s:
Zoning: Energy Code:
Description of Wor; ~ /')~
Radon Gas:
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FINAL
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordar~e with City Codes and Ordinances.
DATE
City License Registration #
State Certified License#
3D
Inspector-
Permit Fee ~~ ~ ~
Signature r.-- ~.L-< C~
Company
Address
Telephone#
Valuation or
Contract Price----dj ;).. Y s:- lrz}
j)gJL_
ELECTRICAL
PLUMBING
MECHANICAL
Tp, Servo
Rough In
Meter Can
Canst. 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 PERKIT
CITY OF ZEPHYRBILLS
BUILDING DEPARTMENT
OWNER'S NAKE
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PHONE ? / .") -(;~;y /- /.) .~~/
OWNER'S ADDRESS
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JOB ADDRESS '3. '-II'; (?"./~1.1t;:<C,-/fV' t/ I 'v,?jjf~E-
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LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I. D. t
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED :_New Construction _Addition _Alteration _Repair _Install
_Sign _Move _Deaolish
PROPOSED USE: _Single Faaily _KIF cJ ____K/H
-L-' of Units
_eo..ercial _Indust. _Swim. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: /;/'c l~~C)/C::ijV/6=.. 9] ~
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
~ Z L( X t'f'
AKP Service
Valuation of Total Construction
_ELECTRICAL
Florida Power Corp.
W.R.E.C.
_MECllARICAL
$
_PLUMBING
GAS
Valuation of Mechanical Installation
,"~ ROOFING SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUILDER
COMPANY
State Cert. or Regist" t
City License Registration t
*******************************.....*.***.
Signature
ELECTRICIAN
COMPANY
State Cert. or Regist. t
City License Registration t
*******.*********.*..*..***.***.*********.
Si2118.ture
PLUMBER
COMPANY
State Cert. or Regist. t
City License Registration t
******************************************
Signature
MECHANICAL
OTHF.R
)
r_l/ ,/
I , /l-:& '-
COMPANY
State Cert. or Regist. #
City License Registration t
***************************************.**
_ COMPANY Ci i'< I i_ l;
(;/ , State Cert. or Regist. ,
l/<-~__ City License Registration f
*******.***.*..*..**..*.***.*.*****.***..*
Signature
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this petlit lay be subject to 'deed restrictions" which JaY be lOre restrictive than City
regulations. !he undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, 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 owner and contractor JaY be
cited for a lisdeieanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requireJents JaY apply for the intended work, they are advised to contact tbe City of Zephyrbills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for tbe work. If the contractor wisbes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to petlitting privileges in the
City of Zephyrhills.
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 provided with a copy of 'Florida's Construction Lien Law - HOJeOWDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsOler Affairs. If the applicant is sOleone otber than the
"owner", I certify that I have obtained a copy of the above described docUlent and prolise in good faith to deliver it to the
"owner" prior to cOllellceJent.
E. CONTRACTOR'SjOWNER'S AFFIDAVIT
I certify that all tbe inforJation in this application is accurate and that all work will be done in cOlpliance witb all
applicable laws regulating construction, loning, and land developleDt.
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a petlit and that all work will be perfofled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify tbat I understand that the regulations of other governJeDtal agenCies laY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Sucb agencies include but are not lilited to:
* DepartJent of EnviroDJeDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water HanageJent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* Atly Corps of Engineers - Seawalls, Docks, lavigable Waterways
* Departlent of Health' Rehabilitative Services, EnvirODJeDtal Health Unit - Wells, Wastewater !reatlent, Septic ranks
* US EnvirODlental Protection Agency - Asbestos abateJent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a 'cOlpensating volUle" will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to petlit issuance.
A perlit issued sball be construed to be a license to proceed with tbe work and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor sball issuance of a petlit prevent the Building Official frOl tbereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCOll! invalid
unless tbe work authorized by sucb petlit is cOlll!nced within six IOnths of issuance, or if work authorized by the petlit is
suspended or abandoned for a period of six IOntha after the tile the work is cOlleDced" One 90 day extension of tile, aay be
allowed for the petlit with fee cbarge of $15.00. The extension sball be requested in writing to the Building Official. An
approved inspection lust be logged during each six IOntb period, or the project will be considered abandoned.
WARlfING TO OWIER: YOUR FAILURE TO RECORD A IOTICE OF COMHBlfCBJIBIlI HAY RBSUL! Ilf YOUR PAYIIG !WICE FOR IHPROVBMnTS TO YOUR
PROPERTY. IF YOU IIfEIID !O OBTAIN FIMAHCING, CONSULT WUH YOUR LBlfDBR OR AN AnoRm BEFORE RBCORDIMG YOUR MOTICE OF
COMHBNCEHRN!. JOBS UHDER $2,500 II VALUE 00 lOT IEED TO RECORD AND POST A I'NOTICE OF COMHBNCEHBIlI".
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SIGMATURE: OWNER OR AGHili SIGMATURE: CON!RACTOR
iJj3A .
STATE OF FLORIDA
COUlllY OF P /1 S c- 0
The foregoing instrument was acknowledged
before me this 7,J. 'J-I ' 199~ by
.
STA!E OF FLORIDA
COUlllY OF I/J ~ c 0
The foregoing instrument was aCknowledged
before me this 7- J- I , 19 9</ by
7<..- c- k {7 AO.' h
who is personally known to me or who has
produced fJ.pf? SO n.4IJ~ /(....,t?Wt'I. To m-l!.,/
as identification and who did/did not
t~~/th~ ~ . .
( ignature) ~
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
BONNiE J. KINNEY
My Comm Exp. 6/10/97
NOTARY .
~ PUBLIC ~ Bonded By Service Ins
~~ 0';; No. CC293758
OF f\; l\PersondlyKnown 1l0lher1.D.
~, l/ (~ I
. <-1'- -rA-U, h
who is personally known to me or who has
produced bIZ5OI.l)}/li ..(',DU)) 70 /lJf!-I
as identification d w 0 did/did not
t.ke~ I.K-
(Sign. ure) ~
(Name Typed, Printed or Stamped)
NOTA PUB IE J. KINNEY
My Comm Exp, ?/10/97
'" NOTAi<Y <( Bonded By Service Ins
y PUBLIC !2 CC293758
;,o~ 0<1: No,
OF f\; ^Per~Of'IiI,y Known \1 0\heI1. D.
'J\
G~VIN ROOFING 1,1
lie. # RC 0046241
Labor Guaranteed One Year .~I
(904) 567.5034
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JOB NAME I
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JOB LoeA r ION' I
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IB, 'ropo", ""'by to fom'," m,t"", oed "bo, -. ,.on:Plete in accordance with abovE SPEClflc.'atlons, for the sum Of:. I'
i:f{,(.,o {.:;~ ~A'e;;'{.; ~ r,uiJ ;<I. vi t?-L2 + /#Rp-&.lLr_~_ doll", ($ --!ij.L&._) i
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tions involving extra costs will be executed only upon written orders. and will become an Slgnat'~re -.---f~-..-L..-~.___.t!~~.__. ----- _. I
extra charge over and above the esti,mate. An ag.reements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire. . torn~do and other rl€CeSsary lrI$urance Note Th!s pro~)o~a; may be /./" kJ jl
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and conditions are satisfactory and are hereby accepted, You are autnorrzed Signature -~~- .- - - ~- --- - -. -- -11
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PROPOSAL SUBMITTED TO
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CITY, STAT AND ZIP CODE
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