HomeMy WebLinkAbout94-4181
BUILDING PERMIT
. N'O
Permit '.
CITY OF ZEPHYRHILLS
(813) 788-6611
4181 B
Date -7 -'L<.sJ4'-f
31j~D
~
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcell.D. #
~ ,s06r<~
~~3 2- ,.:{oLLc,u_
/'-I-2-{g-?~l- 0000 - 00200-
Water MJller:
T,I,F.'s:
0000
Zoning: Energy Code:
Description of Work ..~(.Af.W.J f{/)DM
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
/0 - ~ ~
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordar<::e with City Codes and Ordinances.
c.o.
DATE
Valuation or J,J J 75. (,) D
Contract Price _, _
r /2.S0
City License Registration # '7/
State Certified License#
\<)utJSltJ-rE- -#77
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp, Servo
Rough In
Meter Can
Const. 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.
APPLICATION FOR PERMIT
CITY OF ZEPBYRBILLS
BUILDING DEPARTMENT
,q LMf'Il1~1l-7f
/ /15 0" :l-~" ~F'
\ ()" /
,~ --SU
-~1')"
OWNER'S NAME
$]> '8()'bZ'(
(f'ir ? 2- ~c..L.I</ 6S,
WN~~ 5 If Iff?
PHONE
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION
PARCEL LD.'
WORK PROPOSED: New Construction _Addition Alteration _Repair - Install
_Sign Move Demolish
PROPOSED USE: Single Family _M/F - # of Units _M/H
Co_ercial Indust. Swim. Pool Other
- -
_Restaurant & Health Department Approval
BUILDING SIZE: -3.k.x c?-2-, 5uU:t.A! &t1f Square Feet, 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.
_BUILDING
ELECTRICAL
$
1(17~'oU
PERMITS REQUESTED
Valuation of Total Construction
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 5O~~~)f p.,fJif
~ ~ ~ State Cert. or Reg1st. #
<.vff ~ Ci ty License Registration # _ 7::Z
******************************************
Signature
ELECTRICIAN
COMPANY
State Cert. or Regist. #
City License Registration #
******************************************
Signature
PLUMBER
COMPANY
State Cert. or Regist. #
City License Registration #
******************************************
Signature
MECHANICAL
COMPANY
State Cert. or Regist. #
City License Registration #
******************************************
Signature
OTHER
COMPANY
State Cert. or Regist. #
City License Registration #
******************************************
Signature
APPLICATION APPROVED BY
tJ~~fx~~t~
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned understands that tbis perlit lilY be subject to 'deed restrictions' which lilY be lOre restrictive tban City
regulations. !he undersigned asSUle& responsibility for cmpliance witb any applicable deed restrictions, .
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tbe owner has hired a contractor or contractors to undertake work, tbey lilY be required to be licensed in accordance witb
state and local regulations, If tbe contractor is not licensed as required by law, botb the owner and contractor lilY be
cited for a lisd_anor violation under state law, If tbe owner or intended contractor are uncertain as to what licensing
requirf!IeDts lilY apply for tbe intended work, they are advised to contact tbe City of ZephyrhUls Building Departlent, (813)
788-6611,
FurtbertOre, if the owner has hired a contractor or contractors, he is advised to have tbe contractor(s) sign portions of tbe
'Contractor Sections' of tbis application for which tbey will be responsible, If you, as tbe owner sign as the contractor,
you are indicating that you, ratber tban tbe contractor, are responsible for tbe work, If tbe contractor wishes you to sign
as contractor tbat lilY be an indication that he is not properly licensed and is not entitled to perlitting privileges in tbe
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify tbat I, the applicant, have been provided witb a copy of 'Florida's Construction Lien Law - lIoIeolmer's Protection
Guide" prepared by tbe Florida Departlent of Agriculture and ConsUler Affairs, If tbe applicant is 8CII8OJle other than the
'owner', I certify tbat I have obtained a copy of tbe above described dOCUleDt and p~ise in good faitb to deliver it to tbe
'owner' prior to COlleDcelent,
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all tbe inforaation in tbis application is accurate and tbat all work will be done in COIpliance witb all
applicable laws regulating construction, loning, and land develoPEDt,
Application is hereby Iilde to obtain a perlit to do work and installation as indicated, I certify tbat no wort or
installation has ~ced prior to issuance of a perlit and that all wort will be perfoIled to leet standards of all laws
regulating construction, City codes, loning regulations, and land develOpll!llt regulations in tbe jurisdiction. I also
certify that I understand that the regulations of otber goverDIf!Iltal agencies lilY apply to tbe intended wort, and that it is
If responsibility to identify what actions I lUSt tate to be in coapliance. Such agencies include but are not lilited to:
I Departlent of Bnvirolllelltal Regulation - Cypress Bayheads, Wetland Areas and Envirolllelltally Sensitive Lands,
Water/lfastewater !reatlent
I Soutbwest Florida Water Managl!lll!llt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
I AIIY Corps of Bnqineers - Seawalls, Docks, Navigable Watenays
I Departlent of Healtb i Rebabilitative Services, BnvirODleDtal Healtb Unit - Wells, Wastewater freatJent, Septic fants
t US BnvirODlelltal Protection Agency - Asbestos abatf!IeDt
I also certify that, if fill Iilterial is to be used in Flood Zone 'A' or 'A,etc.', it is understood tbat a drainage plan
addressing a 'COIpeDSating vol.' will be saitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance,
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
Bet aside any proviSions of the technical codes, nor shall issuance of a perlit prevent tbe Building Official f~ thereafter
requiring a correction of errors in plans, construction, or violations of any code, Every perlit issued shall becoIe invalid
unless tbe wort authoriled by such perlit is COII8Ilced witbin sillODtbs of issuance, or if work authoriled by the perlit is
suspended or abandoned for a period of six IODtbs after the tile the work is coamced. One 90 day extension of tile, lilY be
allowed for tbe perlit witb fee charge of $15.00, fbe extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sillODtb period, or tbe project will be considered abandoned.
WARMING fa lMIR: YOUR FAILURE fa RECORD A NOIICE OF CDIIDCBIIIJIf MAY RESULf IN YOUR PAYING DICE FOR IMPROVEIIDfS fa YOUR
PROPmY, IF YOU IIIDIfD fa OB'lII. FIIflIfCIRG, COISULf IIID YOUR LBlfDD OR 11 AnomY BlFORI RECORDING YOUR DICE OF
1DIME1fCBMBIff, JOBS lJRDD $2,500 IN VALUE DO NOI IfBED fa RECORD AIfD POSf A 'NOIICE OF aJlIIBlfCBIIm",
~) ~ ~~~~
IL . OR AGBIft' . R
STAn OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19_ by
f15CO
//fSW
The foregoing instrument was acknowledged
before me this , 19_ by
Sf ArE OF FLORIDA
ccum OF
who is personally known to me or who has
produced
as identifi~a~au, d who did/did not
take an o~t~ ~~,
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
Notal)' Public p~s~o Co. Fl c
My Commission ExpUes,May13.J9)S
who is personally known to me or who has
produced
as identification and who did/did not
take an oa~ IP ~.
(Signature) -
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
Notal)' Public Pasco Co. FL
My Commission Expires May \3, 1995
SIT E
P'LAN
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(RESIDENTIAL USE ONLI ) ,<
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LEGAL DESCRIPTION: 4.
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PiRMIT *
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Show all ~xisting and proposed structures giving dimensions and setbacks. Also, indicate
any adjacent bodies of water and roadways adjacent to the property. Indicate size of
mobile homes such as: 12/x 60',24' x 36'.
EXAMPLES
HOUSE CONSTRUCTION
PROPOSED..AQDI TI ON
MOR TI I=' I-InMI=' c: C'TIlD
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3';")28 SR 54 'West
lEP~ R'illLS, fl. 33~4:
(R13) 788.7308
~NC,
PROPOSAL SUBMITTED TO,
/r
li_
PHONE
DATE
I ,
, Ir"
;.'C
STREET
JOB NAME
JOB LOCATION
ARCHITECT
JOB PHONE
We hereby submit specifications and estimates for:
I)/?~ R~, bJ;r,:'"
4-/7-<1Y
(4'
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IJr .JropO.6l' hereby to furnish material and labor ~ complete in accordance with above specifications, for the sum of:
,,:, ,J d,_
Payment to be made as follows:
,.1'"
/
. dollars ($
),
_;,1""
,,-..<,'
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica-
tions involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
Authorized
Signature
.:..'~
Note: This proposal may be
withdrawn by us if not accepted within
days.
Attrptuutr nf 'rnpnsul- The above prices. specifications
and conditions are satisfactory and are hereby accepted. You are authorized
to do the work as specified. Payment will be made as outlined above,
Signature
.l
f
Date of Acceptance:
Signature
f'RODUCT I 18.3 Lf'\..'~~lnc,. Groton, Mass. 01471, To Order PHONE TOLL FREE 1 +800-225.6380