HomeMy WebLinkAbout94-4294
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BUILDING PERMIT
Permit N.t?
429411
CiTY OF ZEPHYRHILLS
(813) 788-6611
PLUMBING
3i>--- c:riJ
C:::H~~
Date
J-/~ -7Y
~(:) , on
BUILDING ~T~-I
P,op,rty Own" '7 lJ tX~ 2.
Job Address: '/fj- / - rr 'r-
Parcell. D. # i r ~ &. 6 -.;).1- () CJ I D - 0 ~ .2 0 D - tJ oJ D
Sewer Conn
Water Conn:
Water M~!er:
T.\.F.'s:
Zoning: Energy Code:
Description of Work ':"Il:;( ~ . 'I A;/ C-
Radon Gas:
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordarce with Clt.1odes and Ordinances.
FINAL $,
C.O,
DATE
City License Registration #
State Certified License#
17/
Permit Fee
Signature
Company
Address
Telephone#
Inspector
Valuation or
Contract Price
~~-~-s.....crD
,>1
!l!~~ ~
,
~
BUILDING
ELECTRICAL
PLUMBING
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final ct ZI..qc.f
Breakers
Ducts Insl.
compr~sor
Final ,- 2-1 ~ L{
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
~
~
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.001 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 ;nspect;on fees shall be made before any further perm;ts wm be ;ssued to the pe..on own;ng
same.
APPLICATION FOR pEltKlT
CITY OF ZEPBYRJIl.LL5
BUILDING DEPAR'l'KEN'I
JOB ADDRESS
LEGAL DESC1UPTIOB: wr(S)
- ;;2.6-
PARCEL l.D.'
1lI eonstruction
WORK PROpOSED:~~ew
!': W _ P r-'p-vJ
t' Pi t2 t( ! ! :8 <t) s-1--
I;
Al-'~ <?
PHONE
7B&-S-CJ9i
OWNER'S ~
oWNER'S ADDltESS
LOCIL----SUBDIV1SION
B ;;..;<00- 6 () g c)
_t9CJIO--t)
~ddition ---1alteration
Repair
-
InStall
-
_Sign.
---,,<>ve
Deaolish
-
DESCRIP'rI.OR OF WORK:
~ercia1
-
.-J.estaurant &: Health Departaent Approval r:--
~~ -:C:r~~ ~F ~ (ifN
Indus t.
-
. of Units
-
swia. pool
-
KIH
-
PROpOSED USE:
Single Fsaily
-
~/F
Other
- '
AIC-
BUILDIRG SIZE:
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
X
A'1"lACB (2) PLOT I'LANS Ii: (2) SETS OF BUILDING PLARS &: (1) SET ENERGY FORMS.
A'1"lACB (3) SETS OF BUILDING PLABS &: (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDIRG
$
Va1uation of Total Construction
_ELECTRICAL
AIIP Service F10rida Power Corp.
, ? ~ ~ S:.d-D Va1uation of Kecbanica1 Installation
W.R.E.C.
---1IECBARICAL
_PLUHBDfG GAS ROOFING
SPECIALTY
TYPE OF COBSTRUcnOB: _B1oclt _Fnae _Steel
Other
FIBISBED FLOOR ELBVAfiOBS:
Fr.
IS PROJEC'l IN FLOOD ZONE AREA?
YES NO
..........................................
CONTRACTOR SECTION
COMPANY
State Cert. or Regist. .
City License Registration .
................................ .........
yv/e
RIITI.Dn
Signature
COMPANY
State Cert. or Regist. .
City License Registration'
..........................................
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
amAHY ;< 1"-' ~ C -9""l J
State Cert. or Re st.' 6/C)S~ /::<
City License Registration . '/ /
......................................... .
PLlIMRRR
Signature
HECHAtITCAL
Signature
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
OTRRR
'--_/
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
A. NOTICE OF CONDITIONS OF
file undersigned underst::: ~STRICTIONS PERMIT AFFIDAVIT_
regulations. fbe d' t thIS peRit aay be sub'ect '
un erslgned assuaes responsibility t J to. deed restrictions" which Ia b
B. UNLICENSED CONT or COIphance with any applicable deJ r~:f~tf::~iCtive than City
If the owner has hired. a RACTORS AND CONTRACT
state and local regulat' contractor or contractors to undertal ~R RESPONSIBILITIES
~~~r:: aisdeaeanor I:::iat::n :d:~~:~:o:a:s 0:: license: :rr~~::d I:: ~ rt~~:o be licensed in accordance with
788-6611 s aly apply for the intended work the' the, owner or intended contr~ctor are OIfDer ~d contractor lay be
. , y are adVIsed to contact the City of zepbvr:fftaI~ a~ to wbat licensing
z' I S BuIldIng Departlent (813)
~urtheraore, if the owner has hired '
Contractor Sections' of thi ' a ~ontractor or contractors, he is adv'
you are indicating that you, sr::~:c~tion~or which they will be responSib::~ :; ;:e the contractor!s) sign portions of the
as contractor that Jay be an ' d' ,an e contractor, are responsible for th ' as the O1f1ler SIgn as the contractor
City of Zepbyrhills. .lJ] lcatJon that be is not Properly licensed and is en:d\.:r the contr~ct~r wis~es yoU to Si~
en 1 ed to peRl ttlJlg prIVileges in the
C. TRANSPORTATION IMPACT FEES AND '
UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW
I certify that I, the applicant have be (CHA~TER 713, FLORIDA STATUTES AS
:uide" prepared by the Florida DepartJen~o:r;::::l~:: :o;opy of 'Florid~'s Construction Lien L~ - H'::~~~~ction
"owner", I. certify that I have obtained a copy of the above /ons~ :ffalls. If the ~ppl~cant is soaeone other than the
owner" pnor to CoalenCl!lent. escCI ocuaent and prOll1se In good faith to deliver it to the
E. CONTRACTOR' S/OWNER' S AFFIDAVIT
I certify that all the infocJation in this application is accurate and that all work Ifill be done in cOlpliance with all
applicable laws regulatinq construction, Joning, and land developaent.
Application is hereby lade to obtain a peIlit to do work and installation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a peIlit and that all work will be perfoIJed to Jeet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveIllJel1tal agencies JaY apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lillited to:
t DepartJent of Environaental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater TreatJent
t Southwest Florida Water Hanagelent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t ArIJ Corps of Engineers - Seawalls, Docks, Navigable Waterways
t DepartJent of Health & Rehabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater !reatJent, Septic ranks
t US Environaental Protection Agency - Asbestos abatelent
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 'clltpensating volllle" Ifill be subJitted 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
set aside any provisions of the technical codes, nor shall issuance of a peIlit prevent the Building Official frllt thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCClle invalid
unless the work authorized by such peIlit is COllllJlced within six IODthS of issuance, or if work authorized by the peIlit is
suspended or abandoned for a period of sil IODtbs after the tile the work is c-.mced. One 90 day extension of tille, lilY be
allowed for the peIlit with fee charge of $15.00. !be extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sil IODth period, or the project will be considered abandoned.
IIARNING TO omR: YOUR FAILURE TO RECORD A NO'I'ICE OF COHMDCBMD'I' HAY RESULT IN YOUR PAYING DICE FOR IMPROVBIIBlft'S TO YOUR
PROPEJlt'Y. IF YOO IMI'BND TO OBTAID FINANCING, CONSULT WITH YOUR LENDER OR AN AftORMBY BEFORE RECORDING YOUR NO'I'ICB OF
COHMENCEHBMI'. JOBS UNDER $2,500 IN VALUE 00 NO't NEED TO RECORD AND POST A "NO'I'ICE OF COHMENCEMENI'" ~
P rf'!if, p~~~
SIGlAIUBI: llIIIIII OIl AGIIII! ~
STATE OF FLORIDA S!ATE OF FLORIDA .D
COONI'Y OF COUNI'Y OF Las C \J
The foregOing instrument was acknowle~ged The foregoing inst~ent was aCkn~ledged
before me this , 19_ by before me this S'ep.. g , 19 q by
C "\.)jr d)cevJ S'".
who is personally own t9 me or w 0 has
produced' '\s ~ J'--'C.
as identification and who 4ittt' 0 1-
~~oIJ~ ""
. at~ ' 0
~'\ C'e V\ L . k.t-J <) Ii) ,
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Nam~ Typed, Printed or Stamped)
NOTARY PUBLIC
..~."~ DOREEN l. WOOD
f~r;&''f~ MY COMMISSION' CC 191575 EXPIRES
'i."'....A~$ April 29. 1996
--1,1';;; 'f".'<!-~ IIONllED llfRU TlIOV fAIN INSURANCE. INC.
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