HomeMy WebLinkAbout94-4422
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 788-6611
4422 C
Date /0 -..3 j- Y lj
BUILDING
GC~~~~
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
::::::,~,:":~~::-g;.1.~
Water Meter:
T.I.F.'s:
Parcell.D. #
Zoning:
Description of Work
Ene~o~
~~ ,<~ J/2f;
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL ~2- /t!/t-~
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordarce with CIty Codes and Ordinances.
c.o.
Inspector
Permit Fee
Signature
Company
Address
Telephone#
~th)
_L,v\ rt1 ,. 1?,..1..c--
Valuation or , LL..
Contract Price ~~
City License Registration # / 6 ~
State Certified License#
--Jr~..ff /5~1h
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter A
Final I~t-)~c,~ &b
.
Breakers
Ducts Ins!.
Compressor
Fiinal
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
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 ($15.001 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 inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PERMIT
CITY OF ZEPHYRBILLS
BUILDING DEPARTMENT
OIlllEt" S IWIIl q lJ 5SE; I ( rY\ 'j), R n W N
OWlIER t S ADDRESS g:2 q .c; t3 '" G-F L~
PHONE
~'go '15 '2-4-
LOuR,. ZEPI-IY'Tl HILLS Fe... 33.S4-l
, ,
JOB ADDRESS
-<S Il V G:fl
LEGAL DESCRIPTION: LOT(S)
c... ( R. C L~ Z E PH Y R tf I LL So , F L :Ss 54-- I
BLOCIL.-SUBDIVISION CI-tI4L FOHT VIl.LVlS
PARCEL LD.' 'KG'" DR. D (JLI4T 'Ecole~:S \ p~ (,,:E 'in
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED :_New Construction ----.A.ddition ----lUteration -.-.Repair _Install
_Sign -JIove _Deaolish
PROPOSED USE: _Single Faaily ----1t/F _' of Units _H/H
_ec-ercial _Indust. _Swia. Pool ~ther
-.-.Restaurant &: Health Departaent Approval
DESCRIPTION OF WORK: ~,REET
L\ ~1+TS.
BUILDING SIZE:
x
Square Feet,
Height
RESIDEIITL\L: ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
~UILDING
...L'ELECTRICAL
$
.3
AIIP Service
Valuation of Total Construction
~orida Power Corp.
W.R.E.C.
~ClWlICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF OONSTRUCTION: _Block _Fraae _Steel
Other
FIllISHED FLOOR ELEVAnONS:
FT.
IS PROJECl IN FLOOD ZONE AREA? ~
YES NO
******************************************
COHTRACTOR SECTION
,\;.'
RurUlRR
:~CI6I
, , COMPANY
State Cert. or Regist. .
. . City License Registration .
******************************************
Q. COMPANY c;:(U..s;.SELL- /)'1 <ERnw)"
-/ ' ~. J J ~ State Cert. or Regist.' ~R t"'-.f) 1055 \
~ ~City License Registration' Jf-,~
******************************************
Signature
PLUMBER
COKPANY
State Cert. or Regist. .
City License Registration t
******************************************
Signature
KECIIAlfiCAL
COMPANY
State Cert. or Regist. t
City License Registration .
******************************************
Signature
OTRF.R
COMPANY
State Cert. or Regist. .
City License Registration t
******************************************
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this pemit lilY be subject to Ideed restrictions I wbieb lily be lOre restrictive tban City
regulations. 'be undersigned assUIeB responsibility for allpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake work, they JaY be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the O1IIler and contractor lilY be
cited for a .isd_anor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
reguirelents lilY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtherJlOre, if the OIfDer bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
IContractor Sections I of this application for whieb they will be responsible. If you, as the O1IIler sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
as contractor that JaY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
City of Zepbyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of IFlorida's Construction Lien Law - HCII8OlfJler's Protection
Guidel prepared by the Florida Departlent of Agriculture and COnsUler Affairs. If the applicant is SOJI8One other than the
lower", I certify that I bave obtained a copy of the above described docUlBDt and prOllise in good faith to deliver it to the
Howerl prior to COllleDC8leDt.
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
applicable laws regulating construction, loning, and land develoPElt.
Application is bereby .ade to obtain a peIlit to do work and installation as indicated. I certify that no wort or
installation bas ~ced prior to issuance of a perlit and that allllOrt will be perforted to Ret standards of all laws
regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other govl!l'Ul!Dtal agencies lilY apply to the intended work, and that it is
.y responsibility to identify wbat actions I lUSt tate to be in COIpliance. Sueb agencies include but are not laited to:
t Departlent of EnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDleDtally Sensitive Lands,
Nater /Wastewater Treablent
t Southwest Florida Nater Managuent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Naterways
t Departlent of Health i Rebabilitative Services, EnvirODlental Health Unit - Wells, Wastewater Treatlent, Septic 'anks
t US EnvirODleDtal Protection Agency - Asbestos abat8leDt
I also certify that, if fill .aterial is to be used in Flood Zone IAI or HA,etc.., it is understood that a drainage plan
addressing a .cOlpl!llSating vol.. will be sublitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to pemit issuance.
A pemit issued sball be construed to be a license to proceed with the IIOrk and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor sball issuance of a pemit prevent tbe Building Official fCOl thereafter
reguiring a correction of errors in plans, construction, or violations of any code. Every perlit issued sball beCOle invalid
unless tbe work authorized by sueb pemit is ~ced within sillODths of issuance, or if work autboriled by the perlit is
suspended or abandoned for a period of sil IODths after the tae the wort is coaenced. One 90 day extension of tile, lilY be
allowed for the perlit with fee cbarge of $15.00. Tbe 81tension sball be requested in writing to the Bui14ing Official. An
approved inspection lUSt be logged during eaeb sillODth period, or the project will be considered abandoned.
WARNING TO omR: YOUR FAILURE to .~J.D A. NOTICE OFaJIMEI!CEllENt MAY RESULT IN YOUR PAYING !VICE FOR IMPROVIIIEI!S TO YOUR
PROPERTY. IF YOU INtBHD to OB!lIlf FIWCING, COISULT lID YOUR LBHDIR OR D AftORRBY BEFORE RECORDING YOUR DICE OF
COMMENCEMENt. JOBS UNDIR $2,500 IN VALUI DO NOT NEED to RECORD AND POST A "NOTICE OF COJIMENCIMEN!H.
. .
SIGNAtURE: OWNER OR AGm
SIGNATURE: CON!RAC!OR
STATE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
STAR OF FLORIDA
coum OF
The foregoing instrument 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)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name. Typed, Printed or Stamped)
NOTARY PUBLIC
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