HomeMy WebLinkAbout94-4546
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 788-6611
4546/3
Date 1;2 -I 'j -9' 'f
~) ELECTRICAL PLUMBING
Property Owner: /~...vz m (P~
Job Address: t /-.5 I.~~~~
Parcell.D. # ,;2 -~6 -d.-I- .5----- 0
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.LF.'s:
Zoning: En,y Code:
Description of Work .Ao" ,Af ~ V-
Radon Gas:
AHAi"-:!Y h/'71.~- ~~,{)~-f'
17 I
NO OCCUPANCY BEFORE C.O.
FINAL /2-.-/ 5rt{
o TE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
C.O.
Inspector J.
Permit Fee .2'CJ ~
Signature <?--<.,<j; ~
Company
Address
Telephone#
Valuation or
Contract Price
d- Y tIO ~ d-O
---~
City License Registration # 57 ;7
State Certified License#
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BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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 ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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PROPOSAL SUBMITT.ED TO
STREn
'., (
CITY, STATE AND ZIP CODE
ARCHITECT
DA TE OF PLANS
We hereby submit specifications and estimates for:
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JII. 'tapas. h'''by to fom;,h m,'";,, oed ',bo, - wmpl", '" '''o'd,"oo with ,bo", 'P'd"""o"" fo, th, ,"m of
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Iment to be made as fol'ows:
naterial is guaranteed to be as specified. All work to be completed in a workmanlike
ner according to standard practices, Any alteration or deviation from above specifica,
' inVOlVing extra costs will be executed only upon written orders, and will become an
I charge over and above the estimate. All agreements contingent Upon strikes, accidents
,'ays beyond Our control. Owner to carry fire, tornado and other necessary insurance.
,yorkers are fully covered by Workmen's Compensation Insurance.
~ttptuntt of Jroposul- The abOve prices, speCifications
conditions are satisfactory and are hereby accepted, You are authorized
) the work as specified, Payment will be made as outlined above,
of Acceptance:
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JOB NAME
JOB LOCATIO"
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Authorized
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dollars ($
Note: This proposal may be
withdrawn by us if not accepted within
Signature
Signature
PRODUCT J lB-] ~Inc., Groton. Mass. 01471. To Order PHONE TaU FREE I +800-225-6380
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SITE PLAN
(RESIDENTIAL USE ONLY)
PARCEL 1.0.
SEe 'l'WI'
RNG
SUllU
8LOCK
LOT
11 If *~,
PROPEHTY MEASUREMENT
G(S(
f?Cb15?NT '3/ ) O/f,(5IoJt
CURltl-Jrr' OWNEHS
UA'1'E
All drawinss sball be drawn to scale for all parcels or lots five acres or less.
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SHOW ALL EXISTING AND PROPOSED STRUCTURES GIV~G DD1ENSIOHS AND SE'l'RACIS. ALSO, INDICATE
M"i BODIES OF WATER AND ROADWAYS (INCLUDING NAMES) ADJACENT TO TilE PROPEUTY. INDICA'!'E
THE SIZE. YEAR. AND NAME OF MOBILE; SUCH AS 12' x 60'.1981. FLEETWOOD.
All lIEASEMENTSlI, lIRIGHT-OF-WAyll and "JURISDICTIONAL LINES" must b$ shown on all site plans.
DO NOT ENCROACH INTO ANY EASEMENT WITH A STRnr.TTJRF
APPLICATION FOR PERMIT
CITY OF ZEPIIY1WILLS
BUILDING DEPARTKENT
/02 -d.- -9 t.j
/ tP .' .2 cJ A/-!
JOB ADDRESS
~ F/ 1/f1trl
t /5/ fCblf/IVT s/
t11h<"<;', 0 E- If If---?~
PRONE
1~2
I~G
OWNER'S IiAHB
OWNER'S ADDBESS
LEGAL DESClUP'fiON: LOT(S) BLOCIL--.SUBDIVISION
PARCEL LD.' ~ -;;L b - ;)/ - ..5-- 0 (OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction ----..Addition ----Alteration ---..Repair _Install
_Sign
-.--.Hove
----Peaolish
PROPOSED USE: ~iDg1e F_ily
---1t/F _' of Units ---1t/H
_ec-ercial
_Indust. _Swia. Pool _Other
__.Jlestaurant & Health Departaent Approval
DESClIIP1'11lII OP -.t, "'/./tJ5'M<<. {t:;' 0/~ ~ tn' tI"rwdl
BUILDING SIZE: X Square Feet. Height
I~ ~'T~cl7Jl?-
, P;We6
RESIDERTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORHS.
PROPERTY SURVEY REQUIRED FOR ALL NEW COBSTRUCTION.
$
)Cfd7JtrV
PERMITS REQUESTED
~UILDING
Valuation of Total Construction
RT.Rcnu:CAL
AIIP Service
Florida Power Corp.
W.R.E.C.
----llECllAllICAL
$
Valuation of lIechanical Installation
-PLUHBIBG
GAS
ROOFING
SPECIALTY .
TYPE OF COBSTRUCTIOIi: ~loclt _Fraae _Steel
Other
PIllISBED PI.OOR ELEVAnOBS:
F'I'.
IS PROJEct IN FLOOD ZONE AREA?
YES NO
..........................................
RIJITJ)ER
CONTRACTOR SECTION
cx{1.?f7 ...~.....:~"..'" ...~ Sv.J$"77hrt ;kJtt~JIf~c
. /. I" State Cert. or Regist. · ~'7
. . City License Registration . ~__
..........................................
Signature
Rt .RCTlUCIAII
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
PLUMBER
Signature
IlECllANICAL
COMPANY
State Cert. or Regist. .
City License Registration f
..........................................
Signature
OTRRR
COMPANY
State Cert. or ReSist. .
City License Registration .
..........................................
Signature
APPLICATION APPROVED BY
PEBIIIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'I'be undersigned understands that this penit laY be subject to Ideed restrictions' 'wbich lIy be lOre restri(.tive tba:n City
regulations. !he undersigned asSUle& responsibility for COIpliance with any applicable deed restricti0D8.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OImer bas bired a contractor or contractors to undertake work, they JaY be required to be licensed in accordance with
state and local regulati0D8. If the contractor is not licensed as required by law, both the owner and contractor .y be
cited for a lisdl!leallOr violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirl!lellts Jay apply for the intended work, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
788-6611.
Furthenore, if the OImer bas bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
ICon tractor Sections' of this application for which they will be responsible. If you, as the OWDer sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the wort. If the contractor wishes you to sign
as contractor that JaY be an indication that be is not properly licensed and is not entitled to peraitting 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, bave been provided with a copy of 'Florida's Construction Lien Law - lbIeowDer's Protection
Guide- prepared by the Florida Deparuent of Agriculture and ConsUJer Affairs. If the applicant is 8OIl!OIl8 other than the
lOWDer', I certify that I have obtained a copy of the above described docUJent and prolise in good faith to deliver it to the
'owner' prior to COllenC8l8Dt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIJation in this application is.accurate and tbat all work will he done in COIpliance witb all
applicable Ian regulating construction, 1000ng, and land developleJ1t.
Application is hereby Jade to obtain a perlit to do wort and installation as indicated. I certify that no work or
installation bas ~ced prior to issuance of a penit and that all work will be perfoIJed to leet standards of all laws
regulating construction, City codes, loning regulations, and land develOplellt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverJlleDtal agencies Jay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in COIIpliance. Such agencies include but are not lilited to:
· Departlent of EnviIODlelltal Regulation- Cypress Bay4eads, Wetland Areas and InviroDleDtally Sensitive Lands,
Water /Wastellater 'I'reauent
I Southwest Florida Water Hanagl!lellt District - Wells, Cypress Baybea4s, Wetland Areas, Altering Watercourses
I Arl' Corps of Engineers - Seawalls, Docks, lIavigable Watenays
I Departlent of Health & Rehabilitative Services, EnvirODlleDtal Health Unit - Wells, Wastewater 'I'reatlent, Septic lants
I US EnvirODlleDtal Protection Agency - Asbestos abatuent
I also certify that, if filluterial is to be used in Flood ZOne 'A'or lA, etc. " it is understood that a drainage plan
addressing a 'COIpeDSating VOlUl81 will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance. . ,
A penit issued &ball be construed to be a license to proceedlfitb the work and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor shall issuance of a pewt prevent the Building Official fl'Ol thereafter
requiring a correction of errors in plans, construction, or violati0D8 of any code. Ivery per.it issued shall becme invalid
unless the wort authoriled by sucb penit is co.enced within sillODtbs of issuance, or if wort authoriled by the perlit is
suspended or abandoned for a period of sil IODtbs after. the tile the wort is ~cecl. One 90 day utension of tile, .y be
allowed for tbe penit with fee charge of $15.00. 'I'be utension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sillODth PeriOd, or the project will be considered abandoned.
WARlfIRG '1'0 (MfJR: YOOR FAILURE '1'0 RECORD A larICE OF aJIIDCIIIIIft HlY RlSUL'I' III YOUR PAYllfG "'ICE POI lIIPROVEIIIIIS '1'0 YOUR
PROPER'I'Y. IF YOU lifE '1'0 OB'I'AIR irulxGiCOlSUL'I' WI'I'B tOOIi LIIDIR OR AIII1"I'ORDY BIFORI RiCORDIIG YOUI JOIICE OF
~ ro IIIItlIID lID IllSf I '1I11:ICllll~. __
. ~ 1'1-,9 6UrA. ~ ,ooe.u;;^
SIGiA' . . SIGIII ... .
STArB OF FLORIDA /j,
~OF ~CO
The foregoing inst~ent was acknowledged
before me this 1:2;2.. , 19-U by.
srAIB OF FLORIDA ~
coum OF /fS co
Tbe foregoing iD8~. ant was ac~~ledged
before me this ! :2 , 19~ by
who is personally known to 118 ot' wbo bas
produced
as identification and who did/did not
take an oath. c;t1/ ~~
(Signature) . .
Notary Public Pasco Co. FL
(Nue TypJM'/ Wm_ MP1St_.4)19'J,
NOTARY PUBLIC
who is personally known to DIe or who has
produced
as identificati
take an oath
(Signature)
(Name .Typ~~PIim~e~
NOTARY PUBL . 'on Exn\ftS May 1 . 1 5
MY mISs' to
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