HomeMy WebLinkAbout95-4610
BUILOING PERMIT
P . N,O
ermlt .
CITY OF ZEPHYRHILLS
(813) 788-6611
4610A
Date / -J.?J -7"
~ ELECTRICAL PLUMBING MECHANICAL
.' ~- l5Ia"
Property Owner: 2
Job Address:_lb- ~ .~ 7L"' J;.I- /lJt,
Parcel LD, #
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning: Energy Code:
Description of Work.~.A Ot2..M, ~
Radon Gas:
. a;~~ U},t.!l'~
3/'1
/1
JO
FINAL
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordarce with City Codes and Ordinances.
DATE
Inspector
Pe,m;t Fee -i,p':. ~ {\-,
Signature~ dVV J\')L fl/f~A.O'1
Company
Address
Telephone#
Valuation or 0
Contract Price I, { Y--5-: tlZJ
City License Registration # rJ....Y7
State Certified License#
(jtfk (J~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
SlB
Tub Set
Water
Sewer
Final
Tp. Serv.
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
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 ($15.00) 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.
OWNER' S RAHK
OWNER' S ADDRESS
JOB ADDRESS
LEGAL DESCRIP'l'ION:
BLOCK
SUBDIVISION
PARCEL I.D.' / (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~W Construction ----^ddition ~teration -..Jlepair _Install
PROPOSED USE:
_Sign
~le Faaily
--..Kove
->>eaolish
---.Jtl F
_' of Units
---.Jt/H
_ec-ercial
_Indust. _Swia. Pool _Other
--Restaurant 5: Health Departaent Approval l.. ."\
DESCRIPTIOII OF WORlt: ,-Sc;V'e~ ~ODM (Evt~f/r1j (~V\.Q.j/Lte~
BUILDIRG SIZE: d ~ ?)'. 17 & Square Feet. 21 Height
RESIDEIITIAL:
COMKERCIAL :
ATTACH (2) PLOT PLAIIS 5: (2) SETS OF BUILDIRG PLANS 5: (1) SET ERERGY FORMS.
ATTACH (3) SETS OF BUILDIRG PLANS 5: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~LDIRG
$
. __ oCJ PERMITS REOUESTED
J9gS --- Valuation of Total Construction
RT.RC'l'RICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
---llECIIAlIICAL
$
Valuation of Kechanical Installation
~UHBIRG
GAS
ROOPIRG
SPECIALTY .
TYPE OF COIISTRUcnON: _Block _Fraae _Steel
Other
PInSIIBD FLOOR. ELEVATIOIIS:
FT.
IS PROJECT I.R FLOOD ZONE AREA!
YES NO
..........................................
RIITT.DRR
~f4
CONTRACTOR SECTION
" " . I I
. . .~CUfpMlr Y5 t.J. i/1UrY\
State Cert. or Regist. . eD
'tJf i?t1 City License Registration .
..........................................
Signature
RT.RCTRIClAIi COHPABY
State Cert. or Regist. .
Si-ture City License Registration .
..........................................
PLUMBER COHPAIIY
State Cert. or Regist. .
Signature City License Registration .
..........................................
IlECIIAlU.CAL COHPAIIY
State Cert. or Regist. .
Signature City License Registration .
..........................................
OTRRR COHPAIIY
State Cert. or Regist. .
Signature City License Registration .
..........................................
APPLICATION APPROVED BY PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that tbis pmit JaY be subject to 'deed restrictions' wbieb JaY be lOre restrictive tban City
regulations. Tbe undersigned asSUles responsibility for COIpliance witb any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake IOrk, they illY be reguirec1 to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the mmer and contractor liar be
cited for a lisd_anor violation under state law. If the owner or intended contractor are uncertain as to "bat licensing
requireJellts lilY apply for the intended IIOrk, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtheIlOre, if the owner bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
'Contractor Sections' of this application for wbieb they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather tban the contractor, are responsible for the vork. If the contractor "isbes 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 UTILI~ 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 - lIoIeoImer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUl8l' Affairs. If the applicant is SOII8OI1e other than the
lowner', I certify that I bave obtained a copy of the above described docUJeDt and prOlise in good faith to deliver it to the
"owner" prior to COlleDCl!IeDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforliltion in this application is accurate and that all IOrk will be done in OOIPliance "itb all
applicable lallS regulating construction, loning, and land developaent.
Application is bereby Jade to obtain a perlit to do work and installation as indicated. I certify that no vork or
installation bas ~ced prior to issuance of a perlit and that all vork will be perfoIled to leet standards of all laws
regulating construction, City codes,. loning regulations, and land developleDt regulations in tbe jurisdiction. I also
certify tbat I understand tbat tbe regulations of otber goverDleDtal agencies lilY apply to tbe intended vort, and that it is
IY responsibility to identify wbat actions I lUSt take to be in COIpliance. Such agencies include but are not luited to:
* Departlent of InviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and BnviroDleDtally Sensitive Lands,
Water/Wastewater Treatlent
* Soutbwest Florida Water Managl!l8l1t District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* AllY Corps of Engineers - Seawalls, Docks, lavigable Waterways
t Deparblent of Health & Rehabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater Ireablent, Septic lants
t US InvirODleDtal Protection Agency - Asbestos abateJellt
I also certify that, if fill Iilterial is to be used in Flood ZOne 'A' or 'A,etc.', it is understood that a drainage plan
addressing a 'COIpensating volue' will be sublitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to peIlit issuance. .
A perlit issued shall be construed to be a license to proceed "itb the vork and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor sball issuance of a peIlit prevent tbeBuildiDg Official fIOl tbereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery peIlit issued shall becme invalid
unless the vork authorized by such peIlit is COII8Ilced lIitbin sillOntbs of issuance, or if vork authorized by the perlit is
suspended or abandoned for a period of si1lODtbs after tbe U. tbe 1IOrk Is c~cecl. One 90 day ateDsion of tiE, IlaY be
allowed for tbe pmit "itb fee charge of $15.00. Tbe 81tension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during eaeb sil IODtb period, or the project "ill be considered abandoned.
WARlIRG TO OIlIER: YOUR FUtURE TO RECORD A IOI'ICE OF aIIIIIICIIlBIf! MAY RBSULI II YOUR PAYIIG !IIICE FOR IMPROVBIImS TO YOUR
PROPERlY. IF IOU IJIDID TO 081111 FIlIAIIClKG, COISULI WIIH 1008 LBlDIR OR 11 AftORBY BIFORB RICOBDIIG YOUR lorlCE OF
~m~~
.SIGIII!' ' -. - 11 AGiIr - 811:1-111III: nmA ~
STATE OF FLO~
coum OF ~O
The foregoing instrument was acknowledged
before me this r~ 'I , 19!JL by.
1J1~ IJfoAl)N</C~A/
who is pe sonallv known to me or who has
produced
as identification and who did/did not
~a~~
( gnature)
(Rame Typed, Printed or Stamped)
ROTARY PUBLIf., S A STONE
. JAME. ..
Notary Public, State ot Florida
My comm. expires May 16, 1995
CC11 02T~
STATE OF FLORIJ)A) ,
coum OF -/-" A.S' C/o
The foregoing instrument was acknowledged
before me this '\.TiJ.^J ~ tt/ , 19 9r- by
~~~#/?/Zf';V
,~o . 11 y known to me or who has
produced
as identification and who did/did not
~th~~
S' ature)
(Rame Typed, Printed or Stamped)
ROTARY PUBLIC
!d.~.
" JAMES A, STONE
Notary Public, State of Florida
My comm. expires May 16, 1995
CC110274
PARCEL 1.D. #
V~ P-.
OWNER
15f/e irf 'e V
I
SHON ALL EIISTIRG & PROPOSED STRU~~RKS GIVING DIMENSIONS & SETBACKS.
SCIfl:~t1If..1)-fNF >-h.. ~.~
.JJ~/c~ ~I€J:! ~
~.r}f- ".7JYe~:r ~ ~ ';'fj' -.JZ.
-2~.e.J./24 >>4/ ~b'1 .
C)h';~_1. .. Qff-~L D I --I
P/~~7/ ~r-
ALLEYWAY ACCESS FOR
GARAGE OR CARPORT _
15 FOOT SETBACK
REQUIRED.
T,
....... ~
~
~.
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
IV Vr'r ~ I
U /IJJ;t /0 F-r
B~
SU'mu-J
f\~l>
M~ (Pfbt-iCs UNt (
~ ~l>lT PROP.&:RTY LINv' &I
~;~ t<J
~
~s:r(LlUTcnJ
$1-J4u... $ F::-
"....
6r ~y"L
...,
r awl\ll~cr ()(t~
n
~, .f 1ft
(NOT~ EXAMPLES 1 << 2)
~REET )-___.____.___.___._...... ._
. .. -, .... .. ....'-...-..,
_..... .....~. ..... ........,...-.......
1. SETBACKS FOR R1, R2 ZONING
60'
10'
P E-
R X
0 I
10' P S 10'
0 T
S I
E N
D G
20'
2. SETBACKS FOR R3 ZONING
60'
1 0'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAH 30 'DUPLEX
1 0'
FROR!" PROPERTY LINE
FRONT PROPBRTY LDfB
.,~
" .",M.'s.., h,' ~'-' ',' " .)r., '~""',>' "
k~. ~.~"~:,IIU,rl'~ ~~:~~r.;
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.. 70"'-' '~O' ""T J 'N .._l~.. ~
,j,ru:f I'" JU!-J AIHU,. .
Z!~P,..;'{RHILc~::;;:'. 3354.,
(81.3J 782"<i5-~:3
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To
L
'?;? 3' '1-0;1'7
We hereby submit specifications and bid for:
ESTIMJ'TE & AGREEMENT
I
/
/< ,
I /
ljATE:
///7//75
,
1019
~
BID: We hereby propose to furnish material and labor
to complete the work outlined herein for the sum of: , ' .
',,/L. d-/J.../l iJ. . -8.. nE~'It-F-,~
Ollt' I f/L105911cJ1 I f..,U1f fW./IlDtP/f t; dollars
i 9 'YF) 00
($ , ~ l .:-. '.) paym,en~ to be made as follows:
'4.300 03 ~~ ci>i4::- ]dog
FOLD HERE
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Ey'lru.Yon::. t' tJ In) /::::j)
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CONTRACTOR'S GUARANTEE
We guarantee all material used in this contract to be as specified above and the
entire job to be done in a neat, workmanlike manner. Any variations from plan or
alterations requiring extra labor or material will be performed only upon written
order and billed in addition to the sum covered by this contract. Agreements made
with our orkm n are not recognize .
DATE / J... SIGNED, j __
" ,I !//c'1t.#/
FORM 8s003. R PIDFORMS, INC. THOROFARE, NJ 08
ACCEPTANCE OF BID
The above specifications, terms and contract are satisfactory, and
(I) (we) hereby authorize the performance of this work.
DATE
: I L I , r'
1 ! /1 /./
i / I i I ~
f~' //r '::17
/~_.c..<..t2-::,-~ , .
C/
1269
THIS CONTRACT IS VOID 30 DAYS FROM DATE UNLESS PINK COPY IS SIGNED AND RETURNED TO BIDDER
WE COMPLY wr . L WORKMAN'S COMPENSATION & PROPERTY DAMAGE L1ABIL'. 'SURANCE LAws.
CONTRACTOR'S FILE COpy . SIGN WHITE & PINK COPIES & DELIVER TO CUSTOMER
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S1RUC1\JRES SHO'/lN.
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