HomeMy WebLinkAbout95-4662
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 788-6611
_ 46626
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Energy Code: ~Ra~o as:
,/0/y-/'/J' 'L
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~sewer Conn
Zoning:
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Description of Work
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
d - J'7'
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Valuation or -f 0. . ~
Contract Price ~f)
Permit Fee
Signature -
Company
Address
TelephoneHV
~
City License Registration H ~
State Certified LicenseH-----
o "n1..(1
BUILDING
ELE~L
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PL U M B I (\j,G---'
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MEC~.
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. 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 ($15.001 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.
....
Cl:n OF ZItPHY.R.!"L":.".:..:~ 7""'::.:A.")::,"'~'::.: T~\EPAJRTMENT
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/OWN.ER J. t'
JOB LOCATION
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SHOW ALL UXBT~ II PROPOSEUSI'!l'jl\JCftff.:JC,' C; UI':t:NCi D DlBN8ImlS ,. SB'l'BACltS.
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ALLEYWAY ACCESS FOR
GARAGE OR CARPORT -
15 FOOT SETBACK
REQUIRED.
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UTILITY BUILDINGS
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2 ~lBTBACKS FOR R3 ZONING
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAKE
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PHONE
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OWNER'S ADDRESS
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JOB ADDRESS
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LEGAL DESCRI.P'fION: LOT(S)
BLOCK
SUBDIVISION
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PARCEL I. D. t i~' ~ (f" ." ","; .. '
c.') ,:' t~ "..' '\ ;_'! .:) ~J .;.... "
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~New Construction ----Addition ---Alteration ~epair -Llnstall
_Sign
-'love
->>eaolish
PROPOSED USE: _Single Faaily
-'l/F
_' of Units -'l/H
_Swi.. Pool vi Other
_ec-ercial
_lndu8t.
_Restaurant & Health Depart.ent Approval
DESCRIPTION OF WORK:
,"~ " -';"
/ " :~' " ,.. "'~ j, i.r .."
BUILDING SIZE:
r X I~,
...., ,',
..../ v!
I' f t:
~quare Feet, >, -" Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~o/ 'if a
PERMITS REOUESTED
LBUILDING
$
Valuation of Total Construction
_ELEC'I1UCAL
AMP Service
Florida Power Corp.
W.R.E.C.
-1IECllARICAL
$
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
TYPE OF CONSTRUCTION: _Block -1:....Fraae _Steel
SPECIALTY
Other
FIIUSHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
k
YES NO
..........................................
CONTRACTOR SECTION
BmlnER COMPANY
State Cert. or Regist. t
Signature City License Registration t
..........................................
ELECTRICIAR COMPANY
State Cert. or Regist. t
SianAture City License Registration t
..........................................
PLUMBER COMPANY
State Cert. or Regist. t
Signature City License Registration t
..........................................
MECHANICAL COMPANY
State Cert. or Regist. t
Signature City License Registration t
..........................................
OTRF.R COMPANY
State Cert. or Regist. t
Signature City License Registration .
..........................................
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perJit aay be subject to "deed restrictions" wbicb JaY be lOre restrictive than City
regulations.. tbe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ~ner bas hired a contractor or contractors to undertake work, they aay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the lRIDer and contractor .y be
cited for a lisdeJeanor violation under state law. If the otfller or intended contractor are uncertain as to wbat licensing
requirelents JaY apply for the intended wrk, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtherlOre, if the OIner bas bired a contractor or contractors, be is advised to bave tbe contractor(s) sign portions of the
-Contractor Sections" of this application for wbich 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 IIOrk. 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, bave been provided witb a copy of "Florida's CODstruction Lien Law - BoIeoIner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Conslller Affairs. If the applicant is 8OII!One other than the
"owner", I certify that I bave obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the
"owner" prior to COllBDCetent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in tbis application is accurate and that all wrk will be done in cOlpliance with all
applicable laws regulating construction, loning, and land developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no IIOrk or
installation bas COllBDCed prior to issuance of a perlit and tbat all IIOrk will be perforJed to Jeet stanc1ards of all laws
regulating construction, City codes, loning regulations, and land developJeJlt regulations in the jurisdiction. I also
certify that I understand that the regulations of other govel1llleDtal agencies laY apply to the intended IIOrt, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Such agencies include but are not li.ited to:
I Departlent of EnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDleDtally Sensitive Lands,
Water/Wastewater treatlent
I Southwest Florida Nater Managetent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
I ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health i Rebabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater treatlent, Septic tanks
t US BnvirODJeDtal Protection Agency - Asbestos abatetent
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 "cOlpensating volllle" will be subtitted wbicb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A per.it issued sball be construed to be a license to proceed ,lith the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frOl,thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every petlit issued shall becoIe invalid
unless tbe IIOrt authoriled by such perlit is cOIIBnced within Sil IOnths of issuance, or if work autboriled by the petlit is
suspended or abandoned for a period of sil IOntha after the tile the IIOrk is ~ced. One 90 day l!Itension of tile, Jay be
allowed for the perJit with fee charge of $15.00. 'l'be l!Itension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during each sil IOnth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE '1'0 RECORD A NOTICE OF CCJUmNCKIIEI1' MAY RESUL'I' IN YOUR PAYING 'l'IilCE FOR IMPROVIIIBIl'S TO YOUR
PROPIRTY. IF YOU IHtIHD '1'0 OB'I'AIN FINANCING, CONSULt WI'I'H YOUR LIHDBR OR AM AnOmY BEFORE RECORDING YOUR NO'l'ICI OF
COMMENCEMENT. JOBS UlDER $2,500 IN VALUE 00 NOT NEED '1'0 RECORD AND POSt A "NO'l'ICI OF COHHBIfCIMBM1'''.
SIGNATURE: OWNER OR AGlHt
SIGNATURE: CON'l'RAC'l'OR
STATE OF FLORIDA
COUH1'Y OF
The foregoing instrument was acknowledged
before me this , 19____ by
STA'I'B OF FLORIDA
COUH'l'Y 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