HomeMy WebLinkAbout95-4770
BUILDING PERMIT
Permit N;~
CITY OF ZEPHYRHILLS
(813) 788-6611
477 oLE
,;)-S -. cro
~
Pmp"ty Owne, ~b~fv:~f'
Job Address:0 '7~
Parcell.D. #
Date _3-/S---Y.s-
.;Le ; ~
- ~
CUCTRIC~/
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I,F.'s:
Zoning: . Energy ~ode: ../"'" ~ Radon Gas:
Description of Work J11 J4Q j ~ ~
FINAL Ji'~ .- t1 ~
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
Inspector
Permit Fee
Signatc.re
Company
Address
Tel~phone#
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(( ~ fA (
( )..-,-,,,,-'., '~.,' >, . . \>., ,
Valuation or f'7
Contract Price I. / 07J '" cJ-n
/
City License Registration # Y 'I L.j
State Certified License#
c. .\: '-i
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BUILDING
!! of -I /%-:tv;~
ELECTRICAL c>l. 97
rkd~
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Me~~r
Final 4'-)-'1)
Ftr.
Pre SLB
~~~~' b~~ ~ ~
Insul. CL~"" 4..)
WL ~\)p
~
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.
~~._.~-..---~.......~ _.._,--.......-~.
_._ ...,__..._._"'_ __.'...........-:_~...._.........' ~......._____-.-----'T'_._.___~__.~..."_._
APPLICATION FOR PEIUIlT
CITY OF ZEPIIYRIIILLS
BUlLDIRG DEPARTMENT
OWNER' S RAtIK
;:;: nit t{ If) /) F. L Y AJ~t+
OWNER'S ADDRESS '67 LJt>G::, Del2"E16 HI ee 0'2.
JOB ADDRESS ~'7If~to ~f?:Ri~HIRe OR...
LEGAL DESCRIPTION: LOT(S)
PHONE 73D -~'7/;<9
Z '1 P/-il2lll/!:5
BLOCK
SUBDIVISION
PARCEL I.D.' (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction ~ddition ~teration ____epair XInstall
_Sign
--'love
_DeIIOlish
PROPOSWUSE:~Sing1eF_ilY
_~ercia1
~/F _' of Units ~/H
_1ndust. _Swia. Pool _Other
____estaurant &: Health Departaent Approval
DESCRIPTIOR OF WORK: TN ~/A'II I !1Drorcrc:. ev S/luT77::/2 UJIT/! i)vee~/])e
BUlLDIRG SIZE:
x
Square Feet.
Height
RESIDENTIAL: ArrACII (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
COMMERCIAL: ArfACII (3) SETS OF BUILDIRG PLANS &: (1) SET ERERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CORSTRUCTION.
PERMITS REOUESTW
~UlLDIRG
$
17l)D.~
Valuation of Total Construction
RI.R.CTlU.CAL
AIIP Service
Florida Power Corp.
W.R.E.C.
~CllAlll.CAL
$
Valuation of Hecbanica1 I.nstallation
----.l'LutlBING
GAS
KOOPlNG
SPECIALTY
TYPE ~fl OORSDUCTIOR: ---Block _F~e _Steel
Other
PIlUSBED FLOOR ELBVAnONS:
PT.
IS PROJECT IN FLOOD ZORE AREA.,
YES NO
..........................................
Signature
~,,~
.
CONTRACTOR SECTION
COMPANY ~ ,,-ltl ~A--\. ~
State Cert. or Regist. t
City License Registration' ~ij tf'
..........................................
RIJTl.DRR
=
~ amAH
~ f) State Cert. or Regist. .
.. ~ City License Registration .
, ........................................
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
~r'r
PLUMBER
Signature
HEC8AHI.CAL COMPANY
State Cert. or Regist. .
Signature City License Registration .
..........................................
OTIIP.R COMPANY
State Cert. or Regist. .
Signature City License Registration .
..........................................
APPLICATION APPROVED BY PElUlIT OFFICER.
---- --"--"~---"'--"-'-r--- -.. -_.,--~--- - .-___ -_______ ...,__ _..~_,.__....____._,;_ _._"
regulations. fbe unclersigned asSOles responsibility for COIpliance litb any applicable deed restrictions.. : .
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake lad, tJJer .y be required to be liClDSed in acc:ordance lith
state and local regu1atiOJ1ll. If tbe contractor is not licensed as required by lu, both the 0IIIIer and contractor .y be
cited for a lisdl!leanor violation under state law. If the 0ID8I or intended contractor are uncertain as to what liClDSing
'requirelleDu .1 apply for the intended IOrt, they are advised to contact tbe City of Zepbyrhil1s Building Departlent, (813)
788-6611. '
Furtbenore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
'Contractor Sections' of this application for Ibieb tbey will be responsible. If JGU".18 the OIrIler iip 18 the c:ootractor,
you are indicating that you, rather than the contractor, are responsible for the IfOrk. If the contractor wi8hes fOIl to sign
as contractor that .y be an indication that he is not properly liClDSed and is not entiUed to pmitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMEHDED)
I certify that I, tbe applicant, have been provided litb a copy of 'Plorida's COnstruction Lien LaI ~ lIcNoImer's Protection
Guide' prepared by the Florida Departlent of Agriculture and ConsUll8l' Affairs. If the applicant ia 8OIl!ODI other than the
'OlDer', I certify that I have obtained a copy of tbe above described docuIent and prolise in good faith, to deliver it to the
'owner' prior to COIHDCl!leDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all tbe inforaatlon in this application is accurate and that all IOrt lill be done in COIpliance with all
applicable 1_ regulating construction, loning, and land develOplellt.
Application Is hereby ule to obtain. a perlit to do IfOrk and installation as indicated. I certify that DO lIIOft or
installation lias CDIeJ1ced prior to issuance of a pmit and that all'lOrl lill be perfOl'led to _t staDdard8 of all Ius
regulating construction, City codes, loning regulations, and liIDd developlll!llt regulations in the jurisdictilll. .1 also
certify that I understand that the regulations of other goveruental agencies .y apply to the intended lIIOf1, and that it ia
IY responsibility to identify lbat actions I lust take to be in COIpliance. Sueb agencies include but are not lilited to:
t Departlent of Invirouental Regulation - Cypress Bayheads, lIeUand Areas and InvirODlentally Sensitive Lands,
lIater/llasteltater freatlent
t SoUthlest Florida lIater HanagelleDt District - lIells, Cypress Bayhea4s, lIetland Areas, Altering lIatercourses
t AllY Corps of Engineers - Sealalla, Docks, lIavigable lIatenays
t DePaItlent of Health' Rehabilitative Services, InvirODlelltal Health Unit - lIells, lIasteuter lreatlent, Septic lants
t US InvirODlental Protection Agency - Asbestos abatl!ll!llt .
I also certify that, if fill uterial is to be used in Flood loDe 'I' or 'I,etc.', it ia understood that a drainage plan
addrl!8Bing a Icmpensating vol_' will be sublitted which is prepared by a profl!8Bional engineer registered in the State of
Florida prior to perait issuance. '
A perlit issued shall be construed to be a license to proceed lith the 'IOrt and not as authority to violate, canc:e.l alter, or
Set aside any provisions of the technical codes, nor shall issuance of a penit prevent the Bulldint Official fa tbereafter
relJUiring a correcUOJ1 of errors in plana, constructlOJ1, or vlolatioua of any code. Ivery pera1t Issued aIIall becme invalid
unless the worl authoriledby such perlit is co.enced WiWD aillODths of issuance, or if.work authodud hI the pmit is
suspended or abandoned for a period of sillODths after the tile the lIIOflls ~ced. ODe 90 day UtensiCll of tile, .y be
allGled for the perlit lith fee charge of $15.00. fhe utension shall be requested in lriUng to the, BuiWDg Qf~lcial. An
approved inspection .ust be logged during eaeb sil IODth period, or the project will be considered aNQI1oned.
IfUJfIIfG ro 0IfDR: YOUR FAILURE ro RICORD 1lf00lCE OP alllllJlCIIIIIIf lilY RlSULr 111 YOUR P1YIJIG IllICE PCIlDlPlOVlllllS ro YOUR
PROPIRIY. IF YOU II'fDD fO OBfW FIDIICDG, COISDLI IUD YOUR LIIIDIR 01 II AIfOBIIY BIFOJII DmBDIIG YOUR JOIlCE OF
aJlKDCEIIIIfI. JOBS UlIDIR. '2,500 III VALUE DO IIOt 11110 10 RICORD .IIID POSf A. 'IfOtICl OF CCIIIDCIIIIIf'.
m. ~./l)~
SIGIIA!URI: ~ IGDI
SIGllAfURI: COIWCIOR
SIArE OF FLORIDA
coum OF
The foregoing instru.ent was acknowledged
before me this , 19_ by
Sf AD OP FLORIDA
coum OP
The foregoing instrullent was acknowledged
before me this. , 19 ' ' by
who is personally known to lie or who, bas
produced
as identification and who did/did not
take an oath.
who is personally known to _ or who bas
produced
as identification and.whodid/did not
take an oQ.th. ' .
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
. (Signature)
(Name Typed, Printed or Staped)'
NOTARY PUBLIC '
JOB ADDRESS
~
rolleden
>~~~
CiTY
~
rolleden
CUSTOMER NAME ~MtJ II
BILLING ADDRESS ~f)
~~
ROLLADENINCORPORATED
TELEPHONE
OTHER PHONE
We propose to furnish and install the following:
Unit Prdl- Slid Win Entry Room Opening Size Doe lion lIS Profile 01S Profile Fllme
No. Door Door Width Height Manual Clink Motor Mlr/Or Color Color CoI~
1 Ptr X IJ c?,n 1JCf- x.. <6(P X X A -f/ (). tld r:::?
2
3
4
5
6
7
8
,
9
10
/ Total openings to be covered (muJliple count as one). Units are numbered from left to right from: Inside _ Outside _
Filler Panel(s) to be located in section No. . and No. and No. None
- -, -
Shutter(s) to be Installed. InSide LJ Outside CJ
Rear
Indicate by number
counter clockwise
(g) OMIT
Front
TOTAL AMOUNT 00 . t/O
DEPOSIT (\I Mln, Required) 0 . 00
BAL. DUE c.o,o. Pay InSlall., t}ZJ - CJ
Installation estimated to begin in approximately ~
to weeks from date of receipt of deposit. This
is only an estimated date and you will be contacted to
schedule the actual installation date,
Special Instructions:
/'l2~,
(../.J l~
1?4cyJ
/!-'L{ ~
Electrical hook-up included in this price? YES 1<1.. NO [] Surface Mount IJ Recessed 0
TERMS OF PAYMENT: BALANCE OF PAYMENT IS DUE UPON INSTALLATION, In those cases where electrical hook-up is to be pertormed by Rolladen
or its authorized sub-contractor, a maximum of ten percent (10%) of the contract amount may be retained pending completion of same,
r
FLOOR OF BUILDING I S OWNER OF PROPERY? YES~ NO 0 (If NO, fill in Owner's name and address
Is "high-work" reqUired? YES l= NO ~ In space prOVided at top of form,)
Products are to be Installed on the premises situated In p~_O _ County, Slate of fi-
as: Lot Block ~~__, Sub Division.
owned by Purchaser and deSCribed
CONTRACT SUBJECT TO ADDITIONAL TERMS ON REVERSE SIDE
"BUYERS RIGHT TO CANCEL"
"This is a home solicitation sale, and If you do not want the goods or services, you may cancel this agreement
by providing written notice to the seller In person, by telegram, or by mall. This notice must indicate that you do
not want the goods or services and must be delivered or postmarked before midnight of the third business day
after you sign this agreement. If you cancel this agreement, the seller may not keep all or part of any cash
downpayment."
EXECUTED IN SIX COP~, ONE C~ WH~ WAS DtlJVERED TO, AND RECEIPT IS HEREBY ACKNOWLEDGED
B~~rUHIS ~- DAY OF ---------: L- ,19 :.>.
? .... .~~...- ''I ~1r;~~
(X) ._
Accupied 8. Approvud
(Purchaser Sign ^H"ro)
rmnf'l~ NO
7SP;?;<'7~9
PaQ6
of ~__^
POWER OF ATTORNEY
TO: BUILDING OFFICIAL,
I, the undersigned, a certified and registered contractor in the State of Florida, County of
'fA .s. c: 0 , and the qualifier acting for and/or doing business as:
duly authorize and assign
ROLLADEN, INC (company)
Ed uJ 4 f<-.c/ S ,q. <:. k
~~~~ ~ oJ.
Agent's ignature
as my agent
to apply for and sign a Building Permit for:
EdrnuJ\c/ ~'1Y1~~
3 ? J..j tJ 0 V~ ~ .tn/.:=; h; f&:> .l:1L,
)e Ph Lj ~ h.. If s) F L ~33 5 if (
Emilio Cuzan
Company Qualifie 'assi ing Power of Attorney.
Rolladen, Inc.
550 Ansin Blvd.
Hallandale, FL 33009
as the applicant in my behalf.
CGC 008964
Certificate Number
STATE OF FLORIDA --0
COUNTY OF 9'YD W(;../fd-
Before me this day personally appeared Crvvt' I; 0 Cu ~ who, being
duly sworn, deposes and states that the above statements are true and correct.
Sworn to and subscribed before me, this j~ day of ~_pk , A.D., 199-.1.
~~~ ~~
Notary Public
State of Florida at Large
my commission expires:
""~~'f:~:rjJ;;,,. DIANE SOSA
i~' .:t'<, MY COMMISSION * CC 366<<l7
EXPIRES: ApIII18, 1998
IlondIld Thru NolaIy Public UnclelWrltell
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,ROODl CORPORATION
~.. PLANNIIR8 Co PRODUCT ..,..BT1NQ
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ORtOA33174
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(l ROLLAD~N. INC MIAM~ FLOFlIOA 33174
0 !!5!SO AI>J5/N BLVD. _ONe, (3Ol!5) ee3-eeee
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fTJ., HALI.{t:~ALE, FL.
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