HomeMy WebLinkAbout95-4774
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit N;~
4774-8
Date J - / 7 - y....!:. -
~
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
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Property Owner: ./
Job Address3~flO 3~.3:i:.L CI-- ~l?::.
Water Conn:
3&3~/
Parcell.D. #
Zoning: Energy Code:
Description of Wor~t7 .../1..r-7
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL ~'-I./
J
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
? Y' ~ -.
Valuation or /
Contract Price ....3 7'70--: dl..>
/ 9/ ;> .y 19 . c.T i.J
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City License Registration # J /'
State Certified License#
Permit Fee
Signature
Company
Address
Telephone#
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BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
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 ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
'Il
RECYCLED PAPER
C~ntents: 40% Pre-Consumer. 10% Post-Consumer
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'rnposal
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PROPOSAL SUBMITTED TO
PHONE
313/73'1-2"11 :;
JOB NAME
'-;'rifbl',.,::)!l Il:x:o'l.iniu,lS -. ;? Dl;uc3.
JOB LOCATION
DATE
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ARCHITECT
DATE OF PLANS
::n351-3DiJ1
:';'~) lyr:lills,
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JOB PHONE
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We hereby submit specifications and estimates for:
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me 'ropose hereby to'furnish material and labor - complete in accordance with above specifications, for the sum of:
J;' . 'r"(::.:'~:.r" .;,- 1':~".;"C"!":t'
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--'- .- - ~ollars ($ 1 '3! Th _ C~ U
),
Payment to be made as follows:
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<PrJJll . :
All materiai is guaranteed to be as specified. All work to be completed in a workmaniike
manner according to standard practices, Any aiteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate, All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance,
Our workers are fUlly covered by Workman's Compensation Insurance,
Authorized
Signature
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,372.75.:r.cl
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Note: This proposal may be
withdrawn by us if not accepted within
:;J
Acceptance of 'roposal- The above prices. specifications
and conditions are satisfactory and are hereby accepted, You are authorized Signature
to do the work as speCified. Payment will be made as outlined above,
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Date of Acceptance:
Signature
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
\l~ frl\h"'~,~~ n..~il--' f l~.
1.~911 U, ~. 3D) _ 1)~A~ CJ:.~ \ PL
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Dr~~{),)~ (~dl'> ~<;..S.OC .
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U~IA rt.. f~h \-h,01 kvll\ ~ en\( ~ 1. h< <",
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PHONE 9lJ7-!(}1\47
ADDRESS
OWNER
JOB LOCATION
X AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D. 4,
RI!.-"'H t
WORK PROPOSED:____New Construction ----Addition ----Alteration ~epair ____Install
_Sign/Temp.
_Sign
_Move
_Demolish
PROPOSED USE: _Single Family
---.J1/ F
_4, of Units
~/H
GrML-6 Other
_Commercial
_Indust.
_Swim. Pool
_Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED.
PERMITS RROUESTED
_BUILDING
$ 14-.\ 74c, Dj)
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
---.J1ECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Frame _Steel
,Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
******************************************
BUILDER
Signature
ET.RCTRTCTAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
Silmature
PLUMBER
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
MECHANICAL
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
OTHRR
()J~41~
Company J/,j1fay 0lMd.. ).i1C
State Cert. or Regist. # . ~c../Jc'JC;S2J~
City License Registration # 3~
Signature
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
.......---,_..._-_.-.~._....._----,.-.-
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this per.it '.ay be subject to .deed restrictions" whith .ay be lore restrictive than City
regulations. The undersigned alluees responsibility for co.pliante with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas hired a contractor Dr contractors to undertake work, they .ay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor .ay be
cited for a .isde.eanor violation under state law. If the owner Dr intended contractor are uncertain as to what licensing
require.ents .ay apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, 1813}
788-6611.
Further.ore, if the owner bas bired a contractor or contractors, be is advised to have the contractor!s} sign portions of the
"Contractor Sections" of tbis application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that .ay be an indication that he is not properly licensed and is not entitled to per.itting privileges in the
City of Zephyrhills.
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 "Florida's Construction Lien Law - Ho.eowner's Protection
Guide" prepared by the Florida Departeent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
"owner", I certify that I have obtained a copy of the above described docu.ent and pro.ise in good faith to deliver it to the
"owner" prior to co..ence.ent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infor.ation in this application is accurate and that all work will be done in co.pliance with all
applicable laws regulating construction, zoning, and land develop.ent.
Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no work or
installation has co..enced prior to issuance of a per.it and that all work will be perfor.ed to .eet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not li.ited to:
. Deuartlent of Environaental Reoulation - Cypress Bayheads, Metland Areas and Environ.entally Sensitive Lands,
Mater/Wastewater Treat.ent
. Southwest Florida Water "anaoelent District - Mells, Cypress Bayheads, Metland Areas, Altering Watercourses
. ArlY Corus of EnQineers - Seawalls, Docks, Navigable Waterways
f Deuart.ent of Health L Rehabilitative Services. Environlental Health Unit - Wells, Mastewater Treat.ent, Septic Tanks
. US Environlental Protection Aoency - Asbestos abatelent
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 volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with 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 fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every per.it issued shall beco.e invalid
unless the work authorized by such perlit is co..enced within six .onths of issuance, or if work authorized by the per.it is
suspended or abandoned for a period of six lonths after the tile the work is co..enced. One 90 day extension of ti.e, .ay be
allowed for the per.it with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection .ust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO"~NCE"ENT KAY RESUlT IN YOUR PAYING TWICE FOR I"PROVE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUlT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
~ lO.", ~NOER '2,500 IN YAL.UE DO HOT REED TO RECORI AND POST A '''TICE OF ,"",,",'RENT',
-1 . 1< tf;/44k ~9 1 JI1fi
SI6MATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR
STATE OF FLORIDh
COUNTY OF 'ff 5 (, cJ
The foregofng instrum~pt ,was a~knowledged
before me th i s n Ihftr""j" 19..:t.r:. by
STATE OF FLORID~
COUNTY OF ,'5,'e )
The foregoing instttme:z was acknowledged
before me th is I )n.. LJ r", , 19 75- by
to me or who has
/JpJ ftAJ2 L jL;.' / t cA--
who is personally known to me or who has
dti'e/did not
ho ~/did not
GAIL Y. GRINDLE
(Name Typed Pr i ~~&1Ift9T tlOrloa
NOTARY PUBLic o. Xp re r. 25, 1998
Comm. No. co aeeato
(Signatur GAIL Y. GRINDLE
'~ at.lief Florida
(Name Typed, Pdn~~8~~im. e Wi' r.25.1998
NOTARY PUBLIC Y Comm. No. CO 988&80