HomeMy WebLinkAbout95-4829
BUILDING PERMIT
Permit ~
CITY OF ZEPHYRHILLS
(813) 788.6611
4829 ;J
'1-6-7J
Date.
~
l.~'
ELECTRICAL
PLUMBING
MECHANICAL
Sewel" Conn
Property Owner:
Job Address:
Parcell.D. #
:II~ ~J;Iy;1'
Water Conn:
r~-R~
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
~gy Cod_~:
Nod ..L/--dA
(J
Radon Gas:
(
l/9
I 0 " I
FINAl__
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.
e.o.
DATE
Inspector
City License Registration #
State Certified License#
IJ] g--
Permit Fee t2..0.- c-:--;)
Signat~~ Lf.-/-& ()r
Company
Address
Telephone#
Valuation or
Contract Price
, /~,.,
---J /
,- ,.....,,-.....
\_G/'-'
~.L-)<~ ~ .LJd .J2-6..(..
BUILDING ELECTRICAL
PLUMBING
MECHANICAL
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 ($15.00) 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.
r,..-t..., .':
APPLICATIo.N FOR PERHIT
CITY o.F ZEPBYRIIILLS
BUILDIRG DEPAR'IIIENT
~ MA/.1 -Jorf1e
ij
o.WNER'S
~~Q
PHo.NE
o.WNER'S ADDKESS
Jo.B ADDRESS--La9 00 (; CLLe
61lJ&
LEGAL DESCJUPI'I.o.lI: LOT(S)
BLOCK
SUBDIVISIo.lI
PARCEL I. D.'
WORK PRo.POSED: lIev Construction --Addition _Altecation _Repair _Install
,-
V Sign
_Hove
_De.ol.ish
PRo.POSED USE: Single F8Ilily
/ec-eccial
_H/F
_' of Units
----"/H
_Indust.
_Swia. Pool
o.ther
---Restaucant 5: Health Deparblent Appcoval
BUILDING SIZE:
x
~uace Feet,
Height
RESIDENTIAL:
GOtItIERGIAL :
ATI'ACK (2) PLOT PLMiS 5: (2) SETS OF BUIIJ>IBG PLAIIS 5: (1) SET HRERGY Fo.RMS.
ATI'AaI (3) SIttS OF BUILDING PLAIIS 5: (1) SET EIIHRGY. FOBIIS.
PBOPERTY SURVEY REQUIRED FOR ALL IIEW CONSTRUcno.N.
PERIllTS REOUESTED
"""'BUlLDING
$.
Valuation of Total Construction
_ELEcrJUCAL
.AIIP Sendee
Florida Power Corp.
H.R.E.C.
,.
_tlECllARICAL
$.
Valuation of lIecbanica1 Installation
_PLUKBING
GAS
ROOFING
SPECIALTY
TYPE o.F COIlS'lRucnOB: -.Jlloclt ~caae _Steel.
o.ther
FINISHED FLOOR ELEVATIo.NS:
Fr.
IS PROJECI' III FLOOD Zo.NE AREA?
YES NO.
..........................................
Co.BTRACIo.R. SECTIo.N
BUILDER
COIIPABY
State Cert. or R.egist. .
City License Registration .
..........................................
Signatuce
F.1.F.CIRl.CIAB
cottPAliY
State Cect. or Regist. .
City License Registcation .
..........................................
Si-tuce
PLUflBER
COtIPARY
State Cect. or Regist. .
City License Registration .
..........................................
Signatuce
ttECIIABlGAL
OTRF.R .
~1~~
COtIPAliY
State Cert. or Regist. .
City License Registration .
..........................~..~............ I. .
L CUHPAllYDI '/..{~ S(~f)s;. < file.
I.. .(J State Cect. or Regi .. ES O()tJDO I 3
- ~ City License Registration .
...... ................................
Signatuce
Signatuce
APPLlCAnOR APPROVED BY
PERllIT OFFICER.
~'r., .",
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned understands that this perait lay be subject to 'deed restrictiOll8' whieb lay be lOre restrictive thaD City
regulatiOll8. !he undersigned asSUle& respousibility for co.pliance with any applicable deed restrictiOll8.
B. UNLICENSED: CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OIftler bajj" hired a contractor or contractors to undertake IOrt, they lay be required to be licensed in accordance with
state and local reguJatiOll8. If the contractor is not licensed as reguired by law, both the 0IJler and amtractor ., be
cited for a lisdellBaJlOr violation under state la". If tbe OIRler or intended contractor are uncertain as to lbat licensing
reguiruents lay apply for tbe intended IOrt, they are advised to contact the City of Zephyrhills Building IJepartlent, (813)
788.6611.
Purtbenore, if tbe owner bas hired a contractor or contractors, he is advised to have tbe contractor(s) sign portiOll8 of tbe
'Contractor Sections' of this application for whieb they will be responsible. If you, as tbe owner sign as the contractor,
you are indicating that you, ratber than the contractor, are responsible for tbe IOrt. If tbe contractor liaJ1es you to sign
as contractor tbat laY be an indication that be is not properly licensed and is not entitled to pmitting privileges in the
City of Zephyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, tbe applicant, have been provided witb a copy of 'Florida's COnstruction Lien Law - lkIIeoImer's Protection
Guide' prepared by tbe Florida Departlent of Agriculture and ConsUIBI Affairs. If the applicant is 8OIl!OI18 other than the
'OIRler', I certify that I bave obtained a copy of tbe above described docUIent and prOlise in good faitb to deliver it to the
"OIner' prior to co.encuent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIlation in tbis application is accurate and that all IOrt lill tie done in eotpliance litb all
applicable laws regulating construction, loning, and land developleDt.
Application is hereby tade to obtain a perlit to do work and insWlation as indicated. I certify that DO IOrk or
installation bas cmI8J1cecl prior to issuance of a pemit and that all work lill be perf OIled to _t stanc1ards of all 1_
regulating construction, City codes, loning regulations, and land develoPMDt regulations in the jurisdiction. I also
certify that I understand that tbe regulations of otber goveIDl8Dtal agencies lay apply to the intended IOIk, and that it is
Ii responsibility to identify what actions I lUSt take to be in eotpliance. Such agencies include but are not lilitec! to:
t Departlent of Invirollll8lltal Regulation - Cypress Bayheads, lIetland Areas and InviroDleDtally Sensitive Lands,
lIater/llastewater freatlent
t Southwest Florida lIater Hanaguent District - lIells, Cypress Baybea4s, lIetland Areas, Iltering lIatercourses
t IrIy Corps of Engineers - Seawalls, Docts, Xavigable lIatenays
t Departlent of Health' Rehabilitative Services, InvirOJll8Dtal Healtb Unit - ileUs, Wastewater rreatlent, Septic ranb
t us InYiIODlBllW Protection Igency - Asbestos abatuent .
I also certify that, if fill aaterial is to be used in Flood ZOne wA' or 'I,ete.', it is understood that a drainage plan
addressing a 'COIpen8ating volUIB' will be saitted whieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perait issued sball be construed to be a license to proceed witb the wort and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor shall issuance of a perlit prevent the Building Official fa thereafter
requiring a correcticm of errors in plans, construction, or violations of any code. Ivery perait issued shall becoIe invalid
unless tbe IOrk authoriled by sueb perlit is ~ced ,itbin sUlODtbs of issuance, or if IOrk autboriled by the perait is
suspended or abandoned for a period of sUIODtb8 after tbe tile the work is ~cecl. One 90 day 81tensiell of u., .y be
allowed for tbe perait witb fee charge of $15.00. tbe 81tension shall be requested in writing to the Building Official. In
approved inspection lUSt be logged during eaeb sil IODtb period, or the project will be considered abanc1oned.
IIARRING to OIIDB: YOUR FIILURI to RECOBD A XOIle! OF CCIIMDCBIlBHf NAY RESULt IIf YOUR PIYIHG nle! FOR DIPROVIIIIIIS fO YOOR
PROPlm. IF YOU DDIID to OBIIIX FIllUCIXG, COHSULr IIIrH YOUR LDDBR DB IX InomY BIFOBI RICOJIDIIG YOUR JOIlCE OF
ClJIMINCBIlBHf. JOBS UNDIR $2,500 IX VILUlIlO XOI IfDD to RICOBD UD POSt I 'XOIIC! OF aJIIDCIIIDI'.
SIGJllfURB: OIIDB OR IGIHI
SIGU'IURI: COJIRACfOB
StArI OF FLORIDA
CO11m' OF
The foregoing instrument was acknowledged
before me this , 19____ by
Stili OF FLORIDA
COOllY OF
The foregoing instl'Ulllent 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 oCJtb.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
"Jd'"2J,o "1:i ~ a")lV]
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