HomeMy WebLinkAbout95-4846
BUILDING PERMIT
Permit ~
CITY OF ZEPHYRHILLS
(813) 788-6611
484611
Date
,/-/[Z-<J5
BUILDING
ELECTRICAL
PLUMBING
~~ewerconn
Water Conn:
-, / ;J I
Pmp."V Own." j,/,""-h,,,t:~ :z:t-
Job Address: ,~~'-~- r ~.f/ ~
Parcel 1.0. #
Water M~Jer:
T.I.F.'s:
Zoning:
Description of Work
Energy Code:
Ale [~~a~
/ ?[
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
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
Permit Fee
Signature
Company
Address
Telephone# <1 J ~ - t: /) I - 2. I O?
,5'5.' J7J _ ~
'JL- rn:/.
Valuation or
Contract Price ~ 2!:Jr), t/V
City License Registration # /!>-9
State Certified License#
~~+~~
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 ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICAnON FOR PERHIT
CITY OF ZEPBYRBILLS
BUILDING DEPARTHENT
OWNER'S NAHE -;;;. /YJ P II
.
OWRER'S ADDRESS / t, t:J /
JOB ADDRESS S- (p S- <g
Foo /) ..$ L< ,I<P.
/5,9)('~ SI PJf)/IJ (
6-P LL 57'-
PHONE
k_
C;/ y
.
~/ h /7"S
p
LEGAL DESClUP'lION: LOT(S)
BLOC1L...-SUBDIVISION
PARCEL !.D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction ---Addition --J\1teration __epair KInstall
_Sign ---.JIove _Deaolish
PROPOSED USE: _Single Feaily ----1t1 F _' of Units ----1t/H
Lec-erCial _Indust. _Swia. Pool _Other
-'Restaurant Ii: Health Departaent Approval
DESClUP'lIOB OF WORK:
BUILDING SIZE:
x
~uare Feet,
Height
RESIDERTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS Ii: (2) SETS OF BUlLDIBG PLANS Ii: (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS Ii: (1) SET BERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKITS REQUESTED
~UILDING
$
Valuation of Total Construction
_ELECTRICAL
~ClWlICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
$ 320'0. ~
Valuation of lIechanica1 Installation
_PLUllBDfG GAS ROOFING
SPECIALTY
TYPE ()F COBSTRUCTIOB: _Block _Fraae _Steel
Other
PDISBBD FlOOR. ELEVAnOBS:
n.
IS PROJECT DI FLOOD ZORE AREA?
YES NO
..........................................
CONTRACTOR SEctION
BIITT .DER
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
RJ.RCTRICIAR
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
SilmAture
PLIDIBER
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
IlECllAHICAL
signature"7L m
~ lXlIIPAIIY / IE",) ;-h/J E ,4 /t- I
State Cert. or R.egist.' c..l9 C- 0
~ City License Registration' /S"'1
.......................................
;.L 7<6 2;:J <-
'IS 1
OTRRR
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
APPLICATIOR APPIllIVED BY J1 tj hI.t' r ~1 (J
PERHIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'I'be undersigned understands that this perait laY be subject to udeed restrictions! wbieb laY be lOre restrictive than City
regulations. !he undersigned asSUle& responsibility for I3pliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas hired a contractor or contractors to undertake work, they laY 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 laY be
cited for a lisdelleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requireJents laY apply for the intended work, they are advised to contact the City of Zepbyrhills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
.Contractor Sectionsu of this application for wbieb they will be responsible. If fOU, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the wort. If the contractor wishes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to peraitting 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 ,ith a copy of uFlorida's construction Lien La, - lIoIeo1mer's Protection
Guideu prepared by the Florida Departlent of Agriculture and COnsUler Affairs. If the applicant is 8OIl!ODe other than the
uowner", I certify that I bave obtained a copy of the above described dOCUJeDt and prollise in good faith to deliver it to the
.owneru prior to co.enceleDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoI'liltion in this application is accurate and that all work wiII- be done in cOlpliance ,ith all
applicable laws regulating construction, loning, and land developleDt.
Application is hereby Jade to obtain a perlit to do wort and installation as indicated. I certify that no work or
installation bas CDlenced prior to issuance of a perait and that all work ,ill be perfoI'led to _t standards of all laws
regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveruental agencies lilY apply to the intended wort, and that it is
If responsibility to identify what actions I lUSt take to be in COIpliance. Sueb agencies include but are not liaited to:
t Departlent of InvirollleDtal Regulation - Cypress Bayheads, Wetland Areas and InvirollleDtally Sensitive Lands,
Water/Wastewater 'I'reatlent
t Southwest Florida Water Mana!leJent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t AIIY Corps of Inqineers - Seawalls, Docks, Navigable Waterways
t Departlent of Health&: Rehabilitative Services, InvirOllleDtal Health Unit - Wells, Wastewater 'l'reatlent, Septic 'l'anks
t US InvirODleDtal Protection Iqency - Asbestos abat8lll!Jlt
I also certify that, if fill Iilterial is to be used in Flood ZOne IAu or uA,etc.', it is understood that a drainage plan
addressing a uCOIpl!IlSilting volUleu ,ill be sublitted ,hieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A pe,t'lit issued sball 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 fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pe.tIIit issued shall beCClle invalid
unless the IIOrk authorized by sueb perlit is COIIeDced within sillODths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of sil IODths after the tile the work is COIIeDced. One 90 day utension of tile, .y be
allowed for the perlit lith fee ebarge of $15.00. the utension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during eaeb sillOl1th period, or the project ,ill be consid'ered abanc1oDed.
WARKIlfG '1'0 MBR: YOUR FAILURE '1'0 RECORD A NO'I'ICE OF CCIIMDCBIIIJI'I' MAY RBSUL'I' IN YOUR PAYING !IIICE FOR DIPROVIIID!S '1'0 YOUR
PROPERfi. IF YOU III'I'BIID '1'0 OB'IAIN FIKBCING, CONSUL'I' WI'I'H YOUR LIJIDIR OR AM A'I"I'ORDY BIFOBB RBCORDING YOUR DICE OF
COMMIlfCBMm'. JOBS UlfDER '2,500 IN VALUI DO NO'I' mn '1'0 RECORD AND POS'I' A uNOIICE OF aJIMBIfCBlllJl'l".
SIGllAtuIII: OIOIER OR AGBKI
SIGIIA'I'URE: COII'I'IIAC'I'OR
S'I'A'I'I OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
S'I'ATE OF FLORIDA
coum 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 Dot
take an oath.
who is personally known to me or who has
produced
as identification and who did/did Dot
take an oij,th.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
r: t.1\1 HUt-' t: H-:-rc-o-Ht"'H'rTr.j b-' l::. L : - 81 j - b ('1 - 9787
Rpr 12,95
'14:591~o.001 r'.01
4;'
Kl-:N HOPJ~
AIR CONDmONTNG & Hli^'IJNG. INC
r. o. nox ?,;lJ9
1\IVElWJfW. H. 3J~9"2/.39
laB) 61J-:>.)0'1
C,\COH88J
^~~- CONDITIONING PRO~~ .' (lMJllQ .C;:QN~'t'
m\l>lf'.:
7']\1011'/\' "'OODG 1., 1. t, .
Il"H:: .4/n/9!,_.
ll11.jll1(; IIIHlI,l<l;,;: 1 601 ~I !:l~\KI':H !l'J.
d(ll~ J.\I)Ut<I':.:\~:::..D(j[!fJ (,jAl..J. ~.:'J'
CJ'1'Y/f;'l'II:J 1': I'J,I\NT CITY
CTTy/:.j'j'!:',ll': .l:f.I'HYHlIl LI,!;
BQUIPHEtl'J,' :
CondonRi 1""1 \In! 1 .1'11'-_.....
Col1 - Filn c:()11 - Pkq Urd 1. t. 'ION PACVJ\C;E BY 'l'kANE. /.10D # 7'CC060FJOOU
Ij/','l 9. I) !(W ~a:k'l'.
W':~I cUlm IIlIYCIIRH(I:i411 FR.T'..S.H 111 f< 1l1\f1J..lI.;H Ill\YIlMPHCl41l\
~'ll,Tf;R F'RJ\fo.1F,..
Th""rllK,.~'Llt (L'}
___Hf.Jilt. i nq Or,] '!
IJ~lst j nq uc..".! 1 1 nq
Nt Au.
I,OC'.ATION:
:;IJ11.lsbl<., :.:J.'''':'~' .\11:1 access for t.idi! inill.il]]at.inn iE: t.() b~, pr'c,virj'.'d by Yr..lu.
..------.---.------...-....- .~.._._- ...--.----.--------...-.-- ......-..
Ollr",1(h~ 1)1IH ON ROOF IN ~"J\HE LOCATI01J (ltl HEN CIJRB
l1UJidc Unj t. Nt A
DUCT WON(
DlIcl w,;.rk te, bp.. .IH;(;ONW':C'I'I':IJ '1'0 J':~: I f;J'! Nt, J>lJC','
. . ... "-....-..---.-. .-..,...'" ..........'-,.. .,..- -...----... ..........
U .Supply Grilles
_O......K€,tul:'r, Ail:' G!:i llQS
1Uii8PON8I8ILl'r1':I)f"llvmV, Il:iCrllIIIHI, ",,,'.'Ij,," Kf'~l, "Of'I; TIle 11'1'(;...._.._...._.. <.;e.ntl:ol Wilil19 !-(/ll T~) 1:XJ.~1'1IJI;;
Cut. Hng holes & patchj ng. fo/,()Ut'E;k.
!-',WP.J: Wjdnq. ~'A/olPA FOOD 1,.].11..
E:qul pment f(,l\J:\d II 1. 1 <,.11 NI.;W C:llIW
R<>fd<,l. fmd ~~(>I1dcmaate pjpjngK/JI
['r.'rlllit S sur'plied b}' K~:tJ IlOPE Ale liTe. 1 NC
I(omnvc!. Ol.1l UNl '1' &~'RJ\SIl....
----~-_..--_....,~,..~~._h..____~_____________________~._~-*.,.,_.~--~._-----------------------~__~...w_____~_M_~.._~~_~..~.,...~~~,
TruO PROPOSAL ~y ~ "I'fHP~ IF NOT COlWKR'l'BP INTO A. CO'NTRAcr 1U'rNIN 30 DAYS.
'torlna: 1\1'1.(,1' l.nl'lt.:.1J.i<tif'lI j,,: f:"Hllj'>lnINJ, ;" illl,)11f1f,d l:(!I:'I'c'F.,c-r,t."tivr., ('1 lid,', (:flmpany will stal:t, t"C'f'1: .11,d ,"'-'rtjf~'
1.,', (,Ill "fll"", 11", "n.tT.'."." '.'!>'.'L<ltiOIl oJ thr., '."l"'I"""'" UWt'!rf,,'J ",y thi'-' (",,"tnwt. '1'110,1 r"':I.lnn w.lll (,t,tJ,blil',h Ih(.'
dill (. (of ''',Il,p'I(:1 to" 0' OIlT' ""Id. ....'cl, <'x""pl I II" war U,111.}', And ..ny furtlwJ' ,.".lj'."'I.mf,nl..~, t'~'p.1ecc!mentr.' .:q' I,"pnin;
..d Jl !:ct., 1:.r.,rfc.>l'IM,d by Ul'; IHld(,r 11'1/.' 1.!.'lInE: ,',f t.hr, Will'l,.'l"tty ..r.' 1'(lItr.,d 'm the becl: e.f thi.Sl ':"~lrltnlt't. r'tlYInr..r,1. j,.; r.hlt.'
1U,lti('d!;\I(,]V IIP('II (!C>iTlI:>}(tt ((Ill III JlII.'ltdl"U('Il. H"W('\'(!t', if I"'BY'YiE'I't. in lull J:.' 1'1('\ I'p'(:fdved by t.hi<l e,ffjee ~iJt.ldll
I, o;IllY! f H'"' Ih", "1.,,1 (, <'> I 0111 i flvn.i Cf.'), II,,, Wit r ,,,,,1 y wi 1 1 b(. Sll~p~'nd.:>d <AmI i JlI.~!r~J'l1. at the rate of . OOO~ ~I.~J .r, \JJ J 1
hu 1.:1.('1'<.1('1..1 O[l "lilY unpaid bal<ln'::e. The warl'ilIlt~' w111 11'.,1. tllr.m hr, ,'.dngti.lled until th(. m)p~1d })a)'Il)(:f! Mlel 1"1""
11'11(,1"('1'1 h<lVfl h~NI p'll.d l.Ii '\l.ll. T/w jn~(q'(,,,r ~;rflt.~d ilbc.v(' \/i.l1 br._ dl(lJq<~d fM~h day imd J... bLlL'l>d ,)11 ll;~. 1I.P.k.
00N'l'JU\C'1' PlUCK: . 3250.00
i._TAMPA FOOD L.I. P. ROOP'~R ~081!:'1' & SBM. CUJ\B_1C8N HOPB Ale w:u.~ 8UPP't ClUIHB ~. .'. '/I
'j'hl' Jlwt.1l1 lilt .1c.n ilno eifll1pm,~l)r Ftb,)vn m~t',t.1nl'lp.d ill." !1l.Jbj'.'l'L to l'<.)nr.lIl1or,A .11'10 wal.'I'<1l1tj(n' ~'1I llll' j"<.'V\ll.".'" 1.:.;<.\<:' (>1
ttd.!' Agl.oeml!nt. tt,& E:Bm", B!o jf t.hey wet'''' p!'Jnt.ed abovE' and thr;.:,;c., condlt1nlH' and wal:rllntic.'J ".'l>t.L.lllllltl II PIlI 1 (.1
tld t' JIg!: ()Cmt'I,t. .
ACCJlPTANcm OF PROPOSAL:
PRINT NAMB ABOVB
~Hon
AIR ~IT7iNQ & HBATI.N~O' IN
~_. ~ ~~.
l(ntl M. Hnpr>, J'J"~~.
A~2"~
.
PRlNT NAME AB6VE
JO'd llj-10l----
Th18 c:ertlfles that
CERTIFICATE OF JN5URANCI:
iii STATE FARM FIRE AND CASUALTY COMPANY, BlOomington. llfioois
o STATE FARM GENERAL INSURANCE COMPANY, Bloomington. Illinois
Insures the following policyholder for the coverages indicated below:
Name of poIICyhOldei-
KEN HOPE AIR qONDITIONING AND HEATING. INC.
AddreSa of poReyholder
811 6... tl....vel s .Road ~
Riverujew, FL 33569-~7?~~
Location of operations
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY
EftllCtlve Oa.. Exphtlan Date
~ Cornpretlen$Ive : o Dual Limits for; BOOIl Y INJURY
.m..g.8-Gi-~5a:].....4J . .....~.~!l!Ym....... ..1.0l0.1./.9.4.... ..;. .1.010.1/..9.5 __.
:/ti'Manufacturers and i Each Occurrence S 300,000
................ ........ ...n........ ____..99!:'~~r~U:~l!~y....... ............. ............l................ ... ....., Aggregate $ 600,000
o Owners. l.andIords. i PROPeRTY DAMAGE
..................................... ......!l.~.I~!!'.!-:I.~.~.. .... ...... ............ ......t... ... ....... ...........
Each 0c:x:urTence $
Thla In$urance inoludes: iX Products - CompletG<l Operations Aggfegat..
a Owrtei$ or Contractors Protective Liability BODILY INJURY AND
e Contractual LIabIlity ~ Combined Single Limit for. PROPERTY DAMAoe
XX Prof8SSlonal Elrors and OmIssions
il Broad FOI'm Property Damage Each 0ccumln08
e Broad Form Comprehen6ive General Liabirlty Aggregate
POLICY PERIOD CONiRACTUAL UABIUTY liMITS (If different from above)
POUCY NUMUR TV" OF INSURANCE E"ectIve De" Exphtion Date BODILY INJURY
, Each Occurrence
,
.
,
PROPERTY DAMAGE
,
Each Oocurrence
Aggregate
EXCESS LIABlUTY . BODILY INJURY AND PROPERTY DAMAGE
. (CombIned ~ LknIt)
. -
.
.
.
0 .
Umbrella . Each Oocun'enoe $
o Other , Aggregate S
. Part 1 STATUTORY
Xl WcntWS' Compensation . Part 2 BOOIL Y INJURY
.
98-G7-S010-81 .
and Employers liability 1 Each Accldent $
,
.
, OIseeee Each Employee $
Disease . Poley LImIt $
......naI......-.Ownon,!M-..., "'T_~-"-_
, ...................... _ ~...-..
THIS OERTIFICATE OF INSURANCE 18 NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMlNOS. EXTENDS, OR
ALTlR$ THE COVERAGE APPROVED BY ANY POLICY DESCRUIED HEREIN.
CITY OF ZEPHYRHILLS
5335 8TH STREET
ZEPHYRHILLS,FL 33530
::t.::tI.- ul ~
__III.. ___
AGENT
ntI-'j j I ~ J q6 -'
- I
Name and Address of Certificate Holder
..... CadI.....
",ion .IUJ.lftw '993
J..e 2110
M. Machlse 9767
L8nlz
.n".,..RR586
....1410 n... M1 Fltr*Id In U.s.A.