HomeMy WebLinkAbout95-4991
BUILDING PERMIT
...
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
r4-~
.4991/1
BUILDING
020 - tJv
C ELECTRICAY
PLUMBING
~I) .tHJ
€HA~I~sewer Conn
Water Conn:
Date '-.S -..30 --7 ~--
pm"rtyowne,. ~ ~
Job Address: 5/_ _ ___~
Parcell.D. #
Water Meter:
TI.F.'s:
Zoning:
Description of Work
Energy ~
A;LC - A.Mfa.,
Radon Gas:
FINAl_1~ 19- qS
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
I~'f
/
Pe'mit Fee ~
Signature / ~ ~ 4i1
,.
Company
Address
~~
Valuation or
Contract Price
;2.'79...J-- o-D
--
City License Registration #
State Certified License#
1--.?~f.O- ~o/C - <?~?'1
Telephone#
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BUILDING
ELECTRICAL d~.J..
_ L/(?~il1dvW
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.
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APPLICAnON FOR PERIIIT
CITY OF ZEPBYRBlLLS
BUILDING DEPARTHBIIT
OWRER'S IlAHE
PHONE
OWNER'S ADDDSS
JOB ADDRESS
'-
LEGAL DESCRIP'lIOII: lDT(S)
PARCEL LD.'
B~SUBDIVlSION
(OBTAUI FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction ----..Addition ---J\,1teration ---.Jtepair _Install
_Sign
--.-JIove
_DeIIolish
PROPOSED WE: _S~e F_ily
--.Jt/F _' of Units --.Jt/H
_ec-ercial
_Indust. _Swia. Pool _Other
Restaurant & Health Departaent Approval
DESCRIPTIOII OF WOIUt:
BUILDING SIZE:
x
.
Square Feet.
Height
RlmIDEI1TIAL:
COHMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ERERGY FORMS.
ATtAaI (3) SETS OF BUILDING PLANS & (1) SET ERERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW COIISTRUCTION.
PERMITS REOUE.c;TED
---.JjUILDING
$
Valuation of Total Construction
RT.RCTRICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
___CBAIIICAL
$
Valuation of llechanica1 Installation
-PLUMBING
GAS
ROOfiNG
SPECIALTY
TYPE QF COIISTRUcnOIl: -Bloclt _F~ _Steel
Other
PIIIISBED P1OOR. ELEVAnollS:
Fr.
IS PROJECT IN FLOOD ZOO AREA?
...................................*......
YES NO
CONTRACTOR SECTION
BIITI.DD
aJHPANY
State Cert. or Regist. ,
City License Registration .
..................................*.......
Signature
RI.RCTRTCIAR COKPARY
<; ~ State Cert. or IIegiat. f
SiMUature 't...'. ... City License Registration .
~.....*..............................
J/J..:t
PLDMBRR
COMPANY
State Cert. or Regist. .
City License Registration .
.....................*................**..
Signature
IIBCIIAnCA~ COIIPAIIY
. ~ State Cert. or Regist. .
Signature /t.. '/ h. .f?.../~ City License Registration .
~ .~....................................
~ . / l/V
OTRRR COMPANY
State Cert. or Regist. ,
Signature City License Registration .
..........................................
APPLICAnON APPROVED BY PERHIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
De undersigned understands that this penit IlaY be subject to 'deed restrictions' wbich IlaY be lOre restrictive tIIan City
regulations. the undersigned assUIeB responsibility for COIpliance lith any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner lias lIired a contractor or contractors~to undertake IOrk, tIIey laY be required to be liceD8ed in accordance lith
state and local regulations. If tile contractor is not licensed as required by law, botll tile owner and contractor IlaY be
cited for a lisdeJeallOr violation under state lal. If the owner or intended contractor are uncertain as to "bat licensing
requirell!llu IlaY apply for tile intended IOrk, they are advised to CODtact the City of Zepbyrhills Building Departlent, (813)
788-6611.
Furtheraore, if the owner bas lIired a contractor or contractors, he is advised to bave the contractor(s) sign portions of the
'Contractor SectiOll8' of this application for IlIicll they lill be responsible. If you, as the owner sign as the contractor,
you are indicating that fOU, rather than the contractor, are responsible for the work. If the contractor lliahes you to sign
as contractor that IlaY be an Indication that he is not properly licensed and is not entitled to penitting 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, the applicant, have been provided lith a copy of 'Florida's construction Lien Lal - IIaIeoIIner'S Protection
Guide' prepared by the Florida DepartJent of Agriculture and CoI18UleI Affairs. If the applicant is 8CIIl!OIla other tIIan the
'OIDeru, I certify that I have obtained a copy of the above described docuJent and pIOlise in good faith to deliver it to the
uOII1er" prior to co.enCell!llt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infonation in this application is accurate and that all work li11. be done in COIPliance lith all
applicable lilll regulating construction, IOI1ing, and land developElt.
Application is llereby lIilde to obtain a penit to do work and installation as indicated. I certify that no IOrk or
installation baa CDlenced prior to i88uance of a penit and that all work lill be perfonecl to Jeet standards of all laws
regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other govel1lleDtal agencies IlaY apply to the intenc1ed IIOIk, and that it is
If responsibility to identify what actions I lUSt take to be in COIPliance. Such agencies include but are not lilited to:
I Departlent of BnviI'Olllelltal Regulation - Cypress Baybeads, Wetland Areas and BnvirolllenWly Sensitive Lands,
Water/Wastewater !reatElt
I Southwest Florida Water JlanageleDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
I AIIY Corps of Engineers - Seawalls, Docks, lIavigable Watenays
I Depar1:lent of Health i Rehabilitative Senites, BnviIODMlltal Health Unit - Wells, Wastewater Ireatlent, Septic !anks
I US BnviIOlllll!lltal Protection Agency - Asbestos abatelellt
I also certify that, if fillllaterial is to be used in Flood Zone 'A' or 'A, etc. " it is understood that a drainage plan
addressing a 'COIpeD8iting vol_' lill be saitted which is prepared by a professional engineer registered In the State of
Florida prior to penit issuance.
A ~it issued shall be construed to be a license to proceed lith the IOrk and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall i88uance of a penit prevent the Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pemit issued shall becoIe Invalid
unless the work authorized by such penit is co.enced lithin sillODths of i88uance, or if IOrk authorized by the penlt is
suspended or abanc10ned for a period of siJ IODths after the tUe the IIOIk is ~ced. One 90 day atension of tUe, IlaY be
allowed for the penit lith fee charge of $15.00. 'fbe atension shall be requested In lriting to the Building Official. An
approved inspection lUSt be logged during each sil IODth period, or the project lill be considered abanc1oned.
twUfIIIG 1'0 lMfIR: YOOR FAILURE 1'0 RECORD A IOI'ICE OF aJIIIPCIIIIII! lilY RESUL! III YOUR PAYIIfG !IIICE FOR. IIIPROVIIIII'lS 1'0 YOUR
PROPDIY. IF YOU IJI'DIID 1'0 OBIAIII FIIIAIICIIIG, COHSUL! WIn YOUR LBIDIR OR 1II1ftOBDY BB10RI RICORDIIG YOUR DICE OF
C(JUIIIfCBMBll!. JOBS urmlR $2,500 III VALUE DO 101' IIDD 1'0 RECORD 1IID POSI' A 'IOI'IC! OF ClIIIIIICBMIII'.
/
X
SIGII!URI: (IIIIIR OR IGIlI!
,A
SIGIII!URI: COIII'BACfOR
SUII OF FLORIDA
coum OF Y
The foregoing instrument was acknowledged
before me this , 19____ by
SUR OF FLORIDA
coom OF'/.
The foregoing instl'UlleDt 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 o~tb.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Nue Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC