HomeMy WebLinkAbout95-5031
BUILDING PERMlt~-
CITY OF ZEPHYRHILLS Permit lV ·
(813) 788-6611
:~503l A
Date 6 -Ib -9S
c9
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcell.D. #
~::~~.on of wo,; R-'l E:;P'
g I(Jj~ .
, <:'7 ~J'9 - Cl,~
Water Meter:
T.I.F.'s:
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
- Z-l...-qr
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee
Signature
Company
Address
Telephone#
:lS, cJi
'" ~~ 1>1.--.-
Valuation or
Contract Price I - r <71. o-D
./
City License Registration # <...3 7
State Certified License#
m.;}AA
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
-
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Serv.
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.
p- /755
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT ~1\Y\(i.' L. IY\1 \ inn /JYh l ~a-<"- C 1\i\S-t rIAL h 0\'\ \ Y'I c..
ADDRESS \5~\\ ll~" ~O\, 1~d~ C\"~"Y\. ?1?JSLS PHONE
OWNER JuIA Yl \Al. Kr [\'/ ' ~r
JOB LOCATION ?)~?\:1 - [;)J.lt\ AWY\u>12 12-~'I\\S LOT SIZE X
~U4)51In. (/)041
,
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.#
I7-L~' ? \ . lJ02:Ju - OD\OO" ("')\9,0
ICe - I<-ou~
WORK PROPOSED:____New Construction ----Addition ----Alteration ____~r ____Install
_Sign/Temp.
PROPOSED USE: ~ingle Family
____S ign
____Move
____Demolish
____M/F
____4F of Units
_M/H
_Commercial
____Indust.
____Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE:
X
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED.
PF.RMITS REOUESTED
~BUILDING
$ p341.7b
Valuation of Total Construction
____ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
_MECHANICAL
$
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
SilZnature
Company
State Cert. or Regist. #
City License Registration #
******************************************
ELECTRICIAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
PLUMRER
Signature
Company
Sta~s Cart. or Regist. #
City License Registration #
******************************************
MECHANICAL
Signature
Signature
Company IY\:, \ ffi (" (\'Il'i-\rlAclrl ~ V\ " \vt <-.
State Cert. or Regist. 4F ~C ()()C]c)'2-IC;-
City License Registration # 31
OTHER
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit 'lay be subject to .deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has 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 lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furtherlore, 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 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 lay be an indication that he is not properly licensed and is not entitled to perlitting 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 - HOleowner's Protection
Guide. prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
.owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work Dr
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet 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 aay apply to the intended work, and that it is
IY responsibility to identify what actions I aust take to be in cOlpliance. Such agencies include but are not liaited to:
f Departaent of Environaental Requlation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treataent
f Southwest Florida Water "anaqeaent District - NeIls, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlV Corps of Enqineers - Seawalls, Docks, Navigable Waterways
f Departaent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection Aqencv - 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 perait prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such per.it is co.eenced within six lonths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of six lonths after the tile the work is cOllenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged during each six lonth period, Dr the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"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
C~C~T. JOBS u~ $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A .NOTI E OF CO""~NCE"ENT..
tI~ 1< M~ i:t~ .
SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR
STATE OF FL~A
COUNTY OF . ,J(J SCr\
The foregoing instrument
before me this '<)~JC~
~~-R! t jl/~
who is personally known
produced A~~
as iden ficati d w
take at
was aclmowladgerl
, 19 9) by
STATE OF FLOR~
COUNTY OF .:tL" CJ
The foregoing instrument
before me th i s 15~\J'~ 11
was acknowledged
,19'7;- by
did/did not
l)/AI'ILffl L JII,/fc-.-
who is personal~J~known
p-rBBt......"d Mn
as identi 'cati In
take a
to me DT wno has
to me o.F ~~he. ha6
(Name Typed, printN~l~orlda
NOTARY PUBLIC Notary PU IIC,' Mar 25 1998
My comm. exp reI . '0
Oamm. No. CO 88856
- /did not
''-'',~ Contents: 40% Pre-Consumer. 10% Post-Consumer
~
~roposal
Page No_
of
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SUIt-J Certltlt:O
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Platinum ir,staller
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St."t.: HUCj:~:ered
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PROPOSAL SUBMITTED TO
~ ';r. .':'::.~_-:-i '...'-~:n2C
PHONE
~j i ';/'i L :,..:,; 'I u
JOB NAME
DATE
u,j/CI')/95
STREET
G:;~,"~6 Ljl(~l _.~ji'(; ~j:i:~~'::
j\.: It.:':.r':-~ .i,')11~--;:~~
JOB LOCATION
CITY. STATE and ZIP CODE
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,
I ~~....,.,'j:
ARCHITECT
DA TE OF PLANS
I .
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c.......-.. _',,~ . .....~-'-
2. Provide and install !le\1 1 S 1;). ~~(itu.clt,-:d i:,;lc ",^ >:-.
3.
Provicle
color.
ili-Kl in.stall
c;.:u? sliiliyl\.~~;
nO\-'1 c-:i.",-", "SulCiIL:l" ::!(;
11,'1'1(, a J.U 'Ie. u..- ,ni::-rZ:.clty
y: :dJ::- Ll'J<~r'Jl-~,;:; ~~,tl{l-_;'L '.>,
(:...: l l",4..,Jt.jl.~ ~-~'. -id ; kTt~_c 1...,,1.3.
,A/.!'l' '~.L
to
C~lo..')SC
4. l{<~\}l~::lC(".; all li.:hijjFj(.;~l tl?.4.~lti(!(jS (v;~j.lli~_/, Vf~(rC, ()..c ~i.i.t-,/ \/d,il il.:-.:t.~:.;t1i.l'-f).
~. i:~rovick~ ,-_lii( t ~il:) ta,l.l 11(::\1 10.:1(1 l )('-oC...3 1..\..J-'-: th,~:~ 1,)] LL~~ ... i~~l'::;- \/'. _~~ lL.;:J .
6.
Provido ':::';K1 install !l2w L)D~-:tt,li:>k::\..i alu.,in~_L ,-", ,f'c._'-i'-i~) (\/l,iu; ,_jI: dn::,\/.1).
irl~-:rCdll ~:l(;' .:/[ lle\l .):e-lilusrJ.~J 1.1.lu..tLLi-H...Li L"i.:.....j:(; \/'_::- H~.
;_)rovitle uno
7.
i',ny :cot t:.d 1 or claddJe"u hl\AXJ (r\xy.:.: U"~I'-, LC ~l.,
cost-pltL) ba;.;i.; aiJove anJ ;X:;YGiiLl Ll'" CU,lcrcl;';:C ;)l::l,_;:;.
t:.~- L .)
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~:~~~) l':tc\-.;,d
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t>.
niE3ar
s tor~:l
Construction,
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lile. -"co
or ...:k.L ~-li-A.\~ ,..;:
i)ro.;ic(,",
, ,0. ~~ 'oj
5 .Y~_~:'!.c
nt' k.:;_-:;,
('-'elL-Cloty OD
,~,,~'rJ~.1l[lSiLi.;,); c;~-:c lill"iiollS:
~.:1\'.l/::)C" .3c:r."ur.:;c'tl.{"r:tl (la.fl1..;.(:j{~
\..:_.~.\.2,_~~ \....i,,;,.L.1 ~~'L') ~,:;,
to roo:: d,-,C;~.
9.
Ovmc:r i:r) C}cGvic~~ i:iC;Cl~~j;.) Lor Li(::.Liv~_';:_:y trL~CJ:~ L'~'J (jl.ll-)_J rXJ~:c.
C~11tir..:.: l..T.)(;i :-'tr(~1.
lOc;.dtn,-'i/1dll;;IULYJ tor the
J_O.. .hli:,,,,r CCdcTi:'llcti;x-l, r'le. t" c);::-U)l;:::~ G_;;-cc":c~L '~-Lc;_)iliLY and ';jo,:::~,_,:._I~: Cl:)j",)C;n..satio.n
I[l.St.LL"~'~(lC~:; {~I'I; :.')(HJ, (JOO l.i~-J.. t) (:1.1.'..;_ i L0-ro~).!.~i:- t': ,)(:.....l8_ t~..
mt 'rOpOBt hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
!... -;.':"}
,.._'-......,1.- 7_..,'
'j,
dollars ($1, r-...: ,7'-,
).
?'c~ /' j/~
'",- ,.
<...-:/.~' ..
--rl-
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2 .;( :":)_.
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All material is gu ranteed to be as specified_ All wo k to be completed in a workmanlike
manner according to standard practices, Any alteration 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_
Note: This proposal may be
withdrawn by us if not accepted within
:'Ill
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,
. ':;"'/':1. J
Date of Acceptance: t' Signature
..... /:.,(..;..:._,-G....~-