HomeMy WebLinkAbout95-5039
BUILDING PERMII-
CITY OF ZEPHYRHILLS Permit N!
(813) 788-6611
"i~503~ /!;
Date
~ -OlJ -9~-
~ ELECTRICAL PLUMBING
Pmperty owne'-&-,_ Z4: ~
Job Address: ---s ~ _ ~ _ _ _
Parcell.D. #
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T_I.F.'s:
Zoning: ~ ~ne~~~~:
Description of Work _~L-
,[J . Radon Gas:
<Ja4-
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
-qS
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
City License Registration #
State Certified License#
6-..5'-/r
Permit Fee ~ o-i)
Signature ('. . St.JJn.,J~ L.....
Company
Address
Telephone#
Valuation or
Contract Price
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BUILDING
Ftr. - J - '" rZ'?~ f 8ilL
Pre SLB
Lintel
FRM.
Insul. CL
WL
ELECTRICAL
PLUMBING
-
MECHANICAL
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.
.,.......",. ..;
APPLICATION FOR PERKIT
CI IT OF ZEPlIYRlllLLS
BUILDING DEPARTKKNT
OWNER · S ADDRESS_i~ ~v i
M 0.. 'i S mORE
lRl \ ~ uS, ,"",lOr Ltl
1ST Zf Phy",h(\\ S
BLOCK / () SUBDIVISION
.
~cLS-te"r hoc)k-1
-
f\JI
\-\~~
9yr ?:SyS
Lot \~ -5 L.- T"Z
33-><-;(
OWNER'S lWtE_KlQ.."~\6~
JOB ADDRESS
r;~4o
LEGAL DESGlUPrION: WT(S)
PARCEL 1.D.' ZfQ~~~~ \\ S
~a~~
~~y
WORK PROPOSED:_Nev Const.ruction _Addit.ion _Alt.erat.ion ---.Jlepair _Inst.all
_Sign
_Hove
_D~lish
PROPOSED USE:
Single F-.ily
-Leo.aercial
_"'F
_, of Unit.s
_H/H
_Indust.
_Sill i.. Pool
Other
_Rest.aurant 5: Health DepartJIent. Approval
BUIWING SIZE: ;Z (:) X Lf 6.
100
Square Feet..
0----
12. Height.
RESIDENTIAL:
CotIlfERCIAL :
ATI'AGH (2) PLOT PLMS 5: (2) SETS OF BUII.DING PLANS 5: (1) SET ENERGY FORMS.
A'n'AGH (3) SETS OF BUILDING PLANS 5: (1) SET ENERGY FORtIS.
PROPERrY SURVEY Rlr.QUIRlID FOR ALL NEW CONSTRUcrION.
PERKITS RROUESTED
_BUlWING
$ /,;z L?CJ o~
Valuation of Total Construction
_ELECTRICAL
.AlIP Service
Florida Pover Corp.
W.R.R.C.
_HEGIJAIIIlCAL
$
Valuation of HeChanical Installation
_PLlJfIBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCl'ION: -A-B1ock. _Fr-.e _St.eel
Other
FINISHED FLOOR ELEVATIONS:
FI' .
IS PROJEcr IN FLOOD ZONE AREA?
YES NO
...........***..*****...*..*.*..*......*.*
CONTRACIOR SECIION
BUIWER
COflPANY
State Ceet.. or Regist.. ,
City License Registration ,
.........**.**........*..*.*.........*....
Signat.ure
ELECIR.lCIAN
COKPARY
Stat.e Cert. or Regist. ,
City License Registration'
**.*.**..*.**.*******.**.*..**.*.*.*.**.**
SilUJature
PLUHBER
COHPAPiY
Stat.e Cert. or Regist. ,
City License Regist.ration ,
******.**.***.****.*.*..*.*..*.*..*.**.*..
Signat.ure
!t.ECHANICAL
COMPANY
St.at.e Cert. or Regist.. ,
Cit.y License Registration ,
.*******...*.....*..*.....**.....*...*....
Signat.ure
omF.R
."
COMPANY t.U ')
Stat.e Cert. or Regist. ,
City License Registration ,
***..*...*.*.*...**.**.*.*..........**.***
APPLICATION APPROVED BY
PERtlIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to 'deed restrictions" whieb laY be lOre restrictive than City
regulations. Ibe undersigned assUles responsibility for cOlpliance 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 O1IIler and contractor lilY be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
reguirelents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtherlOre, if the O1IIler has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections" of this application for wbieb 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 wisbes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
City of Zepbyrhills.
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 with a copy of 'Florida's Construction Lien Law - HOIeOIDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is SOIeODe other than the
lowner", I certify that I bave obtained a copy of the above described docUlellt and prOllise in good faith to deliver it to the
"owner" prior to COlleRCeleDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in tbis application is accurate and that all work will be done in cOllpliance with all
applicable laws regulating construction, loning, and land developlent.
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOlleDced prior to issuance of a perlit and that all work will be perfoIled to leet standards of all laws
regulating construction, City codes, loning regulations, and land developl8Rt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveIDIeDtal agencies laY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lust take to be in colpliance. Sucb agencies include but are not Iilited to:
. Departlent of EnviroDle8tal Regulation - Cypress B8yheads, Wetland Areas and EnviroDJeDtally Sensitive Lands,
Water/Wastewater Ireatlent
. Southwest Florida Water Hanagel8Rt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
. ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
. Departlent of Health & Rebabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater Treatlent, Septic lanks
. US EnviroDlental Protection Agency - Asbestos abateleDt
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 'cQlpeDsating volUle" will be subtitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit 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 sball issuance of a perlit prevent the Building Official frOll thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery petlit issued shall beCOle invalid
unless the work authoriled by such perlit is cOll8Dced within sil IOnths of issuance, or if work authoriled by the perlit is
suspended or abandoned for a period of sll IOntha after the tile the work is cOBenced. One 90 day utension of tile, laY be
allowed for the perlit with fee charge of $15.00. Tbe extension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during eaeb six IOnth period, or the project will be considered abandoned.
WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHHINCEMEIff MAY RESULT IN YOUR PAYING "'ICE FOR IHPROVIKIIft'S TO YOUR
PROPERTY. IF YOU IIIIDD TO OBTAIN FINAIICING, COMSULT WITH YOUR LBItDIR OR All AnORIIY BEFORE RECORDING YOUR NOIICH OF
COKMEMCIMRIff. JOBS UNDER $2,500 1M VALUE DO MOT MEED 'f0 RECORD AND POS'f A "NOTICE OF COIIMIHCIHEItI..
SIGHA'fURI: COMTRACfOR
SIGHA'fURI: OWIIIR OR AGE1ft'
STATE OF FLORIDA
COURTY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE 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 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)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name. Typed, printed or Stamped)
NOTARY PUBLIC
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T A~viPA. FLORiDA 33604
(813) 238-9755
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SILCOX ENGINEERING, INC.
5409 N_ Nebraska Avenue
TAMPA. FLORIDA 33604
(813) 238-9755
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. :~Jt-COX EN-GINEERING, INC.
Post Office Box 8574
TAMPA, FLORIDA 33674-8574
(813) 238-9755
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,...OX ENGINEERING, INC.
Post Office Box 8574
TAMPA, FLORIDA 33674-8574
(813) 238-9755
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