HomeMy WebLinkAbout95-5056
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7J
~" ~i P~ ~ Sewer Conn
~' l "f Water Conn:
P,"perty Owne" b- ..' ~~ wate: Mete"
Job Address: _ "flr-2---------==---_L._ ~ :.---. T.I.F. s.
Parcel I. D. #
BUILDl~~HY~L~RM!!N~ '~505'1J(
(813) 788-6611
1\ ,.~,
:;2S~
Date
~ - ~f:? - 9'6-
Zoning:
Description of Work
~ergy Code:
/-/,,) ,~
Radon Gas:
/ ~ /:J /('
1/
T::>
10 /11/
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
Valuation or 4 J e, 0 z-, ~H")
Contract Price II- l;- I-~
Permit Fee
Signature
Company
Address
Telephone#
City License Registration # 7f?'
State Certified License# tJ.-/J t!.(J ij37~~
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
Wl
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.
APpt,lCATION fOR PERftlT
CIlT Of" ZIl:mTRBII.LS
BUILDING PEPARJftfr.NT
.....ER.S IWI. J ~I'IN /lJ" ti/), Y heffl'd~ T.4tvdmo..
OWNER · S ADDRESS S 8 ~ 'f G' ,q / / Lf L v to
S ;"f r'h L
.JOB ADDRESS
,LEGAL DESCRIPI'101M: Wr(S)
BIAJCK
SUBDIVISIOR
PARCEL I.D.'
WRI{ PROPOSED:_lNfew c:onstruction _Addition _Alteration _Repair -K-Install
_Sign
_Move
_DeIIOHsh
PROPOSED USE:
Single Fa.i1y
_KIf"
_, of Units
_PliO
_ec-ercial
_Indust.
_Swill. Pool
~/c
Other
_Restaurant. & Health Depart~t Approval
BUILDING SIZE:
x
Square Feet..
Height
RESIDENTIAL:
(:otUtERCIAI. :
ATTACH (2) PLOI' PIJUlIS & (2) SEIS OF BUILDING PLMS & (1) SKI' ENERGY FORKS.......
ATTACH (J) SEIS OF BUILDING PLANS & (1) SEI' ENERGY FORKS.......
......COPY' OF CONTRACT' Rl!'QllI'IRllD.
PERlIIlI'S REOUESTED
_BUILDING
$
;'99$"~
Valuation o~ Total Construction
_ELEGI'RlCAL
AKP Service
Florida Power COrp.
W.R.E.C.
_"F,("'1IANlCAL
$
Valuat ion of Mechanical Installation
~PUJ.tBING
GAS
ROOFING
SPECIALTY
TYPE OF GONSTRUCTIOIM: _Block _I"r:.e _Steel
Other
FINISHED FLOOR El.IWATIOBS:
FI' .
IS PROJECT IN FLOOD ZONE AREA?
.........~..........~............~..................................................................................
YES NO
QJJIlU'RA(''TOR SEGI'IOR
BUILDER
COIfPANY
Slate Cert. or Regist. ,
City License Registration ,
..............................................................................................................................
'1
ELECIRlCIAR/, " mlPlPANY/I~ ~ t:' h-N rJ C.e "'~ .C/",L L E LEe 7' Kt'c4L..
. lJ ~ State Cerl. or Regist.. ,
Sismat.ure ;1) -u~/{ L,~~ City License Registrat.ion t -2 1/"0
........................................................................................................................
Signature
c~7.
PLUflBER
aJIIPANY
Stale Cert.. or Regist. ,
City License Registration f
................................................................................................................
Signature
ltIl:C'HARlCAL
Signature ~~ 5~
t7
WPlPMIY .6)'J /// J ~(t'J/J /'1 r/ f G /? S -e.. 11/(
State Cerl. or Regist. f <:;f coy ..5 '7 y g'
City License Regist.ration f 78'
........................................................................................................................
OIHF.R cortPARY
State Cert.. or Regist. ,
Signature City License Regist.rat.ion I
............................................................................................................................
APPJ.ICATION APPROVIJD BY PERPIlT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. t-IOT]; CE OF pEED RESTR I CT IONf3
The undersigned understands that this perlit lay be subject to "deed restrictions" which lay be eore restrictive than City
regulations. The undersigned assuees responsibility for co~plian(e Kith any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors ~~~dertake work, they .ay-be required to be licensed in accordance Kith
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor eay be
cited for a eisdeeeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireMents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart_ent, (813)
788-6611.
Further.ore, 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 "ill 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 lephyrhills.
(,'
.' .
TRANSPORTATION IMPACT FEE? AND UTI~ITY_~ONNECTION~E~
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 - Ho.eowner'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 document and prolise in good faith to deliver it to the
"owner" prior to coelencelent.
E. !;ONTRACTOR' S/mJNER' S _BEf--I.P0.Y-II.
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 pereit to do work and installation as indicated. I certify that no work or
installation has coeeenced 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 developeent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
.y responsibility to identify what actions I lust take to be in coepliance. Such agencies include but are not li.ited to:
, Depart.ent of Environ.ental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treat.ent
, Southwest Florida Water ManaQe.ent District - Wells, Cypress aayheads, Wetland Areas, Altering Watercourses
f Arty Corps of Enqineers - Seawalls, Docks, Navigable WaterMays
, Departlent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
* US Environlental Protection Aqency - AsbestDs abate.ent
I alsD certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "co.pensating volute" Mill be sub.itted which is prepared by a profes~ional engineer registered in the State of
Florida prior to per.it issuance.
A per.it issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official fro. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every per.it issued shall beco.e invalid
unless the work authorized by such perlit is co..enced within six tonths of issuance, or if work authorized by the pertit is
suspended Dr abandoned for a period of six lonths after the ti.e the work is cot.enced. One 90 day extension of ti.e, lay be
allowed for the per.it 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, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
was acknol1ledged
, 19_ by
STATE OF FLORIDA
COUNTY OF
The foregDing instrument
befDre me this
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
Iflas acknolflledged
, 19_ by
who is personally known to me Dr 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 oath.
(S i gna tLll-e)
(Signature)
(Name Typed, Printed or Stamped)
t.~QJAR'(l:.~LIC
(Name Typed, Printed Dr Stamped)
NOT ARY PUBLI C