HomeMy WebLinkAbout95-5161
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BUILDING PERMIT -
CITY OF ZEPHYRHILLS Permit N!
(813) 788-6611
.
;-5161~
Date,
q-/-f~-
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel I. D. #
Zoning:
Description of Work
l' :m~1~~~A r9.f.
Water Meter:
T.I.F.'s:
City License Registration # / ~ ><? :;....
State Certified License#
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans. Specifications and Fee Must Ac
All work shall be performed in accordance with I Y
c.o.
DATE
Inspector
Valuation or
Contract Price
ignature
Company
Address
Telephone#
PLU
-M~CI"'IAr~ICAL
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
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.
APPLICATION FOR PERMIT
CITY OF ZEPllYRBILIS
BUILDING DEPARTKENT
,~/~ . .J '
V/ly,)J~, ..~~~
/\rr 0
780-9622
OWNER'S ADDItESS
y II C A
37129 Geiger aoad, Zepbyrbills
37129 Geiger aoad, Zepbyrbills
PHONE
OWNER'S NAHK
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S) BLOCIt..--SUBDIVISION Zepbyrbills
PARCEL LD.' SECT. 3, TS 26S, aange 21 E_ (OBTAIN PaOlI PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction ~ddition --fl.lteration ~epair _Install
XXsign
--1fove
_Deaolish
PROPOSED USE: _Single F_ily
--1t/F _' of Units _K/H
_ec-ercial
_Indust. _Swia. Pool _Other
~estaur8Dt Ii: Health Departaent Approval
install channel letter vall sign
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS Ii: (2) SETS OF BUILDING PLANS Ii: (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS Ii: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
~UILDING
_ELECTRICAL
~awnCAL
$
Valuation of Total Construction
A!IP Service
Florida Power Corp.
W.R.E.C.
$
valuation of tlecbanical Installation
_PLUMBING
GAS
ROOFING
xx
SPECIALTY
TYPE OF CONSTRUcnON: _Block _Fraae _Steel
Other
FIllISBED FLOOR ELEVAfiOIlS:
Fr.
IS PROJEC'l IN FLOOD ZONE AREA?
YES NO
........**********.***********************
CORTRACTOR SECTION
O>>WARY J&J SIGIIS
State Cert. or Regist. 'cn~~71
City License Registration' ~,
******************************************
v
PC ,U t1/1 11/1 R &' ~~~ert. or Regist. "
City License Registration .
******************************************
COMPARY
State Cert. or Regist. .
City License Registration .
******************************************
PLUMBER
Signature
COMPANY
State Cert~ or Regist. .
City License Registration .
******************************************
IlECBARIGAL
Signature
COMPANY .
State Cert. or Regist. .
City License Registration .
******************************************
nTIIRR
Signature
,'> I
APPLICAfiON 'APPROVED "y
PEBKIT OFFICER.
, CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
fbe undersigned understands that this perin tay be subject to Ideed restrictions" wbieb tay be lOre restrictive than crty
regulations. !be undersigned assUJeS responsibility for COIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake wort, they tay be required to be licensed in accordance with
state and local regulations. If the contractor ia not licensed as required by law, both t4e 0IIJlItt' and contractor JaY be
cited for a .isdeJeanor violation under state law. If the owner or intended contractor are unce~tain as to what licensing
requiretents tay apply for the intended work, they are advised to contact the City of Zephyrltills Building Departlent, (813)
788-6611.
Furthel'lOre, if the owner bas bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
IContractor Sections I of this application for whieb they will ~ resppn$ible. If JOU, as the owner s~gnas 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 Jay be an indication that he is not properly licensed and is not entitled to perlitting 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, have been provided with a copy of IFlorida's Construction Lien Law - lfoIeowner's Protection
Guide" prepared by the Florida Departlent of AgriCUlture and ConsWler Affairs. If the applicant is SOI8One other than the
lowner", I certify that I have obtained a copy of the above described dOCUleDt and pro.ise in good faith to deliver it to the
"owner" prior to COlleDCetent.
E. CONTRACTOR' SlOWER'S AFFIDAVIT , "
I certify that all the inforaation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, loning, and land develor-ent.
Application is hereby tade to obtain a perlit to do work and installation as indicated. I certify that no wort or
installation has co.Ienced prior to iSsuance of a perlit and that all wort will be perfoI'led to leet 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 governtental agencies JaY apply to the intended work, and that it is
I' responsibility to identify what actions I lust take to be in COIpliance. Sueb agencies include but are not lilited to:
I Departlent of EnvirOlllelltal Regulation - Cypress Baybeads, Wetland Areas and Envirolllentally Sensitive Lands,
Water/Wastewater freatlent
I Southwest Florida Nater Hanagetent District - NeIls, Cypress Bayheads, Netland Areas, Altering Watercourses
t AI'IJ Corps of Engineers - Seawalls, Docks, Kavigable Waterways
I Departlent of Health i Rehabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater freatlent, Septic fants,
I US Envi1'Olllll!lltal Protection Agency - Asbestos abatl!llent .
I also certify that, if fill Jaterial is to be used in Flood Zone "AI or "A, etc. ", it is understood that a drainage pla\t
addressing a ICOlpeJ1Sating VOlUleR will be sublitted whieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A pertit issued shall be construed to be a license to proceed with the wort 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 perlit issued shall beCOle invalid
unless the work authoriled by sueb perlit is COIIllnced ldthin sillOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of sillOnths after the tile the wort is co.enced. One 90 day extension of tile, tay be
allowed for the pertit with fee ebarge of $15.00. the extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during eaeb sillODth period, or the project will be considered abandoned.
NARHIKG 'fO 0WlfER: YOUR FAILURE fO RECORD A KorICE OF aJDIEXCBIIEIIf HAY RESULI IH YOUR PAYIHG TWICE FOR IMPROVEHmS 10 YOUR
PROPERlY. IF YOU llIfBXD 'fO OBTAIK FlIfAXCIIfG, COISULf ,IUm YOUR LlllDIR OR All AnORDY BEFORE RBCORDIXG YOUR HO'fICE OF
COMHIKCEHEIIf. JOBS UXDIR $2,500 1M VALUE 00 KO'f ffIID 10 RECORD AJID POSI A II CI OF COOlDCEHDI'.
~JI~wUJ..
SIGJfAfURB: .. R OR AGIIIf
SIAfE OF FLORIDA AJ SrATE OF FLORIDh
coum OF lL. A S cO coum OF (l!8:S.lQ
The foregOing instrument was acknowledged The forego~n9 inst~ent was ackn~edged
before me this 71 J7J , 19+rby before me th~s Z/-!b , 19~ by ,
~ ~ t.~V "14 ~~ l J Gf, (). ;;t';~"c.K
who is rrsonallv known to me or who has who is personally known to me or who has
produce produce~
as identificat, ion and who did/did not as identific,atioD and who ~~i~ n~
take an oa(;:y~1F-,j:{Lp ta~ an~4-,i' ~
(Signature)~: '- /"). \ ~ _11 (S~gnature ~ L _ A f"\ , '\ r _ 11
~ "CcQo~ ~. ~",Q"Ml~ ~~R..MV. '-.I\"w.~
(Name Typed, Printed or Stamped) (Name Typed, Printed or Stamped)
NOTARY PUBLIC NOTARY PUBLIC
,,"~':i.~:rt.~~:., ~HARnl\l L. CRAV.'FORD
,l;-A' ';0\ MY ""'''' ~ "':Slt':r" ii ,-.' 29""'.'11
.. . -It'"' '-"H...i.... 'oJ" YV e. .
~~~. Ji EXPI~S: JIl"~ 7. 1991
"::\;"'-~~' !ondH Thru NolIIy Pu:-.lic UndIrw:lIl',.
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