HomeMy WebLinkAbout95-5228
BUILDING PERMII-
CITY OF ZEPHYRHILLS Permit N!
(813) 788-6611
"7-5228 13
- -.
.30. tJ1)
crulLDi"~
Pmperty Owo"" % ~ ;. 1L1*",~
Job Address: ~ -i ~ CJ '?
Parcell.D. #
;;L() _ e77J
0U~CTR~
Date
j1-(-7S
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
~
Water Meter:
T.I.F.'s:
Zoning: Energy Code:
Description of Work ~.A-d~
L---..
Radon Gas:, .~
! ..f et.-d-.d < A_ ,..,.~
",~-p~
NO OCCUPANCY BEFORE C.O.
FINAL
Complete Plans, Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
City License Registration #
State Certified License#
3;;2;;L
Permit Fee
Signature
Comp y
Add s
Tel
Valuation or
Contract Price ~/ 079 ,. tTV
9.~%~A~
~~cfJ 6/
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr,
Pre SLB
Lintel
FRM. Cf-'5'''9~ B.L1-
Insul. CL
WL q... 'S'-'1~ 13 J L..t..
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 Oollars ($15.001 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
. CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAME
~~
s~
PHONE
OWNER'S ADDRESS
.11 r0yX a~
JOB ADDRESS -3 y 70 b
LEGAL DESCRIPTION: LOT(S)
BWCK
SUBDIVISION
PARCEL I.D.' (OBTAIN FROM PROPERTY TAX NOTICE)
~..
WORK PROPOSED:_New Construction _Addition ~lteration _Repair _Install
_Sign
_Move
_De.olish
PROPOSED USE: _Single Fatily
_KIF
_' of Units _K/H
_~ercia1
_Indust.
_Swim. Pool _Other
_Restaurant & Health Deparbaent Approval
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PWT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
~BUILDING
$ -2, J c7"Z7 _ crv
.
Valuation of Total Construction
_ELEC'l'RlCAL
AKP Service
Florida Power Corp.
W.R.E.C.
_KECllAIUCAL
$
Valuation of Kechanical Installation
_PLUKBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Frate _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUTT.DER _
CONTRACTOR SECTION
COKPANY "T;c/Io t:? bL t'" d- T~ ~ r)/.t 1/
State Cert. or Regist. ,
City License Registration' '::5 :A ?
() ******************************************
~ COKPANY \J.e-~ Vl 15 --r;Z.VV'AtL..( IcA- c..
L State Cert. or Regist. #
l~ . City License Registration , {;, rJ
* **********************************
PLUKBER
COKPANY
State Cert. or Regist. ,
City License Registration t
******************************************
Signature
KECHANlCAL
COKPANY
State Cert. or Regist. ,
City License Registration ,
******************************************
Signature
OTRRR
COKPANY
State Cert. or Regist. ,
City License Registration ,
******************************************
Signature
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to Bdeed restrictions" which JaY be lOre restrictive than City
regulations. !he undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake workr they lay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by lawr both the owner and contractor JaY be
cited for a lisdeaeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireJents JaY apply for the intended work, they are advised to contact the City of Zephyrhills Building DepartJentr (813)
788-6611.
FurtherlOrer if the owner has hired a contractor or contractorsr he is advised to have the contractor(s) sign portions of the
"Contractor Sections" of this application for which they will be responsible. If your as the owner sign as the contractorr
you are indicating that your 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 Ir the applicant, bave been provided with a copy of uFlorida's Construction Lien Law - HOIeOWDer's Protection
Guide" prepared by the Florida DepartJent of Agriculture and Conslller Affairs. If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described docUJellt and prolise in good faith to deliver it to the
"owner" prior to COllenceaent.
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 or
installation has COIIeDced prior to issuance of a perlit and that all work will be perfoIJed to leet standards of all laws
regulating construction, City codes, zoning regulationsr and land developJeDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other governJental agencies JaY apply to the intended work, and that it is
IY responsibility to identify what actions I lUst take to be in cOlpliance. Such agencies include but are not lilited to:
* DepartJent of HnviroDlental Regulation - Cypress Bayheads, Wetland Areas and HnviroDJentally Sensitive Lands,
WaterfWastewater !reatlent
* Southwest Florida Water HanageJent District - Wellsr Cypress Bayheads, Wetland Areasr Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* DepartJent of Health & Rehabilitative Services, EnvironJeDtal Health Unit - Wellsr Wastewater !reatJent, Septic ranks
* US Environaental Protection Agency - Asbestos abateJent
I also certify thatr if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a uCOlpensating volUle" will be suhlitted 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 violater cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frOJ 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 perlit is cOlIBnced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IOnths after the tile the work is c~ced. One 90 day extension of tiler JaY be
allowed for the perlit with fee charge of $15.00. !he extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOnth period, or the project will be considered abandoned.
WARNING TO OlUfER: YOUR FAILURE TO RECORD A NO'l'lCE OF COMMEIICEHEII! MAY RESULT IN YOUR PAYING nICE FOR IMPROVEMBIt'S TO YOUR
PROPERTY ~ IF YOU III!EIID TO OBTAIN FINANCING, CONSULT WI'l'H YOUR LEllDER OR All A'l"l'ORREY BEFORE RECORDING YOUR NOTICi OF
COMMENCEMENT. JOBS UNDER $2r500 IN VALUE 00 NOT NEED TO RECORD AND POST A DNOTICE OF COHMENCEMD'I'".
SIGNATURE: CONTRACTOR
SIGNA'l'URE: OWNER OR AGENT
STATE OF FLORIDA
COUII'lY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUIlfY 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 oath.
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
~l!:MINOLl!: "'OAM !l1I6
PROPOSAL
Pllge No.
of
PlIges
PROPOSAL SUBMITTED TO:
PHONE,
I
I DATE:
NAMf, J .,'
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We hereby submit specifications llnd estimlltes for,
JOB NAME,
STREET ,
J STATE:
CITY:
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"" malerial is guaranleed 10 be al specified. All work 10 be complired in II work menlike mllnner according 10 slllnd.rd prllclic.h Any llllerlllion or deviaU"" v
from llbov. specificalions involving ex Ira cosls, will be execuled only upon wri"en orders, and will become en exlra cha,ge over .nd llbove Ihe eslimllle. All
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Authorized Sign.'ur.
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ACCEPT A
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The llbov. prices, specifications and conditions llre hereby llCC.p ed. You llre authorized to do the work llS specified. Payment will be made
lIS outlined abov..
ACCEPTED:
Signature
Dllte
Signature
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