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Home My WebLink About95-5249 BUILDING PERMIT: CITY OF ZEPHYRHILLS Permit 11 · (813) 788-6611 :-524Q 13 Date ?-;20-9 ~- /97'/.00 ./ BUILDING :l,--s':S- gv ELECTRICAL I i/ ;;.....5'0 PLUMBING ~'7J. iTO MECHANICAL Sewer Conn /1. ......I)~. CJ7..:; Water Conn: ..? J.5. 'tJ . OV ~opertv Own.. -1 vi 1:::;:Ji:t ~ Job Address: 3 J- _ __ - ~~ Parcel I. D. # Zoning: Description of Work Water Meter: T.I.F.'s: cJ.~ 796. trV NO OCCUPANCY BEFORE C.O. FINAL C.O. DATE Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE Inspector ~(j'-:S Permit Fee m- ~ Signature ~bJ k'/JIU/ Company - Address Telephone# Valuation or "') o:f- R1 ' Contract Price~ 6 .....: 1.17J ~ tJ7) City License Registration # --33 Y State Certified License# ~&0. tf-;5)J ~/R' )j~/S~ v.~ /lJ9 BUILDING ELECTRICAL PLUMBING MECHANICAL ~41~ q-22..~> BILL Ftr. Tp. Servo SLB mCi~4-/_ Cf.-t.'S'-'i5 ~~&....Breakers Pre SLB q...d..~-CfS &f\ Rough In~~OS/ Tub Set Ducts Insl. Lintel Meter Can Water Comp~f~~ 'J FRM. Const. Pole Sewer ,~ FinaL.~J.~0 ~.~ Insul. CL Pool Final~ _ tJ 2,. '"t _ ~ r J\ Wl Pre-Meter J -I ,. ~~~ I b , 11 ~ t:;;Y $IJB ~ -u.,~ 1"".C/A~ ...ii al ~ \ i. . 3rive ay tP~..~ II-~-q 56DB' r; Pavk.ID-$-q~ D2) \lOl2.'f'tf - -S-r ff\O \0...3 -q') BeB ,p~~~ ID..h'~A$ ~)~ I(!)-'~~ J · REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge Clf Fifteen and 00/100 Dollars ($15.001 shall be made for each trip for each trade: /J - r~~. 1(..~"1...q~ ,: L c..- /"") 1 -J- /}.. .. _ "71-: /l.. -. V f>-r:20--9-S a. Wrong Address A./~ ~A<..f/ ~r- b. Condemned work resulting from faulty construction. c. Repairs or corrections not made when inspection called. d. Work not ready for inspection when called. e. Permit not posted on job site. (;) f. Plans not at job site. ~~ JJ-~q~JI)ILL g. Work not accessible..r / l~ 2fPej 'i" b t~ , II ~ 2.&", 'f. J LI _ The payment of inspection fees shall be made before any f'urffi""'-permits will be issued to the person owning same. I;;' /~...q5 IZ~ 15~9S- /2-- "-t(-) /2 - 2l- t;? ll~ ~ 7-1) rz..2. q.. qs / - Ij ~1 <) I ,.~...q'f {-''''1 Cr: \\~~Walk..j~ILq.~ 1\~~~~ {ioh.p.-"'; fO~ /tIc- 70~ w ~~ /1Nj) ~1iW1J.~~i ?l'vfhG-ND ~ 1'~o~ p..lD- M b-Cl>r ~ ~i) {(~~'?f.,z.et~1t trLV;~~ r f IJj~I..+ri7-." ~~-~. c.~''fI<.tL futl-DtN~ ~~ ~~ f3,l,L tf. (.,L gLLL p1j~ ~L- ~~- 8L LL G'l\..L ;$tJ6 $c)~ ~LU:>IN& aac...17l. \(, )h,.~ t)\ Ptl\AN1LAl- 5vB'tO -m- L- (j{ Ii-i) II .-.- (o'iA-l- S~V~ WItLf--~ M~ 1b-rf\ L 7/tO{) 8JL - ') \ / t:...t.fV ,L.---, r'- - M'~OiLAG O~h~ ' .3.F.;L YcJ JJ~A VAL.>J,,"nt'N: 3i3; SOD 'i qq'-l. "0 d ~~(}rJ I tf1.t~O 250.uC .- 23"7\,0C ~NtU:..l1W f'~s 11,5""021- <;.0 3. t5"(). e 0 # ~i- !I-'T'17wt.(.. Df I+rlULttTtcrJ 14,lP-:)" 2,,00 ~A-~W ~ 71 ~ ~ c 1~6y{)a.:rftT7t)^, tmmu Fii:f._s ...~/o x. ~ 100 6l' f1: ~\'/IN (so ~. F-f; oTIt1iJL .. cg5 x: 2..4/i:O ~. (4. ,)~l~~ ~ -- . ' EI157#lscq -#eJ ~(~e "z'ud.i"" rol? / /1~;::Je- c!- ~ r f. -I- a b Ie 1/' ( ~l t. '. fl If . ~~Gt'N.;( ..J<=e.5 <::39tc= a l...!t:c..:.:d, . Cclk<!f 71F l' C!~/f'fel.!~/1 h~s- __ / - + r-aJOi1 ' / II=-; ,. ( I ( ~9oo SF X Z(7S9,~ ret' M- III 7. 9 X 2.( 75(1- oE. ~ 21,'19~, l~ . i ,C 7) .,,~,-;... -:,:::::.:,::-:c,._,-'". 1-.. y.. ,'" \ If-" Me.DiU\L- Dfflte- TABLE A - WORKSHEET CITY OF ZEPnYRHlI~S CONNECTION FEES ORD. #395 &: RESOLUTION #312 WATER $1.75/GALLON SEWER $6. 39 I GALLON RESIDENTIAL (Each Lot or Unit) ""'- Residence $ 350.00 $1,278.00 Travel Trailer Park 131. 25 479.25 COMMERCIAL (PER FIXTURE) Sinks 87.50 319.50 Water Closet 131. 25 479.25 Urinal 87.50 319.50 Lavatory 43.75 159.75 Tub/Shower 87.50 319.50 Washing Machines-Commercial Size 350.00 1,278.00 Washing Machines-Domestic Size 87.50 319.50 FOOD SERVICE - Dishwasher 700.00 2,556.00 Sinks (3 Compartment) 175.00 639.00 Car Wash (Per Stall) 1,000.00 6,390.00 FIXTURE G.P.D. I~ WATER SEWER TOTAL PER FIXTURE Sinks 50 2.0 1,15?..DC !R//IU};D ~JJfo. D C Water Closets 75 ~ 1.050.00 3, '0 ?J-f,,~0 4.1><64 , o~ Urinals , , 50 Lavatories 25 <8 350~c () Ll. 74J.CC I b2-~/)C Tubs/Showers 50 Washing Machine 200 Washing Machine 50 Dishwasher 400 Sinks-3 Comprt 100 Car Wash-pI st. 1,000 31/5D"C~ J L ,02.0C itJr~5LOo ~~ c.HItTt..(;~tl- AT TlWlIL' ~ (JF' A-",~4u'tt7crJ .., "'~--~.., .... , ..--....................,.. ____ ~____......~,...~..t"\' -' APPLICAnOB FOR PERMIT CITY OF ZEPIIYItIIILLS BUILDING DEPAR'l'IIBNT =::~ . L-~~ JOB ADDRESS ::D~: wr(S)~~;~~~UBD~~::ztl~ PROBE JlH/tJ~// I WORK PROPOSED:..2...Hew Coostruction ~ition ----Alteration --..JIepair ~lD8taJ.l ---"ian ----Hove --Deaolish PROPOSED USB: -5iDg1e Faai1y -Leo-ercial ----1l/F _' of Units ---.JI/B _Iodust. ---"via. Pool _O$r Restaurant & Health Departaent Approval DBSCRIPnOB OF WRK: 71~ dJf'~ ~~ X . 19~!) _e Feet. ~~ I Height BUlLDIXG SIZE: i " ATTACH (2) PLOT PLAIlS & (2) SBTS OF BUlLDIXG PLANS & (1) SET DBRGY",POlUIS. ArlACB (3) SETS OF BUILDING PLANS & (1) SBT ENERGY FOBIIS. ,. i PROPERTY SURVEY REQUIRED FOR ALL NEW COBSTRUCTI.OB; ,. ! RBSIDBI1TIAL: COMKERCIAL : PERMITS RmUESTED ...!:.JUILDING .LJucruCAL -=:JmawnCAL ~IJIG $. ;;~()/()60. - Valuation of Total Construction AIIP Service Florida Power Corp. W.R.B.C. $. S"o~ 0 Oi:J,- , Valuation of llechsnica1 I.ostallation GAS ROOFING SPBCIALTY TYPE QF COIlS'D.UC'fiOB: ~loclt ~raae _Steel Other PDISBBD PI.OOIl BLBVAnOBS: n. IS PROJBC'1' IX FLOOD ZOB ADA! ~ - YES 10 .......................................... BUTT.DRR .. . ~~~~ .. ~ Stal;e Ce - t. or Beaiat.' ~f~~?~ City License Registration , ~f., *************.***********.**************** . Signature SiDnAture COHPAIIY: /If?# &~ State Cert. or Regist. .. City License Registration' ...:2 /cP" ****************************************** " RI.RC'l'RTCT All Signature OOIIPARY State Ce -~v.( A'lftWr~ft,A,.~, COHPABY ~..; ~ _ State Cer . Signature / '''PT-L-- City License Regist tioo.' . ************************.***************** . .. ., . ; ~ ., Signature COIIPARY State Cert. or Regist. .. City License Registration " ******.*********************************** {' ;,.', nTIIRR , ',t.,' APPLICAnOB APPJIOVBD BY PBBII1T OPnCER. i ~.~- .~~" .... ~ '. ~. _ ~ r'''fI\~J,.:- . , CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS !he undersigned understands that this penit _y be subject to ldeed restricti0ll81 wbich _y be .ore restricUve than City regulatiOll8. !he undersigned ass.. responsibility. for cmpliance with aDy applicable deed restrlctiCll8. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the OlDer lias bired a contractor or contractors ~to unclertale work, they laY be .l8QlIlred to be liceased la acc:orc1aDce with state and local regulatiOll8. If the contractor is Dot licensed as reQUired by law, both the 0IIDel' and.CDIltractor MY be cited for a Iisc1eleanor violation under state law. If the 0III8J: or Intended contractor are uncertain. as to at liC8D8ing requir8lellU -y apply for the intended work, they are advised to ccmtact the City of ZepbJrbills BuilcUng OepartIent, (813) 788-6611.. . . FurtherJore, if the OIDU bas bired. a contractor or contractors, be is acJvisecl to Eve the contractor(s) sign port1au of the lContractor Secti0ll81 of this applicatim for Idtich they will be responsible. If you, as the OIDU sign as the cmtractor, you are iDtllcating that you, rather than the contractor, are responsible for the work. If the contractor liabes fOIl to sign as contractor that laY be an indication that be is Dot properly lic8D8ed anc1 is not entitled to perlitUng privilegu in the City of zepJaJrbills. . I C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTION LIEN' LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, Ilave been provided with a copy of 'Plorida's COnstructim Lien Law - lIcNoImer's,Protectim Guide' prepared by the Plorida Departlent of Agriculture and COIIBUIU Affairs. If the applicant i8 .... other than the 'OIDer', I certify that Illave obtained a copy of the above described docuIent anc1 premse in good faith to.' c1eliver it to the 1000erl prior to ~CIIIIlt. E. CONTRACTOR' S/OWNER 'S AFFIDAVIT I certify that all the infOIliltion in this applicatim is accurate and that all IIOrt lIill -be done in cmp1iance lith all applicable 1_ regulating COD8truction, loning, and land. develOlE1t. Application i8 Ilereby IIacle to obtain a perlit to do IIOrl and installation as indicated. I certifr that DO IIOlt or installation bas ~ced prior to i88uance of a perlit and that allllOIt will be perf OIled to _t ltaDdards of alllaa regulating COD8truCtion, City codes, IODing regulatiOll8, anc11and c1evelo..-nt regulatiOll8 in the juriadicUm. lalso certify that I under8tand that the regulations of other govemlllDtal agencies laY apply to the inteDl1ed 1IOl1, and that it is If responsibility to identify what actiOll8 I .l\l8t tate to be in COIpliance. Such agencies include bat are DOt lUited to: I Departlent of Invil'ODll!lltal Regulation- Cypress Baylleads, lIetland Areas andlDvil'ODll!lltally SensiUve Lands, lIater/lfaste1fater 'I'reatlent I Soutbllest Florida lIater 1laDag8I8Dt Diltrict - lIe11s, Cypress BayJaeaas, IfeUand Areas, Altering llatercourses I IrIy Corps of Ingineers - Seawalls, Docks, latigable lfatmays t DePaIf;Jlent of Health , BeIlabilitative Smices. IDvirODllllW Health Unit - Vells, lfastenter 'I'rea_t, Septic'l'aab I US Invi1'OllllBlltal Protectiml!lenCJ - I8best08 abat8lellt I also certify that, if fllllaterial is to be used in Plood ZOne 'A' or lA, etc. I, it is unc1entooc1 that. a drainage pllD - - addressing a IImp8D8aUng vol.' will be sw.ittedldtich is prepared by a professional engineer registered in the State of Plorida prior to penit issuance. . .. A ~it issued sIlall be construed to be a license to proceed with the IIOr1 anc1 not as authority to violate,caDCIl,alter, or set aside any provisiOll8 of the teclm.lcal codes, nor sIlall i88UaDC1 of a perlit prevent the Building Offielal fIlII tbereafter requiring a correcticm of errors in plans, COII8tructicm, or violaUOII8 of aDI code. Ivery ptrIit issued..1Iaa1l ~ lDvUid unless tIlellOlt authoriJed bl IUc:Il pmit is c:c.enced ,ithin IUlODthe of i88l1aDCe,. or if 1IOl1 autbor1Jed br the perlit II . 8uspended or abandoDed for a period of lillODthe after the tile the 1IOI1 is ~.' (g 90 day atensiCll of tile, ., be allOled for the perlit with fee charge of '15.00. 'I'he atenslon sIlall be requested in Kiting to the Buil4ing Official. In approved inspecticm .l\l8t be logged during each sillODth periocl, or the project will be conaic1ered u-Illloaed. . IfARIIIIG '1'0 CIfIIR: YOOR PlIWRI '1'0 BICORD I DICK OF aJIIDCIIIIIl' lilY RISOLr III fOUl PAYIIG DICK g .IIIPIIJVIIIII'I '1'0 fOUl PROPIB'I'Y. IP YOU U'I'IIID '1'0 OB'I'W PIJIIICUG, . COISUL'I' 1fI'I'B YOUB LIIIDIR OR III 1'l"l'ORlBY BIPOII RlCDlDIIG YOUI aorlCK or aJIIDCIIIIIr. JOBS _ 'Z,500 II VILUI 00 10'1' DID '1'0 RICOIID IIfD POS'I' A 'DICK OF CCJIIDCIlIIIII'. . SIGJII!UBI: OOIIR OR IGD! ~ S'I'A'I'I 0' PLORIDI coum OP The foregoing in.strtm8Jlt, lIIas acknOWledged before IDe this ,. 19_ by. S'I'A'I'I OP PLOiIDl . . coum OP The foregoing iD8tl'1m8Dt was acJmowledged before me this , 19 I)y . ):I.,~. , , ., '- who is personally mown to _ or who bas produced as identification and who did/did Dot. take an O$th. . (Signature) (Hi1118 Typed, Printed or Stuped) HOTARY PUBLIC who is personally known to .e or who has produced 8S identification and who did/did not take an oath. (Signature) (Hue Typed, Printed or Stamped) HOTARY PUBLIC . ".... _."'_".,........,..~ "._.,e ~;;..;._""':.""".,,....__.,,:'..._T ,,;.-.~ -~,..,.~....,.,........"""'......" APPLIGAITOB FOR PEB!IIT CITY OF zEPIIYRIIILLS BUlLD1I1G DEPAR1'MENT _'5 __ . ~ _'5 ADIlIIBSS ~ ~_.- -- JOB ADDRESS ::D~: un(S)~2/~;~::Jt::!::l~'7.!~~ PHOBE JlU/tJ~// WORK PROPOSED:..l!Jiew Construction ----.Addition ~teration .--.Jlepair _Install _Sign -.--Jlove ->>eaolish PROPOSED USE: ~ing1e Faaily ...Leo-ercial --.-Jt/F _' of Units --.-Jt/B _Indust. _Swia. Pool _Other .-.-.Restaurant Ii: Health Departaent Approval DBSCRIPnOll OF -: 71~ Cff~ ~~"1 BUlLD1I1G SIZE: X . 19/)t) _e Feet. 7.2 I Height RESIDEIITUL: ATTACH (2) PLOT PLANS Ii: (2) SETS OF BUILD1I1G PLARS Ii: (1) SET ERERGY FORHS. COMMERCIAL: ArlACH (3) SETS OF BUlLD1I1G PLANS Ii: (1) SET ERERGY FORHS. PROPERTY SURVEY REQUIRBD FOR ALL NEW CONSTRUCTION. PERMITS REQUESTED ~UILD1I1G $ ;:~t;/lJdO ~ - Valuation of Total Construction ,/ RT.RcrRICAL AtIP Service Florida Power Corp. W.R.E.C. ~CAL ..J:::::......PIRG $. Valuation of Kecbanica1 Installation GAS ROOFING SPECIALTY TYPE QF COIISUUCT10B: ~loclt _Fraae _Steel Other FINISHED FLOOll ELEVAfiOIlS: n. IS PROJEct 111 FLOOD ZONE AREA' )(, - YES NO **..*******......****.***.*..*.*********** Signature . ~~ ~ :e~-t.-or~ ~fJ~?.; City License Registration . '2f<1- ******************.**************.***.**** BITTlDRR COMPANY /I~& &AM State Cert. or Regist. t City License Registration . ..2 / if' *****************************.***.*.****** ~ABY ~ ~~/lILI';J ~ State Cert. Regi t. t(l~-~D ()()~..7 City License Registr tion t /fB ****************************.************. . RT.RC'l'RTCIAIiI Siana.ture PL1IMBER. Signature Signature IlECRAIiIICAL nTIIRR COKPAIIY State Cert. or Regist. . Signature City License Registration . .**************************************.** APPL'ICAfiON APPBOVED BY PEBHIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT -A. NOTICE OF DEED RESTRICTIONS !be undersigned understands that this penit lily be subject to 'deed restrictions' wbich lily be lOre restrictive than City regulations. fhe undersigned asSUleS responsibility for CCIIpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner bas bired a contractor or contractors ~ to undertake work, they lilY be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the lJ1fJ1er and. contractor iii' be cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing requirl!leDts laY apply for the intended work, they are advised to COIItact the City of Zephyrhills Building Departlent, (813) 788-6611. PurtherlOre, if the owner bas hired a contractor or contractors, be 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 wiabes you to sign as contractor that lilY be an indication that he is not properly licensed and is not entitled to penitting privileges in the City of lephyrhills. 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 'Plorida's Construction Lien Law - lkIIeoImer's Protection Guide' prepared by the Plorida Deparl:lent of Agriculture and COnsUler Affairs. If the applicant is 8OII!OI1a other than the 'owner', I certify that I have obtained a copy of the above described c10cUIent and pIlllise in good faith to deliver it to the Downer. prior to COIIeDCetent. E. CONTRACTOR' S/OWNER' S AFFIDAVIT I certify that all the infomtion in this application is accurate and that all wort will -be done in COIpliance with all applicable laws regulating construction, soning, and land develolllBnt. Application is hereby lade to obtain a perlit to do wort and installation as indicated. I certify that no work or installation bas CDIeI1ced prior to issuance of a perIIit and that all work will be perfoIJed to _t staDdards of all laws regulating construction, City codes, zoning regulations, and land develGpElt regulations in the jurisdiction. I also certify that I understand that the regulations of other goveruental agencies lilY apply to the intended work, and that it is ~ responsibility to identify what actions I at take to be in COIpliance. Such agencies include but are not luited to: t Departlent of Envirollll!Jltal Regulation - Cypress Bayheads, Wetland Areas and Envirollll!Jlta11y Sensitive Lands, Water/Vastewater 'I'reatlent t Southwest Plorida Water Hanagetent District - Wells, Cypress Bayheada, Wetland Areas, Iltering Watercourses t IrIy Corps of Engineers - Seawalls, Docb, Havigable Watenays t Departlent of Health i Rehabilitative Smices, EnvirODl8lltal Health Unit - Wells, Wastewater !reatEnt, Septic 'I'anb t US Bnvil'Ollll!lltal Protection Agency - Asbestos abatetent I also certify that, if filllilterial is to be used in Fl00d lone '1' or 'I, etc. ., it is understood that a drainage plan addressing a 'cOlp8DSating volute' will be saitted which is prepared by a professional engineer registered in the State of Florida prior to perlit issuance. I ~it 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 perlit prevent the Building Official fro. thereafter requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becme invalid unless the wort authorized by such perJit is ~ced within sillODtbs of issuance, or if wort authoriled by the perlit is suspended or abandoned for a period of sil IOI1tba after the tile the wort is COIIeDced. One 90 day eltension of tile, lilY be allowed for the perlit with fee charge of $15.00. 'I'be eltension shall be requested in writing to the Building Official. An approved inspection at be logged during each sillODth period, or the project will be considered ab8ndoDed. IWUIllfG '1'0 OWRBR: YOUR FllLURE '1'0 RECORD A HOIICE OF aIIIDCIIIDf MAY RESULt IH YOUR PAYllfG !IIICE PORDIPROVEIID'I'S '1'0 YOUR PROpmr. IF YOU II'I'IJID '1'0 OB'I'lIH PIMlHel.G, COISUL'I' WI'I'H YOUR LlllDBR OD U IftORDY BIPORB RICORDIHG YOUR IO'I'ICE OP allllDCBIID'I'. JOBS UJmBR $2,500 IH VALUE DO 10'1' IfEBD '1'0 RECOBD IHD POSt I -HOIlCE OP C(JIlDCIIIBI!'. Jl '~ -=-' ,.,J~JJM SIGlllfURB: ~OB AGD'I' , ~~ SfAfE OP PLORIDA coum OP Pasco The foregoing instrument was acknowledged before me this 26th, 19 95 by David Hauqen who is personally known to lie ~.Ile--bas ~~-------------~------------ as identification and who aid/did not an oath. ~ ( Si ature) otary Public, StiltEc' of Florida JUNE M. HUlNDON (Name Typed, ~r'ffi~~I~t.ft~8dJS)S)' NOTARY PUBLIC mm. o. 252 2 S'I'A'I'B OF FLORIDA coom OP Pasco The foregoing instrument was aCknowledged before me this 26th , 19~ by Charles D. Poole who is personally known to lie H-"'e~ pc~~------------------------- as identification and who -tHcI/did not ~~~::':~~ My cami"is.;i,lIl Exp_ Feb. 1 1 qq7 (Name Typed, Prillted f'OI' 2Stmlped) NOTARY PUBLIC - ...................... --.-............-.-~.. ~~.~_.. ~'........ APPLICAITON FOR PEBKIT CITY OP ZEPIIY1UIILLS BUILDDlG DUARTKBNT .0595 _'S_ ~ OWNER'S ADDJlBSS . ~ . . JOB ADDRESS ::D:~' wr(S);;'~ ;;;~UBDI::~ !::2('!J~~ PHONE f'H/~~/J WORK PROPOSED:..LNew Coastruction .-Jddition ~teration 'Repair _Install _Sign .---Jlove ---Peaolish PROPOSED USE: ~ing1e Feaily -1(.eo-ercial ----It/F _' of Units ----It/H _Indust. _Swia. Pool _Other . .-Jestaurant Ii: Health Departaent Approval DBSCRU'fiOB OF -. ~ Cff~ :;8~ BUlLDIRG SIZE: X . 19/}1) sq~e Peet. ~,2' Height RESIDEI1TIAL: ATTACH (2) PLOT PLANS Ii: (2) SETS OP BUlLDIRG PLANS 1& (1) SET IUlERGYPOIHS. COMMERCIAL: A'l'TACH (3) SETS OP BUILDING PLANS 1& (1) SET ENERGY FOlUIS. PROPERTY SURVEY REQUIRED FOR ALL NEW COIISTRUCTION. PERKITS REOUESTED 2JsUlLDIRG S. ;;~()/tJ(}O~ - Valuation of Total Construction ,/ RI.RcrJUCAL ...::::JmCIWIICAL ...t::....PLUKBDlG tzx:> AHP Service / Florida Power Corp. W.R.E.C. $. Valuation of Kechaoica1 Installation GAS ROOPING SPECIALTY TYPE QF aJIISTRUcnON: ~loclt _Pr&ae _Steel Other PIIII.SBBD FLOOR ELBVAUOIIS: n. IS PROJECl III FLOOD ZONE ADAT )I. - YES NO .**.......***.***......*.............*.... Signature mRTRAC1O&~ . ~ .. =~ ~. -or b8iB~. t #f~~?~ City License Registration . . '2f,! *.****.**....***.***.****.***..**.. BUTI.DRR Signature COKPANY /I.;/?4 &~ State Cert. or !legist. . City License Registration . .;l J Y .****.*********.*******.***....***** =:reeh~#:~~ City License Regi~~~ion . '/..{"6' **.*************************.*******.**.*. .. I PUDlBRR Signature ItECIIANlCAL IlTIIRR COKPAIIY S1:ate Cert. or Regist. . Signature City License Registration . ***.*********.**********.*.***********.*** APPL'lCAnOI1 APPROVED BY PBlUaT OPnCER. _.~ - , CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS 'file undersigned understands that this pentt .y be subject to 'deed restrictions' wbicll.y be .re restrictive than City regulations. !be undersigned assU188 respcmsibility for cmpliance with any applicable deed restricUCII8. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the ClImer bas hired a contractor or contractors "to undertab wort, they .y be regu1red to be UC8II8Ilt in ac:c:ordaDce with state and local regulations. If the contractor is not licenaed as rllQUirecl by law, both the 0Imer and,COIltractor ., be cited for a lisdeleanor violation under state law. If the 0WD8I or intended contractor are uncertain as to ..lIat licensiag requiretents .y apply for the intended lfOrt, they are advised to COJtact the City of ZepbJl'hills BuildiDg DepirtleDt, (813) 788-6611. ",,", ~.....,." , _. ""'" - ~;'", ,lr~'''''.'.i':'*'"' Furt.berlore, if the OlDer bas bired a contractor or contractors, be is advised to have the contractor(s) sign portiC118 of the 'Contractor Sectilll8' of this application for whicll they will be respoosible. If JOU, as the Eer Sign as the contractor, you are iDdicating that you, rather than the contractor, are responsible for the worl. If the contractor ..iabes fOU to lign as contractor that .y be an indication that be is not properly licensed and is not entitled to perlitting privileges in the City of zephyrbills. 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 'Plorida's COnstrucUon Lien Law - ......'s'Protection Guide' prepared by the Plorida Departlent of Agriculture and consUlleI' Affairs. If the applicant il ..... other than the 'owner', I certify that I have obWned a copy of the above described docuIent and prcaise in good faith to Wher it to the 'owner' prior to co.enC8llllt. E. CONTRACTOR' S/OWER' S AFFIDAVIT I certify that all the intonation in this application il accurate and that all wort ..ill -be done in CCIIpliance with all applicable 1_ regulating construction, Joning, and land, developleDt. Application is hereby lade to obtain a perlit to do worl and insWlation as indicated. I certify that no al or installation bas co.enced prior to isauance of a perlit and that alllfOrl will be perfOIJed to _t standards of alllaa regulating construction, City codes, lODiag regulations, and land develO(JMllt regulations in the jurisdiction. I. also certify that I understand that the regulations of other goveruental agencies .y apply to the intenc1ecJ at, and tllat it is IIJ responsibility to identify 1fbat actions I at tale to be in co.pliance. Sucll agencies include but are not lilited to: t DePaItlent of Invil'Ollllelltal Regulation- Cypress Baybeade, lIetland Areas and InvirODlentally Sensitive Lands, lIater/llastewater !reatlent t Southllest Plorida lIater Hanagetent District - IlelIs, Cypress Baybeac18, lIetland Areas, Altering lllatercourses t AIIY COIPS of Ingineers - Seawalls, Docb, lavigable lIaterways t DepartJent of Health' lebabilitative Services, InvirODl8J1tal Health Unit - lIe11l, lIastewater !reatlent, SepUc .!anb t US lnviI'OlllellW Protectioo Agency - Asbestos abatl!lent I also certify that, if fill .terial is to be used in Plood ZODe 'A' or 'A, etc. " it is understood that a clraiDage plan - _ addressiag a 'COIp8D8ating vo1_' ..ill be sublitted whicll is prepared by a professiODal engineer registered iD the State of Plorida prior to peIlit issuance. ' A ~it issued sball be construed to be a license to proceed ..ith the lfOrk ami not as autllority to violate, c:aDCI1alter, or set aside any provisions of the tecbnical codes, nor sball issuance of a penit prevent the Building Official fa tbereafter reguiring a correction of errorl in plans, construction, or violatiC118 of any code. bery pmlt lssuedaball .... invalid unlesl the work autllodled by 8uch peIlit is ~ced within IDlOIltbs of issuance, or if work autJlodHll b.r tile pmit 18 suspended or abandoned for a period of aU IOIltba after the tile tile ak II ~ced. ,ODe gO day atens1C1l of tile, .y be allOlfed for the perait ..ith fee charge of $15.00. 'file atenaion sball be Iel)Ue8tedin Kiting to the Building Official. An approved iD8pection _t be logged during each Iii 8th period, or the project ..ill be COII8idend abaDikIJed. IIIIUIIIG 10 (IIDR: YOOI PAILURlIO RICORD I forlCl OF aIIIIIcmr lilY 1ISUl.! II YOOR PID !IIICI POI .IJIPIIJVIIIIIIS to YOOR PROPBRrY. IF YOU UIIIID to OBDII PIIlICIIG, COISUL! IIIIB YOOR LIIDIR OIB IftOIIDY BI10RI DaBlDUG fOUl DICI OP aIIMIICIIIIR!. JOBS lJIDIR. '2,500 III VlLUI 00 IIOf IfIID to RICOID lIfD POS! A 'lIorlCl OP co.IfCIIIIn'. . . SIGIfltuBl: (IOIIR OIlG11f! ~~ srAR OP FLORIDA coum OP The foregoing instru.ent.was acknowledged before .e this , 19_ by, srlR OP FLORIDA COOllY OP The foregoing instrument was acknowledged before me this , 19 by who is personally known to lie or who has produced as identification and who did/did not take an oath. who is personally known to _ or who has produCed as identification and who did/did not take an o~th. (Signature) (Hue Typed, Printed or Stuped) HOTARY PUBLIC (Signature) (Hue Typed, Printed or Stuped) NOTARY PUBLIC JUN- }-95 .TRU 10: 31 PM E lLL/BARB BROCKEtlBROUGR FAX NO. 4[17 c:Ef3 L i r.:' 1., L. Whole Building pcrf'orllUlnce Method for coamercial Buil ding", FQ rm 400A-94 ENERGY EPFICIENCY CODE POR aUILDINU CON~T~UCTION Florida Department of CommuniL~ ^ffairs FL^/co~~94 Vft~9ion 2.1A BUILDING TYPE: _.J3usirU~BB (Orfice l_... --- CONSTRUCTION CONDI~ION: New construction DESTGW COMPLETION: _Fini6h~d Buildin~ CONDITIONED FLOOR AREA: _1900 ~AX. TONNAGJ:l: OF EQUIPMENT PER SYSTEM = -- .~, COMPLIANCE CALCVLAT10N: PROJECT NAME EPMC Medic~l Of~1co Bldg.__ ADDRESS ~41t[1t&ught;er'Y' and UI . .,. Ro&dil~ __Zephyrbills, Fl. _East Pasco Medical Center__ OWNER: AGENT: PERMITTING OFF1CB: _Zeph"y~hills CL1MATE ZONE: PERl'fJ.T NO; JURISDICTION .-\ =N7~~'198 NO~_611600 NUMBER OF ZONES: t lofl!mlOD A -----~------~---- A. w.KOLE BUILDING PRESCRIPTIVE REQUIREMENTS: LIGHTING LIGSTING CONTROL REQUIKE~ENTS HVAC EQUIPMENT COOLINC EQUIPMEN~ 1. ~ER IPLV HEATI~G EQUIPMENT 1. COP AIR V!$TRISUTION SYST~INSULATIOH 1. Ventilated WAT~R HEATING EQUIPMENT 1. EF PIPING INSULATIOH REQUIREMENTS 1. Circulating 8 DESIGN CRITERIA RESULT 58.84 lOO.oa 1'ASSES PA.SSES 10.50 9.90 PASSES 10.UO 8.30 PASSES 3.50 3.00 PASSES LBVEL 6.20 6.00 PASSES 0.85 0.82 PASSES 1.00 0.74 PASSES COMPLIANCE CERTIFICATION; ------------------------------------------------~---~-------~,_.~~------------ I bereby certify that th~ plans and specific.tions covered by this calcu- la~ign are in co.p1iance with the Florida Ene~gT Eff~.O.Y C d~e L PREPARED BY: '" ~~ --- DATE: ~. I hereby certif7 tb~t this building is in cQmpli<<nc~ wi~h the Florjd~ En@rgr Efficiency Code. OwNER I AGEN'l: DATE: Review of the plans ~nd 8pecifics- tiona covered by this calculation indicates compli3n~e with the Florida Energy Erficienc~ Code. Before con$truction is co.ple~ed. this buildinl will be in.pected for oQlIlPliance in accor &nee with section 553.908, F i S~atut6 8UILDING l1JllClAL 'DATE: - -