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BUilDING
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit II!
(813) 788-6611
~-5264 ~
Date
?-oZf-rI'
d.2 0 . c:nJ
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
P",pertyOwne, 0 L>~rp~o/')f'1. (ju~ ~fku~)
Job Address: 6 fQ ___ ~
Parcel 1.0. #
Zoning: R E!,ergy ~ ' Ra*n Gas: ' It 0
Description of Work _AL1;-..(? _ _~AH/YL~
Water Meter:
T.I.F.'s:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
,;z2 - 'is
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
:;::;:~(~
Company
Address
Telephone#
Valuation or
Contract Price ~ I d IJ # tTV
City license Registration # / y ~ 7
State Certified license#
~AA1 ~.
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ELECTRICAL /.!:.'-I'I PLUMBING
BUilDING
Ftr. /O-12-~5 6cv
Pre SLB ID ./ L - Ii 5 l3iL"'''-
lintell)...../(Y.'i J 6tlL-
FRM. /0 ~ 3 ~(( ') !bl.'-'L-
..
Insul. Cl
WL
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
Driveway
Tp.Serv.
Rough In /o'~'3 'li S ~J?
Meter Can
Const. Pole
Pool
Pre-Meter
FJ!!al
.-r~l.....
UNll({.~J;JU
iL i. (.
SlB
Tub Set
Water
Sewer
Final
IO~J...l-tj":;
Ui3
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.
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APPLICATJON FOR PERMIT
CITY O~ ZEPlfiRHILLS
BUILDING DEPARTMENT
-?R(rt4/5 ';,tj-4.;-
OWNER'S NAME CC\5 ~ e ~ -S Co I
OWNER'S ADDRESS (,f CJ a ~ W.
JQB ADDRESS (/) 0 Lt ~ ~ ) \
PHONlBL~) 68 7-~d-3 (
~) c,ss c" ~ I: -N>. ~.~ ?,3 h a (
~Iv~ 2fC~~\/rk)1 ts FL 33sLt/
B~SUBDIVISION
LEGAL DESCRIPTION: LOT(S)
PARCEL 1. D. t
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction LJddition ----..Alteration _Repair _Install
_Sign
--1fove
_Deaolish
PROPOSED USE: _Single Faaily
.:A.-~ercial
--.Jt/F _' of Units _M/H
_Indust. _Swia. Pool _Other
DESCRIPTION OF WORK:
____estaurant &: Health Departaent Approval
Dnv( \\'r: :C..J..\"~
~' II
Square Feet, ~ H~ight
~~ },) ~ ~
x~.
BUILDING SIZE: \ a
RESIDENTIAL: ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS' &: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
_BUILDING
. ~f:Dl
$-/4, OoC} .~..
PERMITS REOUESTED
Valuation of Total Construction
_ELECTRICAL
MIP Service
Florida Power Corp.
W.R.E.C.
-'lEClWiICAL
$
Valuation of Mechanical Installation
_PLUKBIlIG
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUGTION: _Block _Fraae _Steel Other
FIllISBED FLOOR ELEVAnONS: (). 0 FT. IS PROJECT IN FLOOD ZONE AREA?
YES NO
..........................................
CONTRACTOR SECTION
RIITT.DER.
Signature Q l cJ,6.."&
COMPANY CA () Y 5
---=-- ,State Cert. or Regist. t
, ()W}h.'.C\"'- \ l' City License Registration t
..........................................
~~u4 /J ~COMPANY .
~~ aZti2il. 4S.tate Gert. or Regist.
tS...eL--. ff . U.0city License Registration'
.................*.......................
RT.RCTRICIAII
SiImAture,/
PLUKBER. COMPANY
State Cert. or Regist. t
Signature City License Registration t
..........................................
KECIIAKlCAL COMPANY
State Cert. or Regist. .
Signature City License Registration ,
..........................................
OTRRR COMPANY
State Cert. or Regist. .
Signature City License Registration t
..........................................
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS _
The undersigned understands that this penit laY be subject to "deed restrictions" wbich laY be lOre restrictive than City
regulations. !be undersigned asSUles 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 work, they lay be required to be licensed in accordance .ith
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor laY be
cited for a lisdl!leanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireJents laY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
. 788-6611.
Furtheaore, if the owner bas bired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections' of this application for .bich 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 wisbes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to perJitting 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, bave been provided with a copy of 'Florida's Construction Lien La. - HOIeOIDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUJer Affairs. If the applicant is SOJH!One other than the
"owner", I certify that I bave obtained a copy of the above described docUJent and p~ise in good faith to deliver it to the
"otmer" prior to COIIIIeDCeJellt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforJation in this application is accurate and that all work will be done in cOIpliance with all
applicable laws regulating construction, loning, and land developllent.
Application is bereby lade to obtain a peIlit to do work and installation as indicated. I certify that no work or
installation bas ~ced prior to issuance of a perlit and that all work will be perforled to lI!et standards of all laws
regulating construction, City codes, loning regulations, and land developlellt regulations in the jurisdiction. I also
certify that I understand that the regulations of other governJental agenCies laY apply to the intended work, and that it is
If responsibility to identify wbat actions I lUst take to be in colpliance. Such agencies include but are not lilited to:
* Departlent of Envirollll!l1tal Regulation - Cypress B8yheads, Wetland Areas and Envirolllelltally Sensitive Lands,
Water/Wastewater !reatlent
* Southwest Florida Water HanageJellt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t AIIY Corps of Engineers - Seawalls, Docks, lavigable Waterways
t Departlent of Health i Rebabilitative Services, EnvirOJlleDtal Health Unit - Wells, Wastewater !reatlent, Septic rants
t US EnvirOJlleDtal Protection Agency - Asbestos abateJellt
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 "co.pensating volDle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to peIlit issuance.
A perJit 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 shall issuance of a peIlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becoIe invalid
unless the work authoriled by such peIlit is COIIllJlced within s1llOnths of issuance, or if work authoriled by the peIlit is
suspended or abandoned for a period of sillOnths after the tille the work is co.enced. One 90 day utension of tille, laY be
allowed for the penit .itb fee charge of $15.00. The utension shall be requested in .riting to the Building Official. An
approved inspection nst be logged during each sillOnth period, or the project .ill be considered abandoned.
WARlIIG to omR: YOUR FAILURE 10 RECORD A IOIICE OF aJlHDCBIIItII MAY RESULI II YOUR PAYIIG IIlICE FOR IHPROVEHmS 10 YOUR
PROPERlY. IF YOU IIUIiD to OBlADf FIJlANCIIG, CONSULI WIm YOUR LBIIDER OR 1JI AnomY BEFORE RBCORDIIG YOUR IfO'fICE OF
COMHEICEHD'l. JOBS UlDER '2,500 II VALUE 00 101 mD to RECORD AID POSI A 'IOIICE OF C(JfIIIICEHm".
SIGIIA!URI: CIfIIlI OR AGm
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SIGIA'IURE: CORIRAC1OR 7
SIAlE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
SIAIE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
AUG-15-B5 17,23 FROM<CASPBRS COMPANY
10,813 28B 7850
PAGE
1/5
Fax
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Caspers Company
4908 W. Nassau St.
(813) 287-2231
FAX #(813) 289-7850
TO:
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DATE:
(~i (:~-5 ye r S
# OF PAGES; 5
(includes cover page)
FROM:
MESSAGE:
CONFIDENTIALITY NOTICE
The .:.nformi't:ion cont~i.t2~d in this =$.csimile 1l2essao-e i-s Lr..tended
on...'-1-' fOJr the us~ off tlH! individt:al or e::tit:y to whic.'2 it is
ad~r~$$~~, Qnd may conc~in inE~~macio:: rhat is legally
privileCfed, CO_'"lfidenti.$.1., and exempt from disclosure under
aop~~cable law_ If the reader -~ ~his m~ssage is not the
i~t9nded rec~~ient, or tbe empl~~ee or agent r~sponsible for
deliverinc th4 message to the i~t~~ded recipient, you are hereby
no"tified "9;hat ~nv disclosure, phot:.ccopyinc;, di.stribution, or the
taking of anv ~ction in reliance on -~he contents of this
fa<?simile is t::nautb.,orized and p.=obibit,ed. _.IE IOU ha........e received
th~s transactlon ~n errOr, p~eaSe zmmec~at~ y no~zfv us by
celepho~~ so th~C we C~n arr~nge for the return of che racsimil~
" .- -- -.....-- -- ............ TJ-..."'..... 'r'ny:'.
AUG-L5-85 17.23 FROM'GASPERS COMPANY
10,813 28S 7850
PAGE 2/5
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IJtaAL DISCan:.a.B. LOT(S) 1l1'lV!I{ S1JBD:IV1S10R
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PARCEL :I..D.'
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10,813 289 7850
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APPLI~ A-:-~ n
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AUG-15-85 17,25 FROM,CASPERS COMPANY
10,813 288 7850
PAGE 5/~
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COlWI'l"lCllrS OF PERlUT AFF.lnAVlT
A. ltO'I'ICB OF JJIliII) RBftRlenOlfB
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CAROLS~LER:
NOTARY PUBUC STATE OF FlOR!D.'>.!
COMMISSION NO. ~
MY COMMISlSIO... EXP_ ~.AY 2O.1m 1
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AUG-15-55 17,25 FROM,CASPERS COMPANY
10,813 285 7850
PAGE 5/5
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1Qft- PUBratC
y SEAL
CAROL S HEeLER
NOTARY PUBUC ~~n: .2.F f"l..OR!DAi
CO~lSSION NO. .~...~ I
MYCOMMl5SK>N EXP. ~.AY20,lm 1
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ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name ./ /.
, /~{ ~].'
Classification
Address <.i ,,'/./.::.
./ "
(.-:,). " ,/..
Owner/Manager
lJ~, /:.,'/t..., ,h'
.
/',/.; ../.> c.
Business Phone
'~,~:.~;~ .<- '.;/
Emergency Contact Phone
.', :iJ /..)#- -. , ;'>,.~ .
,# ~.-,
Occupancy Load
Alann Monitoring Co.
Phone #
TYPE OF INSPECTION CONDUCTED
o QUARTERLY
ORE-INSPECTION
0' APPROVED
ill FINAL 0 ANNUAL
o OTHER
o NOT APPROVED
OBI-ANNUAL
/
,
o COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
o CODE VIOLATIONS
This inspection report specifies code violation(s) which if not corrected could cause a fire, contribute to the
spread of fire, or prevent safe egress during a fire. Your immediate attention to the correction of these
violations shall be required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
r /7/
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/
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I
Inspect. Date
Inspect. Time
/
Fire Dept.ID #
Re-Inspect. Date . . Inspectors Name
...' . i \ r
OwnerlManager Signatur&; .'.A.. ,2t)(\ \:\ 0",_ "- :~~~ C(S,C ~'.__'
,..
../'--.
Trtle
1\....'\ .' (- r. .':'
., ,A 0/\ ';'.> (,(
This building has been checked by the Zephyrhills Fire Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Uniform Fire Safety rules and other local fire safety codes.
While Copy >> File Yellow Copy >> Bid. Depl. Pink Copy >> Business