HomeMy WebLinkAbout95-5297
BUILDING PERMit.
CITY OF ZEPHYRHILLS Permit ]I!
(813) 788-6611
!~5297 i1
Date /tJ -I / - 7 ~-
~;'N~
g~
Property Owner: . .
Job Address: h9 ~<1 . ~ r~
Parcell.D. # ~ ,.:J..6.-;)/ - / b 0 - t?J 0 0 () 0-
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
() $/S 0
Zoning:
Description of Work
~ Energy Code:
A PV' A1. _ AA 'J-.d L 1/4
idon Gas:
d}. /"J-
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
City License Registration #
State Certified License#
/'/63
Permit Fee
Signature
Company
Address
f}~
(
\..
Valuation or
Contract Price
9;;z.o. 0-0
Tel~phone#
8~~-04('~
~ .CZ1 ~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr. L t-- Tp. Servo
Pre SLB -r 1/ ) (>( Rough In
Lintel ",... Meter Can
FRM. J ~ "]..-4 :) Const. Pole
Insul. CL {' 4.~Pool
WL I _ 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 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 ZEPHYRHILLS
BUILDING DEPARTMENT
=:::~6C~l p!::-
JOB ADDRESS ro (f4 ~~ ~ ~
LEGAL DESCRIPTION: LOT(S)
BLOCK
PHONE
~
! A-A.-I D/J.
I~~~
~
~9/~73~?
CJt;(~
SUBDIVISION
PARCEL 1. D.'
3-2-G:,-21
(:) 1 c.. 0 - e- t!J 430 (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition --Alteration _Repair _Install
_Sign
_Move
_Deaolish
PROPOSED USE: _Single Faaily
_M/F
_, of Units _M/H
_~ercial
_Indust.
_Swia. Pool ___Other
Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: ~ WA-t( 5
CJlL Ll
,
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL :
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
_BUILDING
$
tf 62& jJ2-
PERMITS REOUESTED
Valuation of Total Construction
Florida Power Corp.
W.R.E.C.
_ELECTRICAL
AMP Service
_MECllAlUCAL
$
,
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FIRISBED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
CORTIlA=~~;:M.;e~ AIL/MfA/v ~
State Cert. or Regist. ,
City License Registration' ~ /4to 3
******************************************
ELECTRICIAN
COMPANY
State Cert. or Regist. f
City License Registration ,
******************************************
SionAture
PLUMBER
Signature
COMPANY
State Cert. or Regist. .
City License Registration f
******************************************
MECHANICAL
Signature
COMPANY
State Cert. or Regist. f
City License Registration ,
******************************************
OTHF.R
Signature
COMPANY
State Cert. or Regist. f
City License Registration ,
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
rhe undersigned understands that this peClit laY be subject to "deed restrictions" which lay be lOre restrictive than City
regulations. rhe undersigned assUles responsibility for COIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
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
requireleDts lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
FurtherlOre, 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 will be responsible. If fOu, 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 peIlitting 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 I, the applicant, have been provided with a copy of .Florida's Construction Lien Law - HOIeowner'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 docUJent and prOlise in good faith to deliver it to the
"owner" prior to co..encl!lellt.
E. CONTRACTOR'S/OWNER'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, zoning, and land developlent.
Application is hereby lade to obtain a peClit to do work and installation as indicated. I certify that no work or
installation has cOlleDCed prior to issuance of a peClit and that all work will be perf oIled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other governJeDtal agencies laY apply to the intended wort, and that it is
IY responsibility to identify what actions I lUst take to be in cOlpliance. Such agencies include but are not Ulited to:
t Departlent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDleDtally Sensitive Lands,
Water/Wastewater rreatlent
t Southwest Florida Water Managl!lellt District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Kavigable Waterways
t Departlent of Health & Rebabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater rreatlent, Septic tanks
t US EnviroDleDtal Protection Agency - Asbestos abatl!lellt
I also certify that, if fill lateria1 is to be used in Flood Zone "A. or "A,etc.", it is understood that a drainage plan
addressing a uCQlpensating VOIUleI' will be sublitted 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 violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a peClit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every peClit issued sball beCOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the peClit is
suspended or abandoned for a period of six IOnths after the tae the work is cOllenced. One 90 day extension of tile, laY be
allowed for the peClit with fee charge of $15.00. rhe extension shall be requested in writing to the Building Official. An
approved inspection be logged during each six IOnth period, or the project will be considered abandoned.
WARNING '1'0 OWH . YOUR ILURB '1'0 RECORD A KorlCE OF COMMBKCEIlBlft' MAY RESut YO PAYING rvlCE FOR IMPROVEIIEIft'S '1'0 YOUR
PROPER'l'Y.. IF au I '1'0 OBtAIK FIWCING, COKSULt IfIrH YOUR LEJfD A BEFORE RECORDIKG YOUR 1f0000ICE OF
COMMEKCEMEKr. JO R $2,500 IH VALUE DO Kor NEED TO RECORD AIfD UK I OF COMMEIfCEMEIft'".
STATE OF FLORIDA
COlOO'Y OF
The foregoing instrument was aCknowledged
before me this , 19____ by
srArE OF FLORIDA
COUH'l'Y OF
The foregoing instrument was acknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an Oath.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
ALUM- TEK
Aluminum Co.
PROPO
9635 Gray Fox Lane
Port Richey, FL 34668
1-813-845-0465
LICENSED
BONDED
INSURED
Sheet No.
Order No.
Date
STREET
;'
'24
'06 u./k/J
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We hereby submit specifications and estimates for:
<e~.~V') /lffl
~~
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L/"
'2
Scree rJ tllftr(s CJ/\jly
~o{J I .dAb.
qs-/
. T./Q
EXIs' i A/ I
I '/)00/2
_/fl~-14
Cll+l2l~OAI ~che~
~~ 'rop09~ hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
dollars ($ 9070 0 c) )
Payment to be made as follows:
!\rreptanre of Jropoeal -
The above prices, specifications and conditions are satisfactory and are hereby ac-
cepted. You are authorized to do the work as specified. Payment will be made as
outlined above. After 90 days 8 (15) Fifteen Dollar service charge, plus materials
will be charged for service work.
Any alterations or deviation from above specifications involving extra costs will be
executed only upon written orders and will become an extra charge over and above
the estimate All agreements contingent upon strikes, aCCIdents or delays beyond
our control ! ;1,_ ll- C~~
I {/ l' /(,
Date of Acceptance " /1 l
I:"" AO<t"!;t ~;I;'
Authorized
Signature
Note: This proposal may be
withdrawn by us if not accepted within
days.
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REVISION
JOB NO DESCRIPTlON rB PC
LfGfW. DATE
loR. - lROW ~
T.'. - lION PIPE
c.~. - COf,iCRfTf J,l()~ 8.8 .~s
FWO. - FOUWO'
UFo - REHWKf ls.2$.lJS
1'. - PER PLAT
fl. - PEIl OHOImC#4
~. - WfASu~EfI OATA
C. - CALCULATU) OATA
ELEV. - ELEVATTON
l.(IVll : HATIOI/AL GfOOfTIC
VfUICAL CATUU
8.~. - !ASE FLOOP ELEVATION \
- $ET /.~./CAft'/z:t"bl
" "
LA'IOV{ - zS4- 7$
r()vNPArWJ z,tG 5...,
I
,
" "
SEe ?/ TWP ~~ S RGE 2!.( E
T>ouN r?A ~'1- :StJ f'?V'eLf
J (flAt)
T?ESUlpnOJJ : ~~
L.O, 43 Of 5Teptl€.N'S GU3./'J Ar SILVa? OAK->/p/Ms~ rw~r'
A~ f(ec,ORfJef? /AI 1''-4/ 800g 3), pAbeS /$0-/5/, ~
or 7116" flJ8t,1C- ~e:.co~oS Of pAsco cOl.llrry, Fi-O~ I&lA.'
S)
)/OT6S:
)
/. PNPC/Z.G..e~I//Vt? /MfROV€tYJcNrs, ~ ANq. /(<J( M&ASUI!€P.
~, cl..-c.v4 TIO/VS eASe!) oN .4~Sf/I17€O f?A/iJtt'l/ ,F~f/NP4r/ON r(,.Oo!l:..
E~VA 7/o~ IS /,8' 4ptJve- rHG' ce).J~t,/N€ Of )toAl?
CGXTlF/{;{) Tl):
5UNe.A NIL ~ TRtJ5T COMpAN~_
"to TITt..f::,INL-,
AMe:RlcA,V P/ONEE::.1l- T/.I.-€ /NSIJR.ANUE COMpANl.{
MAr<.6U1Z~IT~ ANN 6AR.!JN'G.R-
.... .....t
ClR1U1CAnOM:
nus IS TO CERTlfY THAT A SUIM.'Y Of THE ABOVf;
DESCRlBlD PROPERTY IAS WADE UMDtR 1ft SUPERVISION
AND THAT THE SKETtH HEREOK IS A TRUE AND ACCURATE
REPR~OOAnOK THEREOf AND THAT SAID SURVEY WEm
THE WIKIWUW TECHNICAL STANDARDS AS SET roRTH BY TIlE
tLORlDA OOARD Of PRO~10I(AL LAI(D SURVEYORS II(
CHAPTER 61C17-6 Of nlE tLORlDA ADWINISTRATIVE CODE.
PURSUANT TO SECTION 472.027. tLORlDA STATUTES.
~ d 7h,f~t1
JOHN H. HER
PROfESSIONAL LAND SURVEYOR NO. 2696
Johnny H. Flelcher
fLORIDA REGISfER[O UNO SURVEYOR
P.O. BOX 2165
LUrz, fl.ORIDA 33519 - 2165
PIION~ (813) 919-2201
f,AV \/"-1...4 6€. "BvrLPe'~' INc....
DATE 8.8.~$ DHAWN ~6fJ
SCALE /'{z,o' JOll g '1t;- ~1 f-
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