HomeMy WebLinkAbout95-5323
BUILDING PERMIT =-
CITY OF ZEPHYRHILLS permitN.
(813) 788.6611
~~532311'
Date
ItJ -c2 y- YS-
8 ELECTRICAL. PLUMBING MECHANICAL
PmpertyOwne, Jld~~ ~
Job Address: hS- 0 () t c1
Parcel 1.0. # ~~.;l.6 - f2/ - (;/ D.3 0 ~ a D/ I)D - 0/ LJ tJ
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning: Energy Code: Radon Gas:
Description of Work /~ Y l,b ttI ~ At,( (lA.-"\ A ...b7..'Yr>
-- -
FINAL / /- z. - J
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
City License Registration #
State Certified License#
t:;'1)
.
p~~~
Signat~~ ~', '
Company
Address
Telephone#
Valuation or ">
Contract Price 1 h ,/~. - 0-0
-~~~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
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 ($15.001 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 PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAME
c(J1t t/ ( () U / UJVG
~S-OO blZeiC/Twoa I)
9/ltb
PHONE
7~~
6) ;?()
OWNER'S ADDRESS
~e
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION 5 ('-iI €I!. 8~"3
(J/OO
PARCEL 1. D. t
re>
00
WORK PROPOSED:_New Construction
--^iteration _Repair _Install
_Sign
_Move
_DeJIOlish
PROPOSED USE: _Single Faaily
--.Jt/F
_, of Units _M/H
_eo..ercial
_Indust.
_Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant Ii Health Departaent Approval
SC~ ~11
c:-r ()
()-x Ie.. .
~ /J 5 n9-u:....
(;;t'f-(b
~ ("OftPi5'~TI:
/4trJt=
BUILDING SIZE:
Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS Ii (2) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
(e:, Iff 'ct
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
CONTRACTOR SECTION
COMPANY S ()/J 5TJH E!-
State Cert. or Regist. t
City License Registration t
******************************************
/l-{"ulf / /f})1f ;Z;; C-/
T.::r vv
.
Signature
RT.RCTRIClAN COMPANY
State Cert. or Regist. t
SionAture City License Registration t
******************************************
PLUMBER COMPANY
State Cert. or Regist. ,
Signature City License Registration .
******************************************
MECHANICAL COMPANY
State Cert. or Regist. .
Signature City License Registration t
******************************************
OTHRR COMPANY
State Cert. or Regist. t
Signature City License Registration ,
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this perlit laY be subject to Ideed restrictionsR 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 has bired 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 lilY be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtheIlOre, if the owner bas bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
"Contractor SectionsN of this application for wbich they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, ratber 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 pertitting 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 IFlorida's Construction Lien Law - HDIeOWDer's Protection
GuideR prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the
Rowner", I certify that I have obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the
"owner" prior to cOllencetent.
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 cDlpliance with all
applicable laws regulating construction, zoning, and land developleDt.
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a peIlit and that all work will be perforted to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governtental agencies laY 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:
* Departlent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water Hanagetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Havigable Waterways
t Departlent of Health & Rehabilitative Services, EnvirOOleDtal Health Unit - Wells, Wastewater treatJent, Septic ranks
* US EnviroDlental Protection Agency - Asbestos abatetent
I also certify that, if fill laterial is to be used in Flood ZOne NAI or "A,etc.", it is understood that a drainage plan
addressing a "c~sating voluteR will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A peIlit issued shall be construed to be a license to proceed with tbe 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 pertit issued shall becOle invalid
unless the work authorized by such peIlit is cOlleDced within six IOnths of issuance, or if work authorized by the peIlit is
suspended or abandoned for a period of six IOntbs after the tile the work is cc.enced. One 90 day extension of tile, lay be
allowed for the peIlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOntb period, or the project will be considered abandoned.
WARJlING TO OWNER: YOUR FAILURE TO RECORD A HOTICE OF COMHENCElfEHT MAY RESULt IH YOUR PAYING twICE FOR IHPROVEMEn'S TO YOUR
PROPERTY. IF YOU INTEND TO OBfAIH FIHAHCIHG, COHSULT WITH YOUR LENDER OR AI AftORNEY BEFORE RECORDIHG YOUR NOTICE OF
COHHHNCEHEHT. JOBS UHDER $2,500 IH VALUE 00 HOT NEED TO RECORD AND POST A trHOTICE OF COMHEH "
SIGlAIIIBE:~
(.
STATH OF FLORIDA ,j?
COUN'lY OF r 15 Cd
The foregOing instrument was acknowledged
before me this (0/ / CJ> , 197"-- by
,
STATE OF FLORIDA P
coum OF / #Sed
The foregoing inst~ent was acknowledged
before me this I'Ct-L ~ , 19 95- by
who is personally known to me or who has
produced
as identification and who did/did not
take an o~th~ ~ ~
(Signature)
who is personally known to me or who has
produced
as identifi~ ~wbo did/did not
take an oat air ~
(Signature)
(Name Typ~~g~~fr~~<J pr St~ed)
NOTARY p Ie:;",-. KEITH CORREIA
:'.( tv. 'Z;:~ MY COMMISSION' CC 4514;.
~'1t.,,~/,rl EXPiRES: May 13. 1999
...tf;ifr..':;0' Bonded Thill Noary PullIIc: UnderwriiQ!:
(Name Typ
NOTARY P
'"''''''''''
: : .0[.\
\'; ~~j
"'~,9f:J~~"
t ed)
KEITH CORREIA
MY COMMISSION' CC 451416
EXPIRES: May 13, 1999
B~_~ NoII!y Public Undelwrfesq
(USIDIIft"UL ... fIlLY)
.AlelL J.D.
OC{ ,2 ~
SIC . '1'W l'
'aor~TY HEASURF.HEN'r
;Lf
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)WC
b '560
00,300
,/
SUB.,
b^-6;t/--rcOCOD
06:0 dO
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VR.
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a.or
CUIlVNr OWNI!RS
bA'fl
All 4ravias. ahall be drawn to acala for all parco!. or lot. five aer.. or lea..
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~ to_ -.-' RECYCLED PAPER
... '-\, Contents: 40% Pre-Consumer. 10% Post-Consumer
-'~
'roposal
Page No.
of
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ST^rr~-lU".~!NUM, INC"
37528 State Road 54 West
ZEPHYR HILLS, FL 33541
(813) 788-7308
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PflQf'OSAL SUBMITTED TO
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ST,REET . -...'7""\
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CITY, STATE and ZIP CODE
PHONE
--at fs()
JOB LOCATION
-..)\L-V~,- ~~\
JOB PHONE
We hereby submit specifications and estimates for:
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hereby to furnish material and labor - C
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plete in accordance with above specifications, for ~ sum of:
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All material is guaranteed to be as specified, All work to be completed in a workmanlike
manner according to standard practices. Any alteration 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. Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Authorized
Signature
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".
Note: This
withdrawn by us if not accepted within
1\ccrplancr of 'roposal- The above prices, specifications
1 conditions are satisfactory and are hereby accepted. You are authorized
'0 the work as specified. Payment will be made as outlined above.
. Acceptance:
Signature