HomeMy WebLinkAbout95-5371
BUILDING PERMIT-
CITY OF ZEPHYRHILLS Permit IV!
(813) 788-6611
7~5371 !1
Date
II - 9 - 9-.!:. -
BUILDING
ELECTRICAL
PLUMBING
CMECHA:;~~wer Conn
Water Conn:
pcopertvown.'~~~:~lJr&; (l~
Job Address:<-? /. f.
Parcel I. D. #
Water Meter:
T.I.F.'s:
Zon;n. . E....~ ~
Description of Work ~ ~ tf1 . /L---t .-'
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
Inspector
Permit Fee ..2 /J. o--v
~ c ___
Signature y ""'7 /- c:;::>
Company
Address
Telephone#
Valuation or / ~" ~"l--.
Contract Price <.......::> ~ c;..; U
City License Registration" J.!> S
State Certified License#
--J!-;~~~~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final rid- F,~ '0ltl?-l.
~ . ..1c\-N> rc~
~ll~
II-I ~'<'-J
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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 ($15.00) 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.
OWNER'S IWIE '~j)k MWI~
OWNER'S ADDRESS ?;~(?h M/>ftfJr<< Z-fill1"(}S1J1 L1h I 1/G,
JOB ADDRRSS~?;lJ ~{ 01.
PHOn
'~~DI\ (/(OIC!<(;
C;v6D7-C16
#trtJ'-;.,_ ;e1;-
~[Jt1< r{~11.r' 68t6f;
APPLICATIOl!ii ~OR PERHIT
CI'IY OF ~.EPIlYEPILLS
B1llII.DlliG DEPAR1'!fE'.m'
r12-r ~ I~V~
~ /q?
\f O"'~/;
t
LEGAL DESCRIPTImI: I.OT(S)
JII.OCK
SUBDIVISIOlli
PARCEL LD.'
ttORK PROPOSED :_lIiev Construction _Addition ./ A1teration _Repair _Install
_Sign
_Hove
_DeIaolish
_~rcial
_Indust.
_SwUI. Pool
_K/H
eM ~ j;(M. Other
PROPOSED USE:
Single Faaily
_"IF
_' of Units
~estaurant &: Hea1th nepan:.ent Approva1
BUILDING SIZE:
x
Square Feet.
Height
RESIDElITIAL :
COHKERCIAL :
A'l'TACII (2) PLOI' PI...MiS &: (2) SEIS OF B1llII.DIlIiG P:L.4UiS &: (1) SEl" ENERGY FORMS. **
A'l'TACII (3) SEIS OF BUllDDG PI...MiS &: (1) SEl" ENERGY FORMS. **
**COFY OF COIiITRACT RE'Q1JlIRIlD.
PEKKlTS REQUESTED
_BUILDING
$
Va1uation of Tot:a1 Construction
_ELECTRICAL
LKECHAliICAL
AKP Service
Florida Power COrp.
W.R.E.C.
$ ~O.O()
Va1uation of Hechanica1 Installation
_PLUKBING GAS ROOFDiG
SPECIALTY
TYPE OF CONSTRUCTIOlli: _Block _Fraae _Steel
Other
FlliISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZOBE AREA?
YES NO
...*...*.......v~............*......*...**
COlIiTRACIOR SECTION
COIIPANY
State Cert. or Regist. ,
City License Registration ,
............*..**.........................
BUILD~
Signature
ELECTRICIAN
amp.o-Jt
St.ate Cert. or Regist. ,
~1L$ L1ceuse Keg1stracion .
......*.*********........**........*.*****
5iRDaiLu1-e
COIIPAJNJY
State Cert. or Regist. ,
City License Registration I
**.*.**~**~*.~*+*~~*...********.*.*.**..**
PLUKBER
Signature
Signature
>\RY~,zt: t}PRIl'l~ 1i'lC-
State Cert. or Regist.' n08/, OOD/77
City License Registration I 7.3
******..********v****************.**.
CG!IPARY
State Cert. or Regist. I
City License Registration ,
**********..***********~.*****.*****..**..
0T1IltR
Signature
APPLICATION APPROVED BY
PERKIT OFFICER.
r'~-~-
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlitlay be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
"
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or ~ontractors 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 lisdeleanor violation under state IaN. If the ONner or intended contractor are uncertain as to "hat licensing
requirelents lay apply for the intended work, they are advised to contact the City of 2ephyrhills 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 you, as the owner sign as the contractor,
you are indicating that you, rather than the contriCtor, 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 FEE~
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 - HOleowner'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 doculent and prolise in good faith to deliver it to the
"owner" prior to cOllencelent.
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 cOllenced prior to issuance of a perlit and that all work will be perforled 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 governlental agencies lay apply to the intended Mork, 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:
f Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive lands,
Water/Wastewater Treatlent
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways ,.
f Departlent of Health & Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
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 "cotpensating volule" 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 Mork and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frot 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 cOI.enced within six .onths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six lonths after the tile the work is cOlleneed. One 90 day extension of tile, lay be
alloNed,for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection .ust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT "AY RESULT IN YOUR PAYING TWICE FOR IMPROVEHENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
CO"HENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
~~
SIGNATURE: OWNER OR AGENT '
was acknowledged
, 19_ by
STATE OF FLORID /). ,
COUNTY OF I tiS ()l( ^-
The forege1ing ins rum nt v-Ias ackn~Jledged
befc.re me th i s ~ ",;2.(p -J1--, 19 ~ by
7ih/ldl4 /IJ~~d
who is rIa 11 y knN;l~' me or who has
produce
as i ntification and ho did/did not
tall' n (I th
STATE O~ FLORIDA
COUNTY OF
The foregoing instrument
before me this
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(SignatUl-e)
(Name Typed, Printed or Stamped)
NOTARY PUBLI~v PI JC":\l;CI ..... ""\'ClS
"'~., uc"} , L"\~_J.. 1........ \-'"\'./,,
~ &'S COMMISSI~~: C? 348657
(~ ~ EXPIRE;:) r-..3 ,.', \998
~ ~ BliNOED rHRU
OF f\.\J' ATLANTiC SONDING CO" INC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name
Classification
Address
,//
OwnerlManager
Business Phone
Emergency Contact Phone
Occupancy Load
Alann Monitoring Co.
Phone #
TYPE OF INSPECTION CONDUCTED
o QUARTERLY
ORE-INSPECTION
o APPROVED
o FINAL 0 ANNUAL
ill 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.
Inspect. Date
Re-Inspect. Date
Inspect. Time
Inspectors Name
Fire Dept. ID #
Owner/Manager Signature
Title
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.
White Copy - File Yellow Copy . Bid. Dept. Pink Copy . Business
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SPRINKLER LEGEND
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