HomeMy WebLinkAbout95-5372
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P,aperty Owne' J/1;~ 01jiZj;{:L ~
Job Address: 38-C1:l5 ____
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit N!-
(813) 788-6611
j~537~ 13
Date
1/ -9-9S-
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.LF.'s:
Parcell.D. #
Zoning:
Description of Work
Energy Code: '/ Radon Gas:
.t~~ ~~ ~r
City License Registration #
State Certified License#
Y~3
Permit Fee
Signature
Company
Address
Telephone#
Inspector
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Valuation or
Contract Price
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BUILDING
ELECTRICAL
PLUMBING
-
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM. U~1-Q 'S (), L. L
Insul. CL
/' WL ~
hN~ /l-t.!-tjJ . [LJ..
Driveway
Tp. Servo SLB
Rough In II -.:21...t::l~ S2:> 6 Tub Set
Meter Can Water
Const. Pole Sewer
Pool Final
Pre-Meter
Final /2-~t/~'7 &J?
Breakers
Ducts Insl.
Compressor
Final
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 PERKIT
CITY OF ZEPHYRBILLS
BUILDING DEPARTMENT
OWNER'S NAKE fJtl-s.c..o fkdi,::~.J Arts Ce.~kr-Il-t~cr~"i{:i PHONE 7 Y31 t66
OWNER'S ADDRESS JIb/I{ ~I'~ Ce....~tJ.v.c.. J "2~jtL.c.rAltls J R-
,
"38'tJ3S m~/W ~~a.VC-r Z4~A;J'sJI1~ 11s"~(j
.
LEGAL DESCRIPTION: LOT(S) ~ ~ '/ BLOCK SUBDIVISION I'~~(:C Wv:J;CA.I
rr~'#=N
JOB ADDRESS
c:t rfs
PARCEL 1. D. f
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED: _New Construction _Addition ~teration _Repair _Install
_Sign _Move _Deaolish
PROPOSED USE: _Single Faaily _M/F _' of Units _M/H
Leo..ercial _Indust. _Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: ..r~l-a-r d'< /JiAI/J -C","r tJr nt d,~1 0 ~~-
BUILDING SIZE: fa" 'I -x...l/f2:, 1.l{fl~ - Square Feet. Height (JII'-C- ~.fDnr -
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.
PERMITS REOUESTED
LBUILDING
~ELEC'l'RICAL
$ 737~..EE-
_ ~ Valuation of Total Construction
I 2. 5 AMP Service Florida Power Corp.
W.R.E.C.
_MECHAliICAL
$
Valuation of Mechanical Installation
_PLUHBING GAS ROOFING
TYPE OF CONSTRUCTION: _Block LFraae _Steel
SPECIALTY
Other
FDllSHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
BUILDER
YES NO
***************************
Signature
CONTRACTOR SECTION
COMPANY fJre.c,-sc.... Ccv..~/r~/ ---, J:~
State Cert. or Regist. f c.h- - CA-~~ ~~,j
City . ense Registration f 1~"3
**********************
CO ANY Cl-l r" ~ Cuv...rfJrt:.;-.-
ate Cert. or Regist.' E :;;;,.., 21
City License Registration' J l.f?r
*************************
Si
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
MECHANICAL
COMPANY
State Cert. or Regist. ,
City License Registration f
******************************************
Signature
OTRRR COMPANY
State Cert. or Regist. f
Signature City License Registration f
APPLICATION APPROVED BY 1ft;f}iit;:;;;;;;;~.~.......... PERKlT OmeBa.
CONDITI~NS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit aay be subject to Rdeed restrictions" which aay be lOre restrictive than City
regulations. The undersigned assuaes responsibility for coapliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS .AND CONTRACTO~ RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake wort, they aay 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 aay be
cited for a aisdeieanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireaents ~y apply for the intended work, they are advised to contact the City of Zephyrhills Building Departaent, (813)
788-6611.
Furtheraore, 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 contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that aay be an indication that he is not properly licensed and is not entitled to peraitting 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 RFlorida's Construction Lien Law - HOIeOIfIler's Protection
Guide" prepared by the Florida DepartJent of Agriculture and Consuaer Affairs. If the applicant is SORODe other than the
Bowner", I certify that I have obtained a copy of the above described dOCUllent and prOllise in good faith to deliver it to the
"owner" prior to CODenceaent.
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 coapliance with all
applicable laws regulating construction, zoning, and land developaent.
Application is hereby aade 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 aeet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governaental agencies aay apply to the intended work, and that it is
ay responsibility to identify what actions I aust take to be in coapliance. Such agencies include but are not liaited to:
t DepartJent of EnviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater TreatleDt
t Southwest Florida Water Manageaent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
t Departlent of Health & Rehabilitative Services, Environaental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
t US Environaental Protection Agency - Asbestos abateaent
I also certify that, if fIll aaterial is to be used in Flood Zone RAR or "A,etc.", it is understood that a drainage plan
addressing a "c~pensating voluae" will be subaitted which is prepared by a professional engineer registered in the State of
Florida prior to perait issuance.
A perait 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 frOll thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery perlit issued shall beCOle invalid
unless the work authorized by such perlit is cD8lenced within sil aonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of sillOnths after the tiae the wort is ~ced. One 90 day extension of tiae, aay be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection at be logged during each six _nth period, or the project will be considered abandoned.
WARMING TO omR: YOUR FAILURE TO RECORD A NOTICE OF CQlMDCEJIBHf MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEllllfS TO YOUR
PROPERTY. IF YOU INTEND Tf) OBTAIN FIIIAMCING,COISULT WItH YOUR LBJIDBR OR AN ArrORHBY BEFORE RECORDING YOUR DICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE 00 NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEIIIIf".
SIGNATURE: OWNER OR AGBNT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUNTY 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
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BAY SHORE MEDICAL EQUIPMENT CORP.
"- .
Plurimat
TRAUMA STAND
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SPECIFICATIONS
Motorized variable SID
Vertical movement of the Isocentrlc
pivot arm from floor level:
Bucky angulatlons:
from 35" (9Ocm) to 73" (185cm)
25~5" (65cm) to 67" (170cm)
z 450
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Not to scale
POWER REQUIREMENTS
To power supply module:
120/240V AC 2/1 amps
To universal stand:
. 24 VDC 4 amps
Bucky requires normal Interface.
WEIGHT
820 pounds (373 kg)