HomeMy WebLinkAbout95-5373
BUILDING PERMIT-
CITY OF ZEPHYRHILLS permit]l!
(813) 788-6611
'.."
~~5373~
Date
II - 9-7~ --
~B... LDI ..ELECTRICAL PLUMBING
( , .
, %~~
perty Owner: .
Job Address: 6 {;; ~ t->:.. .
Parcell.D. #
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
Energ$:
(~~ ~
Radon Gas: ~ : 7.
/~Ar~-V-- .-dL'-VL- 4. - J(J~
r
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
DATE
All work shall be performed in accordance w
Valuation or
Contract Price
.2 ~o-o ~ OV
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City License Registration II
State Certified License#
~
13 -+)J II( (1~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
-
Ftr. Il-I?-:{ _Bill-
Pre SLB 1/-1- 4j) _L'-'-
Lintel
FRM.
Insul. CL
WL
Breakers
Ducts Ins!.
Compressor
Final
Driveway
".-/~.~f ~if,V
Tp. Servo
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
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.
STANDAI~D F()IUVA 'dF AGREEMENT
BETWEEN CONTRACTOR AI\H) OWI~ER
.jiilS ACl\U~\I~':\T 11,,,k thcSeL!J)N'o---.- __ d,lv (If. _No(/(;i;m8g~-----_. _il\ tlll' \('M
:<i: :tel" !\U[],ln ! J'HL~me"':r~-:=E1J.lJI:.-- -.--- _hy ~11:l lwt\\cln__ &e.a-9--:;t?J;,E..ll~-_-_---- --- ---------.
.".r';Lafler c3\lcd the Contradc~r, al1d__JIo;:R~rt:L.~ __u__ _ ______ ______ _____ .______~ercinaftcr called the
(..r.I'r, V, ,[1\("",":1" tLat the CO:,Ir.lctor and the O"nt'l" for th" lor.,ider~ti(\ns 11;1111(.,1 ~pce as follows:
i,:\rICI.L J. SCOPE OF TilE WOltK
.J I" c,,,,t)-lj'Ii' :.1...11 fll~i,h :.11 uf tl,,' IIUll"lI,d\ alld 1"'lfollll all (If tl", ,,"rk ,ho,,"1\ Oil tIll' Dr;lwilli~' ;!11l1 d('.("lIl,. (1 ill !l". Slw,ifl, 'lliclI1\
. .,:,tled L'OAlelt.PTl:?:5/~ E~7.Iffl,D,M€jJOtzV;f)~t,!(.{JPlifpJIte6;1:SWot;Sjf2e<<.?AlK - -
i."1'''''.1 IJY , IHti'1\: .\': .111.1 illth,'\('
I .,:,tr.l<"I I;,,, '''lI,'IlI'; clI:,II..,J till" Alll.ot;:,'t:- .Ind ,1,.11\ dll c\"c!)thjll~ 1I',!lIi,cd hy lhis ag.....llIclll. th., f:,'\Il'ralcolldlliollS "I thc COlllr.lel tl\1"
:'1" ,d"ati,,,,'. and Ih.. !)r.lwiog,. '
".!:TIeLI-: 2. ';T,fE (JF COMPLETION
'II". w'Jlk I() be pejfonn/"t1 1I1l,1", lids Conlract shall be' (.omll1C'lI(Td//_) :uW IL)
... d,stantially complcte,l __ _iL..J7/i/fL0Y,c- _ f{' )ec.!5;___ -- ~ .- - -
)
I .;/';/J/i' I~;}
'/~' ~) ..\
,I' <,..,!:it:LEI.'____ ~l1d shall be
>,11 nCLE 3. TIlE C:Ol"TRACT SU~I
TI." OW1ln ,;.all p~y the COlltr~' tor for the !'<'I{orm:wcC' "f the C,,"tra, t. ,"ui'j,'d to ac1diti,,"s ami deductions provided thcl\:iCl, in ClIrrent
!Il:.ds as lol\",\,,{f;ecD~j~7bo~LJIY~.-;@ !h.J.Nj)~.iJo/;r;Q --- .~. -----------------
(St.\tc jlt-rc tilt' lump Sl!ll) 8Ihl\?llt, n!lit prilT<;. liT bo!h, us d,'qTl'd)
.<\,lI!,ori{,.cl r:il; ^:(' Orders WI'l be :,ll],mitkd Lv Ill<' Contractor lor all w(lIk IlI,l sl'('ci!ic:dh- induckd in this COIlIract.
.'.,:TI<:I.I-: 4. I'J\(/' :m.:ss l'Al\IENTS
I h~,t.'rt !W:l' allY j;rll\ i'i.L'lll Idll,le lor IIH' H,Il~"\lIt I\'l:linrd nllf'r the \\ \,:k u'Iu.'ht'1 n u'rtnll\ ~lalol:l' 01 ctllllpldldll.)
AJ\TICLE 5. ACCEIYfANCE AND Fll"AL l':n\IENT
/.'/L-- (IF
T:j.lal 1"'YlIH"ClI ,.lull Lc: .I"" ,ILL.. _ ..__.1.".., ll!iILlt "d.stal1ti..J COICll'1c-liPCI .,[ tll<' WPlk pruvi.Jc.,l the wmk he then
aCId the (:",,:r,1l1 fully t,nilH"""!.
fully COl1llJlell d
.'\1\ lieu.: n. Till: (ONTHACT l)()Cl':\ll':;-';TS
';'Le C"!If"f31 Co"d::i.,n., "f 11". (:"J.(:;icl, th.. Spe,lr;, IliO;J; allll the I1Iawings, t"\~dh('[ with this Aglt'cn.ent. form lhe Clllotr.\( t, and the;
"I" as fully a part of till" c:"nl;....t ,lS it 111"1,.[" C11t:ICb,.d or belt'in r'"1,,,;\t(,(1. '1 he followill" is all it<-II\;{alioll of o',hl:r (".'l'lll'.,ll
i~fl';ni.lti()l\ r'> ~J pt'rlinent
" I ~"'; H 0 l l. ")'~ rA .11 n
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAME #rK ) Nrele:S 1/TTC.--
OWNER'S ADDRESS ~ L
JOB ADDRESS IuM Z K,ctJ-==t 'ex- '
LEGAL DESL'RIPTION: LOT(S) BLOCK
PHONE
SUBDIVISION
PARCEL LD.'
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:____New Construction ____Addition ~lteration ____Repair ____Install
____Sign
---1Iove
____Deaolish
PROPOSED USE: ____Single FaJIlily
____H/F
____' of Units ____H/H
____C~ercial
____Indus t.
____Swia. Pool _Other
Restaurant &: Health Departaent Approval
DESCRIPTION OF WORK: COt\<!..IrJ.-c-- S\g,k"
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.
PERMITS REOUESTED
~ILDING
$ ~tJO ,00
Valuation of Total Construction
~LEC'fR1CAL
AMP Service
Florida Power Corp.
W.R.E.C.
____MECllAHIGAL
$
Valuation of Hechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUC'fION: ____Block ____Fraae ____Steel
Other
FINISHED FLOOR ELEVATIONS:
Yr.
IS PROJEC'f IN FLOOD ZONE AREA?
YES NO
..........................................
Signature
CONTRAC'fOR SECTION
a COMPANY ~t+ rnf\50 n It.i +- ('of'> vn ~~ \ h c.- .
.
State Cert. or Regist. ,
A ~ ~ojK- City License Registration' Olt..e
..........................................
BUIIJ)ER
ELECTRICIAN
COMPANY
State Cert. or Regist. ,
City License Registration ,
..........................................
SillnAture
COMPANY
State Cert. or Regist. ,
City License Registration f
..........................................
PLUMBER
Signature
COMPANY
State Cert. or Regist. f
City License Registration ,
..........................................
MECHANICAL
Signature
COMPANY
State Cert. or Regist. ,
City License Registration f
..........................................
OTHF.R
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this petlit aay be subject to "deed restrictions" wbich aay be lOre restrictive tban City
regulations. !he undersigned assUles responsibility for cOlpliance witb any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tbe owner has hired a contractor or contractors to undertake work, tbey aay be required to be licensed in accordance witb
state and local regulations. If the contractor is not licensed as required by law, botb tbe owner and contractor lay be
cited for a lisdeaeanor violation under state law. If tbe owner or intended contractor are uncertain as to wbat licensing
requireaents laY apply for tbe intended work, tbey are advised to contact tbe City of Zephyrhills Building DepartJent, (813)
788-6611.
FurtherlOre, if the owner has hired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
"Contractor Sections. of tbis application for whicb tbey will be responsible. If you, as tbe owner sign as tbe contractor,
you are indicating that you, ratber than tbe contractor, are responsible for the work. If tbe contractor wisbes you to sign
as contractor tbat lay be an indication tbat be is not properly licensed and is not entitled to perlitting privileges in tbe
City of Zepbyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify tbat I, tbe applicant, bave been provided witb a copy of "Florida's Construction Lien Law - HOIeOWDer's Protection
Guide" prepared by tbe Florida DepartJent of Agriculture and CODSUIf!r Affairs. If tbe applicant is sOJeOne otber tban tbe
"owner", I certify that I have obtained a copy of tbe above described docUJeDt and prOlise in good faitb to deliver it to tbe
"owner" prior to coaenceaent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all tbe inforaation in tbis application is accurate and tbat all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developaent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify tbat no work or
installation bas cOllenced prior to issuance of a petlit and tbat all work will be perforted to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in tbe jurisdiction. I also
certify tbat I understand tbat tbe regulations of otber govel11lental agenCies laY apply to tbe intended work, and tbat it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Such agencies include but are not liJited to:
* DepartJent of Environaental Regulation - Cypress Baybeads, Wetland Areas and Environaentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water Manageaent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Mavigable Waterways
* DepartJent of Healtb & Rehabilitative Services, EnvirODlental Healtb Unit - Wells, Wastewater TreatJent, Septic ranks
t US Environaental Protection Agency - Asbestos abateaent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood tbat a drainage plan
addressing a "cQlpensating volUlf!" will be subtitted which is prepared by a professional engineer registered in tbe State of
Florida prior to perlit issuance.
A perlit issued sball be construed to be a license to proceed witb tbe work and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor sball issuance of a petlit prevent tbe Building Official frCl tbereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perait issued shall beCOle invalid
unless the work authorized by such perlit is COIIenced witbin six IOntbs of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IOntbs after tbe tile tbe work is c-.mced. One 90 day extension of tile, laY be
allowed for tbe petlit with fee charge of $15.00. Tbe extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during eacb six aonth period, or tbe project will be considered abandoned.
WARMIMG TO OWtIER: YOUR FAILURE TO RECORD A MOTICH OF COMMEMCEMEtn' MAY RESULT 1M YOUR PAYIMG TWICE FOR IMPROVEMDl'S TO YOUR
PROPERTY. IF YOU Itn'EMD TO OBTAIN FIIIAMCIMG, COIISULT WITH YOUR LlllDBR OR All AnOIlREY BEFORE RECORDING YOUR IIOTICH OF
COMMEMCEMENT. JOBS UIIDBR $2,500 1M VALUE 00 MOT MEED TO RECORD AIID POST A "MOTICH OF COMMDCEMEJf1'".
SIGNAtURE: OWNER OR AGED
SIGNATURE: COtn'RAC'fOR
STATE OF FLORIDA
COUlfl'Y OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUIItY 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
CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT
RIGHT-OF-WAY USE PERMIT
PERMIT II
DATE:
No construction under ground or above ground of any facility shall be accomplished on any
City Rights of Way without written approval from the City Building Department. Any application
for approval of cQn8truc~ion operations on any City owned Rights of Way shall furnish a detailed
.drawing showing the complete scope of the proposed work in triplicate to the office of the Build-
ing Official for approval prior to the commencement of any work. A copy of this permit is to be
kept readily available at the site of the work at all times.
See No. City Road Date
LOCATION (Legal Oescdptionj. ~b<l1ri~.d5e.wa./~r-. ~~,/:la~ ,:r'-
3 -c;).(, ~~ 1- 01..30 - 00(';(')0 - D<fSD .
Permission i8 hereby granted to h~ ~:e.h r'"_
ri
for the construction and maintenance of
subject to the following conditions:
1. The construction and maintenance of such utility shall not interfere with be property
and right8 of a prior occ~pant.
2. All work shall be done in keeping with the standards of the City Streets Department and
under the supervision of the City Building Official, who will be notified at least one day prior
to commencement of construction.
3. All materia18 and .equipment shall be subject to inspection by the City Building Official.
4. During construction all safety regulations of the State Road Department shall be observed
and tqe City 8hall be relieved of all responsibility from damage of any nature arising from thi8
permit: Subject to the 8ame terms and conditions, the permit holder may take 8ucll safety measures,
including placing and display of caution signs, as it may deem necessary in conduct of construction
and maintenance work hereunder.
5. All private and all City property shall be restored to its original condition as far as
practical in the opinion of the City Building Official.
6! All underground ~ssing installations shall be laid at such depth as may be specified
by the City Building Official.
7. The 8ketch covering the details of this installation shall be made a part of this permit.
This permit is granted with the understanding that the applicant has notified all other utility
users in the area co~ered by the permit and takes full responsibility for any damage incurred by
prior in8tallation8 as a re8ult of his operations in order that they may safe guard their intere8t8.
8. It i8 expre881y stipulated that this permit is a license for permissive use only and
that the placing of f~l;'ilities upon public property pursuant to this permit shall not operate to
. create or to vest any property right in said holder.
9. Whenever the City decides to further exploit the City Rights of Way, any or all of said
poles, ~ire., pipes, cable8, or other facilities and appurtenances authorized hereunder, shall be
immediately removed from. said Right8 of Way, or reset or relocated thereon as required by the City
Building Official at the expense of the holder of this permit.
10. The holder shall save and keep the City harmless from any and all damages, claims, or
injuries that IllaY Occur br.-reason of the construction, maintenance, and operation of said facility.
11. . The holder shall complete the requested work within days or this permit shall
become null and void. In the event the work requested is not completed upon the expiration date
of this permit, the City shall have the right to complete such work and to charge the holder of
the permit for all c08tS incurred in completi~g said work.
. 12. The holder shall post a cash or surety bond with ~e City Manager in the sum of $
dollars to guarantee performance of the obligations herein, and to guarantee maintenance of the
right-of-way d~scribed.herein for a period of one (1) year fOllOWing completion of the requested
,installation. In the event a 8urety bond is posted, the said surety bond shall be made payable to
the City and shall obligate the surety to hold the City harmless in the event the holder of this
permit should fail to. meet any of its obligations hereunder. The bond shall also indemnify the
City for all court costs and reasonabl~ attorneys fees in the event legal action is required to
collect on said bond.
APPROVED BYe
SUBMITTED BY: ~ &Q te
~ / (PermIttee)
.IR&s ewNcR- Ytt: /!J/Js"ONR/~-(
( S gnature & T t e
/ftl9t.f Serla:k. 31-. ~~UI !/~ rl
Address 3 f/(;,ijL
Date
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