HomeMy WebLinkAbout95-5388
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit N!
(813) 788-6611
-~538~){
Date
Ii - I~"'" - 9---s-
BUILDING
ELECTRICAL
PLUMBING
~CHANICA"L.--.:::::sewer Conn
Water Conn:
~op.rtv own.'~~ ~~
Job Address: )1 _ ~,--,-"",!__"
Parcel I. D. #
Zoning: Energy Code: Radon Gas:
DescriPtionofWork~?Z~-(f...T;;// ~~ ~ "" b;;' t;?~
Water Meter:
T.LF:s:
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
City License Registration #
State Certified License#
j,S-9~
.
Permit Fee
Signature
Company
Address
Telephone#
tL:Jj p~
Valuation or
Contract Price ,~--c; tf - v-o
--:--r/--,~d-4- ~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
-
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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 ($15.00) 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
.fd-btJiL
41:9~---
/0....-;/
OWNER' S NAKE P 4.p R -:In ~ AJ 5
:::~7:;; ~~~II
fJ; z z- A PHONE d.d () - 3 5 / 3
~I~ ;;:V;:~A:~ 3:::;
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ----Alteration _Repair _Install
_Sign
--.JIove
_Deaolish
PROPOSED USE: _Single Faaily
_H/F
_' of Units _H/H
_ec:-ercial
_Indust.
_Swia. Pool _Other
_Restaurant &: Health Departaent Approval
DESCRlPT1011 OF 1illll1t,~ .IhLd~IM-e~~"~jl&!.~;t ~
f '
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
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_MECHANICAL
$
Valuation of Hechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
BUILDER
Signature
F.T."RCTRICIAN
COMPANY
State Cert. or Regist. t
City License Registration .
******************************************
SianAture
COMPANY
State Cert. or Regist. .
City L cense Registration .
*********************** ***************
PLUMBER
Signature
te Cer
y e Regis
*************************
OTRl1.R ~R CI>>lFANY B~ ~
/ ~ () State Cert. or Regist. , / ~ 4- 3
Signature . ~ A _ City License egistration t / z:; 9' ~
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'l'he undersigned understands that this pel'lit laY be subject to .deed restrictions" which lay be lOre restrictive than City
regulations. the 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
requirelents laY apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furthel'lOre, if the owner has bired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
RContractor 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 lay be an indication that he is not properly licensed and is not entitled to pemitting privileges in the
City of ZephyrhiIls.
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 - HDIeOWDer's Protection
GuideR prepared by the Florida Deparl:lent of Agriculture and ConsUJer Affairs. If the applicant is sOJleOne other than the
"owner", I certify that I have obtained a copy of the above described docUJent and pra.ise in good faith to deliver it to the
"ownerR prior to COlleDcelent.
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, loning, and land develoPEDt.
Application is hereby lade to obtain a per.it to do work and installation as indicated. I certify that no work or
installation has c.enced prior to issuance of a perlit and that all work will be perforted to .et standards of all laws
regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveIDIeDtal agencies aay apply to the intended work, and that it is
I}' responsibility to identify what actions I lust take to be in COIpliance. Such agencies include but are not liJIited to:
I Deparl:lent of EnviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and EnviroDleDtally Sensitive Lands,
lIater /Wastewater treal:lent
I Southwest Florida lIater Hanagelent District - lIells, Cypress Bayheads, lIetland Areas, Altering lIatercourses
I Al'IJ Corps of Engineers - Seawalls, Docks, Havigable lIaterways
I Deparl:lent of Health' Rebabilitative Services, EnvirOJ1lental Health Unit - lIells, Wastewater treatlent, Septic tanb
I US EnvirDDleDtal Protection Agency - Asbestos abateleDt
I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.R, it is understood that a drainage plan
addressing a "cQlpensating volUle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to per.it 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 pel'lit prevent the Building Official fra. thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pemit issued shall beCOle invalid
unless the work authoriled by such pel'lit is cOllenced within sillODths of issuance, or if work authoriled by the pel'lit is
suspended or abandoned for a period of sillODtbs after the tiJle the work is co.enced. One 90 day l!Itension of tiJle, lay be
allowed for tbe pel'lit with fee charge of $15.00. tbe l!Itension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each six IOnth period, or the project will be considered abandoned.
IIARlfIHG to MER: YOUR FAILURE to RECORD A HOtlCE OF C<IIHElfCEllKlf'l' HAY RESULt IH YOUR PAYIHG twICE FOR IHPROVRIIBlfts to YOUR
PROPERtY. IF YOU IIft'ElfD '1'0 OmUH FINAlfCIHG, COHSULt IIltH YOUR LEllDER OR Alf AnoRm BEFORE RiCORDIHG YOUR HOtlCE OF
COMHEHCEHRlfT. JOBS UlfDER $2,500 IN VALUE DO HOt HEED TO RECORD AlfD POSt A RHOtICE OF COHMElfCIHElft'R.
SIGHA'I'URE: OVIfER OR AGE1ft'
SIGHA'I'URE: COlft'RACtOR
S'I'A'I'E OF FLORIDA
COUlft'Y OF
The foregOing instrument was acknowledged
before me this , 19____ by
StAtE OF FLORIDA
COUlft'Y OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
who is personaJ~lL knQWD to lIS o~~~'?~~S.l:r,....~ to me Dr ::.~
produced'iloli/I"~"L p , , , '~"'IJn.-:H~"U!!!Il
"'i~eIi"",t",,'ifica~,~~~,.an,}:,,d who didl~d ,Dot as ~UiCAtiOl1 aJtd,',U ,:u...~.;~:...,I~~~,',"" '" ',.,',.,.,.,."
take 'C,~1ll.,",,,,, ."".~ > takraii"""o~th. ."~''''' ~:t~
(Signature) (Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
GAS SERVICE o LPG-Bulk SERVICE TYPE 0 Restart o Retention Revenue SIC Code
o Natural o LPG-MTR o New On o Reactivate o Ret/Add
o Other o LPG-Cyl o New Off o Added Load o Other Rate Class AFE#
Customer
Name
Service
Address
Buyer Namel
Mailin Address
Federal Taxpayer 10#
Contact Name
I
I
o dirt
o brick
o paved
o width
o trees
o fences
o walks
o bushes
o sprinkler
o bore:
o new
. ~J'xisting
~Iock
El frame
o stucco
. 0 siding
o other
I
o ROUGH IN NEEDED
MAP
o LOCATION
I
I
o asphalt
o flat
o tile
o regular
o tin
o 12 pitch
o rock
o other
attic Y N
under Y N
slab Y N
Acct. #
o Existing
o New
length
size
relief
o metal
o plastic
I ~:~g:
size
I ::er
appls.
totaJ
c2 "
Lf5'
AMOUNT TO COLLECT $
City
City
Tax 0 City
District 0 Coun
Date
Scheduled
I. :~~:
. ~ outside
o in wall
I ~ ::~:r
'SQther (;rLJ~.L\
I. 0 w/h
Orange
o heater
~her C) () e::. fJ5
Customer Approvaf:
Work PH
/ Zip
Zip
stubouts
outlets
o W/H SHED
o W/H STAND
o COMB VENT
o THERMOSTAT
WIRING
Distance from Street:
o 100# cyl
o tan
o 250 tank
~ other
o DRAIN FIELD
o SEPTIC TANK
<.Q ABOVEl3ROU~
o BELOW GROUND
;
,
i
;~:
,;"
:
!!
, 'J}
\
size
length
difficulty: 0 simple
o moderate
o difficult
, ,
.
; i '
, ,
,
. OJ i?,l<jA.;b
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BUCK SHEET
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PGS 588 (1193)
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Peoples Gas
General Sales Agreement
~
City Z.LIJ h \/(<>/7 j.i'~.:)-I Zip
I /
City St.
Tax ~ty Date
Federal Taxpayer ID# Ace!. # District 0 County Required
r~"'Y"'I.
- I
~~~~mer P A 1) /l (LrI(.A'L4 P /- Z L d-
~~~~~:s '7,;:). _I::::;" (Itl /~I / A I L' d -
Buyer Namel r:~ /7" ~,
Mailing Address ." /-r /Jl ~
Home PH
Work PH
Zip
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~;'t~:~~l~~~:'i:i~r~~if;~[!f.t'~'ir3iftJErfl.W~Hl~t~,:,,~)1:~J,:~::~~J~;fdf~ffflt_rl~~i[~ftlii~i{ Merchandise Charges
Installation Charges
Sd4.0(J
I
Warranty Charges
Sales Tax
Total Cash I
Price GL#
PSA#
IS Date
Allowance Total
o Cash 0 CC
Prepayment 0 Check
Balance ~OD 0 CIS -, I ./. 0'"
Due TI Other "" ~ &; I U
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Other"":"",,.,
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,
TOTAL
AGREEMENT TYPE
o DeliYJrY Only
lIlJ)eIIVeryllnstall
Remarks
o Customer Pick Up
o Install Only
INVENTORY STATUS
o Div. Whs. 0 Transfer
o Cent. Whs. 0 On Order
Total Balance Due
Amount To Bill
nr.. A P 1--:::' t.
e h-1 )-{'.l^ A
"
TJ -P 9;1 t"f A I;). 0 -;I-~ lk" JlJ VIA
J-':~ .:t1t..llW ~ {\1~UJ-'
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Amount To Collect
'-}'!;;:; ~ J .ITJ::, L. A L}.L.o ~ ~
1/ 011 '-
'-I
The manufacturer of the above described goods provides a limited warranty. Consequently. Peoples Sales & Service itself makes no warranties to buyer,
express or implied, and hereby expressly disclaims any warranty of merchantability or fitness for a particular purpose.
I have read all of the terms and conditions on the reverse side and agree to them.
BUYER/OWNER
DATE
AUTHORIZED BY
DATE
CUSTOMER COPY
PGSS
1194
ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name
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1./ II ,if"
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Classification
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Address '7 /-~ <:0
C~,..1 (. (
A'I'
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Owner~~ I),AVY 8( s
q
Emergency Contact Phone ;!d
~?s C)
Business Phone
7rX 0//1
Occupancy Load
Alann Monitoring Co. Phone #
/1;, 1';/ ~b,.,..".:J / A A ,./~ ";')':;' ,> - -:;; 5-/3
TYPE OF INSPECTION CONDUCTED
o
o
o
QUARTERLY
RE-INSPECTION
APPROVED
o FINAL
~ OTHER L P Gc' <c
o NOT APPROVED
o ANNUAL
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r< c/ \.1 ot.', /1{.
) ,
I
OBI-ANNUAL
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,
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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.
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Inspect. Date 1;/, 5"'/ 9 S-- Inspect. Time / ('~~.' /,... < Fire q.~ptJp # 5 <::;-{)
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Re-lnspect.Date , ,lnsj1,tors I)lam, e, -!i '.<,..-/..>C:.-C:;/ "',r,. ""/-'.1
d I ! / /\ -.,.
OwnerlManager Signature '-?'J2i-u1 ~ (.,.lJlM~J,:yd!..X Title Diller-fiN.! (J,i1t}1.A';'/u/'* \
..../ ~
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