HomeMy WebLinkAbout95-5404
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BUILDING PERM1I ---
OTY OF ZEPHYRHILLS Po""it ~
(813) 788-6611
j~540tA
Date
//~ -tS
~ ELECTRICAL PLUMBING
P<oporty Owno' ~ ,~~~;-fI
Job Address: --S ~_-d.L.~~~
Parcell.D, #
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Zoning: ~code:
Description of workX ~ ~
Radon Gas:
FINAL
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.
Inspector
City license Registration # ~~
State Certified license#
:B
Permit F. '" rv
~~:::~: - . Cq::
-~
Address
Telephone#
Valuation or
Contract Price j ~ crv - o-D
_~ / ~-fA
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.
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APPLICATION FOR pERHIT
CITY OF ZEPBYRBILLS
BUILDING DEPARTKENT
JOB ADDRESS
Lt\~t~~ '~~<Q..QfL
:5 2~ \~~I'\.~
~
PHONE
1'6~- \3bl
OWNER' S NAKE
<S~.
-z. \-\.
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~
OWNER' S ADDRESS
LEGAL DESCRIPTION: LOT(S)
PARCEL 1.0.' (OBTAIR PjUlK PIl\,lPEBTY TAX ROTICE)
llOIlK PROPOSIID,_Rew CoII&troctiOll ~ition ~teration ~ir _InataIl
BLOCK
SUBDIVISION
_Sign
--,,-ove
_Deaolish
PROpOSED USE: _Single Faaily
_KIF
_' of Units _K/H
_eo.aercial
_Indust.
_Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant & Health Departllent Approval
~-~~
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL:
coMMERCIAL :
ATTACH (2) PLOT pLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
_BUILDING
}'ERKITS RROUESTED
$ ~ \, ~, ~ Valuation of Total Construction
_ELEC1'RICAL
AMP Service
Florida Power Corp.
W.R.E.C.
---1fECBAIIICAL
$
Valuation of Mechanical Installation
~mmING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
F1' .
IS PROJECT IN FLOOD ZONE AREA'l
YES NO
******************************************
CONTRACTOR SECTION
Signature
COMPANY
State Cert. or Regist. ·
City License Registration ·
******************************************
,UILDER
:;=:
/
~ COKPARY
State Cert. or Regist. ·
City License Registration t
< ******************************************
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OTHER ~ COMPANY ~.J..\~O~ C~S'f.....,~"'~r\
, . State Cert. or Regist. f ~~Sb'~:;~
Signature ~ City License Registration · ~~~
~***********************************
APPLICATION APPROVED BY PERMIT OFFICER.
/
/
COMPANY
State Cert. or Regist. f
City License Registration
******************************************
Signature
COMPANY
State Cert. or Regist. ·
City License Registration
*****************************************
j>>LllMBER
tJRC8ANICAL
Signature
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
lie WId~lgoed uoderstaois that thl. ""'"t .., be .ubject to 'deed r..tricti.... obicb ..y be lOre restrictive tbao City
regul.t,.... 'be under.llOed ....... responsibility for eoopliao" with aoy applicahl. deed r..trictl....
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If th. -. has bired · OOlltractor or COIItractors to uodertale _, tbey ..y be regulred to be IiCOOlled in -.. with
.~.t. aod loc~ regulati~. If th. OOIItractor i. Dot IiCOllBed .. _ by I.., both the -., aod COIltractor ..y be
CIted for a ',.d_ ..olahoo WIder .tate law. If th. -., or inteoded COIItractor are oocertaio .. to ""'t IiCOllBing
requJ'-ts ..y apply for th. 10tODded 1IDr1, lbey are advl.ed to COIItact the City of %epbyrblll. BuIlding I!el>artwent (813)
788-6611. ,
Fortberwore, if tile _r has bired a COIItractor or OOlltractors, b. I. advised to bave the COIItractor(.) .i!ID portl... of tile
'c..tractor Secti.... of thl. applicati.. for obicb tbey will be res_lbl.. If yoo, .. tile lIIIIIer .I!ID .. the cootractor
yoo are iDdlcatioq that YOO. ratller tbao tile COIItractor, are resPODBill. for tile "'d. If the OOlltractor wlsbes yoo to .Ig.
.. COIItractor that ..y be ao iodicati.. that be I. DOt properly IiCOOlled aod I. DOt entitled to ""'"ttiDg prlrilBgOD in lb.
City of Zepbyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW CCllAPTER 713. FLORIDA STATUTES. AS AMENDED)
I certifY that I, tIo appllcoot, 10.. been provided with a copy of 'Florlda'. COnstructioo Lien Law _ DDoeowser'. Protectioo
Gold.' prepared by th. Florida /lepartwent of Jgricultore iOId C_ utairs. If tIo applicoot I. ...... otller tbao tIo
'-". I certifY that I love obtained a copy of tIo above described docuweot aod Prowise in !IOOcI f.lth to deliver It to the
"owner" prior to coaenceJent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that allth. inf01lliltloo io thl. applicatioo I. ilC<Urate aDd that all "'rl will be dooe 10 COIpllaoc. with all
applicable laws regulating construction, loning, and land developJIent.
Ipplicati.. I. bereby 1Od. to obtalo a POlllit to do "'d aod Ioslallatioo .. indicated. I certifY that .. IIDrI or
IOBtallati.. has COIOOoced prior to I....... of a ,"""it and that all IIDrI will be perf,""", to ...t .laodards of all I...
requJatiDg constructl.., City cod.., ..,iog reguJ.ti.... aod Iaoi d'veIGpoeot regu]ati... in the jorlsdicti... I also
certify that I Wlder.taod that th. requJ.t1... of otller _I agenci.. .., .pply to tIo inteoded _, aod that it i.
BY responsibility to Identify what .cti... I ...t tal. to be iD eoopli..... Socb agenci.. Include lot are DOt lilited to:
· Delorblest of ERvI,,",,"laI ~Iati.. - Cypress Baybeois. Wetlaod Ireas and IDvI,,",,"tally Sensitive lands,
Nater/Nastewater 'freablent
· Sootbrest Florida Kater ~t Di.trlct - Well., ClPress BaYbeadB, Metlaod Ireas, Ilt.rloq Natercourses
t Amy Corps of Engineers - Seawalls, Docls, Navigable Naterways
· De artoeot of Heallb & 1eIoblllt.tlve Services BDrI......laI Health Dolt _ loll., iOsteoat.r 'reablest, Septic ,....
t US Envir_ental Protection Agency - Asbestos abatl!lent
I a1.. certify that, if fill ..teri.1 ill to be used io Flood lODe '1' or '1, .tc. " it I. ooder.tood that . dram. plaD
addressiog a '-tiDg vol.... llill be -itted wblcb I. Prepared by a professlooaJ eoqi_ regl.tered iD lb. Stat. of
Florida prior to perlit issuance.
A ,"""It issued .b.1I be constrned to be a Ii..... to P""oed with the IIDrI aod not .. aotborlty to .Iolate, caocel alter, or
set asld. aoy P...I.I... of tIo teclolcal ooies, DOr sbaJl i....... of . peralt P.....t tIo Building Official frow thereafter
reguJrlng · correctl.. of errors ID plaus, cons!ructi.., or .Ioloti... of aoy COde. Every ""'"t Issued sbaJl becooe lovalld
llllIess tIo IIDrI autbori.ed by sucb peBIt ill _ced wlthio .1. ...tbs of 188_, or If ",rl aotborised by the _it I.
BDBpeDded or abaodooed for · period of .ilI IOOtbs after !be tJwe tIo IIDrI iJJ _cod. ODe 9ll day OIteosi.. of tJwe, ..y be
all_ for tIo '"""It with fee cbarge of $15.00. lbe OIwl.. sbaJl be _ted ID orlliDq to lbe Iluilding Offlcl.l. 10
- Iospecti.. ...t be logged dDrlog eacb .Ix IOOth period, or the project will be considered abaoclooed.
IIAllIIIIlG 10 0IIlIEIl: YIIOB FIIWlIE 10 BBClllUJ I IDI'ICB Of CfIIlDCBJlm IIAY 1IBSllL' II YOIlII PlliIG MCB FOIl ilIPIlOiIrIluJs 10 YIIOB
PIilIl'EiIn'. IF YlIU IJfIOOlIO IllIl'III FI1IDCIIG, CDlSDL' rim YIIOB LBIOQ 011 III .IlfQIm iIEFOIIB BBClllUJIIG YOIlIIIDI'ICB Of
C . JOBS UNDER $2,500 IN VALlIE 00 NOf IlEED 'fO RECORD AND POS'f A 'NOfICE COHHDCEHm'.
~
S'fATE OF FLORIDA
coom OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
S'fA'fE OF FLORIDA
coom 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)
IOTARY PUBLIC