HomeMy WebLinkAbout95-5410
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permi~ N!
(813) 788.6611
;~5~iQ~~"
e elECTRICAL PLUMBING
Pmparty Owna" (; It". ~ }4.d::1
Job Address: S -L;).~ - / /
Date / / -~ -y-..s--
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Parcel I. D. #
Zoning: Energy Code:
Description of Work-- ,R Q ~(
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Perm;' Fa~ thJ
Signatur~ ' (r--:\'
~
Company ~ ~ J
Address
Telephone#
Valuation or
Contract Price
3 / c2..s'""", trV
./
City License Registration # ~
State Certified License#
J..I y<!~
BUILDING
ELECTRICAL
PLUMBING
-
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
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 PERKIT
CITY OF ZEPHYRBILLS
BUILDING DEPARTMENT
OWNER'S NAME
ML CPt.-L "', l'1 ~4s ~~~
6~\Gz.. \ \ ~ ~'lE.
~
PHONE t~G- ~~\S-
\ 2..fJ\ ~ i tt\..\ \ ~
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
'2-~_~_ O~-O'\~- ()-,,\~
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ~A1teration _Repair _Install
_Sign
_Hove
_Deaolish
PROPOSED USE: _Single Faaily
_H/F
_' of Units _H/H
_<=<-ercial
_Indust.
_Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant &: Health Department Approval
~--R~'r
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.
_BUILDING
PERKITS REOUESTED
$ 3, l GS ,()D Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_MECHAlU.CAL
$
Valuation of Hechanical Installation
_PLUMBING GAS X ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
CONTRACTOR SECTION
/
Signature
COKPANY
State Cert. or Regist. .
City License Registratio
**************************************** *
,/'
RT.RCTRICIAN
COMPANY
State Cert. or Regist. ,
City License Registrat n'
************************************* ***
//
PLUMBER
COMPANY
State Cert. or Regist. .
City License Registrati
******************************************
Signature
MECHANICAL // COMPANY
State Cert.
Signature City License Registrat .
~ ************************************** ***
OTRRR 4" , , COMPANY Y~t..~~ \. C.N.'S\1.\..c.:\\U~
r5 State Cert. or Regist. I I&Q:)Slo""7~
Signature" , -', \.""' ' City License Registration , 28."?-.
, ~~***********************************
/
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this peIlit laY be subject to 'deed restrictions" wbich laY be lOre restrictive than City
regulations. Tbe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas 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 lisdgeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
require.ents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
788-6611.
FurtherllOre, if the owner has hired a contractor or contractors, he is advised to bave the contractor(s) sign portions of the
"Contractor Sections" of this application for wbich they will be responsible. If you, as the mmer sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for tbe work. If the contractor wishes you to sign
as contractor that lay be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, bave been prOVided with a copy of 'Florida's Construction Lien Law - HOEOWDer's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsUJer Affairs. If the applicant is sOJll!One other than the
"mmer", I certify that I bave obtained a copy of the above described dOCUJeDt and pro.ise in good faith to deliver it to the
"owner" prior to cOMence.ent.
E. CONTRACTOR'SjOWNER'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, zoning, and land developlent.
Application is bereby lade to obtain a peIlit to do work and installation as indicated. I certify that no work or
installation bas cOlleDced prior to issuance of a peIlit and that all work will be perfolled to Jeet standards of all laws
regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other governJeDtal agencies laY apply to the intended wort, and that it is
IY responsibility to identify wbat actions I lUst take to be in colpliance. Sucb agencies include but are not lilited to:
* DepartJent of KnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatlent
* Soutbwest Florida Water HanageleDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* AIIY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* DepartJent of Health & Rehabilitative Services, EnvirOD8eDtal Health Unit - Wells, Wastewater TreatJent, Septic Tanks
* US Environlental Protection Agency - Asbestos abateleDt
I also certify that, if fill laterial is to be used in Flood Zone "AI or "A, etc. " , it is understood that a drainage plan
addressing a 'c~pensating volUle' will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance.
A perlit issued sball be construed to be a license to proceed with the work and not as autbority to violate, cancel alter, or
set aside any provisions of the technical codes, nor sball issuance of a peIlit prevent the Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every peIlit issued shall beCOle invalid
unless tbe work authorized by sucb peIlit is cOlleDced within six IIOnths of issuance, or if work authorized by the peIlit is
suspended or abandoned for a period of six IOntbs after the tile the work is co.enced. One 90 day extension of tile, laY be
allowed for the peIlit with fee charge of $15.00. Tbe extension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during each sixlOnth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMEIn' MAY RESULT IN YOUR PAYING TWICE FOR IHPROVEIIBII'I'S TO YOUR
PROPERTY. IF YOU III'I'EW TO OBTAIJf FIJfAJfCING, COJfSULT WITH YOUR LENDER OR AN AnoRREY BEFORE RECORDIRG YOUR RO'fICE OF
COMMENC JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD A II ICE OF COMMENCEMEII'I'".
STATE OF FLORI~
COUN'l'Y OF ~ ..!1Jl ty----
The foregoing init~ent was acknowledged
before me this f :;)- , 19~ by
Rio McCarty
who is personally known to me or who has
produced.
as identification and who
take an 0
STATE OF FLORID~
coum OF ()-"
The foregoing inst~ent was acknowledged
before me this I {J~ , 19 <75 by
Ale McCarty
who is personally known to me OL ..ho has
~OdUl;~d
as identification
ta oath~
(Signature
~o te of FIorlda
My Comm. Exp. June 6. 1997
No. CC 292357
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Highway 98, Dade City,
Phone # (904)567-8580
Bonded and Insured
Flot~id~
33525
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State of
County of
~)(O
ff~Jlcf/
'jOUR .UNDERS:IGNED hereby gives .lotice that improvement will ~e made to c.:!rt.
real property, and in accordance with Chapter 713, Flor~da Statutes, \
(ollowing information is provided in this Notice of Commencement:
MO'rICB OP CQIIHBIICBMBlft,
1. Description of Property: Parcel No. J V ~ z,rp - z" J 0 z,p 0.0/ / CO - (: 7.
(Legal description of the property and street address if available)
General Description of Improvement ~ ~~l) ~
4... -
1
L .
3.
Owner Information: Name
Address 231 vz,.. / /~~ City
Interest in Property: Dc~ '^-" ~
Name of Fee Simple Titleholder:
(:If other th~n owner)
L State
Address
City
State
Address
State A-_a
"':6 ,) 5(:,
~_ i\.
r; .
Surety: Nilme
Address ~~ I~ ~ City
Amount of Bond: $ 1:Sl~~~~
Lender: Name ~
State ~'-
G.
Address
City
State
7. Persons within the State of Florida designated by Owner upon w",
notic,es or other documents may be served as provided by Sect"
713.13(1)(a)(7), Florida Statutes:
Name N. ~
Address
City
State
H.
_.___.-. .....~..___......__..... ___.....,..,._.__w
In addition to hims~if, -O~ne;-c:f;;iqnate8'
.~"",,~_...~......,..._,... .......'......"..__._.~_.~-~."':t""..---~.
of to receive a copy of t!l
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statut,':,
q.
Explorat.ion dat.e 01 Notice ot Commencement (t.he expiration date is 1 "),
fr?m the date of recording unlee',JIt,ciif,f~?ent date is specified.)
D. l- . H G 30 .. /07- - /-{ 0 r -z, e rp . (
_" ......,~: PlUi I' ,\' :;)~ T' ,,,-~.' ,.,.-,..., -'. ...- - , ,
dl 'j
t ';ignature of OWner:
'~worn to and
-t' \OL1VW.NA
19 crs .
, " ;,: 1: J. ,i~':' .c ,,':(
c :-'1! C: t 'j.
," ,/
JUDrrH l. SCHAPER
Notay PutJIjc, Slate of FlaIIda
No. CC 292357 "
'lot.;ary Public;
"Y Com,m~ssion,Expil;'e~H,' I,
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