HomeMy WebLinkAbout95-5415
BUILDING PERMIT ---
CITY OF ZEPHYRHILLS Permit IT!
(813) 788-6611
~~5~1~ ;g
Date
//-~k'-9~-
0~IL~~ ELECTRICAL PLUMBING
P<operty Owne" .:;:;~1" t' ~ /J../h
Job Address: -5__ '- / ~ ~ ~,
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Parcel I. D. #
Zoning: Energy Code:
Description of Work~..o ;J,~
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
/2-
DATE
Complete Plans, Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Permit
Signatur
Company
Address
Telephone#
Inspector
~
Valuation or
Contract Price
IS 36 . o-u
./
City License Registration # 02/ra.
State Certified License#
~~JA//.M
BUILDING
ELECTRICAL
PLUMBING
-
MECHANICAL
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
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 PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S
N~f'\-1\~N.
~~Q4- \ b'~
~
OWNER'S ADDRESS
St-~&
,
PHONE
~Q~\rt~\Lll
,,'5- O~S
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
.:s~3>~ .tM"tt-*
PARCEL I.D.'-'\- "Z.b... 2.\- (J()\~ - z..\~ - ~'S~
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction -.Jddition ----^lteration _Repair _Install
_Sign
----1Iove
_Deaolish
PROPOSED USE: _Single Faaily
----111 F
_' of Units _M/H
_eo..ercial
_Indust.
_Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet.
Height
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
_BUILDING
$
, I S3~'~-4
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_MECHABICAL $
_PLUMBING
GAS
Valuation of Mechanical Installation
-*-ROOFING SPECIALTY
_Fraae _Steel Other
TYPE OF CONSTRUCTION:
_Block
FlRISBED FLOOR ELEVAnONS:
FT.
IS PROJEC'l' IN FLOOD ZONE AREA.,
YES NO
******************************************
CONTRACTOR SECTION
BUTT.nER
COKPANY
State Cert. or Regist. .
City License Registration
****************************************
/
Signature
::c:~
/ COMPANY
State Cert.
"_."-, City License Registratio
;I' *~.**~*.*******************************
PLUMBER:
COMPANY
State Cert. or Regist. .
City License Registrat
**************************************
Signature
OTHRR
Q
COMPANY
State Cert. or Regist.
City License Registra on'
************************************* ****
MECHANICAL
Signature
Signature
COMPANY ~u... C~~~A
State Cert. or Regist.' f2.c.3lnL.4-~
City License Registration # 2~ C
**************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this perlit lay be subject to Ideed restrictions I wbich laY be lOre restrictive than City
regulations. The undersigned assUJes responsibility for cOlpliance 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 wbat licensing
requirl!lents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtbeI'lOre, if the owner bas hired a contractor or contractors, be is advised to bave tbe contractor(s) sign portions of the
IContractor Sections" of this application for wbich 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 wisbes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to peIlitting privileges in the
City of Zepbyrbills.
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 - HOIeOWDer's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsUleI' Affairs. If the applicant is sOlsone other than the
lowner", I certify that I bave obtained a copy of the above described docUleIlt and pnmise in good faith to deliver it to the
"owner" prior to cOlll!Ilcl!lent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land develo.-ent.
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOlleDced prior to issuance of a perlit and that all work will be perforaed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDJental agencies laY apply to the intended work, and that it is
IY responsibility to identify what actions I lUst take to be in cOlpliance. Such agencies include but are not lilited to:
* Departlent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnvironJeDtally Sensitive Lands,
Water/Wastewater Treatlent
* Soutbwest Florida Water ManageleDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* Departlent of Health & Rehabilitative Services, EnvirORlental Health Unit - Wells, Wastewater TreatJent, Septic Tanks
* US EnvirODlental Protection Agency - Asbestos abateleDt
I also certify that, if fill laterial is to be used in Flood ZOne IAI or "A, etc. II, it is understood that a drainage plan
addressing a uc~pensating volUle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued sball 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 sball issuance of a perlit prevent the Building Official frOJ thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued sball beCOle invalid
unless the work autborized by such perlit is cOlleJlced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IODtbs after the tile the work is coaenced. One 90 day extension of tile, laY be
allowed for the perlit 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 six IODth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHMDCEMEIft' MAY RESULT IN YOUR PAYING TWICE FOR IMPROVBHBIft'S TO YOUR
PROPERTY. IF YOU IIft'END TO OBTAIN FlMAIICING, COIfSULT WITH YOUR LlHDER OR All A BEFORE RECORDING YOUR NOTICE OF
COMMBIfCEMBNT. OBS UNDER $2,500 IIf VALUE DO IfOT NEED 1'0 RECORD AND PO A "N E OF COHMDCEMBIft'".
STATE OF FLORIDA
coum OF
The foregoing i
before me this NOli. ~ 7 , 19Q.5' by
-Personally Known"
~
KATHY C. MONTIETH
Notary Public. State of FlorIda
My Comm. Exp. Jon. 3. 1999
431 1
STATE OF FLORIDA
COUIft'Y OF
The foregoing
before me this N~II. ;;l7
~
KATHY C, MONTlETH
Notary Public. state of FlorIda
My Comm, Exp, Jon. 3. 1999
1
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Phone # (904)567-858()
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