HomeMy WebLinkAbout95-5456
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit N!
(813) 788-6611
i-S45Q K3
Datei::l - J I ~ 9 ,S,-
~
PmpertyOwne, {kJjJ ~
Job Address;~ <. / 8 ... , (J
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter;
T.I.F.'s:
Parcel I. D. #
Zoning: Energ:~~
Description of wo;;-;?(..p ./L.{j"L/ tJ
Radon Gas:
FINAL I' 2-' z..o ,- . ,.
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Perm;' Fe ~
s;gn.'",~ _ - ~n~
Company
Address
Telephone#
Valuation or
Contract Price
db 7C). 0tJ
./
City License Registration # ~R.
State Certified License#
~.IprA
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SL~ j /
Lintel ltV1~ - 4)
1, 0'-
FRM. ,}'
InSUI.~~ ~ t (;..-
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 ZEPBYRHILLS
BUILDING DEPARTMENT
OWNER'SNAME
M~ "J~~ ~f\.Q'>>..A-~
~\S~ ~~ S~
O~~~
PHONE 78"2- 6c~S
l L~~t\~t.\-\ IWl.
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ~teration _Repair _Install
_Sign
_Hove
_Deaolish
PROPOSED USE: _Single Faaily
_H/F
_, of Units _H/H
_~ercial
_Indust.
_Swia. Pool _Other
_Restaurant Ii Health Departaent Approval
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS Ii (2) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKITS REOUESTED
_BUILDING
$ 3, <..c rC:> ..~
Valuation of Total Construction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
~CHANICAL
$
_PLUMBING
GAS
Valuation of Mechanical Installation
~ ROOFING SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FDITSBED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
F
YES NO
******************************************
CONTRACTOR SECTION
RITU.nER
COHPAIIY
State Cert. or Regist. f
City License Registrat' n .
************************************* ***
/'
Signature
=AR
/
/
COMPANY
State Cert. or Regist.
City License Regist ion'
********************************** ******
PLUMBER
COHPAIIY
State Cert. or Regi
City License Regi ration #
********************************* ********
Signature
MECHANICAL
Signature
COMPAIIY
State Cert. or Reg
City License Re tration'
****************************** **********
~~
Signature . -
~ COHPANY ~Mu... ~""'--,,,.~
..... State Cert. or' aeglst..' ~-e..~Slq l<-s..3
. City License Registration I 2Rc...
. ~...***************************.*****.**
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perJit lay be subject to "deed restrictions" which laY be lOre restrictive than City
regulations. Tbe undersigned assUJes responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has bired a contractor or contractors to undertake work, tbey 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 lisdeieanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requireJeDts lay apply for the intended work, they are advised to contact the City of Zepbyrhills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner has bired 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 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 be is not properly licensed and is not entitled to perJitting privileges in the
City of Zepbyrhills.
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 - HCIII!01fIler's Protection
Guide" prepared by the Florida Departlent of Agriculture and COnsUIeI Affairs. If the applicant is SOElne other than the
"owner", I certify that I bave obtained a copy of the above described docUJent and prOlise in good faith to deliver it to the
"owner" prior to cOllellcelent.
E. CONTRACTOR'SjOWNER'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, loning, 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 has COIIenced prior to issuance of a perJit and that all work will be perforwed to leet 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 goverDIeDtal agencies laY apply to the intended work, 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 EnviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and Environaentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water ManageJent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* DepartJent of Health & Rebabilitative Services, EnvirODJeDtal Health Unit - Wells, Wastewater Treatlent, Septic Tanks
* US EnvirODJeDtal Protection Agency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a 'c~sating volUJeR will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perJit 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 perJit prevent the Building Official ftal thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perJit issued sball beCOle invalid
unless the work autborized by sucb perlit is COIIBDCed within six IOnths of issuance, or if work authorized by the perJit is
suspended or abandoned for a period of six IOntbs after the tile the work is cOllenced. One 90 day extension of tile, laY be
allowed for the perJit with fee charge of $15.00. The extension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during each six lOoth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF C<JIMEMCEIlENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEHD TO OBTAIK FIKAIICIKG, CONSULT WITH YOUR LEHDER OR All AnoRIIEY BEFORE RECORDIKG YOUR KOTICE OF
COHHEKCEHEN'l'. JOBS UffDER $2,500 IN VALUE 00 NOT NEED fO RECORD AIID OT OF COMMENCEMENT".
}~. ~ CA~~~
SIGJlAtuRI: QlfftR OR AGHHT N...~ _ -JO '" h.~~ ........
STATE OF FLORIDA ~
COUNTY OF '-."C 0
The foregoing ~t~ent was acknowledged
before me this g , 19q~ by
Y\'~. ~~ ~~~~
whe is per Jm. U -Be O~ who has
produced Db#- ~ /5S-) 33-dD - (n(04~()
as identification and who 'd/did not
take an h.
STA'l'E OF FLORIDA ~
COUNTY OF -.IO\....8,.c D
The foregoing inst~ent was ackn~ledged
before me this / ~ ' 19 ~ by
~ McCart"
who is personally known to me er whe has
predaced"
as identification
take an
(Name Typed
NOTARY PUBL
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11250 South Hlghway 98, Dade Clty, Florida
F'I-IUIH;? # (904) ~'j67'-"8580
Bonded and Insured
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