HomeMy WebLinkAbout96-5596
BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit Jl!
(813) 788-6611
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Date
Property Owner:
Job Address:
Parcel 1.0. #
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Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Zoning:
Description of Work
FINAl_ '2,..2
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
c.o. _
DATE
Valuation or ~ AJ. '2 U'O. '?'~
Contract Price rr eX' _ OJ
.
Permit Fee
Signature
Company
Address
Telephone#
Inspector
City License Registration # l/'f r/
State Certified License# (l/J 6) ;; ~ 9 'I
BUlL
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.
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER' S NAME
tf 'n'1
/J1o~K. (.1/
PHONE 7.$$ - S-6 17
OWNER' S ADDRESS S t; 2 Z
8'1).,
Sr
JOB ADDRESS
.5 .n W'\ L
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL LD.' / /- z (; - 21 - 0010 - 12000 O(S; 3 (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition --1Uteration ~epair _Install
_Sign
-.JIove
_DeJIOlish
PROPOSED USE: _Single Faaily
----1J./ F
_' of Units ----1J./H
_ec-ercial
_Indust.
_Swia. Pool _Other
_Restaurant &: Health Departaent Approval
DESCRIPTION OF WORK: I--srkJl/ J2 tt/i ~ {.
/t/L
,
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
~UILDING
$ ~J 3tJO
Valuation of Total Construction
_ELECTRICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
--.JIEClWlICAL
$
Valuation of Mechanical Installation
_PLotIBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUcnON: _Block _Fraae _Steel
Other
FIllISBED FLOOR ELEVAfiORS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
..........................................
CONTRACTOR SECTION
BUTT .DEll
COMPANY
State Cert. or Regist. t
City License Registration .
..........................................
Signature
RT.RCTRICIAR //
Sionature &L '---f C~___~
COMPANY C~A.--LJE / /
State Cert. or Regist. .
City License Registration .
..........................................
d7.L
PLUMBER
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
tlECllAHICAL - COMPANY 131'1 H If!. ~ h, jd.lf- ~ G A,.s' -e ~ .:r A./t:: .
/7/ / d ~ State Cert. or Regist: f CA~ 6'1:3 q ("II
Signature ~~~ ~ City License Registration # /7
~ ..........................................
OTRRR COMPANY
State Cert. or Regist. ,
Signature City License Registration ,
..........................................
APPLICATION APPROVED BY PERMIT OFFICER.
. . CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'1'be undersigned understands that tbis pemit lilY be subject to -deed restrictions- wbich lilY be lOre restrictive than City
regulations. '1'he undersigned asSUles responsibility for CCIIpliance witb any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tbe owner has hired a contractor or contractors to undertake wrk, tbey laY be required to be licensed in accordance witb
state and local regulations. If tbe contractor is not licensed as required by law, botb the mmer and contractor lilY be
cited for a .isdl!lM!allor violation under state law. If tbe mmer or intended contractor are uncertain as to wbat licensing
requirl!leDts lilY apply for tbe intended wort, tbey are advised to contact tbe City of Zephyrbills Building Departlent, (813)
788-6611.
Furtbel'lOre, if tbe owner bas bired a contractor or contractors, be is advised to bave tbe contractor(s) sign portions of tbe
.Contractor Sections- of tbis application for wbich tbey will be responsible. If JOU, as tbe owner sign as tbe contractor,
you are indicating that you, ratber than tbe contractor, are responsible for tbe IIOrt. If tbe contractor wishes you to sign
as contractor tbat lilY be an indication tbat be is not properly licensed and is not entitled to perlitting privileges in tbe
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 witb a copy of -Florida's Construction Lien Law - HCIIeOIIJler's Protection
Guide" prepared by tbe Florida Departlent of Agriculture and COnsUler Affairs. If tbe applicant is SOIeODe otber than the
-owner., I certify that I have obtained a copy of tbe above described dOCUleDt and pro.ise in good faitb to deliver it to the
.owner' prior to COlleDCl!leDt.
E. CONTRACTOR'SjOWNER'S AFFIDAVIT
I certify that all tbe infol'liltion in tbis application is accurate and tbat all IIOrt will be done in cu.pliance witb all
applicable laws regulating construction, zoning, and land developleDt.
Application is hereby lade to obtain a pemit to do IIOrt and installation as indicated. I certify that no IIOrt or
installation bas ~ced prior to issuance of a perIIit and that all IIOrk will be perfoI'led to Het standards of all Ian
regulating construction, City codes, zoning regulations, and land developElt regulations in the jurisdiction. I also
certify tbat I understand tbat tbe regulations of other goveI1lleDtal agencies lilY apply to tbe intended 1IOl'1t, and that it is
If responsibility to identify what actions I lUSt take to be in COIpliance. Such agencies include but are not 11litec1 to:
I Departlent of EnvirOllleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDleDtally Sensitive Lands,
Water /Wastewater '1'reatlent
I Soutbvest Florida Water HanageleDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
I AIIY Corps of Enqineers - Seawalls, Docks, Navigable Waterways
I Departlent of Healtb i Rehabilitative Services, EnviroDleDtal Healtb Unit - Wells, Wastewater '1'reatlent, Septic rants
I US EnvironleDtal Protection Agency - Asbestos abatl!lellt
I also certify that, if fill .aterial is to be used in Flood ZOne "A- or "A,etc.", it is understood tbat a drainage plan
addressing a -COIpeJlSating volllle- will be sublitted which is prepared by a professional engineer registered in tbe State of
Florida prior to pemit issuance.
A Perlit issued shall be construed to be a license to proceed witb the wrt and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor sball issuance of a pemit prevent tbe Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit i88uec1 sball becoIe invalid
unless tbe IIOrk authorized by such pemit is COIIeDced witbin six IODtbS of issuance, or if work autboriled by the pel'Iit is '
suspended or abandoned for a period of six IOntbs after tbe tile tbe IIOrt is c~ced. One 90 day ateDsion of tile, lily be
allowed for tbe {)emit witb fee charge of $15.00. '1'be extension sball be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sillODtb period, or tbe project will be considerec1 abandoned.
WARHIHG '1'0 lMfER: YOUR FAILURE '1'0 RECORD A NO'1'ICE OF allMDCEIIIR'1' HAY RESUL'1' IN YOUR PAYIlfG '1"IIICE FOR IIIPROVIIID!S '1'0 YOUR
PROPIR'l'Y. IF YOU III'1'BIiD '1'0 OB'lIIH FIWCIlfG, CONSUL'1' WI'1'H YOUR LDDIR OR 1M A'l"l'ORDY BlF01IB RICORDIHG YOUR DICE 01
COHHIIfCEHEH'l'. JOBS UNDER $2,500 Ilf VALUE DO NO'1' NEED '1'0 RECORD AND POS'1' A 'NO'1'ICE OF COMMEHCEIfEH'l'I.
SIGHAflJRE: OWIfER OR AGE1ft'
SIGlfA'1'URE: CON'l'RACfOR
S'1'A'1'E OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me t.his , 19____ by
S'1'A'l'E OF FLORIDA
coum 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)
(Hame Typed, Printed or Stamped)
HOTARY PUBLIC
(Hame Typed, Printed or Stamped)
HOTARY PUBLIC
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