HomeMy WebLinkAbout96-5623
BUILDING PERMIT
CITY OF ZEPHYRHILLS permit]l!
(813) 788-6611
:-56236
Date
~ -c2t -7' "
BUILDING ~~L~ PLUMBING
::~::,~.:,":~,ih~A ~3-:7~~
Parcell.D. #
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Zoning:
Description of Work
E~ ~ode: Radon Gas:
;;g,~-/ ,1; k/~
NO OCCUPANCY BEFORE C.O.
FINAL
3-
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
City License Registration #
State Certified License#
J ~ '..2....
Permit Fee
Signature
Company
Address
Telephone#
~~~ 'Zt~
Valuation or
Contract Price
~It
BUILDING
~jf~ ~-
, <f
ELECTRICAL PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Serv.
Rough In
Meter Can
Canst. 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.
FEB-23-'96 FRI 16:37 ID:
TEL HO:
1.l026 P01
. I ",' 'r' ", '.'
APP1.ICATION F01t PBRlUT
CItr OF ZEPHlRHILLs
bUILDIHG DEPARTMINT
OWNa's NAHB
OWDIl's ADDJtISs
Barbara Potoski
PHONI
715-9106
~617 23rd St.
Zephyrhi lIs, FL
JOB Al)DRB8S
tBcw. DISCIlIRTIONI LOT(S)
same
BLOCJL
SU8.PIVISION
(03TAltl FROM PROPD1'Y TAX )lonCR)
PARCEL I.D.'
WOJUC PROPOSBD:--Jew Construction ~ddltion --L.Altecation ---Repair
----.Staa.
Tift_tall
-Jlo\'e
--.J)eaolish
PROPOSED USB: ...l...SiG81e .P..11y
_eo.el't:ial
---1'I/F _' of Units ---Jf./B
_Indu8t. -Swill. Pool _Other
Restataraat II Uealtll Depar~ent Approval
Wi re for AI c wi th he at pump
)(
Square Feet.
Heiaht
DISOJUPl'IOR OF WOU I
BUILDIBO SIZ.II
USIDEIITIAL:
COlDIIKCIAL :
AttACH (2) PLoT PLANS Ie (2) SITS 01' BUILDIHC PLANS Ie (1) SET UBRQI' P01tMBa
.nAm (3) SITS OF BUILDING PLANS If (1) SBT EH8RGY FORKS.
PROIlRn suavn UQUIR.ED POA ALL NEW CONSTRUCTION.
PERMJ;TS RRQUISTIW
--8UILDlltG
$
, "
Valuation of Total Conatruction .
X RI.Rcntloo.
AIIP SenLee
Florida Power Corp.
W.R.B.C.
--.JmC8AIIICAL
$.
Valuation of Heels.nice1 InstallatiOll
---.l'UJII8IIC
GAs
ROOFINC
SPBCIALn
TrPB OF COISnuartOBI -Block _Pr.e _St..l
Other'
PIlISIIID n.ooa &LBYATIOlS:
PT.
IS PROJECl IN fLOOD ZONB AIlBAt
..........................................
YIS
-
NO
CONTR.CTOR SRCTIQti
BUIt.n1R.
a:l8D&tu~e
CDlPAIY
State C.rta or "'lst. . R6{9SS:i&ixxll!l~XCfCfN~lJU{
City Licease ael11tratioo .
..........................................
IQ."CTIltI:Tq
COHI'AHl' . uez Electric Cor oration
State Cart. or lellat.. EC000163 or
City License Relietration . l~L
..............................
PLUNRD.
Siaaature
COHPANY_
State Cert. or Iteatst. ._
Ci~y License RcS1stration .
..........................................
..
1IICIWi1c;61.
Sipaeure
COfU'ANY
State Cert. or Resist. . I
City License ResiatratioD f
..........................................
O'I'RRR
S:l8Dature
COMPANY
State Cert. or Reaist. .
Cltf License Reli8tration ,
..........................................
APPLICArION APPROVID It
rEIHI! OrrICD.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICB OF DBED RBSTRICTIONS ,
11Io ~ -tudo lIIot 1lI1, lllI!tlt 8IIJ' lie -8Ubloct to .0.... mtrleti...,. 1lllJ0II .., be lOtI nm-lcUre tIIa Clq
regulIUCIJ" fJJe W14enigaed 11111I81 responaJbUJty for COIpUanC8 lith an, appJiclble dnc1 restdcUOIII.
a. UHLICBJf,8ED COlt'l'RACToR8 11Im COlITIlACTOR !m8PON8IBILITIII:S
If lInl .... .... 11I1'1II · CCIIltractor or COOtr8Ctore to unmtale 110ft, IIIey 8IIJ' lie """'1'1II to be ~ II ...... ,11II
.tata IIIIIIloal IIgOJaU..... If tb8 ""'tn,tor i, ..t 11-.01 .. ttgIJ.... ~ lb. bollllllo _ ad CIIIbIctor ., III
cJtad ror .III~ 'lal.U... ""'" .tate I... Iflllo _r or l.tlDded ""'tractor III -.uta . to lIRt u-q
"""''-11"11' appl, ror lIIo lateode.lllOft. the, m ad,i..! to OOIIlIet lho CUyof Ie\lIlrrblllo IallIlat IlrtIrtat, l8l3l
788-6'11.
'.' ..~,.~
1'IIr~. Illllo ... HI bll'lll a ""tr..tar or coatractoCl. .. to IlIrIel to llan lInl OlIatractorl.IIl!lll (IIIrtlaq Of lII8
'CGitrllCtcr 18otMe' of 1lI1, QPJlraU", 10< IIblob lII8r 11111 be CIIJIOOIjbIe, II,.., . lIIo ..... 'IDe II lII8 0IIItrIcI0r.
"'" III loaaettag lIIot JIlII. dlll8r lIIoa lIIo ...trartor. ere _me lor lIIo 1IOCt, Iflllo 1IIIllr8Clor IIldeIIlIlI to Ilga
II alIIlnrIor tllat IOf lie .. loM..U", lIIal lis to nol PfOllIrly 1I0000llllllto 1101 ",UUed to ponttu.g lIrldJegoe IlIlIIo
City of ~fll..
I C. .TRANSPORTATION ~HPACT FEES Af\ID UTILITY CONNECTION FU!)
D. COJIIS'J'Rl/C'rIOlf LIElI' LlIN (CllAPTER 713, FLORIDA 8TATII'1'ES. AS AIIBIIDaD)
1 .....ulJ lIIot I, lh opplleaot, """ ..... _tOed ,11lI . coPr or 'florlGl'e CllaelluctJ", LI'" r.w . '"-er'. PIaUo:U",
Guide' P<\IIIItIII .., lh "0tldI iloportaoot or ~r1C1JIt... IIIlI Conwer Ifr.ln. If lIIo ",If eat II _ otIlor tIia lIIo
'-', I OIttlr, tllat I ..... -....0 · '"PI' of tile abon -lIlId ~t IIIll proaloa 18 IIl10ll flilll to d.U", It to tb8
.011I11'. prior to c:c.encennt.
E. COIITIlACTOR'S/PNlfb'S AFFIDAVIT .
I certlf, lII8t: III Us lDfomtIlIII III 1lI1a ....1I..UOll Ie a""rato 11IIII lII81 .11 1IOCt ,m be _ JO CIlI1I1'- ,ltIllll
applicable JM regulating coutruCUOII, lOlling, and land d.velGplent.
IIl(>lIratloa I. 8enbr """ to olllllll , PIl'IiI to do 110ft "'" 1lIatal1.1I.. II lodlrated. I c:orttfr tllat IIIllltt or
IIIItII~lillll ... - pd01' to I....... or . .....It iIlIlI that .11 1IOCt ,III be perlllllilll to _ 'lIOiIede of'lll ...
regulatlog ....lractl... Clt, ...... lGOlag regul.tl.... 8Id lIDO detelQpllaI regallll... III JIo lerfedlctlaa. 1 alao
rortlfJ tIIIt I aoderItIIIlIlfIat lh reguJall... or Olller go_tel ..eo "'l IPPlp to Us IlIleaded IIIlrl, ... lII8t: It I.
If ruponaJblUq to IdlllUfr Qat ICtJOIlI I .ost tate to be in cOIpUance. Such Ifenci.. laclude Ilat an DOt U.JtId to:
· D8Jertaen1 al...~ _laU... - CfprlllllarlJeade. Ifrtlllllllama IDO latI-lIIlf IIu.IU.. .,
later/lI.taaler rn'blat
t 8outhe8t rlor~ lIIna..t Dlatrlct .. Ifelll, c,pr... Ba,headl, Wetland Areae, Altering IIttrCOllrlel
· k.J eon. of j!j _ .. "aU., Doe." ."igable lIaterva,.
· I of 11II11I '1aIIINIltaU.. Senl.. IDYl_tal 1IeII1lIlIoIt - 11I11.. IaIlIIIter~. lottIaloW
· UlIDtl-W Pnteatloo ~ . IIIleIllIa ~t ,
I 01.. aertllr tllat, II fllJ .tld.1 ie to be UIId III ".... 1008 'A' or 'A. ete , '. It la lllIlIenIDld lIIot a dralaeat pi..
Illdrwblr · ''''''''Uog 1VIlw8' ,III be 8lIhIltted IIIIleII II P"1IIIIlI1lr a 1>lOflllllllltl eog/lIIIr revJatend Ii ilia ItIle of
Florida prior to perllt J.SUlllet.
A P!fIlt IIIlIId 811a1l !Jo .....trued tolls a II..... to PI'OC:OId .ltlllII8 rort iIlIlI 001 .. IlIlIIorlq to tlolatl. tIIICIllltlr. or
Ht ..Ide Illl' _1,111III of lIIo tIdlotJcaI 0llCIee. IIOr olIall I8euooee of . PIflIt _t tile IlIl1dbg Dftlclll ftlll tb8raarllt
rttalrlog · comctl", of ormn III pi.... COIIIlIuctJ.... or '1lIIaU... or IO, rode. ...., PIl'Iit 1_ 11II11 "'- IarIIId
11I1... lIIo 1IOd ..tllarl.... .., ..011 .....11 Ie -- .ilbia .1. IlIOtIIe or I........ or If....t ~ ., lIIo PIl'Iit I.
- 01' eIIaiIoIled lor · Jlltl"" Of IJJ IlIOlII8 after tbo tfIe lb. IlOlll. _. IIl8 10 dop ~ at tloa, ., lie
all.... lor tIIa pontt 1d1ll1ee dIaqe or 115.00. I'IIe atwl", IlIaII be r_tad III rrlUog to lII8 IlIlWor OfflalaI. III
approved IDIJl8CtjllJ lUSt be logged during tech 111 lOath period, or the project lill be COIIIhllr1l1 ~.
UIIIllID lIIIIII: IIDI fAILIIIIr ro IIlIaIID A iIIIIlCI OP COIIbCIltIIIr III' JIIlIIJ/,f IIIIIUII PAfIIlIlIIt:II fllIlJIIIlu".q I\lIDlll
PROPDn. If IOU IJ'J'DD to oml. FJlAlCIIfG, CONSULr IlfB YOUR LIIDII OR IIlftCIIIIr .. IICCIIDUQ IOIJR JOIICI 01
CXIIJIUCJJIur. J08B UlDIR '2,500 Iff VAWI DO lor lIED ro RBCORD UD POS! A 'alCl OF c:tIlIII'Cauur'.
f( ~
81GJllruU: omit OR AGllff
SrA1'1 or PLOIIlDA
coum 01
The foregoiDg instl'WD8Dt "'as acknowledged
before me this , 19 by
-
Sflfl or FLORIDA
COUI!Y OP HillsborouJZh
The foregoing iDstruaent .a8 aCMowledg8d
before lie this 2/26th , l' 96 by
'OTHtVLEl.{ f<,.. HHIVk./tJS \jk.~ .4Nb
~ E T r-J J<'.. ~ J-/-t; IV R {Q,f JE7-
vh Jper80nally knoiii:'to .. or who ba.
produced .... '"",,, ....~
a8 identification 8Dd"wbo did/did Dot
t an.oe.tb.
who is perlODally knOMn to me or who has
produced I
a. identification and who did/did not
tale an oath.
(Signature)
(Hame TYPed, Printed or Stamped)
NOTARY PUBLIC
<
<
(
(Hue Typed, 16296 ~
NOTARY PUSLI Of"'\) MyCommission xpireaOl/251OO (
. I 1-800-:J.NOTAltY - FJa. ~Sema.a:lIoadiDsCo. ~
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