HomeMy WebLinkAbout96-5690
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BUILDING PERMIT--
CITY OF ZEPHYRHILLS Permit ]I!
(813) 788-6611
;-56908
Date
~-!2(/-76
,
ME~lr^b..
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
~ 3 q~
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
~f~
Permit Fee
Signature
Company
Address
Telephone#
Inspector
Valuation or
Contract Price
~ 3)/0,02-
,
PLUM
MEC
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
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 ($15.001 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 ZEPBYRHILLS
BUILDING DEPARTMENT
OWNER'S N~{l,~~() M\~ PHONE 7BB.. 7B~7
OWNER'S ADDRESS 533te '~a"""AA-~ l "ZEQH\IQ I.t\~ 'M....
~ t
JOB ADDRESS S~~
LEGAL DESCRIPTION: LOT(S) BLOGlL--SUBDIVISION
PARCEL I.D.' 12- 2(0- Z\- ~30 - 0:::>400 ~(OBTAIN FROK PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction ----Addition ~teration ~epair _Install
_Sign -.J(ove _Deaolish
PROPOSED USE: ~Single Faaily _KIF _' of Units _K/H
_eo..ercial _Indust. _Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant & Health Departaent Approval
~~OC~
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COHKERCIAL :
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
2, 340...~ Valuation of Total Construction
.
_ELECTRICAL
NIP Service
Florida Power Gorp.
W.R.E.C.
---1'IEGHANI.CAL
$
Valuation of Kechanical Installation
_PLUKBING
GAS
><
ROOFING
SPECIALTY
TYPE OF CONSTRUC'l'ION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJEct IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRAC'l'OR SECTION
BUT IllER
/
/
COKPANY
State Cert. or Regist.
City License Registr ion'
*********************************** *****
Signature
:.:::
/
./
COMPANY
State Cert. or Regis
City License Regis ation'
********************************* *******
PLUMBER
/
/
COMPANY
State Cert. or Re . t. .
City License Re
*******************************
Signature
MECHANICAL
Signature
/
'"
COMPANY
State Cert. or R
City License R istration'
****************************** ***********
()THRR G2J COIlPANY ScM~ 4k,\OI~(,..
State Cert. or Regist.' R~~S'<O"'b~
Signature -. - City License Registration , 2%~
.~~.................................
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'l'be undersigned understands that this perlit lilY be subject to .deed restrictions. wbieb lilY be lOre restrictive than City
regulations. !be undersigned assUJeS responsibility for co.pliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES ,
If the owner bas hired a contractor or contractors to undertake work, they lilY 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 ani contractor lilY be
cited for a lisdl!lleanor violation under state law. If the OlDer or intended contractor are uncertain-as to wbat licensing
requirelents lilY apply for the intended work, they are advised to contact the City of Zepbyrbills Builcling DepartleDt, (813)
788-6611.
FurtherlOre, if the OIner bas hired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
.Contractor Sections" of this application for wbieb they will be responsible. If you, as the OIIDer 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 lilY be an indication that be is not properly licensed and is not entitled to perlitting 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, have been provided with a copy of .Florida's Construction Lien Law - BoIeoIner's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUJer Affairs. If the applicant is SOJeODe other than the
"owner", I certify that I bave obtained a copy of the above described docuaent and prOlise in good faith to deliver it to the
"owner" prior to COIIeDceaent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforliltion in this application is accurate and that all wort will be done in COIPliance with all
applicable laws regulating construction, loning, and land developleDt.
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that DO work or
installation bas COJJeDced prior to issuance of a perlit and that all work will be perfoIJed to Jeet 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 goverDJeDtal agencies JaY apply to the intended wort, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Sueb agencies include but are not liJited to:
t Departlent of Ilnvirolllelltal Regulation - Cypress Baybeads, Wetland Areas and BnviroDleDtally Sensitive Lands,
Water/Wastewater 'l'reatJent
t Southwest Florida Water Manageaent District - Wells, Cypress Baybeads, Wetland Areas, Altering jatercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
t DepartJent of Health , Rebabilitative Services, EnvirODJeDtal Health Unit - Wells, Wastewater rreatJent, Septic rants
t US EnvirODlental Protection Agency - Asbestos abateaent
I also certify that, if fill Jaterial is to be used in Flood ZOne "A. or "A,etc.", it is understood that a drainage plan
addressing a "c~pensating volute" will be sublitted wbieb 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 frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery per.lit issued sball becoIe invalid
unless tbe work autborized by sueb perlit is COIIeDCed within sil IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of sil IOnths after the tile the wort is co.enced. One 90 day eztension of tile, lilY be
allowed for the perlit with fee cbarge of $15.00. 'l'be extension sball be requested in writing to the Building Official. An
approved inspection lust be logged during eaeb sil IOnth period, or the project will be considered abandoned.
WARNING '1'0 OWNER: YOUR FAILURE TO RECORD A NOIICE OF COHMBMCBMm' MAY RESULT IN YOUR PAYING !VICE FOR IMPROVEMBIIS TO YOUR
PROPER'I'Y. IF YOU INTEND '1'0 OB'I'AIH FIJIAIICING, CONSULT WIIB YOUR LBIIDBR OR All AftOIUIEY BEFORE RECORDING YOUR NOTICE OF
COMMEHC JO UJIDER $2,500 IN VALUE DO MOl HiID 'f0 RECORD AKD POST A MNOTICE ~COIIIDCKIIKJII..
~
S'I'A'I'B OF FLORIDA ~
COUMlY OF ~
The foregoing ins~ent was acknowledged
before me this :2> 2.e , 19~ by
I -
STATB OF FLORIDA ~ '
COlJII'I'Y OF ~~
The foregoing inst~t was acknowledged
before me this ~ ~ , 19 ~ by
who is p.!'rsonally known to me or who bas
produced
as identifi and who did/did not
take an <
who is ~ersonall v kno~ to me or who has
produced
as identifi ation
take an h
(Name Typed, Printed or Sta.ped)
NOTARY PUBLIC
t~~
'.D1Ui
KATHY C. MOMlETH
Nota'( Public, State of FIortc:Io
~ Comm. Exp. Jan. 3. 1999
No. CC 431231
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
~"'f .."
If ..
. 'il
KATHY C. MONTIETH
Notay Public. State of FIorlda
My Comm. Exp. Jan. 3. 1999
No. CC431231
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