HomeMy WebLinkAbout96-5812
BUILDING PERMIT 0
CITY OF ZEPHYRHILLS Pernnit N ·
(813) 788-6611
~-5812JS
Date
....j--Y-7b
~~~ ELECTRICAL PLUMBING MECHANICAL
:::'::::ff~.B:J~ <.Pi!! ~(f~
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcel 1.0. #
Zoning: C~ Code:
Description of wor~ CT"'P - ~
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances,
Inspector
Permit Fee ~ '. cJi)
Signatu~ _____ .-e:..-
Company
Address
Telephone#
DAT~ \
WG.L\---
Valuation or
Contract Price ~,O $17. tT7J
City License Registration # J J7?
State Certified License#
~;I
(}it~prl JJl J.j ~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
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 NAKE ~wr~ UL- N\OC(\\t\<; S"~r
,
OWNER' S ADDRESS~ ~O L 60 (do", A J
JOB ADDRESS ~
PHONE I'X 2..-" J 4 1
:::LIIJ\\\S \ ~ 1'3> ~--y. I
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION J l~ ~('~ N\\-\-t?
PARCEL I. D.' (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ----Alteration 0epair _Install
_Sign
----.JIove
_DeIIOlish
PROPOSED USE: _Single Faaily
~M/F
_' of Units X-M/H
_eo..ercial
_Indust.
_Swia. Pool _Other
_Restaurant & Health Departae~t Approval
DESCRIPTION OF WORK:..f\\v..:~\ V\.~'-'~ ~v f -UL-'~-"'L (V\ ()b.~ t\o~_
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
_BUILDING
$ '~OLtq I ~
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
~GlWlICAL
$
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FIRISBED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
Signature~
CONTRACTOR SECTION
GOMPANYAd\Ja.t\W t'Y\obl"k ~~~ s-k.ms
/" / State Cert. or Regist. . <:::::-G-'- () 31.'l "7
0~ ;' City License Registration .
******************************************
RT.RCTRICIAN
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
SimlAture
PLUMBER
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
Signature
MECHANICAL
COMPANY
State Cert. or Regist. ,
City License Registration .
******************************************
Signature
OTRRR
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to 'deed restrictions. wbich laY be lOre restrictive than City
regulations. fbe undersigned assllles 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 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 lisdeJeanor violation under state law. If the owner or intended contractor are uncertain as to "bat licensing
reguirelents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections II of this application for wbicb 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 perlitting 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, have been provided'with a copy of 'Florida's Construction Lien Law - HOIeOKDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consl1ller Affairs. If the applicant is sOJl8One other than the
"owner", I certify that I bave obtained a copy of the above described dOCUllellt and pro.ise in good faith to deliver it to the
"owner" prior to cOllenceJent.
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, zoning, and land develoPEDt.
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 perfoIl8d 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 goveIDIeDtal agencies aay apply to the intended work, and that it is
IY responsibility to identify wbat actions I lUst take to be in colpliance. Such agencies include but are not lilited to:
t DepartJent of EnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater freatlent
t Southwest Florida Water HanageJeDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t AIlY Corps of Engineers - Seawalls, Docks, Ifavigable Waterways
t Departlent of Health & Rebabilitative Services, EnvirDDleDtal Health Unit - Wells, Wastewater freatlent, Septic fanks
t US EnvirDDleDtal Protection Agency - Asbestos abateJeDt
I also certify that, if fill aaterial is to be used in Flood Zone 'A' or 'A,etc.", it is understood that a drainage plan
addressing a uco.pensating volUle" will be sublitted wbich 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
reguiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall bea.e invalid
unless the work authorized by such perlit is cOlleDced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IOntha after the tile the work is cOlleDced. One 90 day extension of tile, laY be
allowed for the perlit with fee charge of $15.00. fbe 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.
WARlfING TO 0WlfEIl: YOUR FAILURE TO RECORD A 1f0000ICE OF COMHEIfCEIIEIft' HAY RESULf IIf YOUR PAYllfG DICE FOR IMPROVEIIDfS fO YOUR
PROPERTY. IF YOU IIft'EIfD TO OB'l'Allf FIIIBCING, COIfSULf WItH YOUR LINDER OR AIf AftORDy BEFORE RECORDllfG YOUR 1f0000ICE OF
COHMEIfCBHEN'r. JOBS UNDER $2,500 IIf VALUE DO If 0'1' NEED fO RECORD AIfD POSf A 'IfO'1'ICE OF COHMBIfCBHBlft'II.
SIGlfATURE: OWNER OR AGEIfT
SIGIfAfURE: COIft'RACfOR
STATE OF FLORIDA
coum OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
STAfE OF FLORIDA
COUIft'Y 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)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
CONDITIONS OF PERMIT AFFIDAVIT
A. ,NOTICE OF DEED RESTRICTIONS
. The undersigned understands that this perlit lay be subject to ~deed restrictlonsW whicb lay be lOre restrictive than City
regulations. The undersigned ass~es responsibility for co.pllance with any applicable'deed restrictions. .
l
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
slale and local regulations. If the contractor ls not licensed as reguired by la., both tbe owner and' contracto~ laJ be
cited for a lisdeaeanor violation under state law. If the ONDer or Intended contractor are uncertain as to what -lIcensing
reguireaents lay apply Cor the intended work, they are advised to contact tbe City of ZepbJrbills Building Departlent, (813)
780-6611.
FurlheClore, if lhe Ollner has hired a conlraclor or contractors, be Is advised to have the contractor(s) sign portions of the
"Conlraclor Seclions" of this "applicatlon for which Lhey wUI be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible Cor 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 perlitting privileges In the
Cily of Zephyrhllls.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CII...APTER 713, FLORIDA STATUTES" 'AS AMENDED)
I certify that I, the applicant, have been provided kith a copy of wFlorida's Construction Lien Law - ROIeOWDer'. Protection
Guide" prepared by the Florida DepartJent of Agriculture and Consuler Affairs. If the applicant 18 sOleone other than the
"ownerW, I certify Lhat I have obtained a copy of the above described doculent and prOlise In good faith to deliver It to the
"owner" prior to cOllenceaent.
E. ~ONTIU\CTOR' S/OWNEn' S AFFIDAVl'l'
1 cerlify lhat all the inCor.atlon in this application is accurate and that all work will be done in COIpliance with all
applicable laws regulating construction, loning, and land developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. 1 certlf, that no work or
installation has co..enced prior to Issuance of a perlit and that all work will be perforlea to leet standards of all laws
regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. 1 allo
certify that I understand that the regulations of other goverDlental agenciel laJ Ippl, to the intended work, and that it Is
.y responsibility to identify what actions I lust take to be in cOlpllanee. Such agencies include but are not 11.lted to:
. Deparllent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and Bnvironlentalir 8ensitive Lands,
, WaterfNaste.ater !reatlent
. Southwest Florida Water Hanageaent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
. ArlY Corps of Engineers - Seawalls, Docks, lavigable Waterways
. De~rtlent of Health , Rehabilitative Services, InvirORlental Health Unit - Wells, Vaste.ater !reallent, Septic Tanks
. US RnviroDlental Protection Agency - Asbestos abateaent
I also certify that, if fIll laterial is to be used in Flood Zone "AW or "A,etc.w, It is understood that a drainage plan
addressing a "co,peusatiny volUle" lIill be &lib.Itted iiliicb is prepared hi a pHlfa3siom:l 2::g!1l~!!r regi!lter!!d !n the State of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed wilb the work and not as authority to ,lolate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of anJ code. Ivery perllt ilsued sball beCOle Invalid
unless the work authoriled by such perlit is cOllenced within six IOnths of issuance, or If work authorlled bJ the'perllt is
suspended or abandoned for a period of lix IOntha after tbe tile the work is cOllenced. One 90 da, utenslon of tile, laJ be
allowed C~r the perlit with fee charge of $15.00. The extension sball be reguested In writing to the Building Official. An
approved Inspection lust be logged during each 8i. IOnth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RICORD A 10TlCE OF C(JfIfBICKHBNT MY RESULT II YOUR PAYING Y1IICl FOR IlfPROVlIIBlTS fO YOUR
PROPERTY. IF YOU IIlTRHD TO OBTAII FINAIlCIIlG, COIBULT WITH YOUR LBHDER OR All AnORRBY BIiFORI RRCORDIIfG YOUR IOTICI OF
COHHENCE"!NT. JOBS UNDER '2,500 IN VALUE DO lOT NEED TO RICORD AND POST A 'NOTICB OF COHHBNCEKBNTi.
-.-1
V~~Q~v-
SIGNIITURK: OWHKR OR AGK
~#A~
IlATURE: COlI MOOR
STATK OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this '/ - 9 ' 19 ~ by
H {r H-M L . 1-1,cJ f.JL-A--lf
who is personally known to me or who has
produced
as identification and who did/did not
ta n olJtb.
SHIRLEY I. JOHNSON
Notary Public, Mecosta County, MI
My Comm. Expires Jan. 12, 1999
Nor. CHERYL NOWlNS~
~y PUBUC STATE OF FLORID4
MMISSION NO. CC~S4717' -
_ ~ONEXP.MAY17,1999
~"
I
AlVIS, Layout Sheet
C UST<)~ E R ).1411)/',:,'1'';'",___, ?J,.~~I"..tV-"t~S!~-&/<.:;:;'~c."Y
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Address: /' d V '''- ~ (i, 1,/ 1/\
City: ':~P/:lV'A?J//L C S State
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EVERYTH~ PR9MISED ~S PART OFT ,H I !;tCO NTRACT IS COVE RED I N ~H E ABOVE.
CUSTOMER Signatur ;q:::~n.-c{ ~~~~/<-.< Date_ p?/ ,3'#6"
/"
ADVANCED MOBILEHOME SYSTEMS CCC042787 CGC033977
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-.;,\. , ~~'I>.,'" \' Onvi.!. 10'1. PHONE: (:105)474-5345
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I COMM. NO. I AnV ANCED MOBILEHOME SYSTEM~
I I 941 S,W. 8th Slreel
oq. ~~ 95 Pompano Beach, Florida 33069-0028
~
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.... ~ - 1 (1"( - 1 r I ~ 'WI r J L" 1.d1.
{ ..
INSTALLATION AGREEMENT
Rcrn'b~
CG C033977 CC CJ\4E81 ,.., Ir} , '
Buyer OWNER: J..JWr61lde ///oL/lJ'I,v6--Si/~ Date4L-19% Phone # (C!!/3) '18'.2.-0/7"7
no. ? /' ,~II~tJ,r- -:?~~JIJ/fl .J.edLl
Address: 7'-'" 07....- CreOL., /lIt, City: ~,/Ty~j7; ~ Zlp.=?.3S-~ Lot#__Park tplll/r,es;e~ l'fH~
County p#Seo Home-Own V"Rent Land-Own RenL t.-"R'P #
/ .~ -:J ~ I
Address ~ -"7:aS- /d-?"vf) ./~
(out of Florida). /-<>-J'CIT . / Cl"\ ,1~Clty:GIC-,eH/AS State /1/% Zip ~.?3:J7 Phone # ~ 7,96' - %~ y
. ./ (out 01 Florida'
AMS III, INC. ("AMS") proposes to furnish all materials and labor for the lob(s) specified below:
~OOF JOB DESCRIPTION. Install Weather-Lok- Roof system (Pat. #4,548.002), consisting of 2" Polystyrane Insulation and .024" aluminum roof with
baked white enamel finish, over existing rool. Remove and ,eplace fan & plum I g vents. This does not include gas appliance stacks.
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ADVANCED MOBILEHOME SYSTEMS
AMS III, INC
13764 W Rena Drive '-.,' ~ f) ~ r
Largo, FL 34641 If
CONT.. NO.
TARA2224
/:CIJr6J /'l. 7C
PRODUCT
: , ,
SOURCE '
D Check here only if space above is insufficient for complete specifications, description of work. or materials. Any additional specifications or plans are
attached to and incorporated into this Agreement.
AMS requires a 30% non-refundable deposit, payable when this Agreement Is executed, but may at its option vary said deposit. The entire remaining
balance is due upon job completion. All of the work to be completea as described above for the sum of:
TOTAL $ -rllbE-rJ7bV.5/h1/1J ro.ery PItH//' 4#..1 If (U.S. DOLLARS.) ('_ 80 -YtY', ? CI
SalesTax' / ~;<,93
TOTAL' ,~;:?8/.1i'3
Deposit Amount $ '7, ':J I, ~.3
Balance Due on Completion' ~.3 00 . CJ 0
A separate written warranty relating to the Weather-Lok- Roof system will be mailed when contract price is paid in full and a completed application for warranty
is received. A copy of the form of this warranty is available upon request.
AMS is authorized to furnish all materials and labor required to complete the work described In the above proposal, for which I/We agree to pay the fun amount
specified in said proposal, and in accordance with all terms of this Agreement.
THE UNDERSIGNED ACKNOWLEDGES THAT BEFORE SIGNING HE HAS READ, UNDERSTOOD, AND RECEIVED A COMPLETED, LEGIBLE COpy OF
THIS AGREEMENT AND OF EVERY OTHER DOCUMENT INITIALLED OR SIGNED BY ME DURING CONTRACT NEGOTIATIONS, AN.D AGREES TO BE
BOUND BY ALL THE TERMS THEREOF, INCLUDING THE TERMS AND CONDITIONS ON THE REVERSE SIDE.
This Agreement shall be binding upon the Buyer'S written acceptance hereof in the space provided below or upon the AMS's commencing performance. Upon
such acceptance or commencement of performance, this Agreement shall constitute the entire contract and be binding upon the parties hereto, there being
no covenant", promises, warranties, or agreements. written or oral, express or Implied. except as herein set forth or as created by applicable law.
NOTICE TO BUYER: THE TERMS AND CONDITIONS ON THE BACK HEREOF ARE PART OF THIS AGREEMENT.
(INIT.) x x EVERYTHING PROMISEDAS PARTOFTHISCONTRACTISCOVERED IN THE ABOVE.
RESPECTFULLY~~
ACC~PTED AND AGREED: r- By AMS REP. _iT ~~
~ /a.c-<.--'-L.v1A-" .tj _ bate:2. / / S-- 19.96 SOCIAL SECURITY .3 ~/,- 3 (,.) - (..)', b I
Date ~ / / ~- 19~ SOCIAL SECURITY # -3 t 10# .:..~ y,- ...5 d..;J '1