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BUILDING PERMIT
N, O.
Permit
CITY OF ZEPHYRHILLS
(813) 788-6611
,~ 6(19)f
Date 7-3/ -7 b
BUILDING
ELECTRICAL
PLUMBING
~H~:~S'W" Conn
Water Conn:
Pcoperty Owne'~ ?!JrtrLi ~L
Job Address:,- <:) 9___ __~ _
Parcell. D, # .J tJ -~ 6 ,;;./ - t? //0 "'- (J r9 6J 0 0'" CJ /-6 ---0
Zoning: Energy Cgd:lJ Radon Gas:
Description of Work y c.... ~A-'L(f-.1?--
Water Meter:
T,I.F.'s:
NO OCCUPANCY BEFORE C,Q,
FINAL
C.O.
sa_z/-
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances,
Inspector
DATE
r:1ScJ f3
Permit Fee ~ ~
s;gnatu:f__ n ?"it~
Compan
Address
Telephone#
Valuation or
Contract Price C2 9.s -y: o-v
/
City License Registration # /r7
State Certified License#
BUILDING
ELECTRICAL
PLUMBING
~d.4 A),-
MECHANICAL
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SL8
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 PERl'lIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
,-.-
0~c~'stA-lC.+ ft +:}. ., ~.' --- ,.,
ADDRESS /J (Q (J! A b!uz Dr. b;J .J!,A!sJQS:
OWNER rriZu:J<.rd <? Lie g u"
JOB LOCATION S1{J!.f For-~<:t L.a..n.e
, '
0".-
. ~<--...,\<:<~,
_' ~iuNEC:.. oJ ~ .>..L ( -
D '-'!2()
'.
LOT SIZE_X
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D,I~ /O-u2..G.-..2./- 0)/0-00000- 0150
WORK PROPOSED:____New Construction ____Addi~ion ____Alteration ____Repair ____Install
____Sign/Temp.
_Sign
____Nove
____Demolish
PROPOSED USE: ____Single Family
_M/P
_t~ of Uni ts
,,_M/H
_Commercial
_Indust.
_Swim. Pool
Other
_Restaurant & Health Department Approval
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 FORtIS. ,~*
**COPY OF CONTRACT REQUIRED,
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
~MECHANICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
$
Valuation of Mechanical Installation
.'" ,
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: FT,
******************************************
Signature
CONTRACTOR SECTION
Company
State Cert. or Regist. 0
City License Registration n
******************************************
}nnLDER
Si!!nature
Company
State Cert. or Regist. n
City License Registration n
******************************************
ET.ECTRT GlAN
Signature
Company
State Cert. or Regist. i!
City License Registration n
******************************************
PLUMBER
Signature
Company Ja.C;\( S' A-I C ~'++-ks '
State Cert. or Regist. i! eft Co <j{()..c)...O
City License Registration j~ /1?1
******************************************
OTHER
Signature
Company
State Cert. or Regist. i!
City License Registration 0
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER,
l~
..,.'-.1-'.."."'" -""'"
~.. .. f ~l." - ...- "',
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. !';;~'Ifc -.'. ,.. '0
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CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
-
Tht undtrsigntd undtrstands that this pertit tay be subject to "deed restrictions" whi(h may be more restr,ictive than City
regulations. The undersigned a5suteS respon5ib~1~tY;for"colpliance w~th any applicable deed restrictions,
.'.j/t. ' ,
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tht owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
stlte and 10cIl regulat~ons, If the contractor is not licensed as required by law, both the owner and contractor ~ay be
cittd for a lisdeteanor violation under state law. If the owner or intended contra(tor are uncertain as to what licensing
rtquirelents lay apply for the intended work, they are advistd to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furtherlore, if the owner has hired a contractor Dr contractors, he is advised to have the (ontra(tor(s) sign portions of the
.Contractor Sections' of this application for which they Hill be responsible, If you, as the owner sign as the contra(tor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contra(tor wishes you to sign
as contractor that lay be an indication that he is not properly li(ensed and is not entitled to per&itting privileges in the
City of Zephyrhills.
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 Constru(tion Lien Law - HOleoHner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuter Affairs, If the appli(ant is sOle6ne other than the
"owner', I certify that I have obtained I copy of the above describad dDcument and promise in good faith to deliver it to the
'owner' prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be done in (oapliance with all
appli(able laws regulating construction, zoning, and land development.
Application is hereby aade to obtain a perlit to'do work and install~tion as indicated. I certify that no work or
installation has cOltenced prior to issuance of a pertit and that all work will be performed to meet standards of all laws
regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. 1 also
certify that I understand that the regulations of other governmental agencies ~ay apply to the intended ~ork, and that it is
IY responsibility to identify what actions I must take to be in COMpliance. Such agencies include but ~le Iic.t lillited to:
. .,J.;
I Department of Environmental ReQulation - Cypress BayheadS, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treatment
f Southwest Florida Water. ManaQelent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses
. Arty Corps ~f EnQineers - Seawalls, Docks, Navigable Waterways
. Departtent of Health ~ Rehabilitative Services. Environmental Health Unit - Wells, ~astewater Treat~en~. Septic Tanks
. US Environmental Protection AQenc~ - Asbestos abatement
I also certify that, if fill laterial is to be used in He.od Zone "A" or "A,etc.", it is understc,c,d tli~t a drainage plan
addressing a 'colpensating volule. will be sublitted which is prepared by a professional engineer reqi51~ied in the State of
Florida prior to per.it issuance.
A pertit issued shall be construed to be a license to proceed with the work and not as authority to yioI~te, cancel alter, or
set aside any provisions of the te(hnical codes, nor shall issuan(e of a permit prevent the Building Official frolft thereafter
requiring a correction of errors in plans; construction, or violations of any code. Every permit iss\l~d :hall be(Ole invalid
unless the work authorized by such permit is (~Iienced within six months of issuance, or if Hork authof Ized by the perlit is
suspended or abandoned for a period of six lonths after the ti,e the work is commenced. Dne 90 day e~tE~5ioll of tile, lay be
allowed for the per~it with fee charge of $15,00. The extension shall be requested in Hriting to the Building Offi(ial. An
approved inspedie,n must be lClgged during each six month period, or the prc,jed Hi 11 be cc.nsidered Clbci\,dc.ned,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
WN'ft-iR AGEN SIGNATURE~~~:Y~/
vA yC- ,~ t -.J, _/.
'5'j?i '1\ATE__ri~-"-c:1F-.~----
. )- 2.3- 9t:.[/
NOTARY AS nY, '/~'
OWNER OR;~~~--~~
MY COMMISSION EXPIR9~ 1'i,:-"'-~~~"---""
~' State 28 ,.,
i " My c<,mm. ElCP. J~...:.
=" COMM ICC DIU';>'
DATE____J.--:.~-=-!:i-~----------------
NOTARY AS T<;Y-)". f ./-) {)f 1A
CONTRACTOR_~'t~,..sd..~~~-"::"'_-~:"''': ~
MY COMMISSION EX~lVAEC~~;f,-~qi~~~.l-
NOTARY PUBLIC, STATE OF FLORIDA
My Commission Expires May 29, 1999
Commisslon No, CC 467880
~\'\Jl' WORK ORDER
. '", JACK'S C~n,#CAC04122U
AlR CONDITIONING & HEATING DATE
/1<irfr~1 i..: Ve S..... ~
TO:
12601 Abbey Drive · Dade City, FL,3:t525.
24 Hours · (904) 521-0420
?-Q-9.
LOCATION OF JOB S 9 0 'I' h ..,.. ~ l' i'
.
Z... o~v'yhj IL~. J='/..
, 1" ,
.,(..Jl-lr
7B8' /'8 '7'j
We propose to furnish all labor and equipment (license and permit when necessary) for complete installation, to be tested and ready to operate
at location above.
We have carefully analyzed your equipment to be of sufficient capacity to produce design conditions according to Florida Energy Code High of
91 Q outdoors temperature and 78Q indoor temperature, Building must be kept reasonably tight, windows and doors kept closed except for
normal passage of persons and properly insulated (minimum of 6 inches thick), '[3 r7 ~ Vi.. T ife~'/- J?<..-> nL r
Eqipment includes: /
1. Air Handler with: S- KW: MO# Fir '-I ( N rOO 0
2. Condenser Unit' t ~ 3 (J X c>:L 'I S,E,E,R, I ~<./ C.O,P./HSPF .8
3. Thermostat MO.' /' B R N Ii P 0 J - /'j .:::::::- ::::-
4. SUDDly-Grille & RAE x; oS ?" ~ (,'
5.
6.--t;:z~~ ~~;~~tl ~;-::: ~t't/~' ~d~ ~ ~y~~~
7. ;t , ~, ~ 1....- I ) H ~ III ~ .,) \- ~oJ
8.
9. /?c.J1 t? c c:..
10.'
11.
12.
13.
14.
15. ...; 5
16,
17,
18.
19. i-J..J yo r ." rt. -1 ..../
~~: ~~ ~~~:
22. J t~~
23. Option: Insulatio - ';4
Total BTU's ~ ~i ~QD
~n~~c C' X. /.:S~~'7
,
/....... ~../ r~-',... ~.-~..J
. '"'
77\.r I'HU:"'':>~ ~ 0 -;L d- i1j;; v ~ rL r ~ ~ / ( ~s .s o/'t!..c) 7l-e.i?,
.'" ~~' ,Lao., r
C~,..c..k.h.fC'- ~'~s~/I ;.It"'~
~. c; CGl,/ /1 C' '",.,..... ~ J." ty ..- '" ~ 4::;. v P)" 1
H.1' ~~II!?M$"~r
( . 'rt ) -r-~
('1<.(,.. k,--. .J~~)~I J'--f~'~Ul.. ,-. {'le,.!-.- trl1uc7$ ;T;.:,.' ..>/r k.Jks, rc~"c::
~'~c<r~.(. ' N~ ~V('<'":.;:~~.~tE::>;f ?r;c,,_ :~1~~~
4~S8-
~~:I(;:eSJ~ r
~ oJ ic r
F A)~;~~ "
24. Up-Grade Service Yes 0 No 0 Size- Amps- Hit
25. Existing Ceiling-Damage 0 Yes 0 No ,It! A
Duct work will be deSigned, Fabricated and installed in accordance with Amencan Society of Healing & Air ConditIOning Engineers Standards of ~:s (' c FvV..!.;t) ':}
Supply and return regIsters and gnlls Will be properly Sized and of alummum, (
LIMITED WARRANTY AND SERVICE:
All equipment. materials and controls furnished by us has a l~ear warranty from the date of installation against defects in workmanship and material. In addition we IXt8nd to you
the manufacturersjfyr, protection plan on the compressor, Our one year service responsibility does not include breakdowns of Air Conditioner due to blown fuses, tripped brlaUrs.
dirty tilters or plugged drain lines, Warranty service will be performed during normal working hour~ of 8,00 a,m, to 5:00 p,m, Any request for service after 5:00 p.m. or on WIIIcandI
or holidays will be billed to customers at current billing rates of tljTle and one-half,
~ 0,::.>
For this service the purchaser agrees to pay the seller the sum of.26S-S00llars, including tax, Payable as fOllow:;:
-/;,~' r;S~~if;t.0 ~~/ d v '(:. __' ,Pricequotednotvalidalter30daya.
T~s order contains the entire agreement aNectmg this purClJase, No other agreement, understaOltmll or warranty has been made a part of this contract unless written herein.
"II this instrument is referred to an attorney for collection or enforcement, the maker agrees to pay a reasonable attorney's fee, plus court costs. If the maker is delinquent for a
period of thirty (30) days, A delinquent fee 011 1/2% per month will be charged, Title to the installed merchandise remains vested in the seller until all money due, as the result of
the sale has been paid to the seller, Your acceptance below will be our authority to proceed with the installation, Thank you for your business."
ACCEPTED DATE
~~f~
lIAW RUIIItIIfA1M
(L.S,) BY
VALID ONLY IF SIGNED BY COMPANY OFFICER
PURCHASER