HomeMy WebLinkAbout96-6035
BUILDING PERMIT
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CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Nt} - 6035r3
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Date
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/7 ~ n' . /JwJjter Conn:
Pmpert'! Owne" LV, A ~. "i ~4-jtif3 8. ~ate' Mete,
Job Address: 3 q, / 0 -. ~c:y::.I1. T.I.F.'s:
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Parcel 1.0. # /~ -~&--.,:) /- 0 O~O -t:) 0 ~oo- 00 &,,'0
E~-'
M~-~ewer Conn
Zoning:
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FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Valuation or f (0 1;'0
Contract Price '
vD
,-
Permit Fee
Signature.
Company
Address
Telephone#
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City License Registration #
State Certified License#
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BUILDING
ELEc:r.aJe~C-'
....----
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PlUMBING.---,----
~
MECHANIC~-
~
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
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.
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OWNER I S ADDRESS' t .;.-- 1/ v'-
6-Z6
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APPLICATION FOR PERKIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
JOB ADDRESS ~
PHONE {PII .~ 9'b 3 .-11 L1 9>
2~//')1(1~>/~ /--=-~'; ~?J5'f1J
z f//;~ ~~ c..?Jt.5-' 0
~ '~~SION kp~ I II
(OBTAIN FROM PROPERTY TAX NOTICE)
OWNER'S N
LEGAL DESCRIPTION: LOT(S)
PARCEL I. D. t
WORK PROPOSED:k:,New Construction _Addition ~teration _Repair ~lnsta1l
_Sign _Move _Deaolish
PROPOSED USE: ~single F8IIily _M/F _' of Units _M/H
_~ercial _Indust. _Swia. Pool t/o the r
Restaurant it Health Departaent Approval
/1._ . L 1/ {....-' It . // ~~. /
DESCRIPTION OF WORK:'/f"flCc.- (jCt.U\ / q/'cf '1;( ~Jt'n
BUILDING SIZE: X Square Feet, Height
RESIDENTIAL :
COMMERCIAL :
ATTACH (2) PLOT PLANS it (2) SETS OF BUILDING PLANS it (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS it (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKITS REOUESTED
-LBUlLDIRG
$
Valuation of Total Construction
_ELECTRICAL
AMP Serv'ice
Florida Power Corp.
W.R.E.C.
_HECHARI'CAL
$
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fr8lle _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
/
IS PROJECT IN FLOOD ZONE AREA? t/~
YES NO
****************************************..
CONTRACTOR SECTION
RIITI.DRR
Signature
COMPANY
State Cert. or Regist. t
City License Registration t
*.....****..........*....*..***..........*
R!.RCTRTCIAR
COMPANY
State Cert. or Regist. t
City License Registration .
*...****.*...**......**.*..**.*.....*.....
SiofUlture
PLUMBER
Signature
COMPANY
State Cert. or Regist. t
City License Registration f
**.***.****........*..**.**..**...........
..
HEGllARIGAL
Signature
COMPANY
State Cert. or Regist. f
City License Registration .
*.*.***.****..*.....*...*****.****..**..*.
OTRF.R
Signature
COMPANY
State Cert. or Regist. .
City License Registration t
***.*.***.***.***.***.**********.*....*.*.
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned understands that this perait JaY be subject to Ideed restrictions" which JaY be lOre restrictive than c-1ty
regulations. 'be undersigned assUles responsibility for COIpliance 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 O1fJler and contractor laY be
cited for a lisdeteanor violation under state law. If the O1fJler or intended contractor are uncertain as to wbat licensing
requireaents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
788-6611.
FurtherlOre, if the owner has hired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
nContractor Sections I of this application for which they will be responsible. If you, as the O1fJler sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
as contractor that lay be an indication that he 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 - HOIeOWDer's Protection
Guide" prepared by the Florida DepartMent of Agriculture and Consuaer Affairs. If the applicant is sOlSOne other than the
'01fJlerR, I certify that I have obtained a copy of the above described docuaent and prOlise in good faith to deliver it to the
"01fJler" prior to cOlleDceaent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all tbe inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a perait to do work and installation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a pertit and that all work will be perforted to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governaental agencies JaY apply to the intended work, and that it is
IY responsibJlity to identify wbat actions I lUst take to be in cOlpliance. Such agencies include but are not litited to:
t DepartJent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater freatJent
t Southwest Florida Water Hanageaent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t Aray Corps of Engineers - Seawalls, Docks, Ifavigable Waterways
t DepartJent of Health & Rehabilitative Services; EnvirODJental Health Unit - Wells, Wastewater freattent, Septic ,ants
t US EnvirODJental Protection Agency - Asbestos abateaent
I also certify that, if fill laterial is to be used in Flood ZOne "AI or "A, etc. " it is understood that a drainage plan
addressing a 'cotpeDsating volute" will be sublitted wbich is prepared by a professional engineer registered in the State of
Florida prior to perait. issuance.
A pertit 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 perait prevent the Building Official frOJ thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued sball beCOle invalid
unless the work authorized by sucb perait is COIIeIlced within six IOnths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of six IOnths after the tite the work is cOllenced. One 90 day extension of tite, lay be
allowed for tbe pera~t with fee charge of $15.00. !be extension shall be requested in writing to the Building Official. An
approved inspectiODlUst be logged during each six IOnth period, or the project will be considered abandoned.
WARlfING '1'0 OWNER: YOUR FAILURE fO RECORD A IfOfICE OF COHMEIfCEllKlf'l' MAY RESUL! IN YOUR PAYING nICE FOR IHPROVEIIBIft'S !O YOUR
PROPERn. IF YOU IJft'EIfD !O OBlAllf FlIfAlfCING, COIfSUL! WIrH YOUR LIlfDER OR All AnomY BEFORE RECORDllfG YOUR DICE OF
COMMENCEHEM!. JOBS UNDER $2,500 IIf VALUE DO If Of NEED '1'0 RECORD AIfD POST A "NOfICE OF COMMEHCEIIKIf'I'".
SIGJlAtURE: OWNER OR ACEM!
SI GJlA'fURE: COM!IIAC'I'OR
S'I'A!E OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19 by
---.,.-
STATE OF FLORIDA
COUNn' 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
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