HomeMy WebLinkAbout96-6058
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N<<1 6058/'1
Date
T/ ;L'J--?,f,
BUILDING
~ANI~ewer Conn
- Water Conn:
",opertyOwne, ~ j~ ~
Job Address: .--s '- a "- J ~ _
Parcell.D. # J L;2 b -;)./ - t9 j)/ [) - c),?-c:J 00 - 0 i) 7 j)
, , .
Zoning: Energy Code: , Radon Gas:
Description of Work Lf1 &?..b,.) /1-/ L--
ELECTRICAL
PLUMBING
Water Meter:
T.I.F.'s:
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
City License Registration #
State Certified License#
''7
/
.
Permit Fee
Signature
Company
Address
Telephone#
~~~
~~dA
IV
Valuation or
Contract Price
'--Ke h't) Y~E C-+C !w.;L
.v1~-A/L
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Serv.
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 ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAME
C,</SS#flVnLI4
~oo,e~
PHONE I 7.8>0 - /06'7
OWNER'S ADDRESS S- 7 l :1
/8T~ ,5r
JOB ADDRESS .5 /Q ~ 1
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION
PARCEL I.D.t / / - 26 - 2/ - 00 Iii - 05'000 - 0070 (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ---J\1teration _Repair _Install
_Sign
_Move
_Deaolish
PROPOSED USE: _Single Faaily
_M/F
_' of Units _M/H
_~ercial
_Indust.
_Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: II\/.s T A / /
1/c
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
$
Valuation of Total Construction
_ELECTRICAL
AMP Serv'ice
Florida Power Corp.
W.R.E.C.
-'lECBANICAL
$ /So 0 . D C
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CORSTRUCTIOR: _Block _Fraae _Steel
Other
FIRISBED FLOOR ELEVATIORS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUTT .Dm
COKPARY
State Cert. or Regist. t
City License Registration t
******************************************
Signature
ELECTRICIAR
COMPANY
State Cert. or Regist. t
City License Registration t
******************************************
SignAture
PLUMBER
COMPARY
State Cert. or Regist. t
City License Registration f
******************************************
Signature
..
Signature
COMPARY ~,q H te (r ",oR o~ A ^"" ~ '''$ .e.1/~
~.L!t. / State Cert. or Regist. f C ACo'l~"f yS>
. a.A----- City License Registration t
******************************************
MECHANICAL
OTRRR
COMPANY
State Cert. or Regist. ,
City License Registration t
******************************************
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'I'he undersigned understands that this perait lay be subject to "deed restrictions" wbich Jay be lOre restrictive than City
regulations. 'I'be undersigned assutes responsibility for coapliance with I any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owDer has bired 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 JaY be
cited for a lisdeaeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requireaents JaY apply for the intended work, they are advised to contact the City of Zephyrbills Building DepartJent, (813)
788-6611.
FurtherJOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
'Contractor Sections' of this application for wbichthey 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 wisbes you to sign
as contractor that tay be an indication that be is not properly licensed and is not entitled to peraitting privileges in the
City of Zephyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, bave been provided with a copy of 'Florida's Construction Lien Law - HoIeowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUter Affairs. If the applicant is SOIeOne 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
Downer" prior to cOllBDceaent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in coapliance with all
applicable laws regulating construction, zoning, and land developaent.
Application is bereby lade to obtain a perlit 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 perforaed to teet 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 tay apply to the intended wort, 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:
* DepartJent of Environaental Regulation - Cypress Baybeads, Wetland Areas and Environaentally Sensitive Lands,
Water/Wastewater Treatlent
t Southwest Florida Water Hanageaent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
* Arty Corps of Engineers - Seawalls, Docks, Kavigable Waterways
* Departtent of Health & Qebabilitative Services; Environaental Health Unit - Wells, Wastewater 'I'reattent, Septic 'I'anks
t US Environaental Protection Agency - Asbestos abateaent
I also certify that, if fill laterial is to be used in Flood Zone "A' or "A, etc. ", it is understood that a drainage plan
addressing a .cOlpensating voluteD will be subtitted wbich is prepared by a professional engineer registered in the State of
Florida ~rior to pertit. 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 shall issuance of a per.it prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pertit issued shall beCOle invalid
unless the work authorized by such perlit is COIIBDced within sillOnths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of silaontbs after the tite the work is COIIBDced. One 90 day extension of Ute, JaY be
allowed for the perait with fee charge of $15.00. Tbe extension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during eacb six aonth period, or the project will be considered abandoned.
WARKING '1'0 omR: YOUR FAILURB '1'0 RECORD A KO'I'ICE OF COHMDCEMm HAY RESULT IK YOUR PAYIKG !VICE FOR IHPROVBIIEH'l'S '1'0 YOUR
PROPERTY. IF YOU IMlEKD TO OBTIIK FINAHCIKG, COKSUL'I' WIfH YOUR LBHDER OR AK A'l"l'ORKEY BBFORBRBCORDIKG YOUR KO'I'ICB OF
cOHHEKCEHEK'l' . JOBS ORDER $2,500 IN VALUE DO KO'I' NEED TO RBCORD AND POST A "KO'l'IcE OF cOMMEKCBMEMI".
SIGKATURE: OWIIER OR AGEK'l'
SI GKATURE: cOK'l'RAC'l'OR
S!ATE OF FLORIDA
coom OF
The foregoing instrument was acknowledged
before me this , 19 by
--
STATE OF FLORIDA
coum 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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