HomeMy WebLinkAbout96-6054
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N! - ~-605.13
s--~ -. tTlJ
Date
r-:L/ -9&
BUILDING
..2 (). (J7)
ELECTRICAL
"'
:.2-0 . cYU
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
:~::::~s~~~ };~~ h~'1
Parcell.D. # _ ___
Zoning: Energy COd~ ~ Radon Gas:
Description of Work ~ J~ r p -Ajl .-dAA.Jl..v~"7 . {?A1..Ak...t.',,(../'L..P--
Water Meter:
T.I.F.'s:
NO OCCUPANCY BEFORE C.O.
FINAL /tJ- - C;~
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Pe,mlt Fss ~
Valuation or g' (J-iTtJ. c:rD ~ ~
Contract P,lcs ~ ~~;:::~ / - ~~~~f
City License Registration # / y..s--b Address 59/)/ &,;?;1~~UC W~
,~~lfISd Ucsnse# .s . Tslephone# /~_3S~5-/~3Y
J:]';;L1Jt:A->/f;..~ p~ >>kl 2l:A//707 Y~l/", ~A!o ~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
F' al
Driveway \SC>t.>D q~~-q0 &B
M--u.t ~,- 2-5- ~ It 6~
Ftr. -9 - S -qh Bof>
Pre SLB q - q:; - q lc So.B
Lintel
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
FRM.
Insul. CL
WL
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
(jJz& !lVD JJllfIlL/{ tllIJC J
~55'57 fJ /) AI T/ ;<I/-m;) ~Jt/ t/t!
JOB ADDRESS $5'7 1I!/IV12...Alt$u /)//f/e
LEGAL DESCRIPTION: LOT;S) &:;-
OWNER'S NAKE
PHONE 108&. ~/';)t OFFICe
OWNER'S ADDRESS
BLOCK
SUBDIVISION
. 5/LtlBt tJ/f;(j
PARCEL 1. D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration ~epair _Install
_Sign
_Move
_Deaolish
PROPOSED USE: _Single Faaily _K/F , of Units _M/D
_eo-erdal _Indo.to (!%)va. Pool _Oth.r
_Restaurant & Health Department Approval
. . (
/Nf1/lLL S/d/l1Jm/JJI- mL f BietojO/lE
(
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet.
Height
RESIDERTIAL:
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.
~UILDING
$
'8c2J1 oJ
PERMITS REOUESTED
Valuation of Total Construction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_KECBAIIICAL
$
Valuation of Mechanical Installation
_PL~ING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FDUSHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUTIJ)ER
COMPANY
WJJ t?tJ '1::ZJu )
State Cert. or Regist. t t ~
City License Registration t
******************************************
::: ~COIIPAlIY DOlflAlh/
. State Cert. or Regist. t E R K'.J 70
..- -.Ii. City Lic..... Registration f 11':::. /7 ~7
' ****** ***********************************
Signature
v
PLUMBER. COMPANY ~
State Cert. or Regist. t
Signature City License Registration .
******************************************
COMPANY
State Cert. or Regist. t
Signature City License Registration t
******************************************
OTRRR COMPANY
State Cert. or Regist. I
Signature , City License Registration I
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this penit lay be subject to "deed restrictions" which laY be lOre restrictive than City
regulations. The undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tbe owner bas hired a contractor or contractors to undertake work, tbey 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 lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building DepartJent, (813)
788-6611.
FurtherlOre, if the owner has hired a contractor or contractors, he is advised to bave tbe contractor(s) sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than tbe contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to penitting 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 Construction Lien Law - HOIeOIDer's Protection
Guide" prepared by tbe Florida Departlent of Agriculture and Conslller Affairs. If the applicant is soeone other than the
'owner", I certify tbat I have obtained a copy of the above described docUlent and prolise in good faith to deliver it to the
"owner" prior to cOlleIlcelent.
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 developllent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation has COIIenced prior to issuance of a penit and that all work will be perfoned to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developllent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveIDIental agenCies laY apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
* Departlent of BnviroDlental Regulation - Cypress Bayheads, Wetland Areas and BnvironJentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water Managelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* Departlent of Health & Rehabilitative Services, EnvirODlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
* US BnvironJental Protection Agency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "An or "A, etc. n, it is understood that a drainage plan
addressing a .cOlpeDsating volllle" will be subtitted whicb is prepared by a professional engineer registered in the State of
Florida p'rior to perlit. issuance.
A perlit issued shall be construed to be a license to proceed witb 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. Bvery penit issued shall beCOle invalid
unless the work authorized by such perlit is co.nced within six IOnths of issuance, or if work authorized by the penit is
suspended or abandoned for a period of sixlOnths after the tile the work is couenced. One 90 day extension of tt.e, laY be
allowed for the penit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOnth period, or the project will be considered abandoned.
WARNING TO 0IUfBR: YOUR FAILURB TO RBCORD A NOTICB OF COMMENCBMlNT MAY RBSULT IN YOUR PAYING nICB FOR IMPROYIMD'lS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AnORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCBMlN'i'. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICB OF COMMENCIMD'l".
7
STATB OF FLORI~
COUNfY OF W/1/#,.(jaJ
The foregoing in~trument was acknowledged
before me this /57'~J'#r/lrll- 191L by
(Name Typ , prinZ~ ;rtl d)
NOTARY PUBLIC ~......tiSiON~"'lq
~ t.t::......~ '.
~ .~1:v.ta ~ '~
=!~ T6 ~*=
=*:. .... e.. =
- · 067 $-
~~ ~ ICe 511 :~fE
~<?.. ~ ~..lfJ~
~"'..o.'.~-: ~.....~.....,~
~ ;'1'" ..", n-\lI\9';.~'~
~~ ,O,:.!........:.c. \)'~
111,.~LIC St~~",:\,\:
~""'''Hm''\'\'~
snnop~ ~
COUNTY OF :u\ tt.A~
The fore oing ins ent was acknowledged
before me this . , 19~ by
. ,... D
who is ersonall
produced
as identification and who did/did not
t~an OiIth. ~ f5,
~L ~'~.I-u" ~~
(SIgnature)
'il!e
(Name Type ~~
NOTARY P~ !to' ~... Apr 22.2000
"'''t OF f\."~
OWNER'S NAKEt.'~7v.....~ ...,?v1~/I~ O.;1QvC /'
(
OWNER'S ADDusUi5-d7' ~7 ~~ ~
5~
< t) A g'/I't AJv 5-<.O..;;L
APPLICATION FOR PERMIT (f)'uV4l. , ~ ~ wi (fO
CITY OF ZEPHYRHILLS '. J<-/ L.~1 J
BUILDING DEPARTMENT . AJ ~ ~
W. ,j/*
<P~NE ;
S>/u ~ /JA~ ~~L ~
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S) ? ~
BLOCK
SUBDIVISION S't /o~,. ~
PARCEL 1. D. t
(OBTAIN FROK PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
_Sign
----.JIove
_Deaolish
PROPOSED USE: _Single F8Jlily
_KIF
_' of Units _K/H
_eo..ercial
_Indust.
_Swia. Pool _Other
_Restaurant &: Health Departaent Approval
DESCRIPTION OF WORK: ~/ ~,.~ ~a..~~~
BUILDING SIZE: 2. (I X 30. ~ Square Feet. 7 Height
RESIDENTIAL:
COMMERCIAL
ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORKS.
ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
~CllARICAL
$
Valuation of Mechanical Installation
_PL~ING GAS ROOFING
TYPE OF CONSTRUCTION: _Block _Fr8JIe _Steel
SPECIALTY
Other
FIRISHED FLOOR ELEVATIONS:
FT.
IS PROJECl' IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUlI.DER
COMPANY
State Cert. or Regist. f
City License Registration t
******************************************
Signature
F.l.RCTRlClAN
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
SitmAture
PLUKBER
COMPANY
State Cert. or Regist. .
City License Registration ,
******************************************
Signature
10
KECHAHICAL
COMPANY
State Cert. or Regist. t
City License Registration .
******************************************
Signature
OTHRR ~~...,...,~.5; ,~ COMPANY ~_~ a ,-.L)
. ~ ~ State Cert. or Regisi': t' K..}l.. lk> t/'1 ;J...cr3
Signature ~~ City License Registration' /pS"f
******************************************
,./-
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that tbis perlit lay be subject to "deed restrictions" wbieb lay be lOre restrictive than City
regulations. fbe 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 owner and contractor lilY be
cited for a lisdeteanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills 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" of this application for which 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 tbe work. If the contractor wishes 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 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 Construction Lien Law - HOIeOWDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and Conslller Affairs. If the applicant is sOleene other than the
"owner", I certify that I have obtained a copy of the above described docUlent and prOlise in good faith to deliver it to the
"owner" prior to co..encelent.
E. CONTRACTOR'SjOWNER'S AFFIDAVIT
I certify that all the inforliltion 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 perlit to do work and installation as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be perforted 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 governtental agencies lilY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Sucb agencies include but are not lilited to:
i Departlent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treatlent
i Southwest Florida Water Managelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
i ArlY Corps of Engineers - Seawalls, Docks, Navigable Naterways
i Departlent of Health & Rehabilitative Services, EnvirODleDtal Health Unit - NeIls, Nastewater Treatlent, Septic Tanks
i US EnvirODleDtal Protection Agency - Asbestos abatelent
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 uCOlpensating volllle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida ~rior 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 shall issuance of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCOle invalid
unless the work authorized by such perlit is cOllenced 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 ~enced. One 90 day extension of tile, lilY be
allowed for tbe perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOnth period, or the project will be considered abandoned.
WAIUIING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMERCEMENT MAY RESULT 1M YOUR PAYIMG fiICE FOR IHPROVEMmS TO YOUR
PROPERTY. IF YOU INTERD TO OBTAIM FIMAIICIMG, COMSULT WITH YOUR LEMDER OR AM AnoRRKY BEFORE RECORDIMG YOUR MorICE OF
COMHEMCEMKMT. JOBS ORDER $2,500 1M VALUE DO MOT NEED TO RECORD AND POST A "NOTICE OF COHMEIfCEMKNT".
SIGMAfURB: OWlfER OR AGEIfT
SIGMATURE: COIfTIIACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STArE OF FLORIDA
COUNTY 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
~,.,...."
.- .., ..' ..
.::..', .:....
Brtiko Enterprises, Inc~
Tomotrow's Technology Applied Today
CONTlU\CTOR
JOB f
Date Form Received Complete B-€3- 7~ i
Signature of Acceptance
w../-lP c(J;o.Gla/ . O~/;
Job Name Subdivision S~/~
Legal Description Lot G'~ Dlk Unit PI~~
lV?"
Sect Twn Rnge
Job Location Loy
city 5),/ / ~J-
8's- db ..,t7~ :i)y- Date needed by:
It:' ,().4 County
Customer Phone
Quoted price::;rt::J':;' OS '
"
(If quoted please attach contract)
other
.
other
Gi~.~ No
Color
Insul
. .
Chairrails: Yes~ No
Florida Glass: Yes No
- -
K~ckplate: Yes____ No____ Size:
Color:
Gutters:
Yes
No
-,
Super Gutter:
Yes
No
Directions to Site:
Additional Comments & Notes:
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SPRING HILL.. FL.34606
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