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Home My WebLink About96-6099 BUIL~!~9Hy~!RM!! N! -63991( (813) 788-6611 PLUMBING J!;'.cfZ:> ~'~ Date 9-lb~Yh BUILDING ;20. eN) GT~ ~h Property Owner: /\ Job Address: ,..5 \. 0 (j i.~ Sewer Conn Water Conn: Water Meter: T.I.F.'s: Parcell.D. # Zoning: Description of Work Energy Code: A-It" (? A-d if << Radon Gas: Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. FINAL C.O. /0- NO OCCUPANCY BEFORE C.O. DATE Inspector Itf'~ Permit Fee Signatura Company Address Telephone# '.~- ~ <..-; <jr:V . /!.- J ...' /-- Valuation or Contract Price J L/ ~-O. o-v / City License Registration # State Certified License# BUILDING J~~- ELECTRICAL / ~6' / PLUMBING ~~(f &~a/ MECHANICAL Breakers Ducts Insl. Compressor Final SLB Tub Set Water Sewer Final Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter 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 PERKIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT JOB ADDRESS j}/ark , 6,jD~ tf9I:;:-I! ~~- - 0' () <j c""::j<l- // ?i;.' --- ~ ~ 1/ /) t-. c{ OWNER'S NAME fJ {} I-J PHONE 76.;: ~ l6~' ~- '/ OWNER'S ADDRESS LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL L D.' / (- ;)~ & - /) J - (0) C - 2. 0 B CJO -, 0 06 0 (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPOSED:_New Construction _Addition _Alteration ---.-:Repair _Install _Sign --1fove _Deaolish PROPOSED USE: _Single Faaily _M/F _, of Units _M/H _ec:-ercial _Indust. _Swia. Pool _Other _Restaurant & Health Departaent Approval DESCRIPTION OF WORK: C-- / r"l ' ~ ) .......- ""-" .I! /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 _ELEC'flUCAL ~ttECllARlCAL AMP Service Florida Power Corp. S 3 c.; 5 c~_ q;;~",;"t Valuation of Mechanical Installation W.R.E.C. ~UMBING GAS ROOFING SPECIALTY TYPE OF CONSTRUCTION: _Block _Fraae _Steel Other FIRISBED FLOOR ELEVATIONS: FT. IS PROJECT IN FLOOD ZONE AREA? YES NO ..........**...*..*.*...*.****..*****.*.*. CONTRACTOR SECTION Signature COMPANY State Cert. or Regist.' - ~(~ City License Registration , *.*.*******************.************ RUTT.DER COMPANY ~AJ NN State Cert. or Regist. . City License Registration , *..********.**.*********.***.***.********* Signature- ------- I L ) //( COMPANY /~7" /oJ S -<;,. (""0, vi". <? State Cert. or Re&ist.' 1PC)~2 City License Registration' .' / P-:;J" .**************.*.*****.*..***.*********** PLUMBER MECHANICAL COMPANY State Cert. or Regist. . Signature City License Registration . ..****.*..*~*************.****.*********** OTRRR COMPANY State Cert. or Regist. . Signature City License Registration # **.***.*******************..************** APPLICATION APPROVED BY PERKIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS Tbe undersigned understands tbat this pemit lay be subject to "deed restrictions" wbich laY be lOre restrictive than City regulations. rhe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner bas 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 laY be cited for a lisdeJeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing requireJents lay apply for the intended work, they are advised to contact the City of Zepbyrbills Building DepartJent, (813) 788-6611. FurtherlOre, if tbe owner bas bired a contractor or contractors, be is advised to bave 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, ratber 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 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, have been provided with a copy of "Florida's Construction Lien Law - HOIeONDer's Protection Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is sOleDne otber than the .mmer", I certify that I have obtained a copy of the above described dOCUlent and prOlise in good faith to deliver it to the "mmer" prior to cOllenceJent. i, E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify tbat all the inforlation in this application is accurate and that all work will be done in COIpliance 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 cOlleDced prior to issuance of a pemit and that all work will be perfolled to leet standards of all laws regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also certify that I understand that the regulations of other govlll1llental agencies laY apply to the intended IIOrt, and that it is If responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to: * DepartJent of EnviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands, Water/Wastewater TreatJent * Southwest Florida Water ManageJent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses * ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways * DepartJent of Health & Rebabilitative Services, EnvirODlental Health Unit - Wells, Wastewater rreatJent, Septic ranks * US EnviroDleDtal Protection Agency - Asbestos abateJeDt 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 volUle" will be subJitted whicb is prepared by a professional engineer registered in the State of Florida prior to pemit. issuance. A perJit 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 pemit issued shall beODJe invalid unless the IIOrk authorized by such pemit is couenced within six IOnths of issuance, or if work authorized by the pemit is suspended or abandoned for a period of six IOnths after the tiE the work is cOllenced. One 90 day I!Itension of t~, laY be allowed for the perlit with fee charge of $15.00. Tbe I!Itension 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. WARJUNG TO 0WliER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVIMINTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAHl FHIAlfCING, CONSULT WITH YOUR LENDER OR AI ATraUEY BEFORE RECORDING YOUR NOTICE OF COMMENCEHBNT. JOBS UHDER $2,500 IN VALU~ DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". ~ ~ nvtv/ SIGNATURI: OWNER OR AGENT ' . /-------------, / ,/ I' I / (~ - ,( /,' ,'..---,.." --___ ~ S~~ CONTRACtOR ..",..~.. Nancy A. Moody /~ l'"'f-.. MY cotIMSSION' CC5348lB EXPIRES :*1:~ FebnJaIY 21 2000 1IOIlllEI'MIl 'TllO'I'W 1NSlIIWlCE. IN!:, /-;' STATE OF FLOR~ coum OF ~ The foregoing instrument was acknowledged before me this 9 - /~ , 19 f!..iL by ~dY\. who is known to me or who has produc as identification and who did/did not take an oa~~ 0, >>1~4 (Signature) AI ~ ~ if / I k' a h c. v Q. /1 ~ .tJ <i. V (Name Typed, Printed(or Stamped) / NOTARY PUBLIC STATE OF FLOR!!>.A) COUNTY OF ~~ The foregoing instrument was acknowledged before me this 9 - / b , 19 Y 6 by ~ or who has who i produ as identification and who did/did not take an ~ J11 d24 (Signature~~' H 'J 01 Yl. c v A. CJ !) , L/ (Name Typed, Printed or Stamped) I NOTARY PUBLIC J-'~"'U"'~ Nancy A. t.tJody :~r'~~~ Mf COttMSSION' CC5348lI6 EXPIRES -: ~ : : FebIuluy 21 2000 ~~:UlAl - BONDED 11RJ 'TllO'I'AW INSURANCE. IN' 'IIfnl~ \"1';f..~:'f~".. Nancy A. M {::f'~'~~ MY COMMISSION # IT:. ~'~'~i February;;' ..'f"Rf.'t.-,~: BONDED THRU TROY Fi,' -Po. BOI'.-79b7P,g-~02(: 3,j",:)() Kins~y Central Heat & Air-Conditioning 7718 Fort King Highway . P.O. Box 2209 Zephyrhills, Florida 33539-2209 (81~) 782-2300 -7. ~--- ~'-""'- '--.-~- "'1"""- -------.---, .'. , 7.5'- 9/0 ? DATE OF ORDER DATE PROMISED ADDRESS APARTMENT CITY - IIOIl(L NATURE OF SERVICE ~ REQUEST o ESTIMATE o CASH /1, ,<.6 - ;J. / - 0:') 10 -,1. 0 "if C> () -&? HARGE Oc ~ SE~CE _PERFOR~. IJ.. $" A ((' 7c;-, < vI' , .- .J ;'V'i &,d". "( /?LI'/" -:f /u.,:,> E/t7f:,olJ/'~.?- ,- f ~ ~ c....J,~<< o i c () v ,~) /' (c. / ...J/t <' r - 7.. '1/-1 DATE ClMUlBl CASH :~-+ TAX TECHNICIAN" CUSTOMER'S SIGNATURE ~ ~