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Home My WebLink About96-6125 BUILDING PERMIT N! Permit CITY OF ZEPHYRHILLS (813) 788-6611 - ...6125 E Date 9-bL6 -9& BUILDING ~ PLUMBING MECHANICAL Sewer Conn Water Conn: P,"perty Owne" ~ - M Job Address: ,~~ .... {iLzJ Water Meter: T.I.F.'s: Parcell.D. # Zoning: Description of Work jrgy Code: {U ~~ Radon Gas: ~h::t;, A;~ :t;;-, ~~r 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 P~rmit Fe~ I o-v ~ SlgnattJre __ () _ Company Address Telephone# Q Valuation or Contract Price f/A- City License Registration # / r tJ.3 State Certified License# BUILDING IV ~-A i~~ M -(jt;:: ~ ELECTRICAL PLUMBING 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 ($15.001 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 ~ - m/t-IZT PHONE -Zlo -938 - '-.so-S OWNER'S ADDRESS 510c vJ BIG".. e.E.AuEr'L R-D JOB ADDRESS 7422 ~u.... 6/vD Tn-oi I rYll <../ '6 0 'B "" LEGAL DESCRIPTION: LOT(S) BWCK SUBDIVISION PARCEL 1. D.' . ~ z. S- 2 I 00 J o. 07 2.CO CO 10 (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPOSED:_New Construction _Addition V Alteration _Repair _Install _Sign _Move _Deaolish PROPOSED USE: _Single Faaily _K/F _, of Units _K/H ~eo..ercial _Indust. _Swim. Pool _Other _Restaurant & Health Department Approval DESCRIPTION OF WORK: Af)o <:.cxx..-et2... CI/2..t2.urrs. J2..e..LDCA-\E. 11\ \'Sc.... D/~'-AY<:; BUILDING SIZE: x Square Feet. Height RESIDENTIAL: COMMERCIAL ATTACH (2) PWT 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 -6"LEGTRICAL $ Valuation of Total Construction '6-^\S\\~ AMP Service Florida Power Corp. W.R.E.C. _HECBARICAL $ Valuation of Mechanical Installation _PLUMBING GAS ROOFING SPECIALTY TYPE OF CONSTRUCTION: _Block _Fraae _Steel Other FINISHED FLOOR ELEVATIONS: FT. IS PROJECT IN FLOOD ZONE AREA? YES NO ****************************************** CONTRACTOR SECTION BUILDER COMPANY State Cert. or Regist. , City License Registration . ****************************************** Signature LECTRI IAN COMPANY Ho/Z/ZON E~ :E:::::C~.L:1UeL f) - -- - State Cert. or Regist. # ~7,r;;8. 1 City License Registration # /9 0 ~ ****************************************** PLUMBER COMPANY State Cert. or Regist. , Signature City License Registration # ****************************************** MECHANICAL COMPANY State Cert. or Regist. # Signature City License Registration , *************~**************************** OTRF.R COMPANY State Cert. or Regist. , Signature City License Registration # ****************************************** APPLICATION APPROVED BY PERMIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this peClit 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 the owner has 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 1Iil' be cited for a lisdeaeanor 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) 786-6611. 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 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 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 DepartJent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the "owner", I certify that I have obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the "owner" prior to couenceJent. E. CONTRACTOR'S/OWNER'S AfFIDAVIT I certify that all the inforlation 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 hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or installation has cOBenced prior to issuance of a perlit and that all work will be perforled 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 governJental agencies aay 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: * DepartJent of EnvironJental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands, Water/Wastewater TreatJent * Southwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses * ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways * DepartJent of Health & Rehabilitative Services, BnviroDlental Health Unit - Wells, Wastewater treatJent, Septic tanks * US BnviroDlental 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 "cOJpensating volUle" will be sublitted which is prepared by a professional engineer registered in the State of Florida prior to per.it. issuance. A peClit issued shall 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 peClit prevent the Building Official frOl thereafter requiring a correction of errors in plans, construction, or violations of any code. Bvery peClit issued shall beCOle invalid unless the work authorized by such perlit is cOlleDced within six IOnths of issuance, or if work authorized by the peClit is suspended or abandoned for a period of six IOntha after the tile the work is cOllenced. One 90 day extension of tile, laY be allowed for the peClit 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 OWNBR: YOUR FAILURB TO RECORD A NO!ICH OF COHMEHCEMElfl' MAY RBSULT IN YOUR PAYIHG !VICE FOR IHPROVBHBlfl'S TO YOUR PROPERTY. IF YOU INTBHD TO OBTAIN FIHANCIHG, CONSULT WItH YOUR LENDER OR AN AtTORNEY BBFORB RBCORDIHG YOUR IIOTICH OF COHMEHCBHElfl'. JOBS UNDBR $2,500 IN VALUB DO HOT NBBD TO RECORD AND POST A "NOTICE OF COHMEHCBHBlfl'''. SIGNATURE: OWffBR OR AGElfl' SIGHATURE: COlfl'RACtOR STATE OF FLORIDA COUII'rY OF The foregoing instrument was acknowledged before me this , 19____ by STATE 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 City of Zephyrhills Building Department 5335 Eighth Street Zephyrhills. Florida 33540 (813) 788-6611 Wm. A. "Bill" Burgess Director of Building, Licensing, & Zoning j\ IIgusl 27, I q'l(i Rc: K -1\Im t RcnovalioJl Slme fl3]6 I /ephyrhills, FIOlida To '"Vhom II !vIay COllCCI1I: Thelc will he Ilo building pCllllit rcqlliJ('d onlhis plOjecl as no SllllClmal work is beillg done, The (\llly perrnils & Icgislmliol1s requiled will he f(H the electrical wOIk. If' allY questiolls. please call R I}- 7XR li611. 7 aliI. .. ."i P,IIl. ~';illrcrely . Q~'d~~ I' olwI t L. Y OlllllallS ElecfJ icallnspecfor 8>. Code Elllc)]celtlcnt Oflicer City of Zephyr hills Ii I, Yibs -------------.--.--- _ _....0.......-.._.--....._""-, ._.-......-._. a~ STATE OF FLORIDA AC#3 9 9 3 11 4 _ Department of Business and Professional Regulation "-.~.~..!~ C8 -C052216 06/08/1996 95902920 CERTIFIED BUILDING CONTRACTOR ~f~~P~6~~iKt ~~~~r.6p~l~iO~NC IS CERTIFIEr) under the provisions of Ch. 4 8 9 . FS. Expiration Date: A U G 3 '1, 1 9 9 8 ~ 00 5i, ~ I aA?-!t ~OP' ()/;.e-- c-~f 7' L~)~ w~ ~);~ 10 ~13 /ff;J-SJ/16- . -........ r Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. ~- Name and address of Insured. LI BE RlY lit. MUTUALiPJ I I I I I I This is to Certify that I Staff Leasing, L.P., Staff Leasing II, L.P., Staff , Leasing III, L.P., Staff Leasing, IV, L.P., Staff Leasing V, L.P. tj 600 301 Blvd., West, Suite 202 I Bradenton, FL 34205 ~ Is at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their teims, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be ~iSSUedp~' 180 EXP. DATE I CONTINUOUS TYPE OF POLICY 0 EXTENDED i w:;O:L1CY NUMBER ___ I [SCI POLICY TERM --r-- COVERAGE AFFORDED UNDER we: 'I I 1-1-97 W A 1-650-004110-296 LAW OF THE FOllOWING STATES: WORKERS AL, AR, AZ, CA, CO, CT, COMPENSATION I i I LIMIT OF LIABILITY GENERAL LIABILITY D CLAIMS MADE IRETRO_DATE __I D OCCURRENCE DE, FL, GA, IL, IN, KY, LA, , , Accident MO, MI, MN, MS, MO, NC, Bodily Injury By Disease NE, NH, NM, OK, PA, SC, $1,000,000 Policy , ; limit TN,TX,UT,VA Bodily Injury By Disease $1,000,000 Each Person General Aggregate - Other than Products/Completed Operations Products/Completed Operations Aggregate _._~-- , Bodily Injury and Property Damage Uability Per I Occurrence Personal Injury Per Person! Organization Other rer__ , , EMPLOYERS LIABILITY Bodily Injury By Accident $1 000 000 Each AUTOMOBILE LIABILITY I I HIRED k~--- - - OTHER EMPLOYEES lEASED TO: I l-= . Each ACCident - Single Limit B.1. and P,D. Combined -~- Each Person --~-------_. - - Each Accident or Occurrence --- -----~_._---"-_.._- I Each Accident or Occurrence - -----~--__t----__+ ------------- I I I I I . ~--- !-.l_ EFFECTIVE DATE: OWNED NON-OWNED L i :.r F.,:!'. (c.:r'-l:::; I f-:{..!i__ .J ()I\~ U! 1':, ()t:.\/ll_Cl~)I\'!Lr'~'f i T l\;i~.,. " The above referenced Workers' Compensation policy provides statutory benefits only to employees of the Named Insured(s) on the policy, not to employees of any other employer. . If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However you will not be notified annually of the continuation of coverage. ' ~~Ef~~b~~~~~.g~l~iLE~NX ~ElJ~0~0~~2N~~H ~~li~~ b~ g~~~~~Pv~~T~~~~ENN~ ~~^Ju7Ms Jtf~~U~~1~8lF~~e~~ AGAINST AN INSURER, SUBMITS Liberty M u tu al G rou p NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF A T A f-H Yf~H J L ~~ ~-----~ cmrmrr t<<Jrn:R f:;. ~:~ ~j :::; [T r.; I"." J' 1--1 OJ" ~<: t.~, E Linda Mielke AUTHORIZED REPRESENTATIVE Orlando/508 (407) 862-8111 (:: ~,:~",/ 1. < .- ";, t'. .Z f~'.}:) 1-1 \/ F.' r-; J L, C r~' L_ . ~< -_~ ::; 4 () OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Companies BS 7721. (FL) I / I