HomeMy WebLinkAbout96-6164
BUILDING PERMIT N!
Permit
CITY OF ZEPHYRHILLS
(813) 788-6611
- -- 6164/1
Date
/0 -/..s~-9 b
BUILDING
ELECTRICAL
PLUMBING
~ANI~
Sewer Conn
Water Conn:
P,"perty Owne, Cu.; f::~7L~
JobAddress:M!i-!Z - _ -~
Parcel L D. /I .__
Zoning: . ... Energy C.Qde:
DescriP~i:n-ofn~~;k_'2fk CA- ~ J'fL
Water Meter:
T.I.F.'s:
Radon Gas:
FINAL -1.(
C.O.
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
Inspector
Permit Fee
Signature
Company
Address
Telephone#
-e . crD
-/ d-""(..
/'
Valuation or c2
Contract Price ___._~ l!:P.. . o--:v
City License Registration # / >-
State Certified License#
g///{~ .~
BUILDING
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 ($15,00) 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
OWNER'S NAKE C A If?. { L I ' V ( , / 'i IT. '
OWNER'S ADDRESS (; I if 7 2071, .s 7:
JOB ADDRESS .s' ;q n--r ~
PHONE
7<6'2-813/
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _A1teration _Repair _Install
_Sign
_Move
_Deaolish
PROPOSED USE: _Single Family
_M/F
_' of Units _M/H
_~ercial
_Indust.
_Swill. Pool _Other
____Restaurant Ii Health Department Approval
DESCRIPTION OF WORK: ~ e. K 2 }( , s r / :.- <7
/
~/c.
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL
ATTACH (2) PLOT PLANS Ii (2) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORKS.
ATTACH (3) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
---1.dfECHANlCAL
AKP Service
Florida Power Corp.
W.R.E.C.
$ 2 '1eo. co
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. t
City License Registration .
*************.**.*****..************.*****
Signature
ELECTRICIAN
COMPANY
State Cert. or Regist. ,
City License Registration t
*.**********************************.*.*.*
SiQfUllture
PLUMBER
COMPANY
State Cert. or Regist. ,
City License Registration f
*.*.**.****......****.*****.*****..**..***
Signature
MECHANICAL
Signature ~ /,6"~
~
COMPANY ,L3 ~ 1-1 ~..I.s /' It..tJ 7",If,.... 'i. 6"1..5 .e.. #/2
State Cert. or Regist. " C)l c: C v '59 ~c5"J '
City License Registration' / '7
************~***.*************.*.****.****
.J: ;v c.. ,
OTHER COMPANY
State Cert. or Regist. t
Signature City License Registration #
***************.****************.********.
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this peIlit 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 witb
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor tay be
cited for a lisdeteanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requiretents tay apply for the intended work, they are advised to contact tbe City of Zepbyrbills 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 wbicb 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 tbat be is not properly licensed and is not entitled to peIlitting privileges in the
City of Zepbyrhills.
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 sOleone other tban the
.owner", I certify that I bave obtained a copy of the above described docutent and prOlise in good faith to deliver it to the
"owner" prior to cOllencetent.
E. CONTRACTOR'SjOWNER'S AFFIDAVIT
I certify that all the inforaation in tbis application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land develo.-ent.
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 peIlit and that all work will be perf oIled 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 tay 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 litited to:
* DepartJent of Environtental Regulation - Cypress Bayheads, Wetland Areas and Environtentally Sensitive Lands,
Water/Wastewater TreatJent
* Southwest Florida Water Managetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
* AllY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* Departlent of Health & Rehabilitative Services, EnvirODlental Health Unit - Wells, Vastewater Treattent, Septic Tanks
t US Environtental Protection Agency - Asbestos abatetent
I also certify that, if fill laterial is to be used in Flood ZOne "A. or "A,etc.., it is understood tbat a drainage plan
addressing a .cOlpensating voluteN will be subtitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit. issuance.
A perlit 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 perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every peIlit issued shall becOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work autborized by the peIlit is
suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day extension of tite, tay be
allowed for the peIlit with fee charge of $15.00. Tbe extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOntb period, or the project will be considered abandoned.
WARNING TO OIUfER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT HAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTElfD TO OBTAIIf FINAlfCING, CONSULT WITH YOUR LElfDER OR AN ATTORNEY BEFORE RECORDIlfG YOUR NOTICE OF
COMMENCEMENT. JOBS UffDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWIfER OR AGBll'l
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUN'lY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUlfTY 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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