HomeMy WebLinkAbout96-6292
BU-ILDING PERMIT N'
CITY OF ZEPHYRHILLS Permit-
(813) 788-6611
6292/
BUILDING PLUM~
Property Owner: ~ I 1_ L-.... Qrc:..e> c::;. A ru
Job Address: 'S ~ I ~ ~ T.!f ~". * ,
Parcell.D. #
Date
1/--- 2- ~ -9fp
MECHfAL
Sewer cL
Water (onn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
Energy Code:
Radon Gas:
)
4..R
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
r-7(
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
p~'m;tFe~~~
Signature
Company
Address
Telephone#
V/8-
/
City License Registration # 9 ~
State Certified License#
Valuation or
Contract Price
BUIL~
~
D ~~~
EL~tfRI AI(
P'-I"~1Blr4{3
r MCCIIANICAh--_..
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Driveway
Tp. Servo
Rough In Jz.....lt,./f~ .PAY
Meter Can 1/- zle -'1~_s
Const. Pole
Pool
Pre-Meter
Final
~ l-z.' 3- Iii '" Sb.B
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
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 ZEPHYRBILLS
BUILDING DEPARTMENT
OWNER'S NAME
Kn__~N.~:s. ~\LI....
~Q..~ ~'" v\.t;..)
PHONE
OWNER'S ADDRESS
~3, t ~ - <is--- ~ ~7' '
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.#
(OBTAIN FROK PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ~teration ~Repair _Install
_Sign. _Kove _Deaolish
.
PROPOSED USE: _Single Faaily _KIF _' of Units _K/H
...6c<-ercial _Indust. _Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: G,-~~~" co .1\'-
l o.)~\oll...\.....J... ~~\~tV
(i:.t8rJ ov It!' it> rv s J
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.
PERKITS REOUESTED
_BUILDING
$
Valuation of Total Construction
....'2s.-ELECTRICAL
1-..<;.J C) AKP Service
y:. Florida Power Corp.
,
W.R.E.C.
_MECHANICAL
$
Valuation of Kechanica1 Installation
_PLUKBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUC'l'ION: _Block _Fraae _Steel
Other
FDlISHED FLOOR ELEVATIONS:
FT.
IS PROJEC'l' IN FLOOD ZONE AREA?
..........................................
YES NO
CONTRAC'l'OR SECTION
BUILDER
COMPANY
State Cert. or Regist. ,
City License Registration #
..........................................
Signature
:.~ ~ COIIPANY z.~'A,,-~,\ ~'-""''\._ "B"v,
State Cert. or Regis t.' C) () ~ A leg r
City License Registration' 9t~
~-. .......................................
PLUMBER COMPANY
State Cert. or Regist. ,
Signature City License Registration f
..........................................
MECHANICAL COMPANY
State Cert. or Regist. #
Signature City License Registration #
..........................................
OTHRR 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 peIlit lay be subject to "deed restrictions" which lay be lOre restrictive tban City
regulations. rhe undersigned assUles responsibility for COIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has 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 lisdeteanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requiretents lay apply for the intended work, they are advised to contact the City of Zepbyrhills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner bas 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 t.AW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - HoteOWDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is soteOne other than the
'owner", I certify that I have obtained a copy of the above described docutent and prOlise in good faith to deliver it to the
"owner" prior to couencetent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that. all the, infotlation in this 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 herehy lade to obtain a peIlit to do work and installation as indicated. I certify that no work or
installation bas cOIIeIlced prior to issuance of a perlit and that all work will be perfoIJed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in th~ jurisdiction. I also
certify that I understand that the regulations of other goveIDIental agencies laY apply to the intended work, 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:
* Departlent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treatlent
* Southwest Florida Water Hanagetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
* ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
* Departlent of Health & Rehabilitative Services, Environtental Health Unit - Wells, Wastewater Treattent, Septic ranks
* 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 that a drainage plan
addressing a uCOlpensating volUte" will be subtitted which is prepared by a professional engineer registered in the State of
Florida prior to peIlit. 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 peIlit is cOllenced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IOnths after the tile the work is coaenced. One 90 day extension of tite, lay be
allowed for the peIlit 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 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHMEHCEMEH'l' MAY RESULT IN YOUR PAYING TWICE FOR IHPROVEHElft'S TO YOUR
PROPERTY. IF YOU IH'l'END TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AftORREY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT HEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY 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