HomeMy WebLinkAbout97-6452
BUILDING PERMIT NO
CITY OF ZEPHYRHILLS Permit.
(813) 788-6611
645ZA
J-.s"'~ c:rP
~L~ ELECTRICAL PLUMBING
Property Owner: r;r.A ",LA ./() ~ o-ey~ '" . r
Job Address: 3-!>-~/ {}1~ 2:~~~'
Parcell.D. # ~__ _L
Date
..1.. - J ~ - r '}
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
4Zg10d~
Radon Gas:
7> Jd~
NO OCCUPANCY BEFORE C.O.
FINAL c"
DATE
C.O.
DATE
Inspector .. t I
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
)70
~ ~ '
Permit Fee --S' v:J2-.st:.. ......-..s.
igna~- ..
~~~ ---.)
Address
Telephone#
v-r..J
Valuation or
Contract Price
/ b .s-U. ,J-v
-'
City License Registration # ~
State Certified License#
__~?~7~
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
1/ -77
/-~
OWNER'S ADDRESS
K/ c ifill<. ))
3((,3"0
\-A;-r
<0 €/'f2
C!hT-rVC~Y ~
CJ 0 ffl~~'c.2)
PHONE
OWNER'S NAKE
JOB ADDRESS
;::> ;;'!;-"j /j/7 _. _ _ A-, _~~
/ d/ ;J ~ ....>- C><- (.~ _~
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL LD.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
_Sign
_Move
_Deaolish
.
P~POSED~E: _Si~leF~i~
_M/F
_, of Units _M/H
_ec-ercial
_Indust.
_Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant & Health Departaent Approval
'7J- /' /lJ S77f-Ll- .y47tlol oR-
10Yk) 1kE--RJjJ
b I/-if))
BUILDING SIZE:
/0 xlO .
(IJ"tJ 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
$
/:J <;0 .
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_MECllARICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
PDUSBED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUTI.DER
CONTRACTOR SECTION
~~~-,7 ~. JO"-:-7I-.L
>",_,;;~:,,":~...- .::;~~"" COMPANY 01 ~
.... .>~,,_.~;;;::::;:;'''c~ .. ... ....~ State Cert. or Regist. ,
~.~ .. . City License Registration'
c."...., .... ******************************************
~-Ll/ 1(/ /fJ vI/'
?Il
SignatuJZe
F.T.RCTRICIAR COMPANY
State Cert. or Regist. ,
SiDnAture City License Registration ,
******************************************
PLUMBER COMPANY
State Cert. or Regist. ,
Signature City License Registration .
******************************************
KECHANICAL COMPANY
State Cert. or Regist. .
Signature City License Registration ,
***********~******************************
OTIIRR COMPANY
State Cert. or Regist. ,
Signature City License Registration t
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this perait laY be subject to 'deed restrictions" wbich lay be lOre restrictive than City
regulations. The undersigned assOles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If tbe 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 lisdeieanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireJents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furtheraore, if the owner bas hired a contractor or contractors, he is advised to bave 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 wisbes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to peraitting privileges in the
City of Zephyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN ~AW (CHAPTER 113, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, bave been provided with a copy of 'Florida's Construction Lien Law - HOJeOWner's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsOler Affairs. If the applicant is sOJeOne other than the
'owner", I certify that I have obtained a copy of the above described docUJeDt and prOlise in good faith to deliver it to the
"owner" prior to couenceJent.
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 developaent.
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a perlit and that all work will be perforaed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in th~ jurisdiction. I also
certify that I understand that the regulations of other goveIDIeDtal agencies JaY apply to the intended work, and that it is
IY responsihility to identify what actions I lust take to be in cOlpliance. Sucb agencies include but are not lilited to:
* DepartJent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater TreatJent
* Southwest Florida Water HanageJent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
* Aray Corps of Engineers - Seawalls, Docks, Navigable Waterways
* DepartJent of Health & Rehabilitative Services, EnvirODJeDtal Health Unit - VeIls, Vastewater TreatJent, Septic Tanks
* US EnvirODlental Protection Agency - Asbestos abateJent
I also certify that, if fill laterial is to be used in Flood Zone "An or "A, etc. ", it is understood that a drainage plan
addressing a "cOlpeDsating volOle" will be subJitted wbich 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 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 ftol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perait issued sball beCOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of six IOnths after the tile the work is COBl!Jlced. One 90 day extension of tile, JaY be
allowed for the perait 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 IOnth period, or the project will be considered abandoned.
WADING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHMBHCEMENT HAY RESULT IN YOUR PAYING TWICE FOR IHPROVIMBIft'S TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FIIWfCING, CONSULT VITH YOOR LENDER OR AN Anomy BBFORE RECORDIHG YOUR DICE OF
COMMENCEMENT. JOBS UHDER $2,500 IN VALUE DO NOT NBED TO RECORD AND POST A "NOTICE OF COHMBHCEHEIft'''.
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
coum 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
~T 9oEJtE;etfC~
~c~]>, . tGJEI'r'
r AnCEL r.. b .
SEe
'1'\-11'
PRO.PCHTY t1E1\SUH81ENT
CUIUU-::J~T O\..'Nl::.HS
(RE.SIDEJ1TIJili USg ONLY)
I{NG
SUULJ
lILOCK
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LOT
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IJATE
I, 11 bh d~ll.vn to ~.cllle for all .l'~tirccls tir lQtri five llCrCS or less.
All arlluing~ dUll ~ ~ u
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SliO\..' ALL EXISTING AND PROPOSED STRUCTURES GIVING DDi.E.NSIONS AND SETBACKS. I\LSO, INDIC^TE
ANY BODIES OF WATER AND ROADWAYS (INCLUDING NAMES) ADJACENT TO TilE PHOPEHTY. INLJICATE
THE SIZE, YE.AR, f~"l9 Nf_'1S OF MOBILE; SUCII AS 12' ^ 60'. Inl. FLEETwOOD.
All "EASEMENTS", "RIGIlT-Of-WAY" and "JURISDICTIONAL LINES" must be shown on all site plans.
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'roposal
Page No,
of
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C''<oI''N
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Zfi'HY~~HH,LS F:_ 3354 J
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PHONE
PRPPOSAL SUBMITTE;Q, TO
L-A
STREET
....\.<
,JpB NAME
,~
JOB LOCATION
\.
CITY, STATE and ZIP CODE
:. ..
ARCHITECT
JOB PHONE
We hereby submit specifications and estimates for:
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mr 'roposr f1ereby to furnish material a79 labor t- co~plete in accordance with above specifications, for the sum of:
"l!'
-'\,
,~. r~
-"'>!&
'-"\
'--~
dollars ($
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,
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),
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All material is guaranteed to be as specified, All work to be completed in a workmanlike
manner according to standard practices, Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate, All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance,
Our workers are fully covered by Workman's Compensation Insurance,
Authorized
Signature
-~.,.',~~,.-~ '--':::'~,'~G:~'~,:'. :.;~,
.-- ._"';r.;.,....':.' -,~
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Note: This proposal may be
withdrawn by us if not accepted within
Acceptance of 'roposal- The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signatur'e:"''''
to do the work as specified. Payment will be made as outlined above.
~"/' : i
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Date of Acceptance:
Signature