HomeMy WebLinkAbout97-6543
BUIL~1~9Hy~!RM!! N! - 6543])
(813) 788-6611
Date , r .... 11- "I 7
BUILDING
ELECTRICAL
~
MECHANICAL
Sewer Conn
Water Conn:
Property Owner: &~\Y'I.'\
Job Address: .3 Y 3 '" ~ \
Q~t\,tv-rov 1
Cl.r -J'J a~~
Water Meter:
T,LF:s:
Parcel I. D. #
Description of Work
A"Y')
Radon Gas:
--/~~ <7
Zoning:
-
"
;?L:::;::;:e:
(f
NO OCCUPANCY BEFORE C.O.
FINAL
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Pe,m;t Fee ~ - dCJ
~~::::: .... " '67J ?>r-
Address
Telephone#
Valuation or / )(
Contract Price ..~ ~
City License Registration # c;;l." OL g-
State Certified License#
BUILDING
ELECTRICAL
~A-~_~
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Con st. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
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.
- . "'..
OWNER t S NAKE
G"Yf>.<^ VI
\
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
kL(\lev!h A
PHONE
OWNER t S ADDRESS
JOB ADDRESS
~/~t""l
LEGAL DESCRIPTION: LOT(S) '::) f
BLOCIL--SUBDIVISION
PARCEL LD,'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
_Sign
_Kove
_Deaolish
PROPOSED USE: _S ingle Faaily
_K/F
_' of Units _K/H
_ec:-ercial
_Indust.
_Swia. Pool _Other
DESCRIPTION OF WORK:
_Restaurant lit Heal~ D~rtaent Approval
~J ~-b ., ~ ~.( 'v.-~ i?. v- -t 0
\
Lc+
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL :
COMMERCIAL
ATTACH (2) PLOT PLANS lit (2) SETS OF BUILDING PLANS lit (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS lit (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
----...BUILDING
$
0...<:.'
~bD
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
--1IECBAIf.lCAL
$
Valuation of Kechanical Installation
_PLUtI8ING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FDlISHED FLOOR ELEVATIONS:
FT,
IS PROJECT IN FLOOD ZONE AREA?
YES , NO
******************************************
CONTRACTOR SECTION
BIJTI.Dg
COMPANY
State Cert, or Regist. .
City License Registration .
******************************************
Signature
F.I.F.CTRICIAN COMPANY
State Cert. or Regist. .
SiDnAture City License Registration ,
******************************************
PLmtBER COMPANY ~1)v\( $ I f S~y,S
~~-ft~(~....... State Cert. or Regist. ·
Signature /' 'V~ -~. City License Registration'
L~ **** *************************************
MECHANICAL COMPANY
State Cert. or Regist. f
Signature City License Registration .
************~*****************************
PL...L'", )
;}(,)~:l~
OTRRR COMPANY
State Cert. or Regist. .
Signature City License Registration .
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands tbat this perlit laY be subject to 'deed restrictions' wbich 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 bas bired a contractor or contractors to undertake wort, 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 lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrbills Building Departlent, (813)
788-6611.
FurtberlOre, if the owner has hired 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, rather than the contractor, are responsible for tbe work. If the contractor wisbes you to sign
as contractor that lay be an indication that be 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 - HOIeOWJler's Protection
Guide" prepared by tbe Florida Deparblent of Agriculture and ConsOle[ Affairs. If the applicant is sOleQne other than the
'owner", I certify that I bave obtained a copy of the above described docUJent and prOlise in good faith to deliver it to the
'owner" prior to cOllencelent.
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 cOlpliance with all
applicable laws regulating construction, zoning, and land developlll!Jlt.
I
Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOll8IlCed 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 the jurisdiction. I also
certify that I understand that the regulations of other goverDIeDtal agencies laY apply to the intended wort, and that it is
IIJ responsibility to identify what actions I lUst take to be in cOlpliance. Such agencies include but are not lillited to:
· Departlent of EnviroDlental Regulation - Cypress Baybeads, Wetland Areas and EnviroRleDtally Sensitive Lands,
Water/Wastewater freatlent
· Southwest Florida Water ManageJent District - Wells, Cypress Bayhea4s, Wetland Areas, Altering Watercourses
· ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
· DepaItJent of Health & Rehabilitative Services, EnvirODJeDtal Health Unit - Wells, Wastewater freatJent, Septic Tants
· US InvirODJental 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 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 is~uance of a perlit prevent the Building Official frOJ thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery perlit issued sball becOle invalid
unless the work authorized by such perlit is COll8Ilced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six IOnths after the tiae the work is coaenced. One 90 day extension of tile, laY be
allowed for the perlit with fee charge of $15.00. Tbe extension sball 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 OWIfER: YOUR FAILURI TO RECORD A NorICI OF C(JIHEHCEMEHf MAY RESULT IN YOUR PAYING fiICI FOR IMPROVIMIIft'S TO YOUR
PROPBRTY. IF YOU IHfIND TO OBfAIH FINAlfCING, CONSULT WIfB YOUR LINDER OR All AnoRHEY BBFORE RECORDING YOUR MOIICI OF
COMMENClMEHf. JOBS UffDER $2,500 IN VALUI DO MOT NEED TO RECORD AND POST A "NOTICI OF COMMENCHMEHf".
SIGJfA'fURI: OIfNER OR AGBHf
SIGJfATURI: COHfRACfOR
STATE OF FLORIDA
COmy 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