HomeMy WebLinkAbout97-6589
. .
BUILDING PERMIT
Permit N!
CITY OF ZEPHYRHILLS
(813) 788-6611
- 65S9A
Date S -d Y-r7
6;~)
p<opertyowne'~~ ~
Job Address: ..3<f/.;l. 7-t I ~
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcell.D. #
Zoning:
Description of Work
Energy Code:
~~~
Radon Gas:
~~~~~
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
2--kf
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Pe'mit Fee ?1:5 - ~
Signatur~ ~ 7/ i.,,~J-y"
Company
Address
Telephone#
Valuation or
Contract Price
~#7rl:).t:1"V
City License Registration #
State Certified License#
~L-
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Ins!.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
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
.)_().V-77
--::>
OWNER'S NAKE
t..oB~7
f3S/;}-'f
.~ /1-ff e:..
V IhJ PI!/:.. No 0 F
l() II(j I~ J>.e
PHONE
780- g~8'"b
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction ~ddition ---..Alteration _Repair _Install
_Sign -.JIove _Deaolish
..
PROPOSED USE: _Single Faaily _KIF _, of Units _M/B
_eo..ercial _Indust. _Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: 7d ;AJs-Ttf-t..c ;3 If ~ g fAIV t'M FORT ~ CI'f ~ Il~D/\!r td.e~P
BUILDING SIZE:
x
, L)-/ ~
Square Feet, 9
Height
RESIDENTIAL:
COMKERCIAL :
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.
_BUILDING
PERMITS REOUESTED
$ t LI1 OlJ . on Valuation of Total Construction
_ELEC'l'RICAL
AKP Service
Florida Power Corp.
W.R.E.C.
--1IECH.AIU.CAL
$
Valuation of Mechanical Installation
_PLUKBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
Fr.
IS PROJEC'I' IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRAC'I'OR SECTION
BUIIJ)ER
Signature p~ ~
COMPANY
~ ~ State Cert. or Regist. ,
~ ~ City License Registration ,
********* ~*******************************
(J{)JA../E-tZ
ELECTRICIAN
COMPANY
State Cert. or Regist. ,
City License Registration ,
******************************************
SionJllture
PLUMBER
COMPANY
State Cert. or Regist. t
City License Registration t
******************************************
Signature
tlECHANICAL
COMPANY
State Cert. or Regist. f
City License Registration ,
***********~******************************
Signature
OTIIRR
COMPANY
State Cert. or Regist. f
City License Registration f
*****.************************************
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit 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 lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
require.ents lay apply for the intended work, they are advised to contact the City of Zephyrbills 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 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 wiabes you to aign
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 l~
D. CONSTRUCTION LIEN unw (ClmPTER 713, 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 ConsUler Affairs. If the applicant is sOIeone other than the
.owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner" prior to cOllence.ent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify tbat all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, Joning, and land developlent.
I I
Application is hereby lade to obtain a perlit to do work and instaifation as indicated. I certify that no worl or
installation bas cOllenced prior to issuance of a perlit and that all work will be perfOCl8d to leet standards of all lara
regulating construction, City codes, Joning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other govefDlental agencies laY apply to tbe intended worl, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Such agencies include but are not liJited to:
* DepartJent of BnviroDlental Regulation - Cypress Bayheads, Wetland Areas and BnviroDlentally Sensitive Lands,
Water/Wastewater TreatJent ,
* Southwest Florida Water HanageJent District - NeIls, Cypress Bayheads, Wetland Areas, Altering Natercourses
* ArlY Corps of Bngineers - Seawalls, DOCks, Navigable Waterways
* DepartJent of Health & Rehabilitative Services, EnviroDlental Health Unit - NeIls, Wastewater TreatJent, Septic ranks
* US BnviroDlental Protection Agency - Asbestos abate.ent
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 .colpensating volOl8" 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~u~nce of a perlit prevent the Building Official frOJ thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCOle invaJicl
unless the Nork authorized by such per.it is cOllenced within six IOnths of issuance, or if NOrk authorized by the per.it Is
suspended or abandoned for a period of sil IOnths after the tile the work is cOllenced. One 90 day eatension of tile, JaY be
allowed for the perlit 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 IOntb period, or the project will be considered abandoned.
NARNING TO ONIER: YOUR FAILURE TO RECORD A NOTICE OF COHHBICBHlNf MAY RESULT IN YOUR PAYING TWICE FOR IMPROVBIID1'S TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDBR OR AI AnORJIBY BEFORE RlCORDIIfG YOUR MOrICE OF
COKMENCKHENT. JOBS UNDER $2,500 IN VALUE DO NOT NBED TO RBCORD AND POST A "NOfICE OF COHHRNCBHlIII..
t~-'A /.i ~.4/'~
SIGN TURE: ONNIm OR AGENT
M~) ~, --/~M-I-
SIGNATURE: CONTRACTOR
" I
STATB OF FWRIDA A {)
COUNTY OF tl J C
The foregoing instrument was a~k~wledged
before me this , '/'//1/ , 191--L by
f{ ole/' f i/cl/lt'/c r ) tJ(} I
who is persOnaljr known to me or who has
produced I)). . )I /' J/:)'? 6 ' ~~ J,? 0
as identific ion and who didh I
take an oat . f / .,~
clv
(Signature)
STATE OF FLORIDA P 0)
COUNTY OF tj f C
The foregoing instrument was ackno~ledged
before me this oJ'? ~ Y , 19 Y / by
j( ok/' J //:;/Jd'l r,f ~~1;:
who is personally known to me or who has
produced R~. //,' J/5Jf'f '/'Y.F -.,<]/,2 -.,f'.-/ If
as identif' ation and who did/did not
take an 0 t . .~ ~.( /J
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
. NOTARY PUBLIC
..~::;r.~:'f~:';-" DORIS K. PUlTZ
{,:r ~''f:~ MY COMMISSION # CC 308944
;~~A.~:,= EXPiRES: August 16,1997
'<t9r..i~~:;> Bonded 1111u Notary Public UndelWlitel1l
,,'':A.~';'''''' DORIS K. PUlTZ
!:~)i:'f;.~ MY COMMISSiON ~ ~G ~~e~~1& I,
~~i.~~f~'; ilnr~~f;~;~~;~;~;';' .~ ,r.:~;'.c,..
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OWNER
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JOB LOCATION
PARCEL 1.0. I
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SHOW ALL EXISTING ~ PROP081D STRUCTURES-GIVING DIMENSIONS' SETBACKS.
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UTILITY BUILDINGS
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(NOTE EXAMPLES 1 & 2)
STREET
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2. SSTBACKS fOR RJ ZONING
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fRONT fROfERTY LINi
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FOR CARPORT~ OR LlKE ~TRUCTVRE~ PL~A~~,COMPLET~ Tij~ fO~~OWIUG:
(1) DESCRIBE WHAT TYPE: . fREE' STANDING OR~ACHi9 (CIRCLE ONS).
. --.--
(2) IF ATTACHED, HOW IS IT TO at FASTENED TO STRUCTURE?
.::.:::- ... /~ ~---' \-.:': "!.~. -+- H c l~ ,..j J. t;
(3) DESCRIBE POST SPACING' FASTENING (If TO CONCRETE, IN WHAT HANNSR?)
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GIVE DIMENSIONS OF CARPORT LENGTH, WIDTH, & HEIGHT:
GIVE AMOUNT OF OVERHANG FROM STRUCTURAL SUPfORT:
/~
(6) COMPLY WITH REQUIRED SETBACKS AS GIVEN IN ABOVE REFERENCED PLOT
PLAN.
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P.O. 80X iJ68
PORT OO"'NGE. fI.OO'D'" 321\9
TEL(I>IIONE: (90i) 767-HH
fAX, (904) 761-6~~6
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