HomeMy WebLinkAbout97-6625
BUILDING PERMIT
66251'1
Y-~-?7
BUILDING
;26. 0()
~CT~
Pmperty Owne' fh~ ~
Job Address: ~--' - '" .
Parcel 1.0. # ql-.;J.;;)-::l./- 0 % - 1;2./DO .~
CITY OF ZEPHYRHILLS
(813) 788-6611
:;LS ... ~ d"D
~ANI~1)
Permit
N!
Date
PLUMBING
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
01/ i)
Zoning: Energy Code:
Description of Work '--f'l ~ -* / t.:-
Radon Gas:
FINAL
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee y~ -:. oc....)
S;gnatu,e ~ 4',.....-(
Company $~_
Address
Telephone#
)11
Valuation or
Contract Price
~ 7 V"c7 - u-v
J~
City License Registration #
State Certified License#
BUILDING
tJ.r1 ) ~ /7lJ
ELECTRICAL .
y/iJ~ )1/C-
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
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.
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APPLICATION FOR PERMIT
CITY OF ZEPBYRHILLS
BUILDING DEPARTKENT
_'5 _ JULY
OWNER'S ADDUSS I 'II 3
JO~ ADDRESS SA""., i
LEGAL DESCRIPTION: LOT(S)
150'( r
rfTh ..5T
PHONE
71' 2. 3 flY' /
BLOCK
SUBDIVISION
PARCEL LD.' () / - l 6 - 2 1- 00 /'0 - I 2/0 ~ .. 01/ 0 (O~TAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction -.--.Addition -JIteration _Repair ~nstall 4jc:..
_Sign
--.JIove
_Deaolish
PROPOSED USE: _Single Faaily
_~rcial
--.J'l/F
_Indust.
_' of Units _M/H
_Swia. Pool _Other
---..Restaurant I( Health Departaent Approval
DESCRIPTION OF WORK: T ,r.J S r "1 / I -e W, . r2. f
A,/c
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS I( (2) SETS OF BUILDING PLANS I( (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS I( (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
_BUILDING
$
Valuation of Total Construction
_ELECT.RICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
--"ECIIAlIICAL
$
Valuation of Mechanical Installation
-PLUHBDiG GAS ROOFING
SPECIALTY
TYPE OF mRsTRucnoN: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVAUONS:
FT.
IS PROJEC'l' IN FLOOD ZONE AREA?
..........................................
YES NO
CONTRAC'l'OR SECTION
RUlI.DER
COKPAIIY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
:::CIAR~
... C LLe, .AfJ
~~~
~ State Cert. or Regist. .
City License Registration .
. . ......................................
J?V
PLUMBER COKPAIIY
State Cert. or Regist. .
Signature City License Registration .
..........................................
tlEClWlICAL COKPAIIY L1;lJ#~ I..J he",,^,; ~;J4J~. #/c..
State Cert. or Regist. . ell CttI.{J,I,I,R
Signature City License Registration . /7
..........................................
OTRRR COKPAIIY
State Cert. or Regist. .
Signature City License Registration .
..........................................
APPLICAUON APPROVED BY PERMIT OFFICER,
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
rbe undersigned understands that this pemit aay be subject to Ideed restrictions I wbieb aay be lOre restrictive than City
regulations. the undersigned assUles responsibility for COIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OIIIler 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 mmer and contractor laY be
cited for a lisdeaeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requireIeDts aay apply for the intended wrk, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
. 788-6611.
FurtherlOre, if the mmer bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
'Contractor Sections' of this application for wbieb they will be responsible, If you, as the OIIIler sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the lIOrk. 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 pemitting privileges in the
City of Zepbyrbills.
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 - HOII!OlII1er's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the
'owner', I certify that I have obtained a copy of the above described docuIent and prOlise in good faith to deliver it to the
Ummer" prior to COlll!llCl!l8Jlt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIlation in this application is accurate and that all 1IOrk will be done in cOlpliance with all
applicable laws regulating construction, loning, and land develo.-ent.
Application is hereby Jade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas COIIeDced prior to issuance of a pemit and that all work will be perforted to leet standards of all laws
regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDleDtal agencies laY apply to the intended wrk, and that it is
IY responsibility to identify wbat actions I lUst take to be in cOlpliance. Sueb agencies include but are not lilited to:
t Departtent of BnvirODJeDtal Regulation - Cypress Baybeads, Wetland Areas and BnviroDlentally Sensitive Lands,
Water/Wastewater treattent
t Southwest Florida Water Managel8llt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t AIIY Corps of Engineers - Seawalls, Docks, lavigable Waterways
t Departlent of Health & Rehabilitative Services, EnvirODl8ntal Health Unit - Wells, Wastewater rreatlent, Septic tanks
t US EnvirODJelltal Protection Agency - Asbestos abateleDt
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 '~ating volUleu will be subllitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to pemit issuance.
A pemit issued sball be construed to be a license to proceed tlith the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a pemit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery pemit issued sball beCOle invalid
unless the work authoriled by sueb pemit is COIIllDced within sil IOnths of issuance, or if 1IOrk authoriled by the pemit is
suspended or abandoned for a period of Sil IODtbs after the tile the work is coaenced. One 90 day l!Itension of tile, laY be
al101led for the pemit with fee ebarge of $15.00. rbe l!Itension sball be requested in writing to the Building Official. An
approved inspection lUst be logged during eaeb SillODth period, or the project will be considered abandoned.
WAIUUNG ro OOBR: YOUR FAILURE ro RECORD A IIO'l'ICE OF COHMBRCBNm MAY RESULr IN YOUR PAYING 'fIIICE FOR IMPROVEMBJI!S to YOUR
PROPBm. IF YOU III'lHIID to OBfIIII FIWCIIIG, COIfSULr WID YOUR LHllDER OR AN AnORDY BBFORE RECORDIIIG YOUR NOTICE OF
COMMBIICBMEtn'. JOBS OlDER '2,500 IN VALUE 00 1IO'r NEED ro RECORD AIfD posr A "NO'rICE OF COIIIBNCBMm".
SIGllAtURE: COtl!RAC'fOR
SIGJlArURI: 0IfIIER OR AGElI1'
StArE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
StArE 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)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC