HomeMy WebLinkAbout97-6800
BUIL~!~9Hy~!RM!I.M! 680013
(813) 788-6611 Date, , -/9'- 7' ')
~ ELECTRICAL
:~~:::,~:~e# '7 !!!-t:!t~--, .
Parcell.D, #
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
(]~ p~
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
.--.
FINAL
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector 0 "
Permit Fee
Signature
Company
Address
Telephone#
~ r Lh)
1 ~, 'W\.. ~\{~
Valuation or
Contract Price
Sov, (J'b
City License Registration # c2 '7'3
State Certified License#
,/3"A.A!/'v.J'v1
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 ZEPHYRBILLS
BUILDING DEPARTMENT
g'3 L{
9KO'l a_'f'1
~/ ~{
JOB ADDRESS
f<'.-r ~ ~
4--'( I '3, ~ I )..., VE12
14 s )4 Eo v E
PHONE ~ g 0 - "3 (;, '7 L
"z.6P HY iZH-ILLs fL s.s~4-(
OWNER'S NAKE
OWNER'S ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION..bH...tl L Fa N T V j LL ~
PARCEL 1. D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction VAddition ~teration ~epair _Install
_Sign
.-Jove
_Deaolish
PROPOSED USE: _Single Faaily
_M/F _' of Units ---1l/H
_~ercial
_Indust. _Swia. Pool _Other
_Restaurant,. Health Departaent Approval
DESCRIPTION OF WORK: ..s eRE"' E ,,( n. b 0 M
BUILDING SIZE: 0 X 2l, \ b ~ Square Feet. ~ I Height
RESlDENTIAL: ATTACH (2) PLOT PLANS,. (2) SETS OF BUILDING PLANS,. (1) SET ENERGY FORMS.
COttHERCIAL: ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
L.sUILDING
$
500
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
.-JIECIIAIIlCAL
$
Valuation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUC'l'lON: _Block _Fraae _Steel
Other
FlRISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
Signature
CONTRACTOR SECTION
~ COMPANY 9.U.5SELL Y\'\ ~110Lu~
State Cert. or Regist.' CO:: 0 31 b /
/ , rv1, 'M\IfJt,vv.... City License Registration' 243
******************************************
RIJTT .DER
SionAture
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
F.T.RCTRICIAH
COMPANY
State Cert. or Regist. .
City License Registration f
******************************************
PLUMBER
Signature
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
MECHANICAL
Signature
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
OTRRR
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The .nde<.lgn.d und.r.tands th.t thl. per.lt BO, b. ..bject t. 'd..d r..tricti.... obleb .., be our. r..trlctl.. tbeo Clt,
regulations. The undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ....r bas hired · rontr.ctor .r contr.ctors to .odert... worl. they .., he required to he licensed in 'ccordaaes .Ilb
.t.t. and local regol.tl.... If tb. contr.ctor I. not Ilc....d as regolred h, I... bolb the ..... and contractor .., be
cited for · .iodose.nor .lol.tion und.r .t.t. I... If the osn.r or Intended contractor are UDCe<tain as to .Iot licensing
requlr....t. .., 'ppI, for the Intend.d BOrl. the, .r. .d.l.ed to contact th. Clt, of Zephyrblll. Building Departseot. (Bll]
788-661J.
Further..... If the osner h.. blred · contr.ctor or contr.ctor.. he i. .d'lsed to 10.. the contr.ctor(.) .Ign porti... of lb.
'C..,tractor SecUoo.' of thl. .ppllcation for ""Ieb the, .ill he r"ponslbl.. If.... as the ..... .Ign as lb8 contractor.
you .r. lndlc.tlog that fOO. r.ther than tbe contr.ctor. .r. r..ponslbl. for the 1Or1. ff the contractor .Iabes IOU to sign
as contr.ctor that .., he .n indication th.t b. I. not Properly Ilc....d and I. not entitled to psrslttlng prl,llegeo in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND Ul'ILITY CONNECTION FEES
, ~'
,
D. CONSTRDC'UON LIEN LAW (CHAPTER '113. FLORIDA STATDTES, AS AMEBDED)
I certify th.t I, th. .ppllcant. 10.. h... provided .Ith . cop, of 'Florlda'. C...tructlon Lieu Lao _ ........... Protection
Guld.' prepared by the Ylorid. Departseot of Agrlcoltur. .od C...oser Aff.lrs. If lb8 .ppllcant is ....... other tbeo the
.....r., f certify that I love obtaloed . copy of the above descrihed doc....t and prosl.. In good faith to dell... It to lb8
"owner" prior to co..enca.ent.
E. CONTRACTOR' S/OWNER' S AFFIDAVI'l'
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, Joning, and land developlent.
,
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no worl or
l08tall.tl.., has """,,ced prior to I....oc. of . per.lt and that .11 ..rl .111 be perfOlSOd to 808l .tooiards of all lOBI
regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also
c.rtlfy tIot I .oderst.od th.t the regul.tlon. of other gn.ernsental agenCies ..y apply to th. luteoled lOr.. and tIot It I.
IY responsibility to identify what actions I lust take to be in COlpliance. Such agencies include but are not li.ited to:
· Oelort&e.t .f En.I,,",,"tal ReguI.tlon - Cypress Ba,head.. NeUaoI Are.. and En,lronoeotally S...ltlve Lando.
Water/Wastewater TreatJent
t Southwest Florida Water Hanaga.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Havigable Waterways
t De artJent of Health & Rehabilitative Services EnviroDlental Health Unit _ Wells, Wastewater TreatJent, Septic 'anks
t US En,iroDlental Protection Agency - Asbestos abateJent
I .1.. ..rtlfy tIot. If fill ..t.rl.1 Is to he u80l In Floud Zon. ... or ....tc... It I. onder8tood lIot . draluaga pi..
addressing · 'COIpOn..tlug ..I.... .111 he 'oIoltted .bleb I. prepared by . Professioo.1 euglneer regl.leroI I. tIo Stats of
Florida prior to perlit. issuance.
. A peroit I".ed sb.11 be con.trued to h. · lice... to Proceed .Ith the ..rl ani not as autborltr to ,Iolats. caaoeI alter, or
set aside any pro,I.lon. of the technlc.1 codes, nor .ball I.,,,"ce of . perait pr....t tIo BuIlding Official f... tIorasfter
reqoirlng a ourrectlon of 'rror. I. pi.... con.trnctlon. or ,101.11... of .., oode. B'", perslt Issuol sIol1 beonoo Inoalld
unles. tbe ..rl ..lIorl.ed by such perolt I. """,,ced .Itbln .iI IORth. of IBBUancu. or If ..r. ..tborllol by !be FORIlt I.
.~ or ahaocIoned for · period of .is ...tIo .ft.r lb. Use tIo IOrIIs _. Doe 90 lIa, eswlon of tile. la' 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 IOnth period, or the project will be considered abandoned.
WARRING TO OWHER: YOUR FAILURE TO RECORD A NOTICE OF COtlHEHClHIlfI' HAY RlSULT IN YOUR PAYIHG f1fICK FOR IHPROVIIIBD'S TO YOUR
PROPERTY. IF YOU INTEHD TO OBTAIN FlltAHCING, COHSULT WnH YOUR LEltDER OR AH ATTORlBY BEFORI RiCORDIltG YOUR RorICK OF
COHHEHCEHENT. JOBS UNDIR $2,500 IN VALUE 00 HOT NEED TO RICaRD AHD POST A "HOTICE OF COHHENCIHIlfI'".
SIGHATURE: OWHER OR AGEHT
STATE OF FLORIDA
COUlITY OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
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
__ ~JJ
SIGHATURE: COHTRACTOR
rn. r:B~
. I
STATE OF FLO~A
COUNTY OF 't!-.tCsCv
The foregoing instrument was acknowledged
before me this t, - to , 1912- by
I? /isse// /'r1. tlUJlVoV
who is personally own to me or who has
produced FL #- b ~ 733- 52- 3'7/-0
as identific on and who d' /did not
take an oat . va
t7L :::.a.t.LP.
(Siglljljture ~. /
l'T~e(4 L, i-"enl1uii~/}
(Name T ed, Printed or St ped)
NOTARY PUBLIC
....~)f.~:i';:~< ANGELA l. PENNINGTON
:o:;A to, MY COMMISSION II cc 522369
~t ,~.J EXPIRES; January 3, alOO
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1J.tRf...~~." Sonlled Thru NoIaIy Public Undslwrftara
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