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BUILDING PE"RMIT 7532 ;j
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date
~-;;L7-7.f-
Lft), W
BUILDING
~ -: tJz>
ELECTRICAL
3..5-- rv
PLUMBING
'2J> '. 07:;
MECHANICAL
Sewer Conn- 'fj p, .;LJ, ~ .
Water Conn:). ...J.~- ~
Water Meter: / n - c)-i)
T.I.F.'s: .32.0. i/i)
~tj1t
Property Owner: n
Job Address: ..3~1 /> ~ ~ ,GL,r.-f
Parcell.D. # :t.'f-d../. ..:J.../- I:JLJO 0 - C;; 01 D 4 ~ y--
Zoning: Ejerg'i,~ode:r-/J Radon Gas:
Description of woifa./>~ m ~ /' J- ~
;;7..1 p~ 'f-1t,-9K"~~ IO"~O Yln-t
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
DAT.E,
- 6-?K
DATE
City License Registration #
State Certified License#
'Ir
Inspector
Permit Fee / 6 ~..... e (Ti.)
Signature CAJ~~
Company
Address
Telephone#
Valuation or
Contract Price
/6 ~. 0-0
~
13 -:t1f~~ If
{J~{} /8"'7
t1;JJ~'J/Y~
~
-
~-S
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl. ~hfqt. (Joll
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 ($ +5':'Oe) shall be made for each trip for each trade:
:l -- '1 / /). .. . . 7!- t!~ LA I :2-;L 7- 9'~
a. Wrong Address ~ . cTV Alo.Z ~ ~
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called. 11{ - /6- 9 ~
d. Work not ready for inspection when called. fL
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
'180'
,,'{OJ
OWNER' S NAKE
;';~/L CC~/~(/I- ~Z>'"c:.s7/c.. O/1~PHONE
OWNER · S ADDRESS
L.vJ'2-15
JOB ADDRESS
#11"9 :::H -> t;,~
. Ocra~.i)
.s lr/ /' LJI2/ ~. AM
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1.D.' '?.'f k2.. (..-')..,1 0" 00 - C/O/C CJ (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED: ~ew Construction _Addition. --Alteration _Repair _Install
_Sign
--1Iove
_Deaolish
PROPOSED USE: _Single Faaily
~/F
_' of Units --1I/H
_ec-ercial
_Indust.
_Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK:
BUILDING SIZE: /1- X JJ . :79~
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
$ "'1.~
Valuation of Total Construction
_ELEC'l'RICAL
/aU- AtIP Service
.
. Florida Power Corp.
W.R.E.C.
--1IECIIAIIlCAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
..................................*.......
'CONTRACTOR SECTION
BUn.DER COKPANY Il~~~ ~,/p
~-zf./J State Cert. or egist.'
Signature 4J~ A ~ City License Registration .
. .......................................
:~'::ur~CA- /J c/J n /11... COIIPANY fie "'"
~ ~~~___ State Cert. or Regist. .
City License Registration .
..............................*...........
y-p--
/rJ
Signature
COMPANY /(1 ~ ~.ff~
w.. t!IilJ State Cert. or aist.'
~~ City License Registration f Y fiY
... ..................*.............*....
PLUMBER
MECHANICAL
Signature ~J3Jowv
COMPANY 4c e-
State Cert. or Regist. .
City License Registration f
.......**...........*...........**....*.*.
tf!::>
OTIIF.R COMPANY
State Cert. or Regist. ,
Signature City License Registration .
.......*........**..........*.*...........
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
- A. NOTICE OF DEED RESTRICTIONS
Ilo undersigned und.r.tand. that thi. p.rsit say be .object to 'deed r..triction.' whleb say be SUr. restricti.. !boo Cltr
regulations. rhe undersigned assUles responsibility for co.pliance 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 Cor a .l.d.....or ,iolatl.. ood.r .tat. I... IC th. ....r or loteodnd cootractor are uncertain un to slot lieeosiag
r.gulr....ts say apply Cor the iotended ..rl, they are ad,lsed to cootaet the City oC Zepbrr.lil. Boiidlog Departsoot, (813)
788-6611.
FurtberlOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
'COntractor Secti.... oC thi. applleatlOD Cor whieb they will be responslbl.. IC you, un the "'or &lga un tIo cootractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
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
"
" .
D. CONSTRUC'I'ION LIEN L1\W (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law _ HDIeONDer's Protection
Guide" prepared by the Florida Deparllent of Agriculture and ConsUler Affairs. If the applicant is SCl.leOJ1e other than the
"owner", I certify that I have obtained a copy of the above described docu.ent and pralise in good faith to deliver it to the
"owner" prior to co..enca.ent.
E. CONTRACTOR' S/OWNER' S AFFIDAVl'I'
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 wort and instailation as indicated. I certify that no worl or
installation has cOllenced prior to issuance of a perlit and that all work will be perfoIled to leet standards of all IllS
regulating construction, City codes, Joning regulations, and land developllent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended worl, and that it is
IY responSibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
· Deparllent of EnviroDlental Regulation - Cypress Bayheada, Wetland Areas and EnviroDlentally Sensitive Lands,
. Water/Wastewater rreallent
· Southwest Florida Water Hanaga.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
· ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
· De arllent of Health' Rehabilitative Services EnvirODleDtal Health Unit - Wells, Wastewater freatlent, Septic fanls
· US BnviroDlental Protection Agency - Asbestos abat8lent
I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.", it is understood .that a drainage plan
addressing a "cOlpensating 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~u~nce of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ever, peIlit issued shall becole iDvalid
unless the work authorized by such perlit is COllenced within sil IOntha of issuance, or if work authorized b, the perllt is
Suspended or abandoned for a petiod of six IOnths after the till! the work is cOMenced. One 90 day utension of tile, la, be
allowed for the perlit with fee charge of '15.00. rhe extension sh~ll be requested in writing to the Building Official. An
approved inspection lust be logged during each sil IOnth period, or the project will be considered abandoned.
WARRING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COIfHENCKllBNr MAY RESULT IN YOUR PAYING NICE FOR IHPROVIIIBIl'S TO YOUR
PROPIRrY. IF YOU INlBND ro OBtAIN FINANCING, CONSULT WIIH YOUR LENOIR OR AM ArJORBIY BEFOR! R!CORDING YOUR MorICI OF
COHMEHCBHRNT. JOBS UHDRR $2,500 IN VALUR DO NOT HERD TO RECORD AND POST A "NOTICR OF COIUIBNCIIIIlfr".
c.1n?--~ ~
SIGNArURI: iR OR AGR J ..
0~
SIGNArURB: CONlDAeT
" I
STArl OF FLORIDA
CoolfJr OF
The foregOing instrument was acknowledged
before me this , 19____ by
STArE OF FLORIDA
COONIY OF
The foregOing instrument was aCknowledged
before me this , 19 by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
CITY OF ZEPHYRHILLS BUILDING DBPARTMBNT
OWNER
JOB LOCATION
L r.~/
~ '2'$
MrJ3e.>Ii~ (';)Af..?;J
PARCEL I.D.' #
SHON ALL EXISTING & PROPOSBD STRUCTURES GIVING DIMBNSIONS & SBTBACKS.
11
o~
~
xy
\')..
1~
7'--
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
J.,~
FRONT PROPERTY INE
STREET
'tcJ
(NOTE EXAMPLES 1 & 2)
1. SETBACKS FOR Rl, R2 ZONING
60'
2. SETBACKS FOR R3 ZONING
60'
10'
P E-
R X
0 I
10' P S 10'
0 T
S I
E N
D G
20'
1 0'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30 ' DUPLEX
1 0'
FRONT PROPBRTY LINE
FRONT PROPERTY LINE
rFNTRAL PERMITTING
PASCO COUNTY, FLORIDA
CONTRACTOR ~: 009864
NAME: WAYNE BUTTERFIELD
ADDR: 38930 BUTTERFIELD LANE
C/ST: ZEPHYRHILLS FL 33540
F"ClI=\::
CHEC~( =1= 5469
DATE: 03/12/98 TIME: 10:09
PAGE t 1 OF :l
ISSUE OFFICE: D
RECEIPT NUMBR: 00354927
OFFICE: DADE CITY
MAJESTIC OAKS 3819 LAUREL VALLEY
CONTRACTOR: 009864
TOTAL AMOUNT:
ACCNT COMPNY ACCOUNT CENTER
114 B450 - 363000 - 2
41.74
AMOUNT DESCRIPTION/PERMT DATA DR/CR
41.74 ****** SOLID WASTE FEE 60
RECEIVED BY 4~L_d.:i..i~_~::~~
~J i
~J
PASCO COUNTY, FLORIDA
Permit No.
~5~.:l
J3
Date Permitted (;2 - !) ~ - 7" Y'
Builder Name/Owner Name lli ~""L tld.
County Parcel No. .3~/7 ~~"'AJ./ 2-1'4
Location J- Y - ;)..6 - 'J-/ - C> c9d7 CJ .... 0 t!/ /0 d ' .l~ . Subd,
ClassificationlType of U~ ~~
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT D
Rate $
Zone No.
Sq. Ft./Unit
Prepared By
Impact Fee Amount $
The above impact fee has been establis ursuant to the Pasco Coun nsportation Impact Ordinance as adopted
by the Board of County Com . . ners. This amount is payable PRIOR to the IS ',ce of a Certificate of Occupancy
or authority to utilize t ermitted structure.
EXEMPT D
RESOURCE RECOVERY ASSESSMENT
RESIDENTIAL
NONRESIDENTIAL
No. Units
I
Gross Sq. Ft. (GSF)
RatelERU - 52.00/Year
or $O,142/Day
ERU Assign No.
Assessment - (No. Units) x ($0.142)
x (No. Days)
Assessment -
(GSF) x (ERU) x (0,142) x (No. Days)
100
TOTAL FEE $
4/~71t.
TOTAL FEE $
The above assessment has been established pursuant to the Pasco County Ordinance No. 89-07 and Resolution No. 89-197,
as commended.
THE ASSESSMENT WILL BE CALCULATED AT THE TIME OF ISSUANCE OF THE CERTIFICATE OF
OCCUPANCY,
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowiedgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and the conditions of payment for same.
Date
Received By
---------------------------------------------------------------------------------------------------------------------------------------------------
OFFICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. No.jS4 q a '7
DATE BY
DATE:5 ~ /~- 9 ~Y.
/"
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldgllnsp
feecal:ce
PC931130941A