HomeMy WebLinkAbout98-7985
BUILDING PE,RMIT
Property Owner:
Job Address:
Parcel I. D. #
CITY OF ZEPHYRHILLS
(813) 788-6611
AFTER HOURS PHONE NUMBER
(813) 788-5262
~ PL~
Q~Jt 0. ld~~
f~5' 500 - ~ r# ~{/ .
Permit
.7985 ;8
~- !30-c"v'
Date
~~
M~~,^,er Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
DescriDtion of Work
..s
FINAL
i
DATE
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,
c.o.
DATE
Inspector
Pe'mi. Fee ..32 - . ~ - ~.
Signature ~~/l ~ .4// b-tl
Company
Address
Telephonei V- frl J - ,-;- '/- rJ 51 0
Valuation or
Contract Price
iJc.-?
;;S-OO' -
City License Registration # d /3{
State Certified License#
Ftr.
Pre SLB
Lintel
Cl-fl~<<' e-1;/1" &.
BUILDING ELECTRICAL.---
----
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PLUMBI~--'--
MEC~ICAL
Breakers
Ducts Insl,
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
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 1$4S.0&l shall be made for each trip for each trade:
~ tl'D
a.
b.
C.
d.
e.
f.
g.
Wrong Address
Condemned work resulting from faulty construction.
Repairs or corrections not made when inspection called.
Work not ready for inspection when called.
Permit not posted on job site.
Plans not at job site.
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 PERKIT
CITY OF ZEPIIY1UIILLS
BUILDING DEPARTMENT
,E {, fl: (. r/tl C S /' (,u''7' ('= c),
8-fJ - {, s-tt,-?.l yD
r- } .5--7?'
7Rz- Y.J?O
PHONE '12 J - 7~ 37
OWNER I S NAME
fJA-v /P p" r!/-';~J
OWNER'S ADDRESS S-S~&1 S/ Y 7d J h
JOB ADDRESS
0- S'()O .vyTft' sT:
LEGAL DESCRIPTION: LOT(S) LAJr.r/'" F/flfJlt"l BLOCK "f61 SUBDIVISION
;K 1lfltt.f:;:; L~: ;:;;; 2.,4 jJ L Clef';: 941 (OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration ~epair _Install
~Sign _Hove _Deaolish
PROPOSED USE: _Single Faaily _H/F _' of Units _H/H
,2(.eo..ercial _Indust. _Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK:
j>'F t T~~ "
J Lc//f(,.{,. J IllY f
BUILDING SIZE: yo X it; , /'-/ f 1 Square Feet,
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
_BUILDING
$ ~ rO 2>
/
PERMITS REOUESTED
Valuation of Total Construction
_ELEC'fRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_MECHAIIICAL
$
Valuation of Hechanical Installation
_PLUHBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FDlISBED FLOOR ELEVATIONS:
PT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
/
Signature
i ~. ClIIIPARY /ft-;rci ,,-/v 5'/6"-' C ().
, State Cert. or Regist.' E5 00 tJ l-l..
il~ ~ City License Registration' ~ / ':?
~-- ....... .................................. sr .
RIITIJ}ER
F.1.F.C'fRICIAR COMPANY
State Cert. or Regist. .
SiooAture City License Registration .
******************************************
PLUMBER COMPANY
State Cert. or Regist. .
Signature City License Registration .
******************************************
MECHANICAL COMPANY
State Cert. or Regist. ,
Signature City License Registration f
******************************************
OTRF.R COMPANY
State Cert. or Regist. f
Signature City License Registration I
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
rhe uodersigu.d und.r.tands tb.t tbi. peroit oay be ',bj.ct to 'deed r..trlction." wbleb oay be ..r. ...trlcti.. lbao City
regul.tion.. 110 und.rsig..d "'WI.. r..pon.lblllty lor coopll..c. with ..y 'pplicabl. deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
II the ....r b.. bired · contr.ctor or contr.ctor. to ,ndert.l. NOrt. they oay be rsgoired to b. licensed In accordance with
.tat. aod local regul.tion.. If the contr.ctor i. not lic....d .. reg,ir.d by I... both the ..... and oootractor lOr be
cited for · .I.d......r vlol.tion und.r .t.t. I... II tbe ONn.r or Intended contractor .r. ....rt.1n .. to IIot lic...IDg
regulr....t. oay ,pply for th. InLend.d NOrl. Lb.y .r. advl..d Lo contacL tb. City of Z.pbyrhill. Building Departoo,t. (813)
788-6611.
F,rtb.r..... if tb. ....r bas bired · cootr'cLor or contr.ctor.. b. i. advi.ed to hav. the contr.ctor(.) .igu portloos of th.
'Cootractor S.ctions' of thi. .ppllc.tion for .bich lb.y .ill be r"pon.ibl.. If YOU. as the "'er .igo as the contractor.
yon are indicating tb.t roo. r.tb.r tb.. the contr.ctor. are r"pon.ibl. for th. NOrl. If the oontr.ctor .Isbes roo to .Igu
as cootr.ctor lb.t lOy be .. Indic.tlon that b. i. not properly llcen.ed and I. not entitled to P<rIittiog pri.llegeo 10 the
City of Zephyrhills.
C. TRANSPORTA'l'ION IMPACT FEES AND U'l'ILl'rY CONNECTION FEES
"
" .
D. CONSTRUCTION LIEN LnW (CnAPTER 713, FLORIDA STATUTES, AS llHENDED)
I certify th.t I. lb. .pplicant. 10.. beeo provided .ith . copy of 'Florid.'. Coo.traction Lien Lao _ HOIeowoer'. Protectioo
G,ld.' pr.pared by the FlorId. Deparlleut of Agric,lt,r. awl Coos...r Aff.lro. If tb. 'ppll...t i. ....... other tloo lbe
.....r., I certify that I hav. obt.ioed · copy of tbe .bov. d..crlbed docuoent .nd Prosi.. I. good f.ith to deliver It to lbe
"owner" prior to cOalencelent.
E. CONTRACTOR' S/OWNER' S AFFIDAVl'l'
I certify that .11 tbe'lnfollOti.. io thi. .pplication i. 'ccur.te .od that .11 NOrt .111 be done In COIpIi.... .ith .11
applicable laws regUlating construction, loning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no wort or
io.tall.ti.. bas COIIenoed prior to I..uanc. of . per.it ..d that .11 NOrt viii be perforooi to ...t 'laodardo of .11 100.
reg,l.ting Co.,tructlon. City codes. .oniog reg'l.ti.... .Dd land dev.I",,".t regul.ti... io the jwrlodlctl... I ai..
..rtlfy lhat I 'Dd.r.tund lb.t th. r.,'I.tion. of ntber ....'"""L.I .gencl.. &Of s,ply to the inleoied ...t. aod lIot It i.
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
· Doparlleot of Envlr.....t.1 Regul.ti.. - ClPr... Boyhood.. Wetland Ar... .nd Ro'ironoentally Seasltive LaoIs,
Water/Wastewater Treatlent
t Southwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Natercourses
t Arl' Corps of Bngineers - Seawalls, Docks, Navigable Naterways
· De arlleut of Heallb , Rehabillt.ti,. S.r'lc.. Ro,lfODIeot.1 Health Doit - >>ell., lO.tevat.r rrealleot, Septic faoIo
t US EnviroDlental Protection Agency - Asbestos abatelent
I .100 certify that. If fill oat.ri.1 i. to b. ,.ed in Flood .... 'A' or "A..tc.'. it I. understood lhat . dratoage plao
addre..l.g · "COBpenBatiog ..I.... viii be ..Ioitled wbicb I. pr.pared by . p,of...I...1 ..gl.... regi.tered io 1Io Slale of
Florida prior to perlit. issuance.
. A peroit iBB.ed .hall be coo.trued to be . lic.... to proceed with tb. NOrl and not .. anlboritr to ,lol.te. .....1 a1tor. or
..t ..id. .ny provi.ions of tb. t,cholc.1 cod". no, shall i.,.!"co .f . per.it pr.ve.t th. 8uildlng Official froo Ii....fter
requlrimr · correctl.. of error. 10 pi.... coo.tructl... or ,iol.tl... of "y cod.. Every ,","it is..oI obaIl becooo iDvaIld
unlOB' the NOrl anlbori'ed by 'uch per.it i. COIIDDced witbin .in IDOtbs of i........ or if wort a'lborl.ed by lie porait I.
OO'pond.d or abandoned for · period of .In IDOlbs .ft.r tb. ti.. the NOrl I. ......coa. 00. !O:day OBt"'lon of tloe. .., be
allowed for th. p.rolt with fee cb.rg. of $15.00. rbe ..t...i.. sh.11 be regu"led io .'Itiog to !be 8oI1diog Official. An
approved inspection .ust be logged during each Sil IOnth period, or the project will be considered abandoned.
_lUG TO OIIi11lB: YOOB FAILBBIl TO BIlCOBD A IIOI'ICI OF ClIlIIBJCBum HAr BIlSULr II _ PArlJlG mClI'Oll __ TO fOOII
PROPERTY. IF YOU Ilf1'BND TO OBTAIN FINANCING, CONSULT NITH YOUR LENDER OR AN ATTORBEJ BBFOR! RBCORDIIIG YOUR IfOTICB OF
COHHENCEHBNT. JOBS UNDER $2r500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICB OF COHH.KNClHBIf1'''.
SIGNATURE: ONNER OR AGENT
-----SIGNATURE: CONTRACTOR
. I
STATE OF FLORIDA
Coolf1'Y OF
The foregOing instrument
before me this
was acknowledged
, 19_ by
STATB OF FLORIDA
COUNTY 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.
who is personally JrJ10wn 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
. .~...-r I.;.f VV
r~./''''''''l """"'J
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SIIEET NO..nl 01 I
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SILCOX ENGINEERING, INC.
5409 Nebraska Avenue
TAMPA. FLORIDA 33604
Phone (813) 238.9755
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SILCOX ENGINEERING, INC.
5409 Nebraska Avenue
TAMPA, FLORIDA 33604
Phone (813) 238.9755
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SILCOX ENGINEERING, INC.
5409 Nebraska Avenue
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