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Home My WebLink About01-0059 BUILDING PERMIT~~ 0059 BUll~G CITY OF ZEPHYRHILLS (813) 788-6611 Permit Date '/2J/O( , ELEC~ICAL PLU~ING /95: 0;> MECHANICAL Sewer Conn Property Owner: Job Address: Parcel 1.0. # Zoning: DescriPtion of Work 'f~of.tf"" ~ h..... rsJ. L( 'it ~ h:rf'or+ Water Conn: /V1a" "" .(~ C ~ wr: A) ~O/. Water Meter: T.I.F.'s: Energy Code: TA{'.k~l\ y HVA( Radon Gas: (y~4t-s I^ /14 eo e-l-.... e 5l-oD , NO OCCUPANCY BEFORE C.O. FINAL C.O. Z -5"_ a DATE Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE Inspector 5" Valuation or Contract Price 2'1 120 ( . bO -- City License Registration # State Certified License# p l\' Ale fe [. . ) . C!l\r~ I. J , \ BUill ING ELECTRIC ~L PLUMBINC MECHANICAL Ftr. Tp. Servo SLB Breakers Pre SLB Rough In Tub Set Ducts Insl. Lintel Meter Can Water Compressor FRM. Const. Pole Sewer Final Insul. CL Pool Final WL Pre-Meter Final Driveway REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Twenty Five and 00/100 Dollars ($25.00) 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 t:!-V1 DATE RECE:IVED PLANS REVIEW OWNER'S NAMc-\\-\.t>\J ~ \\ ",. J R $\ .~~c... \ ' JOB ADDRESSJ4~1.1..\ p..\~~uQ\ ~t), 'Z.E~"',{Rr\lU.S PHONE. 1 t) '. -., 7 D D LEGAL DESCRIPTION: LOT(S) BLOCK ~L) SUBDIVISION PARCEL ID # WORK PROPSED: [JNEW CONSTRUCTION [J ADDITION (OBTAIN FROM PROPERTY TAX NOTICE) [JALTERATION [J REPAIR ~STALL [J DEMOLISH [J SIGN PROPOSED USE: [JSGL FAMILY DWELLING ~MMERCIAL [J MOVE [JMULTI-FAMILY [J INDUSTRIAL [J# OF UNITS [J SWIMMING POOL [J MOBILE HOME [J OTHER o RESTAURANT & HEALTH DEPARTMENT APPROVAL '. "\ DESCRIPTION OF WORK.-"""WS1'f\L.L 4 t\\J~c. <;'1{<;'lUJ\S \N 'MJ\c...\1,l.vt:.. ~HoP (1't\f)(t\J\--\iJP",>'l'S_) \ I /" BUILDING SIZE f~~ SQUARE FOOTAGE 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 REQUESTED [J BUILDING $ VALUATION OF TOTAL CONSTRUCTION [J ELECTRICAL ~BING MECHANICAL AMP SERVICE [J FLORIDA POWER [J W.R.E.C. [J GAS' [J ROOFING $ 21) ~1..0 [J SPECIALTY VALUATION OF MECHANCIAL INSTALLATION [J OTHER TYPE OF CONSTRUCTION: [J BLOCK [J FRAME [J STEEL [J OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREA[J YES ~ BUILDER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ********************************************************'k********* ELECTRICIAN COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************************** PLUMBER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE * * * * * * * * * * *.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ;...* * * * * * * * * * *." * * * * * * * * * * * MECHANICAL COMPANY ~t-\~';\..i-} J:>.1l2. ~ R~(? 111} 0 ?_. . ~ _ ,# j J.A . STATE CERT OR REGIST' # (.A.cn I)~ \.~'1. SIGNATURE ~ ~~ CITY PROCESSING # <\C1 D ~~ It''t"lO ***************************************************************** OTHER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ********************************************************k******** CONDITIO}(S O~ PER1\fI':" A!:!:FJAV-::':" A. NOTICE OF DEED RESTRICTIONS The-undersigned understands that this permit may b,: su:oject ':0 "deed restrictions" which may be more restrictive than City r.:gulations. Th,: und':rsiq-ned assumes responsibility for compliance with any applicable deed rest;rictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undert,'!ke work, they may 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 may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the City of Zephyrhills Building Department,. 813-788-6611. Furthermore, 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 signs as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that may be an indication that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES ,D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided ~'ith a copy of "Florida's Construction lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone ot:her that the "owner", I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. E. CONTRACTOR' S/OWNER' S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning, and land development. Application is hereby made to obtain a permit to do ~iork and installation as indicated. I certify that no work or installation has commenced pl~ior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental agencies may apply to the intended work, and that it is my responsibility 1:0 identify what actions I must take to be in compliance. Such agencies include but are not limited to: *Department of Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment *Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses *Army Corps of Engineers-Seawalls, Docks, Navigable Waterways *Department of Health & Rehabilitative Services, Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is understood that a drainage plan addres~ing a "compensating volume" will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. A permit 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 issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction, or violations of any code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for a period of six months after the time the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six month period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". ~il~~ SIGNATURE: OWNER OR AGENT 1i~- STATE OF FLORIDA COUNTY OF The oregoin instrument was acknowledged Before . s :bi-day of \.....L) , ~0CL\.. by o person acknowledged) [1ho r ally known to me, or "2 51(.,5,;>.;),3 txJ 10 o who has produced D~ \ dt:."\t S L\ c. ( tV '- 6 (type of identification) and who Ddid Diid not take an oath STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged Before . . oS ~ day of j ~} , )&Ol by I .~ (nam f erson a c.. knowledged) rrwho is p nally known to me, or --J~~' o who has produced (type of identification) and whoD did Ddid not take an oath. Signature of person taking acknowledgment Signature of person taking acknowledgement Name typed, printed or stamped Name typed, printed or stamped \l1f[r/Me !fOc>/l-1. ~~ ~ rA. ::t..". ~F fT. ~o ~> "(') '011\ ;t> "t. .;? ~:P ~~ 'O~ 12.}. \~~2. <.1 lCU UX I') ~cJ\ 17 +.~ (7 ._/ ~~ ~ '!. -\ ~ ..) ~- oCl o c> (j (7 J ~ G. rJ '4;) m 1\\ )'i) 1- r, )l -~ ~ c_ >- -t> '^ " X. b ). ....-._~ d ~':S> (' 0"5:- ~ ~ f' C\,~ 7>1.- ~. -s<-. ~"":l\ {' -of(\ -<I ~ ~ l\. oJ_<- if ~~ v-' 0 ...,.... _ ."2. "r e. _ n....~ ~y~ ~(> ~ 0 fH ..J) r ~~{\ cJ:o - vJ'J:' r:J\v.l --. '" 0 6 .Jf'v Vl }-J -p L -t\ 6" w o -J ,; oil. ~-~ p ) ~ V\ X \'1 \"IXiS~2- \q X \'3J/ -n ~~<4 "P U 0 <:.Q ~ dJ y r. '/<. ~ ~ <:R \ II X. I 'l (l1 t 15 Vz. \'1 }C 11 ill.. J ~ ~ --!::: ~ rJ ...c -p -' P -0 0' 70 --\ JO o N [t~ '\) :!= ~C 70 :C I r \J\ ,-. 1) r <::J \..r, j) \"OTICE OF ELECTIO~ TO BE EXEiVIPT Please refer to the written instructions prepared by the Dh'ision of \Vorkers' Compensation before completing this form. ST ATE USE ONLY Eft~.;tive/[ssue Date: Expiration Date: By tiling this application, you elect to be exempt from the provisions of Chapter 440, Florida Statutes and waive any right you may have to workers' compensation benefits ill Control Number: the State of Florida should you become injured on the job. Anv oerson who knowinl!lv and with intent to iniure. defraud. or deceive the Division or any emoloyer. emplovee. or Postmark Date: insurance company or purposes oroeram. files a Notice of Election to be Exempt containine any false or mislead in!! information is l!uiltv of a felony of the third del!ree. Certain Received Date: documentation is required by law to be attached to this application-refer to the instruction sheet for more details. I am applying for exemption a, :> (check only one box in this section): ~o.)STRUCTIo.:\" INDVSTRY ( S 50.00 FEE REQUIRED) [i2t'Sole Proprietor 0 brtner [J ('r!'porate o.fficer (your corp. title:) -o.R- l'o.:\-Co.NSTRUCTIo.N INDUSTRY (NO. FEE REQUIRED) o Co orate Officer ( our co . title: CORPORATE OFFICERS AND PARTNERS: List the registration number of your business on file with the Division of Corporations, Department of State's Office (NOTE: your partnership may not have one, but all corporations must have one. If your partnership doesn't have one, state "N/A"): THIS EXEMPTION APPLICATION APPLIES ONLY TO THE PERSON SIGNING THE APPLlCA nON AND ONLY FOR THE BUSINESS ENTITY LISTED IN THE FOLLOWI~G SECTION Bu:fiess Name: Trade Name; d/b/a; or alk/a: -+" EL ~ Business Mailing ddress: g' Unemployment Compensation No. of Employees: Tax No: 0 Are you required to be registered or certified ursuant to Chapter 489, F. S.? DNo . es: list all certified or registered licenses issued to you pursuant to Chapter 489, Florida Statues C f\ Co D S ~ \ ~'3 Are you or a qualifier for your business required by the county or the municipality in which your business mailing address is located to have an occupational license for the business which is the subject of this application? D No Q'Yes: YOU MUST ATTACH A COpy OF A CURRENT OCCUPATIONAL LICENSE Are you ~1pj0Yed by any sole proprietorship, partnershi~. corporation or business entity other than the business to which this application applIes? ~NO 0 'YES I1st the name of all other busll1esses 111 which you are employed: Has the above-referenced business entity bee 'n operation long enough to have filed with or be required to file by the IRS, an annual Federal Income Tax Return? 1 fO 0 Yes, You must attach tax records. See instruction sheet for details, A FFIDA VIT OF APPLICANT: I hereby certify that the information contained herein is true and correct to the best of my kno\Yledge and belief; that this election does not exceed exemptioil limits for corporate ofl1cers or partners as provided in ~440.02 Florida Statutes; and that I will secure the payment of workers' compensation benetits, pursuant to Chapter 440, Florida Statutes, for any employee Inow have or may hereinafter acquire, for which my business is required by Florida law to secure such benel1ts. "II'. .? ..... '5 IDI '" ~ ! '-l L. 7 CO SOCIAL SECUUTY :-'-0. -1-1 20 I~_ DATE SIG:-'-ED \ I l I 7s OR EXDlI'TlO:-'- .. , mo. day DATE OF BIRTH. yr. A, COUNTY OF . il Sworn to :1nd subscribed before me lhis~ day of Person:1lly Known ~fl"~,-~ -i1.JD(by/1lh/r' c;;. LtJryJ~~< ' 'J .' V I , OR Produced IdentifiC:1tion ---- Type of Identific:1lion Produced r,j? ~_~ ~ J . c / xpires 7" / / & .I ~ p () V VERSE F~ ADDITIONAL'INFORt"IATIO~) (' l'\OTARY SIGNATURE -l LES FORt\I BCl\I-250 Revised February 00 \\;;'~"~/., l~''&.~" ~{~.~j ~"~iif..~~~" EC.JOHNSQ~EE MY COMMISSION # CC b45427 EXPIRES: September 16,2004 Bonded Thru NOlaI}' Public Undorwrit.,.