HomeMy WebLinkAbout01-0166
BUILDING PERMITN~
0166
Property Owner:
Job Address:
Parcel I. O. #
CITY OF ZEPHYRHILLS p /~o~ermit
(813~ ~~
j S' ., ~_____"_'. Date
Cf~;~~QI~ ~
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10
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Sewer Conn
Water Conn:
T.I.F.'s:
Zoning:
c.o.
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.
::/
Inspec.Ji> .
~e~'~~
Signature
Company
Address
ele-phonel '\,
~
Valuation or
Contract Price
City License Registration #
State Certified License#
ELECTRICAL 1&1'7
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
a.
b.
c.
d.
e.
f.
g.
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: t
A S<).....e.~
VJC,.. (, ie.
V;,~
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.
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PASCO COUNTY, FLORIDA
Penn;! NogjiO
Date Permitted _ S I G I u t
Builder Name/Owner Name
t c,\\
~ I
County Parcel No.
~....~ .....~"i: ,_ ,,".
Address/Location J ! " 1\
L;
'-<
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Subd.
',':. f {.
.- ~ t .
C1assificationfType of Use
, '\
I' '_ .'., (
Ii
I L..
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
",./'
-~y
/....
Zone No. /,.-'
/~
/
Prep~d By
· Checked By
Rate $
Sq. FtlUnit
Impact Fee Amount $
.,.
/.t'"
The above impact fee ~~been established pursuant to the Pasco County Transportation Impact Ordinance as adopte(tby the
Board of Pasco COJIDty Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of t~rmitted structure.
RESOURC~RECOVERY ASSESSMENT EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
Gross Sq. Ft. (GSF)
R;1(C ERL:
52,OO/Yc;1r
or SO,I.+21O;1Y
ERU ASSIgn No.
A~~C~~J1lcnt- ()\io. Units) x ($0142)
\ (No, Day~)
As~essment -
(GSF) x (ERU) x <0,142) x (No. Days)
100
TOTAL FEE $
TOTAL FEE $
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED l!NTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTI~G OFFICE OF PASCO COUNTY.
Acknowledgement below docs not imply acceptance of concurrence. but simply receipt of a copy of this form. placing
the huildmg permit owner on notice of this assessment and the conditions of payment for same.
Date
Received By
----- -------~----------------------------------------------------------------------------------------------
OFFICE L'SE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO. .l
DATE
DATE
BY
.. i I
'J
BY~
: I
"'"....
White
Applicant
Canary
Trans/Finance
Canary
RR/Flnance
Pink
Office
Green
Bldg/lnsp
feecalce
PC93113094/D
APPLICATION I'OR PElUaT
CITY 01' DPHYRHILLS
BUJ:LDING DEPAR'!'IdENT
DATE RECErvED
PLANS REVIEW I'EE
OWNER'S NAME ED &flfUl'<
JOB ADDRESS 37545 LOflEtJfl
PHONE '1t 2 -I () (P if
Av~.
.
1.-0 r 1)2.--
LEGAL DESCRIPTION: LOT(S)
SUBDIVISION c:dlMtJ ~Il( ?(}/V
BLOCK
PARCEL ID # 7}f- Zc; -~( - 0010- 0/3 oo~ 01 I Z-
(OBTATN FROM PROPERTY TAX NOTTCF.1
WORK PROPSED: ONEW CONSTRUCTION o ADDITION o ALTERAT I ON o REPAIR ~TALL
o SIGN o MOVE 0 DEMOLISH
PROPOSED USE: rnsGL FAMILY DWELLING OMULTI-FAMILY 0# OF UNITS ~BILE HOME
o COMMERCIAL o INDUSTRIAL o SWIMMING POOL o OTHER
DESCRIPTION OF WORK
CJ RESTAURANT & HEALTH DEPARTMENT APPROVAL
~l5r (VWfJJ( LF- l-It'Ji1IIE
BUILDING SIZE zr" !)l--
SQUARE FOOTAGE / If ~
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
~ILDING $ to 7 ()Q . 00 VALUATION OF TOTAL CONSTRUCTION
[YE"iECTRI CAL J~-o AMP SERVICE 0 FLORIDA POWER 0 W.R.E.C.
~UMBING
~HANICAL $ 500. ()O VALUATION OF MECHANCIAL INSTALLATION
o GAS o ROOFING o SPECIALTY 0 OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES
o NO
BUILDER
SIGNATURE~ .11. ~.-
COMPANy_13JTTfru=( CL- V.>
STATE CERT OR REGIST #~/
CITY PROCESSING # 1'~
******************************************************************
SIGNATURE
~ iI. aaM
COMPANY /kE: El-t: c n2 ( C
STATE CERT OR REGIST #
CITY PROCESSING # /r?1
ELECTRICIAN
******************************************************************
SIGNATURE
~4.~
COMPANY BIiTT&1LF( f;WS"
STATE CERT OR REGIST #
CITY PROCESSING #
PLUMBER
MECHANICAL
* * * * * * * * * * *.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * If. * * * * * * * * * * * * * * * * * * * * *
COMPANY . rC f+1fL LcA/bJ ,
SIGNATURE
~
fl. a.u
STATE CERT OR REGIST #
CITY PROCESSING # ~
**************************************************************~**
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be
may be more restrictive than City regulations. The
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake 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 owner 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 SectionsH of this application for which the~
will be responsible. If you, as the owner signs as the contractor, you are indicating thai
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 i:
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 with a copy of "Florida's Construction
lien Law - Homeowner's Protection GuideH prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "ownerH, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "ownerH 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 work and installation as indicated. I
certify that no work or installation has commenced prior 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 to identify what actions I must take tc
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 "AH or "A,etc.H, it is
understood that a drainage plan addressing a "compensating volumeH 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 b~ requeste~
in writing to the Building Official. An approved inspection must be logged dur~ng each s~x
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 COMMENCEMENTH.
f-J /~
SIGNATURE: 0 R OR AGENT
subject to "deed restrictionsH'whic~
undersigned assumes responsibility for
~l/
SIGNATURE:
9c
CONT~
STATE OF FLORIDA Dil /"
COUNTY OF ill.> ~6
The foregoing instrument was acknowledged
Before me this ~ day ofhJlI/Idf , ~..lJ%Jr
by ~ CAflA.){
(name of person acknowledged)
~o is personally known to me, or
STATE OF FLORID~M-o
COUNTY OF
The foregoing instrument was ac~noWledged
..-- fi/klLt ...:IIil: 7.....rt
Before me this ~day of , ~~I
by FA? ~,(UJ. D{
~ (name of person acknowledged)
~ho is personally known to me, or
Dwho has produced
(type of identification)
and whoD did rg-aid. not take an oath.
~ ,4~~~
Signature of person taking acknowledgement
Brlue-C 4. !%8cL,
Name typed, printed or stamped
aruce A AsbIll
"6' ~___I..ion CC74815T7
*"aiiI *Mv """"....-
e.... Expires June 22. 2002
Dwho has produced
~e of identification)
and who Ddid @d"Id not take an oath
~/J.~
signature of person taking acknowledgment
Name
Gtwct' Ii. f}-)!J,CL
typed, printed or stamped
Bl\IC8 A Astle! .
fj~ eommission CC74.8677
* *Mv 2 2n02
~... '; Expires June 2 , .
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2001027932
COUI'rry
111~ "OREGOING is ,~
Repl: 479422
OS: 0.00
03/06/01
Ree: 6.00
IT: 0.00
Dpty Clerk
JEO PITTMAN~ PASCO COUNTY CLERK
03/06/01 0.:: 52pm 1 of 1
OR BK 4551 PG 70
5 tat e I) t
(U(Z{J)1f-
NOTICB Ot" CO~Nc;e:KCNT
County of PltSC 0
7UB lINnCRSICNCD hor.by 9iv.. notie. that improvement will be made to c~rtuin
reul property, and in accordance with Chapter 713, Floridll StotuteD, the
rollo....i.n<J intorr:'lation i. provided in thi. Notice of CommenCnl"CIlt.:
Parcel No. 3Lf-l.'5"" -J-I-ODIO~O(JtJO-O/12
Ave L-oT IlL
e property an .treet a
I.
D8lIcdption of Property I
l-bl2..eNA
e.crJoptJoon 0 t
e)
2. General Description of Improvement ()1t131t C II-C/Ylt: .5E-. T
) .
O\/n'or Information: Naml3 EDwAI2.0 GIII2fl.'f
MdreIOS37S-Lf~ wRF1J.11- AvE. City7-Elfllfl-HIU.~-
State FL. 335"19
Interest in Pr.operty:
N/lIne of fee Simple Titleholder!
(If other th4n owner)
Address
City.
Stuta
D
1\ .
ContrActor: N.:lme 73vTiElZr-=l ELO !n()!JrL-r; 1-h#17E
^Jdress 3!c,JO !JIlTTtitFt!3UJ J-Il.I..eClty ZEfJ/-IY/lHIU-f
SER.V/cc jA/C.
Stat e FL. J 3 S'lfo
5. Surety: N.:lme
Addross
City
StcH~
NHount of Bond: $
6. L~nder: Name
Address
City
Stc:ltc
7.
Persons within the State of Florida
notices or other documents may bo
71),1)(1)(6)(7), Florida Statutes:
designated by O....nee wpon ....r.c:n
served ~s provided uy Section
N.1mc
^cidre61l
City
StuL~
8. In additi.o.n to himself, Owner c:tcui9nates
of to rec:eive A copy of t~e
Lienor's Not.ce as provJoded Jon Sect.on 71J.IJ(I)(b), Florida Statla,os.
9. r.kpJ.rnc..i.r.Jn dn\.. ot NClt.1ce ot COlllmencemen\...(\.he explcAt,1.on d.)lU is I yeQr
te?m the uuto ot rocording unless a different date is specifled.)
Signature of Owner:
/Y1 A !2c l-f
.
Sworn to
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NOlury Pllbl i.c:
. N.,/ Com;" j !.i S ion Ex p ire, :
,~\. ftn_ A Asbel
.:~ *My Commission CC748677
~!t'A.J' expires June 22, 2002
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