HomeMy WebLinkAbout01-0202
BUILDING PERMIT~~
0202
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date c-S( 2S/fJl
50'~
BUILDING
ELEC~CAL
PLU~ING
MEC~NICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel J.D. #
s ~ \ r \~~ PQ. ~~."
'-fq'"fto ba \\ \S \va.
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
Energy Code:
Re t9\O'/ e l(
Radon Gas:
v.~e" r t)~......d /-CAt' ( {G^ k J
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
'5 - Z~--O
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
Inspector
J'
City License Registration #
State Certified License#
Permit Fee
1- Signature
Company
Address
1J1I Telephone# f'o 7 J< et3o-C;X;S~ 0
Valuation or
Contract Price
Or~~1" i:>e_+r() '~-""1
BUILDING '28'2 '2
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PlUMBI MECH NICAL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
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,
(j3)
OWNER I S NAME
CITY OF ZBPHYkRXLLS PBRNZT APPLICATION
aUZLDDlQ uuuTMiarr 5335 ,tk STIlBaT ZUBnlQLL8, n. 33,.0
PhaDe.813-780-0020 Fax:813.780.0021
%)Aft UCJl~
PLAKe RWl:1hf 111II
.5;1:'11 ~~~ -- cw.~t~-~~ M
r;. 6L1/7;). .?~.R7~1.t.S 914'# 1fo"~
JOB SITE ADDRESS
LBGAL DHSCRIPTtON: LOT<<S)
BLOClt
SUBDIVISION
PAJtCEL ID #
7~-oJ'- c..
(OBTAIN FROM PROPERTY TAX NOTICE)
tfOlUC PROPSED: ONEW CONSTRUCTION
oSIGN
o ADDITION OALTBRATION 0 REPAIR
o MOW )< DBMOLISH
oMOLTJ:-FAHILY 0# OF UNITS
o INSTALL
DESC1UPTION OF
PROPOSBD USB: osm. FAMILY DWELLING
p( COMHBRCJ:AL
CJ RSSTAURANT & HEALTH DBPARTMENT APPROVAL
WORK lZ6Mb\L t:; L 4-') U ~\6
N I A.. SQUAD FOOTAGE N.! P-
D INDUSTRIAL
o SWItoMtNG POOL
o MOBILE HOME
o OTHD,
BUILDING SIZE
HEIGHT ~
RESIDENTXAL :
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS 01' BUILDING PLANS & (1) SIrr EIlJ:RGY FORMS.
ATTACH (Jl SETS OF BUILDING PLANS & (1) SET BNERGY FORMS.
PROPERTY SUllVEY REQUIRED ll'OR ALL NBW CONSTRUCTIQ)!.
~~o
Jil'BRlaTS lUIOtJBSTBD
$ 'qa::o. 00
VALUATION OF TOTAL CONSTIWCTJ:Q)!
AMP SERVICE
'.
D ELBCTRJ:CAL
o PLUMBING
D FLORIDA POWP:>>.
o W.R.B.C.
[J MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SJ:lBCJ:ALTY
DOTHER
TYPB OF COUSTRUCTION, D BLOCK
D FRAMB
o 8'rBBI.
o OTIIBR.
FINISHED FLQOR ELBVATIONS
IS PJl.OJ.Bcr IN FLOOD ZONE AREAO YBS n NO
SIGNA'l'UR!:
COMPANY &7~~~
STA'rB CBRT OR REGIST . ~~
CITY PROCESSING i_
BLaCTIlJ:CJ:AH
SIGNATURE
COMPANY
STATE CERT OR. lUlGIST #
CITY PR.OCESSING #
.....AA...**.**.**..**.....**************.****....................
PLUDD
COMPANY
STATE CERT OR RBGIST i
CITY PROCESSING It
SIGNATURE -
IOICIWO~
...................**.**......****...****......***....*...*.......
COMPANY
STATE CERT OR REGIST. .
CITY PROCESSING It
SIGNATURE
*......**..**.......................*****.....**.........********
OTIIR
SIGNATURE
COMPANY
STATE CERT Oll UOIST #
CITY PR.OCBSSINQ It
**...........*******.**........***.****.***....**.....*********..
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CONDITIONS OF PERKIT AF:tIDAVJ:T
A. NOTICB OF DEED RESTRICTIONS
The undersigne understands that this peCll:!.t may be .subject to "'<1eed restrict1.OJu." which
-y b.. more restrictive than City requlations. The undersigne a.s.-s responeibility for
compliance wtth any app~ieab~e deed restrictions.
8. UHLICDlSED CONTRACTORS AND CONTMCTOR RE.!lP0N5laILITII!:S
If the owner has hired a contractor or contractors to un<1ertake work, tbey lliay be required
to be licensed in accordance with stat. and local regulations. Ir the contractor is not
licenaed .s requdred by law, both the owner and contractor may be cited for a misd....nor
violation under state law. If the owner or 1ntended contcactor are uncertain aa to what
licensing requirements may apply fox the 1ntend.ed work, they are advised to contact the
City of Zephyrh1lls Building Department, 813-788-6611.
I'u.1:thenaore, if the owner ha. hired a contractor or contractors, he is advised to have :tbe
contractor(s) sign portion. of the "Contractor SectionaM of this application for which they
will be responsible, If you, as the owner sign. as the contractor, you are indicating that
you, rather than the contractor, are respon.ible for the work. If the contractor w1.ahes
you to 8ign a. contractor that ~y be an indication that he i8 not properly licensed an4 1&
not eutltled to perRdtting privileqee in the City of Zephyrh1l1s.
c. TRAHSl.'ORTATIOH IM1>ACT !'US AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LMf ICHAPTD 713, FLORIDA. STATtl'TES, AS JlMENDED)
I certify that I, the .applicant, have been provided with a copy of ~rlorida's Construction
lien Law - H~owner'8 Protection Guide"' prepared by tiuo Florida Department of Agriculture
lUld COn811ll1er At1:a1.r8. If the applicant is ....ou. other that the "'owner", r cerify that I
have obtained . copy of the above described document alld. prolll1..e in good. faith to deliver
it to the ~owner'" prior to ccmanencement. '
E, CONTRACTOR' S/otfHER' S AFFIDAVIT
I cert:lry that a11 the infoDllat.ion in thi8 applicat10n 1.8 accurate and that all work will
be done in compliance with all applicable laW8 regulating construction, zoning; and land.
development.
Application is hereby made to obtain a perRdt to do work and tn.ta11atioD as 1nd1cated. r
certify that no work or installation has commenced prior to issuance of a pe%Ddt and that
.11 wOJ:k will be pertol:llled to _at atandarcia of all laws regulating construction, CJ.ty
codes, zOning regulations, and land develop..nt regulations 1n the jurisdiction. I alao
certify that 'I understand that the regulations of other gove~tal agencies may apply to
the intended Work, and that it is my re.ponaibility to identity what actione I must take to
be in c~liance. Such agencie. include but are not liDdted tal *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and EnVironmen~ally Sensitive
Lands, Water/lfaatewa.ter Tre;u:ment
*southwe.t Florida Water Management Di.trict-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourse.
*Army Corps ot: Engineers-Seawalls, Docks, Navigable Waterway.
*Department of Health ~ Rehabilitative Serviees, Bnvironmantal He.lth Unit-Wells,
Wastewater Trea~nt, Septic Tanks
*U.5. Enviro~tal Protection AgencY-Aabestos abatement
1 also certity that, if fill mater~al is to be us@d in Flood Zone "'~" or "'A,etc.-, it is
understood that a drainage plan addressing a "Comp~ating vol~"' will be sUbadtted which
is prepared by a protessiona1 engineer registered in the State of Florida prior to permit
i.!l.!luanee.
A permit issued sha11 be construed to be a license to Proceed with the work and not as
authority to Violate, cancel, alter, or set asida any proVisions of the technical codes,
nor shall issuance of a p~t prevent the Building Official tr~ thereafter requiring a
correction of errors in plana, construction, or violations of any code. Every permi.t
issued shall become invalid unleas the work authorized by such permit is c~ced within
six months of issuance, or if work authorized by the permit is su.spended or abandonect tor a
period of six lIlOnths after th.. time the work is c"..,.,nced. One 90 day extension of time
may be allowed for the peradt with fee charge ot $15.00. The exten.ion shall be requested
in writing to the BUilding Official. An approved inspection must be logged during each .!I1a
month period, or the project w111 be considerect abandoned.
1fARRING TO 0WNBIl.: YOUR FAILURE TO RECOJUl A NOTICl!: or CalMDfCIHBNT MAY RESULT
PAYING TWICE FOR IHPROVDmHTS TO YOUR PROl'ERTY. IF YOU IN'1'ZNJ) TO OBTAIN
w:tT1f YOUR LENDER OR AN ATTOI\NE'l BEFORE RECOJUlING YOUR NOTICE OF
~"'" HE'" '" """ROB' · -.anc c
~~ S
STATE OF FLORIDA STATE OF J'LORIDA
COUNTY OF COUNTY OF
The foregoing inatr\llDel1t wa8~,c_la!knOOWWl" edged The rorelto1ng instrument w.. ackn~edged
Bef'ore - th1s....z3::.. da:!.. of_ _~.~, bBeyfore _ A~h},~ :z::2.d:Ia!...:~Of 1't~~"-M , K"~I
by A4"'- 6.DD~~ C!:~L~
/(name of person aClmOWledqed) _ ~name of pexson a owleclqed)
iirwho is per.ohally known to me, or ~o is personally known to me, or
T.
IN YOUR
CING, CONSULT
J08S UNDER
Owho h..... produded
( tl'Pe
'd n t
o who has p:roducect
(type of identir1cat.1onl
id not take an oath
Signature of person eking acknowledgement
#1).... ~ Andree Engstrom
JI'_ tYP~ ~lIJIUilIlJ>ec912029
.. Expire. February 20, 200.
'd vlvO'ON
Signature of person ta ng acknowledgment
~AndreeEngstrom
Name tY\tllf,t&ew"8f8llllt~1029
.......~ Expjre. February 20.2004
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