HomeMy WebLinkAbout01-0319
BUILDING PERMITN~
0319
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date
Sllfo/o\
'/o.~
BUILDING
"'IS'.'"::'
ELECTRICAL
>s,~
PLUMBING
-:lS".~
MECHANICAL
Sewer Conn
Water Conn:
Property Owner: (( ob~ .}. Pe \ \ e -\- l e.,r
Job Address: "J 7 ;..{ ~;5' (\J€~~o,-, Av-€ .
Parcell. D. # 5'-( - :1 S- ' ~ \ # l) 0 I 0 - 0 J Coo -
Water Meter:
,27~, .:.J2 '
S' S-u, ~
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I ~So. dS!
- .....
17'). -
I ~(). ~
T,LF.'s:
13'10
Se.+
Radon Gas:
U.::J .
,
Zoning:
FINAL
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
6
DATE
Inspector
Permit Fee E7 ~- ~
?' Signature ~ _ tkM
Company
Address
--{Jelephone# '1fZ-- /obL(
Valuation or
Contract Price
City License Registration #
State Certified License#
~",-~':eld
4<..e Ele(
8~e.r[:( 101
A<.e ((e~.'~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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 Twenty Five and 001100 Dollars ($25.00) shall be made for each trip for each trade: , ~ .
a. Wrong Address ~ ~.
b. Condemned work resulting from faulty construction. .~ V-
c. Repairs or corrections not made when inspection called. . .~.
d. Work not ready for inspection when called.,J'/ (/! I
e. Permit not posted on job site. & 0
f. Plans not at job site. . / /' .,/
g. Work not accessible. . &J
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DBPARTMBNT 5335 8~ STRBBT ZBPHYRHILLS, PL 33540
Phone:813-780-0020 Pax:813-780-0021
DATB RBCBIVBD
PLANS RBVIBW PBB
OWNER'S N~ ]2ot3t(LI P~L-L[TI f:(L
JOB SITE ADDRESS "'I74 3~ N6JJ(OtVl
PHONE CONTACT '7 f z - I Cfc <(
nVB
LoT I 3 9
LEGAL DESCRIPTION: LOT(S)
SUBDIVISION
UIJ/VI/ POll. ( c: ~ r/
BLOCK
o 21lYO - (1<; c:>
PARCEL ID # 34- _ 2-5 -?- (- OtJ I 0 - 11 " I ~ IS 0 I ~ ~1' (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION 0 ADDITION o ALTERATION 0 REPAIR GrfNSTALL
DSIGN
PROPOSED USE: ~L FAMILY DWELLING
o MOVE
o DEMOLISH
DMULTI-FAMILY
0# OF UNITS
GtMOBILE HOME
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
m{)~ IL(; [J /);vlr- ~ ~ r V{J
SQUARE FOOTAGE j 53 I
HEIGHT
DESCRIPTION OF WORK
BUILDING SIZE
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 $ & Zoo ,d)
BELECTRICAL J1;& ",0
~LUMBING
UYMECHANICAL $ lRaJ ,rIO
o GAS o ROOFING o SPECIALTY
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
.
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES 0 NO
SIGNATURE
~IJI~
COMPANy-f>U/161lt::1 r;f--V l11og/t-C f-.)OM;; Sfl:~I//lf
STATE CERT OR REGIST #
CITY PROCESSING #
BUILDBR
******************************************************************
SIGNATURE
g~4,W
COMPANY Il(;~ (:WnZIC
STATE CERT OR REGIST #
CITY PROCESSING #
BLBCTRICIAN
******************************************************************
SIGNATURE
~JrW
COMPANY TJU-rT(JL-FlbU) Mlf/;I!.-6 [k;iY1? ~rflvlc~> I~.
STATE CERT OR REGIST #
CITY PROCESSING #
PLUMBBR
MBCRANICAL
SIGNATURE _~
******************************************************************
COMPANY Act!" #(fl {DAltl '
STATE CERT OR REGIST #
CITY PROCESSING #
11, fl/ JJi!
*****************************************************************
OTHBR
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 subject to ~deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
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 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 with 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 other 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 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 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-addressing 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".
~ 11. fkM
SIGNATURE: CONTRACTOR
9?~C;:;/~
,
SIGNATURE: OWNER OR AGENT
acknowledged
1~
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
19
(name of person acknowledged)
Dwho is personally known to me, or
(name of person acknowledged)
[1ho is personally known to me, or
o who has produced
(type
and whoD did Ddid not
of identification)
take an oath.
Dwho has produced
(type of identification)
and who Ddid [}:lid not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
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PASCO COUNTY. FLORIDA
"---~----,^
/'.-~....- '\
Permu NU.~ 31 '-i ,~L
~( fl',.
Date Permitted ,.~ i . ..> ,() ,
Builder Name/Owner Name
r'"
, '; .~J ~ t
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.... , ~. 'C .
County Parcel No.
\, 1. '. ,~i '~" >. : t
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0--~ I;..,)' () _ '~.:"...... .
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Address/Location': ) 'I ) .~
/~.):;i;' l ti ,.,""
;-\",>,
Subd...; ,
v~ \
ClassificationfType of Use
\ '
"
.,
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
,-"
Zone No.
Prepar,ed--B ;'
/...~-,.1
/--Checked By
.""
...
Rate $
Sq. Ft/Unit
Impact Fee Amount $
,.' ,/
The aboye impact fee h~~be~n established pursuant to the Pascop6unty Transportation Impact Ordinance as adopted by the
Board of Pasco C01.lnfy Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of th~permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
Gross Sq. Ft. (GSF)
RJIL' ERl'
.'i200/Year
or SO, 1.+2/Day
ERU Assign No,
.
ASsC~~rllCnl ~ (!\;o Units) x ($0,1'+2)
\ (No, Day~)
Assessment -
(GSF) x (ERU) x (0,1'+2) x (No, Days)
[00
TOTAL FEE $
i
TOT AL 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 does not imply acceptance of concurrence. hut simply receipt nf 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 L'SE ONLY
TRANSPORTATION REC. NO,
RESOURCE RECOVERY REC. NO,
DATE
DATE
BY
_ BY --'-
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal'ce
PC93113094/D
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2001075756
Rcpl: 503141
DS: 0. 00
06/06/01
Rec: 6.00
IT: 0.00
Dpty Clerk
STATE OF FLORIDA
COUNTY OF F~\SCO
THiS is TO C;:[';1 !"'/ "'AT THE FOREGOING IS A
TRUE AND CORRECT :,1; liE DOCUMENT ON FILE
OR OF",PWLIC, '1\\,"',: .hi i',!iS n"FFiC~~SS MY
HANOI 0 !'itf':'::~' "t!'." :"11:) DAY OF
;;;:0/&
';A!V!~'2j1tt~~f~~pU;~ CLERK
JED PITTMAN~ PASCO COUNTY CLERK
06/06/01 0...: 4!,rm 1 of 1
OR BK 463~ PG 524
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HOTICE OV COkxEH'''E~HT
County of f ,4S C 6
';"UII lIHne/lSICHCO horeb)'
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(.ou r e n3'743rf f,It:J(o/11. AvE c1 t)' ZEltI'f/U-ItLLS
Intutst 1n pr.openYI
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(It other th,n owner)
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AddrQss
city
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Mlount ot Bondi $
6, Lwnd.r: Hame
AdurQ"
City
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7 ,
pusons '..J1th1n the Stat. oC P'lorida
notic.s or other documont. may bo
)1),1)( 1)(4)(7), rlorida Statu~.'l
d"i9nlted by O....no r upon w~.C:T1
.erved a. provided u1 Sec~~on
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City
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8 In 4dditl.o,n to himult, O....nH d'o.i9n6te~
O{ to roceivo & COJl), o{ t~e
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'J, (.p.rnl..fJn dn\.1 o( H<Jt..1ce oC CO/lI/llOnao/llonl,o,(I."e ellpLrot.l"n d,)~u I. I year
(,~~ thQ U~~Q ~, rucordin~ unl,.; 6 diC!cr~nt dtto i: .peci(~ed,)
SIC)n4tureo(O'..Jner: J?~ ~/~
fJ "e rll-r Pf"U~ n ~/l-
Sworn to and sub'cribe~-betore me tni. & d.y ot
,TUNE
1;;JII-7co(
HO~Jry P"blic;
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"/,(Oll',n/ o. ion ~~plrl'l
A ~ Bruce A AsbeI
*~ *My commission CC748677
~:'!!.1 Expires June 22. 2002