HomeMy WebLinkAbout01-0184
BUILDING PERMIT~~
0184
~~Jtj
CITY OF ZEPHYRHILLS
(813) 788~6611
Permit
Date
) 1,"1/ J I
BUILDING
ELEC~ICAL
PLUM~G
MEC~NICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel I. D, #
L;
c.. ....7
oA-
(r;.rcl
~"-yr "-: \ \ 5
Water Meter:
T,I.F.'s:
Zoning:
Description of Work
,'-I
Energy Code:
V~2
,
PDt '"
Radon Gas:
(4,0 +-
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Inspector
Valuation or
Contract Price
2'00,
e('
--
Permit Fee
~. SignatU!Jk/
Com
Address
Telephone#
'~
City License Registration #
State Certified License#
(~ -I.~t)~
BUILDING
o
ELE
PLU BING
Ftr.
Pre SLB
Lintel
FRM.
InsuJ. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts In
Compres
Final
Driveway
REINSPECTION FEES: When extra inspection tri~s are necessary due to anyone of the following reasons, a
charge of Twenty Five and 00/100 Dollars ($25.00) ishall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from fa~ty construction.
c. Repairs or corrections not made wh n inspection called.
d. Work not ready for inspection whe 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.
OWNER'S NAME
I ,
)V~\~ \ )
~
,
2 ~j?o/ ~f/tCL s~
t1/f? "-(nfN c. ~ V lhe-t>
(
BLOCK
APPLICATION FOR PERMIT
CITY OF ZEPHYRRILLS
BUILDING DEPARTMENT
DATE RECEIVED :J -7'- 0 (
PLANS REVIEW FEE
,
JOB ADDRESS
Cryo
('/ ry
PHONE
LEGAL DESCRIPTION: LOT(S)
SUBDIVISION
PARCEL ID #
(OBTAIN FROM PROPERTY TAX NOTICEl
DSIGN
'~ADDITION DALTERATION o REPAIR o INSTALL
o MOVE 0 DEMOLISH
DMULTI-FAMILY 0# OF UNITS o MOBILE HOME
o INDUSTRIAL o SWIMMING POOL o OTHER
WORK PROPSED: DNEW CONSTRUCTION
PROPOSED USE: DSGL FAMILY DWELLING
o COMMERCIAL
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK
'70 IN5~,,-
i"'..,c tP,.L
/.tm/ ~F
~ 6 <6 '~'V,c
HEIGHT
BUILDING SIZE
SQUARE FOOTAGE
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.
o BUILDING
PERMITS REQUESTED
;2.(Poo ,HJ
VALUATION OF TOTAL CONSTRUCTION
~-v~
_/
$
o ELECTRICAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
SIGNATURE
COMPANY 5;;I{S~~ /fUJI( /1(./ tJ "I ~C
/~. ce /Y _ STATE CERT OR REGIST #
~c.(/<,/. ~ CITY PROCESSING # 76
***************************************************~~~**~~:J111 ~
'*" Z,tJ,
BUILDER
ELECTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
* * * * * * * * * * *,* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
* * **.** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * *
... .....~,.
CONDITIONS OF PERMIT A~FIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be sLlbject to "deed restrictions" which
may be more restrictive than city regulations. The undl~rsigned 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 NOY.NEEI)-- ECORD AND POST A "NOTICE OF COMMENCEMENT".
~
S TATE OF FLORIDA ~R .
COUNTY OF ..set... 0
The foregoing instrument was ackno~edged
Before ~ this ... ~ day of /J;'A J6t!.ff , :L.9- ~P/
by /'t t.L L 0 /'2-~ 6/ rf
~. (name of person acknowledged)
~ is personally known to me, or
STATE OF FLO~A
COUNTY OF )CJSt!-O
The for.eg.oin. g in~ent was acknowledged
Before me, this day of 1JJ/1~tt.1{ , 1?9~/
by /-'/9U L / C'~~E-/4
~ (name of person acknowledged)
wno is personally known to me, or
o who has produced
(type of identification)
and ~~. o did. Ddid not take an oath.
~~ /~ cxtd- /k:z:s
(Signature of person taking ack ledgement
SHlRoEN It oa. (j)TT0169
Name t - I~;~
\lOIld8dltml!lClW#"-
EXP t,.;;U,. 0 cj
o who has produced
(type of identification)
an~1: ~did Oii~ not take ;n ~ath
~ ~~'- ~~~-e ~~
'/signature of person taking acknowledgment
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