HomeMy WebLinkAbout01-0525
BUILDING PERMITN~
0525
CITY OF ZEPHYRHILLS
(813) 788-6611
;Jrl-
Permit
BUIL~"
-----
PLUMBING
Date
~ewe'co""
Water Conn:
9-7-0 I
Water Meter:
Job Address:
Parcell.D. #
T.I.F.'s:
Zoning:
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
City License Registration # ~ 9 ~l)
State Certified License#
Permit Fee
Signature
Company 6
Address ,//11 1<#lje" }.,.....,L 5."';',, G- 'r;,.. PL
Telephone# ~(P i 7) / h d-h - it'" 6 4!~,..I- I If
C/~5Tf)~ ~#11J..ltJG 6rF.} ,~
Valuation or
Contract Price
MECH~--.
..........-
Breakers
Ducts Insl.
Compressor
Final
ELECTBJ,eAt
~
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PLUMBING
BUILDING
~
SLB
Tub Set
Water
Sewer
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 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.
., t!~~!2"~@
August 28, 2001
Mr. Harold Ogleby
City of Zephyrhills
Building Department
5335 8th Street
Zephyrhills, Florida 33540
Reference:
Right of Way Well Installation
Amoco # 71
37959 SR 54, Zephyrhills, Florida
FDEP Facility #518519737
Handex Project #117949.005
Dear Mr Ogleby:
The Florida Department of Environmental Protection (FDEP) has asked Handex of Florida, Inc.
(Handex) to install six additional monitoring wells to investigate a petroleum storage tmLl( release
at the above mentioned site. While three wells are located on private property, the remaining
tlu'ee wells "vill require a city right-of-way pennit. These wells will be installed by a drilling rig
in the right-of way near the Mainly New England Restaurant-located across 1" Street from the
above mentioned SIte. These wells will be similar to the one installed in March of 2001. The
location of the proposed monitoring wells are shovm on the attached figure. Each well will be
completed flush ,vith grade level and set beneath a steel manhole.
Enclosed is another copy of Handex's state certification certificate, Hillsborough County
Occupational License, Custom Drillings Liability Infonnation" Drilling License, and proof of
workers compensation insurance, in case you need to see these again.
If you have any questions concerning this proposed well instaliation or pennit application, please
do not hesitate to contact the undersigned (8iJ) 626-4646 Ext 14.
Sincerely,
HANDEX OF FLORIDA, INC.
~ i-f'~
Cory Henderson
Project Hydrogeologist
111 Kelsey Lane, Suite E, Tampa, FL 33619' (813) 626-4646. FAX (813) 626-1898
03/08/2001 17:45 FAX 3527359252
HANDEX LEGAL
-+ FL TAMPA
!4J003
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed.. A statement
on this certificate does not confer lights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the lerms and conditions of 1he policy, certain polldas may
require an endorsement. A statement on this certificate does not confer lights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contrnct between
!he issuing insurer(s), authorized representative or producer, and the certificate holder. nor does it
afflrmaUvelyor negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (7/97)
03/08/2001 17:44 FAX 3527359252
HANDEX LEGAL
-+ FL TAMPA
I4J 002
~ . , I
ACORD. CERTIFICATE QF LIABILITY INSURANC&fl6L DA'-rE (MMIDOI'rf)
12/27/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON lliE CERTIFICATE
Ron Sellers & Associates, J:nc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
20 N. Orange Ave., Suite 70:.ll ALleR THE COVERAGE AFFORDED BY lliE POLICIES BELOW.
Or1ando FL 3280J. INSURERS A~FOROING COVERAGE
Phone: 407-999-9994 Fax:407-999-9970
INSURED INSURER A: Hartford Fire ;[nB. Co.
r~URER B; Athena Assurance Company
Handex of Flori-da IDe. INSURER c: "!'Win Citv Fire
111 Ke1sey Lane, Suite E INSURER 0: Greenw~ch XnsuranCB Company
Tampa, FL 33619
I INSURER E:
COVERAGES
TIiE POLICIES OF INSURANCE LISTED BELOW k'\VE BeEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICy ~oo INDICATED. NOlWlTHSTANolNG
/>N'( RR1I)IREMENT. 'fEW DR CONDmoN OF AN( CONTRACT OR 0THel't DOCUMeNT wrrn RESPECT TO WHICH THIS CERllFlCATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFOlWEO FrY THE POlICI6S DESCRl8ED HER9N IS SUBJECT TO AlL TIiE TERMS. EXClUSIONS ANO CONDITIONS OF SUCH
POUClES. AGGREGATI: LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
IINSR lYPE OF INSURANCE POlICY NUMBER DATE~ DATE-rMMtDD/rii LIMITS
LTR 1
GENERAL LlABIUTY EACH OCCURRENCE S 1, 000,000
-'--
A X COMMERCIAL GENERAL lfAIllLllY 21UERMS4331 12/27/00 12/27/01 FIRE DAMAGE (Arr( Qtl~ fore) 5300,000
I ClAIMS MADE ~ OCCUR MQ) EXP (Ally one peI"'..otI) 51.0,000
~ XCU PERSONAL & ADV INJURY S 1, 000, 000
GENERAl AGGREGATE 52,000,000
-
GEN'L AGGm, lIMI'J' APPUES PER: PRODUCTS-COMP~PAGG $2,000,000 .
h POLICY X ~ n- LOC EmD Ben. 1,000,000
AUTOMOBILE UABIUTY COMalNeo SINGLe LIMIT
I-- 51,000,000
A ~ ANY AUIO 21OBRMS4332 12/27/00 12/27/01 (Ea IlCCIdenlJ
AlL OWNED AlJTOS BOoll. Y INJURY
f-- S
SCHEOULQ) AUTOS (Pet pero..onJ
f--
~ HIRED AUTOS BaOIL Y INJURY 1
S l
X NON-OWNED AI1TOS (Per llCdllenO
-
- PROPERTY DAMAGE S
(per ~dc:nl)
GARAGE UAIlIUTY \ // AUTO ONLY. EAACCIDENT S
R ANY AUTO OornER TI-IAN fA ACC $
AlJTO ONLY; AGG S
EXCESS LIABIU1Y EACH OCCURRENCE s 10,000,000 i
~OCCUR ~
B o CLAIMS MADE QK 05500268 12/27/00 12/27/01 AGGREGATE $10,000,000
S
~ D~BLE S
X R8ENT1ON S 10,000 /'
( WORKERS COMPENSATION AND 17' X I 'TORY L1Mrrsl IU~ --------- 1
C EMPLOYERS' UABlUTY 21WBRMS4330 $1000000 "\ i
J.2/27/00 12/27/0l. E.L EACH ACCJOatT
E.L DISEASe - EA EMPlOYEE $1000000 I
E.l. DISEASE - POlICY LIMIT $ 1000000 r 1
I
OTlfER / j
D PROF. POLLU'l':ION* PECOO0446001 'l.:l/27/00 12/27/01 Per C1.aim 10,000,000
ENVJ:RONbmNTAL CONSULTANTS LIAB. OCcurrenc 10,000,000
DESCRIPTION OF OPeAATIONSIl.OCATlONSNaIlCLESlEXCWSIONS ADDQ) BY 9l00RSEMENTISPEaAL PROVISIONS
CERTIFICATE HOLDER I N I ADDmONAL INSURED; INSURER lETTER: CANCELLATION
EVIDENC SHOULD ANY O~ THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D:PIRA 710..
DATE THE1REO~. THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN
EVIDENCE OF COVERAGE NOT1C~ TO THE C~RCATE HOLDER ~ED TO THE LEFT. BUT FAILURE TO DO so SHALL
I~POSE NO OBLIGATION OR LlASILlTY OF ANY KIND UPON THE INSURER, ITS AGEhTS OR
REPRESENTATIVES.
I ~~.-Z/~C.
ACORD 2S-S (7/97) '- ./
@ACORD CORPORATION 198B
UoJ/ UU/ .UU~ ~ I ; ~~ t'iL\. "v~, "v~:;;::>z
HANDEX LEGAL
.. FL TAMPA
MAR-08-2001 16=08
tt ;~f.,,flo '
~ta ,,"~ '" ,-,=-.,.-:::~ flba
fIJppartmrnt nf &tate
J certify from the records of this office that HANDEX OF FLORIDA, INC., is a
corporation organized under the laws of Delaware, authorized to transact
business in the State of Florida, qualified on June 16, 1989.
The document number of this corporation is P~4803_
f further certify that said corporation has paid all fees due this office through
December 31 J 2001, that its most recent annual reportlunifonn business report
H was fired on January 31, 2001, and its status is active.
I further certify that said corporation has not filed a Certificate of Withdrawal.
D
B
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capitol, this the
Eighth day of March, 2001
CR2EQ22 (1-99)
X~Ji~ns
~,rllterine ~
;SEmta.~ of~t-a-h
TOTRL P.02
MAR-19-01 MON 11:02 AM CUSTOM DRILLING
FAX NO. 9416801399
P. 03/03
.~
:~
'l
~;
"
~
~
.~
v"
.0'
J '.
t-:"
~'
..:-: -..: :'.: _: :-.-. =- ~~.: . .::-~.-:::::-.'t'.'.::;.:z. ......."--....
STAT}i:' Oil':n.QWDA
SOUT~sr FLORIDA WATER t,
MANA(:F.MENT DISTRICT
CERTlFlF..8 THAT
~ . Mic.b(l.gl:D. Johnson
llASBEEN nULVL1CENSED AS A W ATE
(~ON'I'RAcroRiN mE STATE OF FLOI
1,U:""'l<:NSI<: Nurvnn<:R:
\-
>;:::Z ,OJ ]JO
" 0>> Oc m.....
]J_ 0-;::: ()C/) <.....
Oul r- ::oem >- N g
mZ --lZ
"":r C/)C) -m 00 0
mm OC/)
Ul]J C/) ZC/) Cl 0
2?m - 0
OlD
z-< 0 Cl
~ -..... V1 0
0- 0
~ ]Jo -l~:I:: -l~ N
m 0
OZ I\)
Cl 000 m >~> >~ m iJ
0- om 3~Z 3~ " 0
cO 0 0
~d " 0' " C ;= 0
>^m > m ::; I
6~ Z m I\)
Cl mx ^ . 00 0
N z(i) ....,. m ...... 0 0
Ul;r. ]J
~ "(i) .eno v.I. n ....
mm en v.I en ;::
~ o- m...., ;r. ~
v.I 'i'jz -< o-m en 0
mlD :r
~ Oc v.I ...., ~-< m Z r-
Cl :r2? m v.I.. -0 :;c m r-
mZ ul en
Cl ]Jm 0->0 . <
Cl mUl ~z:;c Z ...... ID
051' 0
~ ;z: -om...... n lD ]J
-...J 0' m m c 0 :0
en> !"!? 0 0
;::
--l -l Z ul C
I
Cl en m...... m C>
en
Cl OJ Z m en :I:
Cl m 0 mn Z ~ 0
Cl () 0 < -<
0 C -0 0
Cl ;::: (j) ...... m
v.I m :;c C
C/) lD
Cl en > m 0 Z
Cl m ~ ex> r Z ul ~
m ..... 0 m
~ ::0 X Wm 3 ~
m ::0 wZ m ul 0
< m O. Z 0
m
Cl ::0 () -;-J~ -l 0
Cl C/) !!l 0> X >
m "U 01 C
Cl C/) --l W 0 . ~
Cl 0 :E ex> 0
Cl ~ r r n ~
m r
Cl Z m 0 0
Cl ~ 0 Z
--l Z
Cl 0 en m
, ;:: }>
Cl 0 :D C "
..... r-
~ . 0
-< r-
m -l m
t:J > m n
ul
;," Z m
-l ~ Z
.., - en
::!'"!
",_.." ,-.- -'-' m
.~_.. -~.' ,";',
'- m
..'..> q. ><
:;-.. ,.
"-...j I:.- _. ",;i:' ~
-l
., :;c :0
- . . > m
,....::' ~J~. en
' . -l Z
...;:::.. !>., !:..-: :;c en CD
.;;:,.. ~, .
> ...., W
(;.,.} .::.:::' -- Z m 0
'"..." ., en :;c .
""';" +.fi- I\)
:-:...' ...., 0
.~:... !:':"~ 0
.J:.~. m
c-' :;c ....
:D- . . ; ;
- ul "
,.- ...., C::r
.,;:'" m "'. N 0
0:;: ,
m :I:;r. ~ 6
;r.",
'. .> ill "'-i ~ Z
C)m v.I p
,,:- ~; m
:_'-., '-, ~
...... ...,-:; ",-'
I.'j-., J:::
--:<- -- ~~t:" Cl
Cl
N Cl
v.I N ~
)i! '""'
Cl Cl )( -...J
Cl Cl .....
f1A~-19-01 MON 11 :O~ AM . CUSTO~ DRILLING FAX NO. 9416801399 P. 02/03
~"iC1Jibi.'-c~.:~:~-t~i?ttlT~QO~Li~~itrfYi'~SQilAhi~L.'e ~~i~;;~~
r1,6Du(;!iR-'~ -.". H' '--- ---..- -----..,--.. -.,,--..---. - "_.n_ ."..P,-. -'THIS-CERTIFICATe is ISSUED AS A MATIER' OF IHFORMATJ~~'
Mack a}1(1 par.ket., Inc:. ONLY AND CONFERS NO RIGHTS UPON THE a::RTtFJCATE<....
t," ,-. T.,,,.'.'c<",' rn ",~1 HOLDER. THIS a::RTtF1CATE DOES NOT AMEND, EXTEND OR,
'" "',' ''''', . . . .. . ___J\L~~..__!tl.~.9>VE~GE AFFORDED ~v T!:IE POLICIES BElOW..(.
ic:ago, JI. 60604 . ''Ii
.....l2 922 SOOO . ./.,(~ . j" . INSURERS AFFORDING COVERAGE c:'i;\:
itisuru;.i;-.'.'...n.._.'.. --. -- ...--.-' :;~ii~~,~-~I~~91-=c?E.~!E?f~~I~y:,~~.t~li~i1.i ,.., ,,' ;
~~~t :~~ ~,;.:~~~~(~~~q c~:~~i.~:~kW~ync. 1.~~~~_~y',i~_~.~!!<?Y~.Lns':lE~_~~e ,<;<?~Q<:1~1.Y.
l~s_t!.~~'.!g;!":~Sl~E<:':~ ._~E~~Ean9~ C<??1J2a21Y
I L:'-ikc J and, Fl.. 3381 I) INSURER 0:
j .,---.-.--..'...-----.--. .... ...-... .....--
L......._.. ..,. I .........".".._.. '__'..'.. ,'..,,_......w......._. ~~~~~___..__.......______.__._....._____._
_~~,.lA.Qg,s..,~ .<..._ .. ,,<,.<<,..c~,.,__,_. '.' "......~_...<<~,~__.__.
lHF. POI.ICW:S OF "'SU1~"-NCE u~nEO ElElOW HAVE BEr.N ISSUED TO lHE "'SURED NAMED ABOVE FOfHIlE POUCY PERIOD INDICATED. NOlwnHSTANDINO
my F~:QU;*,)"lbW. 11::1'11.4 on CQNOCrk:)H OF #N COl'JTAACT on OHlER DOCUt..ll.:""NT WOl-l RESPECT 1'0 WHICH 1111S CERTFICATE MAY BE ISSUED OR
MAY PERrAt-:, 1HF. ~SUflAN<:E AFfoAOEOBY WE PeUOIES DESCRIBED HEf1i:foI IS SUOJECT TO ALL TilE TERMS. EXCLUSIONS AND CONOrTlONS OF SUCH
POLJ::i($. AOGlllX'-,A'II: LIMITS SHowN v.AV HAVE aEf:"'N RtOUCE<O BY PAID CLAIMS.
Iff'!- l~;';-~;;;~~U~~N~~' "T"-' ""pouc~Nu;:;;iA- ....- - fl'OT6YEFFECTlVE POUCYE.xPl--tfo " .-..,....
AfJ~..r.~k~.R;.~.~;~,I~:: ;.::~'l~"...l,...t. "'8. K..-r" cplis OS"685 - .. -Jo~1 0 0 g~i 15/ 01
. ..J CL AIMS MAOELi] occlIn
X,.C ,tL ..... ,_....
~ J. ..
I Gt' N'l J.GG:"1EG I\TE;.l1MI T A.N'lIE S PF.f'l:
. lPOt~CY[.'l~t\gr r lL..()(:1--..-.......-.. ....."
B "lr~oMoaH.ew.8IUlY Cl\11505685
X ! ~.NY .~u ro
1 All ,WhEO AUI0~
1 SCHFOtJt.FO AUTOS
I '
! .! HIF;LOAiJl0S
I. . j NON .0VINEO AUTOS
,_X ]l?lri EL DN1Acg~~..._.
I X GA.t<.l\GE LIAB
.......--, 04/1'570'0' (4)1"5/6 i"~~:~~~~'~~;~:~:~:~'
(E. .ccldent)
LIMITS
._~_._-----_._------ -----~
E:".E'2~l?~,:!~~~,~~...,$.~ IP_Q Q,..Q 001
~'!:'.~O~MA2.E (~t..on.. l~.. .s2_;;..!L..Q~1
~~_~~yon'!.P!.!:~ ~.l]5_ --I
PERSONAL & AOV INJURY $ INCL OCC
'~~~~~GGREG~2i= iliZA==__I!
,~()~IJ~!.!l:~~Pi'?!' H!,G~~.I.9_Q.QL 00 Q..
_.------.J
I
$2,000,000 :
ri3
.J CE iiUCTI6Ll,
..0 i .HEJ~ ~.r!.ON... J.Q_
I wonx~ns COMPf:NSKflON AND
i EMPlO'\'EfI":' \..,fd3\UTY
I '.
.IACV L}~~S
_L$~_QO C9Mfl!Cg.I~J:
IN/A
I
.oj 00 ~i97'7 ~i2'9 4.
, I
.i CLAIMS MADEJ
i
I
I
I
DED I
BOOll Y INJURY
(por po, 0001
C EXCESS lIAtllLlTf
~1 OCCUR C.
1$
I
PROPERTY DAMAGE \
(per accldenl) $
j -,:~.~-~.~~ ~~.~ ~-~~CI';~~~r~ -- -. -----~~--
[ :TH~R-;tiA~ -ill ~~,c Ls
_...... _ _ ..__J.___ ____. ..~UT~O~~_. .~GG!.!.._ ____~___
! 04/15/00 i 04/ ] 5/0 1 t'EA~ri2ECU_R!lENCE . [ s.2 , 09 Q I..O_9_Q
I i AG.GRE~AT~ _ ! $2 ...QQ 0 I O_Q.Q
1 I PR9P.-_~QMP Olh? I oOOLQ9.9_
I . ....1 \ $ _...,
j ! r--..---' -$'
... Twci"i 5 0 5 685...... --- -. ... --;'o'1Iis}o-o(fo ~li 5)~?r2. . ',.!.T. i~n:~~~.1. ..:,...IOJ~r.'.--.: .-..' .... --:-.:=
: r===-~l~E...ll.E~~H..~C,~E.NT IS~, QO_QLOOQ.
! I 1:..L,()~~!'.~~E.:!:A~~elO_Y~~ ~? ,.9.Q9..L 000..
_:.___ .... .__ _... _'_' .__ __ .!e. c~.pl.~.s.~S.5:POL,I~!,~~I.{!?LQ9 0..1...0 0 0.
'i~~;k~~~I P F~,1'R. .~. [;P~1~056 85 .. .... .... ....I~/_'S~OOJ 04 11510 1 .I..~ iQ_g_~ ~R~g~,,_~~~~ET[K
OE,XHIPTION Qt-' C,f'1:.RA1IONS/lOCA"IONSlVnIIClFiS/t':XGlUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
.n ~ ___._ _~
; C1t-J"11.f31' 11^l\llil Y
. -I AN' AU I 0
I - .
, I
i ,
I
~. .,.. ._- -~
I
BOOll Y INJURY
(por accldonl)
I
\.
CEfH1F1C!\ H? HOLDEH
r......-.......' .... ..-. ..
,-,_..r _ _. ,_.,,~__,~',",&,'_-"'_- --~~'.'- ---,--_........._.-..__&---....-"- ..~..- ---.---.-----.--~----~. --~-.-
u'(\rm ')<;.!; 1719'1\"\
of '/.
,,_.__ _._.._~___O'_ __..M'-'
~~ 83' 6'4 19 / M 3 52 51
_"...._.._ CANC.E~ION .._ .______._________.___..._______._ ______
Sl-IOULO -'NY Of'THE ABCVE OESCf\lDEDPOUClES BE CA>,jctLl.F.D BEFa'lE lHE f)O".f1A noo-
DAlE THEAEOF,TI-iE ISSUING INSURER Will ENOEAVOR TO MAll3 0-,.. D^ YSwRTlE'
NOn~ToTHE CERTIFICAll:'. HDl.OERNMIEOTOTH:.lEFT. BIJfFAllURE TO COSOSHAI ~
IMPOSE NO OBLIGATION OH lIABILrTY OF ANYKIND UPON THE INSURf'R.f1S AGEN1SO'
f.\~P:f3~!iS.~~I!.YsS,__._.._._.. ."
AUTHORIZED REPI.'ESENTA1IVE~ . . _ tJ. .
___-.___ ..~~_. ? -.J~-;;-AcoFlD-CORPf)RA nON 1"
. :.I\..Oo.I1l9~~IN;>u,I"lE{)j 1~~;8h~.1l.l:'.f.'\:.....
\
~',~~~~'~~t;t:"~?;;;~<!f'~iF,:'
CITY OF ZEPHYRHILlS PERMllTlNG REQUIREMENTS
Phone: 813-780-0020
5335 - at:ll. Street
Z~hyrhi11s, FL 33540
Fax; 813-780-0021
· service upgrades or sewer line replacements.
~o application or contract required. Same day pe~itting.
· IF.JOB IS ONDER $2, 500 ~ li"OLLOWlNa IS REOOJ:RED:
(a) Copy of contract with owner & contractor's signature.
(b) If no contract - then application required-signed by both ~ notarized.
(c) ey owner - permit only - unless subs are involved - then USe application for signup.
· IF JC1B IS ~ $2, .99.00 :rm; FOLLOWnlG IS REQul:RED:
"ta) Application complete - notarized siqnat1.t:l:es of both owner & contractor and contract
with both signatures. Before permitting, all subcontrators are to have signed on
application with registrations and worker's camp insurance must be current. MUst have
certified copy of notice of commencement.
(b) 8y owner - same route as (a) excludin9 notice of commencement.
· Agent or power-ot-attorney would be someone with notar~zed letter from owner authorizing
same.
· Time element inVOlving permitting - eome permits can be issued Over Counter same day as
submitted.
· RESIDENTIAL NEW CONSTRUCTION: zaHnroM n:N (10) WORIaNa DAYS AFTD SUBHIT'rAL DATE. REQUIRED
ON-SITE, CONSTRUCTION PLANS, SANITARY FACILITIES AND 1 DUMPSTER.
,. COMMERCIAL ~ CONSTRUCTION: MINnroM TIm (10) WORKING DAYS AFnR SUBM:IT'lAL DATE. REQU1RED
ON SITE-CONSTRUCTION PLANs, ~ITARY FACILITIES AND 1 DUMPSTER. All commercial requirements
must meet compliance.
· Prints to be le~t for review must pay application fee of $.03 per square foot ($15 min);
fee will be ~CREDr~# at time of permitting.
Licenein<J ~nts:
· Proof of either (a) State Certification ~ (b) county Competency with state Registration.
· County OCcupational license.
· Certificate of insurance on worker's comp or state exemption.
· $20.00 Proces~ing ~ee.
· Notarized authorization letter required if anyone other 'than the license holder signs
permit or application.
· If homeowner resides in said dwelling & desires to do work, a homeowner's pe~it may be
pull<!ld. P~operty that will be rented, leased or sold, will have to be contracted by
properly licensed people as per state law.
· Staplas are prohib:i. t:ed in shGathing.
· R~arttinq fllec~ca~ wir:ing " p1umbing ~er 1:0 Ordinanca 1689.
· Property survey required for all new construction.
· City right-of-way use permit required.
· Office hours: 7:30 a.~. - 5 p.m., Monday - ~iday (CLOSED 12 Noon - 1 p.m. for lunch)
· Phone hours: 7:00 a.~. - 4:55 p.m., Monday - Friday
· Permitting ~UBt be processed befo~ 4:30 p.m.
· Inspection requests are scheduled for the following workday.
l~
Z8S0'ON
SllIH~AHd3Z jO AllJ
~dZZ: Z
I 0 0 Z . 8 . 12 VI
OWNER'S NAME_~~l~J( O( . Flor,itA
JOB SITE ADDRESS ) 0 ~ q 1 >!- 5+1'"'-< -I- Z.'pJ..7'" rJ Is J f L
LEGAL DESCRIPTION: LOT (S) Cf D BLOCK ill Do
PARCELID#ro Jot. ;fl .0610 iJ."l66 0'/00
CITY OF ZEPHYRHILLS PERMIT APPLICATION
aUILDING DZPARTMENT 5335 a~ STaEBT ZBPHYRHILLS. PL 33540
Phone;813~780-00AO Pax:813-780-002l
DATB RBCBIVED
PLANS REVIBW FED
I."
PHONE CONTAC!..(813)tJt -fi 1/6'
SUBDIVISION
-
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSEtI: o NEW CONSTRUCTION o ADDITION o ALTERATION o REPAIR ~ INSTALL
OSIGN o MOVE 0 DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING DMULTI-FAMILY D# OF UNITS o MOB ILB HOME
o COMMERCIAL o INDUSTRIAL o SWIMMING POOL ~OTHER
DESCRIPTION OF WORK
CJ RESTAURANT 6&
:r"'J~wlla JiOf\ of
HEALTH DEPARTMENT
.3 JkCM' lor i'r\J
APPROVAL
I..J t /I $ ; l-\
f(O!..u.-rp= 'IS-i
~
BUILDING SIZE
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,
PRO~ERTY SURVEY REQUIREO FOR ALL NEW CONS~RUCTION.
PERMITS REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHAN.I:CAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
~THER ((OW p~r/Vtl';
o
NO
FINISHED FL90R ELEVATIONS
IS ~~OJECT IN FLOOD ZONE AREAO YES
BUILDElt
SIGNATURE V'
COMPANY
STATE CERT OR REGIST #
CITY PRoc,<a;S~NG # J?;l C)
-*****************************************************************
ELECTRICIAN
COMPANY
STATE CERT OR REGIS'!' #
CITY PROCESSING #
SIGNATURE
*****************************************************.***.********
PLUMBBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE -
lomCHA.NJ:CAL
******.*.*...*****.**********..***.**.********.w~*.*****.***.*....
COMPANY
STATE CERT OR R~GXST. #
CITY PROCESSING #
SIGNATURE
*~*****.*****...**.*~***.*******..**w*ww.ww********...*~*w*******
OTH:B:R
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****.******************************..******************-********
8 . d
G880'ON
SllIH~AHrl17 -W All:)
~nU:? Inn?.g 'HW
CONDITIONS OF PERMIT AFFIDAVIT
A. MOTICE OF DEED RESTRICTIoNS
Th@ undersigned understands that this permit may be subject to ~deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responeibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undert.ke work, they ~y be required
to be licensed in accordance with state and local r6gulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for _ misdemeanor
viol_tion under state law. If the owner or intended contractor are uncertain as to what
licensing requir~ents may apply for the intended work, they are advised to Contact the
City at Zephyrhills BUilding Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor (a) sign portions of the ~Contractor Sect1ons~ 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 $ign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhilla.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTE:R 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of ~Flo~ida's Construction
lien Law - Homeowner's P:cotaction Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the appl.icant i5 someone other that the "owne.r", I cerify tha.t I
have obtained a copy or the above described document and promise in good faith to deliver
it to the "owner" prior to commencement.
E. CONTRAC'l'OR' a/OWNER'S Ali'FIDAVIT
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
certi.fy that '! 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 Bayheadst Wetland Areas and Envirolunentally Sensitive
Lanqs, Water/Wastewater Treatment
*Southwest Florida Water Management District-WellS, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*}\nny 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-~bestoB abat6ment
I also certify that, if fill material is to be used in Flood Zone ~A# or ~A,etc."t it is
understood that a drainage plan addressing a ~compensating volumeN will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuanee.
A permit issued shall be construed to be a license to p~oceed 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 errOr$ in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is co~nced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months aftar the time the work i5 commenced. One 90 clay extension of time
may be allowed for the per.mit with fee charge of $15.00. The extension shall be requested
in w~iting to the Building Official. An approvecl 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
~AYING TWICE FOR ~PROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDJ!:R
$2,500 IN VALUE DO NOT NEED TO RECORD ANP POST A "NOTlCE OF COMMENCEMENTH.
SI~~ ~ENT SIGNATORE: CO>rrRAC'rOR
STA'rE OF FLQJ:l.:J:.~ j
COUNTY OF ffdlsJJorol/UI
,
The foregoing instrument was ack~owledged
Before mei:.l}:i.sJ~ day or..)Ji<jus-l , ~I
by C,,~ it Jlu.A.arilJn :
,
" (name of person acknowledged)
'ifwho is personally knowll to me, or
o who has prodUced
(type of identification)
and whoD did I'Jdid not take an oath.
~~~ acknowledgement
STATE OF FLORIDA
COUNTY OF
The --foregoing j-n~t_r.1)ment was
Before me this day of
by
acknowledged
, 19
(name of person acknowledged)
[1ho is personally known to me, or
Owho has produeed
(type of identification)
a.nd who Odld Qiid not take an oath
Signature of person taking acknowledgment
JOS ffff B. LUN]:;:.G VI S~
Name typed, printed or stamped
Wame typed, printed or stamped
v 'd
Z880'ON
Slll H~^Hr1~7 ~n ^ 11:i
Wr1~7.:7. Inn7. 'Q 'JeW
..., "..U,l:I~..u:>1 'L~ _L\:l: :>:>. J:'A.A. lHJIl,;:tH~l:I~
" .:-< 'oi,-.',~c.r UO U! 1"lJ.:.1I U't'l't rll IJUO:>IVII Lll'i.l1.1.l1l~P%~~ Tampa
rnh NU. OO~OOU1~~~
-----_.-_.__._~_..-
STATE OF FLORIDA
SOUTIIWF..sT FLORIDA WATER
MANAGEMENT DISTRICT
CERTIFIES TIIA T
Michael D. Johnti(}n
lIAS BEEN DULY I.ICF..NSED AS A WATER WELl..
CONTRACfOR IN TIlE STATE OF FLORIDA.
LICENSE NUMBER: 9271
L'XrIRATION DATE: ~-GI301Oi-=::'>
Rene' Bailey
CONTRACI'OR UCENS[NG COORDINATOR
IgJUU';:
0' " " , .t'-...: :'u'::::l..u.::::..:'(-, !
...... ','
te;J UU1.
Ul:I/UO/U1. 1.0:00 l"AA 01.JO~01.01:l0 .l1anaeXlampa
f..,. Ij~f::I.Q.S:~. ~~X! ftQ ~ J:1. sfi[ ~hf. ~ .<;::Q )(!;~ .:?f:lgg. .
~ PRACTICAL ENVIRONMENT^L SOLUTIONS
":-9,
,~
~..........~..........~......................................................
DATE: q.S- -0/
TO: j-)'W(//j 6'11#'7
COMPANY:' l;;Arfl,.fL'J, (,f I/-f
FAXNUMBER:GrJ3) 7$6 -66;)./
FROM: C07 J..t. j". j in
FAX NUMBER: (813) 626-1898
# OF PAGES: ;<
COMMENTS: C 1/ S k~ PI'";/ Ii..! } ,,1/, '" D "..//;....) 1,,<.... f.". , , ,. S 1"....,.",. ~/~ ~
:j, yO W' fI, j~.e.. 4.dt"1J #'"7/ !~7~'-./. J^;;n-.~(JlrcJt. 74,'$
W\ II ~~ p,ck~ up /t4-~ fl,-> Ve~ (" or 7J"'~j. tQ~~'_ al/
wi (;<oj ~15JJll..5 - (ip,) 6')6 -~b'/j, 4K'.J N.
- Ca7-
.'
IF YOU DO NOT REC~'VE THIS ENTIRE TRANSMISSION, PLEASE CAL.L (813)-6264646