HomeMy WebLinkAbout01-0533
BUILDING PERMIT~~
0533
CITY OF ZEPHYRHILLS
(813) 788~6611
Permit
.,.,
Date 9-11-0 I
..---
~lJ
MECHANICAL
Sewer Conn
ELE~" P~-
::::,~=~.~4rJ~~:a~
Water Conn:
Water Meter:
T.I.F.'s:
Parcel I. D. #
~:::t~Of:::J#~~~7a~~
NO OCCUPANCY BEFORE C.O. FINAL
Complete Plans. Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
'-01
DATE
DATE
Valuation or ;'.l/D iJ
Contract Price ~ 9. ") D
#,;$"
City License Registration # ~ 61(
State Certified License#
Permit Fee
.ature
Company
Addresr.
Telephone# .
ELECT~--'
------
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
fI
.,... -5F~~1<rrv J:j/IE ~I'hT. f&~
1?<>t-1< ~HEerA1m~dt~1
PL~" MECHANICAL
~
BUILDING.-----.-.....
------
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
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 ($25.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPAR~NT 5335 8th STREET ZEPHYRHILLS, PL 33540
Phone:813-780-0020 Fax:813-780-0021
DATE RECEIVED 9 - 10 - 0 I
PLANS REVIEW FEE
OWNER'S NAME d,(/&ey /l.;W/ E:. '\
JOB SITE ADDRESS 7"~/7 a/9L~ L<;;'V,
PHONE CONTACT 7 J;f - .fY"J ~
LEGAL DESCRIPTION: LOT(S} BLOCK
SUBDIVISION
PARCEL ID #, u Z; '> I 0 a
1 ..." CI 10 6~ laC}
WORK PROPSED: DNEW CONSTRUCTION
dOd'O
o ADDITION
(OBTAIN FROM PROPERTY TAX NOTICE)
o ALTERATION
o REPAIR
o INSTALL
DSIGN
o MOVE
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
DMULTI - FAMILY
0# OF UNITS
o MOBILE HOME
o OTHER
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK ~/." 77'9/ L ~rt'hll/c, /!r?L/l9t:Ir c; nJ?f ~<;{)iPy;e--S.SIc.vV SY'\i,c I'YJ
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (I) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. ~
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCT IONdi" ._0_ ~$~~ ~
~ ~ 1(..,0 ft~
0' ·
PERMITS REQUESTED (D. q,/::At ~j
$ j '-100. at!> VALUATION OF TOTAL CONSTRUcrION ~ 0 I
AMP SERVICE 0 FLORIDA POWER 0 ~.R.E.C.
o BUILDING
o ELECTRICAL
o PLUMBING
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
C1-~
o ~lo 1
d rf?qO
o MECHANICAL $
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE
o NO
BUILDER
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
************************************************************* ****
ELECTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
************************************************************ *****
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*********************************************************** ******
MECHANICAL
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
*********************************************************
OTHER
COMPANY S~-'-u..?~ /'lK'E. athPn7,c:JI//
. ~ STATE CERT OR R GIST # 0 70q~Jac1(J 1%70
~L -L/.K~ 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" qf 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-Asbest,os 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".
"'7
4L<P(.I ~~ SI~i.;~~~
SIGNATURE: OWN OR AGENT
STATE OF FLOR~ STATE OF FLORIDA ()
COUNTY OF ~..J (D COUNTY OF r q~,Q/~
The foregoin~ inst~ent wa~ac)m9wledged ~I The foregoin? instrument wa~~5:~o,-le~ged
Before JXly tl}is.&!!!-. day 0~~~/.t;t-cr; ~ I Befor e thl.s C? day /'Iof ~ 4<" 1-9- 2(){) / .
by J ~.h_ ;<1 ( t ,l~ ~ ?::kCl'-':",,-, by , u..-".......rL, ~ ~""'_..J
,,\,(' (name of person acknowledged) _ /'" ~name person acknowledged)
fYwho is personally known to me, or ~ho l.S personally known to me, or
Owho has produced
(type of identification)
~id not take an oath
and who Odid
~
/
S' nature ~erson taking acknowledgement
',fiN" ~1:~f
Name t ~ ',' 0&;7~Ii~f~ped
')""..::I'~.~'28, 2002
l:::~/frv't6'/1 N ~ A- 1\.1 N C U Y\J rv (~cr H~
Name typei)l~~~<8~~~AM
Notary Public, State of Florida
My Commission Expires, July 27, 2003
Com. No. CC858446
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DBPARTMENT S335 Sth STRBBT ZBPHYRHILLS, FL 33540
Phone:S13-7S0-0020 Fax:S13-7S0-0021
DATB RBCBIVBD 9- /0 -DI
PLANS REVIEW FBB'
f(A "2... !lUAIt..,?-'1. )JOL.J I?' ,S
L\C\" GAll USL~J
OWNER'S NAME
PHONE CONTACT ~"3 7 sa - s,r IS"
JOB SITE ADDRESS
LEGAL DESCRIPTION: LOT(S) OO~O
BLOCK Do Cf Co 0
SUBDIVISION
to\O
PARCEL ID # 5 \ ~ T L.b 12. 2.-'
WORK PROPSED: 0 NEW CONSTRUCTION 0 ADDITION
(OBTAIN FROM PROPERTY TAX NOTICE)
o ALTERATION
o REPAIR
o INSTALL
DSIGN 0 MOVE
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
DMULTI-FAMILY
0# OF UNITS
o MOBILE HOME
o OTHER
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
\ tV~T~Ll. CO{)~\tJ~ ~()f;>L\ A~t~ ~X\--.~c;l
,
ho~.
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.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
$ "51 S;-o '" 'e
VALUATION OF' MECHANCIAL INSTALLATION
o MECHANICAL
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 AREAO YES 0 NO
BUILDBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
BLBCTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
***********************************~****************************
PLUMBBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
~*************************************~******~*~~*******ft L-
MECHANICAL =- t<e to ~ ~Q \\~ COMPANY ~~ "- ':) €>Q\1'V\ € ~
<--:-J \0 STATE CERT OR REGIST # OOz. <../. ~~
SIGNATURE \<~ "2-<; ~ E> ~ m "€,4-L CITY PROCESSING # '1.-~
*****************************************************************
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 ~ownern, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the ~ownern 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 ~An or ~A,etc.n, 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".
~1#-
SIGNATURE: OWN OR AGENT
.., j Q 3 h l!!;\ tfY\ ~lA- l
SIGNATURE: CONTRACTORr.t2ev--- \
STATE OF FLORIDA
COUNTY OF
The foregoing instrument waA acknowledged
Before me this ~day of ~-+#"""t'" , ~GQ.L
by
U (name of person acknowledged)
~ho is personally known to me, or
STATE OF FLD5DA ~ CU
COUNTY OF t 1-'\''-)
The foregoing inst~ent was a~~e~~/
:;fo~;k)f~L'/~ of.5yIJP<<1XY , ~
.~ (name of perso~ acknowledged)
~who is personal y known to me, or
of ))e:ron taki~ acknowledgement
// ;JO;{d j(,(j;(lftl;t(I/IIf'~
. .... '... -:ia~ ~raumuller
Name typed, prlnted 0~fiJ!JJ'Oi:J. e .' CC746079
*~*MY CommiSSion
""''''' "i'~~ Expires May 28, 2002
of identification)
take an oath.
Name typed,
DONNA M. BACKES
~'tCQMM!lililWM' DD 014597
EXPIRES~-June 18. 2005
l-llQO.3-NOTARY Fl NolaIy Service & BondIng, Inc.
C;-i-., 6-P- 2~ ~1 ~'.115
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((C DONNA M. BACKES
'( MY COMMISSION # DO 014597
; I EXPIRES: June 18, 2006
~ 1-800-3-NOTARY FL Notary Sen/ice & Bondng, Inc,
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