HomeMy WebLinkAbout01-0787
BUILDING PERMIT N~
0787
CITY OF ZEPHYRHILLS
(813) 788~6611 -{)!2
~5
BUILDING .. ELECTR~"" PL~-. MECHANICAL
::;:~e' ~r~ ~~~:f;5Y()
Parcel J.D. # //- ;;Lc:'-::LI ;" OIJ/O - /)() 9D 0 - V /9 f)
.
Permit
Date /1- .:19.- [) I
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
B U I LQ.J.N<:r .
----
ELECIRtCM.
--
Permit Fee
Signature
Company
Address
(?TelePhone?::>lcl- ~- c9~~
(Oflr9~ ·
......--PlUMBING MECHANICAL
~~~t~~i~tnp~~ce 'f/~) 9/3. 1'3
City License Registration # c:z f' ~
State Certified License#
Ftr.
~SLB
Lintel
FRM.
Insul. CL
WL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Serv.
/::2- "7-0/ blj Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Driveway
OrJ?r. Y?CX G-arA/tI~ OKb ~ -1-0 I
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.
Nov-13-01 \2:11pm
From-CiRCLE K-FlORiDA REGION
813-744-5221
T-938 P 03/03 F-103
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ZEPHYRHfLLS. PLORIDA
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Noy-13-01 12:11pm
From-CIRCLE K-FLORIDA REGION
813-744-5221
T-938 P.03/03 F-103
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ZEPHYRHILLS. F'LOR1D^
. ---..-- ..-
Noy-13-01 12:11pm
From-CIRCLE K-FLORIDA REGION
813-744-5221
T-938 P.03/03 F-l03
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__ Ina 5&5fi CAU. BOULEVARD DATE: 8!1'J/
ZEPHYRHrllS, FLORiDA
. ---.--- ..-
OWNER'S NAME --D:)l Llt'pS /.,~ - C l QCL~ ~.
JOB SITE ADDRESS S8SS G~ ~O
LEGAL DESCRIPTION: LOT(S) l\ "2-~ BLOCK ~
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CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 Sth STREET ZEPHYRHILLS, FL 33540
Phone:S13-7S0-0020 Fax:S13-7S0-0021 'I_~ I
DATE RECEIVED It ~~
PLANS REVIEW FEE' ______--
.~
~s
PHONE CONTACT
SUBDIVISION ObIO.:. 6eF}cn - 0190
PARCEL ID # t \ 2~ Li
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
DSIGN
o MOVE
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
~ COMMERCIAL
DMULTI - FAMILY
0# OF UNITS
o MOBILE HOME
)(OTHER
o INDUSTRIAL
o SWIMMING POOL
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OP WORK Q"'.""""liA- q"-1;.41 WiG 2~ ~ 4 ~1r
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
~MECHANICAL $
o GAS 0 ROOFING 0 SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL ~ OTHER
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
FINISHED FLOOR ELEVATIONS
BUILDER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
ELECTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
MECHANICAL & -
SIGNATURE A ~ t.L-
*****************************************************************
COMPANY
STATE CERT OR R
CITY PROCESSING
5t1l..Jl
,..
*******************************************~*********
OTHER
SIGNATURE
COMPANY
STATE CERT OR REGIST # PCGO~5"O~'2-
CITY PROCESSING # ~~
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A. NOT~CE 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 ~ OTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
CONTRACTOR
STATE OF FLORIDA ~
COUNTY OF ,.~- ~.l ~ ~O
The foregoing instr>>ment was acjPowledged
Before me this ~ qay of ~{) , 49 ;;WO /
by '=lIf;<il~L!t!t?m.B ~~
(name of person acknowledged)
[1ho is personally known to me, or
. e.- 6/~- ;1/"} - '#- 2ff-~
{rA who has produced FL DRIll. J.. // .
~ {type identification)
and/~di d n t ta e an oath
I
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
o who has produced
(type
and whoD did Ddid not
of identification)
take an oath.
Signature of person taking acknowledgement
Name typed, printed or stamped
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p,ejr
so
ac
lions, in
JOB NUMBER REQU ST FORM
~~O\\'\\\
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'* ReceivedS/,"
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CLIENT LOCATION:
'ttC-llli~ &10 - 61<.C..k..e I( ~l<:lee::,ss. G. ~I ~ It:. 6ro12E." 0\ <en
~D f2.e~e\06E:.?\!"br2.~~ l'5Ol ~ ~r:>.
\AMp6- J ~ oo~fO ~taH.lLL~ ,-:L
CONTACT PERSON
F~ ~t--J\
PHONE NUMBER
Bl~ - 144- c;;,~
~L~
RELEASE #
r.o.#:
ORJGINAL CONTRACT
BASE
. 1~
^,-T"
TIrl
^,-TI03
TOTAl
JOB DESCRIPTION
'REHo\,€;.
'41
,L \<::;~
!~
CONTACT PERSON: "127- {Jf{{- tfLfo 7
PHONE NUMBER ~1Z7- [(47- N/J
~ I'flift If
CHANGE ORDERS
COHT1I.AoCT ESTI"""TEO
AMOUNT COST WlRGlN $ WlRGlH 'Ilo
1 $ $ $
2 $ $ $
3 I I $
. $ I I
TOT Al- l l l
(5cc.r: rtte
fd'e- ~hJ'\
, J
SURVEY
LEGAL
TANK REG.
TAX FOLIO #
(r-f' (~ (4~j:;"Pl)!,\
~/3 -'711- (((pI)
f ,
INVOICE PROCEDURES:.
815 "7ac.. 00'2,0
ACCOUNTING ONt. Y:
~ D
LUUP SUU T & U
ADMINISTRATIVE I SUPERVISOR:
NAME:
DATE
PAYMENT TERMS
PET PAC SOLUTIONS Representative
Tony F 'ck Branch Manager
ACCEPTANCE PETROPAC SOLUTIONS (Seller)
Signature of Officer
Title
Date
PosmON:
TIME:
Revised 1CYZ:3.W W:\WORKS\TYPING\JOBRQST -REV XLS
ACCEPTANCE: Upon acceptance by the purchase and acceptance of an officer
of seller, this document will constitute a bona fide contract subject to all the
terms and conditions on the reverse side. There are no promises, agreements,
or understanding. oral or written other than specified in this document.
Company Name (Purchaser)
Signature
Print Name of Signature and Title
Date
NOTICE OF COMMENCEMENT
'07/00
State of FJortda
County of pACSC' 0
Penn It No
Tax Parc.1 Number JJ '2."" "2 L: ~o 1 0 - oC'tqeo.: ~ ~O
The UNDERSIGNED he,.by glv.. notice that Improvement will be made to certain
real property, and In accordance with Chapter 713, Flortda Statutes, the following
InfonnatJon Is provided In this Notice of Commencement
1. Description of Property: (Legal dMCrt1MIon of the property, and atrMt acid,... "avalla"".)
CIRCt.€ ~ ':;-TVI<..~ -# CJleo
~~- G~,L f!3LVO
-r ~ /:?' LIe. J LiS !4.. ~ 3 s*l:/-I
2. G.n....1 d I~rlptl n of Improv.m.nt: .L /J/>/'J..r-'^
12E-/7f(yl,IA-( oF 4- L/4I?~4 ~~ ~~.}~~<<s-
1OL.b 0 CW~ C ,Q-,,"-{VAJ
3. Own.r Infonnatlon:" I
a.-!!~ ,nd address
\:.1t l!:-LIOS ~., - ~,I (lLli:, ~ 51v4-~
"-=>ffSC' .t.l~(-2.~-~E:.~~..\!X;r- f'~ O/~ ~.~oo
b~nt~ i~ prbpertY '?;7 ~ ~~ 1 (:7
c. Nam. and address of fee .Impl. tltl.holder (If other than own.r)
~~:Z-- - ~~ ftl..~.~
~. Contra~or: Nam. and add..... 12~O A. cf wI N AI
"1 '2, '1?;' pL/~r' '~Y1 '(.2.0
a. Phon. number t/o'l ~v..- o~~,
Fax number .c.Jojl ~) 5~ - () (2 30
5. Surety: Nam. and add,...
~/A,
.11111111111111I11111111111111111111111111111111111111111111I
2001165101
Rcpt.: 546672
DS: 0.00
11/29/01
Rec: 6.00
IT: 0.00
Dpty Clerk
JED PITT"AN~ PASCO COUNTY CLERK
11/29/01 1~:39am 1 of 1
OR BK 4785 PG 714
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FOR CLERK'S OFFICE USE ONL'1
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L_____________________________.
a. Phon. number (
Fax number (
7. Persons within the State of Flortda designated by OWner upon whom notices or oth.r
docum.nts may be .erved a. provided by Section 713.13(1)(a)7., Flortda Statutes:
a. Name and add,... f2.1 c' A~o /J... ~~J l V\. 'r"l
~l-Z? ~n ~~YYl ~~<
~~ /J, FL.. .~c to'?
b. Phone number ~Il efJ 0 - <..~~
Fax number (c.{,1J r:!>~'1 - C)C) =30
8. In addition to hlm..lf, Own.r deslgnat.. of
to rec.lv. a copy ofthe ll.no.... Notice a. provided In Section 713.13(1){b), Florida Statut...
a. Phone number (q.,l ' ~ - d3 '50 flu ~1b< ~ LJ (~1_ A ~
..L. cn~ C. "=?o "%r~l ~ t1L I~ I<-O~ r
Fax numberL:P')l c.."~'-f- a -, Aikn?.t~,. I~" '?7.{O~
9. Expiration date of Notlc. of Comm.nc.m.nt (th. explratJo'" clare 181 y.ar from the date of recording
un'....dmd~~~
Signature ~ /~~ uT
STATE OF FLORIDA COUNTY OF O(1t;r-.G"UL
"fflrmed and subKribed befON me th..dGlV-o d8y of no\..U..m~
who Is ~ m. or who has produced
r ~ A 0-u.w{)D~
l
a. Phon. number (
Fax number . l
b. Amount of bond S
6. L.nd.r: Nam. and address
~/4 '
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Print Nam. f 9wMr M;~-;;r:;
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by /0 11.~
.::tr l ~
(type of 10) as ldentiftcatlon.
SI.0t "0 (
{3. ,.. ~~l
Prtnt. Type or Stamp Narne of Notary
Signature of Notary Public State of Florida
Notarial S.al
#'^ '+ Eleanor Bern"", ., '.'
*~ *My COmrTl'~.,,'.' C ,:.
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