The URL can be used to link to this page

Home My WebLink About01-0866 BUILDING PERMITN~ 0866 CITY OF ZEPHYRHILLS (813) 788~6611 Permit Date 1:J-~/-t7/ BUilDING El~Al PlU~ MECH~l Sewer Conn Water Conn: Property Owner: Job Address: 3% 74 ( -:r~s tJl6;nrIPY C-R 54 E I.Arf '*70 Water Meter: T.I.F.'s: Parcel I. D. # Zoning: DescriPtion of Work ~ Code: 'S k:> t' RV Radon Gas: "'Vye-~ b", :SvV\ <.:>-t~ f1I\1~f' I " NO OCCUPANCY BEFORE C.O. FINAL C.O. DATE Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE City license Registration # State Certified license# Inspector Permit Fee d. 5 . 4-0 >SigMature 1'lf,..J. 5~A.ltA~ L~J!~JJtte/7__1 Company Address \1elePhone# g I J -7 RtfJ.- 3.3g;; Valuation or ~ ~ . t:>-V Contract Price Tp. Servo Rough In Meter Ca Canst. Pole Pool Pre-Meter Final SlB Tub S Wat Sewer Final BUilDING Ftr. Pre SlB lintel FRM. Insul. Cl Wl Breake[ 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 DBPARTMENT 5335 8~ STRBBT ZBPHYRRILLS, PL 33540 Phone:813-780-0020 PaxI813-780-0021 DATB RBCB:IVBD PLANS RBV:IBW PBB OWNER'S NAME I4ne,s JOB SITE ADDRESS $7L/1 r ([) t26YJ/V'e/f ~/.. 5YF PHONE CONTACT ~ /JT# ?6 LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # WORK PROPSED: [JNEW CONSTRUCTION (OBTAIN FROM PROPERTY TAX NOTICE) o ADDITION [JALTERATION o REPAIR o INSTALL OSIGN o MOVE o DEMOLISH PROPOSED USE: [JSGL FAMILY DWELLING DMULTI-FAMILY 0# OF UNITS o MOBILE HOME lWOTHER Ru o COMMERCIAL o INDUSTRIAL o SWIMMING POOL D RESTAURANT & HEALTH DEPARTMENT APPROVAL DESCRIPTION OF WORK ~)lp~~ ,;:/v v f BUILDING SIZE .().....C::::. JL ~R Ru r'RE-/Y1A-de 'B.'f $' "f/V iJ--Ll.{~(-v~~ 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 CONSTRYCTION. ~UILDING o ELECTRICAL $ PERMITS REQUESTED &~ ?j>. 0 () , VALUATION OF TOTAL CONSTRUCTION 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 AREAO YES o NO BUILDBR COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************************** BLBCTRICIAN SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # ****************************************************************** PLUMBBR COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE MECHANICAL ****************************************************************** COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** OTHBR SIGNATURE COMPANY STATE CERT.OR REGIST # CITY PROCESSING # ***************************************************************** CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit Inay 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". SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR acknowledged , 1!L- 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~ o who has produced (type and whoO did Ddid not of identification) take an oath. (name of person acknowledged) C1ho is personally known to me, or o who has produced (type of identification) and who Ddid DUd not take an oath (name of person acknowledged) Dwho is personally known to me, or Signature of person taking acknowledgement Signature of person taking acknowledgment Name typed, printed or stamped Name typed, printed or stamped YOU WILL LOSE YOUIIDRIVER ueENSE FOR AT LEAST 10 DAYS IF YOU DRIVE wmtOUT INSURANCE OR OTHER ACCEPTABLE FINANCIAl. RESPONSIBILITY COVERAGE . In Ohio, 't 's illegal to drive any motar vehicle without insurance or other financial responsibility (FR) coverage, . It,is also illegal for any motor vehicle owner to allow anyone else to drive the owner's vehicle without FR coverage. . PROOF OF COVERAGE IS REQUIRED: . Whenever a police officer issues a traffic ticket. At all vehicle inspection stops' Upon traffic court appearances and' Upon random checks by tpe Registrar 01 Motor Vehicles. . ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL. Lose his or her driver license for HO DAYS on first offense and ONE YEAR on additionai offenses' Lose his or her license plates and vehicle registration' Pay reinstatement fees of $75,00 first offense, $250,00 second offense, and $500.00 any additionai offense' Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND. Be required to maintain special FR coverage ("High-risk" insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for FIVE YEARS. . ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated tor at least 30 DAYS first offense and 60 DAYS second offense, For third or subsequent offenses, the vehicle will be forleited and sold and the person will not be permitted 10 register any motor vehicle in Ohio for FIVE YEARS, . IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have' A SECURITY SUSPENSION for TWO YEARS or more and' A JUDGMENT SUSPENSION for SEVEN YEARS, . THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. . WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. POWER OF ATTORNEY FOR REGISTRATION PURPOSES ONLY . ~_. " TO BE COMPLETED BY OWNER OR PURCHASER OF VEHI?LE~~) LISTED BELOW 'f I, Awl /;'5 ~ D/..) Z /?./6 ~- I t,;;;; /JII,).:J IL., of If '1 t(l-f 5 i-.It' f?wr i"t""; iN tJ ~-;c. /~1 rOil ..( 'I Jt( j Name " ./, Address hereby name /1// c: no! t'k SCh t.(.j e'6-{'1. () f-f-r',:- of Name Address as my attorney in fact to make application for registration or transfer of registration for the following vehicle(s): Plate No. Veh. Year Make Type Serial Number 1.04 2 () f & 'II "'71 f) w)zi., wi ~,.; /fv>tJ f' t/t?~1 de 4 7 D7~~l{) PZ7 'Y-te/v 0 ~of/ *NOTE: IN THE CASE OF A LEASE OR JOINT OWNERSHIP, YOU MAY BE REQUIRED TO PROVIDE: THE LESSEE/ADDITIONAL OWNER'S SOCIAL SECURITY NUMBER (SSN) OR TAX IDENTIFICATION NUMBER (TIN). Lessee/Additional Owner Name SSNfrlN I affirm that the owners (or lessees of leased vehicle) now have insurance or other financial responsibility coverage covering this vehicle and will not operate or permit the operation of this vehicle without FR coverage; and that the vehicle will not be used as a commercial vehicle unless so registered. .'/') ~~~/-4I.f CJi~U-?'L 2 -/ ~-Vf '1 Date of Birth II F. '3 if wi 7 ;-'2- Soc. Sec. or Tax 1.0. Number tJr)rz n+r;,'lf County of Residence gz /"ht {;vlJ City or Township of Residence /2 ~ t-oi Date OWNER CITY ~A/j1t3.<: 3 cf7 V / OF ZEPIIYRlULLS BU.lLD.lNG DKPARTHENT r 15 em#e:!Z Of!.. .S-Y' P ~v/# 76 JOB LOCATION PARCEL I.D."" SIIOW ALL EXISTl.tlG & PROPOSED STRUCTURESG.lV.lNG DIHKNSl.ONS & SETBACKS. UTILITY BUILDINGS MUST SHOW SIZE & FOUNDATION INFOR- MATION. ' (NOTE EXAMPLES 1 & 2) FRONT PROPERTY LINE s'rREE'r 1. SETBACKS FOR RI, R2 ZONING 60' 10' P E_ R X 0 I 10' p s " 10' 0 T S I E N D G 20' FRONT PROPERTY LINK 2. SETBACKS FOR R3 ZONING 60' 1 0' ,-- 10' : 10' EXISTING 10' 1.0 PROPOSED 20'SGL FAM 30 'DUPLEX FRORT PROPERTY LlltB