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Home My WebLink About02-0942 BUILDING PERMIT~~ 0942 CITY OF ZEPHYRHILLS (813) 788~6611 Permit ;)5' ~ BUILDING Date ;l- /-0 ~ . X' f!)A) ELECTRICAL PLUMBING MECHANICAL Sewer Conn Property Owner: ~ 19V\ V\~ -rvla.. ~ Job Address: 5t.f3L{ 7'~ S-t Water Conn: Water Meter: T,I.F.'s: Parcell.D. # Zol)i.ng: E..nergy Code: VV+t-,' v(J DescrlDti~ ~ Work S i ()" Radon Gas: NO OCCUPANCY BEFORE C.O. FINAL C.O. ol DATE Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. 1b I/o... twdic.. -ho n C;-c c(ee, "'fF ~ ~ Permit Fee rig nature Company Address ;aelePhone# 3'3 it - (p If I? ttl"-- '773 - <or1 ,-J Valuation or Contract Price ~{OtJ " tJC .;2r;(~ City License Registration # State Certified License# "dL~ ' Ftr. Pre SLB Lintel FRM. Insul. CL WL Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter Final SLB Tub Set Water Sewer Final Breakers Ducts Insl. Compress r Final BUILDING ELECTRICAL Driveway ~~ [(e.c'.3-j,.o:;l RL'( 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. APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT \ r. "riP, ' ....,;:~ c) 1(.1- \ ;4t\JJI~... ! - (;1.. I ,., I \.--,-- --~-:------ / - ~'{)..- Ot2- DA~l'E RECEIVED . PLANS REVIEW FEE 1f-,1-'\ '17'5 - 2.t.)S'c, PH6~~,? 1 z-- 3o<~ 5>,d- OWNER'S NAME J)~/)n/1 SLJ3L/ /11 t:.. LYi-1) / 7/1,. 57.. .~ ' - -/ JOB ADDRESS LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # WORK PROPSED: DNEW CONSTRUCTION (OBTAIN FROM PROPERTY TAX NOTICEl o ADDITION DALTERATION o REPAIR o INSTALL .SIGN o MOVE o DEMOLISH PROPOSED USE: [JSGL FAMILY DWELLING · COMMERCIAL [JMULTI-FAMILY [J INDUSTRIAL [J# OF UNITS [J SWIMMING POOL [] MOBILE HOME [] OTHER DESCRIPTION OF WORK o RESTAURANT 7'15 - ? 5- APPROVAL / P ou? I tJ;qU-- <} ( BUILDING SIZE '10 SQUARE FOOTAGE HEIGHT RESIDENTIAL: COMMERCIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENER~Y FORMS. ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. o BUILDING $ /s7JtJ a-P- --- PERMITS REQUESTED .-:-'"') () j,./ (P J/l ~ I :.v,v 4; \'3 - ?> 3 '1- ~ ~ ('), VALUATION OF TOTAL CONSTRUCTION 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: [J BLOCK [J FRAME [J STEEL [] OTHER FINISHED FLOOR ELEVATIONS I S PROJECT IN FLOOD ZONE AREA[] YES 0 NO !Ji.'lli.!'lilii!!i!!11i!!illl!il"" U ~ COMPANY Aiv/Z &,., ~/ ~ ' <::::- STATE CERT OR REGIST # ......bc...('}L/~<.1 _ SIGNATURE --== - CITY PROCESSING # .:2 q,~ ~ '-11_AI tUe..1- "t- ' C:fJ.~ 13'-/.&'117 Cc.c.. 0,/0 I) ~J ~c7tJ~ *************************************~*************************~* C, C-f C 0~'c-l{7 ~~ I ELECTRJ:CJ:AN COMPANY _ ,_ / STATE CERT OR REGIST # SIGNATURE t..~, CITY PROCESSING # ~/J ***********************************~~~**~~~**** BUJ:LDER PLUMBER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE MECHANICAL **********~******************************************************* COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE OTHER ~~4 ~;:;"''2f:1F;;~***''::~::::'''(;::TI-'''''''''''' STATE CERT OR REGIST # SIGNATURE CITY PROCESSING # **********************************~~~*t;t*~t?~____ . -<1P; /" .~Cv ds~~(.5? /"y I .j,-' ~.o;;,. '/>4~ , f",-,.7 ^ It" 1(}~~~'" ....'<;:;.,,' .. CONOl T IONS IOF PE.RMIT AFE'IOAVIT 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 responsibi~ity 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 wit.h sLaLe 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, Ilave been provided with a copy of "Florida's Construction lien Law - Homeowner's Protection Guide" prepared by the Florida Department of AgT-iculture 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 conunencement. 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 inq.icated. I certify that no work or installation has cOIrunenced 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 conunenced 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 conunenced. 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 $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEM 1f)~J: YI1. X~ SIGNATURE: OW OR AGENT STATE OF FLORIDA COUNTY OF The foregoing Before e thi by 0 Pa-sc: 0 STATE OF FLORIDA PA <c... 0 COUNTY OF v The foregoing instrument was acknowledged Before me this / S- daX, of ~artd' ~p~~ by .[X)JJfu __---r--l1\~J1 ~ ~ (name of person acknowledged) ~who is personally known to me, or acknowledged ,--t'9"~.9-. person acknowledged) known to me, or D who has produced (type and whoD did BClld not of identification) take an oath. Dwho has produced ~pe of identification) and who Ddid CIld1d not take an oath Ln1~.L.' ~ Signature of perso~aking acknowled ment ~~~~ S1g ature of pe on taklng acknowledgement ;VI ~)A/ / L~ ..:JO/7 e S. d 't d t : CA JONES "'an Name type, prln'e or s' '~, .: NDtlryPublic-mm.ofFlarlila - ~ ~ My Comm, Expll'8l Mlr 15, 2002 ...r:r~" Commission' CC724551 01/08/2002 03:07 8135544539 1evocable for Cause. Carry your Card Always Sign Your Carel. It is Non.Transferable resented when applying for permits. Ir card MUST be P 'ble for all permits issued ltractor will be held reds~nl~ notify' Building Dept. tar thiS Card. If Car IS , nediately, t be renewed prior to expiration .date, our card mus " _ '.~ . .,' .... M....... __", ...,.-....-'-...-.. .-,'--- ........- -.. " DETACH HERE GULF COAST SIGN SVCH lUU, ..:,~.' -,_., ., -- Cert, No. l Work81$ CompenSation ,2' Classification: ~BIBN CmHR.t-)c'nJH S Issued to: ~, '~::":K ~ _JDHI~ fill!,~ ~""..."t.:... ,eo..; c; d/b/a . _~_" ~ GULf Cm~8 'f S II::ii\J m:~fW ~ Expires: ~ ..~ t '2.-".~.:t Iasuil1g OffiC'lr 5.09/ ,~"i, ,.oolU..:.> HILLSSOROUGH COUNTY ,_ ".'" 4".,.1'_ ...'-'" --- ......... ......- -.,....".......-,', .,.",' _ "_.'.4 ......_ ........,-. .....- --. $. (ii .. STAT~ OFFLORIDA AC# .s 8 7 S 7 7 7 , " DEPARTMENT, OF -DVSlt>ltSS AND. .,.. . PROFEsS'tp~L <REf:UJ..A:Tt'ON,' .." ET -0000441()6~~rt'/~OOP 99902124 REG, SPEC IAL tY ELc.Cn~t-CAL C(jNTR WEEKS, JOHN;",t1OR~1lII ..J.IL GULF COAS'r,: "S]~N: 'SER\lICF; REGISTERED AS:' ", ,.';", ,.',:' SIGN SPECIALI,$T"'" ~, . . "'" . HAS REGISTERED u1ldettheprovtslonsotCI1. 489 'FS, Expiratloo Dale: AUG 31. 2002 ~/ PJNELLAS COUNTY CONSTRUCTION LICENSING BOARD CJ?~.!:ETJ;NCY.CARf)"" ", THIS CERTIFIES THAT Jobn M Weeks III DBA Gulf Coast Sign Service HAS MET All THE REQUIREMENTS FOR HOLDING A COUNTYWIDE CERTIFICATE OF COMPETENCY NO. C-7222 . AND IS DULY CERTIFIED AS A(N) , Electrical Sign Spec Contractor IN GOOD STANDING UNTIL SEPTEMBER 30. 2002 v-' DATE OF ISSUANCE 1011101 PAGE 03 ~ IJan 28 02 10:40a Great American Emp Ser 727 797 0704 p _ 1 "ACORD... CERTIFICATE OF LIABILITY INSURANCE I DAn: (MPMOOIYY) 01/24/2002 PRODUCER (727) 446-5051 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CONDON-MEEK, INC, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1211 COURT STREET CLEARWATER, FL 34616-5897 i INSURERS AFFORDING COVERAGE ..- --"+-- ..un. _ i -.----....---. ---- ---.. "'--.--'-- INSURED i INSURER A; CONIIN~NTAL CAS~AL TY..GPMPANL-___ ..- GREAT AMERICAN EMPLOYEE SERVICES, INC. INSURER B: ..----.... ----.. n_,_..'._ 3040 GULF TO BAY BLVD" SUITE #200 INSURE;R c. ------ ___.n ---.- .-----_.... -.- _. .-,. CLEARWATER. FL 33759 INSURER D' .----- u__.. --" ---_.. n_ I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIiE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECl TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIiE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,.~ TYPE OF INSURANCE POLICY NU_ER POLICY EFFECTIvE POLICY EXPIRATION LIMITS ~NERAL LIABILITY EACH OCCURRENCE $ - COMMt:HCIAL GENERAL LIABILITY FIRE DAMAGe (Anyone fire) ~ I-- o CLAI,MS MADE; D OCCUR MED EXP (Anyone person) $ .. ~ PERSONAL & ADV INJURY $ -- I GENERAL AGGREGATE $ ___nn_... ~EN'L AGGREGATE LIMIT APPLIES PER: PRooue IS. COMPiOP AGG $ -1 POLICY Ii P,:g: n LOC ~UTOIIOBlLE LIABILITY r.OM RINl=O SINGLE LIMIT ~ ANY AUTO (Ea lICCidenl) e-- e-- ALL OWNED AUTOS BODILY INJURY (Per person) S I--- SCHEDULED AUTOS .- I--- HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per eCCident) e-- ~ _.__._--- ----..--..-... PROPERTY DAMAGE S (Per DCCidcnl) RRAGE UABILlTY AUTO ONLY.. EA ACCIDENT $ ANY AUTO OTHER TH~ EAACC $ -" AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE S CJ" OCCUR D CLAIMS MADE -, AGGREGATE $ .- s R DEDUCTIBLE $ RETENTION S S A WORKERS COMPENSAnoN AND WC138201697 07/01/01 V 07/01/02 ') I TORY LIMITS I IO~- ..- EMPLOYERS' LIABILITY i'--..~_. E.L. EACH ACCIDENT $ 1 00 000 E,L, DISEASE - EA EMPLOYEE $ -- 1 00 000 E,L. DISEASE - POLICY LIMIT S 500 000 OTHER DESCRIPTION OF OPERA nONSILOCA nONSlVEHlCLESlEXCLUSIONS ADDEO BY ENDORSEUENTISPEClAL PROVISIONS This certificate remains in effect provided the client's account IS in good standing with Great American Employee Services Inc.(GAES). Coverage is not provided for any employee for which the client is not reporting hours to GAES, Applies to 100% of the employees of Great American Employee Services, Inc, leased to WEEKS U.S.A. CORP. dba GULF COAST SIGN SERVICE. CERnFICA TE HOLDER I I ADOmONAL INSURED; INSURER LETTER: CANCELLA nON SIfOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 'Tlil!ftl!()f', THE ISSUING INSURER WILL ENDEAVOR TO _IL ~ DAYS WRI1TEN NOTICE TO THE CERTIfICATe HOLDER NAMI!D TO THE LEFT, BUT PAlLURE TO DO so SHALL CITY OF ZEPHYRHILLS IMPOSE NO OBLlGAnON OR LlAElLlTY OF Afl'f KIND UPON THE INSURER, ITS AGENTS OR FAX: 813-780-0021 REPRESENTATIVES- AUTHORIZED REPRESENT~ #~ LA'l. I "'I. "-L ACORD 25-5 (7/97) V Ii ACORD CORPORATION 1988 01/08/2002 03:07 8135544539 GULF COAST SIGN SVCH PAGE 02 ~CORD.. CERTIFICATE OF LIABILITY INSURANC~F~~4 I DATE (MMlDDIYY) 08/27/0J. PR.ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS ~PON THE CERTIFICATE Florida Xnsurance Cen~er, Inc. HOLDER, THIS CERllFICA TE DOES NOT AMEND, EXTEND OR 4J.4 N. Alexander Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plane City FL 33566 INSURERS AFFORDING COVERAGE Phone: 813-754-3561 J'axI813-764-8402 ~ IN$URlID INSURER. A: Westfie1d Xnaurance Comgany -; INSURER 8; Qulf Coast Si~ Service INSuRER c: John K. ~e.kf iiZ DBA: 10311 01 Hi laborough Ave INSURER 0: Tampa 1'1. 33610 INSURER E: I COVERAGES THE POLICIES OF INSURANCE llSTeo BELOW IU.VE BEEN ISSUED TO THE INSUREO NAMEO ABOVE FOR THE POliCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I$SUED OR MAY PERTAIN. THE INSURANCE AFFORDED gy THE POLICIES DESCRIBCO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONomoNS Of' SUCH F'OLICIES, AGGREGATE LI~rrs SHOWN MAY HAVE 8EE;N REDUCED BY PAID CLAIMS, /~i': TYPE OF INSURANCE POLICY NUMBER Si~~~ olf~ LIMITS / EACH OCCURRENCE $1,000,000 GENERAL UABIUTY 0t.08/02 I-- 03/08/01 $100,000 A ~ COMMt:Rt.:1Al GENERAL LIABIUTY CWP3909626 FIRE DAMAGE tAlly one nre) ,,,- I-- ':.J CLAIMS MADE ~ OCCUR MED EXP (Any one pnon) $5,000 -- PERSONAl & ADV INJURY $ 1.,000,000 GENERAL AGGREGATE $2,000,000 I-- -il'L AGGRn LIMIT A.F'rt PEA: "ROOUCTS - COMPIOP AGG $2,0G-D,OOO X POLICY ~G#r LOC AUTOM08lLE I.lAlSIUTY COMBINEO SINGLE LIMIT - $ ANY AUTO (Ell ;occident) - ALL OWNEO AUTOS 90Dll Y INJURY - $ SCHEDULED AUTOS (Per per&oo) - HIRED AUTOS BODILY INJURY - S NOI'H)WNED AUTOS (~ aCdde/lI) "- F'ROPERTY OAMAGE $ (Per IICddenl) RGE UABlLITY . AUTO ONLY - EA ACCIDENT $ ANY AUlO OTHER THAN EA ACC $ AUrO OfIL Y: AGG $ EXCESS UABlLITY " EACH OCCURRENCE $ :=J OCCUR o CLAIMS MADE AGGREGATE S $ ~ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I IU~rt EMPLOYERS' LIASlLITY E,L, EACH ACCIDENT $ Ii,L, DIseASE - EA EMPLOYEE $ Ii,L, DISEASE - POLICY LIMIT $ OlliER I DESCRIPTION OF OPERATlONSILOCATlONSiVEHICLESlEXCLUSIONS ADDED BY ENg()ft$EMENT/$PECI<\l. PROVISIONS CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER; CANCELLATION SHOULD ANT OF TH!! A80V1!! DI!SCRlSEP POUCIe8 8E CANCELLED I!II!FOItE THE EXP'IRATlON DATE THl!MO/l. THE ISSUIN~ INSURE~ WILL ENDEAVOR TO IliIAIL J.O DAVSWRlTTEN - I NOTICE TO THE CERTIFlCATl! HOLDI!R NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPO$l! NO O8UGATlON OR UAIIIUTY OF ANY KIND UF'ON THE IN$U,.e~ ITS AGENTS OR Ict:l'JiU:SENTATlVES. t?... i C.~ ,. , 'I ' '" .. _..... - .... ... -- - ..... /.1 A.CORD 25-8 (7191) l1:lACORD CORPORATION 1988 CITY OF ZEPHYRH~LLS.PERMIT APPLICATION BUILDING DEPARTMENT 5335 8~ STREET ZBPRYRRILLS, PL- 33540 Phonea813-780-0020 Paxa813-780-0021 DATB RBCBIVED PLANS RBVIBIf I'BB ;J2"lenJ ? 14 Sf, OWNBR'S NAME VO/JIlA !iLl '3 'I JOB SITE ADDRBSS PHONE CONTACT 7;/2 -302;-- LEGAL DESCRIPTION: LOT(S) BLOCK PARCEL ID # SUBDIVISION WORK PROPSED: DNEW CONSTRUCTION (OBTAIN FROM PROPERTY TAX NOTICE) _IGN D ADDITION D MOVE DALTBRATION D REPAIR D INSTALL D DEMOLISH PROPOSED USE: DSGL FAMILY DWELLING o COMMERCIAL OMULTI - FAMILY 0# OF UNITS D MOBILE HOME o OTHER D INDUSTRIAL D SWIMMING POOL o RESTAURANT & HEALTH DEPARTMENT APPROVAL DESCRIPTION OF WORK BUILDING SIZE 1Dy. {;; S"- SQUARE FOOTAGE 26 tJ iJ HEIGHT 7 / 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 $ / SOO PBRHITS RBOUBSTBD VALUATION OF TOTAL CONSTRUCTION o ELECTRICAL AMP SERVICE o FLORIDA POWER o W.R.E.C. o PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION D 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 BUXLDJ!lR SIGNATURE COMPANY STATE CERT OR REGIST CITY PROCESSING # ****************************************************************** BLIOCTRXC:J SIGNATUR. " a.....~ ****************************************************************** COMPANY C!.-.f-c.., 1!Let-~C- STATE CERT OR REGIST # ~_~I~~ CITY PROCESSING # (;,5' PLUllBJ!lR COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATVRE MJ!ICRAlIIlCAL ****************************************************************** COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** OTHER SIGNATURE COMPANY STATE CBRT OR REGIST # CITY PROCESSING # ***************************************************************** f . _~...._............._...,...., ""'.... ............"U....L~ nccJ.U.t\.V.l-l. A. NOTICE OF DEED RESTRICTIONS The updersigned 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 RES~ONSIBILITIES 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 contra~tor that may be an indication that he is not properly licensed and is not entitleq to permitting privileges in the City of Zephyrhills. C. TRANS~ORTATION 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. I 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, Cyp~ess 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 Offic!al 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 ~RO~ERTY. 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 ~NOTI OF COMMENC T". {)~ 9- me ~. Sf'GNATURE: OWNEW'OR AGENT' STATE OF FLORIDA /J STATE OF FLORIDA COUNTY OF ~/LSCO COUNTY OF The foregoing instrument was acknowledged The foregoing instrument wafL:~~owledged ,~ Bef~e me th1s~ day ~f 011;;:21>:1-' ~d--.Before~e thi~ c7ct(tay of ~M.A1?, by~c,nn& -;::T rflrL~~ by .j20nolrQ ~Ujl/)_ \~ (name of person ackno~ledged) ~ (name of person acknowledged) ~who is personally known to me, or ~o is personally known to me, or PO-sc C) o who has produced (type of identification) and who Ddid [):lid not take an oath Name t