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Home My WebLink About02-1240 BUILDING PERMIT CITY OF ZEPHYRHILLS Permit N! 1240 (813) 780-0020 Date "Z;; c23 - tJ 2.. BUILDING ELECTRICAL PLUMBING MECHANICAL Sewer Conn Water Conn: Property Owner: Job Address: Parcell.D. , xg~ L/R~.~ ~~~ Water Meter: T.I.F.'s: Zoning: Description of Work 5nergy ~ ,k e - K.~ Radon Gas: Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. FINAL C.O. DATE NO OCCUPANCY BEFORE C.O. DATE Inspector City License Registration # State Certified License# Permit Fee )?Signature Company Address .)1elePhone#" g i -' 3LJ U Valuation or Contract Price 9;1,6 Or,J~ Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter ! Final PLUMBING BUILDING Ftr. Pre SLB lintel FRM. Insul. CL WL SLB Tub Set Water Sewer 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. OWNER'S NAME Rose ~ fVlL\tQJt ~O JOB SITE ADDRESS tf Ell) 11 f/;t. S fy-- CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8th STREET ZEPHYRRILLS, FL 33540 Phone:813-780-0020 Fax:813-780-0021 5- -? =::l ~ /7 DATE RECEIVED ~ ::..J - C/ e;4. PLANS REVIEW PEB PHONE CONTACT I~ 3 ?:> 71 () 53!J<! 0 ?h~ lt~ -p( LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: DNEW CONSTRUCTION DADDITION DALTERATION DREPAIR D INSTALL DSIGN DMOVE o DEMOLISH PROPOSED USE:~SGL FAMILY DWELLING o COMMERCIAL o MULT I - FAMILY 0# OF UNITS o MOBILE HOME D INDUSTRIAL o SWIMMING POOL o OTHER DESCRIPTION OF WORK ~ ;:;;~ . HEALTH DEPARTMENT APPROVAL 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 $ CfgCf!!- VALUATION OF TOTAL CONSTRUCTION D ELECTRICAL AMP SERVICE D FLORIDA POWER D W.R.E.C. D PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION D GAS D ROOFING o SPECIALTY D OTHER TYPE OF CONSTRUCTION: D BLOCK o FRAME D STEEL D OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREA DYES o NO BUILDER SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # ****************************************************************** ELECTRICIAN COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************************** PLUMBER SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # ****************************************************************** MECHANICAL SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # ***************************************************************** OTHER 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 ~h~ owner has hired a contractor or contractors to undertake work,. they may be required . ' 'tob~'.J.icensed in accordance with state and local r~gu'lations~ .If the contractor is not l~cens7d .~.El, r~~u.:!-red by ~aw, both, the .owner and cont'~c.or may ):le, oi~d for a misdemeanor v101at1OO und~,~tate law. ~fthe, 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 li~i~d t~:, *Department of Environmental Regulation-Cypress Bayheads, Wetland Areas and.Epvironmentally 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.~xt~nsion shall be requested in writing to the Building Official. An approved'inspecti90' !bust .,qe :loggl;!d 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 STATE OF FLORIDA COUNTY OF The foregoing instrument was BefOre me this _____ day of by acknowledged 19_ STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _____day of by acknowledged 19 (name of person acknowledged) Owho is personally known to me, or (name of person acknowledged) [1ho is personally known to me, or o who has produced (type of identification) and whoO did Odid not take an oath. o who has produced (type of identification) and who Odid [}lid not take an oath Signature of person taking acknowledgement Signature of person taking acknowledgment Name typed, printed or stamped Name typed, printed or stamped