HomeMy WebLinkAbout02-1286
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N2 1286
(813) 780-0020 Date 6 -I t(- f) ~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcell.D. #
fJ!.i I (;<~u
t~/i/ rf- Kt;" t
()-4,A/~
U.
Water Meter:
T,I.F.'s:
Zoning:
Description of Work
Ene'gv Cod.~
~~r
Radon Gas:
S~ ~ kT~/;--bO~
FINAL 7- ~--o,;(
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans. Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Valuation or
Contract Price
~ OttO
,90
Permit Fee
'>-6ignature
/ Company
Address
XTelePhone#
:J- 7'70
City License Registration #
State Certified License#
/-8Cd-7'?-. ~ -53Zb
J1/NrIC;"'" f~,r.s+ti
MECHANICAL
Ftr.
Pre SLB
Lintel
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Met
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
BUILDING
ELECTRICAL
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.
{
OWNHR' S NAM~ ../l //;A.A.lL.-e' ct vv"Gk
JOB SITR ADDRBSS ~){5'/ ro/~ .kI~9 ~~
./
I -vJJ.'! I' ,
CITY OP ZBPSYRHILLS PBRHiT APPLICATIO~ G. ~1~_2_o~~
BUILD.IlfQ DBPAltT.MBRT Un 8th STaRlIT ZRPBYRRZLLS. I'L ;Jist'b----
Phon81813-780-0020 l'axIBU-780-00:I1' . c:.,- / O.~
DATa RJlCaZVlID, J ~ -
PLOS awzlIIf 1'.. ,
PHONR CONTA63S- 6).) 7 3 ~ - 5"3d. ~
" . 'f<)'Ck.
-4' ~ ph Y /J h I II j
LBGAL DBSCRIPTION. LOT(S)
PARCBL ID #
WORK PROPSBD. ~BW CONSTRUCTION
BWCI<:
SUBDIVISION
(OBTAIN FROM PROPBRTY TAX NOTICR)
Dsnm
o ADDITIO~
o MOVR
o ALTJlRAT ION
o RBPAIR
o INSTALL
o DRMOLISH
PROPOSRD USR: OSGL FAMiLY oWRLLING. DMULTI-FAMILY
,.l1 COMMRRC~AL
o INDUSTRIAL
,
0# OF UNITS
o SWIMMING. P60L
o MOBILR HOMB
o OTHBR
BUILDING SIZR
o . RBSTAURANT &: HRALTH DRPARTMBNT APPROVAL
jI()e;J< vp (:', f.e' ~y?+,gM I~. k, Y--che:.--c..) J,t1/ocf!
r .
.QRSCRIPTION OF WORK
SQUARB FOOTAGB
HRIClHT
RBSIDBNTIALr
COMMJIRCIAL.
~TTACH (2) Ii'LOT PLANS &: (.;1). SliTS OF BUILDINCl PLANS &: (1) SRT RNBRClY FORMS.
ATTACH (3) SRTS OF BUILDINCl PLANS &: (1) SBT BNBRGY FORMS.
PROPBRTY SURVEY RBQUIRBD FOR ALL HRW CONSTRUCTIQN.
PBRIIITS RBauil;JTBD
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o RLRCTRICAL
AMP SRRVIes
o FLORIDA POnR
o W.R.B.C.
o PLUMBING
o MBCHANICAL
J o()
$ /, t/ r- t!l .
./
VALUATION OF MBCHANCIAL INSTALLATION
o ClAS
o ROOF;J:NG . 0 SPRCIALTY
o OTHBR
, TYPE OF CONSTRUCTIO>>: tJ. BLqCK
FINISHRD FLQoR RLBVATIO~S
o FRAMB
o STBRL
o OTHRR
IS PROJHCT IN FLOOD ZONB ARRAo YRS 0 NO
BUZLDBR
COMPANY
STATB CRRT'OR R&GIST .
CITY PROCBSSINCl #
SIGNATURB.
aLaCT"J:C:rU
~*****.*...A...*...*.**....**..**.....**..........................
SIClNATURR
'0,.
COMPANY
STATB CRRT'OR RBGIST '"
CITY PROC~8SI~Cl '"
. .
PLUIDJ...
..................................................................
COMPANY'
STA~B CHRT OR!",GIST #
CITYPROGBSSING#. .
'. SIGNATUlUI
IIBCIIAIt:rCAL.
.............~........**..*....*.....*...***...*........*.*....*.*
~\.~~ L**~~.......**.......~...........*.......*...........*............
r' ,.. "7 Y 'i"~1t1 CtlA/"f Y<<A~-I t:11C....
O'l'S." ~eJWAr~ (, l..e'lU/.5
COMPANY:
STATH CHRT OR ~GIST. #
CITY PROCESSING .
SIClNATURII
......*.......***...*........**.............**............**.*
COMPANY .4me:'" C./I..,(/ h~~ .JL fA- Fe~y Xvc.
STATB CHRT OR RBGIST # Clb 'b/,j,-ooo'A, 6-
CITY PROCRS,SING #. aq
SIGNATURE
vV"U~~~~NB OF PERMIT AFFIDAVIT
A. ,NOTIC~ OF DEED RESTRICTIONS
Tho Und~rsignod nuderotondo t~ot thie po_t ".y ho ..uhjoct ,to "dood uotdctiono- which
may be more restrictive than City' ~egulations.. Th." lllndersigned aSSUmes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRAcTOR RESI?ONSIBI:t..ITIES
If tho ownor h.. hiud 0 nootroctor or aontron'orO tn nudertoko work, they..y he required
. to be licensed in accordance with state ClOd local reuulations. If the contractor is not
licensed as required by law, both the owner and. contJ[aotor may be oited for a miSdemeanor
violation under state law. If the owne~ or intended contractor are uncertain as to what
licensing requirements may apply for the intended wOl~k, they are advised to contact the
City of Zephyr.tills Building Depart~ent, 813-788-661.l.
Furthermore" if the owner has hired a contractor or'oontractors, he is advised to have the
contractor(s) sign portions of the "Contraotor Seettonsu of this application for which they
wJ,ll be responsible. If you, as the owner signs as t:he contr~ctor, 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 t:hat he is not properly licensed and is
not entitled to perndtting priVileges in the City of Zephyrhills.
C. 'I'RAN~PORTATION IMPACT .FIES AND UTILITY CONNECTION' FilES
D. CONSTRUCTUION LIEN LAIr (CHAPTER 113, FLORIDA S'i'ATUTEtJ, ABAMBNDIlD)
I certify that I, the applicant, have been provided Idth a copy of "Florida'liI Construction
lien Law - Homeowner's Protection Guide. prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is som.eime other that the "ownerN, I cerify that I
bave 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/mINER' S AFFIDAVIT
I certify t~at ,all the information in this application is accurate and that all work will
be ~one in compliance with allap'plicable laws regUlating construction, zoning, and land
development.
Application is hereby made to obtain a penmit to do work and installation as indicated. I
cortify thot no work or inotoll.tion h.o oaomonnod prinr to i.ooonco of . poxadt ond th.t
all work will be perfo~ed to meet standards of all laws regUlating const~uction, City
codes, zO~ing regulations. and land development regulations in the jurisdiction. I also
certify that 'I understand that the regulations of other gover;hDlental agencies may apply to
the intended work, and that it is my responsibility to identify what actions r must take to
be in compliance. Such agencies include but are not limited to: *Departblent of
EnVironmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment ,
*Southwest Florida Water Management Distriot-Wells, CypJi:ells Bayheads, Wetland Areas,
Altering Watercour,es
*Army Corps of Bngineera-Seawalls, Docks, Navigable Waterways
*Department of Health , Rehabilitative Services, EnVironmental Health Uni~~Wells!
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection AgencY-~bestos abatement
I also certify that, if ;till material is to be \lsed in Flood Zone ~'AN or "A, etc.., it is
understood that a drainage plan addressin~ a "compensating volumeN will be submitted which
1s prepared by a prQfessional engineer registered in the State of Florida prior to permit
issuance. , \
A permit issued shall be construed to be a license to prooeed with' the work ~nd not as
authority to violate, cancel, alter, or set aside any prOVisions of the teohnical codes,
nor shall issuance of a permQt prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. BverY.per.mit
issued shall beQome invalid unless the work authorized by such pe~t is commenc~d ~ithin
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 pe~t with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspeQtion must be logge~ during each six
month periOd, or the project will be considered abandoned. \
WARNING TO OWHER: YOUR FAILURII TO RECORD A NOTICE OF COMMBNCIM&NT MAY RESULT IN YOUR
PAYING TWICE I'OR IKI?ROVEMafTS '1'0 YOUR' PROPERTY. II!' YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LBHDIR OR AN ATTORNEY BII'OJU; RECORDING YOUR NOTICE 01' COMMBNCIHINT. JOBS UNDBR
$2,500 IN VALUE DO NOT NEED TO RICORD AND POST A "NOTICE OF COMMENCEMENT"'.
. SIGNATURE. OWNER OR AGENT
)(
,
SIGHATURIl: CONTRAcTOR
r.f~
STATE OJ!' B'LORlDA
COUNTY or .
The foregoing instrument was
Before me this _ day of
by
acknowledged
, 1 !l...-
STATE or FLORIDA
COUNTY OF .
The foregoing Instr~nt was ac~nowledged
Before me this ~ay of , 19..:..:....
by
(name of person acknowledged)
[1ho is personally known to me, or
(name of person .ckno~ledged)
'0 who is per.sonally known to me, or
o who has produced
(type of identification)
and whoOdid Odid not take an oath.
o who' has produce~
, (type of identifioation)
and who Odid [}lid not take an oath.
Signature of person taking acknow1edgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
STATE OF FLORIDA
OFFICE OF TREASURER
DEPARTMENT OF INSURANCE
TALLAHASSEE, FLORIDA
FIRE EQUIPMENT DEALER LICENSE
TIllS CERTIFIES THAT: AMERICAN FIRE & SAFETY SUPPLY CO
4565 NE 36TH AVE
OCALA, FL 34479-
QUALIFIER; EDWARD L LEWIS
HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, REPAIR,
INSTALL OR INSPECT ALL TYPES OF PRE-ENGINEERED FIRE EXTINGUISHING SYSTEMS,
"-*,
~~
Treasurer
Insurance Commissioner
Fire Marsbal-
01 01 2002 07 04
Issue Date Type Class
Marion
County
06461500021985
6725890001 12 31 2003
LicenselPermit Number
Application # Expire Date
STATE OF FLORIDA
OFFICE OF TREASURER
DEPARTMENT OF INSURANCE
TALLAHASSEE, FLORIDA
FIRE EQUIPMENT DEALER LICENSE
TIllS CERTIFIES THAT: AMERICAN FIRE & SAFETY SUPPLY CO
4565 NE 36TH AVE
OCALA, FL 34479-
QUALIFIER: EDWARD L LEWIS
HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, RECHARGE.
REPAIR, INSTALL, OR INSPECT ALL TYPES OF FIRE EXTINGUISHERS INCLUDING RECHARGING CARBON DIOXIDE UNITS. AND TO
CONDUCT HYDROSTATIC TESTS ON ALL TYPES OF FIRE EXTINGUISHERS INCLUDING CARBON DIOXIDE UNITS,
~~
Treasurer
Insurance Commissioner
Fire Marsbal
01 01 2002 07 01
Issue Date Type Class
Marion
County
05962400011978
6725940001 12 31 2003
License/Permit Number
Application # Expire Date
- - - -- - - - - - - --- -- - - - - - - - - - - - - - - - - - -- - -- --- --- - --------- -----
PP~o/~
dX~'(HD c9f.tt g.{t.~ ~y dfk- m~:
cf7in-t; EDWARD L. LEWIS, As PRESIDENT OF AMERICAN FIRE & SAFETY SUPPLY COMPANY,
INC., A FLORIDA CORPORATION, ha4 made~ co-ndl//u~d and a/tlwin/~ and 6y the.1e /t~nld
00. I mak,e~ OMt4Ii:tille and a#,oinl
Daniel Bianchi
a4 MY 1",,6
and IawId aIt"o4eney r ME and in MY na4N,e~ /tkr-ee a,nd dead
FOR THE PURPOSE OF GOING TO THE CITY OF Zephyrhills , IN THE STATE
OF FLORIDA, SO HE MAY CONTRACT AND OBLIGATE AMERICAN FIRE & SAFETY'S LICENSE
AND RECEIVE A PERMIT TO WORK IN THE CITY OF Ze1>hvrhills , IN THE STATE
OF FLORIDA. !
rUn!! a4UI ~ <<?Uo- MY :Jaid ~ lull jwgJe1l and aatAM'(~ Ii> do and ft+m all
and (?/iJM'? a-et and th~:nfl whal4oe1.le1l -1'e<ftU4iIe and n~a7 tJ, be do-ne in a,m/ aka.! tIw
/t-TMmMM a4 jillty~ to all inUAtId a,nd /tu~~~ a.4 I ml?hlo-1' coati do i//tM'dO-na/ly /t~~ miM
jiLlI/W((.J61< ol:JLIJdiIi.tLion a,nd ?<e1mcalwn~ hM'e6? 1<a/i/y-t4ffl and conf/#minfl ad tha.tMY MIld
alto'l'nell M< HIS ,1(/.A,I/liJIe :Jha// hu.{klty do M< C(U.lde tJ be o0ne b? vw/ue hep>~
~ 0fI/~ 0fI/~ I hU/Ve hMreun/b 4(>1 MY knd and:Jeal ON Me 13th
day 0/ June ~ in the Jll!aIIl lidO tAo"4and lum.
SAFETY SUPPLY, INC.
BY:
r::z. 9:)
EDWARD L. LEWIS
PRESIDENT
~ ,yFLORIDA
YF~ of MARION
~e o1t dYCwam~ d?liat' on tAe 13th day 0/ June liuo
tAOUda1td lidO" ~ me~ WILLIAM HUFFMAN, a NOTARY in and r the ~ o/FLORIDA ~
C047'm~Mioned and jWO-1'n~ dmel/in!! ,4t the CITY OF OCALA, COUNTY OF MARION /te?'<1Mtady
ca.me and a/t/tea~ EDW ARB L. LEWIS tJ me jte1'dO?lally knomn., and knomn to. me to. be tAe
:lame /t(>4'<JO?t, AS ~ l4t a,nd lI'~O ed:'f!aLM the wl:tht4t/t<JU1M' 0/ aIt~~ andHE
ru:knomledrd /h,e l.lH:/hin jtome1l 01 a.IIi>><ney to be HIS ad a,nd d.eed.
~ cff~ ~ oYhamehenuMtW:JLd.wn/mdmynamea,nda#~
"'/I _/0/ "ffke IA. day "",,/ !F'" Iud "k,., aW/_/ fa? {fi!
~ - -- (267)
William H an
G)OFFIIlIAb NQfAMV i~.Ab
tmL.IA. I HUmUN
. eOMUISllON NUMBER
00042124
MY COMMISSION EXP
JULY 16, 2005
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CAPTIlJE AIRE
I Ir V ""'T"'.""I'4'4' . ..... _ ___...
P.05
,b: # 16~23 ALlJANCE CHURCH
Location: ZEPHYRHILLS. FL
=ira System #; 1 Ansul R-102
lods Covered: Hood # 1
Gas Valve(s): Mechanical 2.000" Supplied by Distributor
ANSUl-3.0
Tag: Fs..1
~
I
Item # Cas #
1 AT - 3.0
Vendor'
429862
Supplied by ShIp
Distributor Fllctorv Inst Loose
1 0 /O.?"O
1 ,......... o.."i~~.ol;;' ........
10
De8Crl~on
TANK(#1S} - 3.0 ~lIon SS Tank (101' l.Ise with
A\.Itornan Release, Actuator. or 55 Enclosure (UL))
. .-----. -.. . ..---... -. . ...---.. . .-.. ----- .. -... .-... '" -.- .-.... ..-..-___..0 . _"__.___... _______., ..__....._.
AUTOMAN RELEASE. Ansul AlJtoman Mechsn;cal
Release A$sembly (UL)
....--..... ..--...... --.'-'-"-. --......-. ---....-. ........... .-.-.-..........---.-., ......--. ....---..,.-.......
AGENT - Ansufex Low PH Wet Chemical Agent, 3
Gallon (UL)
... -. -.-.... ........ --.. - -------- - ... ..'- -.. -.. -. ...... -.-----.-....... ----. .... -.--.-.. -.--..... ... ...--.... ----..-.....- ---.. .----.--. , ,... ...-.
7 101-20 17492 CARTRIDGE - Carbon Dioxide 101-20, 3 Gallon 1 0 'I]. f' 0
Cartridge (R-102)
.,.......... .....,...., ,.......,... ...,......, ........., .'.......... ,......................... .........., ........, .......... .......... .....vG-.. '........
1 10 TLINK 2491 a LINK - Test Link Package 1 0 I.
0_.' . .-.--. --.. '" ---.-'" ..-.---..... " ....- '-..--.. . .-...... ...' . -'." ...., . -. ____....._. . ._... _ _ ._. '" _. .._._. ... ._...... . _ ._.... _'. . _. .._ .... .. _ ._..__.. . ..0....0_
1 11 MICRO-SO 423879 MICROSWITCH - Single Dual Electric Switch 1 0
. . . - - -. - .. ,.......... ~.. ... -.... . - .. . ..... . -... . . . , .. ....... . . - . -... . ... - - . . . . .. .. - - -.. , . - -. ... - " .......... -. - . . . -... - -... - , ........... - - -- -.. - - -. ... - - - . . -. . . ..... - -..
1 ,~ 4193'31 41SM5 NOZZLE - 2W N.ozzle. DlJ.ct 0 1
'... ---'-".. --...-.-.-..- .--....-....... ...-......... ..-...-.-- "..........-.- .-'--.--..-. ....-..-....-..-.-.....-...... .....-.......... -.--.-..-...,......--- - ........-..--... ...-...-
2 16 419335 419346 NOZZLe. iN Nozzle, Pkmum/AppNance 0 2
............ '-....-... .......... ..--.....-.. "...-"'.-. .......--.. .-......-... .....-..... ......-.. ............ ,....-..--. ..-.....-.... ...........- ...-
2 20 419340 419351 NOZZLE - 246 Nozzle, Appliance 0 2.
".'---'" ..-.....-. .-.--"'-'-' -.......-... ..""'--" .....---..-. ........-.....- .-....-....----,...-.-...... --.-".-'.-'- ......-...-........----... ..-.-..-...--.,...----.--..
1 23 419342 419353 NOZZLE - 290 Nozzle, Appliance 0 1
.. ...... , . .-- --... -'. . ---.-.-.- -. ...-....-- . ...-. -...... ... ..--.. -. -. - ----..- - '" ".' ........ ----.-.. -. - - ----..-... '.. -... .... .. -.... --....... ......... . -.. -.--.-........ ....
1 2S 418569 423572 NOZZLE ADAPTOR - Swivel Nozzle Adaptor 0 1
.. "..... .... ,...... -. ---.. . -. .'--.... - -- --'" .. '..-" -. -. ,. .....--..... ... -. - -....,..... -.. .-.. . -... -.'--. - . ....-...---., '" .---- --.. -_. ....-. -'. . . - .-.. ...--..
6 2.0 QSA-3J8 772elS QUIK SEAL - 318" (UL) 0 6
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1 27 QSA-112 77267 QUIK SEAL - 112" (UL) 0 1
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2 28 5-DET 417369 DETECTOR - Series (Scissor linkage) <l 2.
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. P.04 '
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PASCO COUNTY, FLORIDA
SCHOOL IMPACT FEE
Ordinance No. 01-06
Effective: February 28, 2001 at 2:08 p.m.
Permit No. /,:( q7
Date Permitted:
Builder Name/Owner Name ~ ~A-1Jtl-"" (}. f91J.5f '
ParceIID:~I/-..25"-.2/- Oil). -OIJt300-- tJ/~O
Address/Location: 7':<020 C'7'/j-",-6U/.1 Xr
Subdivision:
ClassificationfType of Use:
Exempt:
How Determined:
c2f.single-Family Detached House
o Mobile Home
o Other Residential
o Collection Fee
Total Fee
\( No
Yes
(056) ;: t 9f-
(057)
(058)
(123)
$ I t. 91 -
,
Prepared By:
Checked By:
I ,;( \)~~_
'----""
The above impact fee has been established pursuant to the Pasco County School
Impact Fee Ordinance No. 01-06 as adopted by the Pasco County Board of County
Commissioners. This amount is payable PRIOR to the issuance of a Certificate of
Occupancy or where a Certificate of Occupancy is not required PRIOR to the final
inspection.
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNT LISTED HAS BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowledgment below does not imply acceptance or concurrence, but simply receipt
of a copy of this form, placing the building permit owner on notice of this assessment
and the conditions of payment for same.
9-:z 7- 0-2-
7(v~~
Received By
Date
OFFICE USE ONLY
RECEIPT NO. /:21/4/5 DATE ~-,f27-o~
White
Customer
Canary
Finance
Pink
School Board
PC01005114/A
BY '7( JJ Jjj:v
Gold
Inspection