The URL can be used to link to this page

Home My WebLink About02-1301 BUILDING PERMIT 0 CITY OF ZEPHYRHILLS Permit N. 130 1 (813) 780-0020 Date &-;/70 lo~ ELECTRICAL PLUMBING MECHANICAL Sewer Conn Water Conn: P,"perty Owne, ~'t ~ I-\~F Job Address: ':) , 2.: A\J Parcel 1.0, , /I .-1.10-1 j O\)l~ tS"'2b~ Water Meter: T,LF.'s: ro\() Zoning: OescriDtion of Work Energy Code: R~~uf Radon Gas: FINAL C.O. - 1- (J.:z. DATE NO OCCUPANCY BEFORE C.O. Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE Permit Fee Signature I' Company Address Telephone# Ftr. Pre SLB lintel FRM. Insul. CL WL Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter Final PLUMBING Breakers Ducts I sl. Co Final ICAL BUILDING 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 Oollars ($25.00) shall be made for each trip for each trade: a. b. c. d. e. f. g. Wrong Address Condemned work resulting from faulty construction. Repairs or corrections not made when inspection called. Work not ready for inspection when called. Permit not posted on job site. Plans not at job site. Work not accessible. \ The payment of inspection fees shall be made before any further permits will be issued to the person owning same. . CENTRAL PERMITTING O~:~~~:COUNTY BUI~D=....PER"'~............... p........p........L...~.li~~~OR OFFICE USE ON~Y · Dade City: (352) 521-5144 FAX (352) 521-5149 eyv'1 ..... 13852 17th St., Dade City . '.- · New Port Richey: (727) 847-8126 FAX (727) 847-8901 7530 Utlle Rd., Rm. 210 New Port Richey · Land O'Lakes: (813) 929-1266 FAX (813) 929-1307 4111 Land O'Lakes Blvd. (US 41), Land O'Lakes THIS APPLICATION MUST BE TYPED OR PRINTED IN INK AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS -----------------------------------------------------------------------------------------~-----------_. IS THIS APPLICATION THE RE ULT ,~TOP WORK ORDER OR NOTICE OF VIOLATION? Y _ N_ ~ OWNER'S NAME: / V PHONE. (&"/3) 7$}.-r _ 'L.-~ <f 9 9 JOB LOCATION:. ":?J?' S- "'1 r --L. 2- V ~ SUBDIVISION: -z:~ 12- h / 1--/ ~ ~ PARCEL 10#: S tI-- T ~ R.3::.L suB02tt2 BLI0.t.laO LOT t)t>//) PROJECT * TAl _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: CITY: STATE: ZIP: ~ FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): address Of applicable): CITY: STATE: ZIP: ~ ~~~=-~;;;;~-=r;~;.~~E7~-;:,rt:;,~-;,~7---~i;;iZ;;;--~~~-==F-~-~:=-0- 9 . BEDROOMS - . BATHROOMS _- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: a:l FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE YEAR SIZE J= Q. a: WORK CODE PLANS ON FILE? 0 NO 0 YES PRE-PAID PLANS FEES: $ ffi MODEL NAME c VALUATION $)-, .~=3 9 s-: 0 c., RECEIPT': --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: u o ffi ARCHITECT/ENGINEER: ffi ADDRESS: i= o MORTGAGE LENDER: ADDRESS: CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CONTRACTO. ... SIGNATURE' ~ ADDRESS: . [ I g STATE UC . Of applicable) ...J a:l e ELECTRICAL CONTRACTOR: ~ SIGNATURE: .... ADDRESS: ~ STATE UC . (if applicable) U POWER CO: PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . (if applicable) o NEW 0 ALTERATION VALUATION: $ PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: (Required) PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . Of applicable) . FIXTURES: SEPTIC PER. PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: SEWER: WATER: WEll OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . Of applicable) TYPE CONTRACTOR: PHONE. (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT.: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr ....NOTlCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE sloe Of THIS APPUCATION (pennil form 10191) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G (OVER) A. NOTICE OF DEED RESTRICTIONS The undersigned understand that this permit may be subject to "deed restrictions" which may be more restrictive than County regu'lafions. The undersigned assumes responsibility for compliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If t.he owner has hired a c.ontrac~or or contracto~ to undertake work, they may be required to l>e licensed in accordance with state and local regu- lations. 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 Pasco County Building Division - Ucensing Section at (727) 847-8009. Furthennore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as ttld owner sign as the contractor, you are indicating that you, rather than the contrac- tor, are responsible for the work. If the contractor wishes you to sign as contractor, that may be an indication that he is not proper1y licensed and is not entitled to permitting privileges in Pasco County. C. TRANSPORTATION IMPACT/UTILlTIES IMPACT AND RESOURCE RECOVERY FEES The undersigned understand that Transportation impact Fees and Resource Recovery Fees may apply to the construction (If new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance numbers 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthennore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance. In accordance with applicable Pasco County ordi- nances. D. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended) If valuation of work is $2500.00 or more, I certify that I, the applicant, have been provided with a copy of "Florida Construction Lien Law - Homeowner's Protection guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner," I certify 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 con- struction, 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 commended prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating constriction. County codes, zoning reg- ulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government 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: . DeDartment of Environmental Protection - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment . Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercources. · Armv CorDS of Enaineers - Seawalls, Docks, Navigable Waterways. . DeDartment of Health & Rehabilitative Services Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks. . US Environmental Protection Aaency - Asbestos abatement . Federal Aviation Authority - Runways. I understand that the following restrictions apply to the use of fill: . Use of fill is not allowed in Flood Zone "V" unless expressly permitted. . If fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a profeSSional engineer licensed by the State of Florida. . If fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. . If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 provi- sions 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 codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit 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. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) conse<:utive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING lWlCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO G YOUR NOTICE OF COMMENCEMENT. rJ SIGNATURE SIGNATURE \j <: ~ / CO~ (,~D/c) <- / b~i)~~ (t t1,-~#L_. DATE DATE NOTARY AS TO OWNER OR AGENT NOTARY AS TO CONTRACTOR /j7 ( r,?_ MY COMMISSION EXPIRES OPFlCL.4IJ.. ARY siAL (' M:MA':l HAI,7,!'ZOG ,. ,__~, "~. c\ ;::: Cf< r'.OlLTt).a, l r,;C/L4..l'tt t'J' ,.: . ':. '" .,";',Ti.i') t. ;.:' ,,,,,,c,- '. . d_.':~_~:(:;.?z,?2lEj ~ /C:,J - ?d /- 3/- J//o CARMAN HARTZOG NOfARY i'UBUC &TATE OF FLOKIDA MY COMMISSI N COMMlSSlON NO. ccm269 EXPIRES