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Home My WebLink About02-1383 1383 iff) , ~ BUilDING 3S'eO (813) 780-0020 3)'~ PLUMBING ;2)" era MECHANICAL Date Zoning: OescriDtion of Work Energy Code: Radon Gas: fYI-/!. 5.d-~ t9c7 Sewer Conn t;< 7 ~ ' , ~ Water Conn:. 350 ' wate: Meter:. / ~o :: r.I.F. s: ~ '/ 0 ..Jr rr ,rrliJ:iY -: /80' oc ~Y"C' t!Nnn" ::: 1'75,00 o ELECTRICAL Property Owner: Job Address: Parcel 1.0. /I Inspector Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. FINAL C.O. NO OCCUPANCY BEFORE C.O. City license Registration # State Certified license# Permit Fee ~~rJ!> LV~~~ Company Address ~ - ~~) 77> Y""L.';:'" U Valuation or Contract Price ELECTRICAL f3aJuf'tr PLUMBING It~ !J~fH BUILDI G A&- . MECHANICAL SlB Breakers Tub Set Ducts Insl. Water Compresso~ Sewer Final ~ ?-~/2-O:I- /-/.:TO Final j../ R~ 1;2 -02-il-:JD 12Li /2U( Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter Final A~/:2-o 2. Ftr. Pre SlB lintel FRM. Insul. Cl Wl ff 8-13/(}~ /./.'-""'0 ./ 1'2 L- '1 1'../ tJ ft,iS5l~11 /C(-- 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: /J ~ a. Wrong Address /J 0_.<11.. ~' 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 Sth STREET ZBPHYRHILLS, FL 33540 PhoneIS13-780-0020 FaxI813-780-0021 8.....1_~..A DATB RBCBIVJlID CL _ C.R';,({.JL_ PLANS RBVIJlIW FRE OWNER'S NAME G-h~j) )Iv 1'-,.z....o;'\J 3?'ti?09 7k~9I~fMN~ PHONE CONTACT JOB SITE ADDRESS LeT s-..> LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION G-rt;"frlJ J-f G,ro. n..c.'.'1 PARCEL 10 # DSIGN (OBTAIN FROM PROPERTY TAX NOTICE) D ADDITION DALTERATION D REPAIR D INSTALL o MOVE 0 DEMOLISH DMULTI -FAMILY 0# OF UNITS B""f;]OBILE HOME D INDUSTRIAL D SWIMMING POOL D OTHER WORK PROPSED: DNEW CONSTRUCTION PROPOSED USE: DSGL FAMILY DWELLING D COMMERCIAL DESCRIPTION OF WORK o RESTAURANT & HEALTH DEPARTMEN'l' APPROVAL frI. (-(- BUILDING SIZE ;l 'L.)("~ SQUARE FOOTAGE HEIGHT RESIDENTIAL: COMMERCIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. ATTACH (3) SETS OF BU!JJDING PLANS & (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL. NEW CONSTRUCTION. PERMITS REQUESTED o BUILDING $ VALUATION OF TOTAL CONSTRUCTION [J ELECTRICAL AMP SERVICE D FLORIDA POWER D W.R.E.C. [J PLUMBING [] MECHANICAL $ VALUATION OF MECHANCIAL INSTALI"ATION [] GAS [] ROOFING o SPECIALTY o OTHER 'I'YPE OF CONSTRUCTION: D BLOCK D FRAME [] STEEL [] OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES o NO BUILDER SIGNATURE .w c...y---;p~. COMPANY o...~ STATE CERT OR REGIST # CITY PROCESSING # ****************************************************************** BLBCTRICIAN SIGNATURE w~ COMPANY Jq.c. <- STATE CERT OR REGIST # CITY PROCESSING # PLUMBBR ****************************************************************** COMPANY L~ ,.. l' ~;..A.--A STATE CERT OR REGIST # ~ /- ~ CITY PROCESSING # SIGNATURE MBCHANICAL ****************************************************************** /1- t:...-<-- SIGNATURE W'~//~ COMPANY STATE CERT OR REGIST # CITY PROCESSING # ***************************************************************** OTHBR COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** CONDI'J.'IONS OF ?EPMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS - 'l'he_undersigned understands that this permit may be .subject to "deed restrictions" Hhich _ may be more restrictive than City reqlllations. 'rhe "Jndersigned assumes responsibility for complia'hce with any applicable deed I:estrictions. B. UNLICENSED CONTRACTORS AND CONTRl\CTOE 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 \-lork, 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. TRANSPOR'l'A'rION IMPACT FEES AND UTILITY CONNEC'l'ION FEES D. CONSTRUC'rUION IJIEN LAW (CHAP'I'ER 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 lntended 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 L~nds, Water/Wastewater Treatment *Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses *Army Corps of Engineers-Seawalls, Docks, Navigable Waterways *lJepartment 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 issHed 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 SiK 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 thtle 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 '1'0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE I!'OR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OB'I'AIN FINANCING, CONSUL'l' WITH YOUR I,ENDER OR AN A'rTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VAI,UE DO NOT NEED TO RECORD AND POS'l' A "NOTICE OF COMMENCEMENT". SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR STATE OF FIJORIDA COUN'rY OF The foregoing instrument was Before IlIe this _ day of by acknowledged , 19_ STATE OF FLORIDA COUN'I'Y OF The foregoing instrument was Before me this _____day of by acknowledged 19 (name of person acknowledged) Dwho is personally known to me, or (name of person acknowledged) Chho is personally known to me, or D who has produced (type and whoD did Ddid not of identification) take an oath. Dwho has produced (type of identification) and who Ddid DUd not take an oath Signature of person taking acknowledgement Signature of person taking acknowledgment' Name typed, printed or stamped Name typed, printed or stamped ::CH,Tr;~r-'"CTDr~ #:: 009B6.<.\ NAME: BUTTERFIELD ~DDR= 37609 NEW HORIZON BLVD :/ST= GRAND 'HORIZONS ZHILLS CEN1'RAL PERMITTr~s PrY; C::(] C CHn'.!"l y" F L C' ,;: I D r~1 DATE: 09/11/02 T]..Mt;...... - 09 :: :L:~ ./-- ~AGF. 1 (}I~ :I. ...::>bUE DFFTC/;;'. .. -.. " . . " ~ ..... 1) OFF T CE ;; ....DN.tL M.JMl':.ll'~',., ')()'_ , ~ ':)80()~:;() :-cm:: SOLID I).J(.'l~:nr CHECI::: M :I. "727 ::ONTRACTOR= 009864 Ten,.;.,L 1~ti"TiDUNT:: ~CCNT COMPNY ACCOUNT CENTER 114 B450 - 363000 - 2 :I. 6 . ~5B AMOUNT DESCRIPTION/PERMT DATA DR/CR 16.58 ****** SDLID WASTE FEE 60 :ECE I VEl) BY ~ n~ ..........~...~O...........................................h...........................................................