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BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N~
,. _ (813) 780-0020
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Parcel 1.0, " S/f- ca.s- ~/- 0 ()/o- D t2 &>oD '- D /~.1;,-
Zoning: C ~code:.f.. ~ Radon G~. .
OescriDtion of Work ~- _ _17 ~:zf.- ~)
1412
Date
~-R.:2.-0tL
Sewer Conn I.:Z 7~ -
Water Conn: ..3 of) -r-$t..) .,"~
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Water Meter: /:~ r 1'707' ,,?l.
T,I.F.'s: ~ ~~_
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NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
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q DA!t,
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Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
City license Registration #
State Certified license#
~I
Inspector
P~'m;t Fee t;;:~ eE-
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Company
Address
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Telephone# 7 ~
DATE
L r; /.(06
Valuation or
Contract Price
ELECTRICAL If7
MECHANICAL 9's
SLB Breakers
Tub Set Ducts Insl.
Water Compresjor
Sewer Final t/ q "'/1- () 2-
Final/9 -/1-tJ:l.. Rt~ I-f:SO
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
FinalL/ 1- I ( -C 1... t..L'1
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
RLy
Driveway
fP c; - /f-ClL
F-lltJ96't?7 rr-
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.
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.
CITY OF
ZEPHYRHILLS
"NOTICE"
OF ADDITION OR CORRECTION
BUILDING
DEPARTMENT
7/5.5
I ADDRESS DATE PERMIT ." I
. 3 701ft{- st01.VY1A ~ 9-/1-~2-!'-I1 C. .
THIS JOB HAS NOT BEEN COMPLETED The following additiqns or corrections sholl be mode before the job
. will be accepted.
,
DO NOT REMOVE
OfFICE HOURS 8 - 5 MON.-FRI.
, AFTER CORRECTIONS ARE MADE CAlL
788-6611 FOR RE-INSPECTION
(fUD
It is unlawful tar any Carpenter, Cantractar, Builder, or ather persons. 10
caver or caUM to be covered, any part of Ihe work with flooring, lath, earth
or other malerlal, until the proper Inspector has had ample time 10 approve
!he Installation.
INSPECTOR
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S~~TR~~ PERMJTTING
F:'i::l~;;CC) CCll.Ji'-!T"!'" FLUF:IDi:',
D6TE~ 09/~~/02 T!M~~ OQ"15
Pl~r=jE:: 1 UF 1
I ::;;GUE OFF I CE:: ))
RECEIPT NUMBR: 00580056
OFFICE: DADE CITY
CONTRACTOR #: 009864
NAME: BUTTERFIELD
ADDR: 37644 LORENA AV
c./f)'I':: 131:~lqi'.lD H'CII:;:IZClN~;; ZHIL.L.H
FUF;:::
CHEC:I::: # :I. '727
f)OL.l D lM~~:;TE
CONTRACTOR: 0()9864
TOT ("II... i~IMOUNT =
ACCNT COMPNY ACCOUNT CENTER
:1.:1.4 B450 - 363000 - 2
:1.6. ~:iB
AMOUNT DEf)CRIPTlON/PERMT DATA DR/CR
:1.6.58 ****** GOLID WAGTE FEE 60
f:;:ECEI',.lED BY
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PASCO COUNTY, FLORIDA
Permit Nu, _~,
Date Permitted _
Builder Name/Owner Name
...i-t
County Parcel No,
::: ~ t'
";
. j,
I,.'
Address/Location
Subd.
Classificationffype of Use
! i'
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $
Zone No.
Sq. Ft/Unit
Prepared By
tmpact Fee Amount $
Checked By
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the
Board of Pasco County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of the permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
Gross Sq. Ft. (GSF)
Rate ERU - 54.00/Year
or $0. 148/Day
ERU Assign No,
Assessment - (No. Units) x ($0.148)
x (No. Days)
TOTAL FEE $
Assessment ....:
(GSF) x (ERU) x (0.148) x (No. Days)
100
TOTAL FEE $
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
oAcknO\tiedgemem below does not imply acceptance of concurrence. but simply receipt uf a copy of this form. placing
the huilding permit owner on notice of this assessment and the conditions of payment for same, _ ' ...
..
Date
Received By
OFFICE USE ONLY
TRANSPORTATION REC. NO,
RESOURCE RECOVERY REC. NO,
DATE
DATE
BY
BY
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal:ce
PC93113094/E
...
J OWNER'S NAME 6-j\...Ia.yoI,) II ~/'--t";' cAi
eTOB SITE ADDRESS L<.-T I 'Z-> 4. un ",,-,It- A v '-
CITY OF ZEPgYRHILLS PERMIT APPLICATION
BUILUIN(~ DBPART!tBN'f 5335 sth STREI!I'f ZBPHYRHILLS, P'L 33540
Phone I 813 ~7S0-0020 Faxl813 -780-00~~TB RBOBIVBD __p~ ~ _,
PLANS RRVIR" rB.
PHONEl CONTACT
.~~ 76 '(If-
LEGAL DESCRIPTION, LOT(S)
SUBDIVISION
r
( J tl<>A.I_'c,,,,,:,
T-A,,,,A1: .
BLOCK
PARCEL ID #
WORK PROPSED, DNEW CONS'fRUCTION
(OBTAIN P'ROM PROPERTY TAX NOTICE)
o ADDITION
o ALTERATION
o DEMOLISH
o REPAIR
rJ IN8TAJJIJ
DSIGN
o MOVE
PROPOSED USE I DSGL FAMILY DWELLING
[] COMMERCIAL,
OMtJLTI-P'AMILY
o INDUSTRIAL
0# OF UNI'rS
o SWIMMING POOL
-Ehf<)BILE nOME!
[J OTIIE!R
DESCRIPTION OF WORK
D RESTAURANT & HEAL'l'1I DEPARTMEN'r APPROVAl.
ftttf
BUILDING SIZE
SQUARE FOOTAGE
881mH'!'
RES IDENTIAl~ I
COMMERCIAI~ I
A'I'TACH (2) PLOT PLANS & (2) SETS OF BUIlIDING PLANS & (1.) BET ENERGY FORMS.
ATTACH (3) BETS OF BUIlJDINGPLANS & (1) BElT ENERGY FORMS.
PROPERTY SUttVEY REQUIRED FOR ALl, NEW CONSTRUCTION.
~BRMITS RIOUISTID
<fJ.--BtlIIlDIUG
$
VALUATION OF TO'fAL COHS'I'RUCTION
gJHlfilC1'RICAL
~"M;IWJ
~A'l'lICAL
AMP SERVICE
D Fl.oRIDA POWER
[J W.R.E.C.
$
VAfJUATION OF MECHANCIAfJ INSTAl,I.ATION
[] GAS
[J ROOF IWJ
o SPECIALTY
o OTHER
'I'YPlll OF CONS'I'RUC'flON I [J BLOCK
o FRAME
o S'l'EEl~
o O'rHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YBlS [] NO
BUILDBR
BlGNA'tURE .w~~
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COMPANY
STATE CERT OR REGIST #
CITY PROCESSING # JL()
It)
ILICTRIOIAH
B IGNA'l'lJREl
bJ~--
COMPANY ~ C-. <-
.
BTATE CER'f OR REGIST #
CITY PROCESSING # /1 '1
PLUMB.a
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COMPANY 4'~P
~ } STA'I'E CERT OR REGIST #
A..AJ'~ .LJJ" ~ CITY PROCESSING #
SIGNA TURE
SIGNATURE
**********************************************************~*******
COMPANY A c... ~
STATE CERT OR REGIST #
W~-<o/~ CI'1'Y PROCESSING #_ ?/~
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MBCHANICAL
OTHIIIR
COMPANY
STATE CERT OR REGIeT #
CI'I'Y PROCESSING #
SIGNATURE
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CONDITIONS OF PERMI1' AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tile undersigned understands that this pennit may be subject to "deed restrictionsH which
lIia~ be" more restrictive than City regulat.ions. 'rile undersigned assumes responsibility for
oomplianoe with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CON'I'RAC'I'OFt RESPONSIBILI'l'US
If the owner has hired a contractor or contractors to undertake work, they nlay be rlillqui.red
I to be licensed in accordanoe with state and local regulations. If the contractor is not
lioensed as required by law, both the owner and contractor may be oited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
lioensing requirements may apply for the intended work, they are advised to contact the
Clty of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advi.sed to have the
oontraotor(s) sign portions of the "Contractor SectionsH of this applioation for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contraotor, are responsible for the work. If the contraotor wishes
you to sign as contractor that may be an indication that he is not properly licellsed and is
not entitled to permitting privileges in the Clty of Zephyrhills.
C. 'l'RANSPOR'l'A'rION IMPAC'!' FEES AND U'l'ILITY CONNEC'l'ION FEES
D. CONBTRUC'rUION MEN LAW (CHAP'l'ER 713, FLORIDA S'1'ATUTES, AS AMENDED)
1 certify that I, the applicant, have been provided with a copy of "Florida's Construction
1i~m Law -- Homeowner's Protection Guide" prepared by the E'lorida Department of Agricultnre
and Consumer Affairs. If the applicant is someone other that the "owner", I oed,fy that I
have obtained a copy of the above desoribed aocument and promise in good faith to deliver
it to the "owner" prior to conunencement.
Ii:. CON'I'AAC'l'OR' a/OWNER'S AFFIDAVI'l'
1 certify that all the information in this application is accurate and that all work will
be done in compliance with all applioable laws regulating oonstruotion, zoning, and land
development.
AppHcation is hereby m~de to obtain a permit to do work ,and installation as indioated. I
certify that no work or installation has oonunenced prior to isst~ance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and lalld development regulations in the juriSdiction. I also
certify tllatI understand that the regulations of other governmental agenoies may apply to
the Jntended work, and that it is my rfj'lsponsibility to identify what actions I lIIust take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypres's Bayheads, Wetland Areas and Environmentally Sensitlve
Lands, Water/Wastewater 'l'reatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Wateroourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*lJepartment: of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Tre.tment, Septic Tanks
*U. S. EnvJronmental I?rottwtion Agency-Asbestos abatement
I also certify that, if fill material Js to be used in Flood Zone "A" or "A,eta.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared I>y a professional engineer regJstered in the state of Florida prior to permit
issuance.
A permit issued shall be construed to be a license to proceed with ~he work and not as
authority to violate, oancel, alter, or set aside any provisions of the technical oodes,
nor shall issuance of a permit prevent the Building Offioial from thereafter reqUiring a
correotion of erl:ors in plans, construationJ orvlo~ations of any oode. Every permit
iuued shall beoome invalid unless the wOJ;kauthodzed by suoh permit is oommenced within
six month, of issuanoe, or if work authorized by the permit is suspended or abandoned for a
period of /!Iix months after the time the work is conunenced,. One 90 day extension of tillle
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 inspeotion must be logged during each six
month period, or the project will be cOllsidered abandoned.
WARNING '1'0 OWNERI YOUR FAII.URE TO RECORD A NO'I'ICE OF COMMENCEMENT MAY RESULT HI YOUR
PAYING TWICE B'OR IMPROVEMENTS TO YOUR PROPER'l'Y. IF YOU IN'l'END '1'0 OB'l'AtN FINANCING, CONSUL'!'
WI'l'ff YOUR I,ENDER OR AN A'r'l'ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'l'. .JOBS UNDER
$2,500 IN VALUE no NO'l' NEED '1'0 RECORD AND POS'l' A "No'l'ICE OF COMMENCEMENT".
SIGNATURE I OWNER OR AGENT
S I GNA'1'URE I CONTRAC'l'OR
S'l'A'l'E Olr Ii'I.ORIDA
COUN'l"l OF
'J'he foregoing instrument was
Before lIIe this ___ day of
by
acknowledged
, 1~_
STA'l'E OF FLORIDA
COUN'rY OF
The foregoing instrument was
Before me this _J.iay of--
by
acknowledged
, 19_:.-
(name of person aoknowledged)
o who is personally known to me, or
o who has produced
(type of identification)
and who[] did Ddid not take an oath.
(name of person aoknowledged)
C1ho is personally known to me, or
Dwho has produced
(type of identifioation)
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