HomeMy WebLinkAbout02-1428
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N~
1428
/
(813) 780-0020
Date
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Job Address:
Parcel I. D. ,
EL~AL
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M~'." Sewer Conn
Water Conn:
Zoning:
DescriPtion of Work
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
DATE
Inspector
Valuation or
Contract Price
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Permit Fee .._~ ,-
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City License Registration II ~
State Certified Licensell
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Qt-~g1
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Breakers
Ducts Insl.
Compressor
Final
BUILDING
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Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
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.
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CITY OF ZEPHYRHIIJLS PERMI'r APPI..ICA'rION
BUILnIW~ DBPAR1'MEN'r 5335 8th STREE'f ZEPIIYRHILLS, 11'1, 33540
PhoneI813-780-Q020 FaxI813-780-0021
DATE RECHIVED
PLANS REVIEW FEE
, OWHER' 9 . ,iAMB -4Cl"\ "lL~GJ-Q <?oJ,\ i-J'~-L __________. PIl~B COHT'C'J11{~IfS: - irfi~
JOB 8 I'l'E ADDRESS 3_1~~_.lrL +k _. &~_~_ ~}!-~---~-~-~u%_'__~_'~_____.____n.__
dAdLz__
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
-------,----.-------.-
PARCEL ID #
WORK PROPSED; 9(NEW CONSTRUCTION
[JSIGN
(OBTAIN F'ROM PROPERTY TAX NOTICE)
[J ADDITION
[J AL.'fERATION
[J REPAIR
[J INSTALl,
rJ MOVE
o DEMOLISH
PROPOSED USE; ~8GI,' FAMIl,Y DWELLING
DCOMMERCIAI,
o MUL'I'I - F'NULY
0# OF' UNITS
[) INDUSTRIAL
OSWII-'1MING poor,
[) MOBILE Hot-1E
[J OTHER
Cl RESTAURANT & HEALTH DEPARTMENrr APPROVAL ()
O'BCRIP'l'lOH OF WORK~z~_n~__~~'-\~'~ - J\c-kt*;:_~Q "-
BUIl,DING SIZE --.Lrf~ / Q~'-~ SQUARE FOOTAGE HEIGHT t.{ I ~'\::'I-:1L
RESIDEN'l'IAI, ;
COMI\1ERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SE:T ENERGY FORl\lS.
ATTACH (3) SETS OF BUII,DHm PLANS & (1) SET ENERGY FORMS,
PROPERTY SURVEY REQUIRED FOR A1.,1, NEllW CONSTRUCTION.
o BUILDING
'7 /A. c C-
$~--'---
PERMIr~REQUESTED
VALUATION OF TOTAL CONSTRUCTION
[J ELECTRICAL,
AMP SERVICE
[] F'I,ORIDA POWER
[) W.R.E,C.
[] Pl,{JMB IN<3
o MffiCHAIHCAL
$
---- VALUATION OF' MECHANCIAL INSTAIJI,ATION
[J GAS
Ll ROOFING
[] SPECIAIJfY
[J OTHER
'1'YlJE OF CONSTRlJC'l'10N: [J BLOCK
o FRMIJE
[] STEEL
o OTHER
FINISHED FLOOR EI,EVA'l'IONS
IS PRO,JECT IN FLOOD zonE AREA[] YEllS
01'10
BUILDER
S lGNATURE:
COMPANY
STATE CERT OR REGIBT
CITY PROCESSING #
****************************************
ELEC'!'RICIAN
SIGNATURE
COMPANY ___________ ___.____ ____ __. ____,_
STATE: CERT OR REGIST #
- Cll~ PROCESSING #
---~~~'-'-------"---""'--'
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PLUMBBR
COMPANY---____----,________
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
MECHANICAL
******************************************************************
COl\1PANY __.~_'_'____.______
STATE: CERT OR REGIST #
CITY PROCESSING #
------------.---------
S IGNJ~TtJREJ
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OTHER
cm'1PANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
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A. NO'l'ICE OF' DEED REB'I'RIC'l'IONS
'J'he undersJgned understands that thlll pennit may be subject to "deed restrictions" vlhich
may be lOore restrictive than City n~glllations. The undersigned assumes responsibility for
compLi.ance HJth any applJcable deed restrictions.
B. UNI,ICENSED CONr1'Rp.CTORS AND CONTHlICTOH RESPONSIBIT"I'l'IES
If the o~~ner has hi.r.ed a contractor or contractors to undertake work, they may bereqld red
1:0 be licensed in accordance vl1th state and local 1:egll1atJons, If the contractor 1.s not
lJoensed as requlred by law, both the ai-mer and contraotor may be cited for a misdemeanor
violation ulIder state law, If the O\-mer or intended contraotor are uncertaJn as to what
licellsing requirements may apply for the intended Iwrk, they are advised to contact the
City of ZephyrhJlls BuJlding Department, 013-788'-6611.
F'urtheunore, 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 vlhleh 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 w.lshes
YOII to 8Jgn as contractor that may be an indlcation that he is not properly licensed and is
!lot entitled to penni\:ting privileges In the Clty of Zephyrhills.
C. '1'RANSPOR'l'Ar1'TON IMPAC'l' FEES AND U'l'ILITY CONNECTION FEES
D. CONS'fRtJC'1'UION LIEN LAW (CHAP'l'ER '713, FI,ORIDA S'1'A'I'UTES, AS ANENDED)
I certify that I, the applicant, have been provlded vlith a copy of "F.'lor,i,da's Constrllctlon
lien Law - Homeowner's Protection Gulde" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applJcant ls someone other that the "owner", I ce.d.fy that I
have obta1ned a copy of the above descrlbed document: and promlse ln good faith to deliver
it to t.he "owner" prlor to commencement.
E. CON'!'HAC'l'OH' S/OWNER' S AFFIDAVIT
1 certify that: all the informaUon in this appIicatJon is accurate and that all Hork vlil.1
be done in compliance \dth all applicable laws reglllating construction, zoning, and land
development.
Application is Ilereby made to obtaJn a permlt to do work and installation as indicated. I
certify that no Hork or installation has commenced pr.ior to issuance of a perm1t: and that:
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and laud development regll1ations in the jurisd.ictlon. I also
certify tltatI understand that the regulations of other governmental agencies may apply to
the intellded vlOrk, and that it is my responsibility to ldent.ify vlhat aet.ions I must take 1:0
be in compliance. 8uch agencies lnclude but are not limited to: *Department of
Ellvironmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Sensit.ive
Lands, Water/Wastewal:er 'rreatment
*Southwest Florida Water Managemellt District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercollrses
*Army Corps of El1gil1eers-Bea\~alls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater 'l'r.eatment, Septic '.ranks
"'U. S. Envir:onmental Pt'otectioll Agency-Asbestos abatement
I also oert:ify that, if fill material 1.s to be used in Flood Zone "A" or "A, etc.", it is
understood that a drainage plan addressJng a "compensat.ing volume" w.ill be subm.itted HhJ.ch
is prepared by a professional eng.l.neer regJstered in the state of Florj,da prior to permit
issuance.
A permit jsslled shall be construed to be a license to proceed with the work and not as
authod ty to violate, caneel, alter, or set aside any provisions of the technical. codes,
nor shall .issuance of a permi.t prevent the BuJlding Official from thereafter requir1ng a
correcU,on of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by suoh permit is comlTlenced witld n
silt months of issuance, or if \~ork authorized by the permit is suspended or abandoned for a
period of six months after the tJme the work is commenced. One 90 day extension of time
may be a.110wed for tile permit with fee charge of $15.00. The extension shall be requested
ill writing \:0 the Building Official. An approved inspection must be logged during each 8JH
month pedod, or the proj ect will be considered abandoned.
WARNING 'J'O OWNER: YOUR FAII,HRE '1'0 RECORD A NOTICE OF COMMENCEMEN'1' MAY RESUL'1' IN YOIm
PAYING TWICE F.'OH IMPROVEMENTS '1'0 YOUR PROPER'1'Y, IIi' YOU IH'l'END TO OB'l'AIN FINANCING, CONSIJI.'l'
WITH YOUR l,ENDER OR AN A'f'l'ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEt1EN'l'. ,JOBS UNDER
$2,500 IN VAI.tIE DO NO'I' NEED '1'0 RECORD AND POS'lr A "NO'l'ICE OF COHMENCEME:W1'".
CCHlDI'J'IONS OF PERMI'l' AFF'IDAVIT
.._--~-_._-_._---~--_._------.._._-
SlGNAr1'lJRE: OWNER OR AGENT
SIGNATURE: CONr1'RAC'l'OH
S'l'Arl'F. OF l!'I.ORIDA
COUNTY OF ___.
The foregoing instrument was acknowledged
Before me this ___ day of ________, 19_
by__
(name of persoll acknowledged)
[J I-Iho is personally known to me, or
STA'1'E OF FLORIDA
COUN'l'Y OF _________
'l'hf'l foregolng instrument was acknowledged
Bafore me this __--slay of--------_, 19
by
(name of person acknowledged)
C1bo is personally known to me, or
[] who ha s produced
(type
and who(] dld (]dJd not
of identification)
take an oath.
o who has produced ._'______,.__
(type of irlentificationl
and who Odic! DUd not take an oath
~-~--~-------~._-_._--_._----_._-----
Signature of person taking acknowledgement
------------..-----.----
Signature of person taking ackno~lledgment I
-~._---.-~.-'-----...--~-~-----.-.-~---.---.---_______N__..
Nalne typed, printed or stamped
Name typed, pr.! n ted or s l:ampec!