HomeMy WebLinkAbout02-1483
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BUILDING
CITY OF ZEPHYRHILLS
(813) 780-0020
If~' ~
PLUMBING
...pertv Owne" .Jj~
Job Address: 31 S-'-I:2 . L1~ .
Parcell.D. # '3'-1 - .;2)'- 2J . fll'OI&'- Cl2.)ioo
Zoning: En~rSlV Code:
DescriDtion of Work trI. ft. ~~
BUILDING PERMIT
Permit N!
1483
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ELECTRICAL
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3S'
MECHANICAL
Date.
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Sewer Conn ~.::l 7. .
Water Conn: 35'0' 020
Water Meter: IrO' C20
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Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
Complete Plans. Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
ycr
Inspector
Permit Fee .~~
~,gnature a.....J'_ __p:_
Company
Address
Telephone# 97 J ..)'-S' U
Valuation or
Contract Price
City License Registration #
State Certified License#
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PLUMBING MECHANICAL
BUILDING
ELECTRICAL
Ftr. Tp. Servo SlB Breakers
Pre SlB Rough In Tub Set Ducts Insl.
Lintel Meter Can Water Compressor
FRM. Const. Pole Sewer Final
Insul. Cl Pool Final
WL Pre-Meter
Final
Driveway rP 11_ ~. -0 ~ I : 'f [) D, '4(r>.- 4t-
REINSPECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
~Ghar~i~~f;ei~i~;~:~:~~:~~'~~;~;~=~;~~ade for each trip for each fm; n ~ ~
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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OI'lNER'S HANE Cr-/I-/f...vJ j-{c.d'-r?..Jt.....:;
JOB SITE ADDHESS __ '-:_....'1 ---t!!-.:> ~ 15 t.t..::L~d.~___
LEGAL DESCR lPTION: LOT (S) I ()AJ BI.OCK
L:l'l'Y OF ZEPHYRHILLS PERMrr APPI~ICATION
BU1LDING DBJ?ARTMENT 5335 ~th S'l'REE'I' ZlllI?HYRHnI,S, FL 33540
fhon.la13-780-~020 F&xI813-7aO-0021 C) yt
DA'n RBCIlIVlllD ~ed~::..:' 2-
I?I,Al'lS RlllVnW Ji'Blll___~~
PHONE COl~'I'Ar.T
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SUBDIVISION
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PAltCEL 10 #
WORK PROtlSED: lJ I~EW CONS'fRUCTION
(OBTAIN F'ROM PROJilERTY TAX NOTtCE)
D ADDITION
D ALTERA T I ON
D REJilAIR
D INS'rM~I,
OSHm
o MOVE
o DEMOLISH
PROJ:lDSED UtlE: OSG1, FAMILY DWELI,nm
DMUl/l'I -- FAMILY
0# OF lnU'l'S
OSWIMMING POOL
~I'E HOME
OOTHEi\
[J COMMERC IA1,
D INDUS'l'RIAL
o RESTAURAl~T & HEAL.TlI DEPARTMENT APPROVAL
1i/JJ1Xh Ik-e- 4 ~
SQUARE FOOTAGE
DESCRIPTION OF WORK
BUILDING SIZE
HElWHT
RESIDENTIAl, :
COI'<1/v1ERCIAL:
ATTACH (2) I?LOT PLANS & (2) SETS OF BUILDING Pi,ANS & '1.) SElT EiNIilRqV FORMS,
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS,
PROPERTY SURVEY REQUIRED FOR ALL NIilW CONSTRUCTION.
~E~ITS REQUESTED
o BUILDING
$
VALUATION OF TO'1'AL CONS'fRUC'fION
II A:LEC'I'RICAI,
AMI? ~ERVICE
o FL,QRIDA POWER
o W.R,E.Il.
o ~LlJj\1BING
o /o1ECHAN I CAL
$
VALUATION OF MECHAl'lCIAI, INSTALLA'l'ION
o GAS
D ROQF'IlKJ
o Sl?li;CrhLTY
o OTHER
'l':iPE OF COl~8'l'RUCTroN: lJ BLOCK
o FRAME
D S'l'ElEL
D OTHER
FINISHED FLqOR EI,EVATIONS
IS PRO,1E:CT IN FLOOD ZONE AREAD YES
D NO
BUILDliJR
CQtIJ PAN '{
STA'I'E CER'f OR REGIST #__
CITY PROCESSING # ~~/
~
SIGNATURE U 0-- ~
****.,*'**,.,*',*..,***,**.*.*,*.,*,*.,..",..,*",..,.,.,.,......
illI.BlOTRICIAN .
SlC:lNATURE _L...-A~ '
CO/IJPAHY /I c. "-
STATE CERT OR REGTST
CITY PROCESSING #
ilLUWI:llllR.
......................,........,.................:~J.lJ7..........
COMPANY J?~~
~~ STATE CERT OR ftEGIST #
~ ~< ~~ ' CIT'{ PROCESSING # '1&'''
#
t.;:)
.--.-------------.------
SIGNATURE
SIGNATURE
"'*"'*'**'*'*************"*'*****"*********'***'*',*,,**,**..,
COlvfl?ANY ./I- G '-
STATE CER'f OR REGIS'!,
CITY PROCESSING H
MlilCHANICAL
. U-A~~b
#
'IS
*'******'*'***********'**'****'*******~*'***********"*".."",*
OTH~R
S HmATURE
COf;1I?ANY
STATE CERT OR REGIST #
CITY PROCESSING #
"'*'*'*'*"'*""""'**"""**'**"**'*'*"'*"'*",****,-.",
---~
CONDITIONS OF PSP~IT. AFFIDAV~T.
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. 1'h,= undersiqned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSI3IIJITIES
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 v.fOrk, 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. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 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 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: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department 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 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 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
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 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 TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this _ day of I 19_
by
(name of person acknowledged)
Dwho is personally known to me, or
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _day of
by
acknowledged
, 19
(name of person acknowledged)
[1ho is personally known to me, or
Dwho has produced
(type
and whoD did Ddid not
of identification)
take an oath.
Dwho has produced
(type of identification)
and who Ddid ~id not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
2-22-1995 6; 0,jH-1
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PASCO COUNTY, FLORIDA
"'.
Date Permitted
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Permit Nu,
Builder Name/Owner Name
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County Parcel No.
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Classificationffype of Use t1't~ b II.,.:.~
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Rate $
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Zone No.
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Sq. Ft/Unit
Prepared By
/
/./
/
.-
,-'
"
Impact 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 - 54.00Near
or $0. 148/Day
ERU Assign No.
Assessment - (No. Units) x ($0.148)
x (No. Days)
Assessment -
(GSF) x (ERU) x (0.148) x (No. Days)
100
TOTAL FEE $
i
i
') I
TOT AL 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.
Acknowiedgement 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
---------------------------------------------------------------------------------------------------------------------------------------------------
"lOFFICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO.
DATE
DATE
BY
BY
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White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldgllnsp
feecal:ce
PC93113094/E
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