HomeMy WebLinkAbout02-1717
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BUILDING PERMIT
. CITY OF ZEPHYRHILLS Permit N2
1717
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(813) 780-0020
Date
lQ-IR- D;2J
ELECTRICAL ~//- M~conn
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?:qA,S -. /, ~~'. T.I.F.'s:
(7)~}i/;J,<
Property Owner:
Job Address:
Parcel 1.0. ,
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
~-2f-O 3
DATE
NO OCCUPANCY BEFORE C.O.
DATE
Inspector
J"()
City license Registration #
State Certified license#
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BUILDING ELECTRICAL
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Permit Fee
~~~~e
Company
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Valuation or ~ ~ --::;) <;:? J' a.2-..
Contract Price ( ~ I
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Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
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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Main
Other Area
Under Roof
Valuation:
SQ.Fr_
PRICE
Building:
Electric:
Plumbing:
Mechanical:
Radon:
105. s ~
2. - ..;)-~
-/ '/ .-
tJJ/+
JJ)ft
,J/fr
School Impact ~ J
Fees: /1+
Connection I'~ J__
Fees: fJ IY1-
Trans. Impact ^' /
Fees: ~ V 1ft
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CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DBlI?ARTMBlNT 5335 8 th S'rRBlBl'r ZBlI?H'lRHILt,S, rL 3 3 ~.O
PhoneI813-780-Q020 Fa~le13-780-0021
IJA'n RJJCJllIVSlD Jll::13,~::~L2
I?J,ANS lUllVIJlJW 1'11II-,-,~;.._,_.tL_______
ol'lNBJR / S IlM1E _flf?:Lk~YLlJ{~iLJ:I_I{~.Lf-;a_~~~'-____________ PHONE CON'l'J\f!'L_______~____=:~ _______
,JOB BITBI ADDRBlSS ---1~_?~n__~~J___~/~~ <_________________ _________________________ _______
IJBlllAL !)BlSCRIP'rIONI LOT(S}
BI,OCK
SUBDIVISION
----~.__._.~--.....--.-._._..__.."_*v__
PAIWElIJ rn It ___3t.f - ~6 :.~_L::..tJPOO- P() 300 -=- CJD._'J- ~____~~~TJ\n~__~Ro~.!.~~=_~_RT~___:~~~_.__~~~!_(~F~~__
WORK PRnl?8BllJl UNIllI'l l'ONSTRt1C'rIOU [J ADDITION DALTERAirHm [) Rl!IPAIR [J INSTAl,!,
~-m 0 MOVIll 0 DElf101,ISlI
PROJ,108EIJ USBII Clsm, FAMILY nWELI,IHGl
f~f1MIllRl!rAr,
[Jr1UUJ'I.. FAMIl,Y
0# OF l1NI'l'S
[)smMMING POOL
fJ MOBII,El IWf1Bl
(]OTHIllR
o INDUSTRIAT,
D RalSTAutt1\NT & ItElAlmI DEPARTt.1BJN'r APPROVAL
)lElSCRIP'rION OF NORK ';;;''71" 1/ _~gj__ J~-ife~ on '5_-/ct-::e _.~_______________________'________.
8tJn,nINl~ SlZBJ
SQUAREl FOOTAGE
UEllOHT -'______________
RlllBIDillHTIAT'1
(~()P1MBlR (! I A I, I
AT'rACH (2) pr,oT PIJAIlS & (2) SElTS OF BUU,IHNG PLANS & (1) 81l1T IllNElROY FORMS,
A'ttAC!H (.J) sEnl OF BUtLDING PI,ANS & (1) SEl'r ElNBJRClY FORMS,
PROPElRTY SURVEY REQUIRElU FOR ALL NEW CONS'!'RuC'rION.
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,1' BlIT LIJI NC~
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$__2...3~_____----, VALUATION OF TOTAL COlIJS'rRUC'rION
PERMITS REQUESTED
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o Fr,oRIDA POWER
[J W.R,E.n,
o J.jElCHAN WAI,
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VALUATION OF MIllCHANCIAI, HT81'Al.l,ATTON
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[J (JAS
[1 ROOFING
(J SPEorAUry
[J O'I'HER
'J'YPE OF (~(JN8'l'RtJ(!TroN I [J BIl)CK
[J FRAl-1111
[J STEElL
[J OTHER
FINI8HllIIJ P'U)OR I1lI,EVATIONEl
------
IS PRO,TEC'I' IN noon ZOHBJ ARllIAO YBlS 0 NO
IUILnBlR <;? cOr"PANY___~e~f.--C~j/l _. ~~-.._"?~i. )1_~___________
RlGHATtIR" ~;L~ _ ~--=--____ ~;~~R P~~~:8~~H~.~~.TI~=_'t~~~;-p~
***************************************************************iK; ~ ~~~p
[AN .((...~ CmlPANY___~tlI2t~-b..__L~_/s.r..~___.____~~'
~ ~ ~"", S'rA'rEl C'BJRT OR. REGrST #--~~L____________
::':::~::'H _/ --=---~_f"~~~~ "I'fY PROCR..",,, #-----L72s.______~______
***"'****'**'*"'*'*****'***"****'*'******'****'*'*'**********'*
PJ,UMSlIR
._----~......._...-..----....._._._.
(~(JM PANY --.----________________.___~______.____
STATE CElRT OR REGIST It ________________._.
CITY PROCESSINO #
8 WHA'I'tJR III
MHlCHANI CAlI
******"*'**'***'******'*********'*******'****'*************'***'*
_.._.__.~.._-------...__.-.__._._------
"""---------...-----.....---
ColvtPANY___
STATEl ('ElRT OR REGI8T #
CITY PROCESSING #
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SHJNATtHHll
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*************"**********'*********'**~'*****'*********'***"****
OTHER
..---.... _._i.._---.:..-_--...._...
(~OMPANY
STATE CElRT OR RElGIST #
CITY PR(~ES8ING #
.--..-----.---.---- .__. --...~--
8WNATlJRE
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----_._--,--.---~-...--._---_.- ~
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CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The underaigned underatands th~t this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
conlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRAC'l'ORS AND CONTRACTOR RESPONSIBILI'I'IES
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 Ilot
licensed as required by law, both the owner and contraotor may be oited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to wlaat
licensing requirements may apply for the intended work, they are advised to oantapt the
City of Zephyrhills Building Department, 613-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to hav&:! the
contractor(s) sign portions of the "Contractor Seotions" of this application for which they
will be responsible. If you, as the owner signs _s the contractor, YQ4 are indicating that
you, rather than the contractor, are responsible for the work. If the contracto!.- wishes
you to sign as contractor that m~y be an indication that he is not properly licensed and is
not entitled to permitting privil~ges in the City of Zephyrhills.
c. 'I'RANSI?OR'l'ATION IMPAC'!' l"EES AND U'l'UI'I'Y CONNECTION l"EES
D. CONs'rRlIC'I'UION LIEN LAW (CliAI?'l'ER 713, FLORIDA STATu'rES, AS AMENDED)
r certify that I, the applicant, have been provided with a copy of "~lorida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Depal-truent of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I eerify that I
laave obtained a copy of the above described document and promise in good faith to deliver
j t to the "owner" prior to cownencement.
E. CON'l'RAC'l'OR' S/OWNER' S AFFIDAVI'r
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
devl?lopment.
Application is hereby made to obtain a permit to do work and installation as indicatlild. I
ceJ:tify that no Hork or installation has commenced prior to issuance of a permit and that
all work V/ill 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 "mat take to
be in compliance. Such agencies include but are not limited tOI *Department of
Environmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally BensJ.tive
Lands, Water/Wastewater Treatment
.Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable WaterHays
*DepArtment of Health Ii Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U,S. Environmental ~rotection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ~Aff or UA,etc.", it is
understood that a drainage plan addreSSing a "compensating volume""will be submitted Hhich
is prepared by a professional engineer registered in the State of rlorida prior to permit
issuance.
A permit issued shall be construed to be a license to proceed with the work and not as
autlaority to violate, cancel, alter, or set aside any provisions of the teohnical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, con~truotioq~ or via~~tions of any oode. Every p_rmit
iss~~d ~hall beoome invalid unless the work authoria;ed by auch permit is oOllullenolad within
siKmonths of issuance, or if work authorized by the permtt is suspended or abandoijlld f~r a
period of aiK montha after the time the work is commenced. One 90 day extension of tillle
may be allowed for the permit with fee charge of $15.00. The extension shall be reques~ed
in writing to the Building Official. An approved inspeotion must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNIilRI YOUR FAILURE '1'0 RECORD A No'rrcE OF COMMENCEMENT MAY RESUW' IN YOUR
I?AYING 'l'WICE FOR IMI?ROVEMEN'1'S TO YOUR PROI?ERTY. IF ":fOll INTEND TO oa'rAIN IHNANqWq, ~'~N~,uL'I'
Wr'rH YOUR LENDER OR AN A'I'TORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'f. .JOBS UNDER
92,500 IN VALUE DO NOT NEED '1'0 RECORD AND POST A "NOTICE OF COMMENCEMENT".
~~~~-
SIGNNI'URE: CONTAACTOR
~
SIGNA'l'UREI OWNER OR AGENT
5'l'A'l'E Q~ ~LORIDA
COUNTY O~
The foregoing instrument was
Before me this ___ day of
by.
acknowledged
, 19_
STA'l'E OF FLORIDA
COUN'l'Y OF
Tht: foregoing instrument Wii\6 aoknowledged
Before me this ~ay of-- , 19--:....
by
(name of peraon acknowledgad)
C1ho is personally known to me, or
Owho has produced
(type of identification)
and Hho Ddid Q.iid not t.ake an oilth
(name of person aokno~l_dged)
Owho is personally known to me, or
o who has produced
(type
and whoO did Odid not
of identification)
take an oath.
Signatur.'e of person taking acknowledgement
Signature of person taking aoknowledgment
Name typed, prlnted
-
or stamped
Name typed, printed 0.1: stamped
Dear Customer:
This tetter is required in order for West Central Signs to apply for permits to install signs
at your location. It needs to be signed by an officer (or owner) or your company and
has to be notartzed. west Central Signs must have the original to be submitted with
permit application. Thank you.
-
Property Owner Authorization Form for Sign permit Applications
I,
Trent Wilhelm
. property owner or agent of
property addressed at 3U-~~~t/1I" ~#Je/h~ /E $.3b'"#
/
do hereby give permission to West Central Signs or its agent to erect a sign at the
above location.
Food Lion, Inc./Kash n' Karry
Property OWner (Please Type or Print)
d~h~t/L/
, Signature of Property Owner or Agent
P.o. Box 1330
Salisbury, NC 28145
Mailing Address
Property Folio #
Date
//j#~
7Q4-'~1 W1S0 ~~ 1450
Telephone Number _
This instrument was acknowledged before me this /~y
"" ~ z.,....
Notary Public (Signatu~"lIo_ Tho R
,~-.,.. mas yan
_ \:~.,_: .: My Commission 00033388
01 ",d' ExDiMA ~llna 1'1 ")"Qf
"Notary'PubliC Name Printed
PerSonally Known V
Produced Identification
Type:
-
SILCOX .ENGINEERING, INC.
. S409 Nebraska Avenue
TNAPA. FLQRI>A 33604
Phane(813)238-t755
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JOB MAS" IJ.!<Ap.,A.Y
SILCOX E,NGINEERING, INC.
.5409 Nebraska Avenue
TAMPA, FLORIDA 33604
Phone(813)2~975S
$16 ~ 4i.i,Ae.
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