HomeMy WebLinkAbout03-1769
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N!
_q>\Ow~
S-~5
BUILDING
Property Owner:
Job Address;
Parcell.D. /I
Zoning:
Descriotion of Work
1769
(813) 780-0020
Date
(- {S-03
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Co]~.
Water Meter:
T.I.F.'s:
Energy Code: Q
'f SAN ()
Radon Gas:
~V.
FINAL
C.O.
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
City license Registration # /'7 h
State Certified license#
Permit F
.><Signature
Company
Address
~lephone# 7%2- '11(p(
Valuation or _____
Contract Price
BUILDING
Ftr.
Pre SLB
lintel
FRM.
Insul. CL
WL
Driveway
h~5T ('kS'E/~{.
.
ELECTRICAL
PLUMBING
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
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.
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUIl.DING IHlJPARTMENT 5335 8th S'fREE'f ZBlPH'iRHH,I.S, FL 33540
PhoneI813-780-Q020 FaxI813-780-0021
IJA'rB1 RIllCJ!lIVBlD ___. _. _ _ __ H___
PI,iU'fS RBlVII!JW FEll
OWNER'" IlAM'.__-1!AiI!c.d"l?c;~__..._-_ .ll:J;;>.{-~ .13u-t..-yw"," mN'l'wr. __.. __ _ .. _ .
,JOB SITE ADDRBJ88 -.-5!i23.-.-..t:d~___.af~____.__ _____..___ '.'_~_.__________._.
LEl~AL DESCRIPTION: L~r(SI
BU)('K
SUBDIVISION
PARC'EI, HI If
- ----------_._..__._-----~.- -------- ---~----~---~-----_._- _. .~-~-_.._--_.._-- --.----.-...-.-. "'---~'.- ..~--_..--_..._~
(OBTAIN F'ROM PROPER'ry 'J'AJ{ NOTWEl)
WORK PROPSElJ I [JNElN CONSTRUCTION
[] AnIJITIOl'T
[JAI/I'EJRATION
[] REJPAIR
[J IN8TAU,
[]SHnl
[J MOVE
o DEJ~10I,ISII
PRO(,lUSEJIl tJSElI C1SGI, FAMIIJY DNEl.IJIllG
Clt1tJliI'I. FAlvtn,y
[]# OF UlH'l'S
lJ MOSII,El Itot11ll
[] OTHER
Ucm1MIllRC!IAI,
[] HmUS'l'RIAL
fJ SWH1MING POOL
BUIr.rHNG 91ZEJ
o R~STAIJRAN'r & ll'AI'Z~TM'N'r APPROVAL
JJtJ2-~J~~~ u~~_ --U(j2--?;~~r~~T_..--------.
SQUARE FOOTAGE _..________ HElJI1HT ...____.___.____
IlEJSCRIP'nON OF NORK
~----------_.._._-~.........
RIll8IDElNTI1\J'1
(~m1MBlRC!I1\I, I
A'I"rACH (:2) PL,OT PI"Al1S & (2) SElTS OF BUlI ,DINrl PI,ANS & (1) SElT ElHElRI1Y FORMS,
A'r'l;ACH (:3) SETS OF Butl,DING PLANS & (1) SET ENERCW FORMS,
PROPERTY SURVEY REJQUIRED FOR ALL NEW CONS'I'RUCTION.
~ERMITS RWQUESTED
t.__________._._ VAl,tJATJON OF TOTAL COHS'rRUCTION
2-:0.0.______ MtlP ~IllRVICEJ ~rnA PONER [J W.R,El,Cl.
[] PWt1BING
U 1.1B:CHl\.N WAI,
$--_.~
- VAlJUATION OF ttlECIIANCIAL, UIS'rAl,I.ATTON
[] GA8
f.J ROOFING
LJ SI?EC!tAUrY
[] O'l'HER
TYPE: OP' CON8TRtJCTlOH I [J BLOCK
[J FRAt1EJ
[] STEEl,
[] OTHEJR
F'rN ISHElII FI,OOR mIJEVl,TIONS
IS PRO,TECT IN FLOOD ZONE! AREA 0 YElS
o No
BUILomR
. -
_._-_.._-'~-_._-----~---_.------------_. ----_.-
CottlPANY__________...____________..._..___.___ _._.__.____._ ___
STATE CElRT OR REGIS'!' # ._."._______._.____.___,,__,__~_.___
CITY PROCESSING #
----.- ~ ...._--~ - '-..-...--..,-.--~-._...___..". .' 40__..___ .,__
91GNATtJREl
***** ~ ***** *** ***** * ******* * ~ ~*** *** * *** ~ * * * ******* **** ** * **** ** * *
COl'1PANY _.1-( ;;f2f_~(q.2_?_Eft~,-:~~_ _. _...
.-- -
STATE ('ERT OR RE:rnS'l' #_._~.g 0:.:.z<2~_??t?
CITY PROc.'ESSINrl #jf,
..---.-.-__._L_ID_.._. _~ _._. __ ______..~._~._._.
***********~* * ***~********~************************************
P I,UM! B1R C!O!vl P ANY -----.-----------.,....-----..------.h__.__.___n._.__ ______
STATE CERT OR REGIST # ________..____._.__.._.___..
8WNA'l'IJRE CITY PROCESSING #
-.--...-.- _._-~-_._---------._-----_. -.-.--""--
**********'***'**************************************************'
MBlC!HANICAT. COMPANY ____________..__.._________ _.._._____.___.
STATE C'ERT OR REG t ST #-~-_.___.h____n____________n_.
SIGNATURE CITY PROCESSING #
----~------__..__._4____._~...._~.____._ __~___.._____..__._____ '_.___.__~_~
*****************'********************~*****************A********
OTHER
--------_.,---...._--_._~--._--~.-
CO/:lPANY
STATE CBlRT OR RElGrST #
CITY PROCESSING #
.~_.---_.._--..;~-----------------------
8 WNA'l'UREJ
****************************************x*******************'****
.--..------. -- ..... _.._--------.._~._._-- - -.-._--_.... ....--
A. NOTICE O~ DEED RESTRICTIONS
The undersigned understands thijt t::U/l perm! t may be subj ect to "deed restrictions" \--Ihi.ch
may be more u:lsLJ:iative than City r-euulations. The undersigned assumes responsibility for
eomplianae \Yi th any appli cable de'"d J:t:/ltrictionl:i.
B. UNIJICENSED 'CON'I'RAC'I'ORS AND CON'I'HACTOR RESPONSIBIJ.I'l'IES
If the: Ol--lner has hired a contractor or contractors to undertake work, they may be required
to be lictlnsed in accordance wlth :>tat.e and 10ea1 regulatlons. If the contractor is !lot
licensed as required by law, both the owner and contractor may be cited for a misdemeallor
vio1ation under state: laH. If the OWner" or inttlnded contractor are uncertain as to vlhat
li censing requirements Inay apply for the intended work, they are advised to contact the
City of Zephyrhill s Building Dl::partment, 813-768-6611.
Flu:therll1ore, 1 t the Ovmer has hin:d a contractor or contractors, he is advised to have the
contracLor(s) sign portions of the "Contractor Sections" of this application for which they
vd!l be rtlsponslble. If you, as the owner signs as the contractor, YQll are indiaati.ng that
you, latlier than the contractor, at-e responsible for the work. If the contractor: wishes
you to siyn CIS contractor that mi:lY be an indication that he i.s not pt'opet'ly licensed and is
Hot elltitled to permitting pr-ivileges i.n the City of Zephyrhi.lls.
C. 'l'RANSl'Ok'!'A'flON IMPAC'l' fEES AND U'l'UI'l'Y CONNECTION FEES
D. CONS'l'RllC'rUlON LIEN LMJ (CIiAP'l'ER '713, FLORIDA STATUTES, AS AMENDED)
1 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 appli.cant is someone other that the "owner", I cerity that I
have obtained a copy of the above described document and promise in good faith to deliveJ:
it to the "owner" prior to COlJunencement.
E. CONTRAC'I'OR' S/OWNER' S AFFIDAVIt!,
I certify that all the information in this application is accurate and t}lat all work will
be done in compliance with all applicable laws ragu} ating constr-uetion, zoning, and land
devf!llopment.
Application is hereby made to obtaln a permit to do \York and installation as indicated. 1
certify that no Hork or installation has conunenced pri.or to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construotion, City
codes, zoning regulations, and land development regulations in the jurisdictJon. I also
certify that I undel'stand 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. Sl~ch agencies include but are not limited to; *Department of
Envirormlental Regula ti on-Cypress Bayheads, Wetland Areas and Environmentally Sens} ti ve
Lands, Water/Wastewater Treatment
*Southwel:Ot jj'lodda Water Management District-Wells, Cypress Bayheads, Wet.1 and Areas,
Altering Watercourses
*Arrny Corps of Engineers-Seawalls, Docks, Navigable Waterways
*lJepartment of Health & Rehabilitative Services, Environmental Health Unit-WeLls,
Wastewater Treatment, Septic Tanks
*11.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
undeJ::stood that a drainage plan addressing a "compensating volume" 'will be submitted Ylhich
is prepared by a professional enginel::r registered in tlle State of florida prior to penuit
issuance.
A permit issued shall be construed to be a license to proceed with the \York and not as
authority to violate, cancel, alter, or set aside any provisions of the technical codea,
nOt shall issuance of a permit prevent the Building Official from thereafter requiring a
cor~eotion of errors in plana, oonstruction, or vio~ations of any oode. Every p~'mit
i s/iued shall become invalid unlfi!ss the work authorized by such permi t is cOllunenced within
six months of issuance, or if work authorized by the permit is suspended or abandoqed f~r a
period of six months after the time the work is conunenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be reques~ed
JII writing to the Bui1ding Official. An approved inspection must be logged during each aix
lIlonth period, or the project will be considered abandoned.
WARNING '1'0 OWNERI YOUR ~AILlJRE TO RECORD A No'rrCE OF COMMENCEMENT MAY RESUL'!' IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER'ry. If YOU INTEND TO OBTAIN FINANqH~q, _(::{~N~UL'r
W!'l'H YOUR LENDER OR AN A'l"rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'!'. JOBs UNDER
$2,500 IN VALUE no NO'l' NEED TO RECORD AND POS'!' A "NO'l'ICE OF COMMENCEMEN'r",
COlHJI'rIONS OF PERMI'f AFb'IDAVIT
SIGNA'l'URE; CONTRAC'l'OR
S IGNA'l'lJRE I OWNER OR AGENT
S'l'ATE Of' fLORIDA
COUN'l'Y OF
The foregoing instrument was
Before me this __ day of
by'
acknowledged
, 15L-
STA'1'E OF FLORIDA
COUNTY OF _____
'rhe foregoing instrument W~6 aoknoVlledged
Before me this _~ay of---, 19 _~_
by
(name of person acknowledged)
[1ho is personally known to me, or
o who has produced _____
(type of identification)
and Hho Ddid D.Hd not take an oath
(name of person acknowl~dged)
Owho is personally kno\Yn to me, or
o \Yho has produoed
(type
and whoL] did (]did not
of identification)
take an oath.
Signature of person taking acknowledgement
Signature of person taking acknowledgment
-~~----_.._~
~1-~-I~;;-ty'p;ZC pdnt-;"d or s l:amped
Name typed, printed or" stamped