HomeMy WebLinkAbout03-1780
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N2
1780
(813) 780-0020
Date
1-/7-~-3
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel I. D. "
Zoning:
Descriotion of Work
-t./ld ~
elK.
Water Meter:
T.I.F.'s:
Energy Code:
'"1741,,> uno IJ~
Radon Gas:
~~O V .3 d S~v'.
I"
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
1-22-03
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
DATE
,RL..Y
City License Registration #
State Certified License#
d~36CJ
Permit Fee ~. lJ-C&-
)CSignature .. _.-c.-- ~
Company
Address
)d8lephone# ~s- ;/07- C7'S-V,f"
Valuation or
Contract Price
f?o~5 c/ec. _~GYII.
BUILDING
ELECTRICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final,/ 1- 22-v3
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compres r
Final
R-<-y
Driveway
ff /-22.-03
3 .~ 0 b &J j::;;{
REINSPECTlON 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.
UI'lHElR'8 llM1El ~~t:'/ ~~:,>;7-
---.---..--...---- ----------,---..-. --- ---- -;0;-.
,JOB SITE! ADlJRBl88 ..__;:s'_?~ /'.------~c:..~L!:~~-__~--
CITY OF ZEPHYRHILLS PERMIT APPLICATION
aUII,nuw DEI?ARTMIlJN'l' 5335 8~h S'rRIlJEl'I' ZIlJPH'iRHII,I,S, P'L 33!54o
Phon. , 811 -780 - 0,0' 0 .... 8 13 - 78 0 " 0 0 ~~'r. '""",v.n -L::! Z ~i!.;f,,_
PI,ANS REVIIlIW Jl'llIll.c_____ __
PHONE: (X)N'I'1V~'I'
- "--- -_._~ .---_. ._.~._. .~ ...- -- --.-------
LElGlIIJ lJH18t!RIP'I'IOll1 LOT(S)
--.-.----.- ------_. ..-._._---~--_.---
BLOCK
SUBlJIVIS Jotl
---.._-.._.__.~.__._------
P1\Rr.!8I, ILl It
-_.__._---~.- ..'--_...~.~~-,--
-~.----.....--------------__4._.___..._________.~______...~___________~._....__ _.__.~._'_____~..__..__
(OBTAIN FROM PROPEJR'l'Y 'rAM NOT.WEl)
HURK PROPSE!IJ I UNElN I.!ONSTRtJCTION
[l8WN
[] ADlJI'rICHl o ALTERATION [J REJPAIR [J 1 N8TAl,I,
[] MOVE rJ DEf"lor,rSII
n~1UW'I. FAHII.Y []# OF l1lU T S lJ MOBnE !Ior1El
o I.NDUS'l'RI AIJ [J SN H1MING POUL [J OTHER
PROJ,lOSEIl USE: I []sr.3L FAMILY DWE1,I,Ilm
U Cot'lMElRi! JAI,
11H]SCRIP'rWN OF NaRK
C::J RBl8'rAlJRANT & HElAI/l'H DElPARTr1EN'r APPROVAL
--~-- 60C. ~ Y'f"~~~__3L.__.;:?;~5-::::L~~~__
Bun,nIN(~ SIZE:
-_._-~.-._---.._----
SQUAREJ FOOTAGE
RESIDElNTIAIJ I
COMMElR(!IAI, :
~.- ---_.----.-----
11m 1GHT __.__ __.______._
A'I"rAC!H (2) PLOT PIJAl1S & (2) SElTS OF BUIJ,IHNG PLANS & (1) SEI'I' ElNElRrw F()R~1S,
A'I"tAC!H (]) SETS OF BUILDING PLANS & (1) SElT ENElRny FORMS.
PROPERTY SURVEY RElQUIRED FOR ALL NEW CONS'I'RUCTION.
~ERMITS REQUES~ED
[] BIJILIJINr3
L1 ElIJBlC'I'R 1. CAl.
[] PI,m1BING
0 '.1BIUHANIC!AfJ
$---.----- VALUATION OF TOTAL COHS'fJUJC'rION
-&~~._----"-. AlilP ,9ElRVICEI Jtr" Fr.oRIrJA PONElR [] W. R, FJ, (;.
[] (JAS
[] ROOFIlm
,
$.---.--------- VAf.JUATION OF lilECllANUIA1, 1N8'1'A1,l,ATTON
fJ 8 PElC1tAI/ry
[] OTHER
'I'YPE OP' CON8TRUCTION: lJ BLOCK
[J FRANE)
[] S'I'EElL
[] OTHER
FIN rSHElIl FI,()OR FJfJEVATIONS
-----------
18 PRO,TElC'I' IN FLOOD ZCJNEI AREA 0 YElS
L1 Nu
BUIJJDmR
--...----.L-_---'-.;.-------______________L___
CXH1PANY___._____.._._____________ ___._..______ ._________ ___'_.__'_
STATE! CElR'l' OR REGIS'I' # ______._____._____.___.____,_______
C I'I'Y PROCESSING IL_.______ __________. ________._____._
81(JNATURE
****************************************************************'*
mr'.lIld. TRltlIl\.~ /7./ cor"PANyA6",_, ~~c,_-=;'c':-:'_ _,__
/~ STATE CER1' OR REcHS'I' 11~d.c.!.<?:".2'.~..1______._._
81<lllA'l'U'E n_~ -'----'---,,,,____,__ cr',y PROCESSIN<' #-~qz,O,,___ _ _'____,__,_
"*"""*""*'****"'***'*"****"'*"*'*"*'**'*******"*'****'
PI,UMBBJR
-....---.---...---------.-.--------
.---.---
COM P ANY ---..-_____________________________..____._____________.__
STATE CER1' OR REGIST # _________________._.___..
CITY PROCElSSING #
8IlJNA'l't1REl
MIlIC!HANltlAl,
***********"******'*'******'***'**'*****************************'
-'---'"._-_._-----,,--_..._-_.._-~_.-.-
~----------_.._~------_....._--_.,---
(!OI\1PANY_____________.__. ..__....
8TATBl ('I11RT OR REG! ST # ____ _.______ _______.___._. _nn_.
CITY PROCElSSING #
.- ,.....-..-,..., -.-- '-~--","...
8 TCHlA1'tJREl
**************************************~*"****************"'**'*
- -----.._-'----.._-~---.._.__._...- -------.--.
OTUER
-_._-~------------_._------
S IC31IA'l'IIRE
--.....----
C()~lIPANY
S'I'A1'E C'ElRT OR RE(HST #-----.-------.------..----.~.--
CI'I'Y PROCESSING # ------_.__._________________
************************************'*******'*********'****'*****
--..--.----- .--.--.-.-------.--.--.-.. ,. -...~.~._--_._-~-..-
CONDITIONS OE' PER1"~IT AE'FIDA"VIT
~ A. .NOTICE OF DEED RESTRICTIONS
The undersigned understands tha..t Lh:l;, pj;:lrmit may b." o;uJl)ec.:t to "deed restdctions" which
may be more n=stl'iotive than City re9ulations. 'I'b,,, \l11d':l'.::d9ned assumes responsibility for
compliance with any applicable deE:d r,,,strictiullo;.
B. UNLICENSED CON'l'RAC'l'ORS AND CON'l'RACTOR RESPONEIIBILI'l'IEJS
I f the o\-./ner has hired a contracto!.' (J,( contractoroS to u::ldertake work, they nlay l,e requi red
to b~ li cenBed 1n accordance w1t:h state and 10c,,1 regula,tlona. If the (~ontractor is not
licensed as required by law, both the o~lfler and contraotor may be oited for a misdemeanor
violation under state law. If the owner or intended contrdctor are uncertain as to Hhat
licensi.ng requirements may apply for the intended work, they are advised to contaot the
city of Zephyrhills Building Department, 813-788-'6611.
Furthermol.'e, if the owner has hirt:!d a contractor or contractors, he is advised to have the
contractor-(s) sign portions of the "Contractor Sections" of this application for which they
Hill be responsible. If you, as the owner signs as the contractor, YQ4 are indicati.ng that
you, rather than the contractor, are responsible for the work. I f the contractor \"iishes
you to s1gn as contractor that m.y be an indication that he 1s not properly licensed alld is
not entitled to permitting privileges in the City of Zephyrhi,lls.
C. 'l'RANSl'OR'l'ATION 1MPAC'l' FEES AND U'l'HITY CONNECTION FEES
D. CONS'l'RIICTUION LIEN LAW (CliAP'l'ER '713, FLORIDA STA'1'UTES, AS AMENDED)
1 cell~tify that I, the applicant, h'.:lve 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
llave obtained a copy of the above described document and promise in good faith to deliver
1. t to the "owner" pri.or to cOlnmencement.
E:. CON'l'RAC'l'OR' a/OWNER'S AFFIDAVI'l'
I certify that all the information in this application is accurate and that all Hork will
be done in compliance with all appl1cable laws regulat1ng construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certi fy that no \JOrk or installation has cOllunenced prior to issuance of a penni t and that
all work will be performed to meet standards of all laws regulat1ng construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. 1 c:llso
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 IllUflt take to
be in compliance. Such agencies include but are not limited to: *Department of
Environnlental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensj.tive
Lauds, Water/WasteHater 'l'reatment
*Southwest Florida Water Management District-Wells, Cypress Baytleads, Wetland Areas,
Altering Watercourses
*Anny Corps of Engineers-Seawalls, Docks, Navigable WaterHays
*IJepat:tment of Health Ii Rehabilitative Services, Envit:onmenta.l Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*lJ. S. Envil.'omnental Protection Agency-Asbestos abatement
1 also certify that, if fill material is to be used in Flood Zone qA" or "A,etc.", it is
undel::stood that a drai.nage plan addressing a "compensating volume" 'will be subrnitted vlhi.ah
it; prepared by a professional engineer registered in the State of Iflorida pdor to permit
issuance.
A permit issued shall be construed to be a license to proceed with the work and not as
autllority to violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a perm1t prevent the Building Official from thereafter requiring a
cor,rection of errors in plans, construction, or vio~ations of any oode. Every permit
issued shall become invalid unless the work authorized by such permit is cOllunenced Hithin
slx months of issuance, or if work authorized by the permit is suspellded or' aballuol1ed for a
period of sLx months after the time the work is commenced. One 90 day extension of time
may be alloHed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Buildi.ng Official. An approved inspection must be logged during each. six
lI~nth period, or the project will be considered abandoned.
WARNING '1'0 OWNER: YOUR FAIWRE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL'l' IN YOUR
PAYING 'l'WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OB'l'AIN t'INANqINq,~\lN~UL'I'
WITH YOUR LENDER OR AN A'l'TORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'l'. ,JOBS UNfJER
q2,500 IN VALUlil DO NO'!' NEED '1'0 RECORD AND POS'l' A "NO'l'ICE OF COMMENCEMEN'IlII.
SIGNA'l'URE: OWNER OR AGENT
SIGNA'1'URE: CONTRACTOR
acknowledged
, 19_
STA'l'E OF nORIDA
COUNTY OF
The foregoing instrument w~s aaknowledged
Before me this ----------5iay of----, 19 _~,_
by
(name of person acknowledged)
[1ho is personally knovm to me, or
S'fA'l'El OF FLORIDA
COUNTY OF
The foregoing instrument was
Before llIe this______. day of
by
(name of person acknowl~dged)
Owho is personally known to me, or
of identification)
take an oath.
o Hha l-ias produced_.___
(type of identification)
and Hllo Ddid DUd not t.ake all oath
o who has produced
(type
and who[] did [] did not
Signatur.e of person taking acknowledgement
Signature of person taking ackuowledgmellt
ilc.-;;;--typ'~~-C-P r T;~~d 0--;"- s t ampeci------'--
Name typed, printed or stampt:ld