HomeMy WebLinkAbout03-1787
BUILDING PERMIT 0
CITY OF ZEPHYRHILLS Permit N_
(813) 780-0020
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Je~t1..A-, fJ1.
< 5"'0 &'5 1~ ST.
D~
Property Owner:
Job Address:
Parcell.D. ,
Zoning:
DescriDtion of Work
1787
Date
/~:23/03
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Radon Gas:
Energy Code:
Re-~~
Inspector
Permit Fee ",:/ S~
~ignature ~ At7
Company
Address
)lelephon~# '$1/~ 'ID~ c.f' ~ >-
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Valuation or
Contract Price
DATE
DATE
City license Registration #
State Certified license#
k'.')',/ 5-t~S
BUILDING
ELECTRICAL
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Driveway
AL
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.
,
UHNEJR I S NA~11ll__ 0i;t~~!L~..._ /YI :_._-P_~~J/e~c..1f.j ~ _.____________ PHONEl CON'l'AC'~_1'!.E.:"I_t~~___...:.
,TOB 8I'I'El ADDRESS -_5j)ff5_._._._q~ Sr..---______~p),'f~Jft~___.f~ ____~3..StI- '?______. _I.
C'{71, . F 2.CI'h
I;El<lAL f)BJ8CRIPTIONI LOT(S) __'i"~~____ BUX'K __?:-Cfo___ SUBfJIVI8JON E!8..i.--"'_E'L._.________
CITY OF ZEPHYRHILLS PERMIT APPLICATION
:SUIl,DING DBlPARTMENT 5335 8th S'fRBlBl'f ZBlPHYRHII,LS, J'L BB40
PhoneI813-780-~020 Faxle13-780~0021 . .
rJJ\.TBl RBC:mrVilD t - "2 J--:Q"'"
~...._.;.;;,;.... - ~-~
PJ,ANS RlIIVlmw Jl'SBI.'-'",._.'t!____ _ _
PAROElI, In # -'~Z'...2L~@{t?_:..j..e,,,~~o~o
WURK PRtJPSBlfJ/ [JNBlN l'ONs'rROCTION [] lWlJI'rIcn.T
(OBTAIN FROM PROPElRTY TAX NOTICE)
._-._-_._~._..._--_.___._...w __..__4_.______.~_
r.J Al/rElRATION
.e9 RBlPAIR
LJ INSTAY,l,
[]SH1N
[J MOVE:
o DE!lf.10LISH
PROPUSBJlJ USE I )YJSGlTJ F1\MII,Y DWEJI,r,IN(-~
fJ (~ot1MBlRl! TAl,
[]~1tJl,'I'I' FAMU,Y
[1# OF lJIUTS
o SWIMMING POOL
IJ MOB r I,E) lIor1Bl
o INDUS'l'RIArJ
[J DTHl!1R
D R~8TAtJRANT & HEALTH DBlPAJ:t'I'~~ENT APPROVAL,
.
IJBl8CRIPTION OF WORK ~_~~___ .... 1J.tzH.L~ ~t:?_~ #'?~_~_________"__.
BUIl.f1IN(J ElIZBl
----------.-.--.---
SQUARE FOO'rAGE -.! ~60
HBll<lfn __________
REBIDBlNTlJUJ I
(~OMMBlRCIAIJ :
A'rT1\(~H (2) PI,OT PI;AI18 & (2) 8ElTS OF BUII,lJING PI,ANS & (1) SElT B1NIJIRGY FORMS.
A'r'1iA<~H (J) SE'l'S OF BUIIJIJING PLANS & (1) SElT ENElR<N FORMS,
PROPBlRTY SURVEY RElQUIRElV FOR ALL NEW CONSTRUCTION.
~ERMITS REQUESTED
[J BtlILIJING
$~.d,~-
VAl,tJATTON OF TOTAL, CONS'rRlJCTION
L1 ElLBlC'I'RlCJAI.
[] PI.tl~IJBINc.3
---__---'-- AtIJP SElRVI<~E
o FUJRIfJA POWER
o W.n.E,n,
o IIJHlCHAN WAI,
$._-_.'
VALUATION OF MECHANCIArJ IH8'rAI,IIATTON
[] (JA8
~ ROOFING
[) 8PElrJtAUry
[I OTHER
rl'~!'PllJ OF CON8'I'RtJCTID1~ I [J BLOCK
o FRAME
fJ STEEL
[] OTIIElR
FINI8HElIJ Fr,(jOl~ B1fJElV1'lTIONS
----------.-
18 PROIJECT IN noon ZONEl AREA 0 YElS 0 NU
eUILnlllR
******************************************************************
CO~1PANY __._______________ _._______________._ ._
STATE CElRT OR RElGIB'!' # --------------------___.L.._____
CITY PROCESSING L__________________.___.._________
f1lGNATUREl
. .
-...--.-....-.-----..----------------.-----
mI.IClTRICIAN
COf'1PANY __________________________.____ ____
STATE CERT OR RElGTS'!' #
SlmTA.'1'lJRBJ _____H_______.___________________________ CITY PROCESSING #
--------..---.- .------------..--.......-.....
**'**'***********'******"*'***'************'**'***********'*"***
---.----.--...--...-- -.-.--.. -.------..---'"------
PI,t1MSBlR
.---....--.-.....------...--....---
C!Ol'<l P Al'lY ----_________----,--________..________________._
STATE CElR'l' OR REGIST # _____~__~__;______..
CITY PROCESSING #
BIr3NA'l'tJRE
MSlC!HANI CAI.
*********'****'***'****"*****'*************"*'*****************'
--->.._------------.....~--_.~------
------~._--
cotvIPANY __.___
STATE ~mRT OR REGrST #
CITY PROCESSING #
---,..._-~._----_._-,,--~~'-- .-.----
SIGNATURE
.----------..-------------..----------..-
*******"*************************'***~**"***~******''**********
OTlIBlR ~~_~'1h~
e WNA'l'UREl {2;l a, ________
(~m1PANY ;,(. ~11'J!tj
STA'l'El CERT OR REiGIST # CCco?>37lb
r!I'rY PROCESSING # 308-.--------------
------~-_.~-----_._--~_.--_._---
._-~..:;---_. ~----
""***"*'*"'****'****"'***'*'**'***"*'***""*'**"*'*~*****
COl\DI'l'IONS OF PERNIT AFFIDAVIT
A. NO'l'ICE OF DEED RE8TRIC'l'ION8
The undersigned understands th~t this permit may be subject to "deed restrictions" wlllch
may be more restriotive than City regulations. 'l'he under'si goed assumes responsibility for
oompliance with any applicable deed restrictions.
B. UNLICENSED (;ONTRAC'l'ORS AND CON'l'RAC'l'OR RE:SPONSIBILI'I'IES
If the mmer has hired a contractor or contractots 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 contractor may be cited for a misdemeallor
violation under state law. If the owner or intended contractor are uncertain as to wllat
licensing requirements may apply for the intended work, tlley are advised to oontaot the
City of Zephyrhills Building Department, 813-766-6611.
Furtherlllo!.'e, if the owner has hit'ed a contractor or contractors, he is adviaed to hiiviD the
contraator(s) sign portions of the "Contractor SectionsU of this application for which they
will be responsible. If you, as the owner signs as the contractarl YQ4 are indicating that
you, ~ather than the contractor, at'e responsible for the work. If the contractor wishes
you to sign alii contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhllls.
C. 'I'RANSPOR'l'ATION I MPAC'I' FEES AND UTILITY CONNECTION b'EES
D. cONS'rRUC'l'UION LIEN LAW (CHAP'l'ER '713, FLORIDA STATUTES, AS AMENDED)
1 certify that I, the applicant, have been provided with a copy of "Florida's Constr\lction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applic/ilnt is someone other that: the "owner", I carify that I
have obtained a copy of the above described Qocument and promise in good faith to deliver
it to the "owner" prior to conunencement.
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 appli.cable laws regu1 ating constl'tletion, zoning, and land
dev~lopment.
Applioation is hereby made to obtain a permit to do work and installation as indioat$d. I
ceJ:tify that no Hark or installation has conunenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating cbnstruation, 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 aations I must take to
be in compliance. Such agencies inolude but are not limited tal *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sens~tive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management Distriot-Wells, Cypress Bayheadsl Wetland Areas,
Altering Watercourses
*Arloy Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.8. Environmental Protection Agenoy-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone qA" or "A,ete.", it is
understood that a drainage plan addressing a "oompensating volume"'will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to pennit
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 coues,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
cor~ection of arrors in plans, pon~truatioq! or vio~~tions of any coda. Every p.cmit
la~u~d ahall beoome invalid unless the work authorized by such permit is oOllunenoed within
six monthlil of issuance, or if work authorized by the permi.t is suspended or abandollild t9r a
period of aLK months after the time the work is aonunenaed. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be ~eQuested
ill writing to the Building Offioial. An approved inapection must be logged during each aia
month period, or the project will be considered abandoned. .
WARNING TO OWNER: YOUR IfAILURE TO RECORD A NO'rICE Ob' COMMENCEMENT MAY RESUI/l' IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OB'fAIN f'INAlH1IN~1 ,~qN~UL'!'
WITH YOUR LENDER OR AN A'l"fORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEWl'. JOBS UNDER
$2,500 IN VAI,UEl no NOT Nji;ED TO RECORD AND POS'l' A "NO'l'ICE OF COMMENCEMEN'l'".
SIGNATURE I CONTRACTOR
S I GNA'l'URE I OWN ER OR AGENT
S'J'A'rJlJ OF FLORIDA
COUWl'Y OE'
The foregoing instrument was
Before me this _ day of
by.
ackno~vl edged
, l~
STATE OF FLORIDA
COUNTY OF
The foregoing instrument w~s
Before me this -----Jiay of
by
aoknowledged
I 19 ~~
(name of person ackno"l~dged)
Dwho is personally known to me, or
o who haa produoed
(type
alld who[] did 0 did not
(name of person acknowledged)
[1ho is personally known to me, or
of identification)
take an oath.
Dwho has produced
(type of identifioation)
and VJha Ddid DUd not t.ake an oilth
Signature of person taking acknowledgement
Signature of person taking aaknow~edgment
Harne typed, printed or stamped
Name typed, printed or stamped
Residential - Commercial
BondedlInsured
Since 1947
Financing Available
Affordable Roofing and Home Repairs
Call: Dick Bray
K Systems International
STATE AND COUNTY
LICENSED CCC033716
(813) 404-4952
Mail Address: P.O. Box 9725 · Tampa, FL 33674
Prompt Service
24 Hour
Full Warranties
References Available
PROPOSAL SUBMITTED TO:
I PHONE:
"1/IJ- %2. '3
JOB NAME:
r~ I DATE:
-'(Vi- Z22I 1- H- 03
NAME:
..:le,o,U\:l'J De~"ec.~I~
STREET:
5i>5, q~ ~T
CITY:
2e ",~y Rl-.fI ~
STREET:
S~
I CITY:
I STATE:
STATE:
=========~~===========~~J:~-======--========================--===================================================
We hereby submit specilications and estimates for:
,aMO\Lt ~~ ~ ~LU A\Jl..U> GA-F )..() ~ ~h~
(lod O"V€J\ 301~ ~ ~ -Cl...Q.Q ~ ~eJ _v~7~-
~0CIfI;.
Mdt
~~
~ #<<) ~
'I
/ ~ &;t7
~
All pennits and inspedioos are included
We furnish Worker's Comp and Liability insurance for your protection
=====================================================================================================================
We hereby propose to furnish labor and materials - complEte in accordance with the above speciifications, for the sum of
dollars ($
) with payment to be made
:lIows: ~ ~~ b,.t. t!1H\J
- Rotted wood I"q)lacement ifneeded win be charged additional. All material is guaranteed to be as specified. All work to be compltted in a
workmanlike manna" according to standard practices. Any alterati or on from above specifications involving extra 00Ilts, will be executed only upon written orda's,
and will become an extra marge over 8Dd above the estimate. All agreemEIIIS cmtingmt upon slrikes, aocidaJts, or delays beyond our control. This proposal subject to
acceptance within -'!10 days and is void thereafter at the option of the lDldersilll1ed.
AuthorizedSilll1~ 81~
=4=--==========---==
Acceptance of Proposal
The above prices. specifications and oonditioos are hereby acoepted. You are authorized to do.1heworK as ~~~ as outlined above.
Accepted: SlllJlature. . . .
/' ... ...