HomeMy WebLinkAbout03-1798
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 780-0020
1798
Date
1-;).7-03
BUilDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Property Owner:
Job Address:
Parcel I. D. "
btJ(~ ~J)
le i(5 5 G &0.0 ~ /.J l v('1.
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Descriotion of Work
Energy Code:
11i\ <)i ~ Ii "'- -rt (, ""'
~
Radon Gas:
Tv Yt'Fb '"
S'15:re~
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
BUilD G
CAl
9'U
Permit Fee 35'
>>ignature'\.~ ~
Company
Address
\!;elephone# 478 - ) ~ ~ 7
7Rr,:J kkC~2Ac?;zh~ .
PLUMBING MECH NICAl
Valuation or ~
Contract Price
City license Registration #
State Certified license#
~3og7
Ftr.
Pre SlB
lintel
I
I
/
/
/
f
/
"
;
Tp. Servo
Rough In
Meter C
Const. ole
Pool
Pre-
Final
SLB
Tub Set
Water
Sewer
Final
FRM. I
f
Insul. St..
'Ill
DriveLav
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.
No.3065
P. I/'
. .24. 2003 4:01PM CITY OF ZEPHYRHILLSHS or pm~IT A~'I~VlT
J a.~~ u_.......""'.J..,., "'.11I0 a~t:r"""l\,;'l'J.tmtt
~he underslqnedunderstand. th~t this p~~qdt ..y b. aubl~at to -d.ed rescrictions" which
. may b. more ~...trtctiv. than City regulat10ns. The unde~.igned ...ume. re.ponaibll1ty for
o~mpl1ang. with .nv .p~licable deed reetrlotlon..
a. ~NLIC8Na.D bONTaAcToR! AWD CONTRACTOR R8SPQHSIBILITIES
If the owner hila hiJ:ec;t a QontUPtor 011 contractor.. to undertake WOtl<, they malt ba requir.d
to 1;1. licenalld 11\ aocordance with IItsl:" I!lnd local regulati<me. II tne ~ontraator i. not;
liceneed .. cequired by law, both the OWner and oontr.otar may ~e o1ted f~ . mt.d....uQr
violation un~.r atat. law. It the owner or intendec;t contraotoe are uncertain as to what
li clilnain9 J:equh_nta IllllY apply for the intended "Qrlc, they ;u;e .dviaad. to OQIltUt &lh_
City of &.phy~h111. Building D~p.rt~nt, 81)-788-8611. . .
F"rth.~~e, it the ownec h.. ~ir.d a eont~.cto~ or oontraotora, he 1. advla.4 to bave Ebe
c02ltJ"actor{,1 .tgn porUona ot tbe "Contractor ".ctionl" of tni, appU.oation tor WhiGb tbell
will be reapondbl.. If YOu,. alii. tho own.c ligna ~a the lKlDtractor;1 YQl,I .~. lnl11oatia9 that
you, rather thaD the oontractor, are re~on.ible for the work. If th. OQntractor wieb..
you ~o algn .a contraetoe th.t ~~.bc an indi~tign that he i. not prQp.~ly 110enleQ and ia
not entitled to p.~tting privl1eg.~ 1n the City of Zapbyrhilla.
c. 'l'MNlll'ORTA'l'ION IHPAlf'l' flU AND UTILITY OOWtf~CTION '11\8
D. ClQtf~'lRUCl'l'tJIOIt LIIlH LNf (CHAP'1'BR 713, rLoRIM S'fA'1'U'1'mS, AS ~DICDI
1 CMlrtify that I, lb. applic.ant, have be.q prQv1dlSd witb a lKlPY Df "rJ,oria.'. Conatruction
lien Law - Homeowner'. Protection Guide" prepa..d by the 'lor!d& DepartmeQt at Agriculture
anq conaunec Affaira, It tho epplic@nt ~. .~Qn. qtho~ t~t tbe nown.r~, l ca~ity taat I
bave obtAln.g A copy of the abovo a..cribed aocument and prami.. 1n good faith to d.li~
it to tbe "ownar" prioc to ~ncement.
S, COH'l'RAC'I'OR' a/OWltICR', Al'lInAVIT
I ~artity tbat all the into~tion in this .application i. .~cueat. and that all Noek will
be done in compliance with all applioable lawe regulating conatruction, ~onll1g, and land
dev,lopmellt.
Appl1"IlUcn 1.1 berabr ..d. to obtain a p.rmJt to do wock and ~".t:all.t.1cm aa 1ntUgatl~. I
ce+t1fy that no work or in.tall.tion ha. D~no.d prior to ta.ullnce of . p.~t and that
all work will be performed to meet atllnder41 of all law. regUlating construotion, City
cod.., zoning cegulatlona, and land d.velo~nt regulation. in the 1urtadiatlon. I .100
certify thAt I UDderstand that th, regUlation. of 9th.r goverQmant.l .~enoi.. may apply to
the inten4ed work, ana that 1~ 1a ~~ r..poA8ibillt~ to id~t1ty what aat10ne I ~.t taka,to
b. in PQ~li.anoe. lSudh agtlllllJi.a ino1L1de but ace not lUntted to I *O.partIMnt of
&nviron~ntal RegulatlQ~-Cypre.e Ba,baad., W~~land Ar.a. and InV1rQnmant.ll~ Sen~t~y.
Lando, Wator/N.at.wacer Treat-.nt
*Gouthw..t r~ori~ Water HAnav..-nt Diatrict-Wal1a, 'ayp~..a Bayh.ad~ Wetland A~...,
AJter1nq Wate~oour.&.
.Army Cprpa of Bn~in&e~.-8..wall., Docke, N.vigabl~ Wateeways
*Veparl:mant Qt B.altb , Rehabilitative Services, Bnvi~gnment.l Healtb Unit-Wella,
"..towater Tre.~MOn~, Septic T.n~a
*U.8. &nvironmsntal .~Qt.ction AgenaY-Aab..toe abat...nt
I alao c.rtify that, it till material ia to b~ u..d in Flood zone ~AH or UA,etQ.., it i.
under.tood that a dcaln&ge plan addreaaing a "compen..ting vol~N/will b. aUbmitted wb1ab
i. peepared by a prof...ionAl snqlne~r'r.gi.tere~ 1n t~~ State of florid. prior to p.~t
ieauano., .
A p.~mit i~.u.. .nal1 be QQD.truad tp be a lie.n.e to prooaed with the work and nat ..
autllocity to violat., oanael, alter, or aet aaide any provlliooa ot th* tochDLQal ao~e"
nor _h.ll i.ouanee of a permit prevent the luLlding Ottici.1 fr~ ther..tt.r r~rlBg a
OQIC,:ectiAll of .uon in plan., "on~~DloUOI}, Dr viaA.~j;!Dna At any aode. "ve~y PW:lI1t
1e'~.d ~ha~l become invalid unl... the work .~tbo.i~.~ by aucb pe~t ia ~noed within
lix IIIOnth. of ie.u"nce, or it work .utbodalld by the perJDit hi .ueponded Dr abandoqf!d ~,r a
p.dod of oix IIlQntha anal' tile 1:1._ the HOlCk 111 ~raci. One 90 day o"talUlicm at ti.
m.y b. allowed tor the perudt with f.. oha1C9. of f15.00. ~he extenaion _hall be ~e~~ed
1h ~ritin9 to ~he Buil~lQQ Offioial. An .ppraveq in.pootion mu.t be logged durt~Q .ach ai.
IIlQnth period, or the pr~j.ot wl11 be con.iei_rod abandoned.
IiARHING '1'0 OWHIIRI YOUR t'AILURli 'fO RlICOBb A HQTlCa 0' CQHNINC~ MAY RUUJJ1' III YOUR.
JAYlMli TWIOa FOR IMIlROVlNlilf'rll '1'0 YOUR I'ROII'&RTY. U' you IHTlIHD 1'0 tlIt'tAtH rlHAMqUIQ. ~IPL"
lITH YOUll LEWPIJI OR AN A'M'ORHI!;Y 8UEllU'! RJICORDING YOUR Ho'1'ICII: or COlICNCIMIDrf. JoN tnlDIll
'~,500 IN VALUB 1>0 NOT NQQ T() RftOORD AND l'08T A '"NOTICE or COMMIIICllaafTu.
. IL~~
S IGNATUtUt I CONTRACTOR
91GNATtJlUh
OWN aa OR Al31lN'l'
lITATI Qr 'LORI~
COUNTY or
The foregoing in.tru.ent was aCknOWledQad
a.fore .., thill _ day of , 1!L-
by' .
(na_ of penon ..q<ltfl.dg..d)'
Dwho h per.onally known t~ _, or
Q who h.. produced
(typ. of id.ntiti~ation)
I!lnu whoD d1c;t Odia not tab an oath.
8'fA'J'!l 01' I'LORI~ dJ ' II~ horc t
couwry OF I ~ '
Th. foreg01og i~nt w~. ~Wl.dg~
:;tora~. i~: I ~()/~ b~ \'\'. ~.ao3
'lJ {na_ ot par.on aQkD_lq~l
~~ ie pe~.onally knQNn to me, or
o Who h.a produc:ed
'type of id.ntltlqA~~onl
and n [ldid ~Q: tAke ~n tllieh
~ ~{A)J:> V. . (1 ^ 11. ~ .
s{ n.t:ure ot .per.on t,~killg .DkD01fl.dcr-nt
S1gnature ot peraon ;.~iDg lIoknowledg..-nt
~ad, printed or .t.~ed
Name typed, pr1nted~Qr .t.~~..4~a~..-~r.r~~
,,'"'" DENISE C. lEAJtJE
COMMISSION , DD06737I
I'IIIJC 'EXPIRES OCT 2A 2005
,- 0"1 IiIONDED 1HIIOUQH
. . RU ~ COIINH'f
,'to , .'
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUII,DING DIllI?AR'I'MElN'f 5335 8th S'fRIllIll'f ZIllPHYRHII,LS, FL 33540.
PhoneI81]-780-~020 Fa~1813-780~0021
tJJ\.'n RIll<1111IVlllD ~~_ ".~ .~"~
PI,AUS RlIlVImw I'BlB_'-_'-n._..U ___ .
UWNmR'. NAMO --Gcid. (',N__.~J~- ~-~_Lg€S T *l"'o:.ANJ:~___ P"ONO mm'^,,'U:' L~~ 15:1': ?~o
.J08 SI'I'B1 ADDRESS _____~_~ .5~_:>-=- --~.fr1~----~L~~---~~-'P=h~\~1_fl---________
IJBlGAL D81sc.!R I p'nON I LO'r (S)
PARCEll, I [l #
---..--..- ----------
BLOC!K
---'-.-.-
SUBDIVISION
_._----~..--~-.. .-.--.....---- .-..-.-............--
HURl< PROPSElrJ t [~N C'ONs'rRtJCT ION
--------_._----------_._--------~-------------------------------- ---------------------.--
[)SHm
o JWIJITION [] ALTERATION [) RElPAIR U TN8TAr,l,
[J MOVE: [] D1:!lrIJO 1, I S II
[h1lJ!,'I'r -. FAf-.1n,y 0# OF tJN !'I'S IJ MOBIl,El IInl1Bl
[J INDUSTRIAL fJ SwnilMING POUL fJ O'mER
(OBTAIN FROM PROPERTY 'I'1\){ NOl'IC~m)
I?R<)t.>OSElIJ USE I []SGJI, FAMILY DWEll,I4INGl
[J C0/1MEJRc! JAr,
CJ R~:8TAlJRANT & HElAlml DHlPAR'H1ElNT APPROVAL
"0. eR IP'l' ION () F "OR K .. ':r::" ,,{ ,,\\ ,,+ , ",~__q{ 0. I t ~I:.<j A, .TIC'. "'--2J,l'..fE ""-..~.~.
Bl1ILDIN(] SIZIll
---_._---._--~----
SQUARE FOOTAGE
-h,____u. ".-'_..__
REBII1BlNTIAl, I
(~OMMBlIWIArJ I
A'I"rACH (2) PIlOT pr4AllS & (2) SETS OF BtJIr,DIN(l PLANS & (1) BElT ElNElRGY FORMS,
A'r'J'AC!H (.3) BE'rs OF BUnDING PLANS & (1) SElT ElNEllWY FORMS,
PROPERTY SURVEY RElQUIRElD FOR ALL NEW CONSTRUCTION_
--- ---------------
HElJGHT
._----._--~--------
tJ B tJ Ir,1JI Nf~
IJ BlLIlICTRlCAI,
FmRMITS REQUESTED
$ ----
VALUATION OF TOTAL CONs'rRUCTION
--------
AMP SElRVICEl
o
FLORIDA POWER
o
WoR,Ill,C},
[] PI,UMB INC~
U I-1ElUHANlt!AT,
I
$-------
- VALUATION OF MECHANCIAI, IHSTALI,ATTON
[J (JAB
L] ROOFING
fJ S PECI Al!l'Y
[J OTHER
'l'YPBl op' (X.lN8TRuc'rION I [J BI,OCK
[1 FRAMEJ
[) S'I'EI!JL
[) OTIIER
FINISHErJ FLOOR mr,ElVl<iTIONS
-------
18 PRO_TEe'I' IN FLOOD ZONE] AREA 0 YElS
o NO
!HtILIJIlIR
mr,BlO'1'RICIAN
******************************************************************
('Ot-1 PAN Y ----.--------.--.---__________.. _____.. ___. .__. .. _ _______ ___ _ h__ _
STA'I'El CElRT OR REJ8IST # ___________________._______
CITY PROCESSING IL_..______________________ ....__________ ___
81GNATURBJ
---.,-_._.---.""-~---=-.;...-_.._...:..-----=--------..-------_.._._---
C0/'1PAN Y __________~_________..___. ____..____. _______
STATE CERT OR RI!JGTST #
S WI TA'l'IJREJ ---------.-----------__________________ C!TY PROCESS IN(~ #
*********************,************.****************************'**
._~-- ..._._-_._-~_....~-'-------------,.- -.... '..-
-----._---~--_.._-.__. --.-..- .._---.-....._-+~---
PI,tIMBBlR
--_..-....__._._-~--..._--.....- -~
----.-----
< JOMPAlIY ___________~--__.______..____. ____.________
STATEl CER'l' OR REGIST # _______________..____...
CITY PROCES8IN8 #
SIC1HAT17REl
MBl(mANICA1,
******************************************************************
-'-'- ----0_'0- ____._______ _..>_.__________~_
_.__.._~------.__._-
C01VJPANY _________________________._______
STATE ('ElRT OR REGIS'r # ~-.---------------___u_
CI'l'Y PROCESSIN8 #
SWNA'riJREl
OTH.. "o"p ANY -=1 ROf? l~ '" L L ,,~cl.~.<:."i'.E:_'I)_~~rm <
.I'"'^'j;:~-~~==== g~~.p~~~~.~~N~.~r:j_()~'?l..::===_~====
*******************************************************'***~*****
**************************************~****************'*********
----.---...--.--...---
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE Of DEED RESTRICTIONS
The undersigned understands th~t this p~rmit may be subject to "deed restriotionsH whiGh
may be more ,restrictive than City regulations. 'l'he undel:signed assumes responsibility for
complianoe with any applicable deed re5trictiontl.
B. UNLICENSED 'CONTRAC'l'ORS AND CONTRACTOR RESPONSIBILI'l'IES
If the OH1Ier has hired a contractor or contractors to undertake work, they may be required
to b~ Ii censed in accordance ~~i.th f:ltate and local regulations. If the contractor is not
licensed as required by la~", both the o~mer and contractor lIlay be cited far a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to v~lat
licensing requirements may apply for the intended work, they are advised to oontapt the
city of Zephyrhills Building Department, 813-768-6611.
Furthermol:e, if the owner has hil:ed a contractor or contractors, he is advised to havlil the
contractor(s) sign portions of the "Contractor sectionsU of this application for which they
will be responsible. If you, as t11e owner signs as the contractor, YQ4 are indicating that
you, l.ather than the contractor, are responsible for the wor'k. If the contractor wishes
you to sign as COlltractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the city of Zephyrhll1s.
c. 'rRANSl?OR'l'A'nON IMI?AC'l' IfEES AND UTILITY CONNECTION FEES
D. CONS'fRUC'rUION LIEN LA~J (CHAP'l'ER 713, FLORIDA STATUTES, AS AMENDED)
r certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection GuideH prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owneru, I cerify that I
have obtained a copy of the above described document and promise in good falth to dellver
it to the "owneru prior to commencement.
E. CONTRAc'roR' a/OWNER' 6 AFFIDAVI'r
I certify that all the information in this application is accurate and tllat all Hork will
be done in compliance with all applicable laws regulating constnlCtion, zoning, and land
devfi?lopment.
Applioation is hereby made to obtain a permit to do work and installation as indioated. I
ce~tify that no ~mrk 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 th~ regulations of other governmental agencies llIay apply to
the intended work, and that it is my responsibility to identify what aationa 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 Sens1tive
Lands, Water/Wastewater Treatment
*Southwest florida Water Management Di5triat-Wells, cypress Bayheads) Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Departrnent of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic 'l'an~s
;!.u.s. Environmental I?rotection Agency-Asbeatos abatement
1 also certify that, if fill material is to be used in Iflood Zone ~Au or "A,eto.#, it is
understood that a dralnage plan addressing a "compensating volume"'will be submitted which
is prepared by a professional engineer registered in tile State of florida prior to permit
iaauance.
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 teohnical codes,
nor allal1 issuance of a permit prevent the Building Official from thereafter requiring a
correction of erron in plana, construction! or violations of any oode. Every pliilrmit
iSriu~d ahall become invalid unless the work authorized by such permit is cOlllmencedwithin
SlK months of issuance, or if work authorized by the perm1t 1s suspended or abandoijetd f9! a
period of six months after the time the work is commenced. One 90 day eKtenslon of tillle
may be allowed for the permit with fee charge of $15.00. The eKtension shall be requ@s~ed
in writing to the Buildlng Official. An approved inspection muat be logged during each SiK
month period, or the project will be considered abandoned. .
WARNING TO OWNHlR: YOUR H'AlLURE '1'0 RECORD A NO'rICE OE' COMMENCEMENT MAY RESUW' IN YOUR
I?AYING 'rWICE FOR IMFROVEMEN'l'S TO YOUR l?ROI?ER'fY. IE' YOU IN'fEND TO OB'fAIN E'INANGIWG, _~qNiuL'f
Wl'I'H YOUR LENnER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE Olf COMMENCEMEN'I'. . JOBS UNnER
$2,500 IN VALUE DO NO'l' NEED '1'0 REGORD AND POS'l1 A "NOTICE OF COMMENCEMEN'l'''.
SIGNA'l'URE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
acknowledged
,19_
STA'l'E OF FLORIDA
COUNTY OF
The foregoing instrument WClS acknowledged
Before me this -------Pay of--, 19 ~
by
(name of person acknowledged)
[1ho is peraonally known to me, or
S'l'A'rE Oli' FLORIDA
COUN'I'V OF
The foregoing instrument was
Before me this ___ day of
by
(name of person acknoWl~dged)
Owho is personally known to me, or
o who has produoed
(type
and what] did Ddid not
of identification)
take an oath.
o who has produced_
(type of identifioation
and ~"ho Odid DUd not t.ake an oath
Signature of person taking acknowledgement
Signature of person taking acknOWledgment
._,,_.._-._~-.--_.__.
Hame typed, printed or stamped
llame typed, printed or stamped
"-