HomeMy WebLinkAbout03-1804
BUILDING PERMIT
Permit N~
BUILDING
/f0
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 780-0020
1-/0 ~~
PLUMBING MECHANICAL
1804
to.....
-
Date /-;2& ~6 "3
Sewer Conn .1/ DO -
Water Conn: -.2 ao -
Water Meter: -/~o......
Property Owner:
Job Address:
Parcel 1.0. II
Zoning:
~j
NO OCCUPANCY BEFORE/C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
~~~Q
Company
Address
~t;;;~e0 9/?-37/'o
y 'T-~J
Valuation or
Contract Price
City license Registration # g 0 g f
State Certified license#
-3903
BUILDING
Ftr.
Pre SLB
lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final /,.2 - /8-- C} 3 I-/;Tu
SLB
Tub Set
Water
Sewer
Final ,/ c2, I,F -C7 3
Breakers
Ducts Insl.
Compressor
Final V ~-16-P?:>
IfY-')
liTo
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reason()a
charge of twenty-five and 00/100 Dollars ($25.00) shall be made for each tri~de: OJL.--
a. Wrong Address cJ< 'i< ~A.c; L) I : /. /l?.
b. Condemned work resulting from faulty construction. ... / ..L ~ t I/)/) if/V ~
c. Repairs or corrections not made when inspection called. 7 - c7
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
BUILDING DIllI?AR'I'MIllN'r 5335 8th S'fRIllIll'f ZIllPHYRHILI,S, FL 33540
PhoneI813-780-~020 FaxI813-780-0021
DA'rlll RBClIlIVED ~~~~-~;L3_
PLANS RBVIIllW FBIll___________
OWNER' B "AME ___i:t_1!:H\N ~'" L~\/ PHONE
JOB SITE ADDRESS ~I/t) . -L.e~ -b;A~~__~____
CONTACT
-~_.__._--
LEGAL DESCRIPTION: LOT(S)
s~
BIJOCK
SUBDIVISION t,.Jr-yuJF.:ne..~ (J.); N~
PARCEL ID #
) "L\- z.~ -"2..t - 011, 0 - CCY:r'::> a - Gb Sc'oD
WORl< PROPSED: ~NEW CONSTRUCTION 0 ADDI'rION OALTERATION
(OBTAIN FROM PROPERTY TAl< NOTICE)
o REPAIR
D INSTAIJIJ
DaIGN
DMOVE
o DEMOI,ISH
PROPOSED USE: OSGL FAMILY DWELIJING
OMULTI - FAMILY
0# OF UNITS
~MOBILE HOME
DO'l'HER
[]COMMERCIAr,
o INDUS'l'RIATJ
DSWIMMING POOL
DESCRIPTION OF WORK
CJ RESTAURANT & HEAIJTH DEPARTMENT APPROVAL
SeT up New
c? tfJ( 'It(
SQUARE FOOTAGE
mo 6, k 1-tClhJ "-
1 0 s l~
BUILDING SIZE
HEIGHT
RESIDENTIAL:
COMMElRCIAlJ:
A'rTACH (2) PLOT I?IJANS & (2) SElTS OF BunDING PI,ANS & (1) SET ENERGY FORMS.
A'r1'ACH (3) sEI'rs OF BUITJDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
6ILDINC~
~EC'I'RICAL
~JMBING
~MECHANICATJ
PERMITS REQUESTED
$
VALUATION OF TOTAL CONSTRUCTION
~OCJ
AMP SERVICE
o FLORIDA POWER
[] W.R.E.C.
~ 00
$___ ex:)-
VALUATION OF MECHA1\fCIAl, INSTALIJATION
o GAS
D ROOFING
o SPElCIAUI'Y
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
[J STEEL
o OTHER
FINISHED FI,OOR EIJEVATIONS
IS PRO,TECT IN FLOOD ZONE AREA 0 YES ~ NO
BUILDIllR
COMPANY \="lo}€..; ~ Y1I 11... C. nlrt,~,... ~ f> ore'S(-
STATE CERT OR REGIST #.AJ-l ODD S"' '5"0 '__
CITY PROCESSING #.-/ ~ 0 ;U
. Vr:5T,
******************************************************************
IllUIC'I'RICIAN '-:Rota ~ 6 QA"-'~ - COMPANyLlTL,I'9,J1;~ 3.!:!J?E!.-/ 1- g-e r< J(_L_~~_
~ ~ ~---------- STATE CERT OR REGIS'!' # ..Lc---2J~----3-_________
SIGNATURE L~____~ - CITY PROCESSING _# So f~ ____._________
***********************************************~****************
-- I" J.L.L4.:..s
PLUMBIllR I (rn v"'"
SI<~NA'!'I~-Lf ")
COMPANY~I2..;SA /'7?/t,.,;:: M~spo,d-
STATE CERT OR REGIST # :Z:Ht:)~ s:-~--o
CITY PROCESSING #
****************************************************************** .~
MIllCHANICAIJ 131 L~ I- oe i>.e.- T COMPANY 17 T1fi~L .s&.!:R. YI~C.-c.. y-- c0~L.<:'-){
~ ~ STATE CER'f OR REGIS..'!' # C-A-c n 5'7_<;'5"".9
SIGNA.uf<-~, ~ - CITY PROCESSING ~,//1 0.2 7
/ ,/
**************************************~********~****************
OTHER
COMPANY
STATE CERT OR REGIST #
CI'I'Y PROCESSING #
S I <3l~ATURE
*****************************************************************
COND~~~O~S O~ ?ERMIT AFFIDAV~T
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that t:h:Ls permi t may be subj ect to "deed restrictions" wtlich
may be more restrictive than City re';Julcltions. The undersi<;Jned assumes responsibility for
compliance with any applicable deedcest:rictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor ,:)c contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor maybe.qiteq for a misdemeanor
violation under state la1r/. If the o'wner or intended contractor ate uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, ,ire responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I 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 applicant is someone other that the "ownerll, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "ownerll prior to commencement.
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 applicable laws regulating construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work 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 the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I raust take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.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
understood that a drainage plan addressing a "compensating volurnell will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
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 codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENTII.
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
acknowledged
19_
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
19
(name of person acknowledged)
Owho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
o who has produced
(type
and whoO did Ddid not
of identification)
take an oath.
Owho has produced
(type of identification)
and who Ddid [):lid not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
996786
~
PERFORMANCE BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813-719-7919
~Q-<C~)~
CITY OF ZEPHYRHlLLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO.
;- /J?-ZC3
DATE gG.
,
=~ a...1.i. YJ?7~Z,'At..l ( j/z4~M-c
p (), ~W 001'
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SERVICE ADDRESS r3; [J /f"j- r:5( ~cLJ-~ Jr ..6-(;;,
14 0# 'fw/f,EP
WATER ..L
SHUT OFF SERVICE 0 . j,.)/1tJ 1'.7
o SEWER
MAILING
TURN ON SERVICE
~
~
READ METER
o
o GARBAGE
~. IN CITY
INSTALL METER
CHECK METER
o
o OUT CITY
i No. OF UNITS
OTHER
o
_ DEPOSIT AMOUNT
"3
--f;-;f
If
"u) ·
/J11~
_ AMOUNT LAST BILL
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPlETED
ORDER TAKEN BY
Retain white form In office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Oept to sign yellow form & return to office_
01109/2003 09: 37 FAX U~ 782 9504
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PASCO COUNTY, FLORIDA
Permit No. ------.Lf'tJ J./
Date Permitted 1- ~&- D3
Builder Name/Owner Name rL. /l1;f ;Jar ~N~ffControl #
County Parcel No, If.:g,-,;2(-DJibo <-?.vorv,- o.5C:.D SubDiv: 0J4N~ 0-1"-.
Address/Location $~) /(~- ~ fry ~/a~
Classification/Type of Use L-;JJ?.JJ...e _ ~~
TRANSPORTATION IMPACT FEE Rate:
Exempt 0 Yes ~NO How Determined
Sq Ft Unit:
Impact Fee Amount $
one No.
TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House
(057) Mobile Home
(058) Other Residential
J.:123) ~ction Fee
Exempt lJ Yes ~J No How Determined
Amount $
~ /R7~--
jP.:t S3 ~~ ~
. r"~7
"-,-/
PARKS AND RECREATION FEE
Land Account Land Credit
Land Total
..- ~.--- _..-'
..-.._"~
Recreation Account __~__ ~1t:~n_9fisJll'-'--"-'- Recreation Total
Zone /.J'!.. TOTAL AMOUNT $
Exempt 0 Yes _.-..G-fj-;.... How Determined
.,........-,...,..~.".,.......-""
L1~FEE
[:and Account _~ it1edit /_.-.-
Facility Acc~un;---~~'8l1it/'" .
Exempt 0 Yes O.J>I.o-'''/ How Determined
~-
,'.P--'''''''''---
Land Total
Facility Total
Total Amount
RESOUR<,:J;.fEl{ -1l1.' 1/. r'/
TOD\t-AMOUNT -d L 'f (5
ERU
Prepared By
Checked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and the conditions of payment for same.
DATE
RECEIVED BY
RECEIPT NO.
DATE
BY