HomeMy WebLinkAbout03-1819
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N2
(813) 780-0020
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Property Owner: j} -Z /11 fA / 5
Job Address: _'1 t }tJ6 J1A,.e~
Parcel I. D, ,
;)t,c
;tJ v'e
1019
Date c{J-",/-O 3
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Zoning:
Description of Work
Energy Code:
Re-~
Radon Gas:
?-_lo-tJ3
DATE
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.
DATE
XL t1 d- {-IJ6
Inspector
~:~~::.:e~ If tfa#
Company
Address
xTelephone# 8'13 - 833 - 77:J.. 0
Valuation or
Contract Price
~ IfMJ
City license Registration ,
State Certified License'
c2 s-c( 3
/l1t/1h~-71/.( ,~r::-45I#tC '
BUILDING
ELECTRICAL
PLUMBING
Driveway
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Con st. Pole
Pool
Pre-Meter
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
aUIUJING DBlPARTMBlN'l' 6335 8~h S'l'RElBl'r Zl!lPH'iRHILIJS, FL 33540
Phone 1813 -780 - 0,020 Fax I au -780 - OO~~~'rB1 RBlCnVllJD ~g,-_~:;;P''32__
PI,ANB RBlVIBlW J'BII_'-~__c__-l:__h___'
OI1NElR'S IlM1E AZALEA IS AL F PHONE r~ON'l'AC!'L2(~.::-__Q~~P
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.JOB S ITEl ADI>RE88332t2k..__ __A/.q~t~___&._!!e_~_________________..________._ _ '_____, __..
LEJ[]J\ L HESeR TPT ION: LOT ( S )
BlJ()(~K
SUBDIVISION
PAR(!I!)IJ III II
WURI< PROPSBllJ I [JNBlI1 ('ONSTRtJC~TION
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(OBTAIN FROM PROPERTY 'rAM NOT Will)
[] AnD I'r ION
DALTBlRATION
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~ltJW'I - FAMIl.Y
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USEII []sr]L FAMILY DWEIJl,UlG
~m1~1BlRCJAlJ
Dff OF UNITS
lJ MOB nm HOME
[J S~n~lMING POUL
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IJE8CRIPTION OF t^lORK
o
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RE18'I'AURANT & HElAIJTH DElPARTt,1ElN'I' APPROVAL
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Bun.rnN(l SIZE
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SQUARE FOOTAGE
HmIGH'r
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RE8IDlllNTIAJJ I
COMMBlRCIAlJ:
A'I"l'1\CH (2) PLOT PlJAllS & (2) SETS OF BUI! ,DINt] PLANS & (1) 8E1'I' E1NElRrPl FORlvlS.
ATTACH (J) SE'l'S OF BU!IJfJING PLANS & (1) SE'r ENERGY FORMS,
PROPERTY SURVEY RElQUIRED FOR ALL NEW CONSTRuc'rrON,
L1 B\lILIJINf~
Ll ElLElCTRICJ\l,
(] P !.IJMB I NG
U 11Bi(JHA.NIC!AJJ
c.b
$ --4-t{.CJ9 -
~ERMITS REQUESTED
VALUATION OF TOTAL CON8TRuc'nON
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MIJP ~E1RVICEl
o FI,ORIDA POWER
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W.R,E1.C1,
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~ROUFnm
'1'Y-PEl OP' CONSTRUCTION: [J BLOCK
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$----..-:...---- VALUATION OF MB:CIIANCIAI, UIS'I'ALLATION
LJ SPEctAUI'Y
[J OTHER
o FRAME]
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FIlHSHElIJ P'l.oOR BllJEV1\TION8
I8 PRO,JECT IN FLOOD zen,TE AREA 0 YES
01'10
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CDr1 PAN Y--------______.__,________ ___, _ ________ _ _u___ ___..__
STATE CEJR'I' OR RElGIST # __________________..___,_______.__
CITY PROCElSSING fL__.._______ _______________.____________,_
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COr1PANY _0___,_____________ __________
STATE CERT OR REGIST #
CITY PROCESSING #
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C~OM PAN Y ------------___________________..__,__,______,_______
STATE CEJRT OR REGIST # _________0_________0
CITY PROCESSING #
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CO/'l PAN y_____
STATE CBRT OR REGrST #
CITY PROCE:8SIHG #
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S TGNA'l'URE
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CONDITIONS OF PERMI'r An'IDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands th~t this permit may be subject to "deed restriotionsU which
IlIdY be more restrictive than City l:'egulations. 'rile undersigned assumes responsibility for
coftolpliar~e with any applicable deed .tel3trictions.
B. UNLICENSED C'oN'I'RAC'I'ORS AND CON'l'HACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they nlay be required
to be l.icensed in accordanoe with ::;tate and local regulations. It the contractor is not
licensed as required by law, both the o~mer and contractor may be aited for a mi::idemeanor
violatioll under state law. If the oWller or intended contractor are uncertain as to Ylhat
licensing requirements may apply for the intended w(n-k, they are advised to contaot the
City of Zephyrhills Building Department, 613-766-6611.
Furthermol::e, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the "Contractor SectionsU of this application for which they
will be responsible. If you, as tlle owner signs as the contractor, YQ4 are indicating that
you, rather than the contractor, are responsible for the work. If the contractor wisJles
you to sign as contractor that mqy be an indication that he ls not properly licensed and is
not entitled to permitting privil~ges in the City of Zephyrhills.
C. 'l'RANSI:'OR'i'ATION IMPACT IfEES AND UTILITY CONNECTION FEES
D. CONS'l'RlJC'rUION LIEN LAW (CHAP'l'ER 713, FLORIDA STATUTESf AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Floridafs Constr\lction
lien Law - Homeowner's Protection Guideu 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 ~ocument and promise in good falth to deliver
it to the "owner" prior to commencement.
E. CONTRAC'rOR' S/OWNERf S AFfIDAVI'l'
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 indiaated. 1
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 construotion, City
Godes, zoning regulationsf and land development regulations .in the jurisdiction. I also
certify that I understand that th, regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what aotions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environment.ally Bensj,tive
Lands, Water/Wastewater Treatment
*Southweat Florida Water Management District-Wells, Cypress Bayheads,-WetJand Areas,
Altering Watercourses
"Army Corps of Engineers-SeaHa LIs, Docks, Navigable Waten/ays
*Departn~nt of Health & Rehabilitative Services, Environmental Healtll Unit-Wells,
Wastewater Treatmentf Septic Tanks
''<U. S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ~Au or "A,etc.u, it is
understood that a drainage plan addreSSing a "compensating volumeu'will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to pennlt
is/i:luance.
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
oorrection of errors in plans, oonstruction, or violations of any code. Every permit
iSf,iUed shi'lll become invalid unless the work authorized by such permit is cOllunenoed within
six months of issuance, or if work authorized by tile permit is suspended or abandoQed for a
period of six months after the time the work is comrnenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension ~hall be requeated
ill\'/ri ting to the Building Official. An approved inspection must be logged during each aLa
month periodf or the pr'oject Hill be considered abandoned.
WAfUHNG '1'0 OWNERs YOUR FAUURE '1'0 RECORD A NOnCE OF COMMENCEMENT MAY RESUW' IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IN'I'END TO OB'rAIN FINANC;IN~I ,~qN~UIlI'
Wl'!'H YOUR LEHDER OR AN A'nORNEY BEIfORE RECORDING YOUR NonCE Olf COMMENCEMEN'r. .1OBS UNDER
:~~~:_l~ VALUE DO H01' HEED 'j'O RECORD AIID POST ~ ~MMENC" EN'''',
S1GNA'I'URE: OWNER OR AGENT SIGNA'I'URE: CONT
sTA'n OF FLORIDA
COUNTY OF
'l'he foregoing instrument was acknowledged
Before me this __ day of ___, 19_
by "_____
(name of person acknOWledged)
Owho is personally known to mef or
STA'I'E OF FLORIDA
COUWI'Y OF
The foregoing instrument WqS acknowledged
Before me this _----S-iay of-----, 19
by
(name of person acknowledged)
C1ho is personally known to me, or
Owho has produced
(type
and whal] did Ddid not
of identification)
take an oath.
o who has produced
(type of identifiqation)
and v/ho Odid DUd not t,ake an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
}I-~-me -t y-p-~'d;-pr in t~d-~~-s tamped---------
Name typed, printed or stamped