HomeMy WebLinkAbout03-1858
Property Owner:
Job Address:
Parcell.D. #
Zoning: ~E~rgy Code: Radon Gas:
Descriotion of Work_~ ..A..~ f';u .s ~ 5 r.
BUILDING
BUILDING PERMIT
Permit N~
1858
CITY OF ZEPHYRHILLS
(813) 780-0020
c2 ~~/-17 '3
Date
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Go(dfJM [I P1Jl~
lc 85 ') ('0,.12 hi V cfJ ,
Water Conn:
Water Meter:
T.I.F.'s:
.~~ ,K,l(k~l Ju,.tr./
FINAL
C.O.
NO OCCUPANCY BEFORE C.O.
DATE
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
Inspector
~ ii-a'~ {)()
c 101 '1
City License Registration #
State Certified License'
Permit Fee
)<Signatur.e
Company
Address
~ephone# ~/ 'r, 9fJ t " { f b f
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
L
.....- .
I-/~ h5I.T~rTa::...
MECHANICAL
G
Tp. Servo
Rough In
Meter Ca
Const. ~e
Pool I
Pre-M~ter
i
Final/
I
!
SLB
Tub Set
Water
Sewe
Fina
Breakers
Ducts Insl.
Compressor
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.
I .... IlI7 t) cJ! -/1-0 J
CITY OF ZEPHYRHII~r~s PERMrr APPIJICA'rroN L ~~ #
BUIUllNG DEPARTMBlN'r 5335 8th g'rREBl'r ZJlJPHYRHII,I,S, FL 33e40 ___
Phoner813-7BO-O,020 Faxr813-7BO..0021 /J
IJATBI RBC1J1]rVIlJD ~e5_~-l3.. ,::<2__3
InANS R!llVIJIIW rBlBl.._~. u.
UI'lNER I 8 HA/I1Hl______G-'!.!I..f.'!.__~~~~..___________________________ PHONE (~ON'l'A<!'~'_______..
.TOB S ITEl ADDRESS n -bk~-6./1.l!_i3Jj/..d..____________________ . ___ __._.__________.
J.J8H1AL IlHl8CRTP'l'IOtl: LOT(S)
BLOCK
SUBDIVISION
~--"----+---._-'-
---------.... ~____"v.___.__.. ___.______
PARCEll, ILl It
HURK PRnpSElD I LJNElN (IONS'l'RUCTION
~--_.._----_.._.~.~--_.._-_._--_.._.__._-----~-----_..---'_.._-----_._-_.._-~-------.._._._._--~.-. .--------..--...-.
(OBTAIN FROM PROPERTY 1'AX NO'l'WEl)
rJ ATlDI'l'WN
o AUl'HlRATION
[] REPAIR
[J INSTAT,I,
[)SHm
[J ~10VE
o DEMOI,ISI/
PRO[.>08EIJ USHlI [Jsm, FAMILY fJWELIJIllr,l
Clt1UI,'l'I.. FAMu,y
0# OF UNITS
[J MOBII,El Hor1E
[J COfilMEJRt! fA r,
rJ INDlJS1'RIAL
[JSVlI/IIMIWJ POOL
/] OTHER
. D ReJSTAURANT & HEJALTH fJEPARTr.1ElN'I' APPROVAL
)lHl8CRIPTWN OF NORK --&lLJ;#_E~ SI/~/o~~.d;!y:_.L I~-.lsi Id!.6____Jdp.iJi_. .u___
BfJILfJINl3 SIZE
------_._--~_._-----
SQUAREJ FOOTAGE
REBItJlllN'I'IAf'1
(~O)\1MI:!IIH!IAr, :
--. -----------.----
HElHmT
A'I"I'1\CH (2) Pi,OT PI"AllS & (2) 8ElTS OF BtJII,DING PI/AN8 & (1) SEl'I' E1NElRl'lY F'ORMS,
A'I"liACH (3) sElTS OF BU!LfJING PLANS & (1) SElT ElNEJRny FORfIlS.
PROPERTY SURVEY REQUIRElD FOR ALL NEW CONS'I'RUCTION.
._'-~.._-.- ."--~,------
~ERMITS REQUESTED
[] 8 \J II.IJI Nr~
$ ---'-__h
VALUATION OF TOTAL CONSTRUCTION
LJ EI.,IlJCTRWAl,
----------------
AMP SElRVICE
o
FllJRIDA POWER
[J
VI . R , E . (J .
[J P r.or18 INC3
~lBIC1HAN I (.;AT,
$- --.'2.W-.::.._~_ VAI,UATION OF MECHANCIAT, H1STAI,I,ATTOI'I
r] GAS
LJ ROOP'ING
[J S PEC1 I AU!'Y
[) OTHElR
TYPEJ OF' COH8TRtJC!TION I [J BLOCK
[] FRAlIEl
[] S'l'EEIJ
[J OTHER
FINISHED FI~OR ELEVATIONS
-...._--~-
IS PROIJElC'I' IN FLOOD ZONEI AREA n YElS
o NO
Bunnma
******************************************************************
corll PAN Y --.----- -..-- .________ ___ .___.. __'__.. _. "_.n___._. .__
STATE! CElRT OR REl8IS'l' # __._____________..________.____..
CITY PROCESSING L___.._.______....._______ ___..__.__._.....
SlmlATtJREJ
--~._- --'_._--_.~----~~_..._---_.._-----_._~----
!lIT,mOTU a IAN
8 J (mATURE: __.._
.... .._u_____ .-___._.h.__._____ .._.__'_._________~
COliP ANY ____.___..____._ ______...______..__.______.___._. ___.__._
STATE CERT OR REGIST #
CITY PROC88SIN<~ #
"----.-- '~--..__.,- .~----___..._...h_.,_____. '.__
*h******h**h*****************************************h************
-..---------.---- '--".__. -.----. --. _.~~-_...-....,_._---
IiI I, tIMS ER COIY] P ANY ----.----------____h_________..__......_....._.____ __.._.
STATE CERT OR REGIST # __________.___._____._._..__......_
BI<mA'l't1REJ CI'I'Y PROCEl8SIN8 #
MBKlHANICAl.
******************************************************************
.....'-----_._._-------_._-~-"...__._----
COlvJPANY ____________._ ... "'__
STATE! ('I!1RT OR RElGIB'r #
CITY PROCElSSING #
--~ ~".._-------- ._-- ---0-- .__..____ __.. '..'____n_.
SIGNA1'tJREI'
*.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *.* * * * * * * * * * * * * * * * * * * * .~ * * * * * * ~
o'.r IIER -.- --:~ -~. __~.________.__ (~OI,1PANY ~~f~hiM_...;/LJ_ .-.f::_..__._J!_~-.---
. STATE! c~bR REll'lI T #
s rml1\'l'lJREl F erry PROCESS ING # ______.___._____"__~.___.____
- - .---~._------ --..----..o...e_1!t...____._____...._.____._._
***********************************************************;*****
--'-------._,--~----- ..~-._-------. -,.~--~-~
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands th,t this p~rmit may be subject to "deed restriotionsH Wllich
may be more restrictive than City regulations. The undersigned assumes responsibility for
con~liance with any applicable deed restrictions.
B. UNIJICENSElD CON'I'RAC'I'ORS AND CON'l'RACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be Ii censed in accordance ,,~i.th state and local regulations. It the oontractor is not:
licensed as required by law, both the owner and oontractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contapt the
city of Zephyrhills Building Department, 813-768-6611.
Furthermo:r::e, if the owner has hired a contractor or contractors, he i.s advised to have the
cant.r-actor (s) sign portions of the "Contractor Sections" of this appli.cation for whi ch t.hey
will be responsible. If you, as the owner signs as the contractor, YQ4 are indicating that
you, rat.her than the contractor, are responsible for the work. If the cont.ractor wishes
you to si.yn as contractor that mOlY be an indi.cation that he is not properly licensed and is
not entitled to permitting privil~ges in the City of Zephyrhills.
c. 'I'RANSt'OR'l'ATION IMPAC'l' ll'EES AND UTILI'l'Y CONNECTION ll'EES
D. CoNS'fRUC'rlJION LIEN LAlli (CHAP'l'ER 713, FI,ORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided wi.th a copy of "Florida's Constrllctien
lien Law - Homeowner's Protecti.on Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the appli.cant is someone other that the "owner", I cerify that I
have ebtained a copy of the above described document and promise i.n good fai.th to deliver
i.t to the "owner" pri.or to commencement.
E. CONTRAC'l'OR' S/OWNER' S AFfIDAVI'l'
I certi.fy that all the information i.n this appli.cati.on is accurate and that all work will
be done in compliance with all applicable laws regulating constnlCtion, zoni.ng, and land
development.
Application is hereby made to obtain a permit to do work and i.nstallation as indioated. 1
certi fy that no work or installaU.on has commenced pr'ior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating conatruction, City
codes, zoning regulations, and land development regulatlons in the judsdi.ction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the i.ntended work, and that it is my responsibility to identify what acti.ons I nmat take to
be i.n compliance. Such agencies include but are not. limited tOI *Department of.
Envi.ronmental Regulatipn-Cypress Bayheads, Wetland Areas and Environmentally Senstti.ve
Lands, Water/Wastewater Treatment
*Southwest rlc~ida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawal.ls, Docks, Navigable Waten/ays
*lJepartment: of Health & Rehabilitative Services, Environmental Health Uni.t-Wel.1.s,
Wastewater Treatment, Septic Tanks
*u.s. Environmental Protection Agency-Asbestos abatement
I also certify that, i.f fill material is to be used in Flood Zone ~AH or "A,ete.H, it is
understood that a drainage plan addressing a "compensati.ng volumeH 'will be submitted which
is prepared by a professional engineer regi.stered i.n the St.ate of Florida prior to permit
issuance.
A permi.t issued shall be construed to be a li.cense to proceed wi.th the work and not as
autllority to vi.olate, cancel, alter, or set aside any provi.si.ons of the technical codes,
nor shall i.ssuance of a permit prevent the Building Offici.al from thereafter requiring a
oorrection of errors in plans, con~truction, or violations of any oode. Every p&rmit
issued shall. beoome invalid unletls the work' authorized by such permi.t is cOllulIenced within
six months of issuance, or if work authorized by the permit is suspended or abandolled for a
period of ai.], months after the time the work is commenced. One 90 day extensi.on of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Bui.ldlng Official. An approved inapection must be logged during each si.x
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A No'rrCE OF COMMENCEMENT MAY RESUL'I' IN YOUR
PAYING TWICE FOR IMPROVEMEN'l'S 'I'O YOUR PROPER'ry. IF YOU IN'rEND TO oa'fAIN E'INANC;INq, ~9N~UI!I'
WI'l'H YOUR LENDER OR AN A'I'TORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'r. .JOBS UNDER
$2,500 IN VALUf!l DO NO'l' NEED TO RECORD AND PoS'l' A "No'l'ICE OF COMMENCEMEN'llll.
SIGNA'l'URE: OWNER OR AGENT
SIGNA'l'URE: CONTRACTOR
~TA'n OF E'LORIDA
COUNTY OF
'l'he foregoi.ng instrument was acknowledged
Before me this ____ day of _______, 1!L-
by __._.________
(name of person acknowl,dged)
Dwho i.s personally known to me, or
STA'rE OF FLORIDA
COUN'rY m'
The foregoing instrument w~s aoknoHledged
Before me this __-Slay of-----, 19 _..:.._
by _____________._
(name of person acknowledged)
[1ho is pe1:sonally knovm to me, 01:
Dwha has produoed
(type
and what] did [) did not
o who has produced__
(type of identification)
and v/ho Odid mid not t.ake an oath
of identification)
take an oath.
Signature of person taking acknowledgement
Signature of person taking acknowledgment
.--.~"--~---------_._--_._------
}i~~;--typed, ydnted or stamped
Name typed, printed or stamped