HomeMy WebLinkAbout03-1867
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N~
1867
(813) 780-0020
Date
:2 --:lS- -1) 3
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel I. D. #
Zoning:
Descriotion of Work
{;q Yh 1 5h~{I1Pn
~ ~<;} ,30? IO'-A Ave.
Water Meter:
T.I.F.'s:
Energy Code: (:;;
<R(t "- ~~
Radon Gas:
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
DATE
NO OCCUPANCY BEFORE C.O.
DATE
Inspector
City license Registration #
State Certified license#
(I ~
Permit Fee
)<Signature
Company
Address
~Iephone#
1JL
c
Valuation or
Contract Price
l(l(TD
~
S' 17- 5'8"3 tJ
/
C;AV/~"\ 'RT~
BUILDING
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl
Compr
Final
ELECTRICAL
Driveway
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) shaH 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
BUI1,nIN(~ DBlPARTMEN'I' 5335 sth a'I'REE'r ZBlPHYRHII,IJS, r1, 33540
PhonaI813-780-Q020 FaxI8i3-780-0021
IJA'I'Bl RBlmllIVEn ___ Co. _~"~.. _.__ h
PI,ANS RBlVIBlW Jl'1lI1....___~ l.'
(J\'INElR I 8 IlM1El____f11tll1)!_._2.l/tl~l./tJ ~~.._...____________.___.____..___ PHONE CON'l'Ar~'!'__.2!~ -~-7(?P,---.
,roB 8 ITEl ADlJRBJ88__J..tI? 1_.__jJJ..._~_1! t(~_':.. _________________ ____ _______ _____...._ _________ _.. __ '_n_ _ ___
LElGAL DEJ8(!R I PT 1011: LOT (S)
BlDCK
SUBDIVISION
P ARC' Ell, I/J II
-...--.--~_.--.. - "-- ..._~. ..~_ _.......m.. ._.~_.._._
HURl< PROP8EltJ I /]NEN (IONS'l'RUCTION
-_._--~_._-_. .._._~-------_._---_.~-------------_.-----_.__._--~..,,--------..--------.---. _._--.......----------~..-.
(OBTAIN FROM PROPER'l'Y 'l'AX NOTICElJ
o ADDI'I'ION
rJ AL'I'ERA'1'ION
[J REPAIR
LJ lNSTAfJI,
[J S Wi'!
[] MOVE
[] DElt10I,ISII
PRO/,lOSEll USE I [lsr.;!!, FAMILY DWELI,IlIGl
[It.1lJUI'I.. FAMn,v
D# OF lINI1'S
[] S W HIM nil] POO IJ
lJ MOBII,E 1l0t1El
r:J CCJt1MIiJRc! IA r,
[J INDUS'l'R I AI.
[J OTHER
IlEJBCRIP'l'ION OF NORK
D R~18'rAURANT & HIllALT!! DIllPARTt,1EN'I' APPROVAL
__...1 e- -~()() -=-..........2i.-------..___.... __<__________.
----~---.------___ ~.__ _n _.~~ _ _. .___ __..
B!IIr,nING SIZE:
--------.--- ---.--------
SQUARE FOOTAGE
~_._--------
H EJ I GFl'f
RIllBIDBlNTIAJJ I
(~Of\1MSlR(!IAIJ :
A'I"rl\CH (:2) PI,OT PIJAllS & (2) SElTS OF BtJIIllJING PI,ANS & (I) SEl'!, ElNElRrlY FORMS,
A'I"rAC!H (3) BE'fS OF BUILDING PLANS & (1) SElT ENEJROY FORr18.
PROPERTY SlIRVEY RElQtJIRElD FOR ALL NEW CONSTRUCTION.
[] B lJ IJ,IJ I Nr3
$-42J_O,
........
FERMITS REQUESTED
VALUATION OF TOTAL CONSTRoc'rION
Ll ElLBlC'I'RlCAI,
-------------.---
At1P SElRVICEJ
o
FlJORIDA POWER
[J
N.R.E.n.
[] Pl,tJt1BIN<.3
LJ HEUHAN IrJAl,
$----..------- VAIJUATION OF t1ElCHANCIAr, UISTAl,I1A'1'TON
[J W\ 8
LJ ROOFING
[J SPEr!IAUl'Y
[) OTHER
'l'YPE OF' COHBTRUCTIDN I [J BLOCK
[] FRAME
[] STEEllJ
[) OTIlElR
FIN ISHElll FLUOR ElIJElVATIONS
IS PRO,fEC'I' IN FLOOf) ZONEJ ARElA 0 YRlS
o No
BUITJnlllR
******************************************************************
Cot1 PAN Y_..__. ____...._ '"_____ __________.. _ __..._._.. ____.._. ___ ."__
8TA'I'El CFJRT OR RElC3IST # .___ _____._..________._._ ___.__
CITY PROCElSS INC3 It__. ______.__________ __. __ ______..__.____
8lr:n.JATtJREl
--.--.- -_._----._-_.~-----..-~--~---------.-------_._~_._--
ml,JlIC'rRIC!.lUt
S Jr3HA'l'lJRE ____
.. . '------- .~-- -.-.---.-.. ._---_..~.._~ ."--. _.-.__.._--~-+---
COl1PANY _..__..__________ _______ -------___n______________ .____
STATE CERT OR REGIST #
CITY PROCESSING #
'--'--"-.-- -....-.+.-.---.----. -----..,----. .---
******************************************************************
--------..-----_ ___ h___ _ ____.__. _.____.__ .__ ~_"__
PIJUMBBJR
.._--,.._--_..._~._._......._-- _._-~_.-
r~(JM PAN Y ----_______..______________________ ._. __ _..________..._
STATE CElR'I' OR REGIST # _____..._.._.__~..______...
CITY PROCESSING #
S I {JNJ\'l'lJRf1l
MBlCHANICAr, CO!vJPANY ______.____.____________...._...__
STATE CEnT OR REGIST # _______..________ _m_n.....__._____.
SIGNATURal CiTY PROCESS INn #
******************************************************************
.----.~ _. ".--.-- --~--.--- ._-_..._.._--~___ _M._
-.---------------..-----.--.,..----.------ - ---...---..---..--. n__________..__n. ._..~_._ _.___.
*****************************************************************
OT lIBR '._ .~;t~y,/;"; 12.()(}rl?-?- (g/(_IC.L.fl_V:lifr~(),.1PANY ~1IJ...lt..I_ ;t.P!k~;f,~-....-..-_m-__..___ ___.
/?, "j-.....J. STJ\1'E f'RJRT OR REGIST # t!-OOIl/zu!
SWW\'l'tJRRJ ~ CITY PROCESSING # -.-..-'L'tt__.:t..__.______._.._....
-- --------------.----- -----.JJll__________.____..._~..._._.______..
***********************************************************~*****
CONDI'l'IONS OF PERlvtI'I' AE'E'IDAVIT
A. NOTICE OF DEED RESTRICTIoNS
The undersigned understande th~t this p!::rmit may be subject to "deed restrictions" wldch
mC:lY be more restrictive than City regulations. '1'he undersigned assumes responsibility for
compliance with any applicable deed restricti.ons.
B. UNI,ICENSED c':ONTRAC'l'ORS AND CON'I'RACTOR RESPONSIBIT,I'l'IES
If the owner lias hi.red a contractor or contractors to undertake work, they may be required
to bl:> licensed in accordance with state and local regulations. If the contractor is nut
11 cansed as required by la\'~, both the G\mer and contractor may be oi ted for a mlsdemeanor
violation under state law. If the owner or intended contractor are uncertain as to \~lat
licensing requirements may apply for the intended work, they are advised to oontact the
City of Zephyrhills Building Department, 613-788-6611.
Ifurtherll1or-e, 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 applioation for which they
wiLl be rtlsponsibltl. If you, as the owner s.igns iSlS the contractor, you are indicating that
YOll, rather than the contractor, are responsible for the Hark. If the contractor Hishes
you to slyn at:! contractor that may be an indication that he ls not properly licensed and is
not entitled to permitting privil~ges in the City of Zephyrhills.
C. TRAN::;POR'1'ATION IMPAC'1' FEES AND U'l'II,I'1'Y CONNECTION !J~EES
D. CONS'rRIIC'l'UION LIEN LAW (CllAP'I'ER 713, FLORIDA S'rATUTES, AS AMENDED)
f cert1fy that I, the appli.cant, 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 "owner", I cerify that I
Ilave obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to conmencement.
El, CONTRACTOR' S/OWNER' S AFFIDAVI'l'
I certify that all the information in this applicat10n is accurate and tllat all work will
be done in compliance wi th all applicable laws regu1 aU ng canstl-tlction, zoning, and land
development.
Applioation is hereby made to obtain a permit to do work and installation as indicated. I
certi fy that no \wrk or installation has conunenced prior to issuance of a penni t 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. J also
certify that I understand that the regulations of other governmental agencies Inay apply to
the intended Hark, and that it is my responsibility to identify what actions I Illlltlt take to
be in compliance. Such agencies include but are not limited to; *Department of
EnvirollTl!ental Regulation-Cypress Bayheads, Wetland Areas and Environment.ally Sensj.tive
Lands, Water/Wastewattlr Treatment
*Southwel:>t Jj'lorida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
"Arllry Corps of Engineers-Seawalls, Docks, Navigable WaterHays
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*u.S. Environmental Protection Agency-Asbestos abatement
1 also certify that, if fill material is to be used in Flood Zone ~A" or "A,etc.N, it is
understood that a drainage plan addressing a "compensating volume"'will be submitted Hhich
is prepared by a professional engineer registered in the State of Florida pdor 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, con~truction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is cOllunenced Hithin
six months of issuance, or lf work authorized by the permit is suspended or abandollect for a
period of si.x months after the time the work is conunenced, One 90 day extension of time
may be allowed for the permit Hith fee charge of $15.00. The extension shall be ~equested
ill writing to the Build1.ng Official. An approved inspection must be Jogged during each'alx
month period, or the project Hill be considered abandoned.
WARNING '1'0 OWNERl YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUW' IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR 1'ROPER'ry. IF YOU IN'rEND TO oB'rAIN E'INANqINq, ~()Nl?UI:r
WITH YOUR I,ENDER OR AN A'I"rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'r. ;JOBS UNDER
$2,500 IN VALUE DO 1'10'1' NEED 'l'0 RECORD AND 1'08'1' A "NO'f'ICE OF COMMENCEMEN'l"'.
SIGNA'l'UREl OWNER OR AGENT
SIGNA'i'URE; CONTRACTOR
acknowledged
, 19_
STA'I'E OF FLORIDA
COUNTY OF
The foregoing instrument WaS aokllowledged
Before me this --slay of----, 19
by
(name of person acknowledged)
Qho is personally kno~1l1 to me, or
STATE OF FLORIDA
COUNTY OF ----
'J'he foregoing instrument was
Before me this _.___ day of
by"
(name of person acknOWledged)
Dwho is personally knoHn to me, or
of identification)
take an oath.
lJ Hha has produced_____________
(type of identification)
and who Ddid [).Ud not t.ake all oath
o Hho has produced
(type
and who[] did Ddid not
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Hame typed, printed or stamped
-
Nan~ typed, printed
Dr stamped
- _.~ ~--"----'------:-'--'--'----'--------'----------,-~------- --.
'-.. . .'" GA VIN ROOFING
PO. Box 1363
DADE CITY, FLA. 33526
Uc.#RC0046241 - Bonded. Insured
p
Page \/0.
of
Prlges
(352) 567-5034
2 YEAR lEAK WARRANTY
JOB ~AME / NO
LOCA TIO/\
"'.
It
To:
...
We hereby submit specifications and estimates for:
>
"
....-...-
/'
...",.
i
-'
>
WE PROPOSE hereby to furnish material and la.bor - cDmple,ttj in accordance with these specifications. for the sum of:
~ / ):.;;.,/ -~../ +- .~
Payable as follo~s:
dollars ($
).
f
t
.....
i...,.".
All material is guaranteed to be as speci fied. All work to be completed in a workmanlike manner
according to standard prar:tices. An~v alterations or deviation from above specifications involving
extra cost will be executed only upon written orders, and '.vill become an extra charge over and
above the estimate. All agreements contingent upon strikes, accidents or delayCs heyond our
control. Owner to carry fire. tornado. and other necessary insurance. Our workers are fully
covered by \-\Torkmen's Compensation Insurance.
Authorized
Signature -'____.___
NOTE: This proposal may be withdrawn
by us if not accepted within
days.
ACCEPTANCE OF PROPOSAL - The prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do
the work as specified. Payment will be made as outlined above.
Signature
Date
Signature
Date