HomeMy WebLinkAbout03-1914
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 780-0020
1914
Date
3-/:3-03
~ ~AL
:",penv Owne' - ~8~
Job Address: ..:5 I ~
Parcell.D. #
P~
;ft,,~~
7ff ~~ .
~NICAL
Sewer Conn
Water Conn:
Water Meter;
T_I.F.'s:
Zoning: Energy Code: Radon Gas:
Qesc,;pt",nof Wo" ~:tq~ A~~""'{3;l;:t5i;;
AW~: "LJj.J...~, _7<: 70 'Ac ~ u ~..eE-/7J7:7"')
~l7mc .5t:zE '1.:5 ,EX.1371~- /9~:1u~'/7I11E
NO OCCUPANCY BEFORE C.O. ~ PhV~' FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Valuation or
Contract Price
~ o DC)
1f (;>0
~mit-fee ., .:i. I -
~.nature-).W . JV1~
Company
Address-~
~~.~)rl?- yqi- lnl
City License Registration # _____-
oe'';f;ed ucens~_______
0-rJ~
BUILDING
E LE CT...QfC"AL
~
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PLUMBING..
~
ME~r'..
---
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Ins!.
Compressor
Final
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 ($25.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
CITY' OF ZEPHYRHIIJLS PERMIT APPldCA'rION
BUIMlING IHllPARTMBJNT 6335 8th S'rRBJEl'r ZBlPHYRUII,I,S, P'L 33/HO
Phon.1813-780-~020 FaxI813-780-0021
lJA'fBl RBC1B1IVllJn
PJJANS RIllVIIIIW Jl'P:"
. / ... ---- -----. -"-. --- .. .(<tI1
OwnER' 8 nAME -K'f_"I__~ ~ e L______ ______________ PHONE f!ON'j~n~JIJ3 .~-:i'i];;~,
,JOB SITE! ADlJREJ8S .5.'tyJ.lD:.~_~_L__________________________ ____ -.---..-----.._m______~_~ u,_ __ .'_'_
/ C ..fl-l.l/ 3-- / .:( - 03
L--
LElGAL DEJSC!RIP'I'IOll: LO'r(S)
BfJ()CK
SUBIlIV I SION
-._._---~._",.-----
PARCEl, '" # _tLl. k-;'--L-"tlLJ1~ 0 D __. 0 ll.\Jl__ _________~O~ TAIl' _ !'ROM!R~ P.I;J""''. TA~~(~~'(",!_
WURK PROPSE!D I LJNIlJl'1 CONSTRUCTION [J AfHJITION 0 A IlI'EJRA'I'ION [J RBlPA IR U ] N8TALI,
----.-.------.-." _... .---.....-.--- '-"'"-'-~--'-
[) S IGll
PRO),108EIl USE: I [\~8m, FAMIlJY DWELIJING
[J MOVE:
[J DEJfvlOI,ISII
r-Jf1lJUn.. FA/v1IliY
[]# OF l1IU'I'S
[]SWH1MUIG POOL
lJ M08II,FJ H()t~E
LJ OTHElR
fJ Cot1M!1IR(! JAr,
o INDUSTRIAl,
C:::J REISTAlJRANT & HEJAlmr DBlPARTt.1E1NT APPROVAf.,
])IDBCRIP'!' toN OF NORK J&jllt.u.;lIlj..fkt'__AL-~," ~~it!?A'~i$;.-@trrf~
BIJIJ,TJIN<l SIZE -.------.. --_.__ 8QU~~OO5W' ~"'-.:. 11m I 1'1' .___ ___._ ___
RE8IDElN'rIl\f1l A'I"I'ACH (2) PLO'I' PTJAllS & (2) SETS OF BUIJ.IHNG PI,ANS & (1) SElT ElNIilRI1Y FORMS.
(~O~1MElRCIJ\fJ: AT'l;J\(!H (3) sm'I'S OF BU1LfJING PLANS & (1) SElT ElNElROY FORr1S.
PROPERTY SlJRVElY REQUIREfiT FOR ALL NEN CONSTRUCTION.
.- ~ /
(//.435' -j~./
~IS RBlQYBlSTl1lD
[) BlJIr.I.lIW~
$ I DO D._ VALUATION OF TOTAL COHs'rRUC'I'ION
-.-.-.J.----_____._..__ .___
[J ELIilCTRlCAl,
---.-------__ Ar1P ~ERVICEJ
o FI,oRIDA POWER
[J W.R.El.n.
f] PWf1BIN(]
U 1.1El<..!HANIC!ATJ
[] (JAS
r.J ROOFING
$.- --..--------.------ VAIJUATION OF f1EC'HANC'IAr, IlIS'J'AI,I,ATTON
[J SPEJr!tAUl'Y
[) OTHER
TYPEJ OF COl'18'I'Rl1C!TION: [J BLOCK
o FRI\NEl
[J STElEL
[) OTHER
F INISHBJfJ FI,OOR lllIJEVATIONS
------...----
IS PROITEJC''I' IN FLoor> ZONE] AREA 0 YHlS 0 No
::"::;::~RID -LLIL1~ _____ _____ ___
Er,!IlCTRICIAN
""****************'**'*****.**********************'***""""'*
Cot1 P 1\ N Y___ _..Ow..JJ.i C_ . __________ __ _.._. __... . _"'_ .. _ ____._____._
STATE! CFJRT OR RElGIS'!' # ...--------____._u___"._____.._.__
C ITY PROCESS I NG tL__ _ ___.________________.. . _____.__.____._
8"/ <mATURE "_'_
.w___.~_._ _._~__u ._~~__ _.___._.___ ..__._____._______....___ '_ _________
cor1PANY_____ ___ _______.____.~__.___.___ _____
S'rATE: CE:RT OR RE)(HS'l' II
CITY PROCES8IN(~ #
-....-.---.... '--'.".-.-. _. .._.
PI,UMBBlR cm'l PAHY ---.-------------____m_____._____..__.__... . _._....___..__
STATE CHlRT OR REGIST # _________.___. ___.__.________
SWW\'l'lJREJ CITY PROCElSSING #
'* , * '* '* , , * " '* '* , *. , , , , , * , , '* '* * '* * " * , , * * , '* " * , * '* , '* , * , * , * '* * , , , , , , , , * , , * , * * * '*
'-.---.- .---- -__. . .u____ _ _.__.. _ _ _____ ._..__.~_..___.__
MBlC!HANI CAl,
"***'***"*'*'*'*****"'*"******'**"'************"'***'*'*****
COlvJPANY _______.___.__._ .._..__..__________.__..._.__.....
STATE CElRT OR REGIST #
CITY PROCESSING #
-----. ._-._~.---_._------._--~--- -.-----------.
SWl'IATlJREl
----'------~------------~----_._------,...._---.._-------
*'***'**"**'*'**"***'****.*********'~'**.*'*******************'*
- --_._.._-----_._._-------._--~.. - .._------_._-~
OTHER
-----_..._------_._.~----------_.._---~----
--_.----_._------~._---_._---_._----
(!or.1PANY
STATEl CE1RT"OR-RErjIST -fr--------.--------.--.
Cl'rY PROCElSS ING # -------__ _________.________....
SImlA'l't1RRJ
***'***"***""****'*"*'*****'***""********'**'*****'**~'*'**
--------- ----.--.----- >- ..--.-...----- .---..---.- -- ---.,
CONDI'l'IONS OF PERM!'f AE'FIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands th~t this perndt may be subject to "deed restriotionsU whicl!
n~y be more restriotive than City regulations. The undersigned assumes responsibility for
complicmce with any applicable deed restrictions.
B. UlnlcENSED (~ON'l'RAC'l'ORS AND CON'l'RACTOR RESPONSIBII,I'l'IES
If the OImer has hired a contractor or contractors to undertake work, they Il\ay be required
Lo be U censed in accordance Hith state and local regulat1ons. If Lhe \Jontractor 1s not
lioensed as requ1red by laH, both the ovmer and contractor may be cited for a misdemeanor
violation under state lail. If the owner or intended contractor are uncertain as to vlhat
li clansing requi rementfl may apply for the intended work, they are advised to contact the
city of Zephyrhills Building Department, 813-788-6611.
r~urther!nore, if the ovmer has hired a contractor or contractors, he is advised to have the
oontractor (s) sign portions of the "Contraotor Sections" of this appli.cation for whi oh they
will be responsible. If you, as the owner signs as the contractor, YQl.l are indicating that
you, l-ather than the contractor, are responsible for the work. If the contractot' Hishes
you to 61gn as contractor that may be an 1nd1cation that he is not properly licellsed and 1s
not entitled to permitting privil~ges in the city of Zephyrhills.
c:. 'I'RANSl?OR'l'ATION IMPAC'l' FEES AND lJ'l'HI'I'Y CONNECTION FEES
D. CONS'rRllc'rUION MEN LA\i~ (CliAprrER 713, FLORIDA S'l'ATUTES, AS AMENDED)
T cert1fy that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guideu prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "ownerU, I cerify that I
llave obtained a copy of the above described document and prom1se in good fa1th to deliver
it to the "owner" prior to commencement.
E:. CON'rRAC'roR' S/OWNER' S AFE'IDAVI'l'
I certify that all the informat1on in this application is accurate and tllat all work will
be done in compliance with all appUcable laws regul aUng construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and 1nstallation as indicated. 1
certi fy that no Hork or installati.on has cornrnenced prior to issuance of a penn1 t and that
all work Hill be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. T 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 must take Lo
be in compliance. Such agencies include but are not limited tOI "'Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensj_ti ve
Lands, WOlLer/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
"'Ann)' Corps of Engineers.-Seawalls, Docks, Navigable Waten~aYfl
"'DepartmenL of Health & Rehabilitative Services, Environmental HealL:h Unit-Wells,
Wastewater Treatment, septic Tanks
*U.S. Environmental J?rotectlon Agency-Asbestos abatement
1 also certify that, if f111 material is to be used in Flood Zone ~Au or "A, etc.", it 15
undel:stood that a drainage plan addressing a "compensating volume" 'will be submitted Hhich
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 Lhe technical codes,
nor shall 1ssuance of a perm1t prevent the Building Official from thereafter requiring a
correction of errors ill plans, construction, or violations of any code. Every permit
issu(:ld I;>ha11 become invalid unless the Hork authorized by such perm1t is oOllulIenced Hithin
six months of issuance, or 1f work authorized by the permit is suspended or ahandoqed for a
period of si.. months after the time the work is commenced. One 90 day extens10n of time
may he alloHed for the permit with fee charge of $15.00. The extension ~hall be requested
in writing to the Build1ng Official. An approved inspection must be logged dur1ng each SiK
Inonth period, or the project will be considered abandoned.
WARNING '1'0 OWNER: YOUR FAILURE TO RECORD A NOTICE Or~ COMMENCEMEN'l' MAY RESUW' IN YOUR
PAYING TWICE FOR IMJ?ROVEMEN'l'S TO YOUR PROJ?ERTY. IF YOU IN'l'END TO OBTAIN r~INA.NqINC~, \_::{.m~UI:r
WITH YOUR LENDER OR AN A'l'TORNEY BEFORE RECORDING YOUR NO'l'ICE OF COMMENCEMEN'l'. JOBS UNllER
$2,50n IN VALUE: no NO'l' NEED '1'0 RECORD AND POS'l' A "NonCE OF COMMENCEMEN'l'''.
__.__._______________n
SIGNA'l'URE: OWNER OR AGENT
S I GNA'I'URE : CONTRACTOR
acknowledged
, 19~
STATE OF FLORIDA
COuNTY OF ---
The foregoing 1nstrument WliS aoknowledged
Before me th1s --SJay of.---, 19
by
(name of person acknowledged)
Qho is personally knOi-m to me, or
STATE OF FLORIDA
COUN'l'Y OF
The foreg01ng instrument was
Before me thia __ day of
by~
(name of person acknowledged)
Dwho is personally known to me, or
o who has produced
(type
and who[] d1d Odid not
of identification)
take an oath.
o who has produced__________
(type of 1dentificationl
and v~ho Ddid OUd not t.ake an oath
Signature of person taking acknoHledgement
Signature of person taking acknoHledgment
Name typed, printed or stamped
Name typed, printed or stamped