HomeMy WebLinkAbout03-1936
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N!
1936
(813) 780-0020
Date
1~ I r - CJ 3
Property Owner:
Job Address:
Parcell.D, ,
Zoning:
Descriotion of Work
ELECTRICAL PLUMBING
i1I'J~1-' 5..~~
( f I )..A~({ ~ dun-e <)
MECHANICAL
Sewer Conn
Water Conn:
BUILDING
c; ( ,
Water Meter:
T.I.F.'s:
ctQergy Code:
(..;~W~
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
;)0
P . F 1#/0 ( e-o
ermlt ee ~
Signature /:? <. ,,~..,../ ~
Company
Address
Telephone# Gq., - 9f:'y}?
j? ~}
7~ f D'
City license Registration # 2,5 eJ 0
State Certified license#
Valuation or
Contract Price
7?~scll!o Co~~
Ftr.
Pre SLB
lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
MECHANICAL
Driveway
Tp. Servo
Rough In
Meter Can
I
Const. Pole /.
Pool I
Pre-Meter ;i
/ Final
". 3 ~() 1- () 3 /Ifb
BUILDING
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
BUII~DING nEJilARTMIllN'r 5335 8th S'rRI!lBl'r ZIllPHYRHU,IJS, P'L 33540
Phone 1813 -780 - 0,020 fax 1813 -780.. OO~:A'rBl RIll(1I!lIVllIn b \L~(.~_3 ..__._
I?T.~NS RlllVIl!lW Jl'J!lBl . ,.
Ol'lNEJR'8 11M1E ~~ ~ PHONE CON'l'1\r!'~Ilii;mi.~.._
,roB SITE ADD~-~88.~..:-3~.1_L==-~ti~~~-_~~-<e;'=.J"i_ ..-Vn4f61;c P~~___I!-)~)
IJEl(U\L DHlSCRIP't'IO!T: LOT(8) -.-.d~-- BIJOC'K _._____...._ SUBDIVISION _.__.____....._.._..._ ._.._.__
PARClElI. III # _..?-..f-~~_=~(___~Q..a2- .QO(~~_-=.~Q?!J1\..~~I..~'_R()~.!.~~=-~~~.~_ 'l\~~..~~~:~~.==~~....
WORK PROl?8Ellll l.]NHlW t'ONS'l'RtJCTION [J ADnI'l'IOll []AL'l'ERATION Ll REPAIR LJ INSTAI,I,
..
[J SIGlI
o 1'10VE
[J DEMOl,ISII
pROPU8ElIl USE: I lJSGlIJ FAf1ILY DWEU,I1-lrA
r'hmUl'I. FAI"1Il,Y
[]# OF lIlH1'S
rJ S\'lIt1MING POOL
[] t-10B!l,El Hot1Bl
[] OTHER
[J CCJt1~1IllRl! IAI I
[J INDUSTRIAIJ
CJ REJ8TAlJRANT & HE:AlmI tJElPARTt1ElN't' APPROVAL,
IlElSCRIPTION OF NORK h'P~.~ __.._._ ~i~\...u~'______""'''______'_h___h_' ____.._.__.
BUU,flIN(3 SIZE: ___.____.__...___.____ SQUARE FOOTAGE _...~_.__ BEl TGH'I' .,,_.___....________
RES IDENTIJU. I
(~O~1MEJRCIAI'1
ATTACH (2) pLO'r PIJAllS & (2) SETS OF BUIJ,DUH3 PLANS & (I) SEl'I' ElNHlRny FORMS,
A'I"liACH (.3) g!Jj'rs OF BUILTJ1NG PLANS & (1) SElT ENERGY FORf-18,
PROPERTY SURVEY RHlQUIRED FOR ALL NEW (!ONS'rRUCTION,
~ERMITS REOQESTED
[] B\JIL1HNC~
L1 ELI!JC'I'R 1 CAI I
[J pI,m1BINr3
0 J.1BICHANH~AJJ
L_l.3.P~,o~ ._, VALUATION OF TOTAL, CON8'!'RtJC'rIOH
---_._.____.__._ Ar-1p ~ElRVICEl
o Ff.ORIDA POWElR
[J VI , R , El , () .
$__________ VALUATION OF ~~BJCIIP.NCIAI, UIS'I'AIJI.A'I'TON
[] (JA8
[.J ROOFING
[) SPElCtAUI'Y
[] O'I'HER
'l'YPEl OP' CUN8'1'RtJt!TIOH I [J BLOCK
[] FRAHE
[J 8'1'EE:Jj
[J OTHER
FIHI8HElIJ FJlqOR EJfJEVATIONS
I8 PRO,TElC'I' IN FLOOD ZONE AREA 0 Y!llS
[] No
BtJILI1SlR
---"~-_.._---._-~._.._._-~.._..~--~--_._._--..---_--_._--_. ---._----
cor~ P AN Y--__~ -....----.___~_h__._ _m__~ .. _._... ____._
STATE CElRT OR REGIST # ._._u____ __..____,..._ ___
CITY PROCESSING IL______._.._.____.. __.__ .,~........ _.
EllGNATlJRE
"***********'~****************************A*******************'~*
B11.BlC'rRIClJUf
. - _...__.._--_._---_._._._.,~--_._-----~---_.,.~.__.__.---.-
COl1PANY _____...._..._____ _____
STATE CElRT OR RECH 8'1' #
CITY PROCESSING #
___n____.__._.........-_..._______....._~._. _'_'_. "_...__
8 J lUT1\'I'lJRBJ ._.._
. ---..--.-- .-.- ,.. ---~._--~_. .---.. -..--- -, ,..-
*k*'*"*A***********~*****'*********'*********'****'**"**********
-.--------.---- ... ------..-. ......, - --.-......--.......---
Pr.UMBIBR
..-..........----.............-....-.-- -_._----~._----------_._-------
COM PAN Y --.--------.-__._..____._~__.__._..._..__._... .._ _...__.._._____...
STATEJ r~ERT OR REJGI8T # .___._______.______......_____....
CITY PROCESSING #
SIlmA'l'tJREJ
-----.--...- -- .-.'------.-.---- ---..---_._--~_._._.._-~
MB!CHAIUCAI,
, * * * * -I. * * , * * * * * * * * * * 'k ~ * * , * * * * '* * * * * , * * * * '* -I. * A * * * * * '* * * * * * * * * * * * * * * * * * '*
.......------------------..-----------.-.--..----------
COlvIPANY ____________.__._... ..____________. ._..___ ..... .__..__...
STATE ('ERT OR REGI8T #_____.__..___._______ .____..___
CITY PRUCESSING #
81GNA1'lJREl
-- ---~-_..~._-----_._._._-,--_._------.._. ----.--.--
*************'***************************'***************'*********
o'rUIlIR ~~__c..~i ~C to&______ r~0l>1PANY ~.f~C!..dhc~L<;_u_2~.~.___
~ S'J'1\TEJ CE1RT OR REGrST # #- 60Q 7
SIGlIA'l'IlREl ~~~~._.___._ CI'rY PROCESSING # -;z..-t:'::.E;;Q~ ..-..~..-~~J___,
---...- ---... ......>--.______...__.2c. ...._.__.__.. _. _..
*******************************************************'******'***
CONDI'rIONS OF PERNa AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
-The crnder:signed understands thijt thio5 permit may be subject to "deed restdotion,s" which
may be more .[estd oti ve than City regulations. '1'he undersigned assumes responsibi 11 ty for
compliance with any applicable deed restrictions.
B. UNLICENSED 'CON'I'RAC'l'ORS AND CON'l'RACTOR RESPONSIBII,I'l'IE:S
If the owner- has hired a contractor or contractors to undertake work, they may be required
to be Ii censed 1n accDrdance ~dth state and local regulatJons. If the contractor is !lot
lioensed as required by law, both the owner and contractor may be cited fDr a mJliidemeaUDl:
viol ation under state laH. I f the owner or intended contractor are uncertain as to ~Ihat
licensing requirements may apply for the intended work, they are advised to contact: the
City of Zephyrh.ills Building Department, 813-788-6611.
Furthennor'e, it the owner has hired a contractor or cDntractors, he 113 advised to have tbe
contractor(s) sign portions of the "Contractor Sections" of this application for whiell they
~liJl be r.esponsible. If you, as the owner signs as the contraotor, YQll are indicating that
you, lather than the contractor, are responsible for the work. If the contl'actor' wishes
you to sign as CDlltractor that may be an indication that he is not properly licensed and is
llot entitled to permitting privil~ges in the City Df Zephyrbills.
c. 'I'RANSPOR'l'A'rroN IMPAC'l' jf'EES AND U'l'ILI'1'Y CONNECTION FEES
D. CONS'rRlJCTUION LIEN LA\iJ (CHAP'l'ER 713, FLORIDA s'rATUTES, AS AMENDED)
J certify tllat I, the applicant, have been provided with a copy of "Florida's Construct10n
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and ConsUlner Affairs. If the applicant is someone other that the "owner", J cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to tht:: "owner" pr10r to conunencement.
fiL COWI'RAc'l'OR' S/OWNER' S AFFIDAVI'r
I certify that all tbe information in this application is accurate and tllat all work will
be done in compliance with all applicable .laws regul ating constr'uction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. 1
certify that no work or installatJon has cormnenced prJor to issuance of a permit 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. I also
certify that I understand that the regulations of other governmental agencies Inay apply to
tile intended work, and that it is my responsibility to identify what actions I IDUSt take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Bensj.tive
Lands, Water/Wastewater Treatment
*Southwest Inorida Water Hanagement District-Wells, Cyp.t;esa Baybeads, Wet] and Areaa,
Altering Watercourses
*Anny Corps of Engineers-SeawallS, Docks, Navigable Waten,aya
*Department of Health & Rehabilitative Services, EnvironrnentaJ 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 dralnage plan addressing a "compensating volume" 'w11l be submitted Hbleh
is prepared by a professional engineer registered in tile State of Florida prior to permit
]ssuance.
A permit issued shall be construed tD be a license to proceed with the work and not as
authority to v1olate, cancel, alter, or set aside any p.l;'ov1sions of the technical codes,
nor shall 1ssuance 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 invalld unless the work authorized by such permit is cOllunenced ~.lthin
six montlls of issuance, or if work authorized by the permit is suspended or abandoQed for a
period of six months after the time the work is cormnenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extellsion sball be tequeated
in wri ting to the Bu1.1 dJ.ng Official. An approved inspection must be logged during each ::d x
month period, or the project Hill be considered abandoned.
WARNING TO OWNER: 'x'OUR FAILURE '1'0 RECORD A NO'I'ICE OF COMMENCEMENT MAY RESUl/1' IN YOUR
PAYING '!'WICE FOR It1PROVEMEN'l'S TO YOUR PROPER'ry. IF YOU IN'rEND TO OB'l'AIN l"INAlH1INq,P9N@UL'I'
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'I'. ,JOBS UNDER
$2,500 IN VALUE DO NOT NEED '1'0 RECORD AND POST A "NOTICE OF COMMENCEMEN'll/1.
_~~_k::~ /1.~f!6rMh
'SI GNA'l'URE: OWNER OR AGEN'l' SIGNA'l'URE: ONTRAC'l'()R
S'l'A'l'E OF FLORIDA
COUNTY OF-
The foregoing instrument was acknowledged
Before we this _'__ day Df _____, 19---,-
by_
(name of person acknOWledged)
Owho is personally known to me, or
STA'l'E OF nORIDA
COUN'I'Y OF
'rhe foregoing instrument we,s aoknoVll edged
Before me this _-----.Jiay of---, 19 -.:.__
by
(name of person aoknowledged)
Ovho 105 personally known to me, or
o who has produced
(type
and who[J did (]did not
of identification)
take an oath.
[J Vlho has produced___ ____
(type of identification)
and Hha Ddid DUd not t.ake all O<lth
Signature of person taking acknowledgement
Signature of person taking acknowledgment
--------~---------~--._------~----
I'lame typed, printed or stamped
-
Name typed, printed or stampi::ld