HomeMy WebLinkAbout03-1969
BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 780-0020
1969
Date
3-3/-03
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel 1.0. "
Zoning:
Descriotion of Work
c!~(J.'Le0 P .!Let! 0'"
5<.{3~ ,t~ ~T.
Water Meter:
T.I.F.'s:
Energy kode:
S N.A-~
Radon Gas:
g-)(fO
FINAL ~- '1 ~ ~.3
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Inspector RL" J- II\}tJ
City License Registration #
State Certified License#
Permit Fee
).-.5ignature
Company
Address
">r8lephone #
~3 - , "
) . / / /
/: // ../ 7L/
( /.",~-1--. ,X- . -- .' .;r
Valuation or
Contract Price
[; j>- h 3- d-:7 J j'
Of,J HR--Y
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.
Compre
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.
'MUER' a II'''E ~ jJ ~l2 '1- Q-"t~~-jf_!'k.foJ; ~__ L o~ _ __~__~_~ ____.._
,TOB S l'fE! ADDRESS . _. n6!L33__~_J! "!~__5L_~__.____ _~ . __. ___
CITY OF ZEPHYRHII~LS PERMrr APPIJICATtON
aU!ljDINCl DIllI?ARTMElNT 5335 8th S'fREm'f ZIllPHYRHILljS, P'L 3j~40 ,.
I?honeI813-780-~020 ta~le13-780-0021 '.
nATIll RIll(!2!lIVJlID ____l:,Il:"'p.J__
I?I.ANS R!llVI!IIW J'llIiH'-n_~_'!: ,___._.
,.,
. '
PHONE C()N'l'Af~'I'
-" .
... ...-- -_.._~...--,-_._...- .'-"-' _.'-,..~
LEOAL DESCRIPTION: LOT Is}
B IJoe; K
SUBlJIVISION
-....--.-------........ ._._..~,---.....--_.._----
PARf.1ElIJ III It
-_._-~----_____M.-:-""'_ ____________.__.___._.._.______..____.___~_______.._......~._'_.____,_'~_.~________~.._..
(DBTAHI FROM PROPEJR'l'Y '!'AJ{ NO'I'H!Ill)
WORK PRnPBElfll [JNBJW c'oNS'I'RtlCTION
[] AI1DITIdN
U AUl'ERA'rION
[} RElPAIR
IJ ] NeT1U,I,
ClSWN
fJ MOVE
o DEWJIIISI!
PROPOSEJI1 USEI I []SrJI, FAfvltLY DWELrIIlm
r-lt1UUl'I. FAHn.Y
U# OF tlNI'I'S
[J SNU1MING POOl,
LJ MOB TI.El Itof1E1
[J OTHIllR
fJ Cm'1~1BJR(! lA [,
[]UlDUS'l'RIAL
o Ral8'I'AURANT & HElAI1T!r DEltJARTt.1EJN'r APPROVAr-l
lI.aCRrPTIO" OF WORK jt1q'~"._fb.1L SI!fL2~A 1?~--_AL7-:::::l--t:t'~ '?-----~---- ~- -, T ''-' ~
8UII.THN(1 SIZE ---J.J'.'-1__?._________ SQUARE FOOTAGE -----8J2_____ HEIGHT .,-__CJ/~~.___
RESIDENTIAl'I
(~O~1MBlR(~ 11\IJ:
A'I"r1\CH (:2) PI,OT PI-lA1IS & 12} SETS OF BtJII,nINI~ PLANS & 11) SElT E1NElRr.H:' FORMS,
A'l'liA.(~H (3) SEl'I'S OF BU!r,rnNG PLANS & (1) SET ENERny FORMS.
PROPERTY SURVEY RElQUIRED FOR Al,L NEVI CONS'I'RUCTION.
RBRMITS REQUESTED
Cl BllnIJIN(~
$
-~----._--_._-
VALUATION OF '1'OTAI-I COHS'I'RlJC'I'ION
[1 EJI,IllCTRHJAI,
------__._____ ANP SERVICEJ
o FI.oRIDA POWER
[J W . R . EJ . (! ,
[] PLllt18ING
o HBIUHAN'IC!AIJ
,
$---------- VALUATION OF tllElCHANCIAI, HIS'I'AI,IJA.TTON
[] (~AB
[.1 ROOFING
[.1 SJ?EJCltAUl'Y
[) OTHER
1'Y'PIil OF' (HlN8'!'RtJ(~II'ION I [) BLOCK
[J FRAMEl
[J STillEr,
[) OTHER
FINI8HEJ1J FLOOR IllIjElVATIONS
I8 PROltElC'l' IN FLOOD ZONEl ARElA. n YES 0 NO
BI1UnlllR /1 / /'I
81(JNJ\TtJRSl ---~L
COr-1PANY ~_..___~________._______..______. __ __.____~._
8'fA'I'El CElRT OR RElGIS'!' # ______.______.._.._____.__.__~..~__..__
CI'rY PROCE:SSING lL__......_________________._.....___.._.__...._
1"*******,***,***,****,****,*****,,*******,*,,***,**,*"**'*"'"
IIJ,IIIC'rRICIA!l
S] mH\TIJREJ __.._
nO_ ~_._____. ___.___... ".__,______. ..___ _.."_~__._____._
COf-1PANY..__________ _____________________..__. _ ____.__
STATE CERT OR REGIS'!' #
C I'I'Y PROc.'E188 INl~ #
"-.--..- _. ---'--". ~.- --'----'-"-"-'-'.'-----,,--, --""-
""'*""""'*'**""'*""'*""****'*******'*'*'*''*"**'*"*'
.--.--...--.....--..______.___u___ _ _ .._. _. _._~_.,*_.. _.....___.__.,
PJJUMBlllR
._._.~---_...~.~~.-..._--_.- -.----------- -----.------
(.'OM PAN Y -.-----_______.,.-_________......__..._..___._____.___..____
8TATE CEJRT OR REGIS'I' # __________-'_____..___._....
CITY PROCESSING #
SWNA'l'tJREJ
MBlClHANICATl
"'****'**'*',.,.,*-*****'****'*'**************'*'**'*'**********'
------..----- --- ~- -------_.~._-_.- '-'--'._'_-~--_._,--.....-
---------------------.---.....---,..------
COlvJPANY ________._________.______..___ ___._______._.. ..__..
8TA'rE C'ERT OR RElCn S'1' #
CITY PROCESSING #
--..--.--.------------..------..--_____...__n_.
S TCUIA'I'lJREl
*'****"*'**""*"*"*"**"***'**"**'*"*'****'*******""**"
_.~.._~_.--._------_.._-_._---- - .~..~-_.,_.
OTIIJIlR
S WHJ\'l'tJREJ
------__.__-.......0.-__
COIIJPANY
S '1' A 'T'El CElR TCiR-MG'fST'#----------------- ----
CI'rY PROCESSING # -------.-----...--_______.
-----......_-~------~_.._._"---------~_._-------
"********'**"******"*'*"'*'***'**'**"****"****'**'*'*'*'*"
. ,
---------....... ..--.---------........-.-- ~--'---. .-.- --..----. - --
CONIlI'rIONS OF PERNI'r AF~""IDAVIT
A. NO'!'rCE OF DEED RES'I'RIC'l'IONS
'l'he undersigned understandl'l thqt this permit may be subject to "deed restrictions" which
. .
'may be more l.estd ati ve than City regulations. 'l'he undersigned assumes responsibiU ty tor
complil;HlGe with any applicable deed restrictions.
B. UNLICENSED 'CON'I'RAC'I'ORS AND CON'l'RAC'rOR RESPONSIBIJ,I'l'IES
I f the oivner has hired a contractor or contractors to undertake work, they nlay be required
to be licensed in accordance with st..te and local regulations. If the contractor is not
I ioellsed as required by law, both the owner and contractor: IlIay be cited for a mifldellleanor
violation under state law. If the owner or intended contractor are uncertain as to Hhat
licensing requirements may apply for the intended work, they are advi.sed to Clonta.ot the
City of Zephyrhills Bui.lding Department, 813-7B8-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to havtl the
contractor (s) sign pOl:tions of the "Contractor Secti.ons" of this application for which they
vlill be l.esponsible. If you, as the owner .signs as the contractor, YOL! are indicating that
you, rather than the oontractor, are responsi.ble for the work. If the contractol: wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not ent:ltled to permitting privileges in the City of Zephyrhi.lls.
C. 'I'RANSPOR'l'ATION IMPAc'r FEES AND U'I'ILI'I'Y CONNECTION )j....EES
D. CONS'l'RllC'l'UlON LIEN LAW (CHAP'I'ER 713, FLORIDA S'l'A'l'UTES, AS AMENDED)
T certify that I, the applicant, have been provi.ded with a copy of "Florida's Constrllcti.on
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agri.culture
and Consumer Affairs. If the appl.i.cant i.s someone other that the "owner", 1 cerity thi:lt I
have obtdned a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to COIlunencement.
E. CONTRAC'POR' S/OWNER' S AFFIDAVI'P
I certify that all the information in this appl.ication is accurate and tllat all work will
be done in compliance with all appUcable laws regu1 ating consti'l\etion, zoning, and hnd
devijllopment.
Appli.oation is hereby made to obtain a permit to do work and installation as indioated. 1
ce~tify that no Hork or installation has cOITUnenced prior to isauance of a permit 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 may apply to
the intended work, and that it is my responsibility to identify what actions I lI111st take to
be in compliance. Such agencies include but are not lirnited tOI *Department of
Environrljental Regulation-Cypress Bayheads, Wetland Areas and Envi.ronment:al1y Sens}.ti.ve
Lands, Water/Wastewater Treatment
*Soutllwest Wlorida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Alteri.ng Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabi1i.tative Services, Environmental Health Unit-WeLls,
Wastewater Treatment, Septic Tanks
*U.8. Environmental Protection Agency-Asbestos abatement
1 also certify that, if fill material is to be used in Flood Zone "AN or "A,etc.H, it is
ullderstood that a drainage plan addressing a "compensating volumelf'will be submitted which
is prepared by a professiollal engineer registered in th~ State of Florida pri.or to permit
issuance.
A permit issued shall be construed to ~e a license to proceed with the work and not as
authority to violate, cancel, alter, or set aside any provisions of t1le technical codel:l,
nor allall issuance of a permit prevent the Building Ofticial from thereafter requiring a
co~~ection of errore i.n plans, cDn~truction, or violations of any code. Every p~'mit
iSl:iued r:lhall become invalid unless the work authorized by such permit is oOllunencad within
aix months of issuance, or if work authorized by the permi. t is suspended or abandolled for a
period of si.x months after the tillle the work is commenced. One 90 day extensi.on of time
may be allowed for the permi.t with fee charge of $15.00. 'rhe extensi.on shall be reguel:l~ed
ill writing to the Building Official. An approved inspection must be logged during each aix
month period, or the project v/111 be consi.dered abandoned.
WARNING '1'0 OWNERI YOUR FAILURE TO RECORD A NonCE OF COMMENCEMENT MAY RESUL'l' IN YOUR
PAYING 'l'WICE FOR IMPROVEMENTS TO YOUR PROPER'PY. IF YOU IN'l'END TO OBTAIN FINANqINq, ~'tN'UL'!'
W!'1'H YOUR LENDER OR AN A'l"I'ORNEY BEfORE RECORDING YOUR NO'l'ICE OF COMMENCEMEN'l'. JOBS UNDER
$2,500 IN VALUE DO NOT NEED 'I'D RECORD AND POS'I' A "NO'!'ICE OF COMMENCEMEN'l"'.
S I GNA'l'URE: OWNER OR AGENT
S I GNA'!'URE I CONTRACTOR
S'fA'l'E OF FLORIDA
COUNTY OE'
The foregoing instrument was
Before llIe this _ day of
by_
acknowledged
,19_
STA'I'E OF FLORIDA
COUN'rY OF
The foregoing instrument WqS
Before me this --J-iay of
by
acknowledged
, 1 9 _...:.__
(name of person acknowledged)
Dwho is personally known to me, or
o who haa produced
(type
and who[] did []did not
(name of person acknowledged)
Diho is personally known to me, or
o who hal3 produced ,___
(type of identificati.onl
and v,ho Ddid [}Hd not t.ake all oClth
of i.dentification)
take an oath.
Signature of person taking acknowledgelllent
Signature of person taki.ng aoknowledgment
Name typed, printed or stan~ed
Name typed, printed or stamped