HomeMy WebLinkAbout03-1979
BUILDING PERMIT
Permit N2
CITY OF ZEPHYRHILLS
(813) 780-0020
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Property Owner:
Job Address:
Parcel I. D. ,
~1 -~'; ~
1979
Date '1- Lj'-c 3
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Descriotion of Work
Energy Code:
c- .
~Ior'
Radon Gas:
Inspector
Permit Fee ~ Rr
;XSignatu~ ~ ""',~
Company
Address
\hlephone# "5 \ ~ - 9y Ci -. L Yo ~
FINAL
NO OCCUPANCY BEFORE C,O,
Complete Plans, Specifications and Fee Must Accompany Application, C.O,
All work shall be performed in accordance with City Codes and Ordinances,
Valuation or
Contract Price
s: 000 . tflA>
DATE
City license Registration #
State Certified license#
~jJ &c;t~ afck.s .
BUILDING
ELECTRICAL
SLB
Tub Set
Water
Sewer
Final
Ftr, ./f-t./'p 3 ~/-fJ?J Tp. Serv,
Pre SLB Rough In
Lintel Meter Can
FRM. Const. Pole
Insul. CL Pool
WL Pre-Meter
Final
Driveway
MECHANICAL
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of twenty-five and 00/100 Dollars ($25.00) shall be made for each trip for each trade:
a. Wrong Address
b, Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d, Work not ready for inspection when called.
e, Permit not posted on job site,
f. Plans not at job site.
g, Work not accessible,
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same,
CITY OF ZEPHYRHlr~IJS PERMrr APPldCATION l~' l{-I-03
BUUDING IlBlPAR':F-MH:NT 6335 8th S'rREm'r ZmPHYRHUI,S I iL 3384 .' _. ' .,
PhoneIB13-780-0,020 'a:X:,813-780..0021 '.. -J' ..,. ''2
fJA'rB1 RB<1Jil!VSD ,-::3i~-,-f?~__
pr,ANS JUlIvnw I'S _,__ _._'!"'.,____.
OI'lNEJR f S llM1El __~o..,~_\_..~ ~ -~~_--=--'Lf'_~~_-il$....~__n__________~____ PHONE CON'l'/W'!'~~3.: 3_~:B-::- -b~_-o""8
,TOB SITS ADlJRBJ8 S.__5.xL'3.k___J...J_h..___ -~1-----________~_______.____
IJBHJJ\L DHlSCRIPTION: LOT (S) 2' 2.1- L~:tl.-\ BU)C'K '2.. 0 "')
--'f.---~;r-- -----.--
PARCEl, III IfJ.L ~.~. t...\_..Qg_~~__._ 20_10 o__.~L\ ~___~___~~~TAIl'~._~~R(~~_-=-~.~~~~~_~.'I:~~._~~~1~~_~~_~._
WURK PRnpSElDI [JNBlN ('ONS'I'RUCTION [J ADDITION [JAUI'ElRATION [] RElPAIR LJ lN8TJU,I,
SUBDIVISION
--..--------.....-.+-.---....-......-..-. ----~--
~smH
fJ ~10VEl
o DEltifOl,ISH
PROJ:lOSEJl USE I [Jsm, FAMILY DWELTJIHrj
[Jr1tJI.1'I - FM1Il,Y
[]# OF mUT8
fJ SWH1MIWJ paUL
fJ MOB u'El Bor11l1
(] OTHElR
8cm1MIllRC!lAII
[] INDUSTRIAL
IJEJ8CRIP'I'HJN OF 110RK
CJ RElS'I'AURANT & HEJAlm{ DBJ~ARn1EJN'I' APPROVAL
-- =r..bL1.~:L5j~.
----~----._-. .--.--___.1_.~___________~____.~ _..._____... ..___.__ _~
BlJII,fHNt; S 1 ZEl
-.------..--------,-
SQUAREl FOOTAGE
-~_._._-_._--......-
HBlHHI'r
RElBIDBlHTIAT'I
Cm~1MIllR(!IAr.'1
A'l"rACH (:2) PI,OT PIJAl1S& (2) 8ElTS OF BUIJ,DUHl PLANS & (1) BElT ElNElRC1IJ F()R~18,
A'r'li1\CH (3) SE'l'S OF BUiLDING PLANS & (1) SBlT ENElRny FORMS.
PROPlllRTY SURVEY RBlQtJIRElD FOR 1\1JL NElW CONS'1'Rl1C'I'ION .
RERMITS REQUESTED
tJ B1Jn.IJINC~
$___..s~_c>t:!. oU___-, VAl,UATION OF TOTAL, COHS'fRtJC'I'ION
Ll lllLIllC'rRlCAI.
-----__.___ AtIJP ~E1RVICEl
o FLORIDA POWER
ow. R , El . (1 .
(] PlttltlJB INC~
o IIJBlUHANIC!AJJ
[] (JA8
r.J ROOFIlm
j'
$------
~SPEJC1AL'I'Y
----- VALUATION OF tlJElCHANCIAI, UIS'rJU,i,ATTOH
[I OTHER
'l'Y'J?1ll OF C!ON8'1'RUC~'I'ION I [] BIl)CK
[J FRAME!
[) STEEL
[] OTHER
FINISHBllJ FI,oOR IllI,ElVATIONS
18 PROLIElC'r IN FLoon ZONE! ARElA 0 YElS
o No
BUILfHllR
SlallATtJRID _d.~_~~_~________
Cot-1P ANY_&~~~ ~~--~-~,l~.\.~_~i:~.. ___:t,~_~____.__
8'1'A'I'81 CERT OR REGIST #/: <J'3---c.o_.55''j33_._~_____
C I'rY PROCElS8ING fL_.__________________...______......_________
******************************************************************
ElJt,lllCTRICIAN
cm1P ANY ______ _________________________.___.
STA'l'El CERT OR RECUS'l' #
SIlHTA'I'11RE ----------..---..--________.._______________~ CJITY PROCESSING #/:
'"---.--. ._-...- - _._.-...-------~..._-.......-...-
* * * * Id * /I * * * * * * * * /I * * ** * ;\ * * * /I /I * * * /I * /I IHd * /I /I * * * I< I< * * * * * * * /I * * * * * * * * * * * * *
._--_..-._----_._--,~_. --"-"-. . -.---.....--.----------
PI,UMBER
..- ....__._......* .--.------- -.~----
C !O~l P AtIY --..-------'~------._------------...-----..--,----------..-
STATE CIlJR'I' OR REGIST If ________________________
CITY PROCEl8SING #
8 WNA'l'tJR El
SWNA'I'iJlHl1
'********,*********.**********************************************
COMPANY __________________________..___ _____
STATE (tElRT OR REGreT # --.----.-----------__.____~n_.
CITY PROCESSING #
.-..--....------.--.---..-....--..---.------..-...-
MIIlClHANI CAT I
-----~---_....__.._--
---~-_.._._-_._-- _._~-~"
**********************************************************'**"*'
OTHER
-.......-..-----------..-..----------.
(!m,1PANY
srr1\11E CPlRT oR-REGrsT -#-_____~h._.______ .--.-.---"-~,.-~~-
CITY PROC8188ING # ---.-----~--- -.-----.-----.-----.--_.
8ImlJ\'1'tJREl
--------""'---_._-_.----~
****************************************'**'*********************
- ~---_._;.-. -_.-- -----_._--~--._--_._.- .-- _._-~.'._---- --_.
CONDl'rIONS OF PER1'1l'f AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The uQderaigned understands th~t this permit may be subject to "deed restrictionsU which
may be more restrictive than City regulations. 'rhe undersigned al3sumes respollsibil:i. ty for
complignce with any applicable deed restrictions.
B. UNI,ICENSED 'CONTRAC'l'ORS AND CON'l'RACTOR RESPONSIBII,I'I'IES
If the ol'iner has hired a contractor or contractors to undertake work, they nlay be required
to be licensed in accordance Hith state and local regulations, If the contractor is not
licellsed as required by law, both the owner and contractor may be c:.:ited for a miademeanor
violation under I:Itate law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, tlley are advised to oontapt the
City of Zephyrhills Building Department, 613-786-6611.
FurtherllioJ::e, if the owner has hired a contractor or oontraotors, he is adviaed to have the
oontraotor(s) sign portions of the "Contractor SectionsU of this application for whicll they
will be responsible. If you, as the owner signs as tile contractor, YQ4 are indicating that
you, lather than the oontractor, are responsible for the wox:k, If the oontraotor wishes
you to siyn as contractor that m<\y be an indication that he is not properly licensed and is
llot entitled to permitting privil~ges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT ji"'EES AND UTILI'!'\, CONNECTION E'EES
D, CONS'fRUC'fUION l,IEN LAW (CHAP'l'ER '713, FLORIDA S'l'ATUTES, AS AMENDED)
1 oertify that I, the applicant, have been provided with a copy of "florida's Construction
lien Law - Homeowner's Protection Guideu prepared by the Florida Depirtment of Agrioulture
and Consumer Aftain, If the applicaqt is someone other that: the "owner", I cerily that I
have obtainecl a copy of the above described document and promi.se in good faith to deliver
j t to the "owner" prior to oonunencement.
E, CONTRAC'l'OR' a/OWNER'S AfFIDAVI'l'
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating constnlCtion, zoning, and land
development.
Appliuation is hereby made to obta1.n a penni t to do work and installation as indiaated. I
ce~tify that no Hork or installation has conunenced prior to i.ssuance qf a peulIi t and that
all work wi.ll be performed to meet standards of all laws regUlating oonstruotion, City
codes, zoning regulations, and land development regulati.ons in the juri.sdiction, J also
certify that I understand that the regulations of otller governmental agencies may apply to
the inteuded work, and that it iel my responsibility to identify what aat10nli I Illust take to
be in compliance. Such agencies include but are not limited tOI *Department of
Environmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Sensttive
Lands, Water/Wastewater 'rreatment
*Southwest li'lorida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waten/ays
*Department of Health Ii Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.B, Environmental frotection Agency-Asbestos abatement
I also certify that, if fill material il:l to be used in Flood Zone ~Au or "A,ete,", it is
undelstood that a drai.nage plan addressing a "compensating volume"'will be submitted Vlhiuh
is prepared by a professional engineer registered in the State of Florida prior to perrnlt
issuance.
A perroit issued shall be construed to be a license to ptoceed with the work and not as
autllority to violate, cancel, alter, or set aside any provisionl:l of the technical codes,
nor sllall issuance of a permit prevent the Building Official from thereafter requiring a
cor~eQtion of errors in plans, cDn~truction! or viol~tions of any code. Every p~Imit
iSfi~~d l:ihall beoome invalid unlen the work authorized by auch permit is cOllunenced w.tthin
six months of iasuance, or if work authorized by the permit is .suspended or abandoflild f9r a
period of si~1 months after the time the work is commenced, One 90 day extenlilion of time
may be allowed for the permit with fee charge of $15.00. The extension shall be reques~ed
in writing to the Building Official, An approved inspection must be logged during each .s.tx
month period, or the project Hill be considered abandoned.
WAm~ING TO OWNER I YOUR FAILURE TO RECORD A NOTICE Of COMMENCEMENT MAY RESULT IN YOUR
PAYING 'l'WICE FOR IMPROVEMENTS TO YOUR PROPER'ry, IF YOU IN'fEND TO OB'l'AIN ji"IINANGlNq,~9H~UI/r'
WITH YOUR LENDER OR AN A'f''rORNEY BEIfORE RECORDING YOUR NO'I'ICE OF COMMENCEMEN'I', 'JOBS UNDER
$2,500 IN VALUE DO NOT NEED 'I'O RECORD AND POST A "NOTICE OF COMMENCEMEN'I'''.
SIGNA'1'URE: OWNER OR AGEN'r
SIGNATURE; CONTRACTOR
S'rA'rE Of E'LORI DA
COUN'rY OF
The foregoing instrument was acknowledged
Before me this ____ day of ___, 1!L-
by.___.
(name of person aclmowledged)
o \tho is personally known to me, or
Dwho has produoed
(type of identification)
and whal] did Ddid not take an oath,
STA'I'E OF FLORIDA
COUNTY Of
The foregoing instrument w~s acknpwledged
Before me this ----Jiay of----, 19 _:.....
by ___.
(name of person acknowledged)
o.,ho is peJ::sonally known to me, or
DHho has produced
(type of identification)
and \</ho Ddid DUd not t.ake all oath
Signatul'e of person taking acknowledgement
Signature of perl:lon taking aoknowledgment
Ha.me typed, j,Jdnted or stamped
-.--_.._-.--.-~..-~_.~--
Name typed, printed or' l:ltamped
APPLICATION FOR PERMIT
CITY OF ZEPHYRHlLLS
BUILDING DEPARTMENT
cJl.J,371)->' ;t
- ~.zi!V 1,/;-/1-03
OWNER'S NAKE ( . G... ~ \ ~ 0 <'Q.."",
OWNER'S ADDRESS _ f>c ~O}l.
JOB ADDRESS 5" D 3 ~ J -{. )....
ll' v-~~~
G,Y 5" '- Lv--t L. \'\
s -+ 2. ~~\-."I ('" hI. \\ ~
LEGAL DESCRIPTION: LOT(S) V.~. '2i3 1-'-\ BLOCK ~()") SUBDIVISION
, , ,
PARCEL I.D.I~l '2.6 1..,,\ eo\o 1.,0'100 D'L\ 0 (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
LSign _Move _Deaolish
PROPOSED USE: _Single Faaily _M/F _, of Units _M/H
_eo..ercial _Indust. _Swia. Pool V(;ther
_Restaurant & Health Department Approval
DESCRIPTION OF WORK:----PO \Ala \0(' fa C. e ld(. \0 C4 c. k S 't j ~ iMtl\tA k1~{) l'9 ~
S','^'$\c s'-t-c.t:\ (;,'1 fok. ~\~lt... ~/~3')<S' CO&.\.Ctc:.-fc ~..kr
BUILDING SIZE: X. Square Feet. Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. Jt:
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. '. ~j-.:J.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. V?~~) :;r;; ~ ~,~, 'Y~
PERMITS REOUESTED j) tv (!A. e1 ~~
f;,0\90 Valuation of Total Constructi n c: ~.~
AMP Service Florida Power Corp. (!J;l,{Jo 'w':k~:C.
STi {( rJUcP
0/ c- Of/.Y
eb '3 <)/~ d,
$
_BUILDING
_ELECTRICAL
_MECHANICAL
$
Valuation of Mechanical Installatio
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION:
_Block.
Fraae V Steel
- -
Other
FlRISBED FLOOR ELEVATIONS: iC,
FT.
IS PROJECT IN FLOOD ZONE AREA?
NO 1f
qO" ~
CONTllAC'l'OR s~ . ~1.1
BUILDER ~ COMPANY S _ y W C{ ~ t 5t V\ s L:L. C
C ~ State Cert. of Regist. ,
Signature A City License Registration f ~ C> U
~ **** * ********************************
YES
******************************************
RT.F.CTlUCIAN COMPANY
State Cert. or Regist. I
SiDnAture City License Registration t
******************************************
PLUMBER COMPANY
State Cert. or Regist. I
Signature City License Registration .
******************************************
MECHANICAL COMPANY
State Cert. or Regist. .
Signature City License Registration I
******************************************
OTRRR COMPANY
State Cert. or Regist. .
Signature City License Registration #
******************************************
APPLICATION APPROVED BY PERHIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to "deed restrictions" which lay be lOre restrictive than City
regulations, The undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertale worl, they lay be required to be licensed in accordance with
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
FurtbeIlore, if the owner bas hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the OlDer sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and Is not entitled to perlitting privileges in the
City of Zephyrhills,
.'
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES {'
D. CONSTRUCTION LIEN L~W (ClmPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law _ HOIeOMDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner" prior to COllenCelent,
E. CONTRACTOR' S/OWNER' S AFFIDAVI'l'
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no worl or
installation has cOllenced prior to issuance of a perlit and that all work will be perf OIled to leet standards of all law8
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of otber goveCRlental agencies lay apply to the intended worl, and that it is
IY responsibility to identify what actions I lust tale to be in cOlpliance. Such agencies include but are not lilited to:
t Departlent of EnviroDleDtal Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treallent
t Southwest Florida Water Hanagelent District - NeIls, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
t Deparllent of Health & Rehabilitative Services, EnvirODlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
t US EnviroRlental Protection Agency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone RA" or "A,etc.", it is understood that a drainage plan
addressing a "colpensating volO1e" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit. issuance.
. A perlit 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 is~u~nce of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery perlit issued shall heCOlB IDvalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the perJit is
suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day eatension of tile, laY be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. In
approved inspection lust be logged during each six IOnth period, or the project will be considered abandODed.
WAMING TO ONNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCEHKHI HAY RESULT IN YOUR PAYING IIIICB FOR IHPROVIIIBIrS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FIHANCING, COHSULT WITH YOUR LENDER OR AN ATTORRKY BEFORK RICORDIHG YOUR NOIICI OF
COHHENCEHENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COHHKNCEHKHI".
SIGNATURE: OWNER OR AGENT
, I
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregOing instrument
before me this
was acknowledged
, 19_ by
STATE OF FLORIDA
COUHlY OF
The foregoing instrument was aCknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
30"h .x6'w.
1~-;~'~~~~'---1
l ~u2~"h.X6'W. J
I 24"h~~~~~1
Ernest S. Si~ P.E.1I8161
Silcox Eagiaeeriog, lac.
Civil Engineering
5409 N. Nebraska Ave.
Tampa. FL 33604
(BI3) 238-9755
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Express Home Buvers
HOMES-MOBILE HOME PROPERnESe NOTES
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~nlr:. art'l'(ork :s tii~ PfO~rtj of :';lIywot.;h Signs- An..,
unaulhcazect usa Qr JC{XOdi..'c..mn. of !his desIgn g;
:;!nc!1y furl1idlcn ~j",f(>S;:. n1~gP-m!:'ts h3~l? been
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Ernest S. Silcox, P.E. ##8161
Silcox EugiDeering, lac.
Civil Engineering
5409 N, Nebraska Ave.
Tampa. FL 33604
(813) 238-9755
By ~igring h,,,e. ,...tomer accept> de"\ll1 ,.. i>. Any
Changes made al!llt completion wit be chaJoed in
acldtllon to originally agreed price 01 work_
SILCOX ENGINEERING, INC.
5409 Nebraska Avenue
TAMPA. FLORIDA 33604
Phone (813) 238-9755
JOB 1\, \)./<:1')! '(, t./:;,tr.~I-\.,~ f .~
SHEET NO. I
OF
CALCULATED BY
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DATE "':!
CHECKED BY
DATE
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