HomeMy WebLinkAbout03-2162
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
2162
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
2162
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 5913 12TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-02200-0050
9,000.00
6/17/2003
75.00
75.00
6/17/2003 Phone:
REMOVE AND REPLACE METAL ROOFING
Name: MOYEIS. J OR
Address: 5913 12TH ST
ZEPHYRHILLS, FL. 33542
MERRIMAN. P
. J
!
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-Five Dollars ($35.00) 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
! "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications and Fee Must Accompany Application.
All work shalll?e performed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
_.~-._- -
X-~~~ . ~~
/ -CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
~- ""-"---------
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPAR1~NT 5335 8th Street, Zephyrhills, FL 33542
813-780-0020 FAX:813-780-0021 ~~I'~ tI~
DATE RECEIVED---!€: ~
PLANS REVIEW FEE
,JOB ADDRESS
rAIi"1....7 ;r11J1.."S/ PorG'iA /Z1;;rr,'~I'UV
S-Cj I ~ (Z"i ~ 5"1 ( 2CO~~rh; J 1'5
I
PHONE
OWNER'S NAME
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
JI-~- Z l-CJO / 0- O'~ 7.-/)0 - ~("') 5"6tlBT.AlN FROM PROPEIITlJAiLl-lO.T.ICE)
WORK PROPSE:D: DNEW CONSTRUCTION
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
Os 1(;[1
o t10VE
o DEt10LISH
PROPOSED USE: OSGL FAMILY D\^lELLING
DCOMMERCIAL
Ot1ULTI - F'At1IL Y
o INDUSTRIAL
0# OF UNITS
o t10BILE Hot1E
,.8- OTHER
o SWIMtlING POOL
o RESTAURANT & HEALTH DEPARTt1EtlT APPROVAL
DESCRIPTION OF WORK J<';I,f.../HJL. A-vi /2<'LJlflfLe S {} G/'\....-{L)
, I
BUILDING SIZE SQUARE FOOTAGE ) 100
.
1'1" T ,4" f K6'O F: N c,/
. /"
HEIGHT
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
o ELECTRICAL
At-1P SERVICE
o
E'LORIDA POWER
o
~~
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W.R.".C.~~~~~
,-- ~
\fl t'.
o ;.t.
.~ ~.,~~
?~ 7~
1~ ~ 'C
'"\,~ () t'"
PERMITS REQUESTED
o BUILDING
$ riI ~ ~ t16 ,,.c
VALUATION OF TOTAL CONSTRUCTION
o PLUM8ING
o MECHANICAL $
VALUATION OF MECHANCIAL H1STALLATlON
o GAS ~OOFlNG 0 SPECIALTY
TYPE Of' CmlSTRUCTION: 0 BLOCK
o OTHER
o FRAt.1E
o STEEL
o OTHER
1S2-J"'J30
F'INISHED FLOOR ELEVATIONS
I S PROJECT IN FLOOD ZONE AREA 0 YES
o NO
BUILDER
src3NATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
****~****k*~*~******~~*~******~+++****~*******+************~******
ELECTRICIJ\N
COMPAtrf
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
****************************~***~~***~***********k**~*************
PLUMBER
COt'lPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURF:
******************************************************************
MECHANICAL
Cot1PANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNl\TURE
*****~******.~****************************************************
SIGNATURE;
~OfAJCJ
~
$,.~~~,
COHPANY 5~t9rr- /""5Mcfp-{~ j!por~<./t;/
STATE CERT OR REGIST # CCCOS7 tf'S'7 /
CITY PROCESSING #
OTHER
******************************+***************~*******~***'*******
COl.JDITJONS OF' PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The under-signed understands that thi:> permit lfIay be subject to "deed restriction.s" which
m~y be more restrictiv~ than City regulations. The undersigned assumes responsibility for
compliance with .any applicable deed restrictions.
B. UNLICENSED C'oN'fRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to \lndertake work, they may be required
to be licensed in accordance with st~te and local regulations. If the contractor is not
licensed as required by law, both the Oymer and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the oymer has 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 OWner sign.s as the 60ntractor, you are indidating that
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to per-mitting privileges in the City of Zephyrhills.
C. 'fRANSPOR'l'A'rION JlI.1PAC'l' FEES AND U'rILl'I'Y CONNECTION FEES
D. CONSTRUC'rUION LIEN LAvJ (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guideq prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior- to conunencement.
E. CONTRACTOR' S/OWNER' S AFFIDAVI'f
I certify that all the information in this application is accurate and that all work will
be done in c~~liance with all applicable laws regulating construction, zoning, and land
dt::veloprnent.
Application is hereby n~de to obtain a permit to do work and installation as indicated. I
certify that no Hork or installation has commenced prior to issuance 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. I also
certify that I understand that the regulations of other governmental agencies may apply to
the .l.iltended work, and that it is my responsibility to identify what actions I must take to
bein-"compliance. Such agencies include but are not limited to: "'Department of
EntlrjQ~ental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
L~b~~ Water/Wastewater Treatment
"'~thwest Inorida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
~i~ring Watercourses
~Army Corps of Engineers-SeaHalls, Docks, Navigable Waterways
"'Department of Health & Rehabilitative Services, Environmental Health Unit-WeLll:i,
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 drainage plan addressing a "compensating volume" will be submitted Yfhich
is prepared by a professional engineer registered in the State of Florida prJor 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 r-equiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is cOllunenced w.i thin
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is conunenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. - The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUIr'I' IN YOUR
PAYING 'rWICE FOR Il'1PROVEMEN'l'S TO YOUR PROPERTY. IF YOU INTEND TO OB'I'AIN InNANCING, CONSUL'!,
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'I'. JOBS UNDER
$2,500 IN VALUE DO NOT NEED 'ro RECORD AND POST A "NO'rICEOF COJltIMENCEMEN'I'''.
SIGNATURE: OWNER OR AGENT
~,.I/ J4i~
SIGNATURE: CONTRACTOR
STATE Oli' InORI DA
COUNTY OF
The foregoing instrument was
Before me this __ day of
by_
acknowledged
__,2Q_
STATE OF FLORIDA
COUNTY OF
'!'he foregoing instrument Has acknowle%ed
Before me this _day of ,_
by
(name of person ackno~fledged)
C1ho is personally known to me, or
(name of person acknowledged)
o who is personally known to me, or
o who has produced
(type
and whoD did Ddid not
of identification)
take an oath.
Owho has produced
(type of identification)
and Hho Ddid DUd not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, pr-inted or stamped
Name typed, printed or stamped
STATE OF FL.ORIDA
COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
To~U6FA~~BC~~~~~6~g~~ ~~;~~~~~i~~~;~~
THIS DAY OF
HAND AND OFFICIAL SEAL
Vi/t1I~ zQf233
JEO ~~. CLERK OF CI~UIT COURT
"'d" /1I/J_" DEPUTY CLERK
BY .
NOTICE OF COMMENCEMENT
Permit No.
STATE OF FLORIDA
I
I 1111I1111111111111111111111111111111111111111111111111111111
I 2003108660
Rcpl:689843
DS: 0.00
06/17/03
L
Rec: 6.00
IT: 0.00
Dpty Clerk
(For Recorder's use only}
Key No.
COUNTY OF
THE UNoERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713. Florida
Statutes. the following information is provided in this Notice of Commencement:
1. Description of Property Parcel NO--U -1..Lo- 21/- Cx.:::WO - bZZc/) - hoSO
(Legal description of the property and street address if available)
2. General Descnptlon of Improvement ~({.lr:1loJJ .Fflo#l .TtiiE;. tJ~~
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3.
Owner Information: NameJANI:S' Iv1tfP?5- It: dress 5//3 iz"'f1{,57,
City ZfY1.1yt-I1Iu...5 State.Ek-ziP 5~9fkerest in Property ~NEf2:J
Name.of Fee Simple Titleholder (If other than owner):
. Address
4. R Contractor Name:
City 5" AIJ ,A,v.J
City
....)> <",71' !3U<...JJLfAtrl ~r:-P".? Address
" /
State rj, Zip 33S?G
State Zip
3"'30/0 "'5/ /2j <;-2-
5.
t<.l<,11-( r.u
-----
Zip :J}{'Z '/
'5"0 \ ~-i ~
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Address
J0~r: lA1-) liVe"
~ "-
s.-- c."" C:'c'
J "
Surety Name
....-:.
State 1/1
Amount of Bond:$
6.
Lender Name
Address
City
State_Zip
City
()M<
7. Persons withm the State of Florida deSignated by Owner L1pon whom notices or other docLlmen:s may be served as provided by Section
713.13(1) (a) (7), FlOrida Statutes:
Name Address City
State Zip
8.
In addition to himself, 9wner designates of
the Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes.
to receive a copy of
Expiration date of Notice of Commencement (the expiration date is (1) year from the date of recording unless specified:
\(. ~t!41!~
17 .~
j:J t> l< -1-; t}- fl1 aU? I J/l.-1 Ii- vl
9.
Signature of Owner:
Printed Name of Owner:
STATE OF FLORJ.DA
COUNTY OF ~'"1-rtL). /,' /J ./ .-~// .
Thefore9oin9Instrllmentwasacknowledgedbefore~~"this ~11Ji!:3 ,~by r/l'l...U~1" ~... .~ ... . whois()
per known 10 me or (..}who produced ,.jJY1 vr~_(J::_-t' .l\~ ' as Identification and wtlO ( )
did or ( not take an oath. _,
E./HP9000iForms/Nollce of Commencement
ReVised 8/20/200\
!t. II !.. ,-,.- / ~., I L"" ,- -n
!~v \ 0;> J -((:J~, -- j/ '-/it;I~~O
~O~,// /-1- -4&"1 kk87J/lt
Print, Ty'e or Stamp Name of Notary
-;,:,-"_:;';:'..:-~<f.
""a.."...
~'m'~j..!!.Y" III,~ DEBORAH-ANN MEREDITH
f ~ Notary Public - State of FlOrida
~ z.ii MyCamnissionExpiresOd12,2005
-..tti"",,-$'" Cornmisflion, D0048239
'Iii..",
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~
Scolt. Blackman Roofing
~Q~
P.O. b 1188
&In N~ FbrtOl ~'"
A1oM: ~1tlOS
F8K: ~103
PROPOSAL SlIBMITTED TO.
PDS (Attention Kelley)
STREET:
12th Street
PHON'::::
JOB NAME:
CITY. STA 1'1:0 lUll! ZIP:
Zephyrhills, Florida
Job LOClition:
hx#:
UAfJo:
06/03/03
Ie:
I
W <: hCln:by submiT speciii(;i1lio~ i1nd estimalC-\ tOe;
Remove and Replace 5 Y Crimp Metal Roof 26 Gauge
Whole Roof: $ 5,950.00
Half Roof: $c7.91D ~o
Remove and Replace Aluruinwu Roof Over BedrooUl and Laundry Room
$ 3,050.00
Emergency Tarp over Metal Roof: $ 250.00
Emergency Tarp over Alwninum Roof; $ 250.00
ALL WORK SHALL COMPL Y WlTHALL
PREY AIlJNGCX>DBS. FLOlUDA8U1U>lNG
CODE. NA110NALELECl'lUCCODEANr
CITY OFZF.PHYRHJLLSORDlNANCES
We propose hereby to fumish m&rerialllI1d labor-complete in accordance with above specifications, for the
sum of:
See Prices Above
(Payment due in full on completion, Thank YOU.)
All moll::liDl ill gLWlUUllflQ to \,lo;lllS spccifJCd.~
wQl1t l<l be olOmplelcd in 11 worl;manlil<e 'l\lll)l\.'
iIII::COnUng 10 s~ PfllCtices. Any allcration of
~il\{i(m frurn llbovc spccifll;.llti()(\S invulving cxtta
COllIS will ~ ~u{lld only upon wri1lcn ar~. a.nd
will be<.:utne an CX1I1l c~ ovtU'lInd above the
cstimalG. Alllllll--.nmtli cunlln&<",l upoo 'IDi_.
l\CCidclnl>l Ot dclll)'!l beyond ow o:.:>naul. Owner to
carT)' ftn:, UU'Il104o io\Oli other IlC:CCllllllfY in.~.
OIU" workcn; ure fully covered by WQrI<.mlwt',; Com-
pcmalion lnSW1lDl:ll.
;-, ......,...
....~
^utllO,I:.:C<I Si9'1oiure:
Note: ThiS proposal may be
withdrawn by \.IS If not accept@d within U days.
St9"-t\Jrl8:
Ac:c::epQnce of PropcllNll~Tlw ;obove
pnQl&, lipecmcatlOn$ ..nO cundltlolUi ;ore SlltI!il'IlC\Qry
.>nd..... hereby ..ccep~. You ere authonEed to do
~ "",,<1<... .peon"". paymo;nt ..III be made as
Q..t/lned ebove.
Slonatu~:
Dete of aa:ep~"'QC:
... -...
........--.. -
_...,..."'.......lIlII~
"P!Kl'''''''
nAil 'A.~
&
_J~ Mo~~ / P/JID(fIrJtl5/Zf?/tv>d
I
-:it- Cg71Y- ~
"rU~.ANC\l
Insured
Claim Number
AUTHORIZATION TO REPAIR - FLORIDA
(To Be Signed Prior to Beginning Services/Repairs)
To: State Farm Florida Insurance Company
I have agreed to use the State Farm Premier Se~i~eCll Pro~ram. I understand the use of this program is voluntary
and I have been offered the opportunity to choose any independent contractor and/or independent service provider(s)
participating in the Premier Service Program. I also understand they are independent contra.Q!ors and/or, independent
service providers hired by me and not by the State Farm Insurance. CompaniesCll. I understand State Farm is not
exercising its option under the insurance contract to repair or replace any part of the property damaged.
Instead, I have selected and authorize: fNL. WI!' ~a-ctf1~perform repairs as indicated on their
estirTlate due to a loss on 57l J f Z7Jf 57. ~ lfttJIdf:f . I understand my dedl;lctible i~ payable
to the authorized independ~nt c9.ntractor and/or independent service provider(s) upo~ sa~%.COf1)f)letion of the
portion of services or repairs provided in their estimate, or as otherwise agreed ta with State arm Florida Insurance
Company.
I agree to pay my independent contractor and/or independent service provider(s) fer any repairs, or additional
improvements made at my direction, that are not covered under my policy.
NOTE: For your protection, the law of your state requires the following to appear on this form: Any person who
knowingly, and with intent to injure, defraud, or deceive any insurance company, files a statement of claim
containing any false, incomplete, or misleading information, may be guilty of a felony and subject to criminal and
civil penalties. Violation of this provision is a felony of third dewee.
5-21
(Date)
2&>3
(Year)
This form can not be altered but may be reproduced only by a State Farm Premier St}rviceolll program contractor/servise
provider.
10408'\.4 Rev. "\2-"\6-2002 F\oriQa
!~