HomeMy WebLinkAbout05-3846
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
3846
Permit Number: 3846
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 39127 7TH AV
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
2/15/2005
35,00
35,00
2/15/2005 Phone:
R1R ENTRY DOOR NO CHANGE TO ROUGH OPENING
Name: RITA BROWN
Address: 39127 7TH AVE
ZEPHYRHILLS, FL. 33542
DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB
DUCTS INSULATED LINTEL PRE-METER WATER
SHEATHING FRAME MISC SEWER
MISC INSULATION WALL MISC MISC.
MISC, INSULATION CEILING MISC. MISC.
MISC. DRIVEWAY MISC, MISC.
REINSPECTlON 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 shall be performed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
. ~~
CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Ftorida Building Code Online
IJnOnlJCrJ1 Allfl~IUJri\t PlOd.Jet Type Det<.JiI
.'--........
'--'
-'
,..
"I'" "I" .,,.
Product Search Organization
Search
Product
Application
Page 1 oIL
"I'"
.,
I
,1
.
.
OvelView
r
User: Public User - Not Associated with Organization.
Application #:
Date Submitted:
Product Manufacturer:
AddresslPhone/email:
Technical Representative:
Technical Representative AddresslPhone/email:
Category:
Subcategory:
Evaluation Method:
VieW
Attachments
N~e~UI~!L1
FLI8
08/04/2003
Masonite International
One North Dale Mabry
Suite 950
Tampa, FL 33609
Steve Schreiber
I Premdor Drive
Dickson, TN 37055
(615) 441-4258
sschreiber@masonite.com
Exterior Doors
Swinging
Certification Mark or Listing
Referenced Standards from the Florida Building Code: Section
Certification Agency:
Quality Assurance Entity:
Validation Entity:
Date Validated:
Authorized Signature:
Performance level of the product and conditions or
limitations of use:
Standard
TAS201
TAS202
TAS203
Yw:
1994
1994
1994
Intertek Testing Services -
E1L!Warnock Hersey
08/11/2003
Steve Schreiber
sschreiber@masonite.com
None Known
httD://www.floridabuilding.org/pr/pr_detl.asp?lPT=18&fm=ROSrch
3/29/2004
Florida Building Code Online
"--'
-'
-
Evaluationffest Reports Uploaded:
Installation Documents Uploaded:
Product Approval Method:
Method I Option A
Application Status:
Approved
Page:
Page III
Model Description
e Steel Door Units
--
L
""
. eo"",.. """ """"_ ; C2000 The ..... "Florida. All rig'" .."""".
I..
....++-.II..nnm fI","';A"'kn;lrl;no n.T'O/nT/nT rlP.t1 ~~n?TPT=l R&fm=ROSrch
Page 20f2
~
...
..,
...
3/29/2004
--
X
Unit
I\1ID-WL -r/lA0001-02
SINGLE DOOR
I. J.;- I t . t
.
1 1 1 1 9"
... - - MAX
f-
... - -
, .. - \
... ~~;'~~~
(}!...... ~'?~ ~r
31'
TYP.
... -
Minimum Fastener Count
... -
l.-.
. 6 per vertical framing member for
TO" height and smaller
· 8 per Y8ftIc:aI framing member for
heIgtds greater than 7'0"
· 4 per horlzon1al framing member
-
- ...
HI... aDd IIrIb ,late. I'IqlIIrt two
2-112- loll .... "r loatIoo.
... -
-
. Width of door unit plus 112"
· Height of door unit plus 1/4"
Rough Opening (RO)
..- -
-
...............,. Tell DIIa RMIw CeIlIflcIII ~~ 1U6447C II1d COPITIst EIIIIIdIIIoh MIIlrIx
--- 13lI26447MlO1, 002, 003, 004; 7!:!l!1J.lIII2.l103, 004; I3CI2tl447&-GOl..._ OO3,OO4I1RMdes
--=-- ....1nIamIIIIari -1lIIIII*I1nlm" ,,""'"...... (ww,........comj, .. ......
-----. (-,~) or1he MasanIbt IIcIncIl CIIIIIr,
Latching Hardware:
. Compliance requires that GRADE 3 or better (ANSIIBHMA A156.2) cylindrical and deadlock hardware be installed,
· UNITS COVERED BY COP DOCUMENT 1246* , 1266*, 3241*, 3246. 3261* or 32&6
Compliance requires that 8" GRADE 1 (ANSIIBHMA A156,16) surface bolts be instaDed on latch side of active door panel- (1) at top
and (1) at bottom.
* Based on required Desion Pressure - see COP sheet for details,
Notes:
1. Anchor calculalions have been carried out with the fastener rating from the different fasteners beIng considered for use, Jamb and head fasteners
anaJyzed for this unit Include 10d common nails, Threshold fasteners analyzed for this unit Include Uquid Nails Builders Choice 490 (or equal
structural adhesive),
2. The common nail single shear design values come from ANSVAF & PA NOS for southern pine lumber with a side member thickness of 1-1/4" and
achievement of minimum embedment of 1-1/4".
3. Wood bucks by others. must be anchored properly to transfer loads to the Structure,
II
MIR:h 10, 2lllI3
Oar-,_"~"",,,,,,,,,,,,,,,
............... ......10 ~ .............
~~~
COPlTest Report \j(1\lcjl1tioll \\~lltrlx
#3026447B-001
WOOD-EDGE STEEL DOORS
,-,'
I! ~ ;; ~ lil ~ lil~ ~ ~ ~ I ~ ~s ~ s
i C! ~ i ~~ C! ~ ~ i ~~ ~ ~
-0 g g g
Ii
I~ ;i N N ~ ~ ~ ~~ ._~ N
~! I ~i ~! ~ Sl ..9
~ Sl ~ ; 'is ! I Sl~ ~i
II N ~~
~; ~ ~ ~I ~ I'. 8 8 8 8~ ~~
; i 8~
J!!. 8 g g
i n I ; ;
...
.
II:
! I I I I I I I I I I I I
g CI
1i Q Q
II:
~ ~
~ ~
~ ~
~ ~
.,; .,;
cD cD
~ ii ;1; ;1; ~- ..:- ilii ;1; ! i
c. ~ltl ~ltl
I. ~ ~ .., ~
. N Rl ~~ ~ ~ ~ ~g: ~g: Rl ~
II: 00 0 ~ 00 00 00 ~
1; ~ - N N ;:Pcp g ; ; -- -- - - -
(! N N Cl' Cl'N ":IN N N N N Cl'
~~ g ~ ~ gg ~g ....g gg ~ ~ ....
- to l-
. '" '" c..> to to ~z ~z '" c..>
II: ZZ Z Z Z Z Z Z z
1"
...la. > > > z> z> z> >> z> z> z> > >> >- z> z> z
.501"
l!li a a a a a CI CI CI CI ... ... ... ... ... ... ... CI CI CI CI CI CI CI a a CI
cd aD :8 ..;u; Irian .nd aici crioi aiai ~g g cD"; .n vi vi u'i.n :8
'- ... .... .... .... .... .... .... ... .. .. .. .. .. .. ... .... .... .... .... .... ....
....- a CI a CI CI CI CI CI a ... ... ... ... ... ... ... CI CI CI a CI CI CI CI CI CI
"ll ~t8 .n an"; :8:8 aricS aim <<:Jiai cDm ~g g a:iari .n ";.0 Iri.n .n
.... .... .... .... ... .. .. .. .. .. .. ... .... .... .... .... .... .... ....
!'.
).E: 00 0 CD 0 CD 0 CD 0 00 CD 0 CD 0 CDO 0 00 0 CD 0 CDO CD
CD
Iii CI ~
IE:::. CI CI CI CI CI CI ~jg ~~ ~~ ~jg lK~ ~ CI CI CI CI CI CI CI CI
-oo ... ... ... ... ... ... ... ... ... ... ... "" "" "" ""
.5;; >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< >< ><
~~ ... ... ... ~~ ... ... ... ... ~~ ~~ ~~ ... ... ... ~ ~~ ~~ ...
E_ .., .., .., .., .., .., .., C') .., C') C') "0
o. c::
z~ ...
Sl
.. ~- ....N N ....N ~- ....N ~
1i - v.:~ v.:- v.:~ v.:- v.:~ ....
0.: - - 0.: - ~ 0.: 0
~ - - -
CI
1!--:- CI CI CI CI CI ~lil lil ... CI ~~ CI CI CI ~
.Ii ... ... ... GO GO lil en ~ "" "" "" "" ..
>< >< >< >< >< >< >< >< )( >< )( >< >< )( >< >< >< 15
:g .. ... ...' u
.,! lfl~ ~ lfl~ N ! lfl ~ lfl~ CI ! ~
I.. ~ ... S! .... S!
....
.
1'- "0
...
.g - - - - - - - - - - - - 00 0 0 0 Q
..- e
g >< -s
~ 0 ~ ~ ~ ~ ::E
! ><~ g ~ ><~ ~ >< >< ><~ ~ j
>< 0 0 >< ~ >< 0 0
OOoo gg "0 "0 "0 '8'g "0 'g '8 '8'8 J '8 g 'i~
~~ 8 0 0 i ::E ~ .!If!
0 0 <> 0 <> ; o <> ;
~ ~ ~ ~ ~ ~ ~ ~ :3; N ~ ~ ~ 'i'o
... CDu
N N S N N C') C') C') ..~
~ ~ ~ ~ ~~ N N N !.5
99 9 ~ ~9 0 ~ 9 ~
..- ~ ~
......:. _N .. ~ N~ .. "'''0
~~ CI CI i N N g.~
8~ i ~ i ii i i i i i ii I i i I~~
::E ::E
_rr.
--...,
....-.~
Hw.
_1I.2lID:l
COPIMAII/MlD shills ref8nnced
In \his IIIIlItx p/lMdes IddIlanII
InlonnIlIon - MiIIbIe 1nIIll1he
MIsonIle WllbsIte
(_.__.com) or'"
MasanI\e 1Il:IncaI_.
..
',-",
.
_ Intertek Testing Services
~ate-
Entry Systems
COP/Test Repol-t VZ1llclatlon Mot! IX
#3026447B-001
..----
WOOD-EDGE STEEL DOORS
.............
=c N ~ ;; N I
I! ~ I; SlI SlI ~ N ~ ~~ N
i 9 9 i
Ii ~ g ~ ... ~ ~~ ~ ~ ~
g ~ Cl
=f ~ ~ ~ ~ ~ ;i ~ll ;i ~ N N N N
!I ~i '"I 9 !~ ,.9 9
-I ! ~ ~ ~ i I ~ ~ 9- I
~i,l .,. ~.. II -~ :!:~
8 8 N _N 8~ N 8
11 8:i: 89 8 ~ 8- 8~
... CD 88 8 8
8 8 8
i I ~ I ~ ~
..
-
a:
S I It> I I I I I I I I I I I I I
~
.. Q Q
a:
~ ~
- -
-
~ ~
0> 0>
fIli fIli
, ..:- ..:- ... ... i i ... ii i .... ...
~E ~~ ~i 0 0 0
It ~ ii ~
Ii i i ;= _N &IN ~ N
a: =0 =0 00 0 ~ ~~ 0 ~
! ;9i ~ ; ~ -- -- ~~ ~ ~ ~
'" "l'N ii N i~ N N
S gg ..:. ~ g
- t;~ G G G
a: zz :z :z :z z :z :z z
i-
..ls. > > > 20 > 20 > 20> > 20 20 :z z:z: z:z: zz z z zz zz z
.E~
Li Cl ... ... ... ... ... ... ~~ Cl It> It> It> It> It> It> It> It> It> "l"l It> It> It> It> It>
~~ ~ QeD ~~ ~lll ui gg g gg gg gg ~~ gg gg g
cp- -or -or ...
L'i' o ... ... ... ... ... .... ... <:> <:> It> It> It> It> It> It> It> It> It> It> It> It> It> It> It> It>
~.e dai ai aia) crieD criui g gg d gg gg gg dd gg gg d
.... . . -or -or -or -or -or ... It> It> It> It>
1'-
j- 00 0 Cl 0 "" 0 "" 0 0 "" "" "" c:l c:l "" '" "" '" c:l c:l c:l "" c:l c:l c:l
...F:
Iii P)
IE;.. ~~ ... ~~ :gg: ~i: <:> i:i: <:> Cl C) C) C) C) C) C) Cl C) C) C) C) C) C)
-- ... CD CD CD ... CD CD CD CD CD CD '" '" ... '" '" ~
"'.t! >< >< >< '" '" >< '" "'x x '" >< '" >< >< '" '" '" '" '" '" '" >< '" '" '"
.e... ~~ ~ CD ... ... CD ...... ... ~~ ... ~~ ~~ ~~ ~~ ~~ ~:g :g
11 P) P) P) P) P) P) P) P) ~
z..... N
C)
i!!: ~- cil- .....N cil- N cil- .....N cil- N cil- .....N ..... ~
'" -
~ en..: - - - - en..: - - en..: en
- -
Ii ~~ CD ... CD C) C) Cl C) Cl i: i: C) C) Cl i: i: ~
... ... ..
... >< '" ClO '" CD '" '" '" '" '" '" '0
.. >< '" x x '" .. .. .. '" '" .. .. '"
'.1 '" . '" ! CD . u
~f::! f::! ... CD CD N f::! :gf::! f::! ~
i.. ~ :!: '" '" '" ... ~ ~ :!:
-- I
"'g 00 0 0 0 0 0 - - - - - 00 0 0 0
I- i
.. x ~ ~ x ~ g ~ ~ :;;
'i ><~ ~ x x x~ ~ x~ 0 i
x >< x
III 0 0 0 0
u X X >< 0
-. gg 1 '8 '8 u )) '8 "" "" gg '8 "" g il~
IF: =- CL 0 g ; ~...
~ 0 :I: N 0 ~ co ~i
. i!r ;= lJ lJ ~ ~ ~ ~
~~ ~ % 8 N N N N N N N ~Pil 9 9 ~ .;111
9 C) 99 9 ~ C) &.e
.- = u. ob
L":' _ N P) _ N P) ;og Ii
N N i N '" i P) . . . i . CD ... ... .
0:11 ii i i i ii i Ii Ii ii i Ii I
u_ c!s
I - -
_Il't:
--...,
.-...-.~
II-h.
_'1.21113
COPIMADIMlD .....18lIlIIIClId
In II1is IllIlrlx pnMdes IdcItIonaI
inID11n111an - MIIIbIe barn IIle
MIIlInIIIl WIbIIII
1-.-nIlt.I:amlorllle
MIIonIIIllIcIlnIcII CIIllllr,
.
.,............'
.
11III IntertekTesting Services
X
Glazed Inswing Unit
COP-WL -IVIA4141-03
WOOD-EDGE STEEL DOORS
APPROVED ARRANGEMENT:
---- ......,
~.-.~
I-h.
Note:
Units of other sizes are covered by this
report as long as the panel used does not
exceed 3'0" x 6'8".
TIIlIllta IlIvIIw Clllltlc.-13026447A.
13ll2lI447B,13ll2I447C IIIlI COPITeI1
==-. MIIIIx IlI02&447MXll,
,13ll:lBWC.OO1
==~
1-,lIIIIemlco.cam) h MaanIIe
......1_,iiiiIOiilIi.com) or h
~ tec:hnIcII c:enter,
Single Door
MaxIIIum unltlizl. 3'0" x n'
oesigD PI'8ISUI'8
+50,5/-50.5
LlmIIed WlIIIIr ..... spec1111hnshaId design II used.
lallie Missile Impact ReslstallC8
Hurricane protective system (shutters) is REQUIRED.
AduII design ..-n n ~ reslsIIrt ,..,.... lar I spdIc buIdna dIIlgn n llIDtIIIPhIc IacaIIlIlllI delermiwd by ASCE 7-11111on1l,
slIlI or IacII ~ ClldIs spedly hldlltall ....00Id.
MINIMUM ASSEMBLY DETAIL:
Compliance requires that minimum assembly details have been followed - see MAD-WL-MAOO01-02 and
MAD-WL-MA0041-D2. '
--'
MINIMUM INSTALLATION DETAIL:
Compnance requires that minimum installation details have been followed - see MIO-WL-MAOOO1-D2.
APPROVED DOOR STYLES:
1/4 GLASS:
I I I I
[I DD
[)[) [)[) [)[) [)D
100 Series 133, 135 SerIes 136 SerIes 680 SIdes 822 Sertes
112 GLASS:
[I I I [I I I LJ I
DD DD Dn
105 Series' 106, 160 Sertes' 129 SerIes' 200 Series' 12 RIL, 23 RIL, 24 M. 107 SerIes' 108 Series 304 SerIes
Series'
'ThIs GIus ldlllllY IIso be Used in the IDIowing door slyfIs: ~ S1JIIlII wIIh 1ClIII; E)1IlJrow 5-pn/; EyIbmw 5-pnl wIIh 1a1lII,
a
''-"'
.kine 16. 2003
llIrllllllllllalna _01,.-___.......... ......1IIIl_
- ...,.......... --.
X
Glazed Inswing Unit
COP-WL -rvlA4141-03
WOOD-EDGE STEEL DOORS
APPROVED DOOR STYLES:
3/4 GLASS:
FULL GLASS:
I
404 SIrles
I
I
450 SIrles
11111
109 Series 114,120,122 152 SIrles 149 SIrles 300 Series
SIrles
410 SerIes
CERTIFIED TEST REPORTS:
NeTL 210-2930-7
Certifying Engineer and Ucense Number: Gerry Ferrara, P.E. /11985.
Unit Tested in Accordance with Miami-Dade BCCO PA202,
Door panels constructed from 26-gauge 0.017" thick steel skins. Both stiles constructed from wood.
Top end rails constructed either wood or sleel. Bottom end rails construcl&d from either wood or steel.
Interior cavity of slab filled with rigid polyurethane foam core. Slab glazed with insulated glass mounted
in a rigid plastic lip lite surround.
Frame constructed of wood with an extruded aluminum threshold.
PRODUCT COMPLIANCE LABELING:
'-"'
TESTED IN
ACCORDANCE WITH
MIAMI-DADE BCCa PA2D2
COMPANY NAME
\.. CITY, STATE
To lIIe best of my knowledge and ability lIIe above slde-blnged
exterior door unit conforms to the requirements of tile 2001 Florida
Building Code, Chapter 17 (Structurel Tests and Inspections).
j::::r;;/~
""'- ""'-r
---
.-e-..
Tal DIIa IleIlIn ~ Bl26447A,
13028447B.13ll26447C IIId COPIrIll
~ VIIdIIIan MIbIII3fI264.47MJ01,
1302&4478-l101,I3ll2ll447C-G01
JII1IWIdII......InIarmIlIa1.
IVIIIbIe frDm blTSlWH WIbsIIt
1-.lIIIBIldD.camj, 1IlI .......
WlllIIIIe ,-..--.com) or..
MIIsor*i 1IchnIcII_.
Stale of AOriel&, Professional Engineer
Kurt Batthazor, P.E. - License Number 56533
II
"-'"
June 18, 2003
0Ur--. _....-.......... _............ ......__
-1IIIljIcI........--
LaWE.S
Companles.nc.
8529 South Park Cr.
Suite 430
Orlando, Florida 32819
Bus, 407/370-2872
Fax, 407/352-6309
Date: 1< II L\ S"
To: City of Zephyrhills Building Department
5335 8th Street
Zephyrhills, Florida 33542
From: Rebeca Alicia Banuelos-Bernard
I hereby authorize the following individual, Michael L. Berkman, to act as my agent to apply for, sign for and pick up permits
under my State Certified Residential Contractor's License, CRC 057468,
Address of Job:
Homeowner Name: 12t7/J ~YDW'tV
3ui) 21 ~(/~J.I1"J/ IW
ZeIA'Ir/IIIIJ" PL ?:>~2-
IZIIL ~fv1,tt-y /)'17'-' No cA/iIt4t (v Jz(tJ
City:
Type of Work:
Thank you for your assistance,
Sincerely,
~Q~
Regional Installed Sales Manager
Primary State Qualifier CRC 057468
s~oc!!tLfJ2i2~
No.public
My commission expires
,,~;~~'f,V;'f~;:'~,. Rebecca Velez
t-'?' ~ "A MY COMMISSION # DD17~963 EXPIRES
~~..":~~$~:: January ,:~_;n7
"<~:.9f~,r~~~~"" BONDED THRU TROY fA~'1 ;~~<;?ANCE, INC
. '
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021 'J II' /
DATE RECE IVED pC! /1/ () 5'
PHONE CONTACT FOR PERMITTING g 13- '261- 3162-
OWNER'S NAME
'f! If/} / B/ZdK~v/
3PJ / Z 7 5k/!€Jv77f IN( -zqlfyrJJlI!s-; t2-
-- BLOCK ~
-
I Z - 2 <... - Z-/- t() ~ g,- Cl>66D- () / Y-b
PHONE &1'3-7&2 -/030
3>35^4Z-
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
SUBDIVISION
PARCEL 10 #
(OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: 0 NEW CONSTRUCTION
o ADDITION
o ALTERAT ION
o REPAIR
o INSTALL
DSIGN
o MOVE
o DEMOLISH
PROPOSED USE:)?SGL FAMILY DWELLING
o COMMERCIAL
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
DESCRIPTION OF WORK
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
F-//L /EjVtlb't f)~ M G/.tm.4E (lJ 1U1J~fJ DI'BvI;Uq
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
& (1) SET ENERGY
FO~.
-1(?;, '5. :::>:-~
FORMS.
PERMITS REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
AMP SERVICE
o Progress Energy 0
W.R.E.C.
o PLUMBING
o MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES 0 NO
BUILDER It
SIGNATURE
,
COMPANY U~/~ 6-m//lNI5/ I~
STATE CERT OR REGIST # G/2L()~ t!
(,V - 6(p/13
**********************************************************J*******
ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
STATE CERT OR REGIST #
SIGNATURE
)J;~jJ -~
*****************************************************************
COMPANY UtJtk.~ Ln,,//lN l5" / IVV
STATE CERT OR REGIST # LlZL 6.J:f1t{.!
[1"1(- (j{.3/13
OTHER
A. NOTIC,E OF DEED RESTRICTIONS
The. undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than city regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may 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 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, 813-780-0020.
Furthermore, if the owner 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 signs 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 may be an indica~ion that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that Ii the applicant, haye been provided with a copy 'of "Florida's Construction
lien Law _ Homeowner's ,Protection Guide" prepared by the Florida Department or 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 commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
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 construction, zoning, and land
development.
Appliqation is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work 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 intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protectiori 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 which
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 the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring 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 commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for la
period of six months after the time the work is commenced. 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 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. JOgS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
acknowledged
,2U-
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
'Before me this _ day of
by
acknowledged
, 20_
(name of person acknowledged)
Dwho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
Dwho has produced
(type of identification)
and wlioD did Ddid not take an oath.
o who has produced
(type of identification)
and who 0 did D:l.id not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped