HomeMy WebLinkAbout05-4168
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
4168
Permit Number: 4168
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 6,275.00
Date Issued: 5/03/2005
Total Fees: 65.00
Amount Paid: 65.00
Date Paid: 5/03/2005
Work Desc: RE-ROOF - 30 SQUARES
Address: 584712 H ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-03900-0010
ARL, DEBRA
5847 12TH ST
ZEPHYRHILLS, FL. 33542
Phone:
REINSPEcnON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade:
(a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when
inspection called (d) Work not ready for inspection when called
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
- ~~
RACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8~H St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECEIVED
~ S-(5'
PHONE CONTACT FOR PERMITTING
OWNER'S NAME 1.?~6AJ1-
JOB ADDRESS S- '0 Y /
c./f/.-L
J2-~ Sf:
PHONE
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID # [/-2t - l.J-f)O/~ -OJ'l'i>'(j -OO!O (OBTAIN FROM PROPERTY TAX NOTICE)
/
WORK PROPSED: ONEW CONSTRUCTION 0 ADDITION o ALTERATION fJ'REPAIR 0 INSTALL
o SIGN
o MOVE
o DEMOLISH
o COMMERCIAL
DMULTI - FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
PROPOSED USE: 0 SGL FAMILY DWELLING
DESCRIPTION OF WORK
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
f.c. -/2 !nr: /;;'~
:J 0 <;i
,I
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
VALUATION OF TOTAL CONSTRUCTION
& (1) SET E~$RGY FORMS.
/
FORMS. //
i/"//,'..-------
<t 1~ "
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.
o BUILDING
-f
$ 62. )5.
j
PERMITS REQUESTED
:)/';)
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 AREAO YES 0 NO
SIGNATURE
~ C-:/
~ Ll / ) ~ ) If! () 0.;:::' ) '/ /',
COMPANY /7v,/- /)/'-/<--"
STATE CERT OR REGIST # ;C.L () iJ 1/ b.2 rJ
BUILDER
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ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
STATE CERT OR REGIST #
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
A. NOT.ICE 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 I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is somSone 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 corrunencement.
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.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work or installation has corrunenced 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.8. 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 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 corrunenced within
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 corrunenced. 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. JOBS UNDER
$2'5:;tf~ ;;;0 RECORD AND POST 71~ C;;;ENT"
SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR
acknowledged
, 20--
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
,20_
(name of person acknowledged)
Dwho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
D who has produced
(type
and whoD did D did not
of identification)
take an oath.
Dwho has produced
(type of identification)
and who D did [}:iid not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped
-- -~- -'- -- "-~-- -----.---_-.--=--~~,----"--- - --- --- -'---
[
GA VIN ROOFINC
P,O, Box 1363
DADE CITY, FLA, 33526
Lic,#RC0046241 "Bonded Insured
.'--,
PROPOSAL
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Page No,
of
Pages
(352) 567-5034
2 YEAR lEAK WARRANTY
JOB NAME / NO.
To:
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LOCATION
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PHONE
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We hereby submit specifications and estimates for:
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WE PROPOSE hereby to furnisp material and labor - complete in accordance with Jbese specifications, for the sum of:
/' ) ,L ' j .J / j "1' \ / // ...-' '-t ':"'-- dollars ($ (~,
Payable as lolIows: ,/
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j,
(/
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All mall-rial is guarall!c('r! to tH' as SplTil"icd. All \vOI-k to be (,oll1plt.tcd ill a workmanlike
1ll,HI]HT according to slandard pral'lic('s. Any alteratiol\s or deviatiot] from atmve spccilka-
lions involvill.l: extra cost \vill he exccuted only upon \vriltcn orders, and \vill bt'eOIlJ(' an
extra charge over and ab()vc the CSTr'i'rrctI{. 1'\11 dp:rct:'i"-r;~'nts conlingl'(][ llpon strikes, accidenls
or delays beyond 0111' l'O]llrol. (hvllcr to carry fire, tornado, and otIler Ilecessary iIlSllnll]('('.
0\]1' workers are flllly covered by \Vorkmt'Il's Compellsatio!1 IIlSIIl'aIH'('.
Authorized
Signature
-It
I(~ -~ "j
.,C..,/ .r:
NOTE: This proposal may be withdrawn
by us if not accepted v.lithin ___ days,
ACCEPTANCE OF PROPOSAL - The prices, specifications and conditions are saiisfactory and are hereby accepted, You are authorized
to do the work as specified, Paymeni will be made as outlined above,
~nalllre
Dale
Signature
Dale
NOTICE OF COMMENCEMENT
State of ;Lu III U:'/f County of fft s c. D
THE UNDERSIGNED 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: J
1. Description of Property: parcelNo@ 11-1..~ -- 2.../- ()19{f)...:::-Q 3 <J~{) ~- e%
L~y4.1 .b,e5~' "zH ~ 1 P 5'''; Ldh / -<j/ 1.5/1( 37 ,r 6~73 f>&1t.1
( (Legal description of the property and street adQress if available)
2. General Description of Improvement f2s; -12 Oo//#t/
1111111111111111111I1111111111111111111111111111111111111111
2005085525
3. Owner Information: Name1iJ IC)....::> 0---.. d ~ Co... y \ -{
Address 5~lj7 lJ +\... ~t- City 2-<. ~\,,^\,l\\~State \=-l
Interest in Property:
Name of Fee Simple Titleholder:
(If other than owner)
-
Rcpl: 880315
DS: 0.00
05/03/05
Rec: 10.00
IT: 0.00
Opty Clerk
Address
4. Contractor: Name tf!.../ft/; ';J
Address f(fj D(j)y-" I J 6' .J
City
/200// /CI c:;-~
City /JjJiJi0 C) LV'
/
State
State/" L .] ],)"2{:
5. Surety: Name -
Address ---
Amount of Bond: $ r--.
6. Lender: Name ~
Address -----
City ·
State
~~90~~~~MA~ : ffs,;o fOUN~Yf' C~ERK
OR BK 6350 PG 391
City
State
7. Persons within the State of Florida designated by Owner upon whom notices or other
documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes:
Name
Address
----
City
State
8. In addition to himself, Owner designates
,...--.
.-----
of to receive a copy of the Lienor's Notice as
provided in Section 713.13(1) (b), Florida Statutes.
9. Expiration date of Notice of Commencement (the expiration date is 1 year from the date
of recording unless a different date is specified.)
--
Signature ofOwner:@ $~.v7.rA'~ &~
, . ) "'rn
Sworn to and SUbscr~re me this) \9 day of
Notary Public: & '" /1;t.Qg~
~ 1 "">-~ ~"\ A ,,' C)~
My Commission Expires: -~\_ ~ ()::)~
PC93053048/ A
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