HomeMy WebLinkAbout05-4898
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
4898
Permit Number: 4898
Permit Type: MECHANICAL
Class of Work: A1C CHANGEOUT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 5130 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
6,336.00
9/07/2005
65.00
'65.00
9/07/2005
CHANGE OUT 7 11
Name: LUMPTON, CHIP
Address: 5130 GALL BLVD
ZEPHYRHILLS, FL
Phone:
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.
V-~ ~. ~.
CONTRACTOR S ATURE. PERMIT OFFI
CALL FOR ItfSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL :33542
B13-780-0020 FAX: 813-780-0021
PHONE CONTACT FOR
DATE RECE lVED
PERMITTING (35;),) 5~ J -If<j '71
PHONE _(~ 13) 0 ~q - ooo~
OWNER'S NAME
R 0 R. L--LC
5/ ~o baLL Blvd~
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 10 #
11-~ft;-J.l-C010 -0'7000-001:2/
(OBTAIN FROM PROPERTY TAX NOTICE\
WORK PROPSED: oNEW CONSTRUCTION
o ADDITION
o ALTERATION
~'REPAIR
o INSTALL
o SIGN
o MOVE
o DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING
~OMMERCIAL
OMULTI - FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
DESCRIPTION OF WORK
CJ
~e
RESTAURANT & HEALTH DEPARTMENT APPROVAL
lUli+
otLt
pk3
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
AMP SERVICE
o Progress Energy []
W.R.E.C.
o PLUMBING
~MECHANICAL
$
It> 330. 00
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
BUILDER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
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ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
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PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
SIGNATURE
*******************************************};t*~**i***t***~~****** \/
COMPANY LllkIS At C-- U) MfMll-
~ F STATE CERT OR REGIST * CAC05i$576
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MECHANICAL
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST",
A. NOTICE 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 po~tions 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. CONSTRUCTOION 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 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.
Application 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 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 commenced 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 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. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE~R A~ SIGNATURE, CONTRACTOR
acknowledged
20_
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this __day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
,20_
(name of person acknowledged)
owho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
owho has produced
(type
and whoo did 0 did not
of identification)
take an oath.
owho has produced
(type of identification)
and who odid Odid not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped
J5~O- gIro-it> 1-~1t-/-{)
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1111111111111111111111111111111111111111I1111111111I11111111
200518661~
state of
~LtittJ
NOTICE OF COMMENCEMENT
County of
PIit sef)
TUE trnOERSIGNED hereby gives notice that improvement will be made to c~rtain
real property, and in accordance with Chapter 713, Florida Statutes, the
follo~ing infor~ation is provided in this Notice of Commenc~mcnt:
1. Description of Property: Parcel No. 5/r40 e-ITII E;(vci./ 'b(l::)'/rh//Is,/
fl.. e!... - -00 0-0 000 - 0 ;J...
(Legal 0 t property an street a ress 1 ava1 able)
2. General Description of Improvement ~e.- ()u.J:; A!{'/ tJJ'Li'1,
Rcpt: 920573 Rec: 10.00
OS: 0.00 IT: 0.00
09/07/05________ Dpty Clerk
3 .
O\'o'ner Information: Name --=:RQR. LLC
llddress B~~E. ~on~~ty ~~ON
Interest in Property: OWNER
State R.
-g3bo I
Name of Fee Simple Titleholder:
(If other th~n owner)
Address
City
State
R
Contractor: Name ~I$ I A-/ k U ~t1Ih 1,
Address f~~32, LLS 14wy 30~ity Da.uk C:./u
Surety: N.::lrne tv! i+ 7
State
FL-
3~5;)5
5 .
Address
City
.
State
Amount of Bond: S
Nit
JEO PITTMAN PASCO COUNTY CLERK
09/07/05 0i:54pm 1 of 1
OR BK 6573 PG 61
6.
Lender: Name
Address
City
State
7. Persons within the State of Florida designated by Owner upon whcrn
notices or other documents may be served as provided by Section
713.13(1)(a)(7), Plorida Statutes:
Nc""~mc
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of the
Lienor's Notlce as provlded In Section 713.13(1) (b), Florida Statutes.
<J.
["xp.i.rn1 ~'Jn d~te of rlot.lce of Comm~ncement (the explrati(:,n dat.e is 1 year
fr~m the d~te of recording unless a different date is specified.)
20 oS.
J
RONALD M. SMITH. JR.
ate of Florida
My comm. expo Sept. 7, 2008
352840
Not~ry Pub 1 ic:
My C::J~,Oli 5 S ion Expires:
PC93053048/ A
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HVAC
SE1RVICE ORDER
INVOICE
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r.Ie ,<ft' A.CU6j.4f}'7~
12212 US HWY w"
nl\.nF~ {;r1~'i FL ~:~:--I:j'~
fj;,nE ('(TV :1;)'1;', 4<Y.77
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BILL TO
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THIS WORK IS TO BE
o C.o.D.
o CHARGE
o NO CHARGE
:: /.J
S REET
i h"
I~'~ ::'! -; tl'
'"f;p<{ ",",' i ,~;-13 ,- l/ 17 - '.;' .~~L
M~.~ ~ ,.f?!)
',,::-< 6,:,1.' ,;l''j J. ..
MOOEI. -;{
:' ,(_:~. ~....""
SERIAL NUMBER
MAKE
~~.;;-
LA
;:-Li f)c It_)
#-, 11/;'/
.~.
MODEL
}-~ ",,~'. ,.~ 0>
C./" jC-..... .,4 Jl. ,l, .~'5 .~--!
6 /"- r ! (,.. /' '-/;// .'"
NAME
/-- /
~.~:,'? ( -- ,i ./
SERIAL NUMBER
PROMISED
--T DATE
CALL BEFORE
DAM
o PM.
WORK PERFORMED
o RECOVERED
o RECYCLED
o RECLAIMED
o RETURNED
o DISPOSAL
o DISMANTLED
o CHANGED OUT/REPLACED
QTY.
TYPE/DISPOSITION
CITY
..7':~!"'''.! _t<-/ .....'~t.....
PHONE
./,> ,; /~l~"
'.t
.--
,/ .I
TECHNICIAN
AUTHORIZED BY
WORK TO BE PREPARED
/ )~/ --~: T~ <,/
P.O. 1/
--,
l
-...-"
IC);'.;"
1-
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;' j>
, .
--
TOTAL $
FILTERS
x
x
TOTAL LABOR
LIMITED WARRANTY: All materials, parts and
equipment are warranted by the manufacturers' or
suppliers' written warranty only. All labor performed
by the above named company is warranted for 30
days or as otherwise indicated in writing. The above
named company makes no other warranties,
express or implied, and its agents or technicians are
not authorized to make any such warranties on
behalf of above named company.
TERMS
TOTAL
MATERIALS
TOTAL
LABOR
1 have authority to order the work outlined above which has been saijsfactorily completed, I agree that
Seller retains title to equipment/materials furnished until final payment is made. If payment is not made
as agreed, Seller can remove said equipment/materials at Seller's expense. Any damage resulting from
said removal shall not be the responsibility of Seller.
o REGULAR 0 WARRANTY
o SERVICE CONTRACT
TAX
CUSTOMER SIGNATURE
DATE
0'~ CYIJ<<J
TOTAL (P 330. {)()