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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
DRIVEWAY PERMIT
5245
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:
5245
DRIVEWAY
DRIVEWAY/NEW
SINGLE FAMILY RESIDENTIAL
Address: 39133 OLD MILL LN
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block:
Subdivision: SUMMERHILL
Parcel Number: 12-26-21-0100-00000-0330
Book:
Section:
800.00
12/14/2005
35.00
35.00
12/14/2005
DRIVEWAY-NEW
Name: JOHN COOLEY
Address: 39133 OLD MILL LN
ZEPHYRHILLS, FL. 33542
Phone:
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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
MUST BE 6" DEEP WITH WIRE MESH AT RIGHT OF WAY
~~
PERMIT OFFI
OR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CI~Y OF ZEPHYRHILLS PERM~~ A~~~L~~,~~V~
BUI:LDING DEPARTMENT 5335 8~H st, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DA'I~E RECEIVED
\2 fILl /o~
PHONE GONTACT FOR PERMITTING
OWNER'S NAME
~t)n 0. E L-EDI.VOP
(
PHONE: 't; \"3 -, <& % 35, L\-
JOB ADDRESS 3<::1.\33 OL-\) .m, ~ \ L-n.
() " t:(:;CJOo...... t> '$ ~o
LEGAL DESCRIPTION: LOT(S) 12...-2..b-ZI-O/t1BLOCK , SUBDIVISION
PARCEL ID '* id-~Lo--d \ ~ 0\00- 0000'0.0"330 (OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: ~EW CONSTRUCTION 0 ADDITION o ALTERATION 0 REPAIR 0 INSTALL
o SIGN
PROPOSED USE: ~S~L FAMILY DWELLING
o COMMERCIAL
o MOVE
o DEMOLISH
OMULTI -FAMILY
o INDUSTRIAL
Of OF UNITS
o SWIMMING POOL
o MOBILE HOt'
o OTHER
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APrROVAL
p Q ( V ~LU f1 <.(
BUILDING SIZE
/ "00
s;: r.
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 PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL ,NEW CONSTRUCTION.
PERMITS REQUESTED
o BUILDING
$ ~OO,<50
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
o PLUMBING
o MECHANICAL
AMP SERVICE
o Progress Energy 0
W.R.E.C.
o GAS
o ROOFING
o SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
$
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES ~~
'~-'-'-T~ -'--,--~'-'- --' ----' ---'---.-, . , '[----~'-------------'- - 1-- - - - - ,- - ----. - --~-'--:'"'---,
, " ' " ' . - ' , ' I' 'I ,-
~-~-~-~ ~~---'----'-,-,--_,,,-,_,----------------~--'--- -~- --,~---~----,~.:...
BUILDER
COMPANY
~~
SIGNATURE
STATE CERT OR REGIST i
*****************************************************************
ELECTRICIAN
COMPANY
SIGNATURE
,
STATE CERT OR REGIST i
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
STATE CERT OR REGIST #
********************************************~****~***************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST i
A. NOTIGE OF DEED RESTRICTIONS
The undersigned understands that this p~rmit may be subject to ude~d 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 contr~ftors 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 maYbe 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 uGoi1tractor 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 CONNECTI.ON FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, hayt;! been provided with a copy'of uFlorida'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 Uowner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the uowner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I ce~tify that ~ll 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 wiil 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 appiy to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies inolude but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetiand 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 uA" or uA, etc.", i.t is
understood that a drainage plan addressing a ucompensating 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 $~5.00. .The extension shall b7 requeste~
in writing to'the Building Official. An approved 1nspect1on must be logged dur1ng each S1X
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: CONTRACTOR
SIGNATURE: OWNER OR AGENT
acknowledged
, 2~
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)
[1ho is personally known to me, or
o who has produced
(type of identification)
and whoO did Ddid not take an oath.
Dwho has produced
(type of identification)
and. who Ddid [}: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
OW~ER -
JOB LOCATION
~o
CITY OF ZEPHYRHILLS BUILDING DEPARTHENT
H. \0 f L i3'c It){~) R. Coo Ley'
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PARCEL I.D.' #
I 'L - '2 C:> - -z ( - () I D 0 - (J C 6c; 0 ~, 0 '? S 0
SIIOW ALL EXISTING & PROPOSED STRUCTUR&S' -GIVING DIMENSIONS & SETBACKS.
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UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
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(NOTE EXAMPLES 1 & 2) STREET
1. SETBACKS FOR Rl, R2 ZONING
60'
10'
P E
R X
0 I
10' P S 10'
0 T 1 0'
S I
E N
D G
20'
FRONT PROPERTY LINE
2. SETBACKS FOR R3 ZONING
60'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30'DUPLEX
1 0'
FRONT PROPERTY LINE
I,
agree to the provisions of this instrument.
Je tf~'
DJ:SCLOSlJRE STATEMENT FOR OWNER
CJ:TY 01" ZEPHYRBJ:LLS BUJ:LDJ:NG DEPARTMENT
Ct9 () L E yo
have read and "fuJ.~y understand and
The undersigned states and affirms that he or she is desirous of constructing,
renovating, adding to or reroofing his or her own damici~e" that he or she
actua~~y occupies, or wi~~ occupy by said damici~e, and same is not for
rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing conditions:
~. That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of
construction.
2. That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s
ordinances and codes pertinent to the bui~ding.
3. That in the event various phases of construction are subcontracted, he wi~~
engage o~y proper~y ~icensed subcontractors and wi~~ persona~~y supervise
such work..
4. That in the event theBui~ding J:nspector sha~~ require corrections to be made,
the owner wi~~ assume fu~~ responsibi~ity to insure they are made, and upon
comp~etion wi~~ ca~~ for a reinspection before proceeding with the bui~ding.
5. That the oWner sha~~ assume fuJ.~ responsibi~i ty for the construction and wi~~
not expect supervision of his work from the City of zephyrhi~~s Bui~ding
Department.
6. That prior to fina~ inspection any additiona~ fees, inc~uding reinspection
fees, must be paid in fu~~. A written request from this office shal~
constitute an official notice,to pay additiona~ fees.
7. That the owner shall comply with a~~ City, State and l"ederaJ. ~aws in regard to
social security, workman's compensation, lien laws, etc., where applicable.
8. That the owner shal~ comp~y with a~l the safety codes issued by the F~orida
J:ndustria~ Commission.
9. State ~aw requires construction to be done by ~icensed contractors. You have
app~ied for a permit under an exemption to that law. The exemption a~~ows
you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a license. You must provide direct
onsite supervision of the construction yourself. You may bui~d or impr~ea
one-fami~y or two-fami~y residence or a far.m outbuilding. You may also build
or improve a commercial bui~ding, provided your costs do not exceed $25,000.
The bui~ding .or residence must be for your own use or occupancy. J:t may not
be bui~t or substantial~y improved for sale or lease. J:f you sel~ or lease a
bui~ding you have bui~t or substantially improved yourself within 1 year after
the construction is comp~ete, the law wil~ presume that you built or
substantia~ly improved if for sale or lease, which is a vio~ation of this
exemption. You may not hire an un~icensed person to act as your contractor or
to supervise peop~e working on your bui~ding. J:t is your responsibility to
make sure that people employed by you have ~icenses required by state law and
by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not
licensed to perform the work being done. Any person working on your building
who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for that employee, all as prescribed by law.
Your construction must comply with all app~icable laws, ordinances, building
codes, and zoning ~r gulations.
OWNER'S SIGNATURE ~ DA'l'B I Z-- /,ohs r
ADDRESS ~< 1; ScJl? { .&.2 /C" Rtf,' I f
PHONE .r/3 -? p(""-- ~ 5"' r'7
WITNESS
PERHJ:T #
CITY ~ ZEPHYRHILLS BUILDING DEPARTHENT
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OWNER ' , ,.g, ( ~ <""~
JOB LOCAT?o~ 39./;3 ..;~ P!,-d '-"'~
PARCEL I.D.' #
SHOW ALL EXISTING & PROPOSED STRUcruR&,S' 'GIVING DIHENSIONS & SETBACKS.
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UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION. .
FRONT PROPERTY
J -- j/./
.; :L i"~/aT)'-
7J3R/uk~; ~
S Y-t{'G'G- A
LINE Cc...":=/l/;C:--'v/""
(NOTE EXAMPLES 1 & 2)
STREET
1. SETBACKS FOR Rlf R2 ZONING
60'
2. SETBACKS FOR R3 ZONING
60'
10'
P E-
R X
0 I
10' P S 10'
0 T
S I
E N
D G
20'
1 0'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30'DUPLEX
1 0'
FRONT PROPERTY LINE
IVlljC'I'~ IC/Yi=
\'~(c. 'P,c.J I -
:::( c s/
FRONT PROPERTY
h y p~;,>~
(" ~ it.:::/y ~
,--,,' f..
LINE
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DATE:
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CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT
RIGHT-OF-WAY USE PERMIT
PERMIT# 5';;2 V 5'
No construction under ground or above ground of any raclllty shan be accomplished on any City RIghts of Way without written approval from the
City BuDding Department. Any application for approval of construction operations on any City owned Rl&ht. of Way IhaII fumlsh a detailed draw"'lhowfnJ
the complete scope of the proposed work In triplicate to the office of the BuDding OffIcial for approval prior to the commencement of any work. A copy of this
permit II to be kept readny avanable at the lite of the work at an times.
fe, 'Z..l - D
PARCELI.D.N 1'2...- ~ -z.... - 100 -Ot:X'oo-o33ceITYROAD () L D MILl
L PI,
DATE j- ~ 'y-O?>
LOCATION (Legal Description):
Permllllon il hereby granted to ~ \ C) If 10 ~ r L <?O 1-'0 l<- Co c9 cF<i' of
for the construction and maintelllUlCe of '::i) R-. / V e1.,.(...) it' 'r'
lubject to the following conditionl:
1. The construction and malntelllUlCe of luch utility lhan not Interfere with the property and right. of a prior occupant.
2. All work Ihall be done In keeping with the ltandardl of the City Streets Department and under the lupervilllon of the City Build'" OffIcial, who
wDI be notified at least one day prior to commencement of conltruction.
3. All materiall and equipment lhan be subject to inspection by the City BuDding Official
4. During construction alllafety regulationl of the Department of Transportation IhaD be oblerved and the City IhaII be relieved of all
relponllblllty from damage of any nature arillng from this permit. Subject to the same terml and conditionl, the permit holder may take luch safety measures,
including plac'" and dillplay of caution Signl, al it may deem necessary in conduct of constnlctlon and maintenance work hereunder. It is the responsibility of
the permittee to place, maintain, and supervise all traffic control and devices.
5. AD private and all City properly shall be restored to its original condition al far as practical in the opinion of the City BuUding OffIcial
6. All underground crolllng installations lhall be laid at luch depth as may be lpecified by the City Building OffIcial
7. . The lketch covering the details of this inltallation Ihall be made a part of thll permit. Thll permit is granted with the undentanding that the
applicant has notified all other utility ulen in the area covered by the permit and takel fuD relponlibility for any damage ineurred by prior Installations as a
relult of his operatlonl in order that they may lafe guard their interelts.
8. It is exprellly stipulated that this permit Is a license for permllslve use only and that the placing of facilities upon pubDc property punuant to this
permit shall not operate to create or to vest any property right In said holder.
9. Whenever the City decides to further exploit the City Rights of Way, any or allsalel polel, wires, plpel, cables, or other facilities and
appurtenanees authorized hereunder, shaD be Immediately removed from laid Rlghtl of Way, or reset or relocated thereon as required by the CitY Build'"
Official at the expenle of the holder of this permit.
10. The holder lhalllave and keep the City harmless from any and all damagel, claim I, or InjUrlel that may occur by reason of the _tructlon,
maintenance, and operation of laid facility.
11. The holder IhaD complete the requested work within ? days or thll permit IhaII become nuD and void. In the event the work requested
II not completed upon the expiratlen date of this permit, the City lhall ha've the right to complete II1Idt work and to charge the holder of the permit for all COlts
incurred in completing laid work.
12. The holder IhaD post a cash or surety bond with the City MlIIIIlger In the lum of S dollan to guarantee performanc:e of the obligations
herein, and to guarantee maintenance of the right-of-way delcribed herein for a period of one (1) year following completion of the requelted installation. In the
event a surety bond il pOlted, the lurety bond lhan be made payable to the City and IhaD obDgate the IUrety to hold the City harmletl in the event the holder of
this permit should fail to meet any of It I obligations hereunder. The bond shaD also indemnify the City for an court COItl and reasonable attorneY'1 fees in the
event legal action II required to collect on said bond.
13. The permittee shall have a 24 hour emergency contact name and number listed below.
(permittee)
SUBMITTED BY:
~ 0 i1 (oJ (0 C) Cr7Y
o L(.J I..) E IL.
Signature & Title
Address 3'q I 3 '"S 0 c... D IV1 (c... (. L- tl I
Phone 8?"/ 5 - ') ~ f - s S- / V
APPROVED BY:
CITY OF ZEPHYRHILLS
BuDding Official
Date:
UtUitlel Supervisor
Date: ~__ _
~~Wj~N~~
City Manager
Date: