HomeMy WebLinkAbout06-5542
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5542
Permit Number: 5542
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: CHURCH
Square Feet:
Est. Value:
Improv. Cost: 2,175.00
Date Issued: 3/08/2006
Total Fees: 45.00
Amount Paid: 45.00
Date Paid: 3/08/2006
Work Desc: RE-ROOF
Address: 5601 20TH T
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-11100-0040
Phone:
~
/ o.-~ \0\1
'y J' ~ V-\ \tY
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
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."
NO OCCUPANCY BEFORE C.O.
A~ ... ~-.
CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CI~Y OF ZEPHYRHILLS PERMLT A~~~~~AT~U~
BUI'LDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX:B13-7BO-0021
DATE RECEIVED
3/~/o(p
PHONE GONTACT FOR PERMITTING
OWNER'S NAME\="('rS+ "?V-e.5(?"'- .f-.tv'I~V\ tk.LAv'('~
JOB ADDRESS . 5" 0 I 2- 6-r~ J f-
PHONE
LEGAL DESCRIPTION: LOT(S) BLOCK
PARCEL ID # /(-2 h- 2/ -00/0-///00- DO~c)
SUBDIVISION
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION
DSIGN
PROPOSED USE: DSGL FAMILY DWELLING
o COMMERCIAL
o ADDITION
DALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
OMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOl'
o OTHER
SQUARE FOOTAGE
APl?ROVAL
?-5 'I e ~ I.-- C/l-F ~~Y''-~ /
J; ve rf '-fA.
. HEIGHT l/
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT
~V00{ CL ~ ,~/
BUILDING SIZE
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.
o BUILDING
PERMITS REQUESTED
L I 75 f 0 0 VALUATION OF TOTAL CONSTRUCTION
$
o ELECTRICAL
o PLUMBING
AMP SERVICE
o Progress Energy 0
W.R.E.C.
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
l~r~"~--'T"1" -- -~-- ~ ~ -~---.......-- - ~-- -I~" ~ ,. r-~- -~'--~---~-~~---~--l ,. - ~ . -- - ----,,-~- ~-I~----;-:;j'"f;"-:~;I
~ I I'r I I I [ I I I l ,; ... ~, JI ~ I I I I, .~. t, 1\1')',
_.....~_~_~_~~...:..J.__..._~._~___~ _'___~____________ - --- ---~----'---'-~~ '
BUILDER
COMPANY
SIGNATURE
STATE CERT OR REGIS'!' #
******************************************************************
ELECTRICIAN
COMPANY
SIGNATURE
-
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST *
******************************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST *
SIGNATURE
*****************************************************************
OTHER i< 60/ / ~ J COMPANY ~t <>fr 61 '" c.t (,vt /t,.J P <'>0 I-r~)
/ ~
SIGNATURE ,~~~ ____ STATE CERT' OR REGIST * t(!C OJ 7 It) 7
A.' NOTI~E OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which
may be more restiictivethanCity regulations. The undersigned assumes responsibtlity for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSiBILITIES
If the owner. has hired a contractor or cbntr~Ftors to undertake work, . they may be required
to be licensed in accordance with state and local regulations. If the contractor is no.t
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 "Gontractor Sections" of this ~pplication for which they
will be responsible. If you,' as the owner signs as the contractor, ydu 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 indication that he is not properly licensed and is
not entitled to permit~tng privileges in the city of zephyrhills.
C.' TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STA'I'UTES, AS AMENDED)
I certify that I, the applicant, haYE\ been provided with a copy'of "Florida's Construction
lien Law _ Homeowner's.protection Guide" prepared by the Florida Department ot 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. .
AppLI.qation 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 developmerit 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 inolude 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 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. Ir YOU INTEND TO OB'I'AIN 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: OWNER OR AGENT
-~
SIGNATURE: CONTRACTOR
acknowledged
, 2CL-
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
'.f 20_
(name' of person acknowledged)
Owho is personally known to me, 'or
(name of perso~ acknowledged)
C1ho is personally known to me, or
o who has produced
(type
and whoO did 0 did not
of identification)
take an oath.
o who has produced
(type of identification)
and who Odid [):lid not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped
H~'L rr-L11_l' It:.~ t'LHN
I""d.x.'::';l..)-:'(~-"jQ~'l 1'leU r I....((j .lL"LL r.UL
~ .....-..,.-...- ," ._._.h, . ..- ,,". .,_...~_...A".~-,,______,,_,,_ '--_'.__~~... t,
..:'~~"!'
ProposaVContract
Se4H -C~. ~tllJji~, 11te.
P.O, Box: 1188
33010 S'R 52
San Antonio. 'FL 33576
(352) SSa-ROOF (7663) · (813) 782-1330
Fax (352) 588-9763
email: blackmanroofing@aol.com
,L~tt.
.tuUtut &
1'J....e.Ift
~~
t!IJd 057957
PROPOSAL SUSMITrED TO
Name F/rsr' R4! p..li4r J :.V~ Cltl "" ... Ch
Slreet S ko I "LD f'~ Sr
City Zt./J\vm#/Lr
/
Sate _F / Zip_
Phone Number 7 g...o .../ DPfI
Date .2/ Q.. 7! 0 h.
WORKED TO BE PERFORMED~.T
~reet 11'- 2 G:..- 2..1 - 00' 0 - /1 I 0 0 :5J_~
I
G::ity
I
State
I
!
Zip
Owner of Property
Fax __.__.____ . Phone Number
Fax____
I
We .!J,ereby propose to furnish all the materials and perform ~tl1e.labor necessary for the completicnof:
e1!femolle e~iSting shingle roof E:fR!9Jace bad faSCia boards at $, 2" 7'd per foot
o Re~ve existing built-up roq.t ~staU 30 teet ot ridge vents . .'.
~-in with 0 15 lb. ~ lb. Cllnstall modified bitimen (granulated) torch down roofing
I .
o In~w galvanized valley metal b1~hite or other color ,.\-
e1r1stall new lead boots ~1a1l25 yr. fungus resistant 3-tab shingle;-r2,/7 S~ 0 D
Q Install new exhaust vents 0 Install 30 yr. fungus resistant dimenskmal shingles .
~I n$W drip OOge, i!/j,.., "JJ,f 'k color 0 Shingle manLlfacturer color
Q I~I new flashing as needed 0 In$t!lllTPO, white rubberi1;ed rooting membrane
ri~cePlywoodat$~,t1V per sheet ~her:...TnJ"4//;4 Al/4..J'k" /'"1 t M4/t/
~"pair rotten trusses at $ ). J 7 &' per loot r I,) b f P c,..i1'\. ,j' 2. (p 6 A..
~Woodwork is an additional charge, see pricing above ~ / /J ~ () (,)
All material is guaranteed to be as specified. and the above work is to be performed is accordance with the drawings and specifica-
tions submitted for above w.~rk and completed in a Substantial workmanlike manner for the sum Of $
with payments to be made.as follows. Payment due in full on completiont unlus otherwise noted. Thank You.
Credit cards accepted. additional2.8%d1ar'Je._
AfIY alteratiOn or d.\'iation from ab<J\I1I spBGificalion'ii I"VQI\ll~ el<lli Q;l..t5 Villi
be executed Ol'll~ upOn wrltt<en ofder3, and Will btcom. 81'1 el<lI'it thal'!l. ovtH' and
above fie e$tImat.. All aoreem.!'Ib oontil'lgt!lnl up.ln strikes. accidents or dslays
DeyOnd our conrl'Ol. owner:o eal'ly firla. lornado llrd other ne(I!SS8n,t 111l!;':fance
upon "bcv~ "Jl:nK_ Wolk8r.' Compensation a!Id PublIC l.iaOlity or.$U rarle. ~n 8tlOve
work 10 boi Utllen I)Ut by Roo/in; CClMrtlcter,
Client gives permission to drive On driveway to deliver materials.
r ACCEPTANCE OF PROPOSAL ;1'
I The above prices, specifit".atioMS and conditions are satisfactory and are h....by aecapt~d. You are authorized to do the work as
:'Specified. I have featt ttt@ OacK or nus F'roposallcontract, wniCll COntainS FlOrioa Statues 71 ~,oo, -71 ~.37. Payment will be made as
outlinedabo'le. / /J ~ . l
Aocepted--=:J;~ ~t:..1' Fec.s.TlUJ Signatur~ ~ -~ i
Date 'S -D 7 - Ot; Signature i
~
~7---'.-~"'"
Officer/Agent Scott Blackman Roofing
No'., ThIs P7'" may bo withdrown by us If no, .ce.""",
within days.
03/07/2005 19:43
8E3:~.5 7]'3=,r~
PHIL. CASTAHlJ
PAGE 01
a3/~S/2eB6 a4:04
3525889'763
Sa\' RCXJFI~
PAGE 01
~6 l<I ...
ddtf tJ$7f1"
PROPOSAlSU8MnTEDTO
;..... Ii I "'c!> 1J~~j k",
SU'Mt . 7 '-/ ~ i -) to'" 5f
City ~'Jt, r II r /1.1.
Qate - , ZIp
PhOn.Number 71" Z 'i/~1f'
ProposaVContract
SetK.e ~ ~HIt<<9' 1~.
P.O. Box 1188
33010 SA 52
San Antonio, FL 33576
(H2) See-ROOF (7663) · (813) 782-1330
F.x (352) 588-9763
emell: blaCkmanrooflng. aol.com
WOAKEOTogePERFoAMED~T
.4".....4.
fI....tI .
'I......"
DatG ~/o"""
___ ~~et
-I City
__ Stalu
'I OWner of Property
Phone Number
Zip ___
Fax.
___Fax____
We herElby propose to furnish all the materials and perform all the labor necessary for tne completio", of;
~move ext.ting ahingle roof 0 Replace bad fasda boardlat $ per foot
:.J RlImOV8 existing built-up roof 9"1'fis'tall ~4_r/l~et of ridge vents
~~ with U 1510, a1OIo. .:) Install modified bitlmen (granulated) torch down rooting
CJ I"s~all new g8llvanized valley metal black. wnite or other color _._____
~;tall n!ilW i..c:t boots ~S yr. fung.Jt r..latant 3-tab shingles
o In't.'I new exhaust .....n. 0 Install 30 yr. tUf'!gua r..iatant dimensional shingles
~~'ll new drip edge, f..u...-~in.,. (0 color 0 Sh,menufacturer ~ _ cotor~_
o Install new f1.'hing as needed l31i1Stall '!'PO, white rubberized C2Qfing membrane
Q R.p1eca plywood at $ . per sheet a Ottler; ~-: ,.. J A/I ';:"".5 ~ ~ (It. h,) '\ ~.>.... ~ 01
Q R.peir rotton trtJUM at $__ ~r foot ~ ~ "" +- L~i""
.Woodwork Is an additIonal chairge, "' pricjpg above
All materiel I. guaranteed to be a. apec::ified, and the above WOrk IS to be performed Is accordance With the drawings and speciflca-
tiona submitted for above work and completed In a suQitan!lat workmanlike manner for the sum 01 $ ~. J 25', 0 u _
with paymenls to b. made as follows. P-.yment due In tutl on com"I~I2D., un.... otherwiae noted. Thank You
_ CAtdit cards~, addItlonal2.eek oh8rQe
'/~~ ~ ~ ----- . "_.
- Offic.r/Agent Scott Blackman Roonng --.
Note; Thus OPOUl may bv withdr.wn by us jf /'\ot acc:eptG(
wit1m I .___ asys.
Client gives PltrmilSion to drive on drlvh/ay to d@lIvarmaterials.
"'"~ '"".Ia. or NYlal/Qn from .bov. .!l"HlOavQI'I4 ltJ.OMng "Ill'll ea.,. ...,.
e. -tellltll onty I,Ij;l(ln 11m"," :lrQrI, &lid wl~ ~m. '1' ~". ell"lIe Ilver ."4
,1)Ove ,n_ .........- All agr._.n.. CO~"1JlII'It '.IItl!ft..,.... .CClClen'i 0' Cltl.y.
"\10M 011' OOMlOI. 0...., to ta"Y II"'. 10'"'1" II'l\l oCtot, Il<<""ry !I\'"""(:,
UllO/lIbOl/' wonc WcH1c.I'I' CIlmHr'tMtlon and Pvbll( Llablll4y'lhlllll'l"~' e" atog..
wolle to b. ,.. O\Il by "wfino CO<Il..Clor
ACCePTANCE OF PRO OSAl
The ~~\,Ie prices, ap8CIfiQ.lltione and condlrloM are aatlsf.ctory .nd are hereby accepted_ VOll are authorized to do the work as
spec,fied. I have read the back of thIS ProPO..llI/Contract. which contains Florida Statu..s113. 001-713_37. Paymlilnt Will be made as
outlfnectabovs. (1. \~ . L ..... ~
ACC4!lPted '0 ~--\~ ; --- - Slgl1llturQ
Data ~ .J tD - \;) fO Signature _.~
Owner Infor_tio"' ..... (' l '^~ Go..l Jv-.e'-'l;. q '^ ~,~ )
l~ddress q '"\ '-'..) It''r \.... City '2..e-c?kr,,", '-'-V St e IR.....
, "3 ~ \- V 2...
03/06/2006 04:04
3525889763
SBR ROCFING
Repl:976680 Ree: 10.00
os: 0. 00 IT: 0. 00
03/08/06 _________ Dpty Clerk
PAGE 03
1111I1111I1111I1111I1111111111111111111111111111111111111111
200604?560
ltO'l'XCB OJ!' COII.IBIIIt"Dma-.a:
~ o..S c.A
state l)f t=\()y-\~~
County of
TUB UMDERSXGRBD hereby give. notice that improvement will be made to e~~t&!n
real property, and in accordanee with Chapter 713, Florida Statutes, the
followinc; information i. provided in this Notice of C~ncc.ellt:
1. Description of Property: Parcel No.
- '2..<0 - ~\
2.
~F
General
3.
Interest in Property:
Name of Fee Simple Titleholder:
(If other th~n owner)
Address
City
State
,-
Contractor: Name ~ ()~
P.O. €:.o~ '\%'0
Address ?~t")\D ~~ 'f=-.';:).
~\~~'frOS'\ ~GD~\~ \ \'f'C ,
city SA\J P.NTotV H.~ State t:=L-
330-"} ~
5.
Surety: N':lIoe
Address
City
Stata
Amount of Bond: S
6. Lender: Name .c;;: .,)_~N~~
Address
city
State
7.
Persons within the State of Florida designated by Owner upon whem
notices or o~her documents may be served as provided by Section
7lJ.13(1)(a) (7), rlorida Statutes:
tlr.lTll!
Address
City
State
<J.
receive a copy of the
(l!(b), Florida Statutes.
8. In addition t
:;"p.irni ..'," d"t... ()( t t.lce or C enc: t.
tr~m the elate of rec onUTl em~n (t.hexplrat.lon d",te 1i1 1 }'ear
unle.s a d~fferent date is specified.)
Signature of Owner: Ov~ ~ ~
Sworn to and subscribad before me this 7tfc:.- day of 1Y1~-;::
20~.
~i tf~~
My CC):n,:,j ss ion Expires:
Not~ry Pllblic:
PC93053048lA
STATE OF FLOF:iOA
COUNTY OF PASCO
THIS IS TO CERm:y THAT THE FOREGOING IS A
TRUE AND CORRECT COpy OF THE DOCUMENT ON FILE
OR OF PUBLIC RECORD IN l1-1IS OFFIC~ITNESS MY
H(;;1D ~FfICIAL SEAL THIS~ DAY OF
.(~ 2-!2Drc
JED~MAN' Cl . OF C!RC).JJTCOURT
BY. ~
. .?._- DEPUTY CLERK
lSlc:...
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CI~Y OF ZEPHYRHILLS PERMLT A~~~~~ATiU~
BUIILDING DEPARTMENT 5335 87H St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECEIVED
PHONE GONTACT FOR PERMITTING
OWNER'S NAME C 1'v'Lolj G) '-1 ck Je VI
JOB ADDRESS . Lf / L{ ~ / / t-"'- .Sf
PHONE
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION
ILL 2 'J .....-- . 0 ~()
PARCEL ID * ,_. {g - L. I - O\:J In' - 0 2~00 0 (OBTAIN FROM PROPERTY TAX NOTICE!
WORK PROPSED: ONEW CONSTRUCTION o ADDITION o ALTERATION o REPAIR o INSTALL
DSIGN o MOVE 0 DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING OMULTI-FAMILY 0* OF UNITS o MOBILE HO~
o COMMERCIAL o INDUSTRIAL o SWIMMING POOL o OTHER
o RESTAURANT & HEALTH DEPARTMENT AP!?ROVAL
DESCRIPTION OF WORK ~ V0U r- / 6 .5 ~ 2.S-:ye~'-. )AI;~ O"J,1r~/jq.f _
ri rC' S Iun~ TFo <u, ";:::"'t't..-7"-
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 PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
o BUILDING
$ , i72-!;;JO 0
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
o PLUMBING
o MECHANICAL
AMP SERVICE
o Progress Energy 0
W.R.E.C.
$
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
~':i~-~~:~'-"-"'" ~~-- -,---~-----'-- .--~ ---, - -r-- ~-_r-r~~______ ----~~--Il~ _. p - -- ---- --~"--"'---~-~~T=~rl,
"I I I I' I. - . r ' ,f, J , ( ,
~I' , II, I I "1
-~ -..............-_=_-'-'l-~_~___'-~__.__L,...;._.___._.:...__~__~__ _ _____~~_------..:___~~...............~~
BUILDER
COMPANY
SIGNATURE
STATE CERT OR REGIST *
******************************************************************
ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
STATE CERT OR REGIST #
*****************************************************************
OTHER tiZo) /"1 ",:J COMPANY S'u-jf-VJ I tl<. cA.w... t+iJ ;2u f)1-/~
SIGNATUR~ ~~ -------- STATE CERT' OR REGIST # (( Co ,7 TJ"7
A. NOTI~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 responsib~lity 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 po~tions of the "Gontractor Sections" of this ~pplication 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 indication 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, 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 appLi.cant 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 th~: 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. .
Appli~ation 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 developmerit 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, 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 certity 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 .construedto 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".
./~
SrtfNATURE: OWNER OR AGENT
. J2:,-k~---
,.;/
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me. this _day of
by .
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this _ day of ' 2rL-
by
(name' of person acknowledged)
Owho is personally known to me, 'or
o who has produced
(type
and wlioO did 0 did not
acknowledged
'.f 20_
of identification)
take an oath.
(name of persor acknowledged)
[1ho is personally known to me, or
o who has produced
(type of identification)
and. who Odid 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