HomeMy WebLinkAbout08-7679
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7679
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:
7679
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 5500 6 S
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-09000-0180
4,000.00
Name: DAVIS, JAMES & SUE
200.00 Address: 2605 ROBIN DR
200.00 PLANT CITY FL 33563
3/27/2008 Phone: 813754-3647
REROOF HOT MOP FIBERGLASS SOME AREAS AND FLOOD COAT ROOF
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3/ uv-
TAPE JOINTS ROOF INSP
FINAL
REINSPECTlON 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."
TRACT SIG RE
PERMIT E IRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner:
11- ~ M'1;- ~
3-2f-D8
<SSW to~ s-1-.
----F' t>>- 31 <:\ c:.s roef: il 1frx:,d C (XL'1- 1-4tJ f-
Date Received:
Site:
Permit Type:
Approved wino comments1
Approved withe below comments: 0 Denied withe below comments: 0
Contractor and/or Homeowner
(Required when comments are present)
Ei 13-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
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Owner Phone Number
P /ant Ci'fy 3'r OW.., Pho.. Numho, I
Owner Phone Number I
- Owner's Name
- OWn.(. Add,... I 2hO~ ~bi n
Fee Simple Titleholder Namel . am
- WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
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-h kr(J'a.~s
Xcph. .33.5'-12
PARCELlD#1 J 1- 2~-;LJ -oo/O~oq()OO -nIXO
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
LOT #
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Fee Simple Titleholder Address I
-JOB ADDRESS
SO()O
6ame
V; +h ~)t.
SUBDIVISION
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-- PROPOSED USE : vf
TYPE OF CONSTRUCTION
- DESCRIPTION OF WORK I H:rt- mop
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1$ 4,000. bO I
1$ I
1$ I
~ I
ROOFING D SPECIALTY D
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA
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ADD/ALT
REPAIR
COMM
FRAME
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D
D
DEMOLISH
OTHER
STEEL
rooF &meJ artAO
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D
ani. -Ha::.tl coaT rOo f
Isf1>rI
OTHER I
BUILDING SIZE
SQ FOOTAGE
HEIGHT
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE D PROGRESS ENERG: ID~ ~E.C
VALUATION OF MECHANICAL INSTALLATION IV
PLUMBING
MECHANICAL
GAS
OTHER
DYES
DNO
Address
I ~ ~P~qJ
RoaR ~n I r)C
FEE CURRENf} I Y / N I
License # Ieee 132(0874
~BUILDER
SIGNATURE
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
I Y/ N
FEE CURRENT
Y/N
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
111111I11111111 111I1111111111111111111111111111111111I1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
111111111111111111111111111111111111111111111111111111111111111II11111111111111111111111111111111111111111111111I11111111I1111111I1111111111111111
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions. '
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 Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify 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.
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, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government 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 Protection-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.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallations not specifically in~luded. in the application. A
permit issued shall be construed to be a license to proce~d with the work a~d not as authorl~y ~o vlol~t~, 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 violat~o~s o~ any codes. Eve'!' ~ermit issued. shall become. invalid
unless the work authorized by such permit is commenced within SIX months of permit Issuance, or If work authOrized by
the permit is suspended or abandoned for a period of six (6) months after the time th~ work is commenced.. An extension
may be requested, in writing, from the Building Officia~ for a period not t~ exceed nln~ty \90) days and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the\Job IS 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.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT T...:::....-..~
Subscribed and swomJQ (or affirmed) before me this
;).~ .P&y ,. tYl fUHz-
o is/are perrnallY known to me or haslhave produced
1) L.- as identification.
CONTRACTOR ~~ ~~
Subscribed and swom to (or affirmed~o e this
~I l'()t'Ut:n ~by ,i""" '1-z-
Who is/are personally known to me or has/have produced
p I L- as identification.
~.~
Notary Public
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Notary Public
Name of Notary typed. printe 0
om mission No.
Commission No.
PAM SCHRECENGOST
MY COMMISSION # DD558899
EXPIRES, July 12,2010
(407) ~153 Florida Notary SeNice,com
ame of Notary typed,
$"""II~ PAM SCHRECENGOST
j\ampeCl - : ? .
OFfI,"''''' EXPlRf,S, July 12. _010
(407) 398~0153 F:oprio. Notary Service. com
Mar 25 08 11:10a
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Desc:riutian
AochorMatcon's Built up Roofing AspbaJt prOduCIS an: manufactured from sc:lecb:dpcttoleum
based materials and pIOCessed .tD various softeaiDg points aDdpenetnWons.. m=ting required
specifications as outJinedin ASTMD-312. 'It is supplied in tank \lCb.icles BDdcurtons
TVDic:al PhVlieal Prooerties
aWlge Itange .Raacc R.p
Propeny Type r TyPe n T1JIC m Type tv
Color DId. Bmvm to DarkBnr..m to .Dark Brvwn CD Dark 8fo1m CO
BJack. Billet Black Blade
Soba.iDg PoiIIt ASTMD-36 135-15Jo F 15s.l7P F' lIS-3JS~ ~ 210-2250 F
ASTM 0.5 Pcmettalioo @ 32 Of: 3 6 15 6
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ASTM D-S Penetrlllion @71 Of 18-fiO )8-40 15-35 . ! 12-25
ASTM D-S Pcnetndion @. 1)50.- 9O-rl0 100 DID.. 90 .QIU. 7S max.
Flash Poios (COC) ASTM D-92 05000 F IIIiD.imual 5000 F mibimum SOOO F mmiftMn SOOO F IIda.inlum
SOlubility ill trichJoraeda)".1em: (%) 9.9.0 IlliD:innJm 99.0.miDillWDl 99.0 miDil2l..... 9!J.O miaimum
ASTM D2042
Ductility @71 of. em JO.O 3.0 2.5 1.5
ASTM Dr J3
l)]JicaI AppticatiolD Tm.!""dtdR
Fer Hanel Mopping 3.50 315 410 440
EVT-@ 125 CPS:l:2jOF
Typical Applic:alion TeQlpenllUnl
For Maebine Sprada- 370 395 430 460
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EVT- @ 75 CPS % 2.~F
*N.,e; EqumSCllllS Tem~ (EYT) is Ibc 1l!ID~ Il wich Ibc IIl1\&idity of1llc aphIha;..:s die ClOOlnlclDr1llc bI:st
opponani\y orm'icWJl iII1crpla,y ~ 18 1k2S pauads persqa&C" nnF 1lIe YisaI~..... ~tIy the CCDpmIIUI'C. is
di&nmt flDl' h:uad-nlOpJtiaI YCI$ID 1IIIIcbi.~ lIPptiCllian
AspIIa1cs shaD' be boJllqenOIlS ad he of Wiler ad shall coa&tna au 1b.esc pbysicaJ propedil$.
.A.aclull' Matnll Asphalt Gceeds ~c:aI dlaraetwistics of ASTM, v \"'1'1-' ^ 'L' .
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REV~~~ ~~,.:I:;c",',iyn ~~()~ JREVAILINGCODES,FLORIDABY~LDr'.j
CIT'~ .'~r~,~7~~~~L~,~,;LL,-, CODE, NATIONAL ELECTRiC C01<hA~'J
PLAt'\]~J [';;.;J'v,."m\ii!::.,\ C> (vrV OF ZEPHYRHILLS ORDlNr'\NCE:,
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ACC&:ptallcc No: 01-07.30.03
ROOFING SYSTEM APPROVAl.I
c._on: Raofia;
Su~.te2o",: Modified
Mftterhd: APP. SDS
.Deck ~ Wood
Maim.. Belin r.....re -'OfISI'
Fire CI..1IintiW See venera! t.imibltion'l
Appl'DY;11 Dale: Sc:1tklm...... 16. %001
Expi....ttioa IDale: J.ftc t 9. .11103
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Table 1
TRADE NAMES OF PaooUCTSMANuFACTURED OR LAaEUD BY ApPUCNCT:
Test Prodnu:r
SpeclfaliGn . DescrintiDp
ASTM 0 2626 UL Asphalt COlIted GlJIIAic base sIaect.
Type IS
Pradaet
All WealberlEmpire
Base Sheet
FIQ-r-Olu'N Base
Sheet
FIc:x-I-Glu..... FR Bue
Sheet
FJints!_ Ply Sheet
Type IV or VI .
FJinllaslic ST.I\
STA Plus 5.0
Flilltlastic UTA, GTA-
FR or Flinduti~
Diaamond CTA
Flintlastir:. errs
r:'lintlastic GMS.
Premium GMS
Flintfaslic FR-P,
Premium FR-P
FHntlastic FR. ClIp
Flcxia;b1s Premium Cap
?GC
Ullril Poly SMS
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.:-~..:-\: u'.. .
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Dim..lio..
36" x 72', Rail
weight:.' Ills.
(2 lCluares)
36" x 101', Roll
weiSE go Ibf.
(3 Iquans)
39 )/.-x sa. Roll
weight: 90 rbs.
(I.s~cs)
36- x 110'. Roll
weilht; 40,155 Jbs.
(S squ.es)
39J/.- xl]'. Roll
weighc 90 Ua.
(J $qu;lrc)
39 1,.. x 33' J-, Roll
weight: IOi Ibs.
(taquan:)
39 )/.- x 24'9-, ROll
'~i&hI: 92 Ills.
~ 5qUIR)
39'1." ,,34'2", Roll
w~ighl: 100/1 OS Ibs.
(I &q18R)
39 ~/I" x 34' 2", Roll
weigbc 10S Ibs.
(I squarc)
J~ 1/._ x 34" r. Rail
weiaht: 90 Ibs.
(I square)
36" x 3a-
(I sqUltre)
J""X 64'4"
(2 !quan:s)
REVIEW DATE .:3-:2"-D f ..
CITY OF ZEPti-r'li:~;!'''liLLS
PLANS EXAiV!iNER . ( ~
UL Type 02 Modified BilUmen collCl:d fibertJass base
ASTM 04601, sheet
type II
(JL T1pe G2 Modified Bitumen c~tcd fiberglass base
ASTMD44iOI. sheet.
lwell
ASTM D 2111 FiberaJass. aspbalt imprcQMted ply sheet.
TyPelVorVI
Ul. Type 01
ASTM D &222, Smooth sunaced APP Modified Bitumen
Grade S, Type II membrane willi nOn-Woven pDlyester mat
relnron:emenc fat larch ~pplic;llion.
ASTM 0 6222" Granule swDaccd APP ModirlCd Bitumen
Grade 0, type II ft1Clllbnlnc wiell ftOG-woven polyester mat
rcinrorccmCllt 'Dr lach I1pplicnlion.
ASTM D6164. Granulcsurfaced SBS Modified Oilamcn
vnJdc O. l)pc II membrane wicb non-WDYCn pD)~ mal
reinforcement for torch ~liCllion.
ASTM 06 I 64, GrDIlule Surr.ced sas Modified Bitull\C1\
Orade G. Type n membrane wich aan-wcVWI polyesler m.t
ASTM D6164, rcin10reement for mop.application.
Fire rai_r, sranlde s,....faI:c:d SBS
Cracle Ci. Type I Madified Bltunten Manbrlne wId, nDn-
woven polyester mat reiafon:omeat far
mop IIpplicatioa.
ASTM 015163. Fin! rcsiSlallt. sranuJesurFaccd'SBS
Grad\; C, Type I MacnrlCd Binnnen membrane widl
fibcrslass mar n:inf'orccmcnt formDp
applications.
ASTM 06163. Granule surfac:ed SBS Modireed l3 itamc:n
Ozadc G, T)'pC r mambr.1nc with fibelll,lIS ,mat
mnron=mem for mop appliClltion
ASTMOGI64 SmoDl" surrac:ad SBS ModirlCd l3itam~ \
Grade S, Type I ~:t~i~m~
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lloating Product canll'Dl &aII'Iiner
ALL WORK SHALL COMPLY WITH ALL
PREVAILn~G COUES. FLORIDABUILDr.'::j
CODE, NATIONAL ELECTRIC CODE AN' ,
ClTY OF ZEPHYIUiILLS OPJ)INANCE::~
~ -...J f# arN_ lladaln.anpu. J:.imItI ofUle
W"aUpedbrm its iDtmdIld
wbeu appJiecl accordiDg
DIoIIlul/iu:turer"s
. - iDatruaiaas.
VdI pa'bm its isueDded
DillDaad BIle Sheet Self IIdberinS SBS when app1iallClCOrdiag
hue DlaliWr.cturcr"s
Jaliaa inllnaiOGS.
bInd8rd wm pafanD its ~
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VIII .-farm its iatmdecl
wbaI.1Ipp1ied &CciClIdiDg
o -uJicbIrer"'a '\.;
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Sllndard
SBS
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iaaal sur&cal
Ibeet
Stalin paIyestao Will pa'filnll its iatmded
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miDcraI 1D8IIIIfat2lnr".
shea 'ajl~
PoI.J'lla' SBS. .,.al1 perfiftl its in-...
. mm.ca .... 11PP1i.. acantiae
SIII'&oed m..:tun:lr"s
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AddressIPJaoaehmail:
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1<480 Uaiml MeetiDc lid
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150805
1508.5
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IIIBdInt XaI:
ASTM D&2:Z2, 2001
ASTM D61Q 2000
ASTM D6164 2000
ASTM D460J 1998
ASTM DI970 2001
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11111111111I1111I11111111111111I111111111111I11 11111 11111111
2008043372
State of Florida
Rcpt: 1169109 Rec: 10.00
DS: 0.00 IT: 0.00
03/24/08 __ Dpty Clerk
J0ED PITTMANA PASCO COUNTY CLERK
3/24/08 1lt'.1 : 37.m 1 of 1
OR BK 7792 PG 656
NOTICE OF COMMENCEMENT
Permit Number
County of HUlIborough
The undersigned hereby gives notice that Improvements wHl be made to oertain reef property, and in ac:cordanoe with
section 713.13 of the Florida Statutes, the following informatIOn is provided in the NOTICE OF COMMENCEMENT.
~&'14~~~~~~f~~ Jl;~-~'lTI~otOQ€;~180
2. General desaiption of Improvements:-.h~~~r t~~s and -flood ('c ,Lj- e.nil~ rooF
38. 'Owner Name ~ ~ ~iS
Owner Address: ~ J. ~~hyrhi ll'\ i FL. ..339/-1
3b. OWneN interest in site: Ou..) nf' f
3c. Fee Slmpfe Title holder (of other than owner) f) I t1..
A~: I
4.R~~"\~~IJ:-~_ (I3H)tP5:-5S~
5. Surety Name: Y) / fL, Amount of bonef:
Address:' Phone Number:
6.
Lender Name:
Address:
r, /11 ~
I
Contact:
Phone Number:
7. Person 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 Statues.
Name: t) J a..... Address:
,
8.
Phone Number:
In addition to himself, Owner designates the following person to receive a copy of the lienof'tlS Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name: 11/ a..... Address:
Expiration date of Notice of com~~~n (expiration date is one (1) year from date of recording unless a
different date is specified). ~ --2.L.I-4--
I, L2~
Signature of Owner
9.
STATE OF FLORIDA
COUNTY OF HllLSBOROUGH
The foregoing Instrument was acknowJedged before me this
&/fmon {DC1.VJ;S-
.D/L
12/
. 20Q2.. by
who (Is)(are) personally
as identiftcation, who didldld not take an
date of
march
known to me or produced
oath.
~~
. -.. --..--./
Signature -Notary Public
(Drive... license#)
Print
MY COMMISSION # DDSS8899
EXPIRES: July 12,2010
--...<.
My Commission Expires
c
(A copy of any bond must be attached at ~ time of recordation of this Nob of Commencement)
Fire Chief Keith Williams
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road. Zephyrhills, FL 33542
Bus (813)780-0041 Fax (813)780-0044
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: ~~
Business Name: ." .
Business Address:
Business Phone No.:
Business Fax No.:
Contact:
Contractor:
Billing Address:
Billing Phone No.:
Billing Fax No.:
Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
B Site Plan N/C Annual N/C Sprinkler $50 1 st Alarm N/C
Mu"i-FamilylCommercial .06 sf 1 st Re-inspection N/C Standpipes $50 2nd Alarm N/C
(Minimum Charge $25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
o Plan Revisions DBl 3rd Re-inspection $250 Hoods $50 4th Alarm $100
4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until lP Gas $50 6th Alarm $200
B 0 - 25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS F~I Tanks- perlank $50
STANDPIPE SYSTEM ~-~~ $45 Sparklers $100
o Per Riser $50 Hydrostatic Test $65 per system Fire Works $500
FIRE PUMP Acceptance Test $45 per system Camp Fire $25
o Per Pump $100 Hydrant Flow $75 Controlled Bum $100
FIRE ALARM SYSTEM HoodIDuct $50
B 0 - 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual
26 plus Devices $100 B System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 Annual
~wm $50 OTHER Waste Tire Storage $50 Annual
Dry $50 ~Fnw_w.. $15 per wall Generator < K\N $100
CO2 $50 lP Gas $25 per lank Generator >30 K\N 150
Other $50 Natural Gas $25 per system Bio-Hazard Waste $100 Annual
KITCHEN EXHAUST migation Tenting $50
o Hood/Ducts $50 ~ T...,O'X1U <<_ $15 perlllnt Torch Pot/Applied $50 .~..
OTHER Fire Pump $45 Haz. Materials $100 Annual
B LP Installation per tank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
(Per Tank) $50 B Exhaust HoodIDuct $30
o Natura' Gas Installation $50 Re-inspection DBl
(Per System) (other than annual)
o Spray Booth $50 o Inspection scheduled DBl B
and cancelled less than
24 hours
B Construction Insp. N/C //
Emergency Vehicle ACt $50 FALSE ALARM
PLANS TOTALr==J INSPECTION TOTALC] PERMIT TOTALtf!J TOTAL I
GRAND TOTAL J 50--- ~
Comments:
Date: 3/2.1,(0(3
Insll1lctoJ: 7k4"/-~
~l:::'-/~U-UULU
L,/[Y 01 "-~f.llIY" 1111::; r-~II I III f'\jJjJlllidllUII
Building Department
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-JOB ADDRESS
Sooo
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Co#' ~)t.
LOT#
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Date Receivlld
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P irlnt C''Iy 3T3 "-,,~ ......., I
Owner Phone Number I
- Owner's Name
- -,. ...,~. I ?-." ~ ~hi n
Fee Simple Titleholder Namel am
Fee Simple Titleholder Address I
I
B
o
o
H:rl- l'YIop ..fi k\9IQSS
I, ~Q .~OO~~G~!.
1$ 1, OO{). b 0 I
1$ I
1$ I
~ !--. VALUATION OF MECHANICAL INSTALLATION
ROOFING L-.J
FINISHED FLOOR ELEVATIONS I I
, . , . , . . . , . . . . . , . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . .. . . . , .. .. . . . .. . . . . . . . . . . . . . . . .. ... ................. ...........'..".....!........,.. ,
~BUILDER I " COMPA: I ~ - Deq.J Roo+; r}{j :ffiij, . I
SIGNATURE REGISTERED Y / N FEE CURRE Y /
Address [ 3o$l. Ucense# Ieee 13'2&'874 I
ELECTRICIAN [ COMPANY I
SIGNATURE REGISTERED ., Y / N FEE CURRENT L.Y..L..tLJ
-- [ ...... 1'0
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[ License # ~ ~~ 0\ 1$~ . .
SUBDIVISION
- WORK PROPOSED
8
~
I
NEW CONSTR
INSTALL
SFR
BLOCK
ADD/ALl'
REPAIR
COMM
FRAME
D
D
D
DEMOLISH
- PROPOSED USE
TYPE OF CONSTRUCTION
OTHER I
STEEL D
OTHER ,
- DESCRIPTION OF WORK
I...................
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YDrE &mt'~ ClY~ and -HD::Hf c.oa:t YOof
'.!!. ~~... ...I. ...~~I~~.!....{..~.~.~x.......I.......................
BUILDING SIZE
~D
D
D
D
D
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
o
PROGRESS ENERGY
o
W.R.E.C
PLUMBING
MECHANICAL
GAS
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
;
'.
ONO
Address
MECHANICAL [
SIGNATURE
Address [
OTHER [
SIGNATURE
Address [
COMPANY
REGISTERED
FEE CURRENT
Y/
License #
COMPANY
REGISTERED
Y / N
FEE CURRENT
11'1111111 Till' II r IIII1I r I J 1'111111' II T 11'11111111111' 11111111111 1111111111' III rill' 1II111I111 11111" 111 II r 11I1 ff 1111'111111111 r 111111' I r 111I J I J
License #
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Fonns; R-Q-W Pennit for new construction.
Minimum ten (10) working days after submittal date. Required onslte, Construction Plans. Stonnwater Plans w/ Slit Fence installed.
SanItary Faclllties & 1 dumpster; Site Work Pennit for subdivislonsllarge projects
COMMERCIAL Attacli (3) complete sets of Building Plans plus a Ufe Safety Page; (1) set of Energy Fonns. R-Q-W Pennlt for new construction.
Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stonnwater Plans w/ Sill Fence Installed.
Sanitary Facilities & 1 dumpster. Site Work Pennlt for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for al/ NEW construction.
II J 11111111111111 II J 111111111 II 1111111 J 11111111111 II II J 111111111111111111111111 J 11111111111111111111111111111 II 111111111111111 J II f 11111 J II II II Jill
Directions:
FlII out application completely.
Owner & Contractor sign back of application. notarized
If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewer;; Service .Upgrades NC Fences (PloVSurvey/Footage)
Driveways-Not over Counter If on public roadways..needs ROW