HomeMy WebLinkAbout13-14030 CITY OF ZEPHYRHILLS
' ' S335-8TH STREET
(st3)�so-oo20 1403"�
DRIVEWAY PERMIT
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Permit Number: 14030 Y Address: ZEPHYR PARK SOUTH AVE LS#4
Permit Type: DRIVEWAY ZEPHYRHILLS, FL.
Class of Work: DRIVEWAY/NEW Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost: ,;:,;,,; ;;,�-,�
Date Issued: 3/28/201 � �Name: CITY OF ZEPHYRHILLS
Total Fees: 3 0 ��u�,�;G�� Address: 5335 8TH ST
Amount Paid: 3 . ZEPHYRHILLS FL 33542
Date Paid: 3/28/2013 Phone:
Work Desc: DRIVEWAY 40 X 15 FOR LIFT STATION #4- FEE WAIVED-PO#19538
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MORRIS &ASSOCIATES INC DRIVEWAY 30.00 k�
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FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one 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 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."
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ONTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
.
CITY OF ZEPHYRHILLS
UTILITIES DEPARTMENT
Pursuant to Purchase Order 1953$and 19539, issued to Morris and Associates, inc.on February
1, 2013 a determination had been made by the City that there is a need for the performance of
or rendering of services by Morris and Associates, Inc. of a certain "Task Order" under the
purview of said Contract. The issuance of this Task Order hereby authorizes Morris and
Associates, Inc.to perForm or render the particular services of work described as follows:
TASK ORDER NUMBER: lS13-03 and 1.513-03 Change Order No. i
Morris and Associates, Inc. shall perform tasks as more specifically defiailed in the attached
"Proposals"dated December 18, 2012 by Morris and Associates, lnc.
Compensation to Morris and Associates, Inc. for rendering all of the identified services and
products shall not exceed 19 448.75 under this Task Order a�d 7 741.25 under Change Order
No. 1 unless authorized in writing by the City of Zephyrhills in accordance with the stipulations
set forth in Bid 11-11-07. Furthermore, compensation for the tasks shall not exceed the
amount set forth as follows unless authorized in writing by the City of Zephyrhills in accordance
with the stipulations set forth in Bid 11-11-07:
- -�$� _ .' „ ,.f I�.` - '�' A�.- -.�` ;'�-.+°#'.3,1'd�.i16.7I,�'r�k�r�.,*.•"rt':
-:Lift�:: - .L•o�a�ion�:,.,�:T:� '.�:=� ���-t`�' - �.,;�mv.i�nt�•'.`
�?.r,.2t�.�:� � ';;a�' •y'-i..:.. 4d+r....`y
'`:+-�=. -. - `:��.'� - :n:.. �"`t?B`,•4?;W".. 5`ti�::kl". - ,..[�71",-':"br:k'=4�.,,'v.+;.�:+�'34.`�'1 p�';
� .."�s !•.:E.c`v:.�,,Y' - .vp<'�.,: '`rF'i"i��.�.;,,Y.;�� �.i>1'7'� �NS.r�d::n itil,1�J
['1��•'r`�`ati r�i'� �"�3i i�=: `�'�.Y t*ew�' -
S ,,.or ;;�:., ;;;a£� ';'�',;;�,. - - �,��.., M.�;�.,�,�:r��
'�, k�. .t �!C+�'�r�S - - .. `,i�:" rv�sC.ir?;t«...r�:::r�:'S"�%`.� .`J• •f, •F _
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°xi'l�` .�.i°.: , .seY.r�•- '- -- , '°a";.�:r.._._,.F�.;::.,,. 7.1. ''� • '"^,,c�e
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um er�-���'`''��'�-,�: �.,;_ �� ;�_�:;, .�>.. ;.,�;.�r;� z �t��.�� r
':.�r,1�w,�-6�c�.., .t;:f#-�v's:• �.�i: .�'�.H.:. :Ff,..r:�?<�af�Z.� r*�f% a:;�,Kd;a.':�K;fw>;�`.�'r,i�, .r Q(r.%;�tt:M� .,�,b� ir
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30 37219 Geiger Road $19,448.75
3U Change Order No. 1 $7,741.25
lea�se�invoic:�;;e"a.�ch:;purchases;ord"e`r:sepa.rately:
By: �g � .�9 13
avfd E. Henderson Date
pirector of Utilities '
" PURCHASE ORDER
No. 00019538
�it� �f s��ph�rrhilis :.�.' L.;
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VENDOR: SIflP TO: BILL TO:
Morris&Associates Inc. Wastewater Plant City of Zephyrhills
Commercial Business Finance 39825 Alston Avenue 5335 8th St.
PO Box 1209
Winter Park,FL 32790- Zephyrhills,FL 33542- Zephyrhills,FL 33542
VF.NDOR NO. VENDOR PHONE NiJMBER TERM.S DATLZ REQUIRED DELIVERY DATE
Morris&A ( ) - � 0 02/Ol/2013
SHIPPYNG INSTRUCTIONS
(none)
I'TEM QTY U/M DESCRIPTION/TASK PRD CODE ACCOUNT UNTT PRICE AMOIJNT
1 0.00 Sanitary Sewer Manhole and 041-3500-535-6322 19,448.7500 19,448.75
LS Rehabilitatian. Task
Order#LS 13-03 for J.S#30
Rehabilitation. Not to exceed
total cost of PO.
IMPORTANT: OUR ORDER IVUMBER MUST APPEAR ON EV�RY II�iVOICE AND PACKAGE
This ocder is given upon the representution and guarunty of the manufacwter or seller thut.no brench oF any SWte or Pederal Law or Regulalion has occuaed in
connection with the manufacturing,processing,branding,lnbeling or iranaportation of the merchandise henein mentioned. ff such breACh occurs or is charged by any
legnlly constituted Smte or}�tleral authority,ihe buyer shall be enlitled lo mscind the order and relurn ihe�nused mer+chaodise and shall also be held hArmtess by the
manufncmror or seller ugainst uny penatty incuned and/or Ihe cost of defense of any procadi�designed ro penuliae the buyer the�eFor.
Page:2 Purchase Order No. 00019538
ITEM QTY U/M DESCRIPTION/TASR PRD CODE ACCOUNT UNIT PRICE AMOUNT
SUBTOTAL: 19,448.75
TAX: 0.00
SHIPPING: 0.00
TOTAL: 19,448.75
TAXABLE: No
CONRIRMING: No
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AUTHORIZED SIGNATURE
SPECIAL INSTRUC'I'IONS:
IMPORTANT: OUR ORDER NUMBER MUST APPEAR ON EVERY INVOICE AND PACKAGE
This order is given upon the representntion and guaranry of�he manufnaurer or ssUer that no bccach of any State or Federal Law or Regulation has accuRed in
connecdon with Ihc manufacturing,pro�essing,branding,lubeling a iransportadon of the merchandise herein mentia�ed. if such breach cecurs or is charged by any
2egally constiwtod State or Pederal authority,ihe buyec sha12 be eatidal to rescind the ader and rdam the unused mer�hendise and shall also be held harrnless by the
manufacturer or seller pgainst any penalty incurned andlor the cost of dcfense of any procceding desig�d to penalize ti�e buyer tLerefor.
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RERMIT APPLICATION '`R'�
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DRtVEWAY PERMIT APPLICATION
CONSTRUCTIOI� WITHIN PUBLIC RIGHT-OF-WAY
All information must be filled-in completely
City of Zephyrhills
5335 8"'Street, Zephyrhills, FL 33542 �._
Telephone 813J80.0000 Fax 813J80.000 ��
Dabe of applk;adon: 3._Z�.-(3 Proce�sed By:. �;�^� P'ermit#:
cpay a�to►sdtf uoe or�Iy) � _ ,
_ OCopr Uo euildin9 D�ar�r�eM �Copv eo Public.worics
PR07ECT 70B SIT : PROPERTY OWNER
Address: �� .� �,- ,,�� Name: � d ,( � ,//
Unit#: Address: t� �( <� Unit: -�`�
Parcel Identification Number: ' .�' ,m,� � Ci State i ,c // ���/
Phone: i - 7� - �o� ax:
CONTRACTOR: �
ComPanY� /��r--��S °rf �ss"�c.
Name: ,,�i, - ,.�
Contractor's License #: LC�•- ' � E-Mail: ✓�� -� � �,.� 4 �-�: c�wr
Phone: _�s�_��?�-�03 7 Cell: �5�3a_. �ozf� Fax: ���- ",�y-- ,�/ �
ARCHITECT/ENGINEER:
Name: Firm Name:
Address: City: State• Zip•
State License #: Phone: Cell: Fax:
Desc�iution of Proiect
TYPE OF DRIVEWAY y� �LENGTH OF DRIVEWAY CULVERTS NEEDED
RESIDENTIAL DRIVEWAY /5"�yyIDTH OF DRIVEWAY ( )REINFORCED CONCRETE
t�C COMMERCIAL DRIVEWAY R•O•W EXCAVATIOI�! ( )CORRUGATED MATERIAL
PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEEf O BOX CULVERT
�OTHER(IXPLAIN)
�ONSTRUCTIONI MATERIAL CURB CUT REOUIR�D ,�,�,,1�
ASPHALT YES �_NO
,y�CONCRETE
HEADWALL REOUIRED? YES �NO
f�OT'ICE TO/f►PPlICAN'T: IE actual work exceeds scop�cf this description,additional permits or drawings
wil! be required.
UTILITY�OC/4TION&REOUI ED• C�LL BEFORE YOU DIG: 1.800.432.4�I0
Fage S of 3
PERMI7 APP'�ICATIOIV
UTILITIES LOCATE CONFIRMATIOk NUMBER:
PROVIDE SKETCFi IN THIS AREA, IF ADDITIONAL SRACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
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AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing
information is accurate and that all work will comply with all applicable codes. I understand these rndes shall take precedence over all
approved construction documents,and issuance of this permit is verification that I will notify the property owner of Florida Lien Law
req., F.S. 713.
The issuance of this permit dces not ensure compliance with deed restrictions and I understand that additional deed
restrictions may apply to this property.
All work shall comply with the current Florida Building Code, Public Works Design Manuat and FDOT Design
Standards(if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.fl.us/public works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBLIC.
NOTE: The City of Zephyrhills is not responsible for mair�tenance or repairs of driveways. Driveway�shall not alter/
intertere with existing stormwater treatme�and/or oonveyance.
PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure
statement. L^ .le (please initial) �
-�.,!'� �u oi� �,� ,,� ���/�
Applicant Print Name Applicant ' nature Date
Permit Technician Signature (or)Notary Signature Date
Applicant is( ) personally known to me or produced as identification.
(rype of identification)
R�g� � o� 3
PERMIT AP�LI�ATION
OFFICE USE ONLY
PUBLIC WORKS USE ONLY
Concrete (min. 6'� Y N
Asphalt Base(min. 6'� Y N
Asphalt(min. 1�/z'� Y N
Length (min. 19� Y N
Width (10'min—20'max) Y N
Existing sidewalk. Y N
New sidewalk. Y N
ADA compliant. Y N
Expansion material required. � Y N
Contiguous parking pad. Y N
Triangular flare (3'W x 7'L) Y N
Visibility triangle o.k.? Y N
Side set back(3'min. R.O.W.) Y N
Plan Review Fee
Additional desai on of work as defined b Public Worics Director and or nee:
/ ( '` ` � r� ` 6�� �—E
Permit application approved by: � — zr 1 __ Date:
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