HomeMy WebLinkAbout15-16264 CITY OF ZEPHYRHILLS -�`
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% 5335-8TH STREET
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BUILDING PERMIT ��
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PERMIT INFORMATION LOCATION INFORMATION `
Permit Number: 16264 Address: 37546 NEW HORIZONS BLVD LOT 67
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: MOBILE HOME SUBDIVISION Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34-25-21-0090-00000-0670
Improv. Cost: 19,395.15 OWNER INFORMATION
Date Issued: 6/01/2015 Name: BENFIELD, JOHN & CHRISTINE
Total Fees: 322.50 Address: 37546 NEW HORIZONS BLVD LOT 67
Amount Paid: 322.50 ZEPHYRHILLS, FL. 33542
Date Paid: 6/01/2015 Phone: (813)782-7842
Work Desc: BATHROOM REMODEL 13 'X 12 '
CONTRACTOR S APPLICATION FEES
LOWE'S H ME ENTERS I C BUILDING FEE 202.50 ELECTRICAL FEE 60.00
EAST PASCO ELECTRIC, INC PLUMBING FEE 60.00
JJS PLUMBING CONTRACTOR
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Ins ections Re uired
FOOTER 2ND ROUGH PL MB MIS IN ULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTlON 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 fl 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.
"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 Must Accompany Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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i 2025092130
�� .. ��p ��p "� Rcpt:168899�3 Rec 1@.Q1QI --'i-
Permi!Numaer .
• ParcelldNumber " �� ns� �.00 IT: 0:00
06f1012@15 K. Fi. , Dp'�y Clerk
� N E'�T ! C E f�7�F �O Nl��M E�N G��l�I�..E N T --- �
State of��Ia a _ _. - .. _� �. �-� __._..__
County of.��� � - _
TWE liNaERS[a�D�fiereby glvas notice that lmprovements�wiii be made to�cerEain real properEy, and�.in accor�ance wif�Se�ion�13,Z34f the
Florida-Stsiutes,the foiiawing iriforr�atian is provl d In Ehis OI` E 8F COMMENC �NT, f���� j} �,�r �1_ �-�
1,De�saripEion af property�{! el descriptlon)r 1''/"� 7 {f c.�.d
' s !r•� � '° �
� a)Sireet{�cb}Address: . . .
2.General dast�lp n af m rbvements: •
3�Ownet lafotm fon or Geaaee nf rmatE (f th Les�f e contractsd'for th�e 11mprav ent; ) '
a)Name and address: l�'l� 1 tf �' T f. ,�t t..f� . ���
b)Name and addresa cf fee.sl pCe titleholdar�(ff dlfferent t an Owraer llsted abave} 1�..
c}lnterest in prcparty: � °
��
� .Cc tnclar Infortntttion
Name and address: �. O w t: S ��a nn� �d.r.r�,s�.5��� �cq c�3 o a� �$1 S R 3 c"J��4n�I'��c �L
b�Telephone�No.: ��'7 � �3�t'3 ° �� Fa�c Na:�(optlonal) 3.z..�'��
S.Suretjr(If appilc�le,a copy of the paymen on s a c ed) .
a�Name and�eddress. �.t�R
b�Telept�bne�No.: � PAULR S 0'NEIL,Ph D PA8C0 CLERK & COMPTROLLER _
06l1@!2@I����m 1 ����
c1 kmount of flond: S• ' p� BK P� -
B,Lend�r -
a)Name and addre�s; n)/A '
b)Telephone�No,: '
7;Peroona wHtifimthe.S�ate df Fioritl�d�aignated by Owner upon whom not)ces af other documents m�y�e servad as provided by Se�lon
r 713.53{i)(aj 7.,Florida Statutes: � �
a)Name and addrsss: � -
b)Telephone Na.: Fa�c No.:{aptiona()
8.a.ln add�{aa to hlmaetf or he�self,Qwner deslgnst�s n!�A o
ta recelve a copy of tha Uenor's Notice as proVlded In Section 713.13{1)(b},Florlda Statutes.
b)Phone Number ot Person or en8ty designatad by Owner:
9.Explratlon date of n�tice c�camrnenaement(the expiratlon date may not be 6efore the aornpletlan df constructlon arid flna! paymant fa the
coatractor but will he 1 ear from the' ate•of recordin .un(ess'a dlfferent data�is s sclflsd : 20
WARNIN.Q�.:Q�QW,�i�, �41�Y PAY h}T5 I�fADE'�Y"FH���6Vi(NE��dF"f F�tHE:�XPIRATION�OF�tFiE:N�TI.C��OF,COMM�Ny E El.�l':", ..; ,
CONSIDEi�D`IMPi�t�pE��.PAYMENI`�Ui�DER CWAP'�'E�'713,.PIfiRfi I,S�CtI0N.713�13,.F�:ORi�A��STATUTlS./kN0�.�1�1�E�t1�'I"�l.D1;X�SUR�
� PAYlNG TWICE�FOt�'�IMPRQV�NlEN'f:S'f0 YOtlR PRflPERTY,A�N�}TfC�OF CQMMEMC�Nt�NT NIttST'8E i�CCR�E�:I�N�:�E'�:1;`�D��.hi-'f�t�
INSPEGTION: IF�YOCl�INTEND�'�0 OBTAlN��FINA�+lCINa,CQNSUL'T YOUEt LEND�R bi�A�4Att Ai'TOE�NEY��FQE2E GC?�IMENCING�"WBEiK OR
RECtlRDiNG ti�OUl�•MOTIC�OF GOMI�ENCEMBNT.
� Under penelt�of pe�ury,I dectare th�a�I�tia've reatl the foregoing no8ce of commencertient and�iat the.facts stafed fheieln are hue to the ti�esCiof iny�
knowledg afld�belie /� ,
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�Slgnamre�ot:0�iri�er cr l.� ";ar s or l {Auth6�ze3 OfiicerlDfre ottPartnerlk4aosger} ( rlet ama and Pi�vtd��Stgri�t�a:THtetOt�CS) .
I
�to Ing�} sbv t was ack �ad befora me thi �2P day�at�_�„ �4 �, • . � _r.28 �.J. .
by as �;�,(vLQ._/ (tyPe.ot autht�iiiy,�A.g:oiflde'r.#�e,'s!lmtsy bi fac!}
fo� ' ,as
� (Name of Peraan) (type a�Whortty,...e.p.ofhcer,tru�tee,abnM`ey In fect) .
for • (name of parEy on b whom Insfru was e�cectited�.
Personaliy Know�r ❑ P uced�iD , .
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Type;of�id . �'.1,��� Notary Slgnature � ��-�
, . ��int name tt�,� !�
.�c- "�'�"a nn�'' , - - n�� .
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_ NATASNAA.Fl.ANSBURG � �e , ��t��-T`—
, � �'``�T��ti� K1NY COMMISSION�FF126p61 ��a
IXPIRES:dAN 34,2�17
�� 8flnded2hronphlstSiatelns�tance
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STATE�F FL�RlI3A, COUEV�y�F PASC� �'�� ' �Ly
THIS IS TO CERTIFY THAT THE FOREGOING IS A f�;�� , '��
TRUEAND CORRECT COPY OF THE DOCUMENT ;� `'"� ° �`
ON FILE OR OF FUBLIC RECORf� IN THIS OFFICE � �� ` ��`°'
�
WITNESS hiiY HAND AND OFFICIAL SEAL THIS ��,�£�;;.'�-_'� :h���� �;
DAY OF +�-. ' .°�
2 ,v� �.�U �Y
PAU S. 'iVEiL, RK&COMPTR� `�'�, � dr ,'``�� .
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BY `' '
_ EPUTY CLERK ���'i`�,� � �
u�ia-ruv-vv�u t t�tty vt Grt�rr�yrra�i5 rc��rii�t r,�,N�tiva��v�� � -�•— -- - - .
; Bullding Department
! i"nOrv o'c r� '
;T'_"' ; . .
aat��Racelved , � ��---��� ph ane.Contact f.or Permlttin '��3 2.�� -. �'-t'-�i b""
sa=�tt m �
1wnf�r's Name "�,E��►c�1 ��jf:'�j..� Owner Phane Number �r� `" 7 S2-'�8ti'2.
;— �}
Jwn��r's Address C�� `��� i''U�� Fl �ai�nf 5 f31 vd � Owner Phone Number C I
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'ee:tlrrnple Tilleholdar N�ame ���,.,_ �� Owner Phone Number � �
�ee;ilmple Titleholder A�ddress ;� _ �
____.��
IOEIF117DtiESS C�75 tl SFLIylr�„�C'�sI+�YF+S��S r�- �35� ] l.OT# �o�
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iUEli51i/IStON �°C'Z�C�. }��6Li oNS�� PAR�EL 1D#�-2�-2I -t9�'`?C3 - C7G�C�C�c� -C��°7� �
�� I (OSTA3NED FftQM PROPERTY TAX NOTICE}
NOt?Ft.PitOPt)S�b �NEW ICONSTft ADDiALT � SIGN Q Q DEMOLISH
e �INSTIALL �� REPAIR
�R()'FC�SEED.U3E [,�] (SFl�t� C� COMM [�„� OTHER ��
fYF�!_t?F GON3TI�UCTIClN [� �bLII� K C] ��M� � STEEL C]
QeS�FtIPTION OF�W�)RM h ao:n 1'��"adeL —��e.�t����� ` ' x � 2�
� a�-_ �� �1
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BUtL,i71N6i StZE SQ Ff301'A(3E�5�'+ r NEIt3HT ���
u��� u�a�a��a��x�c �
(-- ���"�+�� $ /{i� ��. VALUATIt�N OF TOTAI.CONSTRUCTION `i �t3Z�
! I ,39 s�� I ,� i
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��ELECTRICft� $ ' AMP SERVICE Q PRQGRESS ENERGY C� W.R.�.C.
��i� ( �
'__�PLUMBINO $ ;�
' � 6G
[_�MECHANlCAL r$ VALUAT!()N OF MECHANlCAL INSTALLATION /'�°
L��?� �
��GAS [�] IROfaFING �, SPE(,lALTY [� OTHER `� ����
FiNISHECt Ftt30�t Ef.EVt4TiONS ��'� FLQt}D ZONE AREA �YES hi()
C�--- � � �-�,� � ��.�.� ��:�..
ttF�Ffithi-t'Fti-Ftfthiitttit �i-htt `, .
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BUtI_DER �f���'U �� A,� , PANY .����ES� l-Ian+•�, C�ri���2�' _�p4�� .
SIGi{��1TURE � "'W �_�� ftEGISTERER Y i N FEE GURREA ��1�
Address �}Q �o!� �1 0,1� '�`"�� '�+'=�A�t u{s� :3�-�'7� License# C..�o�. ( �J� ��'7t~I ,.7
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EI.EC'I'RICiAN j� `�.�{ t;OMPANY __��t /F�
SiE.i��tTURE `���� F2EC3lSTERED Y J N FEE GURR�t� Y/N
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Address C� ; � �� Llcense# C ]
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PLI�MBER �,p ���� �� t;OMPA(VY
S1t�WATtIRE l� � I I FtEt3lSTERED Y/ E2 �EE CURR�h Y/I`1
/Address �� I��� � � License# � �
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ME:ChIANICAL. , � � CQMPANY ]
SIt3T�ATt1RE ; � FtEGtSTEREO Y/ N PEE CUF2REt� Y/h1
�..�.....�..._.,___..
�ddress �„_ i� � � � Llcense# C �
,_ �..'�'�� —
01'NER ' � i f�OMFAPlY ]
31�N�1Tl1RE _ ;���� R£GISTEftED Y/ N fEE CURREA Y/1�I
!�� � !
Addresa � i I � � � L(cense# � ,_,�
i-}iH- f"I-f' fttiitHi-�H Ftti�tMi-Fti-ii� ��
RE35ti�ENTiAL Attach(2j Plot Plans;(2�sets�of 8ulldfing Plans;(1l set of Energy Forms;R-Q•W Permlt far new consUuctlan,
- — Minimum_tec�(10).wo�kir�g d�� s after_submitka{date. Requlred onslte,ConsUucUon Plans,Stormwater Plans wl Sill Fence Inst�lled,
Sanllaty�FaGlitles&1 d�mp,>�er;Site Work�Permit for subdivlslonsllarye=pro}ects------------- , �
C�)M�IERCIAI. A4tach(3)compiete set of E3 ilding Ptarns p�us a C.1fe Safa#y Page;(1)set of Energy Porms. R-a-VV Permlt for new consWctlan.
Minirnum ten{10}warkir'rg dF� s after submitfai date. Ftequired ansite,Constructlan Plans,Stormwater Pla�s w/3!!t Fence Inst�!led,
Sanitaty�acqitles 8�1 d S��mp5 er.Slte Werk Permlt for al!new proJects,All commerclal requirements must meet cornpllance
SiG3N PEERMIT Attarh(2)sets of Engln(�erei9 Plans, �
"*'PROPER'i'Y SURV�Y ra uired for afi NEW cansfrtsction.
aCili�L��Itlai.'t�I:7
Directions: '
FIII aut applfcatlun c;ompletely, l � �
Owner&Cantractoe sign back of appll�satfar�,notarized i
1f over i2500,�Nc►tice of Commenc��n�an�fs requlred.� (A!C upgrades ovor 57500)
'• Agflnt(for the c+7ntractor)ar Power of�;1ttorn�ey(for the clwner}would be someone with notarized letter from owner authorixing same
O�JG�t TH�COUNTE9R IPEftMiT71NG '{Frvr�t of Appllcation Only)
R�roofs lf shingles 8ewers Serv�ce lJ grades A/C � Fences(PIoUSurveylFootage)
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qrtveways-Not avfsr Countar if on publlc ro Idways..neods'ROW �
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NOTICE OF QEEQ RESTRICTIONS: 'fhe undersigned understands that th(s perm(t m y bei subject to yd��ed"r�'�frictions"
whlch may be more res#rlc#Ive than CQUnty cegulatlons. The underslgnedlassumes ce �on€3lbfUty for compliance wlth any
applicabie deed resfrictions. �
UNUGENSED CONTRACTORS AND CONTRAC70R RESPONSIBILITIE;�: If the �owrItier has hired a contractor or
cantrac#ors fo undertake work, they may be required ta be IEcensed In ac�ordance wit �fat:e and�local re�ula#lons. lf th�
cantractar is not Iicensed as required by law, both the owner and contr�ctor may be rite�� far a misderne�no� vlolatlan
under state law. 1f fhe owner c�r intended contr�ctar are uncsr#a!n as ta;wh{�t !lcensl r� r�:qGlrem�nts may apply for th�
intended work, they are advised #o contact the Pasco Counfy Building (ns�ec#ton Divisi�n—ELfcensing Ser�tion at 727-847••
8009, Furthermore, (f the owner has hlred a contractor or contr�ctors�, he� (s advis�d t'o have tho cc>ntracttrr(s) sign
porf(ons of the "contractor B(ock" of fh4s applicatian for which they wiEl be re;aponsEble� If ou, as the a�t�nE�r slgn as th�
contractor, that may be an indication that he is not properly ilcensed and Is not entitl cl to�permitting pr(vileges in Pascu
County. � ' '
TRANSPORTATION IMPACTIUTILITIES IMPACT AND RE80URCE RECQWERY FE 'S: �The undersigned understand;;
that Transportat3on lmpact Fees and Recourse Recovery Fees may appl�! to Qhe const ��ctl�n of new builtiings, changf; of
use in existing bu(Idings, ar exnans(on of exisfing buildings, as specified iln F'asco Co �rfy�C��dinance number 89=07 �nd
90-47, as amended. The undersigned also understands, that such fees,a as may be t�e, 4vill be ldentifiEjd at fhe timH of
permiffing. if (s further undersfood that Transpo�tation impacf �ee;; and IReF�ource R r,ov�ry Fses rnust b� pald priar ta
receiving a "certiflcale of oocupancy" or flnal power release, If the proJect d��es not i volv�e a certificate of occupancy or
final power release, the fees must be pald prlor fo permlt.issuance. Fu�hermore, If �sc�o County V11at;�rl�swer Smpact
fees are due, they must be p.ald prior to permit Issuance In aecordance with appticable �sc�o County ardinanees.
CONSTRUCTION LIEN.E.AW.�.Gh�pter 713, Florlda 3tatutes, as amended�: Rf valu tlan�af work!s$2,5QQ.00 or more, I i
certify that I, the appl(canf, fiave� �een provided wifh a copy of the �Flarida Con truc�ftion Lien Law Homeown�r';� ,'
Protection Gulde" prepared by the Florida Depa�tment of Agricultur_e and. Consumer A�'ai�s. if the appli��ant Is someono
other than fhe°owner", ! certify that i have obtalned a capy of fhe-abave descrlbed do�ilm�?nt and promista Ir� gr�od faEfli to
deliver it to�the�"owner" priar to cammencement. i �
CQNTRACTOF2'S101t1jNER'S �FFIDAVIT: I certlfy#hat all the Informatlo#� In thls app!t:afk�n 3s accurate�nr� that all wark
will�be c�ane In compliarice witf� ali applicable (aws regulating canstructloh, zoning an lar�d development, Appl(cation i�
hereby made to obta4r� a permlt to do work and lnstailatian as !ndlcated. I cert! that rto work or (nstallatfon ha�
commenced prior fo issuance of a permit and that a11 work wi(( b� performed to mee�t standards of a(i laws regu(ating
cans#ructlon, County and Clty codes, zoning regulations, and land devela��ment re�ulat ons in the jurlsdictfon. I also
certify that_I understand that #he regulatians of ot�ier gavernmenf agenc3es may appip Qo f�e lnfended wc7rk, and thaf tt is
my responsibflity to fdentffy what actions I must take to be In compli�inoe, �Suc;h agenc�,� i�jclude but are riat limited to;
- Depar�ment of Envlronmental Prote�tlan-Cypress Bayt�eads; Vi/efland A e�as�and Envlronm�n�ally Sensit3v�
Lands, Vllater/Wastewater Treatment. ; ' �
- Southwest Florida Water Management Distric#-Wells, Cypc�sss Ba�hea�is, Wetland Arsas, A!#erin�
Wafercourses. � �
- Army Corps of Engineers-Seawalis, Docks, Navigable Wa#erwayi>, �
- Departmen# of Hea}th � Rehabi?It$tl.ve Serv}ceslEnvlronmenlal Hea3th ni#-�1Ve11s, Wa�tev�lat�sr Treatment,
Septic Tanks. I -� ;
- US Envlronmental°Prbtectlan Agency-Asbestos abatemenf. � _�
Federal Aviatian.Aufharfty-Runways. �
i und�rstand khat khe followfng rastrlctlons apply to the usa of ffll: ; �
- Use of fili is not allovtred in Flood Zane"V"uniess express(y permitted. � '
- If the flll material-�i�s to be used in Flood �ane NA", .it is �nderstoad �h�t 'a drafnage pl�in addressing ��
"compensating va�Ume" will be subm#tted at tlme of pe�m€ttlr�g wh3ch is p.tepared by a prafesslonal engineer
� Ilcensed by the�Sfate of Flor(da. �' � ;
- If fh� fl!I material Is ta be used In Fload Zor�e "A" in conne:'ctian wlth a �er�itted bulidfng us�ng stem wal#
construction, I certify that fill wfil be used only fo fill the ��rea w,'Ithfn the ste w�ll.
� If fl1! material ls to be used In any area, I certlfy that use o1' such flll wl!! not adversely a�Ffect adjacent
properfies, if use of fi(I is found ta adversely affect adJacent;prcrpe�fies, t��t �wner may be'c.lfed for violatins�.
the conditions of the 'buiidfng permit issued under the attactied permit a�plic�tion, for lats I«ss than one (1)
acre whlch are elevated by flll, an englneered dralnage plan ls requlred. � '
If I am the AGENY FOR THE OWNER, I promise fn good faith ta Inform t�e �owner of tha j�ermitting conditions set forth in
this a€fiidavit prior to commencing constructlon. f understar�d #hat a separate permft��ayi be requfred far afec#rical work,
plumbing,-signs, weils, poals, afr condition(ng, gas, or ofher (nstallations not specifi allyi included in th�3 applir.a#ion. A
permlt lssusd sha!! be construed fa be a license to proce�d with the work and not as ���atf�ority to,ulolate, c�incel, alter, ar
sef aside any provisians of the technical codes, nar shall Issuance of a p�rmlt preven the�Buiidirig ��ic�s�l ft�om thereaffer
requ(ring a correction of errors In plans, construct(on or vlalations of any oodes. Every pei;mit Issued�shall become invalic�
uniess the wo�k autharized by such permit is commenced wlfhln six morith�� of perm�t lss,uance, or If work atafhorizecf by �
the permit is suspended or ab�andaned for a period of six (8) months after'th�� time the worik(s commenced, An extenslan �
� rrtay be requested;Iri writing!fror»�the�Bu}lding-Of€�cla1 for a-perlocf-not-to exoeed=ni�te�y-i(90)-days-and-w1!!-demans#t•ati�--�- —
justifiable cause for the exfens(on�, 1f work ceases for ninety(90}consecu�(ve� days, th J��b;is cansidered�ibcindoned.
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WARNiNG TO OlNE{�R: YOUR FAlLURE Tt} RECORi? �► NC}TIC� OF COMMENGI�NIENT MAY RESULT IN YQUFt
PAYIN� TWICE FOR IMPRO�EMENTS TO YOUR PROPERTY. �F YOU II+�TEND Tb PJ.I3TAIN_FINANCIN�, CqNSUL`Y
W1TH YO.UR�LEN�E.�.2 t�R AN A'T'TORNEY BEFQRE RECQRDtNt�YdUR'i TIC �F t�4MMENC�MEN1�,
FLORIDA JURAT(F.S, 117,U3) I �
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OdYNER OR AGENT CONT'RACTOR
Subscrlbed and swarn to(or afflrmed)before me this 5ubscrlbed and swo a(or a �me�)�before me th(s� ,
by bY � ---� --
Who Islare personally known fa me or haslhave produced Who Islare personally Known to me �r ha�#lhave prodttced
as identlflcatlon, ,_ � ___,as(denkiflcatlon.
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_ Notary Public i ' _Notary Pub(ic
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Commisslon No. _ Commission No. � .,_,_,,,_,1_�; _,_,
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Name of Natary typed,printed or stamped Name of Notary ryped,printed or st mpecl
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813-/HU-UUGU lJll,�/ UI LG�II I�l l l lnw � +...�����..rr�,...-......� _
, Bu�iding Department
Date Received Phone Con#act for Perm3tting �;
�; ;,
Owner's Hacne Owner Phone Number �,,. _ '� �
_ _ . .. • �+
Owner's Address Owner Phone Number��" �',
Fee S�mple 7itleholder Name Owner Phone Num6er�— � . �,�
Fee Simple Titleholder Address i .
I �OT# .��
, JOB AD�RESS• ,
SUBDiVtSIQN � __� ;PARCE�:1D# : � . -, �,
� �(OBTAINED FROM PROPERTY TAX NOTICE)
WOEtFC PltOPt3SEU � tdEW GONSTR e ADD/ALT �I S1GIV __ �� MOVE Q DEMC}L1SN
I �� �� ' � INSTALL. REPAIR
PROPQSED USE Q SFR � GOMM Q OTf-!ER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL [� OTHER '
DESCRIP7'ION OF;WORK; � ,
BUIi.DING SiZE � � SQ FOOTAGfi:�l�,_� HEIGH'F � � _ '
Q �ll1LDlNG � '� VALt1AT1Uid OF TUTAL GOidSTRt1CTi�{V ' ' . . -• � "
Q EI.ECTRiGAL � � AMP SERVICE Q PFtOGRESB ENERGY [� W.R.E.G.
Q PC.ElMBING � �
Q MECHANICAL � � VALUATION OF MECHANtCAL INSTALlATtON '
� GAS Q fitlOFilUG � SPEClALTY Q OTNER .
FINISHED F1.00R ELEVATIONS � � FLOOD ZONE AREA QVES QNO `
8_t!l�.DEi3_ _,_ -. �. . .
- ... .-- - .-- _ _.__.____._ GOMPANY
SIGNATURE REGISTERED Y J N , FEE CIJRRENT Y I N ' '
A1dd[eSS ' LiCBtiS@# �+ , . �
EI.ECTRICtAN ,,/'�' GOMPANY. �=�x ' •
� SIGNA7`URE REGISTERED Y/ N FEE CURRENT ''Y/N
Address U Il . License#� 1�'' /��'�1�'/�n ��
PLUMBER f / C{?MPANY ^-}�r5 ft�t�+rt.�ii '���
SIGNATURE �'�rl��iG� REGISTERED � Y/ N FEE CURRE Y/N
Address vl 2� ' ��. s` i S� t I�tcense#� ��'�- I�'I�--7�1 J�
MECHANICAL GOMPANY •
SIGNATURE REGISTEREp Y/ N FEE CURRENT Y/N
Address ' - License# �� �
O'iHER :COMPAIUY ' �- �
SICiIVATURE`� _ REGI5TER�p Y J N FEE CURRENT' Y J'N •
Address 'license# �_:�.5;`, _ `-``-` .-a"�.� -
REStDEN'ifAL Attach{2j Plot Plans;(2}sets of Building Plans;{1)set of Energy Forms;R-Q-W Pertnit far new construction,
Minimum ten(10}working days after submittal date. Required onsi#e,Construction Ptens,Stormwater Plans w!Sitt Fence irisfalled;
Sanitary Facilities&1 dumpster;Site Work Permlt for'subdlvisions/large proJects �
GOMMERGIAL AEtach{3)se#s of8uiiding Pians;(4)set of Ene�gy�arms.R-Q-W.Permit for new construction ,
Minimam ten(10)working days after submiftal dafe. Required onsite,ConstrucNan Plans,Stormwater Plans.wi Sitf Fence instalied,
SaNtary Facilities 8�1 dumpster.Site Work Permit for ali new projects.All aommercial requiremenks must meet compliance' � ,
SEGN PERMii' Attach{2)sets of Engineered Plans. , , .
"'*PROPERi'Y SURVEY requtred for alt NEW consfruction. .
I
D9rectians: ' "
Filt out appticatian comptetety. � �
Owner&Contractor sign back of application,natarized
If over$250Q a Notice of Gommencecnent is requ�red. (A/C upgrades over$5000j
*` Agent(far the cantractar)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
'OVER THE COUNTER PERMILTING (Front af Application t3�ly)
F2eroofs Sewers Service Upgrades A/C Fences(PlotlSurveylFootage}
priveways-Nat over Gaunfer if on pubttc roadways..needs ROW
�
• NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restriction's"
� which may be mote 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 I
� portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the I
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasca �
County. .
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to tNe construction of new buildings, change of
use in existing 6uildings, 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 tfiat 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 WateNSewer Impact
�fees are due,they must be paid prior to permit.i5suance 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 Departme�t 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 compliarice 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 pertormed 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 otlier 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, V1later/Wastewater Treatment.
- Southwest Florida Wate� 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-UVells, W�stewater Treatment,
Septic Tanks. �
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways. -
I undersfand 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
li.censeci by the State of Florida. �
- If the fill material is. ta be used in Flood Zone "A" in connection with a permitted builcling using stem wall
construction, I ce�tify that fill will be used only to fill the area within the stem wall.
- If-fll, 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 adjacenfi properties, the owne� may be cited for violating
the.co�ditions 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, s.'igns, wells, pools, air conditioning, gas, or other installations not specifically included in�the application. A �
permit issued shall be construed to be a license to proceed with the work and not as authority to.violate; cancel, alfer, 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 codes. Every permit issued shall become.invalid
unless the.work authorized by such permit is commenced withirr six months of permit issuance, or if work authorized by
the permit is suspended or abandaned for a period of six(6) months after the time the work is commenced. An extension
may be �equested, in writing, from the Building Official for a period not to exceed ninety (9p) days and will demonstrate
justifiable cause fo�the extension. If work ceases for ninety(90)consecutive days�the`job is considered abandaned.
WARNING TO OWNER: YOUR FAILURE TO RECORD.A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING�TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YO.0 INTEND TO OBTAIN FINANCING, CONSULT
WItH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F:S.117.03)
..r"" ,r.� �`y 'I�' ,�,;i17- . _'k',Trl?.c�;gTr,.yC"�,��7.f�i:'y�',1:'_ '?...-,-. : .
OVYNERrt.QR�AGEN,Ti�-- _ _ .._ .. .•,__:;CONTRACTOR�Y`s/�:=� _ .� ., .
...��„
Suti'soribed-and sworn to(or fiTfirmed)betore me this Subscribed and sworn to(or a rmed before rrie this
by by
� Who.is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as idenUfication. as identifica6on.
Notary Public Notary Public
,: .
� Commisslon No. Commission No.
I Name 6f Notary typed,printed o�stamped Name of Notary typed,printed or stamped
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City of Zephyrhills
BUILDING PLAN REVIEW COMI��NTS
Contractor/Homeowner:
�o�ve�
Date Received: ���� ��
Site: �J�J ��o ��� �/i�Zl1Yi S �� �
Permit Type: ��jY-��y� �,�y��J�f��
Approved w/no comments:❑ Approved w/the below comments:\ , Denied w/the below comments: ❑
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This comment sheet shall b ept with the permit and/or plans.
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Kal wit — Examiner Date Contractor and/or Homeowner
(Required when comments are present)
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iNSTAi.LAT10N S�RViC�S CUSTOMER CQi�iTRACT .:.
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LtTWE'S OF ZEPHYF�HtI.LS,FI_,STORE#1854 STtJFlE PHQN�:{813)838-9000 �
� 7921 GAEl BOU�EVARD SA�ESPERSON: ".
EPHYRMII.LS, FL 3354i SALESPERSt�N!D:'i861857 �
Daeument Print Uate:04I08f2tt15
This is anly a Quote for the merchandise and services printed below.'This becomes an agreement upon payment and issuance '�r !�niire agreement,inctuciing the
specifiratly completed pages af this docurttent,the Terms and Condftions included with this document,the applicable portian(s)� t�' �S�g�,c��pr attachments hereto,shall
tae re#erred to herein as this°Conirac�"PLE E READ TFiI ENi1EtE EN'[ !N L D! "TERM AND �1Dt7! jT`� �"`
Lowe's Registratian or Contractor License Number/Lowe's Contractor Name
���I��A�-�(�D�.
Ftar�da Contractor License NumberCGCi5U8497
�, .��"'�.� =�� -
Customer Narne � � �'
SOLD JQHN BENFtELD SR �i��������� i �°o
Customer Address e on
�
-,-� 37'S46 NEW HORIZONS BLVD �
Ciry �tate!Province Zip!Pastai Cade �
�
ZEPHYRHILLS FL 83541 �''
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PRC?JECT SUMMARY Q' -
v
Category Comments/Scape of Wark Amaunt Addendum Reference Barcade �
PROJECT SELLlNG None � ���7.5Q 436866127- PSI BENFIELD
CABfNETS/COUNTEi�S
PROJECT SELLING No Comments � gg�,48 436$47272 - P�i BENFlELD
FE
436847207- PSl BENFIEL.D
PR�JECT SEL.LING Na Comments $ ����•Q2 FLOORtN�
PROJECT SELLflVG No Comments $2723.�58 436844902 - PSI BENFiELD
FP
PROJECT SELLING No Comments $ 3526.$3 436844808 - PSt BENFIELD
GS
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S,�r� �854 P;v�ect�u��i�aiy iur J�i-iiv B�ivriELu 5t�. Page 3 ot�
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PROJECT SELLING No Cornments � ���,�a 436847318 - PSI SENFiELD � '',
P&M � ,_ !,
PR4JECT SELLiNG No Comments $ 767.00 ��s�'?29s - PSI BE�IFIELD �o
RE �
436847137- PSt BENFIELD •`�
PRf3JECT SEILfiNG 1Vo Cornments $ 4425.04 RP TUB. i
Materials Price $ 7919.32
Note:Please see Contract Addenda for a mare detailed merchandise and installation ctescript�on. La6or Ci�arges $1'i475,83
etail t7eciuc�ion -$ 0.0
i PHOTO RELEASE: Custorner grants to Lowe's and Lowe's employees the right to take photographs of aN work performed at#he Premisis related to this Can-
tract,and irrevacabiy grants to L.owe`s a11 right,titie and interest in and to the photographs far use in ail markets and media, worldwide, in perpetuity. Customer
authorizes Lowe's to copyrighF, use and pub{isn the photograpf�s in print and/or eiec#ronically,ar�d agrees tha#Lawe`s rnay use such photagraphs far any lawfuf
� purpose, including, but not limited to, marketing, advertising, publicity, illustration, trainir�g and Web conte�t. Sy initialing hsre, Custc�mer agrees#o the forego- �
ing. [Customer to initial to the left].
Additional Specifrcations: Federal law requires Lowe's ta provide you with the parnphlet Retrovate Right: lmparfanf Lead Hazard Information frar Far»ilies, �
Child Care Providers and Schoois. Sy signing this Contract, Custamer acknowledges having received a copy of this pamphlet befate work began informing .�
Customer of the potential risk of#he lead hazard exposure from renavation activity to be performec3 in Custamer`s dwe(ling unit. �-*
Nt3TECE OF ARBiTRATifJN AGREEMENT �
This Cor�#raci provides that a11 clairns by Cusfomer or Lowe's wiH be resolved by BtN[31NG ARBITRATION. Customer and Lowe's G1VE UP?HE RIGHT T4 GO
TO C(?URT to snfnrce ihis Cor�tcact{EXCEPT for matters#hat may be taker�to SIVIALL G!A(MS Ct}UR7�. Lowe's arid Cus#amer's r�ghts uri(1 be determ�ned by 00
a NEUTRAL ARBI7RATQR and NOT a judge or jury. Lowe's and Customer are entitled ta a�AIR H�ARlNG.But the arbitration procedures are SlMPLER AND m
MORE LIMITED THAN RULES A!'PLICABl,E W COURT. Arbitrator decisians are as enforceable as any court order and are subjec#ta VERY LIMITED RE- �
ViEW BY A CQURT. FQR MORE DETAlLS: Review the se�tion titled ARBiTRATtC}N AGREEMENT,WAiVER�F JURY TRIAL AND WAiVER Cl�CLASS AC- ,�
TION ADJUD[GATION found in the Tetms and Conditions of this Gontract. �
0
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TQTAL CHARGES OF ALL I�IERCNA[VQiSE AND SERVICES whereapplicable
SUB-TQTAL $19395.1
*TAX $ O.Q
DELIVERY $ �.0
ORD�R TOTAL $19395.1
�ALANCE DiJE
r�t v
' Wark 3s io commence npan reasonable availab9!'rty of Contractor andFor any speeiai order or custom made Good{s)which is antioipated to be {�t t 4`��`' �.��1� (fitl in date]. �
�
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�#qrP�R�d Prn�o�t C�,�;rim�y;;,;.;vi��v u�i"iri�i..0�r=t Page 2 of 6
� �) ��� '� co��r ;
�
Estimatect compietiart date is� � It in date). �
, 8aid esiimaieo sui3stantiai corripletion date is not of #he essence. A statement of any contingenaes that would materiaily change said estimated substantial completion date is as fol- �
'� tows: `'�
(if appticabte,inseri a statement of such contingenc9es}. �,
..
�
NOTiCE TO CUS70MER
^�!
Ail ifems listed in this contract and specificaUon sheet(s)are to be installed under canditions agreed upon at time of purchase and at the price appearing on this contract form.This assumes sound ex-
isting substructures,superstructure and points of attachments.Extra labor or material incident to installation necessitated by defective substructures,supersu�cture,points of attachmeM,or the moving
of fixiures or appliances to be billed at exVa cost ta customer_DO NOT SIGN TNIS CONTRAC7 UlVT1L CQMPLEI'E AND YOU HAVE READ THE TERMS AND CONDITIONS OF'f'HIS CONTRACT.
BY SIGNING BELOW,YpU ARE ACK�lOWLEDGING TNAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THIS GONTRACi",YOU ARE
ENTITLED TO A C4PY OF THIS COMRACT AT THE T1ME OF SIGNATURE. � ...,1
WITNESS OUR HAND(S)and SEAL(S}BELOW THIS_�_DAY OF�I� , �1 S
Lowe's Ho Centers,ilC `
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gy; 'u�..� � (Sea!} Owner. � r f �
t , '�� � �,�A
Prini Name: 7 • �'��-�. �u✓�-�`-"� Prmt Nam : r
Address:��l�-,� ��f./ �� �� ^ �i
Co-Qwr�er/Wdness: jSeai) `t�
t , / �
Ci'i'Y: `'``� ��'`� _State: �f ?.�p: ..�3-r � Print Name:
Customer acknowledges receipt of a true capy which was completely iilled in prior to Customer's execution hereof.You the customer may cancel this transaction a#any time prlor to midnight an v�i
ihe thtrd 8usiness day afier the dafe af#hfs#ansaciion.See the attached Natice af Right to CanceE for an e7cplanation of this sfght.
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Ct�nro a R�D;�j��i.�'Si3�Tniiaiy iui✓VtiIV CSCIVY'ItLU�fi Page 3 of 6
2015-{14-29 13:1? isaprt 75 8138384008 >} P �t4
Lowe's Proj�;ct Profile Report
�
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Project Type: Inferiors Customer: benfield,john a
Project Subtype: Baths Customer Phone: (813)782-7842
Store: 1854 Employee: Shampine, Kyle
Project lD; 3319770 Print pate: 3l27/1S 14;33 AM
� Genera!
,
" Ba�h�ocatEan Main Levei
Bath Type Master
Bai:h Style Bath with Double Vanity&Separate 7ub&Shower
But9get $14,OD0 and up
� InstalJation
Notes: Shower and needed plumbing updates. Floors,move
toiie#(Madular home w±th crawl space beneath},vanity...
lights...cauntertop...new tub wJnew(acation.
'�� � Structural
Not}�s: Mpving one wail to possible knee walE on outside af
shower.
� Vanity/SinktTop
NotEis: Double with top.
C Tailet
Note�s: R&R in new location approximately 3 ft to the left.
� Tub/Shawer
NQtes; 7fle new shower wails. Moving drain a few inches ta
accommodate a neo-angle shower.
� Flooring
'�. Note:s: Tils. Remove and replace wilh 'i!4 inoh cancrete board
substrate. Need to find a reducer for doorway to match
as clasely as possibCe the
Page 7 of 3 •
2015-()4-29 13:17 isoprt 75 8138389008 » P 6t4
existing laminate floor.
C Watl Tile
r
Nc�tes; Shower walls anly.
� Millwork
R1c�tes: R&R existing drywall. Patch cQiling where knock-down
will be needed after wall removal.
� Paint
Notes: Poss(bly.
� Lighting
Notes: Vanity lights being repfaced.
C Plumbing
Notas: R&R with va(v� replacement at shower. New location of
#oilet with 31f af ex9t(ine needed ta be added under this
r"` modular hame(skErted access). Moving shower drain a
few inches to accammodate a nea-angle shower vs.the
existing rectangular:Adding a new drain for a new jetted
whiripoal tub with heater. Moving two sinks to
accommodate one douhle vanity and counter.
C_ Window Treatrnents
NotE,s: NA
� EJectrical
NotE:s; G�I moving.Adding power for t�ew Whirlpool tub.
� Other
Notes:
�
Aage 2 of 9 �
2015-04-29 13:17 isoprt 75 81383890Q8 >� p 7/9
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