HomeMy WebLinkAbout15-16292 CITY OF ZEPHYRHILLS
� ., 5335-8TH STREET
(813)780-0020 1629 I
�� BUILDING PERMIT
PERMIT INFORMATION � LOCATION INFORMATION
Permit Number: 16292 Address: 5324 17TH ST
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
� Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-17300-0170
Improv. Cost: 5,179.00 OWNER INFORMATION
Date Issued: 5/22/2015 Name: HOUSING & U D&SEC C/O MICHAELSON
Total Fees: 65.00 Address: 4400 WILL ROGERS PKWY STE 300
Amount Paid: 65.00 OKLAHOMA CITY OK 73108-1870
Date Paid: 5/22/2015 Phone: 813-788-1668
Work Desc: A/C CHANGE OUT 3.5 TON HEATPUMP
CONTRACTOR S APPLICATION FEES
BA R'S PROPANE GAS& C,INC. C CHA EOUT 65.00
,
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Ins ections Re uired
DUCTS INSTALL D
DUCTSINSULATE -�
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 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 properly 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 performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
_ ,
ONTRACTOR 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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PROPANE GAS Service Order ro�'']osal � � � e
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AND AIC �tvc. � r Air.Conditionin 8�He�
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Sales, Service & Instailations WORK ORDER#lSERVICEMAN 584E�: DEC
� • 4441 Allen Rd. • Ze h rhills, FL33541 - DATE/TIME TAKEiU �4/i�/i.5 14:�►�
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' �"=� NOTES: DATE/TIME PROMISED�;��u°f'�i�t;�,�;i5l3:�5"e;���;���:r:
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FILTERS x x Changed Monthly I I
FILTERS x x Changed Monthly � I
❑ REGULAR ❑WARRANTY ��=;�=�.�;���u�T�TAI:'Sl'l,IUtIVIi4R�+�=�i%'`�-`
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LIMITED WARRANTY: All materiais,parts and equipment are warranted by the manufacturers' �"�`_"`'`,��:��r��5�° � � � ��' " '" CALL i
- <;;,,:_— ;:IVjE7ls[OD`OF;PAYN[ENT;:= s;.:='�"���:
or suppliers'written warranty only.All labor performed by the above named company is wartanted for "`' �"`"3''"=="'=`�J-Y���`�=:'y=:.,=;2:,-,y„�'�':��`��%=��t^'�r�.:='•<
30 days or as othenvise indicated in writing.The above named company makes no other warranties, ❑CASH ❑CK# TOTAL i
express or impiied,and its agents or technicians are not author¢ed to make any such warranties on MATERIALS i
behaifofabovenamedcompany. ❑DEBIT 0 CREDIT ❑OTHER MAINTENANCE �
�1 have authoriry to order the xrork oWined above which has been satlsfaGOrity completeA.1 agree that Seller
PROG. W I C �
ratains title to equipmenVmaterials fumished until finai payment is made.If payment fs nat made as agreed, CLAIM# �
selier can remwe said equipmentlmaterials at Sellels expense.My damage resulting hom said removal sha0 �� I �
nAU.UNPAIDSBALHN ES O ER 30 DA S.NOYREFUN S%SERVICE CHARGE WILL BE ADDED MOM'HLY TO DATE COMPLETED If 1
TECH: TAX ��G ���
CUSTOMERSIGNATURE DATE ✓1��Is///Gf(i �o�c TOTAL ��/�f� •QL
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
; ►. Building Department
Date Recefved Phone Contact for Permitting �L J �S oZ — �'J�
Owner's Name f/Ql�I..�iN �G� Fy/1� ��b o Owner Phone Number 8�� 7��"����
/ �uiv�fi�rr�
Owner's Address C/m�C�'P`�� ����'/��o e,eS�i`C ���ner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS ��� �/ �D �, �L° �/�/Ll�r �� . ��'�Z LOT# �
SUBDIVISION PARCEL ID# �� �(A� �� D��D I�3dD D���
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED , B NEw CONSTR� ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK � D DL' � RG' � -- � Cd� O/lJE?/��S ���
BUILDING SIZE SQ FOOTAGE C� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ �/�� D� VALUATION OF MECHANICAL INSTALLATION
QGAS Q ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA [�YES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Addre�s License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL - COMPANY A�/� � �"'o �le o`-%�--1/1�G
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
J Address Ucense# �/�0�� /T 6
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
RESIDENTIAL Attach(2)Flot Plans;(2)sets of Building'Plans;(1)set of Energy Forms;R-O-W Pertnit for new consUuction,
Minimum ten(10)working days after submittal date. Required onsite,ConsVuction Plans,Stortnwater Plans w/Sflt Fence installed,
Sanitary FaciliUes&1 dumpster,Site Work Permit for subdivisfonsAarge pro)ects
- 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,ConsWction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facil(Ues&1 dumpster.Site Work Permit for all new proJects.All commercial requtrements must meet compllance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"'"PROPERTY SURVEY required for all NEW construc8on.
Dlrectlons:
Fill out application completely.
Owner 8 Contractor sign back of appltcaUan,notarized
If over 52500,a Notice of Commencement is requlred. (A!C upgrades over 57500) . - - .
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
DVER THE COUNTER PERMITTING (Front of Application Only) . -
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if an public roadways..�eeds ROW
:. . -.
NOTiCE AF L1EED RESTRICTii�NS: The understgned undetgt�ands�#0�8t this.p�cm�t.may.be.subject to"deed"�estrictlons°
which may be�more resQ�fctive than Countya reguiations. �The undersigned assurries responsibilify far compliance with any
agp#icable deed restrlctlons.
UIdLlCENSED CONTRACTCIRS AND CONTRACTOR R�SPONSlBIL-ITIES: !f the owner has hired a contt�actor or
contractors ta undertake work, they may be required.to be.ltcensed In accordance.with state.and�loca! regulations, !f the
cantractor Is not licensed as requtred-by (aw, both the owner and canGactor may be cited for a misdemeanor violatlan
under state law. tf the awner ar intendedreorrtractor �re uncertain as ta what licensing.requiremerrts may apply��far the
intended work, they a�e advlsed to contact the Pasca Courtty 8uitding Inspectlon Dlvlslon--Lfaensing Sec#ion at 727-847-
8009. Furthermoref tf the owner has hired a cont�aGtor or contractors. he Is advised to have the contracEor(s} slgn
portions of the "conkractor Block" of this application for whia�h they wlll be responsible.. If you� as.the owner sign as the
con#rac#or, that rnay be an indication that he is no#.prope�iy iicensed and is not entitled to permitting privileges In Pasco
Caunty.
TRANSPORTA710N�IMP;RCTtU'FIl.1TIES tMPAC'�ANb RESOURCE RECQVERY FEES: The unders€gned understands
that Transport�atfon Impact Fees and.fZ,eaourse IRecovery.Fees may��apply�#a the constn�ctlon of new bulidings, change of
use in existing buiidings, or,expansion�_of��eXistiri�=6uildings, as speclfted.in Pasco County Ordinanae number 89-07 and
90-07, as amended. The underslgned also understands� thalt such fees�-as�may�be�due„will be identifled at the time of
permitting. it is further understaod that T�anspartation tmpact Fees and Resource Recovery Fees must be pald prtor to
recelving a°cerfiticate of occupancy"or fina) pawec=release. :if the proj�ct does not irnrolve a certificate of oacupancy or
fina! pawer�elease, the.fees must be pald prfor ta permlt lssuance. Futthermore;•if Pasco County iNateriSewer Impact
fees are duef they�must be pald prlor to permlt lssuance�ln accordance with�appltcable Pasco County ordinances.
CONSTRUCTION LIEN L.AW(Chapter T13, Flor�da Statutes�as amended�: (f valuatlon of work is$2�500.U0 ar more, 9
certify that t, #he app0icant, h�ve.been provlded with a copy of the "Flarida- Construction Lien Law—Hameowner's
Protection Gufde" preparad by the Fiorida Departmenf af Agricutture and ConsumerAifiairs.- tf the appitcant ls someone
ather than the"owner", t cer#ify that t-have.obtained a+copy of the above..des.cribed docurr�ent°and.promis�in,good`faith to
deliver it to the°owner"prior to�commencement.
CANTRACTCIR'S/OWNER'S A�FIDAVIT: I certify that aA the Informatian In thi�appllcatlon is accurate and that al!work
wi0�be done in compilance with all appi(cable laws regulating constructian, zoning and land development. AppAcatlon is
hereby made to obtain .a permit to do work,and installation as indicafed.- `1 certffy that no work or tnstaliatton has
commenced prlar to issuance af�a perrr�it and that aif wark will be performed ta meet standards of all iaws regutating�
construatbn, County and City codes, zontng regulations, and land develapment cegalatlons-fn the Jur3sdlctEon. 1 ai'so
certify that ! u�ders#and that the regulations o#other government agencles may-apply�to the lrttended work, and that it is
my responsfbility to Identlfy�what.act(ons I must take to be,in:.cort�pllance: S.uoh agencies Include but are..not Ifmited ta:
- Department of E�lvlronmental Protection-Gypress.Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Wa#erJWastewa#er Treatment.
- Sau#hwest Florida itNater Management �tistrlct Wetls, Cypress. Bey.heads, Wetiand Areas, At#ering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks,Navtgable Waterways.
- Department of Health'8 Retaabll(tative Seni(ces/Ernironmental Health Un1RWeils, Wastewater Treatment,
Sep#ic Tanks. .
- US Environmentaf Protection Agenca+-Asbestos abatement.
- Federai Avlattc�n Authority-Runways.
!understand that the following res#�Ictions apply to the use of fll1:•
- Use of fill Is not aUowed in Flood Zone"V"unless expressly permitted.
- lf the fili materlal 1s to be used tn Fload Zone �A", It. is understoad #hat a drainage plan addressi�g a
"compensating vofume"wil) be submftted at time of permitttng which (s prepared by a prafessiona) engineer
licensed by#he State af florida.
- !f th� fiN mate�lal fs to be used in Flaod �one "A" En�cannec�ion�vv�Eh.a�permitted buitd4ng using stem wal!
' construction} !certlfy that fi!!<wlll�be used only.to f!I!the a�ea wlthin the�stem�wall.
- If fill materlal Is to be used in any area, I certify that use of such fill wil! not adversely affect adJacent
properties. tf use of fill is found to adversely:�ft'ect adJaeent•prr�perties,.the owner may be cited for vlolating
the candEtions af the buitding,permi# issued under the at#ached permit appiica#ion, for lots iess than.one (1)
acre wh3ch are elevated�by tllt;an englneered dr�inage plan is raguired.
If!am the ACENT�OR T'HE OV1tNER, t,�promise In good faith to tnform the owner of�the permltting conditions set forth In
this affidavlt prior ta commer�aing canstruotlon. I understand that a�separate permlt may be requtred for elect�ical worki
piumbing, signs, we0s, pools; air canditioning, .gas, or other installations not.speciflcally included-in.tMe applicatlon. A
permit lssued shall be canshued to be a license to praceed with the work and not as authority to.violste,cancet, al#er, ar
se#astde any prov�sions af the technical cades; nar shall issuance�of a.permit.pr.event the Buttdirig Of�icisl from thereafter
requiring a correcilat�af e�rors In pla�s; constn�ctfon or violatfons of any codes. Every pe�rnlE issued shatl become invalid
unless the work autho�Ized.by such permit.•is.commenced�wlthln stx months of pennit lssaance, or PF wark au#horized by
the permit is suspended or abandoned�fo�a:period of�six(8) mnnt�s after the time the�work�ls commenced. An e�ctensian
may be requested, in writing, from the Buitding,Official far a perlod not#o exceed nlnety(90) c�ays and wll) demanstrate
justi�abie cause for.the extension: If work ceases:for ninety t90)consecu#iva:days,..the�job�is considered aba�doned.
WARNlNG TO CIWNER; YQUR FAlL.URE�:FO.RECC?RD A NQTIGE:OF�C4MMEMCEMENT�MAY RESU�:T iN YOUR
PAYING TWICE.FOR IMPROVEMENTS TO YC1UR.PROPERTY. !��YO.U�IN'FEND�'�TQ�OB'�AlN��FII+tANC1NG;'CON3Ul.T
�IIIT U - 2 . _AM '�TAItIV�Y�� AR�':RECO G,; �UR' O ; `dF� ., . CE N .
PI.OR{DA.lURA3(F.S.i 17.03) ti - - - -
OWNER OR AOENT_ G�L'n'�'e- � -��??� CONTRACTOR �
Su�saibed and sr+wom r afiicmed)be ore me#his 5ubscribed and`swam fa(or aflirmed)�betore me ttiis
�5 z7llS b •by
Who�slare pe�own to.me or hasfiave produced Who Is/ere personally knowm to me•o�hasmave�prodOced �
as ldentl�callon. as identffication.
��Cc 1..2 !� Notary Public . Notary Pub!!c
Co ! �ql}� ;"'-, JACQUELINE B ES Commfssfan.No.
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~�� =Q: Expires December 92,2418
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Name o:N6t�� �' Name of Nokary typed,printed or stamped