HomeMy WebLinkAbout15-16316 - : CITY OF ZEPHYRHILLS
5335-8TH STREET
(ais)�so-oo20 1 6
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16316 Address: 37414 DERBYSHIRE DR
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: WEDGEWOOD MANOR
Est. Value: Parcel Number: 10-26-21-0120-00000-1070
Improv. Cost: 5,229.00 OWNER INFORMATION
Date Issued: 5/28/2015 Name: TATUM DAWN
Total Fees: 65.00 Address: 37414 DERBYSHIRE DR
Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542
Date Paid: 5/28/2015 Phone: 727-482-3640
Work Desc: A/C CHANGE OUT 3.5 TON
CONTRACTOR S APPLICATION FEES
HRI ' C CO. C CHANGEOUT 65.00
Ins ections Re uired
DUCTS INSTALLED
DUCTSINSULATED
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 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 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 pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRACTOR SIGN URE 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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CAC05�575 PROPOSAL
�2232 FI�11Y 30'6 D�4DE CITY (352)521�977 , � . `� (p /Z� ' ��j�
DADE CiTl(, FL 33525 ZEF'Hl°F�HILLS(��3)77�-9515
NAME: Dawn Tatum Date: 05/26/14 SPLIT STEM XX PKG UN(T
SUBD�vISION: Wedgewood HEA UMP )( STR.COOL
ADDRESS: 37414 Derbyshire Drive -�� '- - - � -- � ��'� ` -
cinr: Zephyrhills FI ZIP CODE: 33542 c NoErvsER: 4A6H4042D1000A
PHONE: 727-482-3640 WORK: iR�NO�ER: TEM4AOC42
cEU: REr�rER_ �TER: BAYHTR1508PDCA
EsnanaTOR: JEFF wvvo: AMERICAN STi4NDARD '
- - ' `��� v0.:1V:i:Ji:���}�I��F'� G�i„'� ".��.%�/�1 �r,� - � - EER RATING �4 �,229.00
PRO 3000 THERMOSTAT/GOOD I STANT REBATE: 1,000.00
P� T TAL : s,���.00
HANGING KIT ,• WAR MTY: PARTS: 10 YEARS
IN-LINE FLOAT LABOR: 1 YEAR
DRAIN PAN FLOAT - � _ - - _ - - �.a j._ --�;�;b;�='�, u;�-„ _
n l`.^ 'E',''.
SEAL DUCTWORK TO CODE CONDENSER: MSH4BEO4Z �
, ANCHOR CONDENSER AIR HANDLER: BGEMM KB
TAX,LABORAND PERMIT H�a�R: H6HK008 -01 `
AIR HANDLER IN ATTIC BRAND:
REMOVE EXISTING EQUIPMENT SEER RATIN - � 'rJ 6,2�.00
INSTA REBATE: 900,00
6 q — 9a�o •� T AL : `.s,3s�.00
S/�.a . U-p ARRANTY: PARTS: 12 YEi4RS
�'' • i '/� � ' �5 LABOR: 1 YEAR
� 4` .. _ �Y,._� _. . -. �
CONDEMSER:
IR HAfdDLER: � �
, HEATER: �#
sw�r��: #N/A
SEER RATING: � #NI�►
' ��-- - " ` , - �'' - � � ' � INSTANT REBATE_ #�d/A
i HAVE 7HE AUTHORITY TO ORDER TIiE WORK QURINED ABOVE 1 AGREE THAT SELLER T TA L . ��r„
RETAINS TITLE TO E�l11PMENT AtdD MATERIALS UNTIL FINAL PAYMENT IS MADE.IF PAYMENT WARRANTY: PARTS: �
i 1S NOT(�ADE AS AGREED,SELIFR CiW REMOVE SAID E�UIPMENT AND MA7ERIALS AT LABOR: �
' SELLERS EXPENSE.AWY DAMA6E RESULTING FROM SAm RBUIOVAL SHALL tdOT BE -
�� THE RESPOIdSIBILfTY OF SE EQUIPMENT,PARTS AND MATERIAL � �r �: _��£� � '���F�.i'��,�`:3"`������':�r�'
LIER. LFMfTED WARRA(sTY: �P�Q��LJ�O�' ;�;,�".':'•>;.`"w:
HAS WRITTEN ANWUFACTURER�s wn�n�Y or,�r ;O%�FOR 60.MONTHS p (WAC)
,. _
� OR
� .JNSTANT:REBATE
CUSTONAER SIGfdATURE DATE:
i
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o��-������ �iry ot�ephymills Permit Application Fax-813-780-0021
Building Department
te Received , Phone Contact for PermittU SoZ ��. — �` �� �
rner's Name lLcc1/1 (.�.� Owner Phone Number /�� � 0�' b 7�
rner's Address 7�`� • r'/�v'� Owner Phone Number
e Simple Titleholder Nam� Owner Phone Number
B 3imple Titleholder Address
B ADDRESS IL�LQO � LOT# �
BDIVISION PAttCEL ID# r� � ( o�I O'!a 0 6 O C�0 Q /D�G3
(OBTAINED FROM PROPERTY TAX NOTICE)
)RK PROPOSED B NEW CONS7R B ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
.OPOSED USE Q SFR Q COMM � OTHER
PE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
SCRIPTION OF WORK �f/- � �/ Gr K'!.� /`/J
iILDING SIZE SQ FOOTAGE� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
MECHANICAL $�i�n� /�� VALUATIOM OF MECHANICAL INSTALLATION
i�OC v��
QGAS Q RO.OFING Q SPECIALTY Q OTHER
IISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
ILDER COMPAWY
iNATURE _ — - REGtSTERED "'"-- Y-/ N- FEE CURRE� Y/N �' J
Address Ltcense#
°_CTRICIAN COMPANY
INATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
JMBER COMPANY
�NATURE REGISTERED Y/ N ,FEE CURRE� Y/N
Address License#
CHANICAL COMPMIY /`/ �`C O� CI
NATURE REGISTERED Y N FEE CURRE� /N
Address o� 02 liJ , � Q C� ,."� /%/• 5�.� License#
�ER COMPANY
NATURE REGISTERED Y/ N FEE CURRE� Y/N
Address � Ucense#
i1DENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Pertnit for new c:onstrucdon,
Minimum ten(10)woricing days after submittal date. Required onstte,Construction Plans,Stormwater Plans w/Silt Fence tnstalled,
Sanitary Facilitles&1 dumpster;Stte Work Permit far subdivisions/large pro)ects �
AMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Ehergy Fortns.R-O-W Permit for new construcHon.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Pertnit for all new proJects.All commercial requirements must meetcompliance
N PERAAIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for ali NEW construction. - � � �
cllons:
FIII out applicaHon completely.
Owner 8 Contractor sign back of applfcation,notarized
if over a2500,a Notice of Commencement is required. (A/C upgrades ovar a7500)
Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
iR THE COUNTER PERMITTIMG (Front of Applicatlon Only)
iofs If shingles Sewers Service Upgrades A!C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if an public roadways..needs ROW
NOTICE OF DEED RESTRICTI01dS: The undersigned under.stands�that this,p�rmit.may b�.subject to"deed"restrictions" � -`
which may be.more.restr.tctive�than County regulatlons. �The undePSigned�a�sumes responsibtltty for compHance writh any
applicable deed rest�ictions.
UNLICENSED CONTRACTORS ANID CONTItACTOR itESPON�I�ILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be requlred,to tie_Ilcensed In accordance with state.and�Iocal regulations. If the
� coM�actor is not I(c�nsed as requlred-by lawr, both the owner and contractor may be cited for a misdemeanor violation
� under state law. If Qhe owrner or Intended=contractor are unce�ain as to what Iicensing.requirements may apply�for the
intended wrork, they are advised to contact the Pa�co County Bullding Inspe�lon Divtsion—l:icensing Section at 727-847- ,
8003. Furthermore, If the owner has hlred a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block° of thls applicatlon for which they wlll be responsible. If you, as.the owrner sign as the
contractor, that may be an indicatlon that he Is not properly licensed and Is not entftled to permftting privfleges in Pasco
County.
TRANSPORTA710N IMPACTIUTILITIES IMPAC7 AND itESO1JItCE RECOVERIF FEES; The undersigned understands
�I that Trensportation Ompact Fees and.Recourse Recove.ry.Fees may apply to the constructlon of new buildings, change of
use in existing buiidings, or.expansion of existiri,g�6uildings, as specifled in I�ascv Couraty Ordinance number 89-07 and
' 90-07, as amended. �'he undersigned also understands, that such fees� as;may�be�due, will b� Identlfied at the time of
'� permitting. It is further understood that Transportatfon Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate oi occupanay" or flnal powee release. :If the project does not involve a certffic�te of occupancy. or
final power release, the fees must be paid prior to permit Issuance. Fu�thermoee, if.Pasco County 9Nater/Sewer Impact
fees a�e due, they�must be_paid prior to permit Issuance�in accordance with applic�ble Pascv County ordinances.
CONSTRUCTION LIEN LA►W(Chapter 713� FIoNd��tatutea�as amended�: If valuatlon of work is$2,500.00 or more, I
certify that I, the �pplicant, have been provided with a copy of the "FloPida Construction Llen Law—liomeowner's
' ProtectEon Guide" prepared by the Florida Department of Agric.ulture and ConsumerAffairs. If the appltcant is someone
other than the"owne�", I certify thaQ i have.obtained a copy,of.�he above.described document°and promise in.good faith to
delive�it to the"owrner"prior to•cornmencement.
CONTR/\CTOR'SIOWPIEFt'�AFFIDAVIT: I ce�tify that all the Information in thl� application is accurate and that all work
will be done in compliance writh �II.applicabte laws regulating constructlon, z�ning and land development. Applicatlon is
hereby made to obtain .a permit to .do work..and installatfon as Indlcated. I certffy that no work or Installation has
commenced prlor to issuance of a permit and that all work will be perfo�med to meet standards of �II laws regulating
construction, County and City codes, zoning regulations, and land development regulatlons-In the jurisdiction. I also
certify that I underst�nd that the regulations of other government agencies anay apply�to the intended work, and that it is
my responsibility to identify�wrhat actions I must take to be•in.corrlpliance. Such�agencie�.include but are not Ilrroited to:
- Department of Envlronmental Protection-Cypress. Bayheads, Wetland Areas and Environmentally Sensitive �
Lands, INaterNVastev+�ater Treatment.
- Southwest Florida Water (Wanagement .District-Wells, Cypress. Bay.heads; Wetland .Areas, Altering
� Watercourses. •
- Army Corps of EngineePS-Seawalis, Docks, Navtgable Waterways.
- Department of Health & Rehabilitative Servlces/Enyironmental Health Unit-Welis� Wastewater Treatment,
Septtc Tanks. .
- US Envlronmental Protection Agency-Asbestos abatement.
- Federal.Avlatton AuthoNty-Runways. ,
I understand that the following restrictions apply to the use of flll:�
- Use of fill Is not allowed in Flood Zone"V"unless expressiy permft�ed.
- If the fill material is to b.e used in-Flood Zone "A", It is understood that a drainage plan addressing a
"compensaQing volume" will be submitted at time of perr�itting 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 {�ermitted building using stem wall
construction, I certify that flll�.will:be used only.to.flll the area withln Qhe stem wall.
- If fill material is to be used in any area, I certify that usa. of such flll will not adversely affect adjacent
properties. if use of flll is found to adversely:affect adJacent�properties,.the owner may be'cited for violating
the conditions of the building.permit issued.under the attached {�armit application, for lots less than one (1)
acre which are elevated by flil, an englneered drainage.plan is req�ired. .
if I arn the AGENY FOR THE OWPIEtt,.I,�promise in good faith to inform the owner of the permitting conditlons set forth tn
thls affidavit prfor to commencing construction. I understand th�t a-separat� g�ermtt may be requtred for etectrical work,
plumbing, signs, wiells, pools, air condltioning, .gas, or other installatfons no� spec�fically included in th� application. A
permit issued shall be construed to be a Iicense to proceed with the wrork and not as authority to.violate,cancel, alter, or
set aside any provisions of 4he techr�ical codes; nor§hall Issuance�of a permit prevent the�uildirig Official from thereafter
requiring a correction of er�ors tn.plans, con�truction or vlolatlons of any codes. Every permit 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 perm(t is suspended or.abandoned for a period of six(6) months after the tfine the�work is commenaed. An extension
may be requested, in writing; f�om the Building,Official for a perlod.°not to exceed ninety(90) days and wltl demonstrate
justifiable cause for.the extension. If work ceases.for ninety(90)consecutiv�days,.th�job Es considered aba�doned.
YUARNING TO OWNER: YOU� I�AILURE.TO.R�CORD A P1071GE.OF COIMMEIVCEM�N-T �AY RESULT IN YOUR
PAYING TWICE FOR IWIPROVEMEfdTS Tfl YOUR-:PROPE�TY. IF�YO.U�INT�ID'TO OBTAIN��INANCINC�,�CANSIIL.T
WIT Y UR L . D O AN - RN RE�RECO �� OU " � � ' E E T
FLORIDA JURAT(F.S.117
OWNER OR A(3ENT CONTRACTO
Subscrlbed and swom to or fflrmed)before me thl Subscrlbed and'swom to(ot aflirmed)�before me ,
— by - - - - - - by --- - --- -- — -- - - __
VYho islare personally knovm to me or haslhave produced Who Is/are p.ersonally knouvra to me or has/heve produced
as Id�ntlflc�tlon, as IdentlNcadon.
Notary Public . Notary Public
Commisslon No. ComrFllssion No.
Name oi IVotary fyped,printed or stamped Name of Idotary typed,printed or stamped
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