HomeMy WebLinkAbout15-16549 CITY OF ZEPHYRHILLS
5335-8TH�STREET
(si3)�so-oozo �1'6549
% BUILDING; PERMIT
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; PERMIT INFORMATION � LOCATION INFORMATION
Permit Number: 16549 Address: 5419 9TH ST HISTORIC
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-13500-0010
Improv. Cost: 6,000.00 OWNER INFORMATION
Date Issued: 9/01/2015 Name: KARNER, CHERYL
Total Fees: 97.50 Address: 5419 9TH ST HISTORIC
Amount Paid: 97.50 ZEPHYRHILLS, FL. 33542
Date Paid: 9/01/2015 Phone: (813)702-4016
Work Desc: REROOF METAL- DO NOT NEED HB APPRV'D PER BEV
CONTRACTOR S APPLICATION FEES
TRIPLE CROWN ROOFIN I REROOF RESIDENT AL 97.50
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Ins ections Re uired
DRY IN ROOF INSP -
TAPE JO,�NTS�00�I�
FINAL �
REINSPECTION FEES: (c)With respect to Reinspection�fees will comply with Florida Statute 553.80(2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe 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 BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACT R 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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City of Zephyrhills
BUILDING PLAN REVIEW COMIV�NTS '
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Contractor/Homeowner: � ( �,. �i�
Date Received: �7 �2 �- �
Site: �`1 ' 9 19 `�/
Permit Type: °L,-
Approved w/no comments:❑ Approved w/the below comments: `�j, Denied w/the below comments: ❑
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This c ent sheet shall be kept with the permit and/or plans.
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er— Examiner Date Contrac or and/or Homeo er
(Required when comments are present)
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Product Evaluation Report
GULF COAST SUPPLY& MANUFACTUR/NG, LLC,
�9 Ga. GulfRebT"' Roof Panel over 'x4 Wooc�Purlins
Florida Product Approval #11651.27 R2
Florida Building Code 2014
Per Rule �61 G20-3
Method: 1 -D
CategoryL:-Roofing
Subcategory: Metal Roofing
Compliance Method: 61 G20-3.005(1)(d)
NON HVHZ
Product Manufacturer:
Gulf Coast Supply � Manufasturing, LLC.
14429 SW 2nd�Place, Suite G30
Newberry FL 32669 ��`'""'''��
, ,`�OP�,E� S.k����'
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Engineer Evaluator: = � '_ =
Dan Kuhn, P.E. #75519 =�' NO• 75519 I• =
Florida Evaluation ANE ID: 10743 _�: — �k � : _
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Validator: ;�c�S•.� ORiDP •\���.'
Locke Bowden, P.E. #49704 '•;s/pNAL ENG�••
���'Nl�+o����'�,: �ji S 9450 Alysbury Place ��''���+� ``'�
y����''�V���!T���':���[�.�� Montgomery, AL 36117 ���30��75
4;:Jn�.`.�dl��'`li'a'�1���'gr*fL, � „+.
Contents:
Evaluation Rep�ort Pages 1 - 5
FL#11651.27 R2•1UNE 15,2015
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Compliance Statement: The product as described in this report has demonstrated compliance with the
Florida Building Code 2014, Sections 1504.3.2, 1504.7.
Product Description: GulfRibr"' 3/a" Rib Roof Panel, Minimum Z9 Ga. Steel, 36" Coverage, through
fastened roof panel over Minimum 1x4 Wood Purlins over one layer of Asphalt
Shingles (optional) o�ier minimum �/e" OSB or minimum 15/�z" Plywood Decking.
Non Structural application.
I Panel Material/Standards: Material: Minimum 29 Ga. Steel, ASTM A792 or ASTM A653 G90 conforming to
Florida Building Code�2014 Section 1507.4.3.
Paint Finish Optional
Yield Strength: Min. 102.Oksi ,
Corrosion Resistance� Panel Material shall comply with Florida Building Code
Z014, Section 1507.4.3.
Panel Dimension(s): Thickness: 0.0142" Minimum
Width: 36" Coverage
Rib Height: 3/a" Major Rib at 9" O.C.
Panel Fastener: #9;15x1.5" HWH wii h sealing washing or approved equal
%a minimum penetration through plywood.
Corrosion Resistancei Per Florida Building Code Z014, Section 1506.6, 1507.4.4
Substrate Description: Minimum 1x4 No. 2 SYP wood purlins over maximum one layer of asphalt
shingles(optional) over min. �fe" O5B or min.15/�" thick over supports at
maximum 24" O.C.The 1 x4 wood purlins shall be fastened to the wood rafters
(24" O.C. Max)with (Z) 9 x 2�/z" Deck Screws per rafter(Minimum 1�/s"
penetration into wood rafter). Design of 1 x4 wood purlins, OSB, plywood and
OSB/plywood supports are outside the scope of this evaluation. Must be designed
in accordance w/Floirida Building Code�014.
Design Uplift Pressures: Table"A° I
Maximum Total Upli;ft Design Pressure 101.0 psf
Fastener Pattern I 9„_9„-9"_9„
Fastener Pattern;Spacing , � 24" O.C: � •
Design Pressure includes a Safety Factor=2.0.
FL#11651.27 R2•1UNE 15,2015
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Code Compliance: The product described herein has demonstrated compliance with the
Florida Building Cod i 2014, Sections 1504.3.2, 1504.7.
Evaluation Report Scope: The product evaluation is limited to compliance with the structural wind load
requirements of the Florida Building Code 2014, as relates to Rule 61 G�0-3.
Performance Standards: The product described herein has demonstrated compliance with:
• UL 580-06-Test for Uplift Resistance of Roof Assemblies
• UL 1897-04- Uplift Test for Roof Covering Systems.
I • FM �71-1992, Section 4.4 Foot Traffic Resistance Test
Reference Data: 1. UL 580-94/ 1897-98 Uplift Test
Force Engineering &Testing, Inc. (FBC Organization #TST-5328)
, Report No. 117-0407T 09, Dated 11/16/09
Z. FM 4471-95�, Section 4.4 Foot Traffic Resistance Test
� Force Engineering &TeSting, Inc. (FBC Organization #TST 5328)
Report No. 117-0238T 09E, Dated 07/212009
3. Certificate o`t Independence
By Dan Kuhn, P.E. (FL#75519) � Kuhn Engineering, LLC
(FBC Organii ation #ANE ID: 10743}
Test Standard Equivalence: 1. The UL 580�94 test standard is equivalent to the UL 580-06 test standard.
2. The UL 1897-98 test standard is equivalent to the UL 1897-04 test
standard.
3. The FM 4471-95 test standard is equivalent to the FM 4471-1992 test
standard.
Quality Assurance Entity: The manufacturer has established compliance of roof panel products in
accordance with thei Florida Building Code and Rule 61 GZO-3.005(3)for
� manufacturing under a quality assurance program audited by an approved quality
assurance entity.
Minimum Slope itange: Minimum Slope shall comply with Florida Building Code 2014, including
Section 1507.4.Z an�d in accordance with Manufacturers recommendations. For
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slopes less than 3:12, lap sealant must be used in the panel side laps.
Installation: Install per Manufactiurer's recommended details.
Underlayment: Shall comply with Florida Building Code 2014 section 1507.4.5.1 and 1507.4.5.2.
FL#11651.27 R2•JUNE 15,2015
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Roof Panel Fire Classification: Fire classification is not part of this acceptance.
Shear Diaphragm: Shear Diaphragm vali es are outside the scope of this report.
Design Procedure: For roofs within the parameters listed on the load table,fastening pattern must
at a minimum meet those listed for the applicable wind zone. For all roofs outside
the parameters listed on the load table, design wind loads shall be determined
for each project in accordance with FBC 2014 Section 1609 or ASCE 7-10
using allowable stress design.The maximum fastener spacing listed herein shall
not be exceeded.This evaluation report is not applicable in High Velocity
Hurricane Zone. Refe�r to current NOA or HVHZ evaluation report for use of this
product in High Velocity Hurricane Zone.
FL#11651.27 R2•JUNE 15,2015
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EiVGINEER LOAD TABLE: 29 Ga. GulfRibT'" Panel over 1x4lWood Purlins
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Building5 having a Roof fviean Height s ZO'-0"; Roof Slop'e: 2'j/12" - 12°712" Gable or Hip Roof;Wind�Speeds 12,'0=���3 � ,'•, '
1�70mph, Exposure,C, Risk Category II, Enclosed Buiiding;.base`d on Florida Building Code 2014. , ' ,
120 130 140 150 160 770
FASTENER
WIIND SPEED (MIN.1/4" SUBSTRATE ON CEIdTER ON CENTER ON CENTER ON CENTER ON CENTER ON CENTER
Penetretion) SPACING i SPACING SPACING SPACING SPACING SPACING
' 1x4 Wood '
' ZONE 1.;. #9-15x1.5° Purlihs 24'+ , ; , z4". � 24" � 24" 24'' -� 24'•
,1. ,. . � ,.
ZONE 2 #9-15x1.5" 1x4 Wood Z4" � 24" 24" 24" 24" 24"
Purlins �
. , `,1x4 VUood £, � . • z4" ° .a4" z4° , �
ZONE 3;� , ' #9-1u5x1:5" • 24" � � 24"� � 24" .
Puriins - ;,, �
1.)PANEL DESCRIPTION: GULFRIBT"', MIN 29 GA., GRADE 102,36�"COVERAGE,3/4"TALL.
2.)PANEL FASTENER:#9-15X1.5" HWH WITH SEALING WASHER OR APPROVED EQUAL
3.)MAXIMUM ALLOWABLE PANEL UPUFT PRESSURE: 101.0 PSF�24" O.0 FASTENER SPACING BASED ON TAS 125, UL 580lUL
1897 TESTING.
4.)SUBSTRATE: 1 X4 WOOD PURLINS OVER MAX. ONE LAYER OF ASPHALT SHINGLES(OPTIONAL)OVER MIN �/,b" OSB OR MIN �Sf�"
THICK PLYWOOD WOOD PURLINS ATTACHED TO WOOD RAFTER(Z4" O.C. MAX)WITH(2)9 X 2'/�" DECK SCREWS WITH MIN. 1�/e"
PENETRATION INTO WOOD RAFfERS. PURLINS, OSB AND PLYWOODi MUST BE DESIGNED IN ACCORDANCE WITH FBC 2014
5.)ROOF SLOPE:ON ROOF SLOPES LESS THAN 3:12, LAP SEALANT;MUST BE USED IN PANEL SIDE LAPS.
6.)LOAD TABLE BASED ON WIND PRESSURES CALCULATED PER ASCE 7-10(KD=0.85)MULTIPLIED BY 0.6 PER FLORIDA BUILDING
CODE 2014 i
NIPRODF a Note:Dimension(a)is defined as 10%of the minimum width of the building or
�rZONE2 zoNE3- i 7 40°/a of the mean height of the roof,whichever is smaller,however,(a)cannot be
, ,_i�__________________, _-j,a lessthaneitfier4%oftheminimumwidthofthebuildingor3feet.
`�' '� ��'� �-HIDGE �' ,,��' � FASTENER PATTERN
' ���� ���-- !-----,� � � 1 x 4�Wood Purlins @ 24" O.C.Attached to Wood Rafters
� ' �-------, �: � w/(2)�9 x 2.5"Deck Screws @ Max. 24" O.C.
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ZONE 2 GABLE ROOP �aj �
x-'�------- - ' "a (1) #9-15 x 1-1/2"w/Sealer Washer —Min. 7/16"OSB
� ' ; 9"-9";9"-9" Fastener Pattern @ 24"O.C.
, / RIDGE , Max. (1) Layer of Asphalt Shingles (Optional)
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I IIIIII IIIII I{IIIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII Rcpt,:1709339 Rec: 10.00
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2015140150 08/31/2015 B. M. , Dpty Clerk
• PermR No. ParcallD No �I'��'�� "���l0 � I JSOQ� �0��
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� NOTICE OF COMMENCEMENT
, State of �L����� Couinty of �C�
THE UNDERSIGNED hereby gives notica that improvement wlll be mada to ceAeln raal proparty,and In accordence with Chaptar 773,Florida y�eju�
tha fo�owing InformaUon is provided in tlus NoUce oi Commencemen�tn: ,�- L II 1 �f!��{
I 1, Descriptian of Property. Paroel Iden6ficaHon No.C�� �T'(�W lA�'�S �b� �1�-�-��r� �x����i-����y9 '�.T �Ox•
SVeet Address: �TL9 9+y J�. P�f.A�yl�uf. +'(.• 33 sy0 '7+{/I� JO��/'i�'iLO�i
2. General Description af Improvement n Y'IG.�O� I �~(
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3. Owner Iniortnation ar Lessee infortnation if the Lessee cantracted far the Improvement
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as4�q 4�"mec� I ztA�►"//����5 �L 3�SYD ' m v
Addrass .•',r City State O�c
Interes[In Property: O wN� I �W D
�N
Name of Fee Simple TWeholder ��i I � X N o
(If different fram listed abov i) �Z
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Address Tr�n4. (�rer.n�, 1C00'1 fAli �NL I �� State ���
4. Conlractar: "
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���tp n�e ne I 2�i��h.`I s �. 3Y y ��
Rddress City S� ���
8�3 8'33'7��D I �w N
Contrectors Telephone No: D
3 0
5. Surety: I 'C �
Name � I �r'r
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Address I Ciry Stata x
I Amount of Bond: $ Telephone No.: �'�+°°
6. Lender. I �~3
Name I M -�-�
W A
Addross I Ciry Stete °r
Lenders Telephone No.: s
7, Persons within the State of Florida designated by the owner uplon whom noticas or olher docvmants may be served as Drovided by
Sedion 713.13(1)(a)(7),Florida Statutes:
Name
�
Address I Ciry State
Telephone Num6er of�eslgnated Person:
e. In addition to himself,the ovmer designates I of_ I
to racaiva a copy ottha Lienors NWice ac provided in Sectfon 713.13(1)(b),Florida Statutes.
Telephane Number of Person w Entl(y Desfgnated by Owner. � I
9. E�iration date of Notice of Commencement(tlie efQ�iration dete I ay not be before the completlon o(constructian and final payment to the I
contracta,but will be one year frnrn ihe date of rernrding unless a diffemnt dale is sperfied):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER 7HE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UN�ER CHAPTER 713, PART 1, SECTION 713.13, FLORI�A STATUTES, AND CRN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOIJ INTEND TO OBTAIN FINANCING,CONSULT
I WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WOR OR RECORDING YOUR NOTICE OF COMMENCEMENT. �
Under penalry of perjury,I deGarc that I have read the foregaing notice o cement and the fa ated t rein are ttue ta Ihe hest
of my knowledge and belief, �'
STATE OF FLORIDA �( _
COUNTY OF PASCO /�
Signat e of O xr r ee,or O rs or Lessee's Aulhorized
O /DireU nager
I
Si n ry's Titl Olfice ,p�� n//
The foregoing insWment was a owladged hefvra me thl�J day o���"�"'/I .20/by u`� �""'" v�
ey � v
(rype of riry,e.g.,oificer,tnutee,attomey in fact)for
I (name af h�lf af whom Inswment wes executed).
Personalty Known Praduced Iden' catl n❑ Notery Signatura
Type of Identificatlan Produced Name(Print) P/ � �` rn��
STATE OF FLORlmA,COUNTY OF PAS�t� � �����a�
THIS ISTO'CFRTIFYTHATTHE FQREGOING ISA ��v� • .� ��''�`� ca��wwo¢z�otu �
.: MY COMMISSION e FF ti93s5
TRUE AND CORRECT COPY OF THE DOCUMENT J ° �= EXPIRES:September4,2ots
ON FILE OR OF PllBLfC RECORD IN THIS OFFICE � 0 t �,'s�t��� 8°^dedThruNoteryPubhcUndam�s
� ��o
WI�N�SS MY HAND AND OFFICIAL SEAL THIS � � ,�� *
� �L�data/b UHT Vr ment�c053048 Z Q 1 � , 1M�o� i� ' �
P u�a s.a��i�;e-� ��E� —
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B 9...��DEPUTY CLERK �i � - ' t��
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• ,. •
" TRIPLE CROWN ROOFING, INC. _
` 7140 ANDRE DR. � ZE IHYRHILLS, FL 33541 .
813-833-7720
STATE LICENSE CCC049370
WWW.TRIPLE-CROWN-ROOFING.COM � LNAULT1963@AOL.COM
SPECIALIZINC INALL TYPE i OFMETAL ROOF SYSTEMS
NAME PHONE DATE �
C:�� ��'' � � ���� �.�'' �f� -° ��� -- ��r�l,� c�' °���°.-�-^%-��'
STREET r ° � CITY STATE ZIP
�`�./� J�� ..��- �c�',��1 y s l� , ��!S � �-�S %'��
SALESMAN r'i'�7 � �
Y 7
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We hereby submit specification and work description: � /
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��tl� � /l� ��� !✓UO� ,,�1 �-/-�rn5 l��✓�s /aI. v/(¢�a� ,,� /�
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/ J /�� �/ f--'�'��' 1�'/� ���:�-G 7'_/��'" ; °TO ,�'�i,������'� ��0,� �'C����'.
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j�/L� /G�C/'C���S ta"�� �cf%de/ /��c �i��rC� // �sv� �7� �z�f/li'f✓,�s ��'f,'`.� afo
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C�6G4/� ; ,��/cL �' �-��`�' ��J� r//� L��J L
�.. �� �...,�-� ,�-°-� ��1�•�,�, �! -� ,-� �- �_,� r�-e .�-r�d ��--���r�-� �a:� �
U �� /
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THE ABOVE DESCRIBED WORK WILL BE COMPLETED ACCORDING TO SPECIFICATIONS, FOR THE SUM OF �`
, ($ ,,� 5 r')r7 ). PAYMENT TO BE MADE AS FOLLOWS:$ S .�.�0 AS DOWN PAYMENT
� BALANCE OF$ g. �� I DUE UPON COMPLETION. �
r �
***ANY ROTTED WOOD DISCOVERED WILL BE AN EXTRA,CHARGE ATA COST OF$ �PER 112" SHEET OF
PLYWOOD$ ,U Lin. Ft. Lumber
/
NO ORAL AGREEMENTS HAVE BEEN GIVEN OR ACCEPTED. THIS WRITTEN CONTRACT IS THE
ENTIRE AGREEMENT COVERING ALL THE WORK TO BE PERFORMED ANDIOR MATERIALS TO BE
FURNISHED. THE WRITTEN PORTION ABOVE IS THE ENTIRE CONSIDERATION FOR THE AMOUNT
OF THE CONTRACT. PURCHASER MAY CANCEL THIS CONTRACT ANY TIME PRIOR TO MIDNIGHT
OF THE THIRD BUSINESS DAY AFTER THE DATE PURCHASER SIGNED THIS CONTRACT.
IT IS AGREED:
Contractor will do all said work in a good antl workmanlike manner and in strict accordance with the ordinances, rules and requirements
of the city, Town or Village, wherein the above mentioned property is located. If purchaser should cancel this contact after time stated
above, the Purchaser agrees to forfeit down payment paid. In the event it becomes necessary for Contractor to employ an attorney to
collect any sums due the Contractor pursuant to this contract, then the Purchaser shall pay all reasonable attorney's fees incurred by
the contractor.This contract shall not be binding upon Contractor u�ntil accepted by them. Upon such acceptance by said company, this
contract shall be binding on melus without any further notification to me/us. The undersigned property owner agrees that this contract
may be assigned for the performance of the work antl labor required by the description of the work to be performed. Upon assigned the
parties hereto consent to the performance of the work by and payment to such assignee of the amount of this contract.Any Alteration or
tleviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over
antl above the stated contract amount.
NOTICE TO THE BUYER : (1) Do not sign this contract before you read it or if it contains any blank spaces. (2)You
are entitled to an exact copy of the contract you sign. (3) Under the law you have the right to pay off in advance
the full amount due and under certain circumstances to obtain a partial refand of-the�time.charge. Owner acknowl-
edges receipt of a true copy of this CONTRACT. �f��� > ��,,rr' �
,�`—�..���� `��/' %'?�%1)
� r,,� �`� FURCHASER DATE
�r� r��t ��.� �6/
// ' `'3�G . ° � � � r �/� .
�
�-'�'" J; -�,,'
`" BY: Triple Crown Roofing, I�nc. DATE � PURCHASER DATE
This contract is enforceable only when accepted by management of Triple Crown.
o��-�Qw���� Gity of Zephyrhills Permit Application Fax 813-78d-0d21
Building Department
Date Received � � �f13 p��j _ ?/��
�'" ,s"�,,� Phone Gontact for Permittin
Ownsr's Name ' +�" /n �/"'� Ow�er Phone Namber ,_,�
f �/ g [j.�4 �
` Owner's Address �T � l �. Own�r Phone Number ��
Fee Simple Tltleholder Name Owner Phone Number
� Fee Simple Titlaholder Address I
JOB ADDRESS � I � �. L07# ���►
�
sueaEVis�oH �� � PARCEL ID# ��� '•26'a� �401 Q�l3S0 Q 'OQID
I (OBTA4NED PRQM PRQPERT`f IAX NOTICE}
W4RK PROPOSED NEW CONSTR ADDlA�T � 51GN Q [� DEMC}LISH
e INSTALL 8 REPAIR I
PRdPdSED USE Q SFR �] COMM C,I�] OTHER
TYPE dF CONSTRUCTION Q BLOCK Q FRAME �� 5TEEL Q
DESCRIPTIdIS OF WORK ��Vw+"Tl�'�.t,. ��i�' 8 0� O ij�/'Z A/ �."�S I� .�G� C.�'l�-! ���[
SUI�DlN6 SIZE � � SQ FOOTAGE C� � HEIGHT ��
� QBUILDING � ^ VAI.UATiON OF TC}TAL CONS7RUC710N
(ao aa
QELECTRICAL ri � AMP SERVICE � PROGRESS ENERGY � W,R.E.C. j
� ���
QPLUMBING $ �
�" � �- ,
[�MECHANICAL ��--� VALUATION OF MECHANICAI.INSTALLA710N �(���
-�`(� t�,"
[�GAS � RQOFING [� SPECIALTY � OTHER 4� ti�� /,("� `��
� {� �
FItVISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO �t „� �i
�
BUILDER CbMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address ticense# � �
ELEC7RICIAN � CQMPANY
I SIGNATURE , REGISTERED Y/ N FEE CURRE� Y/N
� Addr�ss License# `^��
i
PLUMBER '�i� COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address l.icense# �i ��
MECHANICAL COMPANY
StGNA1'URE � REGISTERED Y/ N FEE CURRE� Y/N
Address License# � ^ ��
a�HE� ��� COMPANY , jRrfi.�' ��artta,l �ao��� 1�t4
51GNA'TURE P,EGiSTERED ' Y! N FEE CURRE{� Y/N
Address /�7� ��� . ��f Llcense# �CCo�rp3�o ���
� RESiDENTtAL Attach(2)Plot Plans;(2}sets of Building Plens;(1)set of Energy�Forms;R-O-W Permit for new construcUon,
� Nllnfmum ten{10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w!Silt Fence installed,
Sanitary FacfUUss&1 dumpster;Site Work Permit for subdlvlsions/large pro]ects
� CBMMERCIJ4L Athach(3)complete sets of Buflding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit far new canstrucUon,
Minimum#en(10}working days after submittal date. Required ansite,Construction Plans,Stormwater Pians.w/Siit Fence installed,
Santtary FaciltUes&1.dumpster.Sife Work Permit•for alE new proJ�cts.Ail corrtmercia!requlrements must meet comptience
SiGN PERM�T Attach(2)sets af Engineered Plans. �
� ""PROPERTY SURVEY reguired for ati NEW canstruction.
Directtons:
� Fffl out appticatlon comptetely.
Owner 8 Contractor sign back of appEicatlon,natatized
If over�2500,a Natice of Commencement Is required. {A/C upgrades ovar�$750Q�
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized Istter fram owner authorizing same
� DVER THE COUNTER PERMIITING (Front of Applicatian Only)
I Reroofs if shingies Sewers Servlce llpgrades A!C Fences(PlobSurvey/Faotage)
i
Driveways-Nok over Counter if on publfc roadways.needs,R01N ��" �� � - . r
i ' ? 1
. „ i .
�OTICE OF DEED RESTRICTIONS: The undersigned understands�=that this.p�rmtt.may be subJect to�"deed"restrictions"
vhich may be.more cestrictive than County.regulatfons. �The unders(gned assumes responsibfltty for compliance with;�ny �
ipplicable deed restrictions. ` , �. , � ! •
JNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: if the owner has hired a contractor or �
;ont�actors to undertake work, they may be�required�to be=licensed in accordance with state-.and•local regulations. If the
' ;ontractor is not licensed as required-by law, both the owner and contractor may be ctted for a misdemeanor violatfon
inder state law. If the owner or intended ntractor are uncertain as to what licensing.requirements may•apply:�for the
ntended wrork, they are advised to contact he.Pasco County Buflding Inspection Divtston--Licensing Section at 727-847-
1009. Furthe�more, if the owner has hir d a contractor or contractors, he is advised to have the contractor(s) s(gn
�ortions of the "contractor Block° of this ap _Ilcation for which thay will be responsible. If you, as.the owner sign as the
;ontractor, that may be an indication that e is not.properly flcensed and is not entitled to permitting privileges.in Pasco
�ounty. • • • � �
�RANSPORTATION IMPACTIUTILITIES 1 PACT-AND RESDURCE RECOVERY FEES: The underslgned understands
hat Transportation Impact Fees and.Reco rse.Recovery.Fees may apPly to the construction of new buildings� change of
�se in existing buildings, or.expansion•of e-istirig:6uildings, as speclfled in Pasco County Ordfnance number 89-07 and
a0-07, as amended. The undersigned als understands, that such fees,�as;may�be�due, will be tdentified at the time of
�ermitting. It is further understood that Tr nsportatfon Impact Fees and Resou�ce Recovery Fees must be paid prior to
•eceiving a "certificate of occupancy" or fln I power release. .If the project.does not Involve a certificate of occupancy. or
•inal power release, the fees must be patd prior to permit issuance. Furthermore, if Pasco County WatedSewer.Impact
`ees are due, they�must be-paid prior to per it Issuance-in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 71 ;Florld�Statut�s�as amended):,If valuation•of,work is•$2,500.00 or more, I
�ertify th�t I; tNe applicant, Fiave.°been p ovided with'a copy of the "Florida Const�uction �ien Law—Homeowner's
I Protection Guide° prepared by the Florida epartment of Agric.ulture and ConsumerAffairs. If the applicant is someone
'' �ther than the"owner", I certify that I have. btalned a copy.of the above.described document°and promise in.good faith to
deliver it to the°owner"prior to-commence ent. '
CONTRACTOR'SIOWNER'3 AFFIDAVIT: I ce�tify:that all.the inf.ormation in this applicatlon is accurate and that all work
' �vill be done in compliance with all applica le laws regulating construction, zonfng and land development. Application is
hereby made to obtain .a permit to do w rk.and Instailation as indicafed. I certifjr that no work or Installation has
�, oommenced prior to issuance of a permit nd that.all work will be pertormed to meet standards of ali laws regulaking
construction, County and City codes, zoni g regulations, and land development regulations�in the jurisdlctton. I also
certify that ! ur�derstand that the regulation of other government agencies may apply�to the intended work, and that it is
my responsibility to identify what:actions I m st take.to be,in.compliance: Such agencies.include.but are.not Iimited to:
- Department of Environmental rotection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
� Lands,WatedWastewater Trea ment.
- Southwest Florida Water M nagement .District-Wells, Cypress. Bayheads, Wetland �eas, Altering
Watercourses.
- Army Corps of Engineers-Seaw Ils, Docks, Navigable Waterways.
- Department of Health 8 Reha (litative Services/Environmenfal Health Unit-Wells, Wastewater Treatment,
Septic Tanks. _
- US Environmental Protectfon A ency-Asbestos abatement.
- Federal Aviatfon Authority-Run ays.
I understand that the following restrictions a ply to the use of flll:�
' - Use of fill is not allowed in Floo Zone°V"unless expressly permitted.
- If the fill material-is to be us d in Flood Zone "A", it. is understood that a drainage plan addressing a
°compensating volume" will be ubmitted at time of permitting which is prepared by a professional engineer
licensed by#he State of Florida.
- If the fill material is�to be use 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 i any area, 1 certify that .use. of such flll will not adversely affect adjacent
properties. If use of flll is foun to adversely:affect adJacent�properties, the owne� may be cited for viofating
, the conditions of the building.p rmit issued under the attached permit application, for lots less than one (1)
acre which are elevated by flll, . n engtneered drainage plan is required.. .
If I am the AGENT FOR THE OWNER, I,-:p mise In good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commer�cing constructon. I understand that a.separate permit may be required for electrical work,
plumbing, signs, welis, pools, air condttioning, .gas, or other installations not specifically included-in the application. A
permit issued shall be constn�ed to be a lic nse to proceed with the work and not as:authority to.violate, cancel, alter, or ,
set aside any provisions of the technlcal co es, nor shall issuance of a permit.prevent the Bulldirig Otflcial from thereafter
requiring a correction af errors in.plans,-con"tructlon or violations of any codes.- Every permlt issued shall become invalid
unless the work authorized by such permit��s:co,mmenced�wtthln six months of permit issuance, or if work.authoriied by
the pe�mit is suspended or abandoned for a period of six(6)'months afkr��th�tim�th��work Is commenced. An extension
may be-requested,-Bn-wr6ting,-#rom ths Buil Ing,-Offlc3al #or a period not to �xceed ninets+-(90) days and;will-demonstrate
justifiable cause for-the extension. li work c ases,for ninety(90�consecutive;days,..the job is considered�aba�doned.
I� WARNING TO OWNER: YOUR FAILUR .TO,RECORD A MOTtCE.OF-.COMMENCEMENT MAY RESULT IN YOUR
I PAYING TWICE;FOR IMPROVEMENTS T YOUR PROPERTY. IF YOU�INTEND'TO OBTAIN�FINANCING,'CONSULT
WITH Y UR LENDE O AN ATTO EY ORE�RECO ��I G� OU O � CE'O '�'M � C ENT�
FLORIDA JURAT(F.S.117.0
OWNER OR AGEN CONTRACTO �
Subscrlbed and s to or atflrmed)befo me this S scribed a swo to(or affirmed)�befo me thfs
by I—f.S'—-by. � -
� Who islare personally knovm to me or_haslhave produc d Who Is/are perso own me or haslhave produced. •
as Identlflcatlon. as tdentlBcaUon.
Nota Public . ' � Nofary Public
%
Commisslon No. Com sion N .
Name o(Nolary typed,printed or stamped Name ,
;�.y.ci%��, JACQUELINE BOG S
'��`' :: Commission#FF 150422
�; : _
;�. :o: Expires December 12,201 S
��� k:°e�� Bonded Thm iroy Fain Insurance 806385-7U19
.,P���a�'