HomeMy WebLinkAbout15-16633 l
CITY OF ZEPHYRHILLS
5335-8TH STREEf'
' (sis)�so-oo20 16 3
BUILDING PERMIT
' PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16633 Address: 7228 OMEGA CT
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ALPHA VILLAGE
Est. Value: Parcel Number: 35-25-21-0050-00000-0720
�Improv. Cost: 26,425.00 OWNER INFORMATION
Date Issued: 10/07/2015 Name: SHEPARD GILBERT & GLADYS
Total Fees: 427.50 Address: 7228 OMEGA CT
Amount Paid: 427.50 ZEPHYRHILLS FL 33540-1474
Date Paid: 10/07/2015 Phone: 813-395-6444
Work Desc: REMOVE PORCH CONSTRUCT ADDITON 16 X 18
CONTRACTOR S APPLICATION FEES
BACK C NSTRU B I FEE 247.50 ELE TRICAL FEE 60.00
DOUBLE M ELECTRIC MECHANICAL FEE 60.00 NEW ROOF 60.00
BAHR'S PROPANE GAS&A/C, INC.
- BACK CONSTRUCTION �
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Ins ections Re uired
FOOTER 2ND ROUGH PLUMB MISC INSULATION 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.
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 i
may be found in the public records of this county, and there may be additional permits required from other governmental �i
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.
� R�S cb�►(� /.�rc.
CONTRACTOR SIGNATU 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 COMMENTS
Contractor/Homeowner: `�`�
Date Received: �� �—� .3� ��j�'
Site: 7 Z Z� (�Y� (� �
Perrnit Type: /�-�r r� �(,,�1 C� a�GrnG'�,. � ��m'�� �'
Approved w/na comments:❑ Approved wlthe below comments: � Denied w/the below comments: ❑
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This comment sheet shali be kept with the permit andlor plans. ;
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Kalvin tzer s Examiner Date ontractar and/or Homeowner .
(Required when comments are present)
813-780-0020 City af Zephyrhills Permit Application Fax-813-780-OQ21 �
Bu3fding department
Qate Recetved �q—,'�3 -2 a! 5 � ��� — �f �
Phone�Contact far Permtttin
Owner's Name 17�c�wM �• � ��'�ys�• S���� Owner Phone Numb�ar �3".��J'�'�/T�
Owner's Address 7,ZZ8 OMFGA CT. ����5 pwrner Phone Number �
Fee Slmple Titleholder Name �.� • � Owner Phone Number � �
Fee Simple Tltleholder Address •�•
JOB ADDRESS 7�8 D//�IJ��R CT. Z�P�Y�it.G s FG 33 5�0 f 7`/�oT� ��
sueatv�sioN �Pfh1 i�lLLA� �'�`T.s.'�,�pARCEL ID# 3J�:Z�i�I-lJ1150-floDpo—U72G�
(QBTAINEQ FROM PROPERTYTAX NQTICE)
WORK PROPOSED e NEw CONSTR ��LT SiGN Q Q pEMO[.ISH
INSTALL PAIR
I' PROPOSEf}�U$E Q SFR Q COMNI � QTNER
I� 'TYPE OF CONSTRUCTION �I.00K " [� FFtAME � S7EEI.
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DESCRiPTION OF WORK �0�� l�IS77�'✓G �7G�/rJ• /"D��/fi� '�iVc�Tit�L�GT ��p�EIB,�f'��/�DN
BUIlDtNG S12E f� a� X�$ �f q FOOTAGE �5�7 HEIGHT jI '� �O�'���'����
B�«���G �2� O�'�,p� VALl1A710N OF TOTAL CONSTRUCTION
�E�ECTF21GA1. $���� p�r AMP SERVtCE j;EJ(ls'T7�� Q PROGF2ESS ENERGY Q W.R.E.C.
0�� � .�4. ..., O�sO�� �
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' MECNANlGAI $ .lr��,pp� VA�UATION{3F MECNANICA�tPlSTAI.tAT10N � Q�,,� ��{
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[�r��kS� Q R40FING SPEGIAI.'iY � OTHEit ���j.,�j
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FINISHED FLOOR ELEVATI4NS — FL.UOD ZONE AREA C]YES NO �j� `
,�xisrl�� ���
' au��a�R �y G����j�,, �c M � 1�13C�. CO����G?7�/1�j f.t/G.
SIGNATURE r�� � REGISTERED Y/ N FEE CURRE� Y/,N
Address 3903$ C�T,�d�L e��ecGE —',Zl�/LGs Cicense# cGCt',.�`�/�j�
��ECr��c� ����'�' �COMPAN1f dt?t1�Sl,�- /�'t ,�L��7t�1�
SIGNATURE '�A �x REGISTERED Y/ N FEE CURRE� Y/N
Address � License# �� �
PLUMBER � � COMPA�tY °�'
��, $IGNA7URE " REGISTERED Y/ N FEE CURRE� Y/N
, Addrass License# � —�
� r�EC�t,varc�u. _t/i�c/ oMpa�r �''��'S 1��dPl��1`�G.�r�S � �+C
�I SIGNA7URE REGISTERED Y/ N FEE CURRE� Y/N
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Address ` License#
OTHE��� ��I ,��,tp,,�, aM�a�ir ,�� CD�S��'�t1C.�71� � t�tlC- � �
SIGNATURE � REGISTERED Y/ N FEE CURRE� Y/N
Address ��lJc�� C�7"�9t1-F.� U'1tC�, z�f'IlGS License# e�ca�{t�1� �
RESID�N7IAL` Attach{2}.Ptat Ptans;{2}sets a#�Butlding Plans;{1)set af Energy�Forms;R-O-W Perrnit for new cansbvctian,
Minfmum.ten(�1.0)worktng days aftec.submittal date. Required onsite,ConsUuctian Plans;�Stortnwater Pia�s w/Silt Fence installsd,
Sanitary Facilides,&.1..dumpster,Site'Work�Permitfo[subdtdislonsAarge proJects
COMMEI2CIAL Attach{3}coinplete sets of Build�rig Plans plus a�ife Safety Page;(1}set of E�ergy Form5.R{?-W Pertnit for new cansttuction.
Minimum ten(10)warking days after submittal date. Requlred onsite,CanstrucUan Pians,Stormwater Plans�w!Silt Fence installed, .
, Sanitary Facilides$�1 dumpster.Stte Work,Permit for all new proJects.All commerafal requlreinents must`meet compliance
SIGN PERMIT Attacti(2}sets af Englneered Plans: �
•••«PROPERI'Y SURVEY required for all NEW canstructian.
Dlrecttans: �
Fill out applicadon completely.
Owner&Gontractar sign back of appficatlon,nota�ized
If over S25d8,a Nottce af Commencement i�required. (A!G upgrades„over�7500j
`" Agent(for the contractor)a�Powe�of Aktomey(fo�the owner)would be�someone with natarized letter from owner authorizing same
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OVER TNE COUN'i'ER PERMIT'fit!iG�?.,.�=«^(Frar�t�`of'lfi�p�ic�tion Onty),;;•,:•-- �.
Reroo#s if shingles Sewers s ;Servfce Upg'rades.NC , ,�Fe(nce's�(�'IoUSurvey/Footage)
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Qriveways-Not over CounteNf�on��ubtic roadways..needs ROW;,,,. ` r,
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, RIOTICE OF DEED R�3TRICTIONS: The undersigned under�Qands�-that this..p�rmit.may be.subject to"deed"restrictions"
which may be.more�r.est�ictive=tha�n County�regulatlons. 'The uridersigned assurries responsibility for coriipliance with any
applicable deed rest�ictions.
' UNLICENSED CONTRACTORS AND CONTRACTOR R�SPONSI�ILITI@S: If the owner has hired a contractor or
contractors to undertake work, they may be-required�.fo_be;ltcensed in accordance.with state.and�local regulations. If the �
contractor is not Ilcensed as requlred`by law, both the owner and contractor-may be cited for a��isdemeanor vtolation
under state law. If the owner or Intended contractor are, uncertain as to what Iicensing.requirements'may apply�for�the
intended v�ork, they are advised to contact the Pasco County Bullding Inspection Diviston—Licensing�Section at 727-847-
8009. Furthermore, If the owner has hl"red a contracto� or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this appllcation for which they will be responsible. If you,-as.the ov�iner sign as the
contractor, that may be an indication that he is not.properiy licensed and (s not entitled to permitting privileges In Pasco
County.
TFaANSPORTATiON IMIPACTIUTILITIES•IMPAC�'ANb RESO�RCE RECOVERY;FEES: The undersigned understands
that Trensportation Impact Fees and.Recourse Recovery.Fees may��apply�to the construction of nevv bu(Idtngs,.�change of
, use in existing butldings, or expansion�.of�existiri,g'-buildings, �s speclfled.in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees,:.as�may.be�due,:wlll.:.be tdentified at the time of�
permitting. It is further understood that Transportation Impact Eees and Resource Recovery`Fees must be paid prior to
receFving a "ce�fificate of occupancy" or flnal power release. :If the project_do�s not involve�a cer4ificate of occupanoy o�
final power release; the fees mu�t be paid prior to p�rmit issuance. Furthermore;�if Pasco County�Water/Sewer-�Impact
fees are due, they..must be-paid prior to permit�lssuance:in accordance with applicable Pasco�County ordinances.
CONSTRUCTIOId LI�RI L.AW(Chapte�713� Floe�da St�tutes, as amended): If v�luatfon of work is�2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Constructton� Llen_Law—Homeowner's
Protection Guide" prepared by the Florida Departmenf of Agric.ulture and ConsumetAffairs. If the appl(cant is someone
other than the"owner", I certify that I have,obtained a copy of the above described docurnent�and.promise In,good faith to
deliver ft 4o the°owne�'prior to�commencement. � �
COOVTFt�4CTOR'S/OIAINEF3'�AFFIDAVIT: I certify.that all.the-,Information in this appl(cation is accurate �nd that all work
will'be done in cor�pliance with all appitcable laws regulating construction, zoning and land development. Application is
hereby made to obtain .a permit to do work.and Installation as indlcafed.� 'I certffjr that no work�or Installatton has
commenced prior to is�uance of a permit and thaC.all wrork wlll be pertormed to meet standards of all laws regulating-
construction, County and City codes, zoning regulatians, and land development regulattons�in the jurisdictfon. I aiso
certify that I u�derst�nd that 4he regulations of other government agencies may�apply�to the intended wrork, and that it Is
my responsibility to Identify�what.actBons I must take to be,in:.compllance: Such agencles include but are.not Ilmited to:
- , Department of Environmental Protection-Cypres"s.'Bayheads, VVetland Areas and Envfronmentally Sensitfve
Lands,WateNWastewater Treatment.
- Southwest Florida Water Management District-VVells, Cypress.• Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engin�ers-Seawralls, Docks, Navigable Water�rays.
- Depar�ment of Health & ReMab(litative Senrlces/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protectfon Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following�restrictions apply to the use of flIL•� ,
- Use of fill is not allowed in Flood Zone°V"unless expressly permit@ed. ` �
- If the flll 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 permltting which (s prepared by a professional engineer
licensed by the State of Flor(da:
- if ihe fill material is to be used in Flvod Zone °A" (n>connectfon wlth.a�permitted building using stem wrall
construction, I certify that fill•:w111=b.e used only.to.fill the area within the�stem•wall.
- If fill material Is to be used In any area; I cer@liy that .use. of such fill wlll not adversely affect adjacent
properties. If use of flll Is found Qo adversely.affect adJacenQ properties, the o�nrner may be c(ted for viofaQing
the conditions of the bu(Iding:permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by flil, an englneered drainage plan is requtred.
If I am the AGEIdT FOR 7'HE OWNER, I,�promise In good faith to fnforrn the mwner of the permitting conditfons set forth in
this affidavit prtor to commencing construction. I understand that a=separate permlt may be requtred for electrical work,
plumbing, signs, wells, pools, afr conditioning, .gas, or other installatlons not•specifically included in tMe application. .A
permit issued shall be constcued to be a'license to proceed vui�h the work and not as authority to.violate�.cancel, alter, or
set aside any provisions of the technical.codes; nor shall Issuance of a.permit.prevent the Bulldirig Offictal from thereafter
requiring a correction af errors In.plans, constructlon or iriolations of any codes. Every perrnit Issued shall become invalid
unless the work authorized:by such permlt�i�:commenced�wtthln six months of permlt Issuance, or if work authorized by
the pe�mft is suspended or abandoned for a period of six(8)months after the time the�work ts commenced. An extensfon
may be requested, in writing, from the �ullding_Official_for_a_p�riod_not to exceed n6r�ety(90) days and-wEil-demon$trate - ---
ju�tifiable cause for.the extension.. If work c�ases.for nineQy(90)consecutive days,.the job is considered abandoned.
MIARNING TO OWNER: YOUR FAILURE�TO.RECORD.A NOTIGE OF•CAMlWENCEMENT MAY RESU�T IN YOUR
PAYIIVG TWICE FOR INIPROVEMERITS T'O YOUi�PROPERTY. IF�YO.0 iN'fEND'T��OBTAIN•FINANCING,�C.ONSUL.T
WITH YAUR LE D O AN ATTORNEY B FORE�RECOR�D G�YOUR� O �C 'OF' •� � E CE ENT�
FLORIDA JURAT(F.S.11 .0 ) �
OViINER OR AtiENT a C-'^�1" COtdTRA�TO �• ���/� _ �h�/L C0�(ST• l�/C •
Subscribed and sarom to(or aflirmed)before me thls Subscribed and'swrom-to(or affirmedpbefore me ttiis
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Who Islare personaily knowm to.me or haslhave produced Who is/are personally known to,me:or has/have produced •
as Identlflcatlon. :�a as Idendfiptlon.
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� ���- Notary Public ' � /�/%"' • Nota Public �
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Comrtf slon Co" sslo . �. ,,,����,,, II
�� e'�`_. Commission#F�GS S
Name of Notary typed,printed or stamped Idame of Notary ty e� ' o e er ,
��i,(��` 0cndod Trau Troy Fa�n Inswanca 800385•7019
813-780-0020 City of Zephyrhills Permit Application Fax-613-780-0021
Building Department
Date Received 09�23 —2��� B�� 3SS _ /!9S
Phone Contact for Permittln
Owner's Mame �������rs S�A"/� Owner Phone Number CJ�3-395-�YYfF
o Owner's Address �u8 �MEGA �T Owner Phone Number
Fee Simple Titleholder Name - Owner Phone Number
.
Fee Slmple Tltleholder Address
JOB ADDRESS 7�B OMEGA cT. LOT# �
SUBDIVISION /!�-///� V��/lG�i PARCEL ID#
(OBTAINED FROM PROPERTYTA7C NOTICE)
WORK PROPOSED B NEW CoN57R e ADD/ALT � SIGN Q 0 DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q '
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE� HEIGHT �
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
OGAS Q ROOFING Q SPECIALTY Q OTHER •
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY �
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE7. Y/N
Address License#
PLUMBER COMPANY
SIGNATURE ' REGISTERED Y/ N FEE CURREA Y/N
Address License#
MECHANICAL COMPANY AfT2 �S K.o L G .2
SIGNATURE REGISTERED Y/ N FEE C RE� Y/N
Address Lfcense# �
OTHER COMPANY
SIGNATURE RECIS7EReo Y/ N FEE CURRE� Y/N
Address License#
RESIDENTIAL Attach(2)Plot Plans;(2)sets af Bullding Plans;(1)set of Energy Fortns;R-O-W Pertnit for new consWction,
Minimum ten(10)working days after submittal date. Required onsite,ConsWc6on Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FaGlilles 8 1 dumpster,Site Work Pertnft for subdivisionsllarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Sa(ety Page;(1)set of Energy Forms.R-O-W Permit for new wnstruction.
Minimum ten(10)working days after submittal dale. Required onsite,Conshuction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary F�ilities 8 1 dumpster.Site Wark Pertnit for all new proJects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
•'••PROPERTY SURVEY required for all NEW consWction.
Dlrectlons:
Fill out application compietely. �
Owner 8 Contractor sig�back of applicalion,notarized
IF over 52500,a Notice of Commencement is required. (A/C upgrades over E7500)
" Agent(for the contractor)or'Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER.P.ERMIT71AlG (Front of Application Only)
Reroots If shingles Sewers �� Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
a�aaeo-oo2o City of Zephyrhills Permit Application Fax-813-780-0021
Building Departrnent
Date Received o��2�7���S 8� 3�S — ��95
Phone ContactforPermitting
Owner's Name ��D�T �O L19`�y-� S�� Owner Phone Number v�9���5��7 T �
Owner's Address ��O �M��A �T Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
� -
Fee Slmple Titleholder Address
JOB ADDRESS !�—S W I E�OA CT LOT# �
SUBDIVISION ��� V�u�'!�i PARCELID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CoN57R B ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE� HEIGHT �
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
OGAS Q ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
ELECTRICIAN COMPANY v�—'���^/L � ( ZG/y�(
SIGNATURE � REGISTERED Y/ N FEE CURREh Y/N
Address G G ��/ �� ��� �//���1 G�� License# F C(�U� �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address L(cense#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
� RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Pertnit for new consWcdon,
Minimum ten(10)working days after submittal date. Required onsfte,ConsWcUon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FadliUes&1 dumpster;Site Work Pertnit for subdivisionsflarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortns.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,ConsfrucUon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facili8es&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
•"'PROPERTY SURVEY required for all NEW consWction.
Directions:
Fill out applicatlon completely.
Ovmer&Contractor sign back of applicatlon,notarized
If over 52500,a Notice of Commencement is requlred. (A!C upgrades over 57500)
•• Agenl(for the contractor)ar Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMI7TING (Front of Appiication Only)
Reroofs If shingles Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
„�R�CO��G-RET�,TO: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIIIIIIII
• 2015149331
Repl:1713264 Ree: 10.00
DS: 0.00 IT: 0.00
09/16/2015 E. M., Dpty Clerk
PERMIT 1JUMBER:A�PU EE� FOQ
GTY p� ZEPI�YR.F�II�S
� NOTICE OF COMMENCEMENT
'fhe undersigned hereby gives notice that improvement wi11 be made to cert$in real property,and in accordance with Chapter 713,
Florida Statutes,the following information is provided in this Notice of Commencemept.
1. DESCRIPTION OF PROPERTY(LegAl descriptiDn of the property&streM address,if available)TAX FOLIO NO.:
SUHDiVISION��� V/LLA� 3Jr BLOCK�TRACC,�L_LOTD05p BLDG OO UNff Q720
2. GENERAL�D1ESCRIPTION OF[MPROVEMENT:
��13rRV�+Tis�w� .►c ,��� l6'x r8�n1ASo�1RY Roont Rdb�T/anl
3. OWNER INFORMATION OR LESSEE INFOAMATION 1F THE LESSEE CONTRACTED FOR THE 1MPROVEMENT:
a.xeme e�aedcess:�'1l�pT T � (�'CR�YS S S'F16�A� 7229 OME6�? cT Z6PN VQl�FlCGS�FL
b.Inlerest in property 1JW�4�Fi�S ��_I�7�
c.Neme and address of fee simple titteholder(if diH'arerrt from Owner listed above):��Q
4. 8.CONTRACI'OR•s Nnn�:,B13!'u �n�s`T�JC-'1Jan� !�C /��rwa�+�.,d eAr.xl,P,�s��rr
� Contractor's address: ��11D ri G4 Rd//�IAG AVE Z�J7�L(.S�FZ 3SS�I'Z b.Phone number:B 13 355-1/9,5
5. SUREi'Y(if appiicable,a copy ofthe payment bond is ettached):
a.Name and address: /V A
b.PBone number: /Y I7 c.Amount ofbond:3
6.a LENDER�S NAM�: ,� � �
Lender's addresc: �iv� F/1��.5' b.Phone numba: ���p �� ”
7 Persons within ihe State of Florida designated by Owner upon whom notices or other documents may be served as provided by ��� , a'�
Section 713.13(1)(a)7.,Flaida Sffitutes: m 0. � `s �
a Neme anA address: lA�. �tS �i � �'� � s,���� � �y,
b.Phone numbers of designated persons: Q���,3..7-�'��7S• g � _ I II�rt � ' ' ' � � �
S,a.I n e d di tion to h imse l f or herse l f,O w ner desiga a t e s�i J/L U�A i 0• �B G L o f /�C�' C L�f/S T/�t I G. �e e� ~ ,°��
to receive a co p y of the I.ienor's Notice as provided in Section?13.13(1)(b),Florida Statutes. c�'y , e�
b.Phone numba of perwn or entiry designated by Owner: D�.3�.3ss'�f9Jr ��� � �
9 Expiration date of notice of commencement(the expiration dete will be 1 year from the date of recording unless a different date is � •�
specified): ,20,
W.�RNING TO OWNER• ANY PAYMENTS MADE BY THE OWN6R AF'[ER Tl-IE EXPIRATION OF Tf�NOTICE OF COMMENCEMENP
ARE CQNSIDEREA IMPROPER PAYM6NTS LTNDER CHAP"I'ER T13.PART I.SF.C7'fON 7]3.13_FLORIDA STA7UTES.AND CAN Q z V � w
RESUI.T IN YOUR PAYRdG TWICE FOR IMPROVEMENTS TO YOUR PROPEItTY. A NOTICE OF COMMEN�EM�NT MUST BB � W LL. � � W �
RRCOIZnED AND POS7'ED ON Tf�JOB SITE BEFORF TFLF FIRST IN�PEI'TION IF YoU IId7'END TO OBTAIN FINANCING CONSULT U �J � � _ ' J U
CO G � ZU � F- �� �
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(S i g n a t u re of Owner or l.esse e,or O er's or Lessee's (Priot Name aod Provide Signatary's Ti tfice) � � F.. p Q ." O
Authoriud OfScer/Direetor/Partner/Manager) _ w � � U U
PpUlii 5 0'NE1L,Ph.D PRSCO CLERK g COMPTROLLER � = O O � �
State of A�oRrpA 09/16/201��1�0��m 1 �f�i�� O � � � p Y
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County of PASto OR BK ` ♦0 V = �U Z '
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The foregoing instument was aclmowledged before me this I6 day of SCP�N 86R ,20 �5 u- w � Z O .J
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by w��u�M BACR ,as J � p p p _
(narne of person) (type ofauth�ity,...e.g.of6cer,trustee,attorney in fact) �- U C.� � � Q
for �` d n O Uj
(name of party on behalf of whom instrument was executed} � rj ¢ J �
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Personally Known ✓ or Produced Identification Type of Identificadon Produced � _� z F= � }
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��'����/ '�P:�TRICIA L.JOHNSON �'�"" � O°��"'
N;:!/J M1'COMMISSION k FFI85847 ��ture of Not�ry Public)
��vj/� EXPIRES:Dsaiil�u28.7018
(Print,Type,or p Commissioned Name of Notary Public)
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Rev.10•IS-12
FORMS
FLORIDA BUILDING CODE,ENERGY CONSERVATION
FORM 402-2010 Residential Building Thermal Envelope Approach ALL CLIMATE ZONES
Scope:Compliance with Section 402 of the Florida Building Code,fnergy Conservation,shall be demonstrated by the use of Form 402 for single-and multiple-family residences ot three
stones or les�in height,additions to existing residential buildings,renovations to existing residential buildings,new heating cooling and water heating systems in existing buildings as '
applicable.7o comply,a bwlding must meet or exceed all of the energy efficiency requirements on Table 402A and all applicable mandatory requirements summarized in Table 4028 of this
form.If a budding does not comply with this method or Alternate Form 402,it may still comply under Section 405 of the florida Building Code,fnergy Conseivation.
PROJECT NAME: GI���T-J:•SHEP/}Q BUILDER: fJG/,C G�Q c� C7JD � I �%•_ �(J�GLI� . /A'��C. �
AND ADDRESS: 7��8 OME(9/4 CT. pERMITfING
SPsYkiHL�S•,FL. 35 O oFFice: C/� dF Z�/�Y/�fIL�
OWNER: PERMIT NO.: � �3� JURISDICTION NO.: 6 r��p DO
Genera I Instructions:
1 New construction which incorporates any oT the following features cannot comply using this method:gtass areas in excess of 20 pe�cent oi conditioned floor area,electric resistance
heat and air handlers located in attics. Add�tions 5.600 sq.it.,renovations and equipment changeouts may camply hy this method with exceptions given.
2.Fill in all the applicable spaces of the"To Be Installed"column on Table 402A with the information requested.All"To Be Installed"vafues must be equal to or more effieient than the
required levels.
3.Complete page 1 based on the"To Be Installed"column information.
4.Read the requirements of Table 4028 and check each box to indicate your intent to comply with all applicable items.
5.Reatl,sigri and date the"Prepared By"certification statement at the bottom of page 1 The owner or ownet's'agent must also sign and date the form.
..
�
Piease Print CK
1. New construction addition, r existing building ,.�aa�Tio �`• �= � ' -`�-' '
2. Single-family detached or multiple-family attached �2,,S//�/G(E'/C'f��'J/LY.�ET.
;,.•,.,,_.,:, .
3. If multiple-family-No.of units covered by this submission `3;.�^/,/f::-,� .;�, �
4. Is this a worst case? yes/ o) 4. yE�'
5. Conditioned floor area(sq.ft.) 5. 5� �(/Ezj)
6. Glass type and area:
a.U-factor 6a. •��
b.SHGC � 6 b. ...�O�
c.Glass area � . 6c:�� `' 's ft.
,� -?�.•7�' q.
7. Percentage of glass to floo`r area' " °•` � ���2 Z ,�o
8. Floor type,area o imeter,and insulation:
.Slab-on-grade(R-v e) ��Q, �Q/�Q� (J�,F�� �p00 SQ•� 8a.R= Iln.ft.
b. -value) 8b.R= sq.ft.
c.Wood,common(R-value) 8c.R= sq.ft.
'd.Concrete,raised(R-value) 8d.R= • sq.ft.
e.Concrete,common(R-value) 8e.R= �� sq.ft. '
9. Wall type,area and insulation:
a.Exterior: 1. Masonry(Insulation R-value)
9a-1. R= 7.8 37Q sq.ft.
2. Wood frame(Insulation R-value) 9a-2. R=N A•_ sq.�ft.
b.Adjacent: 1. Masonry(InsulationR-value) 9b-1. R= �,IQ. sq.ft.
2. Wood frame(Insulauon R-value) 9b-2. R=�/�. sq.ft.
10. Ceiling type,area and insulation:
a.Under attic(Insulation R-value) 10a.R e ��
b.Single assembly(Insulation R-value) sq.ft��
10b.R= sq.ft.
11. Air distribution system:Duct insulation,location,Qn \ /�
a.Duct location,insulation 7/�J� Tp E�(/S�lI�� (2 Q(Z��lJ 11 a. R= t'J
b.AHU location � 11 b.
c.Qn,Tesc report attached(<0.03,yes/no) 11 c.Test report attached? Yes No
12. Cooiing system: ��
•a-�'Pe 12a.Type:FLEC?'�i /G Il.P
b.Efficiency 12b.SEER/EER: �D.0
13. Heating system: 13a.Type:ELBGJ�i 1G �iP.
a.Type 13b.HSPF/COP/AFUE: 7,tj
b.Efficiency
14. HVAC sizing calculation:attached RDDlr! /¢�d/f70�-N•�• 14. Yes O
15. Hot water system: 15a.T e rEGEG G EX/ST��
a.Type yp �
b.Efficiency 'I Sb.EF•_LJN�[�t/0�1/
I hereby certiry that the plans and specifirations covered by the calculation are in compliance with the Florida Review of plans and specifications cavered by this calculation indicates compliance with the Florida
Energy Cotle. Energy Code.Betore constructlon is completed,this huilding will be inspected for compliance in
W��I�R� d• � /A��il� accordance with Sectior� d�.9 , ,
PREPARED BY•�/(/��• ���C _ �PRIO�) DATE:Oq 23_ZO/S ,
CODE OffICIAL.
I hereby certify th thi h ' g is' comp' ce with the ida En gy Code: .�^ �fp'J
OWNER AGENT A�' DATE:�_L+��S DATE: �C/1 / �
C.4 �� � 2010 FLOAIDA BUILDING CODE-ENERGY CONSERVATION
, �
FORMS
; TABLE 402A , ,
J
BUILDING COMPONENT PERFORMANCE CRITERIA' INSTALLED VALUES: i
U-Factor<0.65 �! �
U-Factor= ��p��j � .�30
Windows(see'.Note 2):, .. _ ,. „ :' SMGC:=.0.30, •' .� .�I->4 � �-SHGC`'' ' ���-i' ' i
� - ' ' %�of CFA<=20% " - •.�O '
� s �„.'•, U-FaCtor<:0.75 ' %ot CFA=..��;�'�+., . - ..... ,
Doors:E - actor "' '�`" � U-Factor a 0:65 ' " � : U-Factdr.,: '
Floor Slatron-grade, , +, ,� No requirement �
ver unconditioned s'ace`s see Note 3 R-13 - ' R-Value=
Walls-Ext.and Adj.(see Note 3):
Frame q-13 R-Value=
Mass (see Note 3) '
Interior of wall: R-7.8 R-Value= 7•8
Exterior of wall: R-6 R-Value=
Ceiiings(see Notes 3&4) � R=30 R-Value=,3Q Tesl report�i,�
Reflectance 025 A Retlectance= yrie No ' ��
Air distribution system(see Note 4)
a Ductwork&air handling unit:
Unconditioned space , Not allowed Location: Test report
Conditioned space A�_ ° ?
Duct R-value —EX�G Ex�'•.S,T/,��: -„ R-value z 6 Y ��o
R-Value= 6 /�O
Air leakage�n _ �n 5 0.03 ��_
Air canditionin s stems see Note 5 � '�'.' \ � ` SEER=13.0 SEER= .
Heating system �� �-X�,j'�►��"ji
Heat pump(see Note 5) Cooling: ;4, SEER=13.0 � SEER=
Heating: � - . HSPF=7.7 ' HSPF= _
y,i 1 .
Gas fumace • "�`�' " AFUE 78% AFUE_
Oil fumece AFUE 78% AFUE_
Eledric resistance:Not allowed(see Note 5) �. �
:.r . .
Water heating system(storage lype) �A, „��/;f!rJ G
Electric(see Note 6): �-.s_ 40 gal:EF=0.92 Gallons= ��
I Gas fired(see Note 7: � 50 gal:EF=0.90 EF= (J�/A[q/dL✓�
) 40 gal:EF=0.59 Gallons=
Other(describe): 50 gal:EF=0.58 EF=
,---.'... „
(i)Each component present in the As P.roposed home must meet or exceed each of the applicable performance criteria in�orderto comply with this code using tFiis method;
otherwise Section 405 compliance must be used.
.,
(2)Windows and doors qualifying as glazed fenestr'ation areas must complywith both the maximum U-Factor�and the maximum SHGC(solar Heat Gain Coefficient)criteria
and have a maximum total window area equal'to or less than 20%of the conditioned floor area(CFA);�otherwise Section 405 must be used for compliance. '
Exception: Additions of 600 square feet(56 m2)or less may have a maximum glass to CFA of 50 percent.
(3)R-values are for insulation material only as applied in accordance with manufacturers'installation instructions.For mass walls,the interior of wall°requirement must be
met except if at least 50%of�ihe R-6 insulation required for the"exterior of wall"is instailed exterior of,or integral to,the wall. .
(4)Ducts&AHU installed substantially leak iree per Section 4032.2.1.Test by Class 1 BERS reter required.
Exception:Ducts installed onto an exist'ing��r distribution system as part of an addition or renovation;duct must be R-6 installed per Sec.503.2.7.2.
(5)For all conventional units with capacities gr'eater than 90,000 Btu/hr For other types of equipment,see Tables 503.2.3(1-8).
Exception:The prohibition on electric�esistance heat does not apply to additions,renovations and new heating systems installed in existing buildings.
(6)For other electric storage volumes,minimum EF=0.97-(0.00132 x volume).
(7)For other natural�gas§Corage volumes;minimum EF=0.67-(0.0019 x volume).
� i, G
TABLE 4028 MANDATORY REDUIREMENTS . - • �• ` � ' . „ ,
COMPONENTS^ SECTION . RE�UIREMENTS CHECK
' To be caulked,gasketed,weatherstripped or otherwise sealed.Recessed lighting IC-reted es meeting ASTM E
Air leakage 402.4 283.Windows and doors=0.30 ciMsq.R.Testing or visual inspection required.Fireplaces:gasketed doors&
- - �`.;outdoor combustion air.
Ceilings/lmee walls 405.2.1', R-19 space paimitting.
Programmable thermostat 403.1 1 Where forced-air fumace is primary system,programmable thermostat is required. I
Air disVibution syslem 403.2 � � `Ducts in attics or on raofs insuteted ta R-8;other ducts R-6.Ducts tesled to Q�=0.03 by a Class 1 BERS rater.
� Heat trap requfred for vertical pipe risers.Compty with etticiencies in Table 403.4.32.Provide switch or clearly
Water heaters 403.4 marked circuit breaker(electric)or shutoH (ges).Circulating system pipe,s fnsulated to=R-2+accessible manual
OFF switch.
Spas and heated pools must heve vapor-ietardant cover's or a'liquid cover or other mearis proven to reduce heat
Swimming pool&spes 403.9 loss except'rf 70%of heat from site-recovered energy.OHltimer switch required.Gas heaters minimum thermal
, efficien =7B% 82%after M16/13.Heat um oot heaters minimum COP=4.0.
� � � � ` Siiing calculatfon performed&attached.Minimum eHiciencies per Tables 5032.3.Equipment efficiency verification
, Cooling/Iteating equipment �`403:6 - � ' iequired.Special occasion cooting or heating capacity requires separate system or variable capacity system.
Electric heat>10kW must be divided into two or more sta es.
Lighting equipment 404.1 At"least 50%of permenently installed lighting fixtures shall be high-efficacy lamps.
' , , . .. � �
2010 FLORIDA BUILDING CODE—ENERGY COMSERVATION C,�