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' CITY OF ZEPHYRHILLS
.� � 5335-8TH STREET
(813)780-0020 17035
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17035 Address: 37350 DERBYSHIRE DR LOT 100
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: WEDGEWOOD MANOR
Est. Value: Parcel Number: 10-26-21-0120-00000-1000
Improv. Cost: 8,130.00 OWNER INFORMATION � �
Date Issued: 2/11/2016 Name: SHIRK RONALD & JUDY
Total Fees: 80.00 Address: 37350 DERBYSHIRE DR
Amount Paid: 80.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/11/2016 Phone: 813-715-2634
Work Desc: REROOF SHINGLE
CONTRACTOR S APPLICATION FEES
FOSTER ROOFING INC REROOF RESIDENTIAL 80.00
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� ` � Ins ections Re uired
DRY IN R F INSP
TAPE JOINTS R IN
FINAL - ���e
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 performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
� �
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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Alt wo��re.pair is extTa.By signin�tltis �rop+os�! ya�� �r��ivi,7��nc�ernzissi�n tc�chan�e an�l cl�ar�e f�r
any bad wood that i�required by taw. Warkms�nslup is�tfar�ntccci for a p�riad of`_,�"1,�years.Price
includes a�!°taxes and pemnit f��s. Prices are subjcct to claanJr witllout notic�.Any le�a f�es pertaining to
ti�is c�ntract c�r ft�r th�callec#ir�a�xh�r�af$��al�b�p�i�i in i"iill l�y cantr�cte�. t�vm�owi7er;nust provide
mr�c�ss thr��ri�reway�r ya�rd to th�roof. , . , ,
��I'e propos�hex�by to f3ttr�isl�m�t�riai atzt�I�3aor-con��lc€e in a�ccrcc�ancc��iih abo�•c s�ifi�ations, for the
sum nf$;��o �' , P�ryc�zent to be madG as follo��s: In full upan job�c�ntpletion,A 3%char��will
be appli�c��or pro�+��r�g � ��s• � � !��� �/� �"�� �
.All m2te��l to b�specified.Ai1y alt�ration dr e��viatio�� fcoiz�1hc abavc s�cc�fict�tions �nvolvizz�extra casts
WII�#3t'6Xt�C���LI dt1��3��ri Wl't�tBlt t�Tt��CS,at�£�tVi���tCC4Y11i:�it CYtC�7 C�7�3�t 13VCT�i'it� ii�70V�'kI'1��S�IIXa�#�.
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Acceptanee af�'�roposal—T e�bo��e prices, s�c�'tficatio��s arid conditions are satisfac�lory artd ar�hereby
�ccepter3,'�''ou ai�e aui�c�rizin�to c�o th�work�s s��cifi�ct. P�.ytt��tzt wii!t�e��Z�tie�s 4uilined ak�ave,azid
ih��,dditi�nal tern�s �nd'cortditions on pa�e� a�-o p�rt oFthis�ontr�ct. �
Si�natuz�e: ��_„�r{� ��. ,��',�e�d, 3��tc+�fAcceptat�c�: ....,.,��t. �2 r� �'. t��,_
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s�saeo-oozo City of Zephyrhills Permit Application Fax-813-780-0021
Building Departmen�
; �
Date Received 2^ ��" � Phone Contact for Permitting —
Owner's Name � � � \ � ,L Owner Phone Number � � �l5►
Owner's Address 3� �J50 �� 5�� Q � Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 3�35 c� ��� S 1 LOT# � �V
SUBDIVISION �2.d O � � PARCEL ID# �O•Zlp• 2.� � � �Z-U � ODU�� I U O
(OBTAINED FROM PROPERTY TAX NOTICE�
WORK PROPOSED e NEW CONSTR,� ADD/ALT � SIGN Q Q DEIVIOLISH
INSTALL �� REPAIR
PROPOSED USE SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION BLOCK Q FRAME �STEEL Q
DESCRIPTION OF WORK � O Q.,`�' � � Cl C Qr.`L K.� ��� � ��
BUILDING SIZE SQ FOOTAGE a�U� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
DELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ �
�MECHANICAL $ 1 VALUATION OF MECHANICAL INSTALLATION �/��
� 3d
�GAS � ROOFING Q SPECIALTY � OTHER ,�j� �
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 CURREA Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COiVIPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY �O � ^S � G
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address � � ��o��u� �`� License# C�� I 3 �
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Pians,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster,Site_Work Pem:it for subdivisions/large projects ^ -
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,Construction Plans,Stormwater Plans wl Silt Fence installed,
Sanitary Facilities&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 construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$250D,a Notice of Commencement is required. (A/C upgrades over$7500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be�someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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KeyFM. Permi#Na. 01125t2016 $. S. , Dpty Clerk
IdOi10E CiF Ct3MMENGE1YlENT
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8. in addition ta hirns+e#f ar hesaeN.f?xrrrer s�ssigrtaEes NJA of ,
to receiva a copy of the t3enors No�ce as m . , .
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s. E�Cpiratiar►dale a�Notk�r a!Comunencement(the e�iratian date is'1 year€rom the d�be of t'e��ording uniess a d'fierent date is speafied.} '
WARI�iGi 70 OWNE�i'J1Mf PpY1�1TS MADE BY THE CIVYNER AFTEA THE EXPtRATiO�t OF THE NOTtCE OF CU►dMENCEMENI'ACiE CONSiDEREQ IMPROPER •
PAYNtENiS L�1DHi t�i�►P°fEH 7i PAAT 7 SEG 713.l3,FLCIRIDA STATUTES AMD CAN REStA.T 8�1 YCaUR PAYiNG tWiGB FQR!MlPROVEMENTS TQ YOUR PROPERTY.
A NQ�TiCE OF C�R�NCG�jT�T gE��(�DED ANU P�Q6TEp QN THt'dOB$iTE B�iHE F�,Si 1l�fSPEC'�iUN.,!F YOU lNTEND TO 08TAIN FlNANCING,
txiFI5t1LT WITH YOUR tH'VDER OR AN ATTORNEI'B�OFaE fX1N1�htCiHG W'ORK�R REC�flRDiNti Yd1R NQriiCE OF CQMMSNCEMENT.
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The faregang instrument was acicno�wle�dped betore me th�sr�g day of, .,��'Gr'�^�I�r'/ .201..5-.by J U�/ti,! J�h i/'/t'"
as F�G✓,�7-f'r tor �me n
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Ver��ca�lon pt�uant 1�o Ses�an 92.525,Flosicia S�fute5:untler peoalties of perf ury,l dedat�e tltat!t�ave read the foregoing z�nd that the faets stated in it are
� fiie ta!he besi af nty lo�owledga�ur�d bellef. - tr�
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� . .. . . EXPiRES:May 2U,2018
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