HomeMy WebLinkAbout16-17368 \
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CITY OF ZEPHYRHILLS �"
5335-8TH STREET
(813)780-0020 17368 �r�
BUILDING PERMIT ,/'
r
PERMIT INFORMATION ' LOCATION INFORMATION /`
Permit Number: 17368 ' Address: 5449 12TH ST �
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: CITY OF ZEPHYRHILLS �
Est. Value: Parcel Number: 11-26-21-0010-13800-0080
Improv. Cost: 7,000.00 OWNER INFORMATION
� Date Issued: 5/19/2016 Name: POTWIN ANTHONY& CHARLENE DALE
Total Fees: 225.00 Address: 5549 12TH ST
Amount Paid: 225.00 ZEPHYRHILLS, FL 33542
Date Paid: 5/19/2016 Phone: (813)862-7305
Work Desc: RM ADDITION 451 SQ FT
CONTRACTOR S APPLICATION FEES
HOMEOWNER BUILDING FEE 105.00
HOMEOWNER ELECTRICAL FEE 60.00
HOMEOWNER MECHANICAL FEE 60.00
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Ins ections Re uired
FOOTER 2ND ROUGH PLUMB MIS 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
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 properly. 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.
.' � �
CONTRA�- OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IIV 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
t • � _ _
i i������»��u�i����i<<��i����������i iii���i�li�i�ii�i��i���
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• ' Rept:1770186 ,�TgO� 00.��
" D5: 0.00 Glerk
0811112026 K. D. K. , DPtY
PRULR 5 0'NEIE,Ph D PflSCO GLERK & CdMPTROL�Et�
NOTICE OF GOMMENCEMENT 05 ORi BK 1�����m P� �'!ZZ _
Permit No.
�C'J�aP�Y IdenSficatiaa No.1/'—2 fv—?f— U O/G�—j.3�t�o —n o S p
THE LINDERSICiTJED haeby give infnrms yau thaz the improvemeat wTll�a madc to ee�in reel pmperty,end im aecordeace with
Section 723.13 of Wa F2orlda 3tshstes.the fatlowiag informatlon is provided ia this Pi(YTIC$pR LqMMgNCEMEiYT.
1.Descri on of e �
7° � �rtr c�ara�rc►tprron.� s c"? /r Tca . � � so-"-~ 15",q v,�� z �£��
$�$�1'Of.,'�/��CS9' r
2.Qeneral descri�oa ofimpmYeme�s: d?1 �t r S
,7 .. r 3,Owncr Tafotmation 1 ^
a}Name sad adetcess�j���r2.r//} 5`��� 1 2�� S i ��t s 1 �S
b)Namc elnd address of fee stmp e tttleholder('�f othei ti�aa awner)
, o)Intenest u►'PiapertY �
b 4.Contcactbr In€atmeSoa � �
a}xameaa�addcess: ..—� � �•1�� ���„' 33 5'1l�
h)Tolephone No.: Fex No.(Opt)
5.Siaery InfotmeHon
a}Name ead'adde�css• • -
b)Amowat of Hond:
c)Telephona No: ' F.ax No.(Opt)
6,Lender
a}Nams and address:
phone No.
7.Identtty of pusoti wishia the State of Florida dealgmted by owner upan whom aatises or ather daauments may be sesved:
a)Namt aud addznas-
b)Telephpne No.: F�t No.(Opt)
8.1n addikion to himsel�ownor designates t&e followiug�reraon w r�ecbiw a qppy bf tha I.ienar's tdotice es�pmvidal in Section
713.I3(2)(b},Florida Sm6�tes:
e}Name and address: '
b)TelcphaneNo.: t• " � ' .FaxNo.(Opt)
9.Fa�iration data of Natiec of�omateneemerit(the exgization date is aao yesz from the date of recasding tmiess a diffetmt @aUe is
speci$acl}:
WARlYtNtG TO C►tY1�R ANY 1'AYMEIVT'S htADL BY'FHE O�yN�RAF'TEIt 2�E E7L'PIRATION OR T$E NQTFCE 8B
COMMENCEM$1VY'AR�CONSYD$RED A4I�ROPER PAYbiE1VT'S iJ1YDER CHA�TER 713,PART I,SECTION 913.13,
PtiORIDA STAT[TTES;A:ND CAN RESULT IN YOLTR PA7lIIVG TWYCE FOR I1kiPROV�l1�NT5 TO.X4UR�ROPERTY.
A NIQTiCB QF COhIl43P.NCEMElYTM�IST BE RECORD$D+�NID POSTED Otd 1'HE JOB S1T�SEFt}�tS THE FIRST
IlYSPEC"xIOTV.II?YOU iNTEND'I'O OBTAIN FINAN'CING,CUNSUI.T YOT7It LENDER OR ATT A'ITCIRIVEY BEFORE
CONlMp;NCIIVG WORK 4R RECORDING YOUR IVCITICE OF CON[MENCEMENI:
's
SFATE OH FLOftIDA /�
COl7I�flY OF PASCO yQli/� r/� c@ �t��'
/ • SlgnenueofOwper�a'tAut6orladOdar/Ilire�OdPutrtQ/Maoega
tip�+���IC�y���.����� �''ry
( ma�rr�
?ho fR is oing iost�uqqeqt was aclmowledged hefae me this,�day of_�f�� . .2Q�,by .
Y�1li���t�{I h''tt'i n as {type of wthariry,ag.afl5car,tinstea.+utomcy
ia fact)for � (neme of perty on bchalf of hom inshvment was
PecsonalIy Knawa___,_OR Praduced Ideoti5cation �r Notaxy Sigaaiim {iU'-t'�tt�Q. ��.
Type of Ideatificatian Produced ��'•�R P'��S(,i[erSR- Nazna(pzmt) � �C V 2.[,'n t c�U E�.S
� � .
VerificaHod pwsvent to Section 92.SZS,F7orida Stawtes.Uader.panefbies of perjiay,I declare thai I l�ave read the forcgomg end that
fhe facts stated in it aze true ta dse best of my lmowtedgt 8nd betie£ �
' '_ , signmuaofNna:atYrnvasigningAbovn
FOlWSMOC,rHdlOQt •
_� . _ � � -. ;:�;y:,;�Y::�;; JACQ ELlNE
; � *: Coinmisston#BOGES
, ::%fp�;�= a�p�ires december 122 018
. . - ThruTroyFenlnsuru�cagp0•385.70(9
F .v�"t,rd3�,"1e��r..�iPy ti_ 1
.-�iei B � �`� ��`A`���F FL�RID� C�U�!'�Y C��F�f�SCO
'""�t�. �� `�' THIS IS TO CERTIFY THAT THE FOf��G01NG IS A
��� y 1'RUE ANG CORRECT GOPY OF THE DOCU�iENT
� '`� ON FILE OR OF PUBLIC REC
` � '�"'��� ORD IN THIS OFFICE
�; � � ��.
— ,�,���. . WITNES Y HAND AND FF CIAL SEAL THIS
�`� ,����� e ' �AY OF
� �' � P ULA S. 'NEIL, CLE 2 �l'
• � ' - _ MPTROLLER
� � �'�• BY
� '' ° � " _ TY CLERK
�TA'�0�
DISCLOSt7R$ STAT�NT FOR OWNER
CITY OF ZEPHYRFIILLS BIIILDING DEPARTMENT
I. have read aad fully uaderstaad aad
agree to the provisions of this instrumeat.
The undersigaed states aad affirms that he or she is desirous of constructiag,
reaovatiag, addiag to or reroofing his or her own domicile, that he or she
actually occupies, or will occupy by said domicile, and same is not for
rent, lease or sale. That he or ahe shall comply with the followiag coaditions:
1. That the owaer and he or she alone shall act as the builder for all phases of
coastructioa.
2. That the owner will comply with all provisioas of the City of Zephyrhills
ordinances and codes pertinent to the buildiag.
3. That in the eveat various phases of coastructioa are subcoatracted, he will
engage oaly properly liceased subcoatractors and will persoaally supervise
such work.
4. That ia the eveat the Suildiag Iaspector shall require correctioas to be made,
the owaer will assume full respoasibility to iasure they' are made, aad upon
completioa will call for a reiaspection before proceediag with the buildiag.
5. That the owaer ahall assume full responsibility for the constructioa aad will
not expect supervisioa of his work from the City of Zephyrhills Buildiag
Department.
6. That prior to fiaal inspectioa any additional fees, includiag reiaspection
fees, must be paid in full. A written request from this office shall
constitute an official notice to pay� additional fees.
7. That the owaer shall comply with all City, State aad Federal laws ia regard to
social security, workman's compensation, lien laws, etc. , where applicable.
8. That the owaer shall comply with all the safety codes issued by the Florida
Industrial Commission. .
9. State law requirea construction to be doae by licensed contractors. You have
applied for a permit uader an exemption to that law. The exemption allows
you, as the owaer of your property, to act as your own coatractor with certaia
restrictions even though you do not have a licease. You must provide direct
onsite supervision of the constructioa yourself. You may build or improve a
one-family or two-family residence or a farm outbuilding. You may also build
or improve a commercial buildiag, provided your costs do aot exceed $75,000.
The buildiag or residence must be for your own use or occupaacy. _ It may not
be built or subetaatially;,improved for sale or lease. If you sell or lease a
building you have built ;or substantially improved yourself withia 1 year after
the coastructioa is complete, the law will presume that you built or
subataatially improved if for sale or lease, which is a violation of this
exemptioa. You may not hire aa ualiceased persoa to act as. your coatractor or
to supervise people workiag on your building. It is your responsibility to
make sure that people employed by you have licenses required by state law aad
by couaty or municipal" licensiag ordinances. You may aot delegate the
responsibility for supervisiag work to a licenaed contractor who is not
liceased to perform the work beiag doae. Any person workiag on your building
who ia not licensed must work under your direct supervision aad must be
employed by you,� which meaas that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for, that employee, all as prescribed by law.
Your constructioa must comply with all applicable laws, ordiaaaces, buildiag
codes, and zoaiag regulatioas. ,
OWNER�S SIGNATURE� � �_ DATE �f-�=�/ �20��
ADDR85S Z�.�g. GJ-s'
PHONE �/,�=�'� �i �'� '3� .- '
�
WITNESS � � PSRMIT # � ,
:��-:.
a��.7eaoo�o City af Zephyrhills Permit Application Fa�c-813-780-0Q21
• Bullding Departrnent
Date Ftecelved � ; .�. • ._. ._ - -- _... _..- __ _ _._
, ,...
. �1'� 2�/ Ahone Goeitact'-for:Peni�lttln .
Owner's Name_�G . � � . , u..� � l - . - � -"`Owner"'Phone Number����c� '"��� "' a
r--/� _._„ J
Ownar's-Address • /Z�� �t_' � OwnerPhone Number---��-�—��0 2- ,�-�Q�
Fee Slmple Tltleholder Name � � Owner Fhone Num6er (" -� ' �
;,,7; ... ,. ._. �.._ _._ ... �----
' • _. � � ' . '. ' i _ .. ._,._� _.-.... ..,,.,. _, ... .. _...__...,. .. ...�
Fe�Siir�pfe Titteholderi4dtlreas ` " .
�ae�o�aess ,,,. ��r,.�.� �t . 2.�� , �j r� i�G-~S `� � _ ._ . �_ --�.or#__el�.�J
SUBQIV1SlON ' ' ��. , �' PARCEL ID# - , . � • - , _. - - ' -- .,-- . . . . . ,
, .. -. ��' ,. ,..� . , :'(OBTIUNED-FRCMPROPEIYTYTAX'NOTiCE)., ': _,
WORK.PRORtiSED , •..NEWCONStR � _:.:..,�:ADDlALT `� .SiGN'� �{��` .� ,, � �, . DEMOI:iSH -
4
� . ' e lNSTALI. � �+ R�PAlR _
PROPOSED:USE, . . . -��] SFR " =[� �CQMM' [,,,�'� `�OTtiEEt. � _ . _
TYPE OF CON37RUC710N ; � Q` ;BLOCK �' ,:�'�,` ;FRAME :,C�,., . .$TEEI.� :Q;;:,>: ,_ .,....:w�;.;; . � ' � - �
- ` '._.. .. .� . - .. .., . . -,
DE3CRIP110N OF WORK - '��+� � l, � /"1/ �� .� . �"-; � - ,.
BUttD1NG�SIZE ��� � �1. i SQ.FQOTAGE �{ 1 ;HEIGH'G '; Y .
_ �w^3�� - � ��
��$l'11i.D1iVG '��;:;• _-� ,.�:;.,.- ; , , . . ,.
�:�����.� VALUATIdN'�!F T`OT'AC`COf!1§'TFtl7CTI0N_ ���,�„� : , .
� .. , ,,. , . _ ,
—�ELECTRICAL $ AMP�SERVIGE Q, PRt)GRESS ENERGY [� W.R:E:C.
, �� . . . • .,
QPLUMBlNt3 `, ($' � � . � - `
��_
�MECHANICA! $ VALUATION OF MECFIPsNEGAL IPIS7AliATlOiV ��,.���
���� _ F P N `
�c�s �,. �ooFi�vG.,-p. s��c�a�.�r,r 0 o�r+�a ,
FINISH�D FLOOR ELEVATiUNS ;.��'} FI.00D ZONE AREA �YE$ NO
� .. .
, ,, ����
BUII.DER -----. ��COMPANY
31GNATURE �G'3��Z�-� ./r�e� REGIStEf2ED Y/ N . GURF2Et� „ ..Y:I.N..•,. .,
Address . License# l �
� � '
Ei.ECi'RiClAFi � GOMPANY` .
SlCiNATURE � � RE6lSTERED Y 1 N cu�n Y!id :
Address ' - � . °.Ltcense# ! � . �
PUlMBER - �� Cf3MPANY° .' � .. .
SIGNA'1'URE :, .R��ts't�REo - . � :,;Y-IA,N �:. � �E cuR�n Y 1 N:
Addre�s , _IJcense#`�� , �'
MECHANlCA4: � •- �---.� - -
���: " G , ..t-_-_..x4 :, � .� , ' ,. .
,,
GtOMPAFIY �
SIG�NATURE � .—. , �..-_,_ �. ��%��' , _ttEGlsTE�Eo -.c-X:(id . GURREE • Y!�}": : , ,
Addreas� � � . `i , " Uceose#�-� - � !�.
�� . � � - . . - , .. . , . ,
QTHER „ . � , .COMPANiC _ _ 's��
SIGNATURE' � .' • � Y �t�Gts'rE�o ' Y/�N`:.. ' ,�E:Gu�t+~ ��.Y,.t:N�.:;
. _. � ��
Addresa� . . . ;�,rfr��.�^ ` . ,, �Licerise�#I` �.
RESlQEN1"IE1L"°���'•�''A - .,;,:2 f: ,�;�;a . r, :,.: -�....r i .:._,,Tt•:.r .,,�.• �,•.�,u.:.�' ,�. : 7Wr.'., , .. _ � .
. .. ttac.�;.(2};PIoi;P#ans;x �sets:of� t't `�:� ,, ���' �s i~� ,.
(.)` Bqfdrig''i'1ans.('I)�sef'ofErieigy,Fiirms:R=O=W:P'erm'itfcrnew,�aoris,truction
� z...� �= .. „._., �... -- - •
,-;;�Minlmum�tenq(1t});yir,otking;days_atters�ibriitHal,date=Requlisd onsiLe;�CoiisWc@amPlan's;`;Siormwatei�Plans wt,.Sllt Fsnce lnsta#led,
Sariltary FacitltlE►s&,iitdUlppSteYr Site+Wo,r`icNP,�r,miE'for,suticlliilslaris/large�projects.; ',:'.:�".�"','"'..,�.`: ` . '. ..`.� - ,�, �
COMMERClAl. Attectt{3pcorriptete:sets�of S�itifing�Plaris plits�a L`ife 5afety F!age;{9)set.of`Energy,Forms:'R-O-W Petmitfor neW�construction:
Mintmum ten(10)v"roiktng days after submlttal date. Required onstte,Construc8on Plans,Stormwater Plans wi Slit Fsnce lnstaHed,
Sanita.ry Fac�tltles&1 dumpster.Site.Work Permit�,forall'newiproj`ecfs:�All commerclal;requinements must.meetcompllance
SIGN PERMlT Attaich{2}'set"s of'Engl�,iee%+e��Ptans:sF,^�'r��, ... __ � ' . - , � - ,
•»•PRQPERTY StlRVEY,teguired far,all NEW.constructiQ,�... . -
�........_.�....�...>. _ _. �.- -
� V��iliai��$: _• , , - - `.�'cti'.:..�: ' . . ' _.r ` � ` ..:t ' . , . _<
F({I,out applicaSon completefy.
Owner:8 Contracto�slgn back of.applica8an,noharized
if aver S�S00,a Nottce;of,,Comrn�enr•ement ts requlred. .(AICFupgrades.over�7500) , _ - .
, .�.s�:.�,.crs,:•��.
" Agent(far tlie ecntractor)Q7:Power of;Attorriey(foT tfie�owrier)woutd be someone with nota�ized letter from owner autho�izing same
'D.V.ER i'HE'COUNTER�,PERMITTING.��--•;(Front�ofiApplication Qnly) • � �
Reroafs3F shingies . Sewers. Servtce Upgrades�,piTC'.: --Fenoes{PlotlSunreylFaatage}
_ __ .. , ..._. , - , •. ,,.. .
Drtvewapa-Not over CouMer if on publlc roadways..needs`RQW
NOTICE OF DEED itESTRiCTIONS: The undecsigned untletgtands:;#ti�t;t�;ils;.p�rmit;may.be•subJect^to"deed",restrlcttons°
whichmay�6e?more'ffresti,(ctiVe��th��r�Gour�ty�reg�lat(ons.''TFie�un'derslgn''e"d=�e�sumes'responsibility�=forYcompiiancewith"any �
appiicable deed:restrictlons: � . . . •
UNLICENSED.�QNTRACTORS�:AND�CONTRACTOR RESPONSIBI�ITIES�: =1f�tiie •owner=has=-hired��a contractor or
contractors.to.undertake w.ork, they:may�b.,e;:.r;e�quired�to�,b.e:llcensed-In:.accordance.with�state.and�IoEal reg„ylations.�•If the
contracto�l9;,not:llcensed•as�requlred'`tiy-law; tiotN the owner.and=confracto��may��be�cited-�for���misdemeanor vtolation
under�state law. .,If.the.�.owner or Intendeci�,c�r�tra�tor,a�ez�uncertaln as to what Iicenaing;requlrements:;mays:apply:>for.the
tntended work, they are advis�d to contact'the';�asco.County Bullding'In�pectton:Dliiision-Ltcens,Ing�Section at 727-847-
8009. Furthermore,•tf'tFie'owner�has hl"red''a'corihacto�or�contract�rs, he�ls advised to have�the contractor(s), sign
portfons of the "confractor Block° of°.this applicatiori tor_which they will".be.r.esponsible. If..y.ou,�..as...the owne�'�sign as the ��
�co�tractor, that�rriay be-an indication=that�fie ts not:properiy Ucensed and�is not`enqtfed;to pem�iifting p�Ivileges dn Pasco
County. �
, TRANSPORTA7I,ON�IMPACTIUTILIT�'IES��IMPAC7`ANb�RESO�JItCE RECOVERY'FEES:-�The undersigned�understands
, that TransporCation,lmpact Fees�and.Reco.urse�Recove".ry.Fees m�y_�appi.y::.to:t(ie construct[on.of.new bulldtngs,.;chan�e•of
° use in existing:tiulidings;�:a�:�.expansion��:of��exis.ti��builifings;(as_'specl8ed'.ln`..Pascq;.County Ordinance number 89-07 and
� 90=07; as amended.,,�,,The undersigned;also,�understands, thait:•suoh fees;:;as:::may�`�e.�.due;:,w,III;;�e,idenUfied.at.theatime�:of
� permitttng:� It Is_�furifier�understcod that Tra►ispoctatlon.Impact Fees an.d`�Resoucce`Recovery:�Fees_must be pald prior to
� receEvtng a�"certiflcate-of��ocxupancy"�or flna4-powercelease: :I��.the proj�ck,.does:no�involve;a:.certfficate of..occupancy-ar
� final power°celease;,the:,fees<mu�t,;be�paid-pr:to�to'permit.lssuance. -.F��th.ertnor:e;��ff-:Pasco;County�lNater/Sewer��lmpact
; fees�are�due,tFiey:musl.be:paid.pMor to.permit�•lasyance-�n,accordance with�:�appllcable�Pasco'County�orciinancas.
{ CONSTRUCTION`L'IEN'lA1fV"(Ctiapter 773,Flor�da Statufe��aa emended): if valuation_of..wark is.$2�500.00�or more; I
i` certify that I,.the�,.applicant,::have-b.een•�provided with. a�copy� of the��"Flortda•�Constructton� Lien.:Law--Homeowner's
� Protection Guide" prepared by the Flo�de Department�of Agricult�re and Consr�mer�Aifairs.� If=the applicant is someor�e
; other than th��'owner";.I certffy;;tfi�t.l.h�ve,opt�tned>.a copy;of the:abQ�re.riescrlaetl��ocurt�ent-,and:p.r.o�Ise�:in,gQod�faith to
,��- de8ver it to�the;'owne��prior:to�cornmencement� � , _ ' ; ��` �:� - .
CONTRACTOR'S/OWNER'S AFFIDAVIT: I.certify.;#kiat all'�ttie='Inf�cmetlon=l�i;thla.appilcation is accurate,�nd that all work
, will'be done in�compliance with all:applicable'laws regulating construction� zontng-and4land:_development. Application is
, hereby made;to obtain .a.permlt,to :do,�;wa�;:,and installation as indtcated:��--:) certffy that no work:�or-Installatton has
commenced p�lo��to issuance of�a perm1t and"that:all work will be pertormed�to meef._standards of�:all laws regulating-
constcucpon, County and Cily codes� z.oning regulatlQns�.and land development r.egulattons�in the�Jurisd(ctton: I .also
certify that I u�derstand that the,regulations of othec government agehcies may��apply�to the-:intended:work; and that it is
my responstbllity-.to�identify•what:acBons I must�take:to bedn:.cc�rrlpliar�ce.:.Such�agericles i�clude but-are.not Ilmited to.:
,., . . ._ ,, , �... ..
- Department of_.E�lvironmental,�PiotecBon=Cypre'ss:°=B�yhead�; Wetland:Areas and Envlronmentaliy Sensitive
. Lands,WatedVVastewater Treatment. .
- Southwest Florida Water Management ..I�istr'Ict=Wells;��Cypress.T�Bay�ieads�� Wetland Areas, Altering
Watercourses. - . -
- Army Corps of Engineers-Seawalls;�Dacks, Mavigatile Wateruvays.
- Department_of Heaith�.& Rehabllltativ.e�Seniicas/.Ernriconmentai::Healtk� Unit:Weil.s, Waste.water�Treatment,
Septtc`Tanks: �� .
- US.Environmental ProtecBon Agency-Asbestos�abetem��E.
- Fedecal Avletlon Authority.-Runways. - _ „
I.understand that.the_f.ollowing.�restrtricdons�epply_to�the t�se offlll:•
- Use of flll is not allowed in Flood:Zpne"V"unless expressly permitted.,_ .,,.
- ._ If the�flll�'.materlal a.ts to.be used;:�ln•flood Zone. "A",`�It'is understoad that a'drainage plan addressing a
-�- . "compensating�volume"will.be submitted at�ime of penr�iftlr:�g wtiich ts prepered by a professtonal engineer
�Ilcensed by:-#he�,State�of:Florlda:. ' ' . ;� , ,. . ..
- If th� flll mate�lai�'t's-to be used�In Flood-Zbne 'A":in�;connection�with.a`��e�mitted building using stem wall
- . constructton� Icertify.thatfUl�;w111.b.eused.only.to.iillthearea:within�the:stem�wall.
- if flll mate�ial 'is°to=be�used=�in :any area, I��cenifyr t#�et .use, of.-sucFi'flll�wiil�rlot adversely affect adjacent
� properties. if use�.of fill,is�found:to adversely..�ifect�adJaEer�t��propertle��..the owner may be cited for vioCating•
the corrd�ions of the'tii�ild(ng,:permit issued=under the�at�cfie�d permtt-appUcatlo��.for•lots less�ihan.one (1)
� .:• acre which are�elevaCed�tiy,:flll;,��rengineer�d dralnage plan�ls required.. `•'�. ' •
If I am the:AGENT..FOR_THE-OVYNER;I�romise In good falth to=lnform.the�owner;of;.the.perrinitting�condttlons set forth In
this affidav(t`p�lor to commei�oing construction: 'f u�derstand thet-aaseparate permit may be requlred for electrical work,
plumbing, signs; wells�,_pools;�,-alr:,conditloning;�,gas,.;ar othec,:ins_ta�Ca"�ons:m�oE�:specJitcally included=in:the�application. �A
permit 1ssued shall:;benconstn�ed.to be�a'Iicense�;ta,proceed wlth the,work and not��as�.autho�ity.t.o.�violate;�-cancel, alter, or
set aside-eny�provisions of�the'.tecfintcal.`codes;�nor shall Issuence�of a:permlt.prevent:the-Bulidirig Offlcial from thereafter
requicing:a:coccecUon::nf;srrors::in�plans�;;consfructlon o�•violatlons:of-anycodes:..E�ery:piermit,-l.ssued�shall�b�ecome invaltd
unlesathe'work_autFio�tzeii.by such p�rrplt�is-coFnmenced•withln sfx,months;of permlt Issuance� or tf.work.authorized by
the p�rmit..is suspQnded;oc..ebandoned�for,.a.:�ertod;of-six-�8)'�montfis�:aReP the..tirne�the�wo�k>is commence�l. An extenston
may:be requested;�;in;wciting;,frflm'ihe�°Building:=0fficlal°�for a pe�lo��not:to�exc�eed•`ninety�(90)��days��a�d•wUf demonstrate ,
justifiable=cause for'the exfenslon. If work.ceases.for nineqi`(90)consecutive:daxs...th,�)ob�ls�considered��abandoned.
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WARNING"TO:'OWNER:' 'YOUR�`FAIL(JRE'�Tt1:;R�GORQ�A;;.I�OTIGE�;OF�;COMMENEEMEI�tTT°:NtAYrRESULT•IN�YOUR
:PAYING,'I�WICE:FOR�;IMPR0IFEMEN�S,TOYQURPROPER�TY IF�YO.U�I��E�ID4�T��:C�B�T�►1NwFINAN€1NG;='CONSULT
_, _WITH YOUR`LEND�R:OR-�AN��TTORNEY��FA'RE��t-ECOR�IWf:��1TOUa'NDTI��;'.,,�CdMAli1(�NC�EN(ENT: _ _ _ . _
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� Subscrlbed and ' o�ora ed he ro me�fhls ���- - Subecxibed;and'.�n� or.atflrmesl �p �
� i�-clo by, � o . -�,, ,.r _ �.-s i�=�f�:.,::by,. :,,; �,�,-�s-h.a=i�3�,..- -���.� � v1
: 1Nho re e►son _, linown:to.me;or; aalheve.prodyaed , Wh. sle _aetsonal, ��own;to:me=orhasRiepe�prodiiced. •
�� �2il�i�' tsc:s�'� as IdentlAcatl4n: -- �� ��1�r1,�rS�a c-e`�is� . aa-ldendflcatlon.
�--- Notery Publtc . •• ''a � Notary Publlc -
Commiss n '��s �e��: �ACQUELIN OGES " ' - "�"',. = �- �mrt�is I JNo. '� '•'� Commissio FF�ES _ • "
,., - ;� �a: Expires Decem�b�j 2,2018 . . , ,,Pa�°�P�` Donded Thm Tr cem er 12,2018 , , � . . _.
,i.Pd iF;°,.••``, B � - '�:- c9.foin�insmerroe A
Name of:No ,; ' �y �Neme of Notary tyrped;printed or etamp
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�� City of Zephyrhills
', BUILDING PLAN REVIEW COMMENTS
I
Contractor/Homeowner: `G� /������
Date Received: �'����
Site: � 2 C/� `S�
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� Permit Type: S( � �
��)l�Vl �' (�r �<iYl ��)
Approved w/no comments:❑ Approved w/the below comments: ' Denied w/the below comments: ❑
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This comment sheet sh 11 be kept with the pernut and/or plans.
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xaminer Date Contractor and/or Homeowner
Kalvm S rtz — s E
(Required when comments are present)
FORMS "
FLORIDA BUILDING CODE,ENERGY CONSERVATION
FORM 402-2010 Resldential Building Thermal Envelope Approach ALL CLIMATE ZONES
Seope:Compliance with Section 402 of the florida 8uilding Code,EnergyConse�vation,shall be demonstrated by the use of Form 402 for single-and multiple-family residences ot three
stories or less in height,additions to existing residential buildings,renovafions to existing residential buildings,new heating,cooling and water heating systems in existing buildings,as
applicable.To comply,a building must.meet or exceed all of the energy efticiency requirements on Table 402A and all applicable mandatory requirements summarized in Table 4028 of this
form.If a bmiding does not comply with this method or Alternate Form 402,it may still comply under Seclion 405 of the Florida Building Code,Energy Conservation.
PROJECTNAME: POtwln Res��ense BUILDER: (,� ,��
AND ADDRESS: ,5'��{q �a+ti' �St PERMITTING r,�
�e h fhi IIS FI.335�I OFFICE: -� p� Ze Yil��5
OWNER: �� � �� W y` PERMIT NO.: g JURISDICTION NO.: (,�
General Instructlons:
1.New construction which incorporates any ol the foliowing features cannot comply using this'method:glass areas in excess ol 20 pe�ent ol conditioned iloor area,electric resistance
heat and air handlers located in attics. Additlons<_600 sq.ft.,renovations and eguipment changeouts may comply hy lhis method wlth ezceptians gfven.
2.Fill in all the applicable spaces oi the"To Be Installed"column on Table 402A with the information requested.All"To Be Installed"values must be equal to or more efficient than the
required levels. -
3.Complete page 1 based on the"To Be Installed"column information. �
4.Read the requirements ol Table 402B and check each box to indicate your intent to comply with all appiicable items.
5.Read,sign and date the"Prepared By"certitication statement at the bottom of page 1 The owner or owners agent must also sign and tlate the form.
Please Print CK
1. New construction,addition,or existing building 1 '�
2. Single-family detached or multiple-family attached 2 S('�.�
��
3. If muitiple-family-No.of units covered by this submission 3 -
4. Is th[s a worst case?(yes/no) 4. ��
I 5. Conditioned t�oor area(sq.ft.) 5 !�.�� [�]
6. Glass type and area:
a.U-factor 6a. •��
b.SHGC _ 6b. �
� a Glass area 6c. sq.ft.
7. Percentage of glass to floor area 7, [O, /
8. Floor type,area or perimeter,and insulation:
a.Slab-on-grade(R-value) Ba.R- Iln.ft.
b.Wood,raised(R-value) 8b.R= I 3 sq.tt
c.Wood,common(R-value) 8c.R= sq.ft.
d.Concrete,raised(R-value) - Bd.R= sq,ft.
e.Concrete,comn�on(R-value) , Be.R= sq.ft.
9: Wall type,area and insulation:
a.Exterior: l. Masonry(Insula[ion R-vulue) 9a-1. R e sq.ft.
2. Wood frame(Insula[ion R-value) 9a-2. R=1_� .S�(�sq,ft.
' b.Adjacent L Masonry(Insulation R-value) 9b-1. R= sq.ft.
2. Woodframe(IitsulationR-value) 9b-2. R=� �(F� sq.ft.
10. Ceiling type,area and insulation:
a.Under attic(Insulation R-value) 10a.R= sq.ft.
b.Single assembly(Insqlation R-value) 10b.R= .3� s sq.ft.
11. Air distribution system:Duct insulation,location,Qn
a.Duc[location,insultuion 11 a. R=
b.AHU location 17 b.
c.Qn,Test report a[tached(<0.03;yes/no) 11 c.Test report attached? Yes No
12. Cooling system: _ ,
a.Type ` 12a.Type: 3��I fbn V�tni•Sp�l�
b.Efficiency 12b.SEER/EER: �3
13. Heating system: 13a.Type:
a.Type 13b.HSPF/COP/AFUE: 7•-1
b.Efficiency
14. HVAC sizing calculation:attached 1a. Yes �
15. Hot water system: ,!�
a.Type 15a.Type: ��/ -
b.Efficiency 15b.EF:
I hereby ceAify lhat the plans and specifications covered 6y th:calculation are in compliance with the Florida Review o1 plans and specificalions covered by ihis caiculation i tate ompliance with the Florida
Energy Code. Energy Code.Before constmction is complet , i9 b ing ill bej cted for compliance in
i ��iZ'�'� �!D`(� accnrdance wilh Section 553.908,F.S.
PREPARED BY�` DATE: /
CODE OFfICfAL.
I hereby certify thal thl uilding is in co yaneev�h'theflorNa Eoergy Code: �.��C,�r�
OWNER AGENT� �i�7 /�i d" 1 DATE: DATE: �
� .
C.4 2010 FLORIDA BUILDING C E-ENERGY CONSERVATION
1
- FORMS '
TABLE402A I
BUIL�ING COMPONENT PERFORMANCE CRITERIA' INSTALLED VAW E5: �I
U aclor<0.65 U-Faclor= '�
Windows(see Note 2): HGC=0.30
/otCFA<=20% SHGC= �
Sk li hls U-Factor<0.75 %ol CFA=
Door;:[xierior door U-Facfor U-Factor<0.65 �• U-Faclor=
Floors: Slab-on-grade No requirement iR-Value=
Over uncondilioned s aces see Note 3 R-13 1
Walls—Ext.and Adj.(see Nole 3): ��
Frame R-13 R-Value=
Mass (see Note 3)
Interior ol walL � " R-7.8 R•Value=
Exterior of wall: R-6 R alue=
Ceilings(see Notes 3&4) Fi=30 R- alue= Test report
Reflectance 0.25 R tleclance= Allached7
Yes/No
, Air distribution syslem(see Note 4)
Ductwork&al�handling unit: Lo ation:
Unconditioned space Nol allowed Test repoA
Condilioned space Attached7
Duct R-value R-value 2 6 Yes/No
R alue=
Air leakage�n Qn 5 0.03 Q _
Air conditionin s slems see Nole 5 SEER=13.0 S ER=
Heating system
Heat pump(see Note 5) Cooling: SEER=13.0 S ER=
Heating: HSPF=7.7 SPF=
Gas furnace AFUE 78% FUE_
Ojl furnace AFUE 78% AFUE_
Electric resislance:Not allowed(see Nole 5)
Waler heeling system(storage type)
Eleclric(sea Nole 6): �0 gal:EF=0.92 Gallons=
' S�'�•al:EF=0.90 EF=
Gas fired(see Note 7): 40 g�I:EF=0.59 Gallons=
Olher(describe): 50 gal:EF=0.58 � EF=
(1)Each component present in the As Proposed home must meet or exceed e of the applicable perf ance criteria in orderto compiy with this code using this method;
otherwise Section 405 compliance must be used.
(2)Windows and doors qualifying as glazed fenestration areas must comply with both the maximum U-Factorand the maximum SHGC(solarHeat Gain Coefficient)criteria
and have a maximum total window area equal to or less than 20%of the conditioned floor area(CFA);othenvise Section 405 must be used for compliance.
Exception: Additions of 600 square feet(56 mZ)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%o(the R-6 insulation required for the"exterior of wall"is installed exterior of,or integral lo,the wall.
- (4)Ducts 8 AHU installed substantially leak free per Section 403.2.2.1 Test by Class 1 BERS raler required.
Exception:Ducts installed onlo an existing air 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 wilh capacities greater than 30,000 Blu/hr For othe�lypes o(equipment,see Tables 503.2.3(1-8).
Exception:The prohibition on eleclric resistance heat does not apply to additions,renovations and new heating systems installed in existing buildings.
(6)For other eleclric storage volumes,minimum EF=0.97-(0.00132 x volume).
(7)For olher natural gas storage volumes,minimum EF=0.67-(0.0019 x volumej. ,
TABLE 402B MAN�ATORY REOUIREMENTS
� COMPONENTS SECTION REOUIREMENTS CHECK
To be caulked,gasketed,weatherslripped or olherwise sealed.Recessed Iighfing IGrated as meeling ASTM E
I Air leakage ,402.4 283.Windows and doors=0.30 cfmisq.tt.Testing or visual inspeclion required.Fireplaces:gasketed doors 8
outdoorcombustionair. �
Ceilings/knee walls 4052.1 R-19 space permitting.
Programmable lhermoslat 403.1 1 Where(orced-air furnace Is primary system,programmable thermostat is required.
Air distribution system 4032 Ducts in attics or on rools insulated to R-8;other ducls R-6.Ducts tesled to Q,=0.03 by a Class 1 BERS raler.
Heat Irap required lor veAical pipe risers.Comply with efficlencies in Table 403.4.3.2.Provide switch or clearly
Waler heaters 403.4 marked circuit breaker(electric)or shWott (gas).Circulating system pipes insulaled lo=R-2+accessible manual
OFF switch.
i Spas and heated pools musl have vapor-retardant Govers or a liquld cover or olher means proven to reduce heat
Swimming pool 8 spas 403.9 � lass except If 70%of heat(rom sile-recovered energy.Off/timer switch required.Gas heaters minimum thermal
" efficien =78% 82%afler 4/16/13.Heat um ool heaters minimum COP=4.0.
Sizing calculation per(ortned&attached.Minimum efficiencies per Tables 5032.3.Equipment efficiency verification
Coolingfieating equipment 403.6 required.Special occasion cooling or heating capaciry requlres separate system or variable capacity system.
Eleclric heal>10kW must be divided into iwo or more s1a es.
Lighling equipment 404.1 ' At leasl 50%of pertnanently installed lighting fixtures shall be high-eKcacy lamps.
2010 FLORI�A BUILDING CODE—ENERGY CONSERVATION C.5