HomeMy WebLinkAbout16-17470� � CITY OF ZEPHYRHILLS �
, �- ��-
5335-8TH STREET
(813)780-0020 17 � '
BUILDING PERMIT
' PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17470 � Address: 7050 GALL BLVD
Perm`t Type: COMMERCIAL � ZEPHYRHILLS, FL,
Class f Work: ADD/ALT COMMERCIAL Township: Range: Book:
Propos d Use: NOT APPLICABLE Lot(s): Block: Section: .
Squa e Feet: Subdivision: CITY OF ZEPHYRHILLS
Es . Value: Parcel Number: 35-25-21-0010-10500-0000
' Impro .Cost: 6,000,000.00 - - OWNER INFORMATION
Date Issued: 6/24/2016' Name: FL HOSPITAL ZEPHYRHILLS
Tot I Fees: 23,437.00 Address: 7050 GALL BLVD
Amo nt Paid: 23,437.00 ZEPHYRHILLS, FL. 33542
D e Paid: 6/24/2016 Phone: (813)783-6189
Wo k Desc: RENOVATION ER & ORTHO ADD CATWALK
CONTRACTOR S APPLICATION FEES
BRASFIELD & GORRIE LLC BUILDING FEE 16,110.00
P
A G EL CTRIC INC. ELECTRICAL FEE 2,685.00
HARPE�1LIMBACH LLC PLUMBING FEE � 1,685.00
HARPEf� LIMBACH LLC MECHANICAL FEE 1 685.00
�
- IRE PLAN REVIEW FEES 1,272.00
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Ins ections Re uired " �
F OTER 2ND ROUGH PL MB MISC INSULATION CEI ING
, FOOTER OND DUCTS INSULATED SEWER MISC.
ROUGH E ECTRIC ' LINTEL MISC MISC.
1ST ROU H PLUMB PRE-METER INSULATION WALL MISC.
DUCTS IN TALLED WATER MISC DRIVEWAY
PRE-SLA SHEATHING MISC. MISC.
CONSTR CTION POLE � FRAME MISC. MISC.
REINS ECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local overnment 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. �
NOTIC : In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that ,
may b 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.
"Wa ning to owner: Your failure to record a notice of commencement may result in your paying twice for
impr vements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Comp ete 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 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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BUILDING PLAN REVIEW COMIVIENTS
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Contrac or/Homeowner: .��/� � n � �
Date�Re eived: � Z7���o
Site: . 7��0 ��l� ��!/J
Permit e: �-r� G�.?j ��-��p ��G'���-���
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Approv d w/no comment Approved w/the below comments: L� Denied w/the below comments: ❑
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This co ent sheet shall be kept with the permit andlor plans.
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K vin Swi —Plans Examiner Date Contractor and/or omeowner
(Required when comments are present)
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SQ.FT. � PRICE
�l�Do� ��'/I�'�T ����
Main `' � O�j U�� v��"
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Other Area
Under Roof
Valuation: �`�p��p017�,�
Building: �.�` L� �e��
Electric: � �'�
2 t �2�
Plumbing: ' � `Q��u�'�
Mechanical: �� ��5�J�
Radon: �f�
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School Impact �t�
Fees:
, Connection c `
Fees: f ro � '�°��,0'J i���N
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� Fees: �Il� �L�5 l l�� �7�
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Jacqr�eline Bo es
From: Bond, Christian <CBond@BrasfieldGorrie.com>
Sent: Tuesday, June 7, 2016 8:44 AM
To: Jacqueline Boges
Subjeat: Florida Hospital -Building permit sub trades
APG w II be our electrician—They are the same Electrician that did our Trailer Permit so I know they are registered and
curren . I will have them swing by and sign onto the permit. I
I am st II working on getting our Mechanical and Plumbing Contractor(Harper) registered. ��
Christian Bond '
Projec Manager I
Erasfield and Gorrie,LLC.
Direct: 407•562•4587 � Cell: �2�.224•9346
This ema I and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed.If you are not the
intended ecipient,you are hereby notified that any disclosure,copying,or distribution of all or part of the transmitted information is strictly prohibited.If you have I
received his transmission in error,please notify the sender immediately by responding to this transmission.Thank you.
1
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' ' 6907 Dairy Road, Zephyrhills, FL 33542
FIRE SERVICE llSER FEES
Occu ancy No.: � o
Pian o.: - Contractor.—��!)1�-�-� � �j j��-
Busin ss Name: �T� Billing Address'.'�
Busin ss Address: ��� � �� l�i�i�
Busin ss Phone No.: Billing Phone No.:
Busin ss Fax No.: Billing Fax No.:
Conta t: - Contact:
REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
ite lan N/C nual N/C Sprinkler $50 1stAlarm N/C
Multi amily/Commercial .06 sf 1st Re-inspection N!C Standpipes. $50 2nd Alarm N/C
(Mini um Charge$25.00 � 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
�Plan Revisions DBL 3rd Re-inspe�tion $250 Hoods $50 4th Alarm $100
. • 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150
S RINKLER SYSTEAAS (Business closed until LP Gas $50 6th Alarm $200
B0-2 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 pl s Heads $100 SPRINKLER SYSTEf�RS Fuel Tanks- Pertank - $50
S ANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
�,Per iser $50 Hydrostatic Test $65 per system Fire Works $500
IRE PUfWP � Acceptance Test $45 per system Camp Fire $25
�Per ump $100 Hydrent Flow $75 Controlled Bum $100
FIRE I M SYSTEAA Hood/Duct $50
0-2 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Mnual
26 pl s Devices $100 System Acceptance $50 Fire Protection $25
SUPPR SSIOM SYSTEMS ecall Acceptance $50 Flammable Application $50 Annual
Wet $50 OTHER Waste Tire Storage $50 Mnual
Dry $50 Fire WalUSmoke Wall $15 perwall Generator<KW. $100
CO2 $50 LP Gas $25 per tank Generator>30 KW 150
Other $50 Natural Gas $25 per system Bio-Hazard Waste $100 Mnual
KIT HEN FJCHAUST Fumigation Tenting $50
�Hood ucts $50 Tent 10k10'or greater $15 per tent Torch PoUApplied $50
OTFiER , Fire Pump $45 Haz.Materials $100 a,nuai
8 LP InstaIIlation per tank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
�Per Tank) $50 E�aust Hood/Duct $30
�Natural Gas InstallaGon $50 Re-inspection DBL
( er System) (other than annual)
�Spray Booth $50 ❑ Inspection scheduled DBL �
and cancelled less than
24 hours
ConstrucHon Insp. N/C
Emergency Vehicle A� $50 �„ • FALSE ALARM
PLANS TOTAL� INSPECTION TOTAL .�.� , PERMIT TOTAL ��' TOTAL�—
���2��� 1 �7�
GRAND TOTAL ���'
Commen s: " � dc�� �( �_ � l
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. Inspect�r: ����:�✓`�
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Permi:No 016075716 Parcel ID No 35-25-21-0010-10500-0000 -
NOTICE OF COMMENCEMENT
state of Florida County of Pasco
THE UNDER�IGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713, Florida Statutes�,
the following i formation is provided in this Notice of Commencement: d��t:������@ Rec: 10.00
1 De cription of Property: Parcel Identification No. 35-25-21-0010-10500-0000 �S: 0.00 IT: 0.00
str et,4ddress: 7050 Gall Blvd. Zephyrhills, FL 33541 �5/16/2016 B. hI. , Dpty Clerk
2. Ge eral Description of Improvement ED Expansion and Ortho Renovation 'AULA� 5�'NE1L,Ph D PASCO CLFRK & COPIPTROLLER
�50R BK 1����m PG ����
3. Ow er Information or Lessee inforrnation if the Lessee contracted for the improvement: ��
qdventist Health System/Sunbelt Inc. ; dba Florida Hospital Zephyrhills '�
Name Tam a
14055 Riveredqe Drive, Suite 250 P FL
Ad ress City State
Int�rest in Property:
Na e of Fee Simple Titleholder•
(If different from Owner listec1 above)
Ad �ess grasfield & Gorrie LLC c'ty state
Co tractor: �
Name g41 W Morse Blvd Winter Park FL
Ad ress , City State
Co tractor's Telephone No.: 407-562-4500 `-�j�'1��
5. Su ety
Name
AdIkiress City State
Artiount of Bond: $ Telephone No..
6. Lerl der•
I Name
A dress City State
Le der's Telephone No.:
7. P rsons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
S�ction 713.13(1)(a)(7), Florida Statutes:
Klaus Mehlhorn
N me
7050 Gall Blvd. Zephyrhills FL
A dress City State
T lephone Number of Designated Person: 813-783-61$9
8. In addition to himself,the owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
T�lephone Number of Person or Entity Designated by Owner•
9 ExIpiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
cdIntractor,but will be one year from the date of recording unless a different date is specified): 1 1/1/17
�NARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
A�2E CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
�SULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF CaMMENCEMENT MUST BE
R CORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
IITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
U der penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of�my knowledge and belief.
STATE OF I LORIDA .�Z/! ��//�'���
COUNTY O PASCO G��GGQ
`,��ir;••., KIMBERLY J.HILL Signature of Owner or Lessee,or Owner's or Lessee's Authorized
:�►`'-"�:
_,,. ,r_ MYCOMMISSIONBEE198821 Officer/Director/Partner/Manager
;�., g EXPIRES:July 19,2016
.�,qf���� BondedThruNotaryPublkUndenmters �IVI[C TOS� C%lr P0.-/�EVT S�t�V9C C5
Signatory's Title/O�ce
The foregoirg instrument was acknowledged before rr� this ���day of '�'QY ,20�e,by 1�+LAU�-a iJ4=µL.H O('�Yti(
I as p�a�C?Qfi � pF PLAIIT 5E.4'�VICC J (type of authority,e.g.,officer,trustee,attorney in fact)for
d�LO��,I OA ��i�i TI�►1_ 'ZE�t�1/i�►1-f 1 Lt� (name of party on behalf of whom instrument was executed).
Personally Known�OR Produced Identification❑ Notary Signature ° �-r-�
Type of Ide tification Produced Name(Print) �`'��f$�b+Ly rT� l�Ej LL �
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� sisaeaoo2o { !�, ��� City of Zephyrhills Permit Appiication Fax-813•789-0D21
� � BulkJing Departrnent
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ateRocoivod �-� � � phoneContaetforPnrmitUn �Z l 2Z l`-�,J�{� L/�" ' �/�'�!
wnar'a Nama F�-��-(�A �S���L. µ=1-���.(7'� S Owner Phon fllan+be '�Sd3``7�2-1 '
wnefs Address �'lV �vE2e a E D Q. s�zso ��p�e Phone Number
ea Simple Tttleholdsr Nama 5 A M C /kS Ofn1fJ� Ownsr Phona Number
ee 8(mplo Titleholdor Address 'rJQ-M E 1� Ou�1NG�.
oe ano�ss 7b sc� �-rA LG. S Wi� Z(i(4L5 L 335�{( LOT# �
NBDIVISION PARCEL ID�
�osrar+m Fao�a aimreanr�x Nonc�
VORKPROPOSED _ � NEwCONSTR� ADDlALT Q SIGN Q [� DEMOLISH
INSTALL REPAIR
'ROPOSED USE Q SFR � COMM � OTHER C L
YPE OF COAI3TRUCTIDtd Q BLOCIC ' Q FRAME Q STEEL Q L�'� L
)ESCRIPTION OF WORK C� dZEN pt/ATc ON � 0 2 i�1-� (ZEN o�/'A�'�o t�/
3UILDIPIG SIZE �� "(1 A�(� 8Q FOOTAGE� HEIGHT �
�BUILDING $ /f �j��f6UO ����AT�Q�FTOTALCONSTRUC710N �(Q�Od� O�D
t I/ 1
�ELEGTRICAL § ��[}U O�vdV Z��Z R�CE��5� Q PROGRESS ENERGY Q W.R.E.C. �
�PLUMBING $ l7to ,�r�
l� �`�
sod,Qoo �,��>. � x� `��� �a
[�MECHANICAL $ �QQ'Oa� t V��AfTlON aF MECHAtdICAL INSTALLATION ��/ I 'U ^J��(�.t.� �
l
OGAS Q ROOFING Q SPECIALTY Q OTHER � �{J/'� .�
FINISHED FLOOR ELEVA7tONS FLOOD ZONE AREA QYES �NO �`" �
C�{,�S
BUILDER COMPAPdY 3 Rl+SFrEzD d--cr�.�r� �c�. 3 ��G
SIGPIATURE REGISTERED /N FEECVRRE� N 1
���
Address a�{l �! M�(LS� f3LVD W�f�'fE12 Q IC�Fl. 3Z'l�(ucense# �C lSoFlo6'7 co'��
r ��'" .
ELECTRICIAN I COPAPANY ' �J��
SIGNATURE ' REGISTERED Y I N FEE CURRE� Y J N "f"
Address License# �,�
�PLUMBER � � COMPaxrK ti�^ r-L.�w,I�4Ch �.LC.
SIGNATURE REGtsTEaED Y I N FeE araREA Y I N
Address �cen5e# C�=t iy'd.Q$j�
MECHANICAL COMPAPIY � e.^-�.i.rnbaeh LLC.
SIGNATURE �'� R��sTepeo Y I N �cua�� Y/N
� Address Icense# �C,j�aag
'll,n
OTHER S.�C__,� �RE�GnSTEFim Y/N G�uRti� Y!iV��i �Z
SIGPIATUR�"�'
���3 �l u5�' �4t °c ��� {�. ucense#• CCC037013
RESIDENTIAl. Attach(2)Plot Plans;( sets of Bunding Pians;(1)set of Energy Forms;R-O-W Permit for new consWction,
AAnlmum len,(10)warking daya after submittal dete:Requlred onsite,Eonstructlon Plans,Stormwater Plans w!Sflt Fence Instalted.
Sanitary FeclllUes�1 dumpster,S)te Work•Permit tor subdivls]ansAarge proJecls
, COMMERCfAL Altach(3)complete sefs of Buildirig?lans plus a Life Safely Page;(1)set of Energy Forms.R-0-W Pertnit for new eonsWcUon.
Minimum ten(70)working days'aker suhmltlal date. Required onsite,CoasWetlon Plans,Stormvrater Pians w/SDt Fence Installed,
Senitary FadliOes 81 dumpster.Slte Work Permit for all new proJects.All commerdel requir¢ments must meet comp►lance
S1Gtd PERMIT Attach(2)sets of Engl�eered Plana
••••PROPERTY SURVEY requlrad foratl NEW eonsWction.
Dlrections:
' Ffil autapplicadon completely.
' Owner&Contractor sign back of appllcatlon,notarized
If ovar$2500,n Notiea of Commencement la requlrad. (AIC upgrades over 57500)
" Agent(for tlta contractor)or Powar of Attamey(fot ihe owner)would be someono w(th notarized letter frnm oumer authorizing same
'OVER THE COUNTER PERMI7�'ING (Frant of Appllpdon Only)
Reroofs If shingles Sewers Servlce Upgredes A/C Fenees(Plo!lSurveylFootage)
Driveways-Not over Counter if on publlc roadways..needs ROW
�___ __..______-__-_--_�� _. .'h
�i �. s��-7sa-oa2o �,� ��� _ City of Zephyrnil�s Pecmit Application ��s��-7eaoo2�
I ='"`� Building Department
i �
Date Recelvec� -� .� � phone Contaet�ar Permi#tln t t�� Z�-t "�JK� , ����
�wner's Name F t-��-t�A ({C�Spj�aL.- ��6�� j LS dwner Phon ambe "��3'�024{ ,
Owner's Addre s
("Lt� �y G1t.�u�� ��. �►�2��3 6�Ow�Phone Number �T� �
Fes Sfmpl�Tltf holder Name 5 a M C �C� Otn/1�Gt`* Owrter Phbne Ncember
Fee Slmpfs Titi hoider Address �'J'�'M� � ''���t�- '
JOB ACIDRESS l C�S� l.'"CA�G- ��^-V� ZH�LLS L 5�3��t � L07# C��
SUBDIVISION �� � PARCEl.ID#
, (OBTAINED FROM PROPERTY TAX NOTIGE)
WORK PROP{) ED , � � NEW CONSTR� ABDiALT � S1GN Q � DEMOLISH •
INSTALL REPAIR
� PROP08ED U E Q SFR � CO{Ul1Ui CR� OTHEft t G
' TYPE OF GON TRtJGTIQN Q B�OClC ' Q FRAME � BTEEl Q 7"! C
DE8CRIPTION F WORK � � �.��ti�a � �aN �- 0 2��+� �.�AjC����(7�
BUIl.D1NG S12 ��S t��G`i � Stt FOOTAGE�� HEIGHT [��
���« ��'�' �' L.�, tI()Q! 6 C�f� ,}�ly d1/�Lip/,�71�FATQTAL CONS'i'RUCTION "i' �Q l Q13� � OG�O
t tp� t{!�
�ElE TRIGAL $ �` ����vQ� ��A�M,�Z R��t(,CE�t�'� Q PROGRESS ENERGY Q W.R.E.C. (�
[�PLU BlIVG � Od Q00 � ���� , '��t�, ii��'�y` ���v1
� , d C� � �,�- �
�MEC ANICAL $ � VAL�! ;IlON OF MEChlANIGAI..IIVSTRI_LATl4N ! [ 't1 � �
�-�Q,�d�, ���,�� R -�1 ���-
QGAS [� ROOFING Q SP�CIALTY � OTHER � ���r
FWISHED FLO R ELEVATIONS FLOQD ZQNE AREA QYES ��10 ��`" /�
� ��
�u«oE� coM�a�v '��SF(ELD ��c��l� G.LC � �l�G
SIGNA7URE ���.� REGISTERED / N FEE CURREh . �
N �
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Addtess �{�� �A.� 1��� ��.1f tl. (J{�j�V��. 1' k�FL ��Tf� ucense# ,CC�C,�"'_�t--O g(9(�"� _ ���'"�cj'
/ ° �s�,.• ,M1
ELECTRICIAN COMPAFtY �,��`
SIGNATURE �' REGISTERED Y i A1 FEE CllRRER Y 1 R! t�" ,•
Address License# � �
�PLUMBER � COMR,�►NY� - �+` s�-t-.smb0.Ck l-�-t—
SIGNATURE REGISTERED Y/ N FEE GURRER Y/N
Addr�ss �cense# �c=C tti"d.$S i a,,, ._._.�
MECHANICAL � ._ � �OMPAMY cf'-I.,1�rv�bach lf,_L,
SIGNATURE ` �__ REOISTEREO Y/. N FEE GURREP Y/Al
Acldress License# ��,1�✓i'1r�a$ �
'(( ;n
QTHER S�G ? ' � COMPANY
SIGNATU � ��� REGISTEREO Y/ N FEE CURRE� Y./N
LicenSe#
RESIDENTIAL Attach(2):P.lot Rlans;.(2)§ets.ofBuilding'Plans;(1)sat of Energy�Foirn's;R O W_Permitfor nei�u_consWo#lon,`'� - — - - -- " "�
- - - M9nimum:Qen..(.S.Oj:wvrking itays:aftec:subinitiat date. Requ�red onsite,Construcdon Plans,Startnwater Plans w/Silt Fence instalied,
Sanitary Facil{ties.&:�1,;dumpster;,31te�=Woric;�Permit for sutidivislarisflarge ptojects . ,_
COMMERCIAL Attach(3)complete sets of Bullrltng Plans plus a l.lfe Safety Page;(1)set o�Energy Parssss.f2•O-W Permit for new cansUucUon,
Minimum ten(10)working days after submlttal date. Requ(red onsite,ConsWcBon Plans,$tormwater Plans w/Silt Fence Installed,
, Sanitary FacitiNes&��dumpster:Site Wark Permtt foF ali'nevu projects.All cammerciat requlrements must meet aomptianc�
SIGN PERMIT Attach(2);sets of Engtneered Rlans.. : .
""P'FtOPEFtTI'SURVEY reguired fo�all.NEW:construcUon.
blreatlan�: �
Ftli out app lcadon completely.
Owner 8 nfracMr slgn baak of apptica#lon,notarized �
If over�00,a Noric�of Gammensemen4la requfred. {AtC upgrades aver�7500}
" �gent(far a cAntra�tor)or Powec of Attattaey(for the owner)would be sameans3 with notarized lettet from awner authotizing same
OVERTHE�CQ NTER.PERMITl'ING�•,.•�,. {FrontotAppltcation Onip} " ' -
Reroofs If shing es Sewers , �Service�Upgrades A/C Fences(PIaUSurvey/Footage)
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Drfvewa -NoYover�Countecff on publfc:roadways..needs R{�W . .-.. .. . -._. ... .... ............ ... {
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NOYICE�� DEED.RESTRIGTION5: �tfie�underslgnect undergtands�.t��thls;,p,�rmit.may be,sub�ect to."deed"restrictton§°
which may be.,more��resUicttve��th��-�Gountq�rieg�i�tfons. �The�.un'd"ersigr��d��ass�rines�r'esp.onsitiiiity for'compilance=wi@h"any
applicable deed rest�ictions. � . � - �• -• • � � �• • -�• '� � ' - � ' •�• ' ' .
UNLICEf�SED 'CONTRAC�OItS �AND CONTRACTOf��,R�SPONSIBILITIES:� If�the_owner .has -hired a�contractar or
cosi�r�ctars to undertake work, they may.be:.r.�,qtalred�.ta,be::licens,edrl�.�ccor.dance.witti-state�:ari�t�local�`regulations'., Ifthe
contractor ts not:�licensed as�required'`by law; both the own�r`�nd-contraetb�=inay;be��clted�for.��misdemeanor violatlon
� '• under state Iaw. If the owner or Intended>;contr,actor.:ace:uncertain �s to whaf'�Icensing;`requlroments,mayR-apply��or:the '
tntended work, they are advised to.contact the Pasco County�uild(ng inspectlon DI'viston—L•icensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors;,���he is advised.:to;have the contractor(s):sign
portlons of the "contrector Block" of this application for whlch thep will'be�esponsible. .If you�;as.the owrier'stgn�as�the
contractor, that�may be�an Indication that�he�is.not.prope�y flc,ensed �nd is noY entftled-to pemiitting privileges in.Pasco
County. ; �- � • . � �.�.... . ... , .., ._;. :. .,, .: ; . .
TRANSPORTATION;IMPACTIUTIL�'TiES��IMRAC'-1'-Apb-RESOURCE RECOVERY�FEES;�The undersigned�understands
that Transportation Impact Fees�and.Reco.urse Recove.ry.Fees may��apply:�.to:the construction of new_buildings, change�of
use in existing buildings,�or»expansi�n:•of�iexlatin�g�buildings, as specifled.in Pascq County Ordinance number 89-07 and
90=07, as amended.._The undersigned also;understands, th�t�such fees�.as tnayr�be:due;,,wlll.�be identified at the�-time�of
Permitting. It Is fiirtPie�understood that Transportatlon.Impact Fees and�Resource Recovery-'Fees.must be pald prior to
rece4ving a "certiflcate of occupancy,":or-finat�.powercelease. :I��the project.,does:not tnvolve�:a certfflcafe of occupancy o�
flnal power release,;the fees;mu�t be paid prior to permit Issuance. Fu�thermote;�If:Pascv County 1Nater/Se.wer��lmpact
fees are due,they.must.be=p�id.pNor to permit•Issuance-�n accordanco with appllcable Pasca�-County ordinances.
CONSTRUCTION L'IEN'LAW(Chapt�r.713�,Florlda 3tatufes�aa arraended):!tf-valuation•of work ls'$2,500.00.or more, I
certify that I, the applicant, have�tieen provided with'a copy of-the "Florida-Constructlon Llen Law—Homeowner's
Protecticrn Gutde" prepared by the Florida Department�of Agric.ulture and ConsumerAffalrs. If the applican#Js�someone
other than th�"owner", I certify that-l�have.oqtained'fa copy.of.the above..descrlbed�dbcuii�ent�and.p.r.or�l.se�tn,gQod faith to
deiiver it to the'ownec"-prior�to�cornmencement: � - ' . .
CONTRACTOR'S/OWNER'S AF�IDAVIT:�:��1.certifjr..that.ali thg�lnformeli�n:in<thi� applicatlon,is�accdrate.and that all work
will�be done in comptiance wiith all.appl(cable laws regulating cons�ruction� zonir�g and:-land�development. Appitcation is -
hereby made to obta(n .a permit.to _do. work::and Installation•as�indtcafed:.•. °I certffy�:that-no:work�:or installattora has -
commenced prior to Issuance of a pennit and that.all work will be p�rtormed 4o meet sNaridards`of ali laws regulaking-
construction, County and City codes, zoning regulatians, and land d�veloprnent cegulaUons-in the jurisd(ction. ( al'so -
certify that I understand that the regulations of other government agencies may-apply�to tHe intended work, and that it is
my responsibility to identify�what.acttons I must•take:M be,ln:.conlpliance: S,uch agenoles include but-are.not Iimited:to: . �
- Department of E�v(ronmental°Protection'-Gypress.Bayhead�; !lV�Uand Areas�and Environmentally Sensitive
Lands,WatedWastewater Treatment.
- � Southwest Florida Water Management .:District-Welis, -Cypress."Bay�eads; Wetland Areas, A4cering
' Watercours�s.
- Army Corps of Englneers-Seawalls, Docks, Navigatile Waterways.
� - Department of Health� 8 Rehabifltativ.e �erdtceslEnvfronmental_.Health Untt-Welis, Waste.water�Treatment,
Septlo Tanks. � _ - .
- US Environmental:Protectfon-Agency Astiestos`.abatement. . _ , �- .. ,
- Federal Avlatton�Authority-Runways. - �
I understand that the followi�ig�restrictions apply to the ase of flll:• - . ,
� - Useoffill,isnot�allowed.inFlood�Zone"V"'.uNess�.expressly��ermitted:� �- - �- �� � � ' '
- If the ffll materlal� is to be used: in.�Flood Zone. "A", it. i� understood that a drainage plan addressing a
"compensating volume" will be submitted at#ime of permftting which Is prepared by a professional engineer
Iicens�d by�#he State�of�Florida: .
- If ihe flll mater`lal ts;to be used in F9ood Zone °A" Ins connec�lon�with:a��permitted building using stem wall
� construction, I ce�tify that flll:wJll�b.e used only.to.flll the area within�the stem�wali.
- If flll ma�erlal Is �to be-used In any area� I �certify that use. of such flll will not adversely affect adjacent
propertles. If use of flll is found to adver�ely.,affect�dJacent��pr�perties,.the owner may be cited for violating
the condllions of tf�e�building:-,permit Issued�under the attacFied permit-applicatlon, for•lots less than.one (1)
acre which are elevateil�by�fllt;�n englneered dralnage plan is required. • •
If I am the AGENT FOR THE 01tMNER, i�promise In good falth to inform the owner of-the permitting conditfons set.forth In
this affidavlt'prtor to commer�cing consb�uctlon. 'I understand thet a:separate permtt may be requtred for elecMcal work,
plumbing, signs, wells,�pools; air conditioning,.gas,'or otMec installations nol•spectflcally includ�d�in.the application. .A
permit issued shall be construed to be�a�Iicense:to proceed with tFie work and not as:authoNty to.violate, cancel, alter, or
set aside any pr�visions of the.technical.codes;�nor shall issuance of a.permit.prevent the�ulldirig O#flcial from thereafter
requiring a correction.af errors in.pians; eonstruction or violations of any codes. Every permlt issued shall become invalid
uniess the work authorized.by such permit:�is.commenced�withtn sUc months of permit issuance, or tf work auttiorfzed by
the permit Os suspended or.abandoned for.a:�eNod of�six�(6)mont�s:.after the time the�workl�commencesJ. An extension
may be requested, In wrfting,.from 1he Building;Officlal for a period.not to.exceed ninety�(90) days and will demonstrate
�justifiable cause for.the extensior�. If work ceas�S:for ninety(90)cons.ecutive:days,..th�Job�Ps considered abandoned.
WARNONG TO OWNfR: YOUR.FAILURE TC1..REC.OR�,A MOTIGE:OF=COMMEMCEMEI�T:MAY�RESULT IN�YOUR
PAYING TINICE.FOR IMPRO�%EMEN'�'��TO.YOUR4�PRt�PE1t�TY.-I�°YO.tJxIN�'�EhID^TO;OB�TAIN=�If�At�E1NG;�CONSULT �
�!/� l! D �O. Af� � .O N . O.�S. O � G:: .O ` � �� '�d .� '• . , ,E � .
�:.ORIDA JURA�a(F.S��iZ.Q3�---- - --- --- — -�---- ----- - - - ------ -- -
OWNER OR AOEPIT,�e������2����w� CONTRACTO � �
���S crlbe and r (or affi�ed)befo`e thls Subsalbed and'swom'to(or affirtned)�befiore�ne tht� �
_bY �Q� 1\ ��P��n.�'�� �26--1b •br �1�i��iitr� ;�l�/t�
VYho Igl rse , �me or•has/h�ve produced Who ls/are onallykno ta me:or-haslhava�produced: •
as Identlflcatlon. � as IdentlficaUon.
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Notery Public . Notary Public
Commisslon No:' Com aston No.
� �.�`�e Q. o�� Notary Public StaM of Florida
.
Name of N Name of Notary typed,pd t or stemped � My Commissian FF 234554
;�i�`'���u'��; EDITH A MAHANEY �'+o,no� Ezpires0 710 6120 1 9
;:'�,�A�� MYCOMMISSION#FF186580
t.,�o;•r:o�.•� EXPIRES January 1,2019
� (407)388-0153 Floridallotary3ervfce.com