HomeMy WebLinkAbout16-17503 i
� CITY OF ZEPHYRHILLS �'�
` ' S335-8th Street /
(813)780-0020 17 03
� ELECTRICAL PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit#:17503 Issued: 6/22/2016 Address: 4704 LAFORCE ST
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class �f Work: ELECTRIC SERVICE REPLACEME T Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: � 500.00 Total Fees: 40.00 Subdivision: EDGEWOOD
Amount Paid: 40.00 Date Paid: 6/22/2016 Parcel Number: 14-26-21-0260-00000-0180
CONTRACTOR INFORMATIQN OWNER INFORMATION
Name: �HOMEOWNER Name: HUTSON HENRY & CONNIE
Addr: Address: RR 1 BOX 201 A
ELIZABETHTOWN IL 62931-5610
Phone: Lic: Phone: 317-997-1923
Work Desc: REPLACE METER BASE & MAIN DISCONNECT
� APPLICATION FEES
ELECTRICAL FEE 40.00
� �\� ,
r \
SPE TI S RE U ED
ROUGH ELECTRIC '
CONSTRUCTION POLE
PRE-METER
FINAL � J
V
REIN�PECTION 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 may be 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.
"Wa�ning 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."
Compl'ete Plans, Specifications and Fee Must Accompany Application. All work shall be pertormed in accordance with City
Codes and Ordinances.
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CONTRACTOR PER OFFI
� PERMIT EXPIRES IIV 6 MONTHS WITHOUT APPROVED INSPECTIO
� CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
; PROTECT CARD FROM WEATHER
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' DISCLOSURE STATEI�NT FOR OHINSR
CITY' OF ZSPIiYRHILLB Bt?ILDING DLPARTMENT
I, have read and fully uaderstaad and
ag�e� to the provisians of this inetrument.
The vndersigaed states aad affirms th.at he or she is desiraus o� constzuctiag,
reriovatiag, addiag to or reroo�iag his ar her owu domicile, that he or she
actival].y occupiea, or will occupy by said domic3.le, and same is nat for
rerit, lease ar sale. That he or she shall comply with the foilowing coaditiaas:
i
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1, ; That the oivuer aad he or she alon� shall aet as the builder for all phases o�
' coastruction.
2. Tha� the o"raer will camply with a21 prov3sions af the City of Zephyrhills
ordiaances aud cades pertinent to the buildiag.
3. That in the eveat variaua phases of coasGruc�ion are subcoatrac�ed, he will
engage aaly prapexly 1.iceased svbeo�stractors and wil3 persoaally supervise
such work.
4. Tha� ia �he event the BuiZdiag saspector sha11 reguire carrectioas �o be made,
the owaer will assume full respaasibility to iasure they aze made, mad upon
comp].etion wi11 call for a reinspeet�ion befor� psocesd3ag T,vith the building.
5. That the ownez shail assume full reepoasa.bility far the coustruction and will
� not expect supervisioa of his work £rom the City o� Zephyrhills Suildiag
' Departmemt.
6. ; That prior ta fiaal iuspectioa aay additioaal fees, includiag reinspectiaa
� fees, must be gaid ia £all. A writ�ea request fraae this of£ice shall
canstitute aa afficial aot3.ce to pay additional fees.
7. Tha� the owner shall comply with all City, State and Federal laws ia regard to
soaial security, warkman's compensation, Iien laws, ete. , where applieable.
8. That the owaer shall aomply with all. the safety cades 3ssued by the Florida
Iadustrial Commiseioa.
9. State law requirea construction to be doaa�,e by liceased contractars. You have
( appl3ed for a pesmit under aa exemp�ioa ta that law. The eacemp�ion allows
� yau, as �he awner of your praperty, to act as yaur owa can�ractar sn►ith certaia
res�rictions even though you do aot have a licease. You must provide direct
ansite supervi.sioa af �he canstruct9.on yourself. Yau may build or imprave a
one-family or two-family resideance or a farm outbuildiag. You may also build
or improve a com:nercial building, provided your casta do aat exceed $75,000.
The buildiag ar sesidence must be far yaur owa use or oecupaacy. It may �not
be built or substaatially improved £ar sale ax lease. If yau se11 ar lea�e a �
buildiag yau have buiZ� ar substantially imgroved yourself within 1 year after
, the cons�ruction is complete, the law wi11 presume that you built or
�� substaatially impzoved if far sale ar lease, s�rhich is a vialatiaa of this
exemption. You may aot hise aa unlicensed persoa to aat ag your coatractor or
to supervise people working on your buildiag. It is your respoasibility to
make sure that people emplayed by you have licenses required by state Iaw and
by couaty or municipal liceasing ordiaanaes. You may aat delegate the
xespansibility for supervising work to a liceased coatractar wha is aat
Iiceased to perform the work beiug daae. Aay person warking oa your building
who ia aot liceased must work uader your direct supervisioa aad must be
employ�d by you, which meaas that you must deduct F.I.C.A. and withholding tax
and provide workers' campensatian far that employee, all as prescribed by law.
Your aanstructa.oa must complg with all applieable laws, ord3.naaees, bui3da.ng
codes, aad zouing regulatiaas.
owr�Rr.s s���mu� �pa� �� - 02�- L�
ADDRESS c 2. ,
Pxo� - 4
'wi�rnass �$xr�sT #
� . ,
e�aaeaao2o City of Zephyrhills Permit Applicatian Fax 813-78Q-0021
� • '� Bullding Department
Qate Recelved. . , � '-Phone�;Coratac#�for`Perritittiri� ' � .
Owner•s Hame � yct SD . . . . Owaer Phone Nu�nber `'7.� '�`� - = 3 . .
+ , . �a j� .
Owner's/lddress `� A �L;z e u L Owner�PhoneNumber '� (�'��'� ^ aa-lb �:
� �„ 3
Fee Simple Tltlehalder Name Qwner Phone'Number x �� • ".���- '����
� ����--r� . _. � . _ . . , .. ,—,�_
Fee Simpl�Titlehalder�lddress . � °� � � . • -
� �
Jp6 ADDRESS � l�1�o v'c C �T, LOT# �+� .
SU80iVIS�ON1 �_ ` + ` � PARCEL ID# � ' ` p
`� (OBTAINEDFROIN`PROE+ERTYTIIX`NCTICE}
WORiCPRQPOSED NEvuCONSTR � ADD/AI,:T Q SIGN Q Q��� DEMOLISH , � ,
j ._ � e INS7'ALC '.8 •�• REPAIR �
PROPQSEp:USE. Q Y SFR � _ �GOMM' 'Q {?THER;` , � : ..
TYPE OF�ONSTRUCTIQN,, - '�] ' BLOCK�' '��]� .. FRAME, . � ST�EL .�], . . •
DEBCRIPTION'OF WORIC �~ .h 4 c -
�� , e �.' ��� �
BUiLD1AtG;SIZE� � � Stl.FQOTAGE��. , ;, HEIGNT`.��.:- � . . ' .
� ar� ,
.. �AV��V�I`{�7 . . � -7z';,.2�jtY;i�:.�...,.r . �..;lr.•��.�.-..'., ,. ., � � . .
- . , � VAI:UAT�ON`aF'TOTAL`CONSTRUCTION
�ELECTRICAL ���'� AMP SERVICE O� PROGRESB ENERGY Q W.R.E.C, ,
5� o 0 0
[����:un�Btr�� �,$.
� �� � „ . . , � � �3
Q ECHANtCAC $ , � 1tAl.t)ATtON;OF MECHANlCA�1NSTALLATIOEV t.M �
� � . .
QC,AS _ Q ROOFlI+►G> Q SPECIALTY 'Q OTHER - `
FINISHED�l.00R ELEVA710NS � FLOOD ZONE AREA ,��YES. NO ,
r�, -
BUli.DER � V . COMPAt�1Y '
SIGNATURE R6C31STEREp Y/ N �E CUttttEn' Y/.N,.
Addre�s � ,'"r ' `L'Icense#� �
EtECTRtC1AN,, • . . . - ,�COMPANY ' �.�. � � �
SIGNATURE ��' RE131STERED Y/ N F�Gurtit�n ' Y/N -�
�4ddre�s . , �Icense.#=;� �
PlUMBER� . . , . , COMP.ANY° ' „ ' . .. . .
SIGNATUR I . ,, �.rtEGIS7ERED. ,...:.Y.�h>N.., . .�e:cuwten� . Y/�N: ' , �
�1ddre� ' - . . Wcense# " _
� ,. •
ME£M�lICAL`. ,YGOMPANY _ ' .
E :�.o,_� .
SIGNATURE ' .. _ . . • � � ` ' REG�S7EttE�� ._ ..Y;/�N ;,FEECURREN �Y/:N.-,� -
lY�dd�`;.-,..�' , , - ,_ � .ic . .,. . � - ..Y `ul,`,r�_,[IS@ri'`'�^ ' ' . - .�.,..
OTHER � , ,4 _ : : ,�. , . . _� _GOMPANY ' � ' . .. . . -
SIC3NATURE. � - - ` • � ,REGtSTERED_ Y , .
�' ' ' .. , �; � , , _ ., /..'N:� FE�GURF3E�,' Y'/,N-:�. � , - .
� �, �... .
Address ;x - .:�..;;,�.;�.;E.; _ �. ,;,; .��' . � , _ `Llcense#^
1 _ r ' �;4-,.:. :��.:�, ,.Y�...:s.� :t''_ . _ :,�:�.. �t-1"g:'..J�'y'.n��x.- '.,��c• .i.f?`•.,,., . , - , ". '
RESlI?ENTiAL.. _-Attach,(2};,R1otP.,latis=(2):sets.of�Builtllrtg�'Plans;,(1.)`set:offEiiergy��Forrris;'R-t3=W",Pemnit;for;nauit,;cbnshric�ttcn;". .
- - 1 - S . -.i.. �:�..�-•-. );f
, -��Mlnlr�ium,tens(:1�Q:hworltingi;days:af�e�;subintttel�:aai8:,-Rs��irea�o�sice;co��aucd'o�;Plans,�Sfor'mwater"Plansw%�SIItFenc,e.lnstalled, .
_ ��Sanitary-Fec1ltU�ss,&>1�s�i��?Pster�,•SIte�Work�Pem:tit'.tor,•_su6dfv_i'stonstlarge�pioeicts� - :.i°�Y`� � ._ � _ - ; _ ,. - - �--- -
- -- —# _ ,,s� - .� ..:r .,.c. - � �^ -
COMt1�ERC1At Attac�►►(3j'complete"sets"af Sult1iing P1ans ptus apL-1ie 8afefy Pag�;(1)set of Energy Forrns.FtA W Permit far nsw oonstiucUon.
MiMmum ten(10)worlcing days'after submlttal date. Requlred,anslte,�ConsUuaUon Plans,Starmwater Plans w!Stlt Fence Installed,,,,
Sanitary Fadlttles 8c 1;�dumpste'r..Site_Wark.Petmtt;foc aA`new�praj8cfs:AIl;comr►zerdat requlrements-must meet.campSlance
SlGN.PERMlT Attacti(2)'sets af`E'ngliieier,ed,F!lans;�;a:�;:r::-�-,::�.._ : ... ' , , ; , ` . ;' " -_ .
""'•PROPERTI!.SURVEY rsqulred•for all_NEW-consWCtion...
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Dlre,cttons: ' -�'��a h ,. _ _ .. __. _.�. �
Ffll out appllcaUan completely.
Oirvner�Cantcactor stgn back�of appltcaSon,notarized
If`over$2500,a Notice.of.Commenc�ment ts requlred. (AJC upgrades over S75dq)__ �- - "
{ 1;,t;�„�yn�t';.,i�,Yrr�'.. � ..- . ...._ _. .._ .......... ...._.,f . ...... ,
" Agent(for the contractbr)`'orfowe�`of Attoiiiey(foc tFie�owner)would-be someone,with notarized letter frnm ovtimer authorizing same
O.V,ER`THE COUNTER�.P.ERMiT�IPIG"=-- ':{Front:6f�ApPllcai8on On�y)�� `. �. _ '� _ - --.
Reroofs If sh[ngles Sewers Servlce Upgrades A/C _ Fences(Plot/Survey/Foohage) »�- -_- .
__.._ _....�..__ .._._..,-: �-_ - _ .,. . ....t ,:;�`:�, '�; ., - ... � �. ._. . ... ., � .
Drlveways-Not over Caunter tf on•publlc roadways.:needs RC1W
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►T10E OF,DEED•RESTRICTIONS: The:undecsigned�•,ilntler�tands��th�t,thls;,p�rrnl�;,may,be:,subJect.to"deed".:resUtctlons'` ' �'
_ ' x., :.�bl '�i:, -:5�r�d uqYi w4:'�rd�. - :�d:.l:.�h'::.war:'r3.:'s,: _ i6�4;ss . .
,�... _. . ,j: �• - ' k+`j^6;F,. i,.... �'`�.��;. ,
ich mey.:be:�more:"r.esttictive,:t���;Gounqi7�latfEfitis:?The;�nd'ecsl�ned�a�'�umegtiresp�n�itiiltiy`for.compllance�with-any
�ifcabie�deed:'re�Mctlo,ns._ � - „4.�;:,r;. - - ' • ` , . �'�":�_,����<,
_ - ,. ,
-,��,,--:.:: -
..:>-,:,>..:-=.,.Hr.,-u:::�, . � . . , . ..,--_._ : ... ._� ..:�. _ __.:�.,.,.._,.,,_„ _�...,.:.;_ ,
ILICENSED";�CONTRAC�ORS_:AND`�CONTRACTOR�RESPO�ISiP�It�� �LS:�==`If=��He-ovirner��has �fiired�"eT'cd�itractor�or
�tractors to undertake work,.:tFte -ma Y,;be<_r.e�qui�d::to•:b.e,licensed;ln,accordance:,with,state�and:�(oEal.reguF,at�ons:,�<If�tii8��r�=�`:�=;��
. ��Ht ,.7• ... -..j.;.......>�,L�,_,tSr.:-_: o
�tractor;is:�not�.licensed as;requlred.by.law� tioth the,owner and:aoontcactor�may, �be�-cited for�a��misdetineano�vloladon
ier state lew.;.If_the owner or Intendetl�,a�n.�trE��tor„ere;.uncertaln:as to�what Ilcensing_,cequirements:;may��appiy}sfo���tli"e��,�-�=-M��
� t t ' ' a-,z:�,..... T
mded work; they'are advlseii�to:coritac�the Pasco'County.Butlding Inspection�,Dlvlslon--Lti�nsing:Sectiornat 727=847- . ,
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)9. Funhermore;�if�tlie�.ov+iner��has'�hl'�ii �a�contractor or contractors,'he''is advised�to�have,the contractor(s),.slgn,„„_,,,;�,., .
�;:_._..,,_
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tlons of'the__contrector B,lock°.of.°.thls.epplh�tion�for;;whtch�theyfwl,ll.,be�r.e.sponsl6le..:df�you,.;as:_fhe"oiivne�;stgn�'as'the��''"
itractor� tliat�iriay be�an�iniiication�that:�tie is not".properly llcensed�and�ls°�not"�entitled�to permitting'priGileges;In Pasco, _ �
unty. =�� , ' _ - . ', .: .,.-.:_ _,':_ ��.x_:.-,� `'°''' . �;
ANSPORTATION�iMPACTNTILITi�S`�I�{ORAC�'�AI�b�I�ESO�JItCE RECOVERY��FEE3:`rtTf�e-�nndersigned'`ur�derstands '�� -
tTransportation Impact Fe�s:and.Recoulrse Recove.ry.Fees_,m'ay:�epply�.#a�,tf�e conattuctton.of..new_.b.uildings;:ichange�of"s��'�<_��`�'='-" "! 1;'
� in exisNng buildings;>a��'�expa�i'sl�n{.o:f,<•�x[s`ti��briil�tngs�as"specifled:in P�scv�County Ordinance number 89-07 and � .
_ ,�;
07, as amended.,,_�� undersigned alsa<understa�ds, thgt`suchfees;:as,�majr"�e:cdue;,>wlll>;be identtfied at the<time=�of�'��='°�`������'�'
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mitting. It is fu�tie�understood that Tra�isportatlon Impacf�Fees and�=Resource Recovery�Fees m`u�ti be pald prior to
elving a."cerfiflcate�,of-_occupancy"-�or flnat�power�release: :If`the proJ�ct,does:no��l�voive:a=.cert�tcate of occupancy=o���>>=�°•���`-' �
il power,release�,the��fees>ma�t��-be p'aid�pcior:,to,pe.r,mit is���nce. �Ft��tkiermore;i�if:Pascm,.CountyrVNater!$.e.wer�lmpact��•°,���-?•.-�
s are due;,,lhey must be.pald�p;rior lo;permit•i'ssuance.ln,acaord'a_nce:wit�applicable�Pasco'County-oniinances.
�NSTRUCTION tiEN LAVII'(Chapter'713� FIo�Jda Statutes�a�amen�i�d); tf valuatlon of work is a2�600e00�or:more,�1: : . -
. ..�,
tify that I, the..applicent,.��iave�-:been�::.provided=with:-.a'�cvpy__vf::,the:="Florida��Construction�<Llen�.°La�—Homeowner's
�tection Guide" prepared.by:;the Florida"DePertment�of Agricultnre and Consumer�kffairs: if the appllcant is svmeone;�; ,:.:•�-��: �
,-- ,.;�.,, ;� . ..
er than the"owner"� I certifjr,:;th�t-,l::hav.e.obfainedya'�copy;of.the;abova.des,crl�ie�d��dbcu�ent:and�;pr.omi.s�,l"n;good;:falth:to . ., ....
Iver it to:.the;�'owner":prio��to�comi'nencement: " `",>`, - .. . � . . . � ;:'-;:� .> _.._ �.. .
�NTRACTOR'�IOWNER'8"AFFIDAVIT: I._ceit(ty�=tkiat.�all��the;,l�ormation�:l��:thl��appllcation is accurat�;�nd that all iivork
�be done (n compliance�with all.appllcable`Isu's�regula$ng constructlon� zontng and��land._development. Appllcatlon Is
eby made to, obtain .a.permit,;to;,;do.;w�tk,:;and,"thstellation as indlcafed:�::�I� centfy"tFiat. no work'=or Installatton fias � ��
nmenced'p�lor to issuance of'a peimit�"and thaf:aU�work will be pertormed�to meet--standards of'ail laws regulating-
istruction� County and City codes� zoning regulatlans� and land development�tegulations�'in tFie:jurisdiction:_� �P�also
Gfy that I u�derstend�that'the regulattons of other�government agenoles may�appl'y,�.to,,th,e.intended�work, and that It is A;
responsibliity to Identify:wF�at:acttons I must;�take;to betin:,compllance.�.S.uch.agencles:lnclude�but�are;�not Iimited.to: � � �
- Depaitmeri! of Erlvtronmentel>�Prote`cNbn�ress"Bayli'ead�;`Vrle�land:Areas and E�vironmentally Sensltive '
Lands,WatedVllastewater Treatment. �. ,, . � �� �
- Southwest Florida W�ter Management;:.:I�IsUict-Wells, Cypress. .Beyh�ads; �'Wetland Areas, Altering �
Watercourses. , � - ��
- Army Corps of EngtneeFs-Seawalls�Docks, Mavlgatile INaterways. `��
- Department of;:Health� 8�Rehabilitafiye.,Senitces/Environmen#a1-,,He.altl�i�,,Un(t:Wells� Waste.water�Treatment,
S�e�tic Tanks:'���' �__�..�.. � - ..� - -
- US Environmental Protection Agency-Asbestos abateme�t..; �
Federal Aviation;Authority-Runwey�: -�
�derstand that.the:.follow�ng;restrlctlons:apply to�the�t�se of flll:�
- Use of fill Is not allowed in Flood;Zone"V"unless expressly permttted.
- If�the flil=material:`ts`-to':;�be' us`ed;�in::flood -Zone. °A", 'It. is unde'rstood�that a'drainege �plan addregstng a
"compe�sating volume"wlll be•submitted_.at�ime of permiftJng wF�ich is prepared by a professional engineer '
Ilcensed-bythe��tate�of•FloFida. ` ' , ' _ _, - '�=1�,i�, _J
- If.th�.flll.:mate�lal"_i�=to;:be,�used (n �lood �one 'A° in.<connectton•with:a��permitted'bulldir�g usin� stem wall
� constrvcBon.,,l.,certifj+that,flll:w�ll:l�e.usedonly.to.iillthe,.area.withtn•:the.stem:�wali. .. -
- -If��flIF inaterlal�'1s=to°=tie''�used in��any �ar�a;`"-I"�+certify that .u�e. of sucFi'�flli will not�adversely aifect ad)acent
properties. If,use of,flll.is found to adversely.��ffect"adJaeent,�praipertles�.the owner m�y be clted for viofating .
the condWo�i"s':of�:'tFie"ti�ilaing;permit iss,ued:°urider the at�a�hed.,pecmit��ppltcatlo�, for�lots less.than-one (1)
acre which�are elevafed�by.;ilil,�n engtneer�ed dralnage plan(g required. _ �
�m the AGENT_FOR:.THEtOWNER;�'J;.promise`In good faith to�inform the�owner�of�ther:permitting conditfons:set forth In
affidavit prior to�commeiioing constructl�n. '"1"under"stand:tFiet a�aepacate perinit may be requlred for electrical work.; , -t '`�
� �� fi�. r ,:< i•;
nbing, signs, wells,.,po,olsi„,air.co,ndltioning�.:gas,:.or::otMec_Inst��tions not.spec�ficaily Inciu�ied-tn.the applfcallon'. .A` '�{
e.,,,.,. ,..�. ,q�
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nit Issued shaif'be`�.cons�'t`r.`uued to�be�e'Ilcense:fo:�proceed with`�tFfe`virortc end no,t,:as_author.ily to ylolate;�cancel�.alte�, or �°, ;`i
eside any provisions of�'tFie tecfinical:codes;�nor shall Issuance�of a.permif.prevent the Bulldirig Ofticial from thereafter.,,,�
iiring a correctton��errors�in:plans�;1cc�nsfin�ctlon or vlola0ons�of°any-codes:.�Eve.ry,,p�ermit-Issued�shall�becume�invalid ��� f`
iss the workautho�tzed:6y-sucfi permiF:�s.coi�imenced�witfifn sUc.months of;permft Issuance, or if work authorized by �:` ''•
f,� ,
pertnit is suspended�or.abandoaed-for;.a:p�riodtof<eix:�fH).:montFis;:aReFthe#i�e�the'work��s commenced. An�extenslon , .,-, ,,
� be requested� in writtng;;.�firom'the>Buildtng;0�icial:�.for a pe�lod:;not�.to..exeeed°nlnety�{90)��days:a�d�wilf demonstrate � + „
fiable cause tor�the exfension: If work.ceases,for nlneqr(90)cansecutive:day.s...the job�ls�considered abandoned. `" `�`
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RNING TO OWNER: VOUR._FAILIJRE TC1:R�EC:O�t[�:A;•I±IOT_l.CE;OF�=COMME�IEEMEI�TaNFAY�RESULT IN�YOUR . `�: +.,
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