HomeMy WebLinkAbout16-17551 CITY OF ZEPHYRHILLS
' � � 5335-8TH STREET
+ + (813)780-0020 1�-��—�'
BUILDING PERMIT �
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17551 Address: 38546 9TH AVE
Perrruit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class af Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Propos�d Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-10400-0171
Improv. Cost: 2,400.00 OWNER INFORMATION
Date�lssued: 8/26/2016 Name: PASKINS SANDRA & DAVID
Total Fees: 127.50 Address: 4284 BUGLE ST
Amount Paid: 127.50 CLERMONT FL 34711-5418
Date Paid: 8/26/2016 Phone:
Wo.'rk D�sc: CONVERT GARAGE TO BEDROOM 20 X 11 --- � �t ' b�
CONTRACTOR S APPLICA 10 FEES
GAST C�ONSTRUCTION LLC BUILDING FEE 67.50
SMITH9 AIR CONDITIONING & HE L MECHANICAL FEE 60.00
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1 Ins ections Re uired
FOOTER I 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.
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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 I
� entities such as water management, state agencies or federal agencies. �
"Wa'rning 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 I
� 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.
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O T R SIGNATURE PERMIT OFFI R
� PE MIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
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CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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FORMS
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FLORIDA BUILOING CO�E,ENEPGY CONSERVATION � •
FORM 4024010 ResldrnIIal.Bullding Thormal Envelope Approach ALL CLIMATE ZONES '
Scope:Cor„C,ance wiN Se�con 402 of IAef�OrAa BuiWmpCoae,Fnerpy Conservairon,shitl tie d?mo^strated Gy;ie use al Form t02!or s:nqle•anA mulpD�e-lamiy rzsidences otthra>
sfones or kss:n helP�t,adORions tc e�.sling�es�tlen4ai EwI01np5,ronot2,tians to ensunq re5�aenLal Cu11CiaAs,new�eaMq,coMinp,L�d rrater h¢atinq sy5tems in rxstiny�vAAinps as
aen!Iwble.Tc aamplg a Emlding musl med or eseetlnll of the eneryy Ettmiency reqW�omems on hhie A02r,anC an aUoIKaC�e mancatory re0���enents summemot in Taole 402B ollhis
Icrm.If a bu!iJinU dces nul camply weh this+rx:haA orAilernal?fun�402,i1 may s;itl compy under Secihm E05 o±fl�rHom.a 8uileing Caae,r.ner�y fanserva(loa
P,ROJECTNAME: �,3$✓L/'b Q� 'A-VI� �BUILOER: _ F?we�� _
ANDAD�RESS� ��yr��/S' �^ IP�MI7l7NG /� '
n � I OFFICE_ ��`� -'7-r�,1
OWNER�fc? �� I"O.1 K� !PEAMIT NO.: S �_� I JURISUICTION NO.: �/ �
Ge neral Instructlons:
1.fle�i censtrucran which mcorpora:t¢am ot;te!m!e�xir,g 1¢atures rannol ecmCh'�sing thls netnctl:A�,ss areas m excess o120 pemenl of contlilioned floor aiea,eLLcliic re5isibncE
treriar.a 2irtantllers loat^C in e[Ucs.Add�lfons 5 600 sy.f4,renovatlons and eqviDmenlcAangeou4 maqcomD�Y 6y t61s methoe wlih exce0��oia given. f
2.Fq.n aU the apD����10 sDaces o1 tt�e'To Ee I�nalleA'rotumn oe T66�e A02P ai!h ihB I:IIOtItYJi;f.O fC�LPS:¢d.All�iD�IOs:dlled"t21uPS RIuS[O¢EQOBI l6 M rD�O B}flCICOI Nflflliie +
requifM'evels.
3:Complete caBo.1�axo on Ihe'To Be Ir�t�iled"cotumn inlormalloo. -
a Featl tSe renuirnmenls al Tahle 4028 art0 chec�c each boz to indicate your Inhnilo comply rdth atl appi�aDle�tems.
5.Read,sipn and date the'PreOared By'cedi5ca�ion slalenent at Ihe Ooltom ol0ape 1.The Dwrm a o+vxls�flent must ehv r9n anG Oalc flulorm.
'Pleees Prinl CK
7. New eonslructlon,adtliUon,ar existing bullding y,� ( l�a � j� '�
2. Singte-famlly deNaehed or mulUpte-tamily alteohed z,� c%�Y a" �/
3. It multlplrMmlly-No,ot units covemd bythis submissian 3, _
q: Is this a worst ease?(yeslno) q, (1 O v
5. '�Conditioned.floorerea(aq.tt.) 5, �`.�..(? ,G
6. Glass iype and area: Q
a.U-factar 6n, "'?� �L
h SHGC 6 b. �- �'_ p
c.Glass acra 6c. �_sq:}t. _�_
'7 Percentage ot gless to floor area " �� ��Lr� ,�. _�
9. Floor typa,erea or peitmeter,and Insulation:
x,Slab-on•�ade(R•valuc) Ba.H= ��3 Iin,fl. ✓
b.Woad.raisaA(R-velucJ Bb.fl= ____lq.it. N
c.Wnnd,crnnmmn(R•valve) 86 R= e h.
d.Contrcte,r�iscd(R•value) -q�
Bd_R= aq.k. _ �)
a Concre�e,cnmmon(R-vslue) Be.q= sq.R. _ '
9. Wall type,area end I�ulaUon:
z Fatcrio: t. M�sanryQnsulafionR-aalue) g0-7.R_ Sq.ft. �
2. WoodfrnmcpnmiationR-valuc) 98-2.R=,_�_��eq.ft. �
b.Adjacenc 1. Mazoury.pnsulationR-value) 3b•1,q= �•�� sq.f4 `�
2. Woadframe(1nsulnGonR-valuc) 9b-2 R=__ sq.R _
S0. Ceiling lypn,area end Insulalion:
a.Underntuc(InsoWtionR-celue) 70a.R=�sq.tt. '�� �
6.Singlcastrmbly(InsulalionR•vxlue) 10b:R- ___sq.R. _
11.,Alr tlistribution system:Duet insulatlon,locatlon,Qn �r�
aDocclon�ion,in5ulation tia.R= - II C�l.f� �
b.AH[llocation t4b.�'LS O • ✓ p�
c,Qn,71�sccepor,aireched t<O.D3;ye4na) 17aTesf report 1[aehed7 Yas � ✓ �
12 Cooling system: � �
o.�yp� ,s�.,y�: c�z...�rn I A i� _ �
b.ElTiciency 12b.5EERlEER: _ �� t�
13. Heatlngsyetem: 13a.7�rpe: t-12f� JP' �� � P
e.Type 13b.MSPFICOP/� AF� �
b.fi�cien�y
14. HVAC slzing ealculation:ottaehed y4. Yes � ��
15_ Hotwatorsystem:
a.'Iype t5a.rype: e� G 'Uf1 _✓
a Effi:imcy �15b.EF:�C�1Cl�_ .�'Z. _
1 hert6y urtAy �e ptcs and tpedfi'atons cwttd hy Ihe akulelqn aie ir,wnpPanw Kiih the Flerf08 Pevkrr�?pl:ns md sD��Lms eawtnd M��aMl�n In6cata�Cxnpi�ce h5N th Ror'!a
EnmprC„Et, . &e�pyfntle.3el�eeomtnmlion;eromD�ted:Nk�ui n ai7beNapeGedio�nmA���i�
�ri-..'��;`�.
a:wr0acxs whh Sc�Hon 553.9'33,F,S
PHEPANEUBY: - MTL.��`
ccoec�c!a. �.
I hreb/uti."y tl�fAh EuZdliv,b In WmGGarce w1k tne Rorlda E^erpp Cmn: ,:
OWNERAGEVI: O0.TC `OP.TE a
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C.4 2010 FLORIDA BUILDING CODE--ENEq6Y CONSHRVATION S
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TABIE 402A '
BUILOINOCOMPONENT T�V �PERFORYAHCECRRERIA' INSTALLEDVALUE3:
�U�Facbrc0.&5 � 'µFactor. 3`?
lYiMows(5ea A'ofo 2): :SHGC a 0.30 I
;�wo1CFA«x0X ''sMGC.. ,.�•2 'I
,SkVli9mn ,��'U.F��lor<0�75 _'�"'__ �%o1CFAm i�.$
fDocrs•EderiorckcrU-Faclw ' u-Fa� C,oreO.&5 I U.Fncta.
Floora: Slatron�preM No roautramont ��
R•V61up_
Owruncondi�m�otls aceE eeeNateJ R•t7 _^__ ���3 _�
`N�aYu-Fa7.and AO�.Is¢n Nma 7}•
Framo R•13 fl•Velue e
M�s (soo Nam 3)
IMenorofwaT R-7.B p-Ve&re= 1�
ExteriorWwelL• __ iR.B R�value.
fCe:lMg.(soo Notae 3&d) ;qa0 q.yplua= i Tosl ropM
Rctiruonce '0.25 Reneaana� �� �V�
_'_ ���
?AG dictrbinion sy iam(sae Nom<)
ya•
�oud,wdc a etr naiM�,�unic �)—..�,�` i I
UixvqTanudWn�co No:enaweA LaalWi: �l�L`�-�'7' TalreOort �
Can?nomW s0a� ntlanc�U7 �
� YeNNo i
oun p•valuo R-velunt0 R•Value=
_ nv�ecxnao on a�s b.oa o�m
�Aircm�ffia:i'qsysleme(SwNat051 ISEER.T&0 SEER=
�Hooliny sys�mn ' 1
Heatpump(seoNole5) Cooa�g: SEER�13.0 SEEq= 7[�{, S..�v� i
� 1leefin0: t15PF.7.7 FfSPF. P �"r
I
Gns liuntte AFUE 78 o AFUE_
Odl�mew qFUG78Y, A�UE+.
Elecvic rea'mence;Not nloruetl(ex Note 5)�
!Woler fwaiin9 eystcm latare9c tyCeJ �
Ekrnk lasc Nme�: i a0 9�EF a 0.42 _.�!GeGons: C�n�-�-c✓a
�I OasTifedseeNo4e ��OaF.EF=O.BO EF� C�R,�-� �
( �I: eo ga�:EF Q 0.59 Gnloro=
ONw(Eewfie} I=fl fF��EF�0 58 i EF= i �
{1)EecA component presenl in tho As PropDsod homa must meot or oxeoetl eacn of Iho epplicabia perfortnance crllaria In ordar�o complywith Ihis eetle using�hls melhod; �
I I olheiwise Sedion 405 eompllanca�must bB used.
� .(2)WlrMowsenddoorequalNyingesglazedfenestrationereasmwtcomplywllhbo�hlhom�imumU-FactaantllhumaHimumSHGC(salerHeAtGainCoeflleienQeriteda
! and have a maximum rolfll wiodow area equal to or�lesa ttten 20Y of Ue contliGonod Iloor area(CFA);otherwise Seclion 405 must 6e usetl lor eompGance. .
Exception:Addifinns of 600 square feei(Ci6 m�or IBss may havo a mabmum glaas fo CFA a150 porceM, pt
(3)R waluessre tor irtsuaGon materffiI anly as eppVed in acmrtlante with manuteclureB'(nstellafion inslrucdons.For masswalls,tho 9nlertrn ofwalf requlrement mustlfe P
�! met�except H at lees�50%ot ihe H6lnsulazion requiretl fa IDa'exterior.ot wa1P is inslafled rxlene�of,or tnregml ro,tha waH. �
(4)�uG16 fl"AHU Instelled su6stentlalty leek trec per SeaGon d03.22,1.Tes16y Class 1'BERS fater roqUiretl.
Dmoption:D�ct3.instnlletl onto an existlng air dislribuGon system es per!al en eddition or renovellon;Ouct must be R•B inslalled per Sec.5032.T.2.
(5)For all wnventianel units wii�capadNes greater Ihan 30,OIX1 Btu(hc For othar rypes ol oqufpment,see TaOley 5032.3(1•8).
Excapllon:'RieproniEltbn on electAe resistenea heat does not appy to aatlHlons,renovationa end nmv henting systems instelled in ozieting hu7dings �
�6)Far oNor electrfesfomge volumes,mmUnum EF z 0.97-(D.00732 z volume).
'i (�Farolhernaturalgasstoregaw;umes,m(nimum6F=o.87-{o.00t8xw1ume). '
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. TA9LECO2B b1ANDATORYREQt11REMQlT6 "�
COMPONENT6 6ECTION pEdUiqEMENTS ----T_CHECK r
� � 1 TobocauRCO,geskeMd,weememtRpyetlorntheiw:seseelee.RecefseClghLi,rylGmrodanmeotlrgAS7ME `
�ALlnnknge 4D2.4 2B3.YfiMowsnndEooneQ30c1My.fl.Testirq�wWcuallnepoctionreqWrodFliop4iwspnskatoadoomd. V 7
oultloor cambuslbn nir. '
jCeOingallmopwalh d0521 p-1BepauycmmlL�q. ' ✓ ,�
Prag�emme6le Ihermonol a0J.1.7' N7nm forrntl•elr himoco In ptlmvy gy�em,DroO���hle Itremrocfai is requlmd, y 5
Alr tliShiDullon ayetem G03.2 Wae In!Na w an raois InSu1918010 R•9;other dutb R�B.Outle fea1M h O,e 0.03'v/e Qess 1 BERS reter. y
�, �HeatUaprapuNa0larverlimlpiperiaere.Ca�ptywMallKfBnNe9inTBblea03A.3R.PIwi098wflchwUomy ✓ a
' WalnAeaters a03.4 maAceddmult0ieake�(electnc)orMu�otl(pssj.Clmleting5y51emp�pcaln5utetoEto.R�2�9tta�71am�nuel 5
I I OFF Br�ltch. `
II Spasendhoatotlpoobmuslhewvepor-ratartNmcaenwe�qubcwcr'arotMrneenapevenbretLLce�eal � �L
9w.nmHg�0018 epae aW.B ban exCept i170X ol henl}rom a0o-�acwuree nnergy,OfNlmor mlah roqu ed.Oee�oelore minimum tMrmd ;�
eMkre a.78%82h aM¢t 4/1&18),Ned pump pool hoelom minlmum CdPa 4.0. �
5"crpeakLlalionpeAormod8a[IacheC Mln�mumMll�ignelesper7oEba5032.J EQUIpmeMaMtbneyvBnReetbn'� �
Codmg�healingequpmonl �403,6 reQu�md.Specialacasienwa'aporhoeungcepac.ryrequreeseperaineystemarvadaGueoy¢Urysynem. I �/
ENcUc�oat>10kVPmuslbntlividatlinbtwoormom as i
LighUng oq�ipmenl 4Ud.1 Ft IOaq SO%W pamunanty IndWbtl 6pMNp(aNrne ahn0 be Iugn-elhcs.y Wmps � � !'
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201Q FLOpIDA BUILDING CODE—ENERGY CONSERVATION C.5
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aourv-nraF_llh��.s't �
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Before me on this L�„ day Qf �:�`.� 20 E�.., .
P�ersorrally appeared
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E�ecuted the foregoing ietter and certified that the statements cantained therein
a;e true, correct and complete.�She is persona!!y known ta me� or has
pravided a vafid driver`s license
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� Natary.Pubf'rc �
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i ( �4���« ,��� 'JEANNINE HUDW.ESTpH
�� � Notary Pubt[a-StaU ot Florida
� = *.s My Comm.Explrea Sep 29.2Q1�
( .. -N� F, ��m�On�1�gA�san.
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
. ' Building Department
' i Date Recetved � � Phone Contact for Permitting —
7TTfTI-I-I- - - -- T�I 17� �r�,�
Owner'sName �A�e-� "an. AS �ll1S OwnerPhoneNumbe `��3 (�/��7� ��
I Owner's Address ya 3� �3 u �Q, �`�'�"V'�� Owner Phone Number
Fee Simple Titlehalder Name ��� f Crv1, lT(/�S�in Owner Phone Number
Fee Simple T(tleholder Address ���(/N U 1-� �r, �i�^-Od�. JL� I �(
JOB ADDRESS ���'(If/ �� � �►'e- 4G� 1�, i I`S � ��5Y oC. LOT# �
SUBDIVISION PARCEL ID#
� (OBTAINED FROM PROPERTY TAX NOTICE)
I WORK PROPOSED e NEW CONSTR� ADDIALT �> SIGN 0 Q DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR Q COMM 0 OTHER
TYPE OFCONSTRUCTION Q BLOCK '�i FRAME � STEEL Q
DESCRIPTION OF WORK C C7S��e� ��5� I�� ��� � e-��N�
BUILDING SIZE �� � I� SQ FOOTAGE �� HEIGHT �
�BUILDING $ .5,E�O�'� VALUATION OF TOTAL CONSTRUCTION �y�O� ��
dt�
�ELECTRICAL $ �/y� � AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. �
W r
OPLUMBING $ Lt^U
� ����`� � �c� �(/���
MECHANICAL $ � VALUATION OF MECHANICAL INSTALLATION o r"
�? ��v.a� �.a�''� �Q,� S
�GAS Q ROOFING Q SPECIALTY � OTHER f/ �^ � V
V �.�
IFINISHED FLOOR ELEVATIONS i��,�,� y Ji } U�OOD ZONE AREA / �YES �'( NO ,\ � �S�i
BUILDER �M��/ � ' �
SIGNATURE REGISTE � Y f N FEE CURRE� Y/N
Address l�+ � � License#
EL CI �pq►�y �/
SIGNATURE REGISTE Eo �.F[-et�en Y/N
Addres Lice se#
�� / PLUMBER �Ci �/ � COMPANY �����'
/�.,(�jpr-- I� SIGNATURE w REGISTERED YI N FEECURREf�' Y(N
d•t_I`���,.
,�JG���, � Address License#
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�3��� MECHANICAL COMPANY �, ��G'�
��r SIGNATURE REGISTERED Y/ N EE CURRE� Y/N
O Address License# � V/Q�
OTHER COMPANY
SIGNATURE REGISTERED Y! N FEE CURREN Y/N
Address License#
1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
RESIDENTIAL Atlach(2)Plot Pians;(2)sets of Buiiding Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submiltal dale. Required onsite,Construction Plans.Slormwaler Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)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 dale. Required onsite,Construclion Plans,Slormwaler Plans w/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
i •. If over 52500,a Notice of Commencement is required. (AlC upgrades over$7500)
Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized lelter from owner authorizing same
� OVER THE COUNTER PERMITTING (copy of contract required)
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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Sep 1316 09:50a � p.1
Fr m: 09/�3/20'16 10:49 di874 P.DO�
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e�3-�za Cityof Z�phyrhiNs Pelmit Applicatian ����� ;
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aw a.e.wra � p►+oo.c�+r�.a..,.�xry� —
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orm�nNwm QGV�� n. � lf\S Dw+wrPhoroNum $� `fi �7�fD.. . _� '
j Owrw�'tAddras ya��r 1� �Q. �'►�' O.enirPhomNumbw
FaalnlObTNMAoIdaJirn� � t 1� Sl��r� Ov�Phon�Numb► �
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riDAK PROtOS� B �.w[D�R� ADDlAL7 �,: 9KiN Q [� DE►10�SH ,
INSTALL REPAIR
PNGPOBED U� � SFli [� COMM � 07NEFi
nPe or car+srnuct�oH p e�xK p� � C� ar� p
GE9CR�TlONOFWOAK �L�11Ie.� CCV � 4/�� � 'tZ=��VR
eu��a�� t`�o r Il sQF�ru� �o He�� �
[�]BUkI�ING �(j(�.� wuuanoN oF rora�coNSraucTioN r`��C'C�� �'G �
�BI.ECTRN?4i ��l'fy ry�.� �'88tVICE � PR0�.99 ENERGY � VYR.E.C. � �I
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' , NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
� which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
' applicable deed restrictions.
� UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
� contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
i under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
� intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing 5ection at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the"contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor,that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of
� use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
, 90-07, as amended. The undersigned also understands, that such fees, as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release,the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner',I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner'prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT. I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating
, construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
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 actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Weils, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill 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 permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating ,
the conditions of the building permit issued under the attached permit application, for lots less than one(1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with 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 Building Official from thereafter
requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall becoma invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,from the Building Official�for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
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.
FLORIDA JURAT(F.S.117.03)� °
OWNER OR AGENT (�J—f CONTRACTOR
�ub bed n sworn to(or affirmed)before me thi Subscribed and sworn to(or affirmed)before me this
a�1,v`'��r����--Cs'�L _ by
�ho is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
r�. (�1� as identification. as identificalion.
�� l� Notary Public Notary Public
Commission No._���'i�O�J� Commission No.
`GP1\�C� T��L�
Name of Notary type� ,printed or stamped
,��ti�yp�.,,�� KAITLEE TATE
•� � Notary PuDlic-State of Florid'
• •s Corn�nlsslon/FF�80038
���s My Comm.E�plrK AOr 7.2020
�� Bondtd thtouq�li�No�l Mou►y Mm.
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� City of Zephyrhills ��
; BUII,I�IIVG PL�T REVIEW COMMENT� „ �•'��'
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Conty-actor/Homeowner: �" � �y( `
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Date Received: �
Site: . J����� �`� j�I'C%`�
Peimit Type: �[�/�Q�� � �����lY�„ �D 1�l�
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: O
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This comment sheet shall kept with the permit ancilor plans. r
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Kalvin Switzer s Examiner Date Contractor andlor Homeowner
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�Zequired when comixients aze present)