HomeMy WebLinkAbout16-17775 CITY OF ZEPHYRHILLS
' '" 5335-8TH STREET
(813)780-0020 17775
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17775 Address: 37355 DERBYSHIRE DR
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: WEDGEWOOD MANOR
E�t. Value: Parcel Number: 10-26-21-0120-00000-0900
Improv. Cost: 4,870.00 OWNER INFORMATION
Dat� Issued: 9/27/2016 Name: GILJAM, JANET
To��al Fees: 60.00 Address: 37355 DERBYSHIRE DR
Amo�nt Paid: 60.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/28/2016 Phone:
Wokk Desc: A/C CHANGE OUT 3 TON
CONTRACTOR S APPLICATION FEES
BAHR'S PROPANE GAS &A/C, INC. A/C CHANGEOUT 60.00
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� Ins ections Re uired
DUCTS INS�TALLED
DUCTS INS�ULATED
FINAL I
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local g vernment 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 ound 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.
"Warn'ing to owner: Your failure to record a notice of commencement may result in your paying twice for
impro ements to your property. If you intend to obtain financing,consult with your lender or an attorney
. before recording your notice of commencement." ,
Comple e 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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C� TRACTOR SI NATURE 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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��J s : : � f PROPANE C.�AS Service Grder Pro asal �����
AND Af C ttvc. Air Conditioning&Heating
�Si�� 1988 813-782�5�U i 3
' � � WdRK ORDER#lSERVICEMAN � 7�1544 SE�'
�a{es, S�rvice & instailations • -pqTEfTiME TAKEhI r�9l�6�16 �8e�3
444� Allen Rd.;� Zephyrhifls, FL 33541 zAt�EN BY kI� ��
NOTE,S: U�� �(�'� �1 ��� �ATEITTh1E PROMISED @�3l�5/1E, ��:�+�
. CUBTOMER#lL.00ATIt�IV �7448
` � -PHONE# 813-459--1'9��
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, �CONTACT . R�STCARD
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GILJAM� JAIVET GILJAM, JANET �
3?3�� DERBYSF4TRE DR 37�55 DERgYSHIRE DR
WE�GEWOQD
ZEP YRHILL.S FL 3��40 - ZEF�HYRHILLS FL�3540
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REFfttGERF.IN;;R-•' LBS:-"�, _ -.';$,perab`s: - - �.
� FIL7ERS x x Changed Mo�thly t
, ' ^ . FIL7ERS x x Changed Monthly � .
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0 REGULAR ❑WARRANTY • TOTAL SUAitMr4RY
-�Dek�ui�idi��;Se`Etings�.�When here" I+1", When Away �Q��° , T Sfat 8Q°. D MAINTENANCE CON7RACT SERVICE �
LtMiTED WARRANTY: Ali materiais,parts and equipment are warraated by the manufacturers� ' CALL � �
' M�7�it3A�O�flAYhiiENT'�
or suppliers'wriBen warranty oniy.AII{abor performed by the above named company is warranted for � -
30 days or as otherwise indicated in wrifing.The above named company makes no other warranties, 0�CASH ,0 CK# � TQrAL t
express or impiied,and its agents or iechnicians are not aut6orized to make any such warcanties on MATERfALS �
behaif of above named company. ._,_-. : ❑DEBIT C�l CREDIT ❑OTHER {
!have aufhority to order the work ou!lineq abuve which has been sat;sfactaity compieked.i agree that Seiler ' ' �a�NTE�ANCE
PROG. W i C �
retains titla to equlpmenUmateriais fumished undl final payment is msde.it payment is not mada as agreed. G(,J��M�. ____�
setler can remova said equipmenUmateriats at Seiler's expanse.Any darriage resuitlng Gom said removal shail
�ot be ihe responsibiliry oi Sellet NET 30 9AYS.A 7 1/2�e 5ERV�CE CHARGE�WIIL BE ADDED MONTHLY TO �
ALLUNPAIOBAtANCESOVER30DAYS.NOREFUNDS DATE C4MPLETEC3!_ ,,�,�jy��"�{
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CUSTOMER S�GNqTURE (�/J�,,,,,,,,j t , L
DATE VJ���GI/�'U.) �� I
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\ s��- saoozo City of Zephyrhills Permit Application � Fax-813-780-0021
- Building Department .
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Date Receive , � phone Contact for Permitting - �/ �v2 — ��d`� �
t r. �. • n d
Owner's Na e v�/��% Owner Phone Number , ���'"' / !" ���
Owner's.�►d ress 373� � S //e C�i � Owner Phone Mumber
Fee Simple itleholder Name Owner Phone Idumber
Fee Slmple Titleholder Address
JOBADDRESS �/���,1 S� f°'�i dd1e� LOT# �
SUBDIVISIQIPI � PARCELID# �� � �/ db DD.� ��
I � • (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PR�POSED . NEW CONSTR ADD/ALT 0 SIGN Q Q DEMOLISH
, B INSTALL REPAIR
PROP.OSE USE Q SFR Q COMM Q OTHER
TYPE`OF ONSTRUCTION - Q BLOCK - Q FRAME 0. $TEEL . Q
DESCRIP710Id'OF WORK M1 �/� l�17A/�I �OL.P�� oc L�d7�'1 D�'l�/��s, � TD/1I
BUILDINGISIZE SQ FOOTAGE� HEIGHT
Q UILDING $ � VALUATION-OF"TOTAL CONSTRUCTION
ELECTRICAL , $ AMP SERVICE �Q PROGRESS ENERGY Q W.R.E.C.
PLUMBING $
I MECHANICAL $ ��� , _\ VALUATION OF MECHANICAL INSTALLATION
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GAS Q ROOFING Q SPECIi4LTY 0 OTHER
FINISH FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO -
�BUILD COMPANY
SIGRIA URE REGISTERED Y/'N FEE CURRE� Y/N
A dress License#
ELECT.ICIAN � COMPAPIY
• SIGN�► URE �� REGISTERED Y/ N FEE CURRE� Y/N
A d�ess Cicense# �
.. PL:UM ER. COMPANY� � ' •
SIGN�TURE -REGISTERED� Y-/ N FEE GURRE� Y/N
�dress License#
',. MEC ANICAL�� ,+7����� � � COMPANY �9-�R�S � � '¢�-��
'�SIGN TURE' G^-�/�" " REGISTERED Y/ N F.EE CURRE�, Y/N
aa�es��� t/��/i�-`1�e�il �, �—�-1/l�5, " �icense# C/�1�0��� �
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OTH R= '• � COMPAMY �
SIGN� TURE"a •� " REGISTERED Y/ N FEE CURRE� Y/.N
Pddress�.>; ' •s' � • • ' License#
�� RES DENTIAL`,;;` Attacti°(2),PIof�Plans;:(2):sets of�B'uildirig'Plans,�_(1'-)`set'of Energy Forms;�R-O-W P.ermit,for new�construction, ,
- � -�, . _�.r�:��Minimum�tens,(;10)working;days-after_sutimittal�date. Required onsite;Constniction Plans,Stormwater Plans w/'Silt Fence installed,
�-• �� � � Sanitary1Facilities:&�;1.,dumpsteg;Site;Work-Permitfor;sutidivisions/large.p�ojects '
�. ;CO MERCIAL Attacfi''(2)'complefe`sets of'Builcling Plans plus a Life Safety Page;(1)�set.of Energy Forms.R-O-W Permit for new construction. -
- �_- -- Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence.installed,
�. Sanitary Facflitfes&1 dumpster,Site Work Permit foi�all'new projects.All commercial requirements must meet compliance
�-SIG,I PERMIT Attach(2)sets of;Engineergd Rlans:�° : � -
**'*PROPERTY SURVEY requlred for_aII.,NEW..construction.
"Directions: ,;�--,.--_;-_. . , . , .
' Fill out applicalion completely.
Ovimer&ConVactor sign back of application,notarized
If over$2500,a Notice of Commencement is required. ,(A/C upgrades over$7500)
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"' Agent(for`the contractor.)orPower"of Attomey(for'tFie ov(mer)would be someone with notarized letter from owner authorizing same
..'OV RTHE COUNTER,PERMI.T,TING-.- .(copy.of-contract-required). .
�Re oofs if"shingles Sewers - -- Servicg Upgrades.A/C"�� �Fences(PIoUSurvey/Footage)
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Driveways-Not over Counter if on'public'�oadways..needs ROW
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IdOtICE OF DEED FtE�TRlCTlQ�IS: The undersigned understands-that..this;peemit may be subject,to°deed"res#ric#ions";��,
which=rriay:be more:restr:icti�e:than.Coun#y�regulatians. The:undersigned�assume`s"responsibility'f.or�cornpliance'with 'any"�°"
appiicable deed restrictions. �. - ' � ::"�.;=� ' ':`�:�=_,�`'
UNLiCENSED:G�NTRAGT4,RS AND CONTRACTOR RESPQNSI�ICiTiES: tf tfie-owner�iias�iaired°a�contractar or
corttractors to undertake wark,'#hey.may be.requir.ed tp be=licensed in accardance with state and:local,regulations,�`_Ifi_#iie-�-�° �
-�: .�.....:,_,_. .
contcactor is nofi:licensed-as r.equired by law, botti"the ovirner-and:cotatcactcir<rii'ay;�be�cited�for;;a misdemeanor violat�on_ �
under state law. If the owner or intended.contractor are uncerkain as to what.licensing requirements:may:apply fo.r.;tfie-=»'�
�, -- ,r,.,. ,
intended�work,�they are advised to con#act�'the Pasco County Buildfng`Inspection Division-l.icensing Section at 727=847�
8009. �Furthermare, if fhe owner has hired a"contractor or cantracfors, he is advised to;'have the contractor(s.). sign �, =
portions af the "cantractar Blacic" of this application for which.they�wiH.be cespansibie: =ifyouu,.as�`,th�-owner"sigrr as:tiie--'" ,
contractor, tha# may be an indication that he is not properiy ticensed'artd'is not�entitleti to perrriitting priviieges,i,n.,Pasco
County. . , _.,,., �>_;..,.... .
TRAPISPORT�ITION IMPACT/UTILITIES IMPACT APlD�EtESOURGE RECOVERY FEES: The"undersigned undecstands �
that Transportation lmpact Fees and Recourse Recovery Fees rrmay�apply'to the construction of;new buildings, change`�of� �' �
use in existing buildings, or expansion:of.existing buiidings, as specified in Pasco County Ordinance number 89�07 and �3
90-07, as amended. The undersigned a(so understands, that such�fees, as inay:b.e due, wili;6e identified�at�tiie';time'�of����'� '�;
perm�tting. �It is further understood that i'ransportatian lmpact Fees and Resouree4�Recavery Fees must be paid priar ta '
receiuing a "certificate of occupancy" or ftnal:power release. If the project does not inVolve a ceitificate of occupancy�or:�'. �� �`
final power release, the fees must be paid prior to permit.issuance. Furkfiermare,,if.Pasco Cou�ty WaterlSewec_�l�pact:�;�� ^
fees are due, they must be.paid prior to-permit issuance in accordance with applicable Pasco.Caunty ordinances. � �
Ct3NSTRUCTiON Lt'EN LA1N(Ciiap�er 713; Florida Statutes, as arnended): ff valuation of wark is$2,500.00-;or more,•.I.,.,.�•
.�._..
ce�tify that i, fhe applicant, have been provided with a capy. of the °Florida Constructian_�Lien. ,Law='Homeowner's
Pratection Guide" prepared by tfie-Flarida Department a#AgricuEture and Consumer:�Aftairs. If the applicanf�is.someone,
other than the°owner", I certify that.l �ave obtair�ed a copy of the above desc�ibed iiacument and pramise-in gaod.#aitli_#o''
deliver it.to the.°owne�'�prior.ta cammencement. ' '
CONTRACTOR'S/OWNER'S AFFIDAVIT;�I.certify that all the information in this application is accurate and that al!work
will be done in camp(iance wi#h alt applicable laws regulating construction, zoning and land-develapment. Application.is
hereby made to obtain a :permit�..to da work and installation as �indicated. I certify that no`wark or insfa(lation�-has
corr�menced prior to issuance of a permit and that all work wil( be perfarmed .ta meet standar.ds of ail iaws regulating
construction, County and City codes, zoning regulations, and land development regulatidns iri the jurisdic#ion: 1�a1sa
certify that ! understand that the regulations of other government agencies may apply ta the intended work, and that it is
my responsibility to identify what actians I must take to be in compliance. Such agencies include-but are not.limited>to:
- Department of Environmental Protectiori=Cypress Bayheads, Wetland Areas and Environmen#ally Sensi#ive
Lands,WaterNVastewater Treatment. �
- Southwest Flarida Water Management District:Welis, Cyplress �ayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-SeawaUs, Docks, Navigable Waterways.
- Department of Health & Rehabilitatixe Senrices/Enviranmental .Health Unit Wells,,.Waste�nrater Treatment;
Septic.Tari{is. -
- US Enviranmentai Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
!unclerstand tttaf tlie following resfrictions appfy to the use of flill:
- Use of fi!!is not allawed in Flood Zone"V"unless expressly permitted.
- If the fill material is-to be used in Flaod Zane "A", it is understood that a drainage plan addressing a
"compensating volume" wiil be submitted at time�of permitting which is prepared by a prafessional engineer -
licensed by the State of Florida.
- If the fi11 mate�ial is to be used in Fload Zane °A" in connectian with a permitted building using stem wail
construction, I certify that�11 will be used only to fill the area v�rEthin the stem walf.
- !f fil! material is� to .be used-in=any area, I certi€y that use of sUch fll! will nat adversely affect adjacent
praperties. If use of.fill is found to adversely affeot adjacent properties, th� owner may be cited for viola#ing
the conditions of ttie�building permif issued under the attached permit application, for lots less than one (1)�
acre which�are e(evated by fi(I, an engineered drainage plan is required.
If!am the AGENT F4R THE QWNER,�I��promise in good faith ta in#arm the owner of the petmitting condi#ions set forth in
this a#fidavit prior to commencing construction. 1 understand that a separate permit.may be required far efectrical work,
plumbing, signs, wells, pools, air conditioningt gas,.or��other instaUations nat specifically included in the apptication. A
permit issued shall be construed to be a license ta:proceed'with the work and�not as authority to�violate,-cancel, alter, or �
set aside any provisions of�tFie technical codes, nor shall issuance of a permit prevent the Building Qffiaial f�am thereafter
requiring a correction of errors in.plans;construction or violatians of any codes. �very�permit issued shall become invalid '
unless the work autharizeci by such permit is commenced within six montits of permit issuance, or if work autharized by
the permit is suspended.or abandonedfor a period-.of s�x(6}montfis after the time the work is`'commenced. An extensian `
may be requested, in:writing, from tlie Builcling-Official for a,period not to exceed-ninety{9Q) days and will derrtonstrate
justifiable cause for the extension. If work ceases for ninety(9qj consecutive days,the job is considered abandoned.
WARNtNG TO OWNER: YOUR FAtLUR�TO REGO„RD�A NOTICE CiF COMMENCEMENT MAY RESULT tN YOUR
PAYfNG TWICE F4R.IMPROVEMENTS;TC.�}Y4UR:.!?Rt�PERTY.:;lE YC1U.:.INTEND~TO�BTA1N FINANCiNG;Ct3NSULT
WlTH YClUR LENDER OR AN ATTORN �EFbRE:REGORDING YOUR Nt�TtGE OF`COMMENCEMENT:
-FI_QRlpA JUR�4T IF.S.-1 -..0 1_ ._ ___- __ _ :�i - - . - - - ---_ - . - - --_ __�. �
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OWNER OR AGENT �-�'�ONTRACTQlt �''C../�"'
Subscribed and swom to affirtned)before e Is Subscribed and sw or affirmed)before me thls
by y
Who islare persona8y k wn to me ar has/have produced Y� Who!s/ar ersonalt to me or t►asthave produced
as identlflcation. ,a�._ as IdenUficatlon.
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Natary Pubtic �-�... � ���' Tlotary Public
Commission No. Co ssion fV .
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�o�tt,P.iiYB���
Name of Notary typed,printed or stamped Name of Natary�r�d 'd(c'�rah�FF 150422
�-� _' Expires December 12,2018
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