HomeMy WebLinkAbout16-17804 I
� CITY OF ZEPHYRHILLS
5335-8TH STREET _/�
(813)780-0020 7804
� '' BUILDING PERMIT �
PERMIT INFORMATION LOCATION INFORMATION
Permit f�umber: 17804 Address: 5138 20TH ST
Perrrpit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Squa�re Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12-26-21-0000-02800-0000
Improv. Cost: 20,000.00 OWNER INFORMATION
Date�Issued: 10/04/2016 Name: PRICHER JERALD
To al Fees: 322.50 Address: 5138 20TH ST
Amo nt Paid: 322.50 ZEPHYRHILLS, FL. 33542
Date Paid: 10/04/2016 Phone: (813)788-2547
Wo,rk Desc: ROOM ADDITION 17 X19 7 SCRN RM 12 X 14
CONTRACTO.R S APPLICATION FEES
HOMEOWNER BUILDING FEE 202.50
HOMEOWNER ELECTRICAL FEE 60.00
HOMEOWNER MECHANICAL FEE 60.00
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Ins ections Re ui ed
FOOTER I 2ND ROUGH PLUMB MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
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ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROU�H PLUMB PRE-METER INSULATION WALL MISC.
DUCTS I�STALLED WATER MISC DRIVEWAY
PRE-SLA 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 �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 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 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 performed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
� NO OCCUPANCY BEFORE C.O.
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v•'� CONTRACTOR 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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C1�O�ZepllyI'�11�iS
BUILDING PLAN REVIEW C011jIlV1ENTS
Contractor/Homeowner: ,T�/Q,�,C../� /��/G�/�2
Date Rec�ived: � �aa- / ��P
site: �/?a�" o?D�fh �,S't. ,�E/�,N�//-'/�/�L,.S
Permit Type: /eDO�YI A���/T/(�I�/ � SG2E-� �OQti1.
Approved w/no comments� Appxoved wtthe below comrnents: � Denied w/the below comments: ❑
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This eomment sheet shall be kept with the permit andlor plans.
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Kalvin Sv,ritze ans Exarniner Date Cantractor andfor Homeawner
(Required when cornments are present)
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8 3-780-0020 , � City of Zephyrhilis Permit Application , , Fax 813-780-0021
�' ` Buflding Department ,
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Date Recei�ed -- /��/��" Q _ -023� - -
Phone Contact for Permitting -/ ' ��'��o " y'�
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Owner's N I me �E' c�� �'l�C P Owner Phone Number ��3-��8-�S`��
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Owner's Address �� CJ Ol.� /tt I�s f� 33 Ka-- Owner Phone Number
Fee Simple Titleholder Name � � Owner Phone Number
I Fee SimplO Titleholder Address
JOB ADD�ESS c5 � � oZ��� oS� �t d�f� �. 33 � LOT# �
, SUBDIVIS ON PARCEL ID# �'�-��"'Z�� OI� '� Qa�v�" ��� d
(OBTAINED FROM PROPERIY TAX NOTICE)
WORK P OPOSED e , NEW CONSTR e ADD/ALT � SIGN 0 0 DEMOLISH
INSTALL REPAIR
PROPOS ID USE Q SFR Q COMM 0 OTHER
TYPE OF GONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIP ION OF WORK � O�U/ /t� � SC �JD/✓L
cr�rti /L�,y— ///�
BUILDINO SIZE {�• ��1�1�i 1.2 N SQ FSOOTAGE 7 % � HEIGHT
�IT'rrIT�ET1�TrITT1�T1�r1�T�TT�rITTIT��T�TT1�1�1�7�T�i�1�P'1'TT�TT�1"
� UILDING ;$ Z� DOO, vty VALUATION OF TOTAL CONSTRUCTION '
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Q�E C E C T R I C A L $ , _ A M P S E R V I C E 0 P R O G R E S S E N E R G Y Q W.R.E.C. I
OPLUMBING $ �Nv� I
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
� a �s P�'`�°� f '
� ��a vr� �
GAS Q ROOFING Q SPECIALTY 0 OTHER
FINISHE FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO �����, / ',
C'f.
-F-�-F-� 6-�1-�1-F-1-F-1-�1-H-a-1-�-f-1-f-I--1--1-I--1-F-i-i-f--i-�1-1--f-f-1-1-I--f--F-1--�F-1-F-F-1-�-F-�-I-t--I-f-F-�-f-i-f-{-�1-I--I--1-t- ,
BUILDER� - '� ���S �COMPANY `e � P I / !'iG�P �
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Add�ess � �5 czU�k ��i��� �� J�3�'� License# '
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ELECTRICIAN _ ` + „ � , COMPANY GUh EY' �� �+- `C� �r��„�°r' �
SIGNAT RE �1 REGISTERED Y/ N FEE CURREN Y/N
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Add ess � d v� s�' 2/��V��,5 �L �,3,5 License#
PLUMBE� COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
MECHANICAL �� .v COMPANY /�fJ!'i.Pr � �I P/�l Cn�/�'
SIGNATURE REGISTERED Y/ N FEE CURREN .Y/N
Ad Iress �3 oZ�� /n� `lS � 33sy License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
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RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Min(mum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)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 date. Required onsite,Construction Plans,Stormwater 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.
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Directiops: •
Fill�out application completely. ,
Owner&Contractor sign back of application,notarized
If oiver$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
•" Agent(for the contractor)or Power of Attomey(for the owne�)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Senrice Upgrades A/C Fences(PIot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE C1F DEED RESTRiCT1�NS: The undersigned understands that fhis permit may be subject to"deed"restricfiions"
which may be mare res#rictive than Caunty regulations. The undersigned assumes responsibility for compliance with any
app(icable desd restrictions.
UNL,ICENSED CONTRACTORS AND CONTRACTOR RESPONSIRILITIES: If the owner has hired .a cantractar or
contractars to undertake vuork, they may be required ta be licensed in accardance with stafie and loca! regulatians. !f the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor�iolation
under state law. If the awner ar intended contractor are uncertain as to what licensing requirements may apply for the
Enter�ded work,they are advised to contact the Paseo County BuiEding Inspection Divisian—Licensing Sectian at 727-847-
8009. Furthermare, if #he owner has hired a contractor or contractars, he is advised to have the contractor(s) sign
partions oF the "co�tractor Sioc4c" of this applicatian for which they will be responsible. !t you, as the owner sign as the
contractor, that may be an indication that he is nat properly iicensed and is nat entitied to permi#ting privi[eges in Pasca
County. '
' TRANSPORZATtON IIVIPACT1UTtLtTIES IMPAC'f AND;RESOURGE RECOVERY FEES: The undersigned understands �
� � thak Transportatian Impact Fees and-Recourse Recovery�Fees may appfy to the constructian 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, wiil be identified at the time of
permitting. It is further understood tf�iat Transportation Impact Fees and Resource Recovery Fees must be paid prinr to
receiving a "certificate af accupancy" or final pawer release. lf the project does not involve a certificate of occupancy or
final power reiease, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid prior ta permit issuance in accordance with applicable Pasco County ordinances.
CONSTt�L3CT10N LIEN LAW{Chapfier 7'I3,Ftorida Statutes,as amended}: 1f vaEuation of wark is$2,500.00 ar mare, 1
cerfiify that I, the applicant, have been pravided with a copy of the "Flarida Construction Lien Law—Hameowner's
Pratection Guide" prepared by the Florida Department of Agriculfure and Consumer Affairs. If the applicant is someone
ofher than fhe"owner", i cer�ify that( have obtained.a copy af the above describeti document and promise in gaad faith to
deliver it ta the"owner"prior to commencement.
CONTRACI"OR'SIQV1tNER'S AFFIDAVIT: 1 certify that aSl tha information in this appIication is accurate and that al1 work
will be done in compliance with all applicable laws regulating construction, xoning and land development. App(icafion is
hereby made to obtain a permit to do work and installation as indicated. l cer�ify that no work or installation has
commenced prior to issuance of a permit and that a11 work will be performed to meet standards of all Iaws regulating
construcfion, County and City codes, zoning regulations, .and land development regulations in the jurisdictian. I also
certify that 1 understand that the reguIatians.of other government agencies may apply fa the intended work, and that it is
, my responsibility to iden#ify what actians i must ta{<e to be in compliance. Sueh agencies include but are not(irnited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Was#ewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
ilttatercourses.
- Army Corps of Engineers-Seawalis, Docks, Navigable Waterways.
- �Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treafiment,
Septic Tanks.
- US Environmental Protection Agency-Asbestas abatement.
- Federal Aviatian Authority-Runways. "
t understand fhat#he foliowing restrictions appiy to the use of fili:
- Use of fill is not allowed in Flood'Zone"V" unless expressly permitted.
- 1f the fll material is to be used in Fload Zone °A", ifi is understood that a drairiage plan addressing a
"compensating volume" will b� submitted at time of permitting which is prepared by a professional engineer
licensed by the State af Florida.
- If the fill material is to be used in Flaod Zone "A" in cannection wifh a permit#ed building using stem wali
construction, I certify that fill will be used only to fill the area within the stem wall.
- if fill material is ta be used in any area, 1 certify that use af such f!! wifi no# adversely aifect adjacent
properties. If use of fill is found to adversely affect adjacent praperties, the awner may be cited for vioiating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are eievated by fiii, an engineered drainage pIan is required. i
If I am the AGEN7 FOR THE OWNER, I pramise in goad faith to inform the owner af the permitting conditions set forth in
this affidavit prior to commencing constructian. 3 understand that a separate permit may be required for e(sctricai work, �
plumbing, signs, wells, pools, air conditioning, gas, or other instailations not specifically included in #he application. A
permit issued sha!! be construed to be a license ta proceed with the work and nofi as authority to violate, cancel, alter, or
set aside any provisions of the technical cades, nor shail issuance of a permit prevent the Building O�ciai fram thereafter i
requiring a correction af errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unEess 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 periad of six(6) months after the time the wark is commenced. An extension
may be requested, in writing, from the Building Official far a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. tf work ceases far ninety{90}consecutive cfays,the job is car�sidered abarrdaned.
WARNiNG TO OWNER: YOUR FAILURE TO RECORD A NUTICE OF GOMMENCEMENT MAY RESULT !N YOUR �
PAYiNG TW(CE FOR tMPROVEMENTS TO YOUR PROPERTY. tF YOU iNTEND TO'OBTAIN FINANCING,CONSULT
WI`TH YOUR LENDER OR AN ATTQRNEY BEFORE RECORDWG YOUR NOTICE OF COMMENCEMENT.
FLt7RIDA JURAT{F.S.1'17.03}
OWNER Ot2 AGEN7 `r'�� CONTRACTOR //T `�
S scribed and swo �a„{or affirrned} ore m(this S�{bscribed and s �p.{or�a.�ffirtmed)b re me this
-23-t by ...1��!'ci(d �}�� c 4t e ,r"" �/'a�—t(o by J g�.�---�t�tP cr'
Who is/are personally known o me ar has/heve produced is/are personally know to me or has/have produced
��c�e e@,� �l�+J e�5 ���Stlentification. � o f t aQ a- r�U e.1"5 ���S L' as ldentification.
� f;���j,Z7i�'�Nofary Public �,����.�`f�' _�1'��'��)!�"t�? Notary Public
Commissian No. ��� � �� Commission No. (/ `/ rr o `�,3 (�� �
Name of Notary typed,printed or stamped Name af Notary typed,printed or stamped
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09/23/2016 E. M. , Dpty Clerk
PRULH 5 0'NEIL,Ph D PRSCO CLERK & COMPTROLLEk
NOTICEOFCOMMENCEIV�NT 09oR3BK ig43�m P� 210�
Permit No.
Propaty IdeMifieetlon No. ��,('oZ�o"o�( -�DD�'D a g�O '��p p
1HE UNDERSIGNED hereby give infomu yau tMet the improvemeot wlll6e made Lo e�rain real PrcpeRy,eed 3n euordmee with
See6oa T13,13 of the Fiorida Statrrtes,the following mformatlon is provlded in d�ii NOTTCE OF COM1III,+NCEMENT.
1.Desaiptioa ofproperty([egaldasd�rrvn: 1;1',ZL-:1 I-b000- O�.Sroo-000fl '
e)scs�enaa�s: �i i�S? �n�-* s+. z�ah ,�h, Cq c_ ��zS - :LLS
2.aenetal desctiption of imp�vemenb:
Y'DOm Q1��.,�{-lppl uJ CrGGn fooM
3,Owna Info�ma$on
a)Neme�daddress��fQi�� ��C�IGr rJ I38 ad�' ��'; Zr,�h�r6���, F�L 33S'��5218
b)Name ahd eddress of fee s�mple dtleholder(if othei thaa oxmer)
e)Inhc+eat ia P�P�Y
4.ContrectbrlafometiDu .
a)Neme�d address:, Du�n P►�
b)Telephona No.: Fex No.(Opt.)
S.SuretyInformedon � .
a)2Tema eed edd�ess:
b)Amowit ofBond:
c)Tolephono No.: • ' F.ex No.(Qyt)
6.Lender
e)Nema�d ed�ess:
• Phone No.
7.IdenUty of.peison within the Smte of Florida deslgnated by owac upon whom notiees oF othv doc�eats may be eerved;
a)Name ead addca+s: �
b)Talephoae No.: ' F�c No.(Opt)
8.In addidon m himsel�owner designates t5e followririg pereon to�ecoiye e eopy of the Lieanr's Noflce av�provided in Section
713.13(I)(b�,Florida Smmtd:
e)Neme end addross '
b)Telephone No.: �• ' .Fax No.(Opt)
9.Facpl�adon dete of Notice of Commencemerit(the expiwtioa date 1�one year frba}the date of recordfng un2ess a dif£etmt date ts
specl5ad):
WARNING'I'O OR'NER ANY PAYMEIV'CS 1SlADS BY TH$OV�NBR AFTEIt T��+]CPIItAT[ON OF THE NOTICE OF
COMMENCEMEIVT ARB CONSID�D A1iP'ItOPER PAYbI1�N'I5 UNDER CBA�TER 713,PART 1,SECTION 713.13, �
FI:ORIDA STATUITZ3;AND CAIQ R$SULT ai YOUR PAYING TWICE FOR DY�ROVxMEN[S TO Y01Jlt�ROPER'1`Y.
A NOTICE OF CU114VIL+NCEMSNT MUST BB RECORDED AIVD POSTEb ON THE JOB SITE BEFORE TEiE PTRST
INSPECTION. II{1fOU IIV'PEND TO OBTAIN FIIVAiQCII�1G,CONSOLT YOilk LENDER OR AN ATTORNEY HEFORE
COMiHENCIIVG WORK OR RECORDINQ YOUR NOTICE OF COMMENCEMENT. .
SfATE OF FLORIDA �
COUIYIY OF PrLSCO /�
' � l�ea¢ce of Owsv ot �Authortmd 0ffica/Directv/Pamv/Mmegar
,Tern.ld_ �r��He�
Pdot Nume
The foregoing ias�ument was aelmowledged befaas me this a3 dey of�'� . .20�by �+�-� C:VI,f'�
ea i vqse l F (type ofeathority,ag.officeq 6ustee,aGomey
ia fact)for (mme af party on behetf of whom ioah�aae�wus euevOed). ,
Pe�sonally Knowa_OR Produced IdendScerion ✓ Not�y Si�efure `�� �r �� �
TypeofIdeatificationProduced�or��e����VC�S �IedV�,rCName(print) ��-►'1�-1 , _ �f�b ��
Varificadon pursuent to Section 92525,Flodde Stah�tca.Under penellfes of perjwy,I decl�e that I heve mad the forogoing aad thet
the facta stated in it aze ttue W the best of my Imowledge end belie£
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��''� ' �, ' ' ��P� S�TATE OF FLORIDA,COUtdTY OF PASCO
��`; G THIS IS TO CERTtFY THAT THE FOREGOING IS A
,_ � _ � d TRUE AND CORRECT COPY OF THE DOCUMENT
� Q� : � ; � N FILE OR OF PUBLIC RECORD IN THIS OFFICE
InC�ud'LYe?'�e�st ITNESS Y HANDAND O FICIALSEALTHIS
� . . � •
y� DAY OF 2
i °-- PAULA S O'NEIL, K& �VI TROLL R
� 188y •�
d'������e���. gY EPUTY CLERK
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Frotri: O9l�8l20�5, 10:49 #aY4 P.001
Dx$CLOSIIItg STATBi�NT FOR QWN�R
GITY OP ZSPBYRIiTLLB SUILDS�TQ DBPAR'17JEN'P
�. \.J�/`c2� l/-r'c�� h�►�" ma�ve �ead r�a.d �ullY usac3ertsa8 saad
agree to the provieioaa of �his iastzument.
Tha uadersigaed s�a�es an@ r►�firms that he ar ehe ia desiroua of coastructia�, i
ren atiag, addiag to or reroofiag hia c�r her awa domicile, that he ar she
ac� lly ocau�ies, or aili occupy by said domi�iie, and �ame ie ao� for
rea , iea+�e or sale. �'hat he or she �hall comply with the followiag conditious:
1. That the awaer aad he oz she alone shall act as the builder for all phaee� o� '
eanstructian.
2. Tha� the owaer wiil cea►�r2y with a1S provisions a�E the City of Zephyrhiils
ord�..aance� aad codes pe�t3aesa,b to the buildiag.
3. fihat in fi:he aveat var3oue phases af aaastructiazt are avbeaatracted. he ari1Z
engage oa7.�r pxcmesly liceasQd subcan�racbore and will pereaaalxy eulaervise
such �vork.
4. That 3n the eveat the Hui2diug Iaeg�c�or eha12 reguire ecrxeotiaas �o ba ma8e,
the owaer wi11 aesvme full reopon�ibility to iaeure they axe made, aud u,pon
campletiou wiZZ caZ2 £or a re3nspect3on before groceadiag arith Che build3ag.
5. That the owaer sha11 ae�ume �'ull respaaaibility for the coastructioa and wili
aot expeat superviaioss of hi� worlc fram the City o� Zephyrhills Sui],ding
i D�:xt�rzSLr.
6. That psior to �inal iaapectiou any addi�iona2 �e+zs, 3,acluding reiuepec�i.oa
fee�, must be paid ia �'u3.1. d�i orrittext zequest irosn t3s3.s aff3ce shall
coastitu�e aa ogficiai aotice to pay additioaal �ees.
T. That the awnes s�ii co�ly w3th aJ.l CSty, State aad Pederal lavra ist regard to
soeia3 security, warkmanrs compensation, liea lawa, etc., v�i�are apgZ3.eab2�.
8. That the o�cnaer shall comply with a11 the ea�ety codea� iseued by the Fiorida �
���us��ial Car�s#ss3.aa, .
9. Sta�e law requfres coa��ruct�,oa ta be daae by ii�eased can�raatara. Stou izave �
applied fcir a germit under aa cxemption to that law. The exempGioa aliow�a '
yon, as the awtter of yaur proper�y, to act aa your oxn eon�ractor with oextaia
restrictiana evea though you do ao� have a l�.cenee. You raust provide direct
cnsite supervieian cf t�he coastseictioa youseeif. You may build or improve a
, oae-�amily or �wa-family reaidence ar a farm autbuildi,ag. Yon may alaa build
ar i�mprove a commercial buildiag. Prvvi$e� �rv�� �c,se� w� a�� �cae3 $7�.OS?d.
The buiidiag Ox re�ideaCe atust be for your owa uee or accupanay. _� may aot
be l�uilt or aube�a�tisily 3m�xoved �or sale or lease. I� ycu se�.I ar iease a
building you b�ve built or aubetaa�ially improved yoursel� withia 1 year after
the ecast�sction is e�lete. the iavr will presume that you built cr
aub��m�tially �t.mproved 3.� €os eaZe �s �.�sa��, whi+�h ia a vic�latiaa of thie
exemption. Ycu may aot hire aa ualieea�ed persou tc aat as yQur aflatraa�or or
to eu�pervi�e peogla workiag aa your bu3lding. �b ie yaur respoasabi�3.ty to
make eure tha� people employad by you have licans�ea requised by state law and
by eauaty or muu3eipa2 lieenaing ordinaace�. Yase may aat 8elegate the
respoueib:Llity for �supesvisia+g work to a lic�ased coa�ractor wha is r�at �
liaexiaed �o gexfarm the �+ark beiag daae. Aay pexean workirng oa yous buildfag
aha ie aot 7.3,cenaed �nus� work uadex your direct +�upervisio�a aad must be
�lo�red b�r you. �chich meaas that you arust deduct F.I.C.P,. aad withholding taae
and provide workers' ee�peasa�.ion £or that emplayee, a17. �� ps�sesibed by laa.
xour aonetruct3oa must compiy with all applicable lawe, ord3nances, buildiag �
- . aodeee, and zoni.ag r�guiatioag. '
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FORiVIS -
FLORIDA BUILDING CODE,ENERGY CONSERVATION
FORM 4�2-20t0 Resldenttal Building Thermal Envelope Approach ALL CLIMATE ZONES
Scope:Compiiance with Section 4d2 af the Florida B�ilding Code,fnergy Conservation,sha0 be demonstraied by the use oi Porm 402 for single-and muitipte-famity residences of threa
stories or less tn height,addit(ons to exisUng resfdential buildings,renovations to existing residentfal buildings,new heating cooling antl water heat(ng systems in existing buildings as i
appUcabie,To comply,a buildfng rnust,meet or exceed all o(th�e`energy etficiency requlrements on Table 402A and all applicable rnandatory requirements summar(zed in 7able 4028 or this
form.lf a buiiding daes nof campEy ivdtt th3s mefhod or Alternate Earm 402,lt may stiH compty uttder Section 40S of the Fforida&uiiding Code,Fnergy Goaservaflan.
PROJECT�IAME: TERR�-D PRrct-h�R BUILDER: (�W yrl g,�^
AND ADII ESS: ,S/"�cg '�'��ti` '�t PEFtM13"1'It�lG j
� Zephyrh�)ts, �'I.335�1� OFFICE: � d '
OWNER: ,�e,��ld Pr�cher PERMIT NO.: (� � JURISDICTION NO.:
General Instr�ctlons; �
1.New const ctfon which incorporates any of the following features cannot comply using this method:glass areas in excess of 20 pe�cent ot conditioned floor area,electric resistance
heat and air h�odiers located tn attics.Add321oas_<640 sq.tt.,renovatians and equlpment changeouts may comply Gy thls method with exceptions gIven.
2.FiI1 in atl ih�applicab(e spacas of tha°To Be Enstalled"coiomn on Ta6(e 402A with the information requested.AtI"To Be lnstalled°vatues mus#be equat to or more efEicient than the �
required level.
3.Complete page 1 based on the"To Be Insialled°column iniormation.
4.Read the r�quirements of Tabie 4028 and check each box to indicate your(ntent to compty with ai!applicabie ltems.
5.Read,sign;and date the"Prepared Sy"ce�tification statement at the bottnm of page 1.The awner or ownets agenf mast atso sign and dafe the form.
�
Ptease Prtnt GK
1, New �onstruction,addition,or existing buifding 1. �C�U�f fDY1 '
2. Singt�famify detached or muttiple-famity atfaohed 2, .S 1n��C�
3. If mu tiple-family-Na,of units covered by this submission 3. - -
4, ts thfs! a wors#case?(yes/no} � f(jD
5. Conc�itioned floor area(sq.ft.) 5. 3(p(
6. Glass type arid area:
a.U-factor g�, .�D '3�
6.SHGC 6b. ••3Q ,
c.Giass area 6c. �sq.ft.
7. Perc ntage of gtass to ftoor area
7. f.fJ.J'� %
8. Floo type,erea or perimeter,and insulation: • �� .
a.Siab-on-grade{R-value} 8a,R=_� �'t im.ft.
b.Wood,raised(R-value) 8b �� Sa rt�
c.Wood,common{R-value) gc,R= sq.ft -
d.Cancrete,raised(R valae) 8c�,�= sq,ft.
e.Concrete,common(R-value) ge,R= sq.ft.
9. Watl type,area and insu(etlon:
a.Fxtedor. ], Masonry(Insulation R-value)
2. Wood frame(Insulauon R-value) 9a•1. R= sq.ft.
9a-2. R=_.�_ �/87 sq.ft.
b.Adjacent: I. Masonry(Insniation R-vaIno}
2. Waodframe(InsulationR-value) gb-1. R= sq.ft.
9b-2. R= �3 .S�O sq.ft.
10. Cei!ng type,area and insutatian:
a.Underattic(InsulationR-value) 10a.R= sq.ft.
b.Single assembly(Insulation R-value) 10b.R=�__ .3Cnr sq,ft.
i1. Air [sfribution system:Duct insutatian,tocation,Qn
a Duct location,insulation 11 a, R=
b.AHU location �Z b,
c.Qn,Tesi reporCattached(<0.03;yeslno} 12 C.7est CepoCt aft�Ched? Yes F!o
12. Co Ung system:
a,Type 12a.Type: WJ�l'� U/tll T-'
b.Efficiency i26.SEER/EER:
23. He tingsystem: t3a.i' e• /•t,/�"G�- Ul1l/�
YP •
a.Type 13b.HSPFICQPIAFUE:
b.Efficiency
14. HV C sizing calcutation:attached 14, Yes Na
15. Ho�water system: ���
�,�,pe 95a,7ype:
b.Efficiency 15b.EF�
t hetebp ce iiy fhat ihe p and specifications cavered by fie oatcufatian are(n compiiance vriih the Rarida Review of pians and specifitations covered by this caic�taHon(ndfcates compliance with She Florlda
6nergy Co e, Energy Code.Betora oonstruction Is completed,ihi 'g wfli be fnspected for oompliance fn
accordance wllh Section 5} 0 F.S.
PREPARE�BY: u����".L'Y+�C__��� OATE: �a2�'���Q „(
�- CODE OFFICIAt
I hereby certify that th ii ng Is in sompliance h the Florida Energy Code: /,'� �7�t +,,, '
OWNER.A6ENT: G pATE: DATE Ur �
C.4 2010 FLORIDA BUtLDiNG CODE-ENERGY CONSERVATION
� FORMS
TABIE 402A
BUILDING COMPONENT PERFORMANCE CRITEAIA' INSTALLED VALUES:
U-Faclo?c 0.65 U-Facfor= .�S
Wndows(see Note 2): SHGC=0.30
%ofCFA<=20% sH�c= • 3D
5 li hts ' U-Factor<0.75 %ot CFA=
' Doors:Exterior door U-Factor U-Faclor<0.65 U-Faclor= .(p
Floors: Slah-on-grade No requirement R-Value= I'(/�f�
Over unconditioned s aces see Note 3' R-13
Walls—ExL and Adj.(see Note 3):
Frame R-13 • R-Value= (3
Mass (see Note 3)
interior of wail: R-7.8 R-Value=
Exterfor of wall: R-6 R-Vaiue=
Ceilings(see Notes 3&4) R=30 R-Vatue= �� Test teport
ReFlectence 025 Retlectance= Altached7
Yes/No .
Air dstribution system(see Note 4)
Ductwork&air handling unit: �,(f/g�.L
Unconditioned spade Not allowed Location: Test report
Conditfoned space (f/1�/r Attached7
YeslNo
Duct R-value ' R-value 2 6 R-Value=
Air leakage on on 5 0.03 Q�_
Aft conditionin s slems see Nole 5 SEER=13.0 SEER=
HeaUng system
Heat pump(see Note 5) Cooling: SEER=13.0 SEER= ���
Heating: HSPF=7.7 HSPF= UN�r
Gas fumace AFUE 76% AFUE_
Oil fumace AFUE 78% AFUE_
Eleclric resistance:Not allowed(see Nole 5)
Water heating sysiem(storage lype)
Electric(see Note 6): 40 gal:EF=0.92 Gallons= ,y f/�
SOgaI:EF=0.90 EF= ��
Gas flred(see Nole�: 40 gal: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 each of the applicable performance criteria in order to comply with this code using this method;
otherwise Section 405 compliance must be used.
(2)�ndows and doors qualifying as glazed fenestration areas must comply with both the maximum U-Factor and the maximum SHGC(solar Heat Gain Coefficient)criteria
and have a maximum total window area equal to or less than 20%of the conditioned iloor area(CFA);otherwise Section 405 must be used for compliance.
Exception: Additions of 600 square feet(56 m2)or less may have a maximum glass to CFA of 50 percent.
(3)R-values are for insulation material onlyas applied in accordance with manufacturers'installation instructions.For mass walis,the"interiorof wall"requirement musi be
� met except if at least 50%of the R-6 insulation required for the"exterior of wall"is installed exterior of,or integral to,the wall.
(4)Ducts&AHU(nstalled substantially leak free per Section 40322.1.Test by Class 1 BERS rater required.
Exception:Ducts instalied onto an existing air distribution system as pari of an addition or renovation;duct must be R-6 installed per Sec.503.2.7.2.
I (5)For all convenlional units with capacities greaier than 30,000 Btu/hr. For other types of equfpment,see Tables 503.2.3(1-8).
Exception:The prohibition on electric resistance heat does not apply to additions,renovations and new heating systems installed in existing buildings.
(6)For other eleciric storage volumes,minimum EF=0.97-(0.00132 x volume).
(7)For other natural gas storage volumes,minimum EF=0.67-(0.0019 x volume).
TABLE402B MANDATORYRE�UIREMENTS
COMPONENTS SECTION REQUIREMENTS CHECK
To be caulked,gasketed,wealherstripped or otherwfse seaied.Recessed lighting IGreted as meeting ASTM E
Afr leakage 4D2.4 283.Windows and doors=0.30 cfm/sq.ft.Testing or visual inspeclion required.Freplaces:gasketed doors&
outdoor combuslfon eir.
I Ceilingslknee.walls 405.2.1 R-19 space pertni[tfng.
Programmable thermoslat 403.1.1 V✓here forced-air furnace fs primary system,programmable thermostat fs required.
' Air distribution system 4032 Ducls in attics or on roots insulaled to R-8;other ducts R-6.Ducts tesled lo Q,=0.03 by a Ciass 1 BERS rater.
Heat trap requfred for vertical pipe risers.Comply with efficiencies in Table 403.4.3.2.Provide switch or clearly
i Water heaters 403.4 marked circuit hreaker(elecMc)or shutoft(gas).Circulating syslem pipes insulated to=R-2+accessible manual
OFF switch.
Spas and heated poois must have vapor-retardant covers or a liqu(d cover or other means proven to reduce heat
Swimming pooi 8 spas 403.9 loss except if 70%o(heat from sile-recovered energy.Off/timer switch required.Gas heaters minimum thermal
- efficien =78% 82%after 4/16/13.Heat um ooi heaters minimum COP=4.0.
S'ving calculatfon perfortned&attached.Minimum efficiencies per Tabies 5032.3.Equtpment efficiency verification
Cooling/heating equipment 403.6 requlred.Special occasion cooling or heatlng capacity requires separete system or variable capacity system.
Eleclric heat>tOkW must be divided inlo two or more sta es,
Lighting equipment 404.1 At Ieast 50%of pertnanently installed lighting fixtures shail be high-efficacy lamps.
2010 FLORIDA BUILDING CODE—ENERGY CONSERVATION C.5
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Flor da Building Code Online Page 1 of 3
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BCIS Home � Log In � User RegistraUon " Hot Topics : Submit Surcharge i Statr&Fads ; Publicatlons ; FBC Staff ! BCIS Stte Map j Links ��SSearch
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��'"� Application Type Revision
Code Version 2014
Application Status Approved
� *Approved by DBPR.Approvals by DBPR shall be reviewed and retified
by the POC and/or the Commission if necessary.
Comments
Archived 0
Product Manufacturer Atrium Companies Inc.
Address/Phone/Email 300 Welcome Center Blvd.
Welcome,NC 27374
(336)731-9550
tbatten@atriumwindows.com
Authorized Signature Thomas Batten
tbatten@atri umwindows.com
Technical Representative
Address/Phone/Email
Quality Assurance Representative Tommy Smith
Address/Phone/Email 300 Welcome Center Blvd.
Welcome,NC 27374
(336)764-6400
tommy.smith@atrium.com
Category Exterior poors
Subcategory Sliding Exterior poor Assemblies
Compliance Method Certification Mark or Listing
Certification Agency American Architecturel Manufacturers Association
Validated By American Architectural Manufacturers Association
Referenced Standard and Year(of Standard) Standard Year
AAMA/WDMA/CSA SO1/I.S.2/A440 2005
AAMA/WDMA/CSA 101/I.S.2/A440 2008
Equivalence of Product Standards li
Certified By I
Product Approval Method Method 1 Option A
Date Submitted 06/11/2015
Date Validated O6/16/2015
h s://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDqsQFcSK%2fI'r... 9/22/2016
Flo da Building Code Online Page 1 of 3
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BCIS Home ; Log In 1 User Regfstratlon � HotTopics ; Submtt Surcharge � Stats&Fads ; Publications t �FBC Staff � BQS Site Map ; Links ��•Search•'
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;,�;��,,�.��J,;1�:,3;,;y;'a.`'' FL# FL14463-R4
� Application Type Revision
Code Version 2014
Application Status Approved
*Approved by DBPR.Approvals by DBPR shall be reviewed and retified
by the POC and/or the Commission if necessary.
Comments
Archived �
Product Manufacturer JELD-WEN
Address/Phone/Email 3737 Lakeport Blvd
Klamath Falls,OR 97601
(800)535-3936
fbcl@jeld-wen.com
Authorized Signature Kaede McLaughlin
fbci@jeld-wen.com ,
Technical Representative JELD-WEN Corporate Customer Service
Address/Phone/Email 3737 Lakeport Blvd.
Klamath Falls,OR 97601
(800)535-3936
customerserviceagents@jeld-wen.com
Quality Assurence Representative
Address/Phone/Email
Category Windows
Subcategory Double Hung
Compliance Method Certification Mark or Listing
Certification Agency National Accreditation&Management Institute
Validated By National Accreditation&Management Institute
Referenced Standard and Year(of Standard) Standard Year
TAS 201 1994 i
TAS 202 1994
TAS 203 1994
Equivalence of Product Standards ��
Certified By
Product A roval Method Method i O tion A I
PP P
Date Submitted OS/28/2015
https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquiKNpeAsu%... 9/22/2016
Flo 'da Building Code Online - Page 1 of 1
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Bu�ines �`� �
Professi�i'u) Product Approval
�USER:Public User
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Product Aooroval Menu>Produc[or Aoolintion Search>Appli�aUon List
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Search Criteria Refine Search
Code Version 2014 R# 4904
Application Type ALL Product Manufacturer ALL
Category ALL Subcategory ALL
Application Status ALL Complfance Method ALL
Quality Assurance Entity ALL Quality Assurance Entity Contract Expired ALL '
Product Model,Number or Name ALL Product Description ALL
Approved for use in HVHZ ALL Approved for use oukside HVHZ ALL
Impact Resistant ALL Design Pressure ALL
Other ALL
Search Results-Ap lications
FL# Tvoe Manufacturer Validated Bv Status
FL4904- Affirmation Masonite International National Accreditation&Management Approved
R7 Category:Exterlor poors Institute,
Historv Subcategory:Swinging Exterior poor (804)684-5124
Assemblies
"Approved by DBPR.Approvals by DBPR shall be reviewed and ratified by the POC and/or the Commissfon if necessary.
, Sontact Us::1940 North Monroe Street.Taliahassee FL 32399 Phone:650-487-1824 I
The State of Florida is an AA/EEO employer.Convriaht 2007-2013 State of Florida.::Privacv Statement::AccessibilfN Stateme�t::Refund Statement
Under Florida law,email addresses are publit remrds.If you do not want your rmail addrrss released in response to a publlc-retords request,do not send
electron(c mail to this entity.Instead,mntact the office by phone or by traditional mafl.If you have any quesdons,please cantact 850.487.1395.*Pursuant to
Sectfon 455.275(1),Florida Statutes,effective October 1,2012,Ifcensees li�ensed under Chapter 455,F.S.must provfde the Department with an email address tf �
they have one.The emails provtded may be used for official commun(cation with[he Itcensee.However emafl addresses are public record.If you do not wish to
supply a personal address,piease provlde the Department wlth an email address'whtch can be made avaflable to the public To determine if you are a Iicensee under
Chapter 455,F.S.,please cltdc here
Product Appraval Accepts:
����
' xecuri �ste�uca
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http,s://www.floridabuilding.org/pr/pr_app_ lst.aspx 7/3/2015 �
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