HomeMy WebLinkAbout16-17963 _i�
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,il CITY OF ZEPHYRHILLS
. _ � 5335-8TH STREET /- �
, (813)780-0020 �79
j� BUILDING PERMIT
; PERMIT INFORMATION LOCATION INFORMATION -
Permit Number: 17963 Address: 38653 12TH AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class �of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Es•t. Value: Parcel Number: 11-26-21-0010-04000-0075
Impr�v. Cost: 26,200.00 OWNER INFORMATION
Date�ilssued: 12/30/2016 Name: RODER, ANITA
Tot'al Fees: 427.50 Address: 38653 12TH AVE
Amount Paid: 427.50 ZEPHYRHILLS, FL. 33542
Date Paid: 1/18/2017 Phone: (813)838-0721
Wo'rk Desc: CLOSET ADDITION 16 X 8- REROOF ENTIRE HOME
-CONTRACTOR S APPLICATION FEES
RYMANIICONSTRUCTION OF FLORIDA IN BUILDING FEE 195.00
EAST PASCO ELECTRIC, INC ELECTRICAL FEE 60.00
RYMAN� ROOFING INC NEW ROOF 60.00
REROOF RESIDENTIAL 112.50
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� I Ins ections Re uired
FOOTER II 2ND ROUGH PLUMB MISC I SULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
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ROUGH ELECTRIC LINTEL MISC MISC.
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1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
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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
II 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 b�e 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�ning to owner: Your failure to record a notice of commencement may result in your paying twice for
impr�vements to your property. If you intend to obtain financing,consult with your lender or an attorney
�� before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
�� City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
II NO OCCUPANCY BEFORE C.O. ,
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�i ONTRACT 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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City of Zephyrhills
, BUILDING PLAN REVIEW COMMENTS ��l��n e,�.""'!
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Contractor/Homeowner: �- b� y I
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Date Reeeived: _ g,� �'
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Site: ��l��r7.?��Z�"� .�
Permit Type: �Q/" b �4 � �l���3
Approved w/no comments: � Approved w/the below comments: ❑ Denied w/the below comments: ❑
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This comment sheet shall be kept with the permit and/or plans.
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Kalvin Switzer '�1 Examiner Dat Contractor and/or Homeowner
'i (Required when comments are present)
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3/1S/2016 Florida Building Code Online
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Florida Depa�tment�f BCIS Home � Log In � User Registration � Hot Topics � Submit Surcharge � Stats&Facts � Pu6licaUons I FBC Staff I BCIS Sfte Map � Links I ,Search' I
Busine;;s � .�' productApproval
Professi r�al �, � USER:PublicUser
Regulati,,on
Product Aooroval Menu>Product or Aonliwtion Search>Aoolication List>Application Detail
:;o i I�-�,�' >_� �" FL# FL5293-R20
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i;� Application Type Revision i
Code Version 2014
I� Application Status Approved �i
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Comments II
Archived U
Product Manufacturer GAF
Address/Phone/Email 1 Campus Drive
Parisppany, NJ 07054
(973) 872-4421
li ndareith@trinityerd.com
Authorized Signature Beth McSorley
lindareith@trinityerd.co�E��Ew r
CITy �'qTE��`l�
Technical Representative Beth McSorley (current)P�A EF ZEPHYRH�LL / "
� Address/Phone/Email 1 Campus Drive � XAM�NE��S
Parsippany, NJ 07054
(973)872-4421 '
bmcsorley@gaf.com
Quality Assurance Representative
Address/Phone/Email
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Category rtoofing PRF�q�L��9Hp������
Subcategory Single Ply Roof Systems�OlZ�pq BC'Cpp�S LY�j��
�A71pNq�E��D1NG C�QE
Compliance Method Evaluation Reportfrom a �Io���gj��e�.���i4'r�B��o��Licensed
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Florida Professional Engineer <<$Qj��f D
u Evaluation Report- Hardcopy Received NANCES
Florida Engineer or Architect Name who developed Robert Nieminen
the Evaluation Report
Florida License PE-59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 07/17/2016
Validated By ]ohn W. Knezevich, PE
U Validation Checklist- Hardcopy Received
Certificate of Independence FL5293 R20 COI 2015 Ol COI Nieminen.odf
I Referenced Standard and Year(of Standard) Standard Year
ASTM D6878 2008
FM 4470 1992
II FM 4474 2004
�I TAS 114 2011
II Equivalence of Product Standards
�I Certified 8y
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II Sections from the Code
https://www.floridabuilding.org/pr/pr app dtl.aspx?param=wGEVXQwtDquwVcULes7wTHo0xyQc%2bdOL6TJJ1U7sr%2b1E7RXrpWYCZw%3d%3d 1/2
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3/18/2016 �� Florida Building Ca1e Online
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�, Product Approval Method Method 1 Option D �
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Date Submitted 12/16/2015
Date Validated 12/16/2015
Date Pending FBC Approval 12/19/2015
i Date Approved 02/10/2016
Date Revised 02/14/2016
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Summa of Products
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FL# Model,Number or Name Description
5293,1 EverGuard TPO Single-Ply Roof Single-ply, thermoplastic polyolefin roofing systems
;I Membrane Systems
� Limits of Use Installation Instructions
Approved for use in HVHZ: No FL5293 R20 II 2015 12 FINAL A1 ER GAF EG TPO FL5293-
Approved for use outside HVHZ:Yes R20.pdf
Impact Resistant: N/A Verified By: Robert Nieminen PE-59166
Design.Pressure: +N/A/-502.5 Created by IndependentThird Party: Yes
Other: 1.)The design pressure noted in this application Evaluation Reports
relates to one specific assembly in the ER Appendix. Refer to FL5293 R20 AE 2015 12 FINAL ER GAF EG TPO FL5293-
the ER Appendix for all systems and associated max. design R20 .odf
pressures. 2.) Refer to ER Section 5 for Limits of Use Created by Independent Third Party: Yes
Bad< Next
Contact Us:: 1940 North Monroe Street,Tallahassee FL 32399 Phone:550-487-1924
The State of Flarida is an AA/EEO employer.Coovriqht 2007-2013 State of Florida. ::Privaw Statemen[: A¢essibiliN Statement:: Refund Statement
Under Florida law,emall addresses are public recards.If you do not want your e-mail address released(n response to a publlo-records request,do not send eledronic
mall to[his entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.*Pursuant to Section
455.275(1),Florida Statutes,effective October 1,2012,Iicensees 1(censed under Chapter 455,F.S.must provfde[he Department with an email address if they have
one.The emails provfded may be used for official cammunication with the licensee.However email addresses are public recard.If you do not wish to supply a
personal address,please provide the Department wi[h an email address whfch can be made available to the public.To determine if you are a licensee under Chapter
455,F.S.,please dick here.
Product ApprovalAccepts:
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� sa3-�ao-oo2o Ci4y of Zephyrhills Permit Application Fax-813-780-0021
; • Building Department
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Date R�ceivedi . � (7 � Phone Contact for F'ermitting
Owner's Plam II 1 1( a- �U�� Owner Phone Pfumber _ �I 'O✓� ���� /
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Owner'sAddress �(.J•1o5 J IU'� �1"�Q- �� (h(��S OwnerPhone�umber
Fee Simple Til leholder'Name Owner Phone fVumber
Fee Simple Titleholder Address
JOB ADDRESIS �CXO 5� 1� � e- I 1 ��!(�.5 �I 3 35�a �mT� ��
SUBDIVISIOW P�4RCEL ID# 1 ��"`�' �� -b�fb' ��Ud� '����
(OBTAIPdED FROM PROPERTY TAX WOTICE)
WORK PROPOSED e NEW CONSTR B ADD/ALT 0' SIGN Q � Q DEMOLISH
INSTALL �REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE"OF COPJSTRUCTIOiV Q BLOCK • Q FRAME 0 STEEL Q
DESCRIPTIOFd OF WORK �.r � �P��OU� I1.0 S U��- G ���1 O I�CIU�� (,'1�1 T(l)()
BUII:DIY�G SIZE � SQ FOOT�4GE I��O HEIGHY
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BUILDING $ �'1 O/` 0(� VALUATION'OF TOTAL CONSTRUCTION
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QELEC'fRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ ���o�
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OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATIOfV ���� �t,�yu�,
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OGAII Q ROOFING Q SPECIALTY 0 OTHER �
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
BUILDER COMPANY
SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N
i4ddress License#
ELECTRICIAN COMPAPlY
SIGYNi4TURE REGISTERED Y/ N FEE CURRE� Y/N
Addressl License# �
PLUMBER. CONVPAPJY
SIGNATURE REGISTERED Y-/ N FEE CURRE� Y/N
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Address� License#
flfl ECH�4RIICA[_ COiU�PAPfY
SIGRfATURE!� REGISTERED Y/ N FEECURRE� Y/N
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Address� License.#
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RESIDENTIAf_ ; Qttacfi;�,(2j;Plot<Plans;'!(2)=sets of Building�Plans;(1)set of�Energy Forms;R,O-W Permit,for new.construction,
. - ,_ Minimum:ten;.(,10)working.days after'sutimittal=date. Requ(red onsite,Constniction Plans,Stormwater Plans w/Silt Fence installed,
� Sanitary.;.F,.acilitie,s,&��,1�.dumpste.,r,Site�W.ork�Permit for:'sutidi"visions/large projects.
CONiMERC1AL Attach(2)`complete"sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new constn�ction.
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 fo��all new projects.All commercial requirements must meet compliance
SIGR�PERfViI i Attach(2)sets of�.Engineered Flans.�•
****PROPERTY SURVEY required for.all.NEW.construction.
Directions: I� • �� � �
Fill out application completely.
Owner&i�Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
rn •Ir.. :'t i..�,. S' ,. . r „ � �. , • :, .
Agent(foli th"e contracfo�)�or`Powe�'of Attorriey(for:tFi'e owner)would be someone with notarized letter from ownerauthorizing,same
OVER THE COUNTER,PERMITTIPIG: �;;(copy of'aontract•required) � � ' ' ,',
Reroofs if shi ii les Sewers , Service Upgrades;A/C Fences(PIoUSurvey/Footage) , ; , - -_ ,-
Drivewrays-Not over Counterif ore public-�oadways::rieeds ROW
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�I�TIC�OF DEI�D REST�ICTiON�: The undersigned understands:that this,permi#may be subject to"dF�ed"restcictions,,,_..
which.;may.:be.more:cestrictive.than County.cegulations: 'Ttie>>undetsig�ied�-assumes�'�cesponsiiialityrfo��campliance witti;�any� �r`
, apPlicable deed restric#ions. _ ^ _ . ,;:,_. ,� .� :,,_. .
UPILICEftlSEG COIdTRACTalRS s4ND� C47M'!'l2s�►CTOR RESPpNSlBI�ITIES: lf-the ovirner fias tiired��a�-contractar ar
cantractors to undertake work, they may,be re.quired;to be:licensed.in accordance with�state and=local r:e�gulatio�s::�.�lf`.the��� �
contrac#ar is.not (icensed�as requiretl by�1aw, boffi the ovvner�and:cont�actor�m'ay��6e cited��for��a rnis`derneanar violation
i under sfate law. If the owner ar intended�contcactar are uncertain as to what licensing requirements:�ma,y.�,apply for�the,� ��
in#ended.wark, thsy are advised to contact`tne'Pascd Courity Bailding inspection`Division==C.icerising Section.at 727-847-
80Q9. Furthermare, if the owner has fiired��a coritractor or cantractars, he is advised to ;have the crnntractor(s}, sign,;;
pa�tions of the "contractor Black" of this application for vuhich th�y wi!! be r.esponsible, !f you, as�tt'ie'"ow�ner's�gn as#tie
cantractor, that may be an indication that he is not properly licensed and"is nof entitled to permitting privileges in Pasco
j Counfy. . �, :_
TRANSPORTAYIOiV IMFA�'fLUTILiTtE�.iMPACT�►P!D RE�OURCE i2ECOVERY��ES: The undersigned understands
that Transpartation Impact Fe�s and Recourse Recovery�ees may.;appty to the construc#ian of new b.uiltlings, ciiange4of` '�'
use in existing buildings, or expansion.of:existing 6uilclings, as specified in Pasco County Ordinance nunnber 89-07 and
9Q-07, as amended. The undersigned also understands, that such.,fees, as�may.�b.e,dwe, will tie;identifiea� at�;the=time�`of�' "
permitting. It is further under'stood that-Transportation Impact Fees and Resource'�Recovery. Fees must l5e paid priar ta
receiving a "certificate of occupancy" or final,power re(ease. If#he project does not involve a certificate o�f occupancy=or.
finai power release, the fees-must be-paid prior to permit issuance. FurtFiermore, if Pasca County Wateir/Serrver Impaet.
fees are due,they must be paid prior to permit issuance in accardance with applicable Pasca Courtty ordin��nces.
COI�STRUGTION�L1E�! RAl�!(G�iap#er 7��;F1oe��cB�Statu�e�,as am�nc�edj: !f valuatian of work is$2,540.04 or more,-.i
certify that I, the appiicant, have been provided with a capy..of the "Florida Construction Lien Law-Homeawner's
Protectian Guiden prepared by the Florida Department of Agriculture and Consumer:Affairs. If the applic��nt�is someone,
ofher than the"owner", (�certify that I hawe abtained a copy of the above describetl'document-and promise in good�fait{i�to
deEiver.it to the."owner';.prior ta commencement.
Ct?G�TR�►►GTOEt'St0l6�NER'S l�iF�IDA!!t�': I_certify.that ail.the infacma#ion in this appiication is accurate ar�d that ali�work
will be done in carnpliance with all applicabEe'laws regulating constructian, zoning and-land�develapment. Appiication is
hereby made to abtain a permit to da:,wark-and installation as indicated. I certify that no work ar ii�stallation has
commenced prior_to issuance of a permit and�that all work will be pertormed to meet standards of all l�aws regulating
construction, County and City codes, zoning reguiations, and land deve(opment reguiations in�:the jurisdiction. i alsa
certify that t understand that the reguiatians of other government agencies may apply to the intended worF;, and that it is
my responsibility#o identify wk�at actions ! must take to be in comptiance. Such.agencias include but are noi:timited.ta:
- Department of Environmental-Rcotection-Cypress Baylieads;'Wetland Areas and Environmenta!!y Sensitive
Lands,WaterNVastew�ter Treatment.
- Southwest Flarida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Dacks;iVavigabie Vttaterways.
- �epartment.of Heaith � Rehabilitative Services/Environmentai .Heat#h Unit-Welts, iNastewater Treatment,
Septic Tanks.
- US Enviranmental Prateation Agency-Asbestos abatement. � .. . - _....
, - Federal Aviation Authority-Runways. ' �
I understand that�#he follawing restr'rctions apply to the use of�il:
- Use of filE is not allowed in�Flood Zone"V'unless expressly permitted.
- !f the fl! materia! is to be used in Flood �ane "A°, it is understood that a drainage plan addressing a
"compensating volume" wil! be submitted at time of permitting which is prepared by a professianal engirieer
licensed.by the State of Florida.
- 1f the fill material is ta be used in Flood Zone "A" in connection with a permifted building using stem wrall
construction, 1 certify that fiii will be used anly fo fili the area within the stem wall.
- !f fill material is to .be used in any area, 1 certify that use af such�fil! wilf not adversety ai'fect adjacent
propertiss. If use of fill is found ta adversely affect:adjacent pcopert�es, the owner may be cite{� for violating
the conditions of the:building permit_.issued under�the attached permit application, for lots {ess than ane (1}
acre wrhich are elevated by fill, an engineered drainage plan is required.
, If I am the AGEi�T Ft�R TH�dJ�i!li�ER, I promise in good faith to infarm.the owner of the permitting conditions set forth in
this affidavit prior fa cammencing canstruction. I understand that a separate permit may be required for electrical work,
plumbing, signs, welts, pools, air conditioning, gas, or other iristallatians not specifically included in the appEication. A
� permit issued shalP�be construed to 6e a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisians of the technical codes, nor shall issuance of a permit prevent the Building Official fnom thereafter
requiring a correction of errars in plans, construction or violations ofi any cades. Every permi#issued shall bE:come invalid
unless the wark authorized by such permit is commenced within, six months of permit issuance, or if work ��uthorized 6y
the perm�t is suspended or abandoned for a periacl�.of six{6)inontfis after the time the work Rs commenced. An extension
may be requested, in writing, from ttie Building Official far a period+not ta exceed ninety{90) days and will demanstrate
. justifiable cause for the e�ctension. tf work ceases for ninety(90)consecutive days,#he job is considered abai�doned.
i llk��RR11MG T8 O!�lI�ER: 1fOUR FAILURE TO RE�ORD A NOTICE f3F COMMENCEMEAIT MAY RESUILT tid YOUR
I PAY1�1G'�'!lUiCE FC}R�NtPROVEMENTS.T.,t3 YO.UR;P�t4�E6�TY.. IF YtJU.�.ERlTEMD��TB OBTAIM�FONAt�lCildta,CONSULT
� '�9�'H Yt)UR L�NDEiR OR AN AT`TC1RElEY��FORE REGtJRD1idG YttUR NOTICE O�'COMMEI+3CE11iiENT; �
FLORIDA JURAT(F.S 117.03) _ - - � - `�`�
OlN�tE12 OR AGEAIT Ct �y w��� COIVTRACTQF2 " ._
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S�cribe�a swar o{or �e )before e th s �� scrib d d swor o r�f�irm�bef e m th^'is �� � �
�..�� y . � �ai� by Gtc�
Who islase personafl,T v kno to me or ha /have produced Who istare personalty kn n to me or aslhave produced
' as identiftcation. � as identificatlon.
��„ �—^' iUotary Public � Notary Pubiic
Commission Nq. Commission Na. �
+�;,• �; T�rnmy Verdadera �' ��; Tammy Verdadero �
Name af Notary ty d, ef� or �g� i�si2oia Name of Notary typed,pri e oF� p pi�s�y16�2a�g '
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� r:� s � 5%fee for credit card processing.
' x� -, ,�i;�" A Division ofRyman Construction,lnc.
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�� ���;''' �-�,. , "`� 36413 SR 54 • Zephyrhilis, Florida 33541 NO. 2040 Proposal#
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`���°'� Phone (813)782-6094 • Fax(813)788-6773
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� 1-855-Go-Ryman (1-855-467-9626) • Lic.#CCC 1325505 Estimate# ��
'�� www.RymanRoofing.com
�� S e r v i n g a l l o f C e n t r a l F l o r i d a J o b#
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, OwnedPurcHaser. ��1��?, I � Date:���'"��
Claim#: II InsuranceCompany:
Policy# ��
Address: ��(��� I �� �it�. City: �_ 6�.a C�� Zip: 33� �
, Home #: I � ��� ���� ���� Cell #: Business#:
' E-Mail Addrel ss:
❑ Compllete tear off of existing Additional NoteslSpecial Concerns:
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❑ Seculie all loose roof decking as needed according
to Florida Building Codes l `
❑ Roof ii ried in with �� ��� �` ��`� �
❑ Instalil new valley metal with galvanized metal �c,c,d'dL �.•�,�, :P�,n.e,-��'e�CanS �,rv�D1
❑ Install new "drip edge color: ��C ��� =
❑ Install new lead boots
❑ Install all new general roof vents �1
� Instaii new '�`PC7 ��'� �'S'�'��.w �8.�� ��'��,�(���� ���l�r a�i% .�LC ���
�Man��facturer:
�r'�-l� cd i�-r. ��n .�,�+c���'
� Colojl. �„��r,i~�
All roof related debris remoVed from job site, pick-up loose
nails�using commercial grade magnet
� All mi�terials, labor and ermits furnished �
�Provide a dp'f'• labor warranty Total Investment$ [ �l%�
Additional Itll ms:
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' Payment Method: � Check# ����1 ❑ Cash ❑ Financing ❑ Insurance Claim
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❑ Credit II ard# Exp. Date CC ID#
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Down Pay II ent: $ �/� �� Amount Financed:$ ` Approx. Monthly Payment:$
� PaymentTerms: � I� ��l-� U ���`� ���`�� �
Extras: �
� Deficiel t 1/2"plywood replaced at a cost of$ � per sq.ft. in the roof field,which includes labor&materi �other wood work/ad-
ditional lab�or,such as, imited to,valley rebuilding, rafter replacement, 1x decking,etc.will be a rate of$�per man hour plus the
cost of materials.
THIS BECOME INDING ONTRACT U ACCEPTA E OF PROPOSAL.PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTRACT.
I ACCEPT THI ROPOSAL HEREBY E TIFY THA EAD AND FULLY UNDERSTAND THE PROVISIONS OF THIS CONTRACT.
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Purchaser�l � Date: [ (� ��
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Purchaser�� Estimator: �� t,���
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NOTICE OF COMMENCEMENT �' �
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State of�� r`���� Caunty oi r�C o
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THE UN�ERSIGNED hereby gives notica lhat(mpmvement vu11 be made to certain real property,and in accardance with Chapler 713,Flarida Stffiutes, 3�n
Ihe fo0owing information is provided in this Nolice af Cammeneement: ; m"
1. OescripUon of Pmperty:Parcel Identlficatlon No. I�-26- a t-oo lo-O+�000-oo`l S
, vmo
i StreetAddress: �J$(o53 �Z{'= (ave� �ohc�rh:lls � 3354Z � �
2, I�Genera!Oesaiption af impmvement �'�� �d' !00� (�VCl� e
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3. Owner Infarmation ar Lessee irdortnatlan If the Lessee contraded far the improvemenl:
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38(c53 ;Z��e �hvrh��us Ft- 335�fZ
Address C(ty State
Interest in PropeAy: d�n�
Nama of Fee Simple Tiilehalder.
(If dltterenl irom Oumer Itsted above)
�d� Slate
�l Cfty
�4. Carhractor. �M!'s.rt COf1S}Y[,cp{�iM �TJnC� (�c T!�'�ah I�ica-ri'nq ���•
364i3 N52 5�t �,�,�h �{.�,ly ls �.335�41
ci s�a�e
CMradors Telephane No.: S(3��8Z-�a�"S �
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5. Surety. o N�
Name �m D
Cj�y� Slate ��j o
Address
Amourrt of Bond: $ Telephone No: �m�
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6. Lender. � �p 7
Name .JN o
Address City State �m N
Lenders Telephane No.: y 3 0
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7, Persans wilhin the SWte of Flarida designated by the ovmer upon whom notices or olher documents may be senred as provided by �"a
Sedion 713.13(1)(a)(n,Florida Stalutes: "
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Name �'"�a
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�d� City Stale � � �
Teiephane Number of Designated Persan: � ��� �0
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8. In addiUon to himself,ihe owner designates °f �� 1 f�'�
to recefve a capy of the Lienors Notice as provided In Sedion 713.13(1)(b).Fiorida Slatutes. r� ��,�� ��
Telephone Number of Persan or Entity Oesignated hy Owner. o �^�` � 9i.
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g. Expirellon date of Noltce af Commeneement(the explration date may not be hefare the campletton of eonsWcUon and flnal payment to Ihe � �
co�radar,but w71 be ane year fram 1he date of reeordng unless a ddterent dale is specifie�:_ ��" � � ��� � � �
WARNING TO OWNER: ANY PAYMENTS MAOE BY THE OWNER AFTFR THE IXPIRATION OF THE NO110E OF COMMENCEMENT m � ' �
ARE CONSIDERE� IMPROPER PAYMENTS UN�ER.CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES. AND CAN � a �
RESULT IN YOUR PAYING TVNCE FOR IMPROVEMENTS TO YOUR PROPERTf. A NOTICE OF COMMENCEMENT MU5T 8E ��
VNTH YOUR LENDER OTR AN ATTORNEY B{EFORE COMMENCING WNSPECTI •ORD�G�YOUR NOTICE OF COM�M�ENCEINENTSULT � �
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Under penally of perjury,I declare that I have read the foregaing not' of co en a\nd Ihat the s ed therein are We to ihe 6est , � � �
of my ImrnMedge and bel(eL \ •��3'Wi p�y� w U
STATE OF FLORIDA (..� � �9 Z�O F � �.
COUNTY OF PASCO
gnature er or Lessee,ar Otmets o�Lessee's Authorized F
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O ueclar aAneAManager '��g,'��S B N� Q
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Sfgnatarys TillelOffice � �O F=,,,p ¢ �
The fil�egDing in5humenl vr�s admowledged before me Ihis Z 4 day oi ��^"�20«by ���^ �*'du .. �' W u'� U V
e of authori e. afflcer,Uvstee,attome in fact)tor � 2 O� �
as ��YP �Y� 9•. Y � I—�-W I.L
II (nama of pa_ o be aif oF om instnunent xras execule�. � a O� O �
Person Knaxm OR Praduced Identification❑ Natary Stgnature =V V W
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Type I f Identificatlon Produced Name(Print) U
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�,p�� Nntary Pu611e Stele of Florida � U O O } � �
Tammy Verdadero
�1r My Camm i s do�F F 1 8 4 0 7 9 � � � �
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