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HomeMy WebLinkAbout16-17997 4 � - l � CITY OF ZEPHYRHILLS ' S335-8th Street � , (813)780-0020 � 17997 � ELECTRICAL PERMIT a � PERMIT INFORMATION � LOCATION�INFORMATION ` I� Permit�:17997 Issued: 12/13/2016 Address: 5729 5731 1 ST , Permit Type: ELECTRICAL MISC � ZEPHYRHILLS, FL. ' Class of Work: ELECTRICAL MISC Township: Range: Proposed Use: NOT APPLICABLE . Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 9 1,800.00 Total Fees: 45.00 Subdivision: TREE LANE VILLAGE Amount�Paid: 45.00 Date Paid: 12/13/2016 Parcel Number: 10-26-21-0000-00100-0000 � ' CONTRACTOR INFORMATION �OWNER INFORMATION� Name: JIM'S ELECTRICAL SERVICES INC Name: TREE LANE LTD Addr: 18302 EASTWYCK DR Address: 10912 N 56TH ST TAMPA FL 33647 TEMPLE TERRACE FL 33617-3004 Phone: (813)810-4079 Lic: Phone: � Wor,k Desc: REPLACE METER/ POLE/ PANEL BOX � � - ' APPLICATION FEES � � ELECTRICAL FEE 45.00 ! '' INSPECTIONS REQUIRED ROUGH ELECTRIC � CONSTRUCTION POLE � � . PRE-METER+ � FINAL I i I � - � (�� � - � 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 � f rst reinspection,whichever is greater,for each such subsequent reinspection. NOTICE:� In addition to the requirements of this permit, there may be additional restrictions applicable to this properly 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. "Warriing 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." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be perFormed in accordance with City i Codes and Ordinances. � I �1�� ! � CONTRACTOR PER OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO ' CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED � PROTECT CARD FROM WEATHER � - - „ i � � , . � . , � - 813-780-0020 City of Zephyrhiils Permit Application Fax 813-780-0021 ' � � . Bullding Departrnent Date Recetved J� -r3—l,� _: Phone�Contact for:PermltUn - � ,o r3 - �� - ��7 I � ` Owner'a Name ��`^'`� �r"S� Own�r Phone Nlumber i Owner'sAddrass +°:91 � N ���• S � �'�""�'�-��� �' p�ynerPh'oneNumber�• Fee Simple 71�IefiolderName - —� � Owner Phane Number ' � Fee Simple 7ltleholder Addresa - I ' JOB ADDRESS � ] I S � S +' LOT# � SUBDIVISIOPI� , �free � PARCEL ID# � - � I . (OBTAIWED F.ROM PROPERTY,TAX NOTICE� WORK PROPOSED ,��NEw CON57R , ADD/ALT �� SIGN' "Q Q �DEMOLISH ; _ INSTALL � ,. �.REPAIR PFtOPOSED:USE , -• :Q SFR. � COMM . ` Q- OTHER ' TYPE OF CONSTRUCTION•'"�� Q� '�BLOCK � � FRAME ;Q STEEL 'Q �.. ,� DESCRIPTION�OF WORK, � , , BUILDING'SIZE' � � �'�Q�FOOTAGE� HEI,GHT``� QBUILDING $ VALUATION OF'�TOTAL CONSTRUCI'ION � ' �E1.E�CTRICAC $ �i � � AMP SERVICE, � �Q '�PROGRE$S ENERGY Q W:R:E:C. OPLUMBING • $ .. - -• ' , 5.. ' ('.J;: QMECHANIGAL � $ ' ' VdI:UATION O�MECHANICAL IN$TALL'A7'ION: I. . ': , . . �� ..�' � ' . .. � I i QGAS f . �] ROOFING Q, ;, SFECIALTY�.,Q.�.•..OTHER,- : , . , � FINISHED FLOOR ELEVATIOfVS FLOOD ZONE AREA ,QY�S. ,NO I .. . �, ,`e � - _ .:.+,r: 'ci'�F'. . .F.,.iF`�.;�_ _. •- , � BUILDER � , , . COMPANY`, . ,�'', . .-;�. , , , , , � SIGNATUPtE I REGISTERED Y/ N Fr��F.EE CURRE�=' � Y'/'N` , . at, ,at.` -`t:� ,`�_s.s •`w_ ;'� '� _ . Address ,�_ ,. y ,.+: ., <Gicense�#:' c , ELECTRICIAW: � � `._ ' ,r�•. .,, .... . ,:{ .;,�,^^.:V�,�����^(:--��J be��-.� ,,� , . �.#COMPANY�`� r , . . �.,.s '"; : r SIGNATURE � i � ���s�rteo Y/ N �E�cu��,� �f��:Y/:N.= . - Ada�.� i ���g`3..�.� :;�-����a C1�"�D!' .`5, , , ,� ,�:.Llcense�#�;-���3�a�5�,9�=r � - . - , . ;� _ , I. _ , .. .. . . ��; .... - . � � � ` � PLUMBEit ' � .., _�C.OiNPANY �::�z..4:a..,. ,r ,: �:,_;.,�. .: �;� :. �. SIGNATURE^' `� � ' � " FtEGIS.T,ERED Y,I.=N:; . r;��cuitrte�,•?,' -^.Y:�/N, _ , � I - - - :.- . , . _ t ��,~-. _,;��� � � - �� , �- , - Address � ' ' -�_` ' . � " '� ;License�#' ` _ _ .��-, _ � .. _... .. .. , =:. _ . .. ...,. a�• i . .r��.�: �.. MECHAI�IICAI:`..I�, . • - . , ' , t. , . - . • COMPANY � .. ,., �.;r:,:A�„ „ _ � V. .1 SIGNATURE� y'x� � REGISTERED Y/.N �E Cu�itEn:ti, Y/-N+ ,M., •r..::., ;,: , Address'` i'1 , ._ . ,. ; . .-��� . �.� t. _ � ' " �.License#`. _'�_ . , .,i� _ :�; ��, .t.,, ,q.: , .. _ ., - , . . . ..,. i ,-4 '' ,�. .. ;.. - . _ r.-,: , .. . . ,. OTHER r�: . .. _ : . ,CO,MPANY � .:. _.�--- . . SIGNATURE� - - . :$ .. .,'•" ==i .'� '_ , , _t. _ �:...:..,. , ,� .. ,v , , Y'/N . '',r' 'REGISTERED�"'"� Y/ PF:.... ;FEE CURRE�• � „ .� -, ,. . " � Addee� .�,,..,.,� r.H' ....c..•� .- � - � - ��, .., , . ' �r Llcense#���� � ' _ mF,`��. j.`._�. .' ... -!r,'c �:. ,. _ '_" ` �r_ '� �. � l.n 4`-w:',':i-' � "� f. RESIDEN7114L 4Attactir(2;Ploti,Pla"ns;�.(2)sets4of'Buildf'ng'[Plans;�(.1)set of�Energy-Fo'rms;�R=0-1N•`Permlt fo�newrrconstruction,. . .�;�'�>. . . .) , , ,,,.:o�; , .. - ,���Mlnimum�.ten„(1,0)�,worl�Ing;d�y,s,�aRerbsubmltital:dafe t;.�Requlreil onslfe;'Cons#ructlon'Plans;'Sfoimwater Flans wl Silt Fence Installed, ``�'_.; Sen(tanr F-adl!y�s�1��wmRster�Ile•bVorktPertnl�•far:suti�idislonsllarg�_�projec�V��'�;���,. '�'-'';���% �' ''� ''` , CO[YIWIERCIAL , Attach(3)�eomplete'sets°of''Bulldl`ng'Plans"p'lus a Ufe�S'afety�Page;(1)set of Energy Forms.R-O-1iV Permit for new consVuctlon:- Minlmum ten(10)worktng days after submlttal date. Requtred onslte,ConsWcdon Plans,Stortnwater Plans w/Sllt Fence Installed, , $anitary Fadlltlas&1 dumpster.Slte Work Pertnit for all new:proJecfs::All commerctalregultements_must meet compllance �'� SIGN PERNOIT AttacFi'(2)'sets of Enginee"redsPlans:,;�:�;��V��; .. ,�.. ..w:-:> ;. „ �-� . NHPROPERTY SURVEY re_quired for all_NEW co.Dstructlon....... .. ... - - . Dlrectlons: •�=e�a�.s;',,": . _ , FIII out eppli I Uon completely. � Owner 8 Conhactor slgn back of appltcatlon,notarized If over�,2500,,a Notice of:Commencement Is rsqulr�d. (AIC upgrades over ST500) ; •. .�`;:,,y,;ay.~�s;.";�a " Agent(for th�contractbr)or'Power of Attor"riey'(for the owner)would be someone with notarized letter from owner authorizing same ., DVER-THE:COUHTER.PEFYMITTING��---:•-(Front•of-Appllcatlon>Only) •�-- " � - Reroofs If shingles Sewers Service Upgrades A/C Fences(PlodSurvey/Footage) _. _ _,.; ._. .. __ _ . . _ _.:.-„�.. � �;>• .,, .. - . _ • � Orlveweys-Not over Counter If on publlc roaduvays:.ne�ds.�tQ_1f1(�����,����•,€ •w.��.�„.n<,1.�_�.�,cs..s••_c_.�>I�.`',.(..;`.a :a':`: ' 'f ;� Lyy?�i:;'•i���,'.�J:.S:: .f�i�..'y � y'�.�,?r�,'ci;-.'t:i�i';::l.f�;;1G��^ l:j�i! 7 �' �l;.i)',,l't:3��i:.'.i���Y1:�r°.?I!,{;('C� '�; Q :t(C%�%�i,{'iic.��.t^.°•�,�:F�::r,`•'iv`'fesC�F.� ���,:"•�' ';, � � .:�e-,.+d n+•. � e :rw��.vaum.+.vi....� �ar.•an.-*. � �'s�n<�r•3`�{-:.n..� ICTIONS. The ue�dersigned;under�tands;:th�t�thfs�.p�rm,it;rrtay:.be,subjer�:to;"deec!";restr`;lctloiis"v::�_..,,,_��; N�'i'!CE�1i�DEED,RESTi3 , . , . :._ . - whtchma tie=mpre�re�''s"tttctive��t#��i�r�Co�i�i 'i'��ilaf�oiis:'µThe:un"derslgned°'�issumes�responsiti!llty{foF"coifipllani:ewith"any y.. �,.. �... . 4 .,_.,._.� appUcatile:'deedrestirictions. :�.; •�: . .. .,� � ..... _ : .. ,r.._� �,. ..�_>:._....-_..,; � -�-�" _��. •e{}ar:�.�'.t.'l°p•:'iti ..�� +�.1. �4..+...: 1.....__....�,._ ...... IUNLICENSED•�CONTRdC7'CMRS�:ANii CONTRACTOR�RE$PQNS181CiT1ES'��=�lf���ie=�owner' has"tiiired"a"ctiritir�c#or ar undertake work�t_ ma �be.ir�quii�ed._ta,{tieal�ceneeil�irt;accordance.with;stafe�.anrl�iocal:r±�gutai�ons:��if�the�=.::_���-����� cantractors to 1:�Y.... .Y . . ..,,,.,�.,.;.;:���,�,-:w..��r � cantractar��is-nat�lEcensed�as��requlred,tiy{aw,:tioth'`ttie awner arid"coratrsctor��msy��tie�clteil�=.foir'�`�mi�demea�or v!olatlon �nder state law. !f the ownec.or IMended1,con_trat�tor�er,'e..uncertaln �s'to,what ltcenaing�;requlre�nen#s;�may,�e�iPlYk��OFkthe°`;':'�:��: "�� lntended�avo'li,they a�e advised;to",'ciontact the P'a�co County Bullding Inapection:Dhti�lon-l:[censing Sectton at T27-847- 8009. Furthemeore, if the ou+mer'fias"`lilred a�icon"tFactor"or contre�ctors, he 1� advlsec! to hav�r the con#ractor(s)��stgn,,�Sr,h„,,,,° .�--�-�kr ...,:� � portlons•of fhe:."rxvn#rector:Bfack".vf,;thtsbappflcation:fa.r_which,.they:witt.b.e�.r.esponslbie ,if you�-as��ti�e own�r�si�qn as the �on#ractar; ttiet�majt be an Indicatiairi ttiat'tie�°fs��not:properly ll�iised��ntl°'is niif"ertBHe� to perrri�ktliig priu}feges fn Pasco r_ �w � . , e=.,�w;����. �.-- CQUC1ty. _ ,.... .�..... „�.: .. „ TR�1[dSPORTATMON=lMPACTlUTILITIES}rMl�ll�T�ANb���tE�OIIRCE RECOYERY�FEES;�'Yhe�undersigried understands �-,v r that T�nsportatian Impact Feesyend..Recourse.Recove.ry_,Fees„triay:apply��to�the`;constructl.on.o�.:new,buildings,;zchan�e��of����'�€='�'��`� use in eiiisting buiidings,�or�.experi9l�n=of�ezie�i�i;g��iull`c#ings, as specffied.tn Pasc� CauMy Ct�dinance number 89-07 and;, 90-07, as amended,t:,.,"Gi,i�underslgned elso;�u�iderstands� thait�such fees;�as�ma�ti�xdua;<�vult{���e.iderit�fed at the��tiiiie�of���� ��==����' pem�itEing. !t Is itiiithet under�toatl'that T��sp�ortatlan lmpact'Fees an�a�Resource�Recov:ery�`Fees:,mu�t be pald prbr to fecelving.a'cecUflcate��of accupai�cy"��or.,flna��.power:�elease:�..1��Ehs.pro�ect,;do�s�no��lnvolve�a~cert�icate of occupan%iy�ar`��4�';x�;�;,' flnal pawer release;;the=:fees=mu�t,�tie"pattl�,prlor ta;permi# Is�uance. F��ther�tiore,�:i�Pasc�,,County`°1NaterlSewec�<l�npact :���, °=rt fees are due;;theymust:be>pald p�lor.to.permit is.s,uance'In,accocd`a.nce`wit�:applloatile:Pasco'�Gauniy�o'dinances. • CON�TRt1CTiON�CIEN`LAYV�Chepter T13�EfaN`da Statutes�aa amendedj: If valuallon of worlc 1s�2�SOQ.00�,or.�more,,�l�-�;. :-�:.x�N cer#ify that• t; �#he :appticant;._haxe,,:been. provideil-��with°a�-c�py�.of�ther:"Flarida�Construction��Uan�::i:aw--i�lomeownet's Protectlon Guide" prepared by,=ftiie Floi�da Deparkmer�t.of Agricuiture and Ca�nsum�r�ANairs. tf the appl{cant is.sameane;,;:..y.;•--�, 3;.{� other than th�"ovmer", !certlfjr,-th�t 1-li�ve:obtqln+a��a=e�opY:of:the3�bova:rles.crlbed��lo+cait�ent;and:pt�r�ils�:lri;good:faitt�.#a . ,., ,{<< � ,; . .. � �,,: .1 ., - e.. . -. . � `...,. � . + ; . .....: ., � ... , ,,.�_..... : : deliver It"ta�.the�'oyvrie'"•:prio�°to�comm"e'ncem�nt:�', = � .' � � • _ _ �ANTRACTOR S/OVYNER S A�'FIDAVIT: I.cer,t�jr;=,th�at;all,�the�lnf�rm�ticmtl��this appUcatlon ts accurat�.�nd that�aA work � I will'be done in compliance with a8.appltca�bte�iaws regulating c�nstruction, xoning and:�,la�d�deveiapm�nt. Applicatian fs hereby made=to obtain�:_a.perrnit:;#o�:;doF w��k;��nd��ii�sfelfattan es indi�ated:�-�->:1� ceMNy Ntst no wark�Nor instatla#ion ti�s' - . comme�nced �p�tor to tssuance ot'�.a permlt'antl that�:all�work wlll be perfncmed�to meet�standanis-df�:aff law� reguta�ing- construction, County and Clty codes, zoning regulatinns� and land d�velopr�ent r.egulatlons�in�ttie.jurlsdictfori:i=`�!�:ai'so= certify that I �nde�s#�and that the regulations af ather�government agenctes may�apply.;,to..the:.Intended:wark� and that!t!s ' my responsibiiity to Identf�y•what.actlons 1�muet�takey;tot:be.�in�conlpllar�ce:t;Such,agenscles�Mnclude�but-are:not Ilmited to:�• - Depa'tment of Er�vironmental��Piat�cf�on=GypreSs'B�a'yh`ead�� Vf/e�and.�lreae and Envtronmentaily Sensitive Lands�WateHVllastewater Treatment. .. � y � - Southwest Fbrxda UU�ter Managemei�t>=:C�ts#r1ct-.V'Uefls;=`''Gyipress,��Bay�eaii�r,- Vlleftand Aress� Attering - Waterr.aurses. ,�- --; .� ..,s . , . - Army Corps of Englneers�Seawalls;Docks�Mav'Igatile Waterways. � . - Department; of�Health�;1�;�Ret�abilitattveW:;Servlces/Envinonmental�.F�ealtl��Unit-Welts;:�V1Fastevitater�Tre�tment, � � Soptl'c Tarifiis:..� ._ . _ :. ,�. . . . � _ . - US Envlronmenta!Protectlan Agency-Asbestos�bat�me,n� « Fedeta!Avletlon:Autltat,ltyr,�fZunt�rajisF�, �. I understand.that:the.�fcllowing:.reatrictlons apply to ttie use af flA: - Use af fip Is�.not aliowed In:Flood72..o.ne"V"unless expressly permitted. - if tFie:�fill' ma#e�iat��is��fo;'be used;�in::flaod Zane. aA"� it is underetood thaf�a dralnage plan addresstng a °compensating vo{ume°wilf be submltted at#ime of>permitttng which is prepared by a professianal engineer ' � ilcenss"d`by.#he,.�t�ite�of'flotlda: -� .:- _ - !f th� flll��•meteria!`�la°'to be�.used In Flood Zone 'A" tn�cannec#ior��w}th�sr�permitted bi�ildfng using stem waN , ' conatruction� I.certify;t�at:fUl.wlU:be;us�d oniy.to fll!the�rea�wlthln�the�stem wal1: � � - If fill mate�lal-Is LL to be used in any area; I �cenifp,that .use. of;such flll will not adversely aftect adjacent. propecties._.If.use:.of.f�tl,is faunct_ta:ad.v.ets�iy;.�fFect adjacent�;praipertles,.the awner may be clted for vlolati�g. � 1. . the�canclltlons��cif�ttteb�itding;perniifi�issued ut�det ttie�_af�acfied_�ecmit�:apptication,��for=lots�.less�than:ane (1) aare�il�lati`aie elevated�tiy..�!!;��r;engineer�d dr�,inage ptan ts required. • If!am the AGEINT FAR�TME:QIMNER.,l;.�iromise:ln.gaod,.f.altk�to i�fortr��ttie owner of�the pemiitting condi�ans=set forth in this aTfidavtt`prior to comrriencln8 consh�uctlon. 1 underatand thet:a�seperate�•permlt may be requtred for electrfcal:work :v.XWa� 1y7..a•. >.E 1 ' plumbfng, signs, welts�.poois,,-alr contditioning;,g�s;..;or:ot�er Insta(I�toris not�spec�leally included•tn.the��application. .A permft Issue��hall be constr.ued ta'b'e,a�llcense�#a;�i�aceed with"'tFie:viiai'rk and:nat-as:�authority.-ta:vlotate;.-cancel, alter, or set aside any�provlslons of tlie.tach�lir.al;cadeg;:nor shall fssu�nce�af a.permit.pcevent th�Buttdirig Ui�tdslfrom thereafter requiring a con�ectlon��af;errors.ln-;plens;:aoristiuction.or.vlola�ans of-any cades�--�very-p�rmlt��lssued si't�ll�tiecome�invalid uniess the work aiithoNzed by such permit:9s.commenced•w(thln s{�c..months ot permlt Issuence, or if uvQrk autttorlxed by the permit fs suspended�or:abandonedyfor:a;period�;of�eix:{�)�montiis`;.afterfthe-tlme the�work�t�comfnen�ed.. An extenslon may be requested,ln.writing,.bfiram,t1re;8uililing,�fficiafi4for a periad�not.fo exceeid'�ninaty�(90)�days a�id�willttdemonstrate Juski�ab#e'c�use�or�the extensfar� if work ceases:for nlnety.{90)cons.ecutive�day.s..#he�ab�is cansidered aba�doneid. IMAItNING TA AlA1N�R: YOUR;�.FAlUJRE;:TCI.,.R�E.CO�t�.�A,'�OTtG���F�:�G.QMMENCGME�T-:AIrAAY�-RESULT IN�Y�UR " PAVIIVC TWICE:FOR�IMPROVEMEN�'��T�:YaUR>:P�L��ER�T�1F:�°I�'�.YO.U{IN'�"EK�D�?TD"�1?BTAIN�F1Ni1��1N�;�UNStl�T �`AT D �t� Rt+� O QY i •R� :, - , � . F�aR�aA,tur�►���.ttr:� � .,. . ..�. � __.,..:.: -_�_ ,-_- - -�. - -__.-._ - - -- - -- -- — --- _ :. , ,.:_ : _.::.,-� . ..:.. . .- . . . . , . .� .�. , . .____�. , . , �_ ..:: �`�--�=� OWAtER OR AOgAtT :.�.. � . CtyNTRAGTOR:.�+–�`�—.=__..- . 8ubscxibad and swrom M(or afllrmedj before me fhls Subscrib�and'swom�M{ar'a�ftme�drb+�fona me-ttil�� by .by..., C7/�Y)' _kCl�•r1 C.�-s , I V�fia isla�personatty known.to.me or:haslhaaa,Rroduced Wha.t sre g.e�q�elly:�crtowmto�. ;oc.fiaslhav,e:pmdiiced. • � 'as Id"eiitlAcaUori.. . Q�U�KJ /.LL���L/� as Iden�ifca�an. Notary Public . .� � o ry Public Commisslon No,`' Com Isslan�No._ ��� �tLS �� � ��f'�' �1�,4-��� �U�'�'/��L-- Name ot Nvlery typed*pdnked or atamped Name ot Notary qrped,pdnled at slamped . ..�.r..� ���Y"~% DEBRAELAINE RUFfELI .. � ��,...:�,�Comm€ssian#GG Q45343 ty����w,=Expires November T,2024 - , ��o,°�; 9ondod3twTroyFaininsurau�ce800.985�70f9 �r. 8�s`;7saoo2o City of Zephyrhills Permit Application Fax a�a-7eo-oo2� ' � � Bullding Departrnent . Dat�Receive'd �� �_ �3� f.� : .phone,Contact for�Permittin ��.� ��� — r o 7 - ,4 _ { .. _ .. ; ,. . Owne�'s Narrie �c�^^`� G� S S � Owner Phone Number � ' Owner's Address , � �Q�Z :� ��' � S L � �{' ��'�?���c . � Owner PFione.Number Fee Simple YItIeHolder:Name � • Owner Phone'Number i - I Fee Simple Titleholder Addresa f JOB ADDftE�3 °�7� � ��'S� � � LOT# + ��ee l�W, � SUBDIVISIORf � PARCEL ID# :' - � . 1 (OBTAINED FROM.PROPERTY,TAX NOTICEj WORK PROP,OSED w:NEW�CONSTR' ADD/ALT �]� SIGN' 'Q �- Q DEMOLISH ' i B; INSTALL� � � REPAIR PROPOSED�USE , - Q _ � SFR� ' [� COMM . � OTHER : " TYPE OF CO�ISTRUCTION`=i Q" 1'•'BLOCK ' Q" ,FRAME � �' STEEL' `Q I , -�. ,� . DESCRIPTION OF WORK' - '� ��`e- Q�� / b''1-e�/ � G�a ) I ,. - ;• /�- I '' ,. . ' �UILDING'SIZE" • ` ��SQ°FOOTAGE�C] , HEI.GHT ,- QBUILDING $ , VALUATION'OF`.�TO'I'AL COySTRUCTION , ' ' (.. . '. _ _ QELECTRICAL $ F"� o p - . AMP SERVICE. Q � '�PROGRESS ENERGY [� W.R.E.C. ..� � . QPLUMBING • .$ " - �i ,,. - � ,.:,:� � ... QAflEI HANICAL $ - - "VAI:UAl'ION OF;MECHANICAL INSTAL'WTION. � Q�S [� ROOFING ,Q; , SPECIALlY;:O _ ,,,OTHER, , � f FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA ,QY�S. _NO i FK � -.5...�... �i:'e. BUILDER COMP]4NY:, , .. �,`�: . �. , - '. � . . SIGNATURE REGISTERED ' Y/ N . ,��F.EE CURREk" `'Y/M Address �- ;,°: ,?~�; - •,Llcense�#• . _ � . . � .. , p.��,. ,. ..} . : : .r.� .,. . ' .. .... ,..-:.: „ ;,y. ,,.: ELECTRICIAN. ;� ., � � ' ry - t.�COiHPANY` � :�`^����':;.�I,«�3:�:.�V 5.�..�� .. >, a" Y'-'•s+`_ ,';e ``" ' SIGNATURE � REGISTERED Y/ N F�:cur��*-� `- �<Y/:N. - _ � .� �- �•, �wdress 1 U�'������--�'�rss vj�' �i- T�=;i��` .. ,_. ,,,?`" , �ucense;#: :�c_(;�,d o5�/9,6 ' :��. - PLUMBEIt�' , r. . ... . ..- • _ .��'�` • • ' ' �- ' SIGNATUItEi,` - s`.4, � � , -. _.C.OMPANY .,.>...;_� . ..s K-. .�� ;, � . . �v .`REGIS�ERED . .:Y,/a N;s .`f;`.-_�FEe:Cu�E�:�. fY-%N, . _.. � - _ ; _ . . .... . , . . ,- Address� � ' " `Li�cense,#� �` - .. .. - .. . ,�� �` ... . . .. .:. - _ .. - - � - - MECHANICAL'� ;'., ,. , - ., . �, � ' COMPANY ' =:,- ` ';,.•,.:�.z'�. _', . :- � SIGNATURE' �' `' F, �... ' . " ` � . '`. ' REGI§TERED _ Y%.N .FEE CURREA:. .;: 'Y/�N : � ' "�. � . i "'�`l�.� . .. � . . .�X.t� � � - _ Addresa;' -- y'�` .,_, , : , ... • .. ..- ,. _ . , , � - � ;,; ,�. s ,� -,..,. i , - . � Lfcense# _ , _; , . ., - _ -. , ,�,,. . ---� ,. _ - ,,. - OTHER . _ � 4 .t .. . � . . , ,�;.-, - _ . . , . ._ , , , : . - '_�`' :COMPANY" � ..,..,, ' _ , SIGNATURE•., _.� ,a• .�-:, ;� . ., -. ., �.. - . �o- �REGISTERED' ' ` Y/ N>..:. ;FEE CuwtE��' Y/N i;y�i r.4�. : . . .. . , _ .. - .. . . .. . • ' '_. . i � . Addeess; +'.. , ..- ��r� >>a� _ - „�,� , ,:��;-� . '., Ucense#� :� � , � • . ° . RESIDENTIAI;s ' � �:.:.: , � ...,.� t..:. _.... �.;.-.. „a�..... ,.„.. .... ,, ... �_. , _ ,:,,;,?Attacfir(2)a.P-.lot;Plans;;:(�2)set's � ' ' � � � � . �� : I ' ... ._... ' 2..,• :.,r,.c'cl r.b"�.i v (VQT1C��F D�ED_RE�.T.ItICT10�1�: �he undersign�d;unde�tands�,th�#;thl�kp.�rmlf�.may,�;b,e,subJectrto;"deed"�res�fct�oiis"�:r,.:_;_,.:,...,� which mey'tie=more':reistti�tive`;th���Coun�`�r9agrllatfons `'The un��erslgrieds assumes respo'nsitilltty�=for.compliance'with`any'`��"�""'°�`��" applicable:deed=rest�ictlons. ` - :r=;.:; •:::�.:; .. • _. ... - - _..-_.�___ __ v�:.,-,° .,,•.,.r_�.�>�; -�:^�:' ' �_._...._...,:_... ...,. r. ._. ..: UNLIClENSED��CONTRACTORS :AND CON�'RACTOR RESP,.ONSIB1tITiE�S:�=<If°the=�owner�Lhas"`htred�a�':cc�r�tiractor or ,.. contractors.to undertake work;-tf�ey may�b_s,.r�iquiF-ed:sto.��tie�llcensed:Iny:aix_ordance.with:state�,and�local�regulallons:��ifrthe�>�•�-- - �t� . . ...1.,>�___,. ..:....-_: ._. _ .,._ ; , : contracto�:=ls��noE`�Ilaensed-as��te'qulred�:tiy law,�bothr�the ovdner a;nd-�conGacto�=��mejr��be��cltetl'.for�����ml�demeanor violation ' under state lau�r. If the ovvner.or Inte'nded,a{contra�torr�are;:uncertain as to.wfiat Itcenaing:requirements'�;;may::�appijr.��fo��*the+=�J���°���=�F' �:..4� ,---:..�,.���..A. � �,... . _ tntended'iaork, tNey are�advlsed�to coritac't.the>>Pasco:Countyx:Bullding Inspectltin;;Dlvi�ion-L•tcensing Section at:727-847- 8009. Furthermore, �If the owri�er'fias'Filred a coin'tracto�"o�µconfractors. he is advised to have�the contractor(,$)�,sign.,,r,,,,..:Y i porNons�of the: conttactor,Block" of..fhis�appllcation�fo_r_.whlch,they wlll:.b.e-r,esp.onsible.>•IfMyou;:�as_.the biivner�aign as the"'`� contractor,that�rnay�be an indtcation�tfiat°tie`=1s�nof:properly�licensed"and��i`s��not"en�tied�to pennitting priitileges (n Pasco County. _ . _. _. . _. ... _......... �...__.... '��_,�Y�_.. I �..:; =,:�:, TRANSPORTATION�IMPACTIUTILCi'IES=rMI�AC��ANb�RE�AI�JItCE R@COVERY�FEE�:��The�undersi�ned understands . thatTransportation Impact Fees.and,Recourse.Recovery.Fees may�,applyfi�.to�t�e'�,conatructlon.:of,new b.u.,ll.dings,�chan�e��of�p��'''°;;:�,���t - use in existing buildings;or.,ezpar�si6rr�of�e�ii§�i`�i,g;'�bulliNngs, a§ spec�ted.tn P�sco Count�Ordinance number 89-07 and: 90-07� as amended...::;,�h� undersigned also;urtderstands; th�t�suoh fees;:as�majr.�b:=due;Y�wllk.be.identified at the=time of'-���� •V�`°'��`' � -.._. s .r„ 4_.,- ..-., permitting. It Is turtlier understood that Tra�i�p�ortatlon Impacf'Fees art�`��Reaour,ceaReco�sry='Fees`:,mu�t be pald prior to rece4ving�a'certi�cate-of�occupa�cy"�or flnal�.power;release:°4�:I��the.proJect::.does^not invclve�'a=certff_tcete of occupancy�o�#���=���`k'°' final power.�release;�;.tFie�:fees=mus�t"tie peld,p�lo�,to,,permit Issu�hce. F�xthermore��if:Pascok;County"1NaterlSewer�lmpac[�=-���,�-��d�� � w. F , , ...., . ,..:..; . CONSTttUCTION'LIENbLA�II Cii'a�'te 713 i�lor da�tat t���ance witFt�:appilcatile:Pasco':County�ordtnances. • lh ( p `�� . � am�nd�d): If valuadon of work is a2,500:00}oc{more;:;l� �;. :��.. certify tFiat .I, �he::appllcant;:=have:.been_ prov[ded_�with-a~copy°r.of��thef�":Florida��ConstivEtion::Lien�-.:Law---Homeowne�'s ��. Protection Guide" prepared by tHe Florida Department;of Agriculture and Consumsr�RfFairs. If the appllcant Is someone: :.., �.;•�-�_ other than 1he'owner", I cert�j+`�th�t I�.h�ve;:obtQ.ined"akcopy:of:th.e�abQve:descri�ed��loai�ent°and.p.rot�ise:`tn,good:�:faith•.to •. ;:, deliver It to.tlie:'owner":'.piior��toycommencement:';,. ,. ' .` � -. . . ."��"' . � , _ ��. CONTF�AACTOR'SIOVYNER'�AFFIDAVIT: I.ce,rtify;�,tfi�at,:ell:�th�;inf.ormatlotr�in�thia appllcatlon is accurat�and that all work will'be done in compliance.wfth all.applicable (aws regulgting constructlon, zpning and:�land�developm�nt. Appticatlon.is hereby made to obtain:a.pecm(t,�to:;do��w��h,and�:;ttistallation es indi�afetl:�-�.=1� certify that no work��:or tnstallatfon liasr � commenced p�ior to iss�ance of.a�perm(E"and tha#�:all�r�rork will be pertormed�to meet=standards-of�all laws regula�ng-_ conshuctton, County and City codes, zoning regulatians, and land development regulatlons�In-tFie�:Jurisdlction:���`1-�a1'so.� ,� certify that I understand that the regulatlons of other�government agencles may•apply..•;to,the�intended.work� and that it is � my respons(bllity to Identf(y•what.acttons I,mu.st�t�k,e�.to bedn;compliar�ca:_;.�Suc.h,{agencles^Include�'but�are.not Ilmited to::� � - Depactment of E�lvtronmental=Protection Gypres�:'Beyliead�; WeNand Areas �nd Enylronmentaily Sensiti�e Lands,WaterlWa9tewater Treatment. _ . - - �` � �� - - Southwest FloNda Water Management�:bisfrlct-lNells; "Cypress•:�Bay�ead�,� Wedand� Areas. Altering � Watercourses. �,,,.. .--�� :_, ;.:;.::,.�.�:� �., .,...�,., � , . , - Army Corps of Englneers�Seawalls,'Docks, Navlgatile Weterways. . - Department-�of:,Health.�&.,,Re�iabllltative�.,;Servlce.s'IEn�Pronmental,F�ealth=Unit:Well.si:�Ill�astewater�Tre�hnent; � Septic Tanks:.��-� __ ' , _ - ' _ ' ' _ ... . .. - US Environmental Protectlon Agency-Asbestos abatemen� � - Federal Avlat[vn:Autho.�Ity�Runways:, I understand.that�the.following:,'restrlctions apply to the use of flIL•• - Use of ftll Is not allowed 1niFlood:Zone"V"unless expressly permltted. - If the-.�flll materlal=`Is��to;b.e used'�`'In ;Flood Zone. �A"� It Is underetood th'at`a dralnage plan addressing a "compensating volume".wlll be submltted at#Ime of; ermittln whlch is re ared b a rof . . P .9 P p y p e s s t o n a l e n g t n e e r � Ilcensed by�tf;ie_State�of`.Flotlda: � . _ - - If th� flll•materlal�:ts°`to be:used In Flood Zone 'A" Im connectton�wlth�a��permltted bullding using stem wall � constiuction,.l'certify;:that-:flll:�iall:b.e�used only.to#111 the area wlthln�the�stem�wall: . � ' - If flll 'materlal�1s��to be used in�:any area; I �ce�tlf�r,�that .use. of-,such�flll wlll not adversely �ifect adjacent . _ propertles., .,If use:of.flll,;ls found�-to=advers�ly:.�ffect a�jacent�pcaipertles�.the owner may be clted for vlolating the condl#ions:.of.the b�illdtngxpemilt�lssued�=under tlie`;�at�ached_pecmlt-appl(catlon;��for:lots�.les"s�than:one (1) aare wFilch are elevated�6y:flll;a�-englneered dralnage plan Is requlred. • If I am the AGENT FOR�.TNE OWNER,.Irpromfse In.good�falth to Inforrra�the owner of�the permltting conditlons'set torth In thts aifidavit prlor to commer�cing constructlon. �1 unitl�rstand thet�_a_separate�permlt may be requlred for electrlcal:work, ., .. �,.., plumb(ng,,signs� wells;.pools;�alr'.cond(tioning;�.gas;�or:otMer Install�tloris not�spec�lc�lly Included-in.the applicatlon. .A - , permit Issued�shall be construe.d to'b'e'a`Ilcense`�to��p'oceed wlth"tNe wo�k and�:not�as:authoHly-:to:=vlolate;�acancel, alier, or I set aslde any provtstons of ihe.technlcal_codes;�nor shall Issu�nce�of a.permtt.prevent the Bulldtrig Ofifctal irom thereaftec � requlring a_coRectlon_af�errors in-.plans'; constiuctlon..or vlolatlons of-any codes:���very�p�ermlt=lssued`shall�tieaome-lnvalld unless the work authortzed.by such perrtalt:is_commenced�wlthln,$fjc.,morxths of�permlt Issuance� or If work authoNzed by the permlt Is:suspended�or;abar�doned�for:a:perlod;of:�six:(fl)�mon�s;,:efterthe-.tlme the�work�ts commenced._ An extenston may be requested, In.,wdting,.from,the�Butlding,Offlctal for a perlod,�not_.to exceed'�ntnet�r-�(90)��days a�d�vii111�demonstrate Justmable�cause for.•ihe extenslor�: If work ceas�s.for nlnety.(90)cons.ecutive:day.�,..the)ob�ts�consldered aba�doned. lAIARNING TO OWNER: YO:UR.FAILURE:rT4,R�ECQ�tQ:AzlalOT�IGE:OF:•�COMMENCEMEI�T�:NtAY�RESULT IN:°YOUR � PAYING TWICE:;FOF,t:IMPRO�IEMEN,�B�TflwX-fl.UR�:P�ORER-:TY:��I�:YO.U�I�F'iE�1D:�T0"�OHT�IN�F1N�Ct�E1N�;�ONBULT �YFi Y��lR����ER���aPir A�ORP�E��fF�REtiR����Fi�`���i�`-�i��=�'�i'�-.'ciiiflWi�"��` .,. . . FLORIDA JURA��(F.S::1.17:Q3}... . , ; .. , ...:. ._ .. .. , . - • --_, _ OWFIER OR A�3�NT�, COMTI3f1GTA �� ' . Subsdlbed and�wom to(or aftlrtned)before me thl� Subsc►lbed end'auiom'to t�a rm - bY /a�/.3//[0 .:,by... • • •G�� Who Islare personally known to.me.or:haalhave,produced . 1M�o.tslare p.ersonalyknown:to:.me.oc#laalhave:produced • � -as Id'enBBcatl4n. - �J�/��C L/G�i(�50 as Identlflcadon. \ Notery Publlc . � !� ` ' �.. Nofary Publlc Commisslon No•: Commiselon No. ' � � EG-' � Name ot Notary typed,printed o�atamped Name oi Not ... • ,�"'�o�•,, DEBRAELAINE RUFFELL • • .. _ }��' �. .. �� - ,�:Commission#GG 045343 �:.�:o?Expires November 7,2020 ''•',A,po wo°'• Bonded Ttw Tioy Fa1n Insurance 8Uo-38�1019