HomeMy WebLinkAbout17-18098 i
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CITY OF ZEPHYRHILLS
� J 5335-8TH STREET
; (sis)�so-oo20 18098
� MOBILE HOME SET-UP
PERMIT INFORMATION � LOCATION INFORMATION
Permit Number: 18098 Address: 37220 NEUKOM AVE LOT 293
Permit Type: MOBILE HOME ZEPHYRHILLS, FL.
Class of Work: MOBILE HOME SET-UP Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34-25-21-0180-00000-2930
Improv. Cost: 7,800.00 OWNER INFORMATION
Date' Issued: 1/25/2017 Name: LINDA KARTES
� Total Fees: 7,387.14 Address: 37220 NEUKOM AVE LOT 293
' Amount Paid: 7,387.14 ZEPHYRHILLS FL 33543-5056
Date Paid: 1/25/2017 Phone: 352-521-0933
Wo;rk Desc: INSTALL NEW MOBILE HOME 1912 SQ FT
CONTRACTOR S APPLICATION FEES
BMI LC I� MOBILE HOME ELECTRICAL 40.00 SEW R ONNECTION MOBILE 1,005.00
' BARNES ELECTRIC OF CENTRAL MOBILE HOME SET-UP 60.00 WATER CONNECTION MOBILE HC 320.50
BMI LLC I MOBILE HOME MECHANICAL 40.00 MOBILE HOME PLUMBING 40.00
BROWN'S'A/C INC TRAFFIC IMPACT FEE 99% 3,595.68 TRAFFIC IMPACT FEE 1% 36.32
POLICE IMPACT FEE 254.00 FIRE IMPACT FEE 273.00
PUBLIC SAFETY 5% 26.35 PARK FEES MH 573.73
WATER METER RES 3/4" 473.78 IRRIGATION METER 473.78
IRRIGATION CONNECTION 175.00
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; Ins ections Re uired '
M BILE OME SET-UP
MOBILE F�OME ELECTRIC
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MOBILE HOME A/C
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MOBILE OME PLUMBING
FINAL �
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
, first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there may be 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
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The payment of inspection fees shall be made before any further permits will be issued to the person owning same
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Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be pertormed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
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� � O TRACTORS SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
� CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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813-780-0020 City of Zephyrhills Permit Application Fax 813-T80-ooz�
' , � Buiiding Department
Date Recelved � � P.,hone�Contact�for°Permlttln 1� — l�l
Owner's Wame L' a Owner Phone Number � / �
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Owner's Address o`� Owner Phone Number
Fee Simple Tltleholder Name � � Owner Phone Number '
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Fee 3lmple Titleholder Address -
JOBADDRESI �aan �L,PL]�.��EiOM �VP_• l--O'�' � ��3 LOT# � �"l3
SUBDIVISION �Zd�'1 - PARCEL ID# �3 — ^ 1"' « —
,. (OBTAINED FROM PROPERTY,TAX NOTICE)
WORK PROPOSED , _� - NS �LSTR e REPAIR � SIGN Q � Q DEMOLISH �
PROPOSEDrU$E �J SFR. � 'COMM Q •OTHER
TYPE OF CONSTRUCTION Q� � BLOCK '' Q FRAME . Q STEEL Q MD f
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DESCRIPTIO�OF WORK �Q1fY1 c� '
BUILDING SIZE' � C�o�� �` SQ FOOTAGE �q I o2 S HEIGHT ..
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QBUIILDING $s'Q� .O� VALUATION;OF`TOTAL CONSTRUCTION �
Q ELECTRICAL $ �/op0 �� AMP SERVICE •[� PROGRESS ENERGY [� W.R.E.C.
QPLUMBING $ �QO fv� - � ��C
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OMECHANICAL $ VALUATION OF;MECHANICAL INSTALLATION. ,,�yo,Q(J��n �
/,d�a0.p c� • (,yy�'���,
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QGAII Q ROOFING Q SPECIALTY � OTHER• ��
FINISHED FLOOR ELEVATIONS FLOOD d��
I �� ZONE AREA QY�S NO .� l�
mi�I 1$
BUILDER C/��� COMPAIVY` � '�� ..
SIGNATURE REGISTERED Y/ N FEE CURRE� ,Y/N �
Addresa �' . 1 4., Il�� � Gcense# ��{!�Q a'33 7�
ELECTRICIAN: �,,�M. �'COMPI4NY �l �G �
SIGNATURE Ci�� � REGISTERED Y/ N FEE'CURRE�°' Y/N �
Address � S�'(� � : 3 , . License# � QD
PLUMBER ', _ �J��y CONIP,.ANY � l��T- ,� ,
SIGNATURE'ii �`�•� REGI3TERED Y./.N FEe cuR�n ' Y•/N -
Address� —l� b l�'`A, . Z. �yy :License.# ,
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MECHANICAL' � ' C�OMPANY �O�r1S �C
SIGNATURE '` � '
REGISTERED Y,/ N FEE CURREP Y/•N
Address ' � h c�V e.'� Licens,e# G I�I 0`15
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OTHER ' - � ;COMP/WY �
SIGNATURE - �- • ' ' ' '' REGISTERE� ' Y/ N.. FEE CURREh Y/N
Address ;. , . ' , . - . - ' � Llcense#
RESIDENTIAL.;;-, :AttacfiY(2)„PIot�P,lans;;(2)sets=of�Bullding:Pl�ans;'(.1)sef of Energy>Foims;`�R=O=W Perrnit for new construcUon,;
•�:..Minimumrten•(,1.0);working;:days"aftec;submlftalilate.�R'equlrcd onslte,:Constiucdon-Rlans;�Stortnwater'Plans w/Sllt Fence installed,
___ --- __�.i_�; San(f�ry Faclllties 8�,1 dum�ster.Sltt�_WorkPemldtlor suhdiVislons/large pro]ects_. -� ' ' __ ___
CORAMERCIAL Attach(3)�complete sets of�Bullding Plans plus a Llfe Safety Page;(1)set of Energy Forms.R-O-W Permit for new constructlon.
i� Minlmum ten(10)working days after submlttal date. Required onsite,Constructlon Plans,S4ormwater Plans w/Sflt Fence Installed,
� Sanitary Factli8es&1 dumpster.Slte Work Permlt for all nauv proJects..All commerctal requlrements,must meet compllance
SIGN PERMIT Attacti(2)sets'of Englneered=Plans.. � -=� � �..
""PROPERTY,SURVEY regui�ed,for all NEW construction.. �_ _ a. � _ ' - . ..
Dlrectlons: �I . -{�:��•. -
FIII out aQplicadon completely.
Owner 8�Contractor slgn back of applfcatlon,notarized
If over 52500,a Notice of Commencement la requlred:. (AIC upgrades over 57500) � ' '_ ,
" Agent(for the contractor)or Power of Atfomey;(fo��ttie owner)would be someone with notarized letter from owner authorizing same
�VER'THE�OUNTERPERMIT7ING-. �• --{Frontof�Appllcation-Only)•- - - - ' �
ReroofsJ.f_sh�ngles__,.._.Sewers.....�__Servlce Upgrades A/C Fences(Plot/Survey/Footage)
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� Dr�Vevireya-NotoveF`Counterffon•publtcrbadways:.�eedsROW� + -, �;.,,;��; , _ ;�, , ;
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NOTiCE OF DEED RESTRICTIONS: �Tha undersigned under�tands�.th�t�:thl�:,.�rmif,ma�/;be;sub ect�to,°deed"restrictlons",�1� ` `
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which may:be=more:r.est�(ctive�-th��r CounEy°regrifatfons, =The undersigned assumes responsltilllty"'for'compllance'witli-'any "' "�
applicable-deed restrictlons. . . � - ...: . .:.:::: .. :: ., ' . . . � , , �: -- ;., ; 4_. ..,
11NLICENSED� CONTRACTORS AND CON'tRACTqR�RESPONSIBILITIES: =1f=the-owner�has�htre�d'�a�_contractar or
contractors to undertake work, tFrey may:be.:reiquired:_to;:be,licensed'in=acco�dance:with-state.and:local..cegulations:�,.Ifthe���°• ° -� �
contractor Is-not ltcensed as�requlced::tiy lew,.tioth�the oumer and-conUactor��may�be�clted�for�a�mi"s'demeanor violation
under state law. If the owner or Intended;;contr;actor�ere,,uncertein as to wHat Iicensing.requirements�;may��apply`��for:-tFie��� �-•-��w��1
t,..,.,...
intended"work, they are advised to contact the Pasco County_ Bulldtng`Inspection..Divislon.-Ltcensing Section at 727-847-
8009. Furthermore, If the ovirner fias�hl�ed�a cond�acto� or contractors. he Is advtsed to have ,the contractor(s),,.sign, ,,�
portions of the"conttactor Block" of this.application.-forE:which�.they,wlll..be.,responslble.==If-you;as�_:#he owne�`sfgn'as�the '� '- � "
contractor, that tnayr be an indication that`he`ts not.propecly Iicensed-ani!`is�not'entitled to;permlEting p�ivileges In Pasco _
County. -- - - . , . .' ' - _ - , � ._ �_. .. .
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TRANSPORTATION.IMPACTlUT141TIES'�rMPAC'���ANb RESOUItCE RECOVERY°FEES: The understgned�understands
thatTransportation Impact'Fees and.Reco.urse Recovery.Fees may<apply�.to�tf�e;constructtor��of new:.buildings�,�change°�of�� `$��'°'�
use in existing buildings,�or,expansian.�of�}ezlstin;g.'�buildings, as specifled.in Pasco County Ordinance number 89-07 and
90-07, as amended.�.,The undetsigned aiso:-urtderstands, tha�t:�such fees;aas�may_�e�:due;�wlll:;tie identified at the-'time�of�� � ���- �`
permitting. It is fu'rtFier understood that Tra�sportation Impact�Fees artd•�Resource.Recove�ry�`Fees..must be paid pr(or to
receiving-a 'ceKi�cate-of��occupancy"or flnal=power>release. :1�-the.project;;does•.not.involvesa�certificate of o�cupancy��or�=�='�--����' •�
flnal power release;-.the<fees mu�t`be patd;prfor,to;permit issuance. F��thermore;if:Pasco,�C,ounty�Water/Sewer�;lmpact� •� < . ,
fees are due,..they_must b'e-'pald.:p�idr to permit_�Issuance,In:accordance.wltff.appilcabFe.Pasco�Countji ordinances. -
CONSTRUCTION"LIEM`LAW'(Cliapter 713� Florlda Statutes�aa�amended): li valuaHo�.of work is$2�500.00;or moce; I� �
certify that I, the applicant,��have•.been-.provided:-�wlth'--a=copy�of;._the "Flo�ida Consfructton� Llen Law—Homeowner's
Protection Gutde" prepared by the Flo�da Departm�ent�of Agrlc.Wtnse and-Consumer.Afhairs. If tMa epplicant is;someone -
other than the"owner", 1 certifjr�:that,I�h�ve.,obtained�a�copy.of..the=abvve.descNbed:docuii�ent°and:pr.ori�lse;,in;good�.fa(th to
deliver it to.the"owner";:p�ior-torcomri�encementc��� � 1. �,. ..r.... - �.; - �
CANTRACTOR'S/OWNER'S AFFIDAVIT: I.ce.ct(fy��.th:at;all-,th�,informa8on.ln�thi� application Is accurat�and that all work
will'be done in compltance w(th all.appitcable�laws:regulating construction, zoning and:,land°�alevelopment. Application is
hereby made to obtatn:.a permit�,,to do.:work;�,,and�Insfellation as Indi�efed:��'I ceitify�that no work�ror installation fias' �
commenced p�tor to Issuance of'a permiC'and that.ali�work will be pertormed to meet-standards of all laws regulating-
construction, County and Ctty codes, zoning regulatians, and land development regulatlons�tn the Jurtsd(ction.= I ai'so
certify that I u�derstand that the regulattons of othe�goyernment agencies may�apply�to�the interided.work, and that it ts
my responsibil(t�to identify•what,�ct(ons I must-take;to be,In:.compllancs;,.S.uch.-agencles.include�but�are.not Iimtted to: : �
- Department of E�lvironmental=Protecfion=Cyp�ess. Bayhead�; Vl/etland Areas and Environmentally Sensitive
Lands,WateHWastewater Treatment. -
- Southwest Florlda Water Management�•.II�isUict,Wells;' Cypress.Y Bayheads; Wetland' Areas, Altering
Watercourses. - - � ��
- Army Corps of Engineers=Seawalis, Docks, Navtgatile Waterways. � •�� �"�`
- Department of.Health:_8 Ret�abilitative;ServiceslEnvironment�l�=.Health Unit-Well.s� Wastewater�Treatment,
S'eptic Tanks:. ° . . .. � �. -- : .
- US Environmental Protection Agency-Asbestos abatement.: , ' , •� -
, Federal�Avlativn:Authority.,=Runweys:� � ' - - � • �
!understand that the.follouving;restrictions apply to the use of flIL•• � .
- Use.of:iill is`n�t allowed�in:;Flood;Zone W unless expressly permitted. � � �
- If the flll mate�lal-is-'�to�be used: In .Flood Zone. "A", It Is understood that a drainage plan addressing a
ucompe�tsattng valume"-��►rill��be submltted at:#ime of:permitttng wh(ch ts prepared by a professlonal englneer
Iicensed by the�tate of?Florida. , j �i � � -
- !f th�.flll material-.is to.be:u5ed (n Flood Zone 'A" in��connectfon�wlth�a,permitted,buHding.using stem wali
� consttuction� I certify.thaf flll:wall:b.e�used;only�.to.flll the area withih`the�stem�wall: � � `
- If flll materlal-is to be used in anjr .area; k�certlfy that .usa of�such flll will..not adyersely affect ad)acent
properties. If use of fill is,found�to.adversely:..�ffect adJaeedt�properties,.the owner may be cited for violat(ng,
the condWons.of the building;permit„Issued=under the.attactied.permit applicatlon;�for:lots-�.less�than.one (1)
- ac�e�wtiicfi;ere elevated<tiy iJit;a�t.engineersd dralnag�plan is required.,, . � - ,
If I am the AGENT'F..OR TNE OWNER; I;pr"omise In good_faith to i'nfoem fhe owner of�the permitting conditlons set forth tn
this affidaVtt'prior to commer�bing construction. I understand that;a;aeparate permlt may be requlred for elecMcal'work, _
plumbing, signs, welis,:pools;, alr.conditioning,�.gas,`.;or otkier Install�t(ons not,spec�tcally Included:tn.the application. .A
permft Issued shall be construedto'be°�a�license�to=proceed with`tFie_work and not�as:authoHty�to._vlolat�,`cancel, alter, or
set aside any pfovistons of�.the technical c�odes;�nor shall issuance•of a.permit.prevent the�Bulldirig O#iiciai from.fhereafter
g � ' p ', ",�� � olatlons of�any codes: :Every'penntt issued�sliall become.invalid
requirin a correction af eTrors in: ;lans; construction.or,vi'
unless the work authorized.by such permit:�ls.commenced�within sGc months of permlt issuance. or tf work authorized by
the permit is suspended�or-.abandoned=for:a:period„of�six�.(�)"monft�s.after the;tirt�e the�wo�k��s commenced. An extension
may be requested� In writing,_f�om.tFie,�Building,Offlcial�for a perlod,�not--to exceetl:ntnety=(90)days a�d�vvill'demonstrate
Justifiable"cause for.�the extenslon�. If work ceases.tor'nine,ty.(90)cons.ecutive�days,_th\job_is.constdered aba�doned.
VIlARNING TO OWNER: YOUR..FAILWRE,.TO..R�C.ORD;�A:..NOTICE OF��COMMENCEMENT�.NFAY=RESULT IN XOUR
PAYING TINICE;FOR�IMPROVEMEN�S T0 YOUR�;P�PERTY:-rl�°YO.U;IN'FEWD:T�'�OBTAIN�fIf�tAI�E1NG;�C.ONSULT
WITH YOUR LEND�R�OR AN�1TTORNEY$EFOR��R��4�IImSa�YOd11�'NO'�ICF"OF.=C�1�11171ENCf�'IENT' '
FLORIDA JURA�(F.S:1. .03) • . ` .�: ,` , : . _ , . � - � . _
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OWNER OR AGENT CONTRACT
S acA"ed artd sxrom, (or afll ed)b re me fhts Sub �Ibe 'end'swom- (or a Rn ' me' I$
vli�' s1 - ' by ' � � •by -
o I are personally novm b�me or aslhave.produced ers own•M: . :or hes/heve��roduced •�
-1-� � as Identlflcatlon. as tdendflcaflon.
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Not�ry Public . Notary Public
��U��(2,(�S� Comr�Isslon.No. � �0 S
Comm slon No:° �
..............
Name of No -�,,,n or s amee Name of Notary typed,printed or atamped �_�' ��:_ RY AL G ROVE
CRYSTAL GROVE �
� ='`2°, � ��`��; °' � �= MYCOP�IMISSION#FF046058
�'� = MY COMMISSION#FF046056 =� o`�
tN�9jFOF�e�oP�� EXPIRES August 15,2017 ''.',foF:��"•' EXPIRES August 15,2017
(407)398-0153 FloridallotaryService.com
(407)398•0153 FloridallotaryService.com
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' City of Zephyrhills
� BUILDING PLAN REVIEW CONIlvIENTS
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Contractor/Homeowner: � IY�Z {�.��
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Date Received: / ��'7 / /'7
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Site: � ����� � YVI l�1/1P �f o��
Permit Typ�e: j")') -
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Approved Iw/no comments: Approved w/the below comtnents: ❑ Denied w/the below comments: ❑
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This comm i t sheet shall e kep with the pennit and/or plans. i
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Kalvin wi er Examiner Date Contractor and/or Homeowner
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01/10/17
I,�Larry W BJ Booker, give Maria Santos permission to apply, sign, and pick up permits
in City of Zephyrhills in my behalf.
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Please remove Keri Peacock from my authorization list.
� Thank you,
�,
L�larry W BJ Booker
BMI LLC
8 i 3-714-1476
,I�;,.
;-=�`'ji�P"8��-: CRYSTAL GROVE
€ MY COMMISSION#FF046058
yNA., .re
`-•.",rFOF�:o?� EXPIRES August 15,2017
(40y)398•0153 FlorldallotaryServ'ce.com
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B i I LLC"39838 Stewart Rd.Zephyrhills, FL 33540'813-714-9508"813-714-1476"BMIBJBooker@gmail.com
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PERMtT WORKSHEET
PERMIT' NIUMBER � � .��asa 1 of 2 �
Installer ���(�� • Llcense# �Q New Home (� Usad Homs [�
Home Insfa(led to the Manufacturer's Installatlon Manual �'
Address of home ��]��� t��S L1�C�vV� �V�e Lo�� 0'1 g�J
being fnstal[ed Home is Instalied•In•accoMence with RUIe 16-C ,�
.�����~ :�\5 'Singfe wide
Manufacturer '-- � �nd�ne!I � W�n��ne tif •(] •
�Q��p n Length x wldth 3�x(,��q� �� Double wide � • . •
NOTE: • /f home�s a single wlde P!!I out one half of fhe blockl f nstallation becal�f
!f home!s a tr/pla or quad wlde sketch fn tvmafndsr�h lt$�ne � • Trfpie/t�uad ❑ ���#
{ahderstand Laferal Arm Systams cannof be used on any home(new or used) �e� �,�«, � +
where the�sidewall tiea exceed 6 ft 4 fn. PIER sPqCINo,T/acceC,�FOR LI5ED HOMES
InstaAet's(nitlals �� e
Typlca(pfer spactng Load Footer �"�— . , •
' be�dng slC@ 16"X 1$" 191/2"X 181/2" 20"X 20" °22"x 22"' 24"X 24" 26"X 26"
2� ��� Werel �P�tY ��1 fn) (256j ��2) (400) (4�+y� (5rs)` (8T6)
I - Show locatfons oi Longitudlnal and Laferal Systetns s •
, b„o�� {use dark Ilnes to show fhese�ucaticros) 2 S e
oU S � g $. 8 8
, � Interpofatedfirom Rule.95G1 plerepaclnq tabla.
PlER PAD s(ZES • OR �
A
I-beam pler pad slza CJ' � '
e ze . n
� Perimeter pfer pad s(ze . �'^� X'
. r� . . � .
--- --�--------- other pter p .
�'" " - _ r��'�--------��r7f-�-�-�._ ad sizes � � • •X '.
-----^ �^- (requlred b�th�rr�fg.) / :X
i,�orS O�->!� x, �.
Draw the approximate locatlohs of marrlage � x
� � wall opentngs 4 foot or greater. Use th(s
�As Wall pl�n W1thN7 0}et��}�hte pa e'ISC CI1b0�'�0 X
SY shOW fhe 18r8,
p , x.
Ust aIl m x
arrla e waii o e
9
p ntngs greafer t
han 4 foo
and fhe � • t x�
ir•pler pad sizes betow,
opentng Pler pad sfze . ��oRs ,
_—� � � 4�-.�1,S fE_ .
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— _.Q �� r�• � . FRAMH ilE3 ~.
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^' � wfthin 2'af end of hd
' L spaced at 5'4"oc�^ •
'- - -- ----
•' 'i'IEDOWN COMPONENTS OTHER'47ES
--------- ----• ------_----- =-
- _ --- - — Mang udlne�SlatiltWng Device(LSDI-- - -Sfdewall Nullmbar - -
�, �o� v�ln�� !!1 n Devlce w L'at �0ngitudinal ' '�—
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Manufact , Marria e
urer Shearwal Wal(
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PERMI�'WORICSHEET '
page 2 of 2
PERMIT NUMBER .' �
. .
OC R T S Slte pre aretlon
The pocket panetrometer.tests are rounded down to�_ � Deb�fs and organic materia!removad
or check here to declare 1000 Ib.soll w[thout esE 'ttng, p Watar drainaga:Natural Swale pad Ofher •
X�� X� X� aston n mu w a un .
Flooc Type F.astener. �►A. S Length: �� S�ac(ng; ��
POCKET pENETROMEfER TESTINO METHOD w���� Type Fastener. Length; Spacing: �
Roof. 7ypa Fastener. Length: 3pacing: 1 ��
1, Tsst the perimeter of fhe home at e locatlons, For used homea a 30 gauge,8 w de,gaivanlzed'metal a p `
wili be centered over the pe�k of fhe roof end fastened�wlth gafv.
2. Take the reading at the depth of the footer. roofing nai(s at 2"on center on both sldes of the centetUne.
� ' 3. Using 600 Ib.Inorements,take the(owest Q�k.t w..tn. aofln � fnM�n . '
reading and round dourn to that Increment � I understam!e propariy Instelled gaeket Is a requirem�nt of atl new and used
homes and thaE oohdensatbn,mqid,meldsw and buckled mariiage walls are
x�� X i1R„�. X�� a result of a poorly Instaited•or nc gesket being ihstalted. t uhderstahd a sfrip
•��V of teps wll!not serve as a gasket,
O P oH S Ihsta(Isr's lnifials �_
The�esuits of the torque probe test ls,��_(nch pounds or check TYPB Aasket �ny���: , .
here tf you are dedaring 6'anchors wlthout test(ng A test �'---- 8etween Floors Yes >f
showtng 27b Inch pounds or less w111 requin C�'foo!an`Tors, •gBtween.Wal(s Yes
Hottum of Ndgebeam Y,.,� •�
Nofe: A atate approVed later�!atm sysfem Is betng used and 4 ft. v : •
anchors are allowed at the s(dewall locatipns. I understand 6 ft weathe roof[n
anchors are requlred at afl centetiins tle polnt�where the torque test �
reading Is 276 or leas ancl where the moblie home manufaclurer may The bottomboard wlp be repafrecl and/or feped. Yes X p ,
re�uires anchors wfth 4000 Iding capacfty. Siding on uNte Is tnstalled to manufacEurer's spectflca ions.� es�_ �
Installer's tnlE(als Ffreplace chknney�tnstalfe�So es not to aitow infrus(on of rafn water, Y e s
A L L T E S T S M U S T B E P E R P O R M ED BY A LICENSED INSTALL�R
Mlscel atl�oua
Installer Name Skirttng to ii�instaUed. Ye�_)� � No "
Dete Tested • Dryer vent Inst�lled outstde of s g, Y""3{'-- WA• �
� Ra�,ga aownnow�er,t inst�iea o�t8iae oi 8kirnr,e:Yes�wq
Dtain(tpes sUp�O�{�at�4 foot itttervals. Ye§�_
Ele�hica�cnossovers protected. Yes,�� �
• eatrlca Qthe1': ,
. Connect elecWcal oonducfors be�ween muttl-wids ut�it�,but not to the ma(n power ' "'
Y source. Thls 4ncludes the bonding wire between mult-w(de un(#s. Pg,_ �"'-
• Installer verliles all Informatton•given�wtth this perm[t worksheet
• umb ntl Is-accurate:and=�rue=based=on=the
------- -- -- - -—-
_ Connect all sewer drains to an exisqng sewer tap orseptic fank Pg. manufacttnsr's tnstallation instructtans and�r Rule 15C•1'&2
Connect all potable wafer supply plptng to an exis�ng water meter,water tap,or other �nstaller 8(gnat Dafe �l/��
. Inilepandenf wate�suppfy systems, pg. / /
62'-8"
H05T UEAM-SPEClAL STIiAPPING qQ'•O.C.MAX_STRAP SPACING
ANO 5PECIAL Bl0[NING HEqUtREO (LLOOR UEPApf.•TIE-�OIYN STflAP5]
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ONE-0IAIF i11E ALLOIY[Il PI[It�PAUNp S�F"O.[.MAX.4PACING
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���, ••5PACING CI�ANGES W�TH M05T BEAM, ON PAGE 2 OF 2
EXP05URE 0.ANO'HIGI1 9(fIP'OFF5Ef5.
6EE 9ETUP MANUAL FOR 5PECIFlC9'�•
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5EE NOTES ANO TABLES ON PAGE 2 OF 2 IRPIM{liq MMNIw I9
REFER TO 5U-07-0005 FOR n�a•o.nrwurananra�ni
SEE WAfiNING6 ANO CAL7TlONS ON PAGE 2 pOO•L PIEH REqU1REMENT5
❑�Q� JACOBSEI�I HOMES TNR-34,645 ,��
NEFER Ttl 7HE JACOBSEN HOMN3 9EfUP MANUAL AN� JACOOBEN NOMES
❑❑.❑ P�BOX 368�600 PACKMD CT. AUOENQUM FOR COMPLETE IN9TALLATION 1N5TflUCf10NS TNfl•6563W-645
�Ak7�7Y I�ANBORr FLOliIM 3,i695
❑„❑ HLJD Wtl�lp ZONE-2
(7a71 T2B�119H THI5 BLOCKIIV6 OIAGRAM 15 P[tOV10E0 A5 A[OURTOU5Y�NLY:THE LICEN9�p 5ET-UP
. ❑❑❑❑ HUO WIND EXP05URE[ATEGORY�C CON7RACTOR SHALL NEVIEW TH15 OETAIL ANO VERIFY[OMPLIANC6 THE LICE•NSEO
W�VW�aChRRIQ�.MII� 34645 - PA6E 1 OF 2 5ET-UP[ONTflACIOR I5 RE5PON510LE ANO LIABLE FOR ALL 1N5iALLATiON.
fiEFER TO SU•OI-OD20,51J-�1.0021�ANp OTHER OETAIL9 IN 7HE 9NT-UP MANUAI FOft MAXIMUM NEIGNT
------(Tflt5=f5-NOT-OE5IGNEO�N�R-INTENOE0�=T0-BEA-5TIL-T-FOVNOATIONI __ .__
��Q� JACOBSEIV HOME5 WARNIntG:
❑❑■� PO BOX 368, 600 PACKAR� R'. =NBTAlLINO A MANUI'ACTURED STRUCTURR'/DUILDINO CAN s0 L`xTR�MrLY DANAeRous. ONLY
5AE'ETY HARBOR, FLORIOA 34695 4UAL[rIGD PGRBONNCL 9HOULD ATTCMPT TO INBTALL A MANUrACTURCD BTRUGTURc/DUILDINO�
IMPROP�R PROCCDUR�B AND/OR TOCHNIQUC8 COULD ReBULT IN SeRiOue SNJUR7 oR DeATH.
❑�,� IN ADDITION TO TFIG DANO�R TO P�R80NNL`i.� IMPROPGR e�TUP/1N8TALLATION COULD RCSUI.1 �
['J27] 726�773Q IN �XT�N8IVGlCOBTLY DAMAOG TO THG DUILOINO/BTRUCTURG� NCV�R ATTGMPT INBTALLAT70N
II" 70U ARL NOT QUALI!'ICD AND/OR DO NOT HAV� TN� PROPG'R TOOLS AND/OR COUIPMENT. S
❑❑❑❑ www�ac�homes�.cam CAUTIOiv: � �W
MANUI'ACTURGD !lUSLD1N08/BTRUCTURCB CAN WL`IOH BCYRRAL TONB. [T IB VCRY IMPORTANT �^ I�fl z Z
COLUMIU INFO. TABLE COLIJMN PAO- MIN.51ZE5[lsq. in.] THAT ALL PGR90NNGL,ON THG JO6 81T�� D� qUALIPtOD AND pROP�RI.Y/ADCpUATCL7 TRAIN�D. �j 0
A BTATB LICtNSCD B�TUP CONTRACTOR IB It00UIRCD TO DG RGSPONSIDLG �OR ALL SAI'�TY CC z � � F
LOAO 1000 /500 2000 2500 3000 95D0 INITIATiVGB, PROORAMS, PoI.SGIqB, AND/OR PROC�DURGS THAT MA7 DG MANDATGD 6Y OSHA y,� �w �
[OL.IUUM. SPAN F�
�wrnuaum nnnon o•�nau n.ryun ��eroaa p�tfOLL ,.,.,�n�. AND/OR ANY OTHL`R LOCAI.� 8'CATC, AND/OR WGOL'RAL COD88 AND/OR RGQUIRCMCNT8. TNC a Q u �Q
CONTRACTOR BHALL INBURC/R�QWRB THAT 9AI`d AND PROP�R T�CHNIQU�e ARB UTILIZCD. '�� �
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51ZB [sq.i�l.] 1UDp 1500 2000 250D 30D0 350Q 100U 150� 2000 2500 300� 3500 /000 15Q0 @O00 250� 3000 3500 �Uf z D�
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t�`�� 576 g . �f1. �4 115� t1ft0 NIO Nt0 N10 9� g6 96 96 96 9fi 96 96 96 96 96 96
i"'___" �— —LC— � _—_ __ ___——NIO==N10—=fYtO==N10==NIR— --——--------__--______ ___ ""___" _—_——__--__ _ ____ —__"_— __ ____ __ __
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GOPYRIOHT U �OiJ,JACODBGN HOMBB,BAFCTT HARDOR,rLORlDh N-� RSOHTB RCB�RVCD. NUD WINI]FJCPD5IJRE CA7[G�RY-[ 34645 - PAGE 2 O� 2
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� - � OLIVER TECHNOLOGIES, INC. - I
INSTALLATION INSTRUCTIONS FOR FLORIDA '�
MODEL 1101 "V" SERiES ALL STEEL FOUNDATION SYSTEM
PAN & CONCRETE (revision 6/07�
PATENT#6634150&OTHER PATENT PENDING '
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I "7�'A.�L�.A�SE�, �'Lm��. 32399-0SUO
Fi��D IQ A�[C�y.[1tiSON, III
Exccntii�D(rectar
; March 20,2002
ivlr.Bert A.�Moore,Financial Manager
i �anu.faciured Housing Foundation Systems
i Oli�ver Technologies, I,uc.
i Post Office BoX 9(46?Swan Avenue)
I�-io�er�t�d,'�'e�ow,essee 3�462
Dear�z. �oore:
i �
i We wish ta ackiwwiedge rec�i�t of yaur speci�cations and test x�esuZts c�
z�izzg tk�at
your Longztudinal�tabilizing and Lateral Bracing System, 1101 V, Ii.sted below complies with
I��speciTecatiorns axzd.xegt�ai�toz�s set by the DeparEment cYf Highv�rd,y gafety and Motor Vehicles,
�,�ules 15C-1.01o5, 15C-1_�ifl7 and 15C-1.U108,Flariday�,�imi,s�al��ve Co�e.
; In��allafinn�iz�stru�iioms x�nust be atirailabl�at the installation site.
Ii+�ODEL# DESC�tI�Tpl'SI
; 1101 V Long�tud.xx�a.�Stabilizin and T,ateral$
g raeing Systam
�OT�• 3'his syste�:� is.f'or�eplac�metzt of lor�gitudirla�ancbspps. Z'his system can only be
used tivftYr sid�w�tl anchor,sp��i�zg of S'4"_ Maximu�n str��t angle 4S°
I:f you b�ave ariy questions,please sdvise at(407) 623-1340.
Sincerely,
I • �+.� �
i �bz�Aexgekt,Pzograxu Mana.ger
Bureau of Mobile Home and
1Zecreationat Vehiole Con.struGtion
i P32B:srb
� Dzvision of Nlottir Ve�iCles
� DII�ISIONSI�.pRID�HiGH'W.�X 1P�,3'�20�. - D12LVER LiC�[�5E5 - i+�E)'�OR vEHIcr.�S • AinMnvlcS7[�8.7rJtvE s�R�zcEs
I�ieii �'skma»Bttilding, T311aM�sscF, �loridu 3:399-OSf�
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- page l
OLNER TECHNOLOGIES,INC. revision 6/07
FLORIDA INSTALLATION INSTRUCTIONS FOR THE
� MODE�1�01"V"SERIES ALL STEEL FOUNDATION SYSTEM
MODEL 1101"V"(STEPS 1-15)
LONGITUDlNAL OIYLY.•FOLLOW STEPS 1-9
, FOR ADDING LATERAL ARM:Follow Steps l0-15
FOR CONCRETE APPL1CA770NS:Follow Steps l6-99
ENGINEERS STAMP ENGINEERS STAMP
1.SRECIAL CIRCUMSTANCES: If the following conditions occur-STOP! Contact Oliver Technologies at 1-800-284-7437:
a)�Pier height exceeds 48" b) Length of home exceeds 76'c)Roof eaves exceed 16"d)Sidewall height exceed 96"
e)�ocation is within 1500 feet of coast
1NSTALLATION OF GROUND PAN
2.Remove weeds and debris in an approximate two foot square to expose firm soil for each ground pan(C).
3.Place grourld pan(C]directly below chassis I-beam . Press or drive pan firmly into soil unfil flush with or below soil.
SPECIAL NOTE:The longitudinal"V"brace system serves as a pier under Ihe home and should be loaded as any
other pier.It is recommended that after leveling piers, and one-third inch(1/3")before home is lowered completely on
to piers,complete steps 4 through 9 below then remove jacks.
INSTALLATION OF LONGITUDINAL"V"BRACE SYSTEM
NOTE: WHEN INSTALLING THE LONGITUDINAL SYSTEM ONLY, A MINIMUM OF 2 SYSTEMS PER FLOOR SECTION IS REQUIRED.SO1L TEST
PROBE SHOULD BE USED TO DETERMINE CORRECT TYPE OF ANCHOR PER SOIL CLASSIFICATION.IF PROBE TEST READINGS ARE BETWEEN
175I8 275 A 5 FOOT ANCHOR MUST BE USED.IF PROBE TEST READtNGS ARE BETWEEN 276 8 350 A 4 FOOT ANCHOR MAY BE USED.USE
GROUND ANCHORS WRH DIAGONAL TIES AND STABILIZER PLATES EVERY 5'4".VERTICAL TIES ARE AlSO REQUIRED ON HOMES SUPPLIED
� WITH VERTICAL 71E CONNECTION POINTS(PER FLORIDA REG_).
4.Select the correci square tube brace(E)length for set-up(pier)height at support location.(The 18"tube is always
used as the bottom part of the Iongitudinal arm). Note:Either tube can be used by itself,cut and drilled to length as long as a
40 i 45 degree angle is maintained.
I
,PIER HEIGHT 125"ADJUSTABLE 1.50"ADJUS7ABLE
(App'lox.45 degrees Max.) Tube Length Tube Length
,� 7 3/4"to 25" 22" 18"
I,I 24 3/4"to 32 1/4" 32" 18"
�� 33"to 41" 44" i 8"
�� 40"to 48,. 54° 18"
5. !n Itall(2)of the 1.50"square tubes(E {18"tube})into the"U"bracket(J),insert carriage bolt and leave nut loose for final
adjustment.
6. Place I-beam connector(F)loosely on the bottom flange of the I-beam.
7. Slide the selected 1.25"tube(E)into a 1.50'tube(E)and attach to I-beam connectors(F)and fasten loosely with bolt and nut.
8. Repeat steps 8 through 7 to create the"V"pattern of the square tubes loosely in place.The angle is not to exceed 45
degree and not below 40 degrees.
9.After al�bolts are tightened,secure 7.25"and 1.50"tubes using four(4)1/4"-14 x 3/4"self-tapping screws in pre-drilled holes.
INSTALL.ATION OF LATERAL TELESCOPING TRANSVER�E ARM SYSTEM
' THE MOOEL 1701'N"(LONGITUDINAL 6 LATERAL PROTECTION)ELIMINATES THE NEED FOR MOST STABtLIZER PLATES 8 FRAME TIES.
NOTE:THE USE OF THIS SYSTEM REQUIRES VERTICAL TIES SPACED AT 5'4".
� FOUR FOOT(4')GROUND ANCHOR MAY BE USED EXCEPT WHERE THE HOME MANUFACTURER SPECIFtES DIFFERENT.
10. Insl Il remaining vertica(tie-down straps and 4'ground anchors per home manufacturer's instructions.NOTe:Centerline
anc�ors to be sized according to soil torque condition.Any manufacturer's specifications for sidewall anchor loads in excess of
4,000 Ibs.require a 5'anchor per Florida Code.
11.NOTE:Each system is required to have a frame tie and stabilizer attached at each lateral arm stabilizing location.This frame tie 8�
sta�ilizer plate needs to be located within 18"from of center ground pan.
� 12.Sel�ect the correct square tube brace(H)length for set-up lateral transverse at support location.The lengths come in either 60"
' or 7�"lengths.(With the 1.50"tube as the bottom tube,and the 1.25"tube as the inserted tube.)
13.Install the 1.50 transverse brace(H)to the ground pan connector(D)with bolt and nut.
14.Slide'1.25"transverse brace into the 1.50'brace and attach to adjacent I-beam connector( I)with bolt and nut.
' 15.Secure 1_50"transverse arm to 1.25"fransverse arm usina four(4)1/4"-14 x 3/4"self-taaainq screws in are-drilled holes.
� I
OLIVER TECHNOLOGIES,INC. Telephone:93'I-796�-0555
1-800-284-7437 Fax:931-79s-8811
j � www.ofrvertechnologfes.com
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INSTALLATION USING CONCRETE RUNNER/FOOTER revision 6/07
16. A concrete runner,footer or slab may be used in place of the steel ground pan.
a)' The concrete shall be minimum 2500 psi mix
b) A concrete runner may be either longitudinal or hansverse,and must be a minimurn of 8"deep with a minimum width of 16 inches
longitudinally or 18 inches transverse to allow proper distance between the concrete boft and the edge oE the concrete(see below).
c)I Footers must fiave minimum surface anea of 441 sq,in.(i.e.21"square),and must be a minimum of 8"deep.
d) If a full slab is used,the depth must be a 4"minimum.
ISpecial inspection of the system bracket installation is not required.. Footers must allow for at least 4"from the concrete bolt to the edge
of the concrete.
NOTE:The boftom of all footings,pads,slabs and runners must be per local jurisdtction.
i LONGITUDINAL:(Model 1101 LC"V")
17. �en using Part#1101-W-CPCA(wetsetl,simply install the bracket in runnedtooter OR W6en instaliing in cured concrete use Part#
101-D-CPCA(drvset).The 1'101 (dryset)CA bracket is attached to the concrete using(2)5/8"x3"concrete wedge bolts(Simpson part#
S162300H 5!8"X 3"or Powers equivalent).Place the CA bracket in desired location. Mark bolt hoie locations,then using a 5/8"diameter
masonry bit,drill a hole to a minimum depth of 3". Make sure afl dust and concrete is bfown out of the holes.Place wedge bolts into drilled
holes,then place'1101 (dry set)CA bracket onio wedge bolts and start wedge bolt nuts. Take a hammer and fighUy drive the wedge bolfs
down by hitting the nut(making sure not to hit the top of threads on bolt).The sieeve of concrete wedae bolt needs to be at or b-low he ton
of"concrete.Complete by tightening nuts.
LATERAL:(Model 1101 TC"V"j
18. For wet set(part#1101-W-TACA)installation simply install the anchor bolt into runner/footer.For dry set instailation(part#110�-D-TACA)
mark bolt hole locations,then using a 5/8'diam.masonry bit,drill a hole to a minimum depth of 3". Make sure all dust and concrete is
, blown out of the hole.Place wedge bolts(Simpson paR#S'f 62300H 5/8"X 3"or Powers equivalent)into(D)concrete dry transverse
co�nnector and into drilled hole.If needed,take a hammer and lightly drive the wedge bolLs down by hitting the nut(making sure not to hit
the�to of threads on bolt,then remove the nut.The I v of c n e b I at r I w the to of n rete_
p ) s ee e o crete weda o t needs to be o be o o co c
19.Wli�en using part#110'i CVW(wetset)or 1101 CVD(dryset),install per steps'17 8'18.
Notes:
1. LENGTH OF HOUSE IS THE ACTUAL.BOX SIZE
2. � =STAB�I�R PLATEAf�D FRAI1�l7E LOCATfON (needsb
beioca0edwit�i�18 nd�eso�foen�roFgand panaoorxre�) .
3. � LOCA710N OF LONGtiUDINALBR�ICING ONLY
i 4. �TRANS'1/ER�SE&LONf',ffUDINALLOCATIONS
' �
REflU1RED NUMB�R AND LOCATION OF�II IODEL 1101 "V" OR 1101 C "V"
I ��►CES FOR UP TO 4/12 ROOF PITCH
ALL WIDTHS;AND LENGTHS UP TO 52'�
�
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• • • • • •
' � � � � � •
ALL WIDTHS;AND LENGTHS OVER 52'TO 80'
' • •
• • • •
• �
• • � • � •
• • • •
I � �
HOME$ WITH 5/12 ROOF PITCH REQUIRE: PER FLORIDA REGULATIONS
6 s„ystems for home lengths up to 52'and 8 systems for homes over 52' and up 80'. One stabilizer
plate and frame tie required at each lateral bracing system.
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Florida approved 4'ground ��� �' w�_„�._� page 3
anctiors may be used in a11 /� � revision 6/07
locations except where • � -r
home manufacturers specl- ��j� / �I �r �r•�!?'-� !
fications farsidewall straps ' � � � '}' ,: � • �
are in excess af 4,U00 Ibs. I-Transverse arm I-beam � ;.i�j=��i��;�:;��'�.�•� ,
These IopGans require a 5' connectar • -�'+=� � _�
anch�or.Per Florida Cade. i' • :� �y-Transverse ann
I ' � / . Top(1.25')
�r bottom(�.5') C=GROUND PAIV
-" %� / `�� �L D=GROUtJD PAN CONNECTOR
��'� �� 7 � -� �' U BRACKETSTRANSVERSE
�/ ' D-Ground F-:'V"brace I-beam � �
,.�j��' Pa� connectors � E=TELESCOPING V SRACE
� � transverse �Y/ � TUBEASSEMBLY W/1.5 BOT-
' �' ��oonnectors .1_ground Pan TOM TUBE AND 1.25 TUBE
I,.�.
� \� � v eracket INSERT
I F="V° BRACE 1-BEAM CONNEC-
' / TORS ASSEMBLY .
E-"V'Brace Tub � H=TELESCOPING TRANSVERSE
, / Top(t.zs^) ARM ASSEMBLY
Battom (1.5-)
�' I=TRANSVERSE ARM I-BEAM
• -Ground Pen CONNECTOR
�� - J=V PAN BRACKET
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Model # 1101 "V"
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I - eam a c amp
Altemate Hole for (7)PerAssembty
Longit de dry Narrower Beam Flange __
concre'�e bracket
part#i 101 D-CPCA , �� .
.. �
i �,:, � �i � Grade 5-7/Y x 1'
� Carriage Bott&Nut
Wet bracket part#
1101 �-CPCA flOt Grade g-1/2^X z v2• Model 1101 CVD
ShOWfI -`"� Cartiage BollB Nul
- _ I-BEAM CONNECTOR BRACKET Model 1101 CVW .
not shown
FFloridaapp�oved4•yround ••-�--�-•-•— C=CONCRETE FOOTER/RUNNER
Eanchors may be used in all �
_Ioca�ions e�eept where home D=CONCRETE U BRACKET TRANSVERSE
�manulacturers specifica�ions ,- . r. � ��� '��s � CONNECTOR(CoflneCtS witlt grade 5-112"x 2
efor sidewall slreps are In �� rJ /!�� I . � , 1/2""carriage boft 8 nut)
iexcess of 4ID00 Ibs.These ��- Transverse arm I-beam ;; li��li lil:l!t� i��? I
�Iontions require a 5'anchor. connecror W ` � _ _•.� __� E=TELESCOPING V BRACE
:Per FloridaiCode. , �H� 7rensverse arm TUBEASSEMBLY W/1.5 BOT-
E�Top(1.25') TOM TUBE AND 1.25 TUBE
i / �,�� bottom(1.5') , •; INSERT
,�/'/ / •.,. �; F="V" BRACE 1-BEAM CONNECTOR ASSEMBLY
/ o-con�reie �''� '�' (connects wilh grade 5-1/2"x 4"carriage boli
� I ' F-:'V'brace I-beam >
� i % U bracket ,.y mnaectors &Ilut)
/I /% transverse \Y/ H=TELESCOPING TRANSVERSE ARM
' �connectors ,J_Conuete ASSEMBLY
��!� � ��� �' v'eracket I=TRANSVERSE ARM I-BEAM CONNECTOR
� (connecls with grade 5-1/2"x 21/2""carriage bolt
`y / �• 8 nut)
E-`V'erace Tu " i �=CONCRETE"V" BRACKET(connects with
� / Top(1.25') grade 5-1/2"x 4"carriage bolt&nut)
��'�„j Bottom (1.5ry
'�i I
� ��: :
\ � Conuete
I ,FooteA Runner
d i
/ ` �``.\ I
Model # 1101 C "V"
OLIVER TECHNOLOGIES,INC. Telephone:931-796-4555
I 1-800-2847437 Fax:931-796-8811
� www.olivertechnologies.com
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II IIII'lllllllllllltl�llllll�lllllllllllllllllllllllll ', pSPt01002065 ITecO 0.00
2017010074 t Clerk
01/24/2017 K. D. K. , Dp y
I' t , ^� lQd �OOaC�O 3�y
� Pertnit No. Parcel ID No�''"1—o�S�1—� V � v
, NOTICE OF COMMENCEMENT
! State of Florida co��ty of Pasco
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
� the following infortnadon is provided in this Nodce of Commenceme�n7�r, ^ ^ �y�, '^
� 1. Description of Properly: Parcel Ident�cation No. ,��7`��o[�—�i.l '{�)������w`o�Qc�
StreetAddress:���aa� 1�/QSl�l�1 t�Q_ � fll�c�['7�'.�. Ze nhu�'h��`� �• t7�75�1
i 2. General Description of Improvement Mobile Home Install
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� 3. Owner Infortnation or Lessee infortnation ff the Lessee contracted for the improvemenF.
[ ;nclai�,���
I i"77o(�O Na�e�Ke.M �'VP•�'�' q3 G.PDLI.U�iu,G �
� Address City �� Siate
' Interest in Property:��P r
Name of Fee Simple Titleholder.
� (If different from Owner listed above)
Address gMl LLC �'�' state
�:� � 4. Contractor.
; "a`"8 39838 Stewart Rd. Zephyrhills FL
Address ���Y
State
Contractors Telephone No.. $13-714-1476
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No..
6. Lender
Name
Address .. City ! State
Lender's Telephone No.:
7. Persons within the Sfate ot Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(�,Florida Statutes:
Name
Address • City State
Telephone Number of Designated Person:
8. In addition to himself,the ovmer designates of_
to receive a copy of the Lienors Notice as pmvided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Qesignated by Owner.
I9. E�iration date of Nofice of Commencement(the expiration date may not be before the completion of consWction and finai payment ro the
contractor,but will be one year from the date of recording unless a different da[e is specified):
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFfER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. I
Uader penalty of perjury,1 declare that I have read the foregoing notice oi commancemeqt and that the facts stated therein are true to the best , I,
of my knowfedge and belief. „ ,
STATE OF FLORIDA �
COUNTY OFPASCO
,Signa re of Owner or Lessee,or ers or Lessee's Authorized
Offiqer/DirectorlPartner/Manager
l , ,�c� �c�f+�S -- C�t�n-�T
Sig�TNe/Office
The foregoing insWment was acknowledged before me thi� ay o C(.i 7 I ,ZO�by ���.� ���
� as (type of authority,e.g., icer,trustee,attomey in fact)for
�
am f b a om ins n wa ecuted).
I ,�!� �
Personally Known LTuR Produced IdentificaGon❑ Notary Signalur
Type of Ident�cation Produced Name(Print) C'rySt C.7fOV2
pq��q S IO'NE ,IL Ph D PRSCO CLERK�f CiMPTROLLER
01124/2017 03:28 m 1 2512 �°s'�YP°e���" CRYSTAL GROVE
Pn
948 PG =_° `�``
OR BK -• MY COMMISSION#FF046058
; - ;,. , ,o�_:
wpdata/bcs/noticecommencement�c053048 ,"•.',!eoF'r�°�;,•' EXPIRES August 15,2017
� (407)398-0153 FloridallotaryService.com
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' � ��s�
-1 - O COIJIIVTY, F'LORIDi4
1
; .. .. 9
' Permit No. ��Q �
` Date Permitted _ ,s-
} Z f
I ., �A --� n �---�—
� ? Builder Name/Owner Name �/v�� ��-C.�
� Control#
� County Parcel No, 3 _2$-Z�_ /`' JI� �
; - n�BO-U d Dd_�.�' ubDiv. (�ra�,� �(Ti�2.'�i'1S
� ` Address/Location �7�Z(� �,C� ��O M �(�-(� / ,-�- Z��
h.D
� � Classification/Type of Use �Q F�, ��. '�yv��
; .
! ? TRANSPORTATION IMPACT FEE
� � Rate: Sq Ft Unit: j/ ��Z.
? _—
Exempt � Yes � No How Determined
i ; Impact Fee Amount $ 3�p 3�. (jQ Zone No.
� __ TAZ:
; SCHOOL IMPACT FEE
� Account (056) Single-Family Detached House Amount _��
(057) Mobile Home $
i (058) Other Residential
' 123) Collection Fee
( Exempt (� Yes �] No How Determined
c
� ;
I � PARKS AND RECREATION FEE
� Land Account Land Credit Land Total
�
� i Recreation Account __ Recreation Credit
� � __ Recreation Total �
� � Zone
� I TOTAL AMOUNT $ �j 7c3, ��
� Exempt [] Yes [] No How Determined
, i
i i LIBRARY FEE
i i Land Account Land Credit
Land Total
� i Facility Account ___ Facility Credit
� Facility Total
( Exempt � Yes � No How Determined
( ___ Total Amount�
� � RESOURCE FEE
` TOTALAMOUNT ERU
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I Prepared By Checked By
I NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL(NSPECTION
PERFORMED UNTIl.THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
I RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not(mply acceptance of concurrence,but simply recelpt of a copy of this form,placing
� ihe building permit owner on nodce of this assessment and thQ conditions of payment for same.
� DATE
� �
i RECEIVED BY
' i RECEIPT NO __ pATE __ g�.
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� ' �-
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a PASCO COUNTY
, y�l� BUILDING CONSTRUCTION SERVICES
8731 Citizens Drive Date: 1/25/2017
�3 Suite 230
• � I-'�, New Port Richey, FL 34654
• , , i ` 727-847-8127
i � �c�c ��� � �!_� I 1 �ts'r
�
��� i
�� Record#: 06POS-00000�#0000
Aaplicant Information Contractor Information Owner Information
�
Proiect Information
Status:#POS Applied:04/11/2016 Issued:
Type:_PER TYPE Finaled: Expired:
Category:l�PER CATEGORY
Sub-Type� PER SUB_TYPE
Parcel Nu�mber: .
Job Addre�ss:
Work Description:
FEE DESCRIPTION ACCOUNT CODE UNITS INVOICE# FEE AMOUNT PAID RECEIPT# DATE
General B�ase Fee 6104-322000 1.00 1228477 $45.00 $45.00 1655512 1/25/17
Residentia�l Reroof with mitigation 6104-322000 1.00 1228477 $40.00 $40.00 1655512 1/25/17
State of Florida DBPR/DCA 8104-208003 1.00 1228477 $4.00 $4.00 1655512 1/25/17
I Surcharge
Unlicensed ContractorTaskforce 6104-322001 1.00 1228477 $5.00 $5.00 1655512 1/25/17
Surcharge
� TOTALS: $94.00 $94.00
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Receiut# Paid Bv Check# CC Auth# Cashier ID Workstation Receiat Date Amt Paid
1655534 Check 4538 177 BCCCP03W 01/25/2017 $57.94
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Total Payments: $57.94
Pavor Address Phone
BMI LLC;
Comments:
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37220 NEUKOM
LOT 293
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MyReports/reports//PRODUCTION/PASCO/ReceiptAA 1/25/2017 Page 1 of 1
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;. �RAND HORIZON HOMES LLC
- ���'�� � 7645 Green Slo e Drive, Zephyrhills, FL 33541
t►' "��;- P
i813-782-9866 Drivers�icense:State: �-�
DATE: /D S G Hirri: '""—�""
W.THIS CONTRACT THE W�ORDS,1�ME,AND MY REFER TO THE BUYER AND C0=6UYER SIGNING TFiIS CONTRACT.THE.IMORDS YOU AND.I
YOUR REFER TO THE DEALER,SUB,IECT 7`p THE TERMS AND CONDITIONS'ON PAGE ONE AND PAGE 7VNp(pAGE TiNp IS ATTACHED)
OF THIS AGREEMENT YOU AGREE TO.SELL ANR I AGREE TO PURCHASE THE FOLLOWING DESCRIBED UNIT.
BUYER: i,e/ ,q ,2 .
BUYER: - - DATE OF BIRTH: �
ADDRESS:3' 3..T �.- � _ DATE OF.BiRTH: �
GRAND HORIZON ADDRESS� ' ' -� PHONE: ��,��/ � 3 _
MANUFACTURER: � �"" �� ' �- L t# '
YEAR: p NEW: MOD . — I SERIAL#
.2 BEDROOMSt _ HOME SIZE=LENGI'M:
',COCATfON R-VACUE' THICKNESS �e oF wsui�anoN �DTH: � ` .COLOR: �
cet�iNG� 30 _ Blown -
�ERioR " �g � PRICE OF HOME: ��7 �
Fl.O:ORS ' �� Baf ._
THiS INSULATION INFORMATION WAS FURNISH DaBY THE STATE SALES TAX -
MANUFACTURER AND IS'IN COMPLIANCE VIATH THE FEDERAL CbUNTY TAX(IF qNY) .06 6 �� , •
TRADE COMMISSION RULE 16CRF,SECTION 46D.16 v'�l'3-0�
_ CITY OR COUNTY IMPACT FEES
CL SING SETTLEMENT DATE: TITCE;PROGESSING 8 DOCUMENT PREPARATION ���
ORIGINAL TAGS 8 TITLE FEES,
3TANDARD$PECIFICATIONS INCLUDED: � , �'r po-a� �
. �Concrete Driveways&Fiat Work•.Carport&Utllity Room �`TOTAL:CA pq�CE - �
/ .
�Skirting�Air Cond(Goning System wifh Heat Stri - '
���In-Ground Irri atlon:&.Timer■ p CASH DOWM PqYMENT `
; 9 Landscaping 8 Sod• - D D. D'v
SALESFERSON: Z.UNPAID BALqNCE OF CASH.3ALE PRICE
REI1flARKS: ' -
TITLE TQ SAID tiOME SIiALL REMAIN IN GRAND HORIZON HOMES,LLC,
•Homeowner is�esponsible for all utility cNarges 6illed in
thei�name. �NTIL THE AGREED PURCHASE PRICE 15 PAID IN FULL O IN CA$H OR BY
•Homeowner is responsible for sod$landsca in from TME�ECUTION OF q❑R�qIC INSTALLMENT CON7RACT,OR BY-A
the time of instaliation: p 9 SECURITY AGREEMENT AND ITS ACCEPTAfVCE BY A FINANCING AGENCY;
THEREUPON A TITLE TO TFiE WITH�N,DESCRIBED UNIT PqSSES TO THE
�Grand Horizon Homes,LLC:Reserves the right to the BUYER AS OF THE DATE OF_EITHER FULL CASH PAYMENT OR ON THE
finalidecision of home location on homesite. SIGNING OF SAID CREDfj�INSTRUMENTS EVEN THO.UGH THE ACTOqL
�Axleis,Hitches;Vl/heets,$Tires not incfudeil jn price, PHYSICAL DELIVERY MAY NOT.BE MADE UNTIL A IATER D
�There have not 6een any:oral representations made.to ATE.
coM�aus which are conVary to the information set forth in this You&I cem(y that Uie additional tertns and conditions printed on page hvp
ct and the accompanyin prospectus.
• ,I - of thfs cantract are agreed to as Part of fhis agreement;the��es if
GRAND HORIZON HOMES LLC o�R
pitnteii above ihe aignatur�es.I am purdiasing tfie above descn'bed unit;fhe
N07 VAUD UryLESg SIGNEp q�,�U ACCEPTEp BY AN OfFICER OF-TF1E COMPANy
� - opUona6equlpment,accessories and insurance,h�nd�dea,:yoluntarily,You
; and'I a8ree thafif any paragraph a�p�y�sion violates the law and is
i - uneniorr,eable;the rest of the conUaa will be veGd:
BY ', - �Thfs agreement confafns fhe entire understandln0 between you and me and
A p no.other represe�mtlon a�inducement,verba�or written;has tieen made
ECT TO ACCEPTA►dCE OF FINANCING BY BqNI(
I,OR � CKNOWLEDGE RECEIPT,OF A CORY OF THIS ORDER AND-rs not containea in ihis contract
lJ IDERSTAND THE SECOND PAGE.OF THIS AGREEMENT: �T�' OR WE,HAVE READ AND
SIGN��D: ,Q�
II � �� �� \`�-$r� 'SIGNED:
OCUILSECURITYNU ER: -
� . _ SOCIAL SECURfry MJ(y�BER- -
; � Page 1 of 2 -
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`�` ; ATlDITIONAL TEI�:MS AND �ONDITIONS.
-, GRAND HORIZON HOMES,�,r.c.
' ! Home Contract Page 2 of 2
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In#his contract tlie wards,T,me,and my refer ta the Bpyer and Ca-Buyer signing this contract.l'he words you,and yaur refer to
the Retaiier.I further agree(continued from other side af Gontract):
1) IF NOT A CASH TRAN�ACTIOl�T. If I do not complete tlis purc3�ase as a cash transaction,I will,before the time of
ctelivery of the unit purchased,enter a retail'mstallmant cantract and sign a security agreement or otfier ageement as may be
reqaiced to finanee my purchase.
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2) FAILURE TU CQMPLETE PURCHASE, If I fail or refuse to complete this purchase within the time frame speci�Zed by
the agreed upon teriris of this contract or as speci$ed in the Uniform Commerciai Cade of the stmte of your jurisdiction ar within
att a�eed upnn extension of tiine,for any reason(ather tlian cancellation because of an increase ua price},or aftar financing is
appro,ved by a tender,ar aftsr residency is.approved by the comrriunity agent,then all deposits become non-refundable ancl are
forfeiteil.I understand yau sha11 have all the rig,hts of a seller upon breach of contract,unc3er the Uniform Cammercial Code of the.
i7nifoim Sales Act(as applicable).In the evenE legal action is brought by the dealar for the enforcamant oftlie terms of this
agreement or that the purchase agreement skall be refened to an attorney wha takes action in any manner to enforce said
=agreerrzent,purchaser agrees to pay reasonable attorney fees and court costs incurred by the dealer.
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3) CHANGES BY MANUFACTURER. I understand the m.�wufacturer may make any changes in the modet,of the designs,.or
any accessories and parts fiom time to time,at�d at any time.If the manufach�fer doss make charzges,neither you nor the
manufacturer are abligated to make t11e same changes in tl�e.tmit I am purchasing and covered by this order,either before or after
it is delivered to me.I recagnize that changes initiated soiely by the manufacturer will not increase the price of my mobile home.
I do recognize and understand,however,that if the manufacturer is required by Federal,State or Local governmental mandate to
�riaka changes in my manufactured hame,the cost incurred by the manufactui�er"in order ta camgly with snch governmentat
mand�te will be added to the price of my manufactured home.
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4) DELAYS. I will not hold you liabie for delays caused by tbe rnanufacturer,accidents,strilees,fires,or any othar cause beyand
yauc contral.
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5) INSPECTION, I have examined fhe product and find it suitabte.for my particutar needs.I have relied upon my own
juiigement and iizspection in determining that it is afacceptable quaIity.On the special unit ordered,I have relied on my
inspection of the display model(s},the brachures anii bulletins andlor the floor plans provided to you by the Manufacturer,in
inaking my decision to purchase the unit described on the reverse side of this agreemant.
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6} MANUFACTURERS WARRAIVTIES. I i3NDERSTAND TI�AT SOME STATES REQUIRE MANUFACTURERS
TQ ISSUE,AND DEALERS�'Q ENDOR.SE,WRITTEN WAR�2ANTY COVERIrtG NEW MANUFACTURED HC)M(ES.
YUiJ �WII�L ATIVISE ME 4F 7CHE'�'YI'E U�WARRANTY CO'VERING Z'HIS NEW MAN[TFACTUR�D HOME.
SEPA�ATE WARRANTIES MAY ALSO COVER THE APPLIANCES SOLD WITH THE NEW MANUFACTURED
HOIb�IE:THERE IS NO EXPRESS WARRANTY ON USED M[A;CIUFACTUI2ED HOMES.WI�iLE Il1+IP'LIED
'WAKI�2AlYTIES QN NEW AND/OR USE�?1VIANUIFA,CTURED�-IOMES MAY BE REQUI�tED BY STATUTORY LAW,
YQLT WdLL NdT PRQVIDE AIYIr WRITING It�+GARDIlYG IMPb.IED Wr�RRANTIES.
7} DE��I'�EIdY AND PLACEMENI'. Delivery and placement ofthe unit purchaseii is iitctuded in ttte pnrchase price.
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8) A/G"AND INSTALLATIOiY: A!C with heat,stcips and installation af unit is inctuded in the pwchase price.
9} IN-GRUUND ERRIGATIUIV,,SOD,AND LANDSCAPING. In-graund irrigarion,Sod,and Landscaping zs included in ttie
purcltas�e prioe.
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10)INSURANCE. I understand that I am ttot covered by izisurance on the unit purchased unril accepted by an insurance
company,and I agree to hald you harmless from any and aii claims due to Ioss or damage prior to acceptance of insurauce
coverage by an insuranee company.
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lIj COI�TNECTIONS,P�RMITS'ANT?CHANGES. I undersTa�d that you are not pemutted to make pIumbing or eIectrical
connections or conuection of certain natural gas or propane appliances where state or tacai ordinance require a licensed plumber
or electrician do this work.I understand that yau are not responsible for obtaining health or sanitation permits,nor£or any laca3,
county,or state pezmits required by s,p}ecial building ordinances oc laws.
� � ,�f'� /�" o.�� - ��--
jp�� �� '"— `—` '�" �J~�f~�� "Bssyer's tnitiat 8uyer's Initiat
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Jacqueline Boges
From: i FATHOM<support@gwfatham.zendesk.com>
3ent: , Wednesday, January 25, 2017 12:19 PM
To: ( Jacqueline Boges
Subject: [Request received] New water meter service for 3722q Neukom Ave Lot 293
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##- P(ease type your repiy abave this line -##
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Nello .lacquefine Boges,
We are warking to resolve your request promptly and will keep you updated. One of aur Support Analyst will keep you
update�d on the pragress of your request.
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Best R;egards,
FATHOIM Support Team
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T'O ADR'J ADRITIONAL CC?MMENTS, reply to this email or dick the link below:
https:/I(gwfathom.zendesk.com/hc/rea uests/114914
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� T' ' �acqueline Boges
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— � -' jan 25, i 0:1 1 AM MST
Customer purchased new MH in need of new water meter service for 37720 Neukom Ave Lot
293 in grand horizon
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_ �.._ _._. . ___ .._---- -_ _.... �_ _ - ------ --�----- - - -.._ ._� -- --- �--_ _. _ �_._._..____ __..___- _
This e I ail is a service from FATHQM.
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Jacqu,eline Boges
From: � FATHOM <support@gwfathom.zendesk.com>
Sent: j Wednesday,January 25, 201712:15 PM
To: � Jacque(ine Boges
Subject: [Request receivedj New irrigation service for customer @ 37220 Neukom Ave lot 293
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�##- Ple,ase type your reply above this line -##
Nella Jacqueline Boges,
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We are� orking ta resolve yaur request pramptly and will keep you updated. One of our Support Analyst will keep you
update� on the progress of your request.
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Best Re'gards,
FATHOM Suppart Team
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TO ADCJ A�DITIONAL COMMER3TS, reply to this email or cEick�he link below:
https:/�awfathom.zendesk.com/hc/re�c uests/114916
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- � : Jacqueline Boges
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'----j- Jan 2S, 10�14 AM MST
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, customer is new and in need of irrigatian meter far mh set up in grand horizon at 37220
( neukom ave
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This email is a serviee from FATNQM.
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Jacqu�line Boges
From: � TQ Randolph (FATHOM)<support@gwfathom.zendesk.com>
Sent: Friday, January 27, 2017 2:09 PM
To: � Jacqueline Boges
Subject� [FATHOM] Re: New water meter service for 37220 Neukom Ave Lot 293
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##- Piease type your reply above this line -##
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Your request (#114914) has been solved. TO REOPEN THIS REQUEST, reply to this email or click the link below:
https://gwfathom.zendesk.com/hc/requests/114914
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�----� ;
� +.-� � ' TQ Randolph (FATHOM)
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�—�' Jan 27, 12:08 PM MST
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COMPLETE 90371 7-2465969
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� Best Regards,
� TQ� FATHOM Support
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� FATHOM ZenDesk Support (FATHOM)
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--- -� Jan 27, 12 08 PM MST
� GIS has been updated to reflect the account.
Thank you.
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j -Bill
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i _., ; Jacqueline Boges
� —�-' 1an 25, 10 1 1 AM MST
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Customer purchased new MH in need of new water meter service for 37720 Neukom Ave Lot
I 293 in grand horizon
- -,- - - - - -- -
- -- -- - -- - - - - -� - � - - -
This e i ail is a service from FATHOM.
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Jacqueline Boges
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From: j TQ Randolph (FATHOM)<support@gwfathom.zendesk.com>
Sent: � Friday, January 27, 2017 4:15 PM
To: i Jacqueline Boges
Subject: [FATHOM] Re: New irrigation service for customer @ 37220 Neukom Ave lot 293
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##- Please type your reply above this line -##
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Your request (#114916) has been solved. TO REOPEN THIS REQUEST, reply to this email or click the link below:
https://gwfathom.zendesk.com/hc/requests/114916
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�;^;, � t TQ Randolph (FATHOM)
�---i' )an 27, 2 15 PM MS
! � � G���YI
Y , WATER ACCT NUMBER IS 2465969. CCOUNT NUMBER IS 2465979
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i THAN .
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IBest Regards,
� TQ� FATHOM Support
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" ' Jacqueline Boges
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�r�—' Jan 27, 2:05 PM MST
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( THANK YOU, HAS THE WATER ACCOUNT BEEN DONE?
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� � � ; TQ Randolph (FATHOM)
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L—��' )an 27, 2•03 PM MST
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i THIS IS THE IRRICATION ACCOUNT
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WATER ACCT 2465969
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Best Regards,
i TQ� FATHOM Support
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