HomeMy WebLinkAbout17-18417 „ v CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 18417
BUILDING PERMIT
PERMIT INFORMATION LOCATION�INFORMATION
Permit Number: 18417 � Address: 38844 5TH AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. I,
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: '�,
Square Feet: Subdivision: ZEPHYRHILLS COLONY
Est. Value: Parcel Number: 11-26-21-0010-17300-0010
Improv. Cost: 4,000.00 OWNER INFORMATION
Date Issued: 4/28/2017 Name: CHAMBERS TIMOTHY
Total Fees: 82.50 Address: 38844 5TH AVE
Amount Paid: 82.50 ZEPHYRHILLS, FL. 33541
Date Paid: 4/28/2017 Phone: 813-997-449
Work Desc: CONSTRUCT DECK& SCRN ROOM 16 X 18
CONTRACTOR S APPLICATION FEES '
HOMEOWNER BUILDING FEE 82.50
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Ins” ections Re uired
F TER 2ND RO GH PLUMB I C IN LATION CEILIN
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY-
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local 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 maybe 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.
"Warning 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 Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
I �
CO RACT --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 REVIEyV COIVIlVIENTg
Contractor/Homeowner: T//�JaT/�� ��}/yI��,C��
Date Received: ,������
Site: ��•� J.�h �t� .
Permit Type: ��-� � �� ���
Approved w/no comments;❑ Approved w/the below comments; � I�enied�,�,�the below comments: ❑
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is comment sheet sha11 be kept with the pemut and/or plans, � ; �
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��5���'— 1 xaminer Date Contractor and/or Homeowner
(Required when comments are present)
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813-780-0020 City of Zephyrhills Permit Applica#ion Fax 813-T80-0021
Building Depa�tment
( Date Recetved � [ 1`T�� � � Phone:Cantact for�Permitttn I� � � — �t � �
I /� / �/ L/l
Owner's Name {.,;,_ — � Owner Phone Number l � l I l .
Owner`s Address ' ! � � v �� Owner Phone Numbar �� M�
Fee Slmple TlNeholder Name �(� t,..�lT.�l/vi��'�J� Owner Phone Number �— �
� . .
Fee Simple Titleholder IAddress � 7J� -! �� � l/�� — l ���J �+� ��� /
JOBADDRESS � � L( ��� �� Z` / I�GS �L'T I.OT# �_�
SUBDIVISION �� � P.ARCEL ID# ��—�� -'�j— �lp— /73�'QO/�?
(09TAINEO FROM PROPERTY TA%NOTICE)
WORK PRBP�SED _NEW CONSTR ADD/ALT Q SIGN` '[� [� DEMOCISH
'.:.e: INS7ALL 8 ,, REPAIR
PROPOSED.USE Q SFFt C} YCCIMM Q {?TH5i2
TYPE OF CONSTRUC'f70N Q BLOCK ' �` FRAME � STEEL Q
DESCRIPTION OF WQRK ' ���� '� ,..„7�� 11�� ( ..r� j �. I� r
BtliLD1NG'SiZE' � �'SQPOOTAGE��1. HEIGHT ���
�B��L����' $ L� fj�� � VALUATION:OF'i'OTAL CONSTRIJC'TION -
LJ L
QECECTRICAI. ($ —�� AMP SERVICE Q PFtQGFtESS ENEf2GY [� W.R.E:C.
�
�PLUMBING � �
Q MECFlANICAI. ��, VACLfATtON OF`iV1ECNANICAI.INSTALLATION' � �,E�L���
lJ l �
QGAS Q RQOFtNCa Q SPEGIAL'fY � OTHER
FINISHED FLOOR ELEVATIONS �_ � FLOOD ZONE AREA QYES NQ
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� BUIIQER � � ,,�/ �OM�AtdY•' t�/�� l�v L-
SIGNAI'URE REGISTERED Y/ N FEE CURRE� Y/N
'� ,, , , .
' Addre�s ' � � � . Cicense#�"� �
El.ECTR{CiAt+1; COMPANY' - "•:. '�: ;;`� . ' , . .
$IGNA7URE � REGISTERED Y/ N F�e GUFtRE���� �•��-Y/N
Addres� � ~ . , - , �, �.- . License.#_,�."'��. �
PL!lMBER ` COMRANY 1 .._ �.- . -- . '
SIGNATURE REGI3TERED Y/,N� ;F.,EE CURRE� Y�/N. ' ,
� €...'� . _
Address � � License,# �� . � -
MECHA1+ItGA1:` -, � COMPANY , � , -.
SIGNATURE ` � ' � Recist�Ren Y./ N � . ��E Cuwt�n.•. -. .Y./:N _
Addre'ss`� � ,, ° �� ` - =" � � License# � . .�: . , � .,
OTH�Et � � �;�GOME�ANY -
SIGNATURE = � ` � REGISTERED Y/ N,. ��FEE CURRE� � Y/N
Address� ' - . � . � • � Cicen'se# � ` �
RESlDENTIAL°>- :At#acti"{2}�Pto.fPlans;�{2)se#s:o�:BuildingPlan's;(1)sefofEnergy�Faims;'R=t}`=W�Perirtltfor';reewcanstructton, �
, �:,:>Minimum,ten;,(�1,0):warking;daj,rs_:atte_r,:"submifkal date.�.Requlred onslte,:Constructlon=Plans;Stortnwate�'Plans w/SIIt Fence fnstalleii,
�� �? �Sanitary Faclltties�&w:1;;dumpste_r;�Site�Work�Rermit.for.su6diVlstonsnarge.proJebts,-,,.�>:.� � ' � �% � -� �
-. �> _�_�,
COMMEFtC1Al. At#ach(3)�complete sets bf Bultding Pians plus a-Cife'Sefe#y Page;{'1)set af Energy Forms.R t}-W Permit for new construc�on.
Minimum ten(10)working days afker submittal date. Required onsike,ConstrucUon Plans,Stortnwater Plans w/Silt Fenca installed,
Sanitary Facilides&1 dumpster.Site Work Rennit for al!ne+rv proJeots..All commerciat requirements.must meef compllance
. SIGN PER�411lt Attaciti(2)sets af Engirieerecl�Ptans:t = ,°°,: ., `
'••"PROPERT'SURVEY required fa�all NEW consttucUon.. _. •
Directlons: • �� � . � � '
FIQ aut applica8on completely.
Owner&Contraotar stgn back of appifca8on,notarized
if aver�2500,a Flotics of Commencement is requlrsd. (AlC upgcades over$7500j
a. ;,,.
"' Agent{for the contrdctor)'ar'Powrer of Attoriiey"(for ttie oJuner)�would be someone with natarized letter from owner autho�izing same
OVER'1HE COUNTER RERMiTffNG :�(Front cf•Applicat�on Only) - - "
Reroofs.if shtngles Sewers Service Upgrades A/C Fenoes(Plof/Survey/Footage)
_ . ,. . ` ..4�_:e mJ.ih..._s?YX>:i-:1 ...... .l.:s r . v s.._.'tS� ..
Driveways-Not over Counter if on pub�ic roadweys.needs�ROW„�„�.,,,-F.-^� ---�• :'� _„��;`. . ;�;;;;;;;,�=i.�.�;"w�1 �'
��or�.�v s4rw r,T , i : . ' .. r�,`:' e.
� as�+�,yAc,+sx • -•��:i.:it�.l�<::-' e:i�':` �' ���.i.f�:�� .%�:1t�i�.iiiGi.i�:.`�7.J.�.,' • 7
q t 1_i`;'�i.:�:'4 : .. . A . • : 3. :t.
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5 }.`f�::i.i i i ,ntiii:'.�r� s, 1'-•• , , i S�:" !1.:.,�i� f.,v . .a.,,X.a:,o':' ; �,��==�'-"'
� �l';Pp,'•;.dG:�,rp1i. �' ..i'-- ' � e,'�'ii�.,:i°,'.. -':�, 'G";",ii,.1��'_,c, . �... '��.
I � ., ..�,.. .. . �. .,.. "'Y: U�'. � ?} �-nw.x.c,-..w,.�,,,,�,..:j.,:xe.w,�.«, .n..._rr...e., e,o,.. ..,.�+;-� ,
� t,��� :iyY r:,,t ��,:�` ... ::.- _". ' � '
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NOTICE OF DEED RESTRICTIONS: The undecsigned:_undergtands:.th�t:this.�p{�rmit may:beysubject:to"deed"�;restrictlons"_�_.� �'',`�.,
which may-be::more�.r.est�ictfve�th��CounEy�cegulatCons:�The�:undersigned assumes'responsitiility'�for"c'ompllance witfi�any�`�' �� ��" ��
appNcable deed_rest�ictions. � = � � , _ � -�
UNLICENSED� CONTRACI'ORS:AND'CONTRACTOR�,RESPONSIBILITIES: �-=1f=the�owner has�hired°`a"contractor or
contractor ts not I censed askrehulred ti law�bofttithe.ownee a d"�vaordance.wlth state.and�local;regulation.s.:=1f the��' � °�°-
.,Y Y _ -- .
` " q y � ctor�may be�c(ted=for��a�misdemeanor violatton
under state law. If the owner or Intended�;contractor�are,;uncertaln as to what Ilcensing.requirements�may�.apply'•;for:tiie=�° - � �-
intended work,tHey a�e advised to contact the.Pasco�County Builiiing'Inspectlon,Divlslon--Llcenstng�Section at 727-847-
8009. Furthe�more, If the owner Fias�Filred a conuacfo� o� contractors, he Is advised to have the contractor(s)�sign._ . ,,; _
portions of the."contractor Block" of.thls_application.�for;which.ihey.wilL.be.responsible:-:�.lf-you,-as-#he oviinern'sign"'a§`the�� � ,'
_. .. _.. _�..�. __....
contractor; that tnay'be an indication that�`he-ls�noY:properly'Ncen"sed'and'�is'nof'entiNed to perinitting privileges In Pasco
, ...
County. - . :_,a,::=:;,: ,....,
. _ _ � _�.... .. .._.
TRANSPORTATION�IMPACTIUTILITiES=rMPAC�ANb RESOURCE RECOVERY FEES:'The undersigned�understands
that Transportatlon Impact Fees and.Recourse Recove.ry.Fees may:_apply�to�the;constructton,:of new_buildings,�change�of'�" '"�=� �'�
use in existing buildings,�or�expansian•�of�ezisti�i�'.6uildings�as spectfled.In Pascv County Ordinance number 89-07 and.
90-07, as amended,,:.,The undetsigned also:understands; th�t"such fe,e�;�,as��may:�e�.due;;wiil;;tie identifled at the'time°�of�_ =�°�'� �"
permitting. It is ftirtFier understood that Transportatlon Impact Fees and�Resource:.Recovery�Fees'.must be pald prior to
receivfng-a °certi�cate.of occupancy" or flnal,powec:release: :If�the.proJ�ct�.:does.not involve�a.certificafe of occupancy.�o��T=�'����'-�_"`
flnal pouver-release;:�the.fees-mu�t"tie paid�,p�lo�to apermit Issuance. Fu�thermore�if:Pasco,County�UVater/Sewer.s;impact � -�• ��
fees are due,they�must.be�pald:priorto,permit;issuance'in.accordancewith�applicable-.Pasco�-.County��ordinances. •
CONSTRUCTION LIEN-LAIN(Chapte�713� Florlda Statutes,�as amended): if valuatlon of work is�2,500.00:or more,.I � �
certify that .I, the. applicant;�-hav.e-been proylded with=a�copy of�the "Florida� Constn�ction�_Lien ;L�v�Homeowner's
Protection Guide" prepared by'fFie'Flo�ida Repartment�of Agric.ulture and ConsumerAffairs. If the app8cant is someone � � t v
other than the°ow�e�", I certi�r.th�t,:l have..obtained�a'=copy,of.the:abQrca�.described�docui�ent-and,.ptomise�.in,good:faith-to .. -..a
deliver ft to-.the.'ownec":,pr�or�to�commencementc�' " " � " � � �" - . _-
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certity,;th,at�all the,informaticm.ln�thl�applicatlon is accurate.and that all work
will'be done in compliance with all.appitcable�laws regulating construction� zontng and��land°development. Appitcatlon is
hereby made to obtain..a permit;,to>do woric:,and :instsllatlon as indt�afed:� :I: certify that no wo�k-=or (nstallatlon lias' �
commenced �p�io� to Issuance of'a permlt'and that':all work will be performed to meet standards-of all laws regulating-
construction, County and City codes, zoning regulatiQns, and land development tegulattons�tn the .jurisdlction.: I�.ai'so _.
certffy that I unde�stand that the regulat(ons of other govemment agencies may�apply�to.the intended work, and that it is
my responsibility,to identfiy•what.actions I must take:to be,In�cqrrlpllar�ce:.,Su�h:agenciesinclude but�are.not Ilm(ted to: �
- DepaRment of E�vlronmental�Protec$on=Cypress.�Bayhead�;�Wetlend Areas and Envlronmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management">:�istrtct:lNells; '-Cypress.�Bay.heads;� Wetland Areas, Altering
Watercourses. � . �. •
- Army Corps of Englneers=Seawalls��Docks, Navlgatile Waterways.
- Department.of.,Health;,&.,ReMabllltative,Ser,vtcesLEnvitonmenfal�.Health-Unit-Well.s, Wastevirater}Treatment, �
Septic'Tanks:._:':..;: ' ° , � � � , _ ., .
- US Envlronmental ProtecNon Agency-Asbestos abatement. : . _` -
- Federal Avlatlon.AuthorNy-Rurnvays� � � ,
-I understand that the following;restrlctlons apply to.the use of flll:•
- Use of�flll Is not allowed 1n.;Flood:Zone"V"unless expressly pe�nitted.,
- If the flll materfal�Is fo�b.e used�iln :Flood Zone. °A", It. Is u'nderstood that a drainage plan addresstng a
4compensating volume"will b� submltted at time of�.permftting whlch Is prepared by a professional engineer
Ilcensed by�he State of;Flo�lda: � � , -. � . . .
- If th� flll materlal��ls to be-used In Flood Zone 'A" (rr connec$ion�virlth�a��ermitted building using stem wall
� conatruction, I certify that.flll:�rall:b.e�used only.to.fill the area wlthln�the=stem=wall: ,_ , '
- If fill materlal ls to be used In any area; I"�certlfy lhat .use of;such^flll wlll.not adversely affect ad)acent
propertles. If use of flll Is found�to adversely:�ffect adJaEenE'propertles,.the owner may be'clted for vlolating
the condl#ions:of the bullding:.perrrilt Issued�-under tlie�attachedypermlt applicatlon,-for:lots-.less:,than�one (1)
acre which"are ele`vated�by flll,�R englneered dralnage plan Is requlred. , •�
If I am the AGENT FOR.THE OWNER, I;promise In.good falth to Inform the owner of the�permltting condftlons set forth In
thls affidavtt�prio�to commer�cing constructlon. I undersfand thet�a�separate permlt may be requtred for elecMcal work, . �
. ,--�.... .-
plumbing,�signs, wells,.pools;. alr conditloning,.gas� or_othe� Install�tlons not•spec�flcal�y lncluded�tn.the application. .A
permit lssued shall be conshued to be a'Itaense�-to',proceed wlth'tNe�wo�k and not�as:authoNty:to:vlolate;:cancel, alter, or
set aslde any provlslons of the tecFinlaal cades; nor shall Issuance�of a.permlt.prevent the Bulldirig O#flclal from thereafter
requlrin.g a conectlon af�errors In.,plans; constructlon or vlolatlons of�any codes. Every�permlt�lssued"sfiall becorrie�invalid
unless the work authorized.by such permlt:is.commenced�wlthln sGc.m.onths of permlt Issuance� or If work authorized by
the permlt Is suspended�or,.abaadoned�for:a;perlod;of slx�.�)�montFis.after the tlme the�work ts commenced. An extenslon
—m��--be-�eques#ed;tn-vurltl�ig;:f�om:tHe-�Bullding_Offlclal-f4r-a_�erlod_:nottn-exceed_nitiety-�(90)��days a�d_w1lLdemonstrate�----,
justl�able cause for�the extenslon�. If work ceas�es,for nlnety(90)_cons.�cutlye d�y.s...4h��ob is.�onsldered'aba�doned.
INARNING TO OWNER: YOUR-FAILURE;.TO.,.R�EC.ORD,A:.MOTIGE-OF�COMMEMCEMENT�:MAY•RESULT IN YOUR�
PAYING TIMICE:FOR�IMPROVEMEN�'S�Tfl,XOUR,:PROPER'tY. IF�YO.U�IN�END'�TO�'�OBTAIN��FINApEfNG;'C.ONSULT
WIT O: A �►iT0 N ,O.E�.�ECOR� G� OU ' : , ;� .,6 ` �„� � .
FLORIDA JURA�{F:S:�.03} � � - � •; ,..,_ . . , , _ . .. ,
OWNER OR AOENT CONTRACTO � ` �
Subscrlbed and swom (or affl ed)�fore e thls Subscrlbed and' m M of a rtn,d�before m tfit '
by -G 1�,t ����-.M.11�-`K� .by.�-/,� -�c.���-�� �� �
Who Islare personally knovm to.me or haslhaae produced Who.ls/are p.eraonallyknown:to me-oc ha ave produced. • .
� � as IdenUflcatlon. � as IdentlftcaUon. •
d� ���� /�/�4���'X�- Notary Publlc . ��CJuL Notary Publlc
Commisslan No: C�� ��5.31� Com Isslon�No._����.�3�G ,
���/� .E�..Ai�� �,t/�,�1L � �,C�}�iv� �v��i�L_
Name of Notery typed,pdnted or atamped
Na �.� . DEBRAELAINERUFFELL
:���.�;:Commission , "`��''•-
#GG 045343 ,.�4ti�"••:�,. DEBRA E�qINE RUFFELL
:;�,�:o:Expires November 7,2020 :.; ,,:Commission#GG 045343
%�;q;;;R"r BondedThruTroy Fa(n Imurance 8oa365�7019 s;,�P?Expires November 7,2020
�'�°;:t.,• Boedad Thru Troy Fain Insuranee 8pp.9g5,7019
� � - �1111111111111111111111111111111111111111111111i1111111111111
2017061095
�Rcpt:1857368 Rec: 10.00 ----�
� Q5: 0.00 IT: 0.00
04/24/2017 K. p. K. , Dp�.y Clerk
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N�TICE C1F COIVIMENCEMEN� Pa��-p 5 � �Ei�'� Dh pR`�CO GLERKo f C1MPTROLLER�
04 O 4 BK l�J��m PG 155?
Permit Na. -- --
Property Identificetion No. ,j/- c�lo —'c��— QG7/C�-�7..3 L� -- C3 C�/c'�
1T�+UNbERSIGNED hereby give informs you tha#ihe improvement will ba made ta certain reat Pmperty>eud'm accordance with
Section 713.13 of the Florida 3datrrtes,thc foltowing in�'omaetlan is pro»ded in this N�TICE dF COMMElwTCEMEN3'.
l.Descripkion ofprogeriy(Jega[derarlptlon)
a)StreetAddne,ss:_ �,� LJ G! �VF 2 L L ,,� '���c� '
2.t3enetai descript�on ofimprovemetUs: ,b F=c_K -t- .sc•_�T�ll �.�/t'1
3.Owner lnfoanatipn /
a)Name and addc�ss: ���t�� . ,�� ��T�'/�9 f�t—�i� ' ;
• b)Name abd addres9 of fee simple titloholder('if odtet Q�aa owner)_.� �Z.��4�e��1 iC"_�,�.({`(��.� �FL�-.3���`�—
cj 7ntarest in prvperty
4.eontcacxoiInfomiarinu �
a)Name aidd addnss•. U���jf�R
b)TolppLoae No.: Fasc No.(Opk}
S,�rety Iaformation
a)Xdeme end eddressz
b)AmotqRt ofBaitd:
c)Teleghane N�!.t • ' Fax No,{Opt.)
6.I.ender
a}2+Tame and eddress•
Phaae No.
7.Tdentity of persoa witfiin the State of Florida dealgnafed by owner upon wLom notices oF.other documents may ba served:
a)Nanne snd addxess:
b)Tele�hone Na.: Fa7c No.(Op�)
8.In additian to himsei�ownc7 desigaaies#Ti�fultawing j�crsan to receiye a copy bf`ffie�,ienor's Nofice ss pmvided in Sechon.
?13.13(lj(b�,Florida Smtams: .
a)Nama end addtx.ss:
b}TaIephoncNo.: � .. , .FwcNa.(Opt.}
9.F..xpixeHon datc of Notice of�ommencemCAt(the eatgirsdion date is one yeur frva�the date of zecording ute7ess a dif�'eie�tt dat�is
speCified}:
R'AI2NING'I'O OW:�TE1t: A�tY�PAYIVIEIWPS IV7ADE BY T'H?&OWN�Ii ABTEAt TSE�IP'IRA�ON OF fiHE hiOTtCE 4F
COMMENCEMENT AtXiE CQIVSID�REI►�MPROPER PAYDlENTS TTNDER C�'LAPIER?13,PART I,b'ECTIOlY?13.13,
FI;ORYDA STA'CUx'ES;�ND CAN RESUI.T TN XOUR PAICtiVG TRnCE 1+OR IMPROVf�MEN'I'S TO YOTJl2 PROP�RTX.
A 7YOTiCE QF C011fihSENCEMENT 2UYUST B�RLCt'}RIfED AND POST'ED QN T�iE JOB S3fiL�BEROItE TSE I�iRST
INSPE�QN,TF YOU IN1`END Z'O OBTAIIYY FINAI�CING,COIYSULT YOiJIz LEND3QYt QR.EDNT AITORNEY BERORE
COMMENCIIV+G WORK QI�RFCORDING XOiJIt Ai(DTI�E OF COMMENCEML+N1:
STAx'E pF FLQRmA � .
CUTIM'X OF PASCO
� Stgoehme of Ownv a's Aut6a�u1 OSar/DlrcctatlP c
�l .� ` �
Y�ntName
.�-- The faxe,goin,g iastnmxec�t Was�c�o,��iged beftm me this o?� day of/7 t'�1�. 2p 7 bY
!��L�Th`y' �- Gf���/I'l��:�wS..�'•' � (type of authcrity,e.g.of6cer,truste�ettozaey
in fact}for (neme ofpecty on behalf of wh�e�was axecuted).�
,/` - -_- - – �•—- -r� _. �P�;e�i�L,-�Z1�' � -_ ._ _._ . -
- --- --Personally Knotm=Olt Praduad Ideati�cedon Notary 3�gnafiae
Typa of IdenGfication 1'roduced Name(prmt) �/�/ � ��l f� /�.U�i���
Verification pursuent ta Section 92.525,Florida Stahrtes.Under peneiHes ofperjuty, dectare that I hava re the fine g end tLat
the facts stated in it aze tmt to tk�e besc of my kaowledga end beHe� t
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s;gmnu�otrr rc�a s;�ng.wov�
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•�1�°�"''�• DEBRA ElAINE RUFFELL
. �,'� �,_Cammissian#GG Oa5343
i o z Ex ires November 7,2020
�%'�`�,°+r,�,R"••'` B o n d e d T l�r u 7 ro y f a i n I n s u r anca 840�3&5-7019 -
DISCLOSIIRE ST�TII�T FOR OWNER
CITY OF ZSPHYRIiIT,LS HIIII,DING TaEPRRTI�T
I, �/�/L Ci/{�l�'! ��;IC� have read and fully ua,ders�and and
agre� to the provisiaae of this instrumeat.
The uaders3gaed states aad affirms that he ar she is desirau� of conatructing,
reaavatiag, addiag ta ar rercofiag his ar her owa domicile, that he or she
actualZy ocaupies, or will occupy by said domicile, and same is not for
reat, lea.se or sale. That he ar she shall comply with th� Eollowiag eoad3tioas: '
Z. That the owaer aad he os she aloae sh�ll act as the buiZder for all phases of I
coastructioa. �
2. That the awaer wi11 comply with �11 proviaioas of the City of Z�ghyrhills
osdi.aaaces aad codes pertiaieat to the buildiag.
3. That iia th� event vaxious phases a� coa�tructiaa are subcontsacted, he will
engage oaly prap�rly liceased subccatrac�ors aad wi1l persoaally eupervise
suoh wark.
4. That ia the event the 8uildiag Iaspec�or sha11 require correat3ons to be made,
th� owaer will a�saume fuZl respoasibi2ity ta iasure they are ma�e, mnd upan
completion wzll ca11 far a reiaspectiaa before proceediag w3.th the buildiug.
5. That the os�aer shall aesume fu21 r�spaasibility for the coaetructioa aad v�i11
not expeat superviaion of his work from th� City of Zephyrhills Buildiag
Departmeat.
6. That pr3or ta fixsal iaspeet3.oa aay addi�iana3 fees, iacludiag xeiaspectioa
fee�, mu�t be pa3d a.n fu11. A wri.tten request from this o�fice sha7.1
coastitute aa of�ici�l aotiae to pay additional fees.
7. That th� orwner shall comply wi�h all City, State aad Feder�l 1a.ws isz regard to
sacial security, workman's aampensatian, Iien laws, etc. , where applicable.
8. That the awner shall comply with all th� saf�ety codes issued by the Florida
Iadustria2 Commissian.
9. State 1aw requires const�uctioa to be doae by 1i.ceased coatractars. You have
applied for a permit uader aa exemption to that law. �h� �emptiaxz allavas
yo�a, as the araaer of your prope�ty, to ac� as your own coatractar with certaisa
restriction� evea though you do aot hmve a Iicense. You must prov3de direct
onsite sup�rvisioa of the aoastructioa yourself. You may build or improv� a
oae-family or twa-�amily residenc� or a farm outbuildiag. You may aZso build
or 3mpxov� a �ammexcial buildiag, grovid�d yaur ecsts da nat exaeed $75,000.
The building or residence mus� b� far your owa use or occupaucy. It may aot
be bui2t or avbstaatially improved £or sale or l�ase. =f you sell or lease a
building you h�ve built or sube��atiaZly improved your�elf within 1 yeas ��ter
the constxuctio� io COIAQ�.�t�� the las,r will presume th�t you bui2t or
substaatially imgroved 3f for sale or 2ease, which 3.s a violat3oa of this
e3cemgtiox;. You may rtot hire aa unlicea�ed pesson ta act as your aoatractor or
�o supervise peop2e working oa Srour buildiag. It is your responsibility to
make �sure that peaple employed by you have liaeaaea r+�guireci by s�ate law aad
� by couaty oz muaicipal liceattiag ardiaances. You may aat d�legat� the
respoasibility far supervisixag work ta � Iicenseti caatraotor who fs aot
i.icensed to pexform �h� work beiag done. Any persoa warki:ag oa your buildiag
who is aat liceased mu8t work uader youx direct eupervisioa aad must-b�
--_-�--_�loy�d b��ou� wb,��,h�t►eaas th�.t..3r.cai--must-deduc�--g�I-:-��--�ad-witlrha�-diag�tax�_�--___- ---
aad provide workers' aampensation €or that employee; aiZ as prescrib�d by Ia`v.
Yovr ccastruation must comply with all applicabSe Iaws, ardiaaaces, buildiag
codes, an,d zoning regulations.
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F.I.P. 1" � p � pIS �3555 �'� , I
r NO ID�} � a 30.fl' �P) 30.0 (Y) 21.0' ' @„ `��'^ .
N 89' 4'26"W. 8a.2�' ( � � ` .
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�^�^�~ ~ � �Centorline�10' Dirt%Rook Ro�d � '
• 20' AU.E1f (P) ,
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� SU�?YEY4R'S NOTES: '
t.fita ta a 8o+a�dary Sunoy, made an !ho pround uader tlta eupmviaion oi a fbri.ln RagleMraf Sumyor �Q�p ZONE CE/2T1fT�YE This is to certify that the pruperty shown hareo� Palls
cnd Nappen F1eW wrvny wae oompleted an �n/18__y___/05_ with Flood 7,ona X ns pof the Raod Inauranoe Rate Map,
2 BaaAngo aro bqaed ona.�f1@�&1Ltf151�y�� ��n{Lol' S1H AVENUE as: Community Panol Mumber j902u5�(]QQ,S,S'�,_,,,,�.drrtad����7/A1 .
� N,_89'S9'3Q"E.. nss�am�d , • ,
3. No undarground u�iEtas,widaflround ancroachmmts ar 6ufldirg tounda8ono xero meaaared or located L�El�O /�A�O ABQR�7101VS:
ae a part nf d�fe eurvey,_unleoa oFhawlea elmwn. Troaa �d ahtuba not(aootnd, �toua pthewxlaa ehown. ��,p,.pp�kD IRON PIPE" F.C,M.�FOUNO CONCREIE MONUS1fNl'
R/WoRtOlfi'—OF—WAY
4.Thfe ounoy atle oonCuotod for tho putpea4 af q 8otridary 9urvey onty, qnd 4 nnt Nta�ded W , f,t.RAFDUND IRON ROD F.FF_�IINISNm FlAOR 0.EVAt10N P9.aPUR BonK
do(Inaate the radulamry NrbdlaHon ol u�ry faderol �tota, ruqtonal or local a9anoy. boarrl. commixilon or S.I.R.�sET IRON R00 P,O.B.4f'OtNi'OF BEnINNINO pp.-YrWE
�tatq regtomt nt looal agniwy, 6oaM, aommtsaion ar olhor almtllar ontlty tlrD.mfOUND P.o.o.APaIN7 oF C6MM¢NCF]AL•T11' W/F�.WooO FRiCE
5.TTdn ourvoy Wa� oonduotad Wllhau!tho bonoftt M an almtlaot of UUo.Fhorofo�h, lhnro may ho athor ' SPX.dSET WUl h DISK �T.I.b(7RATE TOP BJI�7 C/l,—CW�W UNK
tiqhL9—af—Bay oetbaofc Urae,ayr�wmc+�, re�tNattona, fa9h�cliurl, or altwr aimAtar mattero ot A�O.NR CONDI710NFT� 4R�UR�C'rWL R6COR0 BOOK £SM'7.6/SSMGM
wa�o mooM.�na!dapintod at 1hle ourvaY. —P—�ov�ew powat n,e.•a� aontc , (o)�caruU�n
—T aOVat}1E\p 1�7FPNONE S/WeSIDEYlAIH D�OF�O t ��I���RD
a. Flood aone detorminqUan Aaaod an a ooaled Intot etatlon ot the Flood Inaurqnon Rate Ma a ao nhown �)
Ralt3on, pttar to ranafriicyan, EWtidl � � �.��N� 0/Y( a DRWF.WAY C.B.eCNOfZO AFARINC
3 ng Depattment eFxwld sa mntaotud fcr veMflmticn ot t oad zonu. CONC.�ONCREIE ��p���
7, Atta�tlon la dtraatud ta!hn fao!1htl!!Wn autva�r R�ay hwa bean raduoad or wflotgad (n ehe duo ta N.O�VA.AkATI�NAl,OEODF.ttC VEftlil`.AL OAIUM �P�a�'�T h��^R�tUFJICE
' , ropraduottan.1Fila �hould b� laken tnta oaneldawtlon when obtaWng u�ataf dala. W/C-WfiNESS CORNE7i C1�,nCNORO P/�P��M��MBIY
8. '1}IIS SURVEY N�T VMJR WIhIQIJr 1HE 510NATURC AND ORIOINAI. MI5E�SL'N,OF A F1.ORIDA UCEN9F� '
3URYEYOH ANII MAPPER'� •
CERTIFI�'!3 'l1�: ' � P.C. �.A. F.B.�l. Pg. �ow � 051 a^�6
Sean H.&Valerie M Fernandez;SUTIst'ate �N�REBY CERTlFY THAT THE 3!lRVE�'
Title Agency TECNNfCA�S�NOARDS"FOR l.ANO SURVEYlNG Orak C.�. 9tation�t q- S—T—R.
Bank of America NA rN 1'HE STATf OF FLORlDA:'G9dAATER
BtGfT—E, F�ORIDA AOMlNISTRATlVE C00£. Ch�k �.p.J. Misaf�oundary Shset � ot 1
R�s,o� . � � �1H�� � ��1Z���� �
. � V �o '' �' SURI�,EI'/NG AND MAPPING INC.
Eddie P. ehkins, P.L.S �� rsoo H�cxwa��1 NORn�, sur� ro� ,
_ — PRQF�l� StJRVE?'Ofi � MAPpER lAICC FRi1�NC1SL^0 PU1711, tU7�,s,(�. 33549,
' FT_OR/Q4 R�i7157RAnON NO. 83�4 PNONE (813) 948-288Q or 948--299J
• • GbrPiFrcato of Authorizvtlon: L9 �' 8099 FAX (8 t 3) 9 F9-6817
..__.._._,.,.
DESCRiP110N:
�� ��: B�Ut�DARY SUF�u�'Y
LOTS 1 & 2, BLOCK 173, ofi CIN OF ZEPHYRHILLS, according to
�the map or lat thereof, Qs rec rded in PLAT BO�K 1, PAGE 54
of the Pu li� cords of asco County, Florida.
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