HomeMy WebLinkAbout17-18988 CITY OF ZEPHYRHILLS
�; .; 5335-8TH STREET
(813)780-0020 �898$
BUILDING PERMIT
PERMIT INFORMATION� - � ` LOCATION INFORMATION
Permit Number: 18988 Address: 5221 SHADY REST LN
I Permit Type: MECHANICAL - ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 10-26-21-0010-09900-0000
Improv. Cost: 6,527.00 OWNER INFORMATION
Date Issued: 10/26/2017 Name: CURRIER, JACQUELINE
Total Fees: 70.00 Address: 5221 SHADY REST LN
Amount Paid: 70.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/26/2017 Phone: (813)782-0832
Work Desc: A/C CHANGE OUT 2.5 TON 14 SEER W/ DUCTWORK
CONTRACTOR S APPLICATION FEES
AIRTIME AIR CONDITIONIG AND HTG A/C CHANGEOUT 70.00
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Ins ections Re uired
DUCTS INSTALLED
DUCTSINSULAT
FINAL 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
frst reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may 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 I
Ci Codes and Ordinances. NO OCCUPANCY BEFORE C.O. I
NO OCCUPANCY BEFORE C.O. '
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ONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
a�saso-oozo City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
A��• +
Date Received � (.E� _ 5 Qj�
Phone ContactforPermitting
r �nt/� �p,(� � 1 �/ r
Owner's Name �� CL 1 V C.. �v'tl�-I' Owner Phone Number l � � °— � .
Owner's Address L�I ��1 � �7�� �' ` Owner Ph,one Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Add�ess
JOB ADDRESS � L�� � �t'T� ` �5� l�+ ' LOT# �
SUBDIVISION PARCEL ID# ��'r2-�� �(��,��� [ �' �
(OBTAINED FROM PROPERTV TA)C NOTICE)
WORK PROPOSED e NEW CONSTR e ADD/ALT 0 SIGN Q 0 DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FR,4ME 0 STEEL Q y
�! J
DESCRIPTION OF WORK � S � U C �
BUILDING SIZE SQ FOOTAGE� HEIGHT � C R, �r
�BUILDING $ VALUATION OF TOTAL CONSTRUCTION
DELECTRICAL $ AMP SERVICE � PROGRESS ENERGY 0 W.R.E.C.
OPLUMBING $ ^��
r,�r.�
ti�•Z
�MECHANICAL $ ��2 VALUATION OF MECHANICAL INSTALLATION � lJ
OGAS Q ROOFING Q SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS FLOOD 20NE AREA DYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
ELECTRICIAN � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGIS7ERED Y I N FEE CURRE� Y/N
Address c� License#
MECHANICAL '"'� ° �,,; MPANY �� �\VI/d/�� ,�'1 ✓ �'
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address ��1�•+°l lCi'� V��C� �S�'[ License# ' J �
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
�RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, ,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster Site Work Permit for aIl new projects.AII commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERN SURVEY required for all NEW construction.
Directions:
Fill out application completely. �
Owner 8 Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department � ,-�
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N0110EOF.pEED_RE8TRICTtONSt Theu�ndersigned;under�tandsth�t,thls<p��1�n?a!►�be:subject#o,`.,deed3aresMctto�is",_:,., �,�;w
rt�
whioh may:beamore.r�slhictNeAthan G�i�i�it�<t�epi�letfonsb��The Unde�sl�ned�•s�'sumes°responsi�ilily�for complience w,ith•any
apppcabte,deed resMcttans. _ - ...r.u_�.�,:�:,.� . .n ,-''� ..,,",-,
UNUCENSED�CONTRACTORS AN� COt�I�RAC'�'OR•RESPONS181E-17i�S:•�iF die°ovmer'has�hired��a"c6nt��c#or ar
c�ntractors to underkake work,they maytbe;requlred.:to<tie;�tcensed In•accorc`lance.wlth state.and;local�regulati4ns:�tf=the- ' � -
conftactor.is oat IEcensed�:asr teqcilced.?tiy lew.�bottt'the awner'arid�=confi�cMrxmay De#�ltetl'tbr��a=�»t�demeanor v1olatton
under state taw. IP the owner or iMeiided��co,r,i�r„,a:4har,;are,;,�mc�rtaln as to wfiat Itcenstng,regutremer►ts;msy=epptyiz:f6r4the: � -�
Inlended work,they ere ad"viseif to caiintact.ttie.Pasco Couniy;Bulliiliig,lnspection Dh%ielon`-Licensing Sectlan et 727-847-
8009. Furtfiermore, !t the oinmer 1ias�fiireifMia contracfor'or' contractors. he is advlsed ta have'ihe contrador(s):stgn.. ,
�t,..�,..��t,::;�. .
portlons of the bontrec#ar 81oci�of Eh�s.appllcaUon.fa,r,.whiah..fhe}r will..be,tespansib2e.-�lf=you,-as�he ovirner,atgt��s t�se" "
conk�actor;that rnay be•an Indlcatlorrlhet'Fie"�is not'prcperty`Ilcensed�aiid"Is'iiot�entiNed to pemiitang priirllege',s In Pesco
County. . :_._. . .� �'a::�•,._�� ..
'iRANSP;ORTATlON.1MPAGTJtF'fa1:i'i1ER�IN1Rl4L�AFtl3-!tEffiO�tItCE RECOVEEtY-fEEB:-'T#�e undsrslgnediirtderstands
thatTranspartetion Impact Fees:and.Recounae,Recavery_�eea mey;applytito�tfie:conatrucdon.of new.b.u(Idings,�changb�of��'�°�� �
use in exleNi►g buqdittga,�or.exparislot�rof'�ez1aU�►�'�6uiTtHngs,as spectfted.ln Paeco Caunty Ch`dinance number 89-07 and_
80-OT�as amended,�,.;Th�.urttS,ecslgned also��iiderst�nds.thalE"s_uch feesy;as:maj���.due.:�w11F;�e ldentif�ed at the�time=oF°,= •4�. '
permltHng. It Is fu'r'th`�'underatodd.that Transportatlon irtfp�cf'Pees artd'�tesourae�Fteco�isry�Fees mu�t be paid prlor to
recewing a'ce�tiflcate;of accupar�cy"°or flnal�pcwerJcelease: :i�`tt►er proJ6ct:,doesino!•irnolve4a:certfftc�te of accupanc��o�i>�"`;:
final powec:�tetease,�t#ie�faes mti�F6e paid'tpr�`o.�r to;peimi#ias4tatfce. Fu�etmoie;�iE:Pasco,;�ourtty°`{Na#erlSekver,,lmpact •�_ �
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fees are due;,lhey:iquet:be;peld;p�cr to,PernlitclssUa�ice�in_ar:cordance:.wltb:appifcabie:Pasco'�Gounty'ofdtrrences. •
' CONSTRUCTION'L"IEN'L:AW'(Cf�bpter 713R�tor(de Stetutes.aa amended�: ff valuaflon of work Is 52,500.OD�or,mare,:.l� ,��
� cerfify ttiet 1, #he-apgticant�-haue:been prov[ded:wlth:a=copy�of the `Flor�da::Gons�on�Llen_law—�Nameowrre�'s
ProtecUon Quide'prepared by�Uie Flcrida Department;of Agrfculture and Consumer�AftaUs. If the applicant Is someone: _
other than tha'owner",l certlfy:that I;;haye�ciqtAlnedfatcopy;ot:the:abSGva.des,ci�ibed�lticument�and.;p�rqtritse:in,good<faNh�to
deltver 1t ta;the.'owri'er�'pctox'#o�co�ime�ii�metiE:`_ '. _ = � . . � .
CON7RACT4R'SICIYVNER'S AFFIDAVIT: I,ceiti[y.�,Ui�t-al6the.lnformatlon:l�:thla appllcatlon is accurate.and that all work
will'be done In compliance wNh all.appl(cable laws nsgulatlng ccnsiruction,zontng and:land';deyelopment. AppllcaUon Is
hereby made to abtatn.a.permlk,Co�,do.s�otk;asnd;i�i"stBElallon as Eqd[c�fed�:::.j l��c:eit�fji"tliat na watic'�or tnstattation tias
commenced'p�ior ta issuance af'a'perintt"�nd that`:aii work will ba perForm�d�to ri�eet-standards�of sll iaws regulatfng-
conatrucUon, Counlyr and Cfty codes, zoning reguladnns, and land development nagulatlans�ln`Uie j�rlsdlcUon.�'C al's:o
ce�lty tha#1 understar�d that the regula#tons of other govemment agenc(es rnsY•epx?11►;Eo.3he..tntended wo�lt,and that iE ts
my responslbifity to tdentity•what.acitons I m,ust�teke to,be.�in�campilance.,Suc�h;agetrrles indude buk-are.not Ilmfted ta: �•
- Department of Etrvtronmentel�'Protectton�Cypres�`�'beyhead�;WeBand Areas and•Environmentally Sensittve
t,ands,WaterlWestswater Treatmen�
- Southwest Flotlda W+�ter Managemeitt•=blsfrict-VUelis, Cypres.s.`Bayheads; Wefland Areas, Alkering
Watercaurses. , � �
- Army Cotps of Enstneess-5eawa1ls;Docks,Nevipatite Watetways.
- Department ai.Heaith�&,-Rehabiiltafiv,e:,�el;v(ces/�nvironmental Nealtla Unit Weils,:Wastewater Treadnent,
8'epticTanks. • -- .
- US Environmenlal ProtecUon Agency Asbestos abatemen�.
FederaE Avt"atlunrAutho;ity,-fiunWetye:-.
I understand that lhe.follouiing�estrictlons aqply'to the use of flll:•
- Use otSilf{s not al[owed in:Flooa;'�ope'V"unleas expressly.permitked.
- If the::filt'rimatet4al-ts to`tie useit:li►:�lood Zone.'A. it ts understood that a dratnage ptan addresstng a
"compeFlsating volume'will be submitted at Ume of-pe�nftting which is prepared by a professlonal engineer
Ilcensed by_ltte Stale�ot Fl6ttda: - ` - '
- If thA flfl rrtaterfat°is to;be=used tn Ftoad yona`A'tn connection�wl#h:a pecmitted building using stem wati
' conshucHon,I certliy that f�I:yVlil:b.e used only.to.�ll the ar.ea withln�the stem wall:
- It 8l1 materlal Is"to be uaea•in�.any erea, 1 cettity that.usa of'such fIN v+iitl qot adversaly affect adJacent
prqperttes. if use of#111�s,fcsund:to advers�aly,�adja`c�nt-�prcipertias,,the owner may be cited far.ulatating
the cond�lons.iif the.bullal�g�,permft Iss�Ved�under tlia�atlacfied pertnit applk:atlon;°for.lots less:than:one(1)
acre wfilch ere elevatetl�tiy�11;,��englneiered dralnage plan Is requlred..
Ef 1 am Ehe AtifNT FOR:TNE•OWl4ER;l�ioin(se(n�good falth-ta Iciform#h�cwner af ti�e pern�ttHng cond€�ons set.forth In
this aftldavlt`prlor ta comrrie�cing cone6iicd*on. I uriderstend that�separate,permlt may be requlred Tor electrical work,
plumbing, slgns,wells,.pools,,alr condltloning,.gas,.ar other` Install�Horis not�spec�l�mlly Included�tn.the appllcaklon. .A
permtt tssued'shall ba coitstrued to'b`e a°license�tc'proceed wttb'ttie�v�roiti and nat-as:aathority ta,xEota�,`cancel,alter.or
set aslde eny provlstons of the.tecfinlcatcodes;;nar shall tasuance�of e.permlt.prevent the Bulldlrig Qfltclel irom thereafter
requlring a conectlon.af,errore In;plans;cone;tructlon orvlolaUons of�erry codee:�Every-pgrmlt•lssued"sfiall tiecome lnvalfd
unless fhe work authionzed:by such permtt:9s-commencedwtthfn s6c.months bf�permtt tssnanee,or If wo�c authorized tiy
the permlt ta suspended•o��.aba�do�tedyfor a,perlodia€,six{8)•mont�s,:aRer;iqe#l�e the work�s commence�l. M extension
may be requeated,ln�wrltfng,�irom fFie;B'ullding.OfficlaFfbr a peMod:not:to.exceed�rifrie[y(9U)days and wllf demonstrate
�ustttlable cause for.�the extenslo� If work ceases.far nlne#y.(9Q}consecu#ive dsys,_th��ob�fa c�nstdet�ed abandoned. s
:,- . ... . . .
WARNING TO OWPIER: YOUR,>FAILURE,;:,T•,O.R�CO�tQ:A:MOT�GE;OF.•COMMEMCEMEI�T.MAY�RESULT IN YOUR
PAYINti TWtGE„FOR„#MPRQ�tENIEI±I�S:I'#a?_'�(Q�t�,Fit'l�REEZ�;1k:��I�:YQtlalN��EKtD?'Ffl>�B�'Al1+F-F1EFl�N�1Ni3;�OF�3URT
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FLORIpAJURA3'�(F.Si-t1�:03}.. ' , ...' '. ,' .".",. , ,
OWNBR OR AK�ENT... ..: CONI'RA�TO , -
Sutraatbed an bewom to(or nfrtrtnedj beioro ma fhta Subsaibed"end (of"afll ro m ' �y�
Who lalare pensone.11y qsawn to.me.or:heslFiave P►od4�ed Who(d knowrrto sne�or s pradiice+d ,
. - aa tdertHlkaUOn. aa tdanNBcaHon.
4
t�totary Pubitc � otary Publtc �
Commlaslon No.^ Com s .No p �^�. .
:S'�Y�I;B�. . OQV S
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Name otNofary typed,ptlnted or elamped Nam�of Nalery ,�t+. ,o a p�cember 12,.2018
%',�pA�py0.Q`�, 8c;dad7hmTroyFalnlneurance8W385�7019
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110 N_Muirennan Rd- V�n�•gonded•Insured
www.airtimCtilrCopditioning.net valrico,FL 3359a �
r� � HlIlSboraugh:813.438.5949
� Potk:663.937.8072-Pinetlps:727.2$9.729� ' �
,I�I , � _ Nlanvtee:�941.25d.4938 ,
�J FCtx:813.438.5996 .. �
. �o � . CAC i 816958 H��,���y��
sac�s•SERI%�CE•�INSTAtLAT1bN� • ����.� . :.���°�''�J. � C�p�NTRACT �
Ca��inuoras�9n� rauin
E�'P�CT EXCELI�ENCE .. ., ,J � ,� :.
' . ',� . '-7 `. i�o. 13282
Inst�l�atlon oate,�'U��/�C �
Custoriiername: � � �. C� � • • ' � • Date:`(�•''l�P �
Street addreas of job locati�n: 5� � L�,.�, c►�: �, � � FL z�: �
Pi'imary'phane: � Cf� 2..Other phane: • .. � Email: . .
+ • • •• • .�YVhole Mouse AirKntght 9teAl'¢ation System
�Whole HouselJV.Sterilization System ❑Whole House M.�.R.V.Fitrattor►s System�,.1
� � � • •
❑ Replacement � p Add-on Air CondlttoningMeat/Both 0 peplecement p Add-on Air Condi�oning/HeaUBbth •
G Alr HandlerlFumace G Vertical ❑Horizontal ❑ Hea!Pump ❑Air Conditioner ❑P&Ckage unii
�.New O�gtra�Tnermostat�7 Nnn Proprem ' �'Program . 0 '�•5 .�ns..��s�a. ��s'ruH 51C!�. �
O 'New oigitai Progr�smmable Therin:wlth Humidity'Control ' [J�.Model. ��Q d� •
CI Reiocat�from . to' �,� p Numcane Pad
� 0. R�Ixete irorr��to '
❑ New ANU Siand:� Mefa�O Custoin �� New 1004�e aopper, dehydrated refrigerant pipfng
❑ Fiftration: ❑Permanent W2&halsle Flter ❑ Gf1118 , •p Fu11y insulate suction llne piping. '
❑ New safety d�scoonect swiieh ,,rB�Surge Protection •
❑ New Wire from braaker panel to equipment `"�" New water tlgM elearlcal whip
❑ ver�UFlue: � Complete new �lss e�osting � •
� � � ` ' •
� Eneineered duct system for �� _ tons, �vent9 �/ AII labnr , . .
�Economy C7 Antl-MiCrobial$ ✓ py�ining pertnits(wher�r8quirad)
❑ NON-FIBERGLASS�100°/b Rust Resistant Qalvanized Sfie�4'• �/ New A/C olrCuit pr tectfo�B1�nd-
❑ Metal Duet System,�nergy Saving Insutation Incloded �ting size'i's:„�/�_Change to: �„� •
� ❑ Rooms requiring additionAl airflow: �/ Hesting and CoOtlng rontine rimaitrtenanoe far �years
[a New Suppty Vent to: � Check enare system.for satery and eificiency
CI New Retum Vertt tb: ' _ ' ✓ Shoe covers,mAts attd d�p cloths to be used as ne�ssary
C] _ -- f Remove existing eq}�Ipment from premises ,
�(eYMastiC a�d seal au lealdng jairtts d� +( Ciaan up
�Duct Shclkizing , •
• � • � + �' `
EXCIuSiv�"NO LP.1�14/f3"Gu�3I"Alf�: If the Compressbr(the heart oF yoursystam)in your Afr Conditioner telis twice during
lhB first flve years of ownerjhip,we will remove the unit,rather that the component,end shell install a comptetety new one.ff you've
ever bought a"lemon`before,yrou truly appreciate our comrnitment to your long•term satlsfectlon.This guarantee applies to our
Premlum pack�qes onfy. �
No Mald Gusrantee:,we are�o confident In our advanced_I.A.Q,W 5teriiization 8 M.E.R.V.fltrations systems ability to keep
your system clean that we�guarantae with'prop�r annuat mairjt�nanGe your system will be moiB iree;for I"rf6,ar we Nn'll per(orm any
� n�cessary cfeaning to the•atr handler to remeii th'e probiem at our expense.Ask aboiit otir membership paokages.
l�-' �'�Ct� •�al.{�' �„(9Z7 i'��+.�e e�at.vv�a��-
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Tatal Imieshnent S �� � (•)Power C�ompany R�bate$ .(-?Ser.vica Ropalr Refund S_ , • .
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Air Time Nr CondldoNng Representative: ~'�-�"�� r 1 ' Oate of PropaHal: �
qir Tlme AC wi11 be installing a TAX CREDIT.Cert'rfied Comfort System in jrour hnme.We recommend[hat you ca+sult with your CPA to ensure
lhat YOU wlll quafiy 4or th{s tax cred _Air7lme AC accepta no responsbifity B yau do not qualify tor,thia tax credrt, .
CwsRomer Inft►e!s _�.� �}� oat� �•'�'�••;r�..� !Co i�
PayrT►errt to pe made as foitows:6alance due upon Instlai completion end exciuding,eny open parmits.
, Air Time Ail'Condidoning'&�Heating propos6s hereby to iarnish and instatl th9 equ;�pment and msteriets as destxibeci on the
'.back qn the terms and aonditi0ns provided herein.This contraCt is good!or thirty(30)days frorti t}�2 dete hereaf,but may
'be aacepted�t e�r later ate at the sole discretion of Air'F'ima Air Cond'�tioning&H�ating
CustomerApproraf ' � ��IL�-�� Date `__� f� � ��
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PERMIT AGENT AUTHORIZATION FORM �
ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED
I, Anthony Gonzalez CAC1816958
(Contractor's Name) NOT COMPANY NAME (Contractor's License No.)
hereby authorize the following to act as my agent(s) in obtaining permits
in C_'���-� c�-� Z.��tn�, �-�i�LIS
, ;.;:.
` `` Name of A erit: , '- "°" `��� ,, Driver's Cicense No. ''�"``
ROBERT DEESE D200-762-64-171-0
LUIS PATRACAS P362-521-760-620-0
BAR�ARO SUREZ 5623-076-90-191-0
CFIRISFIELL ROJAS R220-104-89-745-0
BERNICE VIBBERT V163-073-79-718-1
REDDY GONZALEZ ' P625-734-73-260-0
This form supercedes any previously submitted letter(s) of authorization.
This form must contain only the people you want to pull permits in your name. To make changes to this
form, you must submit a new form. This form will delete and replace any previous authorization form
and the information contained thereon. �
This authorization will remain in effect until STATE OF F�p r�C�c:�.
cancelled in writing by the undersigned
license holder, courrTY oF _�i��5 bOr o��r�
Sworn to(or affirmed)and subscribed before me this
�� ,day of �Ci'�b v,1�� ,20 ��
bY �6�`E'�.�,'�v�.e ��-Z(9�/�.Z�Ps Q9-`Z_
(Printedlfyped Nam of License Holder Making Statement)
Lice se Holder s Signature NOTARY PUB C
(Signature Notary)
.•''�ti���" CHAISHELLDANIELLEROJAS ����S P L P`� ��� ��
������t (Name of Notary Typed, Printe,or Stamped)
=?. ` No;aryPublic-StateofFlorida ���'�
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