HomeMy WebLinkAbout17-18995' CITY OF ZEPHYRHILLS r'
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5335-8TH STREET
' ' (813)780-0020 1899.�
BUYLDING PERMIT �
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PERMIT INFORMATION - LOCATI.ON INFORMATION
Permit Number: 18995 Address: 5626 12TH ST
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s):19 & 20 Block: 105 Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12-26-21-0040-00300-0130
Improv. Cost: 4,000.00 OWNER INFORMATION
Date Issued: 10/30/2017 Name: FOSSEN, DAVID
Total Fees: 55.00 Address: 1232 WOODLAWN TER
Amount Paid: 55.00 CLEARWATER FL 33755-1168
Date Paid: 10/30/2017 Phone: 813-317-4766
Work Desc: A/C CHANGE OUT 2TON PKG UNIT
CONTRACTOR S APPLICATION FEES
VELOCITY AIR CONDITIONING A/C CHANGEOUT 55.00
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Ins ections Re uired
DUCTSINSTALLE
DUCTSINSULATE
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 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 properly. 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.
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CONTRACT PERMIT OFFI R
PERMIT IRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
i
I `~ ', 813-780-0020 City of Zephyrhills Permit Application F�-a��-�so-ooz�
' Building Departmenl
Date Received Phone Contact for Permitting
1
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Owner's Name V Owner Phone Number U J'� �� �
I Owner's Address �z �� �a�n� Owner Phane Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS �1..C� ' LC.' ►1 \`S ��"v�2-' LOT# �
SUBDIVISION PARCEL ID# � "�! �� � �
(OBTAINED FROM PROPERTY TAX NOTIC�
WORK PROPOSED NEW CONSTR B ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR Q COMM � OTHER ` �e��gI� ✓
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q �,�A'yL ,
I�+ LJ i e � V'
�`�-6
DESCRIPTION OF WORK � MC /i � /
BUILDING SIZE S�FOOTAGE� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
�MECHANICAL $ I�Ofl VALUATION OF MECHANICAL INSTALLATION
QGAS Q ROOFING Q SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS � FLOOD ZONE 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 REGISTERED Y/ N FEE CURRE� Y/N
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Address �� License#
MECHANICAL COMPANY
SIGNATURE REGISTERED / N FEE CURRE� Y/N
Address 3 1� L � W License# � �
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 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 I 1 1 1 1 1 1
RESIDENTIAL Attach(2)Piot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submirial date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities E,1 dumpster;Site Work Permit for subdivisionsAarge proJects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Pertnit 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.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERIY SURVEY required for all NEW construction. -
Directions:'
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC 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 conVact required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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`�- NO?10E OF pEED RESTRiC'ii�[�S: The und6relgned,under�tands;tit�t:ihts:��rmifmzsy_.be,sub ect,to"deed"restrictions"
whichmajrbe�more.r.e'sttlot(ve=ttiai►Gbu�ity�rieg�lat(ans:=The�rinde�algna8-sseurriea'respon"slbfllty"'idr'`'co'mpfiaticewrilii"ariy m "
epp}lcable.daed testrtctioRs. -_.:�. :� -,• • : . . ^ ._.. . .r„�
UNLICENSED•GONTRACTORS AND CON'�RACTt3R�RESPONSIIBILiT1�S: i�tlie�owner`hes�•hlred��a'cantrac#or or
contractors to underteke work,they may,b,e;rqqulred,=�to�beillcenaed ln eccordance.with state.and Io�al�regulaHons:~If the� �
<,,r,:,,a:�:=,;._
snnUactor ts not![cense�'as required'6y tauit, tmftr the owner artd-s'rontrsotor.;msy bev�lEsd�for`�°titisdemeanar utolatian
under state Imw. Sf the owner ar tn#erided=,cq,r,�}raator,;are,�ncertatn sa ta wt�et Itcensing:reguiremeMs„mayfsppty�for-the� -• -
intended wark,theji are"advisieil tb ac(ntacEtlie Pasco County Bulldiiig`Inspeictlon_Dlvislorr-Llcen9ing SecQan at 727-847-
&009. FurlheRnose, tt the ovmer l�as'hired a corilirecto�o�corilractors, hQ is advlsed ta have the can ,tractot(s),,sign .,..
_-a .
parttons of the.cvntrc�cto�8tacic_of.thls_.ap,�t!!ca@on_for_whtoh.they,wllt-ba=reapansibte.- If.-.yaiu,.•as.the ouiriier stgn"a'a't�e" '
contractor,thattnay tie�an IndlcaUon khat'fie�is not propeHy Ilcen"secf"and"Is'"not enq8ed to perrriitdng prii�ileges In Rasco,.
County. ._ � ="' -
3RAM8FOt2TATtON.iMPAGTNTI�1'FIES�FNtPAG�ANb RESt}�1�GE RECOVEEtY FEEB:�'he underslgned iinderstands
that7rensportaUonlmpactFees:and.Recourae.Recavery_�eesmayapp1y�ta�tf�e;construcUon;o�new.bulldtngs,schangerof°°.'��:=
use in exlsNng buildings,or:eicpariglor��of��eiii�H�`�biuildings,as speclfied.in Pascv County Ordlnance number 89-07 and�
9o-U7,as amended,.t:�3;t�e undecsigned also,uriderste�ds,th��`stich fees,;as:ma}r�i�:.dne;�wi1F,=be IcleMllted at the�time�of�. ..
perrnitting. It Is fur'tFriar understood thet Trensporta0on Impact Fees a�cf•Ree'ource;Fteeovsry-Fees,must be pald prior to
recel�ing a"certificate.-ot-occupancy"-or�flnalwpiower_.;celease: :it the pro�eek�oesiriot•Irntolve'�a,.certlflcete of occuparic��or-'�f'=` �
flnal pawer_retease,�iFie-feea�ti;ti�#-"6e pe(iI`�pi#or to;permit Issus�ice. F�t#�teYmmose;lE:Basco,C.ot�nfy'Waterl5ewac-:Impact • .. -,
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fees are due,;lhey�;muat be�p�td=p�or to.pemilt;lssyanee°in.accordance wlth�appllcabher Pasco'.County orclinances. �
COPISTRUC'flON'CIEN'LAYV"(Cliaptar T73,Flortda 8tetutes,es amendacn: !t valuation of woik is�2,50C1.00;or more,_1•, . .�,
certify ttsat.1, the eppllcant,_haue.been ptoytdeil:wlfh:=a coPy`of�fhe_:`F.torlda°Gons�ott�:Lteti':•L"a�—Eiomeowner's
Protection Guide'prepered by the Floitda D`eperfinent;ot Agriculture and Consumer;Rffairs. If the appllcant Is someone: ,
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other than thp'awner",I cerNfy�th�t I;hBve,cip�ined�a�copy;of..the;abpya,desoritied;daaif�►enk;and.ptqr�iiselti,gpod'taithto
det(ver It to the'owner`:piior�to�c�aifners'c�meti�t:= , " ... `", �
CON7RAC70R'S►OWi�ttER'$AF�IDAVIT: 1.ce�tity.:Uiat;aii�.th�;Informatiom.ln:tFtla application ts accurate.and that all work
will'be done in compliance wNh ali.appllcable laws ragulaUng constructlon,zpning and land°dev„elopment. Applicatlon is
hereby rr�ade to obtaln.a.permSt�to,:do_;wotka,and;tfista�ta�on as tndtc�fecE�r=1�ce�llfjr Bia�t na waticyar tns�ttation �ias -
commenced pttor M{ssuance of a permif"�ind that�ali'work will be pertormad to riteet shandards�of sll laws reguleting-
constructlon, County and City codes, zoning regulaRlnns, and land development tegulations�tn the,JurisdlcUon. I,al'sd:
aertlfy that t ufldersland Ehat the regulaftons of other govemment sgenc�es may appty�ta.the.lr�ters@ed warEc,and that it Is
my responstbitHy to tdentity.whst.acUons i must�take.:to,be,in,cortlpiiange:.S.uch,agencles irtclude tiutare.not Ilmfted to: �
- Department of E�lvtronmenta6 Pnritectton=Gypresa'Bayhead�;IlVedand llreas and Envlronmentelly Sens(tive
�ands,WeterlWastewater 7reatment
- Southwest Florida Wa;ter Management:dts#rict:Welis, Cypress`Beyheads; Wetland Areas, Alkering
Watercaurses. �
- Army Corps of Engf�eers-Seawaits;�ocks,IVavtgable iNaterways. ,.
- Department,,af�Heaith;&.ReAa6ilitafiv,e Servicea/Erwironmentai NeatEh Unit Well.s,.Westeurater Treaiment,
SepUa TanKs": �
- lIS Envimnmental Protacttort Agency-Asbestas abatement '
Federal.Avtatton:Au#haciiy;R�nways:-�.
I unde�stand that the,fvlloinrintg:restrirt�ons eqply to Uie use of flll:•
- Use of till I�not allowed ln.FloodrZqne'�l"unteas expressfyi parmltked.
- if Nse-.fifl"mateilal-is #o`be use�l:•tn:flood Zone 'A', it ls understcod that a dralnase plan addresstng a
'compe�saUng volume°will be submftted at Ume of•pe�ifGng wtilch ts prepared by a professional englneer
Acenaed by'the Stateof'.RIoHd"a: �
- , 1#fit�fl11 mateiNal is�to�b�=us�ti tn Ffood Zone'A°[r�connec�Ean•wlth�a pexmitted bnitding using stem wa{i
cunsbvclfon,I certify that NI�.iNJll:b.e used anly.to..tlll fhe ar.ea within�ihe•stem wall.
- If ftll matedal is'to be uaed�in�.anjr area, I certtfy that.use ot`'such fll!w!f# not adversely atiect adJacent
propertles. tf use af,f�l la fonrtcF#o advers�ly,sfl'ect sdJaaer��prcipertles,,the owner may 6a citad far.vtotating
the condlilons..of.the.builtlliig>permlt Is'sued=undar lha�attacfi¢d_permit��pplicatlan,�for.lots less than.one(1)
acre whicFi eie ele'vafed�by flil;a�t englneered dralnag�plan is requlred. ;
{f 1 am fhe At3ENT FOR.THE pWHER;.1�tomCse_tn,g�faitF►fo Infortn fhe owner af ths pertn{tt{r�g c�ndiUans set farth!n
this aitfdevtt`p�lor to cro�miiienciog conatriiictlail. 1 uniderafend thate:separate pennit may be requlred Tor eleatrlcal'work,
plumbing, signs,wells,,pools;,alr.condldoning,.gas,:ar•ofkjer Install�tt�ons na�•specJflcally inciuded•tn.the appltcaHan. .A
srmit issued�hat!be cotisbtted ta'be'a'license'to �
p pioceed wlth'�te work and not:as:authariiy hi vlolate;caticel,aSter,ar
set aslde eny'provislons ut the#eci�ntaat codeig;•nor sheit tssuance•of a.permlt.preveM the Bulidlrig Offidel irom thereafter
nw.;..,,.
requiring a carrection af•eRors in,plans;constivctlon or.vlolaUons of•arry c�des��ve.ry�permik�lssueii sfiell-become invaltd
antess the work asittiori�sdiby such permft�fs.commenced�wtthin_siXMmorz#hs of�pertnit Issuance,ar ti wark aathor�zed tiy
the permit is suspended oc-.abandonec!for,-a;perlod�of,�e{x,(8)monffis�efter;the;time the wotk ta commenced. M extensldn
may be requested,In w�idng;-,ftam tlie::Building.Offici�l for a period-not.to�exirteed"niriiety(90)'day§aad will�demonstrate
jusl�lable cause tor.�the extensfo� 11 w+ork ceases=for rttnety�(9g)r.onsecutive�days,.tk►e f ob�ls consfdered a6andoned. t
WARNING 70 OWNER: YQUR-FAILURE;TO,RF.C'.ORQ.A�t;W'FICE;OF,COMMENCEMEI�!'T�MAY�RESUkT IN YOU12
PAYlNO'IWICEFFOit;IMP1,itlwEMEI�t�S�1'�;,Yfi?UEFPitQPEt�7Y:�I�:Y�t!?lPF�'EMtD�'i'Q=�L?B=�'AU�t'��1t�i�ll+I�,;�ONSi!!T
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FLORIDA JURAT(F.&t1R.03) . . _:< •:+., �.. . .. ........ . .. . .. . '�... ..: ,.
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QWNER OR AOENi � COM'FRA�TO ` �
Suhaathed and awam to(or aiRrmed)heforo me thia Su6spI�ed'a Yeflfrtnedt e �
M' ;5c
Who Islare personally,known to.me or.hadheue P►Oduced o I&lare o.. ry • me.orfiealh ve�p►od
' aa tdenBRcaBori. ea tder�ltRcaH .
Nn#sry Pulr![c }��c
Commisalon No: m alon .��������. BOGES
�' �';�_ Commission#FF 1'5Q �
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Name of Natary typed,pdnted ar emmped Name ofi Nolery - r
°'a;�p• kQ:� 9ontled Thn+7roy FNn Insuranca 800.385�7019
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