HomeMy WebLinkAbout18-19584 CITY OF ZEPHYRHILLS
5335-8th Street
(813)780-0020 584
ELECTRICAL PERMIT
-PERMIT INFORMATION - LOCATION-INFORMATION
Permit#:19584 Issued: 4/18/2018 Address: 38250 A AVE
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE REPLACEMENT Township: Range:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 2,000.00 Total Fees: 50.00 Subdivision: CITY OF ZEPHYRHILLS
Amount Paid: 50.00 Date Paid: 4/18/2018 Parcel Number: 14-26-21-0010=01300-0010
CONTRACTOR INFORMATION OWNER INFORMATION
Name: CENTER STATE ELECTRIC INC Name: ZEPHYR HAVEN NURSING HOME
Addr: 16080 ROCKRIDGE RD Address: 38250 A AVE
POLK CITY FL 33868 ZEPHYRHILLS, FL. 33542
Phone: (863)853-4122 Lic: Phone: (407)975-3000
Work Desc: ADD SUB PANEL & REWIRE NEED FOR A/C
APPLICATIO FEES
ELECTRICAL FEE 50.00
INS ECTIONS REQUIRED
ROUGH ELECTRIC
CONSTRUCTION POLE
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 renspection.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"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 and Fee Must Accompany Application. All work shall be performed in accordance with City
Codes and Ordinances.
CONTRACTOR PER OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-OU20 City of Lephyrhills Permit Application rax-rs�s-rrsu-uuci
Building Department
Date Received (�_ ) / _
PrrrTTrrrr hone Cbetact#or.Perinitting 3 CQ 1 ��
Owner's Name r �V�fl �TI �►7 Owner Phone Number ,
Owner's Address. 9.50 A AVE M\S �� Owner'Phone Number
Fee Simple:Titleholder Name'.. Owner'Phone Number,
Fee Simple Titleholder Address JOB ADDRESS r 319 9115 0 6 LOT#
SUBQII/ISION• PARCEL ID#.
(OBTAINED'FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR`. - AD.DIALT SIGN' 0 �. DEMOLISH
i El. .' INSTALL. B 'REPAIR 7�
PROPOSED;USE. 0 SFR 0 :-COMM Q' OTHER
TYPV0FCONSTR6CTI0N' 0'" BLOCK 0 FRAME Q. STEEL ._.
DESCRIPTION bF wORK " A&Cd $Vvb & n•eid i-e�. Co
BUILDINGSIZE . ' - S4_FOOTAGE :.HEIGHT
=BUILDING $ VALUAT,ION'OF TOTAL CONSTRUCTION
• n,
=EL•ECTRICAL $nOOD� oo . AMP SERVICE �. PROGRESS ENERGY 0 -KkE.C.
PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL.INSTALLATION
=]GAS 0 ROOFING- Q_ SPECIALTY. = OTHER.-
FINISHEDFLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
:BUILDER; COMPANY
SIGNATURE REGISTERED Y'/ N-:..'' FEE:CURREN YIN.
Address // Uceense.#
fLEC,TRICIAN: •, !COMPANY
�1n G
.''SIGNATURE � / REGISTERED Y/ N . •FEE%CURRER.• Y/N "
O� Ss DS�G � OO d #Address I ,
PCUMQER;,,;;. COMPANY:::
SIGNATURE" 'REGISTERED _ Y/-N::? .FEECURREk:; Y/•:N :- . ,
Address. License.# .< .
`.fiAECHANICAL"_` COMPANY...
REGISTER`'SIGNATURE"'°' ED Y/,N FEE;CURRED . ..Y:/.N
Addresss4,.. License.#
OTHER.
_ ,...g: . 7.
CORAPANY
';SIGNATURE,Y;ry:$: i REGISTERED Y/N �FEECURREK Y/N
t:.
'1:16er1Se'#
,ti o s R 0=V11Pe 1t F`rnew,constuction
-RESIDENTIALz. sAttach'(2)PlotPlans :(2)5etsof9uiling plans;(1)-set nfEnergy F rm , rm fo
... ...:-.,� �. -•-•r•, _ ,z., _ _s':r.•i...,.F:;,. 4:,.,.rr
�. ,. ir♦imu xteri 1.0. `orlon'dasaftet. ubirmittataate. Re riired onsite'Constructton Plans',Stomdwater'PIOns wl°S(IYFence'installed;'
Sancta: =Facilities;&ildwm ste.•Si s..W.ork Permit forsubdi5 sloras(la. e'io `cts-
ia3'ORAMERCIAL Attaolr(2)coinplete`s'ets'ofBuilding Plans plus a l ife`Safefy'Page;(1)sef 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 Fenceinstalled,_
Sanity Facilities&:1 dum ster.,Site Wo, Perrnitfor�ll=new.: rb acts.All commercial requirements must meet compliance
rY .P . .,..,l� P 1 q _ p
'.�51.GN;pER�lli' Attach• �)sets;o•fnEngfneeiedQlans��.: .._ . :f--. , ... ".•:
""PROPERTY SURVEY repuired:fgr,,alIVEW,,constructiom—,
-.Fill.out:application.completely.
0Wnev&Contradtor sign-back of-application,notarised
-Ifover.$2500;.a Notice,—of.—Commencement—Is required. :(A/C upgrades over$7500)
:agent'(fdr tfieMcontractgr):tor>PoWer ofAttomey(for'the owner)would"tie someone with notarized letter from owner authorizing same
OVERTHE COUNTER PERAMITTING:.:: ;:.(copy,:of contract:required)
s:Reroofs'-ifafiingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
iDiveways-Not over Counter if'on public�oadways::needs ROW
NOTICE'-OF DEED RESTRICTIONS: The undersignedFunderstan-'sahatahis;permit.ma be 'r. ......
d y; Tsubje&to;<.,deed�restnchons
`:.t�'. �.k-: ,.a'.•,k:, i• •.S.,i: ..';`u�. - ::7., i7�F +.'a.. •+tithe g�Fx. �";. -
which-eta';bWllore�estrict'1464han<'Got� ti' .re `ulations:-The'ui der'.si`'ned`assuMes rss ":o si5iti =o n> 'da ce y#i yart.j ny 9 _ 9. P n ty c .-.p.
applicabld-deed:restrictions. =.:>.
UNLICENSED:;CONTRACTORS AND' CONTRACTOR RESP;ONSiBILlTIES' 1f the>owner aiasrvhired°a-:eontractor or
contractors'to undertake work,.they-. tmay be.requiredato be3licensed in accordance:with.state':arid loco!;regu i lions r If tfie
::'s..�•}=_ ,— _: .7' -- h �rrC,`^.)Y.:sy^^..`v'�2,"-.,:.yi,:F.. :-.i•::.:..: t?'.y:vu1 -_<t.m
contractor.is�not:-licensed,'as<yrequired.by law, both:-the owner-and'cdhtFact�r;maybe,"cited fork aF irtisden eanor-violatian. .
understate law. "lf the owner-or lutentled-;coptractor-are uncertain as,to what-licensing:requ rerri'e t# t'yinay a pi `° t;tia`e-r`:Y:.'
Y S t 'rtry'r' -
intended workrahey:are'advised-to coat_ ct the:Pasco"Courlty'Building`Ii p i lion;Dtvision�--Licensing S..ection at':727=84;7-'
80.09"-Furthermore; .if the owner`lias°hired`a`contractor`or canfrac#ors, he is advised to;have-ttre,,.contractorts) sign.: _-
portions of the-contractor,Block.,,of this,application,for which..they..will.be:resP.onsl Iev .,if<,you,..as:the rowrler'-srgr •as:titie -r
contractor. that.ma 6e an Indira#ion-that'he=is-not`proper licensed and is not entif(ed to ermittin '
Y P P Y P 9 privileges In:
Pasco
County.
TRANSPORTATIONIIMPACT/.UTIL-ITIES;IMPACT AND RESOURCE RECOVERY"FEES:"The undersigned.understands:..-
that'Tr�ansportatlon Impact Fees and Recourse Recovery Fees:mayapply 1othe.cnstruction„o#..new:btaiidings;:changecjfj`%
use iri;existing"buildings, or expansiort•of-e�iisting':titiiidings, as specified in Pasco County Ordinance number 89=07'and
90-07,;as amended. The•undersigned;also.tnderstands;:that.such,.,fees, a's-rnay,�be due; will be identified=atdtMe�tii 'e of."
permitting. Alt is furtherunderstood that'Transportation Impact Fees=and Resourc iRecovery,Fees must be paid;pfior:to
receiving:a certificate.of occupancy"-or final.-,power releaser If the p ei cdateof oo :
fina!�power-release;-,�th'e:#ees:must-be_paid prior to-perMit`issuance. .Furth4iiorex.If-Pasco;County aterfSewerrlia�pact:.:
fees are due;:they:must be;.paid prior to;.permit''issuance::ln;accordance with.appiicatiie tesco'County ordinances.
CONSTRUCTlbWLIEN LA'W.tChapter71,3"Florida-Statutes,as amended): If valuation of work is$2,500;.M,or more„ ;;.
certify-ithat-'i,.'-the applicant,,have-been•--provided-with- a:copy.;-of.=the "Flonda.-Construction::—Jon.:Laul�Homeown es
Protection Guide" prepared"•by the•Florida Department of Agriculture and:Consumer:Affairs. If the applicant:is—.someone,..._,..
other than the"owner", l,certify that 1_.have obtained a copy of the.°above'd*(I.eo).ocument and pramine=fin:gaod;:f�iftr to:
:.-
deliver,it.to'ttiei".owner"��prioei'N` `_Mdhc im6nt`
CONTRACTOR'SIOWNER'S AFFIDAVIT- I,c+ertify#hat'afi:the inform ation in this application is accurate and`that air work
will be,done in compliance with all appiicable laws regulating construction, zoning aridaand=.:development. Application;is
hereby; made to.obtain;a;.:permit;>to do;.work ,ind..,.installation.,6f'indicated: 1 certify that no'work or.installation 'has'
commenced prior-to issuance of"a permit and-that all work will be performed to.:meet<standards~of all laws regulating
construction, County and City codes, zoning regulations, and land development"'regulations`'in ahe jurisdiction.= l°also
certify that I understand that the regulations of other government agencies may-apply�to.the-intended work, and that ilt is.
my responsibility to identify what actions.I,must,take to,be._in,compllance:;Such.agencies include°but;are not,limited taa
,Department of Environmental?b6tiact16h ress Bayheaii Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
Southwest Florida Water Management :District-Wells,' 'Cypress .Bayheads, Wetland Areas, Altering
Watercourses,
Army Corps of Engineers=Seawalls, Docks,-Navigable Waterways:.
Department:-,of. Health,;,;+&,Rehabilitative Services/Env-ironmentoL:.Hgalth�--Unit=Wells,°'W.,asteuvater:Treatment;
US Environmental Protection Agency-Asbestos,abatement.
Federa):Aviation;Authority Run�+vays. \
I understand that411e46llowing-restrctions apply to the use of.fill:
Use of fill.is,not allowed in Flood Zone"V"unless expressly permitted.
- If the fill:,material::Js16;be used in Flood Zone "A", 'it is understood that a•drainage plan addressing a
"compensating volume" will be submitted.,at time of permitting which is prepared by a professional engineer
: licensed:by:the 84116:60 orlda. .
If-the-fill,"inaterial, is:td be used in Flood Zone "A" in connection with a permitted building using,stem wall:.
construction, I-cerfify:that.fill:`11 be used only to fill the area within thesstem wall. ..:.
If fill' Jis to-.,be,used '16 any area, I certify that use of such fill will not adversely affect adjacent.:.,.
properties. If.use of fill;Is found to.adversely-affeidUadjacent properties, the owner may be cited for violating;.
the conditians_:af#he�hulidih§ permit:issued under the'attached;..permit:application, for:fots'`iess than one;(1)
acre which ard,elevated by fill,an engineered drainage plan Is required.
If I arn..the.AGENT:FOR-THE,OWN.ER-:I°.:promise in-good f6ithl to inform the owner-ofAhe-permitting'conditions',set forth in
this affidavit'priorto commencing constrciction'. .l.understand that,a separate permit may be required for electrical work,.;,
plumbing, signs,,.wells,;pools,-air.•conditioning,,gas,::.ori other'.-'— tallations not specifically included in the appiicationt i:A.,,
permit lssuedshall=be-construedto ea license3,to,.proceed.'with'the.Work.,and-ndt�as:'authority-.to violate;.cancel,-alter,!or
set aside:any provlsons-of'ttie'techncal codes, nor shall issuance of a permit prevent the Building Official from thereafter " a
requiring a,correctiont,of.errors.in pions;=canstruction.ar violations of any:codes: =Every`permit Issued sfiall becorrie invalid
unless the work authorized'by such permit is commenced.within,.six,.months of permit issuance, or if work authorized iby:'
the permit is-suspended'!:or abandoned;.fora=period�of six-(6)'nionths:after the time the work is commenced. .An,.extensian
may be.;requested,.1m filing;:from'::the Building Offidial.for a period:not46,ekb6W°ninety'(9q)'days and will-demonstrate
justifiable cause for-ttie extension. .If, cpases for ninety(90)consecutive days,the job is,considered abandoned: }
WARNING'TO OWNER. YOUR:FAILURE<TOt';RECORD"A;NOTICE--OR COIViIMENCEMENT:MAY RESULT IN YOUR
... f�..
Pi4Y1NG�TWICE'FOR=11tIP13fl1FEl1iIENTSaT #YC1tiRf?"ROPEITY:,:i!F Yf?:Iri:1NTENDtTO OBTfA1NFiNAN. < ,.,.._, . .: m.C1NG `CONSULT
WI'WYOUITLENDER'OR AWATTORNEY BEFORE-RECORDING,YOUR`'NO"t•ICE'OP'COMMENCEMENT:"
FLORIDA JURAT:(
OWNEB_OR-AGENT- --. -. . -- -- — CON-TRACTOR - - ---- ___--- --- - ---
Subscribed and sworn to(or affirmed)before me this Subscribed and sw r affirmed ti
by .,.
Who islare personally.known,to,me-.orhas/have,produced Who Is/ac�personaly known tome or has/have produced:
as'Iddii"catlon. �L. i�iyY.fs liCbnS� as Identmeation. _.
Notary Public t"� - Notary Public
Commission No. Cam on No
FF J50422
' :'_°' •k Commission-#
201 i3
Name of Notary typed,printed or stamped Name of Notary ar. fg }ps usnveaDD 3g57a
4 '
CENTER STATE ELECTRIC
QUMY WorkmanlM C-"&
EC#13005505
To whom it may concern,
I would like to authorize the following people of Center State Electric, Inc.to be able to sign and pick up
permits.
Brian Weeks Jr.
Crystal Weeks
Jennifer Roberts
Thank you,
Brian K Weeks
Center State Electric, Inc.
16080 Rockridge Rd.
Polk City, FL. 33868
Phone:863-853-4122
Fax:863-858-6871
STATE OF FLORIDA
COUNTY OF POLK
SWORN TO AND SUBSCRIBED before me this 16th day of April, 2018, by Brian K. Weeks,
who is personally known to me.
LA
C�J O
�•��2t`:uia JOANN GROGGS
Commission#GG 100198
,v'VI Expires August 31,2021
%;�;?; BundatThru Troy Fain lnsunnco80O.385-707e