HomeMy WebLinkAbout18-19635 CITY OF ZEPHYRHILLS
5335-8th Street 19635/
(813)780-0020
ELECTRICAL PERMIT
PERMIT INFORMATION :LOCATION INFORMATION
Permit#:19635 Issued: 5/01/2018 Address: 38220 HENRY DR
Permit Type: ELECTRICAL MISC . ZEPHYRHILLS, FL.
Class of Work: ELECTRICAL MISC Township: Range:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost Total Fees: 45.00 Subdivision: CITY OF ZEPHYRHILLS
Amount Paid: 45.00 Date Paid: 5/01/2018 Parcel Number: 02-26-21-0080-OOA00-0122
CONTRACTOR INFORMATION OWNER INFORMATION
Name: RAULAND-BORG CORP OF FL Name: HCRA PROPERTIES I LLC
Addr: 620 DOUGLAS AVE STE 1316 Address: 333 N SUMMIT ST
ALTAMONTE SPRINGS FL 32714 TOLEDO, OH. 43604
Phone: (407)830-6175 Lic: Phone: (813)788-7114
Work Desc: LOW VOLTAGE NURSE CALL STATION-low voltage label
APPLICATION FEES
ELECTRICAL FEE 45.00
INSPECTIONS REWIRED
ROUGH ELECTRIC
CONSTRUCTION POLE
PRE-METER
FINAL
lj
REINSPECTION FEES:(c)With respect to Reinspection fees fvfll�comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amot9t 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.
"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 OFF19tr-
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO&/
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
U13-7a0-0020 City Ot Gephyrhills Permit Application r-ax-tn 6-1 av-vuci
Building Department
Date Received = /�?
+ Phone Contact?for'Permitting
Owner's Name r_44,4 61 t1k, zg /'�1!%1S Owner Phone Number
Owner's Address `�°� ���'' � �f~I�L� Owner Phone Number,.`�-
r
Fee Slmpl®.Titleholder Name". Ownee-Phone Number '
Fee Simple Titleholder Address p
JOB ADDRESS ����-� ►`t or I,(-%,uC 2e -/j 1-A1,1I•S 33Sq"T LOT#
SUBDIVISIOPI' PARCEL-ID#
(OBTAINED.FROM PROPERTY.TAX NOTICE)
WORK PROPOSED NEW'CONSTR' ADDIALT 0 SIGN [� 0. DEMOLISH
B INSTALL: 8 °REPAIR
PROPOSEMUSE. - Q SFR E :COMM 0 OTHER
TYPEOF GONSTRUCTION' 0 BLOCK Q i:FRAME Q. " ST�E•EL Q
DESCRIPTION OF WORK /�5'�C+� t o, V�+f'f1�SQ •�v/-� � C < 1
BUILDING$IZE SQ'FOOTgGE HEI
• GHT:-
' I
..1444444
QBUILDING $ VALUAT:ION'OF.TOTAL CONSTRUCTION `
Y
=ELECTRICAL $ AMP SERVICE 0. PROGRESS ENERGY Q -W.R.E.C.
QPLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSlALLATIQN- l !(Q
=PAS 0 ROOFING- 0 SPECIALTY. Q OTHER
FINISHEDIFLOOR ELEVATIONS FLOOD ZONE AREA YES NO
;BUILDER , COMPANY
SIGNATURE REGISTERED Y`/ N: FEECt1RREN Y/N.
Address •License,#' -! v L
ELECTRICIAN YF5 COMPANY
;:SIGNATURE REGISTERED Y/ N . ,FEEidUkREh.. ' Y/N.J .
Address Licensee#.
PLUM®ERi, COfiIPANYc
-SIGNATURE REGISTERED ._ Y".N,-'1. FEECUWk.1..
Address. License,#
:.RECHANICAL COMPANY
•;SIGNATURE::' `'REGISTERED Y/."N FEE;CURREN Y-/N .
license.#
OTHEFt`s :: .•;; COMPANY
REGISTERED Y/:N FEE:CURREN' Y/N
Addr®ss;:,.r, ,•r -r__ a ;:�. Li6ense
F41.2:}•C.,: ".ni p. ?i: •(.
a, f "s" -0 P 1. 'r risstruction
ESI EW IAL� ,:4Attaciu:(2),FIatF?,lans (2)Set§of'8uilning;Plans Ener9YFQrm ,R. ,V11 erm t fo e, n
;.
.r,:-Wlihimurrr'ten 1.0,•;y oradq";;da s aftet_subrp9ttal date
.-Required onsite Corsi to coon Plans;`Sto tlwater'Plaris w%Stlt Fence:installed,
.. , :Y
1y. f. ,z
Saul aciilties8�+gldwm ste;a8it`,WorlPenniGfor sub iiiisiops/la. eV ro
V..r..,,.._._. _u
MMERGIAL AttaW(2).complete`s'ets'of'13uilding"Plan`s plus a'Ll e'Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction
Minimum ter,(10).working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence.,installed,
-Sanitary Facilities&1 dumpster;Site Wor�C Permit fog ll:?n6W projects.All commercial requirements must meet compliance
4 -•�:.,
f31GN PERMIT `AttaoTi"; setsofq(rrJgineeredPlans
( _,._.
""PROPERTY SURVEY required for,all NEW construction:_
_ .
`iDlrections
fIII°`out application completely.~
Owner.&Contractor'slgp:back of-application,notarized
a. --if:'over.$2500;.a Notice>,of;Commencement is required. (A(C upgrades over$7500)
Agent(fdr ttie caritractor)�orPower'of Attorney°(fbf'ttie owner)W uld-tie someone with notarized.letterfrom owner authorizing same
''OVER:THE:COUNTERP ,RMLTTING`..,.,. ..(•copy of.contractrregwired) '` "`'
Reroofs,ffaliirib -s Sewers :Service Upgrades A/C Fences(Plot/Survey/Footage)
:Driveways-Not over Counter lion public roadways::needs'ROVU`
NOTICE•.OF DEED:RESTRICTIONS: The undersi neduncler5tan. s>.that:ths permit.may.be subjec #o:."deed',restrctons
wh_i h. "�b Iriore=restrictive:t n =oti:t';.'re ttiatiors `' i'efunoers'r:netl assumes figs o�tslbjt' foYrix` ifance"riith`°;an
c m.aft. a ha ._C . n,.Y 9 g �P ty Y. .
applicabI6.deed restrictions.. :<.<x '^"^�tf ` .'_s•
UNLICENSED"::;CONTRACTORS AND- CONTRACTOR RESPONSISILITIS If the-owner Etas i ira'drya?°contractor or
contractors`to undertake work;:they rrtay-,be•.requ red-#o be ticensed in accordance..with.state';aftd'locai:=regulations:-?If,tile: .- .
+.. ...),".�:._:.:lr. ...`�ti _ _.. .1'.`.::;..X..J:_::ih..::J2s..,i'w;.=.u:•�-__v°'.....,•.
contrastor.:is�not::licensed,'as:.,required"by.law; both:the-owneTv�arad"con actor mdy faexcltedvfor} Frtisderrieanorvioiation
under state law. tf the owner' or.Inter�ded.,co.,ntractor,.are�Uncertain as,to what:licensing cequicemet t�$�rrtay�aR�t�tafat�tHe
intended wolki:they:are'advised`to.contactthe'Pasco Coutity`Btii(i�ir °lnspetation Division-�l sensing S:ection-OU72.7=,M7
80.09:';•Further:more; if-the--oitiner has°lire! a contractor'or contractors, he`is advised #o-;have,the.vcontractor(s).,,,'n.
portions of the "contractor'Block"of this applicatlon_,for.which..they.,:wiil.bey responsible,.,lf_you,,Mas�tlid o:o trier sigt-ra ' h
contractor;that be an indication 14-i"he is not properly''licerised and'is not entitled to permittingiprivileges.inrPasco.:
County. - .. _..... :.r .h5�•,• �• ..
TRANSPORTATION-.IMPACT/UTIL-ITIEs.iMRACT AND-RESOURCE RECOVERY•FEES:-'Tfie underslgned.understands_-
that Transportation Impact Fees and Recourse Recovery Fe::es`-may.,appiy tafthe.constructbn_of.new.,bubirigs,.
use in existing'btiildings,�or.expapsion:of;5;e�iatirig buildings, as specified in Pasco County Ordinance number 89=07 and
90-07, as amended. -The,undersigned also,understands;'Ahat.sucti<fees,:as-.may^be,due; will be identified Mt41`e
permitting. -it is"furtherunderstood tiiafTranspprtation Impact'Fe6s•and kesourcWR'ec over y,.l"ees must be paid prior:to
receiving:a:"certificate.of occupancy"or final,power release-. if the project:does not=involve:a 66tificate of.owupz pt°cy do
final'pgwer-releaser the�fees:niust'be:,paid prior,.to perMit'issuance Further rtore,I,,Pasco:Ct unty Water/Seweretmpact
feesare:.due;.ttiey;must tie::paid prior to:permit issuance.in accordance•with:.appliaable:;l�asco:Coulity ordinances.
CONSTRUCTION LIEN LAW(Chapter 71.3;"Florida Statutes,as amended): if valuation of work is$2,5.,.0,O:Op.o-r.:;.more;; _ s.
certify that- 1,•the applicant,•have';been: provided with 'a :copy;;:of:=the..:"Florida`-Construction:°.Lien LaiiiHomeoiivner's.
Protection Guide" pre pared"W the Florida Department of Agriculture and Conspmer.Affairs. if the applicant'is:.someone.
other than the"owner", l certify that l have obtained a copy of#he.°above;descftieddocornent and.pcomise}in good"faitl :tq: .;..
deliver,it,t61he1fi- V.� nor.5to cr mmencemerit:
CONTRACTOMSTOWNER'S AFFIDAVIT, l,certify:,that'all-the information in this application is accurate and'that alf*ork
will be done in compliance with all applfcable laws regulating construction, zoning�."c tld r.land development. Appfcatltin.is
hereby.; made to.obtain.,a::,permit;to.doh::work"-and.:installation..as��intlieat';; 'I'certify that no -work or,:,lnstaillatlb ,has
commenced prior-id issuance of'a permit and-that all work will be performed'-#o-:meet standards--of all laws regulating
construction, County and City codes, zoning regulations, and land developmerit`regiilations`'in::the jurisdiction:
certify that ! understand that the regulations of other government agencies may.apply,:to.the-Intended work, and that 11it is:
my responsibility to Identify,what actions.I must.,take;to.be,,in,.comp�ianc e:,.,Such,aggeiribies Include but.are not,iimited tw
r 1A.
Department of•Environrrienta!!P,e6tectioh'"Cypress,Bayh#ads; Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management .:District Wells;'`-'Cypress-�.Bayheads,' Wetland Areas, Alte`ring
Watercourses.
Army Corps of Engineers=Seawalls, Docks;'Navigable W6teiways.
Department-.,of Health;,:&.Rehabilitative:Services/Environmental Health=sUnit=Wells;#Wastewater:--Treatment,
Septic Tanks.:
US Environmental Protection Agency-Asbestos.abatement.
Federal Aviation:Authority.Runways,
I understand-that,:tile following:restrictions apply to rite use of fill:
Use of f 1!s,not allowed in Flood Zone"N"unless expressly permitted.
if the frll:'_materiai:'Is Ao°be used !n Flood' Zone "A", 'it is-understood_#hat a--drainage plan addressing, a
"compensating volume" will be submitted-at time of permitting which is prepared by a professional erig'ineer
licensed:by:the-ttate'•:of Florida. .
if the fill"Inaterial:1s to be used In Flood Zone "A" in connection with a permitted building using..stem gall,,
construction, t.certify;that-filt' 11-be used only to fill the-area within the:s#em wall. .:... .
If fill-material is"to be used"iii-'any area, I •certify that use of sucli-fill will not adversely affect adjacent.,...,
properties. .If.use,of fill Is found-:to adversely,aff`ec#ia jacent properties, the owner may be cited for.violating;::
the candidons.Hof,<tt e, s`building permit:" ued under the attached:_per.mit,application, for:lots'-fess'-than an one;(1}
acre wtictfi.are-elevated by fill,:an engineered drainage plan is requited.
if i am the AGENT::FOR.THE:OWN R -_i'•:promise in,.good faith-to inform,the ownerofahe:perrnitting=conditions,set forth in
this affidavit prior'to•commencing construction. .I.understand that a:separate permit may be required for electrical.wor ,. :..
plumbing, signs,.wefts,..pools,-;air.;con dltinning;rgas,-.,.or,otti41ilstafiations not specifically included in the application .A,,,. ::.'::
permit issued shall--,- construedto be'a li'cense7.wproceed'wlth''ttie:work and not<-as aut#tority d violate,.canee!,:alter, or
set aside any provisions of`the`teclinica!codes, nor shall issuance of a permit prevent the Building Official f'rom.thereafter- s;
requiring.a;correctionsof.,srrors,In�plgn.-' _construction,or'.violatians,of-any-codes: .Every permitissued�shall..become invalid
un(ess'the work authorized`bysuch permit is commenced within.,sixmonths of permit Issuance, or if work authorized'tiby
the permit'ls-suspended,;or-abandoned for:;a=:period,.ofz:six(6)m'6n#Fis:af#er the time the work is commenced. .An extension
may be.;re.quested,:ins w iting,,#0ffi..th6 Build!n g Officlaf for a period:not=to:ekceed`ttln days and,will demonstrate
justifiable cause for.the extension. ceases for ninety(90)consecutive days,the job is.considered abandoned: v .
. ., ..... ._._._.__. .. ..
WARNiNG''TO OWNER• `,YOUR FAILURE£TO,RfrCO,R ::A.NOTICE'.Of:.COAAMENCEMENT MAY RE5ULT=iiN YOUR
PAYING TWICE'FOR:t,.,�i'ROdEMENTS' O`YQUt2wF?ROPER4TY :;IF`YOU;INTENDtT.$OSTAM" INANC-1NG'CONSULT
$.'...,., 1 p n.ti., k YNvr T..ei r " ✓
WITH YGUI LENDER GR AN ATTORNEY BEFORE?RECORDING°,YOORVOT1i��'���;Oe�E'IE4�3�€�i►iEi�i
, .•, . ... ' :-. . .. '.. .. ,. ,,. .. ..
OWNER OR AGfNT._ .... CONTRACTOR
subscribed and'swom to(or affimted)before me this subscribed and sworn to(or affimzed)_befortme this '
Who is/are personalty.known,to.me.or.has/have,produced Who is/are personally,known to•me,or-has/have produced.
as(d hIficaVon. = as identification.
Notark Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
VW�1
AME EW
Rauland Florida is a Division of AMETEK;Inc.
Le'adirfg Systems integrator for Florida's Healthcare and Education Markets
License#EGI 3000340
SPECIIAL POWER OF ATTORNEY
1, James S. Taylor (Name of License Holder),license# EG13000340 hereinafter referred
to as the"License Holder,"the Vice President/COO (title),of Rauland-Borg Corporation
of Florida
(Name of Company),hereinafter referred to as the"Company", hereby appoint the
following persons as Attorney=in-Fact of the License Holder/Company,in order to(a)sign and submit building
permit applications, (b)obtain building permits:
Francisco Rodriguez James Ross
Isaac Molina Edwin Rivas
LICENSE HOLDER
Sign:
krit i'YqJe: Jame S. Taylor
Title., Vice President/COO
Company Name: Rauland-Borg Corp of Florida
Mailing Address: 620 Douglas Ave, Suite 1316
Altamonte Springs, FL 32714
Telephone No.: (407) 830-6175
Fax No.: (407) 767-9293
E-mail Address: James.S.Taylor@ametek.com
State of Florida
county of Seminole
The foregoing instrument was acknowledged before me this 19th day of April 2018
by
James S. Taylor —the Vice President/COO of Rauland-Borg Corp of Florida on behalf
of the corporation.He/she is personally known to me or has produced as
identification.
&),A-0 v*a
Notary Public
A
Pmf'VM.M RCOVICH
Stamp MYCOMMISSION 9
#GG182239 0 1
E_ r_-XP1RESM:Marzh22j,202l
620 Douglas Ave, 39b2 Corpo(ex Park 5247 NW I OW4 Avenue 3550 Work Drive, 6950 Philips Highway, 4405 SW 351"Terrace,
Suite-1316 Drive,Suite 2100 Sunrise,Florida 33851 Unit B7 Suite 32 Suite 3
Altamonte Springs,Florida Tampa,Florida 33619 P:954=747-4456 Fort Myers,Florida 33916 Jacksonville,Florida 32216 Gainesville,Florida.32608
32714 P:813-740-2500 F:964-747-6632 P:239-693-5885 P:904-739-7345 P:03-740-250Q
P:407-830-6175 F:1813740-2502 F:239-693-6384 F:904438-9303 F:813-740-250
F:407-767-9293
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