HomeMy WebLinkAbout19-21647 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21647
f BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21647 Address: 37819 ALISSA DR BLDG 20 UNITC
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ORANGE BLOSSOM RANCH
Est.Value: Parcel Number: 15-26-21-0170-02000-00130
Improv. Cost: 16,800.00 OWNER INFORMATION
Date Issued: 8/16/2019 Name: COBB, LAWRENCE S TRUST
Total Fees: 125.00 Address: 37821 ALISSA DR
Amount Paid: 125.00 ZEPHYRHILLS, FL 33542-5670
Date Paid: 8/16/2019 Phone:
Work Desc: REROOF SHINGLE (1 OF 4)
-CONTRACTORS APPLICATION.FEES
REROOF RESIDENTIAL 125.00
Ot
U
s ections Required
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
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 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.
CONT TOR IGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received r Permitting Phone Contact fo
.............
Owner's Name WrWce_ (A>6 Owner Phone Number
Owner's Address 13-7 3,9-) Ali 5 3a 'b f- Owner Phone Number
Owner Phone Number
L
JOB ADDRESS 17 ksi:-a be LOT# C�
SUBDIVISION —00e_0 I
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH
e INSTALL REPAIR
PROPOSED USE SFR Q COMM OTHER
TYPE OF CONSTRUCTION Q BLOCK 0 FRAME STEEL
DESCRIPTION OF WORK FTeCr_ c>q- ni_ 0� 5��Mb Coup
BUILDING SIZE SO FOOTAGE HEIGHT Is
=BUILDING VALUATION OF TOTAL CONSTRUCTION
B LRO /� I Da
=ELECTRICAL 1$ AMP SERVICE DUKE ENERGY = W.R.E.C.
=PLUMBING $ 4��It �1(eq
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION
=GAS [2T ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
Vn k f'16 10(—
BUILDER COMPANY c 0 o _TI
SIGNATURE REGISTERED Y/ N 1�0�FERURREII
Address License# CC 13313 R0
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LLLN J
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED FEE CURREN L_Y_LN J
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License# I
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&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 all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directions:
IgCtions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement Is recItAred. (A/C upgrades over$7500)
Agent(for the contractor)or Power of Attorney(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 , 8ery:lce Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public r6adways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited fora misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County;Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes,-as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I 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 the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WaterMastewater 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/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone W" unless expressly permitted.
- If the fill material is to' 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 State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building.permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned.
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 NOTICrz OF C MMENCEMENT.
FLORIDA JURAT(F.S. 117.03)
OWNER OR-AGENT-- - — CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Sub c ed d s r , or a ed)/ efor m this
by
�!� !� c�l�hs
Who is/are personally known to me or has/have produced Wh (safe Per
ally.known to me or has/h ve produced
as identification. � �J as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed 1d09tWinF68U0NAD0
Commission N GG 346275
Expires June 18,2023
Bonded Thru Troy Fain Insurance 800.385-7019
` Permit No. Parcel ID No 15-d(P-a)-c uo-0,20W
1 - NOTICE OF COMMENCEMENT
State of Pio r li. County of 1 QED
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real properly,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement:
1. Description of Property: Parcel Identification No.
p7g1;5rSlreetAdd2ss: 3-7 Q(
f
2. General Description of Improvement (ear 040
and aQtoteyy►"i- A /bv�-
3. Owner Information or Lessee information if the Lessee contracted for the improvement:
37n I grls Dr r",L-
Address /� ,.,/ City State
lJ Interest in Property: lo f
Name of Fee Simple Titleholder:
(If different from Owner listed above)'
Address en�`n, City State
4. Contractor. [� �j 0 �L (.0 IAA
�oy�s
Address �/ / city State
Contractors Telephone No.: 13� 7a� (R 9
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender.
Name
Address city State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address city State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of
to receive a copy of the Lienors Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief.
STATE OF 1
COUNTY A
�►nv°& Notary Public StaM- hi.
Signature of Owner r L ssee,or Owners or Lessee's Authorized
Avelino Vide
OM cer/Diredor/Partn r nager
My Commission F
or.f� Expires 01/0=02Signatorys Title/
The foregoing instrument was acknowledged be _day of* 20 q by �� ti't J i v�
as (type of authority,e.g.,officer,trustee,attorney in fad)for
(name of party o�instrument was executed).
Personally Kno Produced Identification❑ Notary Signature
Type of Identification Produced Name(Print) X /r 'ar7
wpdata/bcs/noticecommencement_pc053048
CITY OF ZEPHYRHILLS
5335-EITH STREET
(813)780-0020 21648
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21648 Address: 37821 ALISSA DR BLDG 20 UNIT B
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ORANGE BLOSSOM RANCH
Est.Value: Parcel Number: 15-26-21-0170-02000-OOCO
Improv. Cost: 4,200.00 OWNER INFORMATION
Date Issued: 8/16/2019 Name: COBB LAWRENCE S REV LIV TRUST
Total Fees: Address: 37821 ALISSA DR
Amount Paid: ZEPHYRHILLS, FL 33542-5670
Date Paid: Phone:
Work Desc: REROOF SHINGLE (2 OF 4)
CONTRACTOR(S) APPLICATION FEES
REROOF RESIDENTIAL 0.00
//,N A
i/ Ins nectio s Required
DR IN R40F IN
TAPE JOINTS ROOF INSP
FINAL
REINSPECTION FEES: (c)With respect to Reinspectio'n 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 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
CiV Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRA TO SIGNATURE PERMIT OFFICOR
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received - �a Phone Contact for Permitting �rf D a...........1,1,1,
Owner's Name V_aI_i)ren(19 COLL Owner Phone Number
Owner's Address Owner Phone Number
Owner Phone Number
JOB ADDRESS 137,ul All,s� br LOT#
SUBDIVISION PARCEL ID# 6 1 A)-Or�Ceo-Cp RC)
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
e ffr
PROPOSED USE SFR Q Comm OTHER
TYPE OF CONSTRUCTION BLOCK FRAME 0 STEEL
_J
DESCRIPTION OF WORK
BUILDING SIZE F_ SQ FOOTAGE HEIGHT
I I 1 14 14- IL
UBUILDING ' -I
VALUATION OF TOTAL CONSTRUCTION
I I ( , 0c) I
=ELECTRICAL 1$ AMP SERVICE = DUKE ENERGY = W.R.E.C.
=PLUMBING 1$ -21f
rT
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION
=GAS Rl> ROOFING Q SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY 60OL)' _01),
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License# FC 13313 S-6
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN L_yl N J
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License# F—
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LaN J
Address License# F—
i OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License# F—
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&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&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
D=t'l oinIs:
Fill out application completely.
Owner&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 Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
'Sewers- U A/C Fences(Plot/Survey/Footage)
Reroofs if shingles ��ervice,Upgrades
Driveways-Not aver
er Counter if on'pubi,iC r6adw6ys..needs ROW
NOTICE OF DEED : The undersigned understands that this permit may bm subject tm^dmad"restrictions"
which may bm more restrictive than County ' u|m1iono. The undersigned assumes responsibility for compliance vv�hany
applicable deed restrictions.
' `
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state.and local regulations. If the
contractor is not licensed as required by |aw, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised bocontact the Pasco County Building Inspection Division—Licensing Section et727-847-
8009. Furthmrmona, if the owner has hired e contractor orcontractors, he is advised to-have thecontractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
onninoctor, that may boon indication that ha is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply bo the construction cfnew buildings, change uf
use in existing bui|d|nga, or.expansion of existing bui|dinge, as specified in Pommm County Ordinance number 89-07 and
90-07. as amended. The undersigned also undenabandn, that such fees, as may be due, will be identified a1 the time of
permitting. {tie further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior bm
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power na|eooe, the fees must be paid prior to permit issuance. Furthermore, if Pasco Counh/VVoter/Sewer Impact
fees ared they must ba paid prior bo permit issuance in accordancexvitha p|icmb|aPmocmCountyond|nonueo.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes,-as snnemded): |f valuation of work io$2,5OO.00ormore, |
certify that 1, the applicant, have been provided with m copy of the "Florida Construction Lien Lavx—'Ffmmneovxnm/s
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. |f the applicant iosomeone
other than the"owner", I certify that I have obtained a copy nf the above described document and promise in good faith to
deliver itbz the^xmxner" prior bocommencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: | certify that all the information in this application is accurate and that all work
will be done in ngnno|ianca with all applicable |ovms regulating conatnuction, zoning and land dsxma|mprnenL Aop|ioat| `n is
hereby made to obtain a permit to do work and installation as indicated, | certify that no work or installation has
commenced prior to issuance of permit and that all work will be performed to meet standards of all |avvo regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. | also
certify that | understand that the regulations of other government agencies may apply tm the intended work, and that it is
mny responsibility bb identify what actions | must take bmbmincompliance. Such agencies include but are not limited to:
- Department ofEnvironmental Protection-Cypress Bayheoda, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- ' Southwest Florida VVobar Management District-Wells, Cvpm*an Bayhmadm, Wetland Araoe, Altering
Watercourses.
- Army Corps ofEngineem-SeavmaUe. Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-WaUo, Wastewater Treatment,
Septic Tanks.
- U8 Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authoritv-Runvvaya.
| underotand that the following restrictions apply ho the use offill: '
- Use of fill io not allowed |n Flood Zone^V°unless expressly permitted.
- If the fill material is to*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 professional engineer
licensed bv the State ofFlorida.
- |f the fill material is to be used in Flood Zone ^A^ in connection with o pmrm|bed bui|ding using stem vxaU
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, | certify that use of such fill will not adversely affect adjacent
properties. |f use of0| ie found tV adversely s�Naotadjacent propndiao. the owner rnoybe cited for violating
the conditions mf the building.permit issued under the attached permit application, for lots less than one /1\
acre vxhichare elevated by�U. oh engineered drainage plan iorequired,
'
/f| mmnthe AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. | understand that a separate permit may be required for electrical.work,
plumbing, signs, wells, pob|o' air conditioning, gam. orotherinabmUadono not specifically included in the application. M
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions ofthe technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction ¢f errors in plans, construction or violations cf any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be mequmoted, in xvrit/nW, from the Building Official for a period not to exceed ninety (90) days d will dannmnotnaha
justifiable cause for the extension, |f work ceases for ninety(9O)consecutive days, the job,�s consideredabondongd.
WARNU ��� T0OWNE��: YOUR FAILURE
T�� RE������K� �� NOTY��E ��FK���%8*8EN��EQNENl[ 8�AY RESULT IN Y0K���
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 COMME CEMENT.
OWNER ORmmsN Subscribed and sworn to(or affirmed)before me this Sub 'be aids ornt
,,,N(pr irmete re me this
Who islare personally known to me or has/have produced Wh6 i I re personally known to me or has ve produced
asidentification. as identification.
' !
Notary Public Notary Public
Commission No. Commission No.
Permit No. Parcel lD No 15_Xo-o21-b 170-0ab00- cog 0
NOTICE OF COMMENCEME T
State of P OrY d& County of QS W
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713.Florida Statutes,
the following information is provided in this Notice of Commencement
1. Description of Property: Parcel Identification No. r�
Street Address: 3719,21 A bsr, Edf
2. General Description of Improvement- IeAr t7t'F rwlaP.l'Ylen L dT -�,17 M`Q,
3. Owner Information or Lessee information if the Lessee contracted for the improvement:
��Mrce- Cob L
Address C v I State
Interest in Property: Nenkc
Name of Fee Simple Titleholder.
(If different from Owner listed above)
Address '` City State
4. Contractor. RnoO 'h r) Tit ca—i3313S�
aya���a tX `F . AL-
Address Q' \ 70!O',^,^4� City State
Contractors Telephone No.: �� O U[lY
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender.
Name
Address City State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of
to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief. 00,
STATE O
COUNTYNEE
State of Florida -
Signature of Owner o L ee,or Owners or Lessee's Authorized
on FF 943086Oficer/Diredor/Partn r onager/2020 E SQ r?
r— Signatorys Title/Offt ...`���,(iii
The foregoing instrument was acknowledged before me this J day of ,20'L,by ,` / �/ /Y�t
as iM " °-"'� (type of authority,e.g.,officer,trustee,attorney in fad)for
t-
(name of paetf om instrument was executed).
Personally Kno-mom—Produced Identification❑ Notary Signature
Type of identification Produced Name(Print)
wpdata/bcs/noticecommen cement_p c053048
CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21649
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21649 Address: 4527 BLOSSOM BLVD
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ORANGE BLOSSOM RANCH
Est. Value: Parcel Number: 15-26-21-0170-02000-DODO
Improv. Cost: OWNER INFORMATION
Date Issued: 8/16/2019 Name: PREBBLE KELLY BRUCE & JEANNE LYN
Total Fees: Address: 13033 19 MILE RD LOT 139
Amount Paid: GOWEN, MI. 49326-9646
Date Paid: Phone: (813)702-6325
Work Desc: REROOF SHINGLES (3 OF 4)
CONTRACTORS APPLICATION-FEES
ROOF NATION,INC REROOF RESIDENTIAL 0.00
v � v
7/
DRY IN ROOF IN P Ins ections Required
TAPE JOINTS ROOF INSP
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 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.
CONTRA& CO SI NATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received - Phone Contact for Permitting
...........=1=
Owner's Name ruLe w 14, Owner Phone Number
Owner's AddressF Owner Phone Number
R;r-n,at PaD,cL1) i Owner Phone Number
F
JOB ADDRESS RloS-,Cwr) LOT#
SUBDIVISION PARCEL 1D#1 (0-J/- 0/_?06, Co-0()
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN Q Q DEMOLISH
e INSTALL REPAIR
PROPOSED USE 5�F SFR COMM OTHER
TYPE OF CONSTRUCTION ti BLOCK Q FRAME 0 STEEL
DESCRIPTION OF WORK
BUILDING SIZE r SO FOOTAGE HEIGHT
11 1 1 1 1 1 14 44-
F2BUILDING 0' VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL 1$ AMP SERVICE O DUKE ENERGY W.R.E.C.
[PLUMBING
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION
GAS ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIO ds S l:fr FLOOD ZONE AREA DYES NO
I
...............
BUILDER COMPANY d SDI)
SIGNATURE .. REGISTERED Y/ N FEE CURREN Y/N
Address License# Fc-(-c /3-,:2,/35F0
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN L_yl N__J
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License# F_
HHHH! I I I I I I I I I H I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I I I I I I I I I i I I I m I I I I I I I I I I I I I I I I
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 wl Silt Fence installed,
Sanitary Facilities&I 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 Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
ti�rections ...............
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 Attorney(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 Vpgrade_s,_'A(C. (Plot/Survey/Footage)
f
Driveways-Not over Counter ionpdblIdr6ad%wIy s:.needsROW
NOTICE OF DEED : The undersigned understands that this permit may be subject bm^deed^restrictions"
which may be more restrictive than County rebulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions. '
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES- |f the owner honhinada contractor wr
contractors to undertake work, they may be required to be licensed in accordance with state and localregu|aUmnm. If the
contractor in not licensed as required by |oxv both the owner and omntnootmr may be uNad fora misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised 0o contact the�Pasco County Building Inspection Division—Licensing Section at727-84T-
8OOg. Fudhermonm, if the owner)has hired o contractor or oontnactoro, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may bman indication that hahm not properly licensed and |o not entitled to permitting privileges inPasco
County.
TRANSPORTATXONU80PACT/UTILFTUES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
9D-O7. usamended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. |f the project dmmonotinwz|maonedificatmofoocupancyor
final power re|eaoe. the fees must be paid prior to permit issuance. Furthermore, if Pasco Counb/VVobar/Saxmar Impact
fees are due, they must be paid prior bo permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter713, Florida Statutes,-as amended): |f valuation,of work|o$2.5OV.UOmrmore, |
certify that L the opm|icont, have been provided with e copy ofthe "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Deportment of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver itto the"mwner"prior tocommencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: | certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby mode to obtain a permit to do work and installation as indicated. | certify that no work or installation has
commenced prior to isouanoe.ofo permit and that all work will be performed to meet standards of all |avma regulating
construction, County and City codes, zoning noQu|adono. and land development regulations in the jurisdiction. i also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
mny responsibility bz identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department ofEnvironmental Protection-Cypress Bayhmada' Wetland Areas and Environmentally Sensitive
Lands,VVotew/VVamtexa«terTreatment.
' Southwest Florida Water Management [)iatriot-VVmUe. Cypress Bmyheado, Wetland Apeoa. Altering
Watercourses.
- Army Corps mfEnQ}nmaro-SeammUs' Docks, Navigable Waterways.
' Department of Health & Rehabilitative Services/Environmental Health Unit-WmUs, VVosimxvobar Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authohty-Runxmays.
| understand.that the following restrictions apply bo the use offill: '
- Use mf fill io not allowed in Flood Zone Wr unless expressly permitted.
- If the fill material is to be used in Flood Zone ^A", it is understood that o drainage den addressing a
.compensating volume" will be submitted at time of permitting which is prepared by professional engineer
licensed bv the State ofFlorida.
- If the fill material is to be used in Flood Zone ^A^ in opnneot|mn with a permitted building using stem m�
oonmbnction, | oe�Ky that�Uv�Ubeumed only tofiUthe armawithin the stem wall.
- If fill nmmtahe/ is to be used in any area, | oedifv that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely ofNaot adjacent pnnpedies, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for |«da |sse than one (1)
acre which are elevated bv fill, ah engineered drainage plan iorequired. ,
|f| am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. | understand that o separate permit may ba required for electrical work,
plumbing, eigns, xveUa, pools, air conditioning, Qom, or other installations not specifically included in the application. /\
permit issued shall be construed bmbea license to proceed with the work and not as authority to violate, cancel, after, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within mix months of permit issuance, or if work authorized by
the permit im suspended cv abandoned for o period ofsix(G)months after the time the work iecommenced. An extension
may be requested, in xvht/ng, from the Building Official for o period not to axnaod ninety (QO) days and will demonstrate
justifiable cause for the extension. Ifwork ceases for ninety(90)consecutive days, the job is considered abandoned.
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.
OWNER OR AGENT CONTRACTOR_009-w L
Subscribed and swofin-to(or affirmed)before me this, Sub cri d and sworn1orVMAWre me this
Who islard personally known to me or has/have produced VVno isin
personally Known to me or has/have produced
asidentification. as identification.
.
Public `~/ Notary Public
Commission No. Commission No.
Permit No. Parcel ID No 15—a(P'Q 11— 017 Q— C0000—M 0
11 NOTICE OF COMMENCE•r(r•�rr)pNT
State of_PIO d r1 a County of5C0
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement
1. Description of Property:/Parcel Identification No. 1
Street Address: y 5k l B 10 wsorA��(MRi l ki Cl•rr f ( ( / (�
2. General Description of Improvement ill(� 4 Qnj f Q loi-eAf n G C S k i m!p I c�
3. Owner Information or Lessee information if the Lessee contracted for the improvement:
ar Re-t4 P4161e
am C i r &raluAids
Address City State
Interest in Property: D )ntr
Name of Fee Simple Titleholder:
(If different from Owner listed above)
Address rr l r City State
4. Contractor. D6 Y ton
t �fY_• �L �� 3S�
oya'�a ?.Y1E�/LL Q< � QQ
Address / City State
Contractor's Telephone No.: ��13�y�S—6 Il'9 A
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender.
Name
Address City State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name /
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates Of—
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief.
STATE O Lo Notary Public State of Florida —�
COUNTY Avelino Vide
"2—wc�—
M Commission FF 943088 Signature of Owner or L s ,or Owne s or essee's Authorized
Orf�°` Expires01108/2020 Officer/Director/Partner onager
Signatory's Title/Office
/�I r
The foregoing instrument was acknowledged before me this Lday of l�Y ii _,20 If
by L r✓'f 1
as1p—Q L (type of authority,e.g.,officer,trustee,attorney in fad)for
L a✓.t c�— r","—'-- (name of party whom instrument was executed).
Personally Known❑-Ocj�roduced Identification❑ Notary Signature
Type of Identification Produced Name(Print)4v-v—
wpdata/bcs/n oticecommencement_pc053048
CITY OF.ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21650
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21650 Address: 4525 BLOSSOM BLVD
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ORANGE BLOSSOM RANCH
Est. Value: Parcel Number: 15-26-21-0170-02000-OOAO
Improv. Cost: OWNER INFORMATION
Date Issued: 8/16/2019 Name: YOUNG-SCHINDLER, GAIL
Total Fees: Address: 4525 BLOSSOM BLVD
Amount Paid: ZEPHYRHILLS, FL. 33542-5666
Date Paid: Phone:
Work Desc: REROOF SHINGLE ( 4 OF 4)
CONTRACTORS APPLICATION FEES
ROOF NATION,INC REROOF RESIDENTIAL 0.00
Inspections Required
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
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 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.
CONT CTOR SIGNATURE PERMIT OFF16VR
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
....... Phone Contact for Permitting [9/3
Owner's Name Owner Phone Number
Owner's Address R11)530rn Owner Phone Number
2�(_kllk R_ 3 S r Owner Phone Number
F
JOB ADDRESS 5of R)055023 LOT#
SUBDIVISION PARCELID#1 /5-.c2&-,a1-DQQ-0c20co- ooAn
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR K7V ADD/ALT SIGN DEMOLISH
a INSTALL r] REPAIR
PROPOSED USE SFR F__1 COMM 0 OTHER
TYPE OF CONSTRUCTION 0 BLOCK Q FRAME 0 STEEL
DESCRIPTION OF WORK 'Fear 64 r,,?_pfw_eAe_pi- o-� __J� (e rco�
BUILDING SIZE SQ FOOTAGE[= HEIGHT
111111111�4
=BUILDING 0, 6c, VALUATION OF TOTAL CONSTRUCTION
= AMP SERVICE DUKE W.R.E.C.ELECTRICAL 1$
=PLUMBING $
=MECHANICAL VALUATION OF MECHANICAL INSTALLATION
=GAS Q ROOFING SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
I i 2 v M 2 i i i i i i v i i i i i I i i i i i i M i i 1 1 1 1 2 1
BUILDER COMPANY !�n� CDn
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License# FZZ/33[337-6 1
ELECTRICIAN COMPANY
SIGNATURE REGISTERED FEE CURREN LILN_j
Address License#
PLUMBER COMPANY
SIGNATURE F7 REGISTERED Y/ N FEE CURREN L�_ N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License# F__
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LYLN_j
Address License#
HHHHHr+ ,I'll 111-11411111111111 HHHH!HHHHHHH HH!HHHHHHi HH Hill H-f
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&I dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans.phus 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,
stalled,
Sanitary Facilities&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Q44444:lZP I I i;i I I I i I I I I i i i I I I I i I i i I I i I M"11,1.,1,11111, 1 111
Directions:
Fill out application completely.
Owner&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 Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (ciopy of-contractrfkquired)
' i Reroofs if shingles Sewers ',Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on,publlc.roadways.A0eds'ROW
NOTICE OF DEED The undersigned understands that this permit may be subject bm^deed~restrictions"
which may bo more restrictive than County rebulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired o contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by |mvv, both the owner and contractor may be cited for o misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furtharmona, if the owner has hired a contractor orcontractors, he is advised to have thecontroctor(s) sign
portions of the "contractor Block" of this application for vvhk:h they will be responsible. If you, as the owner sign as the
contnaotor, that may bmon indication that he is not properly licensed and is not entitled bo permitting privileges in Pasco
County.
TRANSPORTATXONU%0PACT/UTkL8TKES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing bui|dingm, or expansion of existing buildings, as specified in Pomom County Ordinance number 89-87 and
90-07. as amended. The undersigned also underotande, that such fees, as may be due, will be identified at the time of
permitting. |tis further understood that Transportation Impact Fees and Resource Recovery Fees must be paid priorbm
receiving n "certificate of occupancy" or final power na(mooe. If the project does not involve o certificate of occupancy or
final power na|aooa, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must bm paid prior bo permit issuance}n accordance with applicable PmnmoCounb/mmdinancmm.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes,as amended): |f valuation of work ia$2.5OO.00ormore, |
certify that |, the mpcAimaht, have been provided with a copy ofthe "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. |f the applicant iosomeone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver ithm the^ovxner^prior bocommencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: | certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. | certify that no work or installation Ucdion has
commenced prior to issuance of permit and that all work will be performed to meet standards of all |onmo regulating
cmnatmuodion. County and City codes, zoning magu|aUmno' and land development regulations in the jurisdiction. | also
ma��vthat lundmmtand that the regulations of other government agencies may apply bx the inb*ndmd�work, and that it |s
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department ofEnvironmental Protection-Cypress Bayhmodm' Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management Oiatrimt-VVmUa' Cypress Bayhoade, VVmt|onU Areas, /\|horinQ
Watercourses.
- Army Corps mfEngineero-SeavvoUn. Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authorb+Runma
| understand.that the following restrictions apply to the use offill: '
- Use qf fill io not allowed in Flood Zone^\/"unless expressly permitted.
- the material is to*be used in Flood Zone ^A", is understood that e drainage plan addressing a
^� U compensating volume" will be submitted at time of permitting which is prepared bya professional engineer
|�enmedbv the S�demfF|ohdm.
- If the fill material in to be used in Flood Zone ^A^ in oonnaction with a permitted building using stem
ce
rtify v� beuaadon|ybm0|the araawithin the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill affect found bz adversely e �ot adjacent properties', the owner may be cited for violating
the conditions of the building.permit issued under the attached permit application, for lots less than one M�
acre vvh|nhare elevated byOU. ah engineered drainage plan iarequired.
' '
|f| amthe AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. | understand that o separate permit may be required for electrical vvork,
plumbing, signs, vvaUs, poo|o, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall b,econe�uedbob��aUmanamb» proceed with the xvorhand not amouthordytov�|mb�. cancel, a|tor or
set aside any pnovinionemf the taohnioo| codes, nor shall issuance ofo permit prevent the Building Official from thereafter
requiring e correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
un|omn the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for e period not to exceed ninety (9O) days and will demonstrate
justifiable cause for the extension, |f work ceases for ninety(BO)consecutive days, the job�s considered abandoned.
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.
OWNER OR AGENT CONTRACTOR .
Subscribed and sworn to(or affirmed�before me this Su be and s-�®rmn to(orriffrmetd)beforeme this
Who Were personally known to me or has/have produced Wh is/ re personally known to me or has7have produced
puWm
Commission No.
• Permit No. Parcel ID No J5-0?(c-Rl-o170-b oto oo-00 A 6
(f n
NOTICE OF COMMENCEMENT
State of F I ort dQ County of r 75M
THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real property,and In accordance with Chapter 713,Florida Statutes,
the following Information is provided in this Notice of Commencement
1. Description of Property: Parcel Identification No.
y5
Street Address: d 5 21n=m &V d. y (� (�
2. General Description of Improvement Ter oa al)B re ptace di e/1(. p i 5Sk i b (`0 -
3. Owner Information or Lessee information if the Lessee contracted for the improvement:
GCki I `rdu.a -sc.��n�.lc�
say os�orr, RUA. Ze i2�r�,[1� ��-
Address City State
Interest in Property: O(J-NnQi
Name of Fee Simple Titleholder.
(If different from Owner listed above)
Address r City State
4. Contractor. ooT Q�� r-nL' uc/331550
oy�5re
"46L 1'3 r s pa F9
Address City r State
Contractor's Telephone No.: �3� /d O`l➢�Q !
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender:
Name
Address City State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of
to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date Is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief.
STATE OF FL
COUNTY OF 900 MaIgnatory's
of Florida
ignature of Owne Lessee,or Owne s or Lessee's Authorized
943086 rcer/Director/Pa eNMana er
a Expires m
ignatory's Tdle/
r
The foregoing instrument was acknowledged before me this /.rday of A�,20�P by W 4 4-'JA V/ /4A✓J�
as (type of authority,e.g.,officer,trustee,attorney in fad)for
(name of party on be aif of whom instrument was executed).
Personally Kin-
10 O Produced Identification❑ Notary Signature 11'�
Type of Ident'cation Produced Name(Print)
wpdata/bcs/noticecom mencement_pc053048
City of Zephyrhills
s i LriilTreK; 5335 r St '
Zephyrhills FL 33542
(813)780-0020
ROOFING INSPECTION AFFIDAVIT
Permit
No.:
�1Dn5= licensed under Chapter 468, Florida Statutes as a(n):
Contracto4Engineer Architect Building Inspector
License No.
On or about g/ (� r q did personally inspect the:
Check: Roof Deck Nailing__J�L' Dry in Flashing and Drip edge !�—
Check which was used: 30#felt Peel and Stick_Other(List)
At the following
-address: 37 819 A/;--Za Or ALSSa Dr 1-'51?5 AId55-0n A/vdj
Based upon that examination, I have determined the installation was done according to the Hurricane
Mitigation Retrofit Manual(Based on Section 553.844, Florida Statutes).
Signature;
STATE OF FLORIDA
COUNTY OF PASCO
Sworn to and subscribed
/before this day /0(
BY:
Notary Public State of Florida
308 CHASE!
Zap. f i
'- My CQMMIS�14N#C(308W9
'•',';o,�wa EXPIRES January 17,2021