HomeMy WebLinkAbout19-21974 CITY OF ZEPHYRHILLS
5335-8th Street
' (813)780-0020 21974
ELECTRICAL PERMIT /
- PERMIT.INFORMATION LOCATION INFORMATION
Permit#:21974 Issued: 10/28/2019 Address: 37042 GEIGER RD LOT 7-9
Permit Type: ELECTRICAL MISC . ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE/NEW Township: Range:
Proposed Use: NOT APPLICABLE 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: 10/28/2019 Parcel Number: 10-26-21-0000-01400-0010
CONTRACTOR INFORMATION OWNER INFORMATION
Name: DESIGN ELECTRICAL Name: BALLA, RAFMAN
Addr: 6518 US HWY 19 Address: 6810 N 78TH ST
NEWPORT RICHEY, FL 34652 TAMPA, FL 33610-9549
Phone: (727)848-1112 Lic: Phone: (727)418-8373
Work Desc: INSTALL NEW SERVICE POLE W/3 METER LOT 7-9
APPLICATION FEES
ELECTRICAL FEE 50.00
INSPECTIONS REQUIR
ROUGH ELECTRIC �1
CONSTRUCTION POLE
PRE-METER
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 may be additional restrict?ons 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 OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT"APPROVED INSPECTIO
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 C7�� f Phone Contact for Permitting — 1 f 2
Owner's Name rV'7 ea ! 4 Owner,Phone Number -7
Owner's Address Owner Phone Number
Owner Phone Number ,C�
JOB ADDRESS 7( � r (ZJ
I LOT#'
SUBDIVISION �— PARCEL ID# r_�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK P.,f20POSED NEW CONSTR ADD/ALT SIGN = 0, DEMOLISH.
R INSTALL 8 REPAIR
PROPOSED USE-, Q. ;,SFR•• = COMM u OTHER;.
TYPE`OF CONSTRUCTION:, BLOCK Q :': FRAME _ Imo!• ° STEEL .0
DESCRIPTION%OF WORK
BUILDING SIZE SQ FOOTAGE HEIGHT
BUILDING` . $ VALUATION OF TOTAL CONSTRUCTION
['ELECTRICAL. $, �. AMP SERVICE /Z{� DUKE ENERGY 0 W.R.E.C.
=PLUMBING
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION° `I
=GAS = ROOFING = SPECIALTY OTHER
FINISHED'FLOOR ELEVATIONS FLOOD.,ZONE-AREA, =.YES , NO
BUILDER COMPANY,
SIGNATURE REGISTERED I Y/_N F. FEE CU(RREN, .1 Y/N
Address' License# I
ELECTRICIAN MPANY i�� V.
_
SIGNATURE REGISTERED N FEE CURREN Y/N
/ • S, /�✓ 'License# GX�
Address-
PLUMBER COMPANY
SIGNATURE REGISTERED 'Y/'N FEE CURREt`
Address License# I
MECHANICAL COMPANY
SIGNATURE;' REGISTERED Y/.'N'. FEE CURREN
Address, License
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CU(RRE_ 'Y/N
Address License#;I
RESIDENTIAL Attach,(2}•Piot Plans;,(2}sets of.Buildin4 Plans;(1),set,of,EnergyForms,R�O,-W Permit for new construction,,,`.
Minimum ten�(10)working days`after-submittal:date:•,Required=onsite;Construction Plans;-Stormwatei 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 aftersubmittal date. Required.onsite,Construction Plans,Stormwater Plans w/Silt Fence installed`,
Sanitary Facilities&_'f dumpster:Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach,(2).sets.of EngineergO.-RIans.
` `>
"PROPERTY 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. (A/C upgrades over$7500)
Agent-(for the contractor)orPower of..Attarney.(for.:the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER_ PERMITTING '. ':C>?(c"opy'ofrcontracfregtilred)
Reroofs if shingles Sewers ;-,;.`Se'ivic'e Upgrades{A/C.`. :}Fences(Plot/Survey/Footage)
Driveways-Not over,Co4nter;'if•onipUblic:r6ad'ways:needs'ROV. , .
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. ;
UNL' &SED 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 and1ocal regulations. If-the
contractor.is not licensed as required by law, 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 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,lm pact 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-'071,=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 priorto
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-certify1hat 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:J 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,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/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_which1s prepared,by:a:,professional engineer
licensed;by the State of Florida.
"If'the fill:material is:to. be'used im lood 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 adjade'd ptoperties, the owner maybe:-cited for violating
the conditions of the building permit issued under.. the attached,permit application, for lots less than one.(!)
acre which are elevated by fill, an engineered drainage plan is required.
If,l am,the AGENT FOR-THE.OWNER, I promise in good faith to,inform the'-bminer of the permitting conditions set forth in
this affidavit prior to commencing.construction. I understand that a separate permit may be. required:for electricaLwork,
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 YPUR_PROPERTY. IF,YOU INTEND TO-OBTAIN.FINANCIN'G,CONSULT`
WITH.YOUR.LENDER.OR AN:ATTORNEY-BEFORE RECORDING YO.UKNOTICE OF1.COMMENGEMENT.
FLORIDA JURAT(F.S. 117.03) —
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and. om to.(or,aff1 ed)bef ore me this
by tiY ��___r��/_ Lam$h�✓�
Who is/are personally known-to me or has/have produced Who is re personally n�C own tome or has/have.produced
as identification. `7� Dke' irx G een.0 o as identification.
Notary Public ='Notary Public
Commission No. Commi 'on N
.•';►"" JACOUR
Name of Notary typed,printed or stamped Name of Note _gMnf,'
fl IN627645
W g�dedTfruTroyFainlnsar2Mg00,985701�
CITY OF ZEPHYRHILLS
5335-8th Street
(813)780-0020 21976
ELECTRICAL PERMIT
PERMIT INFORMATION_ LOCATION.INFORMATION
Permit#:21976 Issued: 10/28/2019 Address: 37042 GEIGER RD LOT 4-6
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE/NEW Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 2,000.00. T al Fees: �_oc) Subdivision: CITY OF ZEPHYRHILLS
Amount Paid:. 0 Date Paid: 10/28/2019 Parcel Number: 10-26-21-0000-01400-0010
CONTRACTOR INFORMATION OWNER INFORMATION
Name: DESIGN ELECTRICAL Name: BALLA, RAFMAN
Addr: 6518 US HWY 19 Address: 6810 N 78TH ST
NEWPORT RICHEY, FL 34652 TAMPA, FL 33610-9549
Phone: (727)848-1112 Lic: Phone: 727-418-8373
Work Desc: INSTALL NEW SERVICE POLE W/3 METERS LOT 4-6
APPLICATION FEES
ELECTRICAL FEE .
INSPECTIONS REQUIRE
ROUGH ELECTRIC
CONSTRUCTION POLE
PRE-METER \/\
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 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 OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
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 Sr
Owner's Name C. r p Owner Phone Number
Owner's Address: O y Z C r Owner:Phone Number
'144 Owner Phone Number
JOB ADDRESS e LOT'#'
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PRQP,"OSED NEW CONSTR. ADD/ALT SIGN Q = DEMOLISH,.
e INSTALL 8 REPAIR
PROPOSED USE- _ . SFR. Q COMM = OTHER..
TYPE'•OF CONSTRUCT:IOW = BLOCK 0 FRAME Q STEEL . Q
DESCRIPTION:OF WORK , r-- C, 6/IP �of yr�
BUILDING SIZE SQ FOOTAGE HEIGHT
=BUILDING �� VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL. $ C>00=1AMP SERVICE Q DUKE ENERGY 0 W.R.E.C.
-]=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INS-T-ALIATION
=GAS = ROOFING SPECIALTY OTHER
FINISHED;FLOOR ELEVATIONS. `` FLOOD:ZONE-AREA_. =.YES NO
BUILDER COMPANY
SIGNATURE REGISTERED I Y/,N FEE CURREN
Address License#
ELECTRICIAN6LZ
COMPANY Oc S. (
SIGNATURE REGISTERED N FEE CURREN "Y/N '
-Address S- 19 U. 5. / "License# , 7G lyep_
PLUMBER COMPANY -
SIGNATURE REGISTERED Y/4 N mtcuRREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE:, REGISTERED Y/•N' FEE,CURREN Y/N
Address; License#."I .
OTHER .• COMPANY
SIGNATURE REGISTERED I Y/ N FEE CURREN Y./N J
�)
Address License#T 1
RESIDENTIAL Attach„(2){Plot,Plans;,Q):sets of Building Plans;(1),set.of.Energy.Forms,WO-W Permit for new construction,,,.
Minimum-ten('10)'•woiking days aftersubmittal.date:�Required•onsit%Construction Plans;.Stormwater.Plansw/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.Ail commercial requirements must meet compliance
SIGN PERMIT Attach,(2)sets of.Engineered.Plans.
****PROPERTY—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:.;_(A/C upgrades over$7500)
Agent-(for the contractor)or Pdwer.'6f'Attbrney(for the owner)Would be someone with notarized letter from owner authorizing same
OVER THE COUNTER{PERMITTING; " ,.(copy.of'oontrq,Ct•required)
Reroofsifshingles .Seversy . ServicewUpgrades:•A(C=_. ,<.Fences(PlottSurvey/Footage)
Driveways-Not over Counter if on public roadways..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! 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 beresponsible. 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;#hat 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"occu'pancy-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 certify1hat 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: ..Lcertify 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 meef-standards of all laws regulating
construction, County and City codes, zoning regulations, and'land development regulations•in the juhsdiction.`,I:-also
certify that I understand,.-that the-regulations of other government agencies may apply to--the-
o 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 riot limited to:
Department of Environmental Protection-Cypress Bayheads, 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/Environmental Health Unit-Wells,'Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the;Jollowing,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.mated al-_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 faith4o: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 1n,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;1
set.aside any provisions of the,fechnical:•codes; nor shall issuance of a permit prevent the Buildirrg: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 authorizedby-such permit is commenced within six months..of permit issuance, or.if work,authorized by
the 1.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"fora 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 INTENb.TO OBTAIN FINANCING,CONSULT
WITH_YOUR LENDER`OR_AN..ATTORNEY BEFORE RECORDING YOUR,N.OTICE"OF`,COMMENCEMENT.
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and'sw t or a rived)b ore e this
by by �e
Who is/are personally known,4o me or has/have produced Who,i are personally known to me or has/have produced,,
as identification. (fc Ucci -5'e a sidentification.
Notary Public Ize _ Notary Public
Commission No. CommiUn.N •, JACQUEL BODES
Expires December 1Z 2022
Name of Notary typed,printed or stamped Name of Nota J fintiM Raft9da himim 600425-7019
CITY OF ZEPHYRHILLS
5335-8th Street
(813)780-0020 21975
ELECTRICAL PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit#:21975 Issued: 10/28/20.19 Address: 37042 GEIGER RD LOT 1-3
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE/NEW Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: �6D Book: Page:
Cost: 2,000.00 al Fees: .00 Subdivision: CITY OF ZEPHYRHILLS
Amount Paid 0 .00 Date Paid: 10/28/2019 Parcel Number: 10-26-21-0000-01400-0010
CONTRACTOR INFORMATION ,. ,OWNER INFORMATION .
Name: DESIGN ELECTRICAL Name: BALLA, RAFMAN
Addr: 6518 US HWY 19 Address: 6810 N 78TH ST
NEWPORT RICHEY, FL 34652 TAMPA, FL 33610-9549
Phone: (727)848-1112 Lic: Phone: 727-418-8373
Work Desc: INSTALL NEW SERVICE POLE W/3 METER LOT#1-3
APPLICATION FEES
ELECTRICAL FEE 46.00
INSPECTIONS REQUIRED
ROUGH ELECTRIC
CONSTRUCTION POLE
PRE-METER
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 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 OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
e, Building Department
Date Received 17'1! ,:] .Phone Contact for Permitting 7
Owner's Name: c, 11,q Owner Phone Numb
Owner's Address. Owner.-Phone Number C
II Owner Phone Number:. I
J09 ADDRESS LOT#'
SU.BDIVISI.ON PARCELID_# -0 — Y07 — /'
(08TAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT Q SIGN = 0•. DEMOLISH,.
e INSTALL 8. REPAIR
PROPOSED USE• Q " SFR Q :;COMM = OTHER;.
TYPE'OF•CONSTRUCTION� = BLOCK 0 ' FRAME STEEL =
DESCRIPTION�OFWORK
BUILDING SIZE SO FOOTAGE HEIGHT
=BUILDING _ VALUATION OF TOTAL CONSTRUCTION '
[ELECTRICAL $2,=�vO7—] AMP SERVICE 0 DUKE ENERGY 0 W.R.E.C.
=PLUMBING $
•=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
1,V,,.�
=GAS ROOFING Q SPECIALTY u OTHER q
FINISHEO.,,FLOOR,ELEVATIONS FLOOD ZONE AREA., =YES NO
BUILDER COMPANY
SIGNATURE REGISTERED 1. Y/"N FEE CURREN
Address" License#
ELECTRICIAN COMPANY S. i' ,�►
SIGNATURE /l REGISTERED /'N FEE CURREN N
Address 'License#
PLUMBER' COMPANY
SIGNATURE REGISTERED Y/'N FEE CURREN
Address License#.�
MECHANICAL COMPANY
SIGNATURE;' REGISTERED Y/iN' FEE.CURREf "
-Address; License#,,I '
OTHER cob
P.ANY
SIGNATURE REGISTERED Y/ N FEE CURREN
N
Address License#. I
RESIDENTIAL Attach,(2).PiotP{ans;.(2).sets.of Building Plans;(1),set,of.Energy,Forms.R=0-W Permit for new construction,;
Minimum-.1en=(1:0)-worki_ ng days'after-submittal.date:.-.Required-onsite;'Constructon-Plans,.Stormwater Plans w/-Silt Fence'installed,
Sanitary Facilities&1 dumpster,Site Work Permit for subdivisionsharge 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 Pians;w/Silt Fence installed,
Sanitary.Facilitie's&.I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach,(2)sets of,Eng1neere0.Plans.-
""PROPERTY 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. (A/C upgrades over$7500)
Agent(for the contractor)or.Power.of Aftomey(for thefowner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING .. (copy'of contrapt`required),,,:,,.., j.
Reroofs if shingles Sewers" Servicb-Upgrades�AlC.;., Fence(PlotlSurveylFootage)
.. 4
Driveways-Not over Counter"if 6ifPublic roadways..needs,ROVII;s.;;;'~:
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 responsibilityfor:compliance with.any
applicable,deed restrictions.
UNLICENSED CONTRACTORS AND"CONTRACTOR RESPONSIBILITIES: If the owner has"hired a contractor or
contractors to undertake.:work, they maybe 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 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 to contact the Pasco County Building Inspection"Division—Licerising 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 bean indication that he is not properly licensed and is not entitled to,perm itting 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. understartds;'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.pertn it.issuance in accordance with applicable'Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida.Statutes,.as amendbd): If valuation of work is-$2;500.00,or more,.I
certify that 1, 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 certifythat 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 informatiomin 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,Oeisdict'ion. ' 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,Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls; Docks, Navigable rWaterways.
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 unl'ess 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 1professional 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 maybe 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'engineereddrainage.plan is required.
If:l am.the AGENT FORTME 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_FINCING, CONSULT
WITH:.YOUR-LENDER OR.AN.:ATTORNEY BEFORE'RECORDING Y.OUR.NOT,ICE OF�:COMME N CEMENT. .
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR rA
Subscribed'and sworn to(or affirmed)before me this SubSCribed and.swo t (or affirmed)before e.this
by liy �T t`�,�
Who is/are personally known4o me or has/have produced W /are personally knp n'to me or.ha`s/have produced'
as identification. U�'.V SLR as identification.
i
Notary Public Notary Public
Commission No. Commis io o.
Name of Notary typed,printed or stamped Nam ';yt Wmwd
a• P� Expires December 12,2022
Bottled Thru 7toy Fain kwa=8004W?019
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Design Electrical Con suiting Services, Inc
D8A; Design E|ec1r Company
6S18USHVVY19North POWER WHEN YOU NEED IT MOST
New Port Richey, F134652
Toi:727-O48'111Z `
UcE0OD14224
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Date: 10/8//2019
Attn: Contractor Licensing
RE: Authorized Agent '
`
Please allow the following persons to act onnmy behalf in theprocurement of electrical permits for ONE year.
Susan Conklin
,
Derek Lashure
Stanley Smith
Best Regards,
.
]effrexA. Curtis
Pres.
Uc.#GROO14224
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FB @Desi8ne|ectrca Ise nvices Email:
Ellen L Baldwin
.
;4 Commission#66U[U788
2021
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