HomeMy WebLinkAbout19-22019 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 22019
BUILDING PERMIT
PERMIT INFORMATION LOCATION'INFORMATION
Permit Number: 22019 Address: 5922 FOREST LANE
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: FOREST VILLAS
Est. Value:' Parcel Number: 10-26-21-0110-00000-0090
Improv. Cost:' 6,977.00 OWNER INFORMATION
Date Issued: 11/05/2019 Name: KEITH, DOROTHY
Total Fees: 75.00 Address: 5922 FOREST LN
Amount Paid: 75.00 ZEPHYRHILLS, FL 33542-3259
Date Paid: 11/05/2019 Phone:
Work Desc:' REROOF SHINGLE
CONTRACTORS APPLICATION FEES
WIDNER ROOFING INC REROOF RESIDENTIAL 75.00
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DRY IN ROOF IN P Ins ections Re uired
TAPE JOINTS ROOF INSP
FINAL !
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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
j before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
s City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
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CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received Phone Contact for Permitting C3 13 -- t .5
Owner's Name o✓cc, Qc Owner Phone Number
Owner's Address ate— �" Owner Phone Number
Owner Phone Number
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JOB ADDRESS 5 9 ZZ �—nJ LOT# I�
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SUBDIVISION PARCEL ID# (I`2fo— — O O— ovO0
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT = SIGN = = DEMOLISH
R INSTALL R
REPAIR
PROPOSED USE I = SFR Q COMM = OTHER
TYPE OF CONSTRUCTION = BLOCK Q rFRAME = STEEL =
DESCRIPTION OF WORK cS F1 —
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BUILDING SIZE SQ FOOTAGE HEIGHT
=BUILDING $ n �� VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ `7 AMP SERVICE Q DUKE ENERGY Q W.R.E.C.
=PLUMBING I $ t9
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS I ® ROOFING Q SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
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BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address I License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
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PLUMBER COMPANY
SIGNATURE I REGISTERED Y/ N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License#
OTHER COMPANY UJ ((J1J12 (Zvz�_Pt NS
SIGNATURE REGISTERED I Y/ N FEE CURREN Y/N
Address ���� License# CCC O�� "Z.
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:
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 or the.oWner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING,.-,Y,';;:(copy ofcontrac,.required)
Reroofs if shingles Sewers ' Servige;Upg�ades. A%C.: Fences(Plot/Survey/Footage)
Driveways-Not'b"ver Coun'fer'if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The under signed 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 req l ired 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 contactor 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, Floirida 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 DeparItment 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,Water/Wastewater Treatments
- Southwest Florida Water Managiment 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 Agency1Asbestos 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 I 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 Food 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 NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT -=- - ,. -- -- — CO!dTRACTOR - O L - --
Subscribed and m sworn to(or affirmed)before me this Subscribed and swop
b to({ora affirmed)before me this
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Who is/are personally known do me or has/have produced Who is/are pe sonally known me or has/have produced
as identification. as identification.
ota Public
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Commission No. Notary Public Com ssi No.
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Name of Notary typed,printed or stamped Name of Notary type ,G2764ry
INSTR#20191592.32 OR BK 10001 PG 2861 Page 1 of 1
11/05/2019 12:05 PM Rcpt:2105804 Rec:10.00 DS:0.00 IT:0.00
Nikki AlvarezSowles,Esq.,Pasco County Clerk&Comptroller
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Permit No. Parcel ID No o-Z 6`Z)- 01 f'C 0(yoce - e ��
NOTICE OF COMMENCEMENP
State of County of «-m
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. Z( ` (D (0 'Oo 0 C)C'-- -P U
Street Address: Z
2. General Description of Improvement
3. Owner Information:
5-9 22 e
Address City Ste LLI Y
Interest In Property.
� Wlacn W w
Name of Fee Simple Titleholder. U- = U
(If other than owner) GO Z U U) 0
Address ` city State C (U 00 Z W � Ili4. Contractor. L'_ L1J ~ U) D C3
Name J (; r� n 0= z
Address ` ' City �ta LL IY 0
Contractor's Telephone No.: .�J- 14- b5 -3`� 3 ,L =0 0 � 06
5. Surety. O F- t1 rr 0
Named 0 <0 0 LU
Address City State CCa }(C) D7 LL
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Amount of Bond: $ Telephone No.: C_ Lj- LLJ CL Z
Names LL
A H 0 0
8. Lender.
0 O
Address city State 0 0 � U)
Lender's Telephone No.: LU U,Q J LLI
} LLI li Z
7. Persona within ithe State of Florida designated by the owner upon whom notices or other documents may be served as provided by _y ZZ — -
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address I city state 6
Telephone Number of Designated Person: O C
B. In addition to himself,the owner designates of 0
to receive a copy of the Usnoes Notice as provided In Section 713.13(1)(b),Florida Statutes® �� •
Telephone Number of Person or Entity Designated by Owner u� r 4 • O
d
9. Expiration date of Notice of Commencement is 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
RESU�NNIDYOURDPAYING TWICE FOR IMPROVEMENTS ORYOURPPROPERTY SECTION
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.
STATE OF FLORIDA
COUNTY OF PASCO 'ape ; GHERRYWIDNER
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C=M1W0m#GG 162746 n of Owner or Owners Authorized Officer/Dlrector/Partner/Monager
t� Expires December 6,2021
f op Po, sandain"OlNpyyria" gnatorysTitle/Offlce
The foregoing Instrument was acknowledged before a this j_day of f� n' ,20�clby �
as �� (type of e.g.,eflt�f trustee,aaey In fad)for
(n on beh of whom Instru teTi was er' led).
Personally KnownnAOR Produced Identification❑ Notary Signature
Type of Identification Produced Name(Print) S t t
Verification pursuant l o Section 92.525,Florida Statutes. Under penalties of perjury,I declare that I have read the foregoing and that the facts stated in
It are true to the best of my knowledge and belief.
42.2
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CUSTOMER ORDER N0.'.. SOLD BY.; : ' . TERMS . F.O.B. ;. .: DATE'.., .-, 'r'
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DESCRIPTION,. PRICE:. UNIT. AMOUNT' :;,..,::,:
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City of Zephyrhills
5335 81h St
Zephyrhills FL 33542
(813)180-0020.
ROOFING INSPECTION AFFIDAVIT
Permit No.: .9.0(9
licensed under Chapter 468, Florida Statutes as a(n):
Contractor Engineer_Architect Building Inspector._
License No. CCC--O. 7 Z
On or about=It7 9 did personally inspect the:
Check: Roof Deck Nailing. Dry in ✓ Flashing and Drip edge
Check why
ich was used: 30#felt ..Peel and Stick.. Other(List).. F .
At the following
address: -121 Z��
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).
Signatures
STATE OF FLORIDA
COUNTY OF.PASCO
Sworn to and subs gibed bef a this day
BY: ( ruo
Not ubl tate of Florida
`'•=corm s on�00 i 64s7
Expires Doom*12,2022
•3a�;• Bonded TMu Troy Fotn IM�nco.800386a018