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fLORIDH City of Zephyrhills PERMIT NUMBER
= 5335 Eighth Street
- Zephyrhills, FL 33542 BGR-000270-2020
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 06/18/2020
Permit Type: Building General (Residential)
Property Number Street Address
03 26 21 0190 00000 0030 6401 Laurelwood Drive
Owner Information Permit Information Contractor Information
Name: MILDRED JOHNSON Permit Type:Building General(Residential) Contractor: CHRIS'A/C COMPANY
Class of Work:HVAC Changeout
Address: 6401 Laurelwood Dr Building Valuation:$0.00
ZEPHYRHILLS,FL 33542 Electrical Valuation:$0.00
Phone: (813)713-7003 Mechanical Valuation:$5,394.53
Plumbing Valuation:$0.00
Total Valuation:$5,394.53
Total Fees:$66.97 r
Amount Paid:$66.97 l `
Date Paid:6/18/2020 11:59:50AM
Project Description
A/C CHANGE OUT 3TON SPLIT SYSTEM
Application Fees
Mechanical Permit Fee $66.97
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 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 permit 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 add fee 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.
C04ACTOR SIGNATURE PE IT OFFICE
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-81 3-780-0021
Building Department
Date Received
& -/ -15wa 0 Phone Contact for Permitting
... ................ ...
Owner's Name Owner Phone Number
Owner's Address YD Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number F77
Fee Simple Titleholder Address
JOB ADDRESS F-6 Ylo LOT# c--�
SUBDIVISION PARCEL ID#103 &Q (o 42 / 01910 o DOD d eo
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTRR ADDIALT SIGN DEMOLISH
e INSTALL REPAIR
PROPOSED USE Q SFR 0 COMM 0 OTHER I
TYPE OF CONSTRUCTION Q BLOCK = FRAME = STEEL
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE HEIGHT
=.BUILDING VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL AMP SERVICE Q PROGRESS ENERGY 0 W.R.E.C.
=PLUMBING
1141MECHANICAL VALUATION OF MECHANICAL INSTALLATION
j
=GAS Q ROOFING Q SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
i i i i i A i i i i I i 1 2 11 i i i i i i i i i i I I I i i I I i N A i I i i v i 2 i i I I a i i i i ff i i N i i i v i i H i i H a i i i i i 5 i i i i i i i H i i i I I i HIN i I i i i i
BUILDER CO
MPANY
SIGNATURE REGISTERED YIN -FEE CURREN
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Lj/ N. FEE CURREN L11N J
Address License"#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/,Nj' FEE
CURREN Y/N
Address License#
MECHANICAL
COMPANY
SIGNATURE REGISTERED N FEE CURREN Address 1/—Ll- 01<5 C�10 License#
OTHER COMPANY
SIGNATURE REGISTERED N FEE CURREN
Address License*
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)-workihg days after submittal date. Required-onsite,Construction Plans.'Stormwater Plansm/Silt Fence installed,
Sanitary Facilities&I dumpster,Site Work Permit for subdivisionsAarge projects
COMMERCIAL Attach(2)complete sits 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& 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 signback of application,notarized
If over$2500,a Notice of Commencement Is required. (AJC 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 Sbwers Service,Upgrades A/C Fences(Plot/Survey/Footage)
rivewayi-Not over Counter if on public roadways..needs ROW
NOTICE'OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" r?strictions"
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 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 maybe 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 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.
CONTRA.CTOR'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 rthat 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:
Us`e of fill is not allowed in Flood Zone"V"unless.expressly permitted.
- If the fill material is to be used in Flood Zone "A'',"if.is:'=understood that a drainage plan addressing a
"compensating volume" will be submitted at time oUpermitting which-.is prepared by a professional engineer
licensed by the State of Florida.
If.the till 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''ard&withinthe stem wall.
If fill material1s 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.adjaceot 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:4are,:elevated by fill,an.engineered drainage'pi6n is required.
If I am the.AGENT'fOR:THE OWNER, I promise in good faith,,to_iriform tlie:-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.:tif�a permit prevent the Building,Official from thereafter... :;
requiring.a correction of errors in plans, constructionor 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 perm it 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:TTWICE FORIMPROVEMENTS 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 CONTRACTOR
-
Subscribed and sworn to(or affirmed)before me this Subscribed and swom to(or affirmed)before moKs
by by
Who Is/are personally known to me or has/have produced Who Is/are personally known to me or has/have produced
as identification. as Identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
.j
�c f
ARNOW CHRIS9 A/C
... C 0 m P A N Y
HVAC
CAC068575 /EC13007703 PROPOSAL
12232 HWY 301 DADE CITY (352)621-4977 "NOW PROVIDING"
DADE CITY,FL 33626 ZEPHYRHILLS(813)779-9516 "ELECTRICAL SERVICES"
NAME: Mildred Johnson Date: 06/15/20 ISPLIT SYSTEM XX PKG UNIT
SUBDIVISION: 1HEATPUMP X STR.000L
ADDRESS: 6401 laurelwood dr
CITY: Zephyrhills ZIP CODE: 33542 DENSER: A4HP4036A
PHONE: 813-713-7003 WORK: nancy.lail.online@gmail.co IR LER: A4AH4P3S
CELL: RENTER: EER RATIN - 14 EATER: 5KW
ESTIMATOR: Chris M. D: TRU.by TRANS
m TOTAL ° 6,663.63
HORIZONTAL GARAGE NSTANT BATE: 750.00
DIGITAL THERMOSTAT OT61ALESS REBATE $ 4,913.63.
PAD WAGE: R
UXILARY PAN 16omp 1 10 YR LABOR: 'I Y
IN-LINE FLOAT
DRAIN PAN FLOAT EPISER: 4T1IKfiR4036'
$200 SENIOR DISCOUNT R HANDLER: TEM4AOB.36
GENIE LIFT EER RATING: 14 HEATER: !;KW
SEAL DUCTWORK TO CODE RAND: TRANE XR
REMOVE EXISTING EQUIPMENT e $ 6,194.53
CONNECTED TO EXISTING DUCTS AND ELECTRIC INSTANT REBATE: AMO.00
ANCHOR CONDENSER OTAL LESS REBATE $ 5,394.6
TAX,LABOR AND PERMIT ONNAGE: 3 PARTS: 1
QO P/COIL: 10 YR oR: 1 YR
NSER: 4 W.R. W36G
IR HAN TEM6AO.C36
EER RATING: TER:
BRaND: TRA -XR
INCLUDES FIRST MAINTENANCE CHECK 6,617.02
INSTANT REB 900.00
1 HAVE THE AUTHORITYTO ORDER THE WORK OUTLINED ABOVE I AGREE THAT SELLER OTAL L BATE $ 5,717.02
RETAINS TITLE TO EQUIPMENT AND MATERIALS UNTIL FINAL PAYMENT IS MADE IF PAYMENT ON 3 PARTS: Q
IS NOT MADE AS AGREED,SELLER CAN REMOVE SAID EQUIPMENT AND MATERIALS AT P/COIL: 10 YR LABOR: 1
SELLERS EXPENSE.ANY DAMAGE RESULTING FROM SAID REMOVAL SHALL NOT BE
HE RESPONSIBILITY OF SELLER LIMITED WARRANTY:EQUIPMENT,PARTS AND
MATERIAL HAS WRITTEN MANUFACTURER'S WARRANTY ONLY.
(WAC)
CUSTOMER SIGNATURE DATE:
CHRIS ' A/C:
COM PAN Y
On Friday, August 7, 2020 received pictures & affidavit for Mechanical HVAC change out
inspection for Permit#BGR-000270-2020, 6401 Laurelwood Dr., Zephyrhills.
Drop off location: City of Zephyrhills
5335 Eighth St.
Zephyrhills, FL 33542
Phone: (813) 780-0020
Received by:
10235 US HWY 301, Dade City,33525, (352) 521-4977, (813)779-9515
a / .�rJ .
•�.. can-��rc I / O -3
Cityof2e h rhills
5335 Eighth Street
Zephyrhills, FL 33542 BGR-000270-2020
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 06/18/2020
Permit Type: Building General Residential
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-
03 26 21 0190 00000 0030 6401 Laurelwood Drive
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:.;c:_�, s^
::c2 tt'G`x '=tom `-�-`�•�''ts'.-� .�.�!!m
Name: MILDRED JOHNSON Permit Type:Building General(Residential) Contractor: CFrRIS'A/C COMPANY
Class of Work:HVAC Changeout
Address: 6401 Laurelwood-Dr - -_ - _ ldi g Valuati_on:$QAO
ZEPHYRHILLS,FL 33542 Electrical Valuation:$0.00
Phone: (813)713-7003 Mechanical Valuation:$5,394.53
Plumbing Valuation:$0.00 .
Total Valuation:$5,394.53
Total Fees:$66.97
Amount Paid:$66.97
Date Paid:6/18/2020 11:59:50AM
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A/C CHANGE OUT 3TON SPLIT SYSTEM
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" BE
Mechanical L.✓.-.-3':Ka` .n,'+.i:-es+s#`?'.ss as`. q...-:,i.� �:. R,<' i:neu.' S..,,f� `•e. '
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Mechanical Permit Fee $66.97
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 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 permit 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�lf you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications add fee 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.
CONTRACTOR GNATURE PlgrrOFFl
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
II ".
,DUCT CERTIFICATION FOR INSTALLATION.OF NEW DUCT WORK OR.MODIFICATION OF THE EXISTING
;DUCT SYSTEM
FLORIDA ENERGEY"CONSERVATION"CODE(FBC ENERGY,SECTION 4.03)TO BE LEFT ONSiTE°AND PICKED
UP BY'INSPECTOR
Owner:"_ "" C )"t"mn.
Permit#:. " �.._ f }Cc
'Site Address: (0. C. F �
Contractor w rs 4 t 6
License
Final Ihspection,Date: "
I:certify than have installed new or modified the existing duct,work.associated with the HVAC system
referenced by the•per"mit listed above an&found it complies with°the requirements FBC Energy Code,
Section 403:3:Where modified,the-existing ducts have been sealed using reinforced"mastic or code-
approved equivalent:. Ducts are located within conditioned space(Section 403:3).System was tested as
per FBC Energy code,section 403.3.2.1.All new ductwork is to comply with FBC.Energy 403.2 and FBC
MechaNcal.chapter 6.
f Name of License Holder(print or type). Signature o icense Holder
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