HomeMy WebLinkAbout20-342 613-780-0020 City of Zephyrhills Permit Application Fax sza-7saoa21
Building Department
Date Received :1 Phone Contact for Permitting
t .
Owner's Nam e/a Owner:Phone:Number;
Owner's Address Owner Phone Number.
Fee Simple Titleholder Name Owner Phone'Number
Fee Simple Titleholder Address
JAB ADDRESS LOT III
SUBDIVISION 1 PARCEL.ID# ..
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK.PROPOSED . NEW-CONSTR: .. ADDIALT �.. SIGN .- 0 0 DEMOLISH
e- INSTALL 8 REPAIR
PROPOSED USE 0' 'SFR' C] COMM" [� OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL
DESCRIPTION'OF WOR , ho 0 o t e— . o I + _ L L
BUILDING SIZE SQ FOOTAGE HEIGHT'"
OBUIt.DING $ _ VALUATION OF TOTAL CONSTRUCTION.
=ELECTRICAL $ AMP SERVICE PRO LESS Ery
W.R.E.C.
'
=PLUMBING' $'
=MECHANICAL $ VALUATION OF MECHANICAL INSTAL'LATI N
=GAS Q ROOFING [�,-- SPBGIALTY,,,=: OTHER .
FINISHED FLOOR-ELEVATIONS '` FL'OOD2-ONE*AREA- =YE8'::- NO.=4 f~
WV
-BUILDER COMPANY
Y,/..N• F ;FEI'iCUR :sr,Yi/,
SIGNATURE REGISTERED:-.
E�;.+j.. ._
License#,: �
Address
ELECTRICIAN COMPANY
SIGNATUM REGISTEREP Y/.N'_ ,
Address l lcerise#'�
RLUMBER COMPANY _
:SIGNATURE REGISTERED Y%"N'°'"'`,`'.'FEE CURREN Y'/N-_.
:..
Address '`!icense#` .
MECHANICAL COMPANY
SIGNATURE REGISTERED Y•t N='F' FEE'CURREA Y./.N:: '•.
Address License# .
OTHER. .COMPANY
SIGNATURE zAgGISTERED. Y/;N,••::: FEE CURREh L Y/N
Address .. License:#,;( �.
- y a -
RESIDENTIAL Attach-,(2);Plot:Plans;_(2)_sets.of,Building Plans;,(1);set.ofEnergy Forms;R O:W,P.,ormit for new construction,
Minimum ten(10)woiklrig daks`after'submittal date:'Required'ansite;Gons6ile8ori Mans;Stormwater Plans w1 Silt Fence.instailed;
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)-complete sets of Building Plans plus a LIWSAfetyPage;.(1)set of Energy Forms.R O-W Permit for new construction..
Minimum ten(10):working days:aftersubmittal.date::Required ansite,Construction Plans;Stormwater Plans.w/Silt Fenceinstalled,
Sanitary Facilities&'1 dumpster.Site Work Permit,for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of'Engineared,°Plans:
""PROPERTYsSURVEYrequired-for All,NEW construction.
:.Directions: '
Fill out application completely.
Owner'&Contractor sign bac k-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- (copyof contract-required)
Reroofs if shingles Sewers Service Upgrides A/C FencesIPlot/Survey/Footage)
Driveway"ot over Counter If on public roadways,..needs ROW
NOTICE'OF DEED RESTRICTIONS: The undersigned understands that this permit maybe subject to"deed"restrictions"
which may-be more restrictive than County regulations. The undersigned assumes respori'sibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR` REI PONSBILITIES: "if the owner:has hired: a contractor'or
contractors to undertake work, they may be requiredto be-licensed.in accordance with.state,and local:regulations: If the .
contractor is noti licensed as required'by law, both the owner and contractor may-,be"cite'd'for a`misdemeanor violation
under'state law. ,If the owner or intended>contractor.aie-uncertain as to what.4licensing 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. .,lf.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'sdcl�fees,, as may be due,.,.will be..identitied;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-mot involve a certificate of occupancy Pr
final power release, the fees must.be.paid-,:prior to permit-issuance:' Furthermore, if,Pasco County_Water/SewerIm,pact.
fees are due,.they mustbe.paid.:prior.to,permit issuance in-accordance with applicable,Pasco.County ordinances.
CONSTRUCTIOWLIEN LAW"(Chapter�713,Florida`Statutes,as.amended): -if vaivation.of work is$2,'500:OO:or;more,a
certify,that i,"the .applicant; have,�,beenrOrovided-with-a,copy of-the "Florida' Construction' Lien. Law-Homeowner's
Protection Guide" prepared by-the:Florida Department of Agriculture and.Con sumer Affairs. If the applicant,is:someone
other than the"owner", I certify:tFiat haiave'ot tain'ed a copy of.the-aboVd.described document and-proniise in.good,faith to
deliver it to the"owner"pddr.to commencement:;;,,,;...
CONTRACTOR'S/OWNER':•S AF,FIDAVIT�`;:I'certify that all.the'information n'this<applicationr is.accurate'.and..that all work
Will be done in compliance with all rapplicatile laws regulafing-construction,Vzoning.-and,and;development. Application.is
hereby.made:to obtain a permit to do work anit'installation "as='indicated` I``certify that no work.or installation' has
commenced-prior to,issuances of a;;permit and that all'work will berpeiformed to meet',standard_s of all-.laws-regulating
construe''tion;,"bounty:,and>Gty-codes; zoning regulations;: and .land'development:regulations'in-the jurisdiction,. I.also
certify that'1=,understand::thatthe regulations-of other government:agpncies may apply-to•the;intended work,.and that it is
my responsibility,to'identify.what-actions I musttake:to.be in.,compliance: Such,agencies=include but are not-limited to:.
Departinent,-of.Environmental Protection=Cypress:'i3ayheads;`'V1letland.Areas.and-Environmentally Sensitive
Lands,`WaterMastewater Treatment:,.; ; .:.,
Southwest Florida Water Management District-llVells, . Cypress Bayheads, Wetland Areas; Altering
Watercourses.
Army Corps of Engineers-Seawalls; Doeks, Navigabfi�,Mterways:
Department of Health & Rehabilitative Sere ces/Environmental'1'Health-UnitVells; Wastewater Treatment;
-Septic.Tanks.
- �US=Environmental'Protection,AgencyAsbestos abatement.
Federal Aviation.Authority-Runways:
understand-that-the:following.,restrictions:apply to the;use-of fill:
Use;of fiII1g_n' 'allowed in.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 perrnitting,which is prepared:by'a:-professional engineer,
licensed'by the'Stafe of'Florida.
lUth-bAill.material=is to.be,used:inFlood:Zone "-A"' inconnection with a permitted building using,,stem'wall
S>
constructions l certify:sttiat:fill will'be.us6d,only to fill the area.within-the stem;wall.
If till: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;t m he owner aybe gite&fdr violating
the conditii ns of:.th. building permit issued.,under the,attached permit application, for lots less than one (1).
acre whicF►are elevated by,.fillj an engineered draihage'•plan is required.
If I ann.th'e.A .EN' O Tt 1 01NN'ER;I promise in good faith to-',- ocm ahe;ownerof the permitting,.conditions,set forth in
this of idavii i ribat0 eorli'itlencii'g,construction. I understand that-a separate.permit may be required-for electrical-work,
plumbing Ksigns tilNells."pools �air<cond tioning, gas, or other Installations-;not`"'specifically'included-in the'.application. 'A
permit-is;$l d=shalh;be,cIonstrued,to:.be a-license,to,proceed w,ith,4he.work and not.as authority to violate, cancel,:alter,;or
set asitl"fah,`.:,'ro'visions:pf tl e;'aech'n'ieal'codes; nor shall issuance of a.p.ermitprevent the Building.Official from:ahereafte'r,.'
requiring:a eb: ect on of erfors in3plans con' uctionor violations-of:any~codes ;Every•permit.issued shall`become invalid
unless al ew•ri orl}a�ithgfized ysuct permit'.is commenced'within six months of,permit issuance,.or if work authorized�by.
the perrhit1i9 suspended°or'a bandoned''for'a periodbf six,O)months afterl e'time;the work is~commenced.- Ameztension
may be.::regtfeste'd,;in writing,:from,<<the,;Building.Ofticialrfor.arperiod'`not to exceed ninety. (90) days and will demonstrate
justifiable cause for._the.'extension:.If,work=ceases.for ninety(90)"con6ecutive-days,the job is considered abandoned.
WARNIN.G�-TOz.OWNER:.•,-YOUR>.FAIL:URE=_TO:.RECORD A.NOTICE-OF,.C.O.MMENCEMENT
,MAY
.RESULT'.IN..YOUR
YING'TVIIICt=` ;OR°!hlflpl7bl/trIVIBN7S' OYOUf 'SPRFER'TYfIF�:�fOUiIN 'ENI :"1"d`.'`OB7AIN'FINANCING 'CONSUL:T' ' .
PA .
WITH YOUR'LEND:ER!;OR AN'A I RN BEFORB,'REJWRDING'Y(QWNbTICI`bF{COMMENCEMENT::
....'..- .•:`._ __• _...._ --.. .J_- :,-i.Vie♦:—.-.,.:�.___ -. __._...--.-
FLORID'A-JURAT(FS.'-117 03)"''""—
OWNER OR AGENTCONTRACTOR
Subscribed'and-sworn to"(oraffiiinedybefdre me•this Sub'scribediand sworn to(or,affirmed)before°me this
by: ,by;.
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have,produce&
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
City of Zephyrhills
r Uniform Notice a Lowi-Voltage Alarm System Project
Ownees/CustomerName #
j Address ,
City ZYA I I Stan_ZipY Z'
Phone E-mail
Contractor ic.#CS (at77W93y
li Address._ .;Z .t Cl',---r r'V ? M►ID t'l 4
City 0. C�__ St EL Zip4aL
Phon�S'�'J_00 e)-.DateProjectComplete ji jf6._. A
Scope of Work
4 460 V.(
j Signature•_ 011 Q 4
Owner or tenant or contractor or authorized representative
Notice is hereby given that a low-voltage alarm system project has been completed at the address
�k specified above.I certify that all of the foregoing information is true and accurate.
' 10l1113 section 553.793 FS
i
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a.
a
NONE 3221 Cherry Palm Drive
am, BLE Tampa. FL 33619
®=� An Amphenol Company �vmvxust8o0m 32 ab a co
To.Whom.it:May Concern:
I;Stephen Berrier(License-holder ES12000734) hereby authorize Newell Reid --- -
to act as my agent in all permitting activities regarding low voltage data and communication cabling in .
the City of Zephyrhills on behalf of Amphenol Custom Cable, Inc.
Stephen L. Berner
%riblersi ature
STATE OF Florida COUNTY OF-Hillsborough Sworn to/affi7OR
and subscribed before me this b th
day of 7 LA [ V . 20�Personally known produced identification
Notary Signature.(Notary Sea[) My commission expires: 7�<
`►+'!�? MICHAEL P.WIREMAN
aMY COMMISSION GG 123187
'EXPIRES:July 11.2021
,oF FtQ. WxIed 11VU No"ftft UWemfteB .
Newell Reid From: Bldg Dept <8Dept@d.zephvrhUbfius>
Sent: Wednesday,July 1, 2O287:38AN
To; Newell Reid
Subject: RE: Registration
Good morning,
Updates are completed .You will have to come into building dept to obtain the low voltage label.Cost is$45.00. hours
nf operation is8ann'4:3OpnnS3358th5t33S43 Thank you
Building Dept
813-780'0020
813-780'0021
Florida has a very broad public records law. Electronic communications regarding most City of Zephyrhills business are
public records and available upon request. Your e-mail communications may therefore be subject to public disclosure. U
you received this message in error, please do not read,forward,copy,etc.and delete immediately
-----Original Message—'—
Fromn: Newell Reid <nreid0Dcustonncab|e.conn>
Sent:Tuesday,June 3[\2O2O2:19PK4
To: Bldg Dept<DDept@ci.zephyrhiUs.M.us"
Subject: Registration
EXTERNAL EMAIL
Good Day,
I recently spoke with Jackie in regards to registering Amphenol Custom Cable with the City of Zephyrhills in order to
proceed with applying for and receiving a Low Voltage permit stamp for work which will be done at Publix 1245.
Attached are the required documents requested along with the GC's permit which iy what xve would like to attach to as
a sub. Please let me know if anything else is required for the registration and then proceed on with the permit
application.Our qualifier is out but will return Monday and sign the authorization letter.
Thankyou
Newell Reid
Permit Coordinator
Anmpheno|Custom Cable
3II1 Cherry Palm Drive, 33G19
813'612'5002
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