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F'YlilUfl City of Zephyrhills PERMIT NUMBER -
=u=v. 5335 Eighth Street
Zephyrhills, FL 33542 BGR-600426-2020
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 07/21/2020
Permit Type: Building General (Residential)
Property Number Street Address
03 26 21 0010 00200 0000 37834 Daughtery Rd
Owner Information Permit Information Cohtractotariformation-
Name: SHAHEEN UDDIN Permit Type:Building General(Residential) Contractor: CROSS CONSTRUCTION
Class of Work:Demolition SERVICES, INC
Address: 10006 Kingshyre Way Building Valuation:$2,400.00
TAMPA,FL 33647-2874 Electrical Valuation:$0.00
Phone: Mechanical Valuation:$0.00
Plumbing Valuation:$0.00
Total Valuation:$2,400.00 ✓ / {
Total Fees:$100.00
Amount Paid:$100.00 f `
Date Paid:7/21/2020 10:26:36AM
Project Description. ;
DEMOLITION SINGLE FAMILY 1,116 SQ FT
Application Fees
Demolition $100.00
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.
C RA'TOR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
&13-780-0020 City of Zephyrhiiis Permit Application Fax-813-780-0021
Building Department
Date Received ? 'fj/ Z b Phone Contact for Permitting ( o / 7 ) �a 7 v�3J TV
1 € € it Z € € € € it €
Owner's Name A eC h W Owner Phone Number
Owner's Address ('� KI 6a5 a e- Wa &1 Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address F--
JOB ADDRESS �ti(/ G LOT#
SUBDIVISION PARCEL ID# !7f•ZL'Z�' O •00 ZCO•(,Cif
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED R
NEW CONSTR 8 ADD/ALT = SIGN = ®� DEMOLISH
INSTALL REPAIR
PROPOSED USE = SFR Q COMM OTHER
TYPE OF CONSTRUCTION = BLOCK 0 FRAM/E'L• e�] STEEL =
DESCRIPTION OF WOR - S boa,- 1Nu Gf O im-
BUILDING SIZE J SO FOOTAGE Z b b Z HEIGHT
E]KBUILDING $ 2 O D VALUATION OF TOTAL CONSTRUCTION Z I V 647
=ELECTRICAL $ AMP SERVICE d PROGRESS ENERGY = W.R.E.C.
=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION v�
=GAS = ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY &05-6-007*2;n 5;f4'N«S
SIGNATURE REGISTERED N FEE CURREN L Y/CN-
Address GAGS /v License# 1.�✓®.�/
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN
Address I License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/N I FEE CURREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN
Address I License#
OTHER COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN Y/N
Address License# �—
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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-OW 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(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 Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
13-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
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 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 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 certify that 1 have obtained a copy of the above described
document and promise in good faith to deliver it to the"owner"prior to commencement.
CONTRACTOR'SIOWNER'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 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 IMPROVE NTS TO YOU PROPERTY. IF YOU INTEND T OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR- ;_RNE_B-1 RE REQORDINQ YOUR 7PI!QF.Q_FA"W EbIT,
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT5q— CONTRACTOR
Subscribed and sworn to(or affi d before me this $ubscrbed and sworn to( ed)b ore met i$.
L[�c s�v�o by vn ,i ,Tl d1 Joao b Lac, T �I, �r(J
Who is/are pe ovally known to or haslhave produced o is�r personally known to a or has/have produced
as identification. — as identification.
Notary Public ���LL + Notary Public
Commission No. (; ���3� Commission No. CK 91,9 S 3
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
P PAULA K.SCHNEIDMILLER
MY COMMISSION#GG292530 " °�� PAULAK.SCHNEIDMILLER
ern EXPIRES:March 15,2023 MY COMMISSION#GG292530
oFao�P EXPIRES:March 15,202
CCS
cj17VTCWn7N"-9%P
License#CGC1505176
25221 Wesley Chapel Blvd.
Lutz,FL 33559
Phone(813)907-1013*Fax(813)907-0297
PROPOSAL
Proposal Submitted to: Phone: Date:
Bingham Realty Inc. 813-714-2317 July 13,2020
Street: Job Name
38070 Daughtery Rd House Demo
City, State,Zip Job Location
Zephyrhills,FL 33540 37834 Daughtery Rd. Zephyrhills,FL
Attention Consultant: Email:
Mr. Brian Infantino I binfantinobri@aol.com
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
We propose to furnish all skilled labor, materials, equipment, license, and insurance necessary for the following scope of
work:
SCOPE:
-*.- - Demolition of existing building
-.1- CCS will provide demolition permit
❖ CCS to provide public utility locates
❖ All resulting demolition debris will be properly disposed of in a certified landfill or recycling facility
4- Site will be rough graded to resulting elevation
EXCLUSIONS:
❖ Hazardous waste removal not listed above
-*e Buried Tanks or debris
❖ Imported fill or erosion control
❖ Tree Removal or protection
❖ Well Abandonment
Demolition Total -$2,400.00
We propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of
Payment to be made as follows:
Upon Completion and Acceptance.
All material is guaranteed to be as specified. All work to be completed in a
workmanlike manner according to standard practices. Any alteration or deviation
from above specifications involving extra costs will be executed only upon orders,
and will become an extra charge over and above the estimate. All agreements 7 11-312-oaz>
contingent upon strikes,accidents or delays beyond our control. Owner to carry Authorized Sig tur Gilmore—Senior Project Manager
fire,tomado and other necessary insurance. Our workers are fully covered by Note:This proposal be withdrawn by us if not accepted
Worker's Compensation Insurance. Within 30 dNays.
Acceptance of Proposal:
The above prices,specifications and conditions are satisfactory and are hereby Accepted by Ud-;,-, 71WIzo
accepted. You are authorized to do the work as specified. Payment will be made
as outlined above.
Date of Acceptance:
Please return one signed original to Cross Construction Services,Inc.
ccs5
�Oss CONS N 5Eg�G�
TRUCTIO
25221 Wesley Chapel Blvd.
Lutz,Florida 33559
Phone: (813)907-1013 •Fax: (813)907-0297
CITY OF ZEPHYRHILLS -
TO WHOM IT MAY CONCERN,
PLEASE BE ADVISED RICK POLLESCH IS GRANTED THE AUTHORITY OF
ACTING AGENT FOR RUSSELL E. ARNEY (LICENSE #CBC059838) "OR"
ETHAN T. LILLIBRIDGE (LICENSE #CGC1505176), FOR CROSS
CONSTRUCTION IN MATTERS INVOLVING PERMITTING.
SINCERELY,
ETHAN T. LILLIBRIDGE -VICE PRESIDENT
CROSS CONSTRUCTION
SWORN TO AND SUBSCRIBED BEFORE ME THIS 21 ST DAY OF JULY, 2020.
MY COMMISSION EXPIRES:
TAMARA JAM
NOTARY PUBLIC, STATE OF FLORIDA, PASCO COUNTY TAMMiAMEg
X_PERSONALLY KNOWN TOME. Eo. .
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