HomeMy WebLinkAbout21-1428 Q _
�!n�r100 City of Zephyrhills PERMIT NUMBER
4t. 5335 Eighth Street
Zephyrhills, FL 33542 BGR-001428-2021
Phone: (813)780-0020
•
Fax: (813)780-0021 Issue Date: 01/27/2021
Permit Type: Building General (Residential)
Property Number Street Address
12 26 21 0030 00300 0130 5309 Beltram Drive
Owner Information Permit Information Contractor 1 nformation
Name: DAVID HAYES Permit Type:Building General(Residential) Contractor: BAHR'S PROPANE GAS&
Class of Work:HVAC Changeout A/C, INC.
Address: 5309 Beltram Dr Building Valuation:$0.00
ZEPHYRHILLS,FL 33542-6018 Electrical Valuation:$0.00
Phone: (813)598-6981 Mechanical Valuation:$5,800.00
Plumbing Valuation:$0.00
Total Valuation:$5,800.00 /
Total Fees:$69.00 /
Amount Paid:$69.00 ���
Date Paid:1/27/2021 9:40:54AM
Project Description
A/C CHANGE OUT 2.5 TONS
Application Fees
Mechanical Permit Fee $69.00
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.
O ILTR CT RR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
ge_# JY�Z65
8'13-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received Phone Contact for Permitting (�• ) -J O
n T /� ��3'S -Co981
Owner's Name �ff(,}A (5 �V��o/�r,+ham LDq V i Owner Phone Number
Ownees Address % 194 1& ► / 5 Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 53 j5elfra Dr nulls FL 3�2 LOT#
SUBDIVISION PARCEL ID#hai_07 10 07/-0030 OQ3Oo
(OBTAINED FROM PROPERTY T=Ttcel
WORK PROPOSED e NEW COIVSTR ADD/ALT = SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE = SFR Q COMM = OTHER
TYPE OF CONSTRUCTION = BLOCK 0 FRAME = STEEL` ^_
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE HEIGHT
=BUILDING S VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL S AMP SERVICE = PROGRESS ENERGY Q W.R.E.C.
=PLUMBING $
MECHANICAL $�Q�oo, VALUATION OF MECHANICAL INSTALLATION
=CAS = ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY
SIGNATURE_- REGISTERED I Y/ N FEE CURREN
Address I License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N FEE CURREN
Address I License#
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N FEE CURREK Y/N
Address i License#
MECHANICAL COMPANY t7L3 Fo ne 6aS it Al C Mi
SIGNATURE qq REGISTERED Y/ N FE CURREn Y/N
Address / ` 5 License#
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N FEE CURREA Y/N
Addre.s 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 subdivisionsllarge 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,Stornwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Pernit'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.
3 :-F�'
Directions:
Fill otr.application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC 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. ROW'..needs.
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 coritractor(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'constructiori 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.
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. 1 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"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 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 fo 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 N TICE OF COMMENQFMENT.
FLORIDA JURAT(F.S.117 03
WNE OR AGENT C NT CTOR
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Who i;are persona y mown to me a as/have produced ho is/ a ersanall know o me or h,!Javb produced
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c otary Public �UcYi Notary Public
Commission No. Commission NoA Oki
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SALES SERVICE • REPAIR• INSTAL TON WORK QRDER#/SERV ICEMAN 115257. J`AN
4 444-1 A11en�Rd.`�Zephyrhlils, FL DATE/TIME TAKEN 11 11 `1 i i o iS
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ROUTE/SEQ J'AN33542
HAYESy DAV I D i=iA1GES=g -D,'V I:D`''
4824. 1.6TH S-T 5 1Zi9-�BEL'TRAM DR .
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ZEPHYRHILLS FL. .&3545 ZEPHYRH'ILLS, FL335A.2
CD:, UACC030J'H84 377SM23902500
ESTIMAl%E-=.QN 'MEW UNJ—T' -& =SQI`1E DUCTWORK REPLACED.
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FILTERS x x Changed Monthly I I
FILTERS x x Changed Monthly
❑ REGULAR ❑WARRANTY #
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eh;r i lafS irtg Whenhere' yYti5 When Away:.__''�T;.Stat$ ❑ MAINTENANCE CONTRACT SERVICE r
LIMITED WARRANTY: All materials;parts and equipment are warranted by the manufacldrers'�y "'„`j ONO ,(' T .;; 4`�t CALL I
or supptlers'written warranty only.Atiaabor performed by the above named company iswarranted for t' TOTAL
30 days ores otherwise Indicatedan'writing..The above named company makes no otherwaranties dCAS_ _U CK`#
express or tmplied,.and its agents or technicians are not-authorized to make any such.:warra fles on' MATERIALS I
behalf of abovenamed.company. ❑DEb):61P:CREDIT OOTHER MAINTENANCE . I
I have authority to order the work outlined above which-has been satisfactorily completed)agree that Seller PR0G. W I Ci t
1
retains a0e to equipmentrmaledals fumished until final paymentds made.N•payment is not madeas.agreerd, CLAIM#
sailer can remove said equipmenVmalerials at Seller's expense,Any damage resulting from said,removal,ehall,
not be the responsibility of Seiler.NET 30 DAYS.A 1 12%SERVICE CHARGE-WILL BE ADDED MONTHLY.TO, '}-�+. . '' I
ALL UNPAID BALANCES OVER 30 DAYS.NO REFUNDS •LATE'COMPLETED
TECH;' TAX
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CUSTOMER SIGNATURE DATE -- - J7G� _w6a TOTAL IML I
4 1/27/2Q21 12-26-21-0030-00300-0130 1 Pasco County Property Appraiser
Parcel ID 12-26-21-0030-00300-0130 (Card: 1 of 1)
Classification 00100-Single Family
Mailing Address Property Value
HAYES JOHN DAVID Ag Land $0
4824 16TH ST Land $12,789
ZEPHYRHILLS, FL 33542-6018 Building $83,657
Extra Features $139
Physical Address
5309 BELTRAM DRIVE,
ZEPHYRHILLS, FL 33542 Just Value $96,585
Assessed (Non-School Amendment 1) $96,585
Legal Description (First 200 characters)
See Plat for this Subdivision Non-School Taxable Value $96,585
ZEPHYR HEIGHTS PB 5 PG 50 LOT 13 School District Taxable Value $96,585
BLOCK 3
Jurisdiction
CITY OF ZEPHYRHILLS
Land Detail (Card: 1 of 1)
Line .Use Code Description Zoning,Units _ Type _ Price _,Condition Value _
- -- -
2 0100R 1 LP3-2 SFR - r00R1 _-7 000 00 SF _ _ -
1 0100R- LP3-1 1_--_-- SFR _J _.._- "___. _..._.-.1__.____.___. $1 8� _i _ 1.00 i $12,600
-_ 00R1 } 700.00 SF $l).27 j - 1.00 - ' -$189-
_ Additional Lan_d I_n_fo_r_ma_tion
_- -Acre_s Tax Area FEMA Code �- Neighborhood Code(s)- --
0.18 �yj 30ZH ZHLG`-View Sketch Sketch Building Information - Use 0100-Single Family Residential (Card: 1 of 1)
ear Built 1961 Stories 1.0
xterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Above Average
oof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
nterior Wall 1 Drywall Interior Wall 2 None
looring 1 Terrazzo Monolithic Flooring 2 Carpet
Fuel Electric Heat Forced Air - Ducted
/C Central Baths 1.5
Line_ ;Code bescription Sq. Feet Value
1 �_ _BAS01_ LIVING AREA_MV!�--- 932 "-- - - $59,427 -4
2 ? _FE_P01_ I FINISHED ENCL PORCH 192----"-"T" `r
-- -------- $8,544
FGR
- 3 ----f-_ 01-� FINISHED GARAGE�"��__------ ------252 '__.-___ $6,440___-"----
--- FGR
4 UDyni UNFINISHED DET UTILITY - - --144- -- $2,742_ -4 -
5 _i FCA_01 FINISHED ALUM CARPORT 168 $2,678 -
- 6 USTCd j V_UNFINISHED_ST_ORAGE^_ i _ _ 84_ _ $2,168_ _
7 _ UOP01 ; UNFINISHED OPEN PORCH -; - 172 - $1,658 --
Extra Features (Card: 1 of 1)
Line ,Code _IDescription JYear Units _ _ Value
1 RDWSWC j DRVWAY/SIDEWALK CONC j 1973 234 - $i39.___�
Sales History
Previous Owner: HATHAWAY ANTHONY S
Month/Year jBook/Page -------------,Type-- --___------------ DOR Code---- --------__----------- --
Condition Amount
10/2020 10209 / 3637 Warranty Deed _ 01 Improved 1 $65,000
�08/2013 8934 / 0622 -' -_Warranty Deed - -- -11 - - Improved- J!---$0 _-
-'---
04/2008_ - ' 7801 / 1709 - Quit Claim Deed - ; Improved $0
12/2001 j - 4818 / 1444- _- -'__ Warranty Deed - j - - _ Improved ! $68,000
09/2000 j 4450 / 0008 _Warranty Deed -�i — `- Improved t $65,000J
07/1996 �f 3600 / 1642 _ Warranty Deed Improved } $58,500-
https://search.pascopa.com/parcel.aspx?parcel=2126120030003000130 1/1
INSTR/t 2021032021 OR BK 10281 PG 1297 Peg.1 of 1
02/17/2021 11:25 AM Rcpt:2262169 Rec:10.00 DS:0.00 IT:0.00
Nikki AlvarezSowles,Esq.,Pasco County Clerk&Comptroller
Permit No. �' Parcel ID No 3,"�'S"'Z"1-bC(S'0-0 UU 0 "0 f 3 p
NOTICE OF COMMENCEMENT
Stets of r 1 County of Piz.S W
THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real property,and in amordance with Chapter 713,Florida Statutes,
the following Information is provided in this Notice of Commencement:
i. Description of properly:Parcel Identification No.33=Zr-Z(-O 0S'0 -000 a O -d 13 O
Street Address; .1.3 r ft Aa 1 t-'41.A c ?� ( Y b -14r P-j 3
2. General Description of Improvement rr 0 0
3. Owner Information or Lessee Information If the Lessee contracted for the Improvement:
/Vdv'wiQvt LJE7.1 f,1S'n
Name
AddreseZ 3y }� city I State
Interest In Property:
Name of Fee Simple Titleholder
y,�. t (if different from Owner listed above)
a. contrarian: _ C0r 1 iS)4 c k"-e. P, ��yCr[�S Lrc city state
% 6a-)' er SGk
Address city 3 7 6
Contractor's Telephone•No.:
S. Surety:
Name
Address city State
Amount of Bond: Telephone No.:
6. Landa
Name
Address city state
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(ax7),Florida Statutes:
Name
Address city State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates —of—
to ,_
to receive a copy of the Llenors Notice as provided In Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of mnslnsction and final payment to the
contractor,but will be one year from the date of recording unless a different date Is spedfied):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A 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.
Under penalty of pedury,I declare that I have read the foregoing notice of commencement and the fads stated therein are true to the best
of my knowledge and belief.
STATE OF FLORIDA
COUNTY OF PASCO
I nature o er or Lessee,or Owners or Lessee's Authorized
OfflcerlDl tor/Partnar/Manager
Signatory's Tttla/Office ` 1
The torego ng instrument was acknowledged before me this�day of �0.,N ,20_,by ht b r"i" &�k p�
es I sJ vLL s' (type of authority,e.g.,officer,trustee,attorney In fad)for
(name of party on behalf of whom Instrument was executed).
._�
Personally Known 0 t,7$Produced Identification Notary Signature
Type of Identification Produced I P L- Name(Print)
. ♦sue" sco C BLACNMAN .
� Nfttarq Pu411c-State st Florida
fAtI' tan N GG 236T76
M1 My Gomm.Erp res Jun 20,1022
^Bonded lhrouph National Notary Assn.
wpdat3lbmfnoticemmmencemen(,pc053048
State Of Florida,County Of Pasco
ss This is to certify that the foregoing is a
m true and correct copy of the document
on file or of public record in this office.
Witne s y hand and official seal this
x(I day of —
�� Nikki Aluare wle ,Esci..C�s k&Comptroller
$ ,® Pasco u y,�8 da
,� gy ,Deputy Clerk
� �
B13-780-0020 city of Zephyrhilis Permit Application
Building Department
:pamittin 5�10)
Phone,C"ftd for Pef,d Date ltemqi�ed Phone C"A3d for
r
ownees Name ljo Number 590
ownees Add qjU4+sS+ Omer Phone Number
Fed Simple Titleholder Nam Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS LOT#5
SUBDIVISION PARCEL io#F (OBTAINED FROM PROPERTYTAX NOTICE)
WORK PROPOSED R INSTALL NEWCDNM� ADDIALT = SIGN [--j DEMOLISH
REPAIR
PROPOSED USE SFR M Comm r--j OTHER I
TYPE OF CONSTRUCTION = BLOCK [D FRAME STEEL ED r_—
OF-SCRIPT-'ON OF WORK ph S-TON P+---
arne,oul-, I coor -n+,
BUILDING SIZE So FOOTAGE HEIGHT E=
=BUILDING VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL is AMP SERVICE PROGRESS ENERGY Q W.R.E.C,
=FLUMBING 15
�-'ECHANICAL jsZjqq5,a3j VALUATION.OF MECHANICAL INSTALLATION
=c.ks r7 ROOFING rl SPECIALTY OTHER
FINISHED rLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
. . . . . . . . . . . It It It II
BUILDER i COMPANY I
SIGNATUF1'.- REGISTERED I YIN FEE CURREN
Address License#F
ELECMCrAA1 COMPANY I
SIGNATURE REGISTERED I YIN FEE CURREN i YIN
Address I License#
PLUMBER COMPANY I
SIGNATURE REGISTERED I Y/N FEECUPREN L_XLN J
Add. License#F—
MECHANIC -Wo-F
COPANY
SIGNATU AL REGISTEREDM I Y/N FEEtURREN I YIN
Address MI-71 A W"qd Zi 1/6 ticehse#1 efi e-5-013q q9
OTHER COMPANY
SIGNATURE REGISTERED I YIN I FEE CURREN LILN J
Address License#F-
111i I 111111111 1161111111 11111 111 if 11111111
RESID9NTiAL Attach'(2)Plot Plans;(2)sets of Building Plarvi:(1)set of Energy Forms;R-O-W Permit for now construction,
Minimum ten(10)worldng days after submittal date. Required make,ODns6xUon Plans,Stonewater Plans wl Sift Fence installed,
Sanitary Facilities&I dumpster,Site Work Permit for subdivislorwlarge projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a We Sofory Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)vvq%ng days after submixtal dote..Requited onzite.Construction Plans,Stormwater Plans W Sift Fonco Installed,
Sanitary Facilities&1'dumpster.,SfI67Work permit for all new projects.Ali commercial requirements must meet compliance.
SIGN PERMIT Attach(2)sets of Engineered Plans. 1 '4 . - . . .1.
'PROPERTY SURVEY required for all NEW construction.
4 . . . . . . . . . 11all 01=4 oft
Fill ou,application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice or 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 PERMUTING (copy-of 99npat required
Reroofs if s.-iingles Sewers Seivicm Upgrades A/C �fot/Survey/Footage)
Driveways-Not over Counter it.06 public roadways:.needs'ROW
NOTICE OF DEED I RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than u
Co ' 'rbguIati66&*The undersigned assumes responsibility for compliance with any
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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 iiccdn:16rice,vwth,state.and local regulations. If the
contractor Is not licensed as required by law,both the owner and contractor may be cited a.misdemeanor for I violation
under state law. If the owner or I.ntended 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—Licer sing Section it-727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the cofitractor(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/Unii-mis IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transpdrtatlo'n'Iffip6ct Fees and Recourse Recovery Fees may apply't6 the construction of new builditigs,change of
use in existing buildings;or expansion of e)d§biig 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
tion 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 applicirit, have been,provided with a copy, of the 'Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Floridd,Departmerit 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 descri6eddodurneInt 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 Treatment
Southwest Florida Water .Management 'District-Wells, Cypress 'Bagh6ads, -Weiland 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'T 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"K 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 car* 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'aUth6rity to violate,cancel,alter,or
set aside any provisions of the technical codes,nor shail Issuance of 6 flermll-prevent the Building Official from thereafter
requiring 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 ATTORNEYBEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S.
OVVNER,OR AGENT.
900*1ka d two (Or a sworn r affi edd)be Is
Twlkie rsonally known t(5 me Or"8/yaV6 produced I Personally own-jo me orhaVUve-produced
,as 4iotllic=ation. as identification:
,2A Notary�.b)h Sad. Public otary Public
Commission Na.
Commission No.
Na
Notary Pc State of Fjold, .0",p W NO- Notary PAwic Su
Tommie M Rogers f&J% Tommie MR
C . Rogan
My Commission GG 913245 %1�1, My Commission GG 911324111,
Expires 0911512023 V Expires(111111`13/20"