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111111UHCity of Zephyrhills PERMIT NUMBER
5335 Eighth Street
Zephyrhills, FL 33542 ELCMISC-001624-2021
Phone: (813)780-0020 Issue Date: 03/04/2021
Fax: (813)780-0021
Permit Type: Electric Service Replacement/Misc
Property Number Street Address
34 25 21 0000 29900 0000 7470 Gall Blvd
Owner Information 'Permit Information Contractor Information
Name: FDOT Permit Type:Electric Service Replacement/M Contractor: HIGHWAY SAFETY
Class of Work:Add/Alter Commercial DEVICES INC
Address: 11201 Mckinley Dr Building Valuation:$0.00
TAMPA,FL 33612 Electrical Valuation:$1,200.00
Phone: (813)780-0000 Mechanical Valuation: ,^�
Plumbing Valuation: C I
Total Valuation:$1,200.00
Total Fees:$0.00 /� f
Amount Paid:$0.00
Date Paid:
Project Description
ELECTRIC FOR TRAFFIC LIGHT INSTALLED AT POLE
Application Fees
Electrical Permit Fee- $0.00
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.
CONTRACTOR 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-813-780-0021
Building Department
Date Received Phone Contact for Permitting 759 —
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Owner's Name City.Of Zephyerhills owner Phone Number 813-780-0000 .
Owner's Address 5335 8th Street owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 7470 GaIJ BOule.Vard' LOT#
SUBDIVISION PARCEL ID#
' (OBTAINED FROM PROPERTY TAX NOTICE) -
WORK PROPOSED NEW CONSTR B ADD/ALT = SIGN = = DEMOLISH
INSTALL REPAIR
PROPOSED USE 0 SFR COMM = OTHER
TYPE OF CONSTRUCTION BLOCK Q FRAME = STEEL
DESCRIPTION OF WORK
BUILDING SIZE SO FOOTAGE HEIGHT
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE PROGRESS ENERGY Q W.R.E.C.
.1200
=PLUMBING $
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS' = ROOFING Q SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY Highway Safety Devices
SIGNATURE REGISTERED Y/N FEE CURREN ' Y/N. -
Addres.s _Ah:Hnmey Road Tama FL 33610 License# EC0002114.
ELECTRICIAN COMPANY Highway Safety Devices.
SIGNATURE REGISTEREo Y/N FEE wRREN Y/N
Address s480.Hamey Road;Tampa,FL 33610 license# EC0002114
PLUMBER COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN .. ILL
Address License#
MECHANICAL COMPANY
'SIGNATURE REGISTERED - Y/N FEE CURREN Y/N -
Address License#
r
OTHER COMPANY
SIGNATURE RE6ISTERED •Y'/N• -FEE CURREN Y/N' -.
Address License#
[fi.laI IK1la gas
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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 s6bdivisionsllarge projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortes.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 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.(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..needs ROW
813-780-0020 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 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.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/WastewaterTreatment.
- 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 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.pemmit 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
3MM-___ OR AN ATTORNEY BEFORE RE NOTICE OF COMEIENCEMENT
FLORIDA JURAT(F.S.117.03)
OWNERORAGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this S cri ed nd sworn ( r a fore a this
by �iby
Who is/are personally known to me or has/have produced Wh r are personally known to me or has have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No. �+1Q
Name of Notary typed,printed or stamped Na ped,printed or starhpeFd
� J Pu'•.• MICHELLE D JORD
Map.
�� Notary Public-StateCommission N GG•' My Comm.Expires JaBonded through National N
Highway
6480 Harney Road
'01 _SA
fE.�ty Tampa,FL 33b10
Office 813-.759-1559
I3eV1ces Fax 813=757-0924
March 1,2021
City of Zephyrhills
Building Department
5335 8th Street
Zephyrhills,FL 33542
Phone: 813480-0020 Fax: 813-780=0021
Reference: Permitting Letter of Authorization(EC0002114)
To whom it.may concern:
I James J.;Smith hereby authorize Buck Steele to act on my behalf in all matters relating to my Florida EC
License,EC0002114,to include permitting. Any and all acts carried out by Buck Steele on my behalf,regarding
my EC license,-shall have the same effect as acts of my.own.
Sincerely,: .
ames J. Smith
Highway Safety Devices, Inc.
EC00021.14
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