HomeMy WebLinkAbout20-908 fl City of Zephyrhills PERMIT NSMSEFRAIIIIIIIIII
5335 Eighth Street
t„ Zephyrhills, FL 33542 BNR-00090 -2020
Phone: (813)780-0020
- Fax: (813)780-0021 Issue Date: 10/26/2020
Permit Type: Building New (Residential)
. ,. Properly Number ,4 '_ ¢:;� � Street?ddress^ Aa
1126 21 0010 02000 0011 5985 14Th St
1 = Ownerinformation , __ , ,'- ;Permit�lnformation - Contractor Information
�_, -_
Name: BUTTERFIELD INVESTMENTS INC Permit Type:Building New(Residential) Contractor: BUTTERFIELD
Class of Work:SFR Construct INVESTMENTS INC
Address: 31325 Amber Lea Rd Building Valuation:$140,000.00
DADE CITY,FL 33523 Electrical Valuation:$7,500.00
Phone: (813)973-5250 Mechanical Valuation:$8,000.00
Plumbing Valuation:$6,000.00
Total Valuation:$161,500.00
Total Fees:$18,710.15 1(v,
Amount Paid:$18,710.15
Date Paid:10/26/2020 1:09:21 PM
Protect lDes pion
CONSTRUCT SINGLE FAMILY 1,979 SQ FT
A plication Fees ;,, _. =
Public Safety Impact Fee-Police $254.00 Water Connection Residential Fee $1,010.00
Sewer Connection Residential Fee $2,090.00 Building Permit Fee $730.00
Transportation Impact Fee $3,595.68 Mechanical Permit Fee 12-o $80.00
Driveway Fee $45.00 Mechanical Plan Review Fee $40.00
Plumbing Permit Fee f �'� $70.00 Electrical Plan Review Fee $38.75
Building Plan Review Fee k o6t s $365.00 SIF 1 percent Fee $83.28
Public Safety Impact Fee-Admin $26.35 Plumbing Plan Review Fee $35.00
Transportation Impact Fee-City $36.32 School Impact Fee $8,328.00
Public Safety Impact Fee-Fire $273.00 314 Water Meter Fee(Calc) $732.71
Address Fee $30.00 Electrical Permit Fee I I IPA Z`� $77.50
Park Impact Fee-Single Familyrrownhome $769.56
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.
CONTIACTOR 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 Permittin 7 7 J - 6
Owner's Name Owner Phone Number S13` 3'SZ5 d
Owner's Address 131325 01 r ode 1.6'7` �L Owner Phone Number,
M
Fee Simple Titleholder-Name N/Q Owner Phone Number
Fee Simple Titleholder Andress
JOB ADDRESS S $S /y-fh S fr e Ze Y h►ds FL- 33S`l 2-- LOT#
SUBDIVISION NIA PARCEL.ID# .l 2�0 Z -,Ob J 0-- l 2 DOC) 00
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED "NEW'CONSTR ADD/ALT' SIG Q Q DEMOLISH
INSTALL. 8 ;`• M-.REPAIR
PROPOSED415E - ' SFR Q 'COMM ,OTHER- -
TYPE OF CONSTRUCTION d BLOCK " : FRAME 'STEE L .�
DESCRIPTION OF WORK !`� '� C'ar15`FrGc Lfr'�11 SFR
Z i�'I{ X 1 J'G1 � 27/O4EkG
BUILDING SIZE - _ .
SQ FOOTAGE ' �`I Ii✓l,�J . HEIGHT, 1,5" �O �
BUILDING $ VALUATION:OF TOTAL CONSTRUCTION
�0 0 0�
[ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY _[� W.R.E.C.
=PLUMBING
[MECHANICAL $ j VALUATION OF.MECHANICAL INSTALLATION
=GAS Q ROOFING SPECIALTY, OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
HHHHH
BUILDER �` COMPANY ,QG f��r /e..,r!Gi 1hVeY-/rnewh �vr c .
SIGNATURE REGISTERED Y/ N FEE CURREE\ ' Y 1 N'
Address 3':3 25/'rm6e.r1,e�,, led lokd cG f " 1=L License#
r'
ELECTRICIMW COMPANY aV r y' q a,,, -. ) ��,lac
SIGNATURE "' REGISTERED Y! N FEE CURREP`'' `Y/N'
Addreaa SS/�- %/',QI✓• li - 1�/lt - p License.#_ t_-G dcsc�L �l,
` /1� COMPANY '�J
PLUMBER
SIGNATURE . �f � �'. REGISTERED.. a N: :: ,FEE GURRER-- Yl N. .
Address `Si/ 17 `fit _24"11-3 3 3 ,.License#
MECHANICAL ' : COMPANY
:..
SIGNATURE' REGI8TEERED-. Yl N. E cuRREn:. Y_t<N .
Address'
OTHER ;COMPANY'
SIGNATURE: REGISTERED` '-Y/ N; FEE CURREN Y
Address y - - L16ensaIt
#
h ,. .x. .y
RESIDENTIAL,. -;Attach(2):;PlotiPlans;,('2)sets,of�Building`'�Plans;'(1)`sefof Eneirjy?Foim§;,R=&W Peirrlitfarnaw construction,..
s_...
Minimum',ten;_(10);uvorking;daysafter";subriiltta!'date::Required onslts,>Construction Plans;Stoimwater`Plans w/Sllt Fencs instaAsd,
Sal i(taty Fectti8es:&>1:.durt<pster,Site ltitork,Permitifor`subdivtslbnstlarge:proIeOtt `-
COMMERCIAL Attach(3)compleie se6W'BU1ldtli6g Plans plus aUfe Safety Page;(1)set of Energy Forms.R-O-W Permit for now construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Slit Fence Installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new:projects::Ail commercial requirements-must meet compliance
SIGN PERMIT Attach(2ysets ofEngineered Plans.:
"PROPERTY SURVEY reguired,for ail_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 o#Attorrsejr(#or the owner)would ba someone with notarized letter from owner authorizing same
OVER THE COUNTER.PERMITTING_ -- •(Front•of-ApplicadomOnly)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
f,
NOTICE OF DEED RESTRICTIONS:. The undersigned,understandsthatthispiarmit.may.besubject_to°deed",,restrictions° _'. „_
which may-be::motwr.6str.idtive-than County regulations •'The un"Hidersigned assumea responsibility for compliance with any
applicable`deed restrictions.
UNLICENSED CONTRACTORS•AND-CONTRACTOR-RESPONSIEILiTIESc °If-the-owner,has 'hired'-a",conh ctor or
contractors to undertake work, they.may<be.-regt ired::to.:betillcensed In accordance.with,siate-.andaocal�reguiations 1Uthe ='
contractor is not ll' kid•os�requlred:by'low.,_both the owner and contractor 6iy-b cited-.for'a-misdemeanor violation
under state law. If the owner or Intended;:;contractor;are;uncerlaln as to what licensing_requirements 5may apply-for=the°
Intended work;they are:advised to contact the Pasco.County Building:Inspection Dimston-t:lcensing Section at 727-847-
8009. Furthermore, if the owner"has"`hired a contfactor or contractors, he is advised to have the contractor(s),,;sign.
portions of the "contractor Block" of this-application-for which.they,Wll,,be,.responsible.-::If you;:as.:ihe owner sign°as the` "Y
contractor, that�inay be an indication that'he=ls fiot:properiy licensed-and Is'"not"entitledto permitting privileges In Pasco
TRANSPORTATION-IMPACTIUTILITIES IMPAC'F`AND RESOURCE RECO
County.
. .� � ry VERY'FEES:"The undersigned understands .
that Transportation Impact Fees:and.Recourse Recovery.Fees may.,apply-ito the;construction:of new-buildings,ichangeof"
use In existing buildings, o'expansion_of�existV'jgiibulldings, as specffled.in Pasco County Ordinance number 89-07 and;
90-07, as amended...,The undersigned also,understands, that:`such fees ;as;1nay;be-.�due>willa,be identified at the-,Vh6`of`
permitting. It Is fu heir'understood that Transportation Impact Fees and�Resource RecbVd-Fees.-must be paid prior to
receiving a 'certificate.-of-occupancy"or"finaV..powep,.release:, af,the.project::d)wnot.involve:wcsrtificate of occupancy'oc,�:' _ ='','
final power-release,:Jhe-.fees-mud be paid,prlor to�Permit Issuance. Furthermore;if:.Pasco,.County:Water/Sewer-slmpact
fees are due,.they mu§t,be paid:pMor,to.permit issu-1 imaccordance with-applicable:Pasco•.,County ordinances.
CONSTItUCTION-LIEN`LAW'(Chcrpter 713, Florlda Statutes,as am on.d®d): If valuation of work Is$2,500.001.0r more;.,Ir,°
certify that 1, the applicant;:-have=been-provided; with a copy- of 2the•`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.,obfaired°a�copy.of:theyabove:.rdescribed'Aocument;,and.pt..om1;3ean,good-11aith.to
deliver It to the'owner"'.prior'to,iiommencement'
CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify-that.all the,'informaticm,lnl-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. obtaln...a.permit,,#o:..do:-work.-,and:Installation as indtcatb&;-.. L ce'tlfy 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.imoompllan, , Such.agencies include but are.not limited to:
Department of Environmental Protection=Cypress.'Baylieads;'Wetland Areas-and-Environmentally Sensitive
Lands,Water/Wastewater Treatment.
Southwest Florida Water Management':Dlstriet-.Wells; Cypress. Bayheads;• Wetland' Areas, Altering
Watercourses.
Army Corps of Engineers=Seawalls, Docks, Navigable Waterways.
Department of;.Health_:4..Rehabllitative,.Services/Ertvironmentaf Health Unit-Wells,.:Wastewater Treatment,
Septic Tanks:.'
US Environmental Protection Agency-Asbestos abatement..:..
Federal Avlatlon.Authority fZunways
1 understand.that the,followingrestrlctlo,'ns apply to the use of fill:
Use of fill is not allowed in*lood=Zone %P 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:perrrlitting which is prepared by a professional engineer
licensed by the.State of florida:
If the fill material=Into be-used in Flood Zone "A" im connection-with:a permitted'building using stem wall
construction, I certify that filLwlll.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`propertles,.the owner may be'cited for.violating:.
the conditions-of the.building"permit Issued=under the"'attached U .
jpermit application,fdf.-Iots1ess-.than.'One (1)
acre which are elevated:by fill; an engineered drainage plan is required:.
If I am the AGENT.FOR THE OWNER; (;-promise In good faith to Inform the owner of the permitting conditions set forth In
this affidavit-prior to'commericing construction.. 'I understand that a-separate,permit may be required for electricaf work,
plumbing,.signs, wells,`.poois`alr condttiontng,-:gas;=.or:.other installations not,specificalty included-in.the application. .A
permit issued shall be construed to be a-ltcenw-toproceed with the-work and not•as:outhorlty-to:-violate..cancel, alter, or
set aside any provlsions.of the.technical.codes; nor shall Issuanowd a.permlt.prevent'the,Building Official.from thereafter
requiring a correction of.errors,In,;plans constiuction 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:abandonedfora-:period,of41x-.(6).montt s:after.the tune the•work1s commenced. An extension
may be requested,.in,writing,,.from.the`.Building,Officlal°for a period=not to exceed"ninety(90).days and will demonstrate
justlfiable'cause for.•the extension. If work ceases.for ninety,(90)consecutive-{day-s,..th 6job:is considered abandoned.
WARNING TO OWNER: YOUR..FAILURE-TO,REC:ORD,A::NOTICE:O.F COMMENCEMENT:MAY-RESULT•IN;YOUR
PAYING TWICE;FOR IMPROVEMEN;TS;TO:;YOUR::PROPERT•Y:=�lFrYO.U,II�ITEND-,TO'013TAIN}FINANCING -CONSULT
WITH-YOUR CENDIiR GRAN•-ATTORNi5Y-j31�FORi t CORDfNG YOUP'i TtCf 'S =C INtII ENO LENT: ` -
FLORMA'JURATm(M-117.03).
OWNER OR AGENT CONTRACTOR c�l�
Subscribed and swam to(or affirmed)before me this Subscribed'and'swom:to(or'afflrmed)befo me'thia -
. by
Who Is/are personally known tome or_has/have produced, Who:is/are-personallyknown•to-me.or has/have•oroduced -
as Identificatpn, as Identification.
Notary Public •
- Notary Public
Commission No;" Commission.No. �
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
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PASCO COUNTY, FLORIDA
z:
Permit No. p
!
,,/_ Date Permitted 2„ Z-2a2
Builder Name/Owner Name �VZ Control#'
County Parcel No. Z. lJd l4 D2-DU6 D o SubDly: (_a4l6p, rl�f
Address/Location U or
ClasslficatioMType of Usq c! k {
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: 7 __
Exempt ❑Ves [] No How Determined
y
Impact Fee Amount $,'31 Zone No. TAZ:
. SCHOOL IMPACT FEE.
Account (056) Single-Family Detached House Amount $ - �// 2-t5
(067) M6160 3 Home
l (068) Other Residential
d
23) Collection Fee
Exempt Yes. Q No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone TOTAL AMOUNT $ '
Exempt ❑Yes ❑ No How Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total .
Exempt ❑Yes ❑ No How Determined Total Amount j'
RESOURCE FEE' ERU �?'�"
TOTAL AMOUNT
Prepared By Checked By
NO CERTIFICATE..OF OCCUPANCY WILL BE,ISSUED OR FINAL INSPECTION
PERFORMED.UNTIL THE TOTAL AMOUNTS LISTED 14AVE
BEEN PAID AND
RECEIPTED.FOR BY A CENTRAL PERMITTING OFFICE,OF PASCO COUNTY
Ackrfowiedgamsnt below dose not Imply acceptance of concurrence,but simply receipt of a.copy of-this form,placing
the bonding peimit'owner•on notice of this assessment and the conditions of payment for same:
DATE -RECEIVED BY
RECEIPT NO. DATE BY
CITY OF ZEPHYRHILLS-BUILDING DEPARTMENT
RIGHT-OF-WAY USE PERMIT
DATE: fL. I.' l c; PERMIT#: I
No,construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the City Building
Department., Any application for approval of construction operations on any.City owned Rights of Way shall furnish a detailed drawing showing the complete
scope of.the proposed work in triplicate to the office of the Building Official for approval prior to the commencement of-any work. A copy of this perinit is to be
kept readily available at the site of the work at all times.
PARCEL IDMi -26,--2/.-6O/0-02_000- 6012 CITYBOAD_/`/:
59ro' fy f4 :S�r;
LOCATIONLegal Description): - 1
Cilu u-- Zi,�hti✓)r:'Il t %/'G S y 13Un. �� l.uf S /-(o in r:/ .% jam . 2 0:4 L J.A
a•f r colt of C oc([ i .SZSoG�t l.�ri2s��l-.y7.15F7 .
�a✓ prid7fj S.LS���(;(8'ZS''L%. SP F 1 M. S(RY 'Yq!l.f,'rw Ho F-.T TH 5 TiN
N1�y.DrG,ly'f(�'' G .lyoF
Permisslon is hereby granted to7.Lnr,�i Allk-14-e,Add. of C7U tc. A-1111 Ali 1=6Miii 6,
For the construction and maintenande of:
Subject to the following conditions:
1. The construction and maintenance of such utility shall not Interfere with the property.and rights of a prior occupant. .
2. Ail work shall be done In keeping with the standards of the City Streets:Department and under the,supervision of the City Building Official,who
will be notified at least one day prior to commencement:of construction.
3. All materials and equipment shall be subject to.inspection by the City Building Official.-
4. During construction all safety regulations of the Department of Transportation shall be observed and the City shall be relieved of all responsibility
-from damage of any nature arising from this permit. Subject to the'same terms and conditions,the permit holder may take such safety measures.
Including placing and:display of caution signs,as it may deem necessary in conduct of construction and maintenance work hereunder. It is the
responsibility of the perinittee to????..
5. All private and all City property shall be restored to its original condition as far as practical,in the opinion of the City Building Official:
-6. All underground crossing installations shall be laid of such depth as may be specified by the City Building Official.
7. The sketch covering the details of this installation shall be made a part of this permit: This permit is granted with the understanding that the
applicant has notified all-other utility users in the area covered by the permit,and takes full responsibility for any damage incurred by prior
Installations as a result of his operations in order that they may safe guard their Interests.
8. It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this
permit shall not operate to create or to-vest any property right in said holder.
9. Whenever the City decides to further exploit the.-City Rights of Way, any or.all said poles, wires, pipes, cables; or other.facIftes.and
appurtenances authorized hereunder,shall.be immediately removed from said Rights of Way,or.reset or relocated thereon as required by-the
City Building Official at the expense of the holder of this permit.
10. The holder shall.save,and keep the City harmless from any and all damages,claims,or injuries that may occur by reason of the construction,
rmaintenance,:and operation of said fadmy:
11. The holder shall complete the requested work within days.or this permit,shall.become null and void. In the event the work requested is
not completed.upon the expiration date of this per,IL the City:shall have the right to complete such work and to charge the bolder of the permit
for all costs incurred in completed said work.
12. The holder shall post'a cash or surety bond.with the City Manager In the sum of S dollars to_guarantee performance of the
obligations herein,and,to guarantee maintenance of the right-of-way described herein:for a period.of one(1)year.following completion-of the
requested installation. In the event a surety:bond is posted,the surety bond shall,be made payable to,the City.and shall obligate-the surety to
hold the City harmless In the event the holder'of this permit should fail to meet-any of its obiigallons hereunder. The bond shall also Indemnify
the City for all court costs and reasonable attorneys fees in the event legal action is required to collect on said bond.
SUBMITTED BY:
(PERMi17EE) e.=-;.G(el
Signature&Titled
Address 3/32S
REVIEWED BY:
CITY'OF ZEPHYRHILLS
utilities Supervisor Date
Public Works Date. ..tD 3 DEC
S Etc oT�S 6R/ SL'6. 7
4�
it
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Permit No. Parcel ID No/LA - 171 -()616 _ d Z OOU - 06/f
C NOTICE OF COMMENCEMENT J
State of ( I�Y��� County of (�QSC U
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement
1. Description of Property: Parcel Identification No. //", —� "/UG C d 2 U� - UG/L/'
Street Address:S/y S 1 y-th S-f-eef e // rA-j
2. General Description of Improvement h W Coll f Lt L G� I✓f /� vri/c
3. Owner Information or Lessee Information if the Lessee contracted for the Improvement:
UU-He,-l/'dd lnl-es4-1-f 4fC /:lc
3/325 /-fnl;e�/F�2 /Z� Dade Ctfy 33523 �
Address City State
Interest in Property: 6 L)0 e.�
Name of Fee Simple Titleholder:
L (If different from Owner listed above)
_
01
M m m ^' Address City State
LD ,, m m 0 4. Contractor. le.Y%
Nam'• y—A e Dade 0%f 3SS2$
0 a Address t� City State
mW 0 Contractor's Telephone No.:
01 U
Y iU 01 H Ul a2S 5. Surety:
Ca a M H N Name
Address City State
@ N N� Amount of Bond: $ Telephone No.:
W--R W 10 .
Cp N N 6. Lender: 6'n E
�.•rn m L.a Name
> 7 Address City State
0
N N N Cc U Lenders Telephone No.:
.. 0 7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
m .N -Y. N Section 713.13(1)(a)(7),Florida Statutes:
--
r m K C Z lL Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of_
to receive a copy of the Lienor's 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 construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
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 perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief.
STATE OF FLORIDA
COUNTY OF PASCO `
Signature of Owner essee,or Owner s or Lessee's Authorized
Officer/Director rtner/Manager
rf�i l Cdh-fiac-Fu�
Signatory's Title/Office Q
The foregoing instrument was acknowledged before me this day of SC 1el"Ity,;20 wby C'
as Pe of authority,e.g.,officer,trustee,attorney in fact)for
(nam �f arty on behalf 00(
m Instrumentwas executed).
Personally Known I. 4 Produced Identficafion❑ C(QUIy�l��g'tl^a/p�
Type of Identfcaton Produced ����,P ( Rn W )
MyGom 3E20215 ;L=
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pu \c\Q,'p�=
wpdata/bcs/noticecommencement_pc053048
Envelope Leakage Test Report (Blower Door Test)
Residential Prescriptive, Performance or ERI Method Cornpliance
2017 Florida Building Code, Energy Conservation, 6th Edition
Jurisdiction: c i z rZ //g Permit#: pO p$-- )026
Job Information: .
Builder:aV# r,l Community: Lot
Address: 5— ff s— /y L5
City: Z� 2-ji" .Ls:' c,`istate Florida Zip:`
— -
Air Leakage Test ttesults: Pas`singresi%Its'm`tistineeteitherthePerformance,Prescriptive,orE_RI.Method.;.
[�-PREkRIPTIVE METHOD-The bUi Idin""or dwelling unit shall bg-tested,an d:ver•(fed as having a,mair leakage,rateof not exceeding 7 air changes
per hour at a. ressUre of 0,.2-inch w: 50,'pascals)inClimete Zones 1.and.2.
e:
MIKERFO` MAACE or ER[METHOD-The bdilding ordwellihg unit shall be tested and verified as havinga'h!air leakQ6 rate oth pt exceeding the
selected NCH(50)value,8 shown on FORM R405-20J 7(Performance)or R406-2017(ERI),section labeled as Infiltration;`sub=''section ACH.
Ins =
EACH(50)specified on Form R405-2017-Ener Calc(Performance)or R406-2017(ERI):
Method for calculating building volume
X 60 �t���� _ `ii' ® Retrieved from architectural plans
CFIVI Building"Volume ACH50
' ❑ Code software calculated
Q� PASS :' TAIL77
When ACH50;is less.than.3;ACH56,;Mechanical;',Ventilatioh Field.! easured andkpalcul'at'd `t0 Field measured?and calculated
pq
a,.. „;
in stallation.:rriust lie verified"by building department.
Testing.Testlng'=siallbo etltA pressor0.2csw:g(SOPsca )'Tesingi d sha'becondueeit er
iilldividuals as defined inSection 553.993(5)or(7),Florida Statues,or Individuals licensed asset forth in Section
489.105(3)(1),(g),or(i)oran approved third party.Awritten report of the results ofthe testshall be signedfby.the party conducting the test and•,providedtothe codeofficial.
Testingshall be performed atanytimeaftercreation ofall penetrations ofthebuildingthermaienvelobe.
During testing:
1 Exterior windows and doors,fireplace and stove doors shall be closed,but notsealed,beyond the intended weather-strippingor other infiltration control measures
-2 Dampers including exhaust,intake,makeup air,back draftand flue dampers shall be closed,butnotsealed beyond intended infiltration control measures.
3.Interior doors,if installed at.the time of the test,shall beopen.
4.Exteior doors for continuous ventilation systems and heat recovery ventilators shall be closed and sealed.
5.Heating and cooling systems,if installed at the time of the test,shall be turned off.
6.Supply';and return registers,if installed at the time of the test,shall be fully open.
Testing"company
Company Name: airEnalasys= Phone: 877=437=7728
I hereby,verify that the above Air Leakage resulfs are.in accordance with the 2017 6th Edition Florida Ruilding Code Energy.;`
Conservation requirements according to the,compliance'rnetho;d.,selected,above."-- •`
Ad
Signature of Tester: ate:. - ` Date ofTest: 0; �a 02
Printed Name of Tester: William,Mago
Lice nse/Ce rtificatio n# RESNET 4309320,' '.: ,,.:...,_:,. . .,Issuing-Authority: FSEC