HomeMy WebLinkAbout20-967 F'LYlflti)N City Of ZephyrhillS PERMII'`NUmB'EI2'
5335 Eighth Street try
Zephyrhills, FL33542 BNR-000967-2020
Phone: (813)780-0020 Issue Date: 11/13/2020
Fax: (813)780-0021
Permit Type: Building New (Residential)
�• _y,
111v:Property Number. : rStreetAdd�ess , ., -
26 25 210140 00300 0500 8095 Wheat Stone Drive
F-}� � fi �.� r, ,
tOwnertlnformatton Perinrt Information Contractor Information .
Name: D R HORTON Permit Type:Building New(Residential) Contractor: D R HORTON INC
Class of Work:SFR Construct
Address: 12602 Telecom Dr Building Valuation:$106,000.00
TAMPA,FL 33637 Electrical Valuation:$7,000.00
Phone: (813)549-1968 Mechanical Valuation:$4,500.00 \ n
Plumbing Valuation:$7,200.00
Total Valuation:$124,700.00
Total Fees:$18,376.00 (�1
Amount Paid:$18,376.00
Date Paid:11/13/2020 1:29:47PM
?�o�ectDescrFptton
CONSTRUCT SINGLE FAMILY 2,738 SQ FT-ZEPHYR LAKES
- '"°. P3 {,
Applicationkfees .. �h
3/4 Water Meter Fee(Calc) $473.78 School Impact Fee $8,328.00
Mechanical Permit Fee $62.50 Transportation Impact Fee-City $36.32
Building Plan Review Fee $280.00 Water Connection Residential Fee $1,010.00
Electrical Plan Review Fee $37.50 Mechanical Plan Review Fee $31.25
Public Safety Impact Fee-Admin $26.35 Park Impact Fee-Single Family/Townhome $769.56
Building Permit Fee $560.00 SIF 1 percent Fee $83.28
Plumbing Plan Review Fee $38.00 Public Safety Impact Fee-Police $254.00
Irrigation 314 Meter(Calc) $473.78 Driveway Fee $45.00
Address Fee $30.00 Electrical Permit Fee $75.00
Transportation Impact Fee $3,595.68 Sewer Connection Residential Fee $2,090.00
Plumbing Permit Fee $76.00
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.
(D a j6:W*-"t*z,
CONTRACTOR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
� PASCO COUNTY, FLORIDA
h K
tAY
1 _ PermitNo.
Date Permitted _ 41)— —A ob;
'Builder Name/Owner Name _ Control#' '
County Parcel No. _ 2-� t (} 4006W SubDiv: r'Y
Address/Location
Classiflcation/Type of Usq
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit:
Exempt n Yes [] No How Determined
Impact Fee Amount_ . Jr �P - Zone No. TAZ:
SCHOOL IMPACT FEE
Account (05S) Sitigla-Family Qetached House Amount
(057) Mobite Home
(008) Oth®r Residential
123)- Collection Fee
` Exempt [ Yes.,Q'No How Determined
PARKS'ANMRECREATION FEE-
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zane TOTALAMOUNT
'Exempt ❑Yes ❑'No How Deteirmined O
UBRAM FEE
Land Account Land Credit Land Total
FacllltyAccount Facility Credit facility Total
Exempt C]Yes 0 No How Determined Total Amount _
RESOURCE FEE ERU
TOTAL AMOUNT
Prepared By U Checke&By
NO CERTIFICATE,OF OCCUPANCY WILL BE;ItSUED,OR.Flk&L INSPECTION
PERtwt3# IIIj b,NTIL IE:TOTAL AMCuNTS,LISTED.HAVE
`
• BE�IY.PAID:AND.'
RECEIPTED FOR-BY A CENTRAL`PERM17TtN®OFFICE OF PASGO GQtlNTY
Ackr(owlsdgeMi tM below'do40fMWt Unpty acceptance of cortcutrence+but stmPiY+ Pt pay copy af.tltls fame,placing
the tiui2dtng permit`owvne on nott cf thGa essesament and Nie cbr►d8ions of payiment for some.
DATE RECEIVED BY
RECEIPT NO. DATE BY
D
Q
t
ing eF aml y we ing
Plan Review Comments'
1. "F;RE;.shall be a minimum of 8"above the road elevation-and an engineered site plan.
2: Lots shall be graded to.comply-with R401.3.of the F.B.C.
3: Compaction.test required if 24"or more of fill.dirt is brought in at any.one.place.
4: Tie in survey required before pouring concrete. .
5. Driveways require a R.ON. use permit: .All 4 sides of drivewaythru the sidewalk shall have
"expansion material..
.6: All setbacks shall be met.
7: All:property markers shall be uncovered.and marked at time of first inspection. .
8: All AD.A.requirements shall be met:
9: No electric,plumbing;mechanical;or framing shall be covered without an'inspection.and .
approval"first:
10::All Garages shall comply with section R3016 of the F.B.-C. (Fire Separation):
1.L Appliances.shall.not be installed-in a location where subject to mechanical damage unless
protected.by approved barriers. M303:4 of the F.B.-C.
12. water heaters shall comply with section P607.3 of the F:B:C:
13. Foundation supports for A/C units;shall.be'raised at least 3" above finished grade. M1308.1;
14. Return air in all bedrooms. F.B:C. M1620:4
15. Smoke.detectors.are to be installed in accordance with R313.1 of.the F.B.C.
16:All glazing requirements are to bean:accordance.with R368.4 of the F.B:C:
17..All means.of egress are.to be in accordance with R311 of the F.B.C..'
18. ``Green=gypsum board""shall riot be used as a baeker'in showers or"tubs:'R702-4.2 F.B.C.
10: Combination-type AFCI.breakers are required at all.loedtions requiring an AFCI type breaker.- .
20. Carbon nionokide alarms will be required in new construction that.uses fossil-burning heating
or appliances or an attached-garage. -They shall be'installed in-accordance with the F.B.C:
21. All plumbing,mechanical; and electrical shall be separate from unit.to unit: This includes all
underground:plumbing and electric.
22: All 2016 ME.C.'Codes will be enforced:
23. Tamper- Resistant Receptacles in accordance with 406.11-of the 2016 N.E.-C
24. In accordance with the Land Development Code, lots shall be-sodded before final at least 10.
feet around the structure.'
25: R403.5.3Hot water.pipe insulation.
Insulation for hot water pipe with'a minimum thermal resistance (R-value) of R-3 shall be applied to the
following:.. . -
Piping V, inch (1.9.1 mm)and larger in:nominal diameter.
Piping;serving more than.one dwelling unit.
Piping located outside the conditioned space;.
Piping from the water heater to a distribution manifold:,
Piping located under.a floor slab. .
Buried in piping,
Supply and:return piping in recirculation'systems other than demand recirculation systems.
25:B)lower door test shall be provided'before C.O.
26.A copy of the energy cacls shall be:with permit at all times
27.Copy of fnal.Ynsulation�report shall be provided ivith permit before linaL
28..No fence, pool or screen enclosure :is issued with ahis permit'
F.F.E.-Finished Floor Elevation
F.B.C-Florida Building Code 6t'Edition
R.O.W.-Right of Way
A.D.A.=.Americans with Disabilities Act: N.E.C.-National Electric Code(2016)
-- '- -� uity ot Zephyrh\l\sPermit Application Fax-813-780-0021
Building DepartmentDate Received
. . .
Phone Contact for Permitting
Owner's Name nc- Owner
Phone Number
Owner's Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS
SuaoPvm/om F 'Oct V
WORK PROPOSED wewcumsrn ADD/8LT [---1 S|GN F--) F--| DEMOLISH
ff INSTALL E REPAIR
PROPOSED USE �—� eFR F--\ COMM �--1 OTHER
TYPE DFCONSTRUCTION F--]- BLOCK [—� FRAME F--� STEEL
BUILDING SIZE °^^,""`°"=
=BUILDING I' 1c)( VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL 1$ Cr AMP SERVICE PROGRESS ENERGY W.R.E.'C.
---
F--|G/VS L�� ROOFING [--\ � SpECI8L3Y F--� OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY
a|sm^zURE REGISTERED LY/ N FEE:u«RE^ LYIN �
Address uoonse#
ELECTRICIAN compAmr
SIGNATURE nsG/eTEneo 1\17 reccuRne^ L_lINL I
Address License#
PLUMBER COMPANY
SIGNATURE nsG/arsmsu LY/_N_J Fsscsnnsx L_l/_N_�
Address Uoenne#
MECHANICAL coMpmvr
SIGNATURE no/arsn�o ' L_2�_� �_ �esuun�cxv
s L_Yl NL� .
Address License#
OTHER compAm,
SIGNATURE neo/srsnso LLN_J reEcunnEN L_Y/NL1
I cc
Address pm�—&PlPn Licenon#x n x u x x n x x m m x u n m m x u u x m u x x x m m x x u x m n x u o
RESIDENTIAL Attach(2)Plot Plans;QV sets nf Building Plam�(1)set of Energy Forms;R-O4m Permit for new construction,
Minimum ten(1V)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 /�ach(2)complete o�sof Building Plans plus aU � �
fe� � PaQe;(1)soiufEnorgyF���.R,O4wPannitforne*omnsunctinn.
Minimum ten(1O)working days after submittal date. Required onsita.Construction Plans,Stonnxmter Plans u/Silt Fence insbd\ed.
Sanitary Facilities&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach;4 sets of Engineered P|ans.
°°°°PROPEFTY SURVEY required for all NEW construction. '
Fill out app\icatinncompletely. ^
Owner&Contractor sign back of application,notarized
If over$2so0,p Notice pf Commencement isrequired. (VC upgrades over*75UV)
� Agent(for the contractor)or Power of Attorne�(for the owner)would be someone with notarized letterfrom owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Remofsifshingles Sewers Service Upgrades A/C Fancem(PlnV8umey/Footaga)
Driveways-Not over Counter ifon public madvaya..naedsROW
.
'
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.Iicensed 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/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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT F.S.117.03
I �
I i
OWNER OR AGENTS CONTRACTOR
Subscribed and sworn to(or affilgi ed)bqfore me this Subscribed and sworn to(or affirmed)before me this
by�ahrip beiI xhgi^X� by
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. as identification.
Y 2_ 2��NotaryPu
I I blic Notary Public
Commission No. Commission No.
I I
Name of Notar t ped rinted or sta ped Name of Notary typed,printed or stamped
5 o001 Pia, Notary Public State of Florida t�
; ° Sarah Katharine Pekarik
i cl o` My Commission GG 023395 y
>nd .Expires 08/22/2020 ;
813-780-0020 City of Zephyrhilis Permit Application Fax a13-Sao-002'
: Building Department
Date Received. Phone Contact for Permitting
Ownees.N'ame Owner Phone Number
-Owner's Address Owner Phone Number
Owner Phone Number.
JOB ADDRESS' -.LOT#
SUBDIVISION {�j�- — �A3' (�i��r�Li" PARggL ID#
(OB.TAINED:FROM.Pil(DP,EP-TrY TAX.I40TIC6).
WORK PROPOSED e NEW CONSTR' ADD/ALT �� SIGN [� 0 ";DEMOLISH'INSTALL: 8 REPAiR
PROPOSED USE, Q SFR Q COMM OTHER
TYRE OF CONSTRUCTION = BLOCK 0 FRAME [�� STEEL [�
DESCRIPTION Of..WORK
BUILDING SIZE E ISQ'.FOOT. AGB.= .HEIGHT
j =BUILDING $ VALUATION OF'TOTAL CONSTRUCTION,
i
QEL'ECTRICAL $ AMP'SERVICE DUKEENERGY' Q W.R.E.C.
=PLUMBING
=MECHANICAL -� VALUATION OF MECHANICAL INSTALLATION
=GAS Q ROOFING 0. SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS f FLOMZONE"AREA =YES . NO
BUILDER COMPANY
SIGNATURE ' REGISTERED Y/ N FEE CURREN
Address License#
ELECTRICIAN- COMPANY
SIGNATURE REGISTERED' Y/ N FEE CURREN
Address , License# . j
PLUMBER COMPANY
SIGNATURE -REGISTERED. Y%:N' FEE CURREN
Address License.# .7
MECHANICAL ;' 'COMPANY
SIGNATURE' REGISTERED Y/ N FEE CURREN Y/N. '
Address 4icense4j.,
OTHER COMPANY
SIGNATURE REGISTERED Y7,•N,..., ;•. FEE,CIuR`REN: ..
-Address
`+ .: -. -
RESIDENTIAL Attach'{2}=Plot Plaris;.(2`sets of`Builtlip 'i?latls:,.1).s'et.ofErierg Forrrls;'R Q 1N'Pemjst far new=C•.,nstruction,,
�.
,Mirifinum ten;(!°0)-wonting Clays-affei}'subrrtiktal-date:,"P,46fied onsite;C nsCffuction Plans,St$rmwater Puns w/$ft Fence installed,
Sanitary:Facilitles&4 dumpsWrt,,Slte Wol'k.Permit�fbr•subdivi'sions/latge•prtijects"
COMMERCIAL Attach(2).compfete,sets•gf.,Buildipg-Plans;plus•agl:Ife-afety,pagef(Ilys.et•of!Energy.Fo?ms.R-OrW Permit fdr..•new cohstruction.
Minimum ten(10);working3day ,aftar>subpiittat.date..R qu,re„d.,tpnslte;Construction,P)an%-,§.jormwater,Plan s•w/Silt'Fence,•instalied,
Sanitary Fadilitles&1 dumpafec.Slfe`(IUork PerWffor al('new projects.All.commercial.requirements must meet compliance
SIGN PERMIT Attach(2):sets of Engfneered'Pianv.
****PROA#-RTY SJW VEY•'requfred for air NEW cblistruction.
Directions:
Fill out application completely.
Owner&:Contractor sign.back of=;vpiication,notarized
If over,a25t10,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 con, required)
Reroofs 4 shingies Sewers Service Upgrades AIC Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
I ,
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 talthe.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 toy 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 71.3,.Florida Statutes; as amended): If valuation of work is$2,5.00.00 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•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'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;'zonin•g 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"la'nd 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, Dooks, Navigable Waterways:
Department of .Health &.:Rehabilitative Services/EnXironmentall 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 offill:
Use of fill-is not-allowed in Flood Zone j`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. l
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 usetl 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 1 nderstand.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 fora 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'YOURPROPERTY.. IF•YOU`_INT91ND TO'OBTAIN FINANCING,CONSULT
WITH-YOUR..LENDER.OR AN ATTORNEY'BEFORE RECORDIN:G.YOUR'NO7'rICE•OF-COMMENYCEMENT.
FLORIDA JURAT-(F.S.117.03) !
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or•affirmed)before me this Subscribed and sworn toy(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 produced
as identification. as identification.
• I.
a
Notary Public Notary Public
Commission No. Commission No.
I
I
Name of Notary typed,printed or stamped Name of Notary typed,pi inted or stamped
I