HomeMy WebLinkAbout20-1067 � . 1
i
City of Zephyrhills PERMIT NUMBER
t 5335 Eighth Street
Zephyrhills, FL 33542 BNR-001067-2020
p' Phone: (813)780-0020
j' Issue Date: 01/07/2021
Fax: (813)780-0021
Permit Type: Building New (Residential)
Property Number Street Address
35 25 21 0150 01500 0200 7851 Broad Pointe Dr
Owner Information Permit 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:$105,000.00
TAMPA,FL 33637 Electrical Valuation:$7,000.00
Phone: (813)549-1968 Mechanical Valuation:$5,000.00 ,n
Plumbing Valuation:$7,500.00 // l f
Total Valuation:$124,500.00
Total Fees:$18,374.50
Amount Paid:$18,374.50 (�
Date Paid:1/7/2021 2:05:26PM
Project Description
CONSTRUCT SINGLE FAMILY 2,362 SQ FT-ZEPHYR LAKES
Application Fees
Water Connection Residential Fee $1,010.00 Sewer Connection Residential Fee $2,090.00
School Impact Fee $8,328.00 Transportation Impact Fee $3,595.68
Building Plan Review Fee $277.50 SIF 1 percent Fee $83.28
Mechanical Permit Fee $65.00 Electrical Permit Fee $75.00
Electrical Plan Review Fee $37.50 Irrigation 3/4 Meter(Calc) $473.78
Mechanical Plan Review Fee $32.50 Plumbing Plan Review Fee $38.75
Address Fee $30.00 Building Permit Fee $555.00
Park Impact Fee-Single Family/Townhome $769.56 Public Safety Impact Fee-Police $254.00
Plumbing Permit Fee $77.50 Driveway Fee $45.00
3/4 Water Meter Fee(Calc) $473.78 Public Safety Impact Fee-Admin $26.35
Transportation Impact Fee-City $36.32
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
r
PA8CQ COUNTY,fLORIDA
E Permit No. „'(
Date Permitted mod-�
Builder Name/Owner Name Control#' "
County Parcel No. -S 5 Z6 2 l ()/,SD 0 I,0()OZe)0SubDly:
Address/Locatlon 765 r-go-aP 1"o�Yk-3r
Classlftcationl ype of Usq
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: 2
Exempt ❑Yes Q No How Detemdried
Impact Fee Amount $. 37 (.32- Zone No. TAZ:
SCHOOL IMPACT.FEE
Account (056) SinglgTFamily Detached House Amount $
(057) M6119-Home
} (058) Other Residential
1 3). Coilectton Fee
Exempt [�Yes..(Q Wo How Determined
PARKS AND;RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total {
Zone s TOTAL AMOUNT $ 761�
•Exempt Q Yes ❑No How Determined�
LIBRAR, FEE
Land Account Land-Credit Land Total
Facility Account Facility Credit Facility Total
Exempt ❑Yes (Q-No How Determined Total Amount
RESOURCE:FEE ERU
TOTAL AMOUNT
Prepared By ` Checked By
NO CERTIFICATE OF OCCUPANCY;WILL BE ISSUED OR FINAL INSPECTION
PERFORMED uNTIL THE TOTAL AMOt#NTS LISTED HAVE
BEEN PAID-AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE.OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence,but simply reoelpt of•a copy of We form,placing
the building perimitcwner on notice of tole easessment and tha conditions of payment for same.
DATE RECEIVED BY 77
RECEIPT NO. DATE BY
v'
D
A
S
Single Family Dwelling
Plan Review Comments
1. F.F.E. 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:
51. Driveways require.a R.O.W. use permit. All 4 sides of driveway thru the sidewalk=shall have
expansion material.
6. All setbacks shall be met.
T All property markers shall be uncovered and marked at time of first inspection.
8: All A.D.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 R302.6 of the F.B.-C. (Fire Separation},
1-1. Appliances shall not'be installed in a location where subject to mechanical:damage unless
protected by approved barriers. M303:4 of the F.B.0
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. M 1308:1. .
14. Returh air in all bedrooms. F.B.-C. M1620:4
1.5. Smoke detectors are to be installed in accordance with R313:1 of the F.B.C.
16. All glazing requirern6tits are to be'in-accordance'4ith R308.4 of the F. :C:
17. All means of egress are to be in accordance:with R311 of the RB.C.
18. "Green gypsum board" shall not be used as a backerin showers or tubs. R702:4.2 F.B.C.
19. Combination-type AFCI breakers are required at all locations requiring an AFCI type breaker.
..
20. Carbon monoxide alarms will'be required in new construction that-uses fossil-butmng 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 N:E.C. Codes will be enforced:
21 Tamper- Resistant Receptacles in accordance with 406.41 of the 2016 N.E.0
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.3/: inch (19.1 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 slat;.
Buried in piping,
'Supply and return piping in recirculation systems other than demand recirculation systems.
25. Blower door test shall be provided before CO:
26.A copy ofthe enerEy cacls shall be with permit at all times
27. Copy of final insulation report shall be provided with permit before finab
28.No fence,Pool or screen enclosure :is issued with:this permit
F.F.E.-Finished Floor Elevation
F.B.C- Florida Building Code Oh Edition
R.O.W.-Right of Way
A.D.A.-Americans with Disabilities Act N.E.C.-National Electric Code (2016)
--- uity otZephY[h\Ug Permit Application Fax-813-780-0021
Building Department
D�e' eceived hone Contact for Permitting
Owner'sName Ila. n c- 1 ' ' OwnerPho'ne Numbe'r
Owner's Address
pa Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS
FoUoowoSu»N xz#
(OBTAINED IiROM PROPERTY TAX NOTICE)
WORK PROPOSED mowcomsTn AoDA\LT F--� S|GN �—� �—1 DEMOLISH
Ef INSTALL F_] REPAIR
PROPOSED USE F--� opR F—� COMM [---� OTHER
TYPE nFCONSTRUCTION F—��' BLOCK �—1 FRAME F---1 GTEELBUILDING SIZE SQ FOOTAGE HEIGHT
DESCRIPTION OF WORK
'
�__]BU|LD|NG VALUATION OF TOTAL CONSTRUCTION
F--lELE[TR|[AL AMP SERVICE [--1 PRDGRESSENEREY �--1 vV.R.E.C.
F--7PLUMB|NG
� ^�
=MECHANlCAL MECHANICAL INSTALLATION ~
=GAG ROOFING F—� � SPECIALTY [---1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA
i__�YE8 NO
au|LoEm COMPANY
a|GN�U�� REGISTERED I' rescunnsx N1
Address License#
Eaco,�9 c�' 2
ELECTRICIAN COMPANY
SIGNATURE nsa/aTEnso Nr_]` FsEcunns^ ylN�_1
Address #
PLUMBER COMPANY
SIGNATURE neo/orsnso 'FsstunxEN
Address Uconao#
MECHANICAL COMPANY
SIGNATURE nea/nrERso FtsounnEN`J
Address
OTHER COMPANY
SIGNATURE
nsm/enseso �lY_m_� rcsoumnEx
I cc
Address License#
RESIDENTIAL Attach(8 Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, �
Minimum ten(1u)»mrking days after submittal date. Required nnsiha.Construction P|an�,Stann*ate,Plans vl Silt Fence installed,
Sanitary Facilities&1 dumputer;Site Work Permit for subdivisions/large projects _�
COMMERCIAL At�ch(2)complete a�nnfBuUding Plans plus a��So��pago��)set ofEne�yFv6�u.R,O-WParmit for new construction.
Minimum ten(1O)working days after submittal date. Required nno\to.Construction Plans,Bhormwater Plans vl§i\t Fence installed,
Sanitary Faci|itios&1 dumpster.Site Work Permitfor all new projects.All commercial requirbment5 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$26nV.n Notice of Commencement|*required. (AIc upgrades over*T5VO) .
� Agent(for the contractor)or Power of Attorne�(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Rmnofsifshingles Sewers Service Upgrades AIC Fencem(P|ottGumey/Fontage)
�
Driveways-Not over Counter ifon public mndways..neodnROW '
!
NOTICE C)FDEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" '
which may bo more restrictive
*than County regulations, The undersigned assumes responsibilityfor compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors tounde�okevvorK. they nnaybe required tobe licensed in accordance with state and local regulations. If the
contractor |� not licensed as.required by |mvv, both the owner and contractor may be cited for o 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 [hb contractor(s) a\gD
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contnactor, that may be on indication that he is not propor\y]icenoed and is not entitled to permitting privileges in Pasco
County. /
TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES': The undersigned understands
that Transportation |nnpentFees and Recourse Recovery Fees nnayapply to the conetructionof new buildings, change of
use in existing bui|dings, or expansion of existing buUdinge, as specified in Pasco County Ordinance number 88-07 and
90-07. as amended. The undersigned also underatando, that such faao, 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 isauance. Furthermore, if Pasco CountyVVaterlSexwer 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, aeummonded\: )f valuation of work|e$2'GDO.O0or more, )
certify that |, 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|tto the"ovvner' prior tocommencement,
CONTFACTOWS/QW0ERyS /\FF|[JAV[T: I certify that ail the information in this application is accurate and that all work
will be done in compliance with all applicable |avvo regulating nonotruotion, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. \ certify that no work or installation has
oonlrnenomd prior to issuance of a permit and that all work will be performed to meet standards of all |avvo regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. | also
certify that | understand that the regulations of other government agencies may apply to the intended work, 'nd that it is
nny responsibility to identify vvhatactions l must take tobeincompliance. Such agencies include but are not||m|tedto:
- Department ofEnvironmental Protection-Cypress Bayhoade. YVetand Areas and Environmentally Sensitive
Lands,VVatec8WmetevvaterT[eatmeDt.
- Southwest Florida Water Management Diabiot-WeUa, Cypress Bayheada` VVeti-and Areas, Altering
Watercourses, '
- Army Corps ofEOgineoro'8uaVvo||G, Docks, Navigable Waterways.
- Deportment of Health & Rehabilitative Services/Environmental Health UnU-Wa||o, Wastewater Treatment,
Septic Tanks.
- U8 Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authodty-RuOvvoyo.
| understand that the following restrictions apply to the use offill: '
- Use of fill ianot allowed |n Flood Zone W'unless expressly permitted.
- If the fill material is to be used in Flood Zone 'YY', 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 "/Y' in coDDeuduD with o permitted building using stem vvaU
construction, | certify that fill will beused only to fill the area within the stem wall.
- If fill material is to be used in any area, | 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 |aaa than one /1\
acre which are elevated by fill, an engineered drainage plan iarequired.
/f| 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 commencing construction. | understand that o separate permit may be required for electrical vvork,
plumbing, signo, vveUs, pools, air cond\tioning, gea' or other installations not specifically included in the application. A
permit issued shall be conotruedtobaa ||censetoproceedvviththevvorkandnotooauthoritytovio|ate. canoe|. a|ter, 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 vvithiD'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 vv[it|Dg' from the Building [}ffida| for a period not to exceed ninety /00\ days and will demonstrate
justifiable oausa for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned.
.
WARNING TO OWNER: YOUR FAILURE TO RECORD /\ 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.
- - A U ----' -
p�om/o -- ----
OWNER om AGENT_ CONTRACTOR
Subscribed a6d sworn to(or affir ed)bqfore, me this Subscribed and sworn to(or affirmed),
before me this
Who islare personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. as identification.
Notary Public NotaryPub|ic
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
pumieSta e O ,~°.~.
813-780-0020 City Of Zephyrhilis Permit Application Fax 813-Teo-oo
Building Department
Date Received
z .Phone Contact for Permittin
Owner's.N'ame Owner Phone Number
..owner's Address Owner Phone Number
Owner Phone Number.
e
JOB ADDRESS' -•LOT# '
k SUBDIVISION - GtY"i )tr � PARCEL iD#
(OBTAINEDEROM<RROP.ERTY rAX,NQTICE)•:
-WORK PROPOSED NEW-CONST11 ADD/ALT SIGN -,DEMOLISH'
e INSTALL 8 REPAIR
PROPOSED USE. SFR Q COMM OTHER
TYPE OF CONSTRUCTION 0 BLOCK = FRAME STEEL Q
DES.CRiPTION OR WORK
BUILDING SIZE SQ-FOOTAGE: HEIGHT — .•
iiiiiii
l =BUILDING VALUATION OF'TOTAL CONSTRUCTION•
! =.EL'ECTRICAL $ AMP'SERVICE DUKE ENERGY' 0 W.R.E.C.
=MECHANICAL VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD"Z(7NE'AREA =YES . NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y•/N
Address License# F_—`
ELECTRICIAN' COMPANY
SIGNATURE .REGISTERED' • 'Y/':N FEE CORREN
Address . License#
PLUMBER ;° _ ~^ COMPANY
SIGNATURE •REGISTERED• '' Y7:N FEE'CURREI+
Address License.# I' '
MEGHANI.CAL . ;' .-COMPANY
,.
SIGNATURE' REGISTERED Y/ N FEE CURREA
• r
Address LioeRser#f
OTHER COMPANY
SIGNATURE REGISTERED 'Y/,N,,,.,. ,.. FEE CURREt`• .. Y.V N.,.-
-Address License`#
RESIDENTIAL Attact{-(2}=Plot P.1'fins;.(2)`sets o•,f Bui� irlg:Ptens;..(1).s'et of'E►iegyrForms;'RO=Vi!Permit for nowconstruotioo,,
Qinimdm-.ten;(�10)t days rking:' :afkel•'stih- rffii elate.r RegUlred onsite;`Go`ns r'Uctloh Plans,8form'7rafer Pions l Siit Fence insfailed,
Sanitary:Facilities$-14dumpster'.,Slte Work.Permit*for,s.Ubdivi'sions/iarge'prdjects'
COMMERCIAL Attach(2,).00mpiete,sets-gf,,Building•Plans plus•'apLifer$afgty.Page,(1.)'.set'of=Energy.Forms,R-O-W Permit formew construction.
Minimum ten(10)�wgrkingvdays�lafEQr subrn(ttal.date.,F,iegUYred,onsite;Construction,Rian%,;Stormwater,Plans w!Sllt'Fence installed,
Sanitary Facilities&1 dunipsfer.Slte 7iVork'Permit for ail'new projects.All'oommercial.requirements must meet compliance
SIGN PERMIT Attach(,2),sets.ofRngineered;'Plans:
""'"PROPERTY$,U'1VEY.'requlred for all'NEW construction.
Directions;
Fill out application completely.
OwnerA-.Contractor sign,back of,,gplication,notarized
'If over$250t7,a Notice bf'Commencement is required. (A/C upgrades.over$7500)
*` Agent(for the contractor.)or.Power,of•Attorney(for•the owner).wouid be som eon e:with notarized-letter from-owner authorizing same
OVER THE.COUNTER,<PE,RMIW. ING • (cgpy;'of•contrabt.required)
Reroofs if sliingies Sewers Service Upgrades-A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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,1f Pasco County Water/Sewer Impact
fees are due, they-must be paid prior to.permitissuance in accordance with applicable.Pasco County-ordinances.
CONSTRUCTION-LIEN LAW(Chapter 7.1.3.,-Florida Statutes-, as amended): If valuation of work is $2,.5.00.00 or more,.I
certify that 1, the applicant, have been•provided with a-copy of the "Florida'Construction-Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture-and:Consumer Affairs. If-the•applican.t 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/OWN:ER'S`AFFIDAVIT: l'.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'fan'd 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.toke 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, Wetiand Areas; Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Department of :Health &,,:Reha'bilitative Services/Environmental Health Unit=Wells, Wastewater Treatment,
Septic Tanks.
US.Environmental lProtectiontAgency-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"uiiless-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:whioh is prepared by.a professional engineer
licensed by the State of Florida.
- If the fill material is to be used Jn 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-ANTtND TO' TAIN FINANCING,'CONSULT
WITHYOUR.LEN.DER.OR AN ATTORNEY BEFORE RECO:RDIN:G.YOUR.RIO.hCE.OF-COMIV1ENCEMENT.
FLORIDA JURAT'(F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and sworn to(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.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
:N
| LIVING AREA = 1,828 SQ. FT.