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Home My WebLink About21-3086City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 33542 Phone: (813) 780-0020 Fax: (813) 780-0021 BGR-003086-2021 Issue Date: 10/25/2021 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. Mill 23MOEMZEEEM 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 —Md—� Z PEfAIT omcEf V 11-4z"T kd*:4U1;4*4Rr-1=* fffl�� r is .7'Try 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department & -5-3 V Z/ Date Received I I Phone Contact for Permitting 1( A � t. � 1. �=l 1 Owner Phone Number Owner's Address C) c Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS LOT # 5a=M=Ka==7; SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONITR ADDIAIT 11 INSTALL REPAIR PROPOSED USE SFR Comm TYPE OF CONSTRUCTION BLOCK FRAME SIGN DEMOLISH OTHER STEEL DESCRIPTION OF WORK 'eLks"y/ , — -- 47 BUILDING SIZE SQFOOTAGE= HEIGHT InBUILDING 11P VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL AMP SERVICE PROGRESS ENERGY W.R.E.C. =PLUMBING =MECHANICAL VALUATION OF MECHANICAL INSTALLATION =GAS ROOFING SPECIALTY OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO BUILDER COMPANY SIGNATURE REGISTERED Y/N FEE CURREN Y/N Address License #E===== ELECTRICIAN COMPANY E SIGNATURE REGISTERED ;;;��FEE �CURREN Y Address License #E=::=== PLUMBER COMPANY E SIGNATURE REGISTERED ;;;N;�FEE C�URREN Address E========= License #E===== MECHANICAL COMPANY E SIGNATURE REGISTERED FEE CU�RREN Address License #E:===== OTHER COMPANY FEE CU�RREII SIGNATURE REGISTERED Address License #E=:=== 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, Stormwater 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. 1 as - - - - - - - - - - Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, 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 contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) 11 =i I III; I Eli III I I 1 111, 1 11111•1 1 111111 1 NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictiE}ns" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESF I ILiTIES: 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 ES U CE 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"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 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 EC D A NOTICE OF COMMENCEMENT AY RESULT IN YOUR PAYING iCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO TAI FINANCING, CONSULT ITH YOUR LENDER OR ANA ORN E Y EF CO 1 Y U TICS F CO E CE E T. 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 p Wally c vn to me or has/have produced as identification. as identification. Notary Public •�' Notary Public Commission No. Commission No. Name of otary typed,printed or sta e Name of Notary typed,printed or stamped Div rr,, CARL0S MALD0NAD0 CARL05 SAL RONADO ° Commission#GG 346275 e+r ' '' , : Commission#GG 346275 `F�a• m: Expires June 16,2423 �; a,,..:•;�: Expires June 13,2023 <iK�•4;: Banded Thru Troy Fain Insurance 800.386-7899 ?� ;;., Ronded Thru Troy Fain insurance 888.385 7819 DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS — BUILDING DEPARTME] have read and fully understand and agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the fo—Ilowing conditions: OWNER'S SIGNATURE DATE ADDRESS LhVV,2 2& PHONE z,7,5-6-2, FMasterforms/OwnersAffidavit/Nov07