HomeMy WebLinkAbout21-3195City of Zephyrhilis
5335 Eighth Street
Zephyrhills, FL 33542
BGC-003195-2021
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 11/12/2021
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.
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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
I
PEfIT OFFICEC)
THOUT APPROVED INSPECTION
FIN -A =&I oil = JI 0
r 813-780 0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021 `-
_- --
Date Received V� '
Phone Contact for Permitting
a -_i_
Owner's Name r &'LC �$ �$ C- �e�`n'� fin, iOwner Phone Number
Owner's Address? Ni,,'&Ai8, Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS s`. l Nt7 C.. -'� .�. LOT #
SUBDIVISION PARCEL ID# - " CxA 0 - ICT c t l
(OBTAINED FROM PROPERTY TAX NOT
WORK PROPOSED New coNsrR F ADDLALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFIR COMM OTHER _
TYPE OF CONSTRUCTION Cqj� BLOCK FRAME �I STEEL �]
DESCRIPTION OF WORK
BUILDING SIZE L ___._---J SO FOOTAGE = HEIGHT ---------- —
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE PROGRESS ENERGY W.R.E.C.
=PLUM1981NG � ---
=MECHANICAL VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY L
SIGNATURE ��— —� enisreaeo YIN ee cuRReN ( Yi N -----
Address License
ELECTRICIAN COMPANY
SIGNATURE REGISTERED t 1 N FE! GI IRREN Y ( N
Address �- �m I Ucenseft
PLUMBER '-- COMPANY
SIGNATURE ( REGISTERED Y (N Eer: a!RRFN
Address _ License #
MECHANICAL COMPANY
SIGNATURE Rrcis7,=..rzEo �Y!N r:=ra;Rrt-.N Y!N
Address License #
OTHER' @
l COMPANY t T� GTY
SIGNATURE y rERLD Y% N GEE caRReN Y 1 N
Address A q. � q , � - 9 License # ^ �,
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, Stonmwater Plans wl Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionstlarge 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 dale. 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.
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. LAIC upgrades over $7500)
.. Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized fetter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Retools if shingles Sewers Service Upgrades A/C Fences (Plot/Survoy/Footage)
Driveways -Not over Counter if on public roadways.. needs ROW
813-780-0020 City of Zephyrhills Permit Application Fax-813-789-0021
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 oontractor(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 cower 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 "ownef" 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 constriction, 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, WatenWastewater 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
FLORIDA JURAT (FS. 117.03)
t
OWNER OR AGENT CONTRACTOR'
Subscribed and sworn to (or affirmed) before me this S bscrib and sworn to,{ r affirmed) before e thi
ho is(are personally known to me or has/have produced Jh it WAby
Wo xlare ersonall known to me or has/have produced
as identification. _ s ._as identification.
)< G NYk UPHA JAGI.At
-------__----- ------Notary Public --- NNotary Public State of Florida
Commission No. Commission No. ;' Commission # GG 961470
--- t _ — My Comm. Expires Feb 24, 2024
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Name of Notary typed, printed or stamped Name ff Not, y typed, printed or s mpe — -
Roof Affidavit
Roofing Inspection Affid",Ivit
Cit,-, (Azephly rsills
5335 8th Street, Zeph�,,rhills, FL, 33542
Permit 'Number
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Name
Phone: 813-780-0020
I an; licensed under Chapter 468, 1, fo`id a 'Sto lutc," as abw
Building Insp Architect actor VContractor Engineer
License Numbef-
Pmomd Inspection V A pc�-simalll inspeded the:
M11-n/cId/yyyy v
D ry in < le shir q and Drip _eRoof Deck Nailing
Edge
Clack I�hich e�as a eat.
30 Pound Felt eel and Stick Other
If'other., please explain:
Address of Roor Inspection
rV\\ws
Based upon that examination, I have deternnined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on Section 553,844, Florida Statutes),
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swonl t(& subsefilled BsAnwe I his
DaN i'll \ I z-
rnni/ddiyyyy
Nofkavy 11uh1ic S�atv M'Fhwids
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NYLUPHA JAGLAL
Notary Public , State of Florida
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961470 omm
C ission # GG
Comm. Expires Feb 24, 2024
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