HomeMy WebLinkAbout21-3392 (2)City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542 ELCMISC-003392-2021
Phone: (813) 780-0020 Issue Date:
Fax: (813) 780-0021
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.
!I 11111RIMPI I I Plifl7i 1111 11 11 1 Jill
23131��Mi
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
PEfIT OFFICEC)
ITHOUT APPROVED INSPECTION
1. 11 * ffiffiN11,11, li;�-i
wil'
813-780-0020 City of Zephyrhills Permit Application iql 3 3 (, ), Fax-813-780-0021
Building Department
Date Received I I Phone Contact for Permittin-q W13 ) 2_3 f
Fee Simple Titleholder Address
JOB ADDRESS
Ue>6
IY141fl
ze- Id 14
&
LOT #
SUBDIVISION
PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED
NEW CONSTR
ADD/ALT
SIGN
DEMOLISH
INSTALL
REPAIR
PROPOSED USE
SFR
COMM
OTHER
TYPE OF CONSTRUCTION
BLOCK
FRAME
STEEL
DESCRIPTION OF WORK
X11
BUILDING SIZE
SO FOOTAGE
HEIGHT
==
=BUILDING
VALUATION OF TOTAL CONSTRUCTION
E:ELECTRICAL AMP SERVICE PROGRESS ENERGY W.R.E.C.
=PLUMBING rz ---------------- I
1,P I
=MECHANICAL I VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA =YES NO
BUILDER
F
COMPANY
SIGNATURE
REGISTERED
Address
ELECTRICIAN
COMPANY
SIGNATURE'
REGISTERED
Address
e). AM
PLUMBER
COMPANY
SIGNATURE
REGISTERED
Address
MECHANICAL
COMPANY
SIGNATURE
REGISTERED
Address
OTHER
COMPANY
SIGNATURE
REGISTERED
[Y/ N
FEE CU'RREN
License #
YIN
FEE CURREr,
License #k
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_=H�_�
FEE C U—RR—EN Y
License:==
��FEE
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License
FEE CURREN Y/N
License #
1111111111311111111111111111
RESIDEATIAL 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/ Slit Fence installed,
Sanitary Facilities & 1 dumpster: Site Work Permit for subdivisions/large 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.
4
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 of Attomey (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)
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 CONT CT ESPO S I ILITIE : 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 uncectain 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, 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/OWNERS 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 C O R NOTICE OF COMMENCEMENT Y RESULT IN YOUR
PAYING IC FOR IMPROVEMENTS TOYOUR PROPERTY. IF YOU INTEND TO OBTAIN TAIN FINANCING, CONSULT
I H Y U LE DE N ATT NEY EF EC I Y UN TICS OF COM ENCEMT,
FLORIDA JURAT(F.S. 117.03}
OWNER OR AGENT CONTRACTOR � � }
Subscribed and sworn to(or affirmed)before me this Subscribed an sworn to(or affirmed)before me this
by by
Who is/are personally known to me or has/have produced Who is/are per, n liy k no me or has/have produced
as identification. C. r as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary yped,printed or stamped
;f Y Y„t . CA=MALDONR0
Co46275Exp239onnsuraance 800385`019
813-780-0020 City of Zephyrhills Permit Applicatio Fax-813-780-0021
Building Department
r------- - a
Date Received Phone Contact for Permitting
Owner's Name Owner Phone Number
Owner's Address Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS F!�sv& jgert ... 9f Z— LOT #
SUBDIVISION PARCELID#1 0)'/6) 1
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH
PROPOSED USE
M=
INSTALL
REPAIR
SFR
In
Comm
BLOCK
FRAME
F 2 .
I SCE FOOTAGE
=MECHANICAL r& -------------------- I
GAS ROOFING
FINISHED FLOOR ELEVATIONS
HEIGHTF /Y
AMP SERVICE PROGRESS ENERGY W.R.E,C.
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY OTHER
C"
FLOOD ZONE AREA =YES
BUILDER COMPANY
SIGNATURE REGISTERED —N FEE CURREN
-'#F jzx - -cor Address Lif - License..._ I - q -7 Z-
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN
Address E19=15L ET=Z 5EVE License#
PLUMBER COMPANY
SIGNATURE REGISTERED =/N FEE CURREN
Address I License #
MECHANICAL COMPANY
--T-----T—F--E---
SIGNATURE REGISTERED Y/NECURREN
Address License #
OTHER COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN ==N
Address 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, Stormwater Plans wl Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large 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. Ali 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. (AIC 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)
333MEMSEEMOM
NOTICE F 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 RESPO 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 OU 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 TOOWNER: YOUR FAILURE TO EC A NOTICE OF COMMENCEMENT Y RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND TO TAi FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR TICS OF COMMENCEMENT.
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
INSTR#2021253338 OR BK10491 PG3350 Page 1 of i
SIH 11124/2021 10:14 AM Rcpt: 2382457 Rec: 10.00 DS- 000 IT: 0.00
Nikki Alvarez-Sowles, Esq., Pasco County Clerk & Comptroller
Ptimd No,
! - �10 I � � =M
StXc, tA --Elorida Counly 01
UWERSX:;NED t"dw, notaae dvil iaqwwLowv4 vA be fm-Xb- to certain real psopecty, and in accordance Veth c2optor 713, Fb6da StabAm
in thi.;
11-26-21-NlG-14200-0140
st 55M 18th-St ZephvyhiHs, R 33542
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COUNTY Of PASCO
Sqyutum of Own& 6i Lessee, cmw of 's Audwxaed 'his 0
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'59 STATE OF FLORIDA
Comni# GG31 D501
Expifes 3/11/2023
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NOTE.
BEARINGS SHOWNARE BASED UPON
RECORD PLAT OR DEEDVESCRIPTION
ROM
W COA`P1.1AVC,-W7WFZ,0RVA STATUES 61G17-8.00,71f,9M, IFLOCH HWOF
EASEOR RlOffr-OF-WA YOFRECORD, OMER MAN THOSE ONRECORO
FU'FISREOlItRED,7'HISINFORaTA77OA!AIUSTBEFURfft$MEDTO
THE SURVEYORANO RAPPER,
4
GENERAL Aft) TES:
1.1 EGALDE$r-RIP770PPROV70EDBYOTHERS,
2) THE LANDS SHOW HEREON WERENOTA6VIRACTED FOR EASE rYT9
OR 077fFR RECORDED SPICUMBRANCESNOrSHOWN ON THE PLAT,
1UPROVEREAT S iWU NOT 1, = 7FZL
R WALL 77,15 AP6 TO ThE FACE OF THE WALL A NO
ARENO-gTOBEUSED rORECOVSTRUCTSOUNRARYLWES,
51 ONt Y WSIBLE ENCRO4ChWff7-. L OV TED,
61 MO IDEIVIVICA nVffFMW LIT V-rRq 0 Z5URF 077,57PMF SHMI
7j GIguENSIONS SHOM, I A RE PLAT 4.N0 VSMSI M I RT.ESS 07?!r , SE Sffim-
61 PENCE MWERSH4P NO 7 DE17VIM-NED.
gr) a EVA 77ONS IFS ARE'SA SED UPON N0, KA UNIZIESS OWRWSE NO TED.
Uj 101 RE4RIN(;S REFERENCED TO UNTNOTED 5-k
= 11) MIS SURVEY DEPICTED HERE POWS A CLOSED GEOHMIC RCURE.
LIJ fh NO UNDERGROUND PFROWW-M OR VISIBLE ANSTALLA 77ONS
HA VE SEEN LOCA TEO OTHER Tw SHOWN,
f31 A4L 7TVVEDANGLES ON CURVESARESHMIN, To THE CHORDPISTANDE
a- 141 TM SURVEY18 FREPARED FOR INEfiXCLUMIEUSEANDBEIVERTOF THE
to PAR77IF-SW70HEREOR. LARWY TO THIRD PARIIESDA YNOTOF
tRANSFERRED OR 4SS'9AEV,
1.4; NOWE TWS -ORA KV Y�A Y NOT BE TOSCAL 6 DUE TO ELEC TROPIC TRA P$F,17?
161 POTICE:77fiS DRAOW, PREPARED IN COLOR, SURVEYVVIO FROTIV COLOR.
181 FENCE CORNERS AND HUMNO CORNERS ARE MMSS NONMEM
idol
y 7,
B99OCK10 Ct l BLOCK 142
t
O41
140.00' P.
140,455' M. FV.
1/2' 1A LOT 10
10-7- 43 BLOCK M2
8bXK 142
Legal Description
LOT 14 AND 15, BLOCK 142, CITY OF
ZEPHYRHILLS, FLORVA, AS PER PI -AT THEREOF,
RECORDED IN PLAT BOOK VAGE 54, OF THE
PUBLIC RECORDS OF PASCO COUNTY, FLORIDA.
Revised Certifications. 1217412005
Community Number, 120235 Panel., 0005
SuMix C FI.R.M. Date. 12,117119.91 Flood
Zone. X
Field Work. IIIJO12005 Completed. 121112005
Certified To.
77MO77-IY P. SA WDGE AND KATHLEEN ZUKOSKY;
Meridian Title Company, Inc.; Attorney's Title
Company, Inc.; Master Financial, Inc., its
successors andlor assigns.
Property Address:
5506 18th street
zephyrhills, Florida JJ542
Survey Number: 0-156157
FOR REFERENCE Oft Y
NO-7VAL—OLIDLESS MLED wim mossEv SEAL
UNI- ESS THE SUR VEYOR'S ELECTRONIC SEAL IS A UTHORIZE
LERERO PHOTOCOPYING FORBIDDEM COPYRIGHTED MATERIAL.(
WOOD FEPOE )CA F014%1V
P, 7R5 FENCE itR, NOURAWL CONC BLOCKWALL
PR,7P--MrCORNER 0,RL MISME41741NER COVERED AR&
4N &MBENCHMARK PPPOffRPOtE a= CONCRM
EXCR ENCROACHNEW 7x TRANSFORM P. nELDREASURED
CATV CARLERWER A PLAT""