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Home My WebLink About22-5440ffm City of .. ills 33Eighth art ephyrhill , FL 33542 -4 5 -2022 Phone: (1 ) 0-0020 Fax: (1 ) 7 -0021 Issue Date: 01/1012023 # # BuildingClass of Work: SFR Construct Mechanical Valuation: $19,958.40 Plumbing Valuation: $28,612.00 Total Valuation: $376,358.40 Total Fees: Electrical Valuation: $42,768.00 Amount,955.40 # 7:24:19AM Date Paid: 1/11/2023 e Building Plan Review Fee $1K00 Irrigation 314 Meter ( alc) $732 71 Plumbing Plan Review Fee $0:00 wilding Permit Fee $1,465.60 Transportation Impact Fee - City $36.32 Public Safety Impact Fee -Police $254,00 Electrical Plan Review Fee $0.00 314 Water Meter Fee ( alc) $732.71 Serer Connection Residential Fee $2,090,00 Public Safety Impact Fee Admin $26,35 Park Impact Fee - Single Famllyl"l ownhome $769,56 ,address Fee $ 0.00 Transportation Impact Fee $3,595.68 Driveway Fee $45.00 Mechanical Permit Fee $139,79 SIF 1 percent Fee $83,28 Schaal Impact Fee - Single Family $8,328 00 Plumbing Permit Fee $182,56 Water Connection Residential Fee $1,0%00 Mechanical Plan Review Fee $0.00 Electrical Permit Fee $253.84 management,entities such as water iiMra.7771"MMACM I Codesaccordance with City Ordinances. NO OC NO OCCUPANCY BEFORE C.O. 0 T CTOR SIGNATURE PE IT OFFICE 813-780-0020 City of Zephyrhills Permit Application Fax-813-780.0021 Building Department Date Received hone Contact for Permitting 908 1 770 __ 7763 'r ` 1 I I i' I I I 'a s e—b-, r Owner's Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone Number 813.5745700 23975 Park Owner's Address Sorrento, Ste. 220, Calabasas, Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address NfA JOB ADDRESS 3661$ faarden Wall Way LOT # SUBDIVISION Abbatt Square PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD(ALT SIGN DEMOLISH P� INSTALL REPAIR 4__.,p PROPOSED USE SFR COMM OTHER TYPE OF CONSTRUCTION 1 BLOCK FRAME STEEL DESCRIPTION OF WORK Single Family Residence 1 Pool f Screen Enclosure 1 Fence �j �u/x sr 2376 SIZE BUILDING 1936 BUILDINGSO FOOTAGE HEIGHT ^r.e°�r�e�w^mere^ntA4r�^e^��e°'�j�a�a��a�a-affirm s� BUILDING $ 285120 I VALUATION OF TOTAL CONSTRUCTION ' ELECTRICAL $ �270—— PROGRESS ENERGY W.R.E.C. �`j AMP SERVICE g512�M PLUMBING $ 1 BMECHANICAL $ 19958,4 1 VALUATION OF MECHANICAL INSTALLATION =GAS 10 ROOFING SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS 7 __� FLOOD ZONE AREA DYES D0 BUILDERE:: p«"` COMPANY Lem�Y/ �NFEE �CURREN SIGNATURE REGISTERED Y / N 4301 W Boy ut Blvd Suite 600 T18166 ampa, FL 33607 CGC15 .Address � � License# —� = ELECTRICIAN 6 a r COMPANY Edmonsbn Electric, Inc. SIGNATURE REGISTERED Y 1 N FEE CURREh Y! N Address License # EG13005408 PLUMBER u COMPANY Bayonet Plumbing, Heating & AC, Inc SIGNATURE REGISTERED )) N FEE CURRER Y ( N Address Mn=` License# GPG042998= Bayonet Plumbing, Heating & AC, Inc 1 MECHANICAL , COMPANY Y g� g SIGNATURE „4 REGISTERED L11 N FEE CURRER Y ( N r.r Address ��'`License # GAG058062 OTHER COMPANY C Sterling Quality Roofing, Inc SIGNATURE REGISTERED Y ( N FEE CURREE Y / N �ets AddressLicense #�Bu!ldling 1RESIDENTIAL Attach (2) Plot PISPlans; (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 subdivisionsAarge projects COMMERCIAL Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms, R-0-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. 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 (PloUSurvey/Footage) Driveways -Not over Counter if on public roadways -needs ROW ki 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, 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 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 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. 12MVIONIT17101=1111 it 117i WaXTA41MAZ _=Iklm OWNER OR AGENT _01P'S —==m Subscribed and sworn r. (—or affirmed) before me this ,1111=1 by Christopher Smith Who islare personally known to me orhas4�a�� as identification. Notary Public Commission No. GG 296057 Subscribed and sworn to (or affirmed) before me this 1M7W22 by th Who is/are personally known to me or has/have produced as identification. ✓ --Notary Public Commission No, GG 296057 Stephanie Farmer —Stephanie Farmer Name Name ofNNM:j .W visww"Ellk "Ov MVPAW FMMFA #GO2 4*06Nt". Al Loos Fsbmw 16,-XfE*MF"W1I6,2= 00" 11" TMI f* $04*70 a M I M, j ca - 26 -11 - 0) 0 60 a m 0 Permit No. , Date Permitted F- Builder Name/Owner Name fir( -, control a County Parcel No. ear' ub iv: Exempt 0 Yes 0 No plow Determine Impact flee Amount Zone No, TAZ. SCHOOL I PAC FEE Account (05E) Single -Family Detached House Amount (057) Mobile Home (0558) Other Residential (123) Collection Fee Exempt = Yes = No low Determined_ AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zorn Total Amount Exempt =Yes No How Determined LIBRARY FEE Land Account land Credit Land fetal Facility Account Facility Credit Facility Total Exempt 0 Yes No How Determined Total Amount RESOURCE FEE ERII AMOUNTSPERFORMED UNTILTHE TOTAL BEEN PAID AND RICEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY DESCRIPTICIIIIIELOT I L BLOCK 10, ABBOTT SOUARE PHASE 18, SITE PLAN ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89, PAGE(S)57-62, OF THE PUBLIC RECORDS OF PASCO COUNTY, (NOT A SURVEY! FLORIDA. F_ i PROPOSED ELEVA71ONS AND GRADING his SITE PLAN Prepared for and Certified 70: SHOWN HEREON ARE TAKEN FORM THE ENGINEERING PLANS OF ABBOTT SOUARE RESIDENTIAL, PREPARED BY SVRA'PROVIDED BY CLIENT FALL ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 INA VD 88) LOT —SQ. FT, LIVING AREA =193_6_SQ. FT. PORCH = 24 SOFT, GARAGE -_116 SQ. FT COVERED LANAI =_hVAF_SCL FT. PATIO _Z3 23 SO. FT, POOLAREA --SQ. FT. CONC. DRIVE =_475--SQ. FT. AIC & CONC PAD = 7 SO, FT, SIDEWALK =_30SO, FT LOT SOD =_N/A___SC. FT R/W SOD -_NZ&_SCL FT, LOT OCCUPIED =_�V8_ % AREA TO IRRIGATE =_!i2 qk 0= 2"OAK - = 10,00 PUBLIC UTILITY EASEMENT TW BASE OF WALL BW BASE OF WALL LEGEND: PROPOSED DRAINAGE FLOW (00,00) - PROPOSED GRADE E-00,00 - EXISTING GRADE NOTES: I CUT GRADING TYPE -A PROPOSED PAD ELEVATION = I 11,00 FRONT SET BACK - 20 SIDE SETBACK - TS SIDE SET BACK (CORNER LOT) =10 REAR SETBACK = 15 PROPOSED: MINIMUM FLOOR ELEVATIONS: LIVING AREA: 1 1 1.67 GARAGE AREA: ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 JCDD) RIGHT-OF-WAY TRACT*A' GARDEN WALL WAY N 89.48)OT E (P BASIS OF BEARIN� SEC. 4, TWP. 26 S, RNG 21 E. PASCO COUNTY, FLORIDA fABBOTT SQUARE) Scale: 1 20' ---------------- 22JO -N89`48e4`EIP) 55.00 (P) 'INN ;-N 89'48'04'E (P) 324.92'(P) 'A k 10,966 3 CONC TWALK ' S' 14,8' 0 "T /OR 6 �20. 7 W 45 ENTRY PROPOSED -:G I STORY RESIDENCE PLAN 1941 LOT 10 FLEVEBI, LOT 12 BLOCK 10 q GARAGE 8 BLOCK 10 LOT 11 6 BLOCK 10 40-0 "lE, Ts 40.0 7.5 IR9 7�JF ';PATIO 32X12' C/SA/C J C3 siO R, S 89'48 04- W (P) 55.00 (P) TRACT "B-5" (CDD)LANDSCAPE/ WALL MAINTENANCE AND FENCE AREA; OPENSPACE I APPARENT FLOOD HAZARD ZONE: 'X"COMMUNiTY NO. 120235 SURVEY AB�BREVATIQ�NS (MAP NUMBER 72 IOTC-0289-F) EFFECTIVE DATE, 09/26/2014 Al-ARCLINGTI1 ID) - DEED INV - INVERT NC - POINT OF C57G/F (el - KPCORD LEGEND I A/C - FIRCONDITIONER D E- DRAINAGE EASEMENT UP -LICENSED SUANISS DCC - POINT OF COMPOUND CURIA' PNG - RANGE VINYL HPICE A` - ATUMNUD PENCE — FLORELFTUIF FAON L E -LANDSCAPEAS EENSENT U �P - PERMANENT CONTROL POINT RRS - AOLROAD SPIKE cowc --- b=b_ APE - SASr FLOOD NEVATION LOP - E� OF OF PASAFAUJI LET - LOWEST FLOOR FLOSArON F/E - 1100 FODIEMEN! R/sF - RIGHT OF WAY Wa ReSCH MARKEW C _ CURVE I - FASENR PIT F/C - FENC8 CORNER UT � UCENI SURVEYOR (M) - MFASURED P. - PAGL N- POINT OF INTERSECTION SEC - SECTION SN&D = SET NAIi AND DICK [=-AIIIIAIT WOOD FENCE (,C2_`DTc`_Tcp ECM -FOUND CONCRETE MIES - MITERED E ND SECTION PX-PARKIROALON 1818183 � FENCE CENTERUME IN MONUMENT GV -NO CORNER FOUND I -PROPLEPLINE All-IFTI/2"IRONIO - "' "V Cr INK A C�17-`PDI'Le 0 N U DIRCINMPE CPA � OVERALL POS-POIN OF BEGINNING FIND iSM-1 � GRAPYRE �Cll SAAR = - "C", — c _FO NDRONROD F U OLIN - OVERHEAD WDEPS) POC - POINT OF CONINIENCIMENI TOB � T I OP Cr RANR Co CONIC - CONCRETE FNsD - TOUND FAIL & DISK 0 R -OFFICAtRECORDS POL - POINT ON LINE T TOP - TCAsNs;TP ALUMINUM FENCE (/5 - CONCRETE G�P 2!1:�d�ai?,OIEN PIPE RP PRC - POINT OF REVERSE CURVE U I - U1 I ITY E/O1MFNT [2�] _ COV're, 'D _LLT - UEAR SICEFT TRIANGLE INCHED PIPE PS^PLAT BOOK RE I ENCE DO ON 4TI VFn VINYL FENCE 1060,5699 SURVEYOR'S NOTESz I.) Current title information on the subject property had not been turn ish ad to Initial Point Land Surveying, L.LC, at the time of this SITE PLAN SURVEYORS CERTIFICATE This -difics k 10�W 2,Pkill,hereon described property v.$' CNA nPVy 1% rvc ty t T UO mon an, 7708 Water Oak Drive DO Tarpon Springs, Florida Phone_ (/27)-831-1990 Date of Site Plan 7-1 DWG AS PH I ECL I I 43L 10 HI L 2.) This sketch was prepared without the benefit of a title search No instruments of record reflecting ownership, easements or tic e Out meets , -is to Z D 7y,21RO FRNrdaPLS7123@)grri in c LELF 8183 OF" Ile rights -af-way were furnished to the undersigned, unless otherwise shown hereon. 3,) Roads walks, and other similar items shown hereon were taken 0 from engineering plans and are subject to survey. -,s not reflect nor determine 4. This SITE 'ownership This SITE PLAN is to the Plat of l I'Ioekd!�,, qft' artlev puts 'I." A Flanlt te fe .08.1 -04'00' :3 �F pDW — Drawn by, DJB Zb eEkedbyJlq� ?EWSIONS subject matters shown on UARE PHASE 18 ABBOTTSQ 6,) Dimensions shown hereon are in feet and decimal portions Jeff M FIN A A � thereof. AND FLORIDA I , �R�S� 0AAeo A183 MAPPER NO. LS# YW'AA 7,) Contractor and owner art, to verify all setbacks, building dimensions, and layout shown Hereon Prior to any construction, NOT VALID WITHOUT THE ORIGINAL and immediately advise Initial Point Land Surveying, LLC. of any SIGNATURE AND SEAL OF A FLORIDA + I deviation from information shown hereon. Failure to do so will be LICENSEE) SURVEYOR AND MAPPER Initial Point Land Surveying, LLC. 1 8j67 �AD 11 9 10 W L. LPA�6 —TW:115.2lioBW:107,60 106- TYPEW TYPE'A' , —TW:114.56MEBW:107.42 106, TYPEA T YPE'A F-11S 270 r:AD,,p2l146 MFF7 �108 9 PAD:10830 —TWM3,91*BW:108.10 106. —TW:113.25*BW:109.42 108. T 'A' TYPE 9 60j --- ------- RCP simmam PAD:0 � 5 0 --010636-102,90f TYPE'B' FF:107.67 PAD:107.00 106.15 i 99.39 j TYPE'B' MIM87 @ 0,30% f106,76 102.18 PAD:100,20 099.90-9738 4 TYPE 6 FF:100,77 106.15 99.14 PAD:100.10 ci 099 71-96.94 0 0 E RE YP Ty T TYPE 'E" Typ E 'E =FF:100.5:7 =PFF10981, -70 20 1 9 18 1 -1 AD�jo PAD:108.�5 I'„ 141 ', I PAM99"90 '30� TYPE TYPE TYPE'A FF:105.77 FF:104,19 FF:102.67 98,96 099S3, )c, in TYPE PUA 'AD:105,10 PAD:103,5 PAD:10200 =SD-8il-8 t TYPE W FF:10037 MFF,7 y 09 0 0 PAD:9930 .1 PAD:10&50 -- — — — — --- — — — -- -- — — — --- I u SD&9 L f 1 =L��5'-1,9"RCP@ 03 1 0%- ...1 A 105,25o - 1107.38 - TW:107,63 Aft TW:109,91 TW:105.50 —TW:l Q37 !7 ! TYPE TYPE A F 57 FF:112 57 JF�,27 : TYPE'A' TYPE T MM112A47 �j 2 4 F[F P' PE 'A' T 7 FTFY112'.A67 11267 Y7 F[F PE FTFY112',A67 TYPE T RE ' AFTFylll',A67 �11 6 7 TYPE 'A' FF: 109.57 TYPE 'A' FF:107,47 PADML90 jjj�j go P 111 '80 PAD111,80 PAD:112,00 P �11 ()o PAD112,00 AD P Ill 00 T PAD108,9 ITW:107.02 PAD:106M 7 8 , 4 9 10 TMIR8.44 12 I 13 � OF T�E NW 1/4 01 1/4 OF SEC �121 1 j ___ TW:11, MID .3,4'N rioo ALTHEA LANE 2 - 1 Ql(-L-JT (-)F-- \AlAV WIF)T[-I D7Q 1-1—TW:106.5N I RWIM,. I Cni ITI-I i imp- np- I TI- P- - 1-1 1— 1-11, - , "A' " - " "" .... ..... SILT FENCE TRACT \/R/\ VIRTUAL REVIEW ASSIST Private Provider Plan Compliance Affidavit Private Provider Firm: Virtual Review Assist, Inc. Private Provider: Debra Anne Klahr, BU 1967 Address: 747 Southwest 211 Avenue Gainesville, Fl, 32601 Phone: 813-391-2959 Email: LUI ,&virtualreviewassist,com _C_Y_____ Project: New SFR Address(s): 36618 Garden Wall Way I hereby certify that to the best of my knowledge and belief the plans submitted were reviewed for and are in compliance with the Florida Building Code and all local amendments to the Florida Building Code by the following affiant, who is duly authorized to perform plans review pursuant to Section 553 39 1, Florida Statute and holds the appropriate license or certificate: Name: Debra Anne Klahr Plan Sheets: CS,1,2,3.1,3.2,F1,4,5,6,7,8, SN, SNI,S'I,S4,S5,SS, DI,WP,PAI.0,PAI. 1,PAI.2,PAI.3,PAI .4, SHI.0,SHI. l,SHL2,SHl.3,SH1A,SHI.5 Florida License/Registration/Certification #(s) and description: FS468 Certified Standard Plans Examiner License #: PX2300 Signature of Reviewer: SWORN AND SUBSCRIBED before Ipe by Debra Anne Klahr being personally known to me "I 4,,� or having produced as identification ---and who being fully sworn and cautioned, state that the foregoing i e and correct to, the best of his/her knowledge or belief. foregoing Mki Signa of Notary Print- arne M22�� \/RA VIRTUAL I R-I UAL REVIEW ASSIST Notice to Building Official of Use of Private Provider Effective January 20, 2003 Parcel Tax ID: 04-26-21 - Services to be provided: Plans Review X Inspections Note: If the notice applies to either private plan review or private inspection services the Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute. I Steve Smith , the fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider: DEBRA ANNE ILAHR Address: 747 SW 2ND AVENUE - SUITES 1 Telephone: 813-376-3088 Fax: N/A Email Address (Optional): deb @virtu alreviewassist,com Florida License, Registration or Certificate #: (LICE # B U 1967 / PX2300 / B N4615) KIMMMMINIM , WED building inspections to determine compharic ica e co es, exec t to t e extent spec e n sa Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and, hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the building that is the subject of the enclosed pen -nit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I make any changes to the listed private providers or the services to be provided by those private providers, I shall, within I business day after any change, update this notice to reflect such changes. The building plans review and/or inspection services provided by the private provider is limited to building code compliance and does not include The following attachments are provided as required: 1. Qualification statements and/or resumes of the private provider and all duly authorized representatives, 2.. Proof of insurance for professional and comprehensive liability in.the, amount of $1 million per of 5 years subsequent to the performance of building code inspection services. F-UMEffin (signature) Print Name: Address: Telephone NO., Please use appropriate notary block. STATE OF FLORIDA COUNTY OF —HILLSBOROUGH Individual B efo rem e, this day of 20_, personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed. Corporation Print CorporationName (signature) Print Name:Shristopher Srr�ith its: Authorize ent Address:_ZQQ Je \� �thy� Miami, FL 33172 Telephone No. 813-574-5700 Corporation Beforeme,this 22ND day of MAY -,2o2-2 personally appeared Of Lennar Homes LLC a corporation, on behalf of the state corporation, who executed the foregoing instrument and acklowledged before me that same was executed for the purposes therein expressed. Partnership Print Partnership Name 0 (signature) Print Name: Its: Address: Emm umm= Before me,this day Of 9 20— personally appeared partner/agent on behalf of a partnership, who executed the foregoing instrument and acknowledged before Me that same was executed for the purposes therein expressed. Personally known X ; or Produced identi cation Type of identification produced i _ I U, nti cation Signature, of Notar Print Name ASHLEE CALLAHAN Notary Public Stamp: pubjc,' State of r (orida Commission Expires: 24 456 NOVEMBER 30, 2022 10,05NOV I0 , 2022 Page 2 of 2 COMMERCIAL I2eauired Permits VRESIDENTIAL e El Inspection El Medical Gas Ej Fire Sprinklers El On Site Piping El Irrigation Fire Alarm EJ Potable Backflow Assembly Fire Line Backflow Preventer■ u Irrigation Backflow Assembly "IDemolitionti'' III El Walk-in Cooler Refrigeration ■ Grease Trap.� T e Construction;" C� ancy Classif cation: Factory Residential risk Category: Occupancy Load Assembly business Day Care/Educational Hazardous Institutional ®Mercantile ®:'Storage ®:Utility Building Use: Sinole Family f Alteration Level I Level 2 'Level 3 New Construction ® Interior Finish ® Interior Remodel ❑ Exterior Remodel Ej Addition ® Revision Overall Size: 40 x 65 Number of Stories: 1 Total Sq. FL: 2372 Living Area: 1936 Covered Area: 436 ofBedrooms: 4 # of Baths: 2 Cost per square foots Estimated Value: Roo e: Shin le ®Tile ] Built-u eta l Other S uares: 26 Zoning: =U'LLInside orne Debris: Outside Energy Code: 405-2020 Flood Zone: X Base Flood Elevation: Finish door Elevation: Hydrostatic Vents? ❑ Yes No Sq. Ft. Enclosed Space Below BFE: # of Vents: Size of Vents: 'Total Sq. In. Permanent Openings ® Central A/C El Gas A/C Ileat u p ❑ 'indow A/C o Gas Beat E] Electric Heat On Site Piping Sanity Sewer Storm Sewer Catch Basins Potable Water Under round Fire Line Setbacks Front hear Left Right Asper Approved Site flan Comments: