HomeMy WebLinkAbout23-5773City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542
BNR-005773-2023
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 03/09/2023
Permit T e: u I ing New (Residential)
..........
15 26 21 0230 00000 0220 38092 Fallstone Way
Name: LENNAR HOMES LLC-OWNER Permit Type: Building New (Residential) Contractor: LENNAR HOMES LLC
Class of Work: Townhome
Address: 4600 W Cypress St 200 Building Valuation: $250,320.00
TAMPA, FL 33607 Electrical Valuation: $37,548.00
Phone: (813) 574-5700 Mechanical Valuation: $17,522.40
Plumbing Valuation: $25,032.00
Total Valuation: $330,422.40
Total Fees: $14,333.47
Amount Paid: $14,333.47
Date Paid: 3/9/2023 7:23:44AM
CONSTRUCT TOWNHOME 1634 SO FT
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SIF 1 percent Fee $3153 Building Plan Review Fee $180.00
Fire Wall/Smoke Wall Inspection $15.00 Mechanical Plan Review Fee $0.00
Water Connection Residential Fee $1,140.00 3/4 Water Meter Residential Connection Fee $794,92
Plumbing Permit Fee $165.16 Public Safety Impact Fee -Police $254.00
Transportation Impact Fee - City $34.80 Electrical Plan Review Fee $0,00
Driveway Fee $45.00 Public Safety Impact Fee -Admin $26.35
Sewer Connection Residential Fee $2,400.00 Park Impact Fee - Single Family/Townhome $769.56
School Impact Fee - Single Family $3,353.00 Plumbing Valuation Fee $0.00
Mechanical Permit Fee $127.61 Building Permit Fee $1,291 .60
Transportation Impact Fee $3,445.20 Electrical Permit Fee $227.74
Address Fee 0.00
REINSPECTION FEES: (c) With respect to einspection 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
41%
(� yz
PE IT OFFICE
ITHOUT APPROVED INSPECTION,
alp-Sao-o0 a City of Zephyrhills Permit Application Fax-813a80-0021
Building Department
Date Received Phone Contact for Permitting 908 770 _- 7763
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Owner's Name Lennar Homes, LLC Owner Phone Number 813.574.5700
Owner's Address 4301 W Boy Scout Blvd, Ste. 600, Tampa, FL 33607 Owner Phone Number
Fee Simple Titleholder Name I N/A Owner Phone Number
Fee Simple Titleholder Address N/A
JOB ADDRESS 38092 Fallstone Way LOT# 0022
SUBDIVISION Townes at Autumn Palm PARCEL to# 95-26-21-0230-00000-0220
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR B ADD/ALT SIGN DEMOLISH
PINSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK 0 FRAME STEEL
DESCRIPTION OF WORK' Multi -family / Screen Enclosure / Fence
BUILDING SIZE i /R sir 2086 SQ FOOTAGE 1034 HEIGHT 28°
BUILDING $ 250320 VALUATION OF TOTAL CONSTRUCTION
1.! BELECTRICAL $ 37548 AMP SERVICE EX] PROGRESSENERGY 0 W.R.E.C.
!J RPLUMBING $ 25032 "
H✓ (MECHANICAL $ 17522.4 VALUATION OF MECHANICAL INSTALLATION
GAS FV(] ROOFING SPECIALTY = OTHER y`
FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA 0YES Do
BUILDER
1
� COMPANY
Lennar Moines, LLC
SIGNATURE
% REGISTERED
Y / N FEE CURREM1 Y / N
Address
4301 W Bo ScoupBlvd Suite 600 Tampa, FL 33607
License # CGC1518166
ELECTRICIAN
COMPANY
EdmonSon Electric, Inc.
SIGNATURE
REGISTERED
Y / N FEE CURREN
Address
License# EC13005408
PLUMBER
COMPANY
Bayonet Plumbing, Heating & AC, Inc
SIGNATURE
REGISTERED
Y / N FEE CURREM1 I Y / N
Address
License# CFC0429980—_T��
MECHANICAL
t
COMPANY
Bayonet Plumbing, Heating & AC, Inc
SIGNATURE
r REGISTERED
Y/ N FEE CURREM1 I Y/ N
Address
�
Ueense # CAC058062
OTHER
COMPANY
C Sterling Quality Roofing, Inc
SIGNATURE
REGISTERED
Y / N FEE CURREM1 I Y / N
Address
I
License # CCCO57991
1Ii111111i11I1111i1111111i111111111111I11FItttl11111111I11111111111
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 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.
1-1-4-• F..M. 4-i- ° . .
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)
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, 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'SIOWNER'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 `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.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn 6) (or affirmed) before me this Subscribed and sworn to (or affirmed) before methis
1/5/2023 by ..Christopher Smith 1/5/2023 by Christopher Smith
Who is/are personally known to me or#�,Ged Who is/are personally known to me or has/have produced
as identification. as identification
Notary Public
--,42 _Notary Public
Commission No. GG 296057 Commission No, GG 296057
Stephanie Farmer Stephanie Farmer
Name Name of N
mi WRHWE WMER rrEKM FAMER
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Permit No. f5
Date Permitted
Builder Name/Owner Name Yt
Control #
County Parcel No. 0 C �ti
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Address/Location G
j
Classification/Type of Use f (
TRANSPORTATION IMPACT FEE Rate:
Sq. Ft Unit: `
ExemptEl Yes 0No Flow Determined
Impact Fee Amount S 66 Zone No. TAZ:
—3
SCHOOL IMPACT FEE
Account (056) Single -Family Detached Mouse
Amount $
(057) Mobile Home
(058) Other Residential
(123) Collection Fee
Exempt = Yes = No Flow Determined -
PARKS AND RECREATION FEE
Land Account land Credit land Total
Recreation Account Recreation Credit Recreation Total
Zone Total Amount $ `
Exempt =Yes = No How Determined
Land Account land Credit land Total
Facility Account Facility Credit Facility Total
Exempt Yes No Mow Determined Total Amount �
RESOURCE FEE ERU
Total Amount
Prepared By Checked By _
NO CERTIFICATE OF
PERFORMED .A
BEEN PAID AND FOR BY OFFICE OF PASCO COUNTY
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DESCMPTION. LOT(S) 17-24, TOWNES AT AUTUMN PALMS, SEC. 15, TWP. 26 S, RNG 21 E.
ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89, SITE PLAN 1708 Water Oak Drive
PAGEIS) 113-114, OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA. PASCO COUNTY, FLORIDA
( TOWNES AT AUTUMN PALMS) NOT A SURVEY) Tarpon Springs, Florida
NOTES: Phone: (727)-831-1990
b FloridaPLS7123C@gmaii.com
l"I LOIGRADINGTYPE N/A ----------- --------------------------------------------------------------------------------------- --- LB# 8183
11 PROPOSED PAD ELEVATION NSA I- TRACT'H"
FRONT SET BACK 15 LANDSCAPE BUFFER
S 29)'56fl L 1 1800 fFS I 18 00 (P) IBOU I fio (P) 1800 (P) 1800
SOESET BACK TO 2833 (P) (P (P) 1 28 30'(P) 14 MIS
REAR SETBACK - 20
rz
u ALL WALKS 3.0 UNLESS NOTED Z-7
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V1 ALL A/C 12 IF 3 2
n I n
VE/U/D INGRESS EGRESS/ 100 : �-, �J!11_ 1, 1E-.-I L _;L i�
I- 1 10:0 Scale: 1 20'
UTILITY/ ILITY/ DRAINAGE ESM T o1_ __LANA1_ __1_ANAI__ __LANAI__
6 LANAf_- >NA!� LANAI__-LANA Initial Point Land Surveying, LLC.
LOT - 17131 SO FT 183 18,0 18,0 1 180 18,0 18.0 18'0 183
LIVING AREA - 5336 SO, FT 07 E a� LEGEND
ENTRY - 672 SO, FT 07 E7
6 SURFACE TYPE FENCES
GARAGE - 1848 SOL FT C 9
COVERED LANAI - 868 SO, FT UNIT{ UNIT-C UNIT C
UNIT{ UNIT-B UNIT -A
%
UNITA UNIT-B
PATIO = ?�A SO, FT 1532 cl 1624
1516 1624 1624 E� 1624 1516 1532
POOL AREA = NA SO, FT ic
'PROPOSED =--IIAIT ONY, rFo(F
CONC DRIVE 2400 SO, FT 2STORY
A/C & CONC PAD 80 SO, FT TRACT "I" 144-8 E - ----- ---- -- ---- --
iiRESIDENCES
324 SO. FT �z
SIDEWALK era SWoomF E_
PRIVATE PARK LOT
SIDE YARD SWALE NA SQ. FT. LOT LOT r,LOT LOT LOT EI LOT 9m LOT LOT
CONSERVATION AREA NA SO. FT 23 r' 20 21 20 17
24 19 18 16
LOT OCCUPIED 68 % o
TO F 6 T 61 63 L9 7 0' 8
6,7* 6.7
32 Si,
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AREA TO IRRIGATE
TO: 01.
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Scal,
LE
PROPOSED ELEVATIONS AND TYPE
GRADING SHOWN HEREON ARE TAKEN PROPOSED DRAINAGE FLOW
11 �3' 1 1 T 113 1 113
FORM THE ENGINEERING PLANS OF "MASER 11 �3' 11,
1 3, 1 3 (00,00) PROPOSED GRADE
I CONSULTING PA.', PROVIDED BY CLIENT
LJI 0"
I , ?
to
o 00",
To 10.0, 100., 1 -00.00 EXISTING GRADE
10 E 2'OAK
S. V
10 INGRESS EGRESS/U E & UE
ALL ELEVATIONS REFERENCE
TO NC RENT FLOOD HAZARD ZONE 'X'COMMUNITY NO. 120235
t VERTICAL---------- JI (MAP NUMBER 1230IC-0452-F) EFFECTIVE DATE: 09/26/2014
�RTHAMERICAN APPARENT DATUM
OF
(NAVE) 88) SURVEYOR'S NOTES:
13 ;IP) -------- - -- ------- ------- LOTeti
C 8, 18, 9-, bo IF) T�Oo Pi 18100 (P a 428,33 IPI + 1.) Current title information on the subject prop" had not been
25 ?A P02 Z
PROPOSED Furnished to Initial Point Land Surveying, LLC. at the time of this site plan
2.) This
16 sketch was prepared without the berrolit of a title search, No
LOWEST FLOOR ELEVATIONS
LIVING AREA: 84,83 instruments
is of record reflecting ownership, casements or right"lFway
GARAGE AREA were furnished to the undersigned, unless otherwise shown hereon,
ELEVATIONS REFERENCED TOya 3.) Roads, walks, and other similar items shown hereon were taken from
NORTH AMERICAN VERTICAL DATUM OF engineering plans and am subject to survey,
4.) This site plan does not reflect nor determine ownership,
1988 FALLSTONE WAY
0,85 -NATIONAL GEODETIC VERTICAL 5.) This site plan is subject to matters shown on the Plat of'ZEPHYR
SO-WIDER/W S89'5608"E(P) 32899 (P) COURT
DATUM OF 1929 ---UW 95F ZEPffYf?ffFELy- BASIS O IS BEARING -- — - — - 6.; Dimensions
shown herear, am in feet and decimal portions thereof.
I/E/U/0 EASEMENT 7. Contractor and owner are to verify all setbacks, building dimensions,
NOTE CONSTRUCTION and layout shown hereon prior to any construction, and immediately
GRADING PLANS C�RVE RADIUS ER U, �FEN G T H CHORD BEARING advise Initial Point Land Surveying, LLC. of any deviation from
HAVE MINIMAL IN i 5 (P) information shown hereon. Failure to do so will be at users sole risk.
P)� S
4�86 (P) 4,86 S 88-054 1 - W (P)
GRADING/ELEVATION CIO 68,85 (P) S78-24 07-Wft
INFORMATION f 1 S'20 29
-w--d
CIT 68 8Sr (P) S63-24 03- W (P) '9 Su
This certifies ats pro rty was made
fie
SURVEY AB8REVAT1I6lNS]_____ ...... ....... . ....... under Z s ards of Practice for
A/c - F'No" , I , I , or , r --- ------ -- ----- ----- ( , 1) 1, - : , of - I , I 1-—EAT P1 -POIN101 11-1 Ri - "'EIFT) Drawn By: CWC Party Chief: JH REVISIONS surveys as rie I ors in Chapter
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5_L17,051throu 5_1 NC,� d e, pursuant to
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I - IIIISS Sm 7 - I AIf ME N1 mi - IAFASFIAI D PI , PUN I Of NTERSFC TION IFI - S11TION
1, 11 1 —
I LAS IF, f Ff NC CORNER MET - MITF RT IS f No %I ( I FIN to - PAR11 1 -1 ON SN&D - SET NAIL AND DISK 3 Date of Site Plan: I I
,'FfFFINi' Cm- OUNDCONERETEMONUMENT WE - NO CMNf R I OUND POE - POINT OF IFFUN-P SIR -SFr i/J"WIN"10D 1,13 81, -23-22 CWC Jeff M. Hatirtley Date
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ou{ - coll If IF OF, - I ouND OP f N -E IP) -PAT
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1. - PLOT F001 Put Tt K UFUVfYIASEMFNT OF A FLORf YOR AND MAPPER
ARC LENGTH
DELTA ANGLE
❑' COMMERCIAL BUILDING SERVICES DIVISION VRESIDENTIAL
BUILDING PERMIT DATA SHEET
TRACKING #
38092 Fallstone;
111UPUM1119M=
DATE: 1-16-2023
• aKlahr PX2304-
Building
❑ Inspection Only
IVPlumbing
❑ Ins ection On/
Mechanical
❑ Inspection Only
Electrical Amp
❑Ins ection Onl
IV Roof
❑ Gas
❑ Medical Gas
❑ Fire Sprinklers
❑ On Site Piping
❑ Fire Line
❑ Irrigation
❑ Fire Alarm
❑ Potable Backflow Assembly
❑ Fire Line Backflow Preventer
❑ Irrigation Backflow Assembly
F-1 Demolition
❑ Walk-in Cooler
❑ Refrigeration
❑ Hood
❑ Ansul
❑ Fence/Wall
❑ Grease Trap
❑ Other
❑ Other
T e Construction:
Risk Category:
Occupancy Load
Oe pancy Classification:
Factory ,��
'Residential
,Assembly
❑,Hazardous ��
;❑Storage C=
❑,Business ❑,,Day Care/Educational
❑_,Institutional �❑ ' Mercantile
❑ Utility
Building Use: Single Family townhouse I Alteration ❑ Level I�',Level 2 ❑ Level 3
VNew Construction ❑ Interior Finish ❑ Interior Remodel ❑ Exterior Remodel ❑ Addition ❑ Revision
Overall Size:
18 x 63
Number of ,Stories:
2
Total Sq. Ft.:
2086
Living Area: 1634
Covered Area:
452
# of Bedrooms: 3
# of Baths: 2.5
Cost per square foot:
Estimated Value:
Roof Type: ® Shin le
❑Tile ❑ Built-up
0 Metal ❑ Other Squares: 14
Zoning:
Win,,dborne Debris:
❑ Inside Outside
Energy Code:
405-2020
Flood Zone: X
Base Flood Elevation:
Finish Floor Elevation:
Hydrostatic Vents. ❑IYes No
Sq. Ft. Enclosed Space Below BFE:
# of Vents:
Size of Vents:
Total Sq. In. Permanent Openings
0 Central A/C
❑ Gas A/C
® Heat Pump
❑ Gas Heat
❑ Window A/C
❑ Electric Heat
,81
Sanitary Sewer
Storm Sewer Catch Basins
Potable Water
Underground Fire Line
M1M
Front Rear Left Right
❑✓ Asper Approved Site flan
Comments:
\/V\
VIRTUAL REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Finn: Virtual Review Assist, Inc.
Private Provider: Debra Anne Klahr, BU1967
Address: 747 Southwest 2 nd Avenue
Gainesville, FL 32601
Phone: 813-391-2959
Email: lucv(o).virtualreviewassist.com
Project: New SFT
Address(s): 38078,38082,38084,38086,38090,38092,38094,38096 Fallstone 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 553.791, Florida Statute
and holds the appropriate license or certificate:
Name: Debra Anne Klahr
Plan Sheets: 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,LI,SN, SNI,S3,S4,S5,S6, ST,SS,D1,WP,PAI.0,PAI.1,
PA1.2,PAI.3,PAI.4, SHI.0,SHI.1,SHI.2,SHI.3,SHI.4,SHI.5
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Examiner
License #: PX2300
Signature of Reviewer:
SWORN AND SUBSCRIBED 7bf ,,e me by Debra Anne Klahr
being personally known to me or having produced as identification
and who being fully sworn and cautioned, state that the
fore in is true and c0 ect to the best of his/her knowledge or belief.
Signature of Notary Print Name
am =u-nomki'myAltygn H
commission expires: ASHLEE CALLAHA)f
�M �' �HH2 ' .. 0 '�Lft$iNZ w3o, 2026
MY COMMISSION# HH 295980
EXPRES: NuvwrJw 30,2026
V�D
r. U A L R, F V I E'A A S 5 1 S T
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
WEEN61M
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.
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Firm: VIRTUAL REVIEW A55I5T, INC.
Private Provider: OEBPA ANNE KLAHP
Address: 747 5W 2ND AVE- 5UITE 170,301,357,& 358, GAINESVILLE, FL 32601
Fax: N/A
Email Address (Optional): deb@virtualreviewassist.com
Florida License, Registration or Certificate #: (LIC # BU1967/ PX2300/ BN4615)
I have elected to use one or more private providers to provide building code plans review and/or inspection
services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida
Statutes. I understand that the local building official may not review the plans submitted or perform the required
building inspections to determine compliance with the applicable codes, except to the extent specified in said law.
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
have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance
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 permit 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
review for fire code, land use, environmental or other codes.
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, ainount .of $1 million per
o ccurrence relating to all services peTfofined as a private provider, including tail coverage for, a minimum
of 5 years subsequent to the perfbrrnance of building code inspection services.,
Individual Corporation Partnership
:(signature)
Print
Address;_
Telephone
Please use appropriate notary block.
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Moreme-, this day of
20— personally
appealed
who executed the foregoing instrument,
an , d acknowledged before me that same
was exff,,rnited for the purposes therein
expressed.
Print COTPOTationNamo
By:
Print
Name: Christopher Smith
its: Authorized Acient
Address- 70
Miami, FL 33172
Tclephone•
No, 913-574-5700
Corporation
Beforem,,this 22ND day of
MAY —2o-22
personally appeared,
Of
Lennar Homes, LLC . a
corporation, an
behalf of the state corporation, who
executed the foregoing instrument and
acknowledged b(-,fbTD me that same was
executed for the purposes therein
expressed.
M_
(signature)
Print
Name-
Telephone
No.:
Partnership
Befcmme, this day
of 20—
pers6naHy appeared
partner/agent on b ehalf of
a partnership, who executed the
foregoing instrument and
acknowledged before me that same
Was executcHor thepurposes therein
expressed.
Personally known X or- Produced identification Type of identification produced
Signature of Not ar6l Print Name ASHLEE C&LLAHAN
NDtaiy?ublic Stamp: ASHLEEML*"
MY COMMISSIC64 # jili 295911
Commission Expires: lot. IRES'. 30,2121
EXP
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