HomeMy WebLinkAbout23-5844City of Zephyrhills
5335 Eighth Street
ephyrhills, FL 33542
Phone: (13) 7 0-0020
Fax: (13) 7 0-0021 Issue gate: 03r1412023
Permiti i id e ti l
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04 26 210150 01100 0080 6376 Ten Aore Court
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Name: LENNAR HOMES LLC-OWNER Permit Type: Build! LC
Class of Work: SFR Construct
Address: 4600 W Cypress St 200 Building Valuation: $312,600,00
TAMPA, FL 33607 Electrical Valuation: $46,890.00
Mechanical Valuation: $21,882.00
Phone: {813) 574-5700
Plumbing Valuation: $31,260.00
Total Valuation. $412,632.00
Total Fees: $20,701,19
Amount Paid: $20,701.19 s .
Gate Paid: 3/14/2023 11:27:42AM
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CONSTRUCT SINGLE FAMILY 2073 SQ FT
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Park Impact Fee - Single FamllytTownhome $769.56 Plumbing Permit Fee $196.30
SIF 1 percent Fee $83.28 School Impact Fee - Single Family $8,328.00
Suer Connection Residential Fee $2,400.00 Mechanical Permit Fee $149A1
Irrigation 3f4 Deter (Cale) $794.92 Transportation Impact Fee - City $36.32
Address Fee $30.00 Public Safety Impact Fee -Admin $26.35
Transportation Impact Fee $3,595.68 Public Safety Impact Fee -Police $254.00
Building Plan Review Fee $180.00 Electrical Permit Fee $274.45
Water Connection Residential Fee $1,140,00 Driveway Fee $45.00
Plumbing Plan Review Fee $0,00 Electrical Plan Review Fee $0.00
314 plater Meter Fee (Cale) $794.92 Mechanical Plan Review Fee $0.00
Building Permit Fee $1,603,00
REINSPECTION FEES: (0) With respect to Relnspe Lion fees will comply with Florida Statute 553.80(2)(0) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinapection, whichever is greater, for each subsequent reinpection.
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 ether 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 FO C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNATURE PE IT OFFICE PERMIT EXPIRES IN 6 MONTHS WITHOUT
INSPECTION
CALL FOR EREQUIRED
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received Phone Contact for Permitting 908 770 _ 7763
q-t t-T t._�__r. t. __ ., a•-7-a-•rr-e• - - - — t t..t_�.-T-dr•-t-_.�.�_-�',_..f.•r-• � _
Owner's Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone Number 813.574.57()0
Owner's Address
23975 Park Sorrento, Ste. 220, Calabasas, CA 91302
Owner Phone Number
Fee Simple Titleholder Name I NIA Owner Phone Number
Fee Simple Titleholder Address NIA
JOB ADDRESS 6376 Ten �Cre COUrk LOT# 1108
SUBDIVISION AbbottSquareTy� PARCEL ID# 04-26-21-0150-01100-0080
µ (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED Il,p II NEW CONSTR ADD/ALT SIGN 0 DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR Comm OTHER
TYPE OF CONSTRUCTION BLOCK FRAME L� STEEL
DESCRIPTION OF WORK Single Family Residemc ee i Pool I Screen Enclosure I Fence
BUILDING SIZE L"/R SF 2605 SQ FOOTAGE 2073 HEIGHT 28
BUILDING $ 312600 VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ 46890 AMP SERVICE PROGRESS ENERGY W.R.E.C.
PLUMBING $ 312� jig
MECHANICAL $ 21882 VALUATION OF MECHANICAL INSTALLATIO \)
GAS I� E ROOFING SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS 1 FLOOD ZONE AREA ii BYES DO
BUILDER COMPANY
Lennar IIomcs LLC
SIGNATURE _ _ REGISTERED Y / N� FEE CURREF�Y/
301 W Bo) Scout Blvd Suite 600 Tampa, FL 31607 CGC15181V66 _
Address License #
ELECTRICIAN ~� COMPANY ElBiiOnSon Electric, Inc.
SIGNATURE REGISTERED Y / N _J FEE CURREN Y / N
Address License# EC13005408
PLUMBER COMPANY Bayonet Plumbing, J Heating & AC, Inc
SIGNATURE REGISTERED Y N FEE CURREN Y/ N
Address .<' License # CFC042998 _
MECHANICAL Bayonet onet Plumbing, Heating & AC, Inc
SIGNATURE REGISTERED Y/ N FEE CURREN Y I N
,' CAC058062
Address License
OTHER COMPANY C Sterling Quality Roofing, Inc
YNSIGNATURE Address License # CCC057991�
BBBBBIIBB1108B8BBBBBBBBBBBRBBIlBB9B69BBBWBB89BBBB0688BBIBBBBBBB88BB
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.
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
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 IMPACTIUTILITIES 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, Welland 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_ — n , 0 (�� r.W affirmed)
be
Subscribed and sworn o (or affirmed) before me t
_L,,,�,,22 by Christopher Smith
Who is Lare personaljknown to me or#as4iaua-pr
as identification.
fi
Notary Public
Commission No. GG 296057
Stephanie Farmer
Name
M94MFAMER
%*;h
%dX kIV Em*
mWo I
FilbruG*yOi*Ms,
XW0"W:'*rh QVPmFs
Subscribed and sworn to (or affirmed) before me this
101112022 by Christopher Smith
Who isJare porsanally known to me or has/have produced
as identification.
ZL___ Notary Public
Commission No. GG 296057
Stephanie Farmer
Name ofNi
6f1W P' xf ii fF$4G8& d: 4..w+^
Builder N1rIe11r N P Control
County Parcel No, Su Div: _Ao�
ZMEMEM
Classification/Type of Use
Rate.
tp
Sq. Ft Unit:
Exempt Yes 0 No flow Determined
Impact Fee Amount Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056) Single -Family Detached House Amount
(057) mobile Home
(058) Other Residential
(5) Collection Fee
Exempt Yes = No Flow Determined.
PARKS AND RECREATION FEE
Land Account Land Credit land Taal
Recreation Account Recreation Credit Recreation Taal
Zone Total Amount
Exempt =Yes = No Flog Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt Yes No How Determined Total Almount ���
RESOURCE FEE ERiJ
RM
No CERTIFICATE of OCCUIPANY WILL RE ISSUED OR FINAL INSPECTION
PERFORMED UfkMLTHE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
ACKNOWLEDGEMENT BELOW DOES NOT IMPLY ACCEPTANCE OF CONCURRENCE, BUT SIMPLY REECEIPT OF A COPY OF THIS
FORM, PLACING THE BUILDING OWNER ON NOTICE OF THIS ASSESSMENT AND THE CONDITIONS OF PAYMENT FOR SAME.
RM
ma
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I05.9 PAD:106.8! 1FF:102,07 FF:101.67 FF:101.47 FF'10,57 fF:2d0.07 FF 99.47 FF:98.97 - FF:98:07
.q,,AD:101.4 AD:1fl1.0 AD:100.4 PAD:99.90 AD:99,40 AD:98.8 AD:98.30 PAD:97.40
016656 103.94 '20-27'- 18" RCP @ 0.YPEu 0 o 0
� TYPE'B' .
FF:107.47 n ,-i m cn m cr
106.04 PAD:106.84 "'� �`7 '� ,,r, `^
0106.76 103.74
0 TYPE 'B' l 14 0 2 6+
FF:107.67 / i 36' 30" RCP @ 0 25% isy
Y0625 PAD:107.00
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1 910717 103.32 ,' mc" FF:101.27
TYPE `A' PAD:100.60
" FF 102.1T iYPE B` TYPE'B' IYPE'B' TYPES' 124-30`RCP @ 0 24%
TYPE 'B PAD:201.50 t FF:100.1 FF:99.57 fF:99.17 FF98.7
----w 99.95----100,56
FF:108.0J r+ o PAD:99.5. m PAD:990 n PAD:98.5 PAD:98.1
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�� FF:101.27
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TYPE B' PAD
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07.30
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FF:101.77 =#. 9952--�10012 98.22
TYPE `B` PAD:101.10
FF 107 67Ic TYPE'B
PAD 107A0 I FF:100.87 <*- -' / _,f
5 99.39 ( , 1061--t---
PAD:100.20
-33' - 18" RCP @ 0.30% '• . �`� � ;
0106.76 102..18 TYPE 'A' 99 30 - 09990 97.58 • ,,; ' , ;, s" " r .�' 9N�� '
Ff.201.67
IT
PAD:101.00 r TYPE 'B' "►rr WEST RIGHT 0 WAY
FF:107.57 `�' I FF:100.77 m ��
. r LINE PER AIN
106.15 PA6:146 : "' 99.14 .
PAD:1c7fl.10: i 10 fi
o o rn t 99A8--99.71 96-94 r R I G .
PR E
TYP€9'.B9'
FF:100 TYPE 20 19 18 1PAD:90
lFr�
TYPE A TYPE A TYPE'A
FF:105.77 FT 104.19 FF:102.67 98.86 -099.53 96.30 a'��
PAD.105 10 PAD:103.5 PAD:102.dd r `� 24' - 18" RCP @ 0.14%
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- . INl/5YF z�
DESCRIPTION: LOT 8, BLOCK 11, ABBOTT SQUARE PHASE I B,
ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89,
PAGE(S)57-62, Of THE PUBLIC RECORDS OF PASCO COUNTY,
FLORiDA-
PROPOSED ELEVATIONS AND GRADING
SHOWN HEREON ARE TAKEN FORM THE
ENGINEERING PLANS OF
'ABBOTT SQUARE RESIDENTIAL',PREPARED
BY "WRAPROVIDED BY CLIENT
ALI: ELEVATIONS REFERENCED
TO NORTH AMERICAN
VERTICAL DATUM OF 1988
(NAVD 88)
I his SITE PLAN Prepared for and Certified To:
Lennar Homes
LOT
= 4809 SO. FT
LIVING AREA
= 952
SQ. FT.
ENTRY
- 32 --SO
FT,
GARAGE
= 396
SCL FT,
COVERED LANAI
= 104
SO, FT.
PATIO
- NA
SO, FT,
POOL AREA
= NA
SO, FT,
CONC. DRIVE
352
SO. FT.
AFC & CONIC PAD
- 10
SO, FT.
SIDEWALK
= 61
SO. FT,
SIDE YARD SWALE
NA
SQ. FT,
CONSERVATION AREA
= NA
SO, FT_
LOT OCCUPIED
= 41
%
_
AREA TO IRRIGATE
= 59
%,
= 2"' OAK
= 10,00' PUBLIC UTILITY EASEMENT
LEGEND:
_�PROPOSED DRAINAGE FLOW
(00,001 = PROPOSED GRADE
E-00.00 = EXISTING GRADE
NOTES:
LOT GRADING TYPE -B
PROPOSED PAD ELEVATION = 99-50'
FRONT SETBACK = 20-
SIDE SET BACK= T5'
SIDE SET BACK (CORNER LOT) =10'
REAR SETBACK = 15
PROPOSED:
MINIMUM FLOOR ELEVATIONS:
LIVING AREA: 100.17'
GARAGE AREA:
ELEVATIONS REFERENCED TO
NORTH AMERICAN VERTICAL
DATUM OF 1988
SITE PLAN
(NOT A SURVEY)
iCDD) RIGHT-OF-WAY
TRACT "A"
TEN ACRE COURT
_.„,._.v_____
BASIS OF SPARING i
SEC, 4, TWP, 26 S, RING 21 E.
PASCO COUNTY, FLORIDA
(ABBOTT SQUARE)
4�
Scale: 1 " = 20'
` 4,
,,.' S 89°4S 16" W (P) 39,96' (P) ..
- ..•CPN'C WA L K
PC
S 89'45-16` W (P)
95,05' jP)
----
?tii
3 # I
_
CONK t". 19_3' 7 5'
WALK
O
O
7.S',", ENTRY
LOT 7 0
5.7' }
a
BLOCK 1 i
�
m
PROPOSED
( 2 STORY RESIDENCE
PLAN 2074 c
o
ELEV "A" o
o
GARAGE
LOT 8
�qg�A
BLOCK I 1
f
99
L
_.
— - -
i
LOT 9
d 13,C)
BLOCK 1 i
LOT6
° N
BLOCK i 1
TIS " 13.0 12.0' 7.S'
_._
3.2X3.21,
C`S-AFC v._
----------
LOT 5
BLOCK i I
�y1\ N 89'45'16" E (P) 40.14' }P) -/98)rv^---^-
TRACT "B-3" '
� ICDDI ACCESSJDRAINA KTANDSCAPE(
WALL MAINTENANCE AND FENCE AREA,
1 OPEN SPACE
1
I
APPARENT FLOOD HAZARD ZONE.'X' COMMUNITY NO. 120235
SURVEY ABBREVATIONS (MAP NUMBER 12101C-028 )-FJ EFFECTIVE DATE 09/26/2014
AI - ARC LFNI1,11 I (Dl DEED INV-DE T PC-PONTO CURVE RFCORD LEGEND
ATC-�AIICONI HONER )F DRAINAGL f ASPIEN d .ICENSDM_SNESS PCC PONTO COMPOUNDCTEET NG - PANGS VINY�rENCE
A ^ALUNV M FNCf: ^CCNC
[ OR �L V LEVA1tON F !4N nS A E CASEIJ N, FCF lIMA NT CON RO. }OW RRE-RAIL ROAD SPIKE
9 :-,,AS '-. OOD.I.EVA Oh COR 6EDGE0 PAVEMENT -- LOWS tOOIi FL VATICN P/E POOI OU:PM,EN- R/W-R[Drf OF WAY
3M - PENCH MARII ( FM T • EASEMENT S - LICENt D SURVEYOR I G - PAC . SEC: • If CTION W'�OD CENCI
( CURV I C-FENCE CORN:R (M ^MEASURED PIS ON OF LET ERSECTION SN&D"S 7NAI.ANDUCK ASPHALT —'--
IC C/'.LCULATtD ECM -EDIND CONCRETE MES- MTROEND VC`ON PI<PARKER"ON 1[31IAtR3
LENT RI NE CF A.N. N(EENCi
CHAIN t�iCF _N :E MONUMLN NC' -NC CORVFI �OU`Ip PROPERTY LINE SIR -SE 1 2 DONE ROD L1348183
MP= CORRJGAT_J A.ErA i [ FI `Ot ND RONYPE EPA =OV`RA POETPOINT OF EC.NN;NG TWO -T M.ORARY 8DNCPi MARK �y8lIlCK _'-'H
cal"COLUMN Rm FOUNDRONROD OkIV-O-,E A-`>W'LTFC 'OC MINT Or COMMENCIMENT -OFE O-OF5ANK
C ONC-CONCRFTf -N&D- FOUND NAIL &DSK O.R. =0 ICOt Fe"ORDS PO. JNi ON ENE Wn OWNS`IP A.tUMlNUU FENCE
C/S RCONCR£iL TFFT FOP FOUND OPEN ITA (P -PLAT FRt POINTOF REVERSE CURVE 1. E^U11tT FAIL =COVERED
CST F CLEAR Sidi
iT TRIANGLE PP=FOUND PINCH"D P;PE PB ^PLAT BOOK PRM PERMANt MR FFRENCE MONJM, NT VFk VINYL FENCE
JOB P5610 SURVEYOR'S NOTES: SURVEYOR'S CERTIFICATE 1708 Water Oak Drive
1.) Current title information on the subject property had not been This certifies th ii"11111&t hereon destribed Tarpon Springs, Florida
Date of Site Plan: 7-12-22 a� f}g p
famished to Initial Point Land Surveying LLC at the time of this prop ertyv aa10 kx,�
rvision and Phone: (727)-831-1990
SITE PLAN ``�h
JW SAS -PHI -L -BLi I -SITE meetst a c yyifFloridaPL.S7123CsJgmail.corn2.) Thls sketch was prepared without the benefit of a title search. �$�;t LB# 8183No instruments of record reflecting ownership, easements or r�j9rights-of-way were furnished to the undersigned, unless otherwise 0 3,h=)orI a dm ,artl2
shown hereonour ant o Section 4 2 E,.27� Ftor}d
Drawn by: WE _ 3.) Roads, walks, and other similar items shown hereon were take to "t7 5J to ,G��8,
2hecked by JH 5p7hengineering
nSITE I LAN PLAN asubject�t f e a—ETblectct Io survey. I 1
_ 9 gP
or deterimtie ownership. 2%7 ?4 Q� �
4EVISIONIS '" a 3 is'
") Thu SI SQUARE PHASE Is shown on the Plat of
♦ iL DA � a:' E k .vl N tU&u�
6.) Dimensions shown hereon are in feet and decimal portions Jeff Mai ( '"" a Q [pie 7�
thereof. FLORIDA FR'f pp��rrSS)16�Lv o(meit@i'ORAND s.!
7.) Contractor and owner are to verify all setbacks, building MAPPER NO. LSi"AIU%%1dif�183
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 FT ORID P
deviation from information shown hereon. Failure to do so will be LICENSED SURVEYOR AND MAPPER Initial Point Land Surveying, LLC,
at users sole risk.
Address Parcel# 0 V- 4-L,: 0/ o - OVp v -
Lot Size—
�' Setbacks: Front )- Rea r_3 �_ Sides 7, �-
Elevation 'A
Garage—LL- I I j q11
Roof Single Dimensirs /Architectural_Lfi e-
\/R/\
v F1 T U A L R E V E "Al A S S
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
04-26-21-0150-01100-0080
Parcel Tax ID:
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 Finn: VIRTUAL REVIEW ASSI,5T, INC.
Private Provider: DEBRA ANNE KLAHR
Address: 747 SW 2ND AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601
Telephone: 813-376-3088 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 buildina that is the sublect of the enclosed Dermit aDDlication. as authorized bv s. 553.791. Flori(ola
UULIUIII�; 111b " 10 LV k-1 t%.1111 I IC COHIP11dRUX WIL11 LIX ** Pll'.�M)l UN, C'\UUPL to LQ11L NPMA11VU III NUM Id',
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 mao reX!uire more insurance to ocirotect nip interests. B0 executinpm this form I acknowled.le 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-, erivirommental or ether codes.
The following attachments. are provided. as required:
1. Qualification statements and/orresumes of the private provider and all duly authorized representatives
2: Proof of insurance for professional and comprehensive liability ° ..the. amount of 1 nvllion per
o ccurrence relating to all servici s performed as a private provider, including tail coverage for a minimum
of 5 years subsequent to the perforraa' ce pfbuilding code inspection, services.
Individual Corporation Partnership
Print Coiporation Dante Print partnership Name
By: By.
(signature) (signaure) (signature)
print Print print
Name, Name: Chrilsto her Smith Name:
Address. its. Authorized A ent its:
Address; 7O NNW 1 7 i i V Address:
elephone Miami FL 3317
moo.
Telephone. 'Telephone
No, 913-574-5700 No,:
Please use appropriate notary block.
STATE OF FLORIDA .
COUNTY OF HILLSBOROUGH
Wit]
peforeme, this day of
20. personally
appeared
who exeouted the foregoing instrument,
and aoknowiedged before me that same
was executed for the purposes therein
expressd.
signature
NotaryPublic 5tannp
Commission Expires:
or- Produced idenia cation 'Type of identification produced
p efore one, this day
of 20—
personally appeared
p er/agent onbebalf of
a partnership, who executed the
foregoinginstrument And
aclmowledged before me that me
PrintName ASHLFE QALLA AN
* *; CMhi4Si NN 2959�0 '
Page 2 of 2
VR/\
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 2nd Avenue
Gainesville, FL 32601
Phone: 813-391-2959
Email: I C @)y Lqgalrgviewassi�_tcor-1
Project: New SFR
Address(s): 6376 Ten Acre Ct
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: 4r
Name: Debra Anne Klahr
N
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Examiner
License #: PX2300
Signature of Reviewer:
SWORN AND SUBSCRIBED before 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
fo g g is true an, rrect to the best of his/her knowledge or belief.
ry
e of otary Print Name
Not Public: NOTARY STAMP BELOW My
[—COMMERCIAL BUILDING SERVICES DIVISION VIRESIDENTIAL
BUILDING PERMIT DATA SHEET
V
Building
Ellnyfqi2n C?n!.
WPlumbing
[:1 Inspection Only
VMechanical
El, Inspection Only
WElectrical Amp
Q Ins ection Only
01 Roof
El Gas
[:=
El Medical Gas
El Fire Sprinklers
El On Site Piping
El Fire Line
El Irrigation
El Fire Alarm
E] Potable Backflow Assembly
❑ Fire Line Rackflow Preventer
F1 Irrigation Backflow Assembly
[] Demolition
1:1 Walk-in Cooler
Refrigeration
0 Hood
Ansul
El Fence all
El Grease Trap
0 Other
Other
rm
Category:
Occupancy Load
an lassifleation:
C ey E
0W,Fac
,Factory
'Residential
Assembly E::�
'Hazardous E:=
KBus'ne,,, Day Care/Educational
'ti.
Inti nal Mercantile
nl� ny
Building Use: Single Family Alteration Level I I1(5 Level 2 P Level 3 D
VNew Construction El Interior Finish Interior Remodel E] Exterior Remodel [I Addition E] Revision
Overall Size:
25 x 62
Number of Stories:
2
Total Sq. Ft.:
2605
Living Area: 2073
Covered Area:
532
# of Bedrooms: 4
# of Baths: 2.5
Cost per square foot:
Estimated Value:
Roo e: mg e
Tile ❑ Built-up
❑ Metal ❑ Other Squares: 17
Zoning:
Wirorne
Debris:
-
lInside
E0,
Pf'Outside
Energy Code:
405-2020
Flood Zone: X Base Flood Elevation-, Finish Floor Elevation:
Hydrostatic Vents? Sq. Ft. Enclosed Space Below BFE:
# of Vents:
Size of Vents:
Total Sq. In. Permanent Openings
Central A/C
El Gas A/C
Heat Pump
0 Gas Heat
Window A/C
OXLectric Beat
RIT1,13TIM-211A =1
Sanity Sewer
Storm Sewer Catch Basins
Potable Water
Under round Fire Line
Front Rear Left Right
21 Asper Approved Site Plan
Comments: