HomeMy WebLinkAbout23-5934City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542
BNR-005934-2023
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 04/11/2023
Per! I it TI611 e: Bufldliz,% i
Res denrl
7 v�
04 26 21 0150 00600 0020 6275 Back Forty Loop
Name: LENNAR HOMES LLC-OWNER Permit Type: Building New (Residential) Contractor- LENNAR HOMES LLC
Class of Work: SFR Construct
Address: 4600 W Cypress St 200 Building Valuation: $231,360.00
TAMPA, FL 33607 Electrical Valuation: $34,704.00
Phone: (813) 574-5700 Mechanical Valuation: $16,195.20
Plumbing Valuation: $23,136,00
Total Valuation: $305,395.20
Total Fees: $20,165.01
r
Amount Paid: $20,165.01 ,-7
Date Paid: 4/11/2023 3:28:11PM
CONSTRUCT SINGLE FAMILY 1448 SQ FT
Transportation Impact Fee - City $36.32 Electrical Plan Review Fee $0i00
Irrigation 3/4 Meter (Ca1c) $794.92 Building Plan Review Fee $180.00
Public Safety Impact Fee -Admin $2635 Plumbing Permit Fee $155.68
Public Safety Impact Fee -Police $254.00 Building Permit Fee $1,196,80
Driveway Fee $45.00 School Impact Fee - Single Family $8,328,00
Sewer Connection Residential Fee $2,400.00 Plumbing Plan Review Fee KOO
3/4 Water Meter Fee (Cale) $794.92 Park Impact Fee - Single Family/Townhome $769.56
SIF 1 percent Fee $8128 Mechanical Permit Fee $120.98
Water Connection Residential Fee $1,140.00 Mechanical Plan Review Fee $0.00
Electrical Permit Fee $213.52 Transportation Impact Fee $3,595.68
Address Fee $30.00
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.
"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 PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
TOX
MIIIF110159 ''
813-780-0020 City of Zephyrhills Permit Application
Fax-813-780-0021
Building Department
Date Received
„
Phone Contact for Permittin
M....
908 770 _- 7763
,
Owners Name
CAL HEARTHSTONE LOT OPTION POOL 03 L P
Owner Phone Number 813,574,5700
Owner's Address
23g75 Park Sorrento„ Ste. 220, Calabasas, CA 91302
Owner Phone Number
Fee Simple Titleholder Name
I N/A
Owner Phone Number
Fee Simple Titleholder Address
I N/A
JOB ADDRESS
6275 Back FOrty I OOp
COT #
0602
SUBDIVISION
Abbott Square
PARCEL ID#
04-26-21-0150-00600-0020
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED
NEW CONSTR ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE 4 w SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL
DESCRIPTION OF WORK Single Family Residence i Pool 1 Screen Enclosure 1 Fence
u/Iz SF 1448 18°
BUILDING SIZE 1928 SO FOOTAGE HEIGHT
BUILDING $ 23136Q VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ 34704 I PROGRESS ENERGY W.R.E.C.
�1 AMP SERVICE y
PLUMBING $ 23136µY..__..
VALUATION OF MECHANICAL INSTALLATION
MECHANICAL $ 16195.2
GAS ROOFING SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES 1 r— 7
o
BUILDER COMPANY Lena" Il-mes, LLC
SIGNATUREAll" REGISTERED Y / N FEE CURREN Y / N
Address 43 Boy Scout Blvd Suite 600 Tampa, FL 33607 License # CGC1518166
ELECTRICIAN COMPANY EdmOnsn Electric, Inc.
SIGNATURE REGISTERED Y i N FEE CURREN Y / NN
Address I V License# EG13Q05408
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE REGISTERED Y f N FEE CURREN Y/ N
Address License # I OFC042998�
MECHANICAL COMPANY IByonet Plumbing, Hea�Y/
AC, Inc
SIGNATURE (T� REGISTERED Y / FEE CURREN
Address License #
OTHER COMPANY �terling Quality Roofing, Inc
SIGNATURE REGISTERED Y / N FEE CURREN Y / N
Address License # [CGC057991
91lIfYII11Wl111lIiillilllllll919Iis�Ii!lIt11116111181RdlIIB1018I998
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. (A1C 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)
Hereof, 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'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 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.
II&VII I" rej It] a 201:4 1174 1 :1 aam gin I A lm &-simuol; 1 :4111 -.40111AZIEM Igh-0111A I AII I'll, I Z11 11013illy"Jilt 1 1!
OWNER OR AGENT _ ___,_ CONTRACTOR
Subscribed and sworn
r0tOr�aJrma�)beToremethis
Subscribed and sworn to (or affirmed) before me this
112023 by _C �nsto her Smith by oph --Zhris er Smith
L -- --,
Who islare personally known to me or kaet# wef educed Who is/are ersonall known tome or has/have produced
as identification. as identification.
----Notary Public Notary Public
Commission G 296057 296057 Commission No. /,�G� 6 7
Stephanie Farmer Stephanie Farmer
Name of Notary typed, printed or —stamped— Name of Notary typed, printed or stamped
ELMSAK HOLLEW ELIUAKNOLLEMN
oolfmj"n # 1414 OMO onHM
�,k !w- SAWftT0yftW=o$*3W14%
Permit No.
Date Permitted �4— 2-"
Builder Name/Owner Marne 1 fA_kf_ ..
Control
County Parcel No. t � 5 ? "`� �
.�01SubDlv..__
,Address/Location �t.Ck
Classification/Type of Use � G
TRANSPORTATION IMPACT FEE Rate.
Sq. Ft Emit: �
Exempt Yes No How Determined
Impact Fee Amount Zone
No, TAZ:
SCHOOL IMPACT FEE
Account (056) Single -Family Detached House
Amount
(057) Mobile Home
(058) tither Residential
(123) Collection Fee
Exempt =Yes = No How 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
LIBRARY FEE
Land Account Land Credit
Land Total
Facility Account Facility Credit
Facility Total
Exempt 0 Yes No How Determined
Total Amount
RESOURCE FEE
ERU
Total Amount
Prepared By ( Checked By
CERTI TE t�F OCCUPANY WILL RE ISSUE R FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND RECEIP'TED 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.
DATE RECEIVED BY
RECEIPT NO _ DATE 6Y
1-15
'E 9 CURB INLET
1:95,20
1:95.03
RCP(W)IE:90,95
1-16
'E 9 CURB INLET
1:94.99
1:94.83
RCP(S)IE:88.69
RCP(E)IE:90.72
RCP(N)IEM.19
1-17
'E 9 CURB INLET
1:94.58
1:94.41
RCP(S)IE:90.03
RCP(E)IE:90.03
1-18
'E 9 CURB INLET
1:94.58
1:94.41
RCP(W)JE:90.10
1-19
'E 9 CURB INLET
):94.99
1:94.83
RCP(W)IE:90,79
7-20
'E 9 CURB INLET
):94.98
1:94.81
RCP(S)IE:90.78
KIIVI:J7.t3b
18" RCP(NW)JE:91.58
18" RCP(E)[E:88.92
SD11-8
TYPE 'C'DBI
EOP:94.50
RIM:94.50
18" RCP(SE)IE:91.85
SD11-14
24" FES
EOP:92.25
RIM:92.25
24" RCP(N)IE:90.00
M�i
TyPE `A " FF:97.77
PA6:9�.j
92'- 18" RCP @ 0.300/.
1
P—"95-87
MATCH LINE
SEE SHEET C212
Vf
28' -
60" R
rrs
—24'-18"
RCP @ 0,30
1
TYPE'B'
'E'E'
)7,47
FF:97A7
I
�96.80
PAD96.80
?4
25
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DESCRIPTION: LOT 2, BLOCK 6, ABBOTT SQUARE PHASE I B,
SITE PLAN
SEC, 4, TWP. 26 S, RING 21 E.
ACCORDINGTOTHE PLATTHEREOF, RECORDED IN PLAT BOOK 89,
PASCO COUNTY, FLORIDA
PAGES 57-62, OF THE PUBLIC RECORDS OF PASCO COUNTY,
FLORIDA.
(NOT A SURVEY]
(ABBOTT SQUARE)
LOT = Z.3�SQ. FT.
CURVE DATA (P)
LIVING AREA = 144$_SQ. FT- CURVE RADIUS
ARC LENGTHY CFIPRD ENG7H' CHORD BEARING
pELTA ANGLE
PORCH =_SQL F7. C47 675.00'
43.70 -
43.G9'
S 06't9'32° E
3'42'33"
GARAGE =SQL FT.
_..
COVERED LANAI = N/A SO. FT.
PATIO =_SQL FT.
POOL AREA = N_ jq _SO. FT.
CONC. DRIVE-a2Q_SC L FT.
A/C & CONIC PAD = I2 SQ, FT.
Scale. 1 = 20
SIDEWALK = 49 SO. FT,
LOT SOD = N(A _SQL FT.
R/W SOD = N1A _SO. FT.
LOT OCCUPIED = 45 SS
_
AREA TO IRRIGATE __ go
6'" I
i
I 1 71
(CDDj RIGHT-OF_WAY
LOT 1
BLOCK
i 7ps
2 INa ii 55.E.....
TRACT"A"
GARDEN ALL AY
I
S &5'3145 W iPI 111.00 (P)
. 2 o
N 89'48'04" E (P)
fFj i
23,2.
65.0
o
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P1 a
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F c7 P
O O U
LOT 2
BLOCK 6
,a
PROPOSED 1u
t STORY RESIDENCE
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m?
Z? RR r) ^?
3.o'X6-0' 10
PATIO. b
P)"pN 1450 9.0'
ELEV "B' o
GARAGE R
I 3 1
)i CONC
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0
ENTRY 4.0'�
WALK
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Py
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12"� BEp1RtN00
m
Sgi,
6 SS
,
LOT 3
6
\1
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I
I
II
BLOCK
NOTES:
LOT GRADING TYPE --A
PROPOSED PAD ELEVATION -= 97.50'
FRONT SETBACK = 20'
SIDE SET BACK - 7 5
This SITE PLAN Prepared for and Certified To:
SIDE SETBACK (CORNER LOT � 10
Lennar Homes
REAR SETBACK" i5'
PROPOSED:
� = t0-00' PUBLIC UTILITY EASEMENT
i ALL ELEVATIONS REFERENCED 1,
MINIMUM FLOOR ELEVATIONS:
i To NORTH AMERICAN I
LIVING AREA:98. 17'
VERTICAL DATUM OF 1988
LEGEND:
(NAVD 88)
GARAGE AREA:
ELEVATIONS REFERENCED TO
_ -- PROPOSED DRAINAGE FLOW
NORTH AMERICAN VERTICAL
(00.00) - PROPOSED GRADE
PROPOSED ELEVATIONS AND GRADING
DATUM OF 1988
E-00.00 -= EXISTING GRADE
SHOWN HEREON ARE TAKEN FORM THE
ENGINEERING PLANS OF
`ABBOTT SQUARE RESIDENTIAL', PREPARED )
APPARENT FLOOD HAZARD ZONE: "X` COMMUNITY NO, 120235
BY "WRA- PROVIDED BY CLIENT
SURVEY ABBREVATIONS
(MAP NUMBER 12101C-0289-F,I EFFECTIVE DATE. 09/26/2014
AI^ARC I FNCTHIN)
^DEED
INV^:N\ RI
PC: -FUN r OF CURVE
At -REc ORD
LEGENDI-V,I,N�YI `TOO, '
A C ^ AIR CONDIIIONER
A`^ALUMINUM ENCE
0 E- DRNNAC: [ASt MEN7
t -LICENSED BU SNESS
'CC O N' GF COMPOUND CURVE
PERMANENT
RNC * RAN< F
B E=EASE FLOOD ELEVA ION
E OR ELFV LEVA"cD,
!OR Four G' PAVI MENT
-IANDtCAPL EASEM NT
---LOWEST FLOOR t IEVATION
PCP CONTROL 90'NT
P/E POOL EQUIPMENT
RRS=RA1 ROAD SPIKE
1AC/-RIGUI Or WAY
.; <-GONG
lM^BENCHMARK
SM'T URR MENI
Su LICENSED SURVEYOR
G PAGE
SEC-S C.IQN
WOOD FENCE
< I AvE
LC FENC CORNER
jRS-MEASURED
PI-PON OF INTERSECTION
SN&Q St NAIL AND DISK
...: - ASPHALT —"—
I<7'-CAI ✓,fl 0)
I ENTFRI1
CM - EOUND CONCREIE
MES r all FRED END SECTION
PK -PARKER KALON
LBI8183
0 PAIN LINK FEND
CI F e 0 IAIN LIN< rENCE
MONUM Nt
- EOuNa RON PIPE
NCF^ND CORNER FOUND
OTA- OVERALL.-
a PROPERTY LINE,
PQB PON OF SEGNNING
SR - SE 1"IRONI ', LAN Bi83
TERI" TCM ORARY BENCHMAR!<
BRI(K ---x- -le— --
M'ACOR2UCAEDMETA�PtPtFIR
FOUND NON ROD
OHW- OVERHEAD WIREC)
°OC POINT OF COMMENC 1 MENT
TOBm TOP OF BANK
CON=CO MN
<ONcm CQNC2EiE
FN&D-FOUND NAIL A DISK
OR-O`FICIFLLRECORDS
°OL POINT ON LINETWP
- TOWNSHIP
ALUMINUM FENCE
c-K-CONfREI SLAB
Or - FOUND OPEN PIPE
KI -PIAT
PRC PONT OF REVERSE CURVE
U.I,-U-If.TY ASEM.ENT
=COVERED �\ _
fS a CGFAR S 6 ,,TRIFlNC E
FPP RFOUNDIDI-IDPi°E
I _'LA!BOQX
PRM PeNMANEM RCEERENCE MONUMENT
VE- VINYLFENCF
;JOB lhsso8szowz
SO V R'S I40TES:
1.) Current title information on the subject property, had not been
SURVEYORS CERTIFICATE
This certifies that sketch of the hereon described
1708 Water Oak Drive
Tarpon Springs, Florida
lJate Sit¢ Flan: 1 Z-30-ZZ
of
furnished to Initial Point Land Surveying, LLC, at the time of this
wa property ; 1U}��dtpgylsupervision and
Phone: (727)-831-1990
i B-L2-BL6-SIT I_
SITE PLAN
2.) This Sketch was prepared without the benefitofatitle search-
No instruments of record reflecting ownership, easements or
rights -of way were furnished to the undersigned, unless otherwise
shown here...
meets Ul Ms e rIWV; Practice for
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sur'T-and of Land
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on
FlorldaPLS7123@ mail.comDWGAS-H
LB�Y B 183
}f
Pile
Drawn by DJB
3.) Roads, walks, and other similar items shown hereon were take
"e cidte�.p.Q..7
Checked by JH
from engineering plans and are subject to survey.
4. This SITE PLAN does not reflect nor determine Ownership,
)
t
00825 �,}4'QO
P�
�U"~¢ daiTF ` 1 c �nY%
REVISIONS
S.) This S{TF. PLAN is subject to matters shown on rile Plat of
"ABBOTT SQUARE PHASE 1 B-
- -r✓-ds -L -R -
PP^^��'''�
6.) Dimensions shown hereon are in feet and decimal portions
Jeff M
FLORIDABFPP:aj,,E %� �11R/RAND
thereof.
PER NC7!4j 'FL
7.) Contractor and owner are 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 ofany
SIGNATURE AND SEAL OF A FLORIDA
++''
deviation from information Shown hereon. Failure to do so will be
LICENSED SURVEYOR AND MAPPER
Initial Point Land Surveying, LLC.
at user's sole risk
Pa rce I M Ll CO) o - 0 (10 0 — 0 o
/ 0 0 - I
Address: t-r, " " /-0
Setbacks: Front ear - Si (�) 7,6, filk) c)-
Elevation: A Garage: K
Roof Single Dimension/Architectural:
-RA
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
Project Name: 6275 Back Forty Loop
04-26-21-0150-00600-0020
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.
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Address: 747 5W 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 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
buildin -cliance with the &%'plicable codes, exceLe to the exte"cecified in said law. g insiXections to determine coni�-
Instead, plans review and/or required building inspections will be perfon-ned 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 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. 5 5 3.7 9 1, 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 attar. eats are provided as required:
1. Qualification statements and/or resumes of the private provider and all duly authorized representatives,
2., goof of insurance for professional. nd comprehensive 1 abilit y in -,the, amountof $1 million per
o ccurrence relating to all ser&&S p6if-oimed as a private provider; including tail coverage for. a minimum
of 5 years subsequent to the pmfprinance.of building code inspection s-ervices.
Individual
.(signature}
Print
Name:
Address;
Telephone
'Please use appropriate notary block.
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Individual
B rforD me, this day of
20—personally
appeaiDd
who .executed the foregoing instrument,
and aeknowledged before m5 that s ' ame
was executed fox the purposes therein
expressed.
C!prporation
Print CoiporationNmne
(signature)
Print
,Name--��h �15to �her S�rnith
its: Authorized Eggat-
AddressJ,00 NW 107th AVe
Miarnj,FL 33172
Tel6phono,
No. 813-574-5700
Corporation
Be,foreme,thi-g 22ND day of
MAY 2o 2.2
personally appeared
Of
Lennar Homes LLB a
corporation, ott
behalf of the state rorp Or alion, who
executed the f6mgoing instrument and
aclaio-wlgdged b Df= me that same was
executed for the pmpPses1bpxein,
exprosseI
By;
print
Name.
.JtsP
Addra,ss:
Telephone
No.:
B efore me, daisday
of 20
personally appeared
p artnex/agent on behalf of
apartnership,whDexecutedtho
foregoing instrument �nd
aci6iow1odgBd btfoxerne that same
;Personally known X or -Produced-idexti:�, Getion Type of idDntifloa*tionproduce-d
Signature ofNotaxN PrirrtN e ASHLEE CALLAHAN
Notary Public Stamp;
ASHLEE CAL AN
commission Expir m MY COMMISSION # HH 295980,
EXPIRES: November 30, 2026.
VR/\
VIRTUAL REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Finn: Virtual Review Assist, Inc -
Private Provider: Debra Anne Klahr, BU 1967
Address: 747 Southwest 2nd Avenue
Gainesville, FL 32601
11hone: 813-391-2959
Email: lu��& irtualrevie'"Tassist,com
MMEMEEMM
Address(s): 6275 BACK FORTY LOOP
ROOM_ OWNER,=- am -
and holds the appropriate license or certificate:
Name: Debra Anne Klahr
Plan Sheets CS,Al,A2,A3,A4,A5, A6, SNO,SNI, S3,S4,S5, SS ' STSl l,Sl2,WPl.0,PAl.0,PAI. 1,
PAI.2,PAI.3,PAI.4, SHI.0,SI-11.1,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: "0nk
/1
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
oregoing Lis true and correct to the best of his/her knowledge or belief.
A
Signature of Notary Print Name
commission expires:
d'W'W4V"
ASHLEE CALLAHAN
My COMMISSION # HH 296980
-W
EXPIRES: NoveniW 30,2026
[—COMMERCIAL ERCIAL BUILDING SERVICES DIVISION RESIDENTIAL
BUILDING PERMIT DATA SHEET
TRACKING # FIRE MARSHAL, #01 - DATE: 3/25/2023
FOLIO # 6275 BACK FORTY LP EXAMINER: Debra Klahr P 230C
Required Permits
Build n Plumbing Mechanical Electrical Amp
01 Ins ection Onl Ins ection Onl �] Ins ection On ins ection tJnl
Roof El Gas 0 Medical Gas [ Fire Sprinklers
❑ On Site Piping 11 Fire Tine E] Irrigation El Fire Alarm
❑ Potable Rackflow Assembly E Fire Line Bacliflow Preventer 1:1 Irrigation Backflow Assembly El Demolition
El Falk -in Cooler 0 refrigeration jl Hood ❑ Ansul
El Fence all D Grease Trap E] tither ® Other
Buildin Data
T e Con t coon; V-8 Risk CategoryOccupancy Load
O anoy lassilicati€an: "Assembly business ay Care/Educational
M
Factory 'Hazardousnstitutional [;Mercantile
tResidential Rm) Storage Utility
Building Use: -�.INGLE FAMIL.YPESII)ENCE Alteration Level 1 � Leve12 Level 3
® New Construction E] Interior Finish El Interior Remodel El Exterior Remodel ® Addition ® Revision
Overall Size: Number of Stories: Total Sq. Ft.:
30 X, 65 1 1928
Diving Area.: 1448 Covered Area: 480 # of Bedrooms:
# of Baths: 2
Cost per square foot: Estimated Value:
Roof e:� Shun le rile uiii®h Metal ❑ Other S cares: 2
Zoning: Wi o e Ilel�ris: Energy Code:
'Inside ;Outside 40 -2022 �l�P
Flood Zane: X Base Flood Elevation: Finish Floor Elevation.
Hydrostatic gents? :Yes No Sq. Eta Enclosed Space Below IIFE:
# of Vents: Size of Vents: Total Sqm Inc per anent Openings
Ventral A/C ®bleat Pump ® Window A/C
® Gas A/C El Gas Heat Electric Heat
Rear Left
As per Approved Site Plan
1