HomeMy WebLinkAbout23-5935City of Zephyffillis
ills \ti l �3i`$ Vii
5335 Street
Eighth
ephyrhills, FL 33542
Phone. (13) 730-0020
Fax. (13) 7 0-0021
issue date: 04I1112023
Permi tl f 1 � , � 1,
'Residential
7711177
s t'-II` i v: v., a�7v� f �.t asts: vtitit 4. },,;. pals r hau 3, l.t fitvi
O,..,..,,..
04 26 21 0150 00600 0030 6267 sack Forty Loop
Name: LENNAR HOMES LAC -OWNER Permit `type: Building New (Residential) Contractor: LENNAR HOME hL�
Blass of Work: SFR Construct
Address: 4600 W Cypress $t200 Building Valuation: $282,120.00 f
TAMPA, FL 33607
Electrical Valuation: $42,318.00
Prone: (813) 574-5700 Mechanical Valuation: $19,748.40
Plumbing Valuation: $28,212.00
Total Valuation: $372,398.40
Total Fees: $20,500.02
Amount Paid: $20,500.02
i?ate Paid: 4/11 /2023 3:28A I PAS
,...f CONSTRUCT SINGLE FAMILY 1870 Sty FT
Address Fee $0.00 Public Safety Impact Fee -Police $254.00
Water Connection Residential Fee $1,140.00 wilding Plan Review Fee $180,00
Irrigation 3/4 Meter (Calc) $794.92 Electrical Plan Review Fee $0,00
Sewer Connection Residential Fee $2,400.00 Plumbing Permit Fee $181.06
Building Permit Fee $1,450.60 Public Safety Impact Fee -Admin $26.35
Electrical Permit Fee $251.59 $IF 1 percent Fee $83.28
School Impact Fee - single Family $8,328.00 Mechanical Permit Fee $138.74
Mechanical Plan Review Fee $0.00 Transportation Impact Fee - City $36.32
Transportation Impact Fee $3,595.68 314 Dater meter Fee (Calc) $794.92
Park Impact Fee - single Family/Townhome $769.56 Plumbing Plan Review Fee $0.00
Driveway Fee $45.00
1PT€ FEES: (c) With respect to Reinspection fees will comply with Florida Statute 53,80(2)(c) the
local government shall impose a fee of four tithes the amount of the fee unposed for the initial inspection or
first reinspect€on, whichever is greater, for each subsequent relnpectionm
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, Mate 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. 1f 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 OCCUPANCYF .O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNATURE PE IT OFFICE
EXPIRESPERMIT IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION NOTICE
813-780-0020 City of Zephyrhills Permit Application
Building Department
Date Received
Phone Contact for Permittin 908 770
-TV_y_V - -"
Owners Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone Number
Owner's Address 23975 Park Sorrento, Ste. 220, Calabasas, CA 9 3302 Owner Phone Number
Fee Simple Titleholder Name N/A Owner Phone Number
Fax-813-780-0021
1 813,574,5700 1
Fee Simple Titleholder Address
I N/A
JOB ADDRESS
6267 Back Forty Loop
LOT # 0603
SUBDIVISION AbbottSquare
PARCELto#
04-26-21-0150-00600-0030
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED
H
NEW CON STR
ADD/ALT
SIGN DEMOLISH
INSTALL
REPAIR
PROPOSED USE
U�SFR
�
COMM
OTHER
A._.0
TYPE OF CONSTRUCTION tI v U BLOCK
FRAME
STEEL
DESCRIPTION OF WORK Single Family Residence / Pool / Screen Enclosure / Fence
tT/R SF 2351 1870 28'
BUILDING SIZE SO FOOTAGE HEIGHT
BUILDING $ 252120 VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ 42218� PROGRESS ENERGY W.R.E.C.
AMP SERVICE
lw� (PLUMBING $ 2$212
19748.4
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
GAS ® ROOFING E—] SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES I �--y
o
BUILDER COMPANY 1 ennar (Tomes, LLG
SIGNATURE REGISTERED Y / N FEE CURREN Y / N
Address pew W Boy Scout Blvd Suite 600 Tampa, FL 33607 License # CGC1518166
ELECTRICIAN COMPANY Edmonson Electric, Inc.
SIGNATURE REGISTERED L_ILN_j FEE CURREN Y I N
Address License # I EC13005408
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE REGISTERED Y ! N FEE CURREN Y / N
.v_ .�. ..® Y..®_.®
Address License# CFC042998
MECHANICAL gr" COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE}j REGISTERED Y J N FEE CURREN LY I N
Address License #
CAC058062
OTHER COMPANY C Sterling Quality Roofing, ;Inc�=SIGNATURE REGISTERED �Y / N FEE CURREN Y
Address License # CCC057991 �—��
�91t9I1lIIlI8H1LFIli9o9R[YtIIIEIB9@�198919Ft&IFBB91f1t1&681119919819
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 00) 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
01
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.
IZALVINiMMAUT L"WILOINILIZ104"T•
11 421
OWNER OR AGENT
Subscribed and sworn fe (or affirmed) before me
_1/21,'2023 _by Christopher Smith
Who is/are personally known to me or4hag4ave,4
identification.
Public
Commission Y9Z 9bu5/
Stephanie Farmer
Name of Notary typed, printed or stamped
9 ELIMAKHOUS"
14HO" ,I COMMIWO0
DomsJulte6,2024
, ffJ
Subscribed and sworn to (or affirmed) before me this
X-20,23 --—by Christopher Srarth—
Who is/are personally known to me or has/have produced
as identification
——,Notary Public
Commission No. 167r--
Stephanie Farmer
Name of Notary typed, printed or stamped
V, comm"M*Rfl Como
Permit No. T
�
�� 6�_'t_�-
Date Permitted
Builder Name/Owner Nacre
�
Control #
County Parcel No. r
{
l Subiv: '�t`0411
Address/Location
J
_
Classification/Type of Use
({,
d i
TRANSPORTATION IMPACT FEE
Rate:
Sq, Ft Unit:
Exempt 0 Yes 0 No Flow Determined
3Zone
Impact Fee Amount
No. TAZ:
SCHOOL IMPACT FEE
Account (056)
Single -Family Detached House
Amount $ _
(057)
Mobile Nome
(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 Now Determined
LIBRARY FEE
Land Account
Land Credit
land Total
Facility Account
Facility Credit
Facility Total
Exempt Yes
No Now Determined
Total Amount"
RESOURCE FEE
ERU
Total Amount
Prepared By r Checked By
CAE fICATE DF CIIPANY @P ILL RE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND R CEIPTED 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 BY
1-15
'E 9 CURB INLET
1:95,20
1:95.03
RCP(W)1E:90,95
7-16
'E 9 CURB INLET
1:94.99
1:94.83
RCP(S)IE:88.69
RCP(E)IE:90.72
RCP(N)IE:89.19
1-17
'E 9 CURB INLET
1:94.58
1:94.41
RCP(S)IE:90.03
RCFI(E)IE:90.03
1-18
'E 9 CURB INLET
1:94.58
1:94AI
RCP(W)IE;90.10
1-19
'E 9 CURB INLET
1:94.99
1:94.83
RCP(W)IE:90,79
1-20
'E 9 CURB INLET
):94,98
1:94.81
RCP(S)IE:90.78
Kflvj:jS.bb
18" RCP(NW)IE:91.58
18" RCP(E)IE:88.92
SD11-8
TYPE 'C'DO]
ECP: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
4'- 18" RCP 9 030
1 1 1
TYPE 113, I11,6 TYPE'B'
FF:97.47 FF:97.47
PAD:96.80PAD:96.80
4 25
_G
1
37 95.87 --T 1 96.50-
, T�-
MATCH LINE SEE SHEET C21
U
,-23
DESCRIPT'IONt LOT 3, BLOCK 6, ABBOTT SQUARE PHASE 1 B,
SITE PLAN
SEC, 4, TWP, 26 S, RNG 21 E.
ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89"
PASCO COUNTY, FLORIDA
PAGES 57-62, OF THE PUBLIC RECORDS OF PASCO COUNTY,
FLORIDA.
(NOT A SURVEY)
fABBOTT SQUARE PHASE 2)
This SITE PLAN Prepared for and Certified To:
Lennar Homes
LOT 5159 SOFT,
LIVING AREA 780 _SO. FT.
CURVE DATA (P)
ENTRY = 38 SQ. FT. I CURVE I RADIUS
ARC LENGTH - CHORD LENGTH CHORD BEARING
DELTAANGLE
GARAGE = 443 SO, FT C48 675.00'
24.99' 24.9850927'90"E
2°32'43"
COVERED LANAI = N{A ._SQ. FT. -
PATIO = 18 SO, FT.
POOL. AREA = N/A SO. FT.
CONC.DRIVE = 330 SO,FTScale.
1 = 20
A/C & CONIC PAD = 12 _SO- FT.
SIDEWALK = 34 SO. FT,
SIDE YARD SWALE N/-ASQ. FT.
CONSERVATION AREA - NSA SQL FT,
LOT OCCUPIED 32 %
AREA 7-0 IRRIGATE = 68 %
room
LOT GRADING TYPE _° A
PROPOSED PAD ELEVATION - 97.30
FRONT SET BACK - 20'
SIDE SET BACK 7.5'
SIDE SET BACK (CORNER LOT =10'
REAR SETBACK = t5
PROPOSED:
MINIMUM FLOOR ELEVATIONS:
LIVING AREA: 97.97'
GARAGE AREA:
ELEVATIONS REFERENCED TO
NORTH AMERICAN VERTICAL
DATUM OF 1988
SURVEY ABBREVATIONS
LOT 2
BLOCK 6
OF BEARING
BASIS . W IR1 i 9 1.00' jPl
12 --�-
269
1
S 81'44
�
�
NI
42a
3 5X3. C t"PR POSED
w o
OR Rg51QENCE
C/S-R/ 2 N 1871
ST R LEV
'' Co'
79
0 0 o R
30X6 b
pRTiO o
TRY 4.3 K
EN l
o)N
.�
yOT 3
6COCK 6
Y--!
ca'
m�
377'
t.n
ae 4 1�
�yyx� � n
�
1N
IP) 111 0o lP1
'°
LOT 4
BLOCK 6
� = 10.00' PUBLIC UTIL-TY EASEMENT
LEGEND:
— _..'y,- PROPOSED DRAINAGE FLOW
100.001 PROPOSED GRADE
E-40.00 =- EXISTING GRADE
APPARENT FLOOD HAZARD ZONE. 'X COMMUNITY NO. 120235
(MAP NUMBER 12101C 0289-F) EFFECTIVE DATE 09/26/2014
ALL ELEVATIONS REFERENCED
TO NORTH AMERICAN
VERTICAL DATUM OF 1988
(NAVD 88)
PROPOSED ELEVATIONS AND GRADING
SHOWN HEREON ARE TAKEN FORM THE
ENGINEERING PLANS OF
ABBOTT SQUARE RESIDENTIAL', PREPARED
BY'WRA' PROVIDED BY CLIENT
A ARC LFANTU
(DI - DEED
INV-EASE RT
- POINT OF CURVE
(RI^RECORD
LEGEND '
( ArC - AIR CONOTIONER
A rAtU NOELE
D E- DRAINAGE fASEME.N
ORE EV
A -LIONS FBUIShr55
LF=tfNDSCAPE tASE.MFNi
OF COMFOUNJ CURVE
,,°CC POINTRNG
PCP PERMANENT (Oh'RO. POINT
^ RANGE '
VINYL H-NCE
9 CONC
DH
FLOOD
Bhi.=BAS FLOOD ELEVATION
„LEVAPON
EO =EDGE OF PA
LEE LOWEST FLOOR VA'tON
00„QU-PMENT
R/W R GHO F SPIKE
Y,"'U
c-cueE MAR,e
C=CURVE
LSM EME
S=LIC VEY0.2
IG ACE
CIS -S Cfl(FN`WAY
fEC-SKFtON
WOOD FENCE
�
i ICI=CALCULATED
FENCECOR
/C ��M11C CORN�R
MEASURED
(MJ=M ASURCE)
D-
'i PON OI IN iERSECt•=ION
SN&D QSET NAIL ANDDSI(
��S'HAti----
CENTFRLN
f Us - FOUND CONCRETE
ME S ^ MI F2ED END SECTION
PK-PARKEP KALONLB-8
163
INN -INK FENCE
CNP CHAIN INK FENCE
CMP- CORRUGfl `O META
MONUMENT
TR
NCF-NO CORNER FOI;ND
0FW-O OVERALL
e PROPFRTYJN
FOB POINT OF BEGINNING
SR=SE "IRON ROD l Bn [f183
TOM= 1LMP012ARY BENCH NAR:C
'aR(CK -'--� --x-
CCu.=COLUMN
- FOUNDIRON ROD
FLR D RON
E
O'R -DFRAi
7
FOSpot PINTO. COMURC NC?MENi
TOP- TOP OFBANK
CONC-CONCRETE-
N&DF FOUND L&
RECORDS
O. R- =OF�ICrAt RECORDS
FOL- ONTONLWE
pot
TWP-TOWNEAS
AUMINUM FENCE
C/S, CONCR Tt SLAB
FAR -F FOUND
FO°-FOUND OPEN PIPE
OPEN PE
(P FPvli
PRC POINT O`2EV RS:CtJRVE
Uc=Milli EASEMENT
=COVERED
CST- CLEAR SIGHT TRIANGI t
.PP- FOUND PINCHED PIE
Pa-PLA'Boo,
IRM PERMANENT PERRENCEMONLEMENT
VF- Vi,naFENCE
JOB #15s0852.6 M -
SURVEYORS NOTES'
1,j Current title information on the subject property had not been
furnished to Initial Pant Land Surveying, LLC, at the time of this
SITE PLAN
2.) This sketch was prepared without the benefit of a title search.
No instrument, of record reflecting ownership, easements or
furnished
SURVEYOR'S CERTIFICATE
This certifies th�f� SI hereon described
C II td
property w�g44i�fic�#u�rj$ ervision and
meets th �1Xa�a4c- � >� 11R, cote for
rvey 1 d.of Land
)g ne
dli'1'r§(rg)t+Y
1708 Water oak Drive
Tarpon Springs, Florida
P-
Phone (727)-831-1990
FloodaPLS7123@gmaj. ER
LB# 8183
w
Date of SRe Plan t .5-23
CWC3:AS- -3' R �R Ere TE
File
rights -of -way were to the undersigned unless otherwise
shown hereon,
t 1
Bf.I
ursy4ant i Section 47 T s L % Flor a�
Pta
Y
Drawn by DJB
3.) Roads, walks, and other similar items shown hereon were take
's-p Date �.Q3_
Checked by:JH
from engineering plans and are subject to s17
urvey.
4. This SITE PLAN does not reflect nor determine ownership,A
"g�.'Q�
"y� z
,REVISIONS
f-q�)
6.) This SITE PLAN issubject to matters shown on the Plat of
�S ° r L IDA l
j
'ABBOTT SQUARE PHASE IB'
-----'PF--ft-----.:-----
Jeff M. H
j
6.) Dimensions shown hereon are In feet and decimal portions
thereof.
FLORIDA P tdfl1ssESSS(JjWB R AND
V
7.) Contractor and owner are to verify all setbacks, building
MAPPER NO. LS�AIs2�pr6{k'k?7�3
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
+"A
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.
New Development Check List
Pa rce I M 0 0 / 50
Address:
Setbacks: Front 1 -5 �- 10 , cl Rear , 9 -- , V Sides697,,S
Elevation: Garage:
e Dimen Roof sion/Architectural:
v R U A Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
Project Name: 6267 Back Forty Loop
04-26-21-01510-00600-0030
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.
Private Provider Finn: VIRTUAL REVIEW ASSIST, INC.
Private Provider: DEBPA ANNE KLAHR
Address: 747 SW 2ND AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601
Email Address (Optional): deb@virtualreviewassist.com
#
Florida License, Registration or Certificate #. (LIB 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 minitnurn 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'codo, land use-, envirommental or other codea,
The following attachments, are provided as required:
1. Qualification statements and/or resu=s of the private provider and all duly authorized representatives.
2.. Pro of of insurance for professional and comprehensive lialaility in.the.'amount of $1 million per
o ocurrence relating to all servirds pterfbimed as a private provider, including tail coveragD fora nrininnun
'no of 5 years subs Dquent to the performa' e,of building code inspection services..'
Individual Corporation Part)ier&Wp
LENNAR HOMES LLQ
Print Corporation Name PrintPartnership Name
By, -
(signature} (signature)
Print Print Print
NamD: Name. �hlsto�her �Srrfth Name:
Address; its: Authorized Aggnt lts-
address: _JQQ_hl 9 07th AyoAddress;
ekphonD Miami, FL 33172
Telephones Telephone
No, 813-574-5700 No__
'PleaWase appropriate notary block
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Individual
Corporation
B efbre me, ti is day of
Btforel0c,tbis 22ND day of
20� personally
MAY 20 2-2
appealed
personally appeared
who =outed the foregoing instrunient,
Of
and acknowledged before me that same
Lennar Homes LLQ
was exnaitf,-d for tine purposes therein
on
behalf of th6stata corporation, who
executed the f6regoing instrument and
acicuowledged before the that same was
executed for the purposes t1aprein
C)TresseI
)du
personally known X or- Produced idemi-_�oatlon Type of idrnUc a*tion produced
Signature of Notan,
PrbatName ASHL
ASHLEE CALLAHAN
NotaTyPublic Stamp;
W COMMISSION # HH 295980
EXPIRES: November 36.2026
commission Expires:
5�E
B afore me, this day
Of
pors6nally appeared
p artabr/agent on b Aalf of
apartnerSbip,WhDeXt*,r,Utt',dthB
foregoing instrument And
acknowledgDd before me that same
V r
VIRTUAI- REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Finn: Virtual Review Assist, Inc.
Private Provider: Debra Anne Klahr, BU 1967
Address: 747 Southwest 21d Avenue
Gainesville, FL 32601
Phone: 813-3912959
Email: I 4—viijualreviewassistgoTu
i4a —
Project: New SFR
Address(s): 6267 BACK FORTY LOOP
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
-followinN affiant, who is dans review (t�Iih Section 55 .791, Florida Statute
and holds the appropriate license or certificate:
Name: Debra Anne Klahr
IWINV461u, IMIXIIIIERIUMMOMMM
PAI.2,PAI.3,PAI.4, SHI.0,SHI,I,SHI.2,SHI,3,SHI.4,SHI.5
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Ex finer
License #: PX2300
Signature of Reviewer:
SWORN AND SUBSCRIBED beforemeby Debra Anne Klahr
being personally known to me,,,L or having produced as identification
and who being fully sworn and cautioned, state that the
4oreg is true and correct to the best of his/her knowledge or belief.
91
g' Si ature of No Irznt Name
Notary Public: NOTARY STANIP BELOW My
commission expires: ASHLEE CALLAHAN
My COMMISSION# HN 295M
EXPIRE& NOvember 30,2026
COMMERCIAL BUILDING SERVICES DIVISION
BUILDING PERMIT DATA SHEET
TRACKING # FIRE MARSHAL #01
FOLIO # 6267 BACK FORTY LP
Re c
uiidiu I`lumbin
El Ins ection On DI 'ec1. 0nl
Roof ❑ Cas
El On Site Piping [l Fire Line
El Notable Backilow Assembly Fine Luse Backflow Preventer
El Falk -in Cooler Refrigeration
El Fence all El Crease 'Trap
I2 ESIDENTIAL
DATE: 3/25/202
EXAMINER: Debra Klahr P-X230(
Electrical Amp
E] Inspection Qnl
[J Medical Gas El Fire Sprinklers
® Irrigation Fire Alarm
El Irrigation BackfloawAssembly El Demolition
El Hood EJ Ansul
El Other El dither
rlq�,it_
T e Construction: �®S Risk Category: Occupancy Load
tI ancyClassification: Assembly3sines lay Care/Educational
Faotory Hazardous nal ®Mercantile
clZ stidential � ❑Storage F',1usfi!utsio
Utility
Building Use: SINGLE FAMILY RESIDENCE / Alteration ;Level I Level 2 Level 3
El New Construction El Interior Finish ® Interior Remodel E] Exterior Remodel El Addition El Revision
Overall Size: Number of Stories: Total Sq. Fta:
30 X 42 2 2351
Living Area: 1870 Covered Area. 81 # of Bedrooms:
# of Baths: 2.5
Cost per square foot: Estimated Value:
Roof I e: X Shin le Tile uilt-u fetal [ gther S uares: 1
Zoning: WI orne Debris: Energy Coyle:
[=Inside Outside 4-2g22 SUP
Flood Zone: X Base Mood Elevation: Finish Floor Elevation:
Hydrostatic Vents? Sal, Ft. Enclosed Space BelowBEE:
# of Vents: Size of Vents: Total q> Irr, Terrrnazrerrt f�iaonirr s
[ Central A/C X Heat Dump 'Window A/C
Gas A/C 0 Gas Beat Eleetrie Heat
Front hear Left Right
2 As per Approved Site Plan
"� N"e