HomeMy WebLinkAbout23-6070City 1
v
5335 Eighth Street
Zephyrhills, FL 33542
-006070-2023
Phone: (313) 730-0020
Fax: (313) 730-0021
Issue late: 05r02r2023
PermillBuild! 111lew Residential
��\}\\\t \t
,\y':11Vv
04 26 21 0150 00600 0210 6246 Back Forty Loop
y' ytrifotn v �,r yv. vy a,1il��y
Name: L NNAR HOMES LLC Permit Type: Building New (Residential) Contractor: LENNAR HOMES LLC
Class of Work: SFR Construct
Address: 4301 W Boy Scout Blvd 600 Building Valuation: $282,120.00
TAMPA, FL 33607 Electrical Valuation: $42,318.00�
Phone: 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
Gate Paid: 5r2f2023 11:37:50AM
t�,p &\
,\:..
CONSTRUCT SINGLE FAMILY 1870 Sty FT
Mechanical Permit Fee $138.74 Plumbing Permit Fee $181.06
Electrical Permit Fee $251.59 Irrigation 314 Meter (Cale) $794.92
Driveway Fee $45.00 Plumbing Plan Review Fee $0.00
Public Safety Impact Fee -Police $254,00 School Impact Fee - Single Family $8,328.00
Transportation Impact Fee - City $36.32 Electrical Plan Review Fee $0.00
Public Safety Impact Fee -Admin $26.35 Building Permit Fee $1,450.60
Transportation Impact Fee $3,595.68 3r4 Water Meter Fee (Calc) $794.92
Park Impact Fee - Single Family/Townhome $769.56 Address Fee $30.00
Sewer Connection Residential Fee $2,400.00 Building Plan Review Fee $180.00
SIF 1 percent Fee $83.28 Mechanical Plan Review Fee $0.00
Water Connection Residential Fee $1,140A0
REINSPECTION FEES: (c) With respect to ReInspection fees will comply with Florida Statute 553.30(2)(c) the
local government shall impose a fee of four tunes the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greater, for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies,
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications add fee Must Accompany Application. All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY F C.O.
NO OCCUPANCY BEFORE C.O.
4iu,
CONTRACTOR SIGNATURE
PE IT OFFICE
t81"_7e0 20 City of Zephyrhills Permit Application Fax-813a80-0021
Building Department''
Date Received Phone Contact for Permitiir 90$ 1 770 _ 7763
Owners Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone Number 813.574,5700
Owner's Address 23975 Park Sorren#o, Ste. 220, Calabasas, CA 91302 Owner Phone Number
Fee Simple Titleholder Name N/A Owner Phone Number
Fee Simple Titleholder Address I N/A
JOB ADDRESS 6246 Back Forty hoop e�T # 0621
SUBDIVISION
Abbott Square
PARCEL ID#
04n28.21wt7150-C1t 600-021ti
(OaTAINEDFROM PROPERTY TAX NOTICE)
WORK PROPOSED
NEW CONSTR
ADD/ALT SIGN DEMOLISH
INSTALL
REPAIR
PROPOSED USE SFR
COMM OTHER
TYPE OF CONSTRUCTION II d U BLOCK
E:J
FRAME STEEL
DESCRIPTION OF WORK Single Family Residence / Pool / Screen Enclosure / Fence
351 1870 28`
BUILDING SIZE u/R SF 2SQ FOOTAGE HEIGHT
BUILDING $ 282120 VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ 42318 PROGRESS ENERGY W.R.E.C.
_ AMP SERVICE
PLUMBING $ 28212
1 1 (MECHANICAL $ 1g7� 4 VALUATION OF MECHANICAL INSTALLATION_ T p
� ae
=GAS ROOFING = SPECIALTY = OTHER L,
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA iYES10
BUILDERE!== COMPANY I Lennar Homes, LLC
SIGNATURE REGISTERED L_YI_N_j FEE CURREN �Y/N
4301 y Scout Blvd Suite 600 Tampa, FL 33607 CGC1518I66
Address License #
ELECTRICIAN r" COMPANY Jdmonson Electric, Inc.
SIGNATURE REGISTERED YIN FEE CURREN Y / N
Address License #
EC13005408
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE r....REGISTERED _Y /. N J FEE CURREN Y / N
Address License # CFGOA2998
MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE t REGISTERED Y/ N FEE CURREN Y/ N
Address License #
CAC058062 ���
OTHER COMPANY C Sterling Quality Roofing, Inc
SIGNATURE REGISTERED Y! N FEE CURREN YIN
Address License # CGO057991^�
IIIIIIIlIIIi11111IIIIII4CI71a�IIllileIIIIIIINttIIItOIIiIIltABIiIIIIII
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 subdivisionstlarge 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 wt 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. (AIC 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 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 I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment,
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses,
Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one(1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel,alter, or
set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
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 F CO ENCEMENT.
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT VV CONTRACTOR
Subscribed and sworn fb(or affirmed)before me this Subscribed and sworn to(or affirmed)before me this
3%2812023 _by Christopher Smith 3,2m023 by Christopher Smith
Who is/are personally known to me or Who is/are personally known to me or has/have produced
as identification, as identification.
Notary Public Notary Public
Commission G 296057 Commission
Stephanie Farmer Stephanie Farmer
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
9m:J
.6USSA H0L nt i #tilt' � ExplmsdunoB,2Q2d
„ �e srnnrmrnaats}srota
) ra A t..itr.a.
�^ PAD:97.54 � � _.�_. �. _._ . Zvi-Lv
( 5D21 7 1+t}3 `` 2+ 00
13+�
95.92
95.66 _
95.82
97 30 SD7-5 9 139' 6d"RCP @ 0.3 / MR260 RCP «}{Y,30% !WL 67`-36"RCP t
SD11 6
.r� �.,�,, .,,� ��
a FF:98.17IA 1 ESD76D " m ® SD7-7
rn cn rn m 51 -24"RCP@O.3O1
95.73 24' 1$"RCP @ 0.14% 24'-18"RCP @ 0.30%
97.22-'T'��77' 6d"RCP @ 0.30% 1
0 SD11-14
0
. 7,97 Ln TYPE`B as TYPE'B' TYPE B` TYP ' TYPE'B' TYI
PRt :97.30 SD7 4 FF:97 77 F€:97.77 FF:97.47 FF97.47 FF:97.57 FF:'
, 95.54 0 ' PAD:97.10 PAD:97.10 PAD:96.80 PAD:96.80 PAD:96.90 PAD
\ \ SD7-15 2 23 24 25 26
6:92 - L Q - � QR
83' 6 C 0"RP @ 0.301 o m at
s FF.97,9� 1
pAp:97.30 1 ` ,
96.37 95.8796.50 96:68 97.24 96:48
7 97.13 NT\ - B SITFE# CE
TYPE' - :
FF:97.97
TYPE A {� SD7-3 , PAD:970 It ' "`'w„-�.
FE:98.27 �
,� PAD:97.6 1 � ��. ,..,�� ,, _
I 96.00 97.23
MATCH LINE
SEE SHEET 0212
DESCRIPTION:LOT 21,BLOCK 6,ABBOTT SQUARE PHASE t 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 5782,OF THE PUBLIC RECORDS OF PASCO COUNTY, INOT A SURVEY)
FLORIDA. _ (ABBOTT SQUARE)
PROPOSED ELEVATIONS AND GRADING his SITE PLAN Prepared for and Certified To:
SHOWN HEREON ARE TAKEN FORM THE Lennar Homes LOT -
=,'4(7 FT SO.
ENGINEERING PLANS OF LIVING AREA 7$Q_SO.FT.
"ABBOTT SQUARE RESIDENTIAL-,PREPARED -- ---- ..... PORCH = ,SO,FT.
BY`WRA"PROVIDED BY CLIENT ': ALL ELEVATIONS REFERENCED GARAGE =443 SO.FT.
TO NORTH AMERICAN COVERED LANAI =N�SO,FT.
VERTICAL DATUM OF 1988 PATIO =)g SO_FT.
(NAVD 88) POOL AREA =5,55 SO.FT.
CONIC DRIVE =345 SO.FT. Scale: 1'=20'
A/C&CONCPAD =12 SOFT
SIDEWALK =35SO.FT.
LOT SOD =N/A SO.FT.
R/W SOD =N_Lp . SQ.FT.
LOT OCCUPIED = 31 SET
AREA TO IRRIGATE ' 69 /
4 PCP
1 i I I
) LOT 22 i LOT 23 LOT 24 I LOT 25
} BLOCK 6 I 4' BLOCK 6 I 4' BLOCK 6 BLOCK 6
N 89'4804"E IPI 117JS5'f P) 1 � 1
m m —�
ya
ce
C6
d
1 - ---� S0II'
O 4 !,Y� * OA1LK " 4.3'ENTRY PROPOSED
z STORY RESIDENCE 9 o LOT 21 o
PLAN 1871 o a 3.0`X6.0' w .n-,,o
0 N
ELEV"B' PATIO BLOCK 6
GARAGE R "O V w
1- C0Z
42-0 3.5X3.5 W L-1
X20 5 42.0' C/S-A/C 508' _ H
s - to —«- —"' g
2s.'IP1
'1•iD S 894747"W IP) 112.70'(P) ;.,i
i, O BASIS OF BEARING ia6.
LOT 20 I
I BLOCK6
u
I "r
NOTES:
LOT GRADING TYPE=B
PROPOSED PAD ELEVATION 97.30'
FRONT SET BACK=20'
SIDE SET BACK=75
* 10.00'PUBLIC UTILITY EASEMENT
SIDE SET BACK(CORNER LOT)=10'
REAR SETBACK=15' LEGEND:
--- PROPOSED DRAINAGE FLOW
PROPOSED' 100.00)=PROPOSED GRADE
MINIMUM FLOOR ELEVATIONS.
LIVING AREA:97.97 E-00.00=EXISTING GRADE
GARAGE AREA: CURVE DATA(P)
ELEVATIONS REFERENCED TO CURVE RADIUS ARC LENGTH CHORD LENGTH'. CHORD BEARING DELTA ANGLE
NORTH AMERICAN VERTICAL C65 b75.00' 47.86' 4785 N Ob'0401°W 4°03'44"
DATUM OF 1988 CO 67S.00' 29.97' 29.97' N 09°27'12"W 2`32'38"
APPARENT FLOOD HAZARD ZONE'X COMMUNITY NO.120235
SURVEY ABBREVATiONS (MAP NUMBER 12101C-0289-F)EFFECTIVE DATE:09/26/2014
AIa ACE INGiH ID)-DEED INV=INVEST PC=POINTOF CURVE IRI^RECORD LEGEND
ATC-AIR EON DI1tOYER OE DRAINAGE EASEMENT L3=LICENSE)9UISNES5 PCP-POINT OF COMPOUND CURVE RNA-RANGE VINYL FENCE
AE-A1.lJM.NUM FENC`£ CLORELEV-ELEVATION LANDSCAPE EASEMENT PCP PERMANENT CONTROL POINT SRS-RALROAD SPIKS 1, ,='t SONG
SC 5/551 0/ELF.VFlTI IN OP 01,,)'PAVEMENT ,FE=LOWEST FLOOR ELEVATION P(E=°DOL EQUIPMENT R(W.RIGHT Or WAY
BM=SENIl MAR K55'K ESEASEM SU G ENT ts-LICENSED RVEYOR PAGE SEC-SECTION WOOD FENCE
c=CURVE' /C-FENCE CORNER IMI=MEASURED PI='ONTO INTERSECTION SN&C1-5ET NAI,.ANDOSS AS'HALT -- \ — \ --
ICI-CAICULAE,9 CM-FOUND CONCRETE MPS-MTERED ENO SE ON PK=PARKER SALON LSO/83
a CEN NI MONUMENT NC`-NO CORNER FOUND K 'SOP VI NE SIR-SE 1(2'IRON ROD LBO S IS3 ERAS LINK FENCE
CLF-C'A', 55SENCE F!°-FOUND IRON PIPE O/A=OVERALL p01/ POINT OF SECrINNING TOM-TEMPORARY BENCH MARK IS 'P5 CORRUGATED META(.PiP FIR='0 NO RON ROD COW=OVERHEAD WIREISI POC=POINT OF COMMENCTMENT 'Coo=TOP OF BANK
COL=COLUMN FN&D-FOUND NAIL&DISK OR -OFFICIALRECORDS POL-POINT ON LINE WP OWNS)' ALUMINUM FENCE
CONE-00NCRETONS E SI FOP-FOUND OPEN PIPE (P) -PLAT PRE=POINT OF REVERSE CURVE U.E-UTILTY EASEMENT }�+ I-COVERED \ _
C/S=CONCRSIGHTIARI FPR=FOUNDPINEI1EDPIPE PB^PLAT BOOK PRIM-PERMANENT REFERENCE MONUMENT VF=VINYLI-ENCI ill
CST CLEAR SIGN'1_TANGLE
'JOB#159(1&520621. SUPRVEYOR`S NOTES: SURVEYOR'S CERTIFICATE 1708 Water Oak Drive
1.)Current title information on the subject property had not been
Date of Site Plan 3-14 23 This Certifies that sk #the hereon described Tarpon Springs,Florida
furnIshed
PLAN meets
Initial Point Land Surveying,LLC.at the time of this property wa u g 4 q�tpervisiop and Phone:(727)-831-1990
DWGA4PH LI Lit BL.6SITE STE meets the F fjPjs�BfjPractIce for FlorfdaPL571Z3Cagmailcom
2.)This sketch was prepared without the benefit of a title search. some s Y 7 rd of Land LB#8183 'a `�
No instruments of record reflecting ownership,easements or C�
File: rights-of-way were furnished to the undersigned,unless otherwise 3 I a Ab }F
shown hereon. urs nt t Section 47,'. le
Drawn by DJB 3.)Roads,walks,and other similar items shown hereon were take �Sp Date: 7
Checked by,JH from engineering plans and are subject to survey. tq g
6 R �IPI
4.This SITE PLAN does not reflect nor determine ownershi T z
REVISIONS ) f aT C 4$: Q0' L .
5.)This SITE PLAN is subject to matters shown on the Plot of tU
"ABBOTT SQUARE PHASE TB Jeff M
6.)Dimensions shown hereon are in feet and decimal portions ----�p
. FLORIDA
thereof RC+F�RAND Q
MAPPER NO)E
7.)Contractor and owner are to verify all setbacks,building fil 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
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.
Plan Model Elevation
/ e71
Garage Lot Size Block t
New Development Check List
Parcel#n - f
Address:
Setbacks:Front - jS Rear L ffiJL Sides
Elevation: Garage:
Roof Shingle Dimension/Architectural:
VIRTUAL REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Firm: Virtual Review Assist,Inc.
Private Provider:Debra Anne Klahr,BU1967
Address: 747 Southwest 2nd Avenue
Gainesville,FL 32601
Phone: 813-391-2959
Email: licy` vi l eviewas ist.coni
Project:New SFR
Address(s):6246 BACK FORTY LOOP
I hereby certify that to the best ofn y 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 CS,A1,A2,A3,A4,A5,A6,A7,SNO,SN1, S3,S4,S5,S6,ST,SS,S 1 1,512,WP 1,PA1.0,PA1,1,
PAl.2,PA1.3,PAI.4,SH1.O,SH1.l,SI11.2,SFI1.3,SH1.4,SH1.5
Florida License/Registration/Certification#(s)and description:
FS468 Certified Standard Plans Examiner
License#: PX2300
Signature of Reviewer: t .
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
reg g is true and correct to the best of his/her knowledge or belief,
xgna ire ofNou Print Name
Notary Public:NOTARY STAMP BELOW My
commission expires:
�e Y C0MMI d N NH 29 os p,�o. XPIR :Novem r U,212
Notice to Building Official of
Use of Private Provider
Effective January 20,2003
Project Name: 6246 Back Forty Loop
Parcel Tax ID: 04-26-21-0150-00600-0210
Services to be provided: Plans ReviewX 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.
VIRTUAL REVIEW ASSIST,INC.
Private Provider Firm:
Private Provider: DEBRA ANNE KLAHR
Address: 747 SW 2ND AVE- SUITE 170,301,3574 358, GAINESVILLE, FL 32601
Telephone: 813-376-3088 Fax: N/A
Email Address(Optional): deb vi
Florida License,Registration or Certificate#: (LIC# 8U1967/ PX2300/ N4615)
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 1 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, envirorniental or other codes.°
The following attachments are provided as required:
1. Qualification statements arid/or resumes of the private provider and all duly authorized representatives.
2.:Proof of insurance for professional.and.comprehensive liability in the.amount-of$1 million per
occurrence relating to all services p rfothied as a private provider;including tail coverage for a minimum
of 5 years subsequent to the perforrriazaoe of building code an pection sorvaces,
Individual Corp oration Partnership
• LENNAR.HOLES L.LQ •-
PrintcolporationNanie PriutPartnershipName
By� By
,(signature). . (signature) (signature) 7
Print Print Print
Name. 1S sme: hr{St p ler SIIi`tth Narxie;
Address its;AOthort A rai Itsc
Address:700 NAP 107b Ave. Address:
Telephone iatfti L 33172
No.
Telephone, Telephone
No. 313-574-5700 No.:
Please use appropriate notary block,
STATE OF FLORIDA
COUNTY CAF HILLSBOROUGH
Individual Corporation Partnership
Beforeme,this day of Beforetae,thi22ND day of Beforeme,this day
20 personally MAY 2022,, of 4 2D __,
appeared personally appeared personally appeared
who executed the foregoing instrument of
and acknowledged before me that same Lenn r Homes LLQ p er/agent onbe3 elf of
was executed for the purposes therein corporaia.on,can
•e o2ressed., • brehalf of the state corporation,who a parthersbip,who executed the
executed the foregoing instrument and foregoing instrument t and
acknowledged before me that same was acknowledged before me that same
executed for the pmpos.es-therein was executed.forthepnrposesthereln
expressed. expressed.
Personally known X ore Produced rderlti cation Type ofidenfi oatzanproduced
Signatare ofNoJ @,U-tkPrintNaxue kSHLEE CALLAHAN
NotaryPublio Stamp
�� u
Expires ASHLEE
Commission Ex
p *: Y Go MISSION#HH 295980
":° EXPIRES.November 30,2026
COMMERCIAL BUILDING SERVICES DIVISION iRESIDENTIAL
BUILDING PERMIT DATA SHEET
TRACKING# FIRE MARSHAL#01- DATE: /2023
FOLIO# 6246 BACK FORTY LP EXAMINER: Debra Klahr PX230C
Required Permits
Building Plumbing Mechanical Electrical Amp
El Inspection Only El Inspection Only El dns action Onl ®Ins action Onl
Roof ❑Gas I El Medical Gas El Fire Sprinklers
El On Site Piping El Fire Line ®Irrigation El Fire Alarm
El Potable Backflow Assembly ®Fire Line Backflow Preventer ®Irrigation Backflow Assembly El Demolition
El Walk-in Cooler El Refrigeration ®Hood []Ansul
®Fence all El Grease Trap El Other El Other
Building Data
Type Construction: V�B Risk Category: Occupancy Load
Ognpancy Classification: Assembly jEusiness I1iay Care/Educational
Factory k3azardous nstitutional ®Mercantile
`Residential IR3 ;I D Storage I I ❑Utility
Building Use: SINGLE FAMILY RESIDENCE / Alteration ®;Level 1 ®Level 2 EiLeve1 3
New Construction Interior Finish ®Interior Remodel ®Exterior Remodel ®Addition ®Revision
Overall Size: Number of Stories: Total Sq.Ft.:
30 X 42 2 2351
Living Area: 1870 Covered Area: 481 #of Bedrooms: 4
#of Baths: 2.5
Cost per square foot: Estimated Value:
RoofType: Shingle ]Tile ❑Built up ❑Metal ❑Other Squares: 16
Zoning: Wi orne Debris: Energy Code:
E Inside :Outside 4052020
Flood Zone: X Base Flood Elevation: Finish Floor Elevation:
Hydrostatic Vents'r Yes No Sq o Ft,Enclosed Space Below I;FE:
#of Vents: Size of Vents: Total Sq.In,Permanent Openings
Central A/C ®Heat Pump El Window A/C
El Gas A/C El Gas Heat El Electric Heat
On Site Piping
Sanitary Sewer Storm Sewer Catch Basins
Potable Water Underground Fire Line
Setbacks
Front Rear Left Right
121 As per Approved Site Plan
Comments:
So.vr M Reset Ferm
Permit No.
Date Permitted O =
Builder Name/Owner Name I Control
County Parcel No. D �� SubDiu:
Address{Location 1
Classification/Type of Ilse
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit:_- _.____._
Exempt Yes EJ No How Determined
Impact Fee Amount Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $
(057) Mobile Home
(058) Other Residential
(123) Collection Fee
Exempt 13 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 = Yes J No How Determined Total Amount
RESOURCE FEE ERU
Total Amount
Prepared By Checked By
NO CERTIFI TE OF OCCUPANY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAD 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.
DATE RECEIVED BY
RECEIPT NO DATE BY