HomeMy WebLinkAbout92-2107
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788.6611
Permit
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2107E j
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0'L~ PLU~
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Date :J.. - '( - 7 cl
MEC~ Sewer Conn
Water Conn:
Parcel I. D. #
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
NO OCCUPANCY BEFORE C,O,
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o,
DATE
Inspector
Valuation or
Contract price~ O?:J .
c:ru
Pe,m;' F~ . OV
Signatur ~r-:.,
Company
Address
Telephone#
C4?j
City License Registration #
State Certified License#
Tp, Servo
Rough In
Meter Can
Const, Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Ftr.
Pre SLB
Lintel
FRM,
Insul. CL
WL
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons. a
charge of Fifteen and 00/100 Dollars ($15,00) shall be made for each trip for each trade:
a. Wrong Address
b, Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d, Work not ready for inspection when called.
e, Permit not posted on job site,
f. Plans not at job site,
g, Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
MECHANICAL
l.i~ Company
() State Cert. or Regist. #
;V!) ~~L--- City License Registration ;F
** **************************************
Signature
Company
Cert. or Regist. #
City License Registration #
Signatu
**************************~***************
APPLICATION APPROVED BY
PERMIT OFFICER.
~.
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CONDITIONS OF PERMIT AFFIDAVIT ·
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit 'Iay be subject to 'deed restrictions' which lay be lore restrictive than City
regulations, The undersigned assules responsibility for cOlpliance with any applicable deed restrictions,
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance Nith
state and local regulations, If the contractor is not licensed as required by'laN"both the ONner and contractor lay be
cited for a lisdeleanor violation under state IaN. If the owner or intended contractor are uncertain as t~ what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611,
( ~
Furtherlore, if the owner has hired a contractor or contractors, .he is advised to have the contractor(s) sign portions of the
"Contractor Sections' of this application for which they will be ~~sponsible. If'you, as t~,own!r sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work, If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES.
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of 'Florida's Construction lien law - HOleowner's Protection
Guide' prepared by the Florida Departaent of Agriculture and Consuler Affairs, If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described doculent and pro.ise in good faith to deliver it to the
'owner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated, I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction, I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance, Such agencies include but are not lilited to:
I Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive lands,
Water/Wastewater Treat.ent
I Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc,", it is understood that a drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to vinlate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a perait prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violatinns of any code. Every perlit issued shall beeole invalid
unless the work authorized by such perlit is eOlleneed within six lonths of issuance, or if work authori~ed by the perlit is
suspended or abandoned for a period of six lonths after the tiae the work is cO.lenced, One 90 day extension of tile, lay be
allowed fnr the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official, An
approved inspection aust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COK"ENCEKENT "AY 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
CO""ENCE"ENT, JOBS UNDER $2,500 IN VAlUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT",
STATE OF FlORID~
COUNTY OF , ~)
The foregoing ins~ment
before me th15,~ F;./J
was a~nOWledged
, 19 L by
cJ... ftuLI/ Id u FrS r /-1 TLE Ii!. l17T.f{
who is personally known to me or who has
produced Fl)J-.-tJ: Q ,~OO-~ - 55-'/O(
as identification and who did/did not
take al10a~ ~~
(Si~ture) ~ L .
NfTI'f _ ~WI J
(Name Typed, Printed or Stamped)
NOTARY PUBLI C
NOTARY PUBLIC, STATE OF FLORIDA
My commission expires J.;n. 23, 1995
Bonded thru Patterson - Elecht Agel1~
~~E. ~~
SIGNATURE: CONTRACTOR
STATE OF FLORIDA ~
COUNTY OF . ~_
The forege. i ng i ns tl~nt l>Jas ac kncll>ll edged
befcll-e me this '-~ --- hA., i9 9'.;L. by
LA-U/lfl flUFF ST{.,( rL€-,i (rJfl77y
who is personally known to me or who has
produced FD.;t'+I C 3 00 - S ':;;"J--- 5'5":; 70(
as identification and who did/did not
tak~~~ ~ ~~_
(Sig~ture) ~
4.Q Be. ,Z1l'1 !d. ..
(Name Typed, Printed
NOTARY PUBLIC
NOTAF?Y ru',!
!:Y Commie.'.;c,,;
onded t!;liJ
LewfJ
01- Stamped)
.;; !\fE OF FL .
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sf ee.l 0 0/ \ , +-".. _ c.. /' I YJ.-k-e I C.Du.. (' 5P
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Optional Metal Shoes or PT Plate
dur~icane Anchor
Truss Anchor
........
1-#5 or 2-#4 Rods Continuous
~ over openings
""Inspection Hole
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l , "[ ( L~ t
W rJ..-) ~.(' (' OM
rpo...\\ -t"'"t'e J
("l f!+fl.J . + 0 0 ('0 f d <;, '[ q
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1-t15 Rod
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Natural Solid
Ground
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Compac ted Fi 11
Poison SoU
8"
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16"
Rods in footer on upprovi:d ('1V1 irs
( All €orners )
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0 0 12". 0 . 0 /
1< 16 II -)/
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RESIDENTIAL
A. I-t15 Rod Bent and stubbed out of footing all corners.
B. 2-#5 Rods in footer
C. Rods in footers shall be place on approved chairs placed a max.imum of b'
o.c, and Tied. '.
D. Where rods are t"apped. shall be a minimum of 24" distance with two ties.
FORM 1000-C.91
SMALL ADDITIONS
AND RENOVATIONS
FLORIDA ENERGY EFFICIENCY CODE
FOR BUILDING CONSTRUCTION
Section 10 - Residential Prescriptive Compliance Method
Department of Community Affairs
Climate Zones
CENTRAL 4 5 6
COMPLIANCE WITH SECTION 10 OF THE FLORIDA ENERGY EFFICIENCY CODE MAY BE DEMONSTRATED BY USE OF FORM 1 OOOC-91 FOR ADDITIONS OF 600 SOLARE FEET OR LESS. AND RENOVATIONS
TO SINGLE AND MULTIFAMILY RESIDENCES. ALTERNATIVE METHODS ARE PROVIDED FOR ADDITIONS BY US FORM 1000A-91 or A-91
BUILDER:
RENOVATION
ADDITION
MULTIFAMILY ATTACHED D
SINGLE-FAMILY DETACHED D
5060
~
PROJECT NAIIE
AND ADDRESS: 2.
OWNER: ~
FOR ADDITIONS ONLY:
PERCENTAGE
OF GLASS
TO FLOOR
UNDER ATTIC:
R c
SINGLE ASSEMBLY
R =
GJ(j, D
ITJ,D
Ro ITJ,D
NEW GLASS AREA AND TYPE
CLEAR T1NUILM,SOLAR SCREEN
SO SINGLE- ITIIJ SO
FT PANE FT
SO DOUBLE- ITIIJ SO
FT PANE FT
FLOOR TYPE AND INSULATION
WOOD MASONRY
RAISE~ ~ ITJ. D RAISE~ = DJ.D
COM~O~ ITJ. 0 COMMRO~ []]
SLAB-ON- _ IT] V1
GRADE. R - ,~
IF MULTIFAMILY, NUMBER OF
UNITS COVERED BY
THIS SUBMITTAL ITIJ
CONDITIONED '
FLOOR AREA
PREDOMINANT
EAVE OVERHANG
LENGTH
PORCH OVERHANG
LENGTH
URJ%
WALL TYPE AND INSULATION
WOOD FRAME MASONRY
EXTER~O~ CD. D EXTE~O~ [RJ.D
ADJAC:~ CD. D ADJA~E~T CD. D
COMMO~ CD D COMMO~: rn
R , R .
CEILING TYPE AND INSULATION
COMMON:
DUCTS COOLING SYSTEM HEATING SYSTEM HOT WATER SYSTEM
IN ~. CENTRAL D NONE D ELECTRIC STRIP D HEAT PUMP D ELECTRIC D SOLAR
UNCONDITIONED D D D NATURAL GAS D HEAT RECOVERY
SPACE: R = ROOM NATURAL GAS ROOM/PTHP
rnJ. [(j D PTAC D OTHER FUELS D NONE D OTHER FUELS D OED HEAT PUMP
IN CONDITIONED D NO NEW SYSTEM D NO NEW SYSTEM D NO NEW .f} SF/EF 0 D.ITJ
SPACE: R 0 ~.~ COPIHSPFIAFUE = DrT-~ SYSTEM EF =
ITJ,D SEERI EER = NUMBER OF BEDROOMS - rn
ReView of plans and speCIfications co~ered by this calculation Indicates compliance with
the Flonda Energy Code. Before constr ction is completed. this bUilding will be inspected
for compliance In aCCO~d~n Ith Ion 553.908. F.S. ~
BUILDING OFFICIAL' ________
), - tf - cr &-
DATE
I hereby certify that the plans and specifications covered by the calculation are In compliance With the
Florida Energy Code.
TABLE 10A[ MINIMUM REQUIREMENTS FOR ALL PACKAGES
COMPONENTS SECTION REQUIREMENTS CHECK
WINDOWS 904.1 Minimum of 0.34 CFM per linear foot of operable sash crack (includes sliding glass doors). ~
EXTERIOR & 904.1 Maximum of 0.5 CFM per sq. ft. of door area: solid core, wood panel, insulated or glass doors only. 'I.
ADJACENT DOORS
EXTERIOR 904.1 To be caulked, gasketed, weatherstripped or otherwise sealed. -/...
JOINTS & CRACKS
SOLE & TOP 903.2 Sole plates and penetrations through top plates of exterior walls must be sealed. ~
PLATES
INFilTRATION 903.2 Infiltration barrier must be installed in exterior walls & raised wood floors. 'f
BARRIER
INTERIOR 903.2 All openings in interior surfaces of ceilings and exterior walls must be sealed. '1-.
JOINTS/CRACKS
FIREPLACES 903.2 Fireplaces must have flue dampers, glass doors and outside combustion air intakes. A)1f
EXHAUST FANS 903.2 Exhaust fans vented to uncondi1ioned space shall have dampers, except for combustion JM
devices with integral exhaust ductwork.
WATER HEATERS 904.2 Comply with efficiency requirements in Table 9-7A. Switch or clearly marked circuit breaker (electric) iliA
or cutoff (gas) must be provided. External or built-in heat trap required.
SWIMMING 904.3 Spas & heated pools must have covers (except solar heated). Non-commercial pools must have a Nfl
POOLS & SPAS pump timer. Gas spa & pool heaters must have minimum thermal efficiency of 78%.
HOT WATER 904.4 Insulation is required only for recirculating systems, including heat recovery units. 111 such cases, AlIi
PIPES piping heat loss shall be limited 10 a maximum of 17.5 BTUH per linear foot of pipe.
SHOWER HEADS 904.5 Water flow must be restricted to no more than 3 gallons per minute at 80 PSIG. AlP
HVAC DUCT 904.6 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, IA
CONSTRUCTION, sealed, insulated and installed in accordance with the criteria of Section 904.6. Ducts in unconditioned
INSULATION & space and air handlers located in attics must be insulated to a minimum R-4.2 (R-6 after 1/1/92).
INSTALLATION
HV AC CONTROLS 904.7 Separate readily accessible manual or automatic thermostat for each system. I'
RENOVATIONS 1003.0 Meets the requirements of sec. 1003.0. See step 3 of page 2 of this form. 'I,.
ONLY GLASS
-1 -
CLIMATE ZONES 4.5 ~
TABLE 10B. Prescriptive Requirements for Small Additions (600 Sq,Ft. and Less) and for Renovations to Existing Buildings,
COMPONENT MINIMUM INSULATION
INSULATION INSTALLED
Concrete R-5 Ri..,-
!) Wood frame, 2' x 4' R-l1
..... Wood frame. 2' x 6' R-19
~ Common, Wood frame' R-1l
Common. Masonry' R-3
In Under attic R-30 f<'30
<:I
z: Single assembly R-19
~
w Common. Wood frame' R-1l
0
In Slab-on-grade No Minimum ()
a:: Ra ised wood R-1l
0
9 Raised concrete R-5
.... Common. Wood frame' R-11
0 In unconditioned space 1991 1992 f{~
~ R-4.2 R-6
0 In conditioned soace No Minimum
'Common components are those which separate two conditioned living units in a multifamily building.
TABLE 10C, Prescriptive Requirements for Glass Areas in ADDITIONS ONLY (Renovations see 3 below)
EQUIPMENT MINIMUM INSTALLED
EFFICIENCY EFFICIENCY
1991 1992
...J = 10, Q)
0 Central NC SEER = 9.0 10.0 SEER
0
() Room unit or PTAC EER = 8.5 8.5 EER
=
c:l Electric Resistance ANY
z
j:: Heat Pump HSPF = 6.4 6.8 HSPF
<( = -
w
:::c Room unit or PTHP COP = 2.6 2.7 HSPFI = ~
w HSPF = 6.1 6.1 COP
()
<(
a.. Gas, natural or propane AFUE = .70 .78 AFUE =
en -
Fuel Oil AFUE = .76 .78 AFUE =
a: ~l...!
w Electric Resistance EF = .88 EF
I- = -...L!...
<(
3: Gas, natural or propane EF = .54 EF =
I- -
0
:::c Fuel Oil EF = .54 EF =
Maximum percentage glass to floor area allowed is selected by type, overhang length, and shading coefficient. See below. Maximum % ~stallif
%= JrJ
GLASS TYPE, OVERHANG, AND SHADING COEFFICIENT (TINTING) REQUIRED FOR GLASS PERCENTAGE ALLOWED
UP TO 20% UP TO 30% UP TO 40% UP TO 50%
Single Double Single Double Single Double Single Double
OH - SC OH - SC OH - SC OH - SC OH - SC OH - SC OH - SC OH - SC
l' - 1.0 0' - .90 2' - 1.0 l' - .90 3' - 1.0 2' - .90 4' - 1.0 3' - .90
0' - .86 l' - .86 0' - .70 2' - ,86 l' - .70 3' - .86 2' - .70
2' - .65
0' - .65 l' - .65 0' - .50 l' - .45 l' - .50
0' - .45 0' - .35 0' - .40
Shading coefficients (SC) may be obtained from the manufacturer of the glass. Typical shading coefficients are: single-paned clear
SC = 1.0. double-paned clear SC = .90, and single-paned tint SC = .86.
Form 1000C may be used to comply the following types of construction
SMALL ADDITIONS TO EXISTING RESIDENCES, Additions which have 600 square feet or less of conditioned area may comply with the Energy Code using this form. The prescriptive
requirements in Tables 10A, 1 OB and 1 OC apply only to the components of the addition, not to the existing building. Space heating, cooling, and water heating equipment efficiency levels must
be met only when equipment is installed specifically to serve the addition or is being installed in conjunction with the addition construction, Components separating unconditioned spaces from
conditioned spaces must meet the prescribed minimum insulation levels,
RENOVATIONS. Residential buildings undergoing renovations costing more than 30% of the assessed value of the building must comply with the Energy Code using this form. The
prescriptive requirements in Tables 10A and 10B apply only to the components and equipment being renovated or replaced.
GENERAL DIRECTIONS:
1. On the left side of Table 10B in the column titled "INSULATION INSTAllED", indicate the R-value of the insulation being added to each component. On the right side oITable 10B indicate the
efficiency levels of the equipment being installed in the column titled "EFFICIENCY INSTAllED" All R-values and efficiencies installed must meet or exceed the minimum values prescribed
in the preceding column for that component. Components and equipment neither being added nor renovated may be left blank
2. ADDITIONS ONLY. Determine the percentage of new glass to conditioned floor area in the addition as follows, Total the areas of all glass windows, sliding glass doors and glass panels in
doors which are more than V3 of the area of the door. Double the area of all non-vertical roof glass and add it to the previous total. When glass in existing exterior walls is being removed or
enclosed by the addition, an amount equal to the total area of this glass may be subtracted from the total glass area, Divide the adjusted glass area total by the conditioned floor area of the
addition. Multiply by 100 to get the percent. Find the largest glass percentage under which your calculated percentage falls on Table 1 DC. For example, 29% glass would qualify for the "Up to
30%" column. Prescriptives are given by the type of glass (Single or Double pane) and the overhang (OH) paired with a shading coefficient (sq, Any pair within the selected "Up To "
category is acceptable. For a given glass type and overhang, the maximum shading coefficient allowed is specified, Indicate the category into which the percentage falls in the box at the top
titled "Maximum % = ". In the next column titled "Installed", indicate the calculated percentage of glass in the addition. Actual glass windows and doors previously in the exterior walls
of the house and being reinstalled in the addition, do not have to comply with the overhang and shading coefficient requirements on Table 1 OC. All new glass in the addition must meet the
requirements for one of the options in the glass percentage category you indicated. The overhang (OH) distance is measured perpendicularly from the face of the glass to a point directly
under the outermost edge of the overhang.
3. RENOVATIONS ONLY. Only glass areas which are being replaced as part of the renovations need to meet the following requirements. Any glass type and shading coefficient may be used
for glass areas which are under at least a two foot overhang and whose lowest edge does not extend further than 8 feet from the overhang. Glass areas being renovated that do not meet this
criteria must be either single-pane tinted, double-pane clear, or double-pane tinted.
4. Complete the information requested on the top half of page 1.
5. Read "Minimum Requirements for Small Additions and Renovations", Table 10A on page 1, and check to indicate your intention to comply with all applicable items.
6. Read, sign and date the "Owner/Agent" certification statement on page 1.
2
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT L AU (Uq. e:. Co '-H-y
631'- .s~jsqmA DR
OWNER -H -AfW J d -s-, 9r- UU R-A 6, c.. 'H<.;
JOB LOCATION 53/ (., Sp;f~u f71FJ bf2, 21IJi / /.> LOT SIZE/ ()() X
PHONE
7?~-/j-:3 "/
ADDRESS
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D. #
WORK PROPOSED:____New Construction
~dition
____Alteration
____Repair ____Install
_Sign/Temp.
PROPOSED USE: ~le Family
_Sign
_Move _Demolish
_M/F
_IF of Units
_M/H
_Commercial
_Indust.
_Swim. Pool
Other
____Restaurant & Health Department Approval
/ /
BUILDING SIZE: /0 X /! , Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FOR~S.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED,
/'
____BUILDING
~CTRICAL
PERMITS REOUESTED
$
Valuation of Total Construction
AMP Service
Florida Power Corp.
_W,R.E.C.
____MECHANICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: FT,
******************************************
Signature
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
******************************************
BUILDER ~
ELECTRTCTAN
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
PLUMBER
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
Signature
l.i~ Company
() State Cert. or Regist. #
;'Vl) ~:4'.c--- City License Registration l~
** **************************************
MECHANICAl.
Company
Cert, or Regist. #
City License Registration #
**************************-***************
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. . NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlitlay be subject to 'deed restrictions' which lay be lore restrictive than City
regulations. The undersigned assuaes responsibility for cOlpliance with any applicable deed restrictions,
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor Dr contractors to undertake work, they lay 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 lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as t~ Khat licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (B131
7BB-6611.
,
Furtherlore, if the owner has hired a contractor or contractors, .he is. advised to have the cDntractDr(s) sign portions of the
'CDntractor Sections' of this application for which they .ill be ~~sponsible. If you, as t~,owner sign as the contractDr,
you are indicating that you, rather than the contractor, are responsible for the work. If the cDntractDr wishes you tD sign
as contractor that aay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
;- ~
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of 'Florida's ConstructiDn Lien Law - HOleowner's PrDtection
6uide' prepared by the Florida Departaent of Agriculture and Consuler Affairs, If the applicant is SDleDne other than the
'owner', I certify that I have obtained a copy of the above described doculent and prDlise in gDod faith to deliver it to the
'owner' prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that nD wDrk Dr
installation has cOlaenced prior to issuance of a perlit and that all work will be perforled to leet standards Df all laws
regulating constructiDn, City codes, zoning regulations, and land developlent regulatiDns in the jurisdiction. I alsD
certify that I understand that the regulations of other governlental agencies lay apply tD the intended wDrk, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are nDt lilited to:
f Depart.ent of Environlental ReQulation - Cypress Bayheads, Yetland Areas and EnvirDnlentally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY CDrps of EnQineers - Seawalls, Docks, Navigable Waterways
f Departlent Df Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in FIDDd ZDne 'A' Dr 'A,etc.', it is understood that a drainage plan
addressing a 'coepensating volule" will be sublitted which is prepared by a prDfessiDnal engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with the NDrk and nDt as authority tD viDlate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a pereit prevent the Building Official frol thereafter
requiring a correction of errDrs in plans, construction, or violations of any code. Every perlit issued shall beeDle invalid
unless the Nork authorized by such per.it is cOleeneed within six eonths of issuance, or if wor~ authori~ed by the perlit is
suspended or abandoned for a period of six lonths after the tile the work is cOI.enced, One 90 day extension Df tile, lay be
allowed for the perlit with fee charge of $15.00. The extensiDn shall be requested in Nriting to the Building Official. An
approved inspection lust be IDgged during each six lonth period, or the project will be considered abandDned.
WARNIH6 TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT "AY RESULT IN YOUR PAYING TWICE FOR IKPROVE"ENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCIN6, CONSULT WITH YOUR lENDER DR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
CO""ENCE"ENT. JOBS UNDER $2,500 IN VAlUE DO NOT NEED TO RECORD AND POST A "NOTICE OF CO"KENCEKENT',
~G
6NATURE: OWNER DR A6ENT
~
d~~.
SI6NATURE: CONTRACTOR
~.'
, -----
STATE OF FLORID~
COUNTY OF . f162e.I)
-
The foregoing ins~ment
before me th 15 , ~ F.II.IJ
was a~nOWledged
, 19 L by
STATE OF FLORIDA ~
COUNTY OF . 'O~.-.J_
The foregc<ing instru~nt I-Jas acknc'I-,ledged
befl)l-e me th i s '-~ ~ h/;., i 9 9'.;;J.- by
~ Au~1/ Id U FrS T I--{ rLE,e C17T.'I
who is personally known to me or who has
produced F))J--J;i Q _~OO-~ - ~~5-70(
as identification and who did/did not
take an 0 t) h,.~ ~'-~
(Si~ture) ~. L '
N F'TJIf _ ~ CJ.) I ,,\
(Na~e Typed, Printed or Stamped)
NOTARY PUBLIC
LRUIlf+ !dUFF STU. rL€..l ('7/l~ny
who is personally known to me or who has
produced PD/He 300 - 5~J-.- SS':; 70(
as identification and who did/did not
ta~~~~ A <c~-
(Sig~ture) 4
4Q,BCtZTJ1 !d-
(Name Typed, Printed
NOT ARY PUBLI C
Lew(J
or Stamped)
NOTARY PUBLIC, STATE OF FLORIDA
My commission expires J.,n. 2 b, 1995
Bonded thru Patterson - Becht Agen~
NOT,^\!~y ru.!
My Commie,.,..:"
Bonded tiliu.'
;, !J,jE OF F
. ..3 ;". .) ,LOR/c.;,
flC'. ", - q" ':~<::, I Q9:-
:, I He':~i!t Age~~\,~