HomeMy WebLinkAbout02-1174
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BUILDING
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N2
(813) 780-0020
5~ 5"0 ,$0 -
PLUMBING MECHANICAL
1174
b /. ~C
Date J/-/9-D1P
ELECTRICAL
Sewer Conn / ~ 7P
Water Conn: ~?O
W.t., Mete, ~~
T.I.F'~s~0~ /,~
Property Owner:
Job Address:
Parcell.D. /I 8
,2~J 1?9t:..' 9s-
,
Zoning:
Descriotion of Work
;=: ? j{)-/e- () 2. r:. ,{?/ "-:27,4
~~/~~tUPANCY BEFORE cf~P-> FINAL
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Valuation or
Contract Price
elECTRICAL
Company
Address
~ c! CJIt1phon~
~.m~ t)~/,~~
PLUMBING 19:zo
City License Registration #
State Certified License#
~ :36-
~~:!iGJ~
BU ING
1sT al'~~
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
CITY QF!
ZEPHYRHILLS
"NOTICE"
OF ADD.ITION OR CORRECTION
BUILDINO
DEPARTMENT
///00
I ADDRESS DATE PERMIT.,. I
3'\'53\ ~n~~\.J~ )D-34-tJL )J7'-f
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
, will be accepted.
DO NOT REMOVE
~~~~t~~~CM~
~E~~t..-kor.-.~,~ ~r~'-~ ~
OfFICE HOURS 8 - 5 MON.-FRI.
. AFTER CORRECTIONS ARE MADE CAlL
788-6611 FOR RE-INSPECTION
0~r=--'..
11 II unlawful tar any Carpenter, Cantractar, Builder, ar ather perlOnl, ta
cover or caUM 10 be cavered, ony part of the work with flooring, lalh, earth
or other material. until the proper Inlpeclor hOI had ample lime 10 approve
the Inllallallon.
INSPECTOR
CITY OF
ZEPHYRHILLS
.
"NOTICE"
OF ADDITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
ADDRESS
~o
DATE
/ I/O b
PERMIT .,.
/173 - 7
THIS JOB HAS NOT BEEN COMPLETED The following itiqns or corrections shall be made before the job
, . will be accepted, /,,_
\\1)3: ~~W~~ \'/'t'i ~ Jl~~~ ~f
~ c~",A.u~)~.ih:1 Q{ C- , '1t-'t)~ "-- LJ
l!!t:i: ~~"/'t"06 ~ ~
-11-15: ~:~JGY4~ ~
au
IIN'"
FTER COR IONS ARE MADE CAlL
788-6611 ~SPECTION
INSPECTOR
It il unlawful for any Carpenter, Cantractor, Builder, or other perlOnl, to
caver or caUM 10 be covered, any part of the work with flooring, loth, earlh
or other material. until the proper Inlpeclor hal hod ample lime 10 approve
the Inltallallon.
OfFICE HOURS 8 . 5 MON.-FRI.
CITY OF
'ZEPHYRHI.LLS
it . -
V
"NOTICE"
OF ADD.ITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
ADDRESS
7n~ ( ~_.~ oI1L
i G:;TE/()L PeRMJil7Y I
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
will be accepted.
.
(fJ StilL AJ~fiJ cLAtd Fl u4-fl ON O'J L(..]U)) gf~N& Si~-€-_
It is unlawful for any Carpenter, Contractor, Builder, or other persons, to
cover or cause to be covered, any part of the work with flooring, lath, earth
or other material, until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30 AM - 5 PM MON.-FRI.
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR RE-INSPECTION
INSPECTOR {hV4fifiJ:;
CITY OF
ZEPHYRHILLS
IINOTICE"
OF ADDITION OR CORRECTION
BUILDING
DEPARTMENT
~}-
DO NOT REMOVE
I ADDRESS Ji.TE PERMIT.,. I
37::;)4- M1iA~~ 6'A 1z -) ~T OL ~ 111t{
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
will be accepted.
(J> F~V\'l)..- ~\itU ~ ~or i~ ~1"ALLh.J) r ex+(a( tU J 1(.,\)7 S G.J~1.t\lTihJL
@ \tbJ<s$ 6~)~& ljJ~itlL S'.211. 00' ?~FH!J) 1\1$) t..uJi,b gM<..l~b-
~\J; e~"h. i)lltbUlJM- ~QI\)lr 10 Iirn:tfuL &r"f""~ b"n. -r~ (~i)
~"-~ ~lb~ ~~ rnOV\ ~~lt\ilJ hffU-T_
~.. .5\\\,1) M~s NO\ 4~~~~ ~ ~ "
]2;oCl ~ LuV\,u~~ l~ ~"~B
II II unlawful tor any Carpenter, Cantraclor, Builder, or olher perlOnl, to
caver ar CaUM to be covered, any part of the work with flaorlng, lath, earth
or other material, untlllhe proper Inlpector hal hod ample lime to approve
Ihe Inltallallan.
. AFTER CORRECTIONS ARE MADE CAlL
788-6611 FOR RE-INSPECTION
....,
INSPECTOR rJLJ~)
OfFICE HOURS 8 - 5 MON.-FRI.
Sandy Development
37529 Meadow Oak Way
SQ. FEET PRICE
MAIN OR LIVING: 609 $ 40.00
OTHER AREA UNDER ROOF: 120 $ 15.00
PARKING: 867 $ 0.85
VALUATION $ 26,896.95
FEE SHEET $ 155.00
ADDRESS $ 20.00
DRIVEWAY
BUILDING: $ 252.50
CREDIT: $ -
BUILDING LESS CREDIT: $ 252.50
ELECTRICAL: $ 61.88
PLUMBING: $ 57.50
MECHANICAL: $ 30.00
RADON: $ 7.29
TOTAL $ 409.17
SEWER: $ 1,278.00
WATER: $ 350.00
IRRIGATION: $ -
TOTAL: $ 1,628.00
I
,
WATER METER:I $
IRRIGATION METER $
180~00 I
SUB-TOTAL $
2,217~171
SIF'S: $ 722.00
97.5% $ 703.95
2.5% $ 18.05
j
.t
A:UJ
TI F'S: $ 1,204.00 Credit to Jim
99% $ 1,191.96 Bingham
1% $ 12.04
TOTAL: $ 2,939.17 ,
"
~)--.1t-c( ~
.~
PERFORMANCE BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813-719-7919
u
O~-069/
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO.
DATE 1/--/1.-t? ~
OWNERI
RENTER
~~~~ ~~~:Z;C.
7tQ \~ ~ a~ bkc/
MAILING
SERVICE ADDRESS c37:131
SHUT OFF SERVICE 0
TURN ON SERVICE g/
INSTALL METER 0/'
READ METER 0
CHECK METER 0
OTHER 0
/le1Jl~J tfl~ tJ~
Q./WATER
o SEWER
o GARBAGE
~N CITY
o OUT CITY
-L No. OF UNITS
_ DEPOSIT AMOUNT
% (/a/;& ~
- AMOUNT LAST Bill
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
Retain white form in office at all time .
Send pink & yellow forms to Water Service pI.
Water Service Depl. 10 sign yellow form & return to office.
FORM 600A-97
FLORIDA ENERGY EFFICIENCY CODE
FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
Residential Whole Building Performance Method A
THE LANDINGS APARTMENTS. 1 BEDROOM Builder:
THE LANDING APARTMENTS - PH II Permitting Office.
ZEPHYRHILLS, FL Permit Number:
TOWNVIEW MEDICAL ARTS PARTNERSHIP Jurisdiction Number:
Central
Project Name:
Address:
City, State:
Owner:
Climate Zone:
II I. New construction or existing
2. Single family or multi-family
3. Nmnber of units, ifmulti-family
4. Nmnber of Bedrooms
5. Is this a worst case?
6. Conditioned floor area (f12)
7. Glass area & type
a. Clear - single pane
b. Clear - double pane
c. Tint/other SC/SHGC - single pane
d. Tint/other SC/SHGC - double pane
8. Floor types
a. Slab-Dn-Grade Edge Insulation
b. N/A
c. N/A
9. Wall types
a. Concrete, Int Insul, Exterior
b. Frame, Wood, Adjacent
c. N/A
d. N/A
e. N/A
10. Ceiling types
a. Under Attic
b. N/A
c. N/A
I I. Ducts
a. Sup: Unc. Ret: Unc. AH: Attic
b. N/A
New
Single family
I
I
Yes
760 ft2
92.5 ft2
0.0 ft2
0.0 ft2
0.0 ft2
R=O.O, 79.0(p) ft
R=5.0, 632.0 ft2
R=11.0, 332.0 ft2
R=30.0, 760.0 ft2
Sup. R=6.0, 60.0 ft
Cop, 23.0 kB_
SEER: 10.00 _
12. Cooling systems
a. Central Unit
b. N/A
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 17.0 kBtuIhr
HSPF: 7.00
b. N/A
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 30.0 gallons
EF: 0.93
b. N/A
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pump)
15. HVAC credits
(CF-Ceiling fan, CY-Cross ventilation,
HF-Whole house fan,
PT -Programmable Thermostat,
RB-Attic radiant barrier,
MZ-C-MuItizone cooling,
MZ-H-Multizone heating)
PT-C, PT-H _
l.--n~ass/Floor Area: O. ;;-- Total a~-built po~nts: 9229.50 --.p AS. S-~_. I
Total base pOints: 11242.00
--_.~~...~-~-_..~--~-----~
Review of the plans and
specifications covered by this
Iculation indicates compliance
with the Florida Energy Code.
Before construction is completed
this building will be inspected for
compliance with Section 553.908
Florida Statutes.
EneravGauae@ {Version: FLRCNA-20m
FORM 600A-97
SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
ADDRESS: THE LANDING APARTMENTS - PH II, ZEPHYRHILLS, FL,
PERMIT #:
BASE AS-BUlL T
GLASS TYPES
.18 X Conditioned X BSPM = Points Overhang
Floor Area Type/SC Omt Len Hgt Area X SPM X SOF = Points
.18 760.0 42.08 5756.2 Single, Clear SW 8.0 7.5 40.0 52.82 0.50 1062.9
Single, Clear SE 1.0 5.5 30.0 56.64 0.95 1622.1
Single, Clear NE 1.0 5.5 22.5 43.65 0.96 947.7
As-Built Total: 92.5 3632.7
WALL TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Adajcent 332.0 0.7 232.4 Concrete, Int Insul, Exterior 5.0 632.0 1.00 632.0
Exterior 632.0 1.90 1200.8 Frame, Wood, Adjacent 11.0 332.0 0.70 232.4
Base Total: 964.0 1433.2 As-Built Total: 964.0 864.4
DOOR TYPES Area X BSPM = Points Type Area X SPM = Points
Adjacent 0.0 0.00 0.0 Exterior Insulated 21.0 4.80 100.8
Exterior 21.0 4.80 100.8
Base Total: 21.0 100.8 As-Built Total: 21.0 100.8
CEILING TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Under Attic 760.0 0.60 456.0 Under Attic 30.0 760.0 0.60 456.0
Base Total: 760.0 456.0 As-Built Total: 760.0 456.0
FLOOR TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Slab 79.0(p) -31.8 -2512.2 Slab-On-Grade Edge Insulation 0.0 79.0(p) -31.90 -2520.1
Raised 0.0 0.00 0.0
Base Total: -2512.2 As-Built Total: -2520.1
INFILTRATION Area X BSPM = Points Area X SPM = Points
760.0 14.31 10875.6 760.0 14.31 10875.6
Summer Base Points: 16109.6 Summer As-Built Points: 13409.4
Total Summer X System = Cooling Total X Cap X Duct X System X Credit = Cooling
Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier PQints
13409.4 1.000 1.090 0.341 0.950 4734.6
16109.6 0.3577 5762.4 13409.4 1.00 1.090 0.341 0.950 4734.6
EnerovGauoe"lll DCA Form 600A-97
FORM 600A-97
.. " WINTER CALCULATIONS
Residential Whole Building Performance Method A - Details
ADDRESS: THE LANDING APARTMENTS - PH II, ZEPHYRHILLS, FL,
PERMIT #:
BASE AS-BUlL T
GLASS TYPES
.18 X Conditioned X BWPM = Points Overhang
Floor Area Type/SC Ornt Len Hgt Area X WPM X WOF = Points
.18 760.0 4.79 655.2 Single, Clear SW 8.0 7.5 40.0 9.22 1.35 497.5
Single, Clear SE 1.0 5.5 30.0 8.34 1.03 256.5
Single, Clear NE 1.0 5.5 22.5 12.00 1.00 270.1
As-Built Total: 92.5 1024.1
WALL TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Adajcent 332.0 1.8 597.6 Concrete, Int Insul, Exterior 5.0 632.0 2.90 1832.8
Exterior 632.0 2.00 1264.0 Frame, Wood, Adjacent 11.0 332.0 1.80 597.6
Base Total: 964.0 1861.6 As-Built Total: 964.0 2430.4
DOOR TYPES Area X BWPM = Points Type Area X WPM = Points
Adjacent 0.0 0.00 0.0 Exterior Insulated 21.0 5.10 107.1
Exterior 21.0 5.10 107.1
Base Total: 21.0 107.1 As-Built Total: 21.0 107.1
CEILING TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Under Attic 760.0 0.60 456.0 Under Attic 30.0 760.0 0.60 456.0
Base Total: 760.0 456.0 As-Built Total: 760.0 456.0
FLOOR TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Slab 79.0(p) -1.9 -150.1 Slab-On-Grade Edge Insulation 0.0 79.0(p) 2.50 197.5
Raised 0.0 0.00 0.0
Base Total: -150.1 As-Built Total: 197.5
INFILTRATION Area X BWPM = Points Area X WPM = Points
760.0 -0.28 -212.8 760.0 -0.28 -212.8
Winter Base Points: 2717.0 Winter As-Built Points: 4002.3
Total Winter X System = Heating Total X Cap X Duct X System X Credit = Heating
Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier Points
4002.3 1.000 1.116 0.488 0.950 2068.8
2717.0 1.0730 2915.4 4002.3 1.00 1.116 0.488 0.950 2068.8
EneravGauoe TM DCA Form 600A-97
t::NERGY PERFORMANCE LEVEL (EPL)
DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE SCORE* = 83.3
The higher the score, the more efficient the home.
TOWNVIEW MEDICAL ARTS PARTNERSHIP, THE LANDING APARTMENTS - PH II, ZEPHYRHILLS, FL,
L New construction or existing
2. Single family or multi-family
3. Nwnberofunits, if multi-family
4. Nwnber of Bedrooms
5. Is this a worst case?
6. Conditioned floor area (it>)
7. Glass area & type
a. Clear - single pane
b. Clear - double pane
c. Tint/other SC/SHGC - single pane
d. Tint/other SC/SHGC - double pane
8. Floor types
a. SIab-On-Grade Edge Insulation
b. N/A
c. N/A
9. Wall types
a. Concrete, Int Insul, Exterior
b. Frame, Wood, Adjacent
c. N/A
d. N/A
e. N/A
10. Ceiling types
a. Under Attic
b. N/A
c. N/A
11. Ducts
a. Sup: Unc. Ret: Unc. AH: Attic
b. N/A
New
Single family
1
1
Yes
760 it>
92.5 it>
0.0 ft2
0.0 ft2
0.0 ft2
R=O.O, 79.0(p) ft
R=5.0, 632.0 ft2
R= 11.0, 332.0 ft2
R=30.0, 760.0 ft2
Sup. R=6.0, 60.0 ft
12. Cooling systems
a. Central Unit
Cap: 23.0 kBtu/hr
SEER: 10.00
b. N/A
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 17.0 kBtu/hr
HSPF: 7.00
b. N/A
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 30.0 gallons
EF: 0.93
b. N/A
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pwnp)
15. HV AC credits
(CF-Ceiling fan, CV-Cross ventilation,
HF-Whole house fan,
PT -Programmable Thermostat,
RB-Attic radiant barrier,
MZ-C-Multizone cooling,
MZ-H-Multizone heating)
PT-C, PT-H
I certifY that this home has complied with the Florida Energy Efficiency Code For Building
Construction through the above energy saving features which will be installed (or exceeded)
in this home before final inspection. Otherwise, a new EPL Display Card will be completed
based on installed Code compliant features.
Builder Signature:
Address of New Home:
Date:
CitylFL Zip:
*NOTE: The home's estimated energy performance score is only available through the FLAlRES computer program.
This is nOJ a Building Energy Rating. If your score is 80 or greater (or 86 for a us EP A/DOE EnergyStar1Mdesignation),
your home may qualifY for energy efficiency mortgage (EEM) incentives if you obtain a Florida Energy Gauge Rating.
Contact the Energy Gauge Hotline at 407/638-1492 or see the Energy Gauge web site at www.fsec.ucfedufor
information and a list of certified Raters. For information about Florida's Energy Efficiency Code For Building Construction.
contact the Department of Community Affairs at 850/487-1824.
Enerl!VGauQe@ (Version: FLRCNA-200)
EvUfJ ~~4
at, <;-:t- ~
. L/ 1..,-'...:v'\
OWNER'S NAME l.-~ fld ,'fl'l
APPLICATXON FOR PERMIT
CXTY OF ZEPHYRHXLLS
BUXLDING DEPAaT.MENT
;z -~ -l!>~.-/
DATE RECEIVED --
PLANS REVl:EW FEE
: a ,
,t} (Xl M)'\tle rrf-5 T(v I PHONE 5/0 7 - :/ ~9 ")_
JO(:AD~~S.~ ~l.tl?~",~Ott./J. ~ k
., LEGAL DESCRIPTION: LOT IS) BLOCK S~~SION
PARc:EL io" ?,LI'" ~5""" - ? /-CJO:.JO-t:b3DO' c.cfo (OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: ~ CONSTRUCTION
...-1
DSIGN
PROPOSED USE: [JSGL FAMILY DWELLING
o COMMERCIAL
.1,
o Avon'ION OALTERATION o REPAIR [J INSTALL
o MOVE 0 DEMOLISH
~TI-FAMILY [JII OF UNITS [J MOBILE HOME
o INDUS'l'RIAL o SWIMMING POOL o OTHER
. 0 RESTAURANT & HEALTH DEPAR'fMEN'f APPROVAL
DESCRI PTION OF WO~K B c( " I" Un t' +- jq.;'AA .Nmen+ f3u \ \dW~
. . . JQI 11:\ ~ "'/ '
BU~~~ING SIZE ,y --6 1\ ,C)(J SQUARE FOOTAGE.' HEIGHT ~_
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING P & (1) SET ENER~Y FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING. PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED F'OR ALL NEW CONSTRuc'nON.
'.'
19~ILDING
~{LECTRlCAL
~LUMBING .
~CJlANIC1\L $
[] GAS '~FING [J SPECIALTY
Ty~~,t~~:~~~~;RUCTION: ~OCK
PERMITS REQUESTED
$
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
~FLORIDA POWER
o . W,R.E.C.
VALUA'l'ION OF MECIIJ\NCIAL INSTALLATION
o O'fHER
o FRAME
o STEEL
o O'fHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES ~
, !.. ... '. .!Il
COMPANY Sa n.oll/ De. v~ I ~lY)e.,,"t
STA'l'E CERT OR REGI'ST 1# (1 t3 c. .. C> 'I",;) l'
CITY PROCESSIN~ 1#
.....................................................
,',\ ,
COMPANY F,'I S +- C lcos f: (~d ~.
STATE CERT OR REGIST 1# t::cc> ~'5"? 0
CITY PROCESSING 1# I 'I It:'
ELBCmZC
SIGNATURE
\ : '1,/1
.......................................:............K, f) A
. j'1JcYl~ 1~.J~~
~. . (' J " r. COMPANY 1# ?!k7C F)
nn STATE CERT OR REGIST ~__~_
.. (j.J ~J_><JO.._ ~ CITY PROCESSING II J /
. . .
.............................................:::!... .;...... ... AA. r+-
COMPANY 1" ,",;y... I 4!O ..., .
STATE CERT OR REGIST 1# I J "'^"'" ...J CI
CITY PROCESSING 1# . ~11 S-O f7t:j&; ~
PLUMBBR
SIGNATURE
.... "!,';. .:'
NBCJlARICAL
-.
. t.f; t I: ,.1: .J.:"~ !': ..,. .
.....................................................
SIGNATURE
OTIIBR.l
',:,; qnj~..~..r" J't't.,.:",
COMPANY
STATE CERT OR REGIST 1#
CITY PROCESSING #
SIGNATURE
.................................................................
....._..............~.,-..~';~.... ". l.'n
"\:"H': ;
", "
.." .'~'
'"... "
',I,,',
\:..:
...":'U,'<})), '}.',',I...J1,1,!;j 'J,t' tl,I..'~,r,.:rv'1,},')' J\,~.',I_"l,l)j\V_,l~'_I.'
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may b~
IalIY be.lIl9J:;e . ~estrict.i ve . than cn y regula tions . The
. . c.pmpliance. with. any applicable deed restrictions.
B......UNLICENSED. CONTRACTORS AND CON'rn1\CTOR RESPONSIBILI1'IES
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
licen.ed....required by law, both the owner and contractor may be cit~d.for a misd~anor
viol.tion'under st.te law. If the owner or intended contractor are uncertain as to what
",. licen.ing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611. .
Furthermore,.if the owner has hired a contractor or contractors, he is advised to have. the
.co~~~a~~or(8) sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you,; r.ther. than the contractor, are responsible for the work. If the contractor wishes
you to .ign as contractor that may be an indication that he is not properly li~.ensed and is
not entitled to.' permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D~;;.. .CON~'l'.RUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certffy that I, the applicant, have been provided with a.copy of "Florida's Construction
lien ~w.:-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and' Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to convnencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I 'ce,:tify that all the information in this application is accurate and that all work will
be done in compl~ance with all applicable laws regulating construction, zoning, and land
development. ..
Application is hereby made to obtain a perlnit to do work and installation as in41cated. . I
certify that no work or installation has commenced prior to iss.uance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
code., zoning" regul:~tions, and land development regulations in the jurisdiction. I also.
certify th.t I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what ~ctions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental RegUlation-Cypress Dayheads, Wetland Areas and Environmentally Sensitive
L.nd., Water/Wastewater Treatment
*Southwe.t Florid. Water Management District-Wells, Cypress Bayheads, Wetland Axeas,
. .Altering Watercourses..
*Axmy Corp. 'of Engineers-Seawalls, Docks, Navigable Waterways
*Dep.rtment of lIealth & Rehabilitative Services, Environmental Health Unit-WeltS,
W..tew.ter Treatment, Septic Tanks
*U.S. Environmental Protection Agency-.1\sbestos abatement
I also certify that, if fill mat~rial is to be used in Flood Zone "A" or "A,etc.N, it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
i. prep. red by a profession.l engineer registered in the State of Florida prior to permit.
i..uance. .
A pe~t i.sued shall be construed to be a license to proceed with the work and not ..
authority to' violate, cancel, alter, or set aside any provisions of the technical codes,
nor .h.ll i.suance of a permit prevent the Building Official from thereafter requiring a
c~rr~ct10n .of errors in plans, construction, or violations of .ny code. Everypermit
.i..ued'.hall. become invalid unless the work authorized by such permit is commenced within
six month. of issuance, or if work authorized by the permit is suspended or abandoned. for a
period of .ix months after the time the work is commenced. One 90 day extension of time
may be .llowed for .the permit with fee charge of $15.00. The extension shall be requested
in writing to' the Building Official. An approved inspection must be logged during each six
month period, or the project 'will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE '1'0 RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITIl YOUR LENDER OR AN J\'l'TORNEY BEFORE RECORDING YOUR NO'rICE OF COMMENC ENT. JOBS UNDER
$2,500. IN VALUE DO NO'r NEED '1'0 RECORD AND pos'r 1\ \ NO'l'lCE OF COMMEN E
subject 1:0 "deed restrictions" which
undersigned assumes respqnsibility for
.. ~ ~
~~!~i~~~~~'" i -:" ,
SI.G.NATUREI OWNER OR AGENT
~~:'. '~i.f-\."--~~.:Jr~~_:::~'~;~f"',:' - ., .., ~. "'..: .
::.~~~.~,~.."..... ':';i;',.,;:,.'
The""'foregoing instrument w.s .. acknowledged
Before methi,~ day of , 19_
by. .. ... . .' .
...~.,;*(~- ot'per.on acknowledged)
o who':'1a'peJ:.on.lly known to me, or
.....'. '; -" ,
.....,t'.':"\.......,.,-.r".~"....:...::.r-. _.
o wh~ h.~.p;~uced
. <,. (type of identification)
.nd whoClclidCld1d not t.ke an oath.
o~~;'~1!~~ (
(name of person acknowledged)
is personally known to me, or'
o who has produced
(type of identification)
Oiid not take. an .0athlli"~'~.';;
~
.,.,.......~z,;.~.I":.....~..,...'':''-~...~... ~
.'. "=1 ;L..i,;-:;"~:' ."
""('~ ~~Yl;-"''' ..' #
._-- .._,...~ .
Signature of per.on taking acknowledgement
.................~ 1 - IJ.~_ '.............'-'..."~.. -~ " .. .
\\;'-';arJ...,""'~"" . ~- ,..'.4-""":'lir . ..-~' ,
.C~.......
. . COMMISSION . DD04685A
ElCPIIES A1JG 01 2005
amp~~
N~~~tJP.8d! p~1nted or st.mped
.;,.~s:-- .
, ;~"t--J-~":;:E~;~~~;~"~~iiil?~
.4
"1' '.
. .
PASCO COUNTY, FLORIDA
It J4. ,
Permit Nu.
Date Permitted
....
Builder Name/Owner Name
County Parcel No.
Address/Location
.':' .'..... /
.r
Subd.
Classificationffype of Use
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $
Zone No.
Sq. FtlUnit
Prepared By
---~
\
\_j Impact Fee Amount $
.,.....
Checked By
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the
Board of Pasco County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of the permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
/
Gross Sq. Ft. (GSF)
Rate ERU -
54.00/Year
or $0. I 48/Day
ERU Assign No.
Assessment - (No. Units) x ($0.148)
x (No. Days)
Assessment -
(GSF) x (ERU) x (0.148) x (No. Days)
100
TOTAL FEE $
l
/
')
.;) ,....:...,"',
TOTAL FEE $
r--.,
\ r
.'-/
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY,
Acknowiedgement below does not imply acceptance of concurrence, but simply receipt uf a copy of this form, placing
the huilding permit Owner on notke of this 'assessment and the conditions of payment for same.
Date
Received By
~~ -----.---------------------------------------------------------------------------------------------------------------------------------------------
V
OFfICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO.
"liT /
DATE
/ ,( DATE
.,.1'
BY
./'/ . BY
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldgllnsp
feecal:ce
PC93113094/E
PASCO COUNTY, FLORIDA
Permit No. _ /17-1
Date Permitted /f - / 9- 0 -z....
C ~der N~wner Name t) tJ-11~ %. Control #
County Parcel No. 1.."I~-.26-- ;2./- 00 DO-o03o[)--OcJ SubDiv:
Address/Location .3'1':;-:''1/. '/77/#../1)<,) 04~ I<)~
Classificatlon/Type of Use Lfn-t,! L.IJIJ t:-
TRANSPORTATION IMPACT FEE:J R Sq Ft Unit:
/ ilL
Exempt 'g1' Ves 0 No ermine ~.
Impact Fee Amount $ e . TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $
Exempt tJs~~r::~~~:t~~~~q51 ~
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
'7~~ -
Recreation Account
Recrea .
Recreation Total
TOTAL AMOUNT $
DNa
How Determined
LIBRARY FEE
L:and Account
------
Land Credit
-
--
Fa Qili.ty-er8d it
---
.--
Exempt 0 Y~-EJ1::f; How Determined
.-------
-.REset1RCE FEE
TOTAL AMOUNT
L.J3..ndTotaL
Facility Account
Facility Total
Total Amount
9, 3~.&d--t. &
. 10- 50-6,--
ERU
Prepared By
Checked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and the conditions of payment for same.
DATE
RECEIVED BY
RECEIPT NO.
DATE
BY