HomeMy WebLinkAbout03-1806
BUILDING PERMIT
Permit N2
l38'". 30
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 780-0020
Co~.po I("t'~
PLUMBING MECHANICAL
18L...
'11q. &0
BUILDING
Date , -.J..$ .... 03
J,L..fC,t..5o
fI.:. ~). fa
Sewer Conn I.).' .
.
P..perty Own.' ~~ R Q ~ ~T <U>I, I u -"fu,,<:\
Job Address: 0 blvd.
Parcel 1.0. " D3... -:lfl ~ :1-1- af)/O - 0 f~oo - OtJ.3D
Water Conn: Lf 3'7. So
Water Meter: ! ~. 8-0
T_I.F.'s: ~6f; -- r" T tv
c:2 .888',,90
.
Zoning: Energy Code:
OescriDtion of Work 3, 30-0 SO' ff.
r? ?j.)~L-;'). - [l ~ -1):.3 tiLlP/!
lI~o'3 ~ ",L
NO OCCUPANCY BEFORE C.~
Aadon Gas:
~1;1~~~.~
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
City license Registration #
State Certified license#
do ~
Permit Fee .
c::--'~i'~~~t~~ ~<<-v~ (x1~
Company
Address
~ele~~~ g/~ 7!d J1YV2--
Valuation or
Contract Price
qq. av.
.
~
BUILDING
2-#,/15 E!€'c.
-#??
elECTRICAL
(fliRt's h.aJ,r P!vm6.
#/~
PLUMBING
&j,~s C-~.,j- /J/~
*/'7
MECHANICAL
G.t. ~ 57~tI<-.
Tp. SeN. SLB
Rough In ./;)-/0-0-3 R'-'y Tub Set l./r;2-!rO-03
.f1-{1(;
lintel Meter Can Water .
FRM. -j .:l.' {O - () 3 f(L/.f,rH1t;onst. Pole Sewer
Insul. CL 1.-:2 r (u ~ u', Rtl.f.;/l1poo1 Final 1-/1/-0 '311.:/0
WL v Pre-Meter ~ -.JJ'- 03 ;-jJo
Final 3-IIj-O? JfIu
Breakers
RL'Yi-Ducts Insl., ./' ~7-/tJ"'o 3 7:>t.'(';':;-._,
~n "~v
Compressor
Final :"3 -/#-03 ,RJ5
Ftr.
Pre SLB
Driveway
REINSPECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of twenty-five and 00/100 Dollars ($25.00) 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.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
J -J.. - a.3
DATE RECEIVED
PLANS REVIEW FEE
OWNER'S NAME Cs.:.:.;.QQE.\ D \ e.~\()i:)~,-c, ~<::;\
JOB ADDRESS I~:J.. 4-u GOu.- bL\l:L:>
PHONE
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL TD # O~-2.{..;,-:2-I"-OC)IO .-CflloOO - O()~
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: UlNEW CONSTRUCTION
o SIGN
o ADDITION
o ALTERATI ON
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING
o COMMERCIAL
OMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK --rgNNO~ ~\)Lil."\ n,~
BUILDING SIZE
~"':2_I' I
SQUARE FOOTAGE .;;;;)~"
HEIGHT -' (J
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT
ATTACH (3) SETS
PROPERTY SURVEY
o BUILDING
$ 55(~(J
L..oO
PLANS & (2) SETS OF BUILDING PLANS & (1) SET
OF BUILDING PLANS & (1) SET ENERGY FORMS.
REQUIRED FOR ALL NEW CONSTRUCTION /' ~ J
PERMITS REQUESTED \ // (d
\
VALUATION OF TOTAL CONSTRUCT~GN
ENERGY FORMS. \
'''-... .
tJ 0 I!--J
,I
/
/
o ELECTRICAL
AMP SERVICE
~LORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLA
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
J( FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES 0 NO
BUILDER
SIGNATU~,>o ~ U y~
COMPANY
STATE CERT OR REGIST
CITY PROCESSING #
a.L_
~T~
# Me 0;;;.;;1 ( .3 7'
~~
******************************************************************
ELECTRICIAN r--:::~-,:.. p;,.
<--~ ) "';::;7'"
SIGNATURE '-'.... ,~. ""
COMPANY Z .....-l~ 'u'<;' F LE:Ci "'
STATE CERT OR REGIST # q~
CITY PROCESSING # ODO At (<? <i-
******************************************************************
PLUMBER
&!~ ~ /
~' i/~' I~//l
COMPANY Cjwi C) (1~')
STATE CERT OR REGIST,#
CITY PROCESSING # -l~
P(u~bJ;"'~
SIGNATURE
SIGNATURE
* * * * * * * * * * *.* * * * * * * * ** * * * ** * * * * * * * * * ** * * * * * ** ~ *l** * * C * ** * ****(*
COMPANY \ S &..I.Y d- A- c..
~ ~TATE CERT OR REGIST H
_____ CITY-PROCESSING #
, ** *************************************************************
MECHAN:ICAL
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
.............**..**.....**.......................................
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to ~deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIDILITIES
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
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, 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 responsible. If you, as the owner signs 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 may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION 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 - 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 commencement.
E. 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, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental 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 Regulation-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
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or ~A,etc.", it is
understood that a drainage plan addressing a ~compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
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 code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed 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 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 ATTOAAEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALU~.DO--NeT-NEED---'Ul_R~()RD AND POST A ~NOTICE OF COMMENCEMENT".
; y
/. . ~~;~~ /
~RE:-. OWNER OR AGENT
~U/~
SIGNATURE: CONTRACTOR
STATE OF FLORID~Sc:.o
COUNTY OF
The foregoing instrument wa:r~owledged
Befor~ this .2...-day of , r9~S
by ~a..... ~
(name of person acknowledged)
C1ho is personally known to me, or
~.d-.o has produced..fL OL--
~u (type of identification)
d who did ~d not ta an oath
STATE OF FLORIDA
COUNTY OF ~A.5t!-1J
The foregoing instrument wa~acknowledged
Before me this ~ day of ~€I!!!lfAa~ ~.::;0D,.:2
by
~ame of person acknowledged)
~ho is personally known to me, or
Dwho has produced
(type of identification)
and whoYJdid Ddid not. take an oath.
~~~Kdel~
Signature of person taking acknowledgement
nt
Name typed, print
Name typed4_ rinted or stamped
~ .~-:;;..~~ THOMAS M. WH~ELER
f./";!"":4 MY COMMISSION # CC 928756
~'~~~l EXPIRES: April 17, 2004
"~Rf,~~ Bonded Thru Notary Public Underwriters
a K.DELcono
MY COMMISSION' CC 949169
EXPIRES: Jooe 26, 2004
Bonded Thru Notary PublIC UndorWIIIoIS
SQ. FEET PRICE
MAIN OR LIVING: 3,300 $ 30.00
OTHER AREA UNDER ROOF: $ 25.00
OTHER: - $ -
VALUATION $ 99,000.00
FEE SHEET $ 466.00
ADDRESS $ 30.00
DRIVEWAY $ -
BUILDING: $ 729.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 729.00
ELECTRICAL: $ 138.30
PLUMBING: $ 68.00
MECHANICAL: $ 167.00
RADON: $ -
TOTAL $ 1,102.30
SEWER: $ 1,597.50
WATER: $ 437.50
IRRIGATION: $ -
TOTAL: $ 2,035.00
Total connection fee credit for project: $
530.00
1/5 of connection fee credit applied: $
106.00
WATER METER:I $
IRRIGATION METER $
180~00 I '
SUB-TOTAL $
3,211.30 I
Total T.I.F. credit for projecq $
1/5 ofT.I.F. credit apPlied:1 $
3i :2 J {, .90
_ g- <i?~" 00
~
TI F'S: $ 3,276.90
99% $ 3,244.13
1% $ 32.77
TOTAL: $ 5,600.20 I
-.,
. ,.." -',' ,,"I ,"','.: ~
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.
Re+UVG
City of Zephyrhills
Receipt N~ 130067
/- c;lr-
20 0 ::5
Physical Address
5335 Eighth Street . Zephyrhills, Florida 33540
(813) 780-0015 Date
{J-? :; V ~/ (~~..J.J J) I (J eft .
(
(
l Paving Assessment
lOther
Tax Parcel ID #
-'1_' (11.1
Amount Due ~lfJ/!' .
- -+--H- I .vOG
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;treet No.
~ity, State, Zip
)TICE: All assessments are due and payable within (30) thirty days after date and will
ar interest at the rate oC9% per annum thereafter. Please send postage for return receipt.
3~"'8 ZCH 1-29-.03#005
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2003016333
ate of
~
.\-L..:.;;:: CL.'I '1~~
NOTICE OF COMMENCEMENT
County oi'~OSL,--,
B ImDERSIGNED hereby gives notice that improvement will be made to c~rtain
al property, and in accordance with Chapter 713, Florida Statute; the
llowing information is provided in this Notice of Commencement: '
Description of Property: Parcel No.C-~~1' -"2.t - C:C:1'0 ,. C'J91,Q.~ - <"XJ~\::'
(Legal description of the property and street address if available)
General Description of Improvement .~~~ C)\.A\ ~r,- ~;~ ':....~ ;::S-:-'
(c 0 r re, i 0... ")
(() rr-e i cJ
l tY) \ c\..\c\~ \- C()(I...\\..E:" l))
State t''- 3391 I
O\vner Information: Name G:':I'2-Q..E.li~ \~\.X~::.C>2>~'; \
l~ddress ~l4-'l ~jz:n~\'_['Y'::.Q~City 7....&?~' '\.\.\h~
Interest in Property: Q;~~t:y{,---
Name of Fee Simple Titleholder:
(If other than owner)
Rcpt: 650715
DS: 0.00
01/29/03
Rec: 6.00
IT: 0.00
__________ Dpty Clerk
City
State
Address
Contractor: N.:lme rG. L. 5-n::::Vf- C-005\f20C,,00
Address 3--7~5, g',tt- A-r
C i t y 7t9f-l '( R- W it..-._L- c..
S ta te 1="<... 339t 2,
Surety: N.:lrne
Address
City
State
Amount of Bond: $
'\~2~~~\"Ar2: ~"S~O fOUHTJf CL1ERK
OR BK 5219 PG 774
Lender: Name
Address
City
State
Persons within the State of Florida designated by Owner upon whom
notices or o~her documents may be served as provided by section
713.13(1) (a) (7), florida Statutes:
Nc:rnc
City
State
Address
In addition to himself, Owner designates
of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes.
!"xp.irnt.iIJn dnt.e Ot Jlot.lc,e of Commencem7nt. (the expiration date is 1 year
fr~rn the d.:lte of rucord~ng unless a d~fferent date is specified.)
,/ .._")::>'
>::::t::ea::O::::1-i~d :ef~-m:::i: .f?1~day of :A~4a'_
) I I
(g~C' 0 tfl...
,~.~ k did~
./
Jot.J.ry Public:
1y C:::J:T1.01i 5 S ion Expires:
.........,"'...,.",,, SHlRDEN K. DEL corro
f.~iJ'-\ MY COMMISSION' CC 949169
'H.'. fJ1j EXPIRES: June 26, 2004
'f;t~.'If.~' IlondId Thru Nolary P&mIic UndoIWfiIoIa
:93053048
/ [./:'/0/7 /b.l!-
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ST "Tr or 1l.."Ml^ DEPM fMm.IT OF' TlI.ANSl'OR T ^ nON
mUVEWA Y CONNECTION PERMIT
FOR ALL CATEGORIES
fORM ISO.O'C.II
'YH1lM' rl~
1'''3
r,.. I .0
..:- . .':'.'...;" q-, '.f ',;. ',!;i\i)f(,:- PARTliJ'ERMIT iNFoRMATJON -
I:. .~ - -
, q
APPI.ICA T10~ ~"UMBER: C;/- _4 79 R-c}tJ27
Pemllt Cat::llory: ~ - Aceess CIII!~ifjc.tion: .3
PROJECT: ----=-----.--
PERMITTEE: CORlt.EIf\ hrt\\1 REVoCAl1>u::. T~,-
30\ N oR:rlt
C;~el""'lU;kJ'o~__ . /4p!iO ...=L)2p s: ..e T Stale Road: . I 11 LA.,. ~,
"\
Sial. Road
Stale Road. --
~. "ART 1: PERMITTEE ~FORMATION
Penninee Name. ~RR EtlLl}&.~. fZEVoc..A~l~ \1L~,
-
"'=;." ....;,;", ^"'m l, 71-\ I'l Q..~~ LN<t: t>F. \ "E
City.Slale.l.ip: Z.i:.PU.i(l\\\~ fL-, 3351\
lelcPhon":.L~\~ I' S" - 75g~
Enginccr!Consultanl!or Projeet Man3~er.:i.. f L-. ~~\~~~\ Nbl II'( L.. .
En~!ne~,::~siblc for eonitruclion inspection: ~ r-\ K. ~N- TE(2..... 1-1. ~ '5 L
Mnilinll Address: _ \ 4 <=t \ ~ ~N ~'1 p\ NE _PL/\ Q.j;i- H. ,
lCi'Y'Slale.z,p:~
TelePh()r~_ ( I <i?\; llo 4- - 7 "" 5 0 Mobile o~hone. 1 ~\~) 9_ C> g - :6"3 *1 ~
_ I(,IRC'~
. H''''''.. ,..i'->:!:(, PARt3: PERMrfAPPROVAL'f;,.::<:-g~:~/':'J:
The .bo....e application hIlS ~q reviewed and ;s herrby appro~d IJUbjrello all Provisions u attached
O//J-79J-CkJ27 BY Ch~- 6~
Department or TranspO!1alion ar. G. Boone, .P.E.
/ .Jl zi -0"2-- TrrLE: Area Maintenance Engineer-
(:l....,
fl-2c1-tJ L
.'..t .
i FERJ\OT to.'UMBER:
I
I Conslruc!ie>n shan beLlin br:
and sholl be cOlnplcled no Isler 1"00'
1t>o1"
Dlle cflssuAlnce, _ ~l -'2-+-e:> \
Special provisicns .ttached
YES
~ NO
o
NOTE: fh;$ pemlil is onlv ".Iid (Of ene cllendar year from dale of issuance.
Recomnended for Approv.1 by: _~lJ:tAN ~PADENKO
'/ 2-'-I.-r I
.~..; .
~~-- -
/0...)
~
NOTE:8EEAlTACHED SHEET FOR
~ SPECIAL REQUIREMENTS
THE BROOKSVlllE MAINTENANCE
OFFICE SHAll BE NOTIFIED 48 HOUrS
IN ADVANCE OF STARTING WORK.
PH: (352) 797-5700
\,
f:>AAI'SO-O'O.11
5Y5T1!MS I'\..AN'f1NC
IIJ?J
t." 1 .r J
-::::;_:;;::-~"'F~- 'h-i-t)'.PARf4: GENERAL PRoVisiONS.
....-......
":':'..
~ ~
'.:: ~.
1. N::>lJff the Depnnmenl of Tra..13portalion Maintenance Office 8t least 48 hours in ~dvance of starting proposed work_
P...,;3,[;:1--7 "1 7 - $1 Do . M...!;..: .::s'b\h~ K\l-v.t=~ oil.. (3b e> "AlliE: L
2. A copy of the apprcved permit must be displayed in 8 prominent location in the immediate vicinity orlbe cor.nection
cor.Sl1Uclion.
3. COlTlpl~' wit" 14-96008(1) on Ulility Notification Requirements.
4_ Comply W:Ul 14-96008 Construction & Maintenance orTraffic Requirements.
5. AJI work performed in the Department's right of way shall he done in accordance wit" the most current Dep:u1menl
slardards. specification! IlJId the permit provisions_
(, The permittee sholl not ccrmnence us: of the connectior. prior to I final insFcction and :Iccepl:t11ce by the Derartmenl.
7 Ct'mply with 14-~6.C03(4)(a) Cost ofConslrUction.
8. If a Signilic3111 ChlUlgt" of lhe penniuee's Innd use, u denned in Section ~3S_18, Florida S.alu~es. o:.-c:u:-s, the Department
may begin the process 10 modifY or revoke the connection pennit.
9_ Medians may be added and median openings may be chwged by the Department as p3rt of a Construclion Project or Safety
Project The provision for. medilll mighl ehan[!e the operation of the connection to be for rig.....ltums onl)'.
10. All CO!lditicns in N~iICE OF INTENT WIll APPLY tmIess specifically changed by the Deportment.
I !. All .pp~oved cor.neetion(s) and turning movements are subject to !he Depllrtment's continuing authoriry Ie revoke: or medii}
such connec<ion(s) or turning mO\'e:-nents in order 10 protect safety and traffic operations on the: 'talc highwJY or St~te
Hi/11m-.y Sy'terr.
12. Transportation Control Fralures In the .tate ril:ht of ".ay. Transponation conlrol fe9:ures in the Depll1tmenl'S right of
way, mcluding, but rlo:Jtlimiled 10, traffic signals, medi3lls, median openin~s, or llJlY other transport:ltior. contn.'l fcalures or
meaSUIes in the state right of way are operation:1l and slifeI)' chnracleristics of the State Highway md ITt nOI mCllJlS of
ICCesS_ The De?3r1ment may inst31i, remove or modift any present or future IrIl/'.sportDtion ccnlr01 felltU.'c in the st:lle ri~l
of way such u median opening, trnffic control device or I feature affecting turning mc\'ements L'u-ough . cOlUlectior., 10
make changes to promol~ safet)" in the right of way or efficient tn.ffic operations on the hi~wa}'.
13. The Penninee for him/herself. his/her hein, his/her assigns and successors in inten:st. binds and is bound ar.d obliGoted to
save lIId hold the Slale of Florida, The Department, it agents IIlld employees hannlcss from any and all dam:llles, claims,
expense, or injuries arising cut of any I::t. neglect or omission by the applicant. hislher heirs, assigns BJId successors in
interest that may occur by reason of lh!s, fDCllity desi@JI, construction. maintenll..'x:e or continuing existence of the cOlUlcction
facility, except that the appliclIlt shaH not be liable under this provision for damages arising from the sole negligence of the
Department
14. The Pennillee sholl h.! resp.3nsible for detennining and notify 011 other users o(lhe right dU;lIY.
'OM" ~ 040.11
SY!Te~IS P LA"'l-lll 10
11191
r... ) of }
[o,.co'"-OO"'],.,o CO_CTlO~S
;.'ART5:SPECIALPROVISioNS '_ "
DYES
~ NO
If \h,! is a non.conforming <:on .'c;:\ioll pemlil, n defined in Rule Chlph:rs 14-96 end 14.97, then Ih~ following may he a I"~ of this permit
The non-c:cnlorming c(ln~,ion(s} de~cribed in Ihi~ penn it will C!:lrry no more !han
_.__ in peak hour Iruffi,,_
in ....er31J!: cbilr traffic, or _
2
All n6n-cC>:1(:l:m:ng conneclions ~ill be ~l.Ibjec! 10 closure or rdoeat;on when reuon.blc access becomes avan.ble in !he fUlure_
QHIER SPEC!AL PROV:"ID.lli
J'ART6: PE.RMITTE! CERTIFICATION ANO SIGNATU1U
This p"rmi~ is hcrel:y si8ne~ end ..U provisions '8reed 10 on dale:
l"'k:'q A~nt'
t...".1oCIft ~ ...."...~l
PRINT OR TYPE;t1/ ~A--Af:..L. ChI-{LIE:..M-"
TiTlE: a..!.,1?lL-
I eer1ify Ihl\ I h...,e read and u!1ders14nd :hc info/Tl'!lion end provisions COll..ined in lhis permit_
un:JefUke Ihe pror'J5c~!ivilin. ~~ /"
V.'1TNE$SED BY:~~ Sign('d: /'
PRNT OR TYPE: ~1: ~ J-.1E..J.-,
.._-~-- I'....!
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DArE:
0/ 7-4- / J.. or:(
/
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'ICYC~EO~~P[~
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ST..\T1; OF FLORID/. Dt::'AATMENTOF TAANSI'ORTAl1ON
DRIVEWAY/CONNECTION APPLICATION
FOR ALL CATEGORIES
fOltM 'lo-OI~1l
sysn;...s PUVININO. I t~
..... I or6
1--- OFFK:E USE ONLY
t:J/ -.4 - 79 f- C;()~/ .- : J.l/c-k~,v~
Application Number: . . ~By:
.- ,I" -0- rDOTr.Ar?(1T1'IlOll-'Tl
# : -,
- ~ .. .3--?-7-u/.
C lllellol) . ." .: . Dace:
-. o.
.. . -- .-. - 0-
-APPLICA COMPLETE REMAiNDER OF FORM
PART ':Arri.lCANTINFORMATiol'i' ." ~ ' -.
"fPLICANT: CbrtR.E.\ ~ f~(Y\ \~ f.J:."D~&.f:;. CONSULTING FlRMIPROJFCT MA~"G[R:
Mailing Address: l1'~~ ~\ L.:7-"H N; L..N<€ ~\VE vi, f. c....:. ~ "lG.1 \--~ I'-\(" ,1t-I <- ..
City,Sl:Ik, Zip Z-SPt\,f4l11_L-'S -fL. '536"4L_ WllL/A}"" f" \ 4f-\tE~f\Js_~_________
rclepJtont': ( <it.> I 11 ~ - 75 <6~ ._ IAn Q 1/ ~ ~ 0 1..-' OJ.. Cl:
Mailillll Address:..!:] ,I. "'" 0 I~ r I r t:: r L-A
PROPER1YOW:-lER:~A rkl\\\1 ~V~
TR-v...-SI
R.!sponsible Corponlle omu:~- __
Mllilir.g Addres!' lo 74\ "\O\L}l\ lAK~ ~"t
Cil)".Sl:)~,Zip ZE.f~rl..l.\IU-~ R-. 3~S-1L-
rele?hOnf:8(~ (I So - 1 c;~g
FAX !\.lobi1e Phone, tIC.. ~l; - 1 ~'K - 9 s \ ~
City SIBle. Zip:
'TJ\JY\Pp.. 1 VL-, 3~{,2-~-
Tclephone~} Zl,,4 -1(,':)0
FAX Mobile Phone, elc":~_]Q ~ - 3.3 1 ~
\CII('LI 0Ntl
{CIIl:Lf CHFl
ARE YOlJ AN AUTHORJZED REPRESENTAl"IVE?
lfthe property owner desires to have a representative ~ign and handle the application, lhe owner must provide
a nOlarized teller of authorization attached with the a lication. SEE PART 2 OF nns fORM BELO
PART 2: Al'PLICANTS AUTHOIllZA TION OF REPRESENTATIVE
Aulhori1:ltd Rt'prtsenutivt:
.
(NOTE: All c:or"''POndrn("t will be madoe U'roulh tht rtpreNlltatlvt. A 11(\("-'" letlu or.uthorlatlon must be attuh<<llfyou ue an
alllhorbed rfpnHnutlvt.,
Su.'lllr
Company.
^ddr>:ss:
Continue ooto "en P'lge
FOR.M 8S0~"O-15
SYSTEMS PLANNING. 11194
PAGE 3 of6
IF YOU ARE APPLYING FOR A TEMPORARY, PUBLIC STREET, OR SAFETY
UPGRADE PERMIT COMPLETE TIIE FOLLOWING:
CHECK ONE
o Tempol1l1y Permit, Description:
From (DllI"):
To (Dale):
(NOlllO Qceed 6 months)
o
Public SlttCt, Road or FlICilil)'. (Jescrip~ion:
f,"J1ected DailyTmffic
o Safely Upgrndc:. Iks.:riplion:
Property Physical Sill.: Addres~; 0;,1- 4b (};, A-.LL &-'Il> " v... . S. ~D
Uctwccn:MJ~ 7-5/7 f'!, l:>F ~~~= IQ~ _I"
!;b..:<;"T <;1h.G: oY' !A.5.. '30\ ~C)IL\llt I V AC4\"~,
II ...,..,....... " VI ....-,....- ........ .." IntonNllCllO OIl' ..... __
AnACH EXTRA SHEI!TS IF :-lEEOEO
Please indicate North
',-- E.~I~n\\f.- DRW[J~l ~
):::- ___.~__.-_-_-n ____. __._..._______
<I ~ ').:''-' 0 ---- ---~-7
L; . (V)
'\, .,
IV r' "'_. ____
~ --............---
"f~ j
I(~~
. m___________._ _ '\... __________________________
IF IT WILL 5i:RVE TO DErrER COMMUNICA-ll::,
PLEASE PROVIDE SKETCH Of PROPERTY LOCATION -(SCALE IS NOT IMPORTANT)
L- -~~~.; 0 - c~~~~-~~:AY ANl!CONN.CTION LOCATiONIN'=:::::N~-'-=~=-=--=1
I{ond N:urn:: ~. D' ~~..~, 0 \ Road Nllme: _
Roadw?_, ^coe.'I.~ Mar.OgC~ CIM,ificalion 3 Roodway Accns Manlgeml'nt Classification I
- lA".1IIIIt II lJr........ t^....,..., .. ..~J
4b
1'05h:O SP.:W Lirnir-
MPH Posted Spel:d Limit:
\ifH
Road Section Number: _ / ~..50
c"...........~)
Mile Posl Numlll....: -5: 5(J 0 ~
"',.... . ea.u.:r.1
Road Section Number:
IA~ .0.,......
Mile Po!!. Numbo:r:
,Aw_l... . DrIpuwIan,
(AITACH ADDITIONAL SHEET AS NEEDED)
CON-rlNUt: ON NIXT 'AGE
FORM S~O.{)40-15
SYSTEMS PLANNING. 11/94
PAGE 4 of6
I
APPLICANT (CuRtlnned)
PARl' 7: LOCAL GOVERNMENT DEVELOPMENT AP.aOVALINFORMATJON
S1anJS ofdevelopmcnlllpptOval (check one)
tJj{-\
I
4
Already Approved:
IF SO, PLEASE ATTACH AFPROY I\L DOCU~ENT TO APPLlC ^ nON
Approval Pending.
If "erpprovaJ pcllding" whll1 is expected approval date'l
LocaIgrlvemnll:nl developmcllI approval UfT'lCiaJ:
N~:
Title.
Department/Ornce:
Slree' A ddn:ss:
City, SllIle, liP:
Tdcrhonc: C
N/~
rARY I: SITE rlAN AND CONNEcnON LOCAnON CHECKLIST
FOR CA TEGORJES C.D.E.F &: G. This is Ihe minimum Informll1ion required (or review. This infonnalion mall be sig:ted. 5Calcd Md mllo'li by.
Profes~llonal Engin~r reaUtC'Rd in Florida.
A. Siu: Plan Map (Scale:
Number ofCopb:
Include
Sile circublion pilIlI end parllinala}"Out
Loc~KJn of your proJI05Cd oonnerlions
Location of cltisling mew... openlr1gs5Cf'\oing the property
Lu.:;acion of all public street.. !lefVing the propeny
All know" easements
f>:-orcnY 11fIcs
Ri~hl of way Iin~s
AU oul-potrt:d~
0\1/ ncrsh ip of alfutting parcels
Continu.. en nul p.,e
I
I
I
I
._--_.._-_...._-~
Insel she location map
LoCUlion ofbuiiding, and other pcnnl\l1Cnl features Ihlll affect sighl di$taJ1CC Of circulul'on on puhlic roatb
EXl$1ing joilll property lICCeSll fellIurc:s
FURM Il~O-040-1~
SYSTEMS PLANNING - 1119,.
PAnE ~ of6
J
o
____ __.-CART 8: SITE r_I..AN AND CONNECTION LOCATION ClfECKLIST CONTINUE-.m
I II::: '1 ~ I
Connection Design Plan (Scale: ---' ~
lJralnace Iiom Toro Plans (Sepanlle map !'rom Sh.e PllUl ..
CcnneclKm Design may he requi~d)
(ncleric s:
/'
N/A
~A-
_l'\~
_I_~qf-\-_
~
ylA-
) c.
C'OOI1Cc1ionldrivewBY d'lIllensions (inckl&:
width. B.'1~Ie. I1Idius. lluft. etc.)
~/
.,/
/
Proposed gmding
Culven $ize and Iyfll:
AI; roadway ullemlion"l
Existing gredillg
Alo.lC iliary IlIIles w iIh ems:> :section
Existing tnlTic control device!
SlOnnwarer fuilitits
ProJl('sed IlUlTk conlJOl devices
Drninage facililks
Suiping llI1d signing plans
I'avemcnl design Include cross 5ec:tion for
connecticn(s)
Povem'-'nt lksign including cross section for
8U1tiliDr}' 18IleS
(Duc 10 scali:. thi.'1exhibil mD:, need 10 be scponte from oc.hereKhitoils) Rc:ccnt lICriaI photos an: a\."Cepuble.
tot..ti,," :rnd spnc:nr. 0 f connections, median opo:ning5, Md roads for:
6~O Ft (200 M) c;rch side of me proposed c:onncttion for rolllls witl1 speeds 4~ MPII (70 KPII) or k~'1
1320 h (400 M) em:h side of the proposed connecliOll for roads with spet.'ds greater dlan 4' MPH (70 KPH)
Aba_e l/lfonnalion for both sides or Ihe Slreel
7- 'om.", .._ E.)( ,,~'n~<;,. ~'i "'>Nl\lJ-n~:~;I\ Df'-
"Due 10 a reslri:tivc: O1cdiUl, or OIher phY~k:n1 fc:al\J~$, the requirements or this sect on may tic Jess_
j.=!_---------
rART 9: TRAFfiC STUDY
FOR C!. TEGOR Y D.E,F,&G IIprliC~ or any upplicalion rc:quesling a Traf11..: Signal, New Medilll1 Ope.,;ng, or M(1dlf~d Medlar, i)p:OIng
_ Tramc Study
I
I
I
I
Peale hour movements from ~h pm~d conneclion
ExiS'ling conditions
f"ulUre condition, (Ycur __)
Continue on nut pllCt
fORM 8S0-040-1 ~
SYSTEMS PLA.>.JNING - 11/94
PAGE 15 u(6
....---------_.__.~--- .--.--.--------.------------------------
s-
-S-
._~JPs_-
_____ _____ __ ArI'LICANT (C......,,")
PART 10: ADDrrIONA~JNrOflMA TION wlllcn MA l! BE R.EQUESTED
Numberofpackq~.
Applic:aUon forms bearing original silllatun:s.
Arplicable de5;gn~ end I1?Jlr.: 5TUdin U1d !ealed by 8 pmfeMinnlll tngineer_
NOTES:
PART II: NOTICE TO APPLICANT - -j.
Proposed li::uure, in lhe ri&JIl-9f-wIY. suc:h as median openings..d olher traII'K: control devices, life not put of tile oonncctionfs) to be authori1bJ by a
conncl."tion permil The Oepu1mcn, ~s the rish' to cIIMF Ihese relllures In the fUture in order to pror:lOte safety in tJ1e rir.hl of way or efficient
trOlJlic uper.Jtions on the highway Expenditure by the eppllc:.ant ormonie! lOr InstaJlation Of mo.intenUlcc of such reafU~S .hall ~t no vested right in
the mlUl1tenan~ o(such fralUl'CS.
PART 11: CERTIFICATION ND SIGNATURE
I certJ().lI;at I am familiar w.
complete and 1J(("UA(e
signedL
information contained in this Ippllcatioo and 1h0l to the best ofm)' knowledge and belief slJch iaformntion i.s ll'Ue,
Date:
t4...........~~~.t
Printed Name: I'
rnLE:/
,~ll)oIAL Ot<:NrEA 1l101$TUnu- 'f\MNIl1lf AmxAIIU!I.
c........ A.....J
W'f!<'
-.
...
END
C tH-..n F: rV;T en:;: *~..
NAME~ G..I.... STEVE CONSTRUCfrON
ADDR: 6240 GALL BLVD
C_/:::;T:: ZET'i.-r/h:H ILL.::;" FL
CENTRAL PERMITTING
:::Or:):::;CU CUUi'-.!TY.. FLUh:IDf':,
.~.... ....- ..,.. ,... .
r.O j-:':j f:.i i:::
~-::;~::;I.lL' C!F"f:' I Cj :;; J)
- 1.1,.
OFT. _ I . 1::_: J) (.!J) i::_ L::: Y Tr
F'~i::.C.:[~ J F'T 1~..~I.,Ji'{!r'~h::' 1'~I.)(",:L fj'.>".:.~.;~.;.:.;
FOF.: :: h:E8CH.Jh:SE FTT: Fe)h: PEF:r.-j J T t41 B06
Ci..IELl:: ~, (.();':_;
f;)CCNT
114
TelTr;:,L (.:,(T'iCJtH.-IT::
c::m.tjpi"--!--.( N:::CDI..JN-I CEJ-rrEF;:
B450 .- 363000 - 2
:I. (~:I l;. 11 () ()
td'-iOI.JNT DE~:)CF;: I F'T I CH.,L-'T'EF.:,Trr D() Tt: DF.:_/Ch
196..00 ****** SOLID WASTE FEE ou
h:ECE I t-..'!:::n In---
elL
.. .'. ............ .-.. ...............". ...... ....n.....c.... .... .... .... n...c...h...._...............
------.....
------~...._,
"..-
.,
PASCO COUNTY, FLORIDA
Permit No. --1.-
Date Permitted
/7 / ... /.)
_C:=-"_~-,-:~2~Z;),L.- -J~2.J.?t;, , __ Control #
County Parcel No. (~2-=~!~Gz~_~"{i-:-'i~J.OLO ~-i:(;L)(r(>IG'~~_ SubDlv:
Ad(lress/L .ocatloll ---&.;-';<_11) _-l",l~~L~~~~___________
, ClasslflcatlonlType of Use -L~=ld1~d~' ~4-64~~(~:2adJ
TRANSPORTATION IMPACT FEE Rate: ______-.:.._______ Sq Ft LJnit:-.:t....:J~Q______
Exempt [] Yes ['\71. No How Determined
AJ _______________________________.________.__________ ____.__
Impact Fee Amount ..1___::::?L~lt-:!'~~~t:____
..;'\(.{ /-1$S.-{'.3
----'-------~.__t.....;;;..... __._...--...______
SCHOOL IMPACT FEE -
Account (056) Slngle.-Famlly Detached l-louse
(057) Mobile HOl11e .
(058) Other Residential IVI!
J123) Collection Fee
Exempt L_J Yes [J No How Oetennlned
-------:-~_._.._~._-~._----_._---_.__._--
~~...-_._----_rw ...... "'_'._..._..
PARf<S AND RECREATION FEE
Land Account Land Credit
Zone No.
--.-----
TAZ:
---_.._._-_._--~-.
_'J ____....__~..... ........ ...............~_'_.._._..___...__
Amount
$
-_._._,.~----~.-...._.-...._._..~----_._--
.-.----.-.-----..---.-.---...-.---.--
--..-'------------_.__.~
--------
----.-- ---------.-----.-------
Land Total
Reel eat/oil Account
-----.----..---
--..-...---.----.---..-
Hecreatlon Credit
Recreation Total
Zone
TOTAL AMOLJNT_~_______________________
Exelnpt CO] Yes [j No
110w Determined
ITBRARVf-EE"'-'---'~----"-- --
Land Account L.and Credit
----_._--------_.._._---~._._._-_._-_._--_..._-_.._--
------.-...--.".--.....-...,--.------
---------------
Land Total
-.--. -.'-"-"- '---'-'-. "-'-.-,-", ---.
..._------~._...~_.._..- ---_._~
Facility AccoUllt __________________ Facility Credit
__ Facility Total ._____________
Exempt [] Yes [] No How Detennlned . __ Total Amount __._______
-. V
RESOUR.C.EFEE-~.r(7-7. .V:;::::-______ ERU_:_=~' / 6
TOTAL AMOUNT I -/ cCJ
.._-'"._----_.__...~.._--_.__.__.__.._..._._-
--".,._'-...........-....,,,..._<...._._..........---,-....~..__..~.......--.-.-..-.......---'--.."'-....-....--I<'..-.--"'--..-.--...........-----.__r__.._...~......_
Prepared By ________________________________ Checked By
-- -_._--_._-_.~---_.._---_._----_.-
NO GI:RTIFIGATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMI:D UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptanc;e of concurrence, but Simply receipt of a copy of this form, placing
the blllldlng permit owner on notice of this assessment and the conditions of payment for same.
--_.._-_...__._-~_.._- ------..----.-....-.----..- --..---.
DATE
RE C E IVED. BY---------------------.---
RECEIPT NO. DATE BY
.--------- .------ --_...._--_._------_.__.~--_._-,-~._-----
-
-....--
-------.......
-...-...-........................_....w.............._..,
~.
~
PASCO COUNTY, FLORIDA
Permit No.
Date Permitted
( J~tJlIder NarlJ~/Owner Name -i:;2~-~.~_~;J~-?iH-___.__ Control #
Cuunty Parcel No. (~c-:~-i?.(€---gl----_~?t2L?2:...c.251~_ZJO-- f)?!;J.tl_ SubDlv:
Address/location --~222/f.__~!2d.~_ / ~;~:&!:fl:_____-,--__________
, Classificatlon/Type of Use 1~~2:t3dMiLL~"/' .~ '-:4.?t..&L---L~1CM~t- 'I:Yd:-
-./
,/ ''\
TRANSPORTATION IMPACT FEE Rate: _______~________ Sq Ft Unit: -4 () vi),
E)(empt [] Yes [J No
How Determined
') . tr..)
Impact Fee Amount_l_.:._J';..f-,--1~-:-,____, Zone No. _________ TAZ: _____________
- oj 'i . / -, to <..' 33
sciT6'oCfMPAch .FEt----.......~..J~,..~------ --~--..._~._"_____.__._______
Account (056) Slngle.-Famlly Detached House Amount $ ___.__...._________________
(057) Mobile Hams __________.______._______.___
(0513) Other Residential 1/...../';/.<) _______________._._____.
.JI2:3) Collection Fee I/J (
Exempt LJ Yes [J Nt> Ilow Determined -------------------------___h___
_.._~~-~.._----_._~--~-----~-_._-_._~---_._..._-~
--~.....----.-~_._----------.._.--_.----_..-
PARI{S AND RECREATION FEE
Land Account Land Credit
-~.....~~
---..... -----,-~-
- ~--~------,_..._- ~-_.._---_._...-
Land Total
Recreal/on ACCOUllt
-------_....._--~_.__...- .---
Recreation Credit
Recreation Total
ZOlle
.-.-.. "~--'~--_._-_..- .....~."-~-~..
TOTAL. AMOUNT_~___.__ ______ _____
Exelnpt [) Yes [] No
nBRARYFEE~..-~-._.-....
Land Account
I-Iow Determined ______________________.________________ __p__________
.--..------.......-------..-------...----
- .....---.-..----..------..- .-----. ---.--.
l.and Credit
-..-- -_._~----~.-
Land Total
Facility ACCOll/lt ______________ Facility Credit ____________ Facility Total .____________________
~..-..--.--_~ ~_n_.~ ."__'__'_'
Exempt [] Yes [] No How Determined
RESOUR.C'E FEE---.'--'- J.--'L~.~'-------
rUrAL AMOUNT _J I ~
--~----
Total Amount
__.__'_'4'~'__
--...--.- ERU ---=~2~_~~--_~.
-~_...._--._--~.._._---_.~_.._.__._~
--.'..--.-..'.......--..--.-..-..-.0-...----..-.---.....--'--...----.----.---'-_.r....._._,~_,_._~.____._____
Prepared By __ __ ___________________,___._____ Checked By
-.~-_._~_..-._.-._......._--._- -.. .'-'.--- ---------._~_._. ._--
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOT At AMOUNTS I./STED flA VE
8€€NPA(O AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
AclmDwledgemel1t 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 condlllons of payment for same.
-OA-l"E --.----.---.-- ----- ----------------.-----
RECEIPT NO. DATE
RECEIVED BY
... .----_.._~-------_.._-
.------.------.
BY
, ~,
----.----..--------
------------~.--------~-._._._A..____