HomeMy WebLinkAbout03-2403
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
2403
Permit Number: 2403 Issued: 10/07/2003!
Permit Type: NEW SINGLE FAMILY DWELLING'
Class of Work: 101-NEW CONST/SFR
Proposed Use: NOT APPLICABLE
Sq. Feet: Est. Value:
Cost: 80,100,00 Total Fees: 3,155.48!
Amount Paid: Date Paid:
Address: 6811 OAKCREST WAY
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: OAKCREST
Parcel Number:
Name: DAVID W, JOHNSON BUILDER, INC
Addr: 9504 FORT KING ROAD
DADE CITY, FL 33525
Phone: (352)523-0473 Lic:
Work Desc: SINGLE FAMILY DWELLING
I
J
Name: COPELAND MARY
Address: 6811 OAKCREST WAY
ZEPHYRHILLS, FL. 33542
Phone:
WATER CONNECTION RESIDENl
8UILDING FEE
E
419,00 MECHANICAL FEE
666.00 RADON
67.90
18.88
WATER METER RES 3/4"
..J\I~\b~
~'
It-/(
, l~j
180.00
I
('!S~
l'olnt()-~ {Z'-/ ~ ~ I ~_
L1 . /1 J rlVI'9l.,
?J '15' ~7 3, !J fV'J i
-r -, (tt. c
CONSTRUCTION POLE 0 ~- I 2ND ROUGj-l PLUM~/I~"'~<f lfS"o DUCTS INSULATED i/r5-04 Il'!t J;:.
PRE-METER -g.-p I&~ WATER t/ 2 ,2..(, -~r 0, '1 'FINAL MECHANICAL 0
MISC SEWER t/'? - Z.lvC~ -,=v , MISC
""0 MISC MISC. i MISC.
MISC. MISC. 'I MISC.
DRIVEWAVV ~~/-'V ~d MISC. MISC. FIRE DEPT. FINAL
---REINSPECTION FEES: When extra insPection trips are, necessary due to anyone of the following reason~ a .
charge of Thirty-Five Dollars ($35.00) shall be made~_ ,Ch trip for each tr~de:, 8~ D) K2 ~,.,
- / J!LIG/fTJtJ,t) It1F7I1!.. / /.~j~'Of
. .C"VNV, rEf /7j- orO_
(a) Wrong address (b) Condemned work resulting from faulty constru~on (c) Repairs or corrections not ade w ~
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
"Warning to owner: Your failure to reconfil' 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_~ecording ~our notice !>f comme~~ement."
NO OCCUPANCY BEFORE C.O.
____n_ _. ~ ___
r. ~~~ATDRC-- -. PERMITOFFI
, CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
rg f''''-,
,~"~l
~~-
PERFORMANCE 9USINESS ?RCCUC-;-S. INC. 813-.719-8008 FAX 813-719-7919
03._
/\
'/ llie T
CITY OF ZEPHYRHllLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO.
DATE /0 -5'- ('3
OWNER/
RENTER
--:--.. 11 I' J -J;' -
t ./'./ H L. (c( .! C /1//1 '\ r h
/1 -+
(' /"C"YV1.....{.
. MAILING
--
':) c.c
/"}' .~
C/~7YZ4.-J ,
(/
I
SERVICE ADDRESS 'e Q; (l
SHUT OFF SERVICE 0
TURN ON SERVICE 0...---
INSTALL METER ,~
READ METER 0
CHECK METER 0
OTHER 0
o SEWER
o GARBAGE
G;}-"IN CITY
o OUT CITY
~ No. OF UNITS
_ DEPOSIT AMOUNT
_ AMOUNT LAST BIU
J,
: I i
~
. .,.;:-fl-;; yr.c~r
v-~
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
Retain white form .n office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Oept to sign yellow form & return to office.
.//,,,,,: .// //,- ",,/7 .d:--
/" v/,,,?/ (,~~ ~
ORD R GIVEN BY
X. ~f / {} ;;/~
. '\, l~ Ii. jVztvt. l..1
JUN.19'2003 10:45 352 567 3830
SUNSTATE TITLE #6309 p,002/002
YUiY1I11WIIIIIIIIDUIIIHlllnUIllIIIIIRHnll
STATE OF FLORID"
COUNTY OF p.uco
Rc=pt., 610!566 R_ : & .1'/ll1l
DS, O.H IT: 1lI.1lII!J
NOTICE OF COMMENCEMENT fJ&/191e3 -- .--- Dpt.y t;lerlr
~18~~fIA~e:'~ fotlN~?k
OR BK 5401:>> PI; 1185
,
mE undeniped, as Owner, noCflla .n partin tIIat IIIlprovelllellta...1I be lUd,e to certain real property, and
in _rdaoce 1ridI Scdion 713.13. Florida Slat1ICU, tbe roUowin& infonaatioJr Is stilted in tIJe Notlce of
COlll...._l:
DESCRIPTION OF ~OPER't\':
Lot 4, OAK CRESf EST"TES, PHASE TWO, aeeonliae to map
or plat tltercof n:cordecllo Plat Book 39, rages 64 and 65, Public
Retonl. otPuco COUIlt}', Florida.
GENt!:RAL DE..-.cRJPTION OF IMPROVEMENTS:
CBlFrame RnldeJlI:e
Reli.ble Contnu:tillg, Inc.
61.9 StepbealPlltII
Zephyl'llllls, J'L 33541
OW\'lllER'S IN'I'EREST IN THE PROPERTY DESCRIBED AS: S....ple
and Mary B. Copeland
OWNER AND OWNER'S "DURESS:
CONTRACTORS AI'lD CONTRACfOR' S ADDRESS: RelIable C~ Ine.
6819 Sl&pllens hill
Zephyrbllls, FL :n~l
SURETY (Ib..,.) and SURETY ADDRESS: NJA
AMOlo1\,,- OF BOND: S N/A
NAME MG) ADDRESS OF LENDER. IF ANY, MAKING A LOAN FOR CONSTRUCTION OJrTHE
JMPROVEMENTS:
...- ,.-...:
eom...nity Nall_1 &.Ilk of Pnat COIlIIty
Post Oftit;e Pox fi39
Zeplyrllills, f'Iorida 33539
NAME Of PERSON WlTllIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM
NOTICES OR OTHER OOCTJI'oUNTS MAYBE SERVED:
;-
.....:.:.::'":-.~
-,
COGW1UUIlty NIItioIUlI BaRk uf Paseo CoUllty
Pod ()ff'1Ce Boll 639
Zcpbyrbms, Florida 3JS39
IN ADDmoN'O OWNER DESIGNATES THE FOLWWlNG PERSON TO RECEIVE A CopY OF THE
LlI:NOR' S NOTICE AS PROVIDED IN SECTION 713.13, FLORIDA STATUTIS:
,'r"
CO....lll1lty NlltiOllal Bank
ofpuco COtlIl'Y
Post Office Boll 639
~yrIlin., Florida 33S39
EXl"IRA nON DATE: JUDe 17. 2(104
Lanr Bene'
Auonaey at Law
Polt Offta: Box 1046
Dade City, FIortda 34297-1046
jtJ Ii ;JJ;tzr
Neal B. Hartley, 7~
Ma~~ ~e(f
STATE OF FLORIDA
COUNTY OF PASCO
'Jbe roregoml insmll.ellt was aduIowleclced before l1Ie this 1'- day of JIIH 2003, by Neal B.
Hartlcy.l'r'aiIkIJt DfRelidJle CODtnId"'I~"'1Io Is pel'lOllully IuIowa to DIe or wIIo produced
as ideadf'reation aDd 'Who didldld not ralle oath. * and Mary B. Copelsnd
- Witness ..y 1I~1Id alld offtcld seal in the County nd s..tc lut alorel18id tbt8 17" day of J_ 2003.
~rW' FlORIDA
"""""';:rl, ~ PASCO
~I' I' to~R9'''' r.."U THE FOREGOING IS A
........f!lf;lrtNJ:tc.~. 1:' 'liE OOCUUOOON FJLE
~"!'-!t' lllCOfW '" I -.; O'Ti$EAY.ltIIE5S MY
HA D'~~FFICIAl SF,;.i r.~IS.L.L. O~Y OF
~ _ 2~
. Ctfilk 'J'! ;;, RCUIT altIRT
DEI"JlY ClERK
NOTARY pUBLIC
~
C~~~\ ,:~..i;:'~:'i':' ~,~~~f~~~~ '1'
t.. )...__,(....-.,.._ ': . ~nJ:._,1_(...4
"" ,.._.,...,_..~.,:.(.: .,...~, t....C':j.)4S:.j..
FLORIDA ENERGY EFFICIENCY CODE FOR BUilDING CONSTRUCTION
, Residential Whole Building Performance Method A CENTRAL 4 5 6
FORM 600A-01
5
PROJECT NAME: BUILDER:
AND ADDRESS: PERMITTING CLIMATE 405060
OFFICE: ZONE:
r------ PERMIT NO.o=IJ:IIITI JURISDICTION NO.: [LIJ=rJJ
OWNER:
1. New construction or addition
2. Single family detached or Multifamily attached
3. If Multifamily-No. of units covered by this submission
4. is this a worst case? (yes / no)
5, Conditioned floor area (sq. ft.)
6. Predominant eave overhang (ft.)
7. Glass type and area:
a. Clear glass
b. Tint, film or solar screen
8. Floor type and insulation:
a. Slab-on-grade (R-value + perimeter)
b. Wood, raised (R-value + sq. ft.)
c. Concrete, raised (R-value)
9. Net Wall type, area and insulation:
a. Exterior: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
5. Other:
b. Adjacent: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
10. Ceiling type, area and insulation:
a. Under attic (Insulation R-value)
b. Single assembly (Insulation R-value)
c. Radiant barrier, IRCC, white roof installed?
11. Air distribution system:
a. Ducts (Insulation + Location)
b. Air Handler (Location)
12. Cooling system:
(Types: central-split, central-single pkg., room unit, PTAC., gas, none)
13. Heating system:
(Types: heat pump, elec. strip, nal. gas, LP. gas, gas h.p_, room or PTAC, none)
14. Hot water system:
(Types: elec., natural gas, solar, LP. gas, none)
15, Hot Water Credits:
a, Heat Recovery (HR)
b. Dedicated Heat Pump(DHP)
c. Solar
16. HV AC Credits
(Use: CF-Ceiling Fan, CV-Cross vent, PT-Programmable thermostat,
HF-Whole house fan, MZ-Multizone)
17. COMPLIANCE STATUS: (PASS if As-Built Pts, are less than Base Pts.)
a. Total As-Built points b. Total Base points
I hereby certify that the plans and specifications covered by the calculation are in
compliance with the Frida EneflY ~ode.
11a.
11b.
12a.
12b.
12c.
13a.
13b.
13c.
14a,
14b.
15a.
15b.
15c.
16.
117.
17a.
1.
2,
CK
"
,).
4.
5.
6.
..{Iv
j,'" (1, sq. ft.
,. f If' 1/ ft.
Single Pane Double Pane
IL;)., 7 sq. ft. sq. ft.
sq. ft. sq. ft,
7a.
7b.
8a. R= 0 "61 ,', L ft.
/, ~~
8b. R= sq. ft.
Bc. R= sq, ft.
9a-1 R= 3' 90'J- sq. ft.
9a-2 R= If I~~ sq. ft,
9a-3 R= sq. ft.
9a-4 R= sq. ft.
9b-1 R= sq. ft,
9b-2 R= 11 I'll sq. ft.
9b-3 R= sq, ft.
9b-4 R= __ sq. ft.
10a. R= '3C 13d~, sq. ft.
10b. R= sq. ft.
10c.
R= b , VII.. Cr (cond.luncond,)
V ,l. C' ~(COndJUnCOnd,)
Type: [~ly d (
SEERlEERlCOP: i rj ( (
Capacity: ')- 'J <.S 0 0
Type: fi t'
HSPF/COP/AFUE: I ~ 0
Capacity: ';J.. r- f.{' (/ 0
Type: b ,( " l
EF: I t1 r
f'r
p ~,~ -;
"'~ f.J 73
r ~I
17b. ,., i:>- f
.~ DATE:' -/-03
m ' nee with the Florida Energy Code.
Review of plans and specifications covered by this calculation
indicates compliance with the Florida Energy Code. Before
construction is co pi d, this uilding will be inspected for
compliance in aceo a . on 553,9~,S,
BUILDING OFFI I
DATE:
OWNER AGENT:
DATE:
SUMMER CALCULATIONS
CLIMATE ZONES 4 5 6
ORIENT A TION OVERHANG GLASS SINGLE.pANE OR DOUBLE.pANE SUMMER ~, AS-eUIL T
LENGTH AREA UMMER POlNT MULTlPUER SUMMER POINT MULTIPUER X OH FACTOR . GLASS ~
OH (FEET) (SQ, FT.) CLEAR TINT' CLEAR TINT' (from6A.1) SUMMER PTS
N ~ '~L-.J.. 27.96 22,93 25.65 21.22 t~\Of "7 'X"(
NE 43.65 36.42 39,16 32.78
J E J '6.1 'l.';..rJ ~ 59.31 49.89 52.66 44.33 ' t;q '? /7(,<;;.
I~L SE 56,64 47.60 50.35 42.37
S J 1/ ,,",'1 44.66 37.29 39.98 33.49 , '1 'S 4- )~4':z,
H SW 52,82 44.31 47,07 39.55 .r
j w J'I/ It. I ,.. 53.48 44.87 47.65 40!'iO ,'1'1 T ? -2...f-
NVV C 37.74 31.34 34.10 28.45 -"--~~
U) r~ - H1 102.51 85.02 93.50 78.03
U) A/ I'LJ 1.1:),'7 l1.'? . cd i~~- t.,...:;, /
:3 I
C)
II
OVERHANG RATIO = OH LENGTH !i
OH HEIGHT II
!~ I
,
I
!
,
U)
U)
<l:
-'
C)
~I
FDINT,MJ.T.
.18 X
WEIGHTED GLASS
X MULTIPLIER
,18
25.99
COMPONENT
DESCRIPTION
.= llftERJQ~==+
<i! i.,A,DJACENL uL
3: II!
Cj~]-.=- ',j 1.9
'-t-E'--! . n/?s
T-J
BASE
SUMMER
POINTS
TI ;1..(
-j -9j~
T
~ ~=~==~==fA~='==r i: _ _ _ _~ '~d _ '.- nil
C) UNDER A TIIC
:z I OR SINGLE
::i
W ASSEMBLY
(,,) ----..----_..~..-
0::
o
o
-'
u.
\~~~~rg~~s .J. ,(1,:-__1.__14.31_
T
1'1- 't f if {"
BASE
COOLING
POINTS
/0 t, g-l
HOT
WATER
SYSTEM
BASE
HOT WATER
POINTS
Ilw4 '},-
As-Bum
HWM
6A-22
~"tl
2FOR GLASS WITH KNOWN SHGC, SEE SECTION 2.1.1 APPENDIX C. 3MUST MEET CRITERIA OF S. 607.1.A.
TINT MULTiPliERS MAY BE USED FOR GLASS WITH SOLAR SCREENS, FILM, OR TINT.
'H = HORIZONTAL GLASS (SKYLIGHTS)
T
AS-BUILT
GLASS
SUBTOTAL
COMPONENT
DESCRIPTION
T
i s..M.ffi I AS-BUILT
X FDM,M.lT. SUMMER
(6A-2lHRU6A-6) I POINTS
'-,--:-c' ~'I- .-tYlT),;.,-
- ------. . ---or - - r~---J,;;
_.LZ".. r .-----"Z:
(.tQ _ - _ I~"T). .7'-
AREA
'v' ~
n m .,mZJ7"f;i--'
---- ---~=~---'::Ig'l. - ::::--
-----i1.;,. ',-
'.2-1.....(, --1:-'1'0;,; "'I
_.L'1-~_,--,,~_ '~
__J4:3L_.m r J
T
Pi ~ <it-
,
AS-BUilT
HOT WATER
SYSTEM DESC.
SUMMER POINT MULTIPLIERS (SPM)
6A.1 SUMMER OVERHANG FACTORS (SOF) FOR SINGLE AND DOUBLE PANE GLASS.
. OHRalio i 00.11 I 12.17 18.26 i 27-35, 36-46! 47.57
.. II:' LNorth _~__ _j_1illL_jO.~9L I. 0.971 i_ 0.931 _ L.Q.Il!li...Jl.!l18, 0,776
fNorthea$LU~OO i 0,995 I 0,966 0.908. O,846.L uOJZZ 0.665
> fEast , LJcQQ_LQ.~93._J0c96.4. Qc9Q31...D.1l35_L_Q,755 LO.622
~ ~ i-.s.out~~i=----=L1.o!L+ _QJl99__ i 0.956 - I Q.871 , ..)QJ86l_ 0.70Q . i ..Q.635.Q.580
~ 0 ~--t..111iL;--Qc988-1 _Q..935~_O.84~J_Q.776. ~_ .JlJOLj_OJl1j9 1_ 0,618__.
~ : ISoutll"~est__j,!,QO_I__fL9.97: 0.956. i.Jl&7~-! 0.7~Ll.Jl}09 -LP.e45_l..o~L
! West . l.J..OPi_fL9!J!; Q.@()4J _O,~o.LL.Q'~_L_ 0.757 i _0,69),-1 0,630
INorthwest.--, 1.00 [0.995 0.966 0,911 I 0.857 .' 0.798 ' 0.751 ' .O~70-8
~ OH Len h i 0.0' 1,0' 1.5' 2.0' 3.0' 3.5' 4.5' 5.5'
6.'\-2 WALL SUMMER POINT MULTIPLIERS SPM
,--
FRAME
r--- . WOOD --, STEEL
~~Y~ltE_ i W__L , AJ:iTj-'ExfuIAbJ
.~9. .. t_~.4._L_2.2___L 8"9 2.9
~:!Q.L+...1l.. -f---,8- . L 4,1 1.3
11.12.9 1.9 ,.7 3.0 1.0
13-18.9 i 1.7 i .6 j 2.8 0.9
Tg:.2S:9lTo'r--'-3- T' 2.4 _ 0.8
:?6&UJL. j .~.=:....L..2_~=-I=1.r _-~ . 0.4
6A-3 DOOR SUMMER POINT MULTIPLIERS (SPM)
.()QO~ TYPE ~EXTERI~Rl~_JAC~_N_T
WOOD I 7.2 I 2.4
. ---. ----1.__+_. __
INSULATED I 4.8 I 1.6
6A-5 FLOOR SUMMER POINT MUL r!PLlERS SPM
SLAB-ON-GRADE I RAISED
EDGE INSULATION I CONCRETE
---,----i L_,..___
RNALU~_--l.. SPM . ....~ ,. _R.VALUE
., . 0-2Jl___L -31.9~J l 0-2.9
_~Jl.....+-.:~ .:_--3-(9--
,5-6.9 I -31.7 j 1._~_~-fL_m
7 & U i .31.6 7 & U
6A.6 INFILTRATION & INTERNAL GAINS ISPMI
Air Infiltration 5.17
Internal Gains + 9.14
Infiltration/Internal Gains 14.31
(Combined)
6A.7 AIR HANDLER MULTIPLIERS SPMI
Located in oarnoll 1.00
Located in conditioned area 0,90
Located on exterior of building 1,02
Located in attic 1.10
CLIMATE ZONES 4 5 6
_0.718 0.651 0,611
0.623_0.491__+_ J)M5.
0.571__0,1.11 . i .1)..463
o'54Q JAIS ,_0...1.3.6__,__0,10.7
Q.5aL ,___Qc53.lLc -0,SQ3.....1_ 0.475_~_
~:~i . n_:~~;~~ ":'-{::~l-+--K~~~-
0.674 u--uO,61!f '--6.510'-->-0:532-
6.5' 9,5' 14.0' 20.0'
CONCRETE BLQ.c.l<j~QRMAL~V'J!)
!INTERIOR IEXT,
________ ilNSYLATlON IINSUL
R.VALUE i EXT I ADJ EXT
"..n__ I__--,--~
. 0-2.9 __ I _~.5.J..1..... ~.!i
3-4,9 . 1.4 I .7 .7
5-6.9 -i 1Tl:6- i ,3
7-10.9 .mL,~_ _L4_L_.1
11-18,L_.J_.-,-4~.0. __
J~t~9_j-+--Y-l
FACE BRICK
LOG
---- ~-.._-_.__..-----_. ..-------
R-VALUE :WOODFR
---- --- -- ~
0-6.9 2,9
7=10.9 j- :5 -
11='18.9-' .4
- -- --- ------,-. ---+-
19-25.9 i ,2
26 &U-.' .1
R.VALUE
0-2,9
3-6.9
7-9.9
10&UP
BLOCK
1.0
.6
.4
,2
-----._--~
i61NCH i 8 INCH
R.VAlUE I EXTI EXT
O:i9-' !1:7---t--1,6-
-j:6,9-~1T ___n -:8-
7 & U r .8 --- - .7--
NOTE: SEE SECTION 2,0 OF APPENDIXC FORMUl TIPlIERS
OF ENVELOPE COMPONENTS NOT ON THIS FORM,
6A-4 CEIUNG SUMMER POINT MULTIPLIERS SPM
, UNDER ATTIC i SINGLE ASSEMBLY
_~-VALUE I..~_I R-VALUE_J.._ SPM_
__~9-21.9 I 2.82 t-+.O-10'il...u_i_ 12-27
....32-25.9---i 2.55 j 11'~_~_9:~3
2~29.9_. l__2.2~ L!3.~8:9 mL ~}2
30-37.9 I 2.13 I 19_25,9 6.90
38 & Up i 1.84 I 26-29,9 5.82
RBS Credit 0.700 30 & LJp--_L-S:40
IRCC Credit 0,864
White Roof Credit 0.550
CONCRETE DECK ROOF
j- . CEILING TYPE
R.VALUE ' EXPOSED I DROPPED
-10-13:'9 : '11.13--.L 10.4
. --14=-Z([9- .-- [~ ir:gg_-
. . 21& Up '.-o.fflr-l---:;:70-
SPM
-1.0
:-;f.7
-u
-1.7
L_
I
RAISED WOOD
I~'----~--"-'- ..-.... 'u.n. ___n_ ..._..
I POST OR PIER STEM WALL wi UNDER
! CONSTRUC..TlON FLQ9BJNSU~~TlON
._J=~.=;~~ .:.= ~~.
2~ ~8
1"]3- .-2.i
U~__ _____ _ __________
1.36 -1.8
i ADJACENT
. 1 SPM
. 5,;3
-~-
___L~ 1.8 - -
1.0
6A-8 DUCT MULTIPLIERS DM) See Table 6.10 for Code minimums,
DUCT RETURN DUCTS In:
SUPPLY DUCTS IN: R.Value Attic! Attic!
RBS IRCC
1.107 1.108
Unconditioned Space
AtticlRadiant Barrier (RBS)
AttiCIWhite Roof
Conditioned Space
6A-9 COOUNG SYSTEM MULTIPLIERS ICSMI
SYSTEM TYPE See Table 6.3 for Code minimums COOLING SYSTEM MULTIPLIERS ICSMT
Central Units (SEER) Ratina J5-7.9 8.0-8.4 8.5-8.8 8.9_9.4 9,5-9.9 10.0-10.4 10.5-10,9 11.0-11.4 11.5-11.9 12.0-12.4
CSM .45 .43 .40 .38 .36 .34 .32 .31 .30 .28
PTAC & Room Units (EER) RatillQ 12.5-12.9 13.0-13.4 13.5-13.9 14.0-14.4 14.5-14,9 15.0-15.4 15.5-15.9 16.0-16.4 16.5-16.9 17.0-17.4 17.5 & Up
CSM .27 .26 .25 .24 .24 .23 .22 .21 .21 .20 .19
WINTER CALCULATIONS
cqMATE ZONES '4 5 6
ORIENTATION OVERHANG GLASS SINGLE-PANE OR DOUBLE-PANE I WINTER ~'AS-BUILT
LENGTH AREA Xw'NTER POINT MULTIPLIER WINTER POINT MULTIPLIER X OH FACTOR - '"JLASS ..,
OH (FEET) (SQ, FT.) CLEAR TINT' CLEAR TINT' (from 6A.~OI WINTER PTS
JT N L. 11Jt l- 12.32 12,58 6.43 6.64 ~'1't"l U,..,-r.-:--
~ NE I 12,00 12,31 6.17 6.42 I I
E I'(f 'j. q,C41 9.96 10,54 4.52 5.01 I ' ()\'I '\ :). 5...Q-
SE i 8.34 9,12 3.17 3.84 .-
H S /'a (~ '" '1 7.73 8.59 2,65 3.39 r'1'1\.~ -r-/7
sw . 9.22 , 9,88 3,88 4.45
1~ t-W J L{ /Od -..- 10.74 11.21 5.16 5.56 .",l{~ It))f
r NW 12.22 12,51 6.35 6,58
en H1 11.64 12,36 4,91 5.54
en 1\/ ')J,7 , 7t)L f:l,~;i HIPlIf.. "l.'-t'f
::5
C)
/~! ~
01-
I ~~N{~g~}n
WEIGHTED GLASS
MULTIPLIER
en
~
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.18
5.44
T
AS-BUIL T
GLASS
--f~I't
COMPONENT
DESCRIPTION
, rnEXTERIOR
::I I ADJACENT
~ ~.
AREA
~ BASE WINTER L ~~~R
. POINT, MUL T. I
F--=-~~ n==t I ~ .:;-~.
I
. r
COMPONENT
DESCRIPTION
T
WINTER AS.BUIL T
AREA X POINT. MUL T. I WINTER
fYI-V-!(6A:1;~~~}A-1~f ..- cTI~I~TSI)
-7C;1-t-':-~--'-Tn-n3'e~ n<r'
.. n7Tn?:rn !---h-G- tnnT ).,~
T
t I 0
_LT.
-n)--L~k i ~ ( ,
--f7- T~Qn~~==T--
~ ~~DS~~;L~IC 1- .-I-"->---'------r--......M.-.
::;
iii I ASSEMBLY
u 1-----
"J. {,
tS.
T
0:: f-~ (P"R1~E_TERI,.'_ I - ~ .)" 't -1.9 ... n_:h_'l..1 nn__~Q .
g fBt-I~~[)(AREAl ~ u _ .:1....._---1__ . _ ---- ,. I----n l
~ I------..---------.--J--- - - I I ____,..,,_._~____,_~~____~___.__._____________
i FOR SLAB ON GRADE USE PERIMETER LENGTH AROUND CONDITIONED FLOOR. FOR RAISED FLOORS USE AREA OVER UNCONDITIONED SPACE,
T
(:" L_n__n__.
USE TOTAL FLO R AREA OF CONDITIONED SPACE,
T
lL.jb ~, 7
INFILTRATION &
INTERNAL GAINS
-0.28
--"._.__.__._--~-_.
HEATING
SYSTEM
Base Heating
System x
Multi lier
,63
....
~
o
...
'H - HORIZONTAL GLASS (SKYLIGHTS)
WINTER POINT MULTIPLIERS (WPM)
6A-10 WlNT~R OVERH.6:NG FACTORS (WOF)
CUMATE ZONES 4 5 6
i
wa:
mO Southwest 1.00 1.002 1.013 1.038 1.071 1.118 1.168 1.225
(1)1
L West 1.00 0.999 1.003 1.013 1.025 1.040 1.053 · 1.067
Northwest 1.00 0.999 0.998 0.997 0.997 0.996 0.995 0.994
OH Len h 0.0' 1.0' 1.5' 2.0' 3.0' 3.5' 4.5' 5.5'
6A.11 WALL WINTER POINT MUL TIPLlERSIWPM\
FRAME CONCRETEBLOCK(NORMAL~ FACE BRICK LOG
INTERIOR EXT, R.VALUE WOOD FR R.VALUE BLOCK
WOOD STEEL INSULATION INSUL 0-6.9 7.0 0-2.9 3,7 6/NCH SINCH
R.VALUE EXT ADJ EXT ADJ R-VALUE EXT ADJ EXT 7-10.9 2.1 3-6.9 2.6 R.VALUE EXT EXT
0-6,9 6.8 5.3 9.4 6.7 0-2.9 6.0 3.1 6.0 11-18.9 1.7 7-9.9 1.8 0-2.9 2,2 1.2
7-10.9 2.5 2.1 4.4 3.3 3-4.9 3.8 2.3 2,8 19-25,9 1.0 10&UP 1.3 3.6.9 1.2 ,9
11-12.9 2.0 1.8 3.3 2.6 5-6.9 2.9 1.9 2.0 26 & Up .6 7 &Up .9 .7
13-18.9 1.8 1.6 3.0 2.4 7-10.9 2.3 1.5 1.5
19-25,9 1.1 1.0 2,6 2.2 11-18,9 1.5 1.1 .8
26& Up .7 .7 1.4 1.2 19-25.9 ,8 .7 I NOTE: SEE SECTION 2,0 OF APPENDIX C FOR MULTIPLIERS I
26&Up .5 .5 OF ENVELOPE COMPONENTS NOT ON THIS FORM,
6M2 DOOR WINTER POINT MULTIPLIERS (WPM)
DOOR TYPE .EXTERIOR I_~ACE~T
WOOD I 7.6 : 5.9
------:t-- ' -----
INSULATED I 5.1 4.0
6A.13 CEILING WINTER POINT MULTIPLIERS (wpM
UNDER A mc I SINGLE A5SEMBL Y I CONCRETE DECK ROOF
R.VALUE I WPM-/ R-VALUE WPM! C'-ceiDNG TYP-r-
19-21.9 ,87 10-10.9 1.02 R.VALUE i EXPOSED ~ROPPED
_..B-25.9----1\l._j_.J.1:~_____.JlL__1 10-13.9 C1.16 __ f 1lJ5-
26-29.9 .69 I 13-18.9 .84 14-20.9 t- ,83 I .76
lt~?e;-ro:Eo -+--iH~--t-- :~~ __I~.~-L-~~-_-i~-
IRCC Credn 0,905
WMe Roof Credit 1.044
6A.14 FLOOR WINTER POINT MULTIPLIERS (WPM)
SLAB..QN.GRADE
EDGE INSULATION I
R.VALUE _~__ WPM ,
_ 0-2.f!._-t--.l.?_~
3-4.9 , -1.7 !
---5-6.9 ----2T-_~
~&u"T--2T I
WPM
4.0
II
I I
, I
II
r-
RAISED WOOD
I POST OR PIER STEM WALL w/ UNDER ----,------
I CONSTRUCTION FLOOR INSULATION I ADJACENT
I WPM WPM --r-- WPM
L._~~_~_.-.l-~ _ ~.3-=
0.78 1.7 2.1
-+___ -0.47 - -i --- ---:5L_ fl\
0.14 .3llf---
6A.15 INFILTRATION & INTERNAL GAlNSIWPM\ 6A.17 DUCT MULTIPLIERS DMI See Table 6-10 for Code minimums.
Air Infiltration 0.87 DUCT RETURN DUCTS In:
Intemal Gains -1.15 SUPPLY DUCTS IN: R-Value Unconditioned Attic! Atticl Atticl Conditioned
Infiltration/Internal Gains .0.28 soace RBS IRCC White roof soace
(Combined) 4,2 1.107 1.098 1.100 1.102 1.092
Unconditioned Space 1.078 1.072 1.074 1.075 1.068
1.061 1.056 1.057 1.058 1,052
6A.16 AIR HANDLER MULTIPLIERS (WPM\ 1. 1.067 1.059
Located in oaraoe 1.00 AtticlRadiant Barrier (RBS) ,0 1. 1.051 - 1.045
Located in conditioned area 0.92 8.0 1.( T.041 - - .U~ti
Located on exterior of buildino 1.09 4.2 1.1 - 1.U88 - .U77
Located in attic 1.11 Attic/Interior Radiation 0, 1.073 - 1.066 - .057
Control Coatinos (IRCC) 1.u 1.052 .045
1. .095
AtticJWhite roof 1. - .070
1. - - 1.054
1. 1.UU8 1.U1U 1.0mY
Conditioned Space 6.0- 1.007 1.006 1.007 1.007 I.UOO
6M8 HEATING SYSTEM MULTIPLIERS (HSMI 8:lf 1.005 1.UlJ:> 1.006 1.005 1.000
SYSTEM TYPE See Tables lHl to 6-8 foe code minimums HEATING SYSTEM MULTIPLIERS (HSMI
Central Heat HSPF 6.40-6.79 6.80-6.89 6.90-7.39 7.40-7.89 7.90-8.39 8.40-8.89 8.9-9.39 9.4-9.89
Pump Units HSM .53 .50 .49 .46 .43 .41 .38 ,36
HSPF 9,90-10.39 10.40-10.89 10.90-11.39 11.40-11.89 11.90-12,39 12.40 & uo
HSM .34 .33 .31 .30 .29 .28
PTHP COP 2.50-2.69 2,70-2.89 2.90-3,09 3,10-3.29 3.30-3.49 3.50-3,69 3.70-3.89 3,90-4.19
HSM .40 ,37 .34 .32 ,30 .29 .27 .26
Electric Strip & Gas 1.0 (for gas credit multipliers, see Table 6A.21)
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I I I I 3"X12" RISER PAN ROOF I I I I
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BACK ELEVATION
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concrete slab wi tooter
~ 1~
SIDE ELEVATION
T
7'2"
1
CITY OF
ZEPHYRHILLS
IINOTICE"
OF ADD.ITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
DATE PERMIT r#-
IA) jfJ,/b-d3 2'-1CJ
THIS JOB HAS NOT BEEN COMPLETED. T~e f I wing odditiqns or corrections sholl be mode before the job
will be accepted.
-P a.-4 ~/L Ul ~ a.t:O~ l,z 4.1 ~-;
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 ~.-c.
. rJ~
..~{) /
~ J motNER'S
NAME MI./i (op'/~
JOB SITE AD~li:~s t)aJ( o~f ~.,JJt"'~/'O.1 }ol ~If
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8tb STRBBT ZBPHYRHILLS, FL 33540
Phone:813-780-0020 Fax:813-780-0021
DATB RBCBIVBJ)
PLANS RBVIBW FRR
PARCEL 10 # oJ - 'J'- )1- OJ So - 00000 ~OD'-Io
BLOCK
04/ (1#/;;( ~))t~
PHONE CONTACT 7) '1- '-18 '3 f
~ ?/( f)o~wJ
lr\-tJ~
LEGAL DESCRIPTION: LOT(S)
SUBDIVISION
WORK PROPSED: ~NEW CONSTRUCTION
DSIGN
(OBTAIN FROM PROPERTY TAX NOTICE)
D ADDITION
DALTERATION
D REPAIR
D INSTALL
DMOVE
D DEMOLISH
PROPOSED USE: ~SGL FAMILY DWELLING
o COMMERCIAL
OMULTI - FAMILY
D # OF UNITS
o MOBILE HOME
o OTHER
o INDUSTRIAL
o SWIMMING POOL
DESCRIPTION OF WORK
o RESTAURANT & HEALTH DEPARTMENT APPROVAL
')/'A..~}f /;""';/1 Jwtll''-''-j
." '1.7'" I,
^ -r ,. SQUARE FOOTAGE
/78'~
HEIGHT
U3'L/I'
BUILDING SIZE 1 ,
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~'
0" BUILDING
[!(ELECTRICAL
Gr' PLUMBING
~ECHANICAL
PBRMITS RBQUBSTBD
$ 7o.~
,
VALUATION OF TOTAL CONSTRUCTION
,
( )/) i) J/(1
\._ ~}'7;
AMP SERVICE
B" FLORIDA POWER
o W.R.E.C.
$
;}, ~ 00
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
D SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
Er FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES ~O
BUl:LDBR
/IJ If ~1,fit?(
COMPANY IV. JD 0,", ;S,,/JJu ~<::.
STATE CERT OR REGIST # C. (;.( 0"0 1J t..
CITY PROCESSING #
,,yo
SIGNATURE
IILBCTRIC
............................................................:.....~~
' / COMPANY ~Q.rt\Y\. ~e~\ LJ I ~ .
/ STATE CERT OR REGIST # 6c./3tJo) 383
CITY PROCESS ING # q 7
SIGNATU
PLUMBER
**********************************************************
SIGNATURE
COMPANY
STATE CERT OR R G
CITY PROCESSING #
MBCHANlCAL
SIGNATURE
STATE CERT OR REGIST
CITY PROCESSING #
*****************************************************************
OTRBR
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
*****************************************************************
CONDITIONS O~ ~!.RMI~ AFF~~AVI~
A.. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permi t m!:l y' bH ::n.1b:l'~c:t: 1:0 "deed restrictions" which
may be more restrictive than City regulat:icoi1s. 'rh~! und~H"~I.i.glled assumes resp~nsibility for..
compliance with any applicable deed res tric: Ct.::HlS .
B. UNLICENSED CONTRACTORS AND CONTRACTOFl FW~St?ON:SIBILITU;S
If the owner has hired a contractor or ceont.raGtors to undertilke work, they Diay be required
to be llcensed in accordance with state a,nd ll)Gii1 regulu<tlonn. If the' contractor is not
lic6I1sed'aa required by law, both the owru:u: and contract:.n: mclY,.be ci.ted for a misdemeanor
violatlon under state law. If the owner or, ili't.!ndud 'coii,t,ract:or are uncertain as to what
licensing requlrements may apply for the in1:end.!d nork, they are advised to contact the
City of Zephyrhills Buileling Department, 8I:~-'11~B-6611.
Furthermore, if the owner has hired a contruct:OJC OJ: cont::cactors" he ,is advised to have the
contractor (s) sign portions of the "Contr.ct::.or Sectd:ons" of th1s appllca'tion for which they
will be responslble. If you, as the owner ui~Jns a~1 the contractor, you are indicating that
you, rather than the contractor, are responuibll! fClr thEt work. If the contractor wishes
you to sign as contractor that may be an indicat:ioll that: he is not properly licensed and is
not entitled to permitting prlvileges in tht~ City (If Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY GOllNECTION Ff:I~S
D. CONSTRUC'l'UION LIEN LAW (CHAPTER 113, FLORIDA S'I'ATUTI!:S, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prEtpared by thE! Florida Department of Agriculture
and Consumer Affairs. If the applicant is fJOmeOne othel: 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 clpplicat:ion 1s accurate and tha.t all work will
be done in compliance with all applicable lclws regulating construction, zoning, and land
development.
Application is hereby made to obtaln a perud.t to dCI work and installation as indicated. I
certify that no work or installation has cOlBenced prior to issuance of a permit and that
all work will be perfonmed to meet standardfl of all laws regulating construction, City
codes, zoning regulations, and land developD~nt reg~lations in the jurisdiction. I also
certify that 'I understand that the regulations of eIther governmental agencies may apply to
the intended work, and that it is my responl!libilitJ' to identify what actions I must take to
be in compliance. Such agencies include but: are no.t limited to: *Department of
Environmental Regulation-Cypress Bayheads, '~tland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District:-Wells, Cypxess Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Nalvigable Waterways
*Department of Health , Rehabilitative Servlces, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U. S. Environmental Protection Agency-Asbest:os abatement
I also certify that, if fill material is to be used in Flood Zone UA" or "A,etc.*, it is
understood that a drainage plan addressing aL "compensating volume" wlll be submitted which
is prepared by a professional engineer regiflltered 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 Eluileling 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 perudt is ~nced wi thin
si~ months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the worle: is cOlIII\enced. One 90 day extension of time
may be allowed for the ~ermit with fee charge of $15.00. The extension shall be requested
in wri tin,g to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMI!lN'l' MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN A'l"fORNEY BEFORE RECORDING YOUR NOTICE OF COMMEHCEMEH'l'. JOBS UNDER
$2,500 IN VALUE 00 NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT*.
;tJ 11- JIa;itzt f!uI g: t:!t
SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRAC OR
STATE OF FLOR~ .
COUNTY OF 1-IO~il:j it
The foregoing instrument wa~ acknowledged
Befo,re me this < I '1 'h day of ;)f' pr . i=!J:).OO~
by N 10-1 P-J. t+tH t 1"'-;1
J (naae of person ackno,.ledged)
rn who is personal..ty known to me, or
o who has produced N / A
...I (type of identification)
~~d not take an oath.
STATE OF FLORIDA r-l J
COUNTY OF . 1- OlZ.l~tL
The foregoing in8t~nt was acknowledged
Before ~ this ~ay of Ser L , ~;l 00-1
by l\j~o.. \ 12~'\';'J
...J (name of person acknowledged)
Ulho is personally known to me, or
o who has produced 1\.1/,4-
(type of identification)
and who Delid ~d not take an oath
~V11\tl j), ~{U(,~
Signature of person taking acknowledgment
f)ana L. !)U rL l K
,
Name tYPe~~~lb~~<t &k~tamped
~ ~ .; My Commission 00243306
.,. 0, ",Jf ExpIres August 20, 2007
person acknowledgement
{jan a. L. Dud {' cK
Name typed, printed or stamped
~a\. Dins LDUd8Ck ,
. "J . My Commission 00243308
~'t!".1 Expires August 20,2007
------
---^
~~
"ERFORMANCE BUSINESS "RODUCTS. iNC. 31:3-719-8008 FAX ,313-719-7919
c
3.~ q /) 1'9
;
CITY OF ZEPHYRHltLS
ZEPHYRHILLS, FLORIDA
DATE a/~Jcf
OWNER/ .- t~/J/} ./J ;/ I~/ ~, f.,.Y
RENTER / U ~~~:r /[7 ~2tA~~~
MAIUNG &:>9/1. ~h ,?{~ -; At
/'7 kt.6.s
SERVICE ADDRESS hS'/1 C{)~/I/<L;;t: W~ ~: 1fT
- ~/
~ wATER
WATER ACCT. NO.
o
SHUT OFF SERVICE
TURN ON SERVICE QI
" '.
INSTAlL METER 'fi
READ METER 0
CHECK METER 0
OTHER 0
o SEWER
o GARBAGE
Y IN CITY
o OUT CITY
i
----->-- No. OF UNITS
_ DEPOSIT AMOUNT
J ..
I
,~L
_ AMOUNT LAST BILL
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPlETED
ORDER lAKEN BY
Iv' $/;;/01' ...~
j ., ORDEl'rtfIVEN
I .'
I~"
I. /"
1/
~
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form &. return to office.
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PASCO COUNTY, FLORIDA
.............,....,.-...,"'.'''..............~___,.........,.,~.......'',n..'''''_..~......_.."__."..._'__.............~.,..._._"'..,._.-..".._~.,..._........._.......,.,................,,'~....."'____.
Builder t'lallle/Owner Name .fl~1_1-
C;Ollllty F'8r(;ell'lo,
Permit N\). ...--.-.d:...Lfc23 ._____
IJate Pennltled -L~/~_z_
J::~__.n._ Control I/- __ _______n n___ __
SubDiv:
--_.__._-" -~._.- -+---.-- -..--------
I' .'.. /1 .t", J; .-rj
Add res s/Locatlon .l/2b.jL-.C:!:...c.~~Lec-;f-:C.' -kv/~--._______n_._.__.___u..._,_.._ __ u. ___
Classiflcatloll/Type of Use_ .3-1. ~#~.f,,-~J...,J.~:~_ ___ __.______. ___
TRANSPOHTATION IMPACT FEE Rate: ____________ Sq n Unit: ----.--.-_._m____
Exell1pt I_.J Yes ,[;yNo
How [Jetermlned
--~'-'---. .-....--..-----___... -'0 ____._ .______~
Impact Fee Amount -J.--.4-.-t'~,_h
Zone No. TAZ:
..-------..-..-..----. -.._'---~' .... --~.- .-.~._.._--,...-
~~~:nM(~~ZT ~!i~~;~~;;I;~J::::::IOII:_- A::~,;---~-4~z~~..~.----~~.
(051) Mobile Home
(058) Other Residential
JI2:3) Collectlqn Fee
Exel1lpt [ ..1 Yes Ll./~6' Ilow Determined ______.__.____ ...'_._____.___. __'_" _.. .__
...-.-.-....---...-.-.- .._-----~--_....---"..._._..._.. ~_.. ----.
- - .--.-.. ~'---' ..- ._-~_..- -.--, .-- ----- .. ..- .....--.-.-. ~
p ARRsANfj1H~(~REATlotrFEE""-~-~:-.
Land ACCOlltll La.nd CferJIt
~ ..;.....-.-......."''''''.."...."...,,*-e-.-O .,o'!........_""....'"'''~,_-...- ,~......__ --..._...-.-,......_.__,,.,..___ ",.........._..
Land Total
r~ecle;'ltil)11 Acc( H It It
necreation Credit
Her.reation Total
LUlIe
'renAL AMOUNl.t____ __ ____
/EXEmlpt
...-
,
I Yes ,-] No
Ilow Determined
- .---.--.-.--.-....-. .~'n___._.~._. '--"__"_~_U" .....__....__ ~._
T.lsfiA R'lFF.E"'.'''.....''....''. ,.. "...._~._.. '...-- ,..".-.,.-.....-...,--'-----.-,-,_........o.=__.._..".~._,..__..,.__.._...~_.'"'.'"._." ""_..
--.--. ..
Latlll ACCOlltlt l.and Credit -.---..- Land Total
----. - --- "'""- .... .-.........----..:=:::.-;::._----_.~_._-- -. --- .- .-...._~-_._--..-....__..._~,-_._----
Facility AC(;()lIllt
..-"~
P'8()illty Credit ..__.___._._.___.. Facility Total
Exempt [J.Ye~"- i'-] No How Delermlned _~.~._ Total Amount ___...__...._..__
'RE'SOlIRcEtFEi~.'.-."..'m~'-_-,,-........~._-_...._----- i ........-. Effij'---.--~_..-.-"-.-.~-_...-'"-.
TC)lAL AMOUNT ~:-.UlJ)..._-;jLp:..-~-l -'-"-____'_H________. _...____
._...~.,. ,.. . "-'--' "p,.,.,. "","".~ ""'.~ .~~.......--,-~,....,o...,.". "4.,..."...."......,"..,.>>.'~....."....,_,,_........~. ,..,........ .-......'..~....._40-.-.._....... _
--....- "'"""""-'''-~'''''''.''''''''=''-'''''-'-~' ,.,...,. ..-....,--...,......~,,-~-~=........
Prepared ny "'.H_
..._______ Checked By
NO GEHTIFICATE or OCCUPANCY WIl.L. Bt: IssueD OR FINAL INSPF.CTION
PErU:OJ~MEU UNllL THE TOTAL AMOUNTS L1STEU HAVE
BEEN PAID AND
rU:GEIPTL~D FOR BY A CENTRAL PERMITTING Of=FICe ()F PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence, but slrnply renelpt of a copy of this form, placing
the building perllllt owner on notice of this assessment and the conditions of paYlnent for same.
_._'--~_._.. -'-""-.-.~..-.- ..-_... .u..__n_..__.__ ---....- ..--.....---..".---.-. -----
DATE ReC
RECElf'T NO. -J~ IJAI E :z};/p Jprj BY