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HomeMy WebLinkAbout05-4188 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 4188 Permit Number: 4188 Permit Type: ADDITION/ALTERATION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: 39,500.00 Date Issued: 5/09/2005 Total Fees: 501.50 Amount Paid: 501.50 Date Paid: 5/09/2005 Phone: Work Desc: ADDING BEDROOM,BATHROOM ,SETTING ROOM AND SCREEN ROOM Address: 7237 HIGHLAND LP ZEPHYRHILLS, FL. Township: Range: Lot{s): Block: Subdivision: OAK RUN Parcel Number: Book: Section: Name: RANDY & VIVAN KRINGLE Address: 7237 HIGHLAND LP ZEPHYRHILLS, FL. 33542 ., EAST PASCO ELECTRIC, INC WILLIAMS (INDIVIDUAL) BAHR'S PROPANE GAS & AlC. INC. PLUMBING FEE RADON 49.00 MECHANICAL FEE 7.80 49.70 P M DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED LINTEL PRE-METER WATER SHEATHING FRAME MISC SEWER MISC INSULATION WALL MISC MISC. MISC. INSULATION CEILING MISC. MISC. MISC. DRIVEWAY MISC. MISC. REINSPEC110N FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) 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 "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement. n Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~-. SIG TURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ~ fZ "i IV\~ CI;)~~ , . ~L~7 I~/~JJ-LAJ}) L~"'? "'I~ 0 :Square Feet /1 ,Dollar Amount ~ 5~'\ 00" U. 'Valuation , ~ ., 9, ')"Q 0 .~ I Building '3 Lfs.oC 'Electrical ~ ....",-. ~- ........J :J o~v Plumbing IftfJ .:, .G ~i)D~ LIe. 7Ci '1' 1. f, ~ () Mechanical Connection Fees !\Ijfl Sewer Water Meter School Impact Fee tJ ) ,'fj Transportation Impact Fee N)y:r I Park Impact Fee rJ} it Public Safety Impact Fee rJ/B CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8D St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECE IVED Lj/z ~/oS- I . PHONE CONTACT FOR PERMITTING OWNER'S N PHONE ;f13-7~d--O?~~ JOB ADDRESS /~ LEGAL DESCRIPTION: LOT(S) 33 BLOCK ~ SUBDIVISIONW ~ ~~ PARCEL ID # g 1-.:<..s: - ::l-/ -D{c.X) ~O~_ 0:$8 D (OBTAIN FROM PROPF.RTY TAX NOTICE) WORK PROPSED: oNEW CONSTRUCTION ~TION oALTERATION 0 REPAIR 0 INSTALL oSIGN 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 D RESTAURANT & HEALTH DEPARTMENT APPROVAL DE,SCRIPTION OF WORK A, I f:,e-frD-&ri'.;Se:#i hi /,00"'- . b<<-4, ~e."...,~O>>>>\- cl&~~ . , ~ / BUILDING SIZE 77"0 SQUARE FOOTAGE '790 HEIGHT g I213UILDING RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. ();r..\:)~ ~ p~jT PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. Jr.-. a I\S \. C i11i7 '-31 tL td(I ~_ PERMITS REQUESTED @ S i bl'l1i.D ?~4-Lf:P ~ V ?L-rW) f1..B.) \JjllhfJ VALUATION OF TOTAL CONSTRUC.k\ON) .~ ,: " / l (j) ~I./ (fi-L<.. '> i/ i-rr-- SERVICE 0 FLORIDA POWER O' W.R.E.C. r1h4-.JillJU) $ ~q, OOOrD 0 $y~4-tln'j- AMP ld"""ELECTRICAL ~UMBING ~CHANICAL o GAS ~OFING $ H,\)o D. 0;:) . VALUATION OF MECHANCIAL INSTALLATION o SPECIALTY o OTHER TYPE OF CONSTRUCTION:~LOCK o FRAME o STEEL o OTHER ~.Ae..-evL ~~ FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAo YES 0 NO ~~~ I SIGNATURE , '~ ~ ~ STATE CERT OR REGIST #~(Q.. ()~-,:; L:3 'f EIBCTRICIAN *:;*H~"n*H **H";;*H~"~::::=*J::;:P:::::;;:EP" . SIGNATURE ~ ~ STATE CERT OR REGIST # ER (:I)1'i591 ********************************************************~******:** ~~ 6 ~COOPANY~ ~~~ SIGNATURE "~~~*~"*H"*HH:~~~~*~~:;~*:~~':~~*H::* / ~s. MECHANICAL / f"'oo/'/....... COMPANY ~~'t"'~~ SIGNATURE (~~~ STATE CERT OR REGIST i:'iJ.e,-O<f5<jiz:? ************* ':***********************:z::J*******************: OTHER COMP~ ., PLUMBER SIGNATURE STATE CERT OR REGIST #~ /~t>~~ A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed restrictionsH which may be more restrictive than City regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the City of Zephyrhills Building Department, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "Contractor SectionsH 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 GuideH prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the "ownerH, I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "ownerH prior to corrunencement. 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 corrunenced 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 "AH or "A,etc.H, it is understood that a drainage plan addressing a "compensating volumeH 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 corrunenced within six months of issuance, or if work authorized by the permit is suspended or abandoned fora period of six months after the time the work is corrunenced. 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NE D TO RECORD AND POST A "NOT E OF COMMENCEMENTH. STATE OF FLORIDA COUNTY OF The foregoing inS~~dged ~ :~~b~}~~d~~~ 20{Q " (name of person acknowledged) ~o is personally known to me, or S edge~ , 20_ Dwho has produced (type of identification) ot Dwho has produced ------ (type of identification) .E:f'(lTd' not a ke a th. signaturerof p rson taking acknowledgment 'ii-- . . ~ CornmiUIO" 00188811 Name type'S,or .~~'~!'V~l:~ped gnature f p~~ ing acknowledgement ~=:= Name typed~~t3ri ea or stamped SEC. 34, TWP. 25 S., RNG. PASCO COUNTY, FL( LAUREL HAMMOCK L CE--FntL ;K&D/U-- #4281 " ~I" C\'J ~ . l'- ~II~ Q C\'J C ~ I FOUNDATION SURVEY A SURVEY OF: FIR 1/2" . #3555 ~ FIR 1/2" #3555 LOT 33. OAK RUN SUBDIVISION. IN ,", SECTION 34, TOWNSHIP 25 SOUTH, R.~N.CE. 21 EAST, AS PER MAP OR PPLAT THEREOF RECORDED IN PLAT BOOK 137, PAGES 128." AND 129 OF THE PUBLIC RECORDS OF PASCO COUNTY. FLORIDA. >0.'" d:~J.rf~~L.n.. '? r., c:;:s 2T'APr..~..J~ DI 32 I FIR 1/2" #3555 I 10' 2. ,20' S 89057'54" E (P)&:(M) , 1.49 (P)&(M) ~ON ROD -OF-WAY ~ED ~ '-- del 0:- '-- ~ '-- "'d 0:- '-- 19,80' . (0 <:) . <:) 0) 1EARING 'NE L . <:) <:) ~ ""'" ""'" ,TA :: (0 <:) .. ~ ~ <:) <:) ~ i--.<.1 C\j "r . t>) lr,j <J C\'J ~ . I ~ 0) .. I (;:) ""'" 0 <:) I <:) ~ FIR 1/2" #3555 34 "0.7' ~ Ll. 46.6' ,CONCRETE , FOUNDATION Ll 20.00' . c ' 1\ <:) , "6.9' f ~ 13.3' C 24-'7 ,-- C\j: I I. / It>) . 1 I co - ~ - - _ _FIR t/2~./ ~J #350.5' I : 66.27' (P)&(M) .'\: N 89057'54" W (P)&(M) . I, tOl ~O ./-- 3 3 ~: .6 6.3' <1 '0 . '1' 1 ' 5006 '19" W , . "r lr,j ~ ~ 20.1' . C) c lr,j C\l THIS SURVEY NOT VAllO j IN! ESS EMBOt;SED YV'12-~A SEAL NOTES: 1. FOUNDATION SURVEY ONLY. BOUNDARY SURVEY PERFORMED 02/18/00. 2. LEGAL DESCRIPTION FURNISHED BY CLIENT. (WT NUMBER GIVEN OVER PHONE) 3. BEARINGS BASED ON N 00010'32" E (PLAT) ALONG 'T'T-lE r. E}J7' Ii' Tn. TAlii' n'li' 'U'Tf"!.1.fT, A 1Jn T.nn p . C) C lr,j ~ ~ FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION FORM 600B-97 Residential Component Prescriptive Method B CENTRAL 4 5 6 Department of Community Affairs Compliance with Method B Chapter 6 of the Rorida Energy Efficiency Code may be demonstrated by the use of Form 6ooB-97 for single and mult~amily residences of 3 stories or less in height, and additions to existing residential buildings. To comply, a building must meet or exceed all of the energy efficiency prescriptives in any ~ of the prescriptive component packages iIIllI comply with the prescriptive measures listed in Table 6B-1 ofthis form, An alternative method is provided for addftions of 600 square feet or less by use of Form 6OOC-97. If a building does not comply wfth this method, It ma still com I under other sections in Cha ter 6 of the Code. O-Y\. o.-lU. GENERAL DIRECTIONS 1. New construction including additions which incorporates any of the following features cannot comply using this method: steel stud walls. single assembly roof/ceiling construction, or skylights or other non-vertical roof glass. 2. Choose one of the component packages "A. through "F" from Table 6B-1 by which you intend to comply with the Code. Circle the column of the package you have chosen. 3. Fill in all the applicable spaces of the "To Be Installed' column on Table 68-1 with the information requested. All "To Be Installed" values must be equal to or more efficient than the required levels. 4. Complete page 1 based on the "To Be Installed" column information. S, Read "Minimum Requirements for All Packages". Table 6B-2 and check each box to indicate your intent to comply with all applicable items. 6. Read. sign and date the "Prepared By" certification statement at the bottom of page 1. The owner or owner's agent must also sign and date the form. Please Print CK 1. Compliance package chosen (A-F) 2. New construction or addition 3. Single family detached or Multifamily attached 4. If Multifamily-No. of units covered by this submission 5. Is this a worst case? (yes / no) 6. Conditioned floor area (sq. ft.) 7. Predominant eave overhang (ft.) 8. Glass type and area: a. Clear glass b. Tint, film or solar screen 9. Percentage of glass to floor area 10. Floor type, area or perimeter, and insulation: a. Slab on grade (R-value) b. Wood, raised (R-value) c. Wood, common (R-value) d. Concrete, raised (R-value) e. Concrete, common (R-value) 11. Wall type, area and insulation: a. Exterior: 1. Masonry (Insulation R-value) 2. '!Jood frame (Insulation R-value) b. Adjacent: 1. Masonry (Insulation R-value) , 2. Wood frame (Insulation R-value) 12. Ceiling type, area and insulation: a. Under attic (Insulation R-value) b. Single assembly (Insulation R-value) 13. Air Distribution System: Duct insulation, location 14. Cooling system (Types: central. room unit, package terminal A.C., gas, none) Mctl.(i ~ $, V\ ~/ -€- S9tD Double Pane sq. ft. sq. ft. lOa. lOb. 10c. 10d. 10e. R= R= R= R= R= Iin. ft. sq. ft. __ sq. ft. __ sq. ft. __ sq. ft. R= s: t.f R= R= R= 11 a-l lla-2 11 b-l 11 b-2 __ sq. ft. __ sq. ft. __ sq. ft. __ sq. ft. R= ,;J.:;- R= R= Type: ~'I.s'i- l ~1r SEER/EER: '0 S ~e/"' Capaci~Yi H Type: ~ e.G..-+ t...-w....p HSPF/COP/AFUE: Capac~:i 5D -~, ( -t~4J~r Type:~~'~I~ EF: 12a. 12b. 13. 14a. 14b. 14c. 15a. 15b. 15c. 16a. 16b. __ sq. ft. __ sq. ft. 15. Heating system: (Types: heat pump. elec, strip, nat. gas. L.P, gas, gas h.p., room or PTAC, none) 16. Hot water system: (Types: elec., nat. gas, L.P, gas, solar, heat rec., ded. heat pump. other, none) PREPARED BY: I hereby cenlfy thatlhlS OWNER AGENT: DATE: -1- Revised 1998 TABLE 6B-1 COMPONENTS MINIMUM REQUIREMENTS PACKAGES FOR NEW CONSTRUCTION BCD E F 25% UJ UJ :s (!) Max, 'loaf glass to Floor Area Type Overhang A 15% 15% 20% 20% 25% Double Clear (DC) Single Tint (S1') ouble Clear (DC) Single Tint (S1') 2' 1'4" 2' 2' Double Tint (01') Double Tint (01') 2' 2' Masonry EXTERIOR AND ADJACENT MASONRY WALLS R-5 COMMON MASONRY WALLS R-3 CH IDE. UJ ..J ...J < :i: Wood Frame CEILINGS E COMMON CEILINGS R-11. CEILINGS ALLOWED) UJ a: a a ...J u.. Slab-On-Grade Raised Wood Raised Concrete R-O NSTRUCTION ALLOWED EXCEPT PACKAGE D) R-5 DUCTS SPACE COOLING (SEER) !;( Elect. ~ Gas/Oil (AFUE) Electric Resistance** R-6 12.0 STRIP R-6 10.0. 6.8. R-6 10.0. 6.8* R-6 10.0* 6.8* R-6 10.9 7.6 EF .90 EF .90 NOT ALLOWED (SEE BELOW) NOT ALLOWED (SEE BELOW) a: w;:E ....w <.... :i:UJ ....>- aUJ J: Gas & Oil ** MINIMUM EF OF .54 NATURAL GAS ONLY (SEE BELOW) Other Any of the following are allowed: dedicated heat pump. heat recovery unit or solar system. Climate Zones 4 5 6 TO BE INSTALLED % DC: 0 DT: 0 FEET 00: R= ADJ: R= COM: R- EXT: R= ADJ: R= COM: R= UNDER ATTIC: R = - COMMON: R = R= R= R= R= - CONDo 0 SEER = COP= AFUE = EF= EF = DHP: tj EF= - HRU: SOLAR: 0 EF= - Single package units minimum SEER=9,7, HSPF = 6,6, Minimum efficlenCles for gas and electnc hot water systems appiy to to 40 gallon water heaters, Refer to Table 6-12 for minimum Code efficiencies for oil waler heaters and other sizes, DESCRIPTION OF BUILDING COMPONENTS USTED Percent of Glas. 10 Roor Area: This percentage is calculated by dividing the total of all glass areas by the total conditioned noer area, Overhang: The overhang is the distance the rool or soffit projects out honzontally from the face of the glass, All glass areas shall be under an overhang of at least the prescnbed length with the following exceptions: 1) glass on the gabled ends 01 a house and 2) the glass in the lower stories of a mufli.stol'f house. WIll, Ceiling Ind Floor Insulation Vllues: The R-values indicated represent the minimum acceptable insulation level added to the structural components 01 the wall, ceiling or floor. The R-value 01 the structural bUilding malenals shall not be included in this calculation. 'Common' components are those separating conditioned tenancies in a multifamily building. 'Adjacenr componenls separate conditioned space from unconditioned but endosed space, .Exterior" components separate conditioned space from unconditioned and unenclosed space, Floor: Slalron"9rade floors without edge insulation are acceptable, Raised wood noers shall have continuous stem walls with insulation placed on the stem wallar under the noor except Package 0, Ducts: "CONO" indicates that the ducts must be installed within the conditioned space; that is, the ductwork shall be located on the conditioned side of the Insulation, Ducts in conditioned space are acceptable for any prescriptive package, Space Cooling System: Cooling systems shall have a Seasonal Energy Efficiency Ratio (SEER) lor central units or Energy Efficiency Ratio (EER) for room units or PT AC's equal to or greater than the prescnbed value, Electric Spice Hllting Option: Heal pump systems shall be rated with a Heating Seasonal Performance Factor (HSPF) equal to or greater than the presenbed HSPF, Heal pump systems may contain eleclnc stnp backups meeting the criteria of section 608.t.ABC,3.2.1,2. No electnc resistance space heat is allowed for these packages. Electric Resistance Hot Water Option: For packages designated "Not Allowed", an electric resistance hot water syste:n may be installed only in conjunction with one of the "Other Hot Water System Options", See below, Other Hot WIler System OptJons: My dedicated heat pump, heat recovel'f unit, or solar hot water system may be installed. Solar systems must have an EF of t,5 or higher, E1ectnc reSIStance systems haVIng an EF 01 ,88 or greater, or natural gas systems with EF ,54 or greater may be used in conjunction with these systems, TABLE 6B-21 MINIMUM REQUIREMENTS FOR ALL PACKAGES COMPONENTS SECTION REQUIREMENTS ICHECK Exterior Joints & Cracks 606.1 To be caulked, gasketed, weather-stripped or otherwise sealed. t/ Exterior Windows & Doors: 606.1 Max ,3 cfm/sa.ft, window area; ,5 cfmtsa.ft. door area. ,/' Sole & Top Plates 606.1 I Sole plates and penetrations through top plates of exterior walls must be sealed. ! V Recessed Lighting I 606.1 Type IC rated with no penetrations (two alternatives allowed). Multi-story Houses 606.1 Air barrier on perimeter of floor cavity between floors. I Exhaust Fans 606,1 Exhaust fans vented to unconditioned space shall have dampers, except for combustion IV" devices with integral exhaust ductwork. Water Heaters 612.1 Comply with efficiency requirements in Table 6-12. Switch or clearly marked circuit breaker (electric) ;/ or cutoff (aas) must be orovided. External or built-in heat trap required, Swimming 612.1 Spas & heated pools must have covers (except solar heated). Non-commercial pools must have a Pools & Spas oumo timer, Gas soa & 0001 heaters must have minimum thermal efficiency of 78%. Hot Water Pipes 612,1 Insulation is required for hot water circulating systems (including heat recovery units), Shower Heads 612.1 Water flow must be restricted to no more than 2.5 gallons per minute at 80 PSIG. V HVAC Duct 610.1 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, Construction, sealed. insulated and installed in accordance with the criteria of Section 610.1. Ducts in attics must be V" Insulation & Installation insulated to a minimum of R-6. Air handlers in attics shall be within 5' of an attic access, have a radiant barrier installed above the ahu extending 10' in all directions & meet requirements of other codes. HV AC Controls 607,1 Separate readily accessible manual or automatic thermostat for each system, t/ -2- II11II11111111111111111111111111111111111111111111111111I11I 2005093636 NOTICEOFCOMMffiNCEMENT STATE OF FLORIDA COUNTY OF PASCO THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statues, the following information is provided in this Notice of Commencement: 1. Description of Property: 2. General Description of Improvement: Parcel No. 34-25-21-0100-00000-0330 7237 Highland Loop Rcpl: 883454 Zephyrhills, FL 33542 DS: 0.00 05/12/05 598 sq. ft. room addition Rec: 10.00 IT: 0.00 Dpty Clerk 3. Owner Information: Name: JED PITTMAN~ PASCO COUNTY CLERK Randall and Vivian Kringle 05/12/05 1", : 0~m 1 of 1 7237 Highland Loop OR BK 6361) PG 1485 Zephyrhills, FL 33542 Interest in Property: Name of Fee Simple Tittleholder: If other than owner: Address: City State Zip Code , R4. Contractor: Address: Ryman Construction, Inc. 36413 S.R. 54 West Zephyrhills, FL 33541 5. Surety: Name Address City Amount of Bond: $ State Zip Code 6. Lender: Name Address City State Zip Code 7. Persons within the State of Florida designated by owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes: Name Address City State Zip Code 8. 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. 9. Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified.) Signature ofowner:f-t.,.ll/? ~ 5-y'-v'5- Printed Name Sworn to and subscribed before me this $da ( (f; Notary Public State of ~Iorida Elobbie J Knight My C~ion 00416222 Elpires 0313112008 STATE OF FLORIDA COUNTY OF PASCO THIS IS TO CERTIFY THAT THE FOREGOING IS A flOCUMENT ON FILE OR Of.PU8L1C RECORD IN THIS OFFI'~WITNESS MY HAND AND OFFICIAL SEAL THIS ~ DAY OF /)),9'/ 2~ JED PI ~f CLERK OF C~aC~T COURT BY ~ DEPUTY CLERK Notary Public' My Commission Expires: