HomeMy WebLinkAbout06-5515
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
~
5515
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
5515
MULTI-FAMILY RESIDENCE
103-NEW CaNST DUPLEX 2-UNIT
DUPLEX
Address: 5848 8 H STREET
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-01400-0210
42,900.00
923.61
923.61
3/30/2006
NEW DUPLEX - 858 sa. FT.
Name: RYMAN, KEVIN
Address: 5848 8TH STREET
ZEPHYRHILLS, FL. 33542
Phone:
MARTIN ELECTRIC
WILLIAMS DENNIS (INDIVIDUAL)
RYMAN CONSTRUCTION OF FLORIDA IN
BAHR'S PROPANE GAS & NC, INC.
E
PLUMBING FEE
RADON
FIRE PLAN REVIEW FEES
98.00 MECHANICAL FEE
8.58 WATER METER RES 3/4"
33.58 FIRE INSPECTION FEES
82.00
180.00
15.00
,...,
0~~1~
[f ~-
(e~. ~ ~
H 1
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.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
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."
NO OCCUPANCY BEFORE C.O.
, ~-~
CTOR NATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
~UILDING DEPARTMENT 5335 8TH st, Zraphyi:hi.lls, FL 33542
813-780-0020 FAX: 813-780-0021 --11Iq!
55/1 DATE RECEIVED D0 .
PHONE CONTACT FOR PERMITTING
OWNER'S NAME K~oJtrL ~
JOB ADD~f~~<<p-'AP R~ ~+. iN')
PHONE !fs - 7cP~-O~~
oj ....
. .
LEGAL DESCRIPTION: LOT(S) C)~D
BLOCK OILfOO
SUBDIVISION
c-Q/O
PARCEL ID it /1-;Lt:,-~_~O-()('I'cP. ~f)
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~W CONSTRUCTIO~
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
o SIGN 0 MOVE /'\ 0 DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING EtMUtTI~~ Oft OF UNITS
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
o MOBILE HOME
o OTHER
D RESTAURANT & HEALTH DEPAR.TMEN~~VAL_ /1_ r-6t
DESCRIPTION OF WORK n ~ D~~ ~
BUILDING SIZE 3D;<; ~cf.f P q SQUARE FOOTAGE /~ 79 HEIGHT ~
ILYBUILDING
~ECTRICAL
~UMBING
~CHANICAL
o GAS ~FING
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.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ~
. -:PJ~ QyL ~ .. /(p79~~~er
PERMITS REQUESTED
$~~.~ VALUATION OF TOTAL CONSTRUCTION
c;(f{;;f) . AMP SERVICE 0 Progress Energy 0
W.R.E.C.
$ ~ ,()€)€).€J2J
VALUATION OF MECHANCIAL INSTALLATION
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION~LOCK
o FRAME
o STEEL
o OTHER
,
,
}
j
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES ~
BUILDER
SIGNATURE
STATE CERT OR REGIST i (!..,g(!... OSr/S f
SIGNATURE
COMPANymaJ-r--: ~~
STATE CERT OR REGIST ft C c.. J3C6 I .scP,-S
******************************************************
PLUMBER
COMPAN~~~ LJ~
STATE CERT OR REGIST it c:...~ . Jt-.{.Q S" toO ~
SIGNATURE
MECflANICAL
. COMPANY
SIGNATURE
STATE CERT
Cf
, ,', .,,1;1
*.. * * * * * * * * * * ** * * t;~..~'.f'\..i< ."1' .1l"'.'~... " *'.* ~.t..*...........~
'~ ~'_/ ,,_.... t, _j i,;. ,_J.. -:~,,' i'- ~.;'"~--:, "',' ,
. .COMP-AN.. '
. . .,'," ~. -., . :
E CERT OR REGIST it ~ 13;<550~
A. NOTItE OF 'DEED RESTRICTION~
d h th' it y be subJect to "deed restrictionsN which
The und,rsigned understan stat 1S per~ ma Th ~' : d assumes responsibility for
may be more restrictive than city regu~at~on~. e un e~s1gne 0"
compliance with any applicab~e deed restr1ct10ns.
B. ' UNLICENSED CONTRACTORS AND CONTRACTOR R~SPONSIBILITIES
If the owner has hired a contractor or co~tractor5 to undertake work, they may be ~equired
to be licensed in accordance with stat~. and local regulations. If the contract?r 15 not
licensed as required by law, both the owner and contractor may be cited for,a m1sdemeanor
violation under state law. 'If the owner or intended contractor are uncerta1n as to what
licensing requirements may apply for the intended work, they are ~dyised 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(~) sign portions of the "Contractor SectionsN of this application for which they
will be responsible. 'If you, as the owner signs ~s the contractor, ~ou are indicating that
you, rather than the cQntractor, are responsible for the work. If the contractor wishes
you 'to sign as contractor that may be an indicat;ion 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
o CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I'certify that I, the applicant, have been provided with a co~y of "Florida's cons~ruction
lien Law _ Homeowner's Protection GuideN prepared by the Flor1da Department of Agr1culture
and Consumer Affairs. If the applicaQt is ~o\TIeone other that.the "pwnerNj I cerity that I
have obtained a copy of the above qescribed document and promise in good faith to deliver
_it to the "ownerN prior to conunencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that'all work will
be aone in compli.ance with all applicable laws r~gulating construction, zoning, and land
- development.
Appliqation is hereby made to obtain a permit to do ,work and installation as indicated. I
certify that no work or install~tion has conunenced 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 th~t th~ regulations of other governmental agencies may apply .to
the intended work, and that it is my responsioility 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, CYP!ess Bayhea~s, Wetlapd Areas,
Altering Watercourses
*Army Corps of Engineers-Sea~a~lsl Dock~, Navigable ~aterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certif~ that, if fill material is to be used in Flood Zone "AN or "A,etc.N, 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 Shfll issuance of a permit prevent the Building Official from thereafter requiring a
correc ion of errors in plans, constru9tion, 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 la
period of six months after the t~me the work is commenced. On~ 90 day extension o,t time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building ~fficial. An approved inspection must be logged d~ring each six
month period, or the project will be considered abandoned. .
WARNING TO OWNER: YOUE FAILURE TORE~ORD A'NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROP RTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT
WITH YOUR LENDER OR ~N ATTOR Y BEFORE R ORDING YOUR NOTICE OF COMMENCEMENT. JOB' ER
$2,500.1 ALUE DO NOT NE R CORD POST A "NOTICE OF COMMEN~ MENTN.
STATE OF FLORIDA . STATE OF FLORIDA
COUNTY OF ~ ' COUNTY Of .
The forego>.'n.? ins~. u n~ledged The foregoing lnst
~;f~~/~.~~ ..' 2~ ~;for me t is
__ ~ of person acknowledged) (name of person ac nowl'edged)
~o is personally known to me, or ~p~rsonally known to me, or
.-----'
of identification)
take an oath.
...------
Dw~o 'has produced
(type ot identification)
~- not take an oath
Name typed, printed
Name typed,
CITY OF
ZEPHYRHILLS
IINOTICE"
OF ADD.ITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
PERMIT ."
C-~ ("-
,:.-;, ,) I J
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
will be accepted.
,
~ t.Y:I. -"J:..\. \>-->:, II ~ cen u;('~r1 -+~J
~
~-i \4- -C~J"l""",(,~ b\{"~t\L
kftJr
ADDRESS
S ~L-\ ~
DATE
g-\hS{
a~ e..,c.:.-;
OFFICE HOURS 7:30 AM - 5 PM MON.-FRI.
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR RE-INSPECTION
~
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.
INSPECTOR
'.
f'
55\5
Ryman Construction
5848 - 8th Street - u(>~
SQ. FEET PRICE
MAIN OR LIVING: 858 $ 50.00
OTHER AREA UNDER ROOF: $ 50.00
OTHER: $ -
VALUATION $ 42,900.00
FEE SHEET $ 245.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 427.50
CREDIT: $ -
BUILDING LESS CREDIT: $ 427.50
ELECTRICAL: $ 78.95
PLUMBING: $ 98.00
MECHANICAL: $ 82.00
SUB-TOTAL $ 686.45
RADON: $ 8.58
TOTAL $ 695.03
SEWER: $ -
WATER: $ -
IRRIGATION: $ -
TOTAL: $ -
1535.20 Removed-Due to Existing Structure
398.05 Removed-Due to Existing Structure
WATER METER:I $
IRRIGATION METER $
180~00 I Remains per B.B.
FIRE DEPARTMENT FEES
PLANS TOA TL: $ 33.58
INSPECTION TOTAL: $ 15.00
PERMIT TOTAL
TOTAL: $ 48.58
PUBLIC SAFETY IMPACT FEES
POLICE $ -
FIRE $ -
5% $ -
TOTAL: $ -
254.00 Removed - Due to Existing Structure
273.00 Removed - Due to Existing Structure
26.35 Removed - Due to Existing Structure
SUB-TOTAL $
923.61
PARK IMPACT FEESI $
~ 769.56 Removed-Due to Existing Structure
SIF'S: $ -
100.0% $ -
1.0% $ -
TOTAL: $ -
1659.00 Removed-Due to Existing Structure
16.59 Removed - Due to Existing Structure
T IF'S 'I $
99% $
1% $
11572.12 Removed-Due to Ex'sUng Structure
15.88 Removed-Due to Existing Structure
TOTAL: $
923.61
Page 1 of 1
'.
Karen Miller
From: Todd Vandeberg
Sent: Wednesday, February 15, 2006 8:53 AM
To: Karen Miller
Subject: Ryman
Karen:
Please be advised that City Council approved the conditional use petition for Ryman concerning property located
at the SE corner of the intersection of 8th Street and 15th Avenue. Have Bill look at the lots 1 # pf units that are
pemissable. Thanks
Todd Vande Berg
Director of Development
City Of Zephyrhills
813-780-0006
tvandeberg@ci.zephyrhills.f1.us
. ~
2/15/2006
Map - Pasco C~ Property AppraiK.r Page 1 of 1
Pasco County, Florida Section 11, Township 26, Range 21, 0.7 miles NNW of
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Fire Chief Robert Hartwig
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813) 780-0041 Fax (813) 780-0044
FIRE SERVICE USER FEES
Occupancy No.:
~~s7n~~~:N~:-l~)/~ '*
BusinessAddress: f- :sr
Business Phone No.:
Business Fax No.:
Contact:
PLAN REVIEW FEES
~ Site Plan N/C
Building Plans ~
,RevIsion -.~
STANDPIPE SYSTEM
D Per Riser $25
SPRINKLER SYSTEMS
Do - 25 Heads $30
26 plus Heads $60
FIRE PUMP
D Per Pump $100
FIRE ALARM SYSTEM
Do - 25 Devices $30
26 plus Devices $60
SUPPRESSION SYSTEMS
8 Wet $35
Dry $35
C02 $35
Other $35
GREASENENTILATION
D Hood/Ducts $35
PLANS TOTAL ~
Comments:
.~~
INSPECTION FEES
Annual N/C
1 st Re-inspection $25
2nd Re-inspection $50
3rd Re-inspection $125
4th Re-inspection $250
5th Re-Inspection $500
Construction $15
Commercial $25
SPRINKLER SYSTEMS
Hydro Undergrounds $45
Hydrostatic System $45
Wet Acceptance $30
Dry Acceptance $45
Hydrant Flow $25
Hood / Booth $30
Grease Duct $15
FIRE ALARM SYSTEM
D System Acceptance $50
Recall Acceptance $50
Billing Phone No.:
Billing Fax No.:
Contact:
PERMIT FEE
FALSE ALARM FEE
1 st Alarm N/C
2nd Alarm N/C
3rd Alarm N/C
4th Alarm $25
5th Alarm $50
6th Alarm $75
7th Alarm $100
8th Alarm $150
9th Alarm $200
10th Alarm $250
Non Compliance $150
"Affidavit of Service/Repair"
SPRINKLER SYSTEMS
D Automatic $15
FIRE PUMP
D Fire Pump $15
FIRE ALARM SYSTEM
D Detection $15
OTHER OTHER
Fire Wall/Smoke Wall $15 X'2 WPG" $45
LP Gas $25 Natural Gas $45
Natural Gas $25 Fire Works $25
Fuel Tanks $25 Fuel Tanks $45
Tent $15
Date: ~~~
Inspector:" ?''-/ -.b~-'4.....--ff1
/
GREASENENTILATION
D Hood/Ducts $15
Kitchen Suppression $15
FALSE ALARM I
TOTAL
I
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D l4. P Ltf" >(
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FbRM 600A-2001
FLORIDA ENERGY EFFICIENCY ~ODE
FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
Residential Whole Building Performance Method A
r~ ~j'(
Project Name:
Address:
City, State:
Owner:
Climate Zone:
Model 1678 Duplex
5'1; y ~ I '5<;$ q S ~+h S. \-
,6~) 'n.-'--Y1..\~) ) K
~ (Y'I LVn , \<fu, y,
Central
Builder. Ryman
Permitting Office: c::>..('~~~
Permit Number: 5"513 ('551,*
Jurisdiction Number: lc? I \ (oGU
1. New construction or existing
2. Single family or multi-family
3. Number of units, if multi-family
4. Number of Bedrooms
5. Is this a worst case?
6. Conditioned floor area (ft2)
7. Glass area & type
a. Clear glass, default U-factor
b. Default tint
c. Labeled U or SHGC
8. Floor types
a. Slab-On-Grade Edge Insulation
b. N/A
c. N/A
9. Wall types
a. Concrete, lot losuL Exterior
b. N/A
c. N/A
d. N/A
e. N/A
10. Ceiling types
8. Under Attic
b. N/A
c. N/A
11. Ducts
8. Sup: Unc. Ret: Unc. AH: Attic
b. Sup: Unc. Ret: Unc. AH: Attic
Single Pane
0.0 ft2
0.0 ft"
0.0 ft2
New
Single family
I
2
No
1616 ft2
Double Pane
152.1 ft2
O.Oft"
0.0ft"
R=O.O, 182.0(p) ft
R=5.5, 1456.0 ft2
R=30.0, 1678.0 ft2
Sup. R=6.0, 200.0 ft
Sup. R=6.0, 200.0 ft
12. Cooling systems
a. Central Unit
Cap: 30.0 kBtu/hr
SEER: 11.00
Cap: 30.0 kBtu/hr
SEER: 11.00
b. Central Unit
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 30.0 kBtu/hr
HSPF: 7.50
Cap: 30.0 kBtu/hr
HSPF: 7.50
b. Electric Heat Pump
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 30.0 gallons
EF: 0.97
Cap: 30.0 gallons
EF: 0.97
b. Electric Resistance
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pump)
15. HVAC credits
(CF-Ceiling fan, CV-Cross ventilation,
HF-Whole house fan,
PT-Programmable Thermostat,
MZ-C-Multizone cooling,
MZ-H-Multizone heating)
MAR 1 1 2004
---1
Glass/Floor Area: 0.09
PASS
Total as-built points: 21117
Total base points: 21637
I hereby certify that the plans and specifications covered
by this calculation are in compliance with the Flori
Energy Code. 7 ,/
PREPARED BY: ~
DATE: 5////0 Lj
.
I hereby certify that this building, as designed, is in
compliance with the Flori Energy Code.
OWNERlAGEN
DATE:
Review of the plans and
specifications covered by this
calculation indicates compliance
with the Florida Energy Code.
Before construction is completed
this building will be inspected for
com ce with Section 553.908"4 ~
orida Statutes. OOl)m~
BUILDING ot'j'AL: J;'CJ ) )~"'S <)'
DATE: J 2-b 0(, .
,
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FORM 600A-2001
" SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: I I ,
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 1616.0 25.78 7498.9 Double, Clear S 1.3 7.5 16.2 41.92 0.94 636.1
Double, Clear S 1.3 9.0 16.2 41.92 0.96 653.8
Double, Clear N 1.3 11.0 16.2 26.25 0.99 421.7
Double, Clear N 1.3 10.0 7.1 26.25 0.99 183.1
Double, Clear N 1.3 9.0 9.9 26.25 0.98 254.3
Double, Clear E 1.3 5.0 37.4 55.69 0.91 1883.2
Double, Clear W 1.3 3.5 9.9 50.22 0.82 405.5
Double, Clear W 1.3 3.0 7.1 50.22 0.77 274.6
Double, Clear W 1.3 6.0 32.4 50.22 0.93 1519.5
As-Built Total: 152.1 6231.7
WALL TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Adjacent 0.0 0.00 0.0 Concrete, Int Insul, Exterior 5.5 1456.0 0.95 1383.2
Exterior 1456.0 1.90 2766.4
Base Total: 1466.0 2766.4 As-Suilt Total: 1466.0 1383.2
DOOR TYPES Area X BSPM = Points Type Area X SPM = Points
Adjacent 0.0 0.00 0.0 Exterior Insulated 42.0 4.80 201.6
Exterior 42.0 4.80 201.6
Base Total: 42.0 201.6 As-Built Total: 42.0 201.6
CEILING TYPES Area X BSPM = Points Type R-Value Area X SPM X SCM = Points
Under Attic 1616.0 2.13 3442.1 Under Attic 30.0 1678.0 2.13X1.00 3574.1
Base Total: 1616.0 3442.1 As-Suilt Total: 1678.0 3574.1
FLOOR TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Slab 182.0(p) -31.8 -5787.6 Slab-On-Grade Edge Insulation 0.0 182.0(p -31 .90 -5805.8
Raised 0.0 0.00 0.0
Base Total: ~7~7.6 As-Suilt Total: 182.0 ~805.8
INFILTRATION Area X BSPM = Poipts Area X SPM = Points
1616.0 14.31 23125.0 1616.0 14.31 23125.0
J:nQrm'~o'lnot1i\ nr:A ~nnn ~4_?nn1 I
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FORM 600A-2001
SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
PERMIT #:
BASE AS-BUlL T
Summer Base Points: 31246.3 Summer As-Built Points: 28709.8
Total Summer X System = Cooling Total X Cap X Duct X System X Credit = Cooling
Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier Points
(DM x DSM x AHU)
28709.8 0.500 (1.087 x 1.150 x 1.10) 0.310 1.000 6119.0
28709.8 0.500 (1.087 x 1.150 x 1.10) 0.310 1.000 6119.0
31246.3 0.4266 13329.7 28709.8 1.00 1.375 0.310 1.000 12238.1
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FORM ~OOA-2001
....
WINTER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
PERMIT #:
BASE AS-BUlL T
GLASS TYPES
.18 X Conditioned X BWPM = Points Overhang
Floor Area Type/SC Omt Len Hgt Area X WPM X WOF = Point
.18 1616.0 5.86 1704.6 Double, Clear S 1.3 7.5 16.2 6.74 1.01 110.3
Double, Clear S 1.3 9.0 16.2 6.74 1.00 109.4
Double, Clear N 1.3 11.0 16.2 11.00 1.00 In.7
Double, Clear N 1.3 10.0 7.1 11.00 1.00 n.5
Double, Clear N 1.3 9.0 9.9 11.00 1.00 108.2
Double, Clear E 1.3 5.0 37.4 8.82 1.02 336.3
Double, Clear W 1.3 3.5 9.9 9.55 1.03 96.7
Double, Clear W 1.3 3.0 7.1 9.55 1.04 69.9
Double, Clear W 1.3 6.0 32.4 9.55 1.01 311.5
As-Built Total: 152.1 1397.6
WALL TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Adjacent 0.0 0.00 0.0 Concrete, Int Insul, Exterior 5.5 1456.0 2.75 4004.0
Exterior 1456.0 2.00 2912.0
Base Total: 1456.0 2912.0 As-Built Total: 1456.0 4004.0
DOOR TYPES Area X BWPM = Points Type Area X WPM = Points
Adjacent 0.0 0.00 0.0 Exterior Insulated 42.0 5.10 214.2
Exterior 42.0 5.10 214.2
Base Total: 42.0 214.2 As-Built Total: 42.0 214.2
CEILING TYPES Area X BWPM = Points Type R-Value Area X WPM X WCM = Points
Under Attic 1616.0 0.64 1034.2 Under Attic 30.0 1678.0 0.64 X 1.00 1073.9
Base Total: 1616.0 1034.2 As-Built Total: 1678.0 1073.9
FLOOR TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Slab 182.0(p) -1.9 -345.8 Slab-On-Grade Edge Insulation 0.0 182.0(p 2.50 455.0
Raised 0.0 0.00 0.0
Base Total: -345.8 As-Built Total: 182.0 455.0
INFILTRATION Area X BWPM = Points Area X WPM = Points
.
1616.0 -0.28 -452.5 1616.0 -0.28 -452.5
I I=nQr"\I~:ul"'ol1!i\ n~A i='nnn ~A_?fVl1
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FORM 600A-2001
,
WINTER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
PERMIT #:
BASE AS-BUlL T
Winter Base Points: 5066.7 Winter As-Built Points: 6692.2
Total Winter X System = Heating Total X Cap X Duct X System X Credit = Heating
Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier Points
(DM x DSM x AHU)
6692.2 0.500 (1.078x 1.160 x 1.11) 0.455 1.000 2113.6
6692.2 0.500 (1.078x 1.160 x 1.11) 0.455 1.000 2113.6
5066.7 0.6274 3178.9 6692.2 1.00 1.388 0.455 1.000 4227.1
I:nor"\I~~I.nQTM nr-A J:'nrrn ~6._?f'V"\1
~nar"\I~:::IIII"atfi\/~I~k)~C::'?M1 ~I Rr'DR ,{":t ~
FORM 600A-2001
.
WATER HEATING & CODE COMPLIANCE STATUS
' .
Residential Whole Building Performance Method A - Details
I ADDRESS: · · ,
PERMIT #:
BASE AS-BUlL T
WATER HEATING
Number of X Multiplier = Total Tank EF Number of X Tank X Multiplier X Credit = Total
Bedrooms Volume Bedrooms Ratio Multiplier
2 2564.00 5128.0 30.0 0.97 2 0.50 2326.10 1.00 2326.1
30.0 0.97 2 0.50 2326.10 1.00 2326.1
As-Built Total: 4652.2
CODE COMPLIANCE STATUS
BASE AS-BUlL T
Cooling + Heating + Hot Water = Total Cooling + Heating + Hot Water = Total
Points Points Points Points Points Points Points Points
13330 3179 5128 21637 12238 4227 4652 21117
I
PASS
I
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~nArn"~::lIllnatii'l/j:'I~J:)J:C:1?nn1 j:'1 Qr.PR,~ ~
FORM 600A-2001'
.
Code Compliance Checklist
Residential Whole Building Performance Method A - Details
I ADDRESS:" ,
6A-21 INFILTRATION REDUCTION COMPLIANCE CHECKLIST
PERMIT #:
COMPONENTS SECTION REQUIREMENTS FOR EACH PRACTICE CHECK
Exterior Windows & Doors 606.1.ABC.1.1 Maximum:.3 cfmlsa.ft. window area' .5 cfmlsa.ft. door area.
Exterior & Adjacent Walls 606.1.ABC.1.2.1 Caulk, gasket, weatherstrip or seal between: windows/doors & frames, surrounding wall;
foundation & wall sole or sill plate; joints between exterior wall panels at comers; utility
penetrations; between wall panels & toplbottom plates; between walls and floor.
EXCEPTION: Frame walls where a continuous infiltration barrier is installed that extends
from and is sealed to the foundation to the top plate.
Floors 606.1.ABC.1.2.2 Penetrations/openings >1/8" sealed unless backed by truss or joint members.
EXCEPTION: Frame floors where a continuous infiltration barrier is installed that is sealed
to the perimeter penetrations and seams.
Ceilings 606.1.ABC.1.2.3 Between walls & ceilings; penetrations of ceiling plane of top floor; around shafts, chases,
soffits, chimneys, cabinets sealed to continuous air barrier; gaps in gyp board & top plate;
attic access. EXCEPTION: Frame ceilings where a continuous infiltration barrier is
installed that is sealed at the perimeter at penetrations and seams.
Recessed Ughting Fixtures 606.1.ABC.1.2.4 Type IC rated with no penetrations, sealed; or Type IC or non-IC rated, installed inside a
sealed box with 1 fZ' clearance & 3" from insulation; or Type IC rated with < 2.0 cfm from
conditioned space tested.
Multi-storv Houses 606.1.ABC.1.2.5 Air barrier on perimeter of floor cavitv between floors.
Additional Infiltration reqts 606.1.ABC.1.3 Exhaust fans vented to outdoors, dampers; combustion space heaters comply with NFPA,
have combustion air.
6A-22 OTHER PRESCRIPTIVE MEASURES (must be met or exceeded bv all residences.)
COMPONENTS SECTION REQUIREMENTS CHECK
Water Heaters 612.1 Comply with efficiency requirements in Table 6-12. Switch or clearly marked circuit
breaker (electric) or cutoff (cas) must be provided. Extemal or built-in heat trap required.
Swimming Pools & Spas 612.1 Spas & heated pools must have covers (except solar heated). Non-commercial pools
must have a pump timer. Gas spa & pool heaters must have a minimum thermal
efficiencv of 78%.
Shower heads 612.1 Water flow must be restricted to no more than 2.5 oallons oer minute at 80 PSIG.
Air Distribution Systems 610.1 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically
attached, sealed, insulated, and installed in accordance with the criteria of Section 610.
Ducts in unconditioned attics: R-6 min. insulation.
HVAC Controls 607.1 Separate readilv accessible manual or automatic thermostat for each syStem.
Insulation 604.1, 602.1 Ceilings-Min. R-19. Common walls-Frame R-11 or CBS R-3 both sides.
Common ceiling & floors R-11.
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ENERGY PERFORMANCE LEVEL (EPL)
DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE SCORE'" = 83.6
The higher the score, the more efficient the home.
1. New construction or existing
2. Single family or multi-family
3. Number of units, if multi-family
4. Number of Bedrooms
5. Is this a worst case?
6. Conditioned floor area (ft.)
7. Glass area & type
a. Clear - single pane
b. Clear - double pane
c. Tint/other SHGC - single pane
d. Tint/other SHGC - double pane
8. Floor types
a. Slab-On-Grade Edge Insulation
b. N/A
c. NlA
9 . Wall types
a. Concrete, Int Insul, Exterior
b. N/A
c. N/A
d. N/A
e. N/A
10. Ceiling types
a. Under Attie
b. N/A
c. N/A
11. Ducts
a. Sup: Unc. Ret: Unc. AH: Attic
b. Sup: Unc. Ret: Une. AH: Attic
Single Pane
0.0 ft.
0.0 ft2
0.0 ft.
New
Single family
1
2
No
1616 ft2
Double Pane
152.1 ft2
0.0 ft2
0.0 ft2
12. Cooling systems
a. Central Unit
Cap: 30.0 kBtuIhr
SEER: 11.00
Cap: 30.0 kBtuIhr
SEER: 11.00
R=O.O, 182.0(p) ft
R=5.5, 1456.0 ft2
R=30.0, 1678.0 ft2
Sup. R=6.0, 200.0 ft
Sup. R=6.0, 200.0 ft
b. Central Unit
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 30.0 kBtuIhr
HSPF: 7.50
Cap: 30.0 kBtu/hr
HSPF: 7.50
b. Electric Heat Pump
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 30.0 gallons
EF: 0.97
Cap: 30.0 gallons
EF: 0.97
b. Electric Resistance
C. Conservation credits
(RR-Heat recovery, Solar
DHP-Dedicated heat pump)
15. HVAC credits
(CF-Ceiling fan, CV-Cross ventilation,
HF-Whole house fan,
PT -Programmable Thermostat,
MZ-C-Multizone cooling,
MZ-H-Multizone heating)
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 FLA/RES computer program.
This is not a Building Energy Rating. If your score is 80 or greater (or 86 for a us EPAJDOE EnergyStar: designation),
your home may qualify for energy efficiency mortgage (EEM) incentives if you obtain a Florida Energy Gauge Rating.
Contact the Energy Gauge Hotline at 321/638-1492 or see the Energy Gauge web site at wwwfsec.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.
EnergyGauge@(Vendon: FLRCPB v3.30)
Residential System Sizing Calculation
Summary
Project Title:
Model 1678 Duplex
Location for weather data: Orlando - Defaults: Latitude(28) Temp Range(M)
Humidit data: Interior RH 50% Outdoor wet bulb 6 Humidit difference 44 r.
Winter design temperature 38 F Summer design temperature
Winter setpoint 70 F Summer setpoint
Winter tem erature difference 32 F Summer tem erature difference
Total heatin load calculation 21974 Btuh Total coolin load calculation
Submitted heating capacity % of calc Btuh Submitted cooling capacity
Total (Electric Heat Pump) 273.1 60000 Sensible (SHR= 0.5)
Heat Pump + Auxiliary(O.OkW) Latent
Total Electric Heat Pum
Winter Heatin Load
Load com onent
Window total
Wall total
Door total
Ceiling total
Floor total
Infiltration
Subtotal
Duct loss
TOTAL HEAT LOSS
WINTER CALCULATIONS
1 52 sqft
1456 sqft
42 sqft
1678 sqft
1 82 ft
1 08 cfm
Load
3530
6406
632
1846
4714
3800
20927
1046
21974 .
Code Only
Professional Version
Climate: Central
93 F
75 F
18 F
19394 Btuh
% of calc Btuh
191.7 30000
800.8 30000
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Ooors(3%)
SUMMER CALCULATIONS
Summer Coolin Load ft
Load com onent Load
Window total 152 sqft 4312 Btuh Latenl intem81(5%)
Wall total 1456 sqft 2834 Btuh
Door total 42 sqft 426 Btuh
Ceiling total 1678 sqft 2383 Btuh
Floor total 0 Btuh
Infiltration 94 cfm 1870 Btuh Int_ Gain(12%)
Intemal gain 2400 . Btuh Ceilings(12%)
Subtotal(sensible) 14226 Btuh
Duct gain 1423 Btuh
Total sensible gain 15648 Btuh ooor.(2%)
Latent Qain(infiltration) 2826 Btuh
Latent gain(intemal) 920 Btuh EnergyGauge@ System S' .
Total latent gain 3746 Btuh PREPARED BY:
TOTAL HEAT GAIN 19394 Btuh DATE: :3
EneravGauce<l\l FLRCPB v3.30
/
System Sizing Calculations - Winter
Residential Load - Component Details
Project Title:
Model 1678 Duplex
Code Only
Professional Version
Climate: Central
Reference City: Orlando (Defaults) Winter Temperature Difference: 32.0 F
3/11/04
Window Panes/SHGC/Frame/U Orientation Area X HTM= Load
1 2, Clear, Metal, DEF W 16.2 23.2 376 Btuh
2 2, Clear, Metal, DEF W 16.2 23.2 376 Btuh
3 2, Clear, Metal, DEF E 16.2 23.2 376 Btuh
4 2, Clear, Metal, DEF E 7.1 23.2 164 Btuh
5 2, Clear, Metal, DEF E 9.9 23.2 229 Btuh
6 2, Clear, Metal, DEF S 37.4 23.2 867 Btuh
7 2, Clear, Metal, DEF N 9.9 23.2 229 Btuh
8 2, Clear, Metal, DEF N 7.1 23.2 164 Btuh
9 2, Clear, Metal, DEF N 32.4 23.2 751 Btuh
Window Total 152 3530 Btuh
Walls Type R-Value Area X HTM= Load
1 Concrete - Exterior 5.5 1456 4.4 6406 Btuh
Wall Total 1456 6406 Btuh
Doors Type Area X HTM= Load
1 Insulated - Exter 42 15.0 632 Btuh
Door Total 42 632Btuh
Ceilings Type R-Value Area X HTM= Load
1 Under Attic 30.0 1678 1.1 1846 Btuh
Ceilina Total 1678 1846Btuh
Floors Type R-Value Size X HTM= Load
1 Slab-On-Grade Edge Insul 0 182.0 ft(p) 25.9 4714 Btuh
Floor Total 182 4714 Btuh
Infiltration Type ACHX Building Volume CFM= Load
Natural 0.40 16160(sqft) 108 3800 Btuh
Mechanical 0 o Btuh
Infiltration Total 108 3800 Btuh
Subtotal 20927 Btuh
Totals for Heating Duct Loss(using duct multiplier of 0.05 1046 Btuh
Total Btuh Loss 21974 Btuh
Key: Window types (SHGC - Shading coefficient of glass as SHGC numerical value or as clear or tint)
(Frame types - metal: wood or insulated metal)
(U - Window U-Factor or 'DEF' for default)
(HTM - ManualJ Heat Transfer Multiplier)
Key: Floor size (perimeter(p) for slab-on-grade or area for all other floor types )
EneravGauce<l\l FLRCPB v3.30
System Sizing Calculations - Summer
Residential Load - Component Details
Project Title:
Model 1678 Duplex
Code Only
Professional Version
Climate: Central
Reference City: Orlando (Defaults) Summer Temperature Difference: 18.0 F
3/11/04
Type Overhang Window Area(sqft) HTM Load
Window PaneslSHGC/UllnShlExSh Omt Len Hat Gross Shaded Unshaded Shaded Unshaded
1 2, Clear, DEF, 8, N W 1.33 7.5 16.2 0.0 16.2 15 46 745 Btuh
2 2, Clear, DEF, B, N W 1.33 9 16.2 0.0 16.2 15 46 745 Btuh
3 2, Clear, DEF, B, N E 1.33 11 16.2 0.0 16.2 15 46 745 8tuh
4 2, Clear, DEF, 8, N E 1.33 10 7.1 0.0 7.1 15 46 325 Btuh
5 2, Clear, DEF, B, N E 1.33 9 9.9 0.0 9.9 15 46 454 Btuh
6 2, Clear, DEF, B, N S 1.33 5 37.4 37.4 0.0 15 24 560 Btuh
7 2, Clear, DEF, B, N N 1.33 3.5 9.9 0.0 9.9 15 15 148 Btuh
8 2, Clear, DEF, 8, N N 1.33 3 7.1 0.0 7.1 15 15 106 Btuh
9 2, Clear, DEF, B, N N 1.33 6 32.4 0.0 32.4 15 15 486 Btuh
Window Total 152 4312 Btuh
Walls Type R-Value Area HTM Load
1 Concrete - Exterior 5.5 1456.0 1.9 2834 Btuh
Wall Total 1456.0 2834 Btuh
Doors Type Area HTM Load
1 Insulated - Exter 42.0 10.1 426 Btuh
Door Total 42.0 426 Btuh
Ceilings Type/Color R-Value Area HTM Load
1 Under Attic/Dar1<: 30.0 1678.0 1.4 2383 Btuh
Ceilino Total 1678.0 2383 Btuh
Floors Type R-Value Size HTM Load
1 Slab-On-Grade Edge Insulation 0.0 182.0 ft(p) 0.0 0 Btuh
Floor Total 182.0 0 Btuh
Infiltration Type ACH Volume CFM= Load
Natural 0.35 16160 94.5 1870 Btuh
Mechanical 0 0 Btuh
Infiltration Total 94 1870 Btuh
Occupants
4
Btuh/occu pant
X 300 +
Appliance
1200
Load
2400 Btuh
Subtotal 14226 Btuh
Duct gain(using duct multiplier of 0.10) 1423 Btuh
Total sensible gain 15648 Btuh
Totals for Cooling Latent infiltration gain (for 44 gr. humidity difference) 2826 Btuh
Latent occupant gain (4 people @ 230 Btuh per person) 920 Btuh
Latent other gain 0 Btuh
TOTAL GAIN 19394 Btuh
EneravGauceq!) FLRCP8 v3.30
Manual J Summer Calculations
Residential Load - Component Details (continued)
Project Title: Code Only .
Model 1678 Duplex Professional Version
Climate: Central
3/11/04
Key: Window tY~es (SHGC - Shading coefficient of glass as SHGC numerical value or as clear or tint)
U - Window U-Factor or 'DEF' for default)
InSh - Interior shadin~ device: none(N), Blinds/Daperies(B) or Roller Shades(R))
ExSh - Exterior shadIng device: none(N) or numerical value)
Omt - compass orientation)
EneravGauce<l\l FLRCPB v3.30
NOTICE OF COMMENCEMENT
STATE OF FLORIDA
COUNTY OF PASCO
THE UNDERSIGNED he~~by 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: Parcel No. 11-26-21-0010-01400-0210
5846 8th Street, Zephyrhills, FL
5848 8th Street, Zephyrhills, FL
2. General Description of Improvement: New Duplex
3.
Owner Information: Name: Kevin L. and Tammy L. Ryman
Addfess: 5612 Beech Street
Zephyrhills, FL 33540
State
1111111111111111I1111111111 1111I11111 1111I111111111111111111
2006070067
S~pt0 9862=0 Rec: 10.00
: .00 IT: 0.00
04/0~~~_6_ _ Dpty Clerk
~~90;~~lttA1N4' . PASCO COUNTY CLERK
1.31am 1 of 1
OR 8K 6924 PG 901
Interest in Property:
Name of Fee Simple Titleholder:
If other than owner: Address:
City
R
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
n/a
State
Zip Code
7. Persons within the State of Florida de~ignated 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 o~Commencement (the expiration date is one "(I) year from the
date of recording unless a different date is specified.)
Signature OfOwn~ Printed Name: Kevin L. Rymao
Sworn to and subscribe before me this {{; ~y of AJ>ril 2005.
Notary Public:
My Commission Expires:
Notary Public Slate of "Iorida
Boob!'" ~ Knight
My CommISSion 00418222
::APllll.03/31/2008
-
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PERFORMANCE BUSINESS PROQUCTS. INC. 813-719-8008 FAX 813-719-7G1D
CITY OF ZEPHYRHILLS
ZEPHVRHILLS, FLORIDA
l:,_ bS 2:> ~
WATER ACCT. NO.
DATE L\-lo-OCo
OWNER/ \) V.
RENTER ~J"'J\tA.f\ I L6VIf\
MAILING
~-
SERVICE ADDRESS ~g~~
SHUT OFF SERVICE 0
.:\":,.. "; TURN ON SERVICE 0
INSTALL METER lit'
READ METER 0
CHECK METER 0
OTHER 0
~St.
~ WATER
o SEWER
o GARBAGE
~N CITY
o OUT CITY
~ No. OF UNITS
_ DEPOSIT AMOUNT
31411 W, ~........
~-551.
5
_ AMOUNT LAST BILL
_DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
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.
ORDER GIVEN BY
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PERMIT APPLICATION
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DRIVEWAY PERMIT APPLICATION
CONSTRUCTION WITHIN PUBLIC RIGHT-Of-WAY
All information must be filled-in completely
City of Zephyrhills
5335 8th Street, Zephyrhills, FL 33542
Telephone 813.780.0000 Fax 813.780.0005
Date of application:
DCopyto Building Department
Processed By:
(gray area for staff use only)
Permit #:
DCopy to Public Works
PROPERTY OWNER
Co....
CONTRACTOR:
E-Mail:
Fax:
ARCHITECT I ENGIN EER:
,tJA
Name:
Address:
State License #:
Firm Name:
City:
Phone:
State:
Cell:
Zip:
Fax:
TYP OF DRIVEWAY
RESIDENTIAL DRIVEWAY
_COMMEROAL DRIVEWAY
_PU8UC ACCESS DRIVEWAY
DescriDtion of PrQ;ect
~ LENGTH OF DRIVEWAY
~WIDTHOFDRIVEWAY
R.O.W. EXCAVATION
" " DEPTH _UN EAR FEET
CULVERTS NEEDED
( ) REINFORCED CONCRETE
( ) CORRUGATED MATERIAL
( ) BOX CULVERT
( ) OTHER (EXPLAIN)
CONSTRUCTION MATERIAL
_ASPHALT
+CONCRETE
HEADWALL REOUIRED? _YES LNO
CURB CUT REOUIRED
_YES +-NO
NOTICE TO APPLICANT: If actual work exceeds scope of this description, additional permits or drawings
will be required.
UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
Page 1 of 3
PERMIT APPLICATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
Se~
A-4~ LleJ
AFFIDAVIT: Application is hereby made to obtain a permitto do work and installations as indicated. I certify that all foregoing
information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all
approved construction documents, and issuance of this permit is verification thatI will notify the property owner of Florida Uen Law
req., F.S. 713.
,
The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed
restrictions mayappiy to this property.
All work shall comply with the current Florida Building Code, PublicWorks, Design Manual and FDOT Design
Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.f1.us/public_works.asp)
APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBUC.
NOTE: The City of Zephyrhills. is not responsible for maintenance or repairs of driveways. Driveways shall not alter /
interfere with existing stormwater treatment and I or conveyance.
By signing this application: I certify that I have read and understand the owner/bUilder disclosure
(PleaS.ln~:a~ ~ ~ ~ ! wiD {,
19s j \ l-( A Icant Signature Date
L 9 - .:J. lr IJ~
(or) Notary Signature Date
Applicant is ( ) personally known to me or produced
as identification.
(type of identification)
Page 2. of 3;
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PERMIT APPLICATION
OFFICE USE ONLY
PUBUC WORKS USE ONLY
Concrete (min. 6") y N
Asphalt Base (min. 6/1) y N
Asphalt (min. 1 W') y N
Length (min. 19') y N
Width (la' min - 20' max) y N
Existing sidewalk. y N
New sidewalk. y N
ADA compliant. y N
Expansion material required. Y N
Contiguous parking pad. y N
Triangular flare (3'W x 7'L) Y N
Visibility triangle o.k.? y N
Side set back (3' min. R.O.W.) y N
Plan Review Fee
Public Works Director and or desi nee:
,."
Date:
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