The URL can be used to link to this page

Home My WebLink About06-5728 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5728 v Permit Number: 5728 Permit Type: MECHANICAL Class of Work: AlC CHANGEOUT Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Address: 37840 MEDICAL ARTS CENTER ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 34-25-21-0080-00000-0030 4,930.00 4/24/2006 55.00 55.00 4/24/2006 CHANGE-OUT AlC SYSTEM Name: PALL Y & RAO, M.D., P.A. Address: 37840 MEDICAL ARTS CENTER ZEPHYRHILLS, FL. 33542 Phone: C ~tJI f11'~ SD\e 1- \~ ~ 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. ~. .. ~-~ CONTRACTOR SIGN RE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhllls J-JermlI AppllCcHlurl Building Department .. Phone Contact for Permitting 5ut>wner Phone Number Owner Phone Number I Owner Phone Number I Date Received Owner's Name Owner's Address Fee Simple Titleholder Nam~ I D NEW CONSTR D D INSTALL D PROPOSED USE D SFR D TYPE OF CONSTRUCTION D BLOCK D DESCRIPTlONOFWORK I 1 out A~ S:::J$-fon BUILDING SIZE I SQ FOOTAGE I HEIGHT I I , , , , , . , , . , , . , , , , , , .. , , . .. . , . , , , , , . , , , . , , , . , : , . . , .. , , .. , , . , , . , , .. .. , .. , , , .. , , .. , , , .. , , . , , .. , , .. , .. , , , .. .. , , , , .. , , , .. .. , , , . , , , , .. . , , , .. .. , .. . .. . .. , , D BUILDING 1$ I VALUATION OF TOTAL CONSTRUCTION D ELECTRICAL 1$ I AMP SERVICE D PROGRESS ENERGY D PLUMBING 1$ 1 ~ MECHANICAL 1$ ~9 30 . 00 I D GAS D ROOFING D FINISHED FLOOR ELEVATIONS I I Fee Simple Titleholder Address I I ~ '7 g Y-D I JOB ADDRESS SUBDIVISION WORK PROPOSED ADD/ALT REPAIR COMM FRAME D D o DEMOLISH I D OTHER STEEL OTHER I D W.R.E.C. VALUATION OF MECHANICAL INSTALLATIO( '- SPECIALTY D OTHER FLOOD ZONE AREA DYES DNO I , I I , . I . I I I I ~ I I . . I I . . I . I ~ . I . . I . . I I I , , . . I I . . I I , . I . I . . I . I I . . . . . , . I I . I I . . . , . . . . . I I . . I I I . . . I . . I I . I . I . I . I I . . . I . I . I I I . . . I I I . . I I I . I . I . I I . I I I . . I , I I I I I I . I I BUILDER SIGNATURE COMPANY REGISTERED Address ELECTRICIAN I SIGNATURE Address I PLUMBER I SIGNATURE Address I COMPANY REGISTERED COMPANY REGISTERED MECHANICAL SIGNATURE Address OTHER SIGNATURE Address Y/ N FEE CURRENT Y/N License # Y / N Y/N FEE CURRENT License # Y/ N Y/N FEE CURRENT License # I I *j~ J IAIC;E~R~M\ r< / N I License # ICAC058515 Y/N Y/N FEE CURRENT License # 1111111111111'111111'1111111111'llllllil'lllllllllllll111111'1111111111111'1111111"'111111111111.111111111111'111111111111111'1111111111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (10) working days after submittal date. Required onsile, ConstrucUon Plans, Sanitary Facilities & 1 dumpster COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. . Minimum ten (10) working days after submittal date. Required onsite. Construction Plans. Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance. SIGN PERMIT Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. 1111111111111111111111111111.1.11111111111111111111111111111111111.1111111111111111111111111111111111111111111I11111111111111111111111111111111111 Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000) Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. 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 Pasco County Building Inspection Division-Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The Undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be Identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify 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. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government 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 Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, WaterlWastewater 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. US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: _ Use of fill is not allowed in Flood Zone "V" unless expressly permitted. . If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan. addressl~g a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. ..' ., . If the fill material is to be used in Flood Zone "A" in connection with a permitted building uSing stem wall construction, I certify that fill will be used only to fill the area within the stem ~all. . ' If fill material is to be used in any area, I certify that use of such fill Will not adversely. affect a?Jac~nt properties. If use of fill is found to adversely affect adjacent properti~s, the. ow~er may be Cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. . . . . . If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner ~f the permlttln~ conditions s~t forth In this affidavit rior to commencing construction. I understand that a separate perm~t may ?e reqUlr~d for elect~lca.1 work, lumbing si:ns, wells, pools, air conditioning, gas, or other installations not specifically 1n?luded. In the apPII~atlfn. A p ..' I b construed to be a license to proceed with the work and not as authonty to violate, cance, a ter, or ~:~~:i~~~~~ ~~:~isi:ns of the technical codes, nor shall issuance of a permit prevent the B~i1.ding ~ff~i~11 ~om the~eaftI7~ ""IU~:~: :~::u~;:.,~z:r;~ ~u~~:~r~:".,;;~~:~;;:~I~:~~~ ~:;;;;,~:~ ::~~ r::;:.:u: : ~ ;~:;:'~t~';da ~y ~:~rm~ Is sU~:~~~~n~m;~o~~~ f~~i~df,,":~:II';.,~~~~~i~: ~:~~h,:,:~ t~~;~d~) C:;~:::' will ~:~~~~~~ ~=rifia~l~e:~:e fo~ the exte~sion. If work ceases for ninety (90) consecutive days, the Job IS conSidered aban one . ORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR WARNING TO OWNER: Yg~::~~~~~ ~~~:~ROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CoNSULT ~i:r;O-:I~~:g:RI~:RAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENFCEMENT. FLORIDA JURAT (F.S. 117.03V\O A II AA ,i ,All A fJ AU ~Ltly~ CONTRACTOR ~ OWNER OR AGENT thi Subscribed and sworn to (or affinned) before me thl ' Subscribed and sworn to (or affirmed) before me s by by Who is/are personally known to me or has/have produced Who Is/are personally known to me or has/have produced as IdenUflcatlon. as Identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed. printed or stamped Name of Notary typed. printed or stamped JS~O- t)b-01~b7J)-O ACORD CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MM'DDNYVY) -~--TM 03/08/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bauer & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12210 US Highway 301 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. DADE CITY FL 33525 [INSURERS AFFORDING COVERAGE I NAIC# ~3?.l0 567-3702 -- .. ut=-. -- INSURED CHRIS' AlC COMPANY i INSURER A AUTO OWNERS P.O. BOX 1781 ~URER B: BRIDGEFIELD ZEPHYRHILLS, FL 33539 e.!~SUREfl.L~_~__ ~__-l----._.._~_~___.._. ,._ IINSURER 0: ,--~--------,--L--..--,__~___ I INSURER E i COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, --, -.--- --~-~ I~~~ ~~~):; POLICY NUMBER PRAL+~Y EFFECTIVE POLICY EXPIRATION LIMITS , GENERAL LIABILITY 103/07/07 EACH OCCURRENCE I $ 1,000,000 A ' ~.'RO~ G""" '~"m 12-21700 03/07/06 DAMAGE TO RENTE~~ ~--==~__ , CLAIMS MADE X OCCUR MED EXP (Anyone person) I $ 1 O,O.Q.()...___, ____ -~ .-.- -- PERSONAL & ADV INJURY I $ 500,000 ....J -- - GENERAL AGGREGATE $ 1,000,000 IGEN'L AGGREnE LIMIT A~PLlEIS PER PRODUCTS - COMP'OP AGG $ 1,000,000 -- I ' I POLICY ~bW,: i . LOC LEGAL LIABILITY $100,000 I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i___, $ I ANY AUTO (Ea accident) _..J ALL OWNED AUTOS BODILY INJURY $ ~ SCHEDULED AUTOS (Per person) I ----- .1 ",Rm '"'''' BODILY INJURY I $ __ , NON-OWNED AU~~~ I (Per accident) , i ---- -- PROPERTY DAMAGE $ I (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ._u Il ANY AUTO ! I I OTHER THAN ~$ -- j AUTO ONLY: AGG $ EXCESS'UMBRELLA LIABILITY I EACH OCCURRENCE $ I OCCUR D CLAIMS MADE I AGGREGATE $ $ i l DEDUCTIBLE -_.~-------,. I $ _ou_ , l RETENTION $ I $ WORKERS COMPENSATION AND X T WC STATU- I iO,;r~- ---_.._---~-_.._---- B EMPLOYERS' LIABILITY ! 509700 11/14/2005 11/14/2006 $ 100,000 I ANY PROPRIETOR/PARTNER'EXECUTIVE EL EACH ACCIDENT I --- I OFFICER'MEMBER EXCLUDED? I EL DISEASE - EA EMPLOYEE $ 100,000 --- j If yes. describe under SPECIAL PROVISIONS below E,L DISEASE - POLICY LIMIT $ 500,000 r OTHER I I I I I I I DESCRIPTION OF OPERATIONS' LOCATIONS I VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS AIR CONDITIONING REPAIR AND INSTALLATION CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHILLS 5335 8TH STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REP ESENTATIVES. AUT OR 0 EP ESENTAJ:IVE 'CA- ZEPHYRHILLS, FL 33542 ACORD 25 (2001/08)