HomeMy WebLinkAbout06-6069
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6069
6069
Permit Type: MECHANICAL
Class of Work: A1C CHANGEOUT
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 5147 10TH S
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
2,400.00
8/29/2006
70.00
70.00
8/29/2006 Phone:
REPLACE A1C RELOCATE CONDENSER/AIR HANDLER...SHED..KITCHEN ELECTRICAL
Name: GREEN PERRY
Address: 5147 10TH ST
ZEPHYRHILLS, FL. 33542
~DI;;
~J\~O\Or
REINSPEcnON 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.
Y)/ 11~ ~~
CONTRACTOR SIGNATURE PERMIT OFF I
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-B13-780-0021
Date Received
Owner's Name
Owner's Address
Fee Simple Titleholder Namel
Fee Simple Titleholder Address I
I ~-l tt (
I
Owner Phone Number I r '? -16 1 i....J
Owner Phone Number I rB ~ f <(), ~ 4775
Owner Phone Number I
JOB ADDRESS
'Di~
\1.
I
B
D
D
DESCRIPTION OF WORK (e.l~(.o.i<. Co'fJJQ.",~~{ ~i'{ H~tJJk[ RC!..lll.c..,-
I ~, ~ I '~OIOb
BUILDING SIZE SQ FOOTAGE L..1.;jOv, ---- HEIGHT I'
11111'1""11111'11111.'111,,1111'11111"'1111'1"1111"'III"IIIIIIIII,rllllll'llllrllllllll'IIIII"11111"1IIIIIIII"tll,IIII"IIIIII,IIIII"'11
1$ I
1$ d-6C>, - I
I I BUILDING SHALL COMPLY WITH
$ ALL APPLICABLE BUILDING,
ELECfRICAL, PLUMBING AND
1$ 1"i 00,- I VALUATION OF MECHANICAL INM~JRttAL CODES
GAS D ROOFING D SPECIALTY D OTHER i~v\l~6 L..~tf)l\~K.
r-l r-J::::> -r UN) \':::>
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA L-jYES L- NO
1IIIIIIIIIIIIIIIIIIIIIIIIIIIilllllllllllllllllllllllll11I1111I11111111111I11111111111111111I11111I11111111I1I111111I11I1111111111I1I111I11I1III11I
PARCEL ID#I
SUBDIVISION
WORK PROPOSED
ADD/ALT
REPAIR
COMM
FRAME
PROPOSED USE
TYPE OF CONSTRUCTION
NEW CONSTR
INSTALL
SFR
BLOCK
0 BUILDING
csh ELECTRICAL
0 PLUMBING
Q MECHANICAL
LOT #
D
D
D
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
OTHER I
STEEL D
OTHER I
I~\.\<.t W\1<t.
AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
PROGRESS ENERGY
I
I
I
I
I
I
I
I
I
License # I I
1IIIIIIIIIIIIIIIIIIIIillllllllllllllllllllllllllllllll1111I1111I11111111111II1111I11111111111II1I11111111I1111111111'1111111111111
Attach (2) Plot Plans; (2) 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
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.
Attach (2) sets of Engineered Plans.
**HPROPERTY SURVEY required for all NEW construction.
IIIIII!IIIIIIIIIIIIIIIII'IIIIIIIII'IIIIIIIIIIIIIIIIIII1111111111111111111111111111111111111111111'1111111111111111111111I1111111111111111111111111
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 A1C
o
BUILDER
SIGNATURE
COMPANY
REGISTERED
Address
ELECTRICIAN
SIGNATURE
p~ AJf~
COMPANY
REGISTERED
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Address
MECHANICAL
SIGNATURE
4v {)fv'-/
COMPANY
REGISTERED
Address
OTHER
SIGNATURE
COMPANY
REGISTERED
Address
111111111111111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
D
D
W.R.E.C,
Y / N
Y/N
FEE CURRENT
LIcense #
Hb~ {)v,JiJ~{'
I Y/ N I
Y/N
FEE CURRENT
License #
Y/N
Y/N
FEE CURRENT
License #
r.}'~r Qv,~(~ 4\(,TtVG
I Y / N I FEE CURRENT I
LIcense # I
Y/N
Y / N
Y/N
FEE CURRENT
Driveways-Not over Counter if on public roadways..needs ROW
Fences (Plot/Survey/Footage)
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 wiJh 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 addressing 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 wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner 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 of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proce?d with the work a~d not as authori~y !o violat:, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~II.dlng OffiCial from the~eaft~r
requiring a correction of errors in plans, construction or violations of any codes. Every permit Issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) mo~ths after the time th~ work is commenced: An extension
may be requested, in writing, from the Building Officia~ for a period not t~ exceed n1n~ty ~90) dars and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the Job IS 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.
FLORIDA JURAT (F.S. 117.03)
CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as Identification.
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
DJ:SCLOSlJRE STATEMENT FOR OWNER
CITY OF -ZEPRYRBJ:LLS BUJ:LDJ:NG DEPARTKENT
J:,_~\rVY G'(~ ~rJ
agree to th'e provisions of thi:s instrument.
have read and fu1~y understand and
, ,
The undersi~ed states and affirms that he or she .is desirous of construct~g,
renovating, add.ing to or reroofing h.is or her own dom.ici~e~, that he or she
actua~~y occupies, or w.i~~ occupy by said dom.ici~e, and same is not for
rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing cond.itions,:
~.
That the owner and he or she a~one shaJ.~ act as the bu:i.~derfor a~~ phases of..
construction.
That the owner wi~~ comp~y with a.J.~ provisions of the City of Zephyrh.i~~s
ord.inances and codes pert.inent to 'the bu:i.~d.ing.
That ~ the event various phases of construction
engage o~y properly ~icensed subcontractors and
such work.-
That~ the event the Bu.i~d.ing J:nspector sha~~ requ.ire corrections to be made,
the owner wi~~ assume fuJ.~ respons.ibi~i ty to insure they are made, 'and upon
comp~etion w.i~i ca.J.~ for a re.inspection before proceed.ing with the bu:i.~ding.
That the oWner shall assume fu.1.J. respons.ibi~ity for the construction and wi~l
no~ expect supervision of h.is work~zrom-the City of Zephyrh.i~~s Bu:i.~d.ing
Department.
That prior to f.inal inspection any add.itiona~ fees, inc~uding re~spection
fees, must be paid in fuJ.~. A written request from th.is office sha~l
,constitute' an officia2 notice,to pay add.itiona1 fees.
That the owner shal~ comply with a~~ City, State and Federa~ laws' in: regard to
social security, workman's compensation, lien ~aws, etc., where app~icable.
That the owner shall comp~y w.ith a~l the safety codes issued by the Florida
J:ndustria~ Ccmm.ission.
State ~aw requ.ires construction to be done by ~icensed contractors. You have
app~ied for a permit under an exemption to that ~aw. The exemption a~lows
you, as the owner of your property, to act as your own contractor with certain,
restrictions even though you do not have a ~icense. You must provide direct
ons:Lte supervision of the construction yourse~f. You may bu:i.~d or .improve ,a
one-fam.i~y or two-fam.i~y residence or a farm outbu:i.~ding. You may a~so 'build
or .improve a commercia~ bui~d.ing, provided your costs do not exceed $25,000.
The bu:i.~d.ing or residence must be for your own use or occupancy. J:t may not
be built or_ s~stantia~~y .improved -for sa.J.e or ~ease~ J:f you seJ.l;or' lease' a
bu:i.-*c;.~~}':..Q'I.i.__h.iLYEl_bt:t.i~;; or _substant.i~ly .improv~d yourself w.ithin ~ year after
the constXl1ction iliLc...."1I'lete,tl1e law will preirome -that: you bui~t: or
substantia~~yimproved if for sa.J.e or lease, wh.ich is a violation of th.is
exemption. You may not h.ire an un~icensed person to act as your contractor or
to supervise people work:ing on your build:i.ng. J:t is your respons.ibili ty to
make sure that people employed by you have licenses requ.ired by state law and
by county or mun.icipa~ licensing ordinances. You may not delegate the
responsibi~ity for supervising work to a licensed contractor who is not
~icensed to perform the Work being done. Any person working on your building
who is not ~icensed must work under your d.irect supervision and must be
emp~oyed by you. wh.ich means that you must deduct F.I:.C.A. and w:Lthb.o~ding tax
and provide workers' compensation for that emp~oyee. al~ as prescr.ibed by law.
Your construction must comp~y wi th al~ appl:Lcable laws, ordinances. building
;;~: ;~;(:A:~l).;. f( .?IS'yv DATS f~?b^ ~
E'RONE fIr - 7\1 f - 20 LLJ
WJ:TNESS
2.
3.
are subcontracted, he w.ill
w.ill personally supervise
4.
5.
6.
7.
8.
9.
r
PE:RKI:T -. #:
Date Received
Owner's Name
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
~i .
Owner's Address
Fee Simple Titleholder Namel
JOB ADDRESS
SUBDIVISION
WORK PROPOSED
Owner Phone Number 'f j - 1. ~. 02
Owner Phone Number 11ff' ql/2 - L!77S-
Owner Phone Number I
I {) it-
51.
PARCEL ID#I
~
LOT #
Fee Simple Titleholder Address I
11/LfI
I
I
EJ NEW CONSTR c=:J
INSTALL D
PROPOSED USE D SFR D
TYPE OF CONSTRUCTION D BLOCK D
DESCRIPTION OF WORK I \Xf;'f<':"~ Pw~+t lOll]
BUILDING SIZE 1/0 X b~ wI f.(<.h. SQ FOOTAGE I
ADD/ALT
REPAIR
COMM
FRAME
D
D
D
s-lvr:. J
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D DEMOLISH
OTHER
STEEL
~tJ'd~~
I
D
OTHER I
HEIGHT I
11111111.1111".1'1111111111'1'1111111"""11111"-"111111111"111111111111111"11111111111.1111111111111'1'1"'.1111111".'1'11111111111111"..'1
BUILDER
SIGNATURE
Address
ELECTRICIAN
SIGNATURE
Address
PLUMBER
SIGNATURE
Address
MECHANICAL
SIGNATURE
Address
OTHER
SIGNATURE
Address
1111111111'1111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
PROGRESS ENERGY
D
D
W.R.E.C,
VALUATION OF MECHANICAL INSTALLATION
PY/ 1J~
COMPANY
REGISTERED
A.v
Jj l'~
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
I~b~
I Y / N I
Dw JJe)(
FEE CURRENT
Y/N
License #
l1o~~
I Y/ N I
() w 1Je.';
FEE CURRENT
Y/N
License #
Y / N
FEE CURRENT
Y/N
License #
Y/N
FEE CURRENT
Y/N
License #
Y/N
FEE CURRENT
Y/N
Driveways-Not over Counter if on public roadways..needs ROW
Fences (Plot/Survey/Footage)
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, 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.
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 addressing 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 wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner 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 of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced: An extension
may be requested, in writing, from the Building Officia~ for a period not t~ exceed nin~ty (,90) da~s and wIll demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the Job IS 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.
FLORIDA JURAT (F.S. 117.03)
CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or haslhave produced
as identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
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813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
11 ~ 71 - 161 Y
Owner Phone Number I ff? - g y ) ~ l{ 7 75-
Owner Phone Number I
Owner's Name
Owner's Address
Fee Simple Titleholder Namel
Fee Simple Titleholder Address
JOB ADDRESS
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{bih si,
LOT #
PARCEL ID#I
NEW CONSTR
INSTALL
SFR
BLOCK
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D
D
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
SUBDIVISION
WORK PROPOSED
EJ
PROPOSED USE D
TYPE OF CONSTRUCTION D
DESCRiPTION OF WORK I (Xp,,,t,d Pe.;'{w" ~+ )..DD j
BUILDING SIZE I I SQ FOOTAGE I HEIGHT
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ADD/AL T
REPAIR
COMM
FRAME
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D
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tle.df\\:,A I
OTHER I
STEEL D
OTHER I
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BUILDING
1$
Address
MECHANICAL I
SIGNATURE .
Address I
OTHER I
SIGNATURE
Address I License #
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RESIDENTIAL Attach (2) Plot Plans; (2) 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
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.
Attach (2) sets of Engineered Plans.
*mpROPERTY SURVEY required for all NEW construction.
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Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades A1C
I
1$ {I>O.OV I
o PLUMBING 1$ 1
o MECHANICAL 1$ I
o GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I 1 FLOOD ZONE AREA DYES DNO
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VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C,
VALUATION OF MECHANICAL INSTALLATION
BUILDER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
ELECTRICIAN I
SIGNATURE .
Address I
PLUMBER I
SIGNATURE
I
License #
(W~
COMPANY
REGISTERED
1~Yt.<(., I)wNol'
I Y / N I FEE CURRENT
Y/N
License #
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
License #
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
License #
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
COMMERCIAL
SIGN PERMIT
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, 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.
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 addressing 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 wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner 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 of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Officia! for a period not t~ exceed nin~ty ~90) da~s and will demonstrate
justifiable cause for the extension. If work ceases for mnety (90) consecutive days, the Job IS 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.
FLORIDA JURAT (F.S. 117.03)
CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
by
Who isfare personally known to me or has/have produced
as Identification.
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is'are personally known to me or has'have produced
as identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
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CITY OF ZEPHYRHILLS BUILDING DEPARTMENT
C~-<~~0
JOB LOCATION
':) I Y 7 I b t k )t, L - K; ~l ~
11 ~~ '11-
PARCEL IoD.off
SHOW ALL EXISTING & PROPOSED STRUCTUR&if 'GIVING DIMENSIONS & SETBACKS.
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UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
FRONT PROPERTY LINE
(~OTE EXAMPLES 1 & 2)
STREET
1. SETBACKS FOR Rl, R2 ZONING
60'
2. SETBACKS FOR R3 ZONING
60'
10'
P E
R X
0. I
10' P S 10'
0. T
S I
E N
D G
1 0'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30'DUPLEX
1 0'
20'
FRONT PROPERTY LINE
FRONT PROPERTY LINE