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Home My WebLink About06-6216 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 DRIVEWAY PERMIT 6216 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: 6216 DRIVEWAY DRIVEWAY/NEW NOT APPLICABLE Address: 7243 APPL GATE DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: ALPHA VILLAGE Parcel Number: 35-25-21-0050-00000-0090 1,829.00 11/09/2006 40.00 40.00 11/09/2006 Phone: WIDEN DRIVEWAY EXTEND EXISTING DRIVE WILLI ,WADE 7243 APPLEGATE DR ZEPHYRHILLS, FL. 33542 )~( < ' \' r>- ,'0, /!j 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 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." MUST BE 6" DEEP WITH WIRE MESH AT RIGHT OF WAY ~~~ ~~ CONTRACTOR PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department t-aX-lSl j-flSU-UULl tr~lICf DatEI' Received I). ttJ ~/I~ I'f- fl filE. <J-t4 'TiE Owner Phone Number 'bios - 559- <:>5? 1 I ~V-s -19 7 ~ 5' ?Y7 Owner Phone Number Owner Phone Number I OWner's Name ~v/e. Owner's Address 17 '2 t.( J Fee Simple Titleholder Namel IYZ JOB ADDRESS lOT # SUBDIVISION WORK PROPOSED OTHER I f/IIeK1#v- STEEL D OTHER I C(jNl!..t'tL~ ~ rn/J2r 5(::" t<lff ELECTRICAL AMP SERVICE D PROGRESS ENERGY o ~/(i4{~ f 0 LJ . ;) . f--IC'lL--- {11VJ- _ C k. -} 10 ~ /1 ..c)I ~ \r;:) W.R.E.C, D D D PLUMBING MECHANICAL VALUATION OF MECHANICAL INSTALLATION BUILDER SIGNATURE Wa4~ I COMPANY REGISTERED I #<In< E a..J' fJt;"-;e:: I Y I N I FEE CURRENT Y/N Address ELECTRICIAN I SIGNATURE . Address I PLUMBER I SIGNATURE I License # COMPANY REGISTERED YI N FEE CURRENT Y/N License # COMPANY REGISTERED Y/N FEE CURRENT Y/N Address MECHANICAL I SIGNATURE . Address I OTHER I SIGNATURE Address I License # COMPANY REGISTERED YI N FEE CURRENT Y/N License # COMPANY REGISTERED YI N FEE CURRENT Y/N 111111111111111111111111111111111111111111111111111111111111I11111111111 , 1111111111111111111111111111111111111111111111111111111111111111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-Q-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans wi Silt Fence Installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans wi Slit Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. II) 111111111111/ 111111111111111/ 111111111111111111111111111/ 11111111111/ 11111111111111111111/ 11111111111111111111111111111111111111111111111111/ II 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 AlC Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW License # 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 iocal 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 tequiremehts 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 Ordihance hUh1ber 89-07 ahd 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 ih 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 hot 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 · N, 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 "N 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 properti~s, the,ow.ner may be cited fo~ 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 ~hat a s.eparate perm~t, may ?e requir~d for eiect~ica~ ~or~, plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallatlons not speCifically 1n?luded,1n the application. A permit issued shall be construed to be a license to proce~d With the work a~dnot as authon~y !o vlolat~, cancel, alter, or set aside any provisions of the technical codes, n?r shall.lss~ance of a permit prevent the B~II.dl~g OffiCial from the~eaft7r requiring a correction of errors in plans, construction or Violations o! any codes., Ever~ ~ermlt Issued, shall become, Invall~ unless the work authorized by such permit is commenced within SIX months o.f permltlssu~nce, or If work authorized, by the permit is suspended or abandoned for a period of six (6) mon:hs after the lime th~ work IS commenced., An extension may be requested, in writing, from the Building Official for a period not t~ exceed mn~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 swom 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 swom 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 / D:ISCLOSlJRE STATEMENT FOR OWNER CITY OF ZEPRYRBILLS BUJ:LDING DEPARTMENT /1AJct{./J tD; I /~.-5 I, agree to the provisions of thi:s instrument. have read and fuJ.~y understand and The undersi~ed states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own dam:i.cile~, that he or she actually occupies, or will occupy by said dom:i.ci~e, and same is not for rent, ~ease or sale. That he or she shall comply with the :following conditions.: L That the owner and he or she alone shall act as the builder for all phases of.. construction. That the owner will compJ.y with a.J.l provisions of the City of ZephyrhiJ.J.s ordinances and codes pertinent to .the building. That in the event various phases of construction are subcontracted, he will engage o~y properJ.y J.icensed subcontractors and wilJ. personaJ.J.y supervise such work.. That in the event the Building :Inspector shalJ. require corrections to be made, the owner wil~ _ assume fulJ. responsibiJ.i ty to insure they are made, . and upon compJ.etion wiJ.J. caJ.J. for a reinspection before proceeding with the buiJ.ding. That the oWner shaJ.J. assume fuJ.~ responsibi~i ty for the construction and wiJ.J. not expect supervision of his Work from the City of ZephyrhiJ.J.s BuiJ.ding Department. That prior to :finaJ. inspection any additionaJ. fees, inCluding reinspection fees, must be paid in fuJ.J.. A written request from this office shaJ.J. . constitute. an officiaJ. notice. to pay additional fees. That the owner shaJ.J. compJ.y with aJ.J. City, State and Federal J.aws' in regard to sociaJ. security~ workman's compensation, J.ien laws, etc., where applicabJ.e. That the owner shaJ.l comply with alJ. the safety codes issued by the FJ.orida J:ndustriaJ. Commission. State J.aw requires construction to be done by J.icensed contractors. You have appJ.ied for a permit under an exemption to that J.aw. The exemption aJ.J.ows you, as the own.er of your property, to act as your own contractor with certain restrictions even though you do not have a J.icense. You must provide direct ons:Lte supervision of the construction yourself. You may buiJ.d or improve .a one-famiJ.y or two-famiJ.y residence or a far.m outbuiJ.ding. You may aJ.so'buiJ.d or improve a commerciaJ. buiJ.ding, provided your costs do not exceed $25,000. The buiJ.ding or residence must be for your own use or occupancy. :It may not be buiJ.t or. s~stantiaJ.J.y improved for saJ.e or J.ease~ If you s~l ;or J.ease a buiJ.ding you. have buiJ. tor .substantiaJ.J.y improved YOu:Cseif within J. year after the construction is compJ.ete, the J.aw wiJ.J. presUme .tha:t: you buiJ.t or substantiaJ.J.yimproved if for sale or J.ease, which is a. vioJ.ation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise peopJ.e work:ing on your buiJ.ding. :It is your responsibiJ.i ty to make sure that peopJ.e empJ.oyed by you have J.icenses required by state J.aw and by county or municipal J.icensing ordinances. You may not. deJ.egate the responsibility for supervising work to a J.icensed contractor who is not J.icensed to perform the work being done. Any person working on your building who is not J.icensed must work under your direct supervision and must be empJ.oyed by you, which means that you must deduct F. J:. C.A. and wi thhoJ.d.ing tax and provide workers' compensation for that empJ.oyee, alJ. as prescribed by iaw. Your construction must compJ.y with aJ.J. appJ.icabJ.e J.aws, ordinances, buiJ.ding codes, and zoning regulations. OWNER'S SIGNATURE ~ . ADDRESS 72,j ~€ E'BONE 3 - 5' - s-s-? 7 2. 3. 4. 5. 6. 7. 8. 9. DATE "It) ftqfdc. d f r WITNESS PERMIT .. #: PERMIT APPLICATION 'DRlVEWAY:PERMITAPPLlCATION ,CONSTRUcnON .WITHIN ,PUBLlCRIGHT-OF-WAY All information~ befillecl-in completely ,City of ,Zephyrhills 5335 8th Street, Zephyrhills, FL 33542 Telephone 813.780.0000 Fax 813.780.0005 Address: Unlt#: Parcel Identification Number: CONTRACTOR: Company: (]c.../N<'C.,R Name: Contractor's License #: Phone: Cell :~b 7...sS 1-'-r'J ') E-Mail: Wt,.J: iJd.J-b <P 'TI4M~14 1>>1v. ~10 QJV\ Fax:~" '5- ~~ r-vY'~v ARCHITECT IENGINEER: Name: ~ Address: State License #: Firm Name: City: Phone: State: Cell: Zip: Fax: TYPE OF DRIVEWAY V-RESIDENTIAL DRIVEWAY _COMMERaAL DRIVEWAY _PUBUC ACCESS DRIVEWAY DescriDtion of Proiect vLENGTH OF DRIVEWAY v--W:rDTH OF DRIVEWAY &QJ(L EXCAVATION _DEPTH _UNEAR FEET CONSTRUCTION MATERIAL ASPHALT ~NCRETE HEADWALL REOUIRED' _YES ~ CURB CUT REO~D _YES _NO CULVERTS NEEDED ( ) REINFORCED CONCRETE ( ) CORRUGATED MATERIAL ( ) BOX CULVERT ~ ( ) OTHER (EXPLAIN) 'If NOTICE TO APPUCANT: 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. APPLlCATION UTILTrIES.LOCATECONfIRMATIONNUMBER: ;PROV~DESKETCH:IN .THIS'AREA,:IF .ADDITIONALSPACE :IS REQUIRED, ATTACH TO'THIS APPL'ICAT.ION. ~~ ~v ~l){iri 9-f'6 Ll'" --;~~ }J___-_.<- f€~ fl'l' 5') <. . IJ fP/?afJ I g Y tfJ ~c, &JI r~}e:. <;1 at! ~(lJc~ / ~~.(.\ ~'.r-f;rd' ~ 0s v- <L~ ~1. (/I" dcr' _ _ ~-_ -=- -=- --= [SIt7LEU71UC .s{f)~~ 10'7" /l /tp/{.$~ I}/<.. /k-;/f1A ,UJ (i t4 c.c AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. 1 certify that all foregoing information is accurate and that all work will comply with all applicable cocIes. I understand these cocIes shall take precedence over all approved construction documents, and issuance of this permit is verification that I will notify the property owner of Florida Lien Law req., F.S. 713. The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed restrictions may apply to this property, All work shall comply with the current Florida Building Code, Public Works 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 IDENTIACATION AND WITNESSED BY A PERMIT TECHNIaAN OR NOTARY PUBUC. NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter I interfere with existing stormwater b'eabnent and I or conveyance. PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure statement. ~~ ~ (please initial)._ A . ,.pack <1. V<JJli5 ddO~ %; :fa/,&l Applicant Print Name Applicant Signature Date ' Permit Technidan Signature (or) Notary Signature Date Applicant is ( ) personally known to me or produced as identification. (type of identification) Page 2 of 3 PERMIT .APPLICATION OFFICE USE ONLY Concrete (min. 6'') 11'\1"-'. Asphalt Base (min. 6") Y N VA Asphalt (min. 1 Y2'') Y N tJ A Length (min. 19') Y N Existing sidewalk. IJI' Width (10' min-20' max) New sidewalk. ADA compliant. Y N E"~\ ~"T 11V6 Expansion material required. Contiguous parking pad. Triangular flare (3'W x 7'L) Visibility triangle o.k.? Side set back (3' min. R.O.W.) Plan Review Fee :NClitlomft "".4.;'c.;i:~"" . ondwollk_at!finecn .,. ,mutilic''WDIiksDiFec:tOil;aI1C1;ioMlesi . riee:i:'1t~i;';.'i~;l;.**, :'1\,j'lv,:t0tl(5),~{,;,~':f"!j.;i;~lt.;' ~AeD M~a> 7'( ~II~ U. AJo Permit application approved by: Date: l( Page 3 of 3 ~~ &~~ 11/5/00 \(sV- ~~.. ACQRo.. CERTIFICATE OF I.IABILITY INSURANCE I OA'l'E(MMlCO/YVYYj 10/30/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA rlON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY l'HE POUCIES BEL.OW. INSURERS AFFORDING COVERAGE NAIC;!II , Inc. INSURER A: Scottsdale Insu~ance Company INSURER B: INSURER C: INSURER D: INSURER E: PROOUCER Schmalz Insurance Agency 3894 ~ampa Road, SU1te B Oldsmar, FL 34677 813-855-6639 INSUREO David Wallace' Associat I.~i 542 Douglas Road Dunedin, FL 34698 1727-738-8343 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN :~:'UiO TO iHE INSUREO NAMED ABOVE ,..OR THE POLICV PERIOO INDICATED, NOTWlTHSiANCING ANY ReQUIREMENT, 'rERM OR CONDITION OF ANY CONl :li .:T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER'l'AIN, THE INSURANCE AFFORDED BY THE POLle '.~; OESCRIBED HEREIN IS SUBJECr TO ALL iHe TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HA Vi BEEN Ri I J':eD BY PAID CLAIMS, IN;II D'L: .. IorK NliRD NSURANCE POL.1e :.~ GENERAL L1AllILITY COMMERCIAL GENERAL LIABILITY CLAlMSMAOS 00 OCCUR A CLS1117:3 ;. ANYAUTO liMBER POLI~r~~.fi:'C'r~~~~~i.fp~~N LIMITS DATE MM1DD/VV I~A. M1DD EACH OCCURRENCE $ 1 000,000 ~=~~~ 'tE~c=::w.cel $ 100.000 MEC EXP (Any onll plll'llonj Ii 5.000 :1 06-13-06 06-13-07 pe~soNAl. & ADV INJURY $ 1,000,000 GENERAL AGGREGAre $ 2,000,000 PROOUCTS. COMP/OP AGG $ 2,000,000 COM81NED SINGLe LIMI'I' II (Ee llCCkjent) BODILY INJURY $ (Per person! BODILY INJURY I CPorllaonl) II PROPERTY DAMAGE II (Porllcol~nl) , AUTO ONLY -!SA ACCIOENT $ OTHER THAN EAACC $ AUTO ONI. Y: AGG II EACI~ OCCURRENCE S AGGREGATE $ II II .. $ I TO'R~L::JI~S I IOJ~ E.L EACH ACCIDIiNT II 6,L, DISEASE - EA EMPLOYE $ E.L. OISEASE. POLICY L.IMIT ~ Ii D BY ENOORSEMENT I SPECIAl. PROVISIONS ., CANCELLATION SHOUl.D ~Y OF THE ABOVE OESCRIBED POL.ICIES 81! CANCELLEO BEFORE rHa: EXPIRATlO OATE THEREOF, THE ISSUING INSURER WILL ENOEAVO~ TO MAlL.JL DAYS WRl'liEN NOTICE Yo THE CeRTIFICATE HOLDER NAMEO TO THE LEFT, 8U'l'I"AILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTs OR REPRESENTATIIIES. AUTHORIZEO REP GEN'L AGGREGATE LIMn' APPLIES PER: I POLICY ~~S: LOC AUTOMOElILE LlA81LlTY ANY AU1'O ALL OWNED AU'rOS SCHEDULED AUTOS '~'RED AUTOS NON-QWNED AUTOS exceSS/UMBRELLA LIABILITY OCCUR 0 CLAIMSMAOE DEOUCTIBLE RETENTION $ WORKEASCOMPENSATlONAND EMPLOyERS' LIABILITY ANY PIIO/'flIiTOM>I\I'cTNCAtliXecUTIVE DI'FIe_eMBER exCWOI!O? ~~'E(;~~~~~I~NS btilow OTHER DESCRIPTION OF OPERATIONS ILOCA"10N8IVEHICLES / eXCLUBIONS J :.;) CERTIFICATE HOLDER City of Zephryhills 53358th Street Zephryhills, FL 33542 fax' 813-780-0021 ACORD2S (2001 108) 10/10 39t1d 30Nt1~nSNI Zit1WHOS 9PG1SS8E18 1p:01 900G/0E/01