HomeMy WebLinkAbout06-6325
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6325
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:
6325
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 39208 5TH AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
4,498.00
12/20/2006
55.00
55.00
12/20/2006
REROOF
Name: SANDRA BUCHANAN
Address: 39208 5TH AVE
ZEPHYRHILLS, FL. 33542
Phone:
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 permitl there may be additional restrictions applicable to this property that
may be found in the public records of this countyl and there may be additional permits required from other governmental
entities such as water managementl 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.
~-~
IGNATURE PERMIT OFFI
LL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Date Received
Fax-813-780-0021
#b3z:5
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Owner's Name
Owner's Address I 3 <J J(?)8 S Ii.. /J.v-G-
Fee Simple Titleholder Namel
Fee Simple Titleholder Address I
? (~1 AI &
JOB ADDRESS ~ I_QQ.
~ fh
ibL
LOT #
NEW CONSTR
INSTALL
SFR
PARCELID#I JJ.-)(, -)../- 0030- OO~OO - 00/0
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
SUBDIVISION
WORK PROPOSED
fir
D
ADDIAL T
REPAIR
COMM
D
D
DEMOLISH
OTHER
STEEL
I
D
OTHER I
HEIGHT I
D
D
o
o
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C,
PLUMBING
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
YI N FEE CURRENT
License #
Y/N FEE CURRENT
License #
YI N FEE CURRENT
License #
YI N FEE CURRENT
Y/N
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
MECHANICAL I
SIGNATURE .
COMPANY
REGISTERED
Y/N
COMPANY
REGISTERED
Y/N
COMPANY
REGISTERED
Y/N
Address
License # I
I ~"tI ~~~
License # I (}1 e
YIN
OTHER
SIGNATURE
Address
/32 S re>s-
RESIDENTIAL Attach (2) Plot Plans; (2) 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 Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivislonsllarge 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
StGN PERMIT Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 " /1111 " " I
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 nolarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades AlC Fences (PloVSurvey/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" restrictiDns"
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 727-841-
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 uhderslgned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the constructloh of new buildings, change of
use In existing buildings, Of expansion of existing buildings, as specified in Pasco county Ordinance humber 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 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 AN 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 thah one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, t 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 hot 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 Official for a period not to exceed ninety (90) days 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
WI H RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGEN
Subscribed and s
IJ. -OC-oLe by
Who Is/are personally known to me or ave produced
..- as Identlflcatlon.
Name of Notary typ
Notary Public
~ (Y\~ _ tl JJ~ No"~ p",,',
Commission No. " Notary Public State of FIorIcIa
My Commission 00611711
My CommIssiOn 00611711
Name of Notary type
Stateof ~r\~
NOTICE OF COMMENCEMENT
Countyof 'PasLO
THE UNDERSIGNED hereby gives notice that improvement will be m,ade to certain real property,
and in accordance with Chapter 713, Florida Statutes, the folloWlllg l11formatIon IS provIded 111
this Notice of Commencement:
1. Description of Property: Parcel No. /1-;):;,-JI-C~:X~-m~o -cv/o
L.. ~ _roo ~-'r'M II? J PI'; SV I nrL- / 5~ t ~ <3,- ~2.lI J1j /?~"). s1;)~ S II, ;4;<-
~ '/ .... (Legal description of the property and street address If avaIlable)
2, Gen era 1 Descri pt ion of ] m p ro v emen t ~ ftx,-.f ~~~~Wl~lljll ""111111111" 1/1111"11I1111 11111111
Rcpl: 10~9038 Rec: 10.00
DS: 0.00 IT: 0.00
12/20/06 Dpty Clerk
3.
J1E2D PITTMA~ PASCO COUNTY CLERK
~ - / A / /20/06 0~ : llpm 1 of 1
Ownerlnformation: Name <Jli1d.r4- ~MA_ OR 8K 731'8 PG 1775
Address 3"l~ SIi.. &k. City ~.~k{(J . State rf3srM
Interest in Property:
Name of Fee Simple Titleholder:
(If other than owner)
Address
Contractor: Name
City
State
Address .3?.3:J...r .5L S"y
State V 33S-~..2
City
S. Surety: Name
Address
City
State
Amount of Bonel: $
6. Lender: Name
Address
City
State
7, Persons within the State of Florida designated by Owner upon whom notices Or other
documents may be served as provided by Section 713,13 (1) (a) (7), Florida Statutes:
Name
Address
City
State
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, Exp.iratio,n date of Notice of Commencement (the expiration date is 1 year from the date
of recorchng unless a dIfferent date is specified.)
Signature of Owner: ~ I 6.{eIf{JM.()~
Sworn to and suhscri d f 7\. Iln 1,/1 __
ay 0' ----L.R _LP' j1/U~~
Notary Public:
,2oD~.
My COlllIllission Expires:
PC93053048/ A
..
"1)/
./ ,Il/JIII" .~
'R'Iman 'Roo~in9' 'lHe,
s~ ~ 7~ SiIIee 1910
37325 SR 54 * Zephyrhills, Florida 33542
Phone: 813-782-6094 Fax 813-783-2645
License #CCC 1325505
#~ :~.1
~
Customer:Yir \<.,e ~c.....<:~~o...~
Address: 39~o8 S +"'"' AV~.
Date: ~ - \q "0"
City: .z42_J~"",r'" i\\~
Zip:
Home Telephone: 3\a- 8'7 ~
Alternate Phone #
Business Phone #
~Plete tear off of existing shingles
~ ";6~f dried in with # .LS:..... felt
iH' .Atlstall new valley metal with galvanized metal
llI"'" fie-secure all loose roof decking as needed
lia' ",Anstall all new lead boots ll3 I ",,~Hd
u( ArtStall all new drip edge II P1letJe8~: -\~ 5'"
(l(" Install all new ~ year f~gus-resistant shingles ,
CJ ~ingle Color 0(\ i~ "^<...~ ~ COT7"\I'~
l3" ..All debris removed from the job site
UY' All materials, labor and permits furnished
Additional Items: ::I" 50-\0...\\ .s" o' (!;} f ~ \\ "e.c.../
.R"&CJt!" V~\J. :r" <-\0..\\ ( ') '0 .,
"h." ~l~6..r ~ kool '''~L.. \-.
Total bid price $ 4 ~ctR . 11>0
Extra '5
o
D~Si+ of-'30oo.vo &.,IV~ \d.-\q-ob
~~ c\'Ac.... a'\ ~ 0 lo c...orrP \.L. \,0" or ~, a.9 - d,OO 6
Bad plywood replaced at a cost of $ 4 3. f!JI 0 per sheet in the roof field.-Al1 "tl:1<>r 1AloQIl 'Jlsrl(, B1:I8R a8 valley rel.ll:lileifl~ or l'8#ter
re~laBGI;RiRt, will bi :it a rete effllV /" A .plir Rlafl R81lr ~11l8 tAli Belit gf Rlateriala. R .ooF- '\v b~
Co~kk&. .b~j~
1-\-,).007
THIS BECOMES A BINDING CONTRACT UPON ACCEPTANCE OF PROPOSAL. PURCHASER ACKNOWLEDGES RECEIPT OF A COpy OF THIS CONTRACT.
1. All material is guaranteed to be as specified and completed in a substantial workmanlike manner.
2. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, hurricane and other necessary insurance upon above work.
3, Labor warranty does not cover damage to roofs caused by lightning, hurricane, tornado, hailstorm, impact of foreign objects or other violent storm or casualty damage to roofs due
to settlement, distortion, failure or cracking of roof deck, walls or foundation of a building,
4, Workmen's compensation and public liability insurance on above work to be taken out by RYMAN ROOFING (a subsidiary of Ryman Construction, Inc.), or it's sub-contractors,
5, RYMAN ROOFING, INC is not responsible to provide any materials or to perform any work other than what is described above. Replacement of deteriorated decking, fascia board,
is not included and will be charged as an extra unless otherwise stated herein,
6. This contract is subject to final approval by RYMAN ROOFING, INC. and is the entire agreement of the parties and no other written or other forms will be recognized.
7. A charge of 1.5% will be made on all unpaid balances after 30 days plus charges incurred for non-payment procedures.
Ryman Roofing, Inc. will not be responsible for
any septic tank, sod, shrubbery or paint damage.
Payment due upon completion a/job.
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.
::#~~~M~-' :'"C PI/2M
"
CITY OF ZEPHYRHILLS
5335-8th Street
(813) 780-0020
ELECTRICAL PERMIT
../
6325
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Contractor:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
6325
ELECTRICAL MISC
ELECTRIC SERVICE REPLACEM
NOT APPLICABLE
POWERHOUSE ELEC.,INC.
1,~
12/20/2006 ' ,
35.00""
35.00
12/20/2006
ELECTRIC SERVICE UPGRAD
Section:
I
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 inspection called d) work not ready for inspection when called e) permit not posted
on job site f) plans not at job site g) work not accessible.
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 payin
twice for improvements to your property. If you intend to obtain financing I consult with
your lender or an attorney before recording your notice of commencement."
Complete PI s, Specifications and Fee Must Accompany Application. All work shall be
performed 'n ccor nce with City Codes and Ordinances.
CONTRACTOR
CALL POR INSPBCTION - 8 HOUR NOTICB
PROTBCT CARD PROM WEATHBR
~~
-PERMIT OFFI R
REQUIRED
.
Date Received
Fax-813-780-0021 '9
-a ~.?
City of Zephyrhills Permit Application
Building Department
813-780-0020
Owner's Name (J;EI<. E CI1C1c1r!-
Owner's Address 15918 l.AteJ<7' $"1-
Fee Simple Titleholder Namel
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
JOB ADDRESS
Fee Simple Titleholder Address I ,
I t)~'f8 UU.Il'f ~-f
Ilj; f.6.;fvE 111# fJ
LOTI I
PARCELlD#I/z -Zu-z/ -0026- () o~o - baoo
(q8T AINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE 0
SUBDIVISION
I
D NEWCONSTR c=J ADD/All
D INSTALL D REPAIR
[EI SFR D COMM
D BLOCK D FRAME
I ~k-C-IKIL ,5CX1hLE V/J-7/U)c/~ ~.
I SQ FOOTAGE I
~
o
o
DEMOLISH
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
OTHER I
STEEL D
I . I I. . I I . I I I I . I I I . . . I . I . . . I I'. . I .' . . . . I. I . I . I I, ~ I . . I I . I . .. I . . . . . . . . . . . I I . I . I . . . . . . I . . . . I I I . I . . I I . I . I . . . . . . I . . . I . . I . . . . . I . . I I . I I I I I . I . I . . . I . I I . . . . . I . I I . I
,#mvr( Ch~/Z./7C
, I HEIGHT I
OTHER I
tJuf
I
I
I
DESCRIPTION OF WORK
BUILDING SIZE
SIGN PERMIT
D BUILDING 1$
m ELECTRICAL 1$ I S-DO C-
D PLUMBING 1$
D MECHANICAL 1$
D GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
BUILDER I COMPANY
SIGNATURE REGISTERED Y / N FEE CURRENT Y / N
Address ! '
~~~r:~N I Cf-p K ~
Address I f'l'i~ ~*,c."X den/c-, 7~lfc/15 ?3,s--'f'ol License # I C?~5 I
PLUMBER I I COMPANY I
SIGNATURE . . REGISTERED Y / N FEE CURRENT Y / N
,Address I License # I
ME. CHANICAL I COMPANY I
SIGNATURE . REGISTERED Y / N FEE CURRENT Y / N
Address I License # I
OTHER I COMPANY I
SIGNATURE . REGISTERED I Y / N FEE CURRENT Y / N
Address I I License # I I
1I1111111I11I11111I11I1111I1111111I111111111111111111I1IIIIIIIIIIIIIIIIIIIIIIIIillllllllllllllllllllllllllll111I1111111111111I1111111111I1111II111
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
Atlach (3) sets of Building Plans; (1) set of Energy Forms.
Minimum ten (10) working days after submltlal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance.
Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
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 Atlorney (for the owner) would be someone with notarized letler from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
[00 -h 2Z>o II
~
PROGRESS ENERGY
D
W.R.E.C
VALUATION OF MECHANICAL INSTALLATION
License #
COMPANY
REGISTERED
COMMERCIAL
Driveways
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/UTI~ITIES 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" priof 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 properti~s, the.ow.ner may ~e cited for violating
the conditions of the building pefmit issued undef the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required. . . . . .
If lam the AGENT FOR THE OWNER, I promise in good faith to inform the owner ~f the permlttln~ conditions s~t forth In
this affidavit prior to commencing construction. I understand ~hat a s.eparate perm~t may ~e reqUlr~d for elect~lca.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically In?luded.ln the application. A
permit issued shall be construed to be a license to proceed with the work a~d not as authon~y !o vlol~t~, 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. Ever~ ~ermlt Issued. shall become. Invalid
unless the work authorized by such permit is commenced within six months o.f permit Issu~nce, or If work authonzed .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 Official for a penod not t~ exceed ",n~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.
MENCEMENT MAY RESULT IN YOUR
NO TO OBTAIN FINANCING, CONSULT
T CE 0 COMM NC NT.
r2
CONTRACTOR
Subscribed and swom t~rmed) before me this {
7~J ' by c.t.-/llL[)R.. LOVJo
Who I~re personally :town to me or has/have produced
:..f}J 1- CoY I It. Li~S6-- as Identification.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YO I
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO R
FLORIDA JURAT (F.S. 117.03)
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
U0~
Comm slon .'
l~~~ JACQUELINE 8OGI=S
Name of Notary typ~. ~Ita ~DeceDD 621833
"1.~.....~"i> pires . mber 12 2010
"9f.,~\\ Bonded Thru TroyFam InsuranceaOO-385-7019
~
Notary Public
Commission No.
Name of Notary typed. printed or stamped