HomeMy WebLinkAbout07-6359
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6359
Permit Number: 6359
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
900.15
Address: 6049 18
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0180-00000-0410
52.50
52.50
1/25/2007
REPLACE 2 DOORS SIZE TO SIZE
Phone:
I
FOOTER DUCTS INSULATED SEWER MISC,
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC, MISC,
CONSTRUCTION POLE FRAME MISC, MISC.
REINSPECTlON 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.
(.V.J(A i"-.~~ O/lli1(f:lj~.~ ~ ~
CONTRACTOR SI ATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6359
6359
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost: 900.15
Date Issued:
Total Fees: 52.50
Amount Paid:
Date Paid:
Work Desc: REPLACE 2 DOORS SIZE TO SIZE
Address: 6049 18 H ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot{s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0180-00000-0410
Phone:
F LU
FOOTER DUCTS INSULATED SEWER MISC,
ROUGH ELECTRIC LINTEL MISC MISC,
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC, MISC.
REINSPECTION FEES: Reinspection fees will comply with Florida statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
NO OCCUPANCY BEFORE C.O.
~.
CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CIn 'OJ' ZB'BD8;IU8 RItKI!' Ul'L%CM'IOH
8UIID:QIQ 1I"~ 1331 .- It, ~11.'1)Aftn. J3gll42C11JVIIP --ti, ~, 1..Jq
'~J-1'o-0020 JaXI.13-7.0-0021 ~
i
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OWER'S lWeI : . ~'. PtI<>>O: <i?l3':"'1S?.;?- 1003 WCttsUN
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LEGAL DESCRIPTION I LOT(') 41 ItOCX S08DIVI8I0lI ~ ' ~
PAlCZL 10 t OC;h;tb-J I-OI~- Oapo -OttlO mll"AT" nnw PRnP!l:""Y ..Ax NMT,.r.,
woal( PROPSJ:D. ONEW coeI.T1l.UC1'tON 'C ADDITIOtI
OAL'1'DA'1'ION lJ(.aaPAIR
o X1l8'Z'ALJ.
o SIIDi, i:J NOVI 0 DINOLI..
PIIOPOSED on: ~GL rNolIl.Y OWELLJ:MO OWULfl-rNaLY Ot or lINIn
o C'OMHERC,IAL ' 0 niDUSfRtAL -, 0 S~MMIWG POOL
o HOBILK ROM!:
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"
t::I RU!~ . IW'lI 9UAM'NDI! APPRO'VAL .
oucaunOtl or NOU _~j 11 -(.R ~ ~ t:o.or.s . S i.~ ,I ?;.,'~
BOILOING BIZ!: SQGUI I'OOTAGI . , llEIGI!
USIDIII7IALI A'1"1'ACIl 121 PL01"'LUJ , 121 1m or auXLDIlICJ .w, , (1) 07 .aMY roRHS.
CCHCUCIALI AT't'ACII 131 SETS or 'IOI1.DING ,LAlI. , (11 In IQlIIlQY FOIlIfB.
If' SIIDi PENiIT (>>)1.'1 m St'J'l or &NG~WO ,LAllI' UOOIIt&D. .
PSOPEA'tY SURVey uoaxJUlil) roa ALL MM COlI8ftDCTION.
~~
\)t Il1n.DI~ ,
o ELIiCTAICN.
o PLMING
o HECIWlICAI. ,
o GAl OI\O()FI)lG 0 SPECIAL'lY
I'QNX!'S UQo:J:STKD
V~DATlOlI or tDtAL cotIIITROC'lIOH
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AMP IUVICI 0 PrOCJ&'." en.lL'fY 0
VAt.fIOIf 6r NEClWICIAJ. INSTALlAtION
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VA-llA-e
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noPE or CON8'rItOCTI~: 0 aLOe/(' 0 nwa:
rIWIsa&D FLOO~ .LlVATIONS
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tereR A~6N'\1 CAf~,Q;O nr
n.acnucax
COMPANY
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SI GNATURE
S'I'AR CEllt OR IUlGIS'J' f
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IIGNATURI
OON~AMY'
81'11.1'1 CEI\! OR UGIS'J' f
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wzawn~
SIGHAfOlUl
CONPIUJY ,
8'1'AR CiUl'l' 011. llEGI st .
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SIGXA1'OQ
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CClNPANY
151'Afl CUT 01\ I\tiGUT t
A.' NorlCE or DEED RCSTRICTIONS
Thll W1du'81gned W\dentan~ that thb permit uy be .\Il:)ject to "~ed restrictions" which
may be more re.triotive than City regul.tiona. The undersigned aleume' re,pona~bility for
conplianc. with any applicable d.ed r.strictions~
B. UNLICENSED CONtRACTORS N-lD CONtRACTOR RliSl'OIfSI8ILI'I'I!S
It tn. ownor has hired 0 contractor or contractora to undertake work, 'they may be required
to be licenaed in accordance wit~ .tate and loc'l regulation.. If the contractor ia ,not
lioen.ed .a required by iaw, both the owner and oontractor may be cit.d for a a1sdemeanor
violation under .tate law. If the'owner or intended contractor are uncert.in .. to WhIt
licensing requirement. may apply for the intende~ work, they are advised to contact the
City ot Zephyrhill, Building Department, 813-780-0020.
Furthemore. if the owner h.a hired a COntractor or contractou, he i. adviaed to have the
contractor Is) aign pOftions of the .Contractor Seotion.M of thi. application to~ which they
will be re.ponaibie. It you, a, the owner .lgna I' the contraotor, you are ind1cating thAt
you, rather than the contractor, Ire re.ponslbl. tor the work. ,If the contrActor wishee
you to &1gn a. contractor that may be 'an ind1ea~ion that'he ie not properly 11cen.ed and ia
not entitled to permitting privilegee in the City or Zephyrhll1..
c. rlWiSPORTATION I~PACT n:ES AND DTII.IT"t' CONNECTION FEES
o. CONSTilllCTUIOIl LID! LAW (CHAP1'n 71.3, 1'L01UDA STATuns, AS AMENDED)
I oertify that I, the Jpplicant, hay. b..n provided wlth a oopy'of -Florida'. Construction
li.n Law - Hom.owner'.,Protection Quide" prepated by the Florida Department ot Aqrioulture
and Consuner Affairs, If the applicant ia .omeone other that t~e .owneru, I cerify that I
nave obtained a oopy ot tne .bov~ de.oribed document ana promia. in oood taith to deliver
it to the .owneru prior to comeno...nt.
E. CONTRACTOR'S/ONNCR'S AFFIDAVIT
I certify tnat all the information in thi, application ia accurate and 'that all work will
be don. in compliance with all applioabl. laws regulating conetruotion, zoninq, and land
developnent.
Appliqation i. hareby made to obtain a pe~lt to do work and inetaiiation a. l~oated. I
Certify that no work or in.tallation ha. oomaenced prior to ie.uahoe of a permit and that
all work will be pertorm9d to ~et .tl~rd. of all law. reqU1atlng construction, City
cod.., %oninq regulation., and land' develo~nt requlations in the juri.diotion. I also
certify that I understand that the requlatlon. ot other governaental aqencie' ~y appiy to
tne intended work, and tnat it i. .y reepon.lbllity to identity w~t aotion. I mu.t take to
b. in compliance. Such agencies include but are not liMit.d to: -Department ot
Enviro~ental aegulation-Cypras. Bayh.ads, W.tland Area. and Env1ronRentally Sensitive
LandJI, Water/Wa.t,water Treatment
'Southwest rlor1da Water Manageaent Oistrict-Wella, Cyprese 8ayhoads, "etlan~ ~...,
Alterinq Watereourses
"Anly CoIJl' of ~91.neen-Seowal1., DeCu, Nav1qabl. Waterways ,
"Department or Health , Rehabilitative S.rvlc.., Invironment.l Realth Onit-Well.,
Wast.wat.r Tr.atm.nt, Septic Tanks
'U.S. ~nvironaental Protection Aq.noy-Asbestos abate.ent
I aiso certify that, if fill mAterial i. to be u.ed in FlOOd Zone .AN or ~A,etc.N, it i.
understood that a drAinAge plan addre..inq a .Oo.pen..tLnq volum." wlll ~ e~tted which
1. prepared by a protas.ional anqin.er reqi.tered in the State ot rlorida prior to pe~it
188\lallce,
^ permjt issued shall ,be construed to be I 11cen.. to proceed with the work and not as
authority to violate, cancel, a,lter, or ,et add., any providons ot the technical codea,
nor 'hall issuance ot A permit prevent the Build1nq ~tt10ial froa thereatte. requiring a
correction or errors in plans, construotion, or violation. ot any cod.. Every pe~it
i..ued shall b.c~ invalid unl.., the work .uthor~zed by .uoh permit i. cORm.noed within
.1a ~nth. or l..uance, or it work .uthori~ed by the permit 1, su.pended or abandoned tOr'a
period of six nonths after the t1me,the work 1. commenced. One ~O'day extension at tiMe
may be allowed tor the permit with fee char;o of $15.00. The extenoion ehall be requ.sted
in wr1t1nq to'th. Building Ottiolal. An approved in.pection '.ust be logged durinq .ach six
Month period, or the prOject will be con.laered abandoned.
lf1\Jl.NING TO OW'NER: rOOR D.ILOR& TO JU:COp'D A NO'I'ICR or C~NCtHEN' HAY RESULT IN YOUR
PAYING TWICE i'OR INPROVEMENTS TO 'YOUR PROPERTY. IF rou INTEND TO 081'AIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEr iu:f'ORIl RECORDING YOUR NOTICE OF COMMENCEHENT. JOBS t1NDER
$2,500 IN VALUE '80 N01'iNEE I. ~,'RD'AND POST A .NOTICE OF COHHtIlCENENTN.
Gz~Abu /lA- ~~
SIG TORE i OWNi:R OR A. ENT SIGNMURE I CONTRACTOR
STA.TE or n..oRIAil"b
COONn or 1,\UlJlS, CY ~ '
The toreqoinq in.tl~entwa~aCknOWled9,.d
8efor~e thb ~ d.... ~ ~ J::t- . 2Qttl
by ''''IC~W''\.:t..:;: ~
~.. In.mo' at pereon ac~nowledged)
~o is personally ~own to ft., or
o who has produced
(type of identifiCation)
and W~d1d ,Od ,d lot taka an oath.
StA'!'E OF FloOIUDA
COUNT'(' or
The foregoing instrument was acknowl.dged
Before 11\8, thia ~y of , 20_
by
(n4llle ot per. on aoknowledqed)
~ho i, personally known to Dei or
o who ha. prOduced
(type ot identification)
and who Odid OIid not take an oath
owledqollont
Signature of pereon tak1nq aoknowledqment
~ t~ " pri"';eg ~s. ~~An\RC9 .
"'.W'" ;::,anura L. L>OZZl
\ ~}CO~ission # DD615374
...."...... ExpJres: NOV. 16, 2010
BO:\DED n1RU AI1A\l1C BONDING CO,.INC.
W--. typed, printed or ot.mp.d
PERMITS R US
17128 DOWNS DRIVE
ODESSA, FL 33556
813-926-9965 (PHONE)
813-926-8536 (FAX)
FACSIMILE TRANSMITTAL SHEET
TO:
FROM:
Monica Watson
Permitting Dept.
COMPANY:
DATE:
January 8, 2007
TOTAL NO, OF PAGES INCLUDING COVER:
City of Zephyrhills
FAX NUMBER:
PHONE NUMBER:
SENDER'S REFERENCE NUMBER:
RE:
YOUR REFERENCE NUMBER:
o URGENT 0 FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE
Permitting Department,
Please find the enclosed permit application for Frances Rebensky at 6049
18th St. If you could please contact me when the permit is ready for pickup.
Please call if you have any questions.
Thanks!
Monica
~
City of Zephyr hills
BUILDING PLAN REVIEW coMMEN'rS
y~\~ R ~
Contractor/Homeowner:
kow.ILc ~~ (Do~ta..
Date Received:
I-ID-OI
Site:
(a:) J..\L1
\ C(S-1D 5+-'
Permit Type:
,..Q -l:::>c,cx l? 0 r Cb r 0 ~~ """'b\
Approvedwlthe below comments: ~enied wltbe below comments: 0
Approved wino comments: 0,
G~lM.. \ TT~ \r2.O\)u<....,- ArfYL'::'\f VL yv\~'l) ~-.j t ~ p:,..l'G
REVIEW DATE:iiii f~fl..
CITY OF ZEPHY- I ,
BIJILDlNG OFFICIAL -~af r~~ .
J
This comment sheet sball be kept with the permit and/or A ,
. If "1 -Y0li:II.LC-Lu ~.L,
Bill B Date Contractor and/or Hom er
(Required when comments are present)
, I
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
FENCE PERMIT
6259
Address: 5232 5TH STREET
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-13200-0130
1,900.00
40.00
40.00
11/20/2006 Phone:
CHAIN LINK FENCE 255 VINYL PRIVACY 116
b~p\(eC1 /(Uo~d
g-q-07/~
REINSPECTI N FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are n ssary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty nstruction c) repairs or corrections not made when inspections called d) work not ready for
inspection w en called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In a dition 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 a water management, state agencies or federal agencies.
The payment f inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to wner: Your failure to record a notice of commencement may result in your paying twice for
improvemen to your property. If you intend to obtain financing, consult with your lender or an attorney
before rem ing yo notice of commencement."
~~
CONTRACTOR PERMIT OFF I
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
, I
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner's Name
It- ()o - ofp
<col e (Of'I( c.d\
5~3d-. St\1 'Stree
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Date Received
Owner's Address
Fee Simple Titlehold.r Namel tAn K 0 t A (Y1 d, ffi
Fee Simple Titlehold r Address I
~ 51.3~
I
PROPOSED USE
TYPE OF CONSTRU
SFR
BLOCK
'11" 5\10..1-, 7.;>\*'11'111\\<' I LOU 113 + III
I PARCELlD#\ n-~b-~ ~-OOID- l3~ -0130
(OBTAINED FROM PROPERTY TAX NOTICE)
o SIGN 0 MOVE 0
o
o
,
DEMOLISH
JOB ADDRESS
SUBDIVISION
BUILDING SIZE
NEW CONSTR
INSTALL
WORK PROPOSED
e.
DESCRIPTION OF
0 BUILDING Li (fl) I VALUATION OF TOTAL CONSTRUCTION
0 1$ I AMP SERVICE 0 PROGRESS ENERGY D W.R.E.C.
0 1$ I
0 1$ I VALUATION OF MECHANICAL INSTALLATION
0 GAS 0 ROOFING 0 SPECIALTY 0 OTHER
FINISHED FLOOR I FLOOD ZONE AREA DYES DNO
BUILDER
SIGNATURE YI N FEE CURRENT
Address License #
ELECTRICIAN
SIGNATURE Y/N FEE CURRENT
Address License #
PLUMBER
SIGNATURE Y/N FEE CURRENT
Address License #
MECHANICAL
SIGNATURE Y/N FEE CURRENT
Address LIcense #
OTHER Owner-
SIGNATURE I Y/N I . FEE CURRENT
Address License #
Y/N
Y/N
Y/N
Y/N
Y/N
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 onsite, 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 onsite, Construction Plans, Stormwater Plans wi Silt 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.
11111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111III11111I11111111111111I11II11111I11
Directions: I
Fill out appli tion completely.
Owner & Con actor 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 COUN ER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage)
Driveways-N t 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: Theundersigned 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 humber 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 thah 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 ~nstallations not specifically in~luded. in the application. A
permit issued shall be construed to be a license to proce~d With the work a~d not as authorl~y !o vlol~t~, 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 violat~o~s o~ any codes. Every ~ermit issued. shall become. invali~
unless the work authorized by such permit is commenced Within SIX months of permit Issuance, 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 Officia! for a penod not t~ exceed nln~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.
/~ G1A"
94~. ~ ~tary Public
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 C MMENCEMENT.
FLORIDA JURAT (F,S'1)?03) ~ _
OWNER OR AGENT ~ 'J), 'CfA,( LrJ\. CONTRACTOR
Subscribed and s f r ~rme ore me this Subscribed and swo
.LL.-- ~ 0' ab by' /1 - ;J P - ,,-'b by
Who is/are personally nown to me or hjlSlhave produ~c1 Who is/are personally kno
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Commission No.
Commission No.
Name of Notal)'..tv12ed. printed or sta[T1Qed 10 d
---~i(1-r;~st- Bobble ~wet n
t:.'1"'IJ).'l~,.\ MY COMMISSION # 00268763 EXPIRES
":;.:.~{;rff February 22. 2008
".:iir: ~~~~~.... ()(),'1DF~ '''-11;1:11 "'1':-' ~ ~,lN INSUQANCE. INC
Nam~ ~ed. p~d
~*t i~ COMMISSION # 00268763 EXPIRES
~*.....i~'; February 22, 2008
. '/ff,.f:i'-- BONDED THRU TROY FAIN INSutlANCE INC
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agree
CITY
~(((\Ie GAtClfl
to the provisions of
DISCLOSURE STATEHENT FOR OWNER
OF .zEPB:YRE:ILLS Bt7J:LD:ING DEPARTMENT
have read and fuJ.J.y understand and
thi.s instrument.
The unde signed states and affirms that he or she is desirous of constructing,
renovati g, adding to or reroofing his or her own dom.ici~e;, that he or she
actua~~y occupies, or wi~~ occupy by said dam:LciJ.e, and same is not for
rent, J.e se or saJ.e. That he or she sha~J. comp~y with the :fo~J.owing conditions.:
J.. the owner and he or she aJ.one shaJ.J. act . as the bu.i~derfor aJ.J. phases of..
ruction.
2 . the owner wi~J. comp~y with aJ.J. provisions of the City of Zephyrhi~~s
ces and codes pertinent to -the bu.i~ding.
3. in the event various phases of construction are subco:ritracted, he wi~~
enga e onJ.y proper~y J.icensed subcontractors and wi~~ perso:c.a~J.y supervise
such work..
4. That in the event the Bu.iJ.ding :Inspector sha~~ require corrections to be made,
the er wiJ.J. assume fuJ.J.responsibiJ.i ty to insure they are made, . and upon
camp etion wiJ.i calJ. for a re.i:c.spection before proceeding with the bui~ding.
5. That the oWner sha~~ assume fuJ.J. responsibiJ.ity for the construction and wi~~
not ect supervision of his work from the City of Zephyrhi~~s Bu.i~di:c.g
Depa tment.
6. That prior to fi:c.a~ inspection any additio:c.aJ. fees, inc~uding reinspection
fees must be paid in fuJ.J.. A written request from this office shaJ.~
.cons itute' an officiaJ. notice.to pay additional fees.
7. That the owner sha~~ comp~y wi th a~~ City, State and Federa~ ~aws' in regard to
~ security, workman's compensation, ~ien ~aws, etc., where app~icab~e.
B . the owner sha~~ compJ.y wi th aJ.~ the safety codes issued by the F~orida
trial Commission.
9. J.aw requires construction to be done by ~icensed contractors. You have
ed for a permi t under an exemption to that ~aw. The exemption a~~ows
as the owner of your property, to act as your own contractor with certain
ictions even though you do not have a ~icense. You must provide direct
e supervision of the construction yourse~f. You may bu.iJ.d or improve a
ami~y or two-fami~y residence or a far.m outbu.i~ding. You may a~so'bu.i~d
rove a commercia~ bui~ding, provided your costs do not exceed $25,000.
u.i~ding or residence must be for your own use or occupancy. It may not
i~t or. sUbstantia~J.y improved for sa~e or ~ease~ If you selJ.:o~ ~ease a
ing yotihave bui~torsubstantia1~y improved yourseif within 1 year after
onstruction is comp~ete, the ~aw wi~~ presUme .thAt you bui~t or
a:c.tiaJ.~y improved if for saJ.e or ~ease, which is a. vio~ation of this
tion. You may not hire an u:c.J.icensed person to act as your contractor or
pervise peop~e worlci.ng on your bu.i~di:c.g. :It is your responsibi~i ty to
sure that peop~e emp~oyed by you have ~icenses required by state ~aw and
unty or municipa~ ~icensing ordinances. You may not de~egate the
nsibi~ity for supervising work to a ~icensed contractor who is not
~ic sed to perfo:rm the work being done. Any person working on your bui~ding
who 's not ~icensed must work under your direct supervision and must be
emp~ yed by you, which means that you must deduct F.J:.C.A. and wi.thho~d:ing tax'
and rovide workers' compensation for that emp~oyee, a.~1 as prescribed by ia.w.
Yo construction must comp~y with a~~ app~icab~e ~aws, ordinances, bui~ding
cod , and zoning regu~ : n~! J..
J:j. DATE II -dD -00 r
PERMJ:T #