HomeMy WebLinkAbout07-6877
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6877
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:
6877
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 521516 H ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot{s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-19500-02a6
2,995.00
7/20/2007
45.00
45.00
7/20/2007
REROOF ASPHAULT-SHINGLES
BLAI ,AUD
5215 16TH ST
ZEPHYRHILLS, FL. 33542
Phone:
G(\ ~ l~?;o. 1
C(}
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 no .ce of commencement."
----
ATURE PERMIT OFFI
PIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
LL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
.
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner's Address
fee Simple Titleholder Namel
5~ I f""
. '('
/ ~ It.. 3 .J.
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Date Received
Owner's Name
Fee Simple Titleholder Address I
5~ J.. , S'
1$ 'J (1'1 s-. .J U
1$
1$
1$
C]GAS ~
FINISHED FLOOR ELEVATIONS I
D
D
D
D
I LOTI I .~- A-
I PARCEL 10#1 II-)(P.. ;)/- CXJ/O., 19 roo.. o.J.A<o1
~ (OBTAINED FROM PROPERTY TAX NOTICE)
D NEW CONSTR ADDIAL T D SIGN D MOVE D DEMOLISH
D INSTALL REPAIR
D SFR CI COMM D OTHER I
TYPE OF CONSTRUCTION D BLOCK CI FRAME D STEEL D
DESCRIPTION OF WORK I \L \ ~ jl. pUt- S i~ ":':J r'
BUILDING SIZE ISQ FOOTAGE . HEIGH~ I
III' p, I ~'I ~", 1111'1'11'1111'1" II,.", III1IIII1I H q ".... "'11111' 'I n,,', "." HI IIH'I II If I Pili" ",,,.. pn'" "'1'111"" In ". p pi II fI,llIl,
I
I
I
~
D
I
I ~I!-" j' I-~
JOB ADDRESS
SUBDIVISION
WORK PROPOSED
PROPOSED USE
OTHER I
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
CI
PROGRESS ENERGY
D
W.R.E.C.
PLUMBING
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
ROOFING
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
11111111111111111111111111111111111111111""11"111111111111111111111111'1111111'11"1111111111111"'1"1111'1111'11111111'1'1'11111111111'111111
I
Y/N FEE CURRENT Y/N
LIcense # I
I
Y/N FEE CURRENT Y/N
License # I
I
Y/N FEE CURRENT Y/N
License # I
I
Y IN FEE CURRENT Y/N
License # I I
?r>hY .t~~""T' I
IN I FEE ET I Y/N
License # I tC(O 13d f"rO\- I
BUILDER
SIGNATURE
COMPANY
REGISTERED
Address
ELECTRICIAN I
SIGNATURE .
Address I
PLUMBER I
SIGNATURE
Address I
MECHANICAL I
SIGNATURE .
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
Address
OTHER
SIGNATURE
Address
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 subdlvlsions/iarge 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,
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Directions:
Fill out application completely,
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement 15 required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers' Service Upgrades NC Fences (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" 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 Ilcensed 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 Ilcenslng 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: Theuhdersigned lInderstands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the constrUctloh of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco COl.ihty 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 appllcant, 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, VVetland Areas and Environmentally Sensltllle
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 aN in connection with a permitted building llsing 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 violt;itlng
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 installations hot specifically Included in the appllcatlorl. 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 Isslled 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 ahd will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the Job is considered abandoned,
OWNER OR AG
Subscrtbed and swo 0 or
',:r-, Ii." by ,-
Who Is/er~allY known to me or 5 eve produced
as ldent cation,
Notary Public
Notary Public
Commission No.
,-
State of ---f[;n'(.(H
NOTICE OF COMMENCEMENT
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and I n accordance WI th Ch apter 7 13, Florida Statutes, the fo Howing information is provided in
thIS NotIce of Commencement:
COLlIltyof
f~u("' .rD
1. Descri l' ti on of Property: Parcel No. /1- AiP.- )./ - 00 ~ 0 _ / 'i. 05'00 . 0,* 4(,:,
L tn' Us
2,
1111111111111111111111111I1111111111'11111111111111111111111
2007123507
3. Owner Information: Name
~r
City C -<r"I,,-lUs
Rcpl:lll!862 Rec: 10.00
DS: 0.00 IT: 0.00
07/19/07 -----_Dpty Clerk
Address S J../ S 10 J-~ 5h
Interest in Property:
State ..fL }~S-Y'J.
Name of Fee Simple Titleholder:
(If other than owner)
JED PITT"AN, PASCO COUNTY CLERK
07/19/07 03: 134Rm 1 4'11.
OR BK 757 PG l!J -
4.
Address
Contractor: Name '-'/"""'...,
Address ::I):JJr 5.,1.05"-'1
City
j&~'~:j 7:"C! _
City '2. c";Jlj r L ~(J
State
5, Surety: Name
State rL 1 SJ1.;~
----.-----.--
Address
City
State
Amount of Bond: $
6. Lender: Name
Address
City
State
7. Persons within the State of Florida designated by Owner upon whom notices or other
docll men ts may be served as provided by Section 713.13 (I ) (a) (7), Flori da S latutes:
Name
City
State
Address
8, In addition to himself, Owner designates
of 10 receive a copy of the Lienor's Notice as
provided in Section 713.13 (1) (b), Florida Statutes.
9. Expiration date of Notice of Commencement (the expiration date is 1 year from the date
of recording unless a different date is specified.)
" ~'l ,
Signature of Ownec.X{/f::.. 4L.E-. /!./
Sworn to and subscribed before this
----
....-'
I '~1.- / tt<e-~;" 'in. l3td. <:'.L
Notary Public:
,20..E.,;L.
rvry Commission Expires:
PC930530481 A
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6878
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:
6878
ELECTRICAL SERVICE CHANGE
ELECTRIC SERVICE REPLACEM
NOT APPLICABLE
Address: 39028 PARK D
ZEPHYRHILLS, FL.
NT Township: Range: Book:
Lot(s): Block: Section:
Subdivision: ZEPHYR HEIGHTS
Parcel Number:
1,500.00
7/23/2007
35.00
35.00
7/23/2007
SERVICE UPGRADE
BERNAR ,RONALD
39028 PARK DRIVE
ZEPHYRHILLS, FL. 33542
Phone:
h V")01J2 cl
'1-01-07
,~
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: our failure to record a notice of commencement may result in your paying twice for
improvements to ur property. If you inten to obtain financing, consult with your lender or an attorney
before record' our n . ce of co enc nt."
RACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
r
larouosal Page #
Wesley CIIRllel Electric, LLC
25678 Inkwood Place
Wesley Chapel, FL 33544
813-973-1141 or 713-0964
wcelectric@Verizon.net
of
pages
Z
/";' - I}' G; a 18
w. e hereby submit speCificati~ and estimates for: .$ &L? (c:.-~ .. ..~Wj1t~. td II'll:F)
1~V;:J::;J<'~1u~:::::::-~ WMd>~~
mmm ..& ... ....T .... ........ .~.aoi4i1'1: _m~/I/S' OJ'b1 ......... ~...
m mm /~?I~-<Z5~~<s_.....~...mm.:-~J~...m~.ffl.fe7L ...~-
;t'2j.Q~-EZ~S:"dL:~~::~ - ..C'L1"::::;/S;;;;~_/
1!M'~~ ..'~~R~{'24-~~...;~~:iiQi-.......~-:J:t..~f~~
'fi..' . - ... . Co.s,.-:- /LVd,,;::>'~,Qr"""'2{ .'7 ;:Z;VY' .,;z;:.7!..." _ 0~ m;;;
/F&~,/l1~~~m.~m.~Lt{mm{lt:r......... Cq~m_~5.0 .~.--=... ...
C;o::tle-re 5~~CI~ kl?i-.46~ /7Z#($ .n.a.-t:?
.../A':>;;)-L1 ~C!fL. mOC:f-/.21.>(~2~M'&;1~ .~~~2!'/1..'.""'"
/~5 ... Gi...3. ~ /J~ - ~~L "Lar.=-z ". ./k. B:f.ISI'i1.~~... ...............
t...-tL. .......J 11........ ..... ~.'.""".'.'."-"'. ............m.....1P.. ....... '. m....&. ..................1/.... .."v.m........ ~. .............. '.' '.--~.'."'...' ........~... .. .... ..~. .........../'.........,,'f/X.......... '.' m......52........ .tJ.... 't........'..~....... ..... '.. '. ....... m. ...
42~~ ~pV /9l.~ (.?-Yr>.r?~ CMFv(TJ PJ/// ~a7I"I'~~
.5 /f';M 8 C o:$j- 8./1/1 c;- r t 5-0 ~ fin- ~ ZJC> ~
Date of Plans
-
-
We propose hereby to furnish material and labor - complete in accordance with the above specifications for the sum of:
_.A ~
$ ~ ~~
C
Any alteration or deviation from above specifications involving extra costs will be
executed only upon written order, and will become an extra charge over and
above the estimate, All agreements contingent upon strikes, accidents, or delays
beyond our control.
'? J<:.. days,
,.- \i;;;J
~CCtptanct of 19ropo~al
The above prices, specifications and conditions are satisfactory and are
hereby accepted, You are authorized to do the work as specified,
Payments will be made as outlined above,
Date of Acceptance
Signature
Signature
813-780-0020
City of Zephyrhil/s Permit Application
Building Department
Fax-813-780-0021
Date Received
3iOl.!f
r,lt/ An 0 Owner Phone Number
P/l" Z#owner Phone Number I
I Owner Phone Number I
Owner's Name
Owner's Address
Fee Simple Titleholder Namel
F.. Slmpl. ""ehold.' Add.... I
JOB ADDRESS I ~?o.2~
B
PROPOSED USE D
TYPE OF CONSTRUCTION D
DESCRIPTION OF WORK I l/ ;?
BUILDING SIZE I / Z 7 L.!~ I SQ FOOTAGE I
.
I I I I I I I I I I , , . I , I I I . . I , I I I I I I I I , 1 I I I I I r , , r , I I I . I I I I I I . I I I I. I t 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 . , r 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
1$
~ ELECTRICAL 1$
D PLUMBING 1$
D MECHANICAL 1$
D GAS D ROOFING 0 SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII!IIIIIIIII111111111111111111111111111111111111111I1I11111111111111111I11111111111111111111111I11111111
BUILDER I COMPANY
SIGNATURE REGISTERED Y I N FEE CURRENT Y I N
Address I
~I ~t"Tglr:IAN I
NEW CONSTR
INSTALL
SFR
BLOCK
?ftn..R
,
I
~
o
o
U/t/h:?~
.J)~
2r~"Lb
PARCEL ID#I
fi~
LOT #
SUBDIVISION
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
WORK PROPOSED
D
D
D
5G7?~//LG
/Z7C~
ADD/ALT
REPAIR
COMM
FRAME
OTHER
STEEL
I
D
OTHER I
HEIGHT I
D
BUILDING
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE :2tt/'O
c:;:::r---PROGRESS ENER~;~.C
h~19 !
VALUATION OF MECHANICAL INSTALLATION
COMPANY
I
License # I I
I~? f.:~~~ l~
a//L/
Ct:r.::I~T~RFO
padwelS JO P91UJ.Jd 'pad.<J AlelON JO aweN
padWBls JO palu!Jd 'pad.<J AlejON JO aweN
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O!lQnd AlBIoN
Ol/Qnd AlBIoN
'uO!le::>!J!luapl SB
paonpoJd aAel.//SBI./ JO aw 01 UMOU)f ^/IeuoSJad aJB/S! OlfM
^Q
S!I./I aw aJoJaQ (paWJIJjB JO) 01 WOMS pUB paQ!JosQns
HO~:>VH~NO:>
'uO!le::>!J!luaPI SB
paonpOJd aAelf/SBI./ JO aw 01 UMOU)f ^UBuoSJad aJB/S! olfM
^Q
sll./l aw aJoJaQ (paWJIJjB JO) 01 WOMS pUB paQlJosQnS
~N3mf HO H3NMO
'l.N3W3:>N3WWO:> =10 3:>1l.0N (f;OB ~ .S"=/) ~~nr val~Ol=/
I'"~...n" '~"'l"...w...i... ...wu:." n. ~nOA ~NIO~0:>3~ 3~O=l3S A3N~OllV NV ~O ~30N3' ~nOA Hl.lM
- I'IU~ . .... """"'....... ~.L. "'~
~~ n. ~. "'=:J.W~"U'UA.4.IU' un", ::JI~'AA' nAlU,"'ri
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 ~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 vlolat~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~II~1n9 OffiCial from the~eaft~r
requiring a correction of errors in plans, construction or violat~o~s o! any codes. Every ~ermlt 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 th~ work is commenced: An extension
may be requested, in writing, from the Building Official for a period 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.
WARNING TO OWNER: YOUR FAILURE TO......R~~~~~~~?T!~~~~.~~~!'!.E~~~~~!.~~_~'=-~'!=T2~&:-<?~~
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