HomeMy WebLinkAbout08-7015
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7015
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:
7015
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 5255 18TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-17800-0050
7,000.00
9/11/2007
65.00
65.00
9/11/2007
REROOF - SHINGLES
Name: OSBORNE, GEORGIA E.
Address: 525518TH ST
ZEPHYRHILLS, FL. 33542
Phone: 813 469-0468
;;~ Dr $.--3 - D
7{,~~~ .
7 ;d.; cfdl a
r;Y\&
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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. n
k~.'/e W'#~
C NTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF
ZEPHYRHILLS
"NOTICE"
OF ADDITION OR CORRECTION
BUILDING
DEPARTMENT
[ADDRESS DATE PERMIT.,. I
_ S''bSJ I tli. 51 3- 7-0 X 70 IS' .
THIS JOB HAS NOT BEEN COMPLETED. Th.e following additions or corrections shall be made before the jab
will be accepted.
DO NOT REMOVE
I 1- P-5@~
/1; () A 1/ -
[~/J tAL Fn
}4,) lIt1p?
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR L..-.' ECTION
INSPECTOR . ,. .. s
,
II is unlawful for any Carpenler. Conlractor. Builder, or other persons, 10
cover or cause to be covered, any part of the woI1t with flooring, lath, earth
or other material, until the proper inspector has had ample time 10 approve
the installation.
OFFICE HOURS 7:30AM -4:30 PM MON.-FRI.
City of Zephyr hills
BUILDING DEPARTMENT
RE: Permit # /f 0 IS-
9/17/07
Inspection Affidavit
~ J.k1A1') ~~sed as a(n) Contractor* !Engineer! Architect,
(please print name and circle Lie. Type) FS 468 BuIlding Inspector*
On or about
,. /'
:J-/ 7 / ~
( (Date(& time)
, I did personally inspect the roof
S-~ S-r - ( !~ft-,
(Job Site Address)
License #;
deck nailing and/or secondarv water barrier work at
(circle one)
t examination I have determined the installation was done according to the
. -(Based on 553.844 F.S.)
STATE OF FLORIDA
CO~OF ~
Sworn to and subscribed before me this 2..::..day of
By7LdtfJ?~t~~_zi
77J ~A~
.200t:
. Notary Pnblic, StaterF10ri
C~IY kli:'::> or
-."Produced Identification ~
Type of identification produced.
(print, type or stamp name)
",.~~,. . BOBBIE S. SWETLAND
Commission No.: t.:r :">;to": Commission DO 734406
~ .; Expires February 22, 2012
.''f, " Ilondod ThN Trov Ftin 1_1lOH85-7010
A//l-
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F .S. to make such an
inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the
deck for each inspection.
813-7'80-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
11111111111111
OWner's Name
Owner's Address
Fee Simple Titleholder Name
Fee Simple Titleholder Address
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
LOT #
JOB ADDRESS
PARCEL ID#I
SUBDIVISION
WORK PROPOSED
ADD/ALT
REPAIR
COMM
FRAME
B
NEW CONSTR
INSTALL
PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
BUILDING SIZE
o
o
o
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN 0 MOVE 0 DEMOLISH
OTHER I
STEEL 0
I
OTHER I I
.......1............."..."" ~
HEIGHT I
BUILDING
VALUATION OF TOTAL CONSTRUCTION
PROGRESS ENERGY
o
o
o PL.UMBING 1$ I
D MECHANICAL 1$ I
D GAS 0 ROOFING 0 SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
11...1..1.............,.....'..'..1...'.....11..1'."..1,.'.'..;,.,.....'....1".'..1.1,.......1,............,..,.'....1.1,.1...,.'.....'...'.1...
ELECTRiCAL
AMP SERVICE
o
o
W.R.E.C,
VALUATION OF MECHANiCAL INSTALLATION
Address License # I I
111111111111111111111111111111111111111111111111111111111111111111111111111111111;1111111111111111111111111111111111111111111111I11111111111111111
BUILDER
SIGNATURE
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
Address
OTHER
SIGNATURE
Y/N
FEE CURRENT
Y/N
License #
Y I N FEE CURRENT
Y/N
License #
License #
YI N
FEE CURRENT
I Y IN I
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 subdivisions/large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (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.
II111111I1I1111111111I111I1111111111111111111111111111111111111I1111I111111I1111111111111II11111I1111111111I11111111111111111111111111111111111111
Directions,:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (Ale upgrades over $5000)
Agenlt (for the cqntractor) 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
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 ~hat a s.eparate perm~t may ?e requir~d for elect~ica.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallatlons not speCifically 1n~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 B~J1.dlng OffiCial from the~eaft~r
requiring a correction of errors in plans, construction or violat~o~s o~ any codes. Eve~ ~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 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 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,
FAILURE TO RECORD A NOTICE OF COMM
VEMENTS TO YOUR PROPERTY. IF you
AN ATTORNEY BEFORE RECORBINGYOUR N
-.-
.--..--
A Y RESULT IN YOUR
CING, CONSULT
CEMENT.
~~t1~
Com ion N
Notary Public
Name of Notary typed. printed or stamped
Name of Notary typed, printed or stamped
A. ilartult Itonfing (Of C!tentral1Jflnrilla, .Jnt..
c/o Richard Bartlett
38408 3rd Ave.
Zephyrhills, FL 33542
One of the Largest, Oldest, Most Dependable
Roofing Companies in Central Florida
Specializing in Mobile Home JP Stevens White Rubber Roofs
& Insufated Aluminum Roof Overs
RESIDENTIAL · COMMERCIAL · MOBILE HOME
UCENSED - INSURED - BONDED
· MEMBER OF THE CHAMBER OF COMMERCE ·
OFFICE
PHONE
(813) 782-5585
(813) 973-7737
(352) 523-1944
Uc.#RC 0031769
Serving Zephyrhills. Dade City, Quail Hollow, Wesley Chapel, Land O' lakes and Surrounding Areas
We have re-roofed more roofs (16,000) in the past 35)1ea~ than the four focaj Ieading roofing companies combined.
Date Feilruary
r;!1
J-.L~
2('(;[<
Name
Georgia Oshorne
Address
5255 18th Street
Zepbyrhill, FL 33542
813-46(;--(:4oP
Phone
DESCRfPTlON AMOUNT
Rewove complete roain shin~le roof- both layers. '07 . (me. 00
COlllplete haul away of old rocfing Ihaterial. Replact
rotten wood where necessary. Apprq.x. $200.00 is
included toward the bid (labor and material " seper. te
frOll: the $1.20C.00. Nail down peel and stick shee -$7.200 00
Install wide black drip edge around perimeter. Ins all 200 00 we
new 2011 valley metal in valleys. i'uild cricket beb nd 1+00 . '10
pe "-
chimney. Seal perimeter before shinglin2. Nail on 25 ani
year Class A fiberglass certaineed evergreen shing e. 100. 00 d
1--.
Screw down 10 black ridge vents. 10 year leak warr~ nty_
tv President & Own~r A. ~artl~tt R~of:r~ of Central FL, Inc.
.,0 ~ales tax. ermlt lnc u~d.
Slgn:_, ~/ I
\ Ri~ r-. -""".:.L.Ltt opnn"';t- $2 500. 00
\~~~YOU B 1 .-~
u .' sisAppreoated. a ~e .e upon
Pac""", """"="= u Z7 =ment """" ' . pe~, ""'"'" _ on $5~400. 00
Aljdlfa'lgem'fflrn:ed~~SIiflIe ?:C{Jer"sw;Je!ays tleyOlJl ronl1J . IDGIIIf~~_";f1!!CeSS;jr.'~
OL;rWOTters&'1'f!JiiJawEl!!t!~~5[;omper:S2lion ms;;rilf/Ce. fislial1iBua!IT~~i'iioRe:tJng Itrisbi!1. '"
~ .....ms iI'il elt1a$35 00 00 sIleef ("-ply) Rotten tascia is Sl.m......tiJ!JI. Total
od
1
St:
ip
~~ (2- ~-( fcfcJ'f ~J 7 ~
If l6'd (7? (9tL 733Jf(j Y7<---
1111111111111111111I111111111111111111111111111111111111111I
2008028459
NOTICE OF COMMENCEMENT
Rcpl:1162886 Rec: 10.00
OS: 0.00 IT: 0.00
Penrut No. 02/25/08 . ___ Dpty Clerk
Property Identification No. If - )/6 - ~(- ODil) -( 7 ~.- aoSl)
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida Statutes, the following information is provided ~ NO~ENCEMENT.
I.Description of property (legal description:) ~
a) Street Address: 5255 18th street p yr ills, FL JJ~4l
2.General description of improvements: R e roo f
3.0wnerInformation Georgia Osborn 5255 18th Street Zephyrhills, FL
a) Name and address:
b) Name and address offee simple titleholder (if other than owner)
e) Interest in property
R 4.Contractor Information
a) Name and address:
b) Telephone No.:
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.:
6.Lender
a) Name and address:
33542
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A Bartlett Roofing 38408 3rd. Ave. Zephyrhills, FL
813-782-5585 Fax No. (Opt.) 813780-1805
Fax No. (Opt.)
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713. 13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF C MMENCEMENT. .,
STATE OF FLORIDA
COUNTY OF PASCO
Ie foregoing instrument was acknowledged before me this ~day of
as
:act) for .
Personally Known ~ Produced Identification
Notary Signature
Type of Identification Produced
Name (print) ti i J #-lJ
Verification Pm:s~t to Section 92.525, Florida Sta~tes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated In It are true to the best of my knowledge and belief.
FORMS/NOC,rvsd2007
RICHARD C. BARnrn
MY COMMISSION # DO 447832
EXPIRES: July 31, 2009
Bonded Thill NoIary Public Underwlile"
Signature of Natural Person Signing Above
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received ~ _ I I - (:)7
. G',o,.,PJ/> i'1 c. f"'SeC:Rfl/f-
/ Owner's Name ~......v~ I,... c::; (y
( Owner's Address I 6';) '5 S- / Y d: Sf- .
Fee Simple Titleholder Namel
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
"JOB ADDRESS
SdSS
Fee Simple Titleholder Address
B
PROPOSED USE D
TYPE OF CONSTRUCTION D
/DESCRIPTION OF WORK I 'M Roc~
I I
1111111'1.1'11111111'111111"111111111'111'...'11,11111,1111'IIIIIIII'lllt"IIIIIII"ltt'IIII'llt,IIII,lrlll11111111"1',"111111111'1'11'1'11111'.
/ 1$ .rJ ^ kA.. D^ ".. I VALUATION OF TOTAL CONSTRUCTION
. c;f-Uuv- u 10' )l'Iu'~ f-.JOC-
D ELECTRICAL 1$ I AMP SERVICE D PROGRESS ENERGY
D PI~UMBING 1$ I
D MECHANICAL 1$ I
D GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
1111111111111111111111111111111111111I1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I11111
/~cJ:: 0-. ;2 ~h--d;t h ,If.s
I PARCELlD#1
B
D
D
S'J/ ';tJ7/e~
SQ FOOTAGE I
SUBDIVISION
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
ADD/ALT
REPAIR
COMM
FRAME
BUILDING SIZE
D
BUILDING
LOT #
\ \ - 2(.;,- L\ - 00\0 - li<60D. 0050
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE 0
o
D
o
DEMOLISH
I
D
OTHER
STEEL
OTHER I
HEIGHT I
D
W.R.E.C.
VALUATION OF MECHANICAL INSTALLATION
Address
MECHANICAL I
SIGNATURE .
Address I
OTHER I
SIGNATURE
Address I License #
111I111111111111111111111111111111111111111111111111111111I111111111111111111111111111111111111111111111111111I1111111111I111111111111111111111111
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 w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
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 w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
BUILDER /
SIGNATURE
/"
Address
ELECTRICIAN I
SIGNATURE
Address I
PLUMBER I
SIGNATURE
I
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
COMMERCIAL
SIGN PERMIT
!J()'ry\e oum} e V
I Y / N I FEE CURRENT
Y/N
License #
Y/N
Y/N
FEE CURRENT
License #
Y/ N
Y/N
FEE CURRENT
License #
Y / N
Y/N
FEE CURRENT
License #
Y/N
Y/N
FEE CURRENT
DI~~~ii~~~': ' , , , . , . , , . . , , . . . , . . , , , . . , , , . . . , . , . , . . , , , . . , , , . . , , . . . , , . . . , , , . . . , , , , , . , , , , . . , , , . . , , , . . . , , , , , , , , . . . , . , , , , , , . . . . . , , , . . , . . , . . . . . , . . . . , . . . . .
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
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, WaterlWastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand ~hat a s.eparate perm~t. may ?e requir~d for elect~ica.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallatlons not speCIfIcally In~luded. In the application. A
permit issued shall be construed to be a license to proceed With the work a~d not as authorr~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 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 Issu~nce, or If work authorrzed. 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 nrn~ty ~90) da~s and WIll demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the\!ob 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 COMME~CEMENT.
FLORIDA JURAT (F#.03) . - e /; .. e ~
OWNER OR AGEN '~~ G. f.l-/~~ CONTRACTO ' ,
su~scritJed and sw6m to (or affil"l'lied) before me this Su~scrjbed a d swo~ to (or nned) bf!,~re m~b
q /11 '0 J by (~e~ 0..... {::.' c:.....r:v J' (') ~ <-1/1' L 07 by ('~.p S' t2~_::::.- - - 0< l'\.ll--
Who Is/are personally kno 0 me or haslhave produced Wh~ is/are personally known to me or haslh~ve p~odU?ed
VL. l)€u \1- Lt c as identification. \-l \)'Q.uR- W <!-. as Identification.
Notary Public
~0~~
Notary Public
Commission No. ""'If< K .
/'$!"'!."~ are" L. Miller
:,;y .~o: ..
Name of Notary typea:;}ll....... , ~ October 29, 2010
:(,W,:;\" Bonded Troy Fam -Insurance, Inc. 800-386-7019
Nam
DISCLOSURE STATEMENT FOR OWNER
CITY OF ZEPHYRHILLS BUILDING DEPARTMENT
I, have read and fu~~y understand and
agree to the provisions of this instrument.
The undersigned states and affirms that he or she is desirous of constructing,
renovating, adding to or reroofing his or her own domici~e, that he or she
actua~~y occupies, or wi~~ occupy by said domici~e, and same is not for
rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing conditions:
1.
That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of
construction.
That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s
ordinances and codes pertinent to the bui~ding.
That in the event various phases of construction are subcontracted, he wi~~
engage on~y proper~y ~icensed subcontractors and wi~~ persona~~y supervise
such work.
That in the event the Bui~ding Inspector sha~~ require corrections to be made,
the owner wi~~ assume fu~~ responsibi~ity to insure they are made, and upon
comp~etion wi~~ ca~~ for a reinspection before proceeding with the bui~ding.
That the owner sha~~ assume fu~~ responsibi~ity for the construction and wi~~
not expect supervision of his work from the City of Zephyrhi~~s Bui~ding
Departmen t.
That prior to fina~ inspection any additiona~ fees, inc~uding reinspection
fees, must be paid in fu~~. A written request from this office sha~~
constitute an officia~ notice to pay additiona~ fees.
That the owner sha~~ comp~y with a~~ City, State and Federa~ ~aws in regard to
socia~ security, workman's compensation, ~ien ~aws, etc., where app~icab~e.
That the owner sha~~ comp~y with a~~ the safety codes issued by the F~orida
Industria~ Commission.
State ~aw requires construction to be done by ~icensed contractors. You have
app~ied for a permit under an exemption to that ~aw. The exemption a~~ows
you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a ~icense. You must provide direct
onsite supervision of the construction yourse~f. You may bui~d or improve a
one-fami~y or two-fami~y residence or a farm outbui~ding. You may a~so bui~d
or improve a commercia~ bui~ding, provided your costs do not exceed $25,000.
The bui~ding or residence must be for your own use or occupancy. It may not
be bui~t or substantia~~y improved for sa~e or ~ease. If you se~~ or ~ease a
bui~ding you have bui~t or substantia~~y improved yourse~f within 1 year after
the construction is comp~ete, the ~aw wi~~ presume that you bui~t or
substantia~~y improved if for sa~e or ~ease, which is a vio~ation of this
exemption. You may not hire an un~icensed person to act as your contractor or
to supervise peop~e working on your bui~ding. It is your responsibi~ity to
make sure that peop~e emp~oyed by you have ~icenses required by state ~aw and
by county or municipa~ ~icensing ordinances. You may not de~egate the
responsibi~ity for supervising work to a ~icensed contractor who is not
licensed to perform the work being done. Any person working on your bui~ding
who is not ~icensed must work under your direct supervision and must be
emp~oyed by you, which means that you must deduct F.I.C.A. and withho~ding tax
and provide workers' compensation for that emp~oyee, a~~ as prescribed by ~aw.
Your construction must comp~y with a~~ app~icab~e ~aws, ordinances, bui~ding
codes, and zoning regu~ations.
1
OWNER' S SIGNATURE~ e (() ~
ADDRESS. i. <) ~ ~~. .:Jv ~)"-17 /;.Jt.~, . -f..
PHONE 'l'1_~~ _- 0_,/
2.
3.
4.
5.
6.
7.
8.
9.
DATE 9-/1-~ '7
WITNESS
PERMIT #