HomeMy WebLinkAbout08-7171
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7171
Permit Number: 7171
Permit Type: MECHANICAL
Class of Work: AlC CHANGEOUT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 3,000.00
Date Issued: 11/05/2007
Total Fees: 65.00
Amount Paid: 65.00
Date Paid: 11/05/2007 Phone:
Work Desc: AlC CHANGE OUT 2 TON -NO CONTRACT
Address: 5835 11TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-0360-0010
Name: CARCARY,MARLENE
Address: 5835 11TH ST
ZEPHYRHILLS, FL. 33542
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DUCTS INSULATED
FINAL
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. ~. obtain financing, consult with your lender or an attorney
ing your noti / / ment.)
CONTRAC IGNATURE
PERMIT EXPIRES IN 6 MON ITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
STOP WORK
By order of the Building Official: Wi[[iam}f.. (]3uroess
All Building, plumbing, electrical and mechanical work
shall cease at the below m~ntioned property.
Address: ~~~ I I ~ :sr r -e-- e I-
Date: l/-~ - 0 7
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Contact
Zephyrhills Building Department
5335 - 8th Street
813-780-0020
Code Enforcement Officer:
8'13-780-0020
Date Received
........1..
Owner's Name
Owner's Address
Fee SimplE! Titleholder Namel
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner Phone Number
OWner Phone Number I
Owner Phone Number I
Fee Simple Titleholder Address I
15F'3t) I;resr
I
JOB ADDRESS
SUBDIVISION
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
2e;/lh'1-< (eLLS ~ I LOT# I
PARCELlD#II/- 2 & -;;2. (-Ov/()-0360 -tJo/l?1
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
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E3 ADD/ALl D
REPAIR
D COMM D
D FRAME D
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D
DEMOLISH
NEW CONSTR
INSTALL
SFR
BLOCK
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OTHER
STEEL
OTHER I
BUILDING SIZE
HEIGHT
1$ I
1$ I
1$ I
1$3oCO~ I
f
D GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
11111111111111111111111111111111111111111111'1111111111111I11111111111111I111111111111111111I1111I1111111111111111111111111111I1111I11111111111I11
0 BUILDING
D ELECTRICAL
D PLUMBING
QQ MECHANICAL
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
D
D
W.R.E.C.
PROGRESS ENERGY
VALUATION OF MECHANICAL INSTALLATION
BUILDER
SIGNATUR,E
COMPANY
REGISTERED
FEE CURRENT
Y/N
Y/N
Address
License #
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y/N
YI N
FEE CURRENT
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y I N
FEE CURRENT
Y/N
Address License # I
MECH~ /~/ /? COMPANY 177c,""/s If:f..f- ~ Ht-'C-
SIGNA~~~ REGISTERED r---L1"?"/'N I FEtCURRENT( I Y/N I
Address I /(/1( 4M.JddlJ dr A' "7 elf r /,f- (t 133bf +.. License # Ie /?'tC- c) 50 7'';-C
OTHER COMPANY I
SIGNATURE REGISTERED Y I N FEE CURRENT Y IN
Address I I License #
11111111111111I11111111111111111111111111111I11111111111111111111111111111111111111111111111111111111111111111111111111111I11111111111111111111111
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 subdlvisionsllarge 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.
DI~~~ti~~~': ' . , , , , . , , , , , , , , . , , , . , , , , . . , , . . , . , , , , . , , , , , , , , , . , , , , , , , , , , , , , , , , , . , , , . . , , . , . , , , , . , , , . . , , , , , , . , . , , . . . , , , . , , . . . . , , . , . , . . . . . . . . . . . . , . , . , , . .
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 (PloUSurvey/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
I 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 installations not specifically included in the application. A
permit issued shall be construed to be a license to proce~d with the work a~d not as authorio/ !o. viol~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 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) mon.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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
i PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y~LeENT.
FLORIDA JURAT (F~S. 117.03) ~ '. ,
OWNER OR AGENT,~~"- ~ co~ .
SUbrcri,bed and sworn to (or a rm~efore m(i this . (~. ~ Subscribed and sworn to (or affirmed) before me ~IS - .
\, ~IOJ by ~7\.cd .('\\~_ Cnrl"r:..C<...f ,I\S fo, by 11.""'1'" <~["...... vnl~ hI('"" \
~ Is/are persona. IIy known to me or has/have produced Who. Is/are personally known to me or has/havh p~oduced
1:)€,.uv'>- U. ~ as identification. ~L l)l2.~ (?- \..-\. {!o p~ as identification.
-
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commls~l1 "~ Commission # DD609664
~"" !(I!" Expires October 29,2010
':t,{f:h\' Bonded r"", ""'", 1_..... Ill. 1Illll4M-7011
Name of Notary typed. printed or stamped
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A (;ut(U cERTifiCATE OF LIABILITY INSURANCE
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PRODUCER (813)933-6691 FAX (813)932-6287 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Adcock & Adcock Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
315 W. Fletcher Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33612-3414
John Alexander Green INSURERS AFFORDING COVERAGE NAlC#
INSURED Lloyd's Heating & Cooling, Inc. INSURER A North Pointe Insurance Company 27740
4811 Londonderry Drive INSURER B
Tampa, FL 33647 INSURER C
INSURER D
INSURER E
--..------
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1'1: ~~~ TYPE OF INSURANCE POLICY NUMBER p:;1k~,~rr~~~E POLICY EXPIRATION LIMITS
GENERAL LIABILITY 3094086143 12/01/2006 12/01/2007 EACH OCCURRENCE $ 1, 000, OO(J
~
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,OO(J
I CLAIMS MADE IT] OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
- 2,000,000
GENERAL AGGREGATE $
-- 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $
-l n PRO- n
POLICY JECT LOC
ALlTOMOBILE LIABILITY COMBINED SINGLE LIMIT
-- (Ea aCCident) $
ANY AUTO
--
ALL OWNED AUTOS BODIL Y INJURY
- $
SCHEDULED AUTOS (Per person)
--
HIRED AUTOS BODIL Y INJURY
-- $
NON-OWNED AUTOS (Per aCCIdent)
--
-- PROPERTY DAMAGE $
(Per aCCident)
GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
:J OCCUR 0 CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 1.fc';~g~~c;1 IOJ~-
EMPLOYERS' LIABILITY EL EACH ACCIDENT
ANY PROPRIETORIPARTNERlEXECUTIVE $
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $
If yes. descnbe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS
City of Zephyrhills
Building Department
5335 8th Street
Zephyrhills, FL 33542
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL
_ DAYS WRITTEN NOTlCETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BLIT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
crt)
John Alexander Green/CLS
ACORD 25 (2001/08) FAX: (813)780-0021
@ACORDCORPORATION 1988
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
(850) 487-1395
MISHKEL, LLOYD STANLEY
LLOYD'S HEATING & COOLING INC
4811 LONDONDERRY DR
TAMPA FL 33647
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DEPA.R-'1'~ ~F BUSINESS .MID .;c;~~
'ccl'RO~FESS~ONAL ~REGtn$TIONJ;;_~ ~~c
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DETACH HERE
:s I A I t: Uf' FLUKIUA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKE~S' COMP~NSATION LAW
EFFECTIVE:
PERSON:
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CUT HERE
IMPORT ANT
Pursuant to Chapter 440.05(14), F.S.. an officer of a
corporation who elects exemption from this chapter by filing a
certificate of election under this section may not recover
benefits or compensation under this chapter.
This Certificate of Election To Be Exempt applies only within
the scope of business or trade listed on the certificate.
QUESTIONS? (850) 413-1609
* Carry bottom portion on the job, keep upper portion for your records.
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-06
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