HomeMy WebLinkAbout07-7255
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7255
Permit Number: 7255
Permit Type: ACCESSORY BLDG.
Class of Work: SHED INSTALLATION
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 5432 5TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-09100-0161
2,845.00
Name: MATHEW,ANEESH
Address: PO BOX 0823
ZEPHYRHILLS, FL. 33542
67.50
67.50
11/29/2007
INSTALLATION OF 10 X 16 SHED
Phone:
~f\~ l%
j-1P'
0~~
SHEATHING
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. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
~~ ;
tONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 11-26-21-0010-09100-0161 001
Page 1 of 1
Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions
Other Agency Data: Tax Collector School Board Supervisor of Elections
Data Current as Of: I
ParcellD II
Classification II
Weekly Archive - Wednesday, November 21, 2007
11-26-21-0010-09100-0161 (Card: 001 of 001)
01 - Single Family
Mailing Address
MATHEW ANEESH T
PO BOX 0823
ZEPHYRHILLS, FL 335390823
~~ysicltl~ress. .'b 2
ehy~alA .dress N/~/ <{3
Leaal Description (First 4 Lines)
TOWN OF ZEPHYRHILLS PB 1 PG 54
LOTS 16 THRU 21 INCL BLOCK 91
OR 5247 PG 709
Land Detail (Card: 001 of 001)
Description Type I
SFR SF I
SFR SF II
Assessment (totals)
Ag Land
Land
Building
Extra Features
$0
$52,374
$71,361
$357
Total Assessment
Save Our Homes
$124,092
$0
Taxable Value
$124,092
Use
Price
Value
$44,184
$8,190
0100
0100
$5.26
$0.65
Additional Land Information
Acres 0.48 II Tax Area II 30ZH II FEMA Code 1c=lIResidential Codell ZHLHLP2
Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1967 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Wall Board or Wood Wall Interior Wall 2 None
Flooring 1 Asphalt Tile Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line
1
2
3
4
Description
UCP
BAS
FOP
UDU
Sq. Feet
444
1,296
40
582
Repl. Cost New
$4,202
$81,285
$627
$10,976
Line
1
2
Extra Features (Card: 001 of 001)
escription I Year I Units
UDU-M . 1980 2
UCP I 1980 I 1
I
Value
$238
$119
2003
1999
1999
02
08
04
Sales History
SIMMONS K D&HALL B R&TEZTJ D M
Book/Page Type Amount
5247 / 0709 $88,000
4206 / 1062 $0
4127 / 1425 $0
Previous Owner
Year Month
S.~aa;h_Agall] Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions
Other Agency Data: Tax Collector School Board Supervisor of Elections
http://appraiser.pascogov.comlsearch/parceLaspx?sec=ll&twn=26&mg=21&sbb=0010&...11/26/2007
:-----.COOK pORTABLE-wA-li-EHciiisEs-:-ouRDER FORi\,~i-
I'. -... .___.._.cL_________.~--------._-.-u-. .u.____._.. ____~___....._u_._.__.__.._....._______u__._.... ._.__.__u..
GENERAL AND DEALER INFORMATION
I""u.-"--.'-.---.--' . ---------.----.---. . . ---..-.. __.__.__c_
I DATE; _1-,1 i9./c~"1
I
I ACCOUNT;
i ---rtlF1'lIT11S~-
I
BUSINESS NAME;
VISTA MARKETING
DEALER PHONE #;
SALES PERSON:
CARL CASTEN
DEALER FAX #;
DEALER LOCATION:
ZEPH RYRHILLS FLA.
)EALER NUMBER:
. ~__._..__________.__..____._.____._.__~__,.--.--~=-=--CJTY===--=--==--=~_=====__=_~__~.TA1F.___.=___.____..__._____.._______._______
BUILDING INFORMATION
.------MO-~;~;-C T-~~_~_.._
LOCATION OF BUILDING: l_____~
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r,;;:~..::l~;.~~"-~~U- DOOR DO~___=:!R-~~~- _..J:?.20R _____=======-.=...
1 MISCELLANEOUS
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CHARCOA
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BARN X
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LOFT BARN J C" X J &;
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RIGHT
UTILITY
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GARAGE
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LOFT GAR.
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FRONT
CUSTOMER INFORMATION
MUST HAVE TWO PHONE NUMBERS ON ALL ORDERS FOR DELIVERY
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~ C.l:LI\~RYA-DOR~tF DIffERENT THAN M.l'.!UNG ADDRE5S----.---------------
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HOME L
WORK
CELL - ___
INCLUOE AI~EA CODE
813-788-5459
SAME
293801
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NEW
--- -- -----
USED y,
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SOLD
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INCl.UDf. AREA CODE
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NAME OF EMPLOYER ~C:::-) 7
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SOCIAL SECURITY _ .'1.~., ! ," -- l-.. C,'./
NUMBER ..7' l::::: "7 "--?
MANDAToifY--or,j' ALl-nTO ORDERS
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cITy----...------- STATE---
DRIVER'S LICENSE
NUMBER
ZIP
COUNT'{ ._-_._-~-
DATE OF BIRTH
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!. _______u____~=_~- "':'~*A~ TW~~VE.~~~BUILD~NGS _ARE ~EASURED:i=~OM EAVE TO EAVE***
P/\GE 1
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J' -
RlV1SION 5;07
F~
FINANCIAL INFORMATION
CASH i>RICE
-1 ~.~ -:~-..~; ,r.
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SALES PR!CE_~~:.z') Y> r"'=.
.~ '
~. .'
V n I .')'<.
DISCOUNT_,_!Id:__~_
SALES PRICE
DISCOUNT
(JI'TIONC, TOTAL
OPlIONS TOTAL
RTO PRICE
H' /"'. . ,""'--
StCURJ IY OEPOSJT~\-- I L Y:";, ~. . > ,~
SERVICE FEE
DELIVERY FEE
,/
r f!-..(,~. Q
SUBTO rAt
Y .-2'/c."l ;75
SUBTOTAL _-'="-=--'!" ....... rAX ON DELIVERY
opnONAL DOWN
PAYMENT
LOCAL TAX: 7 %
TAX ON DOWN
PAYMENT
INGLE USE TAX (TN)
i
MONTHLY REN\t7 I --? ( L C'
AMOUNT J:-,' ./. ~.
SE:RVICE FEES
MONTHLY STATE
SALES TAX ______,_
MONTHLY LOCA~;- ?/',' -)~-
SALES TAX______
MONTHL yT~:~~:!]ij~..~...?;'f~',.
DELIVERY FEE
TAX ON DELIVERY
TOTAL DUEl
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L.=~=~~~==__~~-,.._- -=~.~~..-~~-~=.' .
k AI~OLJNT RECEIVEf> BY CHECK NUMBER OR
DEALER REFERENCE NUMBER
==--==
-..-
TOTAL DUE FOR DELIVERY
141:'/. - rSJ I
TOTAL DUE If" CY:jj- -
OPTIONS
PRICE
OPTIONS Tm I\L
COD A~10UtH
DIRECTIONS FROM SALES LOT TO DELIVERY ADDRESS
t---=- -.-
f~-::.-::-:::=-=.'----'------.
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DELIVERY DETAILS
------ .
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I HOW TO
TOWARD
~ACK OF
~t3i'{~RS
I~ASSE'G
--------
FOR DELIVERY STATUS, LOG ON TO COOKPORTABLEWAREHOUSES.COM
---
LOAD THE DOORS?
S THE CAB XX
THE TRAILER
SIDE .-i
ERS SIDE
~ _.-----
_. ALL WEATH.r::..R.._.D ELl..VE. Rn
YES..t.ll.~R.l2_SURFAc;.t._ _ XX
1\!.0..20FT GRO_~ND
***ALL TWELVE WIDE BUILDINGS ARE MEASURED FROM EAVE TO EAVE***
1'01< CUSTOMER
-----.-~PCEASE.PR1N-r;-----
PAGE 2
..=J
REViSiON ~;!07
DELIVERY QUESTION
These q~estions must be answered for all orders!
Yes No Initials.
[ill D (' ''''.L'
, ., - I( .~i.."
-
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D em -.. . ~M\./
1 .Is there clear access to the desired delivery locatlon7
(i.e. is the area clear of trees, overhead wires, ditches, ete.)
2 Will driver need to cross property other than your own7
If Yes, please call the office if this is a Rent- To-Own order.
3 00 you own the property where the building will be placed? IlIt2l I~< I '\#L~
(If not, do you have ownerls permission to place building .... \ I ..
~~ t~e ~~';,"e':,'t~:~:;"ent tcom the p'ope'ty owne, 9"ntin9 cl~'Jort~wa'';;'o~~ '
agent access to his property to deliver and/or retrieve the portable warehouse must be
obtained before delivery will be scheduled.
~
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>* Unless there is a gate wide enough to accommodate our truck and tr-ailer as well
width of the building, the order cannot be placed on a Rent- To-Own basis.
4a How wide is the gate opening? I I
as the
4 Is there a fence* * around the property7
AGREEMENT DELIVERY
A Delivery includes a one time building placement and leveling (up to 6 inches).
B If the customer requires the delivery dnver to perform duties that make the delivery longer
than 45 minutes, the customer agrees to pay a charge of $40.00 per hour.
C Additional charges are payable up front and must be approved on site by phoning the main
D The customer may forfeit all monies paid if the answers to questions 1-4 above prove
inaccurate and the building cannot be delivered.
E The customer must pay all deposits, fees, delivery costs, and applicable taxes before the
scheduling of Rent- To-Own orders.
F The customer must pay a deposit (amount to be determined by management) on special built
buildings prior to the order being processed for construction.
G Cook Portable Warehouses carry a lifetime warranty against termite damage and decay only.
Therefore, it is not necessary to place them on blocks. However, at the customer's request
and approved on site by calling the main office, the driver will block the buildings no more than
1 concrete block high, provided the customer has the blocks on hand at the time of delivery for
a charge of $30.00 for buildings up to 16' and $40.00 for buildings up to 24'. Buildings longer
than 24' must be placed on level ground.
H In the event legal proceedings are filed to enforce your obligation to pay for the building
described herein, you agree to pay Cook Portable Warehouses its reasonable attorney's fees
and cost of suit, in addition to any and all other sums due.
I The Rent-To-Own program has been explained. The customer understand that the term of the
agreement is for 36 months and that 55% of each rental payments (excluding taxes, fees and
other charges) will be applied towards the purchase price if the option to purchase is exercised.
J Any permits and/or compliance of local or state regulations as well as the anchoring of the
building are the customer's responsibility.
K The customer agrees to give the delivery driver a clear and unobstructed ingress and egress to
the delivery location.
l The customer releases Cook Portable Warehouses and its agents or employees from any and all
claims of damages to property (e.g. shrubbery, trees, lawn, fences, driveways, septic tank,
overhead, underground utilities, vehicles, children's toys, etc..), and any other personal
property associated with moving a portable storage building on-and-off the customer's
M In the event that the delivery driver attempts to install the portable building and becomes
stuck, the customer agrees to pay any and all associated costs, including, but not limited to
CUSTOMER SIGNATURE
..-
I have read and understand the above items and have reviewed the diagram on the reverse side of this
order form for correct placement of all options including door(s) and window(s).
Date / I // tl /c/ '-J Print Name~'hi:,vv~ k \), D .::(.-,---," :::-
, 7 . l'---'" ,r, ','. ,-
Customer Signatu~ '-),. _ [,,j /,., ,,-J...\../~
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Dealer
CARL CASTEN
***ALl TWELVE WIDE BUILDINGS ARE MEASURED FROM EAVE TO EAVE***
PAGE 3
REVISION 5/07
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November 26, 2007
City of Zephyrhills
Building Departments
Permits
To Whom It May Concern:
I, Aneesh T. Mathew, owner of: 5434 5th Street, Zephyrhills, FI.
33542, give permission to Frank Davis is put a Storage Shed on the
above mentioned property.
I further give Frank Davis permission to sign the permit and abide by
all laws and regulations set by The City of Zephyrhills.
~~
Aneesh T. Mathew
i NOTICE OF-COMMENCEMENT
I
1111111111111111111111111I1111111111111111111111111111111111
2007193185
Permit No. .
Property Identification No._l \ -:;10;) ) , cDl D -c51 J OD -'C)l l' 0
TIlE 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 in this NOTICE, OF COMMENCEMENT."5CA.M..c:. Q..S below
l.DescriPtionofproperty(/e~esCl'r' tbmlj I~-J d-}~J't1k.'% ~C1 ~P~5'i Ws IL.;/o
a} Street Address: . ;;L f)lcr,.f~- q J O. . ,;:; '7 , " .- tllCld-..t'L 6.~~ //- 91 -/~. (
2.General description of improvements: , . . ..' .. .
R
3.0wner~::~~address: ,h-~k. b. ~;.f ". 5tt1'fS'tl--St '2~~...,.1.'J5
. b) Name and address of fee. simple titleholder (if other than owner) . ~
c) Interest in property ,
4.Contractor Information . , /~\ .
a) Name and address: COO\.("5 '- ),,~'A-<..
b) Telephone No.:
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.:
6.Lender
a) Name and address:
.,....
'f-L
?~2...
FaxN~ .
30/
Fax No. (Opt.) _
Rcpl: 1144371
OS: 0.00
11/26/07
JED PITTMAN, PASCO COUNTY CLERK
11/26/07 03:57if 1 if4~
OR 8K 769 I PG 1
Rec: 10.00
IT: 0.00 k
__._ Dpty Cler
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 iri Section
7l3.13(l)(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): .
j
\
WARNING TO OWNER: ANY"PAYMENTS MADE BY THE OWNER AFTER THE EXPmATIONOF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDERCHAPTER 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 COMMENCEMENT.
. .1
Personally Known _ OR Produced Identification L
STATE OF FLORIDA
COUNTY OF PASCO
Notary Signature
FORMSlNOC,rvsd2007
- . ..__~_.~....._:_._............-_..-,. ._._..----u, _._' .:..
. .-.......--..;.......-.-~..
....-----.-..- .
................
.....CitY..~fzephYth~:l:~:::::
ButEDrnG:PLAN REvIEW. COMMENTS
. Date Received:
. ,.
,
.~j(~
. '/1-1-7~()7'
. 5Lf}q ~' ' '&-.
. ~IL{,~ fJ" I(;X~6' Ski
~~Wlfue bdow c==rts:' . Demed;/fue below commenm: ....0
. Contractor/Homeowne:r:
Site:
Pemri.t Type:
ApPr'ov.ed wino c~ents:D
'. '
This p
kept with ~ p~ ~dloi :plans. .
':;119. -0) ..'tt~ .. -,>..
E~mT1'T1er . D....+- ' . .' c---""" and! H
. . ~ U,UJ..L~......... or omeo'WIlCI:'
. (Reqo.i!-ed whee: CQ'TTITTlP;Dtl': are pres~t)
e Received
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
813-780-0020
'7#55
vner's Name
wner's Address I 5 q "3 if
:ee Simple Titleholder Namel
(,5:, Owner Phone Number
Owner Phone Number I
Owner Phone Number I
8') 3 - 8<1Cj- 0 0b j
g-, "3 - wd~---30~-9
- JOB ADDRESS
Fee Simple Titleholder Address I
I S~ 34
I
5 -If, 'Sf;
'ZejJ h'j y hi i /s
I PARCELlD#1
E3
D
Q-
LOT #
SUBDIVISION
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
ELECTRICIAN
SIGNATURE
53--
PROPOSED USE m--
TYPE OF CONSTRUCTION 0
DESCRIPTION OF WORK I
BUILDING SIZE I 10 'XII,. I SQ FOOTAGE I J b 0 HEIGHT I <6'
111111111111111111111111111'111111"1111111'1111111111111'111111111111111111"11111'111111111111111'11111'1'11111111111111"11111"1111111111111"
I' I
1$ I
I' I Si~~S
I' I VALUATION OF MECHANICALlNSTAUATlON f.i1"~ J .)11" /
GAS D ROOFING D SPECIALTY D OTHER '. ~ . .w-~~
('- - ,"\~>~r1
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO \)-"'\' I,rt
~~~~~~ "I'~ '~ 1I1I1I~~1 f' ~;~ 111111111 :'*~~;;; '; I ~ ~'~""""""""I
Address I License # I I
I
I
I
I
I
I
I
NEW CONSTR
INSTALL
SFR
BLOCK
ADD/AL T
REPAIR
COMM
FRAME
D
D
o
OTHER
STEEL
I
D
WORK PROPOSED
OTHER I
D
D
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C,
D
PLUMBING
D
MECHANICAL
D
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
COMPANY
REGISTERED
MECHANICAL
SIGNATURE
Y / N
FEE CURRENT
Y/N
Address
License #
OTHER
SIGNATURE
v~0~
COMPANY
REGISTERED I Y / N I
.5" If 3 L/ 6~ Sf Z ~~ d~ :3 sS-tf.;L License # I I
11111111111111111111111111111111111111 I111 111111111111111111111111111111111111111111111 111111111111111111
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.
FEE CURRENT
Y/N
Address
111111111111111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
...11111111..1111....1111111..........111...111.111111.111.11..........111......................................................1.................
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with 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 accordanc~ 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 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, c~n~truction 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) mo~ths after the time th~ work IS commenced: An extension
may be requested, in writing, from the Building Official for a period not t~ exceed n1n~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
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.
FLORIDA JURAT (F.e 7.03)" ~ 1\ 1111 ~
OWNER OR AGENT CONTRACTOR ~ .
Subscribed and swo (or affirmed) fore me this SUbs~ed and swo 0 ffirrned) b re e thiS ..
11-29-07 by _ I lL-<t.1' 11- -07 by .
Wh~e person~y known to me or has/have produced Who iS/~rSOnaIlY n<<.?wn to me or ha a ~odu?ed
/ '~~., c:; ,,1d."'~'O" PoolI' c~m.'!};Z ;;."'~~"
4f.-.~:'r~~. JACQUELINE SOGES
Name of NW, ~~e;~010
'~RF..ff.'" 9ondod"l111\1 Troy F.io I",uranee Boo.385-7019
Notary Public
Name of Notary typed, printed or stamped