HomeMy WebLinkAbout08-7884
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7884
7884
Permit Type: ADDITIONIAL TERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 6623 N DR
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block:
Subdivision: SILVER OAKS
Parcel Number: 03-26-21-0150-00000-0050
Book:
Section:
2,069.49
5/22/2008
67.50
67.50
5/22/2008 Phone:
REPLACING 1 DOUBLE DOOR SIZE FOR SIZE
Name:
Address:
BRUNNER, JUDITH
6623 NORTHLAKE DR
ZEPHYRHILLS, FL. 33542
813 788-4997
0A~~
1/3\-
2N I
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPEC110N 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."
r;: ;};)~c!"}r
CTOR 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
BUILDING PLAN REVIEW COMMENTS
Site:
8 G- ~i-y ([;;.e
S-lS- 08
b (0 2-3 IJ()~ LalceJJ,-
7?ej b (e Size 4trr .." Le t)iWJ Ie /)&-J)L-
Contractor/Homeowner:
Date Received:
Permit Type:
Approved wino comments~ . Approved withe below comments: 0 Denied withe below comments: 0
Date Contractor and/or Homeowner
(Required when comments are present)
'iIlV."'IV.'"
~CORQ. CERTIFICATE OF LIABILITY INSURANCE I ~ifn1f'1CATE NO.1 DATE
ACOI. '200'&2-~O?63~
03/2S/200& 01:31 ~Pl
I'ftODUCER THIS ~FtOATE IS ISSUED AS A MATTER OF INFORM4T10N
Highpoint niDk Servicc~ L~C ONLY AND CONPIIRS NO RIGHTS UPON THE CERTlFlCATE
14160 DallaD Parkway #500 HOLDER. THIS cmnFICAT~ ~S NOT AM~ND, ~!~~ 2.fi
Dallas, TX 75254
(800) 632-5096 INSURERS AFFORDING COVERAGE
IN!f(lpjm!" 'tJ!IS" "fi ~lf r INSURER A:. C<Xlln.::ln:1on Pr01Xlrtv and Col8Ualtv Inlllurancl; C
J Ii: C CARPENTRY, me. INSURER B;
13461 79 CT. NOR~R INSURER 0:
WEST PALM BEACH, FL 33412 I'jSURIiR D;
(5'1) .3.3.3 -7"04 Fax: ISH) 333-7747 IN.sU~ E:
THli POLlClliS OF INSURANCE USTEO BELOW HAVE BEeN ISSUED TO Tlti II'ISURED NAMED A80VE FOR TltE POLICY PERIOD INDICATED,
NOTWITHSTANDING
ANY Al!QUlRI!MI!NT, 1ll1U" OR CONDITION OF At<< CONTRACT OR OYHER DOCUMENT WITtI RIiIPECT TO WHICH THIll CiRTlFlCATE MAY IE
~ 1':11I=1) a~
A TYPf 01' INSUIWfCf POLICYNUMIEft ~ ~ LIMITS
~ENI!:AAL UA8IlITY !ACH OCCllAAfNCf .
- ~M!"Cv.L Cl!N!l'W. LlMlIUT"I' 1'lRt: DAMAQe (Mil on. "It) ,
- CLAIMS MAOIi: 0 OCCUM Mt:D l!lI:P lAM OM_Ill S
- P';RSONAI. , MN tuURY S
,.... GeNel'lAL. AGGIleGot.TI! S
nN1. AO<lIleO LIMIT An~ peA: r'l'l00\..I0TS. QCMf'IQ"-'OG S
!'QUC" I ~~ LOO
~U'l'OMOgILE UAIlILITY QOI.tIIIN;D $1NG~ LIMIT .
~A\1TO (I!I IllCIdlnU
-
ALl. OWNED AVTOS IIOPII.V INAII'IY
- .
SCHCllUU!D AUTOS (P<< Pf"OllJ
-
HIHlW AUTOS SODILY1NUI'l"f
- d
- NOH.~ED AUTOS IPlIt .~n1)
PROPl!RlY DAMAGE $
(Pet KI:ldanl)
RAAGE U~IIILITY AUTO OHI. Y -fA ACCID!NT .
foN'r AUTO OTllI<R THAN ~"'ACC S
AUTO ONLY: AGO ,
1lXC!SS L1A!IIUTY !AOH OOOUMI!NO! .
':: occun DCLAlMSMAOIi: AllOIlfOATl! .
.
-
- DEPUC:TlllLE $
1'IETI!NT10l\1 S ~I $
WORKliAI COMPliNSATION AND 04/01/2009 IOJ:I;I-
I!MI'LOYVlS' L1ADlLI'rY WC77779990601 04/01/2008 l!L l!1.CH ACCID!NT' . 1000000
A EL DI8l:A8l! -I!A EM'LOY!l!: . 1000000
".1- Dl8I!A$l! . I'OUC'Y UMlY . 1000000
~THIR LIMITS ,
UMITS .
DUCAIP110N OP' O~TIONSILOCATIONSN~Ql.U5lQN' jlPPiP IV ~1'lSEMENl7SPE<:1AL PAOVl5lONS
1. Insured is afforded Occupatio~al ACcident Coverage a8 a co-employer under the policy for employee5
lCAged fr~ AMS StAff Lca3ing, Inc. 2. 'thi. cer~ifica~e remalnc in c~fQct, providod tho clicnt'8
account illl in good IIItanding vtth AMS. Coverago illl not provided for any employee for which the c1i~t
~.s not reportiI19' vagea to J\MS. Applies to lOOt of the employeeD ot AMS le~Qcd to J & C CARPENTRY,
INC., effective 04/01/2008
I I &DllI11CNAL INSUAfIl; INSUIIGIl LCTTO: ~JlN~1 I Jl,"",N
SHOULD ANY OF tMC AIIOI/i DIiIOIlIIIiD POLlOIQ -Ii DAIlC&I.1$D I15FOA" M;; 5XPlllAlIOI
DATI: 'l1al~r. ~ ISSUING IIDUll9 WII.L ~YOll TO MAL 30 DAYS WRmIN
CITY 010' Z~PHYRHILLS NOTIC:I! TO lHI CIRlI'ICATI HOLDUI IWoMD '1'0 'l'Hf1.U'l'. aln MlUlIlI TO DO 10 IHALl.
Pi J J Ii 8 nr STREB'I' IlIPOSl NO o.uGAllON OR LIA8IUTY 01' ANY _D u.oN '!Ita INI~ ~ ~ 01
~~: 813-760-0021 Ai:PIICC&NT"TIVIii-
ZE~XL~S, FL 33542 AImIOIIIZm R~PItIHNTATIVK l -~ ~
ACORD 25-S rt19'T) o ACORD CORPoRATION 19 I
CERTIFICATE OF LIABILITY INSURANCE ~N"'bef-^ctu2DO~
EMPLOYEE ROSTER
AIIadood ........ ......... .....'..- .... -.. 03IUI2C1118. To l'erfl7"'p/oy<o's "". "'f ..... been ._ 11_ "'~ ~
pIQH allIl..soo- '12&-fKi2J.
It PleuD Bvte 8InP'G}U I'O$ter tOJ' th& l:UoDlls lapel.t8d on . 'WEEkLY bask.
. I-
DA vts, JAMEs D.
OSWALDO, SANTANA
PANTALBON. WILIJAM
SCHALLER, TIJOMAS J.
3I2&'ZOoa PI&a I of]
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
05/02/2008
PRODUCER (561) 338-3030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Starling Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1700 North Dixie Hwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 109
Boca Raton FL 33432- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:Nationwide Mutual Ins. Co 23779
J&G Carpentry, Inc. INSURER B:
13461 79th Court North INSURER C:
INSURER 0:
West Palm Beach FL 33412- INSURER E:
COVERAGES
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.
INSR ADD'L POLICY NUMBER P~A~~~:U&Wf Pg~fl(~~~N
LTR INSRD TYPE OF INSURANCE LIMITS
A GENERAL LIABILITY 77PR769812-3001 05/02/2008 05/02/2009 EACH OCCURRENCE $ 1,000,000
t-- ~~~~~J?~cel
X COMMERCIAL GENERAL LIABILITY $ 50,000
I CLAIMS MADE ~ OCCUR / / / / MED EXP (Anv one oersonl $ 5,000
f- PERSONAL & ADV INJURY $ 1,000,000
/ / / / GENE;RAL AGGREGATE $ 2,000,000
ril'L AGGREnE LIMIT AFlES PER: PRODUCTS. COMPIOP AGG $ 2,000,000
X POLICY ~~8i LOC / / / /
A ~OMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT 500,000
(Ea accident) $
- ANY AUTO
- ALL OWNED AUTOS / / / / BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS / / / / BODILY INJURY
(Per accident) $
NON-OWNED AUTOS
r-- 05/02/2008 05/02/2009
~ OWNED 77BA769812-3002 PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO / / / / OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $
:=J OCCUR 0 CLAIMS MADE AGGREGATE $
$
~DEDUCTIBLE / / / / $
RETENTION $ $
WORKERS COMPENSATION AND / / / / I WC~TATU-I 10lli-
TOR LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIOE;NT $
OFFICERlMEMBER EXCLUDED? / / / / E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER / / / /
/ / / /
/ / / /
DESCRIPTION OF OPERATIONSlLOCATIONSNEHlCLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
( ) - (813) 780-0021 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE lliE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT
-
City of Zephyrhills FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON lliE
Permitting / Licensing INSURER ITS AGENTS OR REPRESENTATIVES.
5335 8th Street AUTHORIZED REPRESENTATIVE for M~a~S~;to-
Zephvrhills FL 33542-
ACORD 25 (2001/08)
~.",i INS025 (0108).05
ELECTRONIC lASER FORMS, INC. . (800)327-0545
@ACORDCORPORATION1988
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813-780-0020
City of Zephyrhills Permit Application
Building Department
:#788f
Date Received
. f
Owner's Name
Owner's Address
Fee Simple Titleholder Namel 0~
Fax-813-780-0021
Owner Phone Number
Owner Phone Number I
Owner Phone Number I ~
Fee Simple Titleholder Address I ~.e.-
I &kx9.3 N~kt\Le-J:x\V~
~!~ I PARCELIDtll O~~I..o.sb~C0:50
~IV~ (jQ{Gs (OBTAINED FROM PROPERTY TAX NOTICE)
E3 NEW CONSTR D ADD/ALT 0 SIGN D MOVE 0
INSTALL LPJ REPAIR
PROPOSED USE 0 SFR D COMM 0 OTHER
TYPE OF CONSTRUCTION 0 BLOCK D FRAME 0 STEEL D
DESCRlPTlONOFWORK I &,p\ac \'~ ~ - :1~<rRtv<..r'
BUILDING SIZE I . l SQ FOOTAGE I =- I HEIGHT I I
~... "~~,':~;~~"'" .., 'i~ .,~';;;~. ~"" .~~~~~:~~'~~~~~~ :~~~~~~~~.'" ",..,..., "..........,."", '" """
D ELECTRICAL 1$ I
D PLUMBING 1$ I
D MECHANICAL 1$ I
D GAS 0 ROOFING D
FINISHED FLOOR ELEVATIONS I I
. JOB ADDRESS
LOTti
10
SUBDIVISION
WORK PROPOSED
AMP SERVICE
DEMOLISH
OTHER I
D
D
PROGRESS ENERGY
W.R.E.C.
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY 0
FLOOD ZONE AREA
OTHER
DYES
DNO
Address
MECHA~ICAL I
SIGNATURE .
Address I
OTHER I
SIGNATURE
Address I License #
1111111111111111 " 11111111111111111II111111111111 " 1111I11 " 111I11111 " I1111I " 1111II111 " 1I1I11 " 111111111111 i 1II1111111111I111111 " 1111I1111111I
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 Slit Fence installed,
Sanitary Facilities & 1 dlJmpster: Site 'Nark Perm!t for subdlvisions/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 wI Slit 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
I~~~~
... (Y^/:N~CURR~~ 71YlN'r
License # 1CG('~s \
I
I
I
I
I
I
I
I
I
I
YI N FEE CURRENT
License #
YI N FEE CURRENT
License #
YI N FEE CURRENT
License #
Y IN FEE CURRENT
Y/N
Y/N
Y/N
Y/N
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 (PloVSurvey/Footage)
Driveways-Not over Counter If on public roadways..needs ROW
NOTICE OF DEED RESTRI<;:TIONS: 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 a~ 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 advi~ed to contact the Pasco County Building Inspection Division-Licensing Section at 727..847-
8009. Furthermore, if the ~wner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor B~ock" 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 IMPAQT/UTILlTIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact F~es 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 und~rstood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of ocdupancy" 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 WaterlSewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
I .
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 ~y 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~o commencement.
CONTRACTOR'S/OWNER'~ 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 thatithe regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identifyW'hat actions I must take to be in compliance. Such agencies include but are not limited to:
Department of ~nvironmental 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 Avlation!Authority-Runways.
I understand that the followi~g restrictions apply to the use of fill:
Use offill is not ~lIowed In Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "N, 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 materi~1 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 uS,e 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 constr,ued to be a license to proceed with the work and not as authority to. violate, cancel, alter, or
set aside any provisions of t~e 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 authoriz~d 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 and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, th~ob is considered abandoned.
WARNING TO OWNER: ~OUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INYOUR
PAYING TWICE FOR IMPRbvEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COf"'MENCEMENT.
FLORIDA JURAT (F.S. 117.03) . 02 ,n_ _ . A
OWNER OR AGENT CONTRACTOR (7 ~
Subscribed andb~wom to (or affirmed) before me this ~ed and ~
Who is/are personally known to me :or haslhave produced Who Is/are
as Identification.
t d-Oci'
Nqtary Public
Notary Public
Commission No.
~.~-
~ , "f, Notary Pub'i
;.: ~ ,; Shelly Bes~c~tate of FlOrida
"'>;~~ MYCOmmiss.
o,!f\; Expires 03/03~O~f74503B
Name of Notary typed. printed or stamped
Pasco County Parcel: 03-26-21-0150-00000-0050001
Page 1 of2
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:
ParcellD
Classification
Mailing Address
BRUNNER JUDITH L
6623 NORTHLAKE DR
ZEPHYRHILLS, FL 335420643
Physical Address
6623 NORTH LAKE DR
ZEPHYRHILLS, FL 33542-0643
Weekly Archive - Saturday, May 10, 2008
03-26-21-0150-00000-0050 (Card: 001 of 001)
01 - Single Family
Assessment (totals)
Ag Land
Land
Building
Extra Features
$0
$54,031
$120,162
$8,035
Legal Description (First 4 Lines)
STEPHEN'S GLEN AT SILVER OAKS
PHASE ONE
PB 31 PGS 19-20
LOT 5
Total Assessment
Save Our Homes
Homestead Exemption
$182,228
$132,506
- $25,000
Use ype Price
0140 SF $8.36
0140 SF $1.50
Additional Land Information Show Mineral Riahts - 5
0.20 II Tax Area II 30ZH II FEMA Code ICU Residential Code
Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1995 Stories 1.0
Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 2.0
Taxable Value $107,506
Warning: A significant taxable value increase
may occur when sold. Click here for details
and info. regarding the posting of exemptions.
Value
$50,160
$3,871
Line Description Sq. Feet II Repl. Cost New
1 BAS 1,644 II $120,998
2 FGR 526 I $15,456
3 FOP 238 II $4,416
Extra Features (Card: 001 of 001)
Line escription I Year Units Value
1 DWSWC I 1995 832 $1,258
2 JACUZZI I 1995 1 $700
3 POOL-6 1995 252 $4,183
4 COOL OK 1995 200 $612
5 SCRN-AF 1995 1,221 $1,282
Year
2001
Month
10
Sales History
CARMANY FREDERICK ALAN
II Book/Page " Type I Amount
I 4759 / 0350 $151,500
-I
Previous Owner
http://appraiser.pascogov.com!searchlparce1.aspx?sec=03&twn=26&mg=21 &sbb=O 150&b... 5/15/2008
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MIAMI-'
tmID~
MIAMI-DADE COUNTY, FLORIDA
MEIRO-DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33130-1563
(305) 375-2901 FAX (305) 375-2908
www.buUdin2codeonline.com
BUILDING CODE COMPLIANCE OFFICE (HCCO)
PRODUCT CONTROL DIVISION
NOTICE OF ACCEPTANCE (NOA)
Trinity Glass International
4621192th Street East
Tacoma, W A 98446
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction
materials. The documentation submitted has been reviewed by Miami-Dade County Product Control
Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and
other areas where allowed by the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control
Division (In Miami Dade County) and/or the AID (in areas other than Miami Dade County) reserve the right
to have this product or material tested for quality assurance purposes. If this product or material fails to
perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may
immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA
reserves the right to revoke this acceptance, if it is determined by Miami-Dade County Product Control
Division that this product or material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the Florida Building
Code, including the High Velocity Hurricane Zone.
DESCRIPTION: "Premium" 6' .8" Inswing Glazed Fiberglass Door wI and w/o Sidelites.
ApPROVAL DOCUMENT: Drawing No. S-2582, titled "3'0 x 6'8 Glazed Premium Fiberglass Door
Inswing 'Non-Impact' ", sheets 1 through 9 of9, dated 08/17/05, prepared by RW Building Consultants,
Inc., signed and sealed by Lyndon F. Schmidt, P.E., bearing the Miami-Dade County Product Control
Approval stamp with the Notice of Acceptance number and approval date by the Miami-Dade County
Product Control Division.
MISSILE IMPACT RATING: None
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Miami-Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been
no change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change
in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement
of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure
to comply with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and
followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is
displayed, then it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its
distributors and shall be available for inspection at the job site at the request of the Building Official.
This NOA consists of this page 1 and evidence page E-I, as well as approval document mentioned above.
The submitted documentation was reviewed by Manuei Perez, P.E.
8
NOA No 05- 0922.03
Expiration Date: April 27. 2011
Approval Date: April 27. 2006
Page 1
Trinitv Glass International
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
A. DRAWINGS
1. Manufacturer's die drawings and sections.
2. Drawing No S-2582, Sheets 1 through 9 of 9, titled "3'0 x 6'8 Glazed Premium
Fiberglass Door Inswing 'Non-Impact' ", dated 08/17/05, prepared by RW Building
Consultants, Inc., signed and sealed by Lyndon F. Schmidt, P.E.
B, TESTS
1. Test reports on 1) Air Infiltration Test, per FBC, TAS 202-94
2) Uniform Static Air Pressure Test, Loading per FBC T AS 202-94
3) Water Resistance Test, per FBC, T AS 202-94
4) Forced Entry Test, per FBC 3603.2 (b) and TAS 202-94
along with marked-up drawings and installation diagram of 3'0 x 6'8 "Premium
Glazed Fiberglass Door, prepared by Testing Evaluation Laboratories, Inc., Test
Report No. TEL-05-0907-1, dated 09/07/05, signed and sealed by Wendell W. Haney.
C, CALCULATIONS
1. Anchor verification calculations and structural analysis, complying with FBC-2004,
dated 09/15/05, prepared by RW Building Consultants, Inc., signed and sealed by
Lyndon F. Schmidt, P.E. Complies with ASTM E1300-02
D. QUALITY ASSURANCE
1. Miami Dade Building Code Compliance Office (BCCO).
E. MATERIAL CERTIFICATIONS
1. Test Report No. ETC-05-781-17122.0, prepared by ETC Laboratories., issued to
Trinity Glass International, dated 10/19/05, Polyurethane Foam, tested per ASTM
D2843 "Self Ignition Temperature"; ASTM E84 "Flame Spread Index", ASTM E84
"Smoke Developed Index", signed and sealed by Joseph Labora Doldan, P.E.
2. Notice of Acceptance No. 05-1206.01 issued to Trinity Glass International, for their
Unfinished Fiberglass Door Skin approved on 03/02/06 and expiring on 03/02111.
3. Notice of Acceptance No. 02-0429,11 issued to Trinity Glass International, for their
Trinity Lite Frame approved on 07/3/02 and expiring on 07/03/07.
F. STATE~NTS
1. Statement letter of conformance and no financial interest, dated 09/15/05, signed and
sealed by Lyndon Schmidt, P.E.
2. Statement letter of no financial interest, dated 07/21/05, signed by Andrew Na.
G. OTHER
1. Letter from the consultant, dated November 10, 2005, stating that the product is
compliance with the Florida Building Code (FBC .
~anuei P.E.
Product Con i er
NOA No -0922.03
Expiration Date: April 27. 2011
Approval Date: April 27 . 2006
E.}
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CD BUILDING CONSULTANTS, INC.
J\., 'W P.O. Box 230 Vatrico FL 33585
Phon_ No.: 8t3.8S8.91lit7
Florida Board of Prof...ional Enol,...,..
C.rtlflcot. Of AuthOrlZatlo~a .
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CD BUILOtNQ CONSULTANTS, INC.
J\... q, f P.O. Box 2.30 Volrlco FL. 3,3585
VV Phone No.: e1.3.I5!5V.V181
Florida Board of Prof...ionol EnQlneers
Certifloote Of AuthoriZ~13
~ 1-If'of
L.yndon F. Schmidt. P.E. No. 43-4QQ
BY
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7888
Permit Number: 7888
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 2,370.00
Date Issued: 5/28/2008
Total Fees: 45.00
Amount Paid: 45.00
Date Paid: 5/21/2008
Work Desc: RE-ROOF
Address: 37713 NE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: ZEPHYR RIDGE
Parcel Number:
Name: HALL, CHARLES
Address: 37713 NEWAL AVE
ZEPHYRHILLS, FL. 33542
Phone:
(; /lJ)
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TAPE JOINTS ROOF INSP
FINAL
REINSPEC110N FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone ofthe 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 ins ion fees shall be made before any further permits will be issued to the person owning same
"Warning to own Your failure to record a notice of commencement may result in your paying twice for
y ur property. lu intend to obtain financing, consult with your lender or an attorney
our no . mmencement."
RACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
- . -.....-, - --.-
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c\l-\~:-,. r: .,,',"\. .'.,~, '''~~'f' ;. ''l.',,~\. .'t~,~ ;."-'.:1":::-...~~~-~.::,,...:,-, "<S~' ',:, .~~~, ',~
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A. 1Bnrtlett itnnfing (@f ctrentrnllJilnribn, 11nt.
Serving Zephyrhills, Dade City, Quail Hollow, Wesley Chapel, Land 0' Lakes and SUr!~nding,Areas
We have re-roofed more roofs (16.~OO) in the past 35 years than the four loealleading roofing ~~"-"1mi~s co bined.
/. .1 .' ,,-,- /./ r / r 1
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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
& Insulated Aluminum Roof Overs
RESIDENTIAL. COMMERCIAL. MOBILE HOME
LICENSED - INSURED - BONDED
· MEMBER OF THE CHAMBER OF COMMERCE .
Phone
Name /
Address
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OFFICE
PHONE
(813) 782-5585
(813) 973-7737
(352) 523-1944
Lic.#RC 0031769
. AAttOUNT
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President & .O,!,
Sign: .
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Richard C, Bartlett
THANK YOU \ ..- !~\ r:
Your Business is Appreciat~. _-_ /) () ;;- i
Payment upon completion unless previous arrangement m<tde.'Wa~~~_.
fing of Central FL, Inc.
All arrangements contingent upon strikes, accidents or delays beyond our controt. Owner to carry fire. tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance. Customer is liable for any charges incurred in collecting this bill.
Rotten wood is an extra $35.00 per sheet (4-ply). Rotten fascia is $2.00 per linear foot Total
- -----~--~--~-~--_._------------_.-._-_._--_.._-
Pasco County Parcel: 03-26-21-0130-00000-0240001
Page 1 of2
Search Again Show Map Generalized Building Schematic Estimate Taxes Frequentlv Asked Questions
Other Agency Data: Tax Collector School Board Supervisor of Elections
Data Current as Of: Weekly Archive - Saturday, May 17, 2008
Parcel 10 03-26-21-0130-00000-0240 (Card: 001 of 001)
Classification 02 - Mobile Homes
Mailing Address Assessment (totals)
SECRETARY OF HOUSING AND Ag Land $0
URBAN DEVELOPMENT Land $22,590
2100 CORAL WAY STE 504 Building $54,215
CORAL GABLES, FL 331452657
Physical Address Extra Features $1,140
37713 NEWAL AVE Total Assessment $77,945
ZEPHYRHILLS, FL 33542-7917 Save Our Homes $0
Legal Description (First 4 Lines) Taxable Value $77,945
ZEPHYR RIDGE
PB 26 PB 78-80
LOT 24
OR 7723 PG 986
Land Detail (Card: 001 of 001)
I Line I Use Description Zoning Units Type Condition Value
I 1 I 0200 MBL HM 00M1 6,000.00 SF $3.90 0.95 $22,230
SUB
2 I 0200 I MBL HM ~~ SF $0.70 . 1.00 I $360 I
SUB ......- .uu
Additional Land Information
A~ 0.15 I Tax Area II 30ZH II FEMA Code [~~]Residential Codell ZIDELP1
BuildinQ Information - Use 02 - Mobile Home (Card: 001 of 001)
Year Built 1998 Stories 1.0
Exterior Wall 1 Above Average Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Sheet Vinyl Flooring 2 Carpet
Fuel Electric Heat Forced Air - Ducted
A/e None Baths 2.0
Line Description Sq. Feet Repl. Cost New
1 BAS 1,215 $61,868
2 FCA 372 $3,768
3 FST 168 $3,870
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 DWSWC 1998 384 $720
2 CAC-4 1998 1 $420
Sales History
Previous Owner PHH MORTGAGE CORPORATION
Year Month Book/Page ~_e Amount
2007 12 7723 / 0986 WD $0
2007 09 7635 / 0065 CT $0
2002 11 5137 / 0708 WD $78,500
http://www.appraiser.pascogov.comlsearch/parceLaspx?sec=03&twn=26&mg=21 &sbb=O... 5/21/2008
813-780-0020
C)!~f Zephyrhills Permit Application
r-.. O::r Building Department
Fax-813-780-0021
Date Receiv~d
Owner's Name
Owner's Address
Fee Simple Titleholder Address
JOB ADDRESS
LOT #
DESCRIPTION OF WORK
E3
D
D
I
I
B
o
BLOCK 0
A~::tEI
PARCEL 10#1
SUBDIVISION
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
PROPOSED USE
TYPE OF CONSTRUCTION
NEW CONSTR
INSTALL
SFR
ADD/ALT D
REPAIR
COMM D
FRAME D
OTHER I
STEEL D
WORK PROPOSED
OTHER I
.., . . I I . . . I I I I . I . I I I . . . I I . . . I , . . I I . . . I I . . I . . I I I . , . . I . . . . I . . . . . . . . . I I I I . , I I I . . . . . I I . . . I , I . . I I I . . . . 1.1 I" I . . . I I I I I I I I . . . . . I I I I . . I . . . . . . . . . . . . . . I . I . . . .
HEIGHT I
BUILDING SIZE
D BUILDING 1$ ~3 ?(/ I
D ELECTRICAL 1$ I
D PLUMBING 1$ I
D MECHANICAL 1$ I
D GAS D ROOFING 0
FINISHED FLOOR ELEVATIONS I I
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o
PROGRESS ENERGY
o W.R.E.C",\
.~ /
.. ~ ,...; /
(tlfij//'
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
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COMPANY
REGISTERED
BUILDER
SIGNATURE
Y / N
FEE CURRENT
Y/N
Address
License #
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y / N
FEE CURRENT
Y/N
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
Address
MECHANICAL
SIGNATURE
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 onsite, Construction Plans, Stormwater Plans w/ 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 w/ 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.
I11I11111I111111I111111I11111111111111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111111I11I111111111111111I
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 NC 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 an)'
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 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 authon~y !o vlol~t~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permIt prevent the BUilding OffiCial from the~eaft~r
requiring a correction of errors in plans, construction or violat~o~s o! any codes. Eve~ ~ermit issued. shall become. invalid
unless the work authorized by such permit is commenced Within SIX months o.f permIt Issu~nce, or If w nzed . by
the permit is suspended or abandoned for a period of six (6) months after the time th~ work IS c enced: xtenslon
may be requested, in writing, from t uilding Officia~ for a period not t~ exceed mnet. da~s and demonstrate
justifiable cause for the exten' . If w k ceases for mnety (90) consecutive days, t \ ob IS consld abandoned.
WARNING TO OW
PAYING TWIC
WITH YOUR
FLORIDA JU
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed. printed or stamped
Name of Notary typed. printed or stamped
AUG /1')" I? f1r\ '7 /tff\li "';'.7':: !:If
; L....f J;..,J...j/..~..~_<...L...i-.... o.,..t
ZEPHYRHI lJ.S WILD It(;
PAZ No. 813-780-0021
P. 001/00:
Citym~'
BUR JDINGBEPAtlDIENT
RE: Permit # __J<6<6<i? . 9/17107.
JD.~tion'Aftida'dt
I ~\cra m Co. r-D.v1\ ,liCCDlCdasa(n)CoDtnIctor* /EnginccrI~
(plcllsDpri8tDllll8~c:bdDlic. '1)pe) . . . FS 468 BoiJ~ lDs~r*
Liceme#;~ RC- 00'617.tL>'j
On or about
t I did ~ iDspect tho!:R9f
(J:JIa" time)
ded:nailinV and/or ~ water bari1er work at ~ 171 ~ he~aJL ffr-.e-. ,
. (c:bde~ (JobSiteAddnss)
. 2.- - ~ r -e .
-
. 'on I havo dc:At;, mifled the inPllsdion was done accontiDg to the
Manual (Based on 553.844 F.S.)
S.
STATE OF FLORIDA
COUN'IY OF .
Sworn to and subscribed be10rc me this. . ~ of
. - -- .
.200_
By.
~otary Public, State ofFJmida
(PriDt, type or stamp name) .
Ccmmission No.:
Personally known ~ or
Produced ldemification
Type ofidenti:fication produCAfi.
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