HomeMy WebLinkAbout08-8102
CITY OFZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
8102
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:
8102
ADDITION/ALTERATION
434-ADD/AL T RESIDENTIAL
SINGLE FAMILY RESIDENTIAL
Address: 5021 SU MERHILL D
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot{s): Block: Section:
Subdivision: SUMMERHILL
Parcel Number: 12-26-21-0100-00000-0110
5,300.00
7/28/2008
90.00
90,00
7/28/2008
SCREEN ENCLOSURE
Name: CHRISTOPHER, BRUCE
Address: 5021 SUMMERHILL DR
ZEPHYRHILLS, FL. 33542
Phone: 813782-0156
PL
FOOTER BOND DUCTS INSULATED
ROUGH ELECTRIC LINTEL
1 ST ROUGH PLUMB PRE-METER
DUCTS INSTALLED WATER
PRE-SLAB SHEATHING
CONSTRUCTION POLE FRAME MISC. MISC.
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. "
fb\. ~Q~
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
PURCHASE ORDER
No. 00001453
VENDOR:
SHIP TO:
BILL TO:
Remington's Aluminum Ine
P.O. Box 2006
Land 0' Lakes, FL 34639-
City Hall
5335 8th St
Zephyrhills, FL 33542-
City of Zephyrhills
5335 8th St.
Zephyrhills, FL 33542
VENDOR NO. I VENDOR PHONE NUMBER I TERMS I DATE T REQUIRED DELIVERY DATE
RemAlum I ( ) - I 0 I 10/02/2008 I
SHIPPING INSTRUCTIONS
(none)
ITEM QTY UIM DESCRIPTION / TASK PRD CODE ACCOUNT UNIT PRICE AMOUNT
1 1.00 PERMIT FOR SCREEN 001-0000-322-0000 90.0000 90.00
ENCLOSURE INCLUDED
ON ANOTHER PERMIT
#8050 FOR POOL
SUBTOTAL:
TAX:
SHIPPING:
90.00
0.00
0.00
TOTAL:
90.00
TAXABLE: No
CONFIRMING: No
S'/lult... ? -&~^'
AUTHORIZED SIGNATURE
SPECIAL INSTRUCTIONS:
IMPORTANT: OUR ORDER NUMBER MUST APPEAR ON EVERY INVOICE AND PACKAGE
This order is given upon the representation and guaranty of the manufacturer or seller that no breach of any State or Federal Law or Regulation has occurred in
connection with the manufacturing, processing, branding, labeling or transportation of the merchandise herein mentioned. If such breach occurs or is charged by
any legally constituted State or Federal authority, the buyer shall be entitled to rescind the order and return the unused merchandise and shall also be held harmless
by the manufacturer or seller against any penalty incurred and/or the cost of defense of any proceeding designed to penalize the buyer therefor.
. ~-.... ,
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...
09/30/2008 08:50 8139948377
KILLEN
PAGE 01
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TRANSACTION REPORT
SEP/25/2007/TUE 03:54 PM
P.Ol/Ol
RECEIVER
99948377
Farm W-9 '.
(AllY. .-...y 2005)
DooA"_1 ar.. TlRSUIY
.....~.,.. .
~ NalnIii (es shown on )IOU' Incoma fa re~
m '
iP
Co 8usinIIS$ 1IItI11e, if dIIr,"", 110m abaYe
15
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t ' City, state, Ilnd ;zIP Qlda
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~ Li5t -=xmI1lIIlnber(8) hen! 4cPlIona'
crJ
ECM
TYPE/NOTE
OK
Request for Taxpayer
'Identification, Number and CertIfIcation
. 1nc111IlduaII
Check epproprfale tIOlC: 0, Sale pmprietDr
Adcte8!l tlumIter, street, and ept. Or S\IlIe nD.)
GlVebnn to 'the
NqUider. Do not
senclb the IRS.
, . ExeaftflDm IllIdIIp
o DCfw. .;................. 0 ~
, ~$ nlmellnd addta& (apIAI)
Citl of Zephyrhills
2~~~y~~~1~~~Ft 33542
FAX 81~-780-0005 p-hone 813-780-0000
o Corponlllon 0 PIl1nc_
EntIiI" yow TIN In the 8IIPI'Clf)Ifate bole. The llN pnMdId nUt match 1he name given on U1$11u ImIid ~
badwp wIthhokrmg. For individuals. 1hIs Is )ct.r eCldsl securily runber (SSN). HoweV8l'. far a resldent ~
aIen. lIClIe "'....mmr. or dlsNQa...ll.d entiy. IIee the P.r I hstnJctIone 01'1 piIge 3. For other erllities. it" ' '
)IIlUr employer ldentllfcalfon numbIr tBfIt. If ~ do not h8ve a ntmber. see How m get.a TIN (1ft plge 3. or
Note. If the at:aJUIJt Is 1n'1IIOtJI thsn one name, see the dJatt on page.4 tbr guidelines ~ whor;e ncmber 1 ~ 1denIliadIocI~.":,,, .1 .
UJ em.r. '. . LL..:LLL.LLl-LL
IIDII Certification . '. '
Under petllllies of perjury, I certify f18t:
1. The number shawn on this form is my carnlCt taxpayer Identificatiun number (or I am WIIilin5l far al'lUnlber to be issued fD ,...; end
2. . I am not ~ 10 beckIp wIlhholdlng bec:ause: fI) , am' exempt fl'am bcIcup wIlHKlIlIng, CII' tb) , have PDt been nodIed by _Intemal
, Rewenw Servk:e (IRS) 1haI1 am subject 10 bac:IqJ wIlhhaIdIng as a III&UIt of a faDtn 1D RIpQIt .. intenlst ar dividends, or (c) the ~ has
. nollfled me that I am no longer sublect to ~ withholding, lIIld '
3. I am a U.S. person ('n:Iuding a U.s. leSldent aIen)..
~ hstruc;tions. You must cross out item 2 8bcM! If you have been nClllll8d by the IRS that you tR amently subject to ~
wIlhhoIcing ~ you haW f8Ied to repc:ll't aII,lnlentst and dMdende on your 1Euc feUn. Far rat esf3le fransactlot IS, item 2 doeS not epply.
For ~ Interest plilId, acquIsI\Ian or abandonment of SllCUIIld property, ~ d debt, cortiJuIians 110 IIfl h:fMduaI....uent
~..~ (IRAJ. end genenllly, payrnlHlI$ alher then intEn=t ... dMdends, you are not MqUhd to &ign the CertIlIcaIIGn, but,m must
pavlde yew correct TIN. (See the inItructions on pIgll 4~
IlIign ] ....... of
Here u.s. ....-...
Purpose of Fonn . ,
A penson lVho is requfr8d to fie an infurmation mum with 1he
IRS. must obtain your CXlIreCt taxpayer Idehllflcatlon number
, (f1N) to r8JlOft.' for e1cample, income psld to you, real estate
1rBnsactlons. mortgage Interest you paid, acqUIsItIon or
abandoIment of seand prcps:ty, cancella60n of debt, or
CXlf'IIIfbdtioi you made to an 1M.
us. person. Use Fann w-g any if you ar8 a U.S. person
(including a resident alien), to provide your correct TIN to the
. person requestil'1g it (the ~lIeStet) 8nd, when appflCable, to:
1. Certify inat the llN yoU III"e giving Is correct (or you are
waiting for a number 10 be issued), , .
2. Certify that you are not subject10 backup wlthhQIdlng,
<< , . ,
S. Claim exemption from backup withholding if you are a
U.S. exempt payee. '. . .
. Note. If a ~ gives you a form ather than Foni7 W-9fo
. teqUetst your '77N" you must use the ~ form if it is
SUbstanti~ similar to,thls Fo1m W-9. ' .
, For federal tax purpose$ you are cOOsIdered a person if you
are:, . .
· 'An individual who Is a citizi:n ~ resident 01 the United
~, .
. .a n"=I~A......k""'" """",__..:__ _____.. __ ____ _'_AZ__
1l r ldentltlcsllon Number IN
D*'"
"
· Any. estale (ather tI1an a foreign estate) or trust See
Regutalions sections 301.7701-6(8) and 7(a,) for s;IdIIIonaI
, information.
Fontign pei8on.lf you 8I'B a foreign person, do not Use
. Form. W-9. Inslead. Uge the appropriate Form W-8 (see
Publication 515. WIIhhoIding;of Tax on ~ Al'1E!nS
.and Foreign Entities).. ,. , .
Nor..esiclent BIen who betonle!t a resident aIIerL
Generally, only a nonreeldent a&en individual rT1lIY use the
terms of a tax tr8ldy ~ redlice or eIImnaIe U.s.. 1aX on
certain t;ypes of income. HowlMlr; most talc tnaatieS contain a
provision known as a -.mnu clause. . EXceptions spedIied
In the saving cIau8e ~ permit an exemption from tax 10
continue for c:eftaIn types of income even IIfter'the recipient
, has otherwise become a U.S. ..dent Ellien for tax: p~
If you ar'Il a U.s. resident a1i... who Is relying on an
exception contained In the saving cI:wse of a 1aX treaty to
cfairn an exelll....l.from U.S.1ax oncer1aln types of Income,
you must Bttach a statement to Form W-91hat specifies the '
following five items: , . "
,. The treaty country. G~, tills mUst be the same
1reaty uncIer whlct1 you cIairned exemption from tax as a
nonresident alien. ' '
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Site:
~~ ';4J' C~ -
'1-~ /- /J i
So/;!. I .;f~-d/l.U (jJI;.
,~5~ ClA4~~___
0~/Home6wner:
Date Received:
Permit Type:
Approved wino comments: ~
Approved withe below comments: 0 Denied withe below comments: 0
) ')2..-r./t:;.
Kalvin
Date
Contractor and/or Homeowner
(Required when comments are present)
813-780-0020
Date Received
City of Zephyrhills Permit Application
Building Department
Owner's Address
Fee Simple Titleholder Namel
I
I
I
ItJr. I LOT # I I
I PARCELID#II2.~2~"'~/-DIOO-~-Dllq
(OBTAINED FROM PROPERTY TAX NOTICE)
o ADD/AL T D SIGN D MOVE D DEMOLISH
D REPAIR ()
o COMM D -efl \'00\ v1C..(cr,,0~
D FRAME D S EL D OTHER I I
C"-Lr c: Gn er'C-1 c;f;L)r --e...., I
SQFOOTAGE~c~ () I
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
...w S I 0 z.-,
i
1--
81
Fax-813-780-0021
Owner's Name
Fee Simple Titleholder Address I
1508 \ 5<)m~r hl ( /
I S_:(fl~('hl I ~
E3
PROPOSED USE D
TYPE OF CONSTRUCTION D
DESCRIPTION OF WORK I
JOB ADDRESS
SUBDIVISION
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
I
5300'
HEIGHT I
BUILDING SIZE
1$
1$
1$
1$
D GAS D
FINISHED FLOOR ELEVATIONS I
ROOFING
601
I
I
I
D
I
AMP SERVICE
D
PROGRESS ENERGY
D
WRE.C
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
D
D
D
PLUMBING
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
BUILDER
SIGNATURE
.~
~::,~~~~~ I ~.~~~ \~~Rb
License # I
A LOm ; JtUjn
Y/N I
Address
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y I N FEE CURRENT
License #
Y/N FEE CURRENT
License #
YI N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
MECHANICAL I
SIGNATURE .
Address I
OTHER r
SIGNATURE "
Address I
111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1111
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 subdivisionsllarge 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 Sift Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement 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
COMPANY
REGISTERED
Y/N
COMPANY
REGISTERED
Y/N
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 I;le 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 Installations not speCifically 1n?luded.1n the application. A
permit issued shall be construed to be a license to proce?d with the work a~d not as authorl~y ~o vlolat~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~II.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 of 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.
FLOR'DAJURAT(F.S~~3) O. "'1\./~ \. (\'() ~,'l~~
OWNER OR AGENT ~ L~ CONTRACTOR lOf)~ ,--
SUb,scribed and sw. n r lT1Jed) bel re this Subscribed andpworn to r aft1rm~d) before me 15
'7 Q /-D$ by . . 17- ,;; J. // g:by
Wh~lsf,are persona Y own to me or has e produced Who isfare personally no to me or hasfh v p~oduced
f- , L .~ i as Identification. In I'> (. as identification. ,
..~&,~lJ q)~~ /~~V~h~~~PUb",
Commission No.
Name of Notary ty