HomeMy WebLinkAbout08-8552 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 8552
MOBILE HOME SET-UP
Permit Number: 8552 Address: 37204 NEUKOM AVE LT#297
Permit Type: MOBILE HOME ZEPHYRHILLS, FL.
Class of Work: MOBILE HOME SET-UP Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34-25-21-0180-00000-2970
Improv. Cost: 9,800.00 7 i9
Date Issued: 11/20/2008 Name: GRAND HORIZON HOMES LLC
Total Fees: 6,965.58 Address: 4025 MORRIS BRIDGE
Amount Paid: 6,965.58 ZEPHYRHILLS, FL. 33543
Date Paid: 11/19/2008 Phone:
Work Desc: MOBILE HOME SET UP
'Jb r,....
BMI LLC MOBILE HOME ELECTRICAL 40.00 SEWER CONNECTION MOBILE 1,005.00
ACE REFRIGERATION INC MOBILE HOME SET-UP 60.00 WATER CONNECTION MOBILE HC 320.50
BMI LLC MOBILE HOME MECHANICAL 35.00 MOBILE HOME PLUMBING 40.00
ACE REFRIGERATION INC MOBILE HOME TIF/SUB 99% 3,595.68 MOBILE HOME TIF/SUB 1% 36.32
POLICE IMPACT FEE 254.00 FIRE IMPACT FEE 273.00
PUBLIC SAFETY 5% 26.35 IRRIGATION METER 220.00
WATER METER RES 3/4" 220.00 PARK FEES MH 573.73
IRRIGATION CONNECTION 266.00 r�
S "
040 O rC
MOBILE HOME SET-UP
MOBILE HOME ELECTRIC
MOBILE HOME A/C
MOBILE HOME PLUMBING
FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c) when extra inspection
trips are necessary due to any one of the following reasons: a) wrong address b)condemned work resulting
from faulty construction c) repairs or corrections not made when inspection 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
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
N TO IG ATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
NOTICE OF COMMENCEMENT (I1111IVIII 7IIII�IIII 11111 VIII VIII 11111 VIII 11111 1111 1111
State of Florida County of Pasco
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, ~. NO
the following information is and in accordance with Chapter 713,FloridaIld Statues,
provided in this Notice of Commencement. -" V
t Nye"
I) Description of Property:Parcel No: �j�—
_ 1' p� r r ") — O —aq
.Zoe' 02 i 3?aoq- A)amOiv Avc: _Zc�v�+�H,cis . 33S�t/
(Legal Description of the property and street address if available) v
I2) General Description of Improvements: Q)i (_' • e1 (s �r�Q
r~m
_____
-an
3) Owner Information: Name ( V 'joo .be,, s G . e 8 0
9dt s ^?aaaic aiZ4oG -e2o4o
Address City State
Interest in Property:
Q
�t' f Name of Fee Simple Titleholder:
other than owner) r.
m
� Nv
Address City State
1 4- Contractor•. Name 3
39 838 -9TtJ4'Lr• r�ojn ,y c, 3354a (ØZ
Address ity State
Surety: Name CD3
Address
City State
6) Lender: Name w
.- r p
�„A m
Address City State x
7) Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.13(l)(a)(7),Florida Statutes:
Name
Address City State
8) In addition to himself,Owner Designates
Of to receive a copy of the Lienor's Notice as provided in section
713.13(1)(b),Florida Statues.
9) Expiration date of Notice of Commencement is one year from the date of recording unless a different date is specified.
1,/13 A8'
Date Signature of Owner
State of Florida
County of /a5Y.c�
The foregoing instrument was acknowledged before me the �l 3 /"O' (Date), by
f+.!e>,c 'Rare 8 (name of person acknowledging),who is personally known to me or who has produced
100'_ -da,-31 _C) (type of identification)as identification.
SEAL: . � JEFF V.WREDE
.; .Z MY COMMISSION I DD 834696
ij EXPIRES:December 1,2012
Bonded Thru Notary PubIc Underwrlere / f C-
t\..Cr_ ry.►t��«,.i C'xpiaarr• is-t-
STATE OF FLORIDA
COUNTY OF PASS C:-Aq�-
THIS IS TO CEitTi T THE FOREGQG IS A
TRUE AND CORREC3 C(YPY OF THE DOCUMEN 6 FILE
OR OF PUBLIC RECORD IN THOS OFFIC ITNE1Y
HAD ND OFFICIAL SEAL T}{l DA4 OF
JED MeH,
CLERK C COURT,.
BY ETYLERK
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: 1 I /
Date Received: // / - O1
Site: 79 /y ff49 , 4" 433 7
Permit Type: // !0►'N °� t4
�C
Approved wino comments:❑ Approved w/the below comments: Denied w/the below comments: ❑
2 ñ7 S( fac&
This comment sheet shall be kept with the permit and/or plans.
vin Switz ans Examiner Date ontractor an r Homeowner
(Required when comments are present)
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received -
1I J -Q J Phone Contact for Permitting
Owner's Name Owner Phone Number
Owner's Address —I ) crr7cC � Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
IFee Simple Titleholder Address I
y�1
JOB ADDRESS 2 O-((�t ► v el $RX t L- l LOT# c%
SUBDIVISION .j PARCEL ID# --�S I ^ O
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED I NEW CONSTR e ADD/ALT Q SIGN Q MOVE Q DEMOLISH
INSTALL REPAIR
PROPOSED USE J.J1 SFR COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK 0 FRAME STEEL Q OTHER
DESCRIPTION OF WORK IIk (O
BUILDING SIZE SQ FOOTAGE ? HEIGHT
, . i i j .. •r ii iiiiiqn i. • . n r r t I•i i I I I I I I i
BUILDING $ . co VALUATION OF TOTAL CONSTRUCTION
Q ELECTRICAL $ I o AMP SERVICE L$ PROGRESS ENERGY Q W.R.E.C.
PLUMBING $
Elli MECHANICAL Is
VALUATION OF MECHANICAL INSTALLATION
LII GAS Q ROOFING EEl SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
I'IIIII,,IIIuItIIuIIIIIIIIuuI1IIuIIIIhh1
BUILDER c .. COMPANY I 1 )Z
SIGNATURE '~J /MM\ REGISTERED I Y/ N I FEE CURRENT I Y/N
Address License# —
ELECTRICIAN COMPANY
SIGNATURE \ REGISTERED Y/ N FEE CURRENT I Y/N
Address ? 15 License#
PLUMBER COMPANY
SIGNATURE g V REGISTERED I Y/ N I FEE CURRENT I Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE 1fl.fSX REGISTERED Y/ N I FEE CURRENT Y/N Address X3 —7O '5 License# I
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N
Address I License#
IIIIIIIIIIIIIIIIIIIlIIII
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.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C 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 A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions,
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTIUTILITIES 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 installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to,violate, 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) 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
the job is considered abandoned.
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,
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.S.11 03) r� r
"� CONTRACTOR
OWNER OR AGEN Subscribed and svvo to(or affirme a re me this
Subscribed and sworn to(or affirme be ore me this i c' o� by V
II-I4-b�G by i `tr
Who is/are personally known to a or has/have produced Who is/ re personally known to me or has/have produced
as identification. 1 as identification.
Notary Public üi ( Notary Public
734c2O 7 Commission
Commission
tinted or stamped
Name o
or stam CHERYL M.L AS
;��n•."i%,�; CHERYLM.LUCAS 'z°' - MY COMMISSION#DD 736207
.: .__ MY COMMISSION#DD 736207 {'• o EXPIRES:November 20,2011
'�?. ovemb ='.. h4P' Bonded Thru Notary Public Un re
EXPIRES:N er 20 2011 i^"' F, +1
'%�;pP Bonded Thru Notary Public Underwriters =.mow.
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CITY OF ZEPHYRHILLS 8553
5335-8th Street
(813)780-0020
ELECTRICAL PERMIT
Address:5451 4T HSLAddress: 5451 4TH LS, FL.
Permit Number: 8553 Range:
Permit Type: ELECTRICAL MISC Township: Section:
Class of Work: ELECTRIC SERVICE/NEW Lot(s): Block:
Proposed Use: NOT APPLICABLE
Contractor: PATTIE ELEC. & REFRIGERATIO Book: Page:
Subdivision: CITY OF ZEPHYRHILLS
Square Feet: Parcel Number: 11-26-21-0010-06200 0030
Est.Value: a
Improv. Cost: 950.00 Name: REXHA VEHBI & HASIBE
Date Issued: 11/19/2008 Address: 429 N RENGSTORFF AVE APT 11
Total Fees: 35.00 MOUNTAIN VIEW CALF 94043
Amount Paid: 35.00 Phone:
Date Paid: 11/19/2008
Work Desc: REPLACE DOUBLE METER SOCKET W/2 SINGLE 125 AMP SOCKfW
ET
ELECTRICAL FEE
35.00
AØ
ROUGH ELECTRIC} ��53
C RU.CTIO-P.QLE1�
RE-METER
FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are a)wrong address ) ned work on
necessary due to any one of the following reasons:called d)work not rbeady forninspect on whent'called e) perm t notrpo sted
c)repairs or corrections not made when inspection
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
ma be found in the public records of this county, and there may be additional permits required from other governmental
Y
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 resultogs your payi
same.
ent"Warning to owner: Your failure to recordf yo u1ce of iatendctomobtai may n financing, consult with
twice for improvements to your property. l
your lender or an attorney before recording your notice of commencement."
Complete Plans, Sp
ecifications and Fee Must Accompany Application. All work shall be
performed in accordance with City Codes and Ordinances.
PERMIT OFFI R
CONTRACTOR
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR WEATHER
NNOTIC REQUIRED M PROTECT CARD PR
813-Tao-oo2o City of Zephyrhills Permit Application Gdo�'d,2/9 Fax-813-780-0021
Building Department
Date Received Phone Contact for Permitting
�Xy� �.� /hi S/�� Owner Phone Number
Owner's Name R
Owner's Address
�9 N Rerc / f' y ypy 3 Owner Phone Number 3S -G9G3�
Owner Phone Number
Fee Simple Titleholder Name
Fee Simple Titleholder Address ��
JOB ADDRESS s/ ys Z r i� /C/•
LOT#
SUBDIVISION PARCEL ID# // ?G JI O /o OG,2OO O3
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR B B ADD/ALT Q SIGN Q MOVE 0 DEMOLISH INSTALL REPAIR
PROPOSED USE Q SFR COMM [ ] OTHER
TYPE OF CONSTRUCTION 0 BLOCK [ ] FRAME [ ] STEEL Q OTHER
DESCRIPTION OF WORK I .fJCe Db/e d Y sor kS / SA Ssc,ESs
BUILDING SIZE P SQ FOOTAGE HEIGHT
BUILDING Is
VALUATION OF TOTAL CONSTRUCTION
Ep ELECTRICAL $ rvI AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
S�
0 PLUMBING $
Lii MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
GAS Q ROOFING 0 SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES QNO
BUILDER I COMPANY
SIGNATURE I REGISTERED I Y/ N I FEE CURRENT IY/N
Address I I License#
ELECTRICIAN COMPANY / ! i r 4/ec�//c
SIGNATURE ;;- 4 ' " - REGISTERED / N I FEE CURRENT Y/N
N w
Address /// 1� Y ,€I P. 3 cq I License# EC-OO/26$
PLUMBER I COMPANY
SIGNATURE I REGISTERED I Y/ N f FEE CURRENT Y/N
Address I License#
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N
Address License#
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)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
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C 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 A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V" unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand 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 proceed with the work and not as authority to.violate, 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) 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, 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.S. 117.03)
OWNER OR AGENTJ��"` CONTRACTOR =,
Subscribed and sworn to(or afli(�'med)before me this Subscribed and sworn to(or armed)before me this
by by
Who Is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification, as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
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