HomeMy WebLinkAbout08-8435 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 8435
FIRE ALARM SYSTEM PERMIT
Permit Number: 8435
Address: 38250 A AVE
Permit Type: FIRE ALARM SYSTEM ZEPHYRHILLS, FL.
Class of Work: FIRE ALARM SYSTEM Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 14-26-21-0010-01300-0010
Improv. Cost: 1,569.00 ,
Date Issued: 10/24/2008 Name: ZEPHYR HAVEN NURSING HOME
Total Fees: 50.00 Address: 38250 A AVE
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/24/2008 Phone:
Work Desc: ADD TO EXISTING VISUAL 1 DEVICE
SIMPLEX GRINNELL LP FIRE ALARM 50.00
aloe
FIRE ACCEPTANCE Final
FIRE ELEVATOR RECALL
Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review,administrative fees,and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"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."
CONTRACTOR SIGNATURE I IC R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- Fire Marshal Office- 813-780-0041
Zephyrhills Fire Rescue
6907 Dairy Road,Zephyrhills, FL 33542
Fire Marshal Bus(813)780-0041
Kerry Barnett Fax (813)780-0044
E-mail: kbamett@fire.zephyrhills.fl.us
Plan Review#: 08-121
Project:Zephyrhaven NH
Number of Pages: 1 plus specs
Date: October 15,2008
The plans have been reviewed for the addition of an alarm device located at 38250 A
Avenue and installation is allowed to move forward at this time. The issuance of the
permit and payment of plan review fees acknowledges that the occupant agrees to the
following points below.
Should anyone have any questions, please do not hesitate to contact the Fire Marshal's
office.
1. Device shall be installed in accordance to NFPA 72, 2007 edition.
Inspections to be conducted:
1. Acceptance Test to check device
KERRY , FIRE MARSHAL
***Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes.This review is not intended to be a final approval of the
submitted plans.It is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances.In the event that further examination or site
inspection reveals areas of non-compliance,it shall be the contractor's sole responsibility,at their sole
expense to bring those areas in compliance.The City assumes no responsibility for the contractor's failure
to be in compliance with all applicable NFPA codes and local ordinances.
Equipment Counts
Zephyr Haven Nursing Home
Fire Alarm Control Panel 0
Fire Alarm Annunciator 0
Pull Stations 0
Control Relays 0
Flow Switches 0
Tamper Switches 0
Smoke Detectors 0
Heat Detectors 0
Duct Smoke Detectors 0
Horns 0
Horn/Strobes 0
Strobes 1
Speakers 0
Speaker/Strobes 0
Door Holders 0
Signal Zam 0
Ansul Monitor 0
TOTAL 1
®Simplex TrueA/ert° Notification Appliances pp ances
UL, ULC Listed; FM, CSFM, Visible Notification Appliances
and MEA (NYC)Approved* for Free-Run Operation
24 VDC powered xenon flashtube visible
notification appliance(strobe)for wall mounting:
Iflt.i ii.
• UL listed to Standard 1971
• Models are available with 15,75,or 110 candela
• Strobe candela rating is clearly indicated on reflector
•
Compatible with ADA requirements(refer to important
installation information on page 2)
• Diode polarized input for connection to reverse polarity,
supervised notification appliance
circuit(NAC)
In/out wiring is accessible from front of housing
providing easy access for installation,inspection, andhr• testing
• Regulated circuit design ensures consistent output
• Rugged,high impact,flame retardant thermoplastic
housing available in red or white
• Covers are available separately to convert housing color
TrueAlert notification appliance design provides FIjI
flexible, easy,and convenient semi-flush or
surface wall mounting:
• Easily mounts to single gang,double gang,or 4-inch
square outlet box TrueAlert Non-Addressable Strobes are Available in Red
• In/out wiring terminals for 18 AWG to with White Lettering and White with Red Lettering
12 AWG wire
• Rear of housing does not extend into box -
Optional adapters and wire guard: TrueAlert non-addressable free-run strobes
• Mounting adapters are available to cover surface provide quick and convenient installation using a flexible
mounted electrical boxes and to adapt to s mounting design.The strobe housing is a rugged,
2975-9145 boxes one-piece assembly(including lens)that mounts to single
• UL listed red wire guard is available for semi-flush or gang,double gang,or 4"square standard electrical box.
Wiring terminals are accessible from the front of the
surface mounting
housing,providing easy access for installation,inspection,
and testing.The cover can be quickly removed(a tool is
required)and when in place,the entire assembly is impact
and vandal resistant. Separate covers are available for
color conversion.
' This product has been approved by the California State Fire Marshal(CSFM)pursuant to Proper selection of visible notification is dependent on
Section 13144.1 of the California Health and Safety Code.See CSFM Listing occupancy,location,local codes,and proper applications
7125-0026:235 for allowable values and/or conditions concerning material presented in
of: the National Fire Alarm Code (NFPA 72),ANSI
this document.tt is subject to re-examination,revision,and possible cancellation.
Accepted for use—City of New York Department of Buildings—MEA35-93E.Additional A 117.1;the appropriate model building code:BOCA,
listings may be applicable;contact your local Simplex product supplier for the latest ICBO, or SBCCI,and the application guidelines of the
status.Listings and approvals under Simplex Time Recorder Co.are the property of
Tyco Safety Products Westminster. Americans with Disabilities Act(ADA).
S4904-0005-5 9/2004
Free-Run Visible Notification Appliances(Strobes)
Model Number Strobe Output Rating
15 cd 75 cd 110 cd Housing Color
4904-9168 "/
4904 9169 ✓ Red with white"FIRE"lettering
4904-9170
4904-9171 "/
4904 9172 ✓ White with red"FIRE"lettering
4904-9173 ✓
Adapters
4905 9937 Surface mount Description, .: imeno
Mode[
red adapter skirt I 5-3/8"H x 5-1/4"W x 1-5/8"D
Use to cover 1-1/2"deep (136 mm x 133 mm x 41 mm)
4905-9940 Surface mount white adapter skirt surface mounted boxes Total depth with strobe=
4-3/8"(111 mm)
4905-9931 Adapter plate, red,for mounting to Simplex 2975-9145 Box 8-5/16"x 5-3/4"x 0.060"Thick
(typically for retrofit, may be mounted vertical or horizontal) (211 mm x 146 mm x 1.5 mm)
2975-9145 Red mounting box, requires Adapter Plate 4905-9931 7-7/8"x 5-1/8"x 2-3/4" Deep
(200 mmx130mmx70mm)
Covers and Guard
jW MMe .,.. .. • IC?et;crlptton
4905-9992 Red cover with white"FIRE"lettering
5-1/8"H x 5"W x
4905-9993 White cover with red"FIRE"lettering (130 m mm x 127 mm x x 3 388 D
mm)
4905-9961* Wire guard with mounting plate, red,compatible with semi-flush or 6-1/16"H x 6-1/16"W x 3-1/8"D
surface mounted boxes (154 mm x 154 mm x 79 mm)
*UL listed by Space Age Electronics Inc.
• • - • •
Mounting is compatible with ( 1 O / \ o
single gang,double gang,and / t
4"(102 mm)square boxes, 0 c o 0 0
deep,by others ° o ( 0 o 0 IMPORTANTI WALL MO NT
INSTALLATION HEIGHT REFERENCE
Bottom of lens
0 Q C is either even
O with,or slightly Electrical
Wiring access hole above bottom i rbox outline
of compatible
Wiring terminals f o boxes
Mounting Holes:
4 square(4)
NFPA 72 requires 80"(2.03 m)
Single gang(2) that the entire lens
Double gang(3) minimum
be not less than
80"and not greater
than 96"above the
finished floor
Transparent housing
and lens assembly
IE Removable cover
d
(tool required)
2 S4904-0005-5 9/2004
General Specifications
UL Listed Range Regulated 24 VDC;see Note 1 below
Rated Voltage Range
ULC Listed Range 20 VDC to 30 VDC per ULC S526-M87
Housing Dimensions (including lens) 5-1/8"H x 5"W x 2-3/4"D(130 mm x 127 mm x 70 mm)
Temperature Range 32°to 122° F(0°to 50°C)
Humidity Range 10%to 93%, non-condensing at 100°F(38°C)
Connections Terminal blocks for 18 AWG to 12 AWG(0.82 mm2 to 3.31 mm2);two
wires per terminal for in/out wiring
Strobe Specifications
Flash Rate 1 Hz
Maximum RMS Current Rating per Strobe Output 15 C 5 cd 110
Cd
(see Note 2 below)
76 mA
192 mA 227 mA
Reference Currents 18 VDC 68 mA
LLlrO
at other voltages 7 7i mA A E �
24 VDC51 mA 128 mA 151 mA
NOTES:
1. "Regulated 24 VDC"refers to the voltage range of 16 to 33 VDC per UL Standard 1971, Signaling Devices for the
Hearing Impaired, changes effective May 1,2004. This voltage range is the absolute operating range. Operation outside
of this range may cause permanent damage to the appliance. Please note that 16 VDC is the lowest operating voltage
that is allowed at the last appliance on the NAC under worst case conditions.
2. The maximum RMS current listed is the device nameplate rating. Strobe designs are constant wattage and the maximum
RMS current rating occurs at the lowest allowable operating voltage. (RMS is root mean square and refers to the
effective value of a varying current waveform.)
Surface Mounting Reference
0 2975 9145 Box with Optional Adapter Skirt
0
and Optional Wire Guard
Surface mount conduit and
O box shown for reference 1l I
4"(102 mm)square
box profile,(38 mm)deep
O O Optional
4905-9961
Wire Guard
( n Strobe
o u W
4905-9931 Adapter Plate
O Optional Surface Mount Adapter Skirt,
4905-9961 Optional Wire Guard 1-1/2"deep:4905-9937,Red;
4905-9931 Adapter Plate (shown here for reference only, 4905-9940,White(conduit knockouts
can be used on other mounting options) are provided on all four sides)
3 S4904-0005-5 9/2004
PERMITS R US
17128 DOWNS DRIVE
ODESSA , FL 33556
813 - 926 - 9965 ( PHONE )
813 - 926 - 8536 ( FAX )
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
Jackie, Permitting Monica Watson
COMPANY: DATE:
City of Zephyrhills Bldg. Dept. September 30, 2008
FAX NUMBER: TOTAL NO.OF PAGES INCLUDING COVER:
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER:
❑ URGENT ❑ FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE
Zephyr Haven Nursing Home
38250 A Avenue
Zephyrhills, FL 33541
Jackie,
Attached please find a permit package to add to the existing Fire Alarm.
Please review & let me know if you need any thing else.
Thanks,
Monica
®Simplex TrueA/ert° Notification Appliances
UL, ULC Listed;FM, CSFM, Visible Notification Appliances
and MEA (NYC)Approved* for Free-Run Operation
24 VDC powered xenon flashtube visible
notification appliance(strobe)for wall mounting:
• UL listed to Standard 1971
• Models are available with 15,75,or 110 candela
• Strobe candela rating is clearly indicated on reflector
• Compatible with ADA requirements(refer to important
installation information on page 2)
• Diode polarized input for connection to reverse polarity,
supervised notification appliance
circuit(NAC)
• In/out wiring is accessible from front of housing
providing easy access for installation,inspection, and
testing
• Regulated circuit design ensures consistent output
• Rugged,high impact,flame retardant thermoplastic
housing available in red or white
• Covers are available separately to convert housing color
TrueAlert notification appliance design provides
flexible, easy,and convenient semi-flush or
surface wall mounting:
• Easily mounts to single gang,double gang,or 4-inch
square outlet box TrueAlert Non-Addressable Strobes are Available in Red
• In/out wiring terminals for 18 AWG to with White Lettering and White with Red Lettering
12 AWG wire
• Rear of housing does not extend into box
Optional adapters and wire guard: •
TrueAlert non-addressable free-run strobes
• Mounting adapters are available to cover surface provide quick and convenient installation using a flexible
mounted electrical boxes and to adapt to Simplex mounting design. The strobe housing is a rugged,
2975-9145 boxes one-piece assembly(including lens)that mounts to single
• UL listed red wire guard is available for semi-flush or gang,double gang,or 4"square standard electrical box.
Wiring terminals are accessible from the front of the
surface mounting
housing,providing easy access for installation,inspection,
and testing.The cover can be quickly removed(a tool is
required)and when in place,the entire assembly is impact
and vandal resistant.Separate covers are available for
color conversion.
This product has been approved by the California State Fire Marshal(CSFM)pursuant to Proper selection of visible notification is dependent on
Section 13144.1 of the California Health and Safety Code.See CSFM Listing occupancy, location, local codes,and proper applications
7125.0026:235 for allowable values and/or conditions concerning material presented in
of: the National Fire Alarm Code (NFPA 72),ANSI
this document.It is subject to re-examination,revision,and possible cancellation.
Accepted for use—City of New York Department of Buildings—MEA35-93E.Additional A 117.1;the appropriate model building code: B OCA,
listings may be applicable;contact your local Simplex product supplier for the latest
status.Listings and approvals under Simplex Time Recorder Co.are the property of ICBO, SBCCI, and the application guidelines of the
Tyco Safety Products Westminster. Americans with Disabilities Act(ADA).
S4904-0005-5 9/2004
Free-Run Visible Notification Appliances(Strobes)
Strobe burr_ut Rating
Model Number tP 9
15 cd 75 cd 110 cd Housing Color
4904-9168 /
4904-9169s / white
Red with "FIRE"lettering
4904-9170
4904-9171 ✓ '
4904-9172 m
White with red"FIRE"lettering
4904 9173
Adapters
Modell`' E Descrtpti p
4905-9937 Surface mount red adapter skirt 5 3/8 tuns
P H x 51/4"W x 1-5/8"D
Use to cover 1-1/2"deep (136 mm x 133 mm x 41 mm)
4905-9940 Surface mount white adapter skirt surface mounted boxes Total depth with strobe=
4-3/8"(111 mm)
4905-9931 Adapter plate, red,for mounting to Simplex 2975-9145 Box 8-5/16"x 5-3/4"x 0.060"Thick
(typically for retrofit, may be mounted vertical or horizontal) (211 mm x 146 mm x 1.5 mm)
2975-9145 Red mounting box, requires Adapter Plate 4905-9931 7-7/8"x 5-1/8"x 2-3/4"Deep
(200 mm x 130 mm x 70 mm)
Covers and Guard
4905-9992 Red cover with white"FIRE"lettering 5-1/8" 5 �� mJ
x 1-1/2"D
4905-9993 White cover with red"FIRE"lettering (130 mm x 127 mm x 38 mm)
4905-9961* Wire guard with mounting plate, red,compatible with semi flush or 6-1/16"H x 6-1/16"W x 3-1/8"D
surface mounted boxes (154 mm x 154 mm x 79 mm)
"UL listed by Space Aqe Electronics Inc.
0 0
Mounting is compatible with ( \ o / \
single gang,double gang,and r
4"(102 mm)square boxes, G c o , o G�
1-1/2"(38 mm)deep,by others ° ° o IMPORTANT!WALL MOUNT
INSTALLATION HEIGHT REFSII
1 Bottom of lens
U C 4 UP C is either even
O with,or slightly f[ Electrical
wiring access hole above bottom box outline
U of compatible
Wiring terminals o boxes
Mounting Holes:
4"square(4)
NFPA 72 requires 80"(2.03 m)
Single gang(2) that the entire lens
Double gang(3) minimum
be not less than
80"and not greater
than 96"above the
finished floor
Transparent housing
and lens assembly
Removable cover
UU) (tool required)
2 S4904-0005-5 9/2004
General Specifications
Rated Voltage Range UL Listed Range Regulated 24 VDC;see Note 1 below
ULC Listed Range 20 VDC to 30 VDC per ULC S526-M87
Housing Dimensions(including lens) 5-1/8"H x 5"W x 2-3/4"D(130 mm x 127 mm x 70 mm)
Temperature Range 32°to 122° F(0°to 50°C)
Humidity Range 10%to 93%, non-condensing at 100° F(38°C)
Connections Terminal blocks for 18 AWG to 12 AWG(0.82 mm2 to 3.31 mm2);two
wires per terminal for in/out wiring
Strobe Specifications
Flash Rate 1 Hz
Maximum RMS Current Rating per Strobe Output 15 C ;≤5 cd 110 cd
(see Note 2 below) 76 mA 192 mA
Reference
i �. - 227 mA
Feferennce Currents 68 mA171mA
at other voltages.; t 292I4VDC 57 mA � � µ�� 128 mA ���� 151 mA
NOTES:
1. "Regulated 24 VDC"refers to the voltage range of 16 to 33 VDC per UL Standard 1971, Signaling Devices for the
Hearing Impaired, changes effective May 1,2004.This voltage range is the absolute operating range.Operation outside
of this range may cause permanent damage to the appliance. Please note that 16 VDC is the lowest operating voltage
that is allowed at the last appliance on the NAC under worst case conditions.
2. The maximum RMS current listed is the device nameplate rating. Strobe designs are constant wattage and the maximum
RMS current rating occurs at the lowest allowable operating voltage. (RMS is root mean square and refers to the
effective value of a varying current waveform.)
Surface Mounting Reference
-2975-9145 Box with Optional Adapter Skirt
and Optional Wire Guard
Surface mount conduit and
O box shown for reference
4"(102 mm)square
O box profile,1-1/2"
0 (38 mm)deep
______ I
O _ O Optional
17j
4905-9961 IL' Ill I
Wire Guard
Strobe
o O � oQr
4905-9931 Adapter Plate
O Optional Surface Mount Adapter Skirt,
4905-9961 Optional Wire Guard 1-1/2"deep:4905-9937,Red;
4905-9931 Adapter Plate (shown here for reference only, 4905-9940,White(conduit knockouts
can be used on other mounting options) are provided on all four sides)
3 S4904-0005-5 9/2004
•
813-780-0020 Ulty of Lepnyrnnls hermit Hppllcavon Lt �4 raA-oio-iou-uv/.i
Building Department _ T
Date Received
Phone Contact for Permittin b U
Owner's Name �o tl6L Cr.J1;�?� ;L'�:f:S;,�; N�,,�., ✓1 ?( k ,1/5 i Owner Phone Number
[__________________________
Owner's Address ;?f1a,';.`ST Si c- 2C 1 ,/, :"t 3 ? r Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address CC yy��
JOB ADDRESS SD M y I IL 33 s y'Z I LOT#
SUBDIVISION ( T\Dc�(L /jraST%JcJ,'T c'. PARCEL ID# i -2E-21- /d
(OBTAINED FROM PR OPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR B ADD/ALT SIGN MOVE Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION L BLOCK FRAME Q STEEL Q OTHER
DESCRIPTION OF WORK E X S7-, ,1 S Rdc " i,, L t D , c- . lam/
BUILDING 312E I I SCI FOOTAGE I I HEIGHT
BUILDING VALUATION OF TOTAL CONSTRUCTION / S-ji' , Q
ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY 0 W.R.E.C.
0 PLUMBING
[ MECHANICAL j$ VALUATION OF MECHANICAL INSTALLATION
GAS Q ROOFING Q SPECIALTY Q OTHER.
FINISHED FLOOR ELEVATIONS L
FLOOD ZONE AREA AYES =NO
BUILDER /L•t, ANY `M(�`���rz I N r�� I
SIGNATURE 1UtV
1 REGISTERED N FEE CURRENT Y/N
Address '�f 7o j o�}k ,'r, Q) .d `T nrPL?
R t- 1 License# [ F(3C i2 21(
I .
ELECTRICIAN 3 3Co/o '-
SIGNATURE COMPANY
REGISTERED Y I_NI FEE CURRENT Lv/N
Address License# $— !V
PLUMBER
SIGNATURE COMPANY
REGISTERED Y/ NI FEE CURRENT Y/N
Address
License#
MECHANICAL
SIGNATURE COMPANY
REGISTERED Y/ NI FEE CURRENT Y/N
Address —^---
License#
OTHER
SIGNATURE COMPANY
REGISTERED [ YIftj FEE CURRENT L 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 hew construction.
Minimum ten(10)working days af:or csbr„Ittal 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 "certifcate 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'permitapplication, 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
maybe requested, In writing, from the Building Official for period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the ob 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 E D RAN ATTORNEY BEFORE RECORDING YOUR OTICE OF COMMENCMNL
FLORIDA JURAT(F.S.117 )
1 r.
OWNER OR AOE CONTRACTOR 7/ t-
Subscribed and to affirmed)be a me this Subscribed and ym to(or affirmed)before me this
6y' y
Who is/are personally known to me or hasthave produced Who Istare personally known to me or has/have produced
as identfcation. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped