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HomeMy WebLinkAbout08-7974 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 7974 BUILDING PERMIT Permit Number: 7974 Address: 38250 AVE A Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 14-26-21-0010-01300-0010 Improv. Cost: 6,200.00 Date Issued: 6/18/2008 Name: S C NURSING HOMES OF ZEPHYRHILLS Total Fees: 65.00 Address: 38250 AVE A Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/18/2008 Phone: Work Desc: A/C CHANGE OUT 5TON TWC SERVICES INC A/C CHANGEOUT 65.00 Sl � C DUCTS INSTALLED DUCTS INSULATED 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 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." ,/ CO TRACTOR SIGNA URE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ACORD CERTIFICATE OF LIABILITY INSURANCE DA/10/0DD/YY) 06/10/08 PRODUCER 1-800-247-7756 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Holmes Murphy & Assoc - WDM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 9207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Des Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE INSURED INSURER A:Employers Mutual Casualty Co. TWC Services, Inc. - 8 The Waldinger Corporation INSURER B:Federal Ins. Co. (Chubb-Chicago) INSURER C: P.O. Box 1612 INSURER D: Des Moines, IA 50306 INSURERE: 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(&B/DD/YY DATE(MMJDDJYY LIMITS A GENERAL LIABILITY 1Z2112709 01/01/08 01/01/09 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) $300,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY r-; X LOC A AUTOMOBILE LIABILITY 1E2112709 01/01/08 01/01/09 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY 1J2112709 01/01/08 01/01/09 EACH OCCURRENCE $5,000,000 X OCCUR LII CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE X RETENTION $10,000 $ A WORKERS COMPENSATION AND 1M2112709 01/01/08 01/01/09 X WCSTATU- OTH- A EMPLOYERS'LIABILITY 1T2112709 01/01/08 01/01/09 E.L.EACH ACCIDENT $500,000 A 1Y2112709 01/01/08 01/01/09 E.L.DISEASE-EA EMPLOYE $500,000 A 1S2112709 01/01/08 01/01/09 E.L.DISEASE-POLICY LIMIT $500,000 OTHER B Inland Marine 06583630 01/01/08 01/01/09 Cont. Equip (ACV) 1,093,592 Installation (ACV) 2,500,000 Special/Deduct. 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: HVAC Repairs CERTIFICATE HOLDER I I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 5338 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE USA ACORD 25-S(7/97) tshoykhetwdsm O ACORD CORPORATION 1988 9019675 AUTHORIZATION I- �P�r •h M<+4 'o , hereby authorize the following to sign for and acquire permits and licenses using my State of Florida License No. Monica Watson Craig Watson Jessica Watson Sonia M. Lee Patricia Arizmendi If you should have any questions, please feel free to contact me at I# : Commission#DD265874 .,,;.; Expires March 2,2008 License No. C146,0c a-�� £/ a°'�°"°'F Inc STATE OF: FLORIDA COUNTY OF: HILLSBOROUGH The foregoing instrument was acknowledged before me this 3 ! T day of IJfltu , 2008 by .r u Zi 27* L2en,-sl who is personally k own or ✓produced identification Notary Pubic TWO 6or f Inc. 5! W.WA1Cn)+we,9311 T93tpa,FL 33634 .11 Phony e13�ba.o7 r/YC SRR v✓C Fax: 413.OW.4 59 PROPOSAL To: ZEPHR HAVEN NURSING HOME Date: April 8, 2008 38250 A AVENUE AVE. ZEPHYRHILLS, FLORIDA 33642 Attention; NEAL FRAISER Project; QUOTE TO REPLACE TRANS 5 TON ROOF TOP UNIT We propose to furnish the materials and/or perform the work described below: QUOTE TO REPLACE THE TRANE 5 TON ROOF TOP UNIT M/N WCD0B0C308A SIN H281421380. PRICE INCLUDES LABOR AND MATERIALS TO COMPLETE THE PROJECT. We have included the following: Equipment operation instruction session Delivery of materials and equipment to the job site Final adjustment and calibration of equipment Removal and Disposal of Old Equipment Labor during normal work hours We have not included: Any work not specifically stated In the proposal Asbestos abatement or hazardous waste disposal All for the sum of: SIX THOUSAND TWO HUNDRED EIGHTYSIX AND 85/100 $6,266.85 Proposal expires sftef 30 days and is subject to the terns end conditions on attached page. PURCHASER'S ACCEPTANCE: Respectfully Submitted, ZEPHR HAVEN NURSING HOME TWC Selrvices, Inc, _ 4<' s _„J- rt i L - CHRIS LOCKLER • ntoa mane Ptintsd n.mo c 04/0810$ . -- Ville ost. segrneet rzooa I of 2 tQ 3Edd N3AVH a,'Hd3Z 5sG1�8ceia 5E91 ee0z/z0Is9 4 � g1 Z o n } nao $ m g ' ' Co 8 fl -i 0 C C z m x C) m 0 o c C m c mx !fl O co)A Ill q°o o m O rD< cwn w t D z D $mom m C# m X O-O z 'D r m OC) r a) o s eo V Q ri r�r N pp v or Oo p C Z o � O p C � .. '���-SfD w • y' t00%'''� ''•�.;,�{,;.,}� •'fir F,,,1 %•:U� d 'o+ �IF�, 1�{+`• Pfd k _ I - , II I1I, I 'ISM;5,'~ ,«�, 'i�' •� i . A•.�i•:. ii'. ^>' ` L\. i f i • 0 it „! .. . T ACORD„, CERTIFICATE OF LIABILITY INSURANCE I6110"11°°"Y'Ds/io/o9 PRODUCER 1-800-247-7756 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Holxlc+p Murphy & ABgoe - wDM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR B.O. Box 9207 ALTER THE COVERAGE AFFORDED RY THE POLICIES BELOW. Doc Moines, TA 50306-9207 INSURERS AFFORDING COVERAGE M18URED 1NSURERA:E ual aIployere Mutual Caeky Co. 'TwC a�rvicee, Sac. - 8 — - "' ',Chew waldinger Corporation INSURERB:Federal In Co. (Chub) -Chieago) INSURER C: -� P.O. Box 167.2 —_ INSURER D: Dee oiaee, IA 50306 INBURERE: JM 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 OTHERDOCUMENT 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 TYPE OF INSURANCE POLICY NUMBDR P01 IcY EFFECTIVE POLICY E1�IRATION - —LIMr18 A GENERALLIASILRY 122112709 01/01/08 01/01/09 EACH OCCURRENCE„ ,_ S1,000,000 Xl COMMERCIAL GENERAL UABJI.ITY FIRM DAMAGE(Any one I ) $300,000 CLAIMS MADE I -J OCCUR MED EXP Any nri p r-an $10,000 PEROONALA ADV INJURY $1,000,000 ____ GENERALAOGREGATE $2,000,000 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2.000.000 POLICY X PRO- Xri LAC A AIROMOBILELIABILITY 1E2112709 01/01/D8 01/01/09 COMRtlNEDSINGLELIMIT $1,000.000 X ANY AUTO (Cn nedtlenl) __— ALP.OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Gerson) X HIRED AUTOS BODILY INJURY $ 7: NON-OWNED AUTOS ( er ecddn� PROPERTY DAMAGE $ (Pnr nc dent) GARAGE UABLLLTY AUTO ONLY-EA ACCIDENT $ — ANY AUTO OTHER TKAN EA ACC S_.._ AUTO ONLY: AGG S A DXCES$LIABILITY 1J2112709 01/01/08 01/01/09 EACH OCCURRENCE $5,000,000_ OCCUR El CLAIMS MADE AGGREGATE $5,_000.000 S DEDUCIIFJI,E $ X RETENTION $10,000 $ A 1M2117.709 01/01/08 01/01/09 x WCATU- 0TH.WORKERS COMPENSATION AND ..,. �0RY_lSTMlt5 I —.... ENIPLOYERS'LUAtILITY 1T2112709 01/01/08 01/01/09 S.L.EACH ACCIDENT 550.000 A 1X2112709 01/01/O8 01/01/09 F.L,DISEASE-EAEMPLOY $500,000 192112709 01/01/08 01/01/09 E,L,018EASE-PbUCYLIMIT $500,000 OH Inland RRrine 06593630 01/01/08 01/01/09 Cent. Equip (ACP) 1,093,592 J(>antaliation (ACV) 2,500,000 Special/Deduct. 5,000 DESCRIPTION OP OPERATIONSILOCATIONSNEIECI.ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re! IWAC Repairer CERTIFICATE HOLDER I I AADLTIONAL INSUR50 WSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEI'ORE THE EXPIRATION City oP Zophyrhille DATE THEREOF,THE ISSUING WSURER WILL ENDEAVOR TO MAUL _60 _DAYS WRITTEN NOTICE TO THE CERTIPICATE HOLDER NAMED TO THE LEFT.BUT FAILURE To DO 80 SHALL IMPOSE NO OBLIGATION OR LWBIUIY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 5338 8th Street REPRESENTATIVES. Zephyrb3.11a, FL 33542 AUTHOREEDREPRESENTATIVE VSA ACORD 25-S(7197) tsheykhetwdem G ACORD CORPORATION 1988 9019675 O • ,• .. •1 I... x'!'1• . • , : • g . : •• • . . 1. t•�`';�'I�.� � .. •i,r:1.n.'...¢• .,..?xy;r� ' L Ir1t l )I : wr k'f �t.' �.•.y.A, 1 r .-I PH4 0 A.-JO 0 1 V • (Tam•�' 4'`o 'A +I'• 'tsIa4 • m' !d•14 k" f•)�i.• Statutes & Constitution :View Statutes :->2007->Ch0713->Section 135 : Online Sunshine Page 1 of 1 d) Furnish to the applicant two or more copies of a form of notice of commencement conforming with s. 713.13. If the direct contract is greater than $2,500, the applicant shall file with the issuing authority prior to the first inspection either a certified copy of the recorded notice of commencement or a notarized statement that the notice of commencement has been filed for recording, along with a copy thereof. In the absence of the filing of a certified copy of the recorded notice of commencement, the issuing authority or a private provider performing inspection services may not perform or approve subsequent inspections until the applicant files by mail, facsimile, hand delivery, or any other means such certified copy with the issuing authority. The certified copy of the notice of commencement must contain the name and address of the owner, the name and address of the contractor, and the location or address of the property being improved. The issuing authority shall verify that the name and address of the owner, the name of the contractor, and the location or address of the property being improved which is contained in the certified copy of the notice of commencement is consistent with the information in the building permit application. The issuing authority shall provide the recording information on the certified copy of the recorded notice of commencement to any person upon request. This subsection does not require the recording of a notice of commencement prior to the issuance of a building permit. If a local government requires a separate permit or inspection for installation of temporary electrical service or other temporary utility service, land clearing, or other preliminary site work, such permits may be issued and such inspections may be conducted without providing the issuing authority with a certified copy of a recorded notice of commencement or a notarized statement regarding a recorded notice of commencement. This subsection does not apply to a direct contract to repair or replace an existing heating or air-conditioning system in an amount less than $7,500. http://www.leg.state.fl.us/Statutes/index.cfm?App mode=Display Statute&Search String... 6/12/2008 813-780-0020 City of Lepr yrniiis i-ermit Hpp ication r-i fL rax-e,;j-,eu-uuz, �Building Department T Date Received Phone Contact for Permittin T13 I _ q jQJ Owner's Name SOU-1 ,Ce is j Nur5 4U7n¢5 6 f 2eph A11Is Owner Phone Number L ?1 -3- q-5SOS /� Owner's Address I3250 5o A '€_ 2C h . (I6 Owner Phone Number 35ya- Fee Simple Titleholder Name Al I Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS SJ p`5o 7 1 V`r LOT# I1 SUBDIVISION Moores ►alt' -Mc I PARCEL ID#1 14 'o� �-00(0-013OO 001 O (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR j ADD/ALT Q SIGN [� MOVE Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR J COMM Q OTHER TYPE OF CONSTRUCTION Q BLOCK /i f_ FRAME D STEEL Q OTHER I 1 DESCRIPTION OF WORK e-' Cka Ou-+ - T - PCB BUILDING SIZE I SQ FOOTAGE I I HEIGHT 0 BUILDING I$ VALUATION OF TOTAL CONSTRUCTION ELECTRICAL �$ AMP SERVICE J PROGRESS ENERGY Q W.R.E.C. Q PLUMBING $ eh MECHANICAL $ / O© OO__J VALUATION OF MECHANICAL INSTALLATION GAS 0 ROOFING Q SPECIALTY Q OTHER. FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA AYES =NO BUILDER /'\fI - COMPANY I N SIGNATURE REGISTERED I Y/ N I FEE CURRENT Y/N Address License# ELECTRICIAN 7 ( Q- COMPANY /u SIGNATURE Imo/ / ` REGISTERED I Y/ N I FEE CURRENT I Y/ Lj Address License# J I PLUMBER I A I J ,A- COMPANY 1V k SIGNATURE I v I REGISTERED I Y/ N I FEE CURRENT I Y/N Address License# ___________________________ MECHANICAL COMPANY V►�LSLi 1G err 1 hla e ti1C( i ei SIGNATURE VY - REGISTERED Ly, N I FEE CURRENT /N Address J G o'Ta(o (P 4 License# OTHER COMPANY SIGNATURE REGISTERED Y INI FEE CURRENT 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 ons/large projects COMMERCIAL. Attach(3)sets of Building Plans;(1)set of Energy Forms.dR OI 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. vi u viii u vu., u ii u vii, vu!u it u vu,u Iv vu,u vu vu..It vi u u vii u vu u viii u lviii.ul.u u vu,I u vi vu u vu u u u vi u vu lu i vu u iv,,,vu u liii u vu vi u iii Urr 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, 'tf e'.`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, thejob 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 Y LEND R OR AN TT RNEY BEF RE R ORDING Y R NO I E F C MMENCEMENT. FLORIDA JURAT(F.S. 117.0 OWNER OR ENT. CONTRACTOR ` ��s Subscribed and m t or a ed)before me this Subscribed and sworn to(or affirmed)b ore 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 Id tification. /Q /(Jotary Public Notary Public c' JA QUELINE BOG S _ Commiss on No. Corn f Expires December 12,2010 ,. r : ?33 0�dod7TxuTrolFYnYwmaaBAP3o49019 d2010 Name of No ry typed,printed or stamped Name of Notary typ " NaN, wwaes,oie