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HomeMy WebLinkAbout09-9682 813 - 780 -0020 City of Zephyrhills Permit Application Fax - 813 - 780 -0021 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 9682 ..yy BUILDING PERMIT �.t t <3 1 ',. ' ,. 7 x� �. � ? `�1 �€ � o- t�'(... a s5 i ` ,€' s : s& .' 2 , 31 Permit Number: 9682 Address: 39576 MEADOWOOD LP Permit Type: RE -ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: MEADOWOOD ESTATES Est. Value: Parcel Number: 13- 26 -21- 0140 - 00000 -1110 Improv. Cost: 2,200.00 # ' ° a Date Issued: 10/23/2009 Name: CHRISTENSEN, KEITH & BALD PAULA Total Fees: 45.00 Address: 39576 MEADOWOOD LP Amount Paid: 45.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/23/2009 Phone: (813)783 -6935 Work Desc: FINISH UP REROOF DONE PARTIAL UNDER PRMT # 7226 AvN =is I G _E =� _ �_ A 45.00 P a/ 6GQ c7/7 DF�Y IN R�b� TAPE JOINTS ROOF SP FINAL i ° - O' d9 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." CON RACTOR SIGNATURE PERMIT OFFI �R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION — 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER * ** "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 compliancy 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 Tots 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 AGENT " ' � CONTRACTOR Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) 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 f lroi o at Page No. of Pages G -21._ O y _ oovoo r Gavin Roofing Quality Roofing Since 1984 N ° _ 012 91 I , / L P.O. Box 1364 • , — Dade City, FL 33526 352 -567 -5034 Lic # RC 0046241 2 Year Leak Warranty PROPO 6' fig- TTE /i-k / f f 6N56i✓ PHONE p / 0 2 3 STREET JOB NAME 3 957k M&- R- ©ocuitoJ I- P CITY STATE and ZIP CODE JOB LOCATION r Pifyolko ci, ARCHITECT DATE OF PLANS JOB PHONE T We hereby submit specifications and estimates for: 7 /1 e., 4- /1.6 --coa 2_ /2pA✓7 1 '/ 2va wil'is/ /9 157/z_ . f - 3 7 5//l'AI • 4.6- ,, L91/ i/ tiv ITN J' /'LT NEt, ii/2 / /' t - J 6-v6- .041, f- ,2,i): V6/17. Iry 1 6- I A✓S7, 2 , i 772/75.5 n 86-- >d-Ha t_ . tor propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Tww /✓',/ 7 ' P J t(kup/,D D 1,L- dollars ($ . °O.. ....--- ). Payment to bemade as follows: C0014 / -6 7/ o 0/ <::-. - All material is guaranteed to be as specified. All work to be completed In a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Authorized 4i r' involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be /j, \ Our workers are fully covered by Workman's Compensation Insurance. Withdrawn by us if not accepted within days • Acce Acceptance of Proposal — The above prices, specifications , / i ptance II' T^ P P 0 2: -/ and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. /^� / Date of Acceptance: Signature v Oct 23 09 09:57a Lg Edwards Ins 3525676766 p. ipti5iii]br CERTIFICATE OF LIABILITY INSURANCE OP ID RE DATE(MNMDD/YYYY) GAVIN -1 10/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE L . G. Edwards Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P . O . Box 1548 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dade City FL 33526 -1548 Phone : 352 - 567 -6751 Fax: 352 - 567 -6766 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Atlantic Casualty Ins Co INSURER B: Gavin Roofing Rick Gavin dba: INSURER C: P 0 Box 1363 INSURER D: Dade City FL 33526 1 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MK AWL' POLICY EFFECTIVE POUCY EXPIRATION LTR INSRD TYPE OF INSURANCE POUCY NUMBER DATE (MMIDD/YYYY) DATE (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 300,000 A X COMMERCIAL GENERAL LIABILITY L0830047240 08/04/09 08/04/10 PREMISES( Ea $ 50,000 CLAIMS MADE X I OCCUR MEO EXP (Any one person) $5,000 ^_ PERSONAL & AOV INJURY S 300,000 GENERAL AGGREGATE _ S 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG S 300,000 POLICY n 1.;EC7 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN - EA ACC S AUTO ONLY: AGG S EXCESS /UMBRELLAUABIUTY • EACH OCCURRENCE _ $ 7 OCCUR 1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ ND EMPLOYERS' LIABILITY Y / N ITORY S I lOER ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT S (Mandatory In NH) EL. DISEASE - EA EMPLOYEE $ X yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT _ $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYOFZ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL CITY OF ZEPHYRHILLS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 813- 780 -0021 5335 8TH STREET REPRESENTATIVES. ZEPHYRHILLS FL 33541 Au REPR ryNTATIVE ACORD 25 (2009/01) ® 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Oct 29 09 11:11a Rick Gavin 352 - 567 -5034 p.2 (3- 75o - City Hof .Zephyrhills BUILDING DEPARTMENT RE: Permit # 96 9/17/07 Inspection Affidavit I /?ic 6/W/i✓ - ,licensed as a(n) Contractor* /Engineer /Architect, (please print name and circle Lic. Type) FS 468 Building Inspector* License #; On or about /O/ y , I did personally inspect the roof BFtimi - ec naz iris and /or secondary water barrier work . ` 9S7 /L /f DG'[��'D� � I' .2-4 (circ e one (Job Site Address) Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) Signature STATE OF FLORIDA COUNTY OF /1.1 Sworn to and subscribed before me this 2 'day of (4C' 4(4- . 200 '! By e c k- t y L. Notary P . i , State ► " lorida et JANICE M. HELMS . �C /� MY COMMISSION # DD X207 pt s BoateddTlvu:t September Pubi 0 1' t, typ " ante) Commis ' n No.: 3) .D cited() 6 fj Personally known L- or Produced Identification Type of identification produced. * General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the . deck for each inspection.