HomeMy WebLinkAbout09-9221 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9221
BUILDING PERMIT
Permit Number: 9221 Address: 6019 R IDGEWAY DR
Permit Type: RE -ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: MOBILE HOME SUBDIVISION Lot(s):56 Block: Section:
Square Feet: Subdivision: ZEPHYR RIDGE
Est. Value: Parcel Number: 21 26 - 0130 - 00000 - 0560
Improv. Cost: 6,200.00 7 :
Date Issued: 6/23/2009 Name: GAMBA H ENR Y
To Fees: 65.00 Address: 6019 RIDGEWAY DRIVE
Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/09/2009 Phone:
Work Desc: RE -ROOF MOBILE HOME WITH SHINGLES
RYMAN CO CO., INC. REROOF RESIDENTIAL 65.00
i iia 4 «, < M r tom" C ® 13 ' . - x '',..:7;;,,'. a i, ,€ € * '��3��
DRY I N ROOF !Nisi
T �Ed6N-T3 ROOF IN3('
INAL o
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; - ording your notice of commencement."
CONTRACTOT'' IGNA PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION — 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813 -780 -0020 City of Zephyrhills Permit Application Fax- 813 -780 -0021
Building Department
Date Received . e,- Q 0
Phone Contact for Permitting --
Owner's Name . . Li. [ 1(pvi / // t- . b1-� Owner Phone Number X} .> j '7 1 20 S 1
Owner's Address 6 cJ I ? A [ cp_U x / , b - Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS GOI - 1 Kkcig�wo y by- . LOT #
SUBDIVISION jr 1 1 I PARCEL ID# Q - C. - Cpl - 0 1.0 - c " 05 0
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT 1 I � SIIGGN 1 I MOVE I 1 DEMOLISH
INSTALL REPAIR 14
PROPOSED USE 1 I SFR I I COMM I] OTHER 1 I
TYPE OF CONSTRUCTION 1 1 BLOCK 1 1 � FRAME I STEEL 1 1 OTHER 1 I
DESCRIPTION OF WORK �.Q-'�rOde Mob be l t..u/ 5' 1 l
BUILDING SIZE SQ FOOTAGE 490 HEIGHT
I I BUILDING $ /" a 0
(O (J(J . -„—. VALUATION OF TOTAL CONSTRUCTION
I I ELECTRICAL $ AMP SERVICE 1 1 PROGRESS ENERGY I_ 1 W.R.E.C.
1 I PLUMBING $ r
I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
I 1 GAS ROOFING 1 I SPECIALTY 1 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 1 1NO
f
BUILDER COMPANY I '_
SIGNATURE REGISTERED 1 LY / N I FEE GURRENI0 I Y/ N I
I
Address License #
ELECTRICIAN COMPANY
SIGNATURE REGISTERED 1 Y / N 1 FEE CURRENT 1 Y/ N 1
Address I License #
PLUMBER COMPANY
SIGNATURE REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y/ N 1
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED 1 Y / N . _I FEE CURRENT 1 Y/ N 1
Address I 1 License # I I
OTH - ' _ �, COMPANY � r1 ( � \ i r)
SIGNA • L' -NEW
do 0
REGISTERED I Y / N ] FEE CURRENT Y / N 1
Address • -.Z,• ,jj License # (CC R 2 - - SS Ce S1
-,
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 NC 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 FO - IMPROVEMENTS TO YOUR PROPERTY. IF YOU I TEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND • OR AN ATTORNE BEFORE RECORDING YOU / OTICE OF COMMENCEMENT.
FLORIDA JURAlt (F.S. 1 ' .03) I '
p• .� . • . .tom AA AO
• to (or affirm:.; a ore me t 1
Subscribed and sworn o ' or affirmed) b= ice' me this � Su a • b
by by
Who is /are personally known to me or has /have produced Who is /are personally known to me or has have produce
do d
as identification.
Notary Public otary Public
Commission No. Commission No.
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped
� ►, Li Rif Mas VISA R
A Division of Ryman Construction, Inc. Proposal # 0 0 5 7
INC. 36413 SR 54 • Zephyrhills, Florida 33541 Cam- ' 6
Estimate #
Phone: 813- 782 -6094 • Fax: 813- 788 -6773 ,,/
License # CCC 1325505 Job # 13
1 - 800 - 800 - ROOF Also, Serving the Central and East Coast of Florida
/ , (766 ) ",,
Customer: tJ ////ft/ 9 �'m 6 lt i- �S
/ Date: q 0
Address: (/ /9 Mewfr70/ ' City: fi 14- / • / ! S Zi
Home #: 7 / Cell #: Business #:
E -mail Address: /,
r6:9, lete tear off of existing c r ? 3 Additional Items: _g !.t CC- L, /L A-C --
IES all loose roof decking as needed according ' "r 422FA
/ to Florida Building Cod ' /L S
R�f dried in with
'Install new valley metal with galvanized metal
tall all new 5 " drip edge color: W f
L'Install all new lead boots drotr 64 4" --0(-1 9A/ 7"
likristall all new 30 year fungus - resistant shingles
n ingle brand/color: Oti' P8W -{CA_ Warranty Package.
oof related debris removed from job site -- rawoCo
All . materials, labor and permits furnished To - •' • price $ -
Extra's /3/0 � � •
V.400. �
, ; -
cU'Bad plywood replaced at a cost of $ ' per sq. ft. in the roof fiea All other wood work/additional labor, such as, but not
limited to, valley rebuilding, rafter replacement, etc. will be a rate of $ ss; 6 per man hour plus the cost of materials.
THIS BECOMES A BINDING CONTRACT UPON ACCEPTANCE OF PROPOSAL. PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTRACT.
1. All material is guaranteed to be as specified and completed in a substantial workmanlike manner.
2. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, hurricane and other necessary insurance upon above work.
3. Labor warranty does not cover damage to roofs caused by lightning, hurricane, tornado, hailstorm, impact of foreign objects or other violent storm or casualty damage to roofs due to
settlement, distortion failure or cracking of roof deck, walls or foundation of a building.
4. Workman's compensation and public liability insurance on above work to be taken out by RYMAN ROOFING, INC., a Division of Ryman Construction, Inc., or it's subcontractors
5. RYMAN ROOFING, INC., a Division of Ryman Construction, Inc. is not responsible to provide any materials or to perform any work other than what is described above. Replacement
of deteriorated decking or fascia boards, is not included and will be charged as an extra unless otherwise stated herein.
6. This contract is subject to final approval by RYMAN ROOFING, INC., a Division of Ryman Construction, Inc. and is the entire agreement of the parties and no other written or other
forms will recognized.
7. A charge of 1.5% will be made on all unpaid balances after 30 days, plus charges incurred for non - payment procedures, plus attomey's fees.
8. A 4% processing fee will be added to all credit card orders.
Ryman Roofing, Inc., a Division of Ryman Construction, Inc. will not be responsible for any damage to septic tanks, sod, shrubbery, paint, satellite signal loss, sprinklers,
concrete drives or any underground piping.
Payment Schedule: Payment Method:
Acceptance of Proposal
STATUTORY NOTICE REGARDING CONSTRUCTION LIENS: ACCORDING TO FLORIDA'S
CONSTRUCTION LIEN LAW (SECTIONS 713.001 - 713.37, FLORIDA STATUTES), THOSE WHO WORK
ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL
HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS
CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR
FAILS TO PAY SUBCONTRACTORS, SUB - SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE
PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU
HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR,
YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS
FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS,
OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO
PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY
PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN
RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A "NOTICE
TO OWNER ". FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED
THAT YOU CONSULT AN ATTORNEY.
I ACCEPT THIS PROPOSAL AND HEREBY CERTIFY . 'T I HAVE READ AND FULLY UNDERSTAND THE PROVISIONS OF THIS CONTRACT.
_ . Date:
Purchas : • d
/ d d
._► �...G� - ��� � / ,
Purchaser: Estimator: .11..4„„A4.
! r
ASPHALT SHINGLES 2007 FBC PRODUCT APPROVALS 1
=STS =,aas=
rH 0 ;IPA _,NC -
ASTM ASTM ' TAS ASTM ASTM 1 TAS
03161 07158 107 03161 07158 1 107 '
CLASS 0 CLASS G CLASS•F CLASS G
CERTAINTEED CLASSIC HORIZEN X
CARRIAGE HOUSE 5444.1
X 5444.1
CENTENNIAL SLATE X
GRAND MANOR 5444.1
L X 5444.1
LANDMARK
X 5444.1
LANDMARK PLUS X
LANDMARK PREMIUM 5444.1
X 5444.1
LANDMARK TL X
PRESIDENTIAL SHAKE 5444.1
X 5444.1
PRESIDENTIAL SHAKE TL X
HATTERAS X 5444.1
PATRIOT 5444.1
X 5444.1
GAF -ELK ROYAL SOVEREIGN X - .
10124.1
CAMELOT
• X 10124.1
CAPSTONE X
COUNTRY MANSION 10124.1 '
X 10124.1
GRAND CANYON X
GRAND SEQUOIA 10124.1
X 10124.1
GRAND SLATE X
GRAND TIMBERLINE 10124.1
X 10124.1
TIMBERLINE ARMORSHIELD II X
TIMBERLINE PRESTIQUE GRANDE 10124 1
X 10124.1
TIMBERLINE PRESTIQUE 30 X
I TIMBERLINE 30 0124.1
I X i I 10124.1
TIMBERLINE PRESTIQUE 40 I X
TIMBERLINE 40 10124.1
X 10124.1
I TIMBERLINE PRESTIQUE LIFETIME X
TIMBERLINE ULTRA 10124.1
X 10124.1
SLATELINE X
10124.1
OWENS CORNING OAKRIDGE PRO 30 X
OAKRIDGE PRO 30 AR 10674,1
•
X 10874,1
OAKRIDGE PRO 40 X
OAKRIDGE PRO 40 AR 10674.1
X 10874.1
OAKRIDE PRO 50 X
OAKRIDGE PRO 50 AR 10674,1
X 10874.1
DURATION X
DURATION PREMIUM 10874.1
CLASSIC X 10874,1
X 10874.1
CLASSIC AR X
SUPREME 10874.1
X 10874.1
SUPREME AR X
PROMINENCE
X 1010674.1
874.1
PROMINENCE AR X
BERKSHIRE 10674.1
X 10874.1
WEATHER GUARD HP X
10874.1
TAMKO GLASS SEAL AR X
ELITE GLASS SEAL AR 1956.2
•
X 1958.1
HERITAGE 30 X
HERITAGE XL 1958.3
X 1956.5
HERITAGE 50 X
HERITAGE VINTAGE AR 1958.4
X 7154.1
Pasco County Parcel: 03- 26 -21- 0130 - 00000 -0560 001 Page 1 of 2
Search Again Show Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes
Other Agency Data: Tax Collector School Board Supervisor of Elections
Data Current as Of: Weekly Archive - Saturday, June 06, 2009
Parcel ID I 03- 26 -21- 0130 - 00000 -0560 (Card: 001 of 001)
I Classification 02 - Mobile Homes
Mailing Address Property Value
GAMBATESE HENRY 3 & LILLIAN L Ag Land $0
6019 RIDGEWAY DR Land $26,698
ZEPHYRHILLS, FL 335427997 Building $79,409
Physical Address Extra Features $1,230
6019 RIDGEWAY DR
ZEPHYRHILLS, FL 33542 -7997 Market Value $107,337
Assessed (Save Our Homes) $71,166
Legal Description (First 4 Lines) Homestead 196.031 - $25,000
See Plat for this Subdivision Non- School Additional Homestead Exemption - $21,166
See Plat
ZEPHYR RIDGE Non- School Taxable Value $25,000
PB 26 PG 78 -80 School District Taxable Value $46,166
LOT 56 & LOT 57 LESS NORTH 35 Warning: A significant taxable value increase
FT THEREOF may occur when sold. Click here for details
and info. regarding the posting of exemptions.
I Land Detail (Card: 001 of 001)
Line I Use °Description I Zoning II Units II Type 11 Price II Condition II Value
1 0200 MBL
SUB M 00M1 6,000.00 SF
$3.90 1.00 $23,400
2 0200 MSUBM 00M1 4,711.00 SF
$0.70 1.00 $3,298
Add" " .: - nd Information
I Acres II 0.25 II Tax Area I . 30ZH I FEMA Code X 'Residential Code' ZIDELP1
Building Information - Use 02 - Mobile Home (Card: 001 of 001)
Year Built 1997 Stories 1.0
Exterior Wall 1 Above Average Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet
Fuel Electric Heat Forced Air - Ducted
A/C None Baths 2.0
Line Description I Sq. Feet II Repl. Cost New
I 1 BAS II 1,984 I $94,240
I 2 FST I 108 II $2,328
I 3 FCA 432 I $4,085
4 FSA II 140 I
I $2,993
5 FOA I 186 $2,233
I Extra Features (Card: 001 of 001)
Line II Description II Year I
I Units ° Value
1 II DWSWC I 1997 450 II $810
2 CAC -4 II 1997 II 1 II $420
Sales History
I Previous Owner II H & R INTERSTATE MOBILE HOMES
1 11 II II 11
http: / /appraiser.pascogov. com/ search /parcel. aspx ?sec =03 &twn= 26 &rng =21 &sbb= 013 0 &bl... 6/8/2009
111111111111111111111111111111111111111111111111111111111111
2009079835
Rcpt:1247424 Rec: 10.00
0.00
DS: 0.0 IT: DP Clerk
06/09/0 _— —
PAULA S. O'NEIL; PASCO CLERK & COMPTROLLER
06/09/09 10: 1 of� 2
OR BK 1 PG L�
NOTICE OF COMMENCEMENT
Permit No.
Property Identification No. • - _.• - • 3 - *COX - 0560
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida Statutes the following information is provided in this NOTICE OF COMMENCEMENT.
z �zkc c — - z,6 P6 7 9 - sQ
1.Descriptl of property ( egai description: _e S _• S L . Or S T V Q►r • •
a) Street Address: 6 R IC Qt4,c.0 _ , . Y ars FCC '33S'C(-_
a
2.General d�cr tion f
3.0wner Information -� �/
a) Name and address: W ny S _ NI-1, (an 1— w rl /' t -2S1L— 6o 19 0 1121Q WcAll
R b) Name and address of fee sim le titleholder (if other than owner) S � ? S-Cie____
c) Interest in property
ntractor Information
a) Name and address: c. Lr.• vt 3 6 • / 1.41 ( 1
b) Telephone No.: T ! • • i Fax No. (Opt.) 5 3
5.Surety Information ,
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PASCO , �►� t t�, Notary Public State of Florida
r Christian : � , . ice or A # i.. _ . G .. • z My Commission DD751810 Si: ature of Owner or Owner's • orized Officer /Director/Partner /Manager
hoc A Expires 01/24/2
1124/2 01 2
Print Name
( The foregoing was acknowledged before me this 3 day of ' '(.& , 20 09 , by L., �,
--1lf n� iLJ�_ as (type of authori , e.g. officer, trustee, attorney
in fact) for (name of party on behalf of whom ins t was executed).
Personally Known ✓ OR Produced Identification Notary Si natu -" _.
Type of Identification Produced Name (print) C. A. y \ ikyMQ
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
FORMS /NOC,rvsd2007 Signature of Natural Person Signing Above