HomeMy WebLinkAbout09-9278 CITY OF ZEPHYRHILLS
5335 -8th Street
(813)780- 0020 9278
ELECTRICAL PERMIT
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Permit Number: 9278 Address: 39345 6TH AVE
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE REPLACEMENT Township: Range:
Proposed Use: MOBILE HOME PARK Lot(s): Block: Section:
Contractor: GUARANTEE ELECTRIC INC Book: Page:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12- 26- 21 -002B- 00500 -0000
I mprov. Cost: 595.00 W s NP:Wii :. d 7 _ .. " z. _ .7;
Date Issued: 6/24/2009 Name: SIXTH AVENUE LLC
Total Fees: 35.00 Address: 39345 6TH AVE
Amount Paid: 35.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/24/2009 Phone:
Work Desc: COVER EXPOSED WIRING, MOVE EXISTING LIGHT FIXTURE & SWITCH
ELECTRICAL FEE 35.00
6
a. 1' "€ Pa V
ROUGH ELECTRIC c�
CONSTRUCTION POLE — °
PRE -METER
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.
"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."
Complete Plans, Specifications and Fee Must Accompany Application. All work shall be
performed in accordance with City Codes and Ordinances.
1 6eg
CO TRACTOR PERMIT OFFI PR
PERMIT EX RES 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 q 7 Fax-813-780-0021
Building Department (/
Date Received. 6-2 c(--O / Phone Contact for Permitting --
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Owner's Name ' at,/ • T y L / /' s ry cz. Avoi,ert . . s ) D.C. Owner Phone Number F 1 3 - 7 8 a — I t -7 4
Owner's Address 3' 3 Y.5 ‘ 1 h A uc 4), f.� ZtP � fL 33 S Owner Phone Number
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Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address L /
JOB ADDRESS 3/3' 75 C ' Ave 2E/HiL�INiaS / GL 3355'x 6 gY LOT#
SUBDIVISION
6` /l1ObL.E MOIE / PARCEL ID# " " ° I 1)1°`9 13 OtJ1/45-66 DDOCv
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED FJ NEW CONSTR ADD /ALT I I SIGN I I MOVE 1 I DEMOLISH
INSTALL t/ REPAIR
PROPOSED USE I I SFR I I COMM I I OTHER I I
TYPE OF CONSTRUCTION I I BLOCK I I FRAME I I STEEL n OTHER I I
DESCRIPTION OF WORK 0_0 Vf i £'Xr 6 u/,AiAi f fr lit- e -3 6 / �,X "'? t 5wi H
BUILDING SIZE SQ FOOTAGE HEIGHT
I 1 BUILDING $ VALUATION OF TOTAL CONSTRUCTION
I Z7 ELECTRICAL $ ,5-`7 ` o O AMP SERVICE I 1 PROGRESS ENERGY I I W.R.E.C.
I I PLUMBING $
I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
I I GAS I I ROOFING I I SPECIALTY I 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES nINO
BUILDER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address ( 1 License #
ELECTRICIAN ) . 1, ,f' J� COMPANY C 4QAN r(E £44 e r ,2 / e. _rive--
SIGNATURE u' / l �.2.1 REGISTERED de / N FEE CURRENT ) I Y / N I
Address /D/,y.5 F/1u- , + Q R. Vt . . /44/ Peg , QK'NfYrL 3 '/dS' License # ,e 1 3o/ 33?/
PLUMBER / COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address License # I
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N l FEE CURRENT I Y/ N I
Address I 1 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) 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 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. Bayheads, Wetland Areas, Altering
Southwest Florida Water Management District - Wells, Cyp ress Y
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 fn material is be
be submitted ed at time of
me o permitting which understood
s prepared a
" engineer
"compensating volume" " will
licensed by the State of Florida.
- If the fill material is to be used in Flood n o i "A" in
area connection with htem wall.
permitted building using stem wall
e construction, I certify that fill will be u only
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 ssued under the attached permit , applicationr for lots les violating )
the conditions of the building permit issued
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
affidavit prior to commencing construction. I understand that aatio separate to permit
specifically may
e required n for e application. electrical
ica r ,
this as, or other
plumbing, issued shall be con wells, onstr air ued to be ai i cing, g
nor shall issuance of a permit prevent the Building Official from thereafter
e s stro be a license t proceed with the work and not as authority to, violate, cancel, alt
er, or
p ermit issu permit issued shall become ie
set aside any correction provisions err ors the in plans, codes, n codes. Every p
requiring a correct of r in plans, construction or violations of any
work authorized by such permit is commenced within six months
the time the issuance,
commenced. , or if work authorized
by
unless the w period of six (6) months o da s n will demonstrate
may permit requested, is suspended in or g, from the for a p
work ceases for ninety (90) consecutive days, the job is considered abandoned.
may be requested, in writing, from i he Building Official for a period not to exceed ninet (90 y
justifiable cause for the extension.
WARNING TO
OWNER: YOUR FAILURE TO RECORD A NOTICE YOU INTEND TO COMMENCEMENT MAY FINANCING, RE L IN YOU
CONSULT
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
TH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
F i LORIDA JURAT (F.S. 1 7.03)
OWNER OR AGENT 4 CONTRACTOR
�` Subscribed and sworn to (or affirmed) N4✓6
before me this ,
Su scrib and sworn (or affirr ed e re me h '
(, bit/ j A v
, 2,c( - by'. ! N ` Who is /ar�personally known to me or has /have produc
Who Is /are personally known to me or has/have • roduced
as identification.
ar Identification. Notary Public
sY'.., es' JACQUELINE BOGES otary Public
2010 N
" "' s December 12, Expire C ommission No. '��"• - • .
Commission � ' � Bonded TnNT FamInsurence8043f5� a '* Commission DD 621833
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Name of Notary ty : - '• �. r t ^ � • " ain Insurance 800385 -701;+
Name of Notary typed, printed or stamped
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FROM :Guarantee Electric Inc FAX NO. :7278688814 Jun. 24 2009 1002AM P1
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Under t
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REQUicliriEN, DAVID ELECTRI c INC
GUARANTEE GU— Aft — FAWN DR FL 34 65 .
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NEW PORT RICHEY 4
CHAR IJIE CRIST
CHARLES W.
SECRETAR
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GOVERNOR DISPLAY AS REQUIRED BY LAW DRAGO
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ALEX SINK STATE OF FLORIDA
CHIEF FINANCIAL. OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WO COMPENSATION
* * CERTIFICATE OF ELECTION TO OE 1901MIPT EIOM FILMR COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected iv be exempt from Ronda Workers' Compensation law.
EFFECTIVE DATE: 03/01/2009 EXPIRATION DATE 031011308
PERSON: KENNEDY DAVID F
FEIN: 593970767
BUSINESS NAME AND ADDRESS:
GUARANTEE ELECTRIC INC
10646 FAWN DRIVE
NEW PORT RICHEY FL 34854
OGOrbi OF fUSINISS OR TRAD I
1- REGISTERED ELECTRICAL CONTRACT
IMPORTAIIT: Noncom to Chapter 440 . 06(14), 1.5., an Ohm et s carpnties ado darts ramtpelss Linn Si e>Mpeer by fillet a certificate et election under this Y
section may sat mere, benefits or campnseriee odor lids or. Purses* In amply 44Lef11V. 1.5., Caldicoles *4 etedios to be exempt... apply only within the
scope el the basis's; or trace listed as roe notice et Omits' to be eregit ltirttsutt is tided 445.11611* F_S, Marius of Mambo* to he exempt sad certificates of
etection to be exempt shall be subject to revocation il, et any time fifer do tilup of Sr site er tbn tommece d Ile certificate, the person muted on the notice or
certiticale no longer moots the regoireaeets et this sorties for isseaece of s coedicea. The ifmtesrtmsst tint rude: a anteing* et any time for failure of the person
nomad ea Ow twitrtieare to swift 16. regaireseatt al Ibis xttiiea.
DWC - 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 QUESTIONS? 11501 473 -1609
JUN -24 -2009 09:14A FROM: MIKE PETERS STATE FA 727- 862 -4443 TO:18137800021 P.1
CERTIFICATE OF INSURANCE
This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
® STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
❑ STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Name of policyholder GUARANTEE ELECTRIC INC
Address of policyholder 10645 Fawn Drive NEW PORT RICHEY, FL. 34654
Location of operations SAME AS ABOVE
Description of operations Electrician
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD UMITS OF UABIUTY
POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Does (at beginning of policy period)
98 BB C914 - v Comprehensive 10/27/2008 10/27/2009 BODILY INJURY AND
Business Liability / PROPERTY DAMAGE
This insurance includes: ® Products - Completed Operations
® Contractual Liability
® Underground Hazard Coverage Each Occurrence $ 1,000, 000
® Personal Injury
® Advertising Injury General Aggregate $ 2,000,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage Products — Completed $ 2,000,000
❑ Operations Aggregate
0
POUCY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date ' Expiration Dots (Combined Single Limit)
❑ Umbrella E Occurrence $
•
❑ Other i ggregate $
Part 1 STATUTORY
•
Part 2 BODILY INJURY
98 - TY - 0854 - 0 Workers' Compensation 10/27/2008 10/27/2009
and Employers Liability Each Accident $ 100000
Disease Each Employee $ 100000
Disease - Policy Limit $ 500000
POUCY PERIOD LIMITS OF UABILITY
POLICY NUMBER TYPE OF INSURANCE
Effective Date Expiration Date (at beginning of policy period)
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
its expiration date, State Farm will try to mail a written
notice to the certificate holder
Name and Address of Certificate Holder 30 days before cancellation. If however, we fail to
mail such notice, no obligation or liability will be
City of Zephryhills imposed on State Farm or its agents or
5335 8 Street representatives.
Zephryhills, Fl. 33542
1- 813 - 780 -0021 .)■.)%S) Qty
Signatu Autrltrrzed Representative
Agent 06/24/09
Title Date
A sfAiie 1AiM ' IKE PETERS
INSURANCE AGENCY, INC.
A st1315 Little Rd
558 -964 e.3 04 -1999 Printed fn U.S.A. INsuaAN0 New Port Richey, FL 34654
OFF: (727) 862 -3516
FAX: (727) 862 -4443
FROM :Guarantee Electric Inc FAX NO. :7278688814 Jun. 24 2009 09:27AM P1
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