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HomeMy WebLinkAbout09-9766 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 9766 BUILDING PERMIT SINGLE FAMILY RESIDENTIAL w 7:77-7-7-77., Permit #:9766 Issued: Address: 39544 AUGUSTA NATIONAL DR LT 1 3 Permit Type: ALUMINUM ZEPHYRHILLS, FL. Class of Work: ALUMINUM PACKAGE Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 6,900.00 Total Fees: 97.50 Subdivision: MAJESTIC OAKS Amount Paid: 97.50 Date Paid: 11/25/200• Parcel Number: 24- 26-21-0000-00100-0090 Name: SUN STATE ALUMINUM INC Name: NHC - FL115 LLC Addr: 6154 FT KING RD Address: 6991 E. CAMELBACK RD STE B -310 ZEPHYRHILLS, FL 33542 SCOTTSDALE, AZ 85251 Phone: (813)788 -7308 Lic: RX0060171 Phone: Work Desc: INSTALL SHED, CARPORT, CONCRETE DRIVEWAY 546 SQ FT :UILDIN 97.50 '�e a, y d 6 /c7rc $ r in Its 5 '14 Oki- 5 , o) • • 4- e • ,. SLAB R .. F INAL RAISED SLAB DRIVEWAY FRAME ELECTRICAL ROUGH 1ST ROUGH PLUMB 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." Xk 4LJ 4i/' CONTRACTORS SIGNATURE PERMIT OFFI ' - - PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 Ar ty of Zephyrhills Permit Application / f ^ Fax- 813 -780 -0021 „ 1L ' y a:, (l' G Building Department �f 7 lY (1)02.411 z 1 Date Received D - `,j -- Phone Contact for Permitting eF/3 7a0 -- $3/ Y Owner's Name 40 /i2 * LOW. ' altos (— ) )C_, Owner Phone Number Owner's Address 3 9s 44,1'0/4 /2a-//07141 4 /' . Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address I- JOB ADDRESS 3< yy v 1tij [crX c J/c a/ 42/x. z f-/ 33W LOT# /3 SUBDIVISION 197Q/PJ4 0s�J 4 PARCEL ID# 02- °L/- t�.�do - w /cV - 0d 0 ✓J (OBTAINED FROM PROPERTY TAX NOTICE) Ft] WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN I 1 MOVE I I DEMOLISH INSTALL REPAIR PROPOSED USE [ I SFR l I COMM I I OTHER I TYPE OF CONSTRUCTION I I BLOCK I I / FRAME � I STEEL n OTHER SL DESCRIPTION OF WORK L c►' 0/4/90/ T �/tci & d/' / iity BUILDING SIZE 13 r X 7 °)" ' I SQ FOOTAGE 3 0 HEIGHT mi BUILDING $ /�' ?� ' VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ cv AMP SERVICE I I PROGRESS ENERGY Ii W.R.E.C. I I PLUMBING $ PASCO PERMIT 13ERVICE I i MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION (31 4 FAX 1 . 906 I 1 GAS I 1 ROOFING I I SPECIALTY I I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES I ] BUILDER ,, /,, /. � ° � S COMPANY ! CJ 44 /f n C SIGNATURE AL wL X�/, ! . I REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address 1' /3 �W /e 1'I j /eV Z 1r R 3L?�01- License # ELECTRICIAN / COMPANY SIGNATURE REGISTERED I Y/ N ] FEE CURRENT I Y/ N I Address License # PLUMBER COMPANY SIGNATURE REGISTERED I Y/ N j FEE CURRENT I Y/ N I Address License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I 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) 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. rstands TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: T of new de b g dings, of that Transportation Impact Fees and Recourse Recovery Fees may apply construction 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 n not ve adversely cited for adjacent t properties. If use of fill is found to adversely affect adjacent properties, the 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. rth in If I am the AGENT FOR THE OWNER, in good permit may be required for conditions electr c this affidavit prior to commencing construction. I understand that a sep plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. set aside an y p i s io construed co ns of the tech nical codes, nor shall proceed the work and not as a permit prevent the Building Official from thereafter set asde any proviio unless t a correcti he work au thorized by of error s s u such permit violations six any months of permit pemit s an e, issued if work authorized by unless tty sch pe m a pb r is suspended o g, f odm the Building Official the Off cial forr a period not to exceed time ed n ninety work days and will demonstrate maybb le cause for in writing, fr justifiable the extension. If work ceases for ninety (90) consecutive days, the is considered abandoned. WARNING TO OWNER: YOUR FAILURE YDUR NOTICE OF YOU IN�ENDE,� OBTAIN FINANCING, CONSULT YOUR PAYING TWICE FOR IMPROVEMENTS TO WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.0) ��j�� ----r-z/6_,_,‘ — `dam Cti� ,/,„-, OWNER OR AGEN - ♦ '^' I _, CONTRACTO Subs bed and sworn to (.r atfirm9fi) Warp me this 1' A �S�u_bsgribed a d sworn to j oy af_ri his �0 tI // 09 by . 8 / / 100entoi"' a by Q t 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. i Notary Public I' `�� /, �... Notary Public Commission N•. -, .. ommisslon o. y i • •IUDA Suzan 5 zanne : • Name of Notary typed, pr _ fission # DD601110 Name of Notary typed pnntes starnpetission # DD601110 sires: NOV. 15, 2010 G'i:OS: NOV. 15, 2010 Tt, .; ATL flC BONDING CO., INC. L TIC BONDING CO., INC. 813-780 -0020 City of Zephyrhills Permit Application (,, f Fax -813- 780 -0021 Building Department VI ' 7 /IOW J Date Received Phone Contact for Permitting 1 -- i i t i i i i i i titi Owner's Name Owner Phone Number Owner's Address Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address / Aic(4)14 JOB ADDRESS fs 1 &� It/�S4 u . LOT # / 3 SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN I I MOVE 1 I DEMOLISH INSTALL 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 1 I OTHER I I DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE HEIGHT I I BUILDING $ VALUATION OF TOTAL CONSTRUCTION I I ELECTRICAL $ AMP SERVICE 1 I PROGRESS ENERGY 1 I W.R.E.C. I I PLUMBING $ I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION I I GAS I 1 ROOFING I 1 SPECIALTY I I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES 1 ]NO BUILDER COMPANY SIGNATURE REGISTERED I Y/ N J FEE CURRENT I Y/ N I Address License • ELECTRICIAN / 6/1/(1" OMPANY ' , / �'' / ! SIGNATURE ISTERED I Y / I FEE CURRENT 1 Y II ' / N Mariam; �w . �i���i v I Address , ` /. pri 10. L # 1l v PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT I Y/ N I Address License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y / N j FEE CURRENT I Y/ N I Address 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. 1 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 t may r se ly it affect d for adjacent properties. If use of fill is found to adversely affect adjacent properties, owner 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 the AGENT FOR THE OWNER, onstructi n I understand that a separate permit may be promise in good faith to info required for conditions electr electrical work, this affidavit work, this affidavit prior to commencing gas, or other installations not specifically included in the application. A plumbing, signs, wells, pools, air conditioning, g set aside a ny p i s io construed ns of the te ch n i al codes, nor shall issuance of a permit prevent the Building Official from thereafter set asde any proviiochi requiring a correction of errors in plans, mit ss violations of any codes. six months of permit issuance, i or wo authorized by unless the work authorized by such per the permit is es in d or , period the ninety m (90) days and will demonstrate may be r equesteted writing, from the Building Official for a period not to justifiable ble cause for in r the extension. If work ceases for ninety (90) consecutive days, the \ j ob is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO PROPERTY. YOU COMMENCEMENT MAY OBTAIN FINANCING, I PAYING TWICE FOR IMPROVEMENTS TO YO CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OW CONTRACTOR NER OR AGENT Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) before me this by by Who is/ era pe 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 G`-VJ °7 z�4:/ THAT PART OF EAST 80.00 FT OF NW1 /4 & THAT PART OF WEST 1/2 OF NE1 /4 OF SEC 24 LYING NORTH OF ZEPHYRHILLS BYPASS EAST AND LYING WEST OF MAJESTIC OAKS COMMUNITY -PHASE ONE AS PER PB 35 PGS 1 07-1 12 EXC NORTH 20 FT THEREOF FOR RD RNV & MAJESTIC OAKS COMMUNITY PHASE ONE PB 35 PG 1 07-1 12 LOT 1 THRU 16 INCL & LOTS 19 THRU 24 & LOTS 26 THRU 31 & LOTS 33 THRU 74 OR 6825 PG 87 1111111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111111 2009169360 NOTICE OF COMMENCEMENT Rcpt.: 1275216 Rec: 10.00 DS: 0.00 IT: 0.00 Permit No. 11/24/09 Dpty Clerk PAULA S. O'NEIL, PASCO CLERK & COMPTROLLER Property Identifcation No. -o16 -0 aZii aj,QD— 0090 11/24/09ayem 1 P6 f l OR BK 0 128 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 CO 1 .NCEMENT. 1.Description of property (legal description:) 67 13 . /n a edy/& dar ,eii' A l ' va a .* r 4/ /e9 i a) Street Address: 3 9 q Ai i f a, ' n , Jis . Ze, f f f SSYc 2.General description of improvements: '/ rl 0 , 74 Cc4 I>LQ.4 3.0wner Information '/'-, a) Name and address: 86- C,&/>c- // - - _I 0/! 3 9 S / 4 fla & /4d4 A l ,Q/� . Z4 4 / ,,(,.. j et iii b) Name and address of fee simple titleholder (if other than owner) d J ,g 0 c) Interest in property ontractor Information a) Name and address: •.--(4,e) <144 .4 -rite, /,r /c0/'/ ,c0t, Ai i �J i /- � ' b) Telephone No.: Fax No. (Opt.) 5.Surety Iniormation 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 X z / i 2;i7e-g/f---rale-01-0"7 Signature of O er or Owner's Authorized Officer /Director/Partner /Manager Print Name The foregoing ins en was acknowledged before me this oz-o day of i?(1Z 41h� 20' b ,6 G-! b&n. / gl OA as Itui 2/ Y in fact) for Jell- (type of authority, e.g. officer, trustee, attorney (name of party on behalf of whom instrument was executed). Personally Known OR Produced Identification V Notary Si G i ry gnature Type of Identification Produced 0 C, j / /�^ / , _ . Name (print) !� Al f • 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. f el.14_ ' FORMS/NOC,rvsd2007 Si a ture of Natural Person Signing Above NOTARY PUBLIC-STATE OF FLORIDA •'' Stacie Hartwig ��� ,i Commission # DD926164 s " a,,,.F � Expires: OCT. 16, 2013 BONDED THRII ATLANTIC BONDING CO., INC. STATE OF FLORIDA, COUNTY OF PASCO "" THIS IS TO CERTIFY THAT THE FOREGOING IS A ' UE AND CORRECT COPY OF THE DOCUMENT 4 FILE OR OF PUBLIC RECORD IN THIS OFFICE MY HAND AND P FICI SEAL TH�1 � ti.�'li�f : I �'•,` . DAY OF /(�/ _ �LLER •'N IL, CLEi COM `„ s ` &(Q, B`* ' , /� mac_ UTY CLERK �k' � Or • a.. . � . 9 ■ l•I'1•' City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor /Homeowner: �(// /1 5k4 4 /M i n ur Date Received: — // - /0 '(-) 9 Site: 3 9W/ liA)(4iXf(64<_ Permit Type: 34' " ` '•'e b.-t / c.A—e 6 l (3 Approved w /no comments: ❑ Approved w /the below comments: Denied w /the below comments: ❑ This comment sheet all be kept with the permit and/or plans. / — Kalvi Swit Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) //r ec' I l' ....,, 1 _ , / 3 CO 7 $ /d I , - ,•,- ' _,- ... , , - L. . ,--- , ,,, "--,.. ,•`-' ' c., ; , , L ......, 1 _ ; - - 71 1 1 % 1 - 1 --, *-,., N... 1 , 1 .... "--1 `-;• 1 , I JO , CO / .)- , 6 ' s „,_ ___ _." - ,., 4 , T . , _ I, , ; 1 , 1 1 1 ■ i 1 1 i ) _ . __.. / ihr /._ '' - 7) //q Z f t . f(j Florida Building Code Online Page 1 of 2 �.�� I ' ` I fi y` I ! t y an j, Ik - . s L, ,... , .._ ..es OCANOi€ AeOirr OCA OCA PROGRAMS CONTACTOCA ::!iir.1 < BCIS Home Log In User Registration Hot Topics Submit Surcharge Stets & Facts Publications FBC Staff BCIS Site Map Links Search l k if k '' ., Product Approval �' "` USER: Public User Community° ;{ �,. A{falrs ... Product Anoroval Menu > Product or Application Search > Application List > Application Detail FL161 -R3 z i.x.,: ' '' , . °� Application Type ,i rk PP Revision R•° '. .a,": * Code Version 2007 / • .. s r Application Status Approved 1 . . .r, ,, 1 , Comments F .7 7, 7 Archived Product Manufacturer Custom Window Systems, Inc. Address /Phone /Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368-6922 Ext 207 mlafevre @cws.cc Authorized Signature Michael LaFevre mlafevre @cws.cc Technical Representative Michael LaFevre ## Address /Phone /Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368-6922 Ext 207 MLaFevre @cws.cc Quality Assurance Representative Ralph Emminger ## Address /Phone /Email 1900 SW 44th Avenue Custom Window Systems, Inc. Ocala, FL 34474 (352) 368-6922 Ext 208 Ralph @cws.cc Category Exterior Doors Subcategory Swinging Exterior Door Assemblies Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who Roberto Lomas developed the Evaluation Report Florida License PE -62514 Quality Assurance Entity Keystone Certifications, Inc. Quality Assurance Contract Expiration Date 12/31/2010 Validated By Steven M. Urich, PE Validation Checklist - Hardcopy Received Certificate of Independence FL161 R3 COI 511038 (Eval ReD Guardian Door).pdf Referenced Standard and Year (of Standard) Standard Year. ANSI /AAMA /WDMA 101/IS2 -97 1997 Equivalence of Product Standards httn: / /floridabuilding.org /nr /nr ann dtl. asnx? naram= wGEVXOwtDawf4ngAXh1045csM... 6/11/2009 Florida Building Code Online Page 2 of 2 • Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 03/04/2009 Date Validated 05/05/2009 Date Pending FBC Approval 05/11/2009 Date Approved 06/09/2009 ..._....._......._.. ......_ ............. Summary of Products FL # IModel, Number or Name Description 161.1 Guardian Hinged Door Guardian Hinged Door w/ Glazed Insert (Operable or Fixed). Limits of Use Installation Instructions Approved for use in HVHZ: No FL161 R3 II CWS-176B (Guardian Door).pdf Approved for use outside HVHZ: Yes Verified By: Roberto Lomas 62514 Impact Resistant: No Created by Independent Third Party: Yes Design Pressure: +40/ -40 Evaluation Reports Other: Not for use in HVHZ. Primarily used with Screen Created by Independent Third R Guardian Door).pdf Rooms. Party: Ye 1161.2 IlGuardian Hinged Door IlGuardian Hinged Door w/ Solid Core. Limits of Use Installation Instructions Approved for use in HVHZ: No FL161 R3 II CWS -242A LGuardian Door no glass)•pdf Approved for use outside HVHZ: Yes Verified By: Roberto Lomas 62514 Impact Resistant: No Created by Independent Third Party: Yes Design Pressure: +40/ -40 Evaluation Reports Other: Not for use in HVHZ. Primarily used with Screen FL161 R3 AE 511050A (Eval Rep Guardian Door no Rooms. alass).pdf Created by Independent Third Party: Yes I Back Next DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee, Florida 32399-2100 (850) 487 -1824, Fax (850) 414 -8436 © 2000-2005 The State of Florida. All rights reserved. fspyLight and Disclaimer Product Approval Accepts: Lgal £L hecY. .1? 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Log In i User Registration Hot Topics Submit Surcharge I Stets & Facts Publications FBC Staff BUS Site Map Links Search , Product Approval 0 I \p „..._0/ USER: Public User .Community, Affairs Product Aoomval Menu > Product or Application Search > Application List > Application Detail D OCINRADDATY PLANDRYG FL # FL163 -R2 li Application Type Revision DEVELOPMeeT Code Version 2007 'EMERGENCY Application Status SKr Approved sampp Comments ° 14.1 " ' " Archived Product Manufacturer Custom Window Systems, Inc. Address /Phone /Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368 -6922 Ext 207 mlafevre @cws.cc Authorized Signature Michael LaFevre mlafevre @cws.cc Technical Representative Michael LaFevre ## Address /Phone /Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368-6922 Ext 207 MLaFevre@cws.cc Quality Assurance Representative Ralph Emminger ## Address /Phone /Email 1900 SW 44th Avenue Custom Window Systems, Inc. Ocala, FL 34474 (352) 368-6922 Ext 208 Ralph @cws.cc Category Windows Subcategory Single Hung Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who developed Roberto Lomas the Evaluation Report Florida License PE -62514 Quality Assurance Entity Keystone Certifications, Inc. Quality Assurance Contract Expiration Date 12/31/2010 Validated By Steven M. Urich, PE Validation Checklist - Hardcopy Received Certificate of Independence FL163 R2 COI 510510A (Eng Eval Rep SH- 3500).odf Referenced Standard and Year (of Standard) Standard Year ANSI /AAMA /WDMA 101/IS2 -97 1997 Equivalence of Product Standards Certified By Sections from the Code 1 oft 3/4/2009 9:53 AM Florida Building Code Online http : / /floridabuilding.org/pr /pr_ app _dtl.aspx ?param= wGEVXQWtD... Product Approval Method Method 1 Option D Date Submitted 11/10/2008 Date Validated 11/10/2008 Date Pending FBC Approval 11/14/2008 Date Approved 12/10/2008 Summary of Products FL # Model, Number or Name Description 163.1 3500 Single Hung 3500 Single Hung Limits of Use Installation Instructions Approved for use in HVHZ: No FL163 R2 II CWS -268A (SH- 3500).odf Approved for use outside HVHZ: Yes Verified By: Roberto Lomas 62514 Impact Resistant: No Created by Independent Third Party: Yes Design Pressure: N/A Evaluation Reports Other: 3500 Single Hung Equal Lite H -050 55x91; 3500 FL163 R2 AE 510510A (Eng Eval Reg SH- 35001.odf Single Hung Oriel H -C45 55x91 Created by Independent Third Party: Yes l Back Next DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee, Florida 32399 -2100 (850) 487 -1824, Fax (850) 414 -8436 © 2000 -2005 The State of Florida. 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