Loading...
HomeMy WebLinkAbout10-10753 CITY OF .ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10753 - PLUMBING PERMIT P ermit Number: 10753 Address: 38407 COTTONWOOD PL Permit Type: PLUMBING ZEPHYRHILLS, FL. Class of Work: PLUMBING RENOVATIONS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: DRIFTWOOD Est. Value: Parcel Number: 02- 26- 21- 021B -00F00 -0030 Improv. Cost: $" 3 p 325.00 � ,.�,.., � ' Date Issued: 7/23/2010 Name: PARKER, JAMES JR Total Fees: 35.00 Address: 38407 COTTONWOOD PL Amount Paid: 35.00 ZEPHYRHILLS, FL. 33542 Date Paid: 7/23/2010 Phone: (813)779 -0999 Work Desc: REPLACE SHOWER PAN GOLDEN RULE PLUMBING INC. PLUMBING FEE 35.00 G dam, i i r _ 1ST ROUGH PLUMB 2ND ROUGH PLUMB SEWER WATER 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 a 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances CONTRACTOR PER OF Iv' PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER. FROM GRAYSTONE CONST (FRI)JUL 23 2010 3:03 /ST. 3:03 /No.6880105721 P 2 GRAYSTONE CONSTRUCTION CORPORATION • 11412 North Central Avenue 6 Tampa, FL 33612 "� Ph: (813) 931.1680 • Fax: (813)931.1690 Purchase Order / Work Order To: Name: Golden Rule Plumbing P.O. Date: 07 -2240 Street: 23011 Bowman Rd Delivery Date: 07-23-10 City/State /Zip: Springhill, FL 34610 Job Name: Parker Job Address: 38407 Cottonwood Place City/State/Zip: Zephyrhills, FL 33542 Attention: Russ 352- 540 -9994 Job No: 0707002STR Re: Shower Pan Liner Cost Category: PLM r"{'.'.ce, ..wo1' ,•NUYr i iw:rr^ c t .art . 20.7.' rtzfl. ti? � 1Cl f �: � r^ni n ` ,� •. "( DESCRIPTION We authorize you to perform services and provide materials for the installation of the shower pan liner at the job noted above. **Cost includes permit and associated fees. Subtotal Terms: Sales !evokes me due on dsc 25 deeds month. Payload node on die 20 following moth. All atoeti.l Minted Labor F.O.B. jobaioe Total 375.00 This pardon order/w at ardor nordiedt a mama kir die p rehare of the Woe and atsterial lined above. aryls all tams of the men raet only as sawed bensie. b eommred to and bound by delivay doe as indicabd. The a.boe.a.sur wean* that On eaboae/vaew ros mend hiabliityt, oda aid waiters ampeanallas bnerance ie abed 'V > ... --- 2 - . sod _ derrin& that.. argon insara.re oertlaraee Au ai L , _ Signature Date; astoias Grapiest Coastrwedoa Carpsrado• r ddlliaasl Wand oast be reeand - aer die prier is nary payment - �� _ • as aaheona sesm'_ The si6.roa pardoner rdoner and of Ilse ►, , • selledabcontractor moms .emplane online loos by beds Ant riaed Selkr/Subcontractor Date: polies. 7xis pardon ado/work eider is not valid Was signed by the pardoner end ❑ Subcout actor Copy ❑ Field Copy ❑ Acco.nti.g Copy ❑ Cenral Contractor Copy JUL -23 -2010 03:43P FROM: TO: 18137800021 P..1 PASCO COUNTY BTTSINE;SS TAX RECEIPT 2009-10 Issued pursuant and subject to Florida Statutes and Pasco County Ordinances. Issuance does not certify compliance with zoning or other laws, This receipt must be posted conspicuously in place of business. Expires September 30. Mike Olson ACCOUNT NO: 080326 TAX X OLL TOR TYPE OF BUSINESS: SIC CODE: 17311.03 PASCO COUNTY FLORIDA PLUMBING CONTRACTOR •; y � � • 4ke : LOCATION ADDRESS: 23011 BOWMAN HD � SPRING HILL GOLDEN RULE PLUMBING INC ; 5r p " _23011 BOWMAN RD SPRING NILL FL 34610 -8202 +� „�:' :DATE RECEIPT AMOUNT 09/11/09 575288 31.25 611,11116JU oA 1A6AnI H 4 .if 1 i ( ACCOUNT NO: 080326 TYPE OF BUSINESS' SIC CODE: 1711.03 - PLUMBING CONTRACTOR • I3 f ii. LOCATION ADDRESS GOLDEN RULE PLUMBING INC 23011 BOWMAN RD 23011 BOWMAN RD SPRING HILL SPRING HILL FL 34610 -8202 DATE RECEIPT AMOUNT 1 '° 07/12/10 587003 31.25 ;1, Pid046H14141111WWWIdliPhhiulligNIPd iJ r - ..w.. . FROM GRAYSTONE CONST (FRI)JUL 23 2010 3:03 /ST. 3:03/No. 6880105721 P 1 GRAYSTONE CONSTRUCTION CORPORATION 11412 North Central Avenue , .1* r Yom, F 33612 Ph: (813)931-1680. Fam ( To: Z-hills Permitting Fax: 813 - 780-00211 From: Ken Lewis pate: 7-2340 Purchase Order for Golden Rule Re: Plumbing Pages: 2 including coversheet. CC: ❑ Urgent ❑ For Review ❑Comments ❑Reply ❑ Confirm Receipt Attn: Permitting Please accept the attached purchase order between Graystone and Golden Rule Plumbing as our agreement for him to perform the plumbing services needed at the noted jobsite. Any questions feel free to call at anytime. Thanks again, Ken .Lewis Project Manager 813- 293 -2979 ken eraystonecc.com 07/23/2010 08:58 3526848296 ECONOMY INSURANCE PAGE 01/01 I - DATE (MM/DDMri* ... 4 CERTIFICATE fOF 'LIABILITY INSURANCE 07/23/10 PRODUCER Economy Insurance Men, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7377 Spring Hill Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, OR Spring Hill, FL 34606 . ALTER THE COVERAGE AFFORDED Sy POLICIES BELOW, . ,.. Phone (352) 688 Fax (352) 688 - 6050 INSURERS AFFORDING COVERAGE I NAIC INSURER a: NORTH POINTE INSURANCE CO. I -. -, INSURED RUSSELL JOHNSON L ICp CFC1427079 INSURER B: MERCURY INSURANCE GOLDEN RULE PLUMBING INC- INSURER.C: _ 23011 Bowman Road - INSURER p: .. . - Spring Hill, FL 34610- ' INS E: I COVERAGES THE POLICIE OF INSURANCE LISTED 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 AI-LTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRT ADD'/. POLICY EFFECTIVE— FFECTIVE POLICY EXPIRATION I LIMITS TYPE OF INSURANCE POLICY NUMBER DRTE imwoorn DATE (MM/DOIYYYYI • _ . GENERAL LIABILITY EACH OCCURRENCE 300,0001 DAMAGE TO : TED 0 COMMERCIAL GENERAL LIABILITY 80900009018 03/12/2010 03/12/2011 PREMISES (Ea ocwRence) 100,0001 • ❑ ❑ CLAIMS MADE R OCCUR MED EXP (Any one person) 5,000 IA ❑ ❑ - _`__ -- PERSONAL 8 ADV INJURY _ 300,0_001 ❑ GENERAL AGGREGATE 600,0001 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG -- 600,000 • ❑ POLICY 0 PROJECT [] LOC AUTOMOBILE LABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO FLC 7015106 -2 06/02/2010 06/02/2011 (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY 100,000 B ❑ © SCHEDULED AUTOS . (Per person) ❑ HIRED AUTOS I BODILY INJURY ❑ NON OWNED AUTOS (Per accident) 300 i ❑ — PROPERTY DAMAGE 50,000+ 0 .. -- ---• .. - - -... _..._.... - ---- . . ..__..._.. ... -. -_.. ....._(Peraeddenll• GARAGE LABILITY AUTO ONLY • EA ACCIDENT ❑ ❑ ANY AUTO I OTHER THAN EA ACC, I ..... E L AVTO ONLY: AGG ' EXCESS 1 UMBRELLA LIABILITY _ I EACH OCCURRENCE ID • OCCUR 0 CLAIMS MADE ■ AGGREGATE • ❑ DEDUCTIBLE ' ❑ RETENTION $ WORKERS COMPENSATION AND • EMPLOYERS' LIABIUTY Y � I '.. T ORY LI M ITS- ❑ ERH ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT OFFICER / MEMBER EXCLUDED? - _! . . - -° (Mandatory In NH) El, DISEASE - EA EMPLOYEE — If yes describe under SPECIAL _ below _ -- E .L. DISEASE - POLICY LIMIT .. .. —�_ ... _. - ... - -._ - -- - -.. OTHER DESCRIPTION OF OPERATIONS 1 LO f VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ( PLUMBING 2006 FORD E150 VIN#1FTRE14W I 76DA32815 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL : CITY OF ZEPHYRHILLS BUILDING DEPT, 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 5335 8th ST. THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ZEPHYRHILLS, FL. 33542 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I I ! (61 3) 780 - 0021 ;0.., , ...N.a,�.v�.. I ACORD 25 (21109 /01) QF 01988 -2009 ACORD CORPORATION. Alf rinks reserved. The ACORD name and logo are registered marks of ACORD e -Bode Systems - Policy Send Form Preview Page .1 .of 1 .ACORDTM CERTIFICATE OF LIABILITY INSURANCE ° ATE(M 02/244/10 /10 ) ` ` � -- PRODUCER ECONOMY INS MART OF HERNANDO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND - 7377 SPRING HILL DR CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE SPRING HILL, FL 34606 POLICIES BELOW. Phone: (352)684-5353 Fax: (352) 684 -8296 INSURERS AFFORDING COVERAGE INSURED GOLDEN RULE PLUMBING INC. INSURER A: North Pointe Insurance Company 23011 BOWMAN ROAD INSURER B: INSURER C: SPRING HILL, FL 34610 INSURER D: INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR I POLICY EFFECTIVE • POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MM /DDIYY) LIMITS GENERAL LIABILITY EACH OCCURENCE $ 300,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 - 1 — )CLAIMS MADE ❑x OCCUR MED EXP(Any one person) $ 5,000 A 8090009018 _ 03/12/2010. 03/.12/2 ,. - . PERSONALANO $ - 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 600,000 E POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ ANY AUTO Sea accident) $ _ ALL OWNED AUTOS BODILY INJURY • SCHEDULED AUTOS (Per person) $ _ HIRED AUTOS BODILY INJURY $ _ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ E ANY'AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURANCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ RDEDUCTIBLE $ RETENTION $ 8 WORKERS COMPENSATION AND DWC STATUTORY EMPLOYERS LIABILITY LIMITS ❑OTHER E.L. EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS PLUMBER • • • • CERTIFICATE HOLDER I ADDITIONAL INSURED:INSURED LETTER: 1 CANCELLATION - (SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. DUNEDIN RESTORATION SERVICE, INC. AUTHORIZED REPRESENTATIVE 1271 SAN CHRISTOPHER DR. DUNEDIN, FL 34698 Faxed to: (727) '733 -3917 ACORD 26 -S (7/97) ACORD CORPORATION 1988 http: / /amelia.e- bode. com/ innovare /g1 /SendFormPreviewAndSend.cfm 2/24/2010 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES ; � DIVISION OF WORKERS' COMPENSATION { 3 F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY � elects exemption from this chapter by filing certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA "a 'j L p p y g WORKERS' C LAW � under this section may not recover benefits or compensation under this D chapter. EFFECTIVE: 06/05/2009 EXPIRATION DATE: 06/05/2011 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: RUSSELL R JOHNSON H exempt... apply only wituin the scope of the business or trade listed on Ism , 943470020 E the notice of election to be exempt. GOLDEN RULE PLUMBING INC ' ^" 23011 BOWMAN RD 4 'r ({suant to Chapter 440.05(13), F.S., Notices of election to he exempt if, af@rtiffice) f elution to be exempt shall be subject to revocation SPRING HILL, FL 34610 s A certificate, the per n na f' 'n of the notice or the issuance of the m�� 9 the requirements of this section the notice or the no longer meets department shall revoke a certificat)r issuance of a certificate. The SCOPE OF BUSINESS OR TRADE: person named on the certificate to 1 at any time for failure of the . 1- CERTIFIED PLUMBING CONTRACTOR section. 'eet Hy requirements of tLis a QUESTIONS? (850) 4 r3 4z CUT HERE * Carry bottom portion on the job, keep upper portion for your records. • IWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 o STATE OF FLORIDA ;` ' � ; , 2 : ,,D'DE T 'O BUS'iI SS`ro D c' 170.' - t tl� i 0 813 CER ' / i, � * . i .,.w rte.7uy! & i 7 , �Ca ,, JORNS1 y,, } ''I Jr' aP s S 1 ) COLD 1 1 @ i! I74 / f' "°&a C7IR , s,,, ,,, rr , . _ 'y ... k � y, .'' t ).„1;-!* ' Q ) `a ,s' . xxpir --P . - 1 n al r t �rA� '. , 1 , 20,`2 `L x»6 0 .:::.; ';, . 3 �' �kaa . . Pasco County Parcel: 02-26-21-021B-00F00-0030 001 Page 1 of 2 I Data Current as Of: II Weekly Archive - Saturday, .July 17, .2010 I Parcel ID 02 001 of 00 'Classification II 04 - Condominium Mailing Address Property'Value PARKER JAMES D JR Ag Land $0 38407 COTTONWOOD PL Land $6,351 ZEPHYRHILLS FL 33542 -6634 Building Physical Address $59,0 $0 Extra Features $0 38407 COTTONWOOD PL ZEPHYRHILLS FL 33542 -6634 Market Value $65;385 Assessed (Save Our Homes) $55,885 Legal Description (First 4 Lines) Homestead 196.031 - $25,000 DRIFTWOOD OF ZEPHYRHILLS A Non - School Additional Homestead Exemption - $5,885 CONDOMINIUM PHASE II Non - School Taxable Value $25,000 CB 3 PGS 44 -46 School District Taxable Value $30,885 BLDG F UNIT 3 AND COMMON Warning: A significant taxable value increase may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line I Use 11Descriptionl Zoning Units Type I Price I Condition I Value 1 II 0400 11 CONDO 1 00R4 1 1.00 0 UT 0 $6,351.00 1 1.00 1 $6,351 Additional Land Information I Acres 11 0.00 I Tax Area 3OZH FEMA Code I X IlResidential Codell 4DWZ I Building Information - Use 04 - Condominium (Card: 001 of 001) Year Built 1988 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall .2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall l Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 1.0 Line II { Description H Sq. Feet 1 Repl. Cost New ( 2 FEP II 80 I l$0 I 3 1 FST II 9 $0 1 4 1 FOP 30 II $0 1 Extra Features (Card: 001 of 001) Line I Description Year Units II Value 1 1 CARPORT 1988 320 2 1 CONDO 1988 1 1 $375 I1 $56,757 3 1 FOP 1988 30 11 $172 4 1 FEP 1988 80 II $1,601 5 1 FST 1988 9 $129 Sales History Previous Owner LAPIANA ANNA L TRUST Year 1 Month Book /Page 1 Type I Amount 2000 II 07 4417 / 0129 0 WD 11 $55,000 1997 3848 / 0433 I $57,000 i f $54,000 1994 11 03 3276 / 2065 WD http: // appraiser. pascogov. com / search /parcel.aspx ?sec= 02 &twn= 26 &rng=21 &sbb =021 B &... 7/23/2010 813 - 780 -0020 City of Zephyrhills Permit Application Fax -813- 780 -0021 Building Department Date Received , Phone Contact for Permittin a -- Owner's Name .10111711 ' (� w,_ Owner Phone Number 3 v t " Owner's Address 3 2 " \ 0 l Co 0 ( Go rj ,,,, A pi_ Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 3 4 C r( (»7 PL. LOT # 003 0 SUBDIVISION (. 1' PARCEL ID# 0 ?_ Z^ ( OZ.( 8 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN In 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE I SFR In COMM OTHER 1 TYPE OF CONSTRUCTION I 1 BLOCK n ( FRAME I 1 STEEL n DESCRIPTION OF WORK -St 0, k.� ' rCLV . RQ f .2i�J BUILDING SIZE SQ FOOTAGE HEIGHT 1 (BUILDING $ �p \% �°✓" / VALUATION OF TOTAL CONSTRUCTION 1 (ELECTRICAL $ (S AMP SERVICE I 1 PROGRESS ENERGY n W.R.E.C. PLUMBING $ (. 3Z ySl9 1 IMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ( r 1 (GAS I I ROOFING In SPECIALTY I 1 OTHER 11 3 F q INISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES NO �� q BUILDER C COMPANY /(J J. kol mil" l /17, Pt C-. SIGNATURE C am' l ) REGISTERED I Y/ N I FEE CURREI' 1 Y/ N I Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y/ N I Address License # PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREN I Y/ N I Address License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRE' 1 Y/ N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN I � Y N I Address (-3 80a4110.1€ r J .70 / / / i /.L . c (6-7/4 License # CFC /7 Z 70 l 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. (NC upgrades over $7500) ** 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 if shingles 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 IMPACTIUTILITIES 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 tequested, 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 m t or a )p� fob this b —Z3 (6 by x .. ei ra-- A- N/Q01iSG5 y Who is /are er onall nown to me or has /have produce Who Is/are personally known to me i has/have produced p $ y as identification. as identification. is- � eft Notary Public i 41:. ";f ; Notary Public *'= Commissio De :rice 21833 Commi-,io -% Commission No. 010 'Ri .t 4` s' Bo Th in Troy Fein 800- 39y7013 Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped