HomeMy WebLinkAbout10-11125 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 11125
BUILDING PERMIT
Permit Number: 11125 Address: 37554 DALIHA TERR Bldg 21 #209
Permit Type: ADDITION /ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434 - ADD /ALT RESIDENTIAL Township: Range: Book:
Proposed Use: TOWNHOMES Lot(s): Block: Section:
Square Feet: Subdivision: EILAND PARK TOWNHOMES
Est. Value: Parcel Number: 03- 26 -21- 0230 - 00000 -2090
Improv. Cost: 43,660.00
Date Issued: 11/10/2010 Name: US HOMES CORP - LENNAR
Total Fees: 452.50 Address: 37554 DALIHA TERR Bldg 21 #209
Amount Paid: 452.50 ZEPHYRHILLS, FL. 33542
Date Paid: 11/10/2010 Phone:
Work Desc: REPAIR/REMODEL SEE SCOPE OF WORK
11.- ..Y 1 :U • .51 L • • •1.II
EDMONSON ELECTRIC INC PLUMBING FEE 40.00 MECHANICAL FEE 40.00
BAYONET PLUMBING HEATING & AIR C FIRE PLAN REVIEW FEES 25.00 FIRE INSPECTION FEES 15.00
BAYONET PLUMBING HEATING & AC IN
l4-/1 •
.. - 2 . - . I - - L Y: V 1 I •
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE -METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE -SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
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 , , tice of commencement."
10_
CONTRA ATURE PERMIT OFFI R
PERM T EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813.76U-UUCU Lolly VI LpIIyi11111J 1 illni. nNNnvu 17
Building Department / (�
Phone Contact for Permitting 8 /___ ? b I - 3 c.3 ate Received / r� / // l 9'7 — / 0 0
sm/a# / t4 cniel 6rnel LUFZ' Owner Phone Number L � 1
nrner's Name RAVENORa9. !
Nner's Address j 375.5 V. . DAL1B --rEri-fL' Owner Phone Number
le Simple Titleholder Namer
1 Owner Phone Number 1
•
;e Simple Titleholder Address I ik ti\
3 755# vn/A _ 7t/L� 2EP1/yieis'/c�t/ t � G 335 - LOT # HT d q
)B ADDRESS �J / Q
/44N,C) 411 6
PARCEL 3— .260""2- 0.23 00000-2 I
UBDIVISION
1 ,,/% (OBTAINED FROM PROPERTY TAX NOTICE)
IORK PROPOSED
r. I NE W CONSTR ADD /ALT 1 I SIGN 1 I MOVE 1 1 DEMOLISH INSTALL REPAIR
IIMI ROPOSED USE 71 SFR I COMM 1 I OTHER [
YPE OF CONSTRUCTION BLOCK I ( FRAME [ I STEEL 1 OTHER ( ,/
ESCRIPTION OF WORK kEPAI/t' / Reno DF L .J //(// —LC F4M /� � F,S / �'� c � - Try
UILDING SIZE 1 1 SQ FOOTAGE I / 7/ 1 HEIGHT 1 a .. 1
B $ 5 i/ 65-0 1 VALUATION OF TOTAL CONSTRUCTION
• ELECTRICAL I$ 3 V
AMP SERVICE tg PROGRESS ENERGY 1 W.R.E•C
• PLUMBING $ y3 ` 1
5 j
• MECHANICAL $ 1/.2 — I VALUATION OF MECHANICAL INSTALLATION
• GAS n ROOFING [ 1 SPECIALTY I 1 OTHER
'INISHED FLOOR ELEVATIONS FLOOD ZONE AREA [ YES 1 INO
A
■ 3UILDER / _ \`� COMPANY l N/�A� /7/0/4•14-5
_� /� % 3IGNATURE REGISTERED [ Y / N 1 FEE CURRENT 1 Y / N
Address 0 1.441fl"AVF,At.±'Z /o G wfrf7L,Fc739O License# I COG/ a 551.51
Y , & COMPANY 1 tUNo,u 5 o Ai E G EC 7 .Z// C C.
31GNATURE
ELECTRICIAN ,..°°......4., IN REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y/ N 1
Address i ..Sf4 /f /t..L74A /'1i4■ rL 33 6/3,) License# L C 00 0.25. 79
PLUMBER )v r
COMPANY $A YO/I/ET Pt Lin tS/N&„h - emit , 9 '4 C
SIGNATURE � (� REGISTERED Y / N FEE CURRENT Y /.N
Address 1 a 0 80,X .533" SA WA/Er'zb /NrIR 3 5447y License # C Pc _ 9 8
MECHANICAL ,
*) COMPANY 8qY On/ET �c vM0 /.(/�,► KE�7i'V � G
i �
SIGNATURE , REGISTERED I Y / N I FEE CURRENT [ Y / N 1
Address . �� BOX 530g $# ONFT7 /N/ r G -.' ?V1 License # CAC J,S3 ' 0 2
OTHER
/(//14 COMPANY C3 L. /A16- 0q‘/Ty /QOGIF- 7u6,.Zvt..
SIGNATURE REGISTERED ( Y / N 1 FEE CURRENT 1 Y / N 1
Address ¥2 /I.. 5 4104 L /uE St_vo c s P 2 o V G / 4 / u , cis WO License # CC" CO 3 7 99
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 onslte, 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 onslte, Construction Plans, Stormwater Plans w/ Silt Fence Installed,
Sanitary Facilities & 1 dumpster, Slte 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 Protectibn- 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 ting will be submitted used
at time of p drainage
permitting which Is prepared edby agprofessio addressing
professional engineer
"compensating
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 required. condi
ons set forth in
If I am the AGENT FOR THE OWNER, I promise lh that n a o s pahat permit t may be r d for cal work,
this affidavit prior to commencing construction. I understand
plumbing, signs, wells, pools, air conditioning, gas, or other installations not spetcificallyhinict luded in the application. A
permit Issued shall be construed to be a licensenor shall issuance wii h the a permidt no a n t it o B r y in Official from ther
set aside any provisions of the technical codes,
requiring a correction of errors in plans, construction or l within six of of perm Pssuaince g , or if wo auto
unless the w authorized by such permit is commenced days .demonstrate
the permit is suspended or abandoned for a period ffc(al for a period not to the tyre 90 is) ds nd commenced, de n
An ned ens o on
O
may be requested, in writing, from the Building ,
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, th�job is considered aban o • NT MAY RESULT IN YOUR
PAYING TWICE FO
WARNING TO OWNER: YOUR F LURE TO RECORD A NOTICE OF COMMENCE
R IMPROV f TO YOUR PROPERTY. IF YOU INT _ INTEND TO uy�: A IN FINANCING, CONSULT
"e= k- u
WIT 0 R LE DEL'. 0 ► ' �,, BEF � RE RECORD NG YOUR '.. /.
FLORIDA JURA7 (F.S, 117. - 00) ��
. .�', .,
) CONTRAC TOR ion .�
OWNER OR AGENT .__ ' s 3"vwE Subscribed and sworn to (o 75rIr G -• - e this wn+
S+�bscribed and sworn to (o ii'►�.c'� " "' ?.v/ by '
9. to b :loge V iLI .cy y�h.� .re personally known to me aoc
Who are personally known to m as identification. as has /h Idenve prtification, dued
/� Notary Public
• - ary Public '� �' /� ~
AI DD 771/ 023 Commission No. •
Commission No, „. „ "
" . ' Name of Notary typed, printed or stamps = .f'',', ; __ Commission 00 774023 te ;p i I 774023 } ''"' ' 1. Expires June 6, 2012
Name of Notary typed, prl =:• ; -;�- � :mmi D D � '"a• -.: - � 3esao +a
t' s June 6, 2012 - 'of,or . doodad TON Troy Hon 'Murano to)
; Expire 5,019
1 .....::;2'''P ` ®xndetlT11N Troy fain nom) P00 38
r, f t;
City of.Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: t Win'eS
Date Received: /O 27- l 0
Site:
3 7 55/ Jal,1 T _ty- ,& / &niz 2/ ZOy
Permit Type: /P e dei
Approved wino comments: ❑ Approved w /the below comments: Denied w /the below comments: ❑
� `� .t % 1 C. f (. U •�� ( !.' f 1 f t I � �. '.' t t 1, 1 .._,.
This comment sheet shall be kept with the permit and/or plans.
l D a Kalvin Switzef - Puns Examiner Date Contract. ..Ja ;r owner
(Required wh n comments are present)
SCOPE OF WORK
Original Permit # 6015
Home Address 37554 Daliha Terr, Zephyrhills, FL 33542
Construction Value: $26,587.00
Pre - Demolition
• Disconnect electric panel from home
• Keep one (1) GFI outlet in garage only for irrigation, pool (if needed) and power
for repairing home
• Turn off gas line in home (if needed)
• Remove existing outlets and switches from electrical boxes
Demolition
• Remove selected drywall
• Remove insulation (except foam insulation against block wall) if any
• Remove/Repair any damage to existing studs - 10‘ C
bi ‘` "�.
• Remove cabinets, countertops and fixtures as necessary k b i 14 --
• Remove tubs, commodes, sinks and hot water heater f
• Remove all appliances as necessary ";
• Remove all duct work and air handler, refrigerarliin'es and'�VAC grills
• Remove flooring -tile, carpet, hardwood, etc. as nee dui
n
• Remove all interior doors and trim, mirrors and shower doors as needed
• Remove /repair any copper damaged by drywall
• Remove all switches and outlet plates
• Note: during demolition we will bring home back to rough -in mechanical,
electrical and plumbing stage. No structural changes will be made in home.
Mechanical Scope of Work
• Re- install all new trunk lines and duct work per what is in existing home
including bath fans
• Replace interior compressor unit
Plumbing Scope of Work
• Repair and replace any damaged copper
• Install new copper after removal as necessary
• Install new tubs and fixtures as necessary
• Repair and replace any damaged copper
• Install new copper after removal as necessary.. r ,
Pagelof2
n LA
15550 Lightwave Drive, Suite 210 Clearwater, FL 33760 • Phone: 727 - 479 -1700 • Fax: 727 -479 -1707 Q
LEIVNAR.COI1/1 e„•
Plumbing Scope of Work (Continued)
• Install new tubs and fixtures as necessary
• Install new commodes and fixtures (at finish) as necessary
• Check for any damage after demolition and repair as needed
• Install new hot water heater
Electrical Scopes
• Repair damaged ground wire in switch, outlet, and light boxes
• Keep existing recessed cans as necessary
• Keep all light fixtures and ceiling fans, reinstall at finish
• Install all new outlets, switches and trim plates
• Install all new recess trims
• Install all new light bulbs throughout homes
Insulation Scopes
• Install new insulation to match or better from whatever was removed during
demolition
• Check and install any fire stopping as needed
Inspections (rough in)
• Mechanical
• Plumbing
• Electrical
• Insulation
Inspections (final)
• Mechanical
• Plumbing
• Electrical
• Insulation
• Final C/O
Page 2 of 2
15550 Lightwave Drive, Suite 210 Clearwater, FL 33760 • Phone: 727 - 479 -1700 • Fax: 727 - 479 -1707
LENNAR.COM
Zephyrhills Fire Rescue
6907 Dairy Road. Zephyrhills, FL 33542
Fire Marshal Bus (813) 780 -0041
Kerry Barnett Fax (813) 780 -0044
E-mail: kbarnett (a)fire.zephyrhills.fl.us
Plan Review #: 10 -131
Project: Renovation /Drywall Replacement
Number of Pages: Packet
November 5, 2010
1 have received and reviewed the packet for the renovation for Chinese drywall located at
37554 Dahlia Terrace and will allow the project to move forward. Please note that this
review does not eliminate any further requirements as the project continues moving
forward. By receiving permit, contractor acknowledges to comply with the items listed
below. Should anyone have any questions, please do not hesitate to contact the Fire
Marshal's office.
1. Firewalls will be required to be looked at prior to any drywall being reinstalled to
verify no additional penetrations have been made and if so sealed in accordance to the
code to maintain the fire rating.
Inspections Required:
1. Firewall
2. Final
.•,1i
KERRY BA' +' FIRE MARSHAL
** *Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes. This review is not intended to be a final approval of the
submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances. In the event that further examination or site
inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole
expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure
to be in compliance with all applicable NFPA codes and local ordinances.
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: /l/- /3 / Contractor: Lem tY /"eve
Business Name: /f Billing Address; r .1 I' A u .6 yi- l Z/)
Business Address: j���� /�a, C r r,4.-Ja • .r z._ .3524°
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES _ INSPECTION FEES PERMIT FEE _ FALSE ALARM FEE
II Site Plan N/C Annual N/C Sprinkler $50 _ 1st Alarm N/C
ii ulti - Family/Com 41111 • . sf ^ 1st Re- inspection N/C _ Standpipes $50 2nd Alarm N/C
(Minimum Charg a _ 2nd Re- inspection $100 _ Fire Pump $50 _^ 3rd Alarm N/C
0 Plan Revisions DBL — 3rd Re- inspection $250 ^ Hoods $50 — 4th Alarm $100
_ 4th Re- Inspection $500 _ Fire Alarm $50 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas $50 — 6th Alarm $200
— 0 - 25 Heads $50 violations corrected) _ Natural Gas $50 _ NON COMPLIANCE $150
26 plus Heads $100 _ SPRINKLER SYSTEMS Fuel Tanks - per tank $50
STANDPIPE SYSTEM _ Hydro Undergrounds $45 — Sparklers $100
El Per Riser $50 — Hydrostatic Te $65 per system — Fire Works $500
FIRE PUMP _ Acceptance Test $45 per system Camp Fire $25
El Per Pump $100 _ Hydrant Flow $75 Controlled Burn $100
~
FIRE ALARM SYSTEM _ Hood/Duct $50
0 - 25 Devices $50 _ FIRE ALARM SYSTEM — Place of Assembly $50 Annual
26 plus Devices $100 — System Acceptance $50 —
Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 _ Flammable Application $50 Annual
Wet $50 OTHER _ Waste Tire Storage $50 Annual
— Dry $50 i re Wall /Smoke Wall 1 5 11 Generator < KW $100
`
CO2 $50 LP Gas per tank Generator >30 KW 150 —
Other $50 Natural Gas $25 per system Bio- Hazard Waste $100 Annual
—
KITCHEN EXHAUST — ` _ Fumigation Tenting $50
❑ Hood /Ducts $50 ^ Tent 10'x10' or greater $15 per tent _ Torch Pot/Applied $50
OTHER .-- Fire Pump $45 _ Haz. Materials $100 Annual
— LP Installation per tank 550 Fire Suppression $30
`
Fuel Tank Installation $50 System Acceptance
(Per Tank) $50 Exhaust Hood /Duct $30
—
El Natural Gas Installation $50 _ Re- inspection DBL
(Per System) (other than annual)
0 Spray Booth $50 ri Inspection scheduled DBL —
and cancelled less than _
_ 24 hours
— Construction Insp. N/C
— Emergency Vehicle Acs $5 FALSE ALARM
PLANS TOTAL il- INSPECTION TOTAL A5 PERMIT TOTAL' I TOTAL [I_
[[��`` GRAND TOTAL I �) "—
Comments:
Date:
Inswctor: `� Z�// 1--/ -i
y
STATE OF FLORIDA, COUNTY OF PASCO IIIOIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1IIIIIIIIIIIIIIIIHIIIl
THIS IS TO CERTIFY THAT THE FOREGOING IS A ,< 2010165519
TRUE AND CORRECT COPY OF THE DOCUMENT 1
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE Rept :1336457 Rec: 10.00
WITNESY HAND AND OFFICIAL SEAL THIS DS: 0.00 IT: 0.00
----DAY OF_ 2 11/17/10 L. Korb, Dpty Clerk
PAULA S O'NEIL, CLERK & COMPTROLLER
DEPUTY CLERK NOTICE OF COMMENCEMENT
PAULA S.0'NEIL,Ph.D.PASCO CLERK & COMPTROLLER
11/17/10 OR BK 124 , 8 PG o 6 7
Permit No. OR BK 8
Property Identification No. 03- 26-21- 0230 - 00000 -2090 �+
THE UNDERSIGNED hereby gives notice that improvements 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.
I. Description of property (legal description :) Lot 209 EILAND PARK TOWNHOMES PB 60 PG 102
a) Street Address: 37554 DALIILA TERM ZEPHYRHILLS FL 33542
2. General description of improvements: Repair / Remodel Single Family Residence
3. Owner Information
a) Name and address SINGHL RAVENDRA R / RODRIGUEZ_ VILMA 37554 DAU HA ]ERR IF.PHYyatlS R. 33542 .
b) Name and address of fee simple titleholder (if other than owner)
c) Interest in property
4. Contractor Information
a) Name and address: LENNAR - 15550 Lightwave Drive Ste 210 Clearwater, FL 33760
b) Telephone No.: (727) 479 — 1700 Fax No. (Opt.)
5. Surety Information
a) Name and address: N / A
b) Amount of Bond: N / A
c) Telephone No.: Fax No. (Opt.)
6. Lender
a) Name and address: N / A
• 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: N / A
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: N / A
b) Telephone No.: Fax No. (Opt.)
9. Expiration date of Notice of Conunencement (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
all y /
cot3NTY of PASCO IJ OIL itSJW (T 1� / l l / Y • ( I ,I ( 1
Signature of Owner or Owner's Aut on d Office /DQeaor /Pawmerg(tuuger
SINGH. RAVENDRA R / RODRIGUEZ. VILMA
Print Name
The foregoing instrument was acknowledged before me this 2• of OC T ; II frL , 20 J , by V /'A,.,i, leos,trLae y
/1y vfnr Oa.* 5 i u co as Owners (type of authority, e.g. officer, trustee, attorney
in fact) for _ (name of party on behalf of whom instrument . executed).
Personally Known OR Produced Identification X Notary Signature
-4:4 ELISSA M. HOlLERAN
Type of Identification Produced Name (p nt) Ft t Isst0I1 DD 774023
Drivers License # Sa) O ,Z ?j y�� . Nit trT h e JUit 6 2012
— cr (oO" —�( genNbAtfMY11 ®yhklMUrd10180D
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, 1 declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief. ) /
•
Signature of Nanual Penton S '7 bove
FORMSMOC., ,d2oo7