HomeMy WebLinkAbout10-11288 CITY OF ZEPHYRHILLS /
5335 - 8TH STREET ✓
(813)780 -0020 11288
BUILDING PERMIT
Permit Number: 11288 Address: 37410 DERBYSHIRE DR
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: WEDGEWOOD MANOR
Est. Value: Parcel Number: 10- 26 -21- 0120 - 00000 -1060
Improv. Cost: 3,300.00
Date Issued: 12/10/2010 Name: MILTON, CLARENCE
Total Fees: 55.00 Address: 37410 DERBYSHIRE DR
Amount Paid: 55.00 ZEPHYRHILLS, FL. 33542
Date Paid: 12/10/2010 Phone: (813)782 -4347
Work Desc: A/C CHANGE OUT 3 TON
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DUCTS INSULATED
FINAL 1-10-1(
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."
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CONTRACTOR SI TURE PERMIT OFFI 'R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780 -0020 City of Zephyrhills Permit Application tax- aiii- /M-uuz►
Building Department f . J 12 b (1J
Date Received 1 (1
( "` Phone C ontact for Permitting J 5� - • -�7 7
r
Owner's Name I 1 1 0 Owner Phone Number 213- �� "t 1
Owner's Address 3 '7 i410 1/6 91 sY 1 NYt Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number I
Fee Simple Titleholder Address `` `` ��p�
JOB ADDRESS 3 '7 `T 10 �/r 19 sh (Y t LOT #
SUBDIVISION Wtett f w o t t PARCEL ID# 10-&)-21- D! C - 00000 ~ 1 t '
tJ (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED I I NEW CONSTR ADD /ALT n SIGN n MOVE n DEMOLISH
INSTALL REPAIR
PROPOSED USE I 1 SFR I I COMM I I OTHER I I
TYPE OF CONSTRUCTION I I BLOCK I I FRAME I STEEL I I OTHER 1
DESCRIPTION OF WORK al U uiiMJ All . Sys-kr '
1
BUILDING SIZE U SQ FOOTAGE HEIGHT
1 I BUILDING $ VALUATION OF TOTAL CONSTRUCTION
I I ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY n W.R.E.C.
I I PLUMBING $
Dini MECHANICAL $ 00 00 VALUATION OF MECHANICAL INSTALLATION
I I GAS I I ROOFING I I SPECIALTY I 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES I INO
BUILDER COMPANY I
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
•
Address License # I I
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address 1 License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address License # I
MECHANICAL /j $ , COMPANY 1 (.�V 1 / W '
c r ��' r ""� Y / N FEE CURRENT Y / f
SIGNATURE REGISTERE I I I
Address 1 �O 3✓, 1/L ► 31 1 liC.,- License# I CACO585`
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I
Address 1 License # I
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 (PIot/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'SIOWNER'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.
1 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. understand other installations r not specifically included in the appl'icafion� A
plumbing, signs, wells, pools, air conditioning, gas,
permit issued shall be construed to be a license to proceed with the work and not as authority to . violate, cancel, alter, or
reeq u ic any a cor rect of errors rors the in plans, construction co d s or a violat violations of any codes. the Building Official from thereafter t issued shall become invalid
rqirng recton of r in plans, by
unless the work suspended or or a by such bandoned d permit period of six (6) within
onths after the time the is commenced. An extension
the permit is suspe
may be requested, r in the wexin tension. the Building
ceases Official
ninety period not to exceed ninety
days, the job is considered onside and
abandoned. andoned. demonstrate
justifiable cauo t exn
IN YOUR
WARNING OWNER: YOUR FAILURE TO RECORD A
TO YOUR PROPERTY. YOU INT
END NCEMENT MAY OBTAIN F NANC NG,
PAYING TWICE FOR IMPROVEMENT
WITH YOUR LENDER OR AN ATTORNEY BEFOR RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117 3) 4 1 �
t f l f ! CONTRACTOR
OWNER OR AGENT Subscribed and sworn to (or affirmed) before me t�,�
Subscribed and sworn to (or affirmed) before me this' by
by Who Who is /a l naiitiknown to me or has /have produced
Who is /are personally known to me or has/have produced as identification.
as identification. r
Notary Public
Notary Public
Commi io No. _ 1
Commission No.,
Name of Notary typed, printed or stamped
ame of Notary typed, printed or stamped
S ,20- )&- 1-6.1q,_ -�
4CH RI S ' AIC SERVICE ORDER
AIP
HIGH EFFICIENT HEATING & COOLING
HVAC
INVOICE
C O M P A N Y
8462
CACO58575
12232 HWY 301 DADE CITY (352) 521 -4977
DADE CITY, FL 33525 ZEPHYRHILLS (813) 779 -9515
BILL TO:
Wedgeweed
- SPLIT SYSTEM f x 1 IPKG UNIT '
NAME: MODEL #
( liftnn Miltnn DATE: 12/1n/1 n 4TTRA0AR11 1 nnnAA
ADDRESS: SERIAL #
37410 Derbyshire Dr 1047111 F3F
CITY: ZIP CODE:
7caphyrhillc
PHONE: 813- 782 -4347 WORK: MODEL # 4TEC3F36B1000AA
CELL: RENTER: SERIAL #
104817KM 1 V
TECHNICIAN: DATE:
.lnsh /.lnrdan 1 2/1 n
PROBLEM REPORTED: BRAND:
Trane
DESCRIPTION OF WORK PERFORMED
Trane 3 ton 13seer straight cool split system. 10kw heat. pad. digital thermostat. PARTS & LABOR
auxilary pan, 2 float switches, hanging kit, connected to existing ducts and electric, PARTS ONLY X
new #6 wire for heater, Tax, labor included START UP
12/10/10
RECOMMENDATIONS hose
10 Year r omprp Warranty
5 Year Parts Warranty
PAYMENT 1 Year Labor Warranty
CHECK # DUE:I I CASH: I I
CREDIT CARD #: SUCTION PRESSURE:
CARD TYPE: LIQUID PRESSURE:
APPROVAL CODE: TEMP. DIFFERENCE:
EXPIRATION DATE: FILTER:
DRAINING PROPERLY:
I HAVE THE AUTHORITY TO ORDER THE WORK OUTLINED ABOVE WHICH HAS BEEN
SATISFACTORILY COMPLETED. I AGREE THAT SELLER RETAINS TITLE TO EQUIPMENT
AND MATERIALS UNTIL FINAL PAYMENT IS MADE. IF PAYMENT IS NOT MADE AS LIMITED WARRANTY EQUIPMENT, PARTS AND MATERIAL
AGREED, SELLER CAN REMOVE SAID EQUIPMENT AND MATERIALS AT SELLERS EXPENSE HAS WRITTEN MANUFACTURER'S WARRANTY ONLY.
ANY DAMAGE RESULTING FROM SAID REMOVAL SHALL NOT BE THE RESPONSIBILITY
ALL LABOR PERFORMED BY CHRIS' A/C HAS A ONE YEAR
OF SELLER.
WARRANTY. CHRIS' NC MAKES NO OTHER WARRANTIES
TOTAL: $ 3300.00
CUSTOMER SIGNATURE DATE: