HomeMy WebLinkAbout11-11388 CITY OF ZEPHYRHILLS
5335 -8th Street
(813)780 -0020 11388
ELECTRICAL PERMIT
Permit Number: 11388 Address: 4623 CHARTER ST
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRIC SERVICE REPLACEMENT Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Contractor: SOLAR INDEPENDENCE LLC Book: Page:
Square Feet: Subdivision: EDGEWOOD
Est. Value: Parcel Number: 14- 26 -21- 0270 - 00000 -0290
Improv. Cost: 150.00
Date Issued: 1/10/2011 Name: BARTON TIFFANY
Total Fees: 40.00 Address: 4623 CHARTER ST
Amount Paid: 40.00 ZEPHYRHILLS, FL. 33542
Date Paid: 1/10/2011 Phone: (813)779 -9064
Work Desc: REPLACEMENT OF LIGHT FIXTURES AND EXISTING WIRE
ELECTRICAL FEE 40.00
/
ROUGH ELECTRIC
CONSTRUCTION POLE
PRE -METER
FINAL - -�(
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are
necessary due to any one of the following reasons: a) wrong address b) condemned work resulting from faulty construction
c) repairs or corrections not made when inspection called d) work not ready for inspection when called e) permit not posted
on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before
recording your notice of commencement."
Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City
Codes and Ordinances.
CONTRACTOR PERMIT OFFI "-
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 Perm Application Fax -813-780-002 1
Building Department ffL)
ot
Date Received / Phone Contact for Permittin , — C
Owner's Name j ^ �C i K y ♦ rd h Owner Phone Number /3- L/79- 0 7 13
Owner's Address qt c) 3 v 4- --, v c5-L Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number I
Fee Simple Titleholder Address
JOB ADDRESS 4 7 1 Ua3 C_kc,rA-- Si- LOT #
SUBDIVISION , PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN n I 1 DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR n COMM I I OTHER I I
TYPE OF CONSTRUCTION BLOCK n FRAME 1 I STEEL n I I
DESCRIPTION OF WORK - At r'r( o ? hp -e �Qv /i L / (,) s . c�� r .�s ,Cj �� v
4 --.: . �i KJ'rtt
BUILDING SIZE SQ FOOTAGE � 4 HEIGHT I `J �J
1 (BUILDING $ VALUATION OF TOTAL CONSTRUCTION
E LECTRICAL $ ( 5 . 0 AMP SERVICE 1 ( PROGRESS ENERGY n W.R.E.C.
I (PLUMBING $
1 $MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
1 1GAS I ROOFING n SPECIALTY I I OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I (YES NO
BUILDER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREI' I Y/ N I
Address I License # I I
ELECTRICIAN COMPANY ---S17 E l -e e r
SIGNATURE �(�,/9�I/`, (�) -C REGISTERED I Y / N I FEE CURREI' ( Y/ N
Address I S3 E/t r t dv r t4- I ,c9 «, ( License # 1 E7Z /3G / 4 / ( a J
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREF I Y/ N I
Address I License # I I
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREh 1 Y/ N I
Address I 1 License # I I
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREh I Y/ N I
Address I 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 $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 IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and
90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law — Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner ", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S /OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection - Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- 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. 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 requested, 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 swom to (or affirmed) before me this Subscribed and sw o m eg) a efore a this
by - 1121 by Li 4't 4. .
Who is /are personally known to me or has/have produced Who Is /are personally known to me or has/ha e produced
as Identification. C c eASA- as identification.
Notary Public ' i im— AC "�� _ Notary Public
QUE J BOGES
Commission No. Comm = on N 'a' • i u; . �, ry
Decem 12, 2014
Name of Notary type., °' ` 701D
Name of Notary typed, printed or stamped ry � p . _,.
r4 Win_ 10, 201' 4; 03PM NOVAK AGENCY No, 2520 P. 1/1
t+ERTiri4H i C OF LIABILITY INSURANCE DATE(MMIDDn'YYY)
PRODUCER 01/10/2071
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
NovaltAgency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
11590 Seminole Blvd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Largo FL 33778
727- 393 -0640 INSURERS AFFORDING COVERAGE NAIC #
INSURED JUDITH A NICITA INSURE- A: WESTERN HERITAGE
SOLAR INDEPENDENCE LLC INSURER
3055 ELKRIDGE DR
INSURER C;
' HOLIDAY, FL 34691 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTEDBELO WHAVEBEENISSUEDTOTHEINSUREONAMEDABOVEFORTHEPOLICYPERIODINbICATED .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 INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREI IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I TR ` r D L POLICY EPFEECrnie POLICYF�(PIRATION
SBIk rvoF OF INSIIR�rF PQLK:Y NUMBER n,YF n11NW111 PO i i I ATIO LIMITS
GENERAL LIA8ILITY EACH OCCURRE E $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY GL10190 06/17/10 06/17/11 P aF , , °, .9 $ 100,000
CLAIM$MIADE 113 OCCUR MEDEXP !Any ere Person) S 5,000
PERSONAL $ 1,000.000
GENERAL AGGREGATE $ 1 1 000,000
GEN'L AGGRE TE LIMIT APPLIES PER: PRODUCTS - COMPIOP AS,G $ 1,000,000
POLICY LOC
AUTOMOBILE LABILITY
ANY AUTO COMBINED SINGLE LIMIT $
(Ea accident)
_ ALL OWNED AUTOS
— SCHEDULED AUTOS BODILY INJURY (Per (Per person)
— HIRED AUTOS
NON -OWNED AUTOS BODILY INJURY $
(P'er accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS! UMBRELLA 41ABILITY EACH OCCURRENCE $
OCCUR El CLAIMS MADE AGGREGATE $
$
_ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION wC STAT OTHL
AND EMPLOYERS' LUIBILITY Y 1 Tno i wi 1 I RR
ANY PROPRIETOR/PARTNER/EXECUTIV�
OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $
(Mandalay In NH)
IyN deaori6a under E .L DISEASE - EA EMPLOYEE S
SPECAAI. PRAVISKlNS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESORIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
LOCATION: 3055 ELKRIDGE DR, HOLIDAY, FL 34691
ELECTRICAL/SOLAR CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
SNOULO ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF ZEPHYRHILLS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 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,
AUTHORIZED REPRESENTATIVJ K111,ry7
1813- 780 -0021
ACORD 25 (2009101) &h 19118 -2009 ACORD CO e .mrehts reserved.
The ACORD name and logo are registered:marks Of ACORD
STATE DEPARTMENT OF FLORIDOA SERVICES f '
- F FINANC
DIVISION OF WORKE I FR
RS' IND y
CERTIFICATE OF ELECTION TO BE EXEMPT OM FLORIDA
W ORKERS ' COMPENSATION LAW
EFFECTIVE: 09/ CITA
15/2010 EXP IRATION DATE 08/14/2012
PERSON: JUDITH NI
FEIN: 800461779
BUSINESS NAME AND ADDRESS:
S OLAR INDEPENDENCE LLC
DBA S I ELECTRIC
3053 ELKRIDGE DR
HOLIDAY, FL 34691
S COPE OF BUSINESS OR TRADE:
2- SOLAR ENERGY SERVICE
1- ELECTRICAL WOR
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