HomeMy WebLinkAbout11-11684 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
, ' (si3)�so-oo20 11684
BUILDING PERMIT
Permit Number: 11684 Address: 39013 1 ST AVE
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12-26-21-0010-00100-0070
Improv. Cost: 2,000.00
Date Issued: 3/24/2011 Name: CLEMENT ABRAHAM & JOHANNA
Total Fees: 60.00 Address: P.O. BOX 137
Amount Paid: 60.00 ZEPHYRHILLS, FL. 33539
Date Paid: 6/07/2011 Phone: (813)312-5651
Work Desc: REROOF SHINGLES//ADD FLAT ROOF (SEE NOTES
5. 5.
MILBAR ROOFING INC
�,Cc'vl.{rct�;�� L�.� 6-7-1�
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TAPE JOIN S ROOF INSP
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 � 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 properly. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
�_� �
CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
v�r a.i.�r �vaa v�. v.' .J.,�.,v i��.'� i ia�.u�i♦ I n�.IL V1f V f
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��ui���N�: ��a�ru�s��
APP 180
t , ,� 4 .. . r��„w:�r���:,n�a:;. APP
�����,�' " �r p ,� ru.�; MOdlfled
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� �w 1 111�i{�141� .��u�,7 Bltumeh
Pirestone xtem, Number: �
W70PUWP1800 (IJ{#�r�W�ite'"') Glass Reinforced eurn-otF Fllm
W7oPwp1800 (Whi�e) Polyester Mat
W70PBPi800 (Bla�k� � , � �
o�scw�pt�tan: �
Ftrascone Avp x8o is a�ranu(e•surfaced app modlfkd b�Cumen If materlal must be stored temporeruy on the roor betore
membrane, It eonslsts ofsel4ek asphalt, modlNed wlth at,�aede applicadon, It must be elevated from the roof surtace on a
polypropy�nc, and rel�Mracd wlth a non-wovcn 190 g/m (5.6 ����, �� on end, and CovePed from !he weather WiCh a Ilght
oz/yd ) polyesler mat, enhanced wRh conetnuous �fass flber cplored opaque tarp in a neat, safe manner not to exceed the
serands �n the machlne dlrecClon. The oombinaClon resuks In a allpwable Ilve load of the storage area.
Flexlbt�, y�t duroble rooRng membrane thaL exteeds the
perFormanc� r�aqulreme�ts of ASTM 0 6222 Type I, Grade C. pp�pQlNfd:
App 190 is Ideal for both new construction and re-rooting applk�tlons Roll Width: 39.4" (1 m)
as a cap shoEt � single or multl-ply appNcatlons. Low slope roofs d any �p�� � e��; 32' �,0" (10 m)
size, even thoee wtlh numerous penetraqons, may accommadate � M�k �verage: 98 f� 9. � s, m
Flreatone APP 1 BO appNcation. , Roll Welght: �105 Ib (47 7 kgj
���,�y����" Pallet Size: 48" x 39" (i.Z m x i rn)
� ;;,��"" � �' Rolis Per Pallet; z0
'�.,, Welght Per Pallet: 2,060 lb (936 k9)
Pallets Per Truckloed: Z�,
F M t
N ora
�'� SehrRafN�anee o.��t �e0 pRIEG►UTxONS:
�• thenerawianee o.eo rese� 1. Take care when transporNng dnd handling Firesbone Modlfled
�' vdPfO1 �� p °0 �� Bitumen rolls to evofd unctu�es and oCher rypes of physlcal
t,le�ea I�Nrhau�r ID e�e� p
.:�'�+'�`"� cwaNlAanon 'roabuen une damage.
coakoa�auqaunaie,�inpsaa�taedra.m�ed..�or 2. Isoiat� waste products� Petroteum praducts, greese, all
��,rnOn��ynel0aaoqepiNeelbr�N��nayy (mineral end vegetable) and anlmal fats from al! Firestone
p Modifled 6ltumen membranes.
�� ���� ��' 3. ThIS product Is not Inbended Ibr a lk�tlon in hot a Iled
wnuMeeurorar proeuct +MIpu1M� 1Mt tl�e rwn0s v�ane deeaminea In Sof � PP
�aesrtl�neew�hNm�pplle�lMCSSIReeIRMInOCeunellpneeedura. �, esphalt. Contaet your Technlc�� Coordinator at 800-4�Z8-
Re 45�7. for specitic rewmmendanons.
1ilct�nce hldex (SRn � d9 4. Ref�r to Materlal Safety pata Sheet for APP MembraneS dnd
SRf ceku/ated vs/ng Me ORNL (DOf� cekw/�tor, ASTM � 1980-01 �18shing.
GI/hBWhlt� �nuks can he� aQhiieve pWi1t8 ilf NIE U.S Green LE�D xWFO1tMA7'x�N: '��st�#ft1!
BundMg Counclrs LLED� raHng system and me�r fne requn+ements Post Consumer Recycled ConeenC: 696
h�rCalllbmh's Tltic 24 �:pu�Hons. Post IndusMal Recycled Conbent. 09b
Manufacturing Locetion: eeech Grove, IN
APPLICATION METNOD:
APP 180 shall be installed by fully heat welding to an "�:
approprlat� subStrate. •�, '"�"�^�"�
sro�a,ae: F M
eT" e �'�'0
All materlal musC be stored out of the weather I� a clean, dry N � : � V�, �
area In Rs oMglnal unopened packaging at a minimum of 40 °F � p„� ��,,�,
( 4 ° C) a n d a m a x i m u m o f X 4 0 ° F ( 6 0 ° C) s o t h e t I t w 1 1 1 b e a o�umawrrr��
minlmum oP 40 °F (4 °C) at the tlme of applicaCion. rspenarrrg
FII'lSt011! Bq(ltllMg Produtts Comp�lY LLC
ThM� xhMf1 I!. mmnt a hipuqht Flnroeiona praaue�e and �pseIIlGNona Kfd la �ubynt b 25p W, 9gM Slroot, Indlsr�pole, !N A8280
cMenpe vAtl�OiA r1011ee. flroMOn0lalMe fMpOHlIdA1y fOr MNehlnp qlMdlty mMaANa, wMqt
mNt F►atone'� puqll�hsa produ�t �pedAo�Nata� Nnlqta FI►exla�e ner I!e rop�eeneeNVer. Sefles, (9o0f 4�M442 • Tmchnk:sl (900) A2E-M1511
an�cMt» ed+taaime. fl�am dNM no eWMen en ena e�ro�eq awexro www,flrostons
m�pa�IblNhi Ibr tho '�o«1drMax ef n�y !itnmluro, FMaetans �awpb no II� tor �truar�� �,can
MaNure or n�uldiM dama0aa. Can�ult A oonl{+Me+M Mn�nurst anpn�er plor lo hwtaNMOn n
th� �tnw�uro�i wundn�ua a eaucturN �Illq� h ProP�Y s�Pp� a plerm�tl Inaenetlon I� In
a��n�n No flrefMnoi rt+��efIMMI�+M nWherlme 10 very Ihls dedNmer. S�S -RFS-025
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pimenslons And Masa English Metrlc
Properey Uni# AS'I'M Fit�e9tone Unit ASTM �prestone
MlnNnum Nominal Mlnlmu�n Nomtnal
Product Thkkness mtl Sb0 18z mm 4 4,�,
Net Mess �b/100 ft� 85 93 g/►n' a,150 4,54A
Bottom Coattng mil 30 48 mm 0,76 1,2
Ph c�l Pro ertles
Peek Load at d°F (-18 °C) Mp 120 Mp Z�
(Tensile Strength) Ibf/in fi0 kN/m 10.5
XMD 98 XMD 17
Elongation at Peak I.oad at � 10 Mb 24 � � MD 24
�'F �'�$ °�� XMD 29 XMD 29
Petlk IA�d et y3.�V °F (Z5 °C) Ibf/In 50 M � $� kN/m g,8 MD 15
(Tenslle Strength) XMD 62 XMD 11
Elongatlon et Peak Load at °� Z3 MD 42 % � MD 42
73.�4 °F (2S °C) XMO 5X XMD 5i
Ultkrnate @longatlon (at 59k of MD 4S MD 4�
Peak Load) at 73.4 °F (25 °C) � 3 � XMD 57 � 3 � XMO 57
Tear SLrenglh �C 73.4 °F (25 °C) IbP �� XMp 85 N 3 �� MD 377
MD -0.05 Md -4.05
Dlmenslonal Stabllfty % Change � XMD -0.04 '�0 Change 1 XMD 0.04
Low Temperature Flexlbllity °F 32 i4 °C 0 -�z
Htgh Temperature Stab111ty �F 230 270 °C x�0 7,32
Granute Loss g 2.0 0.4
Ph cal Pro es Af't�r Heat Conditionl
Peak Load at 73.A °F {�S °C) �bf/fn 50 Mp � kN/m g,g MD iz
(Ten511e Strength) XMD 59 XMD 10
EIon9�aUon at� Pe9k Lodd it � 23 MD aa � 23 Mp 40
73.A� F(2S C) XMD 47 XMb 47
I.ow Temperature Flexiblllty °F 32 12.0 °C p p
S723-RFS�025
06/93/2011 09:05 3525674454 MILBAR PAGE 03/07
. ��tB�r � af in Inc.
15911 11,S. 301, Qade City, Fl 335Z3 sm� ca�c Ro� �CCCraz9osz
ph; $Qd�562-��g� �aX. 3�2����-��� RCI I�g Raaf Cansultam #�Ik9
t�ilb8r��ai"thlldl(.t1�'
R4�F PROPASAt�. gagc z af z
DATE: 03/25/11
TQ. CL�MENT, AgRANAM PH; S73/745-0313
p, 0, BOX 137 info s d've tin s.co
ZEPHYRHILLS, Fl. 33539
�OS: C�EMEN7 RESID�NCE ,
PIN�CREST StJBbIVISiON
39013 1 AV�NU�
ZEPHRYHlLLS, F� 33542
n�c�-=�==...��-=��==-_.....-===== = � ---., � a====aWc=- _^====_��a=_ , ..==,°==a�-_.....= er.....-==m��---_,..,;os_=c
6, Provide and install new 26 gauge galvanized mefal eavedrip around the perimeter of the roof as needed.
C. G�NERAL„� CONDITiONS
1. RepaiNl�eplacement of any rotten or damaged roof �deck, faSCia, trim, framing, etc, will be completed an a
cost-plus basis �bove and beyond the contract price, ��
7., Owner to provide aCCess for delivery trucks to allow roqf loading/unloading for th� entire roof area, �� �
3. MiiBar Roofing, Inc. to proyide Genera! Liabiiity and �WorlFer's Compensation Insarance ($2,d00,000) and
re-roa�ing permit,
D. OPTIONS
j. ��t�M'Id ( � ��' �r+r i r.liht � '' � 7, � � y —������ �
. .... ..
...
1 . ••O � •'r� ��� �I : • ;... �...:,y..,�ia� •,:: r ,..,,.. ,,,�;,, €�;,,;�
: ,� ' '�e ,�:�+ � S,sU '��
Provide and install new�CERTAINTEED "Landmark" laminated dimensiona s ' stre -
{algae-reSistant) with LI ITEDJ,.IEETIME WARRiqNTY �'ROM CERTAINTEED in lieu of
CER7AINTEED "XT 25" 25-year 3-tab with streak-flghte� (algae-resistant) fiberglass shingles,
2. � tion�frar.Ri • � ��': � _ ., : ,c, „ � ::.. : :....... , ,,;�" .. � � ,:� � �.7.:�.�,:t� � n a � sum
47it� �"� � �rV.1�i i'd}tiii: . ' 1: � � .
provide labor and materials to Install �1�'� I.f. af new�pre-�rnished aluminum ridge vent
We propos� to furnish matarlal and labor, complet� In accordance with above Apeciflcatior�s, Forlhe sum of: �^���� W T �
FOUR THQUSAND NINE HUNORED NIN�TY-S�1/EN AND 5�4/100 DOLLARS -----�--'.,�...� ---�4,g97.54
=�^,,^a�===^;"^^===-w� �, �.,.� ��=��a�..�c� —
C��Ca'�...""��..�.....�����F7�"^,�..'���L"�.w�C �.+.,,�'
Paymane to bb mada aa fdllows: Duo upon Completlpn, .
. ___.._---------------�-__
AUTHORIZ�D SIGNA7URE: �Ql�f�i� /C, �OGQ DATE: 03/25/91 •
DAVlD R. �BL,A, PRES
ACCEP7ANCE OF pROPOSAL: Signature:
1rie adov� prlcee, eped�bmlen■ �nd condfttone ere eeusree�ery end Mra�+bY ekceP�• PPII1teCI �
You aro nul�xyd to do Ihe weAc a� ■paeNlnd, P�M w�p be meeo ae euflinod ubw�o,
Invelead amouMe nM pnid In exordence w11h u�s paYmeeM � e11M1 bo COnaldered Qa�; �"` .
delilqUeM BM pnq� IRt9rael AI IM fatB of 1 SG 76 par md�th, Owne� agrnap (e pqy Rll
CoUe ine�X►ed wa, ae arom�y rM+. aaart eoe10. ela, far oolbdfen e! ebllnqueell i1lve�pr,t irxiudinp IMetBBt. Gwnx lo C�►y fl�e, feryy�tle p/KI oUxx' necepary Int�ce. 04r w0lksro na �ully oovamd
xA1hM 30 daya.CW�i�eatbn �neuronce, Mlf�nr Rooflna� hic, M nnt rnn�onelbl� fw du�mnpse eeueed by ou,ora, vAndnll.m� �nptlo�nr.�, .lorme. Thle WaPosW m�y bb wnhdrown by Ue H �d aocopletl
A �
06/03/2011 09:05 3525674454 MILBAR PAGE 96/67
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NOTiC�_O�COMMENCEMENT Rcp{;13687 RaC: 10.00
MRI#4322 ps: 0.00 IT: 0.00
QI5/20/11 C� Cook, DPf�Y Clrsrk
Penmit No.
'�ax Folio No. 12-26•21•0010-OO10U-0070
THE UIVDER5iGWED heroby gives notiee that improvemems will be ionade to eertain resl property, and in aecardance wit#i Sectioo
713.13 of tUe Flotida Statutca, the following uafonntstion is provided ia this NbTxCE 4F CONIIYIENCEMENT.
].bcscriptimt p£prop�rry (kga! descrl,p�fort):P�I�.'CRE5? PB 5 PCi 55 LOT 7 BJ�bCK 1 OR 7835 PO 773
a)Street (jnA) Address: 39013 1 AVEMJE, ZEPHYR�iILLS, FT. 33542
2.Gencral dcscription of improvements: RaOFiNf3
3.Owner lnfotmation �
a)Namc and address: CLBMENT, ABItAHAM & JOfIANNA, P. O. �OX 137, ZEPHYRHILLS, PL 33542
b)'�iaa►e �md address of fce simple title Aolder (if otl+cr tl�m owaer): N/A .
c)Interest in propetty: bWNER
� oatrector information
a)I�(An1E 7md addrCSS: n,tl1•RAR R�OFIN(3. INC. . 15911 U.S. HWY 301. DADE CTI'Y. FL 33523
b)TelephoncNo.: 352/567,6047 Pex No.(Opt)
S.Surcty i»formation
a) Name and address: P�'�p g o ' �_� ��• O p�0 CLBRK � COI�7ROLLER
b) Anoount ef Bond: 0S � � ��� P�,' �f3090
c) TelephOne No,: Fax No. �_ ....
6.L,ender
a) Name and address:
Phone No.
�. i.dentaty e£person within the State ofFlorida designated by owner upon whom notices or other documents may be setved:
a) �famc and address:
� b) Teleplwnc No.: Fax No. (Opt,)
8.In addition to himself.,, owncr desi�►ates the foliowing person to receive a copy of tite Lienar's Notice es provided �13eaion
713.13(i)(b), Florida StahRes:
a) Name attd addross;
b) Tclephoae No.: k'ax No, (Opt.)
9.fixpiration datc of Norice of Coaunenccment (the exp;ntion date is one ye�r trom the date of recording ueleae a dlf[eront datc is
speci�'ied): �
�
WARNING TO OWNE�: ANY PAXM�NCS MADE BX 'I'� OVNNER AcF1'�� T'HE EXPIRATION O� � NOTICE OF
COMMENCEME"NT e1� CONSIDEREA �OPER P.#XM��V'1,'S VNDER CPAY['ER 713, PA,RT I, 3EC�'�UN 713.13,
FLORIDA 3TATUTES, A,ND CAN REBUI.T 1N XOUR PA,XAVG'�'W�CE FOR IIVII'xtOVEIYIENT9 TO YOUAt P�tOPERTY.
A, NOTICE OF COMM�NC�MENT MUS�' �E RECORI)�A ,�N� �OSTEA ()N '�E J08'SITE BEFORE'�'J�E FiR5T
IN$PECTION. iF XOU IN'X'E1Vp TO OH'�.�N k'INANCING, COPiSULT YOUA �.�1�iDER OR AN A'f"CORNFX BEk'OItE
COMMENC[NG WO� OXt RECORDWG XOt7R 1V0�'ICE OF COMMENCEN�k:NT.
9TA7'Q QR PLORNA �
COUNTY OF �t�.J l O�
9i�uuh or OHn+er's AuthoNud O�/Di�aNPrtner/Maneger
�
Pt amc end Title
The foregoing instrument was acknowtedged before me this „� day of �Y1•� , 20 L � , by
J�N,n, G�.�,,..,� as _____��,.M.r �t9pe 4� SUtIfOFi�� E :g. otficer, truatee,
attorney in fach fnr �e.�z (asme of o hal[ of whom ip9ttpinent was excented).
Pcrsonally xCnown�CSR Produced Idcutificetion�Notaiy Sigpature
Type of Identificatior► Produccd Name(prir.!)
A.
� �� � co�ssloN �e oaeo»e
E�VMtES M � 1012
Verification pursuant to Section 92,525, Florida Statattms. Under penaities o£perjury st � �o�,rogo' and that
the facts stated in it are ttue to the best of my la�owledge and belief.
Koua�moc,w�oo�
3' tu ewral Person 3igning (in Ilne # 10.) Abovc
r
Sl'AT6 Of FLORIpA, CpUNTY CIF PASCp
7HIS IS TO CHRTIFY THAT THE FOREd01NG IS A
TRUE AND CORRECT COPY OF TH� DOCUMENT
ON FILE OR OF PU6LIC RECORD IN fiHIS aFFICE
�NI7NE5S MY HAND ANO FICIAL 5EAL 7H _ IS ' /
DAY OF ��JL
PAU S. O'NEIL, CL K& CO PTROLI�R
gy �' �pEPU7Y CLERK
06/03/2011 09:05 3525674454 MILBAR PAGE 07/07
NOTIC� OF b�ED R�STRICTIONS: The undersigned unrJerstands that this permft may be subject to "deed" r�strictlons"
which may b@ mare resfictive than County reyulations. The undersigned assumes responsibllity for compliance with any
applicaDle deed restricdons,
UNLIC�NSED CONTRACI'ORS AND CON71i/,CTpR RESPQNSIBILI7YE8; If the owner has hired a cantractor or
contractors b undert�ke work, they may be required to be �iCenged, i�t �Cpro��e yy�th g�te and loaal regulations. �f the
contractar Is not Ilcensed as required by law, both the owner and contractor may be clted br a misdcmeanor violatlon
under state law, If the ourrner or fntended aontractar are uncertein as to what licensing requirernents may app�y �r the
intended work, they are advised to contact the Pasco County Building Inspectlon 17iviston—.I�iaensing Secdon at 727-847-
8009. Furthetmore, if the owner has hlrod � contraCtor pr cantrectors, he Is advised to have the conqrecto��s) sign
portions of the 'contractor Btock" of this application for which they will be responsibpe. If you, as the owner sfgn as the
contraetor, that may be an indlcation tha! he is not properly licensed and is not enHtlsd ta permMting privileges in Pasco
County,
TRANSRORTATION lMpACTlUTILI11E3 IMPACT qN0 R�SOURCE RECON�RY FEE3: The uhdersigned understands
that Transportation Impact Fees and Recourae Recovery Fees may apply to the constructlon ef new buNdings, change of
use in existing butldings, or expansion of exiabng buildinas, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended, The undersigned also understands, that such f�ea, as may be due, will be identlfi9d at the time of
permitting, It is further understood that Transporte�on impact Fees and Resourx Recovery Fees must be paid pnor to
receiving a"certificate of occupency" or final power release, If the projact does not invoNe a certiflcet� of occupancy or
final power release, the tees must be paid priar to permit issuance. Furthemlore, if Pasco Couniy WateNSewer Impact
fees are due, they must be paid prior to permtt issuance In acoordance with applic:able Pasco County ordlnances,
CONSTRUCTION L.IEN LAW (Chapter 715, Florida $tatutes, a� amende�); If valuetion of work is S2,SOQ,00 or more, I
certify that I, the appllcant, have been provided with e copy of the "Flprida Constn�ction I.ien Lauv—Womeowner's
Prokection Gulde" prepared by the Florida Department of Agr�ul4,re and Consumer Affeirs. If the appiicant is someone
other than the "owne�', I certify that I have obtained a copy of the above descMbed document and promise in good Faith to
deliver it to the "awner" prior to commencement.
CONTRqC7'OR'SIONMER�S AFFIdAV17: I certify that all the infbrmation in this applicatlon is accurate and that all work
wili be done in Compliance with all epplicable laws regulafing constniotion, aoning and land development. Application is
hereby made to obtain a peRTiit to do work and insfall8tion as indiCeted. I Certiiy thet n0 woI'k or installation �has
commenced pHar to issuance of a permit and that ail work will be per�ormed to m�et stendards of all laws regulating
construction, County and Cky codes, zoning regulations, and land devebpment regulations In the jurisdiction. I also
certify that I understand that the regutations of other govemment agencies may apply to the iMended work, and that it is
my responsibility ta identffy what actiqns I must take to be in compliance. Such agencies indude but are not limited to:
~ Departmeni of Ernironmental Protecdon-Cypress eayheads, Wetland Areas and �nvirortmentally Sensitive
Lands, Water/Wastewater Treatment
- Southwest Florida Water Management Oistrict-Wells, Cypress eayheads, Weuand Areas, Altenng
Watercourses.
- Army'Corps of EngineBrs-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US �nvironmental Protection Agency-Asbestos abatementt
Federat Aviation Authoriry-Runways.
I understand that the following restrickions apply to the use of fill:
- Use of filt is not allowed in Flood 7one "V" unless expr�ssly permltted.
- If the HII material is to be used in Flood Zone "A', ft is unde►sbppd that 8 drainage plan addressing a
"compensatlng volume" wi11 be submitted at time of piertnitting which ia prepared by a�prafessionai engineer
licensed by the�State of Florida,
- If the fill material is to be used in Flood 2one "A" in�connectlon with a permitted buildtng using stem wall
constructian, I ceRify that flil wlll be used only to BII the �rea within the stem wall.
- !f fill matorial is to be used in any area, I certify tllat use of such fill wi11 not adversaly aff�ect adjacent
properties, If use of fill is found to adversely aitect adjacent prcµ�rkies, the owner may be cited for violaang
the condition3 of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engintered dralnage plan is requlred.
If I am the AG�NT FOR TH� 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 r+equir+ed for electrical wark,
plumbing, signs, wells, pools, air conditioning, gas, qr other installations not specifically included in the application, A
permit issued shall be construed to be a lioense to proceed with the work and not as authority to violaite, cancel, alter, or
set asfde arry provlslons of the technical codes, nor shall iasuance of a permit prevent the Building Gfficial from thereafter
requiring a correction of errors in ptans, constructlon or violations of any codes. Every permit issued shal! bec:ome invalid
unless thE* work authorized by auch permit is commenced withln six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a perbd of six (8) montti's aRer the time the wprk is commenced, An extension
may be �equested, in writing, from the Buildfng 4fticlal for a period not to exceed ninety (9p) days and will demonstrate
jusHfiabte cause for the extensio�. !f work c+eases f�or ninety (90) consecutive deys, the joa is ccn,�9dered abandpneq.
WARNING TO OWNER: XOUR FAILURE TO R�CORD A N07'fCE OF COMMENCEAA�NT AA,pY RESUL.T iN YOUR
PAYING 'I'WIC� FOR IMPROVEM�N'I'S 70 YOUR PROP�RTY. IF YOU INTENp TO 4BTAIN F`INANCIN�, CONSULT
WIT„ H,�/qUR I ENDER OIQ AM A7TQRl���Y BEF l,?t� RE�OSqQ:N3 Y3L;Ft OTiCE O� CplfipA�NC �eF T
FLORIUA JURAT (f .S, 117.03)
OWNER OR AGENT �(.� CUNTRACTi1R y�/`
subacnAed qnd ro(or mmied) re me mIS sw�s«mad and e to (or d) , mo thie '—'�""
�by 1
�h i are rsoAallg� o me or slhave produeetl Who sla no � o me or hes/haw produced
�.,.,___,...----, as enllficafion. ���
as idantMicetbn.
�� i�
� A �� Publlc
Commiasion No. �SSIOP( M �M�2e C m�asion Na. �� A• ��1�
� � JUL 2B x012 �
rure
wY���
Name ot Nofary 1 , Name oT Notery typed,
�.7� °) / � '
/���^ S'�`� T % � � / 6/
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: /' � � J'�
Date Received: / � ` /�
Site: 3 C / �� � f 'S %�
S
Permit Type: Qe � �[ ��
Approved w/no comments Approved w/the below comments: ❑ Denied w/the below comments: ❑
This co nt heet shall b ept with the permit and/or plans.
i
, ��� ��
Kalvin itze ans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
06/03/2011 09:05 3525674454 MILBAR PAGE 01/07
— — _ � :�,/
813•�90A020 City of Zephyrhilis Permit Application Fax-813•780�0021
Building Mparlmenl
Data ReceivPd ' �
Phone Cont�ot for PerMIHi
i�r's Name t OMn►er Phone Nwnbor
ow„ers adaress � I 3"1 3 owner Phane Numbx
Fee Simple Tiqeholder Name oamsr Phone Nuri►ber
Fe0 Slmple Titlehokler Addresa
JOB ADDRESS O ' � I,GT N �
i
3UBDNISION PARCEL IWp
(06TMNEh RROM CRdpERTV 7AX NOTIC6)
WORK PROP08ED e NEW.CONSTR � A�D/ALT �� Q SI�N Q MOVE Q DEMOLISH
IN3TALL R�PAIR
PRQPO$ED USE � SFR Q COMM '[[� 01'HER t p
TYPE OF GON3TFtUC'f10N Q BLOCK FRAME O 3TE6L � OTHER
DESCRIP710N OF WORK � r � �
� �
BUILDING SIZE Sq FOOTAOE HEIGMT
O BUILDING E . ' $ �"�y J 9 4y
S U VA�UATION OF TOTAL CONSTRUC7lON �� `�� ,
I
Q ELECTRICAI 3 AMP SERVICE Q PRGfGRESS ENERGY �] W.R.E.C.
� PLUMBING S �
Q MECHANICAL �� VAWATION OF MECHANICAI. INSTAILA�i'ION
�
Q C,AS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FI.00R ELEVATIONS ��I FLOOD 20N� AREA �YES �NO
�
sui�oER � aoa��Mr �il�k (��wh�+�_ iH�,
SIGNATURfi REGISI'�REO ' FEEC Y N I
Addre9s �`J�l � ��) L�CILIQ. �.. �) t3 3 Lixnse'# I�,�( i3�.°JOy'Z. w
ELECTRICIAN COMPkIIY �—
SICiNA7URE ' REGISTERED Y f N i FEE CURrtENr Y I N
Addross I.IC6Ri! i� ��
P1.UMB�R COMPANIf
SIGNATURE RECISTEk6p Y/. N ; FEE CuRR�eNf Y I N
Add�as �g�g� �
MECHANIC/(L � COMPAV�IY
�
:NA7URE REO�r�o Y/ N �e curta�Kr Y 1 N
Addro99 � LIoBItSe # � �
OTHER � CGMPANY
SIGHA7URc � REGIB'EV�D Y/ N FcE CURP,ENT Y/ N
Adtlress I,kense # ��
RESIDEN7fAL Atfach (21 Plot Planc; (2) sets bf BuAMnp Plans; (7) sat of EnprqY F�,prrns
Minimum tan (1D) +�rorkinp d0ys aRer suWnktal dab. Rqqulred onslte, Conatructlon Plans, Sanifary FadNd@5 & 1 dumpafer
GOMMERCIA� Attach (3) sets of BWiding Plans; (1) Set of Enetgy foims.
Minimum te� (10) working days �ttar eubmltbl data. Requlred onahe, Gonstruction Plans, Faclikke a 1 dumpster
All Cenxnaroiol tequirem�nls must mea!'eaompllance,
510N PERMIT Atlach (2) sels of Enpfneered Wans.
'""PROPERTY SURHEY requWed for all NEW conairuction. �
recllons:
Fill out epp6eatbn complotey.
Ow�er & GoMMOtor sign badc of appticatfon, notaAzed � � "`
M ove};2500, a Mbtica•Ot Commsneamdnt Is roqul►tid. (dUC upgrodas ovar 55tl00) °
"' AgaM (Por the contrador) or power of Atfomey-(forthe.lnwner) would be someone wlth nocarized letterirom. ownbr authoAzing lame. , ,
OVER TME COUNTER PERAAtTTiN6 (Front M AFplication Ony) �
Rorootg Sewcrs ,; "'ServlCe upgretlas " /Y1C Fences (Pbd9urvey/FootAge) ' '
r
�r9veways-NOt ovar Counler If qn pubBc roadway9..needs•ROW. °
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(ai3)�so-oo20 11684
BUILDING PERMIT
Permit Number: 11684 Address: 39013 1 ST AVE
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12-26-21-0010-00100-0070
Improv. Cost: 2,000.00
Date Issued: 3/24/2011 Name: CLEMENT ABRAHAM & JOHANNA
Total Fees: 45.00 Address: P.O. BOX 137
Amount Paid: 45.00 ZEPHYRHILLS, FL. 33539
Date Paid: 3/24/2011 Phone: (813)312-5651
Work Desc: REROOF SHINGLES
AL 45.
�
_ �
. �„7-�
c�' 4 `� . �
. � ,�
�
�
TAPE JOINTS ROOF INSP � �
FINAL `�
� -- ..�
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 3.80 (2)(c) when e�ctra 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 � 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 properly. If you intend to�obtain financing, consult with your lender or an attorney
before recording your notice of commencement.
/" � J _
� �
RACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 12-26-21-0010-00100-0070 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, March 19, 2011
Parcel iD 12-26-21-0010-00100-0070 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
CLEMENT ABRAHAM & JOHANNA Ag Land $0
PO BOX 137 Land $13,817
ZEPHYRHILLS FL 33539-0137
Building $40,157
Physical Address Extra Features $688
39013 1ST AVE
ZEPHYRHILLS FL 33542 MarketValue �54,662
Assessed (Save Our Homes) $54,662
Leaal Descri�tion (First 4 Lines) Homestead 196.031 -$25,000
Non-School Additional Homestead Exemption -$4 662
See Plat for this Subdivision �'" '
PINECREST Non-School Taxable Value $25,000
PB 5 PG 55 LOT 7 BLOCK 1 School District Taxabie Value �29,662
OR 7835 PG 773 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 Use Description Zoning Units Type Price Condition Value
� 0100 SFR OORl 10,000.00 SF $1.38 1.00 $13,800
� 0100 SFR OORl 67.00 �F $0.26 1.00 $17
Additional Land Information
Acres 0.23 Tax Area 30ZH FEMA Code � Residential Code ZHLGLPl
Buildinu Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1955 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Face Brick
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall i Plastered Interior Wall 2 None
Flooring 1 Terrazzo Monolithic Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line Description Sq. Feet Repl. Cost New
� 1 �� BAS �- 960 $52,445
� 2 � FOP 192 $2,622
3 UCP ��— 288 $2,349
4 � UST 96 � $2,076
Extra Features (Card: 001 of 001)
Line� Description Year Units � Value
�1 � DWC �� 400 $285
� 2 UDU-M �r 1998 �� 1 $403
Sales History
Previous Owner WERNSING BRADLEY E
Year Month Book/Page Type Amount
2008 05 7835 / 0773 WD $70,000
2004 05 5849 / 1013 WD $89,900
2004 O1 � 5696 / 0853 WD $58,600
http://appraiser.pascogov.com/search/parcel.aspx?sec=12&twn=26&rng=21 &sbb=0010&b... 3/24/2011
. DISCLOSIIRE S'�'a��i. .FOR OW1�R
CITY OF ZEPF��T� ��G DEPAFt—�3'
have read and fully understand and
2, -
agree to the provisicus of - �iis inst'�e�t.
The undersigned.states and affirms that he or she is clesisous of' constructing,
renovating, addiag to or seroofi.si4 his or her o�n domici-le, that he or she
said do�ica:le, asid same is not for
actually ocaupies , or wi11 occupy 3�y �1.� � followiug conditions :
•rent, lease or sa1e. That he or she sha11 comply
1. That the o�aaer and _ he or she alone shall act as the bui-1�1ex' for a11 phases of
construction.
2. Tkiat the owner will comply with a11 provisions of �the City of Zephyrhills
ord.inances and aodes pertiaen't to the buildisiq -
3, That in t�e event various phases of constsuction ase subcontracted, he will
e�,qaqe only•properly licensed subcontsactors and will pPSSOnally supervise
such work.
4. Tlzat in the event the Buildiag Inspector sha11 require corrections to be made,
the owner will assume full responsibility to iasisre 'thel' are made � ar�d uPon
completion wi11 aa13 for a reiaspectioa before proceedisig with the building.
5. That the owner stiall assume full respensibilitY for the coastruction and wi11
not expect_supervision of his work from the CitY of Zephyshills Buildiag
Departm�t .
6. That prior to final inspection any add:itional fees, includin4 re�nspection
fees, must be paid in�full. A writtea r�quest from this office sha11
constitute an official notice 'to pay addi..tional fees •
7. That the owner sha11 comply with a11 Ciiy, State and Federal laws in regard to
social security, workmaa's compeasation, lien laws, etc., where applicable.
B. That the owner sha11 comply with al1 the safety codes issued by the Florida
=ndustrial Co�ission.
9_ State 1aw rec� construction to be doae by licensed contractors. You have
applied for a��; t under an exemption to tt3at law. The ex�ption allows
you, as the owner of your praperty, to act as your own contractor with cp*+=�*+
restsictions even though you do not have a licease. �You must direct
onsite supervision of the construction yourself. You may bvild or improve a
one-family or tvvo-family residence or a farm outbuildiag. You may also build
or improve a cammercial buildiag, provided your costs do aot excaed $25,00�.
The building or resideace must be for yovr own use or occupancy. =t may not
be built or substasitially improved for sale or lease. If you sell or lease a
bvild.irig you have built or substantially i�proved yourself withi.n 1 year after
the coastxzictien is complete, the 1a�v wi11 pres�e •that you built or
substantially improved�if for sale or laase, which is a violation of this
e�[ emption. You may not hire aa ualiceasacl �.E= to act as yovr contsactor or
to supervise people �varking on yous build3.ag. It is your respoasibility to
make sure that people employed by you have liceases rez by state law and
by county or municipal licenss.ag ordiaances. You may not delegate the
responsibility for supexvising mork to a licesised contractor who is not.
liceased to perform the �varlc bning dna@- Aay P�rsoa workiag on yous bsiildisig
who is not licensed must work uader yovr direct supesvision and must be
P�j�loyed by you, �vhich meaas that you must deduct F.I.C.A. and withholding ta�c
and provide workess' c�m�nsatioa for that employae, all as prescribed by law.
Your construction must comply v�ith a11 applicable 1aws, ordisiances, buildiag
codes, and zoning regulations.
r�'
owxER� s sz��r� � n� O"� �_7 �-r �� r� ( �
ADDRE55
PHONE Z y /
W22NESS PERMIT #
06/03/2011 15:00 3525674454 MILBAR PAGE 01/01
e�s��ea,ac�a City of Zephyrhllls Perrnft Appd
9�A�IODeO�m,en! � ,B� M�tl��it�,.w�t�
o�ae R�cewaa �13 •OnZ �
Phons Cenuu� iw PemlNy
Ownera Nwns f O�wrr phom Nnm6�r � ��j � s
OwharSi Atldnm� s � . �Wi OMne� Phone NumWt ��
�_
Fes 9Mnpw T1UNroldx Mmm� .�_ QVmer Phaq Munber
F� �knple TipnholdlrAddro�n
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woRKPllqPbsEp � l�a�aNmN1o�P11a�NRYT�xiwnelq
NEWCONSTR ADQIALT � SIGN [� �] D�A1o�.18H
�1'� REPNq
pRqpO�ED UBE � 8FR Q CbMM � OtHER
7 Y�50PC011STRUC71pN 6�pCK Q �p/�� � st�EL a
AE9cRpTICN oF woR!( �Tip' t9 ;r2.S R.�2 — 2CO � � -
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o�.po D. - VALUA'r1�M OF 1'OTN, CON9'�uCT10N
QEf.ECTiIICAI, �� AMp SERVK,M'c �
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Addieme �
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�CTRfCUU1 CoAIPANY
810NATURA � Y
�� Y N
Atler'ew �� � �
SY6NATIIRE �MPANY
� Y/ N PEE (�A Y N �
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' � h1lt � iiYfM1'Illfrm)' � Iq � '• � , � . � , �4�d , a1611v��Cywie�+dlOq.P.lerM�, � .
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�RdAI � t9)��i (fo � daya afle� eul+mlMai data � � f1} set of E,ner�ry fanl�e. R�O�UV Pp�1R tor nsw ��,
8�i1xY Feaqdw d � e�. �e Nkrk PemNNOr�p��' N a� b1�� �r PIaM17 w! 9Yt Fe11� hmf�,
�!f P�RIYp7' Nbeh (2) �els et En6hwxed PM�ne. . ro4�nenh mwt moet oanpNmm
•• "PROPCRT1r 8URVeY raqqk�y kr aA NEW ceneln�opp�, .
DkOCU0119;
� �� � d �p►WOOUC�, �IOkY'Q!d
n wee f�oo� A Neelee eI Ca��ry��M (� nq�Y�.O. (MC upp�qy evrr ttrqq ,
•• �(tor dx e�trxda) or Powor otAqah+oy Hlx �he ew�pr) waule 6a someano+�llh nolerknd kbxilatn avnar awne�np eena
qV6R'IM� COIMTRR PRRMI`fiNG (F�onR of Apptica/oR O�YI.
Roroolb If �Nnplos Se�q� 9aMee Upp�lea q!C• pa�qp� (p�yypy��e� �
Driw�whYS-NM awu CouMe►If an M,�bllc iwdYray�,.need� ROW
�onr�oo�a aeea e5�e� iGOZ�so�go
:oo��
s�s-7so-oozo City of Zephyrhills F'ermit Application rax-�,s-��u-uuz,
Building Department � Q���"
� �,��-;�°�-a����
Date Received Phone Contact for Permittin -
Owner's Name �- � Owner Phone Number � �7 �( Z ��
Owner's Address S � \}� 1ti2� Owner Phone Number �— �
Fee 5imple Titleholder Name —� Owner Phone Number �—
Fee Simple Tltleholder Address
S � JOB ADDRESS � � C � ` ��- LOT #
SUBDIVISION , PARCEL ID# � � - � � - � ( - O O � O � v0 I OQ _�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR � ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR Q COMM � OTHER
TYPE OF CONSTRUCTION BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK R�J �,� �P� - Q.fl��'� '
BUILDING SIZE SQ FOOTAGE ��b � HEIGHT
� OBUILDING $�� � = VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE � GY Q W.R.E.C.
QPLUMBING $ � ' /_ (%1 C�
� _,_,_._.___-----°"`" (O v r
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION X � y�?' -�� �"'
OGAS Q ROOFING Q SPECIALTY � OTHER �
��-�' y�; �
FINISHED F�OOR ELEVATIONS FLOOD ZONE AREA QYES NO Q�f �
�r"�
�kIILDER � --"'"�.�� � , COMPANY O�Q _ 0���- .
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address ' Lice�se # �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
MECHANICAL � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
�dH�ress __"'""°""-.�.-----�-......�. ._.,. _.....__.....�.e...... _�
'.,,.,.-n.. ""°'°'°"^""""` `~^, �
�
THER �
/ SIGNATURE .r � R OMP R Y/ N FEE CURRE� Y/ N �,
Address License # �— � �
iiE�IQ_ENTIAL Attach (2) Plot Plans; (2) sets of Buflding Plans; (1) set of Energy FoRns; R-O-W Permit for new wnstruction,, f
�� (Vlinimum fen (iU) wo'ikTng�days after"�t5b»tltt�tf date. Required or�site, Cor►st�ctioR-P.lans, S�ormwater Plans w/ Silt Fence installed, -`
Sanitary Facilltles 8 1 dumpster, Site Work Permit for subdivisions/large projects �""' `""" '" °"`, ""'' "
COMMERCIAL Attach (3) complete sets of Bullding Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new consUuction.
Minimum ten (10) working days after submittat date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary FaGlities 8 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 requlred for all NEW construction.
Directlons:
Fiil out application completely.
Owner & Confractor sign back of application, notarized
If over;2500, a Notice of Commencement ts required. (A!C upgrades ovar i7500)
"* Agent (for the contractor) or Power of Attomey (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 A/C Fences (Plot/Survey/Footage)
Driveways-Not over Counler if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" re�trictions"
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 owne� sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
Counry.
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 unde�signed aiso 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 Cot�nty 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 ail work
will be done in compliance with ail 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 aiso
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, Wetiand Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health 8 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 pian 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 Fiood 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 fiil material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of flll is found to adversely affect adjacent prope�ties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for Iots less than one (1)
ac�e 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 sha�l 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 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. 11 T:&3 ----"
OWNER OR AGEN ` CONTRACTOR � � —I^
Subscribed nd � rmed�i fore me thls ubscri ed and s r a rmed) before me thi
3-2`F-( � b i�. C; 3 -a _ ii n v�f1 f.
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Who is/a e person novm to me or hasRiave produced Who is/� e p�e� a y k to me or haslhave produce
�, (�,n� as fdenHficaBon. as identlficatlon.
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E� Notary Publlc �� � Notary Public
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Name of Notary typed, printed or stamped Name _; [�t�d or3s�poelkao�a
'IH Result Report p �
_ � 06/03/2011 13:55
Sel'ldl N0. AOmyp11001438
'I�: 25646
Addressee Start Time Time Prints Result Note
93525674454 06-03 13:53 00:01:26 001/001 OK
rMR: Timer Tx. POL: Poiling oRG: Orig}nai size Setting FME: Fr e Erage Tx.
Note MIX: MiXCd OP'sgallel TX. CACL: Manuai TX. CSRC� CSRC. FWD: FOPWeP� PC� PC-Fs7X.
BHD: Doubie-S'ded Binding Direction. SP: Speciai originai. FCOpE: F-code. RTX: Re-TX.
RLY� Re1ay M�X: Confidential. BUL: BUlletin. SIP: 5IP FaX. IPADR: IP pd�^eSS FaX.
I-FAX: I17C FaX
Result 011: Comrnunication OK, S-01t: Stop Comnunication, Pw-OFF: Power Switch OFF,
TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer,
Refuse: Receipt Refused, Busy: Busy, M Full,
LOUR:Receiuin9 length Ouer, POUR:Receiuin9 page Ouer, FIL:File Error,
DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error.
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