HomeMy WebLinkAbout11-11762 ` CITY OF ZEPHYRHILLS "
5335 - 8TH STREET —
(si3)�$o-0020 11762
LP/NATURAL GAS PERMIT
Permit Number: 11762 Address: 6005 GALL BLVD
Permit Type: LP/NATURAL GAS ZEPHYRHILLS, FL.
Class of Work: FIRE-LP/NATURAL GAS Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 03-26-21-0010-11200-0041
Improv. Cost: 500.00
Date Issued: 4/19/2011 Name: SHIVA 6005 GALL LLC
Total Fees: 125.00 Address: 8100 SW 178TH ST
Amount Paid: 125.00 PALMETTO BAY FL 33157-6163
Date Paid: 4/19/2011 Phone:
Work Desc: INSTALLATION 1000 GAL LP GAS TANK (OLD PERMIT #10891)
5. 5.
FIRE INSPECTION FEES 25.00
. lc �. � C � v�
�., -, -.-1 I
�
�
- ina
Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be pertormed in accordance with Ciry Codes and Ordinances.
"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 YOU NOTICE OF COMMENCEMENT."
�
TRACTOR SIGNATURE I IC R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
Zephyrhills Fire Rescue
6907 L)airy Road, Ge�hyrhills, I�L 33542
1'ire Marshal 13us (813) 78U-0041
Kerry 13�rnett E�ax (81 ;) 780-UU44
E;-mail: kbarnett(�r)iire.zephyrhills.fl.us
Plan Review #: 11-037 YY � ' � . �� ~ � �
Project: Propane Tank Installation
Number of Pages: 1
April 12, 20] i
I have received and reviewed the packet for the propane tank installation located at 6005 Gall
Blvd and will allow the project to move forward. By paying for the permit, contractor
acknowledges to comply with the item below. Should anyone have any questions, please do not
hesitate to contact the Fire Marshal's office.
l. The comment sheet that was provided during the original review on September
3� 2010 has been provided. Nothing has changed regarding the requirements
with this review.
Inspections Required:
l. Final
,_--_--..�..,..
KERRY BA TT, 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. tt is the contractor's sole responsibility [o 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 Rescue
6907 Dairy Road, lcphyrhills F[, i35�1?
Firc Marshal . Bus (813) 780-0U41
I�crry [3arnctt Fax (31 ;) 78()-00�4
F;-m��il: kbarnctt�a�tire.zcphyrhills.fl.us
_ . . . _ __.._.._..,._.�_.._..�.. .....__._._, __ _
Plan Review #: 10-099
Project: Burn Permit
Number of Pages: 2
September 3, 2010
1 have received and reviewed the plans for the instal(ation of a 1000 gal propane tank
located at 6005 Gall Blvd 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.
l. An approved site plan from the State has been submitted and approved. Once
installed a copy of the State's fina) inspection shall be given to this authority at
time of the City's final inspection.
2. Tank to be installed in accordance to NFPA 58.
3. Ensure all proper tank marking, warning signs/labels are properly placed.
4. Bollards installed around tank shall be minimum of 4", filled with concrete and
painted yellow.
5. Parking space to the immediate north shall have a sign installed stating "No
Parking". This area shall also be striped off. This eliminates an ignition source
within 10' of tank.
lnspection Required
l. Final /
KERRY B , F[RE 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.
� ��F��iYR�ilLLS FIRE �EP'A►RTMEt�`�
6907 Dairy Road, Zephyrhills, FL 33542
r�re Chief Kei�h Wiliiams Bus (813)780-0041 Fax (813)'780-UO�i�
FiRE SERVICE USER FEES
Occupancy No.:
Plan No.: �4 >> Z Contractor: •r. ' / � �
Business Name: 1.�� Biliing Address: �� ���,
Business Address: t �:� , �
Business Phone No.� Billing Phone No.: —/ -=
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
a Site Plan N!C Annual N/C Sprinkler 350 1st Alarm N/C
Mulli .O6 Sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C
(Minimum Charge $25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
� Plan Revisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100
4th Re-Inspection 3500 ire Alarm 350 5th Alarm $150
SPRINKLER SYSTEMS {Business closed until Gas � 6th Alarm $200
0- 25 Heads SSO VIOIffi1011S COrf2Ct0f�� Natural Gas NON COMPUANCE $1 SO
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- ��n�k a,5p
STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
� Per Riser a50 Hydrostatic Test 365 pe� syscem Fire Works 3500
FIRE PUMP Acceptance Test 345 �� gystem Camp Fire $25
� Per Pump $100 Hydrant Flow $75 Controlled Burn $100
FIRE ALARM SYSTEM Hood/Duct �550
8 0- 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly �SSO Annual
26 plus Devices 5100 System Acceptance �50 Fire Protection a25
SUPPRESSION SYSTEMS Recell Acceptance $50 Flammable Application �SO Amual
Wet $50 OTHER Waste Tire Storage 350 nnnuai
Dry $50 Fire WafUSmoke Wall $15 rwan Generator < �(W �100
CO2 $50 LP Gas ���k Generator >30 KW 150
Other $50 Nffiural Gas �rsyscerr, Bio-Hazard Waste $100 Annual
KITCHEN EXHAUST Fumigation Tenting $50
� Hood/Ducts $50 7ern t0'x10' or greater $15 ���ent Torch PoUApplied $50
OTMER �/ Fire Pump $45 Haz. Materials $100 Annual
� LP Installation per tank /� Fire Suppression $30
Fuel Tank Installation �' 50 System Acceptance
(Per Tank) $50 E�aust Hood/Duct $30
� Natural Gas Installation $50 Re-inspection DBL
(Per System) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL 8
and cancelled less than
24 hours
� Construction Insp. N/C
PLANS TOTAL � NSP CTION 70TAL� PERMIT TOTAL L�� FALSE To AM �__ __ I
GRAND TOTAL ��j^J��
Comments:
Date� � li�
Ins���ctor� 's�� �3���7 � /"��
813-780-002D City of Zephyrhills Permit Application Fax-ti13-780-UU21
• � Building Department
Date Recetved � � phone Contact for Permittin -
Owner's Name � --� `V�c ��-�- Owner Phone Number
Owner's Address Owner Phone Number r �
Fee Simple Titleholder Name � Owner P��ne Number �
Fee Simple Titleholder Address
JOB ADDRESS � C�< < VI��� • LOT # �
SUBDIVISION . PARCELID# (/ ���(� '" da D�/�o��
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR 8 ADD/ALT � SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK "� � � ��) �v � i� —
BUILDING SIZE SQ FOOTAGE� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ I ,_ �� �j� v
i�i l
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �
5 U � ----_
GAS Q ROOFING Q SPECIALTY � OTHER �,---�_
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address ' License #
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
Address Ucense �! �
OTHER � COMPANY � �
SIGNATURE REGISTERED Y N FEE CURRE� N
Address yl�'�� t"C�,�,� ��,L � L License #
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permlt for new construction,.
Minimum ten (10) worki�g days after submittal date. Required onsite, Constructlon Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities 8 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) woricing days after submittal date. Required onsite, Construction Plans, Stormwate� Plans w/ Silt Fence installed,
Sanitary Faclfltles 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 required for all NEW constructlon.
Directions:
Fill out application completely.
Owner & Contractor sign back of applicatlon, notarized
if over 52500, a Notice of Commencement Is required. (A/C upgrades over s7500)
" Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMI7TING (Front of AppUcatlon Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences (Plof/Survey/Footage)
Driveways-Not over Counter if on pubiic 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 wil�h 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, ff 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 expansivn of existing buildings, as spec�ed 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 ident�ed 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. Fu�thermore, if Pasco County WateNSewer Impact
fees a�e 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 Gufde" 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 wiil 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 Environmentaily Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Welis, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Welis, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wail.
- 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 fo� 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 electricai 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 pians, construction or violations of any codes. Every permit issued shall become invalid
uniess 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. 11 .03) �
OWNER OR AGENT � CONTRACTOR
Subscribed and swom to (or affirmed) before me this Subscribed and swom to (or afflrmed) before me this
by b Y
i cR � vrrtytp �qe or has/have produced ;� o�f��� ef�Q� �o(��'( has/have produced
`i � as IdenBfiqBon. l�-�i�-�UI v1�`' v as idenlificaUon.
� �� J J ,
_�,� /�� � -
/� ✓
� GC�b�L'�� � � ' Publlc
,� , -
Commission Commission No. � "" ��
, . WETIAND :: f= Commission DD 734q06
:.: ,. Commission OD 7344
Name of Not �� B b T p R I�' 22, 2012 Name of Notary „ � rbyFainMN�jryips��.� 1 8
�,�„ Bond9d Thn� TrOy Fein IMUronoe BOo-385-70t9
r��.�uL�11}�FF.�.K �iJ��rii31.�..1u��,rs�ei.s.t�.s.r:�a�. ...,�.... ..r..._..�_----� - - - - -
��t��IIGE.S�IIf��i��� . ���'4���. �`d
m.� be sdbmi#t�:d ��cord; ace w�3t �uc�au o� I.P �s 3�. �m+�-
�
� �� �.��� �� !'L 1'.�`v� s �,�'.r, T . � � . LL_G �a� r�_ .
..F�AR#�' �S OF �.ACI�'���': ��'��'. ,�r���� �I Y� Zf�i k It-�1i � �S �� ,3'3S��Z.•Zs�
sra�.c� �c.�.�� o� r�v T��_ 10� �r��, s�o� c�r8.c� J�
.��Y,rr - ����rr �. €..�.�ua�r���r�~�a.�e:
��� • � ����r�ca�� / ��s:
1 / �
�-� nR.e. - - ' - -
� ii+�ins - � _ � -
- l _ _, . �- �
_�� �
v � �s o'�� � -
� �� Nls, �� - .
� r � M tis _--
��Z����' I ���
�� �� . �, � c��3 �
�'! - - ��'` �
� �
. - _ � ,�� ��.� .
, ^ � - .� ,: $ _
�..� . r►—.----,.�—,� �
+j G .
� � ��� _ ��
_ �
� OWat � �AA3S M��D�1t.Mr� j�r
_ ,� � ,L s%otwh�1c
��'��,5�►~#�'�tt3� = �Ei 4 4R QbA� � �[S SD�
S�TS �.U� 8i�7'�Q� WffAT 7.'{� S'f�.� ._..
Name of � � i AS C �t. �ce� �b�c:-d s�
��6DId v � � Pl��i' �v � l3 r?5Z �ltg�
�iss�e�stoi�eco���. � . oaea� 1'�PdNo.SB,a��e�r�po�eF�a
� � �-��y �be p� �a o�ar�eain.� � � �d�� �a� �rea
CYas I�. ���s�pE- _
A�l�i'A' ��,�.. �i�s.s ��
. � -
�---- - --.� �► �Q��i `��� � O� � � .3�w� CAilliieC �vc�a��s � �i �i �. �'��1
�,�-�uu-u�,zu City of Zephyrhills Permit Application Fax-813-780-0021
� Building Department
Date Received
�� �� r � Phone Contact for Permitting _
Owner's Name Owner Phone Number
Owner's Address Owner Phone Number
Fee Simple Tltleholder Name Owner Phone Number
Fee Simple Titlehoider Address
JOB ADDRESS LOT # ��
SUBDIVISION , PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN �] � DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR Q COMM � OTHER
TYPE OF CON3TRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE C] HEIGHT
QBUILDING �� VALUATION OF TOTAL CONSTRUCTION
LECTRICAL $ f �, AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
L�
OPLUMBING $ �
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � J
QGAS Q ROOFING Q SPECIALTY 0 OTHER �"� ,
� � �
FINISHED FLOOR ELEVATI�NS FLOOD ZONE AREA QYES NO "
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address ' License # -�
ECTRICIAN fL COMPANY �� r NC� �1�� f'e�C �?� ,�
SIGNATUR 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
Address License # �
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
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/ Sfit 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 Fonns. 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 appiication, notarized
If aver E2500, a Notice of Commencement (s required. (A/C upgrades over a7500)
** 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 (PlotlSurvey/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 cont�actor or
contractors to undertake work, they may be required to be licensed in accordance with state and locai 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 flnal power release. If the project does not involve a c�r#ificate 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 appiicabie 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 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 flll 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 flll, 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, poots, 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 O TAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO MM NCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT TRACTO
Subscribed and sworn to (or affirmed) before me this u�sc�ibedand swo (or a e ore i
b � �U� / by ,
Who is/are personally known to me or haslhave produced Who Islare pers I�now o e or as/h roduced �
as idenUficatfon. �� � �-- -� as identification.
/�� �� ; -� ,i " � _
L,
Notary Public -����'
, ��
Commission No. Commission N.�'� � Commission DQ �34406 �
" ° Expires ruary
� eon d a dnwTmrFd��r� „ °nce ' eoo•ses aoia
Name of Notary typed, printed or stamped Name of Nota , mped
Latner Electric Company, Inc.
P.O. Boz 99
3210 Mott Road
Dover, Florida 33527
phone (813) 659-0202 fax (813) 659-0643
E C 0 0 0 1 2 1 4
jUNE 29, 2011
Zephyrhills Building Department
5335 8 Street
Zephryhills, FL 33542
RE. Global Investment
6005 Gail Blvd
Zephryhilis, FL 33542
To Whom It May Concern
My company, Latner Electric Company will be electrical contractor on this project work under
the permit issued to AmeriGas Propane, 4600 Paul Buchman Hwy, Plant City FL, license
number 0528. Please add my company to the permit issued to AmeriGas. I am currently
registered with the City of Zephryhills. Thank you for your help.
Sincerely,
�. ,� �
�
Jerry R. Cro�y �'
Presid��t �
Cc: