HomeMy WebLinkAbout11-12155 CITY OF ZEPHYRHILLS
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ELECTRICAL PERMIT
Permit Number: 12155 Address: 5528 GALL BLVD
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRICAL MISC Township: Range:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Contractor: JACK SCHIMELFINING ELECTRIC Book: Page:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-05700-0250
Improv. Cost: 2,350.00
Date Issued: 7/27/2011 Name: WELLESLEY DEVELOPMENT CORP
Total Fees: 75.00 Address: 34619 SR 54 W
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33541
Date Paid: 7/27/2011 Phone: (727)824-0780
Work Desc: INSTALL LOW VOLTAGE DOCTOR OFFICE FOR PHONE CABINET
ELECTRICAL FEE 75.00
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ROUGH ELECTRIC '
CONSTRUCTION POLE �
PRE-METER
FINAL � '
N ECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to
of he following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not mad w
pe tion called d) work not ready for inspection when called e) permit not posted on job site fl plans not at job site g) work not acce sit
)TI E: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be fo nd
pu lic records of this counry, and there may be additional permits required from other governmental entities such as water manag me
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.
T O PERMIT OFFI
PE PIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDiNG PLAN REVIEW COMMENTS
Contractor/Homeowner: ,�(�- .�(' �'yyt- �t� �,.� C �L�l��,
Date Received: ��-- ( c 'j — ( �
Site: �2 `' � �� „�� l�
Permit Type: �� (�a �
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sh�et shall be kept with the permit and/or plans.
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Kalvin 'tzer - Pl xaminer Date Contractor and/or Homeowner
(Required when comments are present)
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
,
Date Received - l 5 �
� Phone Contact for Permittin
Owner's Name - L rii Owner Phone Number
Owner's Address Owner Phone Number �—
Fee Simple Titleholder Name �— � Owner Phone Number �—
Fee Simple Titleholder Address
JOB ADDRESS :JS�-F� GL �V� LOT # ��
SUBDIVISION , PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED � NEW CONS7R � ADD/ALT � SIGN Q [� DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR COMM � OTHER L �{
TYPE OF CONSTRUCTION � BLOCK FRAME � STEEL Q
DESCRIPTION OF WORK w ' �' � 4 S I�R �� ?� �w � 20� /1� Z a,�v
BUILDING S12E SQ FOOTAGEC� HEIGHT
OBUILDING $ � VALUATION OF TOTAL CONSTRUCTION
DELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
� �j ��
�PLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
����
OGAS 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 . U �j 2 License # � C / �j(JD � SO �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address
License #
MECHANICAL COMPANY
SIGNATURE REGtSTERED 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 construcbon,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wl 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 alt NEW construction.
Dtrections: " "" - • •
Fill out application completely.
Owner 8 Contractor sign back of application, notarized
If over;2500, a Notice of Commencement is requlred. (A/C upgrades over 57500)
*' 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 Counter it 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 fo� 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 Iicensed 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
Counry.
TRANSPORTATION IMPACTIUTILITIES 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 ail the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating const�uction, 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 regulativns in the ju�isdiction. 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 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 NOTI ME CEMENT.
FLORIDA JURAT (F.S. 117.03) �
OWNER OR AGENT CONTRACTOR� ,
Subscribed an bswom to (or affirmed) before me this SU4sc b�� n y m t1or a fore m � F
Y � .
Who islare personally known to me or has/have produced Who is/are p�ersonal y known or has/have produced
as identlflcatlon. L..f C��-- as ldentification.
---�,
Notary Publlc ��C Notary Public
� "" JACQUELIN BOGES
Commission No. Commi ion o''' •-
\_. - :`• :,►*s Rl(YMSSIdI
�; ' Expires December 12, 2014
Name of Notary typed, printed or stamped Name of Notary t e�s-�o�9
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AC# � _ _ _. _ _. - ST�TE OF FLORlDA _ _ �.. _ _.___.
DEPARTMENT OF BUSI�ESS AND PROFLSSI� �GULA.TION
ELECTRICAL CC3NTRACTOR3 LICENS B �iR1)
-- ; - $EQ#L10D72301126 .
, • - LICENSE NBR' � '
07 23 2.010 �08014584 EC13001508 �
The ELECTRICAL CONTRACTQR �
Nam+ed below IS CERTIFIED
Under the px�avisions o£ Chapter 489 FS. _ _
Expiration date: AUG 31, 2012
SCHIMELFINZNG, JACK R
"INDIVIDUAL"
po sox 7299
WESLEY CHAPEL FL 33545
CHARLYE CRIST CHARLIE LIEM
GOVERNOR INTERIM SECRETARY
Di S P LAY AS REQUIRED BY LAW -
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ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MhYDD1YW1�
07/14/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORAAATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIfICATE DOES NOT AFFIRMATNELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETNlEEN THE ISSUING �NSURER(S), AUTHORIZED
REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT If the cerdflcate hdder is an ADDITIONAL INSURED, the poNcy(les) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certiflcate holder in Ileu of such endorsement(s).
PROOUCER C NTACT
NAME:
Insurance Office of America, Inc. �"�°N;_ 407 788.3000 �ac.No�:407.788.7933
P.O. Box 162207 e.�
aooaess:
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A tamonte Springs, FL 32716-2207 CUSTOMERID�:
INSURER{S) AFFORDMJG COVERAGE NAIC /
INSURED INSURERA ONmers Insurance 32700
]ack Schimelfining INSURERB
P.O. Box 7299 INSURERC
Wesley Chapel, FL 33545-0104 INSURERD �
INSURER E
INSURER F - - -- -- - - - - - - -
COVERAGES CERTIFICATE NUMBER: 2011/2012 REYISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. TNE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS.
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOVIAV MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��7}Z TYPE OP INSURANCE � INSR YWD POLICY NUMBER � � LIMITS
GENERAlL1ABiLIN 7253758 09/23/2011 09123/2012 =, ,�_�_ �FF_r __ � t 1,000,00
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DESCRIPTION OF OPERATIONS! LOCATIONS I4EHICLES (Alteeh ACORD 101. Additional Remarks Schedub, ff mwe spue is requind)
CERTIFICATE HOIDER CANCELLATION
FAX• 813.780.0021
SHOULD ANY OF TFE ABOYE DESCRIBED POLIC�S BE CANCELLED BEFORE
THE EXPNiATION DATE THERE�, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TFIE PW.ICY PROVISiONS.
Cl t y of Zephyrhi 11 s Bui 1 di ng Dept AUTHORIZED REPRESENTATNE � �
5335 8th Street �'. � '. -
Ze hyrhills , Fl 33542 Mark Manfre RICIA
OO 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
'`� °� CERTIFICATE OF LIABILITY fNSURANCE D 07/15/2 M 0�11�
THIS CERTiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATiON IS WAIVED, subject to the
terms and conditions of the policy, certain policies may require an endorsement A statemerrt on this certificate does not coMer rights to the
certficate holder in lieu of sueh endorsemerrt(s).
PRODUCER David M. Shrader - State Farm Insurance �E �ud roler
273 W. Jefferson St. �� o : 352 � Na : 352
Brooksville, FI 34601
no�o�ss: �ud .toler.� h statefarm.com
� INSURER�S) AFFORqNG COVERAfaE NAIC iF
iNSURErt a. State Farm Fire and Casual Com n z51a3
INSURED Jack Schimelfining dba Jack Schimelfining Electric �NSURERB:
PO Box 7299 INSURER C:
Wesley Chapel, FL 33545-0104 INSURERD.
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NONNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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GENERAL LIABILITY ❑❑ EACH OCCURRENCE 5
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CLAIMS-MADE � OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERALAGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG b
POUCY PRO- �� $
AUTOMOBILE IJABILl7Y ❑ ❑ EOM LIMIT $
ANY AUTO BODILY INJURY (Per person) $
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ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000
OFFICFJMEMBER EXCLUDED? N❑ N � A 98-BH-G649-2F 01/15/2011 01H5/2012
(MandaMry in NH) E.L. �SEASE - EA EMPLOYE $ 500,000
tf yes, desaibe under
E.L. DISEASE - POLICY LIMIT $ 500,000
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DESCWPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 701, Addltional Remarks SchedWe, M more space is required�
Jadc Schimetfining - Contractor licence #EC13001508
CERTIFICATE HOLDER CANCELLATION
CITI( OF ZEPHYRHILLS BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
E EXPIRATION DATE THEREOF, NOTICE WILt BE DELNERED IN
5335 8TH ST . CC ANCE WITH THE POLICY PROVISIONS.
ZEPHYRHILLS, FL 33542
813-780-0021 AU ED REPRESENT TNE
0198&2010 ACORD CORPORATION. All rig e d.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849 1-15-2010
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