HomeMy WebLinkAbout11-12313 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(sis��so-oo20 12313
BUILDING PERMIT
Permit Number: 12313 Address: 6017 14TH ST
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: 26 Range: 21 Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section: 2
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-002A-010000-008
Improv. Cost: 3,144.00
Date Issued: 9/01/2011 Name: MONROE, LAWRENCE
Total Fees: 55.00 Address: 6017 14TH ST
Amount Paid: 55.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/01 /2011 Phone: (813)715-0477
Work Desc: A/C CHANGE OUT GOODMAN VSZ13024 ARUF1824
55.
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DUCTSINSU ED
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 wnstruction c) repairs or corrections not made when inspections 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 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.
"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."
Complete Plans, Specifications Must Accompany Application. All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
� `` i s �'��
CONTRACTOR SIGNATUR PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-OfJ20 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received � -- l __
Phone Contact for Permitting
Owner's Name � � '�., Lylll}P-�l�l� �;� `�" --_�1..� (� Owner Phone Number � 1 � ' ��`�.) � 7 � ��
Owner's Address ls'� 1'T� S Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number �
Fee Simple Titleholder Address
JOB ADDRESS ' U � I "'Y �" � - LOT # � ''
SUBDIVISION PARCEL ID#� �
(OBTAINE� FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR � ADD/ALT 0 SIGN Q MOVE Q DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR 0 COMM Q OTHER �
TYPE OF CONSTRUCTION Q BLOCK 0 FRAME 0 STEEL � OTHER
DESCRIPTION OF WORK C � `Q- V;,�. , V �� I3�1�'1`T' �I ��
BUILDING SIZE SQ FOOTAGE HEIGHT ��
0 BUILDING � VALUATION OF TOTAL CONSTRUCTION
� ELECTRICAL �$ AMP SERVICE 0 PROGRESS ENERGY � Q W.R.E.0
� �
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\,
� PLUMBING $ � � `�� � j
�
� MECHANICAL $ � i, / � � VALUATION OF MECHANICAL INSTAI I �
� �
0 GAS � ROOFING 0 SPECIALTY � OTHER I�Z�- I I � '
FINISHED FLOOR EIEVATIONS � FLOOD ZONE AREA �YES �NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address License #
ELECTRICIAN COMPANY �
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address License #
PLUMBER COMPANY r
SIGNATURE REGISTERED Y/ N FEE CURRENT Y! N
Address License #
MECHANICAL / q, � ` � � COMPANY -x;d) !(J� LU � Y� IJ �� � � f
SIGNATURE ` (f �"L�'` �� i3'�� REGISTERED Y/ N FEE Cl1RRENT Y I
Address �f � � �Tb� I Lice�se # �/"(C�� �/��J
OTHER COMPANY
SIGNATURE REGISTERED Y I N FEE CURRENT 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,
M�nimum ten (1D) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities 8 1 dumpster; Site Work Permit for subdivisionsllarge 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 requiremenis must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000)
** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades A/C Fences (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 ticensed 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 Inspectivn 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 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 specfied 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 Transpo�tation 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 WaterlSewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Fiorida 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 �egulating 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-Welis, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Nealth 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 �tt�ched 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 inf.c�rm 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
the ob is considered abandoned
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, j
WARNING TO OWNER: OVEMEN TO YOUR PROP RT1f. YOU INT BTA N NANC NG CONSULT
PAYING TWICE FOR IMPR
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03) � -"`-��
CONTRACTO '
OWNER OR AGENT ' swo fo (o ffirm ) be re m�i5• i
Subscribed and sworn to (or affirmed) before me this �_ by , —
bY yVho 1sTare ers�� � to me or haslhave produce
Who Is/are personally known to me or has/have produced � as identificatioki:�
as Identification.
� � �� i , ' � .
�_ ublic
Notary Public _ .
Commission No. Commiss s� . SWETLAND
: � �.= Commission DD 7
Name of . ��P�� 2012
Name of Notary typed, printed or stamped �,„ ` BonWdThNTroyFainlneurenceBOD38S7019
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Hernando Pasco Citrus Hillsborough Pinellas
(352) 686-6166 (727) 856-0058 (352) 795-9685 (813) 814-2500 (727) 799-1300
Statewide (800) 897-2335
August 30, 2011
City of Zephyrhills
Building Department
To whom it may concern,
Please except this letter as my authorization for Mark Sittig,
Driver's License# S320-547-56-349-0 to act as my agent for
Senica Air Conditioning, Inc.
If any further information is needed or if there are any questions
please feel free to contact my office @ 727-856-0058
Sincerely,
2� � ,.�� .
� �
Mark Nelson
Lic# CAC 1815564
State of Florida �
County of '. j�',{��y; �1�a1
� S rn to d subscribed before me �his_�c�` day of
,� ,-�_20i � � by � � K �,I _Cc n
Personally Known �� , ., �pRl A. BAKER
///�--�� Or produced identification :�'� �� MY COMMISSION N DO 990020
//{ T e of identification '-'i����`: EXPIRES: September 10 2o�a
/ � •�r�„�p�d:�` Bonded Thru Notary Public Underxriters
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16640 �PP� ,�oac�� 1�03 S� �fiury. 1�i 12240 �ace 7aac� ,�oad
.S� �fiF�, �?.mrida 34610 L��atae ,�u�, �Euzida 3442�1 7a��ia., �emuda 33626
.Sta-te l'cce�e #(�r�el�15564
— �" ���� L1.1L .�.�LO�OL74L �lU'ENGO�D4•�SSOCIATES � ��"""
PAGE 01/02
.ACORo C�R'�IFICATE OF I��ABi�.lTY II�SU
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3 � 3 � �g�-Oa20 CANCEI��ATION
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�XpIRATibN DAT£ THEREOF, 7H� ISSy��NG INSU{=�R y��� �N � ry�AIL
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'`'�° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
OS/23/11
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
FLOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
PRESENTATIVE OR PRODUCE}2, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate hoider 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 statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 813 CONTACT
Florida Insurance Center Inc Na,Me: Judy Wagner AAI AU AIS CPIW
414 N Alexander Street 813-764-8402 q�� Ex� 813-754-3561 A�� Na : 813-752-8794
Plant Ciry, FL 33563 nooRess. Jwagner@floridainsurancecenter.com
Florida Insurance Center, If1C. PRODUCER
CUSTOMER ID #: SENIC-�
INSURER�S) AFFORDING COVERAGE I NAIC #
INSURED Senica Air Conditioning IIIC. INSURERA Westfield Insurence Company 24112
16640 Shady Hills Road INSURER 8
Spring Hill, FL 34610
INSURER C
INSURER D
INSURER E
INSURER F .
COVERAGES CERTIFICATE NUMBER: REVISION NUMBEf2:
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 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR 7ypE OF INSURANCE I N DL U DR POLICY NUMBER MMIDD MM D�lYYYY LIMITS
LTR
GENERAL LIABILI7Y EACH OCCURRENCE I$ 'I �OOO�OOO
A X COMMERCIALGENERALLIABILITY CMM3288093 06/01/11 06/01/12 � pREMISES Eaoca�rrence �$ ���,
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ 5,000
A X Contr Liab Incl PERSONAL & 4DV INJURY $ �,000,000
GENERALAGGREGATE $ ?,OOO,OOO
GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMP/OP AGG $ 2,OOQOOO
POLICY X PRO-
7 LOC $
AUTOMOBILE LIABILITY COMBWED SINGLE LIMIT � �,OOO,OOO
X ANYAUTO CMM3288093 06/01/1'I 06/01/12 �Eaacodent)
BODILY INJURY (Per person) $
ALL OWNED AUTOS
� BODILY INJURY (PeracGdent)' $
SCHEDULED AU1C�S ' PROPERTY DAMAGE
X HIRED AUTOS (per acadent) $
X NON-0WNEDAUTOS ! PIP I $ 'IO,OO
X Hired Phys Damage
s
X UMBRELLa LIAB X OCCUR EACH CCCURI�ENCE $ 1,000,000
EXCESS LfA6 CLAIMS-MADE AGGREGATE $ 'I,OOO,OOO
A CMM3288093 06/01/11 06l01/12
DEDUCIIBLE �
$
X RETENTION $ O � $
WORKERS COMPENSATION V�C STATU- OTH-
AND EMPLOYERS' LIABILITY ,� � N I ' T RY �IMIT ER
ANY PROPRIEfOR/PARTNER/EXECUTIVE E.L EACI-I ACC.IDENT $
OFFICERlMEMBER EXCLU�ED� ❑ 'N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE S
If yes, descnbe under
DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $
A Leased/Rental EQ CMM3288093 06/01/11 06/01/12 Limt too,000
� Ded z,soo
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 10'I, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
C ITYZE P
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Zephyrhills THE EXPIRATION DA7E THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department
5335 8th Street AUTHORIZED REPRESENTATIVE
Zephyrhills, FL 33542
g� ��
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
� SENICA �4lR CO��ITI�f�l1��, 1��. � ��t��
166�0 SHADY HILLS RD � I SERVI( ORLfER
" SPRINC HILL. rLORIDA 34� � � ;����.,; `�—
STA�'E LiC. ��A�18155�4 i�������
1-8�0-897-2335 � w�,�vv.s��aca�aE.c��:'s — 1 1
�����.��� ����; s��-�� �� � � / 210 � 3 0
Pn�w�3 (�27) ���-13�'�$ �
� ���
BILL TO I / n-us woaK is ro ee 1
V I ��1 � � C.O.D. ❑ CHf�RGc ❑ NO CFiARGE
MAKE MqKE
MODEL I MODEL
SERIAL NUMBER �ERIAL NUMBER
i
NAME �/� /� ' l, i
��V�U
smE� _ �� �} 1 _ ATE ' _ ENVIRONMENTAL CHECK C1ST WORK PERFORMED
���, �ROMISED WORK BERFORMED Q"C`f. � TYP�ISPOS1TiON. CONDENSING UNIT COND'SATE DRAINS
( � CLEANm
> � � l� � ❑ RECOVERED L�lEIFD ry�q�N DWUN
� CALL BE RE
� — CLFi1NEDCOIL REPAIRFD
l ❑ RECYCLED MAIN �RPJN
� ❑ P.M.
A
AUTHORIZ B ❑ RECWMED C: DRAIN
FEPAIRED REP.4IRED
� '� ❑ RERIRNED LE1K IN COIL PAN DRAIN
W RKT E PERFORM D � FlEPAIREC FURN. OR FAN COIL
CI DISPOSAL LEAI( IN COPPEF
❑ DISMPMLED TOTAL � x REF REPIACFD BELT
❑ CHANGED OUT/RFPLACED CHECKED qp,lUSTED 6ELT
PdOTOP
CHANGED REPL4CED
QTY_ MATERIALS � SERVICcS UNIT PRICE AMOUNT DESGRIPTION OF W�RK PERFORMED ��oTOa P�LL-`Y
- .- f?EPLACED I ADJUSTED
�: / 1 � D 13ELi PULL.EY
REFRIGERANT F LBS. � ADJUSTED CL�lNED ,
13ELT BLOWER I
� 2��
^ NEPLACED AEPL4CFD
� ' � F_ � ��OMACTOR BEARINGS
9EPL STARL OILED MOTOR I
� � ` aEL4Y
� REP�. SiART OILED 6EAFINGS
' „APACfTOR
� I / ' / LACEDFUN CLEANED
I � ACfTOR HEAT IXCH.
C ED OR REPL4CFD
' ` AD.1. CONTACTOR HEAT EtCH.
' FEPfURED CLEANED OR
WIRING A0.1. P�LOT
REPLACED
� qEPIACED FUSE T}{EAMOCOUPL �
REPL4CED R��A�
COMPRESSOR ���
' EVAPORATOR COIL REPtp.CED
VALVE
REPLACE� B�R�� � I
IXP VALVE
ADJUSTED DUCT
� � // 1 �'.v 'CED REPAIRED
I CAP_ TUBE
FILTERS x x D ���
i REPPJRED THEAMOSTAT
� � COIL LEAK
> FILTERS x x ' qEPAIRED REPLACED I
r
BELrs RECOMMENDATfONS c�weo coi� a.o�us�n
.--� / � � ` � LNEIPD COIL
TOTAL MATEr�iALS
EiL�T. tiTR. CLG TOWcP,
HRS. �B�R I RATE AMOUNT 01 �
REPLACED UNK
I , � REPLACcD KL1X I
REPAIRED WIRE O1�P�Sl
FE°LACcD CON7 �RFi1ScD I
I RcPAIRED
I FIL: c�.�. L ��EANED C Rc°UCED I
���.�eRiA�s�ueoaMr,rse L1Mf I cD WARRAPITY: All materials, parts
CONINUEDONOTHCR5 +�il\� L.4�v.-ri I ' and equipment are warrante� by the TGTAL SUIv1IvIARY
TcRM� manuiacturers' or suppiiers' written warranty
only All la�or pe,rforme� by the above named TOiAL
company is warranted ior 30 days or as NIATERIALS
other,vis2 indicated in writing. The above named T�,Tq�
company makes nc oiher warranties, e:pr2ss L4cOF �
� or implied, and its agents or �echniciar.s are �
; nave autnonN ro ord=r :he �.wr�: outlined above wnicn nas oeen satistac;orily comple[ed- I aoree 1ha? not authorized iC make 8f'.y SUCh warranLies �
3eller retains tille to eqwomenVmatenals furnish?tl until iinai payment is made fi oaymert: is noi maae
as agreeo. Selle� can remove saia �ampmenVmatenais a� Seiler> expense >ny damage r=_sWhng rrom Ofl �J2h3�f Oi above name�' company I RAVEL I,
said remo�a� shal� not oe the resocnsibihh or Seuer CHARGE �
r REGULAR � WARRANTY
��
` SERVIGc CON�RACT �
1 ° Toz � Lt.
CUSTOMER SIGNATUftE
,H,� � �, `2�L�. `
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