HomeMy WebLinkAbout11-12474 CITY OF ZEPHYRHILLS
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BUILDING PERMIT
Permit Number: 12474 Address: 4841 6TH ST
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 14-26-21-0010-01500-0030
Improv. Cost: 1,700.00
Date Issued: 10/24/2011 Name: MILLER, HARRY E& MARIE H
Total Fees: 45.00 Address: 4841 6TH ST
Amount Paid: 45.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/24/2011 Phone:
Work Desc: A/C CHANGE OUT 2 1/2 TON
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DUCTSINSULATED
FINAL � ' �TI��
REINSPECTION FEES: Reinspection fees wiil comply with Florida Statute 553.80 (2)(c) when eactra 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 f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"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 Must Accompany Application. All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONTRACTOR SIGN URE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
sis-�so-oozo City of Zephyrhills Permit Application rax-���-��u-����
Building Department
Date�Received � O �q' � Phone Contact for Permitting ��� 5 � ��' �
Owner's Name 'VI.1 � Owner Phone Number
Owner's Address � �� Owner Phone Number
Fee Simple Titlehoider Name Owner Phone Number �
Fee Simple Titleholder Address �
(I` � 1 ,, i� LOT #
JOB ADDRESS b "� V
SUBDIVISION � PARCEL ID# � —� � ! � I ' �� O ~ � Q � �
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR B ADD/ALT � SIGN Q MOVE Q DEMOLISH
INSTALL REPAIR
PROPOSED USE 0 SFR � COMM Q OTHER
TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME Q STEEL 0 OTHER �
DESCRIPTION OF WORK � O � G 5 ` ��
BUILDING SIZE SQ FOOTAGE HEIGHT
� BUILDING $ VALUATION OF TOTAL CONSTRUCTION
� ELECTRICAL � AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
0 PLUMBING � �� ��%
� MECHANICAL $ � n�� � O VALUATION OF MECHANICAL INSTALLATION
� l .�.
L���' /
� GAS � ROOFING � SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES QNO
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
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address License # �
MECHANICAL COMPANY � S G �
SIGNATURE REGISTERED Y I N FEE CURRENT / N
Address � � � `� V� License # G ��E/ � �
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y 1 N
Address License # �
RE5IDENTIAL 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 Pians w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities 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 alt NEW construction.
Directions:
Fill out application completely.
Owner & Contractor sig� 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 (PIoUSurveylFootage)
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" restrictiorr�"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance witH any
applicabie 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 vr 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 Pascv
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 specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, wili 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"certiflcate 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 Pascv 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'SlOWNER'S AFFIDAVIT: I certify that ail the information in this application is accurate and that all work
will be done in compliance with ali 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 compiiance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative ServiceslEnvironmental 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" unfess 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, 1 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 virill 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, welis, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shail 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 cor�ection of errors in plans, constructivn 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 Buflding OfFicial for a period not to exceed ninety (90) days and will demvnstrate
the ob is considered abandoned.
justifiable cause for the extension. if work ceases for ninety (90) consecutive days, j
WARNING TO OWNER: RO EM N TO YOUR PROPERT1f. YOU INT D BTA N FI� ANC NG, CONSULT
PAYING TiNICE FOR IMP
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 1, .03)
CONTRACTOR
OWNER OR AGENT —" Subscribed and swom to (or affirmed) before me thi
5ubscribed and sworn to or affirmed) before me thi bY
bY Who is%are personally known to me or has/have produced
Who is/are personally known to m as fdentificationroduced as identification.
Notary Public
Notary Public
Commission No. Commission No.
ed, rinted or stamped Name of Notary typed, printed or stamped
Name of Notary typ P
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�� H� I S AI� SERVICE ORDER
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�-- C O M P A H Y 11365
CACO58575 '
12232 HWY 301 DADE CITY (352) 521-4977
DADE CITY, FL 33525 ZEPHYR1ilLLS (813) 779-9515
BILL TO: Rotary Cluh of �yrhi►tc
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SPLIT SYSTEM PKG UNiT
NAME: D'ATE: MODEL #
ADDRESS: SERIAL #
CITY: ZIP CODE:
PHONE: WORK: MODEL #
CELL: Dennis Bulin RENTER: SERIAL #
TECHNICIAN: DATE:
PROBLEM REPORTED� B�N�� Fri idaire
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y., .��#'A�,1 �+F��• f:�.. £k4.
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PARTS & LABOR
PARTS ONLY
START UP :
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10 ear arts warran
�< '�` , > . � . ,, ; 1 year labor warranty
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CHECK # DUE: CASH: "" ��-,� ' � R' > � �' �` � '
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CREDIT CARD #: SUCTtON PRESSURE:
CARD TYPE: LIG2UtD PRESSURE:
APPROVAL CODE: TEMP. DIFFERENCE:
EXPIRATION DATE: FILTER:
.. ,. _ , �. , _;-�::.'�_ DRAININ P
��:;; G ROPERLY:
,::n;�`. :. .;.6'' » �: -•n � .e�,� : , �.�..�a e .c` sA, : .1..;,irY,h` '�,.�?y�t. V � t , „
I HAVE THE AUTHORITY TO ORDER THE WORK OUTLINED ABOVE WHICH HAS BEEN � � � r,
SATISFACTORILY COMPLETED I AGREE THAT SELLER RETAINS TlTLE TO EQUIPMENT ��� �`� �' � L� .�.r� � 5 '�'' x '�
AND MATERIALS UNTIL FINAL PAYMENT IS MADE. IF PAYMENT 1S NOT MADE AS LIMITED WARRANTY• EQUIPMENT, PARTS AND MAl'ERIAL
AGREED, SELLER CAN REMOVE SAID E�UIPMENT AND MATERtALS AT SELLERS EXPENSE HAS WRITTEN MANUFACTURER'S WARRANN ONLY
ANY DAMAGE RESULTING FROM SAID REMOVAL SHALL NOT BE THE RESPONSIBILITY L LABOR PERFORMED BY CHRIS' A/C HAS A ONE YEAR
OF SELLER. ARRANTY CHRIS' A/C MAKES NO OTHER WARRANTIES
------------------------
TOTAL: � � 700.00
CUSTOMER SIGNATURE DATE: