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Home My WebLink About11-12604 CITY OF ZEPHYRHILLS , 5335 - 8TH STREET ` (si3)�so-oozo 12604 BUILDING PERMIT Permit Number: 12604 Address: 5150 4TH ST Permit Type: SLAB PERMIT ZEPHYRHILLS, FL. Class of Work: SLAB Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-15600-0160 Improv. Cost: 2,000.00 Date Issued: 12/08/2011 Name: ALTUM MINDY JO Total Fees: 45.00 Address: 5150 4TH ST Amount Paid: 45.00 ZEPHYRHILLS FL 33542 Date Paid: 12/08/2011 Phone: (770)695-8584 Work Desc: 3 FLAT SLABS; 12 X 50'; 12' X 25'; 16' X 25' NO STRUCTURE TO BE ERECTED �n� , , ; su�B ��-tr FINAL REINSPECTION FEES: Reinspection fees will comply witl� 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 cailed 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. "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. � ONTRAC OR S NATURE PERMIT OFFI R PERMI XPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received p e Contact for Perm ( 3 �S _ 7 p �� er's N � �`c \ � Owner Phone Number ,6v��er's_Adcjcdss � S� �'� �"` Owner Phone Number �— � i Fee Simple Tltieholder Name Owner Phone Number Fee Simple Titleholder Address � O�ADDRES � � S� M ' S � � LOT # � SUBDIVISION � , P�IRCEL ID# ��/ ro� � �4U1 (7 - >S 6 a(p —(J/ (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR e ADD/ALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME [� STEEL Q DESCRIPTION OF WORK ` �r F �j � � �a,,, F� � �� d ( (F�-� /�-�'�.� BUILDING SIZE SQ FOOTAGE �3DO HEIGHT �/ /Gti ��v �" � BUILDING $ � , \ y � �� __,.,�Fk�UATION OF TOTAL CONSTRUCTION DELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ��Q D � _ � ; OGAS Q ROOFING Q SPECIALTY � OTHER ��'°"� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER \ COMPANY ` SIGNATURE '�' REGISTERED / eE CuRR 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 License # OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address Ucense # 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/ 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 Safery Page; (1) set of Energy Forms. R-O-W Permft for new constructlon. Minimum ten (10) working days after submittal date. Required onsite, Construction Pians, 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 constructlon. 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 57500) �" Agent {fo� 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 (PIoUSurvey/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 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 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 Transportatfon 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 invoive a certificate of occupancy or final power release, the fees must be paid prior to permit 9ssuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicabie Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter T13, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that 1, 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 all work will be done in compliance with all applicabie 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 Environmentafly 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 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 materfal 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 fitl 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 specificaAy 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 LEND R OR A TTORNEY BEFORE RECORDING YOUR N TIC OF COMME CEMENT. FL�RIDA JURAT (F.S. 1 03) ( - --- —� � C TRACT � � �--�u aPd swom t fore i u s nd swo d) befor th � bY by o Is/ e rsona known to me or haslhave prod ed Who slare ��ona I'k vm to m or ha as dentification. � as identlflcatlon. � � � �/� � y � � ' , 1 �� , `� � ' tary Public ____ � Commission •°��'�'"'•�'''.- 8��81E $� SWETLAND Com �„�, . :.. ..- ;��` Commiss�� 7344� =� " Expir�s February 22, 2012 - Name .* �79 Name of No �' � R, eoodedThm roY ?�3d J1311d ,OZ � �° �3rnr la� ,� � � �� Cw) .co�os (a) .og �� ca� .o�ob �`3�` C1�1) 3 .AS.SS.i►z s �2 _ x x � — � � � � .. - �3 � + -. �-,. .� � ° ,� � , � a� sQ�T � _. _ � �• � x }'` _ � - , � � � ' ` - �e7D ,� x �° � r'� a 'N19t � � c .9rQ 'y � � x� � • � n � � � � v x � . �--+ 'r'"` , � ; � v � � _ � s � .811 _W x � Q - U � w � '' � � o ° '` v � ao ( � � . " r"� � x � j� m �� c °,� �D � � � < F--- . Z � *' 0 x � � � O _ - ^ - �!1 -urilA. -- � � -� t s�a � x `' � � � � �� a � o � �� "� ��- 4 , � � � x �� 41� � x �. , f � � �. � Sl� _ �: � _� .s�-�� _ . � � /� �� -%/ o Ft`'� ,�.s - �. 1 � . ,. . � b �� a � ,Q,�o n " � ry � � . � �j �� cd� .oE � � � ��' .. � m cMU .co� caa .n� �MI) .S6'6S .49 n � o � CM�) M.AD N i � � � o � � iirq �'q M 'p� � �.v�d a� N►/a .os ) _ . 1N3Ml3Atid 111fHdSY .�Z � 1332�1S FLLi► . DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS —.BUILDING DEPARTMENT �, � ✓ . � �` ` have read and fully understand and agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following conditions: 1. That the owner and he or she alone shall act as the builder for all phases of construction. 2. That the owner will comply with ail provisions of the City of Zephyrhills ordinances and codes pertinent to the building. 3. That in the event various phases of construction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. 4. That in the event the Building Inspector shall require corrections to be made, the owner will assume full responsibility to insure they are made, and upon completion will call for a reinspection before proceeding with the.building. 5. That the owner shall assume full responsibility for the construction and will not expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspection any additional fees, including reinspection fees, must be paid in full. A written request from this o�ce shall constitute an official notice to pay additional fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc., where applicable. 8. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not exceed $75,000. The building or residence must be for your own use or occupancy. It may not be built or substantially improved if for sale or lease, which is a violation of #his exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that people emplo�ed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide worker's compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. OWNER'S SIG�1ATURE C� �- DATE�I ,hc ;�/� ADDRESS 1/ � j PHONE -- ) _ � �- ,� WITNESS ' _ � ' - PERMIT UMasterfom�s/OwneisAffidavit/Nov07 GENERAL PUVVER UF ATT4RNEY � THIS IS A Mt!lTARY PC)WER OF A'tTORNEY PREPARED AND IXEQITED PllRSUANT TO TITLE I0, UNI7ED 5TATE5 COUE, SECTION 1044B, BY A PERSON AUTHC�RIZ►:D Tp RECEIVE LEGAE ASS�STANCE FRpM THE MILTfAitY SERVICES. FEDERAL l.AW EXEMPTS A h{IUTARY P41N�R Of ATYQRNfY FROM ANY REQUIREMENT OE FORM, SUBSTAN�, FORMALITY OR RECQRDIT�IG THAT T5 PROVI�ED fOR POWERS OF ATTORNEY BY TH : L.A�.W OF ANY STATE, GOMMONWEALTH, TERR{TORY, DfSTRICT, bR PflSSE5SlOPt OF 1'HE UNITED STATES. FEDERAL LAW SPEUft£S TH,P�7 �� MILiTARY MJWER OF ATT4RNEY SNALL BE GIVEN THE SAM£ CEGAL EFFECT AS A PO4NER OF ATTOltN£Y PREPARED AP[D £}:ECi�TED IN ACCQRDATK� WITFI 7'HE LAWS OF THE JURISUK710AI WF�RE t'f IS PRESRITED. KNOW ALL PE' SC�NS, chat I, M1NDY )Q ALTUM, a legal resident of FLORIDA and presently res#ding at I990 Narborview br, �n�ter, South Carolina 29153 c�siring to exect�te a GENERAL POWER OF ATTORNEY, do �ereby appoint ]oAnn (.,eig6ly whose addre�s fis 5t50 4th St, Zephyrhills, Florida 33542 as my Attvrney-in-Fatt, for me and in my naine, to do ati :�cts whatsoevet concerning my property and �ersonal aFFairs necessary and advisable in the judgment of my saicl Attorneyan-Fact and as pertnitted by state Eaw, as faliy as ! cautd do If personally present and acting, induding but not limited o: 1. F:EAL RROFF.R7Y TR/�NS�►CTlONk sny otHer person or persoos and mysel(, w)th fuli power ro use tbe (a} To buy, mnrraa to buy, rece'rve, laue, w othawiu aaqulre same for safakapEog any property or papen, a�d ro rnnove ' rcal estace or any op�lons thercon or interem therein; {b) w seN, [herefrom at my dme, w fmm tbne m ttme, atl ar any par[ of tfie mntraa -o seli, mortgape, kase, gnac options ro purchu4 or conre�ts�of any wch box or r�ul� (cJ ro bortvw mortey and [o o[henvi� diKwx of any or aA real ara� in which 1 tww have or ettecuce In my aame any i�trummt ewidmdng i�debtednen } may her �aker acquiro aaY �;, ritk a intueu; to si;n, acacute, Jna�md on my bdw� ard m extend and rcnaw Uu same. as weli atknowt d�t .�nd dr9+rer my and ali trturume�tts u may be u any indebtsdness herctolon 3ncurced by me, For the paymmt ofi neassar � w �nnaenhn4 cpepi�ing suth terms and conQitiau, �nd whkh 1 maY in my way be qable. such w� ranNa and mvenana, �f any as my A[torney-is�m shal! decm ad Rirabi� {c) to mansYe, rep�ir, alar or Improve sny rc+i 3. 7AXE5: To flk tnmme and �il odrer wx returns and ahu or rtnuture chereon, owned by me tn whok a In parc, and dedandoM of es�imand ta�c reqcdred m be made by me by law; to to ptrne� t[he same bY aafon, P�ing or aher�rise tndwtie8. *�A�nt uid ac[ tor mr in alE tax maturs ia Qispua or NaYation. bac not imlud ro, the romvery of posaessioa tbereof md tAe co rcreivc, et�done, and coika cl�edcs !n settkment of �ny refund rcmoval oP ce�anar or afier perso�, a�dmab or abiecu therefrom. of nxa, m flEe daimt for ��m[, refund, or a�edit nxa, to + make my aG�uumarts or settitmenu md ro�n anY aiM all ' 2 B'ERX?NAL PAOFEATY TRANSACT]ONS; (aj To buy, reoelgu, wafrera, settkmonu or �reemana pertalnir� m all xlt, kasr, mr,tnct for chr repatr of, and ln my iaanmr deai wi�h i000me ar other tua �saesscd �inst me or my proppny by any and all pannnal property, tan�i6k or touanqbk, whisfi I may saae. awn or � vfi�ch i now havr or herraher m�y acquire, any e9ght, tl0e oF i tereSC (bJ to execute and de�vsr to the proper autlrotiry 6. GOYfRF9�1ENT DOGU!'4EN7'S YOUCHEItS AND an y s�d ai{ doc�imena eeceaary ro dfect the prope► replstratbn GHECKk [a) To trxeaitt, si�n anQ deGvet any and sfl �orernment and 4uun,sirtg of any atomobila in whkh I taw w may hereaher report�, �DRotbnt, rpuetts, voud�ea a� dema�ls in mY behslt, hare an (nten�acr, {cj m qke posses�ion apd avfer che removsl artd isclwdin�, bus uoa dmlted m tboa 4or any s�rci a�l atbwmees snd shipmeni of any � mY pTOperry+ from or � aay norelwuae, or reimbursemeno pro�xrlY P�Y�k to me bY the Urdud Srates such aher pka of s�on�s, rafekeepin�, or ux, aed to aceatr a� as fot die uanspottation ot dependenu or the shipmen[ o{ deiive� any receiP� or ocher fnurument neaessaryr or aonvenient househoW sfis+c[s or other Droyerty as audariz� by law or far wch purpoux reguudonx @J m reaive, mdorse and adlka tbe D��s of checla pay�bk to my onler dnwo on the Trwwn of thr Unl[ed 3. I.�USIAEESS TRANSACIIONS: 7o dhnand, me for, Sc�[es for wf�atevrr amonn� recover. �ecei n, mmpromisy seMs, ad�st and pay ali acaounts. le8acees, bequesta Interrsk, diridmds, arnuides demands, debts, 7. iNSURANCE TRANSACTtONS: (a) To pay the prenWms caxes, and any a� �I ocher obAgaeiona, whkfi may oow or on, tcraiinate, or aeate any rigkts on any contract of tnm, hereakcn� be due, owing or payable by or m me, and w rarry aa presen[ly owned b� me or 6etraftu acquired, (b) to procure �nd w t msaet eve►y kind aF busimu on my behalf, incN�ding, but Qiftermt, or additbna! mn[racts d instrnace an my 6fe or wi�h not flmil :Q to, tramactbns concerning any and a111qvescments, respect ta protecdny me or my property Erom tll heafth. dis�bfiliy, and ro Ii�vnt and reinvest and excha�e tnvestmmtx, and to xddeM, IlaWlity or bss. jc) to appty fw, anQ receire, any to.in on • rxacute nd deitver �ond and wHidm[ lrtttraments Kor chc thc cub wrrendtr vaq�s, m exercise aay dectlaa or rnmersba acwmpl�shment chereof, artd co ace as my morney or pmxy with rights, and to demind, reuhre or obtain mY �neY, dlvtdenA or . rapec� tp �ny stocks, sh.ires, bnnds a ocher inraamencc, rights or afie thir�y of vaWe to whlch i am or to wirkh I roay become inceresrs as I r�ay now or herea(ter Aakl. entitled �s she proceeds or other retum ar pro![c arising oat aF any mntract oF imuraact or of any one os more of [Ne tnairance 4. I�N1:1T7G TRJltd5AG7(ONS: ja) To d�osit or whhAraw tranuRions herein enumersteQ. � For any � a�rpase, in or From any bank or other flnanclal insticu�k i, any (ands, ckecks, or other aedia wMcfi I now or B. PEBSONAL TRANSAGTiOMS: To do ali aces neassary hmaftri may hare on deposit w be endtkd m, a� w endorsq for m�ntainlna the arttomary Brtn�sUndards oi my dependens �ash and receive the p�a+esds of any snd alt cltecks, voucher�, or tndudin�, by way of illuun�lon Dut no[ NmftsNon, provision ot other oru�ers #or mo�y, to open or tloae xcare�, and w reaire su� 1lring �srters a� thdr malnunanae and operatbn, IooQ, �acemen�s, vauchr�s, nodas or other docume»�s from any bank cbthtnQ, medtp4 sur�ai and de�tal nrq edapclonai FadNdes, ar other Onandal Instimdon miroerninq my and sll xrou�ps or and other inddennk w which my dspen�ima arc aauscomed. banking Epnturctlons in my name or in which t maY hari an i intercst; ib} [a have uatt for atl purposrs [o any or ali sahtty drpostt bwca w raults renad in my rtame or in the namesot GENERA� TRC�Vt5IONk (aj AU busineg mnsactied tKreunQer for � or /or my account shail be trartsacted in rny name, and aU indorsements and Instn nents execuced by my IltrorneY-��-Faa {or the purpose of arryins ouc any of the fore�o[ns powers, shall e�+utn my name, foibwed by thu of m� �ltu�rney-ia�aa acad the deslYnation,'AtroraeY-1�-F�': @l � hereby nHfy �rtd conHrtn sN IaMAuI �cts done and aused ro be done by my said �,trotney-{rr-Fact pura�ant t+o this Po�r of AttorneY• (cj if tfie sutfwriry oontairnd hmtn shall be revoked w termin�ud by operadon of law witho'�t �rottce, I hrreby agret for myset(, executors, admiaistrators, he€rs and atsigns, im m�sideredon ot my attorney's willingnrs ro act purx�aot i� thk� Power of Attaner, m sare and bofd my acrorney harmless from any Iws suffend or any qabiliq inarrred by my acmrnry ln sa aain; afr,er wch ro+roadon or cerenliu[}on widaout iwcice. (dj Notwith�andiag my Ymertian of a�peciflt eMpkaWn daTe herrin, ii an ehe abore spedfied qeph=tion dm 1 shail br, w kave been, c,x�ied le a ralt[wry spcqs o( "mlutng", "misfln�tn-ac�m", w"pciwner of war. thm this pawer of attwney shall automaticalh remain v��d atb in fufl effttt unHi si:ry (60) d�ys a(ter I have rcwrmsi to Unitrd Swta Military mntroi fallowtrtg ttmNnat an or wch sneus. TF.R�NIhATT� k : �his Pvwer oF Attarney shalt betame nutl and void the 13th day a� October 2U12 untess i shouici become incapac itat d; €n that case, it shatl remain in efFect �n[�I revoked by the prindpai. • Notwithstandin� my insertion af a specific expiradon date herein, if on the above specified expiration date I shali be, or have been, carr ed in a milItary status of "missing," "missing-in-actian," ar "prisoner oF war," then tbis power oF atrorfley shal! automatir� iy remain valki and in full effect untii si�cty (60) days after t have rezurned ca United Staces Mtiitary ' mntrol iallowi� termination of such status, IN WITNESS 1N HEREOF, 1 have here unto set my hand on this 13th day of October ZO1L � - MINDYJO �iLTUM ' WitL t6e Arme 1 F��rcea si Sliaw AFB On rhis t3th da � oi� October 2011, l, a paralegal, autho�ized the generai powers of a Notary Public under the provisions of Trtle 10, Unfted States Code, Seaion �44a, certify that the person who�e narne is signed to chis inscrumenc is within. the ctass deFlned by� Title K3, United Srates Code, Section 1044, dtd personaUy appear before me and, after the cantents of this instrument had been read and explained, ctid s�gn thls Instrument and acknowkdge doing so freely and voiuntarity for the uses, purposes, �nd mnsiderations set forth abore. �-°�,_,.„.�_" > ��_� � � . ,�-�------__ 4-�.--' BRITTNE 5 �� vE�, aic, srr w�s, r�s� � , � - • � : �. ., ; ` ,= �. . _(� • ' _ ' t�FfCB Of fIi@ . � i _ � Staff J�dge Advocafe � , '_ �' � Tl�e 10 United Staies Cade , . ' SeCt��'1 1 �44 8 „ 4� � L . � , �,______�.� - , • ��.,` Jac ueline Bo es \ � From: Jacqueline Boges - n � /� ' Sent: Thursday, July 07, 2011 11:16 AM �U ;'X To. Shane LeBlanc �� 1� l Subject: RE: drivewayapplication � �) I (, l� ,�.� � S i ��. � , r OKAY SHANE . � j � 1 , THANK YOU FOR THE U E. WILL N � - OTATE ON APPLICAtTION. � , C� .. -- ----____ ---- ------ � � ---. ._., _ - - r - -- -- .__ .__ __._ .__..__..___ _. �..---- --- - -. --- ----------- - - -.. ._ . _ _ ._r. ..__--- - - From: Shane LeBlanc � � Sent: Thursday, )uly 07, 2011 10:22 AM � �� To: )acqueline Boges '� Subject: RE: driveway application ,/ f .- 0 Jackie: ,.�' r �. ��--___�.___.__--_ I talked with the property owner this morning to inform them that I have denied their permit request, the reason for denial is: there is a large Verizon fiber optic pull box in the path of the proposed driveway. I informed the property owner that they'd need to contact Verizon about relocating the pull box, at that time they could reapply for the driveway permit. Should you have any questions, please let me know. Thanks, SJ L - - - -- -- — -- - - From: Jacqueline Boges � Sent: Friday, July 01, 2011 3:16 PM To: Shane LeBlanc Subject: driveway application Placed in your box application for driveway 5150 4` St. thanks Jackie Boges Code Support Specialist ext. 3513 i . �� -� y,d� Jacqueline Boges From: Jacqueline Boges Sent: Friday, July 01, 2011 3:16 PM To: Shane LeBlanc Subject: driveway application Placed in your box application for driveway 5150 4 St. thanks Jackie Boges Code Support Specialist ext. 3513 �RlCll� r Z N�� P�—�� L� KF'� �� S �?c�9 c � L �` tN-E-( �rc� 6t-� �2 � vi�vq `/ W� �- L C� � � rv c,N E(Z, v. u/ . �NC� �. � � � � c� ( �t � `��Pc��E � � �_ _ _ �—�� PERMIT APPLICATION ��' DRIVEWAY PERMIT APPLICATION CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY All information must be filled-in completety City of Zephyrhills 5335 8"' Street, Zephyrhills, FL 33542 Telephone 813.780.0000 Fax 813.780.0005 �ArYMii'h/)Y�1 ��, � � � ' � $ t Mk ' _ _ ,,� � �� PR07ECT )OB SITE• PROPERTY OWNER Address: ! 5 v � i' � Name: Y"� � N v � � n-- Unit #: Address: � �F rl" Unit: Parcel Identification Number: — 2 -� �, "� nu � d Ci State Zi Z�f/N/t (� 4�-i- R' ts' L 3 g �. z. 0 0-- �� b�o Phone: �'� �' �? Fax: � 3- 6 D'I — lA�...2L_1.!-osio�I 6eu- �l1G'�L. � � S—�`fS�d CONTRACTOR: Company: Name: Contractor's License #: E-Mail: Phone: Cell: Fax: ARCHITECT/ENGINEER: . Name: Firm Name: Address: _ City: State• Zip State License #. Phone: Cell: Fax: DesCrio n,of Proiect ('� T�1 PE�OF DRIVEWAY ��• L NGTH OF DRNEWAY RESIDEM'IAL DRNEWAY WIDTH OF DRI�VEVUAY () REINFORCED CONCRETE COMMERCIAL DRIVEWAY � EXCAVATION PUBLIC ACCESS DRIVEWAY �prH 1 � LINEAR FEEf () BO U VER D MATERIAL CONSTRUCTION MAT ore� () OT ER (IXPLAIN) CU�OUIRED � � ALT ES NO NCRETE 11EeDWALL R�OIlI D� YES �NO NOTICE TO APP ?ceNT If actual work exceeds scope of this description, additional permits or drawings will be required. UTILITY LOCA ONS REOLTRFn• CALL BEFORE YOU DIG: 1.800.432.4770 Page 1 of 3 PERMIT APPLICATION UTILITIES LOCATE CONFIRMATION NUMBER: PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS APPLICATION. �. AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all approved construction documents, and issuance of this permit is verification that I will notify the property owner of Florida Lien Law req., F.S. 713. The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed restrictions may apply to this property. All wo�ic shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design Standards (if appliCable). (Public Works Design Manual online link: www.ci.zephyrhills.fl.us/public_works.asp) APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT TECHNICIAN OR NOTARY PUBLIC. NOTE: The City of 2ephyrhills is not responsible for mair�tenance or repairs of driveways. Driveways shall not alter / intertere with existing stormwater treatrnent and / or wnveyance. PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure statement. (please initial) A i t Pri Name Applicant Signature Date � 7 /�</ Pe i hnici ignature (or) Notary Signature Date Applicant is () personallv known to me or produced as identification. (type of identification) Page 2 of 3 t•�•v• '��VV�J ' t11 ' t.i1t111\ Lil\[� � L'LGt.I[�ll. VH1PiJ � , � i ��►�� ----`------,— . � _ .�, � � , � , I A x ��f� t , i 1 � �ej � 1 i . f �'. 3«�' � � � ; ' i ' � � � j }+ �''^` �r� � _ , �- ; � . i ; � . + � 'i , + , i � RAT k { t $ i ; • + i , `� ' ' ' � + ' � t , ��` � � . CONDITIONS G 8 PpOPERTY STAKtS Y N CUSTOMER TO BE CALLED , Y N SAIESMAN NEEDS 70 GO Y N CUSTOMER TO 9E THEfiE Y N CUSTOMER TO PAV DRIVER Y N IOCATES Y N CqED1T CARO Y N �wid objects or utilities and obtaining buiiding permits are the responsibihry of the ownec Quotatrons Uo not h are charged by the hour as needed. Gulf to Bay �encing lnc. reservrs the right to repossess all materia! delivered �ecitied. The customer agrees to hold Gulf to Bay Fencing Inc. hannless for aU claims arising fiom questians of From claims for personal injury, property damage or trespass from ot by means of the installation of snid fencc lood, or other natural causes. This proposal becomes a contract when accepted by both parties. Interest �rill be �s. Cost of collection and attorney fees, if any, will be added. Contract is based upon lump sum cnntract method. � t � � 4�H STREET , t 24' A�HALT PAVEMENT � ( 6�' R/W PER PLAT) f � w a�c. au� :� � . �� ' ; �} N � o � . � . ° 80' P 59.95' (M) �s.o� rn� as.o�� c�� t a > ., ; { �Q� �' e �-�� , � `'�a 30 ' � ti \ ' c � ,�� i o c�'�� . �� ' � j � � y .�ii "vO � � �Z �� ',� � �.�,�..� �� i � � � > '`, p1 ' �� V� � �, 1 5�1�, O c, O�gf � 13.16' °� oy ' �I'20.43' � ^ � � as� � ac�s �� V � v x � k w yZ,9 * 1*f p W � t r � � �� - � � � �� .. � '� � .� , x � a� � ar�s 20. I Ifi1.ItY H� V /6 ' \ � � O � qp� ' p�i � l_ x (� . — � • � � _ , � Z Cl y N � � � —� � w � -+ r� ` �`' ''� x } , � ,{ � a� b� ; - � . v �- � - � r J � � � �o �� r � � c7 ° 4+ s v � � �� x n1 �. ws � � �a .� � "' � f �,�.+ : �.a'' ►--' 'f � t+'� x � , - �. � t v M � i �. '� 1 � 3: x� � � �: ♦' � �.. �' � ��. ' � t7# o ^ - � Ap � �,,� � v �f o: x \'t, �, " DL9E �, �t� � G � �� t • * . , '` � _ _. . �-� � . � x ._.. .� � � �" � o —� v', ) � � C� G�� ---� �I x �' � � � ".._�: "" . —�. � � � � ' s . p � + � � �. � � �. � _ .. , � . _ � x x - � ?� S 24'S5'S0" E (!�t) - � ��, so.o� cn� � � �� 60� tP) 60.07' (!►�) �� o `'ti aRT,�Y o�, 2Q' A�LEY PER t'd , OZLO-b�S (ZSEI ouI ssa�dx3 a�a�ouo� dZZ:90 Ti 9Z u�C PERMIT APPLICATION OFFICE USE ONLY PUBLIC WOR1�,S U5E O1�iLY Concrete (min. 6'� Y N Asphalt Base (min. 6'� Y N Asphalt (min. 1�/z'� Y N Length (min. 19� Y N Width (10' min — 20' max) Y N Existing sidewalk. Y N New sidewalk. Y N ADA compliant. Y N Expansion material required. Y N Contiguous parking pad. Y N Triangular flare (31N x 7'L) Y N Visibility triangle o.k.? Y N Side set back (3' min. R.O.W.) Y N Plan Review Fee Additional n of wor#c as deflp+ed PuWlc WoMcs Direcbor and or ne�e: � eL 'CC 7-� �e� A ��...� i � i Permit application approved by: Date: Page 3 of 3