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Home My WebLink About12-12966-12965 CITY OF ZEPHYRHILLS f � 5335-8TH STREET (813)780-0020 12966 BUILDING PERMIT Permit Number: 12966 Address: 4845 4847 20TH ST Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: MOORES FIRST ADDITION Est. Value: Parcel Number: 1426-21-0010-02400-0010 Improv. Cost: 2,350.00 Date Issued: 4/10/2012 Name: HEILER, ALFRED 8�TERESAANNE TRUS Total Fees: 50.00 Address: 7602-4 CONGRESS ST Amount Paid: 50.00 NEW PORT RICHEY FL 34653 Date Paid: 4/10/2012 Phone: 727-243-5334 Work Desc: REROOF SHINGLE (DUPLEX-4845-4847) � (�' /��(" 2--- ;� TAPE JOINTS ROOF INSP 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 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 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 property. If you intend to obtain financing,consult with your lender or an attorney before reoording 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. � � ONTRACTOR SI NATURE PERMIT OFFI R PERMIT EXPIRES IN MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER s�s-�ea-oazo City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date,Received Phone Contact for Permitting _ Owner's Name �/r� f Owner Phone Number Owner's Address %'" rc „ , Owner Phone Number �a�- .z . -,3-3 Fee Simple Titleholder Name Owner Phone Number -� Fee Simple Titleholder Address JOB ADDRESS 1'J �, `* � � 1� l 1 �S LOT# � SUBDIVISION , PARCEL ID# � - - ,`� _ - (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN � Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WORK � � / BUILDING SIZE SQ FOOTAGE � �� HEIGHT �� QBUILDING $ r�.,� VALUATION OF TOTAL CONSTRUCTION •�- c.n./.�'+� DELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ -l� Z C �r" OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION i � 1 OGAS [� ROOFING Q SPECIALTY 0 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER �/ '� 3� rf � COMPANY SIGNATURE ,�.REGISTERED Y/ N FEE CURRE� Y/N •� � Address 3 License# ��_,,�1p�"7'�� 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 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/Silt Fence installed, Sanitary Facilities 8�1 dumpster;Site Work Permit fo�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 all NEW construcUon. 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(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 if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed' re,strictions" which may be more restrictive than County regulations. The undersigned assumes responsibiliry 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 appiication 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 final power �elease. 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 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. Apptication 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: - Depa�tment 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 Services/Environmental Health Unit-Vdlells, 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 NOTIC OF COMMENC T. FLORIDA JURAT(F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and sworn to(or affirmed)before me this Subscribed and swom to(or affirmed)before me this by bY Who is/are personally known to me or has/have produced Who is e personall known to me or haslhave produced as identlfication. ��5 ��`--�' as identificatfon. _� Notary Public � Notary Public Commission No. Commi si �� '�' ;;� Comrnission#EE 040520 -.: Name of Notary typed,printed or stamped Name of N � ,;p .,, r�,S�l�lip�o=��9 Pasco County Parcel: 14-26-21-0010-02400-0010 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, April 07, 2012 Parcel ID 14-26-21-0010-02400-0010 (Card: 001 of 004) Classification 08 - Multi-Family - Less than 5 units Mailing Address Property Value HEILER ALFRED G &TERESAANNE Ag Land $0 TRUST Land $44,880 HEILER ALFRED G TRUSTEE Building $150,649 7602-4 CONGRESS ST NEW PORT RICHEY FL 34653-1107 Extra Features $188 Phvsical Address - See All 8 addresses (First �ust Value ;i95,717 Shown) 4845 20TH ST Assessed (Non-6 jhool Amendment �195,717 ZEPHYRHILLS FL 33542-5223 Leaal DeSCriDtion (First 4 Lines) Taxable Value $195,717 MOORES FIRST ADDITION PB 1 PG 57 LOTS 1-4 INCL BLOCK 24 OR 3336 PG 1294 Land Detail (Card: 001 of 004) Line Use Description 2oning Units Type Price Condition Value 1 0800 MULTI FAMT OOR3 26,400.00 �F $1.70 1.00 $44,880 Additional Land Information Acres 0.61 Tax Area 30ZH FEMA Code �Residential Code ZH LP7 Buildina Information - Use 08 - Multi Family (4 or less Units per Building) (Card: 001 of 004) Year Built 1984 Stories 1.0 Exterior Wall i Concrete Block Stucco Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall i Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air- Ducted A/C Central Baths 1.0 Line Description Sq. Feet Repl.Cost New 1 BA� 1,536 $59,044 2 Q 48 $384 Extra Features (Card: 001 of 004) Line Description Year Units � Value � No Extra Features Sales Nistory Previous Owner HEILER ALFRED G&TERESAANNE Year Month Book/Pa�e Type Amount 1997 O1 4541 /0812 � �O 1994 08 3336/ 1294 W D $146,000 1994 OS 3293/0517 � �p http://appraiser.pascogov.com/search/parcel.aspx?sec=14&twn=26&rng=21&sbb=0010&b... 4/10/2012 Pasco County Property Appraiser- Physical Address List for: 14-26-21-0010-02400-0010 Page 1 of 1 Welcome : Records Search : Parcel Details : Physical Addresses Physical Address List for Parcel: 14-26-21-0010-02400-0010 Displaying 8 records View in groups of: 10 25 50 100 500 Street Name • Unit 4841 20TH ST �43 20TH ST —_ .—_—. 4845�-�'" 20TH ST 4847e.�```� 20TH ST 4851 20TH ST 4853 20TH ST 4901 20TH ST 4903 20TH ST Pasco County Property Appraiser Page Layout Modified: 2/17/2009 1:10:37 PM The Local Time Is: 4/10/2012 1:14:26 PM http://appraiser.pascogov.com/search/physadd.aspx?parce1=2126140010024000010&eas=... 4/10/2012 STATE OF FLORIDA -__- - - DFPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET •��t� TALLAHASSEE FL 32399-0783 DUBOIS, STEVEN MICHAEb STEVEN M DUBOIS ROOFIIZTG OF PASCO INC 15348 GREEN GLEN LANE SPRING HILL FL 34610 STATE OF FLORIDA AC� ��°�S�� Congratulations! With this license you become one of the nearly one million DBPARTMS� O�' SU�.II?345� A,I�'L� Floridians licensed by the Department of Business and Professional Regulation. pRQ�8B3�t��14�i �St�+�iT�ON Our professionals and businesses range from architects to yacht brokers,from _._. �;. boxers to barbeque restaurants, and they keep Florida's economy strong. e�C05776$�� ,� f f i;��-3�Q,Q 090484�$9 Every day we work to improve the way we do business in order to serve you better . .� For information about our services,please log onto www.myfloridalicense.com. C�RTI�'I$�9 N� CT�R There you can find more information about our divisions and the regulations that Dt�QI�, ,;�` . impact you,subscribe to department newsletters and learn more about the 3'i'E�N b�' q (�F pA3Cp DepartmenYs initiatives. �- "` �.. Our mission at the Department is: License Efficiently, Regulate Fairly.We , �,'; ,��`1 . constantly strive to serve you better so that you can serve your customers. Ig =g��p �,�F �bo �wiss�, o� 0�.�88 e^s .Thank you for doing business in Florida, and congratulations on your new license! ��- �.��,� �oar150o798 � , s�iracioa�a+at� AIIf� $l, DETACH HERE C# L�� STATE.�F FLQRIDA D'EPARTMEI+�T GTF BUS��S� A�TD P320��5�*Q • _ ��l,�,ATIOi4T CflNST'R��T iNDU�fiRY LiC�t�i�H��,RD ��oos�5�bozs8 L ��NS 1ri�3 '-� ,i� - 06, 15 , �#�:�Q �90'48�489' CC!C05776 '� � ' e-��":_ ''-� � � �he �C�OFING CO�+iTRA�TO�t . -� . _° � Namecl be�ow IS �E32TIFIED � . ' iy'tYder �he provisions o� Chapt��r��8'8 £�'�. ' `�v�` Expiration date: AUG 31, �012 °'� '{`� �� ; ° -° - ' r DUBO�S,� �TEVLI�' M�CHI�EL � `" F:y$` , S�E�TLN M I�ITSO�S R4CQF�NC3 OF PA�C'�Q I�j1��'z�..�. 153�4$ GRLEN C��EN LANE � SPRING HILL, FL 34610 CH�RLTE CRI3T C�€ARLTE LIEM G�VERNt312 INTERIM SECRETARY T�nr�� n�/ wn r�r/1�Flrlrfl f4\I I Aln/ BUS��,S TAX l�TOTIC� • PASCO COiT1�I'I'Y �I,ORIDA '�f i i --c�+ti.1 c I_ �f:i=1�;;;i� Yi�,?i=: i?1'i ;��li)PJ-i {?r3��`)•If3 - � ' ±'�_:ii<tE�_ 1'fE�1. PAYABLE TO: MIKE OLSON, TAX COLLECTOR/ P.O. BOX 276, DADE CITY FL 33526-0276 S I 4a N H E R E � I CERTIFY THAT ALL INFORMATION PROVIDED IN THE ABOVE APPLICATION FOR THIS BUS S.S TAX RECEIPT IS TRUE AND CORRECT '� t�t=V��:T�t 1�1. 1,�i6:=tt�J.(`; (�:tJi i[= ��,tt; tJfi' ('(l��l='t.J [;�if; i�-'�i`f�; ��F��-�i`'" �'�� •�'�' �-�� AUTHORIZED SIGNATURE DATE , :��' i t' �:� 1�11 !.? F=l_ ;'�'sEa1:!- ::;;-:,�;_ 1='�'1�1_'! 1{,c!F ] �} tit_}!ji'�ilc, -rr�r�►=;�;;�,;,�� t�:�w�,r_ t;=� i 1�4)'��:E-� �+� �;C�F•� . 1 ��X C'C;1..L..E'i;"�CiF� -/r / �� t �-�_ ,-��-- t,;�. ;> ;,� -,_ -, -� - a�G9 f IS. :r�._ �� _��3=' 1i�.�i- � ,ai•l� '•I-: � i� , � �. �� f:i I;`r -- -�-• � ---- - �- •- �� 1)f; I 'i:. {. :� k. �� s. 3 C � �.�{E 3� !�. .L I 09-03-2010 \��;��s/ ALEX SINK STATE OF FLORIDA CHIEFFINANCIALOFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW � * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/09/2010 EXPIRATION DATE: 10/08/2012 PERSON: DUBOIS STEVEN M FEIN: 204883108 BUSINESS NAME AND ADDRESS: STEVEN M DUBOIS ROOFING OF PASCO INC 15348 GREENGLEN LANE SPRING HILL FL 34610 SCOPES OF BUSINESS OR TRADE: 1- ROOFING IMPDflTANT Pursuant to Chapter 440 051141, F.S., an of(icer of a corpontion who elects exemption from this chepter by filing a certificate of election under this sectian may not recorer 6eneFits or compensation under this chapter Pursuent to Chapter 440.05112), F.S., CertiFic�[es of election to be exempt.. spply only within the scope oF the business or trade listed on the notice oF elec�ion [o be exempt. Pursuant to Ch�pter 440.051131, F.S., Notices of election to be exempt end certifica[es oF election to be exempt shall be Subject to revocation if, st eny time afte� [he filing of the notice ar the issuance of [he certificale, tAe person named on the notice or certilicete no longer meets the requirements al Ihis section for issuance of a certificate. The department shall revoke a certificate at any time for failure af the person nemed on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES F 1 MPORTANT DMSION OF WORKERS'COMPENSATION Pursuant to Chapter 440.05(14�, F.S., an officer of a corporation who CONSTRUCTION INDUSTRY � elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW D chepter. EFFECTIVE: 10/09/2010 EXPIRATION DATE: 10/08/2012 pursuant to Chapter 440.05112►, F.S., Certificates of election to be PERSON: STEVEN M DUBOIS H exempt... apply only within the scope of the business or trade listed on FEIN: 204883108 R the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of electian to be exem t STEVEN M DUBOIS ROOFING OF PASCO INC p and certificates of election to be exempt shall be subject to revocation ' 75348 GREENGLEN LANE if, at any time after the filing of the notice or the issuance of the I SVRING HILL, Fl sasio certificate, the person named on the notice or certificate no longer meets � the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for tailure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate ta meet the requirements of this i 1- ROOFING section. QUESTIONS? (850) 413-1609 I CUT HERE ; � Carry bottom portion on the job, keep upper portion for your records. WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 CITY OF ZEPHYRHILLS � 5335-8TH STREET ' �sis)�so-oozo 12965 BUILDING PERMIT Permit Number: 12965 Address: 4841 4843 20TH ST Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: MOORES FIRST ADDITION Est. Value: Parcel Number: 14-26-21-0010-02400-0010 Improv. Cost: 2,350.00 Date Issued: 4/10/2012 Name: HEILER, ALFRED 8�TERESAANNE TRUS Total Fees: 50.00 Address: 7602-4 CONGRESS ST Amount Paid: 50.00 NEW PORT RICHEY FL 34653 Date Paid: 4/10/2012 Phone: 727-243-5334 Work Desc: REROOF SHINGLE DUPLEX 4841-4843) TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: Reinspection fees will oomply 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 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� 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 reoord 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 wmmencement." Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. � , CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES I 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• Phone Contact for Permittin _ Owner's Name �r � Owner Phone Number Owner's Address ✓� � Owner Phone Number .� r�a�t3� SYc�a,�7 Fee Simple Titteholder Name Owner Phone Number —� Fee Simple Titleholder Address JOB ADDRESS �7�'y� ?S73 �C�' � Sf z�J� /f� �1CS� LOT# � '� � SUBDIVISION � PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRtPT10N OF WORK ��, � �y,y,� � �� ...�- BUILDING SIZE SQ FOOTAGE / � HEIGHT I� � QBUILDING $ ��—O VALUATION OF TOTAL CONSTRUCTION QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. OPLUMBING $ �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION !/�� .,� f QGAS [� ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES Nq BUILDER � COMPANY'`S ��e��'/� � �L`� x� SIGNATURE REG�STERED Y/ N FEE CURRE� Y/N Address ��3 g �J� � .� ,� �/ �,� 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 Add�ess 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 FoRns;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Requlred 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 Buildfng Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submlttal 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 all NEW construcUon. Directlons: Fill out application completely. Owner&Contractor sign back of application,notarized If over 52500,a Notice of Commencement Is required. (A/C upgrades over 57500) " Agent(for the contractor)or Powe�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 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 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 IMPACTlUTILITIES 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 fu�ther understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to �eceiving 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 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'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 pertormed 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 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 "Ar 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 Iots 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 FINAN CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTIC F COMMENCE NT FLORIDA JURAT(F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and sworn to(or affirmed)before me this Subscribed and swom to( r afflrmed)be ore me this by bY Who is/are personally known to me or has/have produced Who f e rsonally knovm to me or haslhave produced as ldentlfication. �� G.c� as identificat�on. r Notary Public �`' � Notary Public ��, Commission No. Corr�mi \ � :�. • , JACQUEIINE BOGES s: Name of Notary typed,printed or stamped Name o x•Notary . � �qlll� 2014 ��ded Thru t Faln�ns�wanca � ..•�i•,`:,.e�yt} ,M.wn�c++e-aM�,rr 80439�r7019