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HomeMy WebLinkAbout12-13683 CITY OF ZEPHYRHILLS 5335-8TH SIREET ' ` (sis)�so-oo20 �3� �,.. BUILDING PERMIT Permit Number: 13683 Address: 5628 CYPRESS ST Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: YINGLING ADDITION Est. Value: Parcei Number: 12-26-21-006B-00000-0250 Improv. Cost: 1,832.00 Date Issued: 12/07/2012 Name: ALTMAN ROBERT & DANIELLE SAARI Total Fees: 67.50 Address: 5628 CYPRESS ST Amount Paid: 67.50 ZEPHYRHILLS FL 33542 Date Paid: 12/07/2012 Phone: 386-479-3414 Work Desc: INSTALL GARAGE DOOR 16 X 7 �. ( � �^ � �i � ) ! /.� j-- I � � FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. 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� plans not at job site g) work not acc�eessible. 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 performed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. CONTRACTOR NATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Pasco County Parcel: 12-26-21-006B-00000-0250 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, November 24, 2012 Parcel ID 12-26-21-0066-00000-0250 (Card: 001 of 001) Classification 01 - Single Family � Mailing Address Property Value ALTMAN ROBERT WYATT& Ag Land �� SAARI DANIELLE M Land $16,948 5628 CYPRESS ST ZEPHYRHILLS FL 33542-4516 Building $85,064 Physical Address Extra Features �6as 5628 CYPRESS ST 7ust Value �102,660 ZEPHYRHILLS FL 33542-4516 Assessed (Non-School Amendment 1) $102 660 Leaal Descri�tion (First 4 Lines) Homestead Exemption applied for 2013 � YINGLING ADDITION UNREC PLAT OF TRACTS 14 15 16 20 21 22& Taxable Value �102,660 E 16.00 Ff TRACTS 17&23 OF ZEPHYRHILLS COLONY COMPANY Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value �� 0100 SFR OOR2 7,270.00 SF $2.00 1.00 $14 540 �� 0100 SFR OOR2 7,297.00 F ������ �C��� $0.33 1.00 $2,408 Additional Land Information Acres 0.33 Tax Area 3 ZH FEMA Code U Residential Code ZHL LP4 Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001) Year Built 1973 Stories 1.0 Enterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Concrete Biock Stucco Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring i Carpet Flooring 2 None Fuel Electric Heat Forced Air- Ducted A/C Centra I Baths 2,5 Line Description Sq. Feet Repl.Cost New � 1 � 564 $8,235 2 BAS 2,292 $95,806 3 Q 200 $2,090 4 � FGR 528 — $8,820 Extra Features (Card: 001 of 001) �— Line Description Year Units Value 1 ��� 1974 444 $366 2 LFEN E 1974 800 �2g2 Sales History Previous Owner CRADDOCK CLAYTON &SANDRA Month/Year Book/Page Type DOR Condition Amount Code 07/2011 8582/3418 wDeedty 01 Improved $133,000 11/1978 � 0977 /0457 � Improved $50,000—� http://www.appraiser.pascogov.com/search/parcel.aspx?sec=12&twn=26&rng=21&sbb=... 11/29/2012 OF ADDITION OR CC�r�, �,� � • • - • �� �.� ��'�, � ADDRESS .'"— �j � �. �� DATE PERMIT�, / � �-�'�� THIS JOB HAS NOT BEEN COMPLETED. The following additions or correc ions shali be made before the job will be accepted. �S� � � a � ' + �-� �t�o( � .- It is unlawFui for any Carpenter,Contractor,Builder,or oMer persons,to cover or cause to ba covered,a�y part of the wo�1c vvith floo��g,Iath,earth AFTER CORRECTIONS ARE MADE CALL or other material,until the proper inspector has had ample time to approve the installation. 780'O RE-INSPECTION OFFICE HOURS 7 30AM-4 30 PM MON-FRI INSPECTOR s�s-�so-oazo City of Zephyrhills Permit Application Fax-813-780-0021 Building Department � Date Rece7ved �... -- /� phone Contact for Permitting Yl3 r�� __ L(,3-26 Owner's Name �� Owner Phone Number ,3�1i"' /7�1'���/ Owner's Address .J��i�� C r Y�• Owner Phone Number � Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS ,s G aP (- /' Z It r/11/1�`S. /'�� 3 3s y-z LOT# � SUBDIVISION � �� l/7o'al: PARCEL ID# /�i7le-' aI�����'B�BAO-fJ•tSd (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR B ADD/ALT Q SIGN � MOVE Q DEMOLISH INSTALL REPAIR PROPOSED USE � SFR � COMM Q OTHER TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME Q STEEL Q OTHER DESCRIPTIONOFWORK �CD �Q�.9n /`�'? �G# /3..5-i�/.,S' BUILDING SIZE � SQ FOOTAGE HEIGNT 0 BUILDING $ / r 3� �� VALUATION OF TOTAL CONSTRUCTION Q � ELECTRICAL $ � AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. 0 PLUMBING $ � r 2��3 l � Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �`�lti z ' / t> � GAS 0 ROOFING 0 SPECIALTY Q OTHER � �r ��� 3 ,,,� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES QNO P u���(� � � ,2��n/�2_ BUILDER �� `-� ('�.� � COMPANY ri.°G!�lbh �r f�I'• SIGNATURE �C � REGISTERED Y/ N FEE CURRENT Y!N Address lJ�rh ` ,(�i�� �w/`�L -�7� License# CQC�e2S�/6 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 SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N Address License# � � OTHER COMPANY SIGNATURE REGISTERED Y/ 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, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence instalied, Sanitary Facilities 8 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 all NEW construction. Directions: Fill out application completely. Owner 8�Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over 55000) " 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) �riveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictipns" 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 IMPAC7 AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. it is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner" prior to commencement. CONTRACTOR'SIOWNER'S AFFIDAVIT: 1 certify that ail 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 instalfation 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 & 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 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 the ob is considered abandoned justifiable cause for the extension. If work ceases for ninety(90)consecutive days, \j 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. FLORIDA JURAT(F.S. 117.03) �' G� "� ����_ OWNER OR GE CONTRACTOR Su scri�d��d swom to r affirmed��For,`e this Subs ib a d swom to r rmed)J�re me this � /�^/�',�b �i"//��/�"nG�`�.-�r .3 b /�� Who is/are e y own e or has/have produce Who is/are p sonall k mas id nt1B ationroduced P as identification. `��P `��`S,>F O t �} �� c�°��,�0. — Nqt��� Notar�`����,0 vc , � ,10,�,va '� �o' c. �- Commission No. , - Commisslon No. `` Ql�� ed, rinted or sta '` - Name of Notary typed,printed or stamped - � Name of Notary typ P � , _��``` ,.c�_ Florida Building Code Online Page 1 of 3 • w�.+...R �'�°'�tr�-" �. `� �'+x � �.� BCIS Home Log In User Registration Hot Topia Submit Surcharge Stats&Facts p�blicallons FBC Staff BQS Site Map Links Search 8usines� ,.---.. Professional � � ���PERdu'ctUApproval Product E+UUreval htenu>Product or Aonlication Search>qpplication List>Applicatlon Detail FL# FL13521-R1 Application Type Revision Code Version 2010 Appiication Status Approved Comments Archived Product Manufacturer Amarr Garage Doors Address/Phone/Email 165 Carriage Court Winston-Salem, NC 27105 (336) 251-1309 danny.joyner@amarr.com Authorized Signature Brandon Gentle brendon,gentle@amarr.com Technical Representative Brandon Gentle Address/Phone/Email 165 Carriage Court Winston-Salem, NC 27105 (336) 251-1308 brandon.gentle@a ma rc.com Quality Assurance Representative Danny)oyner Address/Phone/Emaii Amarr Garage Door-s 165 Carriage Court Winston-Salem, NC 27105 djoyner@amarr.com Category E�erior poors Subcategory Sectional Exterior poor Assembiies Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professio�al Engineer Evaluation Report- Hardcopy Received Florida Engineer or Architect Name who developed the Evaluation Report momas L. Shelmerdine Florida License PE-0048579 Quality Assurance Entity Intertek Testing Services NA Inc. - ETL/Warnock Hersey Quality Assurance Contract Expiration Date 01/01/2015 Validated By Steven M. Urich, PE Validation Checklist- Hardcopy Received Certificate of Independence FL1352� R1 CCiI S�.atzn;_erlt of In�epend�n�e ;FJis�G,udf Referenced Standard and Year(of Standard) Standard Year httP-��www.floridabuilding.org/pr/pr aUU dtl.asnx?naram=wC'TF.VXnwtT)n„�„nPF,�nuPa.�n��rv�m;,��„ .,,,,,,,,,,,, Florida Building Code Online Page 2 of 3 ASTM E1996 2009 ASTM E330 2002 DASMA 108 2005 DASMA 115 2005 Equivalence of Product Standards Certifed By Sections from the Code Product Approval Method Method 1 Option D Date Submittecl 12/13/2011 Date Validated 12/22/2011 Date Pending FBC Approval 12/27/2011 Date Approved 01/31/2012 —- ---- - --------— -- - Summary of products - 'FL# Mode1,Number or Name Descri 13521.1 Ption Stratford, Heritage and Oak Dwg. IRC-6016-155-26-I, Thru 16' wide. Summit Modeis 600, 650 and 950 Limits of Use Installation Instructions Approved for use in HVHZ: No FL13521 R1 II IRG6016-155-26-I drawin 7-10 Approved for use outside HVHZ: Yes sea�ed.pdf Impact Resistant: Yes FL13521 R1 II Retaii Product Cross Reference i Design Pressure: +37.0/-41.0 Chart.ndf Other: Verified By: Thomas L. Shelmerdine FL PE# 0048579 Created by Independent Third Party: Yes Evaluation Reports FL13521 R1 AE IRC-6016-155-26-I Evaluation Re ort 7-10 sealed pdf Created by Independent Third Party: Yes 13521.2 Stratford, Heritage and Oak Dwg. IRC-6009-150-15-I,Thru 9' wide. Summit Models 600, 650 and 950 !Limits of Use Installation Instructions Approved for use in HVHZ: No FL135Z1 R1 II IRG6009-150-15-I drawin ?-10 Approved for use outside HVHZ: Yes sealed.odf Impact Resistant:Yes FL13521 RS II Retail Product Cross Reference Design Pressure: +35.6/-42.1 Other. Chart.odi Verified By: Thomas L. Shelmerdine FL PE# 0048579 Created by Independent Third Party: Yes Evaluation Reports FL13521 R1 AE IRG6009-150-15-I Evaluation Re art 7-10 sealed odf Created by Independent Third Party: Yes 13521.3 Stratford, Heritage and Oak Dwg. IRC-6009-169-15-I,Thru 9' wide. Summit Models 600, 650 and 950 Limits of Use Instaliation Instructions Approved for use in HVHZ: No FL13521 Rl II IRC-6009-169-15-I drawin 7-10 Approved for use outside HVHZ: Yes sealed �df ! ImpaCt Resistant: Yes FL13521 R1 II Ret�si Pro�iuct Cross R�Pnrence Design Pressure: +45.3/-51.2 ��,_„� .��;F Other: ---- Verified By: Thomas L. Shelmerdine FL PE# 0048579 Created by Independent Third Party: Yes Evaluation Reports FL13521 R1 AE IRC-6009-169-15-I Evaluation Re ort 7-10 sealed odf Created by Independent Third Party: Yes ; 13521.4 Stratford, Heritage and Oak Dwg. IRC-6016-140-24-G, Thru 16'wide. Summit Models 600, 650 and 950 http-��www.floridabuilding.or�/pr/pr SDb dtl.asnx?naram=wC`TFVXnw}Tlrnron(IPFr(1T�AA,,-1l11YVL1cTl;,t+n„ •��,�i.�n�',� Florida Building Code Online Page 3 of; Limits of Use Instaliation Instructions Approved for use in HVHZ: No FL13521 R1 II IRC-6016-140-24-G drawin 7-10 Approved for use outside HVHZ: Yes seaied.�df Impact Resistant: Yes FL13521 R1 II Retail Product Cross Refierence Design Pressure: +29.7/-33.8 Chart.pdf Other: Verified By: Thomas L. Shelmerdine FL PE# 0048579 Created by Independent Third Party: Yes Evaluation Reports FL13521 R1 AE IRG6016-140-24-G Evaluation Re ort 7-10 sealed pdf Created by Independent Third Party: Yes 521.5 Stratford, Heritage and Oak Dwg. IRC-6016-130-15-I,Thru 16' wide. Summit Models 600, 650 and 950 Limits of Use Installation Instructions Approved for se in HVNZ: No FL13521 R1 II IRC-6016-130-15-I drawin 7-10 Approved r use outside HVHZ: Yes sealed.�df ImP esistant: Yes FL13521 R1 II Retai! Product_Cross Reference ign Pressure: +25.6/-29.1 ;'har. �c�r — - ' Other: Verified By: Thomas L. Sheimerdine FL PE #0048579 Created by Independent Third Party: Yes Evaluation Reports FL13521 Rl AE IRC-6016-130-15-I Evaluation Re ort 7-10 sealed.pdf Created by Independent Third Party: Yes 13521.6 Stratford, Heritage and Oak Dwg. IRC-6009-130-15-I Summit Models 600, 650 and 950 Limits of Use Installation Instructions Approved for use in HVHZ: No FL13521 R1 II IRC-6009-130-15-I drawin 7-10 Approved for use outside HVHZ: Yes sealed.ndf Impact Resistant: Ye5 �L7352? R! Ii R�t� t �� Design Pressure• +26J/-31.6 -- .� Pr.>,uct_�:r��„� ��;�a;�,;�,_. Other: � Chart.odf Verified By: Thomas l Shelmerdine FL PE#0048579 Created by Independent Third Party: Yes Evaluation Reports F�13521 Rl AE IRC-6009-130-15-I Evaluation Re ort 7=10 se�i2d,�df - — -----—------------------------.-----------------Created by Independent Third Party: Yes Back ;ye�� Contact Us:. 1940 North Monroe Street Tallaha see FL 323QU Phone:850-4g7-1824 The StaYe of Florida is an AA/EEO empbyer.Coovriah �007- n10 t ta of Florida ::Privacv Statem�-,p«esibilit� tat n?��+••Refund St tem .��.+_ Under Florida law,e-mail addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not send electronic mail to this entity.Instead,conWct the office by phone or by traditiona!mail.If you have any questlons reqarding DBPR's ADA web accessibility,please contact our Web Master at�bma�r�dbor er ate fl us. 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W �. �,p. �. �tt���P :aate�°s; � 81 8t91 Bt�S. i!i J + 0 " m° �m g�C �NF�+,Yau Nu�° �j U+ Y0 �a o�l� m�m `1i> �,`�u v���. ���, T��d � �PI 000 1��1— �'�V�1NN� " �� �1t1t1 ��C ♦4-ION AU!S � $ r°r°eb0- ">'u`",a'.`,>o m g� _�x r�� � � � $oopi & �~m��niu�i�i�.ip� .i�m � 00 � N �� � � $ ��� � �� � � '�� � �� � y j d�s�� c � �� ��� � �� � � � � � °o"� n ` o 00o J� o "' ct � N�� g �e� � �� �N�p p�N O p �^ �O O . ;���'.'�..�_'�� -� �,.`�'' ;f > i;`� ��'.. ���� . .� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS f . � v r �C�utrac omeowner: ._.__...._ .. 9��l " U�.S. Date Received: �C - ,� 9_/6 s� Site: `�, � Permit Type: (� � I� X � �� Approved w/no comments: , Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the pennit and/or plans. �---- � � � alvin tzer—Plans Examiner Date Contractor and/or Homeowner (Required when comments are present)