HomeMy WebLinkAbout13-14634 CITY OF ZEPHYRHILLS
� 5335-8TH STREET
� (si3)�so-oo20 1 4 �
BUILDING PERMIT -�
Permit Number: 14634 Address: 38135 MARKET SQUARE DR
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD/ALT COMMERCIAL Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0010-03900-0030
Improv. Cost: 184,050.00
Date Issued: 10/17/2013 Name: FLORIDA MEDICAL CLINIC
Total Fees: 1,470.00 Address: 38135 MARKET SQUARE
Amount Paid: 1,470.00 ZEPHYRHILLS, FL. 33540
Date Paid: 10/17/2013 Phone: (813)780-8440
Work Desc: INTERIOR REMODEL 3,000 SQ FT AREA INTERNAL MEDICINE
. 1,11 . 60.
MARTIN ELECTRIC PLUMBING FEE 60.00 MECHANICAL FEE 60.00
DENNIS WILLIAMS INC FIRE PLAN REVIEW FEES 180.00
SONNY'S DISCOUNT APPLIANCES
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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 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.
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CONT CTOR SI ATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
, Illlllllllllllllllllllllllllllllllllllllllllllllllllllllllll
2013178448
Rept:1S36977 Rsc: 10.00
DS: 0.00 IT: 0,00
10/16/13 D. Bonilla, Dpty Clark
PRUIq 5 0'NE[L,Ph D Pq5C0 CLERK i COMPTROLLER
10/16/13 Q4�Qp� 1 a cl �
OR BK g 4 p� J,
NOTICE OF COMMENCEMENT
Pcrmit No.
Property Identification No.�a`- 026' a�- CY��o-p3°lon - o 03�
THE i1NDERSIGNED hereby gives notice that improvements will be made to certain reai property,and in accordance with Section
713.13 of the Florida Statutes,the follo�ving information is provided in the NOT[CE OF COMMENCEMENT.
1. Descriptionofproperty(legaldescrfpdon:)LcphyQNi115 G���Ny �. Iq,,,ds PBI �55 �Q'�u'Cs 3�d`12 P-sc �5 c�,,,q�.sw F
a) StrcetAddross: 3R135 M�.RK.'C SG�n.R� �R.
2. Generaldescriptionofimprovements���e1 S�,t�eRi�,jC. pF oPFict
3. Owner Information
a) Nameandaddress:F�aQ�d�. M<d�GA1 G�i�,�G ,?�5� Liq K�ySc, Eilud 1-A.+d o/-AKcS �J•3`163°l
b) Name and address of fee simple titleholder(if other than owner) '
c) Interest in property ��eY F{od ow��-
Contractor Infortnation A f�� �
a) Name and address:� ���`CtoN ��bb� �-1\C�oN �ti57• �u�. a°�ya ���s '�
b) Telephone No. 5�613-�q�i-o S 1� Fax No.(OptJ ZcPh�RN i!!S �v 335yo
5. Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No.(Opt.)
6. Lender
a) Name and address:
� Identity of person within the State of Florida designateA by owner upon whom notices or otha documents may be served;
a) Name and address:
b) Telephone No. Fax No.(Opt.)
8. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
7l3 l3(1)(b),Florida Slatutcs:
a) Name and address:
b) Telephone No.. Fax No.(Opt.)
9. Facpiretion date of Notice of Commencement(the expiration date is one year from the date of recording unless a di fferent date is
specified):
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OE THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECT[ON 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IPROVEMENTS TO YOUR PROPERTY.A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTIOIV.IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDQVG YOU NOTICE OF COMMENCEMENT
STATP.OF FI,ORIDA
COUNTY OF PASCO
S' eWrc OF Ovmer or Owner's 'ed O /Dirocror/PsrtnedMenoga
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I for ing insW n w owledged befgr�yle�is�day of T 20�,by
es�J (typc of authoriry,e.g.ofTicer,wstee,attomey in fact)for
(name of party on behalf of strument was executal
Personally Knowt�OR Produced Identification Notary Signature
Type of Identification Produced Name(print) �� 06'K e S •
Vorificntion pursuant to Section 92.525,Florida Statutes.Unda pen ' f ry'ury,I dxlare that I hav esd th orcgoin nd that the facts stated
in it are true to the best of my knowledge and be[ief.
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•" "� • N FILE C_}}<taF �Uf3i_�C•t�'f�.i:i�t�D It�r i n3�C)`�iC°��
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� � � JITNESS ��r'}` hA�i��P,i�lLi UF�i�,'t�aL��,'_ �HI.,� ,_
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� �EPHYRHILL� FIRE DEPARTMENT
6907 Dairy Road, Zephyrhilis, FL 33542
FIRE SERVICE USER FEES
Occupancy No.: � J �.
Plan No.: , Contractor:
Business Name: �/}Y GZ iC ��I iL Billin dre :
Business Address: - S ,
Business Phone No.. Billing Ph o..
Business Fax No.: Billing Fax No :
Contact: Contact:
PLAN REVIEW FE INSPECTION FEES PERMIT FEE FALSE ALARM FEE
� "-"�-AI Annual N/C Sprinkler $50 1st Alarm N/C
M Iti-Fam ly ommerc . 6 sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C
' arge$25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C
� Plan Revisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100
4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200
0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 plus Heads $1U0 SPRINKLER SYSTEMS Fuel Tanks- pertank $50
STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
� Per Riser $50 Hydrostatic Test $65 per system Fire Works $500
FIRE PUMP Acceptance Test $45 per system Camp Fire $25
� Per Pump $100 Hydrant Flow $75 Controtled Burn $100
FIRE ALARM SYSTEM Hood/Duct $50
8 0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Mnual
26 plus Devices $100 System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 nnnuai
Wet $50 OTHER Waste Tire Storage $50 Mnual
Dry $50 Fire walusmoke wau $15 per wall Generator<KW $100
CO2 $50 LP Gas $25 per tank Generator>30 KW 150
Other $50 Natural Gas $25 persystem Bio-Hazard Waste $100 nnnuai
KITCHEN EXHAUST Fumigation Tenting $50
� Hood/Ducts $50 Tent 10'x10'or greater $15 per tent Torch PoUApplied a50
OTHER Fire Pump $45 Haz.Materials $100 arm�ai
LP Installation per tank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
(Per Tank) $50 Exhaust HoodlDuct $30
�Natural Gas Installation $50 Re-inspection DBL
(Per System) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL 8
and cancelled less than
24 hours
Construction Insp. NIC
Emergency Vehicle A�;--�—$50� ;-� FALSE ALARM��—��
PLANS TOTAL� INSPECTION TOTAL; / � PERMIT TOTAL�/ I TOTAL;/ �
7-__ ��—� ��--.�
GRAND TOTAL ,
Comments:
Date: C —�_��
Inspector:
nin
10/15/201a TUE 15:4a FA% f�002/002
rn�oF coHSTrwcnav � e�octc [� FwuuE � STEEL Q I--
DESCRIPYfON OF VWftK T�V7�°1Zir.2 ��.nn�c�,
BUR.DIM6 SIZE `.
SQ FOOTAQE ��� ME
�evlwlNa s vu.uA�noN o��,�.c� cnoN f r �yi Q Se. �
QEL.ECTR1CAl s AAAP SERVICE pRO�R�SS [,] .R.E.C.
p�wMe�NC s �-�
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QMECHANICAL. S VALUATION OF MEpiAf�IGAL fNSTAILATION �t���v'�s �•I��
CJ� � ft00FING [] sa�cw.rr � ozN�R ! ,� r �(�
FINISFIED FLOOR HLEVATION$ FLppp Z�qR�^ �y�$ Np
BUIl.DER COMPANY j t.� �r_iuS�• �NG .
SIGNATURE � ��- � Y J �E� Y/N
�� ucense� �
E1.6CTRICIAN COMPANY
s�GNa►TURE �o Y! iV r�a�n Y/N
Addross U��*
PLUMBER �P�
SIOHAT�►RE RK�sr�c Y/ N �e pudt�� Y/N
/�ddresa
�—° L.Iconsa�
M1E�HAI�pCAL COMpANY �� , �.SCQ��� ��L�4�L�
SIGNATURE �at�Eo
�I�-?�,�Lt N �EaN�n Y/N
Addrass ��..f.'f�.� .,��/„G� / �1een6e�! � e�
� CaMPAIrI►
SIGNATURE REO�D • Y/ N �a�n Y/N
Addross LICen6e�
RESIOENru►L Attaen(z)Ploc Plans:lz)�ed ot eullding Plane:(1)set or Energy Forms;f�-0-w Pennn ro�new oonstrueaon,
Mh�hnum ten(1�)workmg days ar�s�anntal aate. Requ�red aro�te.conabu�.4lon Pbuis�stvnrwpmr Plar�s w�3ilt Fen�msbnea,
Sanitary►FaIldApes!�1 dumpster;Slle V11ark Pertnitfor subdlvlslol�sllan�e proJeCb
COMMERGIAL Apa�(8)complete 9efs of 9ulldh�g Ptans plus a Ute Saleqr Page;(1)sot of�ne�g�r Forrtis.Ft-O-W Aennitlbr new oonslrudlo�.
MMknum teR{1�woAdn�days after wb�l aate. Raquhred onslte.Gbnabudlo�Pfana.StommNaber Pla�s w/silt�enoa h�slalled,
S��t p�RMIT Alls�2 s�la of &1 dumpster.Sla,Work Pertnit for all new proJects.AN oD111f1'�eMJ�I fbqUlromeM1t6 4N,15t nleet oon�pllanoc
( ) �nghfeered Plane.
'�PROPERTY SURVEY r�lred tor alt NEVY ao�sfruction.
WI�lCt1011l:
F1A OUf eppllCdCOn OOnlplseely/.
Awnner d�CoeMac�or si9n back o�t�ppMr$tlon.ratia�Zed
If owr�500.s�Nol1w af Can1na11csTa1lt Is raqulrod. (AlC upgrad�s wer i7300j
" A�ant(!or fha conb'actor)or Power of AtEomsy(1or Rhe awna�would be someone wqh notsMzed Isl�fnom owner aufhori�rg samp
OVER TFI�C4UNT�R PF.RfIAi1`�1NG (Frent of AppllpUon OMYI
Reroofs It sMnglva S�wers SeMce Upgra,�as AlC Fences(Pb�Su�veylFootags)
DNwM►a�-Not aver CounNr�f on vub�tc roadwars..nseas ROW
�oo��oo'd 16b# ���ti� e�oa���io� ' :�oa�
'°� Bobby Hiiton Construction Company �►2��,���,R 3�
BabbY E HilOa�,3r.
B�dhD Ca�a�or
Ste6:Lioenee No.CB C0477?S
Cei: (813)997-0515
CONSTRUCRON CONTRACT
September 26,2013
To: Oliveri Archifiects
32707 US Highway 19
Palm Harbor,FL 34684
jlo�oliveriarchi�.com �
Project: Rorida Medical pinic �
Inbemai Medkine(Building B)
Cornract tar Florida Medical Qi�ic Praiec�
In strict oompliarwe w8h tl�e drawings�d s�edficatior�s witl�tl�e pi�and doa�P��N
tfie office of Oli�eri ArrhiEects,32707 US Higtrway 19,Paim tlarbor,FL 3468�4,tlte canstruttion afi the
Fiorida MCdiCa1 Genter bldidOt�t is proposed fOr tlte foNOwing klrtlp SWt1 ba9e bid prioe:
TaRai:�184,050
Pavment sd�edule�as foNows•
$36,810 Uown payment
�36,810 At oDmpfetion of dert�ol�on
$36,810 At oompletion of fiamng
$36,810 At oompletlon of drywall
536.810 At o�mpleiion of job
$184,050 TOTAL COSf
*spB medica�equipment is provided by orvner.:s
AB material�s guarar�ed to be as spe '�ied.Aa waic tio be mmpleteci in a svbstarrtiai woriananlike
manner aaording bo�s�ibmitted,per standard p�actioes.Any al6erat3on or deviatlon from
above specificatioru involving c�xVa oosts w�l be ettect�Eed ortly upon v+rritben�+ders,and w�l become
an exda charge av�and aboae the ag�d upon Price,At�a�mrtibnge�upero s6r�ces.
accide�s,a detays beyond acu corrtr+ot.
8obby�Et.7t'onsTr-
Horida Meaid cenorr aAhorimd Age� eobM Htl6on�,dlon.trK.
Flarida
MEd1Ca� October 15, 2013
���1 lCl l C
�o�R��c>�oikECioks City of Zephyrhills
PAUL HUGNES,n�.o,�.a 5335 8`h Street
wiil7P��t
NWRK EISNEN,nn.o Zephyrhills, FL 33542
.�`,r�relart
CHANDRESH SRFtAIYA,M.C) RE: Florida Medical Clinic Internal Medicine Renovation Pr��ject
T�Paz;.r�r
DAViq SIKES,M.0 �
�,icP Pres:dr��i /' (2
7
BARRY FRANK,n�.0 Please accept his letter as formal notification that Florida Medical Clinic, PA
,�rA Pres,de��t
�MIUU DOMINGUEZ M.n has changed contractors for the renovations to our Internal Medicine Off'ice
�_huei Med�cal ON�cF•�
IHA GUTTENTAG,M.o located at 3�9-S1 Market Square,Zephyrhills. The work was ori�;inally to be
""°�'PS"ie�' performed by Wallace Construction,however, will instead be performed by
REYMAtQO MULINGTAPANG,M.D Bobby Hilton Construction. The following companies will be subcontracted
Me,��ber-A'-I ar qc
by Bobby Hilton Construction to complete various aspects of th��project:
Jf�E DELATORRE
��,,�r�x����,�F o�,:P, Sonny's Mechanical, Martin Electric and Plumb Crazy Plumbing.
COILEEN CUFFF
;h�ef C�perahng Of*�ce�
CHRIS ALVAREZ Please don't hesitate to call 813-780-8774 if you have any questions.
CF��e'Finar�,a�O�i ce�
GUS TAYLOk
c��Pf nn�..,,�s+,��t„-e or���,., Sincerely,
�i�1� �.C,
�.�t, ��--�.
Colleen Cuffe
Chief Operating Officer
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10/15/2013 14:51
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813-780-0020 City of Zephyrhilis Permit Application � J ��ax-813-780-0021
Building Deparlment (�'� � �
7.1�
Daf'�Received t � � � �I�
Phone Contact for Permittin
Owner's Name �CRI�r.�l. ,�,{• r G�� ��� ' ��,• Owner Phone Number �z��7v-�?�c°.-- ��"77�
Owner's Address �� `1' Owner Phone Number � �
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Fee Simple Titleholder Name Owner Phone Number C
Fee Simple Titleholder Address �
JOB ADDRESS ��C'k.,Py �r�E'_'•r Z`l-�i/�.S ,I LOT# �
SUBDIVISION PARCEL ID#
(OBTAINED F�pROPERTY T�T►cel DEMOLISH
WORK PROPOSED NEw CONSTR ADD/ALT �_] SIGN
INSTALL e REPAIR
PROPOSED USE Q SFR [� COMM � OTHER �—
TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL � �
DESCRIPTION OF WORK ��°'��r 2 �Y/inr-C.� � --_
BUILDING SIZE —� 3Q FOOTAGE J�i^`'° HE T
OBUILDING $ ! �� ? s'G n`.� ,
VALUATION OF TOTAL CONS UCTION c i
[�ELECTRICAL $ AMP SERVICE PROGRESS E Q .R.E.
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QPLUMBING $ �,,����d�
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MECHANICAL �S � /�
� $ VALUATION OF MECHANICAL INSTALLATION ����h�� �V'
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OGAS Q ROOFING SPECIALTY ! � ����lS-�3
O � OTHER �����r ����� �(a�
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
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SIGNATURE �-%� �� _ � � ��r COMPANY �j}]C. ! �iJ C,r tiS�' �!�C .
REGISTERED Y/ FEE CURRE� Y/N
Address License# C
ELECTRICIAN v /J
i COMPANY �//•✓� ��i
SIGNATURE REGISTERED Y/ N FEE CURREP Y/N
Address {�rD �3S � License# �(� l3 0 O/.3�3
t J�( /�
S G AB URE � � �J��"" ' COMPANY �C' l -f (�� Z
REGISTERED Y/ N FEE CURRE� Y/N
Address License# C
�t� t�'`� - ll t
MECHANICAL �c!� � COMPANY
SIGNATURE ��'' REGISTERED Y/ N FEE CURRE� Y 1 N
�1 3-7�-b�r2�
Address License# C
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# C
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Pians;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FaciliUes 8 1 dumpster;Site Worlc Permit for subdivisionsAarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
'"""PROPERTY SURVEY required for all NEW consVuction.
Directions:
Fili out application completely.
Owner&Contractor sign back of application,notartzed
if over 52500,a Notice of Commencement is requlred. (A!C upgrades over E7500)
" 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 ApplicaUon Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PlotlSurvey/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 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 locai regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanorl��fortthe
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may app y
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 IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understan s
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, ihe 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 ce�tify 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 a�l 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 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-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 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 F NITSTO YOUR PROPERTI(.TIF YOU INTOENDETO OBTA N F NANCSNG CIONSULT
PAYING TWICE FOR IMPROVEME
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S. 117.03) �1 —> �/
CONTRACTOR�7 ���
OWNER OR AGENT Subscribed and s to or a rmed)befo me this
Subscribed and sworn to(or affirmed)before me this by � � � o N R d
bY yyho�— s/a�e personalty known me or haslhave prod�ced
Who is/are personally known to me or has/have produced as identiflcation.
as IdenUfication.
Notary Public
Notary Public ,�s �A�� �� s
Co iss ' 14
Commission No. = :g �ilg6�b�'�2�
��T psy�yy�yonp�lOQ38ST079
Name of Notary typed,printed or stamped
Name of �