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Home My WebLink About13-14787 CITY OF ZEPHYRHILLS ' 5335-8th Street (813)780-0020 14 ELECTRICAL PERMIT Permit#:14787 Issued: 12/05/2013 Address: 5818 BROADMORE ST Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL. Class of Work: ELECTRICAL MISC Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 250.00 Total Fees: 40.00 Subdivision: TREE LANE VILLAGE Amount Paid: 40.00 Date Paid: 12/05/2013 Parcel Number: 10-26-21-0000-00100-0000 Name: JIM'S ELECTRICAL SERVICES INC Name: TREE LANE LTD C/O TEMPLE TERR Addr: 18302 EASTWYCK DR Address: 10912 N 56TH ST TAMPA FL 33647 TEMPLE TERRACE FL 33617-3004 Phone: (813)810-4079 Lic: EC13005496 Phone: Work Desc: REPLACE METER CAN LUG BURNT ELECTRICAL FEE 40.00 ROUGH ELECTRIC CONSTRUCTION POLE �� PRE-METER '� FINAL �_ - � w,�,.` �� `�� ._--�, , �l� ��( `� 6 l('�' REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.8 (2 c) en e�ctra inspection trips are necessary due to any one of the following reasons: a)wrong address demned work resulting from faulty construction c) repairs or corrections not made when inspection 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 rec:ording your notice of commencement." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. n ��ni� LJ CONTRACTOR PER OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Dec. 5. 2013 1 ; 31 PM No, 0533 P, 2/2 ACORl7� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDDIWYY) �""� 3/29/2013 THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA'TiVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED, the policy�fes) must be endorsed. If SUBROGATION IS WAIVED, subJect to the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certiflcate does not confer rights to the certiflcate holder in Ileu of such endorsement s. PROWCER �ME: Denise DeRemigio Adcock-Adcock Property & Casualty Aqency, Inc. PHO� . (813)933-6691 FAx (813)932-6287 rc No: 315 W. Fletcher Ave. .denised@adcock-insurance.com INSURER(3)AFFORDING COVERAGE ryp�� Tampa FL 33612-3414 iNSUr�Ra:Old Do�inion 0231 INSURED INSURER B. Jims Electrical 3ervices Inc irisur�Rc 18302 Eastwyck Drive INSURERD. IN3URER E. T EZ 33647 iN3URER F. COVERAGES CERTiFICATE NUMBER:CL1332905498 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOlWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VNiICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I TR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MM1DD MMlDDfYYYY LIM�TS GENERAL LIABILITY EACH OCCURRENCE $ 1�OOO�OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ee occunence $ 5OO�OOO a�i CLAIMSMADE �OCCUR G87308 �29/2013 /29/2014 MED EXP(Any ona person) $ 1�,00� PERSONAL&ADV INJURY $ 1�OOO�OOO GENERAL AGGREGATE $ 2�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/0P AGG $ Z�OOO,OOO X POLICY PR� LOC $ AUTOMOBILE LIABILITY M I IN LI I Ea acadent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 80DILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y f N TORY LIMITS ER ANY PROPRIETORiPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED� � N/A E L EACH ACCIDENT $ (M�ndatory In NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (Attach ACORD 107,Addklonal Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION �eo-oo2i SHOULD ANY OF THE ABOVE DE8CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, N0710E WILL BE DELIVERED IN City Of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street Zephyrhills, EZ 33540 A�M�R�ZEDREPRESENrAT1VE J Alexander Green, CI � � � ACORD 25(2010I05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025�zo�oos�oi The ACORD name and loqo are reqistered marks of ACORD 813-780-0020 City of Zephyrhilis Permit Application Fax-813-780-0021 Building Department Date Received t 'L --�� phone Contact for Permittin �r r �� _ _ Owne►"s Name Owner Phone Number Owner's Address �°9 I� ��J S �"'�'� ��'�'�� Owner Phone Number � Fee Simple Titleholder Name �— —� Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS ��f u ✓)��`'"�� `-� 1�- LOT# � SUBDIVISION � �Q-�'- Wyv�e V�t\1u.� PARCEL ID# p�{j � � ��'Z� � �� -� (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEw CONSTR ADD/ALT C� SIGN Q C] DEMOLISH INSTALL 8 REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BIOCK Q FRAME � STEEL Q DESCRIPTION OF WORK �'�� '�-�� C��M i!\}�c.,�-r'� �,�, ` , BUILDING SIZE SQ FOOTAGE C� HEIGHT C� QBUILDING $ VALUATION OF TOTAL CONSTRUCTION �'�� ELECTRICAL �� AMP SERVICE Q PROGRESS ENERGY [_] W.R.E.C. QPLUMBING $ �,J WKp QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � '�� OGAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# � ELECTRICIAN �� COMPANY 'JV��S �/�Chn^" ��-`.C��:� �"�C SIGNATURE REGISTERED Y/ N FEE CURREA Y/N Address j Jp�-��' /-�- p-T� J-�-336� License# � ��%J'�q 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 Pertnit for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Faciiities&1 dumpster;Site Work Permit for subdivisionsflarge projects COMMERCIAL Attach(3)complete sets of Building Pians plus a Lffe Safety Page;(1)set of Energy Forms.R-O-W Pertnit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence instalted, Sanitary Facilities&1 dumpster.Site Woric Permit for all new projects.All commerciat 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&Contractor sign back of appiication,notarized If over 52500,a Notice of Commencement is requlred. (A/C upgrades over 57500) '" Agent(for the contractor)or Power of Attomey(for the ovmer)would be someone with notarized letter ftom owner authorizing same OVER THE COUNTER PERMITTING (Front of Appiication 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 p�ivileges 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 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 certficate 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 ce�tify 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 performed to meet standards of all laws �egulating 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 "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�II 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 1 am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this a�davit 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 fo�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 IMPROV�EMTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.� CONSULT WITH YOUR LEN�ER�R AN FLORIDA JURAT(F.S. 117 03) -"""' CONTRACTOR ��`^�� OWNER OR AGENT Subscribed and bwo�(��ed)befor�me this Subscribed and sworn to(or a�rmed)before me this r��_ n r � by Who is/are personally known to me or haslhave produced Who is/are personally known to mas identl atlonroduced as identitication. � � ��("„�' ,. �� Notary Public Notary Public Commisstcur�lo• - Commission No. ;,.,,��:'�Y�;,; JACQUELINE BOGES C� ed, rinted or stamped Name of Notary�(�1. �`, mber 12,2014 Name of Notary typ P I± ---;,;F�ti,. BondedThruTroyFelnlnwran'.e800-3&5-7��9 4T�i ,_a....�......_...,. ,. ....,-e�.<mre _reNi