HomeMy WebLinkAbout15-15889 I
CI OF ZEPHYRHILLS
5335-8TH STREET
, , �si3��so-oozo 15889
' BU�ILDING PERMIT I
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PERMIT INFORMATION � ' LOCATION INFORMATION
Permit Number: 15889 � � Address: 38603 TRELLIS AVE
Permit Type: ADDITION/ALTERATION � I ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL � i Township: Range: Book:
Proposed Use: NOT APPLICABLE ; � Lot(s): Block: Section:
Square Feet: � � Subdivision: CITY OF ZEPHYRHILLS
Est. Value: � � Parcel Number:
Improv. Cost: 600.00 � ' OWNER INFORMATION
Date Issued: 1/05/2015 ; � Name: SHULTZ, ROBERT & MARILYN TRUST
Total Fees: 90.00 i ' Address: 38603 TRELLIA AVE
Amount Paid: 90.00 I ZEPHYRHILLS, FL. 33542
Date Paid: 1/05/2015 ; � Phone: 813-714-1329
Work Desc: INSTALL 9 X 7 GARAGE DO R SIZE/SIZE
CONTRACTOR S APPLICATION FEES
JAMES L FRANK DOOR SE V CE BUILDI G FEE j � 60.00 C NTRACTOR ERTIFICATE 30.00
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Ins ection's Re uired
F TER 2ND ROUGH PLUMB � MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED � ISEWER MISC.
ROUGH ELECTRIC LINTEL i I 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.
REINSPECTlON FEES: Reinspection fees will �omply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the foll wing reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corre ions not made when inspections called d) work not ready for
inspection when called e) permit not pos ed on job site f) plans not at job site g)work not accessible.
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NOTICE: In addition to the requirements of this pe mit,�there may be additional restrictions applicable to this properly 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 m nagement, state agencies or federal agencies.
"Warning to owner: Your failure to record notice of commencement may result in your paying twice for
improvements to your property. If you int nd to obtain financing, consult with your lender or an attorney
before recordi g your�notice of commencement."
Complete Plans,Specifications Must Accom any!Application.All work shall be performed in accordance with
City Codes and Or inances. NO OCCUPANCY BEFO C.O.
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CONTRACTOR IGNATURE � PERMIT OFFI R
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PERMIT EXPIRES IN 6 M NTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPEC ION = 8 HOUR NOTICE REQUIRED
PROTE CARD FROM WEATHER
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C ty of Zephyrhills '
BUILDiNG P AN REVIEW C4M11�!IENTS
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� Contractor/Homeowner: � °�', L' � d%��' �U���.�d�(C
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Date Received: l !� r
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Site: � �P� � �F'�'-1 �� �
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Pernut Type: � `� I l � ' v'� �Y' ,��S
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Approved wlno comments: Approved wlth bel�ow caznznents: ❑ Denied w/the below comments: ❑
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This comment sheet shall be kept with the permi and/or,plans. `�
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Kalvi i er ans Examiner Dat ! i Cantractor andlor Homeawner
; � {Required when camments are present)
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JAMES L , DOOR SERVICE INC.
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6415 �NDELL DR
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WESLEY HAPEL, FL 33544
PHO 813-994-7272
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FAX 8 3-994-7272
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DATE 12/27/2014
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I AUTHORIZE THE O �LOWIIVG PEOPLE TO
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TO PULL AND RECIE PERMITS FOR jAMES L FItANK
DOOR SERVICE INC.
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�- L jAMES L FRANK I
2. jANET FttAI�IZ
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Jar�,s L ��vx '� -
O � R/PRESIDENT
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��„��� Michelle Lynch I
���o�Pa�P���f, I
;2 � , �: State of Florida ,
�������;:My Commission Expires 010912018
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-, oF F°,�� FF 2126
�������e�� mmission No.
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CUSTOMER'S QRDER NQ t',,, DEPAR7MENT DAT
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� ADDRE �
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' SOLD BY CASN C.O.D. GHAfi6E ON.AGGT. MDSE.RETO. PAID OUT '
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REGENED BY ti '
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::� �T�°v<�$o � F£EEP'��#�S S�.lP Ft3R RE���tEit4�E �,-„
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Window Opdons:
For Glass:
Max daylight opening 39-38 z 12-1/2"
(up to+44.3/-51,5 ps�
10'-0"(see notes for other widths) Mex dayligh[opening 1b3/4 x]0-1/4"
D (up to+50.7/-57.5 ps� D
Optional Stnndacd Lites 1/8" DSB
�+ °Q �D (see window opdons) 2B �termediate 1/4" Tempered Gloss
2 I3inge 1C 7J16"InsulatedGlass
. � � � � 2
.� �u �. 7/16"Temperod Insulaced Glazs
y, ,� �: �� �t'o�ixture �a� Max de h ht o 163/4 x 10•1/4"
�� � � Bracket Y g �"j"g
- Q � (upto+44.7/-SlSpsfl
� � '�" �� rn TI �` �r 1 y // • f / / uminum Frame
r �, r�,� � � � � �
------ - � • '* 4D o. �v
-��---- ----- - f�- t-Z- -- - - — ---- ------ ��� �_�_ ��
'" �"` t'-' � � --- --doorheight-- y � Q, y-�--- -- -- - - -
-- -- - P7; t- - -- - �.�d Srile—-
' � C�i rn - — —-1B- —---b���i to_T-O-4-4--?-— -
� p��,. � � ; Tiack T-6"to s'-0^ 5 5 3 C
� d � B Bracket B'-3"to 8'-9" 5 5 3
� � � 2
� � � , ge 9'-0"to 10'-6" 6 6 4
10'-9"to 12'-3" � 7 5
V � ��+ � 4A 12'-6"to 14'-0" 8 8 6
2
14'-3"to 15'-9" 9 9 7
Bottom F'vcture
16'-0"[01 T-6" 10 10 8
� � 17'-9"to 19'-3" 11 11 9
11�is door has been evaluated in acrnrdunce with ASTM E 33Q02 and ANSI/DASMA 108-02 nnd 108-05. 2 2 19'-6"to 20'-0" 12 12 ]0
B Pet ASCE 7-10 az mferenced by FBC 2010, Strut Attachment S W[ Tmek bmeket quanddes ahown nre for B
Design Pressiues(DP)rypically meet or exceed tha requirements for the following wind speeds. use with�de 2 or better spnico-pin�fir
Thesa wind speeds are for T high doors,taller openings typically withstand higher wind speeds. (SPF�or southem pine}vnba.
Width Desi Pressure siae"B" fix sure"C" Wlndows Center Stiles
(6'-06" 10.0 5 /-113 s 105 m h 88 h 8 3
16'-00" 10.7 /-12.0( s� 108 m h 91 m h 8 3
IS'-00" 12.2 -13.7 s 115 m h 97 h 7 3 Supplemenml Invavctions containdetails
for doars up to 20'-0"high,These ore nquiced in
14'-00" 14.0 s /-15.7(sfl 123(m h 104 m h 7 3 S�pporting shucnual elemenrs to be designed additlon co this drewing for installation Always
12'-00" 19.0 s /-21.4 s 143 m h 121 m h 6 2 by tegistered pmfessIonal engineer for use supplemental lxtstcucttons 3n nddiUon to this
11'-00" 22.6 s -25.4( s 1 SS(m h 131 m h 5 2 specified wind loads.If door is not draw[ng during door instellnGoa
]0'-06" 24,8 s -27.9 s 162 m h) 137 m h 5 2 clectrically opernted,a lock must he inst�lled.
10'-02" 26.4 s -29.8 s 167 m h 141 h 5 2 M�ximum door height:20'-0" n�
]0'-00" 273 s /-30.8 170(m h) 144 m h 5 2 MaeimumsecUonheIght:21"
09'-06" 28.8 s -32.4 s 174 m h 147(m h) 4 1 I� �I2 GI �I �O � 03-IS-2012
A 08'-OG" 32.1 -62 g 183 m hl 154 m h 4 1 u � u vo u�u u u ��(� Model 2240.224],2250.2251 A
OS'-00" 34.1 -38.5 s 188 m h I58 m h 4 1 PrOfessional Engineer's seal provided 7ohn E.Scates,P.E. 45S(ps�/-51.3(ps�at 06'-00"t}uough
OT-06" 36.4 s -41.0 s 193 m hl 163 m h 4 1 on]y for verification of windload 3121 Fairgate Drive 10.0(ps�/-11.3(ps�at 16-06"
O6'-OD" 45.5 s -51.3 s 213 m h 160 m h 3 1 construction details Cazrollton,Texas 75007
Pcessiaes must be reduced by the ntio of widths squared for a door wlderth�n one shown. C.H.I.Drawing:FZ5-10-o13t I
Pmssures may be inaeased by the simple iaBio of widths for u door naaower than one shown. Florida P.E.#51737 page 1 of 2
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SWt(if applicable)not shown for clazity. Details on some views may have bcen omitted for clarity.
(.059)galvanized steel top �e veriical wood jamb fasteners may be counter sunk to provide a flat mounring surface.
See jamb attachment details for more information about attaching jambs to struchue.
D fixture.Each fixturc nttached ' (.086)galvaniud stcel D
with four 1/4"x 3/4"scrcws. 2"x 7/16"(nominal)stop molding to be secured with flag bracket fastened to
� � minimum 8d nail or 2-1/2"long scczw on 8"spacing. wood jamb with three o 0 0�
push nut Stop molding notrequired when dooris more than 1"widerthan opening. 5/1G"x 1-5/8"woodlag
nominal(.0185)galvanized steel minimum screws.
(.034)end stile
-___ __ __ Flag bracket nttached
-- - -- ------ ----------- -- - ----- - ---------- -to-horizontal track
- - --- ----
with two 1/4"x 5/8" I
-- --------- -- - --- -(:109)-galvanized-steel toP- - — - — _
fixture. Each fixture attached track bol�and nuts.__
— m�- ----- --
with two 1/4"x 3/4"screws. (.034)center stile 2��(min)x.045(min)
C
C manufachued by C.Ii.I. �vanized steel hsck
Flag bracketattached to
� verdcal hack with two 1 J4"
push nut x 5/8"track bolts and nuts.
End Hin e Intertuediate Hin e �r two 1/4"x 11/32"rivets.
(.034)end stile g g
manufactured by C.H.I. galvanized steel fastened (.058)galvanized steel
� to secrion with � fastened to secROn with (,102)galvanized steel ti�ack
four 1/4"x 3/4"sctews, four 1/4"x 3/4"screws. brac3:et fastened to wood amb
Optional law head room top bracke[ o A �
� with one 5/16"x 1-5/8"wood e
� � I push nut ' lag screw per bracket e
�•■�-2-3/4„
2"(max.for.058 thick)� I 2-3/4"
B 4"(max.for.109 thick) B
Fach hack bracketattached with
�f „ one 1/4"x 5/8"h�ack bolt and nut.
nominal�2"(min.) � �I 3 1 Or two 1/4"x 11/32"rivets.
10(min.)ball roller 3-1/2"(min.)stem � � L
with nylon or steel tread. �� 1'��8��
� 1/2" �
� (.040)50 ksi galvanized steel
o O (.102)galvanized steel bottom O 3"strut attached with two 1/4"z 3/4"
� bracket m�ufactured by C.FLI. ID screws per stile or hinge plate. ��o�o�� n�
Each bracket attached vrith four • �W„�°'""' �t� 03-15-2012
A red 1/4"x 3/4"screws. push nut �Z/t,� Model�4D.2241,2250.2251 A
sh nut (.109)galvanized steel bottom bracke[ 45S(ps�/-51.3(psfl at 06'-00"through'
P� Professional Engineer's seal provided John E.Scates,P.E.
manufactnred by C.H.I. Each bmcket attached 10.0(ps�/-113(ps�at 16'-06"
V�Y� Aluminum extrusion only for verification of windload 3121 Fairgate Drive
weatherstri with four rcd 1/4"x 3/4"screws. construcdon de4vls Cazrollton,Teaas 75007 C.H3.Drawing:FLS-10-o1311
P uonal low head room bottom bracket
�p� Florida P.E.#51737 page 2 of 2
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This is a trust agreement date this December 18, 2013, between ROBERT L:
SHULTZ and MARILYN J. S TZ,I (referred to as "the Grantors" or in the first
person"we") and ROBERT L. SH TZ and MARILYN J. SHULTZ, individually or
jointly, or their successors, as Truste s (collectively referred to as "Trustees", "Trustee"
or"Co-Trustee"). i
This tcvst sha11 be known as th "Shultz Family Ti�ust".
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ARTICLE 1
FAMILY
Either Grantor may be referr to in this agreement as a"Grantor,"or individually �
as "Robert" and "Marilyn." Grantor aze�citizens of the United�States. At some time in
the future, one Grantor will die befor the�other. Because the order of demise cannot be
predicted, one Grantor will be iden fied.� as "First Grantor to Die". The Grantor who
survives will be identified as"Granto 's Spouse".
The Grantors have three chil en:I JULIE ANN ARENAS, whose date of birth is
August 13, 1960; VALERIE JEAN GE'�, whose date of birth is September 8,
1962; and ROBERT LEE SHULT JR, whose date of birth is December 30, 1963.
References to "Grantors' children" ean Grantors' children named above. References to
"descendants"will refer to Grantors' hildren and their descendants.
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ARTICLE 2
T SFERS TO TRUST
The Grantors, ROBERT L SHULTZ and MARILYN J. SHLTLTZ, hereby
transfer, assign and deliver to the T ees alil assets shown on the Schedule"A"annexed
hereto and made a part hereof, rece' t of which in trust is hereby acknowledged by the
said Trustees to be held and admini ered, together with a11 other properiy that may from
time to time be added to this trust, for ithe uses and purposes and upon the following
terms and conditions.
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ARTICLE 3
RE ERVE�D RIGHTS
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The Grantors individually re erve the following personal rights with respect to the
Trust: �
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� � To revoke thi Tn�st in whole or in part;
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• To change e beneficiary of the trust or amend any provision
hereof; j
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I ' OMB NO.25D2-0265��
A B.TYPE OF LOAN
U.S.D�PARTMENT OF HOUSING 8 URBAN DEVELOPMEIJT 7.'Q FliA 2.Q FmHA 3.Q Ccnv.Un;ns. 4_Q VA 5.Q Com�.Ins.
• FIIdAL 6:FILE NUMBER 7. LOAN NUMBER:
� TPA7451086
SEITLEMEt�1T STATEMENT B: MORTGAGE WS CASE NUMBER:
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C. NOTE: Thls form k fumished to give you a stateme�rt olacfuaf ament cosfs. Amounts patd to and by the sefUement agent are shown.
ltems merked'(POCJ'were pald outside the clasing:ff+e are shown here Ior tnlormatianal purposes and are not included in fhe tofals.
I 1.0 31BS fiPA14S1008IT81
D. NAME AND ADDRESS OF BUYER: E. NAME AND DRESS OF SELLER: F. NAME AND A�DRESS OF LENDER:
Shuliz Family Trust Fennie Mae A Federal i aUanat Mortgage
256561nkwood PI PssodaUon i
Wesley Chapel.FL 33544 14221 Da{las Parkway,Suite 10U0
Dallas.TX 7 254 i I
G. PROPERTY LOCATION: H. SETTLEM AGFNT: I 26-0858686 I.SE�TLEMENT�ATE:
38603 TreAls Avenue ������ I � December 23,2014
Zaphyrhlls,FL 33540 p�qCH OF 5 EMENT:
Pasco County,Flodda 54pq Gyp Centei Drive DISBURSEMENT DATE:
AIPHA VILLAGE ESTATES PHASE 2 �i�300
PB 23 PGS 8-9 LOT 134 Tempa,FL 3 609 I I December 23.2014
OR 7378 PG 1212 I �
J.SUMMARY OF BUYERS TRANSACTION ; i K.SUMMARY OF SELLER'S TRANSACTION
700.GROSS AMOUNT DUE FROM BINER: I 400.GROSS AMOUNT DUE TO SELLER:
101_Contract seles rice .Q00.00 401.Contract sales rica 77,U00.00
102 Personal e � 402.Personet m
'103.Setllemant char es to b er line 7400 .220.50 403.
104. 404.
105. I 405.
Adlustments(orlfems pafd bv selferin advance j AdJustments forRems paid by sel(erin edvartce
106.Ci /Town taxes i 4D6.Ci /Town taxas
107.Caunl taxes 11J24/14 to 12131f14 33.13 407.Coun taxes '17JZAl14 to 72/37H4 33.13
108.Assessments � 408.AssessmenLs
�Qg. 409.
110. ' 4'I0.
11�. i 471.
112. � 412.
120.GROSS AMOUNT OUE FROM 6WER ,253.63 420.GROSSAMOUNT DUE TO SELLER 77.033.13
200.AMOUNTS PAID BY OR IN BEHALF OF BUYER: i 500.RE011CTiONS IN AMOUNT DUE TO SELLER:
201.De osit ot eamesl mone ;8,0�0.00 501.Excess de it see tosWctlons
202.Pdnci al amounl of new loan s i 502.SelUeme�t cha es to seller line 1400 4,821.03
203.Fxisli loan s taken sub'ect m i 503.Exisli loan s taken sub ect to
Zpq. I 504.P oN af�rsl mart a e loan
205. I 505. off of second mort e loan
206. ' S06.
2Q7, 507.D .disbwsed as raceeds
208. `�.
209. `�-
Adiustmenfs lori(ems unpard bv seller Adjusfinents for items unpaid 6y selfer
210.C' /rown taxes I 510.Ci (iown texes
211.Coun taxes 511.Coun taxes
z12.AssessmenLs ' S12.Assessments
213. 513.
214. 514.
215. 515.
216. � 518.
217. I 5�7.
21 B. i 518.
219. I 519.
220.TOTAL PAlO BY/FOR AUYER B,QOD:00 520.TOTqL REDUCTIONAMOUNT DUE SELLER 4,82'1.03
300.CASH AT SETTLEMENT FROMITO BUYER: 600.CASH AT SETTLEMENT 701FROM SELLER:
301.Gross amount due irom B er ne 120 78,253.63 !601.Grou amount due tn Seller 'ne 420 77.Q33.'13
302.Less amount aid b lfar B er Line 220 ( 8,060.00) ;602.Less reductlons due Seiter Une 520 ( 4.B21.03
303.CASH FROM BUYER 70,253.63 � 603.CASH 70 SELLER 72,21210
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Printcd an 11R7/ib at 4D:17PM TPA7FS1�BBf7B
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L.SE'�TLEMEPIT CHARGES
700. 70TAL COMMISSlON Based on Price $ 77.00O.QO @ i 5.5000°k 4,235.00 pA�D FitOM PAID FROM
Dlvlslon of Commission(Ilne 700}as Pollows: i eUVERS sfJ.LER's
70'i. $1,925.00 ro BerksFiue Hathaxray HomeSenries Fioride erties FUNDSAT FUNDSAT
SEf71.EMENi SE7'TLEMENT
702. S 2.31Q.00 W Qennis Reai ' �
� 7U3. Cammissfon Pafd alSetUement ' 4,Z35.00
704. Technol Fee tu Fannle Mae from Be to i I '�25•QO
705. � � �
80D. fTEMS PAYABLE IN CONNECTION WiTN LOAN I I
8D . Loan Orlgfnatlon Fee % to ! I
802. Loan Discount °� W I I
803. A reisal fee � � �
804. Credit re rt 10 �
865. Lendersins ctionfee to I
806. Mort a e insurance tiqtion Tee to �
8�7. Assum ifon(ee fo I I
806. a ' �
809. to I I
e'I0. � �
817. to I I
900. iTEMS REQUIRED BY LENDER TO BE PAID IN ADVAAICE �
901. Inleresl From 12/23f14 l0 01/01/15 $ !da 9 d s I °�
902. Mortgaga insurance premfum for month to ' I
903. Hazard nsurance premium for yearto I I
904. Flood insurance premium for 1 yeer W I
905, to I
�000.RESERVES DEPO5ITED WITH LENDER i I
1001.Hazard insurance Mcnlhs S i �Per Month
1002.Mortgage Insurance Months $ I I Per Month
1003.City mperty taxes Months @ $ I ; per Manth
1004.Coun taxes Months 5 i I Pet Momh
�005.Flood inaurance remlum Months @ S I � per Month
�ppg, Months i I per Monlh
1007. Months � i per Monlh
1008.A re ale Ad ustment onihs S i ! r Monih
1100.717'LE CHARGES � �
1101.Se ement or dosi fee to AI6er6elp Law I 5�•�
1102.AbsUact cr tlUe search lo Fdeli NaYionai �le Insurance Cam an �•�
1103.Coudes Ciosin Fee to I I
1104.Lien Search to Title Su rt.LL I 50.00 115.Q0
1105.Estop e!Search � �
1106.Selter Re Fee to Albertelli Law I 150.00
Y107.Attome's fees lo i I
(mWudas a6ove dem numbers: i i �
1108.Owners 1 remium to AlberlelG Law I � 44Z•�5
(inclu es aDove item numbers: I I )
1109.Lender's coverage I �
� 1170.OwneY's coveraga $77,0OO.OD i i 44275
1111, to i
���Z, to I I
1113. lo � I
1200.G VERNPAENT RECORDING AND TRANSFER CHARGE i I
� O7.Recording fees: �eed 31.50: Mortgage ' Releases 31.50
1202.City Counry taxJstamps: Deed : Mo 9age i I
1203.Slate tax/s�amps: Deed $539.00; M gege I 539•�
1204. to �
1205. �
�300.AODfTIONALSEfTLEMENTCHARGES i I
1301.SUN@ l0 �
1302.2014 Pro erty Taxes to Pasco Coun Tax Colfeclor i POC 1,511.53
'1303. to i I
1304. W i I
1305.Statulo Surche lo Fidelit Nat[onal TiUe Insuranca Com an 328
1306. to �
1307. �o � �
1308. �a
1309. fo i I
1310. to �
13�1. fo � i
1312. to ' i
1400.TOTAL SETTLEk1ENT CHARGES(Enter on Lines 103, on J and 502,Section Kj 1,226.50 4,821.03
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� P�InteEOn1?l1711Aet�T:17PM TPA74510fl6!/e
� � HUDt.Po9e 2
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,.- .- � -: -Fina1=_HU °,1��Attachment::,�:� =- � ; � ,
, , ';. >�: ;- ; , .�. ...:.: .} :--�--,-�. :° : =�:,.. -.:. .. ., _. -� _ .
' ,� Buyer. Shuitz Famity Trust I � Selier. Federal Natitonal Mortgage,
25658 Inkwaod PI Associadon
� Wesley Chapel,FL 33544 14221 Dallas Parkway,Suite 1000
Dallas,TX 75254
Lender. �
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Settlement Agent: Albertelli Law �
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(813}454-030U �
Place of SetNement: 5404 Cypress Center Drive
Suite 300
Tampa,FL 33609 �
� Settlement Date: December 23,2014 �
Disbursement Date: December 23,2014
Property Location: 38603 Trellis Avenue
Zephyrhills,FL 33540
Pasco County,Florida
ALPHA VILLAGE ESTATES P ASE 2
PB 23 PGS 8-9 LOT 134 I
OR 7379 PG 1212
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I hava carefully reviewed the HUD-1 Settiement Sta ment and to the 6est nf my knowledge and belief,it is a true and
accurate statement of all receipts and disbursements madelon my acxount or by me in this transacUon. 1 further certify
that 1 have receivad a copy of tfie HUD-1 Settfement tatement.
Shultz Family T� � Federal National Mortgage Association
BY: BYI �`
Robert Shultz,Ttustee � Amanda Hodgson,as Attomey-in-Fact for
I Federai National Mortgage Association
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BY: Iarii Shultz,T e
To the best of my knowledge,the HUD-1 Settlemen Statem � ich t ve prepared is a true and accu account of
the funds which were received and have been or wil be di ursed b e �n ersigned as art of the se ment of this
transaction. . I �
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Albe�tel6
Settle nt ent
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WARNING: It Is a uime to knowingly make false sta nts to fhe Unfted States on this or arry simitar fortn.Penaides upon convfctlon can
tnelude a ftne and tmprisonment For details see:Title 1 U.S.Code Sectlon�0�7 and Seelion 1010.
Prtnted an 12/7?J74 at 4:27:77PM by ahammond I � TPA7451086!78
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r . �, 873-790-002� City of�ephyrhills Permit Applicatio�-�`"` F�$���aao �
Building'Departrnent �;
. Qate+Received Zr'30�� phon Contal tforPertnitting - Z �
-r'�-rrr�-rr
; �, � � a
Owners Name I Owner e Number
Owners Address �O � r� �S Owner Phone Number
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- Fee Simple Titleholder Name I I Owner Phone Number
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Fee Simple TitleholderAddress I
JOBADDRESS � V 3 r `S �Ci LOT# 1 �
SUBDIVISION V,��� W � ARCEL ID# .� - 5-a� - o�� °��QD���`� `�
i (06TAINEDFROMPROVERiYTAXNO7IC�
WORK PROPOSED NEw cANSTR ' ADD/ALT 0 SIGN Q 0 DEMOLISH
INSTALL � REPAIR
PROPOSED USE � SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK �,1 r I � rY� � / (,� �Q G�
BUILDING SIZE SQ FOOTA E I I HEIGHT
UILDING $• ALUATIION OF TOTAL CONSTRUCTION
r i I
QELECTRICAL $ P SEIRVICE Q PROGRESS ENERGY Q W.R.E.C. g�R����'
� �n,/1dL\N
OPLUMBING $ j���`v
ALUATION OF MECHANICAL INSTALIAnON �,,� i��/ � ��
OMECHANICAL $ �!�� 1 �� �
�.��j�j� n�,��1:�v '1.�1A/u/�
QGAS Q ROOFING Q SPECIA ITY Q�OTHER //// l%���_';� er�
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FINISHED FLOOR ELEVATIONS FL i OD ZONE AREA QYES NO ����� 1 `
i � f�v}J/�
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BUILDER C��P�'
SIGNATURE �cisTEaEV Y! N FEECURRE� Y/N L�
� ' Q
Address I I License#
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ELECTRICIAN COMPANY
SIGNATURE REC is�RED Y/ N FEE CURRE� Y/N
Address I I License# /1 A
i'Sl U �
PLUMBER C�IP� � �
SIGNATURE � r�cis�r�o Y/ N �cuwx�n Y/N
Address I I License# l:r� �,�
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MECHANICAL COMPANY
SIGNATURE i t�cls Y/ N �E cu�n Y/N
Address License#
OTHER COMPANY ��� � � ��°����'�
SIGNATURE ttECisTeReo Y/ N FEE CurtRen Y/N
Address "( , �J35'T License# `''J ( �`.
, , , , , , , , , , , , , , � „ � „ � , , , , , , , , ,;� , � , � , � , , , , , , , , , , , , , , , , , , , , ,�,�,�,b, ��
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building lans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after sub ittal date. Required onsite,ConsWction Plans,Stormwater Plans w/Silt Fence installed,
SanRary Facilities&1 dumpster;Site Wo Pertnit far subdivlsions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safery Page;(1)set of Energy Fortns.R-O-W Permit for new consWction.
Minimum ten(10)working days after sub ittal da�e. Required onsite,ConsW ction Plans,Stormwater Plans w/Silt Fence installed,
3anftary Facili6es 8 1 dumpster.Site Wo Pertnit for all new projeds.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets af Engineered Plans.
""PROPERTY SURVEY required for all EW consWCtion.
Directions: I
Fill out application campletely. �
Owner&CanUactor sign back of application,notatized
If over 5z500,a Notice of Commencement is require . {A1CI upgrades over 57500)
" Agent(far the contrador)or Pawer of Attomey(for the er)v,rould be someone with notarrzed letter trom owner authorizing same
OVER THE COUNTER PERMITTiNG (Front of Applica ion Only)
Reroofs if shingles Sewers Service Upgrades A/ Fences(PIaUSurvey/Footage)
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Driveways-Not over Counter'rf on public roadways..nee s ROW
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Sanita( �acilitp s&1 dum ster,Si�te Wor PPerr�itfor,v~M••VV v•v•v,-vv•V••MV••v•• •p,���v�v����••aac� r�a��a.vi om rc�wc n�ataucu,
ry p subdivisions/large projects -
COMMERCIAL Attach 3 com lete�sets of Buildin Plans lus:a�Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal d te. Required onsite,Construction Plans,Stormwater Plans w!Silt Fence installed,
Sanitary Facilities&_1�,dumpster.Site Work Pe it for�all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans. ! j
""PROPERTY SURVEY required.for all NEW_ nstniction.
Directions: i
Fill out application completely. I
Owner 8�ConVactor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/ upgirades over$7500)
" Agent(for the contractor)or Powerof Attomey(for the owner) ould'be.someone with notarized letter from owner authorizing same
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OVER THE COUNTER PERMITTING (Front of Application O ly) - � - � - • � ' `" - ' " " ' ���
Reroofs if shingles Sewer§�"--�=��eryice`Upgrad�s�A'/C,`-": endes•(PIoUSurvey/Footage) �_ " " ' ' , , „
';_.:,..� - - " . � i _,
Driveways-Not over Counter if ori''public.roadways:;neeiis RO ' ., i I ' „ � ,
. _.� � _ ._ ." � ._ .. A_ . : _ ._s�...
t.-. . �-.�. ..�n..t r....�...r . .t.a.c ._f ::- - •
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� ' � NOTICE OF D�ED RESTRICTI NS: The undersigned understands that this permit may be subject to"deed"restrictions"
which rrf'iay be more restrictive th n County�egulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UIdLICENSED CONTRACTOR AND CO TRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work,th y may belrequired to be Iicensed in accordance with state and local regulations. If the
contractor is not licensed as req Ired by law, both the owner and contractor may be cited#or 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 o contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the own r has�hired a contractor or contractors, he is advfsed 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 indic tion tiat hi is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRAfVSPORTATION IMPACTIU ILITIES IIIAPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees nd Recou�se Recovery Fees may apply to the construction of new buildings,change of
use in existing buildings, or exp nsion!of ezisting buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The under igned;�also�understands,that such fees,as may be due,will be identified at the time of
permitting. It is further understo d that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupa cy"o�r final power release. If the project does not involve a certificate of occupancy or
final power release, the fees mu t be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid p ior to�permit issuance in accordance with appl(cable Pasco County ordinances.
CONSTRUCTION LIEN LA1N(Chapter T13�,Fiorida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, ha�e been provfded with a copy of the "Florida Canstruction Lien Law—Homeowner's
Protection Guide"prepared by th Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner",I certify th t I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to c mmencement.
CONTRACTOR'S/OWNER'S AF IDAVIT: I certify that all the information in this applfcation is accurate and that all work
will be done in compliance with II applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permi to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a per,mit and that all work will be pe�formed to meet standards of all laws regulating
construction, County and City c des, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the egulations�of other government agencies may apply to the intended work, and that it is
my responsibility to identify what ctions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Envir nmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WalerlWaste ater Treatment.
- Southwest Florida ater� Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engin ers-S�eawalls,Docks,Navigable Waterways.
- Department of Healt R Rehabilitative Services/Environmehtal Health Unit-Weiis, Wastewater Treatment,
Septic Tanks.
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- US Environmental Pr�tection Agency-Asbestos abatement.
- Federal Aviation Auth rity-Runways.
I understand that the following res rictions apply to the use of flll:�
- Use of fill is not allow d in FloodlZone"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�f Flo�ida.
- If the fill material is to be used in Fiood Zone "A" in connection with a permitted building using stem wall
construction,I certify hat fill wlll be used only to fill the area within the stem wall.
- If fill material is to e used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of ill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the uilding permit issued under the attached permit application,for lots less than one(1)
acre which are elevat d by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE O ER,I pro�mise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing consfruction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specificaily included in the application. A
permit issued shall be construed o be a license to proceed with the work and not as authority to.violate,cancel,alter,or
set aside any provisions of the te�hnical codes,nor shall issuance of a permit prevent the Buildirig Official from thereafter
requiring a correction of errors in lans,iconstruction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by su h permit is commenced within six months of permit issuance,or if work authorized by
the permit is suspended or aband ned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,fro the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If woik ce'ases for ninety(90)consecutive days,th�job is considered abandoned.
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WARIdING TO OWNER: YOUR FAILURE TO i2ECORD A NOTICE OF COMAAENCEMEPIT MAY RESULT IN YOUR
PAYING TWICE FOR 17NPROVE ENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LEPIDER OR AN A ORfVEY 8EF RE RECORDING YOUR NOTICE OF COM ENCEME .
FLORIDA JURAT(F . . 3) !
OWNER OR AGE CONTRACTOR �
Subs bed and swa (or rmed)bef e fs � Subscribed d to rtnedZ e
zf �/� by ' j L-3o—/ 2�5
�pq�o is/�re personally kno o me or has ave produce'd WhA Is/ar ersonally known to me or has/have produced
'f'(_� ,Uf�IIQ-r U�C.eY.SI� as IdenB cadon.l I �(.� �Ri�G�t2�.�Sn-- as identification.
�� �
' L�K)Gt� Notary Public �.�.R Notary Public
Co ssl �����3 Commis fon o.
:�� , ' Commisslon#FF 150 22 i ;,.••.:o:i:%�f,,, JACQUELINE BOGES
Name of I o. �d, ��� 7019 I Name of Notary p�d, r�d P mber 12,2018
I '%'I„'p'd n4p`� Bad�d nw Troy F:m inaivanca eo63e5ao19
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