HomeMy WebLinkAbout15-15921 CI OF ZEPHYRHILLS
�. 5335-8TH STREET
� (813)780-0020 1 5 1
k_ � `•
B ILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 15921 Address: 38233 DAUGHTERY RD
Permit Type: DEMOLITION ZEPHYRHILLS, FL.
Class of Work: 636-DEMOLITION Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: . Parcel Number: 35-25-21-0010-12300-0000
Improv. Cost: 60,000.00 OWNER INFORMATION
Date Issued: 1/20/2015 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 75.00 Address: 7050 GALL BLVD
Amount Paid: 75.00 ZEPHYRHILL FL 33541
Date Paid: 1/21/2015 Phone: (813)783-6189
Work Desc: INTERIOR DEMO ONLY
CONTRACTOR S APPLICATION FEES
SEALANDER CO T CTO S RVIC S DEMOLITION 75.00
�c�(h G�C�.`�-�G�-S[�G
-�
�
1� C� ��
� �
�
���
. In ections Re uired
FINAL s
REINSPECTION FEES: Reinspection fees will omply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the fol owing 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 po ed on job site� plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this p rmit, 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 nagement, 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 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.
CONTRACTOR SIGNAT PERMIT OFFI R
PERMIT EXPIRES IN 6 M NTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPE ION - 8 HOUR NOTICE REQUIRED
PROTE CARD FROM WEATHER
I I I IIII lllli IIIII IIIII Illli IIIII iliii IIIII11111111
� 2015009485
n. ' a
" � Rcpt:i655083 Rec: 10.@0
DS: 0.00 IT: 0.00
Pd�'i`I ���tC'tDMI4�lEN��16��NT 01/21/2015 D. B. , Dpty Clerk
Pezmit I�o.
Praperty Identi�cation No. ' ,,� ° L�_���pZ��� ''00�'"r'O
T�E i3NDERSIGN'FjD her�by gives nofice that impro�r ments will be made to certain z�l property,and in accardance e��ith Section
7I�,13 of the�lorida Statcttes,the following inft�rmatio is pravided iss EIZe?�CD����4}���Dil�f��Ei°d���EN1'.
I. Descriptian of property(te arl�SCP'PyL1 'an:�
a} ;'J�t'�E�f�if�{�L�Sb`: c s
Z. tie�descAption ofimp ovemen#s �
3. Ou>ner infarmatio� C� l'`�R1.,�,,.
a) Name and address� � �
b} �iame and address of fee simple titleholder�if er than otvner}
c) Interest in progerly
..t 4. Coanactor Informataon �"'.:�� � �=,�,�/,� ,q�l�>
i33 �<1123�1i2d�t�t�TTASS: r .��:J e)/
b) Telephone No_: -� �ax I'�To.(Op�) •�6
�;: . SitI�3}+�I1f42XT1s3f3O?I
�� �c"tIYIO ai]CT 3�C�2SS:
b) Arnount af�ond:
c} Teleph�rne Na.: Fa�Na.{flp�.)
6. I.en�er /. �
a) Name and adciress' � o��
�Nv
7. Tdenzity af persan withzn the State of�lorida desi at�d by a�mer upon whom narices or other documents may be served; I oo�o
a} ?�Tame and address: �m Z
b) Telephone No_: F�Nt�.(�pt.) ,�u��
8. In additzon to hitnself,owner desig;�ates the fallow ng person to r�ceive a copy oF the Lienc�r's R?otice as gravided in Secton �a J
713.13(1){b},�larid�.Statu#es:
a) Name and atidress: `���,N�
. b) fielep�one No.: �ax I�a.(f�pt.} � � �
9. Expiration date of Notice of Commencement(the xpiratian date is one year from Lhe date nf recc�rding unless a different date is -p °
specified): � �r�
�
�
�,$'.�l,�t��'ds�'��9�'P+��$a�'�1�°.�.�fio'5�,1�''�'�1���� k$��`�+ C}�T��a�,��'�$$.'I'��+ �+:�Y�.�'�Ot�T��'+�'��+ 3��'I'I�:�CDF �"��ao
��I�14��iTC�..+'��:NN�������I�?�+:�+I�II�'°�n�D ��tF�����I`C�"S IJI�iF���S.".���'�+$2.73�,���`Is 5�+��`��I`�'7�3.13s �+�o
�+'�tAIt��3A.�'i`�'�"$J'��S�z"d$9��I�I�;�u�J$.,�'�+I�'E�I.�i�a't�l?'�iG�'����+`t��$7[Y'I�;}�`a��+i+#"€'S T�B�OFJ�T'T��D�'�+I2'Y'�'.A i� �
id�"i'�`�C�C3�'��.3PviTv�NNC:�1�JiEP�t'I'I���.T�'�'��,,"+ �� RTI���'�3�'"�}�Ti'�+�D f�Pd'I'�J�3��I`�'�I3E�+CD m + 'T'��+3�'� �� o
�T�'���."€`�{�?�T.�£+`�'�#T��,'+��`I$'$'��9�g��ZiT� $�IC�'�'x.�{�I4iSUI,'��'��JI3$.,��8��{9��d Pa�'T{$�2.I��'�E+$`�.i�+ , m
��l'�I�i'd�k�x 1C;`F�'�3������+C��1dP�7��"��T P ��IC�����l�il�`�+P�T�'�•1�?�'. � �
C����i'f'Y{D�'��LtiD �l/f`s'����,e��i�
Si�nature OF Q��ser ar C}v,ner's Auchc�rized OffiwerlBirectorlParEaer,'149�g�
����.s /��til�crr�
�t N�
The foregoin�instrmnent uas acknowCedged befare me this i day of ����a�y 20 i'r'.,.�' ,by k�+i.All� t�A E'H L Oa Q i',N
as F��i�l DA taGS a Tp{. ��'PH FcNli� (ty�a�of authority,e.g,officar,4rustee,attomey in fact)for
Di K3ECTi3 C�+ �r- ��..,a�r a tSPC�iA'tiG4F�i a e of party an behalf 4f who�ins#r€iment was executed}.
Personally Knnwn �/ OR Produced Tdentiiication htotary Signattare �+"'R�"-�-1--��' ' P't`"A'.�
K�M Ea�{;b 3�0 4�f 1 LL
Type of Identi�cation Produced Na,-ne(print} �l
Ve�ific�ation pttrsuant 10 Sectian 92_525,FIori@a Sfafutes.Un er penaities af gerjetry,I declar�that I fiave read the fnrcgning and that ihe facts stated
in it are true ta the best of my kttowledge and belie£
F4X3�tS1NOC.rsd2�7 1�� �'����tGi'1+
Si{7tanseafNariaat PtiaanSign3ngAbovc
,,�i�F�.�_ ItIMBEFiLY J.HI�{.
k: :r_ MY COMM1SSIdN ii EE 198821
���„R���°��` 8ondedxThruRNotary P Wk Und1envrite
:
�
s �
� . �. '
.s., „ , . _ -, � - ° ` � ,�, ..
�
a�aaso-oo2o City of Ze hyrhills Permit Application Fax-813-780-0021
Building Department
�
Date Received� ° � Phone Co tact for Permitting
r -
Owner's Name � {� � t Owner Phone Number �` 3��/F��
Owner's Address °1 o So G a I� �l v d Owner Phone Number
Fee Simple Titleholder Name ,� Owner Phone Number
� r�
Fee Simple Titleholder Address �� ' �7 y�
JOB ADDRESS ���`�" ►JQu 1 W LOT# �
SUBDIVISION P CEL ID# J� 'Z'— QUI� — 12���� ���o
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR B A D/ALT 0 SIGN Q � DEMOLISH
INSTALL R PAIR
PROPOSED USE Q SFR Q C MM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q F ME � STEEL Q
DESCRIPTION OF WORK ' '
BUILDING SIZE SQ FOOTAGE O(V HEIGHT
QBUILDING $ �. VALU TION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP ERVICE 0 PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
QMECHANICAL $ VALU TION OF MECHANICAL INSTALLATION �� � Z(
QGAS Q ROOFING Q S ECIALTY � OTHER
FINISHED FLOOR ELEVATIONS F OOD ZONE AREA QYES NO
BUILDER COMPANY V �p� � �ia
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address �� License# c,.t��/Jr� �p
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER COMPANY ���. L•pa�24� �
Ci,
SIGNATURE REGISTERED / N FEE CURRE� Y/N
Address ��O �J License# F!� f7 °� �p
M ECHANICAL COM PANY
SIGfVATURE 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;( )set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal da e. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
- - - -Sanitary Facilities&-1 dumpster;Site Work Permi for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a ife Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal da e. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permi for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"*'PROPERTY SURVEY required for all NEW nstruction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
" Agent(for the contractor)or Power of Attomey(for the owner)w uld be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Onl )
Reroofs if shingles Sewers Service Upgrades A/C F nces(Plot/Survey/Footage) "
Driveways-Not over Counter if on putilicroadways.:needs RO �
- _., {s �_ ' „ ._. '. ., - � __ -_._ - ....----- ...,..;.
� � , .:,.,., .., �,._, _ „ :ji .�.'., „ • `,..
�
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this perm�t may be subject to"deed"restr;�tions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions. .
UNLICENSED CONTRACTORS AND COiV'TRACTOR 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 IMPACTIUTILITIES IINPAC'T I4WD 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 Transpo�tation 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 WaterlSewer Impact
fees are due, they must•be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN L�►1�11(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. �
CONTRACTOFt'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
wrill be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. f also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is I
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- DeparFment �of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment. I
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. 'i
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks. I
, - 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. i
- 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 O1IVNER, 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, o[ other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the wiork and noY as authority to_violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Buildirig.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 suoh 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.
W�4RFlIFIC TO OViINER: YOUR F�►ILURE TO RECORD �4 NOTICE OF COMMENCEMENT Mf�Y FtESULT 1�1 YOUR
- PAYlNG�TlfVICE-�Olt-I�PROVEnAENTS TO_YOUR PROPER7'Y_. I�YOU INTEND TO`OBT141N FINANCING, COYVSULY _
lAIIYH YOUR LENDEFt OR�►N ATTORNEY BEFORE RECOPtDING YOUR NOTICE OF COMiVIE�ICEfViENY.
FLORIDA JURAT(F.S. 117.Q3
OVdNE92 OR AGENT ��f��fi`/ �i�/(���� CONTRACTO ��•s D/ l.i��<��
Subscribed and swom to(or affirmed)before me this Subscribed and swom to(or affirmed)before me this
1-i1���5 w�.AuS 1vIEiiLNOE�h1 � -Itm- f5 by CAGt�. E, �E��.��rt�Cl�,
Who islare ersonally known e or has/have produced Who Is/are personally known to me or has/have produced
as Identificatlon. r�- �� �ys� '���-5(o°�iyy-O as identification.
��'�-�/�° ��-� Notary Public ��"-0-`0`�' �"� Notary Public �
� Commisslon No. �V LY �Q� ����D Commission No. �U�y 1 q� av I(G �
{�IMI3ERLy 3. NILI. KIMO�FiLy J. H(LL
Name o(,f;�,� ed rinted or stamped Name of Nota�
.. ;j �;�{Py��.,, bMBERL J.HILL
` ''"., KIAIBERLYJ.HILL �'`�s �•-
1••:�,., ----- _ _,�,*. � MY COMMISSION#EE 198821
•�:��:'.? MY COMMISStON 8 EE 198@21 �i"--��,'����� EXPIRES:July 19,2016
�':�-:3� • EXPIRES:Juty 19,2016 � .��,'p����` Bonded Thru Notary Publa Undervmlers
,;;;;;;��' Urnded.Thru Notary Public Under»viters
..��P*:t 7'1i�rfm ._-___ ' '