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Home My WebLink About19-21056 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 21056 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 21056 Address: 7344 GALL BLVD 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: 35-25-21-0010-07200-0000 Improv. Cost: 603,400.00 OWNER INFORMATION . Date Issued: 4/04/2019 Name: LCGR 7344 ALL LLC LEON CAPITAL Total Fees: 12,446.54 Address: 3500 MAPLE AVE STE 1600 Amount Paid: 11,981.54 DALLAS, TX 75219 Date Paid: 5/21/2019 Phone: 217-540-8216 Work Desc: REMODEL INTERIOR/EXTERIOR CANOPY REMOVED 4,390 SQ FT ADD REROOF CONTRACTORS APPLICATION FEES INTERSTRUCT TAMPA BUILDING FEE 2,845.80 J & S PLUMBING INC ELECTRICAL FEE 627.75 MCMULLEN AIR CONDITIONING REFRIG WATER CONNECTION COMMERCIAL 2,014.04 E*STAR ELECTRIC INC PLUMBING FEE 418.50 QUALITY ROOFING INC MECHANICAL FEE 292.95 SEWER CONNECTION COMMERCIAL 4,167.67 'fin r WATER METER 1.5 1,415.63 1 /1 FIRE PLAN REVIEW FEES 131.70 \ REVISION FEE 67.50 REROOF COMMERCIAL 465.00 Ins ections Required" FOOTER 2ND ROUGH PLUMB MI C INSULATION CEILING 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. UNDERGROUND ELECTRIC REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe 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 performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. �� CONTRACTOR SIGNATURE PERMIT OFFICgR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER �� || | K- �~.�~. . ~ . . .~ ./ �~~~ 350O Maple Avenue,Suitel6DO Dallas,TX 75219 June 6iZU19 ' State of Florida, City of2ephvnhiUs RE: Dental Care at Pretty Pond 7344 Gall Blvd ZephyrhU|s, FL3354O To Whom |t May Concern: LCG2R 7344 Gall, LLC acknowledges its ownership of the business building at 7344 Gall Blvd in ZephyrhiUs, FL,that is presently leased to Heartland Dental, L[G2R7344 Gall, LUC has seen the proposed sign package and approves all signage if it comports to city/county code. Landlord authorizes Identiti and their agents to obtain all necessary permits for signage, as well as install all approved signageat7344 Gall Blvd inZephvrhiUs, FL33S4O. Landlord bCG2R7344 Gall Gall, LLCbyLCGZ Investments Manager, LL[, Manager / Rob Pivnick, Authorized Signatory Date 3500 Maple Avenue,Suite 1600 Street Address o[Landlord Dallas,TX 75219 City,State,m Zip Code vfLandlord STATE OF: Lwao COUNTY OF: The fo ing instrumentwas me this day of 2018. Xshe iaueysona/|y known tomacv has produced as identification. � My commission expires: 813a8 0-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department, ve bate Receid 2 Q- `� Phone Contact for Permitting & Owner's Name Heartland Dental Owner Phone Number 727-512-6426 Owner's Address 1200 Network Center Dr Effingham,IL 33541 Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS LOT# 7344 Gall Blvd Zephyrhills,FL 33541 73 ' SUBDIVISION Zehphyrhills Colony Company PARCEL ID# 35-25-21-0010-08800-0010 (OBTAINED FROM PROPERTY TAX NOTICE) _ WORK PROPOSED e NEW CONSTR e ADD/ALT = SIGN Q = DEMOLISH INSTALL. REPAIR PROPOSED USE = SFR 0. COMM = OTHER - TYPE OF CONSTRUCTION = BLOCK 0 FRAME _ STEEL = DESCRIPTION OF WORK Recover existing roofing with new EPS and TPO . BUILDING SIZE SQ FOOTAGE 2320 HEIGHT 20ft =BUILDING $ VALUATION OF TOTAL CONSTRUCTION ELECTRICAL. $ AMP SERVICE = PROGRESS ENERGY C. =PLUMBING $ �� N _ =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION / =GAS = ROOFING 0 SPECIALTY = OTHER x FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA F BUILDER $, COMP'e is - C - - - SIGNATURE REGI E E Y/ N FEE CURREr, Y/'N Address. License#' ELECTRICIAN COMP. Y SIGNATURE REGISTERED Y n Address License# PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURREN Address License# MECHANICAL COMPANY . SIGNATURE REGISTERED - Y/ N FEE CURREN Address License# OTHER COMPANY Quality Roofing,Inc. SIGNATURE ,-' REGISTERED N' FEE CURREh Address 1905.N 40th St Tampa, FL 33605 License#. cccoazaas 1 I Fl li 1. 1111 -1 .1'1 I I IJ I I I I L11 '1 1. 11 11 .1 111-111 111.111 111 11' 1 .1 .1.1 11 1 111 111. 11 :11. 1_ 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.installed, Sanitary Facilities&1 dumpster;Site Work.Permit for subdivisions/large projects COMMERCIAL . Attach'(2)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 construction. . . . . . . ' . . . Directions: FilCout 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 Attorney(for the owner),would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service,Upgrades A/C Fences(Plot/Survey/Footage) Driveways-Not over Counter if on public roadWays..needs ROW. i NOTICE OF DEED RESTRICTIONS: The undersigned understands that-this permit maybe 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 taw. 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'contracioi(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 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-pad.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 1, 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'S/OWNER'S AFFIDAVIT: I certify 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 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 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 wail. 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 undertahe attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required.. If Lam 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-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 OWNER OR AGENT _ CONTRAC4QB �r �-�-� Su scri a an rn t affirm b' o re Hie this Su crib d and swotr d} e a e e i LD y 0 . ti1 { Who is tar b Hall kn n me or as/have produced 1\hb W re ersonally know me or as/ ve produced J. as identification. as identification. L(,7)1 V& n(, Notary Public �` Notary Public Cam is • n No. Commission No.� t '�J ! U Name f NNamlb of N ary typed, rined� Official Seal MIRiAN LYNN AKERS Nicole Raye Morrison s?.' ��_ Notary Public-state of Florida Notary Public State of Illinois p o` Commission N GG 265348 my Commission Expires 05/25/2022 :'( � oFF�... My Comm.Expires Jan 28,2023 Bonded through National Notary Assn. ; State Certified_• CCC042846 Qua Lit 00 Lf2 State Certified • CGC1507166 Power of Attorney Authorized Agent Affidavit I Richard Jenkins (License Holder) hereby grant authorization to the following persons to act as my agent with City of Largo while conducting activities related to obtaining permits and/or inspections. Adam Drury Tanner Jenkins Nathan Cole Vivian Reliz Morgan Sasser The Authorized Agent(s) is to be considered an agent of my business and therefore the signature of said agent is binding and causes me to assume all responsibilities connected to or associated with the signature as they may relate to my property. This authorization will supersede any previous authorization(s) and will remain in effect unless revoked by the undersigned in writing. 3/ J✓q Licen o der e Date State of Gv-i' u County of The foregoing instrument was acknowledged before me this day of u , 20�9 By / 'c �1 who i ersonally kno to me or produced as identification and who did take an oat . `�;�pyiv vie4- MIRIA7LYNN AKERSNotary Pubtate ' Florida Signature Of Notary PUb11C Commission it GG 265348 My Comm.Expires Jan"L8,2D23 Bonded through National Notary Assn. �/J 1905 N. 401h Street 9 Tampa, FL 33605 • Phone (813) 620-4797 9 Fax (813) 626-1756 Submitted To: Quote q: Interstruct'lnc Q10PBDF58 Address: Date: 8186 Woodland Center Blvd 4-20-19 City: State: 21p code:p aa L oo La� Tampa FL Tam a (� _ /!bl Phone N: Fax q: 727.512.6426 'Email Address: 1 State Certified CCCO42846 alex@interstructinc.com State Certified CGC1507166 lob name: lob Phone a: 1905 N 40th St • Tampa,Florida 33605 Job location: Phone:(813)620-4-797•Fax:(813)62.6-1756 7344 Gall.Boulevard Zephyrhills, FL 33541 We hereby submit specifications and estimates for: TPO Roof Recover as listed below: 1. Pull necessary permits. 2. Sweep loose gravel from roof and remove any other loose debris. I. Aqueous insulation to be removed and replace at$18 sq. Ft 4. Additional metal deck to be repaired at$15 sq. Ft&any additional i4"plywood at$2.00 sq.-FT S. Furnish and install new''/:" plywood on rear of parapet walls. -6. Furnish and install 1 layer separator between roofing systems. (preliminary attached) 7. Furnish and install Carlisle 60 mil Thermoplastic polyolefin (TPO)single-ply roofing system. 8. Furnish and install TPO single-ply roofing system on all parapet walls. 9. Furnish and install penetrations,transitions &termination flashings as necessary. 10. Furnish and install new coping cap on parapet walls,color to be chosen by owner. 11. Furnish our(3)three-year contractor's workmanship warranty. 12. Furnish manufacturer's 15 year material warranty. Notes:TPO membrane to be gray in color. The roofing industry Is currently experiencing price volatility in asphalt related products.Because firm,prices cannot be obtained from suppliers,prices at - Irject to change.If there is an increase in the price of asphalt related products,charge to the contractor subsequent to making this proposallcontract,d tl/contra shall be increased to reflect the additional cost to the contractor,upon submittal of written documentation thereof. Sum for the above: .Fifty three thousand four hundred dollars 00/100 Dollar 53,400.00 Payment to be made as follows: Schedule of values to be determined before start of job. All niatc-nals guaranteed to tan as spenhed or equal to.All work ro camplatpd in a ivnikmanlike manner Salesman: according to standani practices.Any alterauous or deviation from above specs icapons involving extra cost will be executed.only upon written orders and will become an extra chuge over and above the estimate. Atl Signature: damage and other necessary Insurance to hold contractor harmbss Irani tenants claims Our workers are fully Ehsan Siddigui 813-777-7647 agreements:ontingentuponstnkes.Kt.rdentsordelaysbeyondourcontrol.O:inertocarrybre,tornado.water Name: covered by Ylorkman's compensation Insurance Any monies not pad as agreed will incur V)4,per month interest rate Any cost incurred by Quabty Fooling.hu far Irrigation will be paid by non prevailing party. Email Address: Ehsan uali Roofin .eom Acceptance ofContraet: The above pnce.spacdtcations and condrtlans are sat:siactory and are he.hy accepted You atNaulhoozed to J.i v„,d.as spadbed Payment will be madoos Outlined above. Owner/Agen _ Signature: Date of S (� l Name: Acceptance: Note:This proposal may be.(ithtim,na by en if not accepted within 30 days from date at top Title: Submitted To: Quote H: Interstruct Inc Q4POOF43 - � i4ddress: Date. 8186 Woodland Center Blvd 4-8-19. . City: State: Zip Code: �'a L � Ile, � i `�� Tampa FL 33614 IZL. i Phone ilk Fax : 727.512.6426 fEmail Address: State Certified CCC042846 ,° alex@interstructinc.com State Certified CGC1507166 Job Name: Job Phone H: 19.05 N 40th Street •Tampa, Florida 33605 Job Location: Phone:(813) 620-4797• Fax:(813)626-1756 7344 Gall Boulevard Zephyrhills, FL 33541 We hereby submit specifications and estimates for: Flat ROOF REPAIR as listed below: 1) Spud back gravel as necessary to form proper tie in for parapet wall. 2) Remove existing roofing materials in repair area and haul away all debris. 3) Furnish and install W plywood on the back of parapet wall. 4) Inspect woodwork and make necessary repairs at an additional cost as follows: $4.00 per sq.ft.on %" plywood decking. $4.50 per sq.ft.on fire-rated plywood when required. $4.50 per linear ft. on 1x6 plank decking: $5.00 per linear ft-on 2x4 structural lumber. $6.50 per.linear ft. on.1x6 wood fascia. $1.50 per linear ft. on 1x2 fascia drip. $15.00 sq.ft. on lightweight concrete. 5) Furnish and install new smooth surface modifiedbitumen interply sheet,fully adhered. 6) Furnish and install a granular surface modified bitumen cap sheet,fully adhered. 7) Properly tie in new underlayment with tar&gravel system. 8) Furnish and install new coping cap, color to be picked out by owner. The roofing Industry is currently experiencing price volatility in asphalt related products.Because firm prices cannot be obtained from suppliers,prices are subject to change.If there is an increase In the price of asphalt related products,charge to the contractor subsequent to making this proposakontracGthe ptu cintract%h 11 be increased to reflect the additional cost to the contractor,uoon submittal of written documentatlon thereof. Nine thousand six hundred dollars 00/100 Dollars S . 9,60o.00 Sum for the above: Payment to be made as follows: Due upon completion. All materials guaranleed W be as specified of equal to AV work to completed in a workmenfike manner Salesman- .wcotdmg to standard practices.Any alterations or deviation from about•sworicalions involving eitlra cost vnll he executed only upon written orders and w:ll become an extra charge over mid above the eatlrtlale. All Signature: 1 damage and oilier necessary insurance to hold contractor harmless from lenanis claims.Our workers are fully Ehsan Sidd 1 qui 813-777-7647 agreements contingent upon slakes,scadents or delays beyond our tomrof chvnor to carry tire,fornado,water Name: covered by Workma+is Compensation Insurance Any monles not paid as agreed veil]incur iltab per awnth Interest Wte Any toil loturrecf by Quality Roofing,hit,for litigation will be paid by norrprevmlhlg party. Email Address: Ehsan -Roofin .coin Acceptance of Contract* lit•above price,spenficabonsandconditions ate salistxiory and are, /� hereby accepted You are aulhonredlnd,, •0.asspecihed Payment wibhe made asoulfinadabove. Owner/Agent Signature. 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ON a lw,ad oN u�ad AajoAldutoo 3'pop h.Tullo.�oosvd Nryd�taA,,o 's vjnv t 00'0:11 OO'O:Sa 00'%:09k1 98Z99OZ:fdOH VW WtO ti 1.OZ11WCO y Jo{ 000d Q L77_0d 7LA6 El ao Z b£ZtrOUR MiSNl F.ouun City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: Date Received: 0 Site: -l 3 Y i yd Permit Type: Ae(0 V 2�' C�Xt,��i Y� YWi r 2 Me W q_1 f- e2 Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. Kalvin S rt r lans Examiner Date Contractor and/or Homeowner (Required when comments are present) 6/17/2019 Florida Building Code Online k i- �X' -",;tom :.a'"i_'`C•r _ _ : ` � _-_:��'��f`_. - -" <ll �.�`.{{.�� a,l BCIS Home Log In User Registration Hot Topics Submit Surcharge Stats&Facts i Publications i Contact Us ; BCIS Site Map i Links { Search l b d - ' >3' Tg Product Approval t USER:Public User + s,a Product Approval Menu>Product or Application Search>Application List>Application Detail FL# y'FL"1;4083;R20,� Application Type Revision Code Version 2017 Application Status Approved Comments Archived Product Manufacturer CatlislEP§FnTec.Systems Address/Phone/Email f285-Ritner Highway P.O. Box 7000 Carlisle, PA 17013 -1E4 (717)245-7000 F03, f malpezzi@syntec.carlislegia �t& t�/ 'INI� GNq 4 Authorized Signature Joe Malpezzi aS /��'�w"y� � "E e�/ malpezzi@syntec.carliesle.cori Aft ��NX�+ A� *11'& C06 tag+ �FA p® ,Y'o Technical Representative Robert Patton Address/Phone/Email 1555 Ritner Highway Carlisle, PA 17013 717 245-7264 Robert.PATTON @syntec.ca rl i om r-Q Quality Assurance Representative Address/Phone/Email , ay Category _Roofing ) f� �. J ��ti! ��✓ Subcategory {�Single F.ly_a;Roof,fSystems Compliance Method Evaluation Report from a Florida Registered Architec 1cjeZnsed orida Professional Engineer Evaluation Report-Hardcopy Received Florida Engineer or Architect Name who developed the Robert J. M. Nieminen Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/14/2021 Validated By John W. Knezevich, PE d Validation Checklist-Hardcopy Received Certificate of Independence FL14083 R20 COI 2019 01 COI NIEMINEN.pdf Referenced Standard and Year(of Standard) Standard Year ASTM D6878 2011 FM 4470 2012 FM 4474 2011 TAS 131 1995 UL1897 2012 Equivalence of Product Standards Certified By https://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgtGLR%2byCBylJmTUImMQ[ToY[ue4MuTwlz7%2fY45xmF5RFg%3d%3d 1/2 6/17/2019 Florida Building Code Online Sections from the Code Product Approval Method Method 1 Option D Date Submitted 02/20/2019 Date Validated 02/21/2019 Date Pending FBC Approval 02/27/2019 Date Approved 04/16/2019 Summary of Products FL# Model, Number or Name Description Carlisle Sure-Weld TPO Single Ply Thermoplastic Olefin (TPO)Single Ply Roof Systems Roof Systems Limits of Use Installation Instructions Approved for use in HVHZ: No FL14083 R20 II 2019 02 FINAL Al ER CARLISLE SURE- Approved for use outside HVHZ:Yes WELD TPO FL14083-R20.pdf Impact Resistant: N/A Verified By: Robert 1. M. Nieminen PE-59166 Design Pressure: +N/A/-722.5 Created by Independent Third Party: Yes Other: 1.)The design pressure in this application relates to Evaluation Reports one particular assembly. Refer to the ER Appendix all systems FL14083 R20 AE 2019 02 FINAL ER CARLISLE SURE-WELD max.design presssures. 2.)Refer to ER,Section 5 for Limits of TPO FL14083-R20.pdf Use. 3.)This Product Approval is for Non-HVHZ jurisdictions. Created by Independent Third Party: Yes Refer to FL16440 for HVHZ. f0 0 Contact Us::2601 Blair Stone Road,Tallahassee FL 32399 Phone:850-487-1824 The State of Florida is an AA/EEO employer.Copyright 2007-2013 State of Florida.::Privacy Statement::Accessibility.Statement::Refund Statement Under Florida law,email 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,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.*Pursuant to Section 455.275(1), Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may be used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.To determine if you are a licensee under Chapter 455,F.S.,please click here. Product Approval Accepts: FORK LFEEM M Credit Card Safe https://www.floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgtGLR%2byCBylJmTUImMQIToYlue4MuTwlz7%2fY45xmF5RFg%3d%3d 212 ON EMO etc. TABLE 2H: STEEL ORSTRUCTURAL CONCRETE DECKS-NEW CONSTRUCTION,REROOF(TEAR-OFF)OR RECOVER SYSTEM TYPE D-1: INSULATED,MECHANICALLY ATTACHED ROOF,COVER Insulation Layer(Note 14) Roof Cover System Deck(Note 1) Attach Fastener Lap Lap Seam MDP No. Type Membrane Fasteners (psf) (Note 5) �--c Spacing Width Spacing Weld -Recover nly:Mira 22-J Carlisle-HP=X'Fastener(steel onl J,Carlisle.HD-14 10-i a.,t e B,Grade 33 3/8-inch insulfoam R- Prelim. Sure-Wel or Eoncre g''type (concrete only)°orCD=fO(concrete-only)Fasteners and 6-inch S.5- 90.5-inch 1.5-inch SC"2D `Sure=Weld - F a -. o.c' 60.0 (' steel o mih-2;50b psi Tech EPS orFaC n"Fold attach EXTRA `Piranha.PlAe or#15 Roofgrip(stee�ly�with 2-3/8" r-�--- inch O.C. outside -sfrucfujal concrete �Eyehook'Seam Plates(AccuSeam) Min.22 ga.,type B, Min.1.5-inch,one Carlisle HP-X Fastener(steel only),Carlisle HD 14-10 SC-208 Grade 80 steel or min. or more layers,any Prelim. Sure-Weld HS (concrete only)or CD-10(concrete only)Fasteners and 6-inch o.c. 5.5- 90.5-inch 1.5-inch -60.0 2,500 psi structural combination attach Piranha Plate inch O.C. outside concrete Min.22 ga.,type B,55 Min.300 psi,min 2- ksi steel,6 ft span,5/8" Sure-Weld or Carlisle HP-X Fastener(steel only)or Carlisle HD 14-10 inch thick cellular 5.5- 114.5-inch 1.5-inch lightweight SC-209 puddle welds 6"o.c.or N/A Sure-Weld (concrete only)and Piranha Plate(through to engage 6-inch o.c. -67.5 min.2,500 psi EXTRA structural deck) inch O.C. outside structural concrete concrete Min.22 ga.,type B, Min.1.5-inch,one Sure-Weld or Carlisle HP-X Fastener(steel only),Carlisle HD 14-10 SC-210 Grade 80 steel or min. or more layers,any Prelim. Sure-Weld (concrete only)or CD-10(concrete only)Fasteners and 6-inch o.c. 5.5-. 90.5-inch 1.5-inch -67.5 2,500 psi structural combination attach EXTRA Piranha Plate or#15 Roofgrip(steel only)with 2-3/8" inch O.C. outside concrete Eyehook Seam Plates(AccuSeam) Min.1.5-inch,one Sure-Weld or SC-211 Min.22 ga.,type B, or more layers,any Prelim. Sure-Weld Trufast#15 EHD Fastener with Trufast 2W'Barbed Metal 6-inch o.c. 5.5- 90.5-inch 1.5-inch 67.5 combination EXTRA Grade 80 steel attach Seam Plates inch O.C. outside Min.22 ga.,type B, Min.1.5-inch,one Sure-Weld or Carlisle HP-X Fastener(steel only),Carlisle HD 14-10 SC-212 Grade 80 steel or min. or more layers,any Prelim. Sure-Weld (concrete only)or CD-10(concrete only)Fasteners and 9-inch o.c. 5.5- 54.5-inch 1.5-inch -75.0 2,500 psi structural combination attach EXTRA Piranha Plate or#15 Roofgrip(steel only)with 2-3/8" inch O.C. outside concrete Eyehook Seam Plates(AccuSeam) Min.22 ga.,type B, Carlisle HP-X Fastener(steel only),Carlisle HD 14-10 SC-213 Grade 33 steel or mi Min.1.5-inch,one Sure-Weld or n. or more layers,any Prelim. Sure-Weld (concrete only)or CD-10(concrete only)Fasteners.and 6-inch o.c. 5.5- 42.5-inch 1.5-inch 82 5 2,500 psi structural combination attach EXTRA Piranha Plate or#15 Roofgrip(steel only)with 2-3/8" inch O.C. outside concrete Eyehook Seam Plates(AccuSeam) Min.1.5-inch,one Sure-Weld or SC-214 Min.22 ga.,type B, or more layers,any Prelim. Sure-Weld Trufast#15 EHD Fastener with Trufast 2.4"Barbed Metal 12-inch o.c. 5.5- 42.5-inch 1.5-inch 82 5 combination EXTRA Grade 33 steel attach Seam Plates inch O.C. outside Min.22 ga.,type B, Min.1.5-inch,one Sure-Weld or Carlisle HP-X Fastener(steel only),Carlisle HD 14-10 Grade 80 steel or min. Prelim. (concrete only)or CD-10(concrete only)Fasteners and 5.5- 54.5-inch 1.5-inch SC-215 or more layers,any Sure-Weld 6-inch o.c. -90.0 2,500 psi structural combination attach EXTRA Piranha Plate or#15 Roofgrip(steel only)with 2-3/8" inch O.C. outside concrete Eyehook Seam Plates(AccuSeam) NEMO ETC,LLC Evaluation Report C33680.09.10-R20 for F1.14083-1120 Certificate of Authorization#32455 6-EDITION(2017)FBC NON-HVHZ EVALUATION Revision 20:02/19/2019 Prepared by: Robert Nieminen,PE-59166 Carlisle Sure-Weld TPO Single Ply Roof Systems;(717)245-7264 Appendix 1,Page 33 of 66 City of Zephyrhills 533QmSt ZephvrhObFL33542 (813)780-0020 ROOFING INSPECTION AFFIDAVIT Permit No.: 1, licensed under Chapter 468,Florida Statutes aso(m): Contrac±mrZ Engineer Architect Building Inspector___ L|oenseNo' C Onorabou did personally inspect the: 0� \ Chec k: yr� Dry in < \� *1 Flashing and Drip edge Check which was used: 30#felt Peel and Stick Other( At the following Based upon that examination,I have determined the installation was done according to the Hurricane Mitigation Retrofit Manual(Based on Section 553.044, Florida Statutes\. Signature: Architecture ■ Engineering Transmittal Date: May 6, 2019 Job No. 18.945.00:30 TO: RE: HD Zephyrhills, FL City of Zephyrhills _ - Building Department 5335 8th St Zephyrhills, FL 33542 i ATTENTION: Jackie Boges PHONE: 813-780-0020 x 3513 EMAIL: COURIER: n/a UPS: Next Day Air USPS: n/a WE ARE SENDING YOU THE FOLLOWING ITEMS: NO. DESCRIPTION 1 HFR Transmittal 2 Full Size Sets of Drawings REMARKS: Enclosed are two full sized sets of drawings for the exterior changes at the Heartland Dental—Zephyrhills, FL. Please let us know if you have any questions. Signed: Abigail Sadler—Project Coordinator Hill Foley Rossi and Associates, LLC 3680 Pleasant Hill Road Suite 200 Duluth, Georgia 30096 Ph: 678-206-8600 Fx: 770-622-9535 email: asadler@hfraa.com If enclosures are not as noted, kindly notify us at once. 3680 Pleasant Hill Road,Suite 200■Duluth,Georgia 30096■P 770 622 9858■F 770 622 9535 5 Jacqueline Boges From: Jacqueline Boges . Sent: Monday, May 6, 2019 12:13 PM To: Audrey McGuire;Abigail Sadler Cc: 'Darren Brown'; 'Brad McCullough' Subject: RE: RE: Heartland Dental - 7344 Gall Blvd.,Zephyrhills, FL 33541 Hello Abigail, Planning has approved the revisions we require 2 sets of the revision plans for plan review here in the building dept you may mail in or bring into our dept for the review. Normally we have up to 30 days on our review time so if you could have the plans submitted sooner than later so that I may get them in for the review. Thank you Jackie Boges 813-780-0020 ext3513 "A rule I have had for years is:to treat the Lord Jesus Christ as a personal friend. His is not a creed,a mere doctrine, but it is He Himself we have."Dwight L. Moody Florida has a very broad public records law._ Electronic communications regarding most City of Zephyrhills business are public records and available upon request. Your e-mail communications may therefore be subject to public disclosure. If you received this message in error, please do not read, forward, copy, etc. and delete immediately. From:Audrey McGuire<AMcGuire@ci.zephyrhills.fl.us> Sent: Monday, May 6, 2019 8:27 AM To:Abigail Sadler<asadler@hfraa.com>;Audrey McGuire<AMcGuire@ci.zephyrhills.fl.us> Cc: 'Darren Brown'<d brown@ hfraa.com>; 'Brad McCullough'<bmccullough@hfraa.com>;Jacqueline Boges <jboges@ci.zephyrhills.fl.us> Subject: RE: RE: Heartland Dental-7344 Gall Blvd.,Zephyrhills, FL 33541 Hi Abby, I saw where you stated you will not be doing any landscape improvements. I will advise that any dead/dying landscaping in place now will need to be replaced as well as any landscaping damaged or removed due to the updates to the building. As far as the updates to the exterior of the building, I have not comments. Jacki`t is ap_p ov�d byzplanM g7 Thank you, Audrey _'vlcGuire Historic Preservation Specialist&Community Planner 1 City of Zephyrhills Planning Department 5335 8th Street, Zephyrhills, FL 33542 Phone: 813.780.0002 Email: amcguir a,ci.zephyrhills.fl.us PLEASE NOTE:Florida has a very broad public records law.Electronic communications regarding most City of Zephyrhills business are public records and available upon request. Your e-mail communications may therefore be subject to public disclosure.If you received this message in error,please do not read,forward, copy, etc. and delete immediately. From:Abigail Sadler<asadler@hfraa.com> Sent: Friday, May 3, 2019 7:15 AM To:Audrey McGuire<AMcGuire@ci.zephyrhills.fl.us> Cc: Darren Brown<dbrown@hfraa.com>; Brad McCullough<bmccullough@hfraa.com> Subject: RE: Heartland Dental-7344 Gall Blvd.,Zephyrhills, FL 33541 EXTERNAL EMAIL Good Morning Audrey, r We were advised to reach out to you directly with any questions. Please let us know if you need any other additional items. Thank you! Abby Sadler I Project Coordinator Hill Foley Rossi and Associates, LLC I www.hillfolevrossi.com 3680 Pleasant Hill Road I Suite 200 1 Duluth, Georgia 30096 o 770.622.9858 x250 d 678.206.8600 a asadler@hfraa.com © u From: Rodney Corriveau [mailto:RCorriveau@ci.zephvrhills.fl.us] Sent: Monday,April 29, 2019 4:02 PM To:Abigail Sadler<asadler@hfraa.com> Cc:Jacqueline Boges<iboges@ci.zephyrhills.fl.us>; Darren Brown<dbrown@hfraa.com>; Brad McCullough <bmccullouRh@hfraa.com>;Audrey McGuire<AMcGuire@ci.zephvrhills.fl.us>;Todd Vandeberg <tandeberg@ci.zephyrhills.fl.us> Subject: RE: Heartland Dental-7344 Gall Blvd.,Zephyrhills, FL 33541 Abigail, Audrey is looking into this and will have a determination once she has reviewed. Please reach out to her directly if you have questions. Thanks, Rod 2 Interstruct LLC-7344 Gall Blvd.-Dentist Office 4,390 sq ft u in IS SQ. FEET PRICE MAIN OR LIVING: $ 69.00 OTHER AREA UNDER ROOF: $ 88.00 OTHER: - .$ - VALUATION $ 550,000.00 FEE SHEET $ 2,790.00 ADDRESS DRIVEWAY BUILDING: $ . _ 2,845.80. ELECTRICAL: $, 627.75 PLUMBING: $ • 418.50 MECHANICAL: .$ 292.9.5 SUB-TOTAL $ -4,185.00 TOTAL _$ 4,185.00 SEWER: $ 4,167.67 credit$5,505.06 WATER: $ 2,014.04 credit 2,660.34 IRRIGATION: $ - TOTAL: $ 6,181.71 WATER METER: $ 1,415.63 1.5 meter IRRIGATION METER $ - FIRE.DEPARTMENT FEES PLANS TOTAL: $ 131.70 INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ 131.70 PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% $ - .TOTAL: $ - na SUB-TOTAL $ 11,914.04 PARK IMPACT FEES na SIF'S: 100.0% $ - 1.0% $ TOTAL: $ - na TIF'S : na 99% $ - 1% $ - TOTAL: $ 11;914.04 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 21056 BUILDING PERMIT PERMIT INFORMATION LOCATION'INFORMATION Permit Number: 21056 Address: 7344 GALL BLVD 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: 35-25-21-0010-07200-0000 Improv. Cost: 550,000.00 OWNER.INFORMATION Date Issued: 4/04/2019 Name: LCGR 7344 GALL LLC LEON CAPITAL Total Fees: 11,914.04 Address: 3500 MAPLE AVE STE 1600 Amount Paid: 11,914.04 DALLAS, TX 75219 Date Paid: 4/04/2019 Phone: 217-540-8216 Work Desc: REMODEL INTERIOR/EXTERIOR CANOPY REMOVED 4,390 SQ FT CONTRACTORS . APPLICATION FEES INTERSTRUCT TAMPA BUILDING FEE 2,845.80 J & S PLUMBING INC ELECTRICAL FEE 627.75 MCMULLEN AIR CONDITIONING REFRIG WATER CONNECTION COMMERCIAL 2,014.04 E*STAR ELECTRIC INC PLUMBING FEE 418.50 MECHANICAL FEE 292.95 / SEWER CONNECTION C MM RCIAL 4,167.67 WATER METER 1.5 —V- 1,415.63 FIRE PLAN REVIEW FEES 131.70 Ins ections Required F OTER 2 D ROUGH PLUMB MISC INSULATION CEILING 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: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe 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 performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRAC RE_ PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION . CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER UILY vI ccNuynuus reams nNNut:auun Building Department Date Received ; 9^ Ph..Contact for Permittin4" 770 622 9858 �'0 f_5 1-T=t- J'S LTL1..l-L1-J=11=(-1=1.L"YT"[t-TTi-'7-[-T'TT>-T - - .SSI=1._Li owners Name i Heartland Dental-Richard Jones_ _ bwccr Phone Number ��'d=�dU=�'16 ' DC/9� ;4200 Network Centre Dr.Effingham,IL 6240 Owner � Owners Address _- g —. Phone Number Foe Simple Titleholder Name j LCG2R 7344 Gall,LLC — ! Owner Phone Number !_727-786_2600 Fee Simple Titleholder Address 3500 Maple Ave.,Suite 1600,Dallas;TX 75219 — — —— — -- , JOB ADDRESS 17344 Gall Boulevard— — _--_ _ —--_— — LOT s —J � SUBDIVISION I, -.__.. . � PARCEL ID#; 35-25-21-0010-08800-0010_ _ i __.—. --_, •— .— (OBTAINED FRO[l PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR 8 ADDIALT = SIGN = = DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR x I COMAI Cr�� OTHER TYPE OF CONSTRUCTION Q BLOCK = FRAMEL=J STEEL _J DESCRIPTION OF WORK (interior remodel from bank to dental office. Exterior canopy removal. —_ I '4,390 S Ft �4390---� F14'-0" ---�� BUILDING SIZE I <l SO FOOTAGE i—__^_ HEIGHT I QBUILDING $550,000 _ j VALUATION OF TOTAL CONSTRUCTION ELECTRICAL i$ AMP SERVICE = PROGRESS ENERGY = W.R.E.C. F-TIPLUMBING U QMECHANICAL — VALUATION OF MECHANICAL INSTALLATION L__ —. __—.-i =GAS F_X� ROOFING 0 SPECIALTY = OTHER n Iv FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA =YES NO BUILDER COMPANY _144erl�¢ T� t 1- t/Qi SIGNATURE t I,; t lJ ll i REGISTERED 'Y I N FEE CURREP Y I N Address �7_G✓$1J �yF�t y cz�, --—p — License# ELECTRICIAN COMPANY SIGNATURE 1 YYr ri.'t �r >��- REGISTERED [_ YIN _ FEE CURREF ! Y/N 1V"`�1 6--E' Address vom tA4"/.w1 tvej- _ 1 5' Fe License# PLUMBER �AM.PANY SIGNATURE s +/REGISTERED I—Y/N I FFEECURREn� Y I N Address ' OZ s. SGv frr,4 ,-A /""-.---.-_i License# (G F«yM 1-1Y3 MECHANICAL COMPANY SIGNATURE I 7 �;_r-�- _J REGISTER CUR REGISTERED Y/ N_) FEE REN —j Y/N Address 1q?7 af' f6k, G — ) Uceme# IG 44 D S6.0 76 , COMPANY { :5rlf4 /,CSC /LJ - H 4�st..•,,- i _ REGISTERED Y/ N_J FEE WRRa [_YIN 5 t Y "'Address L--_ _—r —� license is Id ! [ Qlttlllllltltllltlttllillitlilllteillllt1111 / 111161111111i1t811 ' RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortes;R-O-W Permit for new construction, Minimum ton(10)working days after submittal date. Required onsile.Construction Plans,Stormwater Plans wl Sill Fence installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisionsnarge projects COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new ConstruWon. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stomnrater Plans w/Sift Fence instaned, 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 construction. t-a..a L.s . . toe_[.-• i1.e . . . . Directions. Fill out application completely. Owner&Contractor sign track of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500) Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from miler authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades AIC Fences(PioUSurvey/Footage) Driveways-Nat over Counter if on public roadways..needs ROW %..ny UI I_cNi ryrl I ub rCf IIIL fiPPIIUduUI I Building Department l Date Received �� 3' l Phone Contact for Permitti 770 622 9858 � -1 r rrrrr-r - Owner's Name Heartland Dental-Richard Jones er Phone Number - 6 .fie d�s Owner's Address 200 Network Centre Dr.Effingham, L Owner Phone Number Fee Simple Titleholder Name LCG2R 7344 Gall,LLC Owner Phone Number 727-786-2600 Fee Simple Titleholder Address 1 3500 Maple Ave.,Suite 1600,Dallas,TX 75219 JOB ADDRESS 7344 Gall Boulevard LOT# SUBDIVISION PARCEL ID# 35-25-21-0010-08800-0010 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR XB ADD/ALT 0 SIGN Q DEMOLISH INSTALL REPAIR PROPOSED USE SFR x COMM 0 OTHER TYPE OF CONSTRUCTION XD BLOCK 0 FRAME STEEL Q DESCRIPTION OF WORK nterior remodel from bank to dental office. Exterior canopy removal. BUILDING SIZE 4,390 Sq Ft = SO FOOTAGE 4390 HEIGHT 14'-0" XQBUILDING $ 550,000 VALUATION OF TOTAL CONSTRUCTION X�ELECTRICAL $ AMP SERVICE �0 PROGRESS�E°'N�EERRGY j`Q WN.R./E..C. ( Q OPLUMBING $ ��(� ��j1/*�FA (,�r� l 1 J '\ TY ✓V XX]MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION cl vwl— =GAS F7X ROOFING 0 SPECIALTY = OTHER W n v rl,n FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO fr�� Vim, & , v 4,, (�fj/) �i'�Cil C9 2 l BUILDER COMPANY /1�/+C�r�,t,Gf Tsil�l LLc c� SIGNATURE REGISTERED I Y/ N FEE CURREN Y/N Address 7 f C- jJ License# 146-e, lr4 S 33 ELECTRICIAN _ COMPANY SIGNATURE _ REGISTERED I Y/ N FEE CURREN I Y/N Address 10011 wlilf.,v AVQT L License# PLUMBER MPANY 34 SIGNATURE "�'LI'" � REGISTERED Y/ N FEE CURREN Y/N Address OIZ S. SG .Tfrcr f• ,-A r-4 ,�J ,�j License# G FG l�1.2 9.1 y3 MECHANICAL COMPANY /�-!^III4A - SIGNATURE ry w� REGISTERED Y/ N FEE CURREN Y/N Address ` 7 _��__S�•/_• S f rG + /jG License# GAG 0 S6•4 96 COMPANY REGISTERED I Y/ N FEE CURREN I Y/N 'Address License# 17"1`I_I`I'11�1y1�1RI L:I_I_LI_I_hh.1_L,I=1e1�1�1-t'i 1-'1-1-1-1-1-1-1-1-1=1-1_Is1�1-1-1-h1-1-1�1-1-1-1�1�1`t'1�I t_LlJ_IJ_L=I_I RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set ofEhergy FOrms'R=O=W Pe-mif for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stonmwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects COMMERCIAL Attach(2)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 construction. 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 Attorney(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/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 privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES 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 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'S/OWNER'S AFFIDAVIT: I certify 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 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 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 W"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 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OP TAIN FINANCING,CONSULT WITH YOUR LENDER OR A RNEY BEFORE RECORDING YGIMNOTICE OF QOMMfNCEMENT. FLORIDA JURAT(F.S.117. OWNER OR AGENT CONTRACTOR Subscribed and sworn to(or rmed efore me this Subscribed OR orn to(or rm d)before m t by ho islare person <now me or hasthave produced o islare son Iy k or hasthave duced as identification. as' en 1 cat on. ry Public V Notary Public ommission a. Commission No. Name of Not Wdypecippdntedwmatampedc<m Name of Notary typed,printed or stamped — �i^Y fv1ALEiJA K.COSTELLO V MALENA K.COSTELLO f ZA., �� _ Commission 4 FF 217653 {~ k Commission 4 FF 217653 . Expires May 15,2019 ;�=N: '' z Expires May 15,2019 is .• Bonded Thru Tmy Fein Insurance 890"385=/013 oc F,,.• Bonded Nru Troy Fan Insurance 60J-:85-7019 y Square Feet Dollar Amount Valuation Building Electric Plumbing Mechanical Radon Connection Fees: Sewer 4,1G7, 6-7 Water i L4 I Meter I if Transportation Impact Fee: 45 4)fil�uVcic City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Doctor or Dentist.Off ice ,� ` No. of Practitioners ( }y 2 No. of Employees per 8hr Shift ( 4 Impact Fees Within City Limits Outside City Limits .� Water-Fa_cilities-Capacity Fee $ �4;.67ri4 38� $ 5,842.98 VUastewater_Facilities-Capacity Fee $ '9672;7 $ 12,090.91 TOTAL $ 1;4;347:11 $ 17,933.88 r City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Office ' - r:.i - No. of Square Feet ( 43901 Impact Fees Within City Limits. Outside City Limits � - .,Water Facilities Capacity Fee $��2,.660:34 $ 3,325.43 Wastewater Facilities Capacity Fee $— —5-5m.d6 $ 6,881.33 TOTAL $ 10,206.75 mw tkuniun City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: Date Received: 3—20 A Site: Permit Type: w 11 S —7-b Approved w/no comments-� Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. Bill rgess Buil g Official 6aie Contractor and/or Homeowner (Required when comments are present) COMcheck Software Version 4.1.1.0 Mechanical Compliance Certificate Project Information Energy Code: 2017 Florida Building Oode, Energy Conservation Project Title: Zephyrhills Dental Building Location: Zephyrhills, Florida Climate Zone: 2a Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: 7344 Galll Blvd Heartland Dental Shepherd, Harvey, &Associates, Zephyrhills, FL 3420333541 1200 Network Centre Drive Inc. Effingham, IL 62401 4855 River Green Pkwy Suite 400 Duluth, GA 30096-2569 770-495-4007 Mechanical Systems List Quantity System Type&Description 1 HP-1/AHU-1 (Single Zone): Heating: 1 each-Central Furnace,Electric,Capacity=68 kBtu/h No minimum efficiency requirement applies Cooling:1 each-Split System,Capacity=48 kBtu/h,Air-Cooled Condenser,No Economizer,Economizer exception:High Efficiency Equipment Proposed Efficiency=15.00 SEER,Required Efficiency: 13.00 SEER Fan System: 1600 CFM 1 HP--Compliance(Motor nameplate HP method).:Passes Fans: FAN 4 Supply,Constant Volume, 1600 CFM, 1.0 motor nameplate hp,0.9 fan efficiency grade 1 HP-2/AHU-2(Single Zone): Heating: 1 each-Central Furnace,Electric,Capacity=68 kBtu/h No minimum efficiency requirement applies Cooling:1 each-Split System,Capacity=48 kBtu/h,Air-Cooled Condenser,No Economizer,Economizer exception:High Efficiency Equipment Proposed Efficiency=15.00 SEER,Required Efficiency: 13.00 SEER Fan System: 1600 CFM 1 HP—Compliance(Motor nameplate HP method):Passes Fans: FAN 4 Supply,Constant Volume, 1600 CFM, 1.0 motor nameplate hp,0.9 fan efficiency grade 1 HP-3/AHU-3(Single Zone): Heating:1 each-Central Furnace,Electric,Capacity=68 kBtu/h No minimum efficiency requirement applies Cooling:1 each-Split System,Capacity=48 kBtu/h,Air-Cooled Condenser,No Economizer,Economizer exception:High Efficiency Equipment Proposed Efficiency=15.00 SEER,Required Efficiency: 13.00 SEER Fan System: 1600 CFM 1 HP--Compliance(Motor nameplate HP method):Passes Fans: FAN 4 Supply,Constant Volume, 1600 CFM,1.0 motor nameplate hp,0.9 fan efficiency grade 1 HP-4/AHU-4(Single Zone): Heating:1 each-Central Furnace,Electric,Capacity=68 kBtu/h No minimum efficiency requirement applies Cooling: 1 each-Split System,Capacity=48 kBtu/h,Air-Cooled Condenser,No Economizer,Economizer exception:High Efficiency Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 1 of 13 Quantity System Type&Description Equipment Proposed Efficiency=15.00 SEER,Required Efficiency: 13.00 SEER Fan System: 1600 CFM 1 HP—Compliance(Motor nameplate HP method):Passes Fans: FAN 4 Supply,Constant Volume,1600 CFM,1.0 motor nameplate hp,0.9 fan efficiency grade Mechanical Compliance Statement Compliance Statement: The proposed mechanical alteration project represented in this document is consistent with the building plans,specifications, and other calculations submitted with this permit application.The proposed mechanical systems have been designed to meet the 2017 Florida.Building Code, Energy Cons ation requir ents in COMcheck Version 4.1.1.0 and to comply with any applicable mandatory requirements listed in the Ins ction Checkli Name-Title Isfain*f&,O- Date Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 2 of 13 COMcheck Software Version 4.1.1.0 Inspection Checklist Energy Code: 2017 Florida Building Code, Energy Conservation Requirements: 81.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed.Where compliance is itemized in a separate table, a reference to that table is provided. Section # Plan Review Complies? Comments/Assumptions & Re .ID C103.2 ;Plans,specifications, and/or ;❑Complies ;Requirement will be met. [PR2)1 calculations provide all information ;❑Does Not ;with which compliance can be !determined for the mechanical UNot Observable !systems and equipment and i❑Not Applicable !document where exceptions to the !standard are claimed. Load ; calculations per acceptable ;engineering standards and !handbooks. C405.6 !Plans specifications, and/or ;❑Complies ; [PR17)1 lcalcuiations provide all information ;❑Does Not (with which compliance can be i determined for the electrical systems ;❑Not Observable and equipment and document where ;❑Not Applicable ;exceptions are claimed. Provisions are i made for metering individual tenant units. Feeder connectors(for feeder ;and branch circuits)sized in !accordance with approved plans with maximum drop of 5%voltage drop !tota 1. Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 3 of 13 Section # Footing/Foundation Inspection Complies? Comments/Assumptions &Re .ID C►403.2.4._ Snow/ice melting system sensors for ;❑Complies ;Exception: Requirement does not apply. 5, future connection to controls. Freeze :,❑Does Not C4'03.2.4: protection systems have automatic 6 controls installed. ❑Not Observable F®9]3 :❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) EZ3Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\ eartland Zephyrhills Comcheck.cck Page 4 of 13 Section # Plumbing Rough-In Inspection Complies? Comments/Assumptions &Req.ID C404.5, Heated water supply piping conforms ;❑Complies ;Exception: Requirement does not apply. C404.5.1, to pipe length and volume ;❑Does Not C4045.2 requirements. Refer to section details. ;❑Not Observable; [PL6�]3 I I ;❑Not Applicable ; I C�044.5 Heated water supply piping conforms ;❑Complies ;Exception: Requirement does not apply. 1C-40 pipe 9 ,❑Does Not C4.04.5:1,� to i e length and volume I I y040'1 requirements. Refer to section details. ❑Not Observable; [PL6] ❑Not Applicable I 1 `C404M Heated water supply piping conforms ;❑Complies :Exception: Requirement does not apply. C 04'15Iz; to pipe length and volume ;❑Does Not ; C404 52 requirements. Refer to section details. ;❑Not Observable ;❑Not Applicable I I Heated water supply piping conforms I❑Complies ,Exception: Requirement does not apply. C4041�5k to pipe length and volume ;❑Does Not �EE-,2:0:445 r2-_ requirements. Refer to section details. ;❑Not Observable L63; :❑Not Applicable C4'04A63,' Pumps that circulate water between a ;❑Complies ;Exception: Requirement does not apply. [,PLZw]3 heater and storage tank have controls ;❑Does Not pis that limit operation from startup to ; = <= 5 minutes after end of heating ❑Not Observable cycle. ,❑Not Applicable ; `0404:6'3_ Pumps that circulate water between a ;❑Complies ;Exception: Requirement does not apply. heater and storage tank have controls :❑Does Not that limit operation from startup to I❑Not Observable, <= 5 minutes after end of heating ![]Not Applicable cycle. tp4Q4 6s3 Pumps that circulate water between a ;❑Complies ;Exception: Requirement does not apply. heater and storage tank have controls :❑Does Not that limit operation from startup to ; <= 5 minutes after end of heating ;❑Not Observable: <, cycle. ;❑Not Applicable 'C40463 - Pumps that circulate water between a E❑Complies :Exception: Requirement does not apply. i[P0,] .`,X heater and storage tank have controls ❑Does Not that limit operation from startup to <= 5 minutes after end of heating ;❑Not Observable cycle. ;❑Not Applicable ; G 04W,!�� Water distribution system that pumps ;❑Complies ;Exception: Requirement does not apply. [PL&]e ei water from a heated-water supply UDoes Not pipe back to the heated-water source through a cold-water supply pipe is a :[]Not Observable; ,. a ,r--= ;❑Not Applicable demand recirculation water system. ; Pumps within this system have <_: controls that start the pump upon receiving a signal from the action of a user of a fixture or appliance and 4 '' limits the temperature of the water ; >a.= entering the cold-water piping to 104°F. I I 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 5 of 13 Section # Plumbing Rough-In Inspection Complies? Comments/Assumptions &Re .lD C«404.7 Water distribution system that pumps ;❑Complies ;Exception:.Requirement does not apply. [1PL81]3 water from a heated-water supply ;❑Does Not pipe back to the heated-water source through a cold-water supply pipe is a ;❑Not Observable demand recirculation water system. !❑Not Applicable Pumps within this system have controls that start the pump upon ; receiving a signal from the action of a user of a fixture or appliance and ; limits the temperature of the water entering the cold-water piping to 1040 F. G4'04.7 Water distribution system that pumps ;❑Complies ;Exception: Requirement does not apply. [P.L8]3 water from a heated-water supply ;❑Does Not pipe back to the heated-water source through scold-water supply pipe is a ;[_]Not Observable demand recirculation water system. I❑Not Applicable ; Pumps within this system have ,• controls that start the pump upon o- receiving a signal from the action of a user of a fixture or appliance and ; g: limits the temperature of the water { i r ;t entering the cold-water piping to 104°F. `14'0 Water distributions stem that pumps ![]Complies lies ;Exception: Requirement does not apply. [P18 water from a heated-water supply ;❑Does Not pipe back to the heated-water source z through a cold-water supply is a ;❑Not Observable, 9 PP Yie P•P . _ demand recirculation water system. I❑Not Applicable Pumps within this system have ? controls that start the pump upon ! receiving a signal from the action of a user of a fixture or appliance and = limits the temperature of the water F entering the cold-water piping to Additional Comments/Assumptions: 1 JH1gh Impact(Tier 1) 2 Medium Impact(Tier 2) lEa.11 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report_date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 6 of 13 Section # Mechanical Rough-In Inspection Complies? Comments/Assumptions &Req.ID eW43Thermally ineffective panel surfaces of;❑Complies ;Requirement will be met. sensible heating panels have ;❑Does Not insulation >= R-3.5. ;❑Not Observable ❑Not Applicable C403.2.9. HVAC ducts and plenums insulated ;❑Complies ;Requirement will be met. 1.1 3and sealed according to Florida ;❑Does Not [ME60]2 Section C403.2.9,Table C403.2.9.1. I❑Not Observable ❑Not Applicable 1 ` C403.2.9. 5All ducts, air handlers,filter boxes, ;❑Complies !Requirement will be met. 2 Ibuilding cavities, mechanical closets :❑Does Not [ME79]2 Sand enclosed support platforms that ; form the primary air containment ;❑Not Observable, j passageways for air distribution ;❑Not Applicable systems are constructed and erected in accordance with Table C403.2.9.2 i and with Chapter 6 of the Florida Building Code, Mechanical. Ducts are ; be constructed, braced, reinforced I and installed to provide structural strength and durability.All transverse .joints, longitudinal seams and fitting iconnections are securely fastened in ; accordance with the applicable standards of this section. I C403.2.9. Duct insulation is protected from ;❑Complies ;Requirement will be met. 1.2 jdamage but not limited to the ;❑Does Not [ME80]2 following: 1. Insulation exposed to ❑Not Observable weather is suitable for outdoor , service.Cellular foam insulation is {❑Not Applicable i protected or painted with a coating ; that is water retardant and provides shielding from solar radiation.2. Insulation covering cooling ducts located outside the conditioned space is vapor retardant located outside the insulation, all penetrations and joints Hof which shall be sealed. C4012.9. !Additional insulation with vapor ;❑Complies :Exception: Requirement does not apply. 1.3 y barrier is provided where the ;❑Does Not [ME81]z 'minimum duct insulation requirements! {❑Not Observable Hof Section C403.2.9.1.1 are j determined to be insufficient to i❑Not Applicable ; !prevent condensation. ; C403.2.13 Unenclosed spaces that are heated ;❑Complies ;Exception: Requirement does not apply. [ME71]2 use only radiant heat. ;❑Does Not ❑Not Observable; ❑Not Applicable C403.2.3 )HVAC equipment efficiency verified. ;❑Complies ;See the Mechanical Systems list for values. [ME55]2 ;❑Does Not ❑Not Observable ❑Not Applicable C403:2.9. Ducts, air handlers,filter boxes, ;❑Complies ;Requirement will be met. 3 building cavities, mechanical closets ;❑Does Not [ME10]2 and enclosed support platforms that ; ; !form the primary air containment ;❑Not Observable, Ithepassageways for air distribution :❑Not Applicablesystems are sealed in accordance with;applicable criteria of this section I and Table C403.2.9.2. 11 High Impact(Tier 1) 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 7 of 13 Section # Mechanical Rough-In Inspection Complies? Comments/Assumptions &Re .ID C4'01-2.9. `Cavities in framed spaces are not ;❑Complies !Requirement will be met. 4:' used to deliver air from or return air to ❑Does Not ;[ME78]2 )the conditioning system unless they ; contain an air duct insert which is ;❑Not Observable insulated in accordance with Section []Not Applicable C403.2.9.1 and constructed and ; ,sealed in accordance with the requirements of Section C403.2.9.2 appropriate for the duct materials ; used. C403.2.9. Air distribution systems are sized and ;❑Complies ;Requirement will be met. 5, 3designed in accordance with ;❑Does Not [ME76]2 recognized engineering standards. 'Refer to section details. :❑Not Observable !,[]Not Applicable ; C403.2.9. Air-handling units not installed in ;❑Complies ;Requirement will be met. 6 attics of commercial buildings. ;❑Does Not [ME77]2 UNot Observable; ❑Not Applicable C408�2 2.; Air system balancing accomplished in ;❑Complies ;Requirement will be met. 1- = a manner to first minimize throttling :❑Does Not losses,then for fans with fan system <' power greater than 1 hp,fan speeds UNot Observable: " = shall be adjusted to meet design flow ❑Not Applicable ; ., conditions. Balancing procedures shall be in accordance with NEBB *jt ,M Procedural Standards,the AABC, ° National Standards, i ore equivalent q , procedures. ; C403.2.6. !Demand control ventilation provided ;❑Complies ;Requirement will be met. 1 ;for spaces>500 ft2 and >25 :❑Does Not [ME59]1 i people/1000 ft2 occupant density and ; ; ;served by systems with air side UNot Observable economizer, auto modulating outside ;❑Not Applicable ; air damper control,or design airflow >3,000 cfm. ; `G403>267°= Enclosed parking garage ventilation ;❑Complies ;Exception: Requirement does not apply. Z 2 "_. has automatic contaminant detection ;❑Does Not [MmEt115 ; and capacity to stage or modulate ; fans to 50%or less of design capacity.;❑Not Observable, g ❑Not Applicable , C403.2.7 M Exhaust air energy recovery on !❑Complies :Exception: Requirement does not apply. [ME57]1 systems meeting Table C403.2.7(1) ;❑Does Not ; ;and C403.2.7(2). UNot Observable: F ;❑Not Applicable 403 - µ Kitchen exhaust systems comply with ;❑Complies ;Exception: Requirement does not apply. [MEal7;6]3" replacement air and conditioned :❑Does Not . supply air limitations, and satisfy hood rating requirements and maximum UNot Observable; ' exhaust rate criteria. ;❑Not Applicable ; Jt6A Multiple zone VAV systems with DDC ;❑Complies ;Exception: Requirement does not apply. of individual zone boxes have static ;❑Does Not pressure setpoint reset controls. :See the Mechanical systems list for values. ❑Not Observable❑Not Applicable Multiple zone VAV systems with DDC. ;❑Complies ;Exception: Requirement does not apply. of individual zone boxes have static ;❑Does Not pressure setpoint reset controls. ;❑Not Observable;See the Mechanical Systems list for values. ;❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier2) .3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 8 of 13 Section ^" # Mechanical Rough-In Inspection Complies? Comments/Assumptions &Re .ID wrumuililowmm Multiple zone VAV systems with DDC ;❑Complies ;Exception: Requirement does not apply. of individual zone boxes have static ;❑Does Not �pressure setpoint reset controls. Seethe Mechanical Systems list for values. ;❑Not Observable; ❑Not.Applicable �C4�0344 ` Multiple zone VAV systems with DDC ;❑Complies :Exception: Requirement does not apply. of individual zone boxes have static ❑Does Not ''yFm [!ME pressure setpoint reset controls. :See the Mechanical Systems list for values. ;❑Not Observable; � 1❑Not Applicable , C4'08 2 ".Air outlets and zone terminal devices ;❑Complies Requirement will be met. have means for air balancing. :❑Does Not ;❑Not Observable; . ;❑Not Applicable "wu56idsy ..Et- G,40,3512:-: Refrigerated display cases,walk-in UComplies ;,Exception: Requirement does not apply. 1@Q403 5 1 coolers or walk-in freezers served by :❑Does Not iC4:03,nO` remote compressors and remote F3` ;❑Not Observable: [ME�123J]_,, condensers not located in a ° :❑Not Applicable ' �.�� -•,�;:;; condensing unit, have fan-powered PP condensers that comply with Sections C403.5.1 and refrigeration compressor: systems that comply with C403.5.2.. „C 403t58_: Condensing coils installed in cool air ;❑Complies :Exception: Requirement does not apply. [ME124'�3` stream of another air-conditioning ;❑Does Not t .unit The condensing coil of one air- :[:]Not'❑Not Observable conditioning unit shall not be installed ; in the cool air stream of another air- ;❑Not Applicable ; ,;'<•:: conditioning unit. Additional Comments/Assumptions: 11 High Impact(Tier 1) Z Medium Impact(Tier 2) 3° Low impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhilis, FL\Heartland Zephyrhills Comcheck.cck Page 9 of 13 Section # Final Inspection Complies? Comments/Assumptions &Re .ID CK303.3, Furnished 0&M manuals for HVAC ;❑Complies ;,Requirement will be met.' C•408.2.5. systems within 90 days of system ❑Does Not 3 acceptance. ;[]Not Observable 1 ❑Not Applicable C�4032.4. Minimum one humidity control device ;❑Complies :Requirement will be met. 2 per installed ;❑Does Not T156H humidification/dehumidification ❑Not Observable system.Controls prevent simultaneous operation of ❑Not Applicable humidification and dehumidification ; equipment. C403.2:4. Minimum one humidity control device ;❑Complies ;Requirement will be met. per installed ;❑Does Not [FI56yU humidification/dehumidification i❑Not Observable; g v system.Controls prevent []Not Applicable simultaneous operation of PP a humidification and dehumidification s-7—X . equipment. C403�2 4 : Minimum one humidity control device ;❑Complies ;Requirement will be met. 2,� : 4�:.- �., per installed ;❑Does Not ; I [FI5'6:] humidification/dehumidification system.Controls prevent ;❑Not Observable; w ;❑Not A simultaneous operation of Applicable humidification and dehumidification equipment. ;,C403Q.4w71 Minimum one humidity control device ;❑Complies ;Requirement will be met. C2'41. -; per installed T❑Does Not jF156] humidification/dehumidification :LL system.Controls prevent :❑Not Observable: simultaneous operation of ;❑Not Applicable humidification and dehumidification ? sa ._ equipment. ; G4:0321`° HVAC systems and equipment design ;❑Complies !Requirement will be met. 1, loads 3,.ti.- loads calculated in accordance with ; ❑Does Not , k ANSI/ASHRAE/ACCA Standard 183 or i❑Not Observable; ACCA Manual N or by an approved '❑Not Applicable equivalent computational procedure. PP Design loads shall be attached to the ,.,. " code compliance form submitted to the building department when the V,i s building is permitted or, in the event the mechanical permit is obtained at a later time,the sizing calculation shall be submitted with the application for the mechanical permit. ; JI-EM7 HVACsystems and equipment ;❑Complies ;Requirement will be met. capacity does not exceed calculated ❑Does Not loads. ;❑Not Observable; ❑Not Applicable ; `C40324,. Heating and cooling to each zone is ;❑Complies ;Requirement will be met. 1. controlled by a thermostat control. ;❑Does Not [.FI.4r7+]g Minimum one humidity control device per installed ;❑Not Observable; humidification/dehumidification ;❑Not Applicable system. rC40 2.4. Heating and cooling to each zone is ;❑Complies ;,Requirement will be met. :1 controlled by a thermostat control. :❑Does Not pF147j3 Minimum one humidity control device per installed :.[]Not Observable:, humidification/dehumidification I[]Not Applicable system. 11 High Impact(Tier 1) 2 1 Medium Impact(Tier 2) Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 10 of 13 Section # Final Inspection Complies? Comments/Assumptions &Re .ID C•403.2,4. Heating and cooling to each zone is ;❑Complies ;,Requirement will be met. i controlled by a thermostat control. ;❑Does;Not $F147]3 Minimum one humidity control device + ❑ per installed , Not Observable; humidification/dehumidification �,❑Not Applicable system. C403.2.4. Heating and cooling to each zone is ;❑Complies ;Requirement will be met. 1 controlled by a thermostat control. :E]Does Not [FI j3 Minimum one humidity control device per installed UNot Observable humidification/dehumidification ❑Not Applicable system. C4'03V1,33 24, Thermostatic controls have a 5 °F ;❑Complies ;Requirement will be met. �; deadband. ;❑Does Not ate,. ❑Not Observable {❑Not Applicable C40324;: Temperature controls have setpoint ;❑Complies :Requirement will be met. overlap restrictions. E]Does Not pF12073 - i ;❑Not Observable; ;❑Not Applicable ; C403 24. Each zone equipped with setback ;❑Complies ;Requirement will be met. controls using automatic time clock or :❑Does Not i[Fh39 j programmable control system. ❑Not Observable +❑Not Applicable + ` 4C 08 2 2N Construction documents require that a;❑Complies :Requirement will be met. [F 40 written balance report be provided to E]Does Not ;W the building owner or rep for HVAC ; - systems serving zones with total ,❑Not Observable; condition area >5,000 sgft.Air ;[]Not Applicable ; �. �� s; distribution systems shall be tested, ' adjusted, and balanced by a licensed ; engineer or certified company. ; + C4032#4. Automatic Controls: Setback to 55°F ;❑Complies :Requirement will be met. a (heat)and 85°F(cool); 7-day clock, 2- :❑Does Not C403.2.4 hour occupant override, 10-hour z backup ;❑Not Observable; '` : Applicable �[aF l 4'0] w. �❑Not ;C403.24 Systems include optimum start ;❑Complies ;Requirement will be met. � - 23 ' =` controls. E❑Does Not ;❑Not Observable ❑Not Applicable ; C�"40 24. Systems include optimum start ;❑Complies ;Requirement will be met. r2.3 controls. ;❑Does Not LFI'41]3 + ;❑Not Observable ❑Not Applicable �C403 4,_e Systems include optimum start ;❑Complies :Requirement will be met. 2,3 controls. ;❑Does Not [FI4*1]3 !,[]Not Observable; ❑Not Applicable C 03,2.4, Systems include optimum start ;❑Complies ;Requirement will be met. 2 3 controls. UDoes Not @FI41]3 ❑Not Observable; ❑Not Applicable 1 High Impact(Tier 1) 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 11 of 13 Section # Final Inspection Complies? Comments/Assumptions & Re .ID C408.2.1 ;Commissioning plan developed by ;❑Complies ;Requirement will be met. [F]28]1 !registered design professional or :❑Does Not approved agency. ; ,❑Not Observable; ❑Not Applicable C408.2.3. HVAC equipment has been tested to �,❑Complies Requirement will be met. 1 ensure proper operation. ;❑Does Not ; [FI31]1 ;❑Not Observable; ❑Not Applicable C408.2.3. {HVAC control systems have been ;❑Complies ;Requirement will be met. 2 }tested to ensure proper operation, {❑Does Not [F110]1 I calibration and adjustment of controls. ,❑Not Observable, ❑Not Applicable C408.2.4 !Preliminary commissioning report ;❑Complies :Requirement will be met. [FI29]1 !completed and certified by registered :❑Does Not ;design professional or approved !agency. ![]Not Observable, ❑Not Applicable ;C4'.08:-25::_ Furnished HVAC as-built drawings ,❑Complies ;Requirement will be met. ry , submitted within 90 days of system 1❑Does Not acceptance. ;❑Not Observable; -_ ;❑Not Applicable C408.2.5. ;An air and/or hydronic system ;❑Complies ;Requirement will be met. 3 (balancing report is provided for HVAC ;❑Does Not [FI43]1 ;systems. E ;❑Not Observable; ❑Not Applicable C408.2.5. ;Final commissioning report due to ;❑Complies ;,Requirement will be met. 4 ;building owner within 90 days of ;❑Does Not [F[30]1 !receipt of certificate of occupancy. ❑Not Observable; ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) u'`3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 12 of 13 Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: DAHill Foley Rossi\Heartiand Dental\Zephyrhills, FL\Heartland Zephyrhills Comcheck.cck Page 13 of 13 COMcheck Software Version.4.1.1.0 Interior Lighting Compliance Certificate Project Information Energy Code: 2017 Florida Building Code, Energy Conservation Project Title: Zephyrhills Dental Building Project Type: New Construction Construction Site: Owner/Agent: Designer/Contractor: 7344 Gall Blvd. Heartland Dental Shepherd, Harvey, &Associates, Zephyrhills, FL 33541 1200 Network'Centre Drive Inc. Effingham, IL 62401 4855 River Green Pkwy Suite 400 Additional Efficiency Package(s) Duluth,GA 30096-2569 770-495-4007 Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Allowed Interior Lighting Power A B C D Area Category Floor Area Allowed Allowed Watts (ft2) Watts/ft2 (B X C) 1-Health Care-Clinic 4125 0.81 3341 Total Allowed Watts= 3341 Proposed Interior Lighting Power A B C D E Fixture ID : Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) . Fixture Fixtures Watt. 1-Health Care-Clinic LED 2:A:Wall Sconce:LED PAR 10W: 1 9 10 90 LED 2 copy 1:B:Mini Pendant:LED PAR 10W: 1 4 10 40 LED 2 copy 2:C:LED Downlight:LED PAR 10W: 1 56 12 672 LED 2 copy 2:D:Large Chandelier:LED PAR 10W: 1 3 30 90 LED 1:F:2x4 LED:LED Linear 33W: 2 26 53 1378 LED 6:G:LED Tape Strip:LED Linear 8W: 1 92 1 92 LED 2 copy 3:H:Vanity Light:LED PAR 10W: 1 2 10 20 Total Proposed Watts= 2382 Interior Lighting PASSES: Design 29% better than code Interior Lighting Compliance Statement Compliance Statement: The proposed interior lighting design represented in this document is consistent with the building plans, specifications,and other calculations submitted with this permit application.The proposed interior lighting systems have been designed to meet the 2017 Florida Building Code, Energy Conservation requirements in COMcheck Version 4.1.1.0 and to comply with any applicable mandatory requirements listed in the Inspection Che klist. Name VTitle T Sign re Date Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: DAHill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 1 of 5 COMcheck Software Version 4.1.1.0 Inspection Checklist Energy Code: 2017 Florida Building Code, Energy Conservation Requirements: 76.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section # Plan Review Complies? Comments/Assumptions &Re .ID C405.6 i Plans,specifications,and/or ;❑Complies [PR17]1 !calculations provide all information ;❑Does Not with which compliance can be determined for the electrical systems ;❑Not Observable land equipment and document where !❑Not Applicable !exceptions are claimed. Provisions are; ; made for metering individual tenant ; units. Feeder connectors(for feeder ;and branch circuits)sized in !accordance with approved plans with ; !maximum drop of 5%voltage drop ;total. ; C103.2 Plans,specifications, and/or 1❑Complies [PR4]1 !calculations provide all information UDoes Not ;with which compliance can be !determined for the interior lighting ;❑Not Observable land electrical systems and equipment l❑Not Applicable i land document where exceptions to ; ; :the standard are claimed. Information ; provided should include interior l l ;lighting power calculations,wattage of; ; !bulbs and ballasts,transformers and ; control devices. C406 I Plans,specifications, and/or ;❑Complies [PR9]1 !calculations provide all information l❑Does Not !with which compliance can be ;❑Not Observable; !determined for the additional energy , !efficiency package options. ;❑Not Applicable ; Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 2 of 5 Section # Rough-In Electrical Inspection Complies? Comments/Assumptions &Re .ID C405,2.1 !Lighting controls installed to uniformly;❑Complies [EL15]1 !reduce the lighting load by at least ;❑Does Not 50/a ! ;❑Not Observable ❑Not Applicable C405.2.1 ;Occupancy sensors installed in ;❑Complies [EL18]1 !required spaces. ;❑Does Not I , ;❑Not Observable; ,❑Not Applicable C405.2.1, j Independent lighting controls installed ;❑Complies iC405.2.2. per approved lighting plans and all ,❑Does Not 3 manual controls readily accessible and; ❑Not Observable, [EL:23]2 visible to occupants. , ;❑Not Applicable ; C405.2.2. JAutomatic controls to shut off all ;❑Complies 1", !building lighting installed in all ,❑Does Not [EL22]2 o.buildings. ❑Not Observable 1 ,❑Not Applicable C405.2.3 Daylight zones provided with ;❑Complies [EL16]2 individual controls that control the ;❑Does Not lights independent of general area lighting. ;❑Not Observable ❑Not Applicable ; C405.2.3, ;Primary sidelighted areas are ElComplies C405.2.3. !equipped with required lighting 1❑Does Not 11 1 controls. C405.2.3. ! ❑Not Observable 2 ;❑Not Applicable ; [EL20]1 ; i C405.2.3, ;Enclosed spaces with daylight area ;❑Complies ; C405.2.3. !under skylights and rooftop monitors T❑Does Not 1, ;are equipped with required lighting ; C405.2.3. !controls. ❑Not Observable 3 ;❑Not Applicable ; [EL21]1 C405.2.4 !Separate lighting control devices for ;❑Complies [EL4]1 !specific uses installed per approved ;❑Does Not lighting plans. ! ;❑Not Observable; ,❑Not Applicable C405.2.4 ;Additional interior lighting power ;❑Complies [EL8]1 !allowed for special functions per the :❑Does Not approved lighting plans and is i !automatically controlled and ❑Not Observable; ;separated from general lighting. I❑Not Applicable C405.3 E Exit signs do not exceed 5 watts per ;❑Complies [EL6]1 !face. ,❑Does Not ❑Not Observable; ,❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3JMJ Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 3 of 5 Section # Final Inspection Complies? Comments/Assumptions &Re .ID C303.3, Furnished O&M instructions for ;❑Complies ;? C>408.2.5. systems and equipment to the ;❑Does Not 2 building owner or designated [FIp17]3 representative. :❑Not Observable ❑Not Applicable ; C405.4.1 i Interior installed lamp:and fixture ;❑Complies -;,See the Interior Lighting fixture schedule for values. [FI18]1 lighting power is consistent with what :❑Does Not is shown on the approved lighting plans, demonstrating proposed watts ;❑Not Observable are less than or equal to allowed :❑Not Applicable watts. ; ; G�448.2�5. Furnished as-built drawings for ;❑Complies 1 electric power systems within 90 days :❑Does Not [FI16' o�, of system acceptance. -�f ;❑Not Observable; ;❑Not Applicable C408.3 j Lighting systems have been tested to ;❑Complies [F[33]1 ensure proper calibration, adjustment, ;❑Does Not !programming, and operation. ; i :❑Not Observable I ;❑Not Applicable ; Additional Comments/Assumptions: 1 lHigh Impact(Tier 1) 2 Medium Impact(Tier 2) Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 4 of 5 Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 5 of 5 COMcheck Software Version 4.1.1.0 Interior Lighting Compliance Certificate Project Information Energy Code: 2017 Florida Building Code,.Energy Conservation Project Title: Zephyrhills Dental Building Project Type: New Construction Construction Site: Owner/Agent: Designer/Contractor. 7344 Gall Blvd. Heartland Dental Shepherd, Harvey, &Associates, Zephyrhills, FL 33541 1200 Network Centre Drive Inc.. Effingham, IL 62401 4855 River Green Pkwy Suite 400 Additional Efficiency Package(s) Duluth, GA 30096-2569 770-495-4007 Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Allowed Interior Lighting Power A B- C D - Area Category Floor Area Allowed Allowed Watts (ft2) Watts/ft2 (B X C) 1-Health Care-Clinic 4125 0.81 3341 Total Allowed Watts= 3341 Proposed Interior Lighting Power A B C D E Fixture ID :Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Waft. 1-Health Care-Clinic LED 2:A:Wall Sconce:LED PAR 10W: 1 9 10 90 LED 2 copy 1:B'.Mini Pendant:LED PAR 10W: 1 4 10 40 LED 2 copy 2:C:LED Downlight:LED PAR 10W: 1 56 12 672 LED 2 copy 2:D:Large Chandelier:LED PAR 10W: 1 3 30 90 LED 1:F:2x4 LED:LED Linear 33W: 2 26 53 1378 LED 6:G:LED Tape Strip:LED Linear 8W: 1 92 1 92 LED 2 copy 3:H:Vanity Light:LED PAR 10W: 1 2 10 20 Total Proposed Watts= 2382 Interior Lighting PASSES- Design 29% better than code Interior Lighting Compliance Statement Compliance Statement: The proposed interior lighting design represented in this document is consistent with the building plans, specifications,and other calculations submitted with this permit application.The proposed interior lighting systems have been designed to meet the 2017 Florida Building Code, Energy Conservation requirements in COMcheck Version 4.1.1.0 and to comply with any applicable mandatory requirements listed in the Inspection Che klist. Name VTJtIe a Date Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 1 of 5 COMcheck Software Version 4.1.1.0 Inspection :Checklist Energy Code: 2017 Florida Building Code, Energy Conservation Requirements: 76.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies.that a code requirement will be.met and how that is documented, or that an exception is being claimed.Where compliance is itemized in a separate table, a reference to that table is provided. Section # Plan Review Complies? Comments/Assumptions & Re .ID- - C405.6 j Plans,specifications, and/or L Complies [PR17]1 icalculations provide all information :❑Does Not ;with which compliance can be ;determined for the electrical systems UNot Observable .land equipment and document where ❑Not Applicable lexceptions are claimed. Provisions are :made for metering individual tenant ; units. Feeder connectors(for feeder land branch circuits)sized in !accordance with approved plans with !maximum.drop.of 5%voltage drop ; total. ; C103.2 j Plan s,specifications, and/or_ ❑Complies 1 [PR4]1 calculations provide all information ;❑Does Not with which compliance can be !determined for the interior lighting ;❑Not Observable land electrical systems and equipment I❑Not Applicable land document where exceptions to +the standard are claimed. Information I provided should include interior ,lighting power calculations,wattage of; I bulbs and ballasts,transformers and !control devices. C466 ;Plaris,specifications, and/or ;❑Complies [PR9]1 ;calculations provide all information :❑Does Not 1with which compliance can be determined for the additional energy ;❑Not Observable I :efficiency package options. ;ONot Applicable ; Additional Comments/Assumptions: 1 High Impact(Tier 1) i,2 I Medium Impact(Tier 2) JE31I Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 2 of 5 Section # Rough In Electrical Inspection Complies? Comments/Assumptions &Re .ID C405.2.1 :Lighting controls installed to uniformly I❑Complies [EL15]1 1 reduce the lighting load by at least �,❑Does Not 1 50%. ' ;❑Not Observable ❑Not Applicable C405.2.1 !Occupancy sensors installed,in ;❑Complies [EL18]1 (required spaces. T]Does Not 1 1 , ❑Not Observable: ❑Not Applicable C405a2,s Independent lighting controls installed ;OComplies CF4�0' T%2,-2,. per approved lighting plans and all ;❑Does Not - :, manual controls readily accessible and; Not Observable 1[E1231]2 ❑ =y visible to occupants. ; ;❑Not Applicable ., I t'.20-5j%2 Automatic controls to shut off all ;❑Complies I building lighting installed in all ;❑Does Not 1[ buildings. buildings. UNot Observable 1 �.;s• ``_:_,' 3 ;❑Not Applicable C405P:2 13,, Daylight zones provided with ;❑Complies [ELT6]?;,' individual controls that control the ;❑Does.Not F_•`�='«; lights independent of general area lighting. i❑Not Observable ;❑Not Applicable C405.2.3, ;Primary sidelighted areas are Elcomplies- ; C405.2.3. !equipped with required lighting :❑Does Not 1, !controls. C405.23, T❑Not Observable: 2 ;❑Not Applicable [EL20]1 ! I C405.2.3, ;Enclosed spaces with daylight area I❑Complies C405.2.3. !under skylights and rooftop monitors :❑Does Not 1, !are equipped with required lighting C405.23. !controls. :❑Not Observable 3 ![]Not Applicable ; [EL21]1 C405.2.4 !Separate lighting control devices for ;❑Complies [EL4]1 specific uses installed per approved :[]Does Not lighting plans. ;❑Not Observable ;❑Not Applicable ; C405.2.4 ;Additional interior lighting power ❑Complies [EL8]1 allowed for special functions per the :❑Does Not !approved lighting plans and is !automatically controlled and 1❑Not Observable; I separated from general lighting. ;❑Not Applicable C4053 );Exit signs do not exceed 5 watts per []Complies [EL6]1 face. ;❑Does Not ! ;❑Not Observable; ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) Ji 2 1 Medium Impact(Tier 2) Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 3 of 5 Section # Final Inspection Complies? Comments/Assumptions &Ite .ID 1303.3, Furnished O&M instructions for ;❑Complies 40S.2.5, systems and equipment to the ;❑Does Not 2 building owner or designated [zFll`7]3 representative. ❑Not Observable I❑Not Applicable C405:4:1 i Interior installed lamp and fixture ;❑Complies ;See the Interior Lighting fixture schedule for values. [FI18]1 ;lighting power is consistent with what ❑Does Not :is shown on the approved lighting plans,demonstrating proposed watts ❑Not Observable I !are less than or equal to allowed I❑Not Applicable ; I watts. C�4 S. .5. Furnished as-built drawings for I❑Complies 1 electric power systems within 90 days I❑Does Not ,[,FR16,]3 of system acceptance. UNot Observable ;E]Not Applicable C408.3 1Lighting systems have been tested to ;,❑Complies [FI33]1 ensure proper calibration,adjustment, :❑Does Not programming,and operation. ; ❑Not Observable j ;ONot Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 4 of 5 Project Title: Zephyrhills Dental Building Report date: 02/13/19 Data filename: D:\Hill Foley Rossi\Heartland Dental\Zephyrhills, FL\Heartland Zephyrhills, FL Elec Comcheck.cc Page 5 of 5 nn yip 4 � iiV�� nn/I A IV City of Zephyrhills 61�c p BUILDING PLAN REVIEW:COMMENTS Contractor/Homeowner: Date Received: " r�7 Site: Permit Type: Approved w/no comments:IR Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. en town—Fire Safety Officer /t)atd Contractor and/or Homeowner (Required when comments are present) _Z. -^ .. %.my uI LCNlryt nwS r-ti!i nR t-yPNazaluli Building Department Date Received Phermitti 770 622 9858 "t `1(3�Zc78 ,a/l• / r r�Trrr one Contact for P r Owner's Name Heartland Dental-Richard Jones er Phone Number - 6 De/7n $ Owner's Address 200 Network Centre Dr.Effingham,_IL 6240 Owner Phone Number Fee Simple Titleholder Name LCG2R 7344 Gall,LLC Owner Phone Number 727-786-2600 Fee Simple Titleholder Address 1 3500 Maple Ave.,Suite 1600,Dallas; -75219 JOB ADDRESS 7344 Gall Boulevard LOT# SUBDIVISION PARCEL ID# 35-25-21-0010-08800-0010 (03TAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR XB ADD/ALT = SIGN = DEMOLISH INSTALL REPAIR PROPOSED USE SFR x-] COMM = OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL = DESCRIPTION OF WORK nterior remodel from bank to dental office. Exterior canopy removal. BUILDING SIZE 4,390 Sq Ft SO FOOTAGE 4390 HEIGHT 14'-0" X=BUILDING $ 550,000 VALUATION OF TOTAL CONSTRUCTION FT-1 $ AMP SERVICE = PROGRESS ENERGY = W.R.E.C. %. :... _ -` PLUMBING $ / ►j -\ P ��SS�� OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION =GAS FT] ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS 1 FLOOD ZONE AREA =YES NO /�� t ®lL I 2ST BUILDERV COMPANY 44o-r4d&.'f T,,Al LLC �1 SIGNATURE REGISTERED I Y/ N FEE CURREN Address on 7 f C /�� License# G 1 I S`d t 33 ELECTRICIAN COMPANY �S SIGNATURE �•_Yip REGISTERED Y/ N FEE CURREN Y 1 N W Address 1001/ llf'-1 i I'�7^ 4 License# t/3 PLUMBER PANY SIGNATURE oOo L REGISTERED I Y/ N FEE CURREr, Y/N Address oiZ S. �G s•ft'+Q�,1- / License# C Fc ryt 9.t H3 MECHANICAL COMPANY SIGNATURE �' REGISTERED Y/ N FEE CURREN Y/N Address 17 .2� .0-Ir d i'• rGIfG YG License# G/pG 0 S-6-4 76 OTHER - COMPANY SIGNATURE REGISTERED I Y 1 N FEE CURREN I YIN Address License# IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111111111111 ' 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 installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects COMMERCIAL Attach(2)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,Stornwater 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 construction. i.' ' it ' i " t ' 1 IIIIII ✓. . . . . . . . . . . . . . . . . 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 Attorney(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW Jacqueline Boges From: Jacqueline Boges Sent: Friday, March 29, 2019 3:38 PM To: sepermits@gmail.com' Subject: permit for dentist office Attachments: dentist.pdf,7344 gall bivd turn bank into dentist office 4,390 sq ft.xls Per our phone call today the attached fee sheet is what the permit will cost for renovating the old suntrust building. There is a credit given for water and sewer from the bank usuage to a dentist office. Need the Noc Need the electrician to register. Payment is cash or check...check payable to the city of Zephyrhills. Thank you let me know if you should have additional questions. Jackie Boges 813-780-0020 ext 3513 "A rule I have had for years is:to treat the Lord Jesus Christ as a personal friend. His is not a creed,a mere doctrine, but it is He Himself we have." Dwight L. Moody Florida has a very broad public records law. Electronic communications regarding most City of Zephyrhills business are public records and available upon request. Your e-mail communications may therefore be subject to public disclosure. If you received this message in error, please do not read, forward, copy, etc. and delete immediately. i 35-25-21-0010-08800-0010 1 Pasco County Property Appraiser Page 1 of 2 Due to a software conversion, changes in ownership and sales may be delayed. Data Current as Of: Weekly Archive = Saturday, January 12, 2019 Parcel ID 35-25-21-0010-08800-0010 (Card: 001 of 002) Classification 23 - Financial Institutions (banks,saving & loan,mortgage,credit co) Mailing Address Property Value LCG2R 7344 GALL LLC Ag Land $0 LEON CAPITAL GROUP LLC Land $249,861 3500 MAPLE AVE SUITE 1600 Building $384,738 DALLAS TX 75219 Extra Features $28,043 Physical Address 7344 GALL BOULEVARD ZEPHYRHILLS, FL 33541 Just Value $662,642 Assessed (Non-School Amendment 1) $662,642 Legal Description (First 4 Lines) ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 POR OF TRACTS Taxable Value $662,642 73 &88 DESC AS FOLL: COM AT NW COR OF SW1/4 OF SEC TH ALG Jurisdiction City of Zephyrhills Land Detail (Card: 001'of 002) Line -i Use _— Description Zoning Units Type jPrice_--Condition Value—_� 1 2300 FINANCIAL 0OC2 111,000.00; —SF $8.10 1.00 $89,100 -- 2 2300 1 FINANCIAL I 0OC2 122,965.811 SF i $7.00 1.00 $160,761 Additional Land Information Acres i 0.78 ]T—a—x-Are--a----aOZ—H � Code Commercial Code OPAR2AC Building Information - Use 23 - Financial Institutions (Card: 001 of 002) Year Built 1991 Stories 1.0 Exterior Wall 1 Common Brick Exterior Wall 2 None Roof Structure Flat Roof Cover Built-Up Tar and Gravel Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Carpet Flooring 2 Quarry or Hard Tile Fuel Electric Heat Forced Air - Ducted /C Central Baths 2.0 Line _ Description _ 1S . Feet-- Repl. Cost New _ ---- 1 - --—_(- -— BAS - ---_- 4,230 _ $504,808 i2 CAN 1,704 $60,983 ---------------- — - Extra Features (Card: 001 of 002) Line -- --- Description - Year _-- Units Value 1 PAV ASP 1991 22,630 $6,619 _— 2 SWC 1991 1,230 $554 DRINWIN - ------ 1991 - —�-- , 1 ----- - — $1,763 4 PNEUTUB 1991 2 - _ $8,262 -- - ------------- ---- _ - - --- 5 VAULT 1991------------------------ 220 ._.—_ $2,046 6_-_._------iNITEDEP ._.-..�_.--_ $1,941 7 VAULTDR 1991 i 1 $6,858 Sales History - See All 7 sales Previous Owner: NATIONAL RETAIL PROPERTIES LP Month/Year _Book/Page _ Type DOR Code Condition _�Amount - - 02/2019__ - _ 9857 / 3686 -- --Warranty Deed -- 01_-- Improved $1,100,000 http://search.pascopa.com/parcel.aspx?parcel=2125350010088000010 3/29/2019 Interstruct LLC-7344 Gall Blvd-Dentist Office,4,390 sq ft Column Es SQ. FEET . PRICE MAIN OR LIVING: $;. 69.00 OTHER AREA UNDER ROOF: - $ 88.00 OTHER: - $ - VALUATION $ 550,000.00 FEE SHEET $ 2,790.00 ADDRESS DRIVEWAY BUILDING: $ 2,845.80 ELECTRICAL: $ 627.75 PLUMBING: $ 418.50 MECHANICAL: $ 292.95 SUB-TOTAL $ 4,185.00 TOTAL $ 4,185.00 SEWER: $ 4,167.67 credit$5,505.06 WATER: $ 2,014.04 credit 2,660.34 IRRIGATION: $ - TOTAL: $ 6,181.71 WATER METER: IRRIGATION METER $ - FIRE DEPARTMENT FEES PLANS TOTAL: $ 131.70 INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ 131.70 PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% $ - TOTAL: $ - na SUB-TOTAL $ 10,498.41 PARK IMPACT FEESI na SIF'S: 100.0% $ - 1.0% $ - TOTAL: $ - na TIF'S: na 99% $ - 1% $ - TOTAL: $ 10,498.41 Dentist Office Column El SQ. FEET PRICE MAIN OR LIVING: OTHER AREA UNDER ROOF: - $ 88.00 OTHER: - $ - VALUATION $ 550,000.00 FEE SHEET $ 2,790.00 ADDRESS DRIVEWAY BUILDING: $ 2,845.80 ELECTRICAL: $ 627.75 PLUMBING: $ 418.50 MECHANICAL: $ 292.95 SUB-TOTAL $ 4,185.00 Public Fee 1% TOTAL $ 4,185.00 SEWER: $ 4,167.67 WATER: $ 2,014.04 IRRIGATION: $ - TOTAL: $ 6,181.71 WATER METER: $ 1,415.63 IRRIGATION METER $ - FIRE DEPARTMENT FEES PLANS TOTAL: INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ - PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% $ - TOTAL: $ - SUB-TOTAL $ 11,782.34 PARK IMPACT FEES SIF'S: 100.0% 1.0% $ - TOTAL: $ - TIF'S: 99% $ - 1% $ - TOTAL: $ 11,782.34 INSTR#2019042312 OR BK 9872 PG 2215 Page 1 of 1 03/13/2019 04:46 PM Rcpt:2036288 Rec:10.00 DS:0.00 IT:0.00 PauCa S. O'Nei6 A.D., Pasco county arerk&comytroCCer Permit No. ParcellDNo 0�� NOTICE OF COMMENCEMENT state of County o► PNNSC® THE UNDERSIGNED hereby gives notice that improvement will be made to aerlein real property,and In accordance v/Ih Chapter 713.Florida Statutes, the following Information Is provided In this Notice d Commencement 1.. Dxfptl on of p "P reAddres: a' G2. enDedonofImpors7v'ee)mIde¢mMificetion No. +M e, ' 3, Owner Information or Lessee Information 9 the Lessee comcted for the improvement: Add State Interest in Propedy: Name of Fee Sample Titleholder: (if dditdeM from owner fisted above) Address Ch, state �� ® .• 4, Contractor M— a C� aN. Ststate. Contractors Telephone No., a v I 51 Surely, Name ® •. /� Address '(`,'ny Stale �I' :`� i Amount of Bond:9' Telephone Nw.. 5 Lender. �� 4 Name ¢ Address CRY State Lenders Telephone No.: Q 6-m LU `1 7. Persons WINn the Slate of Florida designated by the owner upon whom notices or other documents may be served as provided by (n LU LL W w Section 713.13(1)(a)(7),Florida Statutes: 0Ur M LL- _ _3 U Name Z U U) C) ~ 00 = `0 N � a Address City State LL � � Z U) a Q Telephone Number of Designated Person: C) Q Q O 0, In addition to himself,the owner designates d.._.., }�ys ,U- U- C K C.� U to receive a copy of the Uenoes Notice as provided in Section 713.13(1)(b).Florida Statutes. Z O O 06 U LL Telephone Number of Penton or Entity Designated by Owner. 0 Fin � w O 9. Expiration date of Notice of Commencement(the erpiraticn date may not be before the completion of construction and foal payment to 9ne 0 _ C V 0 w Z __Icontractor,cut will be one year har o the date of retarding unless a different date Is spedfied): `Q I— _J Q WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ® U m V w = ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER713.PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN — Z O _! RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE = Q LLJ RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. J w O p 0 Z Under penalty of pequry,l declare that I have read the foregoing notice of commenceme a facts stated therein are true to the best U- O a z of my knowledge and belief. O H Z O U STATE OF r a-T-N d n►V 0'1 �W" cn w IIZi z g COUNTY OFAASW Q Z (n(Z I G jV Sig rare d owner or L or tTvrneYs or Leaseds Authorizld �- = IY Q } Pooer/DiredodP rlMa or t��4 1 C � Cl) � � 0 � I a m �'hsignalwyysTitle Pose _441 The foregoing Instrument was acknowledged before me this day oft 1 th.2g)I by �4n�w�1 Ce 'N�w4G� as Nr,✓•�l4Ar� Y(M'f-�I (type of authority,e.g.,officer,trustee,attorney In fad)for imam of party on behalf d vlt in tent was led). Personally Known❑DR Produced Identification Notary Signature C1 t t� Type of Identification Produced-jYld n GI R 61 n�l y t r 1 Neme(Pdrd) L r ' LI U.h fit r COURTNEY L SPAULDING NOTARY PUBUC-SEAL STATE OF INDIANA COMMISSI N NUM13ER wpdaWbcsfnotlwwmmencement_pCOS3M8 COMMIISSSIION EXPIRES FEB.05�� MY I FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. 1. PROPERTY INFORMATION Name of property: DMG Zephyrhills ............... .. ....................._........... .. .......... Address: 5953 7"Street,Zephyrhills,FL.33542 - ....................._.............._: ... ..._... __ ._.... .. -__................................_............_....._...__.........._......... Description of property: Medical Office - _........._....._._....._............. ....__............. Occupancy type: ...._B...................... Name of property representative: John McKee Address: 3553 SW 10t'Street,Pompano Beach,FL.33069 Phone: 631-495-7882 Fax: E-mail: jmckee@SharpGC.com Authority having jurisdiction over this property: City Of Zephrhills Phone: 813-780-0020 Fax: E-mail: 2. INSTALLATION,SERVICE,AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: Fort Knox Fire&Communications ..........................._._........- .._........_............._._.._..........._................................_.... ._................. Address: 5005 N Clark Ave,Tampa,FL.33614 License or certification number: EF20000876 Phone: 813-653-1605 . Fax: E-mail: Scollins@fortknoxfire.com ........... .._............_.. _....... ....._..,........._ .._......... ................ Service organization for this equipment: Fort Knox Fire&Communications Address: 5005 N Clark Ave,Tampa,FL.33614 License or certification number: EF20000876 Phone: 813-653-1605 Fax: E-mail: Scollins@fortknoxfire.com A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: Address: Phone: Fax: E-mail: _..__........_.. .............._....._..._......._...._...... Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE ®Fire alarm system(nonvoice) ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with,the following components: ❑Fire alarm ❑_EVACS ❑MNS ❑Two-way,in-building,emergency communication system ❑Other(specify): .... ..................... . NFPA 72, Fig, 10.18.2,i.1 (p. 1 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 3. DESCRIPTION OF SYSTEM OR SERVICE(continued) NFPA 72 edition: 2013 Additional description 6f system(s): 3.1 Control Unit Manufacturer: Silent Knight Model number: 6808 3.2 Mass Notification System ®This system does not incorporate an MNS 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone ❑Wide-area'MNS ❑Distributed recipient MNS ❑Other(specify): ................... .... . ._._. _._...____. 3.2.2 System Features: ❑Combination fire alarm/MNS ❑MNS autonomous control unit ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface ❑In-building MNS to wide-area MNS interface ❑Other(specify): 33 System Documentation ®An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the numbered record drawings are stored on site. Location: Document Panel 3.4 System Software ❑This system does not have alterable site-specific software. Operating system(executive)software revision level: A Site-specific software revision date: 7/1/19 Revision completed by: Brian D ®A copy of the site-specific software is stored on site. Location: Document Panel 3.5 Off-Premises Signal Transmission ❑This system does not have off-premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: Sentry Net Phone: 800-932-3304 Supervisory: Sentry Net Phone: 8001.-932-3304 Trouble: Sentry Net Phone: 800-932-3304 Entity to which alarms are retransmitted: Hernando County Phone: (352)754-5800 Method of retransmission: Phone If Chapter 26,specify the means of transmission from the protected premises to the supervising station: If Chapter 27,specify the type of auxiliary alarm system: ❑Local energy ❑ Shunt ❑Wired ❑Wireless NFPA 72, Fig, 10A 2.1.1 (p.2 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: Quantity: (See IVFP.4 72,Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: N/A Description: 4.1.3 Device Power Pathways 0 No separate power pathways from the signaling line pathway El Power pathways are separate but of the same pathway classification as the signaling line pathway [I Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: N/a.................... ... ...... ............. ............... ..................... 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: N/A Quantity: N/A ................... .............. ------------------------ (See NFPA 72,Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: N/A Description: ............. 4.2.3 Device Power Pathways Z No separate power pathways from the initiating device pathway [I Power pathways are separate but of the same pathway classification as the initiating device pathway [I Power pathways are separate and different classification from the initiating device pathway 4.3 Non-Voice Audible System Pathways 4.3.1 Pathways Class Designations and-Survivability Pathways class: B Survivability level: 1....................... ................... ................... Quantity: 5 .............. (See NFPA 72,Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: N/A Description: .......... .................................... 4.3.3 Appliance Power Pathways 0 No separate power pathways from the notification appliance pathway ❑Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig, 10,18,21.1 (p,3 of 12) Copyright 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 4 Conventional: _ ___ Coded: Transmitter: Other(specify): .................... 5.1.2 Other Alarm Boxes ®This system does not have other alarm boxes. Description: N/A Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑This system does not have smoke detectors. Type and number of devices: Addressable: 7 Conventional: 0 Other(specify): ... . . .............. ......... Type of coverage: ❑Complete area ®Partial area ❑Nonrequired partial area Other(specify): ............._...._ .........._._ .__. Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Multicriteria ❑Aspirating ❑Beam Other(specify): 5.2.2 Duct Smoke Detectors ®This system does not have alarm-causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other(specify): ....... . ......................... Type of coverage: ...................................................... Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Aspirating ❑Beam 5.23 Radiant Energy(Flame)Detectors ®This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: . . ................... Other(specify): ......... ............ ............ Type of coverage: ............................................. ................... 5.2.4 Gas Detectors ®This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: ............. . ... Typeof coverage: ................._.-.........._._......_._._..................... -----—-...._._............. ..._._............................ 5.2.5 Heat Detectors ❑This system does not have heat detectors. Type and number of devices:,Addressable: 4 Conventional: 1 Type of coverage: ❑Complete area ®Partial area ❑Nonrequired partial area ❑Linear ❑Spot Type of heat detector sensing technology: ®Fixed temperature ®Rate-of-rise ❑Rate compensated NFPA 72, Fig, 10,18,2.1.1 (p.4 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules This system does not have monitoring modules. Number of devices: 5.2.7 Watertlow Alarm Devices ®This system does not have waterflow alarm devices. Type and number of devices: Addressable: Conventional:- Coded: Transmitter: 5.2.8 Alarm Verification ❑This system does not incorporate alarm verification. Number of devices subject to alarm verification: 7 Alarm verification sef for 60 seconds, 5.2.9 Presignal ®This system does not incorporate pre-signal. Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence(PAS) ®This system does not incorporate PAS. Describe PAS: 5.2.11 Other Initiating Devices ®This system does not have other initiating devices. Describe: 6. SUPERVISORY SIGNAL-INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 0 ' Conventional: 0 Coded: 0 Transmitter: 0 Other(specify): 6.2 Fire Pump Description and Supervisory Devices ®This system does not have a fire pump. Type fire pump: ❑Electric pump ❑Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): _..._.. ._....__........._._._._._.._.................... . _.. .._.. _........................ ....._........_... ......_.._.., . . .. 6.2.1 Fire Pump Functions Supervised ❑Power ❑Running ❑Phase reversal ❑Selector switch not in auto ❑Engine or control panel trouble ❑Low fuel Other(specify): ..___._ _I............ ................. 6.3 Duct Smoke Detectors DSDs This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: 3. Conventional: Other(specify): Type of coverage: Partial Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Aspirating ❑Beam 6.4 Other Supervisory Devices ®This system does not have other supervisory devices. Describe: NFPA 72, Fig:10,18,2,1,1 (p,5 of 12) copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. -7. MONITORED SYSTEMS 7J Engine-Driven Generator ®This system does not have a generator. 7.1.1 Generator Functions Supervised ❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto. ❑Low fuel ❑Other(specify): ... . .. .................. . .. 7.2 Special Hazard Suppression Systems ®This system does not monitor special hazard systems. Description of special hazard system(s):. 7.3 Other Monitoring Systems ®This system does not monitor other systems. Description of special hazard system(s): 8. ANNUNCIATORS ❑This system does not have annunciators. 8.1 Location and Description of Annunciators Location 1: Main Entrance-LCD Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES 9.1 In-Building Fire Emergency Voice Alarm Communication System ®This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound-processing equipment: Location of paging microphone stations: Location 1: Location 2: .. ......................................... .................................................. .. .... I Location 3: ............ :............ ......._........_... ..... _...............__..... 9.2 Nonvoice Notification Appliances ❑This system does not have nonvoice notification appliances. Horns: 11 With visible: 11 Bells: 0 With visible: 0 Chimes: 0 With visible: 0 Visible only: 11 Other(describe): 9.3 Notification Appliance Power Extender Panels: ❑This system does not have power extender panels. Quantity: 1 Locations: Main Panel Location ....................... . . ............. ..................__....__._..._.._......._....................__.._.__... . . .... ....__..:.._._........_.._.. ... AIFPA 72, Fig, 10,18,2.1.1 (p.6 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 10. MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High-Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other(describe): Supervision class: 103.1 Special Hazard Notification ❑This system does not have special suppression predischarge notification. S ❑MNS systems DO"NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ®This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number.of telephone handsets stored on site: Type of telephone system installed: ❑Electrically powered ❑Sound powered 11.2 Two-Way Radio Communications Enhancement System ❑This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFP 72, icl. 9C7.1F3.2.'.1 (1�.7 of 12) Copyright©2009 National Fre Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems ❑This system does not have an area of refuge(area of rescue assistance)emergency communications system. Number of stations: Location of central control point: ............._.......................... .._ _........... ............ Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ❑This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two-Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑Hold-open door releasing devices ❑Smoke management ®HVAC shutdown ®F/S dampers ❑Door unlocking ❑Elevator recall ❑Fuel source shutdown ❑Extinguishing agent release ❑Elevator shunt trip ❑Mass notification system override of fire alarm notification appliances Other(specify): 12.1 Addressable Control Modules ❑This system does not have control modules. Number of devices: 3 Other(specify) ................ .:... ....... ............ ................ 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Control panel amps: 20 ............................. ............. Overcurrentprotection: Type: Breaker Amps: 20 Location(of primary supply panel board): Disconnecting means location: I 13.1.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: NFPA 72, Fick. 10.1£1.2.1.1 (p.°cif 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER(continued) 13.1.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 13.1.4 Batteries Location: Main Panel Type: Sealed Nominal voltage: _24 Amp/hour rating: 7 Calculated capacity of batteries to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 ®Batteries are marked with date of manufacture ❑Battery calculations are attached 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System ®This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panel board): _ ..._._.._._.......... ---....__...........__.................._.......................... Disconnecting means location: 13.2.2 Engine-Driven Generator ❑This system does not have a generator. Location of generator: Location of fuel storage: „ „ Type of fuel: 13.2.3 Uninterruptible Power System ❑This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: ._._.--- Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 13.2.4 Batteries Location: ............. Type ... Nominal voltage: ._...._._...._.._-_._.._-... Amp/hour rating: - - Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture ❑Battery calculations are attached AIFPA 72, Fig. 10.18.2.1.1 (p,9 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER(continued), 13.3 Notification Appliance Power Extender Panels ❑This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): 120VAC Power extender panel amps: 20 Overcurrent protection: Type: Breaker Amps: 20 P YP _... ..._..... ........__.......... .... ................_. _.._...._....._._..... __...._.._..._.... Location(of primary supply panel board): Disconnecting means location: 13.3.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 133.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 133.4 Batteries Location: Type: ...................... Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture ❑Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults,and improper branching,but before conducting operational acceptance tests. This is a: ®New system ❑Modification to an existing system Permit number: 21506 The system has been installed in accordance with the following requirements:(Note any or all that apply.) ®NFPA 72, Edition: 2013 ®NFPA 70,National Electrical Code,Article 760,Edition: 2014 ®Manufacturer's published instructions Other(specify): System deviations from referenced NFPA standards: Non Signed: Printed name: .._�I„l�/G/ ....... �1'P- .. Date: -U��/l `................ Organization: Fort Knox Fire& Title: �{ f Phone:C,�q ._Communications......__..._........._.. f�_�........._....._L">✓�G._'1....._.._._.._. .._..... V l......__.JCLt'l.'.._..�3d� NFPA 72, Fig, 10.18.2.1.1 (p. 10 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE:TEST ®Net~,=system All operational/eaurres and functions of this system were tested bv, or in the presence of the signer shown below, on the dote shown below,rind here found to be operating proper-hv ill occorelonce with the requir-enrents for theJollotving: ❑?vlodifications�to an existing system- A//new/r modified operalionit/features mid./iructions of the sirslem were tested bv, or-in the presence of the signc i-showu.below.on the date shown below,tintl were biord to be operating proper-h-in accordrnrce with the requirements of the ftillou-ing: ®NFPA 72, Edition: 2013 ®NFPA 70, National Electrical Code, Article 760,Edition: 2014 ® Manufacturer's published instructions Other(specify): ® Indieidual device testing documentation[Inspection and Testing Form(Figure 14.6.2.4)is attached] Signed: 7�� Printed name: L rin d'✓ve, n Date: p�2//Organization: or nox Fire& Title: j� ��!{ �. Phone: ��—,3 7 - G'F. Communications 16. CERTIFICATIONS AND APPROVALS 16.1 System installation Contractor: This system,as specified herein,has been installed and tested according to all NFPA standards cited herein. Signed: c � s' �� Printed name: 6t^Y�,1 ! i� Date: Organization: Fort Knox Fire& Title: Phone: Communications 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: 16.3 Supervising Station: This system,as specified herein,will be monitored according to all NFPA standards cited herein. Signcd: Printed name: Date: Organization: Title: Phone: Copyrirght 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale,it may not be copied for commercial sale or distribution. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications;and all N�F�PA standards cited herein. Sieved: Printed name: ,ems 1G �✓1 ,.4-an4 Or anization: 6C, Title �,1 i✓�Vt i'1LCci1 Phone: � �� " � 16.5 Authority Having Jurisdiction: I have witnessed a satistactory acceptance test of this system and fund it to be installed and operating properly in accordance with its approved plans and specifications,with its approved sequence of operations,and with all NFPA standards cited herein. Goo�.a� Signcd:L��Stit� _ r �/� Printed name: � -"v"'� � Date: Organization:C_ Title: : �`'� � l4~ Phone: � y Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale,it may not be copied for commercial sale or distribbtion. SYSTEM RECORD OF INSPECTION AND TESTING This form is to be completed by the system inspection and testing contractor at the time of a system test. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert NIA in a#unused lines. Attach additional sheets, data,or calculations as necessary to provide a complete record. Inspection/Test Start Date/Time: Inspection/Test Completion Date/Tithe: Supplemental Form(s)Attached: (yes/no) 1. PROPERTY INFORMATION Name of property: DMG Zephyrhills Address: 5953 7th Street.Zephyrhjlls,FL.33542 Description of property: Medical Offfice ,Name of property representative: John McKee Address: 3553 SW 10th Street.Pompano Beach, FL.33069 Phone: 631-495-7882 Fax: E-mail: jmckee@SharpGC.com 2. TESTING AND MONITORING INFORMATION Testing organization: Fort Knox Fire&Communications Address: 5005 N Clark Ave,Tampa,FL:33614 Phone: 813-653-1605 Fax: E-mail: Scollins@fgrtknoxfire.com Monitoring organization: Sentry Net Address: 1341 Sycamore View Rd,Ste 300.Memphis TN.38134 Phone: 800-932-3304 Fax:. E-mail:'.. Account number: Phone line 1: Phone line 2: Means of transmission: CELL Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific'software: Document Panel 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer: Silent Knight Model number: 6808 4.2 Software and Firmware Firinware revision number: A 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: 120VAC Amps: 20 Location: Overcurrent protection type: Breaker Amps: 20 Disconnecting means location: Copyright CO 2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING (continued) 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: Sealed Batteries Location: Main Panel Battery type(if applicable): Calculated capacity of batteries to drive the systeni: In standby mode(hours): 24 In alarm mode(minutes): 5 5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 6. TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit Lan:ps/LEDs/LCDs Fuses Trouble signals Disconnect switches z Ground-fault Monitoring z Supervision Local annun ciator Remote annunciators Remote power panels El ❑ 6.2 Secondary PoNver Visual Functional Description Inspection Test Comments Battery condition Load voltage Discharge test ❑ I ❑ I Charger test ❑ ❑ Remote panel batteries Copyright D 2012 National Fire Protection Association,This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING(continued) 6. TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. 6.4 Notification Appliances Attach.supplerrientiiry appliance test sheets for all notification appliances. 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Inter face lSignaling Line Circuit Interface/Fire Alarm Control Inter face 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm signal Alarm restoration El Trouble signal 11 Trouble restoration Supervisory signal Supervisory restoration El 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ET El Alarm restoration El El Trouble signal 0 El Trouble restoration 11 ❑ Supervisory signal 1:1 El Supervisory restoration El El Copynght(D 2012 National Fire Protection Association,This form may be copied for individual use other than for resale.it may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING(continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 8. SYSTEM RESTORED TO NORMAL OPERATION Date: t Ti ine: 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72,2013 edition,Chapter 14. Signed: Printed name: Date: Organization: Fort Knox Fire& Title: Phone: Communications Qualifications(refer to 10.5.3): Manufacture Distributer 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING,OR MAINTENANCE 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Date: Organization: Title: Phone: Copyright,g 2012 National Fire Protection Association.This form may be copied for individual use other than for resale.it may not be copied for commercial safe or distribution. 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