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City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 33542 Phone: (813) 780-0020 Fax: (813) 780-0021 I IffiNNOM BAC-005502-2023 Issue Date: 04/03/2023 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 subsequent reinspectlon. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit required from other governmental entities such as water management, state agencies or federal agencies. Complete Plans, Specifications add fee 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. SIGNATURE PE IT OFFICE :101TJ :4 4 11! PU `.TiF�iStTie: i , okodkv y ��I� 0&I ....».,.,. .....Alex $�9 #� ! CcvY tTw In 91 RRItI*II IiR R [Zephyrhllls Dialysis Center, LLC clo Davits Inc - Legal Dep ¢ Hv~ 407-468-8934 owe* Rome Ower's Arlo 20ot1 16th Street, Denser, CC4 80202 �I`C�ttR ld�trt�i�s �.,� Fee StmPI4 T11401101dw HAmO FM 36819 EILAND BLVD LANDLORD LLC Owner Phone Mundsor ;Fes Simple ntlehoWor A#* & 3333 Feach ree R i NE, 10th FL, Atlanta, GA 30326 JOB AGORLIF361119ILA;N $LVII ttNIT 2, ZEPFIYRIFILLLS, FL 33542 � { SUDDIVISi # L t WORK P"OPOSAD PEST19 REPAIR ADWALT 91 C li PROPOSED SFR C OTWR TYPO OFCONSTRUCTION it FRME &TEES. o"CF4PTION Of WORK INTERIOR ALTERATION it9 EXISTINO OUTPA71EWT CLMC BUILDING E 9. HEIGHT tqkAKq CA g4g4kR SE98Gt#3Ii 454,515 00 VALUATION OF TOTAL CONSTRUCTION AWSERV1CF PROGRESS ENERGY WJLMC = 57, OeEiO vALuAvioN<wwcKvireALiNsrALLATioeq FINISHED FLOOR ELEVAT �000 ZONE Y%S 6[W SIGNATURE Add � s Ps�Ira 3306 t R 06 � :. L. ,S,S, EISOdc Ina Ffiscunew IN Addresst palm smngh a s L x C1 7 72 ,tau. t op..� ANY rime ,fir Cozy ° ion' & ration, I �p x w I Addoess2 4595 11th A NCt t o_ 7 2 :4t:diS73Q7 nIslet 14W14 RESIDENTIAL ,. PIWIC III set OFEMMY =i new Ws -PROPERTY SURVEY MOW W 61 NEW 0001004u0m back of #pWA*a nouirked (* OVER THE COUNTER PERMITTING (cow or -ou" rKukod) odw sp-Nol CowAw 0 on Pik e_ ROW 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Buildifinq Department 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 eirth any applicable deed restrictions - UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake eark, 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 Divason—Licensing Section at 727-847- 8009, Furthenoore, if the rosseir 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 property licensed and is not entitled to perafitting 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 penuitfing. 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. It 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/Seyeer 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, 1 certify that 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Hornervener's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "rooner", I certify that I have obtained a copy of the above described docurnent and promise in good faith to deliver it to the "owner" prior to commencement CONTRACTOR'WOWNER'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 pennit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a penritt 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. 1 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 nervt take to be in compliance. Such agencies include but are not linifted to: Department of Environmental Protection -Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water NVastevvpher Treatment. Southvitest 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 °cyfinnpensafing volume" vvill be submitted at tifne 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, posts, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be surnamed to be a license to proceed rvith the work and not as authority to violate, cancel, offer, 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 fearnit issued shall become invalid unless the work authorized by such frannit is commenced within six months Of peralit issuance, or if work authorized by the permit is suspended or abandoned for a Period of six (6);,nonths after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period but 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 TWCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INT9ND.T0 OBTAIN FINANCING, CONSULT FLORIDA JURAT (F. M me or hast have or as identification, '000 Notary Public Commission No Vkefh4JV S" F144AM494V wn�—a —Nc u.-os, % Notary Public State of Florida I a 't, p Nathan S. HaShman my Commission GG 944349 s,00ll."O'ec Expires 02/01/2024 Notary utsfic Egl'e of Florida : =t) $11, Notary Public State of Florida Charlene M Butzer ford my commission GG 331223 Expires s05 0 xpires 05/06/2023 =#T M�EAUTWM' It to #Mel= P, t N,„04_26 200100-0062 NOTICE OF COMMENCEMENT Ft ORIDA c-my"f PASCO I 10, uNi t W,I, -N I I, I 1-, 11, 1,1— 11""1 , that l I ,I ,,I] he ",)l I, to certau i i"A fit iql", I Y ill 0 "1 it, V'd- j I i,ovid"'I it", M"I'l fillnnll ...... ......... I I;ld-Z6-21-0000-00100 _-36fY1-5-jjL?arNj0FEat D, SUITE #2 ZE HPf(RHl( L_S LL�354 2 '-,"w ,I of INTERIOR ALTERATION, /-TENANT IMPROVEMENT WITHIN _QXIISTING 0 PATIENT CLINIC 0"I", tn""T't of I ell- ")to ll'on if the Li'SlIn CO,)OJCp.'d 1111 the 1111PIO-In"ll Willie 2000 16TH STREET QENV R ZIP Acl,lnoss fly Six, ntewst It F""i-tv LESSEE Nil e of Fee Simple Talel,olde, IEACHTREE gf ddl—in from Chele(I'Sted above)3333 LOTH FL ATLA��3261 --QA— Ad'I'llss -- City Still, 4 corlhacto, SHARP GENERAL CONTRACTORS 3545 S016TH STREET POMPANO BEACH. (ZIP: 33069) -EL Address City Stwe Con traClor'S Telephone No 254-98449080 5 Surety Address City Slate P—Ort Of Bond $ Telepholle No 6 Lerds, Lenders Telephone No 7 Persons wthill the State of Flondia designated by the Omer upon villorn notices or other documents may be served as provided by Section 713,13;l)(a)(7). FloncaStatute Telephone Nuinther of Designated Person. 8 In addition to hiolfielf, the oYyiel deSififlates — Of — to proellet a copy of the Lioneirs NotlCo as purteided in Section 713 13il)m) Ronda Statutes Telephone Number of Person or Emily Designated by Omer, 9 ExpneWil date of N.tr:e of Cprrtrencemom (the exprotion date may not be before the compl-tiall Of C-MtroCbon and final P4,11-1 to the contractor, out will be one year from Ina date idnroattrig relless a diffQ,ent dole Is specrierid) WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 71.3, PART 1, SECTION 713.13. FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS to YOUR PROPERTY, A NOTICE OF C04INIENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE'. FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING CONSULT VATH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT Under penalty of petily. I declare that I have the foOq.,nU noolofW mmOnce tni and that th rts Stated theroin are line to Inc b-I of'll, y—Modge, and belief. STA7E OF F1 ORIDA COUNT ( OF PASCO at or Lessee, at Omers or Le- OKcerlDxe rtneriManatfer I fic�414- �4d Signatory's T,1100fice The forell-19 rciW,111111 .., -knwvledljed bah re Oil ffi-s'-L7 orry of 0%5by vo 14-j 05 J&-tr- --Z!!- �6�c _-,44.F— (Iyp, Of .,,In., , 9 officw. t""I" "ll—loy fill 1) for :�;m �'Axxir 2 e— I: ("a", y oil t ial of I'll Pj� I �f2X Personally Known [) 9R Pfod011ld laenlnic4hl Notary S.Vatrae — Type of 16-1p&Oal-) Produced 0 r" a N; a (Pnw) _ — if S 0— Nua $033 Pubk, St* Of 00ft Commissloirt # HH 175362 ouwmed In orl7e Cwq 927 025 Kidney Care 2000 16'h Street Denver, CO 80202 d. 36819 Eiland 131v 7 Zephyrhills, FL 33,542 i Re purpose o IcIaliz Tesl6na TUTO—f_ L'ITIIII -1 -JW#1J-1r 7JJ-,#1L1#1-JrJ-RT6- renovation project, The project is estimated to begin in April 2023 and the project duration is expected to take approximately 100 days. Z= FuSigned by'. 1J#J.t- Au6* 465654574CC5448.- Wade McKnight Director of Construction DaVita Kidney Care (615) 887-6788 at 3-780-0020 City of Zephyrhills Peffnit Application Fax-813-780-0021 Building Department b Alex a Inc Date Received Phone Contact for Permillitin 84 • 3 FM 36819 EILAND BLVD LANDLORD LLC Foe Simple Titleholder Address 36sig EILAND BLVD, UNIT 2, ZEPHYRHILLLS, FL 33642 .. ....... .. . . INTERIOR ALTERATION WITHIN EXISTING OUTPATIENT CLINIC 01 111 a - 11 VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL =PLUMBING D L----j =MECHANICAL F—TS-0 --� ------------------- =GAS = ROOFING FINISHED FLOOR ELEVATIONS F--j;;S-T-j`N`G----7 $1014ATURS 11 Address ELECTRICIAN SIGNATURE Address PLUMBER SIGNATURE Add. MECHANICAL SIGNATURE Address OTHER CM SIGNATURE L AMP SERVICE PROGRESS ENERGY W.R.E,C. pf '6 VALUATION OF MECHANICAL INSTALLATION SPECIALTY = OTHER FLOOD ZONE AREA [=YES NO COMPANY L Sharp General Contractors, Inc, REGISTERED --T—Y — 7/ N771 FFE.11APIN License #E::--��� Address License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Finns; (1) set of Enemy Forms; R-O-W Permit for now construction, Minimum ton (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Slit Fence Installed, Sanitary Facilities & I dumpster; Site Work Permit for subdivislonsfiragis 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 ton (10) working days Aar submittal date. Required walls, Construction Plans, Stormwater Plans wt Sift Fence Installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all now 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 appitooltion completely. Owner & Contractor sign back of application, notarized if over W.WO, a Notice of Commencement to required. (AIC upgrades over $7NO) 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) Rerooft if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footege) Driveways -Not over Counter If on public roadways -needs ROW 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received u Alex Rosh Architects, Inc Phone Contact for Permitting 77 70 j R4 q i n(� It a I W I W Vw_" Owner's Name FM 36819 Eiland Blvd Landlord LLC Owner Phone Number -3 -KTT-Pea-(, 'i t r e e Rd E -,t a t. f,,j F1 Owner's Address li (" -, " , Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 3681-9 Eiland Blvd 42, Zephyrhills, FL 33542 LOT # SUBDIVISION PARCELID#104 26 21 - 000-0-0010Q-062 IOETAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR FX7� ADD/ALT SIGN DEMOLISH INSTALL REPAIR PROPOSED USE SFR COMM OTHER TYPE OF CONSTRUCTION BLOCK FRAME STEEL DESCRIPTION OF WORK Interior alteration w 11 th in existing out patient c1 �in—,c BUILDINGSIZE I 9,C00 SO FOOTAGE HEIGHT [:=,ting =BUILDING $ TBD - --- ------- VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ TBD AMP SERVICE PROGRESS ENERGY W,R.E.C. =PLUMBING $ TBD =MECHANICAL $ TBD VALUATION OF MECHANICAL INSTALLATION GAS ROOFING SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES X NO existing BUILDER COMPANY I TBD -r SIGNATURE REGISTERED L_YLN _J Address License # TBD �®s�^�o� ELECTRICIAN COMPANY SIGNATURE REGISTERED L N_J FEE CURREN YIN Address License# PLUMBER COMPANY TBD SIGNATURE REGISTERED [_y LN _J FEE CURREN Address License # MECHANICAL COMPANY = SIGNATURE REGISTERED Y/N FEE CURREN Address License # OTHER COMPANY SIGNATURE REGISTERED Y/N FEE CURREN /N Address License # E:==== 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 wl 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. 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 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Alex Roush Architects, Inc. Phone Contact for Permitting I Owner's Name FM 36819 Eiland Blvd Landlord LLC Owner hone Number 33 Pea�cnt�ree Rd NE 10th FL, Owner's Address Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 36819 Eiland Blvd #2, Zephyrhills, FL 33542 LOT # SUBDIVISION PARCELID#1 04-26-21-0000-00100-062 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTRF71 ADD/ALT SIGN DEMOLISH El INSTALL = REPAIR PROPOSED USE SFR Q COMM OTHER TYPE OF CONSTRUCTION BLOCK Q FRAME STEEL DESCRIPTION OF WORK Interior alteration within existing out patient clinic. BUILDINGSIZE 1 9,600 = SQ FOOTAGE= HEIGHT [:=Ling =BUILDING $ TBD VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ TBD L-------------------- AMP SERVICE PROGRESS ENERGY W.R.E.C. I =PLUMBING I =MECHANICAL $ TBD I VALUATION OF MECHANICAL INSTALLATION = GAS Q ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES X NO existing BUILDER COMPANY TBD SIGNATURE REGISTERED 11E_J FEE CURREN F= Address E License # ELECTRICIAN COMPANY SIGNATURE REGISTERED L_Y / N FEE CURREN L_y LN_J Address License # PLUMBER COMPANY TBD SIGNATURE REGISTERED Y/N FEE CURREN Address License # MECHANICAL COMPANY [B;� �FEEC.RREN�iii SIGNATURE REGISTERED Address License# OTHER COMPANY TBD SIGNATURE REGISTERED N LFEE CURREN Address License# 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: 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 Energy Code: Project Title: Location: Climate Zone: Project Type: Construction Site: Eiland Blvd. Zephyrhills, FL 33541 11pi q 111liq 11,11'', 2018 IECC Zephyrhills Dialysis Expansion Alachua, Florida 2a Alteration Owner/Agent: HP/AHU-1 0 & 11 (Single Zone): Split System Heat Pump Heating Mode: Capacity = 25 kBtu/h, Proposed Efficiency = 11.60 HSPF, Required Efficiency = 820 HSPF Cooling Mode: Capacity = 27 kBtu/h, Proposed Efficiency = 25.00 SEER, Required Efficiency: 14.00 SEER Fan System: FAN SYSTEM 1 -- Compliance (Motor nameplate HP method): Passes Designer/Contractor: Fans: FAN 1 Supply, Single -Zone VAV, 706 CFM, 0.1 motor nameplate hp, 0.9 fan efficiency grade 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 2018 IECC requirements in COMcheck Version 4.1.5.3 and to comply with any applicable mandatory requirements listed in the Inspection Checklist. Brad Shepherd, PE 10/11/2022 Name - Title Signature Date Project Title: Zephyrhills Dialysis Expansion Data filename: RAAIex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Report date: 10/14/22 COMcheck Software Version 4.1.5.3 Inspection Checklist Energy Code: 2018 IECC Requirements: 88.0% 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 reRuirement, the user certifies that a code, wiement will be met and how that is clocumente r t at an exception C1032 'Plans, specifications, and/or [pn2]1 |calculations ,with whichcomplianceprovide canUe !determined for —mechanical |systems andequipmen and !document where to the |standard are claimed, Load |calculations per acceptable :engineering standards and :handbooks. 1JComplks'Requirement will hemet. |[]ooesmm | | []NmUbsern�b|e | , |LJmmAppicab|e | | � ` | | Project Title: ZephyrhU|sDialysis Expansion Report date: 10/14/22 Sno�/oemeKngsys�xnand �eeze |LJCom��m ies Exception: Requirement ^ ` ` protection have sensors and ![]onesmm | -4 cun�nbcon�gw�dtoUm�ser�ce�v - 'pavement temperature and mmdnor |LJwntObsemab|e! - _ |temperatune.future connection to L]motApp|icab|e | Project Title: Zephyr i|boialysbsxpansiun Report date: 1044/ 2 tioln :Se:, Plumbing Rough -in Inspec I o i i Complies? Comments/Assumptions & 114.113 C404,5, Heated water supply piping conforms DComplies Exception: Requirement does not apply. C4045.1, ito pipe length and volume ElDoes Not C404.52 requirements, Refer to section details. Observable ,oNot EINot Applicable C404.63 :Pumps that circulate water between a []Complies :Exception: Requirement does not apply. [PL7]3 ;heater and storage tank have controls :E]Does Not that limit operation from startup to 'EINot Observable < = 5 minutes after end of heating EINot Applicable cycle. C4043 ,Demand recirculation water systems ElComplies Exception: Requirement does not apply. [PLS]3 have controls that start the pump RDoes Not :upon receiving a signal from the E]Not Observable: ;action of a user of a fixture or appliance and limits the temperature ONot Applicable of the water entering the cold -water i piping to 104'F. Additional Comments/Assumptions: Project Title: ZephyrhiUsDialysis Expansion Report date: 10/14/22 Data filename: mV\|ex noushVDav|ta ZephydhiUssxpan, pL(2nzz)\comcxeckcck page 4of 10 Mechanical Rough -In Inspection Complies? Comments/Assumptions C402.2.6 Thermally ineffective panel surfaces of Zkomplies Exception: Requirement does not apply. [ME41]3 3sensible heating panels have 'E]Does Not :E]Not Observable :E]Not Applicable C403.11.3'HVAC piping insulation insulated in 10Complies Exception: Requirement does not apply. [ME61]2 accordance with Table C403.11.3. �DDoes Not :Insulation exposed to weather is 'protected '[:]Not Observable' from damage and is provided with shielding from solar EINot Applicable C4018A Motors for fans that are not less than "ElComplies Requirement will be met. [ME142]2 11/12 hp and less than 1 hp are ElDoes Not !electronically commutated motors or Not Observable have a minimum motor efficiency of '70 EINot Applicable percent. These motors have the :rneans to adjust motor speed. C403.&5 Each DX cooling system > 65 kBtu Complies Exception: Requirement does not apply. IME143]2 :and chiller water/evaporative cooling ElDoes Not i system with fans > 1/4 hp are �clesigned to vary the indoor fan airflow E]Not Observable :as a function of load and comply with I E]Not Applicable cletailed requirements of this section. C403.12.1 Systems that heat outside the building'FIComplies Exception: Requirement does not apply. [ME71]2 envelope are radiant heat systems E]Does Not 'controlled by an occupancy sensing []Not Observable: device or timer switch. E]Not Applicable C403.2.3 HVAC equipment efficiency verified. E]Complies See the Mechanical Systems list for values. :[]Not Observable :[]Not Applicable C403.2.2 Natural or mechanical ventilation is ElComplies :Requirement will be met. [ME59]1 provided in accordance with ::E]Does Not International Mechanical Code E]Not Observable Chapter 4. Mechanical ventilation has capability to reduce outdoor air supply E]Not Applicable to minimum per IMC Chapter 4. C403.7J :Demand control ventilation provided ElComplies :Exception: Requirement does not apply. E]Does Not ONot Observable served by systems with air side :economizer, auto modulating outside []Not Applicable :air damper control, or design airflow C403.7.2 'Enclosed parking garage ventilation :nComplies Exception: Requirement does not apply. [ME115]3 'has automatic contaminant detection :E]Does Not ;and capacity to stage or modulate �[]Not Observable Jans to 50% or less of design capacity. ;E]Not Applicable C403.7.6 :HVAC systems serving guestrooms in ElComplies Exception: Requirement does not apply. iguestrooms: Each guestroom is ,provided with controls that �automatically manage temperature 1EINot Applicable �Isetpoint and ventilation (see sections C403.7.4 Exhaust air energy recovery on 'ElComplies Exception: Requirement does not apply. [ME57]1 :systems meeting Table C403.7.4(l) E]Does Not nNot Observable E]Not Applicable Project Title: ZephynhiUsDialysis Expansion Report date: 10/14/ 2 1 Mechanical Rough -in Inspe,(11'"Co, Compile Comments/Assumptions C403.75 :Kitchen exhaust systems comply with �,E]Complies Exception: Requirement does not apply. [ME116]3 !replacement air and conditioned ElDoes Not ,supply air limitations, and satisfy hood E]Not Observable rating requirements and maximum E]Not Applicable ;exhaust rate criteria, C403.11.1 'HVAC ducts and plenums insulated in ElComplies Exception: Requirement does not apply. !accordance with C403.11.1 and E]Does Not C403,11.2 �constructecl in accordance with E]Not Observable: [ME60]2 iC403.11.2, verification may need to !occur during Foundation Inspection. C4014.1. Heating for vestibules and air curtains ElComplies Exception: Requirement does not apply. 4 'with integral heating include E]Does Not [ME6311 automatic controls that shut off the i :E]Not Observable heating system when outdoor air i heating and cooling systems :controlled by a thermostat in the C408.22. ;,Air outlets and zone terminal devices 'ElComplies Requirement will be met. 1 have means for air balancing, ElDoes Not 'E]Not Observable EINot Applicable C4015, !Refrigerated display cases, walk-in ElComplies Exception: Requirement does not apply. C403.5.1, '� coolers or walk-in freezers served by iE]Does Not C403.5.2 ;remote compressors and remote !condensing unit, have fan -powered EINot Applicable condensers that comply with SeUlUf :C403.5.1 and refrigeration compressor: systems that comply with C403.5.2.. AdditionaUCmmmnemts/Assummptions: Project Title: ZephyrhiUsDialysis Expansion Report date: 10/14/ 2 Data filename: n:VVexRoush\DaWtaZephyrhiUsexpan,FL(aOao)\Cnmcheck.cck page 6uf 10 Rough -in Electrical Inspec I i!iI Complies? L mmm ents/Assuptions Si Req1).1 C405.6 _LC Low -voltage dry -type distribution ElComplies [EL26]2 'electric transformers meet the E]Does Not ,minimum efficiency requirements of Not Observable E] 'Table C405.6. :E]Not Applicable C405.7 Electric motors meet the minimum ElComplies [EL27]2 'efficiency requirements of Tables ElDoes Not ?C405.7(1) through C405.7(4). []Not Observable ,Efficiency verified through certification ®Not Applicable under an approved certification :program or the equipment efficiency ratings shall be provided by motor manufacturer (where certification .programs do not exist), C405.8II2, ',Escalators and moving walks comply DComplies C405I,8.2. 'with ASME A17.1/CSA B44 and have ElDoes Not 1 controls configured to [EL28)2 ,automatic :reduce speed to the minimum ®Not Observable' E]Not Applicable ,permitted speed in accordance with :ASME A17.1/CSA B44 or applicable local code when not conveying passengers. C405II9 Jotal voltage drop across the 'ElComplies [EL2912 'combination of feeders and branch ElDoes Not ;circuits <= 5%, :[]Not Observable '®Not Applicable Additional Comments/Assumptions: 1 High Impact {Tier 1) 2 Medium Impact {Tier 2} 3 Law Impact {Tier 3) Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: l Roush\DaVita Zephyrhills Expal FL (2022)\Comcheck.cck Page 7 of 10 eetin �Fll�nallnspectlon Complies? Comments/Assumptions Re .11D C303.3, Furnished O&M manuals for HVAC ❑Complies Requirement will be met. C408.2.5, ;systems within 90 days of system ❑Does Not 3 [F18]3 acceptance. ❑Not Observable ❑Not Applicable C403.2.2 I HVAC systems and equipment ❑Complies Requirement will be met. (F127]3 ` capacity does not exceed calculated j❑Does Not loads. ❑Not Observable ❑Not Applicable C403.24. Heating and cooling to each zone is ❑Complies Requirement will be met. 1 controlled by a thermostat control. ❑Does Not [F147]3 Minimum one humidity control device ❑Not Observable per installed humidification/dehumidification EINot Applicable system. C403.2.4. ;Heat pump controls prevent ❑Complies Exception: Requirement does not apply. 1.1 supplemental electric resistance heat ❑Does Not [F14213 #from coming on when not needed. ❑Not Observable ❑Not Applicable C403.4J, 'Thermostatic controls have a 5 IF �'❑Complies Requirement will be met. 2 ideadband. ❑Does Not [F138]3 ❑Not Observable' ❑Not Applicable C403.2.4. ;Temperature controls have setpoint ❑Complies Requirement will be met.�W 1.3 overlap restrictions. ❑Does Not [F[20]3 ❑Not Observable' ❑Not Applicable C403,24, Each zone equipped with setback []Complies Requirement will be met. 2 'controls using automatic time clock or ❑Does Not [FI3913 ;programmable control system. ❑Not Observable' '❑Not Applicable C403.2A4 _ Automatic Controls: Setback to 55°F ❑Complies Requirement will be met. 2,1, !(heat) and 85°F (cool); 7-day clock, 2- -❑Does Not C403.2,4. hour occupant override, 10-hour ❑Nat Observable' 2.2 [F14013 -'backup ❑Not Applicable C4012.4. Systems include optimum start ❑Complies Exception: Requirement does not apply. 2.3 icontrols. ❑Does Not [F141]3 ;[]Not Observable []Not Applicable C408.1.1 `Building operations and maintenance ".❑Complies [F157]1 documents will be provided to the ❑Does Not .owner. Documents will cover ❑Not Observable manufacturers' information, ❑Not Applicable specifications, programming procedures and means of illustrating to owner how building, equipment and ;systems are intended to be installed, ;maintained, and operated. C408.2.1 Commissioning plan developed by❑Complies _ Requirement will be met. [F128]1 ;registered design professional or ❑Does Not approved agency. !®Not Observable i❑Not Applicable 1 I High Impact (Tier 1) 2 Medium Impact (Tier 2) 3 Low Impact (Tier 3) Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Page 8 of 10 # �Flnal Inspection :C :om:p Irl Ees ? C o m m e �nt s A s �su m p t I �on s C4M2.3, HVAC equipment has been tested to ElComplies Requirement will be met. ensure proper operation, DDoes Not E]Not Observable: Applicable C408.2.3. HVAC control systems have been ElComplies :Requirement will be met. 2 tested to ensure proper operation, E]Does Not [FI1011 calibration and adjustment of controls. :E]Not Observable, E3Not Applicable C408.2.4 Preliminary commissioning report tlComplies Requirement will be met. [F129]1 completed and certified by registered ',E]Does Not design professional or approved E]Not Observable ,agency. 'EINot Applicable C408.2.5"Furnished HVAC as -built drawings tlComplies Requirement will be met. I submitted within 90 days of system 'E]Does Not [F17)3 acceptance. 'EJNot Observable :E]Not Applicable C408.2.5. An air and/or hydronic system OComplies :Requirement will be met, 3 balancing report is provided for HVAC 0Does Not [F143]1 systems. Observable EINot Applicable C408.2,5. Final commissioning report due to :E]Complies 'Requirement will be met. 4 building owner within 90 days of '�nDoes Not [F13011 receipt of certificate of occupancy. :E]Not Observable 'E]Not Applicable Additional Comments/Assumptions: Project Title: ZenhyrhiUsDialysis Expansion Report date: I0/14/ 2 Data filename: RAAdexnnushVDavitazephyM`Ubexpan,pL(2U22)\Cnmcheckzck Page 9of 10 Project Title: ZepAyrhiUsDialysis Expansion Report date: 10/14/22 COMcheck Software Version 4.1.5.5 Interior Lighting Compliance Certificat Energy Code: Project Title: Project Type: Construction Site: o|andelvd. ZephyrhiUs' pIL3554I 4W|ovved Interior Lighting Power 1 -Health Care -Clinic 201O|ECC Zephyrhi|lsDialysis Expansion Alteration # Fixtures Pre -Alt. Repl./Addei' Allowed Allowed Wafts Total Allowed Wafts = N/A 42 a 332&000 3328.000 Exemption: Less than 10% fixture replacement. A B C D E Fixture QJ: Description / Lamp / Wattage Per Lamp /Ballast Lamps/ #of Fixture (C X0) Fixture Fixtures Waft. Health Care-Clinig (264� Exempt Total Proposed Watts wm Interior Lighting Compliance Statement Compliance Statement: The project represented inthis document isconsistent with the building plans, specifications, and other calculations submitted with this permit application. The proposed interior lighting systems have been designed tomeet the 20z8|ECCrequirements inCDMcheckversion4,z.5.5andtocnmp|ywithany applicable mandatory requirements listed inthe Inspection Checklist. Name - Title Signature Date Project Title: ZephyrhiUsDialysis Expansion Data filename: u,uidedzck Report date: 14O4/22 Page 1or 3 COMcheck Software Version 4.1.5.5 Inspection Checklist Energy Code: 2018 IECC Text in the "Comments/Assumptions" column is provided by t e user in the COMcheck Requirementsscreen. For each requirement, the user certifies that acode requirement will bemet and how that isdocumented, orthat anexception is being claimed, Where compliance is itemized in a separate table, a reference to that table is provided. 11 High Impact (Tier 1)_ 2 Medium Impa (Tier 2) 3 Low Impact (Tier 3) Project Tide' ZephyrhiUsDialysis Expansion oatafi|ename: unUUed,cck Report date: 10/14/22 Page 2 of 3 Project Title: ZephyrhiUsDialysis Expansion Report date: I0/14/22 Data filename: Untitledzck page 3uf 3 :3 COMcheck Software Version 4.1.5.3 Mechanical Compliance Certificate Energy Code: 2018|ECC pnojoo Title: ZephyrhiUoDialysis Expansion Location: Alachua, Florida Climate Zone: 2a Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: B|andB|°d, zephyrhiUs, FL3354z Mechanical Systems List Quantity System Type & Description z HPmnu-1oo11(Single Zonv): Split System Heat Pump Heating Mode: Capacity = 25xemm. Proposed Efficiency =11.0u*SPF.Required Efficiency =e.uonSpr Cooling Mode: Capacity =o7xevu/o. Proposed Efficiency =us.V0SEER, Required Efficiency: 14.nnSEER Fan System: FAN SYSTEM 1—Compliance (Motor nameplate HPmamod):Passes Fans: FAN 1 Supply, Single -Zone VAV, 706 CFM, 0,1 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 2018 IECC requirements in COMcheck Version 4.1.5.3 and to comply with any applicable mandatory requirements listed in the Inspection Checklist. Brad Shepherd, PE 10/11/2022 Name - Title Signature Date Project Title: ZephyrhiUsDialysis Expansion Report date: 10/14/22 Data filename: nmVcxnnush\oav|tazephyrhi||sexpan, pL(2O22)\comcheckzck page 1 of 10 COMcheck Software Version 4.1.5.3 Inspection Checklist Energy Code: 2018 IECC Requirements: 88.OY6were addressed directly inthe COK4checksoftware 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. [103.2 Plans, specifications, and/or [rn2]' calculations on :with which compliance can be determined for the mechanical systems and equipment and |uocumentwhere exceptions u/the �standard are claimed. Load :calculations per acceptable |engineehngstandards and 'handbooks. TITIMMIMM Complies 'Requirement will bemet. Doesmnt | motObsemab|e! E]wmxpplicab|e | ' ! | Project Title: ZephyrhiUsDialysis Expansion Report date: 10/14/22 Snow/ice meltingand freeze |[lComm|ies |Exception: Requirement does not apply. protection systems have sensors and |[]DoesNo« ' controls configured tolimit service for | pavement temperature and outdoor |[]motQbsemab|e| i temperature. future connection tn |[]motApp|icab|e Project Title: ZephyrhiNsDialysis Expansion Report date: 10/14/22 Section Section # Plumbing Rough -in Inspection Plumbing Rougl Complies? Comments/Assumptions Complies? I D C404�5, —,L Heated water supply piping conforms — ElComplies Exception: Requirement does not apply. C404.5.1, to pipe length and volume E]Does Not C404,5�2 requirements. Refer to section details, !E]Not Observable! [PL613 E]Not Applicable C404.6.3 :Pumps that circulate water between a "ElComplies Exception., Requirement does not apply. [PL713 heater and storage tank have controls :E]Does Not ,,that limit operation from startup to E]Not Observable i <= 5 minutes after end of heating tlNot Applicable cycle. C404,7 Demand recirculation water systems ElComplies 'Exception: Requirement does not apply. [PL813 :have controls that start the pump �FlDoes Not ,upon receiving a signal from the ❑UNot Observable: ,'action of a user of a fixture or i :E]Not Applicable appliance and limits the temperature of the water entering the cold -water piping to 104°F. Additional Comments/Assumptions: 1 High Impact (Tier 1} 2' Medium Impact (Tier 2} 3 Low Impact (Tier 3) Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Page 4 of 10 Z114:1 hi Mechanical Rough -in Inspection L!C402.2.6 Co,: !Iles? Comments/Assumptions At :Thermally ineffective panel surfaces of;OComplies Exception: Requirement does not apply. [ME41]3 sensible heating panels have ©Does Not ;insulation >= R-3.5. ®Not Observable, E]Not Applicable C403.11.3; HVAC piping insulation insulated in ;(Complies _ ?Exception: Requirement does not apply. [ME61]2 accordance with Table C403.11.3. E]Does Not Insulation exposed to weather is CjNot Observable protected from damage and is provided with shielding from solar ©Not Applicable radiation. C403.8.4 Motors for fans that are not less than ;®Complies Requirement will be met. [ME142]2 1/12 hp and less than 1 hp are E]Does Not electronically commutated motors or '[-]Not Observable have a minimum motor efficiency of E]Not Applicable 70 percent. These motors have the ;means to adjust motor speed. C403.8.5 Each DX cooling system > 65 kBtu ;OCompiies Exception: Requirement does not apply. [ME143]2 ;and chiller water/evaporative cooling ❑Does Not ;system with fans > 1/4 hp are Aesigned to vary the indoor fan airflow E]Not Observable as a function of load and comply with®Not Applicable j ;detailed requirements of this section.-------------- C403.12.1 Systems that heat outside the building ©Complies Exception: Requirement does not apply. [ME71]2 'envelope are radiant heat systems ODoes Not ;controlled by an occupancy sensing 'E]Not Observable' device or timer switch. 'E]Not Applicable C403.2.3 HVAC equipment efficiency verified. IC]Complies :See the Mechanical Systems list for values. [ME55]2 'E ]Does Not ®Not Observable'. E]Not Applicable C403.2,2 ;Natural or mechanical ventilation is OComplies ;Requirement will be met. [ME59]1 'provided in accordance with FIDoes Not International Mechanical Code Observable Chapter 4. Mechanical ventilation has iE]Not capability to reduce outdoor air supply ©Nat Applicable to minimum per IMC Chapter 4. C403.7.1 :,Demand control ventilation provided ClComplies Exception: Requirement does not apply. [ME59]1 'for spaces >500 ft2 and >25 ❑Does Not people/1000 ft2 occupant density and Not Observable :served by systems with air side 3E]Not Applicable `economizer, auto modulating outside air damper control, or design airflow >3,000 cfm. C403.7:2 Enclosed parking garage ventilation FlComplies ;Exception: Requirement does not apply. [ME115]3 'has automatic contaminant detection '®Does Not ;and capacity to stage or modulate ;fans to 50% or less of design capacity..[=]Not Observable ©Not Applicable C403.7.6 _ 'HVAC systems serving guestrooms in :®Complies Exception: Requirement does not apply. [ME141]3 !Group R-1 buildings with > 50 ®Does Not ;guestrooms: Each guestroom is (Not Observable provided with controls that E]Not Applicable automatically manage temperature . setpoint and ventilation (see sections iC403.7.6.1 and C403.7.6.2). C403.7.4 'Exhaust air energy recovery on OComplies Exception: Requirement does not apply. _ [ME57]1 systems meeting Table C403.7,4(1) ;C]Does Not and C403.7.4(2). E]Not Observable' ®Not Applicable High Impact (Tier I) 2 'Medium Impact (Tier 2) 3 Low Impact (Tier 3) Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Page 5 of 10 Mechanical Rough -in Inspection Cormpliei 1111%s Comments/Assumptions L_ i C4017.5 Kitchen exhaust systems comply with ElComplies 'Exception: Requirement does not apply. [ME116]3 replacement air and conditioned :®Does Not ,supply air limitations, and satisfy hood ;[]Not Observable ;rating requirements and maximum Applicable exhaust rate criteria. :E]Not C403,11A HVAC ducts and plenums insulated in ':E]Complies Exception: Requirement does not apply. :accordance with C403,11,1 and �: ©Does Not C403J1.2 constructed in accordance with ®Not Observable: ' [ME6012 3C403.11.2, verification may need to ;®Not Applicable occur during Foundation Inspection. C403AJ. ',Heating for vestibules and air curtains Complies ;Exception: Requirement does not apply. 4 !with integral heating include :[--]Does Not [ME63)2 �!automatic controls that shut off the ©Not Observable heating system when outdoor air 'temperatures > 45F. Vestibule EINot Applicable !heating and cooling systems 'controlled by a thermostat in the vestibule with heating setpoint <= 1;60F and cooling setpoint >= 80F. C403,2.2. ;Air outlets and zone terminal devices :OComplies 'Requirement will be met. 1 have means for air balancing, ElDoes Not [ME5313 :E]Not Observable: EJNot Applicable C4015, !Refrigerated display cases, walk-in 'OComplies TMException. Requirement does not apply. C4015A, coolers or walk-in freezers served by :E]Does Not C4015,2 remote compressors and remote �'condensers :nNot Observable' [ME123]3 not located in a condensing unit, have fan -powered ®Not Applicable 'condensers that comply with Sections ;C403.5.1 and refrigeration compressor ;systems that comply with C403.5.2.. Additional Comments/Assumptions: 1 High Impact (Tier 1} 2 Medium Impact (Tier 2} 3 Law Impact (Tier 3} Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: RAAIex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Page 6 of 10 :Sectlo�n le.lD Rough -in Electrical Inspection Complies? Comments/Assumptions I C405,6 !Low -voltage dry -type distribution :DComplies [EL2612 electric transformers meet the 'EJDoes Not !minimum efficiency requirements of [:]Not Observable, :Table C405.6. ONot Applicable C4053 !Electric motors meet the minimum ElComplies [EL27)2 efficiency requirements of Tables E]Does Not :C405.7(1) through C405.7(4). Efficiency verified through certification E]Not Observable under an approved certification EINot Applicable program or the equipment efficiency ;ratings shall be provided by motor :manufacturer (where certification !programs do not exist). C405.8.2, ;Escalators and moving walks comply C1Complies C405,8,2. 4ith ASME A17.1/CSA B44 and have 'E]Does Not 1 (EL28)2 :automatic controls configured to 'reduce speed to the minimum Observable ' permitted speed in accordance with ;EJNot Applicable ,ASME A17.1/CSA B44 or applicable .local code when not conveying passengers. C405,9 Total voltage drop across the 'Ekomplies [EL29)2 combination of feeders and branch DDoes Not circuits <= 5%. EJNot Observable: FINot Applicable Additional Comments/Assumptions: 1 .High Impact (Tier 1) 2' Medium Impact (Tier 2} �; Low Impact (Tier 3� Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan, FL (2022)\Comcheck.cck Page 7 of 10 Section Final Inspection Con�plii ? Corr�entsf�4s��r�rpt ons S� .III C303.3, Furnished O&M manuals for HVAC ❑Complies Requirement will be met. C408.2.5. rsystems within 90 days of system ❑Does Not 3 [F1]3 ;acceptance, ❑Not Observable; jDNat Applicable C403.2.2 '; HVAC systems and equipment ❑Complies ,Requirement will be met. [F127]-3 ;capacity does not exceed calculated ❑Does Not loads. ❑Not Observable ❑Not Applicable C403.2,4. Heating and cooling to each zone is ❑Complies :Requirement will be met. 1 , controlled by a thermostat control. ❑Does Not [F147]3 ;Minimum one humidity control device ❑Not Observable per installed humidification/dehumidification ❑Not Applicable system C403.2.4. '; Heat pump controls prevent Complies :Exception: Requirement does not apply. 1.1 supplemental electric resistance heat ❑Does Not [F142]3 from coming on when not needed. ❑Not Observable', ❑Not Applicable C403.4.1. ;Thermostatic controls have a 5 °F _ ❑Complies ;Requirement will be met. 2 �deadband. ❑Does Not [F138]3 ❑Not Observable ❑Not Applicable C403.2.4. ;Temperature controls have setpoint _ ;❑Complies :Requirement will be met. L3 overlap restrictions. ❑Does Not [F120] ❑Not Observable' ❑Not Applicable W C403.2.4, Each zone equipped with setback ❑Complies quirement will be met. 2 ;controls using automatic time clock or ❑Does Not [F139]3 programmable control system. ®Not Observable I❑Not Applicable _ C403.2.4 ;Automatic Controls: Setback to 55°F ❑Complies Requirement will be met. 2.1, (heat) and 85°F (cool); 7-day clock, 2- j❑Does Not C403.2.4. hour occupant override, 10-hour I❑Not Observable'; 2.2 [F140]3 backup "❑Not Applicable i C403.2.4, ';Systems include optimum start `❑Complies ;Exception: Requirement does not apply. 2.3 ; controls. ❑Does Not [F141] ❑Not Observable ❑Not Applicable C408.1.1 Building operations and maintenance ❑Complies [F157]1 documents will be provided to the ❑Does Not owner. Documents will cover ❑Not Observable' manufacturers' information, specifications, programming I❑Not Applicable procedures and means of illustrating to owner how building, equipment and systems are intended to be installed, maintained, and operated. C408.2.1 Commissioning plan developed by '❑Complies Requirement will be met. [F128]1 registered design professional or ❑Does Not approved agency. ❑Not Observable ❑Not Applicable 1 High Impact (Tier 1) 2 Medium Impact (Tier 2} � 3 - Low Impact (Tier 3j Project Title: Zephyrhills Dialysis Expansion Report date; 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck.cck Page 8 of 10 Final Inspection Cerrs 11i'a 51) Comments/Assumptions C408.23, HVAC equipment has been tested to UComplies Requirement will be met. :ensure proper operation. ®Does Not [F131]1 :E]Not Observable: 'E]Not Applicable C408.23. HVAC control systems have been 'Ekomplies !Requirement will be met. 2 :tested to ensure proper operation, :[]Does Not [FI10]1 !calibration and adjustment of controls. :[Not Observable ONot Applicable C408.2.4 :Preliminary commissioning report 7E]Complies :Requirement will be met, [F129]1 :,completed and certified by registered :[Does Not ,design professional or approved :E]Not Observable!' ; agency. ©Not Applicable C408Z5. ',Furnished HVAC as -built drawings ElComplies ;Requirement will be met. 1 I i submitted within 90 days of system �FlDoes Not [F17]3 acceptance. 'E]Not Observable tlNot Applicable C408.2.5. :An air and/or hydronic system ']Complies 'Requirement will be met. 3 ;balancing report is provided for HVAC ElDoes Not [F143]1 systems, 'E]Not Observable :E]Not Applicable _E408.2.5. Final commissioning report due to 'Elcomplies Requirement will be met. 4 building owner within 90 days of 'E]Does Not [F130]1 ;receipt of certificate of occupancy. 'E]Not Observable: ;E]Not Applicable Additional Comments/Assumptions: 1 High Impact (Tier 1)� 2 Medium Impact (Tier 2) 3;' Low Impact (Tier 3) �� Project Title: Zephyrhills Dialysis Expansion Report date: 10/14/22 Data filename: R:\Alex Roush\DaVita Zephyrhills Expan., FL (2022)\Comcheck,cck Page 9 of 10 Project Title: ZephyrhU|sDialysis Expansion Report date: 10/14/22 AC R CERTIFICATE OF LIABILITY INSURANCE NCE DATE(12022 Y) 11 t23/022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown of Florida, Inc. 8825 NW 21st Terrace Doral FL 33172 CONTME:ACT Yamfle Corral AAI, AAIM NA PHONE (305) 714-4400 FAX (305) 714-4401 A/C No xt : Al, No): E-MAIL Yamile.Corral@bbrown.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Bridgefield Employers Insurance Company INSURED Sharp General Contractors, Inc, 3545 SW 10 Street Pompano Beach FL 33069 INSURERS: INSURER C : INSURER D : INSURER E : INSURER F : nA%19r2AnPA CERTIFICATF Nt7MRFR- 22/23 Master Cert REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE INSD WVD POLICYNUMBER MM102 EF POLICY EXP MMIDOtYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $ UAMAut PREMISES Ea occurrence $ MED EXP Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: POLICY ❑ JECT 0 LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ _ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE I OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 83046908 12/24/2022 12/2412023 PER STATUTE ERH E. L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT _ 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhills Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street AUTHORIZED REPRESENTATIVE 33542 '—— wnKK %) 1V?St4-LU19 A4VKL1 %,UKp°UKA1 IUM. An n9ni5 re5erveU. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD