HomeMy WebLinkAbout24-7563pgvamsk;wm��ir
4
Zephyrhills
Issue Date: 01/25/2024
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 remspection.
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.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
before recording your notice of commencement."
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.
PE I
(V
c'TRACTOR 4 RAC R sic
XPI
--;�l XPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
C TRACTOR SIGNATURE PE IT OFFICE
PE T E R1
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Building813-780-0020 City of Zephyrhills Permit Application
Department
Date Re
,rrrrrrrrnr� rwrrrriw iwrri r
- ♦ + •
Cep' _, t yr t • li • . - .
Fee Simple Titleholder Name E=====
Owner Phone Number
Fax-813-780-0021 o P- c c-T,
1
Fee Simple Titleholder Address
JOB ADDRESS 3 3345 6th Avenue, Slte#k11 LOT# 5605
SUBDIVISION � � PARCEL ID# 12-26-21-002E-00500-0000
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED � NEW CONSTR F--] ADDIALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL
DESCRIPTION OF WORK demo and legal disposal Of SF mobile home
BUILDING SIZE $Q FOOTAGE 1426 HEIGHT
BUILDING VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ AMP SERVICE PROGRESS ENERGY W.R,E.C.
PLUMBING $
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
GAS ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS. FLOOD ZONE AREA =YES NO
BUILDER COMPANY John5OnS Excavation & Services, Inc.
SIGNATURE REGISTERED Lj:LNNLj FEE cuRREft LILN
Address 11706 E. 'Trapnell Ind, Plant City, FL 33566 1License# 66 059540
ELECTRICIAN COMPANY F___. _e
SIGNATURE REGISTERED Y! N FEE CURREN Y 1 N
Address License #
PLUMBER ANY
SIGNATURE ROMP
ERED Y J N FEE CURREt Y I N
Address License #
SIGNATURE MECHANICAL ROMP RED LU N J FEE cuRREn Y! N
Address � License # E=�
OTHER COMPANY
SIGNATURE REGISTERED Y 1 N FEE GURREP.
Address License #
1IE9t&11Ai?r1�II8II19iiI116t1IIEII111III�0IIIIIti��iRG9819t1I9It9�R��
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 wt 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 wt 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. (AIC 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
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building 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 with any applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBIL111ES: 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 property 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 certiricate 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 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.
CONT CTOWS/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, WaterNVastewater Treatment.
Southwest Florida Water Management District -Wells, Cypress Sayheads, 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 maybe 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, 1 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.
MO Or haslhaVe of
as identification.
Public
Commission SWWELLRUPP
MYCOMMi 1 HH f75744
Name of Notary typed, panted ors g ed µ V EXPIRES. anuafyi0, 2026
Bonded ThruNotwy public Unde ers
Ponnil NO, Parcel In No
NOTICE OF COMMENCEMENT
Stengel Counly of
Not Pasco
THE UNDERSIGNED hereby gives notice that improvement will be truela to certain real property, and in at4oielance with Choptei-713, Florida Statutes,
the following Infoanallon Is provided It) Ifft Notice of Commenceirroot
1. Description of Property Parcel Identification No.
FireatAOdress: 9.i,IS (,Ili Ai, w, f4 33W)
2, Gonerat nesedpilon of jr,mrlvernent Demol!Von and legal tifsposal'. qc' I I
& Owner information or IAiqPn Information Ifirral-w"oo voritmcle,,1 for tro lrnprovemanl:
SNkh A-mw H.Cch) T)ob Phdo, A Nioll 11-,isnies,
Name
Washin-ton, NIS J16 F I --
City $late
Interest in Property
Name of Fee Simple 1111ptholdev
(if Offerant from Owner listed above)
Address Johnsons Exoavallon and Services Inc, CRY State
4, Coraraoior:
IIIVV T"L �Tfl a Name Plant City FL
—I
Address (,fly stake
813-752-7097
5, $urety;
Name
Ad—dru-ss City state
Amount at Bond: Tolophone No.;
6, under:
Address Gby State
Landers Toloomlia Na.;
7. Per8orm within 1110 State of rint1da destgnalod by the owner upon whom noticas or other docurinalkii toly be served as provided by
Section 713,13(1)(sr,(7), Florida Startles:
Name
AQd—mss-- City
I alophone Nun%er of Designinad Person:
0, to addition in himself, file, ownerdosignates —of—
to receive a copy of the Lloriot'a Notice as provided In Section Florida $1aturies,
Tolophooe Nimbor of Parent, or Frilly Designated by OinAr;
9. Expirallon date of Notice of C onairencenirent (Pre expiration dale may not be befom tpe completion of construction and final paylvent 411, the
contrauar, but will be one year from the date of recording unities a different date Is r4mifteu):
WARNING TO OWNER; ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE 001,164DERED IMIPROPrR PAYMENTS UNDER 01 PTER 713 PART I SECTION 713 13 Ft ORIDA STATUTES AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS RW OPOW A NOTir,� OF COMMENCEMENt MUST BE
OUR T' OP
TY YOU
INTEND
TO
OBTAIN B ED ON r
S To y F
RECORDED AND POSTED ON THE JOB SITE BErOHETHE r, IRS INBPEO ON, IF YOU INTEND TO OBTAIN FINANCING, CON8UCT
W Y NOTICE
OUR N _ , -NT,
VVITH YOUR LENOER ON AN ATTORNEY acrox cokim 116 c3 ORK OJ RECORDING YOUR NOTICE OF l GEMC
of
Under penalty of portuty, I declare that I nave read the forego notice of wain ncemetit arid that the faclsslaasW CO4.ora'.ro into to Igo hest
of my knowledge and bvlier,
STATE Or FtORIDA
COUNTY Or RAft&
MR
The for"Orill In4trument was rokninviodged had ligg'o—'jay I'/gema 20$Dhy
V of aulliorny, e.g.,
(mine r any unbaluelolwli
tionaily Knew, QR Produced Iderflifloalloo 0 Notary Signature
Typeof Idonfill2l Name (Print)
E i�Woii
SUSAN L. KOWAL
MY COMWISSiON # IiH 422697
EXPIRES: October 12,2027
SIXTH AVENUE
39345 6th Ave. I Zephyrhills, FL 33540
(813) 602-8588 myMHcommunity w.
A&
5
5
413 (7
4125 4124 S606
414
5600 5603� 1
��o
4126 4123 500
415
5,548 5 5 5 3 5 55-2)
n
4127 4122 m 416
>
IM 4 6
554
55 2 45 417
4128 #121
D M
M
#18
5 E-5-1 3 2 1-,39
4129 4120
BETHANY LOOP
419
55 311
`5 f 3 2 q4�130 w A-
420
5535
4131
#-23
-924
,5 6111
412
5-605
#11
601,
410
-48
9
-97
5533
46
52�
45
",n7. ;,
#4
E3 5 9
43
42
LEGEND
Clubhouse
Shuffleboard
UHorseshoes
Bathhouse/Laundry
El
Office
F7---I-
Address
L-12-3-4-
Lot Number
Ak
A&L
0011,
1W
\0
1- \C> 'If
q>
\0
2
C>
LM
b,
4 - 0—
10—
- w
Ln
5%
CO
3,
TABETHA DRIVE
"A"
#114
5600
5, 6 0 3
5602
51 6 0 3
-5 IS 0,41
-603
5 !5'55 4
- 9 z
434
435
454
455
474
475
4100
4119 4 5 -7
2
r
5 S 3
4113
�550
5
>
#53
15 5 5 3
456
Ir-
473
476
M
c
4,
3 9 4 62
4116
433
#j' 6
6)
410 11
9 4 15 0
547
m
'D5 4 8
5F'-S,,4]11""
457
472
#77
Fri
5 zl 21
4112
2
437
4
M
452
# 10,2-
4 61'
411
Cn
M
431
-938
m
451
m
M
#71
478
<
M
1
M
1
5 5 �1 8
�z ,
D- q,
'5538
--
#110
5 E5 3 4
#30
M7
439
450
459
#70
479
5534
5528
5-5- 5
553
15; ---- 35
z: 3 D
053!
4104
1-- 9 4 6 5-
429
-q -1
440
4494
460
#69
`5
480
-5
-4109A
5522
,55
-51
3
ID 5/2-1 8
448
5
75 E2 9
461
F,5 2 8
468
3
#81
67
#10 B
428
441
5-1 5 1
52
447
5 5 2 E5
462
5 5, -1,-
#67
7
48
D f"
"IRZ
4278
5
446
19
46
66
483
r
426
443
ro
4106
A
S
'D
1-d;
#45
464
465
484
425
444
EUGENE DRIVE
4 7
1
5
0 6
5
1'08
M
-4132
7
4133
6TH AVENUE
1, Donathan A. Johnson, President of Johnson's Excavation & Services, Inc. do
hereby designate the following individual (s) as having the authority to sign and submit
applications and related documents for the purpose of obtaining any permits under my
State Contractor's License, reference #CBC059540 for Johnson's Excavation &
Services, Inc. I further acknowledge and accept as a licensed contractor, my
responsibility and liability for each project permitted under the authority designated on
this form, and that my failure to assume and fulfill said duty may be grounds for the
initiation of disciplinary action against my
1. Sean Givens
to and subscribed before me this 15
day of December _, 202ti,
a
My COMMISSION # HH 176744
EXPIRES: January 10, 2026
vuw Thfu Notm puble, Underwriters
(Notary Public)
X ) Is O Is not personally known to me.
1706 East Trapnell Road. Plant City 33566. (813) 752-7097. Fax (813) 719-9052
License # CBC059540 email: lgles�'qTescontracfing com
\\johnsonserver\everyone\DEMOLITION\AUTHORIzation FORM FOR
PERMITS.doc
JOHNSON'S EXCAVATION & SERVICES, INC.
G"ENERAL CONSTRUCTION & CONTRACTING
Demolition Site Work Roll/Off Disposal Set -vice
1706 E.Trapnell Road, I'lant City, FL 33566
(813) 752-7097 t'hone (813) 719-9052 Fax
Oft-jul
To Whom It May Concoli:
the property owner gives Johnson's Excavation &
(owner's name)
& Services, Inc, permission to demolish the structure(s) located
#11 A i �WQEtjqiq ...... jj
(physical address of structure)
in the amount of $ a9Q.kQ_____
This includes Putting all necessary permits and disconnects, if applicable.
The legal description or tax folio number is: _. 12-2 -2j-R2fi--E050 -,QQQQ
The electric meter number is
Please check one Sewer � .... ...... . .......
Name & Address to send invoice:
"y
L
(bwrfer's Signature) (Printed name of Owner)
1ERIMS;
Net,',,10 days
It Is understood and agreed that Johnson's Excavation & Services, Inc reserves the right to lion the property at any time in the
event of nonpayment, It 15 also understood and agreed that in the event legal action is required to collect any payment clue,
Johnson's Excavation & Services, Inc, owner agrees to pay all attorneys'llcies and court costs plus the highest interest allowed by
law on tile unpaid balance from notj,() days.
state of
County of
to
0
The foregoing instrument acknowledged before me this
-Z day of-OLI"4', 20KLV— by
N.1-
Personally Known OR Produced Identification
'I'voo of Identification Produced
Fttj-r-e-oi�-N teary Public
SUSAN L KOWAL
�22697
'X x
MY COMMISSION # H11 422�697
t V
2 �OL
LXPIRE& October 12 " I
Type
or Stamp cc d Name of Notary Public Printed name of Owner
Florida Department of
DEP Form 62-257.900(l)
g",
it N'
Environtal Protection
nme
Effective 10-12-08
Page 1 of 2
A"I FILM'15A
M
Division of Air Resource anagement
NOTICE F DEMOLITION OR ASBESTOS RENOVATION
TYPE Ni0,P
F1 ORIGINAL L-] REVISED El CANCELLATION
COURTESY
TVP�-'.` OF R, "JEC11111" V' (""K G'd'YE ONLY)":
RENOVATION
!FDr- D "ITI -) N, Is 31 R DE RED
DE 1\4 OLI F1 ON? OyiEs Lx! NO
RGENCY RENOVATION
OPERATION? [-iYES ONO
� I --�i-AN Ni-Z -- , '� � k
,S i- A ' D R
0,-, -�A'T- NO
Zip 33 15' -,- 0 County Pasco
Consultant Inspecting Site GREENFIELD ENVIRONMENTAL
�-i Buildina Acre in Years 30
Small Business ❑ Other
Smai! Business ❑ Other
S"S S' F',\'! E S I N 0,
Addr
is �e . . .... uroer
(jaj23)-752-7097
zip 33540
Phone one
A ((813) 752-7097
z 1p 33566
Y P— S El NO
N! 'N'� QMJSI I 0, - posinmamea -1 'A""'rKiNg' days 'L.a;bre the project start date)
"E� �
�)emo./Renovation (mm/dd/yy) Start: Finish:
r- 02/01/2024 02/06/2024
0tit. 0 F" VKN '0 be performea and inethods to be employed, including demolition or renovation techniques
co'ne. �-" ��'."avatol and iegal disposal of removed product by roll off
.. . ......
i arivin ',,',','rea, cad wonniental compliance i ance services
-7097
Phone (SLI �3)52
33566
- ------- -- - -------
"'7
1-AR KIN & SON, !NIC,) Class
-- —in _33
---------
Z 525 1589
Environmentol
18, 2023
Equft',,y- Lit' sttyle Properbee,
N 'ck 8,,a %1---
Prq,,'ect%N,18naqer
Sufte 400
ampa, FL 33607
MOLITION1, ASBESTOS SURVEY FOR THE COMMUNITY #7800 —
T
E 'I AX'OSILE HOME PARK, SITE 11 LOCATED AT 39345 6
S FLORIDA
W n
C A ;M-1ZAs) was conducted on September 13, t"In" mat rials (A
d asLiestos inspecio: Iota Adamski of Greenfield Environmental,
"GE' ,,it i.. r'-,ibeve -mentioned unft. The. purpose of the asbestos sutvey was to identify
materials at the unit prior to planned demolition activities. The
lllie?, V'101118111'1,11,1 "'U10-c' ucted for EPA NESHAD compliance prior to demolition activities, GE
� Is Constuilijrq Firrn with a corresponding license number of A-
4 this ,asbestos surktay was performed In accordance wfth the
aral Regulations (CFR), Part 763 for suspect ACMs,
bons be randomly selected. All suspect,
"3'i "1110"'It
M '—t riais and PACIVI (materials presumed to core in asbestos under
IMS
0JAsi I ude, 29 CFR 1910) were identified. The samples collected from the
u ; a � )i abaled and transported to Air Quality Environmental, Alu48re
ity Enivircis mental, Inc. is a National Voluntary Laboratory
accrad�zed I bor ory (NVLAP No. 200759-0). n
was l iructed of wood and metal on a metal foundation. The
cons
",i' ot vinyl floor piar, a did all system, fiber board panels and
d of insulation, concrete, and caulk. The roof
V "ha Tric-HIVAC system consisted of flex duct.
'itc, not--ontain any suspicious materials.
Florida 33701
total of thr -Mio 2 samples vx re (' F 't c u t
analytical resufts, indicated that 2) dill the materials � nnpl ,l
amounts greater than one percent ). These n—r tefall
caulkand roofing mastic. i Please see, the after,"ned S,,,in ma
analytical results and sample locations. The ilabcr .v�,a ,' ; SH.v°ts
As
Category I non -friable asbestos -containing materials are those in w h i t ,,. , .
fibers are bound with other materials In such a way that the release ors U .o.. e fiens intro
the air from casual contact or normal wear is --u ill; y.
not be removed, cart or abraded In any way these actions
fiber release episode,
The asbestos -containing caulking and roof mastic materials mart be prro)perly rernoved
y a Florida Licensed Asbestos Abatiament Contractor prior" Y� '°
will impact the matedals, Proper notification must be provided to the vocal iegu aik rry
agency prior to asbestos; removal and demolition activities.
E is pleased to have been of assistance to you on this project and we iock fonAtar to
working with you in the future. It you have any questions or it vfvre can be o any fiurther
service, please do not hesitate to call us at (7,27) 96 6.
Sincerely,
GREENFIELD ENVIRONMENTAL,
Max aml
Project Manager
EPA Accredited Inspector
Enclosure
Michael W, Rothenburg, PE
Florida ,rc r d Asbestos ("Y' o suftant
#EA-0000041
SUSPECT ASBESTOS CONTAINING MATERIALS SAMPLED
SIXTH AVENUE MOBILE
3
ZEPHYRHILLS
izi'^;«11 te? 4as}i.,a }Sn;i. 1 escri ion:Approx.
pppx
Qu
t
`Ua� UH Location I Content Felabilityits
No
Non -
kJ 1 cm Asbestos
Located at Patio Good
Friable
Detected
No
Non-
():3, bs',"iCk and Mortar Located at
il Good
Flame Detected Friable
Good
11 � 4'I t � meav ,� ni DP� i o �� chi ` o i �
N
Non-
.sAsbestosFriableGood
.. DetectedE
Areas,
i
o t
t£ t^ "
y }i
4 f , i F d o r I$ iti:" With Yellow k' @ i" kd'
stos
a xuGood
z Friable
D eethe 3
Floor Areas
3" No
... .. Mix.~•» 3.0 Y w���� �"tt, � "'� � ;{
E1
As eAFriable s d lGood
Areas -�,cted
No
%1\111t1ze ,,s X4Son L 34. c*a d'a ST� R�,z< Good
A z
i
Detected
No
on Located a
Good
tl `s ° eif i tag , # ,a
Detected i.
No Friable �
LocatedLocatedx`L"ssu �k € } Good
Detected
..1 t ie �` `a �.:,o..: �`+z`$;"_ o r'. �$ !
: a t �; sb `�as,+,,ti _$ nable Good
Detected i
r
� ""Ck �s O
AsFriahle Good
kDettc `T
..
ILABORATORY ANALYTICAL
Akir4
Client Name. Greerftld Environmental , n :,;ad r iannw ELS A`2 , 0GIE ,,
3 3W $treet Now 3934 6-th Ave,
t, Petersburg, Florida 33701 Date nat y e S t ftoor 14;
Asbestos, Bilk Sarnpllys Test : PUAi FA Method - ,- 31/1 t r = 005 ARI -xx to a, E € t r a f k
*mw
t b oami�..+wd; Y tt e 1 % a t s % Other tmr
111si ,t'te itan �,. t: t
,
2 3 t n
611181 2 ''Concmte owme I tan
g 1
i
�'�*.1 82 3 Concrete aerie t a 5
?. B �'€.siYe 03'. ZLdC$4 s�'ai *:�G@� x+`�#�% k t�i� # 11� t",`
t
b
}
y i i
�5
1118 Imsstic jormy % tny"n
i
111 6 IMSOC NotAnalyzed, Stems At Fkst Mositsho
611186 7 FFloodnq IfauxFloodvinyl NAD
100%r? $a ." and
611187 18 Tlooring faux woodvinyl NXI
0 t
n gray vinyl NADD
and
E
611188 9 Flooring bgray a Wht nyf NIA 0
yellow mastic: MOD
1
1 00% ,: i e,,r
611189 10 Flooring white vinyl NAD 1,= S €T,,r < a4 ,
80 CV rb s s, au ,. 8,;;,de i s
brown mastic D
¢ 00% Binders
t
3
1 � k
611190 11 Drywall System wht compound NAD
'100% Cirdxinatfw and Binders
drywall mat IN j 10 1% r o i'
drywalpowder Nd""`� cC„o £CSIIti`
�1 Pf-.. ir< 'w��i+ Yr,� i.. Y�.k Sl cl ,�P.
6 s R ws
11191 12 �Or)vell- System wht compound NAD
1(0% Car ci elm, and,, Binicler
drywalf mat NAD 1 ` Cellulose
drywall powder tea,^O 4% ; ;eHuk se
94% Gypsur„ r; r.v: Bii derz
i 2% 'k"S)assi }"�`.swr,s
i
a
1
pg
d
t"`i`har�€3iY,S�ia?r�°ttr`t�1� laty¢Pt�, �¢tf�9t� ii�S$2$@$a's'r'$�si��`ti$$fi�;Cid"aiu""�"{elnriEk4�ti;v'$'�,3,Uk}3.�ziidkA,4«Ya,i„. �{'Ysiea"s`t
CitTestaefs a f!'O$OAS! to be as"MOSCOnWwAgonly is 4t ,.. i7toin%§l'14`t e than Oy a ,,,Wbroled V'a.,C. pi rlr,,,,, Emi atxls::,=',,:
a }rug& a s is } a casaa € a fi En Pa tk hits rsdpo" WO it to tit mforpmtod only by rha pila tuav t¢
#ktm pfots- FaP UlptP oro,. 78 is toptirl f1my not 40 used so a t iul kI ortoluct of vi%d £us"C`&i5 ono tw N i„<.`"r° a:.
i3t��%t4f+#f1�4A4ttfka"�S{37Se;a�Eef ttYl9 is $4ta 6i g�{ki�?aCf'689R4:t§€
tk)(W Tito and (Aner f rwfum, art t" atoeiat%, mul*r2 AmAy eard by ERA rrxolhori € o,,y y3orer fofiloq nngohwt rem,Qei ta€r Iusw, , of
hmitaltons to Separating closely bound fibers and m doWeting Abom o,":wwO k-n9th And dMMO N,
fiit�tkfS$f�. � #i",#3SSttlr§8trta #R$f$i3'{t°7$$�Stt&�yCi3i(Y@"."&%tt�&'pi@�`f?$!K$§`4Ytbi$3dfXtaK'ate, saRC�tS:d:'$3E$�,€'t$,�[^i�fi`kk¢hilEx'33k E^@F'�s.4tc`1C? a"Vt":*%.PHe;1t 11i1;s.
AnWysls Pages 1 of
C6&'nt' Pt Jett Name, ELS 42821-0357
39346 ft Ave #11, Zephyftlks
Date Analyzed: September 14, 2023
/ DS - EPAJMathod - SOO/R43/116 -
31
"E"
NAID
l' "'nat NAIL?
i dq�,v ,,vatl pa mcier NAD,
AD
vv"hke NAI
NAD-,
NAD
011VItt ad.
IGRe
3% tsoflle
�-I�nwv
'n 1i j , I "IIs, aobn o
—'W-b x'wv (ell
0 ""W4'
'r'lfi n -wftr
An,t Plae:�em 2
100% Carbonates and Binders
100% callubse
49 Callufte
94% Gypsum and Serrs
211/o Glass ibers
100% Mineral Wool
100% mineral wool
100% Mineral Wool
100% Mineral Wool
100% Mineral Wool
100% Mineral Wool
100% cellulose
100% Cellulose
9.1r% Ceilubw
5,% Siturnen
s6% Cellubse
5% skumen
05% cafluiose
5% Shumen
1 100% synthefics
100% Mineral Wool
1 1000/6 Synthetics
100% Minarai Wool
i
100% Synthefics
1�)10% tvlinaraiWool
97% SIndem.
'100% Carbonates and Binders
'rho PrIA
Atva Lwmauon
Ae Ovuay become ?noble,
Ao Otqo,q,
bV
Awi�w,maoy wege eesww
wharn havo rxMVow Ov"
tty NVLAP"
"Vvn
NVLAP Lab Code 2007594
Of 3
Client Name; Greenfield Environmental projeck Niame, E LS Q` 82 i
432 3rd Street Nortt,, 3934,5 tit Awe 1 "'Pep -
St Petersburg, Florida 33701 Date AnWyzec Septeftxw '14, -'210,23
,,,, Specnfiv' I avcir xv cT'nIqxI'Ivm4 A at) ow I cK, cxmi�,,,W ,, �wW,,,'dw A whwt ,Wov4m�,T b o F'N",
,Wounq only if A canU*ns fro thon 1% a sbos'101'oy C a i"t'w"Ittm V�,.,Lm!Ax',oa
h0l R"Uk0&dA6b"X*% 001%taining Me LOM% wt%ch am, MabWor may, bfcowne q6vmb,�4',,
Iwn the r"Uft mdirwta kv* Otan WYN, k'AlbwAotme C"'IAE At; Owm4y EmmmwrmmW
as rot mcklas pomt cmmh"q un"Oss SpOxIlkViy rw"'un"'A;�r Ado"hon"Hy V mst'Ps
This topon Oatas m to W mftmptoted artily bv Me pcwort f%) Whom tump t"T'Aft'xAec'! "tvu
by
"mt be U"d as A d"Alm IV, PMOVO r*01humImm kv ondws emnk NVLSU�
Govomm""t,
`ioeva and m delecOng ftem of sm"14 iopqM and oarrwer, Whoo am by ros"At m
Lab File Nw"ber: 67856 NVILAP Lvub,
Anelysis Pages 3 of 3
APPENDIX
CERTIFICATIONS
Vern Roberts Envirmn mental Traininig, 4,,w,
7�
1398794'hAvenue N
727-239-111.11-t'45
certi-1,11-�s, tha"Al
MAXWE LL.,ADA- MS1,ki,
Has gatidactorily completed the requisite training 1,61- <,i(xz.,,,ditation under'�N"I"A
Accreditation Man (40CF1063 F") I'm the 4-hour r (Survcy
2/10/2023, and in testimony whercof, we '610 confer cIcr!"f,"",'"',"C
Date ofCome. 2/10/2023 1 �Xpirafion Date 2/ 1 OW"'2,024
Certificate # 02102307AM
Rt r Cm,. r,t s`r"is, Govei'¢` o— Julie 1. Brow. Secretary
Cib
ie l p
f',"PARTMEW OF BUSINESS AND PROFESSIONAL REGULATION
ASBESTOS LICENSING UNIT
1AEREIN IS LICENSED UNDER THE
caa ,s%5' , fit,. ELL) pN V R
ONMENTAL INC
MICHAEUROTHENBURG
432 STREET NORTH
FL 33701
0ATV",: 2023
}
er��yg+g.�».�g�*y #*y� p y#��T j��§4 �vgpy�,r- a�dni�
3 i �^' $��§ M�. the
ka.k.bu xkb�, cthe E«har, L7 a licensee o ent
+1J£}aa s'e; t- a: 48e3iv 548i 'MPbR5w f6