HomeMy WebLinkAbout92-2241
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BUILDING PERMIT
Permit N<! 224113
Date .3 - ,Q 7 - / !L.
CITY OF ZEPHYRHILLS
(813) 788-6611
. 902 y.~. //r. l-S- g-b, o-v 70. crD
~~GLECTRIC~LUMB~GECHA~
:::o:::,~:;;; ~ ~?M~#Ji~.~~7- C
Parcell.D. # ..:3 '/<11(J
Zoning: (.,.. - dl EnerQY Code: J'R' Radon Gas: .3 /, c2 L/
De,crip"on of Wori< ':1Jl; ~L ~;, "'.
Sewer Conn
7. :? r,;r. b{)
-
.2.. ()/ ;2..~--o
.
Water Conn:
Water Meter: / 6..!>',tn:J
T,I.F.'s: ~.;J~ cf; .30
FINAL ~ -
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Valuation or
Contract Price J 'Y' b./ ~. oU
City License Registration # Ii/'
State Certified License# C(3 <:: {J /0 9;l3
Telephone#
Ftr (., tIf"1-::1t Tp. Servo SLB r~ ~ z. ~
p,; S~~'t~1S<' Rough In h Af; 11.J-G Tub Set ~ :t/l.- 6"t.-
Lintel ..... ~ Meter Can Water
FRM. _' - ~41. f> J.t Const. Pole If- 'l- q l- fl6. Sewer tI-B4r, .$'9 -'JZ-
Insul. CL Pool Final
WL l.o, '5 -~ 1- en.v"O Pre-Meter 'l, L q .q~f>tJt..
'S\~tc: C.,')., .'1'2. 'B.P.Final
Breakers
Ducts Insl. G, -If,,/fl6Jr..
Compressor
Final
Driveway
tVa1t~ ()~ IJ/JI-11-
PfiU\~'T vJ ",LV;.
I ')-I'~rl ~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.001 shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
'l"OIIIIVIEW MEDICAL AR'lS CER"I'BR
LO"l' '3 UlUT nen
3,124 Sq.Ft. Living x $ 45
5,872 Sq.Ft. Other x $ .85
VALUATION: $ 146,000.00
Building: $ 924.50
plumbing: 80:00
Elec. 118.75
Mech. 70.00
SUB"1"O'l"AL : $ 1,193.25
BUXLDDiG PLAIIS RBVEnf CREDIT: 100.00
'l'O'l"AL : $ 1.,093.25
COMIIBCTION FEES:
Sewer $ 7,348.50
Water 2:,012.50
Meter 165.00
"1"O'l"AL : $ 9,526.00
RADON GAS: $ 31.24
Sq. Ft. 3,124
TRANSPORTATION FEES: $ 9,228.30
x 99%
x 01%
$ 9,136.02
$ 92.28
GRAJm "1"O'l"AL
: $ 19,878.79
~ TOWNVIEW MED. ARTS CENTER
LOT 3 UNIT C
DR. GROSSBARD
. , .::J:.AIU,..:f. : A - W 0 'R T( ~ H F. F. '1'
,r:TTV OF' 7.'F.PHVRHTT.T.~ r:ONNF.r:TTON To"F.F.~
ORD. 0395 RESOLUTION 1.51 << 329 WATER $1.75/0ALLON SElolER $G.39/CALLON
RF.~TnF:NTTAT. (F:n~h T.ot or tJnit)
Residence $ 350.00 $1,278.00
Travel Trailer Park 131..25 1,79.2S
. ,
~
(:OMHF:R (:1 AT. (l'F.R FTXT1JRF.)
Sinks " 87,.50 319.50
,WOoter Closet 131. 25 479.25
Urinal , 87.5.0 319.50
Lavatory 1,3.75 159.75
Tub/Shower 87.50 319.50
Washing Hachines 350.00 1.278.00
FOOD SERVICE . .
Dishwasher . 700.00 2,556.00
Sinks 175.00 639.00
Car Hash (Per Stall) 1,000.'00 6,390.00
.. '. .
FIXTURE G.P.D. it WATER SEHER TOTAL PER FIXTURE
SINKS 11 '962.50 3,514.50 4 /,77 nn
WATER CLOSETS 5 ,656.25 2,396.25 3,052.50
LAVATORY 5 218.75 798.75 1 017 'if)
'.
SHOWERS 2 175.00 639.00 814.00
2,012.50 7,348.50 9,361.00
3l.!:L,-" HATER t-lETER
165.bo
GRAND TOTAL
9,526.00
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT
Sandy Development Co., Inc.
OWNER
1723 N. Hwy 301, J)::Jnp City, FT
Townview Medical Arts Center
PHONE (904) 567-7992
ADDRESS
JOB LOCATION N. Hwy 301. Ze-phvrhills
LOT SIZE...2..Q!LX 157 AREA sQ. FT. 31,400
LEGAL DESCRIPTION: LOT(S)
3
BLOCK
SUBDIVISIONTownviRw Mprli~::Jl ArtR Center
PARCEL 1. D. ~F
WORK PROPOSED:--K-New Construction _Addition _Alteration _Repair _Install
_Sign/Temp. _Sign _Move _Demolish
PROPOSED USE: _Single Family _M/F _# of Units __M/H
--K-Commercial _Indust. _Swim. Pool Other
_Restaurant & Health Department Approval
BUILDING SIZE: 50 X 127 , 6350 Square Feet, 17 hh' Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
......K..-BUILDING
$
Valuation of Total Construction
......K..-ELECTRICAL
AMP Service
Florida Power Corp.
_W.R.E.C.
......K..-MECHANICAL
$
Valuation of Mechanical Installation
--X-PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Frame _Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
Signatu
CONTRACTOR SECTION
Company S::Jnny J)pvplopmpnt ~9 TnC"',
State Cert. or Regist. 4F CBCOl 23 v
City License Registration # 18
***********************of:*********of:***ofd:*** r }, ) -=-. (,). I', /".
,M"'<,,, ,---.. 't ~ 'j 00 (::;!. 1.).( I
'~t -;J..4Q"."
Company
State Cert. or Regist. #
City License Registration #
******************************************
PLUMBER . Company R::Jyonpt Plllmh~c5
~ c-- 0 State Cert. or Regist. # C 42998
Signatur . -. ~L4A/t City License Registration # 91
******************************************
"......
MECHANICAL (I
Signa ture rJf 1)
Company Sonny' R Sprvi ('p CE'>ntE'>r
~ rI:. . State Cert. or Regist. II RM0018461
~. City License Registration # 2
. **** ************************************
(.....--
Company
State Cert. or Regist. #
City License Registration #
OTHER
Signature
APPLICATION APPROVED BY
~**************************************
d Ai (J ~ <>V -"~~
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
'A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit 'Iay be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ONner has hired a contractor or contractors to undertake work, they lay 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 lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractorlsl sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES.
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
"owner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work Dr
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
I Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and EnvironlentaIly Sensitive Lands,
Water/Wastewater Treatlent
I Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
I US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit 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 perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such perlit is cOllenced within six lonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six lonths after the tile the work is cOllenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved insp~ction lust be logged during each six lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COKMENCEMENT "AY 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
COKMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD ND POST A "NOTICE OF COMKE "
SIGNATURE: OWNER OR AGENT
was acknowledged
, 19 _ by
STATE OF FLORIDA ~
COUNTY OF ~ e..o
The foregoing instru~
before me this ~~
was acknowledged
19~ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befc,re me this
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
.:reVD~ LU. +br-lLer-
who is personally known to me Dr who has
produced
as identification and who did/did not
take lath..
(SignatUl-e)
01- Stamped)
Notary Public. State of Florida
My Commission Expires June 21.1993
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSl"RUCTION
FORM 500-A-91 SECTION 5 · BUILDING DESIGN BY COMPONENT PERFORMANCE APPROACH
Non.Resldentlal Buildings ADMINISTERED BY THE DEPARTMENT OF COMMUNITY AFFAIRS
Residential Buildings over 3 stories ALL CLIMATE ZONES
ZONE:
BUILDING CLASSIFICATION S :
BUILDING PERMIT NO.: d;t
PERMITTING OFFICE:
JURISDICTION NO.:
PROJECT NAME:
ADDRESS:
CITY ZIP COD
BUILDER:
OWNER:
BUILDING INFORMATION
WALLS ROOF/CEILING FLOORS DOORS GLASS
TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA
Concrete (CBS) Adb 11./ ') (P Under attic .t>" ~':H,Ci Slab-on-grade tJ "B('O Wood Single, wall l./if :::}f,) . lJ
Wood frame Single Assembly Raised Wood Metal Double, wall
Metal frame Other: Raised concrete Insulated ~(; J" .... Single, roof
Insulation R-value Insulation R-value Insulation R-value Other Double, roof
SYSTEMS INFORMATION
AIR CONDITIONER HEATING SYSTEM HOT WATER
TYPE EFFICIENCY TONS TYPE EFFICIENCY BTU/H TYPE
Unitary & Heat Pump 1 Central & Heat Pump Electric
<65,000 Btu/h J!L SEER - < 65,000 Btu 1 h _ HSPF - Resistance t'f]
,,65,000 Btu/h EER IPLV 2: 65,000 Btu 1 h _COP - Dedicated Heat Pump 0
- - - Water cooled _COP Gas
-
Water Cooled - EER - IPLV - Evaporatively cooled COP 0
Natural
Evaporatively Cooled -- EER - Electric resistance I, 0 COP {--S""(', LPG 0
PTAC - EER - Gas/Oil (circle one) Oil 0
Chillers - COP - IPLV - < 225,000/300,000 Btu/h _ AFUE - HRU 0
Other: 2: 225,000/300,000 Btu/h Et Other:.!
LIGHTING 5~o<J 33~o Lighting Budget (from lilble 5-13): ~
Total Lighting Wattage Total Conditioned Floor Area - Watts/sq, ft: ,. ~}
PRESCRIPTIVE MEASURES (Must be met or exceeded by all buildings.)
COMPONENTS SECTION REQUIREMENTS CHECK
Windows 502.4 Maximum of ,37 cfm per linear foot of operable sash crack, ~
Doors 502.4 Maximum of 1,25 cfm per square foot of door area,
Joints/Cracks 502.4 To be caulked, gasketed, weatherstripped or otherwise sealed, "'-
Reheat 503,3 Supply air restricted to set cold/hot deck temperature to meet load of worst case zone, Resistance reheat prohibited, Itlt
Ventilation 503.4 Supplied with readily accessible switch for shut-off and/or volume reduction when ventilation is not required, !
HV AC Efficiency 503.4 Minimum efficiencies-Heating: Tables 5-4,5-5 & 5-6, Cooling: Tables 5-7A, 5-7B, 5-8 & 5-9, j"
Transport Energy 503,5 Minimum of 8,0, ,;
Balancing 503,6 Provide means for balancing HVAC air system & water distribution system, ,t-
HV AC Controls 503,7 Separate readily accessible manual or automatic thermostat for each system,
HV AC Ducts 503,8 Air ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, sealed,
503,9 insulated and installed in accordance with the criteria of sections 503,8, 503,9 and 503,10,
503,10 i
Piping Insulation 503,11 In accordance with Table 5-10, '1
Water Heaters 504,2 Automatic electric storage water heaters ~120 gallons and gas & oil-fired storage water heaters
~ 75,000 Btu/h shall meet performance minimums in Table 5-11, Larger sized water heaters shall
meet minimums in Table 11-1 of Standard RS-9 after 1/1/92,
Swimming Pools 504,2 Spas & heated pools must have covers, Non-commercial pools must have pump timer. IJr+
& Spas Gas spa & pool heaters must have minimum thermal efficiency of 78%,
Hot Water Pipe 504.4 Piping heat loss is limited to 17,5 Btu/h linear foot of pipe for recirculating systems (see Table 5-12), ..,
Insulation
Water Fixtures 504,5 Water flow restricted to maximum of 3 gpm at 80 psig: toilets maximum 3,5 gallon flush, >
Public lavatory fixture maximum flow of ,5 gpm or ,5 gallon if has self-closing valve,
Lig hti ng 505,1 Lighting power budgets are listed in Table 5-13, Minimum Ballast Efficacy Factors are listed in Table 5-14, "1",
Uo wall Allowable I ~'l Uo wall Actual . , T If complying under the provisions of S. 502,1, enter the c,ombined Uo values for the entire envelope
Uo rooll ceiling Allowable . r v Uo rooll ceiling Actual 1~3 in this section,
Uo floor Allowable Uo floor Actual Uo envelope Allowable Uo envelope Actual
OTTV wall Allowable ), b. y OTTV wall Actual II ,
OTTV roof I ceiling Allowable OTTV roof I ceiling Actual
Compliance with Section 5 was demonstrated by a Prescriptive Measures methodology:
D 508,0 (a) Detached commercial buildings D 508.0 (b) Skyboxes or sports stadium buildings
less than 100 square feet. that are used only seasonally,
I hereby certity that the pi ns an pecifications covered by th calculation are in compliance
with the Florida Energy e. - .
PREPARED BY: " I DATE: J - ;} ~ - 5 2
I hereby certify that this building is '
OWNER/AGENT:
DATE:
Review of plans and specifications covered by this calculation indicates compliance with the
Florida Energy Code. Before construction Is complet,Kl, this buil . g will be inspected for
compliance in accordance w. tion 08, F .S. - I
BUILDING OFFICIAL:
DATE:
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WALL R.VALUES
BUILDING COMPONENT DESCRIPTION WALL WALL WALL WALL WALL
TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5
Exterior air film . J- \ .1'5
Stucco
Block I. /1 J, II
Stud
Firring strip
Insulation S.60 $< ()O
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Wall board , ..., )
Solid
Other /!Jr- ,'Cfl f L( ~
Other
Other
Interior air film t h<{ l(o~
R TOTAL 7( 71 'l~LfI
U = 1/R ~/J.. f:, ,/3r.t
AREA Jf4''l--- tf .,
r,7/
Weight (Ib / sq ft)
IF FRAME: Size _ x _ Inches O.C, _
ROOF/CEILING R.VALUES
BUILDING COMPONENT DESCRIPTION ROOF ROOF ROOF ROOF ROOF
TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5
Room air film I c:; (
Wall board I 1,
Truss
Insulation :10.
Other~ ..iA lbv
Other " -F' f7.. +l ( ()b
Other '<; h ~JVr;fk'( 103
Other
Outside air film I ~-;
R TOTAL .3 rJ. 3 'J--
U = 1/R ,03 I
AREA (sq, ft.)
U ~ TC
IF FRAME: Size _ x _ Inches O.C, _
0 F Z
A I A
DONALD F. ZAHN. A.I.A.
ARCHITECT
726 TRADEWINDS DR.
BRANDON, FL 33511-6236
FLORIDA REGISTRATION NO, 4472
ARCHITECTURE, PLANNING & FOOD FACILITIES
(813) 689-8783
(813) 681-2332
June 12, 1992
TOWNVIEW MEDICAL ARTS, PHASE II
ADDENDUM NO. 3
PLEASE MAKE THE FOLLOWING CHANGES:
UNIT B:
REVISE INTERIOR IN ACCORDANCE WITH REVISED DRAWINGS
DATED JUNE 12, 1992.
UNIT C:
1. DOCTOR'S OFFICE NO.3 -- DELETE BATTERY PACK FROM
FLUORESCENT FIXTURE; AND INSTALL EMERGENCY LIGHT
EQUAL TO DUAL-LITE EZ-2 ON WALL. CONNECT TO EMER-
GENCY CIRCUIT.
2.
CHANGE ALL PLUMBING VENTS THROUGH ROOF TO
CEPT ONE VENT TO REMAIN AT 3".
?"
- ,
EX-
3. ADD (1) 1/2 H.P. EXHAUST FAN WITH CEILING GRILLE,
DUCT, AND ROOF CAP IN SPECIAL PROCEDURE ROOM. CON-
NECT TO CIRCUITS 40, 42 WITH 20 AMP TWO-POLE BREAKER.
4. ADD AIR INTAKE DUCT WITH AUTOMATIC LOUVER TO SPECIAL
PROCEDURE ROOM. DUCT TO FRONT SOFFIT AND CAP WITH
INSECT SCREENING.
Cf!IL..
AU-TO ./..ouve"
F~e~T w At..L..
'--~u.E. ~
F(~T"i
IN~eGT
~~
~H Al~ I~T @
"frEe j AL p(l.t!)GesPtJl\f': PiOO M
~~~JrL
. /.2 ~ cI!-
. .. .
.. ~.
ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills, Florida 33540
38410 6th Avenue
(813) 782-8184
FINAL BUILDING INSPECTION
Fire Chief
William T. Fenton
Assistant Chief
Robert Hartwig
OCCUPANCY: j?;,fLtJ Sl4'fI'UJ/ 4.rstJ,c. DATE: ~~"^
ADDRESS: 3 'J~i.f{J Hli'rj'l.-t2/ 4trft cT...
BUSINESS PHONE: 7fi"-,fJ(Pf COW-NE~GER: /7;-. (;.W.r:f b~.J
This huildinJ1; has heen inspected by the Zephyrhills
Fire Department under the codes and regulations of the
NFPA Minimum Standards and other local fire safety codes.
L APPROVED
NOT APPROVED
CO~I~IENTS: (J. ~ kv C.O.
INSPECTOR: iJ ,t' ~~
DATE: fj/fj~1- TIME: /tJ/S-
SIGNED:
ICML1~
TITLE:
06/17/86 als
C E N T R ALP E R M I T TIN G
PASCO COUNTY, FLORIDA
CONTRACTOR #:
NAME: SANDY DEVELOPMENT
ADDR: 1723 N HWY 301
C/ST: DADE CITY FL 33525
FOR: RESOURCE
B2241
CHECK # 2774
37840 MEDICAL ARTS COURT
34-25-22
ACCNT
114
TOTAL AMOUNT:
COMPNY ACCOUNT CENTER
B450 - 363000 - ~
84.58
84.58
AMOUNT
RECEIVED BY
,
j/~
----~~~_1t2~~-----------
DATE: 08/19/92
PAGE: 1 OF 1
ISSUE OFFICE: D
RECEIPT NUMBR: 00147793
OFFICE: DADE CITY
UNIT C'
DESCRIPTION/PERMT DATA DRICR
****** 60
NoTICE
OF
RESOURCE RECOVERY ASSESSMENT FORM
PERMIT
II :22/(/~
>?-/f-9:L
.
APPLICANT (OWNER lJ~~ Q~t?Mn~
COUNTY PARCEL II j Lj ~ _- 61. _
LOCATION .,;37FJ/D 7J?.f7~r~ tiA71s (?&JxZJ - (/~7';; (!-
DATE
USE/CODE DESCRIPTION
RESIDENTIAL NON-RESIDENTIAL
II UNITS GROSS SQ. FT. (GSF) ~,;2CJ(J
,
RATE/ERU=$SO.OO X 0.96*/YEAR OR $0.131S/DAY ERU ASSIGN II
ASSESSMENT = (II UNITS)X($0.131S)X(NO OF DAYS) ASSESSMENT=(GSF)X(ERU)X(0.131S)X(NO DAYS)
100
TOTAL FEE $
~1,5g
)0.
TOTAL FEE = $
PREPARED BY
* DISCOUNTED FOR PREPAYMENT
--------------------------------------------------------------------.-----------------
The above assessment has been established pursuant to the Pasco County Ordinance
No. 89-07 and Resolution No. 89-197 as commended.
THE ASSESSMENT WILL BE CALCULATED AT THE TIME OF ISSUANCE OF THE C/O. NO CERTIFICATE
OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE ASSESSMENT HAS BEEN PAID.
APPLICANT HEREBY ACKNOWLEDGES RECEIPT OF THIS NOTICE AND THE REQUIREMENT OF ASSESS~~NT
FEE PAYMENT PRIOR TO C/O OR FINp~ RELEASE.
DATE
RECEIVED BY
---------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
RECEIPT II
/'{77?3
DATE
P-:J-. qz.
~
BY