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BUILDING PERM!! 70116
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BUILDING
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ELECTRICAL
CITY OF ZEPHYRHILLS
(813)788-6611 . _~
,JdJ sf)- O~
(]~-1' 5'~-
PLUMBING MECHANICAL
Date /0 - 2.,-Q7'
,
Sewer Conn J/. a 7 s~ I ~
Water Conn: ~ /20 S. /3
~
A/ft
Water Meter:
Property Owner: 8L~Tj ~ ~tYJ 7l7~~ e:;; &h
Job Address: 'i'tJ:SU ~~~ 0B ~~c
Parcell.D. #
T.I.F.'s:
Zoning:
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.
DATE
Valuation or ':!- a...2.
Contract Price I~ ~/ /j'DO'
Inspector
:~;~~:;:e~ffiii - ~
Company
Address
Telephone#
City License Registration # ,.1l~C}
~~71En;;f CG; ;:~b
BUILDING ELECTRICAL iI/'fJ'.
~I1Y'-1J ~J'
PLUMBING 3>l3
f:)I~ '7J1u/2 ·
MECHANICAL~9,;2.1
Tp. Servo
Rough In //.../.tJ,'i? .e~
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM. I/-~. t:r? I.1/LL.
Insul. CL
WL
SLB
Tub Set / /, ~, ej'J 13/<..L
Water
Sewer
Final
Breakers
Ducts Insl. /1...6~97 Il"-'';f
Compressor
Final
Driveway
l4')~~ l'V?JI'\ ~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($"""") shall be made for each trip for each trade:
;l.5 --. ilV
Wrong Address
Condemned work resulting from faulty construction.
Repairs or corrections not made when inspection called.
Work not ready for inspection when called.
Permit not posted on job site.
Plans not at job site.
Work not accessible.
a.
b.
c.
d.
e.
f.
g.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
-i r
APPLICATION FOR PERKlT
CITY OF ZEPHYRHlLLS
BUILDIJG DEPARTqNT
~~6 t:;~i te>>;,~~.
::050 ~ti.. ~~~,41U>
7tJS/) Q./H<. ~1I{'fFl//I1!d/
PHONE
f? a~. ;1:_. '::";~.
~~. ~' I
. O~o15~
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;_1
OWNER'S NAKE
OWNER'S ADDRESS
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ~teration _Repair _Install
_Sign _Hove _Deaolish
PROPOSED USE: _Single Faaily _M/F _' of Units _M/H
_ec-ercial _Indust. _Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESGRIPl'ION OF WORK: "';;:;?E2/NZ. ~,;4/Pf//1.7/4,J.- ~.d..4t#A~c.~T<<:-/
--'"
..c
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKlTS REOUESTED
~UILDING
$
/%t:/LJo. ~
Valuation of Total Construction
_ELECl'RICAL
AItP Service
Florida Power Corp.
W.R.E.C.
----"ECllARICAL
$
Val.uation of Mechanical Installation
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUcnON: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVAITONS:
FT.
IS PROJECT IN FLOOD ZONE AREA'l
YES NO
******************************************
Signature
CONTRACTOR SECTION
mKPANY &t.c. ~.NJ".7~t~ ~ 6.. -Me.
State Cert. or Regist. . tf)..t78f~
City License Registration . ~~9
* ****************************************
/"
/'
v
RUII.DER
--,.,
COMPANY ,4. ;P ~ h~~:.7R/C
State Cert. or Regist. .
~ , City License Registration' '~
****************************************** I
I~'
Signature
~f lJJbd
COMPANY ~'E.e 4eljfAA//I'.A{';
State Cert. or Regist. . t!...F G()-:z.. ~8 CoD
City License Registration .
******************************************
~g3
/
v
PLUMBER
MECHANICAL /'1
Signature I~#f'~
,
COMPANY ~
State Cert. or Regist. .
City License Registration .
******************************************
OTHRR COMPANY
State Cert. or Regist. .
Signature City License Registration f
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
"A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to "deed restrictions. which lay be lOre restrictive than City
regulations. The undersigned assUles responsibility for cOlpliance with IDlY applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay be reguired to be licensed in accordance with
state and local regulations. If the contractor is not licensed as reguired by law, both the OlDer and contractor lay be
cited for a lisdeleanor violation under state IaN. If the ONner or intended contractor are uncertain as to what licensing
reguirelents lay apply for the intended Nork, they are advised to contact the City of Zephyrhills Building Departlent, (813)
188-6611.
FurtherlOre, if the ONner has hired a contractor or contractors, he is advised to have the contractor(s) 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 IOU 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 ~1
D. CONSTRUC'I'ION LIEN L1\W (CHAPTER 713, FLORIDA STATUTES1 AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law _ HoIeowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is 8OIeOOe other than the
.0wnerD, I certify that I have obtained a copy of the above described doculent and prOlise in good faith to deliver it to the
DownerD prior to COllenCelent.
E. CONTRACTOR' S/OWNER' S AFFIDAVI'l'
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, loning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no worl or
installation has cOllenced prior to issuance of a perlit and that all work will be perf oIled to Jeet standards of all laws
regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDlental 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:
f Departlent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treatlent
I Southwest Florida Water Hanagetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I Arl' Corps of Engineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health & Rehabilitative Services, EnviroDlental Health Unit - Wells, Wastewater Treatlent, Septic lanks
f US EnviroDlental Protection Agency - Asbestos abatelent
I also certIfy that, if fIll laterial is to be used in Flood Zone DA- 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 tbe 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
reguiring a correction of errors in plans, construction, or vioiations of any code. Bvery penit issued shall beeme invalid
unless the work authoriled by such perlit is cOll8nced within sil IOnths of issuance, or if work authorized by the peClit is
suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day 81tension of tille, 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 inspection lust be logged during each sil IOnth period, or the project will be considered abandoned.
WARNING TO OIIMER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCEHENT HAY RESULT IN YOUR PAYING TWICK FOR IIIPROVIIIIIIS TO YOUR
PROPERTY. IF 1'OU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LBJlDIlR OR All ATTORIBY BEFORE RlCOHDING YOUR MorICI OF
7" ~5lIl! IN VAtUl 00 IllJT NIiID ro IlICfll/D AID POS'A:1:;O-. . . I
SIGlAIUIUI: llmR OIl AGm~ -SI~
--
STATE OF FLO~,,'"
COUNTY OF
The forego1ng instrumenf-was ~Utowledged
before me this CS0?~~ \ 0 , 19:Ji. by
~~lc:l \"-\~~~
who is personally known to me or-whe-has
pradueed N\. ~\'
as identification and who did/did not
~"-:~ ~. \~"""--
(Sign ure) ,
JUNE M. HERNDON
(Name Typed, d t.tl" . 1
NOTARY PUBLI :TIlnl_NlIIclJn\lelV<<ll8ll
STATE OF FLORIDA ",
COUNTY OF ,~(:)
The foregOing instrument was ~~wledged
before me this ~ ~ ' \ () , 19\ by
C:....-~~~\~~ \:J. ~oo \li;(
who is personally known to me or who lias-
PEOdaeed ' ~ 'J \ f\-"
as identification and who did/did Dot
~~.~~<\~
(Signat re)
(Name Typed, oQ
NOTARY PUBL i;&: . ~~ MY COMMISSION' CC S9llOO9
_ \ ~i EXPIRES: FebnIaly 1. 2001
-, ..Rf.-x:.'t-'.- Bonded 11IIu NolIIy Publlc uncIIlwI1lIII
E.P.M.C.
7050 GALL BLVD.
INTERIOR RENOVATIONS (DISCHARGE AREA)
SQ. FEET PRICE
MAIN OR LIVING AREA 3,648 $ 50.00
OTHER AREA UNDER ROOF - $ -
'c OTHER $ -
VALUATION $ 182,400.00
FEE SHEET $ 719.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 1,078.50
ELECTRICAL: $ 75.40
PLUMBING: $ 67.50
MECHANICAL: $ 55.00
RADON: $ -
CREDIT: $ -
TOTAL $ 1,276.40
SEWER: $ 4,393.15
WATER: $ 1,203.15
TOTAL: $ 5,596.30
CITY OF ZEPHYRHILLS CONNECTION FEES TABLE A - WORKSHEET
ORD. #395/RESOLUTIONS 312/372 WATER $1.75 GAl. SEWER $6.39/GAL
RESIDENTIAL (Each Lot or Unit)
Residence $ 437.50 $ 1,597.50
Travel Trailer Park $ 164.06 $ 599.06
COMMERCIAL (Per fixture)
Sinks $ 109.38 $ 399.38
Water Closet $ 164.06 $ 599.06
Urinal $ 109.38 $ 399.38
Lavatory $ 54.69 $ 199.69
Tub/Shower $ 109.38 $ 399.38
Washing Machine-Commercial Size $ 437.50 $ 1,597.50
Washing Machine-Domestic Size $ 109.38 $ 399.38
Dishwasher-Limited Use $ 109.38 $ 399.38
Food Service-Dishwasher $ 875.00 $ 3,195.00
Sinks (3-Comoartment) $ 218.75 $ 798.75
Car Wash (Per stall) $ 1,250.00 $ 9,787.50
Car Wash (Reclaimed water) (Per stall) $ 625.00 $ 3,993.75
SINKS 50 5 $ 546.90 $ 1,996..90 $ 2,543.80
WATER CLOSETS 75 3 $ 492.18 $ 1,797..18 $ 2,289.36
URINALS 50 $ - $ .. $ -
LAVATORIES 25 3 $ 164.07 $ 599.07 $ 763.14
TUB/SHOWERS 50 $ - $ .. $ -
WASH. MACH. COMM. 200 $ - $ .. $ -
WASH. MACH DOM. 560 $ - $ .. $ -
DISHWASHER COMM. 400 $ - $ o. $ -
DISHWASHER LIMITED USE 60 $ - $ o. $ -
SINKS-3 COMPARTMENT 100 $ - $ o. $ -
CAR WASH PER/STALL 1000 $ - $ O' $ -
CAR WASH (RECLAIMED WATER) PER/STALL NJA $ - $ _.
SUB-TOTAL $ 1,203.15 $ 4,393.15 $ 5,596.30
WATER METER
GRAND TOTAL $ 5,596.30
FIXTURE
G.P.D.
#
WATER
SEWER TOTAL PER FIXTURE
6l-~.
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~
UiILU{
~ 7. 50
7 S,lfO
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N/A
~ li.rM.C
7050 G-'l'-L ISL.v.
ll'J-riiZ-L DYL. ~vr\17 &A ~ l:> c...ltFW..&i-. ~A)
50~~~ x: 3t &.,~ ~ CD
Lo~e.c.-f-l ~ A.l f ~
5 o.~ 'f:--s - 5"
U1"~ - ~
LV/c. - 3
KIf)'d.~ Gy-r, rJ/ (7
TflmJS. N/tt
~
- This~Instrument Pl"cpurcd Uy:
Namc:
Address:
,-
11"11I11111 \"'11111I1111111111 11111 11111 111I \111
97111c:55
NOTICE OF COM~lENCEMENT
Rcot: 1855&9
DS: 0. 0121
10/02,nn
Rec:
IT:
10.50
0.0121
Dotv ClerK
Permit No.
STATE OF Florida
COUNTY OF Pasco
JED PITTMAN, PASCO COUNTY CLER:{
1121/02/97 12: 44pID 1 of 2 ".
OR BK 3813 PG 1688
TilE UNDERSIGNED herby gives notice that improvement will be maje to certain real
property. and in accordance wi th Chapter 713. Florida Statues. the following
infor-mation is provided in this Noticc of Commencement.
1. Description of pr-operty: (legal descr-iption of property, und street address if
available) See Attached!
2. General description of improvement:
Discharge Center Renovations
3. Owner information
a. Name and address:
Adventist Health Systems, D/B/A. East Pasco Medical Center
7050 Gall Boulevard - Zephyrhills, Florida 33:;41
b. Interest in propertY:OWner
c. Name and address of fee simple titleholder (if other than owner): CPwner
R ~.
5.
Surety
a. Name and address: N/A
Poole Construction Company, Inc.
544 Douglas Avenue
Altamonte Springs, Florida 32714
Contractor: (name and address)
b. Amount of bond $ N/A
G. Lender: (name and address) N/A
7. Persons within the State of Florida designated by Owner upon whoa notices or
other documents may be served as provided by Section 7l3.l3(l){a)1. Florida
Statutes: (n81lle and address) David Haugan
East Pasco Medical Center
7050 Gall Boulevard - Zephvrhills Florida 33541
designates Che 1011ow1ng personlsl~ receTve
as provided in Scction 7l3.l3{l){b).Florida
The Edge Group Consultants, Inc.
444 Bunker Road - suite #201
West Palm Beach Florida 31405
9. Expiration date of notice of commencement -(the expir!ltfon date is 1. year froD'
the date of recording unless a different date is specified)
~ K-. ~ David HaUC2n
, {Signature of Own~ (Print Owner's Naulel
Owner's Address: 7050 Gall Boulevard - Zephyrhills, Florida 33541
The foregoing instrument was acknowledged before me this ~ / :5i) ,C?'7 by
\:)0\\1 \C\ \-\tWC)~ \, 0s pers~nall;k~~~/WhO produ.::ed
8.
In addition to himself, Owner
a copy of the Lienor's Notice
Statutes: (name and address)
(Fd - ~Aft ~ ,#f,/,J.c, (!,~1-<~
as identification and who did not take an oath.
State of Florida County Of~~~ C ~
(\)"'N""'~ ,,,",,,,,,, . ~~\-\.J"(\.\.",,,-- Hy Commission Expires:
'," (Notary)
Commission /I
JUNE M. HERNDON
ISSIIN , CC 590009
lJ.i EXPIRES: FebruIIY 1. 2001
'7 IIondId nuu NalIIY NlIID \MdIIWIIIIII
All Information Must Be Typed or Printed Legib
to Comply With Recording Requirements
LEG A L
ZEPHYRHILLS COLONY CO lANDS
ING H OF DAIRY RD R/~ AS NO~
122 & TR 103 EXC ~ 187 FT OF E
OF TR 104 ALL EXC US HWY 301
FOR P08 TH AlG N LN TR 105
100 FT H OF HE COR TR 1A~ TH
LN IR 104 100 FT W OF NE COR
103 S89DG 55' 34"C 480.69 Fl'
~;8<'\DG ~S' 2'1'E 172.01 FT TO \/
1H ALG ~ LN r.:/\-! SOOOG 1 ()' .q 50 \.I
c:EING t-j LN DA~C;HTER'( IW R/~
552.04 Fl' TO SW COR TR 122 TH
COR TR 120 TH N89DG 56' 31"W
R/~ TH ALG E LN R/W N000G 18'
LESS THAT PT l'R 122 LYING 30
~"_.
OR BK 381 3
2 of 2
PG 1 & 89
o Ese RIP T ION:
PB 1 PC 55 FOLL OESC PROP LY-
LOCATED TRS 105 106 119 120 a
267 FT OF N 172 FT & E 10e FT
f~/W ALL At~A COM NW COR TR I(JS
S89DG 56' 33'E 543.35 FT TO Pl
MOGDC 09' OJ'C ~J1.~4 FT TD N
lR 104 TM AlG N IN TRS 10Q &
lH SOODC 10' 4~'~ 172.00 FT TH
LN t)(, rr-:Y RG R/\.l A~' HO~ LOCI~TCu
1137.22 FT TO S LN TR 172
l'H AI G N LN R/~ N890C 59' 300H
Noooe 09' 03'E 316.21 r'r TO S~
645. ;.8 FT TO E LN us I.u.n 301
:-lO . E .'Jl.. 7. . eo F 1 1 G F1J[:
Fi N OF SOUTH L]NE S~C
. 'on"",,, ~ ,,'
STATE OF FLORiO.'
COUNTY OF PASCO
THIS IS TO CERTlFY TH~T 'THt F0~r~:OiNG. I~S A
TRUE AND coRRECT CGP'( Of Hi;: ?0~:.~i~'C.;:-: .L'~ ,r~LE
OR OF PU811~ RECORi> IN THIS ()r;'h.c.-:t~":':,'S 1,!tY
HAND ~~'CIAL SEAL :~~ cfJ!JsL uM OF
__ 1~ 1:1...
JED !1iTJMAN CI ERK OF CIRClil1 C~llRT .
BY ~'lf}fj~ D.C.