HomeMy WebLinkAbout99-8954
BUILDING PE,RMIT
8954
Date /0 1')6 1ft(
Permit
ELECTRICAL
Sewer Conn
Water Conn:
-7;-
'2,07b. -
S.t~. ':d.
Property Owner: .J"4} +- Pt'''.! (. () fV\e oA..' c..,\,' L.oA;t, W
Job Address: If) 50 6-C\. \L..BJ""",.
Water Meter: - ..,
TI.F.'s: ;;} DJ 30(,. L.
Parcell.D, #
Zoning: Energy Code:
DescriPtion of Work 73(, 0 S'~. F-..... AeloI.
~2
Radon Gas: _'23. -
- ~q)l ~5J' F+
R ~ c:J VI.1.,f. ~ 1'1
NO OCCUPANCY BEFORE C.O,
FINAL
s:.- - /1) ij)
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O,
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
Valuation or .-J 0"'"
Contract Price I
I /2 0 ~
~'-/~
9111
Permit Fee
:Jj;j;~
City License Registration #
State Certified License#
- Signature
Company
Address
~€ (0'" S~.
A. P 6- ~/el.
'f J.
ELECTRICAL
_ Telephone# ~ i) 8~ 2- ;Z W~
lkrrer Mec'-'.
3i3
PLUMBING
BUILDING
/-krl.)b "'ec~.
, 3 i2.
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
~~L~<Aj -Z-IO-OO(@
~ Brv...-. j [Jv <-;'" 3" Z- ~o /) .2 R...
REINSPECTION FEE~xtra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25.00) shall be made for each trip for each trade:
Ftr.
Pre SLB
Lintel
Breakers
Ducts Insl.
Compressor
Final
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
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.
EAST PASCO MEDICAL CENTER
7050 GALL BLVD,
E.R. RENOVATION & ADDITION
SQ. FEET PRICE
ADDITION 7,360 $ 105.00
RENOVATIONS 4,972 $ 60,00
OTHER
VALUATION $ 1,071,120.00
FEE SHEET $ 2,814.00
ADDRESS $ -
DRIVEWAY $ -
~
BUILDING: $ 4,221,00
CREDIT:
BUILDING LESS CREDIT: $ 4,221.00
ELECTRICAL: $ 227.88
PLUMBING: $ 235,00
MECHANICAL: $ 740.00
RADON: $ 123.32
TOTAL $ 5,547.20
.
SEWER: $ 5,112.00 $ 7,188,75
WATER: $ 1,400.00 $ 1,968.75
SUB-TOTAL $ 6,512.00 $ 9,157.50
TOTAL $ 2,645.50
EXISTING
NEW
.
3/4" WATER METER:~ $
T IF'S: $
99% $
1% $
20,306.24
20,103.18
203.06
.0
TOTAL: $ 28,498.94
CITY OF ZEPHYRHILLS CONNECTION FEES TABLE A - WORKSHEET
ORD. #395/RESOLUTIONS 3121372 WATER $1.75 GAL. SEWER $6.39/GAL
RESIDENTIAL (Each Lot or Unit)
Residence $ 350.00 $ 1,278.00
Travel Trailer Park $ 131.25 $ 479.25
COMMERCIAL (Per fixture)
Sinks $ 87,50 $ 319.50
Water Closet $ 131.25 $ 479,25
Urinal $ 87.50 $ 319,50
Lavatorv $ 43.75 $ 159.75
Tub/Shower $ 87.50 $ 319.50
WashinQ Machine-Commercial Size $ 350.00 $ 1,278.00
WashinQ Machine-Domestic Size $ 87.50 $ 319.50
Dishwasher-Limited Use $ 87.50 $ 319.50
Food Service-Dishwasher $ 700,00 $ 2,556.00
Sinks (3-Compartment) $ 175,00 $ 639.00
Car Wash (Per Stall) $ 1,000.00 $ 6,390,00
SINKS 50 11 $ 962.50 $ 3,514.50 $ 4,477,00
WATER CLOSETS 75 4 $ 525.00 $ 1,917.00 $ 2,442.00
URINALS 50 1 $ 87.50 $ 319.50 $ 407.00
LAVATORIES 25 7 $ 306.25 $ 1,118.25 $ 1,424.50
TUB/SHOWERS 50 1 $ 87.50 $ 319.50 $ 407,00
WASH. MACH. COMM. 560 $ - $ - $ -
WASH. MACH DOM, 200 $ - $ - $ -
DISHWASHER COMM. 400 $ - $ - $ -
DISHWASHER LIMITED USE 60 $ - $ - $ -
SINKS-3 COMPARTMENT 100 $ - $ - $ -
CAR WASH PERIST ALL 1000 $ - $ - $ -
IRRIGATION METER
SUB-TOTAL $ 1,968.75 $ 7,188.75 $ 9,157.50
WATER METER
IRRIGATION METER
IRRIGATION CONNECTION FEE
GRAND TOTAL $ 9,157.50
FIXTURE
G.P.D.
#
WATER
SEWER TOTAL PER FIXTURE
10/4/99
~. . :1:'L.?"'\
.p.- ~~ 'f< I'I'~ j) ,11 ~
..- '), .
i2-r j;~ <.. .
-} 1'J <; CJ (y(-\U..- ,~v../,
t ~
SQ. FEET
AIN OR LIVING AREA {~<oo
OTHER AREA UNDER ROOF J-fc, 72-
~ l~
OTHER
BUILDING:
ELECTRICAL:
PLUMBING: Z3c:.;. 6~
MECHANICAL: "7'10 , ~)o
73f.oD RADON: 1173 .bD
CREDIT: rJ 1/1
SEWER:
WATER:
TOT AL:
()\I~
T.I.F'sl
........ "'oiIiT.
PRICE
/0 ~-.:.~
,0.
r-
,-,"1, Q '-'
CJt.) ,
I
~-.
APPLICATION 1"01\ PEI\11 IT
CITY OF ZEPlIymllLLs
BUILDING DEl'Al<nlEliT
rxqft~ j1Jl9'
OWNER'S NAME______
Ea s t Pas co 1.10. r1 j c: ,:11 C'c> nl:.c)'
w_____.___.___~_._~.__...__...__.__._______
PHONE
(813) 788-0411
miNER I S ADDRESS
7050 Gall 80ulcvn~(1
~/; C
.:: 11 .i. 11 r; ,
:' L 3 3 5 4 1
._-~~._--_._~..._-_._-_._._--
JOB ADDRESS
Same As Abm/0
---_..-.__.~----+-- .._--- --~---
LEGAL DESCRIPTION: LOT(S)
See i\tti1ch(~c1! lI!,(lCV ,';IJllDJVISION
--, '--.,---...-
PARCEL 1,1),*
WORK
('Q~"^Tti FonM J)0(1DI10'l'Y 'rAY )J1'I'T'Tf'!:'\
~ ---::r----..-~lfii-.-\..:.'- ::J'';;~7.!......L.!~J.J-~LAJ,!}.A.L~
?f~() fr. ~~I'V -T"J'.2.sF ~/)'(A"7/M
PROPOSEI) :_Ne\~ Construction ~/\dd j UOfl _.._:~__ill t:(~ra t ion _Repair _Ins tall
___Sign
__Jlo\'f)
f) (' 111 () I i Ii h
PROPOSED USE: _Single Family
_H/F
II 0 r UIll t:s
_I'l/I!
v
---':':""Commercial
] (\ d \ U,; t: ,
Sldlil, Pool
_Other
__Hes tnurant & HeaLth 1J()p:t f' LrH'1l i. /\pPf'o\';ll
,;
DESCRIPTIOII OF \-/Ol<K: Ra ~t Pasco l'1.edic_~J.S_~I!_'l:_c=_.t;_.-=_~.~.~E!.::ov~!ion ~_~
BUILDING SIZE: __X_.
S q WI 1.' (~ [,' (' c I.: ,.....________11 e i p,11 L
Addi ti~tIf'Mb',J t .'J;,~
, h~4'6.M<-
RESIDENTIAL:
COMMERCIAL :
ATT^CH (2) PLOT PLANS<< (/.) ~;ETS OF I\II1LilJ1/G PJ.i\NS [( (1) SET ENERGY FOR1-1S,
ATTACH (3) SETS OF nUILIlI1IC; PLI\NS t, (1) [JET E1IERGY FORI'iS.
PIWl'ERTY SURVEY REQUIIUW FOH ;\LL lH:\! C()il~;Tl~lJCTTO;i,
l~illl.1JJiLBI;:S.J. !jJ:~DJ::J2
~BUILDING
--':_ELECTRICAL
?"~'..'.HR7'lJA~'\L'
$
VnlU:1UOIl of To (:.'!] Consl:l't1ction
AMP Servlc(~
__.__I"lorid:\ l'()\'l0.t- Corp,
_W,R.E,C,
$
VaLtl:\t.iO[l or iicck1l1ic:)] Instnllntiofl
c-c.K.p.r.tfM~... -
TYPE OF CONSTIWGTJON: _Block
GAS'
_,________._)~(J()F 1 ;!(;
...-.... _._______S l' E(;1;\ LTY
Fr-:I.:']()
.';(:(>(> I
FINISHED FLOOR ELEVATIONS:
...-.~------.
Other
Xl',
J ': 1')\0,) I: crIll I-' f,(H)!l i",ON (': AHEM
mIll.121m
~ emil' All '__..._,:,.,,; c> Con n t no c t ion C':'c.0 0; ,
St:nl:(~ Core. or Ecgist. If CG~:=;:7G:.J
City l.icr'w;(~ Hcr;i~;(:rilLion if -2<)~ ~ -:
* * * * * * * * * tt * -k -/I: -It * -It 'k t. t. ^ ~ J': -I: I " .~ * :, .\ -It f'o 1< :\ * It -It -!: f: f: t< ." 1\ ;/
YES i;O " '>
***ft*1\f:***-It-lt*1:*"~, ~:'::'., {, 1::' ('.'::'", :~"':1J~ :\,~* P::,.,\ :~t:I, 1':1_ 4D1-9~-"
iLoiLU\"IG'I.'(nL~; j':CTIO)l 7~
Signature
fLLEC:TRI eIMi
S.il?flf.Lt\Jr:e [~~
COlII' i\ In'..____---.:'i~__.:~ 1 ':~ c:J: c: :i. c: ,
~; 1.1\ t: I~ C; (' r t. () r r.~ (~[:. i!i t, il
C i L Y 1. i U' 11.'; () 1\ (~e i ,'; I: r 1\ I. 1. 0 II
*~**************h~~*~~~tth~,~,~.~~A~*k***'t.^A
IilC.
EC OOO,,'iGG
iy--LGZ ~
rlJlliJl1ili
COllPMIY
t!l~,tHAtll..Ql0~
~-----_........ -'-"'~'",
S 1.[1,rl:1 ture
QJJ.Uill
S igrw. tu re
c em P;\ I n:._._......___.__
SI::)tJ~ (;('rl:, OJ: Heglsl:, fI
C l t: Y I. i c(' n [; c H 0.[~ i s I: 1.' aU 0 n II
*****************-It**t<*-It-lt-l:~-I:~~-I:f:-It****-Itf:***.
~PPLICATION APPROVED DY
~-"------'--
PEPJIIT OFfICER.
/
/
C:UIIUJTlU!lS OJ<' !'li:mlJT l\FFID1\Vl'l'
1\ . NOT I ~~ QF ]) E E])]1 E ~; 'I' Ul.(.::!'L(J.1I~J.
Th~ undersiglled unJerf,l:li,(j;'--'liiilL -liiis'i'i:,IJiL 'i,I'( iH~ ,;u!'jl:cI LiI "I!t:d 11~!;Lriclionn" lIhich lay be lore restrictiva th
reguJ(]tiul!S, Till! 1Ilidl:ISiYlleU in;;;lIilfc:; 11'::P'.!lliiildlil.y [Ill cl'"plitllICC wiLh illlY applicable lleeu restrictions,
"
,CiLy ""
B, UNLICE!~S_hi;]) CON'l'H^C'l'()j(~; JIllU CUWI'lU\C'J'Uj( HESl'ONSIlJILI'l'IES
If the owner has lJ[ed a contriJCLor-o~:'-(~ul;t:r;lclors'lo"uii'JI;'i:l~}'-e-~;'oiT;ti1ey lay be raquired to be licensed in accordmce \(iUl
state and local rcguliJLions, If the conLrilcLOI b noL 1 iC11n!;eil ili; requifl:u by lall, both tha ollner and contractor IJ1 be
dtell for a mistleaeilllor '!io]olion \JllrJer uLilLe lilli, If [Ill' OIII!!'1 or InLI!nlleu contractor are uncortain as to what liJol1sing
requirCllents ~oY ilPpll' for L1le inLI'ntJcd \1'.11)" 1111'1' ill': i1l1..i';I:r1 \.0 CUIILild the City of Zephyrhills Uui111ing Departllent, (013)
788-6611.
Furthermore, if tile uliner liils Iii red il cUlIll"dol l'l cOillnl;loll;, hi; is iJdvised to have the contrilctor(s) sign portions of the'
'Contractor Sections" uf lids ilpP] iCiJLiol1 (or \iilicll L11i~Y :,ill bil le!ipoll~jiole. If you, as the Ulmer Ilign as tha cor tractor,
you are indicating Lilat you, raLher I.hilll till' cOI1Lrilcl.ol, ille [I;;ipon:;ibln (or Lhe \lork. If tha contractor wishes you to Ilign
as contractor that VilY be lJn ili'Jicill.iOil L1lilL lie is noL prc'piJr1v licensed ':\lld Is not entitleu to peuilting privilegell in tha
City of Zephyrhills,
.,J,'
C. TH^H.~l!Q!J!'0}'JQ!!. H1I'j\CT FJ';I;~:) )\111) U'J'LI~,,r'Cin_C.9NNEC'l'ION FEES
0, CONS'l'l\UC'l'ION LIEN l:i\\'i (Clli\l''l'EH 'ILl, FL,OHIIJl\ S'l'J\'l'U'l'ES, l\S J\MENDED)
I certfyYti8L-I~li\eQiipIlc~iiL-,--iJiiv'e'Gl;-rili' providc:d \/illl i1 cOPl' of "F]oriua's Construction Lien Lall - Ilollluowoar's Protection
Guille" prepMeo by the FIoriUil lJepiJ[L~!!lIl of rlljriClIllure <IIHJ COIl:;\I~er fl[fDirs. If tllU applicant io SOJleOIlU other than Ule
'o~ner", I certily Lilut I hol'e oblaillell <I cup/, of tllIl <lbO','11 1\\'::1:[ illlli) tlocll~elil uliU prolise in gooo faith to de1iver"it to' the
"o\iner" priur l.o co:wellce~elll.
. '~~',-"
E.. CONTI\J\C'l'OH I S LQ~lil~)l'._~)..._!~EtLU{\_YX'X
l'cer,tify that arlllie in(onation ill l.lli!; ,)pplicillio:1 i;; iICClllill.!1 olld Lliill all work will bu uone in cOl'lpliance with all
app-Jicable la~s regul(]Lin'j cUllsLrucliull, 7,1,1IiiII'J, ,):1.1 JiII:J li::','e,]lil)~eIIL,
,',pplicalicl1 is 1:'~['2iJi ;JilOe Lo OlJLilill i1 pl~I'J! l. l.u il') \1')1 L ;illlJ JII:;l.allillioll ill! illuicilteu. I certify that no \lark or
installatioll has coe~ellclld prior Lo is;;UilIlCI~ o[ ,1 pel,1 i L illld \l1i)L ill I \lI)rk Ifill be perfonod to loot sLanuardB or all lallB
regulatillg construction, CiLy coues, wllillg rcguL1Liol\!J, iilld LIII,I uevelopMcnt ragulations in the jurisdiction. I also
certify L1lat [ ulluersLolIl] L1liiL Llie ICII'JlilliclI:; llf olllllr I]O'iCll1iJeIlLil] iltjeneies !'Joy apply tu tbe intal1ucu \lork, and that it ill
Ii' responsibi jHl' Lo irlellli (y \llioL ileL iOllS r "uIIL Lill,lI l.o be il\ co~pliilllce, Sueh agencies incluuc but arc not lilited to:
I OeparuenL o[ EI~;'J..[__~.I_1!:!~1j...lI.U~~g~ll~.U.~~ - C'ipresl) Bilylleilrls, \{el:lill1d ^rea8 alld Rnvirolllentally Sensitive Lanue,
\{"l.e I /\ii1S le';(ii LI! I' 1 lea l~ellt
I Soutll'liest Florida. \iil~.QiJi~~~g~.~~J_~l.I!.Lri.c1 ,. \lell8, Cypress Bil'(IiQaUB, \/etland t\reas, t\lteril1~ Watcrcouroes
I Miy Corps o[ f;~i-'L~!:~ - Seawal'Js, /Jud.iJ, HiI'.'i(jallJe \!iJLer\iiJYs
I DeDartlent o[ Il~.QHJ!~Deh~.!E~(]_t)..'I.~.S~.r:I!.~:.I:.:'Ll':~I\,jr~~l~~II~~J__!~~_al.tll_~I1J.l - \lello, Wastewater TreatlJent, Septic Tanks
I US Env i ron3en ~~l1:i.~.hec ll.Q~I..i~_~.~D - "I, bE!, lUl; i\billlJ~r:lll
I also celli[]' L1lil\., if fill aillcriill iE to 1)11 used ill 1:]ol)rJ ZUlli! "1\" lIr "I\,eLe,', it is unuerstooO that a drainago plan
addressing u "coupcniJaLin'J vu]uije" Hill L'e :;u!JJiLll:rJ \filil:11 il; prepoHl:U lIy u pro[esllional engineer registerell in the State of
Florida prior Lo pcr~it issuilnce.
,', peruit iSSUe'] Sllilll be COllstruc:d l.o ~I.; ,1 I iCllilil'2 Lo plO(:1211\1 \;ith L1Je \iOrr. ul1d not illl authority to violate, cancel alter, or
set asioe an'i ~rl.ivisiol1s o[ Lhe Lechi1icill codell, 1I0l' [;llilll lSliulIllce o[ a permit ~revent the nuiluing Official frol thereafter
requiring a co[rectiull o[ errors ill pla!IS, cOlIsLrucLiIJ!1, or viuli.111olls o[ allY coua, Every peult issued shall becolo invalid
unless the ~orr, auLhorized by such \1I2ruiL is co]~;ellr:erl ',:iLhill sh uOIiLhs o( issuance, or if worK authorizad by the pertit i6
suspended or abal\'Joileu [or 0 period o[ six lild.llli idtu the ti::e the \lor}; is cOlLlIenceu, One 90 day e1.tension of tile, lay be
alJo)(ed [or Lhe peluitliiLh fei; cliiJ[~': of il~"I)(1, '[l1i~ l'yl..I'li!;!!)11 i;liilll Oil reque6tell in \triLing to the Uullding OffIcial. ^n
2;,proYCQ ir:s~'ccLil):1 ~'J:)L lie logged Ihll!;)() [';dl "jv ~(\IIL11 i'lli'ioll, or Life project will be consillerell ubanlloncll,
\ir',RSIHG TO U'~',~::ii: YOIj!! F,ilLUiiE TO iif:U;ii[) ,i I;U!'!U: (I' '(!li;!':!:U!!!';!if )((,Y 1\r:~ilJLT IN yaUH P^YlHG T\l1C8 FOn 1HPHOVE1IEKTS TO YOUIl
FF.OmE. I? YUU I m:!W 'fU O!lT,''! H F I ~ii!iClli',;, U)!i~.:ULr \i 1 rii YOU!I Li~Hllf:1l Oil l\lj ^1'TOIlHEY UEFOIlE IlliCOIlJJiHG YOUIl K(YllCB OF
CIJr,IjEHCEHEHT, ~iJi!:; U!i:JEfI 12, ~,()O 11; '.'r'liIH; UU I:UI' I:L!:!) '\11 li!)))!!l) fl:LI i'UST 1\ "NUTlCE UP CUlOlEHCEHENl'''"
STi'iE Or f~,\
coum OF _L~..<::.__~___...__u_..__._ ......
Tile f 0 l"l2\j 0 i 11 \jic;!J,~; L nl/lI~.1 L ',-li.H, ll. d.'1l m;.L l~ d (J I.! d
iJ ef 0 r (; m l2 III i [-; ~:;,d_-_JJ__. I J (F.\3.. !J y
~. ~\L \ C:'\"'___...nnm..
wll 16 )(; .sOllt1l1y 1\110'.'111 Lo 111(~ jOt' '.;110 llil:)
pro due (; d ._ _______.________h__.._____.. ___. _.____.._ n
as ide 1\ L if i C ,1li 011 ell I d ~Illo lli d / l1i rJ 11 0 I
all oalh
._-~~~~,
alure)
(lIame Typed, 1'r.llll:l2rl or ~; l.iIII1P(~il)
liOTMn PUULIC
,.~~'.l~';:j;;:, JUNE M. HERNDON
~{l"'''i!
i::~}: MY COMMISSION' CC 590009
~: ~~i EXPIRES: FpbflJlUY 1. 2001
~ -o;l Banded Thru Nolary PublIc Underwrlters
. ..'
~,T^TE UF FL~
CUUIiT\' UF ----t='~'5 CO
'1'1.1(; 101'(.1901119 il).Q..tyr'i.nt WilG tlclmowledged
IJI~[or(.1 me this t:> 'I , 19~ by
who has
. - ....-..- --.--...- ---.--.
(t1tlllH~ Typed, Printed or Stumped)
t10'1'^HY PUBLIC
JUNE M. HERNDON
MY COMMISSION' CC 590009
EXPIRES: FebruaIy 1, 2001
,.' Bonded TI1ru NotlIIy PublIc llnderwrl18F1
~
APPLICATION FOR PEWlIT
CITY OP ZEPHYRIlILLS
BUILDING DEPARnlENT
OWNER'S NAME
East Pasco Medical Center
PHONE
(813) 788-0411
OWNER'S ADDRESS____
7050 Gall Boulevard
Zephyrhills, FL 33541
JOB ADDRESS
Same As Above
LEGAL DESCRIPTION: LOT(S)
See Attached!
BLOCK,
SUBDIVISION
PARCEL I.D,/1o ~TAIN ~O~l P~ERTY TAX NOTICE)
?3'~o ~,J:' /lAP/Qo"" 11P7.:l/ s ~. ';1>77.
WORK PROPOSED:~New Construction ~Addition ~Alterlltion _Repair _Install
_Sign _~jove _Demolish
PROPOSED USE: _Single Family _Hip _I~ of Uni ts _H/H
X Commercial Indust, Swim, Pool Other
-- - ./,
- - 'I
_Restaurant
DESCRIPTION OF WORK:~;tD
& Health Department Approval
~~Y'A~,,/ ~ AlJ:>L?//?'o/
,
BUILDING SIZE:
~.
Square' Fee t ,
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,
PROPERTY SURVEY REQUIRED FOR ALL NEIl CONSTRUCTION,
12 E Rtn T S J1 {ill U t:..ITfJl
~BUILDING
~ELEc:rRICAL
$
Valuation of Total Construction
AMP Service
~I1ECHMaCAL
Florida Power Corp,
_W,R,E,C,
$
Valuation of l-leclwnical Installation
~PLUMBING
GAS'
ROOFING
SPECIALTY
TYPE OF CONSTRU~rl0N: ____Block
_Frame __St:eel
Other
FINISHED FLOOR ELEVATIONS:
IT,
IS PHOJEc,-r IN FLOOD ZONE AREA?
****************.***ft***Aft~***************
YES NO
.lHJILD 1m
CON T H!\.Q:...tQIL;;l~CLUlli
Signature
COl'lPANY Poole ConstJ~uction Co., I;~c.
State Cert. or Regist, 0 CG C027876
City License Registration fJ 249
******************************************
.ELEc:rRICIAli,
S i~..na ture
COMPANY_ APC Eleotric, Inc.
State Cert:. or Regist. # EC 0000486
City License Hegistration iF /7Jl.
******************************************
rLtJMBf;E /kZ COMPANY__~er ;'lcchanical
I'J...UA~// ~'-?14 ..DIb State Cert. or Hegist, if CF
Signature. -VW-R/P?-C >r(;r/'l City License Rcgistwtion II
******************************************
COr:)OrCl tion
CJ33860
l1E.QUL\NI C^~./ COftPANY_ i !arpey Heche n( c 21 CO"i'OC at ion
. >~ -- L Stn(:e CerL. or Regist. 11 G1 C0!;2S48
Signatur ' c: U~ City License Registration II ~'L
*************************.*.~************~
.78~
QILllil\
Signature
CONl'ANY
State Cert. or Regist. #
City License Registration 0
******************************************
\PPLICATION APPROVED BY
PEm-llT OFFICER,
CONUIT1,ONS OF PEIUU'l' l\FFID1\VI'l'
1\. NOTICE OF DEED HES'l'HIC'l'lONS
The undersigned understands that lIlis per!1liL-;;YGesuoject to "deed rc!;trictIon8" which lay be lore restrictive than City
regulations, The undersigned ilSSUles respons i bi I ity [or cOilpl i ance with ilny applicable deed restrictions,
B. UNLICENSED CONTHl\C'l'OHS I\NlJ CON'l'Hl\CTOH HESPONSIBILI'l'IES
If the owner 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 licenseu as requireil by law, both the owner and contractor lay be
cited for a lIisdeleanor violation ulHJer stilte lilW. If the owner or intended contractor are uncertain as to what licensing
requireJents !lay apply [or the intenued work, they llre advised Lo contilcL the City of Zephyrhills Building DepartIent, (813)
788-5511.
Furthenore, if the owner has hireil a contracLor or cOlltracLors, lie is ailvised to have the contractor(s) sign portions of the
'Contractor Sections" of this ilpplicalion. for \Ihich they will be responsible. If you, as tbe OlIner sign as the contractor,
you are indicating that you, rather than the conlrilclor, ilre responsible for the work, If the contract.or wishes you to sign
as contractor that lilY be an intJicatioll that lie is not properly licensed and is not entitled to peuitting privileges in tbe
City of Zephyrhiils,
C. THl\NSPOH'l'l\'l'ION IMPl\CT FEES l\ND UTI LI'l'Y CONNECTION FEES <,'
--~--------,-------
D. CONS'l'HUC'l'ION LIEN Li\i<J (ClIl\PTEH '113, FLOHIDl\ S'f1\'rUTES, 1\S AMENDED)
I certify that I, the applicilnt, have been provideuliith a copy of "Florida's Construction Lien Law - HOleowner's Protection
Guide" prepared by the Floriua Uepartment of Agriculture anu Con8uliler tI[[airs. If the applicant is sOleone other than the
'owner", I certify tllat I have obtained il copy o[ the above describet] doculIcnL ilno prolise in good faWI to oeliverrH to tbe
"owner" prior to COlllJenCesent,
E. CONTRl\CTOH ' S /OWNEH 'S l\FFIDIW IT
I certify that all the inforliltion in this application is accurate and L1lill all work will be done in co~pliance with all
applicable laws regulating construction, zoning, anu lalH] develop~ent,
I
Application is hereby ;ilde to obtain a perllit to do worK llnu installotion as indicated. I certify that no work or
installation has couenced prior to issuance of a per~it llllll that all work will be perfoncd to aeet standards of all laws
regulating construction, City coues, y,oning regulations, uiJU land developilent regulations in the jurisdiction. I also
certify that I unuerstilnu thilt the regulations o[ oLher goverrwcntlll aljencies lay apply to the intended work, and that it is
IY responsibility to identify whilt actions I must tar,e to be in co~pliance. Such agencies include but are not Hlited to:
I Deparl.Jent o[ Envirollllentll~aLion - Cypress l111ylieads, \ietlilnil Areos ond EnvirolUlentally Sensitive Lunds,
Wllter/Wastewaler Treatment
I Southwest Floriuo >lilter Hanag~g!!.t [JiS~!i5.~ - liells, Cypress DiJylieaus, \ietlonu Areas, J\ltering Watercourses
* I\rlY Corps of Engineers - Seawa}}s, [Jocks, Havigilble Wilterways
I Depart.lent of Health & Hehabilitative Service.~L Envir~~u,ent~lelllth Unit - 'Kells, Wastewater TreatJlent, Septic Tanks
* US Environ2ent!ll..Ri.glg,l:.tioIL~.genCl' - rlsbestos ilbille~elll
I also certify t/Jilt, if fill .aterial is to be used in Flood Zone "1\" or "A,etc, K, it is understood that a drainage plan
addressing il "collpensating voluue" will be sulJ~ilLe(] \Ihich is prepared by a professional engineer registered in the State of
Floriua prior to pertit issuonce.
r, partit issued sholl be construeu to be a license Lo proceed with the 'Kork and not as authority to violate, cancel alter, or
set aside any provisions of the technicul codes, !lor sllilll issuilnce of a permit prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every pauit issued shall becOIB invalid
unless the )lork authorized by such peraU is cot!llenced within si~ l'.1onths of issuance, or if work authorhed by the per.it is
suspended or abandoned [or a period of six Illonths after tile ti>Je the \lork is couenced, One 90 day extension of tUB, lay be
allowed for the permit 'Aith fee cllllrge of $15.00. Tlie extelHiion shilll be requested in writing to the Building Official. An
approved inspection lust be loggeu uur ir:g eociJ si~ t!onth periou, or the project will be considered abandoned.
IIARHIHG TO OIlHER: YOUH PI~ lLUnE TO I1ECOIIIl ^ fiOT ICE OF COK}1EIiCEHEHT f(IW HESUL T IN YOUR PAYlHG TWICE FOR IHPROVIlliElfTS TO YOUI!
PROPERTY. II' YOU lHTEHIl TO OUrAlH FiHlIHCIHG, COHSULT \ilTlI YOUn LEHIlEn on AH J\TTORNEY BEFORE RECOlillING YOUR 1l00ICE OF
COIOlEHCEHEHT. JOGS UHIlEn $2,500 IH VM,UE 00 HOT HEW 1'0 IIECOllll Mill POST I~ "HOTICE OF COMMENCEMENT",,'
SIGHATlIHE: COHTMCTOH
SIGHAIUHE: O~HEn UII AGENT
wa s (] cKnow 1 e[19 ed
19 by
STATE OF FLOHIDA
CUUlITY OF
The foregoing instrument
IJofore me this
STrITE OF FLOHlDrl
COUN1Y OF
TIle foregoing ins trumen t
before me this
was acknowledged
, 19_ by
elll U who u i u / u i [1 no L
wli-o is p-ersonally Known to me or who has
prouuced
uS iuen lification and who did/did not
luke un oath.
who is personully
produced
as identification
ta~e an oath,
Known to me or 1'1110 lli.l~;
(Signature)
(Si~Jnu lure)
(Name Typed, Printed or SLumped)
NOTIIRY PUBLIC
plume Typed, Printed or Stamped)
HOTIIHY PUBLIC
)'his JI\~::..rUl~eJlL Prcput-ed By:
th,me;
Addr'ess:
"HIII mn 111II 111II HIlI II II IIllI 11II 'flf
9910't189
Pel'mit /lo.
Rcpt: 350842
DS: 0.00
08/17/99
Rec:
IT:
NOTICE OF CO~l~lENCENE.NT
10.50
0.00
Dpty Clerk
JED PITTMAN, PASCO COUNTY CLERk
08/17/99 11:02a. 1 of 2
OR BK 4208 PG 1042
STATE OF F] or; c1rl
COUr<TV OPa !'ir:n
TilE UNDEHSIGNED her'by gives notice that improvement will be maje to cer'tain real
property. and in accordance with Chapter' 713. Florida Statues. the following
information is provided in this Notice of Commencement.
1. Description of property: (legal description of property. 8nd street address if
available)
See Attached.
2. General description of improvement: East Pasco Medical Center
ER Renovation and Addition
3.
Owner information
a. N=e and address:
Adventist
7050 Gall
Health Systems, D/B/A East Pasco Medical
Boulevard, Zephyrhills, F~prida 33541
Pell'" H. tJJl~ c.~ (: Fe>
Center
b. Interest in property:
c. N=e and address of fee siClple titleholder (if othel' than owner):
R.
Contractor: (name a~d address)
5.
Surety
a. Name and address: NA
Poole Construction
544 Douglas Avenue
Altamonte Springs,
Co., Inc.
FL 32714
b. Amount of bond S NA
G. Lender: (name and address) NA
7.
Persons within the State of Florida designated by Owner upo~ whom notices or
other documents may be served as provided by Section 713.13(1)(a)7, Florida
Statutes: (name and address) Roy Clark
East Pasco Medical Center, 7050 Gall Blvd. Zephyrhills, FL 335.
In addition to himself, Owner designates the following person{s) to receive
u copy of the Lienor's Notice as provided in Section 713.13(1) (b) ,Florida
Statutes: (name and address)
8.
9. Expiration date of notice of commencement (the expiration date is 1 year froD'
t date of recording unless a different date is specified)
,tJ~ OOI1r. IJ,;. '/,IVc!/"........ eft;
(Signature of Owner) (Print Owner's Naule)
Owner's Address:
The foregoing instrument was acknowledged befol'e me this ~ / /1 / q cr by
..- ~ ---
~\\o...\c\ \", \kJ~\L~whO i~nallY known to me/~ho produ,:ed
as ide~ication and who did not take an oath.
State of Florida County of ~~c.n Commission /I .!:500QU9
CJ :\.)()"\,.~"'\\\.\\~~~\.~\i\MY Commission Expires: ~ -/ - ,;;(CC/
I (Notary)
All Information Must Be Typed or Printed Legibly
to Comply With Recording Requirements
,..,....... JUNE M HERNDON --,
,~<!,!\y.fs:t-~ . If
i.r~" :.~ MY COMMISSION' CC !i!lOOlr.:, .
~~~J:,; EXPIRES: February 1, 2001 i
"'~iif.:!~if.;., Bonded T11Iu NolIIy PubIlc Undllwrbl1l
- .- ..
LEG A L
ZEPHYRHILLS COLONY CO LANDS
ING W OF DAIRY RD R/~ AS NO~
122 & TR 103 EXC ~ 187 FT OF E
OF l'R 104 ALL EXC US H~Y 301
FOR P08 TH ALG N LN TR 105
100 FT H OF NE COR TR 1n~ TH
LN lR 10~ 100 FT 4 OF NE COR
103 S89DG 55' 34"C 48G.69 Fl
~;U<"[;G ::;~.' 2-;'[' 172.01 FT TO!/
TH n~_G ~ U~ f,j\-j SOODG 10' ~5" \..l
c:EI~~S ~.: L~; Dt",,-;~c;!-1Tf~R.!' !~:[." r,/~
~s:-~" 0<1 FT 10 S~ COR n,' 1:'.2 TH
COR Th 120 TH N89PG ~;G' 31";";
f~/\..l TIl ALG r: U~ f,/\..l i.JOOOC 1 El'
LESS Th... T F'T 11~ 1:22 L': 1m; 30
OR BK 4208
2. of 2.
PB 1 043
o E S C RIP 1 ION:
P8 1 PG 5~ FOLL OESC PROP lY-
LOCATED lRS 105 106 1]9 120 B
:'.67 FT OF N 172 FT & E 10C FI
fj\..i ALL AI~A COM N~ CGr, Tf;' ] \JS
S890C 56' 33"[ 5~3"35 Fi TO Pl
1'1 (; 8 D C 0 f; I 0:J · C ~ J 1 . ~ .'1 ,. T ;' U N
lt~ l()~ 'Ill .;LG tl u~ TF:S 10q B.
lH S:}CDC 10' 4::;"W 1/2.~C fT TH
LN Oi'L;":Y h:G I.:/~ !=',~. t~O~ '_'JCI'ITCD
1 ~ :? 7 . ::::-. f-' 1 T 0 ~; L N T R 1:' ~
T;~ (,\ C /-j !...r~ F-/1-1 N8?OC :,9' 30"\--!
NOOUS 0~' 03"C 316.21 rl TO S~
L(jS.:R /.1 :0 E LN US H~'r 301
=~ C . r. .:. (. :' . e () F 1 1 U FDC
Fr N nF SDulH LJNE SEe
ST/~,TE Or- FLORID/\
.....' ".iT" ()f \.)!<::;r0
C(........':.':I i." r......'-.'......., _... ...
r<- [' "~),~..'.. ',;-:J'/ ::!~':~~:,: ::~~,~~~~\:~~~;;~\(~i!~E A
". . ... .'. r1-t1ln') , ,)'
(. . ";h.' ...... I..,~. ;;'~:
. .-- ,.' -I. <:r.. -
~._..,. ,"'''''''-'''''.,r",'''.
JED Pi' ", .:' ,,"'.'" t. ',,,,, ",. "
BY'~ ~~ D.C,