HomeMy WebLinkAbout01-0535
BUILDING PERMI1N2
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BUILDING
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ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 788~6611
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PLUMBING
Permit
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MECHANICAL
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Property Owner: f;ci:> t ~4 ~(.(J 11/1<li.~1<-4
Job Address: 7D5",-, (.("ll (?j vel '
Parcell.D. # S S-" :1 '5" 1 / - '. -.f () 0-)-,,)0 ~
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Water Meter: ~ ~
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Zoning:
Descriotion of Work
Radon Gas:
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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
City License Registration #
State Certified License#
Permit Fee
Signature
Company
Addres~
Telephone#
HJ6
Valuation or
Contract Price
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BUILDING :",1I-f '-1
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Pre SLB 10 -.3 -0/ S,e _ Hb'l6'h~n/:f-ir.:c~ Mi.. /fjO n-t~~ ~/l--~-.~bA Lf JfJlJ
Lintel Meter Can Water
:P1fCT.F~iII.i.I-'7-0i hI( J '.
FRM. ./ ;,}~ /4-0.:2.. R.i.-It If'JoConst. Pole Sewer
Insul. CL Pool Final/~-.:2.."o'.l Rtf
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WL Pre-MetEY' 11
Final /Cj -2JI-f)-;J.. ,a '1, J/Ji> "? ~:.--{ ;) - 0... s:. ... ;).../Ub
Driveway P4r/,;,.,fflt< .3 -S- -0;1... t2t.'j
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tLr./;:/ ~,~_ :2-2~""'D ~ jh'Oj #& I'" cP-dS-t);:L, I/,T(.)
,....-..REiN~PEC.,.ION FEES: Wnen extra inspection trips are necessary due to anyone of the following reasons, a
...fh~!, oj, Twenty Five and 00/100 Dollars ($25.00) shall b.; ma~e.fo~ach trip for each trade:
r~ r~ 3~S~O;;' ~Lt 11:1'0 ~ ~~ ~_ 'V-/!>-2 /~~/'€'~,Y
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.
Breakers
Ducts Insl.
Compressor
Final v7-:L& -~.2
Rty
/-1:;-0
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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REVISION NO.9
SEPTEMBER 21,2001
DIAGNOSTICS ADDITION - PHASE II & III
EAST PASCO MEDICAL CENTER
ZEPHYRHILLS, FLORIDA
ESa PROJECT NO. 99087.00
STANLEY D. LINDSEY AND ASSOCIATES, LTD.
1801 WEST END AVENUE, SUITE 400
NASHVILLE, TN 37203
This Revision forms a part of the Contract Documents and modifies the original Bidding
Documents, dated April 13, 2001, as outlined here in addition to being shown on the
drawings as Delta 9, dated September 21, 2001:
CHANGES TO THE DRAWINGS
SHEET S1.01 - FOUNDATION PLAN
1. Modify plan to show slab depressions and details at MRI suite as shown on sketch SSK-4
dated September 21, 2001, Delta No.9.
2. Modify plan to remove note about slab in MRI suite.
SHEET S2.02 - SECTIONS AND DETAILS
1. Modify detail 1/S2.01 to include slab-on-grade information in MRI suite as shown on
sketch SSK-5 dated September 21, 2001, Delta No.9.
2. Add detail 5/52.02 for step in slab at 12" thick MRI slabs as shown on sketch SSK-6
dated September 21, 2001, Delta No.9.
3. Add detail 7/52.02 for step in slab-on-grade as shown on sketch SSK-7 dated September
21, 2001, Delta No.9.
END OF REVISION
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SLAB EDGE CONDITION
SIMILAR TO 11/S2.01 TYP.
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S STANLEY D. LINDSEY
~ AND ASSOCIATES LTD.
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I: STRUCTURAL ENGINEERS
T N ASH V IL L E . TEN N E SSE E
U Project Number 100127.10
HE OF'F'ICES 1104 ATLAloIT A. .JACKSON. LEXINGTOIo4
LOUISVILLE. MEMPHIS. TAMPA AloIO OALAloIOO
Project EAST PASCO MEDICAL CENTER
Diagnostics Shell Addition
Phase II & Phase III
ZEPHYRHILLS, FLORIDA
Project No. Date
100127.10 &21101
Reference Sheet Sheet No.
S1.01
Location
Architect
Earl Swensson Architects, Inc.
SSK-4
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N
9
4000psi SLAB REINF. wi
. ~IWF 6x6-W2.9xW2.9
LOW MOISTURE
GRANULAR FILL
COL. BASE PL.
AND ANCH. BY
VENDOR DWG'S.
EXIST. EDGE
OF SLAB
SEE 11/S2.01
#4@12"
4-#4
.
SHIELDING PLATE BY
VENDOR DRAWINGS
#4@18" EACH WAY
TOP & BOTTOM
CENTERED
IN WALL
2x4 KEY
4'-0" /::
"''>. "",,\:;
SECTION AT M.R.!. PIT
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5 STANLEY D. LINDSEY
~ AND ASSOCIATES LTD.
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I::: STRUCTURAL ENGINEERS
T N ASH V IL L E. TEN N E SSE E
U Project Number 100127.10
R OFFICES III ATLAIlT A. .JACKSOIl. LEXIIlGTOIl
E LOUISVILLE. ...E...PHIS. T.....PA >>40 ORL>>400
Project EAST PASCO MEDICAL CENTER
Diagnostics Shell Addition
Phase II & Phase III
Project No.
100127.10
Date
9IW1
Location
ZEPHYRHILLS, FLORIDA
Reference Sheet Sheet No.
S2.02
Architect
SSK-5
Earl Swensson Architects, Inc.
6'-0"
NOTE:
SEE 1/S2.01 FOR SLAB
INFORMATION NOT SHOWN
*4~12"c/ c
24"
~
2-*4 CONT.
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W
W
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.
2x4 KEY
SECTION @
DEPRESSED MRI SLAB
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5 STANLEY D. LINDSEY
~ AND ASSOCIATES LTD.
u
c: STRUCTURAL ENGINEERS
T N ASH V IL L E. TEN N E SSE E
U Project Number 100127.10
RE OF'F'ICES IN ATLNolTA, .JACKSO.... LEXINGTON
LOUISVII..LE. ...E",PHIS. T.....PA NolO ORL"""OO
Project EAST PASCO MEDICAL CENTER Project No. Date
Diagnostics Shell Addition 1 00127.1 0 "'" A ....1
Phase II & Phase III ;:y",...v
Location Reference Sheet Sheet No.
ZEPHYRHILLS, FLORIDA S2.02
Architect SSK-6
Earl Swensson Architects, Inc.
Z
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0_
1--
-co
Co"-
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C'\l
WWF
.4~12" MAX.
CONT. (2 -MINJ
dz
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0....
I-
TYP. DEPRESSED SLAB ON GRADE DETAIL
5 STANLEY D. LINDSEY
~ AND ASSOCIATES LTD.
u
I: STRUCTURAL ENGINEERS
T N ASH V IL L E . TEN N E SSE E
U Project Number 100127.10
RE OF'F'ICES 11-4 ATL>>4T A. .JACKS01-4. LEXI1-40T01-4
LOUISVILLE. ...E",PHIS. T......PA >>40 ORLAlolOO
24"
.4~12~
CONT.
2x4 KEY
WI WATERSTOP ·
dLl-k
Project EAST PASCO MEDICAL CENTER
Diagnostics Shell Addition
Phase II & Phase III
Location
ZEPHYRHILLS, FLORIDA
Architect
Earl Swensson Architects, Inc.
Project No.
100127.10
~//
\, \
11\1/"-
Date
912401
Reference Sheet Sheet No.
S2.02
SSK-7
REVISION NO.9
SEPTEMBER 21.2001
DIAGNOSTICS ADDITION - PHASE II & III
EAST PASCO MEDICAL CENTER
ZEPHYRHILLS. FLORIDA
ESa PROJECT NO. 99087.00
STANLEY D. LINDSEY AND ASSOCIATES. LTD.
1801 WEST END AVENUE. SUITE 400
NASHVILLE. TN 37203
This Revision forms a part of the Contract Documents and modifies the original Bidding
Documents, dated April 13, 2001, as outlined here in addition to being shown on the
drawings as Delta 9, dated September 21, 2001:
CHANGES TO THE DRAWINGS
SHEET S1.01 - FOUNDATION PLAN
1. Modify plan to show slab depressions and details at MRI suite as shown on sketch SSK-4
dated September 21, 2001, Delta No.9.
2. Modify plan to remove note about slab in MRI suite.
SHEET S2.02 - SECTIONS AND DETAILS
1. Modify detail 1/S2.01 to include slab-an-grade information in MRI suite as shown on
sketch SSK-5 dated September 21, 2001, Delta No.9.
2. Add detail 5/S2.02 for step in slab at 12" thick MRI slabs as shown on sketch SSK-6
dated September 21, 2001, Delta No.9.
3. Add detail 7/S2.02 for step in slab-an-grade as shown on sketch SSK-7 dated September
21, 2001, Delta No.9.
END OF REVISION
f/
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SLAB EDGE CONDITION
SIMILAR TO 11/S2.01 TYP.
r----i
I I
I :1:1 I
I I
I I
L____.J
F9.0
~!
5 STANLEY D. LINDSEY
~ AND ASSOCIATES LTD.
u
C STRUCTURAL ENGINEERS
T N ASH V IL L E . TEN N E 5 SEE
U Project Number 100127.10
HE OFFICES 'N ATLANTA. .JACK SO"," LEXINGTON
LOUISVILLE. ~E~PHIS. T.....PA AND ORLANDO
Project EAST PASCO MEDICAL CENTER
Diagnostics Shell Addition
Phase II & Phase III
ZEPHYRHILLS, FLORIDA
Project No. Date
100127.10 &21101
Reference Sheet Sheet No.
S1.01
Location
Architect
Earl Swensson Architects, Inc.
SSK-4
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
DATE RECEIVED .
PLANS REVIEW FEE
)
OWNER'S NAME East Pasco Medical Center, Inc. PHONE (813) 788-2411
JOB ADDRESS 7050 Gall Boulevard, Zephyrhills, Florida 33541
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
See Attached
(OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: [JNEW CONSTRUCTION
[J SIGN
IX! ADDITION
:KlALTERATION
[JREPAIR
[J INSTALL
[JMOVE
[J DEMOLISH
PROPOSED USE: [JSGL FAMILY DWELLING
f] COMMERCIAL
[JMULTI-FAMILY
[J INDUSTRIAL
[J# OF UNITS
[J SWIMMING POOL
[J MOBILE HOME
[J OTHER
D RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK
Diagnostic
BUILDING SIZE
SQUARE FOOTAGE
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 NEW CONSTRUCTION.
PERMITS REQUESTED
rn BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
rn ELECTRICAL
AMP SERVICE
[J FLORIDA POWER
[J W.R.E.C.
rn PLUMBING
rn MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
[J GAS
o ROOFING
[J SPECIALTY
[J OTHER
TYPE OF CONSTRUCTION: [J BLOCK
[J FRAME
rn STEEL
[J OTHER
. ,
fi..' / 'b 1. tvu
'/1 ~ fJ-.r
FINISHED FLOOR ELEVATIONS
IS PROJECT
[J NO
SIGNATURE
~
COMPANY Poolp- ~onRtructjon Co.. Inc.
STATE CERT OR REGIST # CG C027876
CITY PROCESSING,'
BUILDER
ELECTlUCI
/
VSIGNA~-
********************************* * *
~r. /-1(... uPt)/t 17= :;2c;)
PLUMBER
COMPANY /lP~ BR1:R/~
STATE CERT OR REGIST #
// CITY PROCE~SI #/~ oK {;)~
4' ... -: -, I ) ~
**************************************** * * ~**~rt*I~)*****
HARPER MECHANICAL CORPORATION
COMPANY
,: ~/!' l'//,.. STATE CERT OR REGIST # CFC033860
.A,~' /"''.>/1ff(;.. / , r~ CITY PROCES~ING . ~g " )
, · ~T, .Ut!. iJPf)I1T~1-~!
* * ***-~ *****.**** ****** ************ ****** ****** '* .* * ************* .
~//., COMPANY R MECHANICAL CORPORATION
./J/f,/l . "'..'. _ ..,/..4'...., . $' ):/:..'1.......... ./:: STATE CERT OR REGIST # CMC042548
rf/L"/'~7/~/" /'/{tfC!};';l CITY PR~CESS #
EO 6;; .(..~. tJ/'.bAff 'i"~D)
**************************************** * ,** **************
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
MECHANICAL
SIGNATURE
OTHER
SIGNATURE
*****************************************************************
, ",{.
CONDITIONS OF PERI-lIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
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
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner 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 signs 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 may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION 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 - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify 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.
E. CONTRACTOR'S/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, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental 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 RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest 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
*U.S. Environmental Protection Aqency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ".A" or ~A, etc.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
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 code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 COMMENCEMENT. JOBS UNDER
$2,,'~INI~ V~f D~NOT NEED TO RECORD AND POST A "NO~TICE OF C~~NT".
l...._ " /~ ._~~/ ~
,pfGNA URElt W~ R OR AGENT SIGNA RE: C TRACTOR
STATE OF FLO~DA.
COUNTY OF f <;- ..s e...t,.l---
The foregoin? ins~::.~ment w'(:{!,ck~owledge~ . 'I':
Before me thlS --'..;:L day of ,{"ifI{.}sf; ~,,::2.iV,c
by
~ ./(name of person acknowledged)
~ho is personally known to me, or
STATE OF i!~LORIDA \> Ic
COUNTY OF J e /11 ~ 'rz /) e...
The foregoing ins~r~ent wa~ acknowledged
Before ~e this I"'~ Of:')'1(')1'-l- ,-Ha2Qvt)
by ~p,R'.r --r;- +OOb_
~ (name of person acknowledged)
~ho is personally known to me, or
of identification)
take an oat
Dwho has produced
(type of identification)
id not take an oath
Signature of p r taking cknowledgment
~r'/}!lo-iJi~LJbe~~
Name typed, .. . ~t!.d omertB rry
.* My CommiS8io.~ <<<:<5114088
... Explrl!!" ~t'!p. HI. ~OOO
"'.. ~..,
.,,,( Of ,..fI>'I.'
Poole Const.
7050 Gall Blvd.
Diagnostic Addition Build-Out
SQ. FEET PRICE
MAIN OR LIVING: 21 ,280 $ 75.00
OTHER AREA UNDER ROOF: $ 20.00
OTHER: $ 20.00
VALUATION $ 1,596,000.00
FEE SHEET $ 3,862.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 5,793.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 5,793.00
ELECTRICAL: $ 1,304.14 EPMC
PLUMBING: $ 325.00 CREDIT
MECHANICAL: $ 500.00
RADON: $ -
TOTAL $ 7,922.14
SEWER: $ 10,224.00
WATER: $ 2,800.00
IRRIGATION: $ -
TOTAL: $ 13,024.00
I
I
I
WATER METER:I
IRRIGATION METER $
- I
SUB-TOTAL $ 20,946.141
: I
8IF'8'1 $
97.5% $
2.5% $
T IF'S: $ 58,711.52
99% $ 58,124.40
1% $ 587.12
TOTAL: $ 79,657.66 (
'TOTAL LESS PERMIT FEES: I $ 71,735.521
TIllS InstI'uwent Pl'cpuI'cd lJy:
Nome:
AddI'ess:
1111I111111111I111111I"11I "'" 11111 ""I 111/1111I1 1111111I
2001096579 .
PeI'wit No.
Rcpt: 513483
OS: 0.00
07/17/01
Rec: 10.50
IT: 0.00
Dpty Cle,.k
NOTICE OF COMMENCEMENT
JEO PITTMANi PASCO COUNTY CLERK
07/17/01 1 :29am 1 of 2
OR BK 4667 PG 1998
STATE OF Florida
COUNTY OF Pasco
TilE UNDERSIGNED herby gives notice that improvement will be Dlade to certain 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 propeI'ty. ~nd street address if
available)
Legal Description Attached
2. General description of improvemen t: East Pasco Medl.cal Center
Geriatric Psychiatric Renovation
3. Owner information Don Welch, CFO
a. Name and address: East Pasco Medical Center, Inc.
7050 Gail Boulevard, Zephyrhills, FL 33~41
b. Interest in property:
c. Name and address of fee simple titleholder (if other than owner):
lJ.
ContI'actor: (name and address)
5.
Surety
a. Name and address: N/A
Poole Construction Co., Inc.
P. O. Box 279 - 106 S. Palm Avenue
Howey-in-the-Hills, Fiorida 34737
b. Amount of bond $-1UA
G. Lender: (name and address)
7. Persons within the State of Florida designated by Owner upon whom notices or
other documents may be served as provided by Section 713.13(1)(a)7. Florida
Statutes: (name and address)
8. In addition to himself. Owner designates the following person(s) to receive
It copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida
Statutes: (name and address)
9.
ration date of notice of Commencement (the expir3tion date is 1 year from
dateff recording unless a different date is specified)
/
.
Rl.chard Byfl.eld
(Print Owner's Name)
BOULevard, Zephyrhills, FL 33541
The foregoing instrument was acknowledged befoI'e me this ell / \ 'I. / 0 \ by
"'Q\t...~,..~ \)"\.~\~ \0\ ~erSOnallY known ~who ProdU::- ~~
as identification and who did not take an oath.
'""J
State of Florida County of \ C).....~ c... 0 Commission /I C c '1g- 0 a.3 7
~\..~~~~~Ol-.. My Commission Expires: /).-{- ;;2...0".5
(Notary)
All Information Must Be Typed or Printed Legibly
to Comply With Recording Requirements
.....~.~..
/~OOi)""-'~~
:.: ..*:
;-''' : :
~Ritt":-
JUNE M. HERNDON
MY COMMISSION # CC 980237
EXPIRES: February 1, 2005
ij~na.a tnlll Notl" PUOIMl UnclItwmetl
OR BK
4667 PG 1999
2 of 2
Legal Description
ZEPHYRHILLS COLONY CO LANDS PB 1 PG SS FOLL DESC PROP LYING
W OF DAIRY RD RIW AS NOW LOCATED TRS 105,106,119,120 &
122 & TR 103 EXC W 187 FT OF E 267 FT OF N 172 FT AND E 100 FT
OF TR 104 ALL EXC US HWY 301 RIW ALL AKA COM NW COR TR 105
FOR POB TH ALG N LN TR 105 S89DG 56' 33" E 543.35 FT TO PT
100 FT W OF NE COR TR 105 TH NOODG 09' 03" 901.24 FT TO N
LN TR 104 100 FT W OF NE COR TR 104 TH ALG N L TRS 104 &
103 S 89DG 55' 34" E 480.69 FT TH SooDG 10' 45" W 172.90 FT TH
S89DG55' 24"E 172.01 FT TO WLNDAlRYRD RlWAS NOW LOCATED
TH ALG W LN RlQ SOODG 10' 45" W 1137.22 FT TO S LN TR 122
SElNG N LN DAUGHTER RD RIW TH ALG N LN RIW N89DG 59' 30" W
552.04 FT. TO SE COR TR 122 TH N OODG 09' 03" E 316.21 FT TO SE
COR TR 120TNN89DG56' 31"W645.18FTTOE LNUSHWY301
RIW TH ALG E LN RIW NOOnG 18' 30" E 562.80 FT TO POB
LESS THAT PT TR 122 L YlNG 30 FT N OFSOUTH LINE SEC
STATE 0,
COUNTY OF ;':j., ~:";CCl
THIS is TO CEH i'~'/ THAT THE FOREGOING IS A
THlJE AND CORREC1 ;~i)f'" iJF THE DOCUMENT ON FILE
o . PUBliC REeO'l1) I:"'.. (FiiS 0FF'?lNESS MY
HA M- - OFFICI'il (-j,_ (118 DAY OF
'2-2.fZJ.../
Q , iJi CiRCUIT COURT
..:.z.'d4L- DEPUTY CLERK
4