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BUILDING PERMIT
Permit N2
BUILDING
.
CITY OF ZEPHYRHILLS
(813) 780-0020
1803
Date
/ -;(2-() 3
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
P,op.rty Own" j) 15~~. .~
Job Address: 7 R, " cJl1 { vcR..
Water Meter:
T.LF:s:
Parcell.D. "
Zoning:
Descriotion of Work
Energy Code:
-.tv. $\ e-. Q 0
11 Radon Gas:
o ~~ s;r-
FINAL c2 - - 0 3
DATE
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
City License Registration #
State Certified License#
DATE
Inspector e
/ '-I; () fj 'd-
3o{Lo
p~rmitFee~ .,~
~Ignature ~_ __ _un - _
Company
Address
\Telephone# (7/,..g) ~t.9t'e -)"1 g. ~
Ftr.
Pre SLB
Lintel
Aj)T Sl- cm-i!'f 5ys,/-::Ht c .
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Mete
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final t/ 2 - ? - eJ"3 f-0-,k
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of twenty-five and 00/100 Dollars ($25.00) 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.
L: ,t'J.' X
BUII..DJ:NG
U1I' ZBi~HYRHILLS PERMIT APPI.lICATION I L(1.J.fA'~;? /;; - )~~I":;
DBPARTMENT 5335 ~th S'rREET ZEPHYRH~LLS, FL 335~______ ~
Ii'hon~1813-780-0.020 FIilKI813-7BO-OO:.n '/} J D~7
DA'l'Bl RBCEIVED -,-?_--:..('f2~____""5:::::--
PLANS REVIEW FBB
~ 1/ ~
~dL5 ~ft'-C (~{1d2
,JOB S rTE ADDRESS '/ 7):l..S- G Cl. r--~ WL__
PHONE CON'l'AC'Ifg 171Y'.!!..4..::'> / Z'c:2..
"lNER I 8 HANE
LEGAL D~SCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 10 #
(OBTAIN );i'ROM I?ROI?ERTY TAX NOTICE)
WORK PROl'SED; ONEW CONSTRUCTION
o ADDI'l'IDN
[]AIJTERATION
o REPAIR
[] mSTAI,I,
OSIGN
o MOVE
o DElvjOLISH
I?ROI:lOSED USE: OSGL FAMILY DWELLING
~C()MMERC IAI,
OMUL'l'I - FAMU,y
0# OF mUTS
[] MOBII,E HOME
I] OTHER
o INDUSTRIAL
OSWrMMING POOL
DESCRIPTION OF WORK
D RESTAURAl~T & HEALTH DEPARTMEN'r APPROVAL
In.5TOl/j tire
Ct/arj/ri 5V3 Ie. In
/-
BUILDING SIZE
SQUARE FOOTAGE
HEIGH'r
RES IDENTIAIJ :
COMMERCIAl.J :
ATTACH (:2) PLOT I?LANS & (:2) SETS OF' BDII,DING PLANS & (1) SET ENElRGY FORlvlS.
AT'l'ACH (3) SETS OF BUILDlNG PLANS & (1) SET ENIilRGY FORMS,
PROPERTY SURVIilY REQUIRED FOR ALL NEW CONSTRUCTION.
II ELECTRICAL
f~~ITS ~EQUE~TED
$'X / '?5 t?'3~_ VALUATION OF
AMP SERVICE 0
TO'l'AL CONSTRUC'rION
FLORIDA POWER 0
D BU ILIJING
[J 1'1,OI\18ING
CJ 1.1ECHAlHCAT,
$
VALUATION OF MECHJU1CIAI, INSTALLA'l'ION
... GAS
o ROOFWG
o SI?EClALTY
o OTHER
TYPE OF CONSTRUCTION: [] BLOCK
o FRAlv'JE
o STEEI.J
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROclECT IN FLOOD ZONE AREAO YES
o NO
BUILnER
CottJPANY
STATE CERT OR REGIST #__
CITY I?ROCESBING #
SIGNATURE
****t******.**,***********....****.**.****************.k****.***.*
JilI,BCnUCIAU
COMI?AlW
s'rATE CERT OR REGIS'!' #
CITY PROCE8SING #
SIGNATURE _____
------.-_-----------......_-~
********'****.*.'**.***.**************************'*'.***********.
li>LUMBilR
COMPANY--
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATIlRE
SIGNATURE
*********.************************************~**.*******,,**.**.*
COIVJPANY
STJl.TE CER'f OR REGIST #
CITY PROCESSING #
MECHANICAl,
**************************************~******************.,******
>TH.H ;:= ~ a r 1'>1 COMP,"Y AD T See" 'f~ 5<2'f v/.c 2.s.I!t.c,
. ~. STATE CERT OR REGIST # Foe;o//c)...3
SHJNATURE 'M . CITY PROC'ESSH'G # _____
-- ~..- ..-- -- -, 3o~o
**.,**'*..****.*..******.*.*.****.***.****************k****'....*
CONDITIONS OF PERMIT AFFIDAVIT
A, NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restricti~ns" which
m~y be ~ore 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 requir
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 conunencement.
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 conunenced 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 j
the intended work, and that it is my responsibility to identify what actions I must take ~u
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 Agency-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 conunenced 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 conunenced. 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 UNDEF
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by
acknowledged
, 19_
(name of person acknowledged)
Dwho is personally known to me, or
o who has produced
(type
and whoD did Ddid not
of identification)
take an oath.
Signature of person taking aCknowledgement
Name typed, printed or stamped
~~..
SIGNATURE: CONTRACTOR
STATE OF FLORIDA ;'~].,,("
COUNTY OF .. Z ~~
The foregoing inst~~ent was acknowledg;d
=;fornj?~~~ ~O C1t~5~l%~, ' ~2W2
(name of person acknowledged)
[1ho is personally known to me, or
t8(wJ::?_. has produced FA 7). L f /l3Y~-/II!'/J'~37f{)
//- --~ bd(type. 1den. t1f1cat1.0'
["and who ~_~ ';1id no/ a~an ath!:
--.. .-""..
signature of
,"~~rit; Bobbie Swetland
r:t ':~ MYCOMMISSIONICC893160 EXPIRES
t
Name
.7~
Prepared by:
Lisbeth P. Bruce, Esquire
Blalock, Landers, Walters & Vogler, P.A.
802 11th Street West
Bradenton, Florida 34205
(941) 748-0100
.
Return To:
Virginia M. Koczynski
Beall's, Inc.
P.O. Box 25207
Bradenton, Florida 34206-5207
111111111111 1111I11111 1111I1111I1111111111111111111111111111
2003005598
Rcpt: 645950
os: 0.00
01/10/03
Rec: 10.50
IT: 0 . 00
___. Dpty Clerk
Permit No.
NOTICE OF COMMENCEMENT
JEO PITTMAN", fASCO fOUNTJf CLfRK
01/10/03 0~: 2am 348
OR BK 5199 PG
Tax ID No.
Do not use this space
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713.13 Florida Statutes, the following information is provided in this Notice of Commencement. This Notice
shall be void and of no force and effect if construction is not commenced within ninety (90) days after the recording date
hereof.
1. Description of property: 3'1- ~ 5 - .!J.. / - f)OOO - 00:3 0 0 - 00 '/0
Street Address: Beall's Department Stores ,Inc., 7425 Gall Boulevard, Zephyrhills, FL 33540,
commonly known as Beall's Department Store #30-Zephyrhills.
2. General description of the improvement:
exterior and interior renovation of the Beall's Department Store building containing approximately
75,000 square feet
R
Name:
Address:
Beall's Department Stores, Inc., a Florida corporation
1806 38th Avenue East
Bradenton, Florida 34208
Phone No.: 941/747-2355 FAX No.: 941/747-0857
Interest in property: Leasehold
3.
Owner:
4. Name and address of fee simple title holder (if other than Owner):
Name: Zephyrhills Plaza, LLC.
Address: 16010 Sam C. Road
Brooksville, FL 34613
5.
Contractor:
Name:
Address:
ADT Security Services, Inc.
5471 West Waters Avenue
Tampa, FL 33634
Phone No.: 813/806-7000 FAX No.: 813/806-7191
Smety: Name: N/A
Address: N/ A
Phone No.: N/A
Amount of Bond: N/ A
FAX No.: N/A
A copy of the payment bond (if any) is attached hereto
as Exhibit "N/A").
7.
Lender:
Name:
Address:N/A
Phone No.:
N/A
N/A
FAX No.: N/A
8. Name and address of person within the State of Fiorida designated by Owner as person upon whom
notices or other documents may be served as provided by FS Section 713. 13(l)(a)7:
Name: James C. Simpson
Address: Beall's Department Stores, Inc., a Florida corporation
Address: 1806 38th Avenue East, Bradenton, Florida 34208
Phone No.: 941/747-2355 ext. 4520 FAX No.: 941/747-9435
9. The owner has designated the following person, in addition to himself, to receive a copy of the Lienor's
notice as provided in Section FS Section 713.13(l)(b):
Name: N/A
Address:N/A
Address: NI A
Phone No.: N/A FAX No.: N/A
10. Expiration date of notice of commencement: (the expiration date is one (1) year from th~ date of.
recording unless a different date is
specified):
11. Notice is hereby given pursuant section 17.10 Florida Statutes that the lease contains the following
provision: All persons doing work for or furnishing labor or materials to the demised premises on the
order of or on behalf of the Tenant shall look solely to the Tenant's interest in the demised premises.
The interest of the Landlord shall not be subject to liens for improvements made by the Tenant. If
any mechanic's or other liens, or order for the payment of money, shall be filed against the demised
premises, or any building or improvements thereon, by reason of change and alternation or addition
made or alleged to have been made, by or for, the Tenant, or the cost or expense thereof, or any
contract relating thereto, the Tenant shall cause the same to be cancelled and discharged of record, by
bond or otherwise, at the election and expense of the Tenant, and shall also defend on behalf of the
Landlord, at the Tenant's sole cost and expense, any action, suit or proceeding which may be brought
thereon for the enforcement of such lien, liens or orders, and the Tenant will pay any damage and
satisfactorily discharge any judgement entered therein, and same harmless the Landlord from any
claim, attorney fees or damage therefrom.
The recording of this Notice of Commencement does not constitute a lien, cloud or encumbrance on
the described real property, but gives constructive notice that claims of lien may be filed under FS
Chapter 713.
OR BK
5199
2
PG
of 2
349
Signed, sealed & delivered in the presence of:
~M:-~
Signature-Witness #1
Frank DePalma
es C. Simpson
Vice President of Stores and Real Estate
Address
P. O. Box 25030
Bradenton, FL 34206-5030
STATE OF FLORIDA
COUNTY OF MANATEE
The foregoing instrument was subscribed and sworn to before me this 6th day of January, 2003 by James C.
Simpson, as Vice President of Stores and Real Estate of BEALL'S DEPARTMENT STORES, INC., a Florida corporation
9f. personally known to me,
o who produced Florida state driver's license as identification, and who acknow dged before me that she executed the
same freely and voluntarily for the purposes therein expressed under authority duly ve d in her by sa' oration.
My Commission Expires: 09/05/04
..---..,--
.c:", VIRGINIA M. K~S~ '
......, MY 00MMJssI<>>r f1 w.58S7
"t", f\tl EXPIREs: SIps, 2IIlM
,~ FUlllllllr....' _
Vinnnia M. Koczvnski
Print Name
NOTARY PUBLIC - STATE OF FLORIDA
Commission No. 965857
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