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Home My WebLink About03-2228 ,-'-' I I CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT SINGLE FAMILY RESIDENTIAL 2228 Permit Number: 2228 Issued: 7/15/2003 Permit Type: NEW SINGLE FAMILY DWELLING Class of Work: 101-NEW CONST/SFR Proposed Use: SINGLE FAMILY RESIDENTIAL Sq. Feet: Est. Value: Cost: 77,300.00 Total Fees: 3,159.10 Amount Paid: 3,159.10 Date Paid: 7/15/2003 Address: 4928 TIMBERWAY ZEPHYRHILLS, FL. Township: Range: Lot(s): 3 Block: Section: Book: Page: Subdivision: COURT SQUARE Parcel Number: 15-26-21-0200-00000-0030 F? IC-3!-03 f~ 1r50~05 r f-fh e.- ~ Name: TENBRINK & ASSOCIATES Addr: 35512 CHESTER DR. ZEPHYRHILLS, FL 33541 Phone: (813)782-0678 Lic: - Work Desc: NEW SINGLE FAMILY DWELLING WATER CONNECTION RESIDENl WATER METER RES 3/4" Name: GEIGER, SANDY Address: 4928 TIMBERWA Y ZEPHYRHILLS, FL. 33542 Phone: ((:(q lo,.;~r* L-t.L{"1 pf h~J !f-7,tl3 ~L I 1> PRE-SLAB CONSTRUCTIOI)l POLEy/;:?I-?.,/N, aND ROU;;GH PLUMB ,- - ~ DUCTS INSULATED , /7-1-6 J LINTEL PRE-METER ./ ''''31-&:::?L WATER ~jr.... Y - .3 ! FINAL MECHANICAL FRAME MISC Rut&- SEWER \ T - <-/ - tJ ~ ! MISC INSULATION WALL MISC I MISC. ! MISC. INSULATION CEILING MISC. I MISC. i MISC_ DRIVEWAY~//O-2l(-t'J tl:roIRt'l MISC. I MISC. ! FIRE DEPT. FINAL REINSPECTlON FEES: When -extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or co~r ions no~ made ~hen inspection called (d) Work not ready for inspection when called n ~ i~f~ (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible '\I-.L-5 The payment of inspection fees shall be made before any further permits will be issued to the person owning same --"Warning to owner: Your'failure to record anotice 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 _I?~ff!~ recording your notice of commencement." NO OCCUPANCY BEFORE C.O. ~ -- .. CONTRACTO~T~". PERM~ CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Tenbrink & Associates 4928 Timberway SQ. FEET PRICE MAIN OR LIVING: 1,287 $ 50.00 OTHER AREA UNDER ROOF: 518 $ 25.00 OTHER: - $ - VALUATION $ 77,300.00 FEE SHEET $ 392.00 ADDRESS $ 30.00 DRIVEWAY $ 30.00 BUILDING: $ 648.00 CREDIT: $ - BUILDING LESS CREDIT: $ 648.00 V ELECTRICAL: $ 114.95 V PLUMBING: $ 96.00 ./ MECHANICAL: $ 67.10 V RADON: $ 18.05 v TOTAL $ 944.10 ~. SEWER: $ 1,616.00 " WATER: $ 419.00 \.-. IRRIGATION: $ - TOTAL: $ 2,035.0Q t/ WATER METER: I $ 180~00 I V' IRRIGATION METER $ SUB-TOTAL $ 3,159.10 I SIF'S: $ 97.5% $ Q V e.D. 2.5% $ AY ~. - .~ T IF'S: $ 99% $ 1% $ TOTAL: $ 6,333.10 I 996786 ~ n L.w ~'''', PERFORMANCE BUSINESS PRODUCTS. INC- 813-719-8008 FAX 813-719-'7919 c~~~.3~1 ~ CITY OF ZEPHYRHILLS ZEPHYRHIllS, FLORIDA WATER ACCT. NO. DATE 7-/5 -03 0-U1 :5?-~1l> cy: 3tJ ~::z,;j (!-/k-a (l)A. .:z;~AJ"~ts. ~1.. .:3354/ SCRVlCEADDRESS ,y9:l~ (1~)L,~ ill[" ~ O . WATER SHUT OFF SERVICE OWNER/ RENTER ~ LJ~/tAieI5r MAILING TURN ON SERVICE \( )t(' o SEWER o GARBAGE INSTALL METER READ METER o ~NCITY CHECK METER o o OUT CITY -L. No. OF UNIlS OTHER o _ DEPOSIT AMOUNT -7/( ;). Ar1~ _ AMOUNT LAST BIU _ DATE _ MISC. CHARGE WORK COMPLETED BY & DATE COMPLETED ORDER TAKEN BY Retain white form In office at all times. Send pink & yellow forms to Water Service Dept. Water Service Dept to sign yellow form & return to office. 7-~-t? ~( CITY OF ZEPHYRH.II~LS PERMrr APPI~ICATION BUII,DING IH1JI?ARTMElN'r 5335 8 tll S'rREE'r ZIllPHYRHII,IJS, ri. 33540 Phonel B 13 - 7 B 0 - 0,0 2 0 r ax I 813 -780..0 0 ~:A'rBl RBl<1:&!IVllIn -J-f'::~: -:1)..:3.___ PI,ANS R!lIVIBlW Jl'JlIB....__."__.l:__ _H____. (::::E:::'Ell:::~~~~-~9Zg~~0~~=-=~~ .._~__~~=. PHONECO:1M'~n~I3,}fl.2~ ,.;x.I UG1\L DHlSCRTPTlON: LOT(S) _______3.______ BIJOCK .----___.H_ SUBIJIVI8JON C~+_~~,~___. PARnEll, I D #__._1 5 -~lP:.dL~_J'~\.~_Q_.9.:-j)~P Q..::QQ ~ O__.___~~~TAIN__F_~RO~!.~_'2~~~~~..~_~~~__~~~:_ C!lll.~__, WURK I?ROP8EJIJr }lNElN C'ONS'rRtJCTION [1 ADDI'rIClN OALTElRATHm [] RElP1\IR [J JN8T1\fJII [Jsrrm [] MOVE o DEJr-10I,TSH PR()!,lOSFJIl USEl I )4S(~IJ F1\t-lIIJY DWEI,I,tlm [-h1Ul,'I'I -- FAf"lU,Y []# OF UNT'l'S [] SWH1MING POUL IJ MOB H.FJ not>11il (] OTHER LI Cm1MElRt! fA r, []INDtJSTRIAL CJ RElSTAURANT & HElAIJTH DElPARTr-1EN'r APPROVAL IJEJSCRIPTION OF NORK .-~~-~ ~~i 1':l-_-YY\G\SOY\y_~ht)~~____'_____________n_____'-_ SQUARE FOOTAGE __.l2.0._~_____ HEIGHT BtJn,rHN(~ SIZE --------._____ -0 _._'_~'__---. RE8It1BlNTIM'1 A'r'f1\(~H (2) Pln'I' PI"AlIS & (2) SElTS OF BUI!.DIN(] PI,ANS C()~1MBlRC~IAT, I A'rtAcH (3) SETS OF BUILDING PI"ANS & (1) SET EJNEJR(~Y PROPl:llRTY SURVEY REQUIRElD FOR A1,1, NEl>I CONS'I'RUCTION [] GAS LJ ROOFING [J SPECltAUI'Y [I OTHER ~ 8t1n.IJINf~ ~ ElLBlC'I'RWAl. .XI PI,tJt1BING P( HBlCHANWAI, I>ERMITS RHlQUBlSTED LjQ~_~O .~_-" VALUATION OF ___.aDD __-" AttlP SERVICE ~ L_ ,;j]{JJ'S.Q9____ VAT.JUATION OF ~1EJC'IIANCIAI, HlSTAIJIJATT TYPEl OP' (;ON8TRUC!'rWN I~ I3LOCK FIN ISHElIl FI,OOR I1lI,EJV1,TIONS [] FRAttlEl [] STEEL [] OTHER IS PRrXTEJe''I' IN FLOOD ZONEl ARElA [J YEla pq NO 1!HJUnER 8T<niATiJREi _____ COt1P ANyJ_mBr.iY! Ic...A:JJ-M_~~~-t~_s. J.:IOCL___ ._n .'v~~~ ~~~~Ep~~~~8~~N~E~I~'ef ..-(~~JlY_~~~_~_._. ---.___ -_. - ------ ---. ------- ~-.-.--.---..._____n_.._ *********************** *4***********4************************* Cm1PANY __fY1~!J~!':..~ 1~~~~~_l~C:___~~~ ___ STATE: C'ERT OR REG T ST U~_~_~~: 9.~~.i.?_h__.n ______ C!ITY PPJ)CES8IN(~ # q 1 SlGNATU IIIT.IIC-TRICIMl PIJUMSER f t./"I . _ Bt(lH''1'I,".~~~_ * * * '* * * * '" '* * * * A, '* * '* '* '* '* * '* ,*. '* * '* * '* * '* * * '* * '* * '* '* * '* '* * '*:k'" * * * '* * '* * '" It '* * * '* * '* * '* * * * * * ('o~1!Ii~~Jt._s.:.hl~J:'/_l1,':l1~~~:::J;" . STATE (;BJRT OR REGIST # c'FQ..D411.;2.1 ->ff- . CI'rY PROCESSING If J-"l---.--;)pcr;..x.;;~-;rtc.: ~'-"_..._--~------_._._---.;.....___._~1.~~_ -.----..---- ~_.--_..._--- --, ....-..-. "- --..__..__._---~ MI!lC!HANIC I *,**It,*******,**********,**,*************************************'****** i ~ COI\1PANY~~_Py~~_e,_6~~__.~t!_~_ ________. .. -l /J It STATE ('ElRT OR REGI8T If _CBL~.~<i'ig____.__.__.__._ ~ (!l'l'Y PROCESSING # I, .+.- .4~__.__..______ ____.._________~_..~..______ ***'************************'*************'**************'**********'" 8TGl'IA'I'!IR OTHBlR S WNA'I'tJREl -~~------_._~----------..- cor"IPANY S'I'A1'EJ CElRTOR REGIST -r--------------.-------...-- CI'ry PROCESSING # -.--.~._-----,---.~..--._--_______.... ~_.....-._.:.----------_..._---------_._--------- ***************************************************************** .---..----.-. --_._.__..~.-----_.__."'_..,..~-_............. - . "..._~_.- ..-......- CONDITIONS OF PERMIT AFFIDAVIT A. NO'lllCE OF DEED RES'l'RICTIONS The undersigned understands thq.t thi/> permit may be subject to "deed restrictions" which may be more restrictive than City regulations. Tile undersigned assumes responsibility for compliance with any applicable deed restrictions. B. UNLICENSEP /CON'l'RAC'l'ORS AND CON'l'RAC'l'OR RESPONSIBILI'I'IES I f the o\vller has hired a contractor or contractors to undertake work, they IlIay be required to be licensed in accordance Hilh atate and local regulations. If the contractor is not licensed as required !Jy lavJ, both the ovmer and contractor may be oj ted tal: a mlsdemeanol: violation under statt:: la\;. If the owner or intended contractor are uncertain as to vlhat 11 censing requirements may apply for the intended work, they are advised to contact the City of Zephydlills Building Do;partment, 813-768-6611. Furtherll1ore, if the owner has hir.::d a contractor or contractors, he ls advised to bave the contractor(s) sign portions of the "Contractor So;ctions" of thls application far which they vdll be responsible. If you, as the owner slgns as the contractor, YQLl are indicating that you, lather than the contractor, are responsible for the wOj::k. I f the contnictor wishes you to slgn as contractor that may be an indication tllat he is not properly licensed and is liot elitilled to permitting privileges in the City of Zephyrhills. c. 'l'RANSPOk'l'ATION IMPAC'l' FEES AND U'l'ILI'I'Y CONNECTION FEES D. CONS'l'RUC'l'UION LIEN LAW (CHAprl'ER '713, FLORIDA STATUTES, AS AMENDED) j certify that I, the applicant, have been provided with a copy of "Florida's Constrllcticn 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 cerity that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to con~encement. E. CON'rRAC'!'OR' a/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 indioated. I certify that no work or installation has cownenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify thatl understand that the regulations of other governmental agencies may apply to the intelided work, .:HId that it is my responsibility to identify what actions I must take to be in compliance. Sqeh agencies include but are not 11mi ted to: *Uepcu:tment of Enviroll~ental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sens~tive Lands, Water/Wastewater rfreatment *Souttlwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses *Army Corps of Engineers-Seawalls, Docks, Navigable WatenJays *lJepartment of Health Ii Rehabiliteltive Services, Environmental Health I1nit-Wells, Wastewater Treatment, Septic Tanks *11.8. Environmental Protection Agency-Asbestos abatement 1 also certify that, if fill material is to be used in Flood Zone ~AN or "A,etc.", it is understood tllat 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 authori ty to violate, cancel, alter, or set aside any provisions of the teclllliGal codes, nor sllall 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 becoIne invalid unless the work authorized by such permit is cOliunenced Hithin six months of issuance, or if work authorized by the per-mit is suspended or abandoqed tor a period of sl" 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 sball be requested ill wri ting to the Buildlng Official. An approved inspection must be logged during each. slx month period, or the ptoject Hill be considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NO'l'ICE OF COMMENCEMENT MAY RESUW' IN YOUR PAYING TWICE FOR IMPROVEMEN'l'S TO YOUR PROPERrfY. IF YOU IN'fEND TO OB'l'AIN I:'lNANqn~q, ~9N~UI/r' Wl'!'H YOUR LENDER OR AN A'l"!'ORNEY BEIi'ORE RECORDING YOUR NOTICE OF COMMENCEMEWI'. .JOBS UNDER $2,500 IN VAWI!: DO NOrl' NEED TO RECORD AND POS'l' A "NOr!'ICE OF COMMENCEMEN'llf!. (~ .~~:~ SiGHNi~~R-;'~ ~) S'rA'l'E OF FLORIDA COUNTY OE' The foregoing instrument was acknowledged Before me this ____ day of_, 19_ !Jy_ (name of person acknowledged) Owho is personally known to me, or STA'l'E OF FLORIDA COUNTY OF 'llhe foregoing instrument wa,s acknowl edged Before me this _------1iay of----, 19 by (name of person acknowledged) Dvho is personally known to me, or o who has produced (type and whol] did Ddid not of identification) take an oath. Owho has produced (type of identification) and vJho Ddid DUd not t.ake an oath Signature of person taking acknowledgement Signature of person taking acknowledgment Name typed, IH111ted or stamped Nelme typed, printed or. stamped ""'-- Yv ' ,: ~': .~\". ". ~; (.. .. ,,-" ,'" . " ,'""", \}1 Ju I ' 1 4, 2003 8: 51 AM FIRST NATIONAL BANK PASCO No.9726 p. 2 NOTICE OF COMMENCEMENT 1111111111111111111111111111111111111111I1111111111111111111 2003127504 Building Permit No. Rcpt: 697506 os: 0.00 07/14/03 Rec: 6.00 IT: 0.00 Dpty Clerk Tax Folio No. STATE OF FLORIDA JEO PITTMAN PASCO COUNTY CLERK COUNTY OF Pasco 07/14/03 03: 57pm 1 70f641 OR BK 5443 PG THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes.l..the following information is provided in this Notice of Commencement. 1. Description of Property: (legal descriptiQJl oflhe property, and street address if available) Lot, 3 Court Square, PB 33, pages 63 and 64 Id# 15-26-21-0200-00000-0030 2. General Description of Improvements: Single Family DWelling 3. Owner Information: a. Name and Address: Sandra Geiger 4023 Court Street, Zephyr hills, FL 33541 b. Interest in property: FEE SIMPLE c. Name and address of fee simple titleholder (if other than owner): 4. Contractor: (Name and Address) Tenbrink and Assoc. Inc. 35424 Chester Drive, Zephyrhills, FL 33541 5. Surety: a. Name and address: b. Amount of bond: 6. Lender Information: a. Name and Address: First National Bank of Pasco 13315 Highway 301 Dade City, FL 33525 b. Designated Contact: Raluh W. Cumbee. Amv Pollock. or Taralee Morehouse 7. Persons within the State of Florida designated by Owner upon whom notice or other Documents may be served as provided by Section 713.13(1 ) (a) 7.~ Florida Statutes: (name and address) First National Bank of Pasco 13315 Highway 301 Dade City, FL 33525 8. In addition to himself, Owner designates Ralph W Cwnbee. Amy Pollock or Tar-alee Morehouse of First National Bank of Pasco to receive a copy ofthe Lienor's Notice as provided in Section 713.13 (1)(b), Florida Statutes. 9. Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified). o er expiration date: v t'2~ ignature of Owner N/A N/A STATE OF FLORIDA COUNTY OF PASCO THIS IS TO CERTI~V THAT THE FOREGOING IS A TRUE AND CORRECT copy OF THE DOCUMENT ON FILE OR OF PUBLIC RECORD IN THiS OFFICE. WJTNESS MY HAND AN FFICIAL SEAL THIS.4- DAY OF 2 t71J.3 JED PI A~~: 9 IR,CU IT COURT BY ~ DEPUTY CLERK Signature of Owner Signature of Owner Signature of Owner STATE OF FLORIDA COUNTY OF ~...I.U'i' The foregoing instrument was aclmowledged before me this 1. 3 - 03 _ by ~f(0tC.fl L. b'e~e-,e who are personally known to me or who have prod ced i)L as Identification. NAY IAENEKAAPINSKI ~ Notary Public, State of Ronda My Commission Expires 2117/07 Commission No. # DO 184489 , Jul 15 03 09:158 8~ 5chlem~n plumbin~ 00 813 977 9275 p. 1 ~._,...,.... Othll' Om CERTIFICATE OF LIABILITY INSURANCE 0.", 04(30/:2003 lkln Insurance Company TIlls CartIfIcfte ,. Issued ... IIllItttr of Information only and alIII'l!n no rightll 905 E. Martin LU1I1er King Jr, Dr. upon the CwrtllCBtl Holder. ThIs Clrtlftc:ata dll8S not amend, extancl or IItIr Suile110 the COWll'lllllllfronled b, the polld.lMlow. Tarpcn Springs, FL 34689 Insurers Affording Coverage Pnone: 727-936.5562 FIIC 727.937-2138 NAIC# icuth East Personnel Lelling Insurer ,.. lion Insurance Com pa nv ~ East MLK Jr. Drive Suite # 110 InsUl'8r B: 'IIrpon $prlnga. FL. 34e&9 InlutllrC: 'hone (727)938-5562 'nsurer D: ....- "-.-'-". -'--'--- --.-- Insul'8rE: I '''1Ince llofed bolow nev. been i.....d to lhe inlllnd rwntd Ibcve rcr lht polICy ~ertod 1IlCI1cal1Kf. ..0 lIJly f&QU1.........', ~ or CCInCl~'.n of any contract or 0Ina- dooumonl ';h .1" aHtllcat. may b& IUlJn~ or may perlll." trIG inluranc.lfIorG.d by the IlClioi.. cetorib.G ~..., ISI..qed Ie lIIl the tlrms, edualolll, and cOMtlona Cf SUCh IlCliCln Pogregall ..,. been reduced by paid ell mi. Type of Insurance Policy Number Policy EtIecti~ PoWe)' Expiration 0.- Limits Date (MMlDDIVY) (MMIODIVY) ~NERAL LIABILITY each Occu'renao ~ ~ ~mmercial Generll Uabllity ~m.go to n>fI1od pr.m.... (Ell ~ Claims Made 0 Occur '.-.'. . .'- OCCUITtnoIl " - IIIIdl:Xl' - Pereonel Adv InjUry General aggregate limit appliea per: ::J PaliC) Dprcjed 0 Glnlral AAil'lIQ!te LOC Productt - ComplOp AIlV "UTOMOBILE UABILlTY Combi""d 8ingl. Llrrll - (EA Acaidenll Arv- Bocily InjL.ry - AU Own~ AuIOS - (per Persor) Sc,oo\Jod Al.<l... - Hif90 Au10s Bodily 'I"lury - Non-Owned Aula. (Per Ac<:ide'll) ~ - Prgperty 0., Ill. (Per AcQdGnt) GARAGE UASIL1TY Auto O,Iy - E. A..-.:odorl. 3 Any Auto M__.._ '-----.--- . ---.---- OlI'\er Thin eAN.:r. AL.t... Only: -.-- AGO. EXCESS/UMBRELLA LIABILITY EacM Occurr...ce f 0'-.... AQQrtQale Deductible .- -- .0- ..- .... -. - -. -- ---------. .., ,onUon /'...- "- ; Campel1llllllon and WC 7'1949 04~OI2003 /1~ X I we Slalu- I J~- ~,.' Uablllty IoryLimib '$tcrlpertn.r/8l<eeutiv~ officer/member \ E.L. E.oh A:lOidenl .'OOOOOC E. L, Disease. Ea EmOlOVee $1llOOOoo cribG under I~el pvviaiofUl below E,L 0,_. - Policy Limil8 $1000000 1503002 UHUR A SCHLEMAN PLUf.eING COVERAGE APPLIES ONL. Y TO THOSE EMPl.OYEES LEASED, NOT TO SUBCONTRACTORS. )perllllClNlil.ooallONlVllllcl M/!xolull_ ecldocl by !ncIonomentlllpoalll Provlalono: AI"I"LIES ONLY TO THOSE EMI"LOVEES LEASED TO BUT NOT SUBCONTRACTORS OF cB"ARTHUR A SGHL.eMAN PLUMBING CO INC<IB> Cleflt # ~ On Dale 8/27/02 3LDER CANClLLATlON : HLBlAN PLUMBING CO INC SholJd .ny of ihI...".. d_rl>><! pol cia be ~lIod ..cr. the ""Pil8lion dllo IM"eo!, Ih. 1.1UMg irw"ret will ..,<luyw to m.n ao dllYll wrl:t8l1 nOllC8 10 tII8 ...,.rlcalllllnlcMr nnlld to \he IeIt but IIIIIH 10 RASKA AVE do eo 'h.lIlmpcn no ob4igltlcn or 1i""lI'ty of lI'IY Olnd upon the _rer, ill ogonb or fOI're_,lalivOl. FL 33E113 ." ....,f. .... I I Producer Jnlurecl: Cove rag. ~ CliO of with respeet Ie . I,milllhewn mE INS~ "DOL LTR lit/SRI A WorkE Empie Any pre IXclucHI W Yea. c a..crlptlcM COVEAA 1503002 CERTlFlCATE ARTHUR A 14g28 NO N ~ ACORD CORPORATlON 1988 TAMPA WEST TEN BRINK & ASSOCIATES, INC. SITE PlAN FOR GEIGER RESIDENCE PARCEL 10 #16-26-21-02OO-OOOOO-OO30 44'''- 5::::::~:::::::e EAST ; j~~ ~ J: I- a: o z ~ WEST TEN BRINK & ASSOCIATES. INC. SITE PLAN FOR GEIGER RESIDENCE PARCEL 10 #15-26-21-0200-000oo-0030 17'''' ~ ...... 'a... ~ 5:.:.::::~:::::::iiI :r I- a:: o z ~ EAST FORM 600A-2001 FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION Florida Department of Community Affairs Residential Whole Building Performance Method A Model #1805 Project Name: Address: City, State: Owner: Climate Zone: Central Builder: Ten Brink Pennitting Office: Pennit Number: Jurisdiction Number. I. New construction or existing 2. Single family or multi-family 3. Number of units, if multi-family 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned floor area (fP) 7. Glass area & type a. Clear glass, default U-factor b. Default tint c. Labeled U or SHGC 8. Floor types a. Slab-On-Grade Edge Insulation b. N/A c. N/A 9 . WaIl types a. Concrete, Int InsuI, Exterior b. N/A c. N/A d. N/A e. N/A 10. Ceiling types a_ Under Attic b. N/A c. N/A 11_ Ducts a. Sup: Unc. Ret: Unc. AH: Garage b. N/A Single Pane O.OfP 138.8 fP 0.0 fP New Single family 1 3 No 1287 fP Double Pane O.OfP 0.0 fP O_OfP 12. Cooling systems a. Central Unit Cap: 30.0 kBtulhr SEER: 11.00 b. N/A c. N/A 13. Heating systems a. Electric Heat Pump Cap: 30.0 kBtuIhr HSPF: 7.50 R=O.O, 149.0(p) ft R=13.0, 1192.0 fP R=30.0, 1805.0 fP Sup. R=6.0, 150.0 ft b. N/A c. N/A 14. Hot water systems a. Electric Resistance Cap: 30.0 gallons EF: 0.97 b. N/A c. Conservation credits (HR-Heat recovery, Solar DHP-l)edicated heat pump) 15. HVACcredits (CF-Ceiling fan, CV-Cross ventilation, HF-Whole house fan, PT -Programmable Thennostat, MZ-C-Multizone cooling, MZ-H-Multizone heating) Glass/Floor Area: 0.11 Total as-built points: 18355 Total base points: 20781 PASS I hereby certify that the plans and specifications covered by this calculation are in comPlJak7 Energy Code. ~ PREPARED BY: / DATE: 1/)/0'3 I hereby certify that this building, as designed, is in compliance with the Florida Energy Code. OWNER/AGENT: DATE: Review of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance with Section 553.908 Florida Statutes. BUILDING 0 FI IAL: DATE: 0 EnergyGaugeQll (Version: FLRCPB v3.30) FORM 600A-2001 SUMMER CALCULATIONS Residential Whole Building Performance Method A - Details J ADDRESS:... PERMIT #: BASE AS-BUlL T GLASS TYPES .18 X Conditioned X BSPM = Points Overhang Floor Area Type/SC Omt Len Hgt Area X SPM X SOF = Points .18 1287.0 26.78 5972.2 Single, Tint S 1.0 4.0 9.9 39.84 0.87 341.2 Single, Tint N 1.0 6.0 46.5 24.46 0.98 1109.2 Single, Tint N 1.0 6.0 16.2 24.46 0.98 386.4 Single, Tint N 1.0 7.5 36.0 24.46 0_99 869.8 Single, Tint E 1.0 6.0 16.2 53.27 0.97 836.9 Single, Tint E 1.0 3.0 7.1 53.27 0.85 321.5 Single, Tint W 1.0 3.0 7_1 47.90 0.85 288.7 As-Built Total: 138.8 4163.8 WALL TYPES Area X BSPM = Points Type R-Value Area X SPM = Points Adjacent 0.0 0.00 0.0 Concrete, Int Insul, Exterior 13.0 1192.0 0.35 417.2 Exterior 1192.0 1.90 2264.8 Base Total: 1192.0 2264.8 As-Built Total: 1192.0 417.2 DOOR TYPES Area X BSPM = Points Type Area X SPM = Points Adjacent 0.0 0.00 0.0 Exterior Insulated 21.0 4.80 100.8 Exterior 21.0 4_80 100.8 Base Total: 21.0 100.8 As-Built Total: 21.0 100.8 CEILING TYPES Area X BSPM = Points Type R-Value Area X SPM X SCM = Points Under Attic 1287.0 2.13 2741.3 Under Attic 30.0 1805.0 2.13X 1.00 3844.7 Base Total: 1287.0 2741.3 As-Built Total: 1806.0 3844.7 FLOOR TYPES Area X BSPM = Points Type R-Value Area X SPM = Points Slab 149.O(p) -31.8 -4738.2 Slab-On-Grade Edge Insulation 0.0 149.O(p -31.90 -4753.1 Raised 0.0 0.00 0.0 Base Total: -4738.2 As-Built Total: 149.0 -4763.1 INFIL TRA TION Area X BSPM = Points Area X SPM = Points 1287.0 14.31 18417.0 1287.0 14.31 18417.0 EnergyGauge@ DCA Form 6OOA-2001 EnergyGauge@/FlaRES'2001 FLRCPB v3.3O FORM 600A-2001 SUMMER CALCULATIONS Residential Whole Building Performance Method A - Details I ADDRESS:... PERMIT #: BASE AS-BUlL T Summer Base Points: 24757.9 Summer As-Built Points: 22180.3 Total Summer X System = Cooling Total X Cap X Duct X System X Credit = Cooling Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier Points (OM x oSM x AHU) 22180.3 1.000 (1.087x1.150x1.00) 0.310 1.000 8595_2 24757.9 0.4266 10561.7 22180.3 1.00 1.250 0.310 1.000 8595.2 EnergyGaugelM DCA Form 6OOA-2001 EnergyGauge<K>/FIaRES'2001 FLRCPB v3.30 FORM 600A-2001 WINTER CALCULATIONS Residential Whole Building Performance Method A - Details I ADDRESS: · · · PERMIT #: BASE AS-BUlL T GLASS TYPES .18 X Conditioned X BWPM = Points Over11ang Floor Area Type/SC Omt Len Hgt Area X WPM X WOF = Point .18 1287.0 5.86 1357.5 Single, Tint S 1.0 4.0 9.9 10.88 1.05 112.7 Single, Tint N 1.0 6.0 46.5 15.38 1.00 713.3 Single, Tint N 1.0 6.0 16.2 15.38 1.00 248.5 Single, Tint N 1.0 7.5 36.0 15.38 1.00 552.7 Single, Tint E 1.0 6.0 16.2 13.04 1.01 212.8 Single, Tint E 1_0 3.0 7.1 13_04 1.03 94.8 Single, Tint W 1.0 3.0 7.1 13.80 1.02 99.5 As-Built Total: 138.8 2034.3 WALL TYPES Area X BWPM = Points Type R-Value Area X WPM = Points Adjacent 0.0 0.00 0.0 Concrete, Int Insul, Exterior 13.0 1192.0 1.33 1579.4 Exterior 1192.0 2.00 2384.0 Base Total: 1192.0 2384.0 As-Bullt Total: 1192.0 1579.4 DOOR TYPES Area X BWPM = Points Type Area X WPM = Points Adjacent 0.0 0.00 0.0 Exterior Insulated 21.0 5.10 107.1 Exterior 21.0 5.10 107.1 Base Total: 21.0 107.1 As-Bullt Total: 21.0 107.1 CEILING TYPES Area X BWPM = Points Type R-Value Area X WPM X WCM = Points Under Attk: 1287.0 0.64 823.7 Under Attic 30.0 1805.0 0.64 X 1.00 1155.2 Base Total: 1287.0 823.7 As-Bullt Total: 1805.0 1156.2 FLOOR TYPES Area X BWPM = Points Type R-Value Area X WPM = Points Slab 149.0(p) -1.9 -283.1 Slab-On-Grade Edge Insulation 0.0 149_0(p 2.50 372.5 Raised 0.0 0.00 0.0 Base Total: -283.1 As-Bullt Total: 149.0 372.5 INFIL TRA TION Area X BWPM = Points Area X WPM = Points 1287.0 -0.28 -360.4 1287.0 -0.28 -360.4 EnergyGauge@ DCA Form 6OOA-2001 EnergyGauge@lfIaRES'2001 FLRCPB v3.3O FORM 600A-2001 WINTER CALCULATIONS Residential Whole Building Performance Method A - Details I ADDRESS: , , , PERMIT #: BASE AS-BUlL T Winter Base Points: 4028.8 Winter As-Built Points: 4888.2 Total Winter X System = Heating Total X Cap X Duct X System X Credit = Heating Points Multiplier Points Component Ratio Multiplier Multiplier Multiplier Points (OM x OSM x AHU) 4888.2 1.000 (1.078 x 1.160 x 1.00) 0.455 1.000 2781.6 4028.8 0.6274 2527.7 4888.2 1.00 1.250 0.455 1.000 2781.6 EnergyGauge 1M DCA Form 6OOA-2001 EnergyGauge<ll>fFlaRES'2001 FLRCPB v3.30 FORM 600A-2001 WATER HEATING & CODE COMPLIANCE STATUS Residential Whole Building Performance Method A - Details I ADDRESS: · · · PERMIT #: BASE AS-BUlL T WATER HEATING Number of X Multiplier = Total Tank EF Number of X Tank X Multiplier X Credit = Total Bedrooms Volume Bedrooms Ratio Multiplier 3 2564.00 7692.0 30.0 0.97 3 1.00 2326.10 1.00 6978.3 As-Bullt Total: 8978.3 CODe COMPLIANCE STATUS BASE AS-BUlL T Cooling + Heating + Hot Water = Total Cooling + Heating + Hot Water = Total Points Points Points Points Points Points Points Points 10562 2528 7692 20781 8595 2782 6978 18355 I PASS I EnergyGauge TM DCA Form 6OOA-2001 EnergyGauge<lWFIaRES'2001 FlRCPB va.30 fORM 600A-2001 Code Compliance Checklist Residential Whole Building Performance Method A - Details , ADDRESS:. , , 6A-21 INFILTRATION REDUCTION COMPLIANCE CHECKLIST PERMIT #: COMPONENTS SECTION REQUIREMENTS FOR EACH PRACTICE CHECK Exterior Windows & Doors 606.1.ABC.1.1 Maximum:.3 cfmlso.ft. window area. .5 cfm/so.ft. door area. Exterior & AajaCent Walls 606.1.ABC.1.2.1 Caulk, gasket, weatherstrip or seal between: wincJowsldoors & frames, surrounding wall; foundation & wall sole or sill plate; joints between exterior wall panels at comers; utility penetrations; between wall panels & toplbottom plates; between walls and floor. EXCEPTION: Frame walls where a continuous infiltration barrier Is installed that extends from and is sealed to the foundation to the too D1ate. Floors 606.1.ABC.1.2.2 Penetrations/openings >1/8" sealed unless backed by truss or joint members. EXCEPTION: Frame floors where a continuous Infiltration barrier is installed that is sealed to the oerimeter. oenetrations and seams. Ceilings 606.1.ABC.1.2.3 Between walls & ceilings; penetrations of ceiling plane of top floor; around shafts, chases, soffits, chimneys, cabinets sealed to continuous air barrier; gaps in gyp board & top plate; attic access. EXCEPTION: Frame ceilings where a continuous infiltration barrier is installed that is sealed at the oerimeter at oenetrations and seams. Recessed Lighting Fixtures 606.1.ABC.1.2.4 Type IC rated with no penetrations, sealed; or Type IC or non-IC rated, installed inside a sealed box with 1 rz' clearance & 3" from insulation; or Type IC rated with < 2.0 cfm from conditioned soace tested. Multi-storv Houses 606.1.ABC.1.2.5 Air barrier on oerimeter of floor cavltv between fIoors_ Additional Infiltration reqts 606.1.ABC.1.3 Exhaust fans vented to outdoors, dampers; combustion space heaters compJy with NFPA, have combustion air_ 6A~22 OTHER PRESCRIPTIVE MEASURES (must be met or exceeded bv all residences.) COMPONENTS SECTION REQUIREMENTS CHECK Water Heaters 612.1 Comply with efficiency requirements in Table 6-12. Switch or cJearIy marked circuit breaker (electric) or cutoff (naso l must be . External or built-in heat tran reauired. Swimming Pools & Spas 612.1 Spas & heated pools must have covers (except solar heated)_ Non-commercial pooJs must have a pump timer. Gas spa & pool heaters must have a minimum thermal efflCiencv of 78%. Shower heads 612_1 Water flow must be restricted to no more than 2.5 aallons oar minute at 80 PSIG. Air Distribution Systems 610.1 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, sealed, insulated, and installed in accordance with the criteria of Section 610. Ducts in unconditioned attics: R-6 min. insulation. HVAC Controls 607.1 Senarate readilY accessible manual or automatic thermostat for each sYStem. Insulation 604.1, 602.1 Ceilings-Min_ R-19. Common walls-Frame R-11 or CBS R-3 both sides. Common ceDing & floors R-11_ EnergyGauge™ DCA Form 6OOA-2001 EnergyGauge@lFlaRES'2001 FLRCPB v3.30 ENERGY PERFORMANCE LEVEL (EPL) DISPLAY CARD ESTIMATED ENERGY PERFORMANCE SCORE* = 85.3 The higher the score, the more efficient the home. 1. New construction or existing 2. Single family or multi-family 3. Number of units, if multi-family 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned floor area (ft") 7. Glass area & type a. Clear - single pane b. Clear - double pane c. Tint/other SHGC - single pane d. Tint/other SHGC - double pane 8. Floor types a. Slab-On-Gmde Edge Insulation b. NfA c. NfA 9. Wall types a. Concrete, Int Insul, Exterior b. NfA c. NfA d. NfA e. NfA 10. Ceiling types a. Under Attic b. NfA c. NfA 1 I. Ducts a. Sup: Unc. Ret: Unc. All: Garage b. NfA Single Pane 0.0ft" 138.8ft" 0.0ft" New Single family 1 3 No 1287 ft" Double Pane 0.0ft" 0.0ft" 0.0ft" 12. Cooling systems a. Central Unit Cap: 30.0 kBtufhr SEER: 11.00 R=O.O, 149.0(p) ft R=13.0, 1192.0 ft" R=30.0, 1805.0 ft" Sup. R=6.0, 150.0 ft b. NfA c. NfA 13. Heating systems a. Electric Heat Pump Cap: 30.0 kBtu/hr HSPF: 7.50 b. NfA c. NfA 14. Hot water systems a. Electric Resistance Cap: 30.0 gallons EF: 0.97 b. NfA c. Conservation credits (HR-Heat recovery, Solar DHP-Dedicated heat pump) 15. HV AC credits (CF-Ceiling fan, CV-Cross ventilation, HF- Whole house fan, PT -Programmable Thermostat, MZ-C-Multizone cooling, MZ-H-Multizone heating) I certifY that this home has complied with the Florida Energy Efficiency Code For Building Construction through the above energy saving features which will be installed (or exceeded) in this home before final inspection. Otherwise, a new EPL Display Card will be completed based on installed Code compliant features. Builder Signature: Address of New Home: Date: CitylFL Zip: *NOTE: The home's estimated energy performance score is only available through the FLA/RES computer program. This is not a Building Energy Rating. If your score is 80 or greater (or 86 for a us EPA/DOE EnergySta1Jtl designation), your home may qualifY for energy efficiency mortgage (EEM) incentives if you obtain a Florida Energy Gauge Rating. Contact the Energy Gauge Hotline at 321/638-1492 or see the Energy Gauge web site at wwwftec.ucf.edufor information and a list of certified Raters. For information about Florida's Energy Efficiency Code For Building Construction, contact the Department of Community Affairs at 850/487-1824. EnergyGauge@(Version: FLRCPB v3.30) Residential System Sizing Calculation Summary Project Title: Model #1805 Code Only Professional Version Climate: Central Location for weather data: Or1ando - Defaults: Latitude(28) Temp Range(M) Humidit data: Interior RH 50% Outdoor wet bulb 6 Humidit difference r. Winter design temperature 38 F Summer design temperature Winter setpoint 70 F Summer setpoint Winter tern rature difference 32 F Summer tern rature difference Total heatin load calculation 16429 Btuh Total coolin load calculation Submitted heating capacity % of calc Btuh Submitted COOling capacity Total (Electric Heat Pump) 182.6 30000 Sensible (SHR = 0.5) Heat Pump + Auxiliary(O.OkW) 182.6 30000 Latent Total Electric Heat Pum 93 F 75 F 18 F 18532 Btuh % of calc Btuh 97.7 15000 471.6 15000 161.9 30000 WINTER CALCULATIONS Winter Heatin Load for 1287 Load com onent Window total 139 sqft Wall total 1192 sqft Door total 21 sqft Ceiling total 1805 sqft Floor total 149 ft Infiltration 69 cfm Subtotal Duct loss TOTAL HEAT LOSS Load 4443 2622 316 1986 3859 2421 15647 782 16429 Btuh Btuh Btuh Btuh Btuh Btuh Btuh Btuh Btuh Ducta(5%) SUMMER CALCULATIONS ft Summer Coolin Load for 1287 Load com nent Window total Wall total Door total Ceiling total Floor total Infiltration Internal gain Subtotal(sensible) Duct gain Total sensible gain Latent gain(infiltration) Latent gain(intemal) Total latent gain TOTAL HEAT GAIN 139 1192 21 1805 sqft sqft sqft sqft 60 cfm Load 5766 Btuh 1222 Btuh 213 Btuh 2563 Btuh o Btuh 1192 Btuh 3000 Btuh 13956 Btuh 1396 Btuh 15351 Btuh 1801 Btuh 1380 Btuh 3181 Btuh 18532 Btuh EnergyGaugeCll> FLRCPB v3.30 In' G<l..,('6%) System Sizing Calculations - Winter Residential Load - Component Details Project Title: Model #1805 Code Only Professional Version Climate: Central Reference City: Orlando (Defaults) Winter Temperature Difference: 32.0 F 7/3/03 Window PaneslSHGClFrame/U Orientation Area X HTM= Load 1 1, Tint, Metal, 1.00 E 9.9 32.0 316 Btuh 2 1, Tint, Metal, 1.00 W 46.5 32.0 1487 Btuh 3 1, Tint, Metal, 1.00 W 16.2 32.0 518 Btuh 4 1, Tint, Metal, 1.00 W 36.0 32.0 1152 Btuh 5 1, Tint, Metal, 1.00 N 16.2 32.0 518 Btuh 6 1, Tint, Metal, 1.00 N 7.1 32.0 226 Btuh 7 1, Tint, Metal, 1.00 S 7.1 32.0 226 Btuh Window Total 139 4443 Btuh Walls Type R-Value Area X HTM= Load 1 Concrete - Exterior 13.0 1192 2.2 2622 Btuh Wall Total 1192 2622 Btuh Doors Type Area X HTM= Load 1 Insulated - Exter 21 15.0 316 Btuh Door Total 21 316Btuh Ceilings Type R-Value Area X HTM= Load 1 Under Attic 30.0 1805 1.1 1986 Btuh Ceilina Total 1805 1986Btuh Floors Type R-Value Size X HTM= Load 1 Slab-On-Grade Edge Insul 0 149.0 ft(p) 25.9 3859 Btuh Floor Total 149 3859 Btuh Infiltration Type ACHX Building Volume CFM= Load Natural 0.40 10296(sqft) 69 2421 Btuh Mechanical 0 o Btuh Infiltration Total 69 2421 Btuh Subtotal 15647 Btuh Totals for Heating Duct Loss(usinQ duct multiplier of 0.051 782 Btuh Total Btuh Loss 16429 Btuh Key: Window types (SHGC - Shading coefficient of glass as SHGC numerical value or as clear or tint) (Frame types - metal, wood or insulated metal) (U - Window U-Factor or 'OEP for default) (HTM - ManualJ Heat Transfer MUltiplier) Key: Floor size (perimeter(p) for slab-on-grade or area for all other floor types ) EnergyGauge@ FlRCPB v3.30 System Sizing Calculations - Summer Residential Load - Component Details Project Title: Model #1805 Code Only Professional Version Climate: Central Reference City: Orlando (Defaults) Summer Temperature Difference: 18.0 F 7/3/03 Type Overhang Window Area(sqft) HTM Load Window PaneslSHGC/UllnShlExSh Omt Len Hnt Gross Shaded Unshaded Shaded Unshaded 1 " Tint, 1.00, B, N E 1 4 9.9 0.0 9.9 18 50 493 Btuh 2 1, Tint, 1.00, B, N W 1 6 46.5 6.4 40.1 18 50 2118 Btuh 3 " Tint, 1.00, B, N W 1 6 16.2 0.0 162 18 50 810 Btuh 4 " Tint, 1.00, B, N W 1 7.5 36.0 0.0 36.0 18 50 1800 Btuh 5 1, Tint, 1.00, B, N N 1 6 16.2 0.0 16.2 18 18 291 Btuh 6 1, Tint, 1.00, B, N N 1 3 7.1 0.0 7.1 18 18 127 Btuh 7 " Tint, 1.00, B, N S 1 3 7.1 7.1 0.0 18 27 127 Btuh Window Total 139 5766 Btuh Walls Type R-Value Area HTM Load 1 Concrete - Exterior 13.0 1192.0 1.0 1222 Btuh Wall Total 1192.0 1222 Btuh Doors Type Area HTM Load 1 Insulated - Exter 21.0 10.1 213 Btuh Door Total 21.0 213 Btuh Ceilings Type/Color R-Value Area HTM Load 1 Under Attic/Dark 30.0 1805.0 1.4 2563 Btuh Ceilino Total 1805.0 2563 Btuh Floors Type R-Value Size HTM Load 1 Slab-On-Grade Edge Insulation 0.0 149.0 ft(p) 0.0 0 Btuh Floor Total 149.0 0 Btuh Infiltration Type ACH Volume CFM= Load Natural 0.35 10296 60.2 1192 Btuh Mechanical 0 o Btuh Infiltration Total 60 11Q? Btuh Occupants 6 Btuh/occupant X 300 + Appliance 1200 Load 3000 Btuh Subtotal 13956 Stuh Duct gain(using duct multiplier of 0.10) 1396 Stuh Total sensible gain 15361 Stuh Totals for Cooling Latent infiltration gain (for 44 gr. humidity difference) 1801 Stuh Latent occupant gain (6 people @ 230 Stuh per person 1380 Stuh Latent other gain 0 Stuh TOTAL GAIN 18532 Stuh Key: Window types (SHGC - Shading coefficient of glass as SHGC numerical value or as clear or tint) (U - Window U-Factor or 'OEF' for default) (InSh - Interior shading device: none(N), BlindslDaperies(B) or Roller Shades(R)) (ExSh - Exterior s~ing. device: none(~l,gr numerical v~PB v3 30 (Omt - compass 00entati0n) rgyl.:i8uge<1l1 . {....o(I'" .::' I ;::';: :: f:" j'"-.J ''1" ; -,"j :;: i...j;:: J) )i ". ~ '.! f' '. ,'. '. !. :,i;" .:(:)j--<;:' ',', :':':>'.; ;'.: ....f..!T L._ .':) '--'... !.:.'!\..: : "(,Jet,:.. <-I . c.''''.: ;:'.' ,;. ~;()(>(: .....: :i::: :~:? ,n...l::" f-,.j"r F:' "'_" 1 _., Q;;q ..Hi ('If{~J.. .: () "T" .... I::" .:..~ ': ':'- '":''' ("J .)(..)(..)(..)(..)(..)(. ('!i..'" .....;:::., ";.' '"' ", ;",'i :;: r:::j....) -..-.' !::'l::: I? ("j "; ~:::; f:] 1. :(:i 1";.J (:'j:: " 'f.;' j:. .:1::. PASCO COUNTY, FLORIDA -~"._""-"".._,..~..~~-~"'..._._'-~.~.._-~--~---_._--,~..."_.._-'--_._,,..._,,-.~-- I _1 Permit I\Jn. . -~;{;;2Js/'f?__. Date Permitled .--2"-/.7d~()_:3 Builder N"llIe/Owner Name LkLi~1titL_C_{~Cl:;._.__ Control # ._..._._._. __.___ ,.,) . - ~.~. CUlln I y P al<;elll (). t!L-;;L L :?L--l2c2f).Q.::.ilQLJ'2f2_~'<2.4.'lt)_ S 1I bD I v: (~ t...cY"'"_ (/ Ad d res s/I.o,," 110 n --1"-'i'2.ff'_I2",,:m k,J4j;'___ _ __ ___ . __ :::::c:- _ _ ____ _. ___ ___ ___ ClasstflGatlon/ rype of Use _ :::.j_......,_~__L/t _f2-g"W'1{~__Lkte~<. TRANSPORTATION IMP ACT PEl: -.- Rate: J-!. __ Sq FI UnIIC~'__ _ _. _ _ _____ EXelllpt [J Yes "K~(j\Jo Ilow Determined Impact h:~e Amount _~_,,_____ --- --,.._-"'-~.-...__.-.. ..- ....- Zone No, :cfCJ 1001.. IMPACT .FEE ~'----"-._--------~ TAZ: ..............,........._'-~...~---.............~ ~~-.........~,.....'"'-- ......->................--"'.-....._"""-~_........._.,......._..-...........>,f I\cc;ount (056) (057) (058) {'12J) 1_ ) Yes Single-Farnily Detached House Mobile Home ()lher Residential Coll~tion Fee \lNo How Oetennined Amount $ ~"-"<--'- -.., '. '"-- ~.. "".---.--, '- -'.~- -----.--..-__ "n. "___ .__ ..__.__. Exernpt pARKS AND REC"REA TION FEE ...-...--------~___.._ Land Accolllll Land Credit Land Total ------- -----_.._.~._-. F<ecreation !\CCOlHll --~----.- -._- ", -" ... "..-.-------.--. - ..--.....---.----- .-.-..". F<ecreation Credit r~ecreatjon Total ZWI8 Exernpt r-J Yes [] No TOTAL AMOUNT .-L~_" Ilow Detennlned _._,._---'_._---~....~._"~,,..,_.~~..,,_..,.. _...__...._,.__._~.._--_.. ._.._..._~..._.._-~--~~..._.._--_.__.^'_._.-.._-~._"..._-~ LIBRARY FEE Land !\ccount Land Credit Land Total .. ------~..__.__.._... ""-.....-... .-----------..---- ---. '---'--.- -'. .. -.--.. '-'-"--' -"-'0_-.. --___~._ . ....._____.____0__.. _.___~._.__..,..___~.__ ___'. _..___.___~ Facility ACCOllllt '-_~H~_____,,_ Facility Credit _... -.----.---...---.--.. Facility Total Exempt [-j Yes IJ No Ilow ()etennined Total Amount RESOURCE FEE..-q----...-~:------~.~~~.----~"._._, ERU.-~-..-".------.._..-.--~ -. .' . - "J' -I c.-.rr-At., AMC,_')lJN"j' . i' : \ .-.--'_'___..J___. . _'__ '___n__ ____.-...:...____. --------.--. - . ._-_._--~---~ .-~._-----..__..-...- -----...--- ........~ ~.............."'._._...o.-....... _'.'.~.............................................. ___..... "', -----------""--._--""--..............""..:...---..............._..............~ '......--.............--". -~..._-...- Prepared By _ -h____._____h~_,,___. ________~_______~___ Checked By ._.._-~.~ --------. -...-_.-~.~._-_... _..... -.------.-0-..- __0__.. ._. NO GEHTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION ~)ERt::O.~Ml:D UNTIL lHE TOTAL AMOUNTS L1s'n:D HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY AGknowledg8ment below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building petlnlt owner on notice of this assessment and the conditions of paYl1lent for same. DATE .. _._~--_.---- --..... -----......-.-.----- RECEIPT t.JO. l .,'~ ;1 i. ; -- --'--'-'--'-'-----,-.--. -..-.-..----.-. .--- -----------.---... r~EcEIVED BY Ii. .------.---..-.-- -- DATE: . J , .. , .J BY f \ , I ! ( : ; , --.__.._--~--'-.._~._. --- ~-.-' - ----.- -.-- .---...---.-.-...--. .--.--~-..-.._._...n~~_.._ --'..:..;..'