HomeMy WebLinkAbout03-2461
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
2461
I Permit Number: 2461 Issued: 10/29/2003
I Permit Type: NEW SINGLE FAMILY DWELLING I
Class of Work: 1 01-NEW CONST/SFR i
Proposed Use: SINGLE FAMILY RESIDENTIAL I
Sq. Feet: Est. Value: I
Cost: 74,300.00 Total Fees: 3,141.491
Amount Paid: 3,141.49 Date Paid: 10/29/20031
Address: 4843 TIMBERWAY
ZEPHYRHILLS, FL.
Township: Range:
Lot{s): 30 Block: Section:
Book: Page:
Subdivision: COURT SQUARE
Parcel Number: 15-26-21-0200-00000-0300
I Name: TENBRINK & ASSOCIATES
Addr: 35512 CHESTER DR.
ZEPHYRHILLS, FL 33541
Phone: (813)782-0678 Lic: Phone:
Work Desc: MASONRY SINGLE FAMILY DWELLING
TENBRINK, GORD N & PAULA
4843 TIMBERWA Y
ZEPHYRHILLS, FL. 33542
WATER CONNECTION RESIDENl
BUILDING FEE
5~ tllvloyl-fP>
A
DUCTS INSULATE
rJ WJ 0 FINAL MECHANICAL
~D I MISC
: MISC.
INSULATION ~IL%~ MISC.
DRIVEWAY 'i s. 01( IJ..7'o : MISC. MISC. i FIRE DEPT. FINAL
_.. ..- ,_... ., . _. - I ....___.__.___.~__
-REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade:
(a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not ma~;L .
inspection called (d) Work not ready for inspection when called I) 11;; .
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible /,u J<- '<V
The payment of inspection fees shall be made before any further permits will be issued to the person owning saine
-"Warrung to'owner:Your failure to reconfi'l notice of commencement may resulfin your paying- twice for--
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
__befor.E!.,recordlng you~,notice of coml'l1encement."
NO OCCUPANCY BEFORE C.O.
~--~ --
Y A 2---. ;0 --A ~
~----_._~---~ .------- .-
CONTRACTORS SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
;'P"
r"'"""""'l
H'''~
~
~-
PERFORMANCE BUSINESS PRODUCTS. iNC. 313-.719-3008 FAX 313-719,7919
CITY OF ZEPHYRHILLS
ZEPHVRHILLS, FLORIDA
c3___ 1 L(,? '9
,
WATER ACCT. NO.
DATE / tJ ~ ~/J () ..:3
. /
';J .~!
'~A~i ::f /L:5sa1
"/ I J ~ (---'J
MAILlNG;$,!;)~.$Z'2- L. jI;,a La '-LJ-1..
.......,... ;)' ;-'
,.G ..;t&-li ~ /- L t -q ~ -1' I
SERVICE ADDRESS #.91/ ~ '" j./~.;L-IJ..)~ . A 0/ .;S.cJ
LAp" WATER
OWNER/' A
RENTER ~ L ./.LA-1
JJtL-
SHUT OFF SERVICE
o
TURN ON SERVICE ~.
INSTALL METER ~
READ METER 0
CHECK METER 0
OTHER 0
o SEWER
o GARBAGE
I.-,( IN CITY
I~
o OUT CITY
~ No. OF UNITS
_ DEPOSIT AMOUNT
S- -f-
If II L.u$~~
_ AMOUNT LAST BILL
c
_ DATE
--......
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
V:'
/z:;f7
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_
Tenbrink & Associates
4843 Timberway Lot # 30
SQ. FEET PRICE
MAIN OR LIVING: 1,265 $ 50.00
OTHER AREA UNDER ROOF: 442 $ 25.00
OTHER: - $ -
VALUATION $ 74,300.00
FEE SHEET $ 380.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 630.001 V'
CREDIT: $ -
BUILDING LESS CREDIT: $ 630.00 V
ELECTRICAL: $ 117.40
PLUMBING: $ 96.00 V
MECHANICAL: $ 66.02 V
RADON: $ 17.07\ V
TOTAL $ 926.49
SEWER: $ 1,616.00,
WATER: $ 419.0Ch. ,/
IRRIGATION: $ -
TOTAL: $ 2,035.00
,,/
WATER METER:I $
IRRIGATION METER $
180~00r
SUB-TOTAL $
3,141.49 I
SIF'S: $ 1,694.00
97.5% $ 1,651.65
2.5% $ 42.35
DUE AT e.o.
TI F'S: $ 1,480.00
99% $ 1,465.20
1% $ 14.80
DUE AT e.o.
TOTAL: $ 6,315.491
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPAR'l'MENT 5335 8th Street, Zephyrhil1s, E'L 33542
813-780-0020 E'AX:813-780-0021 /nO/11'71 / .
DATE RECE IVED~-f-!!.J-
PLANS REVIEW ~EE
OWNER'S NAME ~,6--on ~ Po..u..l 0.., '~.vd3r-'inL
,JOB ADDRESS ~ 'ftLJ 3 lfrY1tx..Y ~
LF~GAL DF~SCR1PTION: 1..0T(S) 30 BLOCK
PARCElJ 1D # \S-dle-~\ -Dd.-C)()~ DDOOO- D'?>OO
PHONE Sl~ ('it;;) - L,~~9
SUB D 1 V 1 S ION Ccu..r t S ~ lA.OJ' e...
(OBTAIN F~ PROPERTY TAX NOTICE)
WORK PROPSED: ~EW CONSTRUCTION
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
OS [GN
PROPOSED USE: ~SGI, F'AMILY D\ilJELL,ING
o t10VE
o DEt10LISII
Ocm1MERCIAL
OMULTI - FAt'IIL Y
o INDUSTRIAL
o jl OF UNITS
o mvH1tlING POOL
o 1108ILE HOME
o OTHER
CJ RESTAURANT & HEALTH DEPARTt1ENT APPROVAL
DESCRIPTION OF WORK CCJV\s'h lAC.---t m~y.:l Sj l ~I 'j V\0Y\Ile-
BUILDING SIZE SQUARE FOOTAGE '(O~ HEIGHT
RESIDENTIAL:
Cm1MERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
//) 1/
H ()~T"
& (1) SET ENERGY FOR~e
FORlvJS. 16 ).uf7
'IZl! / ~p'
I .'Z ')
.-< 1('7
7
~UnDING
(3( ELEC'l'RI C1\L
[Y(PLUMRING
~ECHANICAJJ
$ ~'1,UOO.C:O
d.OD
VALUATION OF TOTAL CONSTRUCTION
AtJIP SERVICE IV FLORIDA POWER []
\il1.R.E.C.
TYPE: OF COf\lSTRUCT ION: ~ BLOCK
o FRA11E
o STEEL
"^~ --"'\~
,/./,".:..--.... \
INsr^I'LA'I~
o OTIIER
$
,.;L'140.00
VALUATION OF MECHANCIAL
o GAS
o ROOFItlG
o SFECIALTY
o OTHER
FINIS!!F.D FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES [B'1io
BUILDER
SIGNl\.TUR~. V\-~p~
Cm1PANY lenbY,-rlk-1 ~.s.sCLic.d'es.,-:kLL.
STATE CERT OR REGIST # CG~C434d-d-
CITY PROCESSING #~
****~*~****************~******~*~+***************~**********~*****
COtJ1PANY Y\\.(X./-t:1 VI ~:.-\ €c-\-ri v
STATE CER'l' OR REGIST # Eo' 1300 I ~~ '3
CITY PROCESSING #_..9.:1.
***'k***********k*******k*****************************~*~**********
SIGNA'l'U '
em/II? AN Y ~ 1-1 'e..-YYl()...\i\ 'PlLUYl bl~
STATE CERT OR REGIST # (F c.. 04 (;Ll
CITY PROCESSING # \;t,
PLUMBER
SIGNATURE
MECHANIC
-I- -I- -I- -I- -I- -I- -I- -I- * -I- *1- * -I- -I- -I- * -I- -I- -I- * * * * -I- -I- -I- -I- ,I- -I- -I- -1-' -I- -I- -I- * -I- -I- * -I- -I- ~* -I- t -I- -I- y!' -I- " -;- -I- -I- -I- -I- r)l. -I- , -I-
Cm1PANY ( S ~ tt- A \.:..
...- STATE CERT OR REGIST # c..~LD4 3<14 ~
CITY PROCESSING 11 I'
*********k~**************************************+******k********
OTHER
C01'lPANY
STATE CERT OR REGIST 11
CITY PROCESSING I
SIGNATURE
* * * * * * * * * * * * * * * * * * * k "* * * * * * * * * * '* '* * * * * * *" * * * * * * * * .,._ * * * * * * * .,1,- * * *'~ * * * * * *
CONDITIONS OF' PERI'lJI'I' AFFIDAVIT
h. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" 11'1hich
may be more restrictiv~ than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED dONTRACTORS 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 laH, both the ovmer and contractor may be cited for a misdemeanor
violation under state law. I f the owner or intended contractor are llncertain 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 OHner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for the Hork. If the contractor Hishes
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. 'rAANSPOR'l'A'rION Il>1PAC'l' FEES AND UTILI'I'Y CONNECTION FEES
D. CONS'I'RUC'rUION LIEN LAv~ (CHAP'I'ER 713, FLORIDA STA'I'U'rES, AS AMENDED)
r certify that I, the applicant, have been provided Hith a copy of "Florida's Construction
lien LaH - Homeowner's Protection Guide'! prepared by the Iflorida 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 "oHner" prior to co~nencement.
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 cw~liance with all applicable laws regulating construction, zoning, and land
dt::velopment.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no Hork or installation has cornmenced prior to issuance of a permit and that
all work Hill 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 Inust 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-Sea~,alls, 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 v,hich
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 Hark and not as
authority to violate, cancel, alter, or set aside any provisions of the technical cod(:ls,
nor shall issuance of a permit prevent the Building Official from thereafter requir-ing a
correction of errors in plans, construction, or violations of any code. Every permit
i::;sued shall become invalid unless the work authorized by such permi t is cOllunenced Hithin
six months of issuance, or if Hork authorized by the permit is suspended or abandoned for a
period of six months after the time the work is corrunenced. One 90 day extension of tillle
may be allowed for the pecnit 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 RESUW' IN YOUR
PAYING TWICE FOR IMPROVEMEN'l'S 'I'O YOUR PROPERTY. IF YOU INTEND TO OB'l'AIN FINhNCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$ 2, 500 IN VALUE DO NOT NEED '1'0 RECORD AND pos'r A "NO'fI CE OF COMMENCEMEN'I'It.
~~~ ~~;~~
STATE OE' InORIDA STA'fE OF FLORIDA
COUNTY OF COUNTY OF
The foregoing instrument was acknowledged '1'he foregoing instrument was acknowle~ed
Before me this __ day of 2Q_ Before me this _day of , )_
by, by
(name of person acknowledged)
o who is personally known to me, or
(name of person acknoHledged)
Olho is personally known to me, or
Owho has produced
\(,.j (type
and HhoD did ~id not
of identification)
take an oath.
Owho has produced
~(type of identification)
and Hho Ddid Toid not take an oath
Signature of person taking acknoHledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
1111I1111111111111111111111111111111111111111111111111111111
2003193218
NOTICE OF COMMENCEMENT
p;.. ~ r ~f'-4
County of
'~,I(C
state of
THE ImOERSIGNED hereby gives notice that improvement will be made to c~rtain
real property, and in accordance with Chapter 713, Florida Statutes the
following infor~ation is provided in this Notice of Commencement: '
1. Oeser iption of Property: Parcel No.
?-c! -#..1 C
(Legal descr~pt~on 0
2 .
General Description of Improvement
'/1
.te)
Cfl'Y\ Sty-v'-.,--'~ yy\.li...SL'Yl. ( lj \ ~J \h\..tY\ \ \~ ~'Y\i\ ~
Rept: 724532
DS: 0.00
10/15/03
- //}
Ree: 6.00
IT: 0.00
-_ Dpty Clerk
3. O\voer Information: Name 6tl"l"clcv\ ()Y'~~lo.... \.z.:-'-...8f''''--k..
II d d res s 3s'-S ,;:r C h es.-tU "J:~r-{yi ~ C i t Y
7:X.- P t'j t' h \ \ l~
Statet-G 33s.lJ I
Interest in Property:
CL~Y)~ r/
Name of Fee Simple Titleholder:
(If other th~n owner)
JED PITTMA~ PASCO COUNTY CLERK
10/15/03 0~:36am 1 of 1
OR BK 5583 PG 1069
Address
~~~
. . ~,
4 .
City
State
Contractor: N.::lme" )eJ\\2x~k., ~ \4:ss0L. '~'--C .
Add res s ~ >;"\.f 27 LJ C'k.e.s. +-e./ Dr.
Ci ty "Z.cp ~'j (' h;) IJ
State FL~ 3)'YJ
5. Surety: N.::lrne
Address
City
State
Amount of Bond: $
6. Lender: Name
Address
City
State
7.
Persons within the State of Florida
notices or o~her documents may be
7l3.13(1)(a)(7), florida Statutes:
designated by Owner upon whom
served as provided by Section
tJc;mc
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of the
Lienor's Notice as provided in Section 71J.13(1)(b), Florida Statutes.
<J. r-xp.i.rn1 J.'Jn d~te ()t tlut.lce of Commencement. (the explratlcln date is 1 year
ir~m the d.::lte of recording unless a different date is specified.)
Si<J~ature of Owner:
-!&L 2~
Sworn to and subscribed before me this I =)+-- day of Oc..Avb4
20 () -=?
,,'''~'t...., JAf\ilE L MURPHY
[:f!'!\"S:~;~ . COMMISSION # DD 174344
Notury
,I, "~I
My C ::J:il,;lj 5 s~itan Expi~r~::'t;' :.
"~~.....-;;".@i '.;,~;d';;~ ~m~ ~~ct~ry Public Underwriters
~/",'lfu'ft\\'...
PC93053048/ A
FORM 600A-2001
FLORIDA ENERGY EFFICIENCY CODE
FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
Residential Whole Building Performance Method A
Project Name:
Address:
City, State:
Owner:
Climate Zone:
Model 1706
Central
Builder: Ten Brink
Pennitling Office:
Pennit Number:
Jurisdiction Number:
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 (W)
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. Wall types
a. Concrete, lnt lnsul, 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
I 1. Ducts
a. Sup: Unc. Ret: Unc. AH: Garage
b. N/A
Single Pane
0_0 W
0.0 W
0.0 W
New
Single family
I
3
No
1265 W
Double Pane
0.0 W
109.2 W
0.0 W
12. Cooling systems
a, Central Unit
Cap: 30.0 kBtuIhr
SEER: 11.00
b. N/A
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 30.0 kBtulhr
HSPF: 7.50
R=O.O, I 67.5(p) ft
R=13.0, 1340.0 W
R=30.0, 1706.0 W
Sup. R=6.0, 250.0 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-Dedicated heat pump)
IS. HV AC credits
(CF-Ceiling fan, CV-Cross ventilation,
HF-Whole house fan,
PT-Programmable Thermostat,
MZ-C-Multizone cooling,
MZ-H-Multizone heating)
Glass/Floor Area: 0.09
Total as-built points: 17239
Total base points: 20597
PASS
I hereby certify that the plans and specifications covered
by this calculation are in compliance ith the Flori
Energy Code.
PREPARED BY:
DATE: b
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.
EnergyGaugeQll (Version: FLRCPB v3,30)
FORM 600A-2001
Code Compliance Checklist
Residential Whole Building Performance Method A - Details
I 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 cfmlsa.ft. window area' .5 cfmlsa.ft. door area.
Exterior & Adjacent Walls 606.1.ABC.1.2.1 Caulk, gasket, weatherstrip or seal between: windows/doors & 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 tOD Dlate.
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/Z' clearance & 3" from insulation; or Type IC rated with < 2_0 cfm from
conditioned SDBCe_ tested_
Multi-story Houses 606.1.ABC_1.2_5 Air barrier on oerimeter of floor cavity between f1oors_
Additional Infiltration reqts 606.1.ABC.1.3 Exhaust fans vented to outdoors, dampers; combustion space heaters comply 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 clearly marked circuit
breaker (electric) or cutoff (cas) must be Drovided. External or built-in heat traD reQuired.
Swimming Pools & Spas 612.1 Spas & heated pools must have covers (except solar heated). Non-commercial pools
must have a pump timer. Gas spa & pool heaters must have a minimum thermal
efficiency of 78%.
Shower heads 612.1 Water flow must be restricted to no more than 2.5 aallons oer 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 Seoarate 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 ceiling & floors R-11.
EnergyGauge 1M DCA Form 6OOA-2001
EnergyGauge@/FlaRES'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~ilt Total: 6978.3
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
10233 2672 7692 20597 7956 2304 6978 17239
I
PASS
I
EnergyGauge TM DCA Form 6OOA-2001
EnergyGauge<IDIFlaRES'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: 4258.6 Winter As-Built Points: 4048.6
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 DSM x AHU)
4048.6 1.000 (1.078 x 1.160 x 1.00) 0.455 1.000 2303.8
4258.6 0.6274 2671.8 4048.6 1.00 1.250 0.455 1.000 2303.8
EnergyGauge TM DCA Form 6OOA-2oo1
EnergyGauge<ll>/FlaRES'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 Overhang
Floor Area Type/SC Omt Len Hgt Area X WPM X WOF = Point
.18 1265.0 5.86 1334.3 Double, Tint N 1.0 5.5 23.2 11.29 1.00 261.6
Double, Tint S 1.0 5.5 46.5 7_70 1_01 362.4
Double, Tint E 1.0 5.5 23.2 9.46 1.01 222.0
Double, Tint W 1_0 5.5 16.2 10.07 1.00 163.5
As-Built Total: 109.2 1009.6
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 1340,0 1.33 1775.5
Exterior 1340.0 2.00 2680.0
Base Total: 1340.0 2680.0 As-Built Total: 1340.0 1775.5
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-Built Total: 21.0 107.1
CEILING TYPES Area X BWPM = Points Type R-Value Area X WPM X WCM = Points
Under Attic 1265.0 0.64 809.6 Under Attic 30.0 1706.0 0.64 X 1.00 1091 .8
Base Total: 1265.0 809.6 As-Built Total: 1706.0 1091.8
FLOOR TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Slab 167.5(p) -1.9 -318.3 Slab-On-Grade Edge Insulation 0.0 167.5(p 2.50 418.8
Raised 0_0 0_00 0_0
Base Total: -318.3 As-Built Total: 167.5 418.8
INFIL TRA TION Area X BWPM = Points Area X WPM = Points
1265.0 -0.28 -354.2 1265.0 -0.28 -354.2
EnergyGauge@ DCA Form 6OOA-2001
EnergyGauge<l!l/FlaRES'2001 FLRCPB v3,3O
FORM 600A-2001
SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: I I I
PERMIT #:
BASE AS-BUlL T
Summer Base Points: 23987.0 Summer As-Built Points: 20531.9
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 DSM x AHU)
20531.9 1.000 (1.087x1.150x1.00) 0.310 1.000 7956.4
23987.0 0.4266 10232.9 20531.9 1.00 1.250 0.310 1.000 7956.4
EnergyGauge ™ DCA Form 6OOA-2001
EnergyGauge@/FlaRES'2001 FLRCPB v3.30
FORM 600A-2001
SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
I 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 1265.0 25.78 5870.1 Double, Tint N 1.0 5,5 23.2 20.63 0.97 465.0
Double, Tint S 1,0 5.5 46.5 33.69 0_93 1461.6
Double, Tint E 1.0 5.5 23.2 45_16 0.96 1010.3
Double, Tint W 1_0 5.5 16.2 40,60 0.96 632.4
As-Built Total: 109.2 3569.5
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 1340.0 0_35 469_0
Exterior 1340.0 1_90 2546.0
Base Total: 1340.0 2546.0 As-Built Total: 1340.0 469.0
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 1265_0 2.13 2694.5 Under Attic 30.0 1706.0 2.13X 1_00 3633.8
Base Total: 1265.0 2694.5 As-Built Total: 1706.0 3633.8
FLOOR TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Slab 167.5(p) -31.8 -5326.5 Slab-On-Grade Edge Insulation 0.0 167.5(p -31.90 -5343.3
Raised 0.0 0.00 0_0
Base Total: -5326.5 As-Built Total: 167.5 -5343.3
INFIL TRA TION Area X BSPM = Points Area X SPM = Points
1265.0 14.31 18102.2 1265.0 14.31 18102.2
EnergyGauge<B> DCA Form 6OOA-2oo1
EnergyGauge@lFlaRES'2oo1 FLRCPB v3.30
ENERGY PERFORMANCE LEVEL (EPL)
DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE SCORE* = 86.2
The higher the score, the more efficient the home.
I. New construction or existing
2_ Single family or multi-family
3. Number of units, ifmulti-family
4. Number of Bedrooms
5, Is this a worst case?
6. Conditioned floor area (W)
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-Grade Edge Insulation
b. N/A
c. N/A
9. Wall types
a. Concrete, Int Insul, 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
II. Ducts
a. Sup: Unc. Ret: Unc. AH: Garage
b. NIA
Single Pane
0.0 W
0.0 W
0.0 W
New
Single family
I
3
No
1265 W
Double Pane
0_0 W
109.2 W
0_0 W
12. Cooling systems
a. Central Unit
Cap: 30.0 kBtu/hr
SEER: 11.00
R=O.O, I67.5(p) ft
R=13.0, 1340,0 W
R=30.0, 1706.0 W
Sup. R=6.0, 250.0 ft
b. N/A
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 30.0 kBtu/hr
HSPF: 7.50
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-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 wbich 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:
City/FL 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.lfyour score is 80 or greater (or 86for a US EPA/DOE EnergyStJlrl designation),
your home may qualifY for energy efficiency mortgage (EEAf) 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 www.fsec.ucfedufor
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 1706
Code Only
Professional Version
Climate: Central
Location for weather data: Orlando - 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 15735 Btuh Total coolin load calculation
Submitted heating capacity % of calc Btuh Submitted cooling capacity
Total (Electric Heat Pump) 190.7 30000 Sensible (SHR = 0.5)
Heat Pump + Auxiliary(O.OkW) 190.7 30000 Latent
Total Electric Heat Pum
Winter Heatin Load
Load com nent
Window total
Wall total
Door total
Ceiling total
Floor total
Infiltration
Subtotal
Duct loss
TOTAL HEAT LOSS
93 F
75 F
18 F
15332 Btuh
% of calc Btuh
127.8 15000
417.6 15000
195.7 30000
WINTER CALCULATIONS
109 sqft
1340 sqft
21 sqft
1706 sqft
168 ft
85 cfm
Load
2532
2948
316
1877
4338
2974
14985
749
15735
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
Btuh
:luctsIS% ':
:J::J.nrsf2%}
SUMMER CALCULATIONS
ft
109
1340
21
1706
sqft
sqft
sqft
sqft
Summer Coolin Load for 1265
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
74 cfm
Load
2200 Btuh
1374 Btuh
213 Btuh
2423 Btuh
o Btuh
1464 Btuh
3000 Btuh
10673 Btuh
1067 Btuh
11740 Btuh
2212 Btuh
1380 Btuh
3592 Btuh
15332 Btuh
EnergyGaug~ FLRCPB v3.30
Duetlii7%.i
Manual J.
System Sizing Calculations - Winter
Residential Load - Component Details
Project Title:
Model 1706
Code Only
Professional Version
Climate: Central
Reference City: Orlando (Defaults) Winter Temperature Difference: 32.0 F
10/16/2003
Window PaneslSHGClFrame/U Orientation Area X HTM= Load
1 2, Tint, Metal, DEF N 23.2 23.2 539 Btuh
2 2, Tint, Metal, DEF S 46.5 23.2 1078 Btuh
3 2, Tint, Metal. DEF E 23.2 23.2 539 Btuh
4 2. Tint, Metal, DEF W 16.2 23.2 376 Btuh
Window Total 109 2532 Btuh
Walls Type R-Value Area X HTM= Load
1 Concrete - Exterior 13.0 1340 2.2 2948 Btuh
Wall Total 1340 2948 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 1706 1.1 1877 Btuh
Ceilina Total 1706 1877Btuh
Floors Type R-Value Size X HTM= Load
1 Slab-On-Grade Edge Insul 0 167.5 ft(p) 25.9 4338 Btuh
Floor Total 168 4338 Btuh
Infiltration Type ACHX Building Volume CFM= Load
Natural 0.40 12650(sqft) 85 2974 Btuh
Mechanical 0 o Btuh
Infiltration Total 85 2974 Btuh
Subtotal 14985 Btuh
Totals for Heating Duct Loss(using duct multiplier of 0.05' 749 Btuh
Total Btuh Loss 15735 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 'OEF' for default)
(HTM - ManualJ Heat Transfer Multiplier)
Key: Floor size (perimeter(p) for slab-on-grade or area for all other floor types )
EnergyGauge<B> FLRCPB v3.30
System Sizing Calculations - Summer
Residential Load - Component Details
Project Title:
Model 1706
Code Only
Professional Version
Climate: Central
Reference City: Orlando (Defaults) Summer Temperature Difference: 18.0 F
1 0/16/2003
Type Overhang Window Area(sqft) HTM load
Window PaneslSHGC/UllnShlExSh Omt Len Hat Gross Shaded Unshaded Shaded Unshaded
1 2, Tint, DEF, B, N N 1 5.5 23.2 0_0 23.2 12 12 279 Btuh
2 2, Tint, DEF, B, N S 1 5.5 46.5 46.5 0.0 12 18 558 Btuh
3 2, Tint, DEF, B, N E 1 5.5 23.2 0.7 22.5 12 35 797 Btuh
4 2, Tint, DEF, B, N W 1 5.5 16.2 0.0 16.2 12 35 567 Btuh
Window Total 109 2200 Btuh
Walls Type R-Value Area HTM load
1 Concrete - Exterior 13.0 1340.0 1,0 1374 Btuh
Wall Total 1340.0 1374 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 1706.0 1.4 2423 Btuh
Ceilina Total 1706.0 2423 Btuh
Floors Type R-Value Size HTM load
1 Slab-On-Grade Edge Insulation 0.0 167_5 ft(p) 0_0 0 Btuh
Floor Total 167.5 0 Btuh
Infiltration Type ACH Volume CFM= load
Natural 0.35 12650 73.9 1464 Btuh
Mechanical 0 o Btuh
Infiltration Total 74 1464 Btuh
Occupants
6
Btuh/occupant
X 300 +
Appliance
1200
load
3000 Btuh
Subtotal 10673 Btuh
Duct gain(using duct multiplier of 0.10) 1067 Btuh
Total sensible gain 11740 Btuh
Totals for Cooling Latent infiltration gain (for 44 gr. humidity difference) 2212 Btuh
Latent occupant gain (6 people @ 230 Btuh per person) 1380 Btuh
Latent other gain 0 Btuh
TOTAL GAIN 15332 Btuh
Key: Window types (SHGC - Shading coefficient of glass as SHGC numerical value or as clear or tint)
(U - Window U-Factor or 'DEF' for default)
(InSh - Interior shading device: none(N), BlindslDaperies(B) or Roller Shades(R))
(ExSh - Exterior shading device: none(N) or numerical value)
(Omt - compass orientation)
EnergyGauge@ FLRCPB v3.30
~
~
I-
<0
13
SOUTI-I
SITE PLAN TEN BRINK. ASSOC. INC.
MODEL .1106 LOT.3O COURT SQUARE
PARCEL .1&-26-21-0200-00000-0300
3& 8l-l
S'~' eLlOIN6
3& 8l-l
I
III
.
40'-0-
60'-0-
NORTI-I
2'-6"
J
,.----.------
,
,
,
,
2'-6"
x
i
III
?-
m
3
Additional Land Information
Tax Area Fema Cod
Building Information
Unimproved Parcel 00
Extra Features
No Extra Features
Sales History
DAVIS CONTRACTING INC
Book I Page I Type Amount
4914 j 0307 I
3927 ;' 1996 II \NO
3147 j :014 II \NO $129,
yarcel information for: 15-26-21-0200-00000-0300 Card: 001
: Parcel Detail
Search
Building Schematic Unavailable Calculate Taxes
ParcellD
Classification
15-26-21-0200-00000-0300 (Card: 1 of 1)
00 - Vacant Residential
Mailing Address
TENBRINK GORDON L & PAULA 0
35512 CHESTER DR
ZEPHYRHILLS, FL 335414618
Physical Address
Assessment (totals)
Ag Land
Land
Building
Extra Features
Total Assessment
Save Our Homes
(First 4 Lines)
COURT SQUARE
PB 33 PGS 63-64
LOT 30
OR 4914 PG 307
Taxable Value
Cond
1.00
1.00
Use
0100
0100
Description
SFR,
.70
.53
~3FR
Acres
Res Code
Previous Owner
Year I Month
2002 04
1998 05
1993 04
Page 1 of 1
$16,264
$0
$0
$16,264
$0
$16,264
Value
$16,200
$641
\lV~SPLPl
http://appraiser.pascogov.com/search/parce1.asp?sec=15&twn=26&rng=21 &sbb=0200&blk=000... 10/21/2003
PASCO COUNTY, FLORIDA
........................_,...."'.''"'...............".'-'-",.......'"'''-,~,...........'-''-''-~........''---...............~.
.~......--....-...-..............._...... _.........._..---.......-.....,....,~......~.-....-
Irnpact Fee AlTlOllnt .~.._,_
Zone No.
TAZ:
'sCI'ioc[1MPACT FF.E---~..-..~--_..._---~~'--~~..-....----~-....._-_._._~--_....__~
Account (056) Single-Farnily Detached House Amount $ ___'.__ ___...__'_..__"_,...._...,.. ,__
(057) Mobile Home __.____'_,..___,..,___,__,__,_,.
(CJ58) Other Residential _____'..______._.."..__..,____.
Exe III p t [J! ~ 28 U~~on F~.7ow D eten nln8r1_ _.__ _. . ___. __. . ______ .. _._m._ _ _
'p ARf<S AND' RECREATION FEE ..-,.--.--.-----~.~._------..--_.__.._,_._.
Land ACCoIHlt Land Credit Land Total
-'~-'-_._.- -,..... .._~--._- ---.-
---'-'--.,- - -.-- _.._'~----_.-
Recreation Account r~ecreation Credit Hecreatloll Total
-~~"._..-._- - '---'-'-"- ----~._-_._--..~_._, ~- ---"--'-"-''''~
Zone
TOTAL AMOUNT
..~-_.,--
Exernpt [J Yes [] t'Jo
Ilow Determined
..........-,.......,,_...u.....;,~___........,_.~_...,~ ~_
LIBRARY FEE
Land l\ccOlJl It
- m_..._______.___..____ . .__..'~ ..._. ____.. _." _ _____."__.__ __._. ,____ _'. __._..
,._~""..,-...-----....._.-.........--"".._,.._._.-"-""-._"'-~........----..."-~_._"."""-"'--.........._~.,,..._-,..................""-'->...--..._.....................~_.........."'..........._--'-._......_........_,--_._-"--....._._,...~
Land Credit
_.,-..._-----_.._---~~---.__._-
Land Total
Facility ACclllJl1t
-_...". .._....4____.___.._....,____.____
Exempt [-j Yes [J No
Facility Credit .___.._.'_,________. _,... Facility Total "____________________.
How Deterrnined Total AnlOlIllt
----....--.,---- ._--~--_.__...-.__..,~---
REsoTIFi'C'E-FEE"""--"--'~-'~-'~---'--------'.
r ..
TOTAL }\MOUNT . !.',
1_____--,..
"" ...--....-'""----_...."""-..'...__._,~~-_..--.-....
ERU
. -._.,.,._.._._.......'~-~."-_. '----...-.-.----- -"'---","-,-
....-.......-.... '-"'-'-'''' ,......~-""..~----..._'~._-~----~-,_..__...__...._-----~_._._--_..."_._"_._.__.._--_..._..._-~
Prepared By
......"..'.'---..______________ Cllecked By
---,.'".-. ~--..----_..-" -'-... --'--.~-,--..,--..>. '_.b.____..__. ~_'_.__
NO GEHTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
I)ERPORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFIGE OF PASCO COUNTY
Aclilluwledgernent uelow does not Imply acceptance of concurrence, but simply receipt of a GOPy of this form, placing
tile blJlldlng pennit owner on notice of this assessrnent and thE! conditions of payment for same.
-.----,-,..-."-.. ,,-- ---_. ..~. '-.-,.-- -._~".. ._..__._.__._---~.~-_._-_._._---
DATE
REC;EIPT NO.
", ,.' DATE
,-,-----'-.1.___......, __,
RECEIVED BY
;/
i 't.!
BY i !\ ( , '
-l--~--- ....--.---.
I
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t
I
, :
_4.__ _._.....___"____.__~.,_~_._._
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PASCO COUNTY, FLORIDA
--"-."-"~-"""""'-"'-~~"""""'<-'"''''''''-''' ............_~_"'--...'.h"""'~"n".'.........~.,~........_...-._......~..""...................,...-'-"".~__~__.W..........". '_"-_'~_" _........._......___.~~""'........ ...........,_..__.....".....'" "..."'-.....__,...
I low Deterrnined
---.---, ---...--..--.- .".'--.-----...-.._ - _'~n_..______,_..
Impact Fee An IOllntJ..,
Zone No.
TAl:
s'cTif) ()i:1MP ACT FE E""'~~'~' ....-._._~-~.,_."~.~.~....,----. --..._-.."~.
Accuullt (056) Single.Farnily Detached HOllse Amount
(05?) Mobile Horne
(058) Other Residential
('12::\) Coll}ilction Fee
Exempt I] Yes '[1 No Ilow Determined,.______,_..,
.' -'. .-........,..........._ < ~""'..->lo.____~..._~ .~ ~".""'.. .,,-.._.,. _~ ___, _..,.. ........ ,...._...
$
'.___. ___.no _.,.. .._._.....,..._,,__.....
..~.~-_.__.---_._-- --. _.h '_, .'._~_..____..___
PARks 'A Nfj'REC REA liON FE E .--...-_.~-,_..-..,.."'-_._~_.._~.. -"~'_... .-----...~.._"",....__u__.__...__._.. __'_'__
Lalld ACCCJI II It Land Credit Land Total
PecI8ctliun l\cculInt
F<ecreatiO!l Credit
f~ecreation Total
ZOl18
Exelnpt [j Yes I] r~o
TOTAL AMOUNT ,~________ .-'____.d,.,
How Determined
--'-"~ ~_. -'-..------... .-..,,"-,~--- ."-_._------..._--~,... -'" .--..~_._._'--.._~-......-',."---,_.~,~. ..'-..--.--.------...-,....--....--..------.---.-
LIBRARY FEE
Land 1\(~C()lll II Land Credit L.and Total
---.-----..-----."-.. ._~,~- ..-.------~---.___._ ._u__._..... _ -. ._. _____. _"_~..~.._._ _ ._. .__ __._.___
_.-..-.. .-----.--- --- .-- --._-~-..__.
Facility AC(;(JUllt
..____'__u,_________ facility Credit "-'-'--_______u______ Facility Total
Exempt L.J Yes [J No
,--- +--"'--~._"._ "h__.._,. '_.~.._..,..
How Determined Total Amollnt
----------.. '---'- ----~-'---.,--____.A,..h._._., _____
RE.s6DFfc.EFEE.---:----.~--~-~~-~-.-~--~-.~. ERU
TOTAL I\MOUNT I___L~_ _i:_.__~__n___...__.__,..
.......'.......-....~--,- .."....,.....~..,.........,......, -~.............-"....-._-
.---.. ...,".,... .".._-_......_._."'~~_._.".._._~-~~.__.~_.__.....__.--..~-_.---~--_.-.._~_._._.._,-_._~.=~.---...__.,-_.....,- "'."---""'--
Prepared 8y _
".- - -- -- --..-.- - ..-- ----.. - .._._~--"._-- ------._~~.
Checked By
_. ---..----..-.....---,.. .._" -.... ....-..--.. ...-.._..,,_.~_.._--
NO CEFnlFIGATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PEfU:O.~MED UNTIL THE TOTAL AMOUNTS LISTeD HAVE
BEl:N PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acl\llowledgelllent below does 1I0t i1nply acceptance of concurrence, but simply receipt of a copy of this forlll, placing
the IJllildlng permit owner on notiCE> of tliis assessment and the conditions of payment for same.
DATE
-- -'-'~-"" _. r '"_._,___ _ __.. ______..___________ ,,_ ._-.__ ___
~_._-_._~----_. ...~--- "
F~Er,EIVEO BY
/
.t---...:-_.___...~_.~
RECEIPT NO.
/" DAT!::
f
I
BY
, l
--,-- -----.-.----,-----.---