HomeMy WebLinkAbout04-3463
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
3463
Permit Number: 3463 Issued: 10/20/2004
Permit Type: NEW SINGLE FAMILY DWELLING
Class of Work: 101-NEW CONST/SFR
Proposed Use: SINGLE FAMILY RESIDENTIAL
Sq. Feet: Est. Value:
Cost: 166,400.00 Total Fees: 4,020.78
Amount Paid: Date Paid:
Address: 37303 PICKETT'S MILL AVE
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): 15E & 150 Block: Section:
Book: Page:
Subdivision: SILVER OAKS VILLAGE
Parcel Number: 03-26-21-0200-00000-0150
Name: HOMEOWNER
Addr:
BURNETTE, ROBERT .
37303 PICKETT'S MILL AVENUE
ZEPHYRHILLS, FL. 33542
Phone: lic:
Work Desc: NEW SINGLE FAMILY DWELLING
Phone:
WATER CONNECTION RESIDENl
BUILDING FEE
RADON
E
IRRIGATION CONNECTION
IRRIGATION METER
175.00 MECHANICAL FEE
180.00 WATER METER RES 3/4"
1 .
95.30
180.00
~
(c 0 w\ ')-"7 \~
H EL
DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB
DUCTS INSULATED LINTEL PRE-METER WATER
SHEATHING FRAME MISC SEWER
MISC INSULATION WALL MISC MISC.
MISC. INSULATION CEILING MISC. MISC.
MISC. DRIVEWAY MISC. MISC.
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 corre.s;tions not m...9.-de ~n I-
inspection called (d) Work not ready for inspection when called J ~ 5 f.lLd( ZJ rId k_ lj 1'YJw:-L
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
~
The payment of inspection fees shall be made before any further permits will be issued to the person owning sa
"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."
NO OCCUPANCY BEFORE C.O.
, ~
~-
CONTRACTORS SIG ATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
PROTECT CARD FROM WEATHER
Burnette Canst.
Lots 15 & 15E
SQ. FEET PRICE
MAIN OR LIVING: 3,328 $ 50.00
OTHER AREA UNDER ROOF: $ 50.00
OTHER: $ -
VALUATION $ 166,400.00
FEE SHEET $ 681.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 1,081.50
CREDIT: $ -
BUILDING LESS CREDIT: $ 1,081.501 /1
ELECTRICAL: $ 130.70, ~
PLUMBING: $ 110.001
MECHANICAL: $ 95.301
SUB-TOTAL $ 1,417.50
RADON: $ 33.28, /
TOTAL $ 1,450.78
v
SEWER: $ 1,616.00.. /'
WATER: $ 419.00
IRRIGATION: $ 175.00( /
TOTAL: $ 2,210.00
SIF'S: $
97.5% $
2.5% $
1,694.00
1,651.65
42.35
WATER METER: $
IRRIGATION METER $
SUB-TOTAL
TI F'S: $ - i
99% $ -
1% $ -
TOTAL: $
5,714.78 I
a:
f ~
.;.~.~
e~ .~~~ l'
f~:, ,_ <~~~
.,;~ ,::.~,.-,
:.:' '~::: ~",'
l. ,~'; l",:
" ,
,
V i.';. '.~
'. ~'('. " ",
(",.., .~-,.. ~,J
...."
_r....
..'~
(if.
. ,"
\..: \
\)~lJ, 0. [\)\..,I't v.\)~rm
NOTICE OF COMMENCEMENT
I JIIIII 111111111I 1111I 1111111111 IIIIIIIJII 111I1 11111 11II 1111
2M1418'7328
"Cpt.: 813441
D$, e.n
11I'/83/04
STATE OF FLORIDA
COUNTY OF PASCO
R.c: 111I.08
IT: s.lIle
__.___, Opt~ C:l...~
The undlllrsJ,ned, II Owner. DOtift.. aU partla tbat improvemCllts wiD be made to certain real property, and
in accordance with Seetfon 713.13, Florida StatutM, the IOllolriDZ information " ltated In tile Notice of
Commenl.'!ement:
n.&SCRlPTION OF PROPERTY:
The: Welt 9 feet 01 Lot lSD and all of Lot Ig, SILVIt'R OAKS
VILLAGE PHASE ONE, al per plat thereof reeorded in Plat
Book 35, Pages 63 thru 67 inclu.lve, Public Records of Paseo
County, Florida.
GENERAL DESCRIPTION OF IMPROVEMENTS:
Residential Home
OWNER AND OWNER'S ADDRESS: Robert C. Ie Patricia A. Burnette
3135% Wl'eIlerest Drive
Welley Chapel, FL 33543-7886
OWNER'S INTEREST IN THE PROPERTY DESCRIBED AS: Simple
CONTRACTO'R AND CONTRACTOR'S ADDRESS:
Robert C. & Patricia A. Burnette
31352 Wrencrest nrive
Welley Chapel, FL 33S43-7886
190~~&l"'l2: m;O FUNToV, Cl.ERIC
OR II< 6014 PG 11~1
SURETY (if any) and SURETY ADDRESS: N/A
AMOUNT OF BOND: S N/A
NAME AND 'ADDRESS OF LENDER, IF ANY, MAKING A LOAN FOR CONSTRUCTION OF THE
IMPROVEMENTS:
Community National Bank ofPalltO County
Post Office BOI 639
ZephyrhlUs, FL 33539
NAME OF PERSON WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM
NOTICES OR OTHER DOCUMENTS MAY BE SERVED:
'~':S
Community National Bank olPueo County
PoM Office Box 639
ZephyrblIlt, FL 33539
IN ADDITION, OWNER. DESIGNATED TIU: FOLLOWING PERSON(S} TO RECEIVE A COPY OF
THE LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13, FLORIDA STATUTES:
Commualty National Bank
Of Puco County
Poat omce BOI 639
Zephyrbllll, FL 3353!)
EXPIRATION DATE: October 1. 2005
Larry lIerlch
Attomey at Law
POIt Offiee Box 1046
Dade City, FL 33526-1046
Robert C. & Patricia A. Burne:tte
~~
Robert C. Burnette
dtJ~c;,~d:::
Patricia A. BurnetUi'
STAnt OF FLORIDA
COUNTY 011 PASCO
Tbe foregollll inltrument WIll acknowledged before me tills :zad day of September :Z004, by Robert C. &:
Patricia A. Burnett. who are J!Cnonally known to me or m.o produced
alldentlfieatlon, and dl~(J not take oatil. -
Wltn... my hand lIlnd omelal seal in the County and State lilt .foretllld thla:z- day of September 2004.
STATE OF'FlS.If>A
COUNTY OF PASCO ,
THill. TO OERTiIlY THATM ~ING IS A
TRUI NIP gQRRICT QOPV 0' THe 0009M&N'r ON FILE
OR M PUtU<: IlICORD IN THill OFFIQ€.~ MY
HAND AND OFFICIAl SEAL THIS~ DAY OF
2(.Jii:l
CLElI.K Of QII\ UlT COURT
DEPUTY CLeRK
....\,,'\1111111/11',1.
A""'~ R pirl/!"
,..QP.........~~
~~\88IGV~.:~~
I i~~2l\,l:\ \
5*: ..... }*i
,~\ .00982180 liS;;
~~.~~tf,lI ~"r;~'"
~A-~!~~<i~
~;h!!Z1C 1iT~'\~ ~~
''''ItIlI''"I\1\''~
NOTARY PUBLIC
(-~\Q1..o..-0~l.~tJl~,,:V'v()
",-,--,-
.
Short Form
Entire House
NUCCIO HEATING & AIR CONDITIONING
Job: 2414 SFL
Date: 8/19/2004
By: JC
6306 WEST LINEBAUGH AVE,. TAMPA. FL 33625 Phone: (813)961-7895 Fax: (813)962-4349
rOJect n ormation
For: BURNETTE CONSTRUCTION
~l~\.)E.~ Qt\~:> VlLL't\b'E.. hP-rs 15 1:> q..> 1.7 t;
eSlgn n ormation
Htg
40
70
30
Outside db (OF)
Inside db CF)
Design TD (OF)
Daily range
Inside humidity (%)
Moisture difference (grllb) -
Clg
95
75
20
L
50
60
Infiltration
Method
Construction quality
Fireplaces
Simplified
Average
o
HEATING EQUIPMENT
ROOM NAME Area Htg load CI~ load H~ A VF CW AVF
(ft2) (Btuh) (B uh) (c m) (c m)
FIRST FLOOR 0 0 0 0 0
KITCHEN 180 2743 3652 120 158
Make
Trade
Model
Efficiency
Heating Input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
BREAKFAST
STAIR
DINING
BATH 1
FOYER
GREAT ROOM
SECOND FLOOR
BED3
BED 3 CLOSET
BED 4 CLOSET
BED4
LAUNDRY
BED2
ACTIVITY
BATH 2
COOLING EQUIPMENT
o HSPF
o Btuh @ 470F
o OF
1486 cfm
0.044 cfm/Btuh
0.00 in H20
Make
Trade
Cond
Coil
Efficiency
Sensible cooling
Latent cooling
Total cooling
Actual air flow
Air flow factor
Static pressure
Load sensible heat ratio
o EER
o Btu h
o Btuh
o Btuh
1486 cfm
0.043 cfm/Btuh
0.00 in H20
80 %
182 3462 3736
80 474 209
196 3289 3423
42 905 586
49 1436 647
252 4002 5407
000
144 2341 2045
42 366 300
42 661 509
144 1835 1603
66 430 369
180 1824 1635
182 1127 1194
65 278 1913
Bold/Italic values have been manually ove"idden
152
21
144
40
63
175
o
103
16
29
80
19
80
49
12
162
9
148
25
28
234
o
89
13
22
69
16
71
52
83
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
...:S:. vvrlght:soft Right-Suite Residential 5,9,03 RSR32538
ACCf\ C:IProgram FileslWrightsoft HVACIBURNETTE2414,rrp Calc = MJ7 Orientation = SW
2004-Aug-19 09:56:15
Page 1
STAIR UP 98 1383 1792 61 78
MASTER BATH 140 1106 985 48 43
MASTER BED 252 4218 2987 185 129
MASTER CLOSET 78 2053 1328 90 58
Entire House d 2414 33934 34320 1486 1486
Ventilation air 0 0
Equip. @ 1.00 RSM 34320
Latent cooling 2414 I 33934 I 8614 1486 I
TOTALS 42933 1486
Bold/Italic values have been manually overridden
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
~ vvrlght:soft Right-Suite Residential 5,9,03 RSR3253B
~ C:\Program Files\Wrightsoft HVAC\BURNETTE2414,rrp Calc = MJ7 Orientation = SW
2004-Aug-19 09:56:15
Page 2
~,
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021 ~;l3o;loyr
DATE RECE lVED, "
PHONE CONTACT FOR PERMITTING
OWNER'S NAMECZ~~E\<-\ ,~ , .Rt.)R-~E.\\E PHONE'b'3 'l"33 lat"C)
JOB ADDRESS ,-37 30 3 f>\~kE\\' ~ M,,\'-.L. ~\)~~.:J-;=
LEGAL DESCRI PTION: LOT (S) 15.E. "" \ 5 ~ BLOCK SUBDIVIS IO~\ ~:~~: ~ ~~
PARC"L ID #~!:l"'~"''''''t'\5j') '*OISE 'ORTAr~ FR(L p__~ NOL_~I
WORK PROPSED: ~W CONSTRUCTION 0 ADDITION DALTERATION D REPAIR D INSTALL
D SIGN
PROPOSED USE~ FAMILY DWELLING
o COMMERCIAL
o MOVE
o DEMOLISH
OMULTI-FAMILY
o INDUSTRIAL
D# OF UNITS
OSWIMMING POOL
D MOBILE HOME
D OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK P E u....)
BUILDING SIZE 'd..l.\ ";K.lo~
-b L""") e. ~) "-.J ,,,- ') ~
SQUARE FOOTAGE
l
HEIGHT d~
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
)8(eUILDING
~LECTRICAL
PERMITS REQUESTED
$lli .) ~ ~ ~ ,~~ VALUATION OF TOTAL CONSTRUCTION
-a~l;::) AMP SERVICE X FLORIDA POWER D W . R. E. C.
~UMBING
~ECHANICAL
$ f.o )~~~, ~~
VALUATION OF MECHANCIAL INSTAL
~S
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION:~OCK
FINISHED FLOOR ELEVATIONS
D FRAME
D STEEL
D OTHER
IS PROJECT IN FLOOD ZONE AREAD YES ~
CONTRACTOR .'.,' SECTION
BUILDER DLc.:J \.0t, ~ COMPANY
SIGNATURE.::t '> C""".a...- d/ Y STAT" CERT OR R"GIST #
**********************************C**OM**PAN***Y******O**~**********
ELECTRICIANO LU N S ~ ~
SIGNATURE c;r:) ~ STATE CERT OR REGIST #
v vJf' IN
******************************************************************
PLUMBERaLC>~5~ COMPANY DwY\Q/(
SIGNATUR~~ -'~ ~ STATE CERT OR REGIST i
~, ***************** *************************~*~~**~**** - I ~
MECHANI~ - . __ COMPANY --"~-!O ~- _? <!f~
STATE CERT OR REGIST # ~__..
.c..
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictionsU wt~ich
may be more restrictive than City regulations. The undersigned assumes re~ponsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-780-0020.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s} sign po~tions of the "Contractor SectionsU of this application for which they
will be ~esponsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for th~ 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 Guideu prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "ownerU, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "ownerU prior to corrunencement.
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 corrunenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Envirornnentally 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 "AU or "A,etc.u, it is
understood that a drainage plan addressing a "compensating volumeu will be submitted which
is pre~ared 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 corrunenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FIN NCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C MENCEME JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO 'D AND POST A "NOTICE OF COMMENC
STATE OF FLOfltA
COUNTY OF r~
The foregoing i'l::Jlment wa~knO\f~edged L(
Beforpml ttS Ztay o~ (/J""'-, 20Q..
by n i!., G. q../l~
, ~/ (name of person acknowledged)
~who is personally known to me, or
!:.l (/0
edged nlJ
, 2 0 r2..:J
(name of person acknowledged)
is personally known to me, or
Owho has produced
(type
id not
of identification)
take an oath.
Owho has produced
(type of jdentification)
and who Dd~ take an oath
signature~ person taking acknowledgment
Sign
Name
.1........- :"....~,
typed '.j Pc$-:r;n;t.ed oPE~~S
, il ,,5" #, '" ~ 'iiY COMMISSION DO 018359
i i ~'~:,:,*",:-.,'~,.,',-,:'t,{::,:,:' EXPIRES: June 18, 2005
", '''' _ _ ,'_ t.',u(\(!,~d Thru Notary Public underwmQr:~
~ ~~:;';';g-;,:
\,,'1111"1
Name
typ .....;-~~tI1~MMlSSIOOl/.~~6t1
:~;:~;i~/ EXPIRES: June 18, 2005
',i~-;,\~'~"'-" !3oflded Thru Notary Public Underwriters
".~;;-~:_,-,,~
DISCLOSURE STATEMENT FOR OWNER
CITY OF ZEPHYRHILLS BUILDING DEPARTMENT
I,
agree to the provisions of this instrument.
have read and fully understand and
The undersigned states and affirms that he or she is desirous of constructing,
renovating, adding to or reroofing his or her own domicile, that he or she
actually occupies, or will occupy by said domicile, and same is not for
rent, lease or sale. That he or she shall comply with the following conditions:
1. That the owner and he or she alone shall act as the builder for all phases of
construction.
2. That the owner will comply with all provisions of the City of Zephyrhills
ordinances and codes pertinent to the building.
3. That in the event various phases of construction are subcontracted, he will
engage only properly licensed subcontractors and will personally supervise
such work.
4. That in the event the Building Inspector shall require corrections to be made,
the owner will assume full responsibility to insure they are made, and upon
completion will call for a reinspection before proceeding with the building.
5. That the owner shall assume full responsibility for the construction and will
not expect supervision of his work from the City of Zephyrhills Building
Department.
6. That prior to final inspection any additional fees, including reinspection
fees, must be paid in full. A written request from this office shall
constitute an official notice to pay additional fees.
7. That the owner shall comply with all City, State and Federal laws in regard to
social security, workman's compensation, lien laws, etc., where applicable.
8. That the owner shall comply with all the safety codes issued by the Florida
Industrial Commission.
9. State law requires construction to be done by licensed contractors. You have
applied for a permit under an exemption to that law. The exemption allows
you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a license. You must provide direct
onsite supervision of the construction yourself. You may build or improve a
one-family or two-family residence or a farm outbuilding. You may also build
or improve a commercial building, provided your costs do not exceed $25,000.
The building or residence must be for your own use or occupancy. It may not
be built or substantially improved for sale or lease. If you sell or lease a
building you have built or substantially improved yourself within 1 year after
the construction is complete, the law will presume that you built or
substantially improved if for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person to act as your contractor or
to supervise people working on your building. It is your responsibility to
make sure that people employed by you have licenses required by state law and
by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not
licensed to perform the work being done. Any person working on your building
who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for that employee, all as prescribed by law.
Your construction must comply with all applicable laws, ordinances, building
codes, and zoning regulations. .J ~
OWNER'S SIGNATURE - DATE :3J '3 2:::>LO Lf
ADDRESSSS .;:2..,~ c;,. - / (
PHONE Ci. <-' ,~ Z; 0
WITNESS , ~,-~ :Jig J' ,,~J~ j 5j~('~41~~/ PERMIT # J 1/ to '3
"""'"'---
FO'RM 600A-2001
FLORIDA ENERGY EFFICIENCY CODE
FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
Residential Whole Building Performance Method A
! Project Name-: BURNETTE2414 - - Builder:~- ------ BURNETTE CaNST
Address:~7.s0~ "?;tJ<E'!!.; /J1;d /+t/.e : Permitting Office: 6/7'1 OF .zE?/I'II!IIILL5
City, State: ZGII'/I211ItJ-b I r~ 3-gSY;L Permit Number: ..316":3
Owner:'J? (1, 1:f'1.l2;t.JE~ Jurisdiction Number: jpll-ftJU
__~~mate _Zone: J./ Central __ _ ___
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 V-factor
b. Default tint
c, Labeled V or SHGC
8. Floor types
a. Slab-On-Grade Edge Insulation
b, Raised Wood, Adjacent
c. N/A
9. Wall types
a. Concrete, Int Insul, Exterior
b. Frame, Wood, Adjacent
c. N/A
d. N/A
e. N/A
10. Ceiling types
a, Vnder Attic
b. N/A
c. N/A
II. Ducts
a. Sup: Vnc. Ret: Vnc. AH(Sealed):Attic
b, N/A
Single Pane
268.0 ft2
0.0 ft2
0.0 ft2
New
Single family
I
4
No
2414ft2
Double Pane
0.0 ft2
0.0 ft2
0.0 ft2
R=O.O, 99.0(p) ft
ft2
R=4.0, 2139.3 ft2
R=II.O, 197.0 ft2
R=30.0, 1433.0 ft2
Sup. R=6.0, 145.0 ft
I -;U~~ling syst;ms
a. Central Vnit
Cap: 45.0 kBtu/hr
SEER: 12.00
b. N/A
c, N/A
13. Heating systems
a. Electric Heat Pump
Cap: 47.0 kBtu/hr
HSPF: 8,00
b. N/A
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 40.0 gallons
EF: 0,90
b. N/A
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pump)
15. HVAC 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: 0.11
Total as-built points: 34988
Total base points: 35488
PASS
I hereby certify that the plans and specifications covered
by this calculation are in compliance with the Florida
Energy Code. ~ 1 /) ~ .
PREPAR~~ BYi 4 . \ J ~
DATE: ~ 20 0 I
I hereby certify that this building, as designed, is in
oomplianre with the F:~~~
OWNE~NT: ::> . ~
DATE: ~
--. ....- -- ----- ... --.' -
EnergyGauge@ (Version: FLRCSB v3.30)
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.
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 2414.0 25.78 11201.9 Single, Clear SW 1,0 17,2 13.0 56.99 1.00 739,9
Single, Clear NE 9,0 8,7 40,0 47.10 0.58 1097,8
Single, Clear NE 1.0 19.3 38,0 47,10 1.00 1786,1
Single, Clear NW 1.0 16.2 7,0 40,72 1.00 284.4
Single, Clear NW 6.0 7.8 32.0 40.72 0,69 901.9
Single, Clear SW 1,0 6,3 16.0 56.99 0.97 884,1
Single, Clear NE 1.0 6.3 16.0 47,10 0,98 735.4
Single, Clear NW 1.0 6.3 16,0 40,72 0.98 635.9
Single, Clear NE 1,0 2,0 6.0 47,10 0,76 215.2
Single, Clear SW 1.0 6,3 16.0 56.99 0.97 884,1
Single, Clear NE 1.0 2.0 6.0 47,10 0,76 215,2
Single, Clear SE 7.0 7.3 38.0 61.07 0.52 1208,6
Single, Clear SE 7,0 9.0 24.0 61.07 0.56 818.4
As-Built Total: 268.0 10407.0
WALL TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Adjacent 197.0 0,70 137.9 Concrete, Int Insul, Exterior 4.0 2139.3 1.20 2567.2
Exterior 2139.3 1.90 4064.7 Frame, Wood, Adjacent 11.0 197.0 0,70 137.9
Base Total: 2336.3 4202.6 As-Built Total: 2336.3 2705.1
DOOR TYPES Area X BSPM = Points Type Area X SPM = Points
Adjacent 17.0 1,60 27.2 Adjacent Wood 17.0 2.40 40,8
Exterior 20.0 4,80 96.0 Exterior Wood 20.0 7.20 144.0
Base Total: 37.0 123.2 As-Built Total: 37.0 184.8
CEILING TYPES Area X BSPM = Points Type R-Value Area X SPM X SCM = Points
Under Attic 1433.0 2.13 3052.3 Under Attic 30.0 1433.0 2,13X1.00 3052,3
Base Total: 1433.0 3052.3 As-Built Total: 1433.0 3052.3
FLOOR TYPES Area X BSPM = Points Type R-Value Area X SPM = Points
Slab 99,O(p) -31.8 -3148,2 Slab-On-Grade Edge Insulation 0.0 99.0(p) -31,90 -3158,1
Raised 461,0 -3.43 -1581.2 Raised Wood, Adjacent 19.0 461.0 1.00 461,0
Base Total: -4729.4 As-Built Total: 560.0 -2697.1
EnergyGauge@ DCA Form 600A-2001
EnergyGauge<ll>/FlaRES'2001 FLRCSB v3.30
FORM 600A-2001
SUMMER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
PERMIT #:
BASE AS-BUlL T
INFIL TRA TION Area X BSPM = Points Area X SPM = Points
2414.0 14.31 34544.3 2414.0 14.31 34544.3
Summer Base Points: 48394.9 Summer As-Built Points: 48196.4
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)
48196.4 1.000 (1.087 x 1.150 x 1,05) 0,284 1.000 17890,9
48394.9 0.4266 20645.3 48196.4 1.00 1.306 0.284 1.000 17890.9
EnergyGauge 1M DCA Form 600A-2001
EnergyGauge@/FlaRES'2001 FLRCSB 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 Ornt Len Hgt Area X WPM X WOF = Points
.18 2414.0 5.86 2546.3 Single, Clear SW 1.0 17.2 13,0 11.59 1.00 150,8
Single, Clear NE 9.0 8,7 40.0 14.70 1,00 588,7
Single, Clear NE 1.0 19.3 38,0 14.70 1.00 558,7
Single, Clear NW 1.0 16.2 7,0 14,97 1.00 104,7
Single, Clear NW 6.0 7.8 32.0 14.97 0,99 476.0
Single, Clear SW 1.0 6.3 16.0 11.59 1.01 187.1
Single, Clear NE 1,0 6,3 16.0 14.70 1,00 235.3
Single, Clear NW 1.0 6.3 16,0 14.97 1.00 239,2
Single, Clear NE 1.0 2.0 6.0 14,70 1,00 88,3
Single, Clear SW 1,0 6,3 16.0 11.59 1.01 187,1
Single, Clear NE 1,0 2,0 6,0 14.70 1.00 88,3
Single, Clear SE 7.0 7.3 38.0 10.59 1.47 590.0
Single, Clear SE 7,0 9,0 24,0 10.59 1.37 347.8
As-Built Total: 268.0 3842.0
WALL TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Adjacent 197.0 1.80 354.6 Concrete, Int Insul, Exterior 4.0 2139.3 3,35 7166,7
Exterior 2139.3 2.00 4278.6 Frame, Wood, Adjacent 11.0 197.0 1.80 354,6
Base Total: 2336.3 4633.2 As-Built Total: 2336.3 7521.3
DOOR TYPES Area X BWPM = Points Type Area X WPM = Points
Adjacent 17,0 4.00 68.0 Adjacent Wood 17,0 5.90 100.3
Exterior 20.0 5.10 102.0 Exterior Wood 20.0 7.60 152,0
Base Total: 37.0 170.0 As-Built Total: 37.0 252.3
CEILING TYPES Area X BWPM = Points Type R-Value Area X WPM X WCM = Points
Under Attic 1433.0 0.64 917,1 Under Attic 30.0 1433.0 0.64 X 1,00 917,1
Base Total: 1433.0 917.1 As-Built Total: 1433.0 917.1
FLOOR TYPES Area X BWPM = Points Type R-Value Area X WPM = Points
Slab 99.0(p) -1.9 -188,1 Slab-On-Grade Edge Insulation 0,0 99.0(p) 2,50 247,5
Raised 461,0 -0.20 -92.2 Raised Wood, Adjacent 19.0 461.0 1.00 461,0
Base Total: -280.3 As-Built Total: 560.0 708.5
EnergyGauge@ DCA Form 600A-2001
EnergyGauge@/FlaRES'2001 FLRCSB v3.30
F0RM 600A-2001
WINTER CALCULATIONS
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
PERMIT #:
BASE AS-BUlL T
INFIL TRA TION Area X BWPM = Points Area X WPM = Points
2414.0 -0.28 -675.9 2414.0 -0.28 -675.9
Winter Base Points: 7310.4 Winter As-Built Points: 12565.3
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)
12565,3 1,000 (1.078x 1.160x 1.05) 0.427 1.000 7068,7
7310.4 0.6274 4586.5 12565.3 1.00 1.319 0.427 1.000 7068.7
EnergyGauge TM DCA Form 600A-2001
EnergyGauge@/FlaRES'2001 FLRCSB v3,30
F0RM 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
4 2564.00 10256.0 40,0 0,90 4 1.00 2507,02 1.00 10028,1
As-Built Total: 10028.1
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
20645 4587 10256 35488 17891 7069 10028 34988
I
PASS
I
EnergyGauge™ DCA Form 600A-2001
EnergyGauge@/FlaRES'2001 FLRCSB v3.30
FORM 600A-2001
Code Compliance Checklist
Residential Whole Building Performance Method A - Details
I ADDRESS: , , ,
6A-21 INFILTRATION REDUCTION COMPLIANCE CHECKLIST
COMPONENTS
Exterior Windows & Doors
Exterior & Adjacent Walls
I SECTION
.606.1.ABC.1.1
1606.1.ABC,1,2,1
Floors
I ~
I 606,1,ABC,1.2.2
Ceilings
. 606.1,ABC.1.2.3
Recessed Lighting Fixtures
606.1.ABC,1,2.4
I
I--
I 606.1.ABC.1.2.5
1606.1,ABC.1.3 '
Multi-story Houses
Additional Infiltration reqts
PERMIT #:
REQUIREMENTS FOR EACH PRACTICE
i Maximum:.3 cfm/sq.ft, windo"". ar~~ ,5 cfm/sq.ft. door area,
i Caulk, gasket, weatherstrip or seal between: windows/doors & frames, surrounding wall;
I foundation & wall sole or sill plate; joints between exterior wall panels at corners; utility
I penetrations; between wall panels & top/bottom plates; between walls and floor.
EXCEPTION: Frame walls where a continuous infiltration barrier is installed that extends
I from, and is sealed to, the foundation to the top plate.
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 perimeter, penetrations and seams. ,. __ _ _ __
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
ins_tailed that is sealed_aJ the perimeter, at penetrations and seams, .
Type IC rated with no penetrations, sealed; or Type IC or non-IC rated, installed inside a
I sealed box with 1/2" clearance & 3" from insulation; or Type IC rated with < 2.0 cfm from
i conditionedspa_~, tested,-_ _ _ _____ ____
-LAir barrier 011 perimeter of floor cavity between floors. ._.___m_______
i Exhaust fans vented to outdoors, dampers; combustion space heaters comply with NFPA,
i have combustion air.
CHECK
6A-22 OTHER PRESCRIPTIVE MEASURES (must be met or exceeded bv all residences.)
COMPONENTS SECTION REQUIREMENTS - -- ------------ ------- cli~
-- -.- --- - --- .. -----
Water Heaters 1612.1 i Comply with efficiency requirements in Table 6-12. Switch or clearly marked circuit
~. ---~ i brea_ker (electric) o~cutoff (gas) mUlltb~erovided,- Ex!ernal or built-in heattrap required. u_ __
Swimming Pools & Spas ! 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
. ~: _j efficienc:yo.f78%, --- ',------------- -------------- ---
Shower heads 612.1 ., .lI\fater f10wlllust be restrict~d_!o_no more !han 2.5 gallons per 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,
-.-_.. I Ducts in unconditioned attics: R-6 min, insulation. --
._---------,--- - ".. -----------...- -~ ---------- ---
HVAC Controls ! 607.1 ' Separat~ readily accessible manual Clr automatic thermostat for each syste~.__
Insulation 604.1, 602.1 Ceilings-Min, R-19. Common walls-Frame R-11 or CBS R-3 both sides.
I Common ceiling & floors R-11,
EnergyGauge™ DCA Form 600A-2001
EnergyGauge@/FlaRES'2001 FLRCSB v3.30
ENERGY PERFORMANCE LEVEL (EPL)
DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE SCORE* = 83.5
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-Grade Edge Insulation
b. Raised Wood, Adjacent
c. N/A
9, Wall types
a. Concrete, Int Insul, Exterior
b. Frame, Wood, Adjacent
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(Sealed):Attic
b. N/A
Single Pane
268.0 ft,
0.0 ft,
0.0 ft,
New
Single family
1
4
No
2414 ft'
Double Pane
0.0 ft,
0.0 ft,
0.0 ft,
12. Cooling systems
a. Central Unit
Cap: 45.0 kBtu/hr
SEER: 12.00
R=O.O, 99.0(p) ft
R=19.0,461.0ft'
R=4.0, 2139.3 ft,
R=11.0, 197.0 ft,
R=30.0, 1433,0 ft,
Sup. R=6.0, 145.0 ft
b, N/A
c. N/A
13. Heating systems
a. Electric Heat Pump
Cap: 47,0 kBtu/hr
HSPF: 8.00
b, N/A
c. N/A
14. Hot water systems
a. Electric Resistance
Cap: 40,0 gallons
EF: 0.90
b. N/A
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pump)
15. HVAC 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 C~de compli~~ ' J J
Builder Signatu~~ Date: W~ Lo \f:-
I I
Address of New Home: ~\~~'.s \.(.\~ CitylFL Zip: <"'-EQ\V ~l~ ~L.33.i:
J
*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 EP A/DOE EnergyStar™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 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: FLRCSB v3.30)
MAR-30-2005 21:44 FROM:
l(863)85SSSf.l
TO: 18137885474
P.2
PS~M \~ :ti 34~
313~ 5. p, ~'C--P\{S '^-t\~L
Structural Enftneerinsr. InC.
Mf~hael A.. Robinson, P.E.
921 Shadow Driv~ Suite 3
Lakelan~ Florida 33809
To Whom It May Concern:
March 30, 2005
Subject Bumette Residence
This letter is to certify that it is structurally acceptable to substitute 4x4 wood posts
instead. ofhoUow columns as called for on design drawings.
This design confmms with 2001 Florida Building Code, Section 1606, 110-mphwind
loading criteria.
If any further . nnation is required, please contact me.
.-\" 1 ) } ,,)' ! t : ..<
, .
Michael A. Robinso~ P.E.
,Florida Registration No. 283 I 7.
'L
.
PtQ.M\l~ 3l\:to ~
3 '13 ~3 ?\ ~\<-.e.\'S \1v\.\\...L, -A 0 b
HEADER
BLOCK
FINISH
6RADE
iNSULATION PER'SPEC.
FOOTING DOWELS: #5'S
PER FDN. PLAN - EMBED
v" MIN. INTO FTG. WI
10" GIOo HOOK - LAP 25"
~@VERTICAL #5
,--v../ALL, BASE t FLOOR
FtNISH PER SPEC.
,.
"t
d
.
.
'.
-
'\C
I
.~
~=~#QN
/!Nfil"""" ~ 'ItIlU!I!I!!t
. ..:Pt'. 'T'IlLI!9$ ...... '"' fiIIW\I101! MDOF F'l'lO'!
"'~ 'T1IIU!$6 ~... l"'I!R aEV,
~~M ~~N
~I" ';:;'c!:I"'W FINAL TIOfl
PI!RHIT MIS I~ pat !ftC.
I'4IH. 5/f'J"
r.i'~eir.
51H1"SON I'II1T ....12
Oft IJ!llP' t:T AJ-4
~ ao EA. 1lIIJ!iI5
~c.m'~~'
o::.OHT. 25. l..)Ip
mf' 01' ~
Fll5t PLNI
P~. 1.11lTB--PaR I"\lU.
ttJ!Se ., 'I" 5PAM GJvel f)'}
- N..JAoI. f'RAMf: I4N:)CM
(9121: flU( PLJI\H,I IfeT AU..
~ M"'t!iR. ~.
oJOfSr ~
~~ H'Q16
oR U!lI" H"H2I6
TOP (;If' W1NfX)H
I"l!IIl IIIII..Nl
...c. 1.1NTa.~ I"lJU.
lU3E: II!') IF ~"''M 0'w'ER 6"
.....ut1. MHE ~
~m PDl Pl.JItNJ IN9TAU.
Per;!:~, Sf"I!'!G.
~'tI0N
1/2' = 1'-0"
@r
i
i
j ~
~ ~
i ~
r
..
~4' 115 F'I..~ lJEC.KINS
16 rtIE~. f\.OOIil n~T
~TEM ..... ~ Tal" f"L....1"E!t
FOR T(lp ~N5 Off LJro6E~
CWV<. OEFL-EGrtON ~T'\O " 3tJO}
..
~
~MI"\!OIIl H2,5 DIt ~ IIlrl
JOt9ot'S TO t-EDlSER GCJIoI'o4,
(0Pf.. led ........L~
2'.. 1:;1' Let'l68=I I'V 1/2'
ExP~ ~ ""..0'
~
Structural Eneineerinl!. Inc.
Michael A. Robinson, P.E.
921 Shadow Drive, Suite 3
Lakeland, Florida 33809
To Whom It May Concern:
February 8, 2005
Subject: 37303 Picketts Mill Ave.
Zephyrhills, FL.
This letter is to certify that the steel uprights (vertical reinforcement) do not have to be
continuous from the footer to the second floor lintel.
The loads are transferred from vertical reinforcement in 2nd story into bond beam, then
horizontally to vertical reinforcing for I st story.
This design conforms with 2001 Florida Building Code, Section 1606, 110-mph wind
loading criteria.
If any further information is required, please contact me.
",
Michael A. Robinson, P .E.
Florida Registration No. 28317
CE~TRAL PER0ITTI~G
PASCO COUNTY. FLORIDA
CONn~f~CT[m it::
NAME~ ROBERT C BURNETTE
ADDR~ 37303.PICRETTS MILL AVE
C/~;T ~ Z"-HH..LS. FL
FOR~ RESOlffiCE FEES PERMIT 3463
ACCNT
1.1.4
TOT AI... f.lMClUNT =
COMPNY ACCOUNT CENTER
B450 - 363000 - 2
RECEIVED BY .-f==- .......:....
CHI::: 1.::: I::: ** 7~:;'7
DAT~~ 06/27/05 T:ME~
., ;.t .. ,::;,::~
... ,'.........-
F(:IOE ~ 1 OF 1
I:; bi...lE CJFF I CE:: D
1:~i:::CE IPT i\IUiyjBR:: :; ()fr.'!; :.. ?::!;::.:;
OFFI,::E:: 1)(YOE CITY
2':;..90
f~MOl..n'-lT DESCFnPTI()N/PE:J~MT DAT(.l DFUCI:~
29.90 ****** SOLID WASTE FEE 60
PASCO COUNTY, FLORIDA
, ,
, " '~,f
'. , ' Permit No, -3,~ q
__ _'-'-' , Date Permitted /r; ~ 0/ Df/
~er N~ ~~i (? (;?~A;E-control # . . '
c~unty Parcel No, O;J-;l& -021-0;20C:>-OOOOO-DI!j2 SubDlv0~ 0..g ~
.' f~' I d PI5
Address/Location ~ 7 3 D 3. 'e s-
ClassificationfType of Us,?
TRANSPORTATION IMPACT FEE Rate:
Exempt DYes 0 No
How Determined
Impact Fee Amount $
Zone No.
TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House
(057) Mobile Home
(058) Other Residential
J.:123) Collection Fee
Exempt U Yes D No How Determined
Amount $
PARKS AND RECREATION FEE
Land Account Land Credit
Land Total
Recreation Account
Recreation Credit Recreation Total
Zone
TOTAL AMOUNT $
Exempt DYes D No
How Determined
LIBRARY FEE
Land Account
Land Credit
Land Total
Facility Account
Facility Credit
Facility Total
Exempt 0 Yes 0 No
RESOURCE FEE
TOTAL AMOUNT
How Determined
Total Amount
Prepared By
ZQ,90
~;T
fQ eg.
"ERt:l
Checked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOI)NTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and th~ conditions of payment for same.
{o(L7( Or
DATE
RECEIPT NO. .tl ~(3933
DATE
-Cd 27
['~I..J IC-Jl'~
RECEIVED BY
BY ~ 1:
,[,ecov,rc e r;.e;,