HomeMy WebLinkAbout06-5792
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5792 J
Permit Number: 5792
Permit Type: COMMERCIAL
Class of Work: ADD/AL T COMMERCIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 10,000.00
Date Issued: 5/16/2006 Name: T-MOBILE
Total Fees: 255.00 Address: 800 TARPON BLVD STE 1
Amount Paid: 255.00 PALM HARBOR, TPA 34685
Date Paid: 5/16/2006 Phone: 727 773-2221
Work Desc: ADD ANTENNAS, EQUIPMENT GENERATOR, PROPANE TANK
Address: 38522 A AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 14-26-21-0010-01700-0060
SOUTHEASTERN ENG & CONSTRUCTIOf\ FIRE INSPECTION FEES
25.00 FIRE PERMIT FEES
45.00
\(0
~ ~\~tID
FO D F TER ELE T
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.
REINSPECTlON FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies,
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 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.
D~~ rJZ~.
.,l ' . "-, ~~
/" TRA S A RE PERMIT OFF I
, - - L FOR INSPECTION - 8 HOUR NOnCE REQUIRED -
PROTECT CARD FROM WEATHER
Return to:
VoiceStream Wireless
Attn:. '~~lrgaret Skidmore
140., \ /. Dr. Martin Luther King Jr. Blvd.
Tampa FI. 33607
"
.,
111111111111111111111111111111111111111111111111111111111111
2006100961
Rcpt:998829
OS: 0.00
05/16/06
Rec: 10.00
IT: 0. 00
Dpty Clerk
JEO PITTMAN, PASCO COUNTY CLERK
05/16/06 04: 02pm 1 of 1
OR BK 6991 PG 429
FOR OFFICIAL USE ONLY
Permit No.:
Key No.:
Carrier Site Number: A2G0757
NOTICE OF COMMENCEMENT
State of:
Florida
County of Pasco
THE UNDERSIGNED hearby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida State Statutes, the following information is provided in this Notice of Commencement:
1. Description of Property: Parcel No.: 38522 Avenue A; Zephyrhills, FL 33540 (Legal description of the property and
street address if available) PID# 14-'26-21-0010-01700-0060
2. General Description of Improvement: The installation of telecom oanel antennas and eQuioment on existina telecom
tower for telecom ourooses.
II
3. Owner Information: Name: VoiceStream Wireless - Tamoa/Orlando, Inc.
Address: 3407 W. Dr. Martin Luther Kina. Jr. Blvd. Tamoa, Fforida 33 C. 0 '7
Interest in Property: Leasee
Name of Fee Simple Titleholder (If other than owner):
Contractor: Name Southeastern M.l&..\..Ul. c.oop&:.fl..
Address:4465 W Gandy Blvd.: Suite 800 City: Tamoa
State Florida
33.Cpt(
5.
State
6.
State
7. Persons within the State of Florida designated by the Owner upon whom notices or other documents may be served
as provided by Section 713.13(1 )(a)(7), Florida Statutes:
Name: Mike Ackroyd Address: 3407 W. Dr. Martin Luther Kina. Jr. Blvd. Tamoa. FI.
8. In addition to Himself, Owner designates Ron Grace of VoiceStream Wireless - Tamoa/Orlando, Inc.
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
9.
Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording unless a
different date is specified.)
Signature of Owner: 6?~.
The fo~g~ment was acknowledged before me this Ie;) 1:1- day of ~.a
by _ ~ who is ( L/ ) personally known to me or (_)' produc
identification.
,C;)tJ1J ~
as
Notary Public:
Notary Public Slate of Florida
Ma aret A S~idmore
My CommiSSion
ExpIres 0410712010
813-780-0020
City of Zephyrhills Permit Application
Building Department
if ()eo."
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SUBDIVISION ImCtJf:l5/~~ I PARCELIDlI/i.f.;llrJ'd-I. O()/D. ()/700. DDloDI
IOBTAMD'_ ..-n'TAlIII011Cel
E3 NEWCONSTR E3 ADD/All 0 SIGN D MOVE 0 DEMOLISH
INSTALl REPAIR
PROPOSED USE 0 SFR D COMM 0 OTHER I 1
TYPE OF CONSTRUCllON 0 BLOCK D FRAME 0 STEEL D OTHER I I"
........... OF_ 111ld anmJ"tL)1 ~ U ~~ gccta:b'; rt pr<pt#Z -Ir:u1J:. 6tI
I SQFOOTAGE~' ~ HEIGHT L 1.ex ishw iow~
00 ) V,,"^TIONOF"""'7;{': :J
o t.:; /WlP SERVICE PROGRESS ENERGY 0 WRE,C,
rN-
NOe.- _____
Fax-813-780-0021
WORK PROPOSED
BULDING SIZE
/
C2r' BUILDING
~LECTRICAL
/
~
D PLUMBING
D MECHANICAL 1$
D GAS 0 ROOFING
FINISHED FlOOR ELEVATIONS
I VALUATION OF MECHANICAL INSTALLATION
D SPECIALTY 0 OTHER
FLOOD ZONE AREA
DYES
DNO
C~.~.
--
ELEC1RI
~ ? SIGNATURE
to) . Adcha
PLUMBER
SIGNATURE
ctFi~
T~,"-' I
I
Y / N FEE CURRENT
LicenIe. I
Adcha
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
L!.!...!!-' FEE CURRENT W!LJ
Uc:ense . I
Adcha
OTHER
SIGNATURE
COMPANY
REGISTERED
L!.!...!!-' FEE CURRENT
License # I
W!LJ
Adcha
,J'\
v
Attach (2) Plot P_; (2) sets of Building PIa1s; (1) !lei of Energy Fonns ry'. --r
Minimum len (10) WOl1<ing dayt after submillal date. R~ onsile. Construction Plans, s.m.y Facilities & 1 dumpster 0'.J'
Attach (3) sets of Building Plans; (1) set of Energy Fonns, ,--An1:> '~
Minimum IIln (10) WOl1<ing daya after submittal date, Required OI1Iite. Construction Plans, Sanitay Facilities & 1 dumptter \ ~ - , ,';,) '1
All commerciall'lJqUirements must meet compliance. -:' ') / 0 v
Attach (2) sets of E~ Plans, ~ C - . <>
"*""PROPERTY SURVEY required for all NEW construction. :::> /1 '6
RESIDEN11AL
COIIIIERCtAL
SIGN PERIIIT
DinM:tiona:
Fm out application completely.
Owner & Contractcr sign b8ck of applicaIion. notarized
If __ $ZliCIO, . NoIlce of eon-lCeII_ Is requInId. (AIC lIplIIWIea __ $10001
- Agent (for the contrector) Of Power of Attorney (for the owner) would be someone with notarized IeIIer from owner aulhorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades AIC Fences (PIot/Su'veyn'ootage)
~ 0_ Counter W on public roadways..needs ROW
Fire Chief Robert Hartwig
" "
~~[Y
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813) 780-0041 Fax (813) 780-0044
FIRE SERVICE US~;':r~E~ _. ~h
Billing Address:
Occupancy No.:
Plan No.: Ob -DO~5
Business Name: ~t1 ~ h; Ie...
BusinessAddress:
Business Phone No.: ?f/3--- 3i/Y~2~3 "
Business Fax No,:
Contact:
GREASENENTILATION
n HoodlDucts $15
~ 0 Kitchen Suppression $15 ~
PLANS TOTAL I I INSPECTION TOTA~ PERMIT TOTALc:ttJ
~mme"~ 1Vi~~J;:~
(j, j- /o~
';.trry 6:.;,v? j/'-- ~dA-
PLAN REVIEW FEES
~ Site Plan N/C
Building Plans .04 sf
Revision .06 sf
STANDPIPE SYSTEM
o Per Riser $25
SPRINKLER SYSTEMS
n 0 - 25 Heads $30
o 26 plus Heads $60
FIRE PUMP
o Per Pump $100
FIRE ALARM SYSTEM
o 0 - 25 Devices $30
o 26 plus Devices $60
SUPPRESSION SYSTEMS
~ Wet $35
Dry $35
C02 $35
Other $35
GREASENENTILATION
o HoodlDucts $35
Date:
Inspector:
INSPECTION FEES
Annual N/C
1 st Re-inspection $25
2nd Re-inspection $50
3rd Re-inspection $125
4th Re-inspection $250
5th Re-Inspection $500
Construction $15
Commercial $25
SPRINKLER SYSTEMS
Hydro Undergrounds $45
Hydrostatic System $45
Wet Acceptance $30
Dry Acceptance $45
Hydrant Flow $25
Hood / Booth $30
Grease Duct $15
FIRE ALARM SYSTEM
o System Acceptance $50
o Recall Acceptance $50
OTHER
Fire Wall/Smoke Wall $15
~
LP Gas
Natural Gas
Fuel Tanks
Tent
$25
$15
/'*
~
Billing Phone No.:
Billing Fax No.:
Contact:
PERMIT FEE
FALSE ALARM FEE
1st Alarm N/C
2nd Alarm N/C
3rd Alarm N/C
4th Alarm $25
5th Alarm $50
6th Alarm $75
7th Alarm $100
8th Alarm $150
9th Alarm $200
10th Alarm $250
Non Compliance $150
"Affidavit of Service/Repair"
SPRINKLER SYSTEMS
o Automatic $15
FIRE PUMP
o Fire Pump $15
FIRE ALARM SYSTEM
o Detection $15
OTHER
ITLP Gas
Natural Gas
Fire Works
Fuel Tanks
~
$25
$45
FALSE ALARM I
TOTAL
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
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
conlractor is not licensed as required by law, both the owner and contractor may be ciled 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 Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTIUTIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings. or expansion of existing buildings. as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permiWng. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release. the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due. they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the informalion in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction. zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiclion. I also
certify that I understand that the regulations of other government 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 Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterlWastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads. Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls. Docks, Navigable Waterways.
Department of Heallh & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abalement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone 'Y" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a profeSSional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application. for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions sel forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning. gas, or other installations not specifically included in the application. 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 codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested. in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days. the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT ( 117, 3)
CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
OWNER 0 G
Subsc~ed ~ncj s~'fn to (~~ffirmed) before me th~s
t.~ \ 'b ~cc,:\t=)~.,)< 1tlc,Q, ,\.),j ~ .,~'" ~
-Who Is/are personallv known 10 me or has/have produced
------.rnlC'entification.
SJI ~
::\'\~CI.. ~ ~(''(\\.l'rt~PUbliC
Notary Public
Com ssion ~'~.
~;,t. ~ SHEILAA HANUW/:'.KK
Commission No.
Name of Notary typed. printed or stamped
GROWTH MANAGEMENTIZONING DEPARTMENTIBUILDING DEPARTMENT
AGENT OF RECORD LEITER
TO THE GROWTH MANAGEMENT/ZONINGIBUlLDING DEPARTMENT:
I, /V1/hZ-K- k. cuAs.mtu--dL..- . (contractor/card holder name), License Number
~CXJU 1&.(75'" . of 1f'1&<;' w. ~y ~'/ Sf/tit ?feU, -anTi-Ji:-- 33(/1/
(address), I hereby designate and appoint the below listed Agent(s) of Record for any necessary
permitting processes.
The Agent(s) of Record is vested with the authority to execute and file any and aU necessary sets of
plans, applications, or other required paperwork necessary in the permitting process. The Agent(s) of
Record has my authority to respond to any and all comments from staff
The authorized Agent(s) of Record is:
Lauralee G. Westine, Esquire and/or Edyne K. Bamberski
800 Tarpon Woods Blvd., Suite E-l
Palm Harbor, Florida 34685
Phone (727) 773-2221
Phone (813) 598-1545
Fac. (727) 773-2616
Email Laura lee@westinelawcQJll
DATED 'd/,Io& / i ~
SIGNATURE OF CONTRACTOR: ~.4.. f} ~
PRlNTED NAME OF CONTRACTOR: ;11~ A. Lv/Js;n/~
ST ATE OF FLORlDA
COUNTY OF P'tfscc>
The foregoing instrument was acknowledged before me this I .st= day of 1i~
by /Y/tfIvt:- )- tuH1(~ who is personally known to me or who has produced
as identification.
o-~:'I PCl<9~ Judy Fernandes
: <;: Commission # OD48989'
(SEAL) ~~()O# ~~~~.=~~~ ~~:~o~::
,2006,
~ -:;;~
Not ~liC
-;:;CGbY ~--S
Printed Name of Notary
My Commission Expires: II (1~/rrj
GROWTH MANAGEMENTIZONING DEPARTMENTIBUILDING DEPARTMENT
AGENT OF RECORD LEITER
TO THE GRowm MANAGEMENT/ZONING/BUILDING DEPARTMENT:
I, {n1Ui:YL- /Y'L ccc.:pcrC-- . (contractor/card holder name), License Number
u;.c.. o17~3 . oftt:'I{Pr;' (,0. G/fr..1:)Y BtrVD., 5Vt~ <5z:u '7/PYlFl-; fl.. 3'3/P11
(address), I hereby designate and appoint the below listed Agent(s) of Record for any necessary
permitting precesses.
The Agent(s) of Record is vested with the authority to execute and file any and all necessary sets of
plans, applications, or other required paperwork necessary in the permitting process. The Agent(s) of
Record has my authority to respond to any and all comments from staff.
The authorized Agent(s) of Record is:
Lauralee G. Westine, Esquire and/or Edyne K. Bamberski
800 Tarpon Woods Blvd., Suite E-l
Palm Harbor, Florida 34685
Phone (727) 773-2221
Phone (813) 598-1545
Fac. (727) 773-2616
Email Lauralee@westinelaw.com
DATED
d. / ,/0
~:f#~
SIGNATURE OF CONTRACTOR:
PRINTED NAME OF CONTRACTOR:
fYl/L.-UIL rYI . Coc/p~lL
STATE OF FLORIDA
COUNTY OF ~o
The foregoing instrument was acknowledged before me this I ~ day of fiJ3rwd'tV(
by fY7/w{L-.;r). c.u;RL . who is personally known to me or who has produced
as identification
o#1r'\, Judy Fernandes
: C; Commission # 00489891
(SEAL ~~ ~ Expires November 13, 2009
OF IIanGtcI tll>y """'. Insurance. Inc aCJO.385.7019
, 2006,
~~ ~~~
N blic
d~Y fi:J?A/h4'S
Printed Name of Notary
My Commission Expires: III, 319
AGENT OF RECORD LETTER
I, Mike Ackroyd, Central Florida Area Director, Engineering and Operations, T-Mobile USA,
Inc. (T -Mobile) d/b/a as V oiceStream Tampa/Orlando Inc. (V oiceStream), a licensed carrier,
hereby designate and appoint the Law Office of Lauralee G. Westine, P.A. and/or Lauralee G.
Westine, Esquire, 3442B Tampa Road, Palm Harbor, Florida 34685, Phone 727-773-2221,
Facsimile 727-773-2616, Emaillauraleee@westinelaw.com. as my and/or T-Mobile's Agent of
Record for the purpose of any and all permitting, zoning, and/or land use applications, hearings,
or processes.
My Agent of Record is hereby vested with authority to make any representations, agreements, or
promises which are necessary or desirable in conjunction with any of the aforementioned
processes. My Agent of Record is also authorized to accept or reject any conditions imposed by
any reviewing board or entity. My Agent of Record has the authority to execute documents
relating to any of the above described processes on my and/or T-Mobile's behalf.
.~ ML~
Mike Ackroyd
T-Mobile USA, Inc.
Central Florida Area Director,
Engineering and Operations
\ ~ \ ~ \ c:c,-S-"
Date
STATE OF FLORI~
COUNTY OF //;I3{}~otKJ}t
The foregoing instrument was acknowledged before me this ~1day of tlU06-t'A:::, 2005, by
Mike Ackro dT-Mobile USA,jgc. Central Florida Area Director, Engineering and Operations,
who is ersonally known to m or who has produced as
identification.
i'" a\. Judith PtdwInIkl
,~ ; My Commission 00257884
Of"," Expires December 13.2007
(SEAL)
i~~ I?IM;~
t~!Y-:PUQI~g IJ" . ,
J () 'DITtA. nhw/;<Js./L-i
Printed Name of Notary
BOARD OF COUNTY COMMISSIONER! CITY COUNCIL/GROWTH
MANAGEMENT/ZONING/BUILDING DEPARTMENT
AGENT OF RECORD LETTER
To Whom It May Concern:
I, Lauralee G. Westine, Esq., of the Law Office of Lauralee G, Westine, PA, 3442B Tampa Road,
Palm Harbor, Florida, hereby authorize my employee, Edyne K. Bamberski, Florida Driver's License
Number B516-211-61-784-0, to execute documents and file applications on my behalf in pursuance
of any land use, zoning or building permit application.
0KJJ2 Q~ ~I ~
LAURALEE d. WESTINE, ESQ.
3442B Tampa Road
Palm Harbor, FL 34684
Tel. (727) 773-2221
Fac. (727) 773-2616
Lauralee@westinelaw.com
STATE OF FLORIDA
COUNTY OF \:\.\'C\<;J~M
The foregoing instrument was acknowle~g~dheforemeth.is~ day of \\ \(){JUN\..\ tm.J ,2005,
by '\-\- \D \l ~,:~ ~ , who is ~i~?;allY ~o,,:,n t~~,_Qt)who has produced
as f enlilication. ~~ _ ' ~ ~
~..\Q,C\ ~ .c\u\0~
Notary Public
~ '
Printe
(SEAL)
\..U \: R \C
My Commission Expires:
~~<f,Of~~taYA HANDWERK
<:. ~ '" MY COMMISSION # DD-I128'7
~~~ .
~Oft\.Q" [XFlRES, Mar, 30, 2009
(407)398-0153 FIOfida Notary SlltVice.com
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
IDE Business Unit: 816298
SITE LICENSE ACKNOWLEDGEMENT
This Site License Acknowledgment ("SLA") is made and entered into as of this
7 day of i4/Jri i , 2006, by and between T-Mobile South LLC,
a Delaware limited liability company ("Licensee"), and Crown Castle GT Company LLC, a
Delaware limited liability company ("Licensor"), pursuant and subject to that certain Master
License Agreement (the "Agreement") by and between Crown Atlantic Company LLC, Crown
Communication New York, Inc., Crown Castle PT Inc., Crown Castle South Inc. (converted on
December 31, 2001 under Delaware law to Crown Castle South LLC), Crown Castle GT
Company LLC, and Crown Communication Inc. and T-Mobile USA, Inc. fi'kla VoiceStream
Wireless Corporation and its certain affiliates, joint partners and subsidiaries, dated as of June
20, 2000 and as subsequently amended. Unless otherwise clear from the context in which they
are used, all capitalized terms used herein shall have the meaning ascribed to them in the
Agreement. The terms and provisions of the Agreement are incorporated herein by reference.
Licensor's federal identification number is 76-0627250; and Licensee's federal identification
number is 20-3945483.
1. The Site (the "Site") consists of a portion of that certain parcel of property,
located in the City of Zephyr Hills, the County of Pasco, and the State of Florida, more
particularly described as a parcel containing approximately .455 acres situated as more fully
described in the legal description attached hereto as Exhibit "1" (the "Property"), together with
the non-exclusive right of ingress and egress, seven (7) days a week, twenty-four (24) hours a
day, on foot or motor vehicle, including trucks, and for the installation and maintenance of utility
wires, poles, cables, conduits and pipes over, under, or along an existing right of way extending
from the nearest public right of way, commonly known as B Avenue, to the Site, said Site and
right-of-way for access being substantially as described herein in Exhibit "2".
Prepared by S. Price I Jlu-e
Prepared on: March 30, 2006
Version 1/23/06
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
IDE Business Unit: 816298
2. Licensee's authorized use of the Facilities pursuant to this SLA shall be limited to
Licensee's installation, operation and maintenance of only the communications equipment
("Equipment") as set forth below, subject to the approved Site Engineering Application attached
hereto as Exhibit "3" at the Site as set forth below (the "Site"). Such license is subject to the
Special Conditions, Site Rules and Regulations, and Access and Security Procedures for Users
set forth in the Agreement and is restricted exclusively to the installation, operation and
maintenance of antennas and equipment consistent with the specifications identified below and
in Exhibits "3" and "4".
Manufacturer and type number:
Number of antenna(s):
Weight and dimension of antenna(s)
(LxWxD):
Transmission line manufacturer
& type number for each antenna:
Diameter & length of transmission line:
Number oflines:
Location ofantenna(s)
as described in Exhibit "3":
Height of antenna(s) on tower structure
as described in Exhibit "3":
Direction of radiation:
AC usage:
Equipment building/floor space dimensions
as described in Exhibit "4":
Frequencies/Maximum Power Output
per antenna:
EMS Wireless / RR65-19-02DP
LGP Telecom / LFP1390B TMAs
Six (6) EMS Wireless
Six (6) LGP Telecom
EMS Wireless: 23 lbs (72.0" x 8.0" x 2,75")
LPG Telecom: 10.4lbs (3.2" x 6.7" x 9.0")
Eupen / EC7-50
1-5/8" x 244'
Twelve (12)
Zephyrhills / 816298
194' radiation center
00 / 1200 / 2400
240 V AC / 200 Amps
15' X 23' Lease Area
Tx: 1930.2 - 1944.8 MHz
Rx: 1850.2 - 1864.8 MHz
Output: 1640 Warts
3. The Equipment shall be contained within the Facilities, located on the tower as
described in Exhibit "3" and on the Site Plan (or within an existing building) as described in
Exhibit "4".
4. The first (1st) Basic Annual Payment due and payable by Licensee to Licensor
shall be ~ Y _ . - -L ___ payable in
accordance with the Agreement. Any increase in the Basic Annual Payment shall be calculated
in accordance with the Agreement.
5. Licensee acknowledges that Licensor's rights in the Facilities derive from a
certain Special Warranty Deed recorded June 14, 2001, between GTE Wireless of the South
Incorporated and Crown Castle GT Company LLC (the "Prime Lease"), a copy of which is
Prepared by: S. Price
Prepared on March 30, 2006
2
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
JOE Business Unit: 816298
attached hereto as Exhibit "5", Licensee further acknowledges that Licensor's rights in the
Facilities and the Site are also subject to agreements and permits, the terms of which Licensee
has knowledge:
a.
b.
additional agreements:
title conditions:
regulatory requirements:
N/A
N/A
N/A
c.
6. Notwithstanding anything in the Agreement to the contrary, the SLA Term
Commencement date shall be July 1,2006.
7, Additional Provision(s): (a) Licensee shall be obligated to include with each
monthly payment the following site identifier: Zephyrhills / 816298
(b) Notwithstanding anything to the contrary in the Agreement, the parties hereto agree that with
respect to this SLA, Licensee shall be deemed to have adopted the Agreement and agrees to be
fully bound by its terms and conditions.
[Remainder of Page Intentionally Left Blank]
.,
~ . "..
Prepared by: S. Price
Prepared on March 30, 2006
3
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
IDE Business Unit: 816298
IN WITNESS WHEREOF, the parties hereto have set their hands and affixed their
respective seals the day and year first above written.
Crown Castle GT Company LLC,
a Delaware limited liability company
By: ~,,'-~ ~~
Print Name: Chris B. Moffett
Title: DJr.. Finance - South Area
1,. ().
Witness: f f,9r{1:1:;A.J.,t,t__
Print Name: m; I~ Pe'!-e,r:.s'i..v,-
Witness: ~~ ~
Print Name: 'v bm
Execution Date:
Y/ ~f;c,
T-Mobile South LLC,
a Delaware limited liability company
By: ~0~~. Ad<~
P~mt. ~ a~e: "",, \'...~ . A :' Il"''it\
TItle. j)l6t€..\.~.- t'l"':J~f\"'~':")~
Witness: ~k ~~
Print Narrje: GLt/l1l-1 (<.,(..,lJ '7
Witness: ' ) nO~'
Print Name: Noc\-ee n \'vh.: \ - vlCl~
Execution Date:
4/~/oc,
Prepared by: S. Price
Prepared on March 30, 2006
4
T-MobiIe Site Name: Zephyr Park
T-Mobile Site No: A2G757 A
Prepared by: S. Price
Prepared on March 30. 2006
SLAEXHIBIT "1"
PROPERTY LEGAL DESCRIPTION
See attached Legal Description
5
Crown Site Name: Zephyrhills
JOE Business Unit: 816298
LEGA.L DESCRIPTIO":
LGf. I. 7 rlfld 8. Bloclt 17. of IrIOORE'S FIRST A.DDITlON TO THE CITY OF,
ZEPHYRHILI..S, fl. P" p/flf tI,.,.o' ,.cflrd.d lit PlfI' BGok I. par. 51. of fh.
pI/bile ,ecfI,da Gf Pflaco eOl/lffy. F7of'ldfl.
The flbow d.ac,/b.d paf'clll cOlltQ/Il. 0'4S5 ac,. of land. '"01'. 01' I....
T.Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
SLA EXHffiIT "2"
Crown Site Name: Zephyrhills
JDE Business Unit: 816298
SITE AND ACCESS RIGHT -OF- WAY LEGAL DESCRIPTION
Prepared by: S. Price
Prepared on March 30, 2006
See attached Access and Easement Depiction
6
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V E N U E la"
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.
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
IDE Business Unit: 816298
SLA EXHIBIT "3"
APPROVED SITE ENGINEERING APPLICATION
LOCATION OF ANTENNA(S)
See attached Engineering Application
Prepared by: S. Price
Prepared on March 30. 2006
7
CClsites™ : Crown Castle Online Application
Page 1 of3
~ ~qfYr
IHTUIUTlOIUl....
Application ID: 29910
Revision # 2
Customer Ap'proved: Mar 30 2006
Submitted: Feb 28 2006
Submitted By:
Original Submit Date:
TFUSCO
Feb 28 2006
Desired Install Date: N/ A
R f A II tl First time antenna installation at this JDE Job Number
eason or pp ca on: site
71002
Applications are subject to applicable Crown Castle engineering, regulatory, zoning/planning, and priority property-
owner approval, Approval conditions may result In alternative requirements for type and/or placement of equipment,
Approval conditions may also lead to additional or revised engineering analysis at Crown Castle discretion and upon
consent of the customer.
Company Information Site Information
High Level Company: T-MOBILE Crown Castle ZEPHYRHILLS
MLA: N/A Site Name:
VoiceStream Tmp/Orl, Inc. - DBA T- Crown Castle 816298
Company: Mobile Site ID:
Address: P.O. BOX 53090 Crown Castle North Florida
District:
City /Town: BELLEVUE Address: 702 B AVENUE
State: WA Postal Code: 980153090 City /Town: ZEPHYR HILLS
Customer Job N/A State: FL Postal Code: 33542
Number:
Customer County: Pasco
Site Name: Zephyr Park latitude: 280 13' 40.63" Longitude: -820 10' 45.6"
Customer Structure SELF SUPPORT Structure 285 ft
Site Number: A2G757A Type: Height:
Legal Entity Information
Operating Legal Entity: T-MOBILE SOUTH LLC, A DELAWARE LIMITED UABIUlY CO
Primary Contact: Bob Killian Phone: 813-267-1059
E-mail: bob.killiam@t-mobile.com Fax: 813-248-2512
Address: 3407 W. Dr. Martin Luther King Blvd.
City/Town: Tampa State: FL Postal Code: 33607
RF Contact: Shon Sparks Phone: 813-843-5559
E-mail: shon.sparks@t-mobile.com
Service Information
Frequencies
Transmit Receive
Svc Technology EIRP (WATTS) Std Frequency Start Stop Start Stop
1 GSM 1640.0 1930.2 1944.8 1850.2 1864.8
Antenna Information
Cline Mfg./ Transmit Transmit Receive Receive
# Fig. Pas, Elev Azimuth ModelSv c Start Stop Start Stop Use Orient Status
1 ST-4 A 194ft 0 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR6S-19-02DP
2 ST-4 D 194ft 0 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR65-19-02DP
3 ST-4 E 194ft 120 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR65-19~02DP
4 ST-4 H 194ft 120 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR65-19-02DP
5 ST-4 194ft 240 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR65-19-02DP
CClsi,tes™ : Crown Castle Online Application Page 2 of3
6 5T-4 L 194ft 240 EMS WIRELESS 1 1930.2 1944.8 1850.2 1864.8 TX/RX Mid-Mount Proposed
RR65-19-02DP
Feedline Information
# Fig, Pos, Qty Mfg. Model Length Status
1 5T-4 A 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
2 5T-4 D 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
3 5T-4 E 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
4 5T-4 H 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
5 5T-4 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
6 ST-4 L 2 Primary: EUPEN EC7-50 244 ft Proposed
Secondary: N/A
Optional Component Information
# Fig.
1 5T -4
2 5T-4
3 5T -4
4 5T -4
5 5T -4
6 5T -4
Pos, Mfg.
A LGP TELECOM
D LGP TELECOM
E LGP TELECOM
H LGP TELECOM
I LGP TELECOM
L LGP TELECOM
Model
LGP1390B
LGP1390B
LGP1390B
LGP1390B
LGP1390B
LGP1390B
Tower Mounted Amplifier
Elev, 1 Statusl
190ft Proposed
190ft Proposed
190ft Proposed
190ft Proposed
190ft Proposed
190ft Proposed
Elev.2
N/A
N/A
N/A
N/A
N/A
N/A
Status2
N/A
N/A
N/A
N/A
N/A
N/A
Building/Pad/Power Requirements
Type L W H Power Requirements
Building Requirements VAC 240 Phase Single
New Building/Shelter Cabinet N/A N/A N/A Phase
Existing Building/Shelter Floor Space N/A N/A N/A Amps 200
Building Identification 0 Generator Needed? Yes Generator 15kW
Size (kW)
Pad Requirements Generator Fuel Generator GENERAC
Required Leased Size 15ft 23ft 10ft Type Propane Manufacturer POWER
SYSTEMS
Pad Size 17ft 7ft Generator Fuel 4675FM-
20gal Generator
Number of Equipment Cabinets at time of Install 1 Tank Size Model 1
Battery Requirements
Quantity 0
Manufacturer N/A Model N/A
Comments/ Additional Information
Comments:
New configuration of (6) EMS RR65-19-02DP (12) Eupen 1 5/8" coax, and (6) TMA's. Company's full name is T-Mobile South LLC, a
Delaware limited liability company.
* *Indicates where Cut Sheet data has been entered.
NOTICE: Structural Analysis shall be performed in accordance with the current revision of the TIA/EIA 222
standard and applicable local building permit codes and standards. EME analysis shall be consistent with current
revision of FCC/OSHA standard OETB 65. AM detuning, when required, will be performed to 47 CFR22,371. The
customer is responsible for all analysis expenses.
All construction drawings are subject to Crown Castle engineering approval prior to commencement of tower
attachments and compound installations. Installation of equipment not conforming to approved drawings may
violate the terms of the occupancy agreement and will be correded at the customer's expense. Crown Castle
International requires drawings for pre-construction approval and as built drawings for physical configuration
validation to be submitted as unlocked AutoCAD files (Version 2000i preferred).
Appendix PI. - Antenna, Feedline, TMA Specifications
CCI~itesTM : Crown Castle Online Application
Antenna Specifications
Quantity Manufacturer
6 EMS WIRELESS
Model
RR65-19-02DP
Feedline Specifications
Quantity
" 12
Manufacturer
EUPEN
Tower Mounted Amplifier Specifications
Quantity Manufacturer Model
6
LGP TELECOM
LGP1390B
Type
PANEL
Model
EC7-50
Weight
lOA LBS
Height
72.0 IN
Width
8.0 IN
Depth
2.75 IN
Nominal Size
1-5/8
Dimensions
Length Width Height
3.2 IN 6.7 IN 9.0 IN
Weight
23.0 LBS
Page 3 of:
Flat Plate Area
4.0 FT2
Nominal 0,0.
1.969 IN
Frequency
Low High
N/ A N/ A
Sail Area
N/A
T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Crown Site Name: Zephyrhills
JDE Business Unit: 816298
SLA EXHIBIT "4"
LOCATION OF EQUIPMENT BUILDINGIFLOOR SPACE
AND ANY OTHER APPENDED INSTALLATION AT THE SITE
See attached Site Sketch
Prepared by: S. Price
Prepared on March 30. 2006
8
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T-Mobile Site Name: Zephyr Park
T-Mobile Site No: A2G757A
Prepared by: S. Price
Prepared on March 30, 2006
EXHIBIT "5"
PRl1vlE LEASE AGREEMENT
See attached:
Special Warranty Deed
9
Crown Site Name: Zephyrhills
JDE Business Unit: 816298
<l >..
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THIS INSTRUMENT PREPARED BY
AND UPON RECORDING RETURN
TO:
1111I111111111I1111111 1111111I11111I111111111I111I111111111I
2001079858
'...
t".'
Roberl D. Ward. Esq.
Downs Rachlin & Martin PLLC
90 Prospect Street
PO Box 99
51. Johnsbur~... VT 05819-0099
Rcpt.: 505278~C: 15.00
OS: 1045.80 . 0.00
06/14/01 ~.~P' Dpty Cll:rk
r JED PITTMAN. PASCO COUNTY CLERK ....
06/14/01 11:27am 1 of 3
OR BK 4639 PG 280
SPECIAL WARRANTY DEED
THIS INDENTURE, made as of January 31, 2000, between GTE WIRELESS
OF TII E SOUTH INCORPORATED, a a Virginia corporation(successor in interest by
merger to GTE Mobilnct of Tampa Incorporated), having its principal place of business at
c/o GTE Wireless Incorporated, One GTE Place, Alpharetta, GA 30004 (herein called
"Grantor"), and CROWN CASTLE GT COMPANY LLC, a Delaware limited liability
company, whose address is c/o Crown Castle International Corp., 510 Bering, Suite 500,
Houston, Texas 77507, and whose Federal Tax Identification Number is 76-0627250
(herein called "Grantee").
(Wherever used herein the terms "grantor" and "grantee" include all the parties to this
instrument and the successors and assigns of corporations, and other entities).
WITNESSETH: That the Grantor, for and in consideration of the sum of Ten
and nol1 00 Dollars ($10.00) and other valuable consideration to the Grantor in hand paid
by Grantee, the receipt and sufficiency whereof is hereby acknowledged, by these presents
does grant, bargain, sell, alien, remise, release, convey and confirm unto the Grantee, it
successors and assigns, all that certain land situate in Pasco County, Florida, to wit:
SEE EXHIBIT "Aft ATTACHED HERETO AND MADE A PART HEREOF.
Together with all the tenements, hereditaments and appurtenances thereto
belonging or in anywise appertaining.
TO HAVE AND TO HOLD the same in fee simple forever.
AN D the Grantor hereby covenants with said Grantee that it is lawfully seized of
said land in fee simple; that it has good right and lawful authority to sell and convey said
land; that it hereby fully warrants the title to said land and will defend the same against the
lawful claims of all persons claiming by, through or under Grantor, but against none other.
.\'I'LOllI0672J59vl
Florida Special Warranty o.,~d (c.:orpOr:ltjon)
ZIiPJlYIWII .I.S, FI.()('51
"
~ ""\
OR 81< 4639 PG 281
2 of 3
IN \VITNESS WHEREOF, the Grantor has caused these presents to be executed
in manner and form sufficient to bind it as of the day and year first above written.
GTE WIRELESS OF TilE SOUTH
INCORPORATED, a Virginia
corporation(succcssor in interest by merger
to GTE Mobilnct of Tampa Incorporated)
ess
Printed Name:kev--c9 r~ }.J.. ~';\\.~~~
By: q ~ 4 Avr'1
Name: Jorly A Rllth
Title: \7fC'.e Preslcl.:nf . Fir:'":..,,,;.!) ;:.,,:1 Phmnino
Attest: AIL- 1P-4?)~'-;,. ~. ..
Name' Dale S. Vovles - ..' t eCfretery,
Title: '. . <", . .
~.
"
.~
. ,
. . ,.'
(CORPORATE SEAL)
STATE OF GE:.of{' I A
COUNTY OF Fu c... n ,J
ACKNOWLEDGMENT
'.
"
. '.".".: ':-.' ",,,,.,,
~
The foregoing instrument was acknowledged before me this Z9 -day of January,
AOOO, by ~~_<<-lJ 'rH and ~L.E S. VI')~Lt~, the
V ~::...F"tNA/J(,~~ PJMfNI.NGan~cretary, respectively, of GTE WIREL'SS OF THE
SOUTH INC RPORA TED, a VirgInIa corporation, on behalf of the corporation and
partnership. He/She is personally known to me &F-f1.ftS Pi vdu~cd
e94denti fic.al~VII":"'"'
-
-2-
SrI.1I1/11l672.15!h'l
"""ri<lu Special Warranly I)c~-u (Curpuralion)
ZI':PIlYIlJIlJ.l.'i, Fl.065 I
'-~~."._. J
........--.t..
. .
.,.
...
...
OR OK 4639 PO 282
3 of 3
",
ExnlUIT "A"
(FL0651 - Zcph}'rhills)
Lots 6,7 and 8 in Block 17 of MOORE'S FIRST ADDITION TO TilE TOWN OF
ZEPHYR]] II.LS, according to the map Dr plat thereof recorded in Plat Book I, Page 57,
of the public records of Pasco County, Florida.
Tax Folio No. 14-26-21-00]0-017-00-0010
~I064940<) \'1
Section II
FI.LJ1i51 l"'ph~Thills
Ponco CUUl1l)', Flu,id.l
Page 1 of 1
~_E!.9!~h Again Show Map Generalized Building~Schematic Estimate_Taxes
SeeTa~J:;ollector Information - CurrenUDelinquent Taxes Frequently Asked Questio_ll~
ParcellD
Classification
Line
1
2
Acres
14-26-21-0010-01700-0060 (Card: 001 of 001)
91 - Utilities
Mailing Address
CROWN CASTLE GT COMPANY LLC
4017 WASHINGTON RD
MC MURRAY, PA 153172520
Physical Address
I",~ Description (First 4 Lines)
MOORES FIRST ADDITION TO CITY
OF ZEPHYRHILLS PB 1 PG 57 LOTS
6 7 & 8 INCLUSIVE BLOCK 17
OR 4639 PG 280
Land Detail (Card: 001 of 001)
Description I Zoning I Uni pe
UTILITY 00C3 12,000.00 SF
UTILITY 00C3 ,800.00 SF
Assessment (totals)
Ag Land
Land
Building
Extra Features
$0
$55,482
$34,363
$677
$90,522
$0
$90,522
Total Assessment
Save Our Homes
Taxable Value
~uilding Information
I 0.45 II
Additional Land Information
Tax Area II 30ZH I Fema Code
- Year Built 1971 USE 94 - Telephone Exchange Buildings (Card: 001 of
001 )
Ext Wall 2
Roof COy
Int Wall 2
Flooring 2
Heat
Baths
Ext Wall 1
Roof Str
Int Wall 1
Flooring 1
Fuel
AC
Line
1
Line
Common Brick
Rigid Frame wlBar Joist
Masonary or Minimum
Cork or Vinyl Tile
Electric
Central
None
Built-Up Tar and Gravel
None
None
Forced Air - Ducted
1.00
Description
BAS
Sq. Feet
1,353
Extra Features (Card: 001 of 001)
Description Year Units
CLFENCE 1,920
Repl. Cost New
$81,816
Value
$677
Previous Owner
Year Month
2001 01
1996 08
Sales History
GTE MOBILNET OF TAMPA INC
Book 1 Pa e I Type II Amount
4639/0280 YYD $149,400
3617/0915 $277,600
Se.C3rch A~ir1 Show Map Generalized Buildi~sch~ll1aJig f;~Jimat~T~)(es
Se~_~)( Collector Information - CurrenUDelinQ!.Le[lU.i3xe~ FreiluerlilYA.sked Q!Je$tLons
file://C:\DOCUME~ 1 \EBAMBE~ 1 \LOCALS~ 1 \Temp\4MA05TGlhtm
5/3/2006