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Home My WebLink About06-6337 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 6337 6337 Permit Type: COMMERCIAL Class of Work: NEW CONST/COMM Proposed Use: COMMERCIAL Square Feet: Est. Value: Improv. Cost: 152,617.50 Date Issued: 12/28/2006 Name: CERVALLOS JUAN . '\/iJ Total Fees: 5,402.35 Address: 6215 ABBOTT STATION DR (~-108) Amount Paid: 5,402.35 ZEPHYRHILLS, FL. 33542 Date Paid: 12/28/2006 Phone: 813 788-6257 Work Desc: UNITS 106-108 BUILDOUT - WOUND CARE -sa FT 3213 Address: 6215 ABBOTT STATION DR -108 ZEPHYRHILLS, FL. IDb Township: Range: Book: Lot(s): Block: Section: Subdivision: SILVER OAKS VILLAGE Parcel Number: o3-a<a. Q\-~co. OOOC(J. CXJCo FIRST CLASS ELECTRIC COLBY JAYNES PLUMBING INC CHRIS' AlC CO. PLUMBING FEE SEWER CONNECTION COMMERC FIRE PLAN REVIEW FEES E 95.85 MECHANICAL FEE 3.355.37 WATER CONNECTION COMMERC 192.78 FIRE INSPECTION FEES 14 . 67.10 865.70 30.00 ., , \ ,,,LY dAfl ~. (,~\.)I ,v \ " ,,0' ".. "r Lv >:7 l()V M I FOOTER DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME 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 permitl there may be additional restrictions applicable to this property that may be found in the public records of this countyl and there may be additional permits required from other governmental entities such as water managementl 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. ~~ ~~ C RAC OR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER City of Zephyrhills BUILDING PLAN REVIEW COMMENTS ... ..------. " <:...s:.~/Homeowner: Site: w/i,r~~M<.G?~ /~ - ?2-l)~ ~ ;)./S' Qp..d6- J;d~ g . ~ /~:JJ4L-t- Date Received: Permit Type: Approved wino comments: 0 Approved withe below comments: ~enied withe below comments: 0 (j) ~\)l~ vLfr~ O~'il&~ C'..l~};p,:> CQ'( ~.~)~~ ?tf~. This comment sheet shall be kept with the permit and/or plans. "lding Official I 2-17 ~t Date Contractor and/or Homeowner (Required when comments are present) City of Zephyr hills BUILDING PLAN REVIEW COMMENTS /?'--~ ' ~/Homeowner: '-..:, - - Site: /#~rr' 0~aM" G~ /~ - ~-lJ!p 4> ;1/5' a~l6-~ ild~ g . ~ 0;(/~:~L-t: Date Received: Permit Type: Approved wino comments: D Approved withe below comments: ~enied withe below comments: D (j) t-\o T~ p~ ~IGN C~~T,:> oN <),?iM.PfTF: ~~l. This comment sheet shallbe kept with the permit and/or plans. tin j/;Kg "">f B Burgess - wruding Official l2--k ~t 'Date " ~ ~.?~le.'~ ~I Contractor and/or Homeowner' I ~....... (Required when comments are present) Village Sq Bldrs-6215 Abbott Station - Units 106-108 Wound Center Interior Buildout SQ. FEET PRICE MAIN OR LIVING: 3,213 $ 47.50 OTHER AREA UNDER ROOF: - $ 88.00 OTHER: - $ - VALUATION $ 152,617.50 FEE SHEET $ 639.00 ADDRESS $ - DRIVEWAY $ - BUILDING: $ 651.78 ELECTRICAL: $ 143.78 PLUMBING: $ 95.85 MECHANICAL: $ 67.10 SUB-TOTAL $ 958.50 RADON: $ - TOTAL $ 958.50 N/A - Already Paid SEWER: $ 3,355.37 WATER: $ 865.70 IRRIGATION: $ - TOTAL: $ 4,221.07 WATER METERI $ IRRIGATION METER $ I N/A - Already Paid FIRE DEPARTMENT FEES PLANS TOTAL: $ 192.78 INSPECTION TOTAL: $ 30.00 PERMIT TOTAL TOTAL: $ 222.78 PUBLIC SAFETY IMPACT FEES POLICE $ - FIRE $ - 5% $ - TOTAL: $ - N/A - Already Paid N/A - Already Paid N/A - Already Paid N/A - Already Paid SUB-TOTAL $ 5,402.35 I PARK IMPACT FEESI $ I N/A SIF'S: $ - 100.0% $ - 1.0% $ - TOTAL: $ - N/A N/A T IF'O 'I $ 99% $ 1% $ I NIA - O;lve, Oaks Provision TOTAL: $ 5,402.35 I APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT /~ - g--lJb DATE RECEIVED ff",A-- a~. PLANS REVIEW FEE ~~?71 OWNERIS NAME lCtn [lVt4CS (g;) IS- (fbhtJit 5*-fr~ br: LEGAL DESCRIPTION: LOT(S) BLOCK 2 ).,t/I! SUBDIVISION 5fvel'tkJ:S ~/ /a.v P( ~ PHONE 7ee......(?;,S7 , JOB ADDRESS PARCEL ID # ill -;:J-(g ~d-I-^"01(!)OOo'- M"O M, - <50 '9-()- WORK PROPSED: ~NEW CONSTRUCTION o ADDITION oSIGN 0 MOVE (OBTAIN FROM PROPERTY TAX NOTICEl oALTERATION o REPAIR o INSTALL o DEMOLISH PROPOSED USE: oSGL FAMILY DWELLING ~OMMERCIAL oMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER BUILDING SIZE C.J()I-\'S \DCn J \ a') \0% ') l..uo0(ld (lClL'P SQUARE FOOTAGE ~~/~ HEIGHT DESCRIPTION OF WORK RESIDENTIAL: COMMERCIAL: 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 & (I) SET ENERGY FORMS. FORMS. ~~ p; D. I j~t 1 'f Jf~ '.J ~oC- o BUILDING $ VALUATION OF TOTAL CONSTRUCTION o ELECTRICAL .~ PLUMBING ~ MECHANICAL $ o GAS 0 ROOFING 0 SPECIALTY AMP SERVICE o FLORIDA POWER o W.R.E.C. VALUATION OF MECHANCIAL INSTALLATION o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAo YES o NO BUILDER SIGNATU COMPANY STATE CERT CITY PROCESSING # SIGNATURE ******************************************** COMPANY r:/Z5 C C1/A 5' s;: E Icc~;- C. STATE CERT OR REGI ST #E(~ {/ Q 6 ;Z .s- 7 d CITY PROCESSING # / 5L& ELECTRICIAN PLUMBER / ~/i{ ~ COMPANY ~ STATE CERT OR REGIST ________~ _~ CITY PROCESSING # *** ******J(****************************** VlL.. SIGNATURE MECHANICAL SIGNATURE COMPANY STATE CERT OR REGIST CITY PROCESSING # ************************************************** OTHER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRI' TONS The undersigned understan. that this permit may be subject co ~deed restrictionsU which may be more restrictive than City regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake workl they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by lawl 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 workl they are advised to contact the City of Zephyrhills Building Departmentl 813-788-6611. Furthermore I if the owner has hired a contractor or contractors I he is advised to have the contractor(s) sign portions of the ~Contractor SectionsU of this application for which they will be responsible. If youl as the owner signs as the contractorl you are indicating that youl rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that may be an indication that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTESI AS AMENDED) I certify that II the applicantl have been provided with a copy of ~Florida/s Construction lien Law - Homeownerls Protection Guideu prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the ~ownerl/I I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the ~ownerl/ prior to commencement. E. CONTRACTOR'S/OWNERIS 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 I zoningl 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 constructionl City codesl zoning regulations I 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 workl 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 Bayheadsl Wetland Areas and Environmentally Sensitive Lands I Water/Wastewater Treatment *South~est Florida Water Management District-Wells, Cypress Bayheadsl Wetland Areasl Altering Watercourses *Army Corps of Engineers-Seawallsl Docksl Navigable Waterways *Department of Health & Rehabilitative Servicesl Environmental Health Unit-Wellsl Wastewater Treatmentl Septic Tanks *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone ~AI/ or ~A/etc.1/1 it is understood that a drainage plan addressing a ~compensating volumeu will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. A permit issued shall be construed to be a license to proceed with the work and not as authority to violatel cancell alter, or set aside any provisions of the technical codesl nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plansl constructionl or violations of any code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuancel 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 periodl 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 FINANCINGI CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2/500 If VALUE DO NOT NEED TO RECORD AND POST A ~NOTIC:~F COMMENCEMENTI/. / -- t, O:~NT ~ <~O: STATE OF FLORIDA ,0 /0' COUNTY OF ~ S' \.. 0 The foregoing instrument was acknowledged I ~ ;Jobh Before me this ;ro !i..ay of Ocr-- I ~6 by La.Y\U-~-M n6_ (name of person acknowledged) ;Who is personally known to mel or Signature take an oath of identification) take an oath. and dgement dgment Name typ Name typ ,Florida Energy Efficiency Code For Building Construction Florida Department of Community Affairs EnergyGauge FlaCom v 2.11 FORM 400B-2004 EnveIope Trade-Off Compliance for Commercial Buildings L~~.. Jurisdiction: ZEPHYRHILLS, PASCO COUNTY, FL (611600) Short Dese: SOVCB Project: SILVER OAKS VILLAGE Owner: Ce-.l ~I \ D S J :Su a V} COMMERCIAL BUILDING Address: ~~ Ie:> Abbe. t+ S-\o...-\-\ (.~ 1), l)0',\-' lOCo - toea ZEPHYRHILLS FL. o City: State: Zip: PermitNo: ~ l.P33'1 Storeys: 1 Type: Office Class: New Finished building *Conditioned Area: 7727 -J('Cond + UnCond Area: 7727 Max Tonnage: 4.8 (if different, write in) * denotes lighted area, Does not include wall crosection areas Compliance Summary ~ --..--- ---- . ......- Design Criteria ...-.. - 607.80 771.20 6,080.00 9,346.37 Component ~ - ,....--- - ENVELOPE LIGHTING POWER LIGHTING CONTROLS EXTERNAL LIGHTING HV AC SYSTEM PLANT WATER HEATING SYSTEMS PIPING SYSTEMS Met all required compliance from Check List? Result PASSES PASSES PASSES None Entered PASSES None Entered None Entered None Entered Y esIN olN A IMPORTANT NOTE: An input report Print-Out from EnergyGauge Com of this design building must be submitted along with this Compliance Report. 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 COMPLIANCE CERTIFICATION: I hereby certify that the plans and specifications covered by this C~IC ation are in compliance with the Flori Energy Efficiency Code, ) I PREPARED BY: C~t ~~ /{}j/~I/O~ 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 in accordance with Section 553,908, F,S, /J DATE: DATE: if BUILDING OFFICIAL: I hereby certify that this building is in compliance with the Florida Energy Effir;ency Code, OWNER AGENT;_~""". DATE: If required by Florida law, I hereby certify (*) that the system design IS in compliance with the Florida Energy Code, REGISTRA nON No. ARCHITECT: ELECTRICAL SYSTEM DESIGNER: LIGHTING SYSTEM DESIGNER: MECHANICAL SYSTEM DESIGNER: PLUMBING SYSTEM DESIGNER: (*) Signature is required where Florida Law requires design to be performed by registered design professionals, Typed names and re~listration numbers may be used where all relevant information is contained on signed/sealed plans. Project: SOVCB Title: SILVER OAKS VILLAGE COMMERCIAL BUILDING Type: Office (WEA File: Tampa.tmy) Envelope Compliance L_'_'~_ - - . - - -~- -- Design Load Criteria Zone Heating Cooling Heating Cooling --.. ------~ - - -- Building 376.90 230.90 466.40 304,80 .-.. .--- ~ --.. Total Loads: Desil!1I1 =607.8 Criteria =771.2 I PASSES 1 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 2 ~ External Lighting Compliance .........., l_"_~_ - --~-- . Description Category Allowance Area or Length ELP A CLP (W/Unit) or No. of Units (W) (W) (Sqft or ft) ".~s__,... J_,____~_~......_._..........._.........._ -...----- -- m"".._.......-, ow, .....-..0. __ - - [~ None I Project: SOVCB Title: SILVER OAKS VILLAGE COMMERCIAL BUILDING Type: Office (WE A File: Tampa.tmy) Lighting Power Compliance r.,.,,,_.__ - "--~----._- ....~_..... ---"'-"- Space Ashrae Description Area Height No. of Design Effective Allowance ID (sq.ft) (ft) Spaces (W) (W) (W) ~-- -..----..... ......- -- - -- PrOZo4Sp 1 9,003 Exercise Area (Gym) 1,035 10,0 1 720 720 931 PrOZo5Spl 17 Office - Enclosed 1,078 10,0 1 840 840 1,186 PrOZo6Sp 1 16 Office - Open Plan 1,078 10,0 1 940 940 1,186 PrOZo7Sp 1 14 Clas~,room/Lecture Hall 798 10,0 1 700 700 1.117 PrOZo8Spl 14 Classroom/Lecture Hall 907 10.0 I 760 760 1.269 PrOZo9Sp 1 14 Classroom/Lecture Hall 921 10.0 1 780 780 l.290 PrOZo I OSp 14 Classroom/Lecture Hall 888 10.0 1 700 700 l.243 1 PrOZo 1 1 Sp 16 Office - Open Plan 1,022 10,0 1 640 640 1,124 1 ........., ~......._n._ - - - ----...---..-.....- . Design : 6080 (W) I PASSES Effective: 6080 (W) Allowance: 9346..37 (W) 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 3 Project: SOVeB l'itle: SILVER OAKS VILLAGE COMMERCIAL BUILDING Type: Office (WE A File: Tampa.tmy) Lighting Controls Compliance --...........-.. --~ --.......... - - - - Acronym Ashrae Description Area No. of Design Min Compli- ID (sq.ft) Tasks CP CP ance ........""_.'......,.,n...__...._ ...-..... -- PrOZo4Sp 1 ,003 Exercise Area (Gym) 1,035 1 1 1 PASSES PrOZo5Spl 17 Office - Enclosed 1,078 1 2 1 PASSES PrOZo6Sp 1 16 Office - Open Plan 1,078 I 2 1 PASSES PrOZo7Sp I 14 Classroom/Lecture Han 798 1 2 1 PASSES PrOZo8Sp 1 14 Classroom/Lecture Hall 907 I 2 1 PASSES PrOZo9Sp 1 14 Classroom/Lecture Hall 921 1 2 1 PASSES PrOZo 1 OSp 1 14 Classroom/Lecture Hall 888 1 2 1 PASSES PrOZoll SpI 16 Office - Open Plan 1,022 1 2 1 PASSES ~.....".'" ----........ -- - -.--" - - L PASSES I 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 4 Project: SOVCB 'ritle: SILVER OAKS VILLAGE COMMERCIAL BUILDING Type: Office (WE A File: Tampa.tmy) System Report Compliance PrOSy1 System 1 Constant Volume Air Cooled No. of Units Split System < 65000 Btll/hl" 1 ..,..".....~-_..._- - - -~--~.-..-.. ------ Component Category Capacity Design Eff Design IPLV Comp- Err Criteria IPLV Criteria liance .-........... _...........-...~...... - - -- Cooling System Air Cooled < 65000 Btu/h 13.00 10.00 8.00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0,90 PASSES System -Supply Constant Volume .--.-...- -''- -- - - --~ -- PrOSy2 System 2 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr 1 ,- . ----- --- - Component Category Capacity Design Err Design IPLV Comp- Err Criteria IPLV Criteria liance .....-- -'-........,,-~ ~,~ - Cooling System Air Cooled < 65000 Btu/h 13.00 10.00 8.00 PASS E:S Cooling Capacity Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System -Supply Constant Volume .....--- -- - - ,- - PrOSy3 System 3 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr 1 ~ - Component Category Capacity Design Err Design IPLV Comp- Err Criteria IPLV Criteria liance --- - . - -- Cooling System Air Cooled < 65000 Btu/h 13.00 10,00 8,00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0.90 PASSES System -Supply Constant Volume -,---._~ -,----- , - PrOSy4 System 4 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr 1 ........... - .--... .- - - Component Category Capacity Design Err Design IPLV Comp- Err Criteria IPLV Criteria liance .,_.-s, \ 1llIZnIm:JI......._~" --..-...~~----_...--- Cooling System Air Cooled < 65000 Btu/h 13,00 10.00 8.00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0.90 PASSES System -Supply Constant Volume .........,......, - ,-- -- - 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 5 PrOSy5 System 5 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr I ~..,.".'- - --....- - Component Category Capacity Design Eff Design IPLV Comp- Eff Criteria IPLV Criteria liance -~ - "'"""""-~----- .--- ----............. '--- Cooling System Air Cooled < 65000 Btu/b ]3,00 ]0.00 8,00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System -Supply Constant Volume -"--.. - , ------ -- - -- PrOSy6 System 6 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr 1 _.__.,~ -- - - -. -, - Component Category Capacity Design Eff Design IPLV Comp- Eff Criteria IPLV Criteria liance ....n ____.u...._ - . -- - Coo ling System Air Cooled < 65000 Btu/h ]3,00 10.00 8.00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0.90 PASSES System -Supply Constant Volume - ~---_... - - - , .. .-... PrOSy7 System 7 Constant Volume Air Cooled No. of Units Split System < 65000 Btu/hr 1 - .., Component Category Capacity Design Eff Design [PLY Comp- Eff Criteria lPLV Criteria liance ....~- - - -... Cooling System Air Cooled < 65000 Btu/h ]3.00 ]0.00 8.00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0.90 PASSES System -Supply Constant Volume ---", ----,_.-...- - PrOSy8 System 8 Constant Volume Air Cooled No. of Units Split System < 65000 Bill/hr I nn--..-...._ _.......~........._- -'" -- - Component. Category Capacity Design Eff Design IPLV Comp- Eff Criteria IPLV Criteria liance ---- - - - - -- , Cooling System Air Cooled < 65000 Btu/h 13.00 10.00 8.00 PASSES Cooling Capacity Air Handling Air Handler (Supply) - 0,80 0,90 PASSES System -Supply Constant Volume -- --, ._-~- - I PASSES I 10/14/2005 EnergyGauge FlaCom v 2.11 FORM 400B-2004 6 - Plant Compliance ~." '"= -- .~ ~--- Description J nstalled Size Design Min Design Min Category Comp No Eff Eff JPLV IPLV liance ........""- ,...-..................-..-." - -.,......-... .......,..- --- ... - u:m:1IcrIIIO......... ..~- ....-m ._.... ....,- -.......... L None - Water Heater Compliance """ -"-~-~---~'- - . ,- Description Type Category Design Min Design Max Comp Eff Eff Loss Loss liance -tl ""'....l...............--.__ ----=->';<---. .. .-.........-- . ,--- ---- - - -- . I None I Piping System Compliance -....-. -----, ....- - - -- -- Category Pipe Dia Is Operating Ins Cond Ins Reg Ins Compliance [inches] Runout? Temp [Btu-in/h r Thick Jin] Thick [in] [F] .SF.F] -- -..-.-. - _..~ - - ....,........-- -- ---- I None I ] 0/14/2005 EnergyGauge FJaCom v 2.11 FORM 400B-2004 7 Project: SOVCB .Title: SILVER OAKS VILLAGE COMMERCIAL BUILDING Type: Office (WEA File: Tampa.tmy) Other Required Compliance ......_~ _"'~_M' ---- - ---- Category Section Requirement (write N/A in box if not applicable) Check .~.................... . -,~ - -.,- -.-- .......--- fnfiltration 406,1 Infiltration Criteria have been11let D System 407.1 HV AC Load sizing has been performed D Venti lati on 409.1 Ventilation criteria have been met D ADS 410,1 Duct sizing and Design have been performed D T&B 410.] Testing and Balancing will be performed D Motors 414.1 Motor efficiency criteria have been met D Lighting 415.1 Lighting criteria have been met D O&M 102.1 Operation/maintenance manual will be provided to owner D Roof/Ceil 404,1 R-19 for Roof Deck with supply plenums beneath it D Report 101 Input Report Print-Out from EnergyGauge FlaCom attached? D 10/14/2005 EnergyGauge FJaCom v 2.11 FORM 400B-2004 8 un~}-\'/~~ \/08 Comm ./ Res ~OvN V c ftI~ ~0 \Lf) e:'0T Square Feet ~2l3 Dollar Amount 47 J SQ Valuation I S2 I Co t 7 ------~.~ /./, ~ (Use System for calculation of fees) ? ---.-/ Radon N 111 - A~~ fAu> Connection Fees Sewer 3 3 5~3-7 ( Water 1k <), 7tl W. Meter N l P\ ,...A~ % (180.00) (All Residentials - % ") t'~~') 1 (250.00) 1.5 (650.00) 2 (875.00)_ 3 & 4 (Contact Louie)_ Irr. Meter Irr. Conn Impact Fees School ~\('\ Transportation ~P\ - ~lU/PiL t:.A-I< ,~il~I~N ~ fAit) Park ~\f\ . Public Safety ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 FIRE SERVICE USER FEES. !/ Occupancy No.: Owner: JLJ~StlU.tC... ~l",~~ :]JJ Pla~ No.: 66 ~ t:Vi-~~' . ..~ Billing Address: I Business Name: Sl~~ \ -N_~_ . BusinessAddress: _ . Business Phone No.: Business Fax No.: Contact: Fire Chief Robert Hartwig Billing Phone No.: Billing Fax No.: Contact: /st... b;)"'~ J PLAN REVIEW FEES INSPECTION FEES PERMIT FEE ~ su, Plac N/C Annual N/C . Building Plans ~ 1 st Re-inspection $25 J~}3 Revision 2nd Re-inspection $50 3rd Re-inspection $125 STANDPIPE SYSTEM 4th Re-inspection $250 o Per Riser $25 5th Re-Inspection $500 Construction $15 Commercial $25 SPRINKLER SYSTEMS SPRINKLER SYSTEMS SPRINKLER SYSTEMS B 0 - 25 Heads $30 Hydro Undergrounds $45 0 Automatic $15 26 plus Heads $60 Hydrostatic System $45 Wet Acceptance $30 Dry Acceptance $45 Hydrant Flow $25 Hood / Booth $30 FIRE PUMP Grease Duct $15 FIRE PUMP o Per Pump $100 0 Fire Pump $15 FIRE ALARM SYSTEM FIRE ALARM SYSTEM FIRE ALARM SYSTEM B 0 - 25 Devices $30 B System Acceptance $50 o Detection $15 26 plus Devices $60 Recall Acceptance $50 SUPPRESSION SYSTEMS OTHER OTHER W" $35 Fire Wall/Smoke Wall $15X'Z... ~ IP G" $45 Dry $35 LP Gas $25 Natural Gas $45 CO2 $35 Natural Gas $25 Fire Works $25 Other $35 Fuel Tanks $25 Fuel Tanks $45 Tent $15 FALSE ALARM FEE 1 st 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" GREASENENTILATION o Hood/Ducts $35 GREASENENTILATION o Hood/Ducts $15 f cIJ 0 Kitchen Suppression $15 PLANS TOTAL 1/9;;.. f!- INSPECTION TOTA~ PERMIT TOTAL! I g../-tb<' he,; l~~~.dA lct'f!f,c=-s . FALSE ALARM I TOTAL Comments: 11M Date: Inspector: Fire Marshal \ Kerry Barnett . Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 Plan Review Comments I have reviewed the plans for the "Silver Oaks Village Diversified Therapy" located at 6215 Abbott Station Drive and my comments have been placed below. Please contact me if there are any questions with regards to my comments. 1. Building shall comply with the applicable codes of the Florida Fire Prevention Code 2003 edition, NFP A 99, and City of Zephyrhills. 2. Per NFP A 99 (2005 edition), Chapter 20 "Hyperbaric Facilities" and speaking with Richard Barry, committee member of this part of the code, this facility shall have a sprinkler system in accordance with 20.2.1.2. Plans shall be submitted for this system and permit pulled. 3. Panic Hardware will be required on all exiting doors. 4. A "Knox" access box shall be required per the Florida Fire Prevention Code. An application has been provided. Location of the access box shall be determined on site. 5. Firewall shall be labeled/stenciled "Firewall- Do Not Penetrate" in block style lettering, minimum 2" and located in several areas. 6. All penetrations of the firewall shall be UL compliant. Supporting documentation shall be given to the AHY at time of inspection to show the application used to seal the penetration. 7. The containment site outside shall have ventilation openings at the base of each wall to allow free circulation of air within the enclosure (Chap. 20 5.1.3.3.3.3). 8. Certified fire extinguishers shall be properly located throughout the building in accordance with the code. Inspections required: 1. Firewall. A screw inspection shall be required prior to the tape and mud process. A final firewall inspect shall be required once wall has been sealed at top and bottom, penetrations have been sealed and wall has been labeled. 2. A third party inspection or certification shall be completed on the hyperbaric chamber and all components associated with the chamber that the installation is in accordance to the code. This also includes the containment structure. This inspection or certification shall be forwarded to the Fire Marshal and Building Official. 3. A building final shall be conducted. 2 Separate comments will be made on the sprinkler system once those are submitted. Fees assessed at this time are for plan review and firewall inspections. -~ illlll 111111111I1111111111 11I11 111111111111111111111111 1111 "'005266972 NOTICE OF COMMENCEMENT Rcpl: 952204 os: 0. 00 12/16/05 Rec: 10.00 IT : 0 . 00 Dpty Clerk ST ATE OF FLORIDA COUNTY OF PASCO JEO PITTMANJ PASCO COUNTY CLERK 12/16/05 11:29am 1 of 1 OR BK 6750 PG 1951 The undersigned, as Owner, notifies all parties that improvements will be made to certain real property and in accordance with Section 713.13, Florida Statutes, the following information is stated in the Notice of Commencement: DESCRIPTION OF PROPERTY: Portion of Tract C, Silver Oaks Village - Phase One, as per map or plat thel'eof recorded in Plat Book 35, Pages 63-67, Public Records of Pasco County, Florida DESCRIPTION OF IMPROVEMENTS: Office Building OWNERS AND OWNERS ADDRESS: Juan Cevallos 15801 Dawson Ridge Dr. Tampa, FL 33647 OWNERS INTEREST IN THE PROPERTY: Simple R CONTRACTOR AND CONTRACTOR ADDRESS: Village Square Builders, Inc. 6426 Huntington Dr. Zephyrhills, FL 33542 SURETY (if any) and SURETY ADDRESS: N/A AMOUNT OF BOND: $N/A NAME AND ADDDRESS OF LENDER, IF ANY, MAKING A LOAN FOR CONSTRUCTION OF THE IMPROVMENTS: Stella L. Peters Living Trust 2917 Bayview Lane McHenry,IL 60051 NAME OF PERSON WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCMUMENTS MAY BE SERVED: Juan Cevallos 15801 Dawson Ridge Dc Tampa, FL 33647 EXPIRATION DATE: December 15. 2006 STATE OF FLORIDA COUNTY OF PASCO ,~ J,~ll The foregoing instrument was acknowledged before me this 15th day of December 2005, by Juan Cevallos who is personally known to me or who produced --- as identification, and did/did not take oath. Witness my hand and official seal in the County and State last aforesaid this 15th day of December 2005 NOT <.'1-<.'-'1 PUI1 Dana. r f~ ('~ Commission # 00440442 ~. \) rJ Expires July 14, 2009 "S- OF ~~ Bonded T..y Fein .In!lUl''''''., Inc. 1JOO.385-7019 Village Sq. Builders, Inc. 813-788-6257 813-782-3321 fax 6204 Moorefield Lane Zephyrhills, FL 33541 (physical address) P.O Box 1536 Zephyrhills, FL 33541 (mailing address) Memo To: From: Bill Lance Smith RE Cell 813-997-3981 Phone: Phone: 813-788-6257 Fax phone: Fax phone: 813-782-3321 CC: REMARKS: D Urgent o For your review D Reply ASAP D Please comment Bill, Enclosed is the revised buildout plan for the wound center I also attached the two shell permits that were originally pulled that pertain to these units. Also included are plans for an external oxygen tank: unit with a containment structure. I have an 02 certified subcontractor that will be installing all of this. I would like to start the interior buildout as soon as possible, even via a rough in permit if possible. If I need to submit anything further please let me know. Thanks, Lance CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5263 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: 51,632.00 Date Issued: 12/22/2005 Total Fees: 1,111.16 Amount Paid: 1,111.16 Date Paid: 12/22/2005 Work Desc: OFFICE DUPLEX-UNIT 106 .. ";CON;r~CmORS;(.tL~m,::'9L'< VILLAGE SQUARE BUILDERS INC FIRST CLASS ELECTRIC COLBY JAYNES PLUMBING INC CHRIS' NC CO. 5263 COMMERCIAL 105-NEW CONST/MUL TI 5+ UNIT COMMERCIAL Address: 6215 ABBOTT STATION DR 106 ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: SILVER OAKS VILLAGE Parcel Number: 03-26-21-0200-00000-00CO Name: CERVALLOSJUAN Address: 6215 ABBOTT STATION DR (106) ZEPHYRHILLS, FL. 33542 Phone: (813)788-6257 087 sa FT SHELL ONLY PLUMBING FEE WATER METER RES 3/4" POLICE IMPACT FEE 35.00 RADON 180.00 FIRE IMPACT FEE 176.04 PUBLIC SAFETY 5% DUCTS INSTALLED PRE-SLAB CONSTRUCTION 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 corrections not made when inspection called (d) Work not ready for inspection when called (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible 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." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~. ~. .CTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5264 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: 100,985.00 Date Issued: 12/22/2005 Name: CERVALLOS JUAN Total Fees: 1,798.55 Address: 6215 ABBOTT STATION DR (107-108) Amount Paid: 1,798.55 ZEPHYRHILLS, FL. 33542 Date Paid: 12/22/2005 Phone: (813)788-6257 Work Desc: OFFICE DUPLEX-SUITE 107-108 2126 SO FT SHELL ONLY 5264 COMMERCIAL 1 05-NEW CONST/MUL TI 5+ UNIT COMMERCIAL Address: 6215 ABBOTT STATION DR 107-108 ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: SILVER OAKS VILLAGE Parcel Number: SQUARE FIRST CLASS ELECTRIC COLBY JAYNES PLUMBING INC CHRIS' NC CO. PLUMBING FEE WATER METER RES 3/4" POLICE IMPACT FEE 35.00 RADON 180.00 FIRE IMPACT FEE 360.23 PUBLIC SAFETY 5% 21.26 371.00 36.56 1 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 corrections not made when inspection called (d) Work not ready for inspection when called (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible 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." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~~ CTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 02/22/2007 11:53 8137823321 62/22/2667 12:11 813-9683396 VILLAGE1SQUARE WFC ENGINEERING INC PAGE 02 pl:iGE ell W.F.C. Eru!ineerio2. Inc. 14918 Knotty Pine Place -Tamp&, Florida 33625 -(813) 264-76'0 -Fax (813) 908-3396 EmaU: fcaner3@tampabay.n.com Feb.....,. n, 2007 Mr. Lua Smith VU... Squre Builden P.O. .:1 1536 ZepIIyrtillII, Flel'lda 33539 a.: 0xyaeD T..k Buildial P....IS...... Oau Viii. ~...... Florid. Dear Lana: PIelne let ... letter I d'e..... .y d.rifieatioll .. die ... lie.. fl'IMf"'l 11 t .. ... eoacnte 'ouadatioa for tile above refenuad project. We ue retlulri_.& sialle lay.r of ....1 r.blfol'CeIIleat for tbe fouDdatioD eo.e'edDI 01.... Wowu.c: 8 ..... rebaI' at I'" a.c. ad! W.Y, Ioeated 3" a,"",c tIte footer botto.., .ad oteadiq to ...Itllla. 6" 01 tbe 'lab edge. The v.rticalsteel iD tbe coDcrete pusten ..d noed eelll "UI maid ..d be tied to 111II ~.-t... We hln revited the fouadation plan details aad spedfleatio.1 ror the eoutractioa 01 tbe oxypa privacy tallk buildble to d",Ok tII. lteel pl..:ement, aDd wUl fo.....U'd tlte aaJed priata. P1eue co.taet ae ...ith aDY questiou. 02/22/2007 11:53 8137823321 VILLAGE1SQUARE PAGE 01 Village Sq. Builders, Inc. 813-788-6257 813-782-3321 fax 6204 Moorefield Lane Zephyrhills, FL 33541 <=,sical address) P.O Box 1536 Zephyrhills, FL 33541 (mailing address) FAX Date: 01./21./0711:57 AM Number of pages including cover sheet: 2 To: From: Calvin Lance Smith RE City of Zhills Building Department Cell Phone: Fax phone: 813-997-3981 813-788-6257 813-782-3321 Phone: Fax phone: CC: REMARKS: o Urgent o For your review 0 Reply ASAP o Please comment Calvin, Following is the lener from the engineer regarding the rebar matt. I should received the sealed prints in a few days. give me a call 813-997-3981 Thanks, Lance 03/02/2007 14:37 - Y\ ~ . ~ ~J~ 8137823321 VILLAGE1SQUARE PAGE 01 P.O. Box 1536 Zephyrtlills. FL 33539 Cell 813-997-3981 fox 813-782-3321 Village Square Builders, Inc. WorK 813-788-6257 March 2. 2007 Bill Burgess City of Zephyrhills 5335 8th Sf. Zephyrhills FL 33542 ~~} ~I ~ IE: Temporary C.O. Non Chamber areas permit 16337 Wound Center Dear Bill, As we spoke earlier in the week, I am requesting a temporary C.O. for the patient treatment areas and offices on the above mentioned permit. The schedule I have submitted has us completing the remainder of the wound center (the chamber area) in the next three weeks. f request 30 days to complete the remainder of the work and get the building and site finalized. I appreciate the help that you and the entire building deportment staff has given me regarding this matter. Sincerely, 03/02/2007 14:37 8137823321 % 0:: A. t:: o := ~ U) .E m c:: Li: c: 0 w .2EtVU l:!! ~~~~ ~ en >.- 0 q:: .elll~:= E .....Q)~c'1:l 2 II) = U ,- c: ~ en-cueS ..... .... m..c: .., c: ~.~o~.... cu cu := c en .e Q..:.= E~~>. ~tv .... u:o en ~ ~ 2- !=.fi~(.)-- J9C1)o=ul9 rn_...::~~U) CL.5WQ.(.)Cl,..E m c '2: lD ~ .... c 8- ei~ ~~:c ~c:N _ ~!!: '0 -:i~:::~ c . 'w:l c.- 'm < ~ 'm (.) Co .aa..' a. 16 tv Co q =,~(I)~(.) "6i5g ~ ~~8~8. ~tvKtvE c:J!!~C.., U:u..iL:t= E 0 e ~ .! E 8.8.0. ~~ OJ tv C i3 B rl :=J 'C .;:: 'I:: 8 8 0 ..... enen't: .g cu ~-gl l;: _ :i2 tf'tS tf t:: ~~- 'is. C :> > > --~ en m!j ! c;;rn~ ~ .E.E .. C ~ ........................................,.............,....,...,... :a ~~~~~~~~~~~~Qe & ~~~-~~~~~~~~~~ (,) QQoBoOOOQosOOO VI LLAGE1 SQUARE ~ ! ~ tv 13 Jj~t E~~ tv .... ~ .ccu- ~~o .- lU Co Gi'fi.9 ~c::c: c:_O '~~n ~~ ~ ~ :::J In 00.5: eeGi '1:: 'C c: 1-1-= lU cu .... PAGE 02 :i = .c N 15 e E ~ ~ ,8.... e! tv E E ,I;: ~ c:: U~.!! 0 U ~ m.- aC::lIl~u ;;;;;~c::Cl,.~ UtvO~C: cu - '-11) cu 0 a.~IIl.cO ~ ~ '-e E ! - 0.:::: lU ~ _ en.c ...., OJ c: (.) ~ a .J; ~ oS 'ii) = -= .S 0. ~~a8! 0> S (ij l;: S en c.... III .c c: .- CU c: <_...(/)- ~ C,) !' (,) ~ tv ! ~ :::J~ II) E ..Q~ e g"6 8 .:! Q: j~ ... -,! ! s_ e c::- ~ ._ tv ~ i ~ () .'0 ! ....- ~ =,m X o .~ cu 0..... r- ~ ~m~ c: ... .... ,!!C\JCUlU .... ,g cu N lI) e... fti O.cE~C\JCIlC::: ~5C\JO~lVB ~:"6c:l9~u 4( !5 1\'- ... m !. '-lI)."""OO""'en ~ .Q ii 'C ~ c: .S e g j,! C> 'C ~ Gi mll)lI)~iOc; G!5'S=1i.g::: -eoo8.c=.e ._ Q. E ..... III .!!J _ m 0 ~ qI .- en - D....1-~cnJ!.5~ 03/02/2007 14:37 8137823321 VILLAGE1SQUARE PAGE 03 ~""""""""~S~~~~l:;~~l:iS O~E2~eg____~~~_'So~ OQ)O)O)OlgOO___t'oI C")C")"lI'" ~~~~~~~~~~~~ ~~~ ...... - C") 1; ~ .! ... ! .! IC i 6m ~ 1) C l!? ~ Ie: ... . m 'jij .~ .E m 1 .! ~ .~ ~; Ii i :e .......... 'a'fi g 11l !I!.!ml 0 II) J=ee~lBm ti u 11l m C 'j;; ;.i ~ !'5i-i...e .8:1 ~ ~! ~ i ft ~ ~ I j '; u ,c>.mm-mU:::I Q) UII)E,c~....~1: 0.. c: U~!c:Q) ,~~'i iJ ~.~ i~~ ~~-5:IU~:i.c.!!!~ ....-&i~l:D-.cO....Q. S!m=,msU li,~.! ~JjJj~~~~~~-g ~ P! 11l ;;1 Iii 8 .c _ e u ~&i u~ c c ,- 11l ....~ o 0 .28 Jj~ ........................,........,................,....,............ ~~~~~~~!i~~~~~~~~ ~...................~....~............................ (;>;(;s(;>;(;s(;s(;s(;s(;5(;5(;s(;5[;s[;s[;s(;5[;s Q) - 'en e :c:I c: c&l c: o ::I ~ 0.. II) .~ .g PASCO COUNTY, FLORIDA Permit No. &, ~ :!51 Date Permitted 1;1.- p2 9 - o?:. <!l~~d".'_N_am~wner Name 07" I-fl. :~. k.control # . . County Parcel No. " 3 - ;2 t. .:.O;;Z ot> - 0"'''''''''-''''''''<> SubDiv: tl~ 0~ ~ Address/Location Gbl/a ~~:&bh 0~. 106 - IDg' Classificationffype of Us~ I~/~;()Dr 0 &AJrL. (~AL U.R4l.~ TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: 3 I bl-l.3 Exempt p."\(es D No Impact Fee Amount $ How Determined ,S, f). f,t.7 4~:5/ 'i"r,J Zone No. T AZ: SCHOOL IMPACT FEE Account (056) Single-Family Detached House (057) Mobile Home (058) Other Residential ~23) Collection Fee Exempt !,LJ. Yes D No How Determined Amount $ r~'. O. ~A/YYl--sa:rr-/ / PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone Exempt 0 Yes PO- No TOTAL AMOUNT $ How Determined '-....,."..__. . ,co" LIBRARY FEE Land Account Land Credit . Land Total Facility Account Facility Credit Facility Total Exempt DYes D No RESOURCE FEE TOTAL AMOUNT How Determined Total Amount ERU Prepared By Checked By NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION PERFORMED UNTIL THE TOTAL AMOUNTS 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 thl!) form, placing the building permit owner on notice of this assessment and th~ conditions of payment for same. DATE RECEIVED BY RECEIPT NO. DATE BY 06/20/2007 09:23 UUILU'LUU' ~_._. 3525211562 ......_t&..1 ,'-'_ .fRMC .I:'U~CHA?IN.& C0 -=- .P~E _J'3 n. _~ ''It- ~'--'!I rC\1'\'"U.A. -- (J,J:):J'7. i.J.- W2-lS ~bl)()ri ,,:-:>-\c-<-M L'Y\ I U~ ~ UA n G' {~()~.ll uS \.. M....CA... I: .T t'. m. .-.a....*'I &::.... ~.......-r. ?2.~ l~I._t_ ....-f. /7-d? ..-/-., -'- ,...,.4~~ U&AIf//.) f&!e- ~~~d M...... ... ., UA/pl6"~ FL... 'fI01ICflfAWAt-~L~:1'~I!'4l ~~~~ TIle foIlowt...IMpedi.. .. ....IA W lVPA ", 2~2 Bditio8, Chapter 5 a.. AIId Vaal.. S~... rv- ~~~~:~~~~z:.z:~ .'::;f:;r=:Ab: ;~~~~~ A/t19 T&-Rr ~A''' ~~ ~ rr~"'/ ~ ~ ~~J A-/ ~~~ ~.,i!1-~7AA1 ~ ~AJIht'~ -:}/.&n- ,/.c.. M,A""R.r-rs ..rJtp~L~~ ~- /' be' 5lGJtU BY: hp'p.... ~.. "- ..... , ....,. ,"''''.,. Me ...,n "".A 1 777S7?77BO Page 2 06/20/2007 09:23 3525211562 PRMC PURCHASING PAGE 02 ""_I\~..1 "~.L~ f-~ ..,... ~~/~ MERCURY M .E 0 J C A L. FAX INFORMATION SHEET ro: ;?Jh;& v,/~4!Jf/~ ~~~a6vTtI'rlt1 AnN: C~'o/L ;TG'!T>-DATE: Ib ~. ~? . '- NUMBER OF RECEMNG FAX; $..->-2 ~-Z-( Ed ~ SUBJECT: tP 2:- d'~L-'- NO. OF PAGES (INC. COVER SHEET) ~d IF YOU 00 NOT RECEIVE ALL OF THE PAGES INDICATIiD ABOVE. OR SHOULD ANY OF THE PAGES BE UNCLEAR OR DIFFICULT TO READ. PLEASe CONTRACT 'T2'1.573.0088 OFt 800.23'1.8418 EXT. 3100.3004 OR 30'8 AS SOON AS POSSIBLE.. THANK YOU. 11~1II Street Norih. ClHl'W8ter. Florida 33162~ ': 727-~88 ".",'1"" ne 'ln 'In... 'I 7?7t::7?7'7Rn "all"~ 1 06/20/2007 09:23 3525211562 PRMC PURCHASING PAGE 01 Fax Cover Sheet PASCO REGIONAL MEDICAL CENTER ENGINEERING DEPARTMENT 13100 FORT KING ROAD DADE CITY. FlORIDA 33525 PHONE: 352-521-1124 FAX: 302-521-1542 CONFIDENTIAL HEALTH INFORMA liON NOTICE This Fax may contain confidential health care information that Is personal and sensitive informaVon. It is being faxed to you after appropriate authorization from the patient or under circumstances that do not require patient authorization. You, the reclplft1t, may be obligated uncler Federal or State L.aw to maintain the Infonnation in a safe, secure and confidential manner. fte-dlsclosure without addi1lol1ll' patient penn_ion or as otherwi.. permitted by law may be prohibited. Unauthorized re-dis~losure or failure to maintain confIdenti8IKy could subject you to penalties lln~=';;'ta(:;W"i) ~: ~ . ,~:C Fax: Dille: . Including cover P8ges: Re:~-AtIJ 4A~ M 0;- CC: {/ o Urgent 0 For Review 0 Please Comment 0 PI___ Reply 0 P..... Rec)'CIe · Comments: . ..,; ~)'f'd ~uv.;~~' ~~ ~I /-rnf~~ / ~~ ~~q4.i.if' J~r' ~p a.." IMPORTANT WARNING; This meAilge is intended for the use of the per$On or entity to whId1lt 15 addressed and may OOl'ltoain information that is privileged and confidential. the disdosurv of whiet1 is govemed by aJlpf.eable law. If the reader of this message is not the intended recipient. or the employee or agent responsible to deItver It to the intended recipient. you ere hereby notified that any dissemination. distribution or copying of this information is STRJCTL Y PROHIBITED. If you have received this message in error, please notify us immediately and destroy the related message. 06/20/2007 10:50 3525211562 1 i300 .4!1l1l .. N, C,.,..-. A.. 337fl2 ,fh MERCUR" ~~. 'M"TFj-fAtll :\\~.~~ TestOale: PRMC PURCHASING I.ol:8I ~ 7%7~ FIIlI: 12i.ct;..?1$O Certification Summary Pasco Wound c.... Surgery Center Zephyrhin., FL TECHNICIAN: RONIdJ.GellIer 05111 fCt'/ Job # (NFPA 99, 2002 EdlllOn) ~ WI( Qcygen SyItllm 1 Cerllftctlto of Compliance 1. MMtt.1I code compiant 11aIn.. det8iled on the (Otrtlfloete Ilf ComplIanCe) page ~4 iJctllit. r~ 1IIIdJ.GGItl AN.t.. .OerH,1 12406 ?nn7_n1=i_?n '::1:41 Su~ PIlgD .-or 4 8362254303 PAGE 06 14ll!l~'I':!! . Fl,.. 5 06/20/2007 10:50 3525211562 PRMC PURCHASING These Documents Contain The Certification Reports For: Pasco Wound Care Surgery Center Zephyrhills, FL Project : Attention : 5/17/2007 Bulk Oxygen System Cheryl Jefts Completed by: Ronald J. Gettler- Medical Gss Specialist - N.I.T.C. #00012406 ?nn7-n1=>-?n ?::1~4n I'1Qe f 01 A 6362254303 PAGE 03 Page 2 OS/20/2007 10:50 \: . .. ?nn7-nr>-,n '~~o:1n 3525211552 PRMC PURCHASING MERCJJR~ M E DIe A L* Table of Contents for Pa,!;co Wound Care Surgery Center CfIrtlfiC8tlon Reports, Data and Findings Section 1 CERTIFICATE OF COMPLIANCE hnnllltIlt ~ SUMMARY lnClIAdel$ Pll.,:!Df4 6362254303 PAGE 04 Page 3 OS/20/2007 10:50 vv, ~UI4UUl uu.~~ 3525211552 U~ULL-''''..JU..J PRMC PURCHASING PAGE 05 "YJ.JL...1" ~ ..... ..,. ""... ...'-' '_'-'M... V"'Tr 'WIW ,. - t.. ._MEIlC1J.RY '. ,. ~ M! i,l r t: ^ III I . l~\, Certificate of Compliance this certIfIcIW Islnuftd Apftl17, 20071>yMen:uyMedceI, Thiscertlllcllle "*_10 1heW'Dtfc perfonned pUl1lJlIRl Ig II r'eq\J!IIItfartesling seMces ~PMoo Wound C81'9 s.ArgeryOentlr. ln~wHhthetelml Dfthet 89l'1&emMt, Mi!!rwry MedlCIII has _bed the (lOltlpll!dg medJeIl oatl)lplng system of nid ~or IIlJP'1dfic area of seid Pasco Wound CG", aur;ery CB_.loC8tecIln ZeptI)mI11s, FI. And nereby CII'tIAeIlhat M or Ine 1I1'l18 aid iM!)C!diot'lwe. pMormed and ~CQI:lla$ noted on !he data $heeclL llll'ld non-compllllnce page, Thefollowl~ In~ was made I.A.W. NIEP", H, 2002 EdItkm. ChIIIMDr I. c.. and V_~. Inspected new bufk ~ system and 8IIIm 8l*fem fDfnYP8/tlllrlc ct\tImtlef8. No crossccnl'lldir:lnll rdecI on pipl1'l9. Nocl8<AAolalion noted on .45 micron lilter18kenatct\aml:l4araonnection. AIaI"".1Mn Ia~ng OOI'/'ealfy. Tne "lJlIl: oxygen ~ and all!llmC a1"I eetIIfled 101' PEll1ent use at of Mev 17.2007, ThIs certlfleate sha~ ~ nmdercld 1101<1 at.Gl'lytlme. "dfU1lIrnm'lI$.l'r1Odifi~ or 1'1'1l!l1ntenlmCl8 ~ I*formedon l\'1e 3toremen\lorled ~allCllorequ~m.1'It. k1i4t~ (lab.... Cllf\lllc!llG ~:!of4 ~nn"7 ne::".,n ?"l'J11 8362254303 Pagi! 4 OS/20/2007 09:25 3525211552 ~b/~~/L~~f ~O:~( (~IUt~IIOU PRMC PURCHASING "*L-I''''''''''''''''' I ..JI_u..."-"....... PAGE 03 .....~ . ...... ~~ 1N1t:.f.... I '( -tP}7 ...-/.-., ..l-. 11_ .... s..)IaIUl ~ _.f'L,tt1lR~ ?1T~ . 1~t8_~ r.Ikr:,d-;:'4.IJ UJa.4P'P W6- 5~t1J~ ~d Ad..... . -~U-///JVf//:tn. R ~ . 'aosu:tlf~t/./t:'C~~~~&J : The tolloW1q ialpect1e8 was made lAW Nt? A "' __ 2~2 ~ition, ~~ S ~ AJad V.a.. S~Dl'" . &? P&9?"?pJ ~~ ,.q'~ ~..Jcb~ ~f/7b-L ~~~~llIJA-T e:h~~ ~~~t!./7~AI..- -;;ti~,c !ft/.$;"rr.--, ~:c. ~6.#'.rd ~~~~/-:( ~- "7 =77# &'a:~..-xp~,;~~ ~ _,~r.~[ ~~~;[~;~~~p~ 1 ...---- - I ..;. . ._,.__"--,,. . w:~ ~ "~lW I J WI.... ~.-_.-....~ .~..._ ""0_' __..._................_ 5fGl(I'.D BY: '0'".. _......., .'. 777li727780 Page 2 SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITA-34-902130 Rev J Perry Baromedical Corporation Englneenng ".,. 'I /'J/a{, I . ? Iz(lP(, APPROVALS: OpfItatiGnlf Date <" . ---:::. Date .--. ... . ,.... - ")- S /-~ -6 . QuIJIlty Aaunmce ; --. ~. .-. Chamber SIN b~-Slf <I~s Date Installed S-'1-D ! Nat. Board No. PBC Representative Facility Name P e-S Co State Zip "3"SS""{ L Address City RBO PHONE FAX Other RBOSta<< . NotIce: The only controlled copi.. of this dacUllWlt ant the electronic read-only V81'Slons 10CIdacf on "P' drive. and the signed m....r capy maintained by the QUIIIIty de~rtment. The document user Is ..ponsible far verifying that the latest version Is available for use, by checking the electronic directory to detennine the current ..vision level before u.tng Level 3 or Level 4 documents. Page 1 of' SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITA-34-902130 Rev S Perry Baromedical Corporation TABLE OF CONTENTS SECTION 1JTLE PAGE 1.0 INTRODUCTION 3 1.1 Purpose 3 1.2 Scope 3 1.3 Prerequisites 3 2.0 INSTALLA nON 3 3.0 INTERCONNECT PRESSURE CHECKS 3 4.0 PRESSURIZATION AND EXHAUST SYSTEM 4 5.0 GURNEY AND STRETCHER 4 6.0 COMMUNICA nONS SYSTEM 4 7.0 ACRYLIC 5 8.0 AIR SAMPLES 5 9.0 VISUAL INSPECTION 5 10.0 PERFORMANCE TESTING 5 11.0 TAMPER SEALS 6 12.0 TRAINING OUTLINE (WI-L3-903123) 6 CHAMBER PERFORMANCE INSTALLATION TEST 7 CHAMBER CYCLE INST ALLATON TEST 8 INSTALLATION CHECKLIST 9 Notice: The only contn:lllMl copies of this document ate the electronic: read-only versions located on "F" dIive. and the signed master copy m"ntllned by the Quality department. The document user Is ....pon.lbIe for verifying that the latest version Is available for use, by checking the .electronic directory to detltnnine the current revision level before using Level 3 or Level 4 documents. Page 2 of g SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCEPROCEDVRE ITA-34-902130 Rev J Perry Baromedical Corporation 1.0 INTRODUCTION 1.1 PURPOSE The purpose of this procedure is to establish the requirements for SIGMA 34 and/or SIGMA 40 installation, final checkout of all systems, and criteria for customer acceptance. 1.2 SCOPE The scope of this specification covers the following areas: a. SIGMA 34 and/or SIGMA 40 on-site installation and interface with customer's facility b. Functional checkout of chamber and all associated systems. c. Final acceptance by customer. 1.3 PREREQUISITES The following items shall have been completed before shipment to customer's location. a. Factory acceptance testing to Perry Baromedical Corporation Specifications. b. Customer's representative shall be notified at least one (1) day in advance of the scheduled performance of any or all tests required by this procedure. c. Building service requirements (oxygen. air, exhaust, and electrical grounding) installed by customer. 2.0 INSTALLATION 2.1 Assemble the chamber on the location as directed / given by the customer. 2.2 Lock wheel brakes to prevent chamber movement. 2.3 With the chamber assembly located and secured in position, install supply, exhaust, electrical power and ground interconnects between the chamber and facility connection. 2.4 Check following torque values: Tie rod nuts- 90 ft. lbs. for SIGMA 34 Tie rod nuts- 110ft. Ibs. for SIGMA 40 Pivoting door bolts- 175 ft. Ibs. for both SIGMA models. 3.0 INTERCONNECT PRESSURE CHECK NQIE: A customer representative along with an individual from Perry Baromedical Corporation must be present to witness the tests specified in Sections 3.0 and 4.0. The completion of these tests and the results accepted by the customer signifies acceptance and final turnover of the system to the customer. Notice: The only controlled copies of this dOCUMent as-. the electronic read-only verslema located on np' drive, and the .igned master copy maintained by the Quality deparbnenl The document us.r Is ....ponslb.. for verifying that the latest v....ion Is availabl. for use, by cMc:klng the electronic dlractoty to detennin. the cumtnt ntvlaion level before using Level 3 or , -..-. · ..--..-.... Page 3 of 9 SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITA-34-902130 Rev J Perry Baromedical Corporation 3.1 Pressurization supply line. 3.1.1 Open pressurizing gas isolation valve. 3.1.2 Check all interconnect lines and fittings for any leaks - tighten as necessary. 3. 1.3 Close isolation valve. 3.2 Exhaust Line 3.2.1 Check that exhaust line is connected to the chamber and the wall connection and clamps are installed. (Single exhaust per chamber) 3.3 Ground Wire 3.3.1 Check that the ground wire is properly connected to the chamber and to the facility wall connection. Initials: Perry ~ Customer [~ 4.0 PRESSURIZATION AND EXHAUST SYSTEM 4.1 Check that main pressurization supply is turned on to chamber. 4.2 Tum system on. Verify that door interlock switch is operating satisfactorily. (No Oxygen flow unless door is closed.) 4.3 C10se chamber door. 4.4 Close vent rate control knob. 4.5 Set the rate control knob for Maximum Flow. 4.6 Set the set pressure control knob to approximately 31 psig. 4.7 Check that chamber pressure starts to increase. 4.8 Adjust chamber pressure to 30 psig. NQIE: Chamber pressure will be approximately 1 psig less than set pressure. . 4.9 Demonstrate operation of Exhaust Bypass button. Initials: Perry vA:. Customer [iJ- J 4.10 (Optional - For chambers instal/ed with BIBS systems) Check BIBS connections and verify system operation.. 4.11 Explain BIBS oxygen monitor operation and calibrate. Perry ~!If CusIDmer I Initials: Notice: The only controlled copies of. this document ... the electronic read-only versions loc:atec:I on -P' drive. and the signed muter copy maintained by the Quality department. The document ....r Is ruponslbl. for verifying that the I.test version is avail.ble for use, by checking the electronIc directory to determine the current revision level before using Level 3 or Level 4 documents. Page... of I SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE IT A-34-901130 Rev J Perry Baromedical Corporation 5.0 GURNEY AND STRETCHER 5.1 Check that gurney is properly adjusted, locks finnly to chamber, and stretcher loads smoothly into chamber. Initials: Perry IJ'I1 Customer ~J 6.0 COMMUNICATIONS SYSTEM 6.1 Test the communications system as 'follows: · Turn communications system ON. · Have an assistant enter the chamber and speak. · The chamber occupilnt should be heard over the console speaker. · The console operator is to key the handset and talk to the chamber occupant. · Set volume controls as required. · Connect external audio source (200MV or less at rear of chamber). · Chamber occupant should be able to hear audio inside the chamber. · Key the handset and verify audio source disconnects when operator speaks to patient. · Set volume of audio source as required. Initials: Peny~ Customer [~ 7.0 ACRYLIC WINDOW 7.1 Verify that cylindrical acrylic window is clean and free of scratches or damage. Initials: Perry ~ Customer [D-h 8.0 AIR SAMPLES 8.1 Air sample results taken from hospital installed supply lines are to be reviewed. SamPle:AatisfactOry: Initiab: pJ:[;r Customer [#1- 9.1} VISUAL INSPECTION '.1 Make a final visual inspection of entire system. Check the foUowing items for satisfactory condition: a. Paint b. Fasteners in the proper locations and tight. c. System components clean. d. Acrylic window clean and free from blemishes. Initials: Perry ~ Customer ~J Notice: The only controlled copies of this document .,. the eJKtron!c ....d-only versions located on "p drive, and the signed m....r copy maintained by the Quality department The document user fa ....ponsibl. for verifying that the latest version i. available for use, by chtlcking the electronic directory to determine the currwnt revision-level beta,. using leval 3 or Level 4 documents. Page Soft SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITA-34-902130 Rev J Perry BaromedicaJ Corporation 10.0 PERFORMANCE TESTING 10.1 Operate the chamber as required. and record the results in the Chamber Perfonnance Installation Test in the back of this document 10.2 Operate the chamber as required, and record the results in the Chamber Cycle Installation Test in the back of this document. Initials: Peny rv'l Customer ~] 11.0 TAMPER SEALS 11.1 Affix Tamper Seal Labels* to each of the following components: · CR-l, Computing Relay Totalizer Bias Adjustment · MY-I , Valve Metering, Pressurization Rate · MY -2, Valve, Metering, Depressurization Rate · RV.I, Regulator, Back Pressure, Ventilation Rate Control · SV-2, Valve, Relief, Rate Tank · SV-3, Valve, Relief, Set Pressure Safety · Use Labels, McMaster Carr Stock No. 20195T3 or equal I hereby :art( all of the above has been perfonned and _fuund to be acceptable: \J ~ ~L~ Peny BaromedicaJ Representative Customer Representative 12.0 TRAINING OUTLINE Note: Use Training Outline (WI-LJ-903123) to provide training lto the customer/customer staff upon completion of the Installation Checklist. The inStallation is not complete until the customer is comfortable with the location of the controls and the operation of the chamber. Completion of this training will be part of the Work Instruction. The Work Instruction win be turned in by the technician as part of the Installation and Acceptance Package. I hereby a~e i!r! all of the above has been perfonned and found to be acceptable: ~~& ~ 6f~.~ Peny Baromedical Representa'tive Customer Representative Notice: The only controlled copt.. of this document.... the electronic reilHnly versions Ioc:ated on .'p' drive, and the sigrMd master copy mainbllned by the Quality department. The document user is responsible for verifying that the latest version Is aqllable for use, by checking the electronic directory to determine the current revision level before using Level 3 or Level 4 cIocuments. Page 8 of 9 SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE IT A-34-902130 Rev J Perry Baromedical CorporatioD CHAMBER PERFORMANCE INSTALLA liON TEST Test Date: G - ~ -0 f Chamber Type: Sl~ -~LL- Gas used: CJ 2. Location: p v...5 c....o Q~,~evr \'2- SIN: b'J.C.0~ Number of Cycles to Date: Metering Valve Settings: Pressurization (" rz.." { ~ Depressurization lIe S- Safety Interlock Operation: Satisfactory (Pro/libits Oxygen flow) Unsatisfactory Pressurization Test: Set to attain 30 psig, Record rates at Maximum Flow and Minimum Flow on Cycle Test, Ventilation at min. setting. Depressurization Test: Set to 0 psig. Record rates at Maximum Flow and Minimum Flow on Cycle Test, Ventilation at 250 Ipm. Note: From 25-20psi, adjust closer to :45 if required to ran within S-O parameter. ~0 AclUal CHAMBER PRESSURE Wi7SURE@ 30 psi: (29.0 minimum ) Leak Check: Satisfactory Unsatisfactory (No leaks) Was 30 psig Attained? (Yes or No) ,....... L9~ (Explain) Actual Chamber Pressure @ Set Pressure ... 22.0 paig: Vent Rate (LPM) 125 [or minimum] 385 [25.3 In H2O] Chamber Pressure (psig) <2 (. (p ~{-1 Deviation (psig) f tf_ (1.0 max.) ,7 Exhaust Bypass Time: 30 psi to 0: Test Results Acceptable: [L I""; 2:J--'-' '- J l/ (2:00 max.) [ ] No Tested By/Date: ':;ft ~ s--~ - O~ Notice: The only controlled copies of this document are the electronic read-only version. located on "F" drive, and the signed mulIIr copy maintained by the Quality depar1ment. The document user is responsIble for verifying that the latest verwion Is available for use, by checking the electronic directory to detennine the current revlalon level before using Level 3 or Level" documents. Page T of 9 SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITAe34-90Z130 Rev J Perry BaromedicaJ Corporation CHAMBER CYCLE INSTALLATION TEST Test Date: 5-9-o( . S I ~'"" - S'-I Location: P tl..S Cc Q~,;..J_ Gas Used: (91.... Chamber Type: SIN: G'J.(J"5~ ELAPSED TIME DATA e PRESSUlUZA nON CHAMBER PRESSURE MINIMUM RATE MAXIMUM RATE - o-s -1 : '2-~ (1: IS - 2:30) 5-10 tI/ f 9 (+4:15 -6:30) L:c)cr (+ :50 - 1:15) 10-15 .'ER (+ :45 -1:10) 15-20 4- 2?-(+4:15-6;30) :91 (+ :45 - 1:1 0) - - 20-25 ~: ItJ (4:20-7:15) 25-20 ELAPSED TIME DATA - DEPRESSURIZATION "51 (p <,' 07 (+4:15 -6:30) : s-rf :57 (2-D ,: fO (:45-1:10) 20-15 (+ :45 - 1:15) 15-10 (+ :50 - 1:30) 10-S (+ 1:00 -2:00) 5-0.5 Te" Resultl Accep1abIe: Jyes (5:00 - 9:30) [ J No Tested By/Date: v---)/J ~_ ~-'l-&7 Notlee: The only controlled c:opies of Itll. document are the electronic: ....d-only versions located on "PO drive, and Itle -'gned mas. copy maintained by Itle Quality depar1menl The document user Ie responsible for verifying that the latest version Is available for use, by ehecklng the eleetronlc dlrectDry to detllrm'n. the current revision level before using Leve. 3 or LlMI' 4 documenls. Page 8 of 9 SIGMA 34 & 40 INSTALLATION, TEST AND ACCEPTANCE PROCEDURE ITA-34-902130 Rev.J Perry Baromedical Corporation INSTALLATION CHECKLIST /' Place system~ from skid to walls, 18" on side, 24" at rear. Closer dimensions only if room size requires it. Allow adequate space for fairing installation. Level system from front to rear only if required by placing spare tiles under wheels. ~ Level side to side by putting level on open door and making sure door does not drift on its own )n any position. ~ Check for loose comers by pulling on system at front and rear and opening and closing door. 7 Check tie-rod torque 2r movement. Cam latch movement and cam latch handle rotation. Latch tightness. Check for even gap. Gap should be as close as possible, but not less than /005", and still be easily opened and closed. J .....check that all pivot bolts are torqued and set screws are secure. /,/ .. . \. any penetrator accessory Items. _/ Hook-up supply and exhaust hoses and leak check. CAUTION: Before connecting any gas supply hose, verify with the customer that the system has been tested and is ready to be placed in service. ALWAYS check system cleanliness by flushing the line, preferably into a clean, white rag, prior to making the initial connection CAUTION: Before connecting the chamber exhaust hose. verify with the customer that the building exhaust has been completed lAW the proper codes. L Press chamber to 30 psi and leak check all control plumbing, including volume tank. ~Iso check the cylinder seals, door seal and all hull penetrations. ~heck control system for proper tuning. V Note gas supply pressure while pressurizing the chamber. It should maintain at least 50 psi. If pressure falls below 45 psi (approximately), or causes a Low Pressure Alarm, testing may have. to be completed at a lower rate setting. \// Gurney is level and latches properly - adjust as needed. .z Stretcher should roll freely and latch properly. Notice: The only controlled cOpies of this document ant the electronic read-only veN/one 1ocal8d on "p. drive, and the signed mastllr copy maintained by the Quality department The document UHf'is rnponsible for verifying that the latest version is availabla 10r use, by checking the electronic directory to detennlne the curr.nt revision level before usinG Level 3 or Level 4 documenCa. Page 9 019 CUSTOMER SERVICE ORDER CUSTOMER NAME ADDRESS WC CNTR of Pasco Regional MC 6215 Abbott Station Drive Zephyrhills, FL 33542 DATE 21 May 07 CUSTOMER # 00- DIVERS/P ASCO CONTACT: Linda Lowman PHONE 813-479-0225,352-457-1518 FAX 352-521-1579 P.O. # CHAMBER: DUALPLACE ( ) SIGMA I I ( MULTI ( ) PLUS ( ) CHARGE NO. SIN: 621-34,620-34 34 (X X) 40 ( ) NA TURE OF SERVICE TO BE PERFORMED: ROUTINE P/M () OTHER ( ) Complete install of chambers, and fix corns issue requested by customer. TECHNICIAN ASSIGNED: Will Green SERVICE SCHEDULE DATES: May 22 - May 23,2007 SPECIAL INSTRUCTIONS CUSTOMER~{Jn/I(:Vn SERVICE COMPLETED BY, ~J1> ~ _ f CO~M~NTS ....L '" ~1U. C l<.d DATE: DATE S --;;J-3-tJ7 (Q -2. '3 -Dr ~C1.t~ ~ A c( ~~ 6t:o-od.. I c..-k w- b"l V>. 5 avv J ~ ISO Form 900015A Rev O.xls Customer Service Order