HomeMy WebLinkAbout07-6353
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6353
Permit umber:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost: 125,000.00
Date Issued: 1/05/2007
Total Fees: 14,160.00
Amount Paid: 357.00
Date Paid: 1/05/2007 Phone:
Work Desc: FINAL COMPLETION - SAME DAY SURGERY - CONTRACTOR CHANGE
6353
COMMERCIAL
NEW CONST/COMM
COMMERCIAL
Address: 6733 L
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 03-26-21-0010-03200-0020
Name: MAHOOTCHI, AHAD (MD)
Address: 6733 GALL BLVD
ZEPHYRHILLS, FL. 33542
R
SOUTHERN EQUIPMENT CORPORATION FIRE PLAN REVIEW FEES
TRAFFIC IMPACT FEE 1%
327.00 TRAFFIC IMPACT FEES 99% COM
138.03
13,664.97
~1~~P~
E-
1ST ROUGH PLUMB WATER MISC. MISC.
DUCTS INSTALLED SHEATHING MISC. MISC,
CONSTRUCTION POLE FRAME INSULATION CEILING FIRE DEPT, FINAL
2ND ROUGH PLUMB SEWER MISC. ELECTRICAL FINAL
DUCTS INSULATED MISC MISC. PLUMBING FINAL
LINTEL INSULATION WALL MISC. FINAL MECHANICAL
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.
- ~-~
TOR S NATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CI~Y OF ZEPHYRHILLS PERMIT APPLICATION
BUIILDING DEPARTMENT 5335 8TH st, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECEIVED
PHONE CONTACT FOR PERMITTING 813 -78.:1-' Of~
OWNER'S
~h U ~ -So rm. ~ ~ JJp~ONE [f(~ -- 7 f':; .D<f>-<5"
JOB ADDRESS
LEGAL DESCRI PTION: LOT (S) () ~'D BLOCK O~ O'D
PARCEL 10 # 03--< b- .:2..1- DDlo - b3~OD. ~o
SUBDIVISION 0 D /0
{OBTAIN FROM PROPERTY.TAX NOTICE!
WORK PROPSED: k1NEw CONSTRUCTION
DSIGN
PROPOSED USE: DSGL FAMILY DWELLING
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
DMULTI-FAMILY
0* OF UNITS
o MOBILE HaM
o COMMERCIAL 0 INDUSTRIAL 0 SWIMMING POOL Jd.-oTHER.
yYJ 'e-C~d
c=J RESTAURANT & HEALTH DEPARTMENT APpROVAL
DESCRIPTION OF WORK hv\~ ~{e...L:VVl., {)fS~~@.<.f~t.~)'e~'1~
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
IF SIGN PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
AMP SERVICE
o Progress Energy 0
W.R,E.C.
o PLUMBING
~NICAL
o GAS
o ROOFING
o SPECIALTY
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 AREAD YES 0 NO
~~''''''~''"7'',,",'''' It..,... ""'----""'V~~-7T~- ~-'-.r..'. '~-'-G~--------'T"'- '_'~'rr-' ,~"- ...,-r~' '~"""""'~"':rTI~-~~-~~
'I. -.c.,d I . I II I,,' I I I I I I ' I , j ,I I jf I r f I," I J' '":r. ~, j ~:., I 'I' ... 1h~ "
1111, "Jtll'lll t 11,1 '''1'1 'I' r ' I < ;' - . \, I I I I -' 1'[ J t1, 1J] j'l I ,,,'"1\ '11 1 I" J 111" ~J: ~lpr1Jlli
"II 11111"1 Iltl' I r I r,::'~ I', f 3 '_ ,,-1':..~'j~ f' \ ,I ;. lj f IJ 1111 ( 1,1 01 fe-i'-~ lNf~II~J'ij
-,~~~J..;._~~_~.....__........L~-~------- I __r:-rJ1'0h"r'~
BUILDER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL J COMPANY a) "tile ~dll1l ('It f }~ C.
SIGNATURE ~ ~ STATE CERT OR REGIST * (!.A.!!-f) I ~ I ~ b
/'
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST *
A. NOTIGE OF DEED RESTRICTIONS
Th~ undersigned understands that this permit may be subject to "de~d restrictions" which
may be more restrictive than City regulations. The undersigned aSSUDles responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contr~ptors to undertake work, -they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be ci1:ed for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-780-0020.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor1s) sign po~tions of the "Gontractor Sections" of this ~pplication for which they
will be responsible. If you, as the owner signs as the contractor, ybu are indicating that
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indicat;ion that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C.- TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, .AS AMENDED)
I certify that I, the applicant, hav~ been provided with a copy of "Florida's Construction
lien Law - Homeowner's-Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify 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.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development.
Appll~ation 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 wiil be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies inolude but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetiand Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protectiori Agency-Asbestos abatement
I also certity that, if fill material is to be used in Flood Zone "A" or "A,etc,", it is
understood that a drainage plan addressing a "compensating volume" will be submitted 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 violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for la
period of six months after the tirne.the work is commenced. One 90 day extension of ~im~
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to'the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS ~O YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this.L.:Z!!!:.. day of -:r~l , 2~
by .
(name of person acknowledged)
~s personally known to me, or
j)~
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this ) 71:1(' day of ~......... , 20o-Z-
by
(name of person acknowledged)
~o is personally known to me, or
9~
o who has produced tJ {A- .
(type of identification)
and wnoD did .Q-did not take an oath.
o who has produced ..; ( ~
(type of identification)
and who Ddid QeH.d not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped
813-780-0020
t<; .,'f;
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
Owner's Address
Fee Simple Titleholder Namel
Fee Simple Titleholder Address I
IlR'733
I
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
JOB ADDRESS
~a..U- ~cQr.' 2~,~' :sss~1
I PARCEL ID# I 03 -~" -.::t-I- (fl:IO- () 6..2 fJ'D -- 2JO J- I:)
(OBTAINED FROM PROPERTY TAX NOTICE)
B ADD/ALT D SIGN D MOVE D
REPAIR
D COMM D
D FRAME D
SUBDIVISION
WORK PROPOSED
B
D
D
I
PROPOSED USE
TYPE OF CONSTRUCTION
NEW CONSTR
INSTALL
SFR
BLOCK
DESCRIPTION OF WORK
SQ FOOTAGE I
BUILDING SIZE
111111111111111'111'11111111111'11"'1111111111111'1111111111111111111"11111111'1111111"1111111'11111111111111'111111"11'111111111"1111'111111
1$ I
D ELECTRICAL 1$ I
D PLUMBING 1$ I
D MECHANICAL 1$ I
D GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
1111111111111111111111111111111111111111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111
D
LOT #
DEMOLISH
OTHER I
STEEL D
OTHER I
HEIGHT I
AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
PROGRESS ENERGY
BUILDING
D
D
W.R.E.C.
VALUATION OF MECHANICAL INSTALLATION
License #
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans. Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
Attach (3) sets of Building Plans; (1) set of Energy Forms, R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date, Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction,
BUILDER
SIGNATURE
COMPANY
REGISTERED
Address
COMPANY
REGISTERED
ELECTRICIAN
SIGNATURE
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Address
OTHER
SIGNATURE
COMPANY
REGISTERED
Address
111111111111111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
I
I
I
I
I
I
I
I
I
I
Y/N
FEE CURRENT
Y/N
License # I
4/ I ~ '" l!,)r, (
Y/ N FEE CURRENT I Y/N I
License # I EC 00 0 17 )0
Y/N
Y/N
FEE CURRENT
License #
Y/N
Y/N
FEE CURRENT
License #
Y/N
Y/N
FEE CURRENT
11.......11.....11.......11111....11111......1111..11................111..111....11.......11.........11.11...111..................................
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed""testrictions"
W~ich rnaYb~ more restrictive than County regulations. The undersigned assumes responsibility for compliance With any
applipa~le. deed restrictions. .
lJNU~E~~~DCONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has, hired a ,9ontractof ot
c:()btr~ctotstoundertake work, they may be required to be licensed in accordance with state and 10c~ltegulatidnS,lftlie
c~~tr~ct~riS,n~tlicensed as required by law, both the owner and contractor may becit~dfor arnisd~meapor Viol~tion.
unp~rstat~la\y: . If the owner or intended contractor are uncertain as to what licensing re<1uirem~ntsrnayappl~f(j~ th~
int~ndecly.tot~i ,they are advised to contact the Pasco County Building Inspection Division--Licensihg Section at?27 -8,47-
8?P9,l=urthefmore, if the owner has hired a contractor or contractors, he is advised to have tliecontractor(s) sign
pqrti~ns of th~<li~ontractor Block" of this application for which they will be responsible, If you, as the owner sign as the
. cO,ntractor" tHat may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPO,R~AtION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The, undersigned understands
th~t Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
uS8.in existi~~~uildings, 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
permitting, 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 information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated, I certify that no work or installation has
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 jurisdiction. 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, Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways,
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks,
US Environmental Protection Agency-Asbestos abatement.
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 "V" unless expressly permitted.
If the fill material is to be used in Flood Zone CIA", 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 set 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 (F.S. 117.03)
CONTRACTOR
Subscribed and swarn to (or affirmed) before me this
by
Who Is/are personally known to me or has/have produced
as identification.
OWNER OR AGENT
Subscribed and swam to (or affirmed) before me this
by
Who is/are personally known to me or haslhave produced
as Identification,
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021 i~f^r~/ . .
DATE RECEIVED ~
PHONE CONTACT FOR PERMITTING
OWNER'S NAME ~I 'nCL
eeJ ~ f-c:c: 't--e-r;;.Je~r-m~ ~ PHONE (Jl3 -7t' ~ -0 R~~
cvJL z:.. ~r . -.'
JOB ADDRESS
LEGAL DESCRIPTION: LOT (S) DOd-.O
BLOCK {)S-J,co
SUBDIVISION ero/c>
PARCEL 10 # 03 ,;;)",10 -.:J.j - DiD,D D-.s~Do - ()t)~o (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ONEW CONSTRUCTION
DSIGN
o ADDITION
o ALTERAT ION
o DEMOLISH
o REPAIR
o INSTALL
o MOVE
PROPOSED USE: DSGL FAMILY DWELLING
o COMMERCIAL
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
~ER
.tn ~I c.../L;
BUILDING SIZE
CJ RESTAURANT & HEAl.TH DEPARTMENT APPROVAL
~~ ~ ~ ~ \'\9.-<-0 '\'\In ~ .e.odr.
SQUARE FOOTAGE HEIGHT
DESCRIPTION OF WORK
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
& (1) SET ENERGY FORMS.
FORMS. _I I
NOL N6t l~~d OiP
f'd-13tj IL 0 I NG
~ECTRICAL
Au- 5c...L~ S,~n
PERMITS REQUESTED p""" -+0 rbrMiH1n)
3ssue- ~ {)e,mtt
VALUATION OF TOTAL CONSTRUCTION (Ie...Q? ( .-\-0 Qu-~ 507'+
AMP SERVICE
~progress Energy 0
W.R.E.C.
~~ING
~ECHANICAL
$
o GAS
o ROOFING
o SPECIALTY
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 AREAD YES 0 NO
SIGNATURE
~OMPANy~~)'n..$ff~~ t~;tt:&E-
STATE CERT OR REGIST # c....11c!.- J ~-5t>7 /~
BUILDER
ELECTRICIAN
**.*7***************************
'1,,> JA~'
I I ~ a ..J
COMPANY Ci.-.u- ~ t:k
SIGNATURE
STATE CERT OR REGIST #
PLUMBER
**************************************~~**************************
1 S,
. COMPANYS~ f..:~~-
STATE CERT OR REGIST # c.,:;c..O.1 <l73~
;)'> .
*******~***ii**************************** (' . (\
t' .~OMPANy~&..~rn~,~'~L
.. -1<'.-'
, \
'STATE CERT OR REGIST #
SIGNATURE
MECHANICAL
SIGNATURE
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to ~deed restrictionsU which
may be more restrictive than City regulations. The unde~signed 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 work, they may be required
_ to-be licensed in accordance with stat& and local regulations. If the cbntractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. tf the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-780-0020~ "
Furthermore, if the owner has hired a contractor or contractors, he 1S adv1sed to have the
contractor(s) sign po~tions of the ~Contractor SectionsU of this application for wh~ch they
will be responsible, If you, as the owner signs as the contractor, you are indicat1ng that
you, +ather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indica~ion that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D.. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of ~Florida's Construction
lien Law _ Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is sOmeone other that.the ~owneru, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the ~owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be oone in compliance with all applicable laws regulating construction, zoning, and land
development.
Appli~ation 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, City
codes, zoning regulations, and land development regulations in the jurisdiction, I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not. limited to: *Department -of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetlapd Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ~A" or "A,etc,U, 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 violate, cancel, alter, or set aside any provisions of the technical codes,
nor Sh~ll issuance of a permit prevent the Building Official from thereafter requiring a
correc ion of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for la
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
_ mo~th period, or the project will be considered abandoned. ' .
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR ~N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500.IN VALUE DO NOT NEED TO RECORD AND POST A ~NOTICE OF COMMENCEM NTu.
S
STATE OF FLORIDA
COUNTY OF
The foregoing inst~ent was acknowledged
Bef~be. thisc:5tO ~ay at ~a-. ' 20lPb
by b7e ~ f.- 1/\ l ~ <:::t"""
_ ~e of person ack~owledged)
~ is personally known to me, or
STATE OF FLORIDA
COUNTY Or
The foregoing ins~ent was~ledged
BeforR. mb ..this .;t~V^day 'i,.f, ' 20~
by C> bt"ie..-~,,-,~ ~.
~(name of person acknowledged)
~ho is personally known to me, or
-
o whO has produced
(type of identification)
and wh~~~ _ ~no} t~~oath
/~ ~ L- . /c~
Signat.~f~~9 acknowledgment
. · My CommIssion DD3OIM3,
~ ....... ~ 04, 2e8lI
Name typed, printed or stamped
of identification)
an oath.
Name typed, printed or stamped
11111111111111111111111111111111111111111111111111/1/111111/
2006252662
Rcpt: 1059467
DS: 0.00
... .. . 12/22/06
NOTICE OF COMMENCEMENT
Rec: 10.00
IT: 0.00
Dpty Clerk
STATE OF FLORIDA
COUNIY OF PASCO
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713, Florida Statues, the following information is provided in
this Notice of Commencement
1. Description of Property: Parcel No. 03-26-21-0010-03200-0020
6733 Gall Blvd. Zephvrhills. Florida 33542v
(legal description of the property and street address' if available)
2. General Description ofImprovement: Final Completion of new medical building with
surgery center
3. Owner Information: Name: Fina Real Estate Investments LLC
Address: 6739 Gall Blvd.
Zephyrhills. Florida 33542 JED PITTMAN PASCO COUNTYf CLtRK
12/22/06 09: 37am 1 gO 77
Interest in Property: OR BK 7321 PG
Name of Fee Simple Tittleholder:
If other than owner: Address:
City State Zip Code
e-
4.
Contractor:
Ryman Construction of Florida. Inc.
Address:
3(i413 S.R. 54 West, Zephyrhills, FL 33541
l
5.
Surety: Name
Address
City
Amount of Bond: $
State
Zip Code
6. Lender: Name SunTrust Bank
Address 211 Perimeter Center pkwy.. SuitelOO
City Atlanta State Ga Zip Code 30346
7, Persons within the State of Florida designated by owner upon whom notices or other
documents may be served as provided by Section 713.13 (1 ) (a) (7), Florida Statutes:
Name Heriberto Gonzalez
Address 5435 Gall Blvd.
City Zephvrhills.
State FI
Zip Code 33542
8, In addition to himself, Owner designates:
of 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 one (1) year from the
date of recording unle a different date is specified.)
Signature of Owner: /
Sworn to and subscribed before. me, tIDs/},,":daY of
Notary Public: lSMlu~_ijLI-
My Commission Expires:
Printed Name Ahad Mahootchi
~
, 20().6 .
~)
Notary Public State of J:lorida
Bobbie J Knight
My Commission 00416222
Expires 03/3112008
1111111111111111111I1111111111111111111I11111I11111111111111
20062!52663
Rapt: 10!59467 Raa: 10.00
DS: 0.00 IT.' 0 00
12/22/06 .
NOTICE OF COMMENCEMENT Dpty Clerk
STAlE OF FLoRIDA
COUNlY OF PASCO
THE UNDERSIGNED hert!by gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713, Florida Statues, the following information is provided in
this Notice of Commencement:
1. Description of Property: Parcel No. 03-26-21-0010-03200-0020
6739 Gall Blvd. ZeDhvrhills. Florida 33542
(legal description of the property and street address 'if available)
2. General Description of Improvement: 20' x 40' Addition to existing medical building
3,
Owner Information: Name: Fina Real Estate Investments LLC
Address: 6739 Gall Blvd
ZeDhvrhills. Florida 33542
/
Interest in Property:
Name of Fee Simple Tittleholder:
If other than owner: Address:
City
State
Zip Code
e 4.
Contractor: Rvman Construction of Florida. Inc.
Address:
36413 S.R 54 West, Zephyrhills, FL 33541
5.
Surety: Name
Address
City
Amount of Bond: $
State Zip Code
JED PITT"AN PASCO COUNTY CLERK
12/22/06 0.:37am 1 Df 1
OR BK 7321 'PG 978
6.
Lender: Name
Address
City
State
Zip Code_
7. Persons within the State of Florida designated by owner upon whom notices or other
documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes:
Name
Address .
City State _Zip Code_
8. In addition to himself, Owner designates:
of to receive a copy of the Lienor's Notice as
provided in section 713.13(1) (b), Florida Statutes.
9. Expiration date ofNoti of Commencement (the expiration date is one (1) year from the
date of recording unle a different date is specified.)
Printed Name Ahad Mahootchi
Signature of Owner:
Sworn to and subscnbed before me this ~~y of GD.L
NotmyPub~ 't5~~0"!
My ComnnsslOn Expires:
.20~.
~J
......"
Notary Public State 01 ~Iorida
Bobbie J Knight
My COIlIIIllssion 00416222
Expires 0313112008
,-..,
03/02/2007 12:45 8137886773
Mar Ui.! ur U~:48a AJi Shasti, M.S" P,E,
RYMAN CONSTRUCTION
813 707 6725
PAGE 02/02
p,1
ACCESS ENGINEERING
and CONSUlTING, INC.
-. '.7
~&'-3Cj?
CIVIL ENGINEERING - LA.ND PLANNING - STRUCTURAL
CONSULTING SERVICES - DESIGN AND PERMfTTING
March 2~ 2007
Mr. William A. Burgess, Cc.rtified Building Official
City ofZeph)ThiUs
5335 Eights Street
Zephyrhills, Florida 33542 - 4312
SUBJECT: Same Day Surgery Centers of Florida, LLC I AEC, lo~ hojeet No.: 0422
6739 Gall Boulevard
Zephyrhills, Pasco County~ Florida 33542
Parcel ID No.: 03 - 26 - 21 - 0010 - 03200 - 0020
.Dear Mr. Burgess:
Please be advised 1hat at the time of fiJJ.a1. inspection, the above referenced site was completed
substantially in accordance with the permitted construction plans and specifications.
If there are any questions or concerns pertaining to this matter, please do not hesitate to
contact our PLANT OFFICE.
xc: Dr. Ahad Mah.ootchi, MD., Owner
.File of Record
.a_ "..................._._. ~..___ .... ._... ......... ._,..." .._....... ...... "'~.........'~.,.
HiJlsborough County
11 D E. Re\:nolds SMel. Suite 804
P'mt cii Florida. 33363
TclCf'lhonc: (813) 70;-8336 Fax: (813) 707004i725
\\'\\,\\'. nccc:t~IlI~iI:,,:l:rillJ!, net
.. ... ..... -- ", " "..., .. .-..-. - ,..-" . "... ....~.,_........ .. --..--...--.
Pa.'lCO County
S910'" SIn:et
Zepl1,,'rhllls. Florida 33542
Tdcphono:: (813) i82-9571 Fax: (813\707-6725
.u)y"\}.',accc~~n!!.inceri" g..OO
Healthcare. Design Inc.
Architects Directive:
J Mclaughlin & Company Inc. (Contractor)
SameDay Surgery Center (Project)
November 20, 2006
The contractors unauthorized application of the substitute "Tremco Fire Spray" must he removed,
as it is unacceptable to the Architect of Record due to it resting on the surface, rather than "the space
between" as required. A notification of this was made on September 1,2006 for the contractor to correct
the work.
The engineering judgment, presented by Tremco for application of"Tremco Fire Caulk" is an
acceptable application to the Architect of Record, as is any other application of "Fire Caulk" that
meets 8.2.4.4.1 in that it "is between the penetrating item..." and "limits the passage of smoke." Other
applications of Fire Caulk that may be presented for our review may also be approved,
The contractor J. McLaughlin & Company is ordered to proceed in accordance with the approved
shop drawings as transmitted to install "Fire Caulk" with the annular space as noted on the Shop
Drawing.
Failure, to notify the Architect of hidden or unauthorized substitutions made by the contractor shall
be considered a dishonest business practice and fraudulent billing for services and materials not meeting
the contract document requirements; both of which are actionable. Notice is herby officially served on the
Contractoc, .
The Contractor, J. McLaughlin & Company is notified to stop illegally making representations to
the "Building Officials" as to the Architectural or Life Safety requirements of this project. Under Florida
Law J, McLaughlin & Company Inc. does not hold a valid license for Architecture, nor are they
representatives of the Owner, L3 Healthcare Design Inc or the Architect of Record of this project.
Punitive and legal action will he taken if required, The Contractor has been so notified as to take action to
restrain J, McLaughlin & Company's employees.
Thank you
Sincerely,
L3 Healthcare Design Inc.
:J:::~tlc AlA
Architect
\J
10
CI~.J
375 Douglas Ave. Suite 2009, Altamonte Springs, FL 32714 Ph: 407-865-6160 Fax: 407-865-6914
FLA. REG. AAZ....7..
03/09/2007 08:15
"""
-/~.~
~~~
8137886773
RYMAN CONSTRUCTION
PAGE 01/02
~~Ie ~ fJ{~tMida, 9~~
. OF
FLORIDA
INC.
Licen,,! it ceC12S0!l14
~ FAXCO~RSHEET
A:P~DATE: .3/7/07.
COMP~:. ~ 5 .tJ~M: ~
~r11 (d.~. PAGES(II\'a.VDlNG~1
FAX: 7 f'D - ~ ~ RE:
PHONE:
COPY:
CO.M:MENTS I INsmuCTloNs:
o URGENT
. ". ....
.......~.. . .., ..__...._~..
. L .
~ ~.~~.~ .~.=-~...
~ . -'1-" .'--...
36413 SR 54 . Zephyrhills~ Florida 33541-2275 " Telephone 813nS2-0825 " Fax: 813n88-6773
03/09/2007 08:15
8137886773
RYMAN CONSTRUCTION
PAGE 02/02
1-)'1
~~"".~
c"";Jr ~,~
Print Dabt: 3/812007
~~i:~:7-C;C':"'7'277~~C7':~~7~T77;c7:'
Final
",", 1.
Zephyrhillll FIre Rescue
6907 Deity ReI
Zephyrh"18, 33542
Phone:B13-7~1
Fax: 813-780-0044
In.neded Pal1I
SAME DAY SURGERY
6733 GALL BLVO(OO0825)
ZEPHYRHILLS, FL 33542
Phone: 81S.783-8242
InspectionOate: 3/8/2007 2:15:00PM
In!lp8CtotName: Barnett
IllspectionNurnber: 1-113-07-0) 88.A
InspectionCause: Reinspcction
OccupancyType: HcaJtbcare
PropertyUseType: Medical, Other
\fKKstionCoums: 0
Hrs: 0.05
Comments:
VioIatlol1a COrreeleCl Approved for CO at this time. Address numbers will be changed out to 12.,
Sign Here
Paae 1 of 1
PASCO COUNTY, FLORIDA
Permit No. { ,,35"3
Date Permitted \ :-s -0/
Builder Name/Owner Name . R 11 ("nf\_'r\ ~ 1<.: Control #
. County parce.' No, 03-~lo _~I_ '00\0 -03a.(){j. cX)C;lO SubDlv:
Address/Location (o73~ ~ \ \ ~) \lA.
Classlfioation/Type of USfil ~()).e~c~roQ
TRANSPORTATION IMPACT F.EE. Rate:
~xempt 0 yes 0 No How DE!termlnecl
rno A \ C o..Q..
Sq Ft Unit: <6 \ '1 c:s
Irnpac~ Fee Amount $\ \? 40L} , 00.
Zone No,
TAZ:
SCHOOL IMPACTFE;!E:
Account (056) Single-FamilY Detached House
. (057) Mapile Home
(058) . Other f{esidentlal
. jj}3) Collection Fee .
Exempt .lkfYes 0 No How peterrnln~d
Amount $
PARKS AND RECREATION FEE
Land Aocount . Land Credit
4lnd Total
Recreation Account
f{ecreatlon Credit
RE!creation Total
Zone
Exempt 0 yes 0 No
LIBRARY FE!:
Lancl Account
Facility Account
How Determlneq
Land Credit
FacUlty Credit
How Determined
Land Total
Facility Total
~xempt 0 Yes . 0 No
'RESOURCE FEE
TOTAL AMOl,JNT
. Total Amount
.ERU
Prepared By
Checked By
.' .
NO O!:RTIFICATE Of OCCUPANCY WILl. BE ISSUED OR FINAL INSPEOTION
pERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
. . BEEN PAID ANQ
RI:GEIPTED FOR BY A CENTRAL PJ:RII/lIlTING OFFICE. OF PASCO COUNTY
Acknowledgement lJelow does not Imply accep!ance of concllrrence, but simply recelp.t ota coPY of thl!? fonn. placing
. the building pennlt owner on notice of this assessment al)d thE! condlUom. of payment for same.
,<ilk
PATE
RECEIPT NO.
RECEIVED BY
DATE
BY
03/01/2007 12:04 8137886773
Mar 01 07 09:21a Ali Shasti, M,S., P,E.
RYMAN CONSTRUCTION
813 707 6725
PAGE 02/02
P,L
ACCESS ENGINEERING
and CONSULTING, INC
CIVIL ENGINEERING - L.AND PLANNING - STRUCTURAL
CONSUL. TINCJ SE/,?VICES DESIGN AND PFRMITTfNG
Macch 1,2007
Mr. Wojciech M Mroz., P.E.
Surface Water Regulation Manager
Brooksvilte Regulation Depar1Jnent
2379 Broad Street (U.S. 41 South)
Brooksville. FL 34604 - 6899
SUBJECT:
Same: Day Surgery C.ters of Flori..... LLC J AEC~ lne. Projeet 0..: 04Z2
6739 Gall Boulevard
Zepbyrhills, Pasco Count)', Florida 33542
Applic:aliOll. Number: 46022807.000
As-Bu;1t Submitlal
Dear Mr, Mroz:
Enclosed please find the original plus on.t copy of STATEMENT OF COMPLETI
REQUEST FOR TR.A.NSFER TO OPERA nON ENTITY Forro along with two ce
plans for your use and file.
tftbeR" are any questions Dr concerns pertaining to this matter, please do not besitat
PLANT CITY OFFIC
xc: Ci1y of Zephyr bills
Dr. Ahad Mahootchi, M.D.
File of Record
" .", ...... ".- . ....~. ...............--..-.... ~-"......_...........
HilIsborough Count)'
I 10 E. Rc)'nold$ SIreet. Suite 804
Plant City, Florida. 33563
Telephone: {8 13) 707-S336 Fl)lC.: (813) 707..(,725
WWI\' .:\C~':~~I't! i n L."Crill~.m;!
Pasco County
5910 71~ Street
Zepltyrhills. Florida .33542:
T=ltpho\Je: (IU3) 7K2-957? Fa.,: (1m) 7i17-672.~
www.acccS'l':Jla:inccri.n;.n,-"
03/01/2007 12:04 8137886773
~~~
~~~
RYMAN CONSTRUCTION
---"..
PAGE 01/02
~~.~ ~.7~,. 1~"
License # CBC12509)4
. OF
FLORIDA
INC.
FAX COVER SHEET
DATE: ~t /0 7
" .
."' FROM: ~:6~
PAGES ~~JNGC~):.
...-- .~. --;w
FAX: Jtfi> .~~
RE:
PHONE:
COpy:
COMMENTS / INsTRUCTIONS:
o URGENT
~~~ ~.
<- ~ ~ t-:iSs
h~71t.~~~~~L~
1
36413 SR 54 . Zepnyrhills. FTorida33S41-227S . Telephone 813n82.0825 . Fax: 813n88-fi773
02/~~L?~~7 16:36
8137886773
PAGE 02/02
::2/a-7/0"7 W)J...Q.. ~ ~~
ACCESS ENGINEERING ~ &~'CL
and CONSULTING, INC.
RYMAN CONSTRUCTION
,.
,~
,. "I. .............--~"...... .-,,,,,,,,,
~Ii ' ~~'r",~' ...',' .(/1",' ....'
l~li'('!: t)~~7~_...i' ':. 6~~} \
.: . .~., ::-"4 'ii.~~
_.. ' . .~iI, .'. ~;~,.
..- :.,,,,.~, \ U '
, . f~49:i' , ' '
~:!-:;, ~,,,:~.~..,...~~. ~t":. ':
~ ~- -~ - --.
CIVIL ENGINEERING ~ LAND PLANNING ~ STRUCTURAL
CONSUl. TING SERVICES - DESIGN AND PERMITTING
- -
Februaty 22. 2007
Mr. Richard Burkam, Projact Manager via Fax # (813) 788 . 6719
36413 S, R. 54
2'.epbyrbills, Florida 33541
sUBJECT: Same nay Surpry Co.ten o,FIorld.. LLC I AEC, IDe. Project No.: 04~%
6139 Gall Boulevard
hpbyrhills, PISCO Courrty, Plorlda 33542
p~m No.: 03.. 26 -21- 0010.. 03200,.0020
Site Jnspcctfon I Comx:tiw Action Needed,
Dear Mr. Burkam.:
Per OlD' ~lophone.chat concemi118 the above Ie~ p~eot today, the foUowiD8 please
S,- our list ofrequi1'ed COI'leCtlve aotions.
. Pleue raise bottom. of skimmer to 3 iDche!l below slOt elevation to gain clearance
between skimmer and the grotmd.
. On the east $ide sldmm<<, you may also oreate a sump fin' BdditiortaJ clearance.
. Please provi~ rip raps or other types of emllon QOIltrol at the ends 0(8" and 12" F&'i .
to avoid vcgL'ltation.srowtb _ potential blodcage. .
Ift.btJre arc any questions or concems pertaining to tbf. i.natb!JI', please do not hesitate to
oon~t me at 0 AN.r CITY OFFICB.
"
.I1LL~ ~ ~ oS
~-~~aR-
~-f... (" ,,=--.
~~/07
---'
xc: Dr. Ahad MahootDbi!, MD. via Fax # (813) 719 .3317
File of Record
__.....,,_.______ ..__,."'____..._II....__J...___.-
""'-.... ....."..... ~...-...-._.,...
HDlsborougb county
l' 0 F., R"'IIoldn Su.t. Suite 104-
Plant City, Plorldll, ~ 3 563
Telephone: (813) '07~3~ Fax: (1m) 71"-6725
www.acee!lseftlllncerlnl.lltl.i
. Puco County
59) 0 7'" Street
Zephyrb.Ws, P.lorIda 335...,
'folllphcme: (813) 782-9$77 PIX: (813, 70H725
mw' acecl~h' riel
8137886773
RYMAN CONSTRUCTION
PAGE 01/02
~~, ~ D{~7~" 91eC,
L.icense # CSCl250914
OF
FLORIDA
INC.
FAX COVER SHEET
ATTN: < ~ FRDAoTEM:: .t;z
COMPANY:~~S~~ ___
-:15 ()J'j ~ r;:::; ~ ! PAGES (JNC;=LtlDING COVJr.RmDJr.T):,
FAX: '} j()... (;O~ RE:
, PHONE:
COpy:
COMMENTS / INsTRUCl'IONS:
o URGENT
'- ~ ~G::J...7~(; '/~ ~
~ -+ lc,SS'..3
~ ".-.-
ce' -'~~~~.,
~-_.::::r::. ~~M_~~'
", f'
36413 SR 54 . Zephyrhi/ls, Plorida 33541-2275 . Telephone B13n82.0B25 .. Fax: S13n88-6773
03/09/2007 17:09
8137886773
RYMAN CONSTRUCTION
PAGE 02/03
,~
. Hesltllr:srB Design '''e.
Marcb,9,2007
0..- Sir:
We undcntaad iat the City of ZepbyrhilIs, Building Fh OepIrttnea.t would like to ha\le a copy of the .Final
ApprowI Lettc:r 1l'om AReA. We COJDJnOGly MID imo this request by bulJdiq dep&rtmema. because they waat 10
maJce I," that the public; js protected, prior to any actual surP')' hems CODduct.ed.
CumlntJ)' AHCA', office of pl_ and CODSh'Uction l1u compJetI8d ill' lnspcctfOD of the BuilcUns. bot tho Final
license ftolb ARCA requinls much more. The licensing division will NturtI to i1IIpCCt the buildiDg. for Policies IIIKI
Proc:edurcs. lnteMew stBtf; review mediattlons. equipment elle. The)' wiD expect the fuD ItaW to be 1Iaioed, !Jaw
COJDI)leted drilla JncIudiDg Fire drills, code blue's etc. In order to be prepatecl for 1hi8 tho owner must oc:cupy the
building for aft' Ilnd Doctor's only, ud therefore will n.ed hJs CertfflcaflC of Oc:cllp8llC)' fi'om the city prior to the
final ARCA inspection.
Theref'ora. the isswm~ of the City. CertI&C8te of Oc:c:up1Ulcy to the owner is not an 8utliorizatiOd to be open to cbe
puhlfc, for surgery. Only the State o1&e of AHCA can gnmt that permission.
"Ibe Owner, is 8pCCJ11caUy awwe that he is Dot authoti2ed to be Oplll. to 1bo public DOl' to ~rm my -Say what .0
e\'er until he nceives hi8 State ARCA UCIIlIe. Tbe Owner~ will Wriw a letter to the City to CODfinn tMt he is aWII'e of
Chis lWtrictiOll. And our office by this JetlI:r agrees to copy you with !be approvaI letter hm AHCA WhCb W!l receWe
It .in about 60 days.
To COVer themselves fhxn liabWty. sewnI buiJdins cIepu1meQfI have issued CatitIcaae of OcC\lp8llciee to pnvioua
projec:ts of oars by placing exact wotdiug 011 to the ~c BUch as "Certificate of OccuprlDC)' is sra=d1br Staff
and Oogton' ; FaciJiCy w1IJ acqUire '. licenlo &om the Office of The Florida Asency for Health Care ~
prior to boinB open to cbe public or perfomrlng any Surge..."."
We hope that rhis clarifies the &imina of licensure and occupancy.
L3 HeaJtbeare Design In&;
~~.
VJce Pns.idcnt Project COOIdiDatiOD.
375 Doua'a Avo. Sulle 2ODB, AI......o.... ...rI..... FL 327t4 ....: 407-88508180 Fax: 407-11I5-8814
FLA. 1.1.&11111"" ,
~'d
+lSSS9B~O. OWl .~eIS3a 3~~OH~i~3H Ei
Wd9t:E ~ODa SO ~ew
03/09/2007 17:09 8137886773
a3/B9/2a07 15:48 8137793318
RYMAN CONSTRUCTION
AHAD MAHJDTCHI MD I PA
PAGE 03/03
I-IA<:i1:. IU
Ahad Mabootchi, MD
Ophthalmologist
(813) 779-1138
March 9, 2007
Dear Building Inspectors,
This letter is to clarify that DO surgery win be peQOfDlm in, the new Surgmy Center at
6733 Gall Blvd. untn AReA has ai\'1m us Hcense to do so.
Abed Mahooiehi, MD
Th. .Eye OiDic of Florida
6739 0a1l Blvd, ZephyrhiUs) FL 33542
"."'~'''f'''.''''',''''
iL
"
'!
';;
,(;
Mar 08 2007 8:29AM
MAR/O~/2007/TUE 10:26 AM
. '
SAME DAY SURGERY CENTERS
ZEPHYRHILLS BUILDING
1 813 783 8240
FAX No, 813-780-0021
...-
?-~\rl'-~'"
to;' ,.' .,". .'
:,'eli!i~-'i' '~,
~-'~> .
.~~r '
. i f-li. ,\:I~
, ,
PASCQ. ~OUtfTYrF~OR~D~ ~
. ..
, ,
"
I
i
!
.
1
, i
;
,)
I
!
I
I
!
~
I
i
!
!
p.imIt Nu. ," t d~ '
o.te PtnnllJiij' ~--9-o/
!:'UIIU~ r'f"'lI~"'~~""m"; 'Q.,.....:..~'I"" (1r~~" ~~f## "
. COlJnty farce) No. OBwS,l.o.Al_ ~IO ..()'SQ.oO.~O aubD!V~
'AddreulLoo.n. ~.,73~ ~~ \ . IBJ IJ~ . _ .
OIa_ltloctionlTYpeofU~~ ~ ~~Q~nrO ~~1I"r'~ "
TRANSPORTATION IIIPAcr PSI!,' ' Rate: , Sq ~ Unit (l ~~Cz,
FxGmpt 0 VBtI 0 No . HowP~ "
"
ImpI~FeeAm~ $,\'6404. 0,0, ~8'Na,..
. .
' I
SCHOOL IMflAQT PIPE' . '
Aaoount (0116) Slngle-PlmUy Oetaohed /'klUse
.' . 'OOT) Mc~UI HonJ. .
(058). . Other ltMI-n*J '. .
. ..J:lp) COIlllOllon Fee .
Ex~?1 MY"'" 0 NQ How P8~ ' .
fAfu~fr~D'ImC~TION PEa ': .. . " ' . " ',.
Land AaCOUl\t ' Land Cf'Bd1C lfmd Total ,
d>- w;. .
t;aDl1illUol') Account f"tcreaIlD~ Crd . . "1""- ~~ ~oteJ, , "
Zone TOTAl-AMOUNT:, ',S"
E!~nipf 0 y~ ' 0 No How,D_~
Ub.Jtt\Ry PEts ; . .
~Cf Acootllt " !-and Credit
00
..1>..'
TAl:
. 'r....
", ...
An-.:lU" "
"
, .
r .
I'
,--<l!tV
f
I .
I
!
I
I'acflty AocouJ\~
15xeRq:lt' 0 Y. . 0 No
1._ 1ot., ~
-, f~o"l1y TatIIl
, 0
,Tat.1 Aenaunt ' . . .
~ ~. .
FlOfIIty qr&4It
Haw 08twtnMd . ~
..,~:..
prsJ"lr.d By
: (Q~~Y CciLj)-Bal
. OMq(ed By
~
'.,015
.~
NO oaAtff'JCATI: Of OCOU~ANCY WILL ~ ISStJ~D Oft FINAL INSPscT;DH
PE~OftMJm UJm&.'THS ToT"'- AMOllfTa LfI'JaJ HAVI! .
.IiU!~N PAlDANQ .' '. ,
"~~P ,.OR BY A o~ PJ!""'ITTIHG oPrICItOP PA80~OQlI1m', ,
, Aat,,-~lMIlDwdall ~1mati1~cIl'~rrIMI,'buf.P6'~df.. CO~of'w, iJmJ, PIIaina. :
" . -' 'lbtl_d~g /l'INJfIIt~;dr'''~C11 ar.... ~ .~b1 ~C1'~I..... .
:.
~
~NO,~~ey~/pty4~
. . u
p.2
p, 002
"
" . .