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Home My WebLink About07-6874 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 6874 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 6874 FIRE ALARM SYSTEM FIRE ALARM SYSTEM COMMERCIAL Address: 7422 GALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 35-25-21-0010-07200-0011 2,016.48 7/24/2007 95.00 95.00 7/24/2007 INSTALL 2 PULL STATION- 1 Name: K-MART Address: 7422 GALL BLVD ZEPHYRHILLS, FL. 33542 Phone: GARDEN CENTER & 1 15.00 ,~~~ U<6) ~I~ ~ ki.-- fAil f!J~ 'fyf 6f7[5 i-z;revJ _ VjA) 7 REINSPECTION 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." Je-v t'1. 11/.14 CONTRACTOR GNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Fire Chief Robert Hartwig ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 FIRE SERVICE U~~3 Billing Address: iCf~l--;: 4/ Occupancy No.: Plan No.: tJ7-0:j~ / Business Name: .t..--J41 ~ BusinessAddress: 71.(2-:2 G4-t-/ . Business Phone No.: Business Fax No.: Contact: PLAN REVIEW FEES ~ Site Plan N/C Buil9ing Plans .04 sf Revision ,06 sf STANDPIPE SYSTEM o Per Riser $25 SPRINKLER SYSTEMS o 0 - 25 Heads $30 D 26 plus Heads $60 FIRE PUMP o Per Pump $100 B' FIRE ALARM SYSTEM o - 25 Devices $30 26 plus Devices $60 SUPPRESSION SYSTEMS ~ Wet $35 Dry $35 C02 $35 Other $35 GREASENENTILATION o Hood/Ducts $35 "",,4:R PLANS TOTAL ~ Comments: INSPECTION FEES Annual N/C 1 st Re-inspection $25 2nd Re-inspection $50 3rd Re-inspection $125 4th Re-inspection $250 5th Re-Inspection $500 Construction $15 Commercial $25 SPRINKLER SYSTEMS Hydro Undergrounds $45 Hydrostatic System $45 Wet Acceptance $30 Dry Acceptance $45 Hydrant Flow $25 Hood / Booth $30 Grease Duct $15 ~ FIRE ALARM SYSTEM System Acceptance $50 Recall Acceptance $50 7h 7- (:i<? - /i~ X /4:Y' Billing Phone No.: Billing Fax No.: Contact: PERMIT FEE SPRINKLER SYSTEMS D Automatic $15 FIRE PUMP o Fire Pump $15 ~' FIRE ALARM SYSTEM P Detection $15 , OTHER ~ LP Gas Natural Gas Fire Works Fuel Tanks $45 $45 $25 $45 FALSE ALARM FEE 1st Alarm N/C 2nd Alarm N/C 3rd Alarm N/C 4th Alarm $25 5th Alarm $50 6th Alarm $75 7th Alarm $100 8th Alarm $150 9th Alarm $200 10th Alarm $250 Non Compliance $150 "Affidavit of Service/Repair" FALSE ALARM I TOTAL OTHER Fire Wall/Smoke Wall $15 LP Gas $25 Natural Gas $25 Fuel Tanks $25 Tent $15 I'D INSPECTION TOTA~ GRAND TOTAL GREASENENTILATION B Hood/Ducts $15 Kitchen Suppression $15 ,tip PERMIT TOTALcm ~ 0/fl 7/Lt/o ? '. ;:;'~y 3(; rvc#-- ~~ ~ I . Date: Inspector: Fee Simple Titleholder Address I l'7lf~ I 813-780-0020 Date Received Owner's Name Owner's Address 17a s Fee Simple Titleholder Name I JOB ADDRESS SUBDIVISION WORK PROPOSED PROPOSED USE TYPE OF CONSTRUCTION DESCRIPTION OF WORK BUILDING SIZE City of Zephyrhills Permit Application Building Department Owner Phone Number (Q/O- Ceeo '7. S8CD ~ctk eJl~~~wS~~~o~~N~~er I I Owner Phone Number I G-~ \ \ B\~d I LOT# I PARCEL 10# I '35- ~5 -a I.. 6010.. D,a 00- DtJ/ I (OBTAINED FROM PROPERTY TAX NOTICE) I n NEW CONSTR Ll D INSTALL D D SFR D D BLOCK D I:r~~\\ .71.- f..\\ S\~~ I SQ FOOTAGE I ADD/AL T D REPAIR D OTHER D STEEL D OTHER IX t1ltki'V\. I 6~~ Gr~1\ &c G"r.;f (')~ ~~ \J~'j JCO< I I HEIGHT I I D MOVE D SIGN DEMOLISH COMM FRAME VALUATION OF TOTAL CONSTRUCTION D BUILDING ~ ELECTRICAL D PLUMBING D MECHANICAL D GAS 1$ 1$~/c,.'-I~ 1$ 1$ D ROOFING FINISHED FLOOR ELEVATIONS I I I I I D I DNO D AMP SERVICE D PROGRESS ENERGY W.R.E,C, VALUATION OF MECHANICAL INSTALLATION SPECIAL TY ~ OTHER FLOOD ZONE AREA DYES BUILDER SIGNA TURE COMPANY REGISTERED Y I N FEE CURRENT Y/N Address ELECTRICIAN I SIGNA TURE . Address I PLUMBER I SIGNA TURE Address I MECHANICAL I SIGNATURE . Address I License # COMPANY REGISTERED Y IN FEE CURRENT Y/N License # COMPANY REGISTERED Y I N FEE CURRENT Y/N License # COMPANY REGISTERED L I Y I N FEE CURRENT Y/N Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum !<:l11 ('10) working days :::ft" submitt;;1 ('<lte, R'"<luired on~ite Construction Plans. Sanitary Faci!ities & 1 dumpster Attach (3) sets of Building Plans; (1) set of Energy Forms, Minimum ten (10) working days after submittal date, Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance Attach (2) sets of Engineered Plans ....PROPERTY SURVEY required for all NEW construction, OTHER SIGNA TURE Address RESIDENTIAL COMMERCIAL SIGN PERMIT Directions: Fill out application completely, Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required, (A/C 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 A/C Driveways-Not over Counter if on public roadways,. needs ROW Fences (Plot/Survey/Footage) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations, The undersigned assumes responsibility for compliance with any applicable deed restrictions, UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations, If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law, If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847- 8009, Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible, If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County, TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended, The undersigned also understands, that such fees, as may be due, will be identified at the time of 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 "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida, If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties, If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required, If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions 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 (FS 117,03) ~ ~;'9 vY\~ Commission No, l>b ilSD q, f> 4<!... own to me or has/hav roduced as identification. OWNER OR AGENT Subscribed and sworn to (or affirmed) before me this by Who is/are personally known to me or has/have produced as identification. Notary Public Notary Public Commission No, Name of Notary typed, printed or stamped Name of Notary typed, printed or pe{t;;", C .. #D.D250918 :: :~ '.:: ommlSSlon ~;:" ~.~~J Expires: Oct 31, 2007 "''''~OFf\.O''~'' Bonded Thru ""'"'''' Atlantic Bonding Co.. Inc. \llIlt Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813) 780-0041 Fax (813) 780-0044 July 20, 2007 I have reviewed and approved the plans for additional fire alarm devices located at 7422 Gall Blvd (K-Mart). I have attached the comments for the plan approval. If there are any questions please contact my office at 813-780-0041. 1. Additional devices may be required at time of acceptance test should it be needed. Inspections Required 1. Acceptance test of new devices. N~'\) #~ ~~ :<10 ~~~~~~ ~~ 0\ ~~~ ~~ ';>>~ . ~~ f; T ~~ca ~c~~ ~~ ~~~ ~ ~~ rvC~ ~~ ~t S~~ "'I ~hl a: ~~~~ ~ ~w~~ ~ ~~~~ ~~~!1l en "';<'<l SNOIS,^3~ Dl ~ I ~ ~ ~ g ~ 9 ; ~ ~ ~ !fE 5 ~ z ili; w z ~ ~ g "" ~ r.r. 0;::: O;.a .<:\ ,g ~ .~ 0 a ..g. ..... ~ """'" 4) ~~.g~N e 8.go 8~iS~ ::::;~~u ~~~~ r.np..cU~ :<I ,- d15 :Bv,;~ ~..s"'Oo.; ~ '~rz tJ,.. w a: o .... f/) z <( :::!; .... a: ~ :.:: 8~ili ~h hili ah ~W~hi il!g~ ~z I-H ! , : .. II) ~ II i '::~III h ~It .~~~ 51 II I 'I,: .. Oll! 8 I · · II) Ii: a ~ ~ ill l"- I") f- 0::: <( ~ Y: I :;: ~~ iil~ ,~~ "'- S~ "fu N ';;;' '" ~ ~"'--- ~ ~ ~'- ~~~ Q -a. ~~ \:.IJ ~~ "'- 20,;;: O<d~ cx:.~~~ ~ i ~_ ~ <, 8~Z~Dl -s ., -.- .~ . Page 1 of 1 SPSERIES MANUALPIRE ALARM STATION V.I.,'USTm> ~ ~S'JAlIJIIR!~ 11$(loJl2:f Ge~ 'lMSP__....~......,...........,.._~_...........,. ~~......." .8y..__......~_.anMWil....*'IO..... cloIdllo..............h............. FeATUES; .c..t.....~ .. tWy 1oc::II:f<<....... nmt . .~.......... ~~.,~.potII:lon-Mlen~ OP'l'lOHS: .~kt1~*~"""" . --..........- . LEO......... · ~..~JOIC* SPEClFJCA1lOH$: . ~ 3.314"Wd;~HX~u:rD . '~';2$_ ..~ tWy~OOVAC.'tO.wP ~.....U$WC.3.wP PbcMJIdI48VOC...ot AMP .~: -'.."'P'fItIIiilIl:tI mo.~'~'*, M<.'lDa ~()IiI MOCIl....., tsNU PCUi) MOCIl.$P4IClClUlUflCIJi} SP .. 1/2 ....1 .. .PoiOPut.SIIliM SP4 0Ill.IIlIt Polo NStIIion 1'P .Mlcf<<fItlOM..-ck { ~ ==:~~ =.. DAH MId ".f<<0Ml0.N.:lilln'llliHlmmllr OPEMnoN: ~TP~:= }MrN. ~..... .............IPlltlllorlrld _10........... ~.... ~ CII:lIdIlI:ln,M *"'.~_ M......UI'Y.__"*,,,diclIIn.. .....__intum~_ ~'~IO""""",'.__~"""""" MA[)E.'N.THEU~S.A. 33OOE. tmlS1MJ1:I':L.ONGHACtt.CAtOIO$ ~:($U)_PlCl' ~{M2)_S~ WWlI!t,~.cclm 'httn.//",,,,,,, rcocPf'nntu f'nTn/inHH1PC;:?/<;;:P Frnnt tn ;nO' 7/1 7/2007 Page 1 of 1 SPECIFICATIONS: Ef;U<;tflC$! $Wilch f(~ pl\PM1 ~ UW $tIlOOfi t~ VAC.;It 3 ~J>< 120 VAC at 10 amp 4tPIOC.UO amp. a4 VDC at ,ca amp. ~.Wldth $0311*"~ MJro.pc$l ~118"Wldth ~1J4.~ ... 0e$lIb 3-1jfl+ Wldth 4-118"~ '.1J$.~ ~ ftlO.llll.., HIp. ~""l 20 0l.ltle0$ 5~ OJI,H ~ Mlllerltll' $tabOO QAH, .l.P ISllJtiorI OJI,H, tf' W(l~' ~" ORDERING INFORM.ATION: TP S~1f4lOOJ~~*~~~ ~. TB Tl!mIiI'Ialblock _ ~iQn$. lEO(xt-. fRied, (O)tMnor(A)mberliO.h.~diOdEt* ~iOryWMtl indicatioN.. PS ~.poI!)kI.ly~*~.~~. ON! ~_$$duaI.~."wiIb hal.nmer11lnd~. U> Ult_hlI~~__. KO ~()pell'l<<ld~$W'lon. . NOT$: .op~1'f>,T$_tWolQ~omrd'lm~. $P~..b<t~wIth pigtM~ifMt.~~. .~ (TPlor(l(OMd P$}or(l<<) and 0AH)(!jf (1(0) tlt(KOand U$O)aro ~;bXCl~#1)lj ~~. MADE IN THE U.S.A. f-t "kldeINum~ N~otPolilJ$ n or.2} QPlitlmi SP~~ SPNiS ... R3in and r>ust~ enc:ifo$t.mI. SP.es. -$l.n1aeeDlOAlnI ~ Nd~ bedt../.'lox. ~e<$m.smt!ET.tONG~<:A_ ~(SIb_,*.Fu:_._$._ ._~_ httn'/IU1U"Xl r,::cyc<pC"llrit" r.01'l1/11'l1lHYPC<'?/S:P R~r,k Pht tn 1no 7/17/2007 r-rom: r-Ax.maKer 10: bU4LLL4j8j fJage: L/4 Uate: Ir.3/'2UU/1:14:bj fJM FMG Work Order#: Customer Name: Location ID: 0030146550 KMART - 3761 07/03/2007 Date of Dispatch: KM003761 r-- c= c= ~ ~ ') Provider Information Provider Name: East Coast Fire Protection Phone Number: (800) 252-5069 Fax Number: (804) 222-4393 (. .> -~ ~ '-, Scope of Work 1. Upon arrival call FMG IVR line at 800-306-4122 to check in. 2. Install ciJ'cuits, conduit, wire and new manual fh'e alarm pull station at gal'den center exits. ! And at receiving at the new door. Tie new devices and circuits to existing Simplex 4002 Fire I Alarm system. '0 o ,0 o 3. Upon departure call FMG IVR line at 800-306-4122 to check out. Scheduling Service (must be at least 24 hours prior to date of service) 07/13/2007 Required Completion: ~ , .,j ;.~ ~ ~ -- '" First name of manager at the location: I Last name of manager at the location: I Date customer location called to schedule service: I I Time customer location called to schedule service: I I Performing Service FMG Original Authorized Hours: Provi d er La bor Ra te: FMG Original Authorized Material/Equipment Amount: 24.00 85.00 976.48 FMG Increased Authorized Hours (with FMG authorization code only): I I FMG Authorized Code (if additional hours or material is approved): I I FMG Increased Authorized Material/Equipment Amount (with FMG authorization code only): I I FMG Work Completion/Survey Form All Services performed and parts used listed on the FMG Work Completion/Survey Form' (If it is not on the FMG Work Completion/Survey Form we ca nnot pay you for it) DYes DNa DYes oNo Did you call FMG at 800-306-4122 to confirm your arrival at the location' Did the location ma nager sign the FMG Work Completion/Survey Form? Did you call the FMG Service Department at 800- 306-4122 to verify that the job is done' Did the location manager stamp the FMG Work Completion/Survey Form? (If there is no stamp, did you get a business card or register tape with the location number and address on it?) DYes o No Is the time in and time out noted on the FMG Work Completion/Survey Form? Payment Requirements (FMG Invoice Fax Line 480-753-5481) labor Hours: Is the invoice detailed with breakdown of labor, materials and tax' Material Cost: Are all labor hours and materials on the invoice within the authorized amounts' Tax: Are all labor hours and materials on the invoice clearly noted on the FMG work completion/survey form? Total: Have you faxed FMG at 480-753-5481 the completed invoice, FMG Service Authorization Form and FMG Work Completion/Survey Form? (Mailed invoices will not be accepted) This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www,gfi,com Provider ID: EA S005 DYes DNa DYes DNa DYes DNa DYes DNa DYes DNa DYes o No DYes DNa rrom: rAAmaKer 10: /jU4LLL4j~j J-'age: j/4 Uate: l/j/2.UU/l:14:b4 J-'M FMG Work Order#: 0030146550 Customer Name: KMART - 3761 Location ID: KM003761 Date of Dispatch: 07/03/2007 Location Information Customer Name: KMART - 3761 Location ID: KM003761 Address: 7422 GALL BOULEVARD City: ZEPHYRHILLS Zip: 33541 Location Phone Number: (813) 783-8181 Contact Name: MANAGER ON DUTY On-Site Verification Step 1: Upon arrival, call FMG at 800-306-4122 to check in. Arrival Time: I Departure Time: I Number of technicians at location: I I Name of technician(s): I Step 2: Upon departure, call FMG at 800-306-4122 to check out. Description of Work Completed (Include all work done and materials used) I" "'"m trip Modod I to complete this job? DYes 0 No Technician Verification Signature of Technician: Da te of Service: Customer Verification Name of Manager: I Signature of Manager: I Date: I Location Stamp (If no stamp available attach a business card or register receipt): This fax was sent with GFI FAXmaker fax seNer For more information, visit: http://vwvw,gfi,com nom: rf\AmaKer 10: (:jU4LLL4~~~ I-'age: 4/4 Uate: {fj/'L.UU I 1: 14:04 I-'M "Fa'cllity. Services KMART Work Order Survey Form Store #: KM003761 STORE STAMP Location: ZEPHYRHILLS Contract / Work Order # : Amount of Contract $: Two hour minimum charge may apply Contractor East Coast Fire Protection Date/Time Started Date/Time Completed Dated Awarded N umber of people in crew Project The following service and/or work tickets by the contractor are associated with this project The Store Manager MUST complete the following: 1, Did the contractor provide sufficient notice to the Store Manager prior to arrival at the store? Yes _ No 2. Did the contractor survey the scope of the contract with the Store Manager prior to commencement? Yes _ No 3. Were store operations disrupted? Yes No 4. Was the contractor made aware of the disruptions? Yes No Did he do anything to alleviate the problem? Yes No_ 5. During the project, were any fixtures or merchandise damaged? Yes No Was the contractor made aware of the damages? Yes No 6. If Yes, explain and provide estimate of damages. 7. Workmanship: Above Average Average Below Average 8. Would you recommend using the firm again? Yes No 9. Store Manager's comments (Print Legibly) Store Manager's Signature Date Store Manager's Name (Print) Contractor's Signature Date This Original Survey Form is to be returned with an Invoice, Waivers of Lien, Service Tickets, Etc. This fax was sent with GFI FAXmaker fax seNer, For more information, visit: http://www,gfi,com