HomeMy WebLinkAbout07-7179
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7179
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost: 3,740.00
Date Issued: 11/08/2007
Total Fees: 85.00
Amount Paid: 85.00
Date Paid: 11/08/2007 Phone:
Work Desc: REPLACE EXISTING SIGN W/NEW SIGN
7179
SIGN
FREE STANDING SIGN
CHURCH
Address: 38924 C AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 14-26-21-0100-03300-0040
ZEPHYRHILLS WES
38924 C AVE
ZEPHYRHILLS, FL. 33542
J
FIRST CLASS ELECTRIC INC
{--~ nCL~cO
\ \-d-7-07
I (p..-..
ELECTRICAL ROUGH
FINAL
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."
-f ~K .~<
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Fax-813-780-0021
813-780-0020
City of Zephyrhills Permit Application
Building Department
/H1~
Date Received
Owner's Name
Owner's Address
Fee Simple Titleholder Namel
Fee Simple Titleholder Address I
\1 P-?J
I
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
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PARCELlD#I/7"-.i" -J I -d /CJtJ - c!)J.1c!JtJ - dC7U7611
(OBTAINED FROM PROPERTY TAX NOTICE)
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WORK PROPOSED
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PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
BUILDING SIZE
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D BUILDING 1$ j ? 'Y tfl ct7 cJ
D ELECTRICAL 1$
D PLUMBING 1$
D MECHANICAL 1$
D GAS D ROOFING
FINISHED FLOOR ELEVATIONS I
AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
PROGRESS ENERGY
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W.R.E.C.
Noe V
VALUATION OF MECHANICAL INSTALLATION
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SPECIALTY D OTHER
FLOOD ZONE AREA DYES
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Address
MECHANICAL I
SIGNATURE .
Address I
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SIGNATURE
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11111111111I1111111111111111111I111111111111111111I11I1111II11111111111I1111111111111I1I111111111111I1111I1111111111I11111111111111111111111111111
RESIDENTIAL 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 onsile, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meel compliance
Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
BUILDER
SIGNATURE
ELECTRICIAN
SIGNATURE
PLUMBER
SIGNATURE
COMPANY
REGISTERED
COMPANY
REGISTERED
COMPANY
REGISTERED
COMMERCIAL
SIGN PERMIT
LIcense #
Ieee CJ s:-? sl :r
License # I c(' -- cJO.2-571)
Y / N
Y/N
FEE CURRENT
License #
Y/N
Y/N
FEE CURRENT
License #
Y/ N
Y/N
FEE CURRENT
DI~~~ti~~~': ' , , . , , , , , , , , , , , , , , , , , , , , , , . , , , , , , . . , . , , , , , , , , , , , , , . , . . , . , , , , , , , , , . . . , , , , , , . , , , . , , , '. ' . , , , , , , , , , , , , , , , . , , , . . , , , , , , , . , , , , , , , , , , , , , , , , , , , , ,
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" 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 ~nstallations not specifically in~luded. in the application. A
permit issued shall be construed to be a license to proce?d With the work a~d not as authorl~y ~o. vlol~t~, 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 violat~o~s o~ any codes. Every ~ermit 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 th~ work is commenced: An extensIon
may be requested, in writing, from the Building Official for a period not t~ exceed n1n~ty ~90) da~s and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the\.!ob 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 AN ATTORNEY BEFORE RECORDING YOU TICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 1) ~e
OWNER OR AGENT CONTRACTOR
S b cri ed and s n t (or affi Sub cri d a sworn
b . b
Who Is/are ersonally known me or has/have produced Who i lare rsona I kn
as Identification.
~fkt:~~=P"~i'
;;,J~ My CommiSlion 00273751
Name of Notary typed, printed &~p6pires December 09, 2007
C.
/ I
&7: ~p~~
CommiSSion No.
'iJ; Carolyn Zappulla
. . My CnmmilliOR ~
Name of Notary typed, printed or sta~ClF"~ Expires December 09, 2007
Notary Public
NOTICE OF COMMENCEMENT
.'. ... ~ -"
STATE OF FLORIDA
COUNTY OF PASCO
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance
with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement :
Description of Property: Parcel No. 14-26-21-0100-03300-0060
Street Address: \~B 905 Y C/ ;7/-IJe. 'Ze)J Iz )"tf";{,'/f /::::./
.1,ssY i.
General description of Improvements Install road sign
See ~\ -lId c I.t (/
F ~ j) (J -td I~
Ii: J ~ /
Owner Information:
Name Zephyrhills Wesleyan Church
Street 38924 CAve.
City Zephyrhills, FL 33542
Interest in Property: Owner
/111111 1I1111111l 11111111I1 111111111I111111111111111 1111/111
2007184801
Name of Fee Simple Titleholder (Ifotherthan owner)
Rcpt: 11407!51 Rec: 18.50
OS: 0.00 IT: 0.00
11/07/07 Dpty Clerk
Contractor: JOHN L. SMITH CONSTRUCTION, INC. R
4240 COATS RD.
ZEPHYRIllLLS, FL. 33541
JED PITT"AN, PASCO COUNTY CLERK
11/07/07 12:51J..m 1 Al ~
OR BK 768~ PG ~11
Surety:
Name
Street
City
Amount of Bond
Lender:
Name
Street
City
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
Street
City
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.
Expiration date of Notice of Commencement to be 1 year from date of recording unless a different date is
specified () I ()
Signature of Owner. LJa.J /1/ .Y J f}., n 0
Sworn to and subscribed before me this ;J:J. I~. day of L~~.zt/Le.-v-L>L)
Notary Pub1iC~jt<J ~ r:J~ ~~
My Commission Expire~ :
/1f1;, 3) .}L>lj
2001.
. GARY L. HOI.I.AND
NoIIrr PuIlIIc . .... of FIIdlII
. ~ u,c. II "JftElpllw"S.8"
Ca..I...... . DO "....
......................
Pasco County Property Appraiser - Legal Description for: 14-26-21-0100-03300-0060
Page 1 of 1
. Welcome: Records Search: Parcel Details: Legal Description
OR BK 7683 PG 212
2 of 2
Legal Description
14-26-21-0100-03300-0060
Assessed in Section 14, Township 26 South, Range 21 East
of Pasco County, Florida
ZEPHYRHILLS COLONY COMPANY SUB PB 1 PG 55 POR TRACT 33 DESC
AS COM AT NW COR OF TRACT 33 TH N89DEG 52'28"E 500 FT TH
SOODEG 06'41"E 114.50 FOR POB TH N89DEG 52'28"E 152,55 FT TO A
POINT 10,00 WL Y OF EAST LINE OF SAID TRACT TH SOODEG 06' 41"E
PARALLEL WITH EAST LINE OF SAID TRACT 201.18 FT TO SOUTH LINE
OF SAID TRACT TH S89DEG 51'32"W ALG SOUTH LINE OF SAID TRACT
172,55 FT TH NOODEG 06'41"W 4,81 FT TH S89DEG 51'32"E 20 FT TH
NOODEG 06' 41"W 196,50 FT TO POB OR 5129 PG 934 OR 5155 PG 541
Please be advised that our legal descriptions are for assessment
purposes only, and are not intended for use in legal conveyances.
Pasco County Property Appraiser
Page Layout Modified: 10/9/20074:49:39 PM
The Local Time Is: 11/7/20077:48:21 AM
STATE OF FLORIDA
COUNTY OF PASCO . . . ~ '~l;
. THIS IS TO CERTIFY THAT TI;iE'Fb~EGOING ls'A ,;>
TRUE AND CORRECT COPY OF ~ttie'OOCU~Nt ON F1Lf. .
OR OF PUBLIC RECORD IN THfS;OFFICE. WITNESS MY " .
HAND A~OFF1CIAL SE~l. 1:H1S-z'- DAY OE :
. h</~.) ~2..#lI7 :
JEO PI~LERK OF'bll:I'G~.IT CO.U. RT. . .:.
BY 'fA .L./" " 'QE~qryClERK
htto://aooraiser. oascoQ:ov.com/search/leQ:al.asox?oarcel=2126140 1 00033000060&cache=F... 111712007
Proposal
Date Oct 22, 2007
John L. Smith Construction, Ioe.
4240 Coats Rd.
Zephyrhills, FL 33541
(813) 782-0470
CBC 059519
Proposal Submitted To
Work To Be Performed At
Name Zephyrhills Wesleyan Chmch
Street 38924 C Ave.
City Zephyrhills, FL 33542
Telephone # 715-0263
Street Same
City
Date of Plans 10-1..{)7
Architect J.M, Stewart Corp,
We hereby propose to furnish all materials and labor for the completion of Footer, electric and erection of
lighted sign. Sign and engineered drawings for sign to be furnished by others.
All material is guaranteed to be as specified, and the above work to be completed in accordance with the
drawings and specs submitted for above work. All work and materials to meet local industry standards and
existing codes in effect at date of this proposal, The above work to be performed for the sum of
Thirty seven hundred forty and oonoo Dollars ( $ 3740.00 )
with payments to be made as follows: See attached sheet.
Any alterations or deviations from the above specifications involving extra costs, will be executed only upon
written orders, and will become an extra charge over and above the estimate, All agreements contingent upon
strikes, accidents or delays beyond our control. Owner to carry :fire, wind and all other necessary insurance
required upon above work. Workers Compensation and Public Liability Insurance to be taken out by builder.
Cost of collection and attorney's fees in the event of any default by the Owner and in the event that the Builder
must initiate any collection proceedings or must engage attorneys for any purpose whatsoever relating to this
agreement, including but not limited to seeking the enforcement of its terms and conditions, the Owner
acknowledges, agrees, confirms and warrants, that they are responsible for all costs and attorney's fees incurred
by the Builder. ~
Respectfully submitted ~ ~---I2'
Per John L. Smith Co 'on
This proposal may be withdrawn by us if not accepted within 10 days
Acceptance of Proposal
We, the undersigned have read this proposal and do agree to the terms and conditions as listed above and to any
attachments, if included. We authorize you to do the work as specified. Payment will be made as outlined in this
proposal. jJ 1)
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For: J.M. Stewart
Purchase Order No.: 8798 Footer Ok
Sign Type & Name: Concept 38 Column Ok
Drawing Number: CO-38-N-2000 Bolts Tension Ok
Date: 1 0/2/2007 Variables: Bolts Shear Ok
Approx. Sign Wt, 750 Ibs. Footer: 1 Columns: 2
Wind Speed 120 mph diameter 0 ft. d1 0
Directionality ~ 0.85 length L: 8 ft. do 0.00
Exposure Kz 0.57 width W: 2 ft. b= 4 in
Topographical Kzt 1.00 Height H: 3.33 ft. d= 4 in
Importance Factor"' 1.00 Depth D: 3
Gust Effect G 0.85 Bolts: Spacing: 9 in. ell h= 3.75 in
Qty: 1 k= 3.75 in
Dia.: 0.334 in^2 w= 0.125 in
Velocity Pressure: 1 Qz=O.OO256KzKztKdV21 Area 1 Area 2 Area 3 Totals
Area: 7,00 24,00 0,00
Velocity Pressure: 1 17.86 height 1.00 3.00 0.00
width 7.00 8.00 0.00
Cf 1.60 1.60 1.60
centroid 0.50 2.50 4.00 2.05 ft.
wind pressure 24.29 24.29 24.29
Structural Material: 46000 wind force 170,03 582,97 0,00 753,00 Ibs
Moment 85,02 1457,43 0,00 1542,44 Ib-in
Steel Fb - 46,000 psi P= F(n) #Col, n
Alum. Fb= 35,000 psi 527,102 1 1.0
Allowable Lateral . 400.00 2 0.7
S - Lateral Soil
Pressure 400.00 psf 3 0.5
Allowable Soil Load 2000 psf
qz = Velocity pressure at height Z
Z = Height off groung of Sign Ratios:
Kz = Velocity Pressure Exposure Coefficient*"' Wind Force Aspect 2.67
I = Importance Factor"' 582.97 Clearence 0.75
V = Velocity From ASCE 7-05 Fig. 6-20
P = Design Pressure
G = Gust Response
Cf = Force Coefficient for Solid Signs
Cv -Coefficient of Total Shear
D = Sign Width R1= S LD/3
H = Sign Height 2.50 R1= 3200 Ibs
Wind Force
Calculations conform to ACSE 7 and FBC 170.03 R2= S LD/3
2004 including 2006 supplements. f R2= 3200 Ibs
Notes:
1. From ASCE7-05 6.5.10 0.50
3. From table 1609.6D FBC 2004 Vs
4. Structural Tubing ASTM A500 Grade B.
5. Bolts are ASTM A307. ~
a I:f.>
6. Concrete Strength 2500 psf minimum. ~
7. From table 1610.1 FBC 2004 1 ~
8. Steel Pipe - ASTM A53 Grade B ~
9. Steel Plates and Bares ASTM A36 3.33 t--- R1
10. Structural Steel Wide Flange and WT
shapes ASTM A992 or ASTM A572 Grade 2.00
50 1.00 - t---+ EJ
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~arrett . ~
Windload Calculations
0-15 Exp. B
Florida #44816
New York #063279-1
Page 1 of2
John Francis Barrett, PE
8259 Barton Farms Blvd.
Sarasota, FL 34240
X:\JM Stewart\
8798.xls
J.ohn.E...Barrett . ~
Windload Calculations
0-15 Exp.' B
Footing Depth: FBG 20041805.7.2.1 d= ,5A(1 +(1 +(4,3h/A)) 112) A= 2.34P/(S1b)
1,38 0,53
Weight of Footing: Wf= 150*A*D
8000 Ibs Dead Load OK
Factor of Safety 2,2
Calculations: Bearing Area: A= 16.00 sq. ft.
Soil Pressure OK
Soil Pressure: Ps = 546,88 psf Factor of Safety 3,7
Overturning Moments: M1 = (f1)(d1+H) 651,79
M2= (f2) (d2+H) 3400,66
M3= (f3)(d3+H) 0,00 ft-Ibs
ft-Ibs
Overturning moment due to wind: Mo= 4052,45 ft-Ibs
Weight of Footing and Sign: WSF wAH + Ws ft-Ibs
WSF 8750 Ibs
w = 100 pcf density of concrete
Resisting Moment Due Weight: MR= (WsF)(W/2) H = Height of footer
MR= 8750,00 ft-Ibs
Active Soil Resistance R1= (ASL)L)(D/3)
R1= 3200,00
R2= (ASL)(L)(D/3)
R2= 3200,00
Resisting Soil Moment: Ms= (R1)(D1)+(R2)(D2) Footer Ok
Ms= 18350,00 ft-Ibs Factor of Safety 6,7
Total Resisting Moment: MT= 2.71 E+04 ft-Ibs
I
Moment about (a) Ma: M - (F1D1+F2D2+F3D3)
a-
M - 1542,4421 ft-Ibs
a-
Me= Main Assumes footing rigid subjecting
Mc= 771,22105 ft-Ibs column to bending stresses
Column Design: Section Required: Sx = Mc/Fb
Yield Strength (psi): 46000 Sx = 0,2011881 in^3
Moment of Inertia: 1= 4,8538411 in^4
Column Analysis: Section Designed: Sx = I/c Column Ok
Sx= 2,4269206 in^3 Factor of Safety 12.1
Anchor Bolts: In Tension P= Mc/L
Bolt Yield Strength 64000 P= 1028.2947 Ibs
Area of bolt Ab in2 .334 for 3/4 inch
based on minor dia. .606 for 1 inch S= P/Ab Bolt Tension Ok
.969 for 1.25 inch S= 3078.7268 Ibs/in^2 Factor of Safety 20,8
Bolt Yield Strength In Shear
P = Shear force 55000 S= P/2nAb Bolt Shear Ok
d - bolt minor diameter S= 563,63 Factor of Safety 113,6
Assume Dure shear
Florida #44816
New York #063279-1
Page 2 of2
John Francis Barrett, PE
8259 Barton Farms Blvd.
Sarasota, FL 34240
X:\JM Stewart\
8798.xls
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BUILDrnGl'LAN REVIEW COlY.lJ.VffiNTS
. Date Received:
. .
,
CTo~ (~,'~
. /1- 7 -67
3?/I2-V '1/rL~' . .
, Ro/;/aCf'. e)(;~y ~'6" ~-.) ..., .
~.aw/the below comnieI1ts:'~ ,Denied ~/lbe below commcnts:O
. Contractor/Homeowner:
Site:
permit Type:
ApProved wino comments:D
. ~(/dtYIi;fT" rlIJ
. .,... 0 i'd '('''1~~<- " ,'it
. , Retd/llul"~
f7Q- ()4
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with tb.ep~ andloi:plans. .
1)-7-t7L~ -~~p..
Date V con.tractor mldlor Homeowner . .
. '. . (Reqmred when comments are present) '.