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HomeMy WebLinkAbout08-8442 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8442 BUILDING PERMIT Permit Number: 8442 Address: 38010 MEDICAL CENTER AVE Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0070-00000-0010 mprov Cost: 107,739.80 ; „ a Date Issued: Name: C G M HOLDINGS TRUST Total Fees: 678.00 Address: 38023 MEDICAL CENTER AVE Amount Paid: ZEPHYRHILLS, FL. 33540 Date Paid: Phone: (727)484-1142 Work Desc: EQUIPMENT UPGRADE INTERIOR ONLY PRECISE CONSTRUCTION INC. BUILDING FEE 618.00 ELECTRICAL FEE 35.00 DAVID HARVEY ELECTRIC CO INC FIRE PLAN REVIEW FEES 25.00 oc 0 - .b3 r' ___ FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING FOOTER BOND 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. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one 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." Kw-- CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER FRE 6907 Dry Road, hyrhiHs, FL +3 a e�G Oi Rsrn i .r1 si lctisl us (813)780-0041 '?x (813)760-0C4 FIRE SERVICE USER FEES Occupancy No.: / Plan No.:. O — (i.27 Contractor s,6drat c Business Name: Gra 4. Billing Address: _ 7ii .t Business Address: !53r->0t0 Crt! Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE *Slfttean WC Annual N/C Sprinkler $50 IstAlarm N/C mily/Co sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C evisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200 8 0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per tank $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100 Per Riser $50 Hydrostatic Test $65 per system Fire Works $500 FIRE PUMP Acceptance Test $45 per system Camp Fine $25 0 Per Pump $100 Hydrant Flow $75 Controlled Burn $100 FIRE ALARM SYSTEM Hood/Duct $50 0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual 26 plus Devices $100 8 System Acceptance $50 Fire Protection $25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 Annual Wet $50 OTHER Waste Tire Storage $50 Annual Dry $50 Fire WaWSmoke Wall $15 per wan Generator<KW $100 CO2 $50 LP Gas $25 petank Generator>30 KW 150 Other $50 Natural Gas $25 persysmm Bio-Hazard Waste $100 Annual KITCHEN EXHAUST Fumigation Tenting $50 Hood/Ducts $50 Tent 10x10'or greater $15 per tent Torch Pot/Appled $50 OTHER Fire Pump $45 Haz.Materials $100 Annual LP Installation per tank $50 Fine Suppression $30 Fuel Tank Installation $50 System Acceptance (Per Tank) $50 Exhaust.Hood(Duct $30 Natural Gas installation $50 Re-inspection DBL (Per System) (other than annual) �Spray Booth $50 LI Inspection scheduled DBL and cancelled less than 24 hours 8 construction Insp. N/C Emergency Vehicle Ac, $50 FALSE ALARM PLANS TOTAL�� INSPECTION TOTAL= II PERMIT TOTAL TOTAL GRAND TOTAL Comments: Date: / ___ ...-_ lnsq�ctor. ° —��- 813-780-0020 City of Zephyrhills Permit Application Fax-813-7 9. O Building Department t,/ g h Date Received hone Contact for Pennittin Z — Q rz Owner'a Name Owner Phone Number I39Owner's Address Owner Phone Number Z4SD'S i 0 Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address /'► JOB ADDRESS O D LOT# SUBDIVISION PARCEL ID# • ZS. . •Cd O.OOmoO•L0/O (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR ADD/ALT = SIGN = MOVE = DEMOLISH INSTALL REPAIR PROPOSED USE = SFR ® COMM = OTHER TYPE OF CONSTRUCTION ® BLOCK = FRAME Q STEEL = OTHER DESCRIPTION OF WORK 1.1 a '2.- BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING $ �' 9Z• n� VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $AL/ $ •7SLo AMP SERVICE ZQQ ®.. PROGRESS ENERGY 0 W.R.E.C. = PLUMBING $ - � ((� If MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION V = GAS = ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES ONO BUILDER ^�> O Q� COMPANY GG SIGNATURE �•/s"�"' REGISTERED Y/ N FEE CURRENT Y/N Address Is_1Ce.tbv'tcLlatt4rylA_F4h1i7I License# I L ELECTRICIAN COMPANY V/ ,c/ c / SIGNATURE REGISTERED I_Y/ NI FEE CURREN Y/N U!"•""" CAddress © k .3Pf License# V 2 7G - PLUMBER J COMPANY SIGNATURE ri1 REGISTERED Y/ N FEE CURRENT Y/N Address I License# I MECHANICAL I i2 COMPANY SIGNATURE REGISTERED I_Y/ NI FEE CURRENT Y/N Address License# OTHER COMPANY SIGNATURE REGISTERED I_Y/ NI FEE CURRENT Y/N Address License# 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 COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(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 SIGN PERMIT Attach(2)sets of Engineered Plans. —PROPERTY SURVEY required for all NEW construction. 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 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 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 TH YOUR LENDER ORAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F.S. 03 OWNER OR AGENTJJ4 CONTRACTOR �Sus a andswqQ�t (or affi e��r})biptfore me this Sub •bed and swo to(or affirm }}�qefo�f99 me this by hMEY K.&1NH61�b 3 to by IC.t hiUEY K. ice114 Mo�..D, J-R. o are personally known tome or has/have produce Who i_l re Dersonallv known to me or has/nave produced as identification. -aass identification. Notary Public (• ( G d.) Notary Public Commission No. Dh 48S44.5 Commission No. DD `CSS4TJ YP Name of Ni(�ty ed,grin Name of Notary r st , ••.,`% W GATES * * MD N#t DD 485445 * * MY COMMISSION i DD 485445 EXPIRES:November 11,2009 EXPIRES:November 11,2009 l"rF w Bonded Thru Budget Notary services �AlFOF F�pP\o Bonded Thru Budget Notary Services of F` Zephyrhills Fire Rescue 6907 Dairy Road,Zephyrhills,FL 33542 Fire Marshal Bus (813)780-0041 Kerry Barnett Fax(813)780-0044 E-mail: kbamett@fire.zephyrhills.fl.us Plan Review#: 08-127 Project: Florida Cancer—Interior remodel (equipment upgrade) Number of Pages: 10 Date: October 16,2008 The plans have been reviewed for the interior remodel located at 38010 Medical Center Avenue and is allowed to move forward. The payment of the plan review fees acknowledges that the occupant agrees to the following points below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. There is no change to the interior that affects the life safety of the occupants within the building. Changes made are cosmetic and for equipment upgrade. Building department will inspect all electrical associated with this project. Inspections to be completed: 1. Remodel Final TT, FIRE MARSHAL ***Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes.This review is not intended to be a final approval of the submitted plans.It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances.In the event that further examination or site inspection reveals areas of non-compliance,it shall be the contractor's sole responsibility,at their sole expense to bring those areas in compliance.The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. Pasco County Parcel: 35-25-21-0070-00000-0010 001 Page 1 of 1 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: Weekly Archive - Saturday, October 04, 2008 Parcel ID 35-25-21-0070-00000-0010 (Card: 001 of 001) Classification 19 - Professional Service Building Mailing Address Property Value C G M HOLDINGS TRUST Ag Land $0 MCTAGGART) &CHEEMA P S & Land $95,052 GROSSBARD U TTEES Building $456,198 38023 MEDICAL CENTER AVE ZEPHYRHILLS, FL 335401384 Extra Features $3,105 Physical Address Market Value $554,355 38010 MEDICAL CENTER AVE Assessed (Save Our Homes) $0 ZEPHYRHILLS, FL 33540-1383 Legal Description (First 4 Lines) Taxable Value $554,355 PASCO MEDICAL ARTS CENTER PB 23 PG 24 LOT 1 LESS NORTH 47.00 FT THEREOF TOGETHER WITH AN EASEMENT FOR INGRESS Land Detail (Card: 001 of 001) Line Use IlDescriptionhi Zoning I Units Type Price Condition Value* 1 II 1900 PROF.BLDG 00OP 1 12, 0-0.00 II SF $7.32 1.00 $87,840 1900 PROF.BLDG 00OP I 1,484.00 SF $4.86 1 1.00 $7,212 Additional Land Information Acres 0.31 Tax Area II II FEMA Code X Ilcommercial Codell M3017AP Building Information - Use 19 - Offices Professional or Medical (Card: 001 of 001) Year Built 1985 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Wood Truss Roof Cover Built-Up Tar and Gravel Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Carpet Flooring 2 None Fuel Electric Heat Forced Air- Ducted A/C Central Baths 4.0 Line II Description Sq. Feet Repl. Cost New 1 BASII 5,401 $619,765 2 CAN 150 $5,164 Extra Features (Card: 001 of 001) Line Description Year Units Value 1 PAV CON 1985 8,280 $3,105 Sales History Previous Owner C G M HOLDINGS Year Month Book/Page Type Amount 2003 02 5314/0892 WD $0 1991 06 2022/ 0023 WD $550,000 1989 12 1867/ 1194 I QC $0 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Agency Data: Tax Collector School Board Supervisor of Elections http://appraiser.pascogov.com/search/parcel.aspx?sec=3 5&twn=25&rng=21&sbb=0070&... 10/17/2008 City of Zeph yrhills BUILDING PLAN REVIEW COMMENTS Contracto /Homeowner: Date Received: / — Site: t92 e . Permit Type: 4t Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ Thiscomment sheet shall be kept with the permit and/or plans. x . alvin witz Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) 1111111 III 11111111111111111111 11111 11111 11111 11111 IIIIVIII 2008160299 This space for use by Clerk of the Circuit Court only. Rcpt: 1211672 Rec: 10.00 DS: 0.00 IT: 0.00 11/05/08 — Dpty Clerk State of Florida County of Basco Permit Number Parcel ID er 25 21-0070-00000-0010 The undersigned hereby gives notice that improvements will be made to pertain real property,and in accordance with Section 713.13,Florida Statutes,the following information Is provided In the NOTICE OF COMMENCEMENT. 1. Legal Description of property: JASCO MEDICAL ARTS CENTER PB 23 P024 LOT 1 LESS NORTH 47.00FT THEREOF TOGETHER WITH AN EASEMENT FOR 1NORRS3 AND EGRFS ACROSS THE E 26.00 FT OF THE WEST 56.00 FT OF THE NORTH 47.00 FT OF LOT 1 r+�+ OR 5314 PG 892. - �O a. Street(Job)Address: 388010 Medical Center Ave.Zephyrhills.FL.33540-1383 Tx, 2. General description of improvements: Medical equipment upgrade. en3 3. a. Owner Name and Address: COM Holdings Trust.38023 Medical Center Avenue.Zephyrhills.FL 33540-1383 �mz b. Owner's Interest in site: Owner (O0°z c. Name&Address of Fee Simple Title holder(if other than owner) ILA O3 u %% 4. Contractor Name&Address: J.'recise Constracttgn.Inc..5026 Trenton St..Tampa.FL 33619 - o Phone: 813-241-2403 Fax: 813-241-1422 C� 5. Surety Name: r11 A Amount of Bond: CAddress: Phone: z 6. LenderName: _ Contact: +'c Address: Phone: 7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by rp Section 713.13(1Xa)7,Florida Statutes. N M Name&Address: terry Burchell.8763 River Crossing Blvd..New Port Richey.FL 34655 Phone Number. 727-f84-1142 8. In addition to himself;Owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Name&Address: Jfarvlen Tate.5026 Trenton Street.Tampa Florida 33619 Phone Number: (8113)241-2403 9. Expiration date of Notice of Commencement(expiration date Is one(1)year from date of recording unless a different date is specified). WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IM ROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB&TZfiEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FAVANCING,CONSULT YOUR LENDER OR AN ATTORNEY COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. 10. Signature Owner STATE OFF A COUNTY OI ,o 2c The fceego,}rlg instrument was j4nowledgcd before me this l J day of 200,?,by U r L'.h 1ZQU1'1P. wh (is (are)personally known tome or produced C S Ca '1'1440 t 4 O as identification,who did/did not can oath. �_Xg (DriverrLicense Number) Signature of Nota Verificatlo ant to Section 92.525,Florida Statutes. Under penalties of perjury,I declare that I have read the foregoing and that the it aro true to the best of my knowledge and belief Signatur atural Person signing(in me#10.)Above NOTARY PUBLIC-STATE OF FLORIDA ' Frances E. Reiter Commission#DD823206 . ../Expires: SEP.15,2012 BONDED THRU ATLANTIC BONDING CU.isc. v�� C0URJ STATE OF 1I DA c� COUNTY(JF t AS THIS 19TQQ�ERTI T TH FOREGOING ISA TRUE AND CO COPY OF T4LPOCUMENT QN FILE OR OF PUBLIC,RECORD IN THIS OFFIC TNI S MY HA AND OF,FI L SEAL THISL DAY OF JED PI IAN,CL U ,,L®E�RT• BY ��` DEPUTY CLERK /97, Purchase Order AOR Real Estate, Inc. Dispgtcln via Pn_irtt A member of the US Oncology Network I Punehpae Order Pit RevleiOn Pape 16825 Northchase Drive, Suite 1300 o?t�6-0000�oasl5 D9Ikz 2006 _ 1 NP(877)742-2377 Pyrn*. Terms Freight Terms Ship Via HuusUnited n TX 77081) L9. Pest Snatlon, ProDald and Add T5O Vegdor United States Buyer Phone Currency Vendor: 0000026136 aeLt93,Jamje m ,1932) 001.6226 USD Poquestor Phone PRECISE CONSTRUCTION INC, ,Ng:Sycn.Fluy N 5026 TRENTON STREET ship To; Medleal Ctr-Zephyrhills TAMPA FL 33619 38010 Medical Center Avenue Zophyrhills FL 33540-1383 United States 8111 To; P.0,Box 671286 Houston TX 77267 United States Tax E Pxem t7 N Tax Exempt io; Ina-Sch Item/Pr c•iPtlon Mfe ID Quantity UOM Po Price E, endog 4Rit Ore Deie 1- 1 CONSTRUCTION Fox apAINLAa 1.0QUA 10 ,1?9.90 701199.90 09/ 0/ZOO? INSTALLATION PER PRECISE CONSTRUCTION PROPOSAL DATED 9116!08 PROJECT 6191 ACE 08.078 ZEPHYRHILLS,FL Total PO Amount 101,199.90 Precise Construction, Inc. Florida Cancer instEtute September 16,2008 502$Trenton Street Tampa, FL, 33619 of Zephyrhills Brain Lab Installation Support Task Budget 1-) D all Protection and Labor 2•) Suspended Ceilin s 3.) Biectrical 500A0 4.) Electric Shut Down Allowance '" 27 522.00 5.) Floorin &Base 1,5am 6} Paintin 71OOAO 7•) Floor x-ra &identification `� 2,100.04 8.) Concrete Coffin .&Removal - 1;i3S0,00 9.) H1_PA Ne five Air Control for Floor Culling 9,500:00 la,) Permit Drawlnc�s --� _ 650:00 11.) Cab I"061iowarice 7,000.00 12) General Conditions ~-- 7 500.00 Sub Total: 10$1080 insurance: 82,882.80 Contractor Fee: 1,450.45 Tvt11 isudget: 16 a66,85 S 404,199.90 1 ) includes all protection for concrete cutting;receipt of Brain Lab shipment, concrete floor patch at floor trough,and misc:labor of dpprox..(100)hours I 2.) Remove and replace suspended•ceilings for all above ceiling any damaged ceiling stile included . 1 Supply and installation of 3.) Electrical aS.required by Brain Lab for the complete project 4.) Allowance for cost of dedicated electrical shutdown by utility company 5.) Flooring is to remove•fl0png and,replace.complete vault floor with J&J(30)oz Carpet Supply and instal}atron of vinyl base included 6.) Re-paint of complete interior of the vault is-included.using the existing colors 7.) Ground Penetrating radar to identify,possibte conduits and other buried utilities, 8) Cutting and, oval of concrete for electrical duct and laser pedestal bases 9.) , Supply and connection'of-HEpA negative air•ritfr for concrete cutting only 10.) Structural and electrical permit drawings for permitting.(1)Site visit is included for design Purposes.Billing administrative services are not included. Includes cabinet revisions. Includes the cost to design a,cabinet package to accomadate the new layout. 11.) Allowance for cabinets based on discussion at,tjrne of site visit with the architect. 12.) General COndltjon include drampeters,printing cost mailing costs, permit fees,supervision, phone,and computer.-General Conditions also include utility fees for a Saturday shutdown, NOTE. Items e 4& 11 are atlannrarmces only.Any amount over the allowance amountwill be billed as a change airier.Any atourit under the allowance amount will be credited to the project as a deductive change order.' Title:: CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8442 BUILDING PERMIT Permit Number: 8442 Address: 38010 MEDICAL CENTER AVE Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: .Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0070-00000-0010 Improv. Cost: 107,739.80 Date Issued: Name: C G M HOLDINGS TRUST Total Fees: 678.00 Address: 38023 MEDICAL CENTER AVE Amount Paid: 678.00 ZEPHYRHILLS, FL. 33540 Date Paid: 11/05/2008 Phone: (727)484-1142 Work Desc: EQUIPMENT UPGRADE INTERIOR ONLY PRECISE CONSTRUCTION INC. BUILDING FEE 618.00 ELECTRICAL FEE 35.00 DAVID HARVEY ELECTRIC CO INC FIRE PLAN REVIEW FEES 25.00 ( ) FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING FOOTER BOND 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. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one 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." CONT CTOR SIGNA11JE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8444 BUILDING PERMIT iiiIuaj Permit Number: 8444 Address: 38450 9TH AVE Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: 600.00 Date Issued: 10/20/2008 Name: HINTZ, KEVIN Total Fees: 35.00 Address: 38450 9TH AVE Amount Paid: 35.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/20/2008 Phone: Work Desc: RE-ROOF W/SHINGLES OWNER REROOF RESIDENTIAL 35.00 PdZi1 . DRY IN ROOF INSP TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c)when extra inspection trips are necessary due to any one 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 our property If you intend to obtain financing,consult with your lender or an attorney before record your notice o mencement." ONTRACTOR S GN TU E PERMIT OFFI R PERMIT EXP ES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER DISCLOSURE STATEMENT FOR OWNER CITY OF.ZEPHYRHILLS .BUILDING DEPARTMENT I, o 7iitJ 2 have read and fully understand and agree to the provisions of this instrument The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following conditions: 1. That the owner and he or she alone shall act as the builder for all phases of construction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertinent to the building. 3. That in the event various phases of construction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. 4. That in the event the Building Inspector shall require corrections to be made, the owner will assume full responsibility to insure they are made,.and upon completion will call for a reinspection before proceeding with the.building. 5. That the owner shall assume full responsibility for the construction and will not expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspection any additional fees, including reinspection fees, must be paid in full. A written request from this office shall constitute an official notice to pay additional fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc.,where applicable. 8. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not exceed $75,000. The building or residence must be for your own use or occupancy." It may not be built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise.people working on your building. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide worker's compensation for that employee, all as prescribed,by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoni regulation . OWNER'S SIGNATURE DATE I4 ?20 � ADDRESS 45; PHONE WITNESS PERMIT UMasterforms/OwnersAffidavit/Novo7 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received /� p _ Phone Contact for Permitting Owner Phone Number Owner's Name ��'y� Owner's Address h Owner Phone Number Fee Simple Titleholder Name[ 3 Owner Phone Number Fee Simple Titleholder Address (y l L L- 1i LOT T JOB ADDRESS SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR e ADD/ALT SIGN Q MOVE 0 DEMOLISH INSTALL REPAIR PROPOSED USE J SFR L COMM OTHER TYPE OF CONSTRUCTION Q BLOCK [;] FRAME Q STEEL Q OTHER DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE HEIGHT LII BUILDING Is VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY.._,,. _ Q W.R.E.C. O PLUMBING I Ij MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION 0 GAS = ROOFING 0 SPECIALTY Q OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES =NO BUILDER COMPANY L --I SIGNATURE REGISTERED Y/ N FEE CURRENT I Y/N Address I License# ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N Address I License# PLUMBER COMPANY SIGNATURE REGISTERED Y/ N I FEE CURRENT I Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N Address License# OTHER COMPANY SIGNATURE REGISTERED Y/ N I FEE CURRENT I Y/N Address I License# 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 COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W 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 SIGN PERMIT Attach(2)sets of Engineered Plans. ****PROPERTY SURVEY required for all NEW construction. 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 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 IMPACTIUTILITIES 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(F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and sworn to(or affirmed)before me this Subscribed and sworn to(or affirmed)before me this by by Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as identification. as identification. Notary Notary Public Public Commission No. Commission No. Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped