HomeMy WebLinkAbout09-9991 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9991
BUILDING PERMIT
MIS I II,. q a 2 k L
Permit Number: 9991 Address: 38005 ARBOR RIDGE DR
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD /ALT COMMERCIAL Township: Range: Book:
Proposed Use: MEDICAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35- 25 -21- 0060 - 00000 -0011
Improv. Cost: 176,800.00 N f 7 �:
Date Issued: 1/14/2010 Name: ADVENTIST HEALTH SYSTEM SUNBELT
Total Fees: 1,192.50 Address: 7050 GALL BLVD
Amount Paid: 1,192.50 ZEPHYRHILLS, FL. 33541
Date Paid: 1/14/2010 Phone:
Work Desc: INTERIOR RENOVATION INTERNAL GERIATRICS 2,100 SQ FT AREA
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R•DDA •N TR .. UCTI•N IN :UILDING F 1,066.50 PLUMBIN F E 0.00
STRICKLAND POWER INC ELECTRICAL FEE 0.00 FIRE PLAN REVIEW FEES 126.00
DIVERSIFIED GLOBAL PIPING & CONS
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• *TER 2ND - •U H PLUMB MIS INSULATION CEILIN
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."
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CONTRACTOR SIGNATURE PERMIT OFFI FR
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION — 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
FEB. 26. 2010 3:55PM RODDA CONSTRUCTION NO. 4931 P. 2
r. .
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� A ity bate: maim $QF:12PM
• ue Activity 1W nibor I -1 Ia 4c .c5 0
•
u Activity Cixuse: Request
33542 Inspector Nance: Kenya
Qodt Inspector Phone:
2 Ia0044
10 114011011WIVARO Occupancy Type: Bus n.s
Property Use OootorOffice
•
Total Violation: 4
NFWalirak it, C DR Corrected Violation: 0
3E42 Hours: 0.50
Total Fees: $ 0.00
ReA PI e• Prevertion (2007) 4.6,1.2 Authority Having Jurisdiction.
1 ny regrapasaliflablatammaidertbe aaf iy of building occupants and that are not specifically provided for by this Code shall badeWialaad
y the ,
;ommeeb 4 HANDICAP RESTROOM
Ref Mifilllita**Piikelb09619114 fins Prevention (2007) 9.2.1 Air - Conditioning, Heating, Ventilating Ductwork, Rnd nd ea
ar-C - dAfi•IMmpdt, and related equipment shall be in accordance with NFPA 90A, Standard for the MstaII $IQ11d¢
or NPPA 909, Standard for the Installation of Warm Air Heating and Air-Conditioning Sys. as
PPIloablIkd0M 1211111 tta1$4psOVed existing installations, which shall be permitted to be continued In service.
ommelMOMM.NOINV SOS, rATED THE HALLWAY TO BE AN AIR PLENUM INSTALL A DUCT DETECTOR WITH A MOTE KZY
ESETWW,
Ref. NOW itillMolidklefire Prevention (2007) 13.6.1.1 General Requirements,
le in 911Kk11etn'bution of portable fire extinguishers shall be in accordance with NFPA 10. Standardigr
to
Orlirn efiti lI MIEWINPAMPOUVAIWO IN EAST HALL AREA NEEDS TO BE RECHARGED.
Ref. *Aka go$Opetae atm Prevention (2007) 4.6.1.2 Authority Having Jurisdiction.
,y MMrEM safety of building occupants and that are not specifically provided for by this Code shall be detect Mid
'the "ill9
mmn1Qrt CODE 69A -60.008 BUILDING IS REOUIRED TO BE MARKED AS ON WITH LIGHT IN ONTMSS
3 C i *A A DIMALTESE CROSS IN RED REFLECTIVE LETTERING ON A CONTRASTING 12" X 14" wet
41N eltoki tt . MA XESE CROSS SHALL BE A BLACK "R ". SIGN SHALL BE LOCATED WITHIN 24" TO THRUM OF THE
4 A NDO FEET. "PRIDE" IS A PARTICULAR COMPANY THAT CARRIES THIS ITEM,
•
, mments;
)NDITIONAL CO GIVEN AT THIS TIME. WILL FOLLOW UP WA 30 DAYS TO CHECK FOR CORRECTION. IF NOT CORRECTED
ISINESS WILL BE SHUT DOWN UNTIL CORRECTED.
- Inspection to be performed on or before: March 25, 2010 12:00 am
•
Page 1 of 2
FEB. 26. 2010 3:56PM RODDA CONSTRUCTION - ._.,..,N0.4931.. P. 3
Occupancy Type: Business
Property Use Doct Of iee
. • Total V1 lation: 4
° . - - ' ` OR Corrected Violation: .0
17 . Mg1842. Hours: 0,50
Total Fees $ 000
Kerry Bad --
Zephyt , •
Fire pre.
6907 f t
Zephythilik #{,.
kbarn o
P.01 /01
TRANSACTION REPORT
FEB /26/2009/THU 04:17 PM
FAX(TX)
# DATE START T. RECEIVER COM.TIME PAGE TYPE /NOTE FILE
01 FEB /26 04:16PM 818636673778818636673778 0:01:01 1 OK ECM 0195
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• • CITY OF •ZEPHYRHILLS, .FLORIDA
5335 8th Street
CERTIFICATE OF OCCUPANCY
NAME . Adventist Health System'Sunbelt DATE 2 -26 -2010
• ADDRESS 38005 Arbor Ridge Drive
PARCEL I.D. # 35-- 25 - 21 - 0060 -- 00000 - 0011 SUBDIVISION
TYPE OF BUILDING Interior Renovations Internal Geriatrics PERMIT# 9991
REMARKS Finaled 2/26/2010 Conditional CO based on Dept FINALDATE: 2/26/201
follow up w/i 30 days on or before 3/25/2010 •• •
BILL BURGESS BUILDING OFFICIAL/Bss •
•
WHITE : Contractor or Owner
YELLOW: Bldg. Dept. .
PINK: Utilities Dept. •
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•
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/ ,--irr RODDA
CONSTRUCTION INC.
General Contractors & Constriction Managers
POWER OF ATTORNEY AND AUTHORIZATION TO
DRAW CONSTRUCTION PERMITS
Date: January 13, 2010 RE: Permits
--- John Rodda, President of Rodda Construction, Inc. hereby name, constitute, and appoint
G. .v of Rodda Construction, Inc, my Attorney -In -Fact for the purpose of applying for
and receiving permits in my name.
Si : , • ure of Presiden , o hn Rodda
1110
Signature of Designated Attorney -in -Fact
STATE OF FLORIDA
COUNTY OF POLK
Subscribed and sworn to before me this day of ate— , 2010.
/ .. 1
NO ' ARYPUBLIC u_::... ar,.. as ».nasaaaescoan•aa•aaaaaaacaaaaa
KATHLEEN S. McCALLUM
"" '''' Comm# D00728233
,� �tl` 'D2 � • Expires 1/16/2012
My Commission Expires: N , tp '
'yna»a" ` Florida Nateryt Assn., Inc
250 E. Highland Drive Lakeland, FL 33813 0: 863 - 669 -0990 f: 863 - 667 -3778 Lic. #CG- C061496
✓,s
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: Ro a re„,'4Ciell C't
Date Received: / - 3 -1- /0
Site: 3 600 c 4'biv ' /e
Permit Type: J/ Laoki- e 4(,,,,_,
Approved w /no comments Approved w /the below comments: ❑ Denied w /the below comments: ❑
This co nt he shall be kept with the permit and/or plans.
/-0
Kal in Swit r — Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
Pasco County Parcel: 35- 25 -21- 0060 - 00000 -0011 001 Page 1 of 1
Search Again Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes
Other Agency Data: Tax Collector School Board Supervisor of Elections
Data Current as Of: Weekly Archive - Saturday, December 19, 2009
Parcel ID 35 25 - 21- 0060 - 00000 -0011 (Card: 001 of 001)
Classification 19 - Professional Service Building
Mailing Address Property Value
ADVENTIST HEALTH SYSTEM/ Ag Land $0
SUNBELT INC Land $51,679
7050 GALL BLVD Building $119,834
ZEPHYRHILLS, FL 335411347
Physical Address Extra Features $446
38005 ARBOR RIDGE DR Market Value $171,959
ZEPHYRHILLS, FL 33540 -1301 Assessed (Save Our Homes)
$0
Legal Description (First 4 Lines)
See Plat for this Subdivision 1
Taxable Value $p
ARBOR RIDGE PB 22 PG 44 THE
WEST 2/3 LOT 1
OR 4065 PG 1650
Land Detail (Card: 001 of 001)
Line II Use IlDescription I Zoning II Units II Type II Price I Condition II Value
1 I 1900 II PROF.BLDG I 000P II 7,060.00 II SF I $7.32 1.00 II $51,679
Additional Land Information
Acres 1 0.16 11 Tax Area II 30ZH 1 FEMA Code II X IJCommerical Codell M3017AP
Building Information - Use 19 - Offices Professional or Medical (Card: 001 of 001)
Year Built 1984 Stories 1.0
Exterior Wall 1 Eifs Exterior Wall 2 None
Roof Structure Flat 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 2.0
Line II Description II Sq. Feet
I I Repl. Cost New
1 II AOF II 1,452 I $173,151
I 2 I CAN II 50 II $1,789 I
Extra Features (Card: 001 of 001)
Line II Description II Year I Units II Value
I 1 II PAV ASP II 1984 II 2,202 I $446
Sales History
I Previous Owner II DEVARAKONDA S
I Year II Month I I B ook /Page II Type 11 Amount I
1998 II 12 II 4065 / 1650 II WD I $115,500
1984 04 II 1325 / 1042 II WD I $41,000 I
Search Again Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes
Other Agency Data: Tax Collector School Board Supervisor of Elections
http: // appraiser. pascogov. com / search /parcel.aspx ?sec =35 &twn= 25 &rng =21 &sbb= 0060 &... 12/22/2009
Pasco County Property Appraiser - Legal Description for: 35- 25 -21- 0060 - 00000 -0011 Page 1 of 1
Welcome : Records Search : Parcel Details : Legal Description
Legal Description
35- 25 -21- 0060 - 00000 -0011
Assessed in Section 35 , Township 25 South, Range 21 East
of Pasco County, Florida
ARBOR RIDGE PB 22 PG 44 THE WEST 2/3 LOT 1 OR 4065 PG 1650
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: 2/17/2009 11:49:04 AM
The Local Time Is: 12/22/2009 10:53:20 AM
http : / /appraiser.pascogov. com/search/legal. aspx ?parcel= 21253 50060000000011 &cache =... 12/22/2009
Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire Marshal Bus (813) 780 -0041
Kerry Barnett Fax (813) 780 -0044
E- mail: kbarnett@fire.zephyrhillsfl.us
Plan Review #: 10 -001
Project: Modification of Interior Space
Number of Pages: 7
January 11, 2010
I have received and reviewed the plans for the modification of an interior office located at
38005 Arbor Ridge Drive and will allow the project to move forward. Please note that
this review does not eliminate any further requirements as the project continues moving
forward. By receiving permit, contractor acknowledges to comply with the items listed
below. Should anyone have any questions, please do not hesitate to contact the Fire
Marshal's office.
1. The modification is considered extensive based on NFPA 101, Chapter 43
and further reclassifies it as reconstruction, therefore the project was
reviewed as a new business occupancy.
2. Install emergency lighting in restrooms.
3. No storage allowed in attic.
4. Install panic hardware on rear or secondary exits.
5. Ensure there is a concrete pad where egress is from secondary exits.
6. Address building with 6" numerical.
7. It appears that only one A/C unit handles the space. If unit is 2000 cfm's or
greater a duct detector shall be installed with a remote reset switch. If a fire
alarm is installed it shall be tied into that system.
8. Life safety page shows a fire alarm system. Plans will need to be submitted
by the fire alarm contractor for permitting on that system. A knox box will
also be installed due to the fire alarm system. The latest edition of NFPA 72
shall be the standard. If no fire alarm being installed a letter shall be
submitted stating so.
9. If building is considered by this office as having light weight truss it shall
meet the requirements for building placarding. See this office for sign details.
2
Inspections Required:
1. Final
2. Fire alarm inspection(s) will be required but type will be noted
on that plan review.
t /lid, :14
KE '' 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.
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: ,, -00/ Contractor: /ilk (ftelVV ?,
Business Name: -/_ „ % ,S�ff 1 rC. he Billing Address: 2,� D E /i 4 /w, U,/
Business Address: 3 e li-A- %i- P.
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES _ INSPECTION FEES _ PERMIT FEE _ FALSE ALARM FEE
LI
0 h Site Plan N/C — Annual N/C Sprinkler $50 _ 1st Alarm N/C
!l multi Family /Commercial : 06 s(` _ 1st Re- inspection N/C _ _Standpipes $50 _ 2nd Alarm N/C
EI (Minimum Charge $25. _ 2nd Re- inspection $100 _ Fire Pump $50 _ 3rd Alarm N/C
Plan Revisions 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
_ 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
0 Per Riser $50 _ Hydrostatic Test $65 per system _ Fire Works $500
FIRE PUMP _ Acceptance Test $45 per system _ Camp Fire $25
0 Per Pump $100 Hydrant Flow $75 _ Controlled Bum $100
FIRE ALARM SYSTEM _ Hood /Duct $50
_ 0 - 25 Devices $50 _ FIRE ALARM SYSTEM Place of Assembly $50 Annual
26 plus Devices $100 _ 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 Wall /Smoke Wall $15 per wall —
Generator < KW $100
_ CO2 $50 _ LP Gas $25 per tank _ Generator >30 KW 150
— Other $50 _ Natural Gas $25 per system — Bio-Hazard Waste $100 Annual
Ei KITCHEN EXHAUST _ Fumigation Tenting $50
Hood/Ducts $50 _ Tent 10'x10' or greater $15 per tent Torch Pot/Applied $50
OTHER — Fire Pump $45 — Haz. Materials $100 Annual
LP Installation per tank $50 —
Fire Suppression $30
Fuel Tank Installation $50 _ System Acceptance
(Per Tank) $50 _ Exhaust Hood/Duct $30
0 Natural Gas Installation $50 — Re - inspection DBL
(Per System) (other than annual)
0 Spray Booth $50 0 Inspection scheduled DBL _
and cancelled less than _
_ 24 hours
Construction Insp. N/C
_ Emergency Vehicle Ac $50 FALSE ALARM
PLANS TOTAL / TOTAL PERMIT TOTAL TOTAL!
(,�/ GRAND TOTAL I /11. — 1
Comments:
Date:
Inspic �A' �4 � y ,i.,4___
813- 780 -0020 City of Zephyrhills Permit Application- G cm I Fax - 813 -780 -0021
. Building Department
•
Date Received NM 0
•
LL..77 Phone Contact for Permitting
Owner's Name MN \ 11 � /���� • wner Phone Numbey /'Q ��(�yrJ7 , /
Owner's Address i�� I I ' I I N Owner Phone Number '- --'-" - ... g/i
Fee Simple Titleholder Name / Owner Phone Number ask M14
Fee Simple Titleholder Address
•
JOB ADDRESS V iN - t— I r MI ! b Z i,
SUBDIVISION Pr ��.( �� P .. Ss-- 2 S') 1 - G o �U - 000 00 - do I 1
{._�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED I I NEW CONSTR ADD /ALT SIGN n MOVE n DEMOLISH
J INSTALL ,_ REPAIR
PROPOSED USE n SFR 1 1 COMM n OTHER 1 I
TYPE OF CONSTRUCTION n BLOCK n FRAME n STEEL I / n OTHER �-
DESCRIPTION OF WORK 1 , 1 ei ( f3,6 ,,u id 4,-,o / �,/� "} fik;.,• /l e 6 yy 'kt' )c-c a414,„
BUILDING SIZE SG FOOTAGE HEIGHT
BUILDING $ VALUATION OF TOTAL CONSTRU
I pod • �G CTION __ • � '
n ELECTRICAL $13k 1 • AMP SERVICE PROGRESS ENERG n W.R.E.C.
c \ � C r y ., Q - 00 /�� (x/ ppp
PLUMBING 4 1 .11 o V Q d V f 4 O / D' • �� 1--/-6-C,,
n MECHANICAL - O VALUATION .: MECH `STALLATION 11 GAS n ROOFING I 1 SPECIALTY n OTHER fl a � � //��
FINISHED FLOOR ELEVATIONS FLOOD ZONE nYES 1 INO sz43 ^gyp Y;1.JLi
r '---------- . - .l ...•.... .m ............................m ,_ : i ........,...•....... I ............. m..,...... ,m. . ..,.,..,,
to � // `
BUILDER / COMPANY �� rI �I� . (r , C
SIGNATURE " n —
,` `� — REGISTERED j �� FEE C - R NT 1� r!
Address .fg '14Sgal. i J � \r/ ° e t rt...CB ite3# tl J�
ELECTRICIAN COMPANY �]�� � . '/q�yitL1 �
SIGNATURE , _ REGISTERED FEE CURRE yy „w (/
�, 1 �. / LI else# -__ ,n, Address L
�/ , FLT 1� , rig r%
SIGNATURE I \n e- tL�tf COMPANY RED �H FEE CURRENT , I �
Address G , . I Q � O f i 11J i P� C � X! J license # ` 1 ,
MECHANICAL 0 I COMPANY V
SIGNATURE REGISTERED 1 Y / N I FEE CURRENT 1 Y / N 1
Address
. License #
OTHER �� COMPANY
SIGNATURE r / 11 REGISTERED 1 Y / N 1 FEE CURRENT 1 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. At commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
_ ............................... w..............w.�........,..W. .,, W......,,..... W........... W.......... W.........._ ���.. �w............._... W.....,............................ ..�....,........,�.....�m....,r
Directions:
Fit 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 FAILUR T. RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPR• EMENTS 'O •UR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER O-' A ' O' ` - EFORE RECORDING YO - • • T E • A ; • MMENCEMENT.
FLORIDA JURAT (F.S. 11 `•' t, / I
OWNER OR AGENT /6%, I a ►� 1 1 CONTRACTOR
Subscribed and s or - '- this S b cribe• and s o� j
. fore (• a m fore etl',�
Who is/are personal ' A' or CI„- e produced Who is /are . - sonall k •wn to me)r has/have produced
‘ •. ••ecJ 9 -- 'f — a '., tifi .
.� °s �
Z. Ai • dr • • _
L, 9�Sl f ■ � ��A9• • N
1 weary Public • ` .&- ■/. • - . c \ - . .e.� i ota Public
Commission ?o _ :*s_ Co ission No.
–A . D u - Ki1rH .r tN S. McCALLUM
-.1:_e_ 99• a B : � ? `� t Y f1 �' 1 �� 3 Comm #D7i D00728233
Name of Notary 6040.OQ`S" Name of Notary typed, printed or stamped
B! / • T AT D � � \ , ,s Expires 1/16/2012 f.
�i / / ! /1111111M" �� 9 h ., ,?F,r;; Florida Notary Assn., Inc
wommimmammumumm
r � RODDA
CONSTRUCTION INC.
General Contractors & Constrochon Managers
POWER OF ATTORNEY AND AUTHORIZATION TO
DRAW CONSTRUCTION PERMITS
Date: December 22, 2009 RE: Permits
I, John Rodda, President of Rodda Construction, Inc. hereby name, constitute, and appoint
/!.e L/ p of Rodda Construction, Inc, my Attorney -In -Fact for the purpose of applying for
and receiving permits in my name.
■
k if
Sig di re of President, . • . Rodda
Signatu f Desi / g ': Attorney -in -Fact
STATE OF FLORIDA
COUNTY OF POLK
Subscribed and sworn to before me this .:7 day of , 2009.
4
- i ' // / ade.4.---iy.._
4
NO •RYPUBLIC
. Eti� i rir»�:ins S. v'CALLUM
J � c �ftl d N ��
31tAYP ' Comm# 000728233
_ - E) *'ia 1/16/2012
My Commission Expires: ' ' ,,rp V Florida Notary , inc
,,.. e.ne.noenanua.U.... ...suu u.aa.•
250 E. Highland Drive Lakeland, FL 33813 0: 863 - 669 -0990 f: 863 - 667 -3778 Lic. #CG- C061496
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CITY OF LAKELAND RECteek t+ idol J U L 1 6 2009
2009 -2010 BUSINESS TAX RECEIPT
Business Tax Office, 228 S Massachusetts Ave., Lakeland, FL 33801
THIS BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30, 2010 RECEIPT NO: 00620
Account Number 1205483 Business Classification(s) $ Category Quantity
r
Workers: 61 '' PROFESSIONAL FIRM OFFICE 13555 1
Square Footage: 10900 ' GENERAL CONTRACTOR - CLASS A 4601 2
Fee: 1,023.97
le
Location Address
250 E HIGHLAND DR "' Y
- �v, ' a:
e This bursa tax receipt does not permit lho holder to operate in
• H uslness Nam ®$ Illlailina Addras ' ' % violation deny City low, ordinance or
' '; ' location or must bo approvedd by he CITY DeafnessTex
RODDA CONSTRUCTION INC ,t hccoipr Section aubJed(0 zoning restrictions. This Business Tax
JOHN RODDA, OWNER r Receipt does not constitute an endorsement, approval of
260 E HIGHLAND DR w dl'> avvrovalo{ Ihe holders aldli competence « wthe
LAKELAND, FL 33603 - 3656 ,' — ComplianCe or noncompliance or the holder with other laws,
J 4 •
/1/ C ,....... g
RECEIPT MUST BE CONSPICUOUSLY DISPLAYED IN YOUR PLACE OF BUSINESS VALID ONLY WHEN SIGNED
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8191 'ON" °.t - ` � NOIlaN�1SN00 d440� d l5' Z "x 010 '5 NVr . "�'- J
O �
Ac# 2 , 4 8 2 8 3 8 91 OF FLORIDA
- DEPARTMENT Off' BI AND PR OFESSIONAL REGULATION
t�NSTUC�dI+l IDUS'I'RY - LICENSING BOARD SEQ# L08070100946
_> _ —
DATE BATCH NUMBER -LI CENSE N$R
1 . 0 1 1 0 1 4 1 1 0 '.G 70511'82:03 CGCn
T1ae d' ,'NEkil.k.; ;0' 01'0
• tamed "bd ��v +; "'IS C 7'TFT II
Under he pr i$ions
- Expiration date: AUG 31, 20.10
RODDA, JOHN -A
RODDA CONSTR.UCTI O I INC
212`8 .EAST EDGEWOOD'! jX.RIVE: 4
SUITE -109
LAKgLAND , � FL _3803
CHARL E CR 'ST - = = CHUCK DRAGO
GOVE#T(.R INTERIM SECRETARY
SPLAY AS-REQUIREI3`s'BY'LAW'
CITY OF LAKELAND
2008 -2009 BUSINESS TAX RECEIPT
Business Tax Office, 228 S Massachusetts Ave., Lakeland, FL 33801
THIS BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30, 2009 RECEIPT NO: 00982
Account Number: 1205483 Business Classification(s Class Category Quantity
Workers: 65 PROFESSIONAL FIRM OFFICE 13555 1
Square Footage: 10900 GENERAL CONTRACTOR - CLASS A 4601 2
Fee: 1,068,09
Location Address
250 E HIGHLAND DR
This business tax receipt does not permit the holder to operate in
violation of any City law ordinance or regulation. Any change in
Business Name & Mailing Address location or ownership must be approved by the City Business Tax
RODDA CONSTRUCTION INC Receipt Section, subject to zoning restrictions This Business Tax
Receipt does not constitute an endorsement, approval or
JOHN RODDA, OWNER disapproval of the holders skill or competence or of the
250 E HIGHLAND DR compliance or noncompliance of the holder with other laws,
LAKELAND, FL 33803 -3656
( 7 77 / 4:L.--
RECEIPT MUST BE CONSPICUOUSLY DISPLAYED IN YOUR PLACE OF BUSINESS VALID ONLY WHEN SIGNED
RECEIPT ° / P teg0 U TAX LOCAL BUSINESS AA RE if
. LOCATION: 250 HIGHLAND DR EXPIRES: 9/30/2009 � �
I B (tek PO ui'
,� 44 LAKE LAND IN IN CITY Lou
OWNER: JOHN A RODDA
230150 CONTRACTOR GENERAL
RODDA CONSTRUCTION, INC
250 E HIGHLAND DR
LAKELAND, FL 33813
BUS TAX TYPE: RENEWAL
BASE TAX: 55.00 ADDL FEE: PENALTIES: TOTAL: 55.00
F.S. 205.0535 (5) requires FEIN or owner Social Security Number
• 11J a: '7 � %` °" J31 1GTDR 430 E MAIN'ST • PO BOX 2018 • BARTOW, FL 33831 -2016 TEL (863).534 -4731 • www.PolkT xes.COm;
THIS POt K , 'OURITY LOCAL BUSINESS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED AT THE BUSINESS LOCATION
PAID - 4098411.0001 -0001 420 08/12/2008 55.00
Client#: 4424 RODDCON
ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE ( 09 D )
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lanier Upshaw, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1115 US Hwy 98 South HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 468
Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Westfield Insurance Company 24112
Rodda Construction, Inc. INSURER B: Bridgefield Employers Insurance Comp 10701
250 E. Highland Drive
INSURER C:
Lakeland, FL 33813
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AMYL POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
A GENERAL LIABILITY CMM4641613 12/31/09 12/31/10 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREM SFS Ea occu encel $150,000
CLAIMS MADE X OCCUR MED EXP (Any one person) $10,000
X PD Ded:1,000 PERSONAL &ADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 _
7 POLICY n JECT n LOC
A AUTOMOBILE LIABILITY CMM4641613 12/31/09 12/31/10 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT _ $
-
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS /UMBRELLA LIABILITY CMM4641613 12/31/09 12/31 /10 EACH OCCURRENCE $10,000,000
OCCUR ( CLAIMS MADE AGGREGATE $10,000,000
_ $
DEDUCTIBLE
_ $
X RETENTION $ 10000 $
B WORKERS COMPENSATION AND 83037282 01/01/10 01/01/11 X I TORY I IMIT WC STATUS ER - I I OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE $1,000,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
10 Days notice of Cancellation applies for non payment of premium.
** Supplemental Name **
Rodda Construction, Inc.
Rodda Construction Multi Family, LLC
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 311 DAYS WRITTEN
5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Zephyrhills, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRE ENTATIVE .
a .
ACORD 25 (2001/08) 1 of 3 #S139501/M139313 ALM 0 ACORD CORPORATION 1988
A n� � " `• .= , rd= .FLOR
V7F „ .� }J 3y 1 ! S Mir � r ti � S , pip • a
' r `, , ��. •'5°' . `f '` a 2S % O F` SS NA REGULATION II,
,.>,:;:;; A i': s ? %,lf �� b b r E INC3 HOARD
;. SEQ# L08070101233 • � G • r I 4Ir131i .
07 0 2008 " ..''''
• .T to ELNCTRICA:L CONT ; ' ,, s '` . - ' ' ?
°Na belo ,'IS " CERTIFY . 'c . ,..`, ,I . c^ ,
Under 1~ > p�ov Oxi •Ch f.t0F. �1 « r ;" ,
E xp'irat�.:on , date a AVG 3<1 2 01::I .til , ° !' ""� ,: � ;:.
•
� , �,}�1}�Ia L 'i �
Ya r
e STaIC :D — r�'i 1 17L1a / 5 ti j i ^ C hr ' 1 r r. v ..
r ` F . f •45; ; .ISMP:• Z; 'LA '.a + , � l . .. r � ^ '� ' ' 7 y� 14w , ` ' .
CRARLIE .. CRr3T �r, , '� ., � �� _4-":4, ,1 �} 1` ' , r -� ��;;r CHUCK DRAGO
GOV C Jl�, ? ( � 7 ' •, s � ' a INTERIM SECRETARY
`f r� i C R DB YC AW .
POLK COUNTY LOCAL BUSINESS TAX RECEIPT
ACCOUNT NO. 55712 CLASS B EXPIRES: 9/30/2010
OWNER NAME LOCATION
STRICKLAND, RNETT T 745 LAMP POST LN
LAKELAND
BUSINESS NAME AND MAILING ADDRESS CODE ACTIVITY TYPE ,c ..
230087 CONTRACTOR ELECTRICAL _• A > C ).
STRICKLAND POWER INC g
3 � �a� x
745 LAMP POST LN ‘. r" r :
LAKELAND, FL 33809 `z'.)
rs t.
OFFICE OF JOE G. TEDDER, CFC * TAX COLLECTOR MI S P a- KCOUNTYLOCALBUSINESSTAXRECEIPTMUSTpE
---- CONSPICUOSLY DISPLAYED ATTWF BUSINESS LOCATION I
PAID - 1205674.0001 -0001 12 08/25/2009 55.00
STRICKLAND POWER, INC.
PHONE 863 -683 -5787
FAX 863 - 683 -5857
FACSIMILE TRANSMITTAL SHEET
TO; FROM:
Bobbie Rhett Stxirkland
COMPANY; DATE:
City of Zephyrhills 1/5/2010
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
813-780-0021 2
PHONE.. NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER
0 URGENT ❑ FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE
NOTES /COMMENTS:
•
1453 E GARY ROM)
LA.KALAND, FL 33801
Municipal Board of
CERTIFICATE ' C 3 Inc Or Polk Cogn .
MpErENCr .;:
NUMBER; GCC 8 s;:,
287 .
'x
NAME. JOHN A ROODA
ADDRESS; .wl
CITY; 230 E. Highland Dr.
CL ASSIFICATION :
Lakeland, PL 39693
GENERAL GENERAL CON TRAL TO'
CHAIRMAN:
AP PLICANT. �� �
EXPIRES: 0 9/30/19 ► ;;"
ISSUEb;
Z • d ` 8191 ON _ NOI l3NLSNOD VOOM cI S : Z O l OZ 'S 'Ndr
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 -S (2001/08) 2 of 3 #S139501/M139313
DESCRIPTIONS (Continued from Page 1)
Rodda Gator Building, LLC
Rodda Construction, Inc.
AMS 25.3 (2001/08) 3 of 3 #S139501/M139313
This Instrument Prepared By:
Name: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, FL 33813 I i VIII VIII VIII VIII VIII VIII
20011 0006198
Permit No. Tax Folio No.
NOTICE OF COMMENCEMENT Rcpt.: 1282845 Rec: 10.00
STATE OF Florida
•
DS : 0.00 IT: 0.00
COUNTY OF Pasco 01/14/10 Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvements 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.
1. Description of property: (legal description of property, and street address if available)
Florida Hospital Internal Medicine/Geriatrics Clinic Legal: 35- 25 -21- 0060 - 00000 -0011
38005 Arborridge Drive
Zephyrhills„ FL PAULA S. O'NEIL, PRSCO CLERK & COMPTROLLER
2. General description o improvement: Internal Medicing/Geriatrics Clinic
01/14/10 ep3n 1 °W@ 4
p f p g OR BK 11 PG
3. Owner / Tenant information
a. Name and Address Adventist Health Systems DBA FL Hospital Zephyrhills, 7050 Gall BIvd,Zephyrhills, FL
33541
b. Interest in property: Owner
- • c. Name and address of fee simple titleholder (if other than owner):
Ft 4. Contractor:
a. Name and address: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, FL 33813
b. Phone number: 863- 669 -0990
1 Surety
a. Name and address: N/A
b Amount of bond $ .
c. Phone number:
6. Lender
a. Name and address: N/A
b. Phone number:
7. Persons within the State of Florida designated by Owner upon whom notices • or other documents may be served as
provided in section 713.13(1)(a)7., Florida Statutes:
a. Name and address:
b. Phone number:
8. In addition to himself, Owner designates the followingperson(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b)., Florida Statutes:
a. Name and address: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, Fl 33813
b. Phone number: 863 - 669 -0990
9. Expiration date of notice of commencement (the expiration date is I year from the 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 IMPROPER 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND
TO OBTAIN F Cl SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NO CE OF COM FINANCING,
% EMENT.
I. " : fiIiz(
ature of Own or Owner's Authorized Officer /Director /Partner/Manager)
A, ,2 6v= O4 j 5 ,2vvgc
(Signatory's Title/Office) fiA , ft / / The foregoing instrument was acknowledged before me this / day of✓ , 200, by _Am., ' '
(name o person) - as (type of authority, ... e.g. officer, trustee, attorney ' fact) for (na � e of party o '
..SA f,9: Y 4Y9.YC9
behalf f who instrument ecut KATHLEEN S. MCCALLUM
a a uU ry�ii
s';�a� Comm# 000728233
�' ` - • 4 Expires 1/16/2012
(Si nature of Notary Public - ate of Florida) 4.a;' s
;; Florida Notary Assn., Inc
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification Type of Identification Produced
STATE OF FLORIDA, COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
WITNESS MY HAND AND OFFICIAL SEAL THIS
/ 944 DAY OF 01i}-J■,) 2O /()
PAULA S. O'NEIL CLERK & COMPTROLLER
BY i 4 ' •� DEPUTY CLERK