HomeMy WebLinkAbout09-9527 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9527
BUILDING PERMIT
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Permit Number: 9527 Address: 38544 5TH AVE
Permit Type: WELL MONITORING ZEPHYRHILLS, FL.
Class of Work: WELL MONITORING Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11- 26 -21- 0010 - 16900 -0080
Improv. Cost: V.. >0.:� u:17 a 1_
Date Issued: 9/09/2009 Name: JAPAGE PART c/o 7- ELEVE
Total Fees: Address: P.O. BOX 711
Amount Paid: DALLAS, TX 75221
Date Paid: Phone:
Work Desc: INSTALL WELL MONITOR WITHIN MEDIAN OF 5TH AVE /NO ELECT - /NO CHRGE
HAN ` N, J • HN
Fl L
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."
ONTRACTOR SIGNATURE PERMIT OFFI 'R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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813 -780 -0020 City of Zephyrhills Permit Application Fax- 813 -780 -0021
Building Department
Date Received
Phone Contact for Permitting
Owner's Name 1 ^ L L� Rki -p 4' ,, 7 Owner Phone Number
Owner's Address 3 Ov 64► 4 \ Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
�j /� .Q
JOB ADDRESS ��OC� - f ! - l4/'VeU LOT #
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT I 1 SIGN I MOVE 1 1 DEMOLISH
->,1 INSTALL REPAIR
PROPOSED USE I 1 SFR llV2 COMM 1 1 OTHER 1 1
TYPE OF CONSTRUCTION 1 1 1/� BLOCK FRAME 1 1 STEEL h OTHER 1 I
DESCRIPTION OF WORK 7 vM W 41 b/cc "116 Ck) 1 14/ 1 g O UI
BUILDING SIZE SQ FOOTAGE HEIGHT
BUILDING $ VALUATION OF TOTAL CONSTRUCTION
1 1 ELECTRICAL $ AMP SERVICE 1 1 PROGRESS ENERGY n W.R.E.C.
I 1 PLUMBING $
I 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
I I GAS 1 I ROOFING 1 1 SPECIALTY 1 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 'YES 1 'NO
BUILDER COMPANY S g Ci vJ twJ I ✓' Jv IM e1 k
SIGNATURE REGISTERED l Y/ N 1 FEE CURRENT I Y/ N 1 L
Address a L ) U & CA License# `L/� V
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT l Y/ N I
Address License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y / N . 1 FEE CURRENT l Y / N 1
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y / N 1
Address License #
OTHER COMPANY
SIGNATURE REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y/ N 1
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 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 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 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) �n
OWNER OR AGENT CONTRACTOR
Subscribed q and sworn to (or affirmed) before me this S.i¢ cribed and swo }firmed efore is Q
y 1 -",-(7 b \�J � lAr\ {�f vi f
b
Who is /are personally known to me or has/have produced Who is /are personally known to me or has /have produced
as identification. L, CC. %ASR- as identification.
Notary Public
r,-.:.:\)*CoroQmissiSn S Notary Public
� 621833 Com is on No. Commission No. 0 ; CXpIIea Decemoer 12, 2010
�F,. 9onded Thru Troy Fain Insurance 800 - 385-7019
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped
so _
Shaw ® Shaw Environmental, Inc. 2- 34
World of Solutions`"
� a ^Sl t
September 2, 2009
Building Department
City of Zephyrhills
5335 8th Street
Zephyrhills, FL 33542
Re: City of Zephyrhills Right of Way use Permit
Water Well Contractor John K. Hansen
7- Eleven Store No. 16533
38544 5th Avenue
Zephyrhills, Florida
FDEP Facility ID No.: 518520046
FDEP Work Order No. 2009- 93- W71823
Shaw Project No. 134472
Dear Building Department:
The purpose of this letter is to provide the City of Zephyrhills Building Department (City) with the following
information to obtain a Right of Way (ROW) use permit to install a monitor well within the median of 5
Avenue. The well is required by the Florida Department of Environmental Protection (FDEP) to obtain
groundwater analytical data for the petroleum assessment. Attached to this letter are 3 copies of the
following:
• City ROW Use permit
• Figure 1: Site map illustrating well location and construction notes.
• Figure 2: Construction drawing of the proposed monitor well
• Figure 3: Aerial photo showing the well location.
• Copy of FDEP work order authorizing the well installation.
If you have any questions or require further information, please contact the undersigned.
Sincerely,
Shaw Environmental, Inc.
John K. Hansen, PG, WWC
Senior Hydrogeologist
Attachments:
725 U.S. HIGHWAY 301 SOUTH • TAMPA, FL 33619
N:AEngineering \7 -11 \ 16Wif opy TEf e - hiks yV„Pf i I W P
Bobbie Swetland
From: Bobbie Swetland
Sent: Wednesday, August 05, 2009 2:39 PM
To: 'Hansen, John'
Subject: RE: right of way permit for monitor well installation
No sir, a bond is not required.
Thank you.
Bobbie
From: Hansen, John [maiito:John.Hansen @shawgrp.com]
Sent: Wednesday, August 05, 2009 12:42 PM
To: Bobbie Swetland
Subject: RE: right of way permit for monitor well installation
Yes, I received the fax information, thanks.
In reviewing the ROW permit application, condition #12 indicates that a bond may be required for an unspecified
amount. Would the City require a bond for installation of a single monitor well within the ROW and if so what would the
bond amount be?
John K. Hansen
Senior Hydrogeologist
Shaw Environmental & Infrastructure
725 US Hwy. 301 South
Tampa, FL 33619
813 - 612 -3681 (direct)
813- 6261663 (fax)
www.shawgrp.com
From: Bobbie Swetland [ mailto :bswetland @ci.zephyrhills.fl.us]
Sent: Tuesday, August 04, 2009 10:22 AM
To: Hansen, John
Subject: RE: right of way permit for monitor well installation
I'm glad you were able to download our ROW permit application- I didn't know it was online. I checked & did
not see any listing for Shaw at all in our contractor program. I'll be more than glad to fax you our contractor
registration requirements — we have no application form- we just enter all information when we receive it from
you as the contractor. I'm going to fax info as soon as / finish this email — please let me know if you receive
faxed material.
Thank you.
Bobbie
From: Hansen, John [mailto:John.Hansen @shawgrp.com]
Sent: Tuesday, August 04, 2009 8:08 AM
To: Bobbie Swetland
Subject: RE: right of way permit for monitor well installation
Thanks for your responses and information. I downloaded your ROW permit.
I do not know if our company (Shaw Environmental, Inc., or Shaw E &I, or Shaw Group) is registered with the City. Please
fax me your registration requirements and any registration form to 813 - 626 -1663. Thanks again for your help.
i
John K. Hansen
Senior Hydrogeologist
Shaw Environmental & Infrastructure
725 US Hwy. 301 South
Tampa, FL 33619
813 - 612 -3681 (direct)
813 - 6261663 (fax)
www shawgrp.com
From: Bobbie Swetland [ mailto :bswetland @ci.zephyrhills.fl.us]
Sent: Monday, August 03, 2009 9:44 AM
To: Hansen, John
Subject: RE: right of way permit for monitor well installation
Per your request the following would apply:
1. Yes, but no charge — only if electrical service is required. Permit application can be faxed.
2. If in ROW — yes ROW permit is required.
3. Only if electrical is involved & price would be minimum fee of $35.00
4. We have R -O -W- Use Permit applications in our office or we can fax you one. Upon submittal of
application(s) we ask allowance of 7 -10 business days for review.
Your company or any subs must be registered with us & I can also fax registration requirements. If any other
questions, please let me know.
Thank you.
Bobbie Sharon Swetland
City of Zephyrhills Bldg Dept
Ph: 813 - 780 -0020 Ext 3512
Fax: 813- 780 -0021
From: Hansen, John [mailto:John.Hansen @shawgrp.com]
Sent: Friday, July 31, 2009 9:39 AM
To: Bobbie Swetland
Subject: right of way permit for monitor well installation
We are doing an environmental assessment at the 7- Eleven located at 38544 5th avenue in Zephvrhills for the Florida
Department of Environmental Protection (FDEP) and are requesting approval for installation of a monitor well located
within the median of 5th avenue. We are a licensed water well contractor with the Southwest Florida Water
Management District and will be utilizing a drilling company that is also licensed. A utility mark out will be completed
prior to any drilling to prevent damage to any underground utilities. Please note the following questions:
1. Is a permit required for installation of the well?
2. If so, what type of permit is needed, a right of way permit?
3. If so, is there any cost for the permit?
4. What is the process for obtaining the permit and the estimated amount of time required?
The well will completed at grade level within a steel manhole with a bolt down cover. The work within the median will
only take about 1.5 hours and not require closure of the road. FDOT approved traffic control for the work zone will be
established. Landscaping will be restored to equal or better condition in the work zone.
Your help with this matter is greatly appreciated, thanks.
John K. Hansen
Senior Hydrogeologist
Shaw Environmental & Infrastructure
2
725 US Hwy. 301 South
Tampa, FL 33619
813 - 612 -3681 (direct)
813 - 6261663 (fax)
www.shawgrp.com
* ** *Internet Email Confidentiality Footer * * ** Privileged /Confidential Information may be contained in this
message. If you are not the addressee indicated in this message (or responsible for delivery of the message to
such person), you may not copy or deliver this message to anyone. In such case, you should destroy this
message and notify the sender by reply email. Please advise immediately if you or your employer do not
consent to Internet email for messages of this kind. Opinions, conclusions and other information in this message
that do not relate to the official business of The Shaw Group Inc. or its subsidiaries shall be understood as
neither given nor endorsed by it. The Shaw Group Inc.
http://www.shawgrp.com
3
CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT
DATE: �- �` 09 RIGHT -OF -WAY USE PERMIT PERMIT# 952-7
No construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the
City Building Department. Any application for approval of construction operations on any City owned Rights of Way shall furnish a detailed drawing
showing the complete scope of the proposed work in triplicate to the office of the Building Official for approval prior to the commencement of any work. A
copy of this permit is to be kept readily available at the site of the work at all times.
PARCEL I.D.# 11 " " r' 00 10' 4 4 7 (} oO ^ 0080 CITY ROAD £A Avert ()e
DATE 912/e/ 1 7
LOCATION (Legal Description) :
— C47 of ep31y 4 it pd 1, PG- � I-01S 9 , 10 1 !65 oY q-� 76 PG 996
Permission is hereby granted to UOV n kt I . ' , C(,1 f C of V I'N (i1 W
for theR onanll_ ettenggc�of- Fb pd fe 0.,,, a r &i *
subject to the following � conditions:
l Ld i
1. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant.
2. All work shall be done in keeping with the standards of the City Streets Department and under the supervision of the City Building Official, who
will be notified at least one day prior to commencement of construction.
3. All materials and equipment shall be subject to inspection by the City Building Official.
4. During construction all safety regulations of the Department of Transportation shall be observed and the City shall be relieved of all
responsibility from damage of any nature arising from this permit. Subject to the same terms and conditions, the permit holder may take such safety
measures, including placing and display of cautipn signs, i m y dee n ce ary in� onduct pf construction and maintenance work hereunder. It is the
responsibility of the permittee to 11** G am to 4., t) , T eVe a q 1 41t,
5. All private and all City properly shall be restored to its original condition as far as practical in the opinion of the City Building Official.
6. All underground crossing installations shall be laid at such depth as may be specified by the City Building Official.
7. The sketch covering the details of this installation shall be made a part of this permit. This permit is granted with the understanding that the
applicant has notified all other utility users in the area covered by the permit and takes full responsibility for any damage incurred by prior installations as a
result of his operations in order that they may safe guard their interests.
8. It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to
this permit shall not operate to create or to vest any property right in said holder.
9. Whenever the City decides to further exploit the City Rights of Way, any or all said poles, wires, pipes, cables, or other facilities and
appurtenances authorized hereunder, shall be immediately removed from said Rights of Way, or reset or relocated thereon as required by the City Building
Official at the expense of the holder of this permit.
10. The holder shall save and keep the City harmless from any and all damages, claims, or injuries that may occur by reason of the construction,
maintenance, and operation of said facility. /�(�
11. The holder shall complete the requested work within 6 0 days or this permit shall become null and void. In the event the work
requested is not completed upon the expiration date of this permit, the City shall have the right to complete such work and to charge the holder of the permit
for all costs incurred in completing said work.
)(The holder shall post a cash or surety bond with the City Manager in the sum of S dollars to guarantee performance of the
obligations herein, and to guarantee maintenance of the right -of -way described herein for a period of one (1) year following completion of the requested
installation. In the event a surety bond is posted, the surety bond shall be made payable to the City and shall obligate the surety to hold the City harmless in
the event the holder of this permit should fail to meet any of its obligations hereunder. The bond shall also indemnify the City for all court costs and
reasonable attorneys fees in the event legal action is required to collect on said bond.
SUB ITTED BY:
(Permittee) TO h 4 % I se cs Wt)
Signature & Title .,le i j e dl A"
Address J &J 1 �d4 '7'q, %% ) Ft 22619
APPROVED BY:
n r/ CITY OF ZEPHYRHILLS
Building Official ,i �c
Date: '
Utilities Su s l k C , f
Date: di 4 �O
Public Works ` -
Date: ? 4
City Manage '/ It 1 ti.---)
Date: t it 0
DRAWN SDJF CHECKED BY DRAWING 134472
BY 9 -2 -09 APPROVED BY NUMBER
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FIGURE 2
MONITORING WELL
INSTALLATION DETAIL
(MW-I)
7-ELEVEN STORE No. 16533
38544 5TH AVENUE
ZEPHRYHILLS, FLORIDA
PREPARED FOR
7-ELEVEN, INC.
DALLAS, TEXAS
NOTE: NOT TO SCALE 4L'
Shaw Shaw Environmental, Inc.
Florida Department of Environmental Protection - Division of Waste Management - Bureau of Petroleum Storage Systems
• Petroleum Preapproval Program Work Order 34
Work Order Number: 2009- 93- W87007 Cost Center #: 37450404555 Category: 087888 FY 08 -09
FDEP Facility Id #: 51/8520046 Score: 75 Contract #: N/A
Site Name: 7- ELEVEN FOOD STORE #16533 Eligibility: SCR
Address (Street, City): 38544 5TH AVE. ZEPHYRHILLS County: Pasco
Contractor Name: SHAW ENVIRONMENTAL INC. CID #: 01077
Contractor Address: 725 Us Highway 301 South. Tampa. FL 33619 FEID #: 77 -0589932
Contractor Representative: John K. Hansen. PG Phone #: 813/626 -2336
FDEP Site Manager: Sally J. Mcgregor Phone #: 850/245 -8896
Cleanup Phase: Remedial Action
Cleanup Activity: SUPPLEMENTAL SITE ASSESSMENT
Work Order Description:
Per cost proposal dated June 17, 2009 (received June 18, 2009) and supplemental information received through July 15, 2009, with noted and
discussed changes, Chapters 62 -160 and 62 -770, F.A.C., and Preapproval Procedures and guidance:
Event 1: Redevelop monitoring wells (MWs) MW -8DD and MW -9R and monitor pH readings during and after the development. Install 2 MWs
to 45 feet (ft) with 20 ft of screen and 1 soil boring (SB) to 40 ft or 1 foot into water table. During MW and SB installation, conduct continuous
split -spoon sampling and screen soil samples 1 foot below land surface (Ws) and every 2 feet thereafter with an Organic Vapor Analyzer
(OVA) to the borehole terminus. Collect a high unsaturated (vadose) zone soil sample from each MW and the SB according to the
Preapproval Sampling Parameter Table (PSPT) to delineate extent of contamination. A minimum of 7 days after MW installation, sample 5
MWs for BTEX & MTBE, PAH and TRPH analyses according to the PSPT. The final deliverable will be two paper copies of a Supplemental
Site Assessment Report with cumulative summary tables, conclusions and recommendations and electronic copies of tables and figures in
Excel and CADD, as applicable.
Note: Please see supplemental instructions (attached).
Deliverable 1: `� 2009 Due Date 1:
Deliverable 2: Due Date 2:
Deliverable 3: Due Date 3:
Deliverable 4: «_ _ _. Due Date 4:
Deliverable 5: Due Date 5:
Deliverable 6: Due Date 6:
Final Deliverable: SUPPLEMENTAL SITE ASSESSMENT REPORT Final Due Date: Oct. 15. 2009
Period of Service: Contractor Representative Signature Date To April 13. 2010
Amount (incl. retainage): $16.925.13 Retainage (10 %): $1.692.51
This WORK ORDER is not in effect until signed by all parties. The FDEP will not pay any amount of this WORK ORDER until
the original signed copy has been returned to the FDEP. The FDEP will not pay for any portion of the scope of work that has
not been performed as of the date of Invoice.
-- a dditional Terms An. Conditions On Following Pages- -
/ � 1 Date
FDEP Site Manager: � �vi 7/15/2009
W ATITAIMS FDEP Manager: O . /I 4 9
Cost Center Administrator: / 1 Ara 7 /�dJ,
Contractor Representative: v Wa-4/407
Contractor Representative: n
(second contractor signature Is optional)
FDEP Use Only: Technical review: Initials: Date: II, 09
Fiscal Review: Initials: 1 Date: a / d Dt?
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