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HomeMy WebLinkAbout10-10320 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10320 BUILDING PERMIT • Permit Number: 10320 Address: 7209 GREEN SLOPE DR Permit Type: DEMOLITION ZEPHYRHILLS, FL. Class of Work: 636- DEMOLITION Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34- 25 -21- 0000 - 00300 -0091 Improv. Cost: 10,000.00 ���: � _ S `"' Date Issued: 4/09/2010 Name: CASELNOVA, MICHAEL & ANGELA Total Fees: 120.00 Address: 11335 FORT KING RD Amount Paid: 120.00 DADE CITY FL 33525 Date Paid: 4/09/2010 Phone: Work Desc: DEMO INTERIOR R•.. . -vi" . BU ." _ 0. Pou o r r 4 41. I AL 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 impro ements to your property. If you intend to obtain financing, consult with your lender or an attorney bef a ecording your notice of commencement." I �! .. CONTRACTOR SIGNATURE PERMIT OFFI �R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER , . R -` .{ 1, fi , s City of Zephyrhills BUILDING PLAN REVIEW COMMENTS .Contra omeowner: it Date Received: // - jj —, 9 - a , / ( 1 ) 9 Site::. - .arm : 3•i %/A 9 n Permit Type: L, /f1�2. , ,-/yit,0 Approved w /no comments: '7) Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. 3.-30-io s K — Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) ---- – _. . _ . , RODDA, , , CONSTRUCTION INC. General Contractors & Construction Managers POWER OF ATTORNEY AND AUTHORIZATION TO DRAW CONSTRUCTION PERMITS Date: April 9, 2010 RE: Permits I, John Rodda, President of Rodda Construction, Inc. hereby name, constitute, and appoint OerIAIS Carier of Rodda Construction, Inc, my Attorney -In -Fact for the purpose of applying for and receiving permits in my name. \ell Sp i i - :f President, John Rodda L ./Ad.( - 4..• 02?3 Signature of Designated Attorney -in -Fact STATE OF FLORIDA COUNTY OF POLK Subscrib • » and sworn to before me this — day of i J , 2010. J, L .1. /7)(04,(,/,,,,,,,_ NO ARY PUBLIC .. ,rasa.•. «,.:n- e.e.;._.,;.:: ;; _:,ea.waaaa.aaaaaena KATHLEEN S. lifOCALLUM a " "` " " " '��. Cornm# D00728233 My Commission Expires: _ M1 Ex m # D 18/2012 %4, r Florida Notary Assn., Inc R 250 E. Highland Drive Lakeland, FL 33813 0: 863 - 669 -0990 f: 863 - 667 -3778 Lic. #CG- C061496 COM AT NE COR OF SE1 /4 OF SEC 134 TH ALG NORTH LINE THEREOF N89DEG 58'35 "W 1345.17 FT TO NLY EXTENSION OF WLY RIGHT -OF- WAY LINE OF GREEN SLOPE DRIVE 'PH SOODEG 07'42 "W ALG SAID LINE 1125:78 FT TH SO8DEG 39' 24 "W 77.38 FT FOR POB TH CONT SO8DEG 39' 24 "W 124.98 FT TH N89DEG 58' 40 "W 170.00 FT TH NOODEG 07' 42 "E 120:60 FT TH N89DEG 07'06 "E 188.56 FT TO POB TOGETHER WITH & SUBJECT TO AN EASMENT FOR INGRESS EGRESS & PARKING OVER & ACROSS PARCEL DESC IN OR 5102 PG 1681 AKA PARCEL 3 OR 5102 PG 1679 S/H This Instrument Prepared By: + ( IIII�III�IIIIVII ! Name: Rodda Construction, Inc.. 250 E. Highland Drive, Lakeland. FL 33813 2010049246 2010046 Permit No. Tax Folio No. Rcpf:1298793 Rec: 10.00 NOTICE OF COMMENCEMENT DS 0.00 IT: 0.00 STATE OF Florida 0 4/09/10 C. Cook, Dptiy Clerk COUNTY OF Pasco . 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) �. ! 1 0 W.) Florida Hospital Sleep Center Legal: 34- 25 -21- 0000 - 00300 -0090 v 7209 Green Slope Dr. Zephyrhills„ FL 33541 2. General description of improvement: Sleep lab demolition 3. Owner / Tenant information a. Name and Address: Florida Hospital Zephyrhills; 7050 Gall Blvd,Zephyrhills, FL 33541 b. Interest in property: Owner c. Name and address of fee simple titleholder (if other than owner): Contractor: o a Name and address: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, FL 33813 b. Phone number: 863- 669 -0990 5. Surety a. Name and address: N/A PAULA S. O'NEIL, PASCO CLERK a COMPTROLLER b Amount of bond S 04/09/10 .:1tai POo 6 c. Phone number: OR BK � 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 following person(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, F133813 b. Phone number: 863- 669 -0990 W 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different <1— U cr �� W specified) W LL w W -_, date is spec WARNING TO OWNER: ANY PAYMENTS MADE : Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF t/) 4 0 O ~ 00 I COMMENCEMENT ARE CONSIDERED IMP ' s • ' PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA 'Q O 0 = Q � a STATUTES, AND CAN RESULT IN YOUR P + TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF l L O F W W COMMENCEMENT MU: BE RE RDE + 2 ' OSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND 1l. W Z L7 11 O TO OBTAIN FINANCI CONS LT W + i R LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING 2 1--' Q _�' 0 , 1 ' YOUR NOTICE+, Cl E+ ME u U+ �U loa (Signatu e . Own r or Owner' l�thorized Officer /Director/Partner /Manager) ,-- o Q O Cl O 14 �� (Signatory's Title/Office) W : O u V /� / f ® W O �, /t/ c1 / �W 0 0 _ > 0 The foregoing inserum t was ac nowledged before me this U day of , 2010, by j / �� L . (name of person) as 1 rte (ty . • of authority, ... e.g. officer, tru gttorne in act) for (name of party on ��' 0 0 CE g e behalf whom ' nstrument wa ex cured). i KATHLEEN S " " "e 0 O Z O . . /_. , Al /. -. / °�""" CommA� �o> 2a233 5 1•• w /,8 /2 0 ,2 N LI r' nature o otary Pu 0 re - State o lo , a) a Z Q 1....... : „... ....Fieelide Ncte son” Inc a U) t 1— O s a ...: (Print, Type, or Stamp Com 'ssioned Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced �✓ i/ 813-780 -0020 City of Zephyrhills Permit Application ‘ / � • Fax- 813 - 780 -0021 n Building Department (fr'� / f� j / �n �� Lv Date Received / F h �j 4 , Cr a 41 Phone Co , tact for Permitting 4 " 1 -- ©/ 6 0 / " mat . Owner's Name awe tZMIMINE = 0 IRA - - hone Number �i Owner's Address � �'� ' 'k J y 1 Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address I,�`r JOB ADDRESS 1� ate', .f. • . it1, , ~ I,W SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR Kt ADD /ALT n SIGN n MOVE DEMOLISH N ^ INSTALL •!i REPAIR ,omaci L PROPOSED USE n SFR Ili COMM n OTHER 1 TYPE OF CONSTRUCTION n BLOCK I FRAME n STEEL n OTHER DESCRIPTION OF WORK ATEDOMMINf 1 Cr BUILDING SIZE SO FOOTAGE HEIGHT n BUILDING ID ^ f 0 , O P VALUATION OF TOTAL CONSTRUCTION I /� ( ELECTRICAL $ , 1 IVJ. A�� AMP SERVICE I1 PROGRESS ENERGY I W.R.E.C. n PLUMBING Y in1M11111 n MECHANICAL A VALUATION OF MECHANICAL INSTALLATION n GAS n ROOFING n SPECIALTY n OTHER FINISHED FLOOR ELEVATIONS , il FLOOD ZONE AREA InYES InNO B [ y' Air • ( • 17 COMPANY Fl / • u5 / C REGISTERED sum FEE CURRENT �l l , r Y / N G Address ^ �'� ii License # C p � c o 6 / �/ T l 4i ELECTRICIAN ri / y� OMPANY SIGNATURE T REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address // License # PLUMBER /� COMPANY • SIGNATURE r� REGISTERED i Y/ N I FEE CURRENT i Y/ N Address I 1 I License # MECHANICAL 'n ( /�__ SIGNATURE �r l,� COMPANY REGISTERED 1 Y/ N I FEE CURRENT 1 Y/ N 1 Address n ^ License # OTHER f 1 COMPANY SIGNATURE 111 REGISTERED 1 Y/ N I FEE CURRENT I Y/ N I 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 Attomey (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 govemment 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 OBT _ N FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO • 0 OF • ENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT 2ITRAC R 1 `-L Subscribed and sworn to (or affirmed) before me this wo.• o ,1 ,�,, by Who is/are personally known to me or has/have produced o is/ re • - ona ly flown o m - .r has/have produced as identification. as identification. / Notary Public / " � / . ` /- / �..,., • : Publi •. ,:: a..n Commission No. EN S. MCCA Commission No. a �NUUry, �taYt ` Sg C orrrr D ' J072823 3 Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped ' E res '1 /18/2012 'tiry,?;;;n - Florida Nota ryAsan., Inc 7 1. Remove existing wa 2. Remove all pl umbi nc __ _ 3. Remove all flooring Al N � - 4. Remove all chair ra 5. Remove all casewor 6. Remove all abandon 7, Contractor to prote, 8. Remove all doors al 9. Remove all light fix _ 10. Remove existing cE fr 0 rr a 1� .....r., -i .....r., 11 e Saw cut floor to p i i l l i 1 and provide moisture 12. Contractor to scra to receive new vinyl 1 DEMOLITION l',J D E OLITION PLAN 4 I h = io fi 5V17' ; 7 . V Cf�' a A 1/L lf � i fr i f 1 Pasco County Parcel: 34- 25 -21- 0000 - 00300 -0091 001 Page 1 of 1 71Taia as Of: I Weekly Archive - Saturday, March 27, 2010 Parcel ID I 34- 25 -21- 0000 - 00300 -0091 (Card: 001 of 001) I Classification IL____ 19 - Professional Service Building Mailing Address Final 2009 Value CASELNOVA MICHAEL L & ANGELA M Ag Land $0 11335 FORT KING RD Land $64,427 DADE CITY FL 33525 -8513 Building $294,957 Physical Address Extra Features $3,455 7209 GREEN SLOPE DR ZEPHYRHILLS FL 33541 -1306 Market Value $362,839 Leqa) Description (First 4 Lines) Assessed (Non - School Amendment 1) $362,839 COM AT NE COR OF SE1 /4 OF SEC Taxable Value $362,839 34 TH ALG NORTH LINE THEREOF N89DEG 58'35 "W 1345.17 FT TO NLY EXTENSION OF WLY RIGHT -OF- I Land Detail (Card: 001 of 001) Line II Use IlDescriptionll Zoning II Units I Type I Price I Condition Value I 1 II 1900 II PROF.BLDG II 00C2 11 5,000.00 II SF II $8.00 11 1.00 II $40,000 I I 2 II 1900 11 PROF.BLDG Il 00C2 II 7,000.00 II SF II $2.15 II 1.00 II $15,050 I 3 II 1900 II PROF.BLDG II 00C2 II 9,871.00 lI SF II $0.95 II 1.00 II $9,377 I Additional Land Information I Acres II 0.50 II Tax Area II 30ZH II FEMA Code II -- IlCommericai Codell PTVM2AA I I Building Information - Use 19 - Offices Professional or Medical (Card: 001 of 001) Year Built 2002 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 Common Brick Roof Structure Gable or Hip Roof Cover Metal Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Ceramic Clay Tile Fuel Electric Heat Forced Air - Ducted A/C Central Baths 4.0 I Line II Description II Sq. Feet II Repi. Cost New I 1 BAS I 3,200 I $327,616 I 2 CAN I 64 II $1,945 I Extra Features (Card: 001 of 001) I I Line II Description II Year Il Units II Value 1 II PAV ASP II 2002 II 4,594 11 $2,636 1 2 �I PAV CON 2002 II 452 11 $819 I I Sales History I I Previous Owner ll N/A I Year II Month II Book /Page II Type I Amount I 2002 II 01 5102 / 1679 II W II $ I http: // appraiser. pascogov.com / search /parcel.aspx ?sec= 34 &twn= 25 &rng=21 &sbb= 0000 &b... 3/31/2010 it jt Adventist Health System Contract Review Response Contracting Parties: FH Zephyrhills and Michael L. and Angela M. Caselnova Contract Tracking Number: AH04671 Corporate Legal Services Reviewed by: Shainoor Ladha - KarmaliReview Date: 1/30/09 Cleared Review n Reviewed with Comments Reviewed with Additional Requirements ❑ General Comments: This submission consists of an office space lease agreement furnished by the landlord in this case a physician practicing in the community also served by FHZ. Under this lease, FHZ would lease the space currently used for the physician's private practice since the physician is closing his private practice. FHZ will use this space initially as storage and later for general office space. Consequently, the question, does it make sense for the hospital to rent this space in a medical office building since medical office buildings generally have higher rental rates than a general office building? Accordingly, please provide juslifir do s r�finc this space over another location. Since the physician is a potential referral source, the lease is subject to Stark law and the Anti - kickback statute. The lease agreement would comply with the applicable laws, provided the payment terms are reflective of fair market value in arms - length transactions, are not based on the volume or value of referrals or business otherwise generated between the parties, are not adjusted for proximity or convenience to referral sources, and the hospital can show business reasons in support of selection of this space over another location and that this space is reasonably necessary for hospital's business purpose. Additional Requirements /Language Changes: (i) Add the following to Section I of the Lease Agreement: ili HEALTH SYSTEM Page 1 of 3 B. Landlord does hereby grant to Tenant a nonexclusive license for the use and enjoyment of those certain areas appurtenant to the Leased Premises, consisting of all walkways and approaches to the Leased Premises and the parking area adjacent thereto. The license granted hereby shall exist only during the Term (original and any extended term) of this Lease, and shall terminate simultaneously with any cancellation of the Lease Agreement. In no event shall the aforementioned license be revoked or in any way limited by Landlord during the Term of this Lease other than by such reasonable rules and regulations applicable to all tenants in the medical office building. (ii) Add the following at the end of the paragraph in Section IV of the Lease Agreement: If Tenant is not then in default hereunder, any remaining balance of such deposit shall be returned by Landlord to Tenant upon expiration or early termination of this Lease Agreement less damages, ordinary wear and tear excepted. If Landlord transfers its ownership interest in the medical office building during the Lease Tenn, Landlord may assign the security deposit to the transferee and thereafter Landlord shall have no further liability for the return of such security deposit. (iii) Add the following to Section III of the Lease Agreement: In the event this Lease Agreement is terminated within the first year after the commencement date, then the parties may not enter into a new lease for the same space for the remainder of the first year. (iv) Lease Agreement provides for termination by Landlord for cause but no reciprocal provision exists for Tenant. Thus, add the following: XX. TERMINATION BY TENANT Tenant may terminate the Lease Agreement in the event Landlord is in breach of any of the terms of the Lease Agreement by providing thirty (30) days prior written notice to Landlord and the Landlord fails to cure such breach within the thirty (30) day period. Additionally, a copy of the agreement containing other proposed changes has been e- mailed. We have also forwarded the agreement to Stacy Prince at corporate risk for his review of the insurance provisions. Corporate Tax ADVENTIST HEALTH SYSTEM Page 2 of 3 Reviewed by: Mike Saunders Review Date: 2/23/09 Cleared Review Reviewed with Comments 1 Reviewed with Additional Requirements 1 General Comments: The contract under review is a MOB Lease Agreement. The lease rate is set at $15 per square foot. Based on the subsequent data provided, no significant tax issues were noted. Additional Requirements /Language Changes: Corporate Compliance Reviewed by: Dave Riesen Review Date: 2/23/09 Cleared Review Reviewed with Comments LI Reviewed with Additional Requirements (l General Comments: We believe the contract complies with the appropriate regulatory requirements. Additional Requirements /Language Changes: 1114A Man HEALTH SYSTEM Page 3 of 3 a Is the person a voting member of the board, a senior executive of the AHS entity, or an AHS management employee with total compensation greater than $90,000? [ )Yes b. Does the person hold a material financial interest in a provider - sponsored organization in which the AHS entity is a participant? I [Yes c. Is the contracting party an entity in which a disqualified person owns at least 35 %? ( [ Yes C, d. Did the person have any role in founding the organization or are they a substantial contributor (more than $5,000) to the AHS entity? 1 Yes e. Is the person's compensation primarily based on the revenues of a particular department or function of the AHS entity, which the person controls? ( [Yes f. Does the person manage a discrete segment or activity of the AHS entity that represents a substantial portion of the AHS entities overall operation - 1 I Yes 15. Legal Review a. Has AHS Corporate Legal Services previously reviewed this contract? If yes, name of attorney who reviewed: ®Ye b. Was external counsel used for this contract? If yes, name of attorney, firm & phone #: name 1 (Yes 16. Contract Approval By signing below, / acknowledge l have had an opportunity to read the materials prepared for the above contract and accept responsibility for their content. )Signature Date A) Preparers electronic signature 01/15/09 �;;s B) Entity CFO: electronic signature l ,01/15/09 iAj C) Entity CEO /COO: electronic signature i ` This Contract has been discussed with the Board or Finance -01/15/09 / (Exce0 COI Independent Contractor, Professional Services, Medical Directo Agreements, and Leases) [l Yes No Finance Committee Representative • (Except for Independent Contractor, Professional Services, and Medical Director Agreements) Contract Review Response Corporate Legal Se rvices Date: 01f01t0 t - - -- LEASE AGREEMENT THIS AGREEMENT, made and entered into this 23"' day of February, 2009, by and between MICHAEL L. and ANGELA M. CASELNOVA, hereinafter called "Landlord ", and FLORIDA HOSPITAL ZEPHYRHILLS, INC., hereinafter called "Tenant ". LEASED PREMISES A. The "Leased Premises" shall consist of a 3,200 square foot medical office building located at 7209 Greenslope Drive, Zephyrhills, Florida 33541. B. Landlord does hereby grant to Tenant a nonexclusive license for the use and enjoyment of those certain areas appurtenant to the Leased Premises, consisting of all walkways and approaches to the Leased Premises and the parking area adjacent thereto. The license granted hereby shall exist only during the Term (original and any extended teen) of this Lease, and shall terminate simultaneously with any cancellation of the Lease Agreement. In no event shall the aforementioned license be revoked or in any way limited by Landlord during the Term of this Lease other than by such reasonable rules and regulations applicable to all tenants in the medical office building. II• RENTAL AMOUNT A. Tenant shall pay to Landlord the amount of $15.00 per square foot ($48,000 per year). Payment of rent shall be made in the amount of $4,000.00 for each month during the Tenn (as defined in section III A.) of this Lease Agreement. B. Tenant represents that it is exempt from the requirements to pay sales tax and shall provide Landlord with proof of the exemption upon execution of this Lease and on an annual basis for each year of the Term of this Lease. In the event Tenant's exemption from paying sales tax is not valid or is subsequently revoked, Tenant shall pay to Landlord all applicable sales tax. C. The first payment shall be made on or before February 1, 2009 and subsequent payments shall be made on or before the 1 S ` day of each month thereafter until this Lease Agreement is terminated. D. All payments shall be made payable to Landlord and mailed or delivered to Landlord at 11335 Ft. King Road, Dade City, FL 33525, or such other address as Landlord may designate. III. TERM A. This Lease Agreement shall be for a period, commencing on February 18, 2009 and terminating on December 31, 2013. If the event this Lease Agreement is terminated within the first year after the commencement date, then the parties may not enter into a new lease for the same space for the remainder of the first year. IV. SECURITY DEPOSIT Tenant shall pay Landlord the sum of $500.00 as a security deposit upon execution of this Lease Agreement. If Tenant is not then in default hereunder, any remaining balance of such deposit shall be returned by Landlord to Tenant upon expiration or early termination of this Lease Agreement less damages, ordinary wear and tear excepted. If Landlord transfers its ownership interest in the medical office building during the Lease Tenn, Landlord shall have no further liability for the return of such security deposit. V. UTILITIES AND REPAIRS A. Tenant shall pay for all sewage, disposal services, solid waste assignments, water, electric, telephone and other public utilities furnished to the Leased Premises, and will keep the grounds and interior of the Leased Premises in good order and repair, and in a clean, safe and healthy condition. Landlord shall be responsible for all maintenance to the medical office building and exterior of the Leased Premises. B. Tenant shall maintain the interior of the Leased Premises in a good state of repair during the Term of this Lease Agreement. Tenant shall pay the full cost of any repairs to the interior of the Leased Premises which are required during the Term of this Lease Agreement. Specifically major repairs to the air conditioner /heater, roof, plumbing and electric, etc., shall be the responsibility of the Landlord. VI. NOTICES All notices by each party to the other which pertains to any matter concerning this lease Agreement, shall be provided to each party in writing at the following addresses: LANDLORD: 11335 Fort King Road, Dade City, FL 33525 TENANT: 7 050 Gall Blvd Zephyrhills, FL 33541 Attn: CFO In the event of any change in address by either party, notice of the change of address shall be provided to the other party by certified mail and shall act as substitute for the above - stated address. VII. OPTION TO EXTEND TERM Tenant shall have an option to extend the Term of this Lease Agreement for an additional two (2) years. In the event Tenant elects to exercise this option, the monthly rental shall increase to $17.00 per square foot and shall remain payable on a monthly basis. The monthly rental payments will be $4,533.33. To exercise this Option to Extend Tenn, Tenant must notify Landlord, by certified mail, of his election to exercise this Option, at least ninety (90) days before expiration of the original Term of this Lease Agreement. Any such extension shall be evidenced by a written agreement signed by the parties. VIII. MODIFICATIONS Tenant shall not make any modifications to the Leased Premises without the written consent of Landlord. Modifications include, but are not limited to, painting, flooring, lighting, relocation of walls, doors or windows, plumbing and electrical. IX. INSURANCE A. Tenant shall, at its sole cost and expense, maintain in effect during the entire term of this Lease, comprehensive Liability insurance, including bodily injury, liability and property damage liability coverage in the following amounts: One Million Dollars ($1,000,000.00) per occurrence for bodily injury (including death) and personal injury and One Million Dollars ($1,000,000.00) per occurrence for property damage. Such insurance shall be in policy form and amount, and underwritten by insurance underwriters, or obtained through self - funded programs acceptable to Landlord, and shall include Landlord as an additional named insured. Such insurance may be carried under a blanket policy covering the Leased Premises and other Tenant Premises. Tenant shall, within fifteen (15) days after commencement of the Lease Term, provide Landlord with written certification of all such insurance indicating compliance with the provisions hereof. The insurance policies required hereunder shall include a provision which waives any right of subrogation by Tenant and Tenant's insurance carriers against Landlord. The insurance required hereunder shall in no way limit the liability of the Tenant to Landlord pursuant to other provisions of this Lease or otherwise under law. B. Landlord shall insure the Medical office building in which leased premises are located for casualty damage. C. Tenant shall be responsible for insuring Tenant's equipment and personalty located within the Leased Premises, if Tenant so desires. X. DEFAULT A. In the event Tenant defaults in any obligation of the payment due hereunder, or any other conditions, covenants or provisions of this lease, Landlord shall be immediately entitled to re -enter said premises and to retake possession and shall not be liable for trespass or any other cause of action to Tenant. In the event of default hereunder by Tenant, Landlord shall have the right to accelerate and demand payment in full of the entire unpaid balance of the rental payments for the remaining term of this Lease and shall have the right to pursue any legal remedy to collect all future rents and to evict Tenant from said premises, and Tenant, in such event, shall pay all costs and reasonable attorney's fees incurred by Landlord as provided by law. B. In the event of default hereunder by Tenant, Landlord shall have a lien upon all property of the Tenant usually kept upon the Leased Premises. This lien shall be superior to any lien acquired subsequent to the bringing of the property onto the Leased Premises. 3 XI. ENTRY OF LANDLORD A. The Landlord may, at reasonable times during the term of this Lease Agreement, enter to inspect the Leased Premises, or to make any alterations as necessary to preserve the Leased Premises upon giving Tenant twenty -four hour notice provided Landlord uses best efforts not to interfere with Tenant's Business. XII. UNLAWFUL USE PROHIBITED A. The Tenant will not permit the Leased Premises to be used for any unlawful purpose, or in any way that will injure the reputation of the Landlord or of the building of which are premises for a part, or disturb the adjoining properties. XIII. DESTRUCTION OF LEASED PREMISES A. Should the Leased Premises or any part thereof be damaged or destroyed by fire or other casualty covered by insurance policies applicable to the Leased Premises, Landlord shall, except as otherwise provided herein, and the extent it recovers proceeds from such insurance, repair and/or rebuild the same with reasonable diligence. Landlord shall not be obligated to repair, rebuild, or replace any property belonging to Tenant or any improvements to the Leased Premises furnished by or for Tenant. If there should be a substantial interference with the operation of Tenant's Business in the Leased Premises as a result of such damage or destruction which requires Tenant to temporarily and/or partially close its Business to the public, the Rent shall abate to the extent of interference. B. Notwithstanding anything to the contrary contained in this Section or elsewhere in this Lease Agreement, Landlord, at their option, may terminate this Lease Agreement on thirty (30) days notice to Tenant, given within one hundred twenty (120) days after the occurrence of any damage or destruction if: (a) the Leased Premises is damaged or destroyed as a result of a risk which is not covered by Landlord's insurance; (b) the Leased Premises is damaged and the cost of repair exceeds twenty -five percent (25 %) of the then replacement cost of the Leased Premises. XIV. RECORDATION A. This Lease Agreement is not to be recorded. Tenant's recording of this Lease Agreement in the Public Records of the county wherein the Leased Premises are located or in any other public office shall constitute a default hereunder. B. Landlord, at its sole discretion, may record a memorandum or short lease in the public records, with or without Tenant's signature, for the purpose of complying with the provisions of Section 713.10, Florida Statutes. XV. SURRENDER OF LEASED PREMISES 4 A. Tenant shall deliver and surrender to Landlord possession of the Leased Premises upon expiration of this Lease Agreement, or its earlier termination as herein provided, broom cleaned and in as good condition and repair as the sane shall be at the commencement of the teen of this Lease Agreement. B. Tenant shall remove all property of Tenant and all alterations, additions and improvements, repair all damage to the Leased Premises caused by such removal and restore the Leased Premises to the condition in which they were prior to the installation of the articles so removed. Any property not so removed that the expiration of the term hereof shall be deemed to have been abandoned by tenant and may be retained or disposed of by Landlord, as Landlord shall desire. XVI. TRANSFERS BY LANDLORD A. Subject to all rights of the Tenant under the terms of this Lease Agreement, Landlord shall have the right to transfer and assign, in whole or in part, all of their rights and obligations hereunder and in the Leased Premises, and in such event and upon such transfer, Landlord shall be released from any further obligations hereunder, and Tenant agrees to look solely to such successor in interest of Landlord for performance under the terms of this Lease Agreement. In the event of transfer of the property by Landlord, Landlord's successor in interest shall be bound by all terms and conditions as the Landlord under this Lease Agreement. Upon such transfer and assignment, Tenant shall have the option to immediately terminate this Lease Agreement with written notice to Landlord at the time. XVII. ACCESS TO LEASED PREMISES A. Tenant shall permit Landlord or Landlord's agents to 'inspect or examine the Leased Premises at any reasonable time upon proper notice in accord with section XI and sha?1 permit Landlord to make such repairs, alterations, improvements or additions in the Leased Premises or the building of which the Leased Premises is a part, that Landlord may deem desirable or necessary or which Tenant has covenanted herein to do and has failed so to do, without the same being construed as an eviction of tenant in whole or in part and the rent shall in no manner abate unless specifically provided in this lease agreement while such repairs, alterations, improvements or additions are being made by reason of loss or interruption of the business of Tenant because of the conduct of such work provided Landlord uses best efforts not to interfere with Tenant's Business. XVIII. ASSIGNMENT Tenant shall not assign this Lease Agreement within the written consent of Landlord. XIX. LEGAL CONSTRUCTION A. The captions used in this Lease Agreement are for convenience only, and are not a part of this Lease Agreement, and do not in any way limit or amplify the terms and provisions hereof Any gender used herein shall be deemed to refer to any other gender more grammatically applicable to the party to whom such use of the gender relates. 5 The use of singular herein shall be deemed to include the plural and, conversely, the plural shall be deemed to include the singular. B. This Lease Agreement embodies the entire contract of the parties hereto, and shall not be altered, changed or modified in any respect, except by an instrument of equal dignity to this instrument that is signed by both parties. XX. TERMINATION BY TENANT A. Tenant may terminate the Lease Agreement in the event Landlord is in breach of any of the terms of the Lease Agreement by providing thirty (30) days prior written notice to Landlord and the Landlord fails to cure such breach within the thirty (30) day period. IN WITNESS WHEREOF, the parties hereto have set their hands and seals to duplicates hereof, the day and year first above written or caused the within to be duly executed by their proper officers and the seal of the corporation hereto affixed by proper authority of their Board of Directors. r_Wi:tnfNes: LANDLORD • Ao AL, Michael L. Caselnova Angel . Caselnova • Witnesses: TEN AxNT J FLORIDA H SPITAL ZrPHYRH!LLS, INC. . V4 ' - ,./ tihat-/ - 6' - '/ - >rif-v - -) A -7(2 1\1.." f. /./ • C. e 6 Title 6 , n . 1 9 . 2009 1 U . U9Ai,li 23 No if 1 G tri Am k r , A Ty, i N ! ICEMSED REAL ESTATE iikOKERS brizhills @aol.com December 16, 2008 Florida Hospital Zephyrhills 7050 Gall Blvd Zephyrhills, FL 3354 Attn: Cindy McMillan RE: Current Lease Rates Townview Medical Arts Development Dear Cindy, Per your request, the following are the most recent market lease rates in the Townview Medical Arts Development: 37814 Medical Arts Court Zephyrhills, FL Leased in May 2006 to Amedisys Home Health Services 3 year lease w /option Lease amount of $15.45 per sq ft plus additional $3.50 Cam per sq ft plus tax Base lease amount fixed for initial 3 year term 37806 Medical Arts Court Zephyrhills, FL Leased in January 2006 to Dr. Ingrid Lee -Loy 3 year lease w /option Lease amount of $15.00 per sq ft plus additional $3.50 Cam per sq if plu pax Base lease amount has 3% increases per year (currently at $1.5.91 per sq ft) Thank you Cindy, we look forward to assisting you with our Real Estate services. Sincerely, 6 .7 Brian Infantino Realtor. Associate Bingham Realty, Inc. /4 aos- Loiz -s:1 1971 - - - -- : s VENTIST For gi :E ay( } 1 } A) .I. Y S '1' 1.:1 Received Date: Contract Number: Contract Review Submission Form (For an explanation of the process, documentation requirements, and fair market value information, see the "Contract Review and FMV 2006" document located on the AHS Intranet) 1. AHS entity name: Florida Hospital Zephyrhifls, Inc. 2. Primary contact for this contract: Name: Donald Welch Title: CFO Phone: 813 - 783 -6100 3. Contracting parties: Florida Hospital Zephyrhills, Inc. & MICHAEL L. and ANGELA M. CASELNOVA, 4. Does the non -AHS contracting party have any other contracts with this or any other AHS entity? If "Yes ", please provide a description of the other contracts_ other contracts Yes 5. Type of contract: Lease Explain if "Other": explanation 6. Planned execution date: 02/01/09 Effective date: 02/01/09 Term (months): 60 7. Contract summary and services to be provided: Contract is to lease 3,200 square foot medical office building for $15 a square foot for office space. 8. How does this contract further the facilities exempt purpose and benefit the community? It allows us to have storage and additional office space instead of remodeling in the hospital. 9. What are the dollar amount, frequency, and other financial terms of the arrangement? The lease is $15 a SF or $48,000 year for five years. At the end of 5 years the contract can he renewed for $17 a SF for an additional 2 years. 10. How was the compensation amount determined? a review of rents and leases in the market is attached. 11. What is the source of the fair market value documentation: 12. Is compensation above the 50 and less than the 75 percentile? IA If "Yes ", please provide an explanation (special skills, experience, market demands): ri Yes explanation 13. Is compensation equal to or above the 75 percentile? If "Yes" please provide separate documentation supporting I I Yes ( ( the document titled "Contract Review and FMV 2006 " on the AHS Intranet). high compensation sE 14. "Disqualified Person" Determination: For initial determination of whether or not the contracting pa considered "disqualified ", please answer the following. If any items are checked "yes ", it may diicai an additional review will be needed by the Intermediate Sanctions committee. The "Primary Contact listed above may be contacted to assist in a final determination. Re,i ,rri 1nr1 Inc MOM �-1 N -. 9 0 N o 0 8 d- N O N , d- rn O co N O CIO rn C�) N NI - N � 9* Remove existing window Cut existing concrete f 1 oor to provide for new plumbing. Patch flooring to be smooth and level as required to accept vinyl plank f looi ng. Provide new moisture barrier under concrete patch Lion Notes xisting walls and doors shown dashed. oll plumbing fixtues shown dashed all f 1 oori ng and base. ill chair rails. 311 casework ill abandonded wiring and duct work. or to protect all existing walls to remain. ill doors and frames shown dashed ill light fixtues and A/C grill existing ceiling floor to provide for new plumbing. Patch floor 'e moisture barrier under new patch. smooth and level 12. Contractor to scrape and fill f 1 oor to create o smooth and level surface to receive new vinyl flooring REVIEW cUry UJr PP- �Y4f- i�l_,_c DEM PLAN FLANS EXAMIN =F; V4 • ° // -0" to r +ry COOL, D';; U U WJ U • r �D O N 00 U o M O � M .r N o N U o F+-I 0 cqd c 0 'S a� x a � o � o � o o Q a � 0 a� r� Cd \ O CC3 �i CCU � �TQ Project No. 10006.01 o w 0 3123/2010 11:18:37 AM ...TO,6elrovo's office \cd \A2 -0.dgn --r n ,i -- - k i n✓ ,.I n I/ A2.0 ©2010 BHIPK Architects, Inc.