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10-10949
CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10949 • BUILDING PERMIT Permit N umber: 109 Address: 793 GALL BLVD Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: ZEPHYR COMMONS Est. Value: Parcel Number: 3 5-25-21-0130-00000-0140 Improv. Cost: 31,400.00 Date Issued: 9/24/2010 Name: ZEPHYR COMMONS LLC Total Fees: 447.00 Address: 7990 GALL BLVD Amount Paid: 447.00 ZEPHYRHILLS, FL. 33542 Date Paid: 9/24/2010 Phone: Work Desc: FIRST BUILD OUT NAIL SALON W /BATH -1200 SQ FT Al H: _, � - - • 1- _ IL'IN 195.10 - " A 5 5 .0 0 : TRI AREA ELECTRICAL CONSTRUCTION PLUMBING FEE 50.00 MECHANICAL FEE 45.00 ROY J SCHLEMAN PLUMBING CO INC FIRE INSPECTION FEES 30.00 FIRE PLAN REVIEW FEES 72.00 ABSOLUTE AIR SYSTEMS INC 2 \aQ 11 \ 1 v C` 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 govemmental 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." .9. - I k‘11111e■ .k \ _ ilt-" rir ` �� '- `' ONTRA • R 'NATURE • PERMIT OFFI �T' R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIlII1 III1I1111IIIII1►11I r r 2010134852 • ,f • Rept:1326897 Rae: 18.50 05: 0.00 IT: 0.00 09/21/10 R. Glard, Dpty Clark PAULA S.O'NEIL,Ph.O.PRSCO CLERK & COMPTROLLER 09/21/10 5OA 2 1 63 NOTICE OF COMMENCEMENT Permit No. Property Identification No. 3 ' - - 2r - -o /3b 00000 0/VO THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1. Description of property (k �9 d :) St a /47TACeeD a) Street Address: n A 642 & VA ?6' /HY 94kkI.S, FL 2. General description of improvements: i A/AA 7 ✓'AII.L,ti s'lyE72. 4 oi�J a 4/7 3. Owner Information a) Name and address: Z EP/S/YA Coone.igS p 14 — 360 /l/MDrfed !.N , T4 Pte, fL 33648 b) Name and address of fee simple titleholder (if other than owner) c) Interest in property FrEE Sim /LE Contra Informa a) Name and address: An /MT (ANS RI /C7'1Dt) INC - P.0. 604 79OS 3d , - M/NPA, i rt. li b) Telephone No.: 916 6 /o /1,1 Fax No. (Opt.) 5. Surety Information a) Name and address: b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6. Lender a) Name and address: 1 iS50G0 4 41177011 ,j5 '/00 - VO/ E , "4c/ IJ $ +'/ /YSo T»t+Prt FL 336& Phone No. 913_ -Taps 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: D9L.X ,7b //NJ6#J 3491 /11,114 4 IA) . 7:4 f 2 3 ?6/,' b) Telephone No.: //3 - 933 - 06.24 Fax No. (Opt.) 8. In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes: a) Name and address: b) Telephone No.: Fax No. (Opt.) 9. Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is Specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION 01? THE NOTICE 01? 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 FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE A F COMMENCEMENT. STATE OF FLORIDA COUNTY OF PA9eO tl6J&4. , 6.4 / • l •`d' / Si -4- • of 1 - cr or 7 't AuthhdFized Ot6 artner/Manager f7.4 6.2• ro ns7 Print Name De oregoing instrument was acknowledged before me this . * day of Stria/16N— 2010 , by WO W. - JoIt.•asornt as c.or -(.p. a ...,r•- three,{t». — (type of authority, e.g. officer, trustee, attorney in fact) for Z4 h /r COt'»mn» s I.t.`• (name of party on behalf of hom instrument was executed). Personally Known ✓ OR Produced Identification _ Notary Signature Type of Identification Produced Name (print) - NytNies k. e.ypaeu•'i Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, 1 decl.ue that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief G ?.°i _ Si o a Nn l Peraon Si g v t t DONYA K. BECKMAN • Notary le - State of Florida • � � Pua I My Comm. Expires Da 1, 2013 t 4 1 • �_. ter Commission • DD 949888 k Bonded Though National Notary Assn. 5 7 *— • — OR BK 8423 PG 564 r 2 of 2 1' LEGAL DESCRIPTION Pared Al A palm erfn oe 7, 10, 23,14 32, 47.9 td 311, Sagether vak Tads & 9 , 24, 25,40, 41, 36 and 37, ZaphyrMla Colony Gamma Lando StldIvidon a,corded In Piet Boot 1, Pegs 55 ef the puhle 3=013 te Pasco Cowty. Nord', all tine within SeMon 35, Township 25 Sash, Range 21 Fast, Pam County, Pled and bdny mee perticuldN desaibed as Mows: Cameras at the Northwest corner ef Salton 35, Tewmhip 25 Seedy Parga23 Bet, Pasco Caddy, NOrld[i thence a01n 'ski Section Ina South 5'590' East, 15.13 holm the Point of Be>t rit7 therm continue slag add Ins South 896950' East, 3,0e005 Peet tame lavas weld sedlon IwR, South 00'09'45 Wed, 2,01& 50 fatte the Nosh Right of Way Ins of Pretty Paid Rod; thorn etong add North WBhtd Way line the Wound nine (3) muses 1) North 89•3'13' West, 351.50 Pat 2) Saudi Grow Woo, 5.00 Rut 3) North W53'23' Wet, 53136 Pat thence draft said Net RJ21R of We/ Ine, tlorth ()Moir West, O?3.10 Peet thews North 89'9412' W 102.90 feet thence North 00'0945 East, fed%Ore Poke of Bagesd g. Leas end Except The North 15' theses platted as Rad Rtht d Way. Also dues and Boast The North 290.0 feet of the Sala 515.0 feet of the Pat 1300 fad at the Scathe= 1/ 4 of the Southwest 1/4 of Northwest 1/4 of Seddon 35. Township 25 Sash, Range 21 East, keying paten d'haab 56 and 572ephyrails Colony Company tench Subdlvkten as reoadad In Plat Book 1, Pad 56, Public Ram of Pasco aunty, Pbdds. • • • • • 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 OFFICI L SEAL THIS a'? DAY OF SeV i 2010 PAULA •'NEIL, CLERK & OMPT R BY . _ l 4 0 TY Erttc orr _______ 4 . x 11" City of Zephyrhills BUILDING PLAN REVIEW COMMENTS 4)/ Contractor/Homeowner: � �4 Date Received: Site: 793 6',4--a 4 �v 7 Permit Type: l '57— 6 ci r7 dr / 2 ' Approved w /no comments: ❑ Approved w /the below comments: 7%4 Denied w /the below comments: ❑ • 14/ ■ ! � It ' . This co e % e , t shee shall be kept with the permit and/or plans. 1 1-20- Katy • Switz. (— Plans Examiner Date —�'� ,fir ctor `and/or Homeo er i t ',' • uired when comments are present) 4 . t r;v Sr r ,�I } 12 i ), r <J.ir,�rd� -.4.„ .w1 aCih 4^1 nA .• � t / s 'Y .', IA"t'M 4 ...■ �;. t , 14 r ` Sr�}��t'J!- ki'7ix7 • 4: " 'r' : .Aikz S s3 • , '''': "il 1 - • sY , j • • Z Y1 N O 0 sss r4 CZ qIC w7 0 4 • VI O LA N 4 HZN VIA w d Ww4 WOG W 4 �OtI G al W p V C4 Oil O N..1 a 1■• z0 a► I`ZV Oatx v aa4 - at w ,.. 1/.1 /".. < d O� O.00 Z y eol G. 0 •4 I — U v MN P. O .t - Z r w ,..r O rf tape, NI MS in t• )1.101 OC W V-: o.r oC a< I:7 O _ Z •. a N, J a liJ ill 15 1.4 '' C Z O 5 at C V O - Uf.I NMO- 1:Iw CDt`41 4N 4MN • .k, \ \I. .. . TO/TO 39Vd SW31SAS aIti 31l10Sg17 68 T688L£ T8 SZ : b T O TOZ /£Z /60 AC* 0 5- � 91.0 S'P'ATE OF: FLO.i JDA, . - , D RpARTME`N or- B� g � . - aCQNSTBUG I J o A Q S A At�.'IO>aF: DATE BATCH NUMBER ' LICENSE' - NBR. -;; s : . - ,.. .. L Q70000361 07' :08. 2010 100017167 CliteD2i52:7,7„r;:.4 =. ,. . The PZUraTrIG- CONT;RACTQR' c. -' i* - _ - • r , .: . - •:; . - , . Named- below IS - CEI TIFI - 'W. Under t'1.e raiile1.0 y �L. S yr k�' . P . - ns oaf. Cha�'�. � _ - T • .G., �' '• Expiration date: AUG 31, 20 � � . .12 }'�� . , W (i:i,; ' .. 7 .7 . � SCI;ILEMAN, . ROY..UAY -..•. n � . , ?' - _ . 9 T3 3.ClitiEMAN PLiTNi'INI . -,C o_ `' ` . a /, w . 9O BRIGGETT LANE ;, - = - - - .. BOX 1315 K l • a '' HILLSBOROUGH • FL 33':549. .CHARLIE 'C , .. . AR CR R IST - a . : . CSAR LIE• : =LIEN - OF�SPLI : . :- _ ' ,.,X ' .CRETAjtY - 'fA6 6'Y LAW ::' '- , '' ; • . - 2010-2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9-30 -2011 PouO FAL•au ma on IMCINWfC 1 ROOM I SERTS E'MRO'1r�S 0 0 0 I 7 RENEWAL I 23079.0000 OCC. CODE BUSINESS TYPE H. WASTE TAX CHARGE 090.028 CONTRACTOR - MECHANICAL & MASTER P UMBER sul 40.00 0 2 40.00 18.00 -0 1 1 BUSINESS 913 BRIGGETT LN LOCATION LUTZ 33549 NAME SCHLEMAN ROY JAY /DBA/ROY J SCHLEMAN PLUMB CO INC MAILING 913 BRIGGETT LANE ADDRess LUTZ FL 33549-0000 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR PAID - 8979 - 85 nut HMSO PAID A PRMLEGE TAX TO ENGnSE 813.636.6200 07/19/2010 " HMSO in , PNOITSSioN, oR 0CCUPAnoN sPEUVIEO HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED. ■• STATE OF FLORtQA AC# .• • 5027910 , D$PARTMENT OF BUSINESS • AND - -;, t . PROFESSIONAL , REGULATION' • • • • CFCO21.527 ::07/nA 10 100017147 CERTIFIED 'sl; =NG ,, 06NTRACTOR SCHLEMAN;; : ,C3 . I : — , - - ROY J SC I ,1w. 4:4.0......' Y COD[PaA1Y i . i - ,, ... -- I IS CERTIFIED under the provisions of Cb.489 7S ! , .. Expdratioo 4et. ?U( 31, 2012 L7.0070S00861 i � + ROY J. SCIILEMAN PLUMBING COMPANY, INC. 913 Briggett Lane Lutz, Florida 33548 -7908 Phone and Fax 813 - 948 -1622 State Certified: CFCO21527 E -mail: srschlemaaQa. verizoanet FAX Date: SEPT c To: C /rY of 'Poq ' ffi�G / n/T7di(/ . Subject: bee /A/Fr) Number of pages including this cover sheet 2- 09/20/2010 22:37 3525230434 BAUER ASSOCIATES PAGE 01 AC :WO DATE (MM/DD/YY) CERTIFICATE OF LIABILITY INSURANCE ! 09/21/10 PRODUCER Bauer & Associates THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 12210 US Highway 301 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE • HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Dade City, FL 33525 ALTER THE COVERAGE AFFORDED BY7HE POLICIES BELOW. Phone (352)567 -3702 Fax 352 523 -0434 1,. - � ) INSURERS AFFORDING COVERAGE NAIC # I -.,_ INSURED COLBY JAYNES PLUMBING INC. INSURER n: OWNERS INS. CO. • INSURER e: AUTO OWNERS INS. CO. i 39041 CLINTON AVE - _. DADE CITY, FL 33525 INSURER C: ._• i • • • INSURER D: i INSURER E: • VERA S I INSURER F: THE POLICIES OF INSURANCE LISTED 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 UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ./NSF! NSRD TYPE OF INSURANCE POLICY NUMBER � / DA wo om r ) N I LIMITS • GENERAL LIABILITY � EACH OCCURRENCE i 300,000. 41 COMMERCIAL GENERAL LIABILITY 20556297 -09 01/08/10 I DA 4GE TOREIQTEO — 50,000' I 01/08/11 I P REMISE�Eaoxurence) _...;L... CLAIMS MADE R, OCCUR MED EXP (Any one person) 5,000 • • • A — — I PERSONAL & ADV INJURY 300,000; ! ± _ I .GENERAL AGGREGATE 300, i GEN'LAGGREGATE LIMrrAPPLIES PER: i PR ODUCTS- COMP /OPAGG 300,000: N POLICY ✓ PROJECT F ; LOC AUTOMOBILE LIABILITY :COMBINED SINGLE LIMIT i u 300,000; ANY AUTO Z 9604948901 01/11/10 01/11/11 (Ea accident) 7 ALL OWNED AUTOS • B 7 L... SCHEDULED AUTOS ! BODILY INJURY i • • HIRED AUTOS ! BODILY NJ F. NON OWNED AUTOS I (Per accident) • • —' I PROPERTY DAMAGE 1 (Per accident) .L _ GARAGE LIABILITY ' ' AUTO ONLY - EA ACCIDENT � ANY AUTO . _ — • ! I i OTHER THAN EA ACC _ I I I AUTO ONLY: AGG _ • EXCESS/UMBRELLA LIABILITY I NCH OCCURRENCE OCCUR ! I CLAIMS MADE i • i AGGREGATE • • DEDUCTIBLE i —. . . -'- . .. . ' RETENTION $ WORKERS COMPENSATION AND I EMPLOYERS' LIABILITY .... OORR Y LIMIT S .20644045 01/08/10 01/08/11 . L J OTH_' • _ LIMITS ER 6 ! ANY PROPRIETOR / PARTNER / EXECUTIVE • E.L. EACH ACCIDENT 100,000 OFFICER / MEMBER EXCLUDED? If yes, describe under • E.L. DISEASE - EA EMPL 100 i SPECIAL PROVISIONS below -1 • E.L. DISEASE - POLICY LIMIT 500,000; OTHER I • • DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS :PLUMBING CONTRACTOR • CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF ZEPHYRHILLS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPT. THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY • 5335 8TH STREET • OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. RUTH /ZED REPRESS ATIVE ZEPHYRHILLS , FL 33542 � / / _ 1 FAX ©813 -780 -0021 ACORD 25 (2001/08) CIF � -• ACORD CORPORATION 199 88 Sep. 21. 2010 11:00AM No. 4258 P. 1/1 ACORD . CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) TM I 09/21/2010 PRODUCER Phone:,(813)988 -1234 Fax 813- 988 -0989 ASSOCIATES AGENCY, 988-1234 THIS CERTIFICATE IS ISSUED AS •A MATTER OF INFORMATION PO BOX 16190 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11470 N. 53RD ST. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AI TFP TAR COVFRAOF AFFORnFO RY TMF POLICIFS RFLOW TEMPLE TERRACE FL 33687 INSURERS AFFORDING COVERAGE NAIC # Agency Lic #:R001766 INSURED INSURER A: AUTO OWNERS INSURANCE CO. 18988 FAITHBILT BUILDERS, INC & INSURER B: AUTO OWNERS INSURANCE CO. 18988 FAITHBILT CONSTRUCTION, INC. PO BOX 270538 INSURER C: TAMPA FL 33688 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LTR INSRD DATE IMM/OD/YYI DATE (MM/DONYI LIMITS GENERAL LIABILITY 20670438 06/30/10 06/30/11 EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY DAM — 1,000,000 AGE TO RENTED PREMISES (Ea ocaurence) $ 300,000 CLAIMS MADE X OCCUR MED. EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: — PRO- PRODUCTS - COMP /OP AGG. $ 2,000,000 POLICY n JECT n LOC AUTOMOBILE LIABILITY 4642391900 09/04/10 09/04/11 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 100,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPER DAMAGE $ (Per acciden t) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT _ ANY AUTO _ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ — 71 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND l WC OR RYTLIMITS 1 1 OTHER EMPLOYERS' LIABILITY • ANY PROPRIETOR PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? R yes, describe sneer E.L. DISEASE -EA EMPLOYEE $ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Cky of Zephyrtlills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Building Department EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 5335 8th Street WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO Zephyrhills, Fl 33542 AGENTS OR REPRESENTATIVES. V OBLIGATION OR LIABILITY OF ANY KIND ICON THE INSURER, ITS AUTHORIZED REPRESENTATIVE Attention: Jackie fx 813 - 780 -0021 Trevor McCarthy ACORD 25 (2001/08) Certificate # 206166 6 ACORD CORPORATION 1988 SEP -20 -2010 21:12 P.02 A GORD ° DATE (MMroDmYr) CERTIFICATE OF LIABILITY INSURANCE 9/14/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT N►ME: Hazy R ots Alan Williams & Assoc Ins Agency Inc � "I t (239) 418 -1100 Nol (239)419•1164 T 13700 -1 Ben C. Pratt/ trAlis5: mretz8 alanwilliame . net Six Mile Cypress Pkwy PRCIDU Io ,00007688 Ft . Myers FL 33 912 INSURERI ) AFFORDING COVERAGE _ NAIC p INSURED INSURER A Ohio Casualty Insurance 27074 INSURER a Bridgefield ESI 10701 Tri -Area Electrical Construction, Inc. INSURER CI 1 1 1 1 ( V\ 1'1g. 1 o l s rei N o" NE , uYSURER o ■ Unit 38 INSURER E : • Cape Coral FL 33909 I_... INSURER F I I . COVERAGES • CERTIFICATE NUMBER :10 -11 cL /AU /wc /t M5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED 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 WMICM THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VW TRR TYPE OF INSURANCE O MR VNO POLICYNUMBER (M DINYYYY) ( UNITS GENERAL UABIUTV — EACH OCCURRENCE $ 1, 000, 000 • X COMMERCIAL GENERAL UA9ILITY DAMAGE TO RENTED 2BEMISES,(Eeocanence)_ $ 100, 000 il A , CLAIMS -MADE OCCUR • . B[CO59669654 9/7/2010 9/7/2011 MED EXP./Any one pehsn) S 10,000 X PO Dad 8300 PERSONAL a ADV INJURY s 1 , 000,000 X XCU i Contractual GENERAL AGGREGATE _ S 2 , 000 , 000 GErn. AGGREGATE UMIT APPLIES PER: . • PRODUCTS - COMP/OP AGG S 2,000,000 7 POUCY F 1; j LOC S AUTOMOaILE LIABILITY COMBINED SINGLE UNIT S 1,000,000 000 • X ANY AUTO (Ea ecGOeIIU , , A ALL GAMED AUTOS 53053669854 9/7/2010 9/7/2011 BODILY INJURY (Per Deleon) S _ SCHEDULED AUTOS BODILY INJURY (Per accidere s ` . X HIRED AUTOS PROPERTY DAMAGE' S . (Pe raaideM) X NONOWNEDAUTOS . MecscelpeymeMs S 5,000 unlnsureo molonacomsned $ 100 , 000 . - UMBRELLA LIAB OCCUR . • EACH OCCURRENCE S - .� EXCESS MAR • CLAIMS -MADE AGGREGATE — S DEDUCTIBLE S — • A X RETENTION S 0 US053669854 9/7/2010 9/7/2011 — $ B WORKERS COMPENSATION I WC STATU 10TH- AND EMPLOYERS UAEIUTY Y X TORY ISMS FR • ANY PROPRIETORIPARTNERIEXECUTIVE E 500,000 OFFICER urseeR E7CCWOED9 N/A E.L. EACH ACCIDENT S (Mamdahxy to NN) 0830 -39137 4/8/2010 4/8/2011 E.L. DISEASE - EA EMPLOYEE S 500,000 If yga, desaioe unoer DESCRIPTION OF OPERATIONS below • E L, DISEASE - POLICY UMIT I•S - SOO , 000 - • • DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES Bleach ACORD 107, Adedieml Remarks Schedule, if more apace M required) Re: William T. Leone CERTIFICATE HOLDER CANCELLATION (813)780 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Zephyr Hills Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street Zephyr Hills, FL 33542 AUTHORIZEDREPR5SENTATNE Esther Maddox /CL11 r ACORD 25 (2009/09) 01988 -2009 ACORD CORPORATION. All rights reserved. INSO2S (zoo$Q9) The ACORD name and logo are registered marks of ACORD SEP -20 -2010 21:12 P.01 1 TRI-AREA ELECTRICAL CONSTRUCTION, INC. 1110 NE Pine Island Rd_ Unit 38. CAPE CORAL, FL 33909 + 239 -573 -7235 FAX 239 -573 -3274 FACSIMILE TRANSMITTAL SHEET TO PROM: .... __._ ..:........ . ... _ _ Whom this may concern Jody COMPANY: DATE: 9/21 /2010 FAX NUMBER, TOTAL. NO. OF PAGES INCLUDING COVER: PROM?. NUMBER' ,rFNDF.•R:y' R1 FF,RF,NGF, NUMI IL RP° YOUR R1 NUMQTR: Certificate Of Liability Insurance, and State Of Florida updated License ❑ URGENT Q FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE: RECYCLE N C)TI S /COMMENTS: Thank you, Jody TriArea Electrical Construction, Inc. iodybrantnu.comcast.neti 239- 573 -3274 FAX . SEP -20 -2010 21:13 4 STATE OF FLORIDA P. 03 `�- vv ' • DEPARTMENT OF BUSINESS AND PROF ESSIONAL REGTJLATION "—Re.- '� ULATION `' y p ELEC •TRICAL CONT RACTO RS LICENSING BOARD J (850) 487-1395 • - t ' N � TALLAHASSEE 9 4 0 RTH MONROE STREET FL 32399 -0783 LEONE, WILLIAM T TRI -AREA ELECTRICAL CONSTRUCTION INC P.O. BOX 6737 YOUNGSTOWN OH 44501 Congratulations! With this license you become one of the nearly one million STATE OF FLORIDA A 4 9 9 5 i Floridians licensed by the Department of Business and Professional Regulation. ' DEt?ART OF REG T A :':: Our professionals and businesses range from architects to yacht brokers, from ' PROFESSIONAL REGULATI ON . boxers to barbeque restaurants, and they keep Florida's economy strong. ' EC13003586 4.:•- 0612/•10. 09.8174878 Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfloridalicense.com. CERTIFIED .BLECTRZCAI: - CONTRACTOR There you can find more information about our divisions and the regulations that LEONE,: WILLIAM T_'. • impact you, subscribe to department newsletters and team more about the Department's initiatives. TRI -? ELECTRICAL. CONSTRUCTION Our mission at the Department is: License Efficiently. Regulate Fairly. We r " constantly strive to serve you better so that you can serve. your customers. "` Thank you for doing business in Florida, and congratulations on your new license! Is CERTIFIED under the proviaiono of cet.489 re - • z=94,aoion eau: AVG . .2012 L10061.200236 ' . % DETACH HERE • Acs 4993151 STATE OF FLORIDA •DEPAR.TMENT OF BUSINESS AND PROFESSIONAL' 'ELECTRICAL' CONTRACTORS BOARD 1,- ION ". • RAC•TORSLICENSING BOARD.- .. DATE BATCH NUMBER LICENSE NBR . . SEQ#LI0061200236 • 0012/2010 698174878•:: E • C13003588. .4 :.' - The .. .. ' - • - - ' ELECTRICAL : ' Named' below I 5 CERTIFIED - Under : ' the pz^ovisiona Of Chapter .�489-FS � Expiration. date: AUG'31,: 2012_;,:•^ * 4:'.- , '.L� = _ -' dp '- ' - -I -:1 LEONE, '..WI T r, • . _ • TRI - AREA' ELECTRICAT - CONSTRUCTION' 'INC 111.0 NE: PINE ISLAND RD CAPE CORAL :... • 3 ;T •e 1. :� . i�. . FL 3 909 , - ' p • � < � •:w. •fir - ` - -.r. i'►• :cr ERIST ;GOVERNOR �=• "�- _'�� CHI ' S E'-� Li :: ;- - c INTERIM T A d iSP 1.:•: A -RE :;a SECRE .:. L AY QUIREO BY LAW AltY: '. TOTAL P.03 Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, 11 33542 Fire Marshal 13us (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett(th re.zephyrhills.fl.us Plan Review #: 10 -110 Project: Interior Build Out Pages: 13 September 20, 2010 I have received and reviewed the plans for the interior build out located at 7932 Gall Blvd and will allow the plans to move forward. By paying for permit, contractor acknowledges to comply with the comments below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Plans shall be submitted for changes to the fire alarm and fire sprinkler system by the installing contractors in order to obtain permit to complete the job. 2. Install emergency light in restroom. 3. Ensure duct detector is hooked up and working properly. Ensure all appliances associated with the fire alarm are addressed to the panel properly. 4. A key will be required at final to install in the Knox Box at the front of the building. 5. Ensure all penetrations to the rated walls are done in accordance to the plans submitted. 6. Ensure address is located at the front and rear door. 7. Ensure the electric panel outside is addressed to unit. 8. Label fire wall "FIREWALL -DO NOT PENETRATE" in several areas across the wall. Inspection Required: 1. Screw inspection on firewall 2. Final fire wall 3. Final KE' i • TT, FIRE MARSHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. ZEP YRHILLS FIRE DEPARTMENT • 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith VVilliams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES t 1L' Occupancy N9.: ` Plan No.: -- f � Contractor: �,Zi ,, 7 ,, l Business Name: Billing Address: _ u/ 1 Business Address: / :: .K,,. Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES FALSE ALARM FEE t _ PERMIT FEE _ Site Plan N/ _ Annual N/C Sprinkler Multi- Family /Commercia .06 sf 1st Re-inspection $` 1st Alarm N/C N/C Standpipes $50 2nd Alarm (Minimum Charge 2nd Re- inspection $100 — N/C _ Fire Pump $50 3rd Alarm N/C Plan Revisions DBL — 3rd Re- inspection $25p Hoods $50 4th Alarm __ 4th Re -Ins pection $500 — $100 Fire Alarm $50 _ 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until — LP Gas 0 - 25 Heads $50 _ 6th Alarm $200 $50 violations corrected) — Natural Gas $50 _ NON COMPLIANCE $150 _ 26 plus Heads $100 SPRINKLER SYSTEMS — Fuel Tanks ^ — per tank $50 STANDPIPE SYSTEM _ Undergrounds $45 El Sparklers $100 Per Riser $50 Hydrostatic Test $65 per system _ � Fire Works $500 FIRE PUMP _ Acceptance Test $45 0 per system _ Camp Fire $2S Per Pump $100 _ Hydrant Flow $75 Controlled Burn FIRE ALARM SYSTEM –' $100 Hood /Duct $50 — 0 - 25 Devices $50 -- FIRE ALARM SYSTEM — Place of Assembl _ 26 plus Devices -- Y $50 Annual $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 $1 per wall — Generator .< KW $100 CO2 — — $50 — LP Gas $25 per rank _Generator >30 KW 150 — Other $50 ` Natural Gas $25 per system Bio -Hazard Waste $100 Annual KITCHEN EXHAUST — El — Fumigation Tenting $50 Hood /Ducts $50 — Tent 10'x10' or greater $ 15 pe r ten 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 Acs $50 PLANS TOTAL 724_ INSPECTION TOTAL FALSE ALARM PERMIT TOTAL _ — TOTAL GRAND TOTAL I JLy 2 - Comments: : tor: - - 813 -780 -0020 City of Zephyrhills Permit Application Fax- 813 -780 -0021 Building Department — 4 t 0, Date Received 9-1 7 phone Contact for Permitting L > / 0 -- 7�5 `( Owner's Name Z - \ N . � ... - - I-lb ) Owner Phone Numbe ` Owner's Address 3 ` ` t �0. 1ktAN `I0.1% ` 0 o ik� "I 1 t Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address q JOB ADDRESS 773 4: . 411 A' I LOT # SUBDIVISION - — PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED Fil NEW CONSTR ADD /ALT I I SIGN I I MOVE 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE I I SFR I� I COMM 11 OTHER I TYPE OF CONSTRUCTION I I BLOCK I I FRAME r STEEL IN OTHER I DESCRIPTION OF WORK t S ���` p .7-14101111.11311 i• �� -I S 9I t \ _ _ BUILDING SIZE SQ FOOTAGE / Z.6 6 HEIGHT • I BUILDING $ VALUATION OF TOTAL CONSTRUCTION •20 0 I I ELECTRICAL $ AMP SERVICE (Zpey PROGRESS ENERGY ' N 1 W.R.E.C. S ev0 1 I PLUMBING $ G c 4 bog ( `fi r MECHANICAL $ .7 O v VALUATION OF MECHANICAL INSTALLATION I I GAS 1 1 ROOFING 1 1 SPECIALTY 1 1 OTHER (J en J j FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES LINO � J r s 0A- BUILDER \ COMPANY �, ` C b -ham ` 1 Ty► M� SIGNATURE - ± '' k -, � C``' REGISTERED 1 Y / N I FEE CURRENT Y / N Address o f /A I WN,1 °v.1L.- ia . —Vow t S� 742 License # ti /-? 4 7.23y SIGNATURE . 4 ( j 4 jr , s! , , p , R OMP A N D I Y/ N 1 FEE CURRENT I Y / N Address CO License # PLUMBER dah,_ V COMPANY Re'l T. Sc.:Verna. .4i.,A� / . tC' • / ��` . ,...`mil SIGNATURE 1 REGISTERED I Y / N 1 FEE CURRENT Y / N Address `PS 13 7e 4zi4C Z../..4Z, i. 3355/ License # MECHANICAL D r J COMPANY �A60 s0/€4 ,l� �t 2 $ y"S �;z SIGNATURE T IC J� v REGISTERED I N I FEE CURRENT I N I Address 373 /�v5 - / /�Q Z -� I �l s ` - , License # C A c 1813 / 8 1 OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I Address License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ****PROPERTY SURVEY required for all NEW construction. Directions: - Fill out application completely. ., . . . Owner & Contractor sign back of application, notarized • If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) *` Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW tics,? lo 4e, .l� „4 ', � el L \ , - Ss& . 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 r"eitrictionstW • . UNLICENSED CONTRACTOR AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a' contractor or contractors to undertake work, they may be required to be Iicened in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner'dnd • cottfrdotor ,rrray'•4ge,citerlrfor a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division — Licensing Section at 727 -847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE R ECOVERY F S: 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,Ps merfded): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a<LopY of the "Florida .OSnetructiorr. Law — Homeowner's Protection Guide" prepared by the Florida Department of Agulture and Consumer Affairs. ' If the applicant is someone other than the "owner ", I certify that I have obtained a copy ofihe above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify that all the information in this application i accurate and that all work will be done in compliance with all applicable, laws regulating construction, zoning and` d evelopment. Application is hereby made to obtain a permit to do v`vork and installation as indicated. I certify that po 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 to: my responsibility to identify actions I must take to be in compliance. Protection -Cyp ess Bayheads, Areas .and Environmentally lt Sensitive - Department of Env Lands, Water/Wastewater Treatment. Bayheads, Wetland Areas, Altering - Southwest Florida Water Management District - Wells, Cyp ress Y Watercourses. - Army Corps of Engineers - Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services /Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks.; , A-' - US Environmental Protection Agency- Asbestos abatement. Federal Aviation Authority- Runways. dndetsfand that thd'following restrictions apply to the use _off : Use of fill is not allowed in Flood Zone "V" unfe'ss expreSsly'pettnitted. ° • - - 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 n not d v er se l cited affect d for ado at n prope If use of fill is found to adversely affect adjacent properties, 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, 1. promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing constr l asn or rr other installations not specifically included red the electrical A plumbing, signs, pools, air Condit g, gas, aside a a ny pr v i i o construed ns of the te co hn i be a license to c al codes, nor shall proceed with of a permit prevent the Building O ctaf from thereafter set asde any proi codes, requiring a correction of errors in plans, construction llenced within six of permit t pss work become authorized by unless the work authorized by such permit m a pbe requested, esquested, in writd o g, from abandoned the Building i Offi Official (6) period not to e exceed the ninety days and will demonstrate may be eted, in ing, from job is considered abandoned. justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the j WARNING TO OWNER: YOUR FAILURE TOT IF YOU INT TO OBTAIN FINANCING CONSULT PA TWICE FOR IMPROVEMENTS TO YO UR PROPERTY. WITH YOUR LEND -,- OR AN ATTORNEY BEFORE RECORDING Y • UR NOTICE 0 . .COMMENCEMENT. FLORIDA JURAT (F.S. .03) /�` C ONTRACTOR AA OWNER OR AGENT _ _l ‘,/,, is �(�,y} Subscribed and swo or a' rmed) .efore me this ub libel and sworn o or a' rmed i • eN v V by "r - r .: k BY �� ' Who Is /are personally known to me or has /have produced "�: re personally known to me o I Identification. produced as identification. as ificati G Notary Public � � �` No tary Public . /)_.1__ - ILA._ Co 'sslon No. - 0 0 3a. ( Commission No. La t � — -- — — — — Mary typed, printed or stamped Na a of Notary typed, printed or st • ' „,,r,�, CAROL SMID01f ` ` - � Notary Public - State of Florida • 1 s ; II$ Conw�elCn Expires /um 13, 2011 M ■ 1 . . ' -s: • Commission ! DO 703271 4 %,..',„, ` * Doodad Through Radom' Notary Assn. 0 _...... ... ..,.,. ....- .e.___—...A_ _ _ 08/31/2010 19:23 8139621913 PAGE 01 . City of ZephVrhills Permit Appficatiofi • Building Departmen Contact for Permlttln. Phone .... ..... .. ne Co to Date Rece _ ._ -- :,:a::••••••• Nu ' :::::: Owner Phone Numbs Owner's Name Owner Phone mber Owner's Address Owner Phona Number immumi. Fee Simple Titleholder Name • / Fee Simple Titleholder Address LOT Ij r1= .yea 'A, v' .41\v JOB ADDRESS PARCEL ID# SUBDIVISION ( OBTAINED FROM PRO PERTY TAX NOTICE) DEMOLISH, ADD /ALT SIGN MOVE Q El NEW CONSTR REPAIR WORK PROPOSED INSTALL COMM C] OTHER • PROPOSED USE [ SFR 11II FRAME STEEL OTHER TYPE OF CONSTRUCTION Li BLOCK l� • DESCRIPTION OF WORK —. BUILDING SIZE SQ FOOTAGE r L b ] HEIGHT l 1 BUILDING ($ . 0 �o s 0 1 VALUATION OF TOTAL CONSTRUCTION t I PROGRESS ENERGY �' I W.R.E.0 r-i ELECTRICAL $ AMP SERVICE O e O I _ PLUMBING $ MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION • 1 GAS � ROOFING . 1 SPECIALTY n OTHER FINISHED FLOOR ELEVATIONS r I FLOOD ZONE AREA YES 11:1t40 • BUILDER COMPANY ��1 [�` 1�� C drJ - • SIGNATURE REGISTERED Y / N FEE CURRENT Y / N I Address . License # t- t-• /wf A ELECTRICIAN /G� / COMPANY f RI IIPE ferric/tit icAC Co NS He oct ON SIGNATURE L(/ REGISTERED • 1ZEIPfIIII FEE CURRENT Y / N Address \ 0 IJ E i� I w E I S I AND D R (, 38 Ca QE C v# t4 r C,- f License # Fe �- 1 3 co 3.S • PLUMBER • COMPANY SIGNATURE REGISTERED Y / N FEE CURRENT Y / N Address _ License # C MECHANICAL P � �Q. / A4 sOICG f� /Z i�� 4 SIGNATURE b /'���/. COMPANY REGISTERED I N I FEE CURRENT ' N I Address 37 32.5 . " `Ire 3 7-X- -- License* f A c f 8 l e3? 89 OTHER J COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT Y! N I Address ( M 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 len (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpsler; 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 len (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed. Sanitary Facilities & 1 dumpsler. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plana. ""PROPERTY SURVEY required for ell NEW construction. . Directions: • +M++ r++H+► Fill out application completely. Owner & Contractor sign back of application, notarized • . • If over $2500, a Notice of Commencement is required. (A /C upgrades over 15000) 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 • I Florida Energy Efficiency Code For Building Construction Florida Department of Community Affairs EnergyGauge Summit® FIa /Com -2008, Effective: March 1, 2009 -- Form 400A -2008 Method A: Whole Building Performance Method for Commercial Buildings PROJECT SUMMARY Short Desc: 206319.0.14 Description: Tenant Buildout B7 @ Zeph Owner: Primerica Group One, Inc. Addressl: 7932 Gall Blvd. City: Zephyrhills Address2: RETAIL B7 State: FL Zip: 0 Type: Retail Class: New Special class building Jurisdiction: ZEPHYRHILLS, PASCO COUNTY, FL (611600) Conditioned Area: 1200 SF Conditioned & UnConditioned Area: 1200 SF No of Stories: 1 Area entered from Plans 0 SF Permit No: 0 Max Tonnage 4 If different, write in: Y/ s,». EnergyGauge Summit® FIa /Com -2008. Effective: March 1, 2009 8/27/2010 Page 1 of 7 / :; .'`�� �^ -�� .� �~-.- .\\v4N Compliance Summary Component Design Criteria Result Gross Energy Cost (in $) 1,391.0 1,505.0 PASSED LIGHTING CONTROLS PASSES EXTERNAL LIGHTING None Entered HVAC SYSTEM PASSES PLANT None Entered WATER HEATING SYSTEMS None Entered PIPING SYSTEMS None Entered Met all required compliance from Check List? Yes/No/NA IMPORTANT MESSAGE Info 5009 -- -- -- An input report of this design building must be submitted along with this Compliance Report EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 2 of 7 • CERTIFICATIONS 1 hereby certify that the plans and specifications covered by this calculation are in compli -nc=, i h the Florida Energy Code Prepared By: Tracey Brady Building Official: 1, J / Date: ,� // Date: I certify that this building is in compliance with the FLorida Energy Efficiency Code r s- Owner Age,rit\ \ Date: ! If Required by Florida law, I hereby certify (*) that the system design is in compliance with the FLorida Energy Efficiency Code Architect: Reg No: Electrical Designer: Reg No: Lighting Designer: Reg No: Mechanical Designer: JOSEPH F. KEENE Reg No: FL 60322 Plumbing Designer: JOSEPH F. KEENE Reg No: FL 60322 (*) Signature is required where Florida Law requires design to be performed by registered design professionals. EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 3 of 7 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Building End Uses 1) Proposed 2) Baseline Total 90.80 115.90 $1,391 $1,771 ELECTRICITY(MBtu /kWh /$) 90.80 115.90 26601 33926 $1,391 $1, 771 AREA LIGHTS 23.00 37.60 6741 11020 $353 $575 MISC EQUIPMT 17.60 17.60 5146 5146 $269 $269 PUMPS & MISC 0.00 0.00 1 2 $0 $0 SPACE COOL 31.50 35.70 9219 10449 $482 $545 SPACE HEAT 0.00 0.20 10 46 $1 $2 VENT FANS 18.70 24.80 5484 7263 $287 $379 Passing requires Proposed Building cost to be at most 85% PASSES of Baseline cost. This Proposed Building is at 78.6% EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 4 of 7 • External Lighting Compliance Description Category Tradable? Allowance Area or Length ELPA CLP (W/Unit) or No. of Units (W) (W) (Sqft or ft) None Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Lighting Controls Compliance Acronym Ashrae Description Area Design Min Compli- ID (sq.ft) CP CP ance RETAIL B 25,001 Sales Area 1,200 2 1 PASSES PASSES Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) System Report Compliance RETAIL RTU -4 ton Constant Volume Packaged No. of Units B7 System 1 Component Category Capacity Design Eff Design IPLV Comp - Eff Criteria IPLV Criteria Iiance Cooling System Air Conditioners Air Cooled 13.00 12.23 13.00 PASSES < 65000 Btu /h Cooling Capacity Heating System Electric Furnace 1.00 1.00 PASSES Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System - Supply Constant Volume Air Distribution ADS System 6.00 PASSES System PASSES EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 5 of 7 Plant Compliance Description Installed Size Design Min Design Min Category Comp No Eff Eff IPLV IPLV liance None Water Heater Compliance Description Type Category Design Min Design Max Comp Eff Eff Loss Loss liance None Piping System Compliance Category Pipe Dia Is Operating Ins Cond Ins Reg Ins Compliance finches] Runout? Temp Btu -in /hr Thick 1inl Thick link [FI .SF.F] None EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 6 of 7 Project: 206319.0.14 Title: Tedant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Other Required Compliance Category Section Requirement (write N/A in box if not applicable) Chec Report 13 -101 Input Report Print -Out from EnergyGauge FlaCom attached Operations Manual 13- 102.1, Operations manual provided to owner 13 -410, 13 -413 Windows & Doors 13- 406.AB.1.1 Glazed swinging entrance & revolving doors: max. 1.0 cfm/ft all other products: 0.4 cfm /ft Joints /Cracks 13- 406.AB.1.2 To be caulked, gasketed, weather - stripped or otherwise sealed Dropped Ceiling Cavity 13- 406.AB.3 Vented: seal & insulated ceiling. Unvented seal & insulate roof & side walls System 13 -407 HVAC Load sizing has been performed Reheat 13 -407.B Electric resistance reheat prohibited HVAC Efficiency 13 -407, 13 -408 Minimum efficiences: Cooling Tables 13- 407.AB.3.2.1 A -D; Heating Tables 13- 407.AB.3.2.1 B, 13- 407.AB.3.2.1 D, 13- 408.AB.3.2.1 E, 13- 408.AB.3.2F HVAC Controls 13- 407.AB.2 Zone controls prevent reheat (exceptions); simultaneous heating and cooling in each zone; combined HAC deadband of at least 5 °F (exceptions) Ventilation Controls 13- 409.AB.3 Motorized dampers reqd, except gravity dampers OK in: 1) exhaust systems and 2) systems with design outside air intake or exhaust capacity <300 cfm ADS 13 -410 Duct sizing and Design have been performed HVAC Ducts 13- 410.AB Air ducts, fittings, mechanical equipment & plenum chambers shall be mechanically attached, sealed, insulated & installed per Sec. 13 -410 Air Distribution Systems Balancing 13- 410.AB.4 HVAC distribution system(s) tested & balanced. Report in construction documents Piping Insulation 13- 411.AB In accordance with Table 13 -41 1.AB.2 Water Heaters 13- 412.AB Performance requirements in accordance with Table 13- 412.AB.3. Heat trap required Swimming Pools 13- 412.AB.2.6 Cover on heated swimming pools: Time switch (exceptions); r,rlr Readily accessible on /off switch Hot Water Pipe 13- 411.AB.3 Table 13- 411.AB.2 for circulating systems, first 8 feet of outlet Insulation pipe from storage tank and between inlet pipe and heat trap Water Fixtures 13- 412.AB.2.5 Shower hot water flow restricted to 2.5 gpm at 80 psi. Public lavatory fixture how water flow 0.5 gpm max; if self - closing valve 0.25 gallon recirculating, 0.5 gallon non recirculating Motors 13 -414 Motor efficiency criteria have been met Lighting Controls 13- 415.AB Automatic control required for interior lighting in buildings >5,000 s.f.; Space control; Exterior photo sensor; Tandom wiring with 1 or 3 linear fluuorescent lamps >30W EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 7 of 7 r. cu aL E :a L o c = Q cr , o > � � cn E- F U cC o L i 4) 0.J Q Z. '-- cd 3 0 � o o rz4 Z F.- L o +, OA v i) v, . ,....c; c .� CA • C - ei �/ Li'" O U z cei Q • O CG Pi a., - W b 3 N N r id �"� : w E .•4 c a= E tat A 0 a. C7 [• N V) as ;MI o p L W Z o z w U 0 L U F" .0 — c p c. 0. N a5 E' 0 a t- Ca E- an -6 2 -°o �Q = C7 CS; CO C 7 CCi c Q N C v.-) c M a C o E �! • } Q 0 (� O Flr V Q 7. ��... /� y cn cl - N O z O .r; ° E co E O a >, -J a a o ¢ L a w Q o C4 o N o z N 4 — 00 El _ ❑ ❑ 111 0 y N _C c a l 00 V'1 CQ Li, N O c.., r e . : N O O a n O G L N ' S L o rq en z 4-. Q Cl M GO O ° 00 ON a w a 7 M O — O T 2 �+ [� O 7 ._ o F c U Oa ,n ,-. a N L y U eD — oL o O 2 '° o 0 C o w oo U m °o 33 - 3 o a. kn N i W L `o A 0 61 .1- L 00 O a cQ F. O CA C ° ■ N -1... • E ea n O 3 a L� N M o _ in 2 0 ..... _ 8 ct U O ° 00 O co o o w ° R w`� — — , on c 2 ,c 0' c Y _ ° o w c. m an 7 w ' ° CA -] 3 — o L ct y L Q ee c 1) CD = 2 N vp — CC Q. D W CC >, .:71 F 0 U o: a. a ;0Q)C Z m o ae a = CO ..- w W F co o .- v v O a: CC 02 ,t F G = .7 ,.J F W ,.a wm z mo o z F ; _ a w 3 W CQ v, ce ,u y 0 3 c O.; a� A N W c o N o —, o N N C C Z — N C 000 ❑ ❑ ❑ ❑ = al M Cam co 7 O L IC y .= F. 0 L7 U w O ° as � • r, Ca = A = Q a) 0 1 .=. 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' es ' u oJ )4 0 — cv r, v C °' W.4 ° 0 o 0 U N F � i y J s N QO ° ° I 00000 ❑ ❑❑❑ V) C. 7 - O ••• 0 0 0 0 O O O O C - Z„ = O O O N N N N O r' co co in t .4 w N N N M C" y - O O o 0 0 0 0 0 O O 6 O +' C cw v, u _ p p oo r --- O • or o . 0.... > �' — o 0 0 0 0 0 0 0 CC - U O O O O O vl v) M C .0 ^ O t - 'n O •:1- cn N O O O 7 — O— O p O 0 0 0 E o A o m Z U co E- O coo z o © N ° - o - � w 0 - o° o,o o o`°o o> 'CS s — — o o o o p o 0 s O F" N vo U U O V] l' m ^ O O O M N O o 0 C O ^� c 'l O O © O O Q M E •— • ••• N © © N N O \p © 0 Clo L c 0 o or I� or A C .•• y c., Gz. 0 . cot o ot L = o CI v v c. Ca) ea Tro L. a E-, o v CC o >-ZZZZ Z ZZZ 0 U — �� ► W 0 0 `" v D O 0 ¢ U N • o CQ a. i Z U V ce U L C U m o o w m w Z Ce o o .o O 0 . N 3 T U 3 >.., as a > U 0. a) a • CC a. — X � ' S F- �.) -7.' a • O Q 'o • � . � o p j • z D m U v) o oo a, Z vp N c0 n cot a) z V or a Fes' >,-, •- 00 N — M t7 O - N V N V N N O' _- L b ¢ • 2 2 2 2 2 2 2 2 2 o 0 0 a.) 3 0 © z N E ,..a oo v-1 r--- _ 4 CO CL t •• — N kY N V N N 0 N ¢ ....„ • 0 ❑ ❑ ❑❑ ❑ ❑ ❑❑ ❑ ❑ _� M N > M > 4.: N > — T c en C ;3 u 0 6 a� - _ C v A — A — U G ea 4 1 O es 4. — Ca G7, en V - en — U ,e o e s C° A CI) on �p °_ O 0 0 O D O O O - y' O CD ' � V O o o u o 0 0 CD 0 E u o i s O O O c CC O O O CC Ca p G LT O W.. C ry V .7r. h pc O 7 S N ' S. o U • O c 4 o c w O C O �.�. r V U m r),' O 0a. O m N c— O O U c _. r co U N CA u _ ' o O u 4 . O j O O co co Fes" — O F O O O F V o V 71. O z L O i N Z TA CI c R c R _ 2 U U U o n A ea .. w Z U bD Z Q L O 0) Q G L N N L a> a Z 0 Q. r"' 0 ^ c c s. P. _� c Z d E Z v-, W U c a U X Q U U m W O 01 Z co a z v) cn Q. 3 � o ¢ = oo > 3 >- •ct 0- o .L c. N w . Ca F-' CC U L y x a. O °' >- 5 O a • n rx o. a . ° 0 ' .) cI O Q cC O • • E > a ' `° o ,� cD 0 U a. ,o C7 = — Q a o [i] U y _ -t .c .R c-,1 2- L CL) Iv —• G N N U (.7 rn N U ) L = 0 0 0 L = L 0 O O j, — N c1 — N cn L ,-, 2 -.7 0 1 o a) a 3 a. a. ca , 8 '., o z — z O z en x 0 0 00 0 0 0 0 0 0 - N 00 ❑ � ❑❑❑ ❑ ❑❑❑❑ =CZ o = m 00 > N g O • y t O C -- v C. 4: O R GL C. 4r 'ct U 7 Cc �C? c73C? _ ° o ° o o ° o = C L. O O O O L 6 0 0 ro R O O O O C t O 0 Z O 'ai C O .0 7 p C ++ C a„ o U CO L' C CO CA O © U N u w rn o - — c:' o M S O O O O O O O s = z y i., O E z v) 0 -4... z 0 a Ca C C R U -I.+ 0 > d 3 Z a> > 0 0.0 C. } L O 00 C..1:: O -0 rZ L. _ E C z M E'. H z N C. U ( 5 f %] p sue c j W - U U ¢ oo = _ 3 x o 0 • a. ct a: 3 -J o A � Ts ...= ¢ ou c. L. CIJ � U W C. v) c C 00 CC • CL� o , • CO z) N "' co UU V O J is -J CC L U- L m C Z (V L.T. O N 7,- O N- cN O z O o N O z s 0 s. F- L O GJ Ce CZ N M 3 T N M '1 ad Q] 6J R — E U Q Z z 0 00 o Z 0 o IC- N 00 Florida Energy Efficiency Code For Building'} Construction Florida Department of Commun Affairs EnergyGauge Sum o 1114) 1 FIa /cc r°t -2 o8, Effective: Mar 1, 2009 — Form 40WA Method A: Whole Building Performance Method for Commerc Bu PROJECT SUMMARY Short Desc: 206319.0.14 Description: Tenant Buildout B7 @ Zephi Owner: Primerica Group One, Inc. Addressl: 7932 Gall Blvd. City: Zephyrhills Address2: RETAIL B7 State: FL Zip: 0 Type: Retail Class: New Special class building Jurisdiction: ZEPHYRHILLS, PASCO COUNTY, FL (611600) Conditioned Area: 1200 SF Conditioned & UnConditioned Area: 1200 SF No of Stories: 1 Area entered from Plans 0 SF Permit No: 0 Max Tonnage 4 If different, write in: (: 047// EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 1 of 7 Compliance Summary Component Design Criteria Result Gross Energy Cost (in $) 1,391.0 1,505.0 PASSED LIGHTING CONTROLS PASSES EXTERNAL LIGHTING None Entered HVAC SYSTEM PASSES PLANT None Entered WATER HEATING SYSTEMS None Entered PIPING SYSTEMS None Entered Met all required compliance from Check List? Yes/No/NA IMPORTANT MESSAGE Info 5009 -- -- -- An input report of this design building must be submitted along with this Compliance Report EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 2 of 7 • CERTIFICATIONS I hereby certify that the plans and specifications covered by this calculation are in complian • wi Al the Florida Energy Code Prepared By: Tracey Brady Building Official: m A Date: _ Date: / ` r I certify that this building is i compliance with the FLorida Energy Efficiency Code Owner Age . N.NNI Date: g' / .A 1 /% v If Required by Florida law, I hereby certify ( *) that the system design is in compliance with the FLorida Energy Efficiency Code Architect: Reg No: Electrical Designer: Reg No: Lighting Designer: Reg No: Mechanical Designer: JOSEPH F. KEENE Reg No: FL 60322 Plumbing Designer: JOSEPH F. KEENE Reg No: FL 60322 ( *) Signature is required where Florida Law requires design to be performed by registered design professionals. EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 3 of 7 • Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL AP.tm3) Building End Uses 1) Proposed 2) Baseline Total 90.80 115.90 $1,391 $1,771 ELECTRICITY(MBtulkWh1$) 90.80 115.90 26601 33926 $1,391 $1,771 AREA LIGHTS 23.00 37.60 6741 11020 $353 $575 MISC EQUIPMT 17.60 17.60 5146 5146 $269 $269 PUMPS & MISC 0.00 0.00 1 2 $0 $0 SPACE COOL 31.50 35.70 9219 10449 $482 $545 SPACE HEAT 0.00 0.20 10 46 $1 $2 VENT FANS 18.70 24.80 5484 7263 $287 $379 Passing requires Proposed Building cost to be at most 85% PASSES of Baseline cost. This Proposed Building is at 78.6% EnergyGauge Summit® FIa /Com -2008. Effective: March 1, 2009 8/27/2010 Page 4 of 7 External Lighting Compliance Description Category Tradable? Allowance Area or Length ELPA CLP (W/Unit) or No. of Units (W) (W) (Sqft or ft) None Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Lighting Controls Compliance Acronym Ashrae Description Area Design Min Compli- ID (sq.ft) CP CP ance RETAIL B 25,001 Sales Area 1,200 2 1 PASSES PASSES 1 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) System Report Compliance RETAIL RTU -4 ton Constant Volume Packaged No. of Units B System 1 Component Category Capacity Design Eff Design IPLV Comp - Eff Criteria IPLV Criteria Iiance Cooling System Air Conditioners Air Cooled 13.00 12.23 13.00 PASSES < 65000 Btu /h Cooling Capacity Heating System Electric Furnace 1.00 1.00 PASSES Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System - Supply Constant Volume Air Distribution ADS System 6.00 PASSES System PASSES EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 5 of 7 Plant Compliance Description Installed Size Design Min Design Min Category Comp No Eff Eff IPLV IPLV liance None Water Heater Compliance Description Type Category Design Min Design Max Comp Eff Eff Loss Loss liance None Piping System Compliance Category Pipe Dia Is Operating Ins Cond Ins Rey Ins Compliance [inches] Runout? Temp [Btu -in /hr Thick [in] Thick [in] [F] .SF.F] None EnergyGauge Summit® FIa/Com -2008. Effective: March 1, 2009 8/27/2010 Page 6 of 7 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL AP.tm3) Other Required Compliance Category Section Requirement (write N/A in box if not applicable) Chec Report 13 -101 Input Report Print -Out from EnergyGauge FlaCom attached Operations Manual 13- 102.1, Operations manual provided to owner 13-410, 13-413 Windows & Doors 13- 406.AB.1.1 Glazed swinging entrance & revolving doors: max. 1.0 cfm/ft all other products: 0.4 cfm /ft Joints /Cracks 13- 406.AB.1.2 To be caulked, gasketed, weather - stripped or otherwise sealed Dropped Ceiling Cavity 13- 406.AB.3 Vented: seal & insulated ceiling. Unvented seal & insulate roof & side walls System 13 -407 HVAC Load sizing has been performed Reheat 13 -407.B Electric resistance reheat prohibited HVAC Efficiency 13 -407, 13 -408 Minimum efficiences: Cooling Tables 13- 407.AB.3.2.1A -D; Heating Tables 13- 407.AB.3.2.1 B, 13- 407.AB.3.2.1 D, 13- 408.AB.3.2.1 E, 13- 408.AB.3.2F HVAC Controls 13- 407.AB.2 Zone controls prevent reheat (exceptions); simultaneous heating 1 U f� and cooling in each zone; combined HAC deadband of at least 5 °F (exceptions) Ventilation Controls 13- 409.AB.3 Motorized dampers reqd, except gravity dampers OK in: 1) exhaust systems and 2) systems with design outside air intake or exhaust capacity <300 cfm ADS 13 -410 Duct sizing and Design have been performed HVAC Ducts 13- 410.AB Air ducts, fittings, mechanical equipment & plenum chambers shall be mechanically attached, sealed, insulated & installed per Sec. 13 -410 Air Distribution Systems Balancing 13- 410.AB.4 HVAC distribution system(s) tested & balanced. Report in construction documents Piping Insulation 13- 411.AB In accordance with Table 13- 411.AB.2 Water Heaters 13- 412.AB Performance requirements in accordance with Table 13- 412.AB.3. Heat trap required Swimming Pools 13- 412.AB.2.6 Cover on heated swimming pools: Time switch (exceptions); ►� Readily accessible on/off switch Hot Water Pipe 13 -41 I .AB.3 Table 13 -41 I .AB.2 for circulating systems, first 8 feet of outlet Wit Insulation pipe from storage tank and between inlet pipe and heat trap Water Fixtures 13- 412.AB.2.5 Shower hot water flow restricted to 2.5 gpm at 80 psi. Public lavatory fixture how water flow 0.5 gpm max; if self - closing valve 0.25 gallon recirculating, 0.5 gallon non recirculating Motors 13 -414 Motor efficiency criteria have been met Lighting Controls 13- 415.AB Automatic control required for interior lighting in buildings >5,000 s.f.; Space control; Exterior photo sensor; Tandom wiring with 1 or 3 linear fluuorescent lamps >30W EnergyGauge Summit® FIa /Com -2008. Effective: March 1, 2009 8/27/2010 Page 7 of 7 ., of E ca o 0 Q w o > v cn 0 0 co U 73 co a) V v L C S. — Q m O = � 3 ...= o 0 z ( 24 Z N F N S. 'j .4: ¢ p . a) y o CL o c E-4 1,1 v Q u o Z 1 o N C C z rfi O A-I CI ^" ,..-7 N ® W - b 3 N E ra 4. 0•••1 C Au r tt =I A N � R A-1 o Q tak c 4 Ito w W ** 0 z0 W U F- T U 14 E N F O u u ai U 0 U 0. p r -6 +-. J O ` ° c7 = ,i ,_ 0 o m C7 c� N F¢-' 1.) ° N . 2 m a c M W .r 0 N O E - �i w o a •- 7 C F a ccd 01. u u D W a 0 F- t, N O z u .d C I.' V Or ° F- o u W Q u ,--, Q o 0 O Z Z N N o0 ❑ ° ° ❑ 7 m 00 h N CC 4 N O e.. -I-. ? ,...1 N O O ° C y N CC s a., O M Z U Q y too O, W '1. 0 7 M 00 O H `a= = C. 7 O 02 r-. O c. 0 ca -1-: O o N E . c...) 0. ,r, _ 7 o. 0 o _ �. c u w 0 o ° v w w o U — rn 7 L O O as = c c 0 0 o °' 00 U 6 0 3 o 4- 3 " Q„ -1, V) L w 'c L L L ° o a 'R 6 o c i o N O 3 i h O N > N erl Q N V N O 112 0 = O O �� y (A V) VD S O ea RI = _ � .� 0 w 9 O 7 13 c.. L u O O +C+ O R w 7 , pa C . w W — c 00 L. a x ' D N c C> ° .7 w :U 3 N 7 0 c w 7 cu cf) V H.� _� cn U 2 LU — '' N a co CI. r-- 0 00 U (� ° rn Q ca u O G4 d - a Li �., 0 CC L. H F. J c w) 0 CO ce m Q - G m w E- W Q 0� .a o W z F�� p z o Q 0.4 _ �, E-3 `C� `L a C4 — L LO 0. a v 0 p ;; 0.; a = w ;; 3 ., O C 0 C •O N O N N fr r H 0 z ~ N *0 00 Fr .❑ ❑ ❑ ❑ M y + + a es m a a, tea„ C O0 p i p ' O L cc ,.�.^. cv N ..." a, R / v > w 2i c/7 y t w" t F ; GL r h M C" GT" ° O co ai Z et ° p u v = U o A a �' d C4 a.) A _ M i CO. 5 L M (, •.,,' C V c,�l — a' a at G% r--- 4. U o N 4: a, as M O L 'Ocn o � W w = a + U + ----- O = LT.., oo Q� c y N C, O .0 O cei N O ° 3 u %,..0 co ` N as O w' Q �^ ^O 0] O O as O O i ce . ° L Q '— N d Q N H N i. - L M a W w • {n Z. VA U M u E O 6. 0 w o a O 0 ° o 0 W CID G cc w Y. _ s c w ^O .... r i �..� "� w as 3 ,— x ti) cn L c ' a o y tu ++ ' W O ^C O 4 O N W Z • E w ° 3 3 a, 0 0 Q. 0 tii x F a, fl- . U sm. on ., __ ° c _ 2 m o_ L CI d c cC © CD C 0 o A 0 O .1 G W O O CO a4 QO w d O cu Z F_^ A F - � A Wu a W as W `" x a 3 0 x a, 0 o 0 d .. c r. o a t...4 c o N © t--- o N N N N - c co 0 , . .❑ ❑ ❑❑ ■ ❑ ❑ Tr > . 0D,-.., Or GA CS 0� 0 O a, a z o E'' o L E C 0 > °o U - `; E t E `" o: W a Gla o ›•a o o -az aa ° u Z 4 CD = - W Cd a 0 W CD O 00 O W L u c^ O Q E w O L L O N > R N 4- ' 4 > C L = e .._ y 0 0 o C1 3 a Oa w 4..i o R ° o ° O o N fC GG .G E v1 U . 00 vs 7 Q7 rw Q1 E 1 - Ow L 1 ° _ °.�' x z5 ° cc W , � on a, 0 0 W c. CI 3.. U 0 n C.) v R 0. 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O\ N Z ¢ �r 00 ❑❑ • • ❑ ❑ ❑❑ ❑ ❑❑❑ ❑ ❑ o ? o as v') T ao (N g z r'. a y N a y .4 s s o :4- M o . c . M r 15 r D p A — .ct w• .� ct C. 4: O C. 4 Q. 4: O R \ V U tri C A p U I-. J U CO w+ co _, cc - ca W 0 u d u — C L O O O = C L 0 0 0 = 0. L 0 E u c) o 0 o E ., p o> o o ° o E° o w 0 0 0 G 0 0 0 6 o a) [ . ce 4: ra 4r V) 00 O V .t. n? u L O u O 'C _� O • O 'p c 0 O O + C 02 CD U_ C m O m H N co O co O U p U C_ N o o �= ° o v 0 O cn O • o F - -= o 0 0 o F CA u CA u E Z ° L z z U U U 7 0 A z eko N 04 c L ti O R a O Y Q ' 0. O N - C. 6 O >~ Ec z o _ E c z d E c z W ce V O Li.) C� U a 'v1 O M U m w 00 U Y m W 0. .c a 0 cn d o a> C! W o < 0 C7 - = cc F- ,. , Ti F- R 0 Lu c a, CZ = = Q' rn CZ ,-.1 • a. ++ 0 0 c n U ce C7 u a. t,' . _ o Lc. ,_ U R d. :C CO r=4 a 0 Z N r- v � Z c� N E--- Z rn rn 0 CD 0 `' o r .0 L .4 vTh 0 0 co co) O T --. 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F— s- o as 0e c, N ri > , N r1 "Cl r] vs CO E _ E U n - . z z o0 MI O nr z ..1- 0 0 N O z o N 00 Florida Energy Efficiency °Code For Guiding' Construction Florida Department of COfllff Unity Affairs EnergyGauge - Sum X11 m-20 ,' E ive. l ch 1, 2009 _- Form 400A Method A: Whole Building Performance Method for Commercial Buildings r PROJECT SUMMARY Short Desc: 206319.0.14 Description: Tenant Buildout B7 @ Zeph Owner: Primerica Group One, Inc. Addressl: 7932 Gall Blvd. City: Zephyrhills Address2: RETAIL B7 State: FL Zip: 0 Type: Retail Class: New Special class building Jurisdiction: ZEPHYRHILLS, PASCO COUNTY, FL (611600) Conditioned Area: 1200 SF Conditioned & UnConditioned Area: 1200 SF No of Stories: 1 Area entered from Plans 0 SF Permit No: 0 Max Tonnage 4 If different, write in: (117 7:2; 1. 9 EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 1 of 7 Compliance Summary Component Design Criteria Result Gross Energy Cost (in $) 1,391.0 1,505.0 PASSED LIGHTING CONTROLS PASSES EXTERNAL LIGHTING None Entered HVAC SYSTEM PASSES PLANT None Entered WATER HEATING SYSTEMS None Entered PIPING SYSTEMS None Entered Met all required compliance from Check List? Yes/No/NA IMPORTANT MESSAGE Info 5009 -- -- -- An input report of this design building must be submitted along with this Compliance Report EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 2 of 7 CERTIFICATIONS 1 hereby certify that the plans and specifications covered by this calculation are in compliance the Florida Energy Code Prepared By: Tracey Brady Building Official: /L Date: _ Date: , o--(. U I certify that this building is in compliant- with the FLorida Energy Efficiency Code Owner • Date: 9 / 2/ ji Vk If Required by Florida law, I here certify (*) that the system design is in compliance with the FLorida Energy Efficiency Code Architect: Reg No: Electrical Designer: Reg No: Lighting Designer: Reg No: Mechanical Designer: JOSEPH F. KEENE Reg No: FL 60322 Plumbing Designer: JOSEPH F. KEENE Reg No: FL 60322 (*) Signature is required where Florida Law requires design to be performed by registered design professionals. EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 3 of 7 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Building End Uses 1) Proposed 2) Baseline Total 90.80 115.90 $1,391 $1, 771 ELECTRICITY(MBtulkWh /$) 90.80 115.90 26601 33926 $1,391 $1, 771 AREA LIGHTS 23.00 37.60 6741 11020 $353 $575 MISC EQUIPMT 17.60 17.60 5146 5146 $269 $269 PUMPS & MISC 0.00 0.00 1 2 $0 $0 SPACE COOL 31.50 35.70 9219 10449 $482 $545 SPACE HEAT 0.00 0.20 10 46 $1 $2 VENT FANS 18.70 24.80 5484 7263 $287 $379 Passing requires Proposed Building cost to be at most 85% PASSES of Baseline cost. This Proposed Building is at 78.6% EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 4 of 7 External Lighting Compliance Description Category Tradable? Allowance Area or Length ELPA CLP (W/Unit) or No. of Units (W) (W) (Sqft or ft) None Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Lighting Controls Compliance Acronym Ashrae Description Area Design Min Compli- ID (sq.ft) CP CP ance RETAIL B 25,001 Sales Area 1,200 2 1 PASSES 1 PASSES 1 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) System Report Compliance RETAIL RTU -4 ton Constant Volume Packaged No. of Units B7 System 1 Component Category Capacity Design Eff Design IPLV Comp - Eff Criteria IPLV Criteria liance Cooling System Air Conditioners Air Cooled 13.00 12.23 13.00 PASSES < 65000 Btu /h Cooling Capacity Heating System Electric Furnace 1.00 1.00 PASSES Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System - Supply Constant Volume Air Distribution ADS System 6.00 PASSES System PASSES EnergyGauge Summit® Fla/Com -2008. Effective: March 1, 2009 8/27/2010 Page 5 of 7 Plant Compliance Description Installed Size Design Min Design Min Category Comp No Eff Eff IPLV IPLV liance None Water Heater Compliance Description Type Category Design Min Design Max Comp Eff Eff Loss Loss liance None Piping System Compliance Category Pipe Dia is Operating Ins Cond Ins Req Ins Compliance [inches] Runout? Temp [Btu -in /hr Thick [in] Thick [in] [F] .SF.F] None EnergyGauge Summit® FIa /Com -2008. Effective: March 1, 2009 8/27/2010 Page 6 of 7 Project: 206319.0.14 Title: Tenant Buildout B7 @ Zephyr Commons Type: Retail (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Other Required Compliance Category Section Requirement (write N/A in box if not applicable) Chec Report 13 -101 Input Report Print -Out from EnergyGauge F1aCom attached Operations Manual 13- 102.1, Operations manual provided to owner 13 -410, 13 -413 Windows & Doors 13- 406.AB.1.1 Glazed swinging entrance & revolving doors: max. 1.0 cfm/ft all other products: 0.4 cfm/ft Joints /Cracks 13- 406.AB.1.2 To be caulked, gasketed, weather - stripped or otherwise sealed Dropped Ceiling Cavity 13- 406.AB.3 Vented: seal & insulated ceiling. Unvented seal & insulate roof & side walls System 13 -407 HVAC Load sizing has been performed Reheat 13 -407.B Electric resistance reheat prohibited HVAC Efficiency 13 -407, 13 -408 Minimum efficiences: Cooling Tables 13- 407.AB.3.2.1 A -D; Heating Tables 13- 407.AB.3.2.1 B, 13- 407.AB.3.2.1 D, 13- 408.AB.3.2.I E, 13- 408.AB.3.2F HVAC Controls 13- 407.AB.2 Zone controls prevent reheat (exceptions); simultaneous heating and cooling in each zone; combined HAC deadband of at least 5 °F (exceptions) Ventilation Controls 13- 409.AB.3 Motorized dampers reqd, except gravity dampers OK in: I) exhaust systems and 2) systems with design outside air intake or exhaust capacity <300 cfm ADS 13 -410 Duct sizing and Design have been performed HVAC Ducts 13- 410.AB Air ducts, fittings, mechanical equipment & plenum chambers shall be mechanically attached, sealed, insulated & installed per Sec. 13 -410 Air Distribution Systems Balancing 13- 410.AB.4 HVAC distribution system(s) tested & balanced. Report in construction documents Piping Insulation 13- 411.AB In accordance with Table 13- 411.AB.2 Water Heaters 13- 412.AB Performance requirements in accordance with Table 13- 412.AB.3. Heat trap required Swimming Pools 13- 412.AB.2.6 Cover on heated swimming pools: Time switch (exceptions); r� Readily accessible on /off switch Hot Water Pipe 13-411 .AB.3 Table 13 -41 1.AB.2 for circulating systems, first 8 feet of outlet Insulation pipe from storage tank and between inlet pipe and heat trap Water Fixtures 13- 412.AB.2.5 Shower hot water flow restricted to 2.5 gpm at 80 psi. Public lavatory fixture how water flow 0.5 gpm max; if self - closing valve 0.25 gallon recirculating, 0.5 gallon non recirculating Motors 13 -414 Motor efficiency criteria have been met Lighting Controls 13- 415.AB Automatic control required for interior lighting in buildings >5,000 s.f; Space control; Exterior photo sensor; Tandom wiring with 1 or 3 linear fluuorescent lamps >30W EnergyGauge Summit® Fla /Com -2008. Effective: March 1, 2009 8/27/2010 Page 7 of 7 0 0 bt E es o L Q a,., O > U cn 0 0 at U c� d U y n a ° St �- � 3 ° F z P4 Z + L i y m o el v 44 � i o F• x = o 5 • `� rsi :4 o pa M - _ A C I N E t ° N s e eu 4) V u E A o a A C7 E-i 4) N V) et 'o 3, 41 P. , �. o Q = w OD W z z w 0 0 T V _ N F. p 0 OJ © 0 U F CO - id > O_ ° = c) o. m d Cl en E- ° m c CD a.) C ■ W c , N H t" W o A u o. U b O m o r ; �a c o L. U Q o O N O Z N z . 00 _ . El ❑ El 1=1 y 7 N m 00 CC � vO N O y,,, w 4:. 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E— o y. 0 Ce N M jo N rn d di) J . a O or co 0 E E U 0 O z Co CO 0 co o z0 z O r N 36 CUHACI & PETERSON, LETTER OF TRANSMITTAL ARCHITECTS, L.L.C. 19�L5 � ect Ave p Orlando, Florida 32805 DATE: 09 -23 -10 JOB NO.: 206319 —SA 14 L 407/661 -9100 ATTENTION: Jacqueline Boges 407/661 -9101 FAX RE: Zephyr Commons TO: Building Department Tenant B7 (7932 Gall Blvd) City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 813- 780 -0020 WE ARE SENDING YOU X Attached ❑ Under separate cover via UPS the following items: Ground ❑ Shop Drawings © Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO DESCRIPTION 3 Signed and Sealed energy calculations THESE ARE TRANSMITTED as checked below: ❑ For Approval ❑ Approved as Submitted ❑ Resubmit copies for approval ❑ For Your Use ❑ Approved as Noted ❑ Submit copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return corrects prints ❑ For Review & Comments ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US Ms. Boges Adam Robinson with Primerica asked me to send these to you. I have had the mechanical engineer sign the Third page of the energy calculations as requested. Please let me know if there is anything else that you need. COPY TO: File SIGNED: Gabe Robertson