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Home My WebLink About11-11806 CITY OF ZEPHYRHILLS , . 5335 - 8TH SITiEET �sis��so-oozo 11806 BUILDING PERMIT Permit Number: 11806 Address: 38051 MARKET SQUARE DR Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 02-26-21-0010-03900-0020 Improv. Cost: 340,000.00 Date Issued: 5/10/2011 Name: FMC MARKET SQUARE INC Total Fees: 2,427.36 Address: 38135 MARKET SQUARE Amount Paid: 2,427.36 ZEPHYRHILLS, FL. 33542 Date Paid: 5/10/2011 Phone: Work Desc: INTERIOR REMODEL RHEUMATOLOGY STE 2ND FL (6831 SQ FT) , .5 . JN ELECTRIC OF TAMPA BAY, INC. PLUMBING FEE 60.00 MECHANICAL FEE 60.00 TEHAN PLUMBING INC FIRE PLAN REVIEW FEES 409.86 FIRE INSPECTION FEES 30.00 COMPLETE CLIMATE CONTROL INC I�i3- �i`na�.� ga-IU-I I �L' ��` `�` "� �' . ��`� J 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 t) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before record' g your notice of commencement." �— � �,- CONTRACTOR SI NATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER . i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiiiiii � � 20110�0871 � Rcpt:1366625 Ree: 18.50 - DS: 0.00 IT: 0.00 �� 05/10/ll K. Garcia Dpty Clerk rroT��.� oF co��NC�� . RECEIVED pa�,,t�,o. MAY 0 5 2011 Property Iaentfflcatloa No.__ a 2. - 7. b- 1� o o t o— O q o o— o 0 2„ o WAUACE A$SOCIATES, L.L.C. 'THB iJNDLRSIt32dEI3 hereby gfve informs you that tha fmprovament wiit be mpdp ta certain real property� and tn accordanca with Seation 713.13 of the Florids Statutes, the foilowing lnformation "is provided in tl�ts NUTjCE OF COMMENCEMENT, 1 of property (legel dcretlptlon:) �E E a-rTq� D a)3treotAddrase: 3 1 N1 �T .+q E EPN 4.►•►t�1,S � y • 2.C}eneral iioacripdon of impcovements: 1 N"L o �►.. - oJY F o 4- p�£.p � � L e � c' S�►'�' l' � T �. S CoH . •�. � u1. t-S oe.. F 4 F 3.Owner Inforruadon w . a . e)Nameeadaddresa: FMc. Maa.w�T SQ��r� „��.' 38�35 Mp1.tL-ET SQ�at.E 2.E ��+�ws F� �33 . b) Name and addra�s of �a simplo tideholdor (if othw t]xsa owaer) a3 In:orest in praperty EE s� w1 Q t, � 4.Contractor InPormation . a) Name and addresa: W At�t, RsSoc.�t'� 1.V(. �) .'�3 M�l. �GuJ� �T . 1i . S i. QE.TEkis�l. L �') 03 b) Telephona No.: 'L7 • o- o� � o Fax No. {Opt.) _ L7 • 5� o- o� y s.surety Inforinaeion ar A . , . a) Name and �►ddrees: l� . h b) Amount of Bpad: - � �) Telephone No.: ' Fax No. (Qpt.) 6. Lender � a) Ngme sad addreas: P` � 7. Ideotlty ofpereoa w(thla the�tate ofFlozlda desl ' • phoae No. '" - -- �atod by wrist upon wlaom noHces or other documeata may be served; �� e) Name and addross: PEt,ATOt.R,�c, �13s P�►AlaLE-r S,�a Zgp�uRµ,ws, p�, 33543 D b)'FelophoneTIo.: �- o- '1 Pax o(OP � 1 7 i.t�l t 1 p� � g.in sdditlon to hipuelf, ovmer desi tes the followfng persoa to receive a eopy of t�fe I,ienor's Notice e� 713.13(I)(t�), Florida 3tetutes� provlded iri Sectlon � m� W � a) Nasne and addreae: � F . o •b) Telephona No.: �- . Irax Nn. (Opt.) ~ m 9.Expiretion date olNotice of Comamencement (the explratlon d,ate Is ooe year frqrp che date of reeording unleas a dlffeYent date 1s �� sp�cifiad): r �� WAYiNING TO OVy3'VER: A.IYY�PAYMENC3 M.�iD$ BY 1'YiT OWNTLKAFT$R THE ER!' �`,� � CO1VIiVIENCEII�I�NT AgE CONSID�RED IMpROP�R PAYMFIVT3 UNDER C�IAp1�R 71�3, I 3gCTI01�I 713�.1 3F ~3 N FLO1tIDA 3TATUTES, AND CAN RESULT IN XOUR PAYII�1d TWIC� FOR iMPROVEMENTB TO YOUR PROPERTY, ''' ° A NOTLC� UF' CO1KMElVCEM�iVT MUST BL RECORDEb AND PO D OiV' TIiE .10B 31TE HEFOR� THE FIRST 6i " I1�13PECTION. IF YOU I1�TElyD 'i'O OHTAIN 1�'1NAl�1C1rTG, CqN9UL LElYDER OR AN ATTORNEY HEFOYtE r COIVSMEN�INGl OVORT{ QR RECORDIPTG YO p m YTR rIOTlCE OF CO E E T. -`"'+ � BTATE OF PLORIDA � ��N Q COLJIV7Y OF TASCO C� � N c� N ° � 9lgnature o et ot ' Au er eedDireeur!f+�rtr�w/M�naex: � 3 � Q � � riotN�ma ° r Tha foregoing instrument was acimowledged before mo tlil9 ��day of Zp ( bY v(� 14C, `Jj�/��.. A in fact) E'or � C�YPe 8f authos�.g. o#g�, �atee, ettorney (naane ofparty on bel�►e!f of , o a a e c Personalfy ICnovm �/ OR Produced Identifleation �� Notary 33gnsture �"''�n, � , Lt� RiTA DYKES = r �+'- arY � e a ' 'I�e of Ydentificativn produced �� ' Comm. Expirea Nov S, 2014 �° �-°� ;��''� Bonded Throuph N�tion�l Npt�ry AKn.. VeriBcatlan p�suant to SectFon 92.525, Florida Statutas. Under pensltiee ofpe I ec et , e the factv steted In it aro true to the best of my lmowledga and beliaE � C �� FORMSMOC.rvW1007 s�an�turc ofN ral P Signfns A6ove �ooi�oo d s�s# tb:�o IIQZ/SZ/b0 'wo�� OR BK �5�� PG 222� . • ' 2 of 2 ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 POR OF TRACTS 39 40 41 & 42 DESC AS COM AT SW COR OF NW1/4 OF SEC TH NOODG 13' 24"W ALG WEST BDY OF SEC 662.75 FT TH N89DG 54' 51"E 112 FT TO EAST RNV LINE OF US HWY NO 301 FOR POB TH NOODG 20' 42"E 382.70 FT ALG SAID R/W LINE TH N89DG 57' 16"E 150 FT TH N00 20' 42"E 200 FT TH N89DG 57' 16"E 291 72 FT TH NOODG 02' 44"W 20 FT TH N89DG 57' 16"E 193.19 FT TH SOODG 00' 04"W 602 58 FT TH S89DG 54' S1 "W 638 36 FT TO POB EXC WEST 125 FT OF SOUTH 100 FT THEREOF & EXC FOLL DESC POR THEREOF COM AT SW COR OF NW1/4 OF SEC TH NOODG 13' 24"W ALG WEST BDY OF SEC 687 75 FT TH N89DG 54' S1"E ALG LINE 25 FT NORTH OF & PARALLEL TO SOUTH BDY OF TRACT 41 297.22 FT FOR POB TH N89DG 54' S1"E 40 FT TH NOODG 20' 42"E PARAL- LEL TO EAST R/W LINE US HWY 301 75 FT TH S89DG 54' 51 "W 40 FT TH SOODG 20' 42"W 75 FT TO POB OR 3228 PG 293 _�' � ;:� • . STATE OF FLCIRIQA, CQUNT�' {�� PAS�C� THI� fS TG GER7IFY THA� FC�REGOff�G fS,4 � TRUE AND CORRECT C0�'Y l�F THE DOCUMENT ON FILE OF2 OF PUBLIG RECORD.IN THI� OFF�ICE _ WITNES� _ `ff� DF,Y OF� � ' � PAULA S NEIL, CLERF�& , gy v' /( � DEPt}TYCLERK' 813-780-0020 r � ✓\ City of Zephyrhills Permit Applicatioru� -�',� �� \ Fax-813-780-0021 ,_ Building Department � Date Received � � � � � � � � Phone Contact for Permitting l � __ �, '�' , �� 1 � � � Owner's Name � M�. � q.� Owner Phone Number � � � ��V Owner's Address � j .( � r(' Owner Phone Number ��'� Q 0�� l� Fee Simple Titlehdder Name Owner Phone Number ��j �� - ��, � Fee Simple TiUeholderAddress JOB ADDRESS �� , �0. � a.t L LOT # C� SUBDIVISION PARCELID# �a �aj ^ l— p� �� O��c�i Q Q O C(�,�� a•�, (OBTAINED FROM PROPERTY TA% NOTICE) '( �� 1 WORK PROPOSED NEW CONSTR ADD/ALT � SIGN Q � DEMOLISH t � B INSTALL REPAIR PROPOSED USE Q SFR � COMM � OTHER TYPE Of CONSTRUCTION � BLOCK F E• � STEEL Q —� DESCRIPTIONOFWORK `��'O , T Y�QQ��0. O � ��.�� (�� \ � �n Y�o d.\C4 c� \ Cl eA BUILDING SIZE SQ FOOTAGE p 3 HEIGHT � � �� QBUILDING $ VALUATION OF TOTAL CONSTRUCTION � � �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. �PLUMBING $ � MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS Q ROOFING Q SPECIALTY � OTHER �� I� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO BUILDER COMPANY V.J0��4«. � (�C,�p�� SIGNATURE REGI$TERED �� rj � FEE CURREN I V/ N � — �� 6 � �' License # y � Q ,^ �J�'Z ELECTRICIAN �� .�L COMPANY r �p�, �"� SIGNATURE `�' � �, REGIS7ERED Y/ N FEE CURRE� Y/ N S� �� , C7 � „'�— -C� !✓cL C �ress , icense # !J" � PLUMBER �P �� COMPANY SIGNATURE REGISTERED Y/ N F E E C U R R E � Y/ N .� Address License # F � j MECHANICAL � � �(� J� :� � COMPANY SIGNATIlRE �� REGISTERED Y/ N FEE CURREN Y/ N � a4C� Address "ro � � 3 � License # —� '��(} 6�� OTHER � `— COMPANY � SIGNATURE REGIS7ERED Y/ N FEE CURREN Y/ N �� Address License # � 11111111111111111111111111111111111111111 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, Construdion Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Pertnit for subdivisionsAarge projects COMMERCIAL Attach (3) complete sets of Building Plans plus�a Life Safety Page; (1) set of Energy Forms. R-O-W Pertnit for new construction. Minimum ten (10) working days after submirial 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 $2500, a Notice of Commencement is required. (A/C upgrades over y7500) " Agent (for the conhactor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shing�es Sewers Service Upgrades A/C Fences (PIoUSurvey/Footage) Driveways-Not over Counter if on pubiic roadways..needs ROW Apr 2411 10:14p Complete Climate Control 813 996 0880 p.1 Fran: 04/2512011 C6:36 �320 P.00i/00' eca�eo.00zo Ciry cf Zephyrh1is PermitApplication F.,,�,z7eo.po�� : aww:w o�rtm.n� oaxe Rec.nea (� � � � � � � � � VhoneCOnbctfarPMrn'niwg � � 1 — � �` i " 1 �,� 1 .�. ' R ^, � 4` owmrawnu M{� � Orm�rvnooroNumsr \ p � ow�ors ndar�u �� -� Owner phon� Numb�r 0 � . F�B Simds TiqNfol6rr NYTf 8 _ t �� OwnorPhen�Nup�eer v fea 81mp� TAIaMoWerqddnss .rosnooaESS 3'$ oj a -� �.� L �ar s� . a,en�ioN � PnNCeimm�r �a - �\o - l- oc, o- a oq - o0 o r�vd. ea wonx rROnosfu co•T"'"a•� �o•uru:«onea `e re a i; roEWCONSTR ADpJqI,T G� SIGN O Q OENOUSH INSTAIL REPAIR P �� E Q SFR � CpAAM Q OTHER Trre oF o�vsrnucnau (� B�oac F e L] sr� � oescsPnoro oF wo►sc ��p ,� Ca 1 �`�. 41( � �� saF�� 3 M��,T �� "` a��°a��l ��,�,.4�� J OBU�DING VALUATION OF Ta7A! CAI�LSTRUCnOk � d QEIEC'TRICAL $�"� AMPSERIACE � PFOGRESSENERGY Q 1nR.E.C. �� []PLUiN81NG �—"� L _ ;�� O�� VALUq710M QF MECHANICqL INSUi«A77pN ��s Q RQOFINC p s�cuurv � orMeA � � I �°� �us►eeo Fiooa �varoms � �oa� zeNe r�En Oves no eui��e corrrwr R��4tlL. C C C� L.�. L� SIGNA7UNE �� • R[GSTeR� (J FEEC:tIME+ YI ' nss•� � . � � uoenaes �' �� SIGNA7IJR�E �� COMPMIY s; �� .�� R�� Y M rEEtuml[rr Y/N �,��' .. c�� a.w � � . �i -"� -.'�"° • �'�� COMPM'Y SlGNATURE �Epqto�ep Y f N c[! ulppgr Y/ N .� Addnss �� s � � �� i �� .�� y�.�{ MEOMMCAL A COAIPAIJY CJin. /t 4 StcNa�URe .�t✓ P E C'/i,s�1t� Ll1.e7�l0��'.x �-� �' ae_K «caaT�o i W r�e cuwera� � TO �+ � A"=�= 1��l? Drc r.• ,D.t . O•L, Y'L �renses ol L�( 1�r �� ort�R conrarn ^ ��^� S�GNAiURE REG�STERiC Y/ f��yl� V/N AddIM3 � �r��i��r�i�rrii��ii�ii��ir�iii�i�iri��ii�r�i�i ��il'/��ri��r�iiii RE9�7ENTIAL Allodt (2) Plal P Vn� (2) seis ef Buld'wp Plans; (1► s�i of E�rml £ams� R-O-W Permil forrmw oonsUUClb4 Mi�eum tm f�ol wwKnp Ofys �Ibr auaMW dats. Reqiirod airta. Cautrudbn Pl�na. Slomwwter Plens wf Sal Fanca 1nst�1led, S�it�ry Fadflks 61 �e�lar, Ste Wwk Prmi fir wD0(NSidtaduye yrajeets GOMMERGAL Aqach (J� comPl�t� a�is o1HwltlNy PVnsplusti Ufe Sa4b PNe� (I! set d Enapy Fomu. ft-Q�W permitfornew conaln+eGon. �°� 1 en t�� 4 M �r xlbmhW date. qequ�d en W�. Co�qraaldf Plens, Slannr�Nr Piani wI Sllt Fontf inYallod. Srndsry F�6�s i 1 durrqstx. SB! YMOACPermhtar itl �eM pr�jsp. ql commerdv raqutnmenls piusl meet wrtipllence SION PQRMR AttacM (� aels of Erqitwend Ptsrm. '�PROPEIiTY SURVEY �e0'srsC far �M I�W aonsuuaien. DE�stlq►x Fll ou! appintion aompkfdy. Owner6 Contracbr a�ye b�c d appias�an. �wlaNted 1FOV�ri?SOO,aNOtle�olCoenpwne�rtun[isnquhd. (p/CupprWesovarSf300} " Apent par nie carwa�or) w Fiawxof Altormy Aor the ow�e� wauld be +oreons wilA roladzed INar fraa oww audw'fanp same OVER 7'HE COUNiER CERMITTING tr,om or nay�,aon cny� Rsroors i! �hlnqea Sewcn Suvtos UPp�ades WC FaKes (platJSlrrey� Orivawap-nbt owr Covxsr ron pwlc rosdwy¢, nasAa ROYY 'IH Result Report p i 04/25/2011 08:39 Serldl N0. AOEDW11001438 'i�: 20815 Addressee Start Tf�ne TiMe Prfnts Resul Note 99960880 04 08:38 00:00:49 001/001 OK Note M�e �xue6deS1 ed i4T �� nal P� { ial�� t 9 i in�aiF�FC��e�F-code RTX: Re-TX. LY: Re1�1. �� BUL:�BUilet�n. SIP: �iP Fax. i R: IP Address Fax. FRX: I ntie Result OK: Communication OK, S-OK: Stop Co�munication, P4V-OFF: Power Switch OFF, TEL: RX from TEL, 1�: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M Full, LOYR:Receiuing length Ouer, POUR:Receiufn9 page Ouer, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. esa-ssomao City af ZePa��s P�� qppllo�tion c.,.e��a�� wr fe.a.ivw • Phan� Ca�o�lOr P��nI,Yi,�9 • - �h� \�[ Q R � �� Own�I� N�m� • Ow��f �an� lY��Mr � y own.r�,era...� ' 4 o..,.« �non........n.r w � �� Tw ��'^• a.n.r Pnen• tiu.ne.. 8\ _ l3 P« srnp. nu.r.ow.rwna.w. �o� woowda '?s - �o'r r O iUSUtVIS10N PAROGLIp� �� -� — p - p O��- Y� 0'� B Mlr1YM�o'woY MOrO'fY wow�c wwro�m ins�r.�u.` we►iu�eT O s�cary p � oEUO�ier� °� °� � �warwm wa p eFw � corw p orwr.R M� OF cOINTRl1GTON � BLOCK F Q BTl� Q OlaCWPTON OR WORK Q a\�.t\ O}i �UILOINO iRf �C ROOTAOl�3�� HOAMT �� ` O `4_ �� QOULGIfiO VALIJATION OF TOTAL OONOTRI.IGTON O AMP 9ERVICE � pqppREpa GN6ROY Q WR.E.G. QPLUh�B11Vp Q ` VALUATON pF MCC W WICI.L INBTALLATJON O'�s O woosnm p svccu��v 0 on+r�re �� J� (P FIMgHBO ILOOit RC ATON9 i�� FLOpO ZONE MEA QYEB IVp � CONPANY �� iIONAIIlR! w��I�MO C `� `� L1OM�w Y �il, Z QLtG]ltlQ1A1V '� Q � COM►ANY �� r�� AE I�ON1M0 A � p� 6/ q- ` 02� $ �p ' � ��,nr � PLl1MNR p� 1lONATVI�C •-...ic OOMrANY /l�W�� A� 4 � .,/ /�tla�w� Lb��N � �L ( � YGC�MMi'.AL. GOYrANV B s c � iqwt/�.'I'URE _� / _-- waa.�.. ..a �......e+ -ai3o.' oTM�w .�_ un.w• aIONATUA! GOMVA111V y.c.o„ �. ...v� ... o....� .,�.... ..,....... . ��...... ........ .................. ......... ....�......... ... RlAI�W i�I�l IJl�ol� (21 Pbt PI��: (3) �� e! oulleLnY PI��: !l )��t ef 6nMpy Ferm�: R-C1W P�rrnY Ibr n�w aon�tr�aa0on. •• MKnvn t�n I10) �pq�0 ��IVr wbmI1Y1 d�IS. R�VU��W oeNh�. Ce�aba�a�bn Pl�n�. Bbm�w�r PI�� vrY B�f FMis Itit�d. COMME� � F�a�[Iw i 1 dunp�w� ab yypkP�M far ��P WQ /a� (S) aon�P�v �M� a/ Y�i��Y P W�� Ply�ti LM► Q�II�b r�Ya: (1) �l 01 Erwpy Pvm�. iF0-W P�mr far nsw mMb�dbn. M�Wnun� Mn (�Ol �Y�Y �Y� �6r �uM�Ylt�l dW_ q�q�1�O en�11�. CpWrvotlA� PMn�. 6�omwNYr P1�M W Alk F�ne InK�lletl. SION P6RIW i �(1) wb ef E�iqln��Y PYn�. WpI[ P�/mN M�11 n�w pqb�. All mr�wvl�1 r�4�lr��nb mwt �r oo,npM��w '�TROPGR'TY BURVlY �qf�M(1br�O N!W mrWaKMen_ rlll ou1 �Ppbtibn aarpMblv. ow.... �e�a�s�aw.� .. p.ac � r.ortr.a �pt�le�a. Wc upyeaM� ovr ts�oo� � �M (/�� w Po�w�r of Atbr�y l� tlw wwwh weuld W�om�wy yN[M1 no�1s�C I�tbr h'on� s�wewr �utl�wleln0 Wn� OVSR T�t COUNTlR rlAMITTNO (I�b�l of MWIe�Ywi OnN) Rroow n�IWql�. 8wr� 9�r�Ae� l/oo�+a�� AIG w�o�� fWeVBVw�Y/F��O�) Wtv�w�YR-NW orr CounO�r If on P�b �Y�..titl� ROW � ( ��" ��R) City of Zephyrhills BUILDING PLAN REVIEW COMMENTS f�L ` ! 1 5 Contractor/Homeowner: Q C e f�S(�C�Gr Date Received: ' � �( site: �D �l %✓�� Qre. (!'\/ Q � , Q, ��,��il'�a7`l�YU Permit Type: /I.�rn�� i�y 4�1�/1�� 3 �� Approved w/no comments: Approved w/the below comments: ❑ Denied w the below comments: ❑ This commen sheet sh 11 be kept with the permit and/or plans. � 1�� Kalvin witzer ans Examiner Date Contractor and/or Homeowner (Required when comments are present) Fp r, 1 i, 2C' ' 1: IOPM..:.. ..�h' ELECTRIC .... ..... .. ..... . -._.. No. 0064 P, 1 � 9�00 WplS 110� '! l'ady a�,uil pan�aa�a e��70o�ovao City of Zephyrhitis Permit ApplicaUOn Fexati�ieoao�l . Buidln0 Depyq�.ra Drb R�cdv�d � $ ' .....� ,,,.,,, � ��.��„ 7 �mw e� ao-t. Ownele Wm� L � Own�r Pbene Nutab�r t � O°� y bwners IWdn�y � �i owner Pbenv Nwnbsr '� F.. Slmvb 1ltleheieer N�ma ow�t�r Phaw iJun� �\ -� j� FN Simpb iiMoh0lds►Aedr�sc � �aop�s8 ^� e7s ' 4 '� aY L �oT t� 6U�SIOk � I PARCELIOII ba� "� " �� 00 � O 4b ^ 00 O �Y� �a, (�� F1lOM PRO►Ce7YT+t MOIfC� , wowc�aorasso ►,awoo►�,� noau� p s,c� p [� �MaisH e � °� � � �� REPNR • rIt�P06'W UeE Q 8FR � COIYMA � OTHER TYPE OF CONSTRUC710�1 '� HLOCK � iRAME Q STEEL 0 �"—�^"�-� craawPnoHOFwo�nc �l�d �a � @�C � d.\t,�� a�,�c�Q�� atNLDnao 91zE � � �O�c(' SCI�OOTA�OE $� MEILMT � �� '. � + VAl.uA710NOFTOTALCON.47AUCIlON �ELECTRICAI, S AMP SERVICE [� PR06RES3 ENERGY � W.R.E,C. []PLUMBIN3 s ��"�C�� S VAI.�qT10NOFMECWWIGqLINSTALLA710N d� Q ROOfING 0 BPECUU.rr 0 OtNER FIN6HEDiLOpRELEllA710NS � FLOODZ �q�l QYE3 NO U BULDER COMPMIY W0.�V�LC� C. 'p�� L`. C s1GMATlJRE neaSl6�qo N r� a�w Y/ N •• �, .. u Lbeneex "� � �� 1- ELECTIbCI�►1 MP/WY � C � D�f'�YVI �� , �� T� �� neaiar�a Y fEE GuM[N N P .��J� ^ �„wn�as �l�M L � d ,�� ''+91r3� ru,Meae O Mn a��ru►'�t� �aowro�a Y� N F��u�n Y, ,�ae� tJOenee e hllGlANlCAL i COM?ANY SIGNAIUAE n�s'►4Rlb Y / N • FFSC�WIE7u Y A1fq/!6s . LJealse 0 ' 01'HER COAIPAN1f ^ SIGNA7URE �ewntv� YL_ i N f �cux�„ Y1 AeAress L'�eenee • ' 1lIIIIIf1l/lfllllllllllllli lllliftltllllllllllll�llllllllllll�lllll itEBRIENlIAf. J1tle� (2) P1ol Pfanr 12? �� 9u�dieY Pwns; (t) eet e1 F�eiqy Fam� R-GW PemM for nsw �vuaudleti MNnWm 1� (101 wa1Qn0 Asys albr a+ErnMW Aab. qe9u'sed ondev, Canstruekn Plens. Stvmwvekr Mero w SiR rcnw Incteued. . �y F�iNos R 1 eumprlcr She WwR �t la aubdirpior�p� p�eos ' CD11�AL Al1sM (81 �eple4 seb af fiG�inp Plra pAp�tXS 3ak{y P� {}) sN or �e�r Ferms. R-aW PamNt br new mnstru�tian. bN�i�rr,i 1en (sq � aM ��bnlqd wl�. Re'4uFed oosM�� Caiabudion Plent, Srom�Mr Plsne v� Sil Fex1w Yislqled, SY�fy F�dYYu 6 1 dWllp�kG SIY! MA�k PMINt fx AN lfew pbJ�r,�, N OOQIBM►Oil1 roqJrp� RIU6t ef1oM E01)1plj�q . SIGN PERMR � �.NS a ��w.r.a vr�. '^MPROPERrv SURVEY �qdrea 1er a1 NEW arrtrucmn. u�neelion�: Fil o�e tppMeallan eanpkbehr. Owrwr� Cmarsaersign ba�k a(�pplln6en, npq�@ad N wa i75o4 �I NnM�a of Conwnaneen�nt ts'navind. IwC uppradw ova t7600) "�OCrd (fo► tl+e eenbaetnry er Powx of AlbnfeY �(ip owrMr) wwAA Se saneone ttiNN netsRttd kner /rom owwr sWTq�g !#ms OYER 7M! COU�f}��, pF�� (fronldAppimYq� Q� ' ReeOeMl� ewMSn S�MW ilpprstlee IrC Fanaee (PieuSuNOylFoolx�� , DrirawayrNot evsrce�;l nn qpicrosawhb_needs ROW �nnrinn CL27N !b'OA 11117lI I /�/1 •IIInIJ � � 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 fuRher understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide° prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health 8 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 inGuded in the application. A permit issued shail 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 IMPR VE ENTS UR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR A O E B RE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.0 9MNJiRGR AGE CONTRACTOR Sub ri ed and s o to or affirmed) b ore me lhis ubscribed and sworn to (or affirmed) before me this -�- '�Y" 7. � bY Who i�sla_r� per Ily kn to me or has/have produced Who is/are personally known to me or has/have produced as identrfication as identification l T� i� � 1 ° ��.1� Notary Pubhc c U . Notary Public Commission No. C. £ O S � l' 1 Commission No. G 0. � P � P � �Y �� Name of Nota rint �'• Name of Notary typed, printed or stamped * � * �� 5� , EXPIRES: January 29, 2pi5 '�i' � Bo�Nd ihru BuOpM Nobry �Mow 7X Result Report p i 04/11/2011 08:47 Serial No. AoEDapt�oo��ss TC: 18517 Addressee Start Tine Ti�ne Prints Result Note 99481B05 04-11 08:47 00:00:22 001/001 OK Note �ILIDY: T � xu 1ay le- M i X: d COnfide�t�ale�UL n B�i1�3�is=8o t1 Erase RTXi Re-TX. I InLernet FaX � SiP ��axF �f�^"^° �'' "°°,CSS FaX. Result 01L: Co�munication OK, 5-01(: Stop Communication, Pw-OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, BusY: BusY, M Full, LOUR:Receiuing length Ouer, POYR:Receiuin9 page Ouer, FIL:File Error, DC:Decode Error, MDFI:MDFI Response Error, DSN:DSN Response Error. 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Data Current as Of: Weekly Archive - Saturday, February 12, 2011 -- - --- -- - -_ Parcel ID 02- 26 - 21 - 0010-03900-0020 (Card: 002 of 008) --- -- - -- - - - _- - - ---- - - - -- ----- � - - ----- - -- assification 19 - Professional Service Building ' __.____._..____.__. ___.T_ ___ ___-----r__-----------_.__.._�__..___ __. __.____.___- ----- _^— - - --- - ; Mailing Address � Property Value FMC MARKET SQUARE INC Ag Land �p � 38135 MARKET SQUARE Land $616,074 ZEPHYRHILLS FL 33542-7505 Phvsical Address - See All 10 addresses �F�rstsnowr,� Building $3,935,799 38045 MARKET SQUARE DR Extra Features $155,259 ; ZEPHYRHILLS FL 33542-7504 Market Value $4,707,132 ! Le4al DeSCription (First a �ines) Assessed (Non-School Amendment 1) $4,707,132 ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 POR OF TRACTS Taxable Value $4,707,132 39 40 41 & 42 DESC AS COM AT SW COR OF NW 1/4 OF SEC TH ----- --- i - _ .. _ - - --------- -- _ ___ - -- - ------------ -- --- ---- - - -- ---- - - - -- - - - - - - - - - - - -- --- Land Detail (Card: 002 of 008) - - ----- - ---- - --- -- Line Use Description ' 2oning _; Units T -� --_-- - - -_- =_� -- ype Price ; Condition Value - -.. . - ___= _:_....__ --_ : - _ ,_..-._ - _. -_.=- _.., - _ _ Additional Land Information --- -- - . - -- -------- - •- --- -- --- - cres 7.56 , Tax Area , 30ZH � FEMA Code , X � Commerical Code M301ZAP �- .._ - --- ___.___. ,. - - - - - -`-_�.__�. T�-- -- . ._. -- - - -- - u� �ng Information Use 19 Offices Professional or Medical (Card: 002 of 008) � --- - - -- ---- --- - - --_ - — - ---_ __ ------ - - -- -- Year Built 1984 Stories 2.0 --- Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Concrete Block Stucco Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel Interior Wall i Drywall Interior Wall 2 None Fboring 1 Ceramic Clay Tile Fboring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Packaged Roof Top Baths 6.0 - -- ----- ---___ -- -- _. ._-__.___�_..__- - - -- - - - -- -- ---- -- --- -... _ .. - - -- - - - - - Line Descriptan Sq. Feet Repl. Cost New 1 �AN 2,814 2 BAS $86,307 26, 068 $2, 665, 714 3 A2 7,000 - ---- _-----_-._ ------__._..._._.__.._..._-_�_._`_-_ ______-=----- .�_____------_----- - $715,820 --- -- -- -- - - -----_---- - - - ------------ ----- ______...---___ - - - -- - - -- Extra Features (Card: 002 of 008) - - -� - - - ------- ---- - ; -_ _..-. _-- -- - - - --- - --- Line ----- , Description � Year Units j Value -- ----- - ---- ------ -- - - - - - -- - --- - - -- --------- - - -- - SPRNKFP 2002 33,068 � -- - - - ---- - -- ---- -- - -- -------- -------. $35,135 2003 - - ---- - Z ELEVATR -- - - --- - -- = -- - --- - - $18,240 - - -- - = - - -- -- - - -- - Sales History - -- - - -- - - revwus Owner NORO-MARKET SQUARE HOLDINGS BV - ---- --- -- - - -- -- - --- -- - --- - ----- ear Month - -- - -- - -- - - -- - - - Book/Page Type Amount 11 --- -- - -- -------- -- - ----- - --- - - -- --.- -----. --. �_ 3228 / 0293 W D _$0 1987 -- - - - ----- --- - - - __ -- - ---- - - - --- -- --- -- --- - - ' 1703 / 1337 W D $0 -- -- -- --_-,�--- --- - --- - - -- ----- ---- - --- 7 12 --- - ------- -- - --- 1676 / 0198 W D $0 1 of ] 2/14/2011 8:23 AM Pasco County Properry Appraiser - Physical Address List for: 02-26-2.. http://appraiser.pascogov com/search/physadd.aspx`'parce1=2126020 . ��Vei�ome : Re�ords Search : Parcei Details : Physical Addresses Physical Address List for Parcel: 02-26-21-0010-03900-0020 Displaying 10 records View in groups of: 10 25 50 100 500 — ------ -------- ------- Street Number Street Name * Unit ! 38045 MARKET SQUARE DR 38051 MARKET SQUARE DR 38101 MARKET SQUARE DR 38103 MARKET SQUARE DR 38105 MARKET SQUARE DR 38109 MARKET SQUARE DR 38111 MARKET SQUARE DR I 38113 MARKET SQUARE DR I 38115 MARKET SQUARE DR � 38117 MARKET SQUARE DR Pasco County Property Appraiser Page Layout Modified: 2/17/2009 1:10:37 PM The Local Time Is: 2/14/2011 9:05:20 AM 1 of 1 2/14/20l 1 9:02 AM Property Appraiser - Search Results http:Uappraiser.pascogov.com/search/Default.aspx?pid=nam&ke}�... Weicome : Records Search : Name Search Name Search Results for: FMC MARKET SQUARE IN Home Search Again Displaying 5 records View in groups of: 10 25 50 100 500 Map Parcel Name + Address X 02-26-21-0010-03900-0010 FMC MARKET SQUARE 38123 MARKET SQUARE - - INC DR � X 02-26-21-0010-03900-0020 FMC MARKET SQUARE 38045 MARKET SQUARE INC DR X 02-26-21-0010-03900-0030 FMC MARKET SQUARE 38135 MARKET SQUARE - INC DR X 02-26-21-0010-04000-0031 NC MARKET SQUARE (No Physical Address) 38135 MARKET SQ X 02-26-21-0010-04000-0050 FMC MARKET SQUARE 38021 MARKET SQUARE - - INC DR Weicome � Records Search � Appraisals � Exemptions � Dates � Information � Contact I of 1 2/1 1/2011 9 54 AM . . Page 1 of 2 Gail - Oliveri Architects.com From: John Benedetti [jbenedetti@floridamedicalclinic.com] Sent: Friday, February 11, 2011 3 50 PM To: gail@oliveriarchitects.com Cc: Colleen Cuffe Subject: FW� Rheumatology Suite Gail The legal address is 38045 MARKET SQUARE If you go to the Pasco County Property Appraisers website and do a search by address it is 38045 Market Square Once that page comes up it will be Card 002 of 008 If you click the map you will see that it includes alt of the strip center and the main building plus all of the parking spaces in front of all our buildings Call me Monday when you get in Thanks, John Benedetti John Benedetti Diu-ector of AccountinglPur+�hasing �' � ��'�� sis� �so-s�r�a i��:�d �c�� sis��ss-aaii �� +C'�i��c �benedetti a(�loridamedicalclinic.com c fi �} / ir.3N"�F�@, �9N's.�'ryaa'AtFi_i�Y! r From: Colleen Cuffe Sent: Friday, February 11, 2011 9:40 AM To: John Benedetti Cc: Christian Alvarez Subject: FW: Rheumatology Suite Johr;, 2/14/2011 -_, . � n �, L:_/ ^ ;c � '��no,,:Q , ��p�x�d b�,r and Re�u�r� trta : EMIL C . Nl�1RQUAR��T, JR . , ��Q . �+Iac�a�lane �'e�geason & �Ic��,eia �os� ��f�,ce Y3o� 1669 C:1ea�wat�sc, �'L 33`75`7-1�6� PQG�:R OF ��'�0�3�7�' K[�3flW r�LL MEt�I BY THESE �RESEiITS, 'Ihat FNiC I�RI{ET SQUARE, INC:. ,�10� S herehy constitute anc� appoint OLTVERI 1�RCHITECTS, INC. as its true and la�Tfui attoz�ney-i.r.-fac� fo�.- ic ai�d in its name, plac� and stead, Lo ex�cut.c �nd d�li_ver an_y dacumen�s ncccssary tc� h�ndle al i per_mi_t�ti: issues relating to tne renovaticns to the second story of the buil_di_na ownec� by FMC P�IARK�l SQUARE I�1C. at 38t)51 `-larket Square, Ze�;�n,�rri;.1_s, Fl�� r . FMC t�1ARKF� SQUARE, INC. grar.ts t� its agent, O�TVER_ RRCHITECTS, i.N!:. f�_711 powEr and at�thority to dc� everythiizq �1ecessar1; i P:;� any of the pc�w�rs herein gr_ant.ed �s rl�� ly as F��1C �IARI�.E'P SQ�.iAl�.;?., Iiv��'. miqht or_ cou].a do i.f. personally preser.t f wit?� full pnwe � c_= sub:�t.ituLion or .revocation, hereby ratifying anc.� cc�?if i_rrriFzc� a1i that its agent si laurfully ao o.r_ cause i�c 1�e czo;ie by vir �ue of fit;i.� pofae �� oY artorney and �he powers nerein grar�ted. 1 af 2 L`_d t^7 U�H�REOF, F[�iC ifARI{ET SC�U�a�F:, I�IC. }�a5 hereurt�� set, .irs i�an�� nd seal �i�e �� day of �-L�� ,'�C11. Signecl and Beliver�d in tlle P.-�sence of : 5 FMr M?1RI{ � SQUARE, INC , I �T ) l� V � `; ��_ � �u t`;ltil ��J_c� J1_.,1_.��. � � : � �% �/ L�' �� ( S EP_L I ,l � � ,. • ! � . - � ., , . �---� ----- } Yi i� � Name .-J�`� (� �� r�jC'.l«c� E�� JQE LATORRE � - -- �� !�i'� .%„ � ,� Dated. ,� �'' �� --�---- --- � � �! .. �`.�t/�_�`., r / +� `� � Pri.nt Name: �'�,l_�� '�1�.� � �r 4 STA`l'� G�' F'LORTDP. COUNT`�' UL' L-'ASCC BE I'I' KNOWI�I, that on the �� day of Febr_�.z�ry, 2011., bef_ore me, a notat public in and for t�he State of rlvrida, duly coz?ur:i ssioned ani� swc;rn, pers�nal]_y r_.ame a:�d appPared JOE �EL?1TORRE, to me personally icncwn or wha has �roduced a� identification anct whu��Tc; �ake �n oath, and is known to me to be t�he same person desc _1; anci wro executed the within power cf attorney, and i1e ackna�al�:.daec3 thc w�.ti�il� potirer of at�o_rizey to I�e his act and �eed. =�rl TES�'IMONY WHEREOF, I have hereun�o subscribed m�� name and affix:�d my seal �f office the day and ye�r lasL abeve �a.rit�en. �.... ._ .�,. —I��--�Li.�� 1�� _ ---- 'assdhie�o(y�euor�ey��Bao�VlA�p�oH �;,o,,, I1ot�y'y P�al��_Y�� -------- £f.lU6 33 # Utllssiwtllo� �;c3��" �^�� Pz ; n t 1�ame a�QZ'S no{y sa��dx3 �wuo� h� _. * �+ ,; — - e�l��t�da�lelS =.° p=:� �y Corru�.issi�n E�pir_es; S3NAa VllH ,' ��i d �'� � O`• ,��,.,. �._ ,,�,��„ —�_°M�.,,'. ..�o�^" RITA DYKES ' • « o: Not p� :, � �: M a+'Y blic - State af Fiorida q�zc:.r�f_'nc1:r clr.\m.r,r:ct..q�li:�;;e� paa okiveri.o7_.1S 11 ci��cx z'y aQr: Y Comm. Eaplres Nov 5 , �Q�a �/ Cem�ission � EE 30133 �`""""�� oode� iArough Nationa► Notary Assn. 2 of 2 ' Page 1 of 3 Gail - Oliveri Architects.com From: John Benedetti (jbenedetti@floridamedicalclinic.com] Sent: Monday, February 14, 2011 11.36 AM To: Gail - Oliveri Architects com Cc: Colleen Cuffe, Joe Delatorre Subject: RE. Power of Attorney Letter for Permitting Process Gail, Attached is the POA that you requested for the project at Building B on the Market Square, Inc property Let me know if this fulfills your needs Thanks, John Benedetti John Benedetti Director ofAccountinglPux•chasing �" �� sisj�so-s��a ��.�� Sis��ss-aaii �� '��r�ic= jbenedetti@�laridamedicalclinic �com ��v,- /i�i*, L'�a'r'�'�'f: r�!d�r From: Gail - Oliveri Architects.com [mailto:gail@oliveriarchitects.com] Sent: Monday, February 14, 2011 10:13 AM To: John Benedetti Cc: 'Amir - Oliveri Architects' Subject: RE: Power of Attorney Letter for Permitting Process Thank you John 2/14/2011 - Page 2 of 3 Gail Tucker Office Manager Oliveri Architects Office-727-781-7525 Fax-727-781-6623 -----Original Message----- From: John Benedetti [mailto:jbenedetti@floridamedicalclinic.com] Sent: Monday, February 14, 2011 9:37 AM To: gail@oliveriarchitects.com Cc: Colleen Cuffe; Joe Delatorre; Mark Marquardt Subject: FW: Power of Attorney Letter for Permitting Process Gail, I have requested that our attorney Mark Marquardt draft the POA He felt he could have it for us today to have Joe Delatorre sign and notarize Once received from him, I will forward it to you Thanks, John Benedetti John B ene det#i DirectorafAccouniinglPur+cltasing ��t�l"1t�c�l �sis� �sn-s��a !��c�a l {si��ss-aaii �� `�ini�° �"benedettia�laridamedicalclinic�cam ��o°l.,�r,[�rr�'.�e+P..l�r From: John Benedetti Sent: Monday, February 14, 2011 9:32 AM To: 'Mark Marquardt' Cc: Joe Delatorre; Colleen Cuffe Subject: Power of Attorney Letter for Permitting Process 2/14/2011 ' Page 3 of 3 Mark, As per our phone conversation, attached is the Pasco County Appraisers Parcel information for the building located at 38051 Market Square, Zephyrhilfs, Florida We need a Power of Attorney for Oliveri Architects to work as agent for the permitting process for renovation improvements to the 2nd story of the building owned by FMC Market Square, Inc and occupied by Florida Medical Clinic, P.A. Joe Delatorre will sign the POA and will need to be notarized If you have any questions please call or email me. Thanks, John Benedetti John Benedetti nirectorofAccountinglPux�chasine � �sis� �sn-s��a �1k�� `rc,�� Sis��ss.a�ii {�� C='�in�c �"benedetti rt loridamedicalclinic�com I�t. c�wre'��'a.vs,�iy 2/14/2011 • - ' - AA - 0002921 TRANSMITTAL LETTER PROJ. NAME: Florida Medical Clinic Rheumatology Suite 2" Floor PROJECT #: 10-65 DATE: 2/15/11 TO: City of Zephyrhills FROM: Amir Yacoub Attn Building Department Project Manager 5335 8 Stret 727-781-7525 Zephyrhills FL 33542 1-813-780-0000 SHIPPED VIA: FedEx PICKED UP BY: DATE PRINT NAME: WE TRANSMIT THE FOLLOWING: FOR YOUR: APPROVAL REVIEW X USE PER YOUR REQUEST RECORD DISTRIBUTION OTHER COPIES DATE DESCRIPTION 3 2/9/11 Sets of Signed & Sealed Construction Drawings 3 2/8/11 Sets of Signed & Sealed Energy Calcs 1 Permit Application REMARKS: �.Sl�.. �� b�1 ��.�f 1 b�. t� rc� �Y �ac� v.�„ UC' r�""\ �`n`� ��1.�.� �\ v r S D Y Ca YY� �� Y '� Yv'� Cx,`Q � \� \ .J, O� ��\ V��l' ��Y �� tC C.'� S.�M �'M��{ � �,1V�Y\A�' C��4C'�S , Cs'W� If enclosures are not as noted, please inform us immediately 32707 U S Hwy 19 • Palm Harbor, FL 34684 • Phone 727-781-7525 • Fax 727-781-6623 • E-mail design@oliveriarchitects.com 94/07/2011 12:32 8138187006 TEHAN PLUMBINGINC PAGE 04/04 � ` From: 44lQ712011 12:1$ �289 P.OQ110U2 ._._.,....w► na�.�e�.aosu Cdy of Zaphyr�lla Pecmk �0.ppiitation �tlea+�taaoz� � �� . ma � '--� , � � � � � i � �.caae�ar.r � � r � �' � �t'1��( pR ..� � Oumw� N� '@l1G � Ow�r rdax w�mp.r y Owaw� AeaU�r '� � OwMr Iben� IAm� Fa� BbMb 7NY6ei41r Nrn� O�r Pha� wm�pq �1�1 Q. p-�� Fee sia�pp'f�Nro�p�y, JOBAGONas � 0. 4 �1,. �� ae►eo�oH �,�^� a�Et.n� O �a�- oold - C�.'t.9ao ' a0 ��Yl,. ea, lo�►a�vNarMw�oeru:YUenqq �� 0 8 � . 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I-�FCO573�.Q �� oP rssu�uvc urrni. ��t� se, aea�a rcl�arr, M�chael a x Pk�e cat a.t �e aloag liines 11834 LencasJure Drive Tampa, FL 33626 04/07/2011 13:12 8636474355 GFI NETWORK PAGE 01/01 4 �ATE(MMIDD/YV`IY} '' .��G'� � CERTIFICATE OF LIABILiTY INSURANCE 4 � 2 i' ''� TNIS CERYIFICATE lS ISSUED A8 A MAITER OF INFOC�MATION :ER ve„orge �'r�l.in Insuranae ONL7 AND CONFERS NQ RIGWTS UPON THE CERTI L' HOLOER. TH1S 'GERTIFiCATE DOES NOT AM�ND, EXTEND OR 62S Commerce Dr, 3u�ts 302 ALTER TH� COVERAGE AFFaR0E0 BY THE POLIClES BELOW. s.��l�a, � s�s�s j + 63 682 -4434 IiVSURER3 AFFORDiNG COVERADE �C� iNSU�o T��n plumbi�ng Ina INSURER A snottsdale Iaouranca Com�pany �TOY1fi�.e INSURER B: �lAC�se� �dos�rit4�s, Inc. 1007. �dham Lakes Dr wsurt�R c: Odessa, PZ 33556 �nsurt�t o: 1 —7 O— INSURER E: ' C G � , THE POIIClHS OF INSURANCE LISTED BELO�N HA1/E BE�N ISSUED TO THE INSUR�D NAMED ABOVE FOR THE P4LICY PEitIOD INDICA?ED. Np7YV17HSTAN01fYG i I ANY R�QUIR�M�NT, 7ERM OR CONOITIQN OF ANY CONTRACT OR OTMER DOCUMENT Wl7H RESP�CT TO., WFtICH TFlIS CERTIFICATE MAY BE ISSUED OR i MAY PERTAIN, E'INSURANCE AFFORDED BY THE POLJOIES DESCRI6ED HEREIN IS 3UAJECT TO ALL YHE TERMS, EXCLUSIONS AN� CONOITIONS OF SUCM Pa��C�ES• AGGREGtATE LIMITS SHOWN NWY WiVE BEEN REDUGPp BY PfUD CLAIMS. � L IN POl1CY NUMBER DATE M� �� DATE � N LIMITS l GENERAL LWBt�ITY EACH OCCURRENCE S 1 000 OOO � X COMM�RCIAL G6NERAL LIAliILITY PREM18CS Ee ooa�erx = �OO OOO � � � CLAIMSM+ROE �X 'OCCUR MEDDU'(MyOnopwsa+) S S OOO � CP51310989 12/4.3/10 12/03/11 R PERSONAlBADVINJURY , s 1 000 00 � A { �N�, �� aoo 0001 � GEML AGGREC+ATt IIMIT APPLIES PER PRODLICTS - COMp/OP AGG S Z OOO OOO ' � POLIEY � L� � I AuTOM081LE 6V►BILrtY � ' : CpMBINEO 81tiGLE LIM1T � I aavptrro � °OC1f � � ALL OV�W �09 BODIIY IN.fUR7 y � SCNEDULEO AUTOS j � ��) MIRED AuTOS BODILY INJURY � I NONaOWNED AUTOS ( � I �� s ' � , • 'i i PROPERTY DAMAOE � (perscqCenQ $ -,.,.� �AW1C�E LL4BIUTY AUTOONLY-EAACCIOENT � 8 . ti WNYAUTO OtHER THAN EAACC S I AUTOONLY: � s j FxCESS I l'lMBRELI� LIABIU7Y EACH OCC�RRENCE 5 � OccuR CI Ct,An�SMaoe � aGGREGATE S . i • � I DEDUCTlBIE S _„ . � � RHT�N710N S ' i CO►APBNSA N T or►� ' �..' . j ,w�o EMa�orer� une��m M E Y/N ; �rn- �to�rowP��e � TaTC9231171 1/1'I/11 1/17/12 �.�. �ynccioe�rr a 500 �Q�' , orF�cFP�R �xu,ow? n A Manaimyintpq E.LDIS'�ASE•EAEMPLDYEE s 500 Op�} . M y�e aa�be u�ar SPE�WL PRO�IS�QNS bebW EL Dl8EASE -POIIC� LIMIT S r JO � OTHER . I � i � i DESCRiPT10N OF O�RA710NS I LOCATION8 ! VEHtCLES I EXCIUSION3 ADDED BY ENDORSEMfNT! $PfiCIAL PROVISIONS : i I ' � i { ( i .. .,� i cERn��cr►r� r+a�oER crwcew►no� i arau�o nwr oF n� abeiv! oE�o' no�e ae cA�uen aeFO� rne owxwnoN ` , The C�ty of Zephyrhiiis � � 5335 8th Stxe6� aa� n�eReoF. � msu�,�wnae wuL ero�►vae m wia �t1 a.� wacr+�+ '� � Zephyrhx 118 FL 33542 NoncE To n+E �Hrn�'re � wa�o,o n+e �r, eur c.�n.Wee ro 0o so swua, • � wwo� Ho oauo+�nor oa u�rnu.v w run w�o uvoN txe �s easw,9 oR I � si3-�go-o.oz1 �NTATNEB. I ..., au'r�owzeo �P�s�rrrnr�ve r � ACORD25(2009/01,� • � 1988-2009 A,CORO,CARPORATION. AII NpMs reserved. : - The ACORD name and �ogo an regiatered merks o� ACORo ' Zephyrhills Fire F2escue (�907 Dairy Ilo�td, Lephyrhills. I 335�? i'ire Marshal 13uti ($13) 78()-0041 Kerry l�arnetl Fax (�31 �) 780-OU44 L;-mail; kbarnett(�i %tire.r_.ephyrhills.Fl.us Plan Review #: I 1-041 Project: Interior Renovation Number of Pages: 33 April 22, 2011 I have received and reviewed the plans for the renovation located at 38051 Market Square Dr and will allow this project 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. l. Ensure fire safety practices are adhered to during renovation in accordance to NFPA 1. 2. If either the fire alarm or fire sprinkler system is to be out of service for tnore than 4 hours, this authority shall be notified. 3. The modification to the fire alarm and fire sprinkler system will require a separate set of plans, cut sheets, details, etc... from those individual contractors to obtain a permit to complete the work. 4. The fire sprinkler FDC will be changed out to a 5" 30 degree turndown Storz. 5. As information only, there is no page PS on cover page of plans. 6. Room 110 (electric) shall have a 1 hour rating and l hr door. (NFPA 101, 38.3.2.1 & 8.7). The door to this room shall have a sign on it "NO STORAGE — ELECTRTC ROOM" 7. Install emergency lights in restrooms. 8. Ensure Address is located on front and rear of building. 9. Ensure electric meters and panels located outside for this space are addressed accordingly. 10. Instali a knox box on the front of the building, if not already there Box shall be located by main door at a height of 6 feet. An application can be obtained from this authority. Ifa knox box is present, a key shall be given to this authority to place in that box. 1 l. Ensure duct detectors are installed on AHU's and tied into the FA system. 2 (nspections Required: !. Screw inspect on firewall 2. Final on firewail >. Renovation Final KERRY B RNETT, FIRE MARSHAL ***Please be advised this review of ptans 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 [hat 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. ��i'�i�FiILL� FIRE D�PQeRTlIA�N`T 6907 Dairy Road, Zephyrhilis, FL 33542 r��re C�ief K2iti� VlliHia�7�s Bus (813)78Q-0041 f°ax (813)7I�U-�(3�1�4 FIRE SERVICE USER FEES Occupancy No.: „ Plan No.: ! —D / Contractor. �✓= �/`ie � ��S�Ie� c -�� C C Business Name. � Jti�� r �,h:.• Billing Address: � BusinessAddress: :i��r_. / O'�s�..-��,1�v; ,>'T -,,��,,� yt,�r� ,�-=� Business Phone No.� Billing Phone No.: 7�`�— "7S'�i- �SJS" Business Fax No Billing Fax No.: Contact Contact: PIAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE Site Plan N/C Annual N!C Sprinkler $50 1 st Alarm N/C ;�� Multi-Fam�lylCommercial O6 sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C � (Minimum Charge $25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C � Plan Revisions DBl 3rd Re-inspection $250 Hoods $50 4th Alarm $100 4th Re-Inspection $500 Fire Alarm $50 Sth Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alann $200 8 0- 25 Heads $50 violations corrected) Natural Gas �SO NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- Pe� ��k $5p STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100 � Per Riser $50 Hydrostatic Test a65 Per syscem Fire Works $500 FIRE PUMP Acceptance Test $45 �� sys�m Camp Fire $25 � Per Pump $100 Hydrant Flow $75 Controlled Burn $100 FIRE A�ARM SYSTEM Hood/Duct $50 a 0- 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual 26 plus Devices $100 System Acceptance $SO Fire Protection $25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 Annual Wet $50 OTHER .� Waste Tire Storage $50 Annual Dry $50 ;re Walt/Smoke Wa11 $t��.N.au Generator < KW $100 CO2 $SO LP Gas $25 per tank Generator >30 KW 150 Other $50 Natural Gas $25 � syscem Bio-Hazard Waste 5100 Annual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 70'x10' or greater $15 per tent Torch PoUApplied $50 OTHER Fire Pump $45 Haz. Materials at 00 Annual LP Installation per lank $50 Fire Suppression S30 Fuel Tank Installation $50 System Acceptance ❑ (Per Tank) $50 8 Exhaust Hood/Duct $30 Natural Gas Installation $50 Re-inSp2ction DBL (Per System) {other than annual) � Spray Booth $50 � Inspection scheduled DBL 8 � and cancelled less than 24 hours 8 Construction Insp. N/C �� Emergency Vehicle Ac� $50 ,, FALSE ALARM PLANS 70TAL��k� ��. INSPECTION TUTAL� 1`� PERMIT TOTAI�_ __) TOTALI I GRAND TOTAL ' : j e'' � Comments- Date� Z% C/ Ins��ctor ��" 7 ,��v}.»`i:,'�-,•':�;��:;R.:r{�x�= •�- - .'t�.- : c•��.rx � r.'t� 5_� '�.```�.'?y��'�s.' �i �; , 't � �' ' °�? - '�, : ' �+ - x s. �" $ ti � 3��+.� ',� •Y .�L��o x� r a 4 a � ��V � y .• �•' t � � . � 4 � a�',ij�N:}�� .�. , _ zt . .. � . - i � , . .O �h t � �+ �,i.` � F q. } q � , �� ' t°a A: - � � . . '� , ` f � i��;#' x � ""'" `" a , ' , ��'.�� fi':: - , 1` �' � �`�' � ,: < ",� ' u r. r^' -t • . . . �}..�: ' � � ..� , "t�:in�.�y��a, i �' '�':€�= w r, .. � 'a� �' . ;>_� i - .. . � � F . ,! _ � ,« � � ,!F�r' �, } �"�� . "`,. ,s"'� J? � s � �.' �� ,:,�' r; � �.'' � ,i.` c't�, . �,'' ` �" '4.,. �.i� " ; � •• �;�r�'� } F' ::+��:y:q' �,,qC� t� ':�'r;a - a'r. _ ;r�� LL 4 ,riz"s :� �r• �s�°. � r �",:�t2*;r� ,x',:'rr,.�+�'p,�.��,.", "F;' �. `.. �� „ . �°�«:. = ,*3; y ..� ar'n, �.�,�?<'.i,;�'�`,� ;5.. ."�.�j�t,sc.�z,��y�.��.:"�'ii',:#S�gv e ��n' ' -.�'a.. .,y. = .r , .��i¢�:w� b:;,�t.,�z',1' �..5 ��s�','Ym°mi.?n'��..�'k:.�:,"k2'r�3vr - .`ft *..��d'r';#.''�.z4 4tM1 �2�. F "�. ' "a� es »:i., `«�'�% PROJECT SUMMARY Short Desc: FMC Rheumatology Description: FMC Rheumatology Owner: Florida Medical Addressl: 38051 Market Square City: Zephyrills Address2: State: Florida 7ap: 0 Type: Office Class: Renovation to existing buildi Jurisdiction: ZEPNYRN1T.r �, pASCO COiJNTY, FL (611600) Conditioned Area: 6447 SF Conditioned & UnConditioned Area: 6447 SF No of Stories: 1 Area entered from Plans 6500 SF Pernvt No: 0 Max Tonnage 0 If different, write in: EnergyGauge Summit� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 1 of 10 Compliance Summary Component Design Criteria Result RENOVATED ENVELOPE PRESCRIl'TIVE PASSES LIGHTING POWER 7,110.0 7,116.5 PASSES LIGHTING CONTROLS PASSES EXTERNAL LIGHTING N� None Entered HVAC SYSTEM �VJ4 None Entered PLANT �/!ck None Entered WATER HEATING SYSTEMS PASSES PIPING SYSTEMS ivpk None Entered Met all required compliance from Check List? (Ye�No/NA IMPORTANT MESSAGE Info 5009 -- -- — An input report of this design building must be submitted along with this Compliance Report EnergyGauge SummiiC� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 2 of 10 ENERGY CONSERVATION CERTIFICATION All informotion listed below is provided by others and used in the� � 'l, , , � � � pleeloifop �F co plionce with the Florido Ene Code. This information is intended to mee[ the requirement of Florid��qf's�}�on,6ode: SeCt(o� 15-30.010 Energy Conservation Compliance. � (�: � � � � � � �'" � ♦ •'� : As the Electrical designer I hereby certify that the�l3i� corr�ct f�qt'th�� n indentified as Lighting and Ext-Lighting. In addition I hereby certify that t�ting contr�� ar��i�r�pliance with Florida Building Code 13-415.AB. i'3r►,�•., � S,��.�,,Z ��'� �I� �' • � s . «t � ' �,�� 9 ��i� Electrical Designer: Registration: l��r � n& ��.��'ate: ��ti� �i�r►�•�� CERTIFICATIONS � ��+� Ni��iq�� I hereby certify that the p� ��I��vered by this calculation are in compl� ith the Florida Energy Code *• ; •'� �O p� Prep�ed $y: D'd S. �ss O�: Building O�cial: • � f ,� � � U � I� 1`; � ` �.� �j �i� I �W � Date: � �'�� °ti �O: I certify that this buildin��b�fpliance �ilTi ��Lorida Energy Efficiency Code �� •Q....• * �� r ,�� Owner Agent: �d��cal Date: If Required by Florida law, I hereby certify (*) that the system design is in compliance with the FLorida Energy Efficiency Code Architect: Joe Oliveri Reg No: 0002921 Electrical Designer: George Johnson Reg No: 38680 Lighting Designer: George Johnson Reg No: 38680 Mechanical Designer: David S. Bess Reg No: 51871 Plumbing Designer: David S. Bess Reg No: 51871 (*) Signature is required where Florida Law requires design to be performed by registered design professionals. Project: FMC Rheumatology Title: FMC Rheumatology Type: Office (WEA File: FL TAMPA INTERNATIONAL AP.tm3) Prescriptive Envelope Compliance Item Zone Description Design Criteria Meet Req. Glass Existing RTU Percent glass Ma�c allowed .000 50.000 Yes Skylights Existing RTCT Percent Skylight Maac allowed .000 5.000 Yes Meets Shell Envelope Requirements -- PASSES EnergyGauge Summii0 Fla/Com-2008. Effective: March 1, 2009 2/8/2011 Page 3 of 10 Exteraal Lighting Compliance Description Category Tradable? Allowance Area or Length ELPA CLP (W/Uait) or No. of Units (VV) (VV) (Sqft o f�) None EnergyGauge Summit� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 4 of 10 Project: FMC Rheumatology Title: FMC Rheumatology Type: Office (WEA File: FL_TAMPA_INTERNATIONAL AP.tm3) Lighting Power Compliance Space Ashrae Description Area Height No. of Design Effective Allowance ID (sq.ft) (ft) Spaces (W) �yy� �� 111 10,004 Exam/Treatment (Hospital) 803 8.0 1 1952 1952 1,205 n.rFr rcrnrT 109 8 Food Service - Leisure 258 9.0 1 144 144 232 RUF A YAl1 Dining 104 5 Corridor 117 9.0 1 54 54 59 rnn u mn 105 5 Corridor 55 9.0 1 2'7 27 28 rnn u mn 106 DRUG 3 Storage & Warehouse - 162 9.0 1 54 54 130 c�rnu e r:� Bulky Active Storage 107 6 Toilet and Washroom 72 9.0 1 27 27 65 P A TTFRTT 108 STAFF 6 Toilet and Washroom 72 9.0 1 27 27 65 TlITT FT 7 112 3 Storage & Wazehouse - 68 9.0 1 48 48 54 "'RYn`Tr Bulky Active Storage 103 16 Office - Open Plan 116 9.0 1 96 96 128 �xrnn rr 113 3 Storage & Warehouse- 28 9.0 1 20 20 22 urnr�„ Bulky Active Storage 115 EXAM 10,004 Exam/Treatment (Hospital) 95 9.0 1 186 186 143 �u� 116 EXAM 10,004 Exam/Treatment (Hospital) 94 9.0 1 186 186 141 rni 101 12 Lobby (General) - 620 9.0 1 352 352 806 �a� e rTn.rr_ Reception and Waiting 102 16 Office - Open Plan 315 9.0 1 192 192 347 AF('FATTfI 110 ELEC 1 Electrical Mechanical 38 9.0 1 48 48 57 Equipment Room - General 114 5 Corridor 518 9.0 1 216 216 259 rnn v mn 117 DR 17 Office - Enclosed 100 9.0 1 96 96 110 n�Frr-F e 142 6 Toilet and Washroom 48 9.0 1 27 27 43 n e �rr��rr 143 6 Toilet and Washroom 48 9.0 1 27 27 43 A A TTFAiT 144 DRUG 3 Storage & Warehouse - 42 9.0 1 48 48 34 c er,rvr � gulky Active Storage 145 STAFF 6 Toilet and Washroom 51 9.0 1 27 27 46 �rnrr F�r i 146 3 Storage & Warehouse- 30 9.0 1 20 20 24 nFFrr� Bulky Active Storage 147 5 Conidor 75 9.0 1 27 27 3g rnumm� 118 EXAM 10,004 Exam/Treatment (Hospital) 95 9.0 1 186 186 143 e� 119 EXAM 10,004 Exam/Treatment (Hospital) 95 9.0 1 186 186 143 e� 121 EXAM 10,004 Exam/Treatment (Hospital) 95 9.0 1 186 186 143 ez 122 DR 17 Office - Enclosed 100 9.0 1 96 96 110 (1FFT!`F R 123 EXAM 10,004 Exam/Treatment (Hospital) 95 9.0 1 186 186 143 R1 124 16 Office - Open Plan 54 9.0 1 48 48 59 �unvrr EnergyGauge Summit0 Fla/Com-2008. Effective: March 1, 2009 2/8/2011 Page 5 of 10 125 EXAM 10,004 Exain/Treatment (Hospital) 95 9.0 1 186 186 143 R'1 126 EXAM 10,004 Exam/Treatment (Hospital) 94 9.0 1 186 186 141 134 DR 17 Office - Enclosed 108 9.0 1 96 96 119 n�FTr� � 135 DR 6 Toilet and Washroom 70 9.0 1 27 27 63 Tl1TT RT 136 EXAM 10,004 Exam/Treatment (Hospital) 122 9.0 1 186 186 183 137 EXAM 10,004 Exam/Treatment (Hospital) 122 9.0 1 186 186 183 r� 138 17 Office - Enclosed 171 9.0 1 48 48 188 cuenFn 139 5 Corridor 328 9.0 1 108 108 164 rnnu rnn 141 16 Office - Open Plan 363 9.0 1 452 452 399 �,r�r�ri n i 127 3 Storage & Wazehouse- 64 9.0 1 48 48 51 eTnv n r_� Bulky Active Storage 128 EXAM 10,004 Exam/Treatment (Hospital) 98 9.0 1 186 186 147 rz 129 EXAM 10,004 Exam/'Treatment (Hospital) 98 9.0 1 186 186 147 r� 131 EXAM 10,004 Exam/Treatment (Hospital) 98 9.0 1 186 186 147 ri 132 5 Corridor 159 9.0 1 54 54 80 rnoumn 133 EXAM 10,004 Exam/Treatment (Hospital) 98 9.0 1 186 186 147 rn Design : 7110 (VV) PASSES Effective: 7110 (VV) Allowance: 7116.5 (VV) Passing requires Design to be at most 100% of Criteria EnergyGauge Summii0 Fla/Com-2008. Effective: March 1, 2009 2!8/2011 Page 6 of 10 Project: FMC Rheumatolog,y Title: FMC Rheumatology Type: Office (WEA File: FL TAMPA INTERNATIONAL AP.tm3) Lighting Controls Compliance Acronym Ashrae Description Area Design Min Compli- ID (sq.ft) CP CP ance 111 INFUSION C7 10,004 Exam/Treatment (Hospital) 803 2 1 PASSES 109 BREAKROOr 8 Food Service - Leisure Dining 258 1 1 PASSFS 104 CORRIDOR 5 5 Corridor 117 1 1 PASSES 105 CORRIDOR E 5 Corridor 55 1 1 PASSES 106 DRUG STOR 3 Storage & Warehouse - Bulky 162 1 1 PASSE5 Active Storage 107 PATIENT TO 6 Toilet and Washroom 72 1 1 PASSFS 108 STAFF TOILI 6 Toilet and Washroom 72 1 1 PASSES 11211�vG ROC 3 Storage & Warehouse - Bulky 68 1 1 PASSFS Active Storage 103 WORK AREt� 16 Office - Open Plan 116 1 1 PASSFS 113 BIOMED HA; 3 Storage & Warehouse - Bulky 28 1 1 PASSFS Active Storage 115 EXAM CR2 10,004 Exam/Treatment (Hospital) 95 1 1 PASSES 116 EXAM CRl 10,004 Exam/Treahnent (Hospital) 94 1 1 PASSES 101 WATI'ING 12 Lobby (General) - Reception and 620 1 1 PASSE5 Waiting 102 RECEPTION 16 Office - Open Plan 315 1 1 PA55FS 110 ELEC 1 Electrical Mechanical Equipment 38 1 1 PASSFS Room - General 114 CORRIDOR 3 5 Corridor 518 1 1 PAS5ES 117 DR OFFICE F 17 Office - Enclosed 100 1 1 PASSF.S 142 PATIENT TO 6 Toilet and Washroom 48 1 1 PASSES 143 PATIENT TO 6 Toilet and Washroom 48 1 1 PASSFS 144 DRUG SAMP 3 Storage & Warehouse - Bulky 42 1 1 PAS5FS Active Storage 145 STAFF TOILI 6 Toilet and Washroom 51 1 1 PA5SES 146 OFFTCE SUPI 3 Storage & Wazehouse - Bulky 30 1 1 PAS5ES Active Storage 147 CORRIDOR 5 Corridor 75 1 1 PASSES 118 EXAM A1 10,004 Exam/Treatment (Hospital) 95 1 1 PASSES 119 EXAM A2 10,004 Exam/Treatment (Hospital) 95 1 1 PASSES 121 EXAM A3 10,004 Exam/Treahnent (Hospital) 95 1 1 PA55ES 122 DR OFFICE E 17 Office - Enclosed 100 1 1 PASSFS 123 EXAM B 1 10,004 Exam/Treatment (Hospital) 95 1 1 PAS5E5 124 WORK STAT 16 Office - Open Plan 54 1 1 PA5SFS 125 EXAM B2 10,004 Exam/Treatment (Hospital) 95 1 1 PASSFS 126 EXAM B3 10,004 Exam/Treatment (Hospital) 94 1 1 PASSFS 134 DR OFFICE C 17 Office - Enclosed 108 1 1 PASSFS 135 DR TOILET 6 Toilet and Washroom 70 1 1 PASSES 136 EXAM CS 10,004 Exam/Treatment (Hospital) 122 1 1 PASSE5 137 EXAM C6 10,004 Exam/Treatment (Hospital) 122 1 1 PASSFS 138 SHARED OFI 17 Office - Enclosed 171 1 1 PASSFS 139 CORRIDOR 1 5 Conidor 328 1 1 PASSFS 141 MEDICAL 16 Office - Open Plan 363 2 1 PASSFS 127 STORAGE 3 Storage & Wazehouse - Bulky 64 1 1 PASSFS Active Storage EnergyGauge SummiiC� Fla/Com-2008. Effective: March 1, 2009 2/8/2011 Page 7 of 10 128 EXAM C3 10,004 Exam/Treatment (Hospital) 98 1 1 PASSES 129 EXAM C2 10,004 Exam/Treatment (Hospital) 98 1 1 PASSES 131 EXAM C1 10,004 Exam/Treatment (Hospital) 98 1 1 PASSFS 132 CORRIDOR 2 5 Corridor 159 1 1 PASSFS 133 EXAM C4 10,004 Exam/Treatment (Hospital) 98 1 1 PASSFS PASSES System Report Compliance No. of Units Component Category Capacity Design Eff Design IPLV Comp- Eff Criteria lPLV Criteria liance None Plant Compliance Description Installed Size Design Min Design Min Category Comp No ER Eff IPLV IPLV liance None Project: FMC Rheumatology Title: FMC Rheumatology Type: Oftice (WEA File: FL TAMPA INTERNATIONAL AP.tm3) Water Heater Compliance Description Type Category Design Min Design Maa Comp Eff Eff Loss Loss liance EWH-1 Electric water heater <= 12 [kW] 0.93 0.84 PASSES PASSES EnergyGauge Summii� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 8 of 10 Piping System Compliance Category Pipe Dia ls Operating Ins Cond Ins Req Ins Compliance [inches) Runout? Temp [Btu-in/hr Thick [in] Thick [in] [F] .SF.FJ �— N --� EnergyGauge SummiiU� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 9 of 10 Project: FMC Rheumatolog,y Title: FMC Rheumatology Type: Oftice (WEA File: FL_TAMPA_INTERNATIONAL_AP.tm3) Other Required Compliance Category Section Requirement (write N/A in box if not applicable) Check 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 cfrn/ftz; 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.AB3 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.3.2.1B, 13-407.AB.3.2.1D, 13-408.AB.3.2.1E, 13-408.AB.3.2F � HVAC Controls 13-407.AB.2 Zone controls prevent reheat (exceptions); simultaneous heating and cooling in each wne; combined HAC deadband of at least 5°F (exceptions) Venrilation Controls 13-409.AB.3 Motorized dampers reqd, except gravity dampers OK in: 1) e�chaust � systems and 2) systems with design outside air intake or exhaust capacity <300 cfin 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 accessibie 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 d s.f.; Space control; Exterior photo sensor; Tandom wiring with 1 or 3 linear fluuorescent lamps>30W EnergyGauge Summil� FlalCom-2008. Effective: March 1, 2009 2/8/2011 Page 10 of 10 � ❑ � � � � � o � .� � � d � � j � .� � � a u '~ � F E� � 0 ca O y s �� a .-� d «�.' 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Permit Type: �(� S�G� /�� <��s��/�/�? Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. �' � � ��-i �-- ti� Kalvin witzer lans Examiner Date Contractor and/or Homeo r (Required when comments are present) �� : :�� rhills Fire I�escue (,�isi` ' ,�i�-� IZc�aci, /cE�h�rhill5. I L 335�1? 1=iee (�1ar5hal 13u�, (K13) 780-01)41 Kerrv (3arnetl }�aa (81 ;) 780-U0=�� I__-n�<<il kharnett;cr;.tire.�ephyrhills.(l.t.is Plan Review #: 1 I -082 Project: Revision (building rel�ab) Number of Pages• 13 June 20, 201 1 I have received and reviewed the revised plans for the renovation located at 38051 Market Square Drive and will allow it to move forward. A revision fee was not assessed (double the rate of the normal review). A normal plan review rate was charged due to the complete set of plans not being submitted but only the pages that cl�anged. Paying for revision contractor acknowledges to comply with the items below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office l. This revision did not affect any of the previous life safety review completed on April 22, 201 l. All items noted in that review will remain in effect. 2. Ensure all penetrations in rated walls and floor/ceiling combos are properly sealed to maintain fire rating. ��. � KERR A 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. 1t is the contractor's sole responsibility to ensure that the ptans 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 conn•actor's sole responsibility, at their sole expense to brinb those areas m compliance The City asswnes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. . � • � �� :��0��.� Ff�� 6907 R7airy Road, Zephyrhills, �L 33542 S=ere Chief Ke�r� WiNiarns t�us (8'i 3)7g0-OC141 Fax (81:3) i23�•O�dd FIRE SERVICE USER FEES Occupancy No.: Plan No.: —�i.� Z ontractor. _1��' �S��,C� Busmess Name /%� �� ' i c'� .�j��illing Address: � ..�� , , ; s'; �>;�� Business Address _:� aS E� _ S-fi—�L�J1� Bus�ness Phone No Billing Phone No.: Business Fax No. Billing Fax No.. Contact Contact. PLAN REYIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE � Site Plan N/C Annual N/C Sprinkler $50 1 st Alarm N/C MultrFamdy/Commerc�al O6� 1 st Re-inspection N/C Standpipes $50 2nd Alarm N/C (Mmimum Charge $25 00 2nd Re-inspection 3100 Fire Pump $50 3rd Alarm N/C �Plan Revisions BL 3rd Re-�nspection $250 Hoods $50 4th Alarm $�pp , ��';y� 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $�50 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $2(�p '� 0- 25 Heads $50 v�olations corrected) Natural Gas $50 NON COMPUANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- �� nk $5p STANDPIPE SYSTEM Hydro Undergrounds 345 Sparklers $�pp � Per Riser $SO Hydrostatic Test S65 per system Fire Works $500 FIRE PUMP Acceptance Test �IS per system Camp Fire $25 � Per Pump $100 Hydrant Flow a75 Controlled Burn $100 FIRE ALARM SYSTEM Hood/Duct $50 8 0 25 Dev�ces $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual 26 plus Devices $100 System Acceptance $50 F�re Protection $25 SUPPRESSION SYSTEMS Rec211 Acceptance $50 Flammable Application $50 Annual Wet $50 OTHER Waste Tire Storage $50 Annual Dry $50 Fire wau�Smoke Wa11 $15 per wall Generator < KW $100 CO2 $50 LP Gas $25 Pe� ��r Generator >30 KV1! 150 Other $50 Natural Gas $25 persystem Bio-Hazard Waste aIOO Annual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10' or greater $15 pe� ten� TorCh PoUApplied $50 OTHER Fire Pump $45 Haz. Materials $700 Annual LP Installation per tank $50 Fire Suppression $30 Fuel Tank Installation $50 System Acceptance ❑ (Per Tank) $50 8 Exhaust Hood/Duct $30 Nawrat Gas Installation $50 Re-inspection DBL ( Per System ) (other than annuaf) � Spray Booth $50 � Inspection scheduled DBL 8 and cancelled less than 24 hours Construction Insp N!C Emergency Vehicle Ac� $50 FALSE ALARM PLANS TOTA� INSPECTION TOTAL�� PERMIT TOTALI_ _ I TOTALI l t �� GRAND TOTAL C � � �/ � i �,�. Comments �� / y � � �T� �j�✓� /»J �� -� L, ' C'" �� ` ' � • �' .f°" " C! s�'/ �� v' l L � �4'✓ [ � J � aAI �j 3�I C I V.�.t / �.- l�%i'l l Li 4'! ��'_S� �'�tcz f Cl�ta -�+� r� 1��i/.+�, a r'�'`'" �� G �/'/"�� ,r� c C E��l.'!- /v ;: � T'�.� �� , � � f-c Sf -�r � �'"P" c..�°4 �—�— Date 2 4 // InsR,&ctor %- � �o. ' /`'�;Z;�i. 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 � , Building Department . ' Date Received ^ f 3'(� Phone Contact for Permittin — Owner's Name L� Q-`� �' ��L �--L� �� Owner Phone Number Owner's Address Owner Phone Number Fee Simple Titleholder Name Owner Phone Number �� Fee Simple Titlehotder Address �-v � R� ° �� T ��'�' JOB ADDRESS � o� � A4,�GET .� flQ� ��'�� • �L LOT # SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR B ADDlALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM 0 OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q DESCRIPTION OF WORK Q D EQ,� F 2 o O+� '�F � o �AT� C,l. O S F T� C�J W�'� BUILDING SIZE SQ FOOTAGE� HEIGHT �� l ti� QBUILDING $ VALUATION OF TOTAL CONSTRUCTION DELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ � � S E A �� tS `� � I!$� �M CH NICAL $ VALUATION OF MECHANICAL INSTALLATION ,��,/►^ /_Z j � < OGAS Q ROOFING Q SPECIALTY 0 OTHER � ��7b � ltil FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO • 0'1 o a BUILDER COMPANY � 'k'L��-F� �SSO(,r4 (�� LL c SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address �� = �. • . �1(, �. U `� � �. �� License # ELECTRICIAN � COMPANY SIGNATURE REGISTERED Y! N FEE CURRE� Y/ N Address License # PLUMBER COMPANY SIGNATURE REGISTERED Y! N FEE CURRE� Y/ N Address License # MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # OTH�R COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy FoRns; 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 instalied, 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 57500) *' 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 if shingles 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 subjeGt to "d�ed" 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 indicatibn 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 amendedj: If valuation of work is $2,500.00 or more, i certify that 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone "V" unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Ftorida. - 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 shalt 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 wo�k is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S 117.03) OWNER OR AGENT CONTRACTOR Subscribed and swom to (or affirtned) before me this Subscribed and swom to (or affirmed) before me this by by Who is/are personally knovm to me or has/have produced Who is/are personally known to me or has/have produced as identlficatlon. as identification. Notary Public Notary Pubflc Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped __.__,.. _.�--,-.�._.._,.._..__°__. .._��._,,..�.�..�,..�.,_,_.._ __...�,�.._ __.___..n.. ..,_