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Home My WebLink About11-11910 - CITY OF ZEPHYRHILLS 5335 - 8TH STREET (si3)�so-oozo 11910 BUILDING PERMIT Permit Number: 11910 Address: 5528 GALL BLVD Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-05700-0250 Improv. Cost: 115,743.00 Date Issued: 6/07/2011 Name: WELLESLEY DEVELOPMENT CORP Total Fees: 6,074.51 Address: 34619 SR 54 W Amount Paid: 6,074.51 ZEPHYRHILLS, FL. 33541 Date Paid: 6/07/2011 Phone: (727)824-0780 Work Desc: 2000 SQ FT BUILD OUT MEDICAL OFFICE 5 . ,7 . AMERI-TEC ELECTRIC INC ELECTRICAL FEE 119.93 WATER CONNECTION COMMERC 2,418.00 TOTAL PLUMBING SOLUTIONS INC PLUMBING FEE 79.95 MECHANICAL FEE 55.97 POLAR AIR CONDITIONING SERVICES, FIRE INSPECTION FEES 15.00 FIRE PLAN REVIEW FEES 120.00 �� , ; Zf _�� ; �/-.�3'l��i � �� 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 wrrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site � plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." � � CON CTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 7X Result Report � ' P � 05/26/2011 14:03 SePldl N0. AOQ)4P11001438 TC: 24821 Addressee Start TiMe Time Prints Result Note 98553475 05-26 14:02 OO:D0:48 �1/001 OK Note BND AX M : InCe 5�� ifideflt�al� R Result OK: Communication OK, S-OK: Stop Com�aunication, Pw-OFF: Power Switch OFF, TEL: RH from TEL, MG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busv: Busy, M-Fu11:Memorv Full, LOUR:Receiuing length Ouer, POVR:Receiui� page Ouer, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. JSA 6628 OALL BLVD MEa1CAL OFF�CE 2000 8p RT oU�L�OUT - BOLLENBACK 6UILOER8 INC MAIN OR LIVINC3• 2 000 OTHER AIZEA UNOER ROOF: s 88.00 OTHER- VALUATION 116 748.00 F�E SFIEET 693.00 A�CREBS ORIVEWAY �LOI 643_66 EL.ECTR�CAL' � tYA3 PLUMOINfi: 79.pE MECMANICAL: 66.87 su�roTw� �eo.6o TOTAL TOY_60 SEW�R: 2 722.01 E2,661.7B + i269.77 (CRE�IT RETAIL) /YL�� " ��S WATER: 2 418.00 52.848.76 w 5230.76 (CREUIT R�T.41L) �_-� _1r� � : ! TAL' 8 940_01 WATER METER• N/A IRRtCiAT10N METER i E /IR71111lNT FH PLANS TOTAL: 120_00 1 PE TION TOTAI_: 15_00 � i6.00 PllOL�C SAil7Y �MPIYCT /�EEa P�I_ICE FIR6 ax s rw�- ww 3U6-TOTAL S 6 074.3'1 P F ww s�F•s: � oo_ox �_ox TAL" WA T � F's - PER OROINANCE At1003-06 FEE'8 oY% 31a0 PER 1000 '1% - FEE'8 WAIVEO (WOULU'VE BEEN CNAROE� i6.SB0.00) TOTAL- � Q,074_5'f � � C.�. � �'t� -, �`� s � <t � S �ta: City of Zephyrhills BUILDING PLAN REVIEW COMMENTS � � ontr omeowner: ` �� ,� .� _ .�, G � ��1 �� . ��c�... Date Received: �— /� — � � Site: �� f� �� . Permit Type: � � � � ,� Approved w/no comments: ❑ Approved w/the below comments: ❑ Denied w/the below comments: ❑ � ;6 I /} t ' r /f' , �� , �'� , � i � t! 3 � ry / � .�, / ��1 `! f / �� J . � . ., 1 �(/`�.��` {/ ' t I• C � ( ( T / 1 � �� C S �� 5 c-�` n v� -� �.�� 1,s ��C��'Y.�.S� This co ent she t sh 1 be kept with the permit and/or plans. , _ J �� s KaYvin wi lans Exanuner Date Contractor and/or Homeowner (Required when comments are present) Pasco County Parcel: 11-26-21-0010-05700-0250 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, May 21, 2011 Parcel ID 11-26-21-0010-05700-0250 (Card: 001 of 012) Classification 11 - Retail Stores, One Story, All Types Mailing Address Property Value WELLESLEY DEVELOPMENT CORP Ag Land $0 C/O NYE COMMERCIAL MGMT INC Land $233,915 34619 STATE ROAD 54 W Building $558,537 ZEPHYRHILLS FL 33541-2132 Phvsical Address - See All 12 addresses (First Extra Features $7,056 Shown) Market Value ;799,508 5518 GALL BLVD Assessed (Non-School Amendment ZEPHYRHILLS FL 33542-3958 1 � $799,508 Leaal Descriotion (First 4 Lines) Taxable Value $799,508 See Plat for this Subdivision .�" CITY OF ZEPHYRHILLS PB 1 PG 54 PORTION OF VACATED RR R/W DESC AS COM SW COR OF BLOCK 89 TH S63DG 28' 30"W 60.00 Ff TH Land Detail (Card: 001 of 012) Line Use Description Zoning Units Type Price Condition Value 1 1100 STORE iFLR OOC2 7,000.00 SF $7.00 1.25 $61,250 2 1100 STORE 1FLR OOC2 51,160.00 SF $2.70 1.25 $172,665 Additional Land Information Acres 1.34 Tax Area 3 ZH FEMA Code � Commerical Code M 012DR Buildina Information - Use 11 - Retail Stores (One Story) (Card: 001 of 012) Year Built 1989 Stories 1.0 Exterior Wall i Concrete or Cinder Block Exterior Wall 2 None Roof Structure Shed Roof Cover Min Roof(Corr. or Sh M) Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Carpet Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Central Baths 1.0 Line Description Sq. Feet Repl. Cost New 1 � BAS �- 1,360 $94,656 2 �— AN 160 $3,341 Extra Features (Card: 001 of 012) Line � Y Units Value 1 � FA_ V ASP � 1989 � 2,314 $469 2 SWC � 1989 110 $96 3 LFEN E �— 1989 66 —� $23 Sales History Previous Owner N/A Year � Month Book/Page Type Amount � 1988 07 � 1721 / 0483 WD $500,000 1977 11 0916 / 0132 $312,000 http://appraiser.pascogov.com/search/parcel.aspx?sec=11 &twn=26&rng=21 &sbb=0010&b... 5/26/2011 JSA 5528 GALL BLVD MEDICAL OFFICE 2000 SQ FT BUILDOUT - BOLLENBACK BUILDERS INC umn SQ. FEET PRICE MAIN OR LIVING: 2,000 OTHER AREA UNDER ROOF: -$ 88.00 OTHER: - $ _ VALUATION $ 115,743.00 FEE SHEET $ 533.00 ADDRESS DRIVEWAY BUILDING: $ 543.66 '� ELECTRICAL: $ 119.93 ti PLUMBING: $ 79.95 v MECHANICAL: $ 55.97 ✓ SUB-TOTAL $ 799.50 v � „� �- TOTAL $ 799. � SEWER: $ �/ ✓2,722.01 $2,981 78 + $259.77 (CREDIT RETAIL) �'►�l�d< <"" � WATER: $ 2,418.00 $2,648.76 + $230.76 (CREDIT RETAIL) �Z� �� IRRIGATION: $ - TOTAL: E 5,140.01 WATER METER: N!A IRRIGATION METER $ - FIRE DEPARTMENT FEES PLANS TOTAL: $ 120.0 INSPECTION TOTAL: $ 15.00 PERMIT TOTAL TOTAL: E 135.00 PUBLIC SAFETY IMPACT FEES . POLICE FIRE 5% $ - TOTAL: a - N!A SUB-TOTAL $ 6,074.51 PARK IMPACT FEES N/A SIF'S: 100.0% $ - 1.0% $ - TOTAL: $ - N/A T I F'S : PER ORDINANCE #1003-08 FEE'S 99% $ - 3190 PER 1000 1% $ - FEE'S WAIVED (WOULD'VE BEEN CHARGED $6,380.00) TOTAL: $ 6,074.51 , 813-780-0020 City of Zephyrhills Permit Application Fax-sl�-�ao-oozi �� Building Departm " �'� Date Recaived phone Contack f Pertni � �� D J� Tf T OwnersName JSA Healthcare Corporation ownerPhoneNumber �2�-824-0780 OwnersAddress 10051 Sth Street N, Suite 200 OwnerPhoneNumber , Fee Simpla Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOBADDRESS 5528 Gall Boulevard LOT# � SUBDIVISION � PARCELID# 11-26-21-0010-05700-0250 (OBTAMED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR e ADD/ALT Q SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK � FRAME � STEEL Q DESCRIPTIONOFWORK Medical office built out. BUILDINGSIZE EX1St1Ilg SQFOOTAGE 2000 HEIGHT EX1St1Rg � TTrI"rITfTTr T TTr� �BUILDING $ �� VALUATION OF TOTAL CONSTRUCTION �j �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R E.0 / � !#�rl� X�PLUMBING $ C�' �� MECHANICAL $ VALUATION OF MECHANICAL INSTALLATIGp � �� GAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS EXi St i71g FLOOD ZONE AREA OYES X NO ��..-r.-.-r..-....--^-�-i i-i •-r' ^ • i • .�.�-•-•--•�-•--•--•-'-i-i-%'�i• BUILDER r� COMPANY Bollenback BUild2r5, IriC. SIGNATURE L�6IGZERED Y/ N FEE CURRE� Y/ N Address 160 SCarlet Boulevard, Oldsmar �icense# CGCO23973 ELECTRICIAN i i r COMPANY J I"`T� �" T�� C. N t� SIGNATURE � REGISTERED Y/ N FEE CURREf. Y! N Addrass � 5 W�S �-'r �Ul� C.�' f'Z. License #�L�� Z 3� ��; PLUMBER COMPANY I D q kM /� �/ D�. Bk � •` g"�' �,��' i /G • /►��Q SIGNATURE REGISTERED Y N FEE CURRE� N j/� I/� u Il Address �� Z � � � C � � License # C � _l Z � � �$ MECHANICAL COMPANY DI� r Jf f�/`�//u LLC SIGNATURE REGISTERED Y I FEE CURRE� Y/ Address ,3 f � f Q License # ��7 OTHER COMPANY SIGNATURE REGISTERED Y I N FEE CURRE� Y/ N Address License # 1111111111111111111111111111111111111111111111111111111111111111111 RESIDENTIAL Attach (2) Pbt Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permd for new construction, Minimum ten (10) working days after submdtal date Requued onsite, Construchon Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster, Site Work Permit for subdiwsions/large pro�ects COMMERCIAL Attach (3) complete sets of Bwlding 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. Reqwred 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. t• Directions: • Fdl out application completely Owner 8 Contractor sign back of application, notarized If over 52500, a Notice of Commencement is required. (A/C upgrades over f7500) " 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 (PIoUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009 Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW �Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida DepaRment 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'SlOWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone "V" unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used oniy to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR TICE OF COM NCE ENT. FLORIDA JURAT (F S. 117.03) OWNER OR AGENT CONTRACTOR Subscnbed and swom to (or affirmed) before me this Subscribed and sworn to (or affirmed) fore me this by May 12, 2011 by Kenneth Bollenback Who isJare personally known to me or has/have produced Who islare ersonall known to me or Bfax�la!G�cpfd6�'k'�fdC as identification. as �dentification. Notary Public Notary Public Commission No Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped 8ry ublic $t2t! Of FlOride ; , Thad J Carter +� ,, � My Commiasion EE018732 °ia Expiros06/18l2014 ��`�,? �/�'� �' O�' OR BK 7H�� P � �0� �i(�� 10 of 20 applicable transportation impact fee if such credit applies, B. A person may request at any time a non-binding estimate of the transportation impact fee due for a particular development, however, such estimate is subject to change when a complete application for a building permit or site development permit is made. C. Transportation impact fees shall be calculated as set forth herein based on the fees in effect at the time of the City's issuance of a building permit or site development permit, except where otherwise provided for in this ordinance. SECTION 11. INDEPENDENT TRANSPORTATION IMPACT FEE STUDY. A. Applicants shall have the option to conduct an independent transportation impact fee study by a professional transportation engineer to determine more accurate transportation parameters for their land use. One or more transportation parameters can be challenged. These parameters are trip length generation, trip length, and percent new trips (% new trips). Prior to conducting an independent transportation impact fee study, a methodology statement prepazed by the professional transportation engineer shall be submitted for review and approval by the City. Requests for independent transportation impact fee study must be received no later than thirty (30) days aRer the issuance of a building permit. In the event that the City incurs costs for professional and/or consultant services related to professional evaluation of an independent fee study, the City shall charge such property owner and/or developer fees sufficient to recover the costs incurred by the City. If the independent fee study cannot be completed, reviewed, and finally determined by the City Manager, including any appeals, by the time of final power release (pre-meter) the applicant shall pay the scheduled fee. SECTION 12. EXEMPTIONS AND CREDITS. A. The foilowing shall be exempted from payment of the transportation impact fee: 1. Alterations or expansion of an existing dwelling unit where no additional units are created, where the use is not changed, and where no additional vehicular trips wiil - be produced over and above those produced by the existing use. 2. The construction of accessory buildings or structures which will not increase the traffic counts associated with the principal building or of the land. 3. The replacement of a building or structure with a new building or structure of the same size and use provided that the structures or buildings existed on or aRer November 1990, and no additional trips will be produced ovEr and above those produced by the original use of the land. 4. The construction of publicly-owned or leased governmental buildings. 5. Planned Unit Developments approved by City Council prior to September 30, 1988 unless subsequently amended to permit additional development which would generate traffic, in which case the additional development would be subject _. _.__.. ... ._ __.__._..___ to im act ee assessment. _ -- -._ _.....P._._ ._._...___ ._._.--. , - . �----- - - . 6. The construction` of new residential or commercial buildings, or the alteration or expansion of existing buildings within the CRA as designated in Exhibit "A" l � attached hereto. �-... ---._. ... �_ _ B. Credits: ---_ ._.._._._ __..._. �. __.____..____._....__...__�. _ .. •- -._ _.._. ._..__ _._ _._..-- 1. A person may be allowed by prior development agreement/development order to conshuct or convey right-of-way for a non-site related bridge or road listed in the capital improvement program which is in addition to his required site-related improvements as deterxnined by the City Manager or his designee, and receive credits on a dollaz basis against any transportation impact fee due. 10 JSA SQ. FEET PRICE MAIN OR LIVING: 2,000 OTHER AREA UNDER ROOF: OTHER: - $ - VALUATION $ 115,743.00 FEE SHEET $ 533.00 ADDRESS DRIVEWAY BUILDING: $ 543.66 ELECTRICAL: $ 119.93 PLUMBING: $ 79.95 MECHANICAL: $ 55.97 SUB-TOTAL $ 799.50 ��- buildin surchar e $ ��-b�C��,� TOTAL s 829.50 SEWER: $ 2,722.01 29817�977 � C �� WATER: $ 2,418.00 2648.76-230 7-� 1� °�r �i! �2- � IRRIGATION: $ - TOTAL: S 5,140.01 WATER METER: IRRIGATION METER $ - FIRE DEPARTMENT FEES PLANS TOTAL: INSPECTION TOTAL: PERMIT TOTAL TOTAL: S - PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% TOTAL: a - SUB-TOTAL $ 5,969.51 PARK IMPACT FEES S - SIF'S: $ - 100.0% $ - 10% $ - TOTAL: S - T I F'S : s 6,380.00 3190 per 1000 5309-2119 99% $ 6,316.20 a � / 1 % $ 63.80 -�.� Gtktr �CG� j�y(I'^"`� �1%tnL.. TOTAL: $ 12,349.51 2 Water and Sewer Impact Fee Calculation Land Use Type: Doctor or Dentist Office No. of Practitioners 2 No. of Employees per 8hr Shift Impact Fees Within City Limits Outside City Limits Water Distribution System $ 2,648.76 $ 3,310.95 Wastewater Collection System $ - , � 6,655.00 Wastewater Treatment Plant Capacity �$ 2,981.�78 $ 3,727 TOTAL $ , $ 13,693.18 City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Retai/ No. of Square Feet �ppq Impact Fees Within City Limits Outside City Limits Water Distribution System $ 230.76 $ 288.45 Wastewater Collection System $ , .4�-g3 — _-$�- 57g.7g Wastewater Treatment Plant Ca acit $ 259 77 324.72 TOTAL $ $ 1,192.95 � � � � ��- � . _ . � �Y� �� TRHhlSMISSIDN VERIFICATIOf�J �'EPORT ' . "`_ - �..� ""� � TIP�1E : �J5�'12/1F11 12:1E� N�rME : BOLLENBACk BI_IILDE�'� FA?� : �3138553475 TEL : 8138552655 SER.# : EROJ4J1F�5243 DATE,TIP�1E 05I1i 1t:13 FAn. h•�7.INAP•1E 7�k��21 DUR�T IUh! 00: 0�: 32 P�rt�E {�,; �� E'�LIL T i714. fVi�L�E ST�hdDAF'L� EC��•1 BOI��N B�I �K �31.1�LC]�f��, iN�. �� T�� Conlractor Licensii�o IFr�m Ffeather � Cortipany. �iryafTephyrl�ills F��: fi i 3-7$U-0021 Date: p5J[ Zi201 I P�on�: $13-780-042� �ages; g (Including cover sh�et) R�'� CotltracYor Re�is��jpn CG; Fife ❑ Urgerit � For Review � P1e.�se Camment ❑ Ple�sax Reply ❑ Ot'igin�ls Eo �oqaw ai�: Utl�er Co�7�ImetftlCQn�erA�s: ...__ Hollowing plense �ntl �, copy of our current license �nd. company information to update our registratipn with your m�mic:ipality. Sl�ouki you have any questions oX require a�ty fttrl:heC iriformati�n, pleasc do not liesiCal'e to cont�.ct me. Thank you. Bo�.EN�c� BUILDE(�S, INC. � � � To: Contractor Licensing �rom: Heather Hamblin Com�any: City ofZephyrhills �ax: 813- Date: OS/ 12/2 ��on�e: 313 �a ges: 8 (Including cover sheet) ��: Contractor Registration CC: File ❑ Urgent � �or Fteview ❑ Pleas� Comment ❑ �lease �teply ❑ �riginals to �'ollow via: Other Coro�or��en#/�Cor��nts: Following please find a copy of our current license and company information to update our registration with your municipality. Should you have any questions or require any fiu�ther information, please do not hesitate to contact me. Thank you. The information in lhis transmissron is confrdential and is rntended only jor the :rse of the rndividua! or entrty named aGove. /f the reader of [his message is no! [he intended recipient, you are hereby no[ified lhat any dissemina[ron, drslribution, or copy of lhis commtrnica(ron is slriclly prohiGiled. /f you have received lhrs transmissron in error, or if you are not lhe rndividua! or enlr[y named above, p/ease nol� :�s by telephone (co/!ec[), and return the orrginal message to :rs at the above address vra U.S. Postal Service. You ivi/1 be rermbursed for any postage or any other expense associated ivrth lhe relurn of [hrs document. Thank you. 160 Scarlet Blvd. Oldsmar, FL 34677-0140 Telephone: (813) 855-2656 Fax: (813) 855-3475 �� STATE OF FLORIDA �:�f-��"� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION � � CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ', 1940 NORTH MONROE STREET "��z�"'� TALLAHASSEE FL 32399-0783 BOLLENBACK, KENNETH DAVID BOLLENBACK BUILDERS INC 160 SCARLET BOULEVARD OLDSMAR FL 34677 `�. STATE OF FLORIDA AC� � � �C -� � � � Congratulations! With this license you become one of the nearly one million ' �EP�RTMENT OF BUSZNESS AND Floridians licensed by the Department of Business and Professional Regulation pROFESSIONAL REGULATTbN Our professionals and businesses range from architects to yacht brokers, from ""=��`" � boxers to barbeque restaurants, and they keep Florida's economy strong �GCO239�3 ^ '0�'� J29/10 1Q8019065 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. CERTIFIEk,� ��N�RAL �ONT,�tACTOR There you can find more information about our divisions and the regulations that BOLLENBAC`E�, ��';REI�jNETH �DAY, 2D impact you, subscribe to department newsletters and learn more about the BOLLEN'BA�IC"• $�IT,D�1�� INC DepartmenYs initiatives. - � Our mission at the Department is. License Efficiently, Regulate Fairly. We � constantly strive to serve you better so that you can serve your customers. IS CERTIFIED' undar the rovisions oE Ch.4$9 Fs Thank you for doing business in Florida, and congratulations on your new license! gxpiration aaee: AUG 31, 2012 L10072901253 DETACH HERE � AC� �, ��:� ,f �� STATE QF FLORIDA � � .. �F � DEPARTMENT OF BUSINESS AND PROFESS�ONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOAE2D SEQ# L10U72901283 ' ! �� LICENSE NSR ; � , . ' ��. �; . � 07 „29�2p10 �,f}801.9065 ; CGCO23973 ' � � ; � ,. . � . _ . . f . - .. � � � Tk3.e` G�NEE2AL� CO�TRACTOR • � ��- � � � - � Nained� be�:`ow , �S' �ERTIF�ED ; ' tJ'x�der' ��'i,�:� Q�ov%s'xon`s of' �hapte� .- B��.x��!�5,: - : ; Eacpir��i`on,' d�;te'. AiT� 31, �201 t � °�; - ''� . `°- . Y E �; .. ��. ' ' , -, -,�. .. � � ,' Y , � i � , �, ' ' . , , .' y '. . . :: �,. , ,.��, �_, <'� , °�. � �' , , _ < , . , . ;<ra. , ' ` =: ' ¢` : ''zs BC7Ii�.E ' TCE ETH �A�zD �•` .� a # � �.�i�K;�» 1�T;� � :� . ,' , s B.Q�,��.�``I��G� ;$U�,�,D�1�S` :�.NC . .. i � ], 6 Q. E: S.�ART�k�2' ��IJLEVP:$D �. '-., \ .F. '-~ : , , . . . , O�,D�MAR F'L 34677 `¢ ��' ° ! ( . .. .. , ' _ ,. • .. .. ., ' ; CH�i1Z�;�E ��ZY�T . ' � CHA�2LIE - LIFsM i - �VEI�NO,R ', ` '. . ; ' SECk2�TARY ! �� - ' - - ! t)IS PLAY AS� FZEGI UIREf� BY L,41lV � ' „ � . _� _..�. _ . � _ .��_ ��._..._ _..�_-__--___._.__... .. _ __.._. __ _... __�. __ _.._..� _ _.__ ___ w_ - -' Ca v� a 5 a � w o � N 7_ x � O n O � o � U d � F ' a� � c � v = N NQ � G]a y'o'a C z¢ = Z� v'° ^ O� G � W � a � v �z '�L o�W� z � z� v � �z c-�o �.7��r"�tx � c ' U S'a `� E' ZU u v � �,�, ..w3z pZ := tn vi� �q' zQ ... ¢ w � � z 3 Q � ❑ ,-7 �,o E-. 2 Q� v� o W �� w°�.�z ��, ° 'L ;v � � U � � ` � p o� a, v "^i s n= O cv � N¢ a �� O(- cd ¢ y �O r �..� Z ZC G, * ��J 7 rn Q � M � - G�1 °' � M � "� O � � � � ' � v C � � y U v � H O ^i� O _ `� � � .� � �a_ r 5 � a'f�1"{;� L: : rn3c . ( � s '� r �y i ��E. 'tl '� f.�l.,� _ � . .. ..... . ._ . . .. . f .' . .i _ ., ... � � _. ._ .. ... . . � . ' -. .. .;' �r4 - �� -- . • ,�"�.''.' - _. '�[� l, n �i , F!'�.i"{�..:{�_��. 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' : r _, _, � ' ,. � ` . •4: f ., =_ .., _ ._ s t � '.z._�..�5=.�'�'�::..�: t.`�'� ._. _. .-. �,L� ., .. �+ J Q s . .��. . , � � � (y9 � '° '.� �� 7 � .? � A 7 h- ��,� l� �� t�� N , : ," ,�^ .�r , �k�"iq�.�„A�"'\ �'��t_�t�.�;�� : r� , >,4 �,.,. e ' � 000373 CITY OF OLDSM�R BUSINESS TAX RECEIPT / 100 STATE STREET W. OLDSMAR, FL (813)749-1100 ,V 2010-11 CITY OF OLDSMAR BUSINESS TAX RECEIPT EXPIRES 09/30/2011 THIS BECOMES A TAX RECEIPT WHEN VALIDATED ISSUANCE AND RETENTION OF THIS RECEIPT IS CONTINGENT UPON RECEIPT HOLDER'S COMPLIANCE WITH THE CITY OF OLDSMAR CODE OF ORDINANCES. THE CITY RESERVES THE RIGHT TO INSPECT BUSINESS PREMISES. RECEIPT CAT.:CONTRACTOR CLASS A c I A ��h ° BOLLErdBACK BUILDERS INC ',� �" KENNETH BOLLENBACK 160 SCARLET BOULEVARD Vendor:05350 OLDSMA.R FL 34677 �"'' ' TAX: $187.00 aio � AUTHO - Z D SIGNATURE BUSINFSS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED AND IS NON-REFUNDABLE. Applicant � ��""'� OP ID: DI ' CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDMlYY) 05/12/11 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 POLICIES 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 727-447-6481 CONTACT Bouchard-Clearwater NAME: 107 Starcrest Drive 727-449-1267 A/C Ext : A!C No : P O BOX BO9O E-MAIL Clearwater, FL 33758-6090 ADORESS: Adam J. Bouchard PRODUCER gOLLE-1 CUSTOMER ID #: INSURER�S►AFFORDING COVERAGE NAIC # INSURED Bollenback Builders Inc INSURERA Amerisure Insurance Company 19488 160 Scarlet Blvd iNSUReRe.Westfield Insurance Company 24112 Oldsmar, FL 34677-3005 INSURER C : INSURER D INSURER E : INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYFE OF INSURANCE DD BR pOLICY NUMBER MM% I D/YYYY MMlDDmY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 'I�OOO�OO B X COMMERCIAL GENERAL LIABILITY TRA1954252 ��/��/� � 01/01l12 pREMISES Ea occurrence s 150 ��0 CLAIMS-MADE � OCCUR / MED EXP (Any one person) $ �� X XCU �/ PERSONAL & ADV INJURY $ 'I �OOO�OO X CONTRACTUAL LIAB GENERAL AGGREGATE $ Z�OOO�OO GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ Y�OOO�OO POLICY X P E � LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ �,��+�� B X ANY AUTO TRA1954252 01/01/11 01/01/12 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNED AUTOS $ $ UMBRELLA IIAB X OCCUR EACH OCCURRENCE $ S�OOO�OO EXCESS LIAB CLAIMS-MADE AGGREGATE $ $�OOO�OO B TRA1954252 0llot/11 07/07/12 DEDUCTIBLE g X RETENTION $ $ WORKERS COMPENSATION WC STATU- TH- AND EMPLOYERS' LIABILITY X TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N WC1315940-12 01/01/11 �'�� 2 E L EACH ACCIDENT $ ��0��0 OFFICERlMEMBER EXCLUDED? � N � A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ �,��0,�� If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 'I,OOO,OO g Equipment Floater TRA1954252 01/01111 01l01/12 R/LEASE 75,00 E D 50 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES ANach ACORD 101, Additional Remarks Schedule, if more space is required) FOR CONTRACTOR LICENSE REGISTRAT�ON CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ZEPHYRHILLS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8TH STREET ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATIVE � O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 0 �� o � �� Depa,�tment of State I certify from the records of this office that BOLLENBACK BUILDERS, INC. is a corporation organized under the laws of the State of Florida, filed on August 14, 1985. The document number of this corporation is H71311. I further certify that said corporation has paid all fees due this office through December 31, 2011, that its most recent annual report was filed on January 17, 201 l, and its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Sea! oj Florida, at Tallahassee, the Capital, this the Nineteenth day of January, 2011 o� �� . r �- _ _ - � � - = =_ _ =- -� - �, S'ec�eta�y of State � - -_ = o � � � -�� * * Authentication ID: 000191642760-011911-H71311 � G OD �'5 To authenticate this certificate,visit the following site, enter this [D, and then follow the instructions displayed. https://efile.sunbiz.org/certauthver.html Ba�EN�cK gUILDERS, INC. May 12, 2411 City of Zephyrhills Building I)epartment 5335 8`�' Street Zephyrhills, FL 33542 Re: JSA Zephyrhills Medical Oftice Built Out C/ To Whom It May Concern: This lettcr shall serve as authorization for poug Lamb, Superintendent for Bollenback Builders, Inc., to pick up plans, permits, and sign any and all applications for permits for Bollenback Builders, a General Contractor, for the above referenced project. If you have any questions, please call our office immediately. Sincerely, G ��Z�� - _ Kenneth Bollenback President Before me the undersigned authorized, on this 12 day of May , 2011 personally appeared Kenneth Bollenback, who is known to me to be the person whose name is subscribed on the foregoing instrument, and acknowledged to me that he executed same for the purpose and consideration therein expressed. �v� � Natary PuWic StaM of Fbrlda , Thad J CaRer tary Pu 1C '�`; �,p' MY Commiasion EE018732 My Commission Expires: and• Ex�� o��ano�4 160 Scarlet Blvd. • Oldsmar, FL 34677-3002 •(813) 855-2656 • FAX (813) 855-3475 • www.bolienbackbuilders.com 05/95/2011 16:25 8138553475 BOLLENBACK BUILDERS PAGE 01/01 �O�.ENB�CK BUiLDERS. ING. M,ay 13, 2011. City of Zephyrhilis 13uildi�g Taepartment 5335 8� Street 7�ephyrhilis, FL 33542 Re: JSA 7ephyrhills Medical Office Built Out 5528 Gall Boulevard, 7�ephyrhills, FL 33542 To Whom [t May Concern: This letter shall ser�e as notice that the �alue of th� above re�erer�ced pr.�ject is $115,743.00. The permit application and othcr docuzn.ents were submitted today, Ftiday 1V�ay l.3 f�r processing. if you have any questions, please calt our off'ice immediat�ly. Sincerely, ad Carter Project Manager 160 Scarlet Bivd. • O{dsmar, FL 34677-3002 •(813) 855�2656 • FAX {813) 855�3475 • www.bollenbackbuilders.com Zephyrhills Fire Rescue h907 Dairy Road, Zephyrhills. �� L i35�? I�ire 1�larshal 13us (813) 780-OU41 Kerrv 13��rnett Fax (81 ;) 780-OU44 r E�.-mail: kbarnet.t rr),tire.zephyrhills.tl.us Plan Review #: 1 I-060 Project: Build-Out Number of Pages: 14 May 20, 2011 1 have received and reviewed the plans for the tenant build-out located at 5528 Gall Blvd and will allow the project to move forward. Paying for permit, contractor acknowledges complying with the comments listed below. Should anyone have any questions, please do not hesitate to contact tl�e Fire Marshal's office. 1. Pages P-1, M-1, and E-1 not noted on cover sheet. 2. Ensure address is located on both front and rear doors. 3. Ensure address is located on electric meters to space. 4. Panic hardware shall be on exit doors. Ensure door D108B has panic hardware. 5. Ensure any penetrations made in the rated wall are properly sealed to maintain fire rating. 6. If the roof trusses are bar joist, a lightweight truss sign shall be installed in accordance to Florida Statute. i. Add emergency lights in restrooms and break room. 8. No storage allowed by electric panels. 9. Label janitor room and I.T. room. Inspection Required: �. Penetration inspection on fire walls. 2. Final � . KERRY BAR T, F1RE 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 responsibil�ty 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. ZEPtiYRHIL.LS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhiils, FL 33542 Fire Chief Kei�h Wiiliams Bus (813)780-0041 Fax (813)780-OU44 FIRE SERVICE USER FEES Occupancy No.: � Plan No.: l Contractor: o Business Name: i c.a i€'cr� Billing Address: Business Address: si �� u�.�/ � 7� Business Phone No.: Billing Phone No.: �/ 3��"�:�.5`� Business Fax No.: Billing Fax No.: Contact: Contact: � PLAN REHIEW FEES INSPECTION FEES PERMR FEE FALSE ALARM FEE Site Plan N/C Annual N/C Sprinkler S50 1 st Alarm N/C � Muni-Family/Commercial .�6 sf� 15t 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 $t W 4th Re-Inspection $500 Fire Alarm $50 5th Alarm at 50 SPRINKLER SYSTEMS (Business cl�ed until LP Gas a50 6th Alarm E200 0- 25 Heads S50 violations corrected) Natural Gas $50 Norr coM�inrice $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- � a�k a50 STANDPIPE SYSTEM Hydro Undergrounds S45 Sparklers �100 � Per Riser a50 Hydrostatic Test �GS per system Fire Works $500 FIRE PUMP Acceptance Test a45 Per syscem Camp Fire S25 � Per Pump $100 Hydrant Flow $75 CoMrolled Bum $100 FIRE ALARM SYSTEM Hood/Duct $50 B 0- 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly �SO Annual 26 plus Devices $100 System Acceptance a50 Fire Protection a25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application S50 nnnuai Wet $50 OTHER Waste Tire Storage S50 nnnuai Dry $50 Fire WaIl/Smoke WaII $15 perwat� Generator < KW $100 CO2 $50 LP Gas $25 �r �ok Generator >30 KW 150 Other $50 Natural Gas $25 a� 5ysce�„ Bio-Hazard Waste $100 Annual KITCHEN EXHAUST Fumigation Tenting $50 � HoodlDucts $50 TeM 10'x10' w greater $15 per tent Torch PoUApplied y50 OTHER Fire Pump a45 Haz. Materials $100 Annual LP Installation per tank a50 Fi�e Suppfe55iW1 �30 Fuel Tank Installation $50 System Acceptance a (Per Tank) $50 8 Exhaust Hood/Duct �.30 Natural Gas Installation S50 Re-inSp@CtiOn DBL (Per System) (otherthanannualJ � Spray Booth $50 � Inspection scheduled DBL 8 and cancelled less Man 24 hours 8 Construction Insp. N/C Emergency Vehicle Ac� Q Y FALSE ALARM PLANS TOTAL��%' � INSPECTION TOTAL PERMIT TOTAL L� TOTAL L --- - I 7� GRAND TOTAL , — dv Comments. �' Date: �I Ins��clor ' � "�� May 31 11 01:10p Matt Clapp 813-935-9303 p,1 STATE OF FLORIDA - DEPARTMENT OF BUSINBSS AND PROFESSIONAL REGULATIDN - CONSTRUCTION INDU3TRY LICENSING SOARD (850) 487-1395 ',� fi ' 1940 NORTH MOATRQE STREET °�,��+j°` TALLAHA3SEE FL 32399-0783 CLAPP, MATTHLW R TOTAL PLZTN�ING SOLUTIONS INC IO218 OAKI,EAF AVE TAMPA FF, 33612 STA1E OF FLORIQN . �� S O��I 4g t� J Congratulations! With �his license you become one of the nearly one million ' DgP,�� ;•�.�; �„ -•= Floridians licensed by the Department of Business and Professional Regulation. �-_� � '�,��; Our professionals and b�sinesses range from architects to yacht brokers, from - '� p��'��5��'�;�GiTl;ATS;AN'' ;'' boxers to barbeque restaurants, and they keep F3orida's eoonomy strong. �'�•�, " :� , °` �' ' - "�� ° "�"' ��`'�'' ' �� CFC1426,1:1��_':, -`��3:��;'�:;0,'�{t�90484°636-',:`�� Every day we work to imprrnre the way we do bus+ness in order to serve you better. �� - For information about our servioes, please log onto www.myfloridalicense.com. . C�RTIF� � CO3�ETRACTOR .. There ou can find more information about our divisions and ihe r ulations thet ' CLAPp,, - ��- '' -, -' impact you, subscribe to department newsletters and leam more about the - TO'PAti 'P��.,'��'�T101�8, -�NC,;. . Departmerrt'sinitia6ves. . -'� �, ; � •`` r _ Our mission at the Departme�t is: License Efficierrtly, Regulate Fairly. We � .�- ��, ,� ' constantly strive to serve you better so that you can serve your customers. YS CBR�riF7[s� „�.r Cha prov£sioaa ot c,.ti.469 Fs 7hank you for doing business in Florida, and congratulations on your new license! - .�Diue�ox..,are: - i AUQ �3i�;� � 28;t2 T��90622006'43 ��,.', DETACH HERE A� ,,��`, ,� �'�� -��,.� _ . STATE �OF FLQRIDA� � _ _ _. . -- � - .. - - �-� .. ._ �,�..,. '_ , , ;. � ., , : .; : , ',== ,_,_ , , _;- , , . , , . _' - , • - , ,_ :'tu-� '' , � , ' ��.?AR3'MENT (JF 8�3�NESS' A'�TD PRQFESS.�'ONAL � REGU��'ZON� ,' . �'. ='•` � - t:� - �.°CQNS�RUCT;ZO�, T•NDUSTRY� `��CEN�ING' HO�AI�� -- , ,` -. � : � � •� � ,' ' ',:-,. , _ • � . _ � - � � _�` - ' . ��' - S��#L7.O,G5�200C�5 _ _ _ , � ; . ,... . ,. .:- .�., ... .. - .. � - ,.,. - - LICSNSS NBR ,� _ - � ' � � �,:',�� 06��;.�2'�'2i �:'�'90.4,8�63�. . CP�Z4Z6�I.1.8 - .� :.. : ..-_. - :. . .. _ ,._- . ;,:. �.�ie P�T�TTM��I�=a' � C.�ON'�'�i'AC'�OiR ° . , _ _ . .r . : .: - , . ; � . _ . � � , , , . �� 'C�RTZF�� .. _ . " '_ , , � . ' , U�ider '�h'e provis�:ons of �Chapter-4:89: FS. ... ' � � � • , , ' Expirakion date: AUG 31, 2012, ,-� ." -��" �:��f `. � -' ,. • . ,� , :. , : _. , • _ „ ' , ::: �;,. -. , • , . , - , � . - - . . . . . e�L�AP•�, -MATTTiE� R • ~ � . . . • , , � . •_ T�C3TAL• �PLi�M83�G SOL�JTZONS-- TNC � . . - . . � ' _ , , - ' , 1 f��.�:°8 O`A°KT;E�iF` AVS , ' : . , . - - . • � TAMPA FL 33612 ' � _ , � , .. � • , . � � - - -' ' �, ,- , : � .'CHA�T,,I�:E �C#tI-BT - . � � � � C�ARL�� .-Z,I�M . _ , :` �G�V�IZA�O#�, ` ; '� . � � ,I�A]'.�BRIM S�C1tET'ARY , . � , . . :Q1SpLAY AS REQUIRE� BY LAW , . � 05/31/2011 1�:05 8138551246 SCHMALZ INSURANCE PAGE 91/01 '4� R�vA CERTIFICATE QF LIAB�LITI( INSURANGE s�3i j o ' TH13 CER1'IFICA7'E IS 19SUE� A$ A AAATi'�R OF INFORMATION ON�Y ANC CONFER9 NO RIQHTS UPON 7HE C�RTI�ICATE HOLDER 1'NfS CERTIFICA7E DOE9 NOT AFKIRMA'nVELY OR N�GATIVELY ANIEND, EXTEND OR ALTER 7'M� COVERAGE AFFOROEO BY THE pQ�,1Q�@S BE60W, 1'NIS C�R7IFICATE OF INSURAINCE pO�S NOT CON9TiTUTE A�NTRACT BETWEEN T}IE I$g(JN�Ip fNgIJRER{S�, AUTHORIZEp R�PRESENTATIVE 0(t PRODUCER, AND TME CERTIFICA7E NOI.DER, nY1PORTAN7: If tne �xrqllcat�O holdor is en ADbrnow4L INSUREp, Nio pol�cy(In) mu,t bo ondorsatl. If SueROGATION IS WiuV�p, subje�t ec M�e terms and contlltlons o� thp poNry, eartaln potkle9 mey �qul�e �n •ndoraement A spRomant on tnte certlqcaitQ doeo not confc� Aghes to the cerqlleate holaer In Ncu of such .ndoraemenry.). PRODUCER nll�ME Johrl 3�ha�a.1 Soha�a,lz Izxaura�ncp Agency w�; 8 ,,, g13-855-6639 ,e,� �:813-555-12�46 3894 Ta�� Road, � Sua.be 8 Ap , Johasal�ma,�,��b ab�, , rr. com 01d�mar, FL 3�67,► ��1 AFFORONV. CoVERAeI! NAICA '" Tobal Plun►bS.ng So1u��.ox�s, Iac IN8URERA:�`Ci1e= Iaaur2unce C am A�attihem Clapp �NSURea e: �rogreas ve 10218 08i,]��e�� Aveaue INSURER C , Gommeree & i�qdus r a inpux�aace co Ta�a, FL 3 3 61,2 INSURBR D: 813-935�,2733 INSURERE: INSURER F • COVERAGES CERTIFICATE NiJMBER: RENISION MUMBER: THIS IS TO CERTIFY THAT TH& POLICI�S OF INSURANCE I,ISTED SELOW NAVE B�EN ISSUBD TO THE INSURED NqMED AHOVE FOR TH� POLICY PERIOD �NDrcATEp, N0T1NffWStANbIMO ANY R�QUIREIVFENT TERM OR CONDITION OF ANY CONTRACY OR OTWER DpCUMENT WITH R�SP�CT 70 WHICH THIS CERTIFICqTE MqY B� ISSUEO OR MAY PQRTAfN, THE MiSURANCE AFFORDED BY TH� POUCIES DESCRIB�D HEREIN IS SUBJECT TO ALl THE TERM3, EXClUSIONS AND CONDITION$ QF SllCN POLIC�S, 61MRS SMOWN MAY HAVE BEEN R�DUCED BY PAID CLAIMS, L�TR TYPE OF INSURANCr: NeR wVO POLICY NUMBER Q6NERAL LU181LRY LIMfTS encw xcura�eNCe a 1, 0 0 0, 0 0 p � COMMERCIAL pENERAI LI/�BILf1Y PItEMIS S EA oavrrence S 7.00 � OOO CLAMA3M/IDE � pCCUR MED E%P ( on9 pefeon) i S, O O O A C6LAD008Q6-10 7/22/107/22/1 aeasowa.aa�v�ruu�v a 1, 000, 000 �E��L AGC�EC,nrE � 2. O O O.O O O GEN'1. AflGRECw4TE UMIT APPLIF.S PBR; PRODUCt9 • COMP/OP A(iQ a 2 r 000 � O D O X Pouc,r PRO- I,GC s nuroMOei�E une��.m coMerM�o saua�� mnn ANYAUTO (Ee IllxWM1� f �. � O O O� Q � 0 N.L ONMED AU'I'bS BOD�.Y MuURY (Par perwnl s a R 9CHEDUtED nuTOS 07 619 54 5� 0 B/ 31 / 10 8/ 3�/ 1 � OON ' Y �� tPer °xaent� g R HIR�O AUTpS PROPERTY DAMAGE � (Per ncsldent) � NON-OWNED AUTOS � S UMBRBLLA LIAB OCCUR EACH OCCI�RENCE s 1 � � 0 0� 0 Q � `, g EXCE38 LIAB CLAIMS�MnDE AGGREGl1TE � 1 r 0 fl � 0 � oEOUCT�ets 7.104�9708 5/4/10 5/�k/11 S REfENTION S ! WORKEltB COMPENSIITION YVI:3 A• O• � �'l0YER5 UABILTTY v�N ANY PROPRIETOWPAATNERIF�CUTI��E OCflOEpf�AEMBER EXCI,I�pEpp ❑ M/A �� EACHACCIbENT $ � 1° � E.L. bI3EASE . F�A EMPI,OYEE ! M yss tkseryEOVfitl9r 06S�qIP'110N OF OPERA7fON3 bblaw E.L DISEqS6 . pp�fCY UNIIT S DESCRIP'�'ION OF OPERA110N3 / LdCAT10NS ! VEMICLES (/dMeh ACORO 101, AtltllHmlp� Ramqrka 8chedule, H more epsce le roquM�etl) CHRTIFICATE HOLDER CANCELLAT'ION C�.'t�/ O� /7+E��X'Y��.��.i9 SHOULD ANY OF THE A8p1/� DESCRIBED POUCIE3 BE CANCELL�D BEFORE 5335 B�tl 5�:. TH8 EXP�RATION DMTE 1'HEREOF, NO110E 1AfILL BE DELIVERED IN Zepbxyh� z 1, �, Fx„ 3 3 5� 2 ACCORDANCE WITH TWE POLIGY PROVI310NS. �a��ex�-aso-ooz�. �UTHORP,Ep R6P ATIVE �i 1988-2009 ACORO COI�PORATION. AII rlghb reserved. ACbRD25(2009/09) The ACORD name and logo are reglstered merks of ACORD Permit No. Parcel ID No. 11-26-21-0010-05700-0250 NOTICEOFCOMMENCEMENT IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII State of Florida County of Pasco 2011086876 THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement: 1 Description of Property Parcel Identification No. 11-26-21-Q010-05700-0250 Street Address: 5528 Gall Boulevard. Zeahvrhills. FL 33542 2. General Description of Improvement 2,000 SF Medical office build out consisting of waiting area, check in, check out, vitals, four (4) euam _ Rooms, three (31 offices. storaae room. IT closet. medical records storaae. staff toilet. oatient toilet. and break room. Rcpt:1371429 Rec: 10.00 DS: 0.00 IT: 0.00 3. Owner Information: JSA Healthcare Corooration (Robert Miiler— Facilities Manaaer) 06/06/ 11 K. Kraenge 1, Dpty C lerk Name 10051 5'" Street North. Suite 200 St. Petersburg FL Address City State Interestin Property• Tenant PRULq S 0'NEIL,Ph D PqSCO CLERK & CQMPTROLLER 06/06/11 02:59 m 1 of 1 Name of Fee Simple Titleholder� OR BK �� PG ��5� (If other than owner) Address City State 4 Contractor: Bollenback Builders. Inc. Name 160 Scariet Boulevard Oidsmar FL 3 C f� 7'7 Address City State Contractor's Telephone No.. 813-855-2656 5 Surety: Not Aaolicable Name Address City State Amount of Bond: $ Telephone No.: 6. Lender• Name Address City State Lender'sTelephone No. 7 Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)(7), Florida Statutes: Thad Carter of Bollenback Builders. Inc. Name 160 Scarlet Boulevard Oldsmar FL Address City State Telephone Number of Designated Person: 813-855-2656 8. In addition to himself, the owner designates Thad Carter of Bollenback Builders, Inc. 9. to receive a copy of the Lienor's Notice as provided in Section 713 13(1)(b), Florida Statutes. Telephone Number of Person or Entity Designated by Owner• 813-555-2656 10. Expiration date of Notice of Commencement 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 OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RDI YOUR NOTICE OF COMMENCEMENT STAT ° ��- COUN O Shnrtvr�,�; � �r�AFER Notary Fuc�l�c - State oi f1oAd� Si ure of Owner or Own r's Aut rized Officer/Director/Partner/Manager . f►IyCornm�ssionEr.piresAug28,2(Ni Comm�ssinn # DD 709355 �h 8onded ' �"'' �' Nota►YA�r►. Signatory's itlelOffice /J � — .�`�a� ShQ-�Q � The foregoing instrument was acknowledged before me this ��day of J�l'Q , 20 �, by �� as � (t�pe of authority, e.g , er trustee, attorney in fact) for �S�- (name of p��}„be,half of whom i� umen was xecuted). Personally Known OR P duced Identification Notary Signature �� r � �� `�- Type of Identification Produced Name (print) S vlh � h 6 P 1� Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief � �.�^- ignature of Natural erson Sig ing Ab e wpdata/bcs/noticecomm encement_pc053048wce f�m .. � � l 6','' � � � � t`• • � � �_ T T � Fiorida Energy Efficiency Code For Buiiding Construction Florida Department of Community Affairs EnergyGauge Summii� Fla/Com-2008, Effective: March 1, 2U09 -- Form 4,00&2008 Method B: Prescriptive Compliance for Renovations, Occupancy Change, etc. PROJECT SUMMARY Short Desc: 11-015 Description: JSA Medical Tenant Buildou Owner: Addressl: 5526 & 5528 Gall Road City: Zephyrhills Address2: State: Florida Zip: 0 Type: Healthcare-Clinic Class: Renovation to existing buildi Jurisdiction: ZEPHYRHILLS, PASCO COLJNTY, FL (611600) Conditioned Area: 1923 SF Conditioned & UnConditioned Area: 1923 SF No of Stories: 1 Area entered from Plans 1923 SF Permit No: 0 Max Tonnage 4 If different, write in: EnergyGauge Summii0 FlalCom Effective: March 1, 2009 OS/10/11 Page 1 of 7 Compliance Summary Component Design Criteria Result RENOVATED ENVELOPE PRESCRIPTIVE PASSES LIGHTING POWER 2,790.0 2,884.3 PASSES LIGHTING CONTROLS PASSES EXTERNAL LIGHTING None Entered HVAC SYSTEM PASSES PLANT None Entered WATER HEATING SYSTEMS PASSES PIPING SYSTEMS PASSES 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 Summit0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 2 of 7 CERTIFICATIONS ��. � � � �..,�� '��,,� G � D, LEO ��O . . . . ' •, ��'; I hereby certify that the�1Sp n�peci i iori.�ered by this calculation are in complianc w" Florida Energy Code :?' No 5$00 '; *� _> Prepa� � Vince *' onar�l� � Building Official: . . c o �.(/ � . . _ t • )�` � � � ��j�' ( . • : Date: 9 '�.�'�� 5 ,• . . . . ° �� .� �� 1��', ��° I certify that this building is in c��►pliar�se+V�i�h the FLorida Energy Efficiency Code Owner Agent: Date: If Required by Florida law, I hereby certify (*) that the system design is in compliance with the FLorida Energy Efficiency Code Architect: Rojo Architecture, LLC Reg No: AA #0002952 Electrical Designer: Reg No: Lighting Designer: Reg No: Mechanical Designer: DCH Engineers, Inc. Reg No: EB #27958 Plumbing Designer: Reg No: (") Signature is required where Florida Law requires design to be performed by registered design professionals. Project: 11-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (WEA File: FL TAMPA_INTERNATIONAL AP.tm3) Prescriptive Envelope Compliance Item Zone Description Design Criteria Meet Req. Glass PrOZol Percent glass Max allowed .000 50.000 Yes Skylights PrOZol Percent Skylight Max allowed .000 5.000 Yes Meets Shell Envelope Requirements -- PASSES EnergyGauge Summil0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 3 of 7 External Lighting Compliance Description Category Tradable? Allowance Area ar Length ELPA CLP (W/Unit) or No. of Units (W) (W) (Sqft or ft) � None Project: 11-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (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) (VV) (VV) PrOZo1Sp1 10,004 Exam/Treatment (Hospital) 1,923 9.0 1 2790 2790 2,884 Design : 2790 (W) PASSES Effective: 2790 (V� Allowance: 2884.29 (VV) Passing requires Design to be at most 100% of Criteria Project: 11-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (WEA File: FL TAMPA INTERNATIONAL AP.tm3) Lighting Controls Compliance Acronym Ashrae Description Area Design Min Compli- ID (sq.ft) CP CP ance PrOZo1Sp1 10,004 Exam/Treatment (Hospital) 1,923 15 1 PASSES PASSES EnergyGauge Summit0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 4 of 7 Project: 11-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (WEA File: FL TAMPA INTERNATIONAL AP.tm3) System Report Compliance PrOSy13 System 13 Constant Volume Air Cooled No. of Units Single Package System < 2 65000 Rt �/hr Component Category Capacity Design Eff Design IPLV Comp- Eff Criteria lPLV Criteria liance Cooling System Air Conditioners Air Cooled 13.00 12.00 8.00 PASSES Single Pkg < 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 3.50 PASSES System PASSES Plant Compliance Description Installed Size Design Min Design Min Category Comp No Eff Eff IPLV IPLV liance None Project: 11-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (WEA File: FL_TAMPA_INTEItNATIONAL AP.tm3) Water Heater Compliance Description Type Category Design Min Design Max Comp Eff Eff Loss Loss liance Water Heater 1 Electric water heater <= 12 [kW] 0.98 0.88 PASSES PASSES EnergyGauge Summit0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 5 of 7 � Project:ll-015 Title: JSA Medical Tenant Buildout Type: Healthcare-Clinic (WEA File: FL TAMPA INTERNATIONAL AP.tm3) 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.F] Domestic and Service Hot Water 0.75 True 105.00 028 0.75 0.50 PASSES Systems PASSES EnergyGauge Summit0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 6 of 7 Project: 11-015 • Title: JSA Medical Tenant Buildout � Type: Healthcare-Clinic (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 FlaCom attached � Operations Manual 13-102.1, Operations manual provided to owner � ] 3-410, 13-413 Windows & Doors 13-406.AB.1.1 Glazed swinging entrance & revolving doors: ma�c. 1.0 cfm/ft all � other products: 0.4 cfin/ftz 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.3.2.1B, 13-407.AB.3.2.1D, 13-408.AB.3.2.1E, 13-408.AB3.2F HVAC Controls 13-407.AB2 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 eachaust 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.AB3. � 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 13-411.AB.3 Table 13-411.AB2 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 ma�c; 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 Summit0 Fla/Com-2008. Effective: March 1, 2009 OS/10/11 Page 7 of 7 � ❑ .. � .. � � � � � � � L N � C b[ Q �,.' � � u tr � y � •� w o � o �� y� C/� F-� E"� � � a� "" o U � a) � s. � s.. O � L � �� a d � � ,� O M y o � N � z x rx ^ � � F �+ L � °� � � a�i � o. 0 O � '� y � N � � tq � p Q � °� =� w .. •y �+, a� � o � C1 O � U z c7 = r � � � w ^ > p,� �! �° '' o � � � � 3 N � � pq ' � � �i F"� Ly � V � w. 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U U z Q Q � ; 3 i � d ' G� U vi � �7 �'� Y Q ' ^ N M � � � U � a W 3 � � ri � W o a+ U o ❑ � ❑� ❑ � � o � � _ � c � " � a �, � � w > �.: >- y � a oa a � va — a �' � � � � o � � � � C � = u C o y� Q,_, y = Q r� C E„i .r � ' V a « n. w L ' GL � V� •� � � �+ e: V � � � � u = � � O sC "_' C �p 7 y� � C O Ca °�" C p Z V � �E � L � E"� y � G�" > � � �" � G�" � ��'.. � .r' � ' r�n � `� 'O 3 O i � "'� Z C �+ � C�i � N G� ^� E� � O C1 � � = ° � � � V c � N "' e � � V V1 � � .+ eri `�U+r =i �, � '� > � O � _� � s � b� � .� � .e V� �, � F � . � � � f�' i,d v, r � �.+ � � �"'� � ~ a � � � � � � � � C 1�1 C � p � � � � � O � �+ R � O LT" J"/ �1 V 7 � C. � � Q� � �' �' .� � � u" a > > p „� i E � V �v o � r l � F o CQ a ', � V a ' w � U `-' � � � � W � �U O � o � Y' a ;, z a � � N �L � � 3 � o � � x o w U �+ '� N a •� O�C Z � � .b Q � � L�d � = C9 L �� a� a� � � o �, � .a F L1 � „ L � Q � O z _ „ z � � o 0 z � z o �o 0 N > � .� � 7 � � bA 7 � �i, L � C W r, ., 0 ., � 0 CITY OF / / / / BUILDING ZEPHYRNILLS DEPARTMENT ♦ � M OF ADDITION OR CORRECTION �• • - • ADDRE55 DATE PERMIT f � i � � - �� j��rv THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job will be accepted. 1 a i i � � � /.� � �,� � - ; .� ' � � w-� ��r s� ��r. �_ S ��. l/ �� _ � � c�-� /�U� i -C� � r "v.S � C�X`'.�/� �j �� EU4� S It is unlawFul tor any Carpenter, Contractor, Builder, or other persons, to AFTER CORRECTIONS ARE MADE CALL cover or cause to be covered, any part of the work with Flooring, lath, earth 780-0020 FOR - SPEC I or other material, until the proper inspector has had ample time to approve the installation. OFFICE HOURS 7:30 AM - 5 PM MON.-FRI INSPECTOR