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Home My WebLink About11-12318 CITY OF ZEPHYRHILLS . 5335 - 8TH STREET (sis)�so-oo20 12318 BUILDING PERMIT Permit Number: 12318 Address: 7350 DAIRY RD Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-06900-0020 Improv. Cost: 19,530.00 Date Issued: 9/02/2011 Name: ADVENTIST HEALTH SYSTEM Total Fees: 202.50 Address: 7050 GALL BLVD Amount Paid: 202.50 ZEPHYRHILLS, FL. 33542 Date Paid: 9/02/2011 Phone: (407)975-3000 Work Desc: REROOF FLAT RECOVER OVERLAY DURO LAST .5 � � �`� �-�/ TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: Reinspection fees will wmply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the foliowing 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 � 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. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your properly. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of wmmencement." Complete Plans, Specifications Must Accompany Application. All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. �Or CONTRA R SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 08/31/2011 10:15 3525674454 MILBAR PAGE 01/05 813•7An.fJ�2� City of Zephymills Permit Application Fax•a��-�so , Building.bspartmant � � Q� Oaha Rec�lv�ei' _ � � Phon� CoMee! for Pe+mktln �er's NAmo ' Owner Phon� Numbsr o�] � 1� Owner's Addross x�r+Mtu; 335i� � Owner Pfiono Numb�r � Feo S)mpb Tiqaholtler Name �J Owner Phone Mumlfsr Feo Slmplo Tkleholder Addrer� JOB ADDR�S3 ; � LOTO SUBDIVISION 1 (.v ( ppRCEL IDAt ,� (OBTNNEb FROM PIlOPERTV TAX NOTICE) WORK PROpOSED B NEW CON3TR � ADD/AlT � SICaN a MOVE Q DEMp1,ISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUC710N Q BLOCK Q FRAME Q STEEL Q 07H6R AESCRIPTION OF WORK � J a c BUILDINti SI7.E ' SQ FOOTARE HEIGMT Q� BUfL01NG d VALUATION OF 70TAL CONS7RUC710N �,y� - J J [� ELECTRICAi, ¢�'�'� AMP SERVICE �, PROGRESS ENERGY � W.R.E,C, � � PLUMBING � , I (,� � . Q MECHANICAL S VALUATION OF MECHANICAI INSTALLATION � � o �..,. � Z31 � GAS ►i ~ ROOFING Q SPECIAL7Y Q OTHER � j FINI3MED FI.00F2 E4EVATIONS - FLOOp X01� AREA QYES �NO BUILDER ��o�. � COMPANY l� 1�I �! 147�1�1inc,__ � N SIGNATURE REOISTERED � FEE CURI! T y N � A� tsa�i u� sc�► �e G �� a 3 �� t�e�.��.��Z ELECTRICIAN � COMAP/lMY � sIONATURE ' aEO�eTeRl:a Y/ N i aEE cuRltiNr Y/ N Address l,benss �R PLUMBER � � C�AAPANY � SIGNA?URE I RE015TeR&0 Y! N i FEE CuRrtErn' Y! N Addro89 LIDe1190 il� � ! M6CNANICAI: COMPANY � �iNATURE REOI87ERED „Y / N FEE CURRENT V I N Adtlrase I.Icensa ie OTHER COMPANY ' SIGNATURe � REGI7!'EREA _ Y/ P! FEE CURtiENT Y/ N Address Lfconae i RES{DENTIi4L Atl9Ch (2) Pld PIlNtb; (2) iafs ot 8uikpng Plans; (1) �et Of Enefyy Form9 MMlmum ten (10) wqrking days after submitlfd date. Requlred onsite, Constructbn Pians, Sanitary FacilHks 8 1 Qumpsler COMMERCIAL Attach (3) Sete of BuYtling Pkln�; (1) set Of En@Igy Forms. Minimu�n ten (10) wo�king days aTOe� submtttal date. Required onslfe, Constn�ctbn Plans,� Sankary Fadlilias 8 1 dumpster AII comme►clel roquirementa musl meet compllance. SIGN PERMIT nttach (2) aetc oi Englneerad Plans. •"`PROPERTY SURVEY requited for all NE1N construCtlon. recdons: Fm out appncation comWetey. , Owner 6 Contrudor sign baek ot eppllcotbn, notarizad If ove� 5�500, a Notic� of Cemmsr�cemQn! Is roqulred. (MC upqtades ovo� E6000) ° Agent (tor the contraGor) or Power ot Attorneq (torlhs ovimer) would be someone wkh�nolarized letter irom owner autiinrizing aame OVER THE COUNTER F�ItMITTING {Front o1 AFpliCatlo� Only) - ? � � Reroofs Seweis � Sen�ice Upgr�des ,4/C Fences (PIOUSurveylFootape)' •- DMvawaya-Not over COUn1eNf on,public ro�dways„neetlS ROW' " 08/31/2011 10:15 3525674454 MILBAR PAGE 02105 NoTICE OF pEEp REg7R�CTIONS; 7he und8fsigned undergtands that this permit may be subjeCt to " deed" restriotions" which may tSe more r�sst�ictive tha� County regulatlons. 7he undersigned assumes responsibility for comp��ance with any ' aPPlicable deed restnctlons. UNLfCENSED CON'1'R/�C7pRg AND CONTRACTOR RESPONSIDILITIES: If the pwner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with atate and Ioca1 repulations, If the contractor Is not Il�nsed as required by law, both the pymer and conVactor may be cited far a misdemeanor violetlon under stake law. If the owner or intended contractor are uncertafn as to what lioensing requ;r+eme�� y �pPly for the intended work, they are adv�sed to Conkact the Pa�sco Co�nty Building Inspection Divis 8009. Furthermare, if the owner has hired a contr�ctor or contractcrs, he is adwsed � e �e q�e �t�� portions of the "contraCtor B1oCk" of this appliCetipn for which they wfll be resppn.yibte. If you, ag the oyyner sfgn as the .__ contPactor, that may be an indication that he is not propeNy licensed and �e not entitled to perrnit6ng pr�HlegeS in Pasco Caunty TRANSPOR7ATION IMPAGT/UTII.ITIES IMpqCT AND RESOWRCE R�CpV�Ry FE,�g: The underslgned understands that Transportation Impact Fees and Recourae Recovery Fmes may app�y to q�e co�s{�� n�, bulidings, ch�nge of use in existing buildings, or e�ansion of existing bulldinqs, as specilied in Pasco County Ordtnance number 89-07 end 90-07, as amended. The undersigned also understands, that such fees, aa may be d�� Wi�� be�ntitied at the time of permitting. It is further understood that Transport�tion lmpact Fees and Resaurce Recovery Fees must be paki phor to receiving a"certificate of occupanc�' or final power release, If f�e project does not involve a aertiflcate of oc�up� � fina! pow�r release, the fees must be paid prior to permit issuance, FuRhermore, if pasco Cou�, W�teNSewer Impact fees are due, they must be paid prior to permit issuance in acoordance wiH� app►icable pa�sco Counqr ordinances, CONSTRUCTION LIEN WW (Chapter 713, Flarlda"$tatuteg� as amended): If valuet�n of work is $2,500,00 or more, I certify that I, ihe applicant, have been provided wfith a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of qgriculture and Consumer Aftairs, If the applicant is someone other than the "owner",1 ceRify that ! have obtained a copy of the above described dxument and promise in good faith to deliver it to th� 'owner" prior to commencement. C�N7'RACTOR'S104VNER�S AFFIDAVIT; I certi{y that all the intormation in this application is accurete and that all work wilf be done in compiienee with a!I applicable lews .regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and inataliation as indicated, I certify thet no „wrk or installation• has commenced prior to issuance of a permit and that alt work will be performed � rn�et standarcls of all laws. regulat;ng construction, Counry and City codes zoning regulaGons, and land devefopment r�egulations in the jurisdiction. 1 also certify that I understand that the regulations of other govemment agencies may apply to the inte�ded work, and that It is my responsibility #o identify what actions I must taka to be in compliance. Such agencies andude but are not limited to; - Department of Enviro�menta) Protection.Cypress gayheads, We�and Aceas.and Environmerrtally Sensitive Lanols, WateNWastewater Treatrnenk - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, qltering V1�atercourses. - Army Corps of Engineers-Seawalls, Dodca, Navigable Waterways. - Department of Health & Rehabtlitative Services/Envlronmenta! Health Unit-We11s, Wastewater Tr Sept�c Tanks. - US Environmental Protection Agency-Asbestos abatement , Federal Aviation Authorlty I understand that the foilowing restrictions appry to the uae of flll; - Use of 611 is not allovued in Flood Zone "V° unless expressly permitted, - If the fill material is to be usad in Flood Ione "A", it Is understood that a drainage plan addressing a "compertsa4ng volume' will be submitted at time of peimitdng ufiich is prepared by a pmfessional engineer Ilcensed by the State of Florida, - If the nll material is to be used fn Flood Zone "A" in connecUon with a perrnitted bullding using stem wall construcHon, I certlfy that flll will be used only to �itl the area within the stem wa11. - If fill mateNal is to be used In any aree, I certify that use of such flll wlll not a�versely affect adjacent propeRies. if use of fill is fpund to adversely ai�ect ad)acent propertles, the owner may be cited for �iolating the conditions of the building pertrot issued under the attached pemtit applicedon, for lots less than or�e (1) acre which are elevated by fill, an enginea�d dralnage plan is required. ff I am the AGEN1' FOR THE OWN�R, I prpmise in good feith to infortn the owner of the permitting condiHona set fo�th in this a�idevit prior to commencing constn�ction. I unde�stand that a separate permit may be required for clectrical work, plumbing, signs, wells, pools, air cenditioning, gas, or other tnstaUati4� not specificaliy induded in the eppllrativn. A permit issued shall be construed ta be a lioense to proceed with the ,nrorlc ond not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall iasuance of a permit prevent the Buiiding Official irom thereaRer requiring a carrection of errors in plans, construction or violations of any codes. Every permit issued shall become Invalid unless the work authorized by such permit is commanced within aix months of permit issuance, or if worlc autho�ized by the permit is suspended or abandoned for a period of six (6) manths after the time the work Is commenced. An extension may be requested, in writing, trom the Building dfNcfai for a period not b exceed nlnety (90) days and will demonstrate Justifiable cause for the extensi�n. If work oeases for ninety (90) consc�cutfve days, the job Is xn3Edered abardoned. WARNING '1'O qWNER: YOUR F'All.UttE TO RECORD A NOTICE OF CpMM�NCEMENT MA,Y RESULT IN YOUR PAYING TMCE FOR IMPROVEMENTS TQ YGUR PROPERTY. IF' YOU INTEND T� OBTAIN FINANCING, CONSULT WI UR L1 R AT*Q � �QRE ^ Di �1°'3 Y l•F O C 'C T. FLORIUA JURAT (F,S, 117,63 OWNER OR AGENT CQNTRACTOR suba • a o � to ( Tr mm�e� fo�me this suesc►i�ed and s to �or ) roro me u,k �o b nep ma �hesJhave produced s! e or haalheve producad as idAnt'�'icetion. as IpelklflCatlon. NaAry PubNc �� —�— Notary Publlc Cammisslon No, Commission N •:' � R:ooe�c1z 6 QLIIMA A, t011�1T Name of Notery typo 1„ � tsmpOtl �� Name of Nofa d�� u �� 08/31/2011 10:15 3525674454 MILBAR PAGE 03/05 � ' ,��r+��' ��+�i�l�q ��'1�CR . ��f� u.s. �0�, pade c;�►, F�, �aa2� �e Cer� Pkt: �ax: �,�?,lS67�4454 � !fiq Reg Roar mPlbar�e��thlink.net � J�ooF p ROP!ll�, � a�T�: 08I01J11 � . ' �'O: ZEPWYRHELLS H�AI.TH � R�HAB CELL: 813/364�.50aQ ATTN� 3T� COLTQN 7360 b FlCU1D � � �EPh1Yi�Mlt�, K�, 335ti�� os: zE��RwiLL5 t�� REMAS �o u�arr�r aoaa �PFMRMILI,S, FL �nw ��e--�--��ae�•�, �m��=-�ea�..r..�a.an�.� . �_�� ROOR q�IERLAY GF THE �XI9"1"INC F�1T ROORINQ $YSTEM c�s�-��xae�,s� �� LRr.rve IMf ax18'Unp il�t raaAn9 sYSbm in pl�oe. 2 � A�l�In9 ro�ot��! et new 3!B' BP3'faeMFokl undr�llryrnOM boaro� mael�anlaUy�atMOh �bugh iha �anJh�d� !hp exkUng eaotMig, and IMo Ihe s. P►avido and Innlsq a new Duroa:aat ao mu W1►I�o tarotk+e �m�ane whtcn �a � meahentealy,auom�ee rooF a�w�m� ma aean�s are ►�ee��slded W tom+ ens she�el, Pro�ido Duro-l.�t� s 16-y�ear Na Dolfar umpt faber AnG ma�aelnl �art�lnly Ihal io no! p�o�aled. 4. Ps�aPet W�NS. Run Nxa r�M puro.l:ea! rooling merl�ralks up !he Ins�de A(1M wai ta q� bo'(�II Of !h9 sfdekln egved �ermlrmUon har� A �PVbI�A�'1i 19R1k�eta rvlfh s, Refiash an A�C. ea�,,, ineehan�ca� a,rtn, vdnt sac�s, and aa Po�spaNan� u�r� �rq, �et o�rom�d rashq�. a. ,r,;p,,Rovma and Ind� P Gu►o�.e�f esveddv around th�, pedma�r aSeave as needed. y. Prande �nd Ma�arr moMk�ae-rellet ven�a nt n� or nne vont pr,r tlGOO af � raef area. �� Rsp�� aF a�r �lua�b� abovadp�+rbiaedd Inoulstlan� woi dedc� fasdr, b1m, f�anUn9,lxe. or rodantamny or tha erdslkig raof tleak wAI be coRUflaletl on a nd beyoad are contr�,� aHOe, 9. Owne� ia !n provlde goo� to raaf for deqveytre�ka ior b�dlnplunbading o1 mnkrl�ls, 74, ' Tl11R !Set oF � Wk9a p�derya oae� afly qhpr rpedf�c�lo}1A� bivaprinb. or ea�baAt d00�1rn�fls. M1�Ir R00l111g, Inc� k nat ro^P�11SIble for rinm�ge tb �e eoal oeuead bY odlFint, 1 �. MfIBa� RO�. If1a. lo pro�Ado Ge�lenll Li9bilHy 8nd WorkOf'S COmpenr�llqq k164�1CO (�2,DOO,OpO 1i1111t� 7iMd l0oAn0 Pla►h8t ��ie _� �-�„t�-�= ^ '�"'- =�—. �e�..,., � 1AFe P�OpOl� 10 Iklfll�ih fll �C�.-^-..""` -.,.—..� e�l�..••�.. :— Nnrsr�M n�otasA,tuG F�IyE �p�p wele 111 e�oo�n�� vWp� �ae�+�..p.o�9o�,., ter ard cbeeroet sr.� or; _ � AMR1 dpM00 DOUJIRS 19�530.OQ � paY�M9n� to bn n�d0 are M�ewn: Daa Upoe Csinpl�tlon. ""'—� ===�e..r'��c��ane�+! ,�:,,,��n�..�.�e��m- ---- ��0 _ - �-- �^�.�e��ac.� AUTHORI�E�1 SIONATlJR�; �� I�i6i DA'i'�: OS^D1J11 AQCEP'rAN�� OF PROPCJSA�,�AV1D R. ABLA, P14�6 v�a a�ea�«�oa+a .,d mnaioe� av �nanMdeN enu � �,� nawre: �awa auawna�eadeuK�.,�,�qa.r. va�e.auna�. wu' �, �►f4�a; �. ��wl�s/ �klnh nN MM M �LfdMOS� Yr / co7v � p ond��f�MpD�r1 b 1(OItlrIM7d1gM �,�� M �� '� /� �� -.. , �'l�M�.001Mlee1bl,Me»bteo�e7MIIMlNIb11�In�v,�O�MeMAE ONAIe�M�rYIpe�Eermds�daeMr MeA�IXy ir�nx�noe. Orrtv�MMrR N1! fuy a�aiaa � 08/31/2011 1@:15 3525674454 MILBAR PAGE 04/05 .h'lorida Bui�di�ng Code O�linc h.ttp;//rvww,floridabuil�ing.urg/.,. k'age 1 0� 2 �i . ,� . � „ .. ..... '��'��'1', BCiS Nemn � i.og rn Ueer Replslrsllo� � Hot Topin � SubmR SurCharpe SWCe 6 Facta ; publlestlerQ i� StaR 6CIS 51te Map �I�ce Se� � � Prt�dyct Approval �„r . 'useR PNBIIC IJFK . . �4Pfl4(GC �ooreve� Menu a P�eSlt+�.fir.AOe1 see�eh > - p�PP��a�aon oaRe11 � FI. # 1 •R� ��,�� AppHcatlon Type REVl51on Codc Vcrsion �007 Applfeatlon Status Approved tornment� ALL WORI{ SHALL COMPI,Y W1T�1 ALL ' Archlved � PREVAILING CODES, FLORIDA BUILDING a9. .. Product Manu�'aceurcr CODE, NATIONAL ELECTRIC CODE AND ouro-tast rtoofln� xnc, CITY OF ZEPHYRHILLS OItDINANCES Address/Chone/Em811 525 Mohey Dr. Sapinaw, M� 48601 (989) 753-6486 Ext �Rg6 a�annl�tluro-last.wm Authorized Signakure Janni AI a�ann��duro��ast,eom 4 � � -�" "�� - 2 - j 'Cechnlcal RepreSentative AL�anni CtTY (�F ZEPHYRHILL Address/Pnone/�mall 525 Morley Drive ��qN tii EXqM Saglnaw, MI 4860X R (800) Z48-0280 a�annl��9uro-last.com --- Qualfky I►59urdnce Repr�senCativc Address/PhOne/Emali Caecgory rtooflng Subcategory single Ply Roof Systems Compll�nce Method �vdluatlon Repo�t from a Florlda Reglster�d Archttece or a ucen$ed Floridd Professlonel Engtncer *^'• 8valuatlo� ReporC - Hardeopy Recelved florlda Englneer or Ar�chleect NamF wMO Robert Nlemincn dEVeloped the �valua�on Report floHda llcense P�-59168 quaUty A,vsurnnce �ntlty Underwrlters LaboratorlES inc. QuallYy A.asurante Contract �xpfraClon DaCe O9/z8/20�3 Va11daCee sy ]ohn W. 1(nezevlch, pE i Valldaclon Cheeklisk - Hdrdcepy Recalveq Cfrtlftcate of Independence fL1559 g,4 COi Trtn iv RD CDrtlpe?Iton aJ indenendenc - .�odr R�fer�nced Standarcl and Year (of Standard) 9t��da�t! � , ASTM Dq+{3p 2004 FM 4470 / 4450 1992 TA9 114 1995 U� xB97, 1998 Equlvalence oP ProclucC Standards http://��ww.£�or�.dabuildin�.org/... �ttp;//www.floridabuilding.org/... 8/31/Z0� ] 08/31/2011 1E:15 3525674454 MILBAR PAGE 95/05 F.lo�ida Buxlding Codc 4nlinc k�tt�:/1www.�,o��iclabui�ciiz�.g,org/... k'age 2 ot 2 Certlflcd 9y Sections h�om the tode Product Approval Method MeChod X Optlon b Date Submltted 05/22/2008 Date velldated 05/23/2aoe Date Pending FBC Approval 05/24/2008 Date Approved 06/24/2008 Summqty ot Produeeo `...,'�_..""""""" -,--.�.� m-�-------.�._.,�,._. F� # Model Numbar or Ne�me hascrl bn 1559•x Duro-WSt Single Ply ftaof � ermoplastle, slrtgle-ply roof syst�ms �' S stems 1.Imils of Use Lnstallallon ina�tuctlonm Approvbtl for qg! In H11HZ: No N �ro Last FL APproved for use outoltle HVHZ: Yes , df �" �S� Impact Re9lstanh N/A VeMNed By: Roba►t Nieminen PE-59166 ��9� Pra�ure: +N/A/-xq7.S Createtl ny �ndependent Thlrcl party: Yes Othew i.) See ER Secdon 5 For Uml#5 of Use, 2,) - ry�e �valuatlon Raports deslgn pressure In thls app1lcdlion relates to one specific Pu559 R4 AE ee�52308FtNA D ro La� �+ a �ssembly. Refer to the ER Appendlx for all assemhlles • and m�x dest n reSSUres. CreSted b Indc n0en! Thlyd Pd : Yes 9eCN Nkxt A�pOffM�Mt ef ��[y ANAIfS PlerMe �u1l�g cyee OMJne Cbsas and sca,rda.� �SSS SRUnMnf Oek OOUkwrd ��+�'ac, flor10� 32999-2]00 (0.50J fB7-tA2� fsx (85014t 4-Bi9G �D �000-zos0 T1x Steee ot flohda, +111 rlpnes reeervee. � I� I� � P)ue.ln SeRW�.. � Cu�len�er Se r� �� Vf011YC! Appl'OY�I AEE6ptl: � � � � e � ,�,� ,.�.� : �� .,�.► , h,,.ttp:l/www.floridabuildiu�g.org/.., http://www.£l.oridabuilding.org/... S/31/201.1 � � �� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS ,� Contractor/Homeowner: ,. � /( Date Received: � � � �� / Site: � � Q r �� c � .----- Permit Type: � ►�� 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. � C �� ' ` 2 " % Kalvin Switzer lans Examiner Date Contractor and/or Homeowner (Required when comments aze present) ' _ 813-780-0020 City of Zephyrhills Permit Application Fax-813-780- , � Building Department � 3 ; 3 Date Received — / Phone Contact for Permitting -- �er's Name %y1� .. T Owner Phone Number Q °� =VK�lY2K\l.� 33�� Owner's Address J� � Owner Phone Number Fee Simple Titleholder Name � i'�' Owner Phone Number � Fee Simple Titleholder Address JOB ADDRESS �U ( I LOT # � Sl16DIVISION ?�_��,1HS W �.31�s--� PARCEL ID# � '. - ��- J J (08TAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR � ADD/ALT � SIGN � MOVE � DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR � COMM � OTHER ./¢.i; TYPE OFCONSTRUCTION Q BLOCK � FRAME Q STEEL Q OTHER DESCRIPTION OF WORK � � � ,� _ � 1�,a.� ,-cc. BUILDING SIZE ` SQ FOOTAGE HEIGHT �� BUILDING $ VALUATION OF TOTAL CONSTRUCTION ��J � � ELECTRICAL �$ AMP SERVICE � PROGRESS ENERGY Q W.R.E.0 � � PLUMBING � � � MECHANICAL ($ VALUATION OF MECHANICAL INSTALLATION �„.. � � GAS Q� ROOFING Q SPECIALTY Q OTHER FINISHED FLOOR ELEVATIONS � FLOOD ZONE AREA QYES QNO 1 BUILDER � COMPANY rn�l �� _ _� SIGNATURE REGISTERED / N FEE CURR T Y N Address ��'[ � � ug �� LC�uQ G �) 3 3 License # I(�(, �� `)v`� Z� ELECTRICIAN COMPANY ' SIGNATURE � REGISTERED Y I N FEE CURRENT Y/ N Address License # � PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N Address License # � � MECHANICAL COMPANY �iNATURE REGISTERED Y/ N FEE CURRENT Y/ N Address License # OTHER COMPANY SiviJilTUR'c '� ^EG;�TE��D Y; R F�E CURP.SNT Y/ N Address License # � — 1 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (10) wQrking days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster COMMERCIAL Attach (3) sets of Building Plans, (1) set of Energy Forms. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities � 1 dumpster All commercial requirements must meet compliance. � SIGN PERMIT Attach (2) sets of Engineered Plans. **'*PROPERTY SURVEY required for all NEW construction. .,�� rections: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) " Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of A�plication Only) •! ' Reroofs 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 appMicable deed restrictions. l�il.1C�NSED 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 Furthermofe, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign ��!*!�n- �r tne ° �bntracter 9lAelE ot tnls �pplleAtlon for wh1�h they wlll be re�ponslble. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended)� If valuation of work is $2,500 00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'SIOWNER'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 EnvirQnmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - A"�rmy 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 vrrall 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 fitl 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 apptication, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, 1 promise in good faith to inform the owner of the permitting conditions set forth in this a�davit 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. Evsry 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 extensi�n. If work ceases for ninety (901 c�nser,uti4�e �a��, !he;oh is cc^�:�ered abardoned WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR lMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT W1TH YC)UR I..E�l��ER OR A�! A'!?�R.A+�EY BE�QR� R� vvpLi�r� 'f �2 ivOTiCE ar Ctiilrilfff�fvCEnriENT. FLORIUA JUf2AT (F S 117 03) OWNER OR AGENT �, � 1/�� CONTRACTOR � Subscribed and s n to (or ff�rmed) efore me this Subspribed and swo n to ( r a i ed) b,e�re�me this 1 b � � bY Who i�sonally known to�s► r has/have produced Wh is are perso y k"nown�o me h, s/have produced ---�� as ident�cation. -"-"'------� as identification. Notary Public ouvu �, ��v� Commission No e �p 07426 Commission No � �(PIRES J11� 2� CB�bN' i DU807426 , BONO� _ Name of Notary ty d, or sta Name of Notary typed, p te ped eoNO�n�►+ Ru �est�►� eo�+w�rrY NpTICE C�F DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be rrlore restrictive thar� 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 entitted 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 afi the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended). If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. tf 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. - Departinent of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understar.d 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 d�ainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. � - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building O�cial 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 extensiqn. If work ceases for ninety (901 c�nser,utive dal��, the;ob :s ccn�:�ered abard�ned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IPITEND TO OBTAIIV FINANCING, CONSULT WITH YnUR I.ER��ER OR P.R A':?'4�tAl�Y BE�QR� Rc.^�.^,;;e ;E':^v `{,,'�,iir� yOTiC aF t3ilri��iVC�1�iE1VT. FLORIUA JURAT (F.S 117.03) i �� OWNER OR AGENT � ' CONTRACTOR Subscr�bs n to ( Tr�ffirmed) efore me this Subscribed and sworn to (or affirmed) before me this y ��,.c c? I P hJa Who is are onally known7o me � as/have produced Wh is ar �'" as identification. ��e or has/have produced as identification. Notary Public Notary Public Commission No �� $_ Commission N C ��pN � pp8p7426 OUVIA A , ��I�TT N 28 2012 C9AAN4SSpIY #� ppgp7426 Name of Notary iype r� tamped eon�o �� Name of Nota y ed or w ��v,r�ce r�oao� w � C�a�r i � �I��c�� Rt��lri ��'"ICR 15911 U.S. 301, pade Ciity, FL 33523 stabe cen F'h: $00,/5G�-2393 Fax: �521567-4454 �oofer#CCC9329092 RCI Reg Roo�f milba ��$ultant �D749 rQearthlink.net RQOF PROPOSAL D61TE: 08/01J11 � TQ� zEPHYRFifLLS ��p,LTH 8 REHAB CELL: 813/3�4-�080 Ai?N; $TEVE CQLTpN �t�� GQIkonCc�zenhvrhillshealth carr� 7350 DAIRY ROAD �EPHYRHILLS, FL 335 rJ � �� ZEPHYRFtIIW HEALT'H 8 REHAB 7350 DAIRY RQAD ZEPNYRNILLS, FL -��-__ _��-==_�=--__�---=___-- W --=--; �� ---- ��= - == , _�T..--=----======-�T-===W �_—_=-===_- ROOF O�R�qY p� �H� ��g�ING FL.AT ROOFING SYSTEM (aB'-fi"x46'�B") t leave fhe exiSUng flgt ranflng �yy�,pm in plece. 2. Pravlde �end it�il a new 318' @PS fdndold underlaYn+enl boartl); mechenlcatly..attach through the fan-1q�d� the exisfi�g rooflng, and tnlo fhe bkishng roof d9Ch, 3• Pravido and lnstafl a new purp{est 40 mll whlta rooling memhrane whfch is a mechanfcally-attacHed rvof syatem; ihe Searns are heet-walded to form ong aheet. ArovidO Duro-Leat' s 16-year No Dollar Lfmlt IAbar antl materisl wartainly thai is not pro-ra}ed, 4 • ��Pet Walls. Run tt�e ne�v puror.sat,00�ng m�brane up che Insyo e(!he well tn the botcqm of the axiating eaved�IpF�oping; E9mineta with ierminaqon 4ar. 5 R�-flash all AC. cvrbs, mechanical cur6e, vent stacks, and aN penetrat(ons using uvlth Duro-I„an p�� shing�. R. �,Ptnvld� �nd i�bte7i pre pUrp.�� y��p aroUfltl fh9 p9r(meter 8t OAYB ds Ite9ded. 7 Provfde �nd Inst�fE mofsture-refl�f yeRts et a rata of o�e , lont por 1000 8.f. of rppf aroa. $• RapefrlFi�pJd�pmgrn p{ any rpq��, d2m 9tl, or tl9ck wpl pe COmplAt6tl on a � ��01'atAd 1118Ulatian, rpof deck, fasCi9, trim, frsm�ng, etC. o� YA�f�ateNng of tl�e ewSt�ng ropf aost-plus V�esis ebove and be�nond tNe contrect pr{pp, �, Owner is to provlde accoss io roof ior ddivary b�uoke for Icradinglunloatling of msterlals. rQ� 7hls set oF speclf�,c�tbna takes preceder�ce Qver any otnar apacmcatlons, �lueprir�, or ccnUaot documer�. Mllear Rooting, inc, is not ►osPbnslbla for damage to U5e roof csused by 4th0fs. 11. MiBar Rqp�,�Q, I�. }p � ��I C.ipibillty er� Wp�kpr's Compeneatlqn InsUran� (�2.000,000 limf!) and Yoo$ng permfi NINETEEN ta fumish ma6erlal �nd labor, camP�eta In ac�ordanae wlth above spACHicatlano, ior N�o ConEroct sum oi: –_�_==---___–_ TiiC1U5AfVD FNE NUt+IDKED THIRTY qNp Qpl100 Dd1,LpRS— � �=.�o_ , _ - -- - Paym�nt to ba mado as {blbws: Dup IJppn Qompletlon. � � �� .,..c�W�----=--..�� ----��----- ===s�..��c=— —_=�� — ��— AUTM01�1ZED SIGNATUR�: �Gj'(171� ,,�-[KlFGj aAT�: 08101/19 == WY"- —�..� ACCEPTANC6 OF PROPOSAL:DAVID R. ABLA, PRES rne eoow pr�aes, AuedAauaiG uid SigllStUf 6: / Yau nra mMlq�It6 do um v�wk �Paw ere RlHeMCbrv and Areby sOClPlstl. Prlflt2f�: �{ y�'�, W 7PlCMld P�ntAnt wlll bo iMtl! N OtlUned abo�e. .�.�r �mwine en�unr, �wi w�m �n +ieroraanee wx1„he anr�e� Een,r en.n be m�o�en.e ba#9: � f�� // dqlkiquem and hn�e inb,yd� a ryb r�te of t�!o pM ryq�yi. p�mer apre�a {p p�y eN ��tl, Euth e, ottom¢y foe9, OOtrS OosfG etG� IormmqYxl 0F tleflllquerR Inwkw � nMUtllflp Inleromt Ownor dn wry �� odo ond aow �y i�� Ourwpe� arp (�ryr W veivd � , Florida Building Code Online http://www.floridabuilding.org/... Page 1 of 2 _� � , BCtS Home Log In User Registretion Ho[ Topics Submit Sdreharge Sta[s & Facts Publications FBC Staff BCIS Site Map Links Search � Product Approval � �y£ USER: Pubiic User �, Produd Aoorovai Menu > Product or Aoolicatron Search > Aoolication Lis[ > Application Detafl , �, _ ,, t 6 � 'S . a �� FL # FL1559-R4 A .`�, p , �, Application Type Revision ;� g : g , Code Version 2007 ; a � � Application Status Approved �- M Comments r - « ' � �°� Archived : "'� � � Product Manufacturer Duro-Last Roofing Inc. Address/Phone/Email 525 Morley Dr. Saginaw, MI 48601 (989) 753-6486 Ext 2296 ajanni@duro-last.com Authorized Signature Jannf AI ajanni@duro-last.com Technical Representative AL Janni Address/Phone/Email 525 Morley Drive Saginaw, MI 48601 (800) 248-0280 ajanni@duro-last.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Single Ply Roof Systems Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who Robert Nieminen developed the Evaluation Report Florida License PE-59166 Quality Assurance Entity Underwriters Laboratories Inc. Quality Assurance Contract Expiration Date 09/28/2013 Validated By )ohn W. Knezevich, PE Validation Checklist - Hardcopy Received Certificate of Independence FL1559 R4 COI Trinitv ERD Certificaiton of Indeoendence pdf Referenced Standard and Year (of Standard) Standard Year ASTM D4434 2004 FM 4470 / 4450 1992 TAS 114 1995 UL 1897 1998 Equivalence of Product Standards http://www.floridabuilding.org/... http://www.floridabuilding.org/... 8/31/2011 .Florida Building Code Online http://www.floridabuilding.org/... Page 2 of 2 Certified By Sectfons from the Code Product Approval Method Method 1 Option D Date Submitted 05/22/2008 Date Validated 05/23/2008 Date Pending FBC Approval OS/29/2008 Date Approved 06/24/2008 --- -___...__...__ ---.-----. .._...---___.. __. __.-- -._.. __....__..__.. _.._.._-.--.-. ----- -- --.._. . _.._...._..._.. __.. ;Summary of Products � ; FL # Modet, Number or Name Description ; 1559.1 Duro-Last Single Ply Roof Thermoplastic, single-ply roof systems � Systems � Limits of Use Installatton Instructions � Approved for use in HVHZ: No FL1559 R4 II A1 er052208FINAL Duro-Last FL1559- ' Approved for use outside HVHZ: Yes R4.Ddf � � Impact Resistant: N/A Verified By: Robert Nieminen PE-59166 ! Design Pressure: +N/A/-247.5 Created by Independent Third Party: Yes � � Other: 1.) See ER Section 5 for limits of Use. 2.) The Evaluation Reports � ; design pressure in this application relates to one specific FL1S59 R4 AE er052208FINAL Duro-Last FL1559- assembly. Refer to the ER Appendix for all assemblies R4. df � � and max design pressures. Created by Independent Third Party: Yes i Back Next Department o/ Community AKairs Florfda Building Code Ontlne Codes and Standards 2555 Shumard Oak Bouleva�d Tallahassee, Florida 31399-2100 (850J 487-1624, Fdx (850) 414-8436 O 2000-2010 The State of Florida. All rights reserved. Pnvacv Statement � Coovriaht Statemen[ � Accessibiii[v Statemen[ � Plua-in SoRware � Customer Service Survev � Contact Us Produd Approval Accepts: � �� \(Y:Ii37t'16f IN..St� rirlBiy� + . � Ttwsc�d VlMrf�♦ http://www.floridabuilding.org/... http://www.floridabuilding.org/... 8/31/2011 ��. i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii 2011135788 NOTICE OF COMMENCEMENT Rcpt:1386263 Rec: 10.00 D5: 0.00 IT: 0.00 MRI#4383 08/31/11 K. Garcia, Dpty Clerk Permit No. Tax Folio No. 35-25-21-0010-06900-0020 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with m � Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. o � c 1.Description of property (legal description): ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 TRACTS 69, 70, 71, 74, � w D 75, 76, 86 & 87 LYING WEST OF WIRE ROAD & EAST OF DAIRY; SEC 35 TWN 25 RGE 21; 7350 DAIRY ROAD, '� � ZEPHYRHILLS, FL � � o 2.General description of improvements: ROOFING '"� m 3.Owner Information �� a)Name and address. ADVENTIS HEALTH SYSTEM;SUNBELT INC, (�m S C/O EAST PASCO MEDICAL CENTER, 7050 GALL BLVD, ZEPHYRHILLS, FL 33541-1347 �� o b)Name and address of fee simple title holder (if other than owner): N/A Na D c)Interest in property: OWNER � 4 Contractor Information � r o c� � a)Name and address: _MILBAR ROOFING. INC. , 15911 U.S. HWY 301, DADE CITY FL 33523 � b)TelephoneNo.: 352/567-6047 Fax No.(Opt.) � w °+ � 5.Surety Information F , � a) Name and address: � o b) Amount of Bond: � � c) Telephone No.. Fax No. (Opt.) �� 6.Lender � a) Name and address: � Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: b) Telephone No : Fax No. (Opt.) 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No : Fax No. (Opt.) 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK R RECORDING YOUR NOTICE OF COM ENCEME T �s c v S T oF � �o .I'�e v e Co.� f o �J � LOWAY 10. 's} N � P �� _ g �� Sign re ner o ' er's Authorized Officer/Director/Partner/Manager • • M�t Comm. E�plres JW �21, p015 .��e V �_ C,a 1rf0l.� �!� , b� �J,�.� _�,,��,� f , COIRlllitibp 1► EE 1147M Print Name and Title 001101� �MM��MIR. ) before me this [ day of �� , 20�, by ✓t �'J � y as Sh� �+G vr �y.� (type of authority, e.g. officer, trustee, attorney in fact) for � c. / name of party on behalf of whom instru ent was ted). Personal y Known OR Producecj,.l,dentification Notary Signature Type of Identificati n Produced %!C ry�,, Hy�,�,�ame(print) Gai, i/ h<</�✓ --- AND --- Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I eclare th have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. L%(./`' Signature of Natural Person gning (' .) Above FORMSMOC,rv5d2007 STA"�E OF FLORIDA, C�OUNTY �F PASCO _ THIS IS TG CERTIFY TF�AT �°HE FOREGQIN�i IS A TRUE AND CORRECT COPY OF THE D41C��N� - ON FILE OR OF PUBLIC RECORC� IN TktlS UF�C� , W �� s�QY HAND AND �FICIAL EA��HiS r �� pAY OF PAU S�' IL, CLERK� COMPTROL� pEpUTY CLERK BY