HomeMy WebLinkAbout11-11964 CITY OF ZEPHYRHILLS
' S335-8TH STREET
(sis)�so-oozo 11964
BUILDING PERMIT
Permit Number: 11964 Address: 38135 MARKET SQUARE DR
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: NEW CONST/COMM Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0010-03900-0030
Improv. Cost: 4,058,440.00
Date Issued: 6/13/2011 Name: FLORIDA MEDICAL CLINIC
Total Fees: 146,322.68 Address: 38135 MARKET SQUARE
Amount Paid: 42,049.2 ZEPHYRHILLS, FL. 33540
Date Paid: 6/13/2011 Phone: (813)780-8440
Work Desc: +A�RYO'R ADDITION AMBULATORY SURGICAL CENTER 12,828 SQ FT
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DOYLE ELECTRICAL SERVICES,INC ELECTRICAL FEE 1,977.30 WATER CONNECTION COMMERC 4,615.20
D G SNYDER PLUMBING INC PLUMBING FEE 1,318.20 TRAFFIC IMPACT FEES 99%COM 106,436.36
SOUTHERN EQUIPMENT CORPORATION MECHANICAL FEE 922.74 TRAFFIC IMPACT FEES COMM 1,075.11
FIRE PLAN REVIEW FEES 1,539.36 FIRE INSPECTION FEES 450.00
POLICE IMPACT FEE ✓ 2,090.96 FIRE IMPACT FEE � 2,244.90
(, PUBLIC SAFETY 5% ✓ 216.79
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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.
REINSPECTlON 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)wndemned 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.
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 yo r property. If you intend to obtain financing,consult with your lender or an attorney
before recording r notice of commencement."
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CONT R SIGNA PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
� 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 WaterlSewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 773,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 ConsVuction Lien Law—Homeowners
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner'prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
will be done in compliance with alt 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 pertormed 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 identity 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,WaterNVastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Watervvays.
- Department of Health & Rehabilitative Senrices/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protec6on Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certiTy 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 instatlations not speafically 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 bewme 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: Y�t11Q�FAILUR O RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IM�I20VEMENTS TO Y R PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WI -'YOUR LEN EI2 OR AN ATTORNEY BEF RE RECORDING YOUR NOTICE OF COMMENCEMENT.
FIORIDA JURAT(F,S'117 03)
OWNER OR AGENT �, CONTRACTOR
� Subscnbed and swom to(or affirmed)before me this ! Subscnb d an �worn t r a ir ed before me thi
r °Y i �.� r ���t�t� E � ��r
/� Who is/are personally known to me or has/have produced Who is a personally known to me or has/have produced
as identificatwn as itlentrfication
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, Notary PublicJ � ��� � a.�/1{./��
l Notary Pubhc
\� Commission No Commission No
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, Name of Notary typed,pnnted or stamped Name of Notary typed,printed or stamped � tate Of FlOrida
_ �� � Vickie Dunmire
h,,� , � My Commiasion DD991075
�?o�ri� Expires 06l25l2014
Date: J�.:a�•2�, 2o�i
To: SPR Committee
From: RT Keetch
Re: July SPR meeting
Attendance: Cliff McDuffie,Todd Vande Berg, Shane LeBlanc, David Henderson, Kerry
Barnett, Bill Burgess, Chief Shears, Rick Moore
i. Revised Site Plan for Agape Baptist Church located at 39735 Chancey Road
(File No. 04-��-SPR)
Discussion Points
• The applicant presented the item and stated for the record that"the approval is only
intended for phase one of the project and is for a preschool"
• The multipurpose trail will be on county right-a-way and maintenance will be
negotiated
• Utilities indicated that new pumps may be needed to handle the projected loads (the
issue has been resolved).
Conditions
• When and if reclaimed water becomes available at this site the applicant will need to
hook up to City reclaimed water
• Revise site plans to reflect right-a-way placement, multipurpose trail and a common
sense type C landscape buffer for the north portion of the property that may
incorporate fencing and existing trees to accomplish buffering
• Any additional applicable conditions in the pre Site Plan Committee minutes dated
July 20, 2o1i
• Applicant to submit final as-built at time of D.O.
2. Revised Site Plan for Zephyrhills Florida Medical Clinic located on US 3oi
(File No. os-io-SPR).
Discussion Points � g f 3'� M�� �� ��"���e �S ac° �-1 l 9
��
� The building department m�issue a temnorary certificate of occ�pancy 1�', ,�,
• Removal of curb stops okay ' , � p
Conditions � '
• Retention pond and improvements should be built at the same time
• Any additional applicable conditions in the pre Site Plan Committee minutes dated
July 20, 2oii -- - - - --- _�
.._---_..
• Applicant to submit�al as-built at time of D.O.,�
�...�a.��:, -
��
• Discuss comments from 2008 traffic study to make sure issues have been
addressed
• Will the lift station be public or private? Discuss
• 16 foot driveways required at Fort King road entrance
• Discuss "general easement" for all utilities
3. Revised Site Plan submifted by Florida Medical Clinic located on US Hwy 301
(File No. 8-10-SPR)
This item was recommended for approval per the following conditions:
• Conditions as outlined in May 2010 PSPR minutes (addressed)
• Consider adding more crosswalks in parking lot
• Consider adding additional parking lot stop signs (east to west)
• Note that the proposed provided impervious continues to be non-
conforming at (87% ratio), but it is felt that the additional parking and
landscape improvements oufinreigh the strict interpretation of the code
requirement
�
, � _ __ --�..-y,,,,.,�,..
PRELIMINARY X
RELEASED FOR CONS'TRUGiION
Ciri� of Z�phy7hills
Site Plaa R�cc�iew Agprov�I
APpro�' : �, •�" da�° flf � 20�
By =``�='�.
L�irectot of De��elcnment ___._.
Author.�ed Si�ure
- S' Plan R��ew Fee Paid
I}atG t Amount �). ��
DRARTING INDEX
;- I .O COVER SHEET�
:-2 .0 NOTES & LEGEND
�-3 .0 SITE DEMOLITION
�-4.O S(TE AN D UTI LITY PLAN
�-5 .0 GRADING AND DRAINAGE
�-6.0 DETAILS
�-7 .0 DETAILS
�-8 .0 SECTIONS AND DEt-AILS
�
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� _ � i nNn�c�APE PLAN
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Zephyrhills Fire Rescue
6907 Uairy Roaci, Gephyrhills, I�L 335�42
l�'ice Marshal 13u5 (813) 780-0041
Kerry l3arnetl F�aa (813} 78Q-U044
E-mail: kbar�lett(a)f7re.zephyrhills.fl.us
Plan Review#: l 1-031
Project:New Construction(addition)
Number of Pages: 154
Aprill 1, 2011
I have received and reviewed the plans for the ex ansion located uare Drive
and will require further information before t project will be allowed to move forwar Please
submit necessary documentation addressing the items below. Should anyone have any questions,
please do not hesitate to contact the Fire Marshal's office.
1. Separate plans, along with specs and cut sheets, will be required to be submitted to
this authority to obtain permit for installation/modification of fire alarm system, fire
sprinkler system, and generator.
2. Ensure there are new calculations provided with the fire alarm and fire sprinkler
system plans.
3. Fire sprinkler system allows a single riser for up to 52,000 square feet. An additional
riser will be required for going over that square footage. Also, change the existing
FDC to the 30 degree turn down 5" Storz connection. Repaint backflow preventor
(red).
4. Details, cut sheets, and specs shall be provided to this authority for oxygen tank and
other related gases.
5. Install proper fire lane markings on west and north sides of the building. See NFPA 1
Handbook for examples.
6. Knox Box will be required to be installed at both main entrances. A master key will
be placed in the box. An application can be obtained from this authority.
7. Evaluate for lightweight truss sign in accordance to Florida Statute. Sign shall be
installed to the left of main door at a height of 4-6 feet. Since building is longer than
l00 feet, signs shall be installed every 100.
8. LS Page l, mentions standpipes, ensure plans are submitted for this item.
9. On Page T2, under the square footage breakdown-conditional area, the square footage
is backwards for existing and proposed.
10. Rm 115 (electric room) shall have a 1 hour rating. Door shail also be rated.
1 l. Rm 173 & 174 shall be rated.
12. Ensure all exit doors have panic hardware.
13. Label all doors of electric, mechanical,janitor, etc rooms as such.
14. Ensure duct detectors are tied to the building fire alarm system.
15. Install emergency lights or a circuit on the life safety in all public restrooms and
patient changing rooms.
2
16. Fire extinguishers shall be positioned within 75 feet of travel distance throughout
building.
17. Ensure door 189A is rated(firewall).
18. Add fire extinguishers in mechanical and electrical rooms(140, 141, 142 & 115).
J�P/t/�it�i�G►/��i.��
KERRY BARNETT, FIRE MARSHAL
***Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes. This review is not intended to be a final approval of the
submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances.In the event that further examination or site
inspection reveals areas of non-compliance,it shall be the contractor's sole responsibility,at their sole
expense to bring those areas in compliance.The City assumes no responsibility for the contractor's failure
to be in compliance with all applicable NFPA codes and local ordinances.
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: �/���l fj C� �SS ��Z� 7�.5 C-�- �
Date Received: 3 '� Z.��J/
Site: ��i / 3 S� �rt�KE 7 S Q
Permit Type: f 2 ��� ��.�' ��p�!/
Approved w/no comments:❑ Approved w/the below comments: �1 Denied w/the below comments: ❑
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This comment sheet shall be kept with the permit and/or plans.
� �2�,r _ .��
Kalvin Swit -Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
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e,3aeo•ooso City ot Zephyrhilfs Permit Application fax•813•790-9027
8udding Oepartmem
Ons RecNraa
T�-�–�-- Phone ConR tTw parmtnln _
Own��o Nams M�. ��AQ �Y S � N G Owner Phone Number p�3'��O' �M O
Own�rsAddnos ��$� A4�Lf�T �lAf,E 33rj1{ pY,inerPhonaNumlHr �--�
Fea 8lmpls Titlaheld�r Nams rML ��{�6r,E�' Q• �N(,• pwns�Phone Numbor �
Faa8lmpl�TWa�otderAdtlrosa 3�i�3'S M��W� ZEPN R1��u.i FL 3�J'�{t
JOBADDRESS �V� {���1LC.CT S J RC.E ZEP�'I Q 1'�'IVI.f '�3S Z
l0T M �
SUBUIVISION A PARCEI�DN �Z– ��O'�.�'oo�o—039 00^003 O
� IOOT�D fROM PROPlR1V 7A1f NpilpEj
WORN PqOp08ED NEW CpNSiR AODIALT � SIGN Q Q
INSTALL REPAfR DEMOLISM
PROPOSEO USE Q SFR Q COMM � OTHER
TYPE OF CONSTRUCTON � BLOCN FRAME � S7EEL �""-----�
DESCRIp110NOFWpRK UPl'T`1oN �SL ��tPANS�Q �VI.L S�TE �VZ'�4, ��
BUILDING SILE �N 101� f`f o L gq FOOTAOE j �$7' l��"p`�
HEIONT
�BUILDING S�"�
{ 1 VALUqTION OF TOTAL CON3TRUCTION
f__�—�–�_�1 O
�]EIECTRICAI I� qMp SERVICE a�O� '� PROGRES9 ENERGY Q W R.E.0
�_�
�PlUM81NG ��
�CHANICAL t 4y� �o VAIUATION OF MECHANICAL IN9TALIATION
J O•
�GAB Q ROOFINp Q gp�C1AlTY C� OTHER
FINISMED FlOOR ELEVATIONS �� FLOOD 20NE AREp �YES NO
BUILDER � COMPMIY W AI.A,�R�� I4SSb(.tp1T�s � Le.�
91GNATURE pEO�aTrweo Y/N Feecuqp�n
Y!N
Addrea� S�"{3� M•�.•��1J�0 SZ•�1• ST.P�TE. 3 03 Licanse k
ELECTRICIAN COMPANY
SIONATURE NEG16tEqED Y f N FH8 CURREn Y/N
Adtlress
�anss y
PLUMBtp COMPANY �—_ �
�ONATURE RE019TERED Y J N FE6 CURRE� Y/N
Addnts
liceMa N
MECHANICAL ��PaµY —SOUtFtern Equipment Corporation ' �
BIGNATURE RE018TEHED �Y�N E FEECURREA Y/N
AAdress 1720 W Clevel d Street ampa, FL 33 06 �;�,,1SeA CMC053785 —�
OTHBR COMPANY
SIONATUR! RE018TERED �//r) FEfiCUqqEA �/I N
Address �^--�
IIIIt1111111t11111111111 / 1111 �11111t111111111111C11sIM111�11111111t1E
RESIOEMiIAI Attarh(2)Plot Piens:(2)sNS of Bu00Ng Plxs:(1)sel ol E�erpy Fo�ms:R-0-W Permd lor naw conalruclan,
INnimum ten(10)workinp tlaye atle�suEmlltal date. RequroO ons�la,CmaNUCtlan Plana.Stoimwaler Plana wl Si4 Fenca ins�eNetl.
Sam�aiY Faalilles&t tlumpatYr.Sfro Wark Permit fw eubdineioroNmge proJeeta
COMMERCIAL Allech(��eompl9te te�y M Buidinp plans plus a Lile SMely Pape;�t)6al d Enetpy Fwms R•O•W Pannd/or new conslfual�on,
Mimmum tan(10ywarknp deys aMer submiUal da1a. Raquntl onsil�,ConslruGbn plens,Sbrmweur Plena w/Silt Fence nusllea,
Sandary Faalitles d t tlumpster Sita WorN Perme for all�ew prqeUS.A/cm�mercial reryuirements muat maet camp6ance
91GN PERMIT Altach(2)aeU M Engineerod Alarq
""PROPEHTY SURVEY requketl}w all NEW constructron
OtrecUOns:
Fiq out applicalqn completely.
Owner 8 ConMeclor sign bxk ol appllcatwn,nolanzeG
If ov�r f4600,a Nolloa ot Commencem��n fs requlred. (AfC upgrad�a over f7000)
" Agenl(fa IM conllactorj or Power ol qttaney(lar Ihe owner)wuuld be aomaone wilh nolarizeG Ialter Irom owner authonzinp same
OVER THE CWNTER PERMITTINQ (Front of Applicalion Onty)
Reroofa il shingles Sewera Service UpgraAes NC Fenee4(PIoVSurvey/Fadaga�
Oriveways-Not over Courner rt on pubfic roedways..neeas ROW
,� PA�CO COUNTY, FLORIDA
• Permit No, ��i�
Date Permitted
Builder Name/Owner Name (/VG�( �Cf ' `�'�Cf""`���rol#
County Parcel No. (�� --Z�—Z�—�v10-1�3`Idd'C7�3a SubDiv:
Address/Location 3� � 3� �""'"��� `�,u� ��
Classification/Type of Us@ C'dmMe�'C��r�' AM!�S ���' �l `�''��� �� L�jt��
TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; (2i �z�,
Exempt ❑ Yes � No HoW Determinsd
Impact Fee Amount $ /�� ,��j�/. � � Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $ ^ ���
(057) Mobile Home
(058) Other Residentlal
123) Collectio�Fee
Exempt � Yes [] No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Tota)
Recreation Account Recreation Credit Recreation Total
Zone TOTAL AMOUNT $ /���
Exempt � Yes � No How Determined
LIBRARY FEE
�and Account Land Credit Land Total
Facility Account Facllity Credit Facility Total
Exempt [] Yes � No How Determined Total Amount /�� ,
RESOURCEFEE ERU
TOTAL AMOUNT �
Prepared By Checked Sy
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIpN
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrenGe,but simply recelpt of a copy of this form,placing
the building permit ownei on notice of this assessment and lha conditions af payment for same.
RATE R�CEIVEp BY
RECEIPT NO DATE BY
._... - 7- --�--�+. --�*�y- -.,�.. - � � -- -y - - - - - - - - -- -- -- -- -- - --
4 V
Waliace Associates LLC-38135 Market Square-12,828 sq ft Addition
ou n
SQ. FEET PRICE
MAIN OR LIVING: 12,828
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 4,058,440.00
FEE SHEET $ 8,788.00
ADDRESS
DRIVEWAY
BUILDING: $ 8,963.76
ELECTRICAL: $ 1,977.30
PLUMBING: $ 1,318.20
MECHANICAL: $ 922.74
SUB-TOTAL $ 13,182.00 ^� �r��� � (; /� ��
TOTAL S 7 3,182.00 ��� � is��
SEWER: $ 14,472.00 F� `�� 21'l�
WATER: $ 4,615.20 �
IRRIGATION: $ - n/a
TOTAL: 5 19,087.20
WATER METER: n/a
IRRIGATION METER $ - n/a
FIRE DEPARTMENT FEES
PLANS TOTAL: $ 1,539.36 (
INSPECTIONTOTAL: $ 450.00 � � ��-�'��
PERM�T TOTAL�: a 7,989.36 _ ��`��� Z���' �
P
PUBLIC SAFETY IMPACT FEES ��-�j�
POLICE $ 2,090.96 ���,'�"��� � (
FIRE $ 2,244.90 �j-�'�
5% $ 216.79 r
TOTAL: E 4,552.65 $388 PER 1000 SQ FT
SUB-TOTAL $ 38,811.21
PARK IMPACT FEES
SIF'S:
100.0% $ -
1.0% $ -
TOTAL: $ . N/q � -
; (���1`�5��3 ���3 � �
T I F'S: S 107,511.47 $8,381 per 1000 sq ft
99% $ 106,436.36 �¢Z �6v������2�g� �
1% $ 1,075.11 � '�// C� �� g� / ��d�
`F� � l..
TOTAL: $ 146,322.68 �' �o� 633•6 I �� �l� �-��-+r►� �..
�� ����'t��r�
CITY OF ZEPHYRHILLS
UTILITIES WORK ORDER
WATER ACCOUNT NO.: DATE: 1/23/2012
OWNER/RENTER/BUSINESS: Florida Medical Clinic CONTACT PERSON: Rene Gosselin
MAILING ADDRESS: 38135 Market Square Drive PHONE NUMBER: 727-647-0804
Zephyrhills FI. 33542 EMAIL ADDRESS:
SERVICE ADDRESS: 38135 Market Square Dr.
SHUT OFF SERVICE ❑ ❑X WATER
TURN ON SERVICE �x ❑ SEWER
INSTALL MEfER ❑X ❑ GARBAGE
READ MEfER ❑ ❑X IN CITY
CHECK METER ❑ ❑ OUT CITY
OTHER �
DESCRIBE OTHER: 2'irrigation meter
� NUMBER OF UNITS
�'z � 3u�.� � Cec,k.Q 1�2,h.�,
DEPOSIT AMOUNT
i�-�.�,a.� .1�2� ,�.���- `�(o
AMOUNT LAST BILL 5;� � n�� -� ���
DATE ���' �ek ��dr-�-�
MISC. CHARGE
��
METER: FULL
IIRRIGATION 2' I
WORK COMPLEfED BY&DATE ORDER TAKEN BY: Jackie Boges
COMPLEfED
ORDER GIVEN BY:
Revised 9/2010 , o �, jn � �(�� '7 1Q,
�Cx Vk._ ��
City of Zephyrhills
Water and Sewer Impact Fee Calculation
Land Use Type:
Hospital
No. of Beds 12
Impact Fees \
Withi City Limits � utside City Limits
Water Distribution System $ 4,615.20 5,769.00
Wastewater Collection System $ 9,276.55 11,595.67
Wastewater Treatment Plant Ca aci $ 5,195.45 $ 6,494.33
TOTAL $ 19,087.2 $ 23,859.00 �1
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
�
Contractor/Homeowner: �� S�G/a
Date Received: , �- 2. ��- � ,
Site: � � � � � S •
`_.. "�
,\
Permit Type: �%1�t ���8
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This co ent s et s 1 be kept with the permit and/or plans.
_ �7��
Kalvi Switzer— s Examiner Date Contractor and/or Homeowner
(Required when comments are present)
Le��hyrhilis Fire I�escue
f,�>(?7 U��ir� [tc�ad, lcph�rhill�. I I >;5�4?
l ir� I�-1arsha) I�us (813) 78U-0041
Kerr�- l3arnctl I�ax (81;l 780-00-��
! -mail; kbarnetll�u,tire.ic�hyrhills.fl.us
Plan Review#: 1 1-062 . --�._____ _._ ..___..�.__,.
Project: Revision—Fl Med Clinic Addition
Number of Pages: 1 1
May 25, 201 1
t have received and reviewed the revised plans for the addition located at 38135 Market Square
Drive. There is one remaining item with regards to plans be submitted(Item#1), however this
project will be allowed to move forward. A simple letter can be sent addressing Item #1. By
paying for the permit the contractor acknowledges to comply with the items below. Should
anyone have any questions, please do not hes�tate to contact the Fire.Marshal's office.
l. Local Resolution #589-07 requires the plans be submitted to obtain permit for
generator installation. NFPA 1 also allows this to happen.
2. Safe practices shall be used during construction in accordance to NFPA l.
3. Ensure all penetrations in any fire rating are properly sealed maintaining the
rating.
4. Firewall shall be fire caulked at roof deck and labeled "1 HOUR FIREWALL—
SEAL PENETRATIONS" or similar.
Inspection Required:
1. Firewall Screw Inspection (all areas}
2. Firewall Final
3. Penetration inspection on any existing firewall tied to this space
d. Overall Final
���
r
.
,� ._ ..._
c
KERRY BARNETT, FIRE MARSHAL
***Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes.This review is not intended to be a final approval of the
submitted plaiis it is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances. In the event that further examination or site
inspection reveals areas of non-compliance, it shall be the contractor's sole responsibility,at their sole
expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure
to be in compliance with all applicable NFPA codes and local ordinances.
ZE���'�HILLS FIRE DEPAFtT'NIEIV�°
690'T bairy F2oad, Zephyrhilis, FL 33542
�ere Chiet F(2a�h Wipli�rras Bus (8'13)�78Q-004� �ax (813)780-00�4
FIRE SERVICE USER FEES
Occupancy No.: ,� _9
Plan No.: � .3 Contractor.��,�,'�,��f� ��� /��i�p�;. °'���
Business Name. � 1 /rtiJc�r, l_''�iti�: Billing Address: �c,�3� /yr r.,,�;,.-�_ �j�T�'
Business Address: s�s 3 5 ��„� ,�� .5�� �=1 ��;�;�
Business Phone No : Billing Phone No.:
Business Fax No.. Billing Fax No.:
Contact� Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
8 Site Plan N/C Annual N/C Sprink�er $50 1st Alarm N!C
� Multi-FamilylCommercial 06 S 1 st 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 �� 3rd Re-inspection $250 Hoods $50 4th Alarm $100
� 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $1 SO
SPRINKLER SYSTEMS (Business Gosed until LP Gas $50 6th Alarm $2p0
0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- ��r��k $50
STANDPIPE SYSTEM Hydro Undergrounds 545 Sparklers $100
� Per Riser $50 Hydrostatic Test $65 ��Syscem Fire Works $500
FIRE PUMP Acceptance Test $4$ per system Camp Fire $25
� Per Pump $100 Hydrant Ffow $75 Controlled Burn $100
FIRE AI.ARM SYSTEM Hood/Duct $50
8 0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual
26 plus Devices $100 System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 ,� Flammable Application $50 Annual
Wet $SO OTHER �.�� Waste Tire Storage $50 n�„�ai
Dry $50 Fire Wan/smoke Wan $15 pe�wau Generator<KW $100
CO2 $50 LP Gas $25 per tank Generator>30 KV1/ 150
Other $50 Natural Gas $25 ��sye��m Bio-Hazard Waste �100 Annual
KITCHEN EXHAUST Fumigation Tenting $50
� Hood/Ducts $50 Tent 10'x10'or greater $15 Pe.tent Torch PoUApplied $50
OTHER Fire Pump $45 Haz.Materials $100 Annual
LP Installation per lank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
❑ (Per Tank) $50 8 Exhaust Hood/Duct $30
Natural Gas Instatlation $50 Re-InSpection DBL
{Per System) (other than annual)
�Spray Booth $50 � Inspection scheduled DBL �
and cancelled less than "
24 hours
Construction Insp N/C
Emergency Vehicle Ac� $50 FALSE ALARM
PLANS T�L r y�� INSPECTION TOTAL C�C� � PERMIT TOTAL� __ I TOTAL l_ I
/� �/ ' �(� GRAND TOTAL j� '"
Comments
�
Date� ..S Ls� //
Insq��ctor� �d' -� — _�j�
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received �Z-? � �
Phone Contact for Permittin J�Zp _ Q�7 0 0
Owner's Name L o¢..�0 A M E.p��lt� C,(,�+�l Owner Phone Number
Owner's Address �01 � /'�'aa�l�'T ,, ��� Owner Phone Number o 1 �' 18 0_=�p 't1�.{�
Fee Simple Titlehoider Name Owner Phone Number � ^A�
Fee Simple Titleholder Address
JOB ADDRESS �g��5 M A2�r ,,A-,(� 2�tF LOT# �
SUBDIVISION , PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR e ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR � COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE�� HEIGHT
QBUILDING $ � VALUATION OF TOTAL CONSTRUCTION
DELECTRICAL $ � AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �✓v�S �o� �
QGAS Q ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address ' License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREI� Y/N
Address Ucense#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# -�
OTNER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
RESIDENTIAL Attach(2)Plot Ptans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Requi�ed onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisionsAarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new constructlon.
Minimum ten(10)working days after submlHal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Wor1c Permit for ail new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Enginee�ed Plans.
"*"PROPERTY SURVEY required for all NEW construcUon.
Directlons:
Fill out applicaUon completely.
Owner 8 Contractor sign back of application,notarized
If over 52500,a Notice of Commencement is required. (A/C upgrades over 57500)
*' Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Piot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
' ��� , � _.._. ___ _
p r/'�Q.�,� �, "U� t7 �.�---_.
/D����..-� 1(/�Y'�""" 7 �s� � .� /.-'
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City of Zephyrhills
BUILDING PLAN REVIEW COMME �
� � I �
1
�-ntractor omeowner: ��Q.(,�,,r.Q � ��,5��
Date Received: 9_ ��-j�
3 '
Site: ^
p t
Permit Type: � � p�i � �-
�--
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall e kept with the peimit and/or plans.
�✓�v
Kalvin S ' er s Examiner Date Contractor and/or Homeowner
(Required when comments are present)
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
_ Building Department --�����
Date Received ��a�.��I
Phone Contact for Permittin ,Z-1 2.�o _ O 7 0 �
Owner's Name 1.o Q l O� �D�CPI L C�-1 N t(. Owner Phone Number
Owner's Address ��� E'7 " �a-� Owner Phone Number �
Fee Simple Titleholder Name � Owner Phone Number �—
Fee Simple Titleholder Address
JOB ADDRESS � c � 3� M A 2 K-�T �
LOT#
3UBDIVISION PARCEL IDl�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR B ADD/ALT � SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE C� HEIGHT
OBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ �'�,�J t S� p�L.�G�,J v L1 `o ("I"�—
OMECHANICAI $ VALUATION OF MECHANICAL INSTALLATION ��}-� Q��"
QGAS Q ROOFING Q SPECIALTY 0 OTHER ,����� /��C�i
i
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
BUILDER � COMPANY w A"�q"C� A�`I O L(q'f�
SIGNATURE Aµ REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address �icense#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �—
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""'PROPERTY SURVEY required for all NEW construction.
D(rections:
Fill out application completely.
Owner 8 Contractor sign back of application,notarized
If over;2500,a Notice of Commencement is required. (A/C upgrades over 57500)
*" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire Chief Bus (813) 780-0041
Keith Williams Fax (813) 780-0044
2 May 2012
Plan Number 12-017
Project: Revisions to New Construction Plans, Florida Medical Clinic-Surgery Center,
38135 Market Square, Zephyrhills
Number of Pages: 4 Pages
Date received by this Office: 4-30-2012
This Officer has reviewed the plan revision for new construction at Florida Medical
Center-Surgery Center, 38135 Market Square, Zephyrhills, Florida. The submitted plans
are for mechanical and electrical revisions. No apparent Life Safety or Fire Prevention
impact has been detected based on the plans submitted. Plans are approved as submitted.
Inspections Required:
1. None required
�
Review and approval of the submitted plans does not relieve the contractor from the
responsibility of correcting any deficiencies noted during inspection.
Respectfully submitted on 2 May 2012 by,
���w�k.�c`"_"'
Keith A. Williams, EFO, CFO, CMO, MIFireE
Fire Chief
Fire Safety Inspector, #148104
813-780-0020 City of Zephyrhi�ls Permit Application � ax-d1�eo-oo2�
. Building Departrnent �
Date Received Phone Contact for Permittin - "
Owner's Name �-�Q-►�� F.A l C AZ L 1� l Owner Phone Number � L f� ✓ � � ��1 �
Owner's Address � Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number ��,�
Fee Simple Titleholder Address I
JOB ADDRESS LOT# � �P C'C�
SUBDIVISION � PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEw CONS7R 8 ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE � -� Sp FOOTAGE� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
PLUMBING $ �
� �/���
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLA ION�� ,, � Q � �
� �� l �
OGAS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA YES �O /
� ,, f.
.�
BUILDER COMPANY a- � G!
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# -�
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Constructfon Plans,Stormwater Plans w!Silt Fence installed,
Sanitary Facilities 8�1 dumpster;Site Work Permit for subdivisio�sllarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new constructlon.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
'"*"PROPERTY SURVEY required for all NEW construcUon.
Directions:
Fill out application completely.
Owner&Contractor sign back of appflcation,notarized
If over 52500,a Notice of Commencement is required. (A/C upgrades over s7500)
'" 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
Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire C'hief Bus (813) 780-0041
Keith Williams Fax (813) 780-0044
14 February 2012
Plan Number 12-008
Project: Revisions to plans for Florida Medical Clinic 38135 Market Square, Zephyrhills
Number of Pages: 18
Date received: by this Office 02-06-2012
This Officer has reviewed the revised plans for Florida Medical Clinic, 38135 Market
Square, Zephyrhills. Following the review, a conditional approval to proceed is given.
Payment for permit acknowledges acceptance and compliance of the conditions noted
herein. The following items shall be considered:
1. Revisions requested per original comments have been addressed.
2. Doors were requested to be labeled for certain rooms. These were noted on
plan revisions. Field placement and coordination will assure rooms are labeled
correctly.
3. It should be noted that door 139 in the door schedule appears to be a glass
entry door but is called for room labeling per door schedule remarks. Labeling
should not obscure vision through door.
4. Door 154 in the door schedule refers to remarks (#11) requiring 8'0" door to
have two pair of hinges, these doors are only identified as 7'0" doors.
5. Change of door hardware brand is acceptable and meets requirement.
Inspections Required:
1. FinalInspection.
Review and approval of the submitted plans does not relieve the contractor from the
responsibility of correcting any deficiencies noted during inspection.
Respectfully submitted on 14 February 2012 by,
�� �
Keith A. Williams, EFO, CFO, CMO, MIFireE
Fire Chief
Fire Safety Inspector, #148104
ZEPHYRHI�LS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhilis, FL 33542
Fire Chief Kei#h Witliams Bus (813)780-0041 Fax (813)780-0044
FIRE SERVICE USER FEES
Occupancy No.: /
Plan No.: Contractor• ����'''I��C"� �55�G;�m,S
Business Name: P� .� - < .yc,�� Billing Address:
Business Address. � S /f` w� 2 �(�'k��
Business Phone No.: <�-7�- C� Billing Phone No.:
Business Fax No.� Billing Fax No.•
Contact: Contact: rJ'�7 5�� °���3 �s
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
�Site Plan N/C Annual N/C Sprinkler $50 1 st Alarm N/C
Multi-FamilylCommercial 06 sf 1 st 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 Revis�p s DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100
� 4th Re-Inspection $500 Fire Alarm $50 Sth Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200
0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- �rm�k $Sp
STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100
� Per Riser $50 Hydrostatic Test $65 per system Fire Works $500
FIRE PUMP Acceptance Test $45 persystem Camp Fire $25
� Per Pump $100 Hydrant Flow $75 Controlled Burn $100
FIRE ALARM SYSTEM Hood/Duct $50
8 0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual
26 plus Devices $100 System Acceptance $50 Fire Protection $25
SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 Annual
Wet $50 OTHER Waste Tire Storage $50 Annual
Dry $50 Fire WalUSmoke Wall $15 perwall Generator<KW $100
CO2 $50 LP Gas $25 pertank Generator>30 KW 150
Other $50 Natural Gas $25 ��system Bio-Hazard Waste $100 Annual
KITCHEN EXHAUST Fumigation Tenting $50
� Hood/Ducts $50 Tent 10'x10'or greater $15 Per ce�t Torch PobApplied $50
OTHER Fire Pump $45 Haz.Materials $100 Annual
LP Instanation per tank $50 Fire Suppression $30
Fuel Tank Installation $50 System Acceptance
❑ (Per Tank) $50 B Exhaust Hood/Duct $30
Natural Gas Installation $50 Re-InSpeCtlon DBL
(Per System) (otherthan annual)
� Spray Booth $50 � Inspection scheduled DBL B
and cancelled less than
24 hours
Construction Insp N/C
Emergency Vehicle Ac� $50 FALSE ALARM
PLANS TOTAL� INSPECTION TOTAL� PERMIT TOTAL� TOTAL�
`��lJ�f� 76�'b�
GRAND TOTAL
Comments:
�ate: 7 /`�/�'�/Z
InsA��ctor: /L�'�'r�'z✓�=—
,��r��S i`� \
� � � '` \
�� .:F, r \\
/( �.� �
/ > �'�
/
City of Zephyrhills ��
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: 1/l�(',(�L�t� f��d� �(��� �� � __ l���
/ 1 ���
Date Received: ��2 3-( Z
Site: _ 3�' (3.� ��;��� � .
Permit Type: R`ev��rG� �lE'Gc� //'�ClCc�CZ����1L�
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
,
�� �- . ��u -� �---
¢� ���\�-; vr
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This comment sheet shall be kept with the permit and/or plans.
/ ��/-/Z
Kalvin Switzer ans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
Froa: 1112212011 09;52 #615 P.0011001
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ALLACE
ASSOCIATES, L.L.C.
GENERALCONTRACTORS
March 21,2011
City of Zephyrhills
Building Department
5335 8�'Street
Zephyrhills,FL 33542
Re: Charles Edward Adair CGC 058394
Dear Sir or Madam,
I, Chazles Edward Adair CGC 058394, Sr. �ce President of Wallace Associates, L.L.C.,
hereby authorize the following person to act as my agent in obtaining pernuts from the
City of Crystal River,Florida:
A�ent Name Driver's License Number
Thamas M. LoCicero L226-833-82-168-0
This letter supersedes any previously issued letter(s) of authoriza.tion. This letter is to
remain in effect unless cancelled in writing by the undersigned.
.�
d"
Charles Edward Adair
NOTARY PUBLIC
State of Florida
County of: Pinellas
Sworn to and subscribed to before this 15th day March, 2010 by Charles Edward Adair
who is personally known to me and who did not take an oath.
C..�.. ' �
��y`-�'�-�-�-�VIy Commission Expires:
�N Public
�r�� J ctki�liston WaNaq Fbrida
���{ My Commissbn EE007883
p�pd� Ezpire=08J77/2074
5435 M.L. KING ST. NORTH, ST. PETERSBURG, FL 33703 - PHONE: (727J 520-0700 - FAX: (727) 520-0789
CGC #044505
Florida Energy Efficiency Code For Building Construction
Florida Department of Community Affairs
EnergyGauge Summit� Fla/Com-2008, Effective: March 1, 2009 -- Form 400A-2008
Method A: Whole Building Pertormance Method for Commercial Buildings
PROJECT SUMMARY
Short Desc: Florida Medical Description: Florida Medical Surgery Cen
Owner: Florida Medical
Addressl: 38135 Markey Square City: Zephyrills
Address2: State: Florida
Zip: 33542
Type: Hospital Class: Addition to existing Building
J�u'isdiction: ZEPHYRHILLS,PASCO COUNTY,FT.(611600)
Conditioned Area: 17233 SF Conditioned&UnConditioned Area: 17233 SF
No of Stories: 1 Area entered from Plans 18000 SF
Perntit No: 0 Max Tonnage 30.4
If different,write in:
EnergyGauge Summil�Fla/Com-2008. Effective:March 1,2009
3/18/2011 Page 1 of 11
CERTIFICATIONS
i hereby certify that the pians and specifications covered by this calculation are in compli nc with the
Fiorida Energy Code
Prepared By: David S.Bes� Buiiding Official: � _
'�'',i�,.�
Date: __ .�✓�a�, Date: L _
I certify that this building is in compliance with the FLorida Energy Efficiency Code
Owner Agent: Date:
If Required by Florida law, I hereby cefify(')that the system design is in compliance with the FLorida
Energy Efficiency Code
Arcliitect: Reg No:
Electrical Desi��er: Reg�pl���¢,��f„I,f�
,� .���...���������I
�� �� �� y �
Lighting Decigner. _ � O��fi �:���
� :�b � � �•Z�
�a�s? 4 p o;W�
blechanical Designer.� � � Mf3°! !._ _: �
�:t)' •'J�
i"��� O l+ �:�`
r7 .J Z � O:Z�
Plumbing Desi�ner. _ • •
(') Signature is required where Florida Law requires design to be performed�reg�ed desJArlfj����,
professionals ��i���� pppF`���
�i+auu����
`
. �
\
J �
�
f1�
EnergyGauge Summit0 FIa/Com-2008. Effeetive:March 1,2009
3/I 8/2D 1 1 Page 3 of 1 1
External Lighting Compliance
Description Category Tradable? Allowance Area or Lengt6 ELPA CLP
(W/LJnit) or No.of Units (VV) (VV)
(Sqft or ft)
None
EnergyGauge Summit�Fla/Com-2008. Effective:March 1,2009
3/18/2011 Page 5 of l 1
125 3 Storage&Warehouse-Bulky 75 1 l PASSES
Active Storage
126 5 Corridor 190 1 1 PASSES
127 6 Toilet and Washroom 45 1 1 PASSES
128 6 Toilet and Washroom 45 1 ] PASSES
129 8,002 Dressing/Locker/Fitting Room 300 2 1 PASSES
(General)
130 6 Toilet and Washroom 50 1 1 PASSES
131 6 Toilet and Washroom 50 1 1 PASSES
132 6 Toilet and Washroom 432 2 1 PASSES
110, 117& 118 5 Corridor 795 1 1 PASSES
]O 1 5 Corridor 150 1 1 PASSES
102 12 Lobby(General)-Reception and 1,370 2 1 PASSES
Waiting
]03 12 Lobby(General)-Reception and 680 2 1 PASSES
Waiting
104 17 Office-Enclosed 505 1 ] PASSES
105 6 Toilet and Washroom 120 1 1 PASSES
106 6 Toilet and Washroom 100 1 1 PASSES
107 15 Conference/meeting(Multiple 310 1 ] PASSES
Functions)
175 10,007 Operating Room(Hospital) 180 1 1 PASSES
176 10,007 Operating Room(Hospital) 195 1 1 PASSES
177/181 5 Corridor 365 1 1 PASSES
178 10,007 Operating Room(Hospital) 170 2 1 PASSES
179 3 Storage&Warehouse-Bulky 80 1 1 PASSES
Active Storage
I 80 10,007 Operating Room(Hospital) 165 2 1 PASSES
183 3 Storage&Warehouse-Bulky 35 1 l PASSES
Active Storage
184 6 Toilet and Washroom 44 1 1 PASSES
1 SS 18,002 Laboratory 165 1 1 PASSES
186/191 5 Corridor 200 2 1 PASSES
187 3 Storage&Warehouse-Bulky 25 1 1 PASSES
Active Storage
188 3 Storage&Warehouse-Bulky 25 1 1 PASSES
Active Storage
189 10,002 Recovery(Hospital) 1,330 1 1 PASSE5
192 ]0,007 Operating Room(Hospital) 75 1 1 PASSES
193 6 Toilet and Washroom 60 1 1 PASSES
194 3 Storage&Warehouse-Bulky 60 1 1 PASSES
Active Storage
195 17 Office-Enclosed 55 1 1 PASSES
196 16 Office-Open Plan 500 1 ] PASSES
Existing Computer 17 Office-Enclosed 370 1 1 PASSES
PASSES
EnergyGauge Summii�Fla/Com-2008. Effective:March 1,2009
3/18/2011 Page 7 of 11
RTU-3 RTU-3 Variable Air Volume No.of Units
Packaged System-903 1
Component Category Capacity Design Eff Design iPLV Comp-
Eff Criteria IPLV Criteria liance
Cooling System Air Conditioners Air Cooled 10.30 9.50 9.70 9.70 PASSES
240000 to 760000 Btu/h
Cooling Capacity
Heating System Electric Furnace 1.00 1.00 PASSES
Air Handling Air Handler(Supply)- 0.98 1.27 PASSFS
System-Supply Variable Volume
Air Distribution ADS System 6.00 3.50 PASSES
System
RTU-4 RTU-4 Variable Air Volume No.of Units
Packaged System-903 1
Component Category Capacity Design Eff Design 1PLV Comp-
Eff Criteria lPLV Criteria liance
Cooling System Air Conditioners Air Cooled 1030 9.50 9.70 9.70 PASSES
240000 to 760000 Btu/h
Cooling Capacity
Heating System Electric Furnace 1.00 1.00 PASSFS
Air Handling Air Handler(Supply)- 1.04 1.27 PASSES
System-Supply Vanable Volume
Air Distribution ADS System 6.00 3.50 PASSES
System
PASSES
Pla�t Compliance
Description Installed Size Design Min Design Min Category Comp
No Eff Eff TPLV IPLV liance
None
EnergyGauge Summil�FlalCom-2008. Effective:March 1,2009
3/18/2011 Page 9 of 11
Project: Florida Medical
Title:Florida Medical Surgery Center
Type:Hospital
(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-0ut from EnergyGauge FlaCom attached
Operahons Manual 13-102.1, Operations manual provided to owner �
13-410, 13-413
Windows&Doors 13-406.AB.1.1 Glazed swinging entrance&revolving doors:maac. LO cfm/ftz;all �
other products:0.4 cfm/ft2 �
Joints/Cracks 13-406.AB.1.2 To be caulked,gasketed,weather-stripped or otherwise sealed
Dropped Ceiling Cavity 13�06.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 Ef�iciency 13-407, 13-408 Minimum efficiences:Cooling Tables 13�07.AB3 2.1A-D; d
Heating Tables 13-407.AB.3.2.1 B, 13-407.AB.3.2.1 D,
13-408.AB3.2.1 E, 13-408.AB.3.2F
HVAC Controls 13-407.AB.2 Zone controls prevent reheat(exceptions);simultaneous heating
and coolmg 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 u
systems and 2)systems with design outside air intake or exhaust
capacity<300 cfin �
ADS 13-410 Duct sizing and Design have been performed
HVAC Ducts 13�10.AB A�r ducts,fittings,mechamcal equipment&plenum chambers shall �
be mechanically attached,sealed,insulated&installed per Sec.
13-410 Air Distribution Systems
Balancing 13�10.AB.4 HVAC distribution system(s)tested&balanced.Report in �
construction documents
Piping Insulation 13�11.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�1 I.AB.3 Table 13-411.AB.2 for circulating systems,first 8 feet of outlet
Insulation pipe from storage tank and between inlet pipe and heat trap �
Water Fixtures 13-412.AB.2.5 Shower hot water flow resficted to 2.5 gpm at 80 psi.Public
lavatory fixture how water flow 0.5 gpm max;if self'-closing valve
0.25 gallon recirculating,0.5 gallon non recirculating �
Motors 131114 Motor efficiency criteria have been met
Lighting Controls 13-415.AB Automatic control required for inter�or lighting in buildings>5,000
s.f.;Space control;Exterior photo sensor;Tandom wiring with 1 or
3 linear fluuorescent lamps>30W
EnergyGauge Summit�FlalCom-2008. Effective:March 1,2009
3/18/2011 Page 11 of 11
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CHARLES A. DAVIS, PE
4004 WOODACRE LANE
TAMPA, FL 33624
HYDRAULIC CALCULATIONS
FOR
Oliveri Architects
32707 US Hwy 19
Palm Harbor, Florida 34684
Florida Medical Clinc
Zephyrhills, Florida 33542
REMOTE AREA #1
-DESIGN DATA-
OCCUPANCY CLASSIFICATION: Light
DENSITY: O10 gpm/sq. ft.
AREA OF APPLICATION: 1500 sq. ft.
COVERAGE PER SPRINKLER: 149 sq. ft.
NUMBER OF SPRINKLERS CALCULATED: 17 sprinklers
TOTAL SPRINKLER WATER FLOW REQUIRED: 344.1 gpm
TOTAL WATER REQUIRED (including hose) : 444.2 gpm
FLOW AND PRESSURE (@ BOR) : 344.1 gpm @ 41.1 psi
DESIGN/LAYOUT BY: Charles Davis, PE
FLOW TEST:
TEST DATE:
TEST TIME:
CONDUCTED BY: Zephyrhills Fire Rescue
HYDRANT LOCATION: Market Square Drive Near East end of building
PRESSURE HYDRANT:
STATIC PRESSURE: 62 PSI
RESIDUAL PRESSURE:24 PSI
FLOW RATE: 3217 GPM
CALCULATIONS BY HASS COMPUTER PROGRAM
HRS SYSTEMS, INC.
TU�4E��� •9p�184
Items listed in bold print ��@$t��a�'��iiy transfered from the cal�ulation report
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SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 2
DATE: 3/17/2011 FILES\HRS SYSTEMS\HASS81\PROJECTS�FMCCLINIC 3-17-2011.SDF
JOB TITLE: Florida Med Center
WATER SUPPLY DATA
SOURCE STATIC RESID. FLOW AVAIL. TOTAL REQ'D
NODE PRESS. PRESS. @ PRESS. @ DEMAND PRESS.
TAG �;PSI) (PSI) (GPM) (PSI) (GPM) (PSI)
SOURCE 62. 0 24 .0 3217 .0 61.0 444 .2 54 . 6
AGGREGATE FLOW ANALYSIS:
TOTAL FLOW AT SOURCE 444 .2 GPM
TOTAL HOSE STREAM ALLOWANCE AT SOURCE 100.0 GPM
OTHER HOSE STREAM ALLOWANCES 0.0 GPM
TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 344 .2 GPM
NODE ANALYSIS DATA
DENSIT].'
NODE TAG ELEVATION NODE TYPE PRESSURE DISCHARGE AREA REQ. ACT.
(FT) (PSI) (GPM) (FT^2) (GPM/FT"2)
1 0. 0 - - - - 54 .4 - - - - - - - - - - - -
2 0.0 - - - - 46. 4 - - - - - - - - - - - -
3 2 .0 - - - - 45.4 - - - - - - - - - - - -
4 11.0 - - - - 41. 1 - - - - - - - - - - - -
5 11.0 - - - - 40.7 - - - - - - - - - - - -
6 11.0 - - - - 36.8 - - - - - - - - - - - -
7 11. 0 - - - - 34 .4 - - - - - - - - - - - -
8 11.0 - - - - 32.2 - - - - - - - - - - - -
9 11.0 - - - - 30.0 - - - - - - - - - - - -
10 11.0 - - - - 27. 1 - - - - - - - - - - - -
11 11.0 - - - - 25. 9 - - - - - - - - - - - -
12 11.0 - - - - 25.3 - - - - - - - - - - - -
13 11.0 - - - - 24 .8 - - - - - - - - - - - -
14 11.0 - - - - 21.4 - - - - - - - - - - - -
15 11.0 - - - - 19.7 - - - - - - - - - - - -
16 11.0 - - - - 19. 3 - - - - - - - - - - - -
17 11.0 - - - - 19.0 - - - - - - - - - - - -
18 11.0 - - - - 18.7 - - - - - - - - - - - -
19 11.0 - - - - 15.7 - - - - - - - - - - - -
20 11.0 - - - - 19 .5 - - - - - - - - - - - -
21 11.0 - - - - 12.3 - - - - - - - - - - - -
22 11.0 - - - - 11.3 - - - - - - - - - - - -
23 11.0 - - - - 9. 9 - - - - - - - - - - - -
24 11. 0 - - - - 17.3 - - - - - - - - - - - -
25 11.0 - - - - 13. 8 - - - - - - - - - - - -
26 11.0 - - - - 12.4 - - - - - - - - - - - -
27 11.0 - - - - 10. 9 - - - - - - - - - - - -
28 11 .0 - - - - 9.1 - - - - - - - - - - - -
29 11 .0 - - - - 9.1 - - - - - - - - - - - -
30 11.0 - - - - 8. 1 - - - - - - - - - - - -
31 10.0 K= 5. 60 19. 6 24 .8 80.0 0. 100 0.310
32 10.0 K= 5. 60 18.3 24 .0 . 48.0 0. 100 0. 500
33 10.0 K= 5. 60 17 .5 23.4 .54 .0 0. 100 0. 434
• SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 3
DATE: 3/17/2011 FILES\HRS SYSTEMS\HASS81\PROJECTS\FMCCLINIC 3-17-20].1.SDF
JOB TITLE: Florida Med Center
NODE ANALYSIS DATA
DENSIT�'
NODE TAG ELEVATION NODE TYPE PRESSURE DISCHARGE AREA REQ. ACT.
(FT) (PSI) (GPM) (FT�2) (GPM/FT�2)
34 10.0 K= 5.60 18.4 24 .0 180.0 0. 100 0. 133
35 10.0 K= 5. 60 16.7 22. 9 80.0 0. 100 0.286
36 10.0 K= 5. 60 14 .4 21.2 54 .0 0. 100 0.393
37 10.0 K= 5. 60 13.3 20.4 72.0 0. 100 0.284
38 10.0 K= 5. 60 12.0 19.9 130.0 0. 100 0. 149
39 10.0 K= 5. 60 11 .0 18 . 6 156.0 0.100 0. 119
40 10.0 K= 5. 60 9.7 17 .4 168 .0 0.100 0. 104
41 10.0 K= 5. 60 15. 8 22.3 160.0 0. 100 0. 139
42 10.0 K= 5. 60 12. 9 20. 1 48.0 0. 100 0.419
43 10. 0 K= 5. 60 11.7 19.2 81.0 0. 100 0.237
44 10.0 K= 5. 60 10. 6 18 .3 110.0 0. 100 0. 166
45 10.0 K= 5. 60 8.7 16.5 117 .0 0. 100 0. 141
46 10.0 K= 5. 60 8.3 16.1 135.0 0. 100 0. 119
47 10.0 K= 5. 60 7.8 15. 6 156. 0 0. 100 0. 100
SOURCE 0.0 SOURCE 54 .6 344 .2 - - - - - - - - -
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 5
DATE: 3/17/2011 FILES�HRS SYSTEMS�HASS81\PROJECTS�FMCCLINIC 3-17-2011.SDF
JOB TITLE: Florida Med Center
PIPE TAG Q(GPM) DIA(IN) LENGTH PRES:3.
END ELEV. NOZ. PT DISC. VEL(FPS) HW(C) (FT) SUM.
NODES (FT) (K) (PSI) (GPM) FL/FT (PSI)
Pipe: 13 128.0 3.260 PL 11 . 00 PF 0.5
12 11.0 0.0 25. 3 0.0 4 . 9 120 FTG T PE 0.0
13 11.0 0.0 24 . 8 0.0 0.016 TL 31 .00 PV
Pipe: 14 96.2 1. 610 PL 7 . 00 PF �1 .4
11 11.0 0.0 25. 9 0.0 15.2 120 FTG T PE b.0
14 11.0 0.0 21. 4 0.0 0.295 TL 15. 00 PV
Pipe: 16 71.4 1. 610 PL 10.00 PF :_.7
14 11.0 0.0 21 . 4 0.0 11.3 120 FTG ---- PE 0.0
15 11.0 0.0 19.7 0.0 0. 170 TL 10.00 PV
Pipe: 18 47 .9 1. 610 PL 5.00 PF 0. 4
15 11.0 0.0 19.7 0.0 7 .5 120 FTG ---- PE 0.0
16 11 .0 0.0 19. 3 0.0 0.080 TL 5. 00 PV
Pipe: 19 24 .0 1.380 PL 6.00 PF 0.3
16 11.0 0.0 19.3 0.0 5.2 120 FTG ---- PE 0.0
17 11.0 0. 0 19.0 0.0 0.048 TL 6.00 PV
Pipe: 20 119. 9 1. 610 PL 7 .00 PF Ei.7
12 11 . 0 0.0 25.3 0.0 18. 9 120 FTG T PE 0.0
18 11 . 0 0.0 18.7 0.0 0.444 TL 15.00 PV
Pipe: 2.1 97 .0 1. 610 PL 10.00 PF 3.0
18 11.0 0.0 18.7 0.0 15.3 120 FTG ---- PE 0.0
19 11.0 0.0 15.7 0.0 0.300 TL 10.00 PV
Pipe: 22 75. 8 1. 610 PL 6.00 PF 7_. 1
19 11 .0 0.0 15.7 0.0 11. 9 120 FTG ---- PE 0.0
20 11 . 0 0.0 14 .5 0.0 0. 190 TL 6.00 PV
Pipe: 23 55.4 1.380 PL 10.00 PF 2 .3
20 11.0 0.0 14 .5 0.0 11. 9 120 FTG ---- PE 0.0
21 11.0 0.0 12.3 0.0 0.225 TL 10.00 PV
Pipe: 24 36.0 1.380 PL 10.00 PF ]..0
21 11.0 0. 0 12.3 0.0 7.7 120 FTG ---- PE C1.0
22 11 . 0 0.0 11.3 0.0 0. 101 TL 10.00 PV
Pipe: 25 17.4 1.049 PL 13. 00 PF ]..3
22 11.0 0.0 11.3 0.0 6.5 120 FTG ---- PE CI.O
23 11 .0 0.0 9. 9 0.0 0. 101 TL 13.00 PV
Pipe: 26 128.0 1. 610 PL 7.00 PF �.5
13 11.0 0.0 24 .8 0.0 20.2 120 FTG T PE Ci.O
24 11.0 0.0 17 .3 0.0 0.501 TL 15.00 PV
Pipe: 30 105.7 1. 610 PL 10.00 PF ��.5
24 11 .0 0.0 17.3 0.0 16.7 120 FTG ---- PE C�.O
25 11 .0 0.0 13. 8 0.0 0.352 TL 10.00 PV
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 7
DATE: 3/17/2011 FILES�HRS SYSTEMS�HASS81\PROJECTS�FMCCLINIC 3-17-2011.SDF
JOB TITLE: Florida Med Center
PIPE TAG Q(GPM) DIA(IN) LENGTH PRESS.
END ELEV. NOZ. PT DISC. VEL(FPS) HW(C) (FT) SUM.
NODES (FT) (K) (PSI) (GPM) FL/FT (PSI)
Pipe: 44 18. 6 1.049 PL 1.00 PF 0.7
22 11.0 0.0 11.3 0.0 6. 9 120 FTG T PE 0.4
39 10.0 5. 6 11.0 18. 6 0. 114 TL 6.00 PV
Pipe: 45 17 .4 1.049 PL 3.00 PF 0.7
23 11.0 0.0 9. 9 0.0 6.5 120 FTG 2E PE 0 . 4
40 10.0 5. 6 9.7 17 .4 0.101 TL 7 .00 PV
Pipe: 46 22.3 1.049 PL 5.00 PF 1 . 9
24 11.0 0.0 17 .3 0.0 8.3 120 FTG ET PE C . 4
41 10.0 5. 6 15.8 22.3 0. 159 TL 12.00 PV
Pipe: 47 20. 1 1.049 PL 3.00 PF 1 .3
25 ll.0 0.0 13.8 0.0 7.5 120 FTG ET PE C .4
42 10.0 5. 6 12. 9 20. 1 0. 132 TL 10.00 PV
Pipe: 48 19.2 1.049 PL 2.00 PF l . l
26 11.0 0. 0 12. 4 0.0 7 .1 120 FTG ET PE C�.4
43 10.0 5. 6 11.7 19.2 0. 120 TL 9.00 PV
Pipe: 49 18.3 1.049 PL 1.00 PF 0.7
27 11.0 0.0 10. 9 0.0 6. 8 120 FTG T PE 0.4
44 10.0 5. 6 10. 6 18.3 0. 110 TL 6.00 PV
Pipe: 50 16.5 1.049 PL 3.00 PF U. 9
28 11 .0 0.0 9. 1 0.0 6. 1 120 FTG ET PE Ci.4
45 10.0 5. 6 8 .7 16.5 0.091 TL 10.00 PV
Pipe: 51 16.1 1.049 PL 7 .00 PF ]..2
29 11.0 0.0 9.1 0.0 6.0 120 FTG ET PE C�. 4
46 10.0 5. 6 8 . 3 16. 1 0.087 TL 14 .00 PV
Pipe: 52 15. 6 1.049 PL 5.00 PF C1.7
30 11.0 0.0 8 . 1 0.0 5. 8 120 FTG 2E PE C1.4
47 10.0 5. 6 7 .8 15. 6 0.082 TL 9.00 PV
NOTES (HASS) :
(1) Calculations were performed by the HASS 8. 1 computer program
under license no. 2707107750 granted by
HRS Systems, Inc.
208 South Public Square
Petersburg, TN 37194
(931) 659-9760
(2) The system has been calculated to provide an average
imbalance at each node of 0.001 gpm and a maximum
imbalance at any node of 0.064 gpm.
(3) Total pressure at each node is used in balancing the system.
Maximum water velocity is 20.2 ft/sec at pipe 26.
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 9
DATE: 3/17/2011 FILES\HRS SYSTEMS\HASS81\PROJECTS\FMCCLINIC 3-17-20-_l.SDF
JOB TITLE: Florida Med Center
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EXHIBIT "A"
ALLACE
ASSOCIATES, L.L.C.
GENERAL CONTRACTORS
DATE. April 28,2011
FROM. John L.Wallace
Wallace Associates,L.L.C.
5435 Dr. M. L.King Street North
St.Petersburg, FL 33703
TO: Joseph Oliveri
Oliveri Architects
32707 US Hwy 19
Palm Harbor, Florida 34684
(727)781-7525 fax(727)781-6623
E-mail: jlo�oliveriarchitects.com
PROJECT Proposed ASC Expansion
Florida Medical Clinic
38135 Market Square
Zephyrhills,Florida 33542
Gentlemen.
The undersigned Contractor, hereinafter referred to as"Bidder", having visited the site of the proposed
project,become familiar with all the conditions affecting and governing the construction of the project,
hereby proposes to furnish all materials, labor,equipment,and other items,facilities and services for the
proper execution and completion of:
In strict compliance with the drawings, specifications, addenda, and all other contract documents relating
thereto as prepared by and on file in the office of Oliveri Architects,32707 U.S. Highway 19, Palm Harbor,
Florida 34684 for the following lump sum base bid price:
Base Bid
a5,119,690.00(Five Million One Hundred Nineteen Thousand Six Hundred Ninety and no/100 Dollars)
Approved Value Engineering:
1 Delete Metal Wall Panels $ (156,658.00)
2 Micro Bulk Oxygen Tank(By Owner) $ (44,526.00)
3 Flooring(By Owner) $ -
4 Direct Burial Site Light Pole Bases $ (13,000.00)
5 Relocate Transformer $ (80,000.00)
6 Delete Solid Surtace Counter Tops(plastic laminate)Rooms 105&106 to remain $ (8,990.00)
7 Delete Corian Toilet Partitions(plastic laminate floor mounted) $ (9,190.00)
8 Delete Wood Panel Ceiling over Admitting Desks $ (13,860.00)
9 Delete Wood Veneer at Surgery Lobby and Gallery(paint wails) $ (8,653.00)
10 Delete Landscape Maintena�ce Agreement(allowance) $ (12,000.00}
11 Delete Wallace Associates Contingency Allowance(Owner to carry Contingency) $ (50,000.00)
12 Delete Lockers(OFOI} $ (15,962.00)
13 Delete Covered Parking(allowance) $ -
14 Delete Gallery Benches(OFOI) $ (4,500.00)
15 Delete VWC in Passage 110, 117, 116(paint walls) $ (6,290.00)
16 Delete Office Millwork: 112A, 112B, 113, 114, 148, 149(OFOI) $ (16,110.00)
17 Delete Permit Allowance(By Owne�) $ -
1 of 3
5435 M.L. KING ST. NORTH, ST. PETERSBURG, FL 33703 - PHONE: (727� 520-0700 - FAX: �727� 520•0789
CGC #044505
18 Delete Testing Allowance(By Owner) $ -
19 Delete Pedimats at Airlocks 101 and 197 $ -
20 Aluminum Diffusers at OR Ceilings in lieu of SST S (9,366.00)
21 Delete Endoscopy Work $ '
22 Delete Sitework at W.Parking lot(pervious concrete, covered parking,landscape) 3 (90,500.00)
23 Delete relocation allowance of Overhead Utility Service $ (20,000.00)
24 Re-Engineer HVAC System(standa�d system) $ -
25 Gravity Siack Retaining Watl system for Retaining Walls $ (20,000.00)
Total Value EngineeNng $ (581,605.00)
Subcontractor Savings ,$ [27,745.00j
Total Savings to Date $ (609,350.00)
Proposal wlthout Value Engineering $�,119,690.00
Revised Proposal with Value Engineering S 4,510,340.00
Upon�eceipt of the building permit and notice of commencement,we shatl deliver the projecl to substantial
completion stage in 365 days.
In submitting this bid,the undersigned agrees to the following:
1 To honor the Bid for a perEod of Thirty(30)days.
2_ To enter inta and execute a contract,if awarded, on the basis of this bid, and to furnish all
insurance requireme�ts in accord with the General Conditions of the Construction Contraot and the
General Conditions.
3. It is the intent of the Owne�to apply for a Building Permit during the Bid process. The Cont�actor
shall immediatety follow through on the Permit Application to assufe commencement of the work at
the earliest possible date. Time is of the essence in completing the Project;the Contractor shall
take all steps reasonable to expeditiously secure the Building Permit,and complete the work as
defined by the CoMract DocumerNs.
The undersigned also acknowledges the receipt of the following Addenda:
Adde�dum#1 (revised)dated February 9,2011
BID SECURITY. None required
CONSTRUCTION iNDUSTRIES LICENSING BOARD CERTIFICATION:
Chuck Adair General Contractor CGC#058394
Name of Individual Type of License License Number
�UAI.lFICATION3/CLARIFICATIONS:
1 Price Escalatian Ckause: In the event of significant detay or price i�crease oi material,equipment,
or energy occurring during the performance of this contract through no fautt of the conVactor,the
contract sum,time of completion and contract requirements shaH be equitably adjusted by change
order in accordance with the procedures of the Contract Documents. A change in price of an item
of material, equipment or energy will be considered significant when the pnce of an item increases
more than 5 percent between the date of this coMfact and the date of installation.
2. Impact fees are not included.
3 Builder's Risk insurance is by Owner
4. Payment and performance bonds are included_ If not required deduct: .<$34,000.00>
5. Temporary Water and Power are Sy Owner.
6 Waxing floors is by Owner
?. Signage is by Owner.
8. Windflw blinds are by Owner
2of3
9. The following allowances have been included with this proposal:
a. Permit Fees: Allow..$15,040.00
b. Testing: Allow.. $10,000.00
c. Patch Existing Landscape&Irrigation: Allow $10,000.00
Bidder hereby certifies that all statements and amounts entered herein have been carefully prepared under
the express conditions as described in the Contract Documents and that such statements are true and
correct.
April 28,2011
Dat����
Signature of Officer
Chuck Adair.Vice President
Type NamelTitle of Officer
Wallace Associates. L.L.C.. 5435 Dr.M. L. Kina Street North,St. Petersbura. Florida 33703
Legal Name of Bidding Firm
3 of 3
� �� i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii
'� 2011090062
Rcpl:1372452 Rec: 18.50
' � D5: 0.00 IT: 0.00
06/13/11 C. �Cook, Dpl,y Clerk
PRULp S 0'NEIL,Ph D Pq5C0 CLERK 8, COMPTROLLER
x0'�'YCE OF COMMENCEMEIVT 060R BKl ���'� PG���q,�
�ermit No. .
'roperty Identifioation No. ��-�b ^ �"` �o n 1 e -o'3�O o- O o 3 0
CF�I.JN'DERSIdNED hereby give lnforms you that tho nnprovetnent will be�sde tn certain real property.and in accordenoe wtth
iectton�13.13 oPthe Flaride Stehrtes,the foflowiqg informntion��proVided in thla NO'Y'ICE OF COMMl�.NCEMENT.
L.Description of property(1e al descrtp!lo�:) �&-E R7`t A t.t1 C�
e)srceee qaaresa: � M A�. JA IZ- 1 �wS �
2.�eneral descrlptlon of iiuproVemente: a 1� T �CT �� 1.F. R xPAN � O A F �ST� ov -
i /'��D c C. .) i 1.� .'SX V.. �T 1.l �$
3.Ownar Information
a)IJameandaddress��ML MM.�-T ,SC�,vq,�,C- �Nt.�,3���5 MA�-��T S�•.Z.FP4{�y¢.�}�VVS ,F�. 335'-1L..
b)Name aod address of f sunple tidaho der(if other than owaer) __, -
- e)Intsrest in property E� S��PL�
�ontractor Iaformatlon
a)Name and addnss: W A�LRc.� ASS oC.<<tT�S �-u-� �J 3 1�•L.�.+►1 tp . N. S�.�F-TF_�f B��RJIi �331,o�j
b)Talephone No.: �1 Z.`i- -o o,� •Fouc No.(Qp�) - _-o-o Z
5.3uraty Infnrmation 1 1�
a)1Vamn and addresa• �V
b)Amount of Bpnd: •
c)Telephone No.:,,., , ' Fax No.(Qpt.)
6.Lender 'rq
a)Name at�d addrasa- iV Y�
Phone No.
7.Ide�ity of parson within the te of Florida dw ted by bwner uQon whom no�iees or othar doeument may be suved:
a)IJameradeddress: ���- PE��ro�-a-�38� MA21Gf� P�R�- E�kk Rk}tw �l. `�35 � .
b)Telaphoue No.: � - o^ �'� Fsx No. Opt) � � '1�4�
s.In addition eo himself,oWner dosignatea tho foltowing peraon to receive a copy of t�e�ieuor'a Nodce aa provided iri Seeeion •
713.13(7)(b),Florida Ststutee: ' f n
a)Nama and address: �V TS
•b)Talephano No.: �- •Fax No.(Opt.)
9.Expiration date ot'Notice of Corn�mencament(t6e explret[on�ata ts one'year ltOm the date of recording unlase a dtffetent dato ia
sQaoified):
WARNING TO QWNER: ANY PAYM�NTS NIADL�BY'I`FTE O''VVNICR AFI'ER THE EXPIRATTON.OI+'THS NO'i7C�'OF
COMMENCEMENT ARE CONSTDLIYED IMPROPER PAYM�NT3 UNDER CHAP'X'ER 713,PART l.3ECTIOIV 713.13.
FLOIt7DA STA,TUTES,AND CAN 3tESUI.T IN YO�UR PA'YING TWICE FdR IMPROVSME3V'Y'S TO YOUR Y'ROP�RTY.
A NOTICE OF COMMETI'CEMEIyT MU3T BE RECORDED AND POSTED N E JOH 81TE BEFOItE TFI�1+'IItl4T
IN3YECTIQIV. IF YOU ITTTEND TO O�TAD�I FINANCII�TG,CONSULT YO ER OR ORN�Y HEFORE
COlyfiV[EN�I�TG WORIC pR RECORDING YOUR 1�TUTICE OR COMMEN
S7AT8 OF FLORIDA C��
COUNTY OF PA6C0
• 3iputure ofOwoer Qwnx'� u ori:ed cer 1 todP tlMuuBer '
e.0 ��U4-'�P��
prlot Nama
The foregoing Lna�vment was aclmowledge �b re me this - �� dny of \l( .j `��i' .20�,b��+�-�Q�Q-
aa CtYPa disuehorlty,e.g.otT'leer,tsuates,attbrnay
in fact)for_ ` __. (uame oY party on bohalf of wh e was exec ).
Persoc►alty Known �OR Produced IdentiTicatton_T Notary 3lgnature
��4M.�������` , RITA DYKES
��P 1•� .
Type of Identiflcation Prodneed Nama(ptint) ` - da
. ' = My Comm.Expires Nov 5,2014
?• •_
Vorification pursuant to Section 92•3�a5,Florida Statutea.Under panaltiea of psr clar �ead tii9'i�l'!������1�
the isct9 stated in it are trun to the beat of my knowladge and belief. ��`` BOnded lhroup-h Nel�ron�l NOta�y P�^^
97g+�aturs o A1 Pe n 9i ns Above
FOFWISMOC,rv�d7007 .
ZOO/L00'd 9bZ# LL 'bl IIOZ/ZZ/EO 'wo�j
DATE : 06/13/1_1 PASCO COLTNTY PROPERTY APPR.AISER 08 : 36 : 55
W O N - L I N E P A R C E L P R I N T O U T
.
PARCEL-ID: 02 26 21 0010 03900 0030 TYPE : STATUS : A DLA: 082196
SC TP RG SUB BLOCK LOT TRACT: 0328004
PARENT: DATE-SPLIT: 000000/FIB CLASS : 19
NOTES : 87S/P$2870000INCL1-39-2& 1-39-4 ; 90PAABAV-100 (D) ; 93 LETTER CD-
S/P800000INCLDS1-39-2 & 4 TRIM-RET A/C-CALL 8-14-96 OWNER CHG-
NAME: FMC MARKET SQUARE INC 38135 MARKET SQUARE
/ADDR
FS119 CODE : ZEPHYRHILLS FL 335427505
PREV OWNER: NORO-MARKET SQUARE HOLDINGS BV
STREET ADDRESS : 38135 MARKET SQUARE DR ZEPHYRHILLS F
VALUE & TAX INFO: E X E M P T I O N I N F O: SOH HX APP
LAND AG: NUM CD H W D V T PCT HX-OVRD YEA:R DATE S YR DVD$
-MRKT: 168194 ** NO EXEMPTION(S) ON FILE **
BLDG: 3127421
XFOB : 53422
--------------------
APPR: 3349037
SOH:
NS ASD: 3349037
RPG: OR BK $5�0 P� 2145
EXEM: 2 of 2
--------------------
--------------------
BS TXB: 3349037
S DVD:
S TXBL: 3349037
AREA: 30ZH ACRES : 3 . 54 SPEC HX:
BC TXB 3349037
ADD EX:
C DVD:
C TXBL: 3349037
PRIOR YR VALUE: 3417521
PRIOR YEAR MKT: 3417521
HX VAL: 0 NON-HX: 3349037 MKT DIFFERENCE : 0
MKT CHG HX: 0 NON-HX: 68484- PRIOR HX VALUE: 0
MC LAND HX: 0 NON-HX: 0 PRIOR HX PCT:
PHYS HX: 0 NON-HX: 0 PRIOR NON HX: 3417521
PRIOR N-HX RSD: 3417521
S A L E S :
YEAR MON BOOK PAGE SALES-AMT INST XFER QUAL ST I,IFE I/V TOI
1977 08 0902 1318 I
1987 12 1676 0198 WD I
1987 12 1703 1337 WD I
1993 11 3228 0293 WD 2 MS I
L E G A L D E S C R I P T I O N:
ASSESSED IN SECTION 02 , TOWNSHIP 26 SOUTH, RAN�GE 21 EAST,
PASCO COUNTY, FLORIDA
ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 POR OF TRACTS
39 & 42 DESC AS COM AT SW COR OF NWl/4 OF SEC TH NOODG 13 '
24"W ALG WEST BDY OF SEC 662 . 75 FT TH N89DG 54 ' 51"E
638 . 36 FT FOR POB TH NOODG 00 ' 04 "E 602 . 58 FT TH N89DG 57 '
16"E ALG LINE BEING 60 FT SOUTH OF & PARALLEL TO NORTH
BDY OF TRACT 39 256 . 25 FT TH SOODG 00 ' 04 "W 568 . 70 FT TH
N89DG 54 ' 51"E 38 . 34 FT TH SOODG $'$qT��"�p� C���y`�i�� pqSCO
S89DG 54 ' 51"W 45 . 82 FT TH SOODG �� ��'�R��T�'���B�ING ISA
54 ' 51"W 248 . 90 FT TO POB AKA K-MARTT��Ifq�p CORRECT G�PY 0�THE DOCUMENT
OR 3 2 2 8 PG 2 9 3 ON F(LE OR�JF PUBLIC RECORD IR�THIS OFFICE
/v,TNESS�Y HAND AN�OFFICIAL S�AL THIS
DAY OF + 2 �l�
PAU A S O'NEIL CL . (�& COMPTROLLER
, /
g�(. � _-- C E�'�°Y Ct.ERK
3°�y� �� `
"�� � ` ' ,�` � `�(�
��;`� �cn�, l� �• % �l 51 �� 1
�,.
(��,� �J '
2����
City of Zephyrhills �_,���� + `�
BUILDING PLAN REVIEW COMMENTS �
1 ,�� f ,�,C,, ;�-N'��g�`�
Contractor/Homeowner: ��1 �'6 � � �-�-�/�'� �+��� ,�,,,�
�- u� ��.��
Date Received: �°- f�" �� � �3r Lz�1 r
Site: � �' 1 3 S �� ,
Permit Type:
��rs ��S
Approved w/no comments: Approved w/the below comments: � Denied w/the below comments: ❑
This comment s e t shall b ept ' e permit and/or plans.
��j�
Kalvin Sw' zer— 1 iner Date Contractor and/or Homeowner
(Required when comments are present)
Zephyrhills Fire Rescue
(907 Dairy Road, Lephyrhills, f�L �35�2
I�ire Macshal Bus (813) "780-0041
Kerry 13arnett E�ax (813) '780-UU4�
E-mail: kbarnett(��>fire.�ephyrhills.fl.us
Plan Review#: 11-111 �� � ���� ��
Project: Revision-Addition
Number of Pages: 1 plus Details and Cut Sheets
August 22, 2011
1 have received and reviewed the revised plans for the addition to Florida Medical Clinic located
at 38135 Market Square Dr and will continue in allowing the project to move forward. There are
no additional comments noted after this review and all other previous comments noted through
others reviews remain in effect. Fees have been assessed according to City Resolution for plan
revisions. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's
office.
�
/
KER Y BARNETT, FIRE MARSHAL
***Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes.This review is not intended to be a final approval of the
submitted plans.It is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances. In the event that further examination or site
inspection reveals areas of non-compliance, it shall be the contractor's sole responsibility,at their sole
expense to bring those areas in compliance.The City assumes no respovsibifity for the contractor's failure
to be in compliance with all applicable NFPA codes and local ordinances.
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FLOWOA AGENCY FO�HcALTI-1 CA�ADMINISTRATION
RICK SCOTT BetterHealth Care forall Floridians ELIZABETH DUDEK
GOVERNOR INTERIM SECRETARY
February 17, 2011
_�������
Mr. Joseph L. Oliveri FEB 22 ZpPI
Ofiveri Architects -;T'•
32707 US Highway 19 North
Palm Harbor, FL 34684
Re: Facility Name: Florida Medical Clinic Special Procedures Center
Project Name Expansior
Client Code/File-Project-Submission Number: 14/221-101-005
Dear Mr. Oliveri :
The construction documents dated December 15, 2010, for the referenced project
received on January 20, 2011 have been reviewed and are approved for construction
by the Agency sub�ect to the attached comments. Please note this approval is not
permission to construct work that is not in full compliance with the requirements of the
Certificate of Need (if any) for this project, and all applicable codes and standards.
Before construction may commence, all required local permits and approvals must be
obtained. If construction has not commenced within one year from the date of this letter,
this project will be considered abandoned and will be terminated by the Agency. To
reactivate the project after Agency termination will require resubmission as a new
project.
This project must have an onsite survey and approval of the completed construction by
the Agency before it can be used for its intended purpose. In approximately six weeks
from the date of this letter, the Project Contact Person, as noted on the Plan Review
Application, wi(I be contacted by the Office of Plans and Construction to schedule an
initial construction survey.
Before this project may be considered completed by the Agency, all outstanding
deficiencies from previous review letters, if listed, must be corrected.
Please submit revisions for all deficiencies to the Tallahassee Office at the below
address in the form of addendum, change order or revised contract documents as
appropriate. Upon receipt of these documents, another review will be conducted to
ascertain the appropriateness of the corrections. Failure to respond timely to these
comments can cause a delay to the final completion of this project.
To facilitate all further document reviews of this project, please conform to the following
submittal procedures:
1. Provide a transmittal letter with the following information
�
-•,
� _ �
Headquarters ,
2727 Mahan Drive °�. . Area 7
Tallahassee, FL 32308 f AHCA-Plans & Construction
http://ahca.myflorida.com ����`� 400 West Robinson Street
Orlando, FL 32801
` , ' , Mr. Joseph L. Oliveri
Page 2 of 6
February 97, 2011
Re� Facifity Name: Florida Medical Clinic Special Procedures Center
Project Name: Expansion
Client Code/File-Project-Submission Number: 14/221-101-005
a. The original review comment number
b. The original comment
c. A word description of the revision
d. The sheet or specification page where correction(s) are located
2. Because this submission constitutes a record public document, proper
signing, sealing, and dating by each design professional is required.
If you have questions concerning this review, please contact Sanjay Kochhar,
a�chitectural reviewer; Jason Jiang, mechanical reviewer, , Matt Tala electrical reviewer,
as appropriate at telephone (407) 420-2550.
Sincerely,
� ,
Joseph A. Herwig, Jr., P.E.
Prof. Eng. Admin., Plans & Construction
Tel: (850) 412-4474/Fax: {850) 922-6483
E-mail: Joseph.HerwiqCa?_ahca.myflorida.com
JAH/F/hm/ba
CC: Via E-mail Oliveri Architects
Advance Systems Engineering
APG Electric
Mohan Engineering, Inc.
' � Mr. Joseph L. Oliveri
Page 3 of 6
February 17, 2011
Re: Facility Name: Florida Medical Clinic Special Procedures Center
Project Name: Expansion
Client Code/File-Project-Submission Number: 14/221-101-005
GENERAL
G-1 Provide an Infection Control Risk Assessment (ICRA) signed by an infection
control representative for the existing outpatient facility adjacent to the new
construction. The Guidelines for Design and Construction of Hospitals and Health
Care Facilities, (The Guidelines, 2006 edition), Chapter 1.5-1.2.1
ARCHITECTURAL
A-1 Sheet T2: Under the heading "APPLICABLE CODES" reference the 2006 edition
of NFPA 101 Life Safety Code.
A-2 Sheet D1 b: Provide a fire rated polyethylene barrier separating the demolition to
be done in the existing corridor where door openings will be filled in.
A-3 Sheet D1b: Provide a fire rated polyethylene barrier or temporary wall separating
the work adjacent to existing Computer Room 161 during Phase 1 of
construction
A-4 Sheet LS3: Provide a wall-type designation for a 1-hour fire rated barrier in the
LIFE SAFETY LEGEND.
A-5 Sheet LS3: Provide a 1-hour rated fire/smoke barrier separating all smoke
compartments. NFPA 101, Chapter 20.3.7.5
A-6 Sheet LS3: Show the 1-hour fire/smoke compartment barrier as tracking on the
back wall of the Business Office/Medical Records 113 and show the rest of the
walls in that room as 1-hour fire rated. NFPA 101, Chapter 20.3.7 5
A-7 Sheet LS3: Provide an exit sign on the ambulatory surgical center (ASC) side of
Door 118 leading to the existing corridor. NFPA 101, Chapter 20 2.4.1
A-8 Sheet LS3: Show different wall type designations for the 1-hour fire rated
barriers and the fire/smoke barrier in Equipment Storage 151 and General
Equipment Storage 150.
A-9 Sheet LS3: Show the location of fire extinguishers on the overall Life Safety Plan.
NFPA 101, Chapter 20.3.5.3
A-10 Sheet A1 b: Provide a 20-minute fire rated door at Door 110b located within the
smoke compartment barrier and coordinate with the door schedule.
� • Mr. Joseph L. Oliveri
Page4of6
February 17, 2011
Re: Facility Name: Florida Medical Clinic Special Procedures Center
Project Name: Expansion
Client Code/File-Project-Submission Number: 14/221-101-005
A-11 Sheet A1a: Show a 1-hour fire/smoke barrier designation symbol for the
compartment wall between Smoke Compartment (SC) 1 and SC 2
A-12 Sheet A1 b: Provide 180-degree swing hinges at door 115 to the Electrical Room
and coordinate with the door schedule. Florida Building Code, (FBC, 2007 edition
with 2009 supplements), Section 421.3.4.1
A-13 Sheet A1 b: Reverse the door swings at Doors 118, 174, and 189b so the doors
do not swing into the corridor. FBC, Section 421.3.4.1
A-14 Sheet A1 c: Provide a clinical sink in Soiled Work Room 136. The Guidelines,
Chapter 3.7-3.1.2.1. (2)
A-15 Sheet A1 c: Provide a hand washing station in Soiled Utility 134. The Guidelines,
Chapter 3.7-3.1.2.'1 (2)
A-16 Sheet A1 c: Revise the name of Soiled Utility 134 to "Soiled Holding" or add a
work counter, hand-washing station, and clinical sink to this room. The
Guidelines, Chapter 3.7-3.1.2.1(2)
A-17 Sheet A1 c: Provide door closers for Soiled Utility Doors 134a and 134b in order
to maintain the correct ventilation requirements. The Guidelines, Table 2 1-2
A-18 Sheet A3a: Provide scrub able ceiling tile clipped down or having a gasketed
ceiling grid in the semi restricted sterile corridor area and adjoining rooms. The
Guidelines, Chapter 3.7-52.2.2. (1)(a)
A-19 Sheet A3a: Provide a ceiling access panel in the monolithic ceiling in existing
Procedure R�om �75 so the fire rated barrier can be reviewed by the Office of
Plans and Construction at time of survey.
A-20 Sheet A9a: Provide a 45-minute fire rated door at Door 113. NFPA 101, Table
8.3.4.2
A-21 Sheet A9a: Provide a door closer in the hardware set for poors 150 and 174.
NFPA 101, Chapter 8.4.3.5
MECHANICAL
M-1 Sheet M0.1: Provide either flex master 8M or thermo flex MK-E for O.R and
recovery area. See FBC Chapter 421.3.6.4.
� ' Mr. Joseph L. Oliveri
Page 5 of 6
February 17, 2011
Re: Facility Name: Florida Medical Clinic Special Procedures Center
Project Name: Expansion
C(ient CodelFile-Project-Submission Number: 14/221-101-005
M-2 Sheet M2.0: Provide a fire/smoke damper at the duct penetration of the
fire/smoke barrier wall at Equipment Storage #151 and General Equipment
Storage#150. 1052. See Florida Mechanical Code 2007 Chapter 607.5.4.
M-2 Sheet M2.0: The location of Medical Gas Room#139 does not match with
architecture plan. Revise it.
M-3 Sheet M2.0: Indicate direction of air flow for Med Prep #133, Soiled Work#136
and Soiled Utility#1134.
M-4 Sheet M2.0� Provide a minimum 1 hour fire wall for vacuum pump room and add
fire dampers on duct accordingly. See NFPA 99 2005 Chapter 5.1.3.6.1.1(2)
M-5 Sheet P5: Provide clinical sink in Soiled Wark Room #125. See AIA Guidelines
2006 Chapter 3.7.2.5.4.
M-6 Sheet P0.1� Provide back flow preventer and indirect waste by air gap for Ice
Maker.
M-7 Provide the location of water hammer arrestors on the plan or riser diagram.
M-8 Sheet MG3: Provide missing key notes 9 on the plan.
M-9 Sheet MG4: Relocate area medical gas alarm panel (AAP-1) from corridor to
nursing station or other location that will provide for surveillance. See NFPA 99
2005 Chapter 5.1.9.3.1.
M-10 Sheet MG5: Route receives tank drain to floor drain.
M-11 Sheet MGS: Provide shutoff valves at the discharge of vacuum pump to isolate
each vacuum pump for maintenance or repair See NFPA 99 2005 Chapter
5.1.3.6.1.2(3).
FIRE PROTECTION
FP-1 Sheet FPO: Indicate the date for the water flow test, which shall be within 180
days of construction document submission.
FP-2 Provide missing fire protection specification for AHCA review.
FP-3 Provide quick response sprinkler heads for the project.
" ' ' Mr. Joseph L. Oliveri
Page 6 of 6
February 17, 2011
Re: Facility Name: Florida Medical Clinic Special Procedures Center
Project Name: Expansion
Client Code/File-Project-Submission Number: 14/221-101-005
FP-4 Sheet FP-2: Verify the distance between sprinklers in existing Procedure Rooms.
If it is over 15 feet �part, additional heads are needed to provide complete
coverage for the rooms.
FP-5 Hydraulic Calculation: Change nodes for piping #35(29, 47), #36(14, 37) and
#45(43, 23) to match with the drawings.
ELECTRICAL
E-1 Provide and clarify the flowing time/current curves in your short circuit study
As required by FAC 59A-4:
a. TCC Name: EQ1-N
b. TCC Name: LS-1 N
c. TCC Name: LS-E
d. TCC Name: LSLA-E
e. TCC Name: LSLA-N
E-2 Sheet E 21: Provide and identify the generator Shunt trip in the generator system
requirements as required by NFPA 110.
05-17-'12 12:53 F�OM-�a�la�-As.sociates ?275200789 T-739 P0002/0004 F-117
�
. r�...�" ���"".�-�
Thomas LoCicero-
From: Amir Yacoub(amir�oliveria�chitects.com]
�t: Thursday,AAay 17,2012 9:29 AM
To: Thomas LoCicero
�; Joe Oliveri
g��j�; FV1I;pg45-FMC ASC Zephyrhills final AHCA inspection
Thomas,
Please see the approval below
If you have any questions,please Cctll.
Thank You.
Atnir A.Yacoub
Project Maz�ager
amirCc�oliveriarchit�com
��'�-�!�t_ �e�
a000 m.
32707 US Highway 19 Palm Harbor, FL 34684
727.781.7525• Phone
727.781.6623• Fax
www oliveriarchitetts.c�m
"Faith is the ncaost powerful of all forces of k�uzz�anity. And when you have it,nothing can get you dov►m."
DISCLAIMER:
OLIVERI ARCHITECTS,INC. makes the electronically stored data an tf�is email avatlable for information purposes only.
OLIVERI ARCHiTECTS,INC. makes every possit�e etfiort to ensure this media is virus free; however,OL.NERI
ARCHITECTS, INC.assumes no responsibility foc damage.s caused by use of this data. Use of the data on this abave
email indicates that the user aooepts oonditions
From: Kod�har, Sar�ay[mailto:Sanjay.Kochhar�ahca.myflorida.00m]
�t:TF1�r9daYr Mdy 17�2012 9:Z8 AM
To:Amir Yacoub
St�bje�t: RE: 0945-FMC ASC Zephyrhills final AHCA inspect�on
Amir,
The phase-1 of this project is approved with the following comments.Offitial letter will follow soon.
RCHITECTURAL
A-1 Provide directional exit signs in gallery 103 to clearly identify the direction of travel. Also
provide code required fire al�rm pull station with in 5'-0" of exit.
A-2 Provide designated handicap accessible pa�king spacES for the surgery center, Provide
signage stating" reserved for the surgery cente�'.
i
05-17-'12 12:53 F�OM-Wallace Associates 7275200789 T-739 P0003/0004 F-117
q-3 Provide signage for the entire area which is symbolic, tactile, displayed verbal and
pictorial in accordance with 11-4.30 Florida building Code.
A-4 Provide passage type ixk set hardware for door leading to waiting area from exit
passage 110.
A-5 Eliminate thumb locks from all exterior exit doors. All exit doors shalt require single
operation for exiting.
A-6 Complete the installation of lockers for p�tients to seCUre their belongings.
A-7 Nurse Ca!! signage for the entire area shall match with the room signage.
A-8 All penetrations in the case work shall be tightly sealed to minimize entry of rodents and
i�sects as per the requirements of chapter 59A�$.108.
A-9 Complete the installation of window treatment in the patient care areas to provide
patient privacy.
A-10 Complete the instatlation of pass through cabinets in all the 3 OR's as shown on
�pproved floor plans.
A-11 Provide code required pull station within 5'-0" of exit at east entry 183 and passage 118
as shown on the approved floor plans.
A-12 Exit door in the exit passage 118 shall swing in the direction of travel. Revise the door
swing ac�ordingly.
A-13 Provide directional exit signs in passage 110 and 111 to clearly identify the direction of
trave�.
A-14 Complete the installation of soap dispensers at the OR scrub sinks.
A-15 Provide smooth tr�nsition at the iwo showers in the male and female locker rooms.
A-16 Manifolds for the medical gases in the exterior medical gas areas sh�lt be protected
from the inclement weather.
A-17 Door leading out of the recovery area which is in a rated fire/smoke wall shall drop on
activation of building fire alarm to have positive iatching.
A-18 Eliminate the hold open device from door leading to the clean/s#erile corridor from the
recovery area.
A-19 SeaUcaulk all conduit penetrations in the rated 1 Hr fire/smoke compartment wall in the
recovery area.
MECHANICAL
z
05-17-'12 12;53 F�OM-�allace Associates 7275200789 T-739 P0004/0004 F-117
M-1 Secure final fiiters in RTU-1,2 and 3.
M-2 Provide a Second monitoring IoCation for the master�larm panel. This facility meets the
requirements of a level one medical gas system.
M-3 Provide interlock between the fire/smoke dampers and each respective �ir handker
during manual shutdown of the unit.
M-4 F_xtend the retief lines from the sterilizers to tne flaor drains
FI PROTECTI N
FP-1
ECTRt AL
E-1 Provide and revise the circuit brea[cer settings summary for ground fauit pick-up setting
for AHCA review as required by FAC chapter 59A-4.
�-2 Provide and replace the three circuit breakers `LSLA' MB, `C-1' MB, and `EQLA' MB in
the essenti�l equipment room with the adjustable circuit bre�kers as required by FAC
Chspter 59A-4.
E-3 Provide a pull station and horn/strobe at the exist door 183 in east as required by NFPA
101.
Please feel free to contact me if you have any further questions.
Sanjay K,ochhar
4£�xce of Plans and Coz�stzuction
Agency fox Health Care Adminis�rat�oz�
400'V�.Robinson St., Suate 5-325
Qrlando,FL. 32801
(407)420-2550 �ax (407) 317'7182
mail to: Sanj�y.KOChhar(�ehca,myflorida.COm
..d,..�.�' �flV£R PLORIDA
:ti. . ��u����
•', � a��a�c�
From:Amir Yacoub[mailto:amir@oliveriarchitects.mm]
Ser�:Thursday, May 17,2012 8:56 AM
To: Kochhar, Sanjay
Cc;Joe Qtiveri;Thomas LoCicero
Subject: RE: 0945-FMC ASC Zephyrhills final AHCA inspection
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TX Result Report P �
05/17/2012 12:22
Serial No. AoEDw�too��e
TC: 84470
Addressee Start Ti■e Ti�e Prints Result Note
917275200789 05-17 12:21 00:00:37 002/002 OK
NOte T � T��e S' dCBi 111�i�: OiiTX!� �CiSIP: tiP FazF e Frd.FPCcrp�PpC�-RTXs Re-TX.
�AX e�nCCP��Fa�dEfl �• SP � � �R P Add'CSS FaX.
Result OK: Co�unicatfon Oli, S-OK: Stop Canunication, P�-OFF: Porer Switch OFF,
TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer,
Refuse: Receipt Refused, BusY: BusY, M-Fu11:MeeorY Full,
LOYR:Receiuin9 len9th Ouer, POYR:Receiuing pa9e Ouer, FIL�File Error,
DC:Decode Error, MIDN:FDN Response Error, DSN:DSN Response Error.
a5-17-'12 12:53 FF�CX'1-Wallnce Associatss 7275200789 T-739 P0001/0004 F-117
ALLACE �a�..ro.�"�
/►SSOGIATES, L.L.G. �a�: n��-0��
OtNlRAL CONTRACTORi Fs� �7�7�
lACSl1LZL�'i�ANS�[Z?=AL ss�ss:
�'LX\L' l L.L DA'i'i� � �'���
ws�r� _C �Z�t N �M.a..L sorws s�a ow�wass:HCSVa�i+o cov�. �
FAr.NVa� T�W)iGx t��%/v��
�\����r r 0 O�_� � � ��
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c���s..,t_o
� ^P �w-s E �Z 14�-t c►/� r4.1P�-�.., t.r`
O lV0 lt6/tOA7i=1ViGSftA1tY � PLQASE 1tESPOND �V1L6EN'f'/7t=ifOND 7/AQO1A'YlLY ti
�-�Aics� S €JE �'1'�L/� �".i°t^tli.Fd �Ih/�l�
"�i�.,o.... 1-i c�. 3 �.P P a m.i ..�lL '���+4s � '�-—
�S t� F icP.e.e�s�e.✓ -
— r+lrw.�L L�F-T+^�- 't�ca �� s.►c.e��..� .
1 �hw►1�6 �
r� �+{�c►�,ArS-
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`7JLrNLO`'� oc � c,cp��,.�-v
� J .�la-;d � •�aci 7�i� .-�-%lc.�� 7`Y� ,.c•sr�L-c •
- _ t«.�/�s
G .��
CITY OF / / / / BUILDIN�
ZEPHYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION
� • • - •
�D � DATE PERMIT y/,
�C� �3 J �l��°�� G°a�`ca � �i
THIS JOB HAS NOT BEEN COMPLETED. The f lowing additions or corrections shall be made before the job
wili be occepted.
� L'o �� or'cy ..-v� - c dv �c, /✓
It is unlawful for any Carpenter,Contractor,Bui�der,or other persons,to AFTER CORRECTI N ARE MADE CALL
cover or cause to be covered,any part of the work with flooring,lath,earth 780-0020 � R SPECTIQN
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
CITY OF / / / / BUILt�._
ZEPNYRHILLS DEPARTME�. .
OF ADDITION OR CORRECTION
� • • - •
qATE PERMIT f
�� � � � I i��2�irt �`7�`f
�c' ' �� � t�''` ��'1�'�` G�, � )
V(
THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before tha job
will be accepted.
�,� �(� �i =_ �_ �- ��1L� l nt,��� °' � � � -" � C�-iu N�- ���
� ��'nf'�.. �► �1 � t ������- w1 l t� ���.� ��z~�"Z
� --,��`� �- �►�c���� ��i" C>� ��_ z��"�.
�t is unlaw�ul for any Carpenter,Contrector,Bui�der,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any paR of the work with flooring,lath,earth 780-0020 FOR RE-INSPECTION
or other material,until the proper inspector has had ample time to approve
the insfallalion. ` '� � ,C�
OFFICE HOURS 7:30 AM-5 PM MON.-FRI
INSPECTOR �`(���y J `�
CITY OF / / / / BUILDINa
ZEPHYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION
� • • - •
AD�RE55 �AT PERMIT�,
�� J i+1�1��`r - / ��� t
THIS JOB HAS NOT BEEN COMPLETED. The foliowing additions or corrections shall be made before the job
wili be accepted.
f r�'�Yi-�.., �i� C.���r�(C��o.4 � C.t-�CL13��K�"[�i`'1� `
t l�, C,..��5 � t� '` ��l� ��
l�l �`('Y"'"�l/� ' Ov�n e:1Ar i�C'��'""
b� �r-P�K o:�en U�i 1s � �`!I
�� �
It is unlawFul for any Carpenter,co�t��o�,s���de�,or other persons,�o AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any patt of the work with flooring,lath,earth 78�-� OR RE-INSPECTION
or other material,until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30 AM-5 PM MON-FRI. INSPECTO
CITY OF / / / / BUILDING
ZEPNYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION
� • • - •
��E55 � �v�►J"1���' �\�� D E � PERMIT f �`t'
I G� � �
THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shcll be mode before tha job
will be accepted.
��-- �.+`�`��l.C��-t� l� t �11-`�������
��� 1� ,
C
._ .� , p - ` �
It is unlawFul tor any Carpenter,Contractor.Builder,or other persons,to AFT ORRECTIONS ARE MADE CALL
caver or cause to be covered,any part of the work with flooring,�ath,eartn 780-0020 FOR RE-INSPECTION
or other material,until the proper inspector has had ample time to approve
the installation. � �(�
OFFICE HOURS 7 30AM-4 30 PM MON-FRI INSPECTOR��/`'V��
Bobbie Swetland
From: Bobbie Swetland
Sent: Thursday, September 13, 2012 4:10 PM
To: Todd Vandeberg; Rick Moore; Todd Hiscock
Subject: Inspection for final on project
The below property has requested a final inspection. Please advise if your review/inspection will be delayed. We will
need your comments and/or sign off placed in our Development Order Book located in the Building Department.
Name of project: Florida Medical ambulatory surgical center addition
Address: 38135 Market Sq
Contractor: Wallace&Associates(Foreman—losh)
Thank you,
Bobbie
��``�'� o K, `p � c�K � ��7- � �r� �.Jw. �'�/��/�
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Vendor ID #10 9 9 WALLACE ASSOCIATES L.L.C. ��� ��
ST PETERSBURG,FLORIDA33703
DATE INVOICE NO INVOICE AMOUNT RETAINAGE DEDUCTION BALANCE
,. .—' 4
9-26-12 �92612 15 . 00 . 00 . 00 15 . 00
A�}en�ton'. �4.eICi c 3o�s
Re�crcnu '. Cha��e o� C�r�ya�-o�
�e�m�-�-�k-•. I�}q-�_ , 2 i 1�� I C� � �_. � z-
t `� �
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CHECK CHECK a • • • •
DATE NUMBE A
PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS.
TX Result Report P �
- � 10/03/2012 08:47
SeY181 N0. AOmN11001438
'I�: 1148G1
Addressee Start Ti■e Ti■e Prfnts Resul Note
917275200789 10-03 OB:46 00:00:29 001/001 OK
�Ote T111I�Xi= T��xeer TO�X. �L1: 11 ORB= Ori�1i�na ze�-_S��pt�ti� FIE�C•�FrC�we�rase-TFX�.c
B�ps �e-S �3ti� Bi�i 1'CC �fll SP= �ia I SZP F1�F IPHDR•F-COdCC R�Xe RC-TX.
I�FAX• n �t F���l.� Bulie in. S Ps ax. � IP Elddress Fax.
Result 01(: CoMnunication OK, S-OK: Stop Co■eunication, PyM-OFF: Po�er Switch OFF,
TEL� RX fro� TEL, NG: Other Error, Cont: Continue, No Ans: No Ansrer,
Refuse� Receipt Refused, BusY: BusY, M-Fu11:MerorY Full,
LO{�t:Recefuin9 length Over, POYR:Receiuin9 pa9e Ouer, FIL:File Error,
DC:Decaie Error, I�N:MDN Response Error, DSN:DSN Response Error.
09-28-'Z2 08:43 F1iOM-Wnllnce Asaociates 7275200789 T-849 P0004/0084 F-752
QA7'L� INVdOtNO. INV�OWEAMOYNT RlTNNAOB O<OUCTIOIV Q�►LANCE
9-26-22 09Z61Z ' 13.00 _00 _00 ].5.00
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09-28-'12 08:43 F�OM-wallace Associates 7275200789 T-849 P0004/0004 F-752
DATE INVOICE NO. 1NVOICE AMOUNT RETAINAGE D�DUCTION BA�ANCE�
9-26=12 0�2612 15.00 . 00 .00 7.5.00
CH�CK CHECK � • • � • •
DATE NUMB� �
a�ease oEr�n��s PoRr�nNO a�r,uN�oie vouR�e�cooeos.
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WALLACE AS,3QLI�A►TES L.�,C � �� , ''�'�"".+�.���' e�6'� +q,'��
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t.. . ::<., N:.. C.h. T FX . e' .. .♦ �
Pay..,. *,•��.*��'�*:*,�*�*,�,r**,�*,��e,�;��.��'��r�.�r°�'w`�r�r*****F�rx�:*r�,�r*F�i�?t,een dollars and no cents
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� CITY OF ZEPHYRHILLS, FLORIDA
5335 8th Street
y
****TEMppRARy CERTIFICATE OCCPANCY
NAME �'���E ASSOCIATES/FLQSIDA MEDICAL CLINC� SURGERY CNTR DATE 9/28/12
ADDRESS 3g 135 �ARKET Si�UARE DR
PARCEL I.D.#Q2-26-Z1-0010--fl3900-0030 SUBDIVISION �ITY �F ZEPHYRHILLS
AMBULATORY SURGICAL CENTER PHASE I&II PERMIT# 11964,12184,12455
TYPE OF BUILDING 2494,12801, , 9, �
q � '(" ��'yj'��('Ci�'� �� FINAL DATE:9/28/12
REMARKS 1'�'t v't1 AL.�+ �t��-�-
BILL BURGESS BUILDING OFFICIAU
�t ��. �'
WHITE : Contractor or Owner
YELLOW: Bldg. Dept.
PINK: Utilities Dept.
. _ 'IX Result Report P �
09/28/2012 13:16
Serial No. AoED9M��oot��
'�'�: 113600
Addressee Start Ti�e TiMe Prints Result Note
q172752pp769 09-28 13:13 00:00:54 000/002 COIIL
917275200789 09-28 13:17 00:�:48 002/002 OK
�'�Ote T e Mix� TXi. �1 p�o�t11�{np�L: �s�ix naC1�zeC Setti��=F�s Fr�we�ra5� RTX� Re-TX.
�y� e ay1e�aMB�COnifi�f5tialeC .L�•BU1letin.iSIP rCSiP Fax.�R:FiP Address�Fax.
I-FAXs nCerne Fax
Result OK: Communication OK, S-OK� Stop Cau�unfcatfon, P�-OFF: Porer Switch OFF,
TEL: RX fro� TEL, i+�: Other Error, Cont: Continue, No Ans� No Ans�er,
Refuse� Receipt Refused, BusY: BusY, M-Fu11�MeaorY Full,
LOUR�Receiuir�g len9th Ouer, POYR�Recefuin9 Pa9e Ouer, FIL:File Error,
DC:Decode Error, MDN�I�DN Response Error, DSN�DSN Response Error.
09-28-'12 08:43 F@OM-Wallace Associates 9275200789 T-849 P0001l0004 F-752
����A L L A C E 6'"6�"`�"°«..«��, ���
�.PM��p+rp.PL S37'O� Z� �
ASSOG�ATES. 1...[-.G. p��p»: 7��p.pT00 � �jQ�
OiNSRA< CONTRAQTOR� '�G 7�j7�J00 �
lAC�I1KfL6 TRAN�1ti'!'rAL iH86'Y -
ows'a.
Iwide 9/2�/207Z
ooa�suunt+ �
�ao•r�'o.r�.�a�wc�.o�oso oo��
CK9 o�Z�P��
rwza�a�oas *n1O���
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Tl�oma�LoG'io�o.ProI00t Momlmsr ---
u�FMiC+�.�P�p�t—Land��n��
O rro wsworrsa r��•.� �v X rtawsa�cswoa� �aneosesri�cssvoxo[w+wsw-rsLV n
Jwltie. .
Atpwsaed plwe Snd tbe iatbrsa�sion i+eQdned to rales�a tLs�l oarNSwte a�'000up�awy an
tbe Flaa�Ldal�iediewl Ceatee project fn ZeP'b0'rldns rd�ed t+o�Parads Y�umbe:'1R119b4.
I.ocation�a9�so�tio�:
38133 I�laslcd 8qu�ay 17rI�v� �
ZePlfpn'l�i�1s.I+l-• �_ }��_�
Y.at me lmow iFy�nts t�eed+q�Y�6��0� ��� �T, ---
Hsv�s aa bsud�al day aafd!lla�alaaas w�setioeoAl! ( � C ��
v�ae�o.�.o��.ar� G' ��`e K n�.�� Bv�c-e-
1__�__`�- �,�,,,�P LQ � .
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'1� Result Report r P �
09/28/2012 13:08
Serial No. AoEDVI»oo�43e
'�'�: 113598
Addressee Start Ti■e Ti■e Prints Resul Hote
9172752�789 09-28 13:07 00:00:05 000/001 S-OK
�'�Ote T : TiX�e S�c�ed�Bind��l7�qii^�11SP�sPe�ieaC1�tin9,iFl�ey/F�rd.FPCCso� RTXe Re-TX.
C a : COflfidCfSt al. BU116tf17. SIP� �I��BXF�PADR� IP AddYe9s Fax.
i AX�ernet Fax
Result OK: Comnunication 01(, S-OK: Stop Co�unication, P�1-OFF- Power Switch OFF,
TEL� RX fro� TEL, NG: Other Error, Cont: Continue, No Ans: No Ansrer,
Refuse� Receipt Reft�sed, BusY� BusY, M-Fu11�Me�orY Full,
LOUR�Receiufng len9th Ouer, PO{�R�Recei�ing pa9e Ouer, FIL:FfIe Error,
�:Decode Error, MIDN:MDFI Response Error, DSH�DSN Response Error.
09-28-'12 08:43 FFtOM-Wallnce 1\ssocintes 7275200789 T-849 P0001/0004 F-T52
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