The URL can be used to link to this page

Home My WebLink About12-13744 CITY OF ZEPHYRHILLS , 5335-8TH STREET • (si3)�so-oozo 13744 BUILDING PERMIT Permit Number: 13744/13745 Address: 37918 MEDICAL ARTS CT Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Ciass of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34-25-21-0080-00000-0020 Improv. Cost: 42,856.00 Date Issued: 1/09/2013 Name: PREMIER COMMUNITY HEALTHCARE G Total Fees: 580.00 Address: PO BOX 232 Amount Paid: 580.00 DADE CITY FL 33526 Date Paid: 1/09/2013 Phone: (352)518-2000 Work Desc: INTERIOR RENOVATIONS 2,448 SQ FT SEE BP#13745/13746 MARTIN ELECTRIC PLUMBING FEE 60.00 MECHANICAL FEE 60.00 BO PIPPIN PLUMBING LLC FIRE PLAN REVIEW FEES 25.00 SONNY'S DISCOUNT APPLIANCES N OC-� �� 5 �� ,\�� -�-_ �, FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALI MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one of the foilowing reasons: a)wrong address b)condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site� plans not at job site g)work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your properly. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in acoordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. ONT C SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS , 5335-8TH STREET � (sis)�so-oozo 13745 BUILDING PERMIT Permit Number: 13745/13746 Address: 37920 MEDICAL ARTS CT Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Vatue: Parcel Number: 34-25-21-0080-00000-0021 Improv. Cost: Date Issued: 1/09/2013 Name: PREMIER COMMUNiTY HEALTHCARE G Total Fees: �S�� .��7�c.� Address: P.O. BOX 232 Amount Paid: DADE CITY FL. 33526 Date Paid: Phone: 352)518-2000 Work Desc: INTERIOR RENOVATION SEE BP#13744/13746 1008 SQ FT MARTIN ELECTRIC BO PIPPIN PLUMBING LLC SONNY'S DISCOUNT APPLIANCES � � � E� � -� � �_ �,,� 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. REINSPECiION 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) oondemned work resulting from faulty consbvction 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 acxessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. if you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. � NT CT IGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS ' , 5335-8TH STREET � (si3)�so-oo20 13746 BUILDING PERMIT Permit Number: 13746 Address: 37922 MEDICAL ARTS CT Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 3425-21-0080-00000-0022 Improv. Cost: Date Issued: 1/09/2013 Name: PREMIER COMMUNITY HEALTHCARE G Total Fees: ��p�- �3-��- Address: P.O. BOX 232 Amount Paid: "'r' DADE CITY FL 33526 Date Paid: Phone: Work Desc: INTERIOR RENOVATION SEE BP#13744/13745 4882 SQ FT MARTIN ELECTRIC BO PIPPIN PLUMBING LLC SONNY'S DISCOUNT APPLIANCES -�� , � ! � � �% �1 ,�- < < _ � � �, - � � � FOOTER BOND DUCTS INSULATED SEWER MISC._ ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will wmply 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 applicabie to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property, If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. NT CT SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER _ ' 3�l- ZS-2l - °°�'�' o°°o�-o�o = 8a - oo�o -oaat _ � U3rl�t-4�`t5-�(� -as-�� -oo � L Pertnk Mo. Percel 10 No �"'ac.��' ��a.+0'�� (� � �Q a`a � 01 �� l9 C� NOTICE OF COMMENCEMENT ^ � �\oc-.� i� I m m� s�eie or co m d.J�e•�.,_ �� d �r 1�Y=U I� O THE UNDERSIfiNED hercby yives notice tt�al4nprovemeM ux71 be made to certain reg�property,and in axordance w11h Chapter 713,Fbrida Statules, � u m _ the(oYowing iniormation ia provided in Ihie Notice oi Comne men• � .. L t. DescrlpUon ot Property: Psreel IdeMiflcation No.�"�a��I�—�a� . Q��,� �� a.a I� �� C _ �, s,��:�'P►�g-zZ c�ect�cu� �r�1�c�1- -Z�,.�rt,��ls F� ' C� N = 2. General DescAplion of Improvement_ �� r �__��g� I�.� � f.> �d' �� 3. Owner Iniortnatlon or Lessea intomtalion H fhe Lecsee ntraCed(or the improvemenl:�—7 !_� �m m t;rnrer Canr�c,.��r�.� 1�,[33�� GLri��o lnc. i N ��m add�1$ — �� ICb� �'S .1-.. • �J 'y "..,� G�t�;,.�tS �. 335�p lydercst in Propery: � 1'Cr State �w Name of Fx Simpla TiUeAolder:�lwT K��Ct"� ��Q,��[� �� (ne � (Ii ddferenl fran ONnef fisled ebove) " 0 i� Addross Gnv � Sfnte ~ �r �f1C a Contractar: � �� N � (�l��a �� 33�� a�./� �� /�� 1t ��M�. ContraUo�'sTdephoneNo.:�JC9' y��'�� City State w O � � 5. SurNy. ��t/L o�y Neme \ V I a �re� ab State Amounl o(Bond: S a Tdephone No.: i�o��"'i N�� ia�yyR 6. Lendar: _N�+V Name J�/�A i Zti11i/ Addreas �o�Y Lenders Telephone No.. Gy State •N\m 7 Persons withtn the Sfete of Flarida designated by the ownw upon vMOm notices or atlier doaments mey be aerved as provided by �g�� Sedion 713.13(1)(a�,Florida Statutes: � a m Name Addrass Cih State Tdephone Number of Deayneted Peroon: 6. In eddiUon to h6nseH,the ov�ner deaipn � _ a to reeelve e copy W the Lienora Notica es prodded In Section 713.13(1)(b),Florida Stalutes. TNephone Number ot Person or Entiry Desipnated by Owner: 9. E�IraOon date of NoNce of Commeneemmt(the a�irstlon dele mey nol be 6eforc fha eanpledon of eonshudion end flnel payment to Ihe contrsctor,bW wi0 be ona year from Ne date M reeording unless a d'dferont dale b apedlle�: WARNINO TO OWNER: ANY PAYMEHTS MADE BY THE ONMER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1. SECTION 713.13, FLORIDA STATUTES, AND C/W RESULT IN YOUR PAYINf3 TNACE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORpEO AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCINf3,CONSULT VNTH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penally of perjury,I dedarc Ihat I have read the forcpoinp noUce oi canmencemmt and thel Ihe faps steted thercln a e to tAe best of my knwdedpe end be0et. STATE Of FLORIOA COUNTY OFPASCO SiQnaturc M er or Lessee,a Ownere or Lesse nzed OHker/0irsetm/Peitner/Maneper � �� .� , � "'� sipnatorys Title/Offiee The toreyoing insWmml was adaioNAedped Defore ma Nis!day ol�,2��by��.. p y,�� as ��i� (type oi authorily,ap.,officer,Wstea,attomey n fad)for t e M party on behalf d ent wes exe Personely Known�$Produced.IdmWketion❑ NWary Sign e Type oi Idmtfitation Produced �� Name(Print) ��;J��: iFER MAFFETT _�; ;•_ MY COMMISSION#�D925881 • _ _ , �� EXPIRES Ootober 28,2013 ' 407)S8M0163 FWrks Ma.00m wpdateA�cslndicecammencement�c053048 v�►+.c� STA7E Q� FLORIDA,COUNTY 0�PASCOS� �`?�!'� ; � R�+`'� THIS IS TO CERTIFY THAT THE FOREGO{NG �•Z` • , � TRUt AND GQRRECT COPY OF THE DOCUMENT w ON FILE OR OF PUBLIC RECORD �N EALTON�S'CE n• ��,"je� i"� � WITNESS MY HAND AND OFFICIAL S � t�� DAYOF,� V�j .MPTROL E # � . * PA A S O'N � ,.C� 8`� � ��g89 �. C�'�� '�._.DEPUTY CLERK {f. � •��p�� BY ATE O i:�-� .1 J .�`lS�.S�n ;r._j `�� . -�Ua � Y' [i�J F�.AfflR��. �� ' � A� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS B fr ' y , ( c Cc�,tra�omeowner: '" ' ph,� . '�'. Date Received: /�L��11�_ site: -�7 �2> � ��,� �=��: �� , . Permit Type: � '�2�� T °' G� v��L �%..J .. Approved w/no comments:❑ Approved w/the below comments: ❑ Denied w/the below comments: � This comment sheet shall be kept with the permit and/or plans. Kalvin Switzer—Plans Exa.�iiner Date Contractor and/or Homeowner (Required when comments are present) , ZEPHYRHfLLS FfRE DEPARTMENT 6907 Dairy Road, Zephyrhilis, FL 33542 FIRE SERVICE USER FEES Occupancy No.: Plan No.: Contractor:�v��,'J�:��! �,;�ri�;;��,j��. Business Name: • t�z ,�<:rS � t.d�t� Billing Address: Business Address: ' < � ', L— Business Phone No.: Billing Phone No.: ""Z ' t'�• `' Business Fax No.: Billing Fax No.: Contact: Contact: �,��2 � PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE Site Plan N/C Annual N/C Sprinkler $50 1st Alarm N/C ulti-Family/Commerci 06 sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C (Minimum Charg $25.00 nd Re-inspection $100 Fire Pump $50 3rd Alarm N!C Plan Revisions DBL 3rd Re-inspection $25� Hoods $50 4th Alarm $100 4th Re-InspecGon $500 Fire Alarm a50 5th Alarm $150 SPRINKLER SYSTEMS (Business Gosed until LP Gas $50 6th Alarm $200 8 0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tenks- pertank $50 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 Bum $100 FIRE ALARM SYSTEM Hood/Duct $50 0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly a50 Mnual 26 plus Devices $100 8 System Acceptance $50 ire Protection $25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 nnnuai Wet $50 OTHER Waste Tire Storage $50 Annual �ry $50 Fire Wall/Smoke Watl �15 per wau Generator<KW a100 CO2 $50 LP Gas $25 per tank Generator>30 KW 150 Other $50 Natural Gas $25 pe�system BiaHazard Waste a1OO Mnual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10'or greater $15 per teoc Torch PoUApplied $50 OTHER Fire Pump $45 Hez.Materiels $100 Mnual LP Installatbn per tank a50 Fire Suppression $30 Fuel Tank Installation a50 System Acceptance (Per Tank) $50 8 Exhaust Hood/Duct $30 �Natural Gas Installation $50 Re-inspection DBL (Per System) (other than annual) � Spray Booth $50 � Inspection scheduled DBL 8 and canoelled less than 24 hours Construction Insp. N/C Emergency VehiGe A� $5A •s„ FALSE ALARM PLANS TOTAL� INSPECTION TOTAL�� PERMIT TOTAL� TOTAL� �_��, GRAND TOTAL � , G'Z; Comments: � ti• 1 e��t?l�-�c�-�f� el��cl�,jz.ti� Date: .� Zy+ �- Inspector: t��l�-I t�,�, 1# =�'y��-L--��`� "J`�,(��`�� nin ` Premier tommunity HealthCare Group,lnc. A Family Community Heulth Centvr � � Parmers Together in Heolthmre December 4, 2012 City of Zephyrhills—Building Dept. 5335 8t" St. Zephyrhills, FL 33542 Re: Contractor Certificate Requirements This letter is authorization for the below persons that have been authorized to sign/pick up permits. Donna DeLong, CFO Jerry Smith, Simpson Environmental Services PO Box 232 Dade City, FL 33526 Phone number: 352-518-2000 x9014 Fax number: 352-567-5193 Thank you. Sincerely, � , �� / Schuknecht,CEO �,d. �'ax 232 • Dude (�it.ry, �,�33526 • 352-51�-2000 8�3-�so-oozo City of Zephyrhiils Permit Application Fax-813-780-0021 Building Department � Date Received � -j �� Y3� �� / Phons Contact for Permittin Owner's Name � �{�M\h�v � ` �er Phone Number � ^S��$^aQ�� Owners Address • , � � ' ��3�Sa'�' � Owner Phone Number Fee Simple Titleholder Name Owner Phone Number � Fee Simple Titleholder Address JOB ADDRES d � � '�CS� S �� LOT# SUBDIVISION PARCEL iDA! (OBTAINED F�pROPERTY T�nce)DEMOLISH WORK PROPOSED B NEW CONSTR�ADD/ALT � SIGN INSTALL REPAIR PROPOSED USE Q SFR � COMM �� OTHER [-- TYPE OF CONSTRUCTION Q BLOCK FRAME � STEEL Q � DESCRIPTION OF WORkf� ,��c.y��, (�f�.� "r�._...��:.---:.:-. BUILDING SIZE � � bO � SQ FOOTAGE�� HEIGHT �BUILDING � $ � ,� VALIJATION,O�TQTAL CONSTRUCTION �ELECTRICAL ($ — AMPSERVICE /�Q PR06RES8•ENERGY Q W.R.E.C. L- ��i �) �PLUMBING $ � L�� ---,��w- ��,e,rv� �v� � �/ �'� � —�f F -------" �MECHANICAL a VALUA N OF MECHANICAL INSTALLATION % QGAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO 9UILDER � '�j --'COMPANY 1 A�Jo,✓�Nv+lQo,✓M 6�t/1`AL S t R✓r t E-.j. �,K, S I G N A T U R E / REGISTERED Y/ N FEE CURRE� Y/N Address o �QZ 735, 7'QJ�B`; `l- 3 3 s9 3 Ucense# CGCI o9ab EIECTRICIAN '�^ , COMPANY ��'►��°i 7��- SIGNATURE �� REGISTERED Y/ N FEE CURRE� Y/N Address P�. Qbx '�f �4c�(.i ,'�(, ,3"3� �p License# �G�3r>o�3-�� PIUMBER /�, ��/, � (�COMPANY �� c r{1 ��,� .� �,�(�t G L L L � SIGNATURE t „ t /` REGISTERED Y/ N FEE CURRE� Y/ Address �'�5 t �'1� U (L� (s�d} c�.e �� S�13 License# �� 1� ��-�� o� �� MECHANICAL U COMPANY dNl�✓ � � .��JZUCt�Z-- �JT�`f` SIGNATURE REGISTEREO N FEE CURRE� N • Address v S7u( ` �� . �� - License# �� /�� OTHER COMPANY SIGNATURE REGiSTERED Y/ N FEE CURRE� Y/N Address License# � RESIDENT�AL 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,ConstrucGon Plans,Stormwater Plans w/Silt Fence installed, Sanitary Fadlitles�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 insta�led, Sanitary Facflities 8 1 dumpster.Site Work Permlt for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. """PROPERTY SURVEY required for all NEW construction. Directions: Fili out application completely_ Ovmer 8 Contractor sign back of application,notarized If over 52500,a Notice of Commencement is required. (A/C upgradea over 57500) "' Agent(for the contractor)or Power of Attomey(for the owner)would be someone w(th notarized letter hom owner authorizing same OVER THE COUNTER PERMITTING (Front of AppiicaUon Only) Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"�restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibilfty 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 flcensed in accordance with state and local regulations. If the cont�actor 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 appiy 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 tmpact 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 "ce�tificate 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 Wate�/Sewer impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I certify that i, the applicant, have been provided with a copy of .the °Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner"prior to commencement. CONTRACTOR'SlOWNER'S AFFIDAVIT: I ce�tify that all the information in this appAcation is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be perFormed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also ce�tify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone"V" unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a �compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If ihe fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this a�davit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in pla�s, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a perfod not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BE E RECORDI G YOUR NOTICE OF O N EMENT, FLORIDA JURAT(F.S. �4�) � �'� , I�-... � i � � i . Q AGEI�t� � - ubs ��swo►t�to(or a rmed e ore me t s wSubscrib and swom to(or ao�ed)befo��is a 1 t�—b � ` ` r�by I e '_' are ersona y nown me r haslhave produced Who Is/are p onally kno to mas Identl ��roduced as identlficaGon. n Notary Public Notary Public Commission No ,.•":"•��. WAYNE FRANCIS REI7TINGEN Co mis fon ; : Nptary u c, 8 a ,.�,� '•i ':•` MI omm.Ex irea June 21,2018 �" MY COMiN�SSION#OD925881 Name of Notary typed.Print CommiES On o. Name o Ot nt�d�lilMl�ober 2 , '��',fK,,,�` Bontle(I thru Westem Sure CompanV ,�� '��, FloriAallotaryservke.com (407)398-0153 �,_ ' ��DndD�C�nd�n�D�D��D�CDnCDnCD�pnCD�D��p�CDnCDVCD�dDUC3�CD��D��DV� U . �� C � C 0 � �� °c U � -_- _. . _ � �'�t� ' C � - - �4 � _- -— � � C , � � � - _ �_ � � � � � I ,� U � � � - � � ,�� . �*: � �� _._ c� . U -. � �► ��C ,�fU1� ��0 wE�a�s� � � ,�C , �p.��rtmenf nf �tttfp d J �� VC �tJC ;,� I certify the attached is a true and correct copy of the Articles of �� '�C Amendment, filed on May 20, 2�04, to Articles of Incorporation for HEALTH '()'� �� RESOURCE AI�LI.ANCE OF PASCO, INC. which changed its name 'to PREMIER Q COMMUNITY HEALTHCARg GROUP, INC. , a Florida corporation, as shown by the �V� �aC' records of this office. � � J V �� C I further certify the document was electronically received under FAX audit'�C 0 number H04000110050 . This certificate is issued in accordance with °� '��: section 15. 16, Florida Statutes, and authenticated by the code noted below�VC � The document �� nC number of this corporation is 748142 . 'L7C ��a C '(�jC Q Authentication Code: 704A00035854-052104-74814 � ��c z -�il �U� � V «'O� � � ��c �n� ��c �U� o �� c �U� � J� � 7 V 3n£ ��c �� V J� 7 o� ��c J ��c . �nc ?�C Given under my hand and the �.°Q�o n Great Seal of the State of Florida, :1 L: 'OC ' �� at Tallahassee, the Capital, this the °�� - -_ Twenty-first day of May, 2004 �� ' � : �.c' J C - -_�= =�- ,� L 0 n � � =y� r � v . ^ - _-- �. � �nG �oc � . s 1f � � 5�qc � 41,�.�s. tLC_c�•-�_ �' I� 9UL3 ��C D u�.� C�1�rr�tt�C��ci� �4� � t � ,QC! p�PtT£2FII'�T IIl p��'IIfL' �� V � � � � �V V C�'(1 �. �O_ v O r ,�� O 9C� r� , LdLJk: �n�c�� ca�c��a��c��c��o��a�c�n�"�an�°�c��c��c��c��c��c��c�°c�pc ��n�� n ,�� i _ , i ? { ; - � � � s s Sim�son Environm�nt�l S�rvices, Inc. ' i � f�roFessional Abatement Services � � � i : i ? J�056717 P.O. f�ox 735 •Trilby,Fl 33593- (35Q) 583-Q509 •Fc�x(35Q) 583-3371 � www.simpsonenv.com ? � � � � j ; i � � ( j ? i Quantity Deseription — � ' -------�. Rate Amount � � I ' PREMEER—ZEPNYRHILLS—ADU[�T& CHItDREN i ` � } Dumpster $ 2, 004 . 00 a i � Oerno 2, 505 . 00 � ; ' Plumbing 6, 263 . 00 ^ j � Framing, materia#, ceifing,labor 12, 191. 00 . ; , Heat &air 1 ,41.9 . 00 , i Efectric 2 , 923 . 00 �• � Drywalf 2 , OS'7 . 00 � ` Painting 1 , 670 . 00 � !f � ! � Cabinet 9, 686. OQ � � � Tile 1, 336. 00 € ; Doors, labor& hardware 772 . 00 : i i i � � t l E ( � � r � . � i � � { � i t � i t� i 7 1 } ; "s #' � ! �i ' � � $42, 856 . 00 � � � ._---.,_ � � __,� � ( ` � ----.._ .._. t ! � ��y_ � �� ` � � � .. _ �1-1 ---� .; � � i � � �_ _ � _ ; i s Pasco County Parcel: 34-25-21-0080-00000-0020 001 Page 1 of 1 . � �3� � � Data Current as Of: Weekly Archive - Saturday, December 29, 2012 Parcel ID 34-25-21-0080-00000-0020 (Card: 001 of 002) Classification 19 - Professional Service Building Mailing Address Property Value HEALTH RESOURCE ALLIANCE OF Ag Land �p PASCO INC Land $55,197 PO BOX 232 Building $223,083 DADE CITY FL 33526-0232 Physical Address Extra Features $2,831 37918 MEDICAL ARTS CT 7ust Value ;281,111 ZEPHYRHILLS FL 33541-4323 Assessed (Non-School Amendment 1) $281,111 Leaal Descriotion (First 4 Lines) See Plat for this Subdivision Taxable Value $p TOWNVIEW MEDICAL ARTS CENTER PB 29 PG 68 WEST 97.50 Ff OF LOT 2 TOGETHER WITH INGRESS& EGRESS EASEMENT AS DESC IN Land Detail (Card: 001 of 002) Line Use Description Zoning Units Type Price Condition Value �� 1900 PROF.BLDG OOC2 5,000.00 SF $5.50 1.00 $27,500 �� 1900 PROF.BLDG OOC2 7,000.00 SF $3.50 1.00 $24,500 �� 1900 PROF.BLDG OOC2 3,365.00 SF $0.95 1.00 $3,197 Additional Land Information Acres 0.35 Tax Area 30ZH FEMA Code �Commercial Code PTVM2AA Buildina Information - Use 19 - Offices Professional or Medical (Card: 001 of 002) Year Built 1991 Stories 1.0 Exterior Wall i Concrete Block Stucco Exterior Wall 2 Common Brick Roof Structure Gable or Hip Roof Cover Metal Interior Wall 1 Drywall Interior Wall 2 None Flooring i Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air- Duded A/C Central Baths 5.0 Line Description Sq. Feet Repl. Cost New 1 BAS 2��8 $332,145 2 CAN 21 $814 Extra Features (Card: 001 of 002) Line Description Year Units Value � 1 SWC 1991 408 � $357 2 PAV ASP � 1991 —� 12,219 $2,474 Sales History Previous Owner GARCIA VINCENT F Month/Year Book/Page Type COde Condition Amount 12/2000 4499 / 0563 WDeedty �C� $320,000 Improved 03/1999 4146 / 1046 Quit Claim�� Deed Improved $p 10/1993 3214/ 1156 Quit Claim�� Deed Improved $0 http://appraiser.pascogov.com/search/parcel.aspx?sec=34&twn=25&rng=21&sbb=0080&... 12/31/2012 Pasco County Parcel: 34-25-21-0080-00000-0021 001 Page 1 of 1 . � . 3 � �� uata Current as Of: Weekly Archive - Saturday, December 29, 2012 Parcel ID 34-25-21-0080-00000-0021 (Card: 001 of 002) Classification 19 - Professional Service Building Mailing Address Property Value HEAITH RESOURCE ALLIANCE OF Ag Land �p PASCO INC ��d $18,486 PO BOX 232 Building $76,883 DADE CITY FL 33526-0232 Physical Address Extra Features $432 37920 MEDICAL ARTS CT Just Value #95,801 ZEPHYRHILLS FL 33541-4323 Assessed (Non-School Amendment 1) $95,801 Leaal Descriotion (First 4 �ines) See Plat for this Subdivision Taxable Value #p TOWNVIEW MEDICAL ARTS CENTER PB 29 PG 68 EAST 21.34 F7 OF WEST 128.50 Ff OF LOT 2 OR 4499 PG 562 Land Detail (Card: 001 of 002) Line Use Description Zoning Units Type Price CondRion Value �� 1700 1STORY OFF OOC2 3,361.00 SF $5.50 1.00 $18,486 Additional Land Information Acres 0.08 Tax Area 30ZH FEMA Code �Commercial Code PTVM2AA Buildina Information - Use 19 - Offices Professional or Medical (Card: 001 of 002) Year Built 1991 Stories 1.0 Exterior Wall i Common Brick Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Metal Interior Wall i Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air- Ducted A/C Central Baths Z,p Line Description Sq. Feet Repl.Cost New 1 BAS 1,008 �- $113,289 � Z CAN 42 $1,461 Extra Features (Card: 001 of 002) Line Description Year Units Value 1 S W� 1991 176 $154 2 PAV ASP 1991 1,370 $27g Sales History Previous Owner ADVENTIST HEALTH SYSTEM/ Month/Year Book/Page Type C de Condltion Amount 12/2000 4499 / 0562 WDeedty �� Improved Multi-Parcel Sale 10/2000 4499/ 0558 Quit Claim�� Deed Improved $0 06/1996 3598 / 1182 Warranty � Improved $120,100 Deed http://appraiser.pascogov.com/search/parcel.aspx?sec=34&twn=25&rng=21&sbb=0080&... 12/31/2012 Pasco County Parcel: 34-25-21-0080-00000-0022 001 j �� ,I � �age 1 of 1 . . y//yy��,�1j'/N,I'�.' � �i� ' ` / / ��r 6 �� l �,�� 1� � Data Current as Of: Weekly Archive - Saturday, December 15, 2012 Parcel ID .. 34-25-21-0080-00000-0022 (Card: 001 of 002) ,Cla�s��cation 19 - Professional Service Building Mailing Address � ' Property Value _ HEALTH RESQiJRGE ALL�ANCFt1F' Ag Land �� PASCOINC a. ' PO BOX 232 �nd $26,851 DADE CITY F 526-0232 Building $123,721 ysical Address � Extra Features $663 37922�IEDICAL AR�S C`�f 7ust Value $151,235 ZEPHYRH3LL9�FL 33541-4323 Assessed (Non-School Amendment 1) $151 235 Leqal Descrintioh (First 4 Lines�) � See Plat for this Subdivision Taxable Value #p TOWNVIEW MEDICAL ARTS CENTER PB 29 PG 68 WEST 31.00 Ff OF EAST 71.50 Ff LOT 2 SUBJECT Tm &TOGETHER WITH INGRESS & Land Detail (Card: 001 of 002) Line Use Description Zoning Units Type Price Condition Value � 1900 PROF.BLDG OOC2 4,882.00 SF $5.50 1.00 $26,851 Additional Land Information Acres 0.11 Tax Area 30ZH FEMA Code C�Commercial Code PTVM2AA Buildina Information - Use 19 - Offices Professional or Medical (Card: 001 of 002) Year Built 1991 Stories 1.0 Exterior Wall i Common Brick Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Metal interior Wall i Drywall Interior Wall 2 None Flooring i Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air- Ducted A/C Central Baths 3.0 Line Description Sq. Feet Repl. Cost New 1 BAS 1,488 $179,289 2 CAN 36 $1,325 Extra Features (Card: 001 of 002) Line Description Year Units Value 1 SWC 1991 240 � $225 2 PAV ASP 1991 1,855 $438 Sales History Previous Owner TOWNVIEW MEDICAL ARTS CENTER Month/Year Book/Page Type DOR Condition Amount Code 11/2000 4498/ 0236 WDeedtY �� $150,000 Improved 12/1990 1967 / 0523 WDeedty � Vacant $p http://appraiser.pascogov.com/search/parcel.aspx?sec=34&twn=25&rng=21&sbb=0080&... 12/19/2012 Sim�son Environm�nt�l S�rvic�s, Inc. Professional Abcatement Services CGC1509069 P.O. f3ox 735 •Trilby,Fl 33593 • (35Q) 583-Q509•Fox(35Q) 583-3371 UC056717 CMCI Q49368 �u�,u w.s i m�sonenv.com December 11, 2012 CITY OF ZEPHYRHILLS BUILDING CONSTRUCTION DEPARTMENT 5355 8th Street Zephyrhills FL 33541 RE: Wilton E. Simpson License # CGC 1509069 To whom this may concern: I, Wilton E. Simpson, hereby authorize the following individuals to pull permits for construction related projects under my above referenced license number in your jurisdiction: Tim Yaeger r Casey Mattox ,� Alan John - Jerry Smith - Jasmine Davis- R. Kurt Yann '` . � Wilton E. Simpson STATE OF FLORIDA COUNTY OF PASCO Sworn and subscribed before me this 1 lth day of December, 2012 by Wilton E. Simpson, personally known to me. � � , ' WAYNE FHANCIS REITTING�R . ;�"•"''• '� �- Notary Pu61ic,State of Ftorida NOt� ubI1C '`' �: My Comm.Expires June 21,2016 State of Florida '?�o��; Commission No.EE 190185 '"��"'�� BonAed tbru VJestem Surery Company