HomeMy WebLinkAbout13-14151 CITY OF ZEPHYRHILLS
5335-STH STREET
(ss3)�so-oo20 14�6'f
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL �
Permit#:14151 Issued: 5/07/2013 Address: 5942 17TH ST
Permit Type: GENERAL BUILDING PERMIT ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 13,548.00 Total Fees: 157.50 Subdivision: CITY OF ZEPHYRHILLS
Amount Paid: 157.50 Date Paid: 5/07/2013 Parcel Number: 11-26-21-0010-04300-0160
Name: CERTIFIED FOUNDATION INC Name: VANSELOW ERNA
Addr: 1306 BANANA RD Address: 5942 17TH ST
LAKELAND FL 33810 ZEPHYRHILLS, FL. 33542
Phone: (863)559-8317 Lic: Phone: (813)783-8389
Work Desc: FOUNDATION STABILIZATION
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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 neaessary due to any one of the following reasons: a)wrong address b)condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site� 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 property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complebe Plans,Specifications and Must Accompany Application.All work shall be performed in accordance
with Ci Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
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CONTRACTORS SI NATU PERMIT OFFI
PERMIT EXPIR N 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0920 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received ���Y+�� �j (� 3 �� _ �j 21
Phone Contact for Permittin b p ✓
Owner's Name �-�v"T'i N1 � �j�j.Q/�1� Owner Phone Number ���'] b • �3� 1
Owner's Address J J Owner Phone Number �
Fee 5imple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 5 � I LOT# � 6 �7 ��
SUBDIVISION � � . PARCEL ID# � � `"7-6 "��-O'O�D•O`c�bCJ�--OI �O
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR[, ADD/ALT � SIGN Q Q DEMOLISH
INSTALL �o� REPAIR
PROPOSED USE � �FR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME C] STEEL Q
DESCRIPTION OF WORK �V OH � f� �A� �?.l'Q`��
BUILDING SIZE SQ FOOTAGE C� HEIGHT
�BUILDING $ �`� S+�� VALUATION OF TOTAL CONSTRUCTION
�
DELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY O W.R.E.C.
�PLUMBING $ �/ �( S/�
�/ Z � �
�MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION .— �)dU�
U �-
�GAS Q ROOFING Q SPECIALTY � OTHER % 2�
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NTY
BUILDER �� I�� ��J���Q� f� �
SIGNATURE � �OMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address �� C)`�'� � � ���� License# C'' e—
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
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 submittai date. Requi�ed onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"'*PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely
Owner 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(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be 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 ReGOVery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansivn 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 certi�cate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
be aid rior to ermit issuance in accordance with a licable Pasco Count ordinances.
fees are due, they must p p p PP Y
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 uFlorida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I cettify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V" unless expressly permitted.
- If the fiill 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 Fforida.
- 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 fifl material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shal� issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned.
.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N TICE OF COMMENCEMENT.
FLORIDA JURAT(F.S 11 ) \ ' /J
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OWNER OR AGEN `I CONTRACTOR�` � �"'�-"
S�bscribed and swor to j9r,a�i ) ef reln 's S�s�ibe�nd bwo�to � b�f➢e m this / �
a-I 3 by i\.1 �FI y Iu , Ie�V
Who is/are personally known to me or has/have produced Who is/are personally knovm to me or haslhave produce
t I.� (,i c�+�s� as IdenUficatlon. �'(,. �< <� as identification.
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_� @� r� Notary Public '�"" S Notary Public
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` �iat#EE 040520
Commi S Com ssion No. _r �
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�g ';,;: Commission#EE , '
=*: • ' �Q(�2,2 0 1 4 vu Troy Ftin Irourance gOp3&5-7D I9
Name of Name of Notary typed,printed or s am "
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
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Contractor/Homeowner: �����-1� ��� �'�G ����-S
Date Received: S 2� ( 3
Site: �q T Z � l - `�
Permit Type: �-�i���7�?� `�'.��'J `Z..���
.
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment she�t sh 1 be kept with the permit and/or plans.
a
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Kalv' er Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
� � . . I illlf l lilll lllll lllll lllll lllil lllll lllll lllll lllll llll lill
, 20130778t2
, - - - - - -
�Rcpt:1517464 Rec: 10.00
Pertnit Nurr�ber DS: 0.00 I T: 0.00
Parcel ID Number ��. ^'Z,f�40'b�0 �Q 05/02/13 E. Munguia, Dpty Clerk
%'PAULR 5 0'NEIL,Ph D PqSCO CLERK 8 COMPTROLLER
NOTICE OF COMMENCEMENT 05/02/13 12:36 m 1 of 1
State of Flo ' � , OR BK ���� PG 2��4
���-----__ Thl$:tRE�."SKi:St.'�R�tJFCrriC.Lc'-:f(C:F 1!'itZ.':,Tr!Ti.'L'Kir.�?-il.;:
County of _
THE UNDERSIGNED hereby gives notice that improvemenis will be made to certain real property,and in a ccordance with Section 713.13 of th e
Florida Statutes,the following information is provided in�is NOTICE OF COMMENCEMENT
1.Description of property(legal descriptfon): t OF7�il�yjQ, � �Er�� I�1 j� )b �� `�`J$ °�1-0�-�C,'�
a)Street(job)Address: ���'`3- 1 '� ��.J��fdQ�)��'�' �'f?� ��Q.�'6)7 6r61S(
Z.General description of improvements: FOUndetl011 Sta IilZatlOn
3.Owner Information or Lessee iniormation lf the Lessee contracted for the im ov�nent:
a)Name and address: N1,.YA�S�io rJ S ��- � s`f 7��yJQ�-J f Ll.J,S_�����—
b)Name and address of fee simple titleholder(if different than Owner listed above)
c)Interest in properry:
�4.Contractor Information
a)Name and address: Certified Foundations, Inc., 1306 Banana Rd, Lakeland, FL 33810
b)Telephone No.. 863-859-3889 Fax No.:(op6onal)
S.Surety(if applicable,a copy of the payment bond is attached)
a)Name and address:
b)Telephone No.:
c)Amount of Bond: ;
6.Lender �
a)Name and address:
b)Telephone No.:
7.Persons within the State of Florida designated by Owner upor�v►�hom notices or other documents may be served as provided by Section
713.13(1)(a)7.,Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.:(optional)
8.a.ln addition to himself or herself,Owner designates of
to receive a copy of the Lienors No6ce as provided in Section 713.13(1)(b},Florida Statutes.
b)Phone Number of Pe�son or entity designated by Owner:
9.Expiration date of notice of commencemeM(the expiration date i nay not be before the completion of construc6on and final payment to the
contractor,but will be 1 ear from the date of recordin unless a drfferent date is s ifi ,Zp
WARMNG TO OWNER: ANY PAYMENTS MADE 8Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF CON6IAENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART!,SECTION 713.13,FLORIDA STATUTES AND CAN RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTIC�E OF COMMENCEMENT MUST BE RECQRDED AND POSTED ON THE
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YQU�LENDER OR AN ATTORNEY BEFO�COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalry of perjury,I declare that I have read the for�egoing notics of comme�cement and that the facts stated tlierein are true to the best of my
knowledge nd belief.
���1J ylZ/ � / �'r/1� � VOiJ��r�o 4� C�w n� v�
(Signatu e of Owner or Lessee,or OYvner's or Lessee's(Authorized OfficerlDirectcdP a�rt nerRdsna ger) (Prin t I�I�me and�Provide Si gnato ry's TitIe/0ffice)
The forego;ng instrurnc;nt was acknovuledged before me this ��3 day of j c,qr, 1 ,20 13
by 8S ( e of authonty,e.g.otficer,Vustee,attomey in fact)
�9s�/ C.rny acJ .� ,.s
(Name of Persort) (lype of aulhority,...e.g.oH'�cer,trustae,eftomey in fact)
for _ (nan�e of pariy on L�half ot whom in wrient was executed}.
Personally Known �_Produced ID �
Type of ID •" "'�-. .M R� sErr� tary Signatu!e --�'�Q°�-�
''c �`: MY COMMI551QN#DD984988 Print name /�a��o.-� 5 /�i��,
�• EXP RES A us 14y 20�14
r- �- .}f f-� .' �� :�- a�/.�`a�r, �.ry�.fr� —
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OF pAS��
�,RCU•t, �k p� frt�OR�DA,C�VHE FOREG0ING iS A
�Tp`"[� RTIFY�tHAT THE DOC�MENT
•� '� TH151S'���E
RRECT COPY OF �N THiS OFFIC
`� • ` . � TRU�.AND�� pUBU�RECORp�SEAI-TK�S^
� � � 0�FN.E����ANQ AND FFlC1A_
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F- � � C�''�� < WITNESS MYpAY QF ' " NIPTR��I.
��, � '`�����1 � � PA�O�tyEl�, RK& EPUTY G�ERK
� �,�d�� gY u ��
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����� 1306 Banana Road, Lakeland, Florida 33810
, �: �:��:��,�.,��°��_;M �,
' � , Local Phone.863-859-3889
'�.■■ ���`��.:a������I���:���'����, �����'.,�
�'�� ?;,�_�<< .'<.'�-�� FOUNOATION SOLUTIONS 5(NCE 1989 Toll Free.800-329-3889
April 11, 2013
letter of Authorization
I,James Joseph Collier, President of Certified Foundations, Inc.,authorize my employee, Richard Plage to act as
my agent in securing pe its. I unders d I responsible for any and all work performed by my agent.
CONTRACTOR'S SIGNATURE
License#CGC1519214
State of Florida
County of Polk
.
Sw rn to and subscrib d befor me this � � day of /�� ,2013.
Notary Public ��� ��'• KATHLEEN S.MORISSETTE
3��=
:'; MY COMMISSION#DD984966
,'• , �� � EXPIRES Auguat 14,2p1q
407)3pB-0163 Flondallo Servica.com
Foundation Solutions 5ince i9Hy
Sinkhole Remediation I Pressure Grouting I Underpinning I Chemical Grouting I Pre-Construction Piling www.cfi-i.com
Florida State Generel Contractors License CGCiSor,o67
. � � � � �P"�^�t i ��-�5�
BraCken
E N G I N E E R I N G
July 1, 2013
Ema &William Vanselow
Owner
5942 17th St
Zephyrhilis, FL 33542
Document: Certification of Underpin Placement� Installation
Project: Vanselow Property[713-002]
Location: 5942 17th St, Zephyryhills, Florida 33542
Mr. & Mrs. Vanselow,
At your request we have completed our Underpin Placement & Installation Assessment on the
above referenced structure. This assessment consisted of non-destructive and visual
evaluations of the subject structure and was based on information made available by the site
visits conducted by our office.
During our construction site visits, the pin placements were reviewed with respect to the pin
placement plan. Based on these visits, it is the opinion of the engineer that the installation of the
pins was performed in accordance with the pin placement plan as well as acceptable
construction practices and procedures. Furthermore, it is the opinion of the engineer, based on
typical design loads and assumed conventional construction, that the frequency, spacing and
locations of the proposed pins is sufficient to support/stabilize that portion of the structure
shown. It should be noted that this design is intended only to stabilize that portion of the
structure supported by piers as found within the permit plans and is not intended to serve as a
guarantee or warranty on that portion of the stnacture not supported by piers as found within the
permit plans.
Thank you for the opportunity to provide you with professional engineering services. Please
note that Bracken Engineering reserves the right to revise or update any of the observations,
assessments and/or recommendations as conditions change or additional information becomes
available. This document is to inure to the benefit of the addressee only and may not be relied
upon, used by or referenced by any third party without the written consent of Bracken
Engineering, Inc. If clanfication or additional information is required, please do not hesitate to
contact us.
Sincerely,
Bracken ngineering
C ���
/ _
_
Robert L. De Loach, Jr, CBI, CBC, CFM Wlliam C. Sracken, PE, SI, CFM
Certified Building Inspector Principal Engoneer
July 1, 2013 July 1, 20'13
License No. CBC 1257915/ FL License iVo. PE 47f7�I FL
License No. CA 7419/FL License No. CA ?419 /FL
Cc: File (#713-002) Certified Foundations, Inc (CFI)
2701 W Busch Blvd..Suite 200.TamAa.Florida 33618 8D0.971.7252 813.243.9530
� • �� Insp.No. Date: Sheet:
3 05/16/13 1 of 4
Bracken W��er Time Temp:
ENGINEERING SUnn 12:30AM 82�F
ProjecVfask
713-002
PresenY. Jeremy Hitt from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI Crew
UNDERPIN LIFT/STABILIZATION REPORT
Pfe-Llft Ch@CkI1St: (place an X in box if completed)
� Verified all data in monitoring file has been collected
� Met with site Foreman
� Verified all pins were installed
� Verified all indicated pins have steel speader beams
� Verifed direction of spreader beams for interior pins(if applicable)
� Discussed and recorded lift/stabilization sequence of events with Foreman
� Recorded as-buitt pin locations
� Photographed distressed areas prior to lift
� Recorded how lift is to be monitored from the exterior and interior
� Photographed items above
Pre-Lift Observations/Comments:
* All underpins were installed and the site was prepped for the stabilization
` All steel spreader beams were installed
' The lift was monitored by optical transit on the exterior of the structure with a e strips positioned on the wall above each pin
.
.
.
.
e purpose o is s e vis was o is an ve a e cons on a es o serv an recor were�n su n a
compliance with the contrad documeMs as well as acceptable industry standards.Portions of the information found within this
report were obtained and provided by the contractor Therefore,Braeken Engincering,Inc.reserves the right to revise or update
any ot the observabons,assessment antl/or recommentlaLOns as cond�LOns change or adtlrtonal mformadon becomes available.
Report by: Reviewed by Attachments: �:
JRH JCB Photo Proofsheets File-713-002
2701 W.Buach Blvd.Suite 200,Tampa,florida 33G18 T 800.9717252 F 913.243.9530
BRACKENENGtNEERING.COM
• �� Insp.No. Date: Sheet
3 05/16/13 2 of 4
Bracken W��er. Time Temp
E N Ca I N E E R 1 N G SU�In 12:30 AM $Z�F
ProjecUTask:
713-002
P�Se"t: Jeremy Hitt from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI Crew
UNDERPIN LIFT/STABILIZATION REPORT
Lift and Pressure Amounts:
Pier liit Amourit Pressure Pier Llft Amount Pressure Pier LiR Amount Pressure
1 1/16" 1000
2 1/16" 1000
3 1/16" 1000
4 1/16" 1000
5 1/1 G' 1000
6 1/16" 1000
7 1/16" 1000
8 1/16" 1000
9 1/16" 1000
10 1/16" 1000
11 1/15' 1000
12 1l16" 1D00
Lift/Stabilization Squence:
`All pins were pressurized at the same time and were stabilized at 1000 psi with a 1/16"stabilization lift
.
.
e purpose is s ws was �s an ve a e con on a o serv an recor were in su n a
compliance with the contract documents as well as acceptable industry standards.Portions of the information found within this
report were obtained and provided by the contractor Therefore,Bracken Engineering,Inc.reserves the right to revise or update
any of Uie observations,assessment andlor recommendations as conditwns change or additional information becomes available.
Report uy: R�d by Attachmetrts: c�:
JRH JCB Photo Proofsheets File-713-002
2701 W Busch Blvd.,Suite 200,Tampa,F7orida 33618 T 800.971.7252 F SI3.243.9530
BRACKENENGINEERING.COM
, , ,
• • �� Insp No Date: Sheet
3 05/16/13 3 of 4
Bracken We�er Time Temp
E N G 1 N E E R I N G Sunn 12:30 AM �G�F
Pro�ecUfask
713-002
P�e�"t: Jeremy Hitt from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI Crew
UNDERPIN LIFT/STABILIZATION REPORT
POSt-Llft Ch2CkI15t: (place an X in box if completed)
� Recorded the method in which lift/stabilization occurred
� Photographed distressed areas after lift
� Discussed with Foreman which brackets need to be incased in concrete(if applicable)
� Recorded if pins are welded,boked or pinned in place.
� Recorded if work to be done to the pins beyond Bracken Engineering's plan(grout filled pins,
brackets incased in concrete,etc.)
� Recorded lift amounts and pressures
� Photographed items above
Post-Lift Observations 1 Comments:
' All data in monitoring file has been collected
* The method in which the the stabilization occurred is listed on sheet 2
" No collateral damage was evidenced.
' Consent was given to boft the support brackets into place beneath the foundation/slab of the structure.
• Stabilization lift amounts were recorded on sheet 2
.
Actions Required/Taken:
' Recorded observations,reviewed underpin driving records and photographed activites.
* Took As-buift Dimensions of pin locations
• Relayed finding to the engineer for evaluation
e purpose o is s e vis was o es is an ve a e con ru on a i ies o serv an recor were m su n ia
compliance with the contrad documents as well as acceptable industry standards.Portions of the information found within this
report were obtained and provided by the contrador Therefore,Bracken Engineering,Inc.reserves the right to revise or update
any of the observahons,assessment and/or recommendations as condRions change or addRional infortnation becomes available.
Report by Reviewed by Attachmerrts: �:
JRH JCB Photo Proofsheets File-713-002
2701 W Busch Hlvd,Sutte 200,T�npa,Florida 33618 T 8D0.97I.7252 F 813.7A3.9530
SRACKENENGINE£RING.COM
, r �� Insp.No. Date: Sheet:
3 05/16/13 4 of 4
Bracken Weather Time Temp
E N G I N E E R 1 N G SUII�I 12:30 AM 82�F
ProjecUiask
713-002
Present Jeremy Hitt from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI Crew
UNDERPIN LIFT/STABILIZATION REPORT
As-Built Pin Plan:
13. 9"
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I�
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I� NOTE ALL PIN PoIfS
�-8'-7' 6'-6"--�-8-11"�'I TO BE PRE-DRILLED
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e purpose is s e vis was o is an v e con on a es o serv an recor were in su n a
compliance with the contrad dxuments as well as acceptable industry standards.Portions of the information found within this
report were obtained and provided by the eontractor.Therefore,Bracken Engineering,Inc.reserves the right to revise or update
any of the observations,assessmeM andlor recommendations as conditions change or addrtional information becomes available.
RePOrt by a��wed by: Attachments: c�
JRH JCB Photo Proofsheets File-713-002
2701 W Busch Blvd.,Swte 200,Tmnpa,Fiond¢33618 T 800.97I.7252 F 813.243.9530
BRACKENENGINEERING.COM
� +
• • �� Insp No. Date: Sheet
3 05/16/13 1
Bracken W��er Time: Temp
E N G I N E E R I N G SUnn 12:30-1:00 OG�F
ProjectlTask
713-002
Present Jeremy from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI crew
UNDERPIN MONITORING FIELD REPORT
ITEMS COMPLETED: Pin#'s(w/Photo)
� Removed Surface Obstructions/Cored Slab
X❑ Excavated 1(2-4)2(2,5)3(6)4(7-8)6(11-12)8(13-14)
� Subsurface Obstruction Encountered
� Required elimination of obstruction(see notes�
� Required orientation of pin to be changed(see notes)
� Required relocation of pin(see notes)
� Footing preparation/mod'fiication
� Saw Cut/Chiseled/Bushed
� Placement of steel(as called for)
� Placement of steel(not called for)
�X Pin Installation 1(2-4)2(2,5)3(6)_�-8)5(9-10)6(11-12)8(13-14)
��(��i�t2�_'
CheCkIlSt: (place an X in box'rf completed)
� Met with site Foreman: Jessie Jacobs � Verified vertical angle of pin installation(<5°)
� Recorded excavation at pin locations � Ver�ed spreader beam was centered on bracket
� Noted and recorded information on deviations � Ver�ed direction of spreader beam for interior pins
� Recorded footer preparation for pin locations � Dimensioned footers and slabs
� Recorded placement of steel spreader beams � Dimensioned as-buift pin locations
� Recorded installation of pins � Approximate date for lift:
� Recorded pin installation pressures � Took photos of work done
� Verfied flush connection to face and under footing � Took photos of deficiencies 8�deviations or damage
GENERAL OBSERVATIONS/COMMENTS:
•Torque for helical pile installations recorded.
•Pin#11 torque numbers will be emailed by contractor
The purpose of this site visit was to establish and verify that the construction activities observed and recorded were in substarrtial
compliance with the contract documents as well as acceptable industry standards.Portions of the infortnation found wRhin this report
were obtained and provided by the contractor Therefore,Bracke�Engineering,Inc.reserves the right to revise or update any of the
observations,assessment and/or recommendations as conditions change or additional information becomes available.
Report by Reviewed by Attachments: �:
JRH JCB Photo Proofsheets 713-002
2701 W Busch Btvd.,Suite 200,Tampa,Florida 33618 T 800.971.7252 F 9t3.243.9530
BRACKENENGINEERING.COM
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BraCken
E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 16, 2013 - Page 1 of 3 - Photos Taken By: JRH
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 16, 2013 - Page 2 of 3 - Photos Taken By: JRH
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 16, 2013 - Page 3 of 3 - Photos Taken By: JRH
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� � �� insp.No. Date: Sheet
2 OS/15/13 �
Bracken W��e� Time Temp
EN � � NEER � N � Sunn 10:45-12:15 77°F
Project/Task
713-002
Present Jeremy from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI crew
UNDERPIN MONITORING FIELD REPORT
ITEMS COMPLETED: Pin#'s(w/Photo)
X� Removed Surtace Obstructions/Cored Slab 5(47),11(8-9,29),12(10-11 30)
QX Excavated 5(4-7)
� SubsurFace Obstruction Encountered
� Required elimination of obstruction(see notes)
� Required orientation of pin to be changed(see notes)
� Required relocation of pin�see notes)
� Footing preparation/mod�cation
XQ Saw Cut Chiseled Bushed 7(17-19)
� Placement of steel(as called for)
� Placement of steel(not called for)
XQ Pin Installation 7(17-19)
Ch@Ckllst: (place an X in box if completed)
� Met with site Foreman: Jessie Jacobs � Verified vertical angle of pin installation(<5°)
� Recorded excavation at pin locations � Verified spreader beam was centered on bracket
Q Noted and recorded information on deviations [� Ver�ed direction of spreader beam for interior pins
� Recorded footer preparation for pin locations � Dimensioned footers and slabs
� Recorded placement of steel spreader beams � Dimensioned as-built pin locations
� Recorded installation of pins � Approximate date for I'rft:
� Recorded pin installation pressures � Took photos of work done
� Ve�ed flush connection to face and under footing � Took photos of deficiencies&deviations or damage
GENERAL OBSERVATIONS/COMMENTS.
•Torque for helical pile installations recorded.
•Interior slab was 5".
•Pin#5 was moved(by contractor)to opposite side of wall due to crack in slab(observed).
•CFI was informed to not install pin#5.
•Pins#1,2,4,9,10 were already backfflled by coirtractor.CFI was informed to excavate already backfilled pins for
steel placemeM verification.
•Pins#3 and#6 were already backTllled and a new slab poured.
•Pin#7 was observed to have a thickened footer.
The purpose of this site visit was to esiablish and verify that the construction activities observed and recorded were in substantial
compliance with the contract documents as well as acceptable industry standards.Portions of the information fou�d within this report
were obtained and provided by the contractor Therefore,Bracke�Engineering,Inc.reserves the right to revise or update any of the
observations,assessment andlor recommendations as condkions change or additional information becomes available.
Report by Reviewed by Attachments:
�:
JRH JCB Photo Proofsheets ���002
2701 W.Busch Blvd.,Suite 200,TampQ,F'(orida 336�g T 800.971.7252 F 813243.9530
BRQCKENENGINEERING.COM
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 15, 2013 - Page 1 of 4 - Photos Taken By: JRH
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 15, 2013 - Page 2 of 4 - Photos Taken By: JRH
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 15, 2013 - Page 3 of 4 - Photos Taken By: JRH
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 15, 2013 - Page 4 of 4 - Photos Taken By: JRH
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�� Insp.No. Date: Sheet
1 05/13/13 �
Bracken W�er Time: Temp
E N G I N E E R I N G SUIIn 10�00 AM p6'F
ProjecUTask
713-002
Present Rob DeLoach from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI Crew
UNDERPIN MONITORING INITIAL REPORT
CheCkIlSt: (place an X in box if wmpleted)
� Met with site Foreman
� Verified pin layout
� Verified pins to have steel
� Recorded any obstructions to pin layout
� Recorded if pins required shifting due to obstruction
� Documented the type of pin being installed(length,dia,#of flights,etc )
� Discussed pinning approach(Restorativ tablitive/Pre ntative/Pre-Grout)(circle one)
� Recorded the method in which the pins are to be installed elical,H raulically Advanced,Jetted)(circle one)
� Reviewed approximate pin depths with Foreman per Geotechnical Report
� Discussed method of installation for the interior pins(if applicable)
� Set tentative date for lift:
� Ver�ed that Bracken Engineering has underpin shop drawings/specifications in project file(see attached)
� Indicated to Foreman which pins need to be pre-drilled(if applicable)Pins: All
� Discussed direction of spreader beams on interior pins
� Photographed items above
GENERAL OBSERVATIONS/COMMENTS:
•Arrived on site and layed out the pin and spreader beam locations with the foreman
•The pins are 3.5"diameter and 5 foot long helical piers.
•A stablitive approch is to be taken with a minor lift to close some cracks
•All of the pins are to be helically advanced
•Reviewed depths with Foreman and indicated that the approximate depths are to be between 2535 feet
•Bracken Engineering has the specs for the Chance Bracket and helical pier systems
•Items above were photographed
The purpose of this checldist was to establish and verify that the construction activities observed and recorded were in substantial compliance with
the contrect documents as welt as acceptable industry standards.Portions of the information found within this report were obtained and provided by
the contractor Therefore,Bracken Engineering,Inc.reserves the right to revise or update any of the observations,assessment and/or
recommendations as conditions change or additional information becomes available.
Report by Reviewed by Attachments:
�:
RLD JCB Photo Proofsheets File-713-002
ZI(Il W Busch Blvd.,Suite 200,Tampa,Fiorida 33618 T 8D0.971.7252 F 813.243.9530
BRACKENENGINEERING.0 OM
� . �� Insp.No. Date� Sheet:
1 05/13l13 1
Bracken W�ther Time: Temp
E N G 1 N E E R I N G Clea� 10�00 AM HV�F
ProjecUTask:
713-002
Present Rob DeLoach from Bracken Engineering and Vanselow Property
Foreman Jessie Jacobs and CFI crew
UNDERPIN MONITORING FIELD REPORT
ITEMS COMPLETED: Pin#'s(w/Photo)
� Removed Surface Obstructions/Cored Slab
XQ Excavated 1-2(23-24)
� Subsurface Obstruction Encountered
� Required elimination of obstruction(see notes�
� Required orientation of pin to be changed�see notes�
� Required relocation of pin�see notes�
� Footing preparation/mod�cation
� Saw Cut/Chiseled/Bushed
� Placement of steel(as called for)
� Placement of steel(not called for)
� Pin Installation
CheCk115t: (place an X in box if completed)
� Met with site Foreman: Jessie Jacobs � Verified vertical angle of pin installation(<5°)
� Recorded excavation at pin locations � Ver�ed spreader beam was centered on bracket
� Noted and recorded information on deviations � Ver�ed direction of spreader beam for interior pins
� Recorded footer preparation for pin locations � Dimensioned footers and slabs
� Recorded placement of steel spreader beams � Dimensioned as-built pin locations
� Recorded installation of pins � Approximate date for lift:
� Recorded pin installation pressures � Took photos of work done
� Verified flush connection to face and under footing � Took photos of deficiencies 8�deviations or damage
GENERAL OBSERVATIONS/COMMENTS:
•While on site CFI was excavating pins 1 and 2
The purpose of this site visit was to establish and verify that the construdion activities observed and recorded were in substantial
complia�ce with the contract documents as well as acceptable industry standards.Portions of the information found vvithin this report
were obtained and provided by the contraetor Therefore, Brecken Engineering,Inc.reserves the right to revise or update any of the
observations,assessment and/or recommendations as condkions change or additional information becomes available.
Report by Reviewed by Attachments: �
RLD JCB Photo Proofsheets 7�3.002
2701 W_Busch Blvd.,Suite 200,Tampa,Florida 33fi18 T 800.971.7252 F 813.243.9530
BRACKENENG INEERING_COM
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E N G I N E E R I N G
PROOF SHEET PHOTOGRAPHS
Vanselow Property [713-002]
May 13, 2013 - Page 1 of 3 - Photos Taken By: RLD
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E N G I N E E R I N G
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