HomeMy WebLinkAbout14-15360 CITY OF ZEPHYRHILLS
• _: 5335-8TH STREET
(sis)�so-oozo 1 60
• - ' BUILDING PERMIT
,
x��
�� .:�-�;�� PERMIT�INFORMATION ' ���° �' �� � =�bLOCATION.INFORMA�TION'����'��:�d ;�'
Permit Number: 15360 Address: 5347 GALL BLVD �
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: 11-26-21-0010-12200-0090
Improv. Cost: 35,000.00 ��� ` `��.�* �;�',�`���'�01NNERaINFORM^`'A}TION��'� ;���:� . �_ ���
Date Issued: 6/10/2014 Name: DI MAGGIO'S "THAT'S AMORE" LLC
Total Fees: 663.00 Address: 5347 GALL BLVD
Amount Paid: 663.00 ZEPHYRHILLS, FL. 33541
Date Paid: 6/10/2014 Phone: 813-270-2238
Work Desc: INTERIOR REMODEL 2,800 SQ FT
��a~����CONTRACT�OR S , ' - ., , APPLICATION;FEES,:: � =a',�.
OWNER BUILDING FEE 315.00 ELECTRICAL FEE y 60.00
AIR TECH SERVICES OF PASCO INC PLUMBING FEE 60.00 MECHANICAL FEE 60.00
ROGERS ELECTRIC LLC FIRE PLAN REVIEW FEES 168.00
OWNER
�°�'`� .
��
� �� ��
�,�:.,.r
��� , . , _ , Ins ections�Re uired _ _ . -• �= :;�f'•i ���-:,4.
FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. '
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or 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 properly 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
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
)
C R SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
I CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
' CITY OF / / I I BUILDINa
ZEPHYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION
� � • • - •
ADDRESS DATE PERMIT�,
,^' , , - b�- - C�
THIS JOB HAS NOT.BEEN COMPLETED. The following additions or corrections shall be made before the job
will be accepted.
� �V/�' ��%
�
�'/ QS' �P �Pt /� � a,QC �1�
2 s ,� P , ,..� ✓
� � ' �� `�
� �� � ,� �-
�.� ' .� s �-- ` ` � .�S �� -c�c�
� r y
� .0 S �
It is unia l tor any arpenter,contractor,Buil r,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be wvered,any part of the worlc with flooring,lath,earth 780-0020 FOR RE-INSPECTION
or other material,until the proper inspedor has had ample time to approve
the installation.
OFFICE HOURS 7:30AM-4:30 PM MON.-FRI. INSPECTOR
�-- - - - - J
PIPER FIRE PROTECTION INC.
231 COIVIM�RCE DR.s., � SUPPRESSION
LARGO, FL 33770 / �f �, �� �
STATEWIDE(800)327-7604 �' SYSTEM
PIPIEL'i.AS FAX(727)581-8332 ,.l:.t
SARASOTA FAX(941)377-2001 f��„�-="�' ���°� ��'���c���� REPORT
pfpmall@piperfir+e.com
CUSTOMER NM9E CUSTOMFR NO. DA7E
D/MAGGIO THAT'S AMORE 11/3N4
s�nce aooaess c�r srn� aa 33 �
5347 GALL BLVD. ZEPHYRHILLS FL �� I
aiwricnooa�ss crn srn� na .
CONTACTNAME CON�ACT7FLN0. It�C71aN o INSTALLAT1dJ n
ANNA ROMAN 813-270-2238 s6t+nce u r�ovnnori u
srsr�an�ocnnoN n�uwuFacn�En Mooa� sFwa.a s�
KITCHEN ANSUL R 102 R-23854 6 GALLOIVS
DEfECTONTYPE NUMBER TFM� YEAR MANUALPLAL
FUSE LINK 5 450F 2014 1
EQUIPMENTSHUiDOYVN ElECTRICAL C-!aS HVAC
ELECTRIC/GAS/AIR MICRO SWlTCH MECHANICAL FRESH AIR
� CYLIPIDERWEIGFii AGETITWEIGFR PItEEEURE MFG/TE.ST�TE
N/A N/A 901-30(2004)WT.'60.5oz. 2003,2004 MFG.
O O O O o HOOD= 10����
-► DUCT= 14" x 14"
uv uv
z z � zao
S{-IFf F
8 J3U12NER CHAlt 131ZO1LElt FRYI3R
48"x 23" 36"x 21.�' Zl"x 14"
1. All appliances properly protected w/correct noules YES 20.Check travel of cable nuts/S-hooks YES
2. Duct and plenum covered w/correct nozzles YES 21. Piping and conduit securely bracketed YES
3. Check positioning of all nozzles YES 22. Proper separation between fryer&flame YES
4. System installed in accordance w/MNF UL listing YES 23. Proper clearance of flame to filters YES
5. Hood/duct penetration sealed w/weld or UL device YES 24. Exhaust fan-in operating order YES
6. Check if seals intact,evidence of tampering YES 25.All fitters re-installed YES
7. If system has being discharged,report same YES 26. Fuel shut-off in on position YES
8. Pressu�e gauge in proper range(if gauged) N/A 27.Manual&remote seUseals in place YES
9. Check cartridge weight(If applicable) YES 28. Replace system covers YES
10. Hydrostatic test date checked YES 29.System operational and seals in place YES
11.6 year maintenance date PUA 30.Slave system operational N/A
12.Inspect cytinder weight(if applicable) wA 31.Clean cylinder and mount YES
13. Operate system from terminal link YES 32. Fan warning sign on hood YES
14.Test for proper operation from remote YES 33. Personal instructed on system operation YES
15.Check operation of micro switch YES 34. Proper kitchen portable extinguisher class K YES
16.Clean noules YES 35. Portable extinguishers properly serviced YES
17. Proper nozzle covers in place YES 36. Service and Certification tag on system YES
18.Check fuse links and,clean YES 37 Does system meet UL 300 Standard Np
19.Replaced fuse links YES NOTE DISCREPANCIES OR DEFICIENCIES BELOW
COMMENTS: ANSUL R-102 REGULATED RELEASE MECHANISM AUTOMAN NEEDS TO REPLACED,DOES NOT MEET UL300
STANDARDS. `jt�g�Crr i S p� F�� � ry����
4u�� \D �ollo�
On this date,the above system was tested and inspected in accordance with procedures of a presently adopted editions of NFPA 17,17A, 96
and the manufacturer's manual and was operated according to these procedures with results indicated above.
MARK C.GARCIA 79218300012006 11/3/14 I
s�xvice�crwicwwN Pevarrrio. on� nr,� nr� �►n CU&TOMERAUT110WZFDAGH4�
The above service technician certifies that the system was personatly and found conditions to be as indicated on report.
.a��'
.
.��� :����
• -^l.jr
� • \
City of Zephyrhills
BUILi71NG PLAN REVIEW COMMENTS
�
Cantractor/Hameowner: �� IS�J c5 S �'��i
Date Received: ��-- 2.� -��
s���: ���`� ��ll ��1��,�
..�-- /'
Permit Type: _�t`,,� ���-/
Approved w/no comments:❑ Approved w/the belaw comments: � Denied w/the below cornments: ❑
. ,� � �,
(.� } —�f�. �X�=(1,-,�k.� ��, �
� �
� i.� �t`�.��,�
� �� '`��t�" 'l-lr i �-
r
�; ��t����t=c� �—`� �—�f �z:..-�— ��� (�°�°��_.�i i i'�—�..��hGv
� ������
This camment sheet shall be kept with the permit and/or pians.
�
��� �
Kalvin wrtzer ,lans Examiner Date ontracto andlor Homeowner
(Required when comments a�re present)
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
• , Building Department
IDate 6tec�ived /j'..��f�/ 3 27� -- Z7��
l Phone ContacQ for Permitting
, � \�` �
Owner's i�ame � � c� Owner Phone R�umber
Owrner's Adciress S 3�'� � Owmer Phone Idumber
Fee Simple Titleholder ldame Ouvner�hone Mureiber
Fee Simple Titleholder Address
JOB ADDRESS LOT# ��
SU�DINISIOId �ARCEL ID# �
(OBT.9INED FROM PROPERTY TAX NOTICE)
WORCL 6'ROPOSED e NEw CONSTR� ADD/ALT 0 SIGN 0 Q DEMOLISH
INSTALL REPAIR
��tOP05ED USE Q SFR CONiM � OTHER
�YVPE OE'COIdSTRUCTlO� Q BLOCK � FRAME � STEEL Q
D��C9tIPT10M OF lMORF� S �
�UI�IDI�G SIZE SQ FOOT�►GE� 41EIGH�
OBUILDING $ �� VALUATIOfV OF TOTAL CONSTRUCTION
�ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. �,1
OPLUMBING $ i f��6 I�Z'���J ��"
� `� ����S�l
OMECHAMICAL $ VALUATION OF MECHANICAL INSTALLATIOfV � ���(J �'� ,_'/
O , �,1�-��'
�GAS Q ROOFIMG Q SPECIALTY 0 OTHER (� ��� 1 `, _,rl� �Se-T
� }?' �.�
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO,7 ��y...i�- � 4���
�C �
IBUILDER �'} ��D CO@flPAR� �W
SEGR14►TID� ��� �...�-' �J REGISTERED Y I N FEE CURRE� Y/M
�ddress License#
ELEC�'FtICIAAI • V CORliPdfNV �Q � �
SIGi�ATIDRE REGISTERED / N FEE CURREfi Y/N
Address Z � 33 �icense# --�3��s�'C�7
�LURflBE62 �/��, �V CORflPAR9Y
SIGRIATU�� lY REGISTEREO Y/ N FEE CURRE� Y/�I
�ddress License#
f�iECHAR9ICAL (�, �,/ CORflPAR�Y
�li �� f���tl'�-//��//�
SIG�c�yU�tE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHEI2 CORflP�4tdY
SIGA�A�TQIRE REGISTERED Y/ M FEE CURRE� Y/N
Address License#
E2ESIDERIYIAL Attach(2)Plot Pians;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
I Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Pians w/Silt Fence installed,
Sanitary Facllities&1 dumpster;Site Work Permit for subdivisions/large projects
CO{iflMERCIAL Attach(3)complete sets of Buildfng 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 8�1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet comptiance
SIGfd PERMIT Attach(2)sets of Engineered Plans.
•°•'PROPERTY SURVEY required for all NEW construction.
Directions:
, Fill out application completely.
Owner&Contractor sign back of application,notarized �
If over 32500,a filotice of Commencement Is required. (�41C upgrades over$7500)
•° Agent(for the contractor)or Power of Attomey(for the owmer)would be someone with notarized letter from owner authorizing same
O!/EFt THE COUIdTER PERRIII'PTIfdCa (Front of Application Only)
Reroofs if shingles Sewers Senrice Upgrades A/C Fences(PIoUSurvey/Footage)
Driveavays-Not over Counter if on public roadways..needs ROW
I� .
IdOTICE O� DE�Ci RE��'RICTIONS: The undersigned understands that this permit may be subject to"d'eed" restrictioRS"
which may be more cestrictive#han Gounty regulat�ons. The undersigned assutnes responsibility for compliance with�any , .
applicable deed restrictians. , ,
UNLlCENSED C+C)NTF�ACTQRS AP1D Ct7W��AC�'�!2 RESPONSI�ILlTIES: !f the owner has hired a contractor or
contractors ta undertake work, they may be required to be licensed in accordance wifh state and local regulations. If fhe �
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state taw. If the auvner or in#ended contractor are uncerta'tn as to whaf licensing requiremertts rnay apply for the
intended work, they are advised to cantact the Pasco Caunty Building Inspection Division—Licensing Section at 727-847-
800�. Fur#hermoce, if the owner has hired a contractor ar contractors, he is advised to have the cantractor(s) sign
portians of the "contractor Black" of this application for which #hey wili be respansible. (f yau, as the owner sign as the
contractor, that may be an indication that he is nat properly l9censed and is not entitled to permit#ing privileges in Pasco
County.
1'�►FISPO�'PA710(V IM�'ACT'/U�ILITIE� I�iP�►�i��►R1D RfE�I�U�C� R�COV��tY F�ES: The undersigned understands
#hat Trartsportation Impac# Fees and Recaurse Recovety Fees may apply to the construction of new buiEdings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco Caunty Ordinance number 89-07 and
94-07, as amended. The undersigned also undecstands, that such fees, as may be due, wili be identified at the time af
permitiing. It is fur#her understood #haf Transpartafion lmpac# Fees and Resource Recovery Fees must be paid priar fo
receiving a ""certificake of occupancy" or final powrer release. If the project does not involve a certificate of occupancy or
final pawer release, the fees must be paid pr�or ta permif issuance. Furthermore, if Pasco Caunty V1later/Sewer lmpact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
�4NSTRllCTIO�] L1�EN [.�1tV(C�a�te��113, iFl�eid�Statutes, a� apreer�dec!): If vaEuation o#work is$2,5QQ.00 or more, E
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Proteetion Guide° prepared by the Florida Department of Agriculture and Consumer Affairs. !f the applicant is someone
othe�#han #he"owner", 1 certify that i have obtained a copy of#he above described document and promise in good faith to
deliver it to#he"owner"prior to commencement.
CQNTRAC7'OFt'S/t}�iIPdER'S A��=1�AV1�: 1 certify that a41 the informatian in fhis applicafion is accurate and that a41 wock
will be done in compliance with all applicable laws regulating conskructian, zoning and land development. Application is
hereby made to obtain a permit ta da �nrork and insta4lation as indicated, 1 cer�ify that na work o� 'snsta4tation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all taws regufating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdictian. I alsv
certify that 1 undersfand that the reguiations of other government agencies may apply to the intended work, and that if is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited ta:
- Department af Environmental Protection-Cypress Bayheads, Wetland Areas and Environ►nen#ally Sensifive
Lands, WaterNVastewater Treatment.
- Southwest Florida Water Management Distric#-Wells, Cypress Bayheads, Wetland ,4reas, Altering
Watercourses.
- Army Gorps of�ngineers-Seawalls, Clocks, Navigable Waterways.
- �epar#menf af Health & Rehabilitative ServiceslEnvironmental Neatth Unit-Wells, Wastewater Treatmenf,
Septic Tanks. -
� US Environmen#al Pratection Agency-P►sbestos abatement.
- Federal Aviation Nuthority-Runways.
1 understand that the following res#rictians appfy to the use of fill;�
- Use of fiil is not allowed in Fiood Zone"V"uMess expressty permitted.
- If the fil! material is to be; used in Fload Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time af permifting vsrhich is prepared 6y a professional engineer
licensed by the State of Florida.
- If the fill material is ta be used in Flaod Zone "A" in connection wi#h a permitted building using stem v�rall
construction, I certify tha#fill will be used only to fill the area wi#hin the stem watl. '
- If filt maEsrial is to be used in any area, 1 certify that use of such fiA will not adversely affect adjacen#
properties. If use of�I( is found to adversely affec# adjacent properties, the owner may be cited for vialating
the conditians of the buflding permit issued under the attached permit application, far lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the A,GEfV7'FOR 1'HI� O{AIiVER, I promise in gaod fai#h to inform #he owner of the permitting conditions set forth in
this a�fidavit priar to commencing canstructian. ! understand that a separate perrnit may be required for elec#rica! work,
plumbing, signs, wells, pools, air canditianing, gas, or other installafions not specificaily included'in the application. A`
permit issued shall be canstrued to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technicai codes, nar shall issuance of a permit preven#the Building Official from thereafter
requiring a correction of errors in plans, construction ar violatians af any codes. Every permit issued shall become invalid
untess Ehe work aufhorized by such permit is commenced within six months of permit issuance, or if work authorEzed by
#he permit is suspended or abandoned for a period of six(6) months after#he 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 ninefy(90)cansecu#ive days, the job is considered abandoneci.
t�►�4RPi1P1C TO CiWNEFt: YOUR �AtLURE TO RECO(�� A NQTICE U� CONINIENC��PiEPlT 1V�AY;R,,E�Ul.T IPI YOl��t
F�AYIP�(s'fW11GE �t1iZ�Iflfl�FZOi/E�iif�PITS"f'O Y�'1UF�PFtI�PEFt'YY.- 1�Y�U.IW�EP�1D 1'CD`O�YAON-I�iN�►RIC9�➢C, COf�11�U�.Y
1ij►►ITN Y�i)1��END�R OR A[V A�7C}RN�Y��i�O�E F2�CO�fDtNC YOUf��IOTIGI�OF CG��flE1VCE�EPfT.
FLORIDA JURAT(F.S. 117.03)6 � �"`j�
4l�tPtER OF2 AGEPlT_Er� G' ._. "'"- COPITR,�C70i��J ° �' .
Subsar(bed and sworn to(or med) e e me thls Subscribed and swam to r affirmed efore me this
by bY
Who istare personally known to ms ar haslhave produced Wha fs/are persanally known to me or haslhave praduced
as Identlfication. as identification. ',
Notary Public " Notary Public
Commission No. Commission PJo.
Name af Notary typed,printed or stamped Name of Notary typed,printed or stamped
May, 27. 201� 1 ;�9PM 05127l2014 12:No, 4957#�6;P, 1�01 loo�
From:
e��aeo�a�zo City of ZephyrhNls P�rmit Appii��tion Fax-813-TBO-0021
BUfiding Department
Dete Reeeivsd �-.l''/'-r phqq��nta�t to�Parmtttin � ��� -- ZZ�t�
, � ��• �
Uwnet'g Mame � t awner Phong tdumber
Ot�net's Address S��y •e�, Ubrner Phone Numb�r �� �
Foe Slmple 7ilieholder f�atne � � UWtter PhonO Numbar � f
', Fee 5fr�qle Tfttehalder Addresa
� JQ�AbDI'�tE53 L07# C��
I
' SiJSD1N19tOt� � � PARC��10#
(OBTAINED FRbM PltOPERTV TNC NoTICE)
woRac v�a�os�o � �,�w corrs�n(J� ADt}/AGT Q s��rt � Q ��s�a�.ESN
iNSTALI ��� ft�PAIR
P6tOPflS�ID U°�� Q SPR � COMM � OTHER
"ryPE OF�OfdSTFtUCTIOtd � 94.C1CK pRAM� �] STEEI. �]
i
Ci�3C1diPT10W tlF WORK �. �
I 81{I(,a!!dG SIZ� � � 5�KOt?TAGE�� H�I�HT ��
��UILb1�tG $ ��� VA�.ttATtON bF 70TA�.GONSxF2tfC'i10�
�EIEGTRiGAl. �g� AMP SE�tVIC� � PROGR�SS ENERC�Y [� W.t�.�.C.
�PlUM81NG ��� .
�MECNANICA�. �---��-� VA�UAtION OF MECFSANICAL IPISTALLATION
�JGAS [� Rotl�ING � SP�CIALTY � OTH�R
FINISH�C�FLOOR EL�VAtIONS r�� �Ldt�D ZONE AREA �Y�S NO
L
1��l��,pi�it� ��;� CdMNA�f �W
SIGMA7U E �.rr • �...r.r"""' REGISTEREO Y/ � FEE CURR�P Y I Fl
AddCess l9cense tF ���
�lECTftfCiAht CQMPAtdX
StC3t�ATt1R� RECisrER�o Y t N FE�CttRitEh Y t N
addr�ss L�cense� � —�
Pl.U1NaB�R GOMPANY
SZGIr1ATl�R� � Ft�C3ISTEREO Y J N FEE CtIRRE#+ Y 1 N
�0.dldtesS L1C9nSg# �_ �
fUIECHAfi1lCAL C011APAI�JY {1 G�S
51��1a1'URE RE�4s�R� Y i N �e cuRR�e Y 1 N
Address Q.�?- License# �p+C �{
O'CH�a COMPAN'Y
' 9�IGNA'Ti�R� ' rcEGtsT�RHO Y! N FEE cUltREh Y J N
�,.,,.�.._y I """"^"-[�l�
i iiiiii iiii�iiiii iiiii iiiii iiiii iiiii iiiii iiiii i�iii ii�i�iii
2014085896
Rcpl:1606224 Ree: 10.00
' � NOTICE OF COMMENCEMENT DS: 0.00 I T: 0.00
Permit No.
05/29/14 E. Munguia, Dpty Clerk
Properry Identification No. ��26— Z����0— �Z?�0-�p0
. ,.::•
T'HE LJNDERSIGNED hereby gives�notice that imprbvemenis will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in the NOTICE OF COMMENCEMENT.
1. Description of property(Jegal description:)`.. a�S � �'c'�C v \�. Q�a vV� �a.�- oe �o a�b��30�6
a) Street Address: � "�y�`1 C�a\\ ��,v c�. ZsL.a�•....��,..+,\\ s �e\ 3 3 S �
2. General description of improvements
" CL+,�c.�,�d�.a�A �.�.�c-�-C .
. Owner Information
a) Name and address: ��.1 �`�'c-x..c�,,. �6`h.�Y. 5 3►'�`1 �p\\ Q� �,';�,r��,�
b) Name and address of fee simple titleholder(if other than owner) ����
c) Interest in property �
4. Contractor Information
a) Name and address: �A�sL 'A � OW�9_�'
b) Telephone No.: Fax No,(Opt.)
S. Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No.(Opt.)
6. Lender
a) Name and address:
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served;
a) Name and address:
b) Telephone No.: Fax No.(Opt.)
S. In addirion to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Secrion
713.13(1}(b),Florida Statutes:
a) Name and address-
b) Telephone No.: Fax No.(Opt.)
9. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMF.NCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR�ROVEMENTS TO YOUR PROPERTY.A
NOTICE OF CONIlVIENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION.IF YOU IIVTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCIIVG WORK OR RECORDING YOU NOTICE OF COMII�NCEMENT.
STATE OF FLORIDA �
COUNTY OF PASCO
Signature er or er's Aythorized OtHcer/Director/Pa�er/Menaga
������$t.��� �`c1�ia^(�
� Print Neme
The foregoing instrument was acknowledged before me this�/ day of /�/1.� ,20�by '
as (type of authority,e.g.officer,trustee,attomey in fact)for
(name of party on behalf of who ' strwnent was executed).
ersonally Kno R Produced Identification_ Notary Signahue
. ,,,.,,,,, � uNE
Type of ldentification Produced Name(print) =� � ' tl
� �1f8S �
Verification pursuant t ,, . @r-penalties of pequry,I decl f�Tl� . e�$d � e facts state�'
in it are true to the bes _R_ ;,. �On ES c '
E 44052G
Fonresixoc.,�a�oo� � ;:� ExP�rgS DeC@mb2r 12,2(?��' �
�'P,,,,.°`��� BadedThr�T�oyFan6mparcepp43Fg;,:: �. SipiewoofN�RValPmonSip�in�ADove
PRULR S.0'NEIL,Ph.D.PRSCO GLERK & COMPTROLLER
05/29/14 0�3�?�� p�°;��n� ,
OR BK '��, L '� ,
���� ��
,��j► . � o �.Q STATE OF FLORIDA, COUNTY OF PASCO
� THIS IS T0�CERTIFY THAT THE FOREGOING IS A
a7�' ,G�d► TRUE AND CORRECT COPY OF THE DOCUMENT
� ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
� 1+�G �e arust • * WIT Y HAND AND ICI L SEAL THIS
� � r'+"'� � � DAY OF 2�
� • PAU . . C MPTROLL R
'� . 1�8� * _ _
�r'��oF�.o��OP -
EPUTY CLERK
i
Li � htin . 5000 va
� �
General outlets . 1000va
Si n . 1500va .
g
A c . 10000 .
Hand dr ers . 3000va .
v
Kitchen e u i . 15000 .va .
q p
Wa l k i n co o l e r. S OOOva .
H ood . 3000va .
M i sc . 10000va .
Tota I . 5 3 5 00 .
3 h . 120 208 v = 150a m .
p p
�_
75 = 113am
p
I
L- i � �h ' n . 5000 va
�
� �
. Genera I outlets . 100�va .
Si n . 1500va .
�
A c . 10000 .
Ha nd d r ers . 3000va .
v
Kitchen e ui . 15000 .va .
q p
Walk in cooler. SOOOva .
Hood . 3000va .
M i sc . 10000va .
Tota I . 5 3 5 00 .
3 h . 120 208 v = 150a m .
p p
75 = 113am
p