HomeMy WebLinkAbout16-17951 ►
� � ' CITY OF ZEPHYRHILLS
� - 5335-8TH STREET
� (8i3)7so-oo20 51
�
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit R`lumber: 17951 Address: 5510 24TH ST
Perm�it Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Propos,ed Use: NOT APPLICABLE Lot(s): Block: Section:
Squa;�e Feet: Subdivision: Hi4ZEL HEIGHTS
Es�. Value: Parcel Number: 12-26-21-0070-00000-0130
Impro''v. Cost: 5,795.00 OWNER INFORMATION
Date Issued: 11/22/2016 Name: ADAMES, ADONIS &AYALA, VIRGEN
Tot�l Fees: 65.00 Address: 5510 24TH ST
Amoi�nt Paid: 65.00 ZEPHYRHILLS, FL. 33542
Date Paid: 11/22/2016 Phone: (813)788-5459
Wo'k Desc: REROOF SHINGLE
� CONTRACTOR S APPLICATION FEES
SUN COAST ROOFING REROOF RESIDENTIAL 65.00
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Ins ections Re uired
DRY IN R��OF INSP
TAPE JOINTS ROOF INSP
� FINAL II
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RE NS�ECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
I first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICIE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may b�e 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.
"Wa�'ning to owner: Your failure to record a notice of commencement may result in your paying twice for
imprbvements to your property. If you intend to obtain financing,consult with your lender or an attorney
�� before recording your notice of commencement."
Comp�ete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
�� City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
II NO OCCUPANCY BEFORE C.O.
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II
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CONT C OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
I PROTECT CARD FROM WEATHER
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i ' I 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
I Building DepaRment
i Date Received �� , , � phone Contact for Permitting ��� �� –� �l/
� Owner's Name Owner Phone Number �
IOwneYs Address � Owner Phone Number
IFee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS �� � LOT# �
SUBDIVISION � lJ1/�� PARCEL ID# �2 ��w �
(OBTAINED FROM PROPERTY TAX NOTIC�
WORK PROPOSED � NEW CONSTR e ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM � OTHER
' TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE �� HEIGHT _`�I
��11LDING $��/ VALUATION OF TOTAL CONSTRUCTION
�-1
DELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � � ���
OGAS �—ROOFING Q SPECIALTY 0 OTHER i/�
l
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y I N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
Address License#
� PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED / N FEE CURREA Y/N
Address � .� lS[L� License# 1.:,
1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 I 1 1 1 1 I 1 1 1 I 1 1 1 1 1 I I 1 I 1 1 I 1 1 1
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new cons[ruction,
Minimum ten(10)working days after submittal date. Required onsite,Construclion Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large proJects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortns.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 compliance
SIGN 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$2500,a Notice of Commencement Is required. (AIC upgrades over$7500)
I " Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
i OVER THE COUNTER PERMITTING (copy of conVact required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
IDriveways-Not over Counter if on public roadways..needs ROW
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� NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may 6e subject to"deed"restrictions"
i which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
I 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
i 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
i County
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07,as amended. The undersigned also understands, that such fees, as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
' receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release,the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner',I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit application,for lots less than one (1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or
set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building 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 ATTOR EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S.11 03) �
OWNER OR AGE CONTRACTOR
Wh i�i ed d sw o or ffir b re his Sub ri d a sworn t affiJ ed is �/� ,
Y ( _�_a�f��� �/ _
ona y known to i or has/have produced W,o is/are e or has/have produced
s identification. as identification.
Notary Public Notary Public
I Commissio N � ' Commission No.t �
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IName of N a ty , rin ed or stam ed Name o Not nted or stam ed
- I :�,::��y�,�: MARY M SURNICKI =�'�"•"'�'xy;: �1RY 111 SURNICKI
+'a• ••: MY COMMISSION�FF933614 ,�� MY COMMISSION�#FF933614
I I '�r� EXPIRES November O4,2018 „�����r EXPIRES November O4,20f3
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ty Staie,Zip: Job Address: State of FToridu--''
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TYPE ��� ROOF: ingle Metal ' Tile
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Remove "sting roof.(If applicable�_layers} Replace any damage plywood at a wst of$ ��per sheet and decking at$�per linear foot
Replace � y damaged Fascia and Sub Fascia at$�^per Iinear foat 1
InP� � g �... �—..�L.�Ff � ��/o"(r`ePl:'
Dri Ed�e: ,�OG'� Plumbin Boofs: � v'� FLid e Vents: Vents:
Vatley Fl��shing: Wait Flashing: Metal Coiors: Cobra: �� ,
Shingles��Install 3-Tab Shingles ifetim rchitectural Ultra-Lifetime Architectural '
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Brand: I� �/�7'� Color: C..�'!'J/��� fT�"� �i���� V'
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Metai: Sv Crimp PBR Metal Standing Seam Metal
Tile: � Manufacturer Series Color '
Underlayment Ur��a- -��� �_,... .. _ _..
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! COmments: G ff" .i f fnOd".� Le u/rJ /ta ���:�.�° �f1�!l �GGf 3 �O G�l� d,u+�7��1 ��
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Sun C��ast Roofing Warranty: /�� Years Labor guarantee against Leaks.
Manufacturers Labnr Warranty:_��Ye�rs("Systems Plus"or"Goiden Pledge")
Manu�acturers guarantee on material �,.� Years
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Re-nail decking with 8d r3ng shank nails per Florida bullding code.All material is guaranteed to be specified.All work to be wmpleted in a substantial warkmanlike manner accordang tp speci5cations
submi �i,per standard practices.Sun-Coast Roofing Services will clean up and haut away all jab related debris.,Any alteratian or deviatian from above speci&cations invaIving extra costs will be executed
anly upo written ordezs,and will became an extra charge over and above estimate. AI!agreements aze contingent upon suikes,acts of god,accidents,or other delays beyond cpntrol. Oviner is to carry
fite,torn��do and other building insurances.Our workers aze fully covered by workmen's compensaUon insurance.
Florid Ia°contains important requirementa yau musz foflow before you may file a lawsuit for defective construction against a contractar,subcontractar,ar supplier for an alleged consuuction defect in your
home. �ixty days before you file you must deliver ta the contractor,subtontractpr or supplier a written notice of any construction conditions you allege aze defective and provide your contractor,
subconuactor or suppliez the opportuniry to inspect the alleged construction defeas and make an offer to zepair or pay for the alleged construction defecu.Yau are not ohligazed to accept any offer made
by the c�ntractor,subconuactor oz suppliez.There are strict deadlines and procedures under Florid Law
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Sun-+�oast Raofing: ���z..�"� � r� Date: / � ��
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Clien, Signature: Date: � � G�
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PRi� E$ �� � / �./ Parice includes material,Iabor and germitting '
I'�ote�:
First Wc�i�•ranty%Maintenance Service to be performed within 30 days of campletion of roof .
SUN-COAST Roofing Services has the right to cancel,this confract forany reason,at any Gme,even ahex the contract is signed by t3te purchasez,prioz to the&tarting of any job.We ue not responsible for cncked
drivew�ys.Should it become necessary foz purposes of enforcing ihi�contract,foz tontractor to incur any expenses and become obligated to pay any attomey's fees and court costs,purthascr agrees to reunburse
aontral�j or all such expenses including interest(18%APRj,attomey's fees and court costs.Past due invoices of 30 days or greater,all unpaid balances will cazry an interest xate of 18%APR or 1.59b APR per mottth.
Port O'range:386-750-0069 • Daytona Beach;386-252-0877 • (}xmond Beach:386-6TT-2252' . New Smyrna Beach:386-428-065
I Palm Coast:3$6-864-2�28 • Deland:386-7345529 • Titusville:321-749-7663 . Sanfard:401-322-2925
inr���.+��tP•qtid_SAd_3(�(�A . Tamna•813-867-7050 • Toll Free:$66-476-2649
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• 2016185158
i PertnitNo. ParcellDNo��- ��- al -bo� D- 00000-0130
NOTICE OF COMMENCEMF,�IT
i��rC�
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state or r(u r i d.� counry or t'�•t v _
THE UNDERSIGNED hereby gives notice that improvement will be made to certain reai property,and in aaordance with Chapter 713,Florida Statutes, ������
i the(ollowing information is provided in this Notice of Comme cemenL �-�o ��.�.t� C., � •
�� � Descriplion of Property: Parcei IdenUfication No.�a2�'� I!l�G i I+�J �/U�������n �� ��� �
I Streel Address: "���� �4� S+ree� , Z.e whv v H; i I,� �I 3 3 54 2- ��g P�� ��
2. •General Description ot Improvement r'e�v� T
3. Owner Infortnation or Lessee information if the Lessea conUacted tor lhe improvement:
�1�'s� �r�1(1a YY1`�
�.�CZc"��l''� '�. _ ?�r�)1'i�l l 5 �L
Address City T— State
Interest in Property:
Name of Fee Simpie Titleholder.
(If different fram Owner lisled abovej
� Address Ciry State
4. Contractor:
2 • ��lY� �L.
Address �n_�^� ^� City Stata
Cantradors Telephone No.. �� J1 �
5. Surety:
Name
Address Ciry State
Amount ot Bond: $ Telephone No..
fi. Lender
' Name
Address Ciry State
Lenders Telephone No..
7. Persons within the State of Florida designated by the ovmer uvon whom notices or olher documents mey be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address Ciry State
Telephone Number of Designated Person:
8. In additlon to himself,the owner designates of_
to receive a copy of the Lienofs NoUce as provided in Section 713.13(1j(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencemenl(tha expiralion date may not be befora the completion of construction and final payment to the
contrador,bu[will be one year from the dale o(reeording unless a di(terent date is specified): ��
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT � �
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
Under penalty of peryury,I declare that I have read the foregoing notice of ommencement and that the taas stated therein are true to the best
of my knowledge and helief. � --
STATE OF FLORIDA �
COUNN OF PASCO
Signature of er r Lessee, Ownefs or Lessee's Authorized
RC{9f.:1817265 Ree: 10.00 OfficedDirectodPartner/Manager
DS� 0.00 IT; 0.00 Clerk F
11%22/2016 J. R. Opl.y sisnatQry's r�ue�otece
The foregoing(nstrumeM was acknovAedged before me this Lday of y�u r20��by
as (type t ai orit .g.,ofticer,trustee,attomey in tad)for
(na t erty f wh instrument vras executed).
Personally Known Q8 Produced Identification❑ Notary Sfgnature u
Type of Identification P � �)
�� MARY Ib BURNICKI
;':,r,,,'',': MY COMMISSION 11 FF933614 PRULR 5 0'NE I L,Ph D PRSCO CI.ERK g COMPTROLLER
EXPtRESNwember04.2019 11/22/201 0�:+4 am 1 cof 1
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Iwpdata/bcs/noUcecommencemenl�c053648
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���`����; � t°o� STATE OF FLORIDA, COUNTY OF PASCO
�► THIS IS TG CERTIFY THAT THE FOREGOING IS A
��. � d TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
� " � �c WITNES�MY HAND ANp OFFICIAL SEAL THIS
In yarf'ws 7ncsr
� s � A � •� ��NEIL�FCLER&COMPTROL�L R
� � � 1
a88� � BY � DEPUTY CLERK
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� Fraud toServe the GreritStnte of Fforida
8431d.Dixie F7eewvy New Striyrii4 BevCfi,ft 32268
CorporrateC?fJlce:(38'6j423-o6,6, ��^;�+
Corna Office t(32YJ743-7663
r�,rrpff affi�r�.(Et3)es��osa
Fax:(386jA23-0676
ATCN: City Of Zephyrhills
5335 th St.
Zephy�hiils, FL 335�2
l, Michele Tauscher, as the contractor for Sun Coast Roofing Services, license number CCC1329155.�Authorize
the fo lowing people to subrnit, pay for, and pick up permits,
Britta y Seltman
Chuc Peterson
Mary Surnicki
Kevin Simms
Qann O'donnel!
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V�
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antr ctor Signature
i r ,.,
�I The f; �oi g i strum t was cknowledged before me thi�day of 2Q�1�,�
�, gY�'� / d��_�� �1�as {type of authority,e.g.officer,trustee,attomey in fact}
i
For (� , as
{Name of Person} {Type of autharity,...e.g.officer,trustee,attarney in fact}
Fot' � (name of party on beh of w m instr ment was executed}
Pers�o n � �'�.��ID
=•: �•: Mv cprusMissfoN�F��38�4 Notary Signature
�'•�,!�... ExPtREs i�tovera�et ti4.2M9
�,or��e-a„3 ,,�,,,, Print Name 1� _
� ACCOUNT NO.
2016 -2q17 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30,2017 20367
OCC.CODE � RENEWAL
090.023001 ROOFING,SIDING, RELATED SHEET METAL 30 Employees Receipt Fee 54.00
Hazardous Waste Surcharge 40.00
Law Library Fee 0.00
. . CCC1329155
BUSINESS SUN COAST ROOFING SERVICES INC
1427 HOBBS ST
TAMPA, FL 33619 � , � �
TAUSCHER, MICHELE L
NAME 843 NORTH DIXIE FREEWAY
MAILING NEW SMYRNA BEACH,•FL 32168
ADDRESS Paid 15-622-002314
09/07/2016 94.00
BUSINESS TAX RECEIPT DOUGBELDEN,TAXCOLLECTOR
HAS HEREBY PAID A PRNILEGE TAX TO ENGAGE 813�S35S200
IN BUSINESS,PROFESSION,OR OCCUPATION SPECIFIED HEREON THIS BECOMES A TAX RECEIPT WHEN VALIDATED.
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%°��o�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/WYI�
q 11/17/2016
THIS CER7'IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICdTE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. ��THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate�holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Bouchard Insurance for WBS PHONE g66 293-3600 ext.623 F�
P.O.Box 60��0 ruc No e:c: � ) ivc No:
E-MAIL
Clearwater,I L 33758-6090 ADDRESS:
INSURER(S AFFORDING COVERAGE NAIC#
iNsuRean. American Zurich Insurance Com an 40142
INSURED
INSURER B:
Workforce Bu iness Services,Inc.Alt.Emp:Sun Coast Roofing Services Inc.
1401 Manate� Ave.West Ste 600 INSURER C:
Bradenton,FL 34205-6708 INSURER D:
I INSURER E:
INSURER F.
COVERAG�S CERTIFICATE NUMBER:15FL079893947 REVISION NUMBER:
THIS IS Td CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEC�. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFIC�TE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIO S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�TR I T�'PE OF INSURANCE NSD SWVD POLICY NUMBER MMIDDY� MM DD� LIMITS
CO�MERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE �OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence S
I MED EXP(My one person) $
I PERSONAL 8 ADV INJURY $
GEN'L A�GREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY� PRO- ❑ LOC PRODUCTS-COMP/OP AGG $
II JECT
OTHER: $
AUTOM�BILE LIABILITY COMBINED SINGLE LIMIT �
Ea accident
AN�4I AUTO BODILY INJURY(Per person) $
ALU OWNED SCHEDULED BODILY INJURY(Per accident) $
AU OS AUTOS
I NON-OWNED PROPERTY DAMAGE $
HI I ED AUTOS AUTOS Per accident
$
UMBRELLALIAB pCCUR EACH OCCURRENCE $
EXI�ESS LIAB CLAIMS-MADE AGGREGATE $
DE RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EM LOYERS'LIABILITY X STATUTE ER
ANY PR�PRIETOR/PARTNER/EXECUTIVE Y�N E.L.EACH ACCIDENT $ 'I,OOO,OOO
A OFFICEi�/MEMBEREXCLUDED? � N�A WC 90-00-818-05 12/31/2015 12/31/2016
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE 5 �,�00,000
Ifyes,d�escribe under
DESCRIPTION OF OPERATIONS 6eiow E.L.DISEASE-POLICY LIMIT $ 'I,OOO,OOO
Location Coverage Period: 12/31/2015 12/31/2016 Client# 054357
DESCRIPTIO�OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
covera9e is�rovided tor Sun Coast Roofing Services Inc.
onlythosec employees 843 N Dixie Highway
of,but not su contractors New Smyrna Beach,FL 32168
to:
CERTIFIC�ATE HOLDER CANCELLATION
City of Zephyrhills Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
I 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
I Zephyrhilis,FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS.
iAUTHORIZED REPRESENTATIVE
� `
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD II5(2014/011 The ACORD name and logo are registered marks of ACORD
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LAY AS R�C�UfRED �.Y LAVt/ s�c�� L16p8100aC►1443
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ACORt�� DATE(MM/DD/YYY�
L..�� II CERTIFICATE OF LIABILITY INSURANCE 11/17/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TF�IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENT�4TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. �
IMPORTANT' If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGA�ION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certifcate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER I NAMEACT Jeff Lampert
Presidential�nsurance Services, LLC ac"o EXs: 305-423-0350 �� No;305-423-0351
2665 South ayshore Drive#707 a oR�ess: jeff@insurancequotelive.com
Miami, FL. 3ifi133, INSURER S AFFORDING COVERAGE NAIC#
iNsuRERa: Preferred Contractors Insurance Com an
INSURED I INSURER B:
Sun Coast oofing Services, II1C. INSURERC:
843 North D xie Freeway INSURER D:
New Smyrn Beach, FL.32168 INSURER E:
LIC# CCC�329155
INSURER F:
COVERAGES� CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO�ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. IINOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATL MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSION AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD/YYYY
X COM i RCIAL GENERAL LIABILITY EACH OCCURRENCE $ 'I.00O.00O
DAMAGE TO RENTED rjO,OOO
C IMS-MADE � OCCUR PREMISES Ea occurrence �
MED EXP(Any one person) S 5,��0
q I PC-78674-06 2/15/2016 2/15/2017
PERSONAL&ADV INJURY $ �,OOO,OOO
GEN'LAGG EGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000
X POLICI �jE� � LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: §
AUTOMOBI ELIABWTY COMBINED SINGLE LIMIT �
Ea accident
ANY PIUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTO$ONLY AUTOS
HIREQ NON-OWNED PROPERTY DAMAGE $
AUTiS ONLY AUTOS ONLY Per accident
$
UMB I LLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB AGGREGATE $
CLAIMS-MADE
DED RETENTION$ $
WORKERSi�COMPENSATION STATUTE ERH
AND EMPLbYERS'LIABILITY
' ANYPROP�IETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT 5
OFFICER/ EMBEREXCLUDED?
(Mandato ' in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,desc'be under
DESCRIPT ON OF OPER4TIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of Zephyrhills
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
5335 8th Street ACCORDANCE WITH THE POLICY PROVISIONS.
Zephyrhills, FL 33542 AUTHORIZEDREPRESENTATIVE
� �
II O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
l II