HomeMy WebLinkAbout16-17987 . ,
R� CITY OF ZEPHYRHILLS
5335-8th Street
(813)780-0020 �7. 7 i
ELECTRICAL PERMIT
� PERMIT INFORMATION LOCATION INFORMATION
Permit 17987 issued: 12/05/2016 Address: 38122 HENRY DR
Permit�ype: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class o Work: ELECTRICAL MISC Township: Range:
Propos�d Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 2,375.00 Total Fees: 50.00 Subdivision: CITY OF ZEPHYRHILLS
Amoun Paid: 50.00 Date Paid: 12/05/2016 Parcel Number: 02-26-21-0080-OOA00-0070
CONTRACTOR INFORMATION OWNER INFORMATION
Name: NEW-TECH CONSTRUCTION CORP Name: CITY OF ZEPHYRHILLS
Addr: 1579 BARBER RD Address: 38122 HENRY DR
SARASOTA FL 34240 ZEPHYRHILLS, FL. 33542
Phone: (941)485-8988 Lic: Phone:
Wo k Desc: SERVICE CHANGE OUT 100AMP TO 200AMP
' APPLICATION FEES
ELECTRI L FEE 50.00
INSPECTIONS REQUIRED
ROUGH E ECTRIC
CONSTR CTION POLE
PRE-MET�R
FINAL I
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REIN PECTION FEES:(c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the
local �overnment shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTIC� In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may b 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 nin to owner: Your failure to record a notice of commencement ma result in our a in twice for
9 Y Y P Y 9
' improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement.
,�
Compl te Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City
� Codes and Ordinances.
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CONTRACTOR PER OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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a�s-�aa-ooza City of Zephyrhills Permit Appiication F�-813-780-0021
� ' . Building Department
Date Received _ '� � �'J� ��� ��� 3�1 l�
� Phone Contact for Permitting
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Owner's Namd °-�G � �c?�� Owner Phone Number � 5 �' �" �d b 6
Owner's Addr ss p L?2 „� _�,, ^f}� 'l�y CG Owner Phone Number � Z �'"-�2�'"��I� .
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Fee Simple Ti eholder Name �+�� �C%e�} Q/�./�J 13 Owner Phone Number �— �
Fee Simple Ti�Ieholder Address
JOB AdDRES � t3 I e ) � �OT# C_�
SUBDIVISION �— � PARC �ED#
(OBTAINED FRqM PROPERTY TAX NOTICE)
NfORK RR4P�SED e � NSTALI.$�� REPAIR C� St�� � � ��MOLISH
PROPOSED. SE Q SF12 [� GOMfVI � QTNER
TYPE"OF CQ�STRUCTION Q BLOCK • Q FRAME � STEEL Q
DESCRIPTIO OF WORK �x�'� ��� f��� ��-✓j�'G� �ihf?� " �t� � � 6� �
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BUIL'DING St E � � �J � SQ FOOTAGH Cf��'f H HT tf�j f�
�g�� ��N�' �� VA�UATION'OF TOTAL CONSTRUCTIflN
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�1. CTRICAL $ �� � AMF'SERVICE c��� � PROGRESS ENERGY O W.32.E.C.
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QPl. MB1NG $
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�ME�HANICAL $ VAL.UATION QF MECHANICA�INSTALLATIQN p�
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�GA Q RQOFWG Q SPEClA�TY �� QTHER �
FINISHED FL OR ELEVATIONS � � � FLOOD ZONE AREA QYES NO
BUI�DER COMPANY
SIGNATURE REGISTERED Y/ N PEE CURRE� Y/N
Address License# � �
ELEG7RtGt �/��--,� �a��6��'" COMPANY I av��'��I�G�� �Gi✓,S'�/`��i- ��(� a
SIGNA7URE ' REGISTERED Y/ N FEE CURRE� Y/N
Address' Cicense# �^ ��
P�t1MBER.; �p�pp,�y�
SIGNATURE -REGI$TERED Y•/ 'N FEE CURRE� Y/N
Address License# � �
3UIECHi0.E11C COMPAFIY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Adilress - -' License.#��- -�
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� QTNEf2� .. CONtPANY -
SIGNATURE,� � RE��sTeReo Y/.N FEE CURRE�' Y/N
Address License# �— �
`:RESIQENTf :_ A#fach:{2}Plot`Plans;�{2}�set"s of Build�ng%Plans;{4�}`set`of Enecgy'Forms;R-Q-W.Permit far new.cansUvotion, �
�Minimum,;ten;(,10)i,vorkingtdays afte�submittal tlate. Required`onsite,ConstnicGon Plans,Stormwater Plans w/Silt Fence installed,.
�� � Sanitary Facilities.&<14 dumpster;Site;Wqrk P.e'rmit for.sutid'ivlsions/large projects
�: CflMMEftC1A Attach�{2}"complete sets bf Builciirig Plans plas a�i.ife Safety Page;{1}se#of Energy Farms.ft-O-W Permit for new constructian.
„ Minimum ten(10)working days after submittal date. Required onsite,CanstrucUon Plans,Stormwater Plans w/Silt Fence installed,
" Sanitary Facilities&1 dumpster.Site Work Permit for ait new pro�ects.AN commeeciai requirem.enfs must rneet compliance
SIGN�PERMIT A#tach{2)sets of;Engxneerec!Pians. ,
. """PROPER7'Y 5URVEY r.equired for all.NEW constructian.
'.Diiections: y�- r. •
� Fill out a plication completely. -
Owner&;Cantractar sign back af application,notarized
tf over$ 500,a Notice af Commencemenf is required. (AJC upgrades over$7500)
"' Agent(fo th'e-contractor)ar Power of Attomey(for'the owner)would be sameane with notarized letter from owner authorizing same �
� .OVER TiiE C� UN'fER PERMIFfING . (copy of contract�required)
� Reroofs if shin�les Sewers Service l�pgrades A/C Fences,(PIoUSurvey/Footage)
Drivewa s-Not over Counter if an public,rqadways.�needs•�ROW��-1��•'�"�"'�"�'"'i
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NOTICE OF DEED RESTRICTIONS: The undersigned understands.that.this,permit may be subject to"deed" restrictions'',�, ",
which may.be mare restrictive than Caunty,r.egulations: The�urtdersigned.assuriies°�responsitiility-fo'r i;orripiiance'inrith..any� "
applicable deed restrictions. � ,.... .,. .. .
UNLlCENSED. CQNTRACTORS AND' CONTRACTOR RESPONSfBlLITIES: if the �owner has tiired a� cor�tractar ac
contractars ta undertake work, #hey may be required to be:�licensed in accordance with state and locat regulations:�.lf tiie �
contractor is not licensed.as required by law, both the awner and.contractor may`be citeii�for��:a misdemeanor violation
undec state law. If the owner or intended contractar are uncertain as to what licensing requirements_may=�appl.y for�#i�e� �
intended work, they.are-advised to contacf�tfie Pasco County Building Inspection Di`v'ision=Licensing Sectian at 727-847-
80Q9. Fur#hermore, if #he owner has hired�a coritractor or contractars, he�is advised to �have the contractor{s) sign ,...
portions of the "contractar Block" of this applicatian for which they will be responsible. If you, as"thie owner sign as:�tHe'�" :
contraator, that may be an indication that he�is not properly licensed and is nof erititled�to permitting privileges in Pasco
County. . � ` •
TRAN�PORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands �
that Transportation Impact Fees and Recaurse Recovery Fees may:apply#o t�e canstruction of new buildings, cliartge�of•-"" �'
use in existing buildings, or expansion of.existing"�uildings, as specified in Pasca County�Ordinance number 89-07 and �
90-07, as arr�ended. The undersigned also understands, that such fees, as may.be.due, will be ictentified at�.ttie tirrte�of� :
permitting. I# is fur#her understood fhat-Transpottatian tmpact Fees-and Resource:Recovery. Fees must be paid prior to
receiving a "certificate of occupancy° or final power release. If the project does nat involve a certificate of occupancy.�oc�.�>
final power release, the fees-must be paid prior to permit issuance. Furthermore, if Pasco County Wa#erlSewer�Impast, -�
fees are due, they must be paid prior to permif issuance in accordance writh applicable Pasco County ardinances: �
CCINSTRUCTfON k1EN I:AW(Chapter 713;"Flaiida Statutes,as amendecf}: If valuation af work is$2,50Q.OQ._or:more,.�t., ....
certify that I, the appiicant, have been pravided with a copy. of the "Florida Construction Lien Law—Homeowner's��
Protectian Guide" prepared by the Florida Department of Agriculture and Consurner_Affairs. If the applicant+is someone
other than the"owner", t"eertify that i have abtained a copy of#he abaue'described`document-and promise•in good faith to
deliver it to the."owner" pribr to commeneement: �
CQNTRACTQR'SIDWNERSS AFFIDAVIT: ,I.certify that alE the infarmation in this applicatfon is accurate and that all wark
will be done in compliance with all applicable`laws r'egulating canstruction, zoning and land-development. Application.is �
hereby made to obtain a permit to do work and insta}latian as indicated. t certify that no wark or installation has
cammenced priar to issuance of a perm'it and�that ail work wi(I be performed to meet standards af ali laws regulating
canstruction, County and City codes, zoning regulations, and land develapment regulations in :the jurisdiction'. �! also
certify#hat 1 understand that the regulatians af other government agencies may apply fo the �ntended 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 Environmen#al:Protectian-Cypress Bayheads; Vltetland Areas and Environmentally Sens'rtive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Depa�finent of Health & Rehabilitative ServiceslEnvironmerttai .Health Unit Wells, Wasteuvater Treatment,
Septic�Tanks.
- US Enviranmentat Protection Agency-Asbestos abatement. ,
- Federal Aviatian Au#hority-Runways.
I understand that the following restric#ians apply to the use of fill:
- Use of fill is not allowed in F1oad Zone"V"unless expressly permifted.
- If the fill material is to be used in Flaod Zone "A", it is understood that a drainage plan addressing a
"compensating volume° will be subrrtitted°at time of permitting which is prepared by a pra#essional engineer
licensed by the Sta#e of Flarida.
- If the fill material is ta be used in Fload Zone "A" in connection with a permitted building using stem wal!
canstruction, i certify that fi{I will be used only to fll the area within the stem wali.
- 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 fi11 is found to adversely affect adjacent properties, the awner may be cited fo�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, art engineered drainage�plan is required.
1f i am the AGENT FOR THE OWNER, i promise in good faith to inform the owner of the permitting canditians set forth in ,
this affidavit prior to commencing constractian. I understand that a sepa�ate permit may be required for electrical work, ,
piumbing, signs, wells, paols, a�r candit�oning, gas, or other iristailatians nat specifically included in the appiication. A �
permit issued shall'be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, ar
set asicle any pravisions of the technicaE codes, nor shall issuance of a permit prevent#he Buildirtg C}fFcial from thereafter
requiring a correction of errors in plans,�construction or vialations 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)manths after the time the work is'cammenced. An extension
may be requested, in'writing, fram the Building Official for a period not to exceed ninety (90) days and will demonstrate
—justifable-caus�-for-_the_.extension._If work ceases for ninety{90}cansecutive days,the job is considered abandoned.
WARNtNG TC? QWNER: YOUR FAlLURE TO RECORD A NC1TlCE OF CQMMENCEMENT MAY RESUlT IN YOUR
PAYING TWICE FUR IMPROVEMENTS TO YOUR PROPERTY.. IF YOU.iNTEND•TO QBTAiN FINANCING, CCiNSULT -
WITH YOUR CENDER OR AN ATTORNEY BEFORE RECORDING YOUR�NOTICE OF COMMENCEMENT.
F�OF2IDA JURAT(F.S.117.03)
OWNER QR AGENT CONTRACTOR �'"`T � �� �
Subscribed and swom ta(or affirmed)before me thls Subscribed and swom to(or affirmed befare me this ,,.--,
bY �a-s-�(o �v �G.sp� 1-��-?"'�/��'��Sd2• �
Who is/are personally knawn to me or has/have produced � Who is/are e onally known to me or has/have produced
as tdenSfication. 1.�Q1 ���'�,�'.Q . as�dentification.
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oF��v�, STATE OF FLORIDA
�=-:.__:�==°.� DEPARTM�NT OF BUSINESS�4ND PROFESSIOtVAL REGULATION
e = �'�- �►
� � 4a� ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395
'" °� �` 2601 BLAIR STONE ROAD
CODµB
TALLAHASSEE FL 32399-0783
T LLOS, COSPER LEE JR
NEW-TECH CONSTRUCTION CORPORATION
1�79 BARBER RD
S� RASOTA FL 34240
Congratulati ns! With this license you become one of the nearly f'�.--- -----�-�..-�-�-�_---�_- -_�--=_ ____��� -4Y .� __..�_M-_.��
one million loridians licensed by the Department of Business and { � - �:� - '� ;
Professional Regulation. Our professionals and businesses range � ( /;Y��_ STATE OF FLORIDA �� - � ;
from archite' ts to yacht brokers,from boxers to barbeque � j �;��,,� -DEPARTIVIENT OF.BUSINESS AND � ;
restaurants, and they keep Florida's economy strong. I j- �%'' PROFESSIQNAL'REGULATION - � ,
` � :.> :_i_=�;� . , :- - , � ;
� i _ EC0001689 - � -=--�� ISSIIED:"'�08/17/2016
Every day e work to improve the way we do business in order .'��r•�:�-=, __ _ j ;
I ' -- _ . ; �.__�.;:. ,;_=�=�,..;;� �
to serve yo�better. For information about our services,please � � - - _- :�;,�_=- ,��-;��- ;.- --� , - . , ,
log onto www.myfloridalicense.com. There you can find more p ; :_ CERTIFIED.ELECTRICAL'_GONTRACTOR ; ;
information�bout our divisions and the regulations that impact ; e_--TULCO$,.GOSFER-LEE�JR-�=:=��';:_;.;'�-:;'• - "� ��- i :
you,subscribe to department newsletters and learn more about � �:�NEW TECH-CO�ISTR�U.CTION CORPPRATION -- �. � � �
the Departr�enYs initiatives. i.�-�"�-_-- __. • __ - `:;',_.;;;;:,.._-. ,:. .` _ ; - _ `. �: __ ' `
� j E.- ''-- - � - - - �__:r.:,;.,:.-�.' ... ,
Our missior�at the Department is: License Efficiently, Regulate , ,;=_- �---. •-- -_ ___ ;,�?r.,�;,.,;,. - .:-_•_.- � - -� - _ ,; ;
Fairly.We constantly strive to serve you better so that you can ' !�" •' -�" "�- � -- -`�-"�'_�=--��"- -�- = - --��-= � �
serve your ustomers. Thank you for doing business in Florida, � �r_�S�CERTfFIED..und:e�-t�he p_r-ovis,ions of Ch.489 FS.,:`v--._- , ,
and congra ulations on your new license! t�..�.Piration.da4e,�AUG 31,�20te ,,. � _.--�!__, '�-_L1608170000597- ._
� _�- _ �. ��- - � -- -- _• - -- - -- -- - _ - -
ti' -
DETACH HERE
RICK COTT, GOVERNOR KEN LAWSON,SECRETARY
.---...__.___-- ----.._.----------------------_.__-------__. ...�_.._ _..�__—__.__.__—______._-----_--_---____.—_.___._.-------.---.
�. STAI'E OF FLORIDA - �
,
E DEPARTM@NT OF BUSINESS,AND PROFESSIONAL REGULATION
" ELECTRICAL CO'NTRACTORS LICENSING BOARD . ��1' ��F ;
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-The�ELE�TRICAL CONTRACTOR - - .- _ - _ ;
�� Named_6 Iow IS CERTIFIED - � � _ �=°'�; � . _� � � � '' � +� �` �� ';��
�_ ,U.nder the provisions of Chapter-489 FS. . _ = ,.- � -- --- � _ '`�- : - - . - • � • ` �On"� r
;- Expiratio �date: AUG 31, 2018 `�.. - ' _ � �` !- � `� • . - � '
- . - , - , - . . �
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�� ��' _.T L-LOS, COSPER LEE:JR:f'=_ _ - - - ._ - -_--- , ' -�'`, _ . , � _- - ` , � � ' �
'� _N�1N TECH CONSTRUCTION CORPQRPATION::~;,.�� •�` �,`���
}�" A_- _15�79 BARBER ROAD;_� __:--_ _- : -�.� -___ - -_ -�•� _ -- _ ..- r : - ;-, • � ' ��. , ' ' � ,
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I.SGI IFII• (1R/17/�f11R f11SPl AY AG RFfll IIRFII RY I AW SFO# i��nR��nnon�s�
� � NEWTE-1 OP ID:SP
ACOR� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
�� � 04/13/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICAT�DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TH S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
: REPRESENT�TIVE 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 an conditions of the policy,certain,policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate hol,der in lieu of such endorsement(s).
PRODUCER CONTACT
' Gifford-Heiden I s-NGNG NnMe: Victor L.Garraus
111 E Venice Adenue ac°NN e:r:941-484-0681 ac,No: 941-485-3835
Venice,FL 3428� AonR�ess:victorgarraus giffordheidenins.com
Victor L.Garraus
INSURER(S)AFFORDING COVERAGE NAIC#
iNsuReRA:Auto-Owners Insurance Co 18988
� INSURED N w-Tech Construction Corp INSURER B:SOUtII@�I7-OWII@I'S If1S CO 10190
15 9 Barber Road iNsuReR c:Lloyds' London
S rasota, FL 34240
, INSURER D:
INSURER E:
INSURER F• �
COVERAGES I CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO C RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE IMAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7�ypE OF INSURANCE ADDL 5 B POLICY EFF POUCY EXP LIMITS
LTR N D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
B X COMME CIAL GENERAL LIABILITY EACH OCCURRENCE $ 'I,OOO,OOO
CLAIMS-MADE � OCCUR 20587219 04/27/20�6 04/27/2017 pREMISES Ea cwEence $ 300,00�
X XCU/dontract MED EXP(My one person) $ 10,000
PERSONAL 8 ADV INJURY $ 'I,OOO,OOO
GEN'L AGGR GATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
POLICY� PRO- ❑
JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000
OTHER: BI(II'RISIC $ 5��,00�
AUTOMOBIL�LIABIUTY COMBINED SINGLE LIMR
Eaaccident $ �,���,00�
A X ANY AUTO 4230376900-SEE AUTO �4/2��2��6 04/27/2017 BODILY INJURY(Per person) $
ALLO�ED SCHEDULED
AUTOS X AUTOS BODILY INJURY(Per accident) $
X HIRED UTOS X NON-OWNED PROPERTY DAMAGE $
TOS Per accident
X Comp�$500 X �o i$soo $
UMBRE LA LIAB X OCCUR EACH OCCURRENCE $ S,OOO,OOO
A EXCES LIAB CLAIMS-MADE 4230376901 04/27/2016 04/27/2017 AGGREGATE $ 5,000,000
DED � RETENTION$ �O,OOO g
� WORKERS C MPENSATION PER OTH-
AND EMPLO ERS'LIABILITY STATUTE ER
ANY PROPRI TOR/PARTNER/EXECUTIVE Y�N E.L.EACH ACCIDENT $
OFFICER/ME BER EXCLUDED? � N/A
(Mandatory ir�NH) E.L.DISEASE-EA EMPLOYEE $
If yes,descr�b under
DESCRIPTIO�OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
C PROFESSyIONAL LIAB 60621PNEWT000215 03/07/2016 04/27/2017 PROF LIAB 1,000,000
C POLLUT/iNVIRO LIAB B0621PNEWT000215 03/O7/2016 04/27/2017 POLUENVI 1,000,000
DESCRIPTION OF PERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedute,may be attached if more space Is requlred)
COSPER L. ULLOS JR., LIC#EC0001689 IS COVERED UNDER GENERAL LIABILITY
FAX 1-813-7 0-0021
CERTIFICATE HOLDER CANCELLATION
ZEPH001
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Clt of Ze h I'hIIIS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y P Y ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept.
5335 8th Street AUTHORIZED REPRESENTATIVE
�ephyrhills, FL 33542 ' / �� ���
(/�C�O"r'U �4/?/1.r.t.ccG/
I O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Aco'� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
`� � 4/5/2016
THIS CERTIFMCATE 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSllRER(S), AUTHORIZED
REPRFSENTbTIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:I 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 ho`der in lieu of such endorsement s .
PRODUCER NAMEACT Tricia Hushmire
Insurance Offic�e of America, IIIC. PHONE ']']O-Z�JO-O�T7 FAX 678-450-9180
854 Washington Street NW A/C No:
Suite200 EpA'� .Tricia.Hushmire@ioausa.com -
Gainesville G 30501 INSURER S AFFORDING COVERAGE NAIC#
iNsuReRa:Zurich American Insurance Com an o 27855
INSURED NEWTECH-02 INSURER B:
New Tech Co StfUCtlOfl COfp. INSURER C:
1579 Barber d.
Sarasota FL 3�Z�FO INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:221433728 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED �JOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATEI MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR YPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POUCY NUMBER MM/DD/YYYY MM/DD/YYYY
COMM RCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLpIMS-MADE �OCCUR DAMAGE TO RENTED
I PREMISES Ea occurrence $
MED EXP(Any one person) $
PERSONAL 8 ADV INJURY $
GEN'L HGGI��EGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY�PR� �LOC PRODUCTS-COMP/OP AGG $
JECT
OTHER $
AUTOMOBIL�LIABILITY COMBINED SINGLE LIMIT $
I Ea accident
ANY AUTO BODILY INJURY(Per person) $
AUTOS�E� AUTOSULED BODILY INJURY(Per accident) $
HIRED UTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
$
UMBR LLA LIAB OCCUR EACH OCCURRENCE $
EXCES LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
q WORKERS OMPENSATION WC0114356-01 4/20/2016 4/20/2017 X STATUTE ER
AND EMPLO ERS'LIABILITY
ANY PROPRI TOR/PARTNER/EXECUTIVE Y� N�A E.L.EACH ACCIDENT $1,000,000
OFFICER/ME BER EXCLUDED7
(Mandatoryf NH) E.L.DISEASE-EAEMPLOYE $1,000,000
If yes,descri e under
DESCRIPTI N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OFIOPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedute,may be attached if more space Is required)
Blanket Waiv r of Subrogation in favor of certificate holder is included when required by written contract.
,�3 - �.��-�C� �I
�
CERTIFICATIE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ZEPHYRHILLS BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS.
5335 8TH STREET
ZEPHYRHILLS FL 33542 AUTHORIZED REPRESENTATIVE ,
�r��� ' " __— "`""
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 �2014/01) The ACORD name and logo are registered marks of ACORD
,
bb4�� KERS COMP�NSATION ANO�MPL.OYERS LfABIE.RY INSURANCE POLICY WC 00 EF3 i3
{Ed.04-84)
AtVER 4F OUR RtGH'T T� REC�VER FRC1M OTHERS ENLiC?RSEMENT
We have the cight to recaver our paym�nts from anyane liahle far an inlury covered by Ihis poGcy. We will not
enfa�Ce our right against Ihe person or orqanization named in the 5chedule. (1'his agreement applies onfy to the
extent that you peKarm work under a wdtten contract that requfres you to abtain this agreement irom us.)
17ris� greemenl shall not operate�rectlyr or indt�ectiy to benetit�nyone not named in the Scheduie.
Schedule
AU. ERSONS AND/�R ORGANI7�ITIONS THAT ARE REQUIRED BY WRITTEN CONTAACT OA AGREE-
M� WITH THE INSUR�D�EXECUTED PRiOR TO THE AGCIOENT QR LOSS�7HI0.T WAIVEH OF SUBRO-
GA iON 8E PROVlDEO UNDER'fH15 FOLICY FOR W ORK PEHFORMED 8Y YOU FOft THAT PERSON
AN /OR ORGANIZATION
I
� endo�emeat changes Ihe poficy to whEch it!s altached and is eHecihre an the dale fssued unless athenkiae statecf
', he(ntormativn balow(a roquired oMy whan ihl�andaaaemeat is 18aued aubeaqucni tn preperatloa ot the poficy.)
' Endor�ement �ltective:4/20/15 �otiayNo. WC 0114356-00
�n6�� New Tech Construction Corp. Premium S
�I u�ance campeay councecsigned byr I
RICH AMERiCAN iNSURAPfCE COMPANY OF ILLINOIS
' WI"124(A-84) Page t a(7
WC o0 0313 Gopyrtght te63 Nsuana!Coundt on Compenaetlo�Inauranca�rnc uca►am Fomts"'
�
i
i
8/30/2016 � Sarasota Counly Tax Coliector
Sarasota County Business Tax Receipt
2016- ]� THIS TAX DOES NOT ASSURE QUALITY OF WORK OR CONFIRM THAT REGULATORY OR Account No.
ZONING REQUIREMENTS HAVE BEEN MET,IT IS THE OWNER'S RESPONSIBILITY TO 3903420042465
ENSURE COMPLIANCE.
Busines Type: SERVICE
NEW TECH CONSTRUCTION CORP
' Busines Address: 1579 BARBER RD PAID: 5545722.0001 8!2/2016 $14.43
SARASOTA uninc FL 34240
SIMS SHi WN
' 1579 BARBER RD
SARASO A,FL 34240
All busine ses in Sarasota County are responsible for complying Sarasota County Tax Collector
with the S rasota County mandatory recycling ordinance. Barbara Ford-Coates
101 S.Washington Bivd.,Sarasota,FL 34236
(941)861-8300,option 3
Valid until 9/30/2017 www.SarasotaTaxCollector.com
Info@SarasotaTaxCollector.com
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