HomeMy WebLinkAbout17-19043 CITY OF ZEPHYRHILLS
5335-8TH STREET
' ' '� (813)780-0020 19043
BUILDIPIG PERMIT
PERMIT INFORMATION LOCATION�INFORMATION
Permit Number: 19043 Address: MIS SEE 5829 5824 9TH ST
Permit Type: MISC ZEPHYRHILLS, FL.
Class of Work: RIGHT-OF-WAY TownshiR: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost: OWNER INFORMATION
Date Issued: 11/09/2017 Name: DUKE ENERGY
Total Fees: r 1 Address: 2166 PALMETTO ST STE A
Amount Paid: � � CLEARWATER FL 33756
Date Paid: Phone:
Work Desc: ROW 5829/5824 9TH ST NO CHARGE
CONTRACTOR S APPLICATION FEES
DUKE ENERGY
�
,'�
� ,i �
. _ �
u� �-r�v.�-�Ql.�o,�
Ins ections Re uired
F OTER 2ND ROUGH PLUMB MISC INS LATION 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: (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
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O. ' -
' CONT CT SIGNATURE PERMIT OFFI R i
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
ti
ll l l Vi LtYtl l KI11LL)-[Sl lllll���llLYAtCl_�lt�1 p /�0��
D_aTE: 11-6-17 RIGHT-OF-��'.��'i�$E PER\IIT PER\II7= / �
^ � �o rons�ucriou under gtouu�m�obo�r grouud of on�-facilin s6a1!be acrumplisGed on anc Cir�-Rialut of��-ac n irbuur cr�irren approcal 6'om rhF
C in-Buildina Deparnneu�.An�appli:a�ion for approcal of roncn ncrion operariuns un anc C in-an�ned Ri�6�s of R":+r shall turuia6 a derailed dra�rino
shot�iug iLr comple�F scope u[thr pi oposed 1�'ork in u'iplicale�o tLr offit'e of�he Building OfLcial for approval prinr�o��e cumwe�uemru�of aup�'m�k 3
:op�'of rbis perwi�is ro bF kep�readil}-acaiNble ar rhe sira c•f�he wo�k ar ill rimes.
P:IRC EL I.D.= 11/26-S/21-E (1T1"FO:�D 9T"ST
D.�TE
LOC aT[O��Leaal Desaiption):
FROM 5829 TO 5824 9T"ST
Pf11II1S5�40 li LEI'Pbti"gT':1qfP(1 f0 DUKE EN ERGY oi 2166 PALMETTO ST"A",CLEARWATER,FL 33765
tm�he coninu.rion and main�enance of-
PROPOSED REMOVAL OF 1-30'&1-35'AND REPLACEMENT
WITH 1 4�i'&1�p'WOOD POWFR PO FS
_subjec�to r6e follon•ing cendirious:
1. Zhe consrrncriou and maimenanre of socL nrflin�SLall no�inrerfere ticic6�he propem•and 3ights of a prior occupanc.
Z. .11 irork sl�all hF done in keep[n=�sfrL rLe nandards ot�6e Cin-Sa•eHs DeparnnEn��nd under et�e supe»ision of�he Cicr Building OfficiaL icho
�ill be no�ed a�leas�one da�•piior�o commencemen�o[consrrucrfen.
?. ?ill marerials and equipmem?Lall be subjec�w inspecrion b��he Cin-Buitdin�O�cial.
J. Daring constru�r3ou a11 s�ten rezularions ot��e Drp:+r�men�ol Tthuspar�a�ion sl��li be obserred and tl�e(irc'shal!Ae re6ered o[all
rrsponsibilin-from damage o(anr narure aririns from tLis petmi�.Subjecr�o d�e samr�erws�nd condirions,tLe perwir holder ma��ake sucL safe�-
IDFdSitfFS,inctucling pLxine and displ��-of cauoon signs,ac ir mac dc�rm necess�r}-in conduct of consnvcriou and mainrenanct n�ork hereunder.Ic ii[hr
responsibilin-oC che perminee�o^.^'.?
c. AI!pricare anA all Cin'praperh�s4a11 be tes�ored�o irs urisinal condfriun as far as pr�cdcal in rhe opinion of�he Cin Bnildin�Offizia4
6. �II nudergi ound crossing ius�allatious SD�II hE I.11[I 01 SUCII llPj/fI1.l4 Ill])'UP SIJPCISPd�))'[IIP CIR"BllIIflNlg O[ticial.
' TIIF SI:PfCII CO\'P!'lAt�UP dhI71I5 Of fI115 Illff]II?tlon SI19II bF IPO(IF 0(l.11'f pI tL1i�tPt'1111f,TII�S PPIIDlI1S CI':Ullft�Rl(L ILF�II[IPfil:1D(IIUr f�l�t IhP
� a�7P��[7t1I�1.15 OPfI�IPt11�1 Ofi1Pt tlR�li�'USPI'S 10 Tf1Y.11'P:1 COCPfF(�b�'i�P F1PIlOII]llf�I1�:F5 fll��1'PSpOL51b11�[1"{Of�R\'f�]IO:I�F 1➢CUl"1'FL�?l�'�11'�Of ID4f]ua7I0115�S.l
resulr of his operarions io order�hnt thec mav safe quard rheu iure�ests.
S. lr is espi esslp sripul�ted r6a�ihis pe�mir Ss i license fer permissh�e use oul�•and�h.v tLe plating o[facili�ies upoo puhlic propern�pursuan��o
dii�pennir shall nw opernre ro create ar�a�'es�an�'p�opw n�righr in said liolder.
9. \\'henerer die C ih'detidc�s ru twthFr ecpinir rhe C irr Righrs of A�av,anr oc sll said poles,nirps,pipcK.cahla>.or urher faciliries and
I appurrenaoces antliorued hat eundai,shall b:immediarel7•rFmoco-d from said Righrs ot�l'a�,or reser or relocared TLereon ns reqnircd Ac�fie C:in-Builclin� �
OtficL�)a�the ezpense of r4e liolder o(this pe�ioir.�
10. 7'ha lioldrr sLall sa��e and krep�6e Cin•Lm�mlFvs L�om avr and a0 d.images.diims,or 3ujuti�s that mac ocror b.•reasoo of the conshvcriop,
mainwnance,and operotlou ots•rid facllin-.
11.Ihe Lolder s6a11 complere d�e requesrc�d n�ork n�irhiu da�s or this permit sha11 become null and coid.In�he eceot�he sork �
requesced ls no�comple�ed npon iLe eipirariun da�F of�I�is peimir.�he Cfn•shall Laee tLe iicAr to complete such�rark and�o char�e�he holder at che permit
for a0 totts incurred in complering said n'ork
I I. 7hF Loldei cLall posr a casL or sm rn�boud n'ii6 tLe C'in•\Iauaper io tAe sum of$ �OII�15 fA QUBI'.IOfFP�1F1fO17Dt11[P OI(tlF
obligarfons bereiu.iud ro�ll0i0�IQP ID.IIllIE�BLCP OL ILP fl�hr-of-n'a�'desriibed hereiu[or a period of one Q)ceir tollotirin¢complerion o(the reqaested
iusrallarion.In tLe e�•enr a suren•boud i�pnsced.�6a wren�Aond shall De m.ide parable�o t6e Cirs and shall obligate the zuren-to hold the Cin•hannless in
the e�•enr rlie Lolder of�his permit s6ould fail�o meei am�uf irs obtigarions hrreundet.The bond sLall alio iodemuift•the Cin•for all cour�costs aud
'i�easonaUle arro:ue�'s Eees iu the e�'eu[le�al at�jou is required ro rnlle��ou said boud. ' ••
' 'B\ 7ED Bl"-
irE�m���FF, TE 0 LCHICK
Slqp0f11IF\T11IP �� /SERVICE PLANNER �
:��d,•E„ 2166 PALM 0 ST"A",CLEARWATER,FL 33765
4PPR0�-ED BI" �
I C _ ��'.'�
(ITT OF ZEPA]'RffiLL� ��� �r iv
i Buildiu�Official �'�.1� �`�'��
Da�a: ,I V
c C -r ,�N (� I
L'rili�ie._uPEtzi»� !�'— ��� � /�.�,(� r��J�
Dare• �f�J
Pnblir\Tni k< a��v�1
Dare�
C in-\fanaaFi
Dace:
Y
A�Q� � DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 0813012017
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. 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 certiFcate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and condltions 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
MBfSh U$A I(iC. NAME:
100 Norih Tryon Street,Suile 3600 A/CNNo ext: ac No:
Charlotte,NC 28202 E-MAIL _
ADDRESS:
INSURER S)AFFORDING COVERAGE NAIC#
22830-PXSWG9/1-17-18 GAWX iNsuReR a:Libert Mutual Fire Insurance Com an 23035
INSURED INSURER B:N/A N�A
Duke Energy Corpora6on
Incl.Piedmont Natural Gas Company INSURER C:
, 550 S.Tryon SVeet
' DEC4O-C INSURERD:
Charlotte,NC 2B2O2 INSURER E:
INSURER F:
' COVERAGES CERTIFICATE NUMBER: ATL-004586677-06 REVISION NUMBER: 4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR POLICYNUMBER MM/DD MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY 'Self Insured-See Below' EACH OCCURRENCE S
CLAIMS-MADE �OCCUR DA AG TO NTED
PREMISES Ea occurrence S
X Self Insured MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $
POLICY❑PR� �LOC PRODUCTS-COMP/OP AGG $
JECT
OTHER: $
A AUTOMOBILELIABILITY AS2-641-443955-037(AOS) O9/Ol/2017 0910112018 COMBINEDSINGLELIMIT $ 'I,OOO,OOO
Ea accident
ANY AUTO 'Self Insured(NC,SC, BODILY INJURY(Per person) $
OWNED SCHEDULED OH,KY,IN,FL,TN)' BODILY INJURY(Per accident) 5
AUTOS ONLY AUTOS
X HIRED X NON-0V4NED 'See Below' PROPERN DAMAGE §
AUTOS ONLY AUTOS ONLY Per accident
X SPECIFIED g
UMBRELLA LIAB OCCUR 'Self Insured-See Below� EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ S
A WORKERSCOMPENSATION WC2-641-443955-027(AOS) 09/O1I2018 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N 'Self insured(NC,SC,IN,KY, 2,000,000
OFFICER/MEMBEREXCLUDED? � N/A E.L.EACH ACCIDENT $
(Mandatory in NH) OH,FL,TN)-See Below' E.L.DISEASE-EA EMPLOYEE 5 2,000,000
If yes,describe under 2,000,000
DESCRIPTION OF OPERATIONS beiow E.L.DISEASE-POLICY LIMIT 5
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedute,may be attached if more space is required)
Evidence of insurance.
General Liability: The insured is self insured for$1,000,000 each occurrencel$1,000,000 Personal&AdverUsing Injuryl$2,000,000 general aggregatel$2,000,000 Products Completed Operations. Automobile
Liability:The insured is self-insured for$1,000,000 each occurrence!$1,000,000 aggregate in ihe states listed above. Workers CompensationlEmployers Liability:The insured is Self Insured in the states shown
above with EL limit of$1,000,000 Each Accident,$1,000,000 Disease-each employee,$1,000,000 Disease-policy limit. Excess Liability: The insured is self insured for$1,000,000 each occurrencel$1,000,000
aggregate.
CERTIFICATE HOLDER CANCELLATION
Duke Energy Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
including Piedmont Natural Gas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
550 South Tryon Street,DEC40-C ACCORDANCE WITH THE POLICY PROVISIONS.
Charlotte,NC 28202
AUTHORIZED REPRESENTATNE
of Marsh USA Inc.
Karen A.Burke �p.�j� ¢c.. �
OO 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD