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HomeMy WebLinkAbout19-21865 _ CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 21865 BUILDING PERMIT PERMIT INFORMATION - LOCATION INFORMATION Permit Number: 21865 Address: 38453 5TH AVE-HISTORIC Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-15300-0070 Improv. Cost: 19,375.00 OWNER INFORMATION Date Issued: 10/09/2019 Name: HUDGINS DREW BEN Total Fees: 210.00 Address: 38453 5TH AVE Amount Paid: 210.00 ZEPHYRHILLS, FL. 33542-7625 Date Paid: 10/09/2019 Phone: 813-714-2016 Work Desc: REROOF TPO CONTRACTORS APPLICATION FEES QUALITY ROOF OF FLORIDA INC REROOF RESIDENTIAL 210.00 F_W� oL DRY IN ROOF INSP Ins ections Required TAPE JOINTS ROOF INSP FINAL 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. 00 l CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER _ CITY OF ZEPHYRHILLS ` 5335-8TH STREET (813)780-0020 - 21865 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION r Permit Number: 21865 Addr ss: 38453 5TH AVE-HISTORIC Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Townshi R� Book. Proposed Use: COMMERCIAL Lot(s): lock: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-15300-0070 Improv. Cost: 19,375.00 OWNER INFORMATION Date Issued: Name: HUDGINS DREW BEN Total Fees: 210.00 Address: 38453 5TH AVE Amount Paid: ZEPHYRHILLS, FL. 33542-7625 Date aid: Phone: 813-714-2016 ,gWr esc: R ROOF TPO CONTRACTORS APPLICATION FEES ALITY ROOF OF FLORIDA INC REROOF RESIDENTIAL 210.00 DRY IN ROOF INSP ns ections Required TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute SS3.80 (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. CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER .Aco 12/20/2018 Y) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 018 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 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 Debra Guidry,CPCU NAME: ry, FRSA Self Insurers Fund,Inc. aHc0Nr o Ext•(800)767-3772 Fn/c No): (407)671-2520 4099 Metric Drive E-MAIL Winter Park,FL 32792 ADDRESS:cent@frsasif.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: FRSA Self Insurers Fund/Evanston Insurance Co. 35378 INSURED INSURER B: Quality Roofing,Inc. INSURER C: 1905 N 40th Street Tampa,FL 33605 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. NOTWITHSTANDING 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. I�7R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MMIDDIYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR DAMAGE S(RENTED CLAIMS-MADE PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S ALL AUTOS AUTOS N/A N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N�NIA N 870-033644/3DY3150 01/01/2019 12/31/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) REMARKS:Non-cancelable,without 30 days prior written notice,except for non-payment of premium which will be a 10 day written notice. Richard C Jenkins,License Holder Lic#CGC1507166&CCC042846 CERTIFICATE HOLDER CANCELLATION Attn: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills 5335 8th Street Zephyrhills,FL 33542 AUTHORIZED REPRESENTATIVE Debra Guidry CPCU 04,�gp Underwriting Manager @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I . I RICK SCOTT,GOVERNOR JONATHAN ZACHEM,SECRETARY Florida J r STATE OF FLORIDA DEPARTMENT OF BUSINES&AN:D-PROFESSIONAL REGULATION CONSTRUCITI`O_N INDUSTR,-Y=LI"S-ING BOARD x if ,/,'�.._. _ �:.a, �i. �.�.. THE ROOFING•CONTRAGT.,OR F !EREIN_IS"CERTIFIED UNDER THE PROVISIONS;GF,,CHAP,TER+4.89HFLORID4A-.STAiTUTES i �, ,JE�NKINS;?RICHAR ��=C i' QUAL=I.TY!ROOFINGa�INC`� 6i �,.,� ;FL 336Q5n�y LfCE�,N�S'Er NUMBER?�'CCC042846 EXPIRATfONiDATEc'A_IJGUST 31,2020 Always verify licenses online at MyFloridaLicense.com • I 0 Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 1 . I 818-780-0020 City of Zephyrhills Permit Application Fax-818.780-0021 Building Department Date Received phone Contact for Permitting 3 2 Owner's Name Drew Hudgins Owner Phone Number Owner's Address 1 38453 5th Ave Zephyrhills,FL 33542 Owner Phone Number Fee Simple Titleholder Name I Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 38453 5th Ave ZephyrhiEs,FL 33542 LOT# Lot 7 SUBDIVISION PARCEL to#F11-26-21-0010-15300-0070 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e X NEW CONSTR e ADD/ALT = SIGN = = DEMOLISH INSTALL REPAIR PROPOSED USE = SFR 0 COMM 0 OTHER TYPE OF CONSTRUCTION = BLOCK 0 FRAME = STEEL = DESCRIPTION OF WORK Remove existing roofing and replace with TPO roofing system. BUILDING SIZE SO FOOTAGE 1600 HEIGHT 1 14' =BUILDING $ VALUATION OF TOTAL CONSTRUCTIO 1� _77S =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY = W.R.E..C. =PLUMBING $ F�InVVJS =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION l =GAS 0 ROOFING Q SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO _a_e_a_e_e_e_._e_e_e_e_. iii i i i Oil i It l i l i l l i i It i i .. la BUILDER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN Y/N Address License# ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN Address License# PLUMBER COMPANY SIGNATURE REGISTERED I Y/ N FEE CURREN Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N FEE CURREN Y/N Address License# uali Roofing,Inc. OTHER COMPANY Q ty g� SIGNATURE I Y/ N FEE CURREN Address 5 N 40th St Tam a,FL 33605 License# CCC042846 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII11111111111111111111111 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,Stonnwater 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 Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stomtwater 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&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500) Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) 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 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F.S.117.03) OWNER OR AGENT CONTRACTOR Subscribed and swom to(or affirmed)before me this $ n— b�C.ed�d sbworn (or ffirme a this YY�LLL�Y Who is/are personally known to me or hasthave produced Who is/are personally known to me or has/have produced as identification. '��� as identification. Notary Public • 1_ _ �s Notary Public Commission No. Commission No. P Name of NotaryY° "'', IAH LYNN AKERS typed,printed or stamped Na a of Notary e ,printed stamped =2•• Notary Public-State of Florida o Commission N GG 265348 p'�oFre°` My Comm.Expires Jan 28,2023 Bonded through National Notary Assn. •ctvvr s Submitted To. Quote ft: v Hudgins Law Group Address: Date: ' 38453 5th Avenue oerosr2al e a Q ff' t� • city. State: Zip code. V 0 # 0 V� Zsphyfhals FL 33542 tV ` Phone Ili: Fox 4- (813)9244805 Eroidl Address- State Certified C00042846 dustln0dce0011tractinglio.Com State Certified-CGC 1507166 Job Name. Job Phone M: Hudgins Law Group 1905 N. 40th Street a Tampa, Florida 33605 J Location; Phone: (813)620-4797• Fax: (813)626-1756 86453 5th Avenue,Zephyfiliia.Fi_33542 Fiat roof replacement of 2 smaller flat roof areas near the tear. 1,Remove the existing roof and haul away all debris. 2.Make repairs to existing deck as necessary at an additional cost as follows. $4.00 per SF of plywood $4.50 per LF of structural lumber $8.50 per LF of plank decking $20.00 per 8F of-metal decking 3.Furnish and install new 180 tapered system as necessary to achieve positive drainage. 4.Furnish and install new 60 Mll.TPO roof system and well flashing as.necessary.. 8.Furnish and Install new painted metal coping cap on top of the walls as necessary. 6.Furnlsh our standard 3 year workmanship warranty. 7.Furnish all related material warranties.(20 Year) Option.,ADD new Butters at existing locations.Itt984-14� � �,� et S t- C J a Note:All A/C work will need to be preformed by others. �,� veto AD work to to be complatat in a wedunsahko mwwm eu ordnrg to awaard¢tact,aes An&aogs or davistion from the smile of work rdwWrad heroin OW re"s,in evolium it toot to QuuMy Roopno;Inc.(Tailtraelor f will bo charged to the Customer as a oast that is sownto rain and in additlon to the quoted price.C usdmr s enmluy, will b`ovbtigpv warkmra CqQXnnsahbr; irk@{Lana.If lard ohs aria pet3oM or rtratanais otlarthan CaimtrSer!tunptayae(sl at tta frisk onals strpy*0 Uy Contractor to pettorm curdt"aw's sropa of tiwdr,on the ewir'during Ina pmlpu or char the Conirauor had uompteted its wbik,than ony wanaray issued by Contractor to Cusiunita W lne praiect v4 lmwAawy become nup and Wd.wBhuul exception The Conw®n' Ducnndnta consisf ur ittis Pia meat.tM Terms and Candirmtm.aD doetrme M refentromd timain,tlho workAu on(tf apOrabiai and the}.turned Wotlonish,"Wanamty(d any};wJBdh ere hhborporelod hafain by reta,vmse, Customer sarons that lust ne signature,is boy one of txt Cunbatd 0otaun00 axhnelihitas Whet,arxlpt 11190 arxeplatl,:e of 12 of ua Connect Ooctt111dm6 aryl Statutory Wan6ngs.The parfies aam that there is adequate otfmidar Aft for Ihis Proposat,the mccipt end suTpcamcy of vhvdh is nersby acksm Winlited. I HAVE READ AND UNDERSTAND THIS PROPOSAL,THE TERMS AND CONDITIONS AND ALL DOCUMENTS REFERENCED THEREIN AND AGREE TO BE BOUND BY THEIR TERMS. Sum for the above:--Nineteen Thousand Throe Hundred Se_ve-M .FFwa Dollars and=100 Dollars$ 19.375.00 Payment to be made as follows: Ilan ACCEPTANCE-OF PROPOSAL: the above p icos. specifications and Salesman' conditions are 8aliafactory and are hereby accepted. Contractor is.ausfoftit tl Signature- to do the work as spoeiried. By signing below,Custontar acknowledges that Nath n Cote Customer Is the owner of the props*where work is to bo'performed. Name: No than Address: Rote-This proposai may be withilwan by us if not accoptod wl in 30 day& scorn dale at top. Owner/AgentSignature: go.Pico Cos Date of Name: Hudgins Lw Group Acceptance: Title. % ea INSTR#2019154214 OR BK 9970 PG 3704 Page 1 of 1 09/1012019 03:47 PM Rcpt 2089138 Rec:10.00 DS:0.00 IT:0.00 Nikki Alvarez-Sowles, Esq., Pasco County Clerk&Comptroller IiI Permit No. Parcel ID No 11-2fi 21-001tl-15304.0070 NOTICE OF COMMENCEMENT State of Florida 1 County of Pasco I THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real property,and in accordance vAth Chapler 713,Florida Statutes, the following information is provided in this Notice of Commencement: 1. Description of Property:Parcel Identification No. CITY OF ZEPHYRHILLS PS 1 PG 54 THE SOUTH 89.75 FT OF LOT 7 BLOCK 153 OR 1S58 Street Address: 353 84 5TH AVENUE,ZEPHYRHILLS,FL 33542 2. Gene:at Description of lmfxovement Remove existing shingles and Install new shingles i I I 3, Owner tnfJrmation or Lessee information it the Lessee contracted for the improvement: Drew+gins 38453 51�AVENUEarno 33542 FL Address I City State Interest In i ropeny: Owner Name of Fre Simple Titleholder. (If different from Owner listed above) Address City State 4. Contractor{ Quality Roofing,Inc. ', Name 1905 N 40th St Tampa FL Address 1 city State Contractor's Telaphone No.: 813-620-4797 5. Surety: Name i Address ( city State Amount of Bond: IIITelephone No.: 6. Lender. I Name I Address 1 City State Lender's Telephone No.: I 7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by Section 713,13(1)(a)(7),Florida Statutes: Name i Address City State Telephone Number of Designated Person: 8. In addition to himself,the owner designates Richard C.Jenldns —Of— Quality Roofing,Inc. to receive a copy or the Lienor's Notice as provided In Section 713.13(1)(b),Florida Statutes. Telephone Number of Person or Entity Designated by Owner: 813-620-4797 9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and Gnat payment to the contractor,�ut vdll be one year from the date of recording unless a different date is specfied).- WARNING!TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CItAPTER 713. PART I. 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 perjury.i declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my knovjiedgc and belief. I _ STATE OF FLORIDR COUNTY OF PASCO Signature of Dwrieft-r ssee,or Owner's or Lesseo's Authorized Officer0rectorlPan n er/Mam"er QIZ6 ,J At f; SignaWsTttlelofice I t The foregoing instru i ent was admowledged before me this�day Of�.20ta by A,../JUt.,r..� 'Y t�l..(,�0'u tom' as U C,.) e f (type of authority,e.g.,ot6cert- attorney i'n'Tact)for from arty an b Hofwh stigma � t alud).� Personally Known4'OR Produced Identification CI Notary SignaN fitly` V Type of Identification Produced Name(Print) .�.arrrirr�,r + M" • TAMECAD PHINNEY MYCOIitIIUSSION8M30 M ,V EXPOI�tApd 18,2023 ''.,t,'oF#i°p�'�608dadTlzntFlp28fyFIitDActlltdtiSnlllt#n 9/12/2019 Florida Building Code Online . i .� r � fYl �,( tit. 'AMA , n e���� O^II 4 A M�� � BCIS Home �og In I User Registration Hot Topics Submit Surcharge Stats&Facts ;j Publications ` Contact Us I BCIS Site Map I Links search b a 4fiv"Owl ProductApproval USER:Public User d r Product Approvl I Menu>Product or Application Search>application List>Application Detail _ I FL# I :FL14083=R21- Application I ype Revision Code Version 2017 Application Status Approved Comments Archived REVIEW pAT Product Ma i ufacturer Carlisle SynTec Systems CITYREV OF DEP H Address/Ph ne/Email P O.Box Ili oignway i PLAN EXAMINER Carlisle,PA 17013 (717)245-7000 malpezzi@syntec.carlisle.com Authorized Signature Joe Malpezzi 1 malpezzi@syntec.carlisll co LL ES F SHALL LY Technical Representative Robert Patton NATIONAL CRICA BUILDING C 1 D pREVAj11N, Address/Phone/Email 1555 Ritner Highway ANO ELECTRIC C ©�E: Carlisle, 5- 264 OR®IN E CITY®F-7EPI°YRHILLS (717)245-7264 Robert.PA17ON @syntec.carlisle.comES I Quality Assurance Representative Address/Phone/Email i I Category Roofing Subcateg t Single Ply Roof Systems Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Reportl-Hardcopy Received Florida Engineer or Architect Name who developed the Robert J. M. Nieminen Evaluation Report Florida License PE-59166 Quality Assi rance Entity UL LLC Quality Assurance Contract Expiration Date 12/14/2021 Validated By John W. Knezevich,PE b Validation Checklist-Hardcopy Received I Certificate If Independence FL14083 R21 COI 201..2 01 COI NIEMINEN.pd i Referenced Standard and Year(of Standard) Standard i Year ASTM D6878 I 2011 FM 4470 2012 FM 4474 2011 TAS 131 I 1995 UL 1897 I 2012 Equivalence of Product Standards Certified By I I https://www.floridabuilding.org/pr/prl app_dtl.aspx?param=wGEVXQwtDgtGLR%2byCBylJmTU[mMQIToYlue4MuTwlz5%2bCmP3RNLjxA%3d%3d 1/2 9/12/2019 Florida Building Code Onfn '+ Sections frc m the Code Product Approval Method Method 1 Option D Date Submitted 06 17 2019 Date Validated 06/18/2019 Date Pendir g FBC Approval 06/24/2019 Date Approved 08/13/2019 Summary of Products FL# Model,Number or Name Descripti¢n 14683.1, Carlisle Sure-Weld TPO Single,Ply Thermopla$tic Olefin (TPO)Single Ply Roof Systems - Roof Systems Limits of Use Installation Instructions Approved for use in HVHZ:No FL14083 R210 06 FINAL Al ER FL14083-R21.pdf Approved for use outside HVHZ:Yes Verified B : Robert J. M. Nieminen PE-59166 Impact Resistant:N/A Created ti Independent Third Party:Yes Design Pressure:+N/A/-722.5 Evaluation Reports Other: 1.1 The design pressure in this application relates to FL14083 R21 AE 2019 06 FINAL ER FL14083-R21.pdf one part]CL lar assembly. Refer to the ER Appendix all systems Created b Independent Third Party:Yes max.design presssures.2.)Refer to ER,Section 5 for Limits of Use. 3.)Tt is Product Approval is for Non-HVHZ jurisdictions. Refer to Fl.16440 for HVHZ. 8acic Next Contact Us::2601 Blair Stone Road,Tallahassee FL 32399 Phone:850-487-1824 The tate of Florida Is an AA/EEO employer.Copyright 2007-2013 State of Florida.::Prival y Statement::Accessibility Statement::Refund Statement Under Florid law,email addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not send electronic mail to this a tity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395,*Pursuant to Section 455.275(1), Florida Statut s,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emalls provided may be used for official communication with the licensee.However email addresses are dublic record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.To determine if you are a licensee under Chapter 455,F.S.,please click here. Product Approval Accepts: ® ® aChErJc ®, Credit Card Safe httnc•//www.flnridahitildino.orn/nr/n ann dtl.asox?Daram=wGEVXQwtDatGLR%2bvCBv1Jm i uimMQITOYlue4MuTwlz5%2bCmP3RNL'IxA%3d%3d 2/2 ONEMOjetc. TABLE 1C- ... . CONSTRUCTION, RECOVER SYSTEM TYPE D-1: INSULATED,MECHANICALLY ATTACHED ROOF COVER System Insulation Layer(Note 14) Roof Cover Attach Fastener Lap Seam MDP Deck(Note 1) No. Type Membrane Fasteners Lap Width IPsfl (Note 5) Spacing Spacing Weld Sure-Weld,min.60- W-13 Min.19/32-inch CDX plywood or wood plank One o more layers, Prelim. mil or Sure-Weld Carlisle n Fasteners 12-inch o.c. 5.5-inch 114.5-inch 1.5-inch 22 5 any combination Attach and Piranha ha Plates O.C. outside FleeceBACK FR Sure-Weld,min.60- One or more IayeFs, Prelim. Carlisle HP-X Fasteners' 114.5-inch 1.5-inch 'W-14 Min.19/32-inch CDX plywood or wood plank, mil.orSure-Weld 6-inch'o.c. 5.5-inch 45.0 any combination Attach and Plranha.Plates O.C. outside FleeceBACK FR Car is a HP-XTRA 90.5-inch 1.5-inch W-15 Min.19/32-inch CDX plywood or wood plank at One or more layers, Prelim. Sure-Weld,min.60- Fasteners and Piranha 12-inch o.c. 5.5-inch -45.0 max.24-inch spans;8d ring shank nails,6-inch o.c. any combination attach mil XTRA Plates O.C. outside Carlisle HP-X Fasteners Min.19/32-inch plywood or wood plank at max. and Piranha Plates or#15 24-inch spans;8d ring shank nails 6-inch o.c.in One or more layers, Prelim. 90.5-inch 1.5-inch W-16 Sure-Weld Roofgrip with 2-3/8" 6-inch o.c. 5.5-inch O.C. outside -52.5 the field;#10 ring shank nails 4-inch o.c.at the any combination attach Eyehook Seam Plates perimeter (AccuSeam) Carlisle HP-X Fasteners Min.19/32-inch plywood or wood plank at max. and Piranha Plates or#15 24-inch spans;8d ring shank nails 6-inch o.c.in One or more layers, Prelim. 66.5-inch 1.5-inch W-17 the field;#10 ring shank nails 4-inch o.c.at the any combination attach Sure-Weld Roofgrip with 2-3/8" 6-inch o.c. 5.5-inch O.C. outside -67.5 perimeter Eyehook Seam Plates (AccuSeam) TABLE • ••• • CONSTRUCTION, ••• • • OR RECOVER SYSTEM TYPE D-3: INSULATED,MECHANICALLY ATTACHED BASE SHEET,BONDED ROOF COVER System' Insulation(Note 14) Base Sheet Roof Cover No. Deck(Note 1) MDP(psf) Type Attach Base Sheet Fasteners Attach Membrane Adhesive Carlisle#12 12-inch o.c.at the 4-inch laps Min.29/32-inch plywood at One or more Atlas Summit InsulFast and Sure- and 12-inch o.c.at three, W-18 max.24-inch spans;#10 x 2- layers,any Loose-laid Synthetic Sure-Weld SAT-TPO Self-adhered -120.0 Seal Seam equally spaced rows in the inch wood screws,6-inch o.c. combination Underlayment Fastening Plates center of the sheet. r NEMO ETC,LLC Evaluation Report C33680.09.30-R21 for FL34083-1121 Certificate of Authorization#32455 0 EDITION(2027)FBC NON-HVHZ EVALUATION Revision 21:06/10/2019 Prepared by: Robert Nieminen,PE-59166 Carlisle Sure-Weld TPO Single Ply Roof Systems;(717)245-7264 Appendix 1,Page 7 of 73 d' QUALROO-02 BJONES ACORO® DATE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)8/14/2019 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 certificate 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 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 CONTNAMEACT ASSOCIATES AGENCY,INC. AHO"N E ,($13)988-1234 FAX No:(813)988-0989 11470 N 53rd St Temple Terrace,FL 33617 E-MAIL .certs@associatesins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Southern Owners Insurance Co 10190 INSURED INSURER B:Owners Insurance CO 32700 Quality Roofing,Inc. INSURER C:Westchester Surplus Lines Ins.Co. 1905 N 40th St INSURER D: Tampa,FL 33605 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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. NOTWITHSTANDING 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE F_X]OCCUR 20209725 9/1/2019 9/1/2020 DAMAGE TO RENTED S 300,000 MED EXP(Any one person S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY[XI JPER e T LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 X ANY AUTO 4893827001 9/1/2019 9/1/2020 BODILY INJURY Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S X HIRED X NON-AWNED PeOracEcidentDAMAGE S AUTOS ONLY AUTOS ONLY PIP S 10,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 4893827002 9/1/2019 9/1/2020 AGGREGATE S 5,000'000 DED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ISTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACHACCIDENT S FFI dE oMFin NH)EXCLUDED? ( ry E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Policy G70966244 001 9/1/2019 9/1/2020 Occ$2,00,000 AGG 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ze h chills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY p Y ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street Zephyrhills,FL 33542 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i ACCOUNT NO 2019 •2020 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30,2020 268421 OCC.CODE RENEWAL 690.023001 ROOFING,SIDING,RELATED SHEET METAL To = Employees Receipt Fee . 225.00 Hazardous Waste Surcharge 40.00 Law Library Fee 0.00 CGC1507166 ccc042846 QUALITY ROOFINGIINC BUSINESS 1905 N 40TH ST I TAMPA,FL 3360,520 19 2 0 QUALITY ROOFING INC NAME 1905 N 40TH ST MAILING TAMPA,FL 83005 ADDRESS Paid 18-0-309054 97/17/2019 265.00 BUSINESS TAX RECEIPT DOUG BELDEN,TAX COLLECTOR HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-635.5200' IN BUSINESS.PROFESSION,OR OCCUPATION SPECIFIED HEREON THIS BECOMES A TAX RECEIPT WHEN VALIDATED. ti City of Zephyrhills BUILDING PLAN REVIEW COMMENTS r � Contractor/Homeowner: v�, , 1 Co 1 (� Date Received: oho / J � Site: y�� �� yt Permit Type: &V,P W- Q 26 s f h!!� d, 1 h�i a-(ty f-C.e W►�"� 7 C'� Approved w/no comments. Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. OCT 0 5 2019 Ka i itzer-Plans Examiner Date Contractor and/or Homeowner (Required when comments are present)