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HomeMy WebLinkAbout19-22053 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 2205 /, RESIDENTIAL SWIMMING POOL PERMIT INFORMATION LOCATION INFORMATION Permit Number: 22053 Address: 3208 KRESTERBROOKE LANE Permit Type: SWIMMING POOL RES. ZEPHYRHILLS, FL. Class of Work: POOUNEW Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: HIDDEN RIVER Est. Value: Parcel Number: 24-26-21-0100-00000-0840 Improv. Cost: 52,000.00 OWNER INFORMATION Date Issued: 11/22/2019 Name: FUENTES, GAMALISA & RAFAEL Total Fees: 577.50 Address: 3208 KRESTERBROOKE LN Amount Paid: 577.50 ZEPHYRHILLS, FL 33540 Date Paid: 11/22/2019 Phone: 813-770-7214 Work Desc: INSTALL INGROUND POOL 547 SQ FT CONTRACTORS APPLICATION FEES OLYMPUS POOLS BUILDING FEE 442.50 HAWKINS SERVICE COMPANY PLUMBING FEE 67.50 OLYMPUS POOLS / ELECTRICAL FEE 67.50 V 0 POOL STEEL Inspections Required POOL DECK & FOOTER POOL ELECTRIC BOND POOL PLUMBING/PRESSURE 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 may be 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. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "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." CONTRACTOR PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 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 W" 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 CONTRACT Subscribed and sworn to(or affirmed)before me this Subscribed and sworn t r affirm )b rem this by Who is/are personally known to me or has/have produced Who is/are p rs nally known to or has/have produced as identification. as identification. 4TNotary Public Notary Public Commission No. Commission •��� JACQUELINE SOGES Commission#GG 2713457 Name of Notary typed,printed or stamped Name of Notary typed, SOOP&December 12,2022 ?oR 'a` Berded TW Troy Fain In%ranee 600, r101! 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received / — Phone Contact for Permitting Owner's 4 Name e( C a Owner Phone Number Owner's Address ( r Owner Phone Number Owner Phone Number JOB ADDRESS /Z'c5 LOT# SUBDIVISION / l�r/G� PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED R NEW CONSTR R ADD/ALT 0 SIGN 0 0 DEMOLISH INSTALL REPAIR PROPOSED USE SFR 0 COMM OTHER TYPE OF CONSTRUCTION BLOCK 0 FRAME 0 STEEL _ DESCRIPTION OF WORK t Lol A, BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING $ VALUATION OF TOTAL CONSTRUCTION DO Q ELECTRICAL $ AMP SERVICE 0 DUKE ENERGY 0 W.R.E.C. PLUMBING Is � 7/ =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION l � ���� eA =GAS Q ROOFING 0 SPECIALTY 0 OTHER o / O FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO BUILDER COMPANY V Zv �.S SIGNATURE REGISTERED Y/ N-_ FEE CURREN Y/N Address Z. Q, Q License# l ELECTRICIAN COMPANY SIGNATURE 7� REGISTERED Y/ N FEE CURREN Address l �7 ` i L � License# v PLUMBER ✓���� COMPANY O/ SIGNATURE REGISTERED Y/ N FEE CUR Y/N Address c U License# MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURREN Y/N Address I License# OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURREN Y/N Address I License# 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,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 Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&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 WITRLACOOCHEE RIVER ELECTRIC COOPERATIVE,WC. I "® Your Touchstone Energy'Partner '. POOL CLEARANCEAPPROVAL Date : October 30, 2019 Address : 3208 Kresterbrooke Ln Account Number : 1406 570 447`650 WREC Release No. : 0182/19 Approved : Yes �X No 0 If"No",reason : Inspected by : Stephen Weaver Date : October 30, 2019 Approved by: Stephen Weaver Date : October 30, 2019 Pool Company : Olympus Pools Comments : No conflict NOTE: This approval is only a confirmation that the described pool location conforms to the"National Electrical Code" concerning clearances between pools and electrical conductors. For identification of W.R.E.C.facilities,notify Sunshine State One-Call @ 1-800-432-4770 or 811. P.O. Box 1278, San Antonio, FL 33576 Phone : (352) 588-5115 / Fax : 352) 567-4376 INSTR#2019199172 OR BK 10010 PG 1442 Page 1 of 1 11/21/2019 12:52 PM Rcpt:2110670 Rec:10.00 DS:0.00 IT:0.00 Nikki Alvarez-Sowles„J_sq.,Pasco County Clerk&Comptroller NOTICE OF COMMENCEMENT. Permit No. ((�� Property Identification No._ .;?-Y ac,, ot/ /(J O O ADO-0 THE UNDERSIGNED hereby gives•notice that improvements wiil'be made to certain real property,and in accordance with Section i 713.13 of the Florida Statutes,the Following information is provided in the NOTICE OF COMMENCEMENT. to f' Q 1. Description of property(legal deser "Orin) ' ` 6 7 i a) Street Address: 2. General description of improvements POOLAPA PAVERS ANO SMIM ENCLOSUER 3. Owner Information -^ I � r - ,/ L ` a) Name and address:C� a 1 l t'u-�n i�S � L(�S C'6�'o /t�2 �) Z—Q& 2! 1/s y b) Name and address of fee simple titleholder(if other than owner)_ c) Interest in property OwtlER 4. Contractor Information a) Nameandaddress:. oLvt4puspaoLs4122NtAuat3twAr,,rAmPA.FLm.514 •a b) Telephone No.: als9aaaasa Fax No.(Opt.) $13.9T54021 5. Surety Information a) Name and address: b) Amount of Bond: c) Telephone No.: Fax No.(Opt.) 6. Lender a) Name and address: 7. Identity of person within the State of Florida designated by owner upon whom notices or other doetiments may be served; a) Name and address: b) Telephone No.:• Fax No.(Opt.) 8. 1n addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b�Florida Statutes: a) Name and addiess: b) Telephone No.: Fax No.(Opt.) 9. Expiration date of.Notice of Cornmenceaient(the expiration date is one year from the date of recording unless a different date is specified): WARNING TO OWNER:ANY.PAYMENTS,M-ADEB THE E OWNIER AFTER THE EXPIRATION OF THE-NOTICE OF COMMENCEMENT ARE CONS141gE WD.IMPROPERAYM PIENTS.UNDEIEt CHAPTER 713.PART 1;SECTION 713.13,. 0LORIDA STATUTES AND.CAAMRESVLT IN YOUR,PAYING.TWICE FOR MOVEMENTS TO YOUR PROPERTY.A NOTICE.OF COMMiENCEMENT MUST.BE RE•CORDE1q.AND POSTED"UN•TES JOB SITE BEFORE THE FIRST INSPECTION.IF.YOU INTEND:TO OBTAIN:FINANCING;CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK�OR RECORDING YOU NOTICE OE C MMENCEkgk-,.. STATE OF FLORIDA COUNTY OF PASCO mature Or Owner of Owner's Au orized 0 cer/DirectodPartrl&/Manager C1GiJ'YtUtl 1 S Q•. t�tl� -�' Print Name . / - -- The�pregoing tttnt�� ent// aclmowtedged�b-yefore9^me this _day,ofC / -K� / ,20�L' by t as I. .lrl/ 1 Pi✓. _ (type:of authority,e.g affit ei,trustee,ettotney in fact)for (name_of party'on Beth df whom' sttvmt:nt was executed), ::i Personally Known OR•Produc;d identification/ ! Notary Sigilatriie - --'- � Type of Identification Produced . (D• Name(print) .., r, � Verificatio Under penalties:o c I "I a ihat I have read the foregoing and that the racts stated in it are tru a t o ark4ei>aif : ... FCRMSMocry pp • TwYe�Etilfl wy,Cofttteymton.00190bfti y Se hn o nl!'a=Sipdi,{A6noe I I i I �g>juoB STATE OF FLORIDA,COUNTY OF PASCO 6 THIS IS TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COPY OF THE DOCUMENT "moo nNrr��4 ON FILE OR OF PUBLIC RECORD IN THIS OFFICE W SS MY HAND AND TF7 SEAL TDAY OF 2 NIKKI ALVAR -S W S, CLERK&COMPTROLLER BY DEPUTY CLERK I Jacqueline Boges From: Jacqueline Boges Sent: Wednesday, October 30, 2019 7:58 AM To: Todd Vandeberg; Bill Burgess (bburgess@ci.zephyrhills.fl.us) Cc: Rodney Corriveau; Kalvin Switzer Subject: RE: Pool Setback request Todd are you changing set back for everything that will be constructed in hidden river or will this change only be for the swimming pools? From:Todd Vandeberg<tandeberg@ci.zephyrhills.fl.us> Sent:Tuesday,October 29,2019 6:47 PM To:Gigi Fuentes<gigifuentes71@gmail.com> Cc:Jacqueline Boges<jboges@ci.zephyrhills.fl.us>; Bill Burgess<bburgess@ci.zephyrhills.fl.us>; Rodney Corriveau <RCorriveau@ci.zephyrhills.fl.us> Subject: Re: Pool Setback request Gigi, Hello. I wanted to get back with you. I spoke with the Building Official now that he is back and we have determined as defined as I. The Citys Land Development Code that a pool qualifies as a an accessory structure and as a result will only need to meet a 5' rear and side yard setback. Please pass this information onto your pool contractor and have him submit necessary information for permitting at the City Building Department. Regards, Todd Vande Berg Director of Planning city of Zephyrhills Sent from my iPhone On Oct 25, 2019, at 9:44 AM, Gigi Fuentes<gigifuentes7l @gmail.corn>wrote: EXTERNAL EMAIL Good morning Todd, Thank you again for seeing me on Tuesday 10/22. I was so excited and hopeful after speaking with you that I may have been mistaken when I thought you would call me back that Tuesday. I went by today and left my number again in the event that it was missed placed or that I even wrote it down incorrectly. I'm sure you're very busy so I'd like to refresh your memory. I'm the one that went in to ask about the 10 foot setback rule. We are new to Zephyrhills and live in the Hidden River community Unfortunately our yard is only 24 feet wide. We are really looking forward to building a pool. Although a 10 foot setback would be fine for a homeowner on an acre of land, for those of us moving into these new communities that offer less than a quarter of land the setback does not seem fair. 1 Like I mentioned,when'we met, the pool company has drawn a design with those restrictions and it only allows us 3 feet between our home and the pool start line. Our grandson has spina bifida and his wheelchair-bound this would not be safe for him. The extra 5 feet would allow us to have a pool that works for our family. You mentioned you were checking with the building commissioner and I know he's out of country but if there's anything that we can provide or do to receive an exception for this rule please let me know. Hope to hear back from you soon. Have a wonderful weekend. Gigi Fuentes 3208 Kresterbrooke Ln Zephyrhills Fl 33540 813-770-7214 Ga►nalisa "&igi" Fuentes Disclaimer:Fla.Stat 668.6076"Under Florida law,e-mail 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 entity.Instead,contact this office by phone or in writing." 2 UNIVERSAL ENGINEERING SCIENCES, INC. 9802 Palm River Rd. Tampa, FL 33619 Phone: 813-740-8506 Fax: 813-740-8706 E-mail: TampaBIDScheduling@UniversalEngineering.com Alternative Inspection Services Agreement Project: Olympus Pools, Inc— Fuentes—3208 Kresterbrooke Lane, Zephyrhills FL Private Provider Firm: Universal Engineering Sciences, Inc. Private Provider Name: Jeffrey Morrison, BU2018 Address: 9802 Palm River Road, Tampa, FL 33619 Phone: 813-740-8506 Fax: 813-740-8706 Names, License/Certificate Numbers, and License description of provider and duly authorized agents who will be providing services for this project. Name: License/Certificate No.: License/Certificate Type: Mark Israel 47070 Professional Engineer Mark K Hardy 57233 Professional Engineer George Dixon BN1008,SFP33,PX440, BU1097 Standard Inspector, 1&2, Plans Examiner& BCA Robert Mason BN4490, PX4174 Standard Inspector&Plans Examiner Daniel Sirois BN6668&PX3595 Standard Inspector&Plans Examiner Kevin Eichelberger BN7010 Standard Inspector Kenneth Scheitler BN2552, PX2340 Standard Inspector&Plans Examiner Anthony Pino BN2994, PX2165 Standard Inspector&Plans Examiner Jeff Waterman BN7133, PX3919 Standard Inspector& Plans Examiner Roger Myers BN6695 Standard Inspector Steve Lee BN5627, PX2961 Standard Inspector&Plans Examiner Frank Ross SN4330,PX2269 Standard Inspector&Plans Examiner Gregory Yantorno BN3290,BU 1214 Standard Inspector&BCA Rene L. Pepin BN701, PX329 Standard Inspector&Plans Examiner Andrew Guerra BN7367 Standard Inq�tor .1. Jeffrey Morrison BN6542, PX3515,BU2018 Stagq 'PJ ns Examiner& BCA Ross Howsare BN6929, PX3766 ISty N- s Examiner As the private inspection services provider for this proje� read an • 'to be bound to the provisions of State Statute 553.791. 1 further agree and understand the nVthe above list e" - �nnel may perform inspections on this project and that if for any reason the inspectior�&t n lash c ch Imp Zor if any person listed above should discontinue to quality as a duly authorized agerit yo will be notified i ,vs'r ting immediately. Printed name of Alternative Provider: Jeffrey Morrison, BU201 /q re•of ��l1ve Provider JD to State of Florida, County of Hillsborough, !!)) '++:,Mi++'�, Sworn to (or affirmed)and subscribed beforeme;this?r> l Y_/lday of �s7`o b E 2019, by Jeffrey Morrison,who '1 r, ' is personally known to me. �`� Kim Y. White Printed Name of Notary Signature of Nota Notary Public Stamp: ♦ r r6 • Form#9113.053-2002-01 Notice to Building Official of Use of Private Provider Effective January 20,2003 Project Name., Parcel Tax ID: Services to be provided: Plans Review Inspections Note:If the notice applies to either private plan review or private inspection services the Building Official may require,at his or her discretion,the private provider be used for both services pursuant to nS.�ec,,tio'n 553.191(!}Florida Statute. I (�Ytq jt & rwl ej ,the fec owner,affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: Universal Engineering Sciences,Inc. Mark K Hardy J Private Provider: 9802 Palm River Road,Tampa,FL 33619 Address:Telephone; ---- 813-740-8506 Fax: 813-740-8606 Email Address(Optional): TarnpaB1DScheduling@UniversalEngineering.com Florida License,Registration or Certificate#: 57233 i have elected to use one or more private providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application,as authorized by s.553.791,Florida Statutes.I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes,except to the extent specified in said law. Instead,plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application.The law requires minimum insurance requiremeats for such personnel,but I -understand that I may require more insurance to protect my interests.By executing this form,I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected.I agree to indemnify,defend,and hold barmless the local government,the local building official,and their building code enforcement personnel from any and all claims arising firom my use of these licensed or certified personnel to perform building code inspection services ` with respect to the building that is the subject of the enclosed permit application. 1 understand the Building Official retains authority to review plans,make requiredinspections,and enforce the applicable codes within his or her charge pursuant to the standards established by s.553.791.Florida Statutes.if i make any changes to the listed private providers or the services to be provided by those private providers,I shalt, within I business day after any change,update this notice to reflect such changes:The building plans review and/or inspection'services provided by the private provider is limited to building code compliance and does not include review for fire code,land use,environmental or other codes. Page 1 of 2 The following attachments arc provided as required: 1,Qualification statements and/or resumes of the private provider and all duly authorized representatives. 2. Proof of insurance for professional and comprehensive liability in the amount of$1 million per occurrence relating to all services performed as a private provider, including tail coverage for a minimum of 5 years subsequent to the performance of building code inspection services. Individual Corporation Partnership Print Corporahoo Name Print Partnership Name .....a� By: By: _. (Signature} (signature} (signature) Fr nt Print Print Nsmr:,C'�M Q „ l j Name 9 Name Address•20 114V t l� Its: Its: Address: Address: Tcleftine Telephone Telephone No. No.: Please use appropriate notary block. STATE OFt COUNTY OF Individual l/ Corporation Partnership k3 re this f J day of Before me,this day of Before me,this day l"V h W,2FSj,personally ,20_, of ,20 --' appeared personally appeared personally appeared who executed the foregoing instrument, of , and acknowledged before me that same ,a partnerlagent on behalf of was executed for the purposes therein corporation,on expressed, behal f of the state corporation,who a partnership,who executed the executed the foregoing instrument and foregoing instrument and acknowledged before me that same was acknowledged before me that same executed for the purposes therein was executed for the purposes therein expressed. expressed. Personally known_;or Produced identification a of identification produced . JSignature of Notary 'A—_ Print Name � �� Notary Public:NOTARY 5TAAV BELOW My commission expires; �+ Notary Putft at to of FW48 I TV&Eaton E � t3i3 rta�t5 Page 2 of 2 Client#: 1405231 131 UNIVEENG ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/09/2019 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. ............... ..-......_................... ......._......_..._..._....................._....................._.....__......................... . . -- ._. --.................._..........._....--- ...._..._ _........-.........._..._...................._..........................--.._............. ................... TAW :If the_ ce_..rtificate 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER :CONTACT NAME: McGriff Insurance Services PHONE ................._.._.._-.----.._.—........__......__—_r _......__-- (Arc,No,E,,t):407 691-9600 IA/C,Nap 888-635-4183 PO Box 4927 E-MAIL ) _ _`..__......w.. Orlando, FL 32802-4927 AgogEss_—___.._..--__.............._ _.-.-------..... ..-.-.___-- ' INSURER(S)AFFORDING COVERAGE NAIC i1 407 691-9600 --- ----................__.._._..-----._.._..._......_..__....—.__.._._.._...----- INSURERA:Valley Forge Insurance Company €20508 INSURED INSURER B:Continental Insurance Company 35289 Universal Engineering Sciences Inc INSURER C;National Fire Insurance of Hartford i 20478 3532 Maggie Blvd. ---.........._........_._..---_---_............_...... -------- .. .. -_....................- INSURER D:Various Carriers-See Description Orlando,FL 32811 _._. .._....._.........................---- --....._._......................_—_...... -- INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: #5 19120 Municipal 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 CONTRACTOR 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 ADDUSUBR POLICY EFF POLICY EXP LTR..... TYPE OF INSURANCE __POLICYNUMBER MMIDDIYYYY)_(MMIDDIYYYY)__i___ LIMITS A �( COMMERCIAL GENERAL LIABILITY * * 16075841134 1/01/2019:01/01/2020 EACH OCCURRENCE 1$1 000,000 CLAIMS-MADE i X.00CUR P Et11M Eaorcuence IS100,000 X Incl X,C,U MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 — GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE i S2,000 OOO -- ---,PRO _, ! ....__..,-.;POLICY_XI JECT .._�....._. LOC I PRODUCTS-COMP/OPAGG I S2,000i-----...A...._..OOO ......-'-'DUCTS--'_'__....._... .---.._.._.._..._ s OTHER: I S ...: ......................_._..........._..............................._..........._.._..........._................._...._.__._._......_.....__......._._...._._......_.._... ......_._.. __._..__...._.................... _._...._._.... — --.—._._....__.._... _:--- — j AUTOMOBILE LIABILITY * * I COMBINED SINGLE LIMIT I C 16075841120 1101/2019 01/01/202 Ea accident) 1S1,000,000 X ANY AUTO € BODILY INJURY(Per person) S W'OWNED SCHEDULED ....... ._...._..,_(.. ._ ... ..... __ BODILY INJURY Per accident) $ 'AUTOS ONLY .AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY i { _(Per.acc:ident} _..._...._...— I .....---._..... ... ...__..._.._.._....... —._..-----..................._.— ...._...-'---`-- --..... . .... ...............__.......................__..i.._.................._......... D UMBRELLA LIAB I X ?OCCUR ` See Description 1/011201901/01/202O.EACHOCCURReNCE i sSee Descript X.EXCESS B ESS LIA ( ' ` { _ ';CLAIMS-MADE for EXCESS Llab AGGREGATE DED RETENTIONS _ Information —_— _ _ S WORKERS COMPENSATION + i PER OTH- B ! 6075841151 1/01I201901/0112020 X (STATUTE_...._:. _.ER..I_. _......._......... _. !AND EMPLOYERS'LIABILITY ANY PROPRtETOR/PARTNER/EXECUTIVEY/NN E.L.EACH ACCIDENT I NIA; __.._.___ 1000OOO____ __OFF h _ .(Mandatory in NH) ""' ' i .E.L.DISEASE-FA EMPLOYEE:SI,000,OOO- If yes,describe under DESCRIPTION OF OPERATIONS below__._......._....,__,._._,�___—.___ .............._..._....,....................................... E.L.DISEASE-POLICY LIMIT I S1 OOO OOO . ....... .. ..... ........._ ._ _. ............. ............-- ......._. ............ ......._ ............. ......--- ---.....Y LIMIT.....-----....... 3 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Olympus Pools,Various Lots.*Additional Insured status is granted with respect to General Liability if required by written contract per"Blanket Additional Insured-Owners,Lessees or Contractors-with Products Completed Operations Coverage Endorsement'Form#CNA75079XX 10/16. Primary and Non-Contributory status is granted with respects to General Liability if required by written contract per"Architects,Engineers and Surveyors General Liability Extension Endorsement'Form#CNA74858 01115. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Pasco County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 8731 Citizens Drive Ste 230 New Port Richey, FL 34654 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 3 The ACORD name and logo are registered marks of ACORD #S227228241M22586184 PSBE bESCRIPTIONS (Continued from Page 1) Per Project Aggregate status is granted as respects to General Liability as per"Architects,Engineers and Surveyors General Liability Extension Endorsement"Form#CNA74858 01115. Contractual Liability as respects to General Liability as per Commercial General Liability Coverage Form form#CG0001 04113. *Additional Insured status is granted with respects to Automobile Liability policy on a primary basis with regard to the operations of the named insured if required by written contract per endorsement"Business Auto Coverage Form"form#CA0001 10113. *Waiver of Subrogation status is granted with respects to General Liability if required by written contract per"Architects,Engineers and Surveyors General Liability Extension Endorsement'Form#CNA74858 01/15. *Waiver of Subrogation status is granted with respects to Workers Compensation if required by written contract per Waiver of Our Rights to Recover from Others Endorsement,form#WC000313. *Waiver of Subrogation status is granted with respects to Automobile Liability if required by written contract per"Business Auto Coverage Form"form#CA0001 10/13. With regard to General Liability,when required by written contract,30 Days Notice of Cancellation applies per form"Changes-Notice of Cancellation or Material Restriction Endorsement'form#CNA74702 01115. With regard to Automobile,when required by written contract,30 Days Notice of Cancellation applies per form"Notice of Cancellation or Material Change-Designated Person or Organization"form#CNA72315 02/13. With regard to Workers Compensation,when required by written contract,30 Days Notice of Cancellation applies per form"Notice of Cancellation or Material Change Endorsement'form#CNA87380 11/16. Excess policies follow form of the underlying policies. EXCESS LIABILITY COVERAGES: Excess Liability Policy over General Liability: National Surety Corporation(NAIC#21881) Policy#SSE58214255 Policy term 1-1-2019 to 1.1-2020 Provides an additional$9,000,000 per Occurrence,$9,000,000 per Aggregate,excess liability layer above the underlying$1,000,000 occurrence liability limits/$2,000,000 aggregate liability limit provided by primary General Liability policy with Travelers Indemnity Company of America,policy#P6603G518961TIA18. Excess Liability Policy over Auto Liability: Endurance Assurance Corporation(NAIC#11551) Policy#EXC30000530701 Policy term 1-1-2019 to 1-1-2020 Provides an additional$1,000,000 excess automobile liability layer above the underlying$1,000,000 liability limits provided by primary automobile policy with National Fire Insurance of Hartford #6076841120. (Aggregate Limit where applicable.) Excess Liability Policy over Auto Liability: Landmark American Insurance Company(NAIC#33138) Policy#LHA085007 Policy term 1-1-2019 to 1-1-2020 SAGITTA 25.3(2016103) 2 of 3 #S22722824/M22586184 DESCRIPTIONS (Continued from Page 1) Provides an additional$4,000,000 excess automobile liability layer above the underlying$1,000,000 automobile liability limits provided by Endurance Assurance Corporation Policy#EXC30000530701. (Aggregate Limit where applicable.) SAGITTA 25.3(2016103) 3 of 3 #S22722824/M22586184 UNIVENG-01 JTORREZ DATE(MM1OONYYY) `I CERTIFICATE OF LIABILITY INSURANCE b.� 1 11912019 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 pollcy(les)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 Ondorsomont(s). PRODUCER .CppTACT Ames&Gough 'PHONE FAX, 279 (AIC,No,E*t);(703)827-2277 (A/C No):(703)827 2 8300 Greensboro Drive 5�AIL Suite 980 Ess.admin elmosgough.com McLean,VA 22102 INSURER(S)AffORDING COVERAGE NAIC ft INSURERA:Evanston Insurance Company 36378 ............. INSURED INSUURo-.Continental Casualty Company_{{:NA)A,XV -20443 Universal Engineering Sciences,Inc. IN-SURERC: ................. 3632 Maggio Blvd I Orlando,FL 32811-6697 INSURER E: INSURER F: COVERAGES. CERTIFICATE NUMBER: ...... REVISION NUMBER: THIS 15 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 N S R T YPE OF I NSURAN C E A 0 0 L 1161 U BR PO LI CY NUMBER POLICY Epi '06LICY,6& LIMITS IN P—Y&P— COMMERCIAL GENERAL LIABILITY EACH PCCURRENCE........... OCCUR DAMAGE TO RENTED PREIAISESd(Ea accurrenco), &ADV INJWIR.Y.. OWL AGGREGATE UMIT APPL!45 PER: GENERAL AGGREGATE. POLICY LOC PRODUCTS-CO.VP,'OP AGG S OTHER, I S ,P AUTOMOBILE LIABILITY NE0INGLE LIMIT ANY AUTO • OWNED 'SCHEDU LED AUTOS ONLY = AUTOS PODILY.INJURY(Perappident) PROPERTY MAGE AUTOS ONLY UMBRELLA LIAO OCCUR EACH OCCURRENCE EXCESS LIAB CLAfMS-MADE AGGREGATE DED RETENTION$ ,WORKERSCOMPENSATICN P=R 01'H- AND EMPLOYERS'LIABILITY Y §fXTUTE ER IN ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACHACCIDENT :5 FICERWEMSER EXCLUDED? I1NIA IndatoryinNH) S i'lf as,describe under •USCRIPTION OF OPERATIONS below L DISEASE-POLICY LIMIT A 'Professional Liab. MKLV7PL0003450 11112019 1/1/2020 Per Claim/Aggregate 6,000,000 B 'Professional Liab. EXN591925142 1/112019 11112020 Per Claim/Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Ref:Olympus Pools,Various Lots CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pasco County Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 8731 Citizens DrIve,Sulte 230 Now Port Richey,FL 34664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/14/2019 Leads ..: 2 -Sates- t'f'o}eot Nianagernerlt:: Fil0S -Mass:,ging'.' .Financial.:...:. . •Ch.ckril71c0ons Import Lean Oppomau0es Ust VI" Activity Vlow : Activity Calondar Aetivity Templates Proposal. Proposal Templates Map FILTER YOUR RESULTS.•3 FILTERS APPLIED - - '" "' •"' _ .- . •. .. Sow_d FlileS.•.. _ .. ... ... . .. ... .':Standard FMar.. .. Kaywartl Se!esparson. .. Statue.. _ _ .-Age of Lead. .. Tags.._.. .. - -_ _. Soutra._ - _... --__ __._ Project 7Yp@.. Name t Sansego Soma Open - - O lfus VO'W Email Past,30 Days %-AII Gems Soladrb-- =All Items Sobefed- Hems SekC.ed- .. P Atl llerrs SolecLM- All Da- � :All Dates Gl lc ....... tlol Llnke Cllckad Sd:etlu!ed Appo_ntrnent : Appointment Time' __ _.......- �SuhdIVLNan__. _..._.,__... _.._. 'Lead Data _.._•.__.._...,....._._�.. .. .. .. .. Deal Status .".... Sold Oat. _....,._. Most Rene .__.__ _ _. _ .. _ ,e. •. -ALL- •a9 Dates' ... . . b;ua,,Rosuiru )Reset No Fltle,:i, .. ... .. .. - .. .. . Standard Viow♦ (;j Froozo L�,CoWrrars Peg. of 1 Lw� View 1-21 of 21; r �, a""' �r �z->aaR��-� r�zi�r�,e„�_' -P'r' � �° ��F�'�•�` z, ,Rs��'e'�"' tt .ems >r•�r - .. Opportunity Title Created Date Customer Contact Status- Age Confidence F_stlmated R Estimated R Last Contacted Salesperson C� Source Prop x=nt + ir_7'Andnsw Yost' 't0.11-2019 ;Andrew Yost '- ;Open :3 days .(IIIIIIII 0% s0.00 ?$0.00 'Santiago Se.. '• ;Contact Forth- - - -_-- .. _-. ..._........ ....... ._ _ _.. _ r.. ... .._. _. ..._ .. '-_... ..._._._.._._-. .._�_.....___. .._._. _....._. �. _ _ .. '•(�:ne:. 0,Mas,y'. here .. 9-25-2019 .. .00 ..I Sontag.Sam. •Facebaok .. .. . •�gumss,Mei!"da ;open- days.. ..,,. ..;. - ':. .. 17 095 i500D iS0.00 .';':,_:.. ISontag.S.M. .,!Onfine_Other..,.;...:.•.. _.;.'...., w 10.1.2019 c.nto,5t.Yen open `12days IIIIIIa% $0.00' $o �-� lllllllll ° .J:Y.Ew .'. 6=1:Debm MolendnZ :9-26-2019 Debra Melende¢ :Open 15 days III I I 0°e 150.00•l .$0.00 .,, �nllago S.M. - Contact Form ereira' ""'-Open 27 days ^IIIIIIII 0% .$0.00" 50.00 "' iSantlago Sarna Contam Form ' 9-18-2019 Edwin P _ ;Graham.Denise_ ;10-1-2019 IC*r0an,Denise: Open 13 days "- !IIIIIIII096 50.00 $0.00 .Santiago Sema: ,NeighborfMend- - eLW T ac,I�I�sop,•Ja. n _.:10-6-2019 IJacso J.so �Open_ �I6 days0/ - 50.00 V":$0.00: '`'Santlago Sarna - - - '- -1-- _.. .. _ _ u: n �� :. r :IIIIIIII N.Ighborrfriend _.._..._..._.._......._ .._.._.__....... (]; r.e:,v .Fr .Janunrv,AAen : 19-17-2Di9 ;�IaLuary, IIerJ 'Open27 days IIIII I0 ^` 0.00 - -A •SonOego Semo iOn4ne-OtherII U;rea :+'1�:.IBBID'MamS?rt '' 19-27-2019 •j2ooY Ma U29 .. Open - 16 days :IIIIIIII 0%' .:s0.00 $0.00 .. .•Sontag.Same .- - :Contact Forth C] Han + LW,Juan olrtws 9.23-2019 Juan olnwa "-- 'Open - - 20 days• ,IIII IIII 0%.' -($0.0) :59.90 -_ _ - Sanaaeo Sema Contact For.. - - (]:nt;w ;•�. `1SfiSgan RooNa ';9-30.2019 IS11f1gnn Ronrda Open •13 days - j IIII I11I 0% _, .'s0.00 $0.00- ." _ i SanN.90 Sarna _ -' ;Referral -_ : ;_]; r<Lw Kevin Bobos .9-19-2019 ;KeNn Bobo. :Open i 24 d 0% j So.00 S0.00 ;Santlago Sema 'Contact Form Q. +'�: II111111 i - - - - --- -- .- ^ ran, i♦' L.-Mil-t:':. 9.16-2019 } 9, iM Iicenl open 126,days 11IIIIII 0 :50.a0 :. $0.00 i sansag.$.rna Next Door App - -' -' - +� N:F:: j {r.'�.] Michael F GuasleAa... ;10A-2019 :Michael F Guasto0a :Open 17 days ;IIIIIIII 09b -;50.00 --"" $0.00 - _ -_ -'Santlago Sema - Canted Form ...13i r;rw '{' ..!Music,David ... !10.9-2019 i MOv.P_4YL1. .oP.. :G day s' II 0% 50.00,Tl s0.00..._... .�..._..._ _ Sentla9a$arna:....................... .. ...,._..._..._.........._._., -.. .. 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'� °J�I Rx •. f ,."�- �_ . . .� I ' View t 21 of 21 https://buildertrend.net/Leads/LeadsList.aspz 1/1 xL City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: Date Received: f 1-4—(g Site: 3 20,e 164&1-krw � Permit Type: S)A)4m i' yl y� Approved Who comments:❑ Approved w/the below comments: . Denied w/the below comments: ❑ v� A` y �� C This comment sheet shall be k pt with the permit and/or plans. } NOV 1 5 2019 Kalvin —Plans Examiner Date ontractor an or Homeowner (Required when comments are present) CITY OF " NOTICE / / BUILDING ZEPHYRHILLS DEPARTMENT OF ADDITION OR CORRECTION D • NOT REMOVE ADDRESS Lrs_�booDATE PERMITf 3X-8 - , --� 5­3 THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job will be accepted. 4 it It is unlawful for any Carpenter,Contractor,Builder,or other persons,to AFTER CORRECTIONS ARE MADE CALL cover or cause to be covered,any part of the worts with flooring,lath,earth 78O-OOZO FO R -INSPECTION or other material,until the proper Inspector has had ample time to approve the installation. OFFICE HOURS 7:30AM-4:30 PM MON.-FRI. INSPECTOR