HomeMy WebLinkAbout21-3040City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542
BGR-0 30 -2021
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 10/18/2021
-
11 26 210010 11600 0110 5526 12Th Street
IBM,,
4
Name: ZAYAS MANUEL Permit Type: Building General (Residential) Contractor: DANIELLE FENCE
Class of Work: Fence MANUFACTURING
Address: 5526 12Th St Total Valuation: $6,271.99
ZEPHYRHILLS, FL 33542 Total Fees: $65.00
Phone: Amount Paid: $65.00
Date Paid: 10/18/2021 11:40:40AM
REINSPECTION FEES: (c) With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greater, for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
Complete Plans, Specifications add fee Must Accompany Application. All work shall be performed ir
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
... .. ......
CONTRACTOR SIGNATURE
V
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
Phone Contact for Permitting
Owner's Name
Owner Phone Number
Owner's Address
S 2L 12-ht" W*A Zemh4h qhone Number
Fee Simple Titleholder
Name r Phone Number
Fee Simple Titleholders
itleholder Address
JOB ADDRESS F,;- �72-,
SUBDIVISION
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
BUILDING SIZE
NEW CONSTR
ADD!SIGN
DEMOLISH
El
INSTALL
AIR
I
O
SFR
COMM
I
OTHER kJPfY" I I 0 -ff
BLOCK
FRAME
STEEL = (. I
_1EX VIE 1E]EAE VX VIE-WAL-JUJILVIE W x Vx WIL TICAUXXX VIE V_KXX_1E ILIE VV_V`V IE W_X XXX-Au EKX x_x_XV_W 1E_XX_VV x lux it k
=BUILDING 1$ G'J t � I VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL 1$ AMP SERVICE PROGRESS ENERGY W,R.E.C.
=PLUMBING $
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION rp
=GAS Q ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
1 14" 9 0 1 # t2t;1V
BUILDER T :OMIFANY rnmlp 1. Lp.
SIGNATURE REGISTERED #[�Y FtE CURREN Y/N
Address n Zicens. #
SIGNATURE i J REGISTERED Y/N I FEE CURREN I Y/N
Address I License #
PLUMBER COMPANY =
SIGNATURE REGISTERED / N FEE CURREN L_y LN__J
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED LYj _N FEE CURREN L_LLN_J
Address I License #
OTHER COMPANY = I
SIGNATURE REGISTERED Y/N FEE CURREN LIIN_j
Address 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 clumpster. 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 $2600, 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
-D. Drfye_GFM
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
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 1, 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 limitedto:
- Department of Environmental Protection -Cypress Bayheards, 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.
DA JURAT (F.S. 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who isl_arepersonally known to me or has/have produced
as identification.
Notary Public
Commission No.
Name of Notary typed, printed or stamped
to me or has7tfave produced
as identification.
Notary Public
C omission No . .
n-�On
m m
e tary typed, printed or stamroped
INSTR#2021220570OR BK10461 PG2029 Page 1 of 1
10/1512021 11:08 AM Rcpt: 2364997 Rec: 10.00 DS: 0.00 IT: 0.00
Permit No.
• NOTICE OF COMMENCEMENT
State Of P County of Ra5co
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes,
the following Information is provided in this Notice of Comma t
1. Description ofPmEerty. PqrcelldentTijafionqo.
Street Address:
2. General Descrif
1 Owner InformationAoli Losses information if the Lessee contracted for the improvement
Interest in Property:
Name of Fee Simple Titleholder.
(If different from Owner listed above)
Add
4- =ctrir.a�
Address
Contractor's Telephone No.�
5, Surety:
Address
Amount of Bond: $
6. Lander.
Address
Lender's Telephone No,:
City
Telephone No.:
City
state
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided
Section 713.13(1)(ag7), Florida Statutes:
Address city State
Telephone Number of Designated Person:
UJ
ILLI
81 In addition to himself, the owner designates of < _j
z
to receive a copy ofthe Lienoes Notice as provided in Section 713,13(lyb), Florida Statutes, T) LLJ
LL
Telephone Number of Person or Entity Designated by Owner. (D F-
0-
9. Expiration date of Notice of Commencement (the expiration date may not be before the completion of construction and final payment to the C-) 0
0
5
contractor, but will be one year from the date of recording unless a different dale is specified): i- Uj 0
LU
LL'i
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT jX
X
CHAPTER
ARE CONSIDERED IMPROPER PAYMENTS UNDER R 7�7ART
UR
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTSIR
RECORDED AND POSTED ON THE JOB SITE BEFORE EFTIR2 I SR
1, SECTION 713,13, FLORIDA STATUTES, AND CAN 0 <
PROPERTY, A NOTICE OF COMMENCEMENT MUST BE -
0 U
:CTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT >. Lj, LL
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENC G WO OR YOUR NOTICE OF COMMENCEMENT, 0 Uj
b Z ir-
true to the best 0
not, M, a,
= I� Under penalty of perjury, I declare that I have read the foragoin notice mmen ant and that a are
CL L4J
of my knowtedge and belief. 0 < tz-) 0
STATE OF FLORIDA
COUNTY OF PASCO
erl'or L Authorized U-
Sig o se's
T z 0
o a r";,..r
r a ortm:a r of Q. <
U- x < N
0 0 LJ
Signatory's Title/Office U Q >-
00 Cr Z
tt 2 C-4 zckv-at 8
The f ragoing instrument was acknowledged before me this day of ��, 20 by Ir
l
LU
(A < 00
_-_-as 0 1.0 1 C�4- (type of authority, e.g., officer, trustee, attorney in fact) fort -j LLJ
4
Ina f arty behalf of wh rn knstrument was executed). Ir- UJ
UJ
Personally Known k OR Produced Identification E] Notary slnatul
C)
Type of Identification Produced Name (Print) 7"Mot 03
1
,W ft6 Notery Public State of FVI.':
Celestine Th elestine ThOMItr
m commMew
y cssicrin Hh U24 5s��
xp4= 2
Go Expires 11/1612024 wpc I
Rjzm�! as M.,
FL 33542
Primary Email: heliflyboyl952@yahoo.com
Primary Phone: 850-496-3319
Mobile Phone:
[.TZ 0=1
?)tojeat Desoription: El Fence 0 Kitctien [] Pavers 0 Pergola
L01 I LN I OXT WATA w I 19: 4 Q0-3 16*1161 il, I WA W-11 Ar: 4 W1 Z 1011:1; Ri 161 A ft 11-11 -4 W—H
FENCE 1 72" X 64"ALMOND W/WHITE POST LAKELAND WALK GATE
72- X 128- ALMOND W/WHITE OST LAKEIa D DOUBLE DRIVE GATE
Deposit 2100.00
OPTIONS TOTAL:
PROJECT TOTAL:
DEPOSIT:
*BALANCE DUE,
ACCORDING - CONSTRUCTION
10�VORIOAS CKSTRUCTION LIEN LAW (SECTIONS 713 001, 713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR
PAYMENT AGAINST YOUR PROPERTY, THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN, If YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB -CONTRACTORS OR MATERIAL SUPPLIERS OR NEGLECTS TO MAKE
OTHER LEGALLY REQUIRED PAYMENTS. THE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE PAID YOUR CONTRACT IN FULL, IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY
ALSO HAVE A LIEN ON YOUR PROPERTY THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE
FAILED TO RAY TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY
THAT HAS PROVIDED TO YOU A'NOTICE TO OWNER.' FLORIONS CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS RECOMMENDED THAT, WHENEVER A SPECIFIC PROBLEM ARISES, YOU CONSULT AN ATTORNEY.
We hereby propose to furnish labor and materials cornpletely in accordance. with the above specifications for the sum of:
Total price (includes tax) 8271 99, (ALL DERIT/CREDIT CARD TRANSACTIONS WILL BE CHARGED AN ADDITIONAL 3% PROCESSING
FEE ON THE TOTAL VALUE OF CONTRACT)
contracted price listed above.
Danielle Felice authorized representative. 'Ww 1 Narne (printed) &aza 4 Z
ACCEPTANCE OF PROPOSAL/CONTRACT
The above prices, specifications and conditions �,e Otebj Aa OT contract terms and conditions.
.
Temporary Sales Checklist
City of Zephyrhills
5335 8h Street
Zephyrhills, Fl. 33542
Phone: 813-780-0020 / Fax: 813-780-0021
REQUIREMENTS
Detailed Plot Plan showing setup of location. Refer to Ord 1038-09, See 5
Notarized letter from property owner stating their approval.
A flame retardant certificate is required IF a tent is involved. Inspection required once tent
is erected and prior to opening for business.
Approved certified fire extinguishers per NYPA 10.
No Smoking signs must be placed outside entrances.
IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least
2 exits.
IF tent has sides, the sides shall be in the up position unless there is inclement weather,
then 2 sides must be in the up position.
FIREWORK REQUIREMENTS — (In addition to the above)
M=
Proof of State License.
Proof of Liability insurance.
List of items to be sold at site.
Copy of Drivers License and Social Security Number of all personnel dealing
with the sale of fireworks at the tent location,
$ 3 — City Registration (If Regulated by DBPR — Fee is Waived)
—$5 NO — Fireworks fee - Fire Department fee
$ Temporary Sales Fee for V two days
$—Temporary Sales Fee per day for each consecutive day thereafter, not to
exceed duration of 7 consecutive days and no more than two occurrences
g -a 12 month period-on--sameOrd #1038 -samv property -09, See 6
46--B -0,0- -Tent Fee.(AO/
-� 15.00*XD) —(*$15.00 waived
— Electrical Fee
Property Owner:
n,( -S,
Applicant:
Phone Contact:
Address Site: -2 cv,6i V, kks
Date(s) of Sale:
Ordinance No. 1038-09 (for additional requirements)
Plot Plan showing setup.
Notarized letter from property owner stating their approval.
if tent is greater than 10 x 10, flame retardant certification is required.
No smoking signs must be placed outside entrances.
If there is to be wire fencing or chain link fencing, this fence shall be set
back from the tent at least 5 feet and have at least 2 exits.
If tent has sides, the sides shall be in the up position unless there is
inclement weather, than 2 sides must be in the up position.
#• of liability insurance.
Minimurn • 120 between stake lines.
Adjacent tents shall be spaced to provide an area to be used as a means of
emergency egress.
The ground enclosed by any tent and ground not less than 120" outside the
tent shall be cleared of all flammable • combustible material or
vegetation that is not used for necessary support equipment.
If lighting is installed in tent, it shall be in the way that bulbs are • in
direct contact with the tent. (bulb/lamp cages)
If power is supplied by generator, generator shall be a minimum of 20 feet
from the tent.
Any • cords used shall be placed or positioned to cause a trip/fall
hazard.
A certified portable ABC fire extinguisher shall be located at each tent in
a ble and readily accessible location.
t,`•i of state license.
A pressurized water extinguisher (in addition.11to the ABC)
List of all items to be sold.
Copy of driver's license of personnel selling fireworks to
conduct background check
WHEREAS, the City Council of the City of Zephyrhills, Florida finds the public health, safety,
and welfare will be served through the regulation and restriction of temporary sales and events
on private property; and
WHEREAS, this Ordinance is intended to improve the aesthetic appearance of commercial
areas within the City and to protect the health, safety and welfare of the traveling public by
regulating temporary sales and events on private property.
NOW, THEREFORE, BE IT ORDAINED, by the City Council of the City of Zephyrhills,
Florida as follows:
SECTION 1. PERMANENT COMMERCIAL ACTIVITY TO BE HOUSED.
All permanent commercial activity wherein goods or services are offered for sale within
the City limits of the City of Zephyrhills shall be conducted within a permanent structure erected
on premises.
Rcpt: 1251120 RIc z 18
SECTION 2. §ST_RUCTURAL.ETANDARDS. DS. 0. 00 T: 0.00.50
06/30/09 - - ., Opty Clerk
The aforementioned structure(s) shall comply with all applicable building and fire codes
then in effect.
PAULA S. O'NEIL, PASCO CLERK t COMPTROLLER
2
SECTION 3. TEMPORARY 1RY OUTDOOR SALES. OR SK i Yly PGof
Temporary outdoor sales shall only be permitted when conducted by a permanent
business established on site. The goods sold shall be of the same nature as those sold by the
established on site business. If the event is located in a parking lot, the temporary sale shall not
use more than fifteen percent (15%) of the total required parking spaces.
R
The City Building Department is hereby authorized to issue permits for temporary sales
that conform to this Ordinance. An application for a Special Event shall be submitted and filed
with the Building Department for approval. The application shall show a site plan with the
location, duration and extent of such proposed sales. In addition to the application, the applicant
shall submit a letter from the property owner stating its consent to the teirapbrary.outside sale.
SECTION 5. RESTRICTION OF LOCATION.
Temporary sales shall only be permitted on property within �n appropriate zoning
district. No part of such sales operation shall be located within -any required. setback or
landscape or transition strip. The sales operation shall not impede or adversely affect vehicular
and pedestrian traffic flow or parking maneuvers. One sign, not to exceed (8) square feet, may
announce such sales. Such sign shall not be located in a required setback or landscape or
transition strip. Such sign shall be temporary in nature, non -illuminated, and approved as to
safety and stability by the Building Official.
For the purpose of this Ordinance, temporary shall mean no longer in duration than seven
(7) consecutive days and no more than two (2) such occurrence during a twelve (12) month
period shall be permitted on the same property. In the event that the applicant is a tenant in a
multi -tenant structure, each t�cuantshall be permitted two (2) temporary sales in accourdance
wi
th the provisions of this Ordinance."_
Record and Return to:
City Clerk's Office
5335 Sth Street
76 ... 1,111. Cl 112rA7
% OR FjK8117 ?r- 172
SECTION9. FIRE PROTECTION. 2 of 2
All temporary structures shall be in compliance with all Zephyrhills Fire Rescue rules
and regulations,
SECTION 10. PENALTIES FOR VIOLATION.
Any person or entity found to be in violation of the terms or provisions of this Ordinance
shall be fined $500.00 Per occurrence or incarcerated for a period of up to thirty days.
SECTION I I. REPEALER.
All provisions of the Zephyrhills Code of Ordinances, as amended, and ordinances or parts of
ordinances in conflict herewith are hereby repealed to the extent of any conflict.
SECTION 12. MODIFICATION.
It is the intent of the City Council that the provisions of this ordinance may be modified as a
result of considerations that may arise during public hearings. Such modifications shall be
incorporated into the final version of the ordinance adopted by the Council.
SECTION 13. SEVERABUJITY.
It is declared to be the intent of the City Council of the City of Zephyrhills, Florida, that if
any section, subsection, sentence, clause, or provision of this Ordinance shall be declared invalid, the
remainder of this Ordinance shall be construed as not having contained said section, subsection,
sentence, clause, or provisions and shall not be affected by such holding.
SECTION 14. INCLUSION IN CODE.
It is the intent of the City Council that the provisions of this Ordinance shall become and be
made a part of the Zephyrhills Land Development Code, and that the sections of this Ordinance may
be renumbered or re -lettered and the word "ordinance" may be changed to "section "article,"
regulation," or such other appropriate word or phrase in order to accomplish such intentions: -
SECTION 15. EFFECTIVE DATE.
This Ordinance shall become effective upon passage on the second reading, and signing. by
the M . ayRf. z
TM'he�Toreg
W ince No. 1038-09 was read and passed on the first reading in an open and
,
regular k ity Council of the City of Zephyrhills, Florida, on this I Vb day of May,
2009—
Attest.
6- ity Clerk Jodi Wilkeson, Council President
The forego• dinance No. 1038-09 was read and passed on the second reading, following a
public � gP, i4 an open and regular meeting of the City Council, of the City of Zephyrhills,
.
F10484, Gs-22!44ay of June, 2009.
At;teSQ
'City Clerk
Jodi Wilkeson, Council President
The egi t6�*Aiice No. 1038-09 was approved by me this 22nd
day of June, 2009.
W. Cliff Wt)ufrde, Mao
Approved as to Legal Form and Sufficiency
For :the *relianqe of of Zephyrhills only
"Is
J e Poblick, City Attorney
onm
To Whom It May Concern:
7921 GALL BOULEVARD
Lowe 's Companies will assume all payment charges associated with applying for, signed for, and picked up for permits
for a temporary tent for Christmas Trees.
STATE OFNORTH CAROL|NACOUNTY OF Iredell
The foregoing instrument was acknowledged before nnethis 23—aynfSeptember 2021 byRichard Goodman,
Vice President - Retail Facilities Management of Lowe's Home Centers, a NC Corporation, on behalf of the corporation.
Megan Hammond
NOTARY PUBLIC
North Carolina
to RmA
MY Commission Exph�s 10/3112024
Notary Signature
Personally known X or produced identification N
Richard Goodman
Vice President ' Retail Facilities Management
Lom/e'sCompanies, Inc
Mooresville, NC 28117
D-Eagle Tent Rentals, Inc.
2766 Rifle Range Road
Winter Haven, I'L 33880
863-325-8553
57=01•^ i i
To Whom It May Concern:
1, Tanya Baldwin, authorize Tanya Godwin- to submit, sign and pick up any documents for this
. . . . . . . . . .
If you have any questions, please call.
Tanya Bald
Owner ;Z
State of Florida, the county of Polk. Sworn to (or affirmed) and subscribed before me via X physical presence OR __ online notarizations this
October 8, 2021 by Tanya Baldwin, who Is personally known to me or whom has produced
FL Driver License B435-807.67-835-0 as identification and Who_ has, X has not, taken an oath,
SEAL
No
A ELIZABETH C, DAVIS
S Elizabeth C. Davis
Notary Public, State of Florida
My Comm, expires Sept� 16, 2025
Commission Number
Type, Print or Stamp Name
11
Certificate of Flame Resistance
Issued By
ABC Tents
Date
Manufadwred
Thislis to certify that this fabelcis flume retardant. It is Inherent and cannot be removed
by age. It Is registered with the California State Fire Marshall and meets
P
5903.2 tests and codes.
The Flame Retardant Process Used WILL NOT Be Removed by Washing.
�� - - - - - - - - - - -
r;
11143,
- -
(ConcordNAME: Swrlantha Stuart
Edgewood Partners Insurance Center (EPIC) PHONE IFAX 925.609.5531
i
P.O. Box 5668 ADDRESS: Samantha.Stuart@epicbrokers.com
INSURER(S) AFFORDING COVERAGE NAIL #
...-------
Concord, CA 94524
INSURERA: ARCH T1V5 CO 111150
INSURED
INSURER B --- --- -- --- ---- ---
O-Eagle Tent Rentals, Inc.
INSURER
- �--
PO Box 128
INSURER D ----- 1----
INSURER E:
Eagle Lake, FL 33839
INSURERF
COVERAGES CERTIFICATE NUMBER: 63105680
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 ApDL SC1BRj -- —
POLICv EfFAGLI Y EXP I
LTR i TYPE OF INSURANCEINSD WVDPOL[CYNUMF3ER
MM[DD!'Y _- MMIUDIY Y 1 LIMITS
A X COMMERCIAL GENERAL LIABILITY X j !PRPKG0058204
0
09/3`0f21 09/30/122 EACHOCCURRENCE $ 1 000,ddd
1 X
-- ---
�f GE�tSiNrE� T
30d,000
CLAIMS -MADE OCCUR
—, J
$
�PREMISEaoocu enceZ t— -_ --
MED EXP (Any one person) - 1 s 10,000
i
PERSONAL& ADV INJURY $ 1,000,000
1GENLAGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE 1$ 2,000,000
°g 7—PRO POLICY i E� I LOC
--
— — — —
PRODUCTS CQMPJQPAGG $ 2,000,000
OTHER:
$
AUTOMOBILE LIABILITY -:
COMBINED SINGLE LIMIT $
Ea accident)
IANYAUTO
i BODILY INJURY (Per person) $
OWNS SCHEDULED ; i i
I I
BODILY INJURY (Per accident) $
1
ONLY AUTOS
HIRED NON -OWNED
1 AUTOS ONLY � AUTOS ONLY
PROPERTY DAMAGE
��Per accidenf�.,_--
$
A UMBRELLALIAB X OCCUR r (PRFXS0033904
09/30/21 1 09/30/22 ,EACH OCCURRENCE $ 1 000,000
t
X EXCESS LIABCLAIMS-MADE1
1
...
AGGREGATE I $ 1,000,000
�- — — -
DED I RETENTION$ I I
1 �$�
lWORKERS COMPENSATION
STATUTE ER
l..._-_L. 1__--
AND EMPLOYERS LIABILITY YIN (
-- --- .. __.-.. _.._.--
IANYPROPRIETORIPARTNERIEXECUTIVE
'.OFFICERIMEMBEREXCLUDED? NIA
EA. EACH ACCIDENT $
j __. .._.—. _-- ..-__ ...-__ _ . --- _-.
(Mandatory in NH) !
If describe
E L DISEASE EA EMPLOYEEI $
yes. under
DESCRIPTION O6= OPERATIONS below
C E.L. DISEASE -POLICY LIMIT , $
DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The Certificate Holder is Additional Insured with respect to General Liability as Per the attached endorsement,
CERTIFICATE BOLDER CANCELLATION
City of Zephyrhills HE I
5335 8th Street AUTHORIZED REPRESENTATIVE .
Zephyrhills, FL 33542
USA
Q 1966.2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
SamStuart
63105680
-"'O,--c,,"1e Maj s 7921 Gall Blvd
...... . . .
Imagery @2020 Google, Imagery 02020 Maxar Technologies, U.S. Geological Survey, Map data 02020 100 ft
h4tps:llwww,google.com1mapslplacel7921+Gall+Blvd,+Zephyrhills,+FL+335411(?D,28,2725643,-82,1905973,248mldata=!3ml!... 10/30/2020
{{
r t � ,>,.- a . t. �a��m� �«,.,n `! r•a a h � fit,
{
115 �.'�
f
lit
I 529 b
MICRQTEL PARU j
c�eCtf cLr9 c p
(-V F: �NE�{�i GS t Ik - s
f j ate, 1 ,.1y E aEi zo
s o fm
a
Na.
-
},
e. .ems, mxc zxrr. CAL47.VVAL.-MART CusTomER LOADING�CAN06'YDETAIL _
t
REVIEW OAT, E l ` L r- ' a
ALL WORK SHALL COMPLY WITH CITy OF ZEPWRHILLS
NFFA CODES AND ST, ANDARDSFIRE AND UFE SAFETY EXAMWER—ZJ—Z—:�,
Cighted Exit Signs
No Smoking Signs
I<--40-�
locatedExits open 10ft. Fire Extinguishers are
JIMMY PATRONIS
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPEN SATION
EFFECTIONVE 111 w/28/2020
PERS: TANYA BALDWIN
FEIN: 020667636
D-EAGLE TENT RENTALS, INC.
2766 RIFLE RANGE ROAD
WINTER HAVEN, FL 33880
SCOPE OF BUSINESS OR TRADE:
Door and Window Installation
All Types Residential and
Commercial
M III I 8I III I III I lI I I I III III 1 11 1- A I I
3MMI'l _V1111132055111i ZMEME=
fty1 -1 1, or -MG[Rafimilli 03wanom
IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440,05(12), F.S,, Certificates of election to be exempt issued
under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or
trade listed on the notice of election to be exempt. Pursuant to subsection 440,05(13), F.S,, notices of election to be exempt and certificates of election to be
exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate
no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01209282 QUESTIONS? (850) 413-1609
U. kited Exit Sign
Pdv �ri#�ak§€e� 1ta#
F
1.
Ftro Extln #rl^Ov
No
r# kn Sion y
it
i mil # ttr 'y
s'i
f f I
"r a
CIF!'
rm� L tI }t
r�
Enlr[tm
P
Lighlod ExitSig"
�
j No Smakinu Scot" �
I
lat's on Da rt Onq of ters, .nF� rq ac r a r i
O xquis � r # Witt 44 On na.cant#r polo
T't't r Wli Gs two ttsi# twrtt, f tho tone, The al9ma 3 r-o lighto ,