HomeMy WebLinkAbout02-1552
BUILDING PERMIT
Permit N2
JI, /).~q
BUILDING
$7~
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 780-0020
:1~D iR 10
PLUMBING MECHANICAL
1552
,-
Date //J-I'I-Ofl-
.
Property Owner:
Job Address:
Parcell.D. #
Zoning: _ ' E~rgy C~ ,"
Description of Work ~./j1 L~
Sewer Conn
Water Conn:
, ~ Radon Ga" .
, J~ /J tJa6?.2n.s
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
- .J-g-o 3
.....,pATE
- ~- IJ :3
DATE
L'1 J- }/jo
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
Valuation or
Contract Price
~ ()/l'~. 700'
,
,3D3f
o...Q..
. e.Q
BUILDING
ELECTRICAL
Company
Address.., _
6eleph~P/)) U.2.-7(O,
J3i15 fJJJfij'{JIJIJ/I(. IYJr<!/lVE319.l
I <:::6.. 0.
PLUMBING MECHANICAL
City License Registration ,
State Certified License'
Ll;;~~ ~~~
A~1()(i-/FJ n=D E J.R!T
Tp. Servo SLB rt../'l.f!l-23-tJ~ ,RL~ #.1!r,eakers
Rough In /io--2.~_cz. illl{ Tub Set 1./'10--1.."-01- 1!V( Ducts Insl.~/IO-.2'i-CL ,fct#V1>
/*JO 1~:rO ./1.
Meter Can . Water Compressor -v 4 ~'- L
Const. Pole Sewer Final ",.......--- ~ - ;JsP.-~.3 Il. 'f
Pool Final /3 - :;l. (J - 0 '3> I2U~ /-100 r /.Iff" 0
Pre-Met~ Al/Ab. /a-r:&?;< ~Y' JJ.
Final ,/ ~ ,...".2c.-O 3 {It'f;-Up f2L-)1/k<J/I. 1(-.2 ~--o,;J ?(tj
Driveway , -;e,oI)l\ 6(-ec:., (-:l-/3-0 2. 7'
Sub FLfJ'ff- 1~_5-0-;;' I-I-:To./hy ,K!-13 '0 .. , _
FI?A/YI'J1' OYI Mr.er/t91 YT~ jC~' //_/;;l_4!7";t.. - ~ ttuP- ~~PI
REINlpECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a :Jt/'t"'r, y
charge of twenty-five and 00/100 Dollars ($25.00) shall be made for each trip for each trade:
f ~<}., 1:2-- Z. ~ ..Ol ~(If 5-'P{~ 5 fR()r..1;;,.-e p~ _ /.:< _, /:J. _ {) 2. ;;;)1)
a. V\fIong Address tI'Si; '5;- .. / ~ - / 9:O;:P /? (. Y. R L f4
b. Condemned work resulting rom faulty construction. ,/ ~O ,
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site. /'t. IJ IJ -J I A' 1_
g. Work not accessible. Ll!Mh/( M ~/1A<t CUJC~
Ftr. /1';. 'I-tl,;l.. /1ftJ
Pre SLB /IO'2~ -OJ, ~Ldz
. /I-<f?-O #.ro t-t D
Lintel
FRM. ~IIIJ - 2.e, , 0'2- ~L-'-f
Insul. CL \+~
WL
<{'Ivntb ~' ~~ C~
/ ;;} -..2 7-0 ~ HJi)
- i-)..-tJ3 -72'-'1 ri-lJD
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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R~eEIVEO: 101 2102 11:~O^M; ->ASSOCIATED ELEe~AIC; #4a1; ~Aae 2
10/01/2802 23:38
8137823847
Kt\5H AND K~RY PHARM
PAGE el2
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- -- -- ~ - --.-. .1....._ ... .................. or. n..I;'".I;'" LJ.1. '"'.n. J. .i. _11'f I _______
llJII'AR'l'MBlNT S3.Hi 8th S'.t'RlIIJIJ'l' ZlIPHVRHILLSr ii'll J)54G-~---
Phortl!iI813-'fSO-002b raxIUi"'7BO-00I21 ~ .*')/
DJ\TB R!OIIVIlO ;, ._~-O~
PLANS ItIVIll/'" riB''=- 'VfF-:--~,
I
PHONE CONTAC~2 0 ~ II ::t~
ZEPH~~.IFk- ~~S-~,L__
. .
J OWNIlIR I B NAME --i AS 1-4 l'\' flJltrfl. ~ 'r' ~__
..rOB SI'rs ADbREBS ~732. cs- GA.~__gt:H.)'-~~
LlllGAL DBlSCRrP'rrON I LOT (S) ~.H=D BLOCK _
I?ARClIIL ID #
aUBr)IVISJoN
WORK l?ROPSED l 0 Nmw (lONS'fRUCTION
~-
(OB'l'A1:N P'ROM PROl?BRTY 'J'AX nOTICE)
o ADDITION
~AUflllRATroN
[J DEMOLISH
[j REPAIR
DSIGN
[J INS'l'AJJIJ
o MOVE
PROPOSED uas. [JeGL WAMILY DWELLING
~OMM!llRCI1H1
OMtJLTI-P'AMILY
On OF UNr'l'S
[l MOBIlJE HOfilBl
DOTnER
o JNDtJSTFUAI1
o SWIMMING POOL
CJ ~BlSTAURANT &: HI!ll\L'L'fl DEI?AR'fMBlN'I' APPROVAl_
OoseRI PTIoU OV WORR L:I~1l ~...~ "...n:o", or. 5.CA""" l1l;.. 0" '" "'1;0 "" _______
IItlILbIU" sr., ~ ~ SOUARII 'OOTM. f'f: 972. ".t""T 3? '-l!' ~
"
RmarDI!lNTIAL~
COMMERC!IA1J t
A'I'TAIJH (;;I) PLOT I?LANS & (:I) SETB OF BUI1.nHfG PIJANa
A1''l'ACH (3) BETS all' BtJIJ~DIN(a PLANS & (1) 8 Eli. TilNmRQY
PJWPERTY SURVEY RBlQtnR~D F'o~ AtJL NEW CONSTRUCTIOl-t.
~ (1.) SIlIT ENERGY FORJ.1S.
PORMS, ~
. 'M6'
FD.... ( i ),j.t+ i --
if ~ ;Z ---9;) t).
_----...------..--..-....... ..~/Qf '.. -
~rilOIIJnING
~lIBJC'l'RrCAL
[~PIIUMBINQj
~ MIl1CHAJ:HCAL
VAL.UATtON OF TO'l'Al. COnS'l'RUC'nON
AMP SERVICE
~ FI,OR![1A I:'dW1!lR
o
W.R.m,o,
$~~O. oeo
]i?tGAS
o ROOFINca
[] SPBlCIALTY
VM~UAT!ON OF MECHANCIAL n~BTA.r.r.,i\TION
[] OTHER
'l'YEm OF cdttEl'l'RnC'tlON I a BLOCK 0 FRAMHi
F'lN I811ED FLQOR ElLElVA'rIONS I 'f ~' _ 0 tI
[] STElEL
o o'rnER
Hl !;>ROJIlJCT IN FLDOD ZONIIl AREA[] 't'IIIS
~ No
l1UILDBR
---"---
COMPANY ~
s'rATE ceRT OR RIllGrST # _____~__
CITY PROCESSING #
S IQNA'fl1RHl.
BLBC'l'RtcU.:>>
*******.**~.***.*********.*****'*****************'*~.****,.*".,**
........--'---
COMPANY~
s'rATE CEllt'r OR RElQts11r-'~-
CITY PROcm8SI~G #
8 r CiNA'l'lJREI
J.__~....
~---.......
PLUMBliR
***********************~***************'********************.****~
---..--.---.
(~t)Ml?l\NY __.___.__.
S't'ATE CBlRT OR l{HlGtS'l' #
CI'I'Y PROCESSING It
SlGlNA'l'URBl
--
......__.,.--~
MaCHt.NIOA'-' COi"iPANY ~___~_.__~,~~___
S'l'A'l'E CIllRT on, Rlll(.HST t~
Stcn.J1\TtJRE CI'l'Y PROCIllSSING #
.***************.*************,w*************~*.********t*i**.,***
---.--.-........--......-~-
tlTHIlR
**********~***~***********'**********'*'********************'*'**
..----.....-- -.-....---------.--
---
CO/l1PANY'
STATE: CI!lR'I' OR REGIST II
CITY l?ROCESSING #
~-"""""-----......."'--1-~_......._
SIGNATIJRlil
************************.**********~********************,..******
------_..L~_
'd
lll7,'ON
SllIH~AHd3Z jO AllJ
~V8l:01 GOal '8l'~nv
CONDITIONS OF PERMIT AFFIDAVIT
A; NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. 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
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify 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.
E. 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, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental 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 Regulation-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
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
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 code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be 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. JOBS UNDER
:::~;:G::TO RECORD MD POST ;~~~n.
STATE OF FLORIDA ~ STATE OF FLORIDA .' ....
COUNTY OF 7-- ~f W COUNTY OF l':::::/t1tj4.'J
The foregoing inst~ ent was acknowledged The f.?regoing instru~ent waS~)~Ck~QWledg~d
B~ lTle.- this ~ day of Ot!-'T , fS.1!.aJj..... Bet<O='ic 12 Ll~... , =3'.A_ _ ay of /:L..,<7 - , '9~L
by~ ?2 7;>,;) ~1i(JA) by _ _ 0 _~ C 8..50
(name of person acknowledged) (name of person acknowledged)
Owho is personally known to me, or Gho i~_personally known to me, or
~~has produced r--~ 7/,1... (!~.!J-D-g/:l..~~:J&fO ~~as
fnd;;h~O~Jl(v~~~t7
_.----~P . ~
Signature of person taking acknowledgement
...~\j\~'r~~ Bobbie Swetland
l.~~i ~W CQ~4~4ISSI0N t CCml '0 EXPIRES
Na~. i~_d, P~lit~2~200~tamped
'l,~iif.~"'" SONDED THRU TROY FAIN INSURANCE. INC
Signature of person taking acknowledgmen~
,"~~r~~ Bobble Swetland
iii "
Name -. ,~:hWfH~!tIU~11..22~1I~~t:i
'. .~~ e ruary
to;Oi.~" 80NDED THRU TROY FAIN INSURANCE. INC
"'111"'.
C.L'J.'~ 01f ZEiPHYRHILLS PERMrr. APPI.lICATION
BUILDING Dlill?ARTMEN',[' 5335 atl, S'IREET ZBlPII'fRHILl,13, E'L 33540
Jilhonlilll 813.,7 EIO -oo:a J li'axl 813. 7IH'" oo:n
DN.L'B: F:BC1UVBlD ____._____._____
Pl"UiI~ REVIIllW rBIll
mlHER I SHANE
PH\)t\ EJ CONTACT
.JOB SITE ADDRESS
LEGAL DESCRIPTION: LOT(8}
BLOCI<
SlJBDIVIS roN
PAR~EL ID #
(UBTAIN8'ROM 1?1'WI?ERTY TAX NDTICEJ)
WORK I?HOi:'SElD: []NEW CONS'fRlJCTION
OSICm
n AnDI'rrON o AUI'E:R.~ T I ON [J RE:IlAIR o mS'I'AI,l,
o JI10VE 0 DE:MQl,ISH
o MUI/l' I - FAMII"Y [)# DB' maTS [] MOBII.E HOMEl
o INDUS'l'RIAL [)SWU1MING POCll" IJ OTHER
PROJ:lOSED USE:: DSGL FAMILY DWELI,ING
f] COMMERCIAl,
D RESTAURANT & HEALTH DEPARTMElN'l' APPROVAL
DESCRIPTION OF WORK
BUILDINGl SIZE
SQUARE FOOTAGE
HErm!'f
RESIDENTIAL:
COl>1MERCIAL:
AT'rACH (2) PLOT PLANS & (2) SE'rs Of' BUIIJDINCl P{,ANS /~ (l) S,ElT ElNElRr~y FORMS,
A'r'l'ACH (3) SETS OF BUII"DlNG PLANS & (I) SElT ENERGY FOR~1S,
PROPERTY SURVEY REQUIRED FOR ALL NEW CONElTRUCTION.
I?B:RMI'f~ REQUB:8'l~EIJ.
0 BlI ILDUj(3
Ll ELEJC'I'RICAL
0 I?LUI'.18 ING
0 J.1ECHAHICAIJ
0 GAS o ROOFIHG
$
VALUATION OF 'I'O'l'AL CCJNS'fRlJC"rrON
AMP ~ERVICE
o FLORIDA POWER
o W.k.El.C.
~--_.
VALUATION OF MECHJU1Cj:AL INS'l'AL.l,Nl'ION
o S~ECIALTY
o OTHEJR
TYPE: OF CONSTRUCTION: 0 BLOCK
o FRANE
o STElEI"
[] OTHER
FINISHED FI.OOR EI,EJVATIONS
r s PRO~JECT IN FLOOD ZONlil ;~REJA 0 YES
o NO
BUILDIilR
COt~I?ANY_______.___________.__
STATE CI~R'I' OR REGIS'l' H ______.
CITY PROCESSING ~
SIGNATURE
**""*'**"'*"*'*""*"**"""'*""*"""""'"*"*"tt**"
lill,BlCTRICIAH
S lGNATUREJ __.
COlvJPAHY_____________.,--__,__
STATE CElRT OR RElGIS'!' #
CITY PROCESSING #
""'t't*"**""**""""*""***'*""*"**"""*'""""*'*'
:E>LUMBBlR
COMI?ANY-------
STATE CERT OR REGIST #__
CITY PROCESSING #
SIGNh'l'URE:
***""*"""**"*'*'**'*""***"""*'*"*""*'*"'**""**'*'
MI:IlCHJUl'ICAIJ
SIGNhTlJRE
COI"lPANY---
STATE CERT OR REGIS'!' #
CITY PROCESSING #
""'*"""'*'*'**"**'*****'***'**'*~"**w*'*'******""""'**
OTHER
eXlf\1I?ANY
STATE CER'!' OR REGIST #
CITY PROCESSING #
SIGNATURE
*"""**""""****'*"'*"""'*""""'*"""'"*t"".".,
DATE: 10/14/02 PASCO COUNTY PROPERTY APPRAISER
o N - L I N E PAR C E L P R I N T 0 U T
PARCEL-ID: 34 25 21 0000 00300 0020 TYPE:
SC TP RG SUB BLOCK LOT
12:45:51
STATUS: A DLA: 090302
LEG A L DES C RIP T ION:
ASSESSED IN SECTION 34, TOWNSHIP 25 SOUTH, RANGE 21 EAST,
PASCO COUNTY, FLORIDA
COM NE COR SE1/4 TH N89DG58'35
SOlDG 09'30"E25FT TO SLY R/W
SOlDG09'30"E.38FTTHN88DG51'04"
POBTHN89DG33'48"E32FTTHSOODG04
FTTHSOODG04 '30"W191. 67FTTHN89
157.5FTTOSWCORLOT4TWNVEWMEDART
FTTHCV R RAD182FTDELTA20DGOO'
N69DG58'40"W106.74FTTH CV R
DG55'29"W80.40FTTHNOODG07'42"E
NOODG07'42"E450.33FT TH S89DG
122.48FTTHS89DG58'35"E395.4FT
'35"E200FTTHNOODG07'42"E64.83
2099/25 AND TOWNVIEW MED ARTS
LESS EAST 58.00 FT
"W193.17FT TO WLY R/W US301 TH
PRTYPONDRD TH CONTALG SAID R/W
E10FTTHSOODG07'42"W609.07FTFOR
'30"W125. 09FTTHN89DG58 '40"W208
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CENTR29/68THN89DG58'40"W375.64
OO"CHDN79DG58'40"W63.21FT TH
RAD70FTDELTA70DG06'22"CHD N34
5.89FTTHS89DG58'35"E303FT TH
58'35"E181.40FTTHS10DG18'53"E
THSOODG07'42"W39.91FTTHS89DG58
FT TO POB SUBJECT TO EASE PER
CENT PB29/68 LOT 4 & LOT 5
OR 4021 PG 654
OR Bk 5099 PG 1611
2 of 2
STATE OF FLORIDA
COUNTY OF PASCO
THIS IS TO CERTIFY
TRUE AND CORRECT COpy O~~AJeT~E FOREGOING IS A
O. OF PUBLIC ",CO.O IN ""S~OH ALf
H N Al SEAL THI . ;~~
o PI 2
BY ~ OF CIRCUIT COURT
DEPUTY CLERK
Kash N' Karry
7325 Gall Blvd.
Interior Renovations
SQ. FEET PRICE
MAIN OR LIVING: $ 50.00
OTHER AREA UNDER ROOF: $ 25.00
OTHER: $ -
VALUATION $ 1,072,700.00
FEE SHEET $ 2,826.00
ADDRESS
DRIVEWAY $ -
BUILDING: $ 4,239.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 4,239.00
ELECTRICAL: $ 375.00
PLUMBING: $ 320.00
MECHANICAL: $ 640.00
RADON: $ -
TOTAL $ 5,574.00
SEWER: $ -
WATER: $ -
IRRIGATION: $ -
TOTAL: $ -
WATER METER:I $
IRRIGATION METER $
SUB-TOTAL $
5,574.00 I
SIF'S'I $
97.5% $
2.5% $
I
I
5,574.00 I
TIF'S'r
99% $
1% $
TOTAL: $
ACORDm CERTIFICATE OF LIABILITY INSURANCE CSR Sl< I DATE (MM/DDIYYYY)
B&BPR-1 10/03/02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fessler Agency-Clearwater HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3165 North MCMullen Booth Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33761-2020
Phone: 727-726-3377 Fax:727-725-4698 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Assurance Company of America
INSURER B: Bridqefield Employers Ins. C o.
B & B Professional Plumbing, INSURER C:
Inc.
707 Belleair Road INSURER D:
Clearwater FL 33756
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lTR NSR[ TYPE OF INSURANCE POLICY NUMBER ~~';!~rrI~rJg~E P~k~1t(~~b'1fJ!,~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
~ 12/23/01 12/23/02 ~~~~~s (Ea occurence)
A X X COMMERCIAL GENERAL LIABILITY SCP32354087 $ 300000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
~
GENERAL AGGREGATE $2000000
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
n '!Xl PRO- nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $ 1000000
A X ANY AUTO SCP32354087 12/23/01 12/23/02 (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I--- (Per person) $
SCHEDULED AUTOS
I---
~ HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
c--
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND C!~1/03' X I TORY LIMITS I IU~~-
B EMPLOYERS' LIABILITY 083029306 06/01/02 E~. EACH ACCIDENT $ 100000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED? ---- SJ-DISEASE - EA EMPLOYEE $ 100000
If yes, describe under E.L DISEASE. POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
A I Equipment SCP32354087 12/23/01 12/23/02 Rented 5000
i Ded. $500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICA TE HOLDER
(jJF~ ~
City of Zephyrhills
Building Department
5335 Eighth Street
Zephyrhills FL 33542
CANCELLATION
CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AU IZED ~NTA
@ACORDCORPORATION 198
ACORD 25 (2001/08)
V~l' J. LVUL IU'JJ"~
\"./ t I vI" .:..c.rnlf'\nIL~'';'
~.~ ,) . .:. 't ~. ::
'~I.A. ..n Ul_
'.7".1:1
SEl\.IlNOu. FOAM 408
NOTICE OF COMMENCEMENT
~=:'Q:'~1i 1 sboroug h } 'h~A~ 'N DUPUQATat ~~~W!I!~~!~I 1111I 1111I111I11111111I1111111111I1111
The undersignad h....by informs lit. concerned that imINovement. will b. _de '0 certain reaJ propttl'ty. and in .c:aordanc.
with SaCIJon 713~'J of the Florida Statute.. \he following information is Ji1atad in rhi~ NOTICE OF CQMMENCEMENT.
Oascriptianof property.., ,?,3.~? .~~.~.~:. ~~Y.~.~ .'.. .~~.p.l:1.Y.~h~)')..s, ..f~.... ~~?41..:..,........
................................ ........,................. -. ..- ".. ........ -.. .............
Rcpt: 625027
DS: 0.00
10/14/02
Rec: 10.50
IT: 0.00
Dpty Clerk
" ..... -.. -.. ................................................... ..... -.. -. ..... ....... .......
,..-;-- -
General description at improvements. ... .,..(-. .~A-..c. /a.t:... . ,.j?t..J.I.(..<1. . :.O.~.I "",.",.,......,..".
Own.r..... ,~.a.~I1..~ ..K.~.rFY. );'99d Stores, Inc.
Address....., ,64.~,1.. ~~r.n.~X. .~~.!.. ~~~J?':l.!.. r~, .3.3.6.10
J1E0D PITTMA~ PASCO COUNTY CLERK
/14/02 1~:5;rm 1 of 2
OR BK 509~ PG 1610
Ownerls lnterest in site of'tfJe jmpro_m.~t , . . . . . . . . .N.j.n.. , . . .
Fee Simple TItle holder (if other than owner)
Nama ."
Address ,..,
R Con_ . . . . . ..C.a.son Cons.~;r]1c.~.iol! . .~aJ:lag""'e{lt.. . . Inc.. .
Address ..... 1.~.26, ~. ..~.~.1;L~b.o.~C?~9h...~~~...,...';I'c;i,mp~,..~,l 3.36QJ
Surety (if any) ......... NA. , . . . . . . . . . , . , . " ',....... ,..,. .." .....,."...,,'...,.,.
Address ....."... ........., .............. ................... ".......
Any pewson meking . loan fOr ma construction of the improvements:
..Am~ of.bond-$ .....
Name
...M.O..,..,......,....,..................... ....,.,.
Address .. ,.. .. . , . . . . . . . . .. '" ....,.. .... .......................... ....,. ,'.. .. , .. ............
Person within 'he State of Florida designated by owner upon whom notices or other documants may be served;
Nama ..,.,. Cc;, 'Y .;:1~c;;.,TC;::.4-. , .. . . , elf I'.(;.~,.. . .~~S'7. A...v.~7:a ...,..,... . .1?71~-t.G..~.~ oF. ~;;:-.
A~.,............. ....................................................... '.
In addition to himseff.. ~r design.tes tM. fotlowing-~ to _ive II copy .of the Uenor's N.otice OlIO .pr.ov.ded "l.Section
713.13 (1) lhl. Florida Statutes. (Fill in at Owner's optionl.
Nama
..........1...'..._-_........
..........,....t~ ...-21.
L~.~......
OW",I'
Address . . . . . , . . , . . . . . . . . . , . , . , . . . . . . . . . , . . , . . , . . . .
THIS SPACE FOR RI<COROIiA'S USIi ONLY
Swam to and subscribed before me this
....6..!!!......daY of ,lYe 1"1?:~ . &160&....
~ "1111'"",1.
~II~
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Notar,*~u)Oi,~iSsION~... %
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--"
LEGAL DESCRIPTION
(
\.
... .
DESCRIPTION
TRACT 2: Commence at the Northea5t corner of the SE 1/4 of Section
34, T~wnship 25 South, Range 21 East~ Pa5CO County, Florida, thence
along the NGrth line of said SE 1/4,N-89658'35"-W, 193.17 feet
to the West xight-of-way line of U. S.. Highway 301. the-nee along
said line S-Ol.09'30~-E,'25.00 feet to the South right-af-way
line of Pretty Pond Road, thence continue along the West right-
of-way line of U.S. Highway 301, S-01009130"-E, 0.38 feet, thence
N~88051'04"-E, 10.00 feet, thence S-OOG07'42"-W, 609.07 feet for
a POINT OF BEGINNING~ thence N-8go33'48"-E, 32.00 feet, thence
5-00. 04' 301l-W, 125.09 feet, thence leaving said -right-af-way line'
N-89058'40"-W, 208.00 feet, thence S-OOG04'30"-W, 349.17 feet
to the North'right-of-way of MEDICAL ARTS COURT, thence along
said line N-89058'40"-W, 717.64 feet, to the beginning of a curve
to the right with an angle of 20.00100~, radius of.182.DD feet,
arc of 63.53 feet and chord bearing N-79~58'40"-W, 63.21 feet,
thenca N-69058140"-W, 106.72 feet, to the beginning of a curv~
to the right with an angle of 70006122", radius of 70~Ocr.feet,
axe of 85.65 feet and ~hord bearing N-340S5129"-W. 80.40 feet,
thence N-OO.07142~-E. 5.89 feet, to a point 964.00 feet South
of th~ South right-of-way of Pretty ~ond Road, thence leaving
the right-of-way line of MEDICAL ARTS COURT, S-89058'3S"-E, 303.00
feat, thence N-00007142"-~, 450.33 feet, thence 5-890S8135"-E,
181.40 feet,- thence S-10.rtt'531l-E, 122.48 feet, thence 8-89.58'
3S"-E, 395.40 feet, thence S-00.0714211-W, 39.91 feet, thence 5-890
58140H~E, 200.00 feet, thence N-OO.07142"-E, 64.83 feet, to the
POINT OF BEGINNING; being a port~on of th~ NE 1/4 of the SEl/4
of said Sec~ion 34, and Lots 4, 5 and 6 of TOWNVIEW MEDICAL ARTS
CENTER, as ~acorded in Plat Book ~9, Page 68, Public Records of
Pasco County, Florida. All containing 7.958 acres, more or less.
~~~ A.... - W v"I:i--r $""e::-r