The URL can be used to link to this page

Home My WebLink About04-3210 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 3210 Permit Number: 3210 Permit Type: DEMOLITION Class of Work: 636-DEMOLlTION Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: Date Issued: 7/06/2004 Total Fees: 75.00 Amount Paid: 75.00 Date Paid: 7/06/2004 Work Desc: DEMOLITION Address: 38510 12TH AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: Name: DONALD & CHARLENE KINSMAN Address: 38510 12TH AVE ZEPHYRHILLS, FL. 33542 Phone: REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (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 (g) Work not accessible 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. n Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. " ~~ ONTRACTOR SIGNA UR PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED 7-,:<// -fJV PHONE CONTACT FOR PERMITTING OWNER'S NAME PHONE JOB ADDRESS ;) ~ ~ 10 - /tJ-. (J~ J LEGAL DESCRIPTION: LOT(S) BLOCK PARCEL ID # WORK PROPSED: [JNEW CONSTRUCTION [J SIGN PROPOSED USE: [JSGL FAMILY DWELLING [JCOMMERCIAL SUBDIVISION (ORTAIN FROM PROPERTY TAX NOTICE) [J ADDITION [J MOVE [JALTERATION [J REPAIR [J INSTALL [J DEMOLISH OMULT I - FAMIL Y [J INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME [J OTHER . c:3RESTAURANT & HEALTH DEPARTMENT APPROVAL OESCRIPTION OF WORKC- --i) 10110,h~ BUILDING SIZE SQUARE FOOTAGE HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. & (1) SET ENERGY FORMS. FOPMS . o BUILDING o ELECTRICAL $ \ Ii . ( 1M, /-v;- PERMITS REQUESTED ~( VALUATION OF TOTAL CONST~ //1) t o FLORIDA POWER CI~.C AMP SERVICE [J PLUMBING b MECHANICAL c/ $ VALUATION OF MECHANCIAL INSTALLATION o GAS [J ROOFING [J SPECIALTY [J OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME [J STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREA[J YES [J NO BUILDER ~J. C\::x) SIGNATURE r./'~Al~~~ STATE CERT OR REGIST # CGC0'13'f<>->- ****************************************************************** CONTRACTORiSECTION COMPANYt.-A~(\ Y\k.- ~ ~<-.k. ELECTRICIAN COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # MECHANICAL ****************************************************************** COMPANY SIGNATURE STATE CERT OR REGIST # ********************************************************',******** OTHER COMPANY SIGNATURE STATE CERT OR REGIST # A. NOTICE OF DEED RESTRICTIONS The 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, 813-780-0020. 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 iesponsible. If you, as the owner signs as the contractor, you are indicating that you, rather than the contractor, are responsible for th~ 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 ttlat 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 $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR acknowledged , 20_ STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _day of by STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _ day of by acknowledged , 20 (name of person acknowledged) Owho is personally known to me, or (name of person acknowledged) [1ho is personally known to me, or of identification) take an oath, Owho has produced (type of identification) and who Odid OEd not take an oath o who has produced (type and whoO did 0 did not Signature of person taking acknowledgement Signature of person taking acknowledgment Name typed, printed or stamped Name typed, printed or stamped JI;i,~5, 2C~'~ E:~9P~\'~ S~J~R; SE ~'~S'CO ~;r)Si02 P 2/2 Donald &: Chafle.ue Kinsman, Jr. P.O. :SOl: 571 ZephyrbilJa, Ji'L 33!39 (813) 783:'1'57 July 14, 2004 :Mr. Bill Burgess, Building Inspector Building Department 5335 8th Street Zephyrhills; FL 33542 Dear Mr. Burgess: This letter it to notify you that Paul Davis Restoration is no longer our contractor and will not be building our home located @ 38S10 12th Ave., Zephyrhills, FL 33S42. Ten Brink &. Associates, Inc. is the new contractor that we have selected to build our house, If you have any questions or need any additional information, please let me know. Sincerely~ CI~ Charlene Kinsman xc: Tenbrink Construction jL'. . /J ~ 0 ,V'..Yzd/t?C ,;J ~ I 7 ----- ~ ------ /' -----.... CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 3210 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 3210 DEMOLITION 636-DEMOLlTION SINGLE FAMILY RESIDENTIAL Address: 38510 12TH AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 7/06/2004 75.00 75.00 7/06/2004 DEMOLITION DONALD HARLENE KINSMAN 38510 12TH AVE ZEPHYRHILLS, FL. 33542 Phone: REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (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 (g) Work not accessible 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." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~~/~ ~~ CONTRACTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FI. 33542 813-780-0020 FAX: 813-780-0021 DATE RECE lVED 7) ACf , PHONE CONTACT FOR PERMITTING OWNER'S NAME 111 { ~ ~ : ''\~AQ bl i (l LlI < J;",,,- K I ;'''''''41'/ _PHONE lrt.1 -'to? 7U'U: JOB ADORE SS '3 ~ C; It> .1 'J. A \J e. Z. < (' t.. y.r C 1I { f(:?:5 ':J If d.... LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # WORK PROPSED: ONEW CONSTRUCTION Os I GN PROPOSED USE: OSGL F:AMILY DWELLING o COMMERCIAL (OBTAIN FROM PROP~RTY TAX NOTI~E) o ADDITION o MOVE OALTERATION ~MOLISH [) REPAIR o INSTALL OMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER DESCRIPTION OF WORK c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL 0'(: /l/t b ~ ~ ( l,~ AJ BUILDING SIZE SQUARE FOOTAGE HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. & (1) SET ENERGY FORMS. FORMS. PERMITS REQUESTED '0 7~\ o BUILDING $ VALUATION OF TOTAL CONSTRUCTION o ELECTRICAL AMP SERVICE o FLORIDA POWER o W.R.E.C. o PI,UMBING tJ MECHANICAL $ VALUATION OF MECHANCIAL INSTALLJ~TION o GAS o ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME D STEEL D OTHER FINISHED FLOOR ELEVATIONS IS PRO,JECT IN FLOOD ZONE AREAD YES D NO ********************************************************,,********* CONTRACTOR.SECTION COMPANY fCfu / OCt V/!;. STATE CERT OR REGIST # C Be 05 /.:L 6,6 I /J, 'P <;. 10 r q -J o'/(, BUILDER ~ SIGNATURE. ~ ELECTRICIAN COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # ME CHANlCAI. ****************************************************************** COMPANY SIGNATURE STATE CERT OR REGIST # , ***************************************************************** OTHER COMPANY SIGNATURE , STATE CERT OR REGIST # A, NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed r-estrictions" vlhich 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 uIldertake 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 wllat licensiIlg requirements may apply for the intended work, they are advised to contact the City of Zephyrhills Building Department, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign po~tions of the "Contractor Sections" of this application for which they will be responsible. If you, as the owner signs as tile 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 indica~ion 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 tllat 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. 1 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.8. Environmental Protection Agency-Asbestos abatement I also certify that, jf 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 extensi.on 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 $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR acknowledged , 20_ STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _day of by STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _ day of by acknowledqed , 20 (name of person acknowledged) Dwho is personally known to me, or (name of person acknowledged) Diho is personally known to me, or Dwho has produced (type and wrioD did D did not of identification) take an oath. Dwho has produced (type of identification) and who Ddid [kiid not take an oath Signature of person taking acknowledgement Signature of person taking acknowledgment Name ty~ed, printed or stamped Name typed, printed or stamped r~l. C~!!~i~~~[~~~~~~~!~~ JULY 1,2004 CITY OF ZEPHYRHILLS PERMIT DEPARTMENT To Whom It May Concern: I, RICHARD 1. DAt~~1f:~~fILLER, AUTHORIZE /JWUD W4 LL. TO PULL PERMITS UNDER PAUL DAVIS SYSTEMS LICENSE, CB cas 1266 IN PASCO COUNTY, FLORIDA / ~ I RICHARD J. DAt~~mfILLER PRESIDENT/OWNER PDR . ~'1O/,~fti~ '7;/ /0,/ (~C .. ! .'lb"';';' - -- ~ .",- = -~"_F -- , /,,". ......../ . DEBORAH-ANN MEREDIT H~,J '. ,- . 0_ No1ary Public - State of FIe..:::::;: " \., ~ .' MyCannissian Expies Oct 12, 2005 I {,-:--;[I Commission I OD048239 .'. ;ir' -~ '--' ,~:;;.- - - __ __ ......,...~~:..:.. J 05/04/04 Tl~ 09:42 FAX 727 725 3663 Carlisle Fields and Co ~001 70 D ~6eJ~ g ~ 1.- oCD b...5 ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID lwri DATE IMMlDDIYYYl') PAULD-l 05/04/04 PRODue~R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEIUt NO RIGHTS UPON THE CERTIFICATE Carlisle Fields & Company, Ine HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.o. Box 7910 ALTER THE COViRAGIi AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-7910 Phone:727-797~0441 Fax;727-72S-3663 INSURERS AFFORDING COVERAGE HAle" IN$UR~D IN&UI'lER A: Westfield ~nsurance Company Paul Davis Systems of Pasco, INSURER B: Cincinnati ~nsuranee COmD&n' 01209 Richard Dannermiller INSURM. c: Auto owners Insurance Compal IY1898e Inc.,Dann1 Craft HOldings,Inc* 7944 Ruti io Court INsuAeA 0: New Port Richey FL 34653 . INSURER E: COVERAGES THE POLICIES O~ INSURANCE LISTED 8ELOW HAve BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO INDICATED, NOlWlTHSTANOING "IoN REOuIREMeNT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMeNT WITH RESPliCT TO WHICH THIS CERTIFICAre MAV BE ISSUIED OR MAY l"eATAIN THE INSUR'-NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUa./IiCT TO ALL TIlE TERMS, e>lCLUSIONS AND CONDITIONS OF SUCH POLICies. AGGREGATE LIMITS SHOWN MAY HAW BEEN ReOUCED BY PAID Cl.AIMS. NSRi' TY"1l 01< INSURANCE "OllCY NUMBER '6i~~':u~I\'ifJlXE POU~ LlMrrs LTR DATE MM/DD GENERAL LIABILITY EACH OCCURJ'(eNCE $1,000,000 -- A _!_L~MMERCIAL GeNeI'lA~ LIAeILITY CWP3661700 09/23/03 09/23/04 PAeMISeelr;. Q\!l1Uroncel $ ISO, 000 ~ CLAIMS MADE [!] OCCUR MeD exp (Anyane pillion) 110,000 I"ERSONAL .. AOV INJURy 11,000,000 r--I -,', GENERAl. AGGReGATE $2,000,000 n't AGGREGATE LIMIT Al'P\./E& peR; PRODUCTS-COM~PAGG $2,000,000 ' /Xl PRO- n POLICY X JEeT Loe AlftOMODILE UABLITV COMBINED SINGLE LIMIT - $ ANY AUTO (Ee atcldenl) - I -- All OWNED AUTOS BOOIL Y INJURY SCHEDULED AUTOS rPer~) $ r-- - HI",eD AUTOS BoDll Y INJURY NON-OWNeD AUTOS (p.,. IICcidtllll) $ ,- - .... ~ PROPERTY DAMAGE $ (Per accldenl) pRAGE LtA8Il.ITY AUTO ONt Y . !;A ACCIDENT I ANY AUTO OTHIilR 1't1AA lOA ACe $ AUTO ONLY: AGG 5 El<CEGSlUMI!REu.A LIA.8ILJ'TY EACH OCCURRENCe $2,000,000 ~ I !j OCCUI'\ 0 CLAIMS MADE i CCC4478363 09/23/01 09/23/04 AGGREGATE 52,000,000 _. . i $ I DEDUCTIBLE ! S ' "'eTENTION $ 5 WQRKERS COMPENSATION ANtl X I TORYLIMn'S I IVE.r c EMPLOYERS' UABIUTV BJ:NDER 12/09/03 12/0.9/04 $1, ODD, 000 I ANY PROPAIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT OFFICERI/,leM9E~ EXC~UDEO? E.L OISEASE - EA EMP~OYee 11,000,000 II es, descnb. under S~ECIAL PROVISIONS b~19W E.L. DISeASI5 . POlICY LIMIT $1,000,000 I OTHER i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Janitorial Services CERTIFICATE HOL.DER For Info~ation Only CANCELLATION I'ORIN -1' SHOULD ANY OF THE ABOVE DESCRlBEb ,"OUCIES DE CANCElLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSUReR WILL ENDEAVOR TO MAIL ~ tlAY$ WRmEN NoncE TO THE CERTIFICATE HOl.OER NAMED TO THE LEn, BUT "AlLURE TO DO 110 sHALl. IMPOSE NO 08UGATlOIl OR I.lABIUTY OF ANY KIND UPON THI! INSUR~ ITlI AGENTlI 0" RePItlE$ENTATlVI!S. AUTHORIZED REI''' ORATION 1988 ACORD 25 (2001108) WorkOrder.dsr 6/30/04 5: 14: 13 PM 1883-P02T-0100-1991 Property Owner: Mr. and Mrs, Donald & Charlene Kinsman 38510 12th Ave. Zephyrhifls, FL 33542 Mobile (813) 997-2826 Mobile (813) 997-2823 Work Order Front Elevation 1. 2. 3. 4. Main: L: 45' 6" W: 0' 0" H: 8' 6" 45 LF 94 SF 115 LF 118 LF Main: L: 27' 0" W: 0' 0" H: 7' 9" 32 LF 81 SF 32 LF 32 LF Main: L: 24' 9" W: 0' 0" H: 8' 6" 26.5 LF 26.5 LF Main: L: 27' 0" W: 0' 0" H: 9' 0" Remove Quarter round - 3/4"" Remove Blown-in insulation - 12'11I depth - R38 Remove Fascia - 1 "" X 6"" #1 pine Remove Soffit & fascia - wood - 2' overhang Right Elevation 5, Remove 211I' x 4"" lumber (.667 BF per LF) SUBFACI 6, Remove Siding - T1-11 hardboard - paint grade 7. Remove Fascia - 1"" x 6"" #1 pine 8, Remove Soffit & fascia. wood - 2' overhang Rear Elevation 9. 10. Remove Fascia - 1 "" x 6"" #1 pine Remove Soffit & fascia - wood - 2' overhang LEFT Elevation Laundry Room 13, 14. 15, 16. 17, 18. 19. Hallway 11. 12. Remove Fascia - 111I' x 6"" #1 pine Remove Soffit & fascia - wood - 2' overhang 32 LF 32 LF Main: L: 11' 5" W: 5'10" H: 7' 9" Offset: L: 3' 0" W: 3' 0" H: 7' 9" 244.16 SF 75.6 SF 43.5 LF 17 LF 28 LF 1 EA 1 EA Remove 1/2"" drywall. hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Casing. 21/4"" Remove Shelving - wire (vinyl coated) Remove Light fixture Remove Water heater - 40 gallon - Electric Remove 1/2"" drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Main: L: 5' 7" W: 3' 1" H: 7' 9" Offset: L: 4' 6" W: 2' 3" H: 7' 9" 20. 21. 266.3 SF 27.34 SF Paul Davis Restoration, Inc. of Pasco and Hernando FI. 7944 Rutilio Court, New Port Richey, FI. 34653 License CBC051266 888-PDR-FIRE WorkOrder.dsr 6/30/04 5: 14: 13 PM 1883-P02T-0100-1991 Work Order 22. 23. 24. Kitchen Remove Attic entrance cover and trim Remove Baseboard - 3 1/4'''' Remove Stairway - disappearing (folding) 1 EA 30,83 LF 1 EA Main: L: 15' 2" W: 10' 4" H: 7' 9" 25, 26. 27. 28. 29. Remove 1/2'''' drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Blown-in insulation - 12'11I depth - R38 Remove Batt insulation - 4"" - R13 486.74 SF 156.72 SF 21.29 LF 156.72 SF 82.51 SF Master Bedroom 30. 31. 32. 33. 34. 35. 36. Master Bath 37. 38. 39. 40. 41. 42. 43. Living Room 44. 45. 46. 47. 48. 49. Remove 1/2"" drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Shelving - wire (vinyl coated) Remove Blown-in insulation - 12"" depth - R38 Remove Batt insulation - 4'11I - R13 Remove Window blind - horizontal or vertical Main: L: 5' 1" W: 3' 5" H: 7' 9" Offset: L: 11' 6" W: 10' 11" H: 7' 9" Offset: L: 8' 10" W: 2' 6" H: 7' 9" Offset: L: 5' 6" W: 2' 6" H: 7' 9" 839.43 SF 178.74 SF 85.25 LF 8 LF 178,74 SF 330.34 SF 3 EA Main: L: 5' 10" W: 4'11" H: 7' 9" Offset: L: 2' 11" W: 2' 7" H: 7' 9" Remove Medicine cabinet Remove 1/2"" water rock (greenboard) hung, taped ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Bath accessory Remove Blown-in insulation - 12"" depth - R38 Remove Batt insulation - 4"" - R13 Remove 1/2"" drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Casing - 21/4"" Remove Shelving - 12"" - in place Remove Blown-in insulation - 12'11I depth _ R38 1 EA 288.09 SF 36.22 SF 32.5 LF 4 EA 36.22 SF 62.97 SF Main: L: 15' 3" W: 14' 7" H: 7' 5" Offset: L: 5' 5" W: 5' 0" H: 7' 5" Offset: L: 2' 1" W: 1'11" H: 7' 5" Offset: L: 2' 0" W: l' 7" H: 7' 5" 903.74 SF 256.64 SF 87.25 LF 17 LF 24 LF 256.64 SF Paul Davis Restoration, Inc. of Pasco and Hernando Fl. 7944 Rutilio Court, New Port Richey, FI. 34653 License CBC051266 888-PDR-FIRE 2 WorkOrder.dsr 6/30/045:14:13 PM 1883-P02T -0100-1991 Work Order 50. Remove Batt insulation - 4'11I - R13 51. Remove Window blind - horizontal or vertical FRONT BED 52. 53, 54. 55. 56. 57. 58. REAR BED 59. 60. 61. 62. 63. 64. 65. Bathroom (full) 323.55 SF 1 EA Main: L: 11' 7" W: 11' 6" H: 7' 5" Offset: L: 6' 9" W: 2' 3" H: 7' 5" Offset: L: 4' 0" W: 2' 4" H: 7' 5" 727.58 SF 157.73 SF 76.83 LF 28 LF 157.73 SF 284.92 SF 2 EA Main: L: 11' 5" W: 11' 3" H: 7' 5" Offset: L: 8' 6" W: 2' 3" H: 7' 5" 643.24 SF 147.56 SF 66.83 LF 28 LF 147.56 SF 247.84 SF 2 EA Main: L: 7' 11" W: 4' 11" H: 7' 5" Remove 1/2'11I drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Shelving - wire (vinyl coated) Remove Blown-in insulation - 1211I' depth - R38 Remove Batt insulation - 4'11I - R13 Remove Window blind - horizontal or vertical Remove 1/2"" drywall - hung, taped, ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4"" Remove Shelving - wire (vinyl coated) Remove Blown-in insulation - 12"" depth - R38 Remove Batt insulation - 4'11I - R13 Remove Window blind - horizontal or vertical 66. 67. 68. 69. 70. 71. 72. Roof Remove Medicine cabinet Remove 1/2'11I water rock (greenboard) hung, taped ready for texture Remove Acoustic ceiling (popcorn) texture Remove Baseboard - 3 1/4'11I Remove Bath accessory Remove Blown-in insulation - 12'11I depth - R38 Remove Batt insulation - 411I' - R13 1 EA 229.28 SF 38.92 SF 25.67 LF 4 EA 38.92 SF 47,59 SF 73. Remove Sheathing - plywood - 3/4"" CDX Main: L: 0' 0" W: 0' 0" H: 0' 0" 1760 SF Paul Davis Restoration, Inc. of Pasco and Hernando FI. 7944 Rutilio Court, New Port Richey. FI. 34653 3 License CBC051266 888-PDR-FIRE WorkOrder.dsr 6/30/045:14:13 PM This is to acknowledge that has performed the above listed work in a satisfactory manner. I have read the items listed and all have been completed. ***** PLEASE DO NOT SIGN UNTIL YOU ARE SATISFIED WITH THE ABOVE WORK ***** ***** THIS IS FOR YOUR PROTECTION! ***** Mr. and Mrs. Donald & Charlene Kinsman Dated Memo: STATE FARM PREMIER JOB. CALLDEBBIE FOR ACCOUNT # INFO FOR HOME DEPOT OR LOWES. P,O. # 59C924358 Paul Davis Restoration, Inc. of Pasco and Hernando FI. 7944 Rutilio Court, New Port Richey, FI. 34653 4 License CBC051266 888-PDR-FIRE