HomeMy WebLinkAbout05-5178
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
MOBILE HOME SET-UP
5178
Permit Number: 5178
Permit Type: MOBILE HOME
Class of Work: MOBILE HOME SET-UP
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 4623 CHARTER ST
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block:
Subdivision: EDGEWOOD
Parcel Number: 14-26-21-0270-00000-0290
Book:
Section:
25,000.00
11/22/2005
175.00
175.00
11/22/2005 Phone:
MOBILE HOME SET UP - REPLACEMENT
Name:
Address:
BARTON TIFFANY
4623 CHARTER ST
ZEPHYRHILLS, FL. 33542
813 779-9064
H
MOBILE HOME MECHANICAL
40.00
- ~&- alP
<)\~,~I ~
't~-
FINAL
REINSPECTlON 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
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.
. ~.
CTORS SIGNA URE 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
PHONE CONTACT FOR PERMIT
OWNER'S NAME 'T:rFJ:-..II JJ Y 8A Rid))
JOB ADDRESS 'fb23 C IIAffrEf( 57:
PHONE P13~ 7/9~Y00r
SUBDIVISION_Et>~WdolD SuB JJo.J
LEGAL DESCRIPTION: LOT(S)
BLOCK
PARCEL 10 # 1'1-2(, - 21-0:170- OCJfJOC) -CJ.:lC/(j
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION
o ADDITION
DALTERATION
o REPAIR
~STALL
DSIGN
PROPOSED USE: OSGL FAMILY DWELLING
o COMMERCIAL
o MOVE
o DEMOLISH
OMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
~BILE HOME
o OTHER
c=J RESTAURANT & HEALTH DEPARTMENT
DESCRIPTION OF WORK SET lfJP ~DI8.:rL? 1/0).1 E
BUILDING SIZE .2g XSb SQUARE FOOTAGE J1S6i3
HEIGHT
~UILDING
~LECTRICAL
~LUMBING
~CHANICAL
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) S~~ E~
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.-/ ~ ~ }
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. ~ !
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRU~T~01Jl
// '-"1116.
PERMITS REQUEST D
$ e2f;OQO.DO
.
~CO
AMP SERVICE
$ ;2SG~
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT
BUILDER
SIGNATURE
STATE CER'T'
~-
***********************************+
ELECTRICIAN ~
SIGNATURE
***** **+
--t:
Yp
PLUMBER
SIGNJl"'"
~~'J.~
~~
~~~~~~
\~~~ 0 '$~cjJ
l'Of) 1.'~ ~~9>..~~
''J~\~... 1(:\" A Jl. 'l1J. _~(.\.,,,-e.'),
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 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 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 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 corrunencement.
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.
Appli~ation is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work or installation has corrunenced 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 corrunenced 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 corrunenced. 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~ALUE DO NOT NEED TO RECORD AND POST A "NOTIC~ OF COMMENCEME~'t; ~
~'~RAGENT S~
STATE OF FLORIDA 0 STATE OF FLORIDA f/asao
COUNTY OF r t<.S'C{J COUNTY OF
The foregoing instrument was acknpwledged The foregoing instrument wa~~Wledged,r
Before me..tJ;lis ,~day of ():>>Ux..IJ.q'--, 20t?r Before me ..this} f!/I day pf ... r, 20 ~
-r/~ fL .,.---p a. rJo/J by / 17 ~a.."'i1S /J ft!!:!::C..
acknowledged) (name of perso~ acknowledged)
wn to me, or nh 11 k
LNO is persona y nown to me, or
~o has produced cI r/ U/J' / Af.eA\fl
~2COft PiAN
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Nov 18 2005 3:54PM
HP LASERJET 3200
p. 1
. ACQRQ.. CERTIFICATE OF LIABILITY INSURANCE I DATe [MMlDDIVYVY)
11/18/2005
PRODUCER (813) 788- 5715 FAX (813)782-6445 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Accwrate Insurance Mart ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
38232 - 5th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Zephyrhil15, Fl 33542
Walter Everton INSU RERS AFFORDING COVERAGE NAlCII
INSOR!O Terry Palnter - N-surance Outlets
INSURER A.
DBA: Terry Painter Mobilehome Setup" Repair INSURER B.
35030 Chancey Rd INSURER c.
Zephyr-hills, Fl 33541 INSURER 0:
INSURER E:
THE POLICIES OF INSURANCE LISTE[) BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE F'OUCY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAV 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,
I~~ I'm.~ TYPI! OF INSURANCE POlICY NOMBE R POLICY EFFECTIVE '~lfeY EXPIRATION LIMITS
GENERAL LIABILITY 1961000225 03/05/2005 03/05/2006 EACH OCCURRENCE 5 1,000,000
- OAMAGnC?, RENTED 50,000
COMMERCIAL GeNERAL LIASILrTY s
--1 ClAIMSMAOE W OCCUR MED EXP (A"y one pe..on) 5 1000
A X F'ERSONAL a AnV ,NJURY $ 1,000,000
f-- 2,000,000
GENERAlAOGREGATE 5
--
GEN"L A.GGREGATE LIMIT APPLiES PER. PRODUCTS - COMPIOP AGG $ 300,000
J POlICY n rG& n l,OC
AUTOMOSILe UA8lUTY COM B1NED SINGLE LIMIT
- (Ea accidtlnt) 5
ANY AUTO
-
ALL OWNED AUTOS BOOIL Y INJURY
- 5
SCHEDULED AUTOS (Per peracln)
I--
HIRED AUTOS BOOll V INJURY
I-- $
NON.OWNED AlITOS (Per iloc:ident)
-
- -- PROPERTY [)AMAGE 5
(Per acciden1)
GARAGE LIABILITY AUTO ONL V . EA ACCIDENT 5
R A",'Y AUTO OTHER THAN EA I'CC 5
AUTO ONLY: AGG S
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE S
tJ OCCUR 0 CLAIMS MADE AGGREGATE S
$
q DEDUCTIBLE $
RETENTION S S
WORKERS COMPENSATION AND I ~5;~~~ J IO~-
EMPLOYERS' LIABILITY e,L EACH ACCIDENT
ANY PROPRIETORIPARTNERIEXECUTlVE $
OFFICER/MEMBER EXClUDED? El, DISEASE. EA EMPLOYEE $
~~~I~k'O~~OOS bel..., E ,L DiseASE. POLICY LIMIT S
.
OTHER
OESCRlPTION OF OPERATIONS I LOCATIONS I VE".HICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
City of Zephyrhills
Permit department
5335 8th St
Zephyrhills, FL J3S4n-4~12
CE
SHOULD ANY OF THE ~\fE DESCRIBED POLICIES BE CANCELLED BEFME THE
eXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
...19..-- DAYS WRlrTEN NOTICE TO THE CERTI~ICI\TE HOlDI!R NAMED TO THe lEFT,
IIUT FAILURE TO MAIL SUCH I'lOTlC MPO OBLIOA TION OR LIABILITY
C~AN" KIND UPON THE ESEHTATlVES
AUTHORIZE) REP~
@ACORDCORPORATION19U
'CORD 25 (2001/08) FAX: (813)7&0-OOZl
Nov, 18 2005 3:54PM
HP LASERJET 3200
10.2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, tne policy(ies) must be endorsed, A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, certain policies may
require an endol"..ement. A statement on this certificate does not confer rights to the certificate
holder in lieu of slJch endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
ACORD 25 (2001108)
NOV, 18. 2005844PM
COC-~
NIELSON-MOSHOLDER
NO, 230
P. 1
CONTINUATION NOTICE
DATE:
.
October 11, 2005
AGENT:
Express Surety Services BOND: 10436'951
2500 W. Lake Mary Blvd., SlJite 112
Lake Mary, FL 32746
407-688-9385
PR!NClP AL:
Terry D. PJlinter
35030Clwacey Road
Zephyrhills,FL 33541--2453
OBLIGEE:
.: .. ~
State of Florida
Department of Highway Safety and Motor Vehicles
2900 Apalachee Parkway, Neil Kirlanan Bldg, MS 66
Tallahassee, FL 32399-0640
BOND AMOUNT: $5,000
CONTINUATION EFEECTIVE DATES:
FROM: 10/01/05
TO: 09130/06
CONTINUATION CERTIFICATE
It is hereby a&reed that the above captioned Bond is continued. in force in the above amount for the period
of the continued term stated above and is subject to all the covenants and conditions of said BODd.
This continuation shall be deemed a part of the original Bond, and not a new obligation, no matter how
long the Bond has been in force or how many premiums are paid for the Bond, unless otherwise provided
for by statute or ordinance applicable.
In witness whereof Travelers Casualty & Surety Company of America has caused its corporate seal to
hereunto be aftiked this 11th day of October, 2005.
T~ComponyOf~
B. 1fI~4-
Uiura ~~:osholdor' Atroiney-In-Fact & Florida Residatt A8elIl
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ON-SITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
;J<::>v (0 "200$"
'3S- J
P /6 'bq 7
APPLICATION FOR:
[ ] New System
[ ] Repair [ ] Abandonment
APPLICANT: 7 -;Z.F-:J:=-A).} Y BA /?TovV FA)(-J 5~~ S~.,/l1 066J
AGENT: ,A1.:z:r::1-! A c:-L 5.1) 'r' DE f( TELEPHONE: 3>,..:7-,?...v-3'1~1
MAILING ADDRESS: 110, /3of I ~33;:) 8/iOOksu,'1IQ", f"/ JSI(O Lf
[~Existing System
Holding Tank
Temporary
Innovative
----------------------------------------------
----------------------------------------------
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3) (m) OR 489.552, FLORIDA STATUTES.
= = = = = ~ == ;;.:"~ :: = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
PROPERTY INFORMATION
BLOCK: SUBDIVISION: EfJ~tvoOIf) 5u13 Ab::t. PLATTED:
#: 1'( -2b -;;>/-0 ;??6 ~-~~~: I/M OR EQUIVALENT:
LOT:
PROPERTY ID
Y/N)
PROPERTY SIZE:
ACRES WATER SUPPLY: [
] PRIVATE
PUBLIC [~=2000GPD [
] >2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [Y / N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: '9'6...?J cll.llRrel? ~r-
DIRECTIONS TO PROPERTY: hlcVY-;' ..30/ So 10 c AVE: WESt 7't)
cllAl?rER s-';- SOPTH,
BUILDING INFORMATION
] RESIDENTIAL
] COMMERCIAL
Unit
No
Type of l
Establishment
No. of Building Commercial/Institutional System Design
Bedrooms Area Sq Ft Table 1, Chapter 64E-6, FAC
1
fifD8::aE ,I/o,)1c
'], ~B X 56
2
'"
k~?'cA( \NG f..'
PK-cJ,c-\,~ jI\II., If
3
4
DATE:
)1- A:) - 0...5
DH 4015, 10/97 - Page 1 ( revious editions may be used)
Stock Number: 5744-001'-4015-1
Page 1 of 3
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policy Number: 196B001256
COMMERCiAL GENERAL LIABILITY
SCHEDULE OF CLASSIFICATIONS AND RATES
Named Insured:
TERRY PAINTER MOBILE HOME SEt UP & REPAIR INC
Effective Date: 11/03/2004
Location Address (Premises you own, rent or occupy):
SAME
Loc. No.
1
Bldg. No,
1
Code No.
93003
County,
Borough or
Parish
Rating T err.
HILLSBOROU 4
Classification
Mobile Home Setup and Tie-down On Prepared Site and Hookup to Existing Utility Services- no
site preparation - not dealers nor manufacturers - including Products-Completed Operations.
o
IKJ
o
o
Premium is:
Adjustable (See
Premium AuditConditions)
Flat (Not Adjustable)
Fully Earned When Written
Minimum Premium
PER EACH
Loc, No. Location Address (Premises you own,rentor occupy):
Premium Base
3 EMPLOYEES
Bldg. No.
Code No.
o
o
o
o
Fully Premium is:
Adjustable (See
Premium AuditConditionsl
Flat (Not Adjustable)
Fully Earned When Written
Minimum Premium
Premium Base
Rate:Per Each
All Other
$FLAT
Advance Premium: $ 1, 050 .00
Classification
Rate
Advance Premium: $
Loc. No. Location Address (Premises you own, rent or occupy):
Bldg. No.
Code No.
o
o
o
tJ
Premium is:
Adjustable (See
Premium AuditConditions)
Flat (Not Adjustable)
Fully Earned When Written
Minimum Premium
Premium Base
Classification
Advance Premium:
County,
Borough or
Parish
All Other
$
County,
Borough or
Parish
All Other
$
Prod.-C.Ops
$ FLAT
$
Rating Terr,
Prod.-C.Ops
$
$
Rating Terr.
Prod.-C.Ops
$
$
0' See Schedule of Classifications and Rates (IFG-G-0003) for additional locations you own, rent or
occupy and applicable classifications and rates and premiums.
IFG-G-0002-DL 0503
Page 2 of 2
'. . Policy Number: 196BOO1256
. COMMERCIAL GENERAL LIABILITY
IFG Companies DECLARATIONS
Named Insured: Effective Date:
TERRY PAINTER MOBILE HOME SET UP & REPAIR INC 11/03/2004
Item 1. LIMITS OF INSURANCE
$2, ODD, 000 General Aggregate Limit (Other Than Products - Completed Operations)
$See Form BG-G-173 Products - Completed Operations Aggregate Limit
$1, ODD, 000 Personal and Advertising Injury Limit
$1, 0 0 0 , 0 0 0 Each Occurrence Limit
$50,000 Damage To Premises Rented To You Limit (Any One Premises)
$1,000 Medical Expense Limit (Any One Person)
Refer to individual policy forms and/or endorsements for various coverage sublimits, if applicable.
Item 2. AUDIT PERIOD (If Applicable):
[X] Annually o Semi-Annually D Quarterly D Monthly
Item 3. FORM(S) AND ENDORSEMENT(S) made a partofthis policyattimeofissue:
See Listing of Forms and Endorsements (lFG-I-0150)
Item 4. COMPOSITE RATE
D If box is checked, see Composite Rate Endorsement (IFG-I-O 152) for applicable classification, rates
and premiums. If box is not checked, see page 2 ofthese Declarations for applicable classifications,
rates and premiums,
Item 5. RETROACTIVE DATE (CG 0002 only) :
Coverage A of this Insurance does not apply to "bodily injury" or "property damage"which occurs
before the Retroactive Date, if any, shown here: (Enter Date or "None" If no Retroactive Date applies.
Item 6. PREMIUMS
$ 1,050.00 Total Coverage Part Advance Premium
$ Coverage Part Minimum Premium (if applicable)
These Declarations are part of the Policy Declarations containing the name of the insured and the policy period,
IFG-G-0002-DL 0503
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