HomeMy WebLinkAbout07-6952
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6952
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost: 1,400.00
Date Issued: 8/17/2007
Total Fees: 100.00
Amount Paid: 100.00
Date Paid: 8/17/2007 Phone:
Work Desc: KITCHEN - GAS CONNECTION - RANGE/FRYER
6952
COMMERCIAL
FIRE-LP/NATURAL GAS
MEDICAL
Address: 7050 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 35-25-21-0010-10500-0000
E
FIRE PERMIT FEES
45.00
Ccm,pld::acO ~ t<~p-
FIRE DEPT. FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
fore recording your notice of commencement. n
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~ONTRACTO SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills,FL 33542
Fire Marshal
Kerry Barnett
Bus (813) 780-0041
Fax (813) 780-0044
August 15, 2007
Plan Review Comments
,
I have reviewed and approved the plans for a gas line installation located at 7050 Gall
Blvd. (Florida Hospital) for a kitchen range and fryer. My comments have been placed
below. Please contact me if you have any questions with regardsto my comments.
1. Details and specs shall be submitted with drawing on gas valve, LP tank (if one),
gas appliances and all other components, along with a scope of work.
2. Ballard protection shall be needed if it is in a vehicular area or an area that has
lawn mowing taking place.
3. To ensure correct operation of other systems (exhaust hood, suppression system) a
letter shall be submitted to verify that the suppression system in the hood is
compliant with the gas range and stove and a test and balance is with in normal
limits for the kitchen exhaust hood at gas final
4. A carbpn monoxide detector shall be installed in the kitchen area for the gas
installation.
Inspections required:
1. Pressure Test
2. Final
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Date Received
111111111111
Owner's Name
City of Zephyrhills Permit Application
Building Department
r-ax-/j I "-(/jU-uu.<: I
81a-780-0020
L
)
Owner's Address
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Fee Simple Titleholder Name
Fee Simple TlSeholde, Add",," ,_.
JOB ADDRESS 1\ \) SD
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
~Sf\~ \b"L\)~ I LOT# I
I PARCEL ID#I36' -d6-~\ - bO\ \) ., \ D~Ot)- tJ:S:>O
(OBTAINED FROM PROPERTY TAX NOTICE)
Cl ADD/ALT D SIGN 0 MOVE D
D REPAIR
Qs: COMM D
D FRAME D
SUBDIVISION
DESCRIPTION OF WORK
B
D
D
It~\; f
DEMOLISH
PROPOSED USE
TYPE OF CONSTRUCTION
OTHER
STEEL
I
o
OTHER I
'),. '. 1
I
'..11111....11..11.....11.........11111111.111.1111111.111111111...111...111...1.1.1.111...,.......1111.,...11..11........11.........11111.111.11.
1$ \ ~\)\)
1$
1$
1$
~GAS D
FINISHED FLOOR ELEVATIONS I
l~..'~.. -:-
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HEIGHT I
BUILDING SIZE
SQ FOOTAGE I
D
D
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D
I
lAMP SERVICE D PROGRESS ENERGY
I fj1~ ~M ff '-Li ()
-..I~ -tP? /u6~
I VA~ATION O~~ECHANICAL INSTALLATION
D
I
D
W.R.E.C,
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
PLUMBING
L.~~ ,Y":::'~-/ t
MECHANICAL
; ~
ROOFING
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO'
1 \ '1 \ -I
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f&.c~
I I I . I r I . r , . .. I , t , , 1 , , . . I , ~ I I I I , , , I I I , I I , , I I , , , . . . I I , I , I , r I I , I I , I I I , , , I I . I . . I , I r I I I I I I I I , I I I I I I , , I I I , I I I I I I , , , i . r , I I I , I , I I I I I I I , I I I , , I 1 I I I I I I 1 I . , . . I
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MECHANICAL COMPANY I
SIGNATURE REGISTERED Y 1 N FEE CURRENT Y 1 N
Address~ LIcense # I
~::.:':TURER-~"'\~ ~~= ~~~SFEE~'l\;~i1~] I
1111 I~~:~::'II,~~~:;,~;~ ;,~~,i?~~ /~~~~!k1},~,~, '~~::::'~"I"'~~~ :?-S;:", '" III II ,,!
RESIDENTIA,L 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 onsile, Construction Plans, Stormwater Plans wI Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge projects
Attach (3) 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 onslte, Construction Plans, Stormwater Plans wI Silt Fence Installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
I II I I III I II111111111 I 11111111111111 I I II I 11111111111111111111111111 i 1111I1111111111111I111111 i 11I11111111111111111 i 111I1I111 i III i IIII1I1I11I11I11II
Directions:
Fill out application completely.
Owner 8, Contractor sign back of application, notarized
If over $~2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from ovlmer authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC
~ : ,. ,. . .
COMPANY
REGISTERED
BUILDER
SIGNATURE
YI N
FEE CURRENT
Y/N
Addresis
LIcense #
COMPANY
REGISTERED
ELECTRICIAN
SIGNATURE
YI N
FEE CURRENT
Y/N
Addres!s
LIcense #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Addres~s
LIcense #
COMMERCIAL
--
SIGN PERMIT
Fences (PloVSurvey/Footage)
Driveways-Not over Counter If on public roa<jways..needs ROW
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 Sedion 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 buiidings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco county Ordinance number 89-07 ahd
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): if valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to ineet standards, of all laWs regUlating
construction, County and City codes, zoning regulations, and lan-d idevelopment regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
lands, Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheadsj 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 "V" 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 "N 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 thah 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 separatfl permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN UR NOTICE OF COMMENCEMENT.
FLORIDAJURAT~~3f\,' ~.., _ C\
OWNERORAGE~~\~ CONTRACTOR
Subscribed and sworn t?(or afflrmeCI) before me this. Subscribed and sWQrnt~ tor ~ff1rmed) ,efore me th . ," ,
~ isl~re pe:6naIlY'k~~~ t~me O~h~~~~e~~~d~~~~ Who Isfare pers~~aIlY kno~to';"~\~rh~~~~~ ~rod~~d '-
asldentiftcation. asldentiftcation.
Notary Public
Notary Public
Commission No.
Name of Notary typed,
Zephyrhills Fire Rescue
6907 Dairy Road, ZephyrhilIs, FL 33542
Fire Marshal
Kerry Barnett
Bus (813) 780-0041
Fax (813) 780-0044
July 27,2007
Plan Review Comments
I have reviewed and disapproved the plans for a gas line installation located at 7050 Gall
Blvd. (Florida Hospital) for a kitchen range and fryer. My comments have been placed
below. Please contact me if you have any questions with regards to my comments.
1. Drawing is not ledge able. Drawing shall be schematic/architectural in nature
showing all connections, anchoring locations, pipe size and type, etc...
2. No mention of this being a propane or natural gas installation.
3. Details and specs shall be submitted with drawing on gas valve, LP tank (if one),
gas appliances and all other components, along with a scope of work.
4. Ballard protection shall be needed if it is in a vehicular area or an area that has
lawn mowing taking place.
5. To ensure correct operation of other systems (exhaust hood, suppression system) a
letter shall be submitted to verify that the suppression system in the hood is
compliant with the gas range and stove and a test and balance is with in normal
limits for the kitchen exhaust hood.
6. A carbon monoxide detector shall be installed in the kitchen area for the gas
installation.
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FAX(TX)
~DATE
~UL/30
TRANSACTION REPORT
JUL/30/2007/MON 08:29 AM
RECEIVER
813525677690
TYPE/NOTE
OK
P.Ol/Ol
FILE
SG3 4966
City of,Zephyihills:
Phone: (813}-780-0020
FAX: (813)-780-0021
Building Dept.
-----~---------~--------------------------------------------~----,
TO: Wood Propane
FAX#:
DATE: 07/30/07
FROM:: Jackie
F.AX#: 813-780-0021
# OF PAGES: 3
,.
I MESSAGE:
I
: Attached is the fire marshal comments for plans submitted for the Florida Hospital.
I
J His (Mr. Barnett) phone # is placed on the top of the Letterhead ifU shoul4 have any
further questions.
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_________~________________________.---~---------------____________J
Thank you,
J awe
City of Zephyrhills:
Phone: (813)-780-0020
FAX: (813)-780-0021
Building Dept.
-----------------------------------------------------------
TO: Wood Propane
FAX#:
DATE: 07/30/07
MESSAGE:
FROM: Jackie
FAX #: 813-780-0021
# OF PAGES: 3
Attached is the fire marshal comments for plans submitted for the Florida Hospital.
His (Mr. Barnett) phone # is placed on the top ofthe Letterhead ifU should have any
further questions.
Thank you,
Jackie
----,
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-----------------------------------------------------------------~
July 27, 2007
Plan Review Comments
I have reviewed and disapproved the plans for a gas line installation located at 7050 Gall
Blvd. (f'lorida Hospital) for a kitchen range and fryer. My comments have been placed
below. Please contact me if you have any questions with regards to my comments.
1. Drawing is not ledge able. Drawing shall be schematic/architectural in nature
showing all connections, anchoring locations, pipe size and type, etc...
2. No mention of this being a propane or natural gas installation.
3. Details and specs shall be submitted with drawing on gas valve, LP tank: (if one),
gas appliances and all other components, along with a scope of work
4. Ballrrd protection shall be needed if it is in a vehicular area or an area that has
lawn mowing taking place.
5. To €fisure correct operation of other systems (exhaust hood, suppression system) a
letter shall be submitted to verify that the suppression system in the hood is
compliant with the gas range and stove and a test and balance is with in normal
limits for the kitchen exhaust hood.
6. A carbon monoxide detector shall be installed in the kitchen area for the gas
installation.
~CORD_ CERTIFICA TE OF LIABILITY INSURANCE OP IDJW T ""lE~
1IOODS-l 01/16/07
->Ell THIS CERTIFICATE IS ISSUED AS A MAneR OF INFORMATION
Des Champ. & Gregory, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Main Offioe HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEND OR
181~! Manabo. Ava. w., ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Bradanton FL 34205-5927
Phon.: 941-748-1812 Fax: 941-746-1400 INSURERS AFFORDING COVERAGE NAIC .,
......." INSURfltk Rational Fire & Marine
INSURER 8::
Wood'. Propane Inc rHSURER c:
Steven Wood And Debbie Wood
15229 US mn 301 INSURER 0:
Dada City PI. 33523
INSURER E;
COVERAGES
1JfE" POIJCZ8OFJN8UtWIcE USTtOHtOWWlVE II!JEEH ISSUEOTOntE IHSUIa!:DNAllmA8OVE fDRTHE POUcVPERX::oINDICATED. N01'YJITHS.TAHDING
i<<'f ft~. TEMlOftCOHDmOHCWAHYCONTltAOTOftOY'tfeftDOc:ulleNrv.nt~TOWHlCHnas CI!~ft_V_lUUU)OfII
IlAYPIRTAaM. THE ~ AFFORDm rtf _ POUa!a DEBCfUEo HEIWN IS IUeJlCTTOAU. ntETERMI. UCl..UStl::lMB ANOCOHOnlOItS OF SUCH
PCIUCIo. AGGAEGAl1! UMf1'S 8HOWH MAY HAVE BEEN REDucEo BY PAlDCI.NMa.
IiiM ~ -- '::'~ -===- .......
L'" nPII 0<'-......
~UA8JTY 1!AClf0000000EHCE . 1000000
0MW10E TO REHTEo
A ~ OOIIMERCW.. GENEIW. IJA8!UTY 72I.PS003641 01/09/07 01/09/08 PRe_IS {h____l . 100000
'-- tJ~~ [!J=u. IlEDEXP CAnr_....... . 5000
I PERSotW..,& NN IitJURV . 1000000
GEHlRAlAGGRmAn . 1000000
I GEN1. AGORE4MTE LIMIT APPliES PER: PItOtb::'m . COUPlIClP AGO . 1000000
h "1lCY n: n LOC
I ~UAMnY 00-.,-. UIIIT .
ANt AUTO 'Ea_
L--
I AU. OWNED"""",
I '-- OOCILY IUURY .
SCHeDlJW)AUTCS ,.....-
-
I-- ......,AUtOS OOCILYIUURY
.
""""""'""AUTOS ,....-
-
- PIlOPElnY_ .
j --
~~ AUTOOtft.y~u.~ .
_AUTO """'.-.. fA_ .
NJToOHLY: ..... .
_.~UA8IU1'Y ....,.. OCCURREHCE .
t:J <=OR 0 CLNUSUAQE ___lE .
R=: .
.
. .
'MR<ER$ COIPeIrSA'nOH AND f, WCSTAtu. ! !ont_
-_lJAIIIUrf TORY UIIIl'a ..
-,~ E.l. EACH ACCIDENT .
OR=KstMEIII'ER EXCUItl(07 E.L tHSfASE. EA EUPlOVEE
.
If,..,...... ....
SPECIAL PROwSIQNS.... f.L OCSEAse. POl~ Lt.r .
0......
~ elf" c:aa-.l1ON:I ILJ:lCAlDII, VI!HICLD I DCWSIONa ADCIID av IINCOftSaWNT IIHICtALPIICMIIONs
GAS DlCALERS LPG
.
CERTIFICATE HOLDER
CANCELLAOON
C:ITYOPZ
-.._OF__-.........-'UO___MN
Mft~.lNI!__WLL...1JIOItTOIIM..
10 OAn_
C:I'l'Y OJ' ZEPJttRKILLS
5335 8TH S'1'RBI:'1'
Zl:PHYlUIILLS PI. 33542
NOnce 10 'Dft!: Cl!ltTW'tCATBMOf.DER IUAEO TO THE LEFT, BUTPAILURE 1000 10 aHMl.
M'OIE 1I000000TIOtf 1M: LMIIL.nY OF W'lIUNDUfIClNTHE NtIItet, ITS AOBrITS OIl
ACORD 25 (2001108)
NJUJ
eACORDCORPORATION1~
A,CORD,. CERTIFICATE OF LIABILITY INSURANCE I OATECIIIWO#YYYY)
0310112007
PROOlICER THIS CERTlRCATE IS ISSUED AS A MATTER OF INFORMATION
J. Smith Lanier & Company ONLY AND CONFERS NO RIGHTS, UPON THE CERTIFICATE
HOLDER. THIS CERTFICATE DOES NOT AMEND, EXTEND OR
11330 lakefiekl Drive ALTER THE COVERAGE AFFORDED BY THE POlICIES BELOW.
Building 1; Suite 100
Duluth, GA 30097 INSURERS AFFORDING COVERAGE NAIe"
I8IIlED INSURER A: Zurich-Amerlcan Insurance Company
Staffing Concepts International, Inc., e1a1 All Emp: Steve Wood dba: Woods INSURER B:
Propane INSURERC:
4224 West Henderson Blvd.
Tampa , Fl33629 INSURER 0:
INSURER E:
COVERAGES
TtE POlICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POlICY PERIOD INDICATED. NOlWrTHSTANDING
AN'( REQUIREMENT, TERM OR CONDmoN 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 UMrrs SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
== POlICY_ POlICYEFFECmIE POUCYEllPIRATION LIIIfTS
~LIABlUTY EACH OCCURRENCE $
COMMERCIAL GENERALLWlILITY PREMISES Ea!JCCUnlnCel $
'- U ClAIMSMADE 0 OCCUR MEDEXP{Anyone_} $
PERSONAL & Af:1V INJURY $
GENERAL AGGREGATE $
~'lAGGnUMfTnSPER: PRODUCTS -COMPIOP AGG $
POUCY ~ lOC
~LIAIlIUTY COM8INEo SINGlE UMfT $
AMY AUTO (Ea llCddenl)
-
- ALl OWNEDAUTOS BOOll Y INJURY
$
SCHEDUlEO AUTOS (Per person}
-
f-- HIRED AUTOS BODILY INJURY
$
NON-OWNEDAUTOS {Pen..:idenl}
f--
- PROPERTY DAMAGE $
(Per aa:idenI)
GARAGE LIA8LfTY AUTO ONlY - EAACClDENT $
=l-ANY AUTO OTHER THAN EA ACe $
AUTO ONlY: AGG $
ElI~_LAUA8lUTY EACH OCCURRENCE $
o OCCUR 0 ClAIMS MADE AGGREGATE $
R=e $
$
$ $
WORKERSOO. "-J&t:.TIONAND X WCSTATU-,I IOJr'
a.t.O\'BtS'lIA8lUTY
A ANY PROPRIETOlwARTNERlEXECunve we 45-57-044-03 0310112007 0310112008 EL EACH ACCIDENT $ 1.000.000
OFFICERRIIEMBER EXClllDED? E.l. DISEASE - EAEMPlOYEE $ 1,000,000
~ desc:rlbe under
ffiQYISIONs below E.L. DISEASE - POUCY lIMIT $ 1,000,000
011IeR
LocatIon Coverage Period: 0310112007 0310112008 Certlficatet#: 07FL103757429
Clientt#: 314610
onc-..ONOFOPERAT1ONSfLOCATIONSfVEfIICLES fEXCI.USIONS ADDEOBYENIlOR8EMENT /SPECIAl.PROVlSION8
Cowlrage 'is provided for only Steve Wood dba: Woods Propane
those~ leased to 15229 US Hwy 301
but not sutlCOnlracfors of: North Dade City, Fl33523
,
CERTIFICATE HOLDER
CANCELLATION
SfIOUUl Nl'f OF TIE A80VE DEiSC-.o:u POUClES BE CANCEl.LED BEFORETHEEllPIRA..
City of ZephyrtJills DATE lllEREOF. TIE ISSUING INSUIER WIL1. ENDEAVOR TO IIAIL ~ DAYS WNITBI
5335 8th Street NOTICE TO THE CERTlFlCATE HOUlER NAIlED TO THE lEFT, BUT FAIlURE TO DO so SIUW.
.-ose NO OBUGI'iT1QN OR UA8lUTY OF Nl'f KIIID UPON TIE INSURER. rTlI MEImi OR
ZephymiHs. Fl 33542 REI'RElIEIITATIVES.
AUTHORIzEDREI'RElIEIITATlVE A ~ ~.-
A :
CORD 25 (2001108)
CACORD CORPORATION 1988
- -- - --- ~ - - -. --- -_.'---'~..-
~p ASCO COUNTY OCCUPAtIONAL LICENSE 200&07
Issued pursuant and subject to Florida Statutes and Pasco County Ordinances. Issuance does not certify compliance with
zoning or other laws. This license must be posted conspicuously in place of business. Expires September 30.
ACCOUNT NO: 32421
SIC CODE: 5984
Mike Olson
TAX mLLECIDR
PASCO COUNIY FLORIDA
WOODS PROPANE INC
15229 US HWY 301
DADE CITY FL 33523-2421
TYPE OF BUSINESS:
LIQUIFIED PETROLEUM GAS
DEALER
LOCATION ADDRESS:
15229 US HWY 301
DADE CITY
DATE
RECEIPT
AMOUNT
145.00
09/29/06 513399