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Home My WebLink About07-7158 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7158 7158 Permit Type: ADDITION/ALTERATION Class of Work: ADD/AL T COMMERCIAL Proposed Use: COMMERCIAL Square Feet: Est. Value: lmprov. Cost: Date Issued: Total Fees: 6,491.82 Amount Paid: 6,491.82 Date Paid: 11/08/2007 Phone: Work Desc: EXPANSION TO DINING RM 4,647 SQ. FT Address: 7643 ALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot{s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 34-25-21-0010-03100-0000 137,000.00 Name: CHILI'S BAR & GRILL Address: 7643 GALL BLVD ZEPHYRHILLS, FL. 33542 SOUTTHLAND CONSTRUCTION SVCS INC MECHANICAL FEE PENINSULAR MECHANICAL CONTRACTO SEWER CONNECTION COMMERC FIRE PLAN REVIEW FEES FIRE IMPACT FEE TRAFFIC IMPACT FEES 99% COM 62.06 RADON 1,443.18 WATER CONNECTION COMMERC 28.38 POLICE IMPACT FEE 77.10 PUBLIC SAFETY 5% 2,746.40 TRAFFIC IMPACT FEE 1% 4.73 1,282.00 82.77 1.67 27.73 ~nakd) I~- ZJ6-CJ7 ((SL.v- H MB FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. 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 before recording yo r notice of commencement." C"TI SIG PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ......."'\~.:.. RECEIVE y ." , ~lt iWJi-700-0020 OCT 2 5 20rJte Recer-ed t f7 15 '6 City of Zephyrhills Permit Application Building Department Fax-813-780-0021 ;Je O--f\ei-k ~k I ( I I J I I 7643 Gall Blvd., Zephyrhills, FL 33541 I LOT # L_4__J PARCEL 10# I 34-25-21-0110-00000-0040 I * IOBTAINEO FROM PROPERTY TAX Nor.cE) () - 2~ -<> '1 ~-"11""""O-''''!o.o..c'' ,Ownet:s ~l!\e Brinker Florida, Inc. ~,p\" \.,,,I,il.U " , . -' "'j,1~ .biv1~!Oownor'sAddresJ I 6820 LBJ Freeway, Dallas. Tx 75240 "--^' , F.e~;~~;~'~::~old"'Nam.1 Brinker Florida. Inc. Foo Simple Titleholder Address JOB ADDRESS SUBDIVISION * i~J1 \. \}01 ~C\~ WORK PROPOSED PROPOSED USE lYPE OF CONSTRUCTION DESCRIPTION OF WORK BUILDING SIZE Owner Phone Number Owner Phone Number I Owner Phone Number I r--- , ,--- i 6820 LBJ Freeway, Dallas, Tx 75240 ~~~~~~I=-~~!.'.ercenter.A Replat ! D NEW CONSTR u:;;t ~L T 0 D INSTALL D ~AIR o SFR [id-- COMM 0 OTHER o BLOCK U2r FRAME 0 STeEL D Dining expansion to existing Chili's restauran.t I SQFooTAGE 4,647 s.f. j HEIGHT I 22'-10" SIGN D MOVE 0 DEMOLISH OTHER I VALUATION OF TOTAL CONSTRUCTION It 0 BUILDING 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL 0 CAS 1$ 110,000 1$ 14,500 1$ 0 IS 12,500 o ROOFING FINISHED FLOOR ELEVATIONS BUILDER SIGNATURE Address ELECTRICIAN SIGNATURE '-- Address PlUMaEi<-. .J SIGNATUR~' I Address I MECHANICAL I SIGNATURE , Address I OTHER I SIGNATURE Address I I I I I D OTHER DYES D D PROGRESS ENERGY WRE.C. AMP SERVICE VALUATION OF MECHANICAL INSTALLATION SPECIALlY D FLOOD ZONE AREA DNO I S I) oj t'ij ~ -E L -<-G7/L .( ..r4,c;-s- CYZJ.[J FEE CURRENT ~ Llc&nse # I Ell. lJ b J '1 "J oJ' License /I I I- I I f)if. ~t~ S:''/s'" RESIDENTIAL COMMERCIAL SIGN PERMIT Attach (2) Plot Plans; (2) sets of Building Plans; (1) sel c:J Energy Forms Minimum ten (10) working days after submittal date. Required onslte. Ccnstruction Plans. Sanilary Facilities & 1 dumpster Allam (3) sets of Building Plans; (1) set of Energy Forms. Minimum ten (10) working days after submittal dale. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meel compliance. Attach (2) sets of Engineered Plans ....PROPERTY SURVEY required lor all NEW construenon 1 Directions: Fill out application completely. ONrlOr & Contractor sign back of application, notarized If ov.r $2500. a Notic. of Commencement Is required. (AlC upgrades ovor $5000) Agenl (to( the contractor) or Power eX Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMlmNG (Front of Application Only) Reroofs Sewers Service Upgrades AlC Drhleways-Not over Counter if on public roadways..needs ROW Fances (P1oVSurvey/Footaga) CONSTRUCTION COMPANY Alabama Arkansas Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi FSTABLI$HED 1%9 @ $It ILL 105 North Falkenburg Road Suite A Tampa, FL 33619 813689-7983 Telefax: 813 681-2415 License #: CGC009286 www.ventureconstruction.com November 7,2007 CITY OF ZEPHYRHILLS Building Department Zephyrhills, Florida RE: CHILI'S GRILL & BAR ADDITION 7643 Gall Boulevard Zephyrhills, Florida Gentlemen: I hereby authorize purchase of building permit, and any other related permits, licenses, etc. for the referenced project in the name of Venture Construction Company signed by the following: Mark Braxton for Venture Construction COq1pany I certify that the above person is employed by Venture Construction Company, and I understand that I am fully responsible and liable for all acts performed under said permits. VENTURE CONSTRUCTION COMPANY .:.-:J STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this 7th day of NOVf~mhp.r ,20_ by T F Holling,>worth of Venture Construction Company, who is personally known to me and who did not take an oath. NOTARY PUBLIC ~~ ~~ Gayle R. ~er/Notary Pu ~~ GA YLE R. WOMER My Commission Expires: 0.:1/')5/09 .0 MY COMMISSION # DD387498 EXPIRES: April 25. 2009 1.aoo.l-NOTAIlY H NOlII)' Dltcount Assoc. Co, GENERAL CONTRACTORS Missouri Montana Nebraska New Hampshire New Jersey New York North Carolina Ohio Oklahoma Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Wisconsin Wyoming Commercial and Industrial Construction INTlGIITY Corporate Division: 5660 Peachtree Industrial Blvd., Norcross, GA 30071, P.O. Box 4175, Norcross, GA 30091-4175, 770 441-6555, Telefax: 770441-9813 Atlanta Division: 5660 Peachtree Industrial Blvd., Norcross, GA 30071, P.O. Box 4175, Norcross, GA 30091-4175, 770441-2404, Telefax: 770441-6566 Memphis Division: 3085 Stage Post Drive, Suite 1, Bartlett, TN 38133, 901 372-5766, Telefax: 901 372-6831 Nashville Division: 508 Autumn Springs Court, Suite 2A, Franklin, TN 37067, 615 778-0402, Telefax; 615 778-0001 Richmond Division: 151 Le Gordon Drive, Suite 200, Midlothian, VA23114, 804 379-3610, Telefax: 804 379-2185 Greensboro Division: 4-A Terrace Way, Greensboro, NC 27403, 336852-1946, Telefax: 336 852-2094 BRANCH NOV-01-2007(THU) 13:14 Rx DatelTime NOV-01-2007(THU) 09:18 NDV/Ol/2007/THU 08:54 AM ZEPHYRHILLS BUILDING . : Peninsular Mechanical Contractor (FAX)727 572 0978 813 780 0021 FAX No, 813-780-0021 P. 002/003 P.003 p, 003/003 ~'115.6 .. ..lo."'<IIi"'!f~.-"_. f. , , RECEIVE l}eofoe20 I OCT 2 5 2D~i11 RlciMO I City Dr ZophYltlll1S Perrnil AgglicaUcm Iluf1dIng o..aitlMM Faa-I1~1IHoa1 t)...ZS-o'l br.~~mistruction ~m Brinker Florida Inc,. 'OwnIr.........NIlIIIIIIf -U'-'Ilpa DMsioo;......-;AddI:' I 6820 LBJ Freewav.. Dallas. Tx 75240 I o.._1'M...-...1 -'. . "':Im~TI~IO"'NlliMI Brinker Florida ',ne' J~... Pflan.i.....n....1 Jr..:Ill1lpl.ThI"'_AII4r1$5 I 8820 LBJ Freeway, O:.lIas, Tx 75240 .; JOQAQDIlW I 7643 Gall Blvd.;Zephyrhllls, FL 33541 I LOU LJ. :IUl1DM:11C1t; IZePFlVrlll1l5 8Qpercen..r-A A_lila, I 'pAACl!LllIIl 34-25..21-0110-00000.0040 I_'__....~TM_I . E3 ~~~N$TJt ~ ~T 0 6lGtl CI IttOV&: D DEUOUSH l'Ra'OSrD use O:lPR u;;:r COMM CJ O'IHIlR I: 'm'IlOFCOfolmWC:nON Cl IlLOCK G2( FIlNtIe' 0 ST&eI. 0 OTHI!_I ! Dining expansion. to existing Chili's restaurant. I $QPOOTAGe14,647 s.t. j ~..,.l22'..10", I o 1IUll.0I'lCi I. 1'1 O~OOO I VALUATION 01' Ttl'I'ALCCNSTRUCTICIH o !L!Cl'R\C.\L 1'14,500 I AMPSl!R\l1CE Cl Ilt.UMDIN~ 1$ 0 I o MJ:~""NI~ 1112.500 ., VALUA'I'IQIolOF",;CtlAHlCALINSTALLATIO'- o GAS Cl A~~C CJ SPIiCliILTY Cl OTHER 'Itl~1!O I'\.OOR 1!U!V"1l0H9 I I . R.OCO ZONIiAAEI. Dyes DNO :f< ~ ~ ,41'V~'1 q~1.1 /AtJ} .. WORK .....0'051:0 Ii"CJlll'llllllOl''WgRK OUl\.lII/CO 1Ig:( I f' Cl PIlOGAUS I!HI!"GY' D W,,,-LC:. SICt; ..awl" 1 ....(1\ lZl"'" .......: IZJ.... atWIdIIIg """1; mlt' rt fII"" foIme M1nllt1um IIIlI'ol-.adlJe IIWIlIIlldIllI dlIl1. ~II"" _.. CcN"". n_. Stnllll)'l'IIdlIatII Co' a.-..,..., ."CIlI~ _1I111vl1ll111l1 ""'115; 111 MIDI e-.,. renna. Mi_...ll0J_.....~"""".......llIIIlIII'., RlICIVltwd""...., l:4lnG1rUCllan """'" s.......,.""..,.., clwmpI;lef "'1_ciol....--II""'Il_llXIllIOlitn~., ' , ....... 121- '" 1.,......llII....~'. ' .-.I>IiO....,.,.,. $IJRve,. ............Iot'd Ntw COII'_. II I I I j L.:!.!..!LJ - --- L!.!!!.....J UClnU II 1 J I :.s~ L..!!.!W fCC,CUIlII:Wl' I..1!.!W ~ . 3373~ uc_.. I CAe OI'O~i\ I C~AN'I' L' I IIIl1l11111CD L..:!.L!i.J fW~ L..!!.!L.J .1 L~' I ~ I ~ DUI~DCI> .\ ,I ~'A~, SIGNATlIRe .' , Il&IIlmIllliD . Alltfl" 1105 N.FlIlkcnbullJ Rd. Stet A. Tampa, FL I . :=~ I J ::::: I ~ Milt';. I ; I P~UIIBEfI I I cow,,", '1 ~.:tIO",,'I'U~ Rfa:l1IfIlCII AGar,," I L...!L.!1...J' ftCI' CUllRlNI" . ~.-I ClT\4I:R S1GNATUIlf Addtfts I Rll5I011CnAl. COIWeHClAL V Olrettloftll: 1'lII........-..- _,......,.. OMlcIr I. CCltlIlaClOr;lgn No< cI ........""'" _n.ted "_~511O... _lOti oIC~-' I, f*qltlttCI. tAlC u""eCIH _UDDDI - A...tllDt .t.._nclarlllr _0I~.......1""..._).._1M_"..tdl IIOltri.J:ed Itn..."_____._ OVP 'nGCOIINTIm "e~o fr-raini of ~..bltll1 Oltlrl "',_ &Mc'~ eo- Up..... Nt: ~..-t~r/I'~ O_Y5.NoI_ c.w.... if OIl fullDlJ'.........-llOW C H~~}~ ~- H ( ( (5 11/08/2007 12:08 3525960901 CANCER CARE CENTERS Ncv 08 2007 12:~5PM SOUTHLRND CONSTRUCTION 813SS41?SG IIIIIUII COUI....el.. Serricel,I.c. D.B.A.. SOutbl....d Electrtcal Senie. 9605 B. US HWV 92. 'AMP",- FL 33610 1'1I'13-464-1785 r:'AX'J~(l64.176d November. II, 2007 City of Zephyrhi)ls - Building Department 5335 8th Street ZephyrhiRs, FL 33542 Ref: Letter of Authorization To Whom It May Concern: Please be advised tbat I. Thomas LaMeau - certification number EROOl4408, h~reby authorize the following person to register my license, apply for, p~hase and retrieve pertnits on my behalf as authorized agent I understal\d that J am responsible for ftDy work performed by my .agent. This authorization is valid for the following project: ChiJis 7643 Gall Blvd. Zephyrhills, ,FL 33541 1. Sterling W. Smith sincerelY.~ Ct. ~~ Thoma LaMeau Electrical Contractl;Jl' Sw~to and SUbB~bcd to mc: this 8th day of November, 2007. by C> rrv')<<; m 00 LA . who is =nally known to me '?t who bag produced as identificaJioD an who bas taken an oath. .~~ LaDONNA DAVIS Notary Public, State Of ,- My comm. expo Apr Comm. No. rl~ No1ary Stamp CGC1508447 GENERAL EROO14408 ELECTRICAL PAGE 02 p.2 11/08/2007 12:08 3525960901 CANCER CARE CENTERS no~ UU ~UU7 lZ:2!PM SOUTHLRND CONSTRUCTION 8136S4.1766 PAGE 01 p.3 , JOY/011?001IWED B3:23 ,. ZEPllYRHlllS BUILDIr<<:; ~AI NG.8J3-780-0021 P. 002 .1'~. r, . . ....... ,... - RECEIVE)), ctver,...".. ParmnADOIIcaIOlt ....~ ...,......... ~f:_t' . ...... '" _. ~~.,. . .........--E ~ ~ -'. . '":"""-:....flI..... ....,......... - -] ,...... ....1loII~.... Upu.... ~~...:i. TlZto --=- -' -' :J = ~=.~...::1t~~~ ~ _-1lClIaID 8 ==.-- eJ CI:i" c:J .... C ~ C , ..~ ~_UCl.. I:J "" r::g..- ClllIIlI 0 ~...:. . -., ""01'......... CJ --- I:iar ,__' Q .... Q ......., ~ :::;;7' - ~~~-:;...*t~;)5~~ C.,..., t11D.oeO } wMlloOllIPI.~~~1f I::J --... e~.4.IOD 1...... q --....... c::J ",,-.c. 0....... II 0 I t::l ......c.\ l:,12.600 t .....T.....'~_tlII&A.... o - c:J - 0 ~'Il'CJ __ .....".~ I I. '.wa.__..- ~ ~ ~1.,11 ~~~ . Ir z. ~I ...-. . "- r....... ...... . ~..,,~ _1 ....... ----... . .,.. .... .~..... ~"_t... -- ....~ ....,.. .w... ... ..., -.; t:::rr.-=-r~ ............. . .--...., ~..-:I ......... ......._.... .. .......--.,..-..-..-------..--------- .....-....... ~. 1 IIIIlr) ,,-. ~ ...... .... flI_~_ 1IItl"~. - ;1'1""---'."" .-" ... - . .--....-..... '._'_ '" t,....._.. .,...-.........-..-. .-..... ---- ...-.-.. -- ...- .......- .. l'd E016eOOt~g OI~3S DNl.l~J.NOO 03UNrl ~~:to lO LO "ON NOV-08-2007 THU 03:12 PM FIRST FINANCIAL FAX NO. 9418835852 P. 01/01 ,ACORD CERTIFICATE OF LIABILITY INSURANCE I DAT" IMMlDllIVYYYI TIl SSTBF1CNl: 11/08/2007 PRODUC~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION L19ncho~D=-~rogramB, I.LC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 301 ~. ~in= Scra~r. HOLDER. THIS CERTIFICATE:DOES NOT AMEND. EXTEND OR sun" ~~o ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. orJ.llllclo, rL 3:\"01- INSURERS AFFORDING !=OVERAG~ NAIC# .- ". -" - INSURED INSURER A: liD;" l"'Ulrance COlIl'pany I"h'Jlt Plnancilll Eu,ploy"e :1.....8105, .nc. -.." " -- ~74~ Tamiami Tr..i1 IN5UR~A ll: .- .. ~ .' fore cnar1ot~.., PL 3~,S2 -,"' INSURER c: -- INSURER 0: ~.. -- '. , INSURgA /0, COVERAGES THE POl.lCIE:S OF INSURANCe L.ISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THe POL.ICY pERIOO INOlCATEO, N01WlTHSTANDING ANY RE:QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO \MilCH THIS CERTIFICATE MAY BE: ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCL.USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE I.IMITS SHOWN MAY HAVE. BeeN REDUCED BY PAID CLAIMS, , _=" "'="'" .,,- I~ ~~~ ......." O~ INSURAOIC" . . POl-IcY NUMB~R p~rr ~jf'Ftc"VE I'OIoICVI!llPI'li'~c:" UMITS /OI<CH OCCURR/ONCf ~ -oJglll'.I>~ .....RIO~..' PRIiMIS/OS.!.Es OCCIA'Iln"") $ ~':x.P (My 0"" p6(lcnl, S PER50NA~&flDVINJURY" ~': :"'_... ...0.'-"--'- ~:~~~~::~~::"~G.:';<;;':-I,.'::~ ..-= ", ...- ~NtiRAL LlAfllUTY _ .,~~~MERCIf\L GENeRA~ LI"IlILITY _ -.J C\..I<llolS MADE 0 OCCUR ," '..~. , -_.. ~-,,, ..- q~~'L AClGl'te~ UMIT AP~ pER: I POUCy I I P'k'R;: I I I.OC ~lOMDBILE UAIlILJ'lY ~ ANY AUTO ~ ALL OWNED AuTOS _ SCHi:DULED AUTOS _ HIRED AUTOS _ NON-Cll\lNED AWl'OS COM81NfD SINGLE LIMIT (/Oa ICCldsnU ,-- BOClILV INJURY (f'or per9Ol'll fI00lLY INJURY (Per !ll:dQenl) .- PROPeRTY OAM^Gi;: (Per ~dsnll ' _ .. 5....., ... A ~AOE LIABILITY _I flNv AUTO ~l!SSlUMBREIoLA LIABIUTY ---1 OCCUR D C\..I<lMS t.1ADt! -'1 OEouCTIBL/O I Mr/ONTlON I \IIlORKERSCOM"~SATlDNANg I'ISLTHT1lil 000066-02 eMPLOVERS' UAIlIU'l'V ANY f'ROPflIETOfllPARTNERIIOXECUTIVE OffIOER/MEMBeR ~CLUI;l"P? II va;, QelC/lbe ill!d!l: ._, , ~';:CIf\L OROV'SION~ aelow OTHER AUTO ONLV - EA ACCIOENT ~ ,. EA ACC 5 .'- OTHERT"""N AUTO ONLY: EACH OCCURReNCe AClGfiEG^TI< AGG $ $ $ ,,,- $ 12/31/2006 01/01/2008 $ $ I X I _'M= ST~,~<: I I 'fIlH- ~RY._LI , .Ii #, EACH ACCIDI!NT, $ ~L. DISEASE. EA EMPLOVEE $ 10,". DIS/Ot\SE. POLICY LIMIT $ 1,090,000 J.. 000, O~.~- :1.,000,000 IlE:SCAlPTlON OF OPiAATlONS / LOCATIONS I \lEHIClES/ EXCl.USIDNS ADDIlD Ill' ,,"ODRSEMIiNT I SI"I!ClAl- Pft0\/l51ONS cover~9~ i~ excendc~ co ChB le~ued employeoD of alcern~te employer l~lorida Op~ration3 On~y): Southland Conatr~~tion Se~icee, Inc, client #26G9 (EffectivE: 1.01.20061 IlISCl.AlMBR: The Certificace of Irlliurance doe~ net conptitute i1 .... contra~c between tne issuing in~urerI31, ~~thorized representative or produoer, and the certifieace holder, nor does it affirmatively or negatively amend, extend or alter tho coverage attorded by the policiea listed thereon. Thi~ certificate only appli~~ co Licence Holder; Thomas LaMoilu. CERTIFICATE HOI.Ot=R CAIIICEI.LATION SHOULD ANY OPTHIl Alave De5CRIIIEIl POWCE:! BE CANceLLIiO IIEfOfll!THI! EXPIRATION DATE TH~flEtIf'. THE ISIUING INSURER Wll,l, I!NDI!AVDR TO MAIL 30 DAYII WRITTI!N NOTIC!: TO THE C~llTl~ICI'TE HOUlf:II NAMEDTOTH~ 1ol!l"1', BUT FAILUlleTO 00 80 IHAW-IMPDSE NO DIIl-_TION OR LIAII'IoITY ~ >>II' KIND Uf'ON THe INSURI!Il,I'l'S AGEN'B ~ REPRf:&5NYA'J'lVES. ; City of Zephyrhille l'llclg Dept. 813/'100-0021 AUTHORIZED REPIIl!SENTAnve ~ 5335 Sr.ll StreCl~ :Z;t!ophyrh:l.lh, PL 33542 t'llg= 1 of. 1 ACORD 2S (2001/08) (5) ACORD CORPORATION 1988 I- a.. W u 0 W 0::: ~ (J) tB z Ci5 :::J 0 m ?= z :::J o U J: (!) :::J o 0::: o m (J) :::3 :c13 coS Q~ Q ~ ,... o Q ("I 8 0 0 0 z 8~ a:i 0 ... ~ lri co ... co co N g ,..., /!! w ..... Cl N ~~ . 0 :dE C? ::I <>> rn U) -I W ~ a:: ii: z >< w W 0:: .. Sf i~ (I)~ ::>C'l td 81 ~N U I !It-... (I) -I 83 ~ z - (;j t= M~O ..... o w o o co u 8 cj 0 g ~ :g~ ,co ... ~ ~ (I) Z o i= U ::> 0:: <(I- (I)~C'l iOO>o OU~~ :z:o:z:(;) I-~(I)-I ::>...:I::>u. ~~w~ ~o8~ S(l)~1-' to: ~~ ...0 'S:::! or-..: ~~ rn III ci W t- o:: ~ f;? ~ U z W w :j i 8~~ ><II)~ ~aA~ . CO) ffi~~ 9:0. w m a3 ~ C) 0 ::> w g :: :r t- I- 0. - W o w a::~ ?SI ~ IV ~ r- i ~ UJ e ~ UJ g a w ~~ z ~S _ 91!' en : i :) j:g CD if ; 11/8/2007 10:57 (813-909-8743 Paragon Risk Management Jean Shuff-+City of Zephyrhills 1/2 ACORDfM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDI'fYVY) 11/08/2007 PItODUCER (813) 949-8636 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE Paragon Risk Management, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 119 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lutz FL 33548- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Clarendon America Southland Construction Services, Inc. INSURER B Zurich Thomas LaMeau INSURER C 9605 E US Hwy 92 INSURER D Tampa FL 33610- 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 \MilCH 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, INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMIODIYY) DATE (MM'()DIYY) LI MITS A GENERAL LIABILITY CA0900000152 01/12/2007 01/12/2008 EACH OCCURRENCE $ 1,000,000 - ~~~~~~~9E~~~~;.?en ce \ ~ ==rMERCIAL GENERAL LIABILITY $ 100,000 CLAIMS MADE [!] OCCUR / / / / MED EXP IAnv one personl $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 / / / / GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT AnS PER PRODUCTS. COMPIOP AGG $ 2,000,000 I POLICY n ~~8T LOC / / / / A AUTOMOBILE LIABILITY CN0900000247 01/12/2007 01/12/2008 COMBINED SINGLE LIMIT 500,000 - (Ea accident) $ - ANY AUTO ALL OWNED AUTOS / / / / BODIL Y INJURY - (Per person) $ X SCHEDULED AUTOS - / / / / X HIRED AUTOS BODIL Y INJURY - (per accident) $ X NON-OWNED AUTOS - / - / / / PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ===j ANY AUTO / / / / OTHER TH AN EA ACC $ AUTO ONLY $ AGG EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ :=J OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND / / / / I T~~1If;JNs I 10TH. EMPLOYERS' LIABILITY ER ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $ O~~ICERIMEMBER EXCLUDED? / / / / E L DISEASE. EA EMPL OYEE $ If yes, describe under SPECIAL PROVISIONS below EL DISEASE. POLICY LIMIT $ B OTHER Inl and Marine EC65575385 01/12/2007 01/12/2008 rented or leased 100,000 / / / / / / / / DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLA TlON (81.3 ) 780-0020 (813) 780-0021. SHOULD At('( OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT - City of Zephyrhills - Building FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF At('( KIND UPON THE 5335 8th Street INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTA TlVE -M..r~_~ Zephvrhills FL 33542- ACORD 25 (2001/08) ft_.,-INS025 (0108)05 ELECTRONIC LASER ~ORMS,INC, -1800)327-0545 @ACORD CORPORATION 1988 Page 1 of 2 , 11/8/2007 10:59 (813-909-8743 Paragon RIsk Management Jean Shuff-'Southland Const Serv 1/2 ACORD", CERTIFICATE OF LIABILITY INSURANCE T DATE (M1olJ:lD/l'YVYI 11/08/2007 PRODUCER (813) 949-8636 THIS CERnFICATE IS ISSUED AS A MATTER OF INFORMAnON ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE Paragon Risk Management, :Inc. HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEND OR P.O. Box 119 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lutz I'L 33548- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Clarendon America Southland Construction SeZ:Vices, :Inc. INSURER Et .zurich Thomas LaKeau INSURER C: 9605 E US Hwy 92 INSURER 0: TaDlD8 I'L 3361.0- INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDNG ANY REClUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO \MilCH 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, I~ ...~.J: TYPE OF INSURANCE POlICV NUMBER IP~4i~MIolIOOIVV) DATE (MMJ:l"&VY)" LIMITS A ~I9ERAL LIABILITY CA0900000152 01/1212007 01/12/2008 EACH OCCURRENCE $ 1,000,000 ~ =rMERCIAL GENERAl LIABILITY I ~~~~~~YE~~JuEJ'ence\ $ 100,000 ~ ClAlMSMADE [!J OCCUR 1 1 1 1 MED EXPIAnu one !lArsonl S 5,000 PERSONAL &. ADV IN-lJRY S 1,000,000 / 1 1 1 GENERAL AGGREGATE $ 2,000,000 ~l AGGREn ~IMI: AnS PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POUCY ~T LOC / / 1 1 A ~TOMOBILE LIABILITY CH0900000247 01/12/2007 01/12/2008 COMBINED SINGLE LIMIT 500,000 (Ea occldent) S ANY AUTO - 1 1 1 1 ~ ALL OWNED AUTDS BODIL Y INJURY (Per person) S .!.. SCHEDULED AUTOS .!.. HIRED AUTOS 1 1 1 1 BODILY INJURY (Per accldent) $ ..!. NON-OWNED AUTOS / / 1 1 PROPERTY DAMAGE (Per ecddent) S RRAGE L1ABlLllY AUTO ONL Y - EA ACCIOENT S ANY AUTO / / / / OTHER THAN EAACC S AUTO ONL Y: AGG $ :=JE8S~M~LAL~BLnv / 1 I 1 EACH OCCURRENCE $ OCCUR 0 CLAIMS MADE AGGREGATE $ $ q DEDUCTIBLE / / 1 / $ RETENTION S $ WOR~COMpagAnONAND I / I I I T~1r,1J,y~ I IOl~: EMPLOVERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTlVE E ,L. EACH ACCIDENT $ OFFICERIMEMBER EXClUDED? / / I / E,L, DISEASE - EA EMPLOYEE S "yes, desalbe under E.L. DISEASE - POLICY LIMIT S SPECIAL PROVISIONS below B OTHER Inland Marine I:C65575385 01/12/2007 01/12/2008 r.nted or l....d 100,000 / / / / 1 / / 1 DESCRIPTION OF OPERAnON8A.OCAnONS/VEHCLESIEIlCLUSIONS ADDeD BV ENOORSEMENTISPECIAL PROVISIONS CERnFICATE HOLDER CANCELLA nON (813) 780-0020 (813) 780-0021 SHOULD ANY OF THE ABOVE DeSCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISIUNG INSURER WILL ENDEAVOR TO MAIL ~ DAYS M1nEN NOnCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT City of .zephyrhills - Building FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 5335 8th St.z:eet INSURa ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE ...i;fL v-~ .z8Dhvrhills I'L 33542- ~ ACORD 25 (2001/08) It.... -INS025 (0108),05 ELECTRO NIC LASER FORMS,INC:. _ (800)327-0545 CJ ACORD CORPORAnON 1988 Pogo I or 2 , 11/8/2007 10:59 (813-909-8743 Paragon Risk Management Jean Shuff-'Southland Const Serv 2/2 IMPORTANT If the certifICate holder is an ADDITIONAL INSURED, the 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 endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such 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 (2001/08) ft-: INS025 COl 08).05 Psgs 2 of 2 " -- - --- -- . - .l"l 'C"I IrI ri o ~ '0 Q) o ~ o H ~ g ,0 ~ H H ~B' M< ta;'O ..:t~ ~g OH Hra tIl,:2: tllf4 .<>MU Q"14H jiLi~ g;'AiTn ' I..' , ,~ ", _."~O '~"',:i;:~' t.,.. :. ":...' "'. ".".-1... '~':J1, ' :'~" :0 ~':H'O' (I), 'r^- ,.,.;':~~' ~ O~ 8 t~ ,~tl ~ ! m rl o ('0 o I"- ('\.J """ o <( -- -- _. .-- -- ._-. - .. . .lIi!l ,.... . J;? ,'~Jltj':" ":IZ{', ,':2';~:i! .' "P:1.~ .O\,<Q;;H U ~,? ~:~~' ~ p:t '{,i, ..=i H fJ) Z, m CIl f:l:-f1 . I'z1 ,'0. .a.),CO(J U ,," 0 0 /'4' ~ 'Ot9'.:O.fIt. 'H M fJ) ~ ' as O-H ~ ,:> \0 m .~ ~Qt1N~t Ci ~ u 0 otl ....:to fJ) H ~E-t IZ1Ii-f M tcC 'U ..:t ..:I. M,t),E-tO ('t') " ,:>tZ r:c , , ~ tI2 E-t 0 ZO . ~~~ ~ g'~Fi g~N ,N Zf:4 Ooei:i~ ~~O\ \Q O~.,.., 0 .... ('t')U Cll..E-tH ~t! , ~ ~:a'~ !'~g: ~fJ)i= , \0 U J.t'U tI2 OfJ) .oH~Ot,..:trt Up , \Q:~,~ Gl 5:3~ iS~E-t ouC).c:-r-lQ):: tIl '~~.Q~~~tl b r:i rZJ't:1 J.tJ.tH H ll(lI:,c( ~ Gl~~].~ g ~f:;~~ '. .c: id r:: K-H M ~O\Ooii:C (I)' :f.tZ P M:-A: ~tI2.O\E-t ~ -" --"'" P:: IZ1 ..:t ..:I H:>t E-t~ ii u , ~CI o ~ H tI2 lI:P:: tI.lO fij~ IZ1 m:> ~g ACORD CERTIFICATE OF LIABILITY INSURANCE T DATE (MMlDDIYYYYI TJI SSTBFKNZ 11/08/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lighthouse-Programs, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 301 E, Pine Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 350 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orlando, FL 32801 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: SUA Insurance Company First Financial Employee Leasing, Inc. 3745 Tamiami Trail INSURER B: Port Charlotte, FL 33952 INSURER C: INSURER D: 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, I~~ r:.~~~ TYPE a~ INSURANCE POLICY NUMBER ~~~:~J~ P~W,~~~~ UMITS ~ERAL UABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ~~~~~S Ea occurence\ $ "- o CLAIMS MADE D OCCUR MED EXP (Anyone person) $ "- PERSONAL & ArN INJURY $ "- GENERAL AGGREGATE $ f-- n'L AGGR,EA LIMIT APPLIES PER: PRODUCTS-COMP~PAGG $ POLICY ~fR;: n LOC ~TOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) - ANY AUTO - ALL OWNED AUTOS BODILY INJURY (Per persOrt) $ - SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY (Per accident) $ - NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ ALrrO ONLY: AGG $ SESSlUMBRELJ.A UABILlTY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ $ =~ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WSLTHPE 000066-02 12/31/2006 01/01/2008 X I T't&vS,~{J#C, I I~TRH- EMPLOYERS'LIABIUTY E,L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERlEXECUTIVE OFFICERIMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000 ~~~I:S~~~~~~S below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS Coverage is extended to the leased employees of alternate employer (Florida Operations Only) : Southland Construction Services, Inc. client #2669 (Effective 1.01.2006) DISCLAIMER: The Certificate of Insurance 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. This certificate only applies to License Holder: Thomas LaMeau. CERTIFICATE HOLDER CANCELLATION SHOULD AHY OF THE ABOVE DESCRIBED POLICIES BE CAHCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF AHY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. City of Zephyrhills Bldg Dept. 813/780-0021 AUTHORIZED REPRESENTATIVE ~~ 5335 8th Street Zephyrhills, FL 33542 Page 1 of 1 ACORD 25 (2001/08) @ACORDCORPORATION 1988 n. ,"::~ ~., . : ~ " . , ~".~. H~ .'~ Peninsular Mechanical Contractor (FAX)727 572 0978 ..:....,..... NOV-01-2007(THU) 13:14 r : . ~ .' : :. . ~ 0:.:4:- . '.,1.. '. ,', ." H ',.:.":'.:~,,\i.,,:.;:;;j~,I~,,::.'.:.~....,..:: ....~.:-.::.;..:..;'.. . .:. c. :'.~.; ..=c.:~:. .; i,:.':i;j:;!';" . :' ",;:<~:y:.- , . :' ',.... ;. .: ~ .' .....'M".._. ,,:. .... '"'. ',~5~W:' <ii, , ";;~i."',' ..:;~it,,;,\,-,.:._ , ".11",., ,.,~. '. '.'1-'..'.........., .. '~:f- ~~:,;"" . 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'::I> ' (Jli;]',,)> ~ " 1llItr.l . -; ....1:':4 " , "I;I;2,f/)'; -, , 2:l'n t'.I~ "Zl'n , ' fI.Il-I l:l;IO .; ,ml-l 1-10 . ~ 1-10' 2:2: -trJ a~ Cl> r:< ',~' l:11 a:l 0" 0" Ul . >~ :z: :Jll~ 1-1 "Cil 0 "C'J 3: or:: tI.lt'" ac: 0 t'" oot'" ~ ~f13 )II ot< :J=I '. ~ " ~ n fool 1;1;21:1I H S~ 0 to3l1J 0 :z: >2: Z CIJ "m en :JllUl m t<o m ,,~ 0 :z: 1<1-1 D t'" :tt: :rt ~ t" t" 0 0 lZJ en oo,l " 0 0 cn Ul 0 N cn ... 0 0 0 0 en ~ ". a> oo,l a> NOV-01-2007(THU) 10:33 Peninsular Mechanical Contractor (FAX)727 572 0978 P. 003/005 ACORD... CERTIFICATE OF LIABILITY INSURANCE T DArt; IMMIODNYYY) ~J~/200'7 PRODuceR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Work Camp Specia~ists ONLY AND 'CONFERS NO RIGHTS UPON THE CER.TlFICATE HOLDER. THIS CERilFICATE DOES NOT AMEND, EXTEND OR P.O. Box 9435 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. n~nama City Beach, FL 32417 _ 0-2~=?4-319"7 INSURERS AFFORDING COVERAGE NAle# IN:.t.JRCD PENiNSULAR MECHANIChI. CONTRACTORS, .tNC. INSURER A:. lll::i.dgef':i.eld Empl.oYQJ:S :IAlI. Cg. JAMES B. SPEARS #~COl0371 INSUR,l;R D: PO BOX 8116 INSURER c. MADEIRA BEACH, FIr 33738 INSURER 0: I INSURER E: COVERAGES T"'E POLICIES or: INSURANCE LISTeD DELOW HAVE BEeN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION or: ANY CONTRACT OR OTHGR DOCUMENT WITH RESPECT TO WHICH THIS CERTlPICA'rE MAY BE ISSUED Ol~ MAY PERTAIN, nll~ INSURANCE APFORDED BY THE POLICIES DESCRIBED HEREIN IS SUDJECT TO ALL THE TERMS, I!XCLUSIONS AND CONDITIONS or- SUCH POllelUS, AGGREOATE LIMITS S~IOWN MAY HAVE DEEN REDUCED BY PAID ClAIMS. IN:iH iUlO'L POLICY NUMDl:R ~~';!gM~15~YC POLlCYr,~ LIMITS LTR MlRD r- OATI" MMI ~HrRAI. ~1A(jILITY ,,^C~ OCCURRENCE S COMMERCIAL GENCRAl. LIABILITY ~ ~Rffi:,;:S'F:; iF.. '''''''"","ClII $ '- [J CLAIMS MADE o OCCUR MEO EXP (My Dna po....nl s ~ PCRSOIW.I.AOVIN,JURY S , GENERAL AOORECATE s ~ n'~ AOC~nE LIMIT AnS "lOR PRODUeTS-COM~OP^GG $ "OLlCY ~f.f.T LOC ~OMODILl; LIABILITY COMDINED SINGLE LIMIT s ANY AUTO (l;iliICCiclanl) - - ALl. OWNED AUTOS IlODIL Y INJURY $ SCHEDULED AUTOS (l'w pereon) - - HIRED AUTOS DOOIL Y INJllRy (Par:accidQl1I1 S - NON.OWNEOAUTOS - "HOrERTY DAMAGC $ (Peraccidomll ~CE L1ADILI'TY AUTO ONLY .l;AACCIDENT $ ANYAUTO OTHEfI'l'HAN EAACC S AUl'OONLY: AGG $ =:]"SSIUMBAEUA L1MI~ITY t:ACH DCCURRCNCE $ OCCUR 0 CLAIMSMADC ACCRCGA,", S S =J OF,DUCTIIILf $ RErENTION S $ WORKEj;JS COMF'ENSATIONAND X I T"X~~r~~~ I IUI.'. ER EMPLOYF.RS' LlAIIlLlTY 0830-37339 01/01/07 Ol/OlfOS r"L, EACH ACCIDENT 500 000 /w( PIIOPRIETOII/PNllIl\!H/CJlCCVTIVE S X OffICCRlMEMBF,lt F.XCI.IIOI:D7 E,L DISEASE - l!A eMPLOYF.1 $ 500 000 IIY1ft1,de'_unlMr SOO 000 SPCCIAl.PROVlSIONS bel_ f"L, DISGMr: - POLICy LIMIT S OTHCR O!:SCRlrTION 01' OF'ERATlONS I LOCATIONS , Vl!HJCLES , I!XCLUSIONSAl)OEo 6Y ENDORSD\oIrNT 'SPECIAL "ROVISIONS CERTIFICATE HOLDER CITY OF ZEPHYRBILLS 5335 8TH STREET ZEPBYRHILLS, FL 33540 CANCELLATION SHOULD ANY OF THC MOV!; DESCHIBEO POLICICS Dr, CANCELLED lIel'DR!! THC E')(PIRATION DATE THERCOF, nlF. ISSUINC INSURC:R WILL ENDEAVOR TO MAlL~ OAYS WKITTeN NOTICC TO THE CE..l1f'ICATE HOLDliR NAMtD TO THE LEI'T. BUT I'AILURE TO DO SO SHALL IMPOSF. NO OIlLICATlO ON T14E INSUR!:R ~ AGCNTS OR RF.PRE$ENTATIV , AUTHORI7.EO REI' E ~ ACORD CORPORATION 1988 ACORO 25 (2001/08) NOV-01-2007(THU) 10:33 Peninsular Mechanical Contractor (FAX)727 572 0978 P.004/005 ..~J~_._.._ ~~~..~r.E'Z'.~::'. :'\I"~.... .:.,:~. .~ , ~; ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID p~ DATe IMloVDDIYYYY) '( PENIN-l 06/28/07 ," . PRODUCI!R I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Browr. & Brown ...1.1: Ji.LorJ.da, l.nc::: v;'li... Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 So,," 548 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR -t4 E Jefforson St ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. :00k3villo FL 34605-0548 PhonQ:352-796-B200 Fax: 352-799-1399 INSURERS AFFORDING COVERAGE HAle. INSURED INSURER A.:. Wes~fiQ1d Com~anios 24112 poninsular Mechanical INSURCR R; Contrac~ors, inc. INSURI;R c~ Jame$ Spoars CAC010371 P.O. Box 8116 INSURER D; Madoira Beac:h FL 33738 INSUKER ~ ': COVERAGES THE POLICIES OF INSURANCE LISTED DilLOW HA\lE BEEN ISSUED TO THE INSURGD NAMED ADOW FOR THE rOLlCY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, Tl:RM OR CONDITION OF AIfY CONTRACT Oft OTHER DOCUMI:NT WITH REsrECT TO WHICH THIS CCRTIFICATE ~Y aE ISsuED OR MAY rERTAlN. 'THE II'lSUAANCE A!'FDRDliD 0'1' THI! rDLICI!:S DESCRIDI:D I-lEREIN IS SUBJECTTO ALL THE tERMS, OCCLUSIONS AND CONDIT10NS OF SUCII POLICIES, AOCR.EGATr:. LIMITS :;HOWI'lIMY HAV~ otCN REDUCEP BV PAID CLAIMS. INSK "N~i POUcY NUMBER IlAT~ iNl=J.f~"';I' IlATe' IMJ,b\~~N L1Mm: LTR TYrE 01' IHSUIlANCE ~NERAL LIABILITY ""CH OCCURnENCE s 1.000.000 A X COMMERCIAL CENERAl. LIADILlTY CHM34,3S001 07/01/07 07/01/08 PRIiMISF.S iE~~~~ncel S 150 000 I CLAIMS MADe l1U OCCUR 10,0)0 AGG. MEO EXP Ihl, Dna paBOnl $10 000 ~ Mold Sub1i.m.it PERSONAL & ADV INJURy s 1 , 000 , 000 >-- GI;NlORAt. ACCfiECATE s2,000(.~ GEN'L AGGREOA TE LIMIT APPLltS P"R~ PRODUCtS - COMF'/OF' AGG $ 2 . 000,000 II ,1xl-rRO. n P.D. Dad. 1.000 POLICy X JCeT LOC ~ToMoDILe UABILlTY COMIlII'lEO SINCLE LIMIT $1,000,000 A .!.. ANY AUTO CHM3435001 07/01/07 07/01/08 I E~ ~CQoenll - ALL OWNIOD AUTOS DOOIL Y INJURY IPa,. parsDn) S - SCHEoULED AUTOS .!.. HIRED AUTOS DODIL Y INJURY S ~ NON.OWNr.O AuTOS (PD' Dl;CIdDnl) - F'RO"ERTY DAMAGe s lI'er eccidenll ~RAGe LIADILITY AUTO ONLY. "^ ACCIOENT S ANY AUTO OTHeR THAN EA ACC s AUTO ONLY: AGG S EXCllSS/UMIlR6Ll.A LIADILlTY EACH OCCURRCNC!; $ 1 ,000,000 A I!J OCCUR 0 CLAIMS MADE CMM3435001 07/01/07 07/01/08 AGGRCGATE s 1 , 000,000 S ... ..~._- ~ OCDUCTIOLE $ X RGTI;NTION $0 $ WORKERS COMPeN8l\T10N AND I TORY LIMitS I IUIH' EMPLOYERS' UADILITY l!!:l,. . ANY rROPRIl:TORIPAflTNEIVEXeCUTIVr; E,L, l:AC~1 ACCII)ENT S OFFICER/MGMnER ExCLUOED? C,L, DISEASE - EA EMrLOyr,I; S ~~e~111'~J'8'v'rsfo~s ""10- E.L, DISEASE - POLICY LIMIT S OtHER Rantec:l/Leasad CMM3435001 07/01/07 07/01/08 ACV 30,000 Ecrui'Omont Ded.SOO DEllCMll"TlON OF OPCllATIONS I LOCATIONS I VSlflCU81 EXCLUSIONS ADD CD BY ENDORSEMENT I SPCCIAL "ROVISIONS General Liability Blanket~ Additional In~ured Endorse~ents CG2033 07 04 & CG70B7 01 05 CERTIFICATE HOLDER City of Zophy~hills Buicilng Copt. 5335 8th St. Zephyrhills FL 33540 CANCELLATION ZEPHYRH SHOULO ANY OF THE Alon DESCRIDEO POUC'E:!IIE CANCF.~I.ED DeFORE! TilE ExPIRATION DATI: TI-lE"~F. TOlE ISSUING INSUR~n WILL ENlleAvOR TO NAIL !2-_ IlAYJI W"ITTEN NOTICE TO THE CERTIFICATE HOLDGR NAMEIl TO THE LEFT, OUT !'A1LURE TO 110 SO IIHALL ACORD 25 I~001'DOJ tW ACORD COkf'(JkArICtN ,:i:::l ~ e 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 inlended contractor are uncertairt as to what licensing requirements may apply for the Intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-647- 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 applicatiort 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 Iicertsed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTIUTIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting, It is further understood that Trartsportation 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, Flortda 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 meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other govemment 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, WaterlWastewater Treatment. Southwest Florida Water Management District-Wells, Cypress Bayheads, Weiland 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 "An, 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 "An in connection with a permitted building usirtg stem wall construction, I certify that fill will be used only to fill the area within the stem wall, If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required, If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction, I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the elltension, If work ceases for ninety (90) consecutive days, the job is considered abandoned, OWNER OR AGENT SUbscri[;!: and ''\t'' 0" by o I&are p haslhave produced as Identification, ~~lYffi.."~, ission No. J cl\o.. nnCL ~, t-+Lt--tI't- Name of Notary typed, printed or stamped ~ ~ .(J u lie Commission No. , _{ J~..cLaLi.--~ *' 0 ~~ N - Name of No ' ... Ad n 'ntAd.ru:: <:tamped LINDA M HIGGINS Notary Public ST ATE OF TEXAS My Comm, Exp, Aug, 19,2011 7643 GALL BLVD-CHILI - VENTURE CONSTRUCTION-PRMT # SQ. FEET PRICE MAIN OR LIVING: 473 $ 112.00 OTHER AREA UNDER ROOF: - $ 91.00 OTHER: - $ - VALUATION $ 52,976.00 FEE SHEET $ 591,00 ADDRESS DRIVEWAY BUILDING: $ 602.82 ELECTRICAL: $ 132.98 PLUMBING: - MECHANICAL: $ 62.06 SUB-TOTAL $ 797.85 RADON: $ 4.73 TOTAL $ 802.58 SEWER: $ 1,443.18 WATER: $ 1,282.00 IRRIGATION: $ - TOTAL: $ 2,725.18 WATER METER:I $ IRRIGATION METER $ FIRE DEPARTMENT FEES PLANS TOTAL: $ 28.38 INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ 28.38 PUBLIC SAFETY IMPACT FEES POLICE $ 82.77 FIRE $ 77.10 5% $ 1.67 TOTAL: $ 161.54 SUB-TOTAL $ 3,717.681 PARK IMPACT FEESI $ I N/A SIF'S: $ - 100,0% $ - 1.0% $ - TOTAL: $ - N/A N/A N/A TI F'S: $ 2,774.14 99% $ 2,746.40 1% $ 27.74 TOTAL: $ 6,491.82 1 I CITY OF ZEPHYRHILLs Brinker International Vendor Number: 182243 5335 EIGHTH STREET Check Date: 11/02/2007 6820 LB] Freeway ZEPHYRHILLS FL 33542 Check Number: 930551 Dallas TX 75240 PD/STEFANI 972-770-5929 Invoice Invoice Description Account Number/Message Number Date Net Amount 894110107 11/01/2007 PD/srEFANI HYRNHILLS 6,491.82 Total $6,491.82 Message: For more info check out WWW,brinker,com/vendors ~ REMOVE DOCUMENT ALONG THIS PERFORATION .. LETTER OF TRANSMITTAL ~~ , " . Jason Bell Property Development Manager BRINKER INTERNATIONAL 6820 LBJ Freeway Dallas, Texas 75240 972.770.4156 P 972.770.9694 F TO: City Of Zephyrhills Jackie Boges 5335 8th Street Zephyrhills, FL 33542 DATE: 11/02/07 RE: Chili's SENDING: Via: lID Attached 0 Courier o Under Separate lID Fed-Ex Cover 0 USPS o Fax_ Pages WI Cover o Picked-up o Hand Carried For: o Your Use o Approval o Your Records & Information o Correction & Resubmission o Your Review lID Per Your Request o Signature COPIES 1 DESCRIPTION Check for $ 6,491.82 for permit fees REMARKS: Payment for building permit for Chili's Grill and Bar Remodel Thank you, Jason COPIES TO: PD File BY: Stefanie Brooks (972) 770-9140 COMM /-RES FEE SHEET ~~ c~~--r ---ct\\Lll? PtN.\N~{l~EftN~l~,J Square Feet: Valuation: Radon: Connection Fees: Sewer: Water: Water Meter: ~\e= if -r? Rate Computed At: \ \2.c~ ~se System Calc for Fees) ~"'7 1 j Lft? i ' ~ &;1 !:Iv -.J ' '). T-)J- . I Size %" 1" 1.5" 2" 3" &4" 6/11/07 ~ 220.00 All Residentials 320.00 725.00 990.00 Contact Louie for Quote Irrigation Connection: 266.00 Plus Meter Charge Above Based on size Impact Fees: School: tJlft -Nffr Public Safety: f1t:a.-~ <82- ;17 ,?olt~ 77 a,C ) . _ 1"'0, .:;7 Y--- J/"<";;-- Transportation: Z,"ntf ~ i \f' ~ ~;7 . B~ Park: ~ ,,~b5 -(.- ,'171 -= H07,86 Florida Ener2V Efficiencv Code For Buildinl! Construction Florida Department of Community Affairs EnergyGauge FlaCom v 2.11 FORM 400A-2004 Whole Building Performance Method for Commercial Buildings Jurisdiction: ZEPHYRHILLS, PASCO COUNTY, FL (611600) Short Desc: Chili's Owner: Brinker International Address: 7643 Gall Blvd Project: Chili's - Zephyrhills, FL City: Zephyrhills State: FL Zip: 34606 Type: Dining: Family Class: Renovation to existing building PermitNo: 0 Storeys: 1 *Conditioned Area: 475 *Cond + UnCond Area: 475 Max Tonnage: 4.2 (if different, write in) * denotes lighted area. Does not include wall crosection areas Compliance Summary Component Gross Energy Use Design Criteria Result 1,497.78 1,700.70 PASSES LIGHTING CONTROLS EXTERNAL LIGHTING HV AC SYSTEM PLANT WATER HEATING SYSTEMS PIPING SYSTEMS Met all required compliance from Check List? PASSES None Entered PASSES None Entered None Entered None Entered Y esfN olNA IMPORTANT NOTE: An input report Print-Out from EnergyGauge Com of this design building must be submitted along with this Compliance Report. 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 COMPLIANCE CERTIFICATION: I hereby certify that the plans and specifications covered by this calculation are in compliance with the Florida Energy Efficiency Code. PREPARED BY: Kip Hanzlicek DATE: 10-'1.0' I hereby certify that this building is in compliance with the Florida Energy Efficiency Code. OWNER AGENT' DATE: Review of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code, Before construction is completed, this building will be inspected for compliance in accordance with Section 553.908, F,S, BUILDING OFFICIAL: DATE: If required by Florida law, I hereby certify (*) that the system design is in compliance with the Florida Energy Code. ARCHITECT: ELECTRICAL SYSTEM DESIGNER: LIGHTING SYSTEM DESIGNER: MECHANICAL SYSTEM DESIGNER: PLUMBING SYSTEM DESIGNER: REGISTRATION No. teE VI '" H e~ R. f C If ~N Allq "87 65761 65761 48773 48773 D. Scott Brown D. Scott Brown Kip Hanzlicek Kip Hanzlicek (*) Signature is required where Florida Law requires design to be performed by registered design professionals. Typed names and registration numbers may be used where all relevant information is contained on signed/se1;lled plans, o ~Jf;Y Kl " /7z (' ~ / 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 2 ID -23-01 Project: Chili's Title: Chili's - Zephyrhills, FL Type: Dining: Family (WEA File: Tampa.tmy) Whole Building Compliance Design Reference Total 89.33 100.00 $1,497.78 $1,700.70 ELECTRICITY (MBtu/kWh 79.79 90.70 1$) 29,115.00 33,119.00 $1,438.28 $1,642.70 AREA LIGHTS 6.74 8.34 2,450.00 3,055.00 $121.03 $151.53 MISC EQUIPMT 0.40 0.40 139.00 139.00 $6.87 $6.89 PUMPS & MISC 0.08 0.08 26.00 26.00 $1.28 $1.29 SPACE COOL 20.37 23.18 7,440.00 8,455.00 $367.54 $419.37 VENT FANS 52.21 58.70 19,060.00 21,444.00 $941.56 $1,063.62 NA TU RAL-GAS(MBtu/ther 9.54 9.30 m/$) 119.00 116.00 $59.50 $58.00 SPACE HEAT 9.54 9.30 119.00 116.00 $59.50 $58.00 Credits & Penalties (if any): Modified Points: = 89.34 I PASSES I 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 3 External Lighting Compliance Description Category Allowance Area or Length ELP A CLP (WlUnit) or No. of Units (W) (W) (Sqft or ft) I None I Project: Chili's Title: Chili's - Zephyrhills, FL Type: Dining: Family (WEA File: Tampa.tmy) Lighting Controls Compliance Acronym Ashrae Description Area No. of Design Min Compli- ill (sq.ft) Tasks CP CP ance Chili's 8 Food Service - Leisure Dining 475 1 2 1 PASSES I PASSES I Project: Chili's Title: Chili's - Zephyrhills, FL Type: Dining: Family (WEA File: Tampa.tmy) System Report Compliance Chili's Existing System Constant Volume Packaged No. of Units System 1 Component Category Capacity Design Eff Design IPLV Comp- Eff Criteria IPLV Criteria liance Cooling System Air Cooled < 65000 BtuJh 11.30 9.70 9.70 PASSES Cooling Capacity Heating System Comb. Wann Air Gas 80.00 80,00 PASSES Furnace/AC Unit < 225000 BtuJh Air Handling Air Handler (Supply) - 0.80 0.90 PASSES System -Supply Constant Volume Air Handling Air Handler (Return) - 0.80 0.90 PASSES System - Return Constant Volume Air Distribution ADS System PASSES System I PASSES I 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 4 . Plant Compliance Description Installed Size Design Min Design Min Category Comp No Err Err IPLV IPLV liance I None Water Heater Compliance Description Type Category Design Min Design Max Comp Err Err Loss Loss liance I None I Piping System Compliance Category Pipe Dia Is Operating Ins Cond Ins Req Ins Compliance [inches] Runout? Temp [Btu-in/hr Thick [in] Thick [in] [F] .sF.F] I None I 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 5 Project: Chili's Title: Chili's - Zephyr hills, FL Type: Dining: Family (WEA File: Tampa.tmy) Other Required Compliance Category Section Requirement (write N/A in box ifnot applicable) Check Infiltration 406.1 Infiltration Criteria have been met 0 System 407.1 HV AC Load sizing has been performed 0 Ventilation 409.1 Ventilation criteria have been met 0 ADS 410.1 Duct sizing and Design have been performed 0 T&B 410.1 Testing and Balancing will be performed 0 Motors 414.1 Motor efficiency criteria have been met 0 Lighting 415.1 Lighting criteria have been met 0 O&M 102.1 Operation/maintenance manual will be provided to owner 0 Roof/Ceil 404.1 R-19 for Roof Deck with supply plenums beneath it 0 Report 101 Input Report Print-Out from EnergyGauge F1aCom attached? 0 10/9/2007 EnergyGauge FlaCom v 2.11 FORM 400A-2004 6 bO ~ .- "'d - .- ::l ..0 bll s::: .- ...... <Zl .- ~ ..0 Q) .- 0 ~ ...... s::: ~ 0 .- ...... gp ro , "€ ;> .- 0 s::: s::: If) 0 .- Q) r--- Z Q ~ -.::t = ~ = ~ i 0 $ 0 ~ .:: .:: ~ ~ S = ~ ~ ~ S = ;:: t::: III 00 III ~ Q,/ ;a .... ~ -r:: III ..... ..... ~ == - III 0 ..... 0 'S = 0 ~ 0 0 - ...... ~ U Z ;> ~ ;-l be 8 ~ = Q ~ e :e u - .... ~ .. = - -< ~ ~ IJo. ~ ~ ~ -< == = ~ ~ ~ ;-l I-' u ~~ Q,) t ~ 0 = ~ ~ .. 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Approved withe below comments: 0 Denied withe below comments: 0 This comment sheet shall be kept with the permit and/or plans. Bill . g Official Contractor and/or Homeowner (Required when comments are present) Pasco County Parcel: 34-25-21-0110-00000-0040001 Page 1 of2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: ParcelID Classification Weekly Archive - Friday, October 19, 2007 34-25-21-0110-00000-0040 (Card: 001 of 001) 21 - Restaurants Mailing Address BRINKER FLORIDA INC C/O MARVIN F POER & CO PO BOX 802206 DALLAS, TX 753802206 Physical Address 7643 GALL BLVD ZEPHYRHILLS, FL 33541-4321 Legal Description (First 4 Lines) ZEPHYRHILLS SUPERCENTER-A REPLAT PB 42 PGS 58-59 LOT 4 OR 5212 PG 637 TOGETHER WITH NON-EXCLUSIVE Land Detail (Card: 001 of 001) Zonln Assessment (totals) Ag Land Land Building Extra Features $0 $356,492 $407,712 $34,893 Total Assessment Save Our Homes $799,097 $0 Taxable Value $799,097 Value Acres Commerlcal Code OPAR2BC Building Information - Year Built 2003 Exterior Wall 1 Above Average Roof Structure Rigid Frame w/Bar Joist Interior Wall 1 Wood Panel or Custom Flooring 1 Finished Concrete Fuel Electric A/C Packaged RoofTop Use 21 - Restaurants (Full Service) (Card: 001 of 001) Stories 1.0 Exterior Wall 2 None Roof Cover Built-Up Tar and Gravel Interior Wall 2 None Flooring 2 Quarry or Hard Tile Heat Forced Air - Ducted Baths 2.0 Line Description Sq. Feet Repl. Cost New 1 BAS 4,014 $422,594 2 CAN 65 $2,106 Extra Features (Card: 001 of 001) Line Year Units Value 1 PAV ASP 2003 25,120 $16,956 2 SWC 2003 1,300 $1,950 3 CON PTO 2003 420 $840 4 8CBWS 2003 108 $300 5 UDU-M 2003 120 $2,160 6 LIGHTSM 2003 2 $3,655 7 SPRNKFP 2003 4,014 $9,032 Amount Previous Owner Year Month http://appraiser.pascogov.comlsearchlparce1.aspx?sec=34&twn=25&mg=21 &sbb=O 110&... 10/25/2007 1111111 111111111I1111I 1111I11111 11111 111111111I 11111111I 1111 200717813! . NOTICE OF COMl\lENCEMENT Permit No. Rcpl: 1137963 DS: 0.00 10/25/07 Rec: 10.00 IT: 0.00 Dpty Clerk Property Identification No. 3Ll::~5-21 -0 II C -C:Q~c:__f:_~_Q(4C 'filE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the follovving information is provided in this NOTICE OF COMMENCEMENT. I.Description of property (legal descriptioll:) Lot 4, Zephyrhills Supercenter-A Replat a) Street Address: 7643 Gall Boulevara;zephyrhills, FL 2,General description of improvements: Din~'!9... exe..~!'~..!.~!.!:..!o existing restaurant. 3,OV'11er Infom1ation a) Name and address:.__~!,!.nker Florida, Inc., 6820 LBJ Freeway, Dallas, Tx 75240 b) Name and address offee simple titleholder (If olher than owner) Same ---.----.--,--.------ c) Interest in property _......___.________________..______._____ 4,Contractor Information a) Name and address: _'\l!!n.JUrELConstruction, 10S...N.-Ealken!;l..Yrg Rd4 ste-,-_A...Iiunga. FL 33619 b) Te:Cphone No,:_813c689cZ983. _ Fax No, (Opt,)_BJ3.:657:.1315__________ 5,Surety ll1l'ol1nallOn a) N a me an d address:_.._._....____,,____....__,____.____.__.________,_ b) Amount ofRond: ______ c) Telephone No.: 6,Lcnder a) Name and address:..NQ,!"I~nc:!!!.r_..____ _ Fax No. (Opt.) R Phone No_ 7. Identity of person within the Slate of Florida designated by owner upon whom notices or other documents ";;'iayb~s~n:;~~F"'.- a) Name and address:__J_eanette.._Campbell 8'7300 ~w. \"12 ST.. HI~l~AI-t , fL 3~ot b b) Telephone No,: Q5.4-!'i!'i3-17n1..__.__ Fax No, (Opt,) 305-362-4141 ____ 8,In addition to himsdf: owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13( I )(h), Florida Statutes: a) Name and address: _NLA..__...._...___...__....___________._.._____ b) Telephone No.: _________..____,______ ".._____ Fax No, (Opt.) _______,,_, <j,Expiratlon date of Notice ofCommencemcnt (the expiration date is one year from the date ofreeordmg unless a differenl date is spec i fi cd) :__..__._____._.__.......__ .._..____..._, .__,....___._00 WARNING TO OWNER: ANY PAYMENTS MADE BYTHE OWNER AFTER THE EXPIRAnON OF THE NOTJCEOF COMMENCEMENT ARE CONSIDERED ll\-lPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATllTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOnCE OF COMMENCEMENT MUST BE RECORDED AN STED ON THE JOB SIT.E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, C S LT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR HECORDING YOUR NOTICE ; CO IME CEM STATE OF FLORWA CO!!NTY OF rASCO Ihori~ed"omccrfDireclor!Partl1erlManagcr ; t Name ['he t\lrcgolng instrument was acknowledged before me this ~,..~_ day of_Q~T7)4J~_, 20.12J., by .,Xa.so "'" ._ " __._~'--~__..___._ as ,__~~,~ ~______,,_,.._._ (type of authority, e,g, officer, trustee, altomey ITl fact) for ___m'_ ' _.,__.... ....___ (name of party on behalf of who J instrument was executed), Personally Known / OR Produced Identification _ Notary Signature Type of Identification Produced _,_...._ ~ jJ,_-_, s . ~i-I'l_ Name (print) Verification pursuant to Section 92,525, Florida Statutes. Under penalties of perjury, J the facts stated in it are true to th 'ef. L1NOA M, HIGGINS Nolary Public STATE OF TEXAS My eomm, Ell9',t,ug, 19,2011 , egoing and that j:;:; r.( f,.1S:t..OC. fvsdLO(l 7 ...c.. Osm :a .....0 m~"'1I ~.....- s-t ~.....~ ~...:D cn~_z ~::;"'11 ......... :D -3C1l n o "1lI'" C) n o c: !r~ ~p m ;;Q :lI'li: ZephyrhiHs Fire Rescue 6907 Dairy Road, Z~phyrhills, FL335-J..:2 Fire Marshal Kerry 3amen 3us t::5"i.3 ~gO-GC4"l Fax (813 -SO-CC.J4 Plan Review Comments I have reviewed the plans for the addition at ChiUs (7643 Gall) and my comments have been placed below. Please contact me if there are any questions with regards to my comments. 1. Install panic hardware on new exterior door. 2. Install knox box. 3. Sprinkler and fire alarm plans shall be submitted separately for permits to upgrade system. 4. Assembly permit shall be obtained. Letter attached. 5, Building shall comply with the applicable codes of the Florida Fire Prevention Code 2003 edition. Inspections required: 1. A building final shall be conducted. 2. Inspections for sprinkler and fire alarm will be shown on their respective plan reVIew. Oct-26-07 12:51pm From-VENTURE CONST,CORP, +7704419813 T-709 P,OI/04 F-762 MEMO TO: CITY OF ZEPHYRHILLS FROM: VENTURE CONSTRUCTION COMPANY SUBJECT: REGISTRA TION - CONTRACTOR Please accept this information to register Venture Construction Company as a STATE CERTIFIED GENERAL CONTRACTOR L.ICENSE # CG C009286 The license holder/qualifier is L.eroy F. Hollingsworth d/b/a Venture Construction Company. Mr. Hollingsworth is our Executive Vice President, Please address all correspondence to: VenTure Construction Company P.O, Box 4175 Norcross, Georgia 30091-4175 (770) 441-6555 Our Florida office address is as follows: Venture Construction Company 105 North Falkenburg Road, Suite A Tampa, FL 33619 (813) 689-7983 Oct-26-07 12:51pm From-VENTURE CONST,CORP, +7704419813 i-709 P,02/04 F-762 ACORD.. CERTIFICATE OF LIABILITY INSURANCE CSR PI. VAn; (MMIVDIYYY'f) VBNTU.. 2 10/26/07 PROPUCER THIS CERTIFICATE IS ISS~p AS A.M..ATT~ ~ OF INFORMATIOf Mike Jones ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H&H Insurance services, Inc. HOLDER. THIS CERTIACATE ooes NOT AMEND EXTEND OR 3160 Campus Drive, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Norcross GA 3007~ Phon8:770-409-0014 Fax:8&6-34B-8540 INSURERS AFFORDING COVERAGE NAIC# - ~1ov.r8 Ins of WausauAXV IN&URED INSuReR A. 21458 tleURER 6: ilIle&'~elll1 %at:om.t:~~ So %nJI Ventu~e ~In8eruct1on cam~any L.F. Hol ~sworth, Lie. see 1N6URER c; P.O. Box 1 5 INSURER D: Norcross GA 30091-4175 "SURER E: COVERAGES THE POL-ICIES OF IlliSURANCE LISTED BELOW HAilE SEEN Issueo TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONr~ACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSuRANCE AFFORDED BY TI'1E pO~lc,es oeSCRl8EO IiEREIN IS SuBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE ~IMITs Sl10WN MAV HAVE aEEN REDUCED BY PAID CLAIMS, _.~. -..._~ -1~~f~E p~~ L'fR HlSR '1YPE OP INSURANCE POUC::Y NUM8li" LIMITS ~aw.I..lAlllLlrr fACIot OCCURRENCE S 1,000,000 A ..!... bOMMERClAL CilENEAAl. UAlllUTY TBC-Z91-S27104-136 11/01/06 11/01/07 PRE,;fe':1~.1 s 250,000 - ClAIMS MADE [!] OCCUR MEt! EXP (Any 011O pmon) I . 5 ,_ill..- - PERSONAL & ADV NURY 11,000,000 - GENeAAl. "GQflEGAll!: $2,000,000 ~lLAGCilRiil" LIMIT "n PeR: PROOueTS - OOMPIOP AGO '2,000,000 POLICY X ~& LOC ~DMOElILE UAElIJTY OOMlllNEO SINGLE ~IT $1,000,000 A .!.. ANY AUTO ASC-Z91-527104-106 11/01/06 11/01/07 lEa aCCldenl) ~ AL~ OWNED /l..rTOS llOOIL Y INJURY (pa, poll\lCrl) $ - SCI1EC\,lLEC AIITOS ..!.. "I!tEO AUTOS 130ClJL Y INJuRy S X NOI\j.OW NEO AuTOS (pal _aft!) -.. - -- ....- ,-, p~mOAMA~ , (PIlI acclaoftl) ==rAGE UAlIIL/TY AUTO CNL Y - EA ACCIDENT $ ANY AUTO Oll'lER ll1AN EAACC $ AUTO CNL Y: AGO $ 5ESSlUMIlItSl.l.A I..lA8ILITV EACH OCCURRENCE 55,000,000 B X OCCuR 0 ClAl/olS MADE BE 6564461 11/01./06 U/Ol/07 ACQREaA'TC $5,000,000 S R PGouC'l'lilLe $ RElENllON $ S WOlQ(I!U ~PENl5ATlON IUIO X ITOflYLIMITS I I/,Im A llJiIPI.O'feltS' UA8tLlT'f WCC..Z91.-5~7104-1SG 11/01./06 11/01/07 500,000 ANY P~FtIl!YOAlP~exEcuil\lE E.L, EACH ACCDENT 1 OFFICERlMEMeER EXCLUDED? EoL, DlSEASE - EA EMPLOve S 500,000 ~~c.~~~~~S 11Io_ E.L. DISEASE. POLICY LIMIT 11.000.000 OTHER DESCRIPTION Of OPERAllClNS I LOCATIONS I VEHICLE& I EXCLU8lON$ APDED BY' ENDOA&EMENT I SPEl;lAL p~ Contraotor Registration CERTIFICATE HOLDER City of Zepbyrh1118 Building Departmen~ 5335 9th St zephyrh111a PL 33542 CANCELLATION ZEPHYRH SMOULD MY OF THE A8O\/E DESCRIBED POLICIES lIE CANCELLeD IIE!F'" THE SCfllAA DATE THEREOF, THE IRUINC INSUREiR WILL EN06AVOR TO MAIL ~ DAY.!s WRITTI!N NOTICE TO THE ceRTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 10 811ALL IMf>O&E NO OIIUGATlON OR UASIUTY OF Nt'( KIND UPON THE INSURER, ITa AGENTS OR REPRnENTAllVEa. 1IIi&1' @ACORD CORPORATION 1988 ACORD 25 (2001/08) 0 c::i gg ~ 0 Z ~ U g <:I a: ~ r--: ~ 0 U) CICl "=" z ID8 'C"" I!! I&l 0 c i~ U tOed c ~ w '.... 0::: .. ~ ~ "" l: C :::l ~.... f1 :::l ~ '" MO en W (9)~ t/) ~ '- ~ C.... W -12 ~ 0"" ~8 a.. u:$ % Cl::N )( W >-~.... 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REGTJI.ATION CONSTRUCTION INDUSTRY LICENSING SOARD . 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 (850) 487-1395 JUL 1 4 2006 HOLLINGSWORTBL LE~OY F VENTURE CONSTKt1CTION' COHPANY PO BOX 417S NORCROSS GA 30091 I "II' ~ "'!)', ,,~~ ~,'~~ ;.'J~~.~:..._~I\':.. ~fJ.b4~~:i ;.. '&i~'~~" ::~'jo ...' --. i'i -~, 'l' ~.:ft _.... ;0 """,",' ':wi~' /. 'J ~RO.-;_ ' ,.:i_ li.a-Iu,L'l',:;: '~', ,(';:'j , J,\ ..-..~~'(.. .,.. - , '. '~.1" '\~' ,;" ~fJf ~,~~,.~...,. .-:., '.r":~ '-Sl.~,~. CGc0092S6 ' .- ' 01/rHS!06, OS08:U2'il ~~. ,"~. ". . , ':;;<i.' '"\\"." . :\ - :.:. ~J "";=:~:~ : -. ,~-, . .' .~;i;'? ..... If' ;;: .~'~-' ". .""'" ......-;...... '--....""~, :~'!. ~ _. " Btt 'lreift~ CO.n:.IC.6~-u1f.: < .~,;. ;'. . SWO"'- ~O:Y'" ;'; '~r ';!~~';: ., J . ..., , .."D, #I ,_ ,.,,_. 'r:..~., ' ',q~~01IS,..Rvc:t O. C~An-"'~ ," ,....':_... .'_.....::,. .to. \oj: .',. . : ~ . .... . .?~ -. ~" . - .,~.:':-:xS.~i'I~'.~ C.1I ,~:l... ~ 0.".;89 n. '.,~e:i.w'ke./AUCH31i'20;0'8 . "'~GO'O:i=OOG~" . " . ~ . . ~', DETACH HERE '~ ,~6:'43'9S'~S . " ;':,~~,.~~r~~~h~L~.IIrA: PEPAR'lS!tt a~ S~~ PWJ_S:r.ONAL REGl1LATION ',~~S't~C:~'O~~ ,.RY'1~t~t:EN$.ING BOUD SEQ#L0607060063ti ~:'..: 'I:,..,::~p;.~ ?-::a:': ~-:_::j~. ~t:.~. -. LICENSE NBR , '.o7?;:d6' ,:~aQ6. ':;"~0S..1:it2:31 ~f tG~ijo-8i"fi~ " , '111e.c~~.;c~dQlr;i'f: :"~\-; ?" ,;iName(t,.b~!'low :tS'''cBRTI:fUD : ' :UDder 'the provisions 'cil Chapter 489 FS. E.~ir~tion dat.e:. AUG 31" 20Q~ . ,:;?9: .-~~.~,...): /. :',;' '. .. . ~' \ L"l. . " ,'~ " "" I ',I; '':.'', ~ ~,.~HOL~GS.wom, LEROY F . "~~'" CONST~UCT:ION (!OMPANY.... PO BOX 4175 NORCROSS GA 30~~~ "-<,t -::' . :~.~' ~~:ti::" .i1t!l:\ "'TT~'R .~..:~ ~ &.:.", ~~~ .>, .I.,.~~~' :/ ' Z9L-, vO/VO'd 60L-l EI86lvvOLL+ S:IMONE MARSTILLER 'd~OJ'lSNOJ 3~nlN3^-WOJ, WdIS:ZI LO-9Z-l~O ,=:t=: : :',e,T{eHh NiHians 7EPHYRHU_LS FiRE DEPARTMENT 3907 ':air/ .=oac, Zephyrhills, ,=L 3354,2 eus ,3-;3; -3C-')~J.' -'i;(,;3A Ji-:I:-'~04.. FIRE SERVICE USER FEES Occupancy No.: Plan No.: 0 ~ ~ ;: Business Name: ~~,. ~ Business Address: ~A'7"l' Business Phone No.: Business Fax No.: Contact: PLAN REVIEW FEES ~Site Plan N/C fJ.J, Multi-Family/Commercial.06 sf Minimum Charge $25,00 o Plan Revisions DBL SPRINKLER SYSTEMS B 0 - 25 Heads $50 26 plus Heads $100 STANDPIPE SYSTEM o Per Riser $50 FIRE PUMP o Per Pump FIRE ALARM SYSTEM B 0 - 25 Devices $50 26 plus Devices $100 SUPPRESSION SYSTEMS BE : Brnh~ $50 KITCHEN EXHAUST o Hood/Ducts OTHER B LP Installation per tank Fuel Tank Installation (Per Tank) o Natural Gas Installation (Per System) o Spray Booth Comments: $50 $50 $50 $50 INSPECTION FEES N/C N/C $100 $250 $500 $100 FIRE ALARM SYSTEM B System Acceptance $50 Recall Acceptance $50 OTHER ~ Fire Wall/Smoke Wall LP Gas Natural Gas per system per system $15 $25 $25 per wall per tank per system Contractor: Billing Address: Billing Phone No.: - / Billing Fax No.: ~kA Contact: -Yu...11eJk,'( PERMIT FEE $50 $50 $50 $50 $50 $50 $50 Fl;lel Tanks- pertank $50 $100 $500 $25 $100 $50 $50 $25 $50 $50 $100 150 Sprinkler Standpipes Fire Pump Hoods Fire Alarm LP Gas Natural Gas Sparklers Fire Works Camp Fire Controlled Bum Hood/Duct Place of Assembly Fire Protection Flammable Application Waste Tire Storage Generator < I<JN Generator :>30 I<JN FALSE ALARM FEE 1 st Alarm NlC 2nd Alarm N/C 3rd Alarm N/C 4th Alarm $100 5th Alarm $150 6th Alarm $200 NON COMPLIANCE $150 Annual Annual Annual Bio-Hazard Waste $100 Annual Fumigation Tenting $50 Torch Pot/Applied $50 Haz. Materials $100 Annual B PERMIT TOTALL I l ~. ~ I FALSE ALARM TOTAL I I L--________.......J $50 ~ Tent 1 0'x1 O' or greater Fire Pump Fire Suppression System Acceptance B Exhaust Hood/Duct Re-inspection (other than annual) $50 0 Inspection scheduled DSL and cancelled less than 24 hours B Construction Insp. N/C Em~gency Vehicle Ao $50 PLANS TOTALj J INSPECTION TOTALC] r :t6 ~ GRAND TOTAL Annual 1 st Re-inspection 2nd Re-inspection 3rd Re-inspection 4th Re-Inspection (Business closed until violations corrected) SPRINKLER SYSTEMS ~ Hydro Undergrounds $45 Hydrostatic Test $65 Acceptance Test $45 Hydrant Flow $75 $15 $45 $30 per tent $30 DBL Date: /1/~/d-7 Ins~ctor: ,~r/7 &' rfi'J:-~ City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Restaurant (A) Conventional No. of Seats Impact Fees For Type A Within City Limits Outside City Limits Water Distribution System l $ 1,282.00 $ 1,602.50 Wagt8wat8r C'oIl8<,tiop <>yiHtI+l N tr ~1.g--1<:S- -2,516.8l $ 3,221.02 Wastewater Treatment Plant Capacity $ 1,443.18 $ 1,803.98 TOTAL $ e'6,362.aa $ 6,627.50 ~/17":i. l~ (B) Fast Food/Drive Through No. of Seats Impact Fees For Type B Within City Limits $ $ $ $ Water Distribution System Wastewater Collection System Wastewater Treatment Plant Capacity TOTAL Outside City Limits $ $ $ $ (C) Deli/Sandwich Shop with no dishwasher and disposable dinnerware only No. of Seats Impact Fees For Type C Within City Limits $ $ $ $ Water Distribution System Wastewater Collection System Wastewater Treatment Plant Capacity TOTAL Outside City Limits $ $ $ $ (D) Bakery No. of Square Feet Impact Fees For Type D Within City Limits $ $ $ $ Water Distribution System Wastewater Collection System Wastewater Treatment Plant Capacity TOTAL Outside City Limits $ $ $ $