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Home My WebLink About07-7312 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7312 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 7312 RE-ROOF ROOF REPLACEMENT NOT APPLICABLE Address: 38233 DAUGHTERY RD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 35-25-21-0010-12300-0000 123,482.00 552.00 552.00 12/13/2007 REROOF & TEAR OFF ADVENTIST HEALTH YSTEM 7050 GALL BLVD ZEPHYRHILL FL 33541 Phone: 813 783-6189 ~ ",ec.k& 1-'1 -O~ lCsv-- NR TAPE JOINTS ROOF INSP FINAL REINSPECTlON 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 your notice of commencement." k~~ CONTRACTOR S NATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department Fax-813-780-0021 Date Received stc:-rn 5L1nb.. 1+ 7e.f'h'l rl..d Is I f-: L Owner Phone Number I Owner Phone Number I JOB ADDRESS Fee Simple Titleholder Address I !.:3'il;l. :~3 I NEW CONSTR INSTALL D a lA 4~) t~.".'1 . I B D D 'V- r-e-- Y--oc...> +- Rc~ I Zephy rh I /13 I r:-L PARCEL ID# I LOT # SUBDIVISION WORK PROPOSED B D D I ~c\r 0 r-~ I SFR ADD/ALT REPAIR COMM (OBTAINED FROM PROPERTY TAX NOTICE) D SIGN D MOVE D DEMOLISH D OTHER I D STEEL D OTHER I PROPOSED USE TYPE OF CONSTRUCTION BLOCK FRAME DESCRIPTION OF WORK SQ FOOTAGE I HEIGHT I BUILDING SIZE 1$ 1$ 1$ 1$ o GAS D FINISHED FLOOR ELEVATIONS I 0 BUILDING 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL ROOFING I I I I D I AMP SERVICE D PROGRESS ENERGY D W.R.E.C. VALUATION OF TOTAL CONSTRUCTION VALUATION OF MECHANICAL INSTALLATION SPECIALTY D FLOOD ZONE AREA OTHER DYES DNO COMPANY I REGISTERED ~ FEE CURRENT L..Y.0::U License # I COMPANY I REGISTERED ~ FEE CURRENT L..Y.0::U License # I COMPANY I REGISTERED ~ FEE CURRENT L..Y.0::U License # I COMPANY I REGISTERED ~ FEE CURRENT L..Y.0::U License # I I I~~~ WvrkS I Y / N FEE CURRENT ~ License # ICa..eoWIJSJ I BUILDER SIGNATURE Address ELECTRICIAN I SIGNATURE . Address I PLUMBER I SIGNATURE , Address MECHANICAL I SIGNATURE Address OTHER SIGNATURE Address RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permittor new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ 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. COMMERCIAL SIGN PERMIT Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Driveways-Not over Counter if on public roadways..needs ROW Fences (PloUSurvey/Footage) 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 Section 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 responsibie. 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 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 aiso 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 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, 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. 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 "A" 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 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 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 RECORDING YO NOTI OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT Subscribed and sworn to (or affirmed) before me this by Who is/are personally known to me or has/have produced as identification. Notary Public Commission No. Name of Notary typed. printed or stamped Pasco County Parcel: 35-25-21-0010-12300-0000001 Page 1 of2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Parcel Cards: 1 I .2 I .3. I .4 I .5 I Q I Z Other Agency Data: T1t'" CollectQ[ School Board Supervisor of E:le~tLQn.s Data Current as Of: Weekly Archive - Friday, December 07, 2007 ParcellD 35-25-21-0010-12300-0000 (Card: 001 of 007) Classification 19 - Professional Service Building Mailing Address Assessment (totals) ADVENTIST HEALTH SYSTEM Ag Land $0 SUNBELT HEALTH CORPORATION Land $252,384 7050 GALL BLVD Building $802,076 ZEPHYRHILLS, FL 335411347 Physical Address Extra Features $4,701 38233 DAUGHTERY RD Total Assessment $1,059,161 ZEPHYRHILLS, FL 33540-1400 Save Our Homes $0 Legal Description (First 4 Lines) ZEPHYRHILLS COLONY COMPANY Taxable Value $0 LANDS PB 1 PG 56 E 60.00 FT OF S 200.00 FT TRACT 122 & W 345.60 FT OF S 200.00 FT M Land Detail (Card: 001 of 007) Use Description I Zoning II Units II Type II Price I Co1H Value 1900 PROF.BLDG I OOOP 1112,000.00 II SF I $5.17 1 $62,040 1900 PROF.BLDG ~38'000.00 SF $2.86 1.00 $108EJ/ I 3 II 1900 II PROF.BLOG I 37,120.nn ~F $2.20 1.00 II $81,6 Additional Land Information I Acres " 2.00 II Tax Area II 30Zt-! " FEMA Code ICL]CQmmerical cOd~11 J'1~ Building Information - Use 19 - Offices Professional or Medical (Card: 001 of 007) Year Built 1985 Stories 1.0 Exterior Wall 1 Common Brick Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 Line I Description I Sq. Feet I Repl. Cost Ne 1 I AOF 1 1,100 $115,500 2 CAN 224 I $7,035 I 3 UST 300 $12,600 4 FDC 1,731 $72,660 Extra Features (Card: 001 of 007) I Line I Description Year Units Value I 1 I PAV ASP 1985 21,313 $4,316 I 2 I Pc:fEN_CE 1985 1,030 $385 Sales History Previous Owner KAUFMAN STUART] Year Month Book/Page II Type Amount 1999 09 4256 / 0033 II WD $400,000 I I http://appraiser.pascogov.comlsearchlparce1.aspx?sec=35&twn=25&mg=21 &sbb=OO 10&... 12/13/2007 1111I1111111111111111I11111111111111111111111111111111111111 2007202865 Rcpl: 1148121 DS: 0.00 12/13/07 Rec : 10 . 00 IT: 0,00 Dpty Clerk NOTICE OF COMMENCEMENT JED PITTMANA PASCO COUNTY CLERK 12/13/07 0~:02pm 1 of 1 OR BK 7713 PG 473 Permit No. R PropertyldentificatiooNo.35"-.;J..~--.?-1 - 0010 -lr300 - 0 C> 0 0 11:IE UNDERSIGNED hereby give informa you that the improvement win he made to certain rea1 property, and in accordance with Section 713.13 of the Florida Statutes, the following inforlnation is provided in this NOTICE OF COMMENCEMENT. l.Description of property (/q;rI dercr(ptiolf:) Ze r h ,'/Is C:.lo,", La roI So' PB I f'; '5(., c W t=:-T a) SlreetAddres&; ;;L 33 h... L- 3 3S"""K; .- 00 2.0eneral description of iDJRIYvemenlB: "-~rt?Jf+ '+- re- rva;- 3.Owncr:=~address: AoIvie.nfl:::+ Ifev...~ S'l&~-1?'\ 5U....bJ f- Ht'bO-N., Cor", 70SD ~II P:>lv.J-. I b) Name m.w address offee simple tideholder{ifother than owner) zeF*''frl'lI I 5./ t::-C c) Interest ID propelty 4.Contraetor Information L ...I' L A. .. a)Namcandaddress;~~ l.Vor1".S Vb -r;;~~""-r ioftlYl N. ~e..h>'Gf.s~ ~I 1c.rt'>\FI I-:L b) Telephone No.; ~ 3- ",1-/"7t)O Fax. No. (Opt) .33~1f S.Surety Infurmation a) Name and address: b) Amount of Bond: c) Telephone No.: Fax. No. (Opt) 6.Lender a) Name and address; Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documenlB may be served; a) Name and address; b) Telephone No.; Fax. No. (Opt) 8.In additiOn to himself; owner designates the following pcn;on to receive a copy oflbe Uenor's Notice 88 provided in Section 713.!3(1)(b). F1oridaStatules: . a) Name and address: b) Telephone No.: Fax. No. (Opt) 9.F.xpiration date of Notice of CoJJlJllCll1CClllt (the expiration date is one year rrom the dale of recording unless a different dale is specified); WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER TIlE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATf1rES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPJ:JnY. A NOTICE OF' COMMENCEMENT MUST BE RECORDED AND POSTED ON TIlE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATI'ORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF OMMENCEMENT. STATEOIPPLORJDA COUNTY OIP PASCO 7?'"-cro Print rw- Thefonoaoigg instrument was ac1awwledged heforemetbis ,:)."Ot day of PG:C. ,20"", by ~Ic:. """ fl.O By~";L.D as DIAeC'fol't c.F F'l.AN-r iOeR"'IC.€:~typeofauthority.e.g.officer,lru8lee,attomey in fact) fur t== L-U~P.4 \,\os.fl>. 'Zef'I-I'Ifl:HI Lt. S (name ofparty on hehalfofwhom instrument was executed). Pcnonally Known -6R Produced Identification _ Notary Signature ~ ~ w.....u Type ofldentification Produced Name (print) ~~""BERl-'{ ~ ~I"'\... Verification pursuant to Section 92.S25, Florida Statules. Under penalties ofpeljury,! declare ' the facts staled in it are true to the best of my knowledge and belief. read the foregoing and that ~ KIMBERLY JO HIll MY COMMISSION' DO 338717 . EXPJAES:July 19, 200ll '~TMI NQlliyPllbli: lJrJdeJwrtIn STATE OF FLORIDA COUNTY OF PASCO . THIS IS TO CERTIFY THAT THE foREGOING ISA.. TRUE AND. CORRECT COPy OF THEPOCUMENT ON Fli$. , . OR OF PUClLlC RECORD IN THISOFf...........~.'.c 2...;.W.,..I.T...NE......SS.....:...:.:.:.M........v......... < . H NDOFFICIA SEAL1HtS.......... DAYOf 1cQ .... .......... J AN, C OF CIR~ BY , DEPUTY CLERK LI~TEDPO~ROFATTORNEY ~C- /3j docy1 DATE I hereby name and appoint ~o ro I Yo '1 h-i?.S' Of GENERAL WORKS, LLC to be my lawful attorney in fact to act for me and apply to LI't-V[ of,; Zefhirh)'ILs For a ROOFING PERMIT for work to be performed at a location described as PARCEL # 35- d-5 -~I - C)D Ie) - )~~(..)()_ ODc'J I LEGAL ADDRESS FOR JOB 6S'~?> "?::>~LI~h+--ev1 ~" LeFh\frhl \\s, l---L OWNER OF PROPERTY AND ADDRESS (r,IVC"-1'""I+i's} H~CL 1+1. S-(s4efY) &t h b.1+ }.-f ~c<.l+h Cor . -'JDsu ~a II 131 v.A h f h ]'.11 F=--L ~3 '5 If- Acknowledged: Sworn to and subscribed before me this I 2::>..ft-, day of .~ A.D. 200'1 who is personally known to meLwho produced as identification and who did not take oath. State of Florida County of HI) Is hvv,:,j), (seal) (1~a~ NOTARY PUBIJC-STATE OF FLORIDA ~"""""" Carol A. Haynes ~W kommission #00691780 ~!111'..~ Expires: AUG. 19, 2011 BoimiiD THRU ATLANTIC BONDING CO" INC. .... GENERAL WORKS OF TAMPA, LLC A1EI:TM\tItERlCA IDMPAIUY 6809 North Nebraska Ave. Tampa, FL 33604 Office: 813-621-1700 www.gwtroofing.com Fax: 813-621-1861 Date: December 10, 2007 Proposal No: STR-071210-01 Re: Florida Hospital Building M Dimensional Shingle Roof To: Florida Hospital Attn: Rick Byfield ,aS1€) Six FOI~ R'Oad ~~ <~~ 3 b0\~:Jh}~"'1 ~. Zephyrhills, FL. 33540 General Works of Tampa LLC, hereinafter referred to as "Contractor", proposes to furnish and apply all labor and materials with the necessary tools and equipment to complete the following work according to specifications for "Owner" - Owner shall be deemed as the party that General Works of Tampa LLC has contracted with (i.e. Owner, Owner's Agent, etc.); This proposal represents a replacement of the existing roof system and is further defined as: Building M Roofing System representing tear-off and installation of a dimensional shingle and trim, Scope of Work: Dimensional ShinQle roof system: · Remove the existing asphalt shingle roof system and dispose of debris in a certified landfill. · Inspect the entire roof deck for signs of damage and or degradation due to moisture infiltration or dry rot. · Furnish and install pressure sensitive "Ice and Water" Shield under layment over the entire field of the roof system in excess of building code. · Provide and install new Dimensional shingles (black in color as directed by owner) in accordance with Florida code and Manufacturer's specifications. · Remove existing Fascia (approx 1200sf.) and dispose of off-site. · Provide and install new flat-stock fascia w jrib (see diagram per SMACNA specification) to previous locations (Color to be selected by owner from standard Kynar colors). · Provide and install new soffit panels (approx 3580sf) to perimeter (all low areas identified at walkthrough on 12-5-07) using existing vents ( Almond color selected by owner). · Trim in existing vents with new metal tie-ins. · Remove and replace existing gutters with new gutters (color to match fascia). · Replace existing downspouts with new (color to match fascia/gutters). · All work to be completed in accordance with NRCA and SMACNA guidelines to meet and/ or exceed local building codes. QUAL/FICA TlONs/ExCLUS/ONS -General Works of Tampa 2-year Contractor's Warranty is included in this proposal. -Manufacturer's shingle warranty is included in this proposal. .Permits are included in this proposal. -Lawn Restoration is not included in this proposal. .AlI products utilized in this project will be sufficient to meet or exceed local building codes, and carry a Florida Product Approval Number. -Repair of Roof decking is not included in this proposal, and will be performed at an additional charge of $5.17 per square foot. -All OSHA regulations and protocols are to be strictly adhered to through out the entire course of the project. -This proposal includes all state, county and city sales tax if applicable. -Owner shall be responsible to verify the building's structural capacity to bear the weight of this roof system. -Our price stated in this contract proposal is based upon current material prices. Because of raw material price volatility, including the price of oil, our material suppliers are unable to provide us with price protection for the materials included within this proposal. Accordingly, should our material prices increase during the term of this proposal, and during the time of performance of work contemplated by this proposal, our price for performance of the work contemplated by this proposal shall be increased by such direct material cost increases. Base Bid (One Buildina 190 SQuares of roofina): Two Hundred Twenty-Three Thousand Four Hundred Eighty-Two and no/100 Dollars ($123,482.00) TERMS: Owner/Contractor agree that all payments required under this contract shall be due and payable within 20 days of date of invoice whether billing is for job preparation, material stored, work completed each month or final payment request. Owner further agrees that contractor may charge interest at the annual rate of eighteen percent (18%), unless a lesser percentage is required by law on any sum due under this contract which is not paid within thirty (30) days of invoice date, If payments are not made when due. interest. costs incidental to collection and attorneys' fees (if an attorney is retained for collection) shall be added to the unpaid balance, Contractor reserves the right, without penalty from Owner, to stop work on the project if Owner does not make payments to Contractor when due, Owner hereby releases contractor of notice requirements for lien rights in the event payments are not made when due as outlined in this paragraph, We may withdraw this proposal if not accepted within Thirty (30) days, This proposal has been prepared and submitted by: Steve Rajavich Please call if you have any questions on this proposal. Direct #: 813-477-7650 SUBMITTED BY: General Works of Tampa: ACCEPTED BY: OWNER: Steve Raiavich. Proiect Manaaer By: Under the direction of: Kevin Palmer, Vice President License # CCC048181 (if applicable) Title: Please sign and return via fax for scheduling: 813-621-1861 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 (850) 487-1395 CUTRONA, JERRY MICHAEL GENERAL WORKS LLC POBOX 740708 ORANGE CITY FL 32774-0708 'Y!W2;~~tl\Jlltli,t~ C'~C~~OH~a~'7/~'W C5~.~@O~1~~3" DETACH HERE .,S']rs~~~~~i1F~~t~~. ','.. ~._. >:~~,~.)~"~},,... .- '-.~-~:~~..:f ;:~~.:~~ ;. __:.~!: ~ " i~.--~ .~:;_:"~:~ . ::::-2~?' ~ -~~;-~. "~':i:~} ~ ,~\~::r~~;j'"~\~- ...~~~~,~ .r.," ,SIMONE MARSTILLEB. ;';c . SECRETARY , 'i'td~i'O'S:~b~(t'i;'81fi16'1~,~~lfii~i~>!i"i11E ;~"~]~~~~R~~~~f:;::g~~t~~i}~~~:, " __ ~_,_ ,,~. -. Und~r t~e pro'\ri,si6ns':'9f.:q_11~~~'~~',-(' -~-,~ :~~:;::';o.:::l~r~::J~:f,';~:~!~::i~P:, ,~~: :", GENERAL WORKS LLC , " ",,:,<,~:,c~~ ('.:' ,c:-:.,.:,,,.. _~',~,".;:.:, " 123 NORTH INDUSTRIA~ 'DRIVE ,:", -~~~,('':0;::':i~~~'~ V.';':, :~,?~':~r,~;", ': ORANGE CITY , ;PI.: ;,32~~::;:.:-l'",. ~~:;',i:,~,:-:.'P~t"~"-'~I~~::" ~'~: :'1 > JEB BUSH' ;~~ (~il~~vrt~~lff&~~;r'( GOVERNOR . nLQ.pIA.Y'A'C:Ri::hFlI:oi::'n !:Iv I 1'1 1M CERTIFICA TE OF INSURANCE Date: (MM/DD/YY) 12/11/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lockton Companies, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5847 San Felipe, Suite 320 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Houston, Texas 77057 AI TER THE ~nvFRAr.:E AF THE POUCIES BRnw INSURERS AFFORDING COVERAGE INSURED: Insurer A: Liberty Mutual Fire Insurance Company General Works ofTampa. LLC Insurer 8: National Union Fire Ins Co Pittsburgh PA a Tecla America Co, LlC In!'::urer C: Liberty Insurance Corp. 6809 North Nebraska Avenue Insurer 0: Tampa, FL 33604 Insurer E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWlTHSTANDING 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 BE EXHAUSTED BY PAID CLAIMS, INSR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE EXP1RAnON LIMITS LTR DATE GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMeRCiAl GENERAL LIABILITY TB2-641-435487 -277 02/01/2007 02128/08 FIRE DAMAGE (ANYONEFIREI $ 1,000,000 X OCCURRENCE MED EXP (PER PERSON) $ 10,000 X XCUINClUDED PERSONAL & ADV INJURY $ 1,000,000 X BROAD FORM PROPERTY GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS/COMP, OP. AGG $ 4,000,000 X PROJECT Policy Aggregate $ 20,000,000 X LOCATION AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 AS2-641-435487-287 02/01/2007 02128/08 EACH ACCIDENTl A X ANY AUTO BODilY INJURY - PER PERSON $ X ALL OWNED AUTOS BODILY INJURY - PER ACCIDENT $ SCHEDULED AUTOS PROPERTY DAMAGE - PER $ ACCIDENT X HIRED AUTOS DEDUCTIBlE/COLl & OTHER $ 1,000 THAN COLLISION X NON-OWNED AUTOS X AUTO PHYSICAL DAMAGE EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000 8 X OCCURRENCE BE 5684381 02/28/2007 02/28/08 AGGREGATE $ 5,000,000 X RETENTION $ 10.000 PROD/COMP OPS AGG, $ 5,000,000 WORKERS' COMPENSATION WORKERS' COMPENSATION STATUTORY C and EMPLOYERS LIABILITY WA7-64D-4354B7-267 (AOS) 02101/2007 02/28/08 El EACH ACCIDENT $ 1,000,000 C WC7-641-4354B7-297 (WI & OR) 02101/2007 02/28/08 EL DISEASE-EA EMPLOYEE $ 1,000,000 EL DISEASE-POLICY LIMIT $ 1,000,000 REMARKS: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXClUSIONS ADDED BY ENDORSEMENT PROVISIONS: C~6~ [8J BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON All POLICIES WHERE REQUIREO BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. [8J CERTIFICATE HOLDER IS NAMED AS AN ADDfTlONAllNSURED (EXCEPT FOR WORKERS' COMP/El) WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER: CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABiliTY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, 'EXCEPT 10 DAYS NOTICE FOR NON.PAYMENT City of Zephyrills 5535 8th Street AUTHORIZED REPRESENTATIVE ~-~~ Zephyrhills, FL 33542 Receipt # 2008011581 1 Control No, 005079 For Period Commencing JULY 1ST, 2007 I' 2008 and ending September 30, $183.63 I 07/27/2007 I Total: Dated Application No, This Business Tax Receipt does not permit the holder to operate in violation of any City Law or Ordinance including, but not limited to, Zoning and other land use regulations, If in doubt, the holder should verify that he or she has the appropriate zoning by calling the Office of Land Development Coordination at 274-8405. This Business Tax Receipt must be conspicuously posted in place of business, Classification Description Amount 993000 38222 ADMIN HANDLING FEE ROOFING CONTR/CERT & REG 10.00 2008 173.63 CITY OF TAMPA TAX RECEIPT C i t,y I) f T.:lillP,:l C ash i~V;m'!rSS ~Uillt 1570520 T(~ns 201~~6 7,~27/2007 2: 13: n rnN~JYd Ui Tr.~n Tot.=ll $i:33 63 T.ax $0.00 Cash $0.00 Chec ': $183.63 Credi t C,:lf,j $0, II) 8LS BUS HlESS LI H1SE COmROL# 005079 By: MCF Business Name and Address JERRY CUTRONA 6809 N NEBRASKA AVE TAMPA FL 33604 Business Name and Location GENERAL WORKS OF TAMPA LLC 6809 N NEBRASKA AVE TAMPA FL 33604