HomeMy WebLinkAbout08-7608
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7608
ermlt Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
7608
AOOITION/AL TERATION
434-AOO/AL T RESIOENTIAL
NOT APPLICABLE
Address: 39036 6 H A V
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: ZEPHYR HEIGHTS
Parcel Number: 12-26-21-0030-00100-0320
629.00
52.50
52.50
3/12/2008
REPLACE GARAGE OOOR
SILO, ANOREW &
39036 6TH AVE
ZEPHYRHILLS, FL. 33542
Phone: 813788-5370
~~ D~
'f1' ~IV
M INSULATION CEILING
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
befo rding your notice of commencement."
CONTRACTO S NATURE PERMITOFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7608
Permit Number: 7608
Permit Type: ADOITION/AL TERATION
Class of Work: 434-AOO/AL T RESIOENTIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 629.00
Date Issued:
Total Fees: 52.50
Amount Paid:
Date Paid:
Work Desc: REPLACE GARAGE OOOR
Address: 39036 6TH A
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: ZEPHYR HEIGHTS
Parcel Number: 12-26-21-0030-00100-0320
Phone:
I
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 your notice of commencement."
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner:
i1J re oj lSi; /0
3~/o-utJ
3q()3~ fo~ ~
lepla.ce <QAr~ ~
Date Received:
Site:
Permit Type:
Approved wino commentsi Approved withe below comments: 0 Denied wIthe below comments: 0
t with the permit and/or plans.
.0- {( ~lf8
er
Date
Contractor and/or Homeowner
(Required when comments are present)
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Receiv~d
'1~O~
Fee Simple Titleholder Name
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
-Owner's Name
_ Owner's Address
-0
Fee Simple Titleholder Address I
rO:tP Mil fJt/E ~1wRh;/k J R, I LOY" I 62--
tU-f ~~.... ~'6D tt:i5l1 PARCEll"" I /::(-%4./- OW-DD IDO -IJ3,J.O
(OST AINED FROM PROPERTY TAX NOTICE)
B ~S~~~NSTR ~ ~~g~~T D SIGN D MOVE D
.- PROPOSED USE ozr SFR D ,COMM D OTHER I
TYPE OF CONSTRUCTION D BLOCK D FRAME D STEEL D
-- DESCRIPTION OF WORK I ;(cpCA.C-6 6A~;r(S dOOR
I CJJo ,-/{tt) I -SQFOOTAGEI
11..111...11..'111...11..."..11..111....111...11.....11.'11..11...111""11........."1'.'......,.'."...,.111,........11.......1111111111'1111...
1$ 6;L 11 DO
o ELECTRICAL 1$
o PLUMBING 1$
o MECHANICAL 1$
C]GAS D
FINISHED FLOOR ELEVATIONS I
_JOB ADDRESS
SUBDIVISION
-- WORK PROPOSED
DEMOLISH
OTHER I
BUILDING SIZE
HEIGHT I
ROOFING
I
I
I
I
D
I
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C
BUILDING
VALUATION OF TOTAL CONSTRUCTION
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
BUILDER
SIGNATURE
COMPANY
REGISTERED
~f ~ Q1AJJ.1 e h /
Y I N I FEE CURRENT
Y/N
Address
License #
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y I N FEE CURRENT
License #
Y I N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
111111111111111 1111I1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111111
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge projects
COMMERCIAL 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 wI Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111I
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A1C 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 AlC Fences (PloUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions. .
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing 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 responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new 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 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 government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress 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 Officia~ for a period not t~ exceed nin~ty \90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the,.}ob 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 YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.~.03)JJ /..' . ' J .LL.'
OWNER OR AGEN~/ t((' 8&d;n CONTRACTOR
SUlI""""" end ..,.n. "I ("':'filnned) efore m~ >>>" Sub.crlbed end owom In (,,,mnned) be."e mo thl.
.3::itJ -0 p) by~tirz.E/ ,~ #1 "C;::TJLc, by
Who is/are personally known to me or haslhave produced Who Is/are personally known to me or has/have produced
( I 'r ~ as Identification. as identification.
tary Public
Notary Public
Commission No.
"':~ SOOES
,
Name of Notary typed, printed or stamped
WORK ORDER
PARKER DOORS
1918 Overview Drive
New Port Richey, FL 34655
Ph: (727) 938-6315
Ph: (727) 376-8977
F (727) 938 1849
S52312-GQS
Prelim: 03/07/2008 - First
ax: - I 03/06/2008 I
B J
0
I ANDREW STILO B STILO, ANDREW
L
L 39036-6TH AVE N 39036-6TH AVE
T ZEPHYRHILLS FL 33542 A 12-26-21-0030-00100-0320-COUNTY
M
0 E ZEPHYRHILLS FL 33542
TELEPHONE: (813) 788-5370 TELEPHONE: (813) 788-5370
CALLED IN BY: CONTACT:
WORK, REQUESTED QTY CODE DESCRIPTION PRICE AMOUNT
9 X 7 MODEL 73 W/4 SOLID WHITE 1 MODEL73 9 X 7 MODEL 73 W/4 $545.00 $545.00
1 LHR LOW HEADROOM TRAC $60.00 $60.00
LOW HEAD ROOM . HEADER HEADER , $24.00 , $24.00
--
HEADER
CUST. TO PULL PERMIT
DESCRIPTION OF WORK
TEC.,'CIAN'S RECOMMENDATIONS MATERIALS $629.00
TRIP 1 DATE:
TRIP 1 TIME IN: DISCOUNT $0.00
TRIP 1 TIME OUT:
TRIP 2 DATE: LABOR $0.00
AUTHORIZATION TO ORDER REPLACEMENT PARTS TRIP 2 TIME IN:
TRIP 2 TIME OUT: TAX $0.00
SIGNATUR~ PI;IINTI\I6.Ul:
WORK COMPLETED SATISFACTORY DATE CALL TAKEN BY: MOREIRA Miscellan $0.00
X TERMS I PLEASE PAY
C.O.D. THIS AMOUNT $629.00
SIGNATURE
CUSTOMER PO #
DATE
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Pasco County Parcel: 12-26-21-0030-00100-0320001
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: Weekly Archive - Saturday, March 08, 2008
Parcel ~D 12-26-21-0030-00100-0320 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Assessment (totals)
STILO ANDREW M & BEVERLEY J Ag Land $0
39036 6TH AVE Land $19,950
ZEPHYRHILLS, FL 335424527 Building $62,862
Physical Address Extra Features $580
39036 6TH AVE
ZEPHYRHILLS, FL 33542 Total Assessment $83,392
Save Our Homes $70,658
Legal Description (First 4 Lines) Homestead Exemption - $25,000
ZEPHYR HEIGHTS PB 5 PG 50 Taxable Value $45,658
LOT 32 BLOCK 1 Warning: A significant taxable value increase
OR 5823 PG 159 may occur when sold. Click here for details
and info. regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
I Line II Use I Descriptionll Zoning ! Un" 1~:Ejj
I 1 II 0100 II SFR II OORl II 7,000.00 I S 2.85 . . $19,950
I Additional Land Information I
Acres II 0.16 II Tax Area II 30ZH II FEMA Code IITJIResidential COde11 ZHLGLP3 I
Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1967 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block 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 Ca rpet Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line Description I Sq. Feet " Repl. Cost New I
1 BAS 936 I $68,890 I
2 FEP 120 $6,182
3 FGR 338 $9,936
4 I FOP I 60 $1,104
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 DWSWC 1973 340 $319
2 UDU-M 1991 1 $261
Sales History
Previous Owner DICKEY KENNETH M & MARION A
Year Month Book/Page tli" Amount
2004 04 5823 / 0159 I $80,000
1986 12 1567 / 1131 $35,500
Search Again Show Map Generalized Buildinq Schematic Estimate Taxes Frequently Asked Questions
http://appraiser.pascogov . comlsearchlparcel.aspx?sec= 12&twn=26&mg=21 &sbb=003 O&b... 3/10/2008
Mar 12 08 0?:43a
P ,nelJas Count~ Tax Colle ?27 562 3261
p.2
Occupational l' cenSE 5
The ~ard of Clluntv :ommissloner~ passed a resolution on 7-25-95 repealing
the requiremen: of o~ tainlng a Pinellas County occupational license.
ORDINANCE NO. 95~53
AN ORDINAI\ CE OF THE COUNTY OF PINELLAS PROVIDING FOR THE
REPEAL OF C,APTE R 1 18, ARTICLE IV, DIVISION I, SECTIONS 118-161
THROUGH 118.235 OF THE PINELLAS COUNTY CODE AND DECLARING THE
SAME NULL /. NO V( lID AND OF NO EFFECT; SUCH THAT THOSE PERSONS
REQUIRED U ~DER -HE ORDINANCE TO PAY THE COUNTY OCCUPATIONAL
LICENSE TAx AND )BTAIN A COUNTY OCCUPATIONAL LICENSE IN ORDER
TO ENGAGE jN OR -1ANAGE ANY BUSINESS; PROFESSION OR
OCCUPATIOI\ WITt- [N THE COUNTY SHALL NO LONGER BE REQUIRED TO
PAY SUCH T,oX OR lBTAIN SUCH OCCUPATIONAL liCENSE; AND
PROVIDING F OR AI' EFFECTIVE DATE.
NOW, THERE :ORE/ lE IT ORDAINED BY THE BOARD OF COUNTY
COMMISSIOI\ ERS C F PINELLAS COUNTY, FLORIDA, as follows:
Section 1. The t Cha Iter 118, Article IV, Division 1, Sections 118-161
through 118- ~35 of the PineIlas County Code is hereby repealed and
declared null :md vc id and of no effect.
Section 2, Eff ~ctive :>ate. This ordinance shall take effect September 30,
1995.
Z00l100 III
XNVdKO~ SHooa HIDnIVd
6t8T8C6LZL XVd ZT:TZ 800Z/ZT/CO
PARKER DOORS
1918-0 VER VIEW DR
NEW PORT RICHEY, FL 34655
PHONE 727-938-6315
FAX 727-938-1849
To whom it ma: ' conc, m:
MARCH 12. 2008
This is t) auth( rize the associates ofDA VID PARKER dba Parker Doors to be
able to pull anc:L or app y for a permit for the installation of a garage door. Names of
those associates as of f lis date are as follows.
DAVID PARKl~R JUSTIN PARKER
TAMMY GESS EL MARK GESSEL SHAWN PARKER
CHRISTOPHEl ~ FRY ~ KARA PARKER
This list of nanu s may :hange in the future with written permission.
SWORN ra M D SUBSCRIBED before me this
!)h/(ltf. _' 20 015 . by (b,u,'JIht/k/l./
~to me or v ho pre duced
identification and who d d take an oath.
;) day of
who i~~y)
as
Ai
NOTARY PUBLIC
My commission expires
.'" pu"<. ALLAN DORMAN
.,,:,'....... t> UYCOMMIS!;IO~IOD5829~'1
*' ~ * EXPIHES: OClor,e, c; ,'~
..~~... ac"ded'l1lru BlIllgIIt~SIlfV"'"
""~O!'fl.<1f'
(;oonoo~
ANVdKO~ SHooa HHYHVd
6t8T8C6L(;L XVd (;T:T(; 800(;I(;T/CO
I~ II, _ l'.j,
, ~-' -::;-EE~;::''''''''''~ I
I CERTIFICATE OF COMPETENCY it;!
'd.:
I't
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-OB9~'~f!!
'f'.
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;:.11
ii11
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014048
I.D.l1
Be il known that: D
f"L 34689
elt
UNC ER SEC. 18 PASCO COUNTY CODE HAS MET THE
i PRC IISIO~.EpR A CERTIFICATE OF COMPETENCY
~ ~1l\,H!;'.--""Cr.~ .
~ ~.l-""- ,::z.r-'o0"J /,... / @/J A
~... ~~~~~(.,/ .g':'~~ Q ~,olo
BUII,.l!1fj FICIAL./ DATE
.fj"~~~ ~1iiJ~If:((.~ ~ri{~PJoi'rJ.~.~'!f.Ijj~PAJlljl'':1l:1ft-liJ~1IRi'n)~-i(~jr:~J!'i;I,;l_if!/rf:r~!r)i:ij~)t;J"J_'~I~~ih 'l'._~"t':.if./rr.~~.:~:=-"-'~-. ~' '.
100 III
ANVdWO~ SHOOa HHYHVd
6t919C6L6L XVd 90:06 9006/6T/CO
Date: 3/1112008 04:48 PM
Sender's Fax 10: Barber Agency
Page 2 of 2
ACORD~ CERTIFICA TE OF LIABILITY INSURANCE OP 10 MP DATE (MMIODIYYYY I
PARKE-l 03/11/08
PRODUCER THIS CERTIFICATE IS ISSUEDASA MATTER OF INFORMATIO~
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Barber Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2321 State Road 580 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Clearwater FL 33763
Phone: 727-733-9385 Fax: 712-734-5252 INSURERS AFFORDING COVERAGE NAlC#
INSURED IN SURER A Rationwide Mutual Insurance Co
Parker Doors IN SURER 8 Bridqefield Insurance Co
28 Highland Road 34689 IN SURER C
Tarpon Springs, Florida
IN SURER D
IN SURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REOUIREMENT, 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,
LTR jN'SR[ TYPE OF INSURANCE POLICY NUMBER ~~~~1J~~E.r~!l)E P8H1:Y(~~,.b'b~~~N LIMITS
GENERAL LIAelLITY EACH OCCURRENCE $ 1,000,000
-
A ~ COMMERCiAl GENERAl LIABILITY 77AC464013-3001 04/02/07 04/02/08 PREMISES iE~'=,,~~~nce) $ 100,000
- =:J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAl. & ADV IN..tJRY $1,000,000
GENERAL AGGREGATE $2,000,000
f--
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 1,000,000
h POLICY n ~RBi n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $1,000,000
AN Y AUTO (Ea accldenl)
-
AlL OWNED AUTOS BODIL Y IN..tJRY
- $
A ~ SCHEDULED AUTOS 77BA5007270003 04/02/07 04/02/08 (Per person)
~ HIRED AUTOS BODIL Y IN..tJRY
(Per aCCident) $
~ NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per aCCIdent)
GARAGE LIABILITY AUTO ONL Y - EAACCIDENT $
R ANYAUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
=:J OCCUR o CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X ITO'Rv'LIMI'TS I IO~~
B EMPLOYERS' LIABILITY 830-34103 04/02/07 04/02/08 $ 100,000
ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT
OFF ICERIMEMBER EXCLUDED? EL, DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under $ 500,000
SPECIAl. PROVISIONS below EL DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERA TIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDEO ey ENDORSEMENT' SPECIAL PROVISIONS
Door Contractor
CERTIFICATE HOLDER
CANCELLATION
City of Zephyrhills BUilding
Dept.
5336 8th st.
Zephyrhills FL 33542
CITYZEP SHOULD Ar-f'f OF THE AeOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER IMLL ENDEAVOR TO MAIL ~ DAYS v.RITTEN
NOnCE TO THE CERnFICATE HOLDER NAMED TO TI-E LEn, BUT FAILURE TO 00 SO SHALL
IMPOSE NO oeLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTHO 0 RE
@ ACORD CORPORATION 1
ACORD 25 (2001/08)
Date: 3/1112008 04:48 PM
Fax
From:
Pages:
Date:
Subject:
Sender's Fax 10: Barber Agency
Maria Pape
2
3/11/200802:47:22 PM
cert request
To:
Fax:
Phone:
Page 1 of 2
Phone: (727) 733-9385
Fax: (727) 734-5252
cert dept
(813) 780-0021
( ) -
Message: