HomeMy WebLinkAbout08-7452
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7452
Permit Number: 7452
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 38,115.00
Date Issued:
Total Fees: 355.00
Amount Paid: 355.00
Date Paid: 2/13/2008
Work Desc: INTERIOR REMODEL FIRE DAMAGED
Address: 38349 EVERGREEN VILLAGE DR 1-9
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0010-05300-0020
Name: Z-HILLS L TD
Address: 38349 EVERGREEN VILLAGE DR 1-9
ZEPHYRHILLS, FL. 33542
Phone: 863647-1581
RICHARD J DARLING ELECTRIC INC
ON THE MARK HEATING & AlC INC
MECHANICAL FEE
35.00
(;n&
s: '2- \,- D ~
'ff
F IN
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
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7452
7452
Permit Type: ADDITION/AL TERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 38,115.00
Date Issued:
Total Fees: 355.00
Amount Paid:
Date Paid:
Work Desc: INTERIOR REMODEL FIRE DAMAGED
Address: 38349 EVERGREEN VILLAGE DR 1-9
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0010-05300-0020
Name: Z-HILLS L TD
Address: 38349 EVERGREEN VILLAGE DR 1-9
ZEPHYRHILLS, FL. 33542
Phone: 863647-1581
M ND AN
RICHARD J DARLING ELECTRIC INC
ON THE MARK HEATING & A/C INC
~~ st;J5;
Cf^
frz"'"'- /<.6 ~ 1"';0-08
F LAI
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 PERM IT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
NOTICE OF COMMENCEMEN.
111111111111111111111111111111111111I111111111111I1111111111
2008013302
Rcpt: 1157005
OS: 0.00
01/28/08
Rec : 10 . 00
IT: 0 . 00
Dpty Clerk
STA1EOF F L DR: ~ (\
COUNTY OF ~ f-\ ~ ~ U
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter
713, Florida Statutes, the following information is provided in this Notice of Commencement.
~ -'3 D
1. Description of property: (legal description of property, and street address if available) P'fl r l. "- \ t'd.. - ~<'c '::t \. D t I D{~~)D 'do/) (;:>
L.lLV\-\YQ~;\\.s, ~~hL~'f"''i to. Lf.\n.,j, p~ \l)(..-5'YV'U d')~}; I F'I ()~\r(. (;',3 I)
E:' "f... c.:... '= ''-::.. .()u \'0"'\ \-c 'r R,~ ~ I L.~. G C de ~ ~ \ C,. 1::S q l./,. ~ _ .
2. Generaldescriptionofimprovement: e,'\..>\~V'. tlr K'L~\'~Sc\. 384I.JS Eut,(' C-l(oQ.~'())'\\{\'l'
l\...N:r 9
3. Owner information: \\ + '
a. Name and address: l \\, l \.:s:. L '"' 1\ c...) n A ~ fY\ t' 1"" '0 \; t'.. y... \ \ (. .... ~
~.D~()'t -S""~~cll~\:~\..",vv~ r\ 31~~l)J b. Interestinproperty:-' Do 7""
.
c. Name and address offee simple titleholder (if other than owner): ~ ~~~2~~~~MA:i : ~C;O fOUNToYf C1ERK
OR BK 774 t PG 168
R4.
0'5
Contractor: (name and address) U r lA YY\ ~ 1:'. YU ~ "-
a. Phone number: .~~ cl - S- ~ ~ - S - <..J q S
~ro~ Sam ..LY\) C
I ..
-3 3S ~ ') ~ 0 ~'T"€ L g \ U d
R.'.~~ IL ~A.yUur J FL., :3 s S-.;J" ~
Surety: a. Name and address:
V\) \ (.\
b. Phone number:
c. AmOWlt of bond $
6. Lender:
(name and address):
a. Phone number:
7. Persons with the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713. 13 (l)(a)7, Florida Statutes:
(name and address):
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713. 13 (l)(b), Florida Statutes: (name and address) 3"o..~ 1oL.~ ~~""'-""'<-I
) ~ <") l" q '-~-N ~ \Q. \.-nO 0 ~ ~v...1J~JL '--~ \~ r-l. 33 s: ~~-
\
9. Expiration date of notice of commencement (the expiration date is one (1) year from the date of recording unless a different
date is specified)
This Space for Clerk's Use Only
IsTATE OF FLOAfDA'
!cOUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
!TRUE AND CORRECT COpy OF THE DOCUMENT ON FILE
klR OF PUBUC RECORD IN THIS OFFICE. WITNESS MY
HAND AND OFFICIAL SEAL THIS..6f.... DAY OF
V4tV 2 tZ2ff
J~r;ll2MA~ CLE~K OF CIRCUiT COURT
BY 11 {}.t IA tJ.IJ:t , OEPUTY CLERK
/~- ;e ~ ~
/' (signature of er)
Sworn to and subscribed before me
this d g day of -:::r -A rv l.~ v:\v-, ' (;),-~Ci &
u'k A~~~~~r-'?L~
NOfARYPUBLIC
~ EDNA SUE DRUMMOND
~ MY~~lSSlONf/DD4'763~
, l-Soo.3'NO"rA/lY Fl REs:.hdy 13.2009
. Notary Di_t Assoc. Co.
813-780-0020
City of Zephyrhills Permit Application
Buiking Department
Fax-813-780-0021 3:;';;;)..
S<qs-~-t.j 99
-tt 1l{6'"
Date Received
LOTlJ I '1
Owner's Name
JOB ADDRESS
SUBDIVISION
o
E3 NEWCONSTR D AOOIALT D SIGN D
INSTALL ~ REPAIR
D SFR D COMM D OTHER
D BLOCK D FRAME D STEB. D
I'IN'.. : or """"~Il.~\ ,i" \ h ""''''~''!.
I sa FOOTAGE I I HEIGHT.
MOVE D
DEMOLISH
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
OTHER I
DESCRIPTION OF WORK
BUILDING SIZE
~ BUILDING 1$ 121 ~() VALUATION OF TOTAL CONSTRUCTION
~ B.ECTRICAL 1$ 3115.01) AMP SERVICE D PROGRESS ENERGY
D PLUMBING 1$
IYJ MECHANICAL 1$ '.3~~&-, U D VALUATION OF MECHANICAL INSTALLATION
D GAS CJ ROOFING OTHER
FINISHED FLOOR ELEVATIONS I DYES
BUILDER
SIGNATURE
Address 33> d ')
Xi ELECTRICIAN I
Uf SIGNATURE ,
Address
~~:"~~RE I I ;:>=:R': ~ FEEcURREKT
,,~! . ~16J I l~nse# I
d)::#1 ~f7= 1~~~.i"~K LWU
~ddress 1/'7l>gI,.Cc;feL lS\\I~. Bn>ku;I'~FL. ~'lr.ol license # It~c \~I~,) :1'1
OTHER I I COMPANY I
SIGNATURE . . REGISTERED ~ FEE CURRENT
Ad dress I
I D ~ "" 0 >'V~ to. Y\J ~ ~o \") . ':t. r\) c.. I
Y I N FEE CURRENT ~
." lK:ense# I t.~L \~~D~ I' I ../1.,
1R.~~tl .J D~r\.'G:JJ\..cxt:rl-"~~' .~.
Y I N FEE CURRENT Y I ~',
SO-
license # IE R. \~()\ do ~l ~- I
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License #
llIl
RESIDENTIAL
COMMERCIAL
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-Q-W Perm~ for new construction.
Minimum ten (10) working days after submittal date. Required ons~e, Construction Plans, Stormwater Plans wi Si~ Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
Attach (3) complete sels of Building Plans plus a Life Safety Page; (1) set of Energy Forms, R.O-W Perm~ for new construction,
Minirn.om ten (10) 'Mlrking days after submittal date. Required onsile, Construction Plans, SIormw:ater Plans wi Si~ Fence installed,
Sanitary Facilities & 1 dumpster, Site Work Pennit IDr all new projecIs. AI COfT1rT1efCial requirements must ~ co""'iance
AlIach (2) sets of Engr-red Plans
---PROPERTY SURVEY required for all NEW construction,
SIGN PERMIT
Directions:
FiU out application completely.
Owner & Contraclor sign back of application, nolarized
If over S2liOO. a Notice of Commencement is required. lAIC upgl3des over SllOOO)
Agent (loT the conl1acIor) CK p.,...,.. of AIlomey (fer the """"'" would be someone _ nolarized _ from owner authorizing same
OVER THE COUNTER PERMITTING (F runt of Application Only)
Reroofs Sewers Selvice Upgrades NC Fences (pIotISurveylFootage)
Driveways-Not over Counter if on public roadwaysHneeds 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 'NOrk, 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 IMPACTIUTlLITIES 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 nurrber 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'SIOWNER'S AFFIDAVIT: I certify that all the information in this appfication is accurate and that all work
will be done in compliance with aU 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 'NOrk or installation has
commenced prior to issuance of a perrm and that all work will be performed to meet standards of an 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 lirmed to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterlWastewater 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 perrMted.
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
lice nsed 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 fiU the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fdl 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 alfldavit prior to commencing construction. I understand that a separate permit may be required for electrical1Mlrk.
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 shaH 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 1Mlrk authorized by such permit is commenced within six months of permit issuance, or if 1Mlrk atlthorized 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 YOUR NOTlC ENCEME
FLORIDA JURAT (F.5, 117,03)
OWNER OR AGENT /- L ~
Subscribed and SVIOR'f"to (or affinned) before me this
by
Wlo isfare ,personally known to me or haslh......e produced
l'trZo . ".1" "/. S " OZ]. 0 as identification,
Letno..l. ,. ~~ryPubIC
CONTRACT
Subscribed a sworn to (or
by
IMlo lS/are~""'nally known to me or haslhave produced
as identification,
~h~~lW
Notary Public
Commission No,
8/11 P. ~ ~ LrH '"n rn D n..- d s
Name 01 Notary typed. printed or stamped
Comrrission No,
~}'V n s... oQ l:Y..... "'" ,........ Q t-- (t....... \
Name eX Notary typed, printed or sta~
G) EDNA SUE DRUMMONDS
~ MY COMMISSION H DD417631
~ ~ EXPIRES: July 13,2009
>_ I-lIOO-J-NOTARY Fl. NoIary Disc:ounl AIooc. Co. J
ri);~~'":.?''' EDNA SUE DRUMMONDS
, (~) MY COMMISSION # DD417631
~ EXPIRES: July 13.2009
'-lIOO-J-NOTARY fl. NoIary DiooounI AIooc. C<>
38445 Evergreen Village
Zephyrhills, Florida
To Furnish Labor, Material, Insurance and Supervision to do the following scope of
work to burn -out Apartment Unit 9. Interior work only.
1. Remove trash from apartment and furnish a dumpster.
2. Replace drywall. (Hang, texture, and Finish).
3. To replace HV AC system. ,
4. Install new carpet and vinyl flooring.
5. Install standard grade tub, vanity, sink, toilet and mirror.
6. Furnish and install standard grade Interior doors. One Exterior six panel door.
7. Install single standard window.
8. Paint interior with standard grade paint.
9. Install new standard grade cabinet.
10. Install laminate counter top with stainless steel sink. Faucets included.
11. New Electrical. Scope
Install Electric wiring for
Duplex Receptacles, Weatherproof Outlets, GFCI Protected Outlets,
Single Decor Switches. Smoke Detectors with battery backup, Pre-wire and install
lights. Arc Fault Protection, Washmachine Circult,Dryer Circuit, Water heater with
Disconnect, Refrigerator Circuit, Garbage Disposal Circuit, Range Hood Pre-Wire
and Hung, Range Circuit,4" Florescent Wrap, attic light and switchcombo,Air
conditioner circuit with disconnect, air handler with disconnect.
Appliance furnished by Owner.
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Drummonds and Son, L -1'V (9.-€-
352-583-5499
Fax # 352-583-6394
i~N/ 3D/2i10~/VIED 09.40 AM
ZEPHYRH [LLS BU I LD I ~
FAX No, 813-780-J021
P. 002
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STATE OF FLORIDA
DEPARTMENT OF 8USlNESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
(SSO) 487-1395
WELLS, MARK ROBERT
ON THE MARK HEATING << AIR CONDITIONING INC
17086 CORTEZ RD
BROOKSVILLE FL 34601
(J
'DY'
ACt! 2 7 0 4 4 4 5
. STATEOFFLCfUDA
DBPARTMBNT OP BUSINESS AND
. PROPBSSIONAL REGULATION
CAC1813727
08/09/06 060087074
CERTIFIED AIR COND CONTR
WELLS, MARK R.OBERT
ON THE MARK HEATING & AIR. CONDITI
IS CERT:IFIED IIIIder the provil1..... of Ch.469 W:J,
&xp1Eet:lDD dac.. J,,1J'Q :n, 2008 LOU809007S4
DETACH HERE
ACt 2 7 0 4 4 45
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#Lo6oe0900754
: . LICENSE NBR
08 09 '2006 060087074 CAC1813727
The CLASS A AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 3~, 2008
WELLS, MARK ROBERT
ON THE MARK HEATING & AIR CONDITIONING INC
29250 WILPAYNE ROAD
BROOKSVILLE FL 34602
JEB BUSH
GOVERNOR
2/2'd
!200 08L ~!8:~L ~T
vvvS66L2S~
SIMONE MARSTILLER
SECRETARY
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Jacqueline Boges
From: Jacqueline Boges
Sent: Wednesday, January 30,20088:14 AM
To: Kerry Barnett
Subject: plan
Mr Kerry
I have a submittal of work to be done at an apartment located at the Evergreen Village it had fire
damage. Would you need to review this?
Also did you get a chance to go by 3751 Laurel Valley Blvd?
Jackie
1/3012008
City of Zephyrhills:
Phone: (813)-780-0020
FAX: (813)-780-0021
Building Dept.
-----------------------------------------------------------------~
: TO: On The Mark FROM: Jackie :
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: FAX#:352-799-5444 FAX#: 813-780-0021 :
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: DATE:1-30-08 # OF PAGES: 2 :
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: MESSAGE: :
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: Attached with this cover sheet you will find a permit application and I will need for you to :
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: place signature in the mechanical area. Fax back to the fax # at the top of this form :
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: Thanks Jackie :
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01/30/2008 22:36 3528480225
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DARLING ELECTRIC INC
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01/29/08 16:49 FAX 9417506153
ADMIN CONCEPTS
I4J 001/0'01'
ACORD". CERTIFICATE OF LIABILllY INSURANCE 10001801 I DA'lK (MMIDD/VY'N)
112912110B
PRQDIJCI!R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Risk Concepts Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERl1F~CATE
41043rd Street West Suite N HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEUD OR
Bradenton, FL 34209 ALTER THE COVERAGE AFFORDED BY THE POLICES BI!LOW.
Phone: 1.877.746.2209 INSURERS AFFORDING COVERAGE NAlCII
INSURED Insurer A; Southem Eagle Insurance Co.
Administrative Concepts Corp Reinsurer B: Uoyds of London AA.11ZmOO
406 43rd Street West Reinsurer C: Aspen Reinsurance AA-1121)337
Bradenton, FL 34209 Reinsurer D: Max Re Bermuda AA-319')829
I Reinsur.er E: Odyssey Re 23680
COVERAGES
"THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVIII1liST.l\NDING
~Y REQUIReMENT. TERM OR eoNDlT1ON OF ANY CONTRACT OR OTHER DOCUMENT ~ RESPECT TO WHICH THIS CERllFICATE MAY BE ISSIJED OR
MAY PERTAIN, TtiE INSURANCe AI"FORDED IlYTI1E POLICIES DESCRIIlED HEREIN IS SUIlJECTTO ALL Tl-lE TERMS, EXCLUSIONS AND CONomONS OF SUCH
I---".". POLICIES. AGGREGATE LIMITS SHO\/IIIIl MAY tlAVE BEEN REDUCED BY PAID CLAIMS, POucYEiPlRA'I1DN
It'if = PDLlc:;";,EF~~ L1"T$
POI.1C;Y _e"R DATE MMIDO
~EN!RAl. L1ABIUlY EACH OCCURRENCE S
"-- 3"II..IERCIAl.. GI!NERAl.. LIABILITY ~~F; .... .c,.."",,,,,' S
"-- ClAIMS MADE 0 OCCUR MED EX? (An~ one person) S
- PERSONAl.. L I'DV IN.JJRY S
'-- GENERIIL AGGRf:GATE $
n'L AGG~EnE LIMIT APn PCR. PROOUcrS - COMPIOP AGG S
POLICY ~ LOC
~UTCMDBIl.E 1.1A81UTY COMBINEDSNGLE LIMIT $
IWY AUTO (Ee 8eddlll't)
-
- Al.~ O'M>l5D AUTOS BODILY NJURY
(Per pe",on) $
I-- SCHEDULED AUTOS
I-- MIRED AUTOS BODILY INJURY
S
NON-OW.~O AUTOS (Per aCCIdent)
I--
10- PROPERTY DAMAGE $
(Por ""odcnt)
RRAGE LlAlllI.lTY ~ ~NL Y..:..~.~IR5!'li. .~----_..
ANY AUTO OTME!< THAN EAACC f
Al.JTO ONLY' HSG S
EXcesstUMEIREUA UABUTY EACH OCCURRENCE S
o OCCUR 0 CLAIMS MADE AGGREGA~ S
S
R oeoucrlBLE $
RET~ ION $ (
A WO_l!RS COMPEN!lATlDN AND 1/1/2008 1/112009 X I T~5T~I.!t:" I I OJ;!;!-
EMPLOYERS" LIABlLITY WC0272682.QO
At<< FROFRIETORIPARTNERlEXECU11V!: E.L.liI\CH J\CCJDENT S 1 000 0:>0
OFFlCERlMeMBER EXa.UDED? E.L. DI~ . '^ El\IPLOYIiE S 1.000,0)0
~c~~b~Jts1oNS bol"", E.L. DiSEASe -I'OLCY LIMIT . 1.000.0JO
BC O~ I ..,sase nolB 1IlBt ~OLAl1BlTl t:egJe Insurance UJmpeny I1B relf\Su I mas In excess . er tile JlDIlca.ifS of
Workers Compensation InsUl3nce listed above wlltl undenMllel$ ll$ted A- or beuer alme tlme of pIac:ement of sllCh relns\lllilnc;e. Suctl relnsuli'lee are
DE Excess Coverage Subjeello !heir own IermS, condiUons and limits. This is for informa~onal purposes and nOthing herein shall creale any right
under such reinsurancss.
DeSCIlIP110N OF OPIJIATlONS' L0CA1'10NS I \lBjlCl..ES , EXClUSIONS AllCll!D f1<( ENOOItGMI!Nr I SPECIAL pmV1S1ONS Effective: 12/31/2006 024004
Coverage is extended to the leased employees of alternate employer (Florida Operations Only):
On the Mark Heating and AIr Conditioning
DISCLAIMeR: This Certificate of Insurance does not conslitute a contract between the issuing insurer(s), authorized representative or prodUCE".,
ilnd It>e ~cete h91der, nor does It affirm8tlvely or negatively amend. extend or alter the coverage afforded by the policies listed thereon.
Ce:~TlACAl'E HOLDER
City of Zephymills
CANCELLATION
SHOULD AN'( OF lltE ABOVE DESCRlBSl POLICES BE CANCB.LED BEFORE TliE E ;:PIAAllON
OA115 'TlEREOF. 1lE ISSUNG INSURER WLL ENDEAVOR TO MAIL ...1!L.. DAYli WNl'll:N
NOTIcE;; TO nE CEIlTII'ICATI! WOLDI!R. NAYS!:) TO THE U!f'T. BUT FAILURE TO 00 ~ SHAU
IMPOIiS NO OeUGA'I10N OR UAeILm' OF AI<< KIND UPON'IllE INS\.RER. ITS A:;errs OR
REl'REBENTA_.
AlITHOltlZED REPRESENTATIVE
5335 8th Street
Zephymills, I=L 33542
Fax #
(813) 780-0021
\
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@lACORDCORPORATlON1988
ACORD 2S (2001108)
From: FAXmaker
To 1-813-7.80-0021
pye 2/3
Date 1/29/200811 :5203 AM
Al.,UnLf. l;~K 11t-Il;A I ~ Ut- LIAtslLl1 IN:SUKANl;~ I 01/29/2008
PRODUCER (352) 796-1451 FAX (352)799-5986 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
~illingsworth Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
19259 Cortez Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0, Box 1750
Brooksville, Fl 34605-1750 INSURERS AFFORDING COVERAGE NAIC#
INSURED On the Mark Heating & A/C Inc. INSURER A Safeco Insurance Company
17086 Cortez Blvd. INSURER B
Brooksville, Fl 34601 INSURER C:
INSURER D
INSURER E
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~: ~9:I~} TYPE OF INSURANCE POLICY NUMBER Pgk~CY EFFECTIVE Pg~lfY EXPIRATION LIMITS
GENERAL LIABILITY OlCH48792710 OS/21/2007 OS/21/2008 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 200,000
- ~ CLAIMS MADE [K] OCCUR
MED EXP (Any one person) $ 10,000
- 1,000,000
A PERSONAL & ADV INJURY $
- 2,000,000
GENERAL AGGREGATE $
- 2,000,00C
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $
I n PRO. nLOC
POLICY JE CT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~ (Ea aCCIdent) $
ANY AUTO
~
ALL OWNED AUTOS BODILY INJURY
~ (Per person) $
SCHEDULED AUTOS
~
HIRED AUTOS BODILY INJURY
e-- (Per aCCIdent) $
NON-OWNED AUTOS
~
e-- PROPERTY DAMAGE $
(Per aCCl dent)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
O-OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WCSTATU- I IOTH-
TORY LlMrrS ER
EMPLOYERS' LIABILITY E L EACH ACCIDENT $
ANY PROPRIETORlPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE $
~~e~t?:C~~~~r~~NS below EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
imits shown are those in effect at policy inception date.
SHOULD AtoN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
....l2.... DAYS WRIlTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
City of Zephyrhills
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
~ I'. , o'\J C)
~.... \... ....~.).,.\\~
Vicki Parrish/VICKI
ACORD 25 (2001/08) FAX: (813) 780-0021
@)ACORDCORPORATION 1988
This fax was sent with GFI FAXmaker fax server For more information, visit: http://www,gfi,com
From FAXmaker
To 1-813-780-0021
Page 1/3
Date 1/29/200811 :5203 AM
::::::::;::::::::::::::::::::::;::::::::::::::::;:::::::::::;:::::::::::::;:::::::::::::::::::::::::::::::;:::::;:;:::::::::::;::::::::::::::=::;:::::::::::::;:::::::::::::::::::;::::=:::::=;:::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::;:::::::::::::::::::::::::::;:::::;:::::::::::::;:::::::::::::::::::::::::::::;:::::::::::::::::::;:::::;:::::::::::::::::::;:::::::::;:::::::::::::::::::::;:;:::;:::::::::::::::::::::::::::;:;:::::
FAX TRANSMISSION
;:::::::::;:;:;:;:;:::;:::.;:::;:::::::::::;:::::::::;:::;:.~::;:::;:;:;:;:;:;:;:;:::;:::::;:;:::;:::;:;:;:;:;:::::::::;:::;:;:::;;.;:;:;:::;:;:::;:;:;:;:::::::::;:::::::::;:::::::.}:;:;:;:::;:::::;:;:;:;:;:::::::::::::::::.}::=;:::;:::::::;:::::;:;:::::::::::;:;:::::::;:;:;:;:::;:;:::::;:;:;:;:::::;:;:::::::::::::;:::;:::;:;:;:::::::;:::;:::::;:::;:::::;:;:::;:::::::;:;:::;:;:::;::=::;:::;:::;:.~;:::::::;:::;:::;:::::;:;:;:::::;:;:::;:;:;:;:;:::;:
To:
1-813-780-0021
From:
Vicki Parrish - Killingsworth Agency, Inc.
Subject:
::=:=:=:::::::=:=:=:=::=::::::::::::::::::::::::::=:=:::::::::=:::=:::::::::::::=:::::::::::::::=:::::=:=:=:::::::::=:::::::::::::=:=:::::::::::::::::::::=:::::=:::::=:::=::==:::=:=:::::::::~::::=:::::=:::=:::::=:::=:::::::::::::::::::::=:::::::=:=:=:::::=:::=:::::::::::::::::::::=:::::=:=:=:=:::=:::::=:::=:=:::::::::::::::::::::::::::=:::::=:::=:::=:=:::=:::::::::::::::::::::=:::=:::=:::::=:::=:::::::::::::::::::::=:=:=:=:::::::=:=:::::::::::=:::
Message: Vicki Parrish
Account Representative
Killingsworth Agency Inc,
(352)796-1451
(352)799-5986 Fax
Confidentiality Note: The information contained in this electronic mail/Fax is
privileged and confidential and is intended for the use of the individual or
entity named above, If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or
copy of this electronic mail is strictly prohibited, If you have received
this electronic mail in error, please immediately notify the sender and
delete all copies.
:7:~:::::~:::7:~:':::7:~:~:~:~:::':':':':':~:::::::'::::::=::':7:~:':':':':::':7:::':7:':;:::;:~:~:;:;:::':::~:;:':':':':':':':':7:':7:~:;:~:::::;:~:':':':'~:':::':':':':':::::::::;:;:~:;:~::=::';':':':':::::::7:7:::::::::::':::':':::':':7:::':7:':::::::::~:::':':::':':-:':7:':':7:7:7:7:::':~:;:~:;:':;:;:::;:':':':':':':':':':':':':':::7:::~:::~:~:;:::;:':':':':':':':':':':':':::::~:;:::;:':':':7:':':':':;:::::::':;:7:':;:7:;:':;:':7:':':':':':':::::::::;::
Killingsworth Agency, Inc.
19259 Cortez Blvd
Brooksville, Fl 34601
TeI352-796-1451 Fax 352-799-5986
:;:;:::;:::::::::::~::::;:;=::::;:~:;:.~::::;:::::;:::;:::~:::;-=~:::::;:::::;:~~}:::;:::;:::::~:;:::;:::::~:;=~:;::::;;:::;:::;:;:::;:;:::;:::i:i:;:::~:;:::;:::~:~:::;:::::::::::::::::;:::::~=;:~:::::;:::;:::;:;:::::;:;:;:;:::i:;:::;:::::::;:::;:;:;:;:;:;:::i:i:~:;:;:::;:;:~:;:::::;:;:;:::::;:::;:.:;::i:;:;:i:;:::i:;:;:;:;:::;:;:;:;:::;:;:;:;:;:::::~:::;:;:::i:;:;:~:;:;:;:;:;:;:;:;:;:;:::::i:::;:::::;:~:~:;:;:;:;:;:::;:.~;:::::;:;:;:::;:;:;:::~:;:;:;:;:;:;
This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www,gfi,com
I-'~:::: &.-oN&:
(T. lie c....,-,..~ by P.....tlt.. .~'Iwe)
sua-CONTRACTOR AFFIDAVIT
DAlE: O'l~510g
, ,
TO WHOM IT MAY CONCERN:
I._Richard ]Javl1rllj
dIbIa .RlchCtrd S, ]x::u'--\tr'll) Elec..+.J(; :InC.
License Number: --'11lB 004)"3 30 . wiD be the
(Example: Electrical. Mechanical,
E \ e L -\- r \ c.. c,-l contradDr for this permit application. The job address
Plumbing, Roofing, Gas. Etc.)
is: 3 8 L.jLj5.- Eve-(~.(-e..erl V,IICtge -.:bIt v{.
~-G=,~ a
SIgnature ofUcense Hdderor ~ Agent
STATE OF F \o(\d~
COUNlY OF \4e. r nGLnc1 0
I HEREBY CERnFY that the foregoing insIrumentwas ~ before me tis ;;J5- day of
:-Jor)uCt(''-1 .2001< .by 'ihchn,-d . I rhr73 .~is,,8OI1811y
~ to me orwtio has produced . as idellIiIkaIbL
..~-'-1 ~_ ~[U.L;),
s.9~Public
~a+\t1L1 E. KtOLDr'\
Print. Type. or stantp Name of Notary
."~""'" KATHY E. BROWN
. . NotIry PubIc . Slale d Florida
Com.IdwIun Expha Ju/" 2010
"' eon..~ , DO 57084'7
Bonded HltIonIl ~ Alan,
HetrImdo Co. Dtv. Dept.. 20. N. AfehStnMt. RourD 1~ a~d8. RoddlI346f11 .(3!S2J1M 405D . Far ~1tJ
E:\wodaIa\aermils\.di:ll wM
.. . ...,...........-
01/30/2008 06:03
3528480225
DARLING ELECTRIC INC
PAGE 01
I!
Richard J. Darling Electric, Inc.
Fax Cover Sheet
~
.-f)
Send to: City of Zephymll18- Building Dept ~: eu.I.... omce of RIc:tNIrd,. Darting
~Un: Jackie Dati!: JanualY 29, 2008, "':03 PM
Phone Number: 813-7110-OO20 Phone Number: (352) 196-5809
Fax Number: 813-780-0021 Fax Number: (352) 848-0225
Total Pages Including Cover: 2
X Urgent
Cl Please Review
Cl Reply ASAP
Cl For Your Information
l:J Please Comment
Dear Jackie,
Attached is all the information you requested for Richard J. Darling Electric. Inc. can be put as a
subcontractor on Drummonds and Son, Inc. Permit. Project name is Everygreen Village.
If you have any questions or need anything else feel free to contact me.
Thank you.
Kathy Brown
Richard J. Darling Electric. Inc.
CanflClerlUlIIlly s,..-
TIle __ oonIPo.d in lIIe ~...." be """'-* _1_ -'Y lor lIIe... DIllie indi._ D< -"Y 10 """"" R" _. -0.0.
-.....nl_II_.......... _ It pr1Vjleged or ~ed from d_"-"'~ _ If,..., _ nalllle _ reCllpienl. pi-. <,> be__
"* _... __1011. -no. or CCJII\Ilng '" IN. __ "It SlIIl:U\I f'nI/ltIlIt8d". _ l2INllWY _I~ tly --- - -....
01/30/2008 05:~3
3528480225
- _._-,,_.._~'
DARLING ELECTRIC INC
" ' " . STATE OF fLQt(IV"" ..' ", . ,;', PAGE 02
Dll~AR~ dP:B~~gt~~~~~iI~ON SEQlt.0607270149
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07 27 2006 068015399ERijOiZ~i5
The ELECTRICAL coNTRActOR
Named bel.ow BAS:REGIST.aRED'" '"
Undex- the provi.esions ox Chiipter 489 FS.
Expiration date: AtJG 3~, 2008 '
(INDIVIDUAL MUST BET ALL LOCAL LICEN'SING
REQUIREMENTS PRIOR TO C~CTDlG :IN ,A)1YAREA),' ..:~
-::;A..~L;:NG. RICHARD J" "
R:r. CE..~ J. .DARLmG BLBCTRIC :IN'C
l62 9 7 CORTEZ BOULEVARD
BROOKSVILLE FL 34~01
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. OisPLAY AS REQUIRED BY LAW
HERNANDO COUNT"f
BUILDING DIVISION
CERTIFICATE OF COMPETENCY
DARLING R!CHARD J
RICHARD J DARLING ELECTRIC INC
16297 CORTEZ BLVD,
BROOKSVILLE FL 34601
LICENSE #: AAA0041330
UNLIMITED ELECTRICAL CONTR
EXPIRES: 11/30/2009
, . ,STATS OF FlORIDA~. .'ACI i 61.~:]:11
. . tJ,RPAlt'1'il1Qt,t' OF BUSINBS:S AND
. ,PROPBSSXONAL RBGULATXOR
ER~30~231S
07/27/06 068015399
REG ELBCTRICAL CORTRAC'l'OR.
DARLING, RICHARD J
RICHARD J. DARLrNG ELECTRIC IHC
, (INDIVIDUAL WST MEET ALL LOCAL
LICENSING RBQVXRKMERTS PRIOR
TO CONTRACT'IIIG tx ANY AREA)
HAS RBGIS1'2JlBD' un4~-"be px:-ovl.oi...." of 0..489
.""lraUOIl 4..c... AUG ,3;1.. 2008 (,06072701UO
Jan.29. 2008 5:06PM
KILLINGSWORTH AGENCY, INC,
No.3394
po. -1 /1
ACORct CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIVYVY)
. 01/29/2008
PRODUCER (352)796-1451 FAX (352)799-5986 THIS CERTIRCATE IS ISSUED AS A MATTER OF INFORMATION
Killingsworth Agency. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
19259 Cortez Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 1750
Brooksville, FL 34605-1750 INSURERS AFFORDING COVERAGE NAIC#
INSURED Rlcnara J. Darllng Elec~rlc Inc. INSURER A: F. C. C. I. Ins. Group
16297 Cortez Blvd. INSURERB: F .c.e. I Ins. Co. 0028
Brooksv;lle, FL 34601 INSURER c: Western Surety 0086
INSUREft 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUEO TO THE INSUREO NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITI1STANDIN
ANY ReaUIREMENT, 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 POUCIES DESCRI8ED HEREIN 1$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DO' TYPE Of' INSURANCE POUcY NUMBER POLICY EI'FECTIVE POUCY EXPIRATION LIMITS
GENERAl. LIABILITY CLOOO44S82 08/11/2007 08/11/Z008 EACH OCCURRiNCE S 1 ,000. 00<<l
X COMMEFlCIAL GENERAL UABJLITY DAMAGE TO RElIITEO $ 100.00CI
I CLAIMS MADE [K] OCCUfl ~ MEO EXP (Any 0'l1l1lGf$O'l) $ 5 , Ooel
A PERSONAL & AOV INJURY $ 1.000.0Ge:
- 2,OOO.OO(
GENERAl. AGGREGATE $
- 2.000.000
GEN'L AGGREGATE UMIT APPUES PER: PROOUCTS - COMPIOP AGG $
I POLICY n ~~i n LaC
AUTOMOBILE LfA81UTY COMBINED SINGLE LIMIT
- (Ea accidenll $
ANY AUTO
-
ALL OWNED AUTOS BOOlL Y INJURY
- (Perpll:l'SOll) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (PIIt' accidenO $
NON-OWNED AUTOS
I--
...... PROPERlY DAMAGE $
(Per eccidllll1)
GARAGE UABIUTY AUTO ONLY. SA ACClOiNT $
R ANY AUTO OTHER THAN EA ACe $
AUTO ONLY: AGG S
EXCESSIUM81lELLA UA8lUTY EACH OOCUAAENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
$
R DEOUCTIBLE $
RF.TeNTION $ $
WORKERS COMPENSATION AND WC07AS724S 12/04/2007 12/04/2008 I we STATU- .1 IO~-
EMPLOYERS' UABIUTY e.L EACH ACCIDENT $ 1,OOO,00(]
B ANY PROPRIETORIPARTNERIEXECUTIVE r E.L DISEASE - EA EMPLOYeE $
OFFICEAfMEMBEfl EXCUJOEO? 1,000,OOCl
It~. de&CtlDe under E.L DISEASE - POliCY UMIT $ 1.000.00Cl
S ClAL PROVISIONS below
OTHER 24539642 10/01/2006 10/01/Z008 limit - $5000
C ~asco Coun~y Bond
OESCRIPTION OF OPliRATlONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVl$lONS
~imits shown are those in effect at policy inception date.
C!;RTIFICA TE HOLD~R , A ..,,....,
SHOULD ANY OF THE ABOVE DESCRIBED POUClES 8E CANCfLLED BEFOllE THE
EXPIRATION DATE THEREOF, THE I$$UING INSURER W1LLEHDEAVOR TO MAlL
City of Zephyrhil's Building Depar~~ ...!2..- DAYS WRITTEN NOTICE TO THE CEflTlFlCATE HOLDER NAMED TO THE LEFT,
Attn:' Jackie 8lIT FAILURE TO MAlLSUCM NOTICE SHALL IMPOSE NO 08UGATlON OR UA.8lUtY
5335 8th Street OF AHY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE j~~ 4. Ik~~
Daniel1e Healis/CLARE
ACORD 2S (2001108) FAX: (813) 780-0021
~ACORD CORPORATION 1988
From: FAXmaker
To 1-813-780-0021
Pre 2/2
Date 1/29/200841100 PM
R l, U f"( L.f.. \,;t:K II~I\';A I t: Ut- LIAI:ULII IN~UKAN\';t: I - 01/29/2008
PRODUCER (352)796-1451 FAX (352)799-5936 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
K>ilHngsworth Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
~9259 Cortez Blvd. AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P, 0, Box 1750
Brooksville, FL 34605-1750 INSURERS AFFORDING COVERAGE NAIC "
INSURED Rlchard J. Darllng El ectrlc Inc, INSURER A: F,C.C.I. Ins, Group
16297 Cortez Blvd. INSURER B: F.C,C.I (WC) Ins, Co. 0023
Brooksville, Fl 34601 INSURER C Western Surety 0086
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~~~ ~~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL liABILITY GlOO044582 08/11/2007 08/11/2008 EACH DCCURRENCE $ 1,000,000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,000
- ~ CLAIMS MADE ~ OCCUR
MED EXP (Anyone person) $ 5,000
-
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COM PlOP AGG S 2,000,000
h POLICY n ~~ n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea acCident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per person)
I--
HIRED AUTOS BODILY INJURY
- S
NON-OWNED AUTOS (Per aCCident)
-
PROPERTY DAMAGE $
(Per aCCident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
q ANY AUTO OTHER THAN i:OAACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY i:OACH OCCURRi:ONCE $
:J OCCUR D CLAIMS MADE AGGREGATE $
S
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC07A57245 12/04/2007 12/04/2008 I T"X~$m~;, I IOJ~'
EMPLOYERS' LIABILITY 1,000,000
B ANY PROPRIETORJPARTNER/EXECUTIVE EL. EACH ACCIDENT $
OFFICER/MEMBER i:OXCLUDi:OD? EL DISEASE. EA EMPLOYEE S 1,000,000
If yes, describe under 1,000,000
SPECIAL PROVISIONS below E,L, DISEASE - POLICY LIMIT $
OTHER 24539642 10/01/2006 10/01/2008 limit - $5000
C Pasco County Bond
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
imits shown are those in effect at policy inception date,
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION OATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
.-.!L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Zephyrhills BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
5H5 3th Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Zephyrhi 11 5, FL 33542 AUTHORIZED REPRESENTATIVE ;~t..4
Danielle Healis/CLARE ~u..J
ACORD 25 (2001/08) FAX: (313) 7 &0-0021
@ACORD CORPORATION 1988
This fax was sent with GFI FAXmaker fax server. For more information, visit: http://WI/VIN,gfi.com
~
HERNANDO COUNTY TAX COLLECTOR
JUANITA B. SIKES, C.F.C.
20 NORTH MAIN ST" ROOM 112 * BROOKSVlLLE, FLORIDA 34601-2892
TELEPHONE (352) 7~180 * FAX (352) 7~189 * EMAIL TC@HERNANDOCOUNTY.US
June 25, 2007
Dear Business Owner:
Effective July 1, 2007 you will no longer be required to renew your Hernando County
local Business Receipt (Occupational license), If you are in the City of Brooksville you
will still be required to purchase a City Local Business Receipt {Occupational license) and
lor pay your County or City Hazardous Waste Fee. Per Florida statute you will now have
from July 1 st to September 30th to do your renewal.
If you have any questions concerning these changes, please contact this office.
Sincerely,
.d4D
Juanita B. Sikes, CFC
Hernando County Tax Collector
- -- - - ~-----~-- - -- ---~--~-
C"'\ \'L~
O\\d.d..\\:)~ :l.~\S~W\
Thou ~ 1\J~ ~Q..'tV"\ '--~\..\\h. t\J ~ ~ 't\c..l
FROM :Drummonds and Son
FAX NO, :3525836394
Jan, 29 2008 11:55AM Pi
, '
CONTRACTOR AGREEMENT
TR1S CONTllAC"lOIl AGllDMl:NT is made aD !be
9!k
day of llnl8lY 2008.
The parties to dliS .ASftemeat De as fOUO....:
CONTRACTOR:
1\___""... SolI. ...
Nam~
33.215 Carta JJv.I.. RIde M_. n 33523
Address
l3!2) ., ~ J'u: C3S2) S&J~
TelepIQae ~
OWN&R:
CIIC 12!O:511
Liceue NwDber
N:we
A tmd M Pnpdi~
PO Box 52.5.2 I ~ FIarNb 33m1
Address
1. W.rtc; S.. The Work will he po;4o(med at Ihe Ca1IowiJlI WoJk Site:
3lk4' berplm ViIIap Apl. fItJ ZelitydIiUs florida
1. Scope of Work. 11Ie C<mIractar willlbmish all of thI:. ~rials and peIform 811 oftbe Wo!t dcsaibed em me auacbli:d
to this ~ as EXHIB1T A. whic:lt is put oftbil AlncmcDl, OM. lID fDmiIb.aJJ ~.
3. Wo.........~p h~ AD.lIlIIIIIc:rials m: &'~ to be u 1PCdfic:d and ll!l 1\81.AodW by the man6ctIrm. AD work:
will be ~ompletcd in a ~lib II\&JUIer ~ to s1a]dud pacUc:eI. The marenaIs wl work Mil comply with
qpllC3ble bddtnt, OOUs.llllld. mdi-,
... A~ The ~ rhaDbC 1dIdet.. dimction of. aod in~l~ with the drawingsaad spcc:ifkations
PRIJUal by the Ardaitcf;;t.
.Atcbicccl
N/A
Address
5. Ti..e f1I CGlllPIdiClL l"be Work to be ~ UIldIlr this Agrcemem shall be S1aIUI! by 200L and shall
be 8UbIra1aially c:omp1ded by . ~. ClUlqIIIbat dJe time or Cftn91c1ion is ~ 1IpOD strikes. 8CCidats.
pertonnaoce of mbc:aDIr~ ~.., 1"-_ ot IUIcriaIs aDd otMr dd~'5 bcy01I4 UIe Ccm1Iactor's ~ CODIIOL Owner
is respoDSible for III8kiDC aclCClII5lmi11b1e to 0BnIculr Wonday tbru Prictay from 8 LIIl. till S lUll.
.. COIItrIet ~tke ... Pa)....... Owner 'llliD pwy ~ Ibr tk ~..r.l"tIJIY completion ottb.; WorIc..
1:7 1b; 5aIII qt'DdrCy -Two ".........- DGUIrI ($32,OOO}
C $ 555.00 pcr(llcul)f:ldIa's~doin8.dIewwn.
Paymcat of the CoDbl<< Price ,Wile 1DIde.~:
. '" Iowa pay.-
1"' dmw after dcmoIitioa
r draw due afta 0IywaI1 iMIIII.....
3r<l dI1l'w after tIoorin&
10% Fmal draw upcm aJIIIfIJo::dcm r1jOb.
SpedalonIer..... __10 be PIIid...... ___ .... ~ __~abIe.
N(1te: Fallfln i!O .. ~ Q$1J'OvJtl<<l t1bt1tIe may ruull ", ContrfICtOI' IuIw; 1m mjQK'.eobIe clatnl DglZl1JSl1he property ill
llCCOrQQ/I08 widl applicabl_ Ii_ l/ltfl$.
s~.oo
S64OO-I)0
S9CiOO 00
$6400.00
$3200.00
,.,"" ':lI:\H.J
c:: f...l':: r':nnM':l'rT.....tr1
:t:.O"/O~7""C"'
~~I~~ nnn~'"T/~^
-'
FROM :Drummonds and Son
FAX NO, :3525836394
Jan, 29 2008 :11: 55AM P2
, '
7. I&tru. Arty al1e:lation or deviatioD fI'am tbe lI1lll)pe of wod anacbmcnt A ilMPMag qxtJa costs will ~ nndeI'aWn only
U1K'D wri1le:D order of o-er ... will bcc:aIJle. all adctiboaall3qc am4 mIIY extebd <<be time c4 COftlp1edOD.
t. o.n.er ...lIIIIIIMIitiet. ()lnm is n:spouibIc lOr location or SUM!} mukc1a. tbr prcMdiDg tocaW:lD orall ~d
sprinkler syanm. eIec:Iric. etC. ~ lMIIl SoB, Iac:. (1),8.1.) will1lOt he ft!IIIIlII!Iible for replacelMnt or tep8m of any
and~ sy&Sem$ itSlOl pmpedy ambd om by mmec, It 15 aIao the rapoll8iblNty oro.e (JflIl1tI!t to povid~ adeqUate access
10 the joblri.we. D.S.I. ie JfJt ~ for ~. flU or jdIeUe daIDaF CIaIIed by tnck$, equipmeDt. etc.
~. SllbceIdnctDl'lI. Thc~D8Y eapF SlJbcoI\traet6d 10 perform Work. provided lbatthc CoDtrBCtorwill COlltimle
10 be aapoasftlie for perbmiIIg.all Wcnk IDler tIUs ~ ~ sure law 1U)' Rqaift ~ to depastt
payment amOUlUIO pay ~
It). ....~ Tho- ~win aWUin,pdNqUire SUbcoD~to ~A. Walker's ClmupenIation ~
lL ~ If lbere is any qucISticm aIDlt lbellliCQiag of U\C drawiQllS and ~ it shall be decidailYy the
ArchitllCl whose clecisiOll wiD be fiJIIL Any ~ Of c1aiJ1I. ansmg out of or rdaDDg to tbi$ ~~ (iacludiIIg the
a~ ~ ifdlae is no Io~). or 1k bn:lIcb tbm:of. s1I8IJ be II:ttk:cl 'by amiaatiOP in acmrd8nce widllbe Rules of the
AmcIicu AlbUmIioll. Ali&ol:iatiOu, aDlijudpM!ftl upon 1M awud rmdeft:d by the Nbiaator($) may be cnr:ezed m 8Il~ coon
laWtlP'rrliou 1bI:nlof.
12. ~ AD wodtdoAe by ~ ComnIdot and S\IbCOIIIr3CtGI1 wiD he panIDkcd as specified.
13. Material OWDenlUp. AAy IDIII:daIs S1JIlPliedordcmoby D.S,1.1bat ~aftct tlc compIetiQl\ of tile job are propertY or
D.S_l
1'" ~ This ContraCt is biDdiIIa OIl all p&I'lieS wbo law1Dlly IlICCUd to tile Iigtlrs or 181m rhc ptacc of the o..~ or
COJI,tmetor, EdIer.-nY wirhaIII... Miam ~ ollbe Ollila-.., DOt -go IIUs CamtllCt.
nm PARTlES HAVE READ 11fE CONTRACf. mEY HAVE IWCENED A COMPLETELy FIi..I.ED-INCOl>>Y AND
ACK..\lOWLEDGE RECEIPT OF ~ms OF nm DRAWINGS AND SPECIFICATIONS. THEY HAVE SIONED TIlE
CONTltACT AS OP nm DA11! 'WlllnEN ATTHE TOP.
OWNER
_(jJA ()Ll~t- $(, L L
Dele: JmIllII(y 9., 200ll
CONTRACTOR
~~r~~
'J'lUidm
eo I oJ.... tTnnM':I"""l\-I""I
!~::lT/qc:~CS:-
~~:~~ RvRi./qt/T.~
~u'eline Boges
From:
Sent:
To:
Bobbie Swetland
Wednesday, January 09, 2008 8:39 AM
Karen Miller; Jacqueline Boges
Ladies,
Yesterday I had an inquiry re: a permit for fire restoration on Apt9 in Evergreen Village
Apts. I spoke w/Bill & he said (1) we needed a list or repairs & once he's reviewed that
(2) we need to set-up an on-site inspection of the apt before we can relay what will be
required for permitting.
Contact person is: Sue (352) 583-5499 w/Drummonds & Sons out of Ridge Manor. I called her
this am & gave her information. As the contractor - they're to meet w/apt owners/managers
on-site today & then she will fax info on repairs to us. Also I stated to her that we
needed an update on state license, liability, wc, & btr.
I wanted to let you ladies know this info since I will be gone after 11:15 am today.
As always - many thanks for all your help with everything - you two are the best! !
Bobbie
1