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HomeMy WebLinkAbout08-7408 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7408 Permit Number: 7408 Permit Type: ADDITION/ALTERATION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: 11,400.00 Date Issued: Total Fees: 76.50 Amount Paid: 76.50 Date Paid: 1/22/2008 Work Desc: ENCLOSE PORCH 14 X 6.8 Address: 6442 B ENTWO D DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 04-26-21-0030-00DOO-0030 Name: WILKE, BETTY R Address: 6442 BRENTWOOD DR ZEPHYRHILLS, FL. 33542 Phone: 813 783-6639 ~n& t; ,; ;; {rd SitJW 4- ~(j) qp WM 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." ~/L-Z UJ ~~ CONTRACTOR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OFZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7408 Permit Number: 7408 Permit Type: ADDITION/ALTERATION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: 11,400.00 Date Issued: Total Fees: 76.50 Amount Paid: Date Paid: Work Desc: ENCLOSE PORCH 14 X 6.8 Address: 6442 BRENTWOOD DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 04-26-21-0030-00DOO-0030 WILKE, BE R 6442 BRENTWOOD DR ZEPHYRHILLS, FL. 33542 Phone: 813783-6639 ~~ ~~t~ MI FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PWMB 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 SQ. FEET PRICE MAIN OR LIVING: 95 $ 47.00 OTHER AREA UNDER ROOF: 95 $ 47.00 OTHER: - $ - VALUATION $ 8,930.00 FEE SHEET $ 75.00 ADDRESS DRIVEWAY BUILDING: $ 76.50 ELECTRICAL: PLUMBING: MECHANICAL: SUB-TOTAL $ 76.50 RADON: TOTAL $ 76.50 SEWER: $ - WATER: $ - IRRIGATION: $ - TOTAL: $ - WATER METERI $ IRRIGATION METER $ - I FIRE DEPARTMENT FEES PLANS TOTAL: INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ - PUBLIC SAFETY IMPACT FEES POLICE $ - FIRE $ - 5% $ - TOTAL: $ . SUB-TOTAL $ 76.50 I - I PARK IMPACT FEESl $ SIF'S: $ - 100.0% $ - 1.0% $ - TOTAL: $ - : I T IF'S 'I $ 99% $ 1% $ TOTAL: $ 76.50 I CITY OF ZEPHYRHILLS PERMIT APPLICATION 1'lqO~ BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 )'-18-08 DATE RECEIVED. PHONE CONTACT FOR PERMITTING 7f:? -1(1'/2.- OWNER'S NAME 13-6/TV UJIf-K..~ JOB ADDRESS 0 'ftr2.- oee;.NTu.Joof) UfC.... LEGAL DESCRIPTION: LOT(S) ~ BLOCK j) PHONE -'-;'63-0039 ;:5 i L \) l?TC..' OAt:. S SUBDIVISION PARCEL 10 # 04-~ Z4 - 2-1- 0030-00/)00., on31llOBTAIN WORK PROPSED: DNEW CONSTRUCTION 0 ADDITION ~LTERATION FROM PROPERTY TAX NOTICE\ o REPAIR o INSTALL DSIGN PROPOSED USE: ~GL FAMILY DWELLING o COMMERCIAL o MOVE o DEMOLISH DMULTI - FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER DESCRIPTION OF WORK c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL 6NCt...osE.. ?Of2.Ct-t BUILDING SIZE J 'f X ~. rg SQUARE FOOTAGE q 5". z....- HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERMITS REQUESTED ijt-BUILDING o ELECTRICAL o PLUMBING o MECHANICAL $ $ 1I,4-co-oO VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o Progress Energy 0 W.R.E.C. o GAS o ROOFING o SPECIALTY o OTHER VALUATION OF MECHANCIAL INSTALLATIO~~~ ~~~ ~~~~LL~ IS PROJECT IN FLOOD ZONE AREAtr Y~ - 0 NO o STEEL o OTHER TYPE OF CONSTRUCTION:~ BLOCK o FRAME FINISHED FLOOR ELEVATIONS SIGNATURE ~~A~ ****************************************************************** COMPANY C:;.L. $7816 c..oAJ-5:T. BUILDER STATE CERT OR REGIST # C!.&- ~ O:J--7.- t J) 9 ELECTRICIAN COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** MECHANICAL COMPANY SIGNATURE STATE CERT OR REGIST # ***************************************************************** . .- -.....OTHER COMPANY SIGNATURE STATE CERT OR REGIST # A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed restrictions" which may be more restrictive than City regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. B. 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 City of Zephyrhills Building Department, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "Contractor Sections" of this application for which they will be responsible. If you, as the owner signs as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that may be an indica~ion that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien Law _ Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the "owner", I cerify 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. E. 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. Appli~ation 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, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental 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 Regulation-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 *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is understood that a drainage plan addressing a "compensating volume" will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. 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 code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for 'a period of six months after the time the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six month period, or the project will be 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. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". r;:bJ~4U/t ~~ SIGNATURE: OWNER OR"AGENT r\~ .' 0~L it:::.L A:.L~.},'-- SIGNATURE: CONTRACTOR STATE OF FLORIDA .~~~~ ~ COUNTY OF . 't"_ The foregoing instrument was acknowledged Be~ ~this--EL ~ of rf'i..-lulj' 2~ by G" ef ~~.rnb <;:;,)e _~(name of person acknowledged) UYwho is personally known to me, or STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged Bef e 1Jle . S. --L.f::-day,.. of 1"'-~ ' 20 i:'k by I U ue (name of person acknowledged) is personally known to me, or '--;--J I""CiS C U .r Name typed, printed or AMBER C. TEDDER MY COMMISSION 1/ 00 633100 . 25. 2011 Bonded ThN Nol8JY PublIc \JndeIWIbrs o who --------, . -_._.~~..~,~-,~-"~.".,.~-,~~---_........,.<--_...;._.."",=".......,,-~ . . .....--...---..-.-..-.-..----.-....-.---...-... -..-" .:.. . ._.......___-r--.. ....---.----.-...- . ~~~_..................... . :::::::. ~::: ~::. ----~..__.... ................. :::::Cit;;;:~f.zepny.drllls . BUI::GDINGJlLANREVIEW COMMENTS Site: . 0.~ S~~. ~ir \-Ll(S~o8 . ~ tf q 2.- . '~~;)J })f- ~OSR.... . f>~ch l<\-}d,,~ 'ContractorfHomeowner: . Dare Received: ~ .. :Permit Type: ApprO~~W!no ~~:~ Approvedw/fuebclowcmmnmm: D Denied withe below comments: . 0 . . be kept with the p~ and/or plans. ~( j-Vj' Date Cont.:ract:.or and! or Homeowner . (ReqoiTed when: commeIrts are presf;:D.t) Pasco County Parcel: 04-26-21-0030-00DOO-0030 001 Page Jl.of2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Ouestions Other Agency Data: Tax Collector School Board Supervisor of Elections I Data Current as Of: I Weekly Archive - Saturday, January 12, 2008 Parcel ID 04-26-21-0030-00DOO-0030 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Assessment (totals) WILKE BETTY R Ag Land $0 6442 BRENTWOOD DR Land $29,378 ZEPHYRHILLS, FL 335420621 Building $96,958 Physical Address Extra Features $649 6442 BRENTWOOD DR ZEPHYRHILLS, FL 33542-0621 Total Assessment $126,985 Save Our Homes $74,709 Legal Description (First 4 Lines) Homestead Exemption - $25,000 BRENTWOOD PB 29 PGS 86-89 LOT 3 Taxable Value $49,209 BLOCK D Warning: A significant taxable value increase OR 4104 PG 1030 may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line Use Description z~ Units I Type I ~condition I Value I 1 0100 SFR 0 3,970.05 I SF I . . 1.00 I $29,378 I : Additional Land Information I Acres II 0.09 II Tax Area II 30ZH II FEMA Code [~:JIResidential COde11 SIVLGP2 I Building Information - Use 07 - Single Family Villas (Card: 001 of 001) Year Built 1992 Stories 1.0 Exterior Wall 1 Concrete Block Stucco 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 Repl. Cost New 1 I BAS I 1,216 $99,615 2 I FSP I 120 $3,441 3 I FGR I 336 $10,977 4 I FOP II 66 I $1,393 Extra Features (Card: 001 of 001) Line I Description Year Units Value 1 DWSWC 1992 343 $566 2 CON PTO 1992 50 $83 Sales History Previous Owner HONEYWELL VINCENT R & CHERYL H Year Month Book/Page ~e II Amount 1999 11 4266 I 1572 WD f:: $0 1999 I 02 I 4104 / 1030 WD $75,000 1992 I 02 II 2092 / 1311 I WD $82,900 http://appraiser.pascogov.cOIn!searchlparcel.aspx?sec=04&twn=26&mg=21&sbb=0030&b ... 1/18/2008 G. L. 5TE.V E EXISTING PORe H 14'- 0" 2.4 @:. c.ONe. BLK, "'/-.5ILLS DRYWAl.l/ PAINT d) 08L.24 OIY'PLY WITH ALL ALL WORK SHALLE~ F{ORlDA BUlLDTI':G PREVAILING COD ELECTRlC CODE AND CODE, NATIONyA~uILLS ORDINANCES CITY OF ZEPH Nl REVIEW DATE ( -( ~ .-D Y CITY OF ZEPHYRHllLS (( PLANS EXAMINER I 6442 BRENTWooD PORC.H ENCl05U~E. r 6-g' l I I II Z4 ~ 1-1 I EXISTING pORe. H 14'.OU "\ CONe. 8LK" wj.!lU. DR."M'AL.L /PAtNT 4) DBL.24 ALL WORK SHALL COMPLY WITH ALL 'r' PREVAILING CODES, FLORIDA BUlLD~ J CODE. NATIONAL ELECTRIC CODE A~~I ClTY OF ZEPHYRHILLS ORDINANCE" REVIEW DATE vt ( g ~ 0 ~ CITY OF ZEPHY HILLS PLANS EXAMINER (5 G. L.5TE.VE. 6442. BP-ENTWOOD POR.C.HENCL05U~E. i; ..;.- /;~ 24 ! - I EXISTING pORCH 1+'-0" CONe. BLK. w/-5ILlS DRYWALL/PAINT d) o BL. 2.4 ALL WORK SHALL COMPLY WITH ALL PREVAILING CODES, FLORIDA BUILDTI';S CODE, NATIONAL ELECTRIC CODE AN;:! ClTY OF ZEPHYRHlLLS ORDINANCES REVIEW DATE 1- f r; -0 l{ CITY OF ZEPHYRHILLS PLANS EXAMINER. l-f (;. L.5T~VE. 6442. B~ENTWOOD PORC.H ENCL05U~E ---------- -- -------------------, 0 )>-1 (") , i N<<AIQto D!! c:: ~ Joi co ;;/ '8c. D!!...:t Joi ~ g,; r: :: I IiIJ 'U0\t"'1l!.I -..J I I LJ tIJ lJ:VI LJ ....CDCD t<....to 11 11 g. tIJ ~ OJ I N""c> m Joi.. 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Page 1 55040 nl/87> Issued 04-17-2007 TAILORED PROTECTION POLICY DECLARATIONS INSURANCE COMPANY 610] ANACAPRI BLVD., LANSING, MI 48917-3999 AGENC LEE REED INSURANCE INC 12-0154-00 MKT TERR 052 INSURI) GARY STEVE DBA G l STEVE CONSTRUCTION Renewal E~~ective 06-03-2007 (813) 782-5502 POLICY NUMBER 972312-20548117-07 ZEPHYRHILLS, Fl 33542-3328 Company POLICY TERM Bill 12:01 a.... 12:01 a.m. 06-03-2007to 06-03-2008 ADORES 37651 8TH AVE In consideration of ~t of the p~iu. sf-. below, this pOlicy is rttrWW8d. Pl__ .tt.ch this Declarations and .ttactwents to your pOlicy. If you ha_ any questions, pl__ consult with your agent. COMMERCIAL GENERAL LIABILITY COVERAGE LIMITS OF INSURANCE 6eneral Aggregate (Other Than Products-Completed Operations) Products-Completed Operations Aggregate Personal Injury And Advertising Injury Each Occurrence Damage to Premises Rented to You (Fire Damage) Medical Payments $600,000 600,000 300,000 300,000 50,000 Any One Premises 5,000 Any One Person Twice the "General Aggregate Limit", shown above, is provided at no additional charge for each 12 month period in accordance with ~orm 55300. AUDIT TYPE: Annual Audit FORMS THAT APPLY TO LIABILITY: 59350 (01-06) Il0021 (11-85) CG0220 (07-92) ILOOl7 (11-85) 55238 (06-04) 55196 (03-05) 54255 (03-02) 55157 55146 55296 (07-96) (06-04) (07-05) 55068 55188 55300 (08-89) (09-04) (07-05) '\ LOCATION OF PREMISES YOU OWN, RENT OR OCCUpy LOC 001 SLDG 001 37651 8Th Ave Zephyrhills, FL 33541-3328 TERRITORY: 006 COUNTY: Pasco Classiflication Subline Prelli.. Basis Rates Each 1000 18.861 4.432 PrelliL8 CODE 91340 Carpentry - Construction O~ Residential Property Not Exceeding Three Stories In Height Pre../Op Prod/Co..p Op Payroll 118,255 118,255 $2,230.00 $524.00 CODE 91583 Contractors-Subcontracted Work-In Connection With Building Construction, Reconstruction, Repair Or Erection O~ One Or Two Family Dwellings Prem/Op Prod/Comp Op Total Costs 550,446 550,446 Each 1000 .919 2.128 $506.00 $1,171.00 ... I". . :x ACORDTII CERTIFICATE OF LIABILITY INSURANCE I DATI! (1IIIIIIDD1YYYY) IPU34IVP 01/21/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lighthouse-Programs, LLC ONLY AND CONFERS NO RIGHlS UPON THE CERTIFICATE 301 E. Pine Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 350 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOIN. Orlando, FL 32801 INSURERS AFFORDING COVERAGE NAIC" INSURED INSURER A: SUA Insurance Company Southeastern Companies, Inc. INSURER B: 3350 Bushwood Park Drive Suite 200 INSURER C Tampa, FL 33618 INSURER 0 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 =ES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV ~ID CLAIMS. :=: rl POLICY NUMBER POUCY EPl'ECTIVE POLICY !XPIRATION UIIIT8 ~E.RAL UABlUTY EACH OCCURRENCE $ COMMERCIAL GENERAL lIABILllY PREMISES (E':.I:~::';:ncel $ I CLAIMS MADE 0 OCCUR M ED EXP (Anyone pefllon) $ - PERSONAL & AfN II\IJURY $ GENERAL AGGREGATE $ - GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ I POLICY n ~PRT n LOC AUTOMOBILE. UABILITY COMBINED SINGLE LIMIT - $ A lIlY AUTO (Ea accidenl) I-- I-- ALL OWNED AUTOS BOOILY INJURY SCHEDULED AUTOS (Perpel1lOn) $ - - HIREO AUTOS BODILY INJURY NON-OI/VNED AUTOS (Per acciden1) $ - - PROPERTY OAlMGE $ (Per sccidenl) RRAOE. UABlUTY AUTO ONLY - EA ACCIDENT $ AIIIY AUTO OTHER THAN EA ACe $ AUTO ONLY: AGG $ EXCE8SIUIIIBRE.LLA UABlUTY EACH OCCURRENCE $ :J. OCCUR 0 CLAIMS MADE AGG REGATE $ $ ~ DEDUCTIBLE $ RETENTION $ $ A WORKE.. COIIIPI!NSATION AND WSLTHPE 000082 04 12131/2007 01/01/2009 X I I~TJi- ~LCl'fERlr UABILITY $ 1,000,000 ANY PROPRIETORlPAATNERlEXECUTIVE EL. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ 1,000,000 ~~CI~~ribe ~~r $ 1,000,000 I PROVI I I EL. DISEASE - POLICY LIMIT OTHER DESCRIP110N OF OPERATIONS I LClCATlONII fYEHICLEB f EXCLU8lOHS ADDE.D BY I!NDOMEMENr f 8PECIAL PIIOVIlIIONS Coverage is extended to the leased employees of alternate employer (Alabama, Florida, Georgia, Indiana, Mississippi, Texas and Michigan Operations Only): G.L. Steve Construction f 0203268 (Effective 08-01-02) DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CERTIFICATE HOLDER CANCELLATION SHOULD /W'( OFTHE. ABOVI! DESCRIBED POUQES BE. CANCE.LLED BEPOREll1E EXPIRAllON DATEll1EREOF.THEIUUlNG MURERWlLL ENDl!AVOR'IOMAlLIlI DAY8WRlTTEN NCmCE.'IO ll1E CElmFICATE HOLDER NAME.D'IOll1E. LEFT, BUT FAlWRI!.'IO DO SO 8HALL IMPOlIENO OBUCMTION OR UABlUTYOF /W'( KIND UPONll1E.INlRJRER,ITlI AaEN'nII OR RI!PRESEN1lImVES. City of Zephyrhills Building Department .....[IIM AUTHOIlZED Rl!PRE.SENrAnVE. ........................................-. c....... ....... .. ..... 5335 8th Street . ~t:i~;:..:...::...:.:.:.;:;:..:. '.:~~.?:: ZeDhvrhills FL 33540 Page 1 of 1 ACORD 25 (2001/08) C ACORD CORPORATION 1988