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
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BUI::GDINGJlLANREVIEW COMMENTS
Site:
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'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
@:.
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DRYWAl.l/ PAINT
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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.
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EXISTING pORe. H
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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.
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EXISTING pORCH
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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
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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