HomeMy WebLinkAbout08-7915
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7915
7915
Permit Type: COMMERCIAL
Class of Work: ADD/AL T COMMERCIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv, Cost: 42,562.00
Date Issued: 7/31/2008
Total Fees: 587.50
Amount Paid: 587.50
Date Paid: 7/31/2008 Phone:
Work Desc: INTERIOR REMODEL FOR DEEP FRYER
Address: 6548 ALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0010-05600-0010
Name: PIZZA HUT
Address: 6548 GALL BLVD
ZEPHYRHILLS, FL. 33542
SEAN REILLY COMP PLUMB & WATER T PLUMBING FEE
SOUTTHLAND CONSTRUCTION SVCS IN(
L
FIRE PLAN REVIEW FEES
150.00
4"cJ! D~
V- I q _( ~ ~
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: ~h addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be ~ und in the public records of this county, and there may be additional permits required from other governmental
entities uch as water management, state agencies or federal agencies.
The pay ent of inspection fees shall be made before any further permits will be issued to the person owning same
"Warni to owner: Your failu record a notice of commencement may result in your paying twice for
improve ents to your p- . If you intend to obtain financing, consult with your lender or an attorney
before rding yo "ce of commencement."
"
/
/
/
;:
CTOR 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
Site:
3 D ('MD~6n ~v1
5-23-0 ~
fo 5 cf- 8 Gftl/ B7 LID
_r<efitod~) ( ~ ~ Me{ ~ 1r~er-
ContractorlHomeowner:
Date Received:
Permit Type:
Approved wino comments:D
Stl?it
,h>cd
ctor and/or Homeowner
equired when comments are present)
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813)780-0041 Fax (813)780-0044
Fire Chief Keith Williams
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: ~or~
Business Name:
Business Address: _ ,>< X" - / /
Business Phone No.:
Business Fax No.:
Contact:
pLAN REVIEW FEES
~ite Plan N/C
~ <)00 Muni-FamiIy/Commercial.06 sf
(Minimum Charge $25.00
o Plan Revisions DBL
INSPECTION FEES
N/C
N/C
$100
$250
$500
$100
Annual
1st Re-inspection
2nd Re-inspection
3rd Re-inspection
4th Re-Inspection
(Business ctosed until
violatiOns corrected)
SPRINKLER SYSTEMS
~ Hydro Undergrounds $45
HydrostatiC Test $65
Acceptance Test $45
Hydrant FIaN $75
SPRINKLER SYSTEMS
80 - 25 Heads $50
26 plus Heads $100
STANDPIPE SYSTEM
o Per Riser $50
FIRE PUMP
o Per Pump .
FIRE ALARM SYSTEM
8 0 - 25 DeviceS $50
26 plus Devices $100
SUPPRESSION SYSTEMS
8~~ :
BOther $50
KITCHEN EXHAUST
o Hood/Ducts
OTHER
8 LP Installation per tank
Fuel Tank Installation
(Per Tank)
o Natural Gas Installation
(Per System)
o Spray Booth
FIRE ALARM SYSTEM
B system Acceptance $50
Recall Acceptance $50
OTHER
~ Fire WalllSmoke Wall
LP Gas
Natural Gas
$15
$25
$25
$50 ~ Tent 1 0'x1 0' or greater
Fire Pump
Fire suppression
System Acceptance
B Exhaust HoodIDuct $30
Re-inspection DBL
(other than annual)
$50 0 Inspection scheduled DBL
and cancelled less than
24 hours
B constructiOn Insp. N/C
Emergency Vehicle Ao $50
PLANS TOTALCID - INSPECTION TOTAL[:=J
$15
$45
$30
$50
$50
$50
$50
GRAND TOTAL
Contractor: 31> COt\S~~V'\ 5e-\.lI'<.....
Billing Address:l \ \ 3 k~~{d~ t=:-~ bn-...
l)>( ~ n 8z..s-"
Billing Phone No.: 4~ [- 3~j'- ?~
Billing Fax No.:
Contact:
PERMIT FEE
$50
$50
$50
$50
$50
$50
$50
$50
$100
$500
$25
$100
$50
$50
$25
$50
$50
$100
150
Sprinkler
Standpipes
Fire Pump
Hoods
Fire Alarm
LP Gas
Natural Gas
F,:"!I Tanks- per lank
per system
per~
sparklers
Fire Wor1<s
Camp Fire
Controlled Bum
Hood/Duct
Place of Assembly
Fire Protection
Flammable Application
Waste Tire Storage
Generator < KW
GeneratOr >30 KW
Bio-Hazard Waste
Fumigation Tenting
Torch Pot/Applied
Haz. Materials
FALSE ALARM FEE
1 st Alarm N/C
2nd Alarm N/C
3rd Alarm N/C
4th Alarm $100
5th Alarm $150
6th Alarm $200
NON COMPLIANCE $150
Annual
Annual
Annual
$100 Annual
$50
$50
$100 Annual
FALSE ALARM
TOTAL I
J
per wall
per lank
per system
per lent
B
PERMIT TOTALCJ
I
150- I
Comments:
::or.S/3t:y g~ rn/t! f/:- rA.-
~~~~~~~~/J~III11III11III"'11II11111II1111111II11II
Rc:pl:1182533
DS: 0.00 Rec:: 10.00
OS/23/08 IT: 0.00
Dpty Clerk
JED PITTMAN
OS/23/08 04~J;ASCO COUNTY CLERK
OR BK 784~ 1 of'1
:) PG 359
NOTICE OF COMMENCEMENT
Permit No.
Property Identification No,
THE UNDERSIGNED hereby give informs you that the improvement will be made to oertain n:al property, and in accordance with
Section 713.13 of tile Florida Statutes, the following infonnation is provided in this NOTICE 01' COMMENCEMENT.
l.Description of property (Iepl~) 0').. -.;l" - 11 - c 01 0 - 0 S-G.o 0 - 00' 0
a)StreetAddress: ~SL\S G-o.l\ Q,\vci. z..~DVl\IYY\i\\'S. ~L ~35L{2
2.Genend description of iInprovements: t "'if' (Lto::. (l. rf-6-I1l>D c L- - ~ llD ~\Il.lftdlt.
3.Owner Information
~===:~~~~~~[~~) Po 6(1)(:~S~fO 10'\9~\\~ ~y
c) Interest in property
4.Contractor Information
a)Nameandaddre&5:~O ~f~~5\\~Y1' SE1V\C2 s ~~~:(~f~f~ _ ~P~CL~ _~r? ~f'~O-V1rb.. '32<3'25
b) Telephone No.: LtC', - 3a \ - -II -, y __ _ _ ___
S.Surety Information
a) Name and addre&5:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
':)
).ino''', IIII:} , _
---.......-__ "," 0 >1.181 /,'.j
" ------~ ~j~, " ('
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""" , C--~'" .~A7
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~1:~~8~1::! 81l8~'ld =10 3tiOr{AIJJ.)~1~,~J S/H1;..r,
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VO/801=1.:d0 3J,V1S
Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire Marshal
Kerry Barnett
Bus (813) 780-0041
Fax (813) 780-0044
May 30, 2008
Plan Review Comments
I have reviewed and approved the plan for an interior remodel located at 6548 Gall Blvd
Dr due to the following reasons. My comments have been placed below. Please contact
me if you have any questions with regards to my comments,
1. Panic hardware required on secondary exits if not currently installed.
2. Address front of building, 6" minimum.
3. Install smoke detectors in all storage related rooms. Detectors shall be hardwired
with battery backup and tied together.
4. Certified fire extinguisher Class K required in kitchen area. Certified ABC
extinguisher required to be in the unit.
5. Knox box required due to the suppression system. Application can be obtained
from Zephyrhills Fire Rescue, 6907 Dairy Rd, Zephyrhills. It shall be mounted at
the front door area at a height of 6' .
6. Install emergency lights in public bathrooms if not currently in place.
7. Plans and permit required from contractor for installation commercial
grease/exhaust hood over fryer. This shall include all details, specs, cut sheets,
etc.
8. Plans and permit required from contractor install suppression system for
grease/exhaust hood. All cales, details, specs, cut sheets, etc. required with plan
submittal.
9. Installation of gas lines requires a separate permit and plans by contractor
completing work.
10. Pizza oven shall have a suppression system if placing any items other than pizza
in unit.
11. GFI's shall be located anywhere within 6' of water.
12. Electrical panels shall not be obstructed. 36" required to sides and front.
13, Assembly permit may need to be re-applied for if seating capacity has changed
from original permit.
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE C.MlDDIYYYY)
"" 01/0212008
PfllotlUCIER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Hilton Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, eXTEND OR
10211 West Sample Road At TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 208
Coral Springs FL 33065 INSURERS AFFORDING COVERAGE NAlCfI
INtSUftEO Sean Reilly Plumbing INSURER A; Western Wortd Insurance Company
4844 Headlee Or. INSURER 8:
INSURER c:
Orlando FL 32822 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED aELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POUCY PeRIOD INDICATED. IIj()TWITHSTANOING
ANY' REQUIREMeNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC'J' TO WHICH THIS CeRTlACATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFOItOEO BY THE POLICIES oeSCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. exCWSIONS ANO CONDITIONS OF SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN ReoUCED BY PAID CLAIMS,
IMaR ~o.'~ POLICY NUMBCR PO~ICY Effl!CTlVC POLICY EXPIRATION
UMrnl
,,!!!,NIERAL LlABILIT'f EACH OCCURRENCE $ 100,000
A lL ~~ERCIAL GENERI1JIABILITY NPP1127175 08/22/2007 0812212008 DAMAGE TO RliNTED $ 50 000
- CLAIMS MACe X OCCUR UEo EXP IAn. one "",.."" $6000
PERSONAL & AOV INJURY $ 100.000
GENERALAGG~eGATE s 200,000
~'L ABBREnE LIMIT APn5 PER; PROoUCTS-COM~OPAGG _$ 100,000
X POLICY ~~,: LOC
~TOIIOBILE UA8It.ITY COM81Nlio SINGLE LIMIT $
- MY AUTO lea accidenl)
- ALL OWNED AUTOS 8001L'' INJURY
$
- SCHEDULED AUTOS (Per ""rson)
- HIRED AUTOS 800lL Y IN,JURY
$
- NON-OWNED AuTos (Pot lICdd8ll11
PROPERTY DAMAGIi J
(P.....o:I"""O
~RAGE UAIlIUTY AUTO ONLY - EA ACCIDENT ,
ANY AUTO OniER THAN ~ACC S
AUrO ONLY; AGG $
EXCES8IUMBR.ELLA W\IIIUrt' EACH OCCURRENCIi ,
:::lOCCUFl D CLAIMS MADE AGGREGATE S
Is
R olioUCTI8Le S
RErliNTION $ ,
S .' ,
WOIV<ER:s Co.oEflllATlON ANIl I..."/.;::;-J';t;. I IOdb'-
EMPLOYERS' UABlUTY E.L EAOH ACOloENT S
ANY PROPR.eTOR/PART/IlERlEXECUTIVE
OFFICliRIMr:MeeA exCLUOEO? E.L. DISEASE - EA EMPLOYEe $
~~~Mt~~v~~s b&IOW E,L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION 0" OHrtA'nON8 I LOCATIONS I VEHICLQ I EXCLUSIONS ADDED 8'1 I!NIlOIt$EMENT f 8PEClAL PROVISIONS
813-780.0021
Attn: Jackie
CERTIFICATE HOUlER
City of Zephyrhills
5335 8th Street
CANCELLA TION
SHOUI.O AHYOfTHli AIIOVE DISCMlCD POUClES N CAHCliLLm BEFORI! THI!I!XPlRATlON
DATI! THERl!:OI'. THE ISSUING INlNRIER Wl~L. IiNDUVOR TO MAIL. ~ DAve WftITTDl
NOTICE TO THE c:ERTlflCATe HOlDER.....m TO THE L&FT. BUT FAILURE TO 00 SO SUALL
IMPO$E NO OIlLlCJATlO , ANY ~o UPON THE INBURER, ITS AGI!NT$ OR
ItEPROENTATlVEB
Aunto IUi
Zophyrhllls, FL 33482
ACORD 2S (2001/08)
10/10 39'ii'd
38N'ii'~SNI NO~lIH
8L991PEP96
LE:60 800G/G01L0
\ .
~ 13-78G-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-78G-0021
Date Received
#71/5
Owner's Name
Ownef's Address I Do ~ oX ?F561 0
Fee Slmpte TItleholder Name I
r
LOU\ s\rd,\f', 'l t
.
I
I
I
I
B\vd. UJrn\/rh\\\S 33SLt21 LOT' I I
PARCELIDtI02- 210 - 2-1 -(\() \0 - 05(000 -OcDIO
(OBTAINED FROM PROPERTY TAX NOlICE)
o SIGN 0 MOVE 0
o OTHER I
o STEEL 0 OTHER J
Owner Phone Number
Owner Phone Nmnber I
Owner Phone Number I
JOB ADDRESS
Fee Simple TItleh0Ider Address I
I ( n5L\ S
I
G-oJ\
DESCRIPTION OF WORK
B
o
o BLOCK
I (UJ-foDi:.L
I
NEW CONSTR
INSTALL
SFR
I
E:f
l8J
o
ADDlALT
REPAIR
COMM
FRAME
DEMOLISH
SUBDIVISION
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUcnON
BUILDING SIZE
(,J'f/!;flI... n- -
SQ FOOTAGE I
,AJJr) p~~ f F~y€re
~SO () I HEIGHT I
" '"'' , " , " . . .
o BUILDING 1$
o ELECTRICAL 1$
o PLUMBING 1$
o MECHANICAL 1$
o GAS 0
FINISHED FLOOR ELEVATIONS I
ROOFING
l-rt1f"t~LUATION OF TOTAL CONSTRUCTION
AMP SERVICE 0 PROGRESS ENERGY D W.R.E-C.
VALUATION OF MECHANICALIHSTAUATION CD ~ DV c L
S~~I..
SPECIALTY 0
FLOOD ZONE AREA
OTHER
'-13, j) 0 Q
~,O()Q
I \,)\:.10
I
Il DOO
I
DYES
1~~,~~~tr;D??IN~~~~:Y
~ CLr'\ Urense' I C (2L Ol on '2 F) 2 I
. ~=;R: lSpyl(mt~sL~~Ytrrn0k1
~- <J'?;O-(,9J?,'}. Lirense' IC~G-CJ60 (o~ill
\\) COMPANY I Sb{,J (l.6ILL'( rWJ'lt$(,J c> '"
REGISTERED I Y I N I FEE CURRENT I Y I N I
Urense' ICF~oS7tt7 2 I
I
I
I
I
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
BUILDER
SIGNATUR
\....tfLUMBER
SIGNATURE
~HANlCAL
SIGNATURE
Address
Urense .
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
Lirense .
RESIDENTIAL
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Pennit for new construction,
Minimum ten (10) wor1dng days after submittal date. Required onsite, Construction Plans, Stormwater Plans wi Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Wortt Permit for subdivisionsllarg projects
AItach (3) campIete sets of Building Plana plus a Life Safety Page; (1) set of Energy Forms. R-Q-W Pennit for new construction,
Minimum ten (10) wortdng days after submittal date. Required onsite, Construction Plans, StoomJ8ler Plans wi Silt Fence installed,
Sanitary Faalities & 1 dumpster. Site Wortt Permit for all new projecls. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
-PROPERTY SURVEY required for an NEW constnJc:tion.
COMMERCIAL
SIGN PERMIT
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required.. (AlC 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 Servire Upgrades AIC Fences (PIotISurveylFootage)
Driveways-Not over Cotmter if on public roadways,.needs ROW
Jul 01 08 09:21a
o
4078427214
YUM Bid PraDO_I Commlttment Sheet
-.~.....
TVln.~___._.__ .~. EA_~~._ $1.000
~~ ~
11.EoUFMEHr---..-..------.---. ----.. 1,450
-. ~....:.."..:. .. .. -1::-- '.- !~"~.:.... - .i,':
""'~IF_'_"" -_..~._.--=r Ul ...- -
Olt1er- ~ntal Re'rlgtlralion --- '__1 _ _ " "_ ~
Olher SO
."12. FURNIS..NGS . --.--- -... $200
... '~..'" - ....-+- ~--t-f~"....-1
~n_____-=-~___ _"_"__.__
~~~~ ......-1= ... .r---t.-----.. S
-::-. --..--.. "_. __.,_u_. ..__. "__~-"-. .__:
=:14. co~~:s~s -. ~ _.. ". ~-.-.:~:: ..-_=t:=F~~ - .-:
15.r.ECHANlCA.~____._ ___ __. $12,
PkJmblt!9.~:!l'!t__ ____ ~ _. ~ ~_~$1,150.00 _ _ $1,150
~..:r~ = . j_ .'__ ..~-t::t~'47~~ _ -~ ~~4~
HV~! Curbs J l:!ucIi!!lV Devices. ___ ._-------.!. .__ LS $5.8211.c:m _ $5,820
~:ser H~OOd =--- =.-.:=." ~: 1. _= 3'$2.760.~ ~ S2.7:~
,Test and Balance Repod 1 5100.00 $700
_-~~.eLE~~:~.~r '. ':~'.:_ -:~+ '. ..=_!LS ----. .'_~'_~&.59~
InIerior! Exterior ~LJ.ILOING .!:!.~l FixlU~'__I_ _......!........ _-+-_ L~ ~6-,598.90_~,5
Racewa~JCDnduclOrSlo!!yices_. ____.____:__~ .__.. _.~
Electric/.DrYardl:.ighting ----.T""--.-I- is _ ---"-.,
;~;-D~~~~~laY~~____=~ =-C' -=. '-.=t-__ _ .-=--~ ..=.__=
BUILDING COST SUB-TOTAL
G_eo_CIOr:
"- tile
,....plt...
I
~
Profitand~.lIlt1ead...{.1 =1~. .15_!~%. .2~~._
Supervision (Elt .03=3%. .05:5%. .1.10%)
G~~ ~iti_~.~EX; .03s3%~ .05~~., .1;';i~)
Bonds
..-..-----.---.-......--.--
....._...,_._--~._.._._----_.
David DeVore
Signature
G.C. BUILDING GRAND TOTAL
Building CoeI per SqFt
OTAL BUILDING &. SITE
$42,562
IDIYIOI
J43,741
4nJ2008
Dale
ReM Resource Guide - Forms. YUM Bid Proposal (Fonn G-1) - R8\l1 . tOlOtlO2
p.2
4
3D
_______JluJ
Services, Inc.
11132 CYPRESS LEAF DRIVE
ORLANDO, FLORIDA 32825
Office (407) 381-7774 - Fax (407) 842-7214
License # CBC060252
POWER OF ATTORNEY
I, David A. DeVore, President of 3D Construction Services Inc. give
power of attorney to Dan Anderson SSN # 473-86-7766 to sign for any project
permitting in the city of:
ZeDhvrhills. Florida
- - - - n~ ed on this 22-
'........." YOLANDA D. MORENO
. 'm'~VPtJ."" .
. i~~ ~.{:'~ Notary Public - State 01 Florida
i. · . ~My Commission Expires Feb 5, 2010
I \~ ~l Commission # DO 514652 ·
",:",'1r,r........ Bonded By National NotIry Assn. .
day of May 2008.
4~/4L
(David A. DeVore I Contractor)
STATE OF FLORIDA
COUNTYOF ~~AN?~
Sworn to and subscribed before me this 2 2- day of
n4Y
, 2008.
~ ?-Dt 0
Personally known
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ACORQ.. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODIYYVY)
05/08/2008
PRODUCER (407)831-3832 FAX (407)830-4681 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Blackadar Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE
HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEND OR
988 Highway 427 North ALTER THE COVERAGE AFFORDED BY THE POlICIES BELOW.
longwood, Fl 32750
Fabiola Munoz INSURERS AFFORDING COVERAGE NAIC "II
INSURED 3D Constructlon Services, Inc. INSURER A: Auto-Owners Insurance 18988
11132 Cypress leaf Dr. INSURER B: Bridgefield ~loyers Ins Co 10701
Orlando, FL 32825 INSURER c:
INSURER D:
INSURER E:
COVERAGES
THE POlICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO ll-E 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 CERTFlCATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUClES OESCREED HEREIN IS SUBJECT TO ALL THE TERMS, EXClUSIONS AND CONOITIONS OF SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REOlICED BY PAlO ClAIMS.
INSR lIOO'l TYPE OF INSURANCE POLICY NlMlER POLICY EFFECTIYE POLICY EXPIRATION LIMITS
GENERAL UABlUTY 0346827263491607 06/21/2007 06/21/2008 EAOi OCCURRENCE $ l,OOO,OOC
r-x COMMERCIAL GENERAL UABlLIlY DAMAGE TO RENTED $ 50 , OO(
I ClAIMS MADE 00 OCCUR ~ MEO EXP (Any one pe<son) $ 5,OO(
A PERSClNAL & /ICN INJURY $ I,Ooo,OO(
GENERAL AGGREGATE $ 2,OOO,ooCl
GEN'l AGGREGATE lIMIT APPlJES PER: PRODUCrS. COMPK>P AGG $ 2,OOO,OOCl
I POLICY n ~ n LOC
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
All OWNED AUTOS BOOll Y INJURY
- $
SCHEDUlED AUTOS (Per peaoon)
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NQN-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE UABlUTY AUTO ONLY. EA ACCIDENT $
==1 ANY AUTO 01l-lER THAN EAACC $
AUTO ONlY: AGG $
EXCESSlUMBREliA UABlllTY EAO-IOCCURRENCE $
:=J OCCUR D ClAIMS MADE AGGREGATE $
$
==1 DEDUCTIBlE $
RETENllON $ $
WORKERS COMPENsATION AND 83032819 11/30/2007 11/30/2008 I we STA1U- I I OJ;';!'
EMPLOYERS' llABlUTY 100,000
B ANY PROPRIETORIPARTNERIEXECUTIVE E.L EAOi ACCIDENT $
OFFICERlMEMBER EXClUDED? E.L DISEASE. EA EMPlOYEE $ loo,OO(J
n yes, describe under
SPECIAL PROVISIONS below E. L DISEASE . POlJCY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICt.ES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECW... PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD /IJfY OF THE ABOVE DESCRIBED POlICIES BE CANCElLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING IHStJRER WILL ENDEAVOR TO MAil
_ DAYS WRfTTEH NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Zephyrhills BUT FAIlURE TO MAlL SUCH NOTICE SHAllIllPOSE NO OBlIGATION OR lIABilITY
5335 3th St. OF ANY KIND UPON TIE JNSURER. ITS AGENTS OR REPRESENTATIVES.
Zephyrhills, Fl 33542 AlITHORIZED REPRESENTATIVE ~~
Lorrie Jickell/SWEBB
ACORD 25 (2001108) FAX: (813)780-0005
@ACORD CORPORATION 1988
Jul 01 08 09:21a
o
4078427214
p.1
3D
"'JlFJl.l.Ja'rJlMl
Services, Inc.
11132 CYPRESS LEAF DR
ORLANDO, FL 32825
OFFICE (407) 381-7774 - FAX (407) 842-7214
FACSIMILE TRANSMITTAL SHEET
TO:
Bobbie
FKOM;
David DeVore
FAX NI.:~ER:
813-780-0021
DATE:
July 1,2008
COMPANY:
Zephytbills Building Dept
TOTJ\L NO. or- PAGES rNO.UDING COVER.:
2
PHONE NUMBER:
813-780-??oo
SENDElt'S REFERENCE NUMBER:
RE;
Pizza Hut 6548 Gall Blvd
YOUR REf'EKENCE NUMBER:
riJ URGENT riJ FOR REVJF.W 0 PLEAS": COMMENT 0 PLEASE REPLY
o PLEASf.; RECYCI.E
NOTBS/COMMENTS:
Bobbie, Attached is the back page of my bid ,vith Pizza Hut. The portion of the bid
that includes mechanical, plumbing, and electrical is $20,954.00. Please call me if you
have any questions.
Thank You Again
David DeVore
3D Construction Services, Inc.
Office Phone (407) 381-7774
Office Fo)( (407) 842-7214
E-Mail sgdove59@ool.com
Web Page http://www.3dbld.com/
SEAN REILLY COMPLETE
PLUMBING AND WATER
TREATMENT SERVICES, INC.
4844 HEADLEE DRIVE
ORLANDO, FLORIDA 32822
Office (407) 948-9045 - Fax (407) 281-1050
License # CFC057472
POWER OF ATIORNEY
I, Sean Reilly, President of Sean Reilly Complete Plumbing and Water Treatment
Services, Inc. give power of attorney to Dan Anderson SSN # 473-86-7766 to sign for
any registration and project permitting in the ,: r~'( of:
2.~fHWl(-t(t.-L.s I FLOyLi OA
Dated on this -ci4--- day of June 2008.
By:
qk
Reilly)
STATE OF FLORIDA
COUNTY OF ~ /\\ (S < .
Sworn to and subscribed before me this~ day of June, 2008.
~ilOl;l!:r'~Q8'.IIIi" iiI..... I"";, t..".... II' .......,
: PAULA J. MCCOY :
~''o~~~";7:'';, Comm# D00517204 :
.,~~+.~~ Exl'tres 2112/2010 E
"'l"lI-jzt Bonded t~ru (800"'32~254:
::;~;'~ Florida Notary Assn.. Inc i
. f f~.! ~t. .,,~. ....... .,.....II~I!!.l!l@lol
Personally known
Produced Identificat~~
Type FL~~LkD . ~~~:i~
ALEX SINK STATE OF FLORIDA
CHIEFFINANcrALOFl"lC~ DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
if * CERTIFICATE OF ELECTION. TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * if
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
.~~
. .
r. ~
04-17-2008
EFFECTIVE DATE:
04/17/2008
EXPIRATION DATE: 04/17/2010
SeAN H
PERSON: . RI:ILL Y
FEIN: 841635264
BUSINESS NAMe AND ADDRESS:
SEAN REILLV OONPLETE PLUMBINQ & WATER TREATMENt SERVICES INC
DBA SEAN REILLV PLUMBINQ
4844 H~ADL~~ DRIVE
O~LANDo
FL 32822
SCOPES OF BUSINESS OR TRADe:
1- CONsULTANT
3- REMODELING:
2- DRAIN CLEANING
4- CLEANINC/RCNQVATING BUILDINaS
IMPORTANt: PlrsuOJII In Ch~pler 440 . 05114'. F.li.. ID olfice, of t C:prporttloR II'ftll elects r.llempriDn from 1II1~ eft.p'or by WIng . c:.rtlflcltl! of election UDder Ihls
,pclin I11RY lOT r!eO~er Den.flU or culllpe~'~;on R.fer Ihls CUPI.f. PIII'$~lnt 10 CII'pl., 44ll.05t121. F.S.. C~rtrli~Jtes 01 81~CliOft In h~ .~.mpL_ Rpply ..11' wi/hi.. I~e
'C:Op, 01 th! DlI$lnes~ .or InCl. IISleCl II rile nn/i.. of .'oCtl.n I. be e~"'.IIL PVrllll1 to n'p',r 440.D5(191, F.S.. !foliC:,. of ellcliOG TO be eXi!"1It IIId clrTlfieatlli of
eleCTlaR la De elllmpl ;hlll 110 liUlljeel to rcvoclliol If. ~ IRY lime .Illt tile fillRg of tlie nolice Dr Ill. Inulel /If II, cenifit8lt!. lIIe ,enan allied an !lie IllIic. Dr
cel'TlfiClI. no longer 11I881' lIle feqrriremeln of Ibis seclian fur iU8lRCe Ilf . Ul'Tlflc.lo. The "e,.rtmen, shill t,YOk~ . cenilicttl II Illy II.! fOt f.llare of I.. perllOR
..m.d 01 Ibe eenlficlle ta lII'el lb leqlirelTllRl1 Of Ihi, ~,i;UOR.
DWC-25.l I;MTlfrl:ATE OF ELECTION TO BE EXEMPT REVISED 09-06
QUESTIONS? (850l .413-161
...... ...... ....... ...---....--.-.-.-.....,..-.-.......--. .... -....... ......-._~....._--_.. ."'-"", ....
STA1"E OF rLORIcA
Da-AR,TMalT OF FINANCIAL S~VICEs _
DIVISION OF WOIU(~ COIotPENSATlON
CONSTRUCTION INDUsTRY
C8~FlCAtt or- ~CTION TO BE ~ PROM FLORIDA . _' .
wtmkERS' COMPENSA,1'IoN LAw
EFFECTIVE: 04/17/2008 EXPIRATION DATE: 04/17/2010
PE;R50N: SUN 1"1 REiLLY
FEIN: 841835284
aUSlNESS NAME AND A.DDRESS:
SEAN REI1.LY COMPtETE PLlIMIIJNIO & W^1ER TREATMm SERVICES INe
08.11 SEliN RElT,~Y PLUMBING
4844 HEAo~"E DRIVG
O~LAI'ltIO. FL 32112:1
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
SCOPE OF BUSINESS OR TRADE.
,. ~QNl:U~ TANT
3. f'lEMOOeLlNG
2. DRAIN CLEANING
4. CLEANING/RI1NOVATING BUILOINGS
IMPORTANT
F PlIrsuant tc Chapter 4.co.05(14). F.S., Iln afficer af II l".nrporstilll'r who
OL I:lec;ts exemption tram this chepter by filing a certificate of election
under this section InIlY ntlt recaYer benefits or campe~ion IIOder this
D chapter.
H "urSUllllt ta Chapter 440.05{12l. F.S.. Certificat~s of electian to be
E exempt.. applV anly within the seD"e of the business or:. trade' listed an
the notice of election to be e;!tempt.
R
E Pursuant ta Chapter 440.05(13). F.5.. NDtrces of election to be exempt
lIl"Id certificates af election fa be exempt shall be !lJbject to revacation
if, at any time after the filinll of tile nllti/!", or th.. isSllallCc: of thc
certificate, the Person named an the notice (lr certificetr: no longer meetl
the requirements 01 tIIis SectiDn for isslIlIIlce 01 a CertifIcate. TI1e
dep.tmettt shall revoke a cllrtific~ ~ any timll for fllilure 0.1 the
IIp.f!l:nn 118m.1f on the l:Cr1ifi~c tll ",cet the requirements of this
section.
QUESTIONS? (850) 413-1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for yo~ records.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMf'T REVISEO os-OS
:arl K. Wood, Tax Collector Local Business Tax Receipt Orange County, Flori
lislo(:al bUSiness tax receipt Is in <ldditlon 1;0 and not in lieu of any otner \<Ill' ~uill;ll;l by IllW or ";'uniCip:l1 ordj".nce. Bv~fl'lP~~~ are subjert to r~ulation of zoning, health and I
wfu~~~Tf.11~.~(:eiPt is v;ilid from o~?>W 1 through Septem~fJl~ggceiP~Wl:9fd~uent penalty is added October 1. 1803.0089146
1e03 CONTR-PLUMSINC $Mon 1 EMPL.OYE:E :
TOTAL TAX
PREVIOUSLY PAID
TO-rAL DUE
$30,00
$0.00
S30.00
I.f..,."....-=_....--.....,"'..
/,~;:s:5"~i~~~.~~)~
/ :-..".,. \R~~;Y ~EANI't...!" \
. i;~t~,~~;~ " !
. " iREILLY sE~ Hi r
'. . .'.:~P'teADlE1;:'DR /
',J1E.NDo F,k.":"I?R~i~1716
,::ii:~s:~/ /
915/tD07 03:23 PM Csh 0044 Reg 0
T/Ref 00250Cfifi21 D&I: 9/5
$30_00 . Val No: 0025-0
4844 HEADLEE DR (MOBILE)
U - ORI ANDO. 32822
This reteipt Is official when validated by tne lax Collet;tor.
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFr;SSIONAL REG'OLATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TAL~SSEE FL 32399-0783
(850) 4S7-~3
REILLY, SEAN H
SEAN ~ILL~ PLUMBING
4844 HEADLEE DnxVE
ORLANDo FL 32822
,,-,r. -.-.. . . ...0.0....-...._........._.._.._.._. ,..._
. $TAn OF FL~DA AC# 27
DEPARTMENT OF BUSINESS
. 'PROFESSIONAL UGULATIC
CPC057472
09/06/06 0670
CBRT~FIED PLOMBXNG CONTRACT
RRtLL Y. SBAN Ii .
SEAN' REILLY PLUMBING
;J;S CBR'l'LFIEl:I lIIl&Ir tohtII p~c:rytsi_/lI Q~ ch
~irat.illD q~1 .A17Q 31, 2008 L06091
,..-
,
. . -. , -... - - ------......-
DETACH HERE
AC= 2783284 STATE OF FLORIDA
DEPARTM2NT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTR"!{ LICEl-iSING BOARD SEQ#T,06090ti
: - LICENSE Nl3R
09 06 4006 067011439 CFC057472
The PLUMBI:NG CONTRACTOR
Named belo~ IS CERTIPIED
nuder the provis~onsof Chapter 489 FS.
Expiration date: AUG 31, 2008
-
"' i
w.
", I
;
REILLY, SEAN H
SEAN RRILLY PLUMB~NG
13671 LAKa MARY JANE RD
ORLANDO FL 32832
. JES BUSH
nnVH!~lJn~
SIMONE MARSTILLBR
Qli!''''J;.1 "!TZl 'C'V"
....!.'.
"'
...u,,:-.l
.'~l):~:
~.'.
.' l.IOOa;~
. R400-788-8S-G23..o
~ HMRYRmLLv .
4M4 tIEADI..I!E IlfaVE
0IV.AM)0. FL 3824cloo
.~~
lIIRlH MIl! SI!X HIlT. leT, IHlOR&E.
01-u-85 M 5-10
~, ~ ~1'E
05-2&41 . 114MB . CJO.GD.<<I
~
C-:=:;YIihicM~C-ItIQ!r~P.st~~1w~
:SONtl FOa Pl~bing
(T)pe tltLlcen.. B'dcS)
INSURANCE AGENT Burton Harris
CONTRACTOR'S CODE COMPLIANce BOND
/lLL INFOI\!IAJ:!OH IS TO BE TYPEQ OR PRlIffiiD ~ ,A ru '\1
CONTRACTOR SON!) NOMBER 257951~\~ J=V iJ.
KNOW ALL l\fEN BY THESE PRESENTS
. 'BONE NUMsBR(-30S J ill-S414
That 'We. ~ean fSeau Com le~ .Plumbiu "Water T~ent Secv~ Iuc. and
(LiecnslJ Holdel"S NlDle ifIntlmm.u or NIIIIC IIld CCliipmy Naii If qmsIfftiug .. ~
Western Surety COmpany
(Wllfl1e of Ll1SUt'anea COiipeny Pl'twidillg aolld)
oil corporate authomed to do "business in the State of Florida (horeafter called Su:rety), are held and fianIy
bound. uuto Charlie Crist , , GovenIor ofth~ State of Florida, and his successors in
office, in thepenal S1.UI1 of Five Thousand Dollars ($5.000). tl1e true payment whereofWcl1 and truly to
be made we do bind ourselves, our respective heirs, e;x;eOiltors, adminfttrnto:rs, ~ucce$Bo1'S. gmlass.l.8os,
jointly and severally. firmly by this bond.
DATED THIS 9th DAY OF No'VclIlbex- . 2007
e C( d'"on" _this bJJlld. is ~h that if the above bound Pri2:1cipaI ~ the said
1. ~ .t'~ & \later shall prutcct aU persons suffering any
loss or dama.ge occasioned by said Principal. ailing to comply With any of the provisions of any'
municipal or county code applicable to the work performed by said Principal or officer. employee OJ:'
agont of said PrillCiipal~ or under the direction and supervision of said Principal and shall~ without
additional cost to the person for whom any such work is perfozmed, remedy all defects in said work due
to faulty 1VoT'bttamhip Qr lQaterial flnutshcd Of ~I:d by said PrinCipal, and s1lall reconstruct any such
defeotive work and. will replace Ol:' make good any such defective material to the satisfaction of the
inspector having jurisdiction of the class of work Ctnbnrt.ced in the Code applicable thereto, alt any tfme '
within one (1) year after the performanoe ofatty such work: by Said Principal, his agents or employeesj
and within folty-eight (48) hours after notice from such insPector to reconstruct, replace or .repair the
~.me. then this obligation shall bccomt: mill and void; otherwise to remain in full force and. effect.
The failme or default on the part of the Principal in remedying any defects in such work due to faulty
wo.dcznansbip or WClO.l'cCc.{ coIlStI'Uction or installation or due to faulty materials furnished or used by
said Principal, shall gi-ve the person for whom such work is pel'fo1'lt1ed. a right of action against the
Principal and Suret;y llnd1!, this obliptlon; provided, bOW<:vo<, (bat ""...at, action, or pl'OCeediz,g by
reason of any default shall be brought' on this bond after one (I) year from date of final completion of
the work done by the Principal for any such person.
This bond shalJ be contidered ~ontinuou:s l.l1lti1 such time as notification of cancellation is furnished to .
the HillSborough County Development Stmrices Divi$ion, COl1$tro.l;tiOU Licensing Team. Cancellation
must be received no less than IS days prior to the cancellation effective date.
~ Reilly~ Ile;iJly Oltpkte ~ &; Mater: .
~fMrIt ~ri('J<:lCl ITr Surety Western. Surety COJn~y ,
Primedrryped PrinoipalLicense Holder's Name 407-677-0080
PrIncipall.ieense Holder's SignJ'lnll'~
By
OS/23/03
Attorney-in-Fact Ot' Surety .ht:cn ~
(A:ffbc Insurance Company Seal)
El!ln;el 3E)ttd
IlICItVID ~g\11' 2DOt
.3:JNt'~r NOJ. 1!H
S,,9srPEt>9S
rZ:EI LBBG/€t/Ir
~,-
POWER OF ATTORNEy
KnowAllMen by Tlreael'rese1l18: . -., llONDl'Io.'" 25195Pl
- Ihlo """" 0' A"""'" , ... .... '" m -. ""'" ....... .. "" bond ""'.. . _ """""" OW ..,. ho de"""" by ..
approvln,e; offICer if de.c:irM. ~I WC8tl:rn Sure&)' Ccm~. a gO~tion, does lIc:cby make. Connlnne 81I<f appoint !he t'oUown.g
o H E' _ C!J lWtf1grized ind1v1<1r.laJs:
If OR t.!
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Sean H. Reilly
Complete Plumbing & Water Treatment
4844 Headl~e Drive Orlando, Plorida 32822
Fax Transmittal Form
To: 3-D Construction
From: Sean Reilly
Attn: Da Vti De Vore
Ph: (407) 381-7774
Fx: (407) 842-7214
Mobil;
Office:
Fax:
E-mail:
(407) 948-9045
(407) 281~1069
(407) 281-1050
SCREILL Y @ AOL.COM
Ur~:r:\t
For Review
Ples!'Ie Comment
}'1...,,,* Rl;lply
Date sent:
Time sent:
Number of pages including cover page;
Message:
Dear Mr. De Vore,
I'm sending this fax as requested by Dan Anderson regarding my Occupational license,
State license, Drivers license, Workef$ camp., anCl the comractors Code Compliance Bond,
etc. We are pleased to offer a sterling quality, full service company to meet all of your plumb-
ing needs. Feel free to call if you have any questions Or if we can be of assistance in any
way.
(407) 948-9045.
Sincerely, Sean H. Reilly