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Home My WebLink About08-8282 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 8282 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 8282 RE-ROOF ROOF REPLACEMENT NOT APPLICABLE Address: 6105 20TH ST ZEPHYRHILLS, FL. Township: Range: Book: Lot{s): Block: Section: Subdivision: ZEPHYR BREEZE Parcel Number: 02-26-21-0190-00000-0100 4,200.00 9/05/2008 55.00 55.00 9/05/2008 RE-ROOF 21 SQUARES RICHER, JUN & EDWIN 6105 20TH ST ZEPHYRHILLS, FL. 33542 Phone: 813782-2247 ({JJ~ q,lfiJS ~ (f , .. I/r/l) ( IIIX!-, // ~/ TAPE JOINTS ROOF INSP FINAL REINSPEcnON 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. II ~(~ ~4 . C OR SIGNA E PERM IT OFF I . PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER -~-IJ . EdWiAJ /ViMK l<icHB.te.. Q .Jh <. Owner's Address 6100 ~O. vfreR.~f; ZepAy,-h~l/s Fee Simple Titleholder Name I Fee Simple TItleholder Address 1 16/05 d-OM Sfre_e-r.) ~.e-phyrhdls) FL I Zephyr B"e~.z.e- 813-780-0020 . . D~ Received Owner's Name JOB ADDRESS SUBDIVISION WORK PROPOSED PROPOSED USE TYPE OF CONSTRUCnON DESCRIPnON OF WORK BUILDING SIZE BUILDING D ELECTRICAL D PLUMBING D MECHANICAL D GAS Phone Contact F.+x: (?6a)68~- 07::17 Owner Phone Number J' /:3 - 7 3 ~ - ;)..?- If '7 Owner Phone Number I Owner Phone Number 1 E3 D D I ((e-roof 1 E3 o o 33S-'l~ I LOT' 1 PARCELIDtI 0 J.-)..h-~-O J 9()-OOOOO -0/00 (OBTAINED FROM PROPERTY TAX NOTICE) SIGN 0 MOVE 0 /0 NEW CONSTR INSTALL SFR BLOCK o C8J. o ADD/AL T REPAIR COMM FRAME DEMOLISH OTHER I RE-ROOF (5h/~/L) STEEL 0 OTHER I SQ FOOTAGE I ;'t/ 00 HEIGHT I VALUATION OF TOTAL CONSTRUCTIO .--' 1$ 1$ 1$ ~ FINISHED FLOOR ELEVATIONS I - I I I o I DNO AMP SERVICE 0 W.R.E.C. ~/()ahCYZ o-f l<e-rct)f:t.J,u;o~ ~ .:1-5"/08. BO I (02/Srre-s) VALUATION OF MECHANICAL INSTALLATION ROOFING SPECIAL TV D OTHER FLOOD ZONE AREA DYES rr r r ""J BUILDER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT License # Y / N FEE CURRENT License . Y/N FEE CURRENT License # Y IN FEE CURRENT License # Y/N Address ELECTRICIAN I SIGNATURE . Address I PLUMBER I SIGNATURE I COMPANY REGISTERED Y/N COMPANY REGISTERED Y/N Address MECHANICAL I SIGNATURE I COMPANY REGISTERED Y/N Address / /<D.OF/I()6- ) ~ OTHER SIGNATURE COMPANY REGISTERED Address License # 1&C"53()~ " Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) wortdng days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Wol't( Permit for subdivisionsllarge projects Attach (3) complete il8&LDf.Building Plans plus a Life Safety Page; (1) ~t of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) wortdng days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Wol't( Permit for all new projects. All commercial requirements must meet compliance Attach (2) sets of Engineered Plans. -PROPERTY SURVEY required for all NEW construction. RESIDENnAL COMMERCIAL SIGN PERMIT Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, . Notice of Commencement Is required. (Ale upgrades over $5000) Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW N~TI.CE OF DEED. RES~~ICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" . whlc.h may be more ~e~tnctlve than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restnctlons. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors. to und.ertake work, the~ 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 ~nder state law. If the own.er or intended contractor are uncertain as to what licensing requirements may apply for the Intended work, they are adVISed to contact the Pasco County Building Inspection Division-Licensing Section at 727-847- 800~. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, 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 permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proce~d with the work a~d not as authorio/ !o viol~t~, cancel, alter, or set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the Building OffiCial from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized. by the permit is suspended or abandoned for a period of six (6) months after the time th~ work is commenced: An extension may be requested, in writing, from the Building Official for a period not t~ exceed nln~ty ~90) dars 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 NOT E OF COMMENCEMENT. ~~~RID~~URAT(F.S.117.03) I I ~ . OWN AGENT tcf~ f)1. K ~ CONTRACTOR cribeC! ang. s~ (or lJn'?e~re me this 1lf"A iItz..r uI -&bscribed and SWOI; ~by iii/IV. . 1"." I" us/- :2cOtr by IS~ ~nally k~ to me or has/have produced 0 IS/annle~' lU10wn to mi) has/h~ve p~u~ nor-I, , w'r's IJ~-I".!i&s Identification. as IdentificatIon. 1( ~O).j 3J'iI;)..f'7 ~~ y(~ Commission No.'Dl> '772 Fb mllr-fkc.~ 6Lrt:2-- Name of Notary typed. printed or stamped Lo-~~. ,fj~ Commission No. :J)]) 77:J-.!? ~ 5 M arfha."J? Ga r+z... Name of Notary typed, printed or stamped Notary Public l,.v.~~ P1l6~ . . r C '" '.... .-... ~ 1I',o)-OFf~O~ Notary PubilC State of Florida Martha R Gartz My Commission 00772865 Expires 03/27/2012 #~ P!I.t. Notary Public State of Flonda R ~t ~ Martha R Gartz ~ Co ,; My Commission D0772865 11',0)- o~ Expires 03/27/2012 OF '" Pasco County Parcel: 02-26-21-0190-00000-0100001 Page 1 of2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions other Agency Data: Tax Collector School Board Supervisor of Elections I Data Current as Of: I Weekly Archive - Saturday, August 30, 2008 Parcel ID 02-26-21-0190-00000-0100 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value RICHER JUNE M & Ag Land $0 RICHER EDWIN MARK Land $22,425 6105 20TH ST Building $65,294 ZEPHYRHILLS, FL 335422713 Physical Address Extra Features $10,671 6105 20TH ST Market Value $98,390 ZEPHYRHILLS, FL 33542-2713 Assessed (Save Our Homes) $61,986 Homestead 196.031 - $25,000 Non-School Additional Homestead Exemption - $11,486 Legal Description (First 4 Lines) Non-School Taxable Value $25,000 ZEPHYR BREEZE SUB PB 14 PGS 141-142 LOT 10 School District Taxable Value $36,486 OR 4124 PG 986 Warning: A significant taxable value increase may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) I Line II Use I~nln. I Units II Type II Price I Condition Value* I 1 II 0100 I S 00R2 I 6,500.00 II SF II $3.45 I 1.00 . $22,425 Additional Land Information II-Acres II 0.15 II Tax Area II 30ZH /I FEMA Code ICUIResidential Codell ZEBZLP1 I Building Information - Use 01 - Single Family Residential (Card: 001 of 001) Year Built 1977 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 Concrete or Cinder Block Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Ca rpet Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 Line Description Sq. Feet Repl. Cost New 1 FOA 348 $6,103 2 BAS 988 $69,308 3 FGR 288 $8,067 4 FOP 42 $772 Extra Features (Card: 001 of 001) I Line I Description II Year I Units Value I 1 II DWSWC 1977 500 $419 I 2 II CLFENCE 1977 800 $282 3 UDU-M 1989 1 I $215 4 POOL-6 1990 512 I $6,144 5 SCRN-AF 1990 1,824 I $1,642 6 COOL DK 1990 568 I $1,575 7 I UCA 1996 240 II $394 I I I http://www.appraiser.pascogov.com!searchlparce1.aspx?sec=02&twn=26&mg=21 &sbb=Ol... 9/5/2008 CClMlUTE ROOF PMPMATlllII- SSlVlCES PllGVIDElI TO IELP YOU AVOIl HASILlI AIID TO PII01fGT YOUR ~ &~ wI,li our factory........ Pnljact~. . miu. ""'" _n 10 prol8ClhotrMl _r, shrubs and londocaping. -tr Obtain end poll local pennies In aa:onlance wilh local laws. IIYl1TEM ~Remooe existing lingle roofing end hall_ all ~, . I dOOking for _n and _ wood. ~ "Q,... 0lli0Iing -.ng and _18pla"'!d at a COIl 01 ~ . per UNDULAVIIINT CuI \ l.}>f....t ' In willi 30 lb. Iotlltuoughoullho ...lite rooI. .p:'1l GL./IL.. ~ Oty-ln__,-ofoI5fll11forkMslope. OJ.,) ~ MIL f"'-'I-f nstaJl__101k b."ier...,-"", membrane In 'h. -.g .1.... ~ o Eaues 05kytighls ~ Ollem ~ o Chimney 0 Cridc8Ill 0 Low Slope Ll OIher ~ -e...Jc ~ o InsloII modified biIu...n in doad valleyo and kM oIopo ....... t.~ .J 'LASHINGS /I ~ oolot _ Custome... Initials :2{)-. inch ga/VanIZed or aluminum __ drill odg..t ..... & _ edgas. ~. . ':; now Iaad pipo boot noahings. U Instal new 26 gaug. galvanized, pnl-Ionned volley molal. So '- F D Inalon 1101.._ IdlChen and/or bath tan YOnla. o ROIlIoce okytighl VENTILATION o I...... ridgo ..nls . 0 ~, 011 rfdgo .....s . Olnata" 0",", .....ting. ~(') L F ~ Over DAI_m Color Custome~s Initial. RIDGE n Inotall pmnium high detioOtion r1dgo ~I_ ricIgo C P iooIV sweep job oita ~an out guI\af& ~ away an dabrio 10 applOY8d IaciIiIy ACCORDING TO FLORIDA'S CONSTRUCTION UEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB-SUBCONTRACTORS, OR MATERIAL SUPPUERS, THE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR. PRORERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FUU. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A UEN ON YOUR PROPERTY. THIS MEANS IF A UEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF UEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A "NOnCE TO OWNER:' FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED THATYOU CONSULT AN ATTORNEY. TM connctor....lo commtne:e WOIkhelanlerWll:hln IhIny (30) ct.y. 8Ret' the 1ut1O occur 01 '" fDIorwing: (1) It'lc:: COI*KIDr'hu **"'". naIIce III ~ twom-. Ownw. and (2) the "*-t_. reqund .~ .-atlIe 10 Conncmr. ContrIiC1Ot.... 10 pt'OIeQM work IMretner to oompIMion IInCI ~ ~ IN wort( wllhin . ........ tIMe, MJbjKt to such ...,. u Is perrni-.ible LRtet this ClDfItracL M",...,;.J. guaterweed ..~. All work __ b8 COC'llflItIId ~ to .MandIifd roofing pracIIOes. """.....MiOn or dewiation ham Nabow ~.irwaIvInO_ra cwta wiIIlNt ~ only llPM wma.n an:W Md... bec::omIl an....ctwge ~ IftG IIDcWe 1M .-rnenr. Ahhaughwe..use.u dw QUIon. we CMWIOt be raporlIibIlIlof craMd~. damagH from l'tIin. nail. 01-"" of Gocf. Arty.... due to wortnNIfwhip and "..... occurring dlJrtng dw 0......... ~ will be repaftd ~r our wrIa'en Guu.nIoe. IUrt darMgIt: due to ...... ~ aN noI the ~1IIy at Calia Rooftng. Inc.. .,. ItIe ....., IbM any conIict .... between at'tf ....... of COlItI of ooNl'rUCtion IftCI the -.ms of It'liI CoftIrKt. ... conwcr Mal be coMrOI*'sJ. Wilh P'opet ,*w. 10 .... Ownet. CCInIrIlGIor """ ....... ,.,..... hI.... ___ in ."'10 1no. ~ i.. Conb'aCtor dHm5 it...... '\a do IICL Thill ~ CIDNtiIutIs the entn Cll:lnb'IlCl by and betwMtt Comraacw Mtd OW,. and IN parties ... not bound by cnI apreuion or ~ by .... F*tV or aoent of eiItwr party. n. UcNe.prIdng, ipIICiiIiCadoM Met concMIonS aN heNby~. 'Ibu are alAharimd to cIO .. work .. apec:l1ed. 8ALA1C1E. DUE IN fVLL '" fta! OF COMPI..2TIOH op JOB. '" cue of... ~ 0/1 cWautI,. ce.rg. of 1.5'" pot'tNII'IIh.....-y on all baIlInon over 30 dayI: otd, I.,.....M. if Collis Roclfing. tnc. is reQUftd to.... any IlCIkIn to enforce" conINCt ..... PlY GelliS Aoafw'D Inc.', M\orMyfM&.nd COSIII, whether or noI ...... ia filed. 1'M prD quoIed rotl" propoaaI ShIM be good felt lftll1Y" or for SUCh IongIlr period ar 1M .. optiOn of the Canlractor. ,tcV,~ /A. Contract # DA~ ~[ .SEP-05-2008 10:48 Central FlorUl4's #1 Roofing Specialist! + - --- STREET EXISTING ROOF CONDITION p~~ ~~-( $ d?^" ,,, SoIution.1 Sublotal ~ . '-',.'" ,.,.'. Year Manufaclurer Warranty Year Full ~r Warranty o Rertltl\/EtlAep/a<:e 0 Ratrofit System Color Style Cualomer Inhials Solution *2.Su_1 $ COLUS 1lGIOfIi!lD&li1UnlQlUI Y..r Manutacturer Warranty Y....r Full Lebor Wanamy o RernoYelReplace 0 Relnlfh System Colot Style Customer Initials Solution *3 SultlOl8I $ fLAT",.w_SfSiEII Year Manufacturer Warranty Year Full Labor Warranty C<lIor Style Cuslomer Initials FlaI'LDw Slope S_' $ lOIA HO(jelrJ(, It~V!:.{ H1t-"J SoIulion Number L $ ";)b6 " Flat I Low Slqpe $ Other $ Other $ TOTAL INVESTMENT S CUSlOmer Initials Collis Roofing (Lakelandl 863 682 5757 P.02 485 Commerce Way Longwood,Aorida32750 321.441.2300 321.441.2313 (Fax) sales@col/isroofing.com www.coUisl'Oofing.com Rodda ate CcrtiW Roollft(l; Concnccor,. CCO,8022 lOWf ROO ING fY2 , (',J ..,C" ;..- TOTAL P.02 SEP-05-2008 10:48 Collis Roofing (Lakeland) P.Ol Florrdil Depanrnl-lnt..I! Busine$~(~> Professional Regulation ~LOg On . ..... . . ,'}'~!""'''''.''''''''''.T'''''''' ,.,.." .....,.. ............ .... . Public Services Search for a Licensee Apply for a License View Application Status Apply to Retake Exam Find Exam Information File a Complaint AB&T Delinquent Invoice & Activity List Search . User Services Renew a License Change License Status Maintain Account Change My Address View Messages Change My PIN View Continuing Ed '1 Term Glossary Online Help (FAQs) 863 682 5757 ,j, f' ~'- I OBPR Home , Help I Site Map 11:05;30 AM 91&'2004i Data Contained In Search Results Is Cu....ent As Of 09/05/2008 11:06 AM. Search Results Please see our glossary of terms for an explanation Qf the license status shown in these search results. For additional information, inducting any complaints or discipline, dick on the name. License Type Certified Roofing Contractor Address*: Certified Roofing Contractor Address*: Name Name Type License Number/ Rank CCC056813 Cert Roofing Current, Active 08/31/2010 Status/Expires COLLIS ROOFING ~N(; DBA MaIn 7143 COUNTY UNE RD. PLANT CITY, Fl 33567 COLLIS, DENN[~ Primary M.~ CCC056813 Cert Roofing Current, Active 08/31/2010 "'n 714Zf COUNn' UNE RD."LAN'l" CITY, FL 33567 -- * denotes Main Address -This address is the Primary Address on "Ie. Mailing Address - This is the addreiS where the lIICIil associated with a partk:ular license wID be sent (If different from the Main or License location addre$$e5). Ucense Location Address - This is the address where the place of business is physically located. T@rms of Use I I Privacy Statement I https:l/www.mytloridaliceose.comlwlll.asp?mode-2&search=LicNbr&SID=&brd=&typ= 915/2008 ~".. . ~'6 43' 8' 0.0' 'f '.:' ~'. .:.... <;~.. ::('::~1~~~: ~;:,;:.:f.~,'$TArE~otF.(~ltlDA;'.:., ~ ~ ....7 ..... 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"";-;.t~.. . -';'.':'''r.~:.:...:..:or'''''...': ':",;:,~' '~,' "".' ."f .:....,.. .;a,u.~. awv........... ...'-'V&1I....__'-~w_.~. .... :.. .. .,. ~ I ."....." or: .. . __......... ., ..... . . ,lNamed b.lo"~:tS 'CBU:trI~ . ~~~..; ',,;:.~~i: ....: . ~:~.:; . "."- = '. : UIlder the ,provi.ioJU .of. c;hapt.F::4'!'..J:~. ,,.: ...,;,';~. .~. .~irati~n ,'d~~.1 ("~tr~;: 3~~~..2~e!8:::""~:':,~,:~.:':~S.':!.~~.~:'~~~~~/; rr. . .... '..,". ....... ,." .':. ..t....~ ...,..,. '-tt..,.,','1'....-.:.,z ,,~.~:..~.... '~~r;.' .,..... . ,...... . .t ','" . .~. " ~....',' ........ ":1'.. .' ..':# ,:, '1J!o'~ -J:' . '... ,.;', . .' :.,r." ..c'" ..~,"... ~ {', , .J' '.'~:u..t..--.; .~~ t..' ' ...:. '. - : . ....".', '~" "',,:.:, ::'~:' :;"'.:': .:~'''' ~...?.::.:.-:..~!~~:p;t~:.:.:.::' 1: : LAKIER, JACK .DOUGLAS I..' ..:.....,.~ .:,.. \::''''oIt...:.;..!~~.~;. .,\' CO......s ROOP%IrQ'.m" ,: .....~.., . ..... '.'::II~''';" ,.'. .........:.J':z' ",;r'. .' ~.. ....... ..' . . ..... ....~ ~"',1-Il):...4....'. '~~smm~ R~A .:: . 'it? 3i;'01' ::':r.:~'r~~ "::~~:~~:,.'\~:::~'(~'. ''':'':'::'' , . . . . ..... ..' . ~li.' .'. -j . . . ':.. :~'..: .::;:.;:f.~~\:t)J{':.-:~~~ .~.~,,:' ~~: .... ". . I ." It - 1"" ..,: I...... .1c;". ,. . c'SPLAY AS ~Qui~~'.sv:tAW ....__._._... __to .... ~_..:. :'..._..... ,. .. ,.~"~...~.:".;'-,..-.." 5. 200r 3: 20P 7/24/07 175 W. LO IJ)CAT10N: 485 COMMERCE For the Occupation: CONTRACTOR/OVER 30 EM' " , .. -,. , DETACH HERE . '. ,~ . JEB BUSH' I. ': GOVERNOR ' :"1DU ,,) {; g') /" rf.. 4 glo~:// "/ :- // /' I.' . ,0 , ,J.. .~__.. _ . '.' . , :. I. '. ... :. I .I:~, \. I' SzNoNB~MARSTXLLER .' .~. :' il','..SBaBTART .. ;. . , . . J, '. .. -. ........- -.... .........-..--. SEP-06-2006 14:38 3213491000 97~ P.Ol ACORD". PRODUCER (954) 943-5050 FAX: Frank H. Furman, Inc. '1314 East Atlantic Blvd. P. O. Box 1927 PODlDano Beach INSURED CERTIFICATE OF LIABILITY INSURANCE ~7nMnoor> THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTlRCA TE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . 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. vc go:': '....,...,.., ...... INSR ADD'L TYPE OF INSURANCE POUCY NUMBER ~~:~ "8i'fl EXPIRAllON ~NERAL UABIUTY ~rf2,MMERClAL GENERAL LIABILllY I I CLAlMSMADE [!] QC90R GL01lJ.078 I k (813)780-0005 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELl.ED BEFORE THE City of Zephyrhills EXPIRA1l0N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 5335 8th Street !Q..... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Zephyrhills, FL 33542 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENlS OR REPRESENTATIVES. AUTHORIZED REPRESENTAllVE ~~# ;L.-.--~~_ Frank Furman, Jr/JC (954) 943-5417 FL 33061 Longwood FL 32752 INSURERS AFFORDING COVERAGE INSURERA:Crum & Forster SDecialtv INSURERB:North River Insurance INSURER C: Steadfast Insurance Co INSURERD:FRSA Self Insurer Fund INSURER E: NAIC# 44520 21105 26387 10023 . Collis Roofing Inc. POBox 520668 LIMITS A NN= $ " DAMAGE TO RENTED $ .,) MED EXP 'A~ one ~\ $ P~~"'~".' . .~VI"'" RY $ """'",,.,, A $ DR"""I"'T<: _ 1'11....."'p "I'J>. $ 1/1/2008 1/1/2009. :..r,. / V/ B ~LAGGR~E LIMIT A~ES PER: I POLICY I X I ~~ I ILlY ~OMOBlLE LIABILITY ..!.. ANY AUTO _ AlL OWNED AUTOS _ 5O-IEDULED AUTOS ...!. HIRED AUTOS ..!.. NON-QWNED AUTOS BODILY INJURY (Per ac:cident) COMBINED SINGlE LIMIT (Ea accident) 1/1/2008 1337250375 1/1/2009 BODILY INJURY (Per person) PROPERTY DAMAGE (Pet accident) GARAGE UABILITY R ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN ".. 4f'''' $ AUTO ONLY: EXCESSlUMBRELLA LIABILITY jJ OCCUR 0 ClAIMS MADE C ~DEDUCTBLE AUC914077101 "x1 R~J:NTIOtJ !: 0 D WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETORIPARTNERlEXECUTIVE _. / OFFICERlMEMBEREXCLUDED? H~/ 870033379,// I ~~,~ribe under (__. _::/ OTHER AGG S I~ 1/1/2008 1/1/2009 AGGREGATE S $ S s X I WCSTATIJ- IO~- E.L EACH ACCIDENT S 1/1/2008.-<'1/1/20_09 .... E.L. OISEASE-EAEMPLOYEE $ '- -=>-..,-,--' E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATJONSlLOCAllONSNEHICLESlEXCLUSIONS ADDED BY ENDORSeMENTlSPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) INS025 (0108).08a 1,000,000 50,000 Excluded 1,000,000 2,000,000 2,000,000 $ 1,000,000 $ $ $ 3,000,000 3,000,000 I r I I 1,000,000 1,000,000 1,000,000 @ ACORD CORPORATION 1988 Page 1 of2 J ./ L~/ To All Whom It May Concern: City of Zephyrhills, Florida Building Department From: Collis Roofing, Inc. 2323 W. Memorial Blvd. Lakeland, FL 33815 I, J. Douldas Lanier, the holder of Florida Roofine: Contractor License registration number CCC058022, hereby name, constitute, and appoint Robert L. Sams, Dennis M. Collis, Jay Co Mott, Anna L. Lones, Donald M. John, Martha R. Gartz or Christopher Tyler Rackham as my attorneys-in-fact for the purpose of applying for and receiving permits in my name. I hereby represent and warrant to the City of Zephyrhills that all work is performed under my supervision, and that I shall be fully responsible for the proper performance of said work. Check one of the following: ( ) This power of attorney and authorization to draw permits is limited to the job described as NIA (Type of construction-location) (X) This power of attorney and authorization to draw permits shall continue in full force and effect til I deliver to you a letter revoking the power. STATE OF FLORIDA COUNTY OF POLK Signature of Applicant: -I~ The foregoing instrument was acknowledged before me this 1K- day of A'J().Sf, 200~, by J;e.k.l1~Aa.s ~CU1J e r , who i~rsonally known to ~r who has produced /'J I A as identification. I Notary-Public: State of Florida: Sign ~ 'f! J1cU; Print Irlarl hit '1? Go rf~ Seal: ~. -11,,<< Notary Pub!lc Stale of Florida ~ ~" Manha R Gartz :, r' .; My CommiSSion 00772865 ~..:..- oQ Expires 03/27/2012 .FOFf\: SEP-22-2008 10:34 Collis Roofing (Lakeland) 863 682 5757 P.02 Citx (Of Z~hyr:hills Bll1LDING DEPARnfENT RE: Permit # g~ 8 :J 9/17107 Inspection Affidavit I j {JOUtJ1 a~ La ~ tLr (please print namc;t; circle Lie. Type) /Engineerl Architect, Inspector* License #; (~ D5 8Q;)c;) On or about Cfj 11,0 / 0 ~- (Date & time) deck nailin~ and/or secondarv water barrier work at 6/05 C;;o 11C tQ.ppc-r (circle olle) (Job &k: Address) ~f'pJ.J~ J/JU ~ PL 33S2J~ . Based upon that examination I have determined the installation was done according to the Hurri e Mitigation Retrofit Manual (Based on 553.844 F.S.) STATE OF FLORIDA COUNTY OF . &... swom(;2to dsub~~~.~dayof .."J.....h...... ~ ~~.~~ Notary Public, State of Florida //N A JfJ L LoN~S (Print, type or stamp name) . 2oo...! r --~~::-. i e. '- ~1II412D10 i . SGnded UIIv (8OD~...2SI i - FbIcr. IIIoClIIy AS$ll lnC ......... .., ........... ... ... .............: ...., Commission No.: "0005 1[(3 ~ll Personally known V or Produced Identification_ Type of identification produced. .. Genc::nal, Building. Residl!Dtial, or RoofiDg Comracr.or or any iDdividual certified UQdc:r- 468 F.S. to make sueb an iDspectiOll. Inchxle photographs of each plane of the roof with the permit # or address # clearly shown marked 011 the deck: for each inspection. TOTAL P.02 .4. 'cCt ~. \).5. SEP-24-2008 13:20 Collis Roofing (Lakeland) . . .------"-c..n-,.. 1liIS IS TO GERTlFY THAT THE FIlfIEGOING IS A ,T1!:~~.C2/'YO OF THe DOcUMQlTON FILE 011 Ie ~ THIS lIl'fl~. WITNESS MY , ~1I0 OF IAl.~ THIS~OAV.OF .~~ . ~ I .' ITCOURT I ih . , !. . 'r.' ,'DEPUTY CURl< \\ ~J '. '-'.....~~ ,/ NO'nOOIl'COMMJ/INCDnP.!a ~..~~,\. ~- ,~"""".D'" ~.:lI-OI",,,,,,,,,,,~/t>D .. . ~J.i~ '-"11 ~ ~~:zb OR Ik f~1=, IIG 2a2 ~~.....,....................... ...................._1-..;. ...~. -- . . ~- .................... I.............. NonCE"~ -~ ..... s.u.. '7l1.13 eI.. I. I.erf~:--m:~(..........~~13~ 1'8 !:I ~ 141-/~~ ~, - "" P6; '18" <v MOs- .a".... tir.. ~"'''4; F~......."!;\ ~ 2. 0eIIaaI......... or..._l.--...:~_ r"td :to. "'-- Etlw!."f!!!Jt:-r ~ Ow-.Addraa: .h/~ 'hi-:, z.~'y,.J.;/lsJ FL 33S.I/:L- _ 3b,. 0wIIr..........:--"itb7b'" ___ 3e. F.SIlapJeTllleholder(ot...._.~ NlA AdIhsa: ... = c.tnceor~ ~.~ . Adchu: ---.2323 W. ~I ih:. 1--"",,,, PL 33116 S..., ~ NtA AddNII: ,. ....... N..: Nt A ~ 863 682 5757 P.02 111.IIIIRIIIIIRII.llllllllllnlll 211II121182 1taDt.: 1211541 Reel II.. DS: I.. IT: ... 1I11S118 _tv Clerk -= a.e..:.: "--: 7. Penaa widde .... StIle ofPlarida ..a..; ......y by ....1IpClII..... ....01'.....0: L_ .., be __.. JII'OYided by Scclion 713.I3(IXa}7. Florida sa..... NMlc:NlA Adhis: ...... N.ar: t. In..... ill ~ 0...11 T't . . die fiIIIowiIIa ___ ill.... a tlllp)' of.... Ue.or'. Nadoe at provfcW fa SectIaa 713.13(1)(b).Pfarida S1IMa. Name: NlA AddmI: ....~ 9. Ilxpftdoa ... ofNadcle ott)r- ~ In LI I (apindaa ... is _ (I) ~ Ii.- .... "'--... ............ ... it speciW). WARJIIING TO 0WNEIl: ANY PAYIlIENTIII.\DE ay '1'1II: OWNDlA.Fl'l:ll TBE EXnMTION CW~ NO'I1CE 01' COllllllDrC:Dll:H AU: CONIUloaDlIlIPIlOIiraPAYIIDrTs UNIIIEa CIIA.Pha 713, p.urr 1.8KC1'IOror TlJ.l3,J1.OIUDA h'A11I'I'IS. AND CAN IlESVLT IN YOOIlPAYING 1'WJCI: ftJJl DII'IIOYDams TO YOVa 1'IlOrI:ItTy. A NOnCE or- COIIIIIENCDII:NMIllrJ' -III:COUI:D AND I'OftD ON '1'1II:.... Rn: DnME ..........1IaItaIun. D' 'YOU IHI'I:ND TO O8TAIN I'II'fA.NaNG. CUJlllULTWrm \'0IIIl LDmI:aoa AN AT1'DIINE\' ~ COIGIDIaNG wou: oa DCOIUIING \'OUlNO'nCK OPC'OIDIIENCII:II. . ./t:?~' ~ ~~ ,.....ofaw..CII'O--O.A.........~ SlATEO)rPLOmDA.. . COUNTY op.. PMe-O n......~_..: -.... w.._.. /3 _of 1_"J..vs+- .211 OF -,>=/fJuJ", M. ff.t~ .. ..... ~~... N/" =.::.......... OR" AJ2;o~i3s- I~ 7. J:'~A-7:Jr.wd-s ~sc) . . 9~~-'. _ _ ~ . Ll Nil J ...........ot...,.,............ .......................... ....~~ __ _ __.. /J;:' 17 ,I -L&aMEa c....rk 1M. A l.eJ~ . ....._ orN......rer-,.....""'- . ...:::=-_ lIpMld"""2lllII (A GIllY .,......._ .......... .......,..........,.. ......,- .... ~... TOTAL P.02 SEP-24-2008 13:20 Collis Roofing (Lakeland) 863 682 5757 P.Ol COLLIS ROOFING FACSIMILE TRANSMITTAL SHEET TO: FROM: DATE: 9 /~ftJ' (9/3) 781J~ OO:J{ PHONB NUMBEJt: TOTAL NO. Of PAGEs, INCLUDING COVEll: ~ SENDER'S ItEFERllNCE NUMBER: RE: YOUR RUERENcE NUMBER: o URGENT 0 FOIl REVIBW 0 PLEASE COMMENT 0 PLF,ASE REPLY o PLEASE R.ECYCLE PHONE: (863) 682-5700 PAX: (86.3) 682-5757 2323 W. MEMOR.IAL BOULEVARD LAKELAND, FL 33815