HomeMy WebLinkAbout09-8741 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 8741
BUILDING PERMIT
Permit Number: 8741 Address: 37350 CASTLEBERRY AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: WEDGEWOOD MANOR
Est. Value: Parcel Number: 10-26-21-0120-00000-0680
Improv. Cost: 5,600.00
Date Issued: 1/28/2009 Name: DRIVER, NORMAN & DOROTHY
Total Fees: 90.00 Address: 37350 CASTLEBERRY AVE
Amount Paid: 90.00 ZEPHYRHILLS, FL. 33542
Date Paid: 1/28/2009 Phone: (813)783-1568
Work Desc: REPLACE 12 WINDOWS SIZE/SIZE
WEST COAST WINDOWS&E ERIORS I BUILDING FEE 90.00
V
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one 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 R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions'
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work,they are advised to contact the Pasco County Building Inspection Division--Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the 'contractor Block'of this application for which they will be responsible. If you,as the owner sign as the
contractor,that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTIUTILJTlE3 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 bugs,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,
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 Agric u e 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 conwnencen'ient.
CONTRACTOR'SrOWNER'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 penal 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 n 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,Wand Areas and Environmentally Sensitive
Lands,VVaterllNastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seavarlls,Dodos,Navigable Waterways.
- Department of Hearth & Rehabilitative Health Unit-Weis, 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 till:
- Use of Till is not allowed in Flood Zone V unless expressly permitted.
- If the liii 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 fig material is to be used in any area. I certify that use of such till 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 binding 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 codIi .ng.gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or
set aside any provisions of the technical codes,nor 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 shad become invalid
unless the work authorized by such permit is commenced within six months of permit issuance,or it work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested,in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
Y R ATT Y
FLORIDA AMAT(F-S.117.03)
OWNER OR AGENT
Subst5ed and sworn to(or aTmred)loam,me & aLdnd ed)bdore me Otis
by i - byly�xviU Da1lbGuu ry�
Who Islam personally known to me or hasi a'.e produced Who Ware persondy mown to me or has*are produced
as iderr6bcason. ai idi melon en .
No (�� j�
tary Pubic v�•`^o, Notary Pubic
commi•ssion No. commi�ion�. NOTARY PUBLIC-STATE OF FLORIDA
Christensen
ypes,printed or startped Nameor `� C`nmmicsian#DD803031
Name of Notary t
N°m°'hped•p'tr"ed 'tar"p°d /Expires: JULY 02,2012
BONDED THRU ATLANTIC BONDLNG CO.,INC.
WEST COAST WINDOWS,INC. ra_ VINYL DOUBLE HUNG
8106 TEMPLE TERRACE HWY.
TEMPLE TERRACE, FLORIDA 33637 VINYL SINGLE HUNG
(813) 631-0097 • FAX (813) 631-1426 VINYL GLIDER
{ Hillsborough: SP12954 • Pinellas: C-6530 VINYL SLIDING GLASS DOOR
www.changeyourwindows.com ALUMINUM SINGLE HUNG
n' ALUMINUM GLIDER
Name IV0 eA i - OO( QQ/U % ALUMINUM SLIDING GLASS DOOR
Address n'19v Ci9 Star 6 :; t DOORS
City
28w4t R N/11,Ir 1'U9 . 3JSV Zip STORM PANELS
ACCORDIONS
Home Phone Fax ARMOR SCREEN
Work Phone: (Mr.) OTHER
(Mrs.) S 6ocaa, lw'Q
, d Glass for windows: 1� OW-
Window frame color: UN QN L _` , Panel Type
1 st Floor 2nd Floor
`
I A
Notes:
3/ao J I w�wzc�c�l
TERMS OF PAYMENT
BUYER,do not sign this agreement without first having read it or if it contains any blank spaces. DEMAND
A COPY OF THE AGREEMENT WHICH YOU HAVE SIGNED. A 50 percent deposit is required on all
installations.
Mak7hecks payable to:WEST COAST WINDOWS. Date ' b B .
Price
Purchaser
�a go D Less Down Payment
a �O Balance Due `i/ ' Purchaser
on Installation VL�
Seller
Financed Amount
CONTRACT SUBJECT TO ADDItIONAL TERMS ON REVERSE SIDE
Pasco County Parcel: 10-26-21-0120-00000-0680 001 Page 1 of 2
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Other Agency Data:
Data Current as Of: Weekly Archive - Saturday, December 13, 2008
Parcel ID 10-26-21-0120-00000-0680 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
DRIVER NORMAN&DOROTHY Ag Land $0
37350 CASTLEBERRY AVE Land $21,496
ZEPHYRHILLS, FL 335427959 Building $112,518
Physical Address Extra Features $1,044
37350 CASTLEBERRY AVE
ZEPHYRHILLS, FL 33542-7959 Market Value $135,058
Assessed (Save Our Homes) $96,016
Homestead 196.031 - $25,000
t i ,fi (First 4 Lines) Non-School Additional Homestead Exemption - $25,000
WEDGEWOOD MANOR PHASE I &II
PB 27 PG 11-14 Non-School Taxable Value $46,016
LOT 68 School District Taxable Value $71,016
OR 3565 PG 774 Warning: A significant taxable value increase
may occur when sold. Click for details
and info, regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price Condition Value*
1 0100 SFR 00R4 4,500.00 $4.65 1.00 $20,925
2 0100 SFR 00R4 1,245.59 $0.45 1.00 $561
3 0100 SFR 00R4 971.00 $0.01 1.00 $10
Additional Land Information
Acres 0.15 Tax Area FEMA Code
- Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1996 Stories 1.0
Exterior Wall 1 Above Average 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 Description Sq. Feet Repl.Cost New
1 1,600 $116,848
2 30 $584
3 484 $14,168
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 1996 420 $756
2 1996 160 $288
Sales History
Previous Owner RYMAN NELSON L&
Year Month Book/Page Type Amount
2007 04 $0
http://appraiser.pascogov.com/search/parcel.aspx?sec=10&twn=26&rng=21&sbb=0120&... 12/14/2008
STATE OF PASC(J FLORIDA
COUNTY OF PAS 1111111111111111111111111111111111111111111111111111liIIIIII
•
THIS IS. IFY THAT THE FOREGOING IS A 2008180496
TRUE AND C R OCUMENT ON FILE
OR OF PU If E� NESS MY Rcpt: 1218485 Rec: 10.00
HAND AFFjCIRL� HI , DeY OF DS: 0.00 IT: 0.00
12/22/08 Dpty Clerk
JE PI �I L T 6bUBT,
t T•'D 1TY BY CLERK JED PIT ppSCO�, �� •• �p'� _- NOTICE OF COMMENCEMENT 12/22/08 1 t: COUNTY 32am 1 of CLERK 1
OR BK 7987 PG 923
Permit No.
Property Identification No. 1 C °� _ ? 0 t 1 U O H7 O( C - ' O
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and m accordance with Section
713.13 of the Florida Statutes the following information is provide4.in t1js NQTICE OF COMMENCEMENT.
f;grfuwll .Y44)( lmIJ N ittI ( 3 Ski
1.Description of property(legal dererrpdoa
a)Street Address: ' - rp S L p t 6 r_ 331-
2.General description of improvements f C. p J_V'-L 4_ j a. iN i N O tl W J i`Z( FS i Z tr
3.Owner Information
a)Name and address: Jtl/o i2 tm A tj DO RO3'1-i Y D iU ,E R S 49 ^ S . 190V r
b)Name and address of fee simple titleholder(if other than owner)
c)Interest;nproperty ._. Er,t L 1 £ .ACC N
4.Contractor Information Y/0, I
AM
a)Namandate: Or+ST WiAfDoWs Jn1 G T_PL 'rEekfCE F . 33637
b)Telephone No.: . .'3_.-00 7 Fax No.(Opt)____________________
5.Surety Information I A
a)Name and address:
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt)
6.i.ender
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address- _—V
b)Telephone No.: Fax No.(Opt)
8.In addition to'himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes:
a)Name and Address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is
Specified):
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
�.
COUNWorr JULIAM.�AVALUM_ J Wfr-
`,.' ;s Sigaature ofOwar or Owner's OI}iorr /Manager
Ni l GOMiASfiiON l DD 801827
= . <= EXPIRES:June 30 2012 ,
RF ended lhv War/Pibfic Underwi tel: Print
The foregoing was acknowledged before me this day of .U..cr bRK .20Q%,by d b V Ct t"
____ __ as 1 s c.2,r (type of authority,e.g.officer,trustee,attorney
in fact)for (name of party on behalf of whom instrumeenntwas execrated).
Personally Known OR Produced Identification_ Notary Si
Type of Identification Produced Name(print) U \l Q Ct \JC11 VZ Z�
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief
t77c ti(�-' �. /< V �v ,•ems
Signature of Natural Pawn Signing Above
FORMSAd0C.ry d2W7
11250 N.
TEMPLE °
City ofTem le Terrace Qccup lton i eV `
�7 COY rr
BUSINESS NAME: WEST INDQW 4
BUSINESS LOCATION: 8106`fiE E w
APPLICANT: .; $h
BUSINESS CLASS: CONTRAC � TOE U
WINDOW/ST NE..Its l Vl; NORMAN
WEST COEDS 1111S
is
WEST COAT TEMPLE TERRACE HWY
TEMPLE TERIC iwndl
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12/15/2008 MON 10: 50 FAX O001/001
DATE(MMADIYYYY)
ACORDT, CERTIFICATE OF LIABILITY INSURANCEI 12/15/2008
PRODUCER Alliance Insurance Solutions LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PO Box 1777 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
St Petersburg, FL 33731 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
727-497-1247
www.ins4biz.com INSURERS AFFORDING COVERAGE NAIC#
INSURED Progressive Employer INSURER A.SUNZInsuranceComnany 10133
Services VI, LLC INSURER B.
6407 Parkland Drive INSURER C:
Sarasota FL 34243
INSURER D:
INSURER E.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
i4S lOOTPOLICY EFFECTIVE POLICY EXPIRATION
hR N TYPE INSURANCE POLICY NUMBER DATE IWdVOIYY1 DATE LIMITS
GENERAL LIABIL17Y EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $
CLAIMS MADE OCCUR MED E(P(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LINT APPLIES PER: PRODUCTS-COMPIOP AGO $
POLICY PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGELIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WC STATU- 0TH-
WORKERS COMPENSATION AND
A EMPLOYERS'LIABILITY WCPEO000000603 10/20/2008 1/1/2009 E.L.EACH ACCIDENT $ 1 000 000
ANY PROPRIETOR/PARTNERIEXECUTIVE WCPEO000000604 1/1/2009 1/1/2010
OFFICERIMEMBER E7XCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1 000000
K yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1 000 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
State of FL Coveragge Only
Coverage Provided-for all Leased Employees but not Subcontractors of:
West Coast Windows& Exteriors, Inc.
CERTIFICATE HOLDER CANCELLATION
SHOO LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Zephyrhills DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
Attn:Building Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 80 SHALL
813-780-0021 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
5335 8th Street •10 Days for Non-Payment of Premium
Zephyrhill FL 33542 THORIENTAT,PEE. Y
United States AUTHORIZED REPRESENTATIVE
Douglas Lilak �"
CERT NO.: 1181999 C:IEYT CODE: ?E3V Virginia ?rofLitt ?hone: 1 911 925 2990 12!15%2UU8 7:51:46 *G&RD25(2001108) C ACORD CORPORATION 1988
1211512008 14:00 Jefferson Allsopp Inc FAX 863 688 6417 P.0021003
ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE MJD o s)
PRODUCER (863)688-7691 FAX (863)688-6417 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JEFFERSON-ALLSOPP, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P 0 BOX 3667 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
439 S. FLORIDA AVE. , SUITE 201
LAKELAND, FL 33802-3667 INSURERS AFFORDING COVERAGE NAIC N
INSLRED WEST COAST WINDOWS & EXTERIORS, INC. INSURER A: STATE AUTO INSURANCE COMPANY
8106 TEMPLE TERRACE HIGHWAY INSURER B.
TEMPLE TERRACE, FL 33637 INSURERC
INSURER D.
FAX: 813-631-1426 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DIYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY SOC2466664 04/12/2008 04/12/2009 EACH OCCURRENCE $ 1,000,001
)( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,001
CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,001
A PERSONAL&ADV INJURY $ 1,000,001
GENERAL AGGREGATE $ 2,000,00)
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,001
POLICY c7 LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSILAIBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WCSTATT- OTH-
TORY IMIT R
EMPLOYERS LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCDEN7 $
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFiCATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WLL ENDEAVOR TO MAIL
CITY OF ZEPHYRH ILLS 1O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: BUILDING DEPT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILITY
5335 8th STREET OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES.
ZEPHYRHILLS, FL 33542 AUTHORLZEDREPRESENTATIVE 1 g�
JAMIE POLLARD KIM
ACORD 25(2001/08) FAX: (813)780-0021 OACORD CORPORATION 1988
JOB SPECIFICATIONS.
Name:
oo�- iJoQ . Q w .
Address: 73 1° C4 IrtdQUY' P4V 3 S��
Pho �A 78
Exsting Windows: -A LJ A i kf d,l S.V House: W 00 0 r,9'�%fr
1 - Oci
SIZO,,I ss Type Si z Lass Type - (I
2. 5(7/g 41 12. ?S`4x4q�e
3• t'►' s 41 13,
4. 3534 x i' 4 14. . .
S. - U • 15.
6.
7. 74' " 17.
S.) i8.
19.2a•
Window Brands foo __`4(q94(Or1-cf BL. 6-4lP/
Special Instructions/Supplies : 0
Customer signature Date completed
Comments:
Florida Building Code Online http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param wGEVX..____ ,
a
K
BCE Home Log In Hot Topics Sub mlt Surcharge Stats&Facts Publications FBC Staff BCE Site Map Links Search
Product Approval
- USER:Public User
,. . Product Annroval Menu>Pr duct.or Ann'ation S ar h>Apnlicat'ion List>Application Detail
FL# FL8206-R1
gUApplication Type Revision
Code Version 2004
Application Status Approved
Comments
Archived
Product Manufacturer Vi Win Tech
Address/Phone/Email 2400 Irvin Cobb Drive
Paducah, KY 42003
(270)443-9622 Ext 222
(hall@viwintech.com
Authorized Signature David Martin
dmartin@viwintech.com
Technical Representative David W Martin
Address/Phone/Email 2400 Irvin Cobb Drive
Paducah, KY 42003
(386) 383-9214
dmartin@viwintech.com
Quality Assurance Representative Eldon Reel
Address/Phone/Email 2400 Irvin Cobb Drive
Paducah, FL 42003
(800) 788-1050
ereel@viwintech.com
Category Windows
Subcategory Double Hung
Compliance Method Certification Mark or Listing
Certification Agency National Accreditation &Management Institute,
Validated By
Referenced Standard and Year(of Standard) Standard Year
AAMA/WDMA/CSA 101/I.S.2/A440-05 2005
ASTM E1300 2002
ASTM F588-04 2004
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
'A1 � C T V (\a(3U)S�"ors
Contractor/Homeowner:Date Received: I f
— I 5-c'9
Site: 37350 350 ( fl kkery
ihi
Permit Type:
cacti \2 dsI t≥ fs�
Approved wino comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
• This co t s et sh kept with the permit and/or-plans.
Kal Swi —P Examiner Date . Contractor and/or Homeowner
(Required when comments are present)