Loading...
HomeMy WebLinkAbout08-8488 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8488 BUILDING PERMIT Permit Number: 8488 Address: 6006 GREEN DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: ZEPHYRHILLS COLONY Est. Value: Parcel Number: 01-26-21-0010-12000-0011 Improv. Cost: 8,600.00 Date Issued: 11/03/2008 Name: ZEPHYRHILLS RRH LTD Total Fees: 75.00 Address: 7865 SOUTHSIDE BLVD Amount Paid: 75.00 JACKSONVILLE FL 32256 Date Paid: 11/03/2008 Phone: (904)642-1759 Work Desc: REROOF 30YR THE MASSENGILL COMPANY REROOF RESIDENTIAL 75.00 cN\up 1& J ac12C- -- 3( O2-1 03L DRY IN ROOF INSP TAPE JOINTS ROOF INSP FINAL � Q '�`�1.1 r111 L ill 4 rr *- (Le -� va1, 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 1-800-800-ROOF THE MASSENGILL COMPANY P. O. Box 15581 Femandina Beach, FL 32035 Name: ' e O r ®(\p CCC 1325911 (�S5 1 Address: Larry: 904.887.3622 i Scott: 904.446.5224 Job Location: Fax: 904.321.1584 t- Remove Existing Roof Haul Off All Debris Install New Z— Felt Base Sheet n Replace All Rotten Wood �•c _ 5�n���'F t'�W arc_ a (Install New Plumbing Boots 1 1/2 2 _ 3 4 5. Install New Kitchen Vent Install New 4 ft 6 ______ 8 Off Ridge Vents -Flnstall New 4 1/2 _ 6" Eve Drip d4`� olor 8. Install Rubber Roof 25 Ye 3 T 0 Year 9. Architect 40 Year Architect Color 10. Replace Skylight Size G��v5 Year Workmanship Warranty Comments: Contractor: Date: 20- 2c Owner Acceptance: Date: Not Responsible For Concrete or Landscape Damage: tc c0 o C-� v2 i&I AMOUNT: � ( G fyy TOTAL Due In Full Upon Completion 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Data Received Phone Contact for Pe Owners Name - ® Owner Phone Number V Owners Address 1P S OJ Fz 1 owner Phone Number Fee Simple Titleholder Name Owner Phone Number! r I Fee Staple Titleholder Address r JOB ADDRESS /tP © b tJ \ LAT of I � SUBDMSION 1 PARCEL IDi U —d0I C ©O 1 l (O6TAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT = SIGN e MOVE DEMOLISH INSTALL REPAIR �!` 2v V f PROPOSED USE = SFR = COMM = OTHER TYPE OF CONSTRUCTION = BLOCK = FRAME = STEEL Q OTHER DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE HEIGHT _____________ BUILDING I _iS Q nCJ VALUATION OF TOTAL CONSTRUCTION = ELECTRICAL (S �� AMP SERVICE PROGRESS ENERGY EJ W.R.E.C. = PLUMBING 1 = MECHANICAL (S VALUATION OF MECHANICAL INSTALLATION GAS = ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS J FLOOD ZONE AREA =YES ONO BUILDER COMPANY I_iWifur+RENr SIGNATURE REGISTERED Y/N YIN Address EQ 1 t)≤ Q t 1VQ License# _I,�S ELECTRICIAN _ jCgIjPANY SIGNATURE I REGISTERED Y INI FEE CURREW Y/N Address Licensed PLUMBER COMPANY I SIGNATURE I REGISTERED Y/N FEE Cu RENT Y/N Address License 0 COMANY I $MECHANICAL AL REGISTERED Y INI FEE CURRENT Y!N Address License S I OTHER COMPANY SIGNATURE t REGISTERED Y INJ FEE CURRENT Y/N Address License tF RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans.Stomrwater Plans w/Sill Fence installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisionsAarge projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum tan(10)working days after submittal date. Required onsite,Construction Plans,Sbrtrmrater Plans WI Sift Fence installed. Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. —PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized H over$2500.a Notice of Commencement Is required. (AIC upgrades over$5000) Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing sane OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades AFC Fences(Plot u ey/Fooage) Driveways-Not over Counter if on public roadways..needs ROW 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 IMPACTIUTILITIES 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'SIOWNER'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,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. 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 proceed with the work and not as authority to violate,cancel,after,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 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 WITH YOUR LENDER OR AN ATrORNEY BEFORE RECORDING FLORIDA JURAT(F.S.117.03) OWNER OR AGENT ' 1 '444 iY CONTRACTOR pe�org Subscribed and Y an this swum Subscribed and molpr affirmed)V me this c rs(� 7� Who i are rsori known me orrh gave diced Who W or hasPhave produced as.rmrrrl/tion. hill nlification. :��P�9usrs�F��N"�_ c'so � s- =Z• �. chin• =z• mm. —_ Name of Notary 4 ;*` Name of Notary typed, • 9�:� 8 �'< o� R_ 5j249 ��°(� A:;��lh deny ;:•• \O\�� %°G�•°���d thtu �.. ,'�Q` / F /0/l111111111\\ 2008-2009 BUSINESS TAX RECEIPT CITY OF JACKSON VILLE/DUVAL COUNTY MIKE HOGAN,TAX COLLECTOR 231 E FORSYTH STREET ROOM 130 JACKSONVILLE,FL 32202-3370 PHONE:(904)630-2080 FAX:(904)630-1432 WEBSITE:www.coj.net/tc Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This receipt is furnished pursuance of chapter 770-772 City ordinance codes. MASSENGILL,TONY LYNN THE MASSENGILL COMPANY P0 BOX 15581 FERNANDINA BEACH, FL 32035-5581 ACCOUNT NUMBER: 999997285' LOCATION ADDRESS: P O BOX 185581 FERNANDINA E FL 32035-5581' DESCRIPTION: r .QUALIFYU G AGENT, CONITRACTORS COUNTY RECEIPT DESC: QUALIFYING AGENT,.CONTRACTORS C.OUNTY7AX: 0.00 MUNICIPAL RECEIPT DESC: MC 772.325 MUNICIPAL TAX: 100.00 TOTAL7AX PAID: 100.00 VAbID OIIIt September 1,2008 TOfrSepterrrber30,2009 r, fir 1 '^ '`t rt,1t✓ ***ATTENTION*** THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESS MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receiptholder to violate any existing regulatory or zoning laws of the County or City. Nor does it exempt the receiptholder from any other license or permit required by law. This is not a certification of the licensee's qualifications. TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION. PAID-3301823 . 0001-0001 M01 07/15/2008 100 . 00 Pasco County Parcel: 01-26-21-0010-12000-0011 001 Page 1 of 2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Parcel Cards: 1 1 2 1 3 1 4 1 5 1 6 12 Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: Weekly Archive - Saturday, November 01, 2008 Parcel ID 01-26-21-0010-12000-0011 (Card: 001 of 007) Classification II 03 - Multi-Family - 5 or more units Mailing Address Property Value ZEPHYRHILLS RRH LTD Ag Land $0 C/O DIMENSION ONE MGT INC Land $169,260 7865 SOUTHSIDE BLVD JACKSONVILLE, FL 322560416 Building $608,141 Physical Address- See All 36 addresses (First Shown) Extra Features $11,810 6006 GREEN DR Market Value $789,211 ZEPHYRHILLS, FL 33542-2791 Assessed (Save Our Homes) $0 Legal Description (First 4 Lines) ZEPHYRHILLS COLONY COMPANY Taxable Value $789,211 LANDS PB 1 PG 55 PART OF TRACTS 120 &121 DESC AS COM SW COR OF SEC 1 TH N89DG 49' Land Detail (Card: 001 of 007) Line Use IIDescr1ptionhI Zoning I Units II Type Price IICond1tionhI Value* 111 0300 II MULTI FAM 00R4 I 43.40 II UT II$3,900.00 II 1.00 $169,260 Additional Land Information Acres j 3.10 Tax Area H 30ZH H FEMA Code II X Ilcommercial Codell 5MF225H Building Information - Use 11 - Retail Stores (One Story) (Card: 001 of 007) Year Built 1986 Stories 1.0 Exterior Wall 1 Common Brick 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 BAS 1,286 $82,304 2 CANH 90 II $1,728 Extra Features (Card: 001 of 007) Line Description Year Units Value 1 SWC 1986 3,486 $1,307 2 PAV ASP 1986 37,054 $7,503 3 LIGHTSC 1986 5 $3,000 Sales History Previous Owner N/A Year Month Book/Page Type Amount 1985 10 1449/0136 WD $90,000 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Parcel Cards: 1 1 2 1 3 1 4 1 5 1 6 12 http://appraiser.pascogov.com/search/parcel.aspx?sec=01&twn=26&mg=21&sbb=0010&b... 11/3/2008 NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of �a { OC County of m— To whom it may concern: F+= The undersigned hereby Informs you that Improvements will be made to certain rea!property, in N� accordance with Section 713 of the Florida Statutes,the following information Is stated In this NOTICE OF COMMENCEMENT. Legal description of property a ng improved: Q f2 n �� L 7 .. �/ f Zy Z S W'co tr2cc fit --rh N. q Addr s f p erty 3 being improvedd^. U I(�{r �n/�i.�/t �` /�J/�/�2� r� ^y,r y L '" fa i K 't4i f?+.✓ t t `� General description of improvements: — 2_ Owner t 1 Address S i Y Z Owner's interest in site of the improvement r�+N Fee Simple Titleholder(if other than owner) Name � r+ Address R m FN, Contractor Jul Address "70 S Q (0 Phone No. 1-3( Z3) Fax No. �— T �M urety(if any) :o Address Amount of bond$ o �"� Phone No, Fax No. mm A � Name and address of any person making a loan for the construction of the improvements, m Name Address Phone No. Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name M m Address Phone No. Fax No. 3 In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in ^r•� Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). y'� Name +�+`�� O Address Phone No. Fax No. O0 C Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): t31 C THIS SPACE FOR RECORDER'S USE ONLY �.i Signed=DATE Before me this ay of in the STATE OF FLORIDA cor ry f Du t.State of iorid d herein oy COUNTY OF PASCO himseW herself and affirms that, sta herein are true and accurate �� ••• 1! �•� f THIS IS TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE _ usf OR OF PUBLIC RECORD IN THIS OFFICE.WITNESS MY ; =o 4b,• Qo HAND AND OFFICIAL SEAL THIScLS DAY OF ` =-i' ��� 2^ � NotaryPutmcat Large,St* ' 4ounty r2 3 y oa aHyK tor expires: % : � __ � �—-- JED P AN, E OF CIF3CUIT COURT s n (fl Produced Identification BY DEPUTY CLERKlgTE ��IIIIIIIIIIIIIN��� From:Denise Miller At:Slhle Insurance Group FaxID:Sihle Insurance Grou To:Tony Massengill Date:9/152008 09:24 AM Page:2 of 3 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID DL I DATE(MMVDD7YYYy) MASSE-7 I 09/15/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ERICA HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P 0 Box 160398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Altamonte Springs FL 32716 Phone:407-869-0962 Fax:407-774-0936 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A ddya„ca atruetion Industry 10998 INSURER B. The Massengill Company INSURER C. 23705 Atrigo Blvd INSURER D: Fernandina Beach FL 32034 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 DOCUs ENT 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 RAVE BEEN REDUCED BY PAID CLAIMS. LTR SR TYPE OF INSURANCE POLICY NUMBER DATE(MWDD/YY) DATE(NNVDDM!) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRC 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 DAMAOe $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY. AGG $ EXCESSAMABRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'UABILTTY ANYPROPRIETOR/PARTNER/EXECUTIVE WC10000138232008A 08/04/08 08/04/09 E.L.EACH ACCIDENT $100000 OFFICEPAAEMBER EXCLUDED? If yes,describe under E.L.DISEASE-T__EMPLOYEE $],00000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECULL PROVISIONS CERTIFICATE HOLDER CANCELLATION ZEPHYRH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Zephyrhi i is NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Department 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Zephyrhills FL 33542 REPRESENTATIVES. ACORD 25(2001108) 0 ACORD CORPORATION 1888 STATE OF FLORIDA AC# DEPARTMENT OF BUSINESS AND ,�• PROFESSIONAL REGULATION QB25755 06/18/07 060769104 QUALIFIED BUSINESS ORGANIZATION THE MASSENGILL COMPANY (NOT A LICENSE TO PERFORM WORK. ALLOWS COMPANY TO DO BUSINESS IF IT HAS A LICENSED QUALIFIER. ) IS QUALIFIED under the provisions of Ch.489 as. expiration date: AUG 31, 2009 L07061800840 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CCC1325911 08/10/08 088003999 i RTIFIED ROOFING CONTRACTOR SSENGILL, TONY LYNN E MASSENGILL COMPANY IS CERTIFIED under the provisions of Ch.489 rs expiration date: AUG 31, 2010 L08081000149 09/16/2008 TUE 8: 29 FAX 321 725 7856 J W EDENS & COMPANY 2001/001 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID LT DATE(MMIDDIYYYY) MASC001 I 09/16/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.W. Edens & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Commercial Ins of Brevard, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 325 Fifth Avenue, Suite 108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Indialantic FL 32903 Phone:321-725-7000 Fax:321-725-7856 INSURERS AFFORDING COVERAGE NAIC# i INS D INSURER A: Colony Insurance C Iff INSURER B: Masaen ill Company. INSURER C: A AToony Masse ll Fernand dinagBeach FL 32034 INSURER D: INSURERS: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIMEMENT,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 E SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LMMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR NSF TYPE OF INSURANCE POLICY NUMBER M LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERALLIABILrTY GL3573346 01/28/08 01/28/09 PREMISES(Eaooacenoe) $100000 CAMS MADE a OCCUR MED EXP(Any one person) $5000 PERSONAL&ADVINJURY $1000000 GENERAL AGGREGATE $1000000 GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $1000000 POLICY PR¢ LOC AUTOMOBILE LIABILITY COMBINED ANY AUTO (En aoddent) SINGLE LMT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per perwn) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per eocideM) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO om mm EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ 0TH- WORKERS COMPENSATION AND EMPLOYERS LIABILITY TORY LIARS ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E-L DISEASE-EA EMPLOYE $ If yes ee dabe under SPECIAL PROVISIONS bebw E.L.DISEASE.POLICY LW $ OTHER DESCRWTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Via Fax# 1-904-321-1584 CERTIFICATE HOLDER CANCELLATION ZII:PHRYH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Zephryhilla NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL Building Department IMPOSE NO OBLIGATION OR UA60.ITY OF ANY I0MD UPON THE INSURER,ITS AGENTS OR 5335 8th.Street... _........._... Zephryhilla FL 33542 ETA AUTHORIZED REPRESENTATIVE Brian R. Sullivan ACORD 28(2001108) 0 ACORD CORPORATION 1988 From:Denise Miller At Sihle Insurance Group FaxlD:Sihle Insurance Grou To:Tony Mascengill Date:9/15/2008 0924 AM Page:3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER • The Certificate of Insurance on the reverse side of this form 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. ACORD 25(2001108)