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HomeMy WebLinkAbout08-6898 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 6898 BUILDING PERMIT ..v. ..-=11 Permit Number: 6898 --- Address: 6005 GALL BLVD Permit Type: GAS/FUEL ZEPHYRHILLS, FL. Class of Work: FUEL TANKS Township: Range: Book: Proposed Ii e: GOMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 03-26-21-0010-11200-0041 Improv. Cost: 50,000.00 Date Issued: 8/03/2007 Total Fees: 80.00 Name: MPG GEIGER LTD Address: 6005 GALL BLVD Amount Paid: 80.00 ZEPHYRHILLS, FL. 33542 Date Paid: 8/03/2007 Phone: (727)348-9785 Work Desc: INSTALLATION OF UNDERGROUND FUEL TANKS ADAMS TANK&LIFT INC FIRE PLAN REVIEW FEES 10.00 FIRE INSPECTION FEES FIRE PERMIT FEES 25.00 45.00 jzOS FIRE-PRESSURE TEST FIRE DEPT.FINAL 1 ) I('- n� REINSPECTI0N 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 SIG TURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER !2 /2027/Fi 23: 36 Phi ZEPH'[PHILLS BUILDING FAX No, 813-780-0021 P. 002 813.780-0020 City of Zephyrhllls Permit Application FaX 81s7eo-o0211 Building Department S �' Date Received Phone Contact for Permitting — owner's Name taT -TbCLLST' OwnerPhona Number Owner's Address 1A'&- 37, Owner Phone Number Fee Semple Titleholder Name owner Phone Number .I Fee Simple Titleholder Addr-ss � J013 ADDRESS LOT# L_..__� SUBDIVISION PARCEL ID# (OBTAINED FROMPROPr TAX NOTICE) WORK PROP05ED [NEW CONSTR ADD/ALT [� SIGN �] MOVE DEMOLISH INSTALL REPAIR PROPOSED USE . Q SFR �V' COMM -OTHER TYPE OF CONSTRUCTION OLOCK ((FRAME I_ i STEEL [� OTHER DESCRIPTION OF WORK I i Oc BUILDING SIZE Sq FOOTAGE HEIGHT 4 [� BUILDING $ VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ AMP SERVICE 0 PROGRESS.ENER(3Y• PLUMBING 1 Z?C' if( t MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION j 0 GAS ROOFING Q SPECIALTY Q OTHER, FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA : YES' QNO 1 1`� 31GNATURH • W REOIeTERBD Y N FIE CURR�t=.P,r Y N Address — 13,jr41Je — — /—L Ucense# — ELECTRICIAN COMPANY SIGNATURE S I REGIETEREO I Y FEECURRGfL). Y/ t�D Address License 1F 1I PLUMBER COMPANY ar .I SIGNATURE RE931MR2O Y1 N FEE CURRINNT,�_ Y/N Address Ucenee# jl: MECHANICAL S COMPANY • SIGNATURE REOISTpREDJY1NJ Y/NJ FESCUE SKISL; N Address License fl OTHER COMPANY SIGNATURE RECISTERED Y N . FEE CURRENT'; S Y N Address Llcente# RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plane:(1)set of Energy Forms:R-OW Permit for new construEtton, Minimum ton(10)working days after submittal date, Required onslle,Con�trucllon Plans,Stormwater PI`en'dwl Silt Fence Installed. Sanitary Faculties&I dumpster,Site Work Permit for subdivIslonsnarge projects COMMERCIAL. Attach(3)sets of Building Plans:(1)set of Energy Forms.R-O-W Permitffr new construction. Minimum ten(10)working days after submittal date. Required onslle,Construction Plans,Stormwator Plerte W/Silt Fence Installed. .. Sanitary Facilities&I dumpeter.alto Work Permit for all new projects.All commercial requirements must meat compliance SIGN PERMIT Attach(2)sole of Engineered Plane. •--'PROPERTY SURVEY required for all NEW construction. Directions: • Fill out application completely. Owner&Contractor sign back or application,notarized • If over$2500,a Notice of Commencement Is required. (NC upgrades over$5000) • Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notedaed letter from owner authorizing same 'OVER THE COUNTER PERMITTING (Front of Application Only) Remote Sewers Service Upgrades NC Fences(PlotiSurvey/Foolege) Drlveweye-Not over Counter If on public ruedways..needa ROW /20/2007/FRI 03:33 PM ZEPHYPHILLS BUILDING FAX Ho, 813-780-0021 P, 003 NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"dead"restrictions" which may be more restrictive than County regulations, The undersigned assumes responsibility for compliance with any appligublgdee,dir strictlons. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES:' it the owner-has`hired a/bontractor or contractors to undertake work,they may be required to be licensed-ln aocordanoq with state-and local regulations. If the contractor is not licensed as required by law, both the owner a nd'�oontractdr'fi'ray be'dlted for a`Imisdemeanor 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. Furthermdre, 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 end is not entitled to permitting privileges,in Pasco County- .1: I . •a:. i i...�, 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 00-07,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. urthermore,if Pasco County Water/Sewer impact) fees are due,they must be plaid prior to permit Issuance in accordance with applicable Pasco County ordinances: CONSTRUCTION LIEN LAW,(Ctlapter 713 Florida Statytea.ps amended): if valuation of work is$2,500-00 or more,II certify that I, the applicant,'11ave been'pr vided°with,al'oopy ofIthe "Florida-CanstrUctlori 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 woriI 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 ii 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 Sensitivq Lands,Water/Wastewater Treatment. I - Southwest Florida Water Management District-Wells, Cypress Bayheads, Welland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls,Docks,Navigable Waterways. Department of Health & Rehabilitative ServlceelEnvironmental Health Unit-Wells, Wpstewater 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 permilttd. - If the fill material Is toe' be be submitted ated in Flood �ne of ermitting which is prepared by a pre 'A", It Is understood that a draInageofessionallan ressing eng nee "compensating volume"will 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 wail construction,I certify that fill will be used only to fill the area Within the stem wall. ' terial is to be used In any area, I certify that use of such fill will not adversely affect adjacent if-fill m properties, if use of fill Is found to adversely affect adjacent propertles,the owner may be cited for violatin 8 the conditions of the building permit issued under the attached permit application,for lots lass 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 sat forth I this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical wor , plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically Included in the application, permit issued shall be construed 10 be a license to proceed with the work and not as authority 10,vlQJ-QJ9,cancel,alter,or set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereaftgr requiring a correction of errors In plans,construction or violations of any codes. Every permit Issued•shall become Ir>vaiid 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(8)months after the time the work Is commenced. An exlel?slop may be requested,In writing,from the Building Official for a parlod not to exceed ninety(90)days and will demonBtrake Justifiable cause for the extension. If work ceases for ninety(90)consecutive days,theLjob is considered abandoned.: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYURIE_SULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINJNG,CONSUI,7 WITH YOURUNDER OR AN ATTORryFY BE�O_RE RFGORDINL�XOI�NQT�CF OF CQMM�NCM1L FLORIDA JURAT IRS.117,03) OWNER OR AOeNT �COhlTlb d 8fl cTO 9ubacdbad and swam to(or eR,mted)before me lhls �Sabscricd and/ w(oraffl red)before ma is !— te o me or hasihava produewd ' Who Islets persanellY known to ms or s Idanllfl�tmnrodueed o 1 er y are IdonllflcaCon, 4i J.._41' Notary Public Notdry Public Commission No b 2 V ? Commission No Name R Notary typed,Pdnled or stamped Name of Notary tYPed.Print d or alampe�Tc MICHAEL D.d/LCOTT Notary public, State of Florida Comm.No.DD 294839 FILE No.885 07/23 '07 09:08 I D:ADAMS TANK&LIFT FAX:7275458398 PAGE 2/ 2 JUL/20/2007/FR! 03:36 FM UPEMILLS BUILDING FAX No, 313-7H-um r. uuD NOTICe PEEP RESTRICTIONS; The undersigned understands that Ihls permit may be subject to"dad`reelfotlone' which hpon may be more roserldive than County re9ulagons• The undersigned assumes rospenslbllily for compliance with any appllfisbNkdegd.4P�iOq'�.ap�,ORg AND CPN *cTOR Rt"sPONSrnILfT1E8.- 'If the owrterbas'htreil`a'contractor or tINI.IRENSIM) O11TRA'C'T lafmne. If the eentraclors to undeftake work,they mW be requited to be,licanead4n,aacordwwa.with state fend focal,rr�gu contractor is(lot PomNsad as required l nttortdad wMbraacto the oore unce or ale as to what lken inO roW+iream'en may pplylfor Otto aUon under slate nt. If pelvis Intended work.they a the advised has contact a contractor or acttorrs,hhe Ins advtd1 ed�to havventehe cconttractors)sig poo9. Furthermore, If portions of the'contractor slack'of 1110 application far witch they will be s root ngle. It you. it the owner sign as the contractor,pmt(nay be on Indication shot he Is fat properly licensed and,ia not entlged to ponnitting prtviegu In Pasco County. i TRANSPORT#%TION IMPACTNTIi.ITI�5 IMPACT AND'REEOURCE)tECOVERY FRS: The undorslgned understands of thatTrogsporlatbn Impact Free end Recourse Recovery Fees may apply to the conatructlon of now buildings, ehonOeuse In e><Ntlnp bulMings.Pr gntpanWicn o airistlno buildings,as ypeoi led In Pasco County Ordinance number aa-O7 and 00.07,me amended. The undotslcnad elan Wrtdero orndimme t such and Rasou be due,willF ea must be paaid prior of permittlne. Ills fU tier understood that Transpoftatl Pao to •ee of occupan or final power release.-If the-pr JJact does not Involve a ca#lAonte of occupancy or receiving a rltfiGtto " rwo perm111Weurmce. Fy►�ermore,IT Pasco County Watn Sewer Impact final power release,the lees mV prior PW paid Pd° fees are due,they must be aid prior to permit Issuance in accordance,with applicable Paso County ordinances. . a a d): If valuation of woek Is$2,500.00 or more.I cricr lfy that I, the a �A Chap)$eflter 'irOyld rldq sl atyee�►� i�° , Wen Prate that I, the applicant, vu ad°with Ira'im o'f t Ure and Consumer Affairs.If the applicant someone other won Outdo'prepared b the Plods blaifl d a o Agri he above other th4n the'owner. fhN I have pblalned a copy of the above described document and promise In good falm tot doliver it to lhe,'awner'priar o cvmmatwam nertlN that ell'Iha Information In this application Is acotirate and that all word t. CONTRAC In ccm WNERre � � open,zonlna and land development. Application Is' wit be bone k1 wmpNanPe wtil all applicable laws regulating wnstru. hereby remade to pbtain a permitto do work and inundation as Indnceted. I certify that no work or Ins on ha� commenced prior to issuance of a permit and that performed, eel,to regulations standards ns inntthef Ju l dicam. I��Q oonatructlon. County and City codes,zoning regulations, so certify that I understand that this regulation;of other government agencies may apply to the intended work,and that it l _ my wspenstDep toDepartment Identify what oniPa W I must take to be in oo 55 Bay eaas SWetlaannd AreaenCies s amend Envtron a not tallY SenaitNd Il..a de Wa��tawateter Treatment. n CyP►O Unsouthwest Florida Water Management Pleiet-Wolct, Cypress bayheeds, wend Ames Aka Watercourses. a Waterways. Army Corps of Engineer*a-Seaways,Docks,Navigable Department of Health A Rebabtigadve £a IcaslEnvironmentel Health fl-VYells, Wpatewater Trestmen SepdcTor*s, y-Asbeetas abatement US Environmental Protection Agenc � r�d, k _ Federal Aviation AHtnotity-RunwaYs- I undereland That the following restrictions ad�pyy tO 7.Yrto the Ufunless e of flll:expressly perrtdttgd� use d11lll is not allowed In Flood If Iha fill material Is to be used in Flood Zone'A', It is understood flat a dralltW9s plan ad ressNte • 'cornpanealing volume'will be submitted at time of perrnittlntf which Is prepared by a professional engineer Ilcenaed by the State of Florida. If the fill matorlel Is 10 be used In Flood Zone'A'In connection with a parrnitted building using `"all ea All lon,1 curtlfy that fit Will be used only to fill the area within the stem wall. If-lift material I. 10 be used In any area. I certify that use of such fill will not adversely affect 1a rlt nt properties.the owner may be died for violating properties. If use of flU Is lno permit to ss ed affect Meeeetdached permit oppitca►ion.for lots lass then one f 1 the conditions of va IxrAdlne red drainage plan Is required. acre which are elevated by fill,an onaIn g idlh to Inform the owner of the permitting Qondltlans sot fa0h t • tf I am the AGENT FOR marl OWN11K I promise to good permit m be requited for electrical won this bIng.affidavit prior to comet ., air rpnsliwilon. I understand or other Inst allalieons nnoot pclficalllyy included In the applioatioRl. plumbing.se,wells,pacts, air oottatl Icon ifs 'proceed with the work and not as authority 10.vloiate,cancel,alter.9r permit issued shall be construed to be a license to Official from they a r set aside any Prvvlalorts of the Hi plans. or nor olvIolallonl s of any codesprE mpeormB t;d�nu dshall become 1 vat p . } unless requiring p correction of errors In pi111M. It commenced within six months of permit issu'Mee;or If work ailthorix4d by me es the wont suspended-Or l-Or by asuchbandoned pent Is of sbc(8)months 9fter the We the work is cammer�cad. An exlensb me e Is suspended•or ntbando th fort Rar ilding al for a tedod not to exceed ninety(Bt►)days and will damond$ra a may be requested,In nG from the s*OW Justtfable cause for tine extenslon- If Work oeoae9 for ninety(00)consecutive days.th�Job Is considered abandened.:LWARNING TO OWNER YOUR FAILURE TO RECORD A.NOTICE OF COMMENCEMENT YO R PROP RTY F YOU INTEND O OSTA N FIW LINO CON SUu1 PAYING T1MCE FOR @APRO NT n] um , rs.oRisA ww►t tt~s-117•os) TOCO rrru►cret ampsonAeEMT t"6,s+eorllrcdend w{era d)beo/a et M I /tcM1 snnYeeipad and e„enn ter JQ - Y e nee er eroevad -a Rby er ve p►oduae4 ° 1aeMMcaaan Who IuMe gro„Mn t°rne`leenyllasaon _�, WeOwy P a ceremMensn Ns S or own Ne 6 � txne of Ne�Y i tetY bP , &aggW Notary Publlc,Stab of Flotrld Comm. .DD � . 291!{99 e Z 'PH1LLSs RE DE?ARTMEN T emC7 air./ Road, Zaphyrhills, FL 33542 ''f= o:-ie er Bus (813) Iva-O04 I Fax iii 3) 780-0044 =RRE z ar!CE U . -Ocoancv No.:________________ iWis' ' Pgan No.: aiding address:7 /J usir esS:-`.cc+res�: w Lsness fer e Nc.: millingPhone Na.: —3 Business F x No.: Pilling Fax No.: contact contact: ?L.\N REVIEW FEES 1NSPECT,ON FEES PERMIT FEE FALSE ALARM FEE Site P!an N/C Annual N/C . 1st Alarm N/C Building Pans .04 si 1st Re-inspection 325 2nd Alarm N/C Li Revision .u6 s. L i 2no Re-inspection £50 3rd Alarm N/C dlA`u VIIJF' (o .00 i 3rd Re-inspection $125 4th Alarm $25 S 3 dOP!PE 4th Re-;nsaec:ion $250 5th Alarm $50 Per:Riser £25 Li 5th Re-inspection £500 5th Alarm $75 _ Construction £15 7th Alarm $100H. Commerciai $25 8th Alarm $150 9th Alarm $200 SPRINKLSR SYSTEMS SPRINKL SR SYSTEMS SPRINKLER SYSTEMS 10th Alarm $250 0-25:Heads 530 Hydrc Undergrounds 345 H Automatic $15 J Non Compliance $150 L_25 Pius r eats £60 Hydrostatic System $45 Affidavit of ServiceiReoair' `Net Acceptance £30 Org Acceptance $45 i ;;vorant=low £25 :Hood, Sooth $30 FIRE PUMP —i Grease Ouct S15 FIRE PUMP Per Pump 3100 H. Fire Pump $15 -''RE_-'ALARM 3YST=?ft FIRE.ALARM SYSTEM EM ^IRE ALARM SYSTEM 0 25 Devices £30 System .cceotance 350 fl Detection $15 Li 26 pius Devices $60 L Recall Acceptance $50 SUPPRESSION SYSTEMS OTHER OTHER I Wet 335 H' =ire w,/ail/Smoke Wail £15 _?Gas $45 Drg 335 Gas $25 Li Natural Gas $45 %C2 325 j Natural Gas £^5 Fire Works Li Other 535 .ei ranks Fuel Tanks GREAS=EVE>NTILATICN GREASEIVENTILA71ON —'Hood/Ducts £25 I Hood/Ducts $15 LiKitchen Suppression $15 FALSE LARM PLANS TOTAL ( LI iNSP=%T1CN TOTAL_____I PERMIT TOTAL L TOTAL J GRAND TOTAL I Comments: Adams Tank & Lift, Inc. 4567 131st Ave. N, Clearwater Florida 33762 Phone (727) 540-0931 Fax (727) 540-0848 Lic. #PC C050767 Date: 7-20-07 To: City of Zephyrhills FL Permitting and Licensing I, Donald W. Adams Sr., Pollutant Storage Systems Contractor#PCC050767, do hereby authorize James Wiggers to act as my agent in securing permits in the County of Pasco I understand I am responsible for any and all work performed by my agent. Contractor's Signature Donald W. s r. Agent's Signatu Sworn to and subscribed before me by Donald W. Adams Sr. and_James Both personally known to me this 20th day of July A.D. 2007 M f C-W,4 F_L S/C. C_D - Notary Public— State of Florida, Printed Name Notary Signature My Commission Expires 9 - 2 e�' SEAL: AVAWLD.&ICM Notary Public,State of Florida Comm.No.DD 29�83g My Comm.expires May 9,2006 FILE No.872 07/20 '07 14:26 ID:ADAMS TANK&LIFT FAX:7275458398 PAGE 6/ 6 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH TALLAHASSEE MONROE STREET FL 32399-0783 ADAMS, & L DIFTSTON INC ADAMS TANK 8440 43RD STREET PINELLAS PARK FL 34665-1653 STATE OF FLCN,aA ACID 2 7 516 0 DEPARTMENT or BUSINESS Arm PROFESSIONAL REGULATION PINELLAS COUNTY CONSTRUCTION pq�'Q5R?.��x 08%29/06 068038562 LICENSING BOARD -LC$ET:POLLUTANT.,BTGRA08 SYS CONTR THIS CERTIFIES THAT Donald Winston Adams '�� AAN6 ?�;DOD1A�+p':i�INSTON DRA Adams Tank A Lilt Inc �"AAAN9 '4' & LIST II1C STATE CERT 0 I.PCC060767 HAS REGISTERED HIS LICENSE AND FILED PROOF OF REQUIRED LIABILITY =S CERTIFX D un4 r thó psovirtoae of en.469 im.. AND WORKERS•COMPENSATION INSURANCE RPtsatton e.e.:'AUG 31, 2009 tocoasso2 a7 WITH THIS BOARD. IN GOOD STANDING UNTIL SEPTEMBER 30,2007 DATE OF ISSUANCE 10/1106 DETACH HERE Ac# 2751620 ; ,.STATE OF•FLORIDA CO 878. N SS RFESBTD , p REGULATION " 8T fl ON,>I1 U8TRY LICENSING BO A $ #L060¢ 50262� 080 2 PCt:05Q767:a. ,� =� �,... rF -,: � -•.:";. ; , The'.POLLUT N'!''j;:R tAGB-SYSTEMS, CONTRACTOR Named below-IS.CERTIFIED Under the provisions of Chapter. 489 F8. Expiration dates AUG" 3 2 �w N ..•; ._, - tit• c,. ADAMS DONALD wINSTO ADAMS TANK �TANK & LIFT INC 8440 43RD PINELLAS PARK r+STREET, FL :34665-1653 1' i JEB BUSH JI., t. ,'':.;' i':-•r "IC:F YGy �Iy: c SIZ4ONE MARSTILLER GOVERNOR SECRETARY ---•_—__ r�_ niRDl AY OR REQ IIRED RY I AW -J ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID L31 DATE(MM/DD/YYYY) PRODUCER ADAMS-4 I 07/20/07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown of Florida, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. O. Box 15519 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa FL 33684-5519 Phone: 813-226-1300 Fax:813-226-1313 INSURERS AFFORDING COVERAGE INSURED NAIL# INSURER A: Zurich American Insurance Co. Adins Tarok & Lift Inc INSURER B: AUTO OWNERS INSURANCE M& Shredded Paper 18988 & Converters INSURER C: Steadfast Insurance Co. 26387 4567 131st Ave N Clearwater FL 33762 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE EFFECTIVE POLICY EXIPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 A X COMMERCIAL GENERAL LIABILITY GLO543122903 07/20/07 07/20/08 PREMISES Eaoccurence) $100,000 $2 CLAIMS MADE i� OCCUR 5j --_.—.. MED EXP(Any one person) $ ,000 X 0,000 Ded BI/PD X BF PD/Contractual PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER _.__ POLICY JECT LOC - PRO- PRODUCTS-COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY B X ANY AUTO 9542924300 COMBINED SINGLE LIMIT 07/20/07 07/20/08 (Ea accident) $1,000 000 ALL OWNED AUTOS BODILY SCHEDULED AUTOSINJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE: OCCUR I CLAIMS MADE -- - - AGGREGATE $ DEDUCTIBLE RETENTION $ $ AFOTH WORKERS COMPENSATION AND $ EMPLOYERS LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below __ OTHER E.L.DISEASE-POLICY LIMIT $ C ,' Contractors jPEC543122803 07/20/07 07/20/08 ea claim Poll/Prof Liab CLAIMS MADE $2, 000,000. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS a r $2,000,000 CERTIFICATE HOLDER CANCELLATION CITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of Zephyrhills Attn: Building Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 5335 8th St REPR SENTATIVES. Zephyrhills FL 33540-4312 AU o ED ESENTATIVE 77 ACORD 25(2001/08) ©ACORD CORPORATION 1988 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 4�aa�t 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ADAMS, DONALD WINSTON ADAMS TANK & LIFT INC 8440 43RD STREET PINELLAS PARK FL 34665-1653 StAiE OF FLORIDA AC# 2 7 516 2 0 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION PINELLAS COUNTY CONSTRUCTION pCC0507„67 09/25/06 068038562 LICENSING BOARD CELT POLLUTANT STORAGE SYS CONTR THIS CERTIFIES THAT Donald Winston Adams ' ADAMS, 'DONALD WINSTON DBA Adams Tank&Lift Inc ADAMS''TANK & LIFT INC STATE CERT#I-PCC050767 HAS REGISTERED HIS LICENSE AND FILED PROOF OF REQUIRED LIABILITY IS CERTIFIED under the provisions of chA89 pe._ AND WORKERS'COMPENSATION INSURANCE Expiration datai AUG 31, 2008 L06082502627 WITH THIS BOARD. IN GOOD STANDING UNTIL SEPTEMBER 30,2007 DATE OF ISSUANCE 10/1/06 DETACH HERE AC# 7 5 l 6 2 Q STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ' ' • • = LICENSE NBR - k 108/25/2006 1068038562 IPC050767 The POLLUTANT STORAGE SYSTEMS CONTRACTOR Named below CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG ,31,„ 2008 ADAMS, DONALD WINSTON ADAMS TANK & LI FT T IN C C 8440 43RD STR EET EET PINELLAS PARK FL 34665-1653 JEB BUSH SIMONE MARSTILLER GOVERNOR SECRETARY Policy Number: Z065914305 Date Entered: 7/20/2007 ACORD, CERTIFICATE OF LIABILITY INSURANCE �DATE(MM/DD/YYYY) 7/20/2007 PRODUCER WorkComp Partners THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 215 East Main Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bartow, FL 33830 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (863)533-4178 INSURERS AFFORDING COVERAGE NAIC# INSURED Adams Tank & Lift, Inc. INSURER A:Zeni th Insurance Company INSURER B: 844043rd Street North Pinellas Park, FL 33781 INSURER C: 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. INSRlADD't. LTR POLICY NUMBER POLICY EFFECTIVE Ii TYPE CE [ POLICY EXPIRATION GENERAL LIABILITY LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA E T REN ED LII PREMISES Ea occurence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $ POLICY fl LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Z065914305 7/20/2007 7/20/2008 E.L.EACH ACCIDENT $ 1 r 000,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1 r 000,000 OTHER SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1, 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Zephyrhills NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5335 8th Street REPRESENTATIVES. AUTHORIZED REPRESENTATIVE enger Ze hyrhilis, FL 33540-4312 Robin Stenger ACORD 25(2001/08) ©ACORD CORPORATION 1988 Produced using Forms Boss Plus software.www.FormsBoss.com;Impressive Publishing 800-208-1977