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HomeMy WebLinkAbout09-9946 CITY OF ZEPHYRHILLS 5335 — 8TH STREET (813)780 -0020 9946 BUILDING PERMIT a ;. ,. s aa " :7 ,. - "M':=4- . „ . Ei:.. w >° ,5 1 0 m;p� €�� At.' '. 0e3 ` :fie Permit Number: 9946 Address: 7237 LANDOVER DR 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: ALPHA VILLAGE Est. Value: Parcel Number: 35- 25 -21- 0050 - 00000 -0500 Improv. Cost: 777.00 1d. r „ 7> 7 — ° -;� Date Issued: 1/04/2010 Name: POE, ART & VILLIERS, MARGRET Total Fees: 52.50 Address: 11 CHESTNUT AVE Amount Paid: 52.50 BRAMPTON, ONT L6X 2A6 CANADA Date Paid: 1/04/2010 Phone: (813)782 -0154 Work Desc: REPLACEMENT OF 9 X 7 GARAGE DOOR BAN • • r RH — Ali DO • R 1 BUIL•IN FEE 52.50 ,-, 4.c.4- _,,,L-ock cal jYk --- 3 rk- P $.� mss- ..:k ,<':'.,x. .a „ ''r_, .. , .. Q % 'A 'ate 6A-2-0,1D fr (T 9 4 t � t� <.: > �sC „€�". �,. 4 • •TE - 2ND R•U H PLUMB MI - INSULATI•N EILIN FOOTER BOND DUCTS INSULATED SEWER . MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE —METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE —SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to 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." . air �/A CONTRACTOR SIGNATURE PERMIT OFFI FR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813 -780 -0020 City of Zephyrhills Permit Application 1 ( � /,.� a Fax - 813- 780 -0021 Building Department Date Received IMUNIMMII Phone Contact for Permitting - I ,(cAr i� � �� '1 Owner's Name A \ f` ,Ar ' —...— 4 , J j- V; I l i m , Owner Phone Number , 1 I - N... - e l s i li CJIls/ ". okol- for p - ' 0 ..T 1_trP( gat; Owner's Address r rx.N a zia Owner Phone Number Fee Simple Titleholder Name' Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS I 1 (X1 F7 L,a- aae.r ) 6 r LOT# UCH SUBDIVISION AAA V A \01 LyF f'N ' g,S , 3 -- -..ac-...1 '0'a J 2.1 fig PARCEL ID# I - •; COQ ._ 00 i7 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I SIGN n MOVE [ DEMOLISH INSTALL REPAIR PROPOSED USE n SFR n COMM I OTHER I TYPE OF CONSTRUCTION n BLOCK r ---- 1 FRAME I STEEL Q OTHER I I DESCRIPTION OF WORK RQ.plasv q)( 7 1 (7ctfcU_ }1 A r BUILDING SIZE SQ FOOTAGE HEIGHT ' ' I BUILDING $ r-j ` 1 1 s CO VALUATION OF TOTAL CONSTRUCTION F ELECTRICAL $ AMP SERVICE n PROGRESS ENERGY W.R.E.C. n PLUMBING $ I MECHANICAL I$ VALUATION OF MECHANICAL INSTALLATION n GAS I ROOFING n SPECIALTY I OTHER FINISHED FLOOR ELEVATIONS L%p ZONE AREA rIYES n No =.: --------- 1 c7G tiY\1� V�/iJAI _.. � S ___ BUILDER ._...._ _..... _....__ \ , COMPANY ` (7 SIGNATURE . REGISTERED — t� 1 Y/ N I FEE CURRENT I Y/ N Address I it J 2 a� ft.S . ( 4. S License# 1 I ELECTRICIAN COMPANY I SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I Address I I License # PLUMBER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address I 1 License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I License # 1 Address I 1 I OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address License # 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, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large 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 ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt 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. -- - -t ._ ... = -- ----- _ -�! =`G_�°: -y w"~W : .... _ .-- :- .,.�,- : .. mow- .. =_ -- = - : -._sue -: : Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) •. Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage) 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 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, 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, 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 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA AE ,411 � ) �� OWNER OR R AGGENT NT `, ` - _, CONTRACTOR Sus b 4nd sworn o (or affirmed) fore me this,( Subsc ber swom to or affir l be fe me this A by et I Who is/are personally known to me or has/have produced Who is/are personalty to me or has/have produced a, identification. as identification. 4 — Notary Public G-- -z_ Notary Public ommission No. / 21 "/ 2 Commis • n No. / - 29 /2 Na fIV6tmy'1y8, p ort q� aWpe e of Notary typed, printed or stamped v rr ro J UIV AFi�� t r �n MY COMMISSION #DD753257 I = JASON CARTER ire EXPIRES: JAN 29, 2012 o "' "ti MY COMMISSION „ 1 °F^ Bonded through 1st Rt'4 '- � IXPIRES: JAN 29, 2012 #DD753257 I I Bonded through 1s1 q^-t- • Pasco County Parcel: 35- 25 -21- 0050- 00000 -0500 001 Page 1 of 2 Search Again Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: Weekly Archive - Saturday, December 26, 2009 Parcel ID 35- 25 -21- 0050 - 00000 -0500 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value POE ARTHUR & Ag Land $0 VILLIERS MARGRET Land $24,848 11 CHESTNUT AVE Building BRAMPTON ONT L6X 2A6 $66,121 CANADA, Extra Features $2,478 Physical Address Market Value $93,447 7237 LANDOVER DR Assessed (Save Our Homes) 80 335 ZEPHYRHILLS, FL 33540 -1040 $ Homestead 196.031 - $25,000 Legal Description (First 4 Lines) Non - School Additional Homestead Exemption - $25,000 See Plat for this Subdivision .1-' Non - School Taxable Value $30,335 ALPHA VILLAGE ESTS PHASE 1 PB School District Taxable Value $55,335 19 PG 69 LOT 50 Warning: A significant taxable value increase may occur when sold. OR 4104 PG 1020 Click here for details and info. regarding the posting of exemptions. I Land Detail (Card: 001 of 001) I Line II Use I°Descriptionll Zoning 11 Units II Type II Price II Condition II Value I ( 1 II 0100 II SFR II 00R2 II 7,350.00 II SF II $3.37 II 1.00 II $24,770 I I 2 I 0100 II SFR II 00R2 II 7,832.00 I SF II $0.01 II 1.00 II $78 I I Additional Land Information I Acres II 0.35 II Tax Area II 30ZH II FEMA Code II X ( °Residential Codell ALFAWP1 I Building Information - Use 01 - Single Family Residential (Card: 001 of 001) Year Built 1984 Stories 1.0 Exterior Wall 1 Concrete Block Stucco 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 I Line I Description I Sq. Feet Repl. Cost New I 2 I F II 1,083 $65,392 EA ( 192 $8,091 3 I FOA II 96 $1,449 351 4 I FGR $8,453 ( 5 I FOP I 55 $845 Extra Features (Card: 001 of 001) Line II Description Year Units I Value 1 II DWSWC 1984 1,053 I $856 ( 2 II UDU -M 1990 1 I $ 3 I I CON PTO 1984 192 I $252 4 I SWC 1991 184 I $290 5 I CLFENCE 1997 370 I $322 6 II UDA 1988 162 I $472 � l http : / /appraiser.pascogov. com/ search /parcel. aspx ?sec =3 5 &twn =25 &rng =21 &sbb= 0050& ... 12/30/2009 Florida Building Code Online Page 1 of 1 i AilljtflU, IN BCIS Home Log In User Registration Hot Topics Submit Surcharge Stats & Facts Publications FBC Sta BCIS Site Map Links Search is 1Product Approval ^s USER Public User Community Affairs i;:'i r r r > pi 2, cr or ai;Plir 3t ■ _, " > Application List Search Criteria Code Pcf:ne S= 0r_I1 ode Version 2007 FL# 5675.24 Application Type ALL Product Manufacturer ALL Category ALL Subcategory ALL Application Status ALL Compliance Method Quality Assurance Entity ALL Y ALL Quality Assurance Entity Contract Expired ALL Product Model, Number or Name ALL Product Description ALL Approved for use in HVHZ ALL Approved for use outside HVHZ ALL Impact Resistant ALL Design Pressure Other ALL ALL 1 Search Results - Applications FL# I Type [Manufacturer Validated Status FL5675- Revision Clopay 8 Products Company R2 FL . L 675.24 -1 Gary Approved History Mode :024 PAN- 2F151: 84�d 73, 75, 1500, 190, 76, 76\1, (513 4RST, 4RSF, 6RST, 6RSF, 2RST, 48, 42; 55, 48B, 42B, 555 I (513) Description: Steel Pan (min. 25 ga.) Single -Car (up to 9'0" wide) 1490 WINDCODE® W5 Garage Door Category: Exterior Doors Subcategory: Sectional Exterior Door Assemblies — DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee, Florida 32399 -2100 (850) 487 -1824, Fax (850) 414 -8436 (r 2000 -2005 The State of Florida. All rights reserved. Coovnaht and Disclahne- Product Approval Accepts: e ALL I., �tti I N ,, 3 I y{ 1 { `i P i ' sa B obby f fl.' t r yi1I WITHAL, . w,.. ��_. �7, I 1.)(�lf: l,� 1L1)r� COUL OF N.. T1O;la) LI-L(li?I('(OI;EAN „ j ` ' ( � LPI1) i;Llij L rI�Ft(�1 t �' C t n / 7114Hd3Z M3IA38 http:// www. floridabuilding .org/pr /pr_app_Ist.aspx 12/1 1/2009 12/30/2009 10:21 (813- 909 -8743 Paragon Risk Management Jean Shuff ->City of Zephyhills 1/3 P.O. Box 119 Lutz, FL 33548 tweed Choke- (813) 949 -8636 PARAGON (813) 909 -8743 FAX www.paragonrisk.com RISK MANAGEMENT whitneyw @paragonrisk.com Fax Message Date: December 30, 2009 To: City of Zephyhills Company: From: Jean Shuff Pages: 3 (including this sheet) 10/11 Banko Please see updated certificate for Banko Overhead Doors. Happy New Year, Jean Shuff * 12/30/2009 10:21 (813- 909 -8743 Paragon Risk Management Jean Shuff -►City of Zephyhills 2/3 Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ��- 12/29/2009 PRODUCER (813) 949 -8636 FAX: (813) 909 -8743 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Paragon Risk Management ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 203 Crystal Grove Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lutz FL 33549 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. FCCI Insurance Group 33472 Banko Overhead Doors, Inc. INSURERS Bridgefield Employers 10701 5329 W Crenshaw St INSURER c. Travelers INSURER D Scottsdale Ins Co Tampa 1 FL 33634 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 ADD'LI POLICY EFFECTIVE POLICY EXPIRATION LTR INSW TYPE OF INSURANCE POLICY NUMBER DATE (MM /DDIVYYYI DATE IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN X COMMERCIAL GENERAL LIABILITY PREMISES Ea occur ence) $ 300 , 000_ A CLAIMS MADE X OCCUR CPP0003205 -06 1/1/2010 1/1/2011 MED EXP (Any one person) _ $ 10,000 X Blanket Contractual PERSONAL & ADV INJURY $ 1,000,000 X Coverage is Primary GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG , 1,000,000 POLICY PRO- ,IFCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 C X ALLOWNEDAUTOS 3709P468 1/1/2010 1/1/2011 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 $ D DEDUCTIBLE XLS0064191 1/1/2010 1/1/2011 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION W STAT U- OTH- AND EMPLOYERS' LIABILITY proprietor /partners /exec X TOR YLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE a officers incl E L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 0830 -31494 1/1/2010 1/1/2011 E . DISEASE - EA EMPLOYEE $ 500,000 I y es, describe under S PECIAL PROVISIONS below E . DISEASE - POLICY LIMIT _ $ 500,000 A oTHERproperty - BPP CPP00032055 1/1/2010 1/1/2011 ded $500 $600,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (813) 780 -0021 Ph: 813- 780 -0020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills - Building Dept. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 5335 8th Street Zephyrhills, FL 33542 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ((,, Nathan Jensen /JEANS �e —. S ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD 12/30/2009 10:21 (813- 909 -8743 Paragon Risk Management Jean Shuff ->City of Zephyhills 3/3 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 This Certificate of Insurance 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 (2009/01) INS025 (200901) City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: 490 k0 O ' f i2 - Date Received: ! 2 - M- Site: .7 2 3 7 ka,ri o -- Or- Permit Type: Q,C 7 ( 9 4 'r le Q 19G(erne1 i Approved w /no comments: Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. Kalvi witzer s Examiner Date Contractor and/or Homeowner (Required when comments are present)