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09-9002
CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 9002 MOBILE HOME SET -UP �: '" #E° t21 °:TT i ,. ' w a ,:A4-,& o,4 , .3,,• :_," r . ,,,aa € 9 1\,. y e'g';'' 11 € Permit Number: 9002 Address: 37136 NEUKOM AVE LT 302 Permit Type: MOBILE HOME ZEPHYRHILLS, FL. Class of Work: MOBILE HOME SET -UP Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: GRAND HORIZONS Est. Value: Parcel Number: 34- 25 -21- 0180 - 00000 -3020 Improv. Cost: 9,200.00 * ,_, ..:17 , _:. ` ` �. Date Issued: 5/11/2009 Name: NICHOL, VERNON Total Fees: 6,965.58 Address: 4907 BLANCO DR Amount Paid: 3,667.85 ZEPHYRHILLS, FL. 33541 Date Paid: 5/11/2009 Phone: (813)788 -3868 Work Desc: MOBILE HOME SET UP BIG DAD M OBIL E H O M SET UP BUILDING FEE 60.00 ELE FEE 40.00 LILLEY AIR CONDITIONING INC. PLUMBING FEE 40.00 MECHANICAL FEE 35.00 BIG DADDY'S MOBILE HOME SET UP SEWER CONNECTION MOBILE 1,005.00 WATER CONNECTION MOBILE HC 320.50 LILLEY AIR CONDITIONING, INC. WATER METER RES 3/4" 220.00 IRRIGATION METER 220.00 IRRIGATION CONNECTION 266.00 PARK FEES MH 573.73 POLICE IMPACT FEE 254.00 FIRE IMPACT FEE 273.00 PUBLIC SAFETY 5% 26.35 TRAFFIC IMPACT FEE 99% 3,595.68 TRAFFIC IMPACT FEE 1% 36.32 6011,6 214q c. A iil (7 kx . r / 0 )46 . J at4LA A) ,. _ 0P ' * - fiz,i; .1 Aor-P- )-(A-4-,IP`' t ,,,c, 6/Kx 0 ' ' 5 73 7 3 A V : ��h C�i�Ar1 „tie, MOBILE HOME SET -UP FA / ■ ' MOBILE HOME ELECTRIC ' MOBILE HOME A/C «cJJJ MOBILE HOME PLUMBING FINAL 4 3 Zq 7' r1 rk 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 inspection 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances ,.. / 6efte-- a 0 r - 4 1 a ' , ..I`a. __ 0 i CONTI T0 SIGNATURE PERMIT OFFI I - PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER _ 1 '" City of Zephyrliills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: 6; ` " ` I/ Date Received: 4 7- d 9 Site: 37/3 Alt k _ Permit Type: 114 UL' 1 4 5 ' "`40 & 5 'X Approved w /no comments:❑ Approved w /the below comments: Denied w /the below comments: ❑ ,(kel This comm t sheet shall be kept with the permit and/or plans. 4/--e9-07 ALL„ , Kalvin Switz lanS Examiner Date Contra i iii an. or Homeowner (R.eqq . d when comments are present) • m -4 x m x m D m� cn R� � 7] 1 / I O T. ° Z <_ r Z Z -I !* DD m m Z O m m r- 0 �„ m �o m m CEO c �Y ? x m , mm j m m Z M CD I O m° t m (° t 0 CD XI .N v f � j \ m ; -. d c N m in II E '.. (11 r - m T= o o 0 0 m ! �_ S ��\D ` r�i h D N m . m W a z x o z n m m o 'a - > m o - CO D D n m 0 O 0 { m C y T ( - , � .. 2 - -1 C 0 5 0 y O d m -i 11� ao z r i r 0 m ° i m Z c = cn O r-- ) u) m D m H m n o n z < FZ m wo Z, K r o o F) z mm Xi 0 33 D l m - M 'T) m D 'z (`- m O m I m o m 1 D m D 0 } O c of 7 < p i y w m m Z m m m ' ° � } CD m o v- C3 � ( � - L El ❑ ..g --i4 ❑ 0.1 ' ' z 1 C w .J C .4 z O ' '! m o :-'1 A o dp --„N o So c (d ) T 2 ■ \� m �' C o = U © D r xi N ❑ ❑ ❑).6 Ka t co • m O 2 O m * !_ m o lj' co > m o n -< D I m o m J A m C � p m ` y T f�/1 0) Qt) m -. Vf m z N I : 813- 780 -0020 City of Zephyrhills Permit Application Fax- 813 - 780 -0021 , . Building Department Date Received I (i7f =111 Phone Contact for Permitting • / II , - to., . Owner's Name yaw �� )1 0 , /� 4 - A 0 4 Owner Phone Number F7k i - , 6, ' Owner's Address IMO 7 t3// pg._ 3 3411( Owner Phone Number Fee Simple Titleholder Name --' Owner Phone Number Fee Simple Titleholder Address -- / it/Ca/wain �J JOB ADDRESS I 3 7 / 3. 6 /12.a- l / LOT* `j o .. 2... SUBDIVISION (:;149•11/41 T » i& PARCELID#1 W- py — otegn - 00 0 610 * 3v 1..e" (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR I ADD /ALT n SIGN n MOVE n DEMOLISH INSTALL REPAIR PROPOSED USE I SFR n COMM n OTHER I TYPE OF CONSTRUCTION I BLOCK Lye FRAME n STEEL n OTHER I I DESCRIPTION OF WORK pi( r O/x # (J)"YLP, . BUILDING SIZE , 6 1 SQ FOOTAGE /(J,--?‘? HEIGHT /3 i .:::::: BUILDING .................... .. ..................... OF TOTAL CONSTRUCTION ........................................................................ ............................... iv r ELECTRICAL I$ r O AMP VI r I� E ] PROGRESS ENERGY W. R.E.C. r PLUMBING 1$1i 0 00 IV 1 MECHANICAL $ Z'Z, Q7 VALUATION OF MECHANICAL INSTALLATION F GAS n ROOFING n SPECIALTY Q OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA nYES nNO SIGNATURE i ._. W ' / /, Daidy , SIGNATURE ! C OMPANY R Y/ N I FEE CURRENT I Y/ N I Address /� 1 / __- A. . '4 _ i /v. ' I / License# I "J0c) 7 ELECTRICIAN � / //J� / / / J � /) COMPANY / / /f/C - SIGNATURE (A )-0 It l ✓. r / /` j. ' (j�'lREGISTERED � L I Y / I FEE CURRENT I Y / N I Address IP L'iI. ter.^"., . ' _ /i . • GC�SJ� License # I& 1 30 0 / r2/ PLUMBER SIGNATURE�� . .__ COMPANY ',1 / /1\ ^ /jQ /�� T' - - 7 't - ----,1 --- ifGi3TERED ( Y / NI I FE ENT I Y / N I Addr - [n i/ � nF�r�L/11M / - License # rC2•::2 MECHANICAL : / with, '! COMPANY A • / ( // e(I SIGNATURE I %ice '/ _,..1. v - REGISTERED I Y/ N I FEE CUR Y/ N I • - ai Address //�� r // ry7y� -7 rj '+, m., tense # V `„ J 17 OTHER COMPANY I SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I Address License # I ■ 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 8 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 8 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 8 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 Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C 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 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 °certficate 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/WastewaterTreatment. 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 811 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. 1 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 Y1 R PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LEND R s - AN ATTORNEY : FORE RECORDING YOUR NOTICE OF COMMENCEMENT :.\ FLORIDA JURAT (F 1 ." t� OWNER OR AGEN f„.. . CONTRACTOR ' be a d and sworn to (or afinned) before this Subscri. _ • and : • io or affirmed) before me this Ih' M 1,/■c;4. RJOA) All .. ' ' .. ";., i _ C l , A � hare rrsorlgNy Yip own or has/have produced 'M o : are - • y known to me or has/have produced 07 "/0'7f�l�f identir on �� /ry as identification. �L��26sc.G > "1/.eLL , Notary Pudic Ad - O �r� Notary Pudic Commission No. ission No. ••• •• ' ENE HILL • CLARENE HILL 4G13/ J, /L,L . ;•■ °_ MY COMMISSION # DD 678625 Name of Notary ' 1 • OVOMMISSION # DD 678625Nam ot Notary typed, printed or stamped + •. p EX' `ES: May 28, 2011 �� EXPIRES: May 28, 2011 Q, Bonded Thru Notary Publls UndSrWdters t4 Bonded Thru Notary Public Underwriters Rf„ f 2008-09 Mobile Home tnetafler License Licensee: jnekie 1 Piterson License Number: 1110000537 Effective Date iiiidiEffitiL2g1 10-1-08 9-3009 State at Herds - OspettaentarthobsaySafety emdfilator Vehicles - (*Won of MotoeVelictes IMPERIAL POLK - ‘it( ()GAL BUSINES.7, AX RECEIPT RECEIPT ACC T 1820000151 CLASS EXPIRES: 9/30/2009 B I • ATI i AVE k W tni$ NOT IN CITY .1' LOC ON / OWNFR JACKIE D PETERSON 230180 CONTRACTOR MOBILE HOME SETUP BIG DADDY'S MOBILE HOME SET-UP SERVICE LLC 621 E AVE A WAHNETA WINTER HAVEN FL 33880 BUS TAX TYPT NLNEW AL BASE TAX T,500 ADM. FEE PFNALTIES TOTAL 55 00 F S 205 05.15 (5) reqs, res FEIN Ly owner Social Security Niir JOE G. TED * ER, AX OLLE TOR t E & r: RY BAR-row ,l 3 CTh 1EL 4 4 AW1 POIkT3 COM THIS POLK COUNTY LOCAL BUSINESS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED AT THE BUSINESS LOCATION 0000005500 0000005500 0000000000023008 1001 3 . _ — 10/13/2006 03:28 8638750703 BIG_DADDYS PAGE 01/03 RIC DADDY'S M.f SET -4P S6R.VICE,LL.C. AVeN4tEA ER.S•r WINTek I-I'VeN, RL J2? Phone (863) 287 -41)2 i Fax (883) 875 -0703 OWNER! 1ACKIE PETERSON STATE LICENSE 0 1140000537 SIGNATURE AUTHORITY FORM FOR THE PURPOSE OF OBTAINING BUILDING PERMITS • L.L e., (pm mune bele) (Olt _ sane nme) Do hereby designate the following individual(s) as having the authority to sign and submit applications and related documents for the purpose of obtaining building permits under my license in DP 7. •yh: /k' - esantyF -1 further acknowledge and accept, as a !plat tame of sou* hale) licensed contractor, my responsibility and liability for each project permitted under the author)ty designated on this form, and that my blithe to assume and fulfill said duty maybe grounds for the initiation of disciplinary action against my contractor's license. - ��� DESIGNATED SIGNERS: - EASF,®INA i Contractors Slglatw. Y.y . 1 , ,,. Subs and sworn to before me this 2. • ..!�7rZI-,A • l dayof . if I 4. //..• /. h • . 5. • Public's apsur My commission expires: ale /Oa, ,. MCRISSY M MCCALL ; 4 : M'; rONIKSSION * D0889456 " , . a � �� t`. EXPIRES Juno 26. 2011 (S n ( ) personally known to me ,0eS ^ �. FloliONMpySCMeacom identified by 10/13/2006 03:28 8638750703 BIG_DADDYS PAGE 02/03 Crerm warv.4e "Jaen•1A6I1e,A.AI At argon Inx►ancw Swrvlewe FANID: 6153- 284l2 To: Et 19 Daddy's MH - Christy Date: 4/2/09 11:10 AM Page. 1 of I AC ORD CERTIFICATE OF LIABILITY INSURANCE OPIO 391 DATE`MWDON'''") ENTER -1 04/02/09 PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION BIS/GREEN INSURANCE BLRVICLI'S ONLY ANO CONFERS NO RI0)HTS UPON THE CERTIFICATE "COTS Insurance Inc" HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1500 6th Street NW ALTER THE COVERAGE AFFORDED BY THE POuc1E8 BELOW. Winter Haven FL 33881 Phone:863- 294 -4241 Fax:863- 294 -4243 INSURER3AFFOROIN000VERAGE NAICl1 INSURE!) INNSER n The Burlington Ins co FJC wsuREP s: Big Daddy's Mobile Haase Set Up iN�RER c Service, LLC 'Tackle peterson 621 Avenue A East- Wabneta POURER D: Winter Maven FL 33980 INSURER E: • COVERAGES THE POLICIES CF IP URWNCE LISTED BELOW HAVE SEEN ISSLED TO THE INELRED NAACO MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Writ RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIIE) IEAEIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDTIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED Sri PAID CLAIMS, wy L,TR ! TYPE OF FISURANC6 POLICY NUMBER �r "r 1 DA7E r (MMP70f1 Yw Laws GENERAL WORRY EACH OCQMPENCE 11,000,000 ]L r IVTiC 2,. ca✓AEERCIALGENERAL U m ABU. 2649003199 07/21/08 07/21/09 PREMIS (En 160,000 . �J aAIMS MADE © occup MED EXP )lyy one Pelson) 1 5 , 000 _ PERSONAL A ADV (NARY $1,000,0(10 GENERAL AGGREGATE $ 1,000,000 GEML AGGREGATE LIIM PGR PS : PRODUCTS. COM P AGO $ Included 7 OL PICE n JECY n LOC • AUTOMOBILE UABILI TY COMBINED SINGLE LIMIT $ ANY AUTO CEe AccHlontI ALL OWNED AUTOS SODILY INJURY SCHEDULED AUTOS (Per Omen) 1 _... HIRED AAOS BOOBY IN.A.11Y - NON•ONMEDAUTOS (PereeeMeN) 3 PROPERTY DAMAGE 3' (Per Accident) GARAGE LABLITY AUTO MY - EA ACCIDENT 1 - 1] ANY ALPO OTHER THAN EA ACC 3 AUTOON.Y: nes EXCESSRAIBRELLA UABILITY EACH OCCttIRENCE Y 1 nc0LR CLAIM$ AOOREGAYE 1 .R DEDUCTIBLE 1 MORTON 3 1 WORKERS COMPRI$ATION AND ITOT LfIMR6 I 1OER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT t MY PROPRIETORIPARTNER/E)EQTIVE OFFICEPNHEMBER EXCI.UDEOT L.L. DISEASE - EA EMPLOYEE $ If y�l, Oa1W IAIIef SPECIAL crI PRI wISItXNS WAY E.L. mew- POLICY LINT _ 1 OTHER • • • • - ••..: r LOCATI •' r VENICLES s EXCLUSIONS 400E0 BY = " • _..., 'NT / SPECIAL PROVISIONS JecKle Peterson Installer License # IR0000537 Aggregate Limits shown may have been reduced by paid claims.. CERTIFICATE HOLDER CANCELLATION CI9!YOFS 11404A0 ANY OF THE A90VE DESCIVIEO POLICIES BE mecum BEFORE THE EXPIRATION DATE TIEREOF. THE ISe*NG INSURER WILL ENDEAVOR TO MAIL 3.0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEST, BUT FAILURE TO 00 *0 SHALL City of Eephyrbilis WORE NO OILS/MON OR LIABILITY OF ANY KIND UPON THE INl.JR9f, ITN AGENT1 DR 5335 Stb St. _ Eephprhizls FL 33542 " °NNT"T AUT ACORO 2512001JOi) e ACORO CORPORATION 1988 10/13/2006 03:28 8638750703 BIG_DADDYS PAGE 03/03 ACOR CERTIFICATE OF LIABILITY INSURANCE DArs e0^ I 04/02/09 moms THIS CERTIFICATE IB ISSUED AS A MATTER OF INFORMATION Omega Insurance Solutions ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 199 Menus K Se ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Winter Haven, FL 33880 Winter Haven FL 33980 1 INSURERS AFTOPDING COVERAGE NAIL a F191ER9C Omega Business Solutions Inc R A: GuiranteU Nrsularic 11398 199 Ave K SE INI9UR Se Names Indemnet f �At AM Beef 20097 Minter Haven FL 33880 IN&URER C -- - ......... I INSURER 0;, .,.... _ COVERAGES '- THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURE° NAMED ABOVE FOIL ;HE POLICY PERIOD INDICATED. NOTWITHSTANDING APR' RCOUIRIMSNT, TOW OR CONDITION OF ANY CONTRACT OR OTHER DOCIPAINT WITN RESPD.T 'I'n EAMICH rpMS CERTIFICATE MAY BE IS9UEO OR MAY PERTAIN. THE INSURANCE APPOROEO eY T'1 t POMP ORSCRINSO HEREIN is SUBJECT TO Aid 1 1.II: TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 1 DOLICi8& AOCREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID OLAIM& j� WOW AP Nmasarn PODGY NtM 19g ll;Ifl�l%L •- � �� Mme. LIMITS — dIIIIRAL MAMMY Er ' . itI CO ERCIAL 0 MLI T .11t A ROCIPIP el_..0 -.- - .� CLAIMI MAD OCCUR ,�la EIO' perm i $ PEREINAL& AOV_jMURY S _,■ ORAL tlfjl�lRaeATB !� Nt Ts LIMIT APPLIES P9N; P�t�IP/�TS�fgMP/pPAGO 0 AUTOMDIELE LIABILITY • _ ANY AUTO trOMI INELE LIMIT ALL OWNEOAUTOS '— ' BOOST INJURY SCHEDULED ALTOS (( *r 1 --- _ HIRED AUTOS INJURY NON -OWN WI AUTOS NOMMES .......�� S •..— �— . .. PRCIPERTYDAMAGE s (Per i. duW) OBI LMeILITc , OATS ONLY - EA ACCIDENT 1 ANT AUTO OTINRTNAN EA ACC AUTO ONLY: AEG , 6 E R !IMIINIIIIOI.IA UANUTY , e,Gfi OCCURRENCE 1$ OCCUR ❑ cues MADE .6 1 1 1 DODUOTIBLE .. 1 RETENTION 1 $ WORKIlle COMPENIM110N AND "x L WO_ bTATLL p ry YJ.IIAttS.l. ,. .ER, . A pgp O ruA GPEO0193000001.109 01/0112009 01/01/3010 ,pS,I I� *cciDGNT x1,000000 A NY OI M E EARRLTu0EA E;CU1rvE .M. 0664@6•64 10AM S.. 1 , 00 0 000 r .IA t� NeENwelr C. DEMME- POI,ICY 1 1,000,000 . oTNER EL Each Acre 1,000,000 B Employers Liability RA•39$9 01/01/1009 01101/3010 EL Disease Ea Emp 1,000,000 _ EL Disease Pol Um 1,000,000 B$3 P110N OP OPENATIONI 1 LOCM1ONS ) mecums r sitcLumONE ADDED RT ENDORSEME NT f SPEOEAL PRO i W$ Jackie Peterson license 111110000937 Coverage Is extended to the leased employees of alternate employer (AL, FL, and GA Oniyl DIG DADDY'S SET UP SERVICE, LLC. (Effective 01/01/ 2009). DISCLAIMER The Certificate of Insurance does not constitute Et contract between the issuing ineu er(s), authorized representative or producer, and the certificate holder, nor dote it affirmatively or nagatlwly amend, extend or alter Dove .. e • • • .. the • • tales listed thereon. Covers • B Ben . . Uabii . • viand by National Indemnity (dRA -2389) . GERTI] ICATE HOLDER CANCILLATION City of Zephyrfiilla IN0UTAANYREF 1IE 0 B DN$c O0I PCU0NEDROANcIL 6OWORETHE E1fOMRJ1TRfN DATE Tourer, me snow IMJUNgR WILL ENDEAVOR TO MAIL 1 Q tors warren 53:15 91h 8R NOTICE TO NE GENT1NCA r F Mouses T AMIDTO TN[ LMT, MUT FAILURE TO DO SO SHALL IMPOSE NO °®EMOTION c•R maul OP ANY ICMO UPON he MUREX ITS AGSM Olt ZEE1phyrhllls, PL 33642 IsEEMIMEri AUTN01zIxap,s6e grrTA - are E.- e.ITs ACORP as (mum a • ACORD CORPORATION 1908 \ o\ p w L - w roo ms / . _ .. 1 -4 x 1 Y , p� d x rW C Xi / m r , - --, \ - -' M 41, (0 i lg, , W- °* c. • . . X . /: °V 4 - -1._ __. \._/ IA Q- 4,r; e g A .:;..?4'. 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Cm Fat en scan, Qi yw [.�-..:... 84 7'�1� II 1 I , ®' 1 2 — 1• ii. I��� ALL WORK. SHALL COMPLY WITH ALL • I ; 1 i a g�7AILINCr CODES, FLORIDABtIE -DD?G i ' ' 1 d : z 1 ODE, NATIONAL ELECTRIC CODE AND . : ® 0 1 T1.. O I I I �� �z � CITY OF ZEI'HYRHILLS ORDINANCES • > I — ,L___, 14,q I ___, i. V00 /ZOOd WdOp:OO 600Z GE JeW 9SLS 91L LZL :xeJ 9N] SOH NJS900df JACOBSEN HOMES ENG Fax:727- 726 -5755 Mar 31 2009 00:dOpm P003 /004 r 1 • t 1 • ADDITIONAL PERIMETER BLOCKING (TATS mews N ADDITION To BL00040 REQURED IN Tile NAVAL) . • . . AIL � 1 , `l UIDEi EACH WALL DneRt / LOCATED ON SIDEWALKS -- . - - -- • — NIND • 2 OR MORE 451/2' OYS ' PIERS REQUIRED AT EMI DC • 1 • AND EETREEN EACH OPENNG • �' RECESSED /FM REOUTAE PE RS SPACED 64 0.C. YA1. (18' OR LESS N REP1H) - PIP. HUMS CO SIDEIYAU. 0R MARRIAGE WALL EACH END OF RECESSED AREAS • . • • F IKIIIT uiAr NO . . E1 BLOOMS ROWED D AT 48' 0.C. MAX. . • - RECESSED AREAS N /SIDE• BAY REQUIRE PIERS SPACED 64' 0.C. WAx • • • 1H15 ALSO ; APPLIES• TO ALL DIM BAY =OBS ' UNLESS SUPPOR1ED BY A FRAME MEMBER • —rill,.,- . - N isig 54' OR 60' TUB ATILT/IL OR MARRIAGE WALL • ' G A R D E N TUB A T S K I R L OR MARRIAGE NAIL • OP as MAIL . ill . ' . . _ • . , . : d _Ill • illno 11 . DEFER ' CARNETS ALONG S OEWML OR MARRIAGE NAIL • • ( APPLES TO BATH CABNEIS 80` OR GR .AII:R IN Lfl161H) (SAYE BLOCKIX MAY BE USED FOR INURE 461/1' WIDOWS) . . ,SPECIAL BLOCKING NOTE FOR 15 -' (184 WIDE FLOOR SECTIONS , PERMS EI_OCIONO IS REQUIRED (J*M6AGE RIB) 64' ON MNIER MAX. SPAC610 . NOTE LEVEL. FLOOR •SYSIIEY FIRST (SIDENALL TO SIDERML OR MARRIAGE *MIL) BEFORE. NWWAUJIG PERNE1ER BLOCS . • . • 1. AOOIHONIL BLOCKING MIRED AS OCEAIED ABOW (OSE 16' x 10' PIER PADS), ' 2 LOCATE BLOOM IBIOFR FERBE R = et WM 6' WWI CI NY 0.C. JOISTS J. OOLUOC PIERS ARE IN AMMON TO RE J J PEAS URGER RIL -N EHT HAWN MI • 4. POWER S WCCINO IS RECORD UIDER.IRE BOORS O1A■AEE t SmEEI MIS) 64“ 0.c. MAX. 5. PEAS USED FOR PEAAIEIER SUPPORT MIST BE DISOILLn I11H 11E LON6 DINENSON PARALLEL •1O WE PERYEIEA RAE. • 1 NI191 PERKIER BLOM IS REfaUI D ANY WINO UNE 0P9E SPAN WATER TITAN 17, MIST HAW B11EA1RIRAk PIOIS • PLACED AT M?JL 10 OA. EXCEPT 11 N SEE SPECIAL N01E ' • •'■ ■■ JACOBSEN HOMES DEW , ' � 0 AEA: BRAIN BY: 0.A ADDLE' 4-12-00 �'L'�'� NO SUMO P.o. aox sea ADDITIONAL BLOCKING . / ii MI pox riffiNitt NO COMA calm 11111`- 11111`- ■' N5 W01 0110LS ML App 1R 9! SAFETY H ARD O M, FLORIDA 84e • TIMBAL 1415 /0 I1I114 1[ !■ Nil IN PHONE (BM 725-113e • Kw ONCE NO e>I T FIN =O. puma NuMBEtE ' .SU -01 -0005 (0 / L 6 1 JACOBSEN HOMES ENG Fax:727- 726 -5755 Mar 31 2009 00 :d1pm P004/004 • 17 3 1L .6' X 25 3/16" PIER FOOTER SPACINGS* (MIN. '432. 7/8 SQ.IN) • MAXIMUM I --BEAM PIER SPACING FLOOR MAXIMUM PIER SPACING (SOIL BEARING. CAPACITY) WIDTH , .1000 (PSF) 1500 (PSF) 2000 (PSF) •. 2500 (PSF) 3000 (PSF) 3500 (PSF) 120 WIDE FLOOR... 70•1/2" 110 1/2" SEE NOTE 44 SEE NOTE #4 SEE NOTE. 44 SEE NOTE 44 144" WIDE FLOOR.. 50 1/2' 93,1/2" • SEE NOTE 44 SEE NOTE y4 SEE NOTE 44 SEE NOTE 44 160" WIDE FLOOR•• 54' B5" 116" SEE NOTE •44 SEE NOTE 44 .SEE NOTE 11 ' 184" WIDE FLOOR.. 47 1/2' 75" 102" SEE NOTE 44 SEE NOTE 44 SEE NOTE 44 MIN. PIER CAPACITY 3004 LBS. 4507 LBS. 8009 WS. 7511 LBS.. 9013 LBS. 10,518 LBS. 2 4" X .24" PIER FOOTER SPACINGS* (MIN. 576' SQ, IN) • M AXIMUM I —BEAM ,PIER SPACING FLOOR MAXIMUM PIER SPACING (SOIL BEARING CAPACITY) WIDTH 1000 (PSF) 1500 (PSF) 2000 (PSF) 2500 (PSF) 3000 (PSF) 3500 (PSF) 120" WIDE FLOOR.. 95 I/2' SEE NOTE 44 ' SEE NOTE #4 SEE NOTE (4 SEE NOTE 44 SEE NOTE 44 144" WIDE FLOOR.. 81" SEE NOTE 44 SEE NOTE 44 SEE NOTE 44 SEE NOTE •44 SEE NOTE 44 160' WIDE FLOOR.. • . 74" ' 115 - SEE NOTE 44 SEE NOTE •#4 SEE NOTE 44 SEE NOTE 44 1 WIDE FLOOR•• 65" 101" • SEE NOTE 44 SEE NOTE 44 SEE NOTE 4 SEE NOTE 44 + MIN. PIER CAPACITY 4000 LBS 6000 LBS 8000 LETS. 10,000 'LOS.' 12,000 LBS. 14,000 LBS, • ' NOTE: UNIT WIDTHS WITH •• INCLUDES A 6" OVERHANG ON BOTH SIDES MAXIMUM, FOR TYPICAL PIERS SEA PAGE SU--01 --0021 • NOTES: EN -, ••' . ', DAPIA APPROVAL; 1 PRE - FABRICATED PIER PADS MAT BE USED AS AN ALTERNATE TO THE CONCRETE G �QT E j �3 � e • 5 B e c4L'' 0. L ! FOOTINGS SPEdFlED W ' ••' THE JACOBSEN HOMES SET-UP MANUAL g J Q * I No. . � �f Y� 14'495- `$ ( , , 2. THE PRE - FABRICATED PIER PADS•ARE TO BE INSTALLED PER THE Y MANUFACTURERS NSTALLA110N INSIRUC110NS MO NEEr MIMMUM 4 PPR O VED B r ; 9I0 po CAPACITIES SHOWN ABOVE. * L r M. i ALL OTHER AMUSEMENTS ARE TO DE ADIEAEO TO AS SPECIFIED in THE JACOBSEN gT 'I" O ; w e Ort 1 1 Uwe MOVES INSTAlUT10N R1S1RUG1IO4S. 0 0/1::'‘. 4 • 4. MAX, PIER SPACING 8' FOR UNITS WM 8' I- BEAMS' / Mr FOR MS 8111 10" OR 1 •••'‘'" � �0 ,N �� 12' 1 -BEAS (24' MAX. FROM ENOS). • it ,4 ∎ • , - Eo I �UREo 10ME gaits; Y M BY: � N r t IM1 � CnQ IY�i 1 }I • NO?1CB: l le REV. LETTER: � 00 REV. HOMES• TNEeESPEC61CATIpl9 D.M.T. 09 -22 -01 !t ORMMUL,'PROPRIETARK• AND CONGDENnN. 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Modular Home Set -ups and Aluminum Packages 1) All property markers shall be exposed and clearly marked at time of first inspection. 2) All set -backs shall be met. 3) All garages shall comply with section 309.2 ( Fire separation) of the F.B.C. (as of March 1st 2009) 4) Access shall be made available at time of inspection. 5)Manufacture specification manual, approved plans and permit shall be available at time of inspection. 6)No electric, plumbing, mechanical or framing is to be covered without inspection and approval first. 7)R.O.W. Use permit required for driveways on public streets. R.O. W. - Right Of Way F.B.C. - Florida Building Code • 1111111 11111 111I1 11111 11111 11111 11111 111111111111111 11111111 • 2009064874 Rcpt: 1242549 Rec:10.00 D5: 000 0.00 05/ Dpty Clerk S, O'NE IL, PASCO ERK 8 COMPTROLLER 05/ 0 5/il/09 , of 1 OR 6K „ 1 +1 1032 NOTICE OF COMMENCEMENT Permit No. Property Identification No.3 - .26 - : of C /Sv —000'O- 20.2_0 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following_ informat is provided in this NOTICE OF COMMENCE1n NT. Gran M gjLo Ais - Phftse Fo c�rc- P6 6/ , U�3 1. Description of property (legal description :) IJ I .3 2 0 : .0 i , P6 /67I a) Street Address: U fk- u_ 2. _ if - V _S 3 As. 2. General description of improveme 3. Owner Information J � a) Name and address: I' 1(IVD/tl N/ C# «707 / /(/%JCp �.e. 2 relt S b) Name and address of fee simple titleholder (if other than owner) ;, c) Interest in property 0 , 0N e, • 4. Contractor Information 1 I t a) Name and address: , 1 i . ,� & 1 I: 1 i� °' - • ;! b) Telephone No.: .S, - 2 8 7 -cj //Z pc No. (Opt.) 5. Surety Information � a / Rue_ � Q .� 3 / c � a Name and address: LA)/ /\)44A. b v b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6. Lender 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: 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 AE1'ER 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 C NCEMENT. STATE OF FLORIDA PASCO g G COUNTY OF PASCO X � Signature of Owner or er's Authorized Officer/Director/Partner/Manager Print Nanfe The foregoing instrument was acknowledged before me this 7 day of , pif/J , 2 , by j/Xi'A Z'A) ,A/ //�Ge 4G9 iY (type of authority, e.g. officer, trustee, attorney in fact) for , szvrx me of party on behalf of whom instrument was executed). Personally Known OR Produced Identification v Notary Signature Ct MCNE i TILL �. y /We- /4W / , 0/�,4 -. /G S rid ail •,: MY COMMISSION # DD 678625 / EXPIRES: May 28, 2011 Type of Identification Produced �/��f�6�jb Name (print) /�L l ; " ea,a.a rim Nctery Public Underwriters Verification pursuant to Section 92.525, Florida Statutes. Under penalf' " s perjury, I d- - - that I have re e foregoing and that the facts stated in it are true to the best of my knowledge and belief. PORMSMOC I OF FLORIDA, COUNTY OF PASCO of Natural Pero ,igningAbove TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE OR OF PUBLIC RECORD IN THIS OFFICE WITNESS MY HAND AND OFFICIAL SEAL THIS PA DAY OF ` �¢' 2/20 S . 0' NEIL, CLERK & COMPTROLLER BY 'l- D:PU CLERK r '•r').r'r'1::.A 1 17.0!*.• s.,,c >._ }. ^ .1. • 1)(i"C:Ii • 60 • I f 1 1