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HomeMy WebLinkAbout09-9596 CITY OF ZEPHYRHILLS • 5335 - 8TH STREET (813)780 -0020 9596 BUILDING PERMIT Permit Number: 9596 Address: 3749 COPELAND DR Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 24- 26 -21- 0010 - 03900 -0000 Improv. Cost: 850,000.00 lik ` i77a 7 Date Issued: 10/27/2009 Name: 6116 CASTLE MATT STONE Total Fees: 3,640.00 Address: 3749 COPELAND DR Amount Paid: 3,640.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/27/2009 Phone: (813)367 -9780 Work Desc: BUILD OUTSIDE ENCLOSED MIXER SQ FT 478.52 LA N :U LD R BUILD N F 3.570.00 EL - AL F 35.00 OWNER PLUMBING FEE 35.00 OWNER 1 \0 `\ � 4. �. ,, . tea. , .� .. ; __ .__.. _. , >� � F• • ER 2 •U H PLUM: MISC IN ULATION „ IL N 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." AL ONT4rip SIGNATURE PERMIT OFFI rR P • MIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Date: August 19, 2009 To: SPR Committee From: RJ Keetch Re: August SPR meeting Minutes Attendance: Todd Vande Berg, RJ Keetch, Rick Moore, Shane LeBlanc, David Henderson, Kerry Barnett, Bill Burgess, Mayor McDuffie, Steve Spina 1. Application for Special Event for Future Fest sponsored by God's Vision for Life Ministry at Zephyr Park on September 19 9:00 am to 5:00 pm: This item was approved subject to the following conditions: • The applicant shall provide a certificate of insurance. 2. Request to vacate two Fire Lanes at Meadowood Subdivision: It has been confirmed that the vacation of the fire lanes would not create an access problem for underground utilities. Public works will prepare the documents necessary to legally vacate the proposed section of roadway. Planning will check to see if this application requires Planning Commission and /or City Council approval. The vacation and abandonment was approved subject to the following conditions: • The applicant shall work with the city to come up with an acceptable way to inhibit vehicular traffic from using the fire lanes (i.e. bollards, or a fence). 3. Revised Site Plan for OLDCASTLE Coastal (used to be Matt Stone) located on 20 Street. The item was approved subject to the following conditions: • The applicant shall maintain adequate access (per fire department) • The applicant shall demonstrate that they are not violating FAA height restrictions. • The applicant shall not exceed a maximum 75 decibels continuous noise /(85 db spike). • The enclosure intended to mitigate noise shall be completed prior to operation of the "mixer ". ke pht)4.41 9-35 -0 • \'‘ R I ll ' r =I i , /"I . - 11 . ■ ....'. " 0 City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractorg(m weL J:jszr) fiza5t-g- Date Received: —■ Site: 71 ,- _.• _..e., i , - ----, Permit Type: L 7V .4.. , - Approved w/no comments: 0 Approved w/the below comments: V Denied w/the below comments: 0 4 1 1 .reitof tatUs k (Nspecird bi Ce n f i rit r ,14 ii, r a, \ vs n tu 9evi c) This comment sheet shall kept with the permit and/or plans. • . , Kalvin p witzer — P LIT Examiner Date Cs ii• . ctor , , d/ 414. 11 eowner r (Required wh- . omments are present) 3 3-70 FiAlFRIG44Y EN1NEEIN INC. STRUCTURAL ENGINEERS November 20, 2009 Old Castle Matt Stone 3749 Copeland Drive Zephyrhills, FL 33542 In Care of: B & N Welding & Fabrication, Inc. 2405 East Newsome Road Plant City, Florida 33565 Re: Old Castle Matt Stone Batch Plant Installation 3749 Copeland Drive - Zephyrhills, FL 33542 City of Zephyrhills Permit # 9596 Arkay Engineering, Inc. Job # 12985 To Whom It May Concern: Today, at the request of Kenny Reinhold of B & N Welding, I performed a visual structural inspection of the installation of the new batch plant equipment and the supporting structural steel framing along with the steel work platform areas. The purpose of my inspection was to look at all of the bolted and welded (shop welds and field welds) connections for compliance with the permit plans prepared by Turmac - Columbia Machine, Inc. and the 2007 Florida Building Code (FBC) along with both the 2008 and 2009 FBC supplements. Based upon my observations, the connections for the entire batch plant assembly and supporting structural steel framing along with the work platforms are constructed in compliance with the above noted building codes and plans. If you need any further assistance with this matter, please give me a call at the office. Since .1v Arkay er rig, Inc. •ichard L. Kiey, P.E. IQ58 E. ED6EWOOD DRIVE LAKELAND, FLORIDA 33803 PHONE: 863 - 688 -6500 — FAX: 863 - 688 -655'1 STATE OF FLORIDA CERTIFICATE OF AUTHORIZATION # E3634'7 RICHARD L. KIDDEY, F.E. FLORIDA LICENSE # 372 E -MAIL: a rkayotampabay.rr.com A (.: t e f 1..444. l fr';,y ,;7 "AV i iif e l" .tee. d� 1111111 11111 VIII 11111 VIII VIII IIII• i •i 11111111111111 I11 cr.�, t Cet74.4 .,k pep P % c* 414 g..?.t.xt'~ Jt' vie.fnL 'AV 41,4 4,6 u s Fa i 2009146311 , NOTICE OF•CONIA ENCEMENT r ss -,:.11 jts,u� A. ,,: ,/tsc r Cc A'jJ e. r c + ' V/ ici q4 /ei trii 4444 A Permit No. xc 7 .sd%�' �b/c� fet, F+ /�r1 %ve r(4 ,e4 . 7/ • 4 0e .,4'33' - . .cfne. 8 - 57 - : ` 4'y Property Identification No. �/ ` c 2/ gpjp 03 00 c+yt'v f) 11/ " 1 ; clew' rA1.0SL� .. :tW c "z/4.44 �/ K'/id /ASe > `Ae .tS" ii+ b 7c (J� s,day14 fd.d.s4 a 4 ( THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with 1,410/450 Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. Azh sal' ail Alseiteit hr 1.Description of property (legal descri / 4' • s t d , 4/� . •e r✓ .- ` : en • u,, e , a) Street Address: X799 (j, ,„,,ci 7 ° / ' „�„4l FG 33,SS/2 Wtti.orf rl.�e 2.General description of improvements: L radi j fi ezror 3i5• I'5 3.Owner Information (p /d �' p.4.. R a) Name and address: - all "tcS S9 &d,4, / 41,Atates Yg f � Y��ls L 3� � cross s�s or • b) Name and address of fee. simple titleholder (if other th wner) 34 _ F l 4 33 c) Interest in property � - S4�Gel, 4.Contractor Informatio Name and address i /p. w i £ vh s , CO % G' & x 6C , ,c s 1 - .' /�e j ,- - .1 ze b) Telephone No.: 35 L Wt. - 4 Fax No. (Opt.) 1-. oP3 5.Surety Information m N a) Name and address: b) Amount of Bond: l➢ " c) Telephone No.: Fax No. (Opt.) - 0 ai 6.Lender N a) Name and address: N Phone No. 7. Identity of person within the State of F1on designated by owner u on whom notice or othe documents may be served: t' a) Name and address: eiri, ,�`7y9 c A. , . ifs / L 3A50'2• - a e b) Telephone No.: g! 7 3 - d Fax .. (o it.) . i m m 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section ,< m m 713.13(1)(b) Florida Statutes: a a) Name and address: b) Telephone No.: • Fax No. (Opt.) - • x 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording.unless a different date is specified): • WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION. OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, . FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. m E A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST ° 3 ; n INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE col!: COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. x coo 0 Z STATE OF FLORIDA 031► E1 • COUNTY OF PASCO Si .i.. ofOwv 4/ er' s Authorized Officer /Director/Partner/Manager m 7 . ` 0 Print Name . F+ I m The foregoing instrument was acknow,pdged before me this '' day of UC 20 0 C 7, by E . L. ivCk i f m o 1 - 1 )1'11 as Ket)1 Crr t Op C ti 005 Mcs r (del (type of authority, e.g. officer, trustee, attorney �� 3 in fact) for 0 ( < < { t Y o I (name of party on behalf of whom instrument was executed). 1■ Personally Known OR Produced Identification V Notary Signature ( f'). Z?'"--'u- - - -(' N o A 1 so, Ppe . EMILY FUNNELL p . Type of Identification Produced F L L Name (print) (p ) • �a° , ` Notary Public - State of Florida , 1 . , ∎` • 1 My Commission Expires May 6, 2011 , Commission # DD 650960 Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjur}� I d' r ` `tha$ i rrAid that the facts stated in it are true to the best of my knowledge and belief. • • Signature of Natural Person Signing Above FORMS /NOC,rvsd2007 STATE OF FLORA k QUNTY OF PASCO THIS IS TO CER I 'THAT THE F GOING IS TRUE AND Q'QI RE.7. ). COPY OF T CUMENT ON FILE O bF PUBLid F4ECORD `itif liS OFFICE WITNES £ MY HAND OF ICCIAL SEAL ; CHI _ / DAY OF :'2 a) PAULA S. O'NEIL. OLE & QOMPTROLLER , _._.___ , l r /, / _ DEPKTY CLERK 813 -780 -0020 City of Zephyrhills Permit Application Fax- 813 -780 -0021 /� Building Department � Date Received 9 ._a 9 - 1 P .ne Contact for Permitting g / -5 -- 1111tt11111111IL.LLIe - — / /} Owner's Name (i / ; [� . � _ � ^- / ' Owner Phone Number i 3 - 7; ; 3 - 1 if Owner's Address 371/9 t�'pda&i f -/ LTV l .4414, FL g 4' Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address j/ /} I _ f_ - / /� JOB ADDRESS % 7 9 A /ai 4- ! yA-,(, l L 3�JCV _ LOT # SUBDIVISION / / / PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR K ADD /ALT n SIGN I I MOVE I I DEMOLISH INSTALL REPAIR PROPOSED USE 1 I SFR I I COMM I 1 OTHER I I TYPE OF CONSTRUCTION 1 1 BLOCK I 1 FRAME ! I STEEL OTHER I DESCRIPTION OF WORK A�pl At(`- — P�// A //1ST,1I n'/b J 1,140-014 4fol 4144Se4 BUILDING SIZE ,.1/. 87S''s )/- 8 751 SQ FOOTAGE V7p, 5 HEIGHT 351 /v WA BUILDING $ Q a 0 t) VALUATION OF TOTAL CONSTRUCTION I ELECTRICAL $ ll AMP SERVICE I ( PROGRESS ENERGY n W.R.E.C. I I PLUMBING $ / -3t7 7 KriRY�sf 1 I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION I I GAS 1 1 ROOFING 1 I SPECIALTY I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES 1 INO II " BUILDER �� • 5 COMPANY 1/ " SIGNATURE — / REGISTERED 1 Y / N 1 E CURRENT I Y/ N I Address 1 l I bi»' , � U b/ ✓; C P�. 34 1& 0 1-C — License # ` Y a 1 2 53 r ELECTRICIAN / j��� ' ,V 7 COMPANY SIGNATURE t/ j /('�!t/� REGISTERED I / N I 0 E CURRENT 1 Y/ N iir Address — Lice e # , .te / —r PLUMBER / S , . S ` COMPANY V IT SIGNATURE I/ / REGISTERED 1 Y/ N I FEE CURRENT I Y/ N I w Address License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N 1 Address License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I Address I I 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. Directions: Fill out application completely. Owner & Contractor sign back of 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 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 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 JURAT (F.S. 117.03)) OWNER OR AGENT CONTRACTOR s ri a nd swo t. or affirmed) • • e me this Subscribed and swom to (or affirmed) before me this 4)t g 101 by i .1. _.� by Who is /are personally k to me or ha ave produced Who is /are personally known to me or has /have produced L Li L as identification. as identification. k Notary Public Notary Public Commission No. i)0 "- -DC Commission No. Name of N►�j 4!p^ WHO r ^�„r,1 — — — Name of Notary typed, printed or stamped 4 ; �a1N.,, EMILYFUNNELL = -. ^ Notary Public - State of Florida ;. * ? My Commission Expires May 6, 2011 4 .w• Commission # CD 650960 �� ,,,, ,, , Bonded Through National Notary Assn. Page 1 of 1 • Henry, Craig From: RJ Keetch [rjkeetch @ci.zephyrhills.fl.us] Sent: Friday, August 28, 2009 9:36 AM To: Henry, Craig Subject: FW: Minutes from today's SPR meeting (August 26, 2009) Attachments: SPRAugust262009.docx Craig, Thanks for attending the Site Plan Committee meeting on such short notice the other day. Please see the attached minutes from the meeting which constitute an approval for the project. RI Keetch From: R) Keetch Sent: Wednesday, August 26, 2009 3:47 PM To: Site Plan Committee Subject: Minutes from today's SPR meeting (August 26, 2009) Please see the attached minutes from today's SPR meeting. RJ Keetch Assistant City Planner /Economic Development, City of Zephyrhills, Development Department (813) 780 -0000 x3535 (office) (813) 713 -3948 (cellular) http : / /www.ci.zephyrhillsfl.us/ 8/28/2009 s1 It ,�,.., ; VO z m N 6 4'33'2.5" E 670.00' 1 t.1,9' Z I___, - -x i � J %�— _Y� 3�xi• y..7 :. ". , P N Al• fit. ,s ` "k- . I t ' i • I l r_ .,— 67'D!OA I k � , 1 I I % �' � � �t r s��'�.. . .rf.I 2°�'"� �,% _, 3 '"' yy r .•^ „ I t ,„,,t, 11 j 1X 1 r ' I 6'914v' 'v� ”' ,. • ,amort t I I 4 ' . � $4 : b , 1 nse ua� ? RP. eR ' 1 1 , Pi,c ♦ Ova as 11 ♦ L I): 1 ji S RO pO i ii 1 ' t , e . . 1-- — i ' w 1 T o p cR `"S • 1 . 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B c, • • , 1 Oc J bor. 2009. • • rtY _ !yep yX a11S LL .. -`'{ B dig 1 Ivlsion • . . • r , , ,i, ii $ :.8th:- 4t1 t " .. • L / ' • • • Yhaf�:±n` W Belding Vial 1 -. ,� J,� n n :u. 1. . v r.,. „ - n r 4 � � o r .o 'n rcelawn.Builder,S : i authQrizb � iirt Of T i:�: antion of Industrial and or - 4.... .. •» may_,: al. - � s I request coastal- Produ . B � eg8 > 1rQi'' alit FL . �.. budding car and est ect i 37A� Clop'�lan�ve 2e�hi s 33542. • µ� ,! t: nuin r • • • a ,- ` -. ! u , fo yo ur an t on • tot ... ''...4.;-11::•-•:-..;• h �ua,or. • p ig • • ,..: a, k •. 698169 • * , + r ID PlEB: Jut/A..2011 • ,:... �MMllwfalepYPWklhMdwe • • \Q • ", I 'ti i t s © y rs;r� • ..o.m4 r� _' S.a `__.. • ( O• YC, S - ?4:(' .;... \ ` �►1D w r1 ' y t+ • s p r te- ^� x'. 4 x . $( 1T'YS:: of •' .A d �, .I S7Ak IB � i 'III� �/ ie• VFW • • • • 'u / Efdd , 1 M 1 ,- : -...- n - OCT - -2009 12 :10 PM TREELAWN BUILDERS 352 796 2433 P. 03 .. • I . { r � y ! •� � s r : � r^w y � y Y y Pi`�l , Ft �v Y ..1.'"....i:..'. ` •a ✓ `l ,�I ,�t�� �_ISt t r I )Y.. • µ � j''':'2,;,'•:::'.:''..-:•-",::!.....,'I'': r 1 '%J ,+1. ? � a r • ? It @ ^ , t J ( - x r M . 1 . j *.S Q • i . C ; , a ; r. ;` ). , !r y_. tom} iyr J 1.„"�.,, (.:'•'.'"' ,�ti. - - i . # :.a ,, h_ - y'• * '- :•le . .(•,, S . MM.Y,Vi 1r • 4, ? ' J 1 ' �' ' . A ` ► t :. ". ;! �C .;.:1...:. L� wr r 1 I ( I 4S t � T J , '! , ! ' ' ' 1 - '�� n r l er )` is s 1 ,� JS , • ., R ,.-.. , .r -- '' k 1 7 � , ,'4ii . \IV ( ;:c.:-.±r;,:.:: t t ,. r e 7 . -,: i'�. Y t f l y�j + °�. .:;',..‘i-'7,41 „ � r Jln �' '' I t �f J y M Ilr i ” a Pr y A .....;' ' ' , r J J � !^ yJ y II . r �� ( t a . ^ -f+rd ". �J h ti 1 , t � r ..�; .i � ,�'.run� }Z'C e 13Wt 7 r v q , � (� ry , 5 . tr,:1_ C d 1 Q ) tt"' a I js/.}I'� h i t .l s , - ° ' ;� i • ar [ 6' P G f. , e:. .�!+a ,. ,) � . n Y 1 I. f i t • ,r v \ ' y 5 1 . Y S • {'.j. a f 1, / t ( . I. "N ' . i . '''•:...k: tl , ` + , �' r r ^ � � t F+. 1 - E ,� { Y t v i4. rI � I , i r ' h I ) �J . ' F ' . ' r ' { t • .v 1 + : 1 • Y � i '...++.:.. i . � ,r +. \ j . `,�,1 „i .,7.� � � � �� ' . Mt' � � 7 S • IJ . r t • ` x F . err y r ::•..:!.:::....::,..? : t ,.� \e G L F y ti , , i •7 . v �y�lr 1 �4J `O r . . I e i Y • 1 :I 7• t r, 'I • • '•1 t . r • . i,)utn .,...: 11. APPLICATION FOR REGISTRATION OF FICTITIOUS NAME Note: Acknowledgements /certificates will be sent to the address In Section 1 only. ATTACHMENT 1 Treelawn Builders Fictitious Name to be Registered (ese Nutructione it name includes "Corp' or "Inc') P.O. Box 506 C Mailing Address of BYSlnase `r ] _ ],J 7 Brooksville Florida 34605 -0506 ^^�""'ff co City State Zip Code 3. Florida County of principal place of business: Hemando (see instructions it more than one county) This space for office use only A. Owner(s) of Fictitious Name If Indivldual(s): (Use an attachment If necessary): 1. Beasley Paul C. 2. Last First MA. Last First M.I. P.O. Box 506 Address Address Brooksville Florida 34605 -0506 City State Zip Code City State Zip Code N O • B. Owner(s) of Fictitious Name If other than an Individual: (Use attachment if necessary): 1. 2. co Entity Name Entity Nana Address Address City State Zlp Code City State Zip Code Florida Registration Number Florida Registration Number FEI Number: FEI Number: ❑ Applied for ❑ Not Applicable ❑ Applied for ❑ Not Applicable I (we) the undersigned, being the sole (all the) party(ies) owning interest in the above fictitous.name, certify that the information indicated on this Corm is true rate. In acco rdance with Se 885.09, F.S., I (we) understand that the signature(s) below shall have the same legal effect as t • ma nder math (At Leas 0n Si Rrired) Signature o Owner Signature of Owner Date N Phone Number: (352) 796 -2433 Phone Number. FOR CANCELLATION COMPLETE SECTION 4 ONLY: FOR FICTITIOUS NAME OR OWNERSHIP CHANGE COMPLETE SECTIONS 1 THROUGH 4: er I (we) the undersigned, hereby cancel the fictitious name , which was registered on and was assigned • registration number Signature of Owner Date Signature of Owner Date Mark the applicable boxes ❑ Certificate of Status — $10 ® Certified Copy — $30 NON - REFUNDABLE PROCESSING FEE: $50 Single CR4E001 (11/03) • FILED APPLICATION FOR REGISTRATION OF FICTITIOUS NAME Jun 22, 2007 8:00 am Note: Acknowledgements /csrtM ottlles will be sent to the address In Section 1 onty. Secretary of State Treelawn Builders 06 -22 -2007 90080 026 * ** *80.00 607173700076 Fictitious Name lo be Registered (see Instructions It name Includes "Corp' or "Inc, P.O. Box 506 T C Malting Address of Business Brooksville Florida 34605 -0506 5 3 3 2 7 5 Gty State Tip Code 3. Florida County of principal place of business: Hernando (see instructions 11 more than one county) This space for office use only A. Owner(e) of Fictitious Name If Individual(s): (Use an attachment If necessary): 1 Beasley Paul C. 2. Last First M.I. Last And M.I. P.O. Box 506 Address Address Brooksville Florida 34605 -0506 City State Zip Code City State Zip Code N C B. Owners) of Fictitious Name If other than an individual: (Use attachment If necessary): 1. 2. Entity Name Ently Name Address Address Gry State Zip Code City State Zip Code Florida Registration Number Florida Registration Number FEI Number: FEI Number: ❑ Applied for 0 Not Applicable ❑ Applied for ❑ Not Applicable I (we) the undersigned, being the sole (all the) party(lea) owning interest In the above liictftious•name, certify that the information indicated on this form is true rate. (At In Leas accordance with gnatu R Sect i red) ion 865.09• FS., I (we) understand that the s)gnalure(s) below shall have the same legal effect as if ma Si - • O • i C3 / t�/ ` `/ • /7 Signature a Owner 1 . Signature of Owner Date Phone Number: (352) 796 -2433 Phone Number: FOR CANCELLATION COMPLETE SECTION 4 ONLY: FOR FICTITIOUS NAME OR OWNERSHIP CHANGE COMPLETE SECTIONS 1 THROUGH 4: Tr 1 (we) the undersigned, hereby cancel the fictitious name o , which was registered on and was assigned ca registration number Signature of Owner Date Signature of Owner Date Mark the applicable boxes 0 Certificate of Status — $10 ® Certified Copy — $30 NON - REFUNDABLE PROCESSING FEE: $50 Single CR4E001 (11/03) From Megan Manning At: Lykes Insurance FaxID: 813 - 249 -8607 To: Insurance Certificate Date: 10/13/2009 04:25 PM Page: 1 of 2 DATE (MWDD/ YYY) OP ID M4 ACORD CERTIFICATE OF LIABILITY INSURANCE TREEL -1 10/13/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lykes Insurance , Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 400 N. Tampa St . , Suite 2200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa FL 33602 Phone: 813- 223 -3911 Fax: 813- 221 -1857 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Auto- Owners Insurance 18988 INSURER B Treelawn Builders INSURER C PO Box 506 INSURER D Brookesville FL 34605 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. WI K AUU L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDM/) DATE (MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGt IU KtN ItU A X COMMERCIAL GENERAL LIABILITY 20662768 01/28/09 01/28/10 PREMISES (Ea occurence) $ 50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 4201981100 02/10/09 02/10/10 (Ea accident) $ 500,000 ALL OWNED AUTOS BODILY INJURY X 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 /UMBRELLA LIABILIT EACH OCCURRENCE $ 3,000,000 A 7 OCCUR CLAIMS MADE 4201981101 01/28/09 01/28/10 AGGREGATE $ 3,000,000 DEDUCTIBLE X RETENTION $ 10,000 $ WC SIAIU- UIH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ZEPH533 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Zephyrhills IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5335 8th Street Zephryhills FL 33542 /`Q^/ REPRESENTATIVES. � —� ACORD 25 (2001 /08) ©ACORD CORPORATION 1988 >;f 10/13/2009 16:50 L ion Insurance LION INSURANCE COMPANY -►CITY OF ZEPHYRHILLS 1/1 Date CERTIFICATE OF LIABILITY INSURANCE 1 10/13/2009 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Bolder. This Certficate does not amend, extend or alter Holiday, FL 34691 the coverage afforded by the policies below. 727 - 938 -5562 Insurers Affording Coverage NAIC ft Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the poi cy penod indicated. Notwithstanding any requirement, term or condition of any contract or other document oath 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. INSR ADDL Policy Effective Policy Expiration Date Limits LTR INSRD Type of Insurance Policy Number Date (MM/DD/YY) (MM/DD/YY) GENERAL UABILITY Each Occurrence $ Commercial General Liability Damage to rented premises (EA Claims Made Occur occurrence) $ Med Exp $ Personal Adv Injury $ General aggregate limit applies per: General Aggregate $ D Policy ❑ Project ❑ LOC Products - Comp /Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) $ Any Auto Bodi y Injury All Owned Autos — (Per Person) $ Scheduled Autos , Hired Autos Bodily Injury Non -Owned Autos (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2009 01/01/2010 X I WC Statu• I I OTl+ Employers' Liability tory Limits ER Any proprietor /partner /executive officer/member E.L. Each Accident $1,000,000 OCT -26 -2009 12:08 PM TREELAWN BUILDERS 352 796 2433 P.01 vct 'MR 2:30F i Fl o, 1445 - P. 1 • .3. .. • •• . _ . • • .„ • • City of Zeplethelja bs eider td reglitered in our ems wewill need the bebwidiat : • • 1) Babe Qeetil_id Limes, ex/ 3) Duthie. Tea Zbeoe (>>am �b ?'S!� 1 1 /F �' Cnk��) R9�,�a 4) 1i/otitis 5) &semi lability with the —"Cray y of Zegbyrilli m ik ere. 6) Mamie Noise eba +, ) 7 Autheriestioa .Letteor on your bndnea / bu'leled Wag person or persons who-me authorised 8) Address, Hutoe..pban. and fa ambers G "gyp 4c . wbo are set Dapertimut Of Protheekmal Unmet • rpm any a Deputised Pnokweeaool Lirease wittier certificate or you will cite used to supply itsui .1.8. Documents *hove requirements den be fixed t0 8 =78p. but vdil become valid p ail the are met 1 ofZegkerhilia. Building Thipt 33 6 Streak riiiirhib, FL 3$542 a Pbooe: 8 t.3-78o'opao' a ., 05/27/201O 2:25 PM Receipt No. 01B4505 CR 3 `O26.27 ____-______________ Total/ 3`026'27 Cash: 0,00 Check: 3,26.27 ck#137649 cupeland dr 37 Other/ 3,026.27 Chonge/ 0.00 ck#137649 c dr 3749 Customer #: OOOOOO cashier: bobble City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Retail No of Square Feet 100! Impact Fees Within City Limits Outside City Limits Water Distribution System $ 11.54 $ 14.42 Wastewater Collection System $ 23.19 $ 28.99 Wastewater Treatment Plant Capacity $ . 12.9f $ 16.24 TOTAL $ "47.72 $ 59.65 City of :Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Factory (A) No Showers Provided No. of Employees per 8hr Shift 12 Impact Fees For Type A Within City Limits Outside City Limits Water Distribution System $ 953.55 $ 1,191.94 Wastewater Collection System $ $ 2,395.80 Wastewater Treatment Plant Capacity $ 1,073.44_$ 1,341.80 TOTAL $ 3,944 $ 4,929.55 (B) Showers Provided No. of Employees per 8hr Shift Impact Fees For Type B Within City Limits Outside City Limits Water Distribution System $ - $ - Wastewater Collection System $ - $ - Wastewater Treatment Plant Capacity $ - $ - TOTAL $ - $ - NOTE: Does not include industrial wastes. [City of Zephyrhillsi, 1027/2009 9:34 AM 0007208 ck#48605 Cash 0.00 Check ck 3,440,00 Change O,08 bp#9596 3,370.0O electric 35.00 plumb 35.00 Total 3,440.00 oldcastie Architectural page 1(1) 375 Northridge Road, Suite 250 • Atlanta, GA 30350 • (770) 804 -3363 Date Check Number 10 -07 -09 1 1 0000048605 1 Vendor # 112299 City Of Zephyrhills Invoice Number Invoice Date Gross Amount Discount Net Amount PERMIT #CAPEX -18106 10 -06 -09 3,440.00 0.00 3,440.00 Totals: 3,440.00 3,440.00 42a. (° - $--b9 - (t_m Pa 6t)(0( OCT c F 1 3 209 CITY OF ZEPHYRHILLS