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HomeMy WebLinkAbout10-10569 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10569 BUILDING PERMIT Permit Number: 10569 Address: 6620 GALL BLVD Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 02- 26 -21- 0010 - 03900 -0040 Improv. Cost: 3,900.00 E,00 ;. r3 7 ., k Date Issued: 6/11/2010 Name: SYNC 11 LLC Total Fees: 369.00 Address: 18608 AVE Amount Paid: 369.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/11/2010 Phone: (813)783 -3118 Work Desc: ADD HANDICAP BATHROOM 1,500 SQ FT SP CIAL • - BU Li RS IN BU •IN EE 60.00 EL T AL FEE 35.00 CENTRAL STATE ELECTRIC INC PLUMBING FEE 35.00 MECHANICAL FEE 35.00 LR SIMMONS PLUMBING FIRE PLAN REVIEW FEES 204.00 .\/‘ I )() & - - 14- • •T - 2N1 R■U H PLUMB MI IN ULA ION EILIN FOOTER BOND DU ' 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." v1111E 6)g rir 4 1 l ' , O AI N f CTOR SIGNATURE PERMIT OFFI FR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF 1 1 BUILDING ZEPHYRHILLS DEPARTMENT OF ADDITION OR CORRECTIO DO NOT REMOVE ADDRESS DATE PERMIT # 6y /?he 9 z/ - 1010 THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be mode before the job will be accepted. J �p t;, 00 f X,4 2/ dIo OvsP_ r 4x GIB►' 4,0 r ,„/ ✓ tC noel S /) UP / d >er,/ wk cif ` ( • ) w-e( 01 ffiit (sea/ op/ ( L ?enty 3 weet,fitai p 00-r noic di) r , r . It is unlawful for any Carpenter, Contractor, Builder, or other persons, to AFTER CORRECTIONS ARE MADE CALL cover or cause to be covered, any part of the work with flooring, lath, earth or other material, until the proper inspector has had ample time to approve 780 -0020 FOR RE -I P TION the installation. OFFICE HOURS 7:30 AM - 5 PM MON. -FRI. INSPECTOR / 0' / D /0 � 041(Y ____ 6yr t4* —, R /If kcSa- 14/AA- P '` --Irl.t.116'. City of Zephyrlulls BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: \DFe aP D •R , : - 4. Date Received: - Z -10 6 / 0 ( v . Site: Co (Lv 6'/s- .. f (4) Permit Type: t S . 3 , . `P+ + o d ; c°` 847-4 Approved Approved w /no comments: ❑ Approved w /the below comments: ❑ Denied w /the below comments: 1 PIo mb.'*. CoA e, r) 0 .) y i-c Q f I w elc c ∎ d -or ar'Q Ceto1 real j 5 a c 4.4, (SO D .c5f - This comment sheet shall be ke.t 'th the permit and/or plans. r ‘-'d /L? Kalvin S , itzer / r ' . -. • er Date C • S : act.. s d/or Homeowner (Required when comments are present) ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy No.: c^ Plan No.: /0 Contractor: _5 d/4 2.ir /li.S G ‘- Business Name: Billing Address: 7g 7 / � 9 �/le Business Address: C.444--- �/ / 33S3r Business Phone No.: Billing Phone No Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES _ INSPECTION FEES _ PERMIT FEE _ FALSE ALARM FEE Om Site Plan N/C _ Annual N/C _Sprinkler $50 — 1st Alarm N/C ulti- Family/Commercia .06 _ 1st Re- inspection N/C _Standpipes $50 _ 2nd Alarm N/C (Minimum Charge $25. _ 2nd Re- inspection $100 _Fire Pump $50 _ 3rd Alarm N/C Plan Revisions DBL _ 3rd Re inspection $250 _Hoods $50 _ 4th Alarm $100 4th Re- Inspection $500 _ Fire Alarm $50 — 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until _ LP Gas $50 _ 6th Alarm $200 0 - 25 Heads $50 violations corrected) _ Natural Gas $50 _ NON COMPLIANCE $150 26 plus Heads $100 _ SPRINKLER SYSTEMS _ Fuel Tanks- per tank $50 STANDPIPE SYSTEM _ Hydro Undergrounds $45 _ Sparklers $100 0 Per Riser $50 _ Hydrostatic Test $65 per system _ Fire Works $500 FIRE PUMP _ Acceptance Test $45 per system _ Camp Fire $25 0 Per Pump $100 Hydrant Flow 575 _ Controlled Bum $100 FIRE ALARM SYSTEM _ Hood /Duct $50 — 0 - 25 Devices $50 FIRE ALARM SYSTEM _ Place of Assembly $50 Annual _ 26 plus Devices $100 _ System Acceptance $50 _ Fire Protection $25 SUPPRESSION SYSTEMS _ Recall Acceptance $50 _ Flammable Application $50 Annual Wet $50 _ OTHER — Waste Tire Storage $50 Annual _ Dry $50 _ Fire Wall /Smoke Wall $15 per wall Generator < KW $100 — _ CO2 $50 _ LP Gas $25 per tank Generator >30 KW 150 _ Other $50 _ Natural Gas $25 per system _ Bio -Hazard Waste $100 Annual KITCHEN EXHAUST _ — Fumigation Tenting $50 Ell Hood /Ducts $50 _ Tent 10'x10' or greater $15 per tent _ Torch Pot/Applied $50 OTHER _ Fire Pump $45 — Haz. Materials $100 Annual LP Installation per tank $50 _ Fire Suppression $30 _ Fuel Tank Installation $50 _ System Acceptance (Per Tank) $50 _ Exhaust Hood /Duct $30 0 Natural Gas Installation $50 _ Re - inspection DBL (Per System) (other than annual) fl Spray Booth $50 0 Inspection scheduled DBL _ and cancelled less than _ _ 24 hours _ Construction Insp. N/C — Emergency Vehicle Acs $50 FALSE ALARM PLANS TOTAL INSPECTION TOTAL PERMIT TOTAL TOTAL GRAND TOTAL Comments: Date: e// f /a InsAlgctor: GGG . Pasco County Parcel: 02- 26 -21- 0010 - 03900 -0040 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, May .22, 2010 I Parcel YD 02- 26 -21- 0010 - 03900 -0040 (Card: 001 of 002) I Classification 1 23 - Financial Institutions Mailing Address Final 2009 Value SYNC II LLC Ag Land $0 18608 AVENUE MONACO Land $90,270 LUTZ FL 33558 -5316 Building $46,589 Physical Address Extra Features $4,048 6620 GALL BLVD ZEPHYRHILLS FL 33542 -2510 Market Value $140,907 Legal Description (First 4 Lines) Assessed (Non - School Amendment 1) $140,907 ZEPHYRHILLS COLONY COMPANY Taxable Value $140,907 LANDS PB 1 PG 55 WEST 125 FT OF SOUTH 100 FT OF THAT POR OF TRACT 41 LYING EAST OF US HWY I Land Detail (Card: 001 of 002) I Line II Use IlDescriptionll II Units II Type II Price II Condition II Value I 1 I 2300 II FINANCIAL I OOC2 1 12,000.00 II SF II $7.32 II 1.00 II $87,840 I I 2 A 2300 II FINANCIAL II 00C2 I( 500.00 (I SF II $4.86 II 1.00 I $2,430 I Additional Land Information I Acres II 0.29 II Tax Area II 3OZH II FEMA Code II X IICommerical Codell M3012AP I Building Information - Use 23 - Financial Institutions (Card: 001 of 002) I Year Built 1976 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Rigid Frame w /Bar Joist Roof Cover Built -Up Tar and Gravel Interior Wall 1 Plywood Panel Interior Wall 2 Drywall Flooring 1 Vinyl Asbestos Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 Line I) Description II Sq. Feet II Repl. Cost New I 1 II BAS II 1,530 II $186,354 ( Extra Features (Card: 001 of 002) I Line II Description I Year II Units II Value I 1 II PAV ASP 1976 II 1,700 II $344 I 2 I) DRINWIN I 1976 II 1 II $1,763 I 3 II NITEDEP I 1976 II 1 II $1,941 I Sales History I Previous Owner I SUBURBAN FEDERAL PROPERTY LLC I Year II Month Book /Page II Type II Amount 2008 I{ 09 i 7940 / 1133 11 WD 2008 08 7902 / 1308 WD (I $ I 2005 I) 03 I 6404 / 0121 (I WD II $ http : / /appraiser.pascogov. com/ search /parcel. aspx ?sec= 02 &twn= 26 &rng=21 &sbb= 0010 &b... 5/24/2010 JUN -11 -2010 08:08 FROM:LR SIMMONS PLUMBING 8136542188 TO:7800021 P.1/1 euntI11 CLAW 111U uo All arnrl(nu.(s DIALUIr& FAX No. 013 780 - 0011 P. 001/001 e13aoa41020 City Of Zephvrh lle Permit Application Fwaels•.80.a@1 SWAIN; a /� P rd • '-1O5 Date Rs•eNtod , -2, • t0 Phone C.nermaar Owners Mum �Pa ► ' oiw� Pha• Msmlr► NM's Adams T b 0, Ave. en ato l am . t— O nano i .► . lei is 1g 3.311t 1. Fes aNtyd. TNM OSMN•mi [ 1 Mona Nr•n.er I ( - I • Fes Stemple TNOhob.r Miasma 1 1 JOG ADDIS= WA *S%Vc • - LOTS [ 1 • SUCI NVralor PARCEL Ma , OY7'�- 7 .rr' 00(0- D39�— ,`b 1 to.TAII.O NMI PlioPearY YAK N0/1CIO WORK PROPOSED *MALT (� 50P4 Q I maws REPAIR mamas use COMP f arxeR I _ _ j TYPE OF CONSTRUCTION ® BLOCK [ ] F7llu p STEel . C:1 I 1 pN ow /CRIP11 DP WORK. { rl ` ji 1. nri V Q0.4f'Del ammo see r I f • A I so mamas LI. re. R 1 MOONY .. / Y 1 I113tJILDINO i • , + P VALUATION OF TOTAL cONBrRU4'1lON $ o • . . � s .. �✓ t3LECTRICAL Is o al k a V BERME PROGRESS ENEMY Q' W RE C. I PLl;1OaNp �, • . V (. .f, ply ®f calANIGAL N r ' • VALUAVON OP mectimICAL NreTAUU.Ana+ 1- F. - - ' "� Slut =NAG Q ROOFING Q. OREci err OTHtr'R 1:i ,,, )�) FINISHED FLOOR ELSVArJONe r 1 F1.000 ZONE AREA =vas NO is- rv�i • I efil e 700 r OUILSCR COIIPAfaY r SP' Ali G ellk $.• 1a! /K ga. 1 alenuauRs llsasnium 1 YI N • ( 'mimeos Lit' ^ammo r 3773 le•ple GI. 2A.1.04:(1 I, SW Llam.,•. [ =MEM i n".'... • 7 COMPANY ark A ., . j . $IONATUNg wpm= WWI wI ou.A4 11I 1 1 1' Llamas r ,- .._ -�._.. vow - Ns _� COMPANY 1..1�.1 Mntgx5 ��..N►rrb i h - • rlfasT = E\7J - rexat.wa., &ii MUMS [PI AS401 tENQ f„ R f TfirlP - pima, ICPCett.iq _._�?____) MECNANICAL 1!f • . CO AY ( , 1 SIGNATURE l s6elsnmeo 1 Y/ N 1 w/ mom 1 Y 1 N 1 • Address I 1 Llamas .1 1 OTN� COMPANY - SIGNATURE .etttel ( r., N J Teaaman .LYIN J I I 11SSIDENDAL Almeh (:o Plat PMNM: Gloms m Map Prue: Meal of lTaMpr Fear; FAG AN Parma tar nen oalMru.dan, MIN•um 11. M K AIMMe.days • ar amm1111 d. Hawed r oohs. OpA NANINAPNAL 61Nnsr.la . Pion of 8111 Fqn NMISNL dlNlyssr, eNaWadrFeNR Air nlhdMlsionslbap dnd.als C011MENNpu. •mch. M) eetnvlele..w a slsrlq Piles Pan • Oa e.Al r ••••; re Mt et Emmy Panty. maw w earn ter nonsmammwn, Minimum Ion (11A mamma day. .e.rwrrnr l dots Required snsla, Consta Wen.P4re, ommnr 1. Pu ma s► 811 Foam bl.mlmd, Sashay FacIMes A 1 dummtm a/. Wool( Parrnk far w ma prlrsals. Ail mrtsnwdN rsquirsnWlNs must nlo.lnapMSna. ssos MEN ET Mich. (z). IS dl anoln..r.d Po.,s. ""PROPERTY SURVEY mamma our au New aaneluNaon. - DIrsoll I I U Fs out eolnr Son minpmmq,. - • ow/.r A commis. den ..e. W Sppsastmn,. Reamed N over MK • Sc. .e dt Cemmome meat t. rsgu • (MC timpale. air RAM • • •• Ao••l Mr ale mrrregmr) arm Po•nr of Alrnmr Qer meoems) Ioldd be uanorr+tl M nellittlidillairlig1110161lar OUaotlingmos MR THE COUNTER PERMITTING (Fl*.I ex Applcsem only). Rental 1 shinelgo Sawa& B.•.io tlpgrrd.e• NO Fewras (Plorraysrreaa.rpe• Drlvsr.sy•.Nsr air Courtier tree pubic fonder I,.noad. ROW • JUN -10 -2010 16:19 FROM:LR SIMMONS PLUMBING 8136542188 TO:7800021 P.1/ x oiiuitulu iee:[i LIOrt insurance L.LUN 1N.NIJKANCt: cuNrANT -el :try Ur LtrlITKH1LL.S L/1 Orb CERTIFICATE OF LIABILITY INSURANCE 1 6/1012010 Producer: Lion Insurance Company Tide CerWkate is lamed as a metier .1Information ally bad colds. no right. upon the Certificate Holder. Thin Certificate does not bowed, eetae.d orbiter 2739 U S. Highway 19 Certificate the mw raga afforded' by eke whams herds. Holiday, FL 34691 fishers Affordng Coverage 1 NAIL • Moto** South East Personnel Leasing, Inc_ Insurer 0. Uan tnswa p0 Carmen./ 2739 U.S. Highway 19 N. Il'""'r e Holiday. FL 34691 Insurer Cr • Inner O. kratnr E r COverages • cm merino , " r/w • twat b gWaNn tt$..rr.l not • den • .M e.neaet Or' • • . d1,1 nasc ncao se menace debed dia de tc rbe d n ` r sl noboe metrtta,mi e o lan.adomblorsatue oracles ApphpeoMm exam meifoe eboa pm Ow LIR INSIID Type of Simian= Polley Number p Ors Paley expamion Deb LlrfYt5 (MM/ODMYY) (MMJ130Mf) GENERAL LIABILITY r.drdeeu...Ie. 13 Cwrrrnercial General Uabiily Claims Made 0 Ocar nrmattnerraea (EA New A ....w�.a M od Be L �' - .N.. Pommel Ark In)ttfy i Genrrel apgnspde IImit applies per . Od tY Q Peen tOC Centre Ma � �+ beaunn- Comaoo A 1 I AUTOM081LE LIABILITY Ca.birptl$Mtioel /try Aim (CA Accbtrin 1 "" AI Owned Aten HoeMhwv Sdt.dt Atoll ta'erNereonl 5 r... Hired Alias • 8adur bey Nm.Oreed ParAccI*) f AeselN r .I� A;d►d..p t EXCESS/UMBRELLA LIABILITY ` Ewe crummy,. Ma ❑ cam de Noma* Deaklae A waken Conversation and WC 71949 • 01J1)1l1010 01,0112011 u I boy WC Stew I Lone. . ' Employers' Ley ,y Lade 1 LER ■ MY laepriworrowh edarecudv. oflh;Mlltlarl0er E.L. Each Accideel 11p00,0M cab led? E.L. Dian.- Es Employee 11.000)Xe ItYes, describe under special p rnisione below, E L. Dis..w.. Pocky Limit Stool= Odor Lion Insurance Company is A.M. Moot Company rated A. (Excellent). AMR It 12016 Descriptions of daetllecl added by Endmsenwtlt/$pedv Provheloro: Ciao ID: 60.65.327 Coverage only epplec to active employees) of South East Personnel. Lamina; Inc. that ere leased tulle Hollowing "Client Company': L.R. $bentens Piaabitg, Inc. Covarepe only applies to Injuries irutrrad by South East Pommel bating, Inc. soave artployww(s) , wldle working in Florida. Coverage does not apoty to statutory employee(s) or independent contractor(s) of One Client Company or any other entity. A list of the active employee(s) leased. In the G1e:ntCartherly can be obtained by fatdng a request to (727)937 -2138 or by caning (727) 938 -5562. Project Name: FAX: 813.6542188 & 813654.2188 / ISSUE 06-10410(90) C6RTIp'Ul1 NOLpHI ae.ln DM.: 3/16/2010 rrwcre- LArION CITY OF ZEPH YRMILLS Sawa demo. so.vse.eenb.e poaw.r a =cow amore ter. pr H sur.a, a..eru.tq Wawa wu BUILDING DEPARTMENT alawmr rn. 3° aebe t* ben teao e .rnreero amore arse a e. Iel ate farte. b ee m enet Inpe ro mYgolonorttraW AIM upon M * IsIOear teo Nero aa.y.eenerier 6536 IITH St. ZEPHYRHILLS, FL 33642 4 ,61‘ 6" ._ "4 :. .. - - - - JUN -11 -2010 5?) 5 _ F rom :CENTRP L STATE 8139491586 �:813 P. .UINiII /20 THt. 1 00 8 hM ZEPHYRIIILLS BUI LDING FAX 1+ o. 8 13 - 780 -0To02 780 0021 1 F. 001/0[2 1'2 JUN -1:1 -2014 09: It From: CENTRRL STATE B1'39491S86 To :813 780 0021 P.1 %2 • • CENTRAL :STATE ELECTRIC, INC.- . 190301st:3TREET NZ. - L11TZ,= FL33549 513).9484 FAX fear WNW :F AXTRANSMIIITAL SHEET Date //if/ V /I n r 11.c..d tom Any: Siatif From : • Num acr of pages Ao folbw / Remarks: - A-. , f of3 -78 -- ev2 51 ci- THANK'YOU Ft co! 'ICI number et pis ore not reoeweo piano canbet knm ediabebl JUN -11 -2010 09:51. From: CENTRAL STATE 8139491586 To:813 780 0021 P.2/2 ^ __.n /( ... LU "J 13J 11.:1 :;t. ammo 11.1.,b ifU1LU1IVL, Pre NI. tli3 Iyil :. :nl ) • 0174604020 City of Zephyrhills Permit Application • raw 3•760-0021 • 1u.lflnpo.oenmenl *11)50 Dees a.wived —2.+4.0 • vnonc tonal rug raimlw • ; 3 2 4 4 - Sr " t • OWeer'a Nome _o_ / N LAG . own. rhurro . Nuns . • O.rg.. 1% 6, DI A 11.1. onaCrO L-' _ w.a.r o Phan*Nrrmerrr, L31 f23 I. For Simple Tldeheld.r NMI I Owner Phone Number I 1 Fee Simple TWeheIdsr Addraee _ T AID ADDRESS I (El eV) 081E e,‘ VA 1 Lull 1 SUDOII laION PARCEL EMI 0 7./ .74--44 ' 0010 — 03W0440 I cD rllar. ~am Tax Not= WQRKPROPosE0 ® NEWCONSrA ADMALT' S ION Q a DC•MOLl6)1 INSTALL REPAIR PROPOSED CDR Q SFR COMPS tre O1i- l • J O - -- 1 TYPE OP C ONSTRUCTION © CLUCK Q FRAME. , 1-- STEEL I _r • DEsour11nN I 1►EN ` V OD YY � 1 . 1 BULGING BIZ! I 1 .f 1 ._ 1 I:LI FCJOTAGE [/ J''''' o N�OHT 1 / T I It+ � TM 1 rrrr rn..Tr .. CI �fIU1L01110 A • s' , s VALUATION OF TOTAL CONSTRUCTION . r ° * A .I ELECTRICAL - la ? • • t? el S t A P :Il:fIVICE • UZI PROORES ENERGY W RA r I PWMGING • E. O , 60 (` 5A /dew �MF:CNANICAL 1- ,' ')`VALUATION OFM ECWINICAL.INST/u- • I.AIKN l �N /lO LJGAS d (1oorING SPECIALTY O 1 '` 17 '''ir ��� FINISHED FLOOR ELEVATIONS I . I PLUM /ONE A11L'A pV!6 NO 3. fJ ( t ' p41 w (�j P , • .. CLLV .mr ff r I I BUILDER { `f I coMPANr SPrc , . 6" ?PI ider �•+. SIGNATURE l �I AMEST O Y 1 N rtMCORP. lame Address 3/ . Kesr1C_ EEC „7aPlq.43 FL i ?'r/ mama 1C' /Z. 1 7:01.444.0 ilE71tIaAN . 7 .6 PANT PIS g cc. r ■ C. • I * S < 1 -•c' ~ / / �"'� '� mossieflio Y / N Poe comae viii _ = � 1 . e i_�...� 60 •PLU aoMOANV I L-� MmaxS PXwwh i "Ao SWNATU • antabewo 1 Y I N 1 FEe culNG.. - 1 VIN J Ad.,. 1 . . — _ I Iu nl4Y r- • MECHANICAL • COMPANY ' 51M/MIRE r , nteitraliO I1 rGO culvert. l . Y 1 N • Address L_..___. • I Lr. r.. i 1 ' • OTHP.H COMPAM• ' - i SIGNATURE I Aeol.reeen LV / N I 'we WNRC. . N —r AMdsew I 1 Unveil, A I _ RESIDENTIAL Anedg (2) Pbl Plenr 12) solo of 0ulldlnp Pleas: (1) set of EIMmv Pine; R-O-W W1116 W ROW COMENc%n• Metimum Ion (10) working deyi afareublWal dMe. ReEulWd Onelb, Canstwo0 Plgne, Bbr U r PIES w/ tim F410ISSEle2, . 6.np.ry FaCBdls 61 dummies BM Work Prom* Mr ovesivi:uraJle pe Fromm COMMERCIAL Attach (31 wrea :IC set? of Omni Henn pkel a Lea BOIMy Pope; (1) .el of homily Roane. R-O-W Permit or este moelroblo., N Ineeem um (10) wont% Wiwi . ller NIMES dab Retwinid owavk C....IA* n Piano, alemwrabr Fame girl ES Fence Ir.WW lad. Similar/ raoWaa4 1 dagwbr: 9110 Work Pond WI' oil nrw r rr0 0 00. Al commerd.) raqueanena must wool carrpli...o. SIGN PPRINl Atl.ch (1) aeM of Fnoerer.d Plans. •••PROP61r,TY SURVEY retorkaA tor ae NEW oon.kuoion. • IH'•'yl0.w: 'I I•I.H44+Heelee +1.1 H 1.11•MMMH Fit out apPllebGal ocouieMb Owner a C o n t r a c t o r N o r deck of application, n ob rind • N over Iwo, a Noll.. of C.nmgn.r.ne It le NNW ' (AAG tummies over $1000) '• mew trot ie. rr...lreolon or power of Mew/my We Me owner) would be aomeo ne wall nnl.rrlud MUIR kfen uwaer aubonnrg Game OVER TIC COU /HP.14 PER111T'lB7o (Pront of Applle.gen Only) - Nereols N M,nplot Sewer. awake upprarler AA: • Fenoa. (01oV6urvoyrFooral l ' • Driveways—NW over Courier M public roedw.ya..noode ROW . • 813 - 780-.0020 City of Zephyrhills Permit Application Fax -813- 780 -0021 • Building Department .0-(U 319 61 Date Received " 2.,4 — (0 Phone Contact for Permitting i k3 24 -- F9 ( • Owner's Name V T N C ( L LC Owner Phone Number Owner's Address (Van D Ave, fi on o,to L-u 2 FL Owner Phone Number 8 t 3.12 3 ' 31 1 8 'b35.58 Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address ^� JOB ADDRESS (p l, a`t \ V c. • /, LO , T y, # SUBDIVISION PARCEL ID# d 2 24 — z1_ 001 0 — v'"' " a ` b (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT E1ial SIGN 1 I 1 I DEMOLISH INSTALL REPAIR PROPOSED USE f I SFR COMM f n I OTHER I I TYPE OF CONSTRUCTION BLOCK n FRAME �, I STEEL I I I I DESCRIPTION OF WORK 14 0 a v\0 �p Q (7` r(7t7 BUILDING SIZE r r 0 0 SQ FOOTAGE / ro ° HEIGHT / Y 4 I $ , , C 0 i\ V . • VALUATION OF TOTAL CONSTRUCTION s' 0 e 0 L. r IIELECTRICAL $ 0 0 V c AMP SERVICE Ijp PROGRESS ENERGY ...--r W.R. E.C. ZeIS �i °� 0 pi PLUMBING $ / O Q 0 � V '1 I FM s/zy/lv 1 ./IMECHANICAL $ *315 VALUATION OF MECHANICAL INSTALLATION / 0 d 0 /I �j t) �(�^ I IGAS I 1 ROOFING 1 SPECIALTY I 1 OTHER L ` 5r"'" V FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES NO 3• l° Oil � ley BUILDER I COMPANY SPert 4L ot t s Vui /der S4,4 . SIGNATURE REGISTERED 1 Y/ N I FEE CURREN I Y / N I Address 3773/ KoSt)t 1744. . ,ZepL a1 FL i)sv/ License# C64- / Z 5-5 7/ 9 7 C I AN r a,, � `!` COMPANY � e 11 • % ELECTR re.1 S , . E( ec� C "r l . SIGNr�ATURE "� REGISTERED I Y/ N I FEE CURREI� I Y/ N I oi3 - ?, x?' z ( dd icense i) -" , )I I ., ` VkYWIeJ 1 Yt PLUMBER COMPANY �1 Mltil SIGNATUR Ap k ` r � REGISTERED I Y/ N I FEE CURREN I Y/ N I Address License # MECHANICAL COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREN 1 Y / N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y N I FEE CURREtN I Y/ N 1 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. I111111111111I1t II11111IIItItt1111II1tlII1111111111111 111111111ltl111111111 H IIl III11 1111IIIIIIIIIIIt111l1IIIIIIIllll1111I111 Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is requ (A/C upgrades over $7500) ** 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 if shingles 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 A ATTORNEY BEFORE RECORDING YOUR N e - OF COMMENCEMENT. FLORIDA JURAT (F.S. 117 03) - OWNER OR AGENT /4i1111e41eAmr CONTRACTOR Subscribed and swo to • . ' irm .fi'• efore me this Su scribed and swo n tV (or affirmed) bef., a me this 6)J 1 o,o by swo, . r . fhcia- o by Ke.v,e44- L to Who re personally know o me or has/haveqmoduced re personally known to me • ave produced D - as identification. rL - as identification. 4 - 11( Notary Public A Notary Public Commission No. b © 3 J C.i Commission No. I. D 7)- 33 5 Name of Notary typed, printed or stamped Name of Notary typed, printed or ampe a DIANE L SALIM �'°°°°��••.�..� Notary Public, State of Florida v DIANE 4 SALIM „—' Commission# DD723350 ,A . Notary Public, State of Florida My Comm expires Oct. 9, 2011 /!r� Commission# DD723350 «..... My cothrn. expires Oct. 9 , 2011 W� 1 City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: cd (Y as. 64 f` - ' Date Received: ..S T — h Site: & ' 20 G 59 /7 Z -1) Permit Type: 4=/ /7d` /. 0 he `ra s . /7'" ` Approved w /no comments: ❑ Approved w /the below comments: ❑ Denied w /the below comments: 1,) / /1.4 i 6 e(oie ,/ ikt /ay O(l al 114/d(` � p ( S/ �4 vio Q 0 /6,r m riA -c_______{ 1 A- c - oo( kid Not , e f [1, 9) #i( of ctla (y-e e This comment sheet shall b- kept with the permit and/or plans. /Axe At bli° i in S tzer . % s Examiner Date C • • • c tor /or Homeowner '' egwre• when comments are present) Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett@fire.zephyrhills.fl.us Plan Review #: 10 -065 Project: Revision Cafe /Ice Cream Shop Number of Pages: 4 June 8, 2010 I have received and reviewed the revised plans for the interior remodel located at 6620 Gall Blvd and will allow the project to move forward. Please note that this review does not eliminate any further requirements as the project continues moving forward. By receiving permit, contractor acknowledges to comply with the items listed below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Install smoke detector in storage room. Detector shall be hard wired with battery backup. 2. Install certified fire extinguishers (2 ABC — one in front and one in kitchen, 1 Class K in kitchen) 3. Electrical panel in mechanical room shall have 3' of clearance. 4. Plans shall be submitted for hood install and hood suppression install by contractors to receive a permit to perform the work. 5. Occupant load is determined to be 46 persons with tables and chairs. 6. If air handling unit provides greater than 2000 cfm's a duct detector shall be installed with a remote key switch. 7. Install emergency light in restrooms. 8. Mechanical room cannot be used as an air plenum room with a vent in the door. (may not be applicable) 9. No electric outlet is shown for the stove, therefore an outlet must already be present or the stove is a gas stove. If gas, a plan will need to be submitted by the gas contractor to receive a permit to perform the work. 2 Inspections Required: 1. Final. 4 , i_ ,. ,o, lit/ mell KERR il- • IA' , i IRE MARSHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. see . << OP- Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett@fire.zephyrhills.fl.us Plan Review #: 10 -058 Project: Occupancy Change/Remodel Number of Pages: 3 May 27, 2010 I have received and reviewed the plans for the occupancy change /remodel located at 6620 Gall Blvd and have rejected it at this time for missing information. Reasons for the rejection are listed below. No fees have been assessed at this time. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. There shall be a "before" floor plan as well as the "after" floor plan. All rooms need to be labeled. 2. All exit doors shall be shown on the plan. 3. Any existing emergency and /or exit lights shall be shown on plan. 4. Any new electric installation shall be shown on the plan. 5. Plan currently shows a stove but there is no commercial exhaust hood or hood suppression system noted. These items will require plans to be submitted from a contractor in that field to obtain a permit on those installations. 6. Address, if not on building shall be placed on the building in 6" numerical. 7. Any A/C changes shall also be shown on the plan. 8. Emergency lights shall be added in restrooms. Additional lighting may also be needed in other areas. 9. Based on occupant load, an additional exit may need to be installed due to the not being able to exit through a kitchen. 10. Certified fire extinguishers will be required. One Class K in the kitchen and an ABC in the kitchen and in the main room. 41111,, giv / 4741 - 61F,e,a tin dy� KERRY BA M T, FIRE MARSHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. L zr(d ��SPECIAL OPS c �� BUILDERS INC May 19, 2010 This letter shall serve as a formal notification that the following individuals are authorized to sign for and pick up plans /permits for my company. Ken Prickett Sandra R. Prickett Jennie Prickett Thank you, Ken Prickett President 4%44 _ , ERICGRECO Notary Public, State of Florida A Commission#DD732383 My comm. expires Nov. 0 2011 Special Ops Builders, Inc. • 37731 Kossik Road • Zephyrhills, FL 33541 • Phone (813) 322 -3714 • Fax (813) 862 -9693 AC# 4 0 7 6 2 9 3 ` STATE=OF'FLORID DEPARTI4ENT OF BUS INE .AND PROFE REGULATION CONOTRUC T1 ON INDUSTRY = LICENSING BOARD SEQ# L08100500101 DATE BATCH NUMBER LICENSE NBR 10/05/2008 088`091985 CBC1255197 The BUILDING' CONTACTOR ,Named ',bel,row IS ; ?CERTIFIED Under the provisions of Chapter 4- 'FS, Expiration date: AUG 31, 2010 ,... a ,,; " PRI C3{ETT`, = KENNETH ° SPECIAL - OPS - IILDERS INC 3773: ICOSSIIC ';RD.. ZEPHYRHILLS FL 33541 ' CI RLI ' 0 C II T - - ' ' CHARLES 'EW. DRAGO CCvERNoR •SECRETARY DISPLAY RS REQUIRED BY LAW BUSINESS TAX NO` 'ICE • PASCO COTJNTY FLORIDA 2009-2010 LICENSE YEAR ACCOUNT 083730 SIC CODE 1541 PAYABLE TO: MIKE OLSON, TAX COLLECTOR / P.O. BOX 276, DADE CITY FL 33526-0276 SIGN HERE I CERTIFY THAT A INFORMATION PROVIDED IN THE ABOVE APPLICATION F THIS BUSINESS TAX RECEIPT IS TRUE AND CORREC. SPECIAL OPS BUILDERS INC . S / /9 /o */S E�Ot'S I� AUT ORIZED SIGNA = E DATE ZEPHYRHILLS Ft. 33541 -762 F'AID 102. 1.9 05/19/10 1 "ENPORARY RECEIPT MI OLSON TAX COLLECTOR TEMP RCPT NZLO 05/19/10 CAS Ii r l1 _____ ^ DATE i • PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA 1 MPORTANT DEPARTMENT OF FINANCIAL SERVICES + ' ? F DIVISION OF WORKERS' COMPENSATION ri O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY K. ;r elects exemption tion from this chapter ter b y filing certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA .g g WORKERS' COMPENSATION LAW L under this section may not recover benefits or compensation under this D chapter. EFFECTIVE: 07/16/2009 EXPIRATION DATE: 07/16/2011 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: KENNETH L PRICKETT II H exempt.. apply only within the scope of the business or trade listed on FEIN: 205321218 R the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt SPECIAL OPS BUILDERS MC e exem p and certificates of election to be exempt shall be subject to revocation 37731 KOSSIK RD if, at any time after the filing of the notice or the issuance of the ZEPHYRHILLS, FL 33541 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- CERTIFIED BUILDING CONTRACTOR section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 • A o IJ CERTIFICATE OF LIABILITY INSURANCE 5 /20 ` /2010 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER NAME: Adrienne Decker A KILBRIDE INSURANCE INC (a °ND .Ext) (813) 931 -7467 1401 W. Busch Boulevard E -MAIL F ac,ND) ( 813 ) 932 -7336 Tampa, FL 33612 ADDREsEAdrienne @akilbride.com CUSTOMER ID #: INSURERIS) AFFORDING COVERAGE NAIC# INSURED INSURER A : Bankers Insurance Company Special Ops Builders Inc. INSURER B : 37731 Kossik Road INSURER C : Zephyrhills, FL 33541 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300,000 DAMAGE N X COMMERCIAL GENERAL LIABILITY PREMISES O (Ee ccur $ 100,000 CLAIMS -MADE IX I OCCUR MED EXP (Any one person) $ 5,000 A 090470000526200 05/20/10 05/20/11 PERSONAL &ADVINJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 600,000 X I POLICY n PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON -OWNED AUTOS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certified Building Contractor #CBC1255197 License qualifier: Kenneth Prickett CERTIFICATE HOLDER CANCELLATION City of Zephyrhills Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Zephyrhills, FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS. Phone (813) 780-0020 AUTHORIZED REPRESENTATIVE Fax(813)780-0021 ©1988 - 2009 ACORD CORPORATION. All rights reserved. ACORD25 (2009/09) The ACORD name and logo are registered marks of ACORD 111111111111111111u1111111111111111111111111111111111111111 2010075646 "" Rcpt:1307505 Rec: 10.00 DS: 0.00 IT: 0.00 05/27/10 K. Garcia, Dpty Clerk PAULA S.O'NEIL,Ph D.PASCO CLERK & COMPTROLLER 05/27/10 01:14p 1 of 1 NOTICE OF COMMENCEMENT OR BK 83� PG 105$ Permit No. Property Identification No. (',k d2 C EL. I (7 6 2 2.6 2( ca o I O o 3 O o p0 L` 0 THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal descriptlon:) 2e S CoI0 tAry (0 1.4A eA h y 4� xptS FA PGr S`S (A) (2-5 I' r r 6 S ` h a) Street Address: 6 6 ? p 4 A C.L. (?4,v0, 2. q yi Y it Yi I L /. 1 edit_ o ( 1- 2&cz3 4 I 2.General description of improvements: A- • t, p ' &V9 1 C (3 A t l L y t p c c o- 3.Owner Information V5 ) a) Name and address: S '7° /C IT L l.. C ; l S i; is 9 A Vavq.i cr Pr 0 N dt ( : - o J L ti r2 , eL - 33 - 3 - SS' ,.. b) Name and address of fee simple titleholder (if other than owner) R c) Interest in property ( 6 /0 ontractor Information (-U 1 - t'E45 - • a) Name and address: S P CC S Al-- o Q S X11(7 0'l s (, 37 3 1 K° " 11( C C" r 201k). t" h I IL S I b) Telephone No.: Fax No. (Opt.) 5.Surety Information a) Name and address: , b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6.Lender a) Name and address: N/ A 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: C to ernJ D 26 iA L '-1j- . b) Telephone No.: e(-3 '7 S'3 3 11R Fax No. (Opt.) S 1 707ff c ' ' . 8.1n 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 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. 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 COMMENCEMENT. STATE OF FLORIDA 'Ry P� �_ COUNTY OF PASCO rot "•. 0 CARLEEN A SIIPPERT \ � e4,7 * 4 * MY COMMISSION # OD 731760 Signature of Owner or Owner's Authorized Officer/Director/Pariner/Manager EXPIRES: December5, U11 ( WO 9 S -VI`f R i M A tK . ��' Fle ' sanded Tin midget New Sobs Print Name The foregoing instrument was acknowledged before me this 24 day of /,, v , 20 //) , by rw F Ar'6 le E5 ,5a1--R ) >! A as /'�,q 1;r- Fk / (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on behalf of w instrument w executed . as 1 ?ersonally Known ,.,/ OR Produced Identification Notary Signatur /, , .,,,. n e r Type of Identification Produced Name (print) �� A k J(f,c'X) 4. �t //OPP i.2 " Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. 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