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HomeMy WebLinkAbout10-10705 CITY OF ZEPHYRHILLS • • 5335 - 8TH STREET (813)780 -0020 10705 BUILDING PERMIT . �_ � ... _, •? ... . .... ..... . .. ' ,_: ��s... ,max •� 42 .., s . E r, R €�` u�r�s Permit Number: 10705 Address: 7050 GALL BLVD Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C NEW Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 30- 26 -20- 0000 - 00200 -0010 Improv. Cost: 220,000.00 wow. vodarAgm Date Issued: 7/09/2010 Name: FL HOSPITAL OF ZEPHYRHILLS Total Fees: 3,040.00 Address: 7050 GALL BLVD Amount Paid: 3,040.00 ZEPHYRHILLS, FL. 33542 Date Paid: 7/09/2010 Phone: Work Desc: INSTALL NEW ROOF TOP A/C UNIT- WORK DONE W /OUT PERMIT /PERMT DOUBLE EALAND 'C AN � ` - VI E M AN A s 1,000.10 :U LDIN FE 1, 75.00 APG ELECTRIC INC. ELECTRICAL FEE 387.50 PLUMBING FEE 137.50 SEALANDER CONTRACTOR SERVICES IF' FIRE SPRINKLER SYS 50.00 FIRE ALARM 50.00 WYATT- FITZGIBBONS SHEET MTL IN FIRE INSPECTION FEES 115.00 FIRE PLAN REVIEW FEES 25.00 ■ r j (c6\97 D N ALLD� DUCTS INSIJIATED FINAL 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." ''' i ONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION — 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER : City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contra • I.• 4 5 Le 4 - • Date Received: - -71) Site: 0_ 0 i _/ / _,&*" Permit Type: OF .• a 1 i ?17'� i ...ri L Approved wino comments:16 Approved w /the below comments: ❑ Denied w /the below comments: ❑ ‘ 0 11 (44 if IDe■ ‘7( r C e . #-s18- d z- ,- .4-4-01-t - This comet h- - • .1 be kept with the permit and/or plans. Kal ' Switzer P ans Examiner Date Contractor and/or Homeowner (Required when comments are present) 813 - 780 -0020 City of Zephyrhiils Permit Application - � Fax -813- 780 -0021 Building Department '( v Date Received - j • ' // b Phone Contact for Permitting � 6 -- /�, r ../ Owner's Name . #05P. � /v' yi / .1.4.1' L.S Owner Phone Number 8l3 - 7s3- (0 /s / Owner's Address 7 Q /4-A.� „ /... Owner Phone Number Fee Simple Titleholder Name P j - AA . //0,5p _24,hrh; C LS Owner Phone Number Fee Simple Titleholder Address 7/24 bv4/i 6,t: /2. 1 �(��� /j 'i1. S )'-i<4 33.5''Ir: JOB ADDRESS / LOT # SUBDIVISION PARCEL ID# JJ ..)2 i ,at-/ - G /G - /D,1 2 - Ot70 °O (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I / 1 SIGN I 1 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE I 1 SFR n COMM 1 1 OTHER 1 I TYPE OF CONSTRUCTION 1 1 BLOCK n FRAME 1 1 STEEL n I I DESCRIPTION OF WORK / ,Opf‹: no A e / i BUILDING SIZE SQ FOOTAGE HEIGHT 1 (BUILDING $ /`O O� 01I VALUATION OF TOTAL CONSTRUCTION E LECTRICAL $ AMP SERVICE 1 1 PROGRESSENRGY n W.R.E.C. o1 a-0 . v ft.7 1 ✓f MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION et) COO. ou 1 1GAS 1 1 ROOFING n SPECIALTY 1 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONbAREA 1 (YES NO BUILDER 1 1 \ .5(,f /9//-). Old- CLtg� m. SIGNATURE t j " i� /�/i REGISTERED I Y/ N 1 FEE CURREF I Y N 1 Address 60 License # hGe% /3 Jyh W.; o \��-� k v • COMPANY .1 /� SMINATIME � ` �!!� V�•o�Vv� �' REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 Address License # PLUMBER / 4tN • COMPANY Sled+i4r a Aek ,� SIGNATURE �-5 v y REGIST - D I Y / N FEE CURREN 1 Y / N 1 Address , , - , i ' i License # ace.. /4 y ./ �� _, h i 1 \ 0MPANY W y , - " PiZ I) 4 -S e el /1/61-6- ( - U o ir �) REGISTERED r Y/ N 1 FEE CURREN I Y / N 1 Address License # CM C a3 3 Sa OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN 1 Y/ N I Address License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. * ** *PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $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 Applicat'•n •nl Reroofs if shingles Sewers Service Upgrades A/ v ,..÷-1....,,, • , 1 IV • • . • . Driveways -Not over Counter if on public roadways..nee, 4e °le 3JW44 rrit'aM ,`r •:'s tf 40 it Avs*o3 tie • i • V MS PO AM nelt ano0 S AMU VON ImOila Wad -'14. . l` 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 FAI A ' E TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEME TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER 0 AN ‘■ - EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 11 ♦ OWNER OR AGENT � CONTRACTO Z J .0 r i4 d swo r (or a rmed = forR'tfle this Sub ri sworn t affirm ) re me &/ o s/: re • :rsona ly known to m) or has/have produced is/ personally known to a or has /have produced identification. as identification. • °blic /AL. 'r2L L Notary Public Commission No. _ Commission No. SUSAN L NEMIITT Name of Notary typed, printed or stamped d, printed or stamped w mr, COMM. E *AND 11 . CMmMIIIMu • OD A1lN! Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett(a)fire.zephyrhills.fl.us Plan Review #: 10 -075 Project: Interior Renovation Number of Pages: 17 July 1, 2010 I have received and reviewed the plans for the renovation of the pharmacy area located at 7050 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. Renovation shall be compliant to the Florida Fire Prevention Code 2. Fan will be allowed to stay on at time of alarm activation due to Fl Building Code Chapter 419.3.12.3 3. Separate plans will not be required for fire alarm and fire sprinkler systems because renovation only includes several devices. Permit to perform the jobs will be included on the construction permit. Inspections Required: 1. Pressure test on new head installation. 2. Alarm test to check device. 3. Final (includes safety lighting test w /generator) KE' ' BARNETT, 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. ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -004 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy No.: p Plan No.: lb - v 1.5 / Contractor: J�i4- L- ,4I✓D j ezwei:4=mi'� Business Name: / Z_ / S i ,hq Billing Address: Business Address: '7O 2 e691- C1 Business Phone No.: Billing Phone No.: 6/ 3-_5 - 7.Z s Business Fax No.: Billing Fax No.: Contact: Contact: jil PLAN REVIEW FEES INSPECTION FEES PERMIT F a FALSE ALARM FEE Site Plan N/ , Annual N/C Sprinkler • ,'1stAtarm N/C Muki- Family /Commercial �, 1st Re- inspection N/C Standpipes $50 1 2nd Alarm N/C inimum Charge $2 .1'1 , 2nd Re- inspection $100 Fire Pump $50 , 3rd Alarm N/C ❑ Plan Revisions DBL , 3rd Re- inspection $250 Hoods j4th Alarm $100 4th Re- Inspection $500 Fire Alarm $501 ■ 5th Alarm $150 SPRINKLER SYSTE ' (Business closed until LP Gas 1 1 6th Alarm $200 0 - 25 Heads I violations corrected) �' Natural Gas $50 ,NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per tank $50 STANDPIPE SYSTEM Hydro Undergrounds Sparklers $10 ❑ Per Riser $50 Hydrostatic Test Y per system Fire Works $500 FIRE PUMP Acceptance Test •- per system Camp Fire $25!. ❑ Per Pump $100 Hydrant Flow $75 Controlled Bum $100 FIRE ALARM SYSTEM • Hood/Duct $50 - 25 Devices �l ; 1 FIRE ALARM SYSTE Place of Assembly $50 Annual rt 2 6 plus Devices 100 System Acceptance Fire Protection $25' SUPPRESSION SYSTEMS Recall Acceptance pt $50 Flammable Application 550 I Annual — Wet $50 — OTHER Waste Tire Storage $501 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 5100 Annual KITCHEN EXHAUST Fumigation Tenting $50 I — ❑ Hood/Ducts greater per tent Torch Pot/Applied $50 $50 Tent 10'x10' or rester $15 OTHER — Fire Pump 545 Haz. Materials $100; Annual LP Installation per tank 550 _ Fire Suppression $30 Fuel Tank Installation 550 _ System Acceptance (Per Tank) $50 _ Exhaust Hood/Duct $30 ❑ Natural Gas Installation 550 _ Re- inspection DBL (Per System) (other than annual) ❑ Spray Booth $50 ❑ Inspection scheduled DBL _ and cancelled less than 24 hours _ Construction Insp. N/C , Emergency Vehicle Acs $50., FALSE ALARM PLANS TOTAL) ac— INSPECTION TOTAL! I � 1 PERMIT TOTALle TOIJAL I 1 1 GRAND TOTAL 1 4240 -- 1 Comments: i I 1 Date: V// PO Insqgctor: --�I /� %i- Pasco County Property Appraiser - Legal Description for: 35- 25 -21- 0010 -10500 -0000 Page 1 of 1 Welcome : Records Search : Parcel Details : Legal Description 1111111 11111 1111111111 Nil 111IIIIIIIIIIII11111 IIIIIIIIIIII Legal Description 2010092361 35- 25 -21- 0010 - 10500 -0000 Assessed in Section 35 , Township 25 South, Range 21 East of Pasco County, Florida ZEPHYRHILLS COLONY CO LANDS PB 1 PG 55 FOLLOWING DESC PROP LYING W OF DAIRY RD R/W AS NOW LOCATED TRACTS 103,105,106,119 ,120 & 122 & E 100 FT OF TRACT 104 & E 105.76 FT OF TRACT 121 EXC W 187 FT OF E 267 FT OF N 172 FT OF TRACT 103 & EXC US HWY 301 R/W & EXC R/W FOR DAUGHTERY RD;& ARBOR RIDGE SUB PB 22 PG 44 LOTS 5,6,7 & 8 OR 3041 PG 160 OR 3154 PG 65 OR 164 PG 724 Property Identification No. j5=-02 - 02:3" - - 0 2 1-- pp ,/, - /�,6 -Elio 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 information is provided in this NOTICE OF COMMENCEMENT. 1. Description of property (legal description :) Rcpt : 1312780 Rep : 10.00 a) Street Address: DS : 0.00 IT: 0.00 2. General description of improvements: #9,//.Q R ( r -TO,Q ig /e_., 4e,,..9`•/' 06/28/10 C. Cook, Dpty Clerk 3. Owner Information a) Name and address: f e „ , .., _ , , , • ' 0 r . ( / _ . • — qv b) Name and address of fee simple ti / eholder (if o er than owner) c) Interest in property 4. Contractor Information a) Name and address: tfj ,a4,a,v 4,, A b) Telephone No.: e9 ,3 — 65''5/6 7,24 _• Fax No. (Opt.) . 9/1,3 — 7. 6,3 - y aig 5. Surety Information a) Name and address: 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: .Se{A,C,o,,19,,a,,,,_ cow ip,aa„,f"n,2 6,A „Zoe, ,.5:SoS eja.,, b,EAL0,o, /ice, ...z.444.4.4 b) Telephone No.: X11,3 -!I - 46 - 7 eg Fax No. (Opt.) $,3 .- zee- , YpoZ$ 235 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: ,029,/. 6i92dL.,«r2 7452, /,4 AL4,„,0, ...e.,4,L! 5 Se,pi0 b) Telephone No.: 79/3 — 79 3 -A/ Fax No. (Opt.) 19 ig 9. Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is o>t c pe r Specified): m N D co l • m WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF Com COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, wN FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVE , . TS TO YOUR PROPERTY. Cni o A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE J I, : E BEFORE THE FIRST .b3 is INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSU YOUR LEND' OR AN ATTORNEY BEFORE E COMMENCING WORK OR RECORDING YOUR NOTICE OF CO ■ E i -u''' ° r STATE OF FLORIDA 0 m COUNTY OF PASCO i ' 4 / � F . ao S _ attire of • n• ner or 0 • 's AuthorizedOffic er/ Di irree ctto o /VA:- c, /� fir. / / r//- c9 i Print Name o J/ r The ore� i i strument was acknowledged by . re me th ,: � y day of ' -) , 20 A , by /GQ c %al . , . . �✓l £ - 7 >L.as- / / ti ._ .....-.4._ • (type of authority, e. • ._ ,officer, trustee, attorney in fact) for --..„2, ., ' C5-i � 11 '1ri7 name of party on behalf of why instrument w ex; cut . ,/ V Personally Known X OR Produced Identification Notary Signature �,1 L ' ' t. �� • Type of Identification Produced Name (print) _. .. S a f7 L- Z , E7 O r ` 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. Signature of Natural Person Signing Above FORMS /NOC,rvsd2007 SWAN L. IIEINNfT A ir 1, Maly hillii - SIM MIMS COMMINIMI ,00 WM TTMMMMS .J MANS aIMI4 M M - RUIN ` •� ,/f PIA Oliid AM. ; stows as • inissiniiwIt From:Vickie Dennis FaxID:863- 967 -7592 Page 2 of 3 Date:07/02 /10 11:54 AM Page:2:of3 _ • DATE (MM/DD/YY1 CERTIFICATE OF LIABILITY INSURANCE O o1 07/02110 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mulling Insurance Agency, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 Box 308 208 E Park Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Auburndale FL 33823 -0308 Phone: 863-967-4454 Fax:863- 967 -7592 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. American Fire & Casualty INSURER B. Ohio Casualty Wyatt-Fitzgibbons Sheet Metal Michael Wyatt INSURER C atidgatiald Employers Ina. Co, 905 Strain .Blvd. INSURER D: Lakeland FL 33815 l 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 INK AUU L POLICY NUMBER POLICY EFFECT !Nit POLICY EXPIRATION LIMITS LTR NSRC TYPE OF INSURANCE DATE (MM /DD/YYYY) DATE (MM/OD/YYY GENERAL LIABILITY EACH OCCURRENCE $ 1000000 U/4W A X COMMERCIAL GENERAL LIABILITY BKA1154410814 04/01/10 04/01/11 PREMIS E S (Eaoccu KtN I tU rence) $ 300000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000 PERSONAL 8 ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2000000 n POLICY [7 jECT n LOC Emp Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO BAW54410814 04/01/10 04/01/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 5000000 B X OCCUR CLAIMS MADE US054410814 04/01/10 04/01/11 AGGREGATE $ DEDUCTIBLE $ X RETENTION $ 10000 $ WORKERS COMPENSATION X TORY LIMITS 01H- AND EMPLOYERS' LIABILITY Y / N C ANYIPROPRIETOREXTNE E XECUTIVE 1 I l 0830 -44641 04/01/10 04/01/11 E.L. EACH ACCIDENT $ 500000 (Mandatory in NH) 1 E. L. DISEASE - EA EMPLOYEE $ 500000 If yes. describe under SPECIAL PROVISIONS below E L. DISEASE - POLICY LIMIT $ 500000 OTHER • B rented equipment BM054410814 04/01/10 04/01/11 blanket 125000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYZEP 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Zephyrhills Building Department REPRESENTATIVES. AU 5335 8th Stree AUTHOR), ENTATIVE IZephyrhills FL 33542 ACORD 25 (2009/01) © 19 8 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD •