HomeMy WebLinkAbout09-9311 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9311
BUILDING PERMIT
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Permit Number: 9311 Address: 5510 19TH ST
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD /ALT COMMERCIAL Township: Range: Book:
Proposed Use: CHURCH Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11- 26 -21- 0010 - 14300 -0000
Improv. Cost: 10,887.00 j ..;T.::::: ,;: R
Date Issued: 7/02/2009 Name: FIRST PREBRYTERIAN CHURCH OF ZEF
Total Fees: 152.50 Address: 5510 19TH ST
Amount Paid: 152.50 ZEPHYRHILLS, FL. 33542
Date Paid: 7/02/2009 Phone: (813)782 -7412
Work Desc: REMODEL BATHROOM TO CURRENT CODES
BETTI C ON ST RUCTION LL C PLUMBING FEE 127.50 FIRE PLAN REVIEW FEES 25.00
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FOOTER 2ND ROUGH PLUMB MISC V INSULATION CEILING
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."
6a._
at I
CO C TOR SIGNATURE PERMIT OFFI tr
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
Contractor/Homeowner: M14 CIM_S4ruet&-)
Date Received: ( -So- v C t
Site: 557 0 1 / ( ST
Permit Type: /eP✓l o Gee, / ,e s & -, AM
Approved w /no comments Approved w /the below comments: ❑ Denied w /the below comments: ❑
This com t sh-et shall be ept with the permit and/or plans.
7-7
K ' witze - Plan xaminer Date Contractor and/or Homeowner
(Required when comments are present)
813 -780 -0020 City of Zephyrhills Permit Application ( l ( Fax -813- 780 -0021
Building Department t �`
Date Received 0 13 'I trj _ 3 099
p Phone Contact for Permitting 6
Owner's Name F i r 54 I r•GS Lki ie r- w v. C let t4, -1-, Owner Phone Number ( - 7$2 - 7q 1 2,
Owner's Address 55 0 I9+t s"+r c-+r.+ Ztp, It 335g2i Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 551° I4+t 5kreC'1' Zylnila c tj • 335 i LOT# 1 I ` i 1
SUBDIVISION PARCEL ID #, 1 I— *Z`p •' 2 t c o 1 0 1/ 3 no - 000 8
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR X ADD /ALT I 1 SIGN n MOVE I DEMOLISH
INSTALL REPAIR
PROPOSED USE I SFR I A 1 COMM I OTHER I R c, mock, i RPS +miaow.5
TYPE OF CONSTRUCTION I I BLOCK I 1 FRAME I I STEEL n OTHER I I
DESCRIPTION OF WORK R (, yytne t c , I (P l- -ro - o il [) 6 Coc% g.
BUILDING SIZE SQ FOOTAGE 2-1-7 HEIGHT
I X 1 BUILDING $ 10 i V37. 0 O VALUATION OF TOTAL CONSTRUCTION
I 1 ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I I W.R.E.C.
I 1 PLUMBING $ �' �
1 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION / 4.
I 1 GAS I ROOFING I 1 SPECIALTY n OTHER \....../ Lei' :1 1A.*
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I1YES I — I NO to C L� �'
BUILDER �i If COMPANY 13e-i-±;‘ Go►ns� rt�t( �i t+n , L I. C-
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I
Address I x.7 'Ale...! kev Dv \d ea It `1 CWA,p 1 335'N License # C (.0 1 S i 5 1 3 7
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N 1
Address License # I
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y / N 1
Address 1 License #
MECHANICAL COMPANY
SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT I Y/ N 1
Address I License # 1
OTHER COMPANY
SIGNATURE REGISTERED I Y / N I FEE CURRENT 1 Y/ N I
Address 1 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) 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 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 $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 - WeIIs, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers - Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services /Environmental Health Unit - WeIIs, 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
YOU YOUR LENDER OR AN ATTORNEY BEFORE FINANCING, CONSULT
WITH EFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03) -.rem
OR AGENT l y� Z�2 CONTRACTOR `.' C -'�
Subscribed arid to affirmed) before meths Subscribed and sworn to (or a ed) before me this
- 30 ' ` 6 :I o ./ tc, c / 5 T .- /� (- 30 • OC7by .. R y
Who is /are personally known to me or has /have produced Who is /are personally known to me or has /have produced
as identification. } DR )v A'Q /e DNS as identification.
) 1111 , R � � 2' • ary Public '_-' / / <e- DLL r114
Notary pEH Public
Commission No. Commission No.
<�qV PV
io •. „, DELL M. ANDERSON M.
M ION f DD 934187 Name of Notary typed, printed or starft • p� • Pu� * MY PIR COMES MIS$ er, 434181
Name of Notary typt 1 ' ember 27, 2009 ;r te Se f
'r EOF Fl Bonded live Budgie Maury SNYICM eOF FLC EX ( +'` B D ember 27, 2009
°^ Nu Buffet Notxrsnots
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.:
Plan No.: el- Contractor: itic,1n VOrSkYc..c*t
Business Name: §-+2k Billing Address: i .., "- r
Business Address: 1D �C ',. R. WM ' � f
Business Phone No.: Billing Phone No.: f l
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES _ INSPECTION FEES _ PERMIT FEE _ FALSE ALARM FEE
Site Plan N/C _Annual N/C
N/C
_Sprinkler $50 _ 1st Alarm N/C
Multi—Family/commercial 06 sf _ 1st Re- inspection _Standpipes $50 _ 2nd Alarm N/C
N/C
(Minimum Cha $25. _ 2nd Re- inspection $100 _Fire Pump $50 ` 3rd Alarm
Plan Revisions DBL _ 3rd Re- inspection $250 _Hoods $50 _4th Alarm $100
4th Re- Inspection $500 Fire arm Al $50 _ 5th Alarm $150
SPRINKLER SYSTEMS (Business closed until LP Gas $50 _ 6th Alarm $200
0 - 25 Heads 050 violations corrected) _ Natural Gas 050 _ NON COMPLIANCE $150
26 plus Heads $100 _ SPRINKLER SYSTEMS Fuel Tanks- per tank $50
—
STANDPIPE SYSTEM — Hydro Undergrounds $45 _ Sparklers $100
Per Riser $50 _ Hydrostatic Test $65 per system _ Fire Works $500
FIRE PUMP _ Acceptance Test $45 pe system _ Camp Fire $25
fl Per Pump $100 _ Hydrant Flow $75 _ Controlled Bum $100
FIRE ALARM SYSTEM _ Hood/Duct 050
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 050 Annual
Wet 050 _ OTHER _ Waste Tire Storage $50 Annual
_ Dry $50 _ Fire Wall/Smoke Wall $ 15 p er Ball _ Generator < KW $100
_ CO2 $50 _ LP Gas 025 per tank _ Generator >30 KW 150
Other $50 ` Natural Gas $25 per system _ Bio-Hazard Waste $100 Annual
KITCHEN EXHAUST _ _ Fumigation Tenting $50
El Hood/Ducts $50 _ Tent 10)10' or greater 515 per tent _ Torch Pot/Applied 050
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
Natural Gas Installation $50 _ Re - inspection DBL
(Per System) (other than annual) _
0 Spray Booth $50 0 Inspection scheduled DBL _
and cancelled Tess than _
24 hours
. Construction Insp. N/C
1 �yi11 Emergency Vehicle Aa $50 FALSE ALARM
PLANS TOTAL 11 INSPECTION TOTAL PERMIT TOTAL TOTAL
GRAND TOTAL 1 r .6) I
Comments: �
Date: f I /Q9
Inspgctor: b �r ag
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 #: 09 -055
Project: Interior del - Restroom
Number of Pages: 1
July 1, 2009
I have received and reviewed the plans for the bathroom remodel located at 5510 19
Street and will allow this to move forward. Obtaining permit, the applicant acknowledges
complying with the items listed below.
Should anyone have any questions, please do not hesitate to contact the Fire Marshal's
office.
1. Ensure to install emergency lights in restrooms.
Inspections Required:
1. Remodel Final
- �i3
KE • • B •+ TT, 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.
28750 Walker Dr
Wesley Chapel,FL. 33544
813- 817 -3099
FAX 813 -991 -4437
CGC1515137
June 23, 2009
City Of Zephyrhills
5335 8th Street
Zephyrhills, FL. 33542
The only person authorized to sign /pickup permits is Larry Bettin
Larry ettin
r /
T RANCES SANTANA
Notary Public - State of Florida
k E. My Commission Expires Nov 1, 2010
<.'c_ ✓v� Commission # DD 611107
" ?J" Bonded Through National Notary Assn. -
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NOTICE OF'COMMENCEMENT
2009091883
Rcpt :1251550 Rec: 10.00
Permit No. DS : 0
IT: 0.00
07/02/09 - — Dpty Clerk
Property Identification No. i t •- Ito- 2i O ®i O-1
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 description:) TD W tN a�' 2. nsL.' 113 P 1 P (r+ 5 / Lots 1 -11 Znt, I (GG 11)3
a) Street Address:. 55 id let vtr ec-+ "t i l„ l t s K.1 3 3 5 4 .L
2.General description of improvements: I-� m ,✓l P c -44. rc5 01,, 's 0 1C� a c.� i7 f3
3.Owner Information
a) Name and address: F;f;s+ Pre fric+t.v, C i nwrc,L $S 1 5 r + h ,ktK F {.
b) Name and address of fee simple titleholder (if other than owner)
c). Interest in property d w H 4-4
4.0 tractor Information •
a) Name and address: LOvrrl,' a-e. 3A wo ,l krr 1Jv J s(ty Cow, e .) i F1. 335y'/
b) Telephone No.: . R13-111- 3Dc 9 Fax No. (Opt.) 813--91s-
5.Surety Information
•
a) Name and address: •
b) Amount of Bond: • PAULA S. 'NEIL, PASCO CLERK & COMPTROLLER
07/02/09 Q l? y : f§i 1 0 78
c) Telephone No.: Fax No. (Opt.) _ OR 8 BK BK V 1 PG
6.Lender
a) Name and address:
. " Phone No.
7. Identity of person within the S of F1,2_dda designated byf weer upon whom notices or other documents may be s9 -ved:
a) Name and address: ,re ✓ JD c n.1 G✓'• (f4S rfre j a /?7-1 . Se- „Z2/4 -yrA, /33 L •
b) Telephone No.: 3 7f _ 74 Fax No. (Opt.) f' 5 _- 7r 2. - 4(3 <72.. ..
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: r /+
a) Name and address: /ii . t--4/3 " t 1{ �' %O / 91 is S „,./G.`" d/ VVe /4/ c. L S j 2.
b) Telephone No.: c �� 7 t'Z .Fax No. (Opt.) _ 2' - 2—
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
COUNTY OF PASCO
of Owner or s Authorized OMeer/Director/Nailer/Manager � •
Print Name
The foregoing instrument was acknowledged before me this ex "day of L . 200 9, by 'tWE,v Lc 1
as /i i /� (type of authority, e.g. officer, trustee, attorney
in fact) for aQ,� 5 $ 7 - 4 79 tO ame of party on be .: of whom instrument was executed).
Personally Known/ OR Produced Identification Notary Signature
Type of Identification Produced Name (print) DELL M ANDERSON
J.- t 111 C OAI M ISsrN � Op X34187
►„ "" ' ' _ EXPIRES: Sephmler 27, 2008
H cn4d TMy � N
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have readThEllaTegoing and that
the facts stated in it are true to the best of my knowledge and belief. .
•
Si ofNatural Person Si -
FORMS/NOC.rvsd2007 l;�ng V r ..
STATE OF FLORIDA, COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
WITNESS MY HAND AN u 0 ' CI I SEAL THIS
DAY OF Ludo
PAUL 'N ERK : OM ROLLER
BY �DEPUTY CLERK
FROM :BAY INSURORB FAX NO. :8139073995 Jul. 02 2009 11:11AM P1
A - 9 — �--„4. * CERTIFICATE OF LIABILITY INSURANCE -----1 woman
z oos
PRODUCER Phone: (813)907 Fa (1313)9C17-3985 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
BAY INSURORS CORPORATION ONLY AND CONFERS 310 RIGHTS UPON THE CERTIFICATE
P 0 BOX 7710 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
WESLEY CHAPEL FL 33545 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC 0
•
INSURED INSURER A: MID - CONTINENT GROUP
BETTIN CONSTRUCTION, LLC INSURER B:
28760 WALKER DRIVE INSURER C:
WESLEY CHAPEL FL -. ... _..._.
INSURER D: -
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 OT 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, L•XCWSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE uMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MBR AODL TYPE OF !MIDRANGE POLICY NUMBER rouCV SOMME POLICY SERRATION LIMITS
LTR WERE DATE IIRDODNE DATE IWA'DOIVYI
GENERAL UABILITY 04GL- 000734936 07/14/09 07/14/10 EACH OCCURRENCE t 500,000
X COMMERCIAL OENERAI. LIABWTV DAMAGE ENa O RENTED lUe O ) $ 100,000
CLAIMS MADE I X ( OCCUR
MED. EXP (Any one Pram) $ EXCLUDED
1
A PERSONAL 5 ADV INJURY $ 500,000
— _. . _— GENERAL AGGREGATE 3 1,000,000
GEML AGGREGATE LIMIT APPI.IFS PER: PRODUCTS - COMP/OP AGG• S 1,000,000
X I POLICY I .. 1 J PN:O- r ' LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO 3
(Fa accident)
AU. OWNED AUTOS BODILY INJURY
_. par Person) f
SCHEDULED AUTOS
HIRED AUTOS OOOILY INJURY $
-
NON OWNED AUTOS (Per accident) .... -- -
PROPERTY DAMAGE f
_.._.... .. (Per occident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _-
ANY AUTO OTHER THAN EA ACC f ._ .
AUTO ONLY: AGO f ,
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE 3
OCCUR n CLAIMS MADE AGGREGATE S
1
DEDUCTIBLE ..._._– .. f
RETENTION f 3
WC&TAW- I OTTER
WORKERS COMPENSATION AND TORY IM1TB I
EMPLOYERS' LIABILITY E.L EACH ACCIDENT 3
Apv,Ro.* t #IMRTNERIEMLCUTNE ... -.. ....
oFECEWNNABIREXOLWEOT E.L. DISEASE.EAEMPLOYEE S
R EC I AL PROVISIONS ISION B E.L. DISEASE- POLICY LIMIT f
ICAL PROIl1ON row
OTHER:
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
• CERTIFICATE HOLDER CANCELLATION
CITY OF ZEPHYRHILLS BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
5335 8TH STREET WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
ZEPHYRHILLS, FL 33642 TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILII Y of ANY IOND UPON THE INSURER,
(TS AGENTS OR RENKEStN1ATIVES.
FAX 813-700-0021 AUTHORIZED REPRESENTATIVE
Attention:
A
/'‘,.---‘62-4--31-