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10-10963
CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10963 BUILDING PERMIT ra Permit Number: 10963 Address: 5903 YORKSHIRE DR Permit Type: ADDITION /ALTERATION ZEPHYRHILLS, FL. Class of Work: 434 - ADD /ALT RESIDENTIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: WEDGEWOOD MANOR Est. Value: Parcel Number: 10- 26 -21- 0120 - 00000 -0400 Improv. Cost: 1,820.00 , Date Issued: Gj f ° Name: LEECH, ROBERT SHIRLEY Total Fees: 60.000 Address: 5903 YORKSHIRE DR Amount Paid: 60.00 ZEPHYRHILLS, FL. 33542 Date Paid: 9/30/2010 Phone: (813)780 -1394 Work Desc: INSTALL ONE MANUAL HURRICANE ROLL DOWN SHUTTER -ILL H -' L U L.11 - 60.00 / '14 •. _ 2 • -•U H - : ILA • LN 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 . roperty. If you intend to obtain financing, consult with your lender or an attorney before recording you otice of commencement." 1 _ i �' 44 f t, CONTRACTOR SIGNATURE PERMIT OFFI !TR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813 -780 -0020 City of Zephyrhills Permit Application Fax - 813-780 -0021 Building Department f 3 Date Received • Phone Contact for Permitting ? c7 -- Owners Name Name d 6 - r L e e e ft Owner Phone Number 4 ( 7/6 • 137y Owner's Address S'9og ' rka /'i Owner Phone Number Fee Simple Titleholder Name . Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 590 3 Vogk5NIe. D2ti€ LOT # SUBDIVISION , PARCEL ID# /O / 1_ / I 1 D / 2 G , o 000 y'o 6 (OBTAINED FROM PROPERTY TAX NOTIC ) WORK PROPOSED FA NEW CONSTR n ADD /ALT I I SIGN 1 1 I I DEMOLISH INSTALL I I REPAIR PROPOSED USE I 1 SFR II COMM I I OTHER TYPE OF CONSTRUCTION 1 1 BLOCK I FRAME I I STEEL L 1 I I DESCRIPTION OF WORK J/1S%4G L .O/LIE /2 2 "c c o w ✓S t# Ire` BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING $ f Q2) VALUATION OF TOTAL CONSTRUCTION 1 (ELECTRICAL $ G � AMP SERVICE 1 1 PROGRESS ENERGY I W.R.E.C. 1 (PLUMBING $ 1 (MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION 1 IGAS I I ROOFING [ 1 SPECIALTY I I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 ]YES NO Ae BUILDER / 0 t% COMPANY //J /LrE4Q GL - Z" SIGNATURE ' REGISTERED I Y/ N ] FEE CURREN I Y/ N I Address Z U V O f l J � , � y � , , / C � ✓ / i License # 1 C � ^ C / & 2y ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y/ N I Address 1 1 License # PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREI. I Y / N I Address 1 License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y/ N I Address 1 License # I OTHER COMPANY SIGNATURE REGISTERED Y / N I I FEE CURREN I Y/ N Address License # I RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 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 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. 1 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 Tess than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to, violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO CEMENT. FLORIDA JURAT (F.S. 117.03) ^, OWNER OR AGENT CONTRACTOR Subscribed and sworn to (or affirmed) before me this Subscribed and sworn ffirmed) b fore me this by by sworn affirm, Who is /are personally known to me or has /have produced Who is /are personally known to me or has /have produced as identification. r OL E- / t2o(76/ ? 75? as identification. 1/ Notary Public \ • 1 /j l`k Notary Public Commission No. Commies • .. JACQUELINE B ES = .; ft °,� ommission r 1 . PVC ''' Eoires December 12, 2010 Name of Notary typed, printed or stamped Name of NotraPS4bed," MMtd l} ` '19 Pasco County Parcel: 10- 26 -21- 0120 - 00000 -0400 001 Page 1 of 1 Data Current as Of: j Weekly Archive - Saturday, September 18, 2010 Parcel ID 10- 26 -21- 0120 - 00000 - 0400 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value LEECH ROBERT G & SHIRLEY M Ag Land $0 5903 YORKSHIRE DR Land $17,649 ZEPHYRHILLS F. 33542 -7974 Building $96,409 Physical Address Extra Features $991 5903 YORKSHIRE DR ZEPHYRHILLS FL 33542 Market Value $115,049 Assessed (Save Our Homes) $104,780 Legal Description (First 4 Lines) Homestead 196.031 - $25,000 See Plat for this Subdivision "' Non- School Additional Homestead Exemption - $25,000 WEDGEWOOD MANOR PHASE I & II PB 27 PG 11 -14 Non - School Taxable Value $54,280 LOT 40 School District Taxable Value $79,280 OR 8402 PG 1518 Warning: A significant taxable value increase may occur when sold. Click here for details and info. regarding the posting of exemptions. I Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value 1 0100 SFR 00R4 4,500.00 SF $4.90 0.80 I $17,640 I 2 0100 SFR 00R4 39.00 SF $0.29 0.80 I $9 1 l Additional Land Information I Acres 11 0.10 II Tax Area 11 30ZH II FEMA Code 11 X ( °Residential Code' WDGWLP1 1 Building Information - Use 01 - Single Family Residential (Card: 001 of 001) i Year Built 2002 Stories 1.0 Exterior Wall 1 Above Average Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Carpet Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 Line II Description I Sq. Feet 11 Rep1 Cost New 1 1 11 BAS I I 1,417 1 I $94,514 I 2 __�� IL FGR _ I 460 I $12,273 3 lI L FOP I-- � 20 1 1 $334 Extra Features (Card: 001 of 001) Line Description Year Units Value 1 DWSWC 2002 408 $796 2 CON PTO 2002 100 $195 Sales History Previous Owner WARNIMONT JOAN Year Month Book /Page Type Amount i 08 2010 11 8402 / 1518 11 WD II $110,000 I L 2007 04 7455 / 0143 F WD 1 $0 I 2005 11 02 H 622 / 1378 WD $0 $0 http: // appraiser. pascogov. com / search /parcel.aspx ?sec= 10 &twn= 26 &mg=21 &sbb= 0120 &b... 9/24/2010 09-20-10 16:13 FROM- T-551 P0001/0001 F-746 CITY OF CLEARWATER PLANNING AND DEVELOPMENT DEPARTMENT 100 SOUTH MYRTLE AVENUE POST OFFICE BOX 4748, CLEARWATER, FLORIDA 33758-4748 Telephone (727) 562-4567 Fax (727) 582-4576 • 2009 -2010 OCL-0022988 LOCAL BUSINESS TAX RECEIPT THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN PLACE OF BUSINESS Owner Name & Mailing Address Business Name & Address GREGORY V MOORE • ROLLSHIELD LLC ROLLSHIELD LLC 2040 WEAVER PARK DR 2040 WEAVER PARK DR CLEARWATER CLEARWATER, FL 33765 727-451-7655 cetego:4;• Quantity 037010 CONTRACTOR: CLASS "A" GENERAL 1 LICENSE TYPE: CERTIFIED GENERAL CONTRACTOR LICENSE NUMBER: CGC1513024, PCCLB I-CGC1513024 r.• • • •- LICENSE YEAR PERIOD BEGINNING PERIOD ENDING PRINT DATE — 1 . , zoop 2010 • . October 1 2009 September 30; 2010 . . July 10,•2009 Fee ryeE . . CHECK NO I REGEIPT J FEE BUSINESS TAX - RENEWAL B200900000000000922 318.60 • • • 1 TOTAL RECEIVED 318.60 THE ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY ZONING LAWS OF THE CITY.OF CLEARWATER NORPOES IT EXEMPT THE H91.DER ANY OTHER LICENSE, PERMIT OR IMPOSED TRAFFIC :IMPACT ; FEES. ANY CHANGE IN THE. OUSINESS La6krzoN, NAME, OR OWNERSHIP MUST BE APPROVED. BY. THE 'PLANNING .AND inpARTmeNT.. . • • . . . . MICHAEL DEM DIRECTOR NON-REFUNDABLE 09- 20 -'10 15:45 FROM- T -550 P0006/0006 F -745 OI1. L.LC 2040 Weaver Park Drive - Clearwater, FL 33765 0 , Hurricane Shutter Manufacturer Corporate 727-451-ROLL (7655) - Fax 727-467-0910 License #CGC - 1513024 AGREEMENT Agreement# 1676 Representative 60A ) A 1,7 G / Date . ? .. _..c/2 . 02 4 0 Page 1 of ( Estimated Time of Installation 2. y weeks Referred by Customer Name PbP kT Li1E H ? S// / 41.EY Home Phone $/3 -7290 + /,9y Address 5903 YOIQk .$I41 k t= he • Work Phone City Z f1MYA /LL.5 State 1 t. Zip 239/2 Cell Phone Job Address Email Condo / Assoc. j i ls�GL t 1 )2? &44 Requires Association Board Approval /,;;1 Yes El No • I Number of Openings Products hciiiier& l.JR /Yi1 A046601JA) 51/0714 High Work Elevation Color EiWhite olvor 0 Beige Ej Bronze w l. S• . ) / ' ii, s.A A �] .. 11/ ' .0 ___• .. w � � r r 4 , .:l J A ,, , , �^_'. ^ . it I / "7Jr t AG.... C, ; �A/ .)g..... (91.160A.T 4 10,40k I ....../- ..�i /2/ 2. . r... ..... .. . .. .......... . _...,.,. .. . .. .*- . 7 7?1L . P.. ( . ......1820 • • •-••-. - .... - .. .. fr... iW5 ( o.S.7 . . P,eRM. /7. I,1 0.11. /!?eQ. .... .........., .. . - . . .... ..• - ...... . �AI�L.e . ..... . .. .. .,.r... - I _ .. VISA. Wyy o020 q sel .1 Z4? _ rQoN x. /..it.. .... ..... ... . . . I $D e otpr d rT .. . ... . .. Additional Information p s o. o Terms Cash Finance Contract Amount $ /c 2) a°'s' • . : • ... .. 1 oeposic $ • /$D. !• /D' �'� c� tg� P ®rmll teat� ( :) $ • . • A Cbst to'Ownier . . r o 2 Design Payment $ ` � / Q, .30 Notico Or Commencement $ 13:06 • • 3 Upon Installation $ /t� / L/ c/o 4' PERMIT (1 Administration Fee $ 4840 AOC:WI P (Not Including permit) Sub Total $ Financing /Terms ,,. 11 all payments payable to RoliShield LLC Buyer's Signature Vim- Date p- 2j -- /o Buyer's Signature D e r .. 0 _, 4 --/0 Representative Signature - Accepted By This order becomes an AGREEMENT only when it is accepted by SELLER at his home office. as reflected by the acceptance and signature of a company officer. Execution of this AGREEMENT by BUYER constitutes authorization for RoIISMeId, LLC. To obtain BUYER's credit report from a credit- reporting agency. An interest charge of 1.5% per month will be added to accounts not paid at installation. Additional terms & condition are on the reverse side of this AGREEMENT. 09- 20 -'10 15:44 FROM- T -550 P0001/0006 F -745 • ROLLIFSHIELD, lt-C HURRICANE SHUTTER MANUFACTURER AntePIca's #1 Choice for Oaallty License* CGC- 1513024 k U Facsimile transmittal sheet To: C4 ZelehVr h I \ IS From: \to xl, Je ________ Attn: V-11:\\ Date: p� ¢ I I I I O Fax number(Q13 11S \ . ( 0 Total no. of pages including cover: 6 Phone number: r6V5y1C({) 003 _ Sender's PHONE number: 727 - 451 -7655 Re: sepi \svec SENDER'S FAX NUMBER: 727 -467 -0910 URGENT FOR REVIEW PLEASE REPLY PLEASE COMMENT PLEASE RECYCLE Notes/Comments: od c.. F� �. "-1 � sj /� 105 V� � 1 / L. O� IIIWWW 6-r.--- �a� 1 691- CSI ( d � C X151 &ik,P CL akxL4ex,0 - 6\14.\-Qic-- effsef3(*) I`ki°°°' \ i n -arpee ✓ ComP kl ?)l),X0 111.6tr)S st Cm ` ' cr 'O ���RWE. FLORIDA 33765.OFFICE (727) 451 -ROLL • FAX (727) 467 -0910 www.rollshield.cgrns contact @jollshield.com FORM 0008 REVISED: 7/13/2010 09- 20 -'10 15:45 FROM- T -550 P0003/0006 F -745 05/01/2010 05:06 3524650666 VAUt WJ. /0i C ERTIFICATE OF LIABILITY INSURANCE DATc(MMYOBrfWY) ,q,— O ® 09/16/2010 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 DOSS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If uto certificate holder Is an ADDITIONAL INSURED, the policy(tas) must be endorsed. N SUBROGATION 15 WAIVED, subject to the terns And conditions of the polky, certain policies may Require an endorsement, A Statement on this certificate does not confer rights, to Etta certificate holder in lieu of such endo,oementts). OONTAI%T PRODUCER NAME: ALL BUSINESS UNDERWRITERS E „n.727- 403.9470 & 352 - 871 -5990 M ,64 352- 465-0666 THE POINT AGENCY ADDREZS:. ........ --- BOX 3075 g$i NI or DUNNELLON, FL 34430 voURBRIS) AFFORDING COVERAGE war_ RIBUR U Room A, ACCIDENT INSURANCE COMPANY INSURER a: ROLLSHIELD, LLC IRa1RtERC: GREG MOORE, OWNER mmults. 0 2040 WEAVER PARK DRIVE INSI na E I CLEARWATER, FL 33705 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS LS TO INDICATED. ANY TERM OR CONDITION N HAVE OF CONTRACT OR OTHER DOCC EN WIIYH FOR TTOOLWHICH�THI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ^ '.. �� 4NMT8 TR TYPGOPINSURAN ylruo POW/NUMMI tr A CPi1L'RALUARILJTY AGL -87954 03 03/12/11 EAOM OCCURRENCE s 1,000.000 X COMMERCIAL. GENERAL LABILITY PREMISES RNImeYRRRRII 1 100.000 - 1 CLAIMS - MADE © OCCUR MEDEXP(M,� i 5.0 PERSONAL aADVINJURY 1 1000,000 — GENERAL AGGREGATE $ 210001 GEN T AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OR AGG $ 2,000,000 Xil POUOY n PA rl LoC _ 3 AUTOIWRILEUABIUTY l COMBINED SINGLEUMIT 1 00 (Ee ec.110 ANY AUTO BODILY INJURY (Par Parson) $ • �^ ALL OWNED AUTOS BODILY INJURY (P.r.ddn+0 i — SCH @DULEOAUTQS PROPERTY DAMAGE s NIREOAUTOS . -- s NoN.OWNdD AUTOS •-- $ UMBRRMAUAR _ OCCUR EACH OCCURRENCE E — EXCESS UM CLAIMS•MADF AGGREGATE 1 DEDUCTIBLE 1 RETENTION 1 1 A1IO WORICSRECOMP M0N T r I AT I . AND WIPWYBR9' LMBILNT ANYPRCPRIETORNARTNE� ECIITIVE 0 N)A E.L, EACH ACCIDENT $ OFFICER ME EXCW G.L. =ACC • LA 0MPtOV!E�$ (MaAe1110tY R NN N yyO$� I E.L. DISEASE • POLICY LIMIT 0 r ` ESCRIPTION OF OPERATIONp b - ' oaCRIPnON OP OPENATONS I LODA10NS� (MMCh ACU110101, Ad4lbeat Reemme Seemme, R INO1e spouoriwoms GENERAL CONTRACTOR SPECIALIZING IN THE SALES AND INSTALLATION OF STORM SHUTTERING LICENSED AGENT : GREGORY V. MOORE, ROLLSHIELD, LLC; STATE LICENSE # CGC 1513024 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AJ3OVE DESCRIBED POLMIBIS BE CANCELLED BEFORR CITY OF ZEPHYRHILLS - BLDG. DEPT. 1140 EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN 5335 EIGHTH STREET ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS, FL, 33542 AVTMONlEOREPRESEIfTATRIE FAX TO: 813 -780 -0021 01988 - 2009 ACORD CORPORATION. All tights ,mewed. • ACORO 20 (2009109) The ACORD name and lope are mastered marks of ACORD c` 72ra " ic69 -4,10 • 09- 20 -'10 15:45 FROM- T -550 P0005/0006 F -745 RO jortH HURRICANE SHUTTER MANUFACTURER Anterior's Of choice for penilty License # CGC- 1513024 PERMIT AGENT AUTHORIZATION LETTER 1, Gregory Moore CGC- 1513024 (contractor name) (contractor license no.) hereby authorize the following to act as my agent(s) in obtaining permits in zo Florida. NAME OF AGENT DRIVER'S LICENSE NO. RON VADEN V350- 723 -47.262 -0 LORI BOOZER 8260- 521.70 -592.0 Allen Shanks E152 -017- 61.374.0 Stephanie Koljonen K425-792-89-728-0 Jim Coyne 294- 730 -17 ( Texas) 16rehj Coc"t-- bs C 519,- ovici- d\a -b This letter supersedes any previously submitted letter(s) of authorization. This authorization is to ain in effect. unless cancelled in writing, by the undersigned STATE OF FLORIDA COUNTY OF PINELLAS ontractors Signatu Sworn ! f affirmed) (or armed) art u m bscribed before e This pip f- , 20 / BY , r IP'AINTED/MEDNAME ENGENOLOERMAKINGSTATEMEN ► j Affix Notary Seal NOTARY PUBLIC 1 .y« LORI BOOZER rL0 ,— e III/ 1 .1. MY COMMISSION # DD899026 (Name of Notary Ty mud, or Stamped ` •• � EXPIRES June 15, 2013 )407) sse.01bs FbndanowrySergoe.com My Commission expires: Personally Known Produced Identification (Type of identification Produced) 1151 Kapp Dr. • CLEARWATER, FLORIDA 33765. OFFICE (727) 451 -ROLL • FAX (727) 467 -0910 www.rollshield.com•contact@rollshield.com FORM 0014 REVISED: 9/16/2010 09- 20 —'10 15:44 FROM— T -550 P0002/0006 F -745 PIN C OUNTY CONSTRUCTION • ., LICENSiNO.BOARD • • • B ed - inning'1�OctC)r); ;3 4 • : • . ; THIS CERTIFIES THAT Gregory Vence Moore ! , CS ld 1,I.0 DDA Roll6hic • • Citations ;5i)4.),tr HAIL) . STATE CERTIi 1- C,GC131302A . fog- COO m et �� 1 . � 1 • \ . • t ; , � SAS F)LSQ H'IS/HER LICENSE AND PROOF OF REQUIRED t [.IAIIILITY AND WORKERS' COMPENSATION • ( • INSURANCE WITH THIS BOARD. • � i i i V 1 LCD 1 IN GOOD STANDING UNTIL September 30, 2011 •:, I CGC1513O24 • DATE OP ISSUANCE '09/07/2010 • • Moore, Gregory Vance • * Please cut out license along lines • • • 2040 Weaver Park Drive . • • • . Clearwater, PL 33765 • • . 11)) / , tx.218` ,':: ,'' ?:',.; °', • .( :' • k : • \ , ' ` i .'- ( 0, .NC ^ . • C With this license you become one of the nearly one million , :f'`-.. Is• i s • , '. ,, - •. tt „ � . ,.: • ; ' Floridians licensed by the Department of Business and Professional Regulation. i . ,, . : p •. p ''j ` (, ' , ' t � •' _ - _ r ;. • Our professionals and businesses range from architects to yacht brokers, from ; / t;y . �( :17 � �,. ti > ` ` : , ..ee, >t •., )/,.. °�'`. boxers to barbs ue restaurants, and they keep Florida's economy strong. ( : /,,� Ir. ; � 4 ' • ;,...":/''.6... "' e '�'`)�"'�T�� ? >5 ��'' �'�'� 'ii;Y • Every day we work to improve the way we do business in order to serve you better- it < ,,,.: , I ;c::: i7 w :,• i :;, ! . ., : ; ; ..;, ? G t i► 4)",.: .: For information about our services, please log onto www.myfloridalicense.com. .: t G , , • 'g:; o ,� .1` . 1 ,' •' E=, ► '-'r::•;< • There you can find more information about our divisions and the regulations that ;:( • ,�^- q t r • > -; - :' • ,, 1 , , ,c impact you, subscribe to department newsletters and learn more about the t�4'9:. •> , 4-..,30:.:41 , r i; • Department's , 1 , ) e b initiatives. t . . , ,,tti ';7 rk, ?,..'. ` ; ;/ • Our mission at the Department Is License Efficiently, Regulate Fairly, We :; r i ! •�(,•;� ,; = ' ; .l; I ; e aa . ( '6 •• ' ; ...',. � , *.. constantly strive to serve you better so that you can serve your customers. 'r 0.11. ' • t D `i - Thank you for doing business in Florida, and co on your new license) %*(v '� C? + . s 4n t i s i '• • ' :,. '' "` • �;: • I ' i . ., ' C• ><t ''ia \ (: ;: r�%ariT , /�i•XI>7,•'(r.,alp, j, r...,.. � t`� • • • DETACH HERE !� ,'•'�� ' ' r;! y, �]�., i�" (fit' . '• :•:�:: � .1 . ',... . f +`F y)•. . e � ' ✓ � 'ti, ' S `.. , 4. < � ' ! •,::: 'tip: •: Y,:..,$ J � l ' ' �,� � /� • i a : : . ,•• . // Vic '. ' � y ,z 4 �/ r/ �I,� 7 .., ,. a.4 ) t y t. S . �' �'�{,` nl'Y� 1�J� e � Si\R'.r'3,�J TS,�.C•i�'i9il� K:t!•'>� �J {, ":!:. , t ) yli, !1'�'�c.) •�•,rtsc. \ =i/ >�CT.•��.�i'�l 'C �' J.1: +6- it •4 ':• t ^s •' o:; ,S- .U(• r `.:. 4 • \'. 14 i I•ro. 4•;-.� Z; i / <�n \, L>, �.. r UAIC 1?P.TC(I � .4: < • � l.' �� ilr:ii' j 1 • :. j i:.,i,�',,;:a:; .' ?:i:? " ::�a,. '• l.!'•;a' i... •;tf •_r. ;,r)1 ',i , --,-..,/ ! :i , ,,, p.,• tilt? (,^ 4,.4f,AIN ' • '.6.4 f i l t.' • � •• 1 "•4'1 Y .00 '• lcy ( �)∎. 0,8,' r � � r ' / ,. : ., . ,�1,,jj .•eA �Gy, .,.:1- . ♦ . , 4! 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Oi . . • nlgpl a� A5 Ri= QUIRED �Y LAW • 09- 20 -'10 15:45 FROM- T -550 P0004/0006 F -745 CERTIFICATE OF LIABILITY INSURANCE 09/16/2010 PRODUCER Serial # 175662 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RISM E UPON THE CERTIFICATE FRANKCRUM INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE ODES NOT AMEND, EXTEND OR 100 S. MISSOURI AVE. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CLEARWATER FL 33755 INSURERS AFFORDING COVERAGE NAIC!1 INSURED INSURER A• FRANK WINSTON GRUM INSURANCE. INC. 11600 , INSURER B. FrankCrum 1400.277-1620 INSURER C: 100 5 MISSOURI AVENUE INSURERO• CLEARWATER FL 33756 INSURER E: INS POLICIES OF INSURANCE LILTED DELOW HAVE BEEN ISSU60 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANT REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OP OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T11E INSURANCE AFFORDED BY THE POLICIES DL OED 14E5515 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MA AMYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE FoucT MDIMATION' LIMITS LTR PARC DATE 1MMI00IYY) • _w (MMIODM�i _ EI aENERAL IJAETY EACH OCCURRENCE ' S el MNERCIAL GENERAL UAaIUTV FIRE DAMAOE one AN) 3 El CLAMP NAGE OCCUR RED EIlP 1MYaIUP�w) S 5 PERSONAL IIADYINJURY =ERA AGGREGATE 5 OEN purr APPLIES ^ PEI: PRGOUCTS-COMPIOPMD S .� I /POLICY l 1PROJEDY I /LOG ..mmm.,.. AuTOMOIR,E WIKITT OOMBSEO SINGLE WHIT i LEA Ecc$640) ANY AUTO -4 ALL OWNED AUTOS BODILY MIYRY 3 ~_ SCHEDULED A11103 HIRED AUTOS "MOLYINJURY 1 romposeas NoN-01MIE0 AVTOO PROPERTY MA 5 -' IPo uMdM3 GARAGE uM MJIY AUTO oNLY • EA ACCIDENT E _ ?WV AUTO mil WEN EAAGG 5 AUTO MVP A CC EMUS U LIABILITY EAON OOGURRENCE S J occuR UCIADIS MADE AOGNECAIC 'S • S RETENro?' 3 �y S • CDMPEI A9 MON AND X I "'� A '� ( I pTHEii A anomie' Lyman WC201000001 07/01/2070 01101/2011 TORYlIMRB _ ANY PROPRIETOR / PARTNER I EXEDIRIVE OPPICER I MEMOEREKCLUDED7 E LEAOIAI'JGIOENT $ 1,000.000 U yogi dg.e•M wlAlf E l Damn . EA EMPLOYEE s 1 `00.000 SPEdAI PROWxpNO wlo.I E L DISEASE • POLICY I IT $ 1.000,000 OTHER • OEECRIPTION Oi OPERATIONS' LOCATIONS II VENUES / EIWWSIONO eV ENDORSINEiTI SPECIALPROMabRa EFFECTIVE 04/30/2006, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ROLLSHIELD, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION _. :MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSIRNO RNAMRER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE ci]IIIROATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SHALL IMPOSE CITY OF ZEPHYRHILLS NO oeu0A110N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATTN: BUILDING DEPARTMENT REPRESENTATIVES. 5335 6TH 8T. AUTHORISED REPREIENTATRIE ZEPHYRHILLS, FL 33542 -/ License # CGC- 1513024 • 1 PERMIT AGENT AUTHORIZATION LETTER Gregory Moore CGC- 1513024 (contractor name) (contractor license no.) hereby authorize the following to act as my agent(s) in obtaining permits inC / ( , Florida. RON VADEN V350- 723 -47 -262 -0 LORI BOOZER B260- 521 -70 -592 -0 Allen Ebanks E152- 017-61 -374 -0 This letter supersedes any previously submitted letter(s) of authorization. This authorization is to remain in effect, unless cancelled in writing, by the undersigned STATE OF FLORIDA COUNTY OF PINELLAS Co acts sSi•• - ure Sworn (or affirmed) and subscribed before me This , day of :3"VA e_ , 20 /0 By / 7 ; r�WAIL e / d fA/L (PRINTEDRYPE A LICE SE HOLDER MAKING STATEMENT) Affix Notary Seal NOTARY PUBLIC (Si *lure of Notary) ( ( €L-1 A - l--(Ei Ic (Name of Notary Typed, Printed, or Stamped) My Commission expires: Personally Known OR Produced Identification LEIGH A. MIELUCC Notary Public, State of Florida My Comm FxpireS Sept. 12, 201' (Type of Identifiolike®f 2040 WEAVER PARK DRIVE • CLEARWATER, FLORIDA 33765 ♦ OFFICE (727) 451 -ROLL • FAX (727) 467 -0910 www.rollshield.com ♦ contact @rollshield.com FORM 0014 REVISED: 6/18/2010 QILL SHiELIa«c HURRICANE SHUTTER MANUFACTURER AIIIIIMIlgalrf � 1 011040 FM arearey License # CGC- 1513024 727 - 451 -7655 Property Information ( Building Information Owner: Robert Leech Wind Zone: 120 M Address: 5903 Yorkshire Dr. Exposure Category: B Zephyrhills, FL 33542 Minimum Building Dimension: 30 ft. Mean Roof Height: 12 ft. Structure Category: 11 I Design Pressure Calculations Opening Max Positive Max Negative Number Pressure (psf) Pressure (psf) 1 23.1 -25.3 l 1 Prepared in accordance with: ASCE 7 -05, Section 6 - Wind Loads. Florida Building Code 2007 ed. Page 1 of 1 g Florida Building Code Online Page 1 of 2 .�1, �p►Ir --I� FLORIDA OBPARTi 1�NT�OF --- r' ii S _ y � _ 3 C0� i T A /DClF ROGRASi,18 COf1TACT OCAy ��" O CAHOM F.,, ABO,t DC„ . - . Links Search _:.: - BCIS Home Log In User Registration Hot Topics Submit Surcharge Stets & Facts Publications FBC Staff BCIS Site Map • i lli 4 : Product Approval i , tg USER: Public User Community Aff Product Aoprov Menu > Prod or aoolication Search > aoolication List > Application Detail - FL FL5790 -R5 FGOMMUNITY PLANNING, Revision i"1 ` Application Type r V ._ _ 2007 f� -'DOU DEVELOPMENT MMUlulti7r; Code Version vEVELOaMEN Ap p roved � �) += + � 3 :: E3I Application Status r �r 9 �. 1'' �� � � ] , � MANAGEMEI`Fr _ Comments ;IdQF.F.IGEOFTHE Archived gyp J�t�1 >Y�a� ' SE ERETRIF _ - f"L�1V Product Manufacturer American Shutter Systems Association, Inc. Address /Phone /Email 4268 Westroads Drive West Palm Beach, FL 33407 (561.) 209-8263 bfeeley @easternmetal.co Authorized Signature Bill Feeley Technical Representative Address /Phone /Email Quality Assurance Representative Address /Phone /Email Shutters Category Roll -up Subcategory Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer ' Evaluation Report - Hardcooy Received Florida Engineer or Architect Name who Walter A. Tillit, Jr. developed the Evaluation Report PE-44167 Florida License Quality Assurance Entity National Accreditation and Management Institute Quality Assurance Contract Expiration Date 12/31/2010 /O 201yKampmann Jr. Validated By Validation ChecKilst - Hardcopy Received E790 R5 COI vfd:�,nr . 10 -003 :,artlfcation - Certificate of Independence I�deoendec e Year Referenced Standard and Year (of Standard) Standard 005 ASTM E -1886 2 2005 ASTM E -1996 2002 ASTM E -330 Equivalence of Product Standards Certified By Sections from the Code Florida Building Code Online Page 2 of 2 Product Approval Method Method 1 Option D Date Submitted 03/01/2010 Date Validated 03/03/2010 Date Pending FBC Approval 03/12/2010 Date Approved 04/07/2010 Date Revised 07/02/2010 Summary of Products FL # Model, Number or Name 'Description 5790.1 58mm Bertha End Retention / 58mm ER SLAT BERTHA ROLL -UP SHUTTER W/ OR W/O Non- Retention Roll Shutter VIEW PORTS System (Non -HVHZ) Limits of Use Installation Instructions Approved for use in HVHZ: No FL5790 R5 II Drawing No. 10 -003 A.S.S.A.pdf Approved for use outside HVHZ: Yes Verified By: WALTER A. TILLIT, JR. PE -44167 Impact Resistant: Yes Created by Independent Third Party: Yes Design Pressure: N/A Evaluation Reports Other: Missile Level "D" wind zones 1 thru 4 (Basic FL5790 R5 AE Drawing No. 10 -003 Evaluation protection). Pressure rating: +30.0, -30.0 p.s.f. at 22'- Reoort.odf 10" span for poured concrete (wall mounted, end Created by Independent Third Party: Yes retention with solid slat) and +30.0, -30.0 p.s.f. at 16' -4" span for poured concrete (wall mounted, end retention with combination solid and view port slat) and +30.0, - 30.0 p.s.f. at 8' -7" span in wood (wall mounted, non end retention) See other pressures on sheets 16, 27 and 34 of installation drawings. Back i 1 Next Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee, Florida 32399 -2100 (850) 487 -1824, Fax (850) 414 -8436 © 2000 -2010 The State of Florida. All rights 'eserved. 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Ian dl r7S1 _ _• _ ____J 4N NiRf f 1--m - City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Ho 4e7 meoer: A / Date Received: ' 12 -2 -le Site: 59e' 3 41--ks /).e s r - Permit Type: c 1 l '� C6,c e J Approved w /no comments: Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. ?-)-3 - 112 Kalvin Swi Examiner Date Contractor and/or Homeowner (Required when comments are present)