Loading...
HomeMy WebLinkAbout10-11050 CITY OF ZEPHYRHILLS 5335 — 8TH STREET (813)780 -0020 11050 PLUMBING PERMIT t �: z `s ' gy �` a.s. as "^s.. , ; gfi '� „1 F es s t - t ^' Permit Number: 11050 Address: 4626 WISTERIA DR LOT 35 Permit Type: PLUMBING ZEPHYRHILLS, FL. Class of Work: PLUMBING RENOVATIONS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: WHISPERING OAKS Est. Value: Parcel Number: 15- 26 -21- 0160 - 00000 -0350 Im rov. Cost: 725.00 Date Issued: 10/15/2010 Name: FROST, MARY & THERESIA Total Fees: 60.00 Address: 4626 WISTERIA DR Amount Paid: 60.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/15/2010 Phone: (813)782 -5429 Work Desc: REPLACE WATER HEATER TANK 40 GALLON ” rte, 777 KEHLE PLUMBING INC PLUMBING FEE 60.00 i \ 7� � /° 1S PLUMB 2ND ROUGH PLUMB SEWER WATER 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 a 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances CONTRACTOR PER OF I fir PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER _ - . ,, r < fi . r. - , City of.Zephyrhills BUILDING PLAN REV1EW COMMENTS Contractor/Homeowner: eJ (e yOkr i��)'1 3C Date Received: /0 - 1 2 2 `/ Site: T 6, 2-6 tU s,fer7Q. 7r Permit Type: let° bee /) Approved w /no comments: ❑ Approved w /the below comments: lb Denied w /the below comments: ❑ 7 Z ff Zr.. s /6, / rrn /fe /F / ' ©- r p ,� / ,,,,,,,c. 4 This co.' s - sheet all be . with the permit and/or plans. __ /1 - fi --/ Kalvin Switzer -.. Examiner Date or and/or Homeowner (Required when comments are present) TRANSACTION REPORT p.01./01 FAX(TX) OCT/22/2009/THU 02:24 PM # DATE START T. RECEIVER COM.TIME PAGE TYPE /NOTE FILE 01 OCT /22 02:23PM 913869439434 0:00:37 2 OK SG3 1528 ----- —. — moo iPl ■ 10111120'10' 10:24 McNesi. 'a:.d W:;i Co =rac:oxs Inc. :Piircha'se Order • , 420 N. 73o=_6.ary Ave ~tee Deland, .FL 3272 PO , J raer: 119553 . Order :Da=e: 10 -11 -2010 Z'ob: .50 -10 - . • S»bcon raa=or: Job Size Address: M ?C9I Wistexia / - Wa�iC "A :Cele ?3•:,Tbi °g/ Inc. 4626 Wig =eria Drive • ? a .Sox 35351.1 14 ?CSI -Wea: er 50 -10 -0801 ?alr, Cowin, =L 32335 • 2ep'.^,yr-^_ills , ;1, 33542 Scope of 'Purchase Order: i t-- . ► Weat:.eriza =ion Z. gr- Silly Schmidt (386)233 -046 • . 6 r Eoreow: er Mary 'Tres= .1913)782-5429 • •► + *r, FMN WOA:C 1S CoM2L2^L, SIGN & DA ^S 331.0 & =AK 3 C2( :0 .(386)943- 943 - ► :. *A /C & nLUM3I:1G - A MUTT WAS ?ULLln, A .CO ?! 0! THAT 253MI'' MUST ACCOMPANY THIS 20 k-_3N YOU SEND IT SAC4. TO OUR 0?F.IC3 'Replace 40ga1 - W::,per:ri.,pa: 725.'00 • All work is -o be performed according no supplied general req ire:rre: ta, aid specifications, working drawings, applicable codes,. and OS=A reo::iremeZ mss. S :bco :_rac:or is responsible for providing proof of workers' oo:rye ea:io : . insurance to :a'._ilder. Invoices for - .1:11A) p:xc;" order will only be paid to 7:.e amount of :he purchase • order and mus- reference zhe purchase order : U rber. Addi :ional work requires a change order.' 5J2=e, e.op cY C /& V1 ( , rxd 11 1 D . 7(r!4X1-4PDA'' • ___—_____-_-_-___-.L_-____________________ __....____,___. -_-_ ._.-.L _ - - --- Contract :o-e1 725.00 • McNeal and Wise Co.^._rac_rs Inc. Apprvl: __,,,.: _ _. ._._•• ___�- 1011112010 10:24 McNeal and W::i me Con .racmors Inc. purchase Order 420 N. 3o .;n dar y Aver -e Deland, :L 32720 ?p N�maer: 178553 Order Dame: 10-11 -2010 Job: 50 -10 -0801 S�bco::zracmor: Job Size Address: <e 1e c1:,:r.i.ng, Inc. M ?CSI-- Wismeria /4626- W3A^_a3A PC Box 353511 4626 Wis=eria Drive Palm Coas FL 32135 M2PCSI -Wed.: er 50 -10 -0801 Zep yr^ills, FL 33542 Scope of ?*.:rc^ase Order: Weap= erizamio~ Mr- gr -Billy Sc:.:rid_ (386)233 -0465 ::o:reowcer Mary =ros= (813)782 -5429 ' * * *W-3V W0?3 IS C0M ?L2C3, SIGN & DA_3 33L0W & FAX BACX TO (386)943- 943 * ** * * *A /C & PLUMBING-IF A 232MIT WAS PULL3D, A COPY OF THAT ?iaMI" MUST ACCOM ?ANY THIS PO W 3N YOU SEND IT SACK ^_0 OUR OFFICE*** Replace 40ga1 =W ,perm - ,pan 725.00 All work is co be performed according co s .Ipplied general rea_.ire:ren:s, aid specificam ion s, working drawings, applicable codes, and OSHA red ireme: cs. S _lbco n :racer is responsible for providing proof of workers' compe ~sazion ins ..ra^ce :o b.:ilder. I:'voices for c e p=c ase order will only be paid zo : e amo=mz of = e p•:rc ase order and .r:.:s= reference t e p.:rc^.ase order n=.er. Additional work red -fires a change order. C o P c_ (c_ - 2), ( D (4r MesuPPo'( -- -- Con=racz ^oval 725.00 McNeal and W i::e Co n:rac:rs Inc. Apprvl: Xe le ?1=oi-g, Inc. Approval: Building Permits Manager 1= ' Fib EdA Print Utility .5e4 =Wrdaw Help br the Pernnfi Fite X petinkBanbe, Pemm1t jype I work T}Ve I . five D Show Completed Paris Pemet IL= lasued (3;71,[7 Wok Sheet Address D -> • . 11051 Dft 6INN04GS 111 ro m Permit Will He { hanged X EGINNNGI 11053!1011 §erred I flot4m51 I disc ! 'fees I Cophaclors I e1ttachmetts El LO I n om 1105510 1 DS 11E66110/1 Require i Required Ier*pee oen Inspections Made AWAIT ' PJN CHAS 11O5840t1 I TS9ei Name !Stable I Date Status Comments 11059'10/1 P111 1ST ROUGH PLUMB_ N II 11O%Oj011 PL/2 2ND ROUGH PLUMB_ N 10/22/2011 A water heater -300pm 11 you want you may cal S SEWER N ;k�' 111k110/1 W WATER N 11063110/1 iilf��® INK/311�X' 11064111 4 1106511 T CHAINLII 1106611+ R:SWEETB 11067111 . URE 111: DOWS SIZ 11069(1012 11070111 D HAD TYI 11071111 , O',BRACY C ;i1 1 ' E l !neat .G pelete J Insert J ;clmrog pelete I Delete AesetYaw 1 iub Pants J [ OK .J J Cancel J t Help J I J Help J JBmweiipliecads I1:48PM [ f start N E7 121, . al FA*. fa t' It 1 • 0137=0.0020 City o Zephyrhills Permit Application Fa oI - 7e� Bolding Department r /jo$v � ..: • B6 y y, _yam 9 c4 Deo Received y ' Pro Phone Contact for Pen^Ktl A �+ p Owners Name 1 P ta X Owner Phone Number 1 ~7» — SY ! 1 OvvrMw' Addtase [ 4 b a 6 1�L1 $ k e Y 1' pg. , Owner Phone Number 1 ] Fee Simple Titleholder News I I Owner Phone Number ( I Fee Simple Tleehotder Address [ 11-- .108 ADDRESS 1 4 1 4E26 L i i sk e r i 4 0 P 0�1 (I1'l lls a. 33 SYa Lore [ I e IO ( 1 PARCELIDaI I a b -2lr C ►b 0 ' 0 0Doe -03P (ammo mom PRoolwrrTAll NO1ICE) WORK PROPOSED B NEW coNSTa f1 ADO /ALT = SIGN n Q DEMOLISH INSTALL REPAIR PROPOSED USE = SFR ED COME Q OTHER 1 1 TYPE OF CONSTRUCTION Q BLOCK fl FRAME Q STEEL = 1 i DESCRIPTION of WORK {fie PI 4Ce 4 4.0 8311 G A) Clek w Qlv i y BUILDING SLIE I I SQ FOOTAGE HEIGHT I =eUILPNO Is _ VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL I 1 AMP SERVICE 1 PROGRESS ENEROY Q W.R.E.C. =PLUMBING I VS. V 0 - W `fed lv� ! C "J =MECHANICAL S VALUATION OF MECHANICAL INSTALLATION c; I =OAS Q ROOFING = SPECIALTY 1 OTHER FINISHED FLOOR ELEVATIONS I ] FLOOO ZONE AREA =YES NO COMPANY I BUILDER nedieTF.Reo 1 Y/ N I FEE COMM 1 Y/ N 1- Address r I I d I I ELECTRICIAN COMPANY I SIGNATURE �! J [YIN J Fee CURaen Y I N Address ,�� -.I'♦ License s I J PLUMBER V v R' COMPANY f le le f ivy ivos e SIGNATURE p Rea 1 i 1 N J f c 1 N 1 Address r /op S.s , 1 ' ST 47unner( /.3"o I Scenes I CFC cis lay MECHANICAL COMPANY SIGNATURE REGIOTPA O [ Y/ N 1 FEE cURREl 1 Y/ N 1 Address 1 1 LIcrxtaod I I OTHER COMPANY I SIGNATURE REwe1ERED 1 Y/ N 1 rue Cum T Y I N 1 Address 1 I Lionfem A 1 .1 111 111111111 1 11111111111111111111111111 11111111111111111111111 11111 RESIDENTIAL Attach (2) not PIBns; (2) set of Building Plena; (1) set Of Energy Forma; R.Q.W Parma for new uproocIIon. Minimum ten ( Working data nRer eubmltlal date. Required snake, Constntotlen Plane. StlmwMer Rom w/ Stu Fence k stelintl, Sertftnry FacIlMna & 1 eumoster, SNn Weds Penns for et*dMslensnsrge prokgs COMMERCIAL Attach (3) conwlele sale et Building Pi ens plus e Ure Safety Pegn; (1) set of Energy Fang. R-O-W PemNt for new comfit sSon. idioms ten (10) waking days after 'wombs date. Regtlred onafto, Cenatnxtlon Plena StonmuMer Plena w/ alt Fence Installed, Sanitary FAWN, 4 1 dumpier. site walk Permit for eh new projects. Ali eonunerolel requirements must meet compliance SIGN PERMIT Arleen (2) sets of Engineered Plena. ""PROPERTY SURVEY required for MI NEW construction. - edri�' 'w'�1��1 Irl iii•e 1 1 1�i/rei�i J e e i1� `� - - - • w.�Ir� 1 e 1rr1r1iw}wr Directions: • FiW out application completely. Owner & Contractor sign beck of epplcxtlon, notarized If over OR O% s Nodes of Commeneemsnt le required. (AC upgrades over 57500) Awl not the coMraelor) or Power of Attorney (for the owner) would be someone with rtora(znd Zeller From owner authorizing same OVER THE COUNTER PERMITTING (Front of ApplIcelon Only) Retook If shingles Sewers Servbn Upgrades A/C Fences (PIo1/5tevey/Foclage) Driveways-Not over Counter If on public rorMwnys..neede ROW • NOTICE OF DEED RESTRICTIONS: The undersigned understands Chet 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 reslncllons. UNLICENSED CONTRACTORS AND be A to be RESPONSIBILMES: if the owner has hired a contractor or licensed in accordance with state End local regulations. 11 the convectors to undertake w they may req convector is noot f licensed as required by taw, both the owner and contractor may be Cited for a misdemeanor violation under law, I I ad ed to the vs contact the Pasco County Building Inspection Division— Licensing Section apply t -84 80 Furt they are me o �uR� tore, If are 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 �� will and Iro le. If you. as the P owner er sign in es the contractor, that may be an Indication that he is not properly County. TRANSPORTATION IMPACTIUIIL TIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the c Ord rhe�r b 8 change n off use In existing buildings, or expansion of existing buildings, as specified 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 UEN 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", 1 certify that I have obtained a copy of the above described document and promise In good felth to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: 1 certiy 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 ail work will be performed to meet standards of all laws regulating construction, County and City codes. zoning regulations, and lend 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 1 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/WastewaterTreatment. Southwest Florida Water Management Dlstict- Wells, Cypress Beyheads. 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. 1 understand that the following restrictions apply to the use of ell: - Use *VIM is not allowed in Flood Zone "V" unless expressly permltted. 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 professional engineer licensed by the State of Florida. If the fill materiel Is to be used in Flood Zone "A" in connection with a permltted building using stem wall construction. uction. I certify that S1 will be used only to fill the area within the stem wall. If till material is to be used in any area, I certtfy that use of such fill will not adversely affect edjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for vkNathg the conditions of the building permit issued under the attached permit appOcation, for lots less than one (1) acre which are elevated by fill. an engineered drainage plan Is required. 111 em the AGENT FOR THE OWNER, I promise In good faith to informs the owner of the permtting 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 spedflcaNy included in the application. A permit issued shall be construed to be a license to proceed wlth the work and not as authority to violate, cancel, abler, or set aside any provisions of the tedmlcal cafes, 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 pert 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 (8) 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 (00) 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 $ENDER.f R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subsalbee end swam to (or Minna) Worn me Nils •. ppss��oo �plc� 1/ C by .� I1 F/Lr•.i who Ishwo personally known to me or he&be%Ie to me or hasfisve Produceu �] t produced ss Idenedennan, asIdantllbiMsn, Notary Public /_ • .1- .A15.._ — Wary Public Commisslon No. Name of Notary typed, prinled or .tamped •.�' - i !'• ' • •". ' - . . tr- tr• -n c/3 0 4 A cy• 1 •• 4 27-- T1 RVWDATETO r 3 C TY OF ZEPHYRHILIS P ANS EXAIV1INER 14 013 1 et — es * 10/11/2010 13:51 Lion Insurance LION INSURANCE COMPANY -►CITY OF ZEPHRYHILLS 1/1 Date CERTIFICATE OF LIABILITY INSURANCE 1 10/11/2010 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter 2739 U.S. Highway 19 N. the coverage afforded by the polides below. Holiday, FL 34691 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer 8: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the 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 insuance afforded by the policies described herein is subject to all the terms. exclusions, and conditions of such poi cies. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Date LTR INSRD Type of Insurance Policy Number Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises (EA Claims Made 13 Occur occurrence) $ Med Exp $ General aggregate limit applies per: Personal Adv Injury $ _ D Polity ❑ Project ❑ LOC General Aggregate $ Products - Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ All Owned Autos Bodily Injury - Scheduled Autos ■ (Per Person) $ Hired Autos Bodiy Injury Non -Owned Autos (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Each Occurrence Occur 0 Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2010 01/01/2011 X I WC Static 1 1 OTH- Employers' Liability tory Limas ER Any proprietor/partner /executive officer /member E.L. Each Accident $1.000,000 excluded? E.L. Disease - Ea Employee $1.000.000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits $1.000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles/Exclusions added by Endorsement /Special Provisions: Client ID: 20 -19 -267 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company": Kehle Plumbing, Inc. Coverage only applies to injuries incurred by South East Persomel Leasing, Inc. active employee(s) , while working in Rorida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX: 386 -437 -8488 & 813 - 780 -0021 / ISSUE 10 -11 -10 (SD) Begin Date: 1/1/2002 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHIL LS Should any of the above described policies be cancelled before the expiration date thereof. the issuing insurer will endeavor to mail 30 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 representatives. 5335 8TH STREET ZEPHYRHILLS, FL 33542 j�is.a4� K 10/11/2010 12:14:56 PM -0500 POWERED BY ORCAFAX PAGE 3 OF 3 • A ° CERTIFICATE OF -LIABILITY INSURANCE I DATE (M "DD""'" 10/11/2010 PRODUCER (386)446 -3426 FAX: (386) 446 -3514 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION as Coast Insurors Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 4845 Belle Terre Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite E Palm Coast FL 32164 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Southern- Owners Insurance Co 10190 Kehle Plumbing Inc INSURER a Auto - Owners Insurance, Co 18988 P 0 Box 353511 INSURER C INSURER D Palm Coast FL 32135 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 OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INER ADM - POLICY EFFECTIVE POLICY EXPIRM1ON LTR „teISRG 1VPP OF RELURANCP POUCY NUMBER OATS ISEWINDryyYY% DEW IIWIDDNYYyI UMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea $ 300 , 000 A CLAMS MADE X OCCUR 78004427 10/20/2009 10/20/2010 MEDE)cP (Any one person) $ 10 , 000 PERSONAL 8, ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 000, 000 GEML AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000, 000 POLICY EC T n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LI MIT X ANY AUTO (Ea accident) $ — B ALL OWNED AUTOS 4779532700 10/20/2009 10/20/2010 BODILYINJURY SCHEDULED AUTOS (Per person) $ 1,000,000 H RED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ 1,000,000 PROPERTY DAMAGE (Per accident) $ 1,000,000 GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ _ AUTO ONLY. AGG $ EXCESS/ UMBRELLA UABILITY EACH OCCURRENCE _ $ OCCUR 1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION YYC STATU- I0TM- AND EMPLOYERS' LIABILITY / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If es, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (813) 780 -0021 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WLL ENDEAVOR TO MAE. 10 DAYS WRITTEN 5335 8th Street Zephyrhills , FL 33542 NOTICE TO THE CERTIFICATE HOLDER SHALL TO THE LEFT, BUT FAILURE TO DO SO SHL OPPOSE NO OGLKGATION OR LLAWTY OF ANY NAND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV E `t G Hicks, ACSR /MAGDAL • ACORD 25 (2009!01) ®1989 -2009 ACORD CORPORATION. All rights reserved. INS026 (200901) The ACORD name and logo are registered marks of ACORD Pasco County Parcel: 15- 26 -21- 0160 - 00000 -0350 001 Page 1 of 2 Data Current as Of: Weekly Archive - Saturday, October 09, 2010 Parcel ID I 15- 26 -21- 0160 - 00000 -0350 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value FROST MARY T & Ag Land $0 FROST THERESIA Land $19,262 4626 WISTERIA DR Building $69,860 ZEPHYRHILLS FL 33542 -5648 Physical Address Extra Features $6,325 4626 WISTERIA DR Market Value $95,447 ZEPHYRHILLS FL 33542 -5648 Assessed (Save Our Homes) $74,537 Homestead 196.031 - $25,000 Legal Description (First 4 Lines) Non - School Additional Homestead Exemption - $24,537 See Plat for this Subdivision .'°' WHISPERING OAKS PB 14 PG 86 Non - School Taxable Value $25,000 LOT 35 School District Taxable Value $49,537 OR 4792 PG 914 Warning: A significant taxable value increase may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value 1 0100 SFR 00R2 6,000.00 SF $3.20 1.00 $19,200 2 0100 SFR 00R2 200.00 1 51. I $0.31 I 1.00 I $62 r Additional Land Information I Acres II 0.14 II Tax Area r 30ZH II FEMA Code II X °Residential CodeII WISPLP1 I Building Information - Use 01 - Single Family Residential (Card: 001 of 001) 1 Year Built 1980 Stories 1.0 Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Concrete Block Stucco Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Asphalt Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 1.5 Line Description Sq. Feet Repl. Cost New 1 ° BAS II 1,138 II $63,478 I 360 2 FEP ° $14,057 I 3 FOA ( 262 II $3,681 4 1 FST 30 ° $837 5 FOP 80 II $1,116 6 312 $6,973 3 Extra Features (Card: 001 of 001) Li 1 e U D POOL-6 n 1990 J 280 11 $3,360 d 2 DCFENCE 1990 336 0 $126 3 SCRN -AF I 1990 II 1,168 ° $1,051 4 COOL DK I 1990 II 392 II $1,043 5 UDU -M ( 1980 I 1 ° $110 6 DW WC 1980 — I 726 ° $635 I Sales History Previous Owner GRABUS MARY T http: // appraiser. pascogov. com / search /parcel.aspx ?sec= 15 &twn= 26 &rng =21 &sbb= 0160 &... 10/13/2010 • TO Whom It May Concern: �j671._ / /{� , give the ( License Holder Name) Following i = 'vidual(s) authorization to sign for and pick up permits issued to Lam/ by the City Of Zephyrhills. ( Name of Co .f'! y) Names of authorized individuals: n I l Sign - •• Date:(41 The foregoing instrument was acknowledged before me this A=3 day of del 2010. Notary Signature: . _ �i _ Notary Seal: + . MU NE MO NETT ffolny iwl -- f11Mo of f�llNlo '� S �' • � MP�M�n EglwtM�r /1, Candoo oa # DO T: eatifrnhooOffolauffloory tot t, �C. 1 u 61 �r 1 ri � f fg i K:,° xc tit's t ' ;Utaeor '+3) •rYT 1a %e 813- 780 -0020 City of Zephyrhills Permit Application Fax - 813 -780 -0021 Building Department t 7 / p Date Received Phone Contact for Permittin 7 �/ �[ / 7 -54:7 / 1 Owner y�,� s Name 1 4 Y Ciro 5+ Owner Phone Number 1.13 - 743 2 5 y�r Owners Address b a ' LA S r e r 1 . X fl Owner Phone Number Fee Simple Titleholder Name 1 Owner Phone Number Fee Simple Titleholder Address I JOB ADDRESS y 60? G 1, J ; s4-e r ► e prt Ze ehy 1 IN% Ws R. 33 sya LOT # I SUBDIVISION PARCEL ID# 15 - a b - 21— O Ib 0 - 0 0 000 — 03S° (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED L 1 NEW CONSTR ADD/ALT I 1 SIGN n n DEMOLISH INSTALL REPAIR PROPOSED USE El SFR n COMM I I OTHER I TYPE OF CONSTRUCTION I BLOCK El FRAME r STEEL Q 1 DESCRIPTION OF WORK pi gee 14.0 gq 11 0 H? Clef W q4-4. / f 4ea4 -ev BUILDING SIZE SQ FOOTAGE HEIGHT nBUILDING $ VALUATION OF TOTAL CONSTRUCTION flELECTRICAL y AMP SERVICE 1 PROGRESS ENERGY n W.R.E.C. I (PLUMBING S 0 0 [1 MECHANICAL S VALUATION OF MECHANICAL INSTALLATION I I� ROOFING 0 SPECIALTY I 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO BUILDER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREI 1 Y/ N 1 Address I License # ELECTRICIAN COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREI. 1 Y / N 1 Address License # PLUMBER COMPANY I1 e p�v sslbl1s .*NC SIGNATURE REGISTERED (V) N 1 FEE CURREF 1 N 1 Address /4Q S.Yit) /1P Sr 8U,1nce(( /t 39//0 License# 1 FC 65" 9.‘1 MECHANICAL COMPANY I SIGNATURE REGISTERED I Y/ N 1 FEE CURREN 1 Y/N 1 Address License # I OTHER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREF, 1 Y/ N 1 Address License # I / IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 111111111111111 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/ Sift 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 S7500) Agent (for the contractor) or Power of Attomey (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 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" whicti 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/U71LITIES 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 1, 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 govemment agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection- Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers - Seawalls, Docks, Navigable Waterways. Department of Health & Rehabilitative Services/Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency- Asbestos abatement. Federal Aviation Authority- Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone 'V" unless expressly permitted. If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and swum to (or affirmed) before me this bsaibed and .. • afmmt this i'� +� � bY �i by C.. : /l e' / Who is/are personally known to me or has/have produced Who is/- - perso• : • to me or has/have produced as identification. as identification. Notary Public '/ de-ea 7 _Notary Public Commission No. 41 k * i VALOR LEVERETT stv Name of Notary typed, printed or stamped !* ; , • •)• , ! / r, Illy CampNdpr Ey Mlr It 201 Ciiimmilike 0 OD 7$12111 MoAerl► lwr 0 '� PiY 0 'IN n js N 1'•?Ts l r d� . 4 ♦ a . s • - n O 4- P 1 N s T1 `■ c -- - a (6