HomeMy WebLinkAbout10-11140 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 11140
MOBILE HOME SET -UP
Permit Number: 11140 Address: 37767 NEUKOM AVE LOT 89
Permit Type: MOBILE HOME ZEPHYRHILLS, FL.
Class of Work: MOBILE HOME SET -UP Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34 -25 - . 0090 - 00000 -0891
Improv. Cost: 4,500.00
Date Issued: 11/15/2010 Name: NYE, LYLE & NANCY ,
Total Fees: 7,147.98 Address: 37767 NEUKOM AVE )
Amount Paid: 7,147.98 �/ ZEPHYRH LLS, FL. 33541 /
Date Paid: 11/15/2010 Phone:
Work Desc: INSTALLATION OF MOBILE HOME 32 58 !f'1 or (AT'
,•.iv Y.: •.Y 1- TO: ■•7 -I • — • - 1.i . 1 --- VI - 101 •V VII: .s .11
LILLEY AIR CONDITIONING INC. MOBILE HOME SET -UP 60.00 WATER CONNECTION MOBILE HC 320.50
BIG DADDY'S MOBILE HOME SET UP MOBILE HOME MECHANICAL 40.00 MOBILE HOME PLUMBING 40.00
LILLEY AIR CONDITIONING, INC. TRAFFIC IMPACT FEE 99% 3,595.68 TRAFFIC IMPACT FEE 1% 36.32
PARK FEES MH 573.73 POLICE IMPACT FEE 254.00
FIRE IMPACT FEE 273.00 PUBLIC SAFETY 5% 26.35
WATER METER RES 3/4" 308.70 IRRIGATION METER 308.70
IRRIGATION CONNECTION 266.00
r ,,,, s.... ,
,
To: ■ •Y 1
MOBILE HOME ELECTRIC
to
MOBILE HOME A/C
MOBILE HOME PLUMBING i
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 inspection 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
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
ij NTRACTORS SIGNATURE PERMIT OFFI r - -
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 34- 25 -21- 0090 - 00000 -0891 001 Page 1 of 1
Data Current as Of: I Weekly Archive - Saturday, November 27, 2010 I
I Parcel ID II 34 25 -21- 0090 - 00000 -0891 (Card: 001 of 001) I
Classification II 00 - Vacant Residential
Mailing Address Property Value
NYE LYLE J & NANCY L Ag Land $0
6903 PATTERSON ST Land $26,282
ZEPHYRHILLS FL 33542 -4863 Building $0
Physical Address Extra Features $0
37767 NEUKOM AVE
ZEPHYRHILLS FL 33541 Market Value $26,282
Legal Description (First 4 Lines) Assessed (Non School Amendment 1) $26,282
See Plat for this Subdivision .1' Taxable Value $26,282
GRAND HORIZONS -PHASE ONE
PB 34 PGS 99 -102
LOT 89
OR 8459 PG 487
I Land Detail (Card: 001 of 001) I
I Line II Use I°Descriptionll Zoning 11 Units II Type II Price II Condition II Value I
1 0200 MSUBM $4.31 1.00
00M1 6,000.00 SF $25,860
2 0200 MSUBM $0.55 1.00
00M1 767.00 SF $422
Additional Land Information
Acres II 0.16 II Tax Area II 30ZH 0 FEMA Code II -- ( °Residential Codell GDHZLP1 I
Building Information (Card: 001 of 001)
Unimproved Parcel 00 - Unimproved
Extra Features (Card: 001 of 001)
Line I Description I Year II Units II Value
No Extra Features
Sales History
Previous Owner II HARTMAN CHARLES A & JANET
Year II Month Book /Page II Type II Amount
2010 10 II 8459 / 0487 II WD II $30,000
2000 I 09 1 4448 / 1978 11 WD 11 $
h ttp: / /www. appraiser. pascogov. com / search /parcel.aspx ?sec= 34 &twn= 25 &rng =21 &sbb =0... 12/2/2010
:; 1 111111 IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
2010171487
, : .._.) Q _
Rept:1338677 Ree: 10.00
DS: 0.00 IT: 0.00
12/02/10 C. Condry, Dpty Clerk
PAULA S.0'NEIL,Ph.D.PASCO CLERK & COMPTROLLER
NOTICE OF COMMENCEMENT 12/02/ 10 01: 09 m 1 of 1
OR BK 8417 PG 519
Permit No. 1 / / 40
Property Identification No. 3 q -- t .-2 S- 02 1 — 0 0 ff G -- 0 GdW
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1. Description of property (legal ' A c ., %, n) ) t / di f � a - '�_Ysj S 'Ph � P8 34 P65 q 9 - JO
a) Street Address: . .. r3r � .,717W1i 1W • ! - OR. S' y sq PG VS
2. General description of improvements:
k ' • IIRO i M11%?JS'1111MEMWi tt Y
3. Owner Information
a) Name and address: i 3'716 - . ,.._,014. A , , . '
b) Name and address of f= simple titleh r Ider (if other than owner) 6 ' _ - _ ,• a B�
c) Interest in property Oajr:ti V
4. Contractor Information - --- n // nn fik. Zanier ) � !
a) Name and address: Y' ' .51m, LP ` -/ Qnee 4 E' I a ue/1 �L 33816
b) Telephone No.: • „, ''' „ Fax No. (Opt)
5. Surety Information o ”
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6. Lender
a) Name and address:
of Phone No.
7. Identity person within the State of Horida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8. In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1) (b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt)
9. Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
Specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA --
COUNTY OF PASCO //
Signature" of Owner or Owner's Authorized Officer/Director/Partner/Manager
Lyle. myt
Print Name I
The foregoing instrument was acknowledged before m this L day of g,,,,.,„6:0../ QsI f / . 20 ) 0 , by 1
in fact) for as a) Lk, I �� (type of authori .:. . office , trustee, a mey
(name of p a r t y on behalf . ' .. i • * muted).
Personally Known /oduced Identification Notary Signature •i
Type of Identification Produced `
T sr it i
YP C D 2 q- V GS Name (print) cW
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief. 16�
FORMSMOC,rvsA2e07 Signature of Natural Person Signing Above
st,[ Y PUe.C - -
JAMES H. ROSEN
- *. t *= MY COMMISSION # DD654540
. 1. 77 .0 EXPIRES March 22, 2011
httss
(407) 398 -0153 FloridallotaryService.com
STATE. : , FLORIDA, COUNTY OF PASCO
THIS IS TO C =TTIFY THAT THE FOREGOING ISA
TRUE AND CnRRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC " - CORD IN THIS OFFICE
WITNESS MY HAND AN ' C FFICIA S EAL THIS
DAY OF 1 2 Or 0
PAL 4 O'N I / LER • & COMPTROLLER
��� DEPUTY CLERK
P r l ......,` _.
City of.Zephyrliills
BUILDING PLANREVIEW COMMENTS
Contractor/Homeowner: 3 Fa % 5 PI/
Date Received:
Site: _ i L tha
Permit Type: lee l ( /i # 3 2 / \s
Approved w /no comments: ❑ Approved w /the below comments: ❑ Denied w /the below comments: ❑
1 717
This comment sheet shall be kept with the permit and/or plans.
Nov 14a141z1;1 -014,04A-' 1 0 9 Q,
Kalvin Switzer — Plans Examiner Da e Contractor and/or Homeo r
(Required when comments are present)
Plan Review
Modular Home Set -ups and Aluminum Packages
1) All property markers shall be exposed and clearly marked at time of first
inspection.
2) All set -backs shall be met.
3) All garages shall comply with section 309.2 ( Fire separation ).
4) Access shall be made available at time of inspection.
5)Manufacture specification manual, approved plans and permit shall be available
at time of inspection.
6)No electric, plumbing, mechanical or framing is to be covered without
inspection and approval first.
7)R.O.W. Use permit required for driveways on public streets.
8) At least 10' separation between other units.
9) All work shall comply with the 2007 F.B.0 and the 2008 N.E.C.
R.O. W. - Right Of Way
F.B.C. - Florida Building Code
N.E.C. - National Electric Code
813- 780-0020 City of Zephyrhills Permit Application I I (4.0 Fax - 813- 780 -0021
Building Department
Date eceived
I
r 7 _ /� Phone Contact f r:emdtti 8/s / r� 88 - 3300 le IMaJ
rd!.',_ ' � �'tn� �J Dr 3 . '7, --- 5/ /
Owners Name ! '7 _ /� %/ � - �I
, ��,A' I_, I / + r Ph a I�
Owners Address 3 / �(P / 1'. Q- M � ✓-e -fie Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Add 3 /� ddresss / }� /}
i4v..(
JOB ADDRESS / ! ry (0 + 7 4t.t.I.R.om .nue, Ze4) ��/ � / /IS LOT # S
SUBDIVISION Grand Wor,Zhs PARCEL 34 5 ;I 0oobo -•o79/
(OBTNNED FROM PROPERTY TAX NOTICE)
WORK PROPOSED N NEW CONSTR _ ADD /ALT 1 SIGN n n DEMOLISH
N
INSTALL REPAIR
PROPOSED USE 1 ti( SFR Q COMM I I OTHER I
TYPE OF CONSTRUCTION n BLOCK Q FRAME 1 1 STEEL n I I
DESCRIPTION OF WORK LSe ELI) ' a rdhOr flew mobile /-fo
BUILDING SIZE 4:3 A )(J O SO FOOTAGE / O s6 HEIGHT / O /
1 1BUILDING $ ,Aano • QO VALUATION OF TOTAL CONSTRUCTION
I ELECTRICAL $ p • 00 AMP SERVICE .Loc I PROGRESS ENERGY n W.R.E.C.
PLUMBING $ (t�
J ° —°
CD N
rOFAECHANICAL $ (COQ r CO VALUATION OF MECHANICAL INSTALLATION
1 IGAS ET ROOFING In SPECIALTY I 1 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 RYES ego
'1'1'111111 1'111 '1111'111"1111"11111'11'1111111'1'1111111'1
BUILDER I COMPANY [ j 1 � XC � SLh (I—
J
SIGNATURE ■ 1 ..'„ . -.daft ' •' REGISTERED r N I V N I
Address I o'ZI ave. A Ea 34- GC)Irrle r Hav ij] R 33 Fc License* 1 1 HO0 () 537
ELECTRICIAN
SIGNATURE COMPANY Li iii -41 14-t_ `- , RE G ISTERED *J
� I, Y/ I CuRREn 1 (Y / N I
Address 1 4 I ) ' • • • Fie id l�ioacr♦ a?.ot lee t rIcl Pt 33Sh License # I EC. l ?>( Sit /to
f 9 2 /
PLUMBER G r. a/_ • • C / / 1� 1
SIGNATURE !A REGISTERED r FEE /N
rr�� RE - I � f
Address todI Ave. A 6 O l4QUth F 3 'C) License* 1 IH 00o0S31
MECHANICAL / COMPANY 1-171.12,L, A /c
SIGNATURE /1/9-01. REGISTERED I CYy N J FEE Ct1RREn ION N I
Address 4 r /,' NN F ,. , � • I iz 33 g// License # I C /kw /$1(0'7
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREr I Y/ N I
Address 1 License*
I I I I t 1 I 1 1 1 I 1 I I,, I l 1 1 l I I 1 I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I 1 1 1 I I I I 1 I I I I 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 subdivisionsAarge 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.
4 I .. .. t 1 1•' i
Directions:
Fit out application completely.
Owner & Contractor sign bade of application, notarized
If over $2500, a Notice of Commencement is required. (NC 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. 1 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, 1 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 +CE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT -- - _ CONTRACTOR ,,L
Su...'. - • and swum to (or pffi - before me this Su And . - . : lined) be this
r , by C S• . lhavd Y by ' ' (�".or � 'J r d Pr- 01- re personal � nown to to me or hasRia produced rs/1ye_pgsOn: • to me e or h ve produced
I r .. as identi ion. y ( v1 A- as identification.
Notary Public V Notary Public
Commission go • • { 0 C. • mission No. t) y 54 - 2
Name of Notary typed, printed or stamped__ Name of Nota ie
• .`
fatted or stagYpAd
'Ate, E + "I. ROSEN �$r
° - „ `” i,:4Y (OM ;'SSION # DD654540
!t��a a! viarr..h 22, 2011
(407)358 ,a ..1 .__...__... , d_��•..!otar'3ervice mom
Plan Review
Modular Home Set -ups and Aluminum Packages
1) All property markers shall be exposed and clearly marked at time of first
inspection.
2) All set -backs shall be met.
3) All garages shall comply with section 309.2 ( Fire separation ).
4) Access shall be made available at time of inspection.
5)Manufacture specification manual, approved plans and permit shall be available
at time of inspection.
6)No electric, plumbing, mechanical or framing is to be covered without
inspection and approval first.
7)R.O.W. Use permit required for driveways on public streets.
8) At least 10' separation between other units.
9) All work shall comply with the 2007 F.B.0 and the 2008 N.E.C.
R.O.W. - Right Of Way
F.B.C. - Florida Building Code
N.E.C. - National Electric Code
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To Whom It May Concern:
I Charles Hartman give Samantha Filyaw of Custom Homes of Zephyrhills permission to
pull and sign permits on my behalf for property located at 37767 Neukom Avenue
Zephyrhills.
Thank you,
Charles Hartman
Property Owner 44,
H. ROSEN
DD654540 ;SIGN # DD654540
)011 = [ 3 march 22. 2011
10 g
Nov 08 10 01:03p BIG DADDY'S M.H. SET -UP (863)875 -0703 p.1
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- • License - ..<...��,
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EFFECTIVE DATE: JO012010 E1PfN. \71O .DATE: !NEV/2111 -
111E LICENSE 1S HERESY .0 EDUNDER TM: PROVISIONS OFSECOON IN/11e. . .
FLOITIDASTAtl.'I T3 C0mUCf AND CARRY Q'C3IISIN S AS AN 4YSTAUER OF
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POLK COUNTY LOCAL BUSINESS TAX RECEIPT
ACCOUNT NO- - 23008 CLASS: S EXPIRES: 9/3012011
OWNER NAME LOCATION
PETERSON, JACKIE D 621 E AVENUEJI
WINTER HAVEN
BUSINESS NAME AND MAIUNGADDRESS ,_ CODE ACTIVITY TYPE
230180 CONTRACTOR MOBILE HOMESETUP -
BIG DADDY'S MOBILE HOME SET -UP SERVICE LLC
PO BOX 2281
EAGLE LAKE, FL 33839 -2287
PROFESSIONAL UCENSE (IF APPUCABL E)
DHS1V 1H0000537
OFFICE OF JOE G. TEDDER, CFC * TAX COLLECTOR PBS POLK COMM LOCAL BUSINESS WM RECEIPT WAIVE
CONSP1CUOSLY D1SPUVED/O — INE BUSINESS LOCATION
PAID- 1702195.0001 -0001 09/10/2010.09/10 /2010 11HH. 17 57.75 JACKIE D .PETERS0N
Nov 08 10 01:04p BIG DADDY'S M.H. SET -UP (863)875 -0703 p.3
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JFi DATE (NWDD/YYYY) PETER -1 11/05/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
GIS Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
"GIS Insurance Inc" HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1500 6th Street NW ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
"Winter Haven FL 33881
Phone:863- 294 -4241 Fax:863- 294 -4243 INSURERS AFFORDING COVERAGE NAIC
INSURED 1 INSURER A: The Burlington Ins Co EX
Big Daddy's Mobile Home Set Up INSURER e: Fla Citrus Business
-- -. s
Service, LLC Jackie Peterson INSURER G:
Eagle 33839 INSURER D:
I INSURER E:
COVERAGES
TEE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUI REMENT. TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERPFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUELIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAZ CLAIMS.
LTR IN ,- •• TYPE OF INSURANCE POLICY NUMBER D POLICY LIMITS
GENERAL LABILITY EACH OCCURRENCE S 1,000,000
A El COMMERCIAL GENERAL uABILfTY 26473004009 07 /21 /10 07/21/11 I ES jea" ° noel $ 50,000
■ CLAIMS MADE L X . I OCCUR MED EXP (Any one pommy S 5,000
PERSONAL d ADV INJURY 1 1,000,000
GENERAL AGGREGATE 11,000,000
GENL AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS - COMP/OP AGG 5 INCLUDED
PRO-
POLICY Jjecy El LOC
AUTOMOBILE UABIUTY
CONFINED SINGLE LMT!T
ANY AUTO (Ea accident)
AL_ OWNED AUTOS _ - - � BODILY INJURY I b
SCHEDULED AUTOS (Per X 601)
HIRED AUTOS ( BODILY INJURY i S
NON-OWNED AUTOS (Per accident)
_T PROPERTY DAMAGE 5
(Per accident)
GARAGE UABIUTY AUTO ONLY - EA ACCIDENT 5
I ANY AUTO OTHER THAN EA ACC 5
AUTO ONLY: AGG 5
N]CCESSIUIIBNTELLA tJABILITY I ; EACH OCCURRENCE 5
I OCCUR I 1 CLAIMS MADE ! AGGREGATE S
$
I DEDUCTIBLE • _ s _.._._
I l
RETENTION $ g
WORKERS COMPENSATION AND 1 TORY I. IM 5 1 I ER
$ EMPLOYERS'LIAALTDY 106 -45771 09/03/10 ' 09/03/11 EL EACHACCIDENT 1100000
ANY PROPRIETOR/PARTNER/EXECUTIVE •
OFFCCERMEMBER EXCLUDED?
E.L. DISEASE - EA t3NPL0 S 100000 . describe under( II
S.ECIAL PROVI ONS below EL DISEASE - POLICY LIMIT 15500000
`^
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Jackie Peterson Installer License # IH0000537
Aggregate Limits shown may have been reduced by paid claims in reference to
General Liability...
CERTIFICATE HOLDER CANCELLATION
C=SC ,z SHOULD ANY OP THE ABOVE UESICDOBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WIU. ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Zephyrhills
5335 8th St. IMPOSE NO OBLIGATION OR LABILITY OF ANY HIND UPON TIE INSURER, ITS AGENTS OR
Zephyrhills FL 33542 _ REPRESENTATIVES.
ACORD 25 (2001/08) ACORD CORPORATION 1988
Nov 08 10 01:04p BIG DADDY'S M.H. SET-LIP (863)875-0703 p.2
DADT.Ny'S M. frt. .5 ET-14P 5 ERVICZ, LLG.
.21 AVENt.LE A F.AST
". 'MN 1V2.1-1AV N, FL 33880
■
; "Po' ; r -
Phone (863) 287-42 12
Fax (363) 875-0703
OWNE1t1A POE PEFERSON ,- , , /
STATE ucEnsE v-steesessr- J.tt - //l.)...5.2 ( 3 1
SIGNATURE AUTHORITY FORM
FOR THE PURPOSE OF OBTAINING BUR.DING PERMITS
. . _
01.c . p . 'Son
4e-ii e3 avictic_ nk [1 e_i- up Sevlil a.
tout awe Awe) Wet bushing name hate)
Do hereby designate the following indfreldual(s) as having the authority to sign and submit applications and -
ra ts dor= for the purpose of obtaining building pennks under my license in
i of , yr b Jiic county. I furtheracknowledge and accept , as a
(pint sane otcomly here)
licensed contractor, my ;immortal fity and liability for each project permitted under the authority designated
on this form, and that my bilere to assume and fulfill said duty may be grounds fertile irritation of
disciplinary action against My contractor's license.
---- mmuolunno.--
DESIGNATED SIGNERS:
Cautractot's $Ignstune DATE
.
1. =het h Subscribed andswom to berme me this ¥tL
2. 2___". p____.
3.
4. .......1..nr
5. Notary Mlle's Span
'. SSI°' "3 . s ,' ' - — • ir 7 ' !.. ROSEN
(e4.- -,ki,•f,,i,,,
Es not ( ) Persona* Imam to me
Identified by r10q4; 4 P)-vve 4 c-
11/08/2010 11:48 8636444271 LILLEY AC PAGE 02/02
D 3,w
4141 die field 5Road
A{ Raieland, le 33811
(86/!' 3) 644-0496 6 1 -800 -282 -3194
taco, (863) 6444271
November 5, 2010
City of Zephyrhills Building Dept
1, Edward P. Degel of Lilley Air Conditioning, Inc. authorize Samantha Filyew to sign
for and pull electrical permits for mew the City of Zephyrhills. My state number is
EC 13001921. If you have any questions please contact our office.
Thank you,
f3,1
Edward P. Degel
Lilley Air Conditioning, Inc.
11(0 g /®
o . Date
` :4 „ 11. ROSEN
y *_ t orl,h4(SSION # DD654540
!For EXPIRES March 22, M11
(407) 398 !1a FloridallotarySefVIce.CC111
11/08/2010 11:48 8636444271 LILLEY AC PAGE 01/02
R .. , Jaz.
4141 Otatte Meld Road
£a I e and, :,C 33811
(863) 644 -0496 1- 800-282 -3194
sac: (863) 6444271
November S, 2010
City of Zephyrhills Building Dept
1, Robert B. Lilley of Lilley Air Conditioning, Inc. authorize Samantha Filyew to sign
for and pull mechanical permits for me in the City of Zephyrhills. My state number
is CAC018967. If you have any questions please contact our office.
Thank you, •
(7
Robert B. Lilley
Lilley Air Conditioning, Inc.
AAA ~ -- lC e1 r0
Notary Date
,: � .� y r:s H ROSEN
= , , "ON # DD654540
�^` 22, 2011
Pasco Cou'ty Parcel: 34-25 -21- 0091)- 00000 - 0891 001 rage 1 or 1
Data Current as Of: • Weekly Archive - Saturday, September 18, 2010
Parcel ID 34- 25 -21- 0090 - 00000 -0891 (Card: 001 of 001) j
Classification 00 - Vacant Residential
Mailing Address Property Value 1
HARTMAN CHARLES A & JANET Ag Land $01
37643 LANDIS AVE Land $26,282
ZEPHYRHILLS FL 33541 -9311 Building $
Physical Address Extra Features $
Physical Address N/A
Market Value $26,282
Legal Description (First 4 Una s)
Assessed (Non - School Amendment 1) $26,282
See Plat for this Subdivision .
GRAND HORIZONS -PHASE ON Taxable Value $26,282
PB 34 PGS 99-102 1
LOT 89
OR 4448 PG 1978
Land Detail (Card: 001 of 001) _- --- - - --
Une Use Descrlptior Zonin • Units Type Price I Condition Value
MBL HM
1 0200 00M1 6,000.00 SF $4.31 1.00 $25,860
SUB
MBL HM
2 0200 SUB 00M1 1 767.00 SF $055 1.00 $422
_ - Additional Land Information
s 0.16 -
Acre ___ -
Residential .1 Tax /! re a 30Z FEMA Code R esidetial Code! GDHZLP1
Bu ding Information (Card: 001 of 001)
U improved Parcel 00 - Unimproved
_Extra Features (Card: 001 of 001)
Line 1 __ Descripbon I Year 4 Units A Value
No Extra Features
Sales History
Previous Owner GRAND HORIZONS INC _
Year Montt Book /Page Type Amount
2000 09 4448 / 1978 WD $0
http / /www.appraiser.pascogov.co search/parcel.aspx ?sec= 34&twn= 25 &rng=21 &sbb=0... 9/21/2010
- ii�- It PASCO COUNTY, FLORIDA
Permit No. /// 'XCI
Date Permitted
Builder Name /Owner Name 8 , r I a i` s control # '
County Parcel No. 3‘1 `� 2 ()O 2 a Q At v: UJ "'aid 472'
720 -')
Address /Location 3 ! 76 7 `i a .K nq 7 t& id 1 A9
Classification/Type of Use /4,A h' 'eti d6/ /e ghlk-
TRANSPORTATION IMPACT FEE . Rate: Sq Ft Unit;
Exempt ❑ Yes ❑ No How Determined
Impact Fee Amount $ k3 2- t7 Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056) Single- Family Detached House Amount $ t
(057) Mobile Home
(058) Other Residential
123) Collection Fee
Exempt Yes ❑ No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone TOTAL AMOUNT $ S73. 7.3
Exempt ❑ Yes ❑ No How Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt ❑ Yes ❑ No How Determined Total Amount
RESOURCE FEE ERU
TOTAL AMOUNT
Prepared rmi
R, 6c._ Checked By
o NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE. OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and the conditions of payment for same.
DATE RECEIVED BY
RECEIPT NO. DATE BY
PERFORMANCE BUSINESS PRODUCTS, INC. 813 - 719 -8008 FAX 813 -719 -7919
4
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO. DATE / " /5
OWNER/
RENTER I JY/
�
MAILING / 6 /e e_a"l s/qc ,DR
2 r'[k'L 3,55'41 /
y
SERVICE ADDRESS 5 7 7 6 / Alfa l OM
SHUT OFF SERVICE
11
TURN ON SERVICE ] ❑ SEWER
INSTALL METER ❑ GARBAGE
READ METER ❑ IN CITY
CHECK METER ❑ ❑ OUT CITY
No. OF UNITS
OTHER ❑
DEPOSIT AMOUNT
j //Ye-(4P- AMOUNT LAST BILL
3/ 4/ DATE
MISC. CHARGE
T
WORK COMPLETED BY ORDER TAKEN BY
& DATE COMPLETED
(2
OR! R GIVEN BY
L i is.
dania,a6.
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form & return to office.
. PERFORMANCE BUSINESS PRODUCTS. INC. 813 - 719-8008 FAX 813 - 719-7919
1C) IP
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO. DATE /1"1-4
OWNER/ _ 6 RENTER Art' 26'1 S
MAILING 76 95 H..e s//Y__. 1
ze ��, ��s � 3 35 - V
SERVICE ADDRESS 3776 7 iet k -1 4,Ae Zef .69
SHUT OFF SERVICE
[IC WATER
TURN ON SERVICE ❑
❑ SEWER
INSTALL METER ❑ GARBAGE
READ METER ❑ IN CITY
CHECK METER
❑ ❑ OUT CITY
No. OF UNITS
OTHER ❑
DEPOSIT AMOUNT
5f4 C e r . y AMOUNT LAST BILL
DATE
i�l
h1 f MISC. CHARGE
WORK COMPLETED BY ORDER TAKEN BY
& DATE COMPLETED •
g ROE VE -BY
(-1,Sallka■100-U2-- '-("111161-4-)
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form & return to office.
•
C(i
0' . r PASCO COUNTY, FLORIDA
• . Permit No 1 //(O
Date Permitted //-1.5 iO/
Builder Narr /Owner Nam ,,; ; _' �� /_ ontrol #
County Parcel No. , - f - 0 9' `"OV Z)C 'Og' S ubDi i ?f �/.'�_.
Address /Location -�gry7 ay, v
Classification/Type of Use ---' ./' / )4L�- ,ice i — /1,7 7 `
TRANSPORTATION IMPACT FEE . Rate: Sq Ft Unit;
Exempt I i Yes Wi No How Determi ed
' Impact Fee Amount $ 3 t 6 3 � ,L co ., e No. TAZ:
rr 1
SCHOOL IMPACT FEE
Account (056) Single- Family Detached House Amount $
r .
(057) Mobile Home .,- - -> .._
(058) Other Residential
12 ' Collection Fee
Exempt es [] No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone 0 TOTAL AMOUNT $ : � r 73, i
• ye/ //' /
Exempt n Yes [ No How Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt ( Yes fl No How Determined Total Amount
RESOURCE FEE ERU
TOTAL AMOUNT S• 0'7
Prepared By ; ,/.l - A ,E ,_ Checked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing . .
the building permit owner on notice of this assessment and tho conditions of payment for same.
DATE RECEIVED BY
RECEIPT NO. DATE BY