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HomeMy WebLinkAbout10-11182 CITY OF ZEPHYRHILLS 5335 - 8T1-I STREET • (813)780 -0020 11182 BUILDING PERMIT Permit Number: 11182 Address: 38743 FEATHERING WAY LOT 9 Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: EAGLE RANCH Est. Value: Parcel Number: 14- 26 -21- 0170 - 00000 -0090 Improv. Cost: 9,000.00 Date Issued: 11/22/2010 Name: ROSSI, STEVEN Total Fees: 80.00 Address: 38743 FEATHERING WAY Amount Paid: 80.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/22/2010 Phone: 352 - 999 -888 Work Desc: A/C CHANGE OUT 3 TON ADDING THERMAL UNIT 4LAG BOLT FOR SOLAR - •1 •rp- . - a ... •1 :•.of 0 V 4A-OyAe.._OAA) DUCTS INSULATED FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commence ent." CONTRACTOR SIGN RE / PERMIT OFFI 'R PERMIT EX ' IRES 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 + j ( ) a 2— D9te Received Phone Contact for Permitdn V ( �pe-4/\ n Owner's Name S • V / • Rd ...5 1 � ,,�J Owner Phone Number 3.S y Z / 7 9- 0 $ O Owner's Address AO I e"/` d' /O Ack- 0'1 r 1 " /' j y#' Owner Phone Number I Fee Simple Titleholder Name I Owner Phone Number I Fee Simple Titleholder Address I / ),�' ' ) �j �/ JOB ADDRESS I3 193 - - ttfilit 144 At/ /4) //s r" 335 L I LOT# I q SUBDIVISION l t. Pete"e 4-- PARCEL ID# t 1 'O 0/90 6000 ' O '7o (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT 1 SIGN Q n DEMOLISH INSTALL REPAIR PROPOSED USE F71- SFR n COMM I OTHER TYPE OF CONSTRUCTION = r!- BLOCK FRAME r� STEEL = 1 / / _., 0( DESCRIPTION OF WORK /4/S� /�/ U'h /j! ,4 / 4c g pi r C�a/Z?i�7 'O.//" �"��T ��` f BUILDING SIZE I SO FOOTAGE HEIGHT BUILDING $ I VALUATION OF TOTAL CONSTRUCTION T ELECTRICAL $ l AMP SERVICE I PROGRESS ENERGY n W.R.E.C. nPLUMBING $ nMECHANICAL $ . VALUATION OF MECHANICAL INSTALLATION nGAS n ROOFING I I SPECIALTY r OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA nYES NO BUILDER COMPANY I SIGNATURE REGISTERED I Y/ N I FEE CURREN 1 Y/ N I Address 1 License # ELECTRICIAN COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N Address 1 License # PLUMBER COMPANY I SIGNATURE REGISTERED 1 Y/ N I FEE CURREN I Y N Address 1 1 License # 1 MECHANICAL � J COMPANY • O�- 'a -D j SIGNATURE /� REGISTERED I 1 N 1 FEE CURREN 1 Y/ N Address License # OTHER COMPANY I SIGNATURE REGISTERED ( Y/ N I FEE CURREN 1 Y/ N 1 Address 1 License # 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 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 omits, 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 Penult for new constriction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Pemrit 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. 1 Directions: Fill out application completely. Owner & Contractor sign back 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 A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division — Licensing Section at 727 -847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the °contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, 1 certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law — Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the °owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other 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, WateriWastewater 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. 1 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 NOTI OF OMMENCEMENT. FLORIDA JURAT (F.S. 117.03) �. OPENER OR AGEN7( CONTRAC • • 0 h i j// . �.4111 Su to (or affirmed ore me this S swum 3 ' //..2„7-4 y v'' 9 / by Alf �r �^ or l2.O L. f ti Who islet@ personally known to me or has/have produced • is/are 2 - known to me or hasRiave produced as identification. LL - as identification y � ./. Notary Public i Notary Public • miss . j •� •; lion k C i), Com N.. +; 4 _ :a" Commission DD 621833 • Name of No "re, " q , : re a c: i 0 Name of Not' rig t ma d Waded VW FelnInwMOeM OBO•T01e P JIV BODES 4,- " � ? Commissi DD 621833 Expires De ember 12 2010 Tt ni TroY Fall Insurance 800-388-701 9 AIM w AW•■••••11111111■ _' A JIIP A: »erica Solar Ersergy� LZ_C SOLAR CON TRACTORS Licensed /rssu■ed - Borsded Soar 177ear75 Free Errergy- I, Labron E. Taylor, Jr., as a State Certified Solar Contractor, do hereby authorize, Debra L. Crawford to sign and pick up permits. Contractor 7LLabron E. Taylor, Jr. Subscribed and sworn to (or affirmed ) before me this 72 /voi 2410 by 1 , 01 �' 1' 4 �' ,l % • Who is /are personally known to me or has/have produced I 79 ' ' 0 C, 2 - 4 / 77 0 as identification. A rx e dv Notary Public Commission No. D0 9 (10 /'3 Name o *. • , red v•-• •..• .xr. .. "' , • D " 'BALD TOSSING DONALD LOS Niue COW/WON # 00940463 • T COMM /MON 1 0X.�J3 w.,13 EXMRES NOV 16 4013 'R;. .. : Bor ;,EC fl11O N SUiAt ia.; 1I17 • , OMPANY 5109 Meadows End, Lakeland, FL 33810 • Phone 863 - 859 -7800 • Fax 863 - 816 -5426 AC# STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING SEQ# DATE BATCH NUMBER LICENSE NBR 08/24/2010 108045406 CVCO56667 The SOLAR CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2012 TAYLOR, LABRON EDWIN JR AMERICAN SOLAR ENERGY LLC 5109 MEADOWS END LAKELAND FL 33810 CHARLIE CRIST CHARLIE LIEM GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW POLK COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT NO 15624 CLASS: B EXPIRES: 9/30/2011 OWNER NAME I LOCATION TAYLOR, LABRON E JR ; 5109 MEADOWS END LAKELAND BUSINESS NAME AND MAILING ADDRESS CODE ACTIVITY TYPE 230270 CONTRACTOR SOLAR AMERICAN SOLAR ENERGY LLC 5109 MEADOWS END LAKELAND, FL 33810 -6923 PROFESSIONAL LICENSE (IF APPLICABLE) SOLAR CONTRACTOR CVCO56667 OFFICE OF JOE G. TEDDER, CFC * TAX COLLECTOR CONSPICUOS Y SPL H BE PAID - 2088908.0001 -0001 10/01/2010 10/01/2010 JMW 221 73.53 AMERICANSOLAR ENERGY Nov 18 10 01 :44p Lg Edwards Ins 3525676766 p.1 --.. OP ID: KS A I,. )' • CERTIFICATE OF LIABILITY INSURANCE DATE 11 / 11h8/10 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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 352- 567 -6751 NAM E AcT Karen Surratt L.G. Edwards Insurance Agency 352 -567 -6766 PHONE 352 -567 -6751 FAX 352 567 -6766 INC. No. Eel: -- .____ -- -- (A/C, No): P.O. Box 1548 s ADDRESS: karensurrattgtampabay.rr.com Dade City, FL 33526 -1548 PRODUCER cu olyieR ;pi AMERI -1 INSURER'S) AFFORDING COVERAGE _NAIL b _ INSURED American Solar Energy, LLC INSURER A : American Vehicle Ins Co Labron E Taylor, Jr INSURER e : Guarantee Ins Company Inc 5109 Meadows End Lakeland, FL 33810 INSURER c : Old Republic Surety Company INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM1D11PYYYY) (MM/DDIYYYY) OMITS GENERAL LIA8ILFTY EACH OCCURRENCE i $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GL0521016551 04/25/10 04/25/11 PREMI E 1 O RENTED ■ S 100 PREMISES (Ea mnvrence) _________ — CLAIMS -MADE [ X 1 OCCUR MED EXP (Any one person) S 5,000 PERSONAL A ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 _ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 1,000,000 XI POLICY 1 1 PRO 1 1 LOC $ — AUTOMOBILE UABN.ITY COMBINED SINGLE LIMIT $ -- (Ea accident) ANY AUTO �_....___. �.._... - -_. BODILY INJURY (Per person) $ ALL OWNEO AUTOS �� BODILY INJURY (Per accident) S r SCHEDULED AUTOS PROPERTY DAMAGE $ +' HIRED AUTOS (Per accident) NON -OWNED AUTOS $ J iUMBRELLA UAB OCCUR 1EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE 3 DEDUCTIBLE $ ----- RETENTION $ $ WORKERS COMPENSATION WC STAT I - OTH AND EMPLOYERS' LIABILITY X�TORY LIM _11$ L. EB . Y! N B ANY PRKWRIETORIPARTNER/EXEC J1IVE GWG0334000313 -110 09/23/10 09/23/11 E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? I Y I N/A - -'— - -' (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 100,000 If yea, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 500,000 C 'Hillsborough Co OFL0584009 06(13/10 ! 06/13/11 Surety 5,000 iL&P Bond 1 ( Bond DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more apace Is required) Solar energy contractors - Labron E Taylor, Jr.- License #CVCO56667, is exempt from workers compensation coverage. 30 day cancellation for workers compensation CERTIFICATE HOLDER CANCELLATION CITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLIC )ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 813 - 780 -0021 5335 8TH STREET AUTHORIZED REPRESENTATIVE ZEPHYRHILLS, FL 33541 C__-- y ©1988 009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The AGORD name and logo are registered marks of AGORD Nov 18 10 01:43p Lg Edwards Ins 3525676766 p.l OP ID: KS ACCORD" D ATE (MMroturrrr! CERTIFICATE OF LIABILITY INSURANCE 11/18/10 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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 352-567-6751 N ro.cr Karen Surratt L.G. Edwards Insurance Agency 352- 567 -6766 lac.NNo. E 352-567-6751 1 ( No): 352-567-6766 P.O. Box 1548 E-MAIL ADDRESS: karensurratt@tampabay.rr.com Dade City, FL 33526 -1548 PRODUCER CUSTOMER ID 0: AMERI -1 INSURER(S) AFFORDING COVERAGE I NAIC tl INSURED American Solar Energy, LLC INSURER A : American Vehicle Ins Co Labron E Taylor, Jr INSURER e : Guarantee Ins Company Inc 5109 Meadows End INSURERC: Republic Surety Company Lakeland, FL 33810 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP LIMITS LTR INSR wVD POLICY NUMBER (MM1DD/YYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GL0521016551 04/25/10 04125/11 DAMAGE ES ( RtNIED 100,000 PREMIS Ea oca col � $ CLAIMS -MADE n OCCUR MED EXP (Any are person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 ^, GENERAL AGGREGATE $ 1,000,000 GG AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 Jl POLICY n JFC P1 LOC 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO ! BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE l $ • EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS' LUt&UTY TORY I IM FR B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N NIA GWG0334000313 -110 09/23/10 09/23/11 E.L. EACH ACCIDENT $ 100,000 IM OFFICEREMBER EXCLUDED? (Mandatary In NH) E.L. DISEASE - EA EMPLOYEE S 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below . E.L. DISEASE - POLICY LIMIT 1 S 500,000 C Hillsborough Co OFL0584008 06/13/10 06/13/11 Surety 5,000 L&P Bond ( Bond DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additions! Remarks Schedule, If more space Is required) Solar energy contractors -Labron E Taylor, Jr.-License #CVCO56667, is exempt from workers compensation coverage. 30 day cancellation for workers compensation CERTIFICATE HOLDER CANCELLATION CITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 813-780-0021 5335 8TH STREET AUTHORIZED REPRESENTATIVE ZEPHYRHILLS, FL 33541 ,/g / �` ry ^ / V � ^� i © 1988 009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD • • 111111111111111111111111111111111111111111111111111111111111 2010167389 Ree 10 RcPt: 1337143 IT: 0 " Clerk DS: 0.00 Farias P NOTICE OF COMMENCEMENT, 1',/22/ 10 J • PAULA S.0'NEIL,Ph.D.PRSCO CLERK & COMPTROLLER Permit No. 11/22/10 �1�$a� PO° 3 Property Identification No. ( .24.',0 /-0/10- OR BK 4 f( 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. 64716 1. Description of property (legal description :) 64716 Kf/,rem /B L PG / .z9 LDT9 or 6?1'? N `?6 L a) Street Address: i • e i . f 2. General description of improvements: (•.o pp _ 11 D - r - _ i re cfe, � � . �/ 3. Owner ormaand . 4eVem 6. J QOSS Ro. 64c°�fO)" / eade i r P.- 3 y52f ^•2{t °2- a) Name and address: l b) Name and address of fee simple titleholder (if other than owner) c) Interest in property /DD `10 C v` 4. Contractor Information a) Name and address A / / _ l �� J r d 6 °" ' o,� Spite . , � °9 / i c 1 3 $ /d b) Telephone No.: ," , Mj' O� Fax No. (Opt) Al ' t 5. Surety Information a) Name and address: b) Amount of Bond: c) Telephone No.: Fax No. (Opt) 6. Lender a) Name and address: Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: • 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 TIIE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAFFER 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. 4111 STATE OF FLORIDA COUNTY OF PASCO Signature of Owner or Owner's Mthorized Officer/Director/Partner/Manager Print Name The foregoing instrument was acknowledged before me this efol day of NO V HBen- 20 /O by S%yew) ROM as (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed). Personally Known OR Produced Identification v Notary Signature 9 ,,, Ye°a'A • Type of Identification Produced D . L . Name (print) PAM -MIA L.. JO N I oni R a.phi - yea 16.Oao Verificrtt oti pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the f cts stated in it are true the best of my knowledge and belief. Signature of Natural Person Signing Above ',ORMalnitYC,nsene1 pRICIAL. ht CCy ssi FXP11tFS' �O Ill' a fl.NelerY two,' ('p ARY STATE OF FLORIDA, COUNTY OF PASCO THIS IS TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE OR OF PUBLIC RECORD IN THIS OFFICE IVITNESS MY HAND AND OFFICIAL SEAL THIS 2 Z DAY OF Note. 2C..Ui PAULA S. O'NEIL, CLERK 8, COMPTROLLER BY DEPUTY CLERK