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HomeMy WebLinkAbout11-11393 CITY OF ZEPHYRHILLS 5335 - 8Th STREET 11393 (813)780 - 00 20 BUILDING PERMIT Number: 11393 Address: MISC ST IEE DESCRIPTION Permit Permit Type: M ISC Z Book: Permif Type: Township: Range: Class of Work: RIGHT -OF -WAY Lot(s): Block: Section: Proposed Use: NOT APPLICABLE Subdivision: CITY OF ZEPHYRHILLS E s Sgu Parcel Number: Estt. . Val : Improv. Cost: 1 /28/2011 Name: DAIRY RD Dat Total e es: Address: MISC ST SEE DESCRIPTION Total Fes:m'� ZEPHYRHILLS, FL. 33542 Amount Paid: A �� ( Date Paid: Phone: (941)915 -10 Work Desc: MISC ST -DAIRY RD APPR 330 SU OF DAUGHT RD -2' STEEL GAS MAIN -NO CHRG ( 9 » ( r ,), j I.. - MISC. FOOTER BOND DUCTS INSULA SEWER MISC MISC. ROUGH ELECTRIC_- LINTEL 1ST ROUGH PLUM INSULATION WALL__ MISC. B- PRE -METER MISC DRIVEWAY DUCTS INSTALLED___ WATER MISC. MISC. PRE -SLAB SHEATHING MISC MISC. CONSTRUCTION POLE FRAME . when extra inspection REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c ) trips are necessary due to any one of the following reasons: a) wrong address b) condemned work not ready resulting from faulty construction c) repairs or corrections not made when n at job site a work not work not ready inspection when called e) permit not posted on job site f) plans not 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 dditional 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 { , e for ce "Warning to owner: Your failure to ��" If t obtain financing, consult with your lender or an attorney improvements to your property. I Y before recording your notice of commencement." I it -i . PERMI �R CO TRACTOR SIGNAT ► - E PERMIT EXPIRES IN 6 MONTHS WITHOUT HOUR NOTICE REQUIRED INSPECTION CALL FOR INSPECTION PROTECT CARD FROM WEATHER ACORD,� CERTIFICATE OF INSURANCE ISSUE DATE 07/02/2010 rights PRODUCER This certificate is issued as a matter of information only and confers no 9 hts upon the Certificate Holder. This Certificate does not amend, extend or alter the MCGRIFF, SEIBELS & WILLIAMS, INC. coverage afforded by the policies below. P.O. Box 10265 Birmingham, AL 35202 COMPANIES AFFORDING COVERAGE 800 - 476 -2211 Company Associated Electric & Gas Ins. Svcs. A INSURED Company B Peoples Gas System TECO Energy, Inc. Company P.O. Box 111 C Tampa, FL 33601 Company D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. LIMITS OF LIABILITY LT TYPE OF INSURANCE POLICY NUMBER EFFECTIVE XIRATION LT A GENERAL LIABILITY X0521A1A10 07/01/2010 EACH OCCURRENCE $ 1,000,000 ❑ Commercial General Liability Self- Insured Retention 07/01/2011 FIRE DAMAGE ® Claims Made ❑ Occurrence $1,000,000 MEDICAL EXPENSE $ ❑owners' and Contractors' Protection PERS. AND ADVERTISING INJURY $ ❑ GENERAL AGGREGATE $ 1,000,000 ❑ PRODUCTS AND COMP. OPER. AGG. $ General Aggregate Limit applies per: ❑ Policy ❑ Project ❑Location A AUTOMOBILE LIABILITY X0521A1A10 07/01/2010 COMBINED SINGLE LIMIT $ 1,000,000 Self- Insured Retention 07/01/2011 BODILY INJURY (Per person) $ ❑ Any Owned Automobiles 0 e $ 250,00 $ 1:1 All Owned Automobiles BODILY INJURY (Per accident) ❑ Scheduled Automobiles PROPERTY DAMAGE (Per accident) $ El Hired Automobiles COMPREHENSIVE ❑ No owned Automobiles COLLISION El WORKERS' COMPENSATION WC Statutory Limit I I Other 1 I $ AND EMPLOYERS' LIABILITY EL EACH ACCIDENT EL DISEASE (Each employee) $ EL DISEASE (Policy Limit) $ 2,000,000 A EXCESS LIABILITY X0521A1A10 07/01/2010 EACH OCCURRENCE $ 2,000,000 ❑ occurrence Claims Made 07/01/2011 AGGREGATE S S CO521A1A10 07/01/2010 Each Accident or Each $ A EXCESS WC 07/01/2011 Employee for Disease $ 1,000,000 Excess Workers Compensation $ $ $ Excess Liability policy provides insurance in excess of Peoples Gas System's Self- Insured Retention as stated above. CERTIFICATE HOLDER 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. Authorized Representative City of Zephyrhills t 5335 8th St. ° J S, 6 Zephyrhills, FL 33540 Page 1 of 1 Certificate ID # YWT9R74G JAN -27 - 2011 15 813 228 4997 P.02i02 24 WHOLESALE MARKETING ISSUE DATE • , ;,;, l,; ° , ; '- CERTIFICATE OF INSURANCE o 71o2rzo , o ,. ,, :, � .— v D'" issued as a matter of information only and s or alter the ' ' ' This certificate is , ' Holder. 1 {s Ceruficale does net amend, '- M," ; ;, PRODUCER upon the Certificate , ,� �'� " :} coverage afforded by the policies below. P.O. S IFF. SEIBELS A. WILLIAMS, INC. , ,,, �; ... 1 r COMPANIES AFFORDINO'CERAr*E P.O. Sox am, ; ° A `,; i 600 -4 7 ham, AL 35202 ,; 76 -221, ,';‘,,,,,.2 • °' �,�� f300� is & Gas Ins. Svcs. ComPanY Associated E{ecta' 1 4 9 INSURED ` fi,;,; Peoples Gas System ; >;< „ r 1 '' TECO Energy Inc, G , "; ,s ' P.0.6ax 111 y' .x" Tampa, FL 33801 ° 'j- ",•' "7 Tame Company ° , ,,,;1' . fi , • D ,titt l' . ,. MdictiM Nolwilhs } �r bi for o► may pe I the ted. Ahee a h3t51 t>71'; ' la' 1y, ∎ f any is to ems that the ponds Of of contract n c or other oc have been issued why tInsured is u certificate may herein for the t d by Patti afford • ; , ' i . any roqulreme !bed herein �in condition is i u je to all e San document with respect UM�g ee LIABILITY edu e d • GENERAL UABIL by the policies described herein is subject to all the terms, ,conditions and exclusions FFECTIO policies, Limits shown may [1 TYPE OF INSURANCE POLICY NUMBER EXPIRATION S 1,000" `'� `'ti',' "'p " .; ® 0521AIA,0 07!0112010 EACH OCCURRENCE ��� ;t:: "; GER ` 4 � Canmerael Gen• Liability Self- InBUnDd Retention p7f01/2011 FIRE DAMAGE Mumma $1.000,000 MEDICAL EXPENSE �Ig {NG INJURY , i , > >. elaim. Niacin 0 Mums D ACVE 'ii', 6' ® lots' Miamian PERS. AN , ! T� r'G l"' „ /' � �� 0 Owners' and Cenkae % r ” 1 p ER. Ail . '. , `' u , ' °` O PRODUC S AND COMP. � �; sb Llmh Ne6 Dee it, 1 ;. ; : ,;' General LJ Pealed � S 1 OQQ ` , , 0 Pulley I]F.eealWn „n ,� . �. ? e COMBINED SINGLE LIMIT '`� X �A1A10 07101120,0 Y.r r F RILE LIABILITY non 0710112011 Bf D •_ + = '= ° " Se- Invun3d Rete _ mobile $250.000 80.1 d A mebei A COMPREHENSIVE (.i i, . ed Aulereobles COLLISION 1777 "7M Irk ,';' . WORKERS' COMPENSATION El EACH 14CCIDEh1T +; iY- AND EMPLOYERS' LABILITY , ,,, _ „ • .. � °. Emipmmal ''';';�A • ' �, ,{ :: 0710112010 EACH OCCURRENCE 2�0, , t ,,';;''4,;M 07101/2011 X0521 Al A10 Z 'y.'�•'r c ; J :.; EX ass LIABILITY ;i �" ❑ Occun ®Claims Made +•y' } �l , : . 0 710112010 , ,•r , r . ^ ;l, . I. 5121A1A10 mployee for Disease I EXCESS WC 07/01/201 ' Essese Workers' Cempereaclan ;,•' 14 �C' If- Insured Retention as stated above. �•'It s of Peoples Gas System's Sa ;�° Excess Liability policy provides insurance in excess , "r•; " " 'e I • CERTIFICATE HOLDER ' "' ; ', ! ,', . , SHOULD ANY OF THE ABOVE DESCRIBED G gtyRE CANCELLED LL ENOEAVOR ?' Yr' ,;t1 "'y r MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HO l THE EXPIRATION DATE 'f THEREOF, ' ;l ! -DER NAMED TO' n.E '.. >; ! ` LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO DBLIGATIO1d DR LIABILIT fy,F,',i i,t x`,y, ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. ry r I!i ' Authorized Representative . ' , City of Zephyrhills , ', , 53:35 8th St. �"` i; ; i rt �•sc: Zephyrll{Ils, FL 33540 \ , , 4 . , , . ;ti ,, y ° ',' ' ' TOTAL P.02 JAN -27 -2011 15 813 228 4997 P.01/O2 24 WHOLESALE MARKETING N. 4 , Br ady'G. G' urgel i,: : „`1 er Risk Manage •,. ,�,, Manager, inent , Inc ; ', ,, .,.: T T 702 North Franitlii�' S 33 02 rt, ; ,Y :' ` it �7 Tea,, FL '' '(8,1.3} 218 -4184 , , ' t ; i, % ,�', %rid. {' • FAX , , '1,;; • '4 To: City of ZephyfiiliS ‘ * ,; From Brady Gurgel :t '.: : 80 -0021 :� Fax: 813 -7 ;'''� ,, ^i P (including z ; ' : . Date: January 27, 2011 a "' ' r. Phone: , , ?,•r �';�'�•• '` Certificates of Insurance " ",,tt ,, act Peoples Gas System :" ," ;t > 1 w J W. � A ( ; rl,w h '' cl , ' I • t •,;(,',.;)',' 11 ..��, i h- A,' 1 S ...f r , % ; st 1 ; 1 , • .xti f.; s , .. m, 4 r r YAK r , , ' '';,±?, ''rR , ;h, . • CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT DATE: `I 51 2 o t t RIGHT -OF -WAY USE PERMIT PERMIT# y`% /13 7 5 No construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the City Building Department. Any application for approval of construction operations on any City owned Rights of Way shall furnish a detailed drawing showing the complete scope of the proposed work in triplicate to the office of the Building Official for approval prior to the commencement of any work. A copy of this permit is to be kept readily available at the site of the work at all times. PARCEL I.D. # CITY ROAD 1'-M 1;Zpa,p DATE 1 / LOCATION (Legal Description) : 1 I • i Q41 Raiz, r) vim+ Appel ,t4c. . a3©' L lL Og n ip tl jzoskt) cAApPal( ?O` I.] ©6z't1 -t OF C 1 L Oi 0 A--t& 4 ti Q' uct" Permission is hereby ranted rg.t...cc ca of 'TEj 1 ��� Goo.. S for the construction and maintenance o p , ��p' 2. �T�t L , vv1.2.110 _subject to the following conditions: 1. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant. 2. All work shall be done in keeping with the standards of the City Streets Department and under the supervision of the City Building Official, wl will be notified at least one day prior to commencement of construction. 3. All materials and equipment shall be subject to inspection by the City Building Official. 4. During construction all safety regulations of the Department of Transportation shall be observed and the City shall be relieved of all responsibility from damage of any nature arising from this permit. Subject to the same terms and conditions, the permit holder may take such safety measures, including placing and display of caution signs, as it may deem necessary in conduct of construction and maintenance work hereunder. It is the responsibility of the permittee to ? ? ?? 5. All private and all City properly shall be restored to its original condition as far as practical in the opinion of the City Building Official. 6. All underground crossing installations shall be laid at such depth as may be specified by the City Building Official. 7. The sketch covering the details of this installation shall be made a part of this permit. This permit is granted with the understanding that the applicant has notified all other utility users in the area covered by the permit and takes full responsibility for any damage incurred by prior installations as a result of his operations in order that they may safe guard their interests. 8. It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this permit shall not operate to create or to vest any property right in said holder. 9. Whenever the City decides to further exploit the City Rights of Way, any or all said poles, wires, pipes, cables, or other facilities and appurtenances authorized hereunder, shall be immediately removed from said Rights of Way, or reset or relocated thereon as required by the City Building Official at the expense of the holder of this permit. 10. The holder shall save and keep the City harmless from any and all damages, claims, or injuries that may occur by reason of the construction, maintenance, and operation of said facility. 11. The holder shall complete the requested work within days or this permit shall become null and void. In the event the work requested is not completed upon the expiration date of this permit, the City shall have the right to complete such work and to charge the holder of the permit for all costs incurred in completing said work. 12. The holder shall post a cash or surety bond with the City Manager in the sum of $ dollars to guarantee performance of the obligations herein, and to guarantee maintenance of the right -of -way described herein for a period of one (1) year following completion of the requested installation. In the event a surety bond is posted, the surety bond shall be made payable to the City and shall obligate the surety to hold the City harmless in the event the holder of this permit should fail to meet any of its obligations hereunder. The bond shall also indemnify the City for all court costs and reasonable attorneys fees in the event legal action is required to collect on said bond. SUBMITTED BY: (Permittee) TD Signature & Tit - 1j _ _ _u a _ Ttc.tl • Address 140 04.44AUGLS t1 r 334acs- 44110, 1,&7,' r i 2 °ion c Lg4e) 4t 5- 14 I -Lt I1 APPROVED BY: CITY OF ZEPHYRHILLS je-tspe Building Offietat Date: / -'//- II Utilities Supervisor C ? /O /1 e/� 77 f Lil/syFS r Date: _ Public Works �,r' __ �� i V G.EACE et Al 'T� D S N SCE72l4 Date: /,2 Air ! - C City Manager ` : / C/J` h � - Date: //// z J// i/ i I i Z I W a a N 1 w I WI ..••••I e0 A li 1 7 V $ y a • cc ik) .E as 0 1' 1 p in o -. v � iv m `V I • W 0 Q • N O i ao I li I n ' N ti 0 1 - NN N ao • PP w i Daughtery Road — N E- — - ihtery Road I 0 4 - �O 1 i W 6 I E I ID I I u I 1 . \ 1 0 N �• ,y 1 N i N I O I I o ill � y i i C7 N 0 w El F I .G (13 <V m 2 ea C � � - in as ro li .. N (j0, o._ Cn D C 1 N cc N - i /J F Ce N ! I 1 0 D N I O 'Q_ E. I . , - E (fi O Q R C7 !2 a) p 0 a I I) 8 i N N a. d r) 'x U00 L.-4 ..,_. t 41