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HomeMy WebLinkAbout11-11433 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 11433 BUILDING PERMIT Permit Number: 11433 Address: 7320 GALL BLVD Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35- 25 -21- 0010 - 08800 -0000 Improv. Cost: 110,400.00 Date Issued: Name: TOWNVIEW RETAIL LLC Total Fees: 777.00 Address: 725 CONSHOHOCKEN STATE RD Amount Paid: 777.00 BALA CYNWYD PA 190042102 Date Paid: 1/25/2011 Phone: (610)667 -5800 Work Desc: INSTALL REFRIGERATION INSIDE SAVE 0 LOT �7. 0 WIRIMMEMEIMMOMMEIMMINIIIIIIIMINEMINEMOmmuim DUCTS INSULATD - FINAL �L � ` 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 • mmencement." / Z i&e, iv -40"----di ,, . • CONT=.. CTOR SIGNATURE PERMIT OFFI FR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER • 813- 780 -0020 City of Zephyrhills Permit Application / '1 I Fax - 813- 78�21 // f� Building Department 4v -` P *Mt,' F Date Receiv `� �� V 3�y y r 3 3 T Ph one C on t act f or Permitt f i J I ' ' r_ // ,^/ Owner's Name SA ✓G 4- 1 -'° 'r / k f r Owner Phone Number .7/ L i' .: 4, l03 d Owners Address /00 ea/4/0 4 1-6 6/ 1-64-E 41-- Owner Phone Number Ea,wll 4 - -1fY,, M0 C. 3oy.5 Fee Simple Titleholder Name •11/1/ / e.fd A. fif'/ � / / I t c- Owner Phone Number Fee Simple Titleholder Address • - CD/43y0yAC.� FtJ 1�f/�"i I 1 i 6 At -it / At //�6v�� �..�od -- �GG / JOB ADDRESS 73 20 (s4 L1, /3L✓V Ze191 y,4-/61_ l j /1— LOT # SUBDIVISION PARCEL IO# �� „ 4. v0 /° U�rUO 626)6)41 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR _ ADD /ALT 1 SIGN n 0 DEMOLISH INSTALL _ REPAIR PROPOSED USE SFR COMM 1 1 OTHER 1 1 TYPE OF CONSTRUCTION 1 .„-r BLOCK I I FRAME 1 1 STEEL n . _ 1 DESCRIPTION OF WORK / tel /e.e6 t if A/ 601 C-(4 17; I./ BUILDING SIZE /''' SO FOOTAGE HEIGHT nBUILDING $ VALUATION OF TOTAL CONSTRUCTION nELECTRICAL $ AMP SERVICE n PROGRESS ENERGY 1 W.R.E.C. 1 1PLUMBING $ i / / 0 o ) MECHANICAL $ //O PM). 7d VALUATION OF M F,FA AL INSTALLATION nGAS n ROOFING n SPECIALTY 1 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA nYES NO ' • 1 1 1 1 '.d 1 1 1 1 1 1 1 1 1 1 1 1 1•• 1•••• 1 1• BUILDER COMPANY SIGNATURE REGISTERED I 1 Y/ N 1 F EE CURREI. 1 Y/ N Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ Ni ( 9 Address License # PLUMBER %COMPANY SIGNATURE �= REGISTERED 1 Y/ N 1 FEE CURREN` 1 Y/ N 1 Address n,limm License # MECHANICAL / �� COMPANY .7 fl ��iQr � f � I1� f �/Q r l 0 A/ /f/O/414i / �/Vt • SIGNATURE 11 ... _� . ` REGISTERED 1 Y / N 1 FEE CURREN 1 Y / N Address License # OTHER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 Address License # 1111111111111111111111111111111 1 111111111 11111111111111111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ""PROPERTY SURVEY required for all NEW construction. Directions: L' ' • 1 1 1 1 1 1 1 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 (PIot/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" whic l may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any ' applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division — Licensing Section at 727 -847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and 90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law— Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner ", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S /OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection- Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers - Seawalls, Docks, Navigable Waterways. Department of Health & Rehabilitative Services /Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency- Asbestos abatement. Federal Aviation Authority- Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone "V" unless expressly permitted. If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots 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 (. ./1�e Subscribed and swom to (or affirmed) before me this Subsc b d and r n�p. or affirmed) before me this by I- h by 17 +n104'41 / .20/1 Who is/are personally known to me or has/have produced Who is /are personally known to m@ or has/have produced as identification. as identification. Notary ublic ry d n � � Notary Public ((�� // Commission No. Commission No. 1/ 1 .3 / / Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped ?01t'Rr rpBc GWENDOLYN FAY LAHERA * `r , , * MY COMMISSION t DD 799397 EXPIRES: June 22, 2012 i peor v,,de Bonded Thru Budget Notary Services Io AO PURCHASE ORDER SHIP TO PO # REV # PAGE SAVE -A- LOT -05200 312964 0 1 of 2 7320 Gall Blvd. Zephyrhills,FL 33541 THIS PURCHASE ORDER NO. MUST APPEAR ON United States ALL INVOICES, PACKING LISTS, CARTONS & i :. ,/#4131' CORRESPONDENCE RELATED TO THIS ORDER ' SUPPLIER i BILL TO 5 -STAR REFRIGERATION & AIR SAVE -A -LOT, LTD Attn: Construction CONDITIONING INC 100 Corporate Office Drive WEEKI WACHEE, FL 34613 Earth City , MO 63045 United States SUPPLIER NO. SUPPLIER PHONE DATE ISSUED I REQUESTOR NAME P - CARD BUYER NAME 7511230 () 06- JAN -11 RITA HUSLAGE TERMS BUYER PHONE REVISION DATE I F.O.B. SHIP VIA SUPPLIER CONTACT NET 30 ADDITIONAL Quote dated 11/26/10; project manager David Motley 727 452 - 4536 Buyer Email: Rita.J.Huslage @save a lot.com INSTRUCTIONS : Line 4 ABS Item# Description of Goods and or Services Delivery Date Quantity UQM Unit Price Lint: total 1 06131100 REFRIGERATION INSTALLATION 01/07/11 110,400.00 USD 1.000 110,400.00 01/07/11 110,400.00 This purchase order is expressly limited to the terms stated herein, and any additional. different or contingent terms proposed by or made by Seller are rejected unless expressly assented to in writing by authorized representatives of Purchase Order Total 110,400.00 SUPERVALU, Inc. The terns and conditions contained herein will govern the goods and services provided under this purchase order. PURCHASE ORDER SHIP TO PO # REV # PAGE SAVE -A- LOT -05200 312964 0 2 of 2 7320 Gall Blvd. Zephyrhills,FL 33541 THIS PURCHASE ORDER NO. MUST APPEAR ON United States ALL INVOICES, PACKING LISTS, CARTONS & y ( f CORRESPONDENCE RELATED TO THIS ORDER 1 J / SUPPLIER g BILL TO 5 -STAR REFRIGERATION & AIR SAVE-A-LOT, LTD CONDITIONING INC Attn: Construction 100 Corporate Office Drive WEEK! WACHEE, FL 34613 Earth City , MO 63045 United States SUPERVALU PURCHASE ORDER ADDITIONAL TERMS AND CONDITIONS 1 Supplier, by accepting this Purchase Order ( "PO ") or by shipping or sending the described goods to SUPERVALU, agrees to all terms and conditions herein and guarantees that all goods or services furnished under this PO ( "Goods ") shall comply with the requirements of the Fair Labor Standards Act of 1938, as amended. 2 Supplier warrants that (i) the Goods are free from infringement of any patent, trademark, or trade name and are not in violation of any law, (ii) Supplier has good title to the Goods sold hereunder and guarantees that said title is and shall remain free and clear of any and all liens, mortgages, financing statement, and encumbrances of whatsoever nature, (iii) all services shall be performed in a good workmanlike manner. To the extent services may disturb existing building materials known or presumed to contain asbestos, Supplier shall conduct the services in accordance with all applicable federal, state, and local environmental and safety laws, (iv) all Goods delivered hereunder are free from defects in design, material and workmanship, (v) the Goods conform to applicable specification, drawings, samples or other description referenced in the Description of Goods and /or Services herein, and (vi) the Goods will be merchantable and suitable for the purposes intended. The foregoing warranties are in addition to all other warranties provided by law or provided by custom in the industry or given by Supplier. 3 Supplier hereby indemnifies, defends and holds harmless SUPERVALU, its affiliates, directors, associates, agents and representatives from and against any and all claims, actions, fines, penalties, liabilities, damages, injuries, costs and expenses (including, without limitation, costs and expenses for investigation and litigation and reasonable attorneys' fees) which arise out of or in connection with Supplier or any of its employees', agents', subcontractors', or independent contractors' breach of any covenants, warranties or representations made herein. 4 Supplier shall inspect all Goods prior to shipment to SUPERVALU and shall retain, and make available to SUPERVALU upon request, all inspection records relating to the Goods. Notwithstanding any prior inspection or payments, all Goods will be subject to final inspection at the destination set forth in the PO. Should SUPERVALU determine that the Goods are non - conforming or defective, SUPERVALU may, at its election, (i) cancel this PO, (ii) accept such Goods with an agreed -upon reduction in price, or (iii) return the Goods and require replacement or credit. Should Supplier fail to deliver replacements for such non - conforming or defective Goods promptly, SUPERVALU may cover and charge Supplier costs occasioned thereby. 5 F.O.B. point shall be SUPERVALU's location unless otherwise stated in the Description of Goods and /or Services of this PO. Notwithstanding any prior inspection and the F.O.B. point, Supplier will bear all risk of loss, damage or destruction of the ordered Goods until final inspection and acceptance of the Goods by SUPERVALU. Supplier will bear the same risk with respect to any Goods rejected by SUPERVALU. Title to, and sale of, the Goods described hereunder passes to SUPERVALU upon shipment, but all risks of loss are on Supplier as provided herein. 6 Without prior written consent by SUPERVALU, Supplier shall neither disclose to any person outside its employ or financing companies, nor use for purposes other than performance of this PO, any information pertaining to the existence or terms of this PO, including but not limited to SUPERVALU's drawing, blue prints, descriptions or specifications or specifications which are a part of this PO. Upon termination of the PO, Supplier, at SUPERVALU's request, shall return to SUPERVALU all written materials delivered to Supplier or generated by Supplier pursuant to the performance of this PO. 7 The failure of SUPERVALU to enforce, at any time, any provision of this PO, to exercise any election or option provided herein, or to require at any time the performance by Supplier of the provisions herein will not in any way, be construed to be a waiver of such provisions. 8 Neither party may assign or transfer this PO without the written consent of the other. In the event a lower price for any item becomes effective prior to the Delivery Date, the price for such item set forth herein shall be automatically amended to such lower price. 9 Time is of the essence in this transaction. SUPERVALU reserves the right to cancel this PO if shipment of all Goods is not received by the Delivery Date, or if no Delivery Date is indicated, if not timely received, or in the case of services to be performed, at any time. Supplier will notify SUPERVALU of any delays or threats of delay in the timely delivery or performance of Goods. SUPERVALU may revoke any acceptance of the Goods for defect or nonconformity within a reasonable time. If Supplier becomes insolvent, files a petition in bankruptcy, makes an assignment for the benefit of creditors or has a trustee appointed to take possession of Supplier's property or business, this PO and /or any related PO may be cancelled, without liability, at SUPERVALU's option. 10 All items must be shipped freight prepaid and freight charges, if any, added on invoice. A copy of the original paid freight bill must be attached to invoice for all freight charges so added. 11 Supplier shall issue a separate invoice for each Ship To location on a PO showing all charges for items plus freight and applicable taxes. 12 This transaction shall be governed by the Idaho Uniform Commercial Code in effect on the PO Date. Identification of the Goods related to this PO or any subsequently issued PO shall occur at the moment Supplier ships or sends the Goods. 13 This PO shall govern in the event of any inconsistency between the provisions of this PO and any additional terms not covered in this PO but contained in any service report order, work order, invoice, shrink -wrap agreement, or click -wrap agreement. 14 SUPERVALU is providing procurement services to Bristol Farms pursuant to Services Agreements. Purchase orders issued by SUPERVALU for goods and services for Bristol Farms are issued as a service by SUPERVALU pursuant to the Services Agreements. 11 STATE OF FLORIDA }e a, k — DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION y. ::'01:\";,::=7 1940 N CONSTRUCTION INDUSTRY STREET LICENSING BOARD (850) 487 -1395 NORTH MONROE TALLAHASSEE FL 32399 -0783 MATTHEWS, JOSEPH EDWARD III 5 ST RE FRIGERATION & AIR CONDITIONING INC PM 6252 COMMERCIAL WAY WEEKI WACHEE FL 34613 Con ratulationsl With this license become one of the nearly one million 14 so 'IND Floridians l by the De artment of Business and Professional Re elation � ' Our professionals and businesses rang e from architects to yacht brokers, from ?$ �t IAN boxerr o barbeque restaurants, and t ey keep Florida's economy strong,' �p46'8 #,P7 , o �+ 108 Every day we work to improve the way we do business in order to serve you better For information a our serv p lease log onto www.myflo ri dalicense,com , 1� �,� +� There you can find more information about our divisions and the regulations that , . . , ..III• pa impact you, subscribe to department newsletters and learn more about the 5� �� iertmen #`s initiatives. Our mission at the Department is: License Efficiently Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. I e�i 4$ ➢ as Thank you for doing business in Florida, and congratulations on your new licenses ; . s dsftfxn da res -Alto ' x t t. AOQ8t1Z01 '23, , DETACH HERE ' :'STATE OF.. DA P .,4 �.. . s '' • - I.1-'' s k i T. I � fr , � � 0 * „° § a , , S 4t + - x: e� 4` a '':�� � � ,.. Mc 00B0201 2 ' , 6' ,3 „ ` A E S �'• The ' - -, -'fitd N� 4 F._ •*`- }�i z e 3 v r ® �g � y .���yy,. �;i1 �t _ ratio 4, a UG 1 , � : . i¢ `p � ,.' g,,, .: PH 9 iA 11 ° < 'r 13 111'.4":41r . •t . �o ,. 34613 �. � �a , CAL tIEI ' r ." Fr It P 3 ISPI A A RF( (JI t 6 IIY -LAW co v® • CERTIFICATE OF LIABILITY INSURANCE OP ID KH DATE(MMlDONYYY) .,,� 01/07/11 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 l.UIV I AL I NAME: Brown & Brown of Florida, Inc PHONE Kandee Hagelston FAX P 0 Box 548 Afc,No,Ext): 352- 796 -8200 (AIC,No): 352 - 799 -1395 273 North Broad Street AD kandeehagelston @bbbrooksville.com Brooksville FL 34605 -0548 PRODUCER CUSTOMER ID #: 5 STAR -1 Phone:352- 796 -8200 Fax:352- 799 -1399 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A : Westfield Insurance Company 24112 5 Star Refrigeration & Air INSURER B. FFVA Mutual Ins Co /USIS 10385 Conditioning, Inc. 16210 Aviation Loop Drive INSURER C Brooksville FL 346D4 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. 1NSR I ADDL Stitt "- --------- ._._._...... _ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE i INSR WVDj POLICY NUMBER LIMITS (MMfDD /YYYY) (MM/DD/YYYY) - GENERAL LIABILITY ! EACH OCCURRENCE $ 1 000 000 _PREMISE I X COMMERCIAL GENERAL L - - ..... �, LIABILITY (Ea occurrence) CWP4951483 09/18/10 09/18/11 PREMISES (Ea occurrrr ence) $ 150,000 i CLAIMS -MADE I , X OCCUR MED EXP (Any one person) $ 10,000 X Prop Dmg Ded $1,000 PER CLAIM i PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 POLICY [X I 'ET LOC $ AUTOMOBILE LIABILITY { COMBINED SINGLE LIMIT (Ea accident) 1 $1,000,000 A X I ANY AUTO ! CWP4951483 ;09/18/10 ; 09/18/11 BODILY INJURY (Per person) 1 $ ALL OWNED AUTOS i BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS Per accident) 1 X NON -OWNED AUTOS I $ . A X $ OCCUR CWP4951483 09/18/10 109/18/11 EACH $2,000,000 EXCESS L ABIAB I X ' AGGREGATE 1 $ 2 CLAIMS -MADE DEDUCTIBLE ,, X '. RETENTION $ 0 - 1 $ B WORKERS COMPENSATION I WC84000228222010A 10 /01 /10 1 O1 /11 1 X WC STATU- '.OfH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETORJPARTNER /EXECUTIVFri T E .L. EACH ACCIDENT $ 1, 000 , 000 OFFICER/MEMBER EXCLUDED? N f A (Mandatory in NH) ! EL , DISEASE _EA EMPLOYEE $ 1 000 , 000 yes, .L N under $ 1 , 000 , 000 DESCRIPTION OF OPERATIONS below El. . DISEASE - POLICY LIMIT A Leased /Rented Equi 1CWP4951483 09/18/10 1 09/18/11 Limit $50,000 Ded. $1,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI TYOFZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills Conttractor Licensing AUTHORIZED REPRESENTATIVE 5335 8th Street Zephyrhills FL 33542 © 0 1 RP i is reserved. ACORD 25 (2009/09) The ACORD name and logo are registe d rk of ACORD . A1� V S t REFRIGERATION ATIO ai % AIR CONDIlIONING 16210 Aviation Loop Dr Brooksville, FL 34604 352 - 345 -4813 Phone 352 - 345 -4817 Fax SPECIFIC POWER OF ATTORNEY FOR CONTRACTOR LICENSING FOR CITY OF ZEPHYRHILLS, FLORIDA I, Joseph E. Matthews, III, of Hernando County, Florida, the undersigned, hereby grant a limited specific power of attorney to the following person(s): AUTHORIZED PERSON(S) AUTHORIZED PERSON(S) SIcJTURE DL# f , LEON B. SMITH ,_ O' _ /1---J J 5530- 522 -79 -415 -0 The attorney(s) -in -fact shall have the full power and authority to undertake and perform only the following acts on my behalf: REGISTER MY CONTRACTOR'S LICENSE, APPLY FOR, SIGN FOR, AND PICK -UP PERMITTING DOCUMENTS for 5 Star Refrigeration & Air Conditioning, Inc., Contractor's License Number CMC 046885, to include such incidental acts as may be required to carry out and perform the specific authority granted herein above. This power of attorney is effective upon execution. This authorization may be revoked by me at any time, and shall automatically be revoked upon my death or change of company name. Any City of Zephyrhills, Florida employee may accept and rely upon same until receiving written notice of revocation hereof. Signed this 7th day of January, 2011 J oseph Edward Matthews, III, CMC 046885 Certified State of Florida Mechanical Contractor and Qualifier for 5 Star Refrigeration & Air Conditioning, Inc. STATE OF FLORIDA COUNTY OF HERNANDO Sworn to and subscribed before me this 7th day of January, 2011, by Joseph E. Matthews, III, personally known to me. 4 p` ,O �- Gwendolyn`F. Lahera`, Notary Public Commission No. DD 799397 40, ":7.k GWENDOLYNFAYLAHERA Expiration: 06/22/12 * * MYCOMMISSIONIDO799397 EXPIRES: June 22, 2012 � j9 TFor FI OP�� e Bonded TM Budget Notary Services 111111IIII1111111111i 11111 11111 11111 11111 11111 11111 11111111 NOTICE OF COMMENCEMENT 2010162228 Permit No. Rcpt:1335309 Rec: 18.50 Tax Folio No. 35 2-5 L t Go1C 03d0 c. c OC �. DS: 0.00 IT: 0.00 11/09/10 K. Garcia, Dpty Clerk 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 description): see_ e(_ •' i - i b1 a) Street (job) Address: - 7 zo . • L'. &v./et/9 -�•: p L. , - FL_ 2.General d e s c r i p t i o n of i m p r o v e m e n t s : i yl :v r i apt Paci A4 t v s 5 j,2 ay Jt -.q . Le f' �� 0 c �,z 1 ,-- rLE 3.Owner Information a) Name and address: 514 - Ulf - - Lc r L i0 (G c. CcY2.,ex.rs cc',, e' 0a i ( '42Tia (:i r Mt (fibLip)'_ b) Name and address of fee simple titleholder (if other than owner) Tt.. ✓,.E w 2 - M + , t_ c) Interest in property i 2:nf..4 N r' 4.Contractor Information a) Name and address: C-- c Wit, rzu :.; rc/w . r N • t 6C '7 N • I `t f S ; , T ,st /a � -- 336 e. 5 � b) Telephone No.: c? .- 14 q 4 i Fax No. (Opt.) 5. Surety Information j a) Name and address: ?.J( it b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6.Lender / a) Name and address: (' ! a Phone No. 0o m n 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: W to ,„ a) Name and address: 7C F•. o m z (Opt.) Telephone No.: Fax No. t. ) m 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 032 713.13(1)(b), Florida Statutes: . iN 3 O a) Name and address: %) o b) Telephone No.: Fax No. (Opt.) Ws n 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date 1.-h o is specified): 1 p r o A WARNING TO OWNER: ANY PA MADE BY THE OWNER ' ' • THE EXPIRATION OF THE NOTICE OF (CC ; COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS t ER CHAPTER 713, PART I, SECTION 713.13, W n FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE ' • R IMPROVEMENTS TO YO ' PROPERTY. (0 ° 3 A U NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED • N THE JOB SITE : ' O , '.4_11: r r FIRST 35 INSPECTION IF YOU INTEND TO OBTAIN FINANCING, CONSULT YO ' LENDER OR . d' ' i Y BEFORE r- COMMENCING WORK OR RECORDING YOUR NOTICE OF COMME NC 1 NT. m STATE OF FLORIDA COUNTY OF PINELLAS 10. P --- Signature of Owner , - . = s • ,,, orized •-:. l' - tor/Putnerclaanager) . v; n At OTc,cc Print Name T f rego' instrument was acknowl before me this day of OC 2d () by .. ' r (.1/ L V' W� as v -ti ' 4'"' J (type of authority, e.g,. officer, trustee, attorney in fact for _ L (name of party r , . beh • of w , Personally nown L. I ' � � , snit , , ent was executed). � i ' Y rcahon Notary Signs .�., s /, L .j�,/ 4_____, I. lici Type of Identification Produced ( Name ' t) , IPA (/C 0 i-- WORN Verification pursuant to Section 92.525, Florida Statutes. Under penalties of 'try, I .. a .. I .. - i -; d the foregoing and that the facts stated in it are true to . _ . _ . o °"v P'� S EILA PRECIOUS ..�` tee'• FORMS, OC.rved20o7 SR O% k +t Notary Public - State of FI I" „Air '� My C omm. Expires .:elv;.y.l r. -. .' 1 t , e # 10. Above Comm 0 DD • 87 ” %% %%%% Bonded Through National Notary Assn. OR BK 846,3 PG 940 2 of 2 DATE: 11/09/10 PASCO COUNTY PROPERTY APPRAISER 14:20:35 O N - L I N E P A R C E L P R I N T O U T PARCEL -ID: 35 25 21 0010 08800 0000 TYPE: STATUS: A DLA: 100107 SC TP RG SUB BLOCK LOT TRACT: 0328004 L E G A L D E S C R I P T I O N : ASSESSED IN SECTION 35, TOWNSHIP 25 SOUTH, RANGE 21 EAST, PASCO COUNTY, FLORIDA ZEPHYRHILLS COLONY CO LANDS PB 1 PG 55 POR TRS 73 88 & 89 & POR OF LOT 8 PASCO MEDICAL ARTS CENTER PB 23 PG 24 BEING MORE PARTICULARLY DESC AS: COM AT NW COR OF SW1 /4 OF SEC 35 TH ALG N LN OF SAID SW1 /4 S89DEG 51' 40 "E 15.00 FT TH SOODEG 07' 20 "W 514.86 FT TO PT ON W BDY OF TR 73 FOR POB TH S89DEG 50'57 "E 188.54 FT TH SOODEG 09' 03 "W 16.33 FT TH S89DEG 50'57 "E 305.23 FT TH SOODEG 9' 3 "W 65.00 FT TH S89DEG 50'57 "E.154.33 FT TO E BDY OF TR 73 TH S09'3 "W 433.51 FT TH N89DEG 55'34 "W 50 FT TH S09'03 "W 117 FT TH N89DEG 55'34 "W 200FT TH S09' 3 "W 109 FT TH N89DEG 55'34 "W 259 FT TH S09'3 "W 205.36FT TO N R/W LN OF N MEDICAL AVE TH N89DEG 56'33 "W 133.84 FT TO E R/W LN OF US HWY 301 TH CV CONCAVE TO W RAD 57395.80 FT CHD NOODEG 4'19 "W 747.11 FT TH S89DEG 50'57 "E 171.18 FT TH NOODEG 7'20 "E 197FT TH N89DEG 50'57 "W 173.54 FT TH NOODEG 7' 20 "E 3 FT TO POB;OR 7642PG342 ,.510,-„, 4.sst , 7 ,,.. , ..„.:.„..:,.._ • s City of Zephyrhills BUILDING PLAN REVIEW COMMENTS gp ontra /Homeowner: , , e _ . ' _ _,, L ` ( LS. " Date Received: /-//- , / �3 ,Q D �2 Site: ,,-, Permit Type: ,9, A _ „CA Approved w /no comment: Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment sheet shall be kept with the permit and/or plans. Kalvin S er — P1 s xaminer Date Contractor and/or Homeowner (Required when comments are present)