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11-11453
CITY OF ZEPHYRHILLS v 5335 - 8TH STREET (813)780 -0020 11453 BUILDING PERMIT - MIT INFORMATION "; 3...,. A:a iN . . ; A ION Permit Number: 11453 Address: 6020 GALL BL Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 03- 26 -21- 0010 - 12800 -0000 Improv. Cost: 139,100.00 "g ; `F e t' t `, ,, :, ',' F p 7 :2::,:„ _ . o Date Issued: 4/18/2011 Name: GALL BOULEVARD LAND TRUST Total Fees: 1,529.65 Address: 350 HARBOR PASSAGE Amount Paid: 1,529.65 CLEARWATER, FL 33767 Date Paid: 4/18/2011 Phone: (727)643 -8922 Work Desc: REMODEL SPACE INTERIOR 10,119 SQ FT FOR FAMILY DOLLAR -APPLIC 'l'hi' 4, 3 -3- ' 7' \A* - WY: 1 01 \• \ :V t \ • . 1 - I ' 1 . JEFFERSON MECHANICAL SERVICES IN PLUMBING FEE 90.75 MECHANICAL FEE 63.53 VELOCITY ELECTRIC FIRE PLAN REVIEW FEES 607.14 FIRE INSPECTION FEES 15.00 HEADWAY OF NW FLORIDA INC c ilit/i0 Yl 74 — 6 1_6 11 II I T* .'€-:i161 CoN0d+ r ,:_'..6 i 1 °Fir\ iPp.., . . $ P _ f § W 8,.. L__ E _ I®: ,. P 10 • - 1, = •1 ' • VT: 1 1 i1 •1 1 FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE -METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE -SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. 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 commencement" AI iika--- Ilir G .4 /l Al .v_ > . C 0NTRACTOR SIGNATURE PERMIT OFFI FR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: e_h �ei' s h-u ' d, Date Received: l /5 - 1/ Site: ( 20 6A_ L( � U IS Permit Type: 1 ` -►°� eitv10. . -(c ) 1/ 9 S . Approved w /no comments: ❑ Approved w /the below comments: Denied w /the below comments: ❑ I) r r i y � j i 1.4',4 j / (T l � l (/ 6C1 �} �t �� �%(�fi e <,? 1 o"7 r/ r Rts. Iel(;) Ca 011 r/ / 1Le C) S 7C s�c 11 / 7[��C �/ ! e if (1 feci( A,11 s- fi(NY) fi t t t tor S , red g) a ( r/iit / q f a SS ; 6 , 1 �� �,� i � �C y / e(i �7 This comment sheet sha 1 be kept with the permit and/or plans. ( -221/ Kalvin Switzer — s Examiner Date ' ontr. ctor and/or Homeowner (Required when comments are present) FfCr 04/12/2011 10 :13 #299 P.001 /001 • • • 1111111 11111 11111 11111 11111 11111 11111 11111 11111 111111111 I I I I • 2011071075 • ' Rcpt:1366675 Ree: 18.50 • • ' - " DS: 0.00 IT: 0.00 • • 05'10/11 C. Cook, Dpty Clerk • NOTICE OF COMMENCEMENT' l /�/� J � 50' NE IL , Ph . D . PRSC0 CLERK & COMPTROLLEF • Permit No. / c7' 05 PRULR :' 10/ 11 10 ?tea n� 1 of 2 • Property Identification NO. �3" to `�/ /O - A) �'D d UOd U' O R BK �: LL�+71 P 2vO�- • . THE UNDERSIGNED hereby give Informs you that the improvement will be made to certain red property, and in accordance with Section 713.13 of the Florida Statutes, the following Iaformationla provided in this NOTICE OF COMMENCEMENT. • 1.Description ofproperty (legal d-, •n • a) Street Addreeg: A, Y1 e • ir1:11T•ilafe tails' R?. T7.1 INNil '.� ' 2 Gene description o . ovements: - SA-0 ' n , + . . .1 _ . I t:7iT.'`• mtned cam3r/s 7 1.31n'lemirtramt Z 3.Owner Information , • a) Name and address: ( G U) IN .. d • i + cl v . 1 3 Co '4Gr bo/ Pc. e C t QG fy1IG•� � L, 31161 b) Name and address of fee simple ti 1rr tleholder (if other than owner) • c) Interest in property _ • Contractor Information _ / A r e) Name and address: Na A .a c . �.[ 1 Not N ; . A - T•r, L r Z • L r> • ' � � 0 S.� : T� d b) Telephone No.: fjx. , - ei (. o / Pic. p.4. Fax No. (Opt.) P •:v. y �'r LAD.' i t 32 ��/ 1 • S .Surety Information . a) Name and Address: • ' b) Amount of Bond: - . • c) Telephone No.: Fax No. (Qpt.) 6.Lender i a) Name and address: - • 7. Identity design ate ofperaon within the State of Florida des' Phone No. d by weer Capon whom notices or other doenmenta may be nerved: . a) Name and address: b) Telephone No.: Fax No. (Opt.) 8.In addition to himself owner designates the following person to receive a copy ofthe i,ienor's Notice as provided lid Section • 713.13(1)(b), Florida Statutes: • a) Name and address: . • b) Telephone No.: if.— Fex•No. • • 9.Expiration date of Notice of Commencement (the expiration date is one'ycar from the date of recording unless a diffet'ent date is specified): • WARNING TO OWNER: ANY'PAYMENTS MADE BY THE OWNER AFTER THE EXPTR 4TION•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 OBTAnV FINANCING, CONSULT YOUR. LEND R OR AN ATTORNEY BEFORE . COMMENCING WORK OR RECORDING YOUR NOTICE OF CO CEMENT - STATE OF FLDRThA / - COUNTY OF PASCO x / J ''''�) �"/'� w ' ,, • • Signature cot OvAter or Prowl AYStortaostl 0211aer/Direetor paanedMan. . • FFrI t Name . • •d The foregoing instrument was acknowledged before me this . ` � • ay of ii ..� 2p I i. , by v t 5c-fig,/c.,/- ' rn fact) for a of authority, e.g. officer, trustee, attorney attbey (name of party on behalf • • om Initnzmeat euted). Personally.Knowa OR Produced Identification, : Notary Signature .1 ...A! e. IL.... d rk..&_ L ) Type of Identification Produced r C-0 Name (print) gb `! 1 • Verification pursuant to Section 92.525, Florida Statufea. •Under penalties of perjury, I dec . e_that I have read the foregoing and that ' the facts stated in it are true to the best of my knowledge and belief tic Q�� 1 _ Si , rm. of -' -- SigningAbov. FORMaMOC,rv.d20g7 - �y _ DIANNE R. BUEG - • . �B Notary Public, State of Florida • • • � Commission* EE 11740 • My comm. expires August 15,2014 - . OR BK 8547 PG 2661 2 of 2 DATE: 05/10/11 PASCO COUNTY PROPERTY APPRAISER 10:41:21 O N - L I N E P A R C E L P R I N T O U T PARCEL -ID: 03 26 21 0010 12800 0000 TYPE: STATUS: A DLA: 070199 SC TP RG SUB BLOCK LOT TRACT: 0330022 L E G A L D E S C R I P T I O N : ASSESSED IN SECTION 03, TOWNSHIP 26 SOUTH, RANGE 21 EAST, PASCO COUNTY, FLORIDA ZEPHYRHILLS COLONY CO LANDS PB 1 PG 55 THAT PART OF TRACTS 113 & 128 LYING EAST OF US 301 DESC AS COM AT SE COR OF SECT- ION 3 TH NOODG 25' 50 "W 23.95 FT TO NLY RIGHT -OF -WAY LINE OF NORTH AVE PER OR 1227 PG 653 FOR POB TH CONT NOODG 25' 50 "W 473.35 FT TO WLY R/W LINE OF FORT KING RD TH N25DG 39' 30 "W 137.85 FT TH WEST (N90DG 00' 00 "W) 177.53 FT TH S23DG 19' 56 "E 135.82 FT TH S65DG 25' 48 "W 242.20 FT TO PT ON CURVE CONCAVE TO NE OF NELY R/W LINE OF US 301 TH ALG ARC OF CURVE RAD 1031.21 FT CHDBRG & DIST S15DG 54' 11 "E 45.00 FT TH N65DG 25' 48 "E 144.52 FT TH S23DG 38' 48 "E 164.62 FT TH S65DG 25' 48 "W 150.00 FT TO PT ON CURVE CONCAVE TO NE OF SAID ELY R/W LINE US 301 TH ALG ARC OF CV RAD 1031.21 FT CHDBRG & DIST S31DG 40' 25 "E 192.05 FT TO NLY R/W NORTH AVE TH S87DG 00' 18 "E 233.28 FT TO POB AKA PARCEL 1 OR 3707 PG 186 Family Dollar- 6020 Gall Blvd- 10,119 sq ft- Headway of NW FI. Inc permit #11453 c.owmn b SQ. FEET PRICE MAIN OR LIVING: 10,119 OTHER AREA UNDER ROOF: - $ 88.00 OTHER: - $ - VALUATION $ 139,100.00 FEE SHEET $ 605.00 ADDRESS DRIVEWAY BUILDING: $ 617.10 ELECTRICAL: $ 136.13 PLUMBING: $ 90.75 MECHANICAL: $ 63.53 SUB -TOTAL $ 907.50 RADON: TOTAL $ 907.50 SEWER: n/a WATER: n/a IRRIGATION: $ - TOTAL: $ - I WATER METER: existing IRRIGATION METER $ FIRE DEPARTMENT FEES PLANS TOTAL: $ 607.14 INSPECTION TOTAL: $ 15.00 PERMIT TOTAL TOTAL: S 622.14 PUBLIC SAFETY IMPACT FEES POLICE n/a FIRE n/a 5% $ - n/a TOTAL: $ - SUB -TOTAL $ 1,529.64 PARK IMPACT FEES n/a SIF'S: n/a 100.0% $ - 1.0% $ - TOTAL: $ - j, TIF'S: n/a Wj' TOTAL: $ 1,529.64 Qd c-4 R32- V + � S 2- . ,S Family Dollar SQ. FEET PRIC MAIN OR LIVING: 10,119 OTHER AREA UNDER ROOF: - $ 91.00 OTHER: - $ - VALUATION $ 139,100.00 FEE SHEET $ 605.00 ADDRESS DRIVEWAY }�� BUILDING: $ 617.11 ELECTRICAL: $ 136.J3 PLUMBING: $ 901 MECHANICAL: $ 6 .53 SUB -TOTAL $ 917.50 building surcharge $ 151.79 TOTAL $ 1,1159.29 SEWER: WATER: IRRIGATION: $ - TOTAL: $ I - 1 WATER METER: I IRRIGATION METER $ / 1 FIRE DEPARTMENT FEES PLANS TOTAL: INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ - PUBLIC SAFETY IMPACT FE S POLICE FIRE 5% TOTAL: SUB -TOTAL 1,059.291 ( PARK IMPACT FEES! - I SIF'S: - 100.0% $ - 1.0% $ - TOT $ - TIF'S: 99% ,%$ (t 3 2— TOTAL: $ 1,059.29 I 9 '{(cI l $ f, 05/ . 813 - 780 -0020 City of Zephyrhills Permit Application Fax -813- 780 -0021 r Building Department ii it / J 3 1- ( Date Received f /1 L 7 Phone Contact for Permittin. V , Owner's Name 1�� irll cf. •r .A Owner Phone Number 7 ( 9922 Owner's Address 3g-O 'h9r o NWT/ 1 Pi-Owner Phone Number 7 P-- - 9 4 • 1b07 Fee Simple Titleholder Name I Owner Phone Number Fee Simple Titleholder Address I � / //,+,�, r /O►I ]� c1 JOB ADDRESS 1 60020 GIG IL. ' ?L4 V 22 44.241-000, r✓ .s 2 cLOT # SUBDIVISION PARCEL ID# I 0 -Z(. -? I4 V - 017...00. 1 D (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR 8 ADD /ALT I I SIGN n n DEMOLISH INSTALL REPAIR PROPOSED USE n SFRi COMM I 1 OTHER TYPE OF CONSTRUCTION r-i /kJ LJ FRAME r- STEEL te DESCRIPTION OF WORK -i-#/ -Teti 0 Y? 0 � �D�JA' i i 6 &J / i 1--77 / y l L6� / k4 BUILDING SIZE SQ FOOTAGE 0 HEIGHT nBUILDING IS q, 6 I V ALUATION OF TOTAL CONSTRUCTION`S 1 3 T. 10 0 . 0L ` n ELECTRICAL ($ I L / O I AMP SERVICE n PROGRESS ENERGY n W.R.E.C. nPLUMBING I$ `./6-0 ° 1O �' i fl , ► , l _‘-i8� 1 n ( MECHANICAL $ / A ,� u Qv „O1 VALUATION OF MECHANICAL INSTALLATION CVO 3 S4S '0'4-- ` L I (�',�� .e€4 sa6S r GAS I ROOFING Q SPECIALTY I f � - -1 OTHER Un FINISHED FLOOR ELEVATIONS • • . • , • r . IMO YES NO ( e_st a_c -1.15 111111 1 1.1' 1� • 11''11'11 • BUII, ,1„0` , COMPANY r- �/ I.' i /.-Itea/ ' / ' 1 1 _to. t / TOCA ' SIGNA • : � /r -. GISTERED =UN ■ �i � ��'��-��� � Q p / Address 602 ,f.`»1,"�tn?��Jr?► ...! i- i 9'3760 License# C6ee 1 S AY sicsV -Sr Q+ _________\) �PiO v p2) - ` a rk ELECTRICIAN ) 1 ' COMPANY 1. /JJ SIGNATURE • ""r REGISTERED I Y / N I FEE CURREN 1 Y / N ' lif ,s ' r Address License # s / PLUMBER - , COMPANY !1 ^ COMPANY SIGNATURE I REGISTERED 1 Y/ N I FEE CURREN I Y/ N I i , 6 5- l U �v skin. s, ^ 2 1 Address _ _ License # - MECHANICAL ` s e _ 4 'wir COMPANY P8 r SIGNATURE REGISTERED MIZE FEE CURREn MEM Address I License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y / N I Address 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 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 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. 1 a 1 Directions: 1 Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C 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 bEED 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 /UT1LITIES 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. 1117.03 A OWNER OR AGENT LA A A... L - CONTRACTOR , / ^e7/" Subscribed and swom to (or affi .) be'. re me this Suybpscribed and swo 4qr affirmed) Wore me is by J -t �( -(I by L([/] m CChv /bp Q r, Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produ as identification. as identification. U� 9 49 1---- 2 - 1 41/1 Notary Public � (( �� Notary Public /� mmission v Commission No. GZ ' - - - - of Florida My Commission Expires Na . - _ -- - Name of Notary typed, pd. - . . sta... -. 0;,;.V. GEORGIA TSANGARIS T3 ►� Rustenber9he aRy �ommbtdon EE0 eigh * ° ,,, 1 commission* `� ommssion N DD 966195 ;,r� � Exprtes 10104!2014 _�.. S RI,,; rs February 28, 2014 NOW ZE HYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780-0044 FIRE SERVICE USER FEES Occupancy No.: /� Plan No.: /'1 - ; Contractor: Ccih co,I /)qei e «1 <ii Business Name: /..' ./.30 / /44 -- Billing Address: • ., i , to Business Address: el; .:41 Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES _ PERMIT FEE _ FALSE ALARM FEE Site Plan - , Annual N/C — Sprinkler $50 _ 1st Alarm N/C 9/ Multi Family /Commercial .06 sf , 1st Re inspection N/C Standpipes $50 2nd Alarm N/C (Minimum Charge $25.00 , 2nd Re- inspection $100 _ Fire Pump $50 3rd Alarm N/C 0 Plan Revisions DBL , 3rd Re- inspection $250 _ Hoods $50 4th Alarm $100 4th Re- Inspection $500 _ Fire Alarm $50 — 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until — LP Gas $50 ` 6th Alarm $200 0 - 25 Heads $50 violations corrected) r Natural Gas $50 — VON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per tank $50 STANDPIPE SYSTEM ^ _ Hydro Undergrounds $45 _ Sparklers $100 0 Per Riser $50 r Hydrostatic Test $65 per system _ Fire Works $500 FIRE PUMP _ Acceptance Test $45 per system _ Camp Fire $25 0 Per Pump $100 _ Hydrant Flow $75 _ Controlled Burn $100 FIRE ALARM SYSTEM _ Hood /Duct $50 8 26 plus Devices 0 - 25 Devices $50 — FIRE ALARM SYSTEM — Place of Assembly 550 amual $100 System Acceptance $50 Fire Protection $25 SUPPRESSION SYSTEMS _ Recall Acceptance $50 ^ Flammable Application $50 Amu al — Wet $50 OTHER — Waste Tire Storage $50 Amu al _ Dry $50 e ,ire Wall /Smoke Wan $15 per wall — Generator < KW $100 _ CO2 $50 ( LP Gas $25 per tank _ Generator >30 KW 150 Other $50 r Natural Gas $25 per system — Bio -Hazard Waste $100 Amu 3I KITCHEN EXHAUST _ — Fumigation Tenting $50 0 Hood /Ducts $50 ^ Tent 10'x10' or greater $15 per tent — Torch Pot/Applied $50 OTHER _ Fire Pump $45 _ Haz. Materials $100 Annual LP Installation per tank $50 _ Fire Suppression $30 ^ Fuel Tank Installation $50 _ System Acceptance (Per Tank) $50 _ Exhaust Hood /Duct $30 0 Natural Gas Installation $50 _ Re- inspection DBL (Per System) (other than annual) _ 0 Spray Booth $50 0 Inspection scheduled DBL and cancelled less than _ _ 24 hours _ Construction Insp. N/C _ Emergency Vehicle Acs a$50 ✓ _ FALSE ALARM PLANS TOTA ' / INSPECTION TOTAL 7 /'5 PERMIT TOTAL [ I TOTAL � GRAND TOTAL Comments: Date: InsiNctor: - :r . , L L, /f ic Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett @fire.zephyrhi1Is. fl.us Plan Review #: 11 -005 Project: Interior Renovation Number of Pages: 16 January 20, 2011 I have received and reviewed the plans for the interior renovation located at 6020 Gall Blvd and will allow the plans to move forward providing changes are submitted with regards to the comments below. Either new plans can be submitted with an attached sheet outlining the changes made within the plans or a general comment sheet can be sent back in letter format indicating the changes therefore allowing attachment to the original submitted plans. This additional information will be required prior to receiving permit. By paying for permit contractor acknowledges to comply with the items below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Page CR, indicates no fire alarm or fire sprinkler system. This building has both and will continue to have both. 2. Page G -1, this project must also comply with the Florida Fire Prevention Code. The Florida Fire Prevention Code will supersede the Florida Building Code in all areas dealing with life safety. 3. Page G -1, Rated walls shall be stenciled in accordance to NFPA and/or the FFPC. Florida does not use the I.B.C. or North Carolina Building Code. 4. Page G -1, during demo, fire safety practices shall be in accordance to FFPC and/or NFPA 1. If either of the fire protection systems (fire alarm/fire sprinkler system) are down, this authority shall be notified or fire watch may need to be established in the applicable buildings tied to these systems. Fire watch will be provided by this agency at an additional cost. 5. Page A -1 & A -2, fire wall shall be inspected by the Fire Marshal and not the Building Inspector. 6. Page A -3, there is a notation about fire sprinkler plans. Fire sprinkler plans will require to be turned in separately with all calculations, cut sheets on all components used and details. Plans shall show how it is now and what the finish project will be. This is required to obtain a fire sprinkler permit. If there is a backflow preventor for this system, it shall have tamper switches installed. The sprinkler system currently covers two other tenants. System shall be modified by installing additional flow switches so that when heads activate in it will indicate where they activated in the fire alarm panel. 7. Page E -1, penetrations through any fire rated wall will be UL listed. 8. Page E -1, address the outside electric panels. 9. Page E -3, Fire alarm plans will be required to be turned in separately with all calculations, cut sheets on all devices used and details. Plans will show how it is now and what the finish project will be. This is required to obtain a fire alarm permit. Panel shall be addressable and devices labeled back to the panel. Strobes • 2 shall remain on when system is silenced. Tamper switches on backflow preventor shall be tied into panel, if applicable. Install weatherproof horn/strobe outside main entrance. 10. Ensure address is located on front and rear doors. Mimi mum 6 inches. 11. A Knox box will be required. Application can be obtained from this agency. Box will be located outside main entrance at a height of 6 feet. 12. Building shall be evaluated for lightweight truss in accordance to F.S. 633.027 and/or Florida Administrative Code 69A- 60.008. This sign shall be to the left of the main door at a height of 6 feet. 13. Additional fees will be assessed with the additional plan review for the fire alarm and fire sprinkler systems. Inspection Required: 1. Firewall Inspection. 2. Final KERRY BARNETT, FI ° ; ' SHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. 04- 06 -'11 15:19 FROM- T -204 P0004/0006 F -462 rluw. u4 /UGILUI•I IJ:u4 SLCO r. uuJluu4 alb - 700.0020 Utty of Lepnymnls ran= Hpphcauon rvM. J-seu A# . D a11 Waved '' bPhsne .. ter y, 1 �-- Own?' Nano r � _ ' . i �� .t;.. Omit Mom Number Owner's Address a) 1r .C_ .. _ , w _. 9 Owner Phan timbre 1 1 ' Fee 8Imp11 Thteheldor Nemo . - Owner Phone Number - - I Fee Simple T1WROlder Address 1 ���� i J os MOMS 1 !® 'a U s lV,d 0�"'•` 1 LOT p 1 - 1 SUBDIVISION 1 — 1 , PARCEL IBOI - -- I toatiamo mow mummy Tam mows) WORN PROPOSED ® NEW COW* Di ADO/ALT O SIGN I= Q DEMOLISH INSTALL REPAIR PROPOSED USE I=1 SFR Q COMM i=j OTHER 1 -. 1 TYPE OP CONSTRUCTION ] ..'' BLOCK © FRAME STEEL ED 1 I DESCRIPTION OP WORK r.,, _ �. _ _ _ SUILPINO SIZE 1 1 SG FOOTAGE v HEIGHT 1 r I • BUILDIN 1 g,, ,�D v I V G ALUATION OP TOTAL CON57HUCTION/ vacs • [ELECTRICAL r 1 AMP SERVICE (= PROGRESS ENERGY I= W.RE.C. QPLUMBING I$ I �°5 (=MECHANICAL S VALUATION OF MECHANICAL INSTALLATION 46j1 1. ..) .. ' I=GAB [, ROOFING 0 SPECIALTY Q OTHER FINISHED FLOOR ELEVATIONS - ROOD ZONE AREA MYR) NO N — -Li/WilliaMWii1►' I" / 31011* _ �sr ►t-, s<,. Mal AM • : W!-0-7•-- D' [ � fEet ` r . .. Lhrousoll WA G It SIGNATURE REGIS EREO 1 ) Y/ N I FEECIAID ( Y I N 1 1 Awes ' 1 /Mineil 1 I • L_____ PLUMBER I R2 SIGNATURE REGISTMIEO r 1urMea ' Address I License it I I MECHANICAL I COMPANY . SIGNATURE rasaallrao 1 1 Y 1 N 1 Fee C+IJRRen I Y1 N 1 I Adores f Llaenee S I I. OTHER 1 COMPANY I SIGNATURE MEaaslenm I Y 1 N I ME Cuter 1 1 I 1M" I 1 Address 1 1 Mange* I . I • RESIDENTIAL MGM (z) PIOt Piet: (2)1411 Of Sulking Plans: (1) sal of Energy Falco. R-0•W Pemdt far nerd Cagbuc0oh,. . fMimun ten (10) wmldp days alter subenlBM dale. Required Mlle, C011511uNkm Place. $lafmwaler Plans tine SIN Pence IRSI$el. COMMERCIAL Attack (3) c sets al Building WPM Plerq pNq a Llfe SOW Meow Ppme. R434 Pant 00 new ooRSlruc BIL Mefmuln len (10)woddng dope alter sabROb) date. Receded mite. . Conseucdon Plena. IMITWsW Puns W SM Fence Insulted. SarOhry Fadddss S 1 diappOW. SIG Work Purmft Mr sI now minty. m COI Metda) ft qulvinntr mwt cowl compliance S IGN PERMIT Medi (e) sob of Engineered Piero. • • ""PROPERTY SURVEY requited for al NEW consebellon. O Peluelpel • Fa eul e0PN00011 comMeleM. Owner S Cod/actor Op era of applibellen. notarised • II over 51000, a Nadea of commencement Is required. (AjC upgrades over 07000) Agin (tor the conVac1 e) or Power of Abomsy (far the owner) would be someone web notarized 1MW from owner •upatome soma . OVER THE COUNTER PERNITTINO (Front of Appeal/on Orgy) Renato it shingles Sewers Sondes Upgrades AIC Fences (PIoNSwvey/FouISOs) • Driveways-Not over Counter If on pubIo roadways..naads ROW • Apr 12 11 01:48p Velocity Electric, LLC 850 - 936 -0122 p.1 8t3- 700-0000 City ofZeph wpm Permit Application F.tts+s- zeaoozl L / Bulking /1 j 1 Dale Mao.w.a linn21.111111. none Contact for .. rr OwswneraltWt. g/ /i ! - 1 f � Owner Phone Number ag Owner's Addns LIVPALataitaidiji (I r kOwrer Phone Number [ 7,-7. 704 - 100'7 Fee Simple Titleholder Name l 1 Owner Phone the1nbH 1 1 Fe• Morph TlMelsolewMews [ ! JOB ADDRESS 6 / ,- a &4LL.. d 0 ,� IAT • 1 I SUB4YIStON 1 PARCEL IDs • ' v • i D 1 I Dlams felkEn7YTAMMOICE7 WORK PROPOSED e NEW CO113111! ADD/ALT CJ SIGN CD ED oEmousH INSTALL REPAIR PROPOSED USE rl SFR gi cOtr111 1:::3 OVER TYPE OF coNSTRuc Q BLOCK lailli FRAIN = STEEL CD DESCRIPTION OF WORK 1_ 'IJ 71 10 it g g !Val Irt OAsi D i aez-i- sua.wNG st>;F [ 1 so mouse 0 HEIGHT 1 1 UILOI CDSNG 1 94, $D0 VALUATION OF TOTAL coNSTRUC {r 1 Tir i d 04 1 EDELEcrR`cAL Is I d 340 I Ave sl3(v10E 1 PROGRESS ENERGY p W.R.E.C. ^ JPLUMBWNG IS 6, 6 0 1 Qpo L i E/1L_ `- ig -1►�y ' ) CDaEcrtAracAL Is j q g VALUATION OF LrECHANICAL sasTALUATION 0 3 se F1 [-7 ROOFING [J sPEcIALTY 1--'1 crn+ER -3~ nam 'S ed 5 Ca SS FLOOR ELEVATIONS i 1 FLOOD ZONE AREA NO es. - Vi` G 1I. 1...11 1 e- a "II .. " 11 .. " .M "IM. t11/t 111/1 �iR�"'T/1� 1 1IwLDER 42 t '2 0 COMPANY MP .1 , I /: er-- 4 o I- ■ - I:I n.1. �a aM t1sIATLRe �fr mum I r. _. ' 13160 LA..: I CC!, 27-q 1 Addr � r ��i f ', � -E ELrECTiactm `� "i � , coi43;' 1 Y /1O.: 676C/ 'ibc, - ° TO SIGNATURE nENa7t#DD I Y N commas (YIN I 41 it s ; e - - cOMPAN -4 I 1 5 0 _ -r i s) SIGNATURE SI - , meows= I Y t N j manes 1 YIN ,134.-----if j�Z J ,� . _ _ I s. - 3 the COMPANY 1 . Q�j Ai 14) SIGNAT1 Sew' ,u ,® I r I N I MECUMS I Y f N I J Address i I Limnos :I I OTHER COMPANY SIGNATURE AtsMSrraa 1 Y f N I rottslilet, i YIN 1 Mena 1 1 Lioettae :I I 11111116 / 111111111111111111111E11111111111111111111 11111111111/11E111 REs1DENIIAL Attach (Y) Plot Pins; (O sets of Bulling Paws: ( 1) sat el Energy Form: R-O-W Pend for newbwWettm % MMmlm ten (10) wetting at& submlttl dab. Required onsip. Canant lloft Piers. Storrnwele( Mans wd Sal Fence etstelsa, Sinewy FerSies & 1 rernpslsr: SIN Wont Petwitftr todegfiristonWlerge paints new COMMERGIAI ten W�+w'N -a days P e=AMIN dots. Required awns. Co +cXn � Fenno. olinlm II Plrr wl Sit Fans Welled. Seamy Fediass 11 drbpsbr. lab went Penn tot ell new pniede. AI cemmetelel rapuiremwes moat meet turnellenue SMG% PERMIT AIWA f=) sated Engllewed Plena. ""PROPERTY SURVEYV.pueed for W NEW construe/kn. Dheclronr FA eutapplllcaEan completely. Owner it Contractor sign back of appeceden. notarized 11 over 1126110. • Nodal off Ce nnsuewnen1Is required 4N0 upgrade weer MOO) Agent (tor ate eaneocmrl or Power or AManey Rorke owner) woukl ba someone win noUrnal letrfoom owner eclhodulng same OVER THE COUNTER passarnme Mont of App Onh) Remote ft shingles Sams Serum Werner AIC Fenno (PIOVSunsyfFae.Se) DewewayuNo1 owr Clunlorl en Debile nadweys..neada ROW 100/00'd ECU 6Z:o1. LLOZ /9l /E0 :ioij Mar.15. 2011 . 8:47AM No.1839 P. 1 City of Zephyrhiljs Permit Application N.......,......,0 � Buddha) D.pettrftent r 1L Date R.e.ived 1 / " t r Phone Contact for PennIWn •. r J J • ten• rr�� Owners Name 1 f ,..� l, ._+ p i Own.. Phan* Number 2. - . • / • 4 Owners Address 1 O %Lkh (4 t afar ix t Number Phone Nber 17 �.�. 7 6 • t Q1 Fes Simple Titleholder Name L _ I Owner Phone Number 1 1 Fee Simple Tlq►helder Add { - J OB ADDRESS 100._ 7 &G1L 41,1 ■ 2 r L. . 1 LOTii o • _ �, . y ' „...., SUBDIVISION I P ARCEL )br a ^,.+ - V old - O'll2 ... 101ITAINE0 FRO. PROPERTY TA% NOTICE) WORK PROPOSED B ...... NR CY I ADD /ALT SIGN Q Q DEMOL15H O INSTALL © REPAIR PROPOSED USE ED SFR MM f OTHER EgarMgdMieggi TYPE OF CON9TftUC1ON {:::1 BLOCK JJ COMM © N � STTE • EL p • �/jJ� .� DESCRIPTION OF WORK I 7� K. 0 te G AiOU, L 1 6A.,r 1 v"'�' ” / y I e 1 B UILDING SIZE I I SD FOOTAGE o . HEIGHT I 1 FiSUILDING 1$ 9 4, a90 I VALUATION OF TOTAL CONSTRUCTION 1 3� 1 0 d . t) 7 - V 1 r • EJELECTRICAL I9 I 6 jSoo I AMP SERVICE 1:73 PROGRESS ENERGY F En W.R.E.C. QFLUMBpNO 1 4/ 0 1 CVO ` % fs1L - t - 16 1 ) Q MECifANIOAL S / A, VALUATION OF MECHANICAL INSTAUATION 1 x r3 P104- , VV QGAS © ROOFING 0 SPECIALTY [" OTHER S . • FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =ES NO ( .) af,„ 014_ - ' - 1i ""6--"1-1---'11 III 11.1,1Ie1-'a--• •--' _-.- r1 - 6Ii . S IIG N ATTURE �J � I i d� r �'" �� f / ._ i Item 01 4 I Address 1 3r14 q 4heralml[ br, 014,0441 4_ 13760 Licenses I Cher 0 '2.29/2 I y y �� ELEc RIciAN comeANv i 6J SIGNATURE ezmete I Y/ N / FEE tern L Y/ N 1 I Addresss - -. •wI �.1 , — / t w es�..�_ �AJ e - 1 1 � te 'PLUMBER ',` - /I., / ^1 COMPANY 1/' t/IF' Trf e d r Ci 60^ T SIGNATURE . "A4 G il % 1 RE 1 Y N 1 FEE&AREA • i , .� -3 e w �.1 , �� .�_ a _ ' a -- t t , e�r.e. I fe �l.,esr -- 1. MECItANICAL Sep _ 1 "wet COMPANY SIGNATURE I REGISTERED ® PEE t91RREl, WEE Adam* 1 - . 1 License h1 1 OTHER COMPANY l ' I SIGNATURE 7 D Y/ N f Fa RET cUR 1 Y I hi Aridness 1.,. J Cleanse a 1 • 1 11111111 1111111 I11I11111111111111( 111111110 11111111111111111111A1111 RESIDENTIAL A14d, (2) Plot Plane; (a) sets of Building Plans: (1) set of Energy Farms: RAW Permit Ter new cbnssbuction, MifiMern ten (10) working days after mantes! dale. Required ensile, C,aulruction Plana, Stohmvrfer Plans w/ Silt Fence installed, SanRary Fadllhes a 1 dlmpahr: Sas WofIi Permit for subdivision:dirge projects COMMERCIAL Mach (a) complete sets of Building Plena 1711e a Life Safety Page; (1) Sat of EINryy Fortes. R•O•W Permit for new construction. Minim.n ten (10) working asya stlx subs tot Me. Remand mile, Ceratraalen plane, Slormw lsr Pions wr S1t Pence trlstalad. Unary NON* 51 dumpaht. Sae Work Permit for all new pmjcct.. Al commercial requirements must meat compitance SIGN PERMIT mad, (2) sets of Engineered Plane. •""'PROPERTY SURVEY maims tar at NEW construction. 1 101 1 1 1' 11111111111111 `iIIIIIIIIlsIa1as . aia`"er1 � Fill out epplcatlon completely. Owner 5 ContrRtlw sign back of application. notarized Hovey $2100. a Notion of Corrpnencement le required. (NC upgrades over ;MO) •• Agent (for the contractor) or Power OrMornay (for the vow) would be someone Wier motorized letter from ouster auVloredng same OVER THE COUNTER PERMITTING (Fiord of Apple? lion Only) Ronan: if shingles Sewers Semite Upgrades NC Fences (PlovSurveyfeotage) Pr(vewaya Nat over Counter if era public roadrgrys..nceds ROW • 100 /L00'd 9U# 1.1.:£L LIU /bl /£0 :1110ad FROM :Jefferson Mechanical Services FAX NO. :352- 795 -1350 Feb. 9 2011 4:47PM P1 atIllaraftwotbuto /1 fi a worPliw.ar. t 72 - FrtmAttestAilialleitdongim t t ontronttmetttototor [ t 1 — ......a F - r �" . ; a = ,.. ur in era®rwaa L menaimMINIE CI an ® mar oneariactsur ® 9 D afficomnatareenumr t "Tf41O1r ifinintiffirIOA/ - r of vittammaironnui. 1 .24r ID it 01) tElawerawam eswaseree irm wiggagglieiffiffsw ® mum MSS CI MIMS ® SOlEitreinr 9 morale will S ` b E.n. _ .�._E i NMaaa 1 7 - ! j , j VA smumig 1 COMM 1 VIrSa1 0 Irmo II I D 0 i awu«aIMA dower II ab t amass® p w' m t aa=m., p Irma 8 Alamo I I J ra.ee it I �� �.,r i in p Ica-4 %eta 1 ,1- n. C. ' Iw MINIM= ./- 1 .rrnffN. t4 .. __ T* L Y4I-1 d t d omen 1111.1111111111111.111 a mo, I �® D p Irr ■ f .nt®.a, p roar I • r•••••••••• a■•• a• a•■• r••• Mrr••s•••••■■•a■■aa•iraa•r••a.a ase.wtaas• w"a`.� adavwa+a e.aa•evawds�era*rasi .�'O '�"iRimasawrrfAAAwi p, cif wrx Irr�aia.oYr raraaalYi aea - . ""7Ra warA&Thwitr morattreara. , dlwarll .a Is etrio r - dwaqtArshoabe aeBRaw rrooaarrm.rrs M s 91.ammilbo.r,t de r s(40110AtomomUltue IX Result Report P 1 • 04/06/2011 13:05 Serial No. AOEDW11001438 TC: 18048 Addressee Start Time Time Prints Result Note 918504602021 04 -06 13:03 00:01:40 004/004 OK THR Timer TX. Pollinngg 86� :: O 7 ri fina Si Set ME: Frame E Note BN DO S1d 0 r ecti o n1 S Speze cial ti nngg F SO iggin -cod R TX : Re -TX. RLY: Relay M X Conf BUL: Bulletin SIP: SI Fax. IPADR: IP Address Fax. 1-FAX: Int Fax Result OK: Communication OK, S -OK: Stop Communication, PW -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M Full:Memory Full, LOVR:Receiving length Over, POVR:Receiving page Over, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. 1. C ity of ZephyrYiills: Building Department Phone: (813) - 780 -0020 -.41414111.1111141114\ Fax: X813)- 780 -0021 TO: Jeremy FROM: Bobbie PAX: 850 -460 -2021 FAX #: 813 - 780 -0021 DATE: 4/6/2011 # OP PAGES: 4 including But cover MESSAGE: I decided to give you a fax cover sheet so hopefully there wouldn't be any confusion on What you needed to do_ First, we need to get you registered which page 2 will give you our requirements_ Then you need to complete the 5 circled items on pages 3 8c 4. Once these items are all completed you can fax information at permit application back to us and you should be good to go. Please know that after that we still will need a certified copy of the Notice of Commencement and fees to be paid of S 1 , 529_65 before we can issue the permit. If any questions please do not hesitate to give me a call, 813 -780 -0020, ext 3512_ l e 4 : ;v weito City of Zephyrhills: i,,,,O' Building Department Phone: (813)- 780 -0020 Fax: (813)- 780 -0021 TO: Jeremy FROM: Bobbie FAX: 850 - 460 -2021 FAX #: 813- 780 -0021 DATE: 4/6/2011 # OF PAGES: 4 including fax cover I I I I MESSAGE: I decided to give you a fax cover sheet so hopefully there wouldn't be any confusion on what you needed to do. First, we need to get you registered which page 2 will give you our requirements. Then you need to complete the 5 circled items on pages 3 & 4. Once these items are all completed you can fax information & permit application back to us and you should be good to go. Please know that after that we still will need a certified copy of the Notice of Commencement and fees to be paid of $1, 529.65 before we can issue the permit. If any questions please do not hesitate to give me a call, 813 - 780 -0020, ext 3512. I I I I 7 f I • I I I 1 I I 1 j i I 1 I I 1 I I I I I I I I I 04- 06 -'11 15:19 FROM- T -204 11001/0006 F -462 UIO NW :FIORIDA INC 981 HIGHWAY 98 EAST, SUITE 3 -261 DESTIN, FL 32541 -2525 PHONE: (850) 460 -2020 FAX: (850) 460 -2021 FACSIMILE TRANSMITTAL SHEET TO :BOBBIE FROM: DAVID WOOD, JEREMY HARTFORD COMPANY: ZEPHYRHILLS BUILDING DATE: 4/6/11 DEPARTMENT FAX NUMBER:813 780 0021 TOTAL NO. OF PAG 8, INCLUDING COVER: PHONE NUMBER: 813 780 0020 SENDER'S REFERE CE NUMBER: RE: YOUR REFERENCE NUMBER: NOTES /COMMENTS: Attached is a copy of out GC License, tax, Authorization letter — The worker comp and general lib. Should be coming from the issuer shortly. • ,04- 06 -'11 15:19 FROM- T -204 P0002/0006 F -462 Q F N. W F L : -.O• :. •.:1 `:D. ';A`; 0: .' :[� INC .0 O M.f A hJ.C`T:1 O H .'S E1$tt`i :01. • A:N H• 1:E>a�: .i.1..M11 " E.NA R si i ii' � c I� • A .W;°MA N OW M.E.D:.S�iNA tcoils IN'E'.SS • . • • Date: 4/6/2012 To: City of Zephyrhills — Building Department. Headway of NW Florida (CGC1518898) (EIN 20- 4179116)Here by authorizes Jeremy Hartford an employee of Headway of NW Florida Inc. to be an authorized signer, pick up, permits, call for inspections, etc. for Headway of NW Florida, and it's License Holder David A. Wood. Should there be any questions or concerns please contact us at (850)460 2020 State of FLD,fr'/ of O �ty - �. day of + •- � e persnall'Y ap arson � 1 Day' A. Wood to me knoovn to be the P ; sident foregoing instrumen and ackn executed the executed the sum is C 9�cd that he SEAL (signed) L� . r N. r , I � � DANIEL L . HARTFORD MY COMMISSION o EE043742 '• r EXPIRES November 21, 2014 1 <07'l3N.Otdi RlordaNOla : e rWC.,ce m Headway of NW Florida Inc. Office: (850) 460 2020 981 Highway 98 East Fax: (850) 460 2021 Suite 3 -261 Headwavta headwavnwfl.com Destin, Fl 32541 Check out our website www.headwavnwfl.com i • • '445n•V‘W '1 - ' , ' S , iN r ' • 4'.11C r f r ,/,, , .1, (S, ‘•,( „,. ''' :'■';',44'..., , 0 li .W, !".., ,,14;,;. otithT, „,f----,v+ , m ....• 8 8 8 0 CP • L % Y -0 T, - .Tfi ,■ -.. V1 i 4 ,., . . § 2 'a ••'. , ' IN ,A 15 ( yt `‘•--•-- . N , -4 x Ok -. .it k i , i'5V .,1VW . . k,' 4 ,AL.: 0 0 tr; d tit , . ! '-7.;r.i., Pit A1 ---1711- -is - 46 .1e. 2 )- 2- V fl a ; ,,, ( '',A - • t,,,..7,.,c4 '1g:; . i' - c:, di a. • 0 cr) Z . a. 1 0 0 , 4-1, ,fr, 0 ... im • .7 ... i 4 • . 1. 4: . 4....4: ( ,. ,( — ti 8 .0' 1 ' 1. - p'tEl , 'i' ,, - OS:. 0 1` A k .:.,,”' , ';'-.q c- , to E = •''' - ' 4 1 r , .crAr.r., _ , •.4 • r, V 0 g Rini' 4" ...?.cFce vh,, , k .., t „ z 0 6 IN z 1 # $ ' - -- k ■r• ' ' t r tr - , , ' " ' 17 . . a - , Q ' 4")+W.7 4.1 '‘V - ..' 1 1 1 1 H . w , Ea if —. tR iBiRo 2. ' , '''4 . k. 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't71'4 . ; - ,,,te 714, `K.• ,, ;,,ir' /7 Or idt■ ''',4"4 .,,i4 r • 9000/£000d D03-I -1 61 : SI IT ,-90-f/0 39D.-.3 • .04- 06 —'11 15:20 FROM— T -204 P0005/0006 F -462 A � C o RD CERTIFICATE OF LIABILITY INSURANCE q /6� p1 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 far. CT Lindsay Johnson Heritage Insurance Services PilN1 cm . (941)723-1400 ! a Ned: (My 723-1440 uamYO , 1009 10th Avenue West A� 1 P 00000040 Palmetto FL 34221 INSURERS/ AFFORDING COVERAGE NAIGI INSURED INSURERA:United SDeCialt y Insurance 12537 INSURE a :Cosner • _ • nd Indust Insurance Headway of NW Florida Inc INSURER C: 981 Highway 98 E INSURERO: Suite 3-261 INSURERE: Dentin FL 32541 -2525 INSURERF: . COVERAGES CERTIFICATE NUMBER:m. 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 IMTH 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. ILNTSR TYPE OF INSURANCE IM wyll POLICY NUMBER IM IMMMIUD EXP LIMNS GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABILITY PREMISES E S 100, 000 A I CLAIMS-MADE © OCCUR S.L 3492610 - 8/23/2010 8/23/2011 MED EXP (Any oneuereon) $ 5,000 PERSONAL BADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE UNIT APPLIES PER PRODUCTS - COMP/OP Asa S 2, 000,000 GE 1I POLICY f ,sa I I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Es ac de t) _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S _ HIREO AVYOS (Per accident) — NON -OWNED AUTOS S S X UMBRELLA LIAB OAR EACH OCCURRENCE $ 1,000,000 ... EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 _ DEDUCTIBLE Y .—... $ -M 8 RETENTION $ 13E044052654 3/9/2010 3/9/2011 C a WORKERS COMPENSATION I T A tic I I OT AND EMPLOYERS' UAa1LITY ANY FROPRIETOR/PARTNEIVEXECUTIVE YIN E.L. EACH ACCIDENT S OFFICER/MEMa4R N (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, 5 OES IDN OF OPERATIONS below E.L. DISEASE • POLICY UNIT S DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more Mace fe regulnd) CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephryhilis ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 5335 8th St AUTHOWZED REPRESENTATIVE _ Zephyrhills, FL 33542 David Clements /SARAH ACORD 25 (2009109) 61958-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD 04- 06 -'11 15:20 FROM- T -204 P0006/0006 F -462 Acaforr CERTIFICATE OF LIABILITY INSURANCE DATE 106 /O O DIYYYY 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 OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BEWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the poiicy(ies)must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require and enddorsement. A statement on this certificate does not confer rights to the certificate holder in Lieu of such endorsement(s). PRODUCER Risk Concepts Corporation CONTACT NAME: 410 43rd Street West Suite N PHONE NUJO E• 877 -746 -2208 IPAx ' No): Bradenton FL, 34209 PRODUCER Cl/voile:9m INSURERS AFFORDING COVERAGE MCI INSURED INSURER A r Rc,ullWn Fehr. Incur nce (:"Want( 10151 Administrative Concepts Corpora tion INSURER B ; Alters A AA 319082e 406 43rd Street West INSURER 0 I Amlin Bermuda A AA 1480019 Bradenton FL, 34209 INSURER o r Aspen,iryTUranos UK Ltd. A AA 1120337 INSURER 5; Cam Bermuda ' A AA 3194161 I NSURFdt F : Uoyds of London A ,AA- 1122000 COVERAGES CERTIFICATE N R : 4 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, INbK • F OF WAN .. NM NUM EPF POLICY EXP PEA KW NIMAFR LIMITS GENERAL LIABILITY — COMMERCIAL GENERAL LIABILITY EA CC R_ S --'1CLAtM9 J OCCUR MEN ERP m one wr _ PERSONAL R ADV INJURY s ZiERLA GENERAL AGGREGATE s — � POLIcYn 7 .. PRODUCTg.COMP/OP A40 s 111 S AUTOMOBILE LIABILITY COMBINED SINCE LIMIT ANY AUTO (Ea aoddenq S — ALL OWNED AUTOS BODILY INJURY (Per Parson) $ SCHEDULED AUTOS MULELT INJUNT(Yen _ HIRED AUTOS E (Pe NON-0NAJEO AUTOS 5 — — _ s ...... 5 UMBRELLA Le IA OCCUR EACH OCCURRENCE S _ EXCESS LIAR CLAIMS MADE AGGREGATE 5 DEDUCTIBLE 8 $ RETENTION $ �� — s A WORKERS COMPENSATION • $• OTK AND EMPLOYERS• LIASILITY �' X iuTATVu.ve TORY JJ 1 i e N ANY PROPRIETERIPARTNP CUTNE N /A El. EACH =away OPFICEWMEMeER w eXCDEGV 2011 02882 - 000 01/01/2011 12/31/2011 S 1.000000.00 (M'nMSNfy In NN) E.L. DISEASEEA EMPLOYEE $ 1.000.D00.00 n F yes roirrn describe ender n EL DIEEASE•POuCv UMIT $ 1.00000908 ccralrrnnu no no►anT,nus ...1,,,,., B C Workers Compensation Please note that Soumem EvO a Insuranoe Company has reinsured it's fiabSbOe in axeass of $250,000 under the poheies a D E Excess Coverage Insurance listed above will the underwriters limed A- or better at the time of placement of such reinsurance. Such Mirturance 8 are subiect to their own terms, oondftlons and Omits. TIM it for iMOnnafional purposes and nothing shall create a v note( under such relnsuranae. DESCRIPTION 08 OPERATIONSI Lacs:nor / VEHICLES (AMMO *COR0 101, Additional Romans Schedule, If more spats Is raga wee) Effective•. Coverage is Wended to the leased employees of alternate employer (Florida Operations Only): 09/17/2010 081416 Headway of NW Florida, Inc. DISCLAIMER: This Certifiers* of Irw a nee does not Constitute a contract between the issuing Insurer(s), authorized representative or producer. and Me oeni$vate holder, nor does If alamlafiwly or negaINay amend, exIend or alter mo coverage afforded by the pohdea Ilsted mason. CERTIFICATE HOLDER CANCELLATION City Of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE mu. BE DELIVERED IN ACCORDANCE WITH TIE POLICY PROVISIONS. 533513th Street AUTHORIZED REPRESENTATIVE ZephybillS FL, 33542 __ `., Fax1t: (813) 780 -0021 ACORD 25(2009/09) 751 - 20110406 • Jacqueline Boges To: James Jefferson Subject: RE: registration info Greetings James, In reference to the $30.00 fee I do believe your license is a Department of Professional if that is the case we do not charge for any professional licenses. Pay attention to line #9 . I will email the application per your request as soon as I get the company registered. No problem I can manage that. Thank you From: James Jefferson f mailto: jeffersonmechanicalservices2008 Ctyahoo.coml Sent: Monday, February 07, 2011 8:06 PM To: Jacqueline Boges Subject: Re: registration info Thank you Jackie, can I pay the $30 fee by check or credit card over the phone or online? Would you be able to email the application? Bo Jefferson President Jefferson Mechanical Services, Inc. 9385 West Green Bay Lane Crystal River, FL 34428 352 - 795 -1350 phone /fax From: Jacqueline Boges <iboaesCaci.zephyrhills.fl.us> To: jeffersonmechanicalservices2008 (yahoo.com Sent: Mon, February 7, 2011 4:33:30 PM Subject: registration info See attachment for register . Once your company is registered with our jurisdiction I will fax over the application to add you company on as mechanical for the job. Need to make sure can get fax through it only takes seconds. Thanks Jackie Boges Code Support Specialist ext. 3513 1 Jacqueline Boges To: jeffersonmechanicalservices2008 @yahoo.com Subject: registration info Attachments: contractor certificat.docx See attachment for register . Once your company is registered with our jurisdiction I will fax over the application to add you company on as mechanical for the job. Need to make sure can get fax through it only takes seconds. Thanks Jackie Boges Code Support Specialist ext. 35 1 Mar 14 2011 10:40AM LOGAN INSURANCE 8504380085 p•1 ACORD CERTIFICATE OF LIABILITY INSURANCE VE OC DATE (MMIDD/YYYYI 1 03/14/11 PRODUCER 11118 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Logan Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3801 North 9th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pensacola FL 32503 Phone :850- 438 -1449 Fax :850 -438 -0085 INSURERS AFFORDING COVERAGE NAIC # 'INSURED INSURER A: Southern Insurance Company INSURERS: V locity Electric, LLC INSURER — Navarr FL 3256 INSURER D. — INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLI�C ■1BIt mum. POLICY NUaIEER WAIN/ (IEWDD1 a11 E �RA71QN LIMITS ,HERE TYPE OF INSURANCE 1� �1 GENERAL LIABILITY EACH OCCURRENCE $ — DAMF.L L IU Ntr 1tU COMMERCIAL GENERAL LIABILITY PREMISES (Ea occ wence) $ ] CLAIMS MADE I I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMB APPLIES PER PRODUCTS - COMPIOP AGG $ — 1 POLICY f 1 I UOC . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per acc dent) NON-OWNED AUTOS PROPERTY DAMAGE $ 7 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY , EACH OCCURRENCE $ OCCUR I� CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WL.SIAIU- UIH- WORKERS COMPENSATION AND I TORY LIMITS I ER IJABILITY SIC0013333 -01 08/03/10 08/03/11 E.L. EACH ACCIDENT ,4100000 A ANY PROPRIETORIPARTNERIEXECtTfIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100000 Hysa �IAL PRVISION deacr O e V u l r er S beIa E.L. DISEASE - POUCYLIMIT $ 500000 SPE OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIO ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION CITYZBP SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN The City of Zephyrhi lls NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL Fax: 813-780-0021 IMPOSE NO OBLIGATION OR LWBILFTY OF ANY KBD UPON THE INSURER, ITS AGENTS OR 5335 Ace Street Zephyrhills FL 33542 REPFU.'SENTATIMES. AUTHORIZED REPRESENTATIVE j ` Kelly M Pierce L ACORD 25 (2001108) ACO D / RPDRATION 1988 !: DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION k..�� 4', ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 4, p TALLAHASSE STR FL T 32399 -0783 WEBB, STANLEY DEAN \;; VELOCITY ELECTRIC LLC z 2780 RIVER RUN ROAD NAVARRE FL 32566 ,_ STATE OF FLORIDA AC# 74! Congratulations! With this license you become one of the nearly one million 4 ' A D,EPAR� OF BUSINESS AND ' Floridians licensed by the Department of Business and Professional Regulation. ' v Our professionals and businesses range from architects to yacht brokers, from � Kr PROF'Si?i�?' $EATYAhi boxers to barbeque restaurants, and they keep Florida's economy strong. ER3.30142 7 4,6 /11W2..4 . 09817792 Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfloridalicense.com REG ELEC„r ; �CTOR There you can find more information about our divisions and the regulations that - T+EBB $ , .�'" ,. impact you, subscribe to department newsletters and !eam more about the VELOCITY ' � + C Department's initiatives. I<,INffZ'rT eta • ',ta , � I' ALL LOCAL c a e 1 . . PRIOR Our mission at the Department is: License Efficiently, Regulate Fairly. We TO CONTRACTING ,ZNTANY AREA) constantly strive to serve you better so that you can serve your customers. $REGISTERED ;yua®r the provis oas gt ch.48 Thank you for doing business in Florida, and congratulations on your new license! ; zatigd date AUG a .- 2012 1,10081801005 . DETACH HERE STATE OF FLORIDA IDA DEPARTMENT CT C AL CO RACTORS LICENSING C BOARD ON DATE BATCH NUMBS LICENSE NBR ` . ` , 06/18-/201,0 098177925 ER13014297 ' The ELECTRICAL, CONTRACTOR Yr � ` Named below HAS REGISTERED f Under the provisions of Chapter a� 'Br. , Expiration date: AUG 31, 2012 . , "`` ,' (INDIVIDUAL MUST MEET ALL LOCAL I . SI +IG REQUIREMENTS- " PRIOR ' TO' CONTRACT] NG ) WEBB, ' STANLEY DEAN - -'-.'.".,1, , -.4 , ''' ' VELOCITY ELECTRIC -_LLC •f "I` 2780 - RIVER RUN ROAD NAVARRE FL 32565 v `` CHARLIE CRIST — CHARLIE LI ) GOVERNOR- 'INTERIM EEY DISPLAY AS REQUIRED 3Y LAW F Vit Santa Rosa County COMPETENCY CARD 6051 Old Bagdad Hwy, Suite 202, Milton, FL 32583 CONTRACTOR NUMBER: ER13014297 CLSS: Master Electrician CONTRACTOR NAME: STANLEY D WEBB DBA: VELOCITY ELECTRIC LLC ADDRESS: STATUS: Active STATE EX: 08/31/2010 2780 RIVER RUN RD, EXPIRE DATE: 10/1/2011 TAND REC # 005181 NAVARRE, FL 32566 WC EX: 08/06/2011 GEN UB EX: 05/21/2010 Santa Rosa County COMFE7MCYGIRD 6051 Old Bagdad Hwy, Suite 202, Milton, FL 32583 ER13014297 Master Electrician STANLEY!) WEBB DBA VELOCITY ELECTRIC LLC 2780 RIVER RUN RD, NAVARRE, FL 32566 STATUS: Acute STATE EX: 08/31/2010 Expire Date: 10/1/2011 TAN REC # 005181 WC EX: 08 /06/2011 GEN UB EX: 05/21/2010 w I" m m a � co n m O) W '^ In CD c co c CO 11 - � � �/ L r f0 1 C a E (Q U r O LL n Owl ` Y E �W E CO 1 J E Z `� a) o =b a) co U c L T, 4-, c U) J �o N • \\ \ mm / k o « ) \ m o 8 $\ \$ i ■° T. 0 m \ 0 $/ �q $ R VI \ k 7� r t � z �I k qz �\ �� \ 0. ? 2 K �� 0 r 0 \ § t / ) » « S 0 � n 3 2 2 $ r m C Z ° m ez s - \ \k \ 0 i 0 tr z e Z. o ril 0 cn r. \ k \§ ! � \ ^ ril tri . \\ 7m / *2 Pt /} � f \\7% $ no � � 2 I 2 § > Id 3 0 ? f \\ k k w oa ` \ — k / 2 a ----j FROM :Jefferson Mechanical Services FAX NO. :352- 795 -1350 Feb. 9.2011 1:29PM P4 V 6)\ Y Jefferson Mechanical Services, Inc. 9385 West Green Bay Lane Crystal River, FL 34428 352- 795 -1350 phone /fax Jeffersonttechanicalservices2008 @ayahoo .corn PERMIT AND LICENSING AGENT AUTHORIZATION FORM I, James A. Jefferson, Jr. , license number CMC1249927 owner /president of Jefferson Mechanical Services, Inc. HEREBY AUTHORZIE DANIEL K. MANCINI AND /OR CRYSTAL S. JEFFERSON TO ACT AS MY AGENT AND SIGN IN MY ABSENCE IN THE CITY OF ZEPHYRHILLS, FLORIDA. This authorization is to remain in effect, unless cancelled in writing by the license holder and notarized. r V 0 J es A. J Jr_ State of Florida County of Citrus I hereby certify that on this day, before me, as an officer duly Authorized in the state and county aforesaid a acknowledgements, personally appeared James A. Jefferson, Jr. who i(personally known to m has produced as identification an who did / did not take an oath. Witness my hand and official seal this GT day of , 20 a • j/Yt/►�oL N P ublic • AFFIX NOTARY SEAL t. - groom I� M FROM :Jefferson Mechanical Services FAX NO. :352-795-1350 Feb. 9 2011 1:24PM P2 , . STATE OF FLORIDA , ,.. ‘,--; ---- v * .,..i. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 4 :1 ''...,,, q ., ••+ 1 ' ' e\— CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ., ' No- 1: 1940 NORTH MONROE STREET 4 •z_,.yr TALLAHASSEE FL 32399-0783 JEFFERSON, JAMES ALAN JR JEFFERSON MECHANICAL SERVICES INC 9385 W GREEN BAY LN CRYSTAL RIVER FL 34428-6044 • . ... . . • 1,..7,--.„ , '-‘4 - 2-' , 7 - - C" \ , ,,V,';' , :fre 7 .;,.7i-.7.?■,... ,W.. _„. C,"" 0 I f, „ i _ i ■ 1 .:-_,.•0 „Ip, _■,„..1'. t, ,',: .,c•- — , , 4 .. ),, q...,..4„,6,0.nt_•9'...'- ..... .1. ' Congratulations! With this license you become one of the nearly one million .,,ye Floridians licensed by the Department of Business and Professional Regulation. . h - , , ..1_?‘;'"'-7, s7.1-.; ''''.,: .- ri T`' :-)... : -- - ',, Our professionals and businesses range from architects to yacht brokers, from - .4-5f.- 41 , _ , !-!?: ,, ir• ..,..1 .1 (ET q'.. 3,5) ' --er- boxers to barbeque restaurants, and they keep Florida's economy strong. _ , . _ . --7i. -ii- -• 4 . - 4.,;:•;;WII.': . :;"46 1. ' Every day we work to improve the way we do business in order to serve you better. ,,, , _..., , „? „•-•,\ 0.h For information about our services, please log orrto www.myflorldalicense.com. • - f ,:.• . ; • -■ 'f,, ' ,, ; IA • , There you can find more information about our divisions and the regulations that '. , 5-;. ,,4, „-,-,,,,, i ,..- , • 21 impact you, subscribe to deparbnent newsletters and !earn more about the • ...- — . ', . ',:-. .T , .7 //.. •-'4: - - .-.. .. , Department's initiatives. t, .-=)i-.V:',:`, YZ•••;",• -,,, ...r... , - $'44;;*.- ,k--:t . -..... 4' __ • " , ,„•:-..-, .' ', • • - , _ „ .„,', Our mission at the Department is: License Efficiently, Regulate Fairly. We .i-';',r," . W.,IJ', Goa ws "ti constantly strive to serve you better so that you can serve your customers. i'!,,- traT. - '' tp. .,) -''t4t - - ';0 : /t • - , ..,'. ,., .,-,;•-•,..:-.. „... - , .1. ,,, ., ,, „.. - -s, • Thank you for doing business in Florida, and congratulations on your new license! • - ,.&S- . _x , -,,•-•'‘, ,... .„4'-e,....-1 : ... - .„: 4 ( ,- "Jr/fel r " - •.fir3rA''''IC:..." •.-.. . 14 DETACH HERE — •• • . .,. - • . ,- ir. -, q,-,,,,%„-, --- tt-,613fi -- --...w - r,g ,-- - - TY,A;4,- , ,...,„ - .,. . — — , - ‘,..-.., - . --,- ---• - --- r--- ,,.5)!r.,,,,.: ., -, 4'.- - 7' - )'' .44.•-it' -,'.- - •:'C'' '1 „• ..r ,,,, ,tf • •(*r, • ,„__...,.,,,,,..„._.„ „..,_., ,,--=' -„u_re;71.ity-lt.-9. _,-A.-,,..,:,--....- ij._1-A=4.- , 1-4... 1 II' _4 *,__ ' •: 0.A. . t..P..".4 ' ' ,3 ,2. . . --„„*-,- ...t,i.7-- 17 ly.,4 04, _ , -,, , T, , • .,- . t .• ,s el-'1 . -,, - '4 1 .._ .4A _ 4 , s _ vi . j .01.,„, , f, ,. 6„ 4. t ... v e..:. .7, ,cateriA,•rtt*--,,,-,, _ ,,, ,.. ,-- 4. , ,■• 4,', ,, •,.., ,• • - ,'N'S +7 *. , _ r . 6,4 t V " '',/ '- 4' i A' ' ... ?4 ".. l '•2k ' 1 ' 2)" '''- 4 A.M . 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Apkar.4i,----.., ' ..r„ , 5 ,.,: t e:72 4 ',...,s2:'7,Pai›.. 2°9 :"..f.: : ,.; ; -.* ;:.,..V.1 . 11* - 7)••• •• igt ,44111'-''',' , 4b. -4 11. / • . 3 .• ..'":' ''''''- .. !"- " ''' -. • '. ' -.----- . - .. 4, ..' •!" -2 $ ....% :" ' ''..-/ 1.-2.,.. '.....&,:/ - ;`,-”-- ''.'' ''''k ."'.-,.'' `I'Ll.l'. ---... V . V' FROM :Jefferson Mechanical Services FAX NO. :352- 795 - 1350 Feb. 9 2011 1:28PM P3 " > 11 -01 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 4F * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW fF CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Wmkers' Compensation law. EFFECTIVE DATE: 12/1212010 EXPIRATION DATE: 12/11/2012 PERSON: JEFFERSON JAMES A JR FEIN: 770720908 BUSINESS NAME AND ADDRESS: JEFFERSON MECHANICAL SERVICES INC 9385 W GREEN BAY LN CRYSTAL RIVER FL 34428 SCOPES OF BUSINESS OR TRADE: 1- HVAC CONTRACTOR 2- REFRIGERATION IMPORTANT: Perseem re CM■pur 440. 05(141, F.S., se officer of a corporation who deck exemption Irem this dopier by filing a cerrnncate of *lectioe ender this entitle may net recover benefits or cempe1salion ender this chapter. Persnoot 10 Chapter 440.05114, F.S., Certificate* of election to be exempt,.. sooty only Lenin the scope of Ibe business or Crude listed on the entice of 0101001 t0 be exempt. Pursuant to Cbepter 440,06113), F,O., Notices of election to be exempt 01d cmtNlcmes of ele1i00 to be exempt shall he sebjett to revocation II, at soy time liter the lilfog of the wee of the Imam of the calif icete, the person named on the eotice or certificate oo longer meets the regoiremeas of thls section tor intone of e certificate. The deportment shall revoke e certificate et spy time for Whoa of the persa earned en the certificate to meet the orpiment; of this section. QUESTIONS? 1850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 - 06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES F t -' ; (r DIVISION OF WORKERS' COMPENSATION i > Pursuant to Chapter 440.05114), F.S., an officer of a corporation villa CONSTRUCTION INDUSTRY '' elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA Q q L under this section may not recover benefits or compensation under this WORKERS' COMPENSATION LAW D chapter, EFFECTIVE 12/12/2010 EXPIRATION DATE: 12/11 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON JAMES A JEFFERSON JR 12/11/2012 H Pursuant apply only within the scope of the business or trade listed on FEIN 770720908 R'the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt JEFFERSON MECHANICAL SERVICES INC and certificates of election to be exempt shall be subject to revocation 9385 w GREEN BAY LN if, at any time after the filing of the notice or the issamce of the CRYSTAL RIVER, FL 34429 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: Person named on the certificate to meet the requirements of this 1• HVAC CONTRACTOR 2- REFRIGERATION Section. QUESTIONS? (850) 413-1809 CUT IIERE * Carry bottom portion on the job, keep upper portion for your records. DWC - 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 Feb 08 2011 10:25PM CENTRALRIDGEINSURER 3525270348 p.l • CERTIFICATE OF INSURANCE I ISSUE DATE 2/6/2011 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Central Ridge Insures, LLC DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2535 N Reston Terrace Hernando, FL 34442 COMPANIES AFFORDING COVERAGE COMPANY A Western World Insurance Company LETTER INSURED COMPANY B N/A LETTER Jefferson Mechanical Services COMPANY C NIA 9385 W. Green Bay Lane ry l 1 \(} ✓ LETTER Crystal River, FL 34428 1 �, COMPANY D _� I -�,+ LETTER Har tford . I�M ` U COMPANY E NIA LETTER COVERAGES THIS IS TO CERTFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWRIISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO PLLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF POLICY POLICY POUCY UMITS I.TR INSUEANCE NUMBER EFFECTIVE DATE EXPIRATION DATE A GENERAL UABILITY 11PP1292574 12/5/2010 12/5/2011 GENERAL AGGREGATE 2,000," PRODUCTS- COM/OP AGG. 1,000,0. • PERSONAL &ADV. INJURY 1,000,01 EACH OCCURRENCE 1,000,' " " DAMAGE PREM RENTED TO YOU 100,000 MED EXPENSE (Any one person) 5,000 g PERSONAL LIABILITY COMBINDED SINGLE LIMIT MEDICAL PAYMENTS TO OTHERS C EXCESS LIABILITY EACH OCCURRENCE AGGREGATE D Workers 31, EACH ACCIDENT 500,000 Comp 21WECZJ8438 4/27/2010 4/27/2011 3L DISEASE 500,000 TL POLICY LIMIT 500,000 • E PROPERTY BUILDING CONTENTS LOSS OF USE DESCRIPTION OF OPERA - IONS / VEHICLES / SPECIALTY ITEMS Air Conditioning Systems or Equipment dealers or distributors & installation, servicing or repair, Waiver of Subrogation THIS INSURANCE 1S ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS UNES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBUGATION OF AN INSOLVENT UNLICENSED INSURER. SURPLUS LINES INSURERS' POUCY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. • SURPLUS LINES AGENT JlRGINIA C. PHILLIPS LICENSE# A201695 13577 FEATHERSOUND DRVE PO BOX 17069 CLEARWATER, FLORIDA 33762 CERTIFICATE HOLDER Should any of the above described policies be cancelled before the expiration date, City Of Zephyrhills the company shall endeavor to mai 30 days written notice to the certificate holder Buildng Dept named to the left but failure to mail such notice shell impose no obligation or Ilabiliy 5335 6th Street of any Idnd upon the company, Ns agents, or representative*. ZephyrhIlls, FL 33542 AUTHORIZED SIGNATURE 76692 FROM :Jefferson Mechanical Services FAX NO. :352- 795 -1350 Feb. 9 2011 1:3OPM P5 2010/2011 it . ' ` 6 CITRUS COUNTY BUSINESS TAX RECEIPT •` State of Florida l r 210 N Apopka Ave, Suite 100, Inverness, Florida 34450.4298 • l`' ' ACCOUNT# 36048 352.341512 • EXPIRES f v, 20 ji�ECEIPT# 99990260149 . , l v r. r . Business Name JEFFERSON MECHANIC44 SER ;,;, cation : 9385 W GREEN BAY LANE ES A JEFFERSO 'R 2-?ft Owner Name ]AM � �$,•, � r; ��y� ?:;�•�,: „'r s? '' -�y CRYSTAL RIVE 34428 ..,�, ,. c .' • r � ,� . yb � • :.. '� , R. FL 3 Mailing 85 W GREEN 8 ', .,, -••/ „7' sG . Address 93 F / -5%' ' ,ter i ,' ,,, 'i, CRYSTAL RIVER, 4 4z , ` -4..‘,",', ' ' w •; 4 ' fa ,. it Business Phone : 352- 795 -13501 t \ Business Type , R100 CERTIFIED MEC NICAL CONTR r 1: ., ` L”. r fz. Ii ,�. •'cur STATE CMC1 �• 9927 , .. I . F a r • Vendi;bla,,,8,siiness Only •.f Number of Veiadin• Machines : ' : «csx .•r. a in • Machine T • e :114 Tax Amount HazMat Sub- i aF Prior Yea - ction Cost Total Paid 0, $25.00 f/” $0• $20.01) . < 0' : , Y� Q, -''', 45.00 �,. ',;, '. ;. • `5• • 45.0 + ; ; {,:> :�/, Y•,' fS 3 ` A. `qty! _ i 4 ,, , ,; .f; E OF BUSINESS � ,/ THIS RECEIPT MU ' 'r P °E1) CO � , USINESS L I � , 0. i ;4.:•/. ti°�'' �%' it ''�j r 4 THIS BUSINESS TAX RECEIPT I'CQNFIRM'•:RE •+ QUIREMENTS HAVE BEEN MET. IT IS THE `e RES p I, CE. PLEASE CONTACT OUR OFFICE IF THE � RS H I P,O � �• i ' ES OR IF YOUR BUSINESS IS CLOSED 0 This section to be comp ;ta. above named business. i ti Business has been sold to: i X ` Signature of current receipt holier upon transfer or ownership change Date 1. A . ' Date Business Closed: Signature: i .� Al ` � , PAID - 033 -09- 00003979 08/31/2010 45.00 « 1 Print Date: 7/22/2011 11:08:16AM t Inspection Report Final Activity Date: 7/22/2011 10:40:54AM Zephyrhills Fire Rescue Activity Number: I- 113- 11- 0534.A !` 4'-./ Activity Cause: Reinspection Fire Prevention Bureau FLORIDA 6907 Dairy Rd Inspector Name: Kerry Barnett Zephyrhills, FL 33542 Inspector Phone: Phone: 813- 780 -0041 Status: Pass Fax: 813 -780 -0044 Party: Occupancy Type: Mercantile VACANT TENANT SPACE Property Use: Grocery Store (000538) Total Violation: 0 6020 GALL BLVD Corrected Violation: 0 ZEPHYRHILLS, FL 33542 Hours: 0.50 Total Fees: $ 0.00 Violation No New Violation Pre - existing Violation No Pre - existing Outstanding Violation Comments: - � REINSPECT COI . PLETED. ALL ISSUES CORRECTED. CO APPROVED AT THIS TIM )111 ( 0 ? ,..._, F4 -/ , 627 to 'W,fir k C i CA / 4°13 Kerry ar - ry r 7 .:,.. 6 J Zephyrhills Fire Rescue Fire Prevention Bureau 6907 Dairy Rd / Zephyrhills, FL 33542 ,lidll fig, kbarnett @fire.zephyrhills.fl.us i ,-- / / 7 ,A, Page 1 of 1 No. 676127 Oig DATE RECEIVED FROM / / J /.1Z /_ 01.-. _ / : ..ti 4 / /� r'1� DOLLARS Are U C � ' ORRENT - /��� �� OR �f j . ASH ! /PI...- �f/ OR r f ,.._ 2 � ACCOUNT ', FR" w PAYMENT FARM CHECK r 1:4 MONEY BY / /jam _ 1182 BAL. DUE ORDER