HomeMy WebLinkAbout11-11568 CITY OF ZEPHYRHILLS �
• 5335 - 8TH STREET � �
�sis)�so-oozo 11568
PLUMBING PERMIT
Permit Number: 11568 Address: 5216 7TH ST HISTORIC
Permit Type: SEWERLINE REPLACEMENT ZEPHYRHILLS, FL.
Class of Work: SEWERLINE REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-16700-0180
Improv. Cost: 500.00
Date Issued: 2/25/2011 Name: ZEPHYRHILLS TOURIST CLUB
Total Fees: 46.00 Address: 5216 7TH ST. HISTORIC
Amount Paid: 46.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/25/2011 Phone:
Work Desc: REPLACEMENT SEWERLINE
SUN CITY CENTER PLUMBING LLC SEWERLINE 46.00
��
i
FINAL �
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when e�ctra 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 � plans not a job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
f
C T CTOR PER OFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
s�3-780-002o City ot Lephyrhills Nermit Appucation rax-uis-iuu-uuzi
, Building Department
Date Recelved Phone Contact for Permittin —
t
Owner's Name �' � �l s' Owner Phone Number
Owner's Address G� � Owner Phone Number
Fee Simpie Titleholder Name � � Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS + � �� � � • (� RI OT # �
SUBDIVISION � � PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK � `.
BUILDING SIZE � � SQ FOOTAGE � HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
PLUMBING $
�'�. - j .�C� �
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ��(
QGAS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address ' License #
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License # � �
PLUMBER � � COMPANY Si<°l � ' ��
SIGNATURE - � REGISTERED Y/ N FEE CURRE� Y/ N
Address License # �
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address Ucense # �
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License # �
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, ConstrucUon Plans, Stormwater Plans w/ Silt Fence installed,
Sanitarv Facilities 8 1 dum�ster: Site Work Permit for subdivislons/larae oroiacis
: ����� � �����
�` , , . 4 . , _ q t .. : � ,,�' �
c� _-. ,�-�,'*; F + �a,:
�
,
.� l .
.'����i'J�' , `• n
r ��+�' , . � �?�'
t •r = • °s. , >
_ '
-. . - _.:. � I `��:�-', -
.
.
.
�
�
, ,� �,� - , . -
-
�,�
� 4
{
� g , _ t}fy i,Sl. 1�...` �,
,� aw�+���.'� `. � . .-,. ;«,` _ • ` ^ -
�t! F '�F'��� `.� , ;� ,° � � *.:. k� :
+►���s�f�• �klk�`c @���.�. �,��": ; `��=�:
, .
� ��i� T
FROM :BAY INSURORB FAX N0. :8139073995 Feb. 25 2011 03:26PM P1
A � CER1`IFIGATE �F LIABILITY INSURANGE �TE(MMIDD/YYY17
"�. oansr�o,a
PRO�ucER PFane: (e1a�907 Fax; (813?oo�-aess TNIS CERTIFiCATE is �38UED A8 � MATTEa OF MIFORMnnoN
BAY INSURQR$ CORPpRATION pNLY AND COHFERS NO RIOMtB UPON TNE CERTIFlCATE
P O BpX TT 70 HOLD�R. THIS CERTIFICA7E 1�085 NOT AMENp, EXTEND OR
WE9LEY CHAPEL FL 93646 ALiER TH� C AFFORDEO !1Y P01.IC 8ei„pyy.
INBURERS AFFCRCNNCi CQVERA[�E Nq� �
INSURED � Fi �� + INSURER A; NORTH pp�NTE lM8URANCE CQ � i '
SUN CITY CENTER PLUMBING, LLC IN B; RLI SURETY � �-' � ""'
10049 CREEK BLUFF pR INSUit C: � ��
RiVERVI�YV FI. 33678 ._, . _ �
INSURER p; '
_._.._.. ,. ...... ._.._..._ . r.._.
INSUR�R E: __.__. ...._......
COVERAGES
THE POIICIE OF NVSU L18 D BELQW W►VE 1!E!N 13 D TO Th� tNBURED NAMEp p9QyE FOR TWE ppLICY PERI p I ICATED, NOTWIT1iBTANDMIG
ANY RE4UIREM��riT, TERN OR Cp11DRI0N OF ANY CONTHACT OR OTHER DOCUI�NT WI7H RESPECT TO WHICH TINB CER'►If1CATE MAY B@ 18SUED UFi
MAY PERTAIN, TME INgUqANCE AFfOROEp pY THE pOUCIEg pEBCR�eED H�eREIN IB 3UBJECT TO ALL TME 7ERMS, EXCWSIONS AN� COND(iIONS OF 8UCM
POLICIEB. A(iGRFGqTE LIMrTS SNOWN MAY HI1VE gEEN REDUCED BY PAID CLAIMS.
iNa�a TYPE oF IN8URANCE� Pdu4w NUM6ER �� asecTlV! Poucr q�IMT1oN _ . �
i �" �"a u�nrs �
OEN UABIUTY 9Q9PQ��Qa70 09/ZBMO O9/Z8111 EACM oGGIJRRENCE s 1,00 .
x CONN�IERC44L GEMERAL I.IA9ILITY oAMnO! to par�rtRD .._�..._.._. ..�
PREIAISls �o eodwna) : 100.000
I CI.AIMS MADE � X i oCGUR MED. �XP U4yr orie p area n ) s 5�Q 0�
A .. ._.__---. P�RSO►�ni. � �nv iNru�► � b � 1�000 000
. �
GENERIIL qGpRE0 S $OQO�00
GkN'I. AOOREGATE LIMIt APPLIkS PF.R� PR ODUCTB-COM P/OP A�p, B 2,000,000
X PQI.ICY �� LOC ° - ...
AuTOMOp14E 41ABIWri
COMBINFA 81NGlE LIMR
� A�T� (Ee acdtlenl) •
.. ALL OWNED AUTOS 80bILY INJURY .. M.
SCHEDULED AUTOS �� Peno�1 !
HIREn AUTOS — `
NON-0WN@D AU'f03 BODILY IN =
(Per noaidaml
� PROP�RTY DAMAOE a
GARAR! LIAbILRY (Pe► oockJsn
AU70 ONLY - EA ACCIpENT s
ANY I►UTO _.. _ ...
on�eR T►�aN en Acc e
AUTO ONLY; � = -"'
EXCE58 / UM6RELLA LIA8ILITY EACM OCCURRENCE Z
.._
. ..._ .. . ...._. ...
OCCuR y CLAIMS MADE AGGREGA'f� _
. . _ _..
o�our.TiRI.F — � s •-
RETENTION S --•----- .._..._._._..__..
Z
WORKERS CCMIPRNSATION ANO wc eTATU� o �
EA�LQYRRS' LIABIWTY 1'onY UYRa
A�rvhearelETORNARTNEME�rrvE E.L. EACIiAI:(:If1ENT �._ _
osFYC�fA1�A19E11 iXCIUbEb'r •- ,. ...__._._.... .
Il Ya. dwerNN mldu ,
E.L. �ISEl1S@ EMPLO S
°P � ��� °NOxi E.L. 019EASE.PpI,ICt( LIMIT �
O H�R; CO�rnACTORS CppE LSM0018804 G8/28M9 09/28f11 f6,000. COOE COMPLIANC� BOND
� COMPLiANC� BOND
DESCRIP11pN OF CIPERATI�1&ILOCATIONSIIlEWICLE3lEXCl,U$IONS ADpEp �Y ENDOR$�MENTI SPECIAL RROVISION8
LICENSE NO�DER: MICNAE4. �q$ET�R
�.ICECSE NUMB�R: CFC74ZT898
CERTIFICATE HOLDER CANCELI,ATION
CITY OF 2EPNYRhI1LLS BUILDING OEpARTMENT &HWLD ANY OF TF{� ABOVE OESCRIAFD POLICIES BE CpMOELLED BEFORE THFz
a9as aTFI STRE� EXPlRATIGN Dq� '�'�{�REOF, 7� �$gwN3 INSUq�R WILL ENDEAVOq Tf1 MAII t(f 1]�yg
Z�pWYRHiLL.R, FL 33642 ��TTEM NOTICE TO T►� (,'�RTIFICATE HOI.O&R NAMED TO TFIE LQFT, BUT FIULUR6
TO DO Sa sruLLL IMp08E NO oeu6nTION OR 1a91uTr oF NdY KINO UPOr� rne INSURER,
m3 AGENTS OR REVRES�NTATIVEB.
FAX 8� ��780�0021 AUTHORI2�p REPRp3ENTATNf.
Atter�llon: �' `- ���
l�i
ACORD �6 (20p1/08) CertlflC�te # 8862 � A40RD CORPORATlON 1988
HILLSBOROUGH COUNTY BUStNESS TAX RENEWAL INSTRUCTIONS
Chapter 205 0535 (5) Fiorida Statutes requires one of the following:
FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURiTY NUMBER
1. SIGN and return entire form in enclosed envefope. Your vatidated Business Tax receipt wili be returned to you.
2 Business Tax rece+pts expire midnight, September 30th. Failure to disptay a valid Business Tax receipt after
September 30th is a violation of Hitlsborough County �rdinance 95-4, as amended by 02-5
MAKE CHECK PAYABLE TO:
DOUG BEtDEN, TAX COLLECTOR
P O Box 172920
TAMPA, FL 338T2-0920
2010-2011 HILLSBOROUGH C�UNT( BUSINESS TAX RECEIPT EXPIRES 9-30-2011 Fo�.io No
- ��fpCILITIES�ORAiAdNINES O�RDOMS --- �0� -- �EA�`S - --- � —� O�-�M IO YE�S ---- --� 3 � I "� �� 216175
H WAS1E TAX
CATEGORY COOE B SINESS TYPE SURCMARGE
090 D20 PLUMBING CONTRACTOR 40 00 18.00
ro� cT ^r,3>—�rA �A
�^.00 (D ?7'yfi � � p C
a��;n nro o �nn�"=u�
,_n r ��. c o c� = n:�
.... r.� -� a � .s. .. �n s --�
�i+ cr v� 1.�J IJ �1► �h (¢ X
!n u; Ur ic � r_, r- .. ..
� '�? ...�� c fp A
�-� fi a G 3 ►J V W� N
7�' X 8' IA � U? ! � CrJ t+f .. A
ausiNESS 10049 CREEK BLUFF DR �-, � n rr� c, .r - 'a
LOCATiON RIV�RVIE�N3357$ = �' � '' t ° � �"'=' °' °'
p !? �n W � '7 r .� +-� —
>, � C 14 rt tn c. a �
w+ME LASE'�E� MI�HA�I. J�ftOt�ilE m� a '_°. -> °� ,� u
MAILING 1Qp+i9 CF�EEK BLI�F bR
F� x s� o n a T r*'
ADDRESS RfVERVIEiNFt 33378 m ro � � ° � � ° �
� � . �* .-• ua 'o m a i
C� Li 7�p c* t�7 A— _
BUSlNESS TAX � � � ""�"� �°'�
aa ����-a.���.,�
DOUG BELDEN, TAX COIIECTOR • N o�� +w a�• o v
HAS MEREBY PFUD A PRINLEGE tqX Tp ENGAGE 813-fi3b-52Q0 = a• � CA r ' n ' O��
w euswESS. PROFessior+. oR occ�vAnoN sPec�Fieo rrtrxEOri THIS BECOMES A TAX RECEtPT WHEN VAIIDATED.
M �' ^ Gll
�+A O �r�N - i
C�'. C� 4 C O- �* �'�
a, w . --� r� x
r.a �r c� '' ..
4206 2161750Q000 000018002 000040006 � � �'� � ! �
r,. � cnt,
r, — �.
�.. G �'
A ;�
. F _ = i
`
i • ` 0������0��
��_E� /
JEFF ATWATER STATE OF FLORIDA
CHIEFFINANCIALOFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
�* CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW **
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 02/21/2011 EXPIRATION DATE: 02/20/2013
PERSON: LASETER MICHAEL J
FEIN: 371572699
BUSINESS NAME AND ADDRESS:
SUN CITY CENTER PLUMBING LLC
10049 CREEK BLUFF DR
RIVERVIEW FL 33578
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT Pursuant [o CAepter 440 . 051141, F.S., an officer ol a corpontion who elects exemption From this chap[er by liling a certilicate oF election under this
sec[ion may nol recover beneFits or compensa�ion under this chapter Pursuant to Chapter 440.05(121, F.S., Certiticates oF eleclion [o be exemp[... apply only within the
scope oF [he business or trade lis[ed on [he notice of election to be exemp[. Pursuant [o Chapter 440.05113�, F.S., Notices of election to be exempt end cerlificates of
election 10 be exempt shall be subject to revacatioa if, at any time alter the filing al the na[ice or the issuance ot the certifiate, [be person named on the notice or
cerlifice[e no longer meets the requirements of this section Far issuance uF a certificate. The department shall revoke a certificate at any [ime lor tailure oF the person
named on the certificate ta meet the requirements oF this section.
QUESTIONS? (850) 413-1609
WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA I MPORTANT
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION O Pursuant to Chapter 440.051141, F.S., an officer of a corporation who
CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of election
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA � L under this section may not recover benefits or compensation under this
WORKERS' COMPENSATION LAW
D chapter.
EFFECTIVE: 02/21/2011 EXPIRATION DATE: 02/20/2013 H pursuant to Chapter 440.051121, F.S., Certificates of election to be
PERSON: MICHAEL J LASETER exempt... apply anly within the scope of the business or trade listed on
FEIN: 371572699 R the notice of election to be exempt.
BUSINESS NAME AND ADDRESS. E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt
suN CITV CENTER PLUMBING LLC and certificates of election to be exempt shall be subject to revacation �
iooae CREEK BLUFF DR if, at any time after the filing of the notice or the issuance of the
RIVERVIEW, FL 33578 certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements af this
1- CERTIFIED PLUMBING CONTRACTOR section.
QUESTIONS? (8501 413-1609
� � 3 _ (p � � I `t' � � CUT HERE
Z� U
�, 3_ (p1 �� 0 � Carry bottom portion on the job, keep upper portion for your records.
IWC-251 CERTIFICATE OF ELECTION TO 8E EXEMPT REVISED 01-11