HomeMy WebLinkAbout11-11773 CITY OF ZEPHYRHILLS
, = 5335-8th Street
(si3)�so-oo20 11773
ELECTRICAL PERMIT
Permit Number: 11773/11495 Address: 7326 GALL BLVD
Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL.
Class of Work: ELECTRICAL MISC Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Contractor: FORT KNOX FIRE & COMM INC Book: Page:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-08800-0000
Improv. Cost: 2,350.00
Date Issued: 5/12/2011 Name: TOWNVIEW RETAIL LLC
Total Fees: 75.00 Address: 725 CONSHOHOCKEN STATE RD
Amount Paid: 75.00 BALA CYNWYD PA 190042102
Date Paid: 5/12/2011 Phone: (610)667-5800
Work Desc: LOW VOLTAGE SECURITY SYSTEM- TJ MAXX
ELECTRICAL FEE 75.00
�l
��
ROUGH ELECTRIC
CONSTRUCTION POLE
PRE-METER
FINAL ,� �
.��
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are
necessary due to any one of the following reasons: a) wrong address b) condemned work resulting from faulty construction
c) repairs or corrections not made when inspection 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."
Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City
Codes a Ordinances.
�
NTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
s�s-�so-oozo City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
' 79l�
Date Received � l� � phone Contact for Permitting 0[ 3 /' �
1 1 1 1 1 1 1 1 1 1 1 i 1
Owner's Name �-+ m� x� Owner Phone Number Q' p��' ��O � �� /
Owner's Address 7��� A � LvD Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS � LL, LV LOT # �
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEw CON57R B ADDlALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM � OTHER OYV !� ys
TYPE OFCONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK � C-�� � S< S �J�ISTr} �'rJ�
BUILDING SIZE SQ FOOTAGE � HEIGHT �
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $� ' J AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
,�, vo�ra yc,�
�PLUMBING $ �
�MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �' ��
�
�GAS Q ROOFING Q SPECIALTY O OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address � License #
ELECTRICIAN COMPANY cl r f7✓VJ-Z' TItL ,� /��I�J
SIGNATURE REGISTERED N FEE CURRE� Y/ N
Address License # �6
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y 1 N
luldress License #
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y! N
Address License �k
OTHER COMPANY
SIGNATURE REGISTERED Y! N FEE CURRE� Y/ N
Address �Z�� D3�n5 #'� 'j1�YY►PH� L33G3y License# LF`
�i�������������������i�����ii����������ii�����ii�����i���i��i��i���
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Pertnit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stortnwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster, Site Work Pertnit for subdivisions/large projects
COMMERCIAL Attach (3) complete sets oi Building Plans plus a Life Safety Page; (1) set of Energy Fortns. R-O-W Pertnit for new conslruction.
Minimum ten (10) working days afler submittal date. Required onsite, Conslruction Plans, Stortnwater 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 construdion.
Directions: •
Fill oul application completely
Owner 8 ConVactor sign back of applicatlon, notarized
If over E2500, a Notice of Commencement is required. (A/C upgrades over 57500)
" Agent (for the contractor) or Power of Attomey (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 (PIoUSurvey/Footage)
Driveways-Not over Coun[er'rf on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County
TRANSPORTATION IMPACTlUTILITIES 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 appiicable 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. 1 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 8 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 shatl 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 COMM CEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEN TO OBT FINANCING, CONSULT
WIT YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOT E OF C ENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to (or affirmed) before me this _Subscrip d swo r a ) ore, rqe N
by gT:r R LL
Who islare personally known to me or hasJhave produced Who is/are to me or has/have produced
as idenlificatlon. as identification.
1 � ,. `
Notary Public (f�}.�... �f �LJ�'`��.J Notary Public
Commission No. Commission No.
Name of Notary typed, printed or stamped a,� typed, `�� m�Ij'�ER �^
;;�, '�; (vlY COP,IMISSION it DD849437
''?a,a�� EXPIRE� January 05 2013
(�C7)39A-0151 ��Flontl�NOtaryService.cnm
�..��F��� STATE OF FLORIDA
?�'!`�-,___=__��, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
p< °�
�� f� ��.atr3° ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487
''��;,, _'� '� 1940 NORTH MONROE STREET
'''�oD„ TALLAHASSEE FL 32399-0783
COLLINS, SEAN P
FORT KNOX FIRE AND COMMUNICATIONS INC
6201 JOHNS ROAD
SUITE #7
TAMPA FL 33634
_y -:�_�,_ ,
�� � AC# :� ..� .,� �_ :1 � :�
�° "' �, STATE OF FLORIDA
Congratulations! With this license you become one of the nearly one million ;:"'' ��
Floridians licensed by the Department of Business and Professional Regulation �� DEPARTMENT OF BUSINESS AND
�����'� PROFESSIONAL REGULATION
Our professionals and businesses range from architects to yacht brokers, from �` �'�
boxers to barbeque restaurants, and they keep Florida's economy strong �
EF20000876 06/24/.10 098180712 �
Every day we work to mprove the way we do business In order to serve you better. �;
For information about �ur services, please log onto www.myfioridalicense.com CERT ALARM SYSTEM CONTRACTOR 2 �
There you can find more information about our divisions and the regulations that COLLINS , SEAN P
impact you, subscribe to department newsletters and leam more about the FORT KNOX FIRE AND COMMUNICATION ;
Department's initiatives � t
_ �
Our mission at the Department is License Efficiently, Regulate Fairly We ;
constantly strive to serve you better so that you can serve your customers s
Thank you for doing business in Florida, and congratulations on your new license! Is CERTIFZED under the provisions of cn 469 Fs A
axpiration 3ate AUG 31� 2D12 L10062400913 �
DETACH HERE
--- - - - _
I ,�' ,. _,� dF F"'� s .,� ..T y;.� --------- ------------�---------;
� � — ���� � �� s ��� STATE OF FLORIDA !
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L10062400913
�^` LICE
h.r'.`'�;� . NSE NBR
;r
06/24/2010 098180712 EF20000876
The ALARM SYSTEM CONTRACTOR I
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Fxpiration date: AUG 31, 2012
COLLINS, SEAN P
FORT KNOX FIRE AND COMMUNICATIONS INC
6201 JOHNS ROAD �
SUITE #7
TAMPA FL 33634
CHARLIE CRIST � CHARLI� LIEM
GOVERNOR INTERIM SECRETARY
DISP AS REQUIR BY LAW '
'°`` ° CERTIFICATE OF LIABILITY INSURANCE DATE(MMUDDM(Y1�
04/08/2011
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 AMENO, 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 dces not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
PAYCHEX INSURANCE AGENCY INC ac no �: an �2-s�as � No : an e��-0aa�
150 SAWGRASS DR E.��
ROCHESTER, NY 14620 � �•�^
(877) 362-6785 PRODUCER
• 6658VA137
SVJ96 7OA INSURER(S) AFFORDING COVERACaE NAIC •
INSURED INSURER A.'TFIE TRAVELERS INDEMNITY COMPANY OF AMERICA
FORT KNOX FIRE AND INSURER e:
COMMUNICATION INC INSURER C.
6201 JOHNS RD STE 7 INSURER D:
TAMPA, FL 33634
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 060395805380890 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.
NSR n,PE OF INSURANCE �� SUBR POLICY EFF POLICY EXP
TR INSR POLICY NUMBER M�p MM/pD LIMRS
GENERAL LIABIITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY D E TO R D
CLAIMS-MADE � OCCUR PRE I E S
MED EXP An one rson $
PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: pR T- M P A $
PR0.
POLICY JECT LOC
$
AUTOMOBIIE LIABILfTY COMBINED SINGLE IIMIT $
(Ea acddent)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY (Per accident) $
HIRED AUTOS �PeOP� $
)
NON-OWNED AUTOS $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
E%CESS LIAB CLAIM&MADE AGGREGATE $
DEDUCTIBLE
RETENTION $ $
A WORKERSCOMPENSATION N/A UB-1223N649-11 �3/�l/2��� 03/01/2012 X T �ER
AND EMPLOYERS' LU181LITY Y!N
ANY PROPRIETOR/PARTNER/EXECUTIVE � E.l. EACH ACCIDENT $1 OOO,OOO
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH� E.L. DISEASE - EA EMPLOYEE $ 1,OOO,OOO
If yes, desaibe u�der
SPECIAL PROVISIONS below E.L. DISEASE - POLICY L�MIT $ �,OOO,OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Renwrka Scheduk, if more apace is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF ZEPHYRHILLS-BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
5335 8TH STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE
ZEPHYRHILLS, FL 33542 INITH THE POUCY PROVISIONS.
Phone Number 813 780 0020 AUTHORI�D REPRESEHTATNE
C% � (/ � l�" ��"'�J
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
'4`,.°R°� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM'Y'�
4�8�2011
PRODUCER (913) 385-5000 FAX: (913) 385-3500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Tozier, Parkway, Housh 6 Jones ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 7787 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Overland Park RS 66207 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: SCOttSC131e insurance Comapany
Fort Rnox Fire 6 Co�unications Inc INSURER 8: C@=tdlII II/W at Lloyds
4517 George Road, Suite 240 INSURER C:
INSURER D
Tampa FL 33634 INSURER E.
COVERAGES
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 ISSUEO OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OISUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR D' DAT��MEFFECTNE p PALICYEI(PIRATION L �� S
TR NSR TYP OPINSURANCE POLICYNUMBER
GENERAL LIABILITY EACH OCCURRENCE S 1 OOO OOO
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurtence $ lO0 OOO
A A CLAIMSMADE � OCCUR p51330681 1�22�2011 1�22�2012 MEDEXP(Myoneperson) ; 5 000
PERSONAL & ADV INJURY $ 1 OOO OOO
GENERAL AGGREGATE S Z OOO OOO
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ 2 OOO OOO
X POLICY PR � �pC
AUTOMOBILE LIABILIT' COMBINED SINGLE LIMR
ANY AUTO (Ea acddent) $
ALL OWNEU AUTOS BODILY IWURY
SCHEDULED AUTOS (Per person) S
HIRED AUTOS
BODILY INJURY E
NON-OWNEO AUTOS (Per accitleM)
PROPERTY DAMAGE $
(Per acci0ent)
GARAGE LIABIUTY AUTO ONLY - EA ACCIDENT S
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY� qGG S
A EXGESS I UMBRELLA LIABILITY EACH OCCURRENCE S 3 OOO OOO
X OCCUR � CLAIMS MADE AGGREGATE S 3 OOO OOO
$
A DEDUCTIBLE 50012288 1/22/2011 1/22/2012 g
RETENTION $ _
WORKERS COMCENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOWPARTNEWEXECUTIVE ❑
OFFICER/MEMBER EXCLUDED? E.l. EACH ACqDENT $
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE S
If yes, desaibe under
SPECIAL PROVISIONS below E.L. DISEASE - POIICY LIMIT 3
OTHER
susiaess Personal 15, 000
B Commercial Property 42oe53 2/17/2011 2/17/2012 rroperty 1,000 deduct
Replacement Cost
DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLE3/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELIED BEPORE iHE EXPIRATION
City of Zephyrhills- Building Department pA� TM�oF THE ISSUING INSURER WILL ENDEAVOR TO MWL 1 � DAYS WRITTEN
5335 8th Street
Zephyrhi l ls � � 33542 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFf, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR L1pg�LRy OF ANY KIND UPON THE INSURER, RS AGENTS OR
REPRESENTATNES.
AUTHORIZED REPRESENTATNE
Vance Loqan
ACORD 26 (2009/01) O 1988,2009 ACORD CORPORATION. All rights reserved.
IN5025 �zoosoi� The ACORD name and logo arc registered marks of ACORD
HILLSBOROUGH COUNTY BUSINESS TAX RENEWAL INSTRUCTIONS
Chapter 205 0535 (5) Florida Statutes requires one of the following
FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER
1. SIGN and return entire form in enclosed envelope. Your validated Business Tax receipt will be returned to you.
2. Business Tax receipts expire midnight, September 30th Failure to display a valid Business Tax receipt after
September 30th is a violation of Hillsborough County Ordinance 95-4, as amended by 02-5
MAKE CHECK PAYABLE TO:
DOUG BELDEN, TAX COLLECTOR
P O Box 172920
TAMPA, FL 33672-0920
2010-2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9-30-2011 FOLIONO
--- -- - --
FACILITIES7RMACHWES ROOMS SEATS � EMPLOYEES - — ----- -
�_�� o� 0 1 io� �TRANSFER� 236484
H. WASTE TAX
CATEGORY CODE BUSINESS TYPE SURCHARGE
090 000 ALARM SYSTEMS REPAIR OR INSTALL (OVER 5,000 SQ FT RES) 18 00
� a �rr ..-, ,_� 7+ .r m ^I
' � ? � L4 _i -'+ �
' 1 Ut '"� i9 ''„f' .'' r� srt C�
O� —. C b;1- cr � i i ta C
}" �'7 2 R CO � tt� � 1+
ra -• rs ,a �.. rn
�R cr 'P '7 }.,,y F 1 y} .Ct ?p 1—s
� � � � aT�S'���tn.�x 3 00
`� --i � cr F.a �_, -A tp
�� C 3 hJ CA �� a i—i
BUSINESS 6201 JOHNS RD 7 � X c a`�`� =� i. "��
LOCATION TAMPA 33634 f .,, !4 � :a �'' � � ; `G ����
D �'1 uti ct O — i.-++ : �
NAME COLLINS SEAN P '� �'� �_. �'{`�
�ro —•
MAILING FQRT KNOX FIRE AND COMMUNICATIONS INC '�'' �' �� n ' �T-` a'l
ADDRESS 6201 JOHNS RD 7' ro `� 4: ��" r, °'
TAMPA FL 33634 � " `"'"' �' �''''� ° '
c� sro �*t.�- - c
m ;v n a r, �s �a� �.a *
BUSINESS TAX � -`�`��' `����V�`
,v c �- � x.
o. tn e,n c* O yM C� r, H
DOUG BELDEN, TAX COLLECTOR " u ' °'�° '`�'' °' `• �°
c r� u� c.. �� x�
HAS NEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-635-5200 �—' � '=' �
IN BUSINESS, PROFESSION, OR O(:CUPATION SPECIFIED HEREON THIS BECOMES A TAX RECEIPT WHEN VALIDATED. �. -� �� .c. . ��
� ' - :� a -,
�, o � a� :.�s �
� n
v« i ��
��� ��� �a ,-,
4406 23648400002 000003004 000000000 �., '-" �=
�
_ �
O A
�
ep � ---
�
F' �L 'h'ALL
� � � � � � �
O � I 1 I I Z ,^
� � tJ i
�
� O � � � � � i i �
� � �- M >
�
� � - "� �-' ii ii =
� �� ( �
� „
o � ,-� ¢ -�- -�- -�
y y I �
�. y �� ..,�. - ' � "
! �
`^'�' A f p� 1 � j_
b " I�' � �� �- �- �-
< �� � � � � �� y
� � .. _., �� � i
�
� �,
� �� �
o � ' -� °-�-
� � �
D
�, �, ] _ �- - -� � � � �
�; _ ,�
�� ° T �' — � �-
o � � ? ._ �
rn
n � = L i �
A �.?' c t' � � � �. � �
A: �o ` � ,. �-�--� h--�
n rn
� � �, ■ ��� �
� L•
� ] `� �- = �-- i
� N
� �
� � —�-_.
:° � ----�-- �'
�
m ►�._
c _� — ' � � -- �
---1__' ��
�ALL _ �
�
�' - ;' �
� � � �
_ � � � ' 1
f ' - '. - ° 1
• -� ` -
� � ' -- ` ° �
' �,
z � r �� ��
c�y � � i i I I I
O O O O O O O O � � � I I � � � � y (J_
(�D (�D N N (�D (�D N (D c �' '� �
iOC c�nAW � � D I I I I I
���� ��� � �' L�Z �I – ;��I C� w
���� a cn ia c� i w o - � e
�`� � N � ? � � j� � �
�� � �� �
«m.� m 00 r' i i i i i i C� 0 a� �
yN�� ��� � llbH - 1 I; I I I o� "
� � � CD (D � � �� � � � _ —_— N N � �
p "� r
� � Q � O Q O � � I I I I � S. � A
� S � y a" {�
� � !�p p � � � � � ; � �_ _� � � a o0 00 �
N N � � z I � � � o � �
(._.� - Tlc�l. ���-,C� � o, o� o � � � �
I T — — _ T r . � � � ° � �
o w w .°+
A �
�--�-- .--- --�._ �-- � � ---
_ I i= z n I
Dx �
j �' m � I
:j � Gzl �
— � t.i � `�
i_ �� � � � c � J �
DGMESTICS ' � � I I S
•,x
o !� �
' ��
�i—i� ; �
�
rn rr. Oi O Q i � I
; ��� � �
� I � �' �__ � ��\ � �
- � �� �
, � � ,,
�
� I
� z ,
�
�'_E_T4FL�� � y,�
m � ;� � � [!\ N
_ � I � ' ,, I \ �_rl / �
' !- I m = ❑ _ m V
� �
Q �
� ^
� x y�+
m ��
o i '= I
- � � N
m i q m r �; � �
� N l �.
i, � � r r+i I .0 11 (
i. � �
� � � � �
, � � �
; ��
i �- �' �
i = � � �. �
�
�
( � r
�� r _ r
— ______� I l.
f � j � �
� I � �— {r-� � �e4 :pi. r —r— � —r— —�— —i i •
�� — — :'H il
N N N N N
O O O o 0
3 3 7 7 7
fD fD (D fD (D
N...���� w
ocow�rn n
I I I I I �
�o �o �o O v �
0 o m< o z
oo�m� �,� �
�v<.m � � � �
° oco Q.�' " � z
� � �vo � ��x� � m
°.o ° o a ��o °'�
o -�
� �o
� v �o g �
O� v N � /0
� W O h+ �
lri 00
O W W r
H. � t—J ' 1�i1 � � � �+ �
�.�-,- - - � — — -- r--�--� �
rl - - - �- `
� ' z
W
w �,' !3m\ � ^
x �+ � 1
�i r t 1 �
Q� � � \ �
� � -t: . �
� � C� � _ , �D -------- t =
_' T � _ y '� ------- :z:� '3
. , � ll' E E I v, �
� ------ -- -- -�;-_ -- .' --=-- �� � :
� �
� L
_'�'T'— �� '_' ' _ � 't � 1 t
--- -. � --- ' �
� �
I ,� . _�__ --`-- ' --- -- - 1 .�—� �
� ' t
� E- --�--- , - _ - - --� = _ - �.
n —==_�___ - __-- __ � � _ =1
_., ;'- ] � �
F 7 E- �
�i.Z ''- ____ F' � ' T -- ' � �_� - !� �
_ � -- tl E E- ' '— _ .\
r
.� '� — J— I`1
, � r --
" � y � �
� `± --`-'- ^ d _ W ` �'1�
f� C� �i _ _ �' " r . � �
� - --- .iw �ina � ,. �
g' �..� , —'—'—' � ; O v SSING ��
r -� T . .1 .''' E i i . M
_ —'—__ f UL I.E ' (p 1RANCE �
- ---- -`- ---- - - -- � �� � �
- ------ �' `` �
-- r =_ -� -- N
- - ..�
– �,
- - -- � � __—= � � � �, � �_ � �
- _== f I f I � �� ' -- �
E -- �, _ ,-' �
-_-_- =-_ ?i �, f f � � _ � _:
�, i i i� i i c� � �.
------ _; � ►�
� ------- c°.F,. w , ; v
I t- , E•�� o� t o o ' v
I F �
_ -- �� �, N- - • � r
- � ; - ��
_ � � �- �
I _ ---�, �
J - _ ' .. ' * L E '_J
}L
C G �0
� . � _ � .� �� �
_ ' T 2
E T � ` " _ ` '• F
O
0 � � � Q � � � — — � � �� I O
� � � � � � � � �
O V� C � W N i H � .. � �
� � � � � � � � ALL WORI� SHALL
COMPLYWITHALL � � � z
�-oor=p��pm
� � s � � � fD ' PREVAILING CODES, FLORIDA BUII.DiN � � � � �
�����=cQ��z
� `D `D `� � CODE, NATIONAL ELECTRIC CODE AND � A � � .�
w w `° ° � � � � LS ORDINANCES � � � �
rn o�� v", o�° CITY OF ZEPHYRHIL
In A lA � �
� � W� � m r�] N e r'C
� O ~ � O a �
O w n� �
o w i,�
�f6GM1�+f1I �l4� G
�.A1 1 T &.fI fw6r�fl [ f�f7i6�6��,?
PLANS F.:.��hlill�ER �'�
�� _ � ��_ _ f �G"
F,:�+�,L �'�%+LL —
I p = �
,� �� � �
! � �� >
W � ��
��� i i ► ,� _
�� �� i
DOMESTICS
'"; I "� �� � -
I I I � (
� t�` � ^ : � �
` � .
J � �
I �
� �- _ ° r� �
III i � , � �
�
�
�
i
N
�
; ---�- --- - -- � �
i �
mT � a' c _ - I ' 1�
��-- _� �-�_ � j � ,� �
m _ �__ � � ,� � �
-- D
GIFTYJARE � I { ' ` `� � ' �
O -� �
r 1 � � s, n
���r - � - �- " J . l rT I r�l rn . ,t;
� �- -� - � � 1 l i Z �1 �' �� �
� ( '� �t--� vi I�' vi .
�
� �=T1� `�
�,�I — � — �o��. � H 4LL
- � - I �
r_
O O O O { � rEc h.,�. i — i -- �
7 � 7 7 � —�'�__��__;
i
(D (D (D fD �n � � � � —� ,� '---, � m �
CJ1 ? W N ��� ; r� � i� w
0
� � � � r' � � ; A �,I (�
N f�D N f�D �~ —� �% � i� �� �
e
w w �� — , ���� x. �
1 � � � � � !�� � y A
--- - - -- .� � J .. � �
tn cn o o �.� �--
0
mwoo —
f�l1 l�A �� � T M � I---I--- -- m III n �' � �
m m w w """`'t-� ..i"(_� � h ���� � m
x x = _ ,• T �, .�
.� .� � v ---�,
�vo o • '_� fi � �o� �'
�°p� ��-- '� � p�,� �d
o�� l � ��N
� ' - —t- ?T1Tl � Tl � i .. �, � " �
o Ww 8
l
,r �z c'
ls�T E��
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: �� �� �� ��/�-r- ���l�
Date Received: �' � Z ��
Site: 73�6 ��-l/ �`�
Permit Type: G—�'?a/ f/�!� /�"� ,l�'-� / '✓' ��/l��
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
�
Kalvi S'tz Plans Examiner Date Contractor andlor Homeowner
(Required when comments are present)
'' Fort Knox Flre and G'omm unlcations, Inc.
6201 Johns Road Suite 7, Tampa, FL 33634
Phone #813-653-1605 Fax #813-653-1710
EF20000876
TO WHOM IT MAY CONCERN: Zepherhills Buidling Department
The following individuals are authorized to obtain permits on all construction projects on
my behalf: Sean Collins
Richard A onte
SS#09162 9
DL#a153 40-73-3810
i
Signa ur f Cont or
Se Collins
rinted Name of Contractor
STATE OF FLORIDA COUNTY OF Hillsborough Sworn to (or affirmed) and
subscribed before me this 12 day of � , 2011 by Sean Collins,
who is X Personally Known to me or has Produced (type of identification) as
identification.
---�' ,
tt�'•�''- �ONNA WITMER
:+P�•. .�:
L./) = *_ iVIY COMMISSION k DD849437
Signature of Notary Public ��''�;►;`''�� � XPIRES January 05, 2013
(407) 398-0153 �-londallolary3ervice.com
State of F'lorida Donna Witmer
Print/Type/Stamp Name of Notary Public