HomeMy WebLinkAbout11-11908 CITY OF ZEPHYRHILLS �
5335 - 8TH STREET
(sis)�so-oozo 11908
BUILDING PERMIT
Permit Number: 11908 Address: MISC ST/AVE SEE DESCRIPTION
Permit Type: MISC ZEPHYRHILLS, FL.
Class of Work: RIGHT-OF-WAY Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost:
Date Issued: 5/24/2011 Name: FORT KING RD
Total Fees: ,? Address: MISC ST/AVE
Amount Paid: r'� ZEPHYRHILLS, FL. 33542
Date Paid: Phone:
Work Desc: ROW FORT KING /NORTHERN ROW OF NORTH AVE GAS LINE-NO CHARGE
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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 cailed e) permit not posted on job site � 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 properly. If you intend to�obtain financing, consult with your lender or an attorney
before recording your notice of commencement.
ONTRACTOR S GNAT PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
. CITY OF ZEPHYRIIILLS - BUILDING DEPARTMENT
DATE: I �l RIGHT-OF-WAY USE PERMIT PERMIT# �� JL' �'
No construction under ground or above ground of any fecility shall be accomplished on any City Righ[s of Way witAout wri[ten approval from th
City Building DepartmenL Any applicatioo for approval otcons[ruction operations on any City owned Rights ot Way shall (urnish a detsiled drawing
showing the coroplete scope of the proposed work in Mplicate to the oflice of the Buildiog Offlcial for approval prior to the commencement o( any work. A
copy of this permi[ is to be kept readily available at the site of the work at all times.
PARCEL I.D. # CITY ROAD _�'j' �IML� R�A C�
DATE (�
LOCATION (Legal Description) :
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e v3Citisc�. t �lfiltTj-� �.�n .— �L-----�.7r�� --��T4l� L 1 T�-►l
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Permisaion is hereby gnoted to TgL� �� e ltY of T� •�p, Q�ay�p ���
for the construction and maintenrnce of - '
— `� t��c,�i ��-�s� e C-�.� rv1 a w.
_subject to the tollowing conditiooa:
1. The construchon and maintenance of such utiGty shall not interfere with the property and rights of a prior occupant.
2. All work shall be done in kceping w[th the standards of the City Streets Department and under the supervision of the City Building Ofticial, w
will be notified at least one day prior to commencemeot of conatructioa
3. All materials and equipment shall be subject to inspection by the City Building Official.
4. During construc[ion all safety regulaHoos of the Department of Transporta[ion s6a11 be observed aod the City shall be relieved of all
responsibility from damage of any oature oriyng [rom thia permi4 Subject to the ume terms and wndiUons, the permi[ holder may take such safety
measures, including placing and diaplay of caution si�a, as it may deem neceasary in conduct of construction aod meintenance work hereunder. It is the
responsibility of the permittee to ????
5. All priva[e rnd all City properly shali be reatored to its original condition as far as practicsl in the opinion of the City Building OfficiaL
6. All under�round crossing inahlla[ians s6a11 be laid a[ such depth as may be specified by [he City Building ONicial.
7. The sketch covering [he details otthia inshlla8ou shall be made a part of this permit. This permi[ is granted with the understanding [hat the
applicant has notified all other utility users in the area covered by [he permi[ and takes full responsibility for any damage incurred by prior instrllations as a
reault of 6is opentiona in order that [hey may sak guard [hetr in[eres[s.
8. It is ezpressly stipulated tha[ [his permit is a license for permissive use only and that the placing of facilities upon public property pursuant to
this permit ahall not operate to crea[e or to vest any property rig6t in said holder.
9. Whenever the City decides to further exploit the City Rights of Way, auy or all said poles, wires, pipes, cables, or other facili[ies and
appurtenances authorized hereundeq shall be immediately removed from said Righ[s of Way, or reset or relocated thereon as required by t6e City Building
Official at the expense of the holder of thls permit.
10. The holder shall save and keep the Ctty harmless Gom any and all damages, claims, or injuries [hat mwy occur by reason of the construc[ion,
maintenance, and operation at said facility.
11. The holder shall complete the requested work within days or this permit shall become null and void. In the event the work
reques[ed is not comple[ed upon the e:pintion date of this permit, the City shall have the right to complete such work and to charge the holder of the permit
(or a11 rnsts incurred in completing said work.
12. The ho►der ahall past a cosh or surety bood with t6e City Manager i¢ the sum of S dollars to guarantee performaoce of tA
obligations herein, and [o guarantee maintenauce of the right�f-way described hereie for a period of one (1) year following completion of the requested
installstlon. In the even[ s surety bond is poated, the surety bond shdl be made payable to the City and shall obligate the surety to hold the City harmless in
the event the holder of this permit should tail to meet any of its obligations hereunder. The bond shall aiso indemoify the City for all court costs and
reasoeable attorneys fees in the event lcgal ac[ion is required to collcct on said bond.
SUBMTCfED BY:
(Permittee) o, 4 i� q t+=, — � O�
Signature & Title N
t�►G Tc�C.E+n.i �c.. w.,�
naa��s l4� �c►�S ��, y -- o
�'�'���� �'L. 33�0 5 -�9 60
APPROVED BY: S � � � �� �� �
C1TY OF ZEPHYRHILLS
�ua�� „� ,
Date•
Utilities Supe�%p�r
Date• J % J
PubllcWorks �� �� L.�S
Date: _ 1,3 M.4`� �l
City Manager � / /', ( /�, � �,
Date:_ �, \( I
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``` °RO� CERTIFICATE OF LIABILITY INSURANCE �A�(M�D/YYY1�
06�09�2�„
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFiCATE HOLDER. THIS
CERTIFICATE DOE3 NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF IN3URANCE DOES NOT CONSTITUTE A CONTRACT BETYVEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certHicate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, sub)ect to
the terms and conditions of the policy, certain policies may require an endorsemenL A statement on this certiflcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PROpUCER
MCGRIFF, SEIBELS � WILLIAMS, INC. NAME:
P.O. Bwc 10265 PHONE gpp_47��11 FAX
Birmingham, AL 35202 C N Ext ; � No :
aMAll
ADDRES3:
INSURER S AFFORDIN6 COVERAGE NAIC 0
INSURED
INSUREn q:Associated Eledric 8 Gas Ins. Svcs.
Peoples Gas System qrsurtErt s:Libe Insurance Cor .
TECO Energy, Inc.
P.O. BOX 711 INSURER C:
Tampa, FL 33601 iNSURert D:
INSURER E .
INSURER P :
COVERAGES , CERTIFICATE NUMBER:vwG2�8Y� REVISION NUMBER:
THIS IS TO CERTIFY THqT THE POLICIES OF INSURANCE LISTED BELOW HAVE gEEN ISSUED TO THE INSURED NAMED ABWE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE Oi INSURANCE PpLICY NUMBER ���r EFF POLICY EXP
p` GENERAL LIABILITY M �� M� L1MRS
X0521A1A10 07/01/2010 07/01/2011
Self-InsuredRetention EACHOCCURRENCe g 1,000,000
CAMMERCIAL GENERAL LIABILI7Y $1,000,000
X PREMISES Ea occwrrence $
CIAIMS-MADE OCCUR
MED EXP (My one person) $
PERSONAL & ADV INJURY $
GENERALqGGREGATE S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRa LOC PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILIIY $
� �� I L L
ANY AUTO
ALL OWNED SCHEDULED BODILY INJURY (Per parson) $
AUTOS NpN��NED BODILY INJURY (Per aocident) $
HIRED AUTOS AUTOS PROPERTY DAMAGE
Per accident $
UMBRELLA LIqB $
OCCUR
EXCESS LIAB EACH OCCURRENCE $
CLAIMS-MADE
AGGREGATE f
DED RETENTION $
WORKERS COMPENSATpN $
AND EMPLOYERS' LIABILITY T C STI T p R
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OPFICERIMEMBER EXCLUOED7 a N/ A E.L. EACH ACCIDENT $
(Mandatory in NH)
�fy� desaibe under E.L. DISEASE - EA EMPLOYEE $
DESCRIPTION OF OpERAT10NS below
B EXCESS WC EW764N004913110 E.L. DISEASE - POLICY LIMIT $
Excess Workers' Compensation o8/01/2010 07/01/2011 Each Accident or Each
Employee ior Disease S 1,000,000
S
$
DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (pttaeh ACORD 107, AddMionsl Remarks Seheduls, H more s $
Excess liability policy provides insurance in excess of Peoples Gas System's Self-Insured Retention as stat d abov�e.
'WC Statutory Limit is excess of $35,000,000 (i�sured by Liberty Insurance Corporation)
CERTIFICATE HOLDER CANCELLATION
SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DA7ETHEREOF, NOTICE WILL BE DELNERED IN
ACCORDANCE WITHTHE POLICY PROVISIONS.
Creative Contractors IItC. M1T}iORIZED REPRESENTATIVE
620 Drew Sheet �
Clearwater, FL 33755 , ��,p „ a . �, �
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ACORD 25 2010/05 Pase � of � O 1988-2010 ACORD CORPORATION. All rights reserved.
� ) The ACORD name and logo are registered marka of ACORD
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