HomeMy WebLinkAbout11-12087 CITY OF ZEPHYRHILLS �
5335 - 8TH STREET
' ' (si3)�so-oo20 12087
BUILDING PERMIT
Permit Number: 12087 Address: 7345 GALL BLVD
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: 34-25-21-0000-00300-0020
Improv. Cost: 45,000.00
Date Issued: 7/11/2011 Name: MERCHANTS STATION LLC
Total Fees: 1,022.40 Address: 7345 GALL BLVD
Amount Paid: 1,022.40 ZEPHYRHILLS, FL. 33542
Date Paid: 7/11 /2011 Phone:
Work Desc: REMODEL INTERIOR WITH ADDING PARTITIONS & FINISHES
MILLER ELECTRICAL SERVICES INC FIRE PLAN REVIEW FEES 542.40 FIRE INSPECTION FEES 30.00
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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 called 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 property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commenceme "
CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: '7�T �S � f ��, S ��
Date Received: (� - 2 7— � �
Site: �7� � ,S �,4-� ( �� � �
Permit Type: r� � � x► �-r `� r ,Ar� � :S7�c ,�C.c��)
E'!Ke �o�— x {�rY �e �
Approved w/no comments: ❑ Approved w/the below comments:� Denied w/the below comments: ❑
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This comment sheet shall e kept with the permit and/or plans,
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Ka 'n S'tz lans Examiner Date ntractor andlor Homeo r
(Required when comments are present)
, 813-780-0020 City of Zephyrhills PermitRpplication Fmt-813-78Q0021
Building Depadment
Oate Recetved _ Z� �, p�ne CorRact for Permittin ?�l 23 I__ L(o J
owner'sName HI��1T SQV(LS11�{b VWbS, lNt uwnerPhoneNumber 2'05 � 9V2-4Z92
Owner's Address 451 IwDvi �A l. 1.�1 61Rn�waNAr1 A� ;Sl�� Om�er Phone Number
Fee Simple Titleholder Name MERCHf�NTi STATt ofl I.LC Owner Phnne Number
FeeSimple7itleholderAddress 1t5oY NdRTH��Y-�. D9. C�+ata�ai.1AT� OF1 �152y9
�oeAOO�ss MERtH�qN7S SC�ur►126 Z345 Gwt� f3�vD ��.�.# �
sueonnsioN PnRCa iox
(OBTAINED FROM PROPERTY TA% NOTiCE)
WORFC PROPOSED � NEW CONSTR � ADD/ALT Q SIGN Q � DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR � COMM Q OiHER � — p.() O�
TYPE OF CONSTRUCTON � BLOCK Q FRAIu� Q STEEL �
�ESCRIPTION OF WORK las�r+qti�, srocw AAEA RA��nor�, Fimuc uvvr+ �LT1T110i� �`�' � 111 S
BUILDING SIZE SQ FOOTAGE � M6GHT �
[�IALDING $ � � � VALUA710N OF TOTAL CONSTRUCTION �"
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�ELECTRICAL $ � � O � t � ' ANP SERVICE �p{�p � PROGRESS ENERGY Q W.R.E.C. .N• � �"K�'
QPLUMBING w//1 $ `' v �� 2 Uc�? ?� � f fJ�— 1 ���'�
/���y �
�Iv�CHANfCRL A/ $ VALUA710N OF MECHAMCAL INSTALLATION ��� �C ��
/�i �
�GAS � � ROOFING � SPECIALTY Q OlHER ������
FINSHEDFLOORELEV IG1NS FLOODZOf�AREA QYES O "' /
� Net'l� L/RY /W('
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BUILDER ` CpMPqNy /� �� (.l, I{ L r.-4.
SIGNA7URE � REGISTEREG Y FEEWRREN Y/
Address sl � i 5� �1� LIrA '�' c;,�fv� /'L ����� ! c
License# �—�� / �✓ �J �gD
ELECTRICIAN � pp�Pqryy �,.�'C(i�/LC�ISTf
S�GNATURE RE31S7EREG Y/ N FEECURREN Y/N
Address License it
PLUMBB2 COMPANY
SIGNA7iJRE RE�isteREO Y/ N FeECUaREN YIN
Adtlress License Jt
MECH/WICAL � COMPANY
5�6NA7URE REGISTEREO Y/ N �e cuaaeN Y/ N
'��� license �k
OTH62 u COMPANY
516NA7URE /� RE�ISTERED Y/ N �EECURREN Y/N
Address License 7F
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 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I t 1 1 1 1
RESIDENTIAL Attach (� Ploi Plans: (2) sets of Bulldng Plans; (1) set of Energy Fa�ms; R-O-W Permit Tor new constructlon,
Minimum ten (10) working days afler subm�tal dete. Required msits, Constnutlon Plens, Stormwater Plais w! Silt Fence installed,
S�Hary Fadlfites & 1 dunpster, Sfte Wark Permil for subdfvisfonsAarge projects
COMMERCIAL Attech (3) complete sets of BWlding Plans plus a Life Satety Pege; (1) set of Enerqy Forms. R O-W Perrnit for new construction.
Minimum len (1� arorking days aller subm3tal dale. Required ansite, Cansinictfon Plans, Stormweter Plans w/ SiM Fence installed,
Sanitary Fadiflies & 1 dunpsfer Site Work Pertnit }or all new projecls. All commercial requiremerts must meet campliance
SIGN PB2MIT Attazh (� sets of Engineered Plers.
""PROPERTY SURVEY required fa all PEW construdlan.
Dlrectlons.
Fill out application completely.
Owner & Contreetor sign back W appllcatiwi, nderized
tt over $2500, a Notice ot CommeneemeM Is reqWred. {NC upgrades over $7500)
" Agent (for the corRrectar) or Pawer of Atlomey (Tor tha wrrrer) would be someone v�nlh notarized letter from owner aidhor¢ing same
OVER THE COUNTER PERMIITING (Front of Application Only)
Reroofs iT shngles Sawers Service Upgredes A/C Fences (PIo1/SurveyiFoWage)
�rivearays-NOi over Courter if on public roadways..needs RQW
NO710E OF DEED RESTRIC710NS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restridive than County regulations. The undersigned assumes responsibility for compliance with any
applicahie deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILI7IES: If the owner has hired a c�tractor or
contractors to underteke work, they may be required to be licensed in accordance with state and local regulxtions. If the
contractor is not licensed as required by law, both the owner and contractor may be cded fw a misdemeanw 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 contracta or contractors, he is advised to have the contractor(s} sign
portiw�s of the "contractor Block" of this application for which they will be respotisible. If you, as the owner sign as the
contractor, that may 6e an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County
TRANSPORTATION IMPACT1U71LITIE5IMPACTAND RE50URCE 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, es specified in Pesco Counry Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that sucfi 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 invdve 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.
CONSTRUCl10N LIEN LAW (Chapter 713, Florida �atutes, 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 Fiorida Depertment of Agriculture and Consumer Affairs. If the applicant is someone
other than the `owner", I certifij thet I have obtained a copy of the above descnbed document end 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 reguiating 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 ail work will be performed to meet standards of all Iaws 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 identiiy what actions I must take to be in compliance Such agencies include but are not limited to:
- Department of Environmental Protection-Gypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterNUastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, AJtering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Heafth & Rehabilitetive Services/Environmental Health Unit-Welis, Wasteweter Treatment,
Septic Tanks.
- US Envirwimental 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 permdted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating vdume' 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 fili will be used only to fill the area within the stem wall.
- If fill material is to tae used in any area, I certify that use of such fill will not adversely affect adjacent
propeRies. If use of fili is found to adversely affect adjacent properties, the owner may be cited fa violating
the conditions of the building permit issued under the attached pertnit application, for lots less than one (1)
acre which are elevated byfill, an engineered drainage plan is required.
If I am the AGENT FOR TNE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit priw to commencing construction. 1 understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pods, air conditioning, gas, or �her installations not specifically included in the application. A
permit issued shail he construed to be a license to proceed with the work and not as authority to vidate, cancei, alter, or
set aside any provisions of the technical codes, nw shall issuence of a pertnit prevent the Building Official fran thereefter
requiring a correction of errors in plans, constructiai or violations of any codes Every pertnit issued shall become invalid
unless the work authorized by such permit is commenced within six months of pertnit 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 eactension
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 ahandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOl10E OF MM N MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU TE OBTAI FINANd�ING, CONSULT
1MTH YOUR LENDER OR AN ATTORNEY BEPORE RECORDING YOU O OF CO ENCEMENT.
FLORIDA JURAT (F J 17 03)
OWNER OR AGENT � �� CONTRACTOR � �___
Sub cribP�nd swom (or affirmed) before this Su cnb antl s m t or affirmed) befo�p rr�e, tbi
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a2'. ! a- o —�2. v T � --- -��� _���g____ �ye �: 1 �- --
Who islare on known to m r haJhave �rotluced VYho is/are pe nally n to me or has;have orotlucetl
__ ___as iden4fication as �dentificahon
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p b���ame nf � typed prin[ed �r stampPd Name of otary typed, printed or ;tamped
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��d a�' ,�' ° IQiYSTAL A NEVILI,E
bd fia 5 ta�� ;.; �� MY COMMISSIoN k QD 74A218
� IXPIRES: Jarwary 25, 2012
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, 2011098766
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DS: 0.00 IT: 0.00
06/27/11 C. Cook, Dpty Clerk
Permit No Parcel ID No "-� � � � ��r i' V v� � C ��' �� �' `� �} �`�
NOTICE OF COMMENCEMENT
State of Florida County of Pasco
THE UNDERSIGNED hereby grves notice thffi improvement will be made to certa�n real property, and in accordance wdh Chapter 713, Florida Statutes,
the following information is provided in this Notice of Commencement:
1 Description of Property Parcel Identification No.
Street Address: MerchanYs Square 7345 Gall Blvd. Zephyrhills, FL 33541
2. General Description of Improvement Install stock area partition, Instail fitting room partition, Install tenant specific receptacles,
Install stock area fixtures, Install sales area shelf standards, Install slatwall finishes, Paint, and Install floor finishes.
3. Owner Infortnation _ N�6�ET� SPo'RT ING Gooas �/��
451 fNDVST�it9L Ud QIW'N1NGH�1�"+ (35Z11� �L
Address City State
Interest in Property Tf►IAPIT uNDt1t LEi4 iE �q(,�ifkw�b.�T
Name of Fee Simple Titleholder MER�-�11ts S'f14T1GP{� �.1.�
�ISG1 NoRtH1.ti9KE pQ � fotherthanowner) �,�N�,��pT� �yS1�lA� 0!1
Address City State
4. Contrador Argos Buiiders LLC
310 S DillaN��t�Ste 215 Winter Garden (34787) FL
Address City State
Contractor's Telephone No. 321-231-2693
5 Surety
Name
Address City pqULA S 0 'NEIL,Ph D PqSCO CLERK & COMP7ROLLER
Amount of Bond: $ Telephone 06�2�� l i 02 : 38 m 1
6. Lender O R BK �5�,' P � of 2
Name 3 26 7
Address City State
Lender's Telephone No.
7 Persons withm the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7), Flonda Statutes:
N!A
Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself, the owner designates N�A of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
Telephone Number of Person or Entity Designated by Owner
9 Exp�ration date of Notice of Commencement is one year from the date of recording unless a diHerent date is specfied:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TMCE 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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
STATE OF FLORIDA / /FQf{'y`. /� _ _ _
COUNTY OF PASCO ( 73�GN^'"�—
Sig ture of Owner or Ownefs Authorized Officer/Director/Partner/Manager
D��tEcTVYt pf Co�ISTYivcT�o�
� Signatory's TitlelOffice
The foregoing instrument was acknowledged before me this day of , 20 ��, by ���b /) �Y eW Z
i
as r 0' (rype of authority, e g, oKicer, trustee, altomey in fact) for
'a�e�s � �� (name of party on behalf of w in�stru was executed)
'�� Pe nown � Produced entification Notary Signature [ �J 6�–�– �
� /
� Type �i ation Produced Name (Print) � � ! � l�D�ar
� '�,qh�errficatio pur uant to Section 92 525, Flonda Statutes Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in
���� true th best of my knowledge and belief � n � �
` � 1`, � 7�IA/�(��
� Signat e of Natural Person Signing Above
p �_� \ �,y
�E'ulq��wPn�ar6 formslnoticecommencement_pc053046wc
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OR BK g566 2� 32��
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DATE: 06/27/11 PASCO COUNTY PROPERTY APPRAISER 14:34:43
O N- L I N E P A R C E L P R I N T O U T
PARCEL-ID: 34 25 21 0000 00300 0020 TYPE: STATUS: A DLA: 073108
SC TP RG SUB BLOCK LOT TRACT: 0328004
L E G A L D E S C R I P T I O N:
ASSESSED IN SECTION 34, TOWNSHIP 25 SOUTH, RANGE 21 EAST,
PASCO COUNTY, FLORIDA
COM NE COR SEl/4 TH N89DG58'35 "W193.17FT TO WLY R/W US301 TH
SOlDG 09'30"E25FT TO SLY R/W PRTYPONDRD TH CONTALG SAID R/W
SO1DG09'30"E.38FTTHN88DG51'04" ElOFTTHS00DG07'42"W609.07FTFOR
POBTHN89DG33'48"E32FTTHSOODG04 '30"W125.09FTTHN89DG58'40"W208
FTTHSOODG04'30"W349.17FT TO N R/W OF MEDICAL ARTS CT TH
N89DEG58'40"W 717.64FT TH ALG ARC CV R RAD 182FT CHD N79DEG
58'40"W 63.21FTTH N69DEG58' 40"W106.72FT TH ALG ARC CV R
RAD 70FT CHD N34DEG55'29"W 80.40FT TH NOODEG7'42"E 5.89FT
TO PT 964FT S OF S R/W PRETTY POND RD TH S89DEG59'35"E 303FT
TH NOODEG7'42"E 450.33FTTH S89DEG58'35"E 181.40FTTH S10DG
18'53"E 122.48FTTH S89DEG58' 35"E 395.40FTTH SOODEG7'42"W
39.91FTTH S89DEG58'40"E 200FT TH NOODEG7'42"E 64.83FT TO POB
BEING A PORTION OF NEl/4 OF SEl/4 OF SEC & LOTS 4& 5
TOWVIEW MED ARTS CTR PB29 PG 68;TOG W/EASEMENTS OR 7544-179
STAiE G� FLORIDA, COUNTY �7F PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT C�PY OF TH� DnCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
,�d�TNESS MY HAND NC� OFFICIAL SEAL THIS
_,�- DAY OF �� � d /%
PAU S O'NEIL, ERK & COMPTROLLER
% - �,
BY G [)F',=� �Tv CLERK
Pasco County Parcel: 34-25-21-0000-00300-0020 001 Page 1 of 2
Data Current as Of: Weekly Archive - Saturday, July 02, 2011
Parcel ID 34-25-21-0000-00300-0020 (Card: 001 of 012)
Ciassification 16 - Shopping Center Community
Mailing Address Property Value
MERCHANTS STATION LLC Ag Land $0
C/O PHILLIPS EDISON & CO Land $1,246,320
11501 NORTHLAKE DR
CINCINNATI OH 45249-1669 Building $1,973,407
Physical Address - See All 14 addresses (First Extra Features $125,618
Shown) Market Value $3,345,345
7321 GALL BLVD Assessed (Non-School Amendment
ZEPHYRHILLS FL 33541-4372 1 � $3,345,345
L@Qal D@SCI'IDt1011 (First 4 Lines)
COM NE COR SE1/4 TH N89DG58'35 Taxable Value �3,345,345
"W193.17Ff TO WLY R/W US301 TH
SO1DG 09'30"E25FT TO SLY R/W
PRTYPONDRD TH CONTALG SAID R/W
Land Detail (Card: 001 of 012)
Line Use Description Zoning Units Type Price Condition Value
�� SH �R G ������
1 1600 OOC2 5.00 A� $180,000.00 1.00 $900,000
� 1600 SH �R G OOC2 2.96 AC $180,000.00 0.65 $346,320
Additional Land Information
Acres 7.96 Tax Area OZH FEMA Code � Commercial Code ITE2A1
Buildina Information - Use 14 - Grocery Store, Market (Card: 001 of 012)
Year Built 1993 Stories 2.0
Euterior Wall i Concrete or Cinder Block Exterior Wall 2 None
Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel
Interior Wall i Drywall Interior Wall 2 None
Flooring 1 Asphalt Tile Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Packaged Roof Top Baths 4.0
Line � Description Sq. Feet Repl. Cost New
1 � BAS 39,826 $2,483,948
Z F�ST 9,600 $299,376
3 � AN 1,490 $27,879
Extra Features (Card: 001 of 012)
Line Description Year Units Value
1 PAV ASP 1993 203,372 $41,183
2 LIGHTSM 1993 1 $786
r 3� LIGHTDM 1993 2 $1,776
�- 4 � LI HTTM 1993 9 $g,g25
5 LIGHTFM 1993 2 $2,146
6 � SPRNKFP 1993 49,426 $37,070
Sales History
Previous Owner INLAND SOUTHEAST MERCHANTS
Year Month Book/Page Type Amount
2007 06 7544 / 0179 WD $0
� � ��
http://appraiser.pascogov.com/search/parcel.aspx?sec=34&twn=25&rng=21 &sbb=0000&bl... 7/5/2011
Zephyrhills Fire Rescue
(907 [)airy Road, /�phyrhills. (� L 335�2
I'ice Marshal L3us (813) 78U-0041
K.erry 13arn�tl t�ax (813) 780-O04�
L;-mail: kbar»ett(a,`.lire.�e�hyrhills.11.us
Plan Review #: 11-091 w v �� Nw ��� �
Project: Building Renovation (rehab)
Number of Pages: I S
July 1, 2011
I have received and reviewed the plans for rehab of a tenant space for a Class B Mercantile
located at 7345 Gall Blvd and will allow it to move forward. Paying for permit contractor
acknowledges complying with the items listed below. Should anyone have any questions, please
do not hesitate to contact the Fire Marshal's office.
1. The 2007 Florida Fire Prevention Code shall be followed for this project. The
International Code is not accepted as noted in the plan.
2. Exercise safe construction practices in accordance to NFPA 1.
3. If fire alarm or fire sprinkler system is to be out of service for any reason (longer
than 4 hours) notify this authority. A fire watch will have to be established with
proper documentation provided to this authority showing it was conducted.
Paperwork will be given to the contractor by this authority for fire watch.
4. Ensure egresses from the construction area are unobstructed.
5. Ensure certified fire extinguishers are readily available and accessible during
construction.
6. Post no smoking signs in the demo area.
7. Any alteration to the fire sprinkler or fire alarm system shall be cause for plans to
be submitted showing changes in order to obtain a permit to conduct the work.
Supply all documentation, cut sheets, etc... with plans.
8. Sprinkler violations previous noted to property maintenance that affect the system
in this space shall be corrected.
9. Ensure AHU is tied into fire alarm system through duct detectors.
10. Ensure penetrations in firewalls are sealed appropriately. Also ensure the walls
are sealed to the roof deck appropriately and labeled as a firewall.
11. Paint red striped lines on the floor around fire sprinkler risers (3 foot on sides and
front) to assist in indicating not to obstruct riser.
12. Install additional exit sign at second entrance in to rear storage (not noted on
plan). Also install addition exit signs to provide directional marking in retail area
and storage area.
l3. lnstall emergency lights in restrooms and at rear egress area.
14. Prefer a yellow striped egress path through the storage related space.
15. [nstall a lightweight truss sign in accordance to Florida Statute. An "R" sign shall
be located to the left of the main door between 4— 6 feet.
16. A key will be required to be located in the knox box outside the main door.
2
17. Ensure rear door is addressed, as well as, the electric meter.
Inspection Required:
l. Firewall penetration
2. Final
KERRY BAR , RE MARSHAL
***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
submrtted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compl�ance
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.
Z��y.l���€�°il��.� �iRE 13��'Af��'�IAEf4`�°
6907 �airy Road, 7_ephyrhilis, FL 33542
�sre Chief f(e�rh Wifliatns �us (8'i3)7$0-Ot141 Fax (81:3)730-0{)�,�
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: �- Contractor: �i��'�3 S �% �C�iL
Business Name ''�. �4 .a��i,�r� ����.�— Billing Address� j
Business Address� _ � ��r.�� (�y�i1 �, �� � ��
�' ^ �?�' �- 5�
Business Phone No Billing Phone No.: "
Business Fax N� Billing Fax No..
Contact Contact.
PIAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
Site Plan N/C Annual N/C Sprinkler $50 1 st Alarm N/C
Multi O6 sf 1 st Re-inspection N/C Sta�dpipes $50 2nd Alarm N/C
(Mirnmum Charge $ZS 2nd Re-inspection a100 Fire Pump 350 3rd Alarm N/C
� Plan Rewsions DBL 3rd Re-inspection 5250 Noods $50 4th Alarm g�pp
�j7�� 4th Re-Inspection $500 Fire Alarm $50 5th Alarm 5150
SPRINKLER SYSTEMS (Busmess closed until LP Gas $50 6th Alarm a200
0- 25 Heads $50 violations corrected} Natural Gas $50 NON COMPLIANCE $� 5p
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- Pe� ra�k y50
STANDPIPE SYSTEM Hydro Undergrounds �45 Sparklers $�pp
� Per Riser $50 Hydrostatic Test �65 persystem �i�e Works $500
FIRE PUMP Acceptance Test S4$ per system Camp Fire �25
� Per Pump $100 Hydrant Flow a75
Controlled Burn a100
FIRE ALARM SYS7EM Hood/Duct $50
0 25 Devices $50 FIRE ALARM SYSTEM Place o( Assembly $50 A�nual
26 plus Oevices $100 System Acceptance a50 Fire Protection a�
SUPPRESSION SYSTEMS F2ecall ACCeptance $50 Flammable Application $50 annua�
We� 350 OTHER �'Z l Waste Tire Storage $50 Annual
�ry $50 ire WalllSmoke Wa11 �rwan Generator <�(yv 5100
Co2 $50 LPGas 325 pe�ca�k Generator>3UKW �Sp
Othe► $50 Natural Ga5 $25 pe� system Bio-Haza�d Waste $100 qnnual
KITCHEN EXHAUS7 Fumigation Tenting $5p
� HoodlDucts $50 Tent 10'x10' or greater $15 Pe, tent TO�Ch PoUApplled $50
OTHER Fire Pump $45 Haz Materials a�OO Annual
LP lnstallat�on pPr tank $50 F�re Suppressan $30
fuel Tank Installation $50 System Acceptance
(Per Tank) $50 B Exhaust Hood/Duct $30
� Natural Gas Installalion $50 Re-mspection DBL
(Per System) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL 8
and cancelled less than
24 hours
Consiruction Insp. N!C
Emergency Vehicle Ac� $50 FALSE ALARM
P�ANS TO7AL � INSPECTION TOTAL� � PERMIT TOTALL _�� TOTALI I
<� /'� �7V'
GRAND TOTAL �
Comments
Date __�1 I
Insq��ctor ' � � .� �'7 f � �''��
AKC�OS
BUILDERS, LLC
6/27/2011
City of Zephyrhills- Building Department
5335 8�' Street
Zephyrhills, FL 33542
Re: Hibbett Sports # 1020
Please allow James Nugent and/ or Ronald Miller to pick up permits, Certificates of
Occupancy, schedule inspections and pay any fees on my behalf.
Please contact me if you have any questions.
Sincerel , !
�
i
..� �
Jason ominger
Presi ent
����� ��
���a�
��� ���s� �.�,R N �w� a�l, a� � I
� �
`��� -�� ��` �
- r + �tr "'� IWYSTAL A NEVILLE
:
:.: :,� MY COI�AISStON N DD 744216
''ss � ' EXPIRES: January 25, 2012
' 9aideatNuPbWyPUhlcUndennlMrs
310 South Dillard St. Suite 21 S Winter Garden, FL 34787
Phone:407.8773009 Fax:407.8773028
� 1
CITY OF WINTER GARDEN
300 WEST PLANT STREET
WINTER GARDEN FL 34787
I�I�T�R
Gfl RD�fI P: 407.656.4111
WWW WINTERGARDEN-FL.GOV
� • � � . . . ..
LOCAL BUSINESS TAX RECEIPT FOR CITY OF WINTER GARDEN
Business Name: ARGOS BUILDERS, LLC Location: 310 S DILLARD ST S 215
Receipt No: 11-00004991 Class: BUILDING CONTRACTOR
Tax/Add'tl Tax: $ 86.00 $ Issue Date: September 30, 2010
Late Penalty: $ 0 00 Expires: September 30, 2011
Total Paid: $ 0 00 Restrictions: MUSTCOMPLYWITHLOCALBUSINESSTAX�EQUIREMENT3
Comments: HOME OFFICE FOR BUILDING CONTRACTOR
ARGOS BUILDERS, LLC
310 S DILLARD ST S215
WINTER GARDEN FL 34787
BUSINESS TAX RECEIPT MUST BE POSTED IN CONSPICUOUS PLACE AT ALL TIMES
---------------------------------------------------------------------------------------------------------------------------------------------------
***PLEASE NOTE THE TOP PORTION IS YOUR 2011 LOCAL BUSINESS TAX
RECEIPT AND IS PAID THRU SEPTEMBER 30, 2011***
1 Business Tax Year is from October 1 through September 30 Tax fees are prorated after April 1 for a half-year fee
2. All new commercial business tax must be inspected by the Fire Department to meet all applicable state and city code
requirements. You will be contacted to make arrangements for your inspection.
3 An Orange County Business Tax must be paid AFTER YOU HAVE BEEN ISSUED THE WINTER GARDEN
BUSINESS TAX RECEIPT They are located at 201 S Rosalind Ave, 2nd FL, Orlando, (407) 836-5650.
� �„� STATE OF FLORIDA
�' •: DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
� � 1940TRUCTIOM INDUSTRY LICENSING BOARD (850) 487-1395
� NORTH ONROE STREET
��D.�� TALLAHASSEE FL 32399-0783
DOMINGER, JASON R
ARGOS BUILDERS LLC
493 NEWHEARTH CIRCLE
WINTER GARDEN FL 34787
_ .. _ r ;..:. _ : , .. �.. . .. _.,_,. . ..� a ,� ., . .r .,. .
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:°;..s'. ,,, � ; �gi',�',��." . ,'F". �IQi,R' ;,r; :.
Congratulations! With this license you become one of the nearly one million -'-; �'' = �-' � �- • "
Floridians licensed by the Department of Business and Professional Regulation "''`' - '�������` `���"' ���
f '� t �' _, �M�
Our professionals and businesses range from architects to yacht brokers, from �':,�� _> =;;�_ � m�;; �. �-; � + F. - s, "�� � R:,: �.� ,. : i . :.'
u�._�,,,, �_.
boxers to barbeque restaurants, and they keep Florida's economy strong "'� � i�`�� � :�`�' �-'-�"' � ��-� �� 'cr�:;.'�4 :-``. - : , �
� � =���s" `� ��'' -- � �o �•�2
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Every day we work to improve the way we do business in order to serve you better .,;"';�-�; �.-�:, ��;:° �_r� -,;�► -. :�- •ru_� =-;. '_. �"
. z r t �, � - H .. .,� .
For information about our services, please log onto www.myfloridalicense.com. °_ ,�� `,- : F . - A ��'�"�'fR
There you can find more information about our divisions and the regu�ations that ".'-}�}� -.: ,��_ `; '.:.,
impact you, subscribe to department newsletters and leam more about the �;� `' x �� �
Department'sinitiatives. _'��' >F���� _ '��^'�-"�'�",
_ ,,, 3;,� `r' � ' . �.,,
Our mission at the Department is: License Efficiently, Regulate Fairly. We ,,., •. �„`_-�. �:°��,,cf �•��~��x� �`�.�,� ;��_ -
constantly strive to serve you better so that you can serve your customers. - � �- ���}uF=-�..:., �..,0.:•;;�..�-�a�:�
Thank you for doing business in Florida, and congratulations on your new license! -_ -�c=���=:'s��;���
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'`��,� CERTIFICATE OF LIABILITY INSURANCE DATOGI2/
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 certifcate does not confer rights to the
ceRificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
407-359-1009 N,u�E:
Sil G oup 407-386-7427 ac"N Ex� : - -- --_- — __ — _ — _ -- - — �ac N�---
1200 City View Center A DR�ESS:
Oviedo, FL 32765 — , - -
Jeannine Ellenson INSURER(S) AFFORDING COVERAGE _ _ _ __ � _ _NAIC # _
INSURER A; Commerce & Industry Ina
--
- ---- - -- - -
INSURED Argos Builders LLC INSURER B:
Rebecca Dominger ----- ------- --- - -- ----- --- --- - - --------
310 S. Dillard St. Suite 215 iNSUReRC : _ ____ ____
Winter Garden, FL 34787 INSURER D
INSURER E �
- — --- ------ ---- - --- �- - --
INSURER P : '
COVERAGeS CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BE R EDUCED B PAID CLAIMS.
f LTR NPE OF INSURANCE ADDL SUBR pOLICY NUMBER —� MMIDD/YYYY I� LIMITS
' GENERAL LIABILITY l � EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY i I ���(`'E T6l2ENTE��
--- I P REMISES _(E_a_x currence) $
CLAIMS-MADE OCCUR MED EXP (Any one person) $
PER SONAL 6 AD V INJURY $
-� ---- -- - --- - -- �-- -- --
GENERALA $
C GEN'L AGGREGATE LIMIT APPLIES PER: , � PRODUCTS - COMP/OP AGG $
POLICY I PRO- I LOC li - -- -- - � $ - -- -
AUTOMOBILE LIABILITY '' �� ' �, ' COMBINED SINGLE LIMIT �
- (Ea accide y_
ANY AUTO � I ' BODILY INJURY (Per person) I$
ALL OWNED , SCHEDULED BODILY INJURY Per accident $
AUTOS _� AUTOS � ( )' -- ---
PROPERTY DAMAGE +
NON-OWNED �-�"-
_ HIRED AUTOS AUTOS 1 Per accident) _ $
--
� , UMBRELLA LIAB l i, OCCUR �'� �
EACH OCCURR $
� EXCESS LIAB I� CLAIMS-MADE AGGREGATE $
--- -� -- -- ` - - -- -
I DED RETENTION $ � ' $
WORKERS COMPENSATION I �� WC STATU- OTH-
I AND EMPLOYERS' LIABILITY � ' TORY LIMITS ER
/4 � ANY PROPRIETORJPARTNER/EXECUTIVE Y/ N I IWC003�9598$ 04/25H 1 I, �4/25/� 2 �EqCH ACCIDENT $ �,���,��
� OFFICER/MEMBER EXCLUDED? � N � A -- -- �----- _ _
(Mandatory in NH) I I �F L. DISEASE - EA EMPLOYE I S �,QOO.00O
It yes, describe under i --- -- -- --- --
DESCRIPTION OF OPERATIONS below
�E.L. DISEASE - POLICY LIMIT � $ 'I,OOO,OOO
I I
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DESCRIPTION OF OPERATIONS I IOCATION5/ VEHICLES (Atfach ACORD 101, Additlonal Remarks Schadule, if more space ia required)
CERTIFICATE HOLDER CANCELLATION
CITYZEP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CI�/ Of Z@pF1�/fI11IIS ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department
5335 8th Street AUTHORIZED REPRESENTATIVE
Zephyrhills, FL 33542
O 7988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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07-07-'11 16:09 FROM-Miller Electric 4078127171 T-768 F001 F-949
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L '�
ELECTRICAL SERVICES INC.
2153 PREMIER ROW QRLANDO, FL 32809
(407} 812-1822 FAX (407) 812-7171
July 7, 2011 �
City Of Zephy�hills T$uilding Dept
5335 8 th St�t
Zephyrhills, FL 33542
Re: �ibbett Sports
T'lease rCgiSter us in yoUx Syst�m as at1 active contraCtOr This letter a�nd the
accompanying pages are intended to com�lete the requirements. Our correct address and
contact infornnation is on the top. I have requested COI frant our yVorkexs Compensatio�a
and Crenexal Liability c,axriers and included a copy iz� this fax.
If there xs any problerns please contact us.
Total of 4 pa$es includi�.g this one shou�d be received
Thank you
�
Steve A. iller
State of Flo�ida Certified Electrical Contractar EC 0000594
07-�7-'11 16;09 F�OM-Miller Electric 4078127171 T-768 P002 F-949
�►�'a' p CERTIFICATE �F LIABILITY INSURANCE oi�o6� o�i""
THIS CERTIFICATE IS ISSUED AS A MATTER OF INPORMATION ONLY AND CONFERS NO RiGHTS UPON TNE CERTIFICATE HOLLIER. THIS
GERTIFlCATE DOES N07 AFFIRMATIVELY OR NEGATIII��Y AMEND, EXTENO OR ALTER TH� CQVERAGE AFFORDED BY THE POLICIE$
BEL4W. TF�IS CERTIFICATE OF INSt1RANCE DOES NOT C�N$TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATtVE OR PRODUCER, AND TNE CERTIFICATE HOLDER.
IMPORTANT: If !he Certiflcate ho{der is an ADOITIONAL INSURED, the policy(ies) tnust b2 Endoraad. If SUBROGATION 1S WANEG, SubjeCt to
ths tarms and condidon5 0� the poltcy, certain policie9 mdy require an endorsement. A st0tement on lhis aarfJflcats does not coMer rights to tl1e
r,artlfleate holde� in lieu of 9uCh andorsem s.
PRODl1CFJt NAMEf T
Doug JOnas c/o AJG Risk Manageme� Services, Inc. P •(480 951-4177 F ,,, ^ �� � 951-4268
8800 E. ChapBrral Rd, Suite 230 E-MA1L
Scottsdale, AZ 85250 �����
INSUR S AF OINp CQ1/ERAGE NAIC t
�nsur�rca: Zurich-ArnenCan Insuranoe Comparry 16535
INSURED INSURER 6 :
Oasis Acquisition, Inc Alt Emp: Miller Elechical Services Inc irisutt�t c:
2054 Vista Parlcway Suite 300 INSURER D :
West Palm 8each, PL 33411
INSURER E :
INSUR£R F :
COVERAGES CERTIFICATE NUNBER: 11FL075815852 REVISION NUMB�R:
THIS �S TO CERTIFY THAT TME POLICI�S OF INSURANCE LiSTED B6LOW hIAVE BEEN ISSUED TO THE INSl1RED NAMED A80VE FOR T11E POLICY P£RIOD
INDICATED NOTVIATHSTANDING ANY REQU�REMENT, TERM OR CONDiT10N Of ANY CONTRACT pR OTHER DOCUMENT VNThI RESP$CT TO 1AM�CH THIS
CERTIFICATE MAY BE 15SUED OR MAY PERTAIN, TH£ INSURANCE AFFORDED BY 7ME POl1CIES DE$CRIBED HEREIN 15 SUBJEC7 TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POtICIE3. LIMITS SHOwN MAY HAVE BEEN REDUCED BY PAID CWMS.
TYPE OF IN6YRANOE � E � �� � LIMTS
�� N MND POLICY NtlMBER MMID MID
oE►+au� uas�urr �,,cr, xcuaaENCe s
COMt�RCtAL GENERAL LIABILTTY PR MI earanenee 4
CuIMS•MADE � OCCUR MED F�(P OM peft0l�) S
PERSONAL 8 ADV INJURY S
GENEFiAIAGGREGRTE S
GEN'L AGGRE4A7f L1MIT APPIIES PER: PRODUC'rS - COMPIOP ACaG S
POLICY PR lOC =
AUSOMOBILE LIABILIIY Ea � ecide
ANY AUTO BODILY INJURY �Par pwsa+) t
�I �OSULED BODILY INJURY (Per accident) i
NON-0WNED PROPBRrfl+�C+E :
HIRED AUTOS AUTOS
s
uMBREIU une OCCUR EACM OCCURRENCE S
�� � CWMS-MAOE AGGREGA7E i
DED RfTENT10N s f
WORKERS COMPEN9ASION X V4C STA7U- OTH-
pND EAIPLOYFRS' WIBMJTY
ANY PROPRIETORIPARTNER/dCECUTn/E �� N/ A WC 29�3�87�9 ��01r1�11 06101/2012 E.L EACM ACCIDENT E 1,000,000
A o�ic��e� excwo�m l„_J
(M in NM) E.L. DISEASE. EA EMPL S �,OOO,OOO
DESCRI�10 OF dPERAT10NS oelow El. �ISEASE - Pp41Cr Lw11T S 1,000,000
Locatfon Covorags P�rlod: 06I0112011 06/01/2012 Cli�nt�l: 526
OESC�uP1yON OC OPERATIONS! lOCA710NS J VEMCLE9 (AttNCh ACORD tot, Adatdona� RemaAcs S�hedula, H mOro sp�ee is roqulrotl)
Coverage trs provided for Mfller Eledrical Services lnc
only tlwse empbyees 2�53 Premier Row
leased to but not Odando, FL 32809 ,
subcantradas of:
CERTIFICATE HOLOER CANCELLATION
CITY OF ZEPHYRHI LLS SNOULD ANY OF THE ABOVE DESCRIBED VOLICIES BE CANCELLEO BEFORE
A77N: BUILDING DEPT TNE EXPIIiAT10N pATE THEREQF, NOTICE WILL BE DELNERED IN
5335 8TH ST ACCORDANCE W17N THE POLICY PROVISfONS.
ZEPHYRHILLS, FL 33542
AV7'HQR�O REPRESEN7ATNE
����„''
� 1888-2010 ACORD CORPORA710N. Atl rights reserved.
07-0?-'11 16:�9 FROM-Miller Electric 4078127171 T-768 P003 F-949
r �
' CERTIFfGA7E QF LlABILITY IN$URANCE � oi�o� �'
r�S C�RTIFICATE IS I3SUED as A MaTTER OF INFORMA110N ONLY AND coNFERS NO RIGHTS UPON 1HE CERTIFICA7E HO[.[�R. TI�Ns
CERIIFICA'1'� DOES NOT AFFlRMATII/ELY OR NEGATIYELY AMENI�, �XTEND OR ALTER THE COVERAGE AFFORDED BY 111E POLIdES
BELOW. TFNS CER7tFlCATE OF INSURANCE DOES NOT CONST1TUrE A CONTRACT BETWEEN TNE ISSUING INSURER(S� AUTHORI2ED
REPR�sErRArnE OR PR4DUCER, /WO THE cER�FICaTE HOLDER.
IMPORTANT: If the ceA�cate holder is an ADDI110NAL INSURED, the policy(iea) must be e�orsed. If SUBROGATION IS WAIVED, subjec:t to
the terms and conditians of the policy, certain policies may require an endorsement. A statement on this certificete does not cqnfor rights to the
certificata holder in Ifeu M euch er�dorsemeM s
vr�o�uc�R 407-869-0962 C NqNEACT Melinda L ch
SIHL� INSl1RANCE GROUP, INC. qpy.774.093g ;� � E ,407�89-8424 N, 407-389-8494
P. O. BOX 160398 A ML ch sihle.com
ALTAMONTE SPRINGS, FL 32716 � �
Cheryl Noble MILLE31
M15URE S AiFORDINGCOV�JIGE NAICi
��� Mfller Electrical Serviaes inc �,su�a:Westfield Insurance Group 24712
2153 Premier Row ,�� e :
Orlando, FL 32809
w�c:
�+sukEa o :
1NSURER E :
INSURdtF:
COVERAGES CERTlFlGATE NUMBER: REVISION NUMBER:
TMIS IS TO CERTIFY THAT TFtE POLICIES OF 1NSURANCE IISTEO BEl,QW HAVE BEEN ISSUED TO THE IN5URE0 NAMED ABWE FOR THE POLtCY PERIOD
INDICAT�D. NONVRHSTANDMJCi ANY R�GlU1REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHHR DOCUARENT WRH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES OESCRIBEO HEREN IS SUBJECT TO AlL THE TERMS,
EXCLUS�ONS AND CONDITIONS OF SUCF1 POLICIES. �lM�'TS SHOWN MAY HAVE 9EEN REDUCED BY PAtD CLAIMS.
� TYPB OF INSYitANCE POLICV nn�M6ER MMAO/YYYY Mr+oorcrvv L��
GENERALLIABILITY �MQG(�/RRErIICE S ����
14 x COMMERCIALGENERFLLIABIIITY RA3376346 0911511Q ����� pRp.1�S�S Ee aw�6noe = ���
CLAIMS�MPDE QX OCCUR MED EXP (My or+o pirso�) S �Or
X Per �ocallon A99 a�RSOnia� a,�,ov r�a,ar s 1,000,
X C��� W�• GENERnLaGGREGATE S 2,000�
GEN'IAGGREGATELIMITAPPLiESPER PRODUCTS-COMp�OPAGG 6 Z.��.
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euvr PROPR�ErOR��RnuEWE)cECV'rrv� Y � N E,�, �N ,ACCIDENT :
OFFICERIMEMBEREXCWOfO� � NlA.
ryan�late+Y M� NMl E �. DISEASE - EA EMPLOYEE f
If y99, C64CtiDB urWB�
DESCRIPTI N OF OPERATIONS belOw E L. DISEASE - POLICY LIMfT S
DEBCRPTION OF OPERA710NS i LOCA110NS! VEY#CLES (AtMCh ACQIm tot, A�tla�N RamoA�a 8ch�dul�, If mon spue la requlred} �
CERTIFlCATE FfOLDER CANCELLATIOlJ
ClTYZEP
• SHOULD ANY OF THE ABOVE DESCRIBED POI.ICIEB BE CANCELLED BEFORE
CityofZephyrhilis TM+E ExP1�►noM oA7E i1�REO�, No11t� wkL BE DELNEREO IN
ACCORDANCE NfITM 7HE POLICY PR0IASIONS.
Building Dept
$3.35 Stli SLI'eeL AIRNORt2ED ItEPRESBJTATNE
2ephyfiills, FL 33542
�� Q �.iEb(f_�
,�
� 1986-2009 ACORD CORPORATION. AI1 rlghls reserved
qcoRD 25 (2ooeAe) The ACORD name and togo are regist�red marks of ACOrtD