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Home My WebLink About11-12187 CITY OF ZEPHYRHILLS r' � 5335-8th Street (813)780-0020 12187 ELECTRICAL PERMIT Permit #:12187 Issued: 8/10/2011 Address: 6020 GALL BLVD Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL. Class of Work: ELECTRICAL MISC Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 2,286.00 Total Fees: 75.00 Subdivision: CITY OF ZEPHYRHILLS Amount Paid: 75.00 Date Paid: 8/10/2011 Parcel Number: 03-26-21-0010-12800-0000 Name: STALEY INC Name: GALL BOULEVARD LAND TRUST Addr: 754 MONROE RD Address: 350 HARBOR PASSAGE SANFORD, FL 32771 CLEARWATER, FL 33767 Phone: 407 792-2046 Lic: Phone: (727 43-8922 Work Desc: LOW VOLTAGE INSTALLATION FAMILY DOLLAR VOICE & DATA ELECTRICAL FEE 75.00 � , �r ' ROUGH ELECTRtC CONSTRUCTION POLE PRE-METER FINAL - REINSPECTION FEES: Reinspection fees will oomply with Florida Statute 553.80 (2)(c) when extra inspection trips are neoessary 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 cailed e) permit not posted on job site � plans not at job site g) work not aacessible. 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 wunty, and there may be additional pertnits required from other govemmental entities such as water management, state agencies or federai 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 wmmencement may result in your paying twice for improvements to your properly. If you intend to obtain financing, consult with your lender or an atborney before recording your notice of commencement." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. I J,x,., � �l.�il.� �--- - CONTRACTOR SIGNATURE PER OF I PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER o� �� ' . Z3a� � • �� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: C�, `e Date Received: �_ Z � -� l � Site: d ZC� � /�- � l 1-� � �� `� � � �� C Permit Type: 1� Approved w/no comments: Approved w/the below comments: � Denied w/the below comments: ❑ This comment sheet shall be kept wi ermit and/or plans. � �- 7 Z �=�� Kalvin Switz — 1_ s Ex ' r Date Contractor and/or Homeowner (Required when comments are present) Nv1d �vnna�vu � � z-b� � �nl.u�� s6sg - '1VWilOJ +NpWM767p �I7yp1C z " �R �� o n a � ' u � 3� # �, 1�� ld '`dl`d70 L66 I Oc N� �NOIlV',)O"1 �11�7('O�IJ � � � � Y § U � • a tN o so�a�'s�uvNf 2� OC g,j � n � avoa 3ouio� to�o� �\y� � J � ; � a � � 3 � � �+ g � � � � � �� r�� d �� d � � � � � � � � H �_ � � o � �� s � A � u � w � � � �a� � R ��>�� u N ��a�ac�� VVVVV ti/ �� dd�� $ 8 w z �� g � � � a � - - _ � S � �3NIw � � � 3 � � � H �� - � � N � �� 1 � � � � � � N � � � � � �,� =' „ � N . /// r� II � � y � � C � ._ / ? � V � . � � ' � f 4i � � � � f � Q Ri � O I�i � � � � w1 � � � � t . � � !i r� �! r, � � � � o�"a ��a�d��io� � � �� e ."�c V � �,7 � `S7�''T�r.._ } �k� ��,� 8 bQ o � s ?� � od�b� � sr �� < $IIM,� dLV0�7��?7b'n � ' b �,�.� ��,� �� 7dHS��M7 d .►-.� t , - ""�� .a R 1•� .rl a-t a�u � * ti � �u 4 w t � k � w � t�. w n ,. g ,�' L � (1� - } � � � �` � � _ folr� s� � w A ' A� 4 . 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A-J � � � L w 8 A ^ R R *` ___^__ _____ ~ t }, � � . �� ---------- '� T O �_��_�_�_ �� 1 _'�� __�___� � L * A'� � 3 M � 9/b IIOZ 'W'd85�9Z�Z0 xe}opue��o Ll68lZELOV 4073218917 orlandofax 02:26:03 p.m. 07-28-2011 2/6 , ai3-�eo-oo2o City of Zephyrhills Permit Apptication Fax-813-780-0021 Building DeparkneM � '1Rz-z�� Date Racalvad phon� Contact fir PertnlUlng � ��Illlil 11111 t — i OwneYs Namr � Y l Owner Phona Numbar OwneYsAddress � }�f1Op( }�t�G{Ci ��Q aruvr�e� 33 '� Owm►PhoneNumber FeeSimpk7iWhoWarNamQ ��y � ,..} Own�rPhoneNumber � .—.��_+ Fea 5lmple 7itlahotda� Address JOB AODRESS l(/C �G� C`1 I V C� LOT• � s�ea�� P�� a3 - oo � v- ,- �oer�weu Frtor wewpen riuc nonc� WORK PROPOSED � NEW cONSrR 8 ADD/ALT Q SIGN Q Q pEMOIISH INS7ALl REPAIR PROPQSED USE Q SFR d COMM � OTHER iYPE OF CONSTRUC710N Q BLOCK � FRAME Q STEEL Q DESCRIPTION OF WORK d f G�. r BUILDINf3 SIZE �� SQ FOOTAG@ �� HEIGHT �_`] 1 1 1 1 � r� 7 1 PI 1 1 1 1! 1 1 1 1 � 1 IT� 1 1 1 1 1 �7 1 ITI � 1 1 � f 1 1 1 1 1 1 1 1 1 1 1 1 7 P'! 7 11TT1TnT*' �BUlLDING S VALUA170N OF TOTAL CONSTRIfCTION �ELEC7RICAL S � �� AMP SfRVICE Q PROGRESS E1�RGY Q W.R.E.C. �PLUMBfNG E •r � �il� /�y��' ��'� � L.(r� a/ i "1 QMECHANICAL t VALUATiON OF MECHANICAI INSTALLATION �� J j z � g � QGAS Q ROOFING Q SPECIALTY Q OTHER T FINlSHED FLOOR ELEVATIONS �� FLOOD ZONE AREA QYES NO BUILDER � COMpANY SIGNATURE � REGISTERED Y! N F� ctraaEn Y/ N Addrau License f �� EIECTRIGIAN 1 COMPANY ' ` j L{�, � �„ � � �n � . SIGNAIURE aEasiettEO Y N cuRpv. Y! Addreas 1 7 �U9 LicenseR �l.y��QI(i �1 O]� ..� PLUMBER COMPANY � SIGNATURE REOIb'TERED Y/ N F� cuw+en • V/� Address license i � MECNANICAL COMPAN1f �— SIGNATURE RE013TERED Y! N FEECURREA Y/N Addmas �� OTHER � � COMPpNY � SIGNATURE � REOISiERED Y/ N F� CURRE� Y/ N Address Licenset �—� ��iii��t��i��ii��ii��i��rii�i�i�i�i��i�i�� RESIDENTIAL Attach (2) Plot Plans; (2) sets o( 8uil�np Plsns; (1) set ot Energy Forms; R-O-W Permn for new consNuclion, Minimum ten (10) wurking days aTter suhmittal dafe. Required aisrle, ConstniWon Plans, Srortnweter Pians w/ SA� Fence instalbd, Sanitary FatiYties 8 1 dumpster; Site Wor1c Permfl /w subtlivisionsAarge proJeets COMMERCIAL Attach (3) complete sets � Building Plana p�ua a LHe Safety Page; (1) set of Energy Forms. R-O-W PermN for new constructron. Minimum ten (10) woAci� days afier submXlal date. Required onsite, Coruhuqiai Plans, Stormwater Plena w! SNt Fence inafalled, Sanitary Fari6fies d 1 dumpater. Si� Work Permit tor all new projeda. All commerdal reqWrements must meet compGance SIGN PERMIT AttacA (2) sets of Engineered Plans. ""PROPERTY SuRVEY required for aM NE W wnstnulion. DErecNons. Fill out application compktely. Owner 6 ConVador sign badc ol applicafwn, notahzed It over i2S00, s Notlae of Commencament Is nquired. (A/C upgwdea avar f7500) " AgeM (for Ihe conmedar) or PmMer of Attorney (tor the owne� would be someone wilh notarized letler from oaner auttwrizing same OVER THE COUNTER PERMI?71NG (Front of Applicffiion Onfy) Reroofs if shingles Sewers Service UpgraOes NC Fences (PIot/Survey/Footape) Drivewaya-NOt ovar Coimter if on puWic roadways..needs ROW a is-�ao-oo2o City of Zephyrhills Permit Application F2x-813-730-0021 Bwldmg Department Date Received phone Contact for Permitting - � 1 � 1 1 � � I 1 t � � 1 1 ' UV � Owner's Name Owner Phone Number Owner's Address 3�U HQ� Y�G� �U��t�1C' ��GY 1 i�'e'� �3 '� Owner Phone Number Fee Simple Titleholder Name ��.y � ��. —� Owner Phone Number �— ._� Fee Simple 7itleholder Address JOB ADDRESS �(1C ,�.L� �'j � , ,�/ Ci LOT # � SUBDIVISION �--� PARCEL IQ# �� -� �,y � a c, "' Q n ( V — ( � , � � - �� (08TAINED FROM PROPERN TAX NOTICE) WORK PROPOSED � NEW CONSTR 8 ADD/ALT � SIGN Q � DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR d COMM � OTHER TYPE OF CONSTRUCTION � BLOCK Q FRAME O STEEL Q DESCRIPTION Of WORK �\ �,� T \ } aJ�'� BUILDING SIZE � � SQ FOOTAGE � HEIGHT [� � � � � � 1 1 � � �� 1 1 11 � � � 1 � 1 � � � � 1 1 1 � � � � � 1 1 � � � 1 1 � � � � 1 1 1 � � � � 1 1 � � � � � � 7"ITTTr �BUILDING $ VALUATiON OF TOTAL CONSTRUCTION �ELECTRICAL $ 4 � l � AMP SERVICE Q PROGRESS ENERGY Q W-R.E.0 L OPLUMBING $ �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS O ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YE5 NO BUILDER � � COMPANY � SIGNATURE ftEGISTERED Y/ N FEE CURRE� Y! N Address License # �— —� ELECTRICIAN COMPANY l�, � �- SIGNATURE REGIS7ERED Y N P6 CURRE� Y/ Address �, � 7(�U � License # � l"i{Li ��-- PIUMBER COMPANY � SIGNATURE REGI5T[RED Y/ N PEE CURREP Y/ N Address License # MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURREP Y/ N Address License # OTHER COMPANY SIGNATURE REGIS7ERED Y/ N FEE CURRE� Y/ N Address License # IIIIIIIII IIIIIIIIIIIIIIIIIIIt 111 1111111111I111ii1111111111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Bwlding Plans; (1) set of Energy Forms, R-O-W Permrt for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stortnwater Plans w/ Sit Fence installed, Sanitary Facilities & t dumpster; Site Work Permit For subdivisionsllarge projects COMMERCIAL Attach (3) comp�ete sets of Building Plans plus a Life Safety Page; (i) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w! Silt Fence installed, Sanitary Facilities & i dumpster Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. '*"PROPERTY SURVEY required for all NEW construction, Directrons. Fili out application cornpletely Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A!C upgrades over 57500) "' Agent (for the con[ractor) or Power of Attorney (for the owner) wouid be someone wilh notarized letter from owner authorizing same OVER THE COUNTER PERMI77ING (Front of Application Only) Reroofs it shingles Sewers Service Upgrades NC Fences (PIoUSurvey/Footage) Driveways-Not over Counter if 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 IMPACT/UTILITIES 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 WaterlSewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work wili be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Watervvays. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone "V" unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAY�NG TWICE FOR IMPROVEMENTS T OUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCI , CONSULT WITH YOUR LENDER OR AN TTO N B FORE RECORDING YOUR N TICE OF C MENCEM FLORIDA JURAT (F.S. 11 .03) � OWNER O GE -^ CONTRACTOR Su crib r irmed) vefore m Sub$c�tbed�and swo t r affirtne ) be re m thi -�" �� 1� by �-� O��A�Q 7/ /ll by Who is/are personal y cnown to me or has/have produced Who is/are uersonally known to hasihave produced as identification. as identificatian. n� . �� '� Notary Public � AA � Notary Public Commission No. E L- Q 3 �1 Commission No. G E�� ll �7 � Cund �cQ. m Q��e � C'►�, n d� �. Uu�,r�, Name of otary typed, printed or stam d Name of Notary typed. printed or stamped � 'M S .1 .. . 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(i '7 x[LVt "'� _°",�- 2Y-0' 7'-1' Y-6' Y-Y 28'-10' � 25' /64' -22 SH 36' N ERS -�.53S ' L�� 8 � �� '4• q, ", � � $ � � PAttfIED SiRIPE ,-� . � � NO BLIXM AREA Q r ��Q� a�ervkfamx�arnt � I �� e i " ""o'e � � � ��E�� 4�g �� Q �� D D D D D D D D D D Ov0 G��D�v t W N� �x�� N �� A b n O E m D A O � � � $ �.� � m SI � ' ; ea � � m o ° c� z r� A R+i � �n N �'- � .[�i � f Z K !'1 N N p � �� `� ' "= N y y o w x m �e � �� `� � o � � y 8 �' �s � � �..� � G � � ��y ��- � - N � � n � � �� `� �$� � y D � � ��", ��M � � �E �o� ��n � r � c v v v v v v v v v �DDDDDDDDD � �� g � 1+N N� N� F+� � �-011 C� �� ,° d�� .., °:°�� rn Q rK � .. D '� - - A y f „Dy r � D � � � i� � � Y p o �n a<--�i t� m x 6 � � � .,. ��' p � � A � � � � i v m i y c� � 0 � € p � �� - �'�'� y ti m 9� F t � aiR �� FX � x�N R 4 � � � ti n � m " � � y �$ � yA �� N � o � � � � d � �� `� � �� N o � � � � � N � p <; j �� V Wv � 4� � � � � �, � � � � � 70401 MONROE ROAD I W � p A� � MATTHEWS, NC 28105 0 .• r� N � �,'y � rn O T � � In PROJEGT M� LOCATION: y � 30I JJ7 OCALA, FL D vl d � � � �� mb o � U� D � �� p Q� A� A a 0 � J � STORE p� DESCRIPTION. PORMAT O A - A � N p N v 8593 FIXTURE 4 CR-2 HARDWARE PLAN Stalev inc. AGREEMENT This Agreement (hereina.fter referred to as"the Agreement") is entered into this 27�' da.y of J_ ul�� 2011, by and between Staley Inc. (hereinafter referred to as "Staley"), and Family Dollar (hereinafter referred to as"Customer") for Family Dollar New Store Project. WHEREAS, Staley Inc. operates and is engaged in the business of providing low voltage cabling and related services; and WHEREAS, Customer desires to retain Staley Inc. for the purpose of perfornling certain services which Staley Inc. is engaged in providing; and WHEREAS, Staley Inc. desires to provide services to Customer; NOW THEREFORE, in consideration of the mutual covenants, terms, provisions, and other matters set forth herein, and other good and valuable consideration, as well as the mutual promises of the parties, the receipt and sufficiency of which is hereby acknowledged, Staley Inc. and Customer agree as follows: 1. En�agement of Services. Customer hereby engages Staley Inc. with the purpose of performing those certain services as detailed in the pmposal which is attached hereto and made a part hereof, and Staley Inc. agrees to accept such engagement on the terms and conditions as herein described. Both parties will use their best efforts and good faith in cooperating to further the purpose of this Agreement. 2. Comuensation. T'he compensation to be paid to Staley Inc. by Customer is as follows: Terms as follows: Contra.ct totaling: $2,286.00 3. Default. In the event Customer shall default in any of the teims and provisions pertaining to Customer's responsibilities under this Agreement, Customer specifically agrees that, in addition to any and a11 other remedies Staley Inc. may have under the law, services shall immediately be terminated and Staley Inc. shall have no other responsibility to perform additional services until said default is cured or resolved to the satisfaction of Staley Inc. Staley Inc. agrees that in the event it is notified by Customer of a perceived default in Staley Inc. obligations under this Agreement, in addition to any other rights under the law that Customer may have, upon written notice, Staley Inc. will attempt to cure said default in a good faith, best efforts basis. The parties hereto specifically agree that in the event of a default wherein it becomes necessary to resort to the Courts of competent jurisdiction to resolve the differences of the parties, the prevailing party shall be entided to reasonable out of pocket expenses including reasonable attomey fees not to exceed ten percent of the amount recovered. 4. Indeoendent Contractor. The parties specifically agree that Staley Inc. is an independent contractor under this Agreement and, as such, sha11 be responsible for a11 state, federal, and local withholdings; income taxes; unemployment taxes; or other required charges attributable to the employees of Staley Inc. Nothing herein shall be construed as creating a partnership, joint venture, or other relationship of employers/employee; it being the e�ress intent of the parties that Staley Inc., pursuant to the terms of this Agreement, is an independent contractor of Customer. 5. Amendment. This Agreement may not be amended or modified in whole or in part except in writing, referring to this original Agreement, signed by both parties or their respective legal representatives, and attached hereto and made a part by reference. 6. Entire Agre.ement. T'his Agreement contains the entire terms, conditions, and understandings of the parties, it being their express intent to set forth their agreement herein in full. IN WITNESS WHEREOF, we hereunto set our hands and seals this 27th day of Jul.y , 201 l. Staley Inc. 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'1 1 � �') Jii � , � ., � 1 t 11� 1 1 ' � 11 � � � 1: 1 1 ��1 HUCA A��RO ' CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY) 7/26/2011 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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Carol n Hunter BancorpSouth Insurance Services, Inc. ac No eM: 501 614-1178 a Na: 501 614-1478 P.O. Box 251510 n carol n.hunte bxsins.com Little Rock, AR 72225 pR cusTOMeR i� a INSURER�S) AFFORDING COVERAGE NAIC # INSURED Staley II1C. INSURER A.A111Q�IC8fl GU8�8tlt@@ S� LI8b1I1 26247 Staley Electric, LLC �NSUReR e:Continental Casual Com an 20443 Staley Technologies, LLC �r,suReRC.Zurich American Insurance Co 16535 3400 J E Davis Drive INSURER D Little Rock, AR 72209 INSURER E INSURER F . 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 NOTIMTHSTANDING 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. INSR 7ypE OF INSURANCE ADDL SU POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 'I,OOO,OO 14 X COMMERCIAL GENERAL LIABILITY CP0926380601 4/19l2011 4/�9/2012 pREMISES Ea occurrence $ �,��,�� CLAIMS-MADE [X] OCCUR MED EXP (Any one person) $ � �,�� PERSONAL 8 ADV INJURY $ 'I,OOO�OO GENERALAGGREGATE $ Y,OOO,OO GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ Z,OOO,OO POLICY X PR � X LOC $ AUTOMOBILE LIABILITV COMBINED SINGLE LIMIT A X ANYAUTO CP0926380601 4/19/2011 4/19/2012 �Eaaccident) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS $ (Per accident) NON-OWNED AUTOS g $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 'IO,OOO,OO EXCESS LIAB CLAIMS-MADE AGGREGATE $ 'IO�OOO,OO B 4024504243 M19J2011 M19/2012 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILIN Y � N X TORY LIMITS �ER C OFFICER/MEMBERlEXCLUDED�ECUTIVE ❑ NrA WC926380701 4/19/2011 4N9/2012 �00 E.L. EACH ACCIDENT $ �,OOO (Mandatory in NH) E L DISEASE - EA EMPLOYE $ �,0��,�� If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 'I,OOO,OO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Zephyrhills- Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5335 8th street ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills, FL 33542- AUTHORIZED REPRESENTATIVE i�� I . � � �� O 1988-2009 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD wl;ldt't� I��S1 `��"� Ir��. LETTER OF AUTHORIZATION COMPANY�� ,1��,�`y��,_ QUALIFIER �1 ��1 F�? i��( f'. � LICENSE #�-C �� 3 a--�� TRADE ��P�t -'� IavU �l01} � U I, �.1Gt�`..1 �" �.Y �2 �, hereby authorize�_ C� �� Zp ,�j��, lI� to issue permits to�,n �u (��Z , who is acting as agent to secure permits for me and/or the company I qualify in the designated construction trade. I understand that as a qualifier, I take full responsibility for work approved under the permit and all work is to be performed by me and/or the company I qualify. This authorization is valid for all permits unitl it is revoked by the qualifier. , �.. State of Flor a County of Seminole The f r oing instrument was acknowle�ed before me this a7 day of ��,bY a�� ✓Personally known Produced as identification. {Notary Seal} � ^ - �� "". �� Candice M. Autre NOTARY PlKtl,iC STATE OF FLOMpA • . Com+t►� EEG3��7 E�q�kes 1'!/15J�p14 754 MONROE RD. SANFORD, FL 32771 PHONE (407) 321-0368 FAX (407) 321-8917 Pasco County Parcel: 03-26-21-0010-12800-0000 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, )uly 23, 2011 Parcel ID 03-26-21-0010-12800-0000 (Card: 001 of 003) Classification 14 - Supermarket Mailing Address Property Value GALL BOULEVARD LAND TRUST Ag Land $0 SARAVANOS GUS & Land $467,100 KOUTROUMANIS DEAN CO-TRUSTEES Building $181,090 350 HARBOR PASSAGE CLEARWATER FL 33767-1811 Extra Features $50,967 Phvsical Address - See All 3 addresses (First Market Value $699,157 Shown) 6020 GALL BLVD Assessed (Non-School Amendment �699,157 ZEPHYRHILLS FL 33542-2543 1 � Legal Description (First 4 Lines) Taxable Value $699,157 ZEPHYRHILLS COLONY CO LANDS PB 1 PG 55 THAT PART OF TRACTS 113 & 128 LYING EAST OF US 301 DESC AS COM AT SE COR OF SECT- Land Detail Card: 001 of 003 Li�e Use Descri tion Zoning Units Ty e Price Condition Value � 1400 SUPERMKT OOC2 3.46 AC $135,000.00 1.00 $467,100 Additional Land Information Show Minerai Rights - 1 Acres 3.46 Tax Area 30ZH FEMA Code �Commercial Code SITE2AU Buildin Information - Use 14 - Groce Store, Market Card: 001 of 003 Year Built 1959 Stories 1.0 Exterior Wall i Concrete or Cinder Block Exterior Wall 2 Concrete Block Stucco Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Asphaft Tile Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Packaged Roof Top Baths 2.0 �- Line Description Sq. Feet Repl. Cost New �- 1 FST 800 � $17,096 2 � �AS -� 9,435 � $403,252 -� 3 CAN 712 $9,146 Extra Features (Card: 001 of 003) Line Description Year Units Value -� 1 -� P�V ASP 1984 111,651 � $22,609 I �-� SPRNKFP 1984 10,235 $7,676 � 3 LIGHTSM � 1984 3 $ 1,913 4 �_ I_iGkiTTM � 1984 2 � � Sales Histo Previous Owner JAEB STEPHEN L � �� Month Book/Page Ty e Amount 1997 02 3707 / 0186 1lVp $0 1992 06 3037/1035 � �p 1992 06 3037 / 1026 {�C $p http://appraiser.pascogov.com/search/parcel.aspx?sec=03&twn=26&rng=21 &sbb=0010&b... 7/26/2011 1'-6' - 2 'D 'H- 2'SH 511 ,,,,� 9'-0' 9'-0' 8'-0' 7-6' r-6' 7-6" 7-6' 8'-0' 8'-4' o y r- � a � BREAK AREA � � I I I I I I $ N � �� I I I I I o � I I I I I I � ,� I I I 1 I I W A I I I I I I � � I 1 I I I I � r� / � g I I I I I I ^: j I I I 1 I I � ' � � � i = I I I I I I � I I I I I I � I 1 I I I I � � � I I I I I I � I I I I I I y 5'-7' I I I I I I' � • � � � ^ y a w � � m � O � � � / � za'-r za-2 2a'-s' `° � - - 22" 60 /22 HLF � --- ____ OPE BAC a � �? 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