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HomeMy WebLinkAbout11-12298 CITY OF ZEPHYRHILLS �/ 5335-8th Street (813)780-0020 � 229$ s ELECTRICAL PERMIT . , ., Permit #:12298 Issued: 9/27/2011 Address: 38122 HENRY DR Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL. Ciass of Work: ELECTRIC SERVICE REPLACEME T Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 91,000.00 Total Fees: 673.50 Subdivision: CITY OF ZEPHYRHILLS Amount Paid: 673.50 Date Paid: 9/27/2011 Parcel Number: 02-26-21-0080-OOA00-0070 ,�. . .,.. ,;�;�; �; . ,,;. ,. y; r;,� ': � ����N �':a�=:=a�,..;a,..; il ,^, .; �;, ,�`;'.�. ;:�, Na e: JERRY HOFFMAN CONSTRUCTION INC Name: CITY OF ZEPHYRHILLS Addr: P.O. BOX 2164 Address: 38122 HENRY DR BRANDON FL 33509 ZEPHYRHILLS, FL. 33542 Phone: (813)503-2696 Lic: Phone: Work Desc: REPLACE EXISTING ANTENNA ON TELECOM TOWER /NOT TO GROUND ,, �- .,,:� ��. �. �;.- rt�:�- ° ., .� :,:;:>k. � a , < ', >;.., � `B,� �' x"�. r.�, i � ° 'e �k.�'� - � . � �- »,, � .,. , , . -� � y '� . tu _ ' ,Jy!'�,',+.h, {Y' . �" y '�v�d4 ELECTRICAL FEE 673.50� `� , � Y i � a �; �,,.� � - , .. . .�:� , y � .., , � qq '� '�' _ �, � : ROUGH ELECTRIC CONSTRUCTION POLE ' PRE-METER� FINAL �.J� � � � � � � � 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 wnstruction c) repairs or corrections not made when inspection called d) work not ready for inspection when called e) permit not posted on job site t� 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 perrnits required from other governmental entities such as water management, state agencies or federal agencies. "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, aonsult with your lender or an attorney before recording your notice of wmmenoement." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. � � v , C NTRA PER OF I ERM EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION — 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER s�saao-oo2o City of Zephyrhills Permit Application Fax-813-780-0021 ��� (1-�f U-S �� Building Department ( a0 I �j 9fs�- Dats Received �., 1�-- �� Phone Cor�ct for Permittin �� � �` Trr - rrrri OwnePs Name A fi�-T I�(t2�E�s Owner Phone Number �]�> - 1-�7?j� � ow�rs aaaresa I 10 ! GK.F�� t�� 3�D L.� �O�IAe,, pwner Phone Number Fee Simpie Titleholder Name G Ty oF �PN �IR.N � c_L_S Owne� Phone Number Fee Simple Titleholder Address �3 35 �� Sr ��:Q{.� ! LC s � L 3,35 �}- Z. JOB ADDRESS 3� ( ZZ N� � �fL 2 EP�F �-I I LLS � 3 3 t� LJ- Z LOT # �� SUBDIVISION `r'�I 5�/� � PARCEL ID#� fl2 "'2fo� Z�- 6�0- j�,�pp.. 6o O (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROP03ED e NEW CONSTR 8 ADD/ALT � SIGN O Q pEMOLISH INSTALL REPAIR PROPOSED USE � SFR Q COMM '� OtHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q - PN UN �fZ, DE8CRIPTION OF WORK ^ l T tJ(� S 6 N"T�LECDM �,t)� � I1fD �{p�(SE7'b ��, BUILDING SIZE �_ � 3Q FOOTAGE �� HEIGHT �_ �BUILDING $�' 1 o�,OO VALUATION OF TOTAL CONSTRUCTION QELECTRiCAL $ � AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C. QPLUMBING $ � � q % � �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �i Z � � QGAS Q ROOFING [� SPECIALTY �� OTHER FINISHED FLOOR ELEVATIONS �� FLOOD ZONE AREA QYES NO . . . BUILDER � / / '� COMPANY "����'1 !� �ix,4a✓ � `rr.�r, c;7. y ,c.s 31GNATURE ���'`�'`'�/ � �� REGISTERED Y! N FEE CURRE � Y/ N Acldress ° Q . o o2.1 bq �nlDa►J �t. 3�A� ticense # CC�GO4 I 3 E�ECTRICIAN COMPANY SIQNATURE REGISTERED Y/ N FEE CURRE� Y/ N �d� License # � �l PLUMBER COMPANY SIGNATURE _ REGISTERED Y/ N FEE CURRE� Y/ N Address License # � MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # � OTHER COMPANY SIGNATURE REGISTERED Y! N FEE CURRE� Y/ N Address License # -� IIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIItlllllllllllllllllllllll RESIDENTIAL Attach (2) Pbt Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Sik Fence installed, Sanitary Facilities 8� 1 dumpster, Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permk for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities 8 1 dumpster. Site Work Permit ivr afl new projeds. All commerc.ial requirements must meet compliance 31GN PERMIT Attach (2) sets of Engineered Pians. ""PROPERTY SURVEY required for all NEW construction. . . . ... . ... . . Directions. • Fill out application completely. Owner 8� Contractor sign badc of application, notarized If over;2500, a Notice of Commencement is requlred. (A/C upgrades over s7500) "" 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 Applicadon Only) Reroofs if shingles Sewrers Servioe Upgrades A/C Fencc�ss (PIoUSurvey/Fo�age) Driveways-Not over Counter if on public �oadways..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 applicabie deed•restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors ta undertake work, they may be required to be licensed in aa:ordance 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 atfvised 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 Counry. TRANSPORTATION IMPACTNTILITIES 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 e�sting 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. {t is further understood that Transporta6on 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 invotve a certificate of occupancy or final power release, the f�ees must be paid prior to permit issuance. Furthermore, if Pasco County WateNSewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN I.AW (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 "owne�', 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 alt the information in this application is accurate and that al! work will be done in compliance with all applicable laws regulating construction, zoning and land developmant. 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 pertormed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. 1 also certify that I understand that the regulations of other govemment 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 inGude 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 Heatth 8� Rehabilitative Services/Environmental Health Unit-Welts, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Rurnvays. 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 permittec! building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fil{ ma#erial is to be used in any area, 1 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. tf I am the At3ENT 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 specificalty induded in the application. A permit issued shall be construed to be a liaense to p�oceed with the work and not as authority to violate, cancet, 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 issua�ce, 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 wrt�iting, from the Building Official for a period not to exceed ninety (90) days and wili demonstrate justifiable cause for the extension. If work ceases fo� ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAtLURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT ITH Y R LE OR A ATT Y F COR IN Y U N TI E F COM E FLORIDA JURAT (F.S. 11'7.03) OWNER OR A(3ENT �i ,/ � � � �— CONTRACTOR ^ �' u ��� `� � �� Su and swom to (or affirmed) before me this S ' nd swo to (or affirmed) before thi _P���/ -�tjr /7 ! by �r2�d-4� n1 � i'�v�:�r�r.-w o i are I n to me or has/have produced o i a persona known to m r has/have produced as identification. as identiflcation. � �'v ' _ Notary Public Notary Public Com ission No. Commission No. Name of Notary typed, printed or stamped Name of Notary r ,,y'p"��r. AN(�EIJ1 K, LEVhS �v*" "�� Notary Public State of Fbrida '"� .*= MN COhp41�SSI0N A DD 976989 Carl Stickeier p�p�q� �� ��� ;o Q My Commission DD769061 ��„ .` 8onded Thru Notary PubNc Undervrrilers �'yo� nd` Expires Q3116l2012 STATE OF F�ORIDA -� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION � - w `'��t CONSTRUCTION INDUSTRY LICENSING BOARD '�, ;�' 1940 NORTH MONROE STREET �850) 487-1395 � ��' �ALLAHASSEE FL 32399-0783 HOFFMAN, GERALD MICHAEL JERRY HOFFMAN CONSTRUCTION INC PO BOX 2164 BRANDON FL 33509-2164 STATE OF FLORIDA AC# �C � b 717 '� Congratu�ations' With this license you become one of the nearly one miliion DEPARTMENT �QF _BUS_INESS - AND, - Floridians licensed by the Department of Business and Professional Re gulation - p R O F E S S r � N_ A�?. R E G II L A T I O N; " Our professionals and businesses range from architects to yacht brokers, from ` -,�: Y=�. __ �,_�,:, _ boxers to barbeque restaurants, and they keep Florida's economy strong. ' '-- ��� ���; � CGC041943'�.~'__ � rf ��:%o�j,i�,, 10802391I ;a:.�.° r: cy., _�,.�a. - Every day we work to improve the way we do business in order to serve you better .;°.R�� ,;�,.-_��•_ �- � . For information abg�t our s,�LV�ce�,�le��e_I9g 9otQ.in�vitw myflgridalicense.com. CERTIFI$D;�G��L?..�ESx7'ri2ACTOR There you can find more information about our divisions and tne regulations that HOFFMAN.;<;�C#$�II�iCSA'E3i '. - _ impact you, subscribe to department newsietters and learn more about the J�RRY:"HOFFMANj ��2U�TION,`INC DepartmenYs initiatives `� �_� �"��..- ��;-n-; - - _ . .�` v��, . . Our mission at the Department is� License Efficiently, Regulate Fairiy. We = ^' -�;.. , �.�;��:°�` . constantly strive to serve you better so that you can serve your customers. =s_ csxTiF=En ,�aor� cs: Thank you for doing business in Florida, and congratulations on your new license! -. _ p=o�i8son. ot cn,;489 ss ezpiistioa dat��:�AUG� 31i;���0.12 .L1006�03D1543� . �� 3• so� , 2�� � Mr.�� � E G ��' 6�j 3. 2D�-3 �� � DETACH HERE C/ _�f� --- ---- — AC# � STATE:OF FLORIDA � -.�J Q St.���: 7 7:� _ - - - - �- �����'k`�' DEP,.,ARTMENT OF_ �BiT$INESS � AND ' PROFESSIONAL REGULATION - - _ r : ' � ' _ � `"��'ti'- 'CQNS'TRUCTION:=INDUSTRY _LI,CENSING =BOARb °` �" ' ' •���;;:: ;� - - . ° SEQ#Liooso� . . LICENSE �NBR ':;;=��3x� ;�'„ ° . � ! A� (� . : ' `.'A':. A i x � y + t.:::%� �jti '" .� � .: ,S� . O8�'�03 �:b10 ° 108023911 CGC041943,:�"• =-=' �;�-Pr==: -4 . �� . '@ �._.:�Fi.Y%i ':'^ n�+-. `. - .The ,��GENEFtAL'� � = � S l {,� _' _:�`�, "°� � �' j 'C er - :?Y� :!' � Named �,�;e�:�ow-,�,3-;C�RTIFIED < ;��_ ���°�, � _:. - -.�_.�"�.� . . � UFider.�':��lie"_ pi��..y:i��ions af ���Chapter+� _��:a.*F4S� ;�" ;, �'',�`�,�: - . , Ex p at•ion clate : AUG 31, 2 012 � "'�: { �•x ' �". `; " � 1 �:' ; ir ,�.• f �`,,., _�s � .r -:$;�.:-:,., � ��.�� .,.,�.�' ,�� �: .-. ` • r ;;�: _= - - �r-'�, - . . � 1i >:..;:..,, '':�';;�- .: - ::, �,A. r:_ HOFFMP.N, GERALD MICHAEL .. � �.��� ��y�;': JERRY .,HQF�'MAN CONSTRUCTION I�N�. � -- � �k PO �.BQX ��1.=64 _ .. U '`•::==��A.=.� :;�.:, . BR�iND.ON . FL 33509-� ��Y• ' � rp 9 - L'�. L � i i �i � � , , - � CH�iRL�IE, ,CRIS.T ` CHARL�E LIEM � GOVERNOB � SECRETARY � DISPLAY AS REQUfRED BY LAW ' , i , , „� :i: �� Date� March 8, 2011 ��� Peggy Anderson Tower Engineering Professionals T-Mobile Towers 3703 Junction Blvd 12920 SE 38th Street Raleigh, NC 27603 Bellevue, WA 98006 (919) 661-6351 Office: (425) 383-3537 arucker(a�tepqrouq.net Subject: Structural Analysis Report Carrier Designation: AT&T Co-Location Site Number: 10015984 Site Name: Zephyrhills T-Mobile Designation: Site Number: A2G0082A Site Name: Pasco County (VS) Engineering Firm Designation: TEP Project Number: 110908 Site Data: 38122 Henry Dr., Zephyrhilis, Pasco County, FL 33540 Latitude N 28° 14' S2.9'; Longitude W 82° 11' 9.4" 190 Foot – Self-Supporting Tower Dear Ms Anderson, Tower Engineering Professionals is pleased to submit this "Structural Analysis Report" to determine the structural integrity of the above mentioned tower. The purpose of the analysis is to determine structural acceptability of the structure stress level Based on our analysis we have determined the stress level for the structure and foundation, under the following load case, to be: LC1. Existing + Proposed + Future Equipment Sufficient Capacity Note: See Table 1 for the existing, proposed, and future loading. Structure Controlling Component Ca acit 82 1% Diagonal Bolts (140 - 160-ft) The analysis has been performed in accordance with the ANSI/TIA-222-G-2-2009 Structural Standard for Antenna Suqportinq Structures and Antennas – Addendum 2 and the 2007 Florida Buildinp Code (with 2009 Supplement) All modifications and equipment proposed in this report shall be installed in accordance with the appurtenances listed in Table 1 for the determined available structural capacity to be effective We at Tower Engineering Professionals ap preciate the opportunity of providing our continuing pr fe sional services to you and T-Mobile Towers. If yE�Ih��r��s�+��� ed further assistan on t r any other projects please ive us a call cREVAILING CODES, FLORI BUI D 1t 11 /! ODE, NATIONAL ELECTRIC CODE AND ``, ,��� Respe tfully ub itted by: CITYOFZEp �� �`l'.�. '•'qC ��/ �YRFIILLS ORDIlVANCES ���� ,.��•. .." '"��9 ��� ' ••s � ;m � = o• �9 '. * = drew T. H ane, P E —.p: �������� ,`� -= ,��� � � ; STATE OF . =�1� \ W � Da �� � � � F P � � a , ., � lYY � ` �' �'��� �� ( % G�,'�^� "� �R1� . � ?� `�! ,�;�, � � ���,����`Ho�.L � -- ���'i���� �!�,�� ������ RISA Tower Report - version 5 42.0 `� ��� �i <� / �� � y� ( �1 I� / �—'"�---... --- March 8, 2011 190 Ft Self-Supporting Tower Structural Analysis A2G0082A Pasco County (VS) Project IVumber 110908, Revision 0 Page 2 TABLE OF CONTENTS 1) INTRODUCTION 2) ANALYSIS CRITERIA Table 1- Existing/Future/Proposed Antenna and Cable Information Table 2- Design Antenna and Cable Information 3) ANALYSIS PROCEDURE Table 3 - Documents Provided 3.1) Analysis Method 3.2) Assumptions 4) ANALYSIS RESULTS Table 4- Component Stresses vs. Capacity Table 5- Component Stresses vs. Capacity — Foundation Table 6- Dish TwisUSway Results for 60 mph Service Wind Speed 4 1) Recommendations 5) APPENDIX A RISATower Output 6) APPENDIX B Additional Calculations RISATower Report - version 5 4.2.0 March 8, 2011 190 Ft Sglf-Supporting Tower Structura/ Ana/ysis A2G0082A Pasco County (VS) Project Number 110908, Revision 0 Page 3 1) INTRODUCTION This tower is a 190-ft self-supporting tower designed by Valmont in November of 1998 The tower was originally designed for a fastest mile wind speed of 105 mph with no ice and 50 mph under service loads per TIA/EIA-222- F for the appurtenances listed in Table 2. TEP did not visit the site All information provided to TEP was assumed accurate and complete. 2) ANALYSIS CRITERIA The structural analysis was performed for this tower in accordance with the requirements of ANSI/TIA-222-G-2- 2009 Structural Standard for Antenna Supportinp Structures and Antennas - Addendum 2 using a 3-second gust wind speed of 110 mph with no ice and 60 mph under service loads with the following criteria� 1) Tvpe of Analvsis: Rigorous Structural Analysis 2) Classification of Structure: Class II Definition: Structures used for services that due to height, use or location represent a substantial hazard to human life and/or damage to property in the event of failure and/or used for services that may be provided by other means. 3) Exqosure Cateporv: Exposure B Definition. Urban and suburban areas, wooded areas, or other terrain with numerous closely spaced obstructions having the size of single-family dwellings or larger. 4) Toqoaraphic Cateaorv: Category 1 Definition: No abrupt changes in general topography, e.g. flat or rolling terrain, no wind speed-up consideration shall be required 5) Earthquake Cateaorv• Not Considered Commentary� Earthquake effects may be ignored per this Standard for site locations where Ss does not exceed 1.0 (Pasco County Ss=0.10) Table 1- Existing/Future/Proposed Antenna and Cable Information Existing/ Elevation �ty Antenna Model Mount Glty Coax Coax 1 Owner/ Proposed (Ft) Type Coax Size Location Tenant - - - , _ _.._ . . 3 TMBX 6517-R2M f Low � Existing 190 9 RR65-19-OODP ; Profile ' 24 1 5/8 BC-Face T-Mobile ! 12 S20045Al2 LNA Platform ' 12 , DBXNH-6565B-R2M ; 9 Andrew E15S09P78 : ' 19 � 15/8' � Pro osed 175 3 Andrew ATCB-B01-xx RET's ; �2° �p 3 .315" � p 3: RRUS11 Dual PA RRU RBS6000 jPlatform 1 ,774�� AB-Face AT&T 2 , DC2-48-60-0-9E 2 3/8 1 , DC6-48-60-18-8F 12 � Existing 160 9 AP17-1900/090D , Sector 9' 1 5/8 ; CA-Face Verizon ' ' Mounts ' � ! 12' Existing 150 6 D6950G65RCZE-M � Sector 12 1 5/8 CA-Face Sprint , � ' Mounts Future 100 7 4' MW Dish P �p e 1 1 5/8 ; BC-Face T-Mobile , Mount Notes: - 1) Coax positioning based on inspection report by SiteMaster 2) Mount assumed per photos 3) Coax stacked 12-on-12 4) Coax stacked 7-on-12 RISATower Report - version 5.4.2.0 March 8, 2011 190 Ft Self-Supporting Tower Structural Ana/ysis A2G0082A Pasco County (VS) Project Number 110908, Revision 0 Page 4 Table 2- Design Antenna and Cable Information Mounting Center Line �uanity of Antenna Antenna Model �uantity Coax Coax Level (ft) Elevation (ft) Antennas Manufacturer Coax Size Location _ _ _ _..._ _ __,. . ._ __.._---' -- - -. .__ _ ... _ -_- i -----_ __.. _ _ �. _ 190 190 12 ; CSA PCSA 060-19 175 175 12 CSA ; PCSA 060-19 Unknown I Unknown ; Unknown 155 155 12 CSA PCSA 060-19 3) ANALYSIS PROCEDURE Table 3 - Documents Provided Document Remarks Reference Source . . ___._.__.___.-- - - __... .__...__ _._. --._ -._ . ._...- —.... Design Drawings Valmont dated November 13, 1998, T-Mobile� Order Number iM337-01/MF40659 Geotechnical Report� LJ Nodarse & Associates, Inc dated December 15, 1996, _ T-Mobile Project Number 96T-107J-9 SMGBI Report SiteMaster dated October 28, 2007 - T-Mobile' Correspondence Correspondence from T-Mobile with regards to the existing, _ T-Mobile proposed, and future loading, SAW dated February 10, 2011 3.1) Analysis Method RISATower (version 5 4.2 0), a commercially available analysis software package, was used to create a three-dimensional model of the tower and calculate member stresses for various loading cases. Selected output from the analysis is included in Appendix A. 3.2) Assumptions 1) Tower and structures were built in accordance with the manufacturer's specifications 2) The tower and structures have been maintained in accordance with the manufacturer's specification 3) The configuration of antennas, transmission cables, mounts and other appurtenances are as specified in Table 1. 4) TEP assumed the following material properties: a) Legs: ASTM A572 Gr 50 b) Bracing: ASTM A36 c) Anchor Bolts ASTM A354-BC 5) Serviceability with respect to antenna twist, tilt, roll, or lateral translation, is not checked and is left to the carrier or tower owner to ensure conformance. See Table 6. 6) This report is not a construction document. 4) ANALYSIS RESULTS Table 4- Component Stresses vs. Capacity Section Elevation (ft) Component Type Size Critical P �� b � SF*P allow °�a Pass / Fail Na• Element (Ib) Capacity _.. __ _. . ----- . - — ._. . ____ ---__-.�. . ___._ _ ..__..._ _ . . _ _...._ _. _ , T1 190 - 180 Leg ' PIPE 2.5 STD (SCH 40) � 1 '-8898.940 i 57361.699 15.5 Pass � T2 180 - 160 Leg , PIPE 3.5 STD � 20 -43349.301 �104062.000 ; 41 7 Pass ' T3 160 - 140 Leg Pipe 5 STD (SCH40) � 50 -88222J03 �169274 000 52.1 Pass T4 140 - 120 Leg Pipe 5 STD (SCH40) 75 � 37005.000 !� 69274 000 80.9 Pass T5 120 - 100 Leg PIPE 8 STD (SCH40) ' 99 ;1g7042.000�358212.000 52.2 Pass � RISATower Report - version 5 4.2.0 March 8, 20i 1 190 Ft S�If-Supporting Tower Structural Ana/ysis A2G0082A Pasco County (VS) Projecf Number 110908, Revision 0 Page 5 Section Critical SF•P_allow °k No. Elevation (ft) Component Type Size Element P �� b � (Ib) Capacity Pass / Fail --__ - - - _..__. ___, . _ _. _ .._. . �-- -- - T6 100 - 80 Leg Pipe 10 STD (SCH40) 123 �p33880.000 !498329.000 46.9 Pass T7 80 - 60 � Leg Pipe 10 STD (SCH40) i � 41 2g5569 000 �498329 000 57.3 Pass T8 60 - 40 ' Leg Pipe 12 STD (SCH40) ' � 59 �337550.000 �623679.000 54 1 Pass I T9 40 - 20 Leg Pipe 12 STD (SCH40) � 1�� 389071 000 623679.000 62.4 Pass i T10 20 - 0 Leg P12EH 195 440393.000'822322.000 53.6 Pass Ti 190 - 180 � Diagonal L1 3/4x1 3/4x3/16 8 -2565.140 � 6609.350 38.8 Pass T2 180 - 160 , Diagonal L2x2x3/16 ; 25 -5984 970 � 9594.310 62.4 Pass � T3 160-140 � Diagonal L21/2x21/2x3/16 55 -7973.200 ; 11468.300 , 8 29'� b � Pass T4 140 - 120 Diagonal L3x3x3/16 84 -8828.960 15865.200 55.6 Pass T5 120 - 100 Diagonal L3x3x3/16 ; 108 -9617.300 � 14123.400 68.1 Pass T6 100 - 80 Diagonal L3 1/2x3 1/2x1 /4 131 -12421 700 20565.100 , 60.4 Pass T7 80 - 60 Diagonal L3 1/2x3 1/2x1/4 149 -13188.500 17943.100 73.5 Pass T8 60 - 40 Diagonal L3 1/2x3 1/2x3/8 167 -14341.900 ; 23301 100 61.6 Pass T9 40 - 20 Diagonal L3 1/2x3 1/2x3/8 185 -15028.400 i 20601.000 72.9 Pass T10 20 - 0 Diagonal L4x4x3/8 203 -16252.200 i 26494.900 61.3 Pass Ti 190 - 180 Top Girt L3 1/2x3 1/2x1/4 4 -992.686 24069 100 6 2� Pass T2 180 - 160 Top Girt L3 1/2x3 1l2x1/4 23 -415.333 24491 400 1 �� Pass T3 160 - 140 Top Girt L3 1/2x3 1/2x3/8 52 25.330 70204.898 0.2 Pass T4 140 - 120 Top Girt L3 1/2x3 1/2x3/8 78 -1676.010 23012.500 15.6 (b) Pass T5 120 - 100 Top Girt L4x4x3/8 100 -1730.500 24801.600 15 3(b) Pass T6 100 - 80 Top Girt L4x4x3/8 124 '-1939 100 , 26303.301 7 4 Pass T7 80 - 60 Top Girt L5x5x5/16 143 -2843.020 32448.400 11 9(b) Pass T8 60 - 40 Top Girt L5x5x5/16 160 �-3289 700 20486.301 � 6 ' 1 Pass 19.2 (b) T9 40 - 20 Top Girt L5x5x5/16 178 -3730.390 16959 000 22.0 Pass T10 20 - 0 Top Girt L5x5x5/16 196 -3294.600 14011.300 23.5 Pass Summary Leg (T4) 80.9 Pass Diagonal 82 � pass (T3) Top Girt z3.5 Pass (T10) Bolt Checks 82.1 Pass � Rating = 82.1 Pass Table 5- Component Stresses vs. Capacity - Foundation Notes Component Elevation (ft) % Capacity Pass / Fail . _ - - - - - � Foundation Download (Individual Leg) - � 61.8 Pass - Foundation Uplift (Individual Leg) - 53 3 Pass RISATower Report - version 5 4.2.0 March 8, 2011 190 Ft S�If-Supporting Tower Structural Analysis A2G0082A Pasco County (VS) Project Number 110908, Revision 0 Page 6 Structure Rating (max from all components) - 82.1 % Table 6- Dish Twist/Sway Results for 60 mph Service Wind Speed Beam Deflection Elevation Dish Model �ft� Deflection Tilt (deg) Twist (deg) (in) -__ _ _ --- _ .___- _ - - - -- _ 100 4'0 HP MW Dish 0.894 0.077 0.002 4.1) Recommendations 1) If the load differs from that described in Table 1 of this report, or the provisions of this analysis are found to be invalid, another structural analysis should be performed. RISATower Report - version 5 4.2.0 March 8, 2011 190 Ft S�If-Supporting Tower Structura/ Analysis A2G0082A Pasco County (VS) Project Number 110908, Revision 0 Page 7 APPENDIX A RISA TOWER OUTPUT RISATower Report - version 5 4.2.0 iso.o n I � l a m�_ _ i r� �_ , _� �ao.on DESIGNED APPURTENANCE LOADING � ' TYPE ELEVATION TYPE ELEVATION I � o � � I 5/6-in x 4-f� Lightnirg Rod (T-Mobde) 190 (3) Andrew E15S09P78 (ATI) 175 � � � � Plattorm Mount [LP 715-1 ] (T-MObAe) 190 RRUS-11 (ATI) � 17g � m ' I X -�i � I TMBX-6517-R2M w! mounl pipe 190 RRUS-11 (ATI) 175 N a n, � �(T-MObde) RRUS (ATI) 175 d I, �' I TMBX-6517-R2M w/ mount pipe 190 DC2-48-60-0-9E (ATI) , 175 � (T-Mobile) DC2-48-60-0-9E (AII) 175 �,— _ �� � 160 0 ft ( M 7-R2M w/ mount pipe � 90 DC6-48-60-18-BP (ATI) 175 L B I T �A _� �' I � i Sector Mount [SM 502-3] (Venzon) 160 ��� , (3) RR65-19-OODP w/MOUnt Pipe 190 . ,, � (T-Mobile) � (3) AP17-1900/090D w/MOUnt Pipe 160 I � � I � (3) RR65-19-OODP w/Mount Pipe igp (Ver¢on) �' cv '�, I, �'I I (T-Mobde) (3�AP77-1900/090DwlMOUntPipe 160 "' `� ' ' ! (3) RR65-19-OODP w/Mount Pipe �gp — (Venz � ' = w I � X I I(T-Mobile) '(3) AP77-1900/OgOD w/Mowt Pipe j 160 � , � I (4) S20045A7 (LMohile) �gp (Venzon) _ 1 40.0 ft 4 Sector Mount [SM 402-3] (Sprmq 150 o m I - O 520045A1 (T-MObtle) 190 N � � � --- (2) DB950G65E-M w/Mount Pope �, 150 � � �, ', (4) 520045A1 (T-Mobile) �90 _ (Sprin�) ' n , � � I � Platlorm Mount [LP 712-1 ](ATI) 175 --� a � l i I - (2) D6950G65E-M w/MOUnt Pipe 150 � � n (4) DBXNH-6565 w/MOUnt Pipe (AT1) 175 (Sprint) � � � � I (4) DBXNH-6565 w/MOUnt Pipe (AII) 175 (2) D8950G65E-M w/MOUnt Pipe 150 , �@J �i I (4) DBXNH-6565 w/MOUnt Pipe (AII) 175 i(Sprmt) ' , � I (3) Andrew E15S09P78 (ATI) j 175 2.4' Dia x 5-ft Pipe (T-MObile) 100 � � (3) Antlrew E15S09P78 (ATI) 175 4FT HP MICROWAVE 100 ,._ izoo - � ° SYMBOL LIST I � J � � I � I MARK SIZE MARK SIZE � o �, I A PIPE 25 STD (SCH 40) B L7 3/4x1 3/4x3lifi ~ � I � _ — _ _. _ W I w ' MATERIAL STRENGTH a' m GRADE Fy Fu GRADE Fy Fu I � " -- i000.n — __ -- - — � y A572-50 50 ksi I 65 ks� A36 36 ksi 58 ksi a N � � a J '' � 0 TOWER DESIGN NOTES < 1 Tower is located in Pasco County, Florida. 8 I 2. Tower designed for Exposure B to the TIA-222-G Standard. , _ , � 3. Tower designed for a 110 mph basic wind in accordance with the TIA-222-G Standard. � � 4 Deflections are based upon a 60 mph wind. o � eo o ri 5. Tower Structure Ciass �I. � i � I 6. Topoqraphic Cateqory 1 with Crest Height of 0.000 ft ° � < 7 TOWER RATING: 82.1 % � a I I � ' I � I _ 600ft —� I �-1 _ i Ud � I I ol I � � I I I x m ' l I U j N _ � o i � � _ 400ft N N I ALL REACTIONS a I I ARE FACTORED , , $ � � MAX. CORNER REACTIONS AT BASE. DOWN: 45373516 UPLIFT -3978751b �-- zo o rc SHEAR: 45835 Ib � � I AXIAL � = I I 638501b w, N I ' F a I I SHEAR � MOMENT 749281b 7989542/b-ft — --�_ ' - -- o o n � ; � TORQUE 1 1825 16-1t I � REACTIONS - 1 f 0 mph WlND i� q -, -� � � � m m - �' ° _ - , o j � c c � 3 0 n I I m m I a I o, � L L� 0 0 ti ii _ u� 3�I Tower Engineering Professionals ob A2G0082A Pasco Count � � 3707 Junction Blvd. P'°;�� rEP+ot ��o9oa � R8lelgh, NC 27603 C�ient: T-Mobiie o. aw�by:Aaron Rucker '�p Phone: (919) 661-6351 � 0de TIA-222-G � �a NTS FAX. 919 661-6350 PdIh: H.@011W908A2G0082GSWquraMISAW2G0082APascoCOUnt �9ND � Y � � V � O �. � ° � � c I N N � O �'? �' Q [ a o � � - x ���_����? - c� cl�=���' � -�� ��r���r����� c__ s i . .. : � 2 2 , � _ _ ' _ " " _ _ � _ � z ' �;' ':4��� m I C �C c ;l acccc ' .. �� �����=:a� x� v I o � � E O ,�3 y'° o=----- � Z` jzzzzz � ° a o s e z d G) d i i d � � 3 Fa o � � � � V 3 � C O i F ~ p ' ( � h��i_ O N LL ] � ' G T� �i QIZLLG.G. 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O C u� u� in �n �n �n u'� �n u� Q Uv c oaomoowcomcoao p U LL oo ao 0o ao co ao 0o ao eo �' a c } m 3 � �' o a Q c o � � o 0 � a� � � U � � � (D (O V N E� (O f0 (D (O CO (O (O � � N O p m c� � L � M .� o � _ � N � O � a� -- � � U Z fn � �' �- �V �� V O O� O C N� Y Y N— N O O m L 11� C� � V � N M fA Vl N L.L Ll.l 3� � Y y Q a O_ a �n �... � Y Y Y a 'O n n O�� ^ O O N N N n Y =1 � ch � 0 N O O.- � N � � cO p � � ^ W M V N op � ap ^ � � T ^ � n � M �� �� II II II II II II II m $ $ $ `y C (C c � O N E IQ o C O M N O E� a � W� � r M ld m � W � II II a u u � � � ° a � u u 3 � -e � a � `� ._. <�?�� y � � (��`� �t�l�) ,y„ City of Zephyrhills BUILDING PLAN REVIEW COMMENTS ,---� Contractor/Homeowner: � Q���Q'1 ��/�t � Date Received: �- l�- `J Site: � �/ Z ��2 �,��-2� Permit Type: � rQC� � �.S�i Qh �n r�c� �/yl ��-� L�t �'�� Approved w/no comments: Approved w/the below comments: O Denied w/the below comments: ❑ This comm she�t all be kept with the permit and/or plans. �' 2 -( Kalvi S't e- Plans Examiner Dat Contractor and/or Homeowner (Required when comments are present) Aug 30 11 10:09a 813-653-2023 p.2 STATE OF FLORIDA -•DEPARTMENT OF BUSTNESS AND PROFgSSIONAL REGULATION � CON3TRIICTI�N INDUSTRY LTCENSING B�ARD (850) 487-1395 1940 N�RT�I MONROE STREEi .�'���'� TALLAHA$SEE FI, 32399-0783 HOFF'MAN, GERALD MICHAEL JERRY HOFFMAN C�NSTRUCTION INC PO HO% 2164 BRANDON FL 33509-2164 Congratuiations! With this license STATE °� �i°r°` . :aC� �.� � � � � 7 you become one of the nearly one million - s Floridians �icensed by tt�e Department of Business and Professional Re uEation. = ggp`�T��.�.�`•:��USIN$SS;:°A `� Our professionals and businesses range frorn architects to yacM broker frorn �'`.' _ _ �PROFESST�ONI�I; �YZEGU�AT�pN,»�'�� boxers to barbeque restaurants, and they keep �lorida's economy strong. "'� ='='�- .��:` �.�::;,- - =�' = ': - . ', ; ='-�'� ::;- ;. ; ; �.` `3'080239fi1�,� Fvery day we work Lo improve the tivey we do business in order to serve you better ;' �- - � '" - �or information about our services, please log onto www.myfloridalicense.cam. _ CERTIFIjD�'•°iG'SN'LRAL•:;Cf�1Q�`-�ACTpg There you can find more information abouY our divisions and the regulations that �_;� gp�,ag�N ��g;� ;,-,, „ - impact you, subscribe to department newsletters and leam more a6out the %;t JERRY ��.HOFl? � Departmen#'s initiatives. - - - - - �N:tCON$,�UG'�:�OM-�I�F�� - . �}: _ - .;r A .. _.� _ - _ _ - - - _ :.;.,; Y..: _ - Our mission at the Departmenf is: License Efficiently, ReguEate Fairfy. �Ne - _ �-- - � ''"�'��'"� .'� =-- • . - oonstantly strive to seroe you better so that you can serve your customers. �� ,I •�' Thank you for doing business in Florida and C;ongratula6onS on your new liCense! : IS CBRTiFTSD �;.oaer the prwisiodd' af ,Ca.'489 Fs '= nsp�=ae�on AIIG.: 31, '207.2 ;i.I'OUe'0.3_Q25,93 �� ;, - ' . - - ,�. DETACH HERE A V1f. 4 � �; ' � _ . _ , _; .:���:����;: ���: _ , << _ ST�TE FLORIDA � ,tt� '. ,_ :F :� Y .:�` `.},.�$:.:_;=.. _-::. -:: _ ; _ _- - - - - - - - . . y ! � � ' �•��TMs� -.�w �='r�.-�• ':�-:,;; •,,DE�PAR?`-�N'I` O� P�20FESS30NAL. 'REGTJLA�ION � . _',,-'�' ` �._:_ °:;::, - ':,;= - r_ .r �_ _ ._CONS3'RIICT�Ol�-� �I�i�S.TR� LI�CENSIN� :BO - - , . ,- : " f, - �: ;�„ - ;i :� .4•l;�a� �'a '' - - i ' - 'A�' -_ •., . � ' �-- . ; . � � .����E �: . � �= �= . :_' �.:�: :-_ �: � : - SE4#Liti:o.ao�3o�i5���3 . NSE f r - �� _ . -_ i . _, _, : =..08•:._p3. .2.0;30 . 1'QBfl2391I .C�CD43;943. . . � - - - _ �: Th�' G��TER�rL�' :jCO1VTRACT6R � ' : -- -- � . .. - - - , - . -- . �;�I�Tamec� ;r�be'�i�env° -I•S"'.�CE�.tTIF`IED�: � . - _ - - . - . - _ - - . •_TJnder::'•t��ie� p�ovi�si�oas of 4'8�9•. ���5,.;- - - - = " - � - - - - " • Sxgiration ciatei AVG 3Z, 2012 �• - � - " _ - .. - _: -, - � - - • _ : _ HfJFFMAN,;',�':GE�RPiLD M3.CHAEL, . . - -_' -- - - - - - - • ,� , _ " J�SRRY` ;=HOP'�'M�3N. "' CON3,Z'RUCT.I ON _fiN.0 � � - � - . - . PO- �??X ��l`•64� =.' ; .. _ _ - - - _ - - ' - -- ' - HRANDON .FL 33509�2�15� ' =.'---, �, - - � - - � . _ CHAktI+`TE• �CRZ`ST - ,_- , - _ - - CHARL�E LIEM - - -, ,�O'tT�RN�B - - . - SECRETARY - . - • - — - =.DISPLAY AS REQUiRED 8Y LAW - - � ' Aug 30 11 10:09a 813-653-2023 p.4 20'10-2Q11 I�I��SB�ROUGN COUNTY BUSIN�SS TAX RECElP7 EKPlRES 8 - 3a - 2011 FpL1pN0 5T0.�.775 �.C'LI�ESORkuCMU.e P.00�aS SEATS O ^ � _i�'.L _' I � 0 2 REh�EVtA� 170G8 OOC�O OCC �:ODE BJSI�VES5 T"Fc k, a�aSrE i,y� 090.01Q CO'J7t�kCTOR- GENE�L SURChi+CRGt < . ., . • . 40.00 1b.�G �'�'�, _ [:.. � .. -- " <. ' ' ! ' ' � .. ._ . . .... , i .. 3USINESS 453E O;K P.IVER CIR L�CATION V.4LRIC0 33594 r�AM`` HOFFMAN GERF,L�' 1r9!CHLti=L r�tAILIr�G FQ BOX 2164 h7DRES5 BR,qNpr�v Fl 3350�-2i64 �������� �' `� ������� DOJGBE�DEN,TAXCOLLEC70R •�'�'AIC�-231?1 -S5 MA;t HERE9Y PiL"pAPRINIEGE TAY, rpE�E 813-535-520� 08124l201 J`<• 58.00 7N Q�5 ' � SS.PRpr � 5510N, pqpp�p�rpwS�ECIFIEDN=f�p� . THIS B� COf.7ES A TAX 4fCEIGT WHcN VALIDq1°_�. Aug 30 11 10•09a 813-653-2023 p.3 Hillsborou�h County Flonda BUILDI�VG SER YICES DIYISIOIY ��l�T�����T� C��' �QMPETEtVCY CERTIF]CED GET�TERA�► - CONTRACTOR c�coa�ga� Certitcate Number 10/31/2.OX 1 License Expiration Date Issued to: HOFF1VfA�T GER,ALD MICHAEY, (T�MP) DBA: JERRY HOFF11-IAN CONSTR INC VVorkers' Comp: Ol/29/2012 ��``e --� Issuing Officer CU7' A�O�JG O'JTSR D�'ITED L=NES FO=,D AIqVG THE N.IDDLE LOTTE'� I,IIJ� P=.A�E IN WALLET � ' _""""'"" """" """" I """""""""" S=GN YCUFt C]�7yD •'"'"" i !Thie card ?.s non and is revccable for czuse! � IT:�e coatrac_:or liste3 hereon will be 4e:,d respor,:_b:e I °or all pe=n:ita issu�d urZer this card. Lf this csrd is� tlost or stolen, :wti`y tTe 3 i11sbozoLSa Co ^ ontracto= Licersing Team i�nnedia:ely at (813) fi3�-73;8/7303 I Yo�z card :m�st be renewed pr_or to tYe ex�iration date I sh�wn o� the fro:�t ��� � � ���/� � i ; � _ S ineture not vali Sess sig,:ed � �______ _______ _"""" ""'"""""_'_""_"' � CERTSPZCATE OF CR�E'i'E�•1CY � HILLSHORp�/GH C�ONTY. ET,pllIpa � I '•;Te:CERTIF_T.:D GE:I�RA� CCATItkCTOF. I VO PERM=':' LAJTTL STAT3 RECIST32FJ, IF 1 � 5 PLICS.3I,� � � CGCC4i.54? 3 0/31/2011 I � Ce. N�. � I Issued Tc: �P=ration Date � i HOFFMAN GE�AI.D PffCHA&?. (T�fP) I � DB'�'' ��Y NOE"FA'TAt: CONSTR �7C ao:kers•COmp 02/19/2012 � � I � w�-�-�c�' I --._.___ Is_ucnc Cf�icer � ________________________________________ Aug 30 11 10:09a 813-653-2023 p,6 F A X _ � '(yy;4;} . ..: � - x t - UNITED MEMB�RS I1�SURANCE, INC. bSZ6 West Lineb�u� Avenae Tamps, FL 33625 CgI3) Z66-Z390 1-500-940-5432 ('813) ZSS-?323 fas E-Mail ss�dic aQnni9l,com Date: August 2S, 201 � To: City of Zephyr[iills - Buiiding pepartmerrt Fax: 8i 3-78U-0021 Re: VertiCon, Inc. (pnevious name of insured: Jeny Ho#fman Construction, Inc.} From: Sandie Kyser Number of p»ges induding c�ver. 2 Dear Sir or Madam: Please see attached General Liablfity Ins�rance Certificate Eor VertiCun, lnc. Please note; th� insured changed their corpora�ion name effective 8/t6111. Pr�evious name of insured was �l�mr �n Constructton. Sincerely _ ���i� Accxwnt Executive (ext. 8) Aug 3011 10:09a 813-653-2023 p.5 � ,. .�• ;, � =� D1-99-20i0 � ��.- : :1 �w�_fci ALEX SIPlK STATE OF FLORIDA CHiEFFif�ANCIALCFFICEfi DEPARTMENT OF FINANCIAL SERVICES QlVIS10N OF WORKERS' COMPENSATiq� *� GERTIFlCATf OF ELECTION TO BE EXEMPT FROM FLQRIDA WQRKERS' COMPENSATI�N LAW �* CONSTRUCTION IIVDUSTRY EXEEVf�TION This certifies that the individual listed �elo�v has elected ta be exempt from florida Ulorkers' Compensation law. EFFECTlVE DATE: 01/19l2Q10 EXPIRATION DATE: 01/19/2012 PERSON: HOFFMAN GERALD FEll�i: 650949531 BUSINESS NAME AND ADQRESS: JERRY MOFFMAN COIVSTRUr'1'ION INC P 0 BOX 2164 BRANDON FL 33509 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR It1POp7APl7: °rrsaant to CAapler A4U OSllq), F.S., a� olLcer al a corparatipn wbc elecls ezemp�ion Erom tNis chepier hy filing a certificafe ol elec�ian under :his section ma� not recover beneFits or compep;aiior u�aer Ihis chap�er_ Pursuan� lo CMapte• :t0.05(IZI, F S., Certilicnes el eleclion to Ae exempt... aFply orly wi1Li■ tne scope a` the buziness or Irace lisled on the no�ice ol =lectio� io 6e exem�t. Far3uani 10 [hapler 44).65;13F, F.S., Notices ol eleciion to 6e eKemp� end certiticate; o� eleci on lo be exemFt sball he sabjett Ic revoatiar. i(, a[ afry !ime after Ine lilfrg of the no�ice ot lEe issuaace of �he cettilieale, ihe �ersoi nan�e� an the no�ite ar certi(icaie ro langer �ceG Ih¢ req�iremems ol tkis seciioa for issuance el a certlficete. 7he �epartme�t s�all �evoke o cenific�ee .�� an�� time fot failvre af the person ramed �� IY^ certificale lo meet the requireme�ls ol [his secl:on. - IV<<C-251 CEA7IFICATE OF EtECT�OPJ 70 BE EXEMPT REVISEO 09-06 QUESTIONS? �85Q) 413-1b09 PLEASE CUT OUF TH� CARD BELOW AND RETAIN FOR �UTLAE REFERENCE STA7E OF F�ORIDA �EPARTMENT OF FINANCIAL SERV[GES lMPORTANT DNlSION �F WORKERS'COMPEHSATI�rJ _. }. �� O�ur5uan[ to ChaptCr 440_05(141, F.S., an afficar oi a corporation vrho CONSTRUCTION IAlDIlSTRY � - zfecls ezemption from this c.iapter by filin� a cartificate of election CERTIFICA7EOFELECTIONT03EEXEM.7FROWfPLDRIDA .-�``',�. L under this section may oct recov:r benefits or comp�nSation under this WORKERS' COMFENSATION LAW D chaF�er. EFFECTIVE: 01/19/201p EXPIRATION DATE: Q1/!g/2p12 PERSOV: GERALD HOFFMAN Pursuant to Chapce• 440.051121, F.S, Certifica�es ai electio� tc be H exemp:. appiy only tivilhin the scape of the business �r trede listed cn FEIN: 650149531 � the notice oi election to he exem�t. BC,511�ESS RAME AND ADORESS. R �eRAr HoFr•uw,x CONSTP.II�TION ivc E Pursuant to Chapter 440.Q�(13), F.S., T�oti�ES of electio� to b� exempt r o 3ox zisa and certificates o� election :o be exempt shzll he subj>ct to revocation 3RAtt��ON, FI 37509 �i, ot any time zfter -he ii.ing af the no:ice or the issuance oi tne certificate, the oerson named o� the noti:e o• certificate no I�nger meets the requiremenis o( this section for issuan�e oi a certiticate. 7he � deoartment shali revoke a ceni'icate at any iirne fcr failure oi the COPE �F BUSitVESS OR TRA7E: pe named or the certificate to m�et the �ea�irernents oi this � • CERTIFIED GENEA:.I CONTfi:.CTOR SBCt1011. GJESTIO�'S? ?850i 413-1609 CU7 HEFiE �� Carry bottom poriion on the job, keep upper portion for your records. VJC-252 CEfiTPICATE OF E!ECTICN TC 5E cXEA�PT R�VISEC 0E-06 Aug 30 11 10:10a 813-653-2023 p.7 �_Q�. 'CERTIFICATE OF LiABIL�TY lNSURANCE °"��"""°°;� ' � 8i3-Z$5-23pp THIg CE�TIF[CATE �g FggVEp /�a A MATTEri OF INP�RMATON UNITEO MEMBERS IN3URAIVCE lNC. ONtY ANO CONFatB NC 1tiGHTg !lppN TNE CE�itTIF{CATE $826 YVEST UNEBAUGFf AVENUE A�E ��r,py�g�OE�� RD B'�Y TF f P�Ot�,1�CIE�S �BEWW TAMPA, FL 33625 a+su�o A�18ltRER$ AFFORdIN6 COVERAGE NAIC � n�,� ESS87C IN3URANCE COMPANY vERncor�, �nrc. � P.4. SOX 216�t ����; BRANDON. FLORIDA 335�pg��g4 ��au�R ¢ �Haue� e VERAGES T!!E POk1GtE8 OF INSURAf�(CE U81EQ �tOW FUIVE S�t 138UED TO TMH INSUR� NAMEDABOVE FOR THE POltCY AERIOD INdC�1TED. N07VVITTtSTANO[!G ANY RE4UIRQIEN7. TERA1 OR CONDiT10N OF IINY CONTRIICT Ofi OTkER OOCUIWfFlT WI7H itESPEC't TO 1NHICH TH18 CERTiFICATE AU4Y BE ISbt�D OR MAY P9iTAld,1HE IN8URAIiCE AfFORDED SY THE POLK�ES DESCRIBEp H6tElN 18 gUaJECT Tp ALL THE T�ilNlg, p(C W�ON8 AMD COND�TIOMS OF SUCM POLIpES- AG[iREGATE C9WRS SNOWN IMV HAVE �EN REDVCEO BY PND CLAlAB. roumr�u�m[�e t �� A owr�uu.ta4anr � oca,�� s 1 OQQ OQO X eo►r�neuwoeroew�e.u,►a�mr s 100000 wu►rs �uc� �X xcxin r�o Exa un en. .�aee� s 5 000 3 ��'¢ 2lGf2�11 2/6JZQ12 �ASOw�s�ovtwuAr s 100p.000 oa+ew��oc�onse s 2 000 000 GEN'L144QREGA7E1.1N�tAPPlIESPER: PROOUL'TS-COMPAPAt33 i 1,Q00.� X POLK:1' ��' lOC INTOYOML�ENAp,iTy AItY AllTD '� S� UYIT s N.L OYYNED AUTVli SCFIEOULEDAUTOS �� i MpEO AllTGS A10N-OrYNEpAVfpS � S �PqOPE�RT1'�OANJIGE s ���� 1WTOONL7-lAACpDENT S AIJr 111fT0 OTFIER THAN EA qCC S JWi00NL7• � : E�Il�ltlllAf.N�RdTY GACMO�ETOCS f OOCUR � CU�MS �tADE A03RE61►TE i S D[-�UCTIBLE s e�nrroN a = waauua ear►�n� ruo � ewK.orenv�u�anr ANYPROPH1E70RNARTlEItIQ�i1JINE EL£AGIM�Nf S OGFIC�UYEMOER EXCLtpgp? H dnvlaurWr ELa16EASE-FJIEYtALOY t O'MSR EL OI�EA� - POLICY (�IiOT f � os a�+e�noMS ►ioai►roNS ivexic�esl oeaus�s woEe w Ewoaw�ateri sPQeui� s�ovaioNs CERTIFICATE HOL�ER CANCEI.f.ATlpp awon �o �w�. oF TMe �� oesaeNO vos�s � u�tso �ae� n�e exv�u►nou GITY OF Z�PHYRHILLS - BUIEDING DEPARTMENT o�� txe� r� �swa wsu�ae w�,c a�voR ro � 30 n+►rs � 5335 8'1'H Sl'REET Not� ro rye ce�r�cwre e�a.oai n�n ta n�e u�s. au� r�uurse m oo so ar,�u. ZEPHYRHILLS, FL 33542 � NO ORJOATION 011 C1AOp.f�Y 01 ANY Ifl1� Uhd! TNE NiYi�C, Rt AOEMTS OR FAX: $13-780-0021 nsRe�ran�ea� �utMa�,�Re.n6s�,wr��nrE , �� ACORD 26 f2001/081 � ACaRD CORPORA'!'lON 9968 Aug 2511 02:52p 813-653-2023 p,2 2010-2411 HIL��gpRpUGH COUNTY BUSINESS TAX RECEIPT T"�'S FF �, � M� K�. � R ,� EXPIRES 9-30-2G11 FOLIO M� O £EaT„ .�� E � 0 2 RENE�NAL 17008.0000 OCC. CODE 8USlNcSS TYP� rl 1JA�7E TaX �J9�.070 �ONTRACTOR- G���'cRAL S! RCH:,RGE , _. E ��: . -' . ; • 4Q 0�� 18 �JO h�� - -- _ � . _r:-�: � � : _ . . ; � .. ; . eusrr�ess 4538 OAK Rlb"ER C!R ^ � COCATION VALRt�p 335cq NAME HpFFMAN GERALD MICHAEL RM,fUNG PO BO}( 2964 Ao��`ss BRF+NGOIJ FL 3,� ���I�ESS Tr4X ���EfP`i � DOIiG BELDEN, 7AX COLLECTOR '�AID -[3171 - pg HAS HERE9Y PaIDA PRr.�IEGE T/V{ ;O Ep��C +N BU£I,iE55. PROFESSi�.O,z O��ppTpn ipEGF1ED HEREp�. H� J C�F+/�24�20 i 0�'� 5� TyIS 3eCORAES A TAX RECEIP7 WHEN Vq��DhTED I Aug 2511 02•51 p 813-653-2023 p.1 P. O. BQx 2164 J E R R Y H O F F M A N Brandon Florida 33509-21 b4 CUNSTRUCTION, INC Cell: 813.503-269b O�ce/Faz.• 813.653-2023 Email.• ihoffm l 0�atampaba • rr com Facsimile From: Jer Hof�r�an Date: Augus# 25, 2011 To: Pho►re: F� City af Zephyrhills Buiiding Department 813-780-UO20 813-780-0021 Original ❑ will / B will not follow. Pages (incJudirrg fax sl�eet): 2 Comments: Re: Contractor Certificate Please see attached Business Tax Receipt which previously left out of our fax of docurnerrts. If you have any questions or need anything further, please call me at 813-653-2023. Thank you for your assistance, Becky Hoffman Aug 30 11 10:09a 813-653-2023 p.1 , P. O. Hox 2164 J E R R Y H O F F M A N Brandon, Florida 33509-2164 C01�TSTRUCTION �NC. Cell.•813.503-2b96 � 0,�'f'rce/Fax: 813.653-2423 Email.• ihoffm]Or.tampabav.rr.com Facsimile From: Jer Hoffman Date: August 30, 2011 To: Phone: Fax: Jadcie @ City of Zephyrhills Building Dept. 813-780-0020 813-780-0021 Original ❑ will / 8 will not follow. Pages (irrcluding fax sheet): 7 Comments: Re: Contractor Certificate Jackie, per our teiephone conversation, I ha�e athached additional copies of #he following: • State Certified License • County Competency (just foc your information� • Business Tax Receipt • Worker's Compensation Exemption • General Liability Insurance Certificate Please cal! me once you have everythEng entered. We ha�e permit in for approval for. 38122 Henry Dr. Zephyrhills, FL 33542 Please call me at 8'l3-G53-2023. 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