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Home My WebLink About11-12579 , CITY OF ZEPHYRHILLS � 5335 - 8TH SIREET � �si3)�so-oo20 12579 BUILDING PERMIT Permit Number: 12579 Address: 4841 16TH ST Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 1426-21-0010-02000-0040 Improv. Cost: 5,800.00 Date Issued: 12/05/2011 Name: PABON ISRAEL 8� MARIA Total Fees: 105.00 Address: 4841 16TH ST Amount Paid: 105.00 ZEPHYRHILLS, FL. 33542 Date Paid: 12/05/2011 Phone: (561)301-3397 Work Desc: A/C CHANGE OUT 2.5 TON W/ ELECTRIC JOHN PHILIE ELECTRIC �� / � �� . � Y � ELECTRICAL FINAL REINSPECTlON 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 acxessible. 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. "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 attorney before recording your notice of aommencement." Complete Plans, Specifications Must Acwmpany Application. All work shall be performed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. ��?� � `� � ' CONTRACTO SIG ATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Fax-873-780-0021 Building Department Date Received � r�� y - � i �� Phone Contact for Permitting e� u(„) ^� n, � / /� 1 � 1 i 1 � Owners Name ...L_,5 i�J'1�� / /i N Owner Phone Number W I�W ' '3�'j7 Owner's Address y O y( /(X Owner Phone Number � Fee Simple Titleholder Name Owner Phone Number fee Simple Titleholder Address JOB ADDRESS / LOT # � SUBDIVISION � PARCEL ID# `/ `�� 0�� 'Od-WO w (OBTAINED FROM PROPERTY TA% NOTICE) WORK PROPOSED � NEW CONSTR 8 ADDlALT � SIGN � O DEMOLISH INSTALL REPAIR PROPOSED USE � SFR � COMM � OTHER r TYPE OFCONSTRUCTION � BLOCK � FRAME O STEEL Q DESCRIPTIONOFWORK � C �•SrQn � ( P � �e�+ Pe � D BUILDING SIZE �_—� SQ FOOTAGE �� HEIGHT � v� -rTrt-r'r"rre"r'rr�-r�-�"�"err'r'T�r'T7"r-r'1"rr r'tTrrr"r-r'r'f-�r-r-�-rr �BUILDING $ VAIUATION OF TOTAL CONSTRUCTION ��ELECTRICAL �� AMP SERVICE O PROGRESS ENERGY � W R E C �_�PLUMBING $ �MECHANICAL $ M.� VALUATION OF MECHANICAL INSTALLATION / ��LJ � [�GAS � ROOFING Q SPECIALTY � OTHER ,�Y/ L �'� FINISHED FLOOR ELEVATIONS fL00D ZONE AREA �YES NO -`.-�'+-lT��.} '-.-:-:-�:-:.�-:�+�-' .-..-.-.-C+�:�S-+-:-�`.�:-7�i��-� •�� :�;�-;••;��:,� BUILDER � COMPANY SIGNATURE REGISTERED Y/ N FEE CURREn Y/ N Address License # �— � ELECTRICIAN COMPANY `J[)h�"1 � P_ ('ICI: �IG SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address Y 1� #� License# �� PLUMBER � COMPANY �- SIGNATURE REGIS7ERED Y/ N FEE CURREI. Y! N Address �— --� � License # �— MECHANICAL `� I COMPANY DDI�y uz°5�' �L.I1.(�. �—� SIGNATUR `i �� REGISTERED Y N FEE CURRE� / N Address � c� /� n Q License # � OTHER � COMPANY —� SIGNATURE REGIS7ERED Y/ N FEE CURRE� V/ N Address License # —� I � IIIIIIIIIIIIIIIIIIIIIIIII IIilllllllllllllllllllllllllllllllllllll RESIDENTIAL Altach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Fortns, R-O-W permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Consiruction Plans, Stormwater Plans w/ Silt Fence installed, Sanilary Facilities & 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 Fortns R-O-W Permit for new construction Minimum len (10) working days aRer submittal date. Required onsite, Construction Plans, Slormwater Plans w/ Silt Fence inslalled, Sanitary Facilities & 1 dumpster Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ""PROPERTY SURVEY required tor all NEW construction. Di rections. • �� t• Fill out application completely Owner 8 Contractor sign back of application, notanzed If over $2500, a Notice of Commencement is requlred. (A/C upgrades over j7500) " Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notanzed lelter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs d shingles Sewers Service Upgrades A/C Fences (PIOVSurvey/Footage) Driveways-Not over Counter rf on pubhc 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 Water/Sewer 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 will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated 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 - DepaRment of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & 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 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO ICE OF COMMENCEMENT. FLORIDA JURAT (F S 1 03) �� ' Y OWNER OR AGENT � CONTRACTOR � Subsc e and swor to (o�r a before me th � Subsc be and swor ffirme�befo e e is o is! e pers nally k� wn o�e o��p isla e perso a known to me or has/have produced s ntrficatwn as identification � u r � � Notary Publit Commisswn o Commission No rotl.ar a��o /LL� •� �o C Name�f • pe �f��,� Name of Notary ty ta ��RES; June 5 , 20�5 EXPIRES: June 5, 2015 �''qr �y,�` eaded Thru eudget Naary s«vices � Fl.o"�� ded Thru 8udget No1dY $NNcot Pasco County Parcel: 14-26-21-0010-02000-0040 001 Page 1 of 1 Data Current as of: Weekly Archive - Saturday, November 26, 2011 Parcel ID 14-26-21-0010-02000-0040 (Card: 001 of 002) Classification 08 - Multi-Family - Less than 5 units Mailing Address Property Value PABON ISRAEL & MARIA E Ag Land $0 4841 16TH ST Land $11,220 ZEPHYRHILLS FL 33542-6017 Phvsical Address - See All 2 addresses (First Building �6i,670 Shown) Extra Features $0 4839 16TH ST 7ust Value �72,890 ZEPHYRHILLS FL 33542-6017 Assessed (Non-School Amendment Leaal Descriution (First 4 Lines) 1� ��2,890 MOORE'S FIRST ADDITION PB 1 PG Taxable Value $72,890 57 LOT 4 BLOCK 20 OR 8597 PG 1176 Land Detail (Card: 001 of 002) Line Use Description Zoning Units Type Price Condition Value �1 0800 MULTI FAMT OOR3 6,600.00 � $1.70 1.00 $11,220 Additional Land Information Acres 0.15 Tax Area ZH FEMA Code � R�sidential Code ZHLGLP7 Buildina Information - Use 08 - Multi Family (4 or less Units per Building) (Card: 001 of 002) Year Built 1986 Stories 1.0 Exterior Wall i Concrete Block Stucco Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring i Cork or Vinyl Tile Fiooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 1.0 r Line � Description Sq. Feet Repl. Cost New � 1 B� 2,148 $93,223 2 F�_P 24 $217 Extra Features (Card: 001 of 002) Line � Description Year Units Value No Extra Features Sales History Previous Owner LARE CHAD A W& RACHEL D Year � Month � Book/Page Type Amount �— 2011 09 8597 / 1176 WD $73,000 2001 04 4593 / 0744 WD $82,600 �— 1990 � 12 1973 / 1013 WD $63,000 http://appraiser.pascogov.com/search/parcel.aspx?sec=14&twn=26&rng=21 &sbb=0010&b... 12/2/2011 � In�roice Coolquest, Inc October 6, 2011 16640 Bachmann Ave , Unit #1 Summary� INSTALL - UNIT Hudson, FL 34667 Invoice #� 8687-15300 727-859-0500 Toll Free 877-826-2665 Tech NICK www.coolquest.com LIC # CAC1813939 Due Date. 10/7/2011 Job Date 10/10/2011 Bill To: Job Name: ISRAEL PABON ISRAEL PABON 4839 16TH ST 4839 16TH ST ZEPHYRHILLS, FL 33542 ZEPHYRHILLS, FL 33542 561-301-3397 561-301-3397 Item Code Description Hrs/Qty Price Amount HORIZONTAL TEMPSTAR 2.5 13SEER HEATPUMP 5KW HURRICANE PAD AND CLIPS THERMOSTAT-3000 HANGING KIT EMERGENCY PAN FLOAT SWITCH COPPER LIr]E SET 20' 7/4 AND 3/8 LINE COVER EXSISTING BREAKERS: GE A/H: 50 AMP COND: 30 AMP EXSISTING WIRE SIZE: #8 NEW DISCONNECT VALUE OF JOB:$5800 RUN CC# WHEN JOB IS COMPLETE Tota I $0 00 PARTS WARRANTY All parts are warranted per manufactures specifications NO WARRANTY ON REFRIGERANT OR PARTS with glass, rubber, plastic, or printed circuit boards. We are not responsible for any damages or inconveniences caused by clogged drain line problems or inadequate duct sizes unless otherwise stated on this invoice. Coolquest is not liable for damages caused by water leaks, unless othervvise stated above LABOR WARRANTY Any labor charges relative to equipment service noted is guaranteed for a period Terms: UPON COMPLETION Signature Date THANK YOU FOR YOUR BUSINESS c � L AIR CONDITIONING, HEATING & APPLIANCES LICENSED & INSURED CAC1813939 12/2011 TO: WHOM iT MAY CONCERN: I, JANE M. HARPER AUTHORIZE THESE INDIVIDUALS TO BE AN AUTHORIZED REPRESENTATIVE TO PERFORM ANY NECESSARY ACTIONS FOR THE ABOVE LICENSE INCLUDING REINSTATEMENTS. NANCY EVERETT GARY SC07T TAYLOR ROBERT CAPAZ THANK YOU, w �� JANE M. HARPER (President/owner Siate of FLo2l�i�q County of �i1sc'O On this �� day of _1�E=C , 2 o i i bef�o s�r e personaJ ly a�pp eared �J /fNF'�`/_ 6,l,c�P_.O�i2 to me known to be the person who executed the t►�Y p� foregoing instrument, nd ackn ledged that he �' ��'�' �"� � executed the sam is free ac nd deed. * *�' ��MISSION t EE 09062p SEAL (signed Q • �� `o � EXPIRES: June 5, 2015 �l1L� �UBU 'E'a �.dw Baided Thru Budgd Wd�ry serrices ��.. •. 16640 Bachmann Ave. Unit #1 • Hudson, Florida 34667 http://coolquest.com � 727.859.0500 • Fax 727.869.6477 1.2/05/201.1 08:19 FA� 7278896477 Coolquest/dipatch � OOOli0003 �1 OP ID: SG '`�` °� °' CERTfFICATE OF LlAB1LITY INSURANCE �7E(�IMlDO/YYYY) 4 2l02/19 THIS CERT(FICATE tS lSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RfGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFlRMATIVELY OR NE(3ATIVELY AMEND, EJCtEND OR ALTER THE COVERAGE AFFORD�D BY THE POLICIES BELOW. TH1S CERTtFlCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TNE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND TtiE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an ADDITIQNAL INSURED, the polky�ies) must be e�dorsed. Ii 3UBRaGATION IS WAIVEO, subject to the terms and condrtions of the poNcy, certain policies may requfre an endorsemer►t. A statement o� thls ce►ttficate does not confer rights to the certiiicate holder in lieu of such endorsernen s. PRODUCER 813 ��A T Stahi 8 Associates ins., inc. 3939 Tampa Road 813-818�396 P "� p � p : Oldsmar, FL 34677 �"M- Stahl � Assoclates Insurance aD io � COOLQ-1 AFFORDING COVERAGE NAIC 0 �rrsuaEO Coo(Quest, Inc. n�suReaa: Preato�fan Insurance Joh� Philie Electric LLC ,n�uRERB:Southem Owners Ins Co. A Professional Appliance iNSURER C : Repair of West Florida Inc. 16640 BachmannAve. #� '"su�RO: Hudson, FL 34667 �RE: IM$tIRER F : COVERAGES CERTIFICATE NUMBER: REVIStON NUMBER: TIifS IS TO CERTIFY THAT THE POIICiES OF IrlSURANCE IiSTE� BELOW FIAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TFi£ POUCY PERfOD INDICATED. NOTWITHSTANOING /WY REQUIREfdENT, TERM OR CONOfTION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICHTE MAY BE ISSiJED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POlICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOiTIOMS OF SUCH POUCIES. LIA�TS SHOWN MAY i�lAVE BEE�1 REDUCED BY PAIO CLAIMS. LTR TYPEOFMSURANCE POUCYNWIBER NMIDD E � �� UMRS GEMERAI WIBILITY FACH OCCURRENCE 5 �s�sOO B X co�eac+n� ce�rvw �wai�rtv 004012011 07/01/11 07/o1N 2 Es s 300,00 cwa�s� �X occua r�o exa «+. a�s«+) s 10,00 veHSOru� s nnv uuurtr s 1,000,00 GENERALAGGREGATE S Z�OOO,O GENI AGGREGATE IIMfT APPLfES PER: PRODUCTS - COMPlOP AGG S 2�OQO� POLICY PRO �� g AUTObIOBN.E 11A8RRY COMBMED SIHGLE LIMIT S SOO,OO (Ea aaident) a x��,TO �cF�000�aoz oz�2s,�� oy�anz 80�ILYINJURY�Pvperson) s ALl OWNEO AU70S 8000.YINJURV(Paraccide�k) $ SCFiEDUIED AUTOS vROPER7Y DAMA(3E g HIRED AUTOS (PeraoaOeM) NOM-0WNEO AUTOS 5 S UMBRELLA LIAB p�UR EACH OCCURRENCE 5 EXCE33 LIAB �q,��E 0.GGREGAtE 3 DfDUCTlBLE � S RETENTION S 3 VYORKER3 COMPEN9ATION WC 5TAM OTFI- ANO EM VL01IER8' UAB�LITY Y/ N ANY PROPRIETORfPAA'TTlER/EJ(ECUTNE E.L EACN ACCIDENT 5 OffICERIAlEMBER EXClU0E0? � N I A (1Nsndatory M Nl1) E.L DISEASE - EA EMPLOYEE S ttyes dete�ibe �attlx �ESCRIPTION Of ERATIONS below E.L. OISEASE - POIICY LIMfT S DESCl�T10N OF OPERATION8/ LOCATIONS 1 VElIICIES (At1�cA ACORD 101, MApIOnM Rem�rks Sehedid�, N moro spacs Is reQulnE) Ucense Holder is John G. Philie, Ltcense S ER0045321, expires 8/31/2012 Fax # 813-780-0005 /a��./, CERTIFICATE HOLOER CANCELLATION ZEPHY-1 3HOUtD ANY OF TFIE ABOVE OESCRIBEO POLIGES BE CANCELLED BEFORE TItE EXP�RATION DATE THEREOF, NOTICE WILI BE DEIIVEREO �M City of Zephprhills ACCOROANCE WITH THE POLICY PROV13101r3. 5335 8th Street Zephyrhills, FL 33542 �►UTNORIZEOREPRE8£N7ATIVE "�i1P!�r`w"� �I � 1968•2009 ACORD CORPORA710IV. All rights reserved. 12/05/2011 08:20 FAX 7278696477 Coolquest/dipatch �0003�0003 ' ° CERTIFICATE OF LIABILITY INSURANCE °�aEo� °°"""' / /aoii THIS CERTIFICATE IS ISSUED A3 A MATTER pF �NFORMATIOIV ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFlRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE �SSUING INSURER(S►, AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the oertificate holder is an ADDI1lONAL INSUREO, the policy(fes) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditio�s of the policy, certain policies may require an endorsemerrt. A statement on this cer0ificate dces not confer rights to the certificate holder in lieu of such endorsemeM(s). PRpOUCER 1-727-797-4190 CONTACT Arthur J. Gallagher Riak Management S�:vicea, Inc. � PHONE FAX A!C No : 4904 Eisenhower Hlvd., Ste 250 E AD ESS: Tampa, PL 33634 INSUR S AFFORDINGCOVERAGE ��p nvSURERw. TE��Y INS CO INC �42376 IMSURED Paychecka Plus, Inc. INSURER 8. INSI/RER C . 2920 Enterprise ROad #208 INBURERD. Clearwater, PL 33�63 �NSURERE INSUREA F . COVERAGES CERTIFICATE NUMBER: 2�3o94i3 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW HAVE BEEN ISSUED TO TNE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO. NOTWITHSTANOING ANY REQUlREMENT, 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 POIICIES �ESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAIp CLAIMS. INSR TyPE OF INSURANCE L BR POUCY EFF � GOLKY E7fV LTR i POUCY NiJM�R GENERAI WB711TY ' UMITS I � EACH OCCURRcNCE 5 j COMMERCIA� GENERAL LIAB4iTY � MA ED PREMI E� � c Rence ' S CLAIMSMnDE � OCCUR I j I MEO E�Xp (q� o„e �,�„ ' S � PERSONAL & ADV INJURY S � ! GENERA�nGGREGATE ;S GEN1 AGGREGATE LIMIT AFPItES PER: � PRODUCTS - CAMP/OP AGG � 5 � 70UCY � �T LOC I S AUTOM081LE LIABfLITY j COMBINED 31NGLE LIMIT � � ' i Ea acdderK 5 � I ANV nUTO i BODILV INJURV (Pe/ p¢Bpn) $ ALL OWNED j —' SCHEOUIED � AUTOS � AUTOS BOOILY IWURV (Car accidern) S : NiREO AUTOS ; I��WNED I PROPERTY OAMAGE 5 —1 Per a ' ent � � S � � UMBRELLA LIAB i pCCUR � EACH OCCURR 5 � EXCESS LIAB CLAIMS-MADE I AGGREGATE S � I OEO RETENTION S S A i WORKERSCOMPENSAT(ON ThTC3266546 12/O1/12 X �STATU- ' OTH- ; AND EYPLOYER8' LIABI�ITY �� N 12 / O 1/ 1 T � ; ANYPROPRIETOR/PARTNER/EXECUTIVE i � OFFiCER/MEMBER EXCWDEO? � N I A i � i E.l. EACH ACCI� S 1, 000, 000 I(Mandatory in NH) i I E.L. OISEASE - EA EMP�OYE 5 1, 000, 000 ; If yes, desaibe under � � �ESCRIPTION OF OPERATIONS below I I � ! E.L. OISEASE • PpLICv LIMrt S 1, 000, 000 i I i I � � DESCRIP71pN pF OPERATtO1�E3 ! LOCATIONS I VENtClES (Attach ACORp 10t, Ady;t;onal Remarka ScMWde, if more spsce is requred) Joha Philie Sleetric, LLC ie an alteraate employez. Coverage ia provided ta contracted employeee of Paychecka Plus, Inc. aot aubcontract labor. John J. Philie is the Licenae Dolder. LicanaeltBR0015322. Exp Aug. 31, 2012 RE: Storr Office Eaviro�enta CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE City of Zephyrhills THE EXPIRATIpN DATE THEREOF, NOTICE WILL BE DEUVERED IN Ci ty Manager ACCORDANCE WITH THE POUCY PROYISIONS. 5335 8th Street w�Tr�pR�EOrtEV�seNTwnve 2ephyzhills, FL 33542 ` i\_ _�G �� IISA �CJ�� O 1988-2010 ACORD CORPORATION. All rights reserved. 12/05/2011 17:37 FAX 7278696477 Coolquest/dipatch f� 0001/0001 PASCO COLT�TY B�:SI��S� '�`��X I�.�CEIP"�' �(�11-1� issued pursuani and subject to.Florida S:atutes ano Pzsco Co;:^*�• Ordin2nces. �ss�ance does no; ce�i� co�+pliance wi�h zoning ar other laws. This rece�F! m�st �s aos?ed co^s��c::b��!y �n �!ace cf busi::ess. e'xpires Sepiembe.* 3C. N��ke ��sor� � ACCOUNT N0� 037670 ��i.c�'. ��i,�,�� TYPE OF BUSINESS� � SI� CDDE� 1731.02 n:��7f^JL"�T`.'?�;._.�RiI>.�, ELECTRICAL CONTRACTOR .•'y��sz,,.f••, LOCATION ADDEifSS� JOHN PHILIE EIECTRIC LLC •� �..- 16640 SACMMANN AVE UNIT 1 � 16640 BACHMANN AVE UNIT 2 ;� ^�� ; HUDSON tiUDSON FL 34667-4238 : •�� : �'•, ��,,,, DATE RECEiPT AMOUNT ... 08/16/11 609837 31.25 I�I�I�I�u��a��d111J��o1�1�1�l��un��l�Unbll��lH�� •. . 12/05/2011 1B:22 FAX 7278696477 Coolquest/dipatch f� 0002/0002 A U1l ,�5` � y�•�'�}' .t � .' . ' � _ � ' ' ^ 5 �,. • ' ��.2:: 9 ti� ��+,9 9 •"a= ' • ` 5r _'`�' ' ` a • y .. r � _I"I'* �'"'.: .i:�,'L 'i' ?.', ' �'��: f�.:.�..j:t' n `��.• : Nr, ::, : ' ��f=i "` .. 1 x �{Y.�ir'a � .,�. u ` '� 7: 7. .,• -` � _ _.,_ -+•• . ,, �? . i: = fV�:rt�. ' S' t � �O � vn�t.:?4.j'r:.� M:(.µ.?� � ' \. . 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