The URL can be used to link to this page

Home My WebLink About12-12926 CITY OF ZEPHYRHILLS 5335—8TH STREET • �si3��8o-oozo 12926 BUILDING PERMIT ., qx� �-. >� s,��. � ;..�m d ' ,�` Permit Number: 12926 Address: 39031 3RD AVE Permit Type: ACCESSORY BLDG. ZEPHYRHILLS, FL. Class of Work: SHED INSTALLATION Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 12-26-21-0000-03500-0000 Improv. Cost: 1,810.00 �g�° � ,�. Date Issued: 4/05/2012 4.:� �Name: WARREN, WILLIAM & KATHLEEN Total Fees: 92.50 �.�� ' Address: 39031 3RD AVE Amount Paid: 92.50 1 ZEPHYRHILLS, FL. 33542 Date Paid: 4/05/2012 Phone: 813 477-8218 Work Desc: SHED INSTALLATION 8 X 12 :�� v`"? ?`�-'? t,.r.�,+°`:a��-.��'� � z$� 3.,�- u� , , \ ��i�`'�"� a'"�n, �`�'^ �.,{!.� � `'.x�. 'x{ ;�...0. � �.-� �t.,�. �c �r�tr ��,q . c`-* ' v, c��'t^4±:, . f!r,.:�"r �;��,,� d ''I;-,< � ��-k.,. �' ,��,�, Et"`� �,..:'� 3>t� �:;�.pY9�9vk��'' ..�.�'d,,�'ue• SHEATHING si FINAL REINSPECTION FEES: Reinspection fees will aomply 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 t) 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 additionai permits required from other governmental entities such as water management, state agencies or federai agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application. All work shall be performed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. �G°� CONTRACTOR SIGNA RE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER t �� " �� .K. ` I City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: � ��G`b-+�'-�' ��l Date Received: 3 •Z I—� � Site: 3�1 � � I 3 f� l�-1�� Permit Type: � X ( �- ��G� Approved w/no comments. Approved w/the below comments: Denied w/the below comments: • �' �C%/ �, � C- , l f�i�l �( t��/ S � �GJE�G`� 2'i� � �j�C- C� l7 ZGrL`�/ 2- �✓ �'�P�..Q� ��C G7 � O�L= �J� /�� `� This comment sheet shall be kept with the permit and/or plans. � �"�,��- �� . , Kalvi Switz r s Examiner Date Contractor and/or Homeowner (Required when comments are present) 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received -'l, ��,� g 5��3 7�j-'� __ s{�� Phone Contact for Permittin Owner's Name � C �� ! �!� w��9�1L� �� Owner Phone Number �r�"L��"� �'�� awner's Address � ! d�( ��"`� U�, Owner Phone Number C Fee Simple Titleholder Name Owner Phone Number C Fee Simple Titleholder Address JOB ADDRESS � � ` �� v�' LOT# � SUBDIVISION PARCEL ID# � '��'vZ —�`�'�"��—� (08TAINED FROM PROPERTY TAX NOTICE) .�� Q / WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN � [� DEMOLISH INSTALL REPAIR PROPOSED USE � SFR Q COMM 0 OTHER TYPE OF CONSTRUCTION BLOCK Q FRAME � STEEL Q � DESCRIPTION OF WORK � � � ( 2 BUILDING SIZE � � r � SQ FOOTAGE� HEIGHT ] �BUILDING $ 1� G/�r '�„ VALUATION OF TOTAL CONSTRUCTION f 0 �ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.0 �PLUMBING $ � �� OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �GAS 0 ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO � m�F �� .r,.� � 3 7_ d"1- BUILDER � COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C RESIDENTIAL Attach(2)Plot 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/Silt Fence installed, Sanitary 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 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&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 for all NEW construction. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over 57500) ** Agent(for the contractor)or Power of Attomey(for the owner)wouid be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of ApplicaHon Only) Reroofs if shingles Sewers' Service Upgrades A/C 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 unde�take 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 IMPACTIUTILITIES 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: - 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 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�II 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 OBTAI FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR°NOTICE O CO CEM NT. FLORIDA JURAT(F.S. 117.03) OWNER OR AGENT CONTRACTOI� s � Subscribed and swom to(or affirmed)before me this Subscribed and swom to(or affirmed)befor e this bY � L'j-d?- by Who islare personally known to me or has/have produced Who is/are per�_nall+�kiwwn to me or has/have produced as identification. as identification. �- i Notary Public j i"�(�Q Notary Public C r issi o. :"""'" . JA EUNE BOGES Commission No. - ' ��2,2014 -•: �� EXp1rPS DeCe►n ,s Name of Notary typed,printed or stamped Name of Notary p. ed .�.„__..�...�._..,.�- _.._._._.�... �..�....� .__...-- - - ,:�_..�..,�.«- ---`�--------�CIT'.Y •UF ZSFHYRHII.LS BUII.11ING DEP2IRTHETiT OWNER `.�(, I L.L.. � �� ,� ��f�Y��%� d`,� JOB I�OCATSON � � � � ( � �� l/ ' PARCEL I .D . " �� / oZ ��sZ�"a;J — O� " C�,�.�C2�-�' � C�6�'C� I C� � SEiOW I,LL E%IST'I�G b� .P_RUFQSSll STRU(_"Ti'URES GIVaNG .DIHSNSIONS �� SETBACKS. �� , /� �� ?�� - ALL ' LL C�MPLY'�1�'1T ALL PREVAILII�TG CODES,FLORIDA B ILD `G C ,NATIONA�.F.LECTR.`C COD AN CIT. OF ZEPHYI�H1I.l.S�RD1?VAN '�:S �M� �i�N�W'�'� N d � ..��:-,�, . �, , ,� �.! � -«� R�Vi�vv ��T�.�;�� UTI�.ITY aU�ZDINCS _ C�TY O��E�HYRHILL_S MUST SHOW SIZE & ��AN� ��M�N�F� FOUNDATION INFOR- MATION. FRONT PROPERT'Y LINE � � � (:NO��E �ESAiVIPLES 1 & 2 ) STREET 1 . SETBACKS FOR R1, R2 ZONT_NG 2 . SETBACKS FOR R3 ZONING 60 ' 60' 1Q� 10' ' P R X . O I I� ' P S 10' 10 ` EXTSTING 10' 0 T 1 0 ' 1 Q ' S I - E N D G PROPOSED Z�� 20 ' SGL FAM 30'DUPLEX F'ROI�"P' PR�PBEZ'TY LINE F'RONT PROPSRTY LINS � � "��z��; `�� Vista Marketing 3161 Hwy 301 South Zephyrhills, FL 33540 , � � Phone 813-788-5459 Fax: vistamart@msn.com _ _ _. Vista Authorized Agent of Weather King Buildings (CARL) ,SE�ECT orvE O CASH SALE o ReruTro owrv , ��UILD AT MONTEZUMA GA PLANT SALESMAN ANICETO SUMILE DATE. O3 16 20�2 Choose Building Sale Type INVENTORY#_ _ _�� ' � New-On Lot Sale �Please Select One Of The Building Types �Treated Econ o Buiidings � Rrp HO�DER: Consolidated Rentafs I �Painted �Vinyl �Treated O Metal � � Srv�e oF e�o� cnoose size :arger --— SI��G COLpRS. TRIM COLORS. ROOF COLORS. IBARN 8x12 ;Custcm S;z� !' --- ---- �' �� CABIN I �COTTAGE SHED I 'i "EXTRA OPTIONS"DESCRIPTION COST GARAGE �— ' $O 00 LOFTED BARN ' $O OO Lofted Barn Cabin ', ; Side LBC $0 00 $0 00 ISide Lofted Barn ; ' $0 00 !IUTILITY �. Utility 8'Walls i $�00 $0 00 Side Utility 8'Walls i I�SELECT YOUR PAYMENT DUE DATE _ Q_ls�_ O srH O iorr+ O isrr+ I TOTA� $0 00 PURCHASER NAME William Warren Jr. �o,RENTER _ CO-Cell. CO-Employer CO-Wk Ph. MAILING ADDRESS DELIVERY ADDRESS 39031 3 RD AVE. 39031 3 RD AVE. Ci �Exempt State State: F=lorida Zip: 33542 County pasco ❑6cempt County County p8sC0 State: Florida ZIP: ❑exempt Gty City ZEPHYRHILLS HOME PHONE. $�3-477-HZ�H Own /Rent Land? _ WORK PHONE Landlords Phone. _ Ce��: 813-782-2341 Landiords Name. _ Employer CASH SALE PBN-8X12 RENT-TO-OWN-SALE � SALES PRICE $1,81 O 00 1 SALES PRICE $�.�� 2 OPTION COST(Describe Above) $��0 2 OPTION COST (Describe Above) 3 TOT.vL PRETAX COST(�WE 1+LINE 2) $1,810 00 3 TOTAL COST (LINE 1 + LINE 2) $O 00 SALES TAX BREAKDOWN 4 Cost Reduction AMOUNT 4 sn�es scate Tax�uNE s x o os � $108 60 5 NET Cost Reduction(LINE 4=1.0+tax rate 1 07000 $0 00 5 Co Code O Line 3x Rate 0 01000 $18 10 6 AMOUNT TO RTO(LINE 3-Line 5) $0 00 6 Gty Code #N/A �ine 3x Rate O 00000 $O 00 7 MONTHLY PAYMENT(LINE 6=2�1.6) $O-OO 7 TOTAL SALES TAX(LINES 4,5 8 6) $126 70 SALES TAX BREAKDOWN 8 rOTn�CoST wi Tnx�LwE s+�� $1,936 70 8 M/State SALES TAX(LINE 7 x OA6) $0 00 9 CASH RECEIVED 9 Co Code 0 l.me 7x Rate 0 01000 $0.00 1 D NET AMOUNT DUE(LINE 8-LINE 9) $�,936 70 l 0 City Code #N/A Line:7x Rate �.�� $�� FOR ALL REPAIRS FAX 888-695-7616 11 TOTAL SALES TAX(LINES 8,9&10) $0 00 DRIVER TO PICK-UP REMAINING "BALANCE" �z TOTAL PAYMENT(LINE 7+LINE 11) $o 00 DUE AT DELIVERY OF"BUILDING"," LINE 10" 13 TotalCost36MOnthsputonContract(Line 12x36) $0.00 ESTIMATED DELIVERY DATE. 14 SECURITY DEPOSIT $O 00 10 TO 15 WORKING DAYS FROM PURCHASE DATE. 15 TOTAL RECEIVED(Show Method,CkTt-CC-Cash. $O OQ OPTION DRAWING.SHOW STANOARD"DOOR "THEN PLACE YOUR"OPTIONS" PENCIL in WHERE&give Measurements from END orSIDE of BLDG.to PLACE options. DOORS FACING _ PREFERRED DELIVERY TIME ll 1 DIRECTIONS _ II li Weather King PoRable Buildings and ifs agents are not responsible for permits,setbacks,restnctions,or covenants.Please contact your local codes department or Homeowners Association.It is up to the customer to decide whether ground conditions are �r swtable for delivery Weather King Portable Buildings is not responsible for yard or driveway damage. Free delivery and set up , includes one trio;additional trips may incur charqes to the customer I,the customer,have read the disclosure above, �-� ' and fully accept the terms provided therein Customer's Signature. j �� / First 50 miles Free Delivery From Lot Thereafter$3 00 Per Mile „ ' Pasco County Parcel: 12-26-21-0000-03500-0000 001 Page 1 of 2 Data Current as Of: Weekly Archive - Saturday, March 17, Z012 Parcel ID 12-26-21-0000-03500-0000 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value WARREN WILLIAM &KATHLEEN Ag Land $0 39031 3RD AVE Land $16,038 ZEPHYRHILLS FL 33542-5266 Building $68,310 Physical Address Extra Features $2,634 39031 3RD AVE ZEPHYRHILLS FL 33542-5266 Just Value $86,982 Assessed (Save Our Homes) $86,982 Le9al Description (First 4 Lines) Homestead 196.031 - $25,000 COM SW COR OF S 198 FT OF SW Non-School Additional Homestead Exemption - $25,000 1/4 OF NW 1/4 OF SW 1/4 TH E Non-School Taxable Value $36,982 244.4 FT TH N 50 FT FOR POB TH School District Taxable Value $61,982 N 148 Ff TH E 80 FT TH S 148 Warning: A significant taxable value increase may��ctur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value � 0110 SFR RURAL OOR1 9,000.00 SF $1.70 1.00 $15,300 � 0110 SFR RURAL OOR1 2,840.00 SF $0.26 1.00 $738 Additional Land Information Acres 0.27 Tax Area 30ZH FEMA Code �Residential Code ZHLGLPS Buildinq Information - Use O1 - Single Family Residential (Card: 001 r�f 001) Year Built 1958 Stories 1.0 Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Plastered Interior Wall 2 None Flooring 1 Asphalt Tile Flooring 2 None Fuel Electric Heat Forced Air- Ducted A/C Central Baths 1.0 Line Description Sq. Feet Repl. Cost New 1 BAS 1,924 $84,656 2 FOA 90 $1,012 � 3 FOP 70 � $792 4 FDG 600 $10,560 5 UCA 300 $1,980 Extra Features (Card: 001 of 001) Line Description Year Units � Value 1 FIRE PL 1988 1 � $1,280 2 CLFENCE 1983 600 C $212 �- 3 � DWC 1990 324 C $462 4 CON PTO 2008 324 � $680 Sales History Previous Owner WARNER MALCOLM R&CLAIRE B Year Month Book/Page Type � Amount 2005 09 6597 / 0353 WD � $186,000 1987 02 1582 / 1409 WD C $52,500 � � http://www.appraiser.pascogov.com/searcl�/parcel.aspx?sec=12&twn=26&rng=21&sbb=0... 3/20/2012 - - --- - \ � � , . � �, , — �/ _-_ - - ��.=�_ ___ - ..��___.._e_.__��aw.�w _ --——- - -_- _ °� -�, ;�� , . T, ,. —.-- -- - - - -- -�._-_:�_: . .-.,. _--- _-- ___.. � ._ `_,_. _ __ _ . -- -- _- - - -- -__- J_-___- ._ -, v _`�a�� _ _ _' _ Fi ACCOUNT NO� 034741 � "-� � '' SIC CODE� g742 ==_ -_ --= TYPE OF BUSINES5� � -�-_,--_ r1ARKETING CONSULTANTS ° VISTA MARKETING LOCA7'ION ADDRESS� <. PD BOX 2232 5243 5TH ST -F ZEPHYRHILLS FL 33539-2232 - . ZEPHYRHILLS '�', - DATE RECEIPT AMOUNT � ��'��'��1��'11�1111�11��•�111�11�11'��11111�1��1�� o7i22ii 1 607674 13.75 ; � ---- ----------�- -----.----___�___.. _----_LL..�_-�-..=-�_, _�..____________.___ �-�- -- - - � --,�__ -,- ,m.,.=---- - - -----...___. ------ -.3..__�._,_ _ ._- --- -- —_- - �.�.-__.�.�—��--..:-��.-��;�__�_.�-� ra ' �'1 � OP ID:JD8 � '`��° CERTIFICATE OF LIABILITY lNSURANCE °"��31'W°,°z"Y' THi8 CERTIFICATE IS ISSUED AS A MATTER OF IN�ORMATION ONLY AND CONFERS NO RIGHT8 UPON THE CERTIFfCATE HOlOER.THIS CERTiFfCATE OOE$ NOT AFFIRAAATIVELY OR NEOATIVELY AAAEND, EXTENd OR ALTER THE COVERAGE AFFORDED BY YHE POLICIES BELOW. ZHIS CERTIFlCATE OF INSURANCE OOE8 NOT CONBTITUTE A CONTRACT HE7VVEEN TFlE iS8U1NG IN8URER(S►, AIfTHORIZHD REPRESENTATNE OR PRQDIJCER.AND TNE CERTiFlCATE HOLDEit. {MPORTANT: N ths cortlflcata holdot i�an ADDITI01VA1. INSURED,fhs poilcy(los}tnuat bo sndorsed. If SUBROCiATtOM IS WAf1/HD.aubject to Me terms end condlqons oT th�polley,certaln pol{cles may requlre an sndorsement A stabmsnt on thls certiflcata doas not co�isr rlghts to the ceAlficate holde�In Ileu of euch andoreemsn s. PqODUC6R 831-288-42T1 • Poroh 8Mbling Wabb 831-288-4911 ° Ne c ko: 132 E Maln Sbeet !: . —__ wsv.Ny,nr n�ss „� :� Davls S.Porch III -•- ��ro r CONSO-1 _ _ _ - ° -- - lN9UR s AFFOI�DINO COVERAG! _ NAIC�_. aeuneo J�Consolidatod Industriea,LLC u�E�A:Ownsrs Insurance Company 32T00 Oavid Sullivan �- -- - P.O.Box 108 ��e: � ...-- -- Paris.TN 38242 °��c: ------ --.. - -- - - o�ween o: INBUqER F: r: COVERAOE8 CERTIFICATE NUMBER: REVI810N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF IN3URANCE LISTED BELOW HAVE BEHN ISSUED TO THE INSUREO NAMHD ABOVE FOR THE POLICY PERI00 INDiCATED. N071MTNSTANDING ANY REGUIREMENT,TERM OR CONDITIOM OF ANY CONTRACT OR OTHER OOCUMENT W17H RESPECT TO NMtCH THIS CERTIFICATE MAY BE lSSUED OR MAV PERTAIN, THE tNSURANCE AFFORDED BY THE POlIC1E5 OEBCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONOITIONS OF SUCH POUpES.LMAITS SHOWN M�AY HAVE BEEN REWCEO BY PNO CLAIMS. nrve oF iwsuR�nCe pa�y�� ' urrts - - Q�� EACHOCCURRENCE f �.00O,O A X co.aMeacw.c,�n�weiurr 3098092 0?J01112 OTro1n3 pp aE8 Ee_�oaoa�— s 300,0 _ CLA�M6�AADE a OCCUR YIEO E1tP(My onspason t 70A PERSOru�i nov auUnr t 1,000,00 �„_„�_ GENERALAGORE(3ATE i ' Z.00O,00 OEN'�ACGREWI7E L�qT IIPPLIEB PlR� PRODUCTS•COM170P A00 s 2,000,0 POIICV � LOC ~ 3 _` AUTOM081LE lYiBIL(iY GOMBINED S1NGlE lIM{T = �,Q�.O A X arv auro 871$89802 0?J9D1/12 02/01/�3 �Ea�aidwn) � aoour iwuRr�aa�p«�au s X ILLL OWNEO AUTOS BOOLLY INJURY(Per soeiQ�nt) S _X SCNEDULEO AUTOS PROpERiY DAI�MGE X HIREDAIJTOS {PeraoeJ0au) s X IiON-0WNEDAUTp9 ^ i - --' _ • UYYREU.A 1.u9 )( �C� EACN OtCURRENCE S 6,C00,00 FaccESS une cw�s.auoe wocr±ECU►TE s 5,000,— A -- 6718686�3 0?ro1H2 0?J01113 - -- - --- - OEDUCTIBIE 3 _ R NTION = WORKlM COMhENBATION W STATU• Ori+ aro BrPWY@Re'W�eartr ,.. IORY.LfMI A nN1IPROPRIETORIPARTHERlE7�ECUTNE Y/N 03�•j��J•2 OZ/01/12 04/01/13 E.L EACNACCIOENT S 1��0�0� Oii10EWMEAtBERExCLUDEDO � N�A ._ (M�nQMOry M MX) E.l.D�SEISE-EA EMPLOYEE S �.��rOd � T�OON�MTIDHS bMOw E L O�SEASE.POLICY IIMR S 7�UOO,OO OEBC WPTtON OF OVERA190N9/LOC/1TpON9 f VQNOCLEB(Ap�M ACppD/01,AOdltleml R�mMn leMA�A�,tt ena�rpae�N r�quksa) CE TIFICATE HOLDER CANC O SHOULD ANY OF THE ABOVE DE8CRIBED POLIC163 BE CANCELLED BEfORE PROOF OF INSURANCE TME E%PIRATiON DATE THHREOF, NOTICE 1MLL BE dEUVERED IN PROOF OF INSURANCE �►ccwea►ace wrr►i nie Poucv PROV�siorrs. PROOF OF INSURANCE AI/TMOII¢EpR81R88ENTATNE �?a� 3 ,��.�- �198e-2009 ACpRD CORPORATtQN. Ail eiqMs nserved. ACORD 2B(2009108) The ACORO nama and Iogo are regiatered merka ot ACORO