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15-16451
I CITY OF ZEPHYRHILLS 53�i5-8TH STREET _ ; :,(si3)�so-oozo 16451 �°"+� ' FIRE SPRINKLER SYSTEM PERMIT �f� PERMIT INFORMATION LOCATION INFORMATION - Permit Number: 16451 Add'ress: 38250 A AVE �" Permit Type: FIRE SPRINKLER SYSTEM ZEPHYRHILLS, FL. -� Class of Work: FIRE-SPRINKLER SYS Township: Range: Book: I Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 14-26-21-0010-01300-0010 Improv. Cost: 16,291.78 OWNER INFORMATION � Date Issued: 7/17/2015 - Name: ZEPHYR HAVEN NURSING HOME Total Fees: 150.00 Address: 38250 A AVE Amount Paid: 150.00 ZEPHYRHILLS, FL. 33542 Date Paid: 7/17/2015 Phone: (407)975-3000 Work Desc: INSTALLATION FIRE SPRINKL�R HEADS INSTALL IN STORAGE �. CONTRACTOR S ' - . ° APPLICATION FEES SIMPLEX GRINNELL FIRE SPRINKLER SY 50.00 FIRE PLAN REVIE FEES 25.00 FIRE INSPECTION FEES 45.00 CONTRACTOR CERTIFICATE 30.00 "� � ` I �G � / � Ins e ; 'on uired - � FIRE-PRE SURE TES FIRE ACCEPTANCE Final �- Chapter 633, Florida Statutes,authorizes the Ci to charge and collect user fees to pay for the costs of fire prevention and protection related activities suc as inspections, plan review,administrative fees,and other costs relate to the aforementioned. Complete Plans, Specifications and Fee Must Accompa y Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permi�.s or opening up for commercial activity without an approved final inspection shall be charged double permit fee per da�r of operation or a minimum of$100.00, whichever is greater. All work shall be performed in a�cordance with City Codes and Ordinances. "WARNING TO OWNER: YO iR 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 Y�UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N,OTICE OF COMMEN ENT." � � /���� �``�'� � i e �— ' CONTRACTOR SIGNATURE PERMIT OFFICE � PERMIT EXPIRES IN 6 MON�THS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIR� RESCUE DEPT- 813-780-0041 Cit}II of Zephyrhills BUILDING PLAN REVIEW COMMENTS ' ' - � Contractor/Homeowner: l�; �1/)��Q� .�Q�,y1 v�� �� Date Received: ?-' � —( s� • Site: �� 2 S� � �T"'L- Permit Type: �4/Jr �►�� `L°� ��S�y''t Approved w/no comments:O Approved w/the b low comments: � Denied w/the below comments: ❑ r� � � �� L . ���� ���� �� I > � - , � � This comment sheet shall be kept with the permit and/or plans. �,� �� � 2��r �✓ r�- �- ��c/�S B' 1 Burgess—Building Official Dat Contractor andlor Homeowner (Required when comments aze present) 1 1 � � 1 t 1 s 2 i ! t � ____.�l� �.,,�, s�s-�aa-�o2o City o�Zepnyrhills F9re �ax-a�3aso-oo2s , P�rmit Applicetion ���j" 'j Qj— Zi��/. Date Received �— �� Phone Canta for Pertnit 727 365 2232 Oumer's Name Zephyr Haven Heaith and Rehab ( pwners Phone Number g"13 782 5508 Owner's Address 38250 A Ave Zephyrhills,FL 33542 � _ Fee Simple T+tteholder Name � TltSehotde�Phone Number [� [� � Fee Simple TiUehoider Add255 � I .dob Address 38250 A Ave Zephyrhills,FL 33542 " r� Lot# �^ Sub Division I Par�el# � � Bio-Fiazard Waste Storage-ANNUAt � Fumigation Tent Q Comm Exhaust Kitchen HoodlDuct o f-fazardaus Material{Tier II or RQ Facility)ANNUAL � Contralled Bum � Hood Ittstalla@on f���,/D p3 � Emergancy Ganerator a 30 kw � LPlNaturai Gas-Installation -� I�.� 'Z,D � Emergerzcy Generator>30 kw Q l.Plidatutal�as-ANNUA[.Saie � Fire Prptection Ma+ntanance-ANNUAL � Places of Assembl -ANNU ,� Y ��Z� �y emi �l—�fn r �� � Sprinkier � ❑ ❑ Cl � � Recrealianal Bum � ,.�/jO� Fire Alarm � ❑ t� O � � Sparisters � �� �" � ��� � � Hood Cleaning � ❑ ❑ C� � a Sprinkler System Inshailations � //��� C _p,� ��(�"' Haod Su ression � ❑ ❑ ❑ � � r`• �`� pp � 5tandpipes{Spnnkler Sys} �� f C � Fire Alarm Installatian • � Torch Roofing(Tar Keitle � /1�,J(f'� oFire Pumps o Wasie Tire Storage ANHUAt ������% � FlammableApplication-ANNUAL $16,291.78 � Valuation af Proj� ,;�^�►� � Fuei Tanks � �� � Other: �- I Contractor Company Simp(exGrinnel( Signature Registered Y/N Fee Current Y I N Address Od niversity Center Drive Tampa,Fl 33612 � License# FPC13-Od00d8 ELEC7RICIAN Gompany � S+gr�ature Regtstered Y l 1t) Fae Currant Y/�2 Address � License# PLUMBER Company �� Signature Ftegistered Y/N Fee Current - `(/!� Address � License# MEGHANICAL Compatty �� � 3ignafure Registered Y/N Fee Current Y/N Address � Licanse# � OTHER Company � Signature Registered Y!N Fee Curnent Y!N Address � . - Ucense#1 � Direetlons: � � ' Fill out 8pplicafion comg(etely. Owner 8 Contractor sign back of applicaUOn,notarized(Or,copy of signed cantract with owner) Ii over$2500,a'No6ce pf Commencement is requir+ed{Mechan3cal woric over$50Q0) � S�pply turo{2}sets flf drawings with applicable daGUmentat3ort i - Aflow 10-14 days for review aHer submittal date. Parcel#-obtained from Property Tax Mqdce(httpJ/appraiser.pascogov.com) � NOTiCE O�UEED RESTRICTiONS: The unders�gned understarsds that fhi permlt may be subject to"deed"restrictions" which may be mare restrictive than County tegulalions. The uadersigaed a sumes rasponsibpity fot compltance witfii any ' apQUcabla deed restrictlons. UNGlCENSF�? GpEiTRACTORS AND CONTRACTOR Ft�SPONStBtLiTi S: {f the owner has hired e cantractor o� co�tractors to undertake work,they may be required ta be Itcensed fn atxo�dance wlth state and[oc21 regulaUons. If the contractor ts not(ICensed es required by taw, dath tfie owner and cantrac ar may 6e elted tor a misdemeanor viotatFon � under state law. Ef the ownsr or#ntended contractor are uncertain as W wihat Itcensing requlrements may apply for tha intended work,they are advised to contact the Pasao County Bu(l�ng Inspqctlon D'nrislon-�.icensing Section at 727-847- � 8009. Furtfiermore, if the owner•has hired a cantractor ar confradors, he is aclvised ta have the contractor(s} sign ' portions of the'contractor Block'of thls appllr�a!'ion for whtch they w(!1 be y�espanslble. !f you,as the o+rmer slgtt as Rhe car�tractor,tha#may be an inrJication thaf he is noi properly licensed and Is nof enfiflad fo permifting privileges in Pasco i County. ( � TRANSPORT`ATION(MPAC�lJTiLlT1ES IMPACT AND R�SOURCE RECOVERY FEES: The underslgned understands that Transportatton impact�ees and Recourse Recovery Fees rnay appiy fo tfis consfrucfio�of rtew buitdings,change of use in exfsting build'sngs,cr e�ans[vrt af eztsting bulidtngs,as sQedfied ic�Pasco County Otdinance num6er 89-47 and 90-07,as amended. 'fihe undersigned also understands,that such fees,as may be due,wiA be IdenGf+ed at the time of permitting. 1f is further understood fhaf TransporfaUon lmpact Fees atsd�esottrce Recovery Fees must be paid pr�or to recelving a'certifiaate of accu�ancy"ar flna!power release. Ii the pro;ect�does not invotve a certHicete of occupancy or final power release, the feas must be patd prior to permif iasvance. Fu�ttjermore, H Pasco Counfy WaierlSewer Impact fees are due,they must tre paid priar to pern�it Issuarsce tn accardance wtth appticable Pasco County ordfnances. CONSTRUCTIUN LIEN LAW(Chapter 713,Fkrrida 3tatutes,as mnend�d): iP valuation oi work is$2,50Q.OQ or more,I certify that t, the appttcatrt, have been provided witfi a copy of fhe 'F�orida Cansfrtrefion Lien C.aw—Nomeowner's Protectfon Guide'prepared 6y the�lotlda Deparkment oi Agdculture and Consutr=ar Affalrs. Ii the applicant Is sameone other than the"owner",I csrtify that I have obtained a copy oi the above described documenk and promise in good faith to deiiver ft to the'owner'prior fo commencemen#. _ GONTRACTDR'SlOWNER'S AFFIpAVl7: 1 certHy that all the EnformaUon n thls application is accurate and that all wvrk wiii be done in cromptiance with atl appticable.taws t+egutating construction,l zoning and tand deveiopment. Appticatio�Is hereby mada to obtaln a permit to do work and f�stailaklon as lndfcaE�d. t ce�t!(y ttrat no worfc or tnstaifatian has commenced prior to lssuance of a permit and that a!t work wlll 6e perfo�med to meet stendards of alI laws regulating construction, Counfy and City codes, 2oning regvlafions, and (and developmenf regulattons in the)urisdtcqon. I atso cartffy Yhat I undersfand th�t tt�e regulations af othes govemment agencies�may agply to the ir�ter�ded wodc,and that it is I my responstbilfty to identify what actions I must�ake to bs in compliance, Such agencies irtclutte but are not Ifmited to: I - Depacfinen#of Environmenfai Profectlon-Cypress Hayheads, �Vteftand Areas and Environrnentalty Sertsitive Lands,WaterlWastewaterTreatmsnk - 5auffnvesi F(orida Wafer Management districf-Weqs, iprass Bayheads, Wefiand Are�s, Aitering Waterconrses. - Attny Corps of Engineers-Seawalfs,Dodcs,(VavEgatale Watetways. . - Department o# Health 8 Rehabilftative ServtcestErrviro»menFat Health ilnit-WeBs, {Nasfewater Treatmenf, Septic 7'a�lcs. - U5 Envkronmental Proteotton Agency-Asbestos abatement. � - Federal Aviafion Au#horiiy-Rumn+ays. � 1 understand that the following restdcilans apply to the use of ftll: - Use of fi0 Is not altowed ln Ftood 2ane'V'uniess expressiy pe� itted. - tf the flE! lnatetEaE Is to be used !n Fiaod Zorte 'A", It Is understaod that a drainage plan addressing a °comQensatfng volume"wf11 be submitted at time of permitting which ts prepared by a professlonal engineer lieertsad by the Sfate of Florida. - 1€the fill materla! Es ta be used in �lood Zane 'A"in conneetion wlth a permltted building using stem wall construction,I certil'y that fill wIl!be used oniy to fill the area wRhin the stem wa0. - Fi t3l1 meterisl fis to 6e used in any area, ! certtiy that use(of suct� fii1 wi11 na# adverse[y afEecf ad�acerTt properUes. If use of flA is fauncf to adversely affact ad�sceRt propertles,the owner may be cited for vtolating the conditions of ihe buiidi�g permit issued under the aftach�d permit appllcation,for lots iess than one(1} acse whfch are elevatet!by fll1.an englneered dralnaye pian is�equtrad. if I am the AGENT FOR TliE OWNER,1 pramise in gaad falth to fnt'txm the owner af the perrnitting condl#ions sef forth fn this affldavit prior to cammeneing constrvetian, i understand that a separate petmit may be requlred fot'eieofrical worit, piumbtng,s:gns,wella, Pools, atr condBioning, gas, or other lnstallaUuns not spedllc�lly}nciuded 1n Ehe applica6on. A permit issued shalt be constrved to be a license to proceed with the work and not as suthority to vioiate,cancei,aiter,or set aside any provislons of the technlcai codes,nor shaii issu�ce o!a pe it prsvertt the SuRdirig OECclai irom thereafter requiring a cot�ecllon of enors in plans,consfruction or vialations of arry codea, Every pertnit Issued shall become fivalid � unlsss the work authorized by such permii is commenced withfin sbc monihs of permtt tssuance,or ff wark aufhortred by the permit is auspended or abandoned iar a psriod at slx{6j months after�tee Ume the work fs commanc�d. An exlenslan m�y be requested, In wriGng,from the Building QffEcial for a period not t9 exceed ntnety(90}days and witi demonstrate jusiifiable cavse for the extertsion. Sf work ceases for ninety(9a}consec�days,the job is cocisidered abandaned. WARNIr3C'a TO OWNER: YOUR FAfi.UR�TQ RECOftD A NOTtCE OF GOMMENCEMENT MAY RESULT 1N YOUF2 PAYING TWiGE FOR 1MPROVElIAENT5 TO YOl�R PROPERTY. I�YOt�4NTENd TO OBTAlN F1NAhfClNG,CONSULT WITH Y,�UR LEN�ER OR AN ATTORN�Y B�F4RE R�CORDINC.,YOI,lR NQTICE OF COMMENC�MEN'T F[.ORipAJUWiT jF.S,ttT.q3) OWNER OR ACiENT GONTRACTOR �,�p-=—�,=�•� .� Subsatbed and swm tv(or affirtnad)belore me lhts ,� Subsalbed (or af9rtnsd)hefore�thl� ��i � by �>`�.}cQt..r L "� by . °C'4 .afi^'S 4�* ��—�1 Who Isfare personany knoNm to me br hasliufve producad Wh fslr�0 at lurown tn or haslhav�roduced as kianttfrcattan. _�""3���+`�a�� as ld� �tloa i I hiWaty PubEtc � ' ��°'6— Nofary puh!!a Commisaion No. � Cammisstars No.� �� lti� .A � . �!— . \�� ��'.�C'I',��V �y Name otNoGary typed,prtMeO ar stamped 1Jeme ot NuFary iyped,{tdated or mped pUU�ee ' ���<PµY AG���i�� M.gTANLEY =_< :°' Notary Publfc-State of Florlda rs: .Q�;My Comm.Expires,Sep 26,2018 "� Commission#FF 136556 ,'4'��iii��p4` � � . . il I � , , � i . . , , ., ,., . {;� �,,,; , ,., • . . . , ,., � ��, , . ., ' ;i ..�.. . � ,. , ,,, - .�..:�;:- ,- .. _ . i ` � https://acevxchch1Q01.sunbelt.org/owa/WebRead_.. � . .� S� � � � �� 10bD0 Universiiy Centar D Suite 275 7AP�1PA.FL 33612 � SirMp�lexCri�tne/f (8 t3)626 5d82 S FAX.(813)6fi4 1731 , - �,vw�v simplexgdnneli corn Simp(exG innell Quotat�on . _ TO Zsphyr Ha;en ilur7ng Hr.::ne Projec[ Zephyr Ha�;en tJursing Home , 38250AAb`E Customer Reference: ZEPHYRHI�LS Fl,335d2-�?59 5im�lexGnnneli,Reference 29241�20i Cate 06,'22r2015 , Pag a 1 of+� Sin�:l?;��nnn?A:s pleased lo offer for yo r c��nsideratioa this quotation forth�e above pro�ect , omments YI'l3�if�; :����,i;�: Provide!.abnr anci material tn retvork th existinp,sprinkler system ta prwicie additional tire �ret�etic�n to cluse�s located in tlze pati�nt rnoms f�er AHCA requiremenEs for Zephyr Hav�r� NursinY f;,cility 5ystem is to h�design•rci as Light hscard k0/150Uft= pricinK is besed on an exisiirt�;3deyuate water supply `-; , ;E;:_: �_ 11::.`-_i=•:?t���'�k4. ='; ti�;1�t„st=.5i:<=,'�:; ;f.ii ���713t'itf3�i�Ci*, Sunpl�xGrinnell's ::�ork shall tW#;in a[th2 ex.istin,v,sprinkEer�ystem ' � j29�Nes:155 degree.5R ;�.",C t�Ce3led, penclan•.•:prirakler hea(ts witl�tacto�y pe�nied r;hice cuvtn plate�s. � 2 T:e in in:o exi9tin�*sy<<eiti �.. , , .� :''. ,is�f�i. SimpiexGrinnell preprnes to prc:vide th fnll�win�]eb spe�i'.ic items indudiFjg but not limited to ;he I fvlto+.virsF r.., ,.,; , _ �nstalled�r7aterials shal=be per F1�A speci[icatiarts 3ntt 5ftb11�ntlude� - a. O��erhead pipe,Fii:in�s,he:t�gers;�rid tire�prinklers 2 ii,stallat�on of all sihna�;e and placards as requirecf 3 Ins.alfed fittiny,s will L�e xrewe�or flan�;e�bl�ck cast irc�n rated at 175p3�vr 3n approved �:quivalent suth as n7e�haniCal, ,rouved,ptain end vr weided conrtecFions. a tr�s:aflat�vr,shall include ali rtec�ss:+ry vftsEts, r'8fse5,and drops in pipirfg and ds required f�y " , �lil{C�1flV CQIIC�iS.lUf13 a li�s:allali�n of ttdng�rs yti•i;l be s aced in accorcld�ice to MFRA 23,piping marzufacturer's 1 of 2 06/29/15 U9:38 - L � � � hCtps:/lacevxchch1Q01_sunbelt.org/owa/WebRead... ' ' i � , - �I Fro�ect Zephyr Haven PJursing Noms _ I "f`��� Customzr Reference SimplexGrinnell fteference•29241420� Sj/7'j�"1'��'Y(G`/j%J!I@f/ Date 0&t22120i5 � paga 2 af r, Sir[l�?IeXC�flnf1911 QUOtBttdtl Ca�:�ents{eontmue�; s���i`icacions,and wili be of art pproved type � G Ir�st'sllation of systetr�s•.4ii1 be vc� i�ied ir�the fieid cn ensure proper installation, �• '`::'�.i�'-.. � f 5=�.'.i:t's!� � II 5i�riplezGrinnell has excluded th�!ollon�ng 4rom this prUpt»al: 1 f'dinLiiiM;0:SFrinkler pi�;ii��. 2 Ci,ttinp,,pacrhinp„�r re�;�ir of dr wai!o< <r�asonry ' ; Additional fire prate�tiun requi�ed due t�cf�aciges in wall I�cations 4 Fire wa[cli it required or clesired �•,-,:c�„i _. ��,-,,::e-a!•.:�t21+i!_;�:�t��:�t�� ;tsi:� a_.�.,_Y�,;Rc:<tit,n�. : Th,S quotaTiori is qsse��uptuti work beir�peNormed during normal business hours. tvorrnal 2 siiE�workin};hours are 7:4�am-3:30pm unless othe.rwise�gr�ed upon. 3 It i5[Ite Uwner'S r�spaiis�t�ili!y i�provitle atlequate hea((40 dearee F minimum)1�� drtls J,. . {�rotected by a vret-pip<<prinkl r system to prevenl`reetrrtg � � 5 !E is aswmed parking�:,dl�e proI ided durir�g the dur�tian of this project and adequate n�a�erial lay down area and m3;k�rial Siarage. ^,i.. i,r; � '�� il�f� s'!5 .... .._� . �l,�7.. =`�:t.':;�. > .�flC; ;i�i1E^:"t";�;d1t33�uSEt3:r; . 1: _ ' This tricl intludes a price 1or the�;urchas af ste�l proJuct�or products made trom plastics or - ° otfter commaaities. Customerherebti �yrees �tidacknawledgesthatthepriceandavail�@ilityot steel,pls�tics and uthec cQmmooities is p�rt�culariy�vvl�tile and unpredictable and that becausp of tactars bepn»d the - control u! SimplexGrinneU,it rnay be diFlicult or nearty impossible#�r[o acquire Steel pr�ducts a nd proJuct�.rnaUe Pram pl�stics cE� other c rnmadities. ThErefore;Customer agrees tf�at Simplr�urir=nrll st7all not be resp�nsibt �for faiiu�e Cu provitSe sen+ices,defiver produtts,or oitt�r�vi:e perlorm or�ctie centr�ct due to the latk oi available steel products or produtt�made Erom pl;��„i�s oi att,ercommailities. ln he event SimFlr.xGrinriell is unable,after reasonablc! Cammerual e!for:s,to acquire and prc ide steel or steel produUS,or proclucts made Erom plastics ur oCher commodiCies,i!requir J for this piUject,the CustUmer hEreby agrees that SimplexCirirtirtell itiay termir�ate:he agr ement,or the relevat�t portion of Ehe Agreem��it,at no additlarr�l tast arid witttiout y�r�alty Cu tvrner at;rees tn pay SimplezGrinnell in fufl(or all work peric��'rttrd u��o Che tirtte oF an�,�iuch E n��lnatiun USimplexGrinn�ll is able to ohtain the steel produtEl ar products rnadt Iru�r, plasti s or other cummadities,but ttle prite ot any of the 1 of 2 - 06/29/i5 09:38 _ ,� I � � https://acevxchch1001.sunbelt.org/owa/WebRead"... � ���� Profect.Zephyr Haven Nursing Hame Customer Rpference. SimplexGnnneli Reference 292atd201 SrmplexGrinnell Date 96+22f2015 Page 3 of 6 Simplex�rinneil Quatation Camrnents{continuedi produtt�lias m�reased by mcre!lian 111�:G from ihe date of ihe bid,proposal or the date SimplexGrinnell si�;ned the eonuac!,whi heveruccurred First,then Siit�plexGri��r�ell rnay��ass thresugl�that�n rease unde�th2 contrac[throuqh a reasonable price i�icrea5e to reflect the increased cast oI i ia[erial Total net sellir�ptic ,FOB Ship�mF;point of$16,�9�.�� (Siyteeri thousand t�:���I�undr d ninzty one dollars and seventyel�{ht tents) Jaak J. Keith ll Fire Spri��kler Sales Re�resente��ve Sir»plexGrinnel! 15U�Ur:l,•ersi;y Ce��ter Qr, _ Tampa,FL 336i2 0:813.F;2G.5�82 F$13.971.5:65 jakeitt��+�•un{yleK�;iinhell.cUtn w�vw.sirn�ilexgiinneH.com I . 1 of 2 06/29/15 09:38 � . ' https://acevxchch1001.sunbelt.org/owa/WebRead... ���� � Project. ZephyrHavei�Nursing Nome Customer Reterence SimplexGrrnnell Reference 292414201 Sit»p/ex�rinne!/ Data os�22.�0�5 - Page a of 6 SALE A INSFALLRTIQN AGREffAENT ���x,::z�r.: !CJ!Rfl�J'1 A'37E;t�Y.�N'13J�:J':!'.:.J•CC:�t::i"IJ:�:T.'C@�I :. :"i:Y_��:i��'l.7f�l �'P�9tU+:!•1:$JRag-,drf,wti k'�MC�ktj 22. Liraited tYartaaly. Su0p�c1 b S1C iLT�.a}tlii b�OA' :��any 4tUKl'.#�re¢JUetl ii�f�k•�.7].: •.i.�je,.�ti>.w:,�:'n-;: - . �:ia�tr.c 4;�pa•uTatea ol a�d uv:+ aRC Camca�X CaerPSr��a�r+:i4s aw oqu�rne�d i.a��g�e»ed tACr,fw .:'..UiS]RA� C+sS�rr.�.•�ial h.a.�r. 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