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Home My WebLink About07-7211 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE 7211 Permit Number: 7211 Permit Type: FIRE PROTECTION MAINTENANC Class of Work: FIRE-PROTECTION MAINTENAN E Proposed Use: COMMERCIAL Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Address: 7320 GALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s}: Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 11/19/2007 25.00 25.00 11/19/2007 FPM-FIRE ALARM - QTRL Y TOWNVIEW RETAIL LL 725 CONSHOHOCKEN STATE RD BALA CYNWYD PA 190042102 Phone: 610667-5800 E- FIRE LIGHT TEST-Final FIRE SYSTEM ACCEPTANCE Fina Chapter 633, Florida statutes, authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review, administrative fees, and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT 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." ~~- CONTRACTOR SIGNATURE P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 h;:;~;C::'LL'~ - - I ::,~:::~::" 'r~8.,~!, fW P/LrlY>e'r3),V> LL c;t':>"-J".J. Get/! 15/J/.J,f .z-t'0A;~ I Titleholder Phone Number I II II 813-780-0020 Date Received OWner's Name Owner's Address Fee Simple Titleholder Name City of -Zephyr hills Fire Permit Application I eft> s-CIP/r:z= I I r 73;;<~ ~ &vc.Q I Fee Simple Titleholder Address D Fire Alarm Installation D Fire Pumps D Fire Works D Flammable Application- ANNUAL D Fuel Tanks o Other: I :0;:' I~ ~~ I Md~' i5tf71 ).v' J1/~ tJ..ve. 71~ rL :H/,l" ELECTRICIAN Signature Address I I I I I I I Sub Division ___IIIlI''''''- o o D o o ~ PLUMBER Signature Address I MECHANIC4 Signature . Address I OTHER Signature (~a-~ I Parcel # o Fumigation Tent o Hazardous Material (Tier 1\ or RQ Facility) ANNUAL o Hood Installation o LP/Natural Gas-Installation o LP/Natural Gas-ANNUAL Sale o Places of Assembly-ANNUAL o Recreational Bum o Sparklers o Sprinkler System Installations D Standpipes (Sprinkler Sys) D Torch Roofing o Waste Tire Storage ANNUAL I w.tl3ml'" Fax-813-780-0021 Ill'" r)w)""'F~~~ltl""'..,n u.i~!fi.~~ I ~ ~ II Bio-Hazard Waste Storage - ANNUAL Comm Exhaust Kitchen Hood/Duct Controlled Bum Emergency Generator < 30 kw Emergency Generator> 30 kw Fire Protection Maintenance - ANNUAL Sprinkler Fire Alarm D tZl D I Lot# I {UtjIAII'lt;U rKUIVI t"KUt"t:K~2 I~UII~~) J_ _~~lJ.~W' ~1 r~:R'if - -~.. J-<~ Hood Clean/Suppression Valuation of Project -...,,,,. Ii. Company Registered License # Company Registered License # Company Registered License # J.U'u j" Y I N I Fee Current I ~ F (!:r!>CJ/) ~ ~ I Y IN I I Y IN I I Y I N I Fee Current I I Y/N Y/N Company Registered License # Y/N Fee Current Company Registered Y/N Fee Current Y/N Y/N Fee Current License # Fill out application completely. Owner & Contractor. sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. __....._....___...._J__..._....,_~~..._....__ .. __..__~__. .___ HNOT,ICE.QFDEED.RESTRICTIONS: The undersigned understands that this permit maybe sl:lbject to ~deed" rastrictions" which. may be, more restrictive than County regulations. The undersigned assumes responsibility 'for comp.liance With any applicable deed restrictiens. . . UNLICENSED CONTRACTORS AND ,CONTRACTOR RESPONSIBILITIES: If the owner has hirer:! a contractor or contractors. to und,ertake 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. CONSTRUCTION LIEN 'LAW (Chapter713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more;" 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-,aJl-applicable,.laws, regulatiRg."construction,...zoning..and..land....w.. 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 , understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to i~entify what actions , must.take to be in compliance. 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.tocoritlTl~ncing construction. I understand that a separate permit may be required for,electricalwork, plumbing, signs; wells,-pools, air conditioning, gas, or other installations not specifically included in the application, A ~rmit':issuedstjCiII.'be construed to be a license to proceed with the work a~d not as authority to violate, cancel, alter, or setaside! anYprovisions of the technical codes, nor shall issuance of a permIt prevent the Building Official from thereafter 'requiring.a.correction of errors in pl~ns, construction or violations of any codes. Every permit issued shall become invalid ,unless''itie:work'aufhorized'by such permit is commenced within six months of permit issuance, or if work authorized by tlie;:peniiJ(is"susp~rided or abandoned for a period of six (6) months after the time the work is commenced. An extension ma)rbe requested. .:in writing, from the Building Official ,for a period not to exceed ninety (90) days and will demonstrate , j~s.~;fI,~ble 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 IMPROVENiENT~ ~2 Y~LJ~..r~.9~~rrt}~,.~Y1~II;~cP.J9,9J?!Jf1lt11.glt.JAt.JCJNG, CONSULT Wl+hI y.mUR:~LEtaIIl6R-(!)R~AN-A+r€JRN,s.v.ISEF-GlRE~RBO~1N'G YOtlR.,J.n)TlCE OF COMMENCEMENT. i~~:j:r!r:::~..~_..-coPmlAcrOR~""~" ,. ..., " -....,.. S4bsaibed and swo.rn to {or affirmed) before me this SuJ;>scnbed and sworn to (or affirmed) before ':"Ie thIS .' .. 1I11~/cn by e"'c...-~ C;;'. ,t...lc.uA,.clafJ.-e~\\'(~(OJ by C:hc-<l"I_i~ t=. ~uC'i-e..I.e.tte Who is/are personally known to me or has/have produced Who is/are personally known to me or haslh~ve produ~d r-:l... "t>C2v 12.. L..\ ~ as identification. as Identification. ~~ o..,~ Notary Public ~;...~ <-)~g,~ Notary Public ,Commission No. Name of Notary 2007-2008 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT . .. IFACIUT'u'OIlMACl<ltl!s oWOOMS ollllllATa oll~yQ!6 21\ L' EXPIRES 9-30-2008 F~IONO II 7699 H. '-""'STI: TAX Sul'tCIiAAGE OCC. CODe 280.002 6USINESS TYPE PUBLIC SERVICE. ALARM SYSTEMS 150.00 NAME tAAlUNG AOOl'leSS 5471 WWATEBSA,VE .'" '.. TAMPA:3363:4 .: ~ ., > :: ..: t ::. r; .....~I ..;.. , ADT"SECU.R1TY ;SERVlCES':INC -- ATrN: LICENSING OEPT .-....,.., POBOX 3052 BOCA RATON FL 33431-0942 ,:"",,,. r.~ 'j; .... ~.c ~~ ~~: . ~ ;- l- ,t f-"\. :..i' ..,::.::.:;. BUSINesS 1..0CA"TlON " ,,,,it '~_...I" .......~.- BUSI'NESS TAX DOUG BEI.DEN. TAX COLLECTOR 813-635-5200 THIS eCCllll!II A TAX Rt:c:eJPT wttl90l VAUDo\TeO. HAS HEREBY PAlO A PRI\ILEQl; TAl( TO I;ltQACE IN Bl,l$_B. PAQFP$IQN.OI\ OCClA'A~ _lID _CII. CERTIFICATE NUMBER 393523 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. PRODUCER Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, COMPANIES AFFORDING COVERAGE COMPANY A: AI South Insurance Co. COMPANY B: American Home Assurance Co. COMPANY C: Commerce & Industry Ins Co COMPANY 0: Illinois National Insurance Co. COMPANY E: Insurance Company of the State of PA COMPANY F: New Hampshire Ins. Co, COMPANY G: New York Marine & General Insurance Co. (Lead) COMPANY H: White Mountain Insurance Co, INSURED ADT Security Services, Inc. 32100 US Hwy 19 N Palm Harbor, FL 34684-3727 United States CO TYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MMIDDIYY) DATE (MMlDOIYY) B AUTOMOBILE LIABILITY B X ANY AUTO B ALLOWED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS CA 1606993 (VA) CA 1606992 (MA) CA 1606994 (AOS) 6/29/2007 6/29/2007 6/29/2007 10/1/2008 10/1/2008 1 0/1/2008 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Anyone fire) MED EXP (Anyone person) COMBINED SINGLE LIMIT $15,000,000.00 $15,000,000.00 $7,500,000.00 $7,500,000.00 $1,000,000,00 $10,000,00 $7,500,000,00 B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY ] CLAIMS MADE IKJ OCCUR OWNER'S & CONTRACTOR'S PROT GL 1595415 6/29/2007 10/1/2008 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE PROPERTY B EXCESS LIABILITY BE 9835073 6/29/2007 10/1/2008 EACH OCCURRENCE $10,000,000.00 X UMBRELLA FORM AGGREGATE $10,000,000,00 OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO 0 EMPLOYERS' LIABILITY C THE PROPRIETOR! $2,000,000.00 A PARTNERS/EXECUTIVE INCL $2,000,000.00 F OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $2,000,000.00 OTHER DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLESlSPECIAL ITEMS Please see page 2 for additional insureds and any additional language, City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 33540-4312 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCElLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAil 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE MARSH USA INC, BY: David Kong. Casualty Program -....\ ~ 1..::::::- .......0 1 --"'\ CERTIFICATE NUMBER 393523 PRODUCER COMPANIES AFFORDING COVERAGE Marsh, Inc, 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 INSURED ADT Security Services, Inc. 32100 US Hwy 19 N Palm Harbor, FL 34684-3727 United States WORKERS COMPENSATION POLICIES Carrier Policy Number Eft. Date Exp. Date State (B) American Home Assurance Co. WC 1616576 6/29/2007 6/29/2008 CA (B) American Home Assurance Co. WC 1616584 6/29/2007 6/29/2008 AOS (D) Illinois National Insurance Co. WC 1616577 6/29/2007 6/29/2008 MI (C) Commerce & Industry Ins Co WC 1616582 6/29/2007 6/29/2008 FL (B) American Home Assurance Co. WC 1616581 6/29/2007 6/29/2008 NJ (A) AI South Insurance Co. WC 1616578 6/29/201:17 6/29/2008 GA (B) funerican Home Assurance Co. WC 1616579 6/29/2007 6/29/2008 PA (F) New Hampshire Ins. Co. WC 1616580 6/29/2007 6/29/2008 NY,WI (B) funerican Home Assurance Co. WC 1616585 6/29/2007 6/29/2008 OR (E) Insurance Company of the State of PA WC 1616583 6/29/2007 6/29/2008 AR,MA,VA Project: town 174 If ther<= is a question regarding this certificate please contact Marilyn Zimmerman (Email: mzimmerman@adt.com Phone: 813-806-7141) City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 33540-4312