HomeMy WebLinkAbout07-7286
CITY OF ,ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
.....,..t!,.,....... "....."
7286
Permit Number: 7286
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: 6851 IRE RD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0010-01200-0000
12/07/2007
25.00
25.00
12/07/2007 Phone:
FPM-HOOD CLEAN - 6 MOS MAINTENANCE
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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."
...
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPEcnON
CALL FOR INSPEcnON - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
City of Zephyrhills Fire
Permit Application
Date Received
\2-7-07
Contact Phone Nbr
Owner Name
Owner Phone
I
II 7R2
II 4604
I
I
Owner Address
Zephyrhills Elks Lodge
6851 Wire Rd. Zephyrhills, Fl. 33540
R13
Fee Simple Title Holder
I Titleholder Phone Nbr
II
II
Fee Simple Titleholder Address
Job Address
6851 Wire Rd. Zephyrhills, Fl. 33540
Subdivision
ParcelID
o?.-7.(p - Z I - DDlb.. b, 2.00.. 0000
B Bio-Hazard Waste Storage - ANNUAL
Comm Exhaust Kitchen Hood - Duct
D Controlled Burn
D Emergency Generator <30 KW
D Emergency Generator> 30KW
~ire Protection Maintenance - Annual
D
D
Hood Clean - Suppression r:::r-
Fire alarm Installation
Sprinkler
Fire Alarm
D
D
D
D
D
D
Fumigation Tent
Hazardous Material (Tier II or RQ Facility) Annual
Hood Installation
LP - Natural Gas Installation
LP - Natural Gas Annual Sale
Places of Assembly - Annual
Fire Pums
Fire Works
Flammable Application - Annual
Fuel Tanks
B
B
B
Sparklers
Sprinkler System Installations
Standpipes ( Sprinkler System)
Torch Roofing
Waste Tire Storage Annual
Value of Project
$ I I
D
D
D
D
D
D
Recreational Burn
Other: I
Contractor Sign Company
Address Registered y N I Fee Current I
Electrician Sign. License
Company
Address I Fee Current I
Registered y N
Plumber Sign License
Address Company
Mechanical Registered y N I Fee Current I
Address License
Other Sign ~ Company
Address 18330 Lawrence Rd. Dade City, F1 Registered y N I Fee Current I I
License
Directions:
Fill out application completely. Company Security Fire Equipment, LLC
Owner & Contractor sign back of application, notorize ( Or signed I f") N I FoeC"""'" I
Copy of contract with owner) Registered
If over $2500.00, a Notice of Commencement is required
Mechanical work of ( $5000.00 ) requires a Notice of Commencent
502552000220004
Supply two (2) sets of drawings with applicable documentation
Allow 10 - 14 days for review after submittal date.
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit maybe 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 'icensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furtherm<;>re, 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 (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that', 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
I 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.
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,
I
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 )Nork 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 NOTICE OF COMMENCEMENT.
FLORIDA JU~T (F.S. 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
, as identification.
Notary Public
~;d~__ ~,~
Notary Public
Commission No.
I
Commission No. ~~~~~ Karen L. Miller
€:~ "~ Commission # 00609664
Name of Notary typ ctober 29, 2010
--- f/Utl ~... , 1__,..... 110O-315-7019
Name of Notary typed, printed or stamped
I
I
813-780-0020
Fax-813-780-0021
City of Zephyrhills Fire
Permit Application
Phone Contact for Permit
Date Received
II
II
Owner's Name
Owner's Address
Owner's Phone Number
II
II
~
~~~"',
Titleholder Phone Number
Fee Simple Titleholder Name
Fee Simple Titleholder Address
Job Address
,~!W""."""""",fflOOi'1!-IIIiil~
I Lot#
~~~~:iJfl)~
~I~'_
ri'i!1
Bio-Hazard Waste Storage - ANNUAL
Comm Exhaust Kitchen Hood/Duct
Controlled Bum
o
o
o
o
o
o
Emergency Generator < 30 kw
Emergency Generator> 30 kw
Fire Protection Maintenance - ANNUAL
Sprinkler 0
Fire Alarm 0
Hood Clean/Suppression 0
Fire Alarm Installation
(Ut:lIAINt:U t-KUM t-'KUt-'t:K I Y I AX NU 11l;t:)
Fire Pumps
Fire Works
Flammable Application- ANNUAL
Fuel Tanks
Other:
-
'''''''.'''i.'~W''~~
Parcel #
Sub Division
o
o
o
o
o
o
Contractor
Signature
Address I
ELECTRICIANI
Signature .
Address I
PLUMBER
Signature
Address I
MECHANICALI
Signature .
Address I
OTHER
Signature
Address
o
o
o
o
o
o
o
o
o
o
o
o
Fumigation Tent
Hazardous Material (Tier 1\ or RQ Facility) ANNUAL
Hood Installation
LP/Natural Gas-Installation
LP/Natural Gas-ANNUAL Sale
Places of Assembly-ANNUAL
Recreational Bum
Sparklers
Sprinkler System Installations
Standpipes (Sprinkler Sys)
Torch Roofing
Waste Tire Storage ANNUAL
I
I Company \
Registered
I License # r
I Company ~
Registered
I License # I
I Company \
Registered
I License # I
I Company \
Registered
I License # I
I Company I
Registered
License #
,I
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...........~IiI_--
I
Valuation of Project
Y/N
Y/N I
Fee Current
Y/N
Y I N I Fee Current
Y/N I Fee Current Y/N I
I
Y/N I Fee Current Y/N 1
I
Y/N I Fee Current [ Y/N
Directions:
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.