HomeMy WebLinkAbout07-7348
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
',.",
7348
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
7348
FIRE PROTECTION MAINTENANC
FIRE-PROTECTION MAINTENAN E
COMMERCIAL
12/26/2007
25.00
25.00
12/26/2007 Phone:
FIRE SPRINKLER ANNUAL TESTING IN HYPERBARIC ROOM
Name: CERVALL S, JUAN
Address: 6215 ABBOTT STATION DR (101)
ZEPHYRHILLS, FL. 33542
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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 AITORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
.....
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
813-780-0020
City of Zephyrhills Fire
Permit Application
Date Received
/ 2.. -1.. 6-07
Owner's Name
fJ/lS(O Hr1A J/{)L
/.] cR) h I'tr ~ ~c:I
I
I
Owner's Address
Fee Simple Titleholder Name
Fax-813-780-0021
Phone Contact for Permit
Owner's Phone Number I 5 5'- l.. II S- L ( Ill; au I
I
I Titleholder Phone Number II II I
I
Fee Simple Titleholder Address
Job Address 6l/~
Sub Division
D Bio-Hazard Waste Storage - ANNUAL
D Comm Exhaust Kitchen Hood/Duct
D Controlled Bum
D Emergency Generator < 30 kw
D Emergency Generator> 30 kw
~ Fire Protection Maintenance - ANNUAL
Sprinkler [gJ
Fire Alarm D
Hood Clean/Suppression D
D Fire Alarm Installation
D Fire Pumps
D Fire Works
D Flammable Application- ANNUAL
D Fuel Tanks
D Other:
/2?J/() iJ /l
I
2 (::Jl/P<-y 6l(J ".c( ") J..ry(
Lot #
D
D
D
D
D
D
D
D
D
D
D
D
Parcel #
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
Recreational Bum
^,' .-"- .-,,_.- "".~"'"''
(:~~
Sparklers
Sprinkler System Installations
Standpipes (Sprinkler Sys)
Torch Roofing
Waste Tire Storage ANNUAL
Valuation of Project
Contractor
Signature
Address I
ELECTRICIANI
Signature .
Address I
PLUMBER
Signature
Address I
MECHANICALI
Signature .
Address I
OTHER
Signature
Address
..-
~-l
~~
Company
Registered
License #
Company
Registered
License #
Company
Registered
License #
Company
Registered
License #
Company
Registered
Y I N Fee Current
Y/N
Y I N I Fee Current
Y/N
Y I N I Fee Current
Y/N
. Y I N I Fee Current
Y/N
Y I N I Fee Current
Y/N
License # I I
m~n~&~&iiliii1~ii:~~WJf.81.~:illtrit<;.;;'~{.'$~~k.~ilif~*m~~~w~1t.~JZW""~:
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.
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.
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
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,
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 ~ork 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.
FLORIDAJU~T (F.S. 117.03)
CONTRACTOR
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
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
Notary Public
Commission No.
I
Name of Notary typed, printed or stamped
Commission No.
Name of Notary typed, printed or stamped
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
u,
Owner's Name
Owner's Address
Fee Simple Titleholder Namel
JOB ADDRESS
Fee Simple Titleholder Address I
I "a ,6"
I
~'rI &-ftTfW i)r ';{e/fIQt3f1IJ.LS, n. 3'st110T#
I PARCEL ID#I
Cl ADD/ALT 0
D REPAIR
D. COMM 0 OTHER
D FRAME 0 STEEL D OTHER I
~4A1JiL~ ;JII)/J/lt... -(c:S;U/4, I~ Hl.{fJdZ ~MIQ.
I I sa FOOTAGE I I HEIGHT I I
..,......11111,..,111...',.,111.11,..,11,.....,1.....,11"I"I'p."I,II"','I""IIIIII,'I",,'II,"'IIIII"........1111.......111.'111.,111111111111
SUBDIVISION
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE 0
DEMOLISH
WORK PROPOSED
EJ
o
o
IMtE
NEW CONSTR
INSTALL
SFR
BLOCK
I
I
~MI
PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
BUILDING SIZE
0 BUILDING 1$ I VALUATION OF TOTAL CONSTRUCTION
0 ELECTRICAL 1$ I AMP SERVICE D PROGRESS ENERGY 0 W.R.E.C.
0 PLUMBING 1$ I
0 MECHANICAL 1$ I VALUATION OF MECHANICAL INSTALLATION
0 GAS 0 ROOFING D SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
1.11.".'.11111."..."..1'1...'1."....11."..'1'11'.1.1111."..."...'11.".."'111"".."'1.'.11.'.'....'..P..IIIII"..."...I'III.I.II"..."
BUILDER
SIGNATURE
COMPANY
REGISTERED
Y/ N
FEE CURRENT
Address
Y/N
License #
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address License #
MECHANICAL I COMPANY
SIGNATURE . REGISTERED Y / N FEE CURRENT Y / N
Address I I License #
OTHER C1~~tJ7'flo~/I L ~f^:o~ I
SIGNATURE~ (/., ~g STEREO Y/ N FEE CURRENT Y/N
Address I I License #
11111111111111111111111I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
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 on site, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge 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.
1111I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111IIIIIIIIIIIIIIIIIlIIlIIIIIIlIIIIIIIII
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this pennll may be sublecl 10 '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
contraclors 10 undertake work, they may be required to be licensed In accordance wllh stale and local regulations. If Ihe
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 al727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
porllons of the "contraclor Block" of this application for Which they wlli 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 IMPACTIUTILlTIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned underslands
that Transportallon Impact Fees and Recourse Recovery Fees may apply to Ihe construction of new buildings, change of
use In exlsllng 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 Identlfted at the time of
permltllng. II is furlher understood thai Transporlallon Impacl Fees and Resource Recovery Fees musl be paid prior 10
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 pennll Issuance. Furthermore, if Pasco County Waler/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapler 713, Florida Stalutes, as amended): If valuallon of work Is $2,500.00 or more, I
cerlify that I, Ihe applicant, have been provided wllh 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 descrtbed documenl and promise In good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'SfOWNER'S AFFIDAVIT: I certlty that ali the Information In Ihis application is accurate and that ali work
wlli be done In compliance wIlh ali applicable laws regulating construction, zo;>nlng and land development. Application Is
hereby made to obtain a pennll to do work and Instaliation as indicated. I certify that no work or Instaliatlon has
commenced prior 10 Issuance of a permit and thai ali work will be performed to meel standards of all laws regulaling
construction, County and City codes, zoning regulations, and land development iegulations in the lurisdlctlon. I also
certify thai I understand that the regulations of other g""ernment agencies may apply 10 the intended work, and that it is
my responsiblilty to Identify What actions I must lake to be in compliance. Such agencies include but are not Iimiled to:
_ Department of Envlronmenlal protectlon-Cypress Bayheads, Wetland Areas and Envlronmenlaliy Sensitive
Lands, Water/Wastewater Treatment.
Southwest Florida Water Managemenl Dislrlct-Welis, Cypress Bayheads, Weiland Areas, Allering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Deparlment of Health & Rehabliltative SelVlcesJEnvlronmenla1 Health Unit-Wells, Waslewater 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 Ihe fill material Is to be used In Flood Zone 'A", il Is understood Ihat 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 malerialls 10 be used In Flood Zone "A" In connection w1lh a permitted bUilding using stem wall
construction, I certify that fill will be used only to fill the area within the st~m ~all. .
If fili material Is to be used In any area, I certify that use of such fill wlli not adversely. affect adjac?nl
properties. If use of fili Is found to adversely affect adjacent propertres, the. owner may be crted for Violating
the condilions of Ihe building pennlt Issued under Ihe attached penn I! application, for lols less than one (l)
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 \0 Inform the owner ~f the permitting condItions S?t forth In
this affidavit prior to commencing construction. I understand that a s~parate permllmay be reqUired for etec~lcal work,
I b' g signs wells pools air conditioning gas or other Installations not spectflcally Included In the application. A
;;r'::tI;7s~ued shall be 'const~ed to be a Iicen~e to proceed wilh the work and not as authorilylo violat~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~'ldlng .offiCial from thereaft?r
requiring a correcllon of errors In plans, conslructton or vlolatio~s of any codes. Every ~ennlt Issued shall become. Invalid
I the 1IIfOrk authorized by such permills commenced WIthin SIX months of permit ISsuance, or If work authOrized by
~;:s:rmlt Is suspended or abandoned for a period of six (6) months after the lime th? work is commenced: An extension
ma p be requested, In wrttlng, from the Building .official for a period not to exceed mn~ty (90) dars and WIll demo:)'trate
lusrlftable cause for the extension. If work ceases tor ninety (90) consecutive days, the,Job IS conSidered abandone .
. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN yoUR
~:~:~~gi':o':tE~p~g:MENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATI RNE FORE RECORDING YOUR NOTICE.oF COMMENCEMENT.
FLORIDA JURAT(F,S. ".7.03.y.' - /lIJ -J-J....
'Z-. I CONTRACTOR 7 r UJ/v~
oWNER OdR AdGE T am ed) before me this SUbsprib,d and sworn to (or a~\"ed efo. m5e this
. S)JbRcrlbe an swo /9-;f3..1 O'{ by \'<\= 0 ~
Ae.JJ/. ~~ b d Wh I I re personallll known to me 0 as/have produced
Who Istar ersonally known me or has/have produce 0 s a iJ\ "T as Identification.
_as Identification.
Notary Public
~O.JJI..I~~~"Yh. b J.J~..u..Jt~.-J Notary Public
T r
commission No._ -
BEVERLEY M. SCHENCK
Name of Not
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