HomeMy WebLinkAbout08-7581
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7581
erml Number: 7581
Permit Type: FIRE PROTECTION MAINTENANC
Class of Work: FIRE-PROTECTION MAINTENAN E Book:
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued: Name: ADVENTIST HEALTH S
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33541
Date Paid: 3/06/2008 Phone: 813783-6189
Work Desc: FPM-COMMUNITY CARE MOBILE OFFICE BLD-FIRE ALARM-ANNUAL
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
PERMn EXPIRES IN 30 DAYS wnHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
DATE
~
03042008
PERMIT030408#5
NUMBER
056313
DISCOUNT
AMOUNT
DETACH BEFORE DEPOSITING
No. 3012833
0.00
25.00
0.00
25.00
c\
/ 16rt I
813-780-0020
.
Date Received
Owner's Name
Owner's Address
City orZephyrhills Fire
Permit Application
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Fax-813-780-0021
Phone Contact for Pennit
Owner's Phone Number
If
Fee Simple Titleholder Name
Fee Simple Titleholder Address
I Titleholder Phone Number I
II
/I
Job Address
I Lot#
Sub Division
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o
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D
D
D
D
D
I
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l::UD-Mazard \!vaste 5torage - ANNttAl
Comm Exhaust Kitchen HoodlDuct
ControllEid Bum
Emergency Generator < 30 kw
Emergency Generator> 30 kw
Fire Protection Maintenance _~
Sprinkler 0
Fire Alarm I2t
Hood Clean/Suppression D
Fire Alarm Installation
Fire Pumps
Fire Works
Flammable Application- ANNUAL
Fuel Tanks
Other:
Contractor Company I
Signature Registered
Address I ~t.~ J?j;: 3~j License # I
ELECTRICIAN Company I
Signature I Registered
Address I I License # I
PLUMBER / I Company I
Signature Registered
Address I I License # I
MECHANIC4 I Company I
Signature . Registered
Address I I License # I
OTHER I Company i
Signature Registered
Address , , License #
Directions:
EJ
D
o
o
o
D
D
o
o
o
o
o
Parcel # I
_ t"''" "'N",:, eKUM eK~e.K "
FUllljY~liulI T "'lit
I tv.. l'lU 11\..t:)
Hazardous Material (Tier II or RQ Facility) ANNUAL
Hood Installation
LP/Natural Gas-Installation
LPlNatural Gas-ANNUAL Sale
Places of Assembly-ANNUAL
Recreational Bum
Sparklers
Sprinkler System Installations
Standpipes (Sprinkler Sys)
Torch Roofing
Waste Tire Storage ANNUAL
. r Valuation of Project
~j m-fl} /.v 67. ne I(
Y I N r Fee Current Y I N
:::
Y I N I Fee Current
Y/N
Y / N I Fee Current L Y I N I
J
Y I N I Fee Current I Y I N I
I
Y I N I Fee Current Y I N I
l
Fill out application completely.
OWher~ .COntFciCfOFsigtf6aCk-(jf applicati6h,-OOtaiiZoo{Ot,coPY-Ofsignea contTaetwttn 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.
--_,,---~,,__,,~_."'_P~-'~- ,.-..--"-
.NO"CE.QFDEED.RESfRlCTIONS: The undersigned understands 'lhat this """"tt m~be subjec\ to '_do restrlctions"
Which m~ be more restrlOliVe.than County regulations. The undersigned .assumesresponslblllty for comPliance With any
applicable deed restrictions. . . .
UNUCENSEDCONTRACTORS ANDCONTRACl'OR RESPONSIBILmES: II the owner has hired a coniIaclor or
contraclt>rs to undertake work. they may be required to be licensed In accordance with .s_ and local reg1llaUons. II the
contractor Is not licensed as required by law, both the owner and contraclt>r m~ be.cJtedlor a.misdemeanor violalion
under state law. lithe owner or intended contractor are uncertain as to what licensing requirements may eppiy lor the
intended work. 'lhey are advised to con1acl the Pasco County BuUding Inspection Division-licenslng Section at 727.a47-
80119. Further111ore, U the owner has hired a contractor 0' contraclt>rs, he Is advised to have the contractoris) sign
portlons.ol the "contra- Block" of this applicaUon lor which they will be responsible. Ii you, as the owner sign as the
contractor, that m~ be an Indication that he Is not properly licensed and Is not enUUed \0 peno\lllng privileges In Pasco
County. .
CONSTRUCTloNUEN'LAW (Chapter713, Florida StatUteS, as amended): livalUalion 01 work is $2,500.00 or more;' I
cerlI\y that I, the applican~ have been provided with a copy of the "FIorldaConstruction Lien Law--Homeowner's
protection Guide" prepared by the ROOda Depariment of Agriculture and Consumer Affairs. Ii tbe appilcant is someone
other than the "owner", I.certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement. .
CONTRACTOR'SlOWNER'S AFFIDAVIT: I cerlI\y that ali. the tnformation in this application is accurate and
.. ..... .'. .that. ail. work . will be <lone in. compliance.wi\h..all.applicable.laws .regulatiR9.<lORslnlclioR,:.ZOAIRg.:aAd..laRd.......w
development. Appljca\ion Is herebY made to obtain a permtt to do work and Installation as indicated. I cerIify
that no work or installatiOO has commenced prtor to issuance of a penott and that all work will be performe.d to
meet standards of all taws regulaUng construction, County and City codes, zoning regulations, and land
development regulations in the jurtsdiclfon. I also certify .that I understand that the regulations 01 other
government agencies m~ apply \0 the Intended work. and that it Is my responsibUIty to. idenUfy what actions I
must-take to be in compliance. -
Ii I am the AGENT FO!!. THE oWNER. I promise in good faith \0 inform the owner of the permitting conditions setforth in
this affO<lavil (irior.\o coml!1"ncing consllllclion. I understand that a separate permit may be required lor.electrlcalwork,
plumbing, signs: wells, .pools, air eondltioning, gas, or other installations not speclficaily. included In the application. A
""""liil;sue.dsliail:be coi1s\rUed to be a'llcense \0 proceed with the work ~d not as aUthority \0 violate, cancel, alter. or
SelJiside imi prOVioions of the technical codes, nor shail i!Illuance of a penott prevent the BuDding Offleial from thereafter
. requiflilg.aClJl1'll<'tion of errors In p~s, construction or violations of any cod.... EveI}'pennB is$Ued shall become invalid
. ii1J!jiSiiiti8;i'i<>i1<' .iJt!lorizedby ouch penntt .. commenced within six months of permII IsSuance, or ff work authorized by
: tfiii:pei!iill.IS~U$ii!lride.d or abandoned for a period of six (6) months after the time the work is commenCed. .An extension
mill"i;e ieqoesIed. tn .wrlting, from the BuUdinQ QlfiClallor a period not ~ exceed nin<:lY ~9lI) <I~ and will domonstrate
.~.. cause fOr the extension. Ii work ceases for nmety (90) consecutiVe days, the JOb IS consIdered _ndoned.
. ..... .... .. .-...... .~... . .-. .....- .~.'"
OWNER OR AGENr
Subscribed and swom {or before me
.. by
Who \sJare pefsonally \<nOWIl to me or haS/hSve produced
. as IdentIfiCation.
coNTRACTOR
Subscribed and SWO
. py
Who islare personally known to me or haS/haVElproduced
as identllication.
Notary public
Notary Public
.Commission No.
cOmmIsSion No.
Name of NotarY 1yped. printed or stamped
Name of Notary 1yped. printed or stamped
Technician Work Report
Date of Work: Not Scheduled
District : 292
Technician
Francis Lewis Mckinney
Task Number
Scheduled Start
Service Request
Service Request
Customer Acct
Customer Name
Site Name
Owner Christopher R Brackett
13261836
In Planning
Time
Type
Number
838842
Community Care Mobile
Inspection-Auto Gen
9166410
Payment Terms: Immediate
Office Building
Contact Name
Klaus Mehlhorn
Phone
813-788-0411
Site Address
City
State
38240 Daugherty Rd,
Zephyrhills
FL
Zip
33541-0000
Bi11To Name
BillTo Address:
City
State
Florida Hospital Zephyrhi11s
7050 Gall Blvd,
Zephyrhills
FL
Zip
33541-1399
Contract Number: 155823
Inspections: Mar 2008
Service Plan: FA-TEST/INSP
Task Type
Task Name
2 Person Inspection
FA-Mar 2008
Priority Medium
Current Inspection: Mar 2008
Problem
System
Inspection
SYSTEM-FA-SIMPLEX 4002
Simplex 4002 System
Mar 2008 Created BY AutoGen
Serial:
Summary
Notes
CONTRACT COVERAGE
ANNUAL INSPECTION OF THE SIMPLEX 4002 FIRE ALARM PANEL AND ALL
ASSOCIATED DEVICES INCLUDING, (21) SMOKE DET; (7) DUCT DET; (18)
HEAT DET; (5) PULLS; (19) A/V's.
CLEAN/SENSE TESTING TO BE PERFORMED 100% EVERY OTHER YEAR
(EVEN) .
LEGACY ACCOUNT NUMBER
LEGACY CUSTOMER NUMBER - 01033668
INSPECTION
INSPECTION - No Sense Test Or Cleaning
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