HomeMy WebLinkAbout08-7666
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
COMM EXHAUST HOOD/DUCT PERMIT
7666
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:
7666
FIRE COMM EXH HOODIDUCT
FIRE-COM EXH KITCHEN HOODI
COMMERCIAL
Address: 7422 GALL BLVD
ZEPHYRHILLS, FL.
UC1I"ownship: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 35-25-21-0010-07200-0011
Name: K-MART
Address: 7422 GALL BLVD
ZEPHYRHILLS, FL. 33542
4/02/2008
130.00
130.00
4/02/2008 Phone:
REMOVE EXISTING SUPPRESSION SYSTEM UPGRADE TO UL 300 SYSTEM
30.00
0-~ D~
~u:
~/
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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD R NOTICE OF COMMENCEMENT."
....
CTOR SIGNATURE P IT OFFICER
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
,Oato'RQOQ!vecl
From: 9414833321 Page; 2/3 Date: 2/19/20083:01:13 PM
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813-7811-0020
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I ,0 ai(J~~IZll.arq Waste Stora,ge : ~NNUAl. "" '
" . ...,:L8J' '. Cornm Exl'tsU~t KItchen Hoo'diouc~' ,~ :<
:: 0 "COnlr~q~au',;.,",', .., ,: ..
',0 . Eroergel\gy GGfletalor~ iO'k~ '. . "
I 0: EmergenD.Y GenflfatCr> 80'k\y .,"
, '0 Ala p;Qle;;UO~ M~lnten~nca' .~NNU^L ' " "
',.d,
FlfS~l1mn' '" ' , .. " 0 .
Huod C~,uppre&&lgr\ '0 "
D Fife A1l1nt1'lnalaUalicln
0,' Fire ~!'lPs "
'I:J Pitt Work:l' , ' ,
o F1a~mabltJ.A~Pli~lioh.AN'~\!,Al..:
o ' FuelTank&
.~ Other: "
.' ' 'Sprinkler, .':,;"
, . ",0 f!umlgati?n T~nt ' " "
" : ': T~r' ~~r(lo~~ Milterj~1 (TI~rU or ~Q f~l;1l1ty) ,ANNU~('
, ' " ..0' Hood In''ltalllUon '" " -, "" .',".'
.'. " D,"l!lNlltur..l~~II\~lIaUDn.. ',',' ' " '.
. 0 ',I.~/Natural,Gil>.,~NMUA.L Slle '. '
o 'f: pj~C(4S of, A9'QmbIY.ArmUA~ '
, ',." ,0. ReCll'e~nllllJ~m \'", ,':'.
'D:sparklarJ. '<.., , '.,
.' . ':0 'SPrin,k~ ~~lem, In~u~ofli,
,,OJ Standpi; (Sprinl<loY Sys) , ,
,'. D TCII'Ch!W~nQ .' ," .
'0 ,Wa.t'i'1;lf~i s~ruge ANNUAl-
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P.LU~:4$.: $ll~ ',: ,:" ' .~ 0 : Ween"# " ~ " , y'
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~CHAN'~I' ---, ',,', ..,~l, ' " "0,', ~alllPll/)Y ",I ~ ~' ' ~' ......:
SlIIllalure , _ "; 1': ... .. , :": ,', ' : ';, RegJ9t8Rl~ ,.' ~~y IN, F:, Fee C1:lrl'llnt ' r ,v. f N l
Address I ' n ,Ucenll8# 'I -- , ' _ {,
: ,~~;~ ,', { " . ,- , . ~., ':" " ; ]1', , . ~;~~ Fv I N~ ~ee CUfforrt ex I ~ 1
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FI!IGutuppllcatlon &:Ompltte~. -', .' ..:1 ..', ,I
OWrlCf .. CDIltnll:tor, sign baCk of llPplicellon, nol;lrlzed (arIC:O~ of Il~ned ooo1tict WIlt\' OW"lir)
, If Ovel' S2tiQO. i Notice of Commoflcament Ia I1lquirad tMflctlal\if' \vorl; over,a6000} ,
suppl~ two (2) 811!& of dl1lwif1AS v,4tl'I ~flpll'~le ,dOGurnomauon " ",
Allow 1 D-14 dl1ye for revlew aft..t ~1Jbmitb11 data. . :.' , ,
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NOl1~J1JEm'~~~:~:::~od :~:$ :~:::=:~~w'deed'm~'
, Wh, lell may !>9 more r~&trlctlVe.than,county. reg,utal,iDns, The nde, telgned atsumo&, re6pon$lblli~'fot.compllance witheny .
applicable (lead ...~t.rlctionG.' . ' ,'" ' , - ' , '
'1,lNI.ICEN$,BD 'CONTAACTOR~ 'AND CONTRActOl' R1!~SIBI~mES; If ilia '-ownsr h.. 'hlre~ 8 co.nIrllctor or
~ W lIIIdllfia"" \Yl>ri<. lh8Y may bs <equiiea to b. Ii.,..ed in accordan"" ."llh .\fI1e .nd Iocol regulation.. ,Ii the.
_. :~ oon~'1,s nDt \ll;tilnse~ 88 rcqui~d by t8W.,~Ottl. the ,own~l'\d'~Qntractor:ma~ be cited for i1,mlsde!TIeanof vlol~t!on
, under 8tate law. If thij oWner or iT)t(tndecl' contn1Otor are UR ,In Ba to:Whet llcen6ing t:equirement& m.y apply for the- , '
.1nief\dIlIl-, they ... ~10 _ tho _ CoUnlY "<ling Ii1apecI1on ~.Inii SecIion al721~1' " .
... 80119, F~; Ii tho . ciIinot two hinld......."" or oonl/!lCllJnl..1It Jo aclI(Ialld \0. hlMl'Iho~')' otgn
pOriIonS or ,tho '.._r B1ll1ll<' .ot-\tll. ~ tot WhIG theY will be ...pomoJbIe. . K..jOU. .. iha .bWnor oIgn." "'" '
. ~' rm may be 00 ","I\OIlIkin\liit 119 Is not pnJIlOIIY~' ,~~ed ,find is, not entltJe~'~ ,permitt1n9,;prIV!le(les i~ Pasco
.CONS1RucmoN UEIUAW (C/lapter71~ FI,;,w,. siatut' ,.. ........1'.. Ii ~aIuoIion. 01 I'I\lIkJo,$2.500.00 or moie.1 ,
c:etllfV lhot! I. t\u>.ppllolU\l. I\lN" boon provldecl willl a . py <if lI10 'FlOtilla ~n .LIBn ~.o'
P.roteotiollQulda'~ 'prepared by the Ronda Department of lA~cu\ture and Consumer .Affatrs. If the. 8Ppltcant is iomeone
, ot~ar than ~t1,8 "owner''. Ice" rtify thgt.I, ,have obta,lned a COPY. of he abo~ diSCFlbe, d document ~~d pron'ti~e.'tn go~ faitQ to
, deliver it to ~the ~oWner'l prior to commencement. . ' " , .' , . ' .'
,_ I CONTAACTOR'SIOWNt:It'S AFFtOA\tIT: . 'I' cert that all the information in thiS applioatlon is acourate 'and "
, " ,1 that all work will be done in compliance with' al applicable-, laws regl,l,lpting construc\lon, z.oning end land ,
" .' i da\I8k1llmant. APpIIoaUon ,1~.1taI<lbY mi\lB to o'bt n a pl!rm~\o ~ work.nd inota!I~U./I!l!llod1"led"l cortIIY '
that no w()rk or in6tallatlQn'ha& ~mmenced 'P.,.i~r 0 Isauance Qf a permit and thatall work wm be p,8rformB~ to" '
: meetsb;ind~rdaof all laws regulating con~\tuQt n, Counw and 9ity cQde9, '.zonlng regulations, and land
, . \development mgula\lom;,in the jur\&dlctiofl. 1$0' oertlfy that I'understand that the regulaUons of otl:le~,
. I gcy~nm.nt "9e,l'd1es In~. apply 10 \t).ln~ded ark, Md Ihallll' my ro,ponslbi'IYjO Idel\\lfY ""at aCIIorts I.
I must take to lie 10 coMpllanoe.. .' ' " . " ,.' . ," "
~ lam 11)8 ~'POR 1H~ OWNER; I.proml~ In gcod fall to infurm the 'It'""r 01 th..p.r",lUnu co"diIIoh. ~ai.forih In, ..
. ~ eIIldf4,P1lor 10 ~....,vuo\ton, lundarstMd ihat. ..per".ll8f1l1ft may bo. roqulllld (or e1l!C\l\cal work.
. p~ ligne. wells. pool" air ....-.unv. 'lIO' or other illStoIIalIonOnot opeoi1II:aIIY In.luil;.!: th the ilPPlI/;o\Itln. A
. pOmIII ,..uad lhoII be """""""" to bo . _ to _od Itn t\u> _ ard '"*.. ~ lti.IQ\..... 00"""" ~lor. or
HI oakhi "l'Y pnwtotono ol.ll1O.1idm1a;l! <Oil... nor 111oII1HU .... 010 petfllil pTOY8nt ... BUII4lln9 OIII!:loI !tom \herotIltBr
requlrlng B paf!'8CUon of '8rro, .r~ in plana, GOostnJclion or ViO, kit' n8 of any codes-, ' ~ery perm,lt Issued shall become Invalid
...... thl>l""'" _rIZsd by iueh ~ i. """""""" \VI hln '"' l1IOI1t\)o 0I.P'f1"1l1at_. or W .,or!< I\IlI1OItZ8d by.
tho parmlt II' .u"iandod'ol' oban<lol\Od lor e,perio\I 01 oix.16) on\II$ _ th. - tho work 10 oommoneo=d. No OlCt8llSton
may be requested. 'n writlngl from, the Building Official for a eriod not to eltceec1nlnely (gO) days andV'!ilI,demQf'\Btra~e
ju~tiflable cause for the axtenslDh. tf:worn ooBses forninew ( OJ confieculive days, the job Is conGlder~d jpundoned.
W~Nu.GI1o"~ . VouRjo~ TORci:ORri'~ N~~ Of COWl_~NTMAY RE$O~T IN. VOUR
. pAVING TWICE l'llR llIPROYaolENT\! 'TO YOUR I'l\Ol>I! TV.' IF VOU1lITEIID 10 OIlTJuNflNANCilill, CONSULT
Inf 0 LI: DER 0 .'N AltO Y EFOR CO N YO TI E OF COM liNea ENT.
P\-ORlqA JURAT (F.o.117.0:.:l' , ,
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, .OWNER o~AGJ!Nt .', ~. -. cON RAc:'fOlt . .
~~~ ..om to cor o"""''''~... :J!e';"<::l'! ~Io 1.,0-) iofor. m.'"
, " ' j~r&_ nallY. tomicirhAltlaI/.PfoCl~od, ,.' -,' .'.V,Vnol iltflPip'50naIIYk1l~\Omcor;ha&/tla\lep'roducecl .
\ l ,\ . , sa id$l\t1ncation " " , . " ' 8!lldon!lfklal101\.' "
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,,' Na{lleofN4"fY~' Prln~.or~~ ' " , am NotaIY\YPed,Pii\Wo,,,,mped,
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Zephyrhills Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire Marshal
Kerry Barnett
Bus (813) 780-0041
Fax (813) 780-0044
March 24, 2008
I have reviewed and approved the plans for a commercial hood suppression system
located at 7422 Gall Blvd (K-Mart). I have attached the comments for the plan approval.
If there are any questions please contact my office at 813-780-0041.
1. System shall be installed in accordance with all applicable NFP A codes, latest
editions.
Inspections Required
1. Acceptance test. This would be done in coordinating with the alarm company.
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813)780-0041 Fax (813)780-0044
Fire Chief Keith Williams
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: Oi :=K?>
Business Name: ...~
Business Address: 7 1::l.-{? ~
Business Phone No.:
Business Fax No.:
Contact:
PLAN REVIEW FEES
B Site Plan N/C
MuUi-Family/Commercial .06 sf
(Minimum Charge $25.00
o Plan Revisions DBL
INSPECTION FEES
N/C
N/C
$100
$250
$500
$100
Annual
1 st Re-inspection
2nd Re-inspection
3rd Re-inspection
4th Re-Inspection
(Business closed until
violations corrected)
SPRINKLER SYSTEMS
~ Hydro Undergrounds $45
Hydrostatic Test $65
Acceptance Test $45
Hydrant Flow $75
per sys1em
per system
SPRINKLER SYSTEMS
8 0 - 25 Heads $50
26 plus Heads $100
STANDPIPE SYSTEM .
o Per Riser $50
FIRE PUMP
o Per Pump
FIRE ALARM SYSTEM
8 0 - 25 Devices $50
26 plus Devices $100
SUPPRESSION SYSTEMS
~:: ::
Other @
KITCHEN EXHAUST
o Hood/Ducts
OTHER
8 L.P Installation per tank
Fuel Tank Installation
(Per Tank)
o Natural Gas Installation
(Per System)
o Spray Booth
FIRE ALARM SYSTEM
8 System Acceptance $50
Recall Acceptance $50
OTHER
~ Fire WalVSmoke Wall
LP Gas
Natural Gas
$15
$25
$25
per wall
per lank
per system
$50 ~ Tent 10'x10' or greater $15 perlent
Fire Pump $45
Fire Suppression ~
System Acceplance
D Exhaust HoodIDuct $30
D Re-inspection DBL
(other than annual)
$50 D Inspection scheduled DBL
and cancelled less than
24 hours
B Construction Insp. N/C
Emergency Vehicle Ao $50
PLANS TOTAL~ INSPECTION TOTAL~
$50
$50
$50
$50
GRAND TOTAL
Comments:
Billing Phone No.:
Billing Fax No.:
Contact:
PERMIT TOTAL~
PERMIT FEE
$50
$50
$50
~
Sprinkler
Standpipes
Fire Pump
oods
Fire Ala""
LP Gas
Natural Gas
FI}8I Tanks- per tank
Sparl<lers
Fire Works
Camp Fire
Controlled Bum
Hood/Duct
Place of Assembly
Fire Protection
Flammable Application
Waste Tire Storage
Generator<KW
Generator >30 KW
BkrHazard Waste
Fumigation Tenting
Torch Pot/Applied
Haz. Materials
B
\ :'0-
FALSE ALARM FEE
1 st Ala"" N/C
2nd Alarm N/C
3rd Ala"" NlC
4th Alarm $100
5th Alarm $150
6th Alarm $200
NON COMPlIANCE $150
$50
$50
$50
$100
$500
$25
$100
$50
$50
$25
$50
$50
$100
150
$100 Annual
Annual
Annual
Annual
$50
$50
$100 Annual
FALSE ALARM
TOTAL I
Date: ~);tL\ (66
InsljQctor. '/-eK"i-& rJejf ~ fV.--
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
03/14/08
PRODUCER 1-727-797-4190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher Risk Management Services, Inee ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2600 McCormick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300
Clearwater, FL 33759
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich American Ins Co 16535
A-1 Contract Staffing Group
INSURER B:
3829 Coconut Palm Dr. INSURER C:
Tampa, FL 33619 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR r..~~~ Pg,k+~~~~~~,!;~\E Pg~!fFY/~'a:~~N ~
LTR POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
]~"'., ~,,~,~'U~ PREMISES lEa occurence) $
CLAIMS MADE D OCCUR MEO EXP (Anyone person) $ "~--
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
~~'L AGGREnE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $
POLICY P'~PT LOC
_~TOMOBILE LIABILITY i
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
--
-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
--- ----
-- HIRED AUTOS BODILY INJURY
(Per accident) $
NON~OWNED AUTOS
-- I ~"
~- PROPERTY DAMAGE $
(Per accident)
~~RAGE LIABILITY ! AUTO ONL Y ~ EAACCIDENT i$
ANY AUTO ! OTHER THAN EAACC I $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE I --"-
AGGREGATE $
" ~
$
~~ DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WC343478605 01/01/08 01/01/09 X I T'6~~I~JNs I X I OJ~~
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? i E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under $1,000,000
SPECIAL PROVISIONS below E.L. DISEASE ~ POLICY LIMIT
OTHER I
i
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Sean Patrick Enterprises Inc. dba Alliance Fire & Safety, Inc. dba Accutech Fire Sprinklers is an alternate
employer. Coverage is for contracted employees of A-1 Contract Staffing not subcontracted labor.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Zephyrhi11s DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
-
Contractor Licensing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Zephyrhil1s, FL 33542 AUTHORIZED REPRESENTATIVE ~C~
USA
ACORD 25 (2001/08) betraJ.k
8309747
@ACORDCORPORATION 1988
Alllance Fire & Safety
500 Base Avenue E.
Venice, FL 34285-0208
Post office Box 637
Venice, FL 34284
Phone:
Facsimile:
Toll Free:
941-485-5402
941-483-3321
877-664-6612
THE INTELUGENT CHOICE FOR YOUR
UFESAFETYSOLUnoNS
~ ~31q/i)'b€ I ;<(3
March 17. 2008
To Whom it may concern,
Attached within this envelope are a letter of authorization, general liability &
workers' camp certificates, business tax receipt, and copy of current certified state
license. Also, the permit and cut sheets for pre-engineered kitchen suppression system
to be installed are included, however the notice of commencement will be delivered
when we come to sign and receive the permit.
If you have any questions or concerns, please feel free to call my mobile#:
(941) 626..7528
Or our office:
(941) 485-5402 Fax: (941)-483-3321
Thank you for your immediate attention in this matter.
Sincerely,
Matthew Koller - Permit & Design Coordinator
mkoller@alliancefiresafetV.com
FIRE AlARM SYSTEMS. FIRE SPRINKLERS . SEC~ITY . SUPPRESSION. ACCESS CONTROL. EXTINGUISHERS
SAFETY EQUIPMENT. CCTV. EMERGeNCY LIGHTING. LOW VOLTAGE CONTROL. SYSTEMS
UL MONITORING SERVICES. COMPLETE TESTING SERVICES
CITY OF ZEPHYRHILLS
Permit Authorization Form
I, Michael R. Willis. Sr. (Contractor) . Contractor License No. 48254100012004 ,
hereby authorize the following to act as my agent(s) in obtaining permits in the City Of
Zephyrhills, Florida.
Name Of Agent Driver's License No.
Sean Hill H400-795-68-042-0
Tim Humbert H516-80 1-56- 310-0
This authorization is to be in effect March 11,2008 until March 10,2009.
~/~
f Contractor's Signature
STATE OF F)Dyida-
COUNTY OF PI) I k
Sworn To (or affirmed) and subscribed before me this
I I +-~ . Day Of '-Y'Y\.Q y r f...... -
. 20~ by Michael R. Willis. Sr.
NOTARY PUBLIC
~/ '--f7. Cu~--b4
Signature Of Notary)
I .a:......:.~ BRIOOETN. CURns
~: :~ MY COMMISSION # DD 634084
~~. ...o$.'Jl EXPIRES: March 23, 2011
'''1'Rr..Il<-;''' Bonded Thill N01aJy Public Underwrll8lll
(Stamped Name Of Notary)
My Commission Expires: YrlCVld ,';) 31 dO II
Personally Known:'/.. OR
Produced Identification:
(Type Of Identification)
ST ATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF STATE FIRE MARSHAL
T ALLAHASSEE,FLORIDA
FIRE EQUIPMENT DEALER LICENSE
THIS CERTIFIES THAT: ALLIANCE FIRE & SAFETY,INC DBAJALLIANCE FIRE & SAFETY
500 BASE A VENUE EAST
VENICE, FL 34285-
QUALIFIER: MICHAEL R WILLIS SR.
HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, REPAIR,
INSTALL OR INSPECT ALL TYPES OF PRE-ENGINEERED FIRE EXTINGUISHING SYSTEMS,
~~
Chief Financial Officer
Issue Date Type Class
Sarasota
County
48254100012004
9867440001 12 31 2009
01 01 2008 07 04
LicenselPermit Number
Application # Expire Date
ST ATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF STATE FIRE MARSHAL
TALLAHASSEE, FLORIDA
FIRE EQUIPMENT DEALER LICENSE
THIS CERTIFIES THAT: ALLIANCE FIRE & SAFETY, INC DBAJALLIANCE FIRE & SAFETY
500 BASE AVENUE EAST
VENICE, FL 34285-
QUALIFIER: MICHAEL R WILLIS SR,
HAS COMPLIED WITH FLORIDA STATUTES AND HAS QUALIFIED FOR THE TYPE AND CLASS SHOWN HEREON TO SERVICE, RECHARGE,
REP AIR, INSTALL, OR INSPECT ALL TYPES OF FIRE EXTINGUISHERS INCLUDING RECHARGING CARBONDlOXIDE UNITS, AND TO
CONDUCT HYDROSTATIC TESTS ON ALL TYPES OF FIRE EXTINGUISHERS INCLUDING CARBON DIOXIDE UNITS,
~.~
Chief Financial Officer
Issue Date Type Class
Sarasota
County
48253800012004
9867460001 12 31 2009
01 01 2008 07 01
License/Permit Number
Application # Expire Date
ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
03/14/08
PRODUCER D080720 1-407-332-0029 THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION
Insurance Solutions of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
910 Belle Avenue, Suite 1140 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Winter Springs, FL 32708
Scott E. Lugering INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Everest Indemnity Insurance COItWany
Alliance Fire & Safety, Inc. Alliance Protective Systems
Inc., dba Alliance Fire & Safety INSURER B: Travelers Insurance COItWany
P.O. Box 637 INSURER C:
Venice, FL 34284 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, N01WITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR DD'L Pgk+~~~~~6g;V~~ Pg~'fJI~~6~~N
LTR N"RC POLICY NUMBER LIMITS
A ~NERAL LIABILITY RMG6400014 03/02/07 04/27/08 EACH OCCURRENCE $1,000,000
i"me'" G,""'" ",,"'UN DAMAGE,~ YE RENTeD $ 50,000
PREMISES Ea occurence)
f--. CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
f--. PERSONAL & ADV INJURY $ 1,000,000
f--. GENERAL AGGREGATE $ 2,000,000
rl'L AGGRE~E LIMIT APn PER: PRODUCTS - COMP/OP AGG $1,000,000
POLICY X ~~RT LOC
B ~.:rOMOBILE LIABILITY 21483 04/28/07 04/28/08
COMBINED SINGLE LIMIT $1,000,000
ANY AUTO (Ea accident)
--
-- ALL OWNED AUTOS BODILY INJURY
X (Per person) $
-- SCHEDULED AUTOS
X HIRED AUTOS
-- BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
-
X COItW Ded $500
PROPERTY DAMAGE $
X ColI Ded $500 (Per accident)
GARAGE L1ABtLlTY AUTO ONLY - EA ACCIDENT $
F~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:J OCCUR D CLAIMS MADE AGGREGATE $
$
F~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WCSTATU-.1 IOTH-
iORY LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
~p'fd~~~~~vi19gNS below EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITIEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 1,,-
,,() o;t,t [:
@ ACORD CORPORATION 1988
City of Zephyrhills
5335 8th Street
Zephyrhills, FL 33542
ACORD 25 (2001/08) MKollerAFS
8308920 -
ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
03/14/08
PRODUCER 1-727-797-4190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2600 McCormick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300
Clearwater, FL 33759
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich American Ins Co 16535
A-l Contract Staffing Group
INSURER B:
3829 Coconut Palm Dr. INSURER C:
Tampa, FL 33619 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ~~~~ P~.k+~~~~~6g;V~~ Pgkif:I~~6~~!gN
LTR POLICY NUM BER L1M ITS
~NERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY ~~~~~~ YE~~~~nce) $
f-- ~ CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $
I-- PERSONAL & ADV INJURY $
f-- GENERAL AGGREGATE $
~]'L AGGREnE LIMIT APn PER: PRODUCTS - COMP/OP AGG $
POLICY P,~,9T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f--' $
ANY AUTO (Ea accident)
-,
-, ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-,
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
~rAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~i?ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
_J OCCUR 0 CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WC343478605 01/01/08 01/01/09 X I fnfSTAT~!: I X IOJ~-
T RY LIMIT
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $1,000,000
~P~~~ec';,r~6~~gNS below EL DISEASE - POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Sean ~atrick Enterprises Inc. dba Alliance Fire & Safety, Ine. dba Accutech Fire Sprinklers is an alternate
employer. Coverage is for contracted employees of A-l Contract Staffing not subcontracted labor.
CERTIFICATE HOLDER
CANCEL LA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Contractor Licensing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE ~C~
USA
ACORD 25 (2001108) betraik
, 8309747
@ ACORD CORPORATION 1988
CITY OF VENICE
. \ '401 W.Venice Ave.
, .., Venice, FL 34285
LOCAL BUSINESS T AX RECEIPT
BUSINESS NAME:
MIKE'S FIRE & SAFETY
BUSINESS LOCATION: 500 E BASE AV
BUSINESS OWNER:
MIKE'S FIRE & SAFETY
(ALLIANCE FIRE & SAFETY)
P.O. BOX 208
VENICE FL 34284
BUSINESS CLASS: MERCHANTS, RETAIL AND
LOCAL BUSINESS TAX RECEIPT
NUMBER: 0005222 108-00018682
EXPIRES:
September 30, 2008
~*
, [,"1' C:j,<;:L:
. ' .
~'
/'" ,', 4" '/
l.::;;lt ,(:;;/<./
CITY CLERK
111111111111111111111111111111111111111111111111111111111111
2008050329
NOTICE OF COMMENCEMENT
Rcpt.: 1171960
DS: 0.00
04/03/08
Rec: 10.00
IT: 0.00
Dpty Clerk
Permit No,
JED PITTMAN, PASCO COUNTY CLERK
04/03/08 04: 36~ 1 Jl,l 1.
OR BK 78C?J~ PG ~8l!J
Property Identification No, 3S'-l.f -2.1' 0010 -(J1Z4t7-elDII
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713,13 ofthe Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT,
R
I ,Description of property (legal description:) Z~~H'I'ttl(lu.s e.U)Ur et1I'1'I4U~ I..AJJ&1S PII p~SS Pitt(" 'F~/lA&r:t 1 z.."~
a) Street Address: 742.2. t:AJ,/" IS/.V&1
2,General description of improvements:
V"~I>E EIt:I.s1:l1J~ Kl'ra'~1J HMI>' ;SY'.r~MS Tel VL3t>o ~"'AJJJ>AflD
3,OwnerInformation rth,/l,/vfewl!'rAI1..4 (;, 72.~ COfll,SI1I?It()c,.ICEN r:r/o.-rc IlP
a) Name and address: e/D S~l1l rz ~e PAIl1,.,rll LU: SA&..A-CYNwY'&>' PI.. I '()D~
b) Name and address offee simple titleholder (if other than owr,er)
c) Interest in property
4,Contractor Information
a) Name and address: ^("''-,~e FIt! "~AF'f;n/. ,...&
b) Telephone No,: ''tI-'U5'-5~2- .
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.:
6,Lender
a) Name and address:
.5'Cl't15~SE p.vGB
\1st-Ira, FL J+Z.IS-
Fax No. (Opt.) 7f,....,." - 3$ll
Fax No, (Opt.)
Phone No,
7, Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No,: Fax No. (Opt.)
8Jn addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713 .13(1 )(b), Florida Statutes:
a) Name and address:
b) Telephone No,: Fax No, (Opt.)
9,Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR A ORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF C~~,~CEMENT. ~
STATE OF FLORIDA ,.~ -"_,' ,4
COUNTY OF PASCO 7"' ~
Sign r orOwner Own s Autho .
b/#
The foregoing instrument was acknowledged before me this ~ ~j? day of r- fi' -:P'VA..{"h , 20 of/, ~//~...,,,,,J
as (type of authority, e,g. offiGd; trustee, attorney
in fact) for (name of party on behalfof::::J: instrum~ :xecute~
Personally Known _ OR Produced Identification X- Notary Signature vw0 ~
Type ofIdentification Produced,J)(Wf{S ue-ens€' Name (print) L I~~ ~-et\'\\s.1a ~
Verification pursuant to Section 92.525, Florida Statutes, Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
Signature ofNalural Person Signing Above
FORMS/NOC,rvsd2007
-
USA THfMISTOS
Notary PubIc - AIIIana
Maricopa County
ExpIres 04/3012011
Alliance Fire " Safety
_ Bese Avenue
P.o. Box 637
Veoke. Florida 34284-0208
TeIe: (941) 485-S402
Fu:: (941) 483-3321
1 (ffT7) 664-6612
Fire & Safety
Formerly d:la
Accutech Fn SprilkIers &
MIke's Fie & SatBty
'THE INTlWGENTCHOICE fOR YOUR
UP! SAFETY SOLUnONS
Building Department
To whom it May Concern:
Enclosed is the check for 7422 Gall Blvd, K-Mart Fire Pre-Engineered Suppression permit.
Please make sure we are scheduled for 8:00am on Friday, April 4th for fire final. If you have any
questions or concerns, please call me at my cell 941-626-7528,
Thank you,
Matthew Koller
Design & Engineering Department
Alliance Fire and Safety
FIRE ALARM SYSTEMS. FIRE SPRINKI.ERS . SECURITY. SUPPRESSION . ACCESS CONTROL. EXTINGUISHERS
SAFETY EQUIPMENT . CCTV. EMERGENCY LIGHTING. LOW VOLTAGE CONTROl SYSTEMS
ll. MONrrORlNG SERVICES . COW'LETE TESTING SERVICES
c:\Docwneata IIId Settinp\danlll\Desktop\Permittiq PDF.\NOTICB OF COMMBNCBMBNT FORM LET1'BR.doc