Loading...
HomeMy WebLinkAbout08-7682 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE 7682 Permit Number: 7682 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: 7921 GALL BLV ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 34-25-21-0010-00100-0010 3/27/2008 25.00 25.00 3/27/2008 Phone: FPM-ANNUAL FIRE SPRINKLER -LOWES HOME CENTER Name: LOWES HOME CENTER Address: 7921 GALL BLVD ZEPHYRHILLS, FL. 33542 dm~ I(~ #'. W/'6;P' ~tf/c -/-or! ~s cpA.3~~55 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 INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 . 813-780-0020 Date Received Owner's Name Owner's Address Fee Simple Titleholder Name City of Zephyrhills Fire Permit Application 1\ 'l~b/2 Fax-813-780-0021 Phone Contact for Permit I loWE '5 \4o""'-E CE ~T~S " l~ C. Owner's Phone Number 8 l '3 .0 . Box.. I 000 i:k. '854 TAx 'D E'l'T '1..ETA J Mo &l(.e.S V \ L..L E" , kJ (. I Titleholder Phone Number II II Fee Simple Titleholder Address Job Address f:s-A L-L 'BL-V D I Z6"'Ptt'1l2..1+\ LLS FL '3~54\ I Lot# Sub Division 1-,':t2\ I Parcel # D D D D D ~ Bic-Hazard Waste Storage - ANNUAL Comm Exhaust Kitchen Hood/Duct D Fumigation Tent D Hazardous Material (Tier II or RQ Facility) ANNUAL D Hood Installation D LP/Natural Gas-Installation D LP/Natural Gas-ANNUAL Sale D Places of Assembly-ANNUAL D Recreational Burn D Sparklers D Sprinkler System Installations D Standpipes (Sprinkler Sys) D Torch Roofing D Waste Tire Storage ANNUAL Controlled Burn Emergency Generator < 30 kw Emergency Generator> 30 kw Fire Protection Maintenance ~~lJAL Sprinkler ~ Fire Alarm D Hood Clean/Suppression D Fire Alarm Installation D D D D D D Fire Pumps Fire Works Flammable Application- ANNUAL Fuel Tanks Valuation of Project Other: Contractor Signature Address I ELECTRICIANI Signature Address I PLUMBER Signature Address I MECHANICAL I Signature Address I OTHER Signature Address Company Registered License # Y/N Fee Current Y/N Company Registered License # Y/N Fee Current Y/N Company Registered License # Y/N Fee Current Y/N Company Registered Y I N Fee Current Y I N I I I~NE Aum"","",,, fi ~~ sPt2.INlU.ElZ.Sl Y I N I Fee Current I Y I N I o OO~d.OO License # J-~ Company Registered License # ~A- 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, 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 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 work 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 MA Y 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 JURAT (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 Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary C. EYSTER MY COMMISSION' DO 723440 EXPIRES: October 9. 2011 IIcnded 11lIU NolaIy Public UndIrwrtIen ~] WAYNE Automatic: Fire Sprinklers, Inc. Company's Name WQj;~~.:l:E.;..,'!'!:~!~~ F/rc.. SPYI'1 k f-et"'.S; +"> c., Qualifier Name ---.fr...:i:e.. 5c b..~::1_~_..._._~___.,. License Number _ q 0"- '13400 O.'2.1-..f.:?Q~_ I hereby authorize the ~,~..12P2f.~r--.!l11l.J . , to issue permits to -J'...e.fl!:L Wq+SOJL..________._.______, whose position with my company is 0(" <'1'iPJ i'1 . "---.~--~._~~-------_._--_.__.~~---._.---- Check one: ) This authorization is good for the job at: -,.----._.~~ ( )Q r\ny and all pemits until further notice..______ ---~J-D~ Dale *.....This action mllst bear the notarized signature of the license holder". STATE OF FLORlDA COtJNTY OF 6R f:)f\.}(; ~ ."...._-<o...>t'.\.~"i_':''I''.;:,;'\"....;,;...._\...".<;'''_.;,,,........!...~ (~ S4:pr---"" ~'-Rl[iH'A,MCCUU:(};H ;:':;r :" COMMISSION # DO 485833 ., ,1,,;) . LXPIRES: February 26,2010 ):.., :"'1100 11'1", NOlllty Public Underwriters :._,~~"....,,-..._~ PersonalI y /Professionally K.n OWTI_.__'i!._____ -OJ'- Produced ldentification Type ofID Produced -===-=--=--=- 1'\ J S-t: The foregoing instrument was acknowledged before me this oL day of ---tf:a.L~_ 200&>, bY--M€- S~~b (name o~person aCknowledging) -- ._, !1} t. OCloc:t---. . otary Signature Post Office Box 770 . Brandon, Florida 33509-0770. (813) 267.0076. FAX: (813) 654-3419 Curpori\[e Office: 222 Capitol Court. Oco('c. Florida 34761-3033 . (407) 656-3030 . FAX (407) 656-8026 !""c/IlJ!/lf 01[11'(',1: J()('/';solll'ille r'll/'! '\{ycn PO'1/pallo Beach COllcol'd, NC ~WAYNE Automatic Fire Sprinklers, Inc. Company's Name Wa..)'ne.. .4t..{Jo~.!I.::l:jL F(ve.. Spl"J'I-Jk.l-fr.tJ:he.. Qualifie.r Name f'..e+ e.. S c It ~~~.__.._.____.__ License Number '10"1...9 Jl.fO({)Q.~"=-1J2f;?~~_ I hereby authorize the . C "+'!..s2..f--.2.t;eh.)!rjdM _.. to issue permits to -~':LiI."Vlde.Y) _____""_' whose position with my company is .-1Le."r.i9!:L __._________ Check one: ) This authorization is good for the job al: ____ ( X) .Any and all pemlits until further notice. __.______.__ lhe permit must be signed in front Mthe bud ' understand thai I remain fully responsible for al --3dJ-Og__ Dale a.. .This action must bear the notarized signatllre of the license holder. H STA TE OF FLORIDA COUNTY OF Of.. A ~6 t_ ___ "~~~\!;<t", (. t~'~':'a ~;..I.~'Q'" ~i.....t~~,.. ,,_.""~f,,~1I "l'sC- The forc.g oing instrument was ac~.p(lwledged before me this ~ _ day of --~_200~by.~ ~hl..~~b__ ~ e of person acknowledging) ~Cc... QC1~ -':otary Signature RUTH A. MCCULLOCH MY COMMISSION # DD 485833 EXPIRES: February 26, 2010 BOrldtt1 ThtU Notary Public Undelwn:'3rs Per50 na l/y IProfess ionally Kn O'-Vll_.lQ...._..___.._ -or- Produced Identification -.--.....--.....------...- Type of 10 Produced -----.---....-..--.--...--. Post Office Box 770. Brandon, Florida J3509-0770 . (813) 267-0076 . FAX; (813) 654-J419 "------~;ror;He Office: 222 Capitol Coun . Ococe. Flonda 34761-3033 . (407) 656-3030' FAX (407) 656-8026 i,' " (' ii' IIlI i () Ij'iCr' .\" J oeks!! 11 ,. i II e Fo /'( ,l I ,,' r y F' 01/11'(/110 B eo eli Concort!. :V C ~I WAYNE Automatic Fire Sprinklers, Inc, Company's Name W'~<:-_l!.y~_.~~qf-t.:.<.. E.i!"e... S'p,.,.,...? k..1-fY' JiII4 C. Qualifies:Name fe+-? SC"'kE_~.____._.______ License Number...3 0 '1-. Cf.$ <:ta>OQ.~1.. <e. 0 '1- I hereby authorize the -=-~._~ f' -k~l1_y r J., "., 1$-. . to issue permits to ..i.!oe..Tct '110'-' ---_..__.._____.._..__.__, whose position with my company is h.p S' 'oJ. ----1L.",__L_.:L .':1-______.____._________. Check one: ) This authorization is good for the job at:________ ex:) Any and all permits until furrher notice._____________ ____-3.. d) -()p Dare presentative. I ed ) der said permits. ,. hThis action must bear the notarized signature of the license holder"" STATE OF FLOR1DA COUNTY OF {')PJi i\J6 [' _ "} -iT TIle t()H~going instrumenl was acknowledged before me this e.L day of ----L"Cn..LC \..... 200E, by_-J~Q. ~~..J:L. ___ (n~rne of 2!rson acknowledging) ~';I'.,'r,il"h~~~~ 'sr \...."'~'~:?" RUTH A. MCCULLOCH ry , 1(( ~ .flVI ^ /" (1 (\ -" I (....f A~~""':~~ MY COMMISSION ff Dp48583,) '~~-L~{ ~d ~ ~:: .. .&E EXPIRES: Februai'j tb, 201,0 . Olary SlgJ13ture -;'..~;;;.. ..'b~"':- I?ondwd Ttltl.l Notury PubliC UnderNlt,r,Jrs "'Rf,,\~' ._ =~ ,,~.... Personal I y IProfess i0naIJ y Known_~____.....___. -or- Produced Identification__ Type of IO Produce.d _==.~._==_==~ Post Office Box 770 . Brandon. Florida .B509-()77() . (SU) 267-0U76 . FAX: (813) 654-3419 - -----.-..(~:)rpOr'lle Office: 22::: CJpito] Courl. Oeoee. Florida 34761-3033' (407) 656-3030' FAX (407) 656-8026 ;;'1"'[('''(1/ O/ficc'.': .!ocksolll.jlle Fori ,\-f.\'C!" POll/POliO Beach COlicord. NC ACORDTM CERTIFICATE OF INSURANCE DATE 9/4/07 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BROWN & BROWN INC CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 220 SOUTH RIDGEWOOD AVENUE AFFORDED BY THE POLICIES BELOW, POBOX 2412 COMPANIES AFFORDING COVERAGE COMPANY DAYTONA BEACH, FL 32115 A GREENWICH INSURANCE CO 22322 INSURED COMPANY WAYNE AUTOMATIC FIRE SPRINKLERS, INC B HARTFORD CASUALTY INSURANCE CO 29424 HAZARD FIRE PROTECTION ENGINEERING COMPANY WAYNE FIRE INSPECTIONS C NAVIGATORS SPECIALTY INSURANCE CO 36056 COMPANY 222 CAPITOL COURT D FFVA MUTUAL INSURANCE CO (FL ONL YI 10385 OCOEE FL 34761 COMPANY E HARTFORD INSURANCE CO OF THE SE 38261 COMPANY COVERAGES THE POLICIES OF INSURANCE BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD INDICATED. NOTWlTliSTANDING 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. CO LTR TYPE OF INSURANCE POUCY NUMBER POUCY EFFECllVE POLICY LIMITS DATE (MMlDDIYYI EXPIRATION DATE IMlDD/YY1 GENERAL LIABILITY RMG6400124 09/01/07 09/01/0B GENERAl AGGREGATE $ 2,000,000 A ~ OMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 2,000,000 00 CLAIMS MADE (gJ OCCUR PERSONAL & ADV IN JURY $ 1,000,000 DOWNER S & CONTRACTOR-S PROT EACH OCCURRENCE $ 1,000,000 ~ IUIT FIRE DAMAGE (Anyone fife) $ 50,000 APPLIES PER PROJECT MED EXP (Any one person) $ 5,000 B AUTOMOBILE LIABIlITY 21UENLJ7216 09/01/07 09/01/0B $ 1,000,000 [gJ ANY AUTO COMBINED SINGLE LIMIT o ALL OWNED AUTOS [gJ HIRED AUTOS ~ODIL Y IN JURY $ Per Person) [gJ NON.OWNED AUTOS BODILY INIURY $ 0 (Per AccidonlO 0 PROPERTY DAMAGE $ GARAGE LIABILITY AUTO DNLY-EAACCIDENT $ o ANY AUTO OTHER THAN AUTO ONLY: $ 0 EACH ACCIDENT $ 0 AGGREGATE $ C EXCESS/UMBRELLA LIABILITY NY07EXC169817NC 09/01/07 09/01/08 EACH OCCURRENCE $ 1,000,000 (gJ OCCURRENCE AGGREGATE $ 1,000,000 SIR $ 10,000 D WORKERS COMPENSATION AND VVC8400016B652007A 04/01/07 04/01/0B lXI STATUTORY LIMITS EMPLOYERS LIABILITY THE PROPRIETOR! o INCL EACH ACCIDENT $ 500,000 PARTNERS/EXECUTIVE $ 500,000 OFFICERS ARE: o EXCL DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE $ 500,000 E OTHER LEASED/RENTED EQUIPMENT 21 MSLJB023 09/01107 09/01/08 $100,000 PER ITEM $2,500 DEDUCTIBLE $200,000 AGG DESCRIPTION OF OPERATlONSJlOCATlONSNEHICLESJSPECIAL ITEMS CANCELLATION: EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM TAMPA - BRUCE COPPIN AND RICHARD LENNERTH ARE LICENSE HOLDERS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ZEPHYRHILLS THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO ATTN: BILL BURGESS MAIL~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 5335 8TH ST THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR ZEPHYRHILLS FL 33540 REPRESENTATIVES. ~~ ACORD 25-S (3/93\ @ ACORD CORPORATION 1993 NOTEPAD: INSURED'S NAME - WAYNE AUTOMATIC FIRE SPRINKLERS, INC EFFECTIVE DATE: 911/07-911/08 PAGE 2 ADDITIONAL INSURED-OWNERS, LESSEES, CONTRACTORS CG 20 33 07 04 ADDITIONAL INSURED-OWNERS, LESSEES, CONTRACTORS-COMPLETED OPERATIONS CG 20 37 0704 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG 24 041093 ENDORSEMENTS CG 20 33 07 04, CG 20 37 07 04 AND CG 2404 10 93 APPLY AS REQUIRED BY CONTRACT, PROVIDED CONTRACT IS EXECUTED PRIOR TO lOSS ST A TE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTlFICA TE OF COMPETENCY THIS CERTIFIES THAT: PETE SCHWAB 222 CAPITAL COURT acOEE, FL 3476]- BUSINESS ORGANIZATION: WAYNE AUTOMATIC FIRE SPRINKLERS, INC. CONTRACTOR I INCLUDES THE EXECUTION OF CONTRACTS REQUIRlNG THE ABILITY, EXPERIENCE, KNOWLEDGE, SCIENCE, AND SKILL TO INTELLlGENTL Y LAYOUT, F ABRlCA TE, INSTALL, INSPECT, ALTER, REPAIR, OR SERVICE ALL TYPES OF FIRE PROTECTION SYSTEMS. EXCLUDING PRE-ENGINEERED SYSTEMS. Chief Financial Officer ~~ 07 0 I 2006 07 15 Orange Issue Date Type Class County 90293400022002 7646570001 ]50.00 06 30 2008 LicenselPennit Number Application # Taxes & Fees Expire Date f 20f)7;;;~8 l'iU,....S.Of.toUGHOQUNTY BUSINESS TAXRECS1PT 'L~E8Qll7H~. 01 S8:, 0 I SEATS '. 0 .1 ~PlOYlES - 66c. CODE '. BO~INlESSTYPi .. . .. , . . """!.."" '."-"',.,""...',,", .,', '-. "', '. 090_0152" ....DrIR~~LI0~;~~I~~7'€fJ~2RfCTOO... R(COoM;,CAR&Pm;~PJll!I;ARSSYST REPAIR OR , \ .. ", .. ';.' ..' ,- " ,': .. ,', '.. .. .,\, : .. ."'...' ,,' ..... '''",'' , .. ~" .." , .. .., .. ..', ' .- ',-,' '; '" '.. .... ' .. '. . .' t !;'(,t' "ii'...." '- .' ',. ,~:! f J "', Qlje""" PAlMtJR - .. . . .. '., ....'.'... ,," ..'... . .,.. ,....l:Oq,rjQr'l!'/','"i~~~~'.9/' ..' .261 eXP1R~s,....~21O' FOIJQNO , ~f:ENEWAll .1. A .' .152133,qO~O . WAStE.fA SURCHARG~ ' A()OO -.r 54.00 .W8IG.t-l~fVICHfii$Jbpt-l~R! bBA,W.p;YNE~lJ'rOflllA T1G FIRE SPRINKLERS INC 3~26CHf;:RR'v~J).l:.~:OR ' :tA~R~fi't'~3~'1~i"'.' . ,......;..;,~--~..-..:..~'~":.!-~'- ,,::.., :: ,- .';,:, ',',' -",",-, ._','....,......'.,';, "-.:,,',:.1 ',' -:'. ..,...,.....,.,'-,.,:1...'" ':,' ":":.' .....- ',".', .,.'...., . ,.,;,.._.....'.. I DOUG PEt,.b~N,TA~~9t..J:(:T()R . ...... ..'Q'~36-~;29Q, .,''''. . .... rHI$ aeCOMl'ls A t:!")(,~1i9~IPtW.."NVAUPA'r"[)