HomeMy WebLinkAbout08-7735
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7735
Permit Number: 7735
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:
Book:
4/10/2008
25.00
25.00
4/10/2008 Phone:
FPM-FIRE ALARM ANNUAL-SUNTRUST BANK
Name: SUNTRUST BANK
Address: 5435 GALL BLVD
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 ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
....
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTlON
CALL FOR INSPECTlON - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
Date Received
Owner's Name
Owner's Address
Fee Simple Titleholder Name
813-780-0020
City of Zephyrhills Fire
Permit Application
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Fax-813-780-0021
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Phone Contact for Permit
Owner's Phone Number
353
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I Titleholder Phone Number
Fee Simple Titleholder Address
Job Address
Sub Division
D
D
D
D
D
D
Contractor
Signature
Address
ELECTRICIAN
Signature
Address I
PLUMBER
Signature
Address I
MECHANICAL I
Signature .
Address I
II
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I
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II 1"4)'/ I
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I3lvJ
I Lot#
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
Parcel #
D
D
D
D
D
~
Bio-Hazard Waste Storage - ANNUAL
Comm Exhaust Kitchen Hood/Duct
Controlled Burn
Emergency Generator < 30 kw
Emergency Generator> 30 kw
Fire Protection Maintenance - ANNUAL
Sprinkler D
Fire Alarm ~
Hood Clean/Suppression D
Fire Alarm Installation
Fire Pumps
Fire Works
Flammable Application- ANNUAL
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(OI:lIAINI::U J-HOM PHOPI::HI Y lAX NO II t; 1::)
Valuation of Project
Fuel Tanks
Other:
Company
Registered
License #
Company
Registered
License #
Company
Registered
License #
Company
Registered
License #
OTHER
Signature
Address I
Directions:
Company
Registered
License #
A/"IfY"1 Cor '<?
Fee Current I Y I N
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Q)/N I
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.
Y/N
Y/N
Fee Current
Y/N
Fee Current
Y/N
Y/N
Fee Current
Y/N
Y/N
Y/N
Fee Current
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" restnctlons
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 -84 7-
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.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The underSigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings. change 01
use in existing buildings, or expansion of existing buildings. as specified In Pasco County Ordinance number 89-07 ami
90-07. as amended. The undersigned also understands, that such fees, as may be due. will be Identlflecl at tile time ul
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid pnor tu
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 permit issuance. Furthermore. if Pasco County Water/Sewer Impact
fees are due. they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work IS $2.50000 or more I
certify that I. the applicant. have been provided with a copy of the "Florida Construction Lien Law-Homeowners
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. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands. WaterlWastewater Treatment.
Southwest Florida Water Management District-Wells. Cypress Bayheads, Wetland Areas, Altenng
Watercourses.
Army Corps of Engineers-Seawalls. Docks. Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells. Wastewater 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 the fill material is to be used in Flood Zone "A". it is understood that 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 material is to be used in Flood Zone "A" in connection with a permitted bUilding using stem wall
construction. I certify that fill will be used only to fill the area within the stern wall.
If fill material is to be used in any area. I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties. the owner may be cited for Violating
the conditions of the building permit issued under the attached permit application. for lots less than one (1)
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 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 MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEN ER OR ATTORNEY BEFORE RECORDING YOUR NO OF COMMENCEMENT
FLORIDA JURAT (F. 17.
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CONTRACTOR
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Who Is/are personally Iglown 10 me or has/have produced
R Nil JAJ /II as Identification
otary Public
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Name of Notary typed. printed or stamped
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Name of Notary typed. printed or stamped
AC# 2 69 7 8 0 5
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#r..Of;1080401431
489 FS.
MIDDLETON, ALFRED C
LINUS ALARM CORP.
18824 COUNTY LINE ROAD
SPRING HILL FL 34610
JEB BUSH
GOVERNOR
DISPLAY AS REQUIRED BY LAW
SIMONE MARSTILLER
SECRETARY
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ACCOUNT NOI 031'3
SIC CaDit 1731.03,
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TYPE OF IUSDIES$t
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LINUS ALARM CORP
PO BOX 5159
$PI!MGMILL fL 3~1l-5159
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18&24 ~~Y'IIt;....;
SP"I. .."t.,~.. ... ',.,;, .,v/';\
DATE
Oa/Q6/87
L
ACORDTI. CERTIFICATE OF LIABILITY INSURANCE I OA TE (MM/DDIYYYY)
04/04/2008
PRODUCER Universal Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
3115 Spring Glen Road - Suite 507 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Jacksonville FL 32207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone: 904-396-5789 Fax: 904-396-3441 INSURERS AFFORDING COVERAGE NAIC#
---
INSUREO Linus Alarm Corporation I INSURER A Maxum Indemnity Company
Mr Richard Curry INSURERB: Associated Industries Ins. CO
PO Box 5159 ] INSURER c:
Spring Hill FL 34611 INSURER D: -.-
I 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 DD' I POLICY EFFECTIVE POLICY EXPIRATION
POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000
f-c-c-
~hMMERCIAL GENERAL LIABILITY ~~~~~~~?E~~~~~~nce) $ 100,000
A J CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 5,000
'X~&O PRO-OOO4660-04 08/19/2007 08/19/2008 PERSONAL & ADV INJURY $ 1,000,000
r-
i- GENERAL AGGREGATE $ 2,000,000
GEN.L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG $ 1,000,000
rxl POLICY n ~~i?T n LOC I Fire Damaqe
AUTOMOBILE LIABILITY ,
I c-- COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
c--
c-- ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
~ I !
HIRED AUTOS
-- , BODILY INJURY $
NON-OWNED AUTOS I (Per accldenl)
-- I
I
~ ---~ PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY , AUTO ONLY - EA ACCIDENT $
I
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
OESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE i AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION ANO ! T'6~$r~JNs I IOTH-
EMPLOYERS' LIABILITY I ER
B ANY PROPRIETOR/PARTNER/EXECUTIVE TWC3159897 03/01/2008 03/01/2009 EL EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1 00 000
If yes, describe under
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES I EXCLUSIONS ADDEO BY ENOORSEMENT I SPECIAL PROVISIONS
donna@linusalarmcorp.com
CERTIFICATE HOLDER
CANCELLATION
City of Zephyrhills
5335 8th Street
Zephyrhills FL 33542
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRA nON
DATE THEREOF, THE ISSUING INSURER WILL ENOEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLOER NAMEO TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZEO REPRESENTATIVE
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)