HomeMy WebLinkAbout08-7737
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7737
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:
7737
FIRE PROTECTION MAINTENANC
FIRE-PROTECTION MAINTENAN E
COMMERCIAL
Address: 6848 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02-26-21-0010-00900-0020
4/15/2008
25.00
25.00
4/15/2008 Phone:
FPM-FIRE ALARM ANNUAL -ZEPHRYHILLS CINEMA 10
Name: HOME TH E OF Z PHYRHILLS
Address: 6848 GALL BLVD
ZEPHYRHILLS, FL. 33542
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 INSPEcnON
CALL FOR INSPEcnON - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
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(113-780-0020
City of .Zephyrhill5''FIr.e~ ..
. .Permit Application
~ '-113 '"1-813-780-0021
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. ~ - 'Phone Contactfor Permit
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Date ReceIved
~ 4 7 t08
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Owner'sAddIllSS .16:848 .~all.'Blvd., . Ze hvrhill,
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0Wner'& Phone Number
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D. Blo-Hazard Waste Stor. ~:AN"'U~
o '- Comm ExhaUlt KItchon I-loodIDuct
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o Emel'lleney G8nenl~r,> SO kw .
. oa . Fire P~tectIon MBlnten~1W8 -.AN~ I!!!!J ~ B
Sprtnkler 0 . [J iJ', l:J'.
FIleA'.nn ..CX1 p. 6' IX '.'
tigod Cleaning O. iJ 0'0 .
HoOd Suppreselon 0 : () [) 0 'C:=J
~ . FIfB Alann 'n&tailallon .. .
Fint Pumps , : .
: .FireWor]<& . '.. '
FliImmable Application- ANNUAl..
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D. other: "1'
Contrac:tor I . i ~ . ,. .....,'. ..' ~ company~"" ~m i ne
Signawre The H rt i e A ~ ;il r () ". RegIStered' '. N FeeCumlnt
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Address I . I 'lIcenee tI. l-=-.
~::re I I . '~m:~ F yiN
Address I I Licen&eI I
Olreclion&:
. Flft out lIppllce!ion compIMIly,
OWner & ContnlcliDr &111" back of application. ~ (Or. copy at slgl\ed connct with owner)
If DY8C' $2500. a Not1ce of Commencement b 18qulttld.(rMchanlce' work over 56000) .
Supply two (2) set. ofdnlWlng, with appllc:8ble docI.I11entatlon . .
Allow 10-14 day~ for review llItBr &ubm/ltIl date, PatDeI' - obtained from Property TBJ( Notice (http://appr.alser.pll6cogov.com)
!....
'0 Fumigation T.ant
.'. 0 HazM\OuB Material mer II or RQ FacllIV) ANNUAL
. D HaocI"~l8l1on
E3 LPIN~llnl Gas-lnsieilatlon '
. ' LPIN~~i G........':JAl Bale .
. .' . Pia_of AIIII~JlUAL
o Recreal10nal Bum
:0 Sparlder&
. D Sprinktlll' S~ lneteIIatlonl
D. ~P'I~& (~~nid.rsyej.'
o TofcIl RopflnglTar K.ta. . .
D W" riAl Storage ANNUAL
: . . App.r{;c-
$ 1 7' C\
~ 0 ,1 Valuation ~ Proj~
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; 'NOTICE OF:DEEDRESTRICTIONS: "The.underslgned understands.that this permit maY.he:subJect!'to~"de8d~1J:estrictlons".'.
which may be more restrictive than County:regulations. The'.und~rsigned,assumes responsiblllty:for:compliarme'wlth any:' .
: applicable deed restrictions.. .
UNLICENSED :CONTRACTORS .AND 'CONTRACTOR RESN>NSIBILlTlES: If' the owner has -hlred-;a ~coritractor .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 B .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 acMsed'to contaCt. the-Pasco County Building Inspection DMsion-Lloensing Sectlon,at 7.27~47-
6009. Furthermore, if the owner has hired -a contractor or contractors, he is advised 'to ,have ihe contractor(s) sign
portions of ,the "contractor Block" of this application 'for which 1hey will be responsl~le. If you, as.the owner 'sign 'as the
contractor, that may be an Indication 1hat he is not properly licensee:! and is not entitled-to 'p~rmltting :priVlleges in .Pasco
County. "
CONSTRUCll0N LIEN LAW (Chapter713. 'Florida Statut..,.as :amended): If valuation of work is '$2;500.00 or mOrB, I
certify that I, 1he applloant. have .been provided with a copy of -the --Florida Construction Ueo Law-Homeowner',
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 cop)' of the above described document and promise in good 'falth to
deliver It to the .owner" prior to commencement.' . .
CONTRACTOR'S/OWNER'S,AfFIOAVIT: I certify that all the Infonnatlon 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 pennlt- to do work and installation as Indicated. I certify
that no work or installation has commenced prior to Issuance of a permit arn:l'that all work will be performed to
meet standards of all laws 'regUlaUng construction, County and City codes, .zoning regulations. and land
development regulatiollJi in fl:le 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 'fOOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit priOl"'to commencing construction: .1 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. constructiDn 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 Ume the work Is commenced. Al1 extension
may be requested, In writing, from the Building Offtclal for a period .noUo'excHd ninety (90) days and.wlll demonstrate
justifiable cause for the extensiDn. If work c,eases for ninety (90) consecutive days, the job Is considered abandoned.
CONTRACTOR
Subscribed Bnd swam tD (Of aftIrmed) tIefore me this
. by
. Who islal'8 personally known to me or hasJhll"lfG produced
as 1dent!ficaU0I1.
,
;/) C '-fiLl . t ck t) (}L,,-11 . NotllllY Publln
- II
Commi5s1on No, . .
1S (: +j " 0(~ {~-' 4;, 1\5
Name of NDIBIy typed., rlnted or stamped
No1ary PUbHc
Commission No.
Name of Notary typed. prlnlBd or stamped
.e.~;.sy , I
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~ommj5sion # L..b28762
, / ':it 22, 2010
Bun~..::;(.;, L4.U A~lU1h:'i... .-1(J.L-,l:ing CO,) Inc.
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ACORD". CERTIFICATE OF LIABILITY INSURANCE I DAft IMMIDIlI'fYVYI
04/0812008
..I'tOOUCER THIS CERTIFICATE IS ISSUED M A MATTER OF INFORMATION
Carroll-Marshall-Haines, Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
205 Ave G SW ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Drawer 1460 !INSURERS ~~~I;?~~ COVERAGE
\Mnter Haven, FL 33882-1460 HAle"
INSUltED HARTLINE ALARM CO INC INSURER A; SCOTTSDALE 'NSU~~rLG.EJ~.Q~.e~b1Y 41297
P.O.BOX 1257 INSURIiR B; .--....-.---
LAKE WALES, Fl 33853 INSURER c:
INSURER 0:
INSURER E:
COVERAGES
lliE POLICIES OF INSURANce USTED 8ELOIN HAVE BEEN ISSUeD TO THE INSURE!D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrrHSTANDfNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSUAANCI AF~DED BY THl! POLICIES DESCRI8eD H!REIN IS SU8JECT TO ALL THE TERMS. EXCLUSIONS AND CONomONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'Ol.-,;;;r DI'IM~r----'-'-
'OlICY NUIIBR ,... ICY !....CTIYe LIMITS
A ..!!,NElIAL L1A1IlU1'\' CLS1~83194 03/05/08 03105/09 Eo\CH OCCuRRENCE S 2 000 000
~ :=iMERClAl GENERAL l'''8IUT'I ~~S'EB_\ . 50 000
_ CI.AIIolS N"oe ~ OCCUR liED ElU> lAI'II ClIlI p_nl . 5000
"ERSON~ .. AlN INJURY I 2 000 000
GfNER"lAGBRE~TE I 2 000 000
~N1. "GaAn! LIttIlT "'nPER: PRllOUCTS . COMPIOP -'GG S 2.000.QOJt
POLICY ~:.P; LOC
~TDMoelU! UAIIlU1'V COMBINED SINGl,t L1111T .
I-- ANY MITO (EucCldlntl
'-- ALL OWNIiD AUTOS BOOll Y INJURY
GCHEOUI.EO AUTC)$ (Pet p_> I
-"
1-- !-lIRliO Auros BOOfL Y INJURY
S
'--- NQN.QWNIlOA\lTOS (PI'ICClillenI)
-- ---..- PROPERTY DAM"GE S
(Pit ICCIclenll
~IUGE I.IABIUI'T AUTO ONl. v - Eo\. ACCO!NT S
ANY -'lUTO EA I\CC S
OTHER THAN
""UTO ONL Y~ AGG S
DIS'~MIIAILlA UAllUIY EACH OCCURRENCE S
OCCUR 0 ClAIMS MADE ~~
AGGREG-'lTE S
S
q lleOUCTllII.E S
RETENTION S S
WOfUtl!RI COMNNSATlDIl AND ~we ST-'lTtt.1 IOlr'
lIi....~OftRI. UMII.ITY .OBY..I.IMI, S.
AIN PlItOPRIliTOR"'''RTNERII!XICUT1VE E.L. Eo\.CH ACClOENT S
OF"ICIi~~R DCLUDID')
~~CI1~U;0Ns bIIl1W E.L. DISEASE - EA EMPlO'l'EE S . .-
E. L DlSIiJ\SE: . POLICY UIIIT I
DTHIR
DEIC".,TION Dl' DPER-'lTIONS' I.OCATKlNS I VEHICLES/ DeLUSIONS AOIlI!D BY ENDOItSEMENT' SPECIAL PROVlSlClN8
CERTIFICATE HOLDER
CANCELLAnON
CITY OF ZEPHRYHILLS BLDG DEPT
FAX; 813780-0021
5335 8TH ST
ZEPHRYHI LLS, FL 33542
/
SlflOULD IWY OF nte ...oV! 1lI!SCltlOID POIJCES BI CNlCEUED BEFORE TlfE UP.AnoN
DAft ,"I~D~. ""I ISSUlllG INSURER WLI. I;NOli"VQIl TO MAl&. ....1L ~YS W1tITftN
NOllCE TO TM. ClrItTl~ICATE MOLDEIt MMlEll TO ~ !.EFT. 8VT FMoURf1 TO DO SO SHALL
IMPOSE NO 08UG.foTION DR LlIoIIIL"" M lUll,. 1111I0 UI"ON THE INSUII!!R. ITS AGeNTS 011
REl'IIElENTATNES,
AUTH~ P SENTAnv~
II
ACORD 25 (2001/08)
ueV~1:Y
4/tl/ZUUtl l:U~ ~M ~AUc
Z/UUZ
r ax ::leever'
Cwlifioale of In.u..nce
Thll OIriIflGI&.III...,~ _ .1MIl. d Infarm~CI'l CI'lIy .,d Galf., no ~."a, L1Plllth. ClrtJIGI&. Haw dh.th., th_ provtded by 1111, pall~.
Thll OIriIflGI&. daa nal Mlll1d. ...,d. or Ill. 111. cav...llft'orded by 111. pald_ ducrlbed h__n.
MARSH
9000 Town Center Perkwy In....,... Affording Coy_ge
Brademon. FL 34202 AnI...... ...... Auur... Co~
Cove..g..: M_II. fill AnI..... Inl.ft."'.' Draup,ln&(AID)
n,q II to aeriIfy th.. .. paIIay(Iu) oIln11nnae d.-Jbed "-In heYe -..1...,11I the InIInd ..-rted hMIIn far !hi policy peItad IndIcI8IId.
NatwlI1...,d1ngIl11 I'tIqUlrftll1l,l.-m or GaldlllCll dll11' aanlred or a1h. daa.J1Mnl with ....ed 10 whldI... ClrtJIIGI&. ,.,., be I..,ed ell' mll1 pertlln.
1I1.ln..,.,w ....crded by th. pall~I_) ducrlbIId h.eIn I, ..bled 10 IIIllht1t.ma. GCI'1dIIICIl,.,d adLIlI_ d aldl paIIcw(I-l.
(AuIr....) UmllllhCMn "'111 have b., reduced by plld c:llllm..
Type of In.u..nce Cwlific:lte Exp. Polic:y Num..... Limin
Dlle
RMWC44G2574 EmPloy.. Liability
Worb.... 1.1.2001 Badly Injuly Br AlxlidenI
Compenulion RMWC4I15117 0.11IO.000 E&t1 Acldclenl
Badly Irpy By 01__
0.11IO.000 PCIII~ Umll
BadlIy 1~L1ry By 01_
h.OIlll.llllO Eect1 P.1CIl
other:
Employ... LMMd To: Effec:tive DII. : Ol-07A1f-ZOOI
.07'.Bartline Al.~ co IDe
Th.IIbav. rtI..,oed wcn.,' aampll1_CIl pall~(I"1 prwlde(,I_lIIuIay bIIllIIll only lo ."plqr.. dthe fUmed lnalred(1) CIl ..dl pafl~(Iu). "alla
th. ."p1ay_ dIllY Cllh.. ."play..
Notic:e of Clncellation: Should any d the poIcIeI deIcrlbed h8r8h be cancelled blIfanI the __Ion date ther8ct, thllMurar
III'fordlng CCWII8g8 wt. endelIvor to mel 30 dBy. write" I'lClIlce to the ClMtIfIcatI holder nemed hlnln. 1M fallul'l to melllUCh notloe
.han Impoee no obligation or IllIbllly d any kind upon thllMnr alfonlng ClCMlrage. I. 'G8'dI or l'I.....nIIIlV8I.
CeJtifiOllt. Holder
~e.~
City of Ztphyrhilll
Building Dept
5335 8th St
Zephyrhilll. FL 33542
Michael C. W....
A~horlllcl Reprw.entatlYe of M'Nh USA Inc.
(1111)443-84811 OI-Aft-ZOOI
PhCll.
DallIIIalId
OJ~QQgill~
ALARMS, ACCESS CONTROL & CCTV
Florida State Certificate #E FOOD 1006
SPECIAL POWER OF ATTORNEY
I, Harvey L. Hartline, an Alarm Contractor I License license holder,
Number EF-OOOI006 and a full time salaried employee of The
Hartline Alarm Company, Inc. do hereby appoint Mark L. Jones~
Alan L. Hartline~ Charles Caudill as my Attorney-in-Fact, to act in
my name and place, and for my benefit and on my behalf with
authority to do the following:
To sign for me, in my absence, any documents necessary to obtain
the proper permits to start and complete the installation of any
Hartline Alarm Company, Inc. security/fire alarm system.
I hereby grant to my Attorney-in-Fact full right, power, and authority
to do every act, deed, and thing necessary or advisable to be done
concerning the above powers, as fully as I could do if personally
present and acting.
This Power of Attorney shall become effective as of April 1, 2008,
and shall continue effective until March 31, 2009, however, that this
Power may be revoked by me as to my Attorney-in-Fact at any time
by written notice to my Attorney-in-Fact.
Dated~~e Wales, Florida.
Harvey L. Hartline
STATE OF FLORIDA
COUNTY OF POLK
On this-:/.D' day of ',;-~J , 2008, before me, the
undersigned, a Notary Public for the State of Florida, personally
appeared Harvey L. Hartline, to me known to be the identical person
named in and who executed the above Power of Attorney, and
acknowledged that such person executed it as such person's voluntary
act and deed." "': ;':'T'''r (~\~T 7FFLORlDA1, ./ 1
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";'J. .:2N@fl)ARY PU LIC
P. "i ~~,\~.~nu( l;onJL:l.g Co., Inc.
Lakeland, FL
863-686-1575
Corporate Office:
P.O. Box 1257 · Lake Wales, FL 33859-1257 . 863-678-0678 . 800-446-2345 . Fax 863-678-1236
Sebring, Fl Orlando, FL Tampa, FL
863-382-2590 407-472-1270 813-490-1697
Vero Beach, Fl
772-567-2902
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lIcE~~~~IAL PJ;?~&pUNTY LOCAL BUE~'~sESS9h~~ECIDrsT
A
LOCATION:
401 N SCENIC HIGHWAY
45 - LAKE WALES - IN - IN CITY
HARVEY L HARTLINE
OWNER:
230000
L TD CONSTRUCTION
30.00
THIS POLK COUNTY LOCAL BUSINESS TAX RECEIPT MUST BE" CONSPICUOUSLY DISPLAYED AT THE BUSINESS LOCATION
0000003000 0000003000 0000000000007615 1001 0
HARTLINE ALARM COMPANY INC
PO BOX 1257
LAKE WALES, FL 33859-1257
RENEWAL
30.00
ADDLFEE:
PENAL TIES:
TOTAL:
BUS TAX TYPE:
BASE TAX:
I
.. 0
I
. -
. I
..:. ..:~..
Of
55.00
..II] =-:eta i :::II] 1]:::1:. t.:.':CIiI] 1I11:{1i ICI]: '1C!I'::I~'~11~""KII:.lI':II);_'UOD:J~':1I11"'.:I_ICI:IC'I5'''[I.I=-':I."1;jC1""1Cfl~M'_"""'A,.,.;mI:tr..:<""""IlIl_
THIS POLK COUNTY LOCAL BUSINESS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED AT THE BUSINESS LOCATION
I .
IMPERIAL POLK COUNTY LOCAL BUSINESS TAX RECEIPT
LICENSE I ACCH 2150000009 EXPIRES: 9/30/2008 CLASS
LOCATION: 401 N SCENIC HWY B
45 - LAKE WALES - IN - IN CITY
OWNER: ALAN L HARTLINE
230035
230037
440012
530115
CONTRACTOR ALARM
CONTRACTOR ALARM LIMITED
DEALER TANGIBLE PERSONAL PROP
RENTAL SERVICE
THE HARTLINE ALARM CO INC
HARVEY L HARTLINE - ST CERT
PO BOX 1257
LAKE WALES, FL 33898-0000
BUS TAX TYPE:
BASE TAX:
RENEWAL
55.00
ADDL FEE:
PENAL TIES:
TOTAL:
0000005500 0000005500 0000000000012395 1001 4