HomeMy WebLinkAbout08-7769
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
FUMIGATION TENT PERMIT
7769
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:
7769
FIRE FUMIGATION TENTING
FIRE-FUMIGATION TENT
NOT APPLICABLE
Address: 6143 PLEASANT T
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: OAKSIDE MHP
Parcel Number: 02-26-21-0020-00300-0010
4/17/2008
50.00
50.00
4/1712008
FUMINGATION SWMH SCHED 4-28-08
Gl~ tY
if6
j
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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
~
~I ~ONffiA~IG~ P - -I: O~I~ER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
LOCATION: 0143 p~~ ~ ,~
Type (House, Apt., Store): SWf\t\\-\
Fumigant (Brom-O- Gas, Vikane): V ~
L\'-~8-u~ .
Scheduled:
Date:
Exposure Period: 24 Hours
Certified Operator in Charge:
BOLTIN PEST CONTROL, INC.
NOTICE OF FUMIGATION
Approx. Time:
4pm*
HERBERT BOLTIN, JR.
* '-\ pm is approximate time we will
shoot the gas. Our technicians
will be at the site at Bam to
put up the tent.
Dade City
352-567-2395
Toll Free
888-272-2871
15534 U.S. 301, Dade City, Florida 33523
n\'j~1 1'1.: (U'.~';' hL.V 'JL,~''t ~l~~ L..:-...rnln.fllL.....,.j .rY)iL.!..'j!"~'-.)
r~! !~~. OlJ~.!OU-U'JLl
r. :_'U:
Fe~ Simple Tltleh9lder N4lme
CIty of.zephyrhfll~ Pire rt: 1111. ~
P It A /'..l.' -., I(i.
. errn PP ,c",Ion . .
r --... pron~~~r"pe~~..J,~aJ-C~~-::! tLL~~J~
. J owner's Phone NU~be! I . I.' .,r--
S~, 4\1~'fL 3~SLf~ .
. ~ Tlbet10lder Phone N1.rnber [ II II
Fa)(~13-7eO-0021
813-780-0020
CNmer'5 Name
Owner's Addr~s
Fee8iml1le ~itleOoIder Addre$s
".... ~'_a::..:._:~
-" 1~- J
~.""'m~11-t:'11
'1i"~P"'"
~.._~:t:i~.
Job Add~
. S'Jb Oivi$ion
1:.-.1.
r .. '~n . ill
.0
o
D
D
o
o
Firll Prateaiion Malntenanoo ~ ANNUAL
Sl1l1nkler
FIre.A1arm .
.0
D
D
Hood Cl$arilSuppre..",l-.JI'i
.Flfl~ AJaim 'ltl..ta~:ation
o
o
.0
o
o
D
FIre Pumps
standplpa.\: (Sprinkl~ Sys)
Torch Roollng
Flr& WarIts
FllimrnabJe App"~tlon- ANNUAL
. Fuel T~
.,
Valuation ~f Project
Other:
Contrilcb"
Signature
Address
Company
RegIstered
LJcel\3e if.
~~t' R-s-t- ~ .
r Y I N i FeeCul'r$n\ 'L_Y I Nl
.1 ~e. ~L(3 1
L Y IN I Fee Current I Y IN.:)
I ~:J
.1 Y I N r Fee currant Y ! N I
I
ELECTRICIAN Company
Signature . R~tst~recl
Adclrl!laa r -J Ucen:e #-
PL.UMBER .1 .~.' Company
Signature' . ~ R~istered
Adcll'Elss. f I Uce~fJ # .,
~:1~=4 . .l.~~;~~~.f
Address r I Ucense # I
:i".L ..,,~~__ _"._~;:.;,-.:~:. "'_'. _~~~ ! : IN
FIn out qpplleatlon completill)'. . . . .
. Owner & COntractor sign baak of eppljcation.rlOta~ed (Or, ~opy or" $lgned contract WIttI owner)
If over $2500, II Nlltlo::* of Commencement is roql.linild (Meo,"'ank.a! work over 55000)
SUpply two (2) sets of dT5WinSl~ with applICable dacurneniation
Allow 10-14 dllyslor relli.ow after ~ubm!tlal date. .
.'~ .. .
.y I N r Fee Current
Y INj
:J
F$$ Curreni L Y {N I
. iII~t.;---....~,;~~_ .1-....
;1'."1 l'U:':U_' 1"t~, U:,,:.~:' r;:, .:::.ti.tJr;I1JL,> tC.!lL~'lI'H_;
f r. J. !'J O. I~! ~ j - ;' '~'..; - U 1..1 ~ 1
t, 'Jlh
~~__~'o-___"''''__~___---::~.'__~'''''':--''l'''__.~_''_'_ "____.. _ ..' .....;.. ...........
..~O'T,lCE.0F:~DEEO.RE5TRlC110NS: The' Uildersigned'undttfstands that this permlt m~'he subje.ctlo ~daed"'restrict;ons.
.-whlc.R may 'be.more re~trlctive.than County ~gulatioo5. Theunclersignad. assumes 'responsibRity'for Compliance with ar!y
applicable deed restrlctians. . , " .
'UNLICENSED.CONTRACTORS AND ,CONTRACTOR RESPONSIBIUTIES:. If' the owner' has hired:2 contractor or
contractors to undertake work, they may bGl T2<juJrad .to .be . licensed 1rl zooorclao<>> with 'state and. locaL'regUlatlons. If:the
contractor is not licensed as requR-oo by law, both the owner and contractor may be cited for a.tDlsdemeanor violation
under state law. tf the owner or Intended cont~ctor are unoertain a:s to'what licensIng :requiraments may apply fOr the
intended work,they are advised to oontact thef'asco pountyBuidlng Inspection' Divl~lon-l.:lcensing Section at 7.21 ~64 7 ~ .'
. 8000. -t:urthermore, If the owner has h!reda oontractor or contra(,wrs, he Is advised to have the contraotor(s) sign
. 'portIons. of the "CQntractor Bloc!<" of ti-tl$ ~plical.ion for. whIOh they W11i be responsible. .!f you, as the owner sign as the
- contractor, .ft-.at may be anlndicat10nfhat he Is not properly licensed and is not entittedto per:mitting priVileges in Pasco
County. . . . . '.
-CONSTRUCTlON'USN'LAW (Chapwl''713, 'Florida StatutS8"as amendfld): If.valliation.ofwork is-$2.50D.OC or more; 'I
. CertIfY that I. ihe applicant, have peen provlded with a copy of the . afllJrldaConstructlon. Wen Law-:-Homeowner's
Protection GuideR prepared by the Flonda Department of Agioulture and CO:lSlJrner Afiak~. If the appli~nt i$ 5omeone
other than' the .owner-, I-certify that I have obtained a copy of the above' descrIbed document and promIse in goOd faIth to
delive~ It to the .ownerw prior to .commencement. . . . . .
.. . CON"mACTOR'S/OWNeR'S AFFIDA VlT: I certIfy that all. ~e information In this application ,is accurate and .'
... .".. ,.- -'that. all''\vork .wIlI. he 1:1000 In compliance. with-'all--app6oahle'.~w5 .regl:llatif\g-oohttnfOt~Gfli":'ZORIAg'.:and-laRd.n---:_.
devetopmenl AppUcatIon is hereby made to obtaIn a perm!tto do work. and JnstaUation as indicated. I certify
that no. worfe. or installation has commenced prior to Issuance of tI permit and that all worl< war be perfqnne.d to
meet atandardi'l of all laws regulating construction. County and City codes; zoning regulations, and .land
. develop'm~"t regulations In the jllJ"isdioliOl1. I. al;o certify .that I understand that the regl:llatians of other
government agencies may apply to the Intended \Vork, and- that It Is my r:esPoI1;IbGlty to.ldsntlfy what actions I
. mustiake to be in compliance. . '.. .
Ifl am the A~ FO~ THE OWNeR. I promise in s?Dd faith to inform the ov.iner of the permittirig. cOnditions set forth,ln
thisafijdavff Prior 46. coriu'flE'!ooing construction. I understand that a separate permit may -be required for. el.ecb1car'W9rk.
plumblng, signs; wellS, :pools, air conditioning, gas, or other InstaUations not ~peclfIcaHy. included in the application. A
~.r.lT.1lt ;S.l;u~d. ~11:t!J~ oofisjrued to bE; B'license to prooeed with. tha work and not aiJau'thority to violate, canqei, el/ter, or
&el-asidfi aoy'prOV1~lons of the technical codes, nor shall issuance of a psnn1tprevent the BuDding Official from thereaftel
. requiring-s'oarrection at errors in plans, construction or violatlons of any codes. Every peltr\lt issued shall become Invalid
'. i:iQW~~~~~~:_~~lpQIized:'by Buoh'.pennit f$' ~mmem?ed WithIn she month~ of ~ann,lt.I~u~nce, Oiif \~ork authorized by
. the.:~[r11lt'J$ ~u~n~d or lilbandoned for a penod of SIX (6) months after ltte time the work IS commenced.. An extension
. . 'ma'y1Je ~eqli,l8;ted, ~n writing, from the BUIlding Ot'ficIaI.1or a periad not to exceed ninEtty (90) .daysand',will dl:lOlOnstrate
,jiiStitiabfe ~i.tse far the extensIon. If work cea~es for ri!nety (90) oonsacuttve days, the job Is considered abandoned,
.,. .. \ -'-', . ~ . . .
WARNING ro OWNER: YOUR FAILURE TO PJ:lCORO A NOTICE OF COMlYf5NCEMI:NT MAY RESULi IN YOUR
PAXlNG lW!CE FOR IMF'~OV~E""T.S Tq Y2UR..r.~9P.~'1Y.'tJF.y..o..u.lt!(5NP.AQ,REJ:rArfll..~'~NCJNli,. CONSULT
:' WJ;J:' )(.tn_~. - ',' . ;~A't;fD' . ~lB'5F-tnlf~REC~vm!lR.fiOiWE O,F COM~eNCEM~r. .
~-~:~'~A~NT' ....~:_..,~.:.:~~:_:_~..~u..._..:..~,.~........_....~__..~_ cO~c:i~~:.~'~~"~~p~~_.~ h' . ..... .. ...... ...._..u...u..u..
SUbs~. and 5Wt'lfT1 to {O.f ellin'.Ilod) before me tis Subsotlbed ;lIIm 5W:lCT1~1n (O~. .f\lte JIJO tlis
by_ ~~g. by _~~_.~
'M1o ware~)' k/lCIWl ilm:; ~~~ueed : ~onall)" 'M\ .. ~=~
"'C'ltary Public .
---4 V(a~AJJ'v ~ .-:(. -7Y (J / ~ Noblr>- Pltiic
.commil!$lon No. .bJ) 4L 0; / j 0. g
Katherine S. Daley
NarDs or Not1lrY typed, ~rlnlad Dr $l:nped
oOmmlslJi;.1l'l No.
Name of NDtery /wed, pMted or st1mped
,;.""'",, KATHERINE S. DALEY
i~m"~Y" "'\ NclfBry Public. - State of FIoltdI
i. . . iMr CommllIIIon Expns Jul22. 2009
'" fiI CommllIIIon.D0431368
~~ ,,9rt:'~" Bonded By National Notary AIM..
--~----------.........