HomeMy WebLinkAbout08-7804
,
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7804
ermit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
7804
FIRE PROTECTION MAINTENANC
FIRE-PROTECTION MAINTENAN E
COMMERCIAL
Address: 38220 HENRY DR
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
4/28/2008
25.00
25.00
4/28/2008 Phone:
FPM-HOOD SUPPRESSION SEMI ANNUAL-HEARTLAND OF ZEPHYRHILL-DONE 1/08
Name: HCR MANOR CARE
Address: 38220 HENRY DR
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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN AITORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
'--
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPEcnON
CALL FOR INSPEcnON - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
APR/II/2007/WED 02:41 PM ZEPHYRHILLS BUILDING
813-78()'()020
P. 004
F~-813-780-0021
. '1..
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Date Received
.
Owner'5, Name .
Fee Simple Titleholder NaITlB
~ee Simple 'TItleholder Addre88
FG a
TltIehold~ Phone Num~r . L N,{] .L
J'L
OwrIer's Addre&&
Job Address
Sub Dlvlslon
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Or
. \'"1,;1 Is' FL. 3~Yo
PBrceI #.
Cof\trIIctol'
SIgnature
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. Bio-Huard W88te Storage -ANNUAL 0
Comm ExI1sUlit K1t!ltlen HlIOd/Duct D
Contrallfld Bum 0
I::rnergenoy Gensta10r .:.: 30 kW .8 .
erriBrgencY Generatei' ;>0 30 kw
Fire Protection MalntenallCle - AtlNUAL ,
. ~ 'I!!!!.I ~ IUIfIIlI' .
:~:~ ~D ~ ~ ~ ~ =natBu~
Hood ClMni~ 0 CI 0 t::J. Sprinkler Sy8Wm InstaIlaIloII&
Hood SuppnnWon tl X [] 0 ~dplpee (spdnkJer Sys)
FlreA~nn'lnstalllltlon eWe- ~ocJ o..lr~j ~ E3 TOl1lhRoofing/l'arKettIIJ
Fire Pu~ .~' I ('\ sp~.c.:\.-'I~" ~ '" Waste Tk& Storage ANNUAL
Fn \lYcrb \ loB n:::..\: "'~\., \Nt.. ~
Fl8mmabIIiAppllcaUon-ANNUAL "~c:k.J,' 0" PlV:-~'+ J$IO~ Oc:> ,I Valuation ofProjeQt
J=U81 Tanks
Other:
F~mlga~n Tent
HlIZaIdous Material (TIer Il or RQ Facility) AIoINUAL
Hood Installation
LP/Natul'l.l Gas-Installation
lP/Natural Ge&-ANNUAl ~
PlslHlS of Ae&lirnblyoANNIJAL
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MEOCHANICAL[
Signature
AddlU5 I
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AddIus I
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Rsgl&tered.
, LIGeI1&B #
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F.. C\Jr\'ent l-.Y' I N )
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Fill out applieQon campletely. . . .
OwrIer " C:~r sign baok of 1lPPI1aatIon. nclarizIId (Or. copy of sigl1lld contI1ICt with owner)
If over 12600., NQ\toe of Commencement Is required,(MeohiI~1 WbIi< over $GIlDO) ,
Supply two (2) 8Bt& of dtaWlngs with .ppli~b" documentllliCKl . .
Allow 10-014 days for revl_lfter submittal date. ~I i# - obl&lllMld fmm ~perty TIDC NotIce (http:t/appnllllier.plllCOllOV'.com)
APR/II/2007/HED 02:41 PM ZEPHYRHILLS BUILDING
FAX No, 813-780-0021
P. 005
'MOTICE OF :DEEP 'RESTRICTIONS; 'The .~nderslgned understands ,that thie permit may .be:8ubjecttto':"d_~1tes1rletions.'.
which may be more restrictive than County.regulatlons. The'.underslgnad.assumes respbn$lbfllty:forlCOmpJlaACe'with any.. .
.applicable deed restrictions. .
'UNLICENSED :CONTRACTORS .ANP . CONTRACTOR RESPONSIBll.;meS: If the owner has 'hlred':a ~contractot 'or'
contractors 'to undertake' work, they may be required to be licensed in.accordance with state and 10C81'~lations. If the
contractor is not licensed as required by law, both the owner :and 'contractor may be cit8d '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 aavlseci'to contact the.pasco County Building Inspection Division-Llcensing Sectlon.at 727.-847-
. 8009. Furthermore, If the owner has hlred.a contractor or contractors, he is ad\'lsed to have "the contractor(s) sign
portions of the Rcontractor Block" of this application 'for which 1hey will be responsible. If you, as'the owner 'sign 'as the
contractor, that may be an indication 'that he is not properly Iioensed and is not entitled 'to 'permlttlng .prlvlleges in Pasco
County.
CONSTRUCTION .LIEN.LAW (Chapter713. 'Florida Statutes,.as:amended): If v.aluation of work Is '$2;000.00 or more. I
certify that I, 1he applicant. have been provided with. a copy of ' the RFlorida COnstruction .Lien Law--Homeowner's
Protection Guide". prepared .by.the Florida Department of AgrIculture and. Consumer Affairs. If the $pplicant 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 RownerM prior to commenoement. . . .
CONTRACTOR'SIOWNERtS.AFFIDAV1T: I certify, that aU 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 too,btain a pennlt 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 U1e 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 idenUfy 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 construc;J:lon. .1 understand that a separate permit may be reQulr~d for electrical work,
plumbing, signs, wells. pools. air conditioning, gas, Dr other Installations not specifically Included In the appllcat.lon. 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 Offioial from thereafter
requiring a correction of errors In plans, constru~on or vlo!atiollS of any codes. Every permit issued shall become Invalid
unless the work authorized by suoh permit Is commenced within six months of permit Issuance, or If work authorized by .
, the pennlt 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 'perlod not to exceed ninety (90) days and wlU demonstrate
justlflable cause for the extension. If work ceases for nlne~ (90) oon8eoutive days, the job is considered abandoned.
WARNING TO OWNER: 'YOUR .FAICURE TO .RECORD A'N011CE 'OF 'COMMENCEMENT MAY"RESULTIN YOUR
PAYING 1WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
Y E 0 B E 0 INOY NOTlCEOF NT.
FLORIDAJURAT(F.S 11?)l3} I ('. '
OWNER OR AGENT _ -.J ~ I
$ubsciibed ;md sworn to. (or s.tIinn ) b."~m. .. . P:Y I I
~~~r~~'1~~~veProd~d. .
, ..~." I < ~ ..\....... as identification. . .
CONTRACTOR
Sl.IbIcrlbed and sworn t\) (or aflinnecl) before me this
py .
Who IsI8re ~y known to me or ~ve produced
as id8l'lllllcatlon.
CL3~_.-
CommiMlon No. . .
Notary PublIc .
Commission No.
Name of Notary typed. printed or stamped
Name of Notary typed; printed or ltamped
p,,, .
_ .~ r,.-....", '...
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DMSION OF STATE FIRE MARSHAL
TALLAHASSEE. FLORIDA
FIRE EXTINGUISHER PERMIT
.
nDSCERTIFlESllIAT: TIMOTHY SCAUI
EMPLOYER: EVEREADY FIRE.t SECURITY EQUIPMENr INC
7933 WEST HOMOSASSA TRAIL SUITE A
HOMOSASSA, FL 34441-
~CENSE NUMB;;) 08194700011985 - FIRE EQUIPMENT CLASS D UCENSE L o..-""(;("\'z.1" ~)
F- ---
HAS COMPUED WI1H FLORIDA STATIITES AND HAS QUALIFIED FOR 1lIE TYPE AND CLASS SHOWN HEREON 1'0 SER.VICE. REPAIR.
INSTAll, INSPECT AU. TYI'B OF PRE- ENOINEERED FIRE EXTINGUISIBNO SYSTEMS.
CWefI'iaMW omcer
tlh,c ~
01 01 2008 09 04
. Issue Date Type Class
Citros
County
t in.1! T\:oindt NanIIIcr
9860410002 12 31 2009
AppIic:Ition #I ExpiR ..
A L.Urn,( ~t:K III-I~A I t: UI- LIAtslLl1 IN~UKAN~t: I 04/14/2008
PItDDUCER (352)126-3818 FAX (8")883-8680 THIS CERTIFICATE I8I8SUED AS A MATTER OF INFORMATION
L.ssiter-~are Insurance ONLY AND CONFERS NO RIGHT8 UPON THE CERTIFICATE
HOLDER. &~IS ~~r~~IICATE DOES NOT A~~AhglE'~~.
of Citrus County ALTER TH COV RA E AFFORDED BV TH P S B .
PO Box 1209
Inv.rn.n, FL 34451 INSURERS AFFORDING COVERAGE NAIe II
INSUR&D INSURER A Burlington Insurance Co.pany 123620
Eveready Fire .. Securi ty INSURER B
P.O. BOK 250 INSURER c:
no.osassa Springs, FL 34441 INSURER 0:
NSURER E:
From; SSS-SS3-S6S0
To: 13526211222
Pre: '213
Date. 41141200S 3'22'42 PM
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING
Nf( REQUIREMENT. TERM OR CONDITION OF Nf( 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.
_ l'i'I"IIll' INSUJltANCI! PDLICYNUMBM ~~ LIMITS
IH!NIIW. LIAIUTV HGl.0018203 03/06/200lJ 03/06 2009 EACH OCCURRENCE S 500.0od
I--
X COMMERCIAL GENERAL LIABlLfTY DAMAGE TO RENTED $ 50. OM
I CLAIMS MADE [!J OCCUR MED EXP (Afri one person) $ 1,_
A PERSONAL 8. ADV INJURY S 500.001.
- 1. 000. OO(
GENERAL AGGREGATE $
- 500,001,
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMPIOP AGG S
I POLICY n ~8t n LOC
~MOIILI LIABILITY COMBINED SINGLE LIMIT S
ANi AUTO (Ee eccident)
-
ALL OWNED AlJTOS BOOlL Y INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AlJTOS BODILY INJURV
- $
NON-OWNED AlJTOS (Per accident)
-
- PROPERlY DAMAGE S
(Per accident)
OAAA~I LIABILITY AUTO ONLY. EA ACCIDENT S
=i Am AlJTO OTHER THAN !!AACC $
AUTO ONL v: AGG $
I!XCI!SSAlM8RiLLA LIABILI1Y EACH OCCURRENCE S
=:J . OCCUR 0 CLAIMS MADE AGGReGATE $
S
=i DEDUCilBLE $
RETENilON $ $
WOIV(I!lUI CDMPI!NlATION AND I iORYl.iMrl'S I lo~r
IIIPLOYIiA8' LIABILITY E.L. EACH ACCIDENT $
ANYPROPR~O~ARTNE~CunVE
OFFICERIM BER EXCLUD 01 E1. DISEASE. EA EMPLOTEE S
~r.t't~~~~~~~NS below E.L. DISEASE. POLICY LIMIT $
[Illol1!1t
DUCRlPTlON OF OPERATlONII LOCATIONIIVlHICLEI/IXCLUIIONI ADDED IV INDORIIMENT IIPICIAL PROVIIIONl
City of Zepbyrhills Building Depart.."t
5335 8th Street
Z~hyrhills, FL 33542
CA ELLA N
IHOULD AN( OF THE AIM DIICRIIED POLlCIllIE CANCELLED IPORl THE
EXPIRATION DATI! THI!IlEO~, THE ISIUING INSUlUiIt WLL I!NDIAVDR TO MAIL
-1lL. DAVI Wltl'TTl!N NOTICE TO THE CIImFICATI! HOlDER NAMID TO THE LiFT,
IUT FAILURE TO MAIL IUCH NOTICE lHALL IMl'OtI NO OBLIGATION OR LIABlLn'V
OF AH't KIND UPDN THE INSURI!R, ITlI AGB'lTI DR ItEPRliHNTATIIIH.
AUTHOItlZI!D IU!PUII!NTAT1VI! . "1/; '.1 . fr' /,
r!lhlr.1I'1. i'r~' 'Y',.J.'
if ' (.1
ACORD 25 (2001108) FAX: (813)180-0021
MCORD CORPORATION 1888
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EVEREADY FIRE & SECURITY EQUIPMENT, INC.
PO BOX 250 HOMOSASSA SPRINGS, FL 34447
7933 W HOMOSASSA TRAIL HOMOSASSA, FL 34448
352-628-3553
352-621-1222 (FAX)
A.CD.BD", CERTIFICATE OF LIABILITY INSURANCE
COVERAGES
TME F'OUClES OF INSURANCE! USTED BI!!LOW HAVE BEEN ISSueD TO THE INSURED NAMEO ABOVE FOR 'THI!! POLICY PEI1IOD INOICATEO. NOTWITHSTANDING
ANY REOUlReMENT, TERM OR CONDITION 0fI ANY CONTRACT OR OTHER DOCUMI!!NT WIT1-! FlESPECT TO WHICH THIS ceRTIFICATE MAY BE ISSUED OR
MAY PEFlTAIN, THE INflUAANCE AFFORDeD BY THE POUCIES Ol!SCRIBED HEREIN IS Sl.8JECiTO ALL THE TERMS, EXCWSIONS AND CONOmONS OF SUCH
POUCIES.AGGREGATE UMlTSSHOWN MAYI1AVE!eN REDUCED BY PAID CLAIMS,
1'aIJtl'f .......liR. lYE I'alJCV IXPIllaTlaN UMITlI
I TII ...._
~LLIMIUTY E4CHOtlI'lUE; $
i COMMIiACI/ij,GEN9IAl.LJABjUTY .
I OLAlMe MADE 0 OCCUR MEt> EXF' (Any lllle_l $
- "eI'l9ONAl.. & ACN INJURY $
- GIi~~GGRiGATe $
~lAGGFIlinUMITAI"nPeRl PfIOCUOTS. OO"."IQII AGQ $
I"OUCY ~!l~ L.OC
~UA8IIJT'I COr.tlBINIiO SlNGLf UMlT ..
ANY AUTO lEI --'1)
-
- ~L OWNED AUTOS Broil Y INJURY
(l"er 1lIIr8OO) $
- llCHEaULfD AUTOS
I-- HiReD AU'l'OS BODILY INJURY
(.....actOdtlnl) $
I-- NON-OWNED AUTOS
~DAMAaE $
(PI\/' Gl1ldInl)
~GELlAlJIU1Y AU'l'OONLY. SA ACCICiNT $
Holy AUl'O OTHIiRTHAN eA ACe $
AUTOOHLV; AGG $
EXCI!lIlI/UMIIRl!LLA l.IUIUTY GACH OCCUl'lReNCIi! $
o OCCUR 0 CLAlMS......DE AGGI'a!GATE $
$
R .DEOUCTIElI.E $
RETENTION $ .
WClRKERSCOIIJlENSA"ON .-HD X 1Nc: GT ATU- I 10J.ti-
.I'LOYII'I&' UIIIlUTY a EACH ACCIDENT 1,000,000
A INr Pl'lCI"I'UfTOII/IOARlNiRlllCiCUTlVlii we 4O~51-066.00 1012512007 1012512008 $
OI'PICElVMEUEI&R EiXCLUOED'I ~L, DlSiASl! . EA EMPl.OYE.I; $ 1.000,000
I g~~~~~~e- 1i.L. DISI!!ASe. POUCY !.NIT i 1.000,000
OTMIR Cerdtio8bll:
Location Cover.ge 'Period: 01/2112006 1 012512OO8 07FLO'76789345
Cllentt: 298
balal"11Q111 OF OPElIATIOI'e8/ L.OCATICIN& IYIlHICU:S' IXCLIJSION8 AElIl1lD SY ENIXlRlIEIIEiNT I SPlCI... PIlOVISlONS.
Cavel1lQ8 ill provtded tor only Eveready Fire & Seclll'lty Equipment lnc
IhDH ernQloyeelleased to 1933 W HomOBB:IS Trl S. A
but not 8ubaanlraotol'l 01: HomOll88S Springs, FL 34447
..u .
PRODtI(lUI
Andrew Catapano c/o USI Northeast
555 P1tasantville Road
Suite 201 North
BriarcHft Manor, NY 10510
lNaulIEI)
DSK Group, Intl. et al A1t. Emp: Eveready Fire a. Security Equipment Ine
6716 W Grover Cleveland Blvd
HomOS8S$a. FL 34446
CEATIPICATE
SA
CITY OF ZEPHYFlHILlS BUILDNG DEPT
5336 8TH ST
ZEPHFWHILL.S. Fl 83542
ACORD 25 (2001108)
DATI! c..wD/YYVY)
04117/2008
TtlS CERT1F1CATE IS ISSUED AS A MAlTER OF INFORMATION
ONL V AND COrftRS NO R1GHT6 UPON THE CER11FICAT!
HOLDER. THIS CEJmFICATE DOES NOT AMEND, EXTEND ON
THE COVERAGE .. THE POUClE W.
INSURERS AFFORDING COVERAGE
IN I'lA: Zurich-Am8rican Insurance Compen
'"SUAEI'I8:
lNSUFlEl\ Cl
INSURER D:
INSURER Ii:
HAlO"
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