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Home My WebLink About08-7825 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE 7825 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: 7825 FIRE PROTECTION MAINTENANC FIRE-PROTECTION MAINTENAN E COMMERCIAL Address: 6026 GALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 03-26-21-0010-12800-0000 5/02/2008 25.00 25.00 5/02/2008 Phone: FPM-FIRE ALARM ANNUAL-BEALS OUTLET #542-SCHEDULED 5/2/08 Name: HE S Address: 6026 GALL BLVD ZEPHYRHILLS. FL. 33542 F/lJ2 u& ~/(5 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 PERMrr EXPIRES IN 30 DAYS WrrHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 813-78D-0020 Date Received Mi:KHW~& Owner's Name Owner's Address Fee Simple Titleholder Name Job Address Sub Division D D D D D D Contractor Signature Address ELECTRICIANI Signature , Address I PLUMBER Signature Address I MECHANICAL1 Signature Address I OTHER Signature Address Directions: City of Zephyr hills Fife' Permit Application It Sq z. II O~I L.'E7'f ;tr 1 B v5 Fax-813-78D-0021 lJ Phone Contact for Permit II II Owner's Phone Number I I II Titleholder Phone Number , "__,,,rrmll'lf~- _m_ =B1ii_!l".MI~~m>i!.iffi-- I Lot# Parcel # 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 Bum D Sparklers D Sprinkler System Installations D Standpipes (Sprinkler Sys) D Torch RoofingfTar Kettle D Waste Tire Storage ANNUAL Valuation of Project I Fee Simple Titleholder Address I LlOOJ.~ I ~~~lli~Dj ~.L:.< _ ~ D Bio-Hazard Waste Storage - ANNUAL Comm Exhaust Kitchen Hood/Duct Controlled Bum Emergency Generator < 30 kw Emergency Generator> 30 kw Fire Protection Maintenance - ANNUAL ~~~D :~:::~ ~ ~ ~ ~CJ Hood Cleaning 0 0 0 0 CJ Hood Suppression 0 0 0 0 CJ Fire Alarm Installation Fire Pumps Fire Works Flammable Application- ANNUAL Fuel Tanks Other: OJllf&il~~~--"'-"1:: 1m -.. I ,.&i~U_ I 'I!Illifu I Company Registered License # Y/N Fee Current Y/N 0.-. ~ Company Registered License # Y I N I Fee Current Y/N Company Registered Y/N Y I N Fee Current License # Company Registered License # Y/N Y I N Fee Current Company Registered Y/N Y I N Fee Current License # 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. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) NOTICE OF :DEED RESTRICTIONS: The undersigned understands that this permit may.besubjectto'''deed''rrestrictions'' which may be more restrictive than County regulations. The undersigned assumes responsibilityfor:compliancewith 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 (Chapter713, 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'SAFFIDAVIT: 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 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. FLORIDA JURAT (F.S. 117.03) CONTRACTOR Subscribed and swo by IC Who is/are personally known t 'iP 1.t:- 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 typed, printed or stamped MAY-02-200B FRI 12:24 PM FAX NO, P. 02 ACORD,. CERTIFICATE OF LIABILITY INSURANCE l)~Te~0~8 THIS ~nFICATE IS ISSUED AS A MAneR OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERlIFICA're HOLD&R, THIS CERTIFICATE DOES NOT AMEND, EX1END OR ALTER THE COVERAGE AFFORDED BY THE POUClES BELOW, PRODUCER Alarm Insuranoe Agency l25D Wappoo Creek Drive, suite 18 Charleston, Be 29412 132 Montgomery Avenue Soarsdale. BY 10583 1'" 2- 200 soarOl WSUflEIl. A: INSURER B: INI5UR~ c: INSUAiR D: lNSUAiR E: NAIC" 10657 Soar.dale Security Syst.... :Ene. THe POWellES OF INSURANCE USTEO BELOW HAIlE BEI!N I"LlIlO TO 1'HI' INSURED NAMED MtCNEI'OR THI' POUCYPERlOD INDICATED. NO'lWITHSTANCINO N<f'( REOUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR 'JTHER OQCUMI'NT WITH RESPECT TO INHICI'l TI'IIS CERTIFICATE UAY.e ISSUED OR MAY PI'IiTAlN. THE INSURANCE AFFORDED BY THE POUClESoescR.IED HEAIiIN IS 6u$JSCT TO ALL THETEFlM6, El(Ql.USIONS AND CONDITION6 O~ sue", pcuc,". AGGftE~TE UNIITS SHOWN MAY H"1Ili BE!a-I flQOUceD BY 2AJD CLAIMS. ':': ~~ TYPE..... '''SURANCE POl.IOY NUM.eR ~~~ E '"8k''%Yra:r,b~qr<I UMITS ~NEAA1. UABla.m l!ACH OCCURRENCE! $ 1.000.000 ..x eclMMERCIAL GENERAL 1.1IoB11.1'TY .....is IS._1 ~ 100 000 I CLAlMS MADE I:i:I OCCUR MEP I!XI'(Anylll\._) $ 5000 A- X li!rror. Ii: I'DIOO9873-3 3/02/08 3/02/09 PeRSONAL & M:N INJUfl.Y $ ~ oon 000 X OIUssioD.S GIiNE/W. AGGRmATE $ 2,000.000 ~AOOR1ii~': APl'Url pflODUCT5 . CQMPItlP AGG S .,nnn nnn I"OUCY X JECT I.OC ~TOMOllll..E U"BILITV COl481NED SINGI.Ii I.IMrr S Al'!YAUTO (Iia l;cIClllll) - - ALL OWNED AUTOS 80DIL Y INJURY ~ ISCHSOULRD AUTOS (PDt'""",.",) f-- f-- HIRED AUTOS BODll- Y INJllllY $ NON.()WNIiD AUTOS (Per-I f-- Pfl.OP~ DAMAGE S (Pita_I) ==rGE I.IAIIIl.I'TY AUTO ONL V . EA ACCIDI!NT $ ANYAUTO 0'T11l11t THAN EAACC S AUTOON1.Y: AOrJ I 1lXCl!$6/11MBReUJ\ UMIUlY EACH oeeUIlfl!NCE $ 5 000 000 :xl OCCUIl 0 CLAlMSM"OE MlGRiOATE ~ 5.000 000 jc!uK:E000312 03/02/08 03/02/09 ~ A ~ DEDUCTIBLE $. I X RETENTION $ 10 000 $ WORKEl'S COMPENliAllON AND X ITORYUMITS I t'~ &;MPLOVERS' U"BILI'TY QB-9188Y38-9-08 04/15/08 04/15/09 Ii.!.. I!"cH ACCIDENT $ 1 000 000 ~ 1'IID1'!lI1!1lIIW1\R~ D CFFl~ E!JlCI,.lJIIE!D 14. DlSIWIE - EA EMP1.0VlIe S 1 nnn nnn 1IyIl:I.._.~nQDl' Ill. DISEASIi - POUCY LIMIT 1.000 000 SPECIAL PR0\II51ONS DeI_ , OTHiR DESCRIPTION OF OP~TtONS I LOCATIONS /VEHICLES IEXCI.USIONSIIIlIlEP llYI'NOORSElAENT ISPECIAl-f'flOI/lSIONS tIB..9188Y38-9-08, Workerl s compensation policy is valid in FL. This Acord Certifioate is B three page document. COVERAGES City of zephyrbilla - Building nept SJ3S 8th Street Zephy:rb~lls, FL 33542 CANCEu..A TION SHOULD N<f'( OF THE AIlOVa OI!SCf\IBED POLICII5 Be CANCfLl.liD BEFO..... THE S(p'f\ATlON DAllE TH~F. TI'IE ISSUING INBURE!fl. WILl EilDEAVOR TO MAIL .15.- DAYS WRITTEN NOTICE TO THECERTlF1CATE HO\.OE!Il NAMED TO nil! l-EFT.llUTFIoILURE TO go 110 6HAl-l- IMPOSE NO 081.1GA'l'1ON OR UABILI'TY OF ANY ICtID UPON THE 1N6UflEiIl. ITS AGeNTS DR REPfl.PI!NTATIVES. AUTtiOf'IIlED ""'Rl!SENT~ CERTlFICATl' HOUJER ACORD25 (2001108) MAY-02-2008 FRI 12:24 PM FAX NO. p, 03 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thIs certificate does not confer rights tothecertlflcate holder in lieu of such endorsement(S). If SUBROGATION IS WAIVED, subject to the terms and condition9 of the policy. certain policies may require an endorsement. A stateml~nt on this cerllflcate does not confer rights to the certificate holder In lieu of such Ell'ldorsement(s), DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized rElpresentative or producer, and the certIf1cate holder. nor does it affirmatiVely or negatively amend. 8lltend or alter the coverage afforded by the policie& listed thereon. ACORD2512DD"08) MAY-02-2008 FRI 12:24 PM F~ 00. P. 04 Daw: 12 8 2007 132 Montgomery Avenue Scarsdale, BY 10583 FROM:Ala~ %nsurance Agency 125D wappaa Creek Drive, suite 1B Charleston, BC 29412 843-762..6607 TO: Bd~rs4ale security Bysteas Inc. Page 3 of Certificate: Additional Insure4 coverage only triggered when required in written contract between insure4 an4 a44itional insured. Contraotual Liability provided under the CGL policy listed above is Liaited Form for t~e perils of -bodily injury- and -property damage- only. certificate Bolder is notified that if contractual requireaent bet~en named insured and additional insured for notice of material change will not be giv~. MAY-02-2008 FRI 12:24 PM FAX NO, p, 01 s c A R s o A L E SEe U R IT Y S Y $ T E M $, IN COR P 0 RAT E 0 FftJ( COVER SHEET '. 'j To: Company: From: Date: Fax No: ~ 0 ,e-o .-OOd-'J Pages: tf including cover sheet ~~~,ll> -.:.-::: .- Christine Diedri(~h -'12-\ o~ ~~'b'c4''') i --- ----.Lft'\6lJJ\ Q.MCE; / IF YOU HAVE ANY PROBLEMfi RECEIVING THIS FAX, PLeASE CALL Christine AT 914-722..2309 132 Montgomery Avenue, Slcar.male, New York 10583-5503 914--722-2200 Fax 914-722-2299