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Home My WebLink About08-7890 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE 7890 ermlt Number: 7890 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: Address: 38250 A A V ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 14-26-21-0010-01300-0010 5/22/2008 25.00 25.00 5/22/2008 Phone: FPM-SPRINKLER -QUARTERLY-ZEPHYR HAVEN NURSING HOME Name: ZEPHYR HAVEN N Address: 38250 A AVE ZEPHYRHILLS, FL. 33542 0/\& 1/~--u~ 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 INSPEC110N CALL FOR INSPEC110N - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 813-780-0020 Date Received Owner's Name Owner's Address City of.Zephyrhills Fire Permit Application Phone Contact for Permit Fax-813-780-0021 '';}''1fl I J Owner's Phone Number I I I 38as-o I I Titleholder Phone Number I II II Fee Simple Titleholder Name Fee Simple Titleholder Address Job Address Sub Division Cltil_ ------EJ D D D D D D D D D D D - I Lot# .A A\lt" Zepb1"hdl5 1 FL. I Parcel # I 33S'-l1 {UIj I AINt:U rKUIVI t"KUt"t:K I Y I AA NU 111.t:) - B D D D D D D D D D D D Sparklers Sprinkler System Installations Standpipes (Sprinkler Sys) Torch Roofing Waste Tire Storage ANNUAL tllQ-f1azard Waste Storage - ANNUAL FUlIIiYi:lliUII T ..lit Comm Exhaust Kitchen HoodlDuct Hazardous Material (Tier /I or RQ Facility) ANNUAL Hood Installation LP/Natural Gas-Installation LP/Natural Gas-ANNUAL Sale Places of Assembly-ANNUAL Controlled Bum Emergency Generator < 30 kw Emergency Generator> 30 kw Fire Protection Maintenance - AHI~u~ CUoti-ltI/1 Sprinkler 0" V Fire Alarm D Hood Clean/Suppression D Fire Alarm Installation Fire Pumps Fire Works Flammable Application- ANNUAL Recreational Bum Fuel Tanks ., Valuation of Project Other: Contractor Company I Signature Registered Address I Lf7()( CJe& k.. Pt::-~r Bot. -r~ PI- ., ""It License # I ELECTRICIAN I Company I Signature I Registered Address I , License # I PLUMBER I Company / Signature Registered Address I I License # I MECHANIC4 I Company I Signature . Registered Address I I License # I OTHER I Company I Signature Registered Address I ,,~..,.-. I License # I ~ .... E..... _.~.~,.~,... . Directions: "Sj rn-O I.,.,. 6-'", nflo.{! If Y I N r Fee Current I Y I N Y I N I Fee Current Y/N Y I N I Fee Current Y/N Y I N I Fee Current Y/N Y I N I Fee Current Y/N '"""'v'~._~ _...~ n.' Fill out application completely. OWner & Contractor sigh back of application,notaiized (Or, ccipy 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. ----....-..----.....--....-.....-....-...- ,.---.-....- .NOT,ICE.OF.',DEED.RESTRICTIONS: The underslgned understands that this permit m~ybe subject to ~deed" restrictions" -Which may be. more restrictive .than County regulations. The undersigned assumes responsibility .for compUance with any applicable deed restrictions. . . . UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILmES: If the owner has hired a contractor or contractors. to und.ertake work, ther 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.LlEN'LAW (Chapter713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more;" certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than' the "owner", I.certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. . CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and cthat-. all. work -will. be <lone in. compliance. with--a1l--applicable.-laws . regulatiRg.-construction,...zoning..and--land..u.. ..... development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work- or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating .construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify .that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to. identify what actions I must-take to be in compliance. . If l.am the AGENT fO~ THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior -to. commencing construction. I understand that a separate permit may be required for. electrical. work, plumbing, signs; wells,-pools, air conditioning, gas, or other installations not specffically. included in the application. A ~t1nitis$uedshclll:b~ construed to be a .license to proceed with the work and not as autho.rity to violate, cancel, alter, or sel..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 pl~ns, construction or violations of any codes. Every permit issued shall become invalid .Linl~ssitjE6ivork;aUtnorized..by such permit is commenced within six months of permit issuance, or if work authorized by .. tlie:p.emm;is.su$'p~rided or abandoned for a period of six (6) months after the time the work is commenCed. An extension -maY7pe requested, -in .writing, from the Building Official.for a period not t~ exceed ninety (90) days and.will demonstrate . j~~~~le C8,iJse 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.~CE FOR IMPRO~NiENTS -':~.N Y~~R_r~gp.~~"",~;,"rB.lJJH:u;t.!P,Ig,g~;rN _:~INMlCJNG, CONSULT WI+H~R4L-E . R...(!) .. N 'I~E_R~.:y.01J.K:WTICEOF E EMENT. i.-..~..,"l...:lEIQ....::...I~..,'.,..~...,..;......'.:_,_..._.........'>.....".. ..... '....w.ffl.>.... . j,' .~..:' . . .., . _ ._ _. _', ..... ..._._.....................................__..................- . ..... ..... ..... ...................m. .OWNER DR AGi:NT CONTRACTOR Subscribed and swam {or e before me Subscribed and swa .. ~ ~ Who lsIare personally knoWn to me or has/have prodUced Who is/are personally knoWn to me or has/have produced . as Identification. as Identllication. Notary pubnc Notary Public .Commission No. Commission No. Name of Notary typed. printed or stamped Name of Notary typed. printed or stamped Ma~ 15 08 04:26p SG 1:qCD Fire & Security SinlpJexG,.innell 813-313-1606 p. 1 SimplexGrinnell LP 50 Technology Drive Westminster, MA 01441 (978) 731-2500 AP FAX: (978) 731-7756 Payment Requisition Form This form is to be used onlywhen payment is required and an invoice is...flQt available ( i.e. permits. drawings, bids). If an invoice is available please go through the standard payment procedures for submitting invoices to accounts payable. Please provide a detailed reason for payment and attach any available back up when submitting request. Please supply vendor number. If not available, send an email tosg.apinquiry@tycoint.com. Please fill in "Request for vendor number" in the subject line. Reference the full remit-to address in the body of the email. You will receive either a response with the current vendor number or information on how to have the new vendor setup. This payment will be made per system payment terms. Exceptions will require additional approval. (RM < $25k or VP > $25k) Note: Signature cards must be on file with Accounts Payable for all approvers stating their approved dollar limit. Request Date: 05/09/08 Requestor: Email Address: Chris Brackett cbrac kett@simplexqrinnell Vendor Number: 056313 Pay-to Vendor Name: Remit-to Address Line 1: Remit-to Address Line 2: City / State I Zip: City of Zephyrhills 5335 8th Street Zephyrhills, fI 33542 Payment Amount: $25.00 ~ Need by Date: 05~/08 Checks will be cut on Tuesdays & Thursdays Reason for Payment: Permit for quarterly Sprinkler inspection at Zephyr Haven Nursing Home. Delivery Method: U.S. Mail LJ FEDEX l.:j l::J Deliver to District District Number: 292 FedEx Contact: Scott Brackett Permanent 11 Per District U Deliver to Vendor Vendor Name: Contact: Mail-to Address Line 1: Mail-to Address Line 2: City I State / Zip: Telephone: Approver (Print Name): Tille: Signature: Date: Cost Distribution ~ PO Num $ Amt w "0 #1 / ~ 0 Q) #2 Vl III #3 .s:: 0 #4 '- ::I n. #5 Subtotal $ - Ui Proj Num Ctrl Dist SAmt 0 #1 0 .0 #2 0 -.. #3 t5 ~ #4 (5 #5 Subtotal $ - a. Acet Num Dept Dist SAmt x #1 62477 662 292 $ 25.00 w "0 #2 III Q) #3 ..c: '- Q) #4 > 0 #5 Subtotal $ 25.00 Grand Total $ 25.00 Cost Distribution in balance. Additional Approvals (when applicable) Print Name: Title: Signature: Date: Print Name: Title: Signature: Date: Technician Work Report District : 292 Date of Work: Not Scheduled Technician Miguel A Rivera Owner Christopher R Brackett 14067570 Task Number Scheduled Start Service Request Service Request Customer Acct Customer Name Site Name Contact Name Site Address City State BillTo Name BillTo Address: City State In Planning Time Type Number 21390 Zephyr Haven Nursing Home Inspection-Auto Gen 9655274 Payment Terms: Immediate Neal Frasier Phone 813 -7825508 38250 A Ave, Zephyrhills FL Zip 33541-5759 Zephyr Haven Nursing Home 38250 A Ave, Zephyrhills FL Zip 33541-5759 Contract Number: 139394 Inspections: Feb 2008, May 2008, Aug 2008, Nov 2008 Service Plan: SP-TEST/INSP Task Type Task Name Problem System Summary Notes 1 Person Inspection SP-May 2008 Priority Medium Current Inspection: May 2008 Inspection SYSTEM-SP-WET SPRINKLER Wet Sprinkler System May 2008 Created BY AutoGen Serial: LEGACY CUSTOMER NUMBER - 01142858 INSPECTION - 1-100% Inspection In January, Smoke Detector Cleaning As Needed, Ahca Inspection In July 100% Sensitivity Testing Required Every Even Year GENERAL SERVICE SERVICE - Inspection Comments - KITCHEN PART - 360d FUSIBLE LINKS Quantity: 2 __ Interval: Semi-Annually do not charge service call, $85 plus parts 125.00 a hood cleaning no service call