HomeMy WebLinkAbout08-7923
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7923
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:
7923
FIRE PROTECTION MAINTENANC
FIRE-PROTECTION MAINTENAN E
COMMERCIAL
Address: 37815 15TH AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: N/A
Parcel Number: 10-26-21-0600-00000-0010
6/04/2008
25.00
25.00
6/04/2008 Phone:
FPM-SPRINKLER -ANNUAL-JOSEPH JOSPEH-JUNE 4TH BEING DONE
Name: JOSEPH, JOSEPH
Address: 37815 15TH AVE WEST
ZEPHYRHILLS FL
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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 INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
2007-200tfHIlISBOROUGH COUNTY BUSINESS TAX RECEIPT
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BUSINESS TYPE
FIRE SPRINKLERS- CONTRACTOR (COMP CARD REaD)
~USf'.Jtss
LiJCA liON
9203 KING PALM DR 0
TAMPA 33619
NlIMI: ROBERT L BURCH
MAILING CINTAS FIRE PROTECTION
: '".DDRCSS 92030 KING PALM DR
i TAMPA Fl 33619
IBUSINESS TAX
L;;I:~B:::~:::.:"~~~;;~",~'~::;:cllt" "f~~'~.
DOUG BELDEN, TAX COLLECTOR
813-635-5200
THIS BECOMES A TAX RECEIPT WHEN VALIDA TED,
4206
20439800002 000018002
000040006
EXPI~RES- 9-30-2008 FOLIO NO 1
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, _-_LJ __-304~~~
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SUHGHARfJf:
TAX
4000
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF STATE FIRE MARSHAL
TALLAHASSEE, FLORIDA
CERTIFICA TE OF COMPETENCY
THIS CERTIFIES THAT: ROBERT L BURCH
9203-D KING PALM DRIVE
TAMPA, FL 33619-
BUSINESS ORGANIZATION: CINTAS FIRE PROTECTION
CONTRACTOR IINCLtIDES TIlE EXECUTION OF CONTRACTS REQUIRING TIlE ABILITY, EXPERIENCE. KNoWLEoGE, S"",,,CE, AND
SKILL TO INTELUGEN'IL Y LAYOUT, F ABRlCA TE, INSTAlL, INSPECT, AlTER, REPAIR, OR SERVICE AlL TyPES OF FIRE PROTECTION
SYSTEMS, EXCLUDING PRE-ENGINEERED SYSTEMS.
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01 24 2008 07 10 l:lillsborough
Issue Date Type Class
98912400012008
Chief Financial Officer
County
License/Permit Number
9891240001
300.00
Taxes & Fees
06 30 2008
Application #
Expire Date
s
ACORD", CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYV)
06/03/2008
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Aon Risk servic~s Northeast, Inc.
c/o client service center AND CONFERs NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
1000 Milwaukee Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Glenview IL 60025 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE-(8661 283-7122 FAX- (847) 953-5390 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Greenwi ch Insurance company 22322
cintas corporation INSURER B Westchester Fire Insurance co 21121
dba cintas Fi re protection
9203-0 King Palm Drive INSURER C XL specialty Insurance co 37885
Tampa FL 33619 USA
INSURER D
~ INSURER E
SIR Mil 'AM~I\I'
TIm POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIm INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CON1RACT OR OTHER DOCUMENT WITH RESPECT TO WIDCH TInS CERTIFlCATE MAYBE ISSUED OR MAY
PERTAIN, TIm INSURANCE AFFORDED BY TIm POLICIES DESCRIBED HEREIN IS SUBJECf TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR ::S~ POUCYEFFI!:CTIVI POUCY I!:XPIRATION
LTR TYPE OF INSURANCE POUCY NUMBI!:R DATE(MM\DDlYY) DATE(MM\DDlyy) UMITS
A ~"._>n RGD943715702 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000
X COMMERCIAL GENERAL LL\BILITY DAMAGE TO RENTED $100,000
CUtiMS MADE I!] OCCUR PREMISES (Ea occureneo)
one person S5,OOO
X Contractual Liability PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGAlE $2,000,000
GEN'L AGGREGAlE LIMIT APPLIES PER $1,000,000
PRODUCTS - COMP/OP AGG
o POLICY 0 PRO- ~ LOC
lECT
A AUTOMOBILE UABlUTY RAD943715802 07/01/07 07/01/08 COMBINED SINGLE LIMIT
r::: ANY AlITa AOS (Ea accident) $5,000,000
A RAD943715902 07/01/07 07/01/08
ALL OWNED AlITOS MA BODIL Y INJURY
~ SCHEDULED AUTOS (Per person)
~ HIRED AlITOS BODILY INJURY
~ NON OWNED AlITOS (Per accident)
~ comp/co 11 Cov. Incl. PROPERTY DAMAGE
with $0 Oed. (Per accldmt)
GARAGE UABIUTY AUTO ONLY - EA ACCIDENT
R ANYAlITO OTHER THAN EA ACC
AlITO ONL Y :
AGG
B EXCESS /UMBRELLA UABlUTY G22035277002 07/01/07 EACH OCCURRENCE ) 5 , DDD , DDO
~ OCCUR 0 CLAIMS MADE AGGREGAlE $5,000,000
aDEDUCTIBLE
RETENTION
C RWD ./ ., X Jwc STATU-' I~JH-
C WORKERS COMPENSATION AND RWR943511402 07/01/07 07/01/08
EMPLOYERS' UABlUTY
c RWE943512102 07/01/07 07/01/08 E,L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED> E.L. DlSE.<\SE-EA EMPLOYEE Sl,OOo,OOO
lIves, describe undo: SPECIAL PROVISIONS E.L. DISEASE-POLICY LIMIT $1,000,000
below ~
OTHI!R
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
~ ,."""""-
City of Ze~h~rhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn: aui dlng Department DAlE TIlEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
5335 8th street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Zephyrhills FL 33542 USA BUT FAILURE TO ])(} so SHALL IMPOSE NO OBLIGATION OR LIABIUTY
OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE ~ ~..9"___~..:::.v~
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CI
-IRE PROTECTION
9203-D King Palm Drive
Tampa, FL 33619
Phone: 813-621-6094
Fax: 813-628-4661
SPECIFIC POWER OF ATTORNEY
I, Robert Burch, of Tampa, Florida, the undersigned, hereby grant a limited and specific
power of attorney to the following as my attorney-in-fact for the limited purposes
specified herein below:
Theresa Sauerwine
Troy Gerrets
Brian Renshaw
The attorneys-in-fact shall have full power and authority to undertake and perform only
the following acts on my behalf: Apply for permits, sign all permit applications, pick up
permits, register contractors licenses and sign all forms necessary for obtaining a permit
and/or registering contractor's licenses for Cintas Fire Protection. Contractors License #:
98912400012008 (exp. 06/30/2008) to include such incidental acts as may be required
to carry out and perform the specific authority granted hereinabove.
This power of attorney is effective upon execution. This authorization may be revoked at
any time, and shall automatically be revoked upon my death, provided any City of
Zephyrhills employee may accept and rely upon same until receiving written notice of
revocation hereof.
Signed this 3rd day of June, 2008
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
~;; ~
'---SmNATURE OF LICENSE HOLDER
Sworn to and subscribed before me this 3rd day of June 2008.
-LPersonally Known to me or
_Produced as Identification
ARY PUBLIC, State pf Florida
My Commission Exp: "'r7"S oZLJCJ./
Type of 1.0.
,,~ JEAN K. PERRI
MY COMMlSSIO~ # DD409189
EXPIRES: April 15, 2009
1-8Q0..3.NOTARY F1. Notary Disoount Assoc. Co.
FAX No. 813-780-0021 J P.002
City of-Zephyrhills Fire f' 1113 Fax-81H80-0021
Permit Application
.l.~,tJ~".~J ... ~umM-~ _~~n.eco~~~LP~lt.J~~~.+!.Q1~
r Jo.sedl Jasef)h, I owner'sPhoneNumb~r I, X' /3llC2Q5I.l t' ~7 I
i~J(,~05- /rd/~;7JQllnd Rd_ --Tamp:1... F~ 33W! l
Fee SImple Titleholder Name 'I .' _ ~ . Titleholder Phone Number ! II II I
Fee Simple Titleholder Address i: _ ,u , -,
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JObAddress_--3igrs-- _-~ ftt~ ,-Cc;oh'fh1fLJ FL.. Il.ot#' I ]
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Contractor I I
Signature
Address I J
ELECTRICIAN ~ ' -I
SIgnature L " '
Address r I
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M~r J
M!:CHANICAYI
Signature ' I '
Address I J
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Directions:
FiJI out appilcatlon completely.' '. " '
Owner & Contra~or sign back of appllcatlon, '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 drawlngs wlth applicable documentation
AllOw 1 o~14 days for review after submittal date. '
OCT/31/2007/WED 02: 18 PM
ZEPHYRHILLS BUILDING
813-780..0020
Date ReceIved
....- tJ;~ rlt111 r
Owners Name
Owner's Address
sub Division
~~II;"'-,,'V
,D Blo-Hazard Waste Storage" ANNUAL
o Comm Exhaust Kitchen Hood/DUct
D controlled Bum
D . Emergency Generatpr < 30 kW
. D emergency Generator:> 30 kW
~ Fire ProtecUon Maintenance" ANNUA/...
sprinkler . ' ,r'!5lJ'
Rre A1ann, , U
Hood Clean/Suppression 0
D
D
.D
o
D
D
Rre Alarm Installation
FII'9 Pumps
Fire Works
Flammable Application- ANNUAL
Fuel Tanks
Other:
r-
D Fumigation Tent
o Hazardous Material (Tier II or RQ Faclllty) ANNUAL
.D' Hood Installation
D LPlNatural Gas-Installation
o l...PlNatural Gas-ANNUAL Sale
D places of ASSembly-ANNUAL
D Recreational Bum
'0 Sparklers
D sprtnlder system Installations
D Standpipes (Sprinkler Sys)
o Torch Roofing
, D, Waste Tire Storage AN~UAi.. "
J~.a5D . Cf) 't
:
Valuation of Project
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Fee Current ~L Y I N I
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Pee Current I Y I N I
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Y IN I
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Company E
. Registered Y I N ~.
Ll~nse 1# ,[.,
Company I
R~gisterad' Y I N I
L1cenSEl #: "I
Company I
RegIstered . Y 1 N
License # 'I
Company I
Registered .
License # ' I
l Y/N J
Fee Current
Y I N I~ Fee curr~nt L Y I N I
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Company ,
Registered
Y/N I
~::~~~ # ~~~-__.~'fr~_"'\ilc...___...~J-..;.., ~~~
Fee CUlTent
OCT/31/2007/WED 02: 18 PM ZEPHYRHILLS BUILDING
FAX No, 813-780-0021
P. 003
...
.,NOT:ICe,GF.:I;>EED.RESTRICTIONS: The'undersl!;lned understands that thIs permit m~y-b.B subject to ~de8d~ restrictions" .
.whi~h may be-'mcr.e restrictive .than 'County 'regulations. TIte undersigned assumes -responsibllity'fer compJia[:\ce With ahY, '
applicable d.eed r.estrlctlons. ' " ' " .' ,
'UNLlCENSeO CONl"RACTORS .AND ,CONTAACTrOR RESPONSIBI~ITIES: If the owner has hired a contractor or
'contractorsto undertake w.ork, they. may be requIred to: b.fi) licensed jn ~ccordance wlth'state a.nd local regulations, 'If the
contraotor is not licensed as req\.llred'by law, both.the owner and contractor ~ay 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
lntendedwork, .they are advised to contacl'the Pasco County 8uilding.lnspectio'n DMsion-l.:icensing Section at 7.27-847-
8009. 'Furtherm'oi'e, if the owner has hired a cOr.llractor or contractors, he Is advIsed to have the eontragtor(s) sign
poition~ .oqhe .G.ontrac~or Block" of this 'appllcatl6n for which they will 'be responsible. If you, as the owner ~Ign aa the
contractor,' that may tie an indication that he is not.properly,IfC(;}nsed and is not-entitled ,to per:mittlng privileges, in Pasco
County.. ' ' , , ' , ,', '
CON~TRUc:TIONUEN'LA;W (Cl'tapter713, Florida 5~tutesi as,amended): Ifval9ation.of work Js $2.500~OO or more;' I
certify that I. the applloant, have been pro'o/Ided with. a. copy of the "Florida Cons~~ction Lien Law-:-Homeowner's
pr,otectl6il Guide~ prepared by the Florida Department of Agriculture and Consumer Affairs.., If, the applicant is someo~e ,
other thaliihe .owner", I.certify that'l 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 oertlfy that all: the informatlqn in this applicatiop .Is accu~te and,
... "..... ..; '-that. all "work -will. be '-dene lr"': Goml3"ance. :with",~t~'app\icabIB:.laws ,regl:llatil"1g.<GORstnlCtlClR-i,'ZOfliAg,:and..IBl'lIilm<..-,
devE;llopment Application Is hereby made to obtain a permit to' do work and instaUation as Indicated. I certify
" that no wor.k. or'installatlon has commenced prlor.to Issuancie of a permit and that- all work will be performed to
meet stanci~rdsof all 'laws regulating .CbnstruGtJon, County afld City codes, zoning regulations, and .land'
developm~Jlt .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.~ is my'responslbUity to. i~ehtlfy what actions I
, ' , must1ake to be In compliance. ' .
, If I.am the AG~NT FOR,. T.HEOWNER, I. promise In g~od faith to Inform the owner of-the permitting conditions set forth;!n
this affidavit pri,or-~9,J:;Oii'II:TlImcjilg construction. I understand that a separate permit may -be. requIred for.electrlcafwork,
plumbing; signs; weJls, :pools, air Conditioning, gas, or ,other installations not ,?peciflcally,lnoluded in the application. A
p,e.r.ro.lt:is.~UE!,d.sti_all:b.~ cor'is,trued to be a'license to. proceed with the work and not as aLith~rity to violate, cancel, alter, or,
seUisi.qaany-provisicms of th~ teohnlcal codes, nor ~hall issuance of a permit prev~nt the Building .qfflciaf from tjlereafter
'reqtl.lr\ng.a:cQrraction of errQ'rs in pl"lns, constrliction ar viQlatlons of any codes. Every permit is~ued shall become invalid '
.', 'u.P'~~~':W~~.~9~~_e.~f!1o.rized:'bY such ,permit ia- commet'!ced WIthin six month~, of permit is.~uanoa, or If work authorized by ,
. .th.e,pe~~,s $u~p~ncl~d or abandoned for a perIod of, six (6). months aftflr the time the work is commenced. ,An extension,
. . 'n:'ay:.:be ~-eql;Jested, ~n .writlng, from the Building Official ,for a period not to exceed ninety (90) ,days and.wili demonstrate
,:justjfjq~le o~i.J.se for the extensIon, If, work ceases for ninety (90) consecutive days, the job Is considered abandoned.
..... "'-. . .. .' .
WARNING TO OWNER: YOUR'i=AILURE TO 'RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR.
PAYING TW!,CI; FOR IIII!P~ov~Ni~~T.? T_O Y,Q~R r.~q~ERr(! ..IF,Y..O\U.!~I!i~.Q.69..J~~J~/~'f'i~~CJNG~ CONSULT
..WI;rH. ND R.,(l) '".AN,..A::Q1OR~E~SEt:im~ tEe, I ,~V:dCf .WTl'CE . F COMMENCEMENT. '
11--'UIiIS1 Ii . -. l't;<t"#.lJ5f' ..\, i . ," " '., .
~'...".;,.;i.f~.<.iw'.~.."...,....:--" ,:.. ...,..:_J.:".. ....:..............,,;..--._m:-m-.......m-..---m-.m..-.----.....__...::....-'m.~.... " :
.OWNERDRAGE,NT .,.., CONTAACTO~-
Subsmibed and 6wom to {or affirmed) before roB thIs subl';~ec\ and sworn to (or affirmed) before me thIs
. . ~ ' " ~ ' .,
Who is/are pe~onallY known to me or haslhave produced Who is/are perso.naIlY known to me or. hfilslllave produced
as idenllficatlon. ,- as Identillcation.
...... ...... ..... ......"....-.."'-.
CommIssion' No,
,NotaryPubllc ~
. ~_N~_ ... ..
", . ~jEI9AJ K .-:P~K~i
N~me of Notary!yp2d, prlnted or stamped
Notary Public
= .
Name of Notary typed. printed or'stamped
l~' .JEAN K. PERRI
~ MY COMMISSIO~ # D0409189
~ EXPIRES: April 15. 2009
1-800-3-N<JfARY Fl, ~ DiI<oUDl- Co.