HomeMy WebLinkAbout08-7984
CITY OFZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUALF:IREPROTECTlON MAINTENANCE
7984
Permit Number: 7984
Permit Type: FIRE PROTECTION MAINTENANC
Class of Work: FIRE-PROTECTION MAINTENAN E
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued: 6/19/2008
Total Fees: 25.00
Amount Paid: 25.00
Date Paid: 6/19/2008
Work Desc: FPM-ANNUAL SPRINKLER ATZPD
Address: 6118 8TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel 'Number:
Name: CITY OF ZEPHYRHILLS(POLlCE DEPT)
Address: 6118 8TH ST
ZEPHYRHILLS, FL. 33542
Phone:
0AtC7
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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 wrTHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
OCT/31/~007 /WED 02: 18 PM ZEPHYRHILLS BUILD INC
813-780,0020
Date Received
ar- , ~w
Owner's Name
Owner's Address
FAX No. 813-780-0021
P. 002
City of.Zephyrhills Fire
Permit Application
Fax-S1~H8D.0021
Phone Contact for Permit ]~ L~~,JJ..(l.JJJ
IA ( 3 11'78"0 l./t'Yt:Dl
.3351-1
Titleholder Phone Nurnber I
Fee Simple Titleholder Name
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f! IilI .. 1 I1IIIlI'~ r -.ll ~L,.fl~ -""-. ~
lL21.J ~ .- ~+h ~1YeeA - ?eP\yr-hi' I::> Il.ot#. I I
lPotice- ~(Yi/iYT]('lJ+ I Parcel # .,b~:~~~~Jv~~~R0~~Sf?~~?~ J
. ~T ...dI I . r I 1'''' ~l
Blo-Hazard Waste Storage ~ ANNUAL D Fumigation Tent
Cornm Exhaust Kitchen HoodJDuct 0 Hazardous Material (Tier" or RQ Faclllty) ANNUAL
Controlled Bum .D. Hood Installation
. Emergency Generatpr < 30 kw D LP/Natural Gas-Installation
Emergency Generator> 30 kw D LP/Natural Ga5-ANNUAL Sale
Fire Protection Maintenance - ANNUAL D places of A6s6mbly-ANNUAL.
~ D Recreatlonal Bum
D .0 Spar1ders
Hood Clean/Suppression 0 D Sprlnl<ler System Installatlons
D Standpipes (Sprinkler SY5)
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W .flrL). ()()t Valuation of Project
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Fee Simple Titleholder Address
Job Address
sub Division
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Contractor
Signature
Address I
ELECTRICIAN l
Signature I
Address I
PLUMS!::R I
Signature
SprInkler
Fire Alarm
Fire Alarm Installation
Fire Pumps
Fire Works
Flammable Application- ANNUAl..
Fuel Tanks
~_._-
....-0..___.,
Torch Roofing
Waste Tire Storage ANNUAL .
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Other:
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DlTections: .
Fill out applh::atJon completl:'ly. .
Owner & Contr~ctor. sign back of application, 'notarized (Or, copy of signed contract with owner)
If OVBr $2500, II Notice of Commencement Is required (Mechanical work over $5000)
Supply t\No (2) sets of drawings wIth applicable documllntatlon
Allow 10-14 days for review after submIttal dati;!.
Address I
M. ECHA.NICAl.:j
Signature
Address I
--~~:
Company I
' Registered Y I N
l.lcense #1' .
Company [
Registered L Y IN'
Licen5e # . I
Company I
RegIstered . Y I N
License # .,
Company I
Reglstllred , Y IN!.
License # I
Company j
Registered (;;fJJ N J
~l~~~e # ~i;:~..__~_~
FeEl Current Y I N
Pee Current I Y I N
Fee Current Y I N
Fee Currant r- Y I N I
I
Fee Current I @ N !
"'_,,~: ~ m.~_"_~:"L~,,,, ~
OCT~31/?007/WED 02: 18 PM ZEPHYRHILLS BUILDING
FAX No, 813-780-0021
?, 003
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..NO'tICE,QF.:OEED.RESTRICTIONS: The underslgned .understands that this .permIt mC\y'b.B subject to ~deBd. restrictions. .
-whic~ may be.mere restrictive .than County regulations. Ttot.e undersigned assumes 'rasponsibllity.fo~ comp.!iaf.lce with any .
applicable d.eed restrlctlans. . ..
.UNLlCeNSED CON1"RACTORS .AND .CONmACTOR RESPONSI8ILITIES: If the owner has. hired a contractor or
contractofsto undertake w.ork, they may be required to b.e licensed jn accordance wlth'state and local regulations, .If the
oontractor is not Ilcensed as required by law, both the owner and contractor may be.cited for a.:misdemeaoor violation
under state law. If -the ownar or intended contractor areuocertaln as to what licensing .requirements may apply for the
intendedwork..they are advised to contactthe Pasco.County Building. Inspection Dlvision-l:.icensing Section at 727-847-
8009. 'Furthemlore, if the owner has hired a conu-actor or contractors, ha Is advised to have the contractor(s) sign
portions .ofthe "c;ontractor Block" of this .appllcatlon for which they will .be responsible. If you. as the owner ~Ign as the
contractor,.ihat may be an indication that he is not.properlyn~nsed and is not"antitledto per:mittlng privileges in Pasco
County.. . . . . .'
CON~TRUGTION"LIENl.A;W (Chapter'713, Florida S~tutes. as amended): Ifvaluation of work Is $2,500.00 or more;.'
certify that I, the applicant, have been proVided with. a copy of the "Florida Constrqction LiBn Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs... If the appllcant is .someone
other than-the "owner", I.certify that.1 have obtained a copy of the above descrIbed document arid promise in good faith to.
deliver It to the "owner" prior to.commenoement . '" . . . .
CONlRACTOR'S/OWNEKS AFFIDAVIT:. I oertify that all: the information in this application.ls aCGu~te and.
........ .." 'that- all ,work -will' be-dr.me In: GElm~llanOB.:with-.atl.~applicable..laws .regl:llatiFig.<GOAstrl:lCtlOA.;.,zoAiFlg.;and,.13Ad---'''-
development. AppUcation Is hereby made to obtain a permIt to do work and installation as Indicated. I certify
that no wQrkor'installatlon has commenced prlor.to Issuanca of a permIt and ~hat.all work will be performed to
meet stand~rds.of aU laws regulating .construCtJon. County and City codes, zoning regulations, and .Iand
dBvelopm~.nt .regulations in the Jurisdiction. I also certify :that I understand .that the regulations of other
government agencies may apply to the Intended work, and thaUt is my responsibility to. i~entlfy what actions I
. must-take to be In compliance. '
If l.am the AGENT fO~ T.HE OWNER, I promise In good faIth to Inform the owner of the permitting conditions set forthJn
this affidavit prior _~(j. coii'lI:llE!ncii:1g construction. I understand that a separate parmit may be requIred for. electrical" work,
plumbing; signs; weJls, :pools, air eonditloning, gas, or other installations not ~peciflcally.lnoluded .in the application. A
p.ef.{1:l.It:i~SQed.stl,all,'b.l;l cOll!'\trued to be a .license to. proceed .with the work and not as aLitharity to Violate. cancel, alter, or
set~si.qlia.ny..proYI~icms of th~ teohnical codas, nor ~hall issuance of a permit prevent the Building .qfflcial from thereafter
. . reqtJlrimg.a'correction of ern~irs in plans, constrliction or violations of any codes. Every permit iS$ued shall become invalid
. .iJnl~sii;Ij$~WQJi(~i;iutnprjzad'.bY such'.perritlt is commerlC;ed Within six month~ ofperrnlt is~uanc8J or If work authorized by
. .. .th.e:p.eriiin.:;!:tsu~p~ricl!!ld or "abandoned for a period of. six (6) months after the time the work is commenced. . An exte.nsion .
. may.;'pe ~-eqlJested, -in .writing, from the Building Official ,for a periOd not to exceed ninety (90) . days and.wilidemonstrate
. j~~~ifl~~le CiliJ.se 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.
WlPA !ING TW!f;..~.?R IMP~OV~NiE~J~~ VQ'i~ r.~mrEmrJ!::.;:~W..lW5N.Q,;t9J~~J.AI/ll{!~""CJNG,. CONSULT
_. . .1_ o=.RU.'. R,.l1). ",AN~A+.:nor~l'u::,'IlltlEr;:W",g.: tl::!.... . rw.l"'~..1'.uu .;y,rOffCE 'F COMMENCEMENT. . .
..li ;::::JlEliij~ .;, ~.._' 1'fI't~bgf' ."~; . .' '. .... . ; .' .
. "'~:~~=~;:~:;'::'=',:--':----'~~r:~::~ .
.. . . . by" . by __7 ~I?C:fI-
Wl10 islaTS per,sonally known to .me or hasfhave produced . Who isfara perstmally kno\Nrl to me or ~sJhave produced
as identification.. -...- '-.- as Identification.
Notary Public
~~/
Name of Notary type
Notary Public
= .
CommIssion. No.
Name of Notary typed, printed or.stamped
.
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FIR~ PROT~CTION,
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 Nelson
Leo De La Garza
Jasen Buddemeier
Mike Bardell
Brian Renshaw
Fred Ledford
Phillip Sutphin
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 18th day of June, 2008
STATE OF FLORIDA ~
COUNTY OF HILLSBOROUGH
~NA- -.. LICENSE HOLDER'
Sworn to and subscribed before me this 18th day of June 2008.
Type of 1.0.
~~
c::..1iR:)TARY PUBLIC, State of Florida
My Commission Exp: 7'-,0-..:f&:J 9
-LPersonally Known to me or
_Produced as Identification
"JEAN K PERRI
MY COMMISSIO~ # DD<W9189
EXPIRES: April 15, 2009
1.aoo.J-NOTARY FJ. Nolaty DiIcount Aa&oc. Co.
I ACORDT. DATE (MM/DD/YYYY) I
06/03/2008
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Aon Risk services 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.
FAX- (847) INSURERS AFFORDING COVERAGE NAIC #
PHONE-(866) 283-7122 953-5390
INSURED INSURER A: Greenwich Insurance Company 22322
cintas Corporation INSURER B: westchester Fire Insurance Co 21121
dba cintas Fire Protection
9203-D King palm Drive INSURER C: XL specialty Insurance Co 37885
Tampa FL 33619 USA
INSURER D
INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTIlER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY TIlE 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. LIMITS SHOWN ARE AS REQUESTED
INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD\YY) DATE(MM\DD\YV) LIMITS
A ~~~"UIT RGD943715702 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000
CLAIMS MADE ~ OCCUR PREMISES (Ea occurence)
MED EXP (Anv one person) $5,00C
X Contractua 1 L i abi 1 i ty PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000
PRODUCTS - COMP/OP AGG
D POLICY D PRO- ~ LOC
JECT
A AUTOMOBILE LIABILITY RAD943715802 07/01/07 07/01/08 COMBINED SINGLE LIMIT
'X ANY AUTO AOS (Ea accident) $5,000,000
A i-- RAD943715902 07/01/07 07/01/08
ALL OWNED AUTOS MA BODILY INJURY
I- SCHEDULED AUTOS ( Per person)
7- HIRED AUTOS BODILY INJURY
~ NON OWNED AUTOS (Per accident)
7- Comp/Co 11 Cov. Incl. PROPERTY DAMAGE
7- with $0 Ded. (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
B ANY AUTO OTHERllIAN EA ACC
AUTO ONLY
AGG
B EXCESS /UMBRELLA LIABILITY G22035277002 07/01/07 07/01/08 EACH OCCURRENCE $5,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $5,000,000
!:3DEDUCTIBLE
RETENTION
C RWD X ~C STATU-I WllI-
e WORKERS COMPENSATION AND RWR943511402 07/01/07 07/01/08 ORY LIMITS ER
EMPLOYERS' LIABILITY
C RWE943512102 07/01/07 07/01/08 E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICERlMEMBER EXCLUDED" E.L DlSEASE-EA EMPLOYEE $1,000,000
If yes. describe under SPECIAL PROVISIONS EL DISEASE-POLICY LIMIT $1,000,000
below
OTHER
DESCRIPTION OF OPERATlONSfLOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Ze~hyrhills SHOULD ANY OF llIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE llIE EXPIRATION
Attn: Bui ding Department DATE llIEREOF, llIE 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON llIE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUllIORIZED REPRESENTATIVE ~ ~.9"'--....Jf/"~~
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STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF STATE FffiE 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 I INCLUDES THE EXECUTION OF CONTRACTS REQUIRlNG THE ABILITY, EXPERIENCE, KNOWLEDGE, SCIENCE, AND
SKILL TO INTELLIGENTLY LAYOUT, FABRICATE, INSTALL, INSPECT, ALTER, REPAIR, OR SERVICE ALL TYPES OF FIRE PROTECTION
SYSTEMS, EXCLUDING PRE-ENGINEERED SYSTEMS.
%~
01 24 2008 07 10 lIillsborough
Issue Date Type Class
98912400012008
Chief Financial Officer
County
LicenselPermit Number
9891240001
Application #
300.00
06 30 2008
Taxes & Fees
Expire Date
-.
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AN It:l3S'v'l-3tll.::l
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2007-200IfHIlISBOROUGH COUNTY BUSINESS TAX RECEIPT
rFACILITiES:=:~~~ .qf [~~~~
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_-9lIUPJhm---- --~rr._.
EXPIRE-S.m9'~30-2008 FOllU t-oG j
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OCC CODE
090015 ...
H ....iA.S1f TAX
BUSINESS TYPE
FIRE SPRINKLERS- CONTRACTOR (COMP CARD REOD) .
SURCH,.\Hf...j.l:
4000
1800
8IJSi'.JESS
LIXA liON
9203 KING PALM DR 0
TAMPA 33619
NlWI: ROBERT L BURCH
MAiLING CINTAS FIRE PROTECTION
j:'ODRr::.;" 92030 KING PALM DR
I TAMPA FL 33619
IBUSINESS TAX
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DOUG BELDEN, TAX COLLECTOR
813-635.5200
THIS BECOMES A TAX RECEIPT WHEN VALIDA TED
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