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Home My WebLink About08-8152 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE 8152 Permit Number: 8152 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: 6851 WI D ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 02-26-21-0010-01200-0000 8/05/2008 Name: ELKS E 25.00 Address: 6851 WIRE RD 25.00 ZEPHYRHILLS, FL. 33542 8/05/2008 Phone: 813782-4604 FPM-SPRINKLER ANNUAL-ELKS LODGE DONE AUG 5TH ~ ~ (\l~ / D Vg/tv 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 ATIORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." ~ P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTlON CALL FOR INSPEcnON - 8 HOUR NOnCE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 .813-780-0020. f ~l5 V ij~~~~,:;~j=i~*""f@l,m;4l!~~t"",,,,~~J-..w~~~~~_1 City of Zephyr hills Fir.-e Permit Application Owner's Name Owner's Address Fax-813-780-0021 -w_~~~~=~g~1rL,",,,.~__1L_,,,,~,_ I Own:rs Phone Number I', U I "'""~~'.';"_~'_M''''~'''_.';'f~"""",,,,~.o..: 1,1 I . L .- Z.iipffy~JtI(...S. i:,iC~ O~Y"i 1.131 't > I W,It,! 1/..#16 Z.itlU""Il""'" ~ ,; r.. H ~~r) I Titleholder Phone Number Fee Simple Titleholder Name Fee Simple Titleholder Address II II Job Address Lot# I Sub Division Z.t,PI1VtfHIt...S e/.#t.S Lt:I.,/'i "Z'll t is I AJilllt ~r:4" l../I.,.,iI".... s Ii... B~ l'j Parcel # D D D D D D D D D B D - i'!'\ '~ Contractor Signature Address ELECTRICIANI Signature . Address ] PLUMBER Signature Address I MECHANICALI Signature . Address I OTHER Signature --:=~",.="='" Directions: Bio-Hazard Waste Storage -ANNUAL Comm Exhaust Kitchen Hood/Duct Controlled Bum Emergency Generator < 30 kw Emergency Generator> 30 kw Fire Protection Maintenance - ANNUAL ~~~~ Sprinkler [l[J 0 0 W L-J Fire Alarm 0 0 0 0 c=J Hood Cleaning 0 0 0 0 c=J Hood Suppression 0 0 0 0 c=J Fire Alarm Installation Fire Pumps Fire Works Flammable Application- ANNUAL Fuel Tanks Other: D D D D D D D D D D D D Fumigation Tent Hazardous Material (Tier II or RQ Facility) ANNUAL Hood Installation LP/Natural Gas-Installation LP/Natural Gas-ANNUAL Sale Places of Assembly-ANNUAL Recreational Bum Sparklers Sprinkler System Installations Standpipes (Sprinkler Sys) Torch Roofingrrar Kellle Waste Tire Storage ANNUAL g / 5/D6 -1fj(Sdf1(r Valuation of Project r; r, 3~1''t Company Registered License # Company Registered License # Y/N Y/N Fee Current Company Registered License # Y/N Fee Current Y/N Company Registered Y/N Fee Current Y/N License # Company Registered Y/N Fee Current Y/N '" i"'"'.'~<-_""""""."""~"''"'~-''.,""'''''f9''''-~'"_.'_'''='~"~~,~,,. .. ""T"'~""i_~'''-''-''~"''-'''''''''.''''~.'~.L~~ 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:OEEORESTRICTIONS: 'The undersigned understands ,that this permit maybe'subjectto-~deed','rrestrictions" which may be more restrictive than County. regulations. The.undersignedassumes responsibilityfor:compliar.lce'with any .applicable deed restrictions. UNLICENSED CONTRACTORS AND 'CONTRACTOR RESPONSIBILITIES: If the owner has 'hired';a-'contractoror 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 Iicensing'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 1he 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.topermittingprivileges in Pasco County . CONSTRUCTIONLIEN.LAW (Chapter713,Florida Statutes,.asamended): 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 OTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) _ .#., "/}/J _ OWNER OR AGENT -~ /( ~ Subscribed and swom to (or affirmed) before me this by Who is/are personally known to me or has/have produced as identification. Who is/are m t9 (or affirmed).betore me this by "/4,...;;) 1<' Ci..a",s/'.e. rsonally 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 Aug 05 08 11 :21a James Clouser 727-584-8341 p.4 ACORD.. CERTIFICA TE OF LIABILITY INSURANCE OPID P1 I DATE~1 WSCIN-J. osloslos I'ROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION wa1~ace We1cb & Wi1J.ingham Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 300 rixst Avenue South, 5th Fl HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Sex 33020 Ai. TER THE COVERAGE AFFORDED BY THE POLICIES BEL.OW. st. Petexsbuxg r.L 33733 j INSURERS AFFORDING COVERAGE Phone: 727-522-7777 Fax: 727-52J.-2902 NAIC. INSURED i~RA: -...." I_t;y XIl.uz._ Co INSURER 8: r1o..1a. ..1;&11 r~."1DD SIr WSC XI1Itc:1:iOn services, LLC i INSlJlER c, 208 Tr ic Blvd & :~RO: Largo 33'770 ;~RE: ------~-- w:.......-, ...._ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS'JED TO THE IiIISURED NMIEO ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ~y REOUIREM9IT, TERM OR CONDITION OF IlNY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHIOi THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOR:>ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS. EXClUSIONS AND CONDITIONS OF SUOi POLICIES, AGGREGATE lIMITS SHO,^,,< MAY HAVE BEEN REDliCEO BY PAID ClAIMS. LTR INSR TYPE OF tNSURNCE POLICY__ I~~N DATE IMIlIlID i IJIIITS GENERAL LIAIIUTY r EACli <lCOJI(RENCE $1000DOO A X ~RCW. GENERAl. LIABILITY 51GL00335307J. 09/13/07 09/J.3/08 I ~S(&~",:;'llIlC&) $ 5000D ClAlMSMl\OE ~ OCctR I MEt> EJ(p {Any one persml $ 5000 tj , PERSCH\i. & t>Dl/ II\l.AJRY $ 1000DOO GEtERi't. AGGREGATE 52000000 GEI'I'l AGGREGATE LIMIT .'lPPLIES PER: I'f!OOUCTS - COWICP AGG 52000000 IF'Ol.lcy-H~ nlOC AUTOMOBIL.E LIA8LfTY CCMlINED S!l<<>lE lWlT - (Euccioter1l) S f'H'( "'-""0 - ALL OWNED AUTOS 8ttJIl y 1JII.Ur( - (Pet JMnClOJ $ SCHEOLlEl AUTOS - HREO AI.1TOS 8()[)Il Y 1N.ARr - S NON.O'MED ,",UTOS (Pet 1ICdclenI) - - PROPERTY Oi\MAGE $ (Per aa:iclllll) c:ARAGE L-.sTV AUTO ClHL. y . EA ACCIDENT S R f'H'( "'-""0 OlliER 1H'IN EAN:.c $ AtJfO ClHL. Y: AGG S EIlCESSlUMBRELLA LIABilITY EACH OCOJRRENCE S tJ CCCLfl o CLAt.IS w.JE AGGREGllTE $ f R Caxx:J1flLE S flElEHTlON $ S WORKERS COMI'BaAl1ON N(O rTCRY LIMITS I IUJ:t B EliIPLDYERS' L.lA8ll1TY 52035051 12/J.5/07 12/15/08 E.L, EAOi ACCIDENT S 10000D NI'f PROPflIETORiPARTNERiEl<EOJTIVE Cf'FICERIIo1EMBER ExClUCEO? E.L_ OISEASE . EA ENPlOYEE S 100000 II v.... descnbo under S 500000 SPECIAl. PROVISICNi 11_ E.L.OISEASE - POliCY lMT OTtER DESCRII'TlON OF Ol'ERATlONS I LOCATIONS I Vl!HCLES I EllCL.USIDNS ADDEO 8'1' ENCORSEII!NT I SPECIAL 1'R0'0tS1CNS ~ire sprinkler system and domestic backf10w iDapection, service and xepair. City of Bephyhi11.s is ac:klit.ioDa~ insured wi ~h respect to GeDeral. Liabil.i ty if xeqaixed by w.Eit~ coDtxact. CERTIFICA.TE HOLDER CANCELLATION City of Bephyrhil.ls Bui~dinq Department 5335 - 8~b S~rcc~ Zephyxbi~1a, rL 33542 St40ULO AtN OF nee ABOYf! DESCIUIIEO ",,-IClES Be CANr;E\.LB) HFOftE THE EXP!RATION DAn: 'THEREOF. THE IS8UINC INBURSt WILL ENDEAVOR TO MAL ~ DAYS WJUnEN NOTICE TO l1tE a;~1CAlIi HOL.OER NAIIIiD TO THE LEFT, BUTFIoII.URE TO DO SO SH.\L.L _OlE NO OBUCAnON OR LIABILIT'I' OF "IN KIND U,.OH THE INIIL.IlEllITll AGen'8 OR _RE'ENT"TlYEs. II, AeSE . ACORD CORPORATION 19BE ACORD 25 12001/08) Aug 05 08 11 :20a James Clouser STATE OF FLORIDA , DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE. MARSHAL TALLAHASSEE..FLORIDA · CERTnnCATEOFCO~ETENCY 727-584-834~ 30' lrD p2 '~'.' ., V '. . , " ... .,..' THIS CERTIAESTHAT: JAMES R CLOUSER . '208. TROPIC BLVD E LARGO, FL 3377~ . BUSINESS ORGANIZATION: WSC INSPECTION SERVICES CONTRACTOR n IS LIMITED TO THE EXECUTION OF CONTRACTS REQUIRINGlliE ABILITY TO LAYOUT, FABRICATE; INSTALL, INSPECT, At TER, OR SERVICE WATER SPRINKLER SYSTEMS, WATER SPRAY SYSTEMS, FOAM-\V ATER SPRINKLER SYSTEMS, FOAM';'W A TER SPRAY SYSTEMS, STANDPIPES, COMBINATION STANDPIPES AND SPRINKLER RISERS, ALL PIPING TIfAT IS AN INTEGRAL PART OF TIlE SYSTEM BEGINNING AT TIlE POINT Of SERVICE, SPRINKLER TANK HEATERS, AIR LINES, ~ SYSTEMS USED IN CONNEcnON WITH SPRINKLERS;' AND TANKS AND PUMPS'CONNECTED THERETO, EXCLUDING PRE-ENGINEERED SYSTEMS. '~~ CbicCFinaaaal OOicer 07 012008 07 ] 6 Pinellas 52386700012001 0607690001 Application 11 150.00 06 30 2010 Issue De. Type CliISS County ,LicenselPennit Number ' Taxes a: Fc:csExpin:Date Aug 05 08 11 :~Oa James Clouser 727-584-8341 p.3 ~~.,'.. '.l.A\'VII~~. (~,~~,.;?~.."l,,' , ~,~'~ ~,':':/' . . Qp,~. '..' BACICE'LOW -RtEV/TBST/BEPAXR' CONm. II' FIIU:.SPRDIKLlm SYSTEMS ~s:i.ficati.on OLDOL DESCRIPTION NArCS' 'No. HOCLIC, AD.ount, '$5'0;00 ' ~, o .STA!rE:.52386700012001 CONTR. II 6/30/2008 Certif:i.cate'Number: 37000 ... . CONrP.J:I..WADa SPlUNKLBR ,~ SYSTEMS t 5238~nD012001 06/30/06 NEED ,UFCERr 17'.,12-00-1825 12/31/02 , , .. " ., , CER~:IF:ICA'l'EHAS"NO'r. BaN~TED'DUETO f!.f.[$~~G INFOm9.!l'IC'tL FAX: . Enga,ging in iloybl1sicness, occupation is subject 'to . t:oningreist:tic1:ions. Thec()ile<:tion of ,this Business Tax;/Administrative Service Chal;gedoesnot authorize the ho.lder t'8 operate :invio:Lation<ofany,cityordinance, law orregU.latiol'l.>EachholdE!ri~ solely,res.poIlsib.le fornotifyingtheComm:unit y Development Di:JpartiDent,.' in writing, "of any change'insiatus, ,location. or o"mership~ ',., Renewal noti. ces ,wj),,l"besentJ,o . ,the ,last.., known address and '.owner ()frec():rd.IssUclriceiSll1 no wayintended,~s.aIl~pprqv~l ()jo:ctisappro~al Of .,theholders '..c;pznpe:t~:~~e::or:",:'ski'~l'.~".:,.' ',"'. . ...'.....-..-. .....:'.. .......:.... '~"'.'~..:. .......>"...::'. . ....... '.' . ..:::', " '..'< ":'. . '-.. :.. . '" "': ".' -: '.:':. '.'; -"." ,Tl:1isBllsinessTaxReq~ip:texp,ires 30 SePtelDb~r.20pf.'p~naltiesar.ei'rC)vided" '~;F:;S."" 205 'notrenewedbefqre, l'Octc>ber 2008 .Additioilalp~Jial,i:tes, o:f.upto $25'0 'may ; app ly if not i~newe.dJ:jy31<P~ce~er200B. '., , , '.,'. ,'. ". .',., ,. ".'., ',..", Aug 05 08 11 :20a James Clouser 727-584-8341 p.1 WSC INSPECTION SERVICES, LLC P.O. BOX 1620 LARGO, FL 33779-1620 Phone: 7Z1-685-4679 Fax: 727-584-8341 FAX TRANSMITTAL FAX TO: City of ZeDhvrhills FROM: Michelle Del Vecchio ATTN: Buildina DeDartment '# OF PAGES 4 INCL. COVER FAX #: 813-780-0021 DATE: 08-05-2008 REF: Business Infonnation for WSC Inspection Services, LLC. The following pages include: State License Business Tax I Occupational License Certificate of Insurance with City of Zephyrhills listed as an additional insured Please call either me or Jim Clouser, the owner, if anything further is needed. Thank you. Michelle