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CITY OFZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL fIRE PROTECTION 'MAINTENANCE
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8181
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv.Cost:
Date Issued: 8/08/2008
Total Fees: 25,00
Amount Paid: 25,00
Date Paid: 8/08/2008 Phone:
Work Desc: FPM-SPRINKLER QUARTERL Y- WESTBROOK MANOR-SCHEDULE 8/8/08
8181
FIRE PROTECTION MAINTENANC
FIRE-PROTECTION MAINTENAN E
COMMERCIAL
Address: 6701 DAIRY RD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 02.,26-21-0010-03900-0060
'Name: ALLEGIANCE SENIOR CARE
Address: 6701 DAIRY RD
ZEPHYRHILLS, FL. 33542
cJ~~o~
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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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOURPROPERTYIIF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OFCOMMENCEMENTI n
...
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
City of Zephyr hills 'Fir.-e'
Permit Application
Date Received' ., ,. J F / ~b ~ Ie.. ' , . . ,"' . P~~"ne Contact for Pe,rmit. J .,. I I [I I
"':~:'::;iWlt~&HK:~:?:1~~~~~~!iMH~j'$tK~W;~W:g{~..";".;",:~,,,>""'~""":":"f~''''''''''''~''::~A'''~_'''''')i;'~'''':,,,,^,;';~'''''';~\<.~~~-''''Di}..~.ti.l~~~~_:f,:~ig~::~;,~)i;'w:\""""~~.~"..,.;<<>~2!b'"""""""~:;,,,,,~.j";;;:<:",,,,,~mr"'.':':~":~N;';~'~''''''''~'>i';'''''+''~
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813-780-0020
Owner's Name
Owner's Address
Fee Simple Titleholder Name
Fee Simple Titleholder Address
Fax-813-780-0021
Titleholder Phone Number
II
II
Job Address I
Sub Division I
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Contractor
Signature
Address
ELECTRICIAN
Signature
Address I
PLUMBER
Signature
Address I
MECHANICALI
Signature
Address I
OTHER
Signature
;~~".,~
!\~~m~~~\
&
\~I~~ ~
I Lot#1
Parcel #
"."",..,;11I""
D Fumigation Tent
D Hazardous Material (Tier II or RQ Facility) ANNUAL
o Hood Installation
o LP/Natural Gas-Installation
o LP/Natural Gas-ANNUAL Sale
D Places of Assembly-ANNUAL
D Recreational Bum
D Sparklers
D Sprinkler System Installations
D Standpipes (Sprinkler Sys)
o Torch Roofingrrar Kettle
o Waste Tire Storage ANNUAL
Valuation of Project
Bic-Hazard Waste Storage -ANNUAL
Comm Exhaust Kitchen Hood/Duct
Controlled Bum
Emergency Generator < 30 kw
Emergency Generator> 30 kw
Fire Protection Maintenance - ANNUAL
0~'~;"~D
Do 0 oc=J
Doooc=J
Do ooc=J
Sprinkler
Fire Alarm
Hood Cleaning
Hood Suppression
Fire Alarm Installation
Fire Pumps
Fire Works
Flammable Application- ANNUAL
Fuel Tanks
Other:
I
_~~~_.,_",_d<Wt;
Company I I
Registered Y I N Fee Current Y I N
License # I
Company I
Registered Y I N
License # I
I Y/N
License # I
Company I
Registered Y I N
License # I
Company I
Registered Y I N
Fee Current
Y/N
Company
Registered
Y/N
Fee Current
Fee Current
Y/N
Fee Current
Y/N
Address
License #
Directions:
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 besubject:to'~deed"rrestrictions"
which may be more restrictive than County' regulations. The ,undersigned assumes responsibility for :complial7lce\with any
.applicable deed restrictions,
UNLICENSED CONTRACTORS AND 'CONTRACTOR RESP,ONSIBILITIES: 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 7.27-847-
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 whichihey 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'SAFFIDA VIT: 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 (gO) 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 F COM ENCEMENT.
FLORIDA JURAT (F.S, 117.03)
CONTRACTOR
Subscribed and swo
by
Who is/are personally known to me or has/have produced
as identification,
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
Aug. 8. 2008 11: 35AM
Cox Fi re Protection
STATE OF FLORIDA
..DEPARTMENT OF FlNANCIAL SEIlVlCES
.DIVISION OF STATE:FIRE MARSHAL.
TALLAHASSEE, 'fLOiUJ>A . .
. CERTIFICATE OF'COMPETENCY
No. 2485 P. 1
.
.. .
. ., .
THIS C~TIFlES THAT; 'RONALD E cox
7910 PROFESSIONAL PLACE
TAMPA, FL 33637- ,
BUSINESS ORGANIZATIoN: cox FIRE PROTECTION INC .
CONTRACTOR II IS LIMITED TO mexEtOnON of coNTRACTS ~QuiM:iG'THE ABrLJ1Y TO LAYOUT, FABRICATE, INSTALL,INSPECT,
ALTfR.oR SERVICE WATER SPRINKLER SYSTEMS; WATER SPRAY SYSTEMS, FoAM-WATER SPRlNXLER SYSTEMS, FOAM.W A TER
SPRAY SYSTEMS, STANDPIPES, COMBIJIiATION STANDPIPES A~DSPRINKLEJtt IUS~J{Sj ALl,PIPING THAT IS AN INTEGRAL.P~T OF THE
SYSTEM BEGINNING A'rTHE POINT of SERVICE, SPRINK,LEll TANK HE~TERs; AIR LINES', THERMAL SYSTEMS USED IN CONNECTION
WITH SPRINKLERS; AND TANKS AND PUMPS CONNECTED THERETO, EXO-UDtNG PM-ENGINEERED SYSTEMS.
~.~
Chid Flnlnelll Omcer
07 01' 2008 07 16. HiIIsborough
Issue D'IAl Type Class County
.016982000.11985 '.
LicenselPemiit Number
0687S4003S
Application 11
150.00 0630 2010
.Taxes & Fees' Expire Date
. .
"'
...
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
8183
Permit Number: 8183
Permit Type: FIRE PROTECTION MAINTENANC
Class of Work: FIRE-PROTECTION MAINTENAN E
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 5500 6TH T
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-09000-0180
8/08/2008 Name: DAVIS, JAMES & SUE
25.00 Address: 2605 ROBIN DR
25.00 PLANT CITY FL 33563
8/08/2008 Phone: 813 754-3647
FPM-FIRE ALARM -ANNUAL-BABCOCK FURNISHING
L)~eJ
~v5~0tl
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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTYI IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENTI"
...
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTlON
CALL FOR INSPECTlON - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
ZEPHYRHILLS BUILDING FAX No. 813-780-0021~g? P.OOl
City of.Zephyrhllls Fire .-tf FaX-813-780-OO21
PermIt Application .
"~te R~~e.!.v~i _ j.L".........V'r---'-'" ..__~ I ,_ . p~~ntact for PermIt -lJ~J-'r++-~~~ll.~~~L~
'I~\".)~ c. "" ~Ul 0 I OWners PhcrIQ Numher I II ' . I L
12.k052~t'. ~'M\-C,~~ pl ~38D~
Ii "I Ti1l,hol'oc Phon, _be< I II II
Fee Simple Titleholder Address' . ::. :~;
==-~-~-:4~~J.;~M~~~LV;~;;; ;- --:~;-:~
sub Division _ _ _ _ I Parcel # ll\-- Z~.. 11 -~~~ ~a~ - 9 l~
. (U 1 "r=,~KU r=,1"I. rli I II,,;
~ t""'......~1 -..IlII!:":I....-- - ._.!!j! 11 1 .."" . .!lfi!J ~ ~1RlP"", """,-..A:1ll~II!" r~
,D BID-Hazard Waste Storage - ANNUAL
D Comm Exhaust Kitchen Hood/Ouct '
D Controlled Bum
D ,Emergency (lenerator <: 30 kw
D
.
D Fumlgatlon Tent
D
D Hood Installation
D LP/Natural Gas-Installation
D LP/Natural Gas-ANNUAL Sale, ,
o Places of A~$emhly-ANNUAl..
o Recreallonal Bum
D Sparklers
D Sprinkler System Installations
D StandpIpes (Sprinkler Sys)
D Torch Rooting
D . Wasw Tire Storage ANNUAL
r
OCi/ll/2007/THU 01: 11 PM
B13-7BO-0020
Owner's Name
Owner's Address
Fee Simple Titleholder Name
Hazardous Material (Tier II orRQ Facility) ANNUAL
Emergency Generator> 30 kw
Fire Protection Maintenance - ANNUAL
, ,
D.
o
,D
D
D
D
Sprlnkler
,Fire Alal11l
Hood Clean/Suppression
Fire Alal11l Installation
D
.
o
Fire Pumps
Fire Worl<s
Flammable Application- ANNUAL
Fuel Tank..
1
Valuation of Project
Other:
';'~_l ~ddr~sL':::~~':'~_~_~~"RI'I~~ -")..
Directions: .
Fill out application completely.
owner & COntractor sign back of application, notarized (or. copy of signed contract wi1l1 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.
Contractor
Signature
Company
Registered
Licen.,e #
C~mpany
Registered
I License #
l Company
Registered
J License #
I Company
Registered
I LIcense #
I Company
Registered
ELECTRICIA
Signature
Address I
I
PLUMBER
Signature
Addre510 I
MECHANICA~
Signature
Address I
OTHER
Signature
-
J. Ucan:ss #
...-.. _.il LlIlllillP__ r r
I CtJiplrJlrfla I i:..W t/ flj,!!1IIL1n/CdJ/~J b,(..
. Ct.X N J Fee Current ~ · .
1C:r:~"i'5' I .
I Y/N
I
I. Y/N
.\
I Y l N r Fee Current
I
I Y/N I Fee Current I Y/N I
L.~_~__~~~ ...." _,
Fee Current I
Y/!iJ
I
Y IN I
I
Fee Current
-=
Y/N/
I
OCf/ll/2007/THU 01: 12 PM ZEPHYRHILLS BUILDING
FAX No. 813-780-0021
P. 002
--'-......--...---......-..':'...---..,.--....-................---...- .........-.-.--..-. ,..~._. ,-.".
.~NO:t:IC;E.QFDeED,.REs:rR'C'fIONS: The undersigned understands that this permit m~y'he subject 10 ~deed" restrictions"
-Which may :be..more restrictive than County regulations. TRB undersigned assumes 'responsibility 'for compJiant;e with any
applicable dead restrictians, , ,'. '
UNLICeNSED CONTRACTORS AND .CONTRACT-OR, RESPONSIBILITIES: ,'If the owner has hired a contractor or
contractors to' undertake work, they may be required to' be licensed in accordance wlth'state and localreg.Ulatlons, If the
contractor Is not licensed as required by law, both theownar arid contractor may be.clted for' a'.mlsdemeanor violation
under state law. Ifthe owner or intended contractor are uncertain as to. what licensing 'requlrements may apply for the
Intended worls, they are advised to contact the Pasco .County Building Inspection Division-licensing Section at'7-27--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 tndication that he Is not properly licensed and is notentitlad to permitting'prMleges in Pasco
county, ,.
CONSTRUCTION'LiEN'LAW (Chapter713, Florida.Statutes, as amendtld): Ifvaluation of work is $2,500.00 or more; I
Certify that I,' the applicant, have been provided with a copy ,of the "Florida Construction Lien La~Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs, If the applicant Is someone
other tharrthe "owner., Icertify that I have obtained a copy of the above described document and promise in good faith to
deliver it to theuowner" prior tocommencemenl '.,
CONTRACTOR'S/OWNER'S AFFIOA VIT: I certify that all the information In this application is accurate and
," ::that. aU' work -will be-done Inu compliance,wlth"aU.-applioable..law5' ra!;lUlatiflg"GOnstrtiotiol'l;,";ioniAg,~and..land.."
development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify
'that no work. or installation has commenced prior to Issuance of a permit and that all work will be performed to
meet standards of all laws regulating construct jon, County and City codes. zoning regulations, and land
developm~nt regulations in the jurisdiction. I also certIfy .that I understand that the regulations of other
government agencies may apply to the Intended work, and that it IS my responsIbility to, identify what actions I
must take to be in compliance,
If I ,am the AGFNT fOR T.HE OWNER, I promise In good faith to inform the owner of the permitting conditions set forth In
thls am.davlt prior -tp, comm~nclhg construction. I understand that a separate permit may .be required for. electrical' work,
plumbing; signs; wells, pools, air conditioning, gas, or other installations not specifically. Included In the application. A
PfJfmltjs~~l:!.d,Sti;;!II'b.e oons.trued to be a,:license toprocaed .wlth the work and not as alithority to violate, cancei, alter, or
set..asIOe. any':provl$loJls of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
"requirh~g.a'.carrecllon of errors in pl~ns, constructlon or violations of any codes, Eve!)' permit Issued shall become Invalid
,', ,un.J~~~'jg#~i^?~t~.~i:J\!1o.rized ~bY such permit lS'comrnen?ed Within six months o.f permit, is~u~nce, or if ~ork authorized by
,{n.e:~trrrlt.Js susp~nd~d or abandoned for a period of SIX (6) months after the time the work IS commenced. An extension
, ma'y:pe requested, in writing, from the Building Official ,for a period not to exceed ninety (90),.days and'.wllI demonstrate
. j~~*-!~l;ile i::~i.tse for the extension. If work ceases for ninety (90) consecutive days, the job is consider6d abandoned.
Notary Publl~
Notary Public
Commission No.
,CommisEiIDn No.
Name of Notary typed, printed Dr EiUtmped
Nama of NDtery typed, prlnt~ or6tamped