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Home My WebLink About08-8661 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8661 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 8661 Address: 6719 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANC E ZEPHYRHILLS, FL. Class of Work: FIRE-PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: 23,260.00 Parcel Number: 03-26-21-0010-03300-0010 Improv. Cost: Date Issued: 12/18/2008 Name: SUN MEDICAL CORP Total Fees: 25.00 Address: 6719 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 12/18/2008 Phone: (813)783-6189 Work Desc: FPM-SPRINKLER QUARTERLY-SUN MEDICAL CORP SIMPLEX GRINNELL LP FIRE PERMIT FEES 25.00 A FIRE ACCEPTANCE Final 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." a., 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 813-780-0020 City of Zephyrhills-Fire- r %� Fax-813-780-0021 Permit Application Date Received )c ((p p Phone Contact for Permit l 3 3 yq Owners Name 1 C Owner's Phone Number I II I Owners Address Fee Simple Titleholder Name Titleholder Phone Number I II II Fee Simple Titleholder Address Job Address i1 ' Cc+i i 2 o d . 2.e p (hj L S Lot# Sub Division Parcel# LII Bio-Hazard Waste Storage-ANNUAL [ ] Fumigation Tent Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RQ Facility)ANNUAL Controlled Bum Hood Installation LIIIEmergency Generator<30 kw LP/Natural Gas-Installation LIII Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale a Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL emi ®n Other Sprinkler ❑ ❑ B a Recreational Bum Fire Alarm IIIJ ❑ ❑ ❑ LIIIJ Sparklers Hood Cleaning O ❑ ❑ I LIII! Sprinkler System Installations Hood Suppression O O O I JJ Standpipes(Sprinkler Sys) Fire Alarm Installation Torch Roofing/Tar Kettle QFire Pumps Waste Tire Storage ANNUAL aFire Works LII Flammable Application-ANNUAL Valuation of Project QFuel Tanks 0 Other: Contractor ___________________________________________I Company --/n -Cy Signature — Registered Y/N Fee Current Y/N Address J L17 p .# -e'-- `jy,i 3361O License# ELECTRICIAN Company Signature Registered Y/N Fee Current I Y/N Address License# PLUMBER Company Signature Registered Y/N J Fee Current Y/N . Address I License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address j License# OTHER Company Signature Registered Y/N I 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 maybe subject'to"deed":restrictiorrs which may be more restrictive than County regulations. The-undersigned assumes responsibility forrcompliance,with any _applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: 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 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.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'S-AFFIDAVIT: 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 THEOWNER, 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 OBT IN FINANCING, CONSULT WITH YOUR LENDER OR ANA NEY BEFORE RECORDING YOUR NOTIC C MENCEMENT. FLORIDA JURAT(F.S.117.0 OWNER OR AGEN CONTRACTOR Subscribed and sworn to(or�f i b fore me this Subscribed and ssworn ed)before me this by Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as identification. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped Technician Work Report Date of Work: Not Scheduled District : 292 Technician : Miguel A Rivera Owner : Christopher R Brackett Task Number : 16876772 In Planning Scheduled Start Time Service Request Type : Inspection-Auto Gen Service Request Number : 11401040 Customer Acct : 942689 Payment Terms: Immediate Customer Name : Sun Medical Center Site Name Contact Name Mike Prilliman/ Prop Mgr Phone : 813-7151515 Site Address : 6719 Gall Blvd, City : Zephyrhills State : FL Zip 33541-2571 BillTo Name : Century 21 Bill Nye Realty, Inc BillTo Address: 34619 State Road 54, City : Zephyrhills State : FL Zip 33541 Contract Number: 125251 Inspections: Sep 2007, Dec 2007, Mar 2008, Jun Service Plan: SP-TEST/INSP 2008, Sep 2008, Dec 2008, Mar 2009, Jun 2009, Sep 2009, Dec 2009, Mar 2010, Jun 2010, Sep 2010, Dec Medium 201 Current Inspection: Dec 2008 Task Type : 1 Person Inspection Priority Task Name : SP-Dec 2008 Problem : Inspection System : SYSTEM-SP-WET SPRINKLER Serial: Wet Sprinkler System Summary : Dec 2008 Created BY AutoGen Notes : CONTRACT COVERAGE ANNUAL (SEP) AND QUARTERLY (DEC/MAR/JUN) INSPECTIONS OF ONE WET RISER. LEGACY CUSTOMER NUMBER - 00281477 INSPECTION - This Site Not Covered By East Pasco Med. Per Gwen GENERAL SERVICE SERVICE - W/O 01/04 84020004 09/21/03 $1,397.61 Special Action Not Released For Units Over 4 Months Past Due - Status Changed To Not-On-Contract - See Scd006 For Details Dec 1O O8 O3: 42p SG 813-313- 16O6 P. 1 't'q a ' ,�{, fr1 ["r SimplexGrinnell LP Fire& 1�LS`U YY �j ({� 50 Technology Drive Securi 11 y lr rY I(�I n ��F ��N Westminster,MA 01441 Sii»piexGrinne// 1 10 n- Dµ 33 /0 (978)731-2500 T AP FAX:(978)731-7756 Payment Requisition Form This form is to be used an{ywhen payment is required and an invoice is not 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 to sg.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: 12/10/08 Cost Distribution PO Num $Amt Requestor: Chris Brackett #1 Email Address: cbrackett( simplexarinnell a) #2 m #3 Vendor Number: 056313 2 #4 d #5 Pay-to Vendor Name: City of Zephyrhills = = Subtotal $ - Remit-to Address Line 1: 5335 8th Street y Proj Num Ctrl Dist $Amt Remit-to Address Line 2: U #1 City/State'/Zip: Zephyrhills,fl 33542 0 #2 #3 Payment Amount: $100.00 �' #4 #5 Need by Date: 12/11/08 Subtotal $ - Checks will be cut on Tuesdays&Thursdays fl Acct Nurn Dept Dist $Amt Reason for Payment: w #1 62477 652 292 $ 100.00 Permits for sprinkler Inspections at Zephyrhills Health&Rehab,Sun Medical Center 0 #2 Florida Hospital Zephyrhills,and Chill's#00894 in the city of Zephyrhills,FL for a) #3 December 2008. > #4 #5 Delivery Method: U.S. Mail O FEDEX Subtotal $ 100.00 Deliver to District Grand Total $ 100.00 District Number: 292 FedEx Contact: Scott Brackett Cost Distribution in balance. Permanent!1 Per District Li Deliver to Vendor Additional Approvals(when applicable) Vendor Name: Contact: Print Name: Mail-to Address Line 1: Title: Mail-to Address Line 2: City/State/Zip: Signature: Telephone: Date: Approver(Print Name): Danny Prendes Print Name: Title: TSM Title: Signature: / l/�z � Signature: Date: , z-- /c'- f- Date: