HomeMy WebLinkAbout09-9646 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
- (813) 780 -0020 9646
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 9646 Address: 37900 14TH AVE
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE - PROTECTION MAINTENAN•E Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 10 26 - 0010 - 03400 - 0000
Improv. Cost:
Date Issued: 10/14/2009 Name: DISTRICT SCHOOL BO PASCO COUNTY
Total Fees: 25.00 - pU CS - Address: 7227 LAND 0 LAKES BLVD
Amount Paid: 25.00/ " LAND 0 LAKES FL 34638
Date Paid: 10/14/2009 Phone:
Work Desc: FPM -FIRE ALARM ANNUAL -PASCO COUNTY SCHOOL BD -NO CHARGE PERMIT
I- P - IT EES 25.00
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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." fp.°
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P 'T 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
81;1-780-002Q City of Zephyrhills'Fire. Fax - 813 -780 -0021
Permit Application
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Date Received Phone Contact for Permit
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Owner's Name , STMPT,FXGRTNNF,LL Owner's Phone Number 813 626 5482
Owners Address 4701 Oak Fair Blvd TAMPA FL 33610
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Fee Simple Titleholder Name Titleholder Phone Number
Fee Simple Titleholder Address 1
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Job Address ? 7 6 100 f U to►e. r LA . (41 h kit 5 VL 35-1- Lot #
Sub Division Parcel #
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J Bio- Hazard Waste Storage - ANNUAL Fumigation Tent
1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
1 Controlled Bum Hood Installation
1 Emergency Generator < 30 kw LP /Natural Gas - Installation
1 Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
1 Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
1Utrlyl (Semr1 IAnl ( Other
Sprinkler 1 1 ❑ ❑ ❑ 1 I Recreational Burn
Fire Alarm N2r ❑ ❑I 1 1 I Sparklers
Hood Cleaning 1 1 ❑ ❑ ❑ 1 I I ( Sprinkler System Installations
Hood Suppression 1 1 ❑ ❑ ❑ 1 1 I Standpipes (Sprinkler Sys)
1 Fire Alarm Installation 1 1 T Roofing/Tar Ro r Kettle
1 Fire Pumps 1 I Waste Tire Storage ANNUAL
1 Fire Works
I
Flammable Application- ANNUAL I I Valuation of Project
1 ' 1 Fuel Tanks
1 Other: 1
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Contractor /
d Company -) Crot? KFrw -e. t (
Signature Registered Y/ N I Fee Current 1' Y / N 1
Address 1 License # - 1
ELECTRICIAN Company
Signature . . Registered Y/ N 1 Fee Current 1. Y / N 1
Address 1 1 License # 1 1 ,
PLUMBER - Company
Signature Registered ¥ / N* 1 Fee Current I Y/ N` 1
Address 1 1 License # . • I
MECHANICAL Company
Signature Registered Y/ N 1 Fee Current Y / N j
Address 1 1 License # 1 1
OTHER Company -
Signature Registered Y / N 1 Fee Current I Y / N1
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'h iricti �ns
which may be more restrictive than County regulations. The.undersigned assumes responsibility for compliance 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 If the
contractor is not licensed as required by law, both the owner and contractor may be cited 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 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 1, - 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 and
development. Application is hereby made to obtain a permit to do work and installation as indicated. l certify
that no work or installation has commenced prior to issuance of a permit and 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 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 • N FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTO' - BEFORE RECORDING YOUR NOTICE r' Ca ENCEMENT.
FLORIDA .11./RAT (F.S. 117.
OWNER OR AGENT / CONTRACTOR _
Subscribed and sworn • (or - r ed) before me this Subscribed and s om to or timed) before me this
by b y
Who is /are personally known to the 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
Oct 14 09 05:09p Jenny Eisenmann 1- 813 - 313 -1604 p.2
2009 - 2010 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 - - 2010 FOLIO NO.
FACILITIES OR MACHINES - ROOMS SEATS - EMPLOYEES
0. 0 0 I 130 RENEWAL I 7287.0000
H. WASTE TAX
OCC. CODE ' BUSINESS TYPE
• SURCHARGE
090.028 CONTR/}CTOR A).ULT» 4.E SER I4 VICES FIRE A ,MS AND SPRINKLER SYSTEMS 40.00 • 338.00
330.001 ' RETAIL t 2 ( KAL =. I - A RDOU S IWT A � � s 30.00
280.065' FIRE EXT*Ial SH #f2:SEFiiY1( Eit € � i4s.: 40.00 80.00
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BUSINESS 4701 OAK FAIR BLVD
LOCATION TAMPA 33610786 ,
• NAME SIMPLEXGRINNELL LP
MAILING PO BOX 3042
ADDRESS BOCA RATON FL 33431 -0942
BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR PAID - 10118 -85
HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-635-5200
07/16/2009 "` 487.50
IN BUSINESS. PaoFESSION, OR OCCUPATION SPECIFIED HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED.
•
•
Oct 14 09 05:08p Jenny Eisenmann 1- 813 - 313 -1604 p.l
aT
CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
706025
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES DESCRIBED HEREIN.
Marsh, Inc. COMPANIES AFFORDING COVERAGE
1166 Avenue of the Americas
New York, NY 10036 COMPANY A: Al South Insurance Co.
Telephone (212) 345 -5000 COMPANY B: Commerce & Industry Ins Co
INSURED COMPANY C: Fireman's Fund Insurance Company
COMPANY D: Illinois National Insurance Co.
COMPANY E: Insurance Company of the State of PA
SimplexGrinnell, LP COMPANY F: Nall Union Fire Ins Co of Pittsburgh, PA
4701 OAK FAIR BLVD COMPANY G: New Hampshire Ins. Co.
TAMPA, FL 33610
United States
• COVERAGES
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 1110 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE
AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL. THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY LIMITS
LTR .
DATE (MM/DD/YY) EXPIRATION
G GENERAL LIABILITY ' GL 090 -73 -63 (Primary GL) 10/1/2009 10/1/2010 [ GENERAL AGGREGATE $2,000,000.00
X COMMERCIAL GENERAL '
PRODUCTS - COMP/OP AGG $2,000,000.00
CLAIMS MADE X I OCCU PERSONAL 5 ADV INJURY $1.000. 000,00
OWNER'S & CONTRACTOR'S EACH OCCURRENCE $1,000
FIRE DAMAGE (Any one fire) $1,000,000.00
1
MED EXP (Any one person) 1 $10,000.00
F AUTOMOBILE LIABILITY CA 091 -93 -98 (MA) 10/1/2009 10/1/2010 COMBINED SINGLE LIMI
F X ANY AUTO CA 091 -93 -97 (VA) 10/1/2009 10/1/2010 $1,000,000.00
F X HIRED AUTOS CA 091 -93 -96 (AOS) 10/1/2009 10/1/2010
X NON -OWNED AUTOS
A WORKERS COMPENSATION AND ..WE ,'"0615- 16- 11141441j,GA, ) 10/1/2009 10/1/2010 X WCrATUTORr :TM
B EMPLOYERS' LIABILITY WC 060 - 16.8741 (f1.4 - 10/1/2009 10/1/2010 I I a
D ! THE PROPRIETOR/ WC 060-1 - (MI) 10/1/2009 10/1/2010 EL EACH ACCIDENT $2,000,000.00
E PARTNERS/EXECUTIVE -16 -8745 (AR,MA,VA) 10/1/2009 10/1/2010 EL DISEASE - POLICY LIMIT 52,000,000.00
F OFFICERS ARE:' WC 060 - 16 - 8742 (OR) 10/1/2009 10/1/2010 EL DISEASE - EACH
F WC 060 -16 -8740 (CA) 10/1/2009 10/1/2010 $2.000,000.00
G WC 060 - 16.8748 (AOS) 10/1/2009 10/1/2010
G WC 060.16 -8743 (TX) 10/1/2009 10/1/2010 "-
G WC 060168746 (ND,NY,OH,WA,WI,WY) 10/1/2009 • 10/1/2010
•
EXCESS LIABILITY GENERAL AGGREGATE
I OTHER THAN UMBRELLA FORM PRODUCTS - COMP /OP AGG
•
EACH OCCURRENCE
UMBRELLA FORM
OTHER I I
C Builder's Risk/installation/Contract Works OC 9112860 5/1/2009 5/1/2010 USD 51.000.000.00 perjobsile
C I Rental EquipmenVContractol's Equipment OC 9112860 5/1/2009 5 /1/2010 USD 5 1,000.000.00 perjobsile
C I Blanket Transit OC 9112860 5/1/2009 5/1/2010 USD 51,000,000.00 per conveyance
DESCRIPTION OF OPERATIONS /LOCATIONSNEHfCLESISPECIAL ITEMS
Project: Da
CERTIFICATE HOLDER CANCELLATION
City of Zephyrhills SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WIE
INSURER AFFORDING COVERAGE WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN,
5335 Eighth Street BUT FAILURE TO MAIL SUCH NOTICE SHALL. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER
Zephyrhills, FL 33540-4312 AFFORDING COVERAGE. ITS AGENTS OR REPRES ENTATIVES . OR THE ISSUER OF THOS CERTIFICATE.
United States �. —1 0 W
MARSH USA INC, BY. Franklin Hallock, Global Marine
David Kong, Casualty Program Transit Program
•
VALID AS OF: 10/14/2009
For questions regarding this certificate contact: Lisa Marie (Email: lieoxes implexgrinnell.com Phone: 813. 626 -5402 x246)
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valuables, INSURAN d to p
valuables, please consider Insured or eg
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complete and attach a Return
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addressee's an additional tee, agent. Advise the clerk or • resent the anti'
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addressed to APUs and FPQs J—
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY �
• Complete items 1, 2, and 3. Also complete A X ignature 0 Addressee
item 4 if Restricts d Delivery is desired. 0 Agent
C. Date of Delivery
• Print your name and address on the reverse P rinted Na *)
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• Attach this card to the back of the mailpiece, ❑ Yes
or on the front if space permits.
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2. Article Number 7005 1820 00 1853 4333
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Domestic Return Receipt
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