HomeMy WebLinkAbout09-9744 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 9744
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 9744 Address: 38250 A AVE
Permit Type: FIRE PROTECTION MAINTENANCE 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: Parcel Number: 14- 26 -21- 0010 - 01300 -0010
Improv. Cost: € :
Date Issued: 11/06/2009 Name: ZEPHYR HAVEN NURSING HOME
Total Fees: 25.00 Address: 38250 A AVE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 11/06/2009 Phone:
Work Desc: FPM- SPRINKLER QUARTERLY- ZEPHYR HAVEN NURSING
SIM'L X R N LL LP I - RMIT S 25.00
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FIR A PTAN 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." inr
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
1
837 � 80 -Cu20 City of Zephyrhills - Fire. V , G Fax -813- 780 -0021
Permit Application [
1 _
Date Received „
Phon Contact for erml
Owners Name STMPT,FXORINNELL Owner's Phone Number 813 626 5 4 8 2
Owners Address 4701 Oak Fair Blvd TAMPA FL 33610
Fee Simple Titleholder Name - Titleholder Phone Number
Fee Simple Address 1
Job Address 3'6 O ( -) Dt Nye_ . e h V h 1Iu5 Pi_ '3 35`t ` Lot #
Sub Division Parcel #
_. -:_ _,-,-- . .,.- ;_ ° mss.. s Y: - .
1 • Bio- Hazard Waste Storage - ANNUAL 1 1 Fumigation Tent
I Comm Exhaust Kitchen Hood /Duct 1 I Hazardous Material (Tier If or RQ Facility) ANNUAL
1 . 1 Controlled Bum 1 1 Hood Installation
1 Emergenc < 30 kw 1 1 LP /Natural Gas - Installation
. , 1 1 Emergency Generator > 30 kw 1 1 LP /Natural Gas - ANNUAL Sale
1 . 1' Fire Protection Maintenance - ANNUAL 1 1 Places of Assembly - ANNUAL
5 41 ttrly ISemil IAnI1 Other
Spriner _ ❑ ❑. • 1 (
kl Recreational Burn
Fire Alarm 1 1 ❑ ❑ ❑ 1' , ( 1 ( Sparklers
Hood Cleaning I 0 ❑ ❑ 1 ( 1 1 Sprinkler' System Installations
Hood Suppression II D .. ❑ _ • ,❑ 1 1 I 1 Standpipes (Sprinkler Sys)
1' Fire Alarm Installation 1 or Roofing/Tar cfi Rao r Kettte -
(• 1 Fire Pumps Waste Tire Storage ANNUAL
• I Fire Works
, 1. " Flammable Application- ANNUAL I I Valuation of Project
Fuel Tanks
1 Other 1 _ •
r.rm au,r, a ,, - a .,..., „rte ;aA, . .. <,,!,,,...: i.. a =- . a, - <:;.a >... ,-> .. z., --= :, « v as. _ . ; * - ,-,,,,_
Contractor Company 3 re' fe, rI vti t( • Signature Registered Y / N Fee Current urrent 1' Y / N 1
Address 1 : r • 1 . _ , .. . 1 License # 1
ELECTRICIAN Company
Signature - Registered Y/ N Fee Current 1 . . Y / N 1,
Address 1 . I License #
PLUMBER Company
Signature Registered Y 1 N '1 Fee Current I Y / N:'' I : •
Address 1 I License # . 1 - I
MECHANICAL • Company
Signature Registered Y / N 1 Fee Current 1 Y / N j
. Address 1 I License # I
OTHER • Company •
Signature Registered Y/ N 1 Fee Current 1 Y / N . 1
_solma Address License # I
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 subject to 'deed ":restrictions"
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 -84T
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 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 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 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 Tam the AGENT FOR THE OWNER I promise in good faith to inform the owner of the permitting conditions set forth in
this of tdavit prior to commencing- construction_-.. - C understand that.a_separate. pertntt 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 a' • Cc :' ENCEMENT.
FLORIDA JURAT (F.8. 117.1
/ ,
OR OR AGENT CONTRACTOR %/
OWNER ■
Subscribed and sworn • (or i • ed) before me this Subscribed and s om to or - - imed) before me this
- by by
Who is/are personalty 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