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Home My WebLink About09-9868 • CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9868 ANNUAL FIRE PROTECTION MAINTENANCE 7, a ti : ^'�u� ,r' 0 F o- 7 e. 7 -a : 7 t 3 N_ s t Permit Number: 9868 Address: 6855 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANCE ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 03 26 - 0010 - 01600 - 0020 Improv. Cost: Date Issued: 12/07/2009 Name: GOLDEN CORRAL Total Fees: 25.00 Address: 6855 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 12/07/2009 Phone: (813)783 -8969 Work Desc: FPM- HOOD CLEAN QUARTERLY- GOLDEN CORRAL A • - •N -- U A IN I F R P R FEE 25.00 C tO Se-0 / 2 Z 2 p � ^;.rESnr g _;ia9. _ ffi st s yr wy•+a$€ `. k'��v�` �a: FIR AC EPTAN ina 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." eflaPP 1i 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 Page 1 of 1 - , :117.1 7 8C-002C City of Zophyrhillo Filo rex -Er 3-71*-3021 Permit Application alit. Fiarinvecl I I, Phone Contact kr Pe.rne 1 1 = --........ ....--- riverwirs 1,12rne 1"— A — N -a PERSOLEBZWEE—CIMITZL----.— , — ] Chm Ph " "' kl 1 i = ilna "----- C 7 hvneel; Mom:cr. , 5104 MI TRRAY HTLT, DR _TAMPA Fi —1161 5-4714 For Froloir: Trtiehotter Name I Triterlokter P NuMINT I i I &male True Aukfrez:, I Jrla AdOrt.:1 GOL[W2S; CORRAL 6855 GALL BLVD. ZEPHYRITI_ C • ' ''— 7 " t yet e Sus Gmstor Pweki e : = No-Heterrt WAN.. Storage - ANNUAL 7] rurnioretion Tani 0211 CCrnv” Eek$4 Kitchen 145ocLOJEt El Ma=ardcus Ltate eel ;rite II or Ro ly Faciit ANNUAL El Cordtded Bvt. _ n Hand IrmtalatIon ED :...neercienty Generator .: 20 kw LPTNstural Kixs-lratatator, Ef j ErnorpettcyGcleraece :. 30 low LPIkk4turel G.-AtatuAL Sam 71 Fire tent, Mainimunor - ANNUAL Places ef Asoernah.A.NINUAL ----- t ri 1E9 Uther Sprinkler C 7 r Paernanonal Wm Fee Acorn C 7 M Spaneetes E 7 77 sl. spn rchu nk:Z. c ..sec w ir tntI od, sai s Waa ris 14:1W alorming r Hood Siwremon L.: 1 = r , F (re Alarm Irtgaltior, "toren RoofrielTar Kettle Fel:, P.trerts Waste Tire Storage ANNUAL Fire Works FIerrnatre Appiealiar. ANNUAL 1 I Valuation of Project Fur: Tonu.. — = Other: _ C.catrart:r 1 —"-- Cornparty f Surourr I Resestered Y I N I kw cu-rers 1 Y 1 N J AdCre5•5 I Liter** e 1 I L .........- FL...C Company Se:mature aogool Y ; N 1 i-oe currant 1 y....N AtlCiret: L 1 Lteeren e i PLUMBER Calumny 1 Sterklex. Regearree YiN i I-ac Curart J YIN kriorria. License et f. N1 Ctenpany 1 Sten:dere koetweree Y . i For Cixtsr* I Y ; N i Adiir= - ...---I License 0 071 cormyrn. I Stemless Roan:wee YIN i NA- tarter< 1 Y;IN 1 Armee= Lieerek. 0 i ... ___ . _ . _ ............. _ . _ DstIctiora ;Ili , 31,/ auptication omelette" 0,,,, & commeter zigr bock of Appiitamon, notarized 10r, coo of .Uelvd ounPec with c".flgol tF e 52501 Et Wilk* et CAIMMertternant es required (Mecetericzo wreck y $,MCIII) Sixoty Awx 12; :oass. et &avow van.: applicable titnun-wmAitn Alo. 10-14 oar. for review atter rattnetael deer. Pamela - careened trorr Property Tex Now, limp ,...drkleiteer ok-v-r-oyo, cam) http://192.168.1.105/scarilimage.pdf?id=0&prev=-1&time=-1259949039031&type=4 12/4/2009 A NOTICE OF VEED RESTRICTIONS: The undersigned understands that this permit may be 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 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 (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, 1 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 1 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, 1 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, 1 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 RECOADING YOUR N TICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) 14 - e'I ` OWNER OR AGENT CONTRACTOR Subscribed and sworn to (or affirmed) before me this Subscribed and sw4m co (or affirmed) me this by bq Who is/are personally known to me or has/have produced Who is/are persona fiy 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 ii '.' • 11 -19 -2009 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/19/2009 EXPIRATION DATE: 11/19/2011 PERSON: ANDERSON TERRY FEIN: 861092704 BUSINESS NAME AND ADDRESS: ANDERSON PRESSURE CLEANING INC 5104 MURRAYHILL DR TAMPA FL 33615 SCOPES OF BUSINESS OR TRADE: 1- PRESSURE WASHING IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -160 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES F ` + F DIVISION OF WORKERS' COMPENSATION ± O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY • : 1 , elects exemption from this chapter by filing a certificate of election L CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA �y under this section may not recover benefits or compensation under this WORKERS' COMPENSATION LAW D chapter. EFFECTIVE: 11/19/2009 EXPIRATION DATE: 11/19/2011 H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: TERRY ANDERSON exempt.. apply only within the scope of the business or trade listed on FEIN: 861092704 R the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt ANDERSON PRESSURE CLEANING INC and certificates of election to be exempt shall be subject to revocation 5104 MURRAYHILL DR if, at any time after the filing of the notice or the issuance of the TAMPA, Fl. 33615 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- PRESSURE WASHING section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 Page 1 of 1 _ ._.r__.._. __._R .. . . fax Pill 2009 Florida Annual Resale Certificate for Sales Tax R. arms THIS CERTIFICATE EXPIRES ON DECEMBER 31.2009 titAgfria Name Ord r OCagOIn AcIcItrAg. Conitcate NIKEtber ANDERSON PRESSURE CLEANING INC_ 39.801298oe364 5104 HURRAY HILL DR _ TAMPA FL 336154734 This r to ceRity that as tang 4p Penang! ProrelTy Curthaxd ar rented. re 4 wormy rented. or selvtces purchased by the trGa r, txtS,ryL• s pre harm pur h11 ,d or rented for cm of the todowitg pn . • Meese as tanattht peopvnal pregat4: • Rw:.mtal as real re wct • Re.rtxxxl • ran. Pmr sxrw' of Y . component t p as t ta ngta rt ant..e f °QV^ - rtr. • tr_artzH:�+.*.:r[o and ra►a tart cx the fells, <r! :,emspeuxe.x pzt of in. y • Hula al mte• rh tamable Persnrtel f t t> 4 by n iniaLl properly t. W r. ru otir timer. that Is tsalnj rr <�Katl tot sak. by rrar • Re final as tranatote ,onyy AroPertS- r[rrnpoia't•.anri..r pgx.vx,m4. Ttrp ta1tifieoue carnal be reassigned or trxrtxfermd. INS tastificae, can Orly be used by the active registered dealer ex fir, 8uttxtritra ent};tgyeee., Misuse at thi Aetna' ,reimate CtxMtcate vita sua>ratct the user to p:n:llbe l as peovidnd by tee. Use s r Pramaded t : : ' t` � - -� ' a•ser. heti. et o• « nn Phauur016. Wale: Presented bY ' ` , - .r" . .... -. ...co. a ' lmmsa_..hzcc , i ... /I/4'4i � 2 r,r t 2009 - 2010 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 -30 -2010 ro.,c hi, . 0. ,. K.,..:. ..,:. .., ,, ,.- _:;mot, L.__�__ 51 RENEWAL I 0903.000 OCC. CODE BUSINESS TYPE 11 vtti, a- SI.RGw•lGE 7 &D 060 PUBLIC $CRVICE-INDUSTRIAL CLEANING 40 00 22 00 1)J' U LSS 5104 MURRAY WILL. DR t r.CATnrx: TAMPA. 3:3615 riaur ANDERSON PRESSURE CLEANING M 5/04 MURRAY }HILL- DR a;xr: _: TAMPA El 33615 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLLCTOR PAID -14602 - w.. r, ri' 9. r' vie Aft4V1. ;u ♦t TO Cm,' Cr 813-635-5200 37,24;2009 °' fi2 D0 N nJi N. , i.r.... .. . • y. • ••...t ..: -•., :x TM; UEGDYES n TAX A!'l:E ;�T NR{ Ylit "OA t!' http: // 192 .168.1.105 /scan/image.pdf?id =0 &prev =1 &time = 1256599844734 &type =4 10/26/2009 r CA1E SSuED • CONTAACT NO. Pfrg ND. March 17, 2009 ART4462009 NEW THIS DECLARATION PAGE IS ATTACHED TO AND FORMS PART OF CERTIFICATE /COVER NOTE PROVISIONS ITEM CEMI CATS POLICY NUMBEA: ARTE020576 }� �,".,.-R, V -`fi ];.:',#e-:Sr . t'-; :4 3• •'#' a r, =7 - �•> . Name of Assured §:.'.'-' . -, , f , ssur ri- � � f � _ t � : ANDERSON PRESSURE CLEANING INC ` . { 4 " ,, g { Y 1 � 0 " _ £ ' sir 5104 MURRAY HILL DRIVE a �r f`, - TAMPA, FL 33615 ; ` s - M .,- , �� ..; . � 1 OTERO INSURANCE GROUP . . x "` `3 s 7520 W. WATERS AVE., #2 ¢ ' ` "_ 4 S r r rf _Z = h:,< -: max' - =' � � t�'m '_� "t:=:l - - :: -f = ?" `= -' - A ..:....: - -. TAMPA, FL 33615 W4r;_r _=- �. 2 Effectrme From 120tam Both Days at Standard Time : March 10, 2009 TO March 10, 2010 1 Ac iirg upon your ins rust or, ` NAME OF INSURERS AMOUNT OR PERCENT 3 1 aha'r UNDERWRITERS AT LLOYD'S, LONDON 100% IIIM _fr the s. ar:ce r, the i 1111111 ' MUM i LIMIT COVERAGE RATE PREMIUM I $1,000,000 COMMERCIAL GENERAL LIABILITY SEE CL150 $1,180.00 4' i TOTAL BASE $1,180.00 SPECIAL CONDITIONS TERRORISM PREMIUM POLICY FEE $35.00 INSPECTION $65.00 5 See SFE -01 (02/03) Schedule of Forms and Endorsements TAX $R4.00 FStSOSERVCE FEE 51.28 FHCF FEE $12.80 TOTAL $1.358.08 - 6 Countersigned: TAPCO UNDERWRITERS, INC. CLEARWATER, FL In witness whereof this covernote has been signed at BURUNt3TON. NC this 17 da of March • 2009 T UNDERWRIT C • SURPLUS LINES AGENT 13577 FEATHERS DRIVE , BCAUTHR FL VIRGINIA C. PHILLIPS Po BOX 17069 1 If'.FGIAFS A711RRQM PI Ab12WATFD RI Aeon .97a) �1/