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Home My WebLink About09-9923 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9923 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 9923 Address: 381 MARKET SQUARE DR 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: 02 26 - 0010 - 03900 - 0030 Improv. Cost: Date Issued: 12/21/2009 Name: FLORIDA MEDICAL CLINIC Total Fees: 25.00 Address: 38135 MARKET SQUARE Amount Paid: 25.00 ZEPHYRHILLS, FL. 33540 Date Paid: 12/21/2009 Phone: (813)780 - 8440 Work Desc: FPM -FIRE ALARM ANNUAL - FLORIDA MEDICAL CLINIC '::.41074f 7777 -I AL C.M 1 A Is■. IR PER 1 E 25.00 � 1 / i(ep ,c'e.-04d / 3 6 inc" t e 4- ` 1)r4 be bra: 1- A 'TAN inal �� 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 ICOMMENCEMNT 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." .,!! P 1 ' 7 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 -0720 City of.ZephyrhillsFire. 401 7 ,3 Fax - 813 -780 -0021 Permit Application l/ Date Received Phone Contact for Permit MEM 1 4 1 5Zl Owner's Name , croc. r(la kuk ZoNa.iff In(. Owner's Phone Number 1 , Owner's Address 5 %\3) r(\OIkR.4 y JQy{ L..P filtirk; L'S 1" Z Fee Simple Titleholder Name 1 Titleholder Phone Number Fee Simple Titleholder Address 1 Z 2 Job Address 381 5 h�d r kl4 I JCt YL f. L j i, n'k / l F/ J 2. Lot Sub Division Parcel # n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent . n Comm Exhaust Kitchen Hood /Duct ( I Hazardous Material (Tier II or RQ Facility) ANNUAL n Controlled Bum I Hood Installation n Emergency Generator < 30 kw n LP /Natural Gas - Installation 1 1 Emergency Generator> 30 kw 1 ] LP /Natural Gas - ANNUAL Sale Fire Protection Maintenance - ANNUAL 1 Places of Assembly- ANNUAL ItAtny1 16emi1 177 Other Sprinkler n ❑ ❑ ❑ ( I Recreational Bum Fire Alarm ■ ❑ ❑ • ( ( ( I Sparklers Hood Cleaning n ❑ ❑ ❑ I 1 ( Sprinkler System Installations Hood Suppression n ❑ ❑ ❑ ( I ( Standpipes (Sprinkler Sys) Fire Alami Installation n Torch Roofing/Tar Kettle n Fire Pumps n Waste Tire Storage ANNUAL Fire Works n Flammable Application- ANNUAL ) Valuation of Project 1 I Fuel Tanks n Oth; 1 Contractor ' Company rD,11Li �r[ ..c ,, Signature , I AW. -,�, It Registered W/ N Fee Current / N Address I r I License # R E F p-7:5 ELECTRICIAN • Company Signature Registered Y/ N I Fee Current I Y/ N Address I License # PLUMBER Company Signature Registered Y / N 1 Fee Current 1 Y / N Address I I License # MECHANICAL Company Signature . Registered Y / N . 1 Fee Current 1 Y / N I Address I License # OTHER Company Signature Registered Y / N j 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 (httpJ /appraiser.pascogov.com) 'NOTICE OF :DEED RESTRICTIONS: The undersigned understands that this permit may subjectto "deed ":restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility :for compliari e any .applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has `hired 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' 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 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 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 aii 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 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 (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 RECORDING YOUR NI ICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) CONTRACTO & 441 AL. _ lOIL OWNER OR AGENT Subscribed an • rn to (or a r*n It before sne this Subscribed and swum to (or affirmed) before me this • b y Who is/are per. •Wally known '� e or has/have produced Who is/are personally known to me or has/have produced as i as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped