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HomeMy WebLinkAbout09-8941 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 8941 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 8941 Address: 7350 DAIRY RD 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: 35- 25 -21- 0010 - 06900 -0020 lmprov. Cost: r._ , _ ;.. , e,= 7 . .P Date Issued: 3/19/2009 Name: AD HEALTH SYSTEM Total Fees: 25.00 Address: 7050 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 3/19/2009 Phone: Work Desc: FPM -FIRE ALARM ANNUAL- ADVENTIST HEALTH -OLD DONE 11/2008 SIEMENS BUILDING TECHNOLOGIES, 1 FIRE PERMIT FEES 25.00 0 (16 / i rC f ug: rw R x A=A1 7= `° 1lifiL 7 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." 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 -7B0 -0020 City of Zephyrhills Permit Application (0 ( Fax- 813- 780 -0021 Building Department Date Received ((1 2— 1 Ip.liir W Phone Contact for Permitting J 0 Owner's Name rll p A4 1.s ir-k. OA. S 7 .Si P vh Owner Phone Number 1 Owner's Address ' )OSb t4,1t fca )L9t y�'Itrl� FLT ?354 Owner Phone Number r Y Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 13 SC Oq,f Y tkt I Z>: eilyik 1 / • /. . '1 5i I, LOT# SUBDIVISION I PARCEL ID# ? J 2 S 2., t Co ED 0000 oats (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN 1 1 MOVE 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE n SFR 1 1 COMM 1 ( OTHER 12 „, ,..A•1 orr, I TYPE OF CONSTRUCTION [] BLOCK I /n 1 FRAME I STEEL I 1 OTHER I 1 DESCRIPTION OF WORK AAt\Ue t . / t Ake, nn , pe c f. , oek BUILDING SIZE SO FOOTAGE HEIGHT n BUILDING $ VALUATION OF TOTAL CONSTRUCTION III 7 t VS ! "S P REf ELECTRICAL $ AMP SERVICE h PROGRESS ENERGY n W.R,E.0 I I PLUMBING $ I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION A j ° 1 GAS I ROOFING 1 1 SPECIALTY 1 1 OTHER �Y ` FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA [ I INO BUILDER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y/ N 1 Address License # PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y/ N 1 Address License # 1 MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N 1 Address License # OTHER COMPANY S,crvu .. 1,\14(.1 (l1ct TT L,.,L, SIGNATURE (� v REGISTERED 1 Y/ N 1 FEE CURRENT 1 Y / N I Address ►j k Q ��..,In. ,''. Q e C� I , -, e 4 - 3,31.341 1 License# Er /000C`+ RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ****PROPERTY SURVEY required for all NEW construction. reci .... ...... ............................... _.........__.........._....._......................................................................................................................................................................,. ............................... Directionss : Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A /C upgrades over $5000) Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW NOTICE OF DEED 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. TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and 90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, 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. Such agencies include but are not limited to: Department of Environmental Protection- Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers - Seawalls, Docks, Navigable Waterways. Department of Health & Rehabilitative Services /Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency- Asbestos abatement. Federal Aviation Authority- Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone "V" unless expressly permitted. If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. 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 NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) before me this by 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 _, b• N ro �N %» HN a' °° ° v t0 r � to o op L=1 H td H H p, ti k o 0O ij t� � j hi ti PJ O H CI J CO on xnHH Cr I - ° D a 0 W C CO H Ctx� O W H/ H m �' ,d tv C 1 ... 3 N � , till Hx (1 H �HZ N O o y wN 0 o .© ci z uN H Q L.tI 0;0MM W 4 r. ' rn � r; 0 {" "'r1 C H r- � r o rntcl co tic) I:, �� ZVI tf1H HO ZZ W V H it Z M y, H0 H H vl 0 Ca m tx1 e) VI IA 0 co x a N 03 0 0 [■ 41. W ACORD CERTIFICATE OF LIABILITY INSURANCE / 14 / /DD/YY) 10!14/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MARSH USA, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 44 WHIPPANY ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 1966 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MORRISTOWN, NJ 07962 - 1966 COMPANIES AFFORDING COVERAGE COMPANY 100129 6 7BA - SBT1 - 08/09 218 A Gerling America Insurance Company INSURED COMPANY SIEMENS BUILDING TECHNOLOGIES, INC. B Liberty Mutual Fire Ins Co 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089 -4513 COMPANY C Liberty Insurance Corporation COMPANY - -- - -- D COVERAGES This certificate supersedes and replaces any previously issued certificate. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION LTR DATE (MM /DD/YY) DATE (MM /DD /YY) UMITS A GENERAL UABIUTY GLD11101 - 00 10/01/08 10/01/09 GENERAL AGGREGATE $ 10,1)00,01)0 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ INCL. CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 OWNERS & CONTRACTORS PROT EACH OCCURRENCE $ 1,000,000 , FIRE DAMAGE (Any one fire) $ 1,000,000 1 MED EXP (Any one person) $ 100,000 B AUTOMOBILE UABIUTY AS2 631 004334 - 218 10 /01 /08 10/01/09 COMBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO — X ALL OWNED AUTOS BODILY INJURY $ N/A SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X ;NON -0WNED AUTOS (Per accident) N/A -- -- - - -- (PROPERTY DAMAGE $ N/A GARAGE UABIUTY AUTO ONLY - EA ACCIDENT _ $ ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS UABIUTY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND WA7 - 004334 - 018 (AOS) 10/01/08 10/01/09 X ! We STATU- OTH- EMPLOYERS' UABIUTY TORY LIMITS L ER C WC7 631 - 004334 - 028 (OR, WI) 10/01/08 10/01/09 EACH ACCIDENT $ 1,000,000 • C THE PROPRIETOR/ X INCL EW7 - 004334 048(OH) 10/01/08 10/01 /09 DISEASE - POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE. EXCL $500K LIMIT / $500K SIR DISEASE - EACH EMPLOYEE $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS RE: CONTRACTOR LICENSE REGISTRATION FOR THE BRANCH WILLIAM VALE AND JEREMY LEMBO ARE INCLUDED AS ADDITIONAL INSURED UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES, BUT ONLY WITH RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS BUILDING TECHNOLOGIES, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. CERTIFICATE HOLDER NYC 002739289 - 11 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURANCE COMPANY WILL ENDEAVOR TO MAIL THE CITY OF ZEPHYRHILLS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN: CONTRACTOR LICENSING 5335 8TH STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UABIUTY OF ZEPHYRHILLS, FL 33542 ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE of Marsh Inc. L- _ of USA r/X - Aµ o BY: Mary Radaszewski ACORD 254 (1195) e ACORD CORPORATION 1988 s J ii�te .� DRIVER LICENSE CLASS E I WILL V 40 0-926-64-135-0 `_= A4, ., IAM F VALE JR 1850 SPARKLING WATER CIRCLE OCOEE, RL 34161.9126 DOB: 04 -1964 SEX: M HGT: 6 -02 a 41 2006 Lg� 151 r nt', r Wi t. W � 6. 7 r ` 1 ORGAN DONOR ".. . h.. X SAFE bR(VER Operation of a motor vehicle constitutes consent to any sobriety test squired ^ by law }1 2008 -2009 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 -30 -2009 FOLIO NO FACIUTIES OR MACHINES ROOMS SEATS EMPLOYEES 0 0 0 1 d RENEWAL 50792.0000 OCC. CODE BUSINESS TYPE H. WASTE TAX SURCHARGE 090.008 CONTRAC TOR ECTt KCAL 18.00 Yi 1' ii ; mss.. � k, AVIC *be 4420 BUSINESS 8403 BENJAMIN RD #F LOCATION TAMPA 33634 • NAME SIEMENS CERBERUS DIVISION MAILING 8403 BENJAMIN RD #F ADDRESS TAMPA FL 33634 -0000 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR PAID - 8020 - 85 HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813 -635 -5200 07/14/2008 "' 18.00 N BUSINESS. PROFESSION. OR OCCUPATION SPECIFIED HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED.