HomeMy WebLinkAbout09-9030 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780 -0020 9030
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 9030 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: 4/17/2009 Name: ZEPHYRHAVEN NURSING HOME
Total Fees: 25.00 Address: 38250 A AVE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 4/17/2009 Phone:
Work Desc: FPM - SUPPRESSION SEMI - ZEPHYR HAVEN- SCH WK OF 20TH
FIREM■STER FIRE PERMIT FEES 25.00
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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." 01P
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
813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021
Permit Application L ,
Date Received —/ 5'"-e, 5'"-e, / c Phone Contact for Permit �7 Z8 IMMO
Owner's Name 1 �C pi.i.vr 1-1Ci...," — I Owner's Phone Number I
Owner's Address I
Fee Simple Titleholder Name I 1 Titleholder Phone Number 1 1 I
Fee Simple Titleholder Address
Gc P- X£`.«mn';H•"a� � / .v`�
Job Address 3O.2 ✓ 0 4 Ave. Lot #
Sub Division I Parcel # I
ED Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL
E Comm Exhaust Kitchen Hood /Duct El Hood Installation
Controlled Bum n LP /Natural Gas - Installation
n Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale
n Emergency Generator > 30 kw n Places of Assembly- ANNUAL
Fire Protection Maintenance - ANNUAL = Recreational Bum
InTail EMI) (j Other
Sprinkler E ❑ ❑ ❑ n Sparklers
Fire Alarm n ❑ ❑ ❑ I I CI Sprinkler System Installations
Hood Cleaning Ei ❑ ❑ ❑ 1 1 0 Standpipes (Sprinkler Sys)
Hood Suppression Et ❑ er ❑ I 1 n Torch Roofing/Tar Kettle
El Fire Alarm Installation El Waste Tire Storage ANNUAL
n Fire Pumps
Fire Works
Flammable Application- ANNUAL
1 ( Valuation of Project
Fuel Tanks
Q Other: I
Contractor Company Fire 0X 71 - 11 /� cvl ot: C�` l
Signature 7/116/ \ Registered Y / N I Fee Curren I Y / N
Address I I License# 1 7AlSy8"6 la-ex I
ELECTRICIAN Company I
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I License # I
PLUMBER Company I
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I License # I
MECHANICAL Company I
Signature Registered Y/ N I Fee Current I Y/ N I
Address I I License # I
OTHER Company I
Signature Registered Y/ N I Fee Current I Y/ N I
Address License #
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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;DF:DEED RESTRICTIONS: The undersigned understands that this permit maybe • subjectfto - " deed° :restrictions"
.which may more restrictive than County regulations. The.undersigned.assumes responsibility .for:compliarice'with any
.applicable deed restrictions.
UNLICENSED 'CONTRACTORS AND "CONTRACTOR RESP.ONSIBILmES: If the owner has - hired - :a- contractor or • -
contractors - to undertake work, they may be required 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 - fora misdemeanor violation iolation for the
under state law. if -the advised o t intended contractor sco County licensing
Division—Licensing l Section:at 727-847 -
8 009. a F advis
he is advised to have the contractor(s) sign
8009.: Furthermore, if the owner has hired .a contractor or contractors,
portions ;pf the "contractor Block" of this:application"for which - they will be responsible. If you, as 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 e Florida Statutes, as amgndedj If valuation of work 'B12500.00 or more I
( ave .b pr
certify that 1, - the applicant, have .been n 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 itlto the `owner" prior to commencement.
CDNTRACTOR'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. l certify
met ee t no wrk or
st annd a rd s ofa all la n has co ws regulating on��oissuance , ounty .and City codes, .zoning regulations, performed d land
m at
adrd of ll la g
development regulations in the jurisdiction. I also certify that 1 understand that the regulations of other
. government agencies may apply to •intended work, and that it is my responsibility to identify what actions I
must take to be in compliance.
If 1 am the AGENT'FORTHE OWNER, I promise in -good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. 'trn understand
or installations a separate to sspecifically may a req d
uired n the electrical o , A
pt m i t i signs welts on air conditioning, 9 a
er, or
permit issued shall be construed be a to be a � des shall proceed
of a permit prevent the the ding i Offtcal c from thereafter
set aside any provisions of the technical codes, etTriit issued shall become invalid
requiring a correction of errors in plans, construction or violations of. any codes. Every p
unless the work authorized by such permit is s9x (6 within onths aftenh e t me the�work issuance,
'IS commenced. An authorized
extension
the perriiit is suspended or abandoned for a p e riod of 90 days and will demonstrate
may be requested, in writing, from the Building Official, for ag a consecutive a days, the job is considered abandoned.
justifiable cause for the extension. if work ceases for ninety (90) MAY
WARNING TO OWNER: YOUR FAILURE TO UR RECORD 'NOTICE PROPERTY. IF YOU INTEND TD OBT� FINANCING, T
PAYING TWICE FOR IMPROVEMENTS TO YO + � M NCEMENT.
WITH YOUR ENDER OR AN ATT = R EYBEFDRE RECORDING YOUR NOTICE OF
FLDRIDAiJURAT (F.S. 117.0 /
411 CONTRA> DR (. a� ed) before me this
Subscribed OR AGENT swum ' - ..before me this Subscribed
and sworn to Subscribed and•swom to (or - � by
--by isa personally known to me or has/have produced
Who is/are personally known to me or ent f cats produced fre as identifcation .
as idenUfrcation.
Notary Public
Notary Public
ommission No.
Commission No. c
Name of Notary typed; printed or stamped
Name of Notary typed, printed or stamped