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HomeMy WebLinkAbout09-9060 v o CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9060 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 9060 Address: 5230 6TH ST 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: 11-26-21-0010-13300-0130 Improv. Cost: 4 ° i I , ,9 Date Issued: 4/23/2009 Name: WACHOVIA B A NK Total Fees: 25.00 Address: 5230 6TH ST Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/23/2009 Phone: Work Desc: FPM FIRE ALARM ANNUAL- WACHOVIA BANK -SCH 4/23/09 • d , >_. 17.': ar, fl. .-✓ . ^'?a. , -.3 _ y ,, s : BORRELL FIRE SYSTEMS FIRE PERMIT FEES 25.00 (D.S • z a e',. ter-; -1 s. 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." -1,! iror 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 . if/ 813- 780 -0020 City of Zephyrhills Fire �tg 0 Fax -813- 780 -0021 Permit Application Date Received 1 1 Phone Contact for Permit I 813 I I 239 I 1 3473 Owner's Name I Wachovia Bank N A I Owner's Phone Number I 1 1 I I I Owners Address I P.O. Box 36246, Charlotte, NC 28236 -6246 Fee Simple Titleholder Name Titleholder Phone Number I 1 Fee Simple Titleholder Address I 5230 6th Street Job Address 1 Lot# 19 -24 Sub Division Town of Zephyrhills I Parcel # 111 26 21 0 010 15400 0190 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL I Comm Exhaust Kitchen Hood /Duct Il Hood Installation E l Controlled Burn I LP /Natural Gas - Installation 0 Emergency Generator < 30 kw I LP /Natural Gas - ANNUAL Sale I — I Emergency Generator > 30 kw I Places of Assembly- ANNUAL © Fire Protection Maintenance - ANNUAL El Recreational Burn ry (Semi' mii Other Sprinkler I El ❑ ❑ n Sparklers Fire Alarm © ❑ ❑ I I n Sprinkler System Installations Hood Cleaning El ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) Hood Suppression n ❑ ❑ ❑ I I I Torch Roofing/Tar Kettle 0 Fire Alarm Installation I—I Waste Tire Storage ANNUAL I] Fire Pumps Fire Works n Flammable Application- ANNUAL 1 I Valuation of Project I-I Fuel Tanks 71 Other: I I /� Contractor Company an Orr Protection Systems dba Sorrell Filre Signature C t-- `'- ( / / ^ Registered Y / N I Fee Current I Y / N I Address 1 2804 Broadway Center Blvd, Brandon, FL I License# EF20000636 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 1 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 J Address I I 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) BOIBELL Fire Systems ORR Protection Systems April 20, 2009 City of Zephyrhills Building Department 5335 8 Street Zephyrhills, FL 33542 Tel: (850) 780 -0000 Fax: (813) 780 -0005 RE: Power of Attorney To Whom It May Concern: The following individuals will be signing for and picking up permits on my behalf and on behalf of Borrell Fire Systems, Inc Div or Orr Protection Systems, Inc. Allen Ebanks This request is effective through rld1DbeY 31, 20cii. or until termination of employment. Please call with any questions, %YL Charles A. Foote Subscribed and sealed before me this rOdav of rr 1 t .2009 II`.. _: 1. -: _.. ..:I` Notary Public • • +`� Y fp MARC'! M. RODRIGUEZ ,+o. " MY COMMISSION #DD605252 t 2:' n EXPIRES: OCT 15, 2010 ' cc Bonded through let State Insurance .. BORRELL Fire Systems Division of ORR Protection Systems, Inc. 2804 Broadway Center Blvd. Brandon, Florida 33510 813 - 239 -3473 FAX 813 - 237 -6565 800 - 711 -6002 Tampa • Orlando • Jacksonville • Ft. Lauderdale • Ft. Myers • Tallahassee • Miami • Ft. Walton Beach FL FM 81158700012006 • FL FM 81158900012006 • FL EF 20000443 • , Client#: 810583 64ORRSAF ACORD CERTIFICATE OF LIABILITY INSURANCE 4/20/200 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BB &T Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2600 Eastpoint Parkway (40223) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 436869 Louisville, KY 40253 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co of P 19445 Orr Safety Corporation; Orr Protection INSURER B: New Hampshire Insurance Company 23841 Systems Inc.; Orr Protection Systems INSURER C: Inc. dba Borrell Fire Systems INSURER D: PO Box 19802 Louisville, KY 40259 -8029 INSURER E: COVERAGES 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYl DATE (MMIDDIYY) A GENERAL LIABILITY GL4020898 07/01/08 07/01/09 EACH OCCURRENCE $1,000,000 X D AMAGE TO RENTED $ 500 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) r CLAIMS MADE © OCCUR MED EXP (Any one person) $ 10, PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000, n POLICY n MT - I I LOC A AUTOMOBILE LIABILITY CA3853776 07/01/08 07/01/09 COMBINED SINGLE LIMIT $1,000 r 000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS /UMBRELLA LIABILITY BE4890963 07/01/08 07/01/09 EACH OCCURRENCE $10,000,000 OCCUR n CLAIMS MADE AGGREGATE $10,000,000 DEDUCTIBLE $ X RETENTION $ 0 $ WC STATU B WORKERS COMPENSATION AND WC7578122 07/01/08 07/01/09 X I TORY 1 IMITS I OT F H- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Zephyrhills, FL 33542 REPRESENTATIVES. AUTHORIZED REPRESENTA IVE ACORD 25 (2001/08) 1 of 2 #S3456375/M3369401 MCH © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 - (2001/08) 2 of 2 #S3456375/M3369401 , - . , STATE OF FLO RIDA t, • 4 ' s - DEPA RTMENT OF BUSINESS AND PROFESSIONAL REGULATION ip n, ' m- E I' - - .. ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487.1395 • . : - 1940 NORTH MONROE STREET `' silo TALLAHASSEE FL 32399 -0783 FOOTE, CHARLES A BORRELL FIRE SYSTEMS INC PO BOX 198029 LOUISVILLE KY 40259 • 1 r • ; ,.- O. AEI - .3835195 " . ` ST ' A•. Congratulations! With this license you become one of the nearly ane mlitlon D EP ARTMENT OF• BU A ; I . • Floridians licensed by (tie Department of Business and Professional Regulation. • t • • : PROFESS TONAL REGULATION `.' Our professionals and businesses rangy from architects to yacht brokers, from ` :. . ' t. , . , boxers to barbeque restaurants, and they keep Florida's economy strong- r- EF200 • - 07/01/OB - 066000473 Every day we work to improve the way we do business In order to serve you better. -'. '., . • .•. :., : ' • ' , _ . ' : ' For information about our services, p1eas4 tog onto www.myfloridaticenso.cam. :.• .-CERT: ALAS - SYSTEM •C01i TRACTO I There you can find more information about our divisions and the regulations that ,.' FQOTL • . CHARLES ': A. - , ' . , '' . . .= • impact you, subscribe to department newsletters and Team morn about tht� .: 'SORRBI,L, FIRE` SYSTEMS INC ,• • , . • ;- . • Department's initiatives, - • Our mission at the Department is License Efficiently, Regulate Fairly. We constantly strive t0 Serve you getter 50 that you can Servo your customers• IS .Cgtt 'Y FY$t7 ttrder the provielaa■ ot Ch 4 vs•, Thank you for doing business in Florida, and congratulations on your new license! 'rspiii,i„ uca, Ann . 31,' 2010 • -. 01.80701.0i) : DETACH HERE • ... ,..., -�... . • •.,.• : . 1. ! - __ • DE . D V :' B U S INESS `•AND ''PRGE� :REGULATION ' - • { - E.; ECTRICA '`GONTRAC! OR Si' I, C NG .BOARD • ..... : t 1 t , r �• •,ti'' ' r�' : 1" •6c .F . _ % SEC# LU9fl7Oloij 5i} • - ` 2•-• - - ••- .... ... 5 : ":' tea. .F • .', DATE BATCHNUMBER L ] CEN3P::NBR' _, • i. °C a'•' . .. . 07/01/ 086 O.Q473 =. f EF20O4 #.6:3 - -, = -Adc f t3ona .,Eu ine.en. Qual.• i.catiori .- . . -The AI�ARM�'S1. S E14!:' CON`1`RAC OH .- cr �7 '• 1- : -= A.6 . • _'141 ne e :3oa1ow.-IS!CERTTF:IED _ - : f .. . — ' Y ' • Un • 't f:`0 ' 2#39: . F $ ,.4•' ..,i i - ,. - - .. :E it . oat.'• ' : - 31 , '20I G:.• • t •4 ' .. :''..-•••••,•••••-. _ .r. ; • i' �. �. .r,;. . }.� _ . {„t•1 �':rJ '.,�':T'krm�,f r"'� - �1'' 7 {R ° r - • E CARLES` A'';:, _r' , , 4 .. ;,.ki ?.ir r ▪ °; . HO1%RELL if FIRE SYS'TEL S';.,IRU''''�;i•'" f ,�.— ' �:' . -t...` < . -, •11601 i.ItTERCLIAI'+)!GE; •DR '•'. • y r;�r '' �' � ..:.., r IS I LE y''K• 4U 9. 2 2 . ' • � . • F l; Sv z. '•LOCI .V. 'L - ' , ?',:' . �. .'� K '. - - • ,: ' RRI3TL -� = ` ,_;.f � . . ; ? . _ - ' .r • ' - CH U CK DR • , • • ': . • C OVERWO == ` - ', ,- IId'IERUM SECRETARY J5PiJ4, $ AEQUMED°SY:LAW-....,;.:., ...: 2008 -2009 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 - - 2009 FOLIO NO. FACILITIES OR MACHINES SEATS EMPLOYEES 0 0 0 12 RENEWAL 21866.0000 H. WASTE TAX OCC. CODE BUSINESS TYPE SURCHARGE 090.000 CONTRPQOR7, RE �RM YSTEMS s , b 40.00 36.00 �, . 3 . ws` /"r 4 h : . 5 R ;.YH t : 4� t. .: IM io :<. .; fix&: BUSINESS 2804 BROADWAY CENTER BLVD LOCATION BRANDON 33510 NAME JORDAN DONALD R MAILING DBA / BORRELL FIRE SYSTEMS INC ADDRESS 2804 BROADWAY CENTER BLVD BRANDON FL 33510 BUSINESS TAX RECEIPT DOUG BELDEN, TAX COLLECTOR PAID — 4141 * ** — 6 HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813-635-5200 12/04/2008 76.00 IN BUSINESS, PROFESSION, OR OCCUPATION SPECIFIED HEREON, THIS BECOMES A TAX RECEIPT WHEN VALIDATED.