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HomeMy WebLinkAbout09-9069 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9069 ANNUAL FIRE PROTECTION MAINTENANCE f Permit 6 ,7 ;7 ,�� , '22' �...� mit Number: 9069 Address: 6030 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: 03-26-21-0010-12800-0000 Improv. Cost: `� �, Date Issued: 4/27/2009 Name: GALL BOULEVARD LAND TRUST Total Fees: 25.00 Address: 350 HARBOR PASSAGE Amount Paid: 25.00 CLEARWATER, FL 33767 Date Paid: 4/27/2009 Phone: Work Desc: FPM- FIRE ALARM ANNUAL- BEAL'S OUTLET #542 SCARSDALE SECURITY SYTEMS INC FIRE PERMIT FEES 25.00 T -o9 v� 1:1 72 r+ E " as .. Y:{"`: °' W a aE -s ' � 4V W' 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." 42 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 , . . .10 Ok9 813-780-0020 City of Zephyrhills Fire Fax- 813 -780-0021 Permit Application Phone Contact for Permit Date Received I I 1 1 I I ;LP�t(� D -I e t ' Owner's Phone Number Owner's Name (�,�, ,t� ( &-0\-1.1 ( J C. -N' I Owner's Address I Le 030 Q 1 Vd ' • l 1 1 1 I I Titleholder Phone Number l Fee Simple Titleholder Name Fee Simple Titleholder Address I I Lot# I Job Address 1 I I I 1 Parcel.* Sub Division El Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL Comm Exhaust Kitchen Hood/Duct El Hood Installation . Controlled Bum LP /Natural Gas - Installation • Emergency Generator < 30 kw LP /Natural Gas - ANNUAL Sale Emergency Generator 30 kw Places of Assembly- ANNUAL Fire Protection Maintenance - ANNUAL Recreational Bum ® ml ® Other Sprinkler ❑ ❑ , Sparklers Fire Alarm ❑ ' / I I Sprinkler System Installations Hood Cleaning El ❑ ❑ ❑ ( 1 [] Standpipes (Sprinkler Sys) Hood Suppression 0 ❑ ❑ • ❑ I I E Torch' Roofing/Tar Kettle Fire Alarm Installation = Waste lire Storage ANNUAL Fire Pumps Fire Works I I Flammable Application- ANNUAL Valuation of Project Fuel Tanks Q Other: I C I Company G�St • 5-c Contractor l j r ei j,(� (/ (/ Registered rows Fee Current Signature ' ���".""���� '� ' License # I E F o-O 000 y �, 0 Address 0- r w M t AI .' . C °l � • I ELECTRICIAN) I Company Registered Y / N I Fee Current 1 Y / N Signature Address I I License # PLUMBER ( Company ( Signature I Registered Y/ N I Fee Current I Y / N Address 1 I License# I I MECHANICAL I Company I Signature l Registered Y/ N I Fee Current I Y/ N. I Address I I License # I OTHER ( Company ( Signature I Registered Y/ N I Fee Current I Y/ N I 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 T ax Notice h //a raiser. as ov.com) Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property (ttp: PP P ceg 'NOTICEi;OF TEED RESTRICTIONS: 'The undersigned understands that this permit maybesubject°to ";rrrsli fictions" which may be more restrictive than County regulations. The•.undersigned.assumes responsibility. for:compliarrcetwith 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 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 intendediwork, 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 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 riot 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 1, - 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 itto 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 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 1 am the AGENTFORTHE 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 is-sued 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 swam to (or affirmed). before me this Subscribed and sworn to (or affirmed) before me this by by Who isfare personally known to me or has/have produced Who isfare 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 4/27/2009 2:31 PM FROM: Alarm Insurance Alarm Insurance Agency TO: +1 (813) 780 -0021 PAGE: 002 OF 004 DATE(MMIDDNYYY) ACORD,M CERTIFICATE OF LIABILITY INSURANCE 4/27/2009 PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Alarm Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 125D Wappoo Creek Drive, Suite 1B ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Charleston, SC 29412 843- 762 -6607 INSURERS AFFORDING COVERAGE NAIC # INSURED Scarsdale Security Systems Inc. INSURER A First Mercury Ins 10657 INSURER B 132 Montgomery Avenue INSURER 0 Scarsdale, NY 10583 INSURER D Travelers 11223 1914- 722 -2200 scarOl INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDCATED. 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 %DO'L - POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR MW TYPE OF INSURANCE POLICY NUMBER DATE NM/DID/1'Y) DATE (MMIDDIYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RJNMNUC 1 V KCII 1 CU X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ _ 100 , 000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000 A X Errors & FM41009873 3/02/09 3/02/10 PERSONAL &ADVINJURY $ 1,000,000 X Omissions GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPUESPER PRODUCTS - COMP /OP AGG $ 2,000,000 PRO - _ POLICY ©JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALLOWNED AUTOS BOOLY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODLY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ —I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X I OCCUR n CLAIMS MADE AGGREGATE $ 5,000,000 _ CUMI000312 03/02/09 03/02/10 $ A DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND X ITORY LIMITS 1 IU - EMPLOYERS'LIABILITY UB- 9188Y38 -9 -08 03/02/09 03/02/10 E L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D OFFICERNEMBER EXCLUDED, excludes NYS E.L.DISEASE - EAEMPLOYEE $ 1,000.000 !Nes. describe under SPECIAL PROVISIONS below E.L. DSEASE- POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS UB- 9188Y38 -9 -08, Worker's Compensation policy is valid in FL. This Acord Certificate is a three page document. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills - Building Dept DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Zephyrhills, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEIJTATIV. EJ�'� L 1 ACORD25 (2001108) ©ACORD CORPORATION 1988 4/27/2009 2:31 PM FROM: Alarm Insurance Alarm Insurance Agency TO: +1 (813) 780 -0021 PAGE: 004 OF 004 Date: MEMO 12/18/2007 TO: Scarsdale security Systems Inc. FROM:Alarm Insurance Agency 125D Wappoo Creek Drive, Suite 18 132 Montgomery Avenue Charleston, SC 29412 Scarsdale, NY 10583 843 - 762 -6607 Page 3 of Certificate: Additional Insured coverage only triggered when required in written contract between insured and additional insured. Contractual Liability provided under the CGL Policy listed above is Limited Form for the perils of "bodily injury" and "property damage" only. Certificate Holder is notified that if contractual requirement between named insured and additional insured for notice of material change will not be given. 4/27/2009 2:31 PM FROM: Alarm Insurance Alarm Insurance Agency TO: +1 (813) 780 -0021 PAGE: 001 OF 004 F A X •••• • Alarm Insurance Agency • • • • • • • • To: City of Zephyrhills Fax number: +1 (813) 780 -0021 From: Alarm Insurance CSR6 Fax number: Business phone: Home phone: Date & Time: 4/27/2009 2:31:50 PM Pages: 4 Re: scar0l -Cert for City of Zephyrhills