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HomeMy WebLinkAbout09-9185 _ - CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9185 ANNUAL FIRE PROTECTION MAINTENANCE n ` •• . .. { Permit Number: 9185 Address: 7425 GALL BLVD 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: 34-25-21-0000-00300-0000 Improv. Cost: Date Issued: 6/02/2009 Name: ZEPHYRHILLS PLAZA LLC Total Fees: 25.00 Address: 7425 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/02/2009 Phone: Work Desc: FPM - SPRINKLER ANNUAL-BEALS #30 v:77 "" s- WAYNE AUTOMATIC FIRE SPRINKLER I FIRE PERMIT FEES 25.00 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." err' /i ICY 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 -6020 City of Zephyrhills Fire 1 ( Fax -813- 780 -0021 Permit Application Date Received I 1 Phone Contact for Permit I I I I I I Owner's Name 12Q,PheloCILS Plaza., LLC.- 1 Owner's Phone Number 1 g' 1 I 17b (tabgb Owner's Address 590 LP CO `"'Q tAX iu 9 .N� 0CP Fee Simple Titleholder Name I 1 I Titleholder ' `- itleholder Phone Number I Fee Simple Titleholder Address I 1 Job Address 749-5 G o-- 6&4d- i vy► v ' `U" I J ' v 351-11 �( Lot # jy Sub Division 1 (J I Parcel # 34- 2 g 1 .01 (0 ot 00I 00 . MO El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Burn n LP /Natural Gas - Installation n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale r[-cc Emergency Generator> 30 kw L_J Places of Assembly-ANNUAL I x I Fire Protection Maintenance - ANNUAL r-i Recreational Burn 't IQtrlyl Semi) Other Sprinkler I I n ❑ ❑ $ 0 Sparklers Fire Alarm El ❑ ❑ ❑ I 1 [] Sprinkler System Installations Hood Cleaning El ❑ ❑ ❑ I I I—I Standpipes (Sprinkler Sys) Hood Suppression CI ❑ ❑ ❑ I I [] Torch Roofing/Tar Kettle In Fire Alarm Installation Waste Tire Storage ANNUAL n Fire Pumps Fire Works n Flammable Application- ANNUAL I I Valuation of Project Fuel Tanks n Other: I I Contractor Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # ( 1 ELECTRICIAN Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I License # ( 1 PLUMBER I Company I Signature I Registered I Y / N 1 Fee Current 1 Y / N I Address I License # I MECHANICAL Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I 1 License # 1 OTHER Company 1JRYNE AMTE MPet1G F 2-6 SP9-40 GI ' Signature te __- ij FERN ., Registered MUM Fee Current �■ I Address li p CH'QJe- Y I ALM ®� �/k�/�P�F ?i L o 1 I License # I 09b4(0( 0 abOI a- IC0i5 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) ACORDTM C EI TIFICK E QF INSUI NC - DATE 4/3/09 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BROWN & BROWN INC CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 220 SOUTH RIDGEWOOD AVENUE AFFORDED BY THE POLICIES BELOW. P O BOX 2412 COMPANIES AFFORDING COVERAGE DAYTONA BEACH, FL 32115 COMPANY A GREENWICH INSURANCE CO 22322 INSURED COMPANY WAYNE AUTOMATIC FIRE SPRINKLERS, INC. B HARTFORD CASUALTY INSURANCE CO 29424 HAZARD FIRE PROTECTION ENGINEERING COMPANY 222 CAPITOL COURT C NAVIGATORS SPECIALTY INSURANCE CO 36056 COMPANY OCOEE FL 34761 D FFVA MUTUAL INSURANCE CO (FL ONLY) 10385 COMPANY E HARTFORD FIRE INSURANCE CO 38261 COMPANY COVERAGES , THE POLICIES OF INSURANCE 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 E LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY LIMITS , DATE (Mb DD"!Y) ! EXPIRATION I DATE (M /DD/YY) GENERAL LIABILITY RMG640012401 09/01/08 09/01/09 GENERAL AGGREGATE $ 2,000,000 • A ® OMMERCIAL GENERAL LIABILITY PRODUCTS - COMP /OP AGG $ 2,000,000 • ❑❑ CLAIMS MADE ® OCCUR PERSONAL & ADV INJURY $ 1,000,000 ❑ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 ® (FNFRAI APARFO.ATF I MIT FIRE DAMAGE (Any one fire) ' $ 60,000 APPLIES PER PROJECT MED EXP (My one person) $ 5,000 B AUTOMOBILE LIABILITY 21UENU7216 09/01/08 09/01/09 $ 1,000,000 ® ANY AUTO COMBINED SINGLE LIMIT ❑ ALL OWNED AUTOS ® HIRED AUTOS BODILY INJURY $ (Per Person) ® NON -OWNED AUTOS BODILY INJURY $ ❑ (Per Accident0 ❑ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ❑ ANY AUTO OTHER THAN AUTO ONLY $ 0 EACH ACCIDENT $ 0 AGGREGATE $ C EXCESS/UMBRELLA LIABILITY NY08EXC169817NC 09/01/08 09/01/09 EACH OCCURRENCE ® OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 SIR $ 10,000 • D WORKERS COMPENSATION AND WC84000168652009A 04/01 /09 04/01/10 ► i1 STATUTORY LIMITS EMPLOYERS LIABILITY Florida THE PROPRIETOR/ p INCL EACH ACCIDENT $ 500 PARTNERS /EXECUTIVE $ 500,000 OFFICERS ARE: ❑ EXCL • DISEASE- POLICY LIMIT DISEASE -EACH EMPLOYEE $ 500,000 E OTHER LEASED /RENTED EQUIPMENT 21MSLJ8023 09/01/08 09/01/09 $100,000 PER ITEM $2,500 DEDUCTIBLE $200,000 AGG DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /SPECIAL ITEMS CANCELLATION: EXCEPT 10 DAYS NOTICE FOR NON - PAYMENT OF PREMIUM - CERTIFICATE HOLDER - ... - .......CANCELLATION - .: , : - - ..:.:.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I WAYNE AUTOMATIC FIRE SPRINKLERS, INC THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO i 222 CAPITAL COURT MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OCOEE, FL 34761 OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. r, 1'' 11-14.44,--- , ACORD 25 -S (3/93) ©ACORD CORPORATION 1993 ■ NOTEPAD: INSURED'S NAME - WAYNE AUTOMATIC FIRE SPRINKLERS, INC. PAGE 2 EFFECTIVE DATE: 9/1/08 - 9/1/09 ADDITIONAL INSURED- OWNERS, LESSEES, CONTRACTORS CG 20 33 07 04 ADDITIONAL INSURED- OWNERS, LESSEES, CONTRACTORS- COMPLETED OPERATIONS CG 20 37 07 04 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG 24 04 10 93 ENDORSEMENTS CG 20 33 07 04, CG 20 37 07 04 AND CG 24 0410 93 APPLY AS REQUIRED BY CONTRACT, PROVIDED CONTRACT IS EXECUTED PRIOR TO LOSS. • • r t