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HomeMy WebLinkAbout09-9215 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9215 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 9215 Address: 7313 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 -0050 Im rov. Cost: Date Issued: 6/08/2009 Name: TACO BELL Total Fees: 25.00 Address: 7313 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/08/2009 Phone: (859)624 -3866 Work Desc: FPM - SUPPRESSION SEMI- TACO BELL - WORK DONE ON 3/19/09 #4f77:€77-77:—: ' : ( x g; ° \ r 1 : a phi {, x ; a. Ei€a ass v Al FIRE EQUIPMENT CORP FIRE PERMIT FEES 25.00 CjO 1 -o . .3, 9 , - .: 1 3 +0 ° 5 a g a.» �v '? ¢ 4 k 3: a FIRE ACCEPTANCE Final e ,,� k y y , �. , .,� ,� „ 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." �r s r.1� P T 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 iI q 813- 780 -0020 City of Zephyrhilis Fire 1 Fax -813 -780 -0021 Permit Application (�f Date Received I Phone Contact for Permit 13o 11 J -i'5 1182 q"_3 1 Owner's Name I TA C C7 _. e � # y 8 a Owner's Phone Number I 727 3 8 C I .3 y6 Owner's Address 7 313 GA // Nit/A. Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address I n I Job Address 73/.3 G,4( ( �.d , Lot# Sub Division Parcel # n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RO Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Burn n LP /Natural Gas - Installation n E mergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale n E mergency Generator> 30 kw I I Places of Assembly- ANNUAL n F ire Protection Maintenance - ANNUAL n Recreational Burn IQtrlyl (Semi � Other Sprinkler n ID ❑ ( I Sparklers Fire Alarm I ❑ (21 0 I 1 I ( Sprinkler System Installations `0 — Hood Cleaning I ❑ ❑ ❑ I 1 I I Standpipes (Sprinkler Sys) �� Hood Suppression IZ. ❑ `YL ❑ I 1 I I Torch Roofing/Tar Kettle In Fire Alarm Installation n Waste Tire Storage ANNUAL F Fire Pumps Fire Works Flammable Application- ANNUAL 1 ( Valuation of Project Fuel Tanks (n O ther: Contractor / / 1 Company ' • = Al -6 ' i t '* . Signature /� Registered j U Fee Current Qu� Address I3tt9 N,.) `2nrb NAiAVAi I et_ -317 1 I License# 3 [1 ?� ' 701)Q0 1 2-oo¢ ELECTRICIAN Company I Signature Registered Y/ N 1 Fee Current 1 Y / N 1 Address I I License # I PLUMBER Company I Signature Registered Y / N 1 Fee Current I Y/ N I Address I I License # I I MECHANICAL Company ( 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 1 Y/ N 1 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) Range Hood Systems Report SERVICE COMPANY DATE OF SER ICE TwE A LI I PM. 3-a-4, i►L -2• /v ✓ A -1 FIRE EQUIPMENT ANNUAL 1 1 RECHARGE f..2../c.) L" °" 1 RENOVATION ■ ABA FIRE EQUIPMENT LocATIONOF rearm CYUnoHts 3619 N.W. 2nd Avenue / 7- c.H'riti Miami, Florida 33127 MANUFACTURE MODEL NUMBER WET DRYCHEMNCAL • (305) 573 -8273 ekarlagiTE R 1 cYL, , SIZE EWE , CYLINDER SIZE SLAVE i i FIDlli eD F LINKS 4fi0` F FUSE MO• F OTHER CUSTOMER , Name T/te--o 541-1- 41- 4' 6 I o J . , + -or ELECTRIC GAS Address 73/ 7 6.y cc 4 ✓ / , H p SE NUMBER LAST HYDRO TEST GATE LAS I REC DATE City P9/JY� /a� /1 L s PL.' 33j-91 i�2N T ° t ,AL AEFE o -a- t' X - UF R•S RENCE L. " 3 TeiephoneP3 - )id " asf/ Store No ''AA PAGE N U Da DRAWING NUMBER R10 0 Owner or Manager COOKING APPLIANCff LOCATIONS : T TO RIGHT BLNT�JY.LR AWL) ZCIZ f'ey '. it 1. All appliances properly covered w /correct nozzles ■ 20. Replaced fuse links J_ 2. Duct and plenum covered w /correct nozzles .� 21. Check travel of cable nuts/S -hooks _iG 3. Check positioning of all nozzles. _._. 22. Piping & conduit securely bracketed _AZ._ 4. System installed in accordance w/MFG UL listing _.C___ 23. Proper separation between fryers & flame ✓ 5. Hood/duct penetrations sealed w/weld or UL device _ ' 24. Proper clearance -flame to filters _..r__ 6. Check if seals intact, evidence of tampering jZ_ 25. Exhaust fan In operating order ✓ 7. If system has been discharged, report same _Z__ 26. All filters replaced ✓ B. Pressure gauge in proper range (If gauged) //fi 27. Fuel shut-off in on position _V_ 9. Check cartridge weight (If applicable) ✓ 28. Manual & remote set/seals in place _� 10. Hydrostatic test date • 29. Replace systems covers 11.6 year maintenance date 30. System operational & seals in place ----- 12. Inspect cylinder and mount I, 31. Slave system operational Age 13. Operate system from terminal link +/ 32. Clean cylinder & mount 14. Test for proper operation from remote _44_ 33. Fan warning sign on hood _1L 15. Check operation of micro switch s___ 34. Personnel instructed hi manual operation of system 4 16. Check operation of gas valve 35. proper hand portable extinguishers 17. Clean nozzles 38. Portable extinguishers properly serviced 18. Proper nozzle covers in place _, 37. Service & Certification tag on system _J 19. Check fuse links and dean _� NOTE DISCREPANCIES OR DEFICIENCIES BELOW Comments:it Avms /v.rr .%44' ' Pe&-N Aecs/y 4,# On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 1 , 17A, 98 and t, manufacturer's manual and was operated according to these procedures with r indcated above , SERVICE TE "'. IAN PERMIT NO. DATE: TIME: AM PM f' STOMERSA 40i%' AG' II he above service technician certifies that the system was personally inspected and found co , • ns to be as indicated • this report WHITE -CUSTOMER COPY YELLOW- DISTRIBUTOR PINK -AUTHORITY HAVING JURISDICTION Jun, 2. 2009 10:47AM A -1 FIRE & ELECTRIC No. 1841 P. 2 01/13/09 I Certificate of Registration 1 R. 01 /09 Issued Pursuant to Chapter 212, Florida Statutes DEPARTMENT OF REVENUE 23- 8012018697 -6 06/17/75 06/01/75 1 MONTHLY Certificate Number Registration Effective Date Opening Date Filing Frequency This cenIfies that A 1 FIRE EQUIPMENT INC 3619 NW 2ND AVE MIAMI FL 33127 -3119 has met the sales and use tax registration requirements for the business location stated above and is authorized to collect and remit tax as required by Florida law. This certificate Is non - transferable. POST THIS CERTIFICATE IN A CONSPICUOUS PLACE r THIS IS YOUR SALES & USE TAX CERTIFICATE OF REGISTRATION (DETACH AND POST IN A CONSPICUOUS PLACE) REFER TO THE BACK OF THIS SECTION FOR SPECIFIC INFORMATION REGARDING YOUR COUNTY'S TAX RATES. THIS IS YOUR ANNUAL RESALE CERTIFICATE FOR SALES TAX Note: New dealers who register after mid- October are Issued annual resale certificates that expire on December 31 of the following year. These certificates are valid immediately. DR -11R. R. 10/00 DR -13 I 2009 Florida Annual Resale Certificate for Sales Tax I R. 01/09 THIS CERTIFICATE EXPIRES ON DECEMBER 31, 2009 DEPARTMENT OF REVENUE Business Name and Location Address Registration Effective Date Certificate Number 06/17/75 23- 8012018697 -5 A 1 FIRE EQUIPMENT INC 3619 NW 2ND AVE MIAMI FL 33127 -3119 • This is to certify that all tangible personal property purchased or rented, real property rented, or services purchased on or after the above ReglslraUon Effective Date by the above business are being purchased or rented for one of the following purposes: • Resale as tangible personal properly. • Re rental as real property. • Incorporation as a material, Ingredient, or component • Re•rental as tangible personal property, • Incorporation into and sale as pan of the repair of p art or tangible person properryy plat Is bein • Resale of services, tangible personal property by a repair dealer. prod Tor sa b manufacturing, compoundin • Re-rental Be transient rental property. or processing. This Certllcate cannot be reassigned or transferred. This certificate can only be used by the acUve registered dealer or its autho _ : • ployees. Misuse of this Annual Resale Certificate will subject the user to penalties as provided by law. Use signed I py — . oses. • Presented lo: Presented by:- (Insert name or seller on oholocoov) (dale) Auln - dzegagne • arsr) (Sale) Jun, 2. 2009 10:47AM A -1 FIRE & ELECTRIC No, 1841 P. 1 4 10 6 , A-1 FIRE EQUIPMENT FACSIMILE TRANSMITTAL SHEET To: From: ATIN: JACKIE Holly Castillo FAX NUMBER: Date: 813.780.0021 06/02/2009 COMPANY: TOTAL NO. OF PAGES INCLUDING COVER: CITY OF ZEPH'Y'RHILLS (5) PHONE NUMBER: SENDER'S REFERENCE NUMBER: R. YOUR REFERENCE NUMBER: PERMIT INFO IJ URGENT ❑ FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY PLEASE RECYCLE NOTES/COMMENTS: Jackie, Here is the business tax receipt, workman's comp, general liability & state license per request. Thanks! Holly Castillo A -1 FIRE EQUIPMENT d ELECTRIC 3619 NW 2" AVENUE MIAMI, FL 33127 Email: hcastillo @alfireandelectric.com PH: 305 - 573 -8273 EXT. 124 • FAX: 305 - 573.1569 Jun. 2. 2,009 1Q :48A A -1 FIRE & ELECTRIC No, 1841 P. 5 • e A §7 T § * (- o 8 2 S o • o " w m § / « §7 / k o z f 2 7§ § 02 \ oo § � § \ § ri 7 0 n k z'"' B , PI § p m 4, J / §/ \ \ � t § oi 2 § ,m% _ f § % .3 o m n 9 & E , � §/ / § � /% g \ [ k 2 % \ i \ t §; R & y ( 2 { f q [ 2 mm t i / §r % E • g, § k il!! � a 2§ / \ � / 7 [ \ , m § _ . G I . §§ \ - § 2d / 0 ' §2 P 0 I 2 § r il t, / � / 2 m \/4 \ 2 u t® 4 •, , 0 Jun 2. ,2009 10:48AM A -1 FIRE & ELECTRIC No. 1841 P. 3 ACOR 7M. CERTIFICATE OF LIABILITY INSURANCE DAT 03/ 03/2 009 , PRODUCER Phone ;. (305) 445-5060. Far .305. 448 -8189 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WEXLER INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1120 PONCE DE LEON BLVD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CORAL GABLES FL 33134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # _ INSURED INSURER A: HANOVER INSURANCE COMPANY ABA FIRE EQUIPMENT CO, INC. INSURER B: ASPEN SPECIALTY INSURANCE A -1 FIRE EQUIPMENT CORP, INSURER C; AMERICAN INTERNATIONAL A -1 ELECTRIC COMPANY 3819 N.W. 2ND AVE. INSURER 0: MIAMI FL 33127 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 CONORION 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 AOD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LYR INSNr DATE IMMOOryY) DATE (MWOD/YY) GENERAL LIABILITY CRA521 N09 02/01/09 02/01/10 EACH OCCURRENCE S 1,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED easiness pi occurs $ 50,000 C9) CLAIMS MADE © OCCUR MEO. EXP (My one person) $ 5,000 B PERSONAL & AOV INJURY 5 1,000.000 GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LI MIT. APPLIES PER: PRODUCTS - COMP/OPAGG. S 1,000,000 PRO - 7 POLICY JECr LOC AUTOMOBILE UABILITY AHX436235401 11/01/08 11/01/09 COMBINED SINGLE LIMIT ANY AUTO (Eaacdaenq 5 1,000,000 .— ALL OWNED AUTOS BODILY. INJURY (Per. person) S X SCHEDULED AUTOS A X HIREO.AUTOS _ BODILY INJURY S X NON- OWNED.AUTOS (Per l) acdden — PROPERTY DAMAGE $ • (Per swam) GARAGE LIABILITY , AUTO. ONLY .EAACCIOENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS /UMBRELLA LIABILITY 0E019893868 02/01/09 02/01/10 EACH OCCURRENCE S 2,000,000 • OCCUR 0 CLAIMS MADE AGGREGATE _ S 2,000,000 C S _ DEDUCTIBLE S _ .-- RETENTIONS 10.000 S WORKERS COMPENSATION AND I TO RY. .LIMITS I I OTMER EMPLOYERS' LIABILITY E.L, EACH ACCIDENT S ANY PROPRIETOR/PARTNERIO[ECUTIVE OFFICERMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S II yes. laseaP molar SPECIAL PROVISIONS Plow E.L. DISEASE- POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS GENERAL LIABILITY - $15, 000 DEDUCTIBLE • CERTIFICATE HOLDER CANCELLATION . CITY OF ZEPHYRHILLS SHOULD .ANY OF THE .ABOVE. DESCRIBED POLICIES BE CANCELLED. BEFORE THE 5335 8TH STREET EXPIRATION.DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO. HAIL 30 DAYS WRITTEN .NOTICE TO THE .CERTIFICATE HOLDER NAMED TO THE. LEFT, BUT FAILURE ZEPHYRHILLS, FL 33540 TO. 00 SO. SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY. KIND UPON TH INSURER ITS AGENTS OR REPRESENTATIVES. AUTMORIZSO REPRESENTATIVE Attention: M J. Wexler ACORD 25 (2001/08) Certificate # 107936 0 ACORD CORPORATION 1908 Jun. 2., 2009_10:48AM A -1 FIRE & ELECTRIC No. 1841 P. 4 AC'ORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) OP ID AF A -1 11/04/08 PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ONS Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. L?>Eeland FL 33002 -0002 ' ne i 063- 683 -1011 Fax :863- 683 -0521 INSURERS AFFORDING COVERAGE NAIC — TNSuREO INSURER A: Florida Retail Federation ABA Fire Equipment Co. , Inc . INSURER B; A -1 F re Equipment, Corp. . A- E ectrlc Company INSURER C: 3619 N . W. 2nd Avenue INSURER O: Miami FL 33127 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED - NOTWITHSTANDING ANY REOUIREMENT, 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 TERM6, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSK awti- POLICY NUMBER POCY F r1VE P OLICY EXPIR N LIMRS LTR INSR[ TYPE OF INSURANCE DATE (M / F YY) DATE (MMIOD GENERAL LIABIUTY EACH OCCURRENCE $ UAMALit 10 KENItU COMMERCIAL GENERAL LIABILITY PREMISES (Ea ooarence) 5 CLAIMS MADE OCCUR MW EXP (My one person) S PERSONAL & ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS - COMP /OP AGG $ POLICY n 131:1 n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea sodden') ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per eodden) PROPERTY DAMAGE (Per acddenl) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTNERTHAN EA ACC AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 7 OCCUR n CLAIMS MADE AGGREGATE _ $ _ 5 DEDUCTIBLE $ RETENTION 5 I $ WORKERS COMPENSATION AND X ITORY LIMITS 1 X I A EMPLOYERS'LIABILRY 0520 -26360 12/21/08 12/21/09 E.L EACH ACCIDENT $ 500,000 �ICER/MEMBEREXCLUDED? EL. DISEASE - EA EMPLOYEE 5500,000 Il y es, Aeadlbe ISIO EL. DISEASE - POLICY LIMIT S 500,000 SPECI PROVISIONS below _ OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES / EXCLUSIONS ADDED By ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ZEPBYRFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION • DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FNLURE TO 00 SO SHALL City of zephyrhi 11 a IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5335 8th Street REPRESENTATIVES, �L Zephyrhille FL 33540 RUTH E RESENTATIV I%I' _ —„., ACORD 25 (2001/00) ® ACORD CORPORATION 1900