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Home My WebLink About09-9236 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780 -0020 9236 ANNUAL FIRE PROTECTION MAINTENANCE Permit Number: 9236 Address: 7050 GALL BLVD Permit Type: FIRE PROTECTION MAINTENANCE ZEPHYRHILLS, FL. Class of Work: FIRE - PROTECTION MAINTENANCE Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 30- 26 -20- 0000 - 00200 -0010 Improv. Cost: Date Issued: 6/15/2009 Name: FL HOSPITAL OF ZEPHYRHILLS Total Fees: 25.00 Address: 7050 GALL BLVD Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/15/2009 Phone: Work Desc: FPM -HOOD SUPPRESSION QUARTERLY FOR HOSPITAL , �U IF tea utgs yA SIMPLEX RINNELL LP FIRE PERMIT FEES 25.00 C V \ O9 � .. d' VGZ _ 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 $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." %TA!' P � IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041 813- 780 -0020 City of Zephyrhills Fire. Fax - 813- 780 -0021 /Z45--1)? Permit Application Date Received ' Phone Contact for Permit Owners Name �� k 1 1-e - (\C., U J Owners Phone Number 2 I � 1 1(4 I �, Owner's Address I L101 Ck— ci • ` � 1.-2,a . l PCA, CL" 331x? I n Fee Simple Titleholder Name I } Titleholder Phone Number 1 1 I I 1 Fee Simple Titleholder Address I z`"" k�'i'�'.�F' 3E"' •.+'LY.aY::FR `:r '+5:" l C.,.s4 +$t.�Zr°:7= a ain.s.. R - 45 eY°+i. '. � -. 4s.'•Ev?3^ -:k''. ' °tI'Ay'"<'?°4°{.�Xs' Y�'sn'.4s" .x. �:ua:� ffS�'.':E�<'.F.iY`w: Job Address 70 5o C', N-LL It V.1 - -e i S vi_33std Lot# I Sub Division Parcel # '- :•sw.:.,-- +.w-zz ?=z?va� , .±..:...,,�y =,,e,.;�s.: ii,_.,.n... ^ :z'.a:�,r.ev- :- a-':. <,;,.5:z.* €taa..a.s_a,. Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL I 1 Controlled Bum n Hood Installation I - 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation I I Emergency Generator> 30 kw 1 I LP /Natural Gas - ANNUAL Sale n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL I Utrlyl l Semi l I Other Sprinkler - ❑ ❑ Recreational Burn !� i Fire Alarm p ❑ ❑ i I n Sparklers 99.5 � ,x I I ( r Hood Cleaning ❑ ❑ ❑ Sprinkler System Installations Hood Suppression I W I IV ❑ ❑ I I Standpipes (Sprinkler Sys) n ri Fire Alarm Installation L `=�+ I I Torch Roofing/Tar Kettle Fire Pumps I I Waste Tire Storage ANNUAL I I Fire Works n Flammable Application- ANNUAL n I ( Valuation of Project Fuel Tanks n Other: I .... . .. :. . ...o4 ?«sa.'�.: '� �i Y.• ?k.• - xdrxe: ��-: ��". seY" r¢. 2N`. �3: 4�� 'ihvci:i'?h�e41+i'a'f"✓'e ='r.4 4 '_ Contractor ' Company 3 cr."? Signature J S I Registered Y/ N Fee Current Y/ N I Address I I License # I - ELECTRICIAN I Company I Signature l Registered i Y / N J Fee Current I Y/ N I Address I I License # I I PLUMBER I Company I Signature I Registered I Y/ N ] Fee Current I Y/ N Address I I I I License # MECHANICAL' I Company Signature Registered Y/ N j Fee Current I Y / N j I Address I I I I License # OTHER I I Company I Signature Registered Y/ N I Fee Current I Y / N 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 Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice htt //a ( p: ppraiser.pascogov.com) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may subject'to "deed "Frestrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for :compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired :a or contractors to undertake work, they may be required to 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 for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may :apply for the intended work, 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 they 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 not entitled permitting privileges in Pasco County. CONSTRUCTION. LIEN LAW (Chapter713, Florida Statutes, ,as fine amended): If valuation Construction work e i $2 or more, I certify that I, the applicant, have been provided with a copy Protection Guide" prepared by the 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 it to the "owner" prior to commencement. CONTRACTOR'S /OWNER'S AFFIDAVIT: 1 certify that all the information in this application is accurate and y that all work will be done in compliance with all applicable taws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that 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 I am the AGENT FOR THE 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, A plumbing, signs, wells, pools, air conditioning, gas, the work and not ascau t d violatee aP " I ter, or permit issued shall be construed to be a license to p roceed with th 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 OBT N FINANCING, CONSULT WITH YOUR LENDER OR AN ATTO - - BEFORE RECORDING YOUR NOTICE • C ENCEMENT. FLORIDA JURAT (F.S. 117. � - OW CONTRACTOR OR AGENT Subscribed and s om to or - rmed) before me this Subscribed and sworn . (or • • ed) before me this by Who islare personally known to me by Who is/are personally known to me or has /have produced i has/have dentifi identification. produced as identification. as icati Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped DETACH BEFORE DEPOSITING No. 3052068 INVOICE DISCOUNT DATE NUMBER AMOUNT 06092009 PERMIT060909 0.00 250.00 056313 0.00 250.00 Jun 09 09 11:12a SG tL�GO 91 I N 1 2 2009 I SimpfexGrfnnell LP Fire & v Security Vii 50 Technology Drive f Pf _ Westminster, MA 01441 Situp /excGrinne!/ t „ Ph YrhiliS (978) 731 - 2500 AP FAX: (978) 731 -7756 « ' ent RequisWbn Form I This form is to be used onlywhen payment is required an. - + n'ci c e is not available ( i.e. permits, drawings, bids). If an invoice is available please go through the standard payment procedures for submitting invoices to accounts payable. Please provide a detailed reason for payment and attach any available back up when submitting request. Please supply vendor number. If not available, send an email to sg.apinquiry@tycoint.com. Please fill in "Request for vendor number" in the subject line. Reference the full remit -to address in the body of the email. You will receive either a response with the current vendor number or information on how to have the new vendor setup. This payment will be made per system payment terms. Exceptions will require additional approval. (RM < $25k or VP > $25k) Note: Signature cards must be on file with Accounts Payable for all approvers stating their approved dollar limit. Request Date: 06/09/09 Cost Distribution PO Num $ Amt Requestor: Irma Perdomo o #1 Email Address: Ioerdomo@simplexq r1nell.com cu #2 N s #3 Vendor Number: 056313 L_ # o_ #5_ Pay -to Vendor Name: City of Zephyrhills Subtotal $ - Remit -to Address Line 1: 5335 8th Street -.,-,5 , Proj Num Ctrl Dist $ Amt U Remit -to Address Line 2: o #1 City / State / Zip: Zephyrhills, fl 33542 n #2 o Y #3 Payment Amount: $250.00 a #4 #5 Need by Date: 06/09/09 Subtotal $ Checks will be cut on Tuesdays & Thursdays Q Acct Num Dept Dist $ Amt Reason for Payment: L t #1 62477 652 292 $ 250.00 Permits for inspections in Zephyrhills, FL for June 2009. T #2 #3 #4 #5 Delivery Method: U.S. Mail ❑ FEDEX o Subtotal $ 250.00 Deliver to District Grand Total $ 250.00 District Number: 292 FedEx Contact: Scott Brackett Cost Distribution in balance. Permanent / 1 Per District 11 Deliver to Vendor Additional Approvals (when applicable) Vendor Name: Contact: Print Name: Mail -to Address Line 1: Title: Mail -to Address Line 2: City / State / Zip: Signature: Telephone: Date: Approver (Print Name): Danny Prendes Print Name: Title: TSM / Title: Signature: rs, ,./ "/" t -- ' Date: /_9- �. g i' Signature: Date: